WorldWideScience

Sample records for care utilization history

  1. Health care utilization

    DEFF Research Database (Denmark)

    Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren

    An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...... are important, but that economics cannot alone explain the differences in health care utilization....

  2. Child Health USA 2013: Prenatal Care Utilization

    Science.gov (United States)

    ... Health Services Utilization > Prenatal Care Utilization Prenatal Care Utilization Narrative Early and adequate prenatal care helps to ... 20.3 6.0 Adequacy of Prenatal Care Utilization Upon Initiation, * by Maternal Race/Ethnicity, 2011 Race/ ...

  3. History of Chiropractic Care

    Science.gov (United States)

    ... ACA News Digital Edition Archives: ACA News Articles Advertising Opportunities News Newsroom News Releases Letters to the Editor Facts About Chiropractic Chiropractic in the Media ACA Radio Chiropractic Cares Social Media Facebook Twitter YouTube Instagram LinkedIn Advocacy Regulatory Policy Issue ...

  4. Computerized Nursing Care Planning Utilizing Nursing Diagnosis

    OpenAIRE

    Crosley, Joan M.

    1984-01-01

    This paper presents a brief description of the beginning phase of a long term project introducing computerized nursing care planning utilizing nursing diagnoses within one nursing department. Areas for future study are proposed.

  5. Generalized anxiety disorder and health care utilization

    OpenAIRE

    Kujanpää, T.

    2016-01-01

    Abstract Generalized anxiety disorder (GAD) is a mental health problem, which is characterized by excessive anxiety and worry, problems that are difficult to control. In the general population, the 12-month prevalence of GAD is 2-3%, with the lifetime prevalence being about 5%. However, GAD is more prevalent among primary care utilizers i.e. approximately 5-8% of them suffer from this disorder. Earlier studies have revealed GAD to be associated with a high utilization of health care resou...

  6. Utilization of dental care: An Indian outlook

    Science.gov (United States)

    Gambhir, Ramandeep Singh; Brar, Prabhleen; Singh, Gurminder; Sofat, Anjali; Kakar, Heena

    2013-01-01

    Oral health has a significant impact on the quality of life, appearance, and self-esteem of the people. Preventive dental visits help in the early detection and treatment of oral diseases. Dental care utilization can be defined as the percentage of the population who access dental services over a specified period of time. There are reports that dental patients only visit the dentist when in pain and never bother to return for follow-up in most cases. To improve oral health outcomes an adequate knowledge of the way the individuals use health services and the factors predictive of this behavior is essential. The interest in developing models explaining the utilization of dental services has increased; issues like dental anxiety, price, income, the distance a person had to travel to get care, and preference for preservation of teeth are treated as barriers in regular dental care. Published materials which pertain to the use of dental services by Indian population have been reviewed and analyzed in depth in the present study. Dental surgeons and dental health workers have to play an adequate role in facilitating public enlightenment that people may appreciate the need for regular dental care and make adequate and proper use of the available dental care facilities. PMID:24082719

  7. Utilization of postnatal care among Nepalese women.

    Science.gov (United States)

    Neupane, Subas; Doku, David

    2013-12-01

    This study investigated risk factors associated with the type of birth attendants and timing of postnatal care among a nationally representative sample of Nepalese women. The 2006 Nepalese Demographic and Health Survey on women age 15-49 years old who had delivered within 3 years prior to the survey (N = 4,136) was used. Multivariate logistic regression was employed to study the association between socio-demographic variables and type of birth attendants and timing of postnatal care. Only 23 % deliveries were assisted by skilled attendants. A majority of Nepalese women did not have postnatal check-ups. Education (OR = 1.46, 95 % CI = 1.11-1.92), wealth (OR = 2.57, 95 % CI = 1.59-4.15) and sufficiency of advice during pregnancy (OR = 3.09, 95 % CI = 2.16-4.41), were all independently associated with having postnatal check-ups. Similarly, maternal age, education, parity, wealth, sufficiency of advice and place of delivery were associated with having delivery assisted by a skilled attendant. The utilization of postnatal services is still very low in Nepal. Public health interventions are needed to increase the utilization of postnatal care as well as delivery assisted by skilled attendants. Such interventions should target poor women, the less educated and those in rural areas in Nepal.

  8. Case History of Assessment, Development and Utilization

    Energy Technology Data Exchange (ETDEWEB)

    Lienau, Paul J.; Culver, Gene; Lund, John W.

    1989-09-01

    Klamath Falls, Oregon, is located in a Known Geothermal Resource Area (KGRA) which has been used by residents, principally to obtain geothermal fluids for space heating, at least since the turn of the century. Over 500 shallow-depth wells ranging from 90 to 2,000 ft (27 to 610 m) in depth are used to heat (35 MWt) over 600 structures. This utilization includes the heating of homes, apartments, schools, commercial buildings, hospital, county jail, YMCA, and swimming pools by individual wells and three district heating systems. Geothermal well temperatures range from 100 to 230oF (38 to 110oC) and the most common practice is to use downhole heat exchangers with city water as the circulating fluid. Larger facilities and district heating systems use lineshaft vertical turbine pumps and plate heat exchangers. Well water chemistry indicates approximately 800 ppm dissolved solids, with sodium sulfate having the highest concentration. Some scaling and corrosion does occur on the downhole heat exchangers (black iron pipe) and on heating systems where the geo-fluid is used directly. The development of the city district heating system in 1981, resulted in perhaps the most extensive and, in some ways, the most complete aquifer tests ever conducted in the United States. Hundreds of private well owners using downhole heat exchangers were concerned that pumping the reservoir would impact the performance of their wells. The geological setting, historical development, and reservoir testing that led up to this major aquifer stress test in 1983 are presented. The institutional and legal problems that resulted in the establishment of a city ordinance controlling the use of the resource and a Geothermal Advisory Committee to oversee future utilization and development are also discussed.

  9. Utilization of dental care: An Indian outlook

    OpenAIRE

    Gambhir, Ramandeep Singh; Brar, Prabhleen; Singh, Gurminder; Sofat, Anjali; Kakar, Heena

    2013-01-01

    Oral health has a significant impact on the quality of life, appearance, and self-esteem of the people. Preventive dental visits help in the early detection and treatment of oral diseases. Dental care utilization can be defined as the percentage of the population who access dental services over a specified period of time. There are reports that dental patients only visit the dentist when in pain and never bother to return for follow-up in most cases. To improve oral health outcomes an adequat...

  10. Assessing the role and effectiveness of prenatal care: history, challenges, and directions for future research.

    OpenAIRE

    Alexander, G R; Kotelchuck, M

    2001-01-01

    Despite the widespread use of prenatal care, the evidence for its effectiveness remains equivocal and its primary purpose and effects continue to be a subject of debate. To provide some perspective on why the effectiveness and organization of prenatal care continue to be debated, the authors (a) briefly review the history of the development of prenatal care in the US; (b) attempt to conceptually define prenatal care in terms of its utilization, content, and quality; and, (c) highlight some of...

  11. Health care utilization by immigrants in Italy.

    Science.gov (United States)

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

    2013-03-01

    Healthcare utilization studies show how well documented disparities between migrants and non-migrants. Reducing such disparities is a major goal in European countries. However, healthcare utilization among Italian immigrants is under-studied. The objective of this study is to explore differences in healthcare use between immigrant and native Italians. Cross-sectional study using the latest available (2004/2005) Italian Health Conditions Survey. We estimated separate hurdle binomial negative regression models for GP, specialist, and telephone consultations and a logit model for emergency room (ER) use. We used logistic regression and zero-truncated negative binomial regression to model the zero (contact decision) and count processes (frequency decisions) respectively. Adjusting for risk factors, immigrants are significantly less likely to use healthcare services with 2.4 and 2.7 % lower utilization probability for specialist and telephone consultations, respectively. First- and second-generation immigrants' probability for specialist and telephone contact is significantly lower than natives'. Immigrants, ceteris paribus, have a much higher probability of using ERs than natives (0.7 %). First-generation immigrants show a higher probability of visiting ERs (1 %). GP visits show no significant difference. In conclusion Italian immigrants are much less likely to use specialist healthcare and medical telephone consultations than natives but more likely to use ERs. Hence, we report an over-use of ERs and under-utilization of preventive care among immigrants. We recommend improved health policies for immigrants: promotion of better information dissemination among them, simplification of organizational procedures, better communications between providers and immigrants, and an increased supply of health services for the most disadvantaged populations. PMID:23239018

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

    Science.gov (United States)

    Joe, William; Rudra, Shalini; Subramanian, S V

    2015-11-01

    Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly.

  13. Ambulatory Medical Care Utilization Estimates for 2007

    Science.gov (United States)

    ... the caveats discussed in the ‘‘Methods’’ section. The relationship between characteristics of the patient’s ZIP Code and the choice of ambulatory care setting is shown in Table 5. For persons ...

  14. Addiction and the Utilization of Medical Care

    Directory of Open Access Journals (Sweden)

    Yen-Ju Lin

    2012-01-01

    Full Text Available We investigate the effect of different scales of addictive factors on the utilization of medical services in this paper using a two-part model. Data are from the 2005 National Health Interview Survey and the claims data in the National Health Insurance Research Database in Taiwan. The results show that personal addictive behavior is significantly associated with both outpatient and inpatient utilization. Moreover, our result implies that those who smoked at least 20 cigarettes per day might not visit a doctor until the illness was severe. It suggests that the government can accomplish these goals by promotion and education in order to increase public awareness of personal health.

  15. Income-Related Inequalities of Health and Health Care Utilization

    OpenAIRE

    Xie, E.

    2011-01-01

    By utilizing the China Health and Nutrition Survey (CHNS) data, this paper examines the extent of deviations in terms of horizontal equity in the field of China¡¯s health and medical community, i.e., that those in equal demand ought to be treated equally, and computes the contribution of income in health inequality and utilization inequality of health care. The main conclusions are: There is pro-rich inequality in health and utilization of health care; income contribution to inequality of hea...

  16. Does Integrated Care Affect Healthcare Utilization in Multi-problem Refugees?

    Science.gov (United States)

    White, Carol C; Solid, Craig A; Hodges, James S; Boehm, Deborah H

    2015-10-01

    A history of trauma is common in refugee populations and appropriate treatment is frequently avoided. Using a convenience sample of 64 patients in a Somali primary care clinic, a culture and trauma specific intervention was developed to address retention into appropriate treatment. One goal of the intervention was to improve the rate of engagement in psychotherapy after a mental health referral and to test the effect of psychotherapy on health care utilization using a staged primary care clinical tool. Forty-eight percent of patients given a mental health referral engaged in psychotherapy. Patients engaging in psychotherapy had higher baseline utilization and over 12 months trended towards less emergency room use and more primary care. Our findings suggest that the intervention improved referral and retention in mental health therapy for East African refugee women. PMID:25150558

  17. The natural history of asthma in a primary care cohort

    NARCIS (Netherlands)

    Winkler Prins, V.; Nieuwenhof, L.J.L. van den; Hoogen, H.J.M. van den; Bor, J.H.J.; Weel, C. van

    2004-01-01

    BACKGROUND: We examined the natural history of asthma in a primary care cohort of patients 10 years after the cohort was stratified for asthma risk by responses to a questionnaire and bronchial hyperresponsiveness (BHR) testing. METHODS: Children and young adults who were born between 1967 and 1979

  18. P-1139 - Increased utilization of health care services after psychotherapy

    DEFF Research Database (Denmark)

    Fenger, Morten Munthe; Mortensen, Erik Lykke; Poulsen, Stig Bernt;

    2012-01-01

    period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment. Results Of the 761 patients, 216 patients did not show up for treatment, while......Background Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care...... services for patients referred to psychotherapeutic treatment in 2004 and 2005. Method The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation...

  19. Community wide electronic distribution of summary health care utilization data

    Directory of Open Access Journals (Sweden)

    Westert Gert P

    2006-03-01

    Full Text Available Abstract Background In recent years, the use of digital technology has supported widespread sharing of electronic health care data. Although this approach holds considerable promise, it promises to be a complicated and expensive undertaking. This study described the development and implementation of a community wide system for electronic sharing of summary health care utilization data. Methods The development of the community wide data system focused on the following objectives: ongoing monitoring of the health care system, evaluation of community wide individual provider initiatives, identification and development of new initiatives. The system focused on the sharing of data related to hospital acute care, emergency medical services, long term care, and mental health. It was based on the daily distribution of reports among all health care providers related to these services. Results The development of the summary reports concerning health care utilization produced a system wide view of health care in Syracuse, New York on a daily basis. It was not possible to isolate the results of these reports because of the impact of specific projects and other factors. At the same time, the reports were associated with reduction of hospital inpatient stays, improvement of access to hospital emergency departments, reductions in stays for patients discharged to nursing homes, and increased access of mental health patients to hospital inpatient units. Conclusion The implementation of the system demonstrated that summary electronic utilization data could provide daily information that would support the improvement of health care outcomes and efficiency. This approach could be implemented in a simple, direct manner with minimal expenses.

  20. Patterns of health care utilization for low back pain

    Directory of Open Access Journals (Sweden)

    Stewart WF

    2015-08-01

    Full Text Available Walter F Stewart,1 Xiaowei Yan,1 Joseph A Boscarino,1 Daniel D Maeng,1 Jack Mardekian,2 Robert J Sanchez,3 Michael R Von Korff41Geisinger Center for Health Research, 2Pfizer, Inc., 3Regeneron Pharmaceuticals, Inc., 4Group Health Research Institute, Seattle, WA, USABackground: The purpose of this study was to determine if primary care patients with low back pain (LBP cluster into definable care utilization subgroups that can be explained by patient and provider characteristics.Materials and methods: Adult primary care patients with an incident LBP encounter were identified from Geisinger Clinic electronic health records over 5 years. Two-thirds of the cohort had only one to two encounters. Principal component analysis was applied to the data from the remaining one-third on use of ambulatory, inpatient, emergency department, and surgery care and use of magnetic resonance imaging, injections, and opioids in 12 months following the incident encounter. Groups were compared on demographics, health behaviors, chronic and symptomatic disease burden, and a measure of physician efficiency.Results: Six factors with eigenvalues >1.5 explained 71% of the utilization variance. Patient subgroups were defined as: 1–2 LBP encounters; 2+ surgeries; one surgery; specialty care without primary care; 3+ opioid prescriptions; laboratory dominant care; and others. The surgery and 3+ opioid subgroups, while accounting for only 10.4% of the cohort, had used disproportionately more magnetic resonance imaging, emergency department, inpatient, and injectable resources. The specialty care subgroup was characterized by heavy use of inpatient care and the lowest use of injectables. Anxiety disorder and depression were not more prevalent among the surgery patients than in the others. Surgery patients had features in common with specialty care patients, but were older, had higher prevalence of Fibromyalgia, and were associated primary care physicians with worse efficiency

  1. Tweedie distributions for fitting semicontinuous health care utilization cost data

    OpenAIRE

    Kurz, Christoph

    2016-01-01

    We explore a statistical distribution that can simultaneously model the probability of zero outcome for non-users of health care utilization and continuous costs for users. We compare this distribution to other com- monly used models on example data and show that it fits cost data well and has some appealing properties that provide flexible use.

  2. Household health care facility utilization in the Philippines.

    Science.gov (United States)

    Russo, G; Herrin, A N; Pons, M C

    This paper presents probit estimates of household utilization of health care facilities in the Philippines. Using household data from the 1987 National Health Survey and supply data from the Department of Health, separate probit equations are estimated for each of the four major types of facilities in the Philippines: Public hospitals, private hospitals, major rural health units and barangay (village) health stations. The probability that a household will utilize services from these facilities is estimated as a function of socioeconomic, demographic and supply variables. The results indicate substantial differences in utilization patterns by income class. Households in the highest income quartile are approximately twice as likely (0.451 versus 0.236) to utilize private hospital services vis-à-vis households in the lowest income quartile, ceteris paribus. The results also indicate substantial substitution between public and private services. An increase in the availability of private hospital beds significantly reduces the probability that a household will utilize government facilities. PMID:10050192

  3. Care Utilization Patterns and Diabetes Self-Management Education Duration.

    Science.gov (United States)

    Johnson, Tammie M; Richards, Jennifer; Churilla, James R

    2015-08-01

    Objective. Previous studies have shown that receiving diabetes self-management education (DSME) is associated with increased care utilization. However, the relationship between DSME duration and care utilization patterns remains largely unexamined. Our purpose is to characterize DSME duration and examine the relationship between DSME duration and clinical- and self-care utilization patterns. Methods. The study sample included 1,446 adults who were ≥18 years of age, had diabetes, and had participated in the 2008 Florida Behavioral Risk Factor Surveillance System survey. Clinical- and self-care outcomes were derived using responses to the survey's diabetes module and were based on minimum standards of care established by the American Diabetes Association. The outcomes examined included self-monitoring of blood glucose at least once per day; receiving at least one eye exam, one foot exam, A1C tests, and an influenza vaccination in the past year; and ever receiving a pneumococcal vaccination. DSME duration was categorized as no DSME, >0 to 10 hours. Results. After adjusting for sociodemographic variables, compared to those who did not receive DSME, those who had 4-10 or 10+ hours of DSME were more likely to receive two A1C tests (odds ratio [95% CI] 2.69 [1.30-5.58] and 2.63 [1.10-6.31], respectively) and have a pneumococcal vaccination (1.98 [1.03-3.80] and 1.92 [1.01-3.64], respectively). Those receiving 10+ hours of DSME were 2.2 times (95% CI 1.18-4.09) as likely to have an influenza vaccination. Conclusion. These data reveal a positive relationship between DSME duration and utilization of some diabetes clinical care services. PMID:26300613

  4. The Natural History of Asthma in a Primary Care Cohort

    OpenAIRE

    Winkler Prins, V.; Nieuwenhof, L.J.L. van den; Hoogen, H.J.M. van den; Bor, J.H.J.; van Weel, C

    2004-01-01

    BACKGROUND: We examined the natural history of asthma in a primary care cohort of patients 10 years after the cohort was stratified for asthma risk by responses to a questionnaire and bronchial hyperresponsiveness (BHR) testing. METHODS: Children and young adults who were born between 1967 and 1979 within 1 of 4 affiliated family practices of the Nijmegen Department of Family Medicine, The Netherlands, were asked to participate in an asthma study in 1989. Of 926 patients available, 581 (63%) ...

  5. Allomaternal care, life history and brain size evolution in mammals

    OpenAIRE

    Isler, K.; van Schaik, C. P.

    2012-01-01

    Humans stand out among the apes by having both an extremely large brain and a relatively high reproductive output, which has been proposed to be a consequence of cooperative breeding. Here, we test for general correlates of allomaternal care in a broad sample of 445 mammal species, by examining life history traits, brain size, and different helping behaviors, such as provisioning, carrying, huddling or protecting the offspring and the mother. As predicted from an energetic-cost perspective, a...

  6. Guided care: cost and utilization outcomes in a pilot study.

    Science.gov (United States)

    Sylvia, Martha L; Griswold, Michael; Dunbar, Linda; Boyd, Cynthia M; Park, Margaret; Boult, Chad

    2008-02-01

    Guided Care (GC) is an enhancement to primary care that incorporates the operative principles of disease management and chronic care innovations. In a 6-month quasi-experimental study, we compared the cost and utilization patterns of patients assigned to GC and Usual Care (UC). The setting was a community-based general internal medicine practice. The participants were patients of 4 general internists. They were older, chronically ill, community-dwelling patients, members of a capitated health plan, and identified as high risk. Using the Adjusted Clinical Groups Predictive Model (ACG-PM), we identified those at highest risk of future health care utilization. We selected the 75 highest-risk older patients of 2 internists at a primary care practice to receive GC and the 75 highest-risk older patients of 2 other internists in the same practice to receive UC. Insurance data were used to describe the groups' demographics, chronic conditions, insurance expenditures, and utilization. Among our results, at baseline, the GC (all targeted patients) and UC groups were similar in demographics and prevalence of chronic conditions, but the GC group had a higher mean ACG-PM risk score (0.34 vs. 0.20, p insurance expenditures, hospital admissions, hospital days, and emergency department visits (p > 0.05). There were larger differences in insurance expenditures between the GC and UC groups at lower risk levels (at ACG-PM = 0.10, mean difference = $4340; at ACG-PM = 0.6, mean difference = $1304). Thirty-one of the 75 patients assigned to receive GC actually enrolled in the intervention. These results suggest that GC may reduce insurance expenditures for high-risk older adults. If these results are confirmed in larger, randomized studies, GC may help to increase the efficiency of health care for the aging American population. PMID:18279112

  7. Comprehensive care and pregnancy: The unmet care needs of pregnant women with a history of rape

    Science.gov (United States)

    Munro, Michelle L.; Rietz, Melissa Foster

    2013-01-01

    This paper proposes a framework for assessing the unmet needs of rape survivors during pregnancy based on the Sexual Assault Nurse Examiner (SANE) practice level theory and an empirical exploration of rape survivors’ health status in pregnancy via a secondary analysis. Our findings indicate that there may be unmet needs in pregnancy related to all five post-assault comprehensive care components: (1) physical care, (2) pregnancy prevention, (3) sexually transmitted infection screening, (4) psychological care, and (5) legal care. Rape history and its current impact on the survivor predicted somatic disorders, substance use, unwanted pregnancy, infections, posttraumatic stress disorder, and recent abuse. PMID:23215990

  8. The history of China's maternal and child health care development.

    Science.gov (United States)

    Guo, Yan; Bai, Jing; Na, Heya

    2015-10-01

    The history of maternal and child health (MCH) development in China can be divided into six stages: before 1949 when the People's Republic of China was founded, traditional Chinese medicine shielded women's and children's health while modern medicine began to bud; 1949-1966, the MCH system was established and gradually improved; 1966-1976, the decade of the Cultural Revolution, the road to improve MCH twisted and turned along with the political instability; 1976-1990, especially after the "Reform" and "Opening Up", China's MCH care had been booming and the MCH status continued to improve with the rapid social and economic development; 1990-2008, with the booming economy, MCH care gained increasingly national and international attention. Through improving legislation and investment, China made great strides in the improvement of MCH. After 2009, the comprehensive health care reform laid an institutional basis for the development of MCH and promotion of health equity. PMID:26271835

  9. Utilization review of psychiatric care: building a program that works.

    Science.gov (United States)

    Wilson, P A

    1988-01-01

    Since the early 1970s the federal government, private insurers, and employers have searched for ways to control health care costs. In 1972, Congress, dissatisfied with hospitals' utilization review efforts under the Medicare program created Professional Standards Review Organizations (PSROs). Ten years later when the Medicare reimbursement system underwent radical changes, the utilization review system remained more or less intact but had its name changed to Professional Review Organizations (PROs). The insurance industry has developed and employed, with varying levels of success, several cost-saving tactics, including deductibles and copayments for specialized care, limitation of benefits by diagnosis or facility type, exclusion of specific disorders, inclusion of dollar limits, pre-payment claims review for specific types of service, and post-payment review with retroactive denial of claims. Case management is the latest development in the ever-widening search to put a lid on health care costs. These attempts to measure the effectiveness of care vis a vis the dollar spent for it have been especially difficult for psychiatry, a less measurable science than other fields of medicine. Because psychiatry straddles the disciplines of sociology, psychology, and medicine, it is not easily understood. Inadequate documentation of care, a paucity of outcome studies, and confidentiality issues all combine to make utilization review particularly difficult in psychiatry. This paper will describe a collaboration between Blue Cross and Blue Shield of Maryland and four private psychiatric hospitals in the state that resulted in a workable, effective utilization review program acceptable to providers, payers, and patients. PMID:10318292

  10. Inequity in maternal health care utilization in Vietnam

    Directory of Open Access Journals (Sweden)

    Goland Emilia

    2012-05-01

    Full Text Available Abstract Introduction Vietnam has succeeded in reducing maternal mortality in the last decades. Analysis of survey data however indicate that large inequities exist between different segments of the population. We have analyzed utilization of antenatal care and skilled birth attendance among Vietnamese women of reproductive age in relation to social determinants with the aim to reveal health inequities and identify disadvantaged groups. Method Data on maternal health care utilization and social determinants were derived from the Multiple Indicator Cluster Survey (MICS conducted in Vietnam in 2006, and analyzed through stratified logistic regressions and g-computation. Results Inequities in maternal health care utilization persist in Vietnam. Ethnicity, household wealth and education were all significantly associated with antenatal care coverage and skilled birth attendance, individually and in synergy. Although the structural determinants included in this study were closely related to each other, analysis revealed a significant effect of ethnicity over and above wealth and education. Within the group of mothers from poor households ethnic minority mothers were at a three-fold risk of not attending any antenatal care (OR 3.06, 95% CI 1.27–7.41 and six times more likely not to deliver with skilled birth attendance (OR 6.27, 95% CI 2.37–16.6. The association between ethnicity and lack of antenatal care and skilled birth attendance was even stronger within the non-poor group. Conclusions In spite of policies to out rule health inequities, ethnic minority women constitute a disadvantaged group in Vietnam. More efficient ways to target disadvantaged groups, taking synergy effects between multiple social determinants into consideration, are needed in order to assure safe motherhood for all.

  11. Visualization of patient prescription history data in emergency care.

    Science.gov (United States)

    Ozturk, Selcuk; Kayaalp, Mehmet; McDonald, Clement J

    2014-01-01

    Interpreting patient's medication history from long textual data can be unwieldy especially in emergency care. We developed a real-time software application that converts one-year-long patient prescription history data into a visually appealing and information-rich timeline chart. The chart can be digested by healthcare providers quickly; hence, it could be an invaluable clinical tool when the rapid response time is crucial as in stroke or severe trauma cases. Furthermore, the visual clarity of the displayed information may help providers minimize medication errors. The tool has been deployed at the emergency department of a trauma center. Due to its popularity, we developed another version of this tool. It provides more granular drug dispensation information, which clinical pharmacists find very useful in their routine medication-reconciliation efforts.

  12. HISTORY OF THE HEALTH CARE CLIMATE IN GLUCHOLAZY

    OpenAIRE

    Migala, Mariusz

    2008-01-01

    The history of health care climate in Glucholazy, in the province of Silesia Opole begins in the 17th century, when the Jesuits who owned this territory discovered the healing properties of it. However, at that time they could not make proper use of these powers and the properties of nature were soon forgotten for many years. They were rediscovered as late as in the 20the century when the town was granted health resort rights and it applied Sebastian Kneipp`s methods of treatment. When the me...

  13. Joint utility task group CGI data-base procurement history module

    International Nuclear Information System (INIS)

    The purpose of the procurement history record module of the Joint Utility Task Group's (JUTG's) commercial-grade item (CGI) data base is to assist utilities to cost effectively implement the dedication methodology provided in the Electric Power Research Institute's (EPRI's) report NP-5652, open-quotes Guidelines for the Utilization of Commercial Grade Items in Nuclear Safety-Related Applications.close quotes

  14. Health care utilization, prognosis and outcomes of vestibular disease in primary care settings: systematic review.

    Science.gov (United States)

    Grill, Eva; Penger, Mathias; Kentala, Erna

    2016-04-01

    Vertigo and dizziness are frequent complaints in primary care that lead to extensive health care utilization. The objective of this systematic review was to examine health care of patients with vertigo and dizziness in primary care settings. Specifically, we wanted to characterize health care utilization, therapeutic and referral behaviour and to examine the outcomes associated with this. A search of the MEDLINE and EMBASE databases was carried out in May 2015 using the search terms 'vertigo' or 'dizziness' or 'vestibular and primary care' to identify suitable studies. We included all studies that were published in the last 10 years in English with the primary diagnoses of vertigo, dizziness and/or vestibular disease. We excluded drug evaluation studies and reports of adverse drug reactions. Data were extracted and appraised by two independent reviewers; 16 studies with a total of 2828 patients were included. Mean age of patients ranged from 45 to 79 with five studies in older adults aged 65 or older. There were considerable variations in diagnostic criteria, referral and therapy while the included studies failed to show significant improvement of patient-reported outcomes. Studies are needed to investigate current practice of care across countries and health systems in a systematic way and to test primary care-based education and training interventions that improve outcomes. PMID:27083883

  15. Adherence with tobramycin inhaled solution and health care utilization

    Directory of Open Access Journals (Sweden)

    Sacco Patricia

    2011-01-01

    Full Text Available Abstract Background Adherence with tobramycin inhalation solution (TIS during routine cystic fibrosis (CF care may differ from recommended guidelines and affect health care utilization. Methods We analyzed 2001-2006 healthcare claims data from 45 large employers. Study subjects had diagnoses of CF and at least 1 prescription for TIS. We measured adherence as the number of TIS therapy cycles completed during the year and categorized overall adherence as: low ≤ 2 cycles, medium >2 to Results Among 804 individuals identified with CF and a prescription for TIS, only 7% (n = 54 received ≥ 4 cycles of TIS per year. High adherence with TIS was associated with a decreased risk of hospitalization when compared to individuals receiving ≤ 2 cycles (adjusted odds ratio 0.40; 95% confidence interval 0.19-0.84. High adherence with TIS was also associated with lower outpatient service costs (IQR: $2,159-$8444 vs. $2,410-$14,423 and higher outpatient prescription drug costs (IQR: $35,125-$60,969 vs. $10,353-$46,768. Conclusions Use of TIS did not reflect recommended guidelines and may impact other health care utilization.

  16. Barriers to formal emergency obstetric care services' utilization.

    Science.gov (United States)

    Essendi, Hildah; Mills, Samuel; Fotso, Jean-Christophe

    2011-06-01

    Access to appropriate health care including skilled birth attendance at delivery and timely referrals to emergency obstetric care services can greatly reduce maternal deaths and disabilities, yet women in sub-Saharan Africa continue to face limited access to skilled delivery services. This study relies on qualitative data collected from residents of two slums in Nairobi, Kenya in 2006 to investigate views surrounding barriers to the uptake of formal obstetric services. Data indicate that slum dwellers prefer formal to informal obstetric services. However, their efforts to utilize formal emergency obstetric care services are constrained by various factors including ineffective health decision making at the family level, inadequate transport facilities to formal care facilities and insecurity at night, high cost of health services, and inhospitable formal service providers and poorly equipped health facilities in the slums. As a result, a majority of slum dwellers opt for delivery services offered by traditional birth attendants (TBAs) who lack essential skills and equipment, thereby increasing the risk of death and disability. Based on these findings, we maintain that urban poor women face barriers to access of formal obstetric services at family, community, and health facility levels, and efforts to reduce maternal morbidity and mortality among the urban poor must tackle the barriers, which operate at these different levels to hinder women's access to formal obstetric care services. We recommend continuous community education on symptoms of complications related to pregnancy and timely referral. A focus on training of health personnel on "public relations" could also restore confidence in the health-care system with this populace. Further, we recommend improving the health facilities in the slums, improving the services provided by TBAs through capacity building as well as involving TBAs in referral processes to make access to services timely. Measures can also be

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

    NARCIS (Netherlands)

    Wong, A.; Wouterse, B.; Slobbe, L.C.; Boshuizen, H.C.; Polder, J.J.

    2012-01-01

    Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends

  18. Economic Inequality in Eye Care Utilization and its Determinants: A Blinder–Oaxaca Decomposition

    Directory of Open Access Journals (Sweden)

    Mohammad Hassan Emamian

    2014-11-01

    Full Text Available Background The current study aimed to determine eye care utilization, to assess the role of economic inequality in the utilization of eye care services, and to identify its determinants in Shahroud, North of Iran. Methods Of the 6,311 invited people, 5,190 (82.24% individuals aged 40 to 64 years old participated in the study. A history of a visit by an ophthalmologist or optometrist was considered as eye care utilization. The gap between low- and high-economic groups was decomposed into its determinants using the Oaxaca decomposition method. Results Among the participants, 16.32% [95% Confidence Intervals (CI= 15.31–17.33%] had never been examined by an ophthalmologist or optometrist, and 30.94% (95% CI= 29.69–32.20% had not undergone an eye examination in the past 5 years. This negative history was significantly higher among female subjects [Odds Ratio (OR= 1.79, 95% CI= 1.51–2.14], the low-economic group (OR= 2.33, 95% CI= 1.90–2.87, the visually impaired (OR= 1.41, 95% CI= 1.05–1.90, and the uninsured (OR= 1.93, 95% CI= 1.45–2.58. The negative history of eye examination decreased with increasing in age (OR= 0.94, 95% CI= 0.93–0.96 and education (OR= 0.94, 95% CI= 0.92–0.96. In this study, 24.72% (95% CI= 22.30–27.14 of the low-economic group and 9.94% (95% CI= 8.75–11.14 of the high-economic group had no history of eye examination. Decomposition of the gap between the two economic groups showed that education and gender were the most important determinants of inequality. Conclusion A considerable percentage of adults, even those with visual impairment, do not receive appropriate eye care. There is a definite economic inequality in the community for which poverty per se could be the major cause

  19. History of the Animal Care Program at Johnson Space Center

    Science.gov (United States)

    Khan-Mayberry, Noreen; Bassett, Stephanie

    2010-01-01

    NASA has a rich history of scientific research that has been conducted throughout our numerous manned spaceflight programs. This scientific research has included animal test subjects participating in various spaceflight missions, including most recently, Space Shuttle mission STS-131. The Animal Care Program at Johnson Space Center (JSC) in Houston, Texas is multi-faceted and unique in scope compared to other centers within the agency. The animal care program at JSC has evolved from strictly research to include a Longhorn facility and the Houston Zoo's Attwater Prairie Chicken refuge, which is used to help repopulate this endangered species. JSC is home to more than 300 species of animals including home of hundreds of white-tailed deer that roam freely throughout the center which pose unique issues in regards to population control and safety of NASA workers, visitors and tourists. We will give a broad overview of our day to day operations, animal research, community outreach and protection of animals at NASA Johnson Space Center.

  20. Placement History of Foster Children: A Study of Placement History and Outcomes in Long-Term Family Foster Care

    Science.gov (United States)

    Strijker, Johan; Knorth, Erik J.; Knot-Dickscheit, Jana

    2008-01-01

    The files of 419 children in family foster care and kinship foster care were used in a retrospective longitudinal design study that examined their placement histories in child welfare. Significant associations were found between the number of placements on one hand, and the prevalence of attachment disorders, severity of behavioral problems, and…

  1. The History and Current Status of Federal Legislation Pertaining to Day Care Programs.

    Science.gov (United States)

    Searcy, Ellen O.; Ouellet, Ronald

    This report is a brief summary of the history of Federal Day Care provisions through the sixties and an analysis of the child care legislation pending in Congress during 1971. The 92nd Congress, in attempts to answer the growing demands for Federally-sponsored child care, introduced four separate bills dealing with child care financing: HR. 1…

  2. Barriers to utilization of antenatal care services in Eastern Nepal

    Directory of Open Access Journals (Sweden)

    Krishna Kumar eDeo

    2015-08-01

    Full Text Available BackgroundWorld Health Organization (WHO recommends at least four pregnancy check-ups for normal pregnancies. Ministry of Health and Population (MOHP Nepal has introduced various strategies to promote prenatal care and institutional delivery to reduce maternal and child deaths. However, maternal health service utilization is low in some selected and socio-economic and ethnic groups. Hence, this study aims to assess barriers to the recommended four antenatal care (4ANC visits in eastern Nepal.MethodsA cross-sectional quantitative study was conducted in Sunsari district. A total of 372 randomly selected women who delivered in the last year preceding the survey were interviewed using a semi-structured questionnaire. Bivariate and multivariate logistic regression analysis was carried out to identify barriers associated with 4ANC visits.ResultsMore than two-third women (69% attended at least 4ANC visits. The study revealed that women exposed to media had higher chance of receiving four or more ANC visits with an adjusted Odds Ratio (aOR=3.5, 95% CI: 1.2-10.1 in comparison to women who did not. Women from an advantaged ethnic group had more chance of having 4ANC visits than respondents from a disadvantaged ethnic group (aOR=2.4, 95% CI: 2.1-6.9. Similarly, women having a higher level of autonomy were nearly three times more likely (aOR= 2.9, 95%CI: 1.5-5.6 and richer women were twice (aOR=2.3, 95% CI: 1.1-5.3 as likely to have at least 4ANC visits compared to women who had a lower level of autonomy and were economically poor.ConclusionBeing from disadvantaged ethnicity, lower women?s autonomy, poor knowledge of maternal health service and incentive upon completion of ANC, less media exposure related to maternal health service, and lower wealth rank were significantly associated with fewer than the recommended 4ANC visits. Thus, maternal health programs need to address such socio-cultural barriers for effective health care utilization.

  3. Migrant women's utilization of prenatal care: a systematic review.

    Science.gov (United States)

    Heaman, M; Bayrampour, H; Kingston, D; Blondel, B; Gissler, M; Roth, C; Alexander, S; Gagnon, A

    2013-07-01

    Our objectives were to determine whether migrant women in Western industrialized countries have higher odds of inadequate prenatal care (PNC) compared to receiving-country women and to summarize factors that are associated with inadequate PNC among migrant women in these countries. We conducted searches of electronic databases (MEDLINE, EMBASE, and PsycINFO), reference lists, known experts, and an existing database of the Reproductive Outcomes And Migration international research collaboration for articles published between January, 1995 and April, 2010. Title and abstract review and quality appraisal were conducted independently by 2 reviewers using established criteria, with consensus achieved through discussion. In this systematic review of 29 studies, the majority of studies demonstrated that migrant women were more likely to receive inadequate PNC than receiving-country women, with most reporting moderate to large effect sizes. Rates of inadequate PNC among migrant women varied widely by country of birth. Only three studies explored predictors of inadequate PNC among migrant women. These studies found that inadequate PNC among migrant women was associated with being less than 20 years of age, multiparous, single, having poor or fair language proficiency, education less than 5 years, an unplanned pregnancy, and not having health insurance. We concluded that migrant women as a whole were more likely to have inadequate PNC and the magnitude of this risk differed by country of origin. Few studies addressed predictors of PNC utilization in migrant women and this limits our ability to provide effective PNC in this population.

  4. The origin of parental care in relation to male and female life history.

    Science.gov (United States)

    Klug, Hope; Bonsall, Michael B; Alonzo, Suzanne H

    2013-04-01

    The evolution of maternal, paternal, and bi-parental care has been the focus of a great deal of research. Males and females vary in basic life-history characteristics (e.g., stage-specific mortality, maturation) in ways that are unrelated to parental investment. Surprisingly, few studies have examined the effect of this variation in male and female life history on the evolution of care. Here, we use a theoretical approach to determine the sex-specific life-history characteristics that give rise to the origin of paternal, maternal, or bi-parental care from an ancestral state of no care. Females initially invest more into each egg than males. Despite this inherent difference between the sexes, paternal, maternal, and bi-parental care are equally likely when males and females are otherwise similar. Thus, sex differences in initial zygotic investment do not explain the origin of one pattern of care over another. However, sex differences in adult mortality, egg maturation rate, and juvenile survival affect the pattern of care that will be most likely to evolve. Maternal care is more likely if female adult mortality is high, whereas paternal care is more likely if male adult mortality is high. These findings suggest that basic life-history differences between the sexes can alone explain the origin of maternal, paternal, and bi-parental care. As a result, the influence of life-history characteristics should be considered as a baseline scenario in studies examining the origin of care.

  5. Factors Influencing Health Care Utilization in Older Hispanics with Diabetes along the Texas-Mexico Border

    OpenAIRE

    Mier, Nelda; Wang, Xiaohui; Smith, Matthew Lee; Irizarry, David; Treviño, Laura; Alen, Maria; Marcia G. Ory

    2012-01-01

    Little is known about predictors of health care utilization for older Hispanics with chronic conditions. This study aimed to determine: (1) the level of health care access for older Hispanics with type 2 diabetes living in a US–Mexico border area; and (2) personal and health correlates to health care utilization (ie, physician visits, eye care, emergency room [ER] use). This was a cross-sectional study based on a community assessment conducted at a clinic, senior centers, and colonias. Coloni...

  6. Pharmaceutical care in the Netherlands. History, definition and projects

    NARCIS (Netherlands)

    van Mil, J.W F

    1996-01-01

    The evolving concept of Pharmaceutical Care knows different interpretations in a different countries. In the Netherlands community pharmacists already perform several functions which may be part of the Pharmaceutical Care concept. The Dutch concept of Pharmaceutical care is tested in the TOM and OMA

  7. HIPPOCRATES IS CARE: HISTORY AND SOME BIOLOGICAL PATHWAYS ON CAREGIVER

    Directory of Open Access Journals (Sweden)

    Rosangela Souza Kalil

    2011-08-01

    Full Text Available AbstractHippocrates is the mainstay of care. Plato and Aristotle state humoralism as the way that Hippocrates understands human health disorders. He closely observed patients to restore humoral equilibrium, relying on healing power of nature to recover health, rejecting drugs or any kind of procedure that could harm the individual. The development of a common ground of understanding is desirable as a process of negotiating treatment goals and methods which may create an atmosphere of support and solidarity. The concept of supportive care was formalized in Belgium in 1992 with attention to multicultural aspect of our population. The biological basis on care are backed on cortical circuitries, association of pathways, existence of several neurotransmitters, which mediates integrative process promoting behavior, emotion and cognitive. Care may influence favorably all these biological systems and help to improve quality of live or even cure the patient. Descriptors: Hippocrates is Care, Biological Basis on Care, Pathways of Care.

  8. Comparing Aging in Place to Home Health Care: Impact of Nurse Care Coordination On Utilization and Costs.

    Science.gov (United States)

    Popejoy, Lori L; Galambos, Colleen; Stetzer, Frank; Popescu, Mihail; Hicks, Lanis; Khalilia, Mohammed A; Rantz, Marilyn J; Marek, Karen D

    2015-01-01

    The goal of this study was to compare utilization and cost outcomes of patients who received long-term care coordination in an Aging in Place program to patients who received care coordination as a routine service in home health care. This research offered the unique opportunity to compare two groups of patients who received services from a single home health care agency, using the same electronic health record, to identify the impact of long-term and routine care coordination on utilization and costs to Medicare and Medicaid programs. This study supports that long-term care coordination supplied by nurses outside of a primary medical home can positively influence functional, cognitive, and health care utilization for frail older people. The care coordinators in this study practiced nursing by routinely assessing and educating patients and families, assuring adequate service delivery, and communicating with the multidisciplinary health care team. Care coordination managed by registered nurses can influence utilization and cost outcomes, and impact health and functional abilities.

  9. Explaining the link between access-to-care factors and health care resource utilization among individuals with COPD

    Directory of Open Access Journals (Sweden)

    Kim M

    2016-02-01

    Full Text Available Minchul Kim,1 Jinma Ren,1 William Tillis,2,3 Carl V Asche,1,4 Inkyu K Kim,5 Carmen S Kirkness1 1Department of Internal Medicine, Center for Outcomes Research, University of Illinois College of Medicine at Peoria, 2OSF St Francis Medical Center, 3Department of Internal Medicine, University of Illinois College of Medicine at Peoria, Peoria, 4Department of Pharmacy Systems, Outcomes and Policy, University of Illinois at Chicago College of Pharmacy, Chicago, IL, 5Battelle Memorial Institute, Atlanta, GA, USA Background: Limited accessibility to health care may be a barrier to obtaining good care. Few studies have investigated the association between access-to-care factors and COPD hospitalizations. The objective of this study is to estimate the association between access-to-care factors and health care utilization including hospital/emergency department (ED visits and primary care physician (PCP office visits among adults with COPD utilizing a nationally representative survey data. Methods: We conducted a pooled cross-sectional analysis based upon a bivariate probit model, utilizing datasets from the 2011–2012 Behavioral Risk Factor Surveillance System linked with the 2014 Area Health Resource Files among adults with COPD. Dichotomous outcomes were hospital/ED visits and PCP office visits. Key covariates were county-level access-to-care factors, including the population-weighted numbers of pulmonary care specialists, PCPs, hospitals, rural health centers, and federally qualified health centers. Results: Among a total of 9,332 observations, proportions of hospital/ED visits and PCP office visits were 16.2% and 44.2%, respectively. Results demonstrated that access-to-care factors were closely associated with hospital/ED visits. An additional pulmonary care specialist per 100,000 persons serves to reduce the likelihood of a hospital/ED visit by 0.4 percentage points (pp (P=0.028. In contrast, an additional hospital per 100,000 persons increases the

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

    Directory of Open Access Journals (Sweden)

    Vu Duy Kien

    2014-08-01

    Full Text Available Background: A health system that provides equitable health care is a principal goal in many countries. Measuring horizontal inequity (HI in health care utilization is important to develop appropriate and equitable public policies, especially policies related to non-communicable diseases (NCDs. Design: A cross-sectional survey of 1,211 randomly selected households in slum and non-slum areas was carried out in four urban districts of Hanoi city in 2013. This study utilized data from 3,736 individuals aged 15 years and older. Respondents were asked about health care use during the previous 12 months; information included sex, age, and self-reported NCDs. We assessed the extent of inequity in utilization of public health care services. Concentration indexes for health care utilization and health care needs were constructed via probit regression of individual utilization of public health care services, controlling for age, sex, and NCDs. In addition, concentration indexes were decomposed to identify factors contributing to inequalities in health care utilization. Results: The proportion of healthcare utilization in the slum and non-slum areas was 21.4 and 26.9%, respectively. HI in health care utilization in favor of the rich was observed in the slum areas, whereas horizontal equity was achieved among the non-slum areas. In the slum areas, we identified some key factors that affect the utilization of public health care services. Conclusion: Our results suggest that to achieve horizontal equity in utilization of public health care services, policy should target preventive interventions for NCDs, focusing more on the poor in slum areas.

  11. Medicare-Certified Home Health Care: Urban-Rural Differences in Utilization

    Science.gov (United States)

    Hartman, Lacey; Jarosek, Stephanie L.; Virnig, Beth A.; Durham, Sara

    2007-01-01

    Context: Availability of Medicare-certified home health care (HHC) to rural elders can prevent more expensive institutional care. To date, utilization of HHC by rural elders has not been studied in detail. Purpose: To examine urban-rural differences in Medicare HHC utilization. Methods: The 2002 100% Medicare HHC claims and denominator files were…

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

    Science.gov (United States)

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

    2010-01-01

    Objectives: Objectives of this population-based study were: (1) to examine the relative contribution of childhood abuse and other adverse childhood experiences to poor adult health and increased health care utilization and (2) to examine the cumulative effects of adverse childhood experiences on adult health and health care utilization. Methods:…

  13. Disaster and primary health care utilization: a 4 year follow-up.

    NARCIS (Netherlands)

    Dorn, T.; Yzermans, J.; Kerssens, J.; Veen, P. ten

    2005-01-01

    Background: Although crucial for the management of the post-disaster phase, the impact of disasters on primary health care utilization is largely unknown. Often, pre-disaster base-line data is lacking. The current study quantified primary health care utilization after a major fire disaster in The Ne

  14. Prescription data improve the medication history in primary care

    DEFF Research Database (Denmark)

    Glintborg, Bente; Andersen, S K; Poulsen, H E

    2010-01-01

    Incomplete medication lists increase the risk of medication errors and adverse drug effects. In Denmark, dispensing data and pharmacy records are available directly online to treating physicians. We aimed (1) to describe if use of pharmacy records improved the medication history among patients...... consulting their general practitioner and (2) to characterise inconsistencies between the medication history reported by the patient and the general practitioner's recordings....

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

    Science.gov (United States)

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

    2012-01-01

    Health care utilization is expected to rise in the coming decades. Not only will the aggregate need for health care grow by changing demographics, so too will per capita utilization. It has been suggested that trends in health care utilization may be age-specific. In this paper, age-specific trends in health care utilization are presented for different health care sectors in the Netherlands, for the period 1981-2009. For the hospital sector we also explore the link between these trends and the state of medical technology. Using aggregated data from a Dutch health survey and a nationwide hospital register, regression analysis was used to examine age-specific trends in the probability of utilizing health care. To determine the influence of medical technology, the growth in age-specific probabilities of hospital care was regressed on the number of medical patents while adjusting for confounders related to demographics, health status, supply and institutional factors. The findings suggest that for most health care sectors, the trend in the probability of health care utilization is highest for ages 65 and up. Larger advances in medical technology are found to be significantly associated with a higher growth of hospitalization probability, particularly for the higher ages. Age-specific trends will raise questions on the sustainability of intergenerational solidarity in health care, as solidarity will not only be strained by the ageing population, but also might find itself under additional pressure as the gap in health care utilization between elderly and non-elderly grows over time. For hospital care utilization, this process might well be accelerated by advances in medical technology.

  16. Utilization and Costs of Health Care after Geriatric Traumatic Brain Injury

    OpenAIRE

    Thompson, Hilaire J.; Weir, Sharada; Rivara, Frederick P; Wang, Jin; Sullivan, Sean D.; Salkever, David; MacKenzie, Ellen J.

    2012-01-01

    Despite the growing number of older adults experiencing traumatic brain injury (TBI), little information exists regarding their utilization and cost of health care services. Identifying patterns in the type of care received and determining their costs is an important first step toward understanding the return on investment and potential areas for improvement. We performed a health care utilization and cost analysis using the National Study on the Costs and Outcomes of Trauma (NSCOT) dataset. ...

  17. Income Inequities in Health Care Utilization among Adults Aged 50 and Older.

    Science.gov (United States)

    Penning, Margaret J; Zheng, Chi

    2016-03-01

    Equitable access to and utilization of health services is a primary goal for many health care systems, particularly in countries with universal publicly funded systems. Despite concerns regarding potentially adverse implications of the 1990s' health care policy and other reforms, whether and how income inequalities in service utilization changed remains unclear. This study addressed the impact of income on physician and hospital utilization from 1992-2002 among adults aged 50 and older in British Columbia. Those with lower incomes were found less likely to access general practitioner and specialist services but more likely to access hospital services. Income-related disparities in physician care increased over time; hospital care declined. Volume of GP and hospital care was inversely associated with income; these differences increased regarding GP services only. Findings of declines in hospital-care access, accompanied by increasing income-related disparities in physician-services access, show that inequities are increasing within Canada's health care system. PMID:26757886

  18. [Utility of Smartphone in Home Care Medicine - First Trial].

    Science.gov (United States)

    Takeshige, Toshiyuki; Hirano, Chiho; Nakagawa, Midori; Yoshioka, Rentaro

    2015-12-01

    The use of video calls for home care can reduce anxiety and offer patients peace of mind. The most suitable terminals at facilities to support home care have been iPad Air and iPhone with FaceTime software. However, usage has been limited to specific terminals. In order to eliminate the need for special terminals and software, we have developed a program that has been customized to meet the needs of facilities using Web Real Time Communication(WebRTC)in cooperation with the University of Aizu. With this software, video calls can accommodate the large number of home care patients.

  19. Male care and life history traits in mammals.

    Science.gov (United States)

    West, Hannah E R; Capellini, Isabella

    2016-01-01

    Male care has energetic and opportunity costs, and is more likely to evolve when males gain greater certainty of paternity or when future mating opportunities are scarce. However, little is known about the substantial benefits that males may provide to females and offspring. Using phylogenetic comparative methods and a sample of over 500 mammalian species, we show that mammals in which males carry the offspring have shorter lactation periods, which leads to more frequent breeding events. Provisioning the female is associated with larger litters and shorter lactation. Offspring of species with male care have similar weaning mass to those without despite being supported by a shorter lactation period, implying that they grow faster. We propose that males provide an energetic contribution during the most expensive time of female reproduction, lactation, and that different male care behaviours increase female fecundity, which in turn helps males offset the costs of caring. PMID:27299954

  20. Urban-rural disparity in utilization of preventive care services in China.

    Science.gov (United States)

    Liu, Xiang; Li, Ningxiu; Liu, Chaojie; Ren, Xiaohui; Liu, Danping; Gao, Bo; Liu, Yuanyuan

    2016-09-01

    Preventive care service is considered pivotal on the background of demographic ageing and a rise in chronic diseases in China. The disparity in utilization of preventive care services between urban and rural in China is a serious issue. In this paper, we explored factors associated with urban-rural disparity in utilization of preventive care services in China, and determined how much of the urban-rural disparity was attributable to each determinant of utilization in preventive care services. Using representative sample data from China Health and Nutrition Survey in 2011 (N = 12,976), the present study performed multilevel logistic model to examine the factors that affected utilization of preventive care services in last 4 weeks. Blinder-Oaxaca decomposition method was applied to divide the utilization of preventive care disparity between urban and rural residents into a part that can be explained by differences in observed covariates and unobserved part. The percentage of rural residents utilizing preventive care service in last 4 weeks was lower than that of urban residents (5.1% vs 9.3%). Female, the aged, residents with higher education level and household income, residents reporting self-perceived illness in last 4 weeks and physician-diagnosed chronic disease had higher likelihood of utilizing preventive care services. Household income was the most important factor accounting for 26.6% of urban-rural disparities in utilization of preventive care services, followed by education (21.5%), self-perceived illness in last 4 weeks (7.8%), hypertension (4.4%), diabetes (3.3%), other chronic diseases (0.8%), and health insurance (-1.0%). Efforts to reduce financial barriers for low-income individuals who cannot afford preventive services, increasing awareness of the importance of obtaining preventive health services and providing more preventive health services covered by health insurance, may help to reduce the gap of preventive care services utilization between

  1. HISTORY OF EARLY LEGISLATIONS FOR WOMEN CARE IN MADRAS PRESIDENCY

    OpenAIRE

    Nandhini, R

    2012-01-01

    This paper highlights the women care measures undertaken by the Central Legislative council to the whole of British India and by the Madras Legislative council to Madras Presidency till 1937 when provincial autonomy under the Government of India Act, 1935, came into operation. These councils had enacted some laws to assign some rights for women and to care for their well beings against uncivilized barbaric customs which were once the rules in Madras Presidency as in all other states of the Br...

  2. Effects of parental smoking on medical care utilization by children.

    Science.gov (United States)

    Vogt, T M

    1984-01-01

    A household interview survey of 2,582 adult members of the Kaiser-Permanente Medical Care Program of Oregon conducted in 1970-71 contained detailed questions about cigarette smoking patterns. Detailed, computerized medical records were maintained for all inpatient and outpatient care rendered between 1967 and 1974 to the 1,761 children of the interviewed sample. Adjusted for age, family size, socioeconomic status, and duration of Health Plan membership, children in non-smoking households used significantly more outpatient services than did children in smoking households, a relationship largely accounted for by their use of more preventive medical services than by children in smoking households. There were no significant differences in inpatient medical care use and outpatient care use for respiratory illness by children of smoking and non-smoking households. PMID:6689838

  3. 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 ...

  4. The Effect of Free Adult Preventive Care Services on Subsequent Utilization of Inpatient Services in Taiwan.

    Science.gov (United States)

    Tian, Wei-Hua

    2016-07-01

    The objective of this article is to investigate the relationship between the utilization of free adult preventive care services and subsequent utilization of inpatient services among elderly people under the National Health Insurance program in Taiwan. The study used secondary data from the 2005 Taiwan National Health Interview Survey and claim data from the 2006 Taiwan National Health Insurance Research Database for the elderly aged 65 or over. A bivariate probit model was used to avoid the possible endogeneity in individuals' utilization of free adult preventive care and inpatient services. This study finds that, when individuals had utilized the preventive care services in 2005, the probability that they utilized inpatient services in 2006 was significantly reduced by 13.89%. The findings of this study may provide a good reference for policy makers to guide the efficient allocation of medical resources through the continuous promotion of free adult preventive care services under the National Health Insurance program. PMID:27287671

  5. Health Care Service Utilization of Dementia Patients before and after Institutionalization: A Claims Data Analysis

    Directory of Open Access Journals (Sweden)

    Larissa Schwarzkopf

    2014-06-01

    Full Text Available Background: Community-based and institutional dementia care has been compared in cross-sectional studies, but longitudinal information on the effect of institutionalization on health care service utilization is sparse. Methods: We analyzed claims data from 651 dementia patients via Generalized Estimation Equations to assess health care service utilization profiles and corresponding expenditures from four quarters before to four quarters after institutionalization. Results: In all domains, utilization increased in the quarter of institutionalization. Afterwards, the use of drugs, medical aids, and non-physician services (e.g., occupational therapy and physiotherapy remained elevated, but use of in- and outpatient treatment decreased. Cost of care showed corresponding profiles. Conclusion: Institutional dementia care seems to be associated with an increased demand for supportive services but not necessarily for specialized medical care.

  6. Health Care Service Utilization of Dementia Patients before and after Institutionalization: A Claims Data Analysis

    Science.gov (United States)

    Schwarzkopf, Larissa; Hao, Yi; Holle, Rolf; Graessel, Elmar

    2014-01-01

    Background Community-based and institutional dementia care has been compared in cross-sectional studies, but longitudinal information on the effect of institutionalization on health care service utilization is sparse. Methods We analyzed claims data from 651 dementia patients via Generalized Estimation Equations to assess health care service utilization profiles and corresponding expenditures from four quarters before to four quarters after institutionalization. Results In all domains, utilization increased in the quarter of institutionalization. Afterwards, the use of drugs, medical aids, and non-physician services (e.g., occupational therapy and physiotherapy) remained elevated, but use of in- and outpatient treatment decreased. Cost of care showed corresponding profiles. Conclusion Institutional dementia care seems to be associated with an increased demand for supportive services but not necessarily for specialized medical care. PMID:25337076

  7. Prescription data improve the medication history in primary care

    DEFF Research Database (Denmark)

    Glintborg, Bente; Andersen, S K; Poulsen, H E

    2010-01-01

    Incomplete medication lists increase the risk of medication errors and adverse drug effects. In Denmark, dispensing data and pharmacy records are available directly online to treating physicians. We aimed (1) to describe if use of pharmacy records improved the medication history among patients...

  8. Dental Care Utilization and Satisfaction of Residential University Students

    Directory of Open Access Journals (Sweden)

    Bamise CT

    2008-01-01

    Full Text Available Aim: The objective of this study was to provide information on the level of utilization and satisfaction of residential university students with the dental services provided by the dental clinic of a teaching hospital. Volunteers and Material: A stratified sampling technique was used to recruit volunteers from the outpatient clinic of the Obafemi Awolowo University Teaching Hospital Complex, Ile-Ife, Nigeria. Information was collected by a self-administered questionnaire composed of questions that measure the level of utilization and satisfaction with the dental services provided. Questionnaires were provided to 650 randomly chosen students residing in the University hostels. There were 39 refusals, and 6 incomplete questionnaires were discarded. This left a sample size of 605 volunteers. Results: Forty seven students (7.8% indicated that they visited the dental hospital within the last 12 months. Males and females utilized the dental services equally, and utilization increased with age and the number of years spent on campus. Anticipation of painful dental treatment, high dental charges, long waiting times and being too busy for a dental visit were cited as the most important impediments to seeking dental treatment. Females expressed greater satisfaction with the services. Conclusion: Dental service utilization among the students was found to be low. Oral health awareness campaigns, improving the quality of the services, and shortening the waiting time are expected to increase service utilization and satisfaction.

  9. Self-report versus care provider registration of healthcare utilization: impact on cost and cost-utility

    NARCIS (Netherlands)

    M. Hoogendoorn (Martine); C.R. van Wetering (Carel); A.M.W.J. Schols (Annemie)

    2009-01-01

    textabstractOBJECTIVES: This study aims to compare the impact of two different sources of resource use, self-report versus care provider registrations, on cost and cost utility. METHODS: Data were gathered for a cost-effectiveness study performed alongside a 2-year randomized controlled trial evalua

  10. Maternal health care amid political unrest: the effect of armed conflict on antenatal care utilization in Nepal.

    Science.gov (United States)

    Price, James I; Bohara, Alok K

    2013-05-01

    Armed conflicts, which primarily occur in low- and middle-income countries, have profound consequences for the health of affected populations, among them a decrease in the utilization of maternal health care services. The quantitative relationship between armed conflict and maternal health care utilization has received limited attention in the public health literature. We evaluate this relationship for a particular type of health care service, antenatal care, in Nepal. Using count regression techniques, household survey data and sub-national conflict data, we find a negative correlation between the number of antenatal care visits and incidents of conflict-related violence within a respondent's village development committee. Specifically, we find that under high-intensity conflict conditions women receive between 0.3 and 1.5 fewer antenatal care check-ups. These findings imply that maternal health care utilization is partially determined by characteristics of the social environment (e.g. political instability) and suggest health care providers need to revise maternal health strategies in conflict-affected areas. Strategies may include decentralization of services, maintaining neutrality among factions, strengthening community-based health services and developing mobile clinics.

  11. Implications of utilization shifts on medical-care price measurement.

    Science.gov (United States)

    Dunn, Abe; Liebman, Eli; Shapiro, Adam Hale

    2015-05-01

    The medical-care sector often experiences changes in medical protocols and technologies that cause shifts in treatments. However, the commonly used medical-care price indexes reported by the Bureau of Labor Statistics hold the mix of medical services fixed. In contrast, episode expenditure indexes, advocated by many health economists, track the full cost of disease treatment, even as treatments shift across service categories (e.g., inpatient to outpatient hospital). In our data, we find that these two conceptually different measures of price growth show similar aggregate rates of inflation over the 2003-2007 period. Although aggregate trends are similar, we observe differences when looking at specific disease categories.

  12. Family Structure Types and Adequate Utilization of Antenatal Care in Kenya.

    Science.gov (United States)

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

    2016-01-01

    Features of the health care delivery system may not be the only expounding factors of adequate utilization of antenatal care among women. Other social factors such as the family structure and its environment contribute toward pregnant women's utilization of antenatal care. An understanding of how women in different family structure types and social groups use basic maternal health services is important toward developing and implementing maternal health care policy in the post-Millennium Development Goal era, especially in the sub-Saharan Africa where maternal mortality still remains high. PMID:27214674

  13. Improving care for women with a history of gestational diabetes: a provider perspective.

    Science.gov (United States)

    Oza-Frank, Reena; Ko, Jean Y; Wapner, Andrew; Rodgers, Loren; Bouchard, Jo M; Conrey, Elizabeth J

    2014-09-01

    To identify perceived roles with regard to care for women with gestational diabetes mellitus (GDM) history and resources for improving care among women with a history of GDM from the perspective of obstetrician/gynecologists (OB/GYNs), certified nurse midwives (CNM), family practitioners, and internists. In 2010, a survey was sent to a random sample of OB/GYNs, CNM, family practitioners, and internists (n = 2,375) in Ohio to assess knowledge, attitudes, and postpartum practices regarding diabetes prevention for women with a history of GDM. A total of 904 practitioners completed the survey (46 %). Over 70 % of CNMs strongly agreed it is part of their job to help women with GDM history improve diet and increase exercise, compared with 60 % of family practitioners/internists and 55 % of OB/GYNs (p need for more local nutrition specialists and patient education materials, compared with family practitioners/ internists. Between 60 and 70 % of OB/GYNs and CNMs reported lifestyle modification programs and corresponding reimbursement would better support them to provide improved care. Health care providers giving care to women with GDM history have varying perceptions of their roles, however, there was agreement on resources needed to improve care. PMID:24343308

  14. The Predictive Syndemic Effect of Multiple Psychosocial Problems on Health Care Costs and Utilization among Sexual Minority Women.

    Science.gov (United States)

    Valentine, Sarah E; Elsesser, Steven; Grasso, Chris; Safren, Steven A; Bradford, Judith B; Mereish, Ethan; O'Cleirigh, Conall

    2015-12-01

    Previous studies documenting sexual minority women's disproportionate risk for a range of medical, mental health, and substance use disorders have not provided a predictive framework for understanding their interrelations and outcomes. The present study aimed to address this gap by testing the syndemic effect of co-occurring psychosocial problems on 7-year health care costs and utilization among sexual minority women. The sample was comprised of sexual minority women (N = 341) who were seen at an urban LGBT-affirmative community health center. Medical and mental health care utilization and cost data were extracted from electronic medical records. Demographically adjusted regression models revealed that co-occurring psychosocial problems (i.e., childhood sexual abuse, partner violence, substance use, and mental health distress [history of suicide attempt]) were all strongly interrelated. The presence of these indicators had a syndemic (additive) effect on medical costs and utilization and mental health utilization over 7-year follow-up, but no effect on 7-year mental health costs. These results suggest that the presence and additive effect of these syndemic conditions may, in part, explain increased medical costs and utilization (and higher medical morbidity) among sexual minority women. PMID:26438415

  15. The Impact of Wilderness Therapy: Utilizing an Integrated Care Approach

    Science.gov (United States)

    Tucker, Anita; Norton, Christine Lynn; DeMille, Steven M.; Hobson, Jessalyn

    2016-01-01

    With roots in experiential education and Outward Bound, wilderness therapy (WT) is a growing field of mental health care for youth. WT uses outdoor modalities combined with therapeutic interventions to assist youth to promote clinical changes. Previous research has shown it to be effective in improving the mental health of clients; however, little…

  16. [Psychiatric care and knowledge, utility of the useless].

    Science.gov (United States)

    Touzet, Patrick

    2012-01-01

    What knowledge is necessary in psychiatric care? Philosophy is a valuable ally of caregivers, it enables them to take a step back from their activity, in order to be able to sustain their thought Platon, Hadot and Heidegger support this course to become "specialists in everything". PMID:23311065

  17. Dental care utilization in a Swedish county in 1993 and 2003.

    Science.gov (United States)

    Sondell, Katarina; Söderfeldt, Björn; Hugoson, Anders

    2010-01-01

    The aim of the present study is to analyse factors influencing the patterns of utilization of dental care in an adult urban Swedish population aged between 30 and 80 in the years 1993 and 2003. This study is part of two large epidemiological dental studies of randomly selected individuals, performed in 1993 and 2003. It comprises clinical and questionnaire data from 555 and 505 individuals in the two studyyears. In 1993, more patients visited the private dental care system more often than the public system. This difference still existed in 2003, but to a 50% lower extent. All age groups had less utilization of dental care in 2003 than in 1993. The largest change was seen in the 30-year age group in utilization patterns of dental care between the two study years. A hierarchical block regression method was performed in four steps, analysing utilization for the two study years separately. The dental service system influenced the utilization patterns significantly for both years. The health factors strengthened this main result. Irrespective of dental health, patients were predicted to visit the private dental care service system more often in both 1993 and 2003. The socio-economic differences between people in Sweden were of no consequence for dental care utilization. As to age and attitude towards treatment costs, a substantial change was observed and might reflect a change in social patterns with greater inequalities, but the overall picture of equal access in dental care in Sweden remains. PMID:21306087

  18. Awareness and utilization of preventive care services among the elderly under National Health Insurance.

    Science.gov (United States)

    Chen, Chun-Chih; Lin, Yen-Ju; Lin, Ying-Tzu

    2013-12-01

    This empirical study investigates the factors affecting the awareness and the utilization of preventive care among the elderly in Taiwan. We use data obtained from the 2005 National Health Interview Survey. A recursive bivariate probit model is adopted to analyze the factors affecting the awareness and the utilization of preventive care. The probability of awareness of free preventive care under the National Health Insurance is higher for those who are younger, Mainlanders, have received more education, have a spouse, exercise regularly, have better self-rated health status, and have chronic diseases; the probability of awareness is lower for those who are aborigines and who live in the south and the east. Awareness of preventive care services, having a spouse, living alone, having better health status, and the existence of chronic diseases increase the probability of preventive care utilization; working reduces the probability of preventive care utilization. Our result supports the views in Arrow (Am Econ Rev 53(5):941-973, 1963) that health information is an important factor determining the demand for medical care. Policymakers may enhance such preventive care service utilization by increasing the awareness of such services among the elderly. PMID:23754318

  19. Patients in a depression collaborative care model of care: comparison of 6-month cost utilization data with usual care.

    Science.gov (United States)

    Angstman, Kurt B; Williams, Mark D

    2010-04-01

    A collaborative care model (CCM) has been implemented for management of depression. This paper studies the impact that the CCM had on cost measures for the period of six months after initial diagnosis of depression compared to patients receiving usual care (UC). There was a significant increase in the CPT costs for the six months following diagnosis in the CCM group ($451.35 vs. $323.50, P < 0.001). The average CPT cost rank and CPT cost differential were also significantly increased in the CCM group. The adjusted means of the CPT costs were (when controlling for prior utilization) $452.11 for the CCM group and $322.09 for UC (P < 0.001). In the CCM group; there were 161 patients (73.5%) that achieved a clinical response for their depression compared to the UC group, which had a 15.1% (18/119) response rate (P < 0.001). There also was a significant difference between the groups in those who were symptoms free of their depression (PHQ-9 score < 5), with the CCM having 59.4% of the patients symptom-free compared to 10.9% of the UC group (P < 0.001). In this group of patients, CCM is associated with markedly improved clinical outcomes for depression, however with a modest short-term increase in CPT costs. PMID:23804062

  20. HIPPOCRATES IS CARE: HISTORY AND SOME BIOLOGICAL PATHWAYS ON CAREGIVER

    OpenAIRE

    Rosangela Souza Kalil; Fernando Raphael de Almeida Ferry; Fernando Samuel Sion; Jorge Francisco da Cunha-Pinto; Marcelo Mendes de Azevedo Costa-Velho; Carlos Alberto Morais De Sá

    2011-01-01

    AbstractHippocrates is the mainstay of care. Plato and Aristotle state humoralism as the way that Hippocrates understands human health disorders. He closely observed patients to restore humoral equilibrium, relying on healing power of nature to recover health, rejecting drugs or any kind of procedure that could harm the individual. The development of a common ground of understanding is desirable as a process of negotiating treatment goals and methods which may create an atmosphere of support ...

  1. Why we should care about evolution and natural history

    DEFF Research Database (Denmark)

    Kjærgaard, Peter C.

    2016-01-01

    to take the discussion of science and religion beyond our own professional circles. Peter Harrison's The Territories of Science and Religion gives us an opportunity to do so. We can use his book to understand why people consistently get the relation wrong. However, we need to take the next step ourselves......, involve historians in the common academic goal, across disciplines, to make sense of the world around us and make that combined knowledge truly useful. Evolution and natural history might help to that effect....

  2. Libraries of life: using life history books with depressed care home residents.

    Science.gov (United States)

    Plastow, Nicola Ann

    2006-01-01

    Depression is a common, and often undetected, psychiatric disorder in geriatric care home residents. Reminiscence, an independent nursing therapy used by a variety of health and social care professionals, can prevent or reduce depression. This practice development project explored the use of reminiscence life history books as an interpersonal therapeutic tool with 3 depressed care-home residents living in residential care and skilled nursing facilities. The process of choosing to produce a book, assessment of capabilities, and methods of construction are described using 3 illustrative case studies. Three themes emerged: reviewing the past, accepting the present, and dreaming of an alternative future. This project demonstrated that life history books, tailored to individual needs and abilities, can facilitate reminiscence and reduce depression by increasing social interaction. The benefits to residents, their families, and care staff are discussed and the relevance to nursing practice highlighted.

  3. Husbands' involvement in delivery care utilization in rural Bangladesh: A qualitative study

    OpenAIRE

    Story William T; Burgard Sarah A; Lori Jody R; Taleb Fahmida; Ali Nabeel; Hoque DM Emdadul

    2012-01-01

    Abstract Background A primary cause of high maternal mortality in Bangladesh is lack of access to professional delivery care. Examining the role of the family, particularly the husband, during pregnancy and childbirth is important to understanding women's access to and utilization of professional maternal health services that can prevent maternal mortality. This qualitative study examines husbands' involvement during childbirth and professional delivery care utilization in a rural sub-distric...

  4. Demographic profile and utilization statistics of a Canadian inpatient palliative care unit within a tertiary care setting

    OpenAIRE

    Napolskikh, J.; Selby, D.; Bennett, M.; Chow, E.; Harris, K; Sinclair, E.; Myers, J.

    2009-01-01

    Background Canadian data describing inpatient palliative care unit (pcu) utilization are scarce. In the present study, we performed a quality assessment of a 24-bed short-term pcu with a 3-months-or-less life expectancy policy in a tertiary care setting. Methods Using a retrospective chart review, we explored wait time (wt) for admission (May 2005 to April 2006), length of stay [los (February 2005 to January 2006)], and patient demographics. Results The wt data showed 508 referrals, with 242 ...

  5. Home Health Care Utilization: A Review of the Research for Social Work

    Science.gov (United States)

    Kadushin, Goldie

    2004-01-01

    The author reviewed the literature to identify the variables associated with home health care utilization using the Andersen-Newman model as a framework for analysis. Sixty-four studies published between 1985 and 2000 were identified through PUBMED, Sociofile, and PsycINFO databases. Home health care was defined as in-home skilled nursing,…

  6. Medical Service Utilization among Youth with School-Identified Disabilities in Residential Care

    Science.gov (United States)

    Lambert, Matthew C.; Trout, Alexandra L.; Nelson, Timothy D.; Epstein, Michael H.; W. Thompson, Ronald

    2016-01-01

    Background: Behavioral, social, emotional, and educational risks among children and youth with school identified disabilities served in residential care have been well documented. However, the health care needs and medical service utilization of this high-risk population are less well known. Given the risks associated with children with…

  7. Novel biomarkers in critical care: utility or futility?

    Science.gov (United States)

    Ackland, Gareth L; Mythen, Michael G

    2007-01-01

    One of the holy grails of modern medicine, across a range of clinical sub-specialties, is establishing highly sensitive and specific biomarkers for various diseases. Significant success has been achieved in some of these clinical areas, most notably identifying high-sensitivity C-reactive peptide, troponin I/T and brain natriuretic peptide as significant prognosticators for both the acute outcome and the development of cardiovascular pathology. However, it is highly debatable whether this translates to complex, multi-system pathophysiological insults. Is critical care immune from the application of these novel biomarkers, given the numerous confounding factors interfering with their interpretation?

  8. Does Group Prenatal Care Affect Satisfaction And Prenatal Care Utilization in Iranian Pregnant Women?

    OpenAIRE

    A Fotouhi; K Mohammad; H. Eftekhar; Jafari, F.

    2010-01-01

    Background: The need to provide high quality prenatal care services, which take account of women’s views and specifically address their need for information, support and communication, has been advocated and group prenatal care, had been suggested as one of the ways to achieve this objective. The purpose of this study was to examine the impact of group versus individual prenatal care on satisfaction and prenatal care use. Methods: This was a cluster-randomized controlled trial with the health...

  9. Socioeconomic inequity in health care : A study of services utilization in Curacao

    NARCIS (Netherlands)

    Alberts, JF; Sanderman, R; Eimers, JM; VandenHeuvel, WJA

    1997-01-01

    The aim of this study is to examine whether there is socioeconomic equity in health care utilization in Curacao, Netherlands Antilles. We explore how educational level is related to utilization of GPs, specialists, hospitals, dentists and physiotherapists, taking into account the effects of sex, age

  10. Utilization of supportive care by survivors of colorectal cancer : Results from the PROFILES registry

    NARCIS (Netherlands)

    Holla, Jasmijn F M; van de Poll-Franse, L.; Huijgens, Peter C; Mols, F.; Dekker, Joost

    2016-01-01

    PURPOSE: In an equitable healthcare system, healthcare utilization should be predominantly explained by patient-perceived need and clinical need factors. This study aims to analyze whether predisposing, enabling, and need factors are associated with the utilization of supportive care (i.e., dietary

  11. Predictors of Long-Term Care Utilization by Dutch Hospital Patients aged 65+

    Directory of Open Access Journals (Sweden)

    Elderkamp-de Groot Rianne

    2010-05-01

    Full Text Available Abstract Background Long-term care is often associated with high health care expenditures. In the Netherlands, an ageing population will likely increase the demand for long-term care within the near future. The development of risk profiles will not only be useful for projecting future demand, but also for providing clues that may prevent or delay long-term care utilization. Here, we report our identification of predictors of long-term care utilization in a cohort of hospital patients aged 65+ following their discharge from hospital discharge and who, prior to hospital admission, were living at home. Methods The data were obtained from three national databases in the Netherlands: the national hospital discharge register, the long-term care expenses register and the population register. Multinomial logistic regression was applied to determine which variables were the best predictors of long-term care utilization. The model included demographic characteristics and several medical diagnoses. The outcome variables were discharge to home with no formal care (reference category, discharge to home with home care, admission to a nursing home and admission to a home for the elderly. Results The study cohort consisted of 262,439 hospitalized patients. A higher age, longer stay in the hospital and absence of a spouse were found to be associated with a higher risk of all three types of long-term care. Individuals with a child had a lower risk of requiring residential care. Cerebrovascular diseases [relative risk ratio (RRR = 11.5] were the strongest disease predictor of nursing home admission, and fractures of the ankle or lower leg (RRR = 6.1 were strong determinants of admission to a home for the elderly. Lung cancer (RRR = 4.9 was the strongest determinant of discharge to the home with home care. Conclusions These results emphasize the impact of age, absence/presence of a spouse and disease on long-term care utilization. In an era of demographic and

  12. The Utilization of Local History in Teaching American Religious History: A Gilded Age and Progressive Era North Dakota Case Study

    Science.gov (United States)

    Price, Christopher Neal

    2013-01-01

    Teachers of college-level courses on American religious history generally leave out the importance of local and regional histories when telling the story of religion in America. The study of local history provides a fertile ground for understanding broad national trends in a local context. This dissertation focuses upon a little-studied religious…

  13. Food Insecurity and Health Care Utilization Among Older Adults in the United States.

    Science.gov (United States)

    Bhargava, Vibha; Lee, Jung Sun

    2016-01-01

    This study examined the relationships between food insecurity and utilization of four health services among older Americans: office visits, inpatient hospital nights, emergency department visits, and home health care. Nationally representative data from the 2011 and 2012 National Health Interview Survey were used (N = 13,589). Nearly 83.0% of the sample had two or more office visits, 17.0% reported at least one hospital night, 23.0% had at least one emergency room visit, and 8.1% used home health care during the past 12 months. Adjusting for confounders, food-insecure older adults had higher odds of using more office visits, inpatient hospital nights, and emergency department visits than food-secure older adults, but similar odds of home health care utilization. The findings of this study suggest that programs and policies aimed at reducing food insecurity among older adults may have a potential to reduce utilization of health care services.

  14. Socioeconomic Distribution of Health and Health Care Utilization in a New Town in Hong Kong, China

    Institute of Scientific and Technical Information of China (English)

    TAK SUN IGNATIUS YU; TZE WAI WONG

    2004-01-01

    Objectives To assess the association of socioeconomic indicators with various chronic and acute illnesses and the utilization of public health care in a new town in Hong Kong, China. Methods Illness experience and socioeconomic and demographic data of 7570 residents from 2022 randomly selected households were collected through telephone interviews. The relationships between socioeconomic indicators and illnesses/choice of health care were explored using stepwise logistic regressions after adjusting for sex and age. Results Significant positive associations were noted between low household income and diabetes mellitus, any chronic illnesses among adults and flu among younger subjects; low educational level and accident-related illness among adults; being born in Chinese mainland and flu, any acute illness in adults. For the utilization of public health care, low household income was the most consistent risk factor. Conclusion This study did not demonstrate a unidirectional socioeconomic gradient in health but supported the hypothesis that socioeconomic deprivation was associated with the utilization of public health care.

  15. Drug Utilization in Geriatric Population in a Tertiary Care Centre

    Directory of Open Access Journals (Sweden)

    T Ramesh Kumar, S Shahina, JC Shobha, MUR Naidu, P Usha Rani, T Vijay

    1999-07-01

    Full Text Available One hundred and fi fty-two prescriptions of patients aged more than 65 years were picked up fromin-patients of ollr hospital and analysed for drug utilization pattern. The mean age of the patientswas 69.9 ±5.7 years. The mean number of drugs per prescription were 6.33 ± 2.35. Tablets wereused in 48.5%, injections in 39.6%, capsules and syrups in 5.5% each and inhalers in 1.1% ofpatients. Antibiotics were prescribed for 140 patients, diuretics for 34, ACE inhibitors for 33, Calciumchannel blockers for 59, H2 blockers for 84, narcotic analgesics and NSAlDs for 36 and 33 patientsrespectively. Beta blocker usage was minimal. Digoxin, aspirin and thrombolytics were used in 10,50 and 5 patients respectively. Compliance was 100% and side effects Iike haemoptysis, gastritis,palpitation and vomiting were seen in I patient each.

  16. [The cultural history of palliative care in primitive societies: an integrative review].

    Science.gov (United States)

    Siles González, José; Solano Ruiz, Maria Del Carmen

    2012-08-01

    The objective of this study is to describe the evolution of palliative care in order to reflect on the possibility of its origin in primitive cultures and their relationship with the beginnings of the cult of the dead. It describes the change in the symbolic structures and social interactions involved in palliative care during prehistory: functional unit, functional framework and functional element. The theoretical framework is based on cultural history, the dialectical structural model and symbolic interactionism. Categorization techniques, cultural history and dialectic structuralism analyses were performed. Palliative care existed in primitive societies, mostly associated with the rites of passage with a high symbolic content. The social structures - functional unit, functional framework and functional element - are the pillars that supported palliative care in prehistory societies.

  17. [Introduction to palliative care for the oncologist-history and basic principles of palliative care].

    Science.gov (United States)

    Shima, Yasuo

    2010-10-01

    The basic principle of palliative care has evolved over time and is the historical origin of the modern hospice. WHO proposed the first definition of palliative care in 1989, and the definition was revised in 2002. These definitions have something in common. Both relieve the pain and suffering to improve QOL. Palliative care is also good for any kind of life-threatening disease, regardless of whether it requires short or long term recuperation. That also need to be able to accept equally all the people of the community. The provision of general palliative care is the responsibility of all medical, nursing, and health professionals for the welfare of all patients with life-threatening disease. Specialist palliative care is based on the basic principles of palliative care, intensive clinical training, and systematic acquisition of knowledge and skills training to support palliative care education, clinical research and training provided by the profession. It has been established by nursing and medical experts in palliative care that palliative care can provide expertise in interdisciplinary teams in different settings. It is necessary that the medical system.

  18. Tracking vaccine compliance in a primary care setting: online history, reminders, order entry, and charting.

    OpenAIRE

    Flanagan, J. R.; Walker, K. P.

    1999-01-01

    In a new primary care setting with three medical disciplines participating, a vaccine history and order entry system was implemented along with other online documentation systems as the primary documentation tools for the clinic. Reminders were generated based upon a set of algorithms consistent with 1998 nationally accepted vaccine guidelines. Vaccine compliance data were analyzed for the entire population cared for in this setting for a 6 month period. Rates of compliance with national reco...

  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. The influence of women's empowerment on maternal health care utilization: evidence from Albania.

    Science.gov (United States)

    Sado, Lantona; Spaho, Alma; Hotchkiss, David R

    2014-08-01

    Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women's status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women's empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008-09 Albania Demographic and Health Survey. The linkages between women's empowerment and maternal health care utilization are analyzed using two types of indicators of women's empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women's roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women's empowerment at home could be effective in helping assure good maternal health.

  1. Husbands' involvement in delivery care utilization in rural Bangladesh: A qualitative study

    Directory of Open Access Journals (Sweden)

    Story William T

    2012-04-01

    Full Text Available Abstract Background A primary cause of high maternal mortality in Bangladesh is lack of access to professional delivery care. Examining the role of the family, particularly the husband, during pregnancy and childbirth is important to understanding women's access to and utilization of professional maternal health services that can prevent maternal mortality. This qualitative study examines husbands' involvement during childbirth and professional delivery care utilization in a rural sub-district of Netrokona district, Bangladesh. Methods Using purposive sampling, ten households utilizing a skilled attendant during the birth of the youngest child were selected and matched with ten households utilizing an untrained traditional birth attendant, or dhatri. Households were selected based on a set of inclusion criteria, such as approximate household income, ethnicity, and distance to the nearest hospital. Twenty semi-structured interviews were conducted in Bangla with husbands in these households in June 2010. Interviews were transcribed, translated into English, and analyzed using NVivo 9.0. Results By purposefully selecting households that differed on the type of provider utilized during delivery, common themes--high costs, poor transportation, and long distances to health facilities--were eliminated as sufficient barriers to the utilization of professional delivery care. Divergent themes, namely husbands' social support and perceived social norms, were identified as underlying factors associated with delivery care utilization. We found that husbands whose wives utilized professional delivery care provided emotional, instrumental and informational support to their wives during delivery and believed that medical intervention was necessary. By contrast, husbands whose wives utilized an untrained dhatri at home were uninvolved during delivery and believed childbirth should take place at home according to local traditions. Conclusions This study provides

  2. Health care utilization patterns in developing countries: role of the technology environment in "deriving" the demand for health care.

    Science.gov (United States)

    Wouters, A V

    1992-01-01

    Health care services, in combination with several intermediate (proximate) determinants of health such as environmental sanitation and nutrition, directly influence health status. In the economics literature, this is referred to as the health production technology. Although many studies recognize that demand for health care depends on the health production technology, otherwise known as a "derived" demand, this review indicates that few of them have so far been able to fully incorporate this technology in estimating significant determinants of health care use. Understanding the technology environment could help explain why substantial portions of the population do not gain access to care even when financial factors do not appear to be a barrier. Also, low utilization of health services may simply reflect the low productivity of these services when other complementary factors such as nutrition or clean water and sanitation are lacking. Finally, since health-producing technology is often a multistep (multivisit) process, health care demand studies generally offer an incomplete picture of health care utilization patterns because they focus on a single event such as the first visit of an illness episode. Researchers should obtain more complete information on the interaction between all health production inputs, their availability and access to them. Multidisciplinary methodologies are likely to be useful.

  3. 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...

  4. Health Care Utilization and Expenditures Associated With Remote Monitoring in Patients With Implantable Cardiac Devices.

    Science.gov (United States)

    Ladapo, Joseph A; Turakhia, Mintu P; Ryan, Michael P; Mollenkopf, Sarah A; Reynolds, Matthew R

    2016-05-01

    Several randomized trials and decision analysis models have found that remote monitoring may reduce health care utilization and expenditures in patients with cardiac implantable electronic devices (CIEDs), compared with in-office monitoring. However, little is known about the generalizability of these findings to unselected populations in clinical practice. To compare health care utilization and expenditures associated with remote monitoring and in-office monitoring in patients with CIEDs, we used Truven Health MarketScan Commercial Claims and Medicare Supplemental Databases. We selected patients newly implanted with an implantable cardioverter defibrillators (ICD), cardiac resynchronization therapy defibrillator (CRT-D), or permanent pacemaker (PPM), in 2009, who had continuous health plan enrollment 2 years after implantation. Generalized linear models and propensity score matching were used to adjust for confounders and estimate differences in health care utilization and expenditures in patients with remote or in-office monitoring. We identified 1,127; 427; and 1,295 pairs of patients with a similar propensity for receiving an ICD, CRT-D, or PPM, respectively. Remotely monitored patients with ICDs experienced fewer emergency department visits resulting in discharge (p = 0.050). Remote monitoring was associated with lower health care expenditures in office visits among patients with PPMs (p = 0.025) and CRT-Ds (p = 0.006) and lower total inpatient and outpatient expenditures in patients with ICDs (p monitoring of patients with CIEDs may be associated with reductions in health care utilization and expenditures compared with exclusive in-office care.

  5. Effectiveness of a transitional home care program in reducing acute hospital utilization: a quasi-experimental study

    OpenAIRE

    Low, Lian Leng; Vasanwala, Farhad Fakhrudin; Ng, Lee Beng; Chen, Cynthia; Lee, Kheng Hock; Tan, Shu Yun

    2015-01-01

    Background Improving healthcare utilization is essential as health systems around the world grapple with the escalating demands for acute hospital resources. Evidence suggests that transitional care programs are effective to improve utilization of healthcare. However, the evidence for transitional care programs that enhance the home medical care model and provide multi-disciplinary patient-centered care is not well established. We evaluated if a transitional home care program operated by the ...

  6. 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

  7. The spillover effects of Medicare managed care: Medicare Advantage and hospital utilization.

    Science.gov (United States)

    Baicker, Katherine; Chernew, Michael E; Robbins, Jacob A

    2013-12-01

    More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial - offsetting more than 10% of increased payments to Medicare Advantage plans.

  8. The Spillover Effects of Medicare Managed Care: Medicare Advantage and Hospital Utilization

    Science.gov (United States)

    Baicker, Katherine; Chernew, Michael; Robbins, Jacob

    2013-01-01

    More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out the effects of greater managed care penetration on hospital utilization and spending throughout the health care system. We find that when more seniors enroll in Medicare managed care, hospital costs decline for all seniors and for commercially insured younger populations. Greater managed care penetration is not associated with fewer hospitalizations, but is associated with lower costs and shorter stays per hospitalization. These spillovers are substantial – offsetting more than 10% of increased payments to Medicare Advantage plans. PMID:24308880

  9. Comparison of Health Care Resource Utilization by Immigrants Versus Native Elderly People.

    Science.gov (United States)

    Franchi, Carlotta; Baviera, Marta; Sequi, Marco; Cortesi, Laura; Tettamanti, Mauro; Roncaglioni, Maria Carla; Pasina, Luca; Dignefa, Codjo Djade; Fortino, Ida; Bortolotti, Angela; Merlino, Luca; Mannucci, Pier Mannuccio; Nobili, Alessandro

    2016-02-01

    To compare the utilization of health care resources (drug prescriptions, hospital admissions and health care services) by immigrant versus native elderly people (65 years or more), by using administrative database of the Lombardy Region. For each immigrant (an older people born out of Italy), one person born in Lombardy (native) was randomly selected and matched by age, sex and general practitioner. The 25,508 immigrants selected were less prescribed with at least one drug (OR 0.72, 95 % CI 0.67-0.76) and had a lesser use of health care services (OR 0.79, 95 % CI 0.75-0.84) than natives. No statistically significant differences were found for hospital admission rates (OR 0.99, 95 % CI 0.99-1.04). A lower rate of health care resource utilization was observed in elderly immigrants who had been living in the host region for as many as 10 years. PMID:25576178

  10. An intelligent approach to machine component health prognostics by utilizing only truncated histories

    Science.gov (United States)

    Lu, Chen; Tao, Laifa; Fan, Huanzhen

    2014-01-01

    Numerous techniques and methods have been proposed to reduce the production downtime, spare-part inventory, maintenance cost, and safety hazards of machineries and equipment. Prognostics are regarded as a significant and promising tool for achieving these benefits for machine maintenance. However, prognostic models, particularly probabilistic-based methods, require a large number of failure instances. In practice, engineering assets are rarely being permitted to run to failure. Many studies have reported valuable models and methods that engage in maximizing both truncated and failure data. However, limited studies have focused on cases where only truncated data are available, which is common in machine condition monitoring. Therefore, this study develops an intelligent machine component prognostics system by utilizing only truncated histories. First, the truncated Minimum Quantization Error (MQE) histories were obtained by Self-organizing Map network after feature extraction. The chaos-based parallel multilayer perceptron network and polynomial fitting for residual errors were adopted to generate the predicted MQEs and failure times following the truncation times. The feed-forward neural network (FFNN) was trained with inputs both from the truncated MQE histories and from the predicted MQEs. The target vectors of survival probabilities were estimated by intelligent product limit estimator using the truncation times and generated failure times. After validation, the FFNN was applied to predict the machine component health of individual units. To validate the proposed method, two cases were considered by using the degradation data generated by bearing testing rig. Results demonstrate that the proposed method is a promising intelligent prognostics approach for machine component health.

  11. Associations between Primary Health Care- and Hospital Utilization among Elderly People in Norway

    OpenAIRE

    Deraas, Trygve Sigvart

    2013-01-01

    Summary Background: Geographical variations in health-care utilization in many countries have been an area of debate. Health-care supply factors, population and/or environmental need factors might explain the so-called small-area variations (SAVs). Demographic forecasts indicated a significant increase in the elderly population over the next few decades, with a resulting increased need for health services. The Norwegian Coordination reform and health policies in many western countries...

  12. Increased utilization of health care services after psychotherapy: a register based study

    DEFF Research Database (Denmark)

    Fenger, Morten Munthe; Poulsen, Stig Bernt; Mortensen, Erik Lykke;

    2012-01-01

    545 patients completed treatment; 228 responded and 201 did not respond to treatment. Data on treatment response was missing for the remaining 116 patients. Completer patients increased their use of all health care services with 296% (ES=0.58) in the four year pre-post comparison, while the control...... a long-term period psychotherapy patients increased their utilization of health care services with a factor 3 compared to a control group....

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

    Science.gov (United States)

    Prakash, Ravi; Kumar, Abhishek

    2013-07-01

    Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005-06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.

  14. Allocating health care: cost-utility analysis, informed democratic decision making, or the veil of ignorance?

    Science.gov (United States)

    Goold, S D

    1996-01-01

    Assuming that rationing health care is unavoidable, and that it requires moral reasoning, how should we allocate limited health care resources? This question is difficult because our pluralistic, liberal society has no consensus on a conception of distributive justice. In this article I focus on an alternative: Who shall decide how to ration health care, and how shall this be done to respect autonomy, pluralism, liberalism, and fairness? I explore three processes for making rationing decisions: cost-utility analysis, informed democratic decision making, and applications of the veil of ignorance. I evaluate these processes as examples of procedural justice, assuming that there is no outcome considered the most just. I use consent as a criterion to judge competing processes so that rationing decisions are, to some extent, self-imposed. I also examine the processes' feasibility in our current health care system. Cost-utility analysis does not meet criteria for actual or presumed consent, even if costs and health-related utility could be measured perfectly. Existing structures of government cannot creditably assimilate the information required for sound rationing decisions, and grassroots efforts are not representative. Applications of the veil of ignorance are more useful for identifying principles relevant to health care rationing than for making concrete rationing decisions. I outline a process of decision making, specifically for health care, that relies on substantive, selected representation, respects pluralism, liberalism, and deliberative democracy, and could be implemented at the community or organizational level.

  15. Influence of women health care adoption on contraceptive use: utilization of prenatal and postnatal care

    International Nuclear Information System (INIS)

    The effect of women heat seeking behaviour during pregnancy and post delivery period on contraceptive use and family size are important dimension of female fertility. These determinants of female fertility have rarely been explored, particularly in developing countries confronting problems of rising population growth. A study was conducted in district Faisalabad, Pakistan to explore the influence of pre and postnatal care on contraceptive use. A random sample of 1051 married women was studied from the urban and rural areas of the district through formal survey. It was found that contraceptive use is associated with pre-and postnatal care. Minimum of 5-7 prenatal and at least 2 postnatal visit have been identified as effective to promote contraceptive use. Involvement of health professional, motivation through mass media and improved access to health care services during the period of pregnancy and after childbirth are the measures suggested to enhance contraceptive use in the society to curtail family size. (author)

  16. Understanding health-care access and utilization disparities among Latino children in the United States.

    OpenAIRE

    Langellier, BA; Chen, J; Vargas-Bustamante, A; Inkelas, M; Ortega, AN

    2016-01-01

    It is important to understand the source of health-care disparities between Latinos and other children in the United States. We examine parent-reported health-care access and utilization among Latino, White, and Black children (≤17 years old) in the United States in the 2006-2011 National Health Interview Survey. Using Blinder-Oaxaca decomposition, we portion health-care disparities into two parts (1) those attributable to differences in the levels of sociodemographic characteristics (e.g., i...

  17. What Ambulatory Care Managers Need to Know About Examination Room Utilization Measurement and Analysis.

    Science.gov (United States)

    Klarich, Mark J; Rea, Ronald W; Lal, Tarun Mohan; Garcia, Angel L; Steffens, Fay L

    2016-01-01

    Demand for ambulatory care visits is projected to increase 22% between 2008 and 2025. Given this growth, ambulatory care managers need to proactively plan for efficient use of scarce resources (ie, space, equipment, and staff). One important component of ambulatory care space (the number of examination rooms) is dependent on multiple factors, including variation in demand, hours of operation, scheduling, and staff. The authors (1) outline common data collection methods, (2) highlight analysis and reporting considerations for examination room utilization, and (3) provide a strategic framework for short- and long-term decision making for facility design or renovation. PMID:27232683

  18. Real-world comparison of health care utilization between duloxetine and pregabalin initiators with fibromyalgia

    Directory of Open Access Journals (Sweden)

    Peng X

    2014-01-01

    Full Text Available X Peng,1 P Sun,2 D Novick,1 J Andrews,1 S Sun2 1Eli Lilly and Company, Indianapolis, IN, USA; 2Kailo Research Group, Indianapolis, IN, USA Objectives: To compare health care utilization of duloxetine initiators and pregabalin initiators among fibromyalgia patients in a real-world setting. Methods: A retrospective cohort study was conducted based on a US national commercial health claims database (2006–2009. Fibromyalgia patients who initiated duloxetine or pregabalin in 2008, aged 18–64 years, and who maintained continuous health insurance coverage 1 year before and 1 year after initiation were assigned to duloxetine or pregabalin cohorts on the basis of their initiated agent. Patients who had pill coverage of the agents over the course of 90 days preceding the initiation were excluded. The two comparative cohorts were constructed using propensity score greedy match methods. Descriptive analysis and paired t-test were performed to compare health care utilization rates in the postinitiation year and the changes of these rates from the preinitiation year to the postinitiation year. Results: Both matched cohorts (n=1,265 pairs had a similar mean initiation age (49–50 years, percentage of women (87%–88%, and prevalence of baseline comorbid conditions (neuropathic pain other than diabetic peripheral neuropathic pain, low back pain, cardiovascular disease, hypertension, headache or migraine, and osteoarthritis. In the preinitiation year, both cohorts had similar inpatient, outpatient, and medication utilization rates (inpatient, 15.7%–16.1%; outpatient, 100.0%; medication, 97.9%–98.7%. The utilization rates diverged in the postinitiation year, with the pregabalin cohort using more fibromyalgia-related inpatient care (3.2% versus 2.2%; P<0.05, any inpatient care (19.3% versus 16.8%; P<0.05, and fibromyalgia-related outpatient care (62.1% versus 51.8%; P<0.05. From the preinitiation period to the postinitiation period, the duloxetine cohort

  19. Resource Utilization and Costs of Care prior to ART Initiation for Pediatric Patients in Zambia

    Directory of Open Access Journals (Sweden)

    Hari S. Iyer

    2014-01-01

    Full Text Available Objective. We estimated time to initiation, outpatient resource use, and costs of outpatient care during the 6 months prior to ART initiation for HIV-infected pediatric patients in Zambia. Methods. We enrolled 1,102 children who initiated ART at <15 years of age between 2006 and 2011 at 5 study sites. Of these, 832 initiated ART ≤6 months after first presenting to care at the study sites. Data on time in care and resources utilized during the 6 months prior to ART initiation were extracted from patient medical records. Costs were estimated from the provider’s perspective and are reported in 2011 USD. Results. For the patients who initiated ART ≤6 months after presenting to care, median age at presentation to care was 3.9 years; median CD4 percentage was 13%. Median time to ART initiation was 26 days. Patients made, on average, 2.38 clinic visits prior to ART initiation and received 0.81 CD4 tests, 0.74 full blood count tests, and 0.49 blood chemistry tests. The mean cost of pre-ART care was $20 per patient. Conclusions. Zambian pediatric patients initiating ART ≤6 months after presenting to care do so quickly, utilize fewer resources than mandated by national guidelines, and accrue low costs.

  20. Geographic variation in commercial medical-care expenditures: a framework for decomposing price and utilization.

    Science.gov (United States)

    Dunn, Abe; Shapiro, Adam Hale; Liebman, Eli

    2013-12-01

    This study introduces a new framework for measuring and analyzing medical-care expenditures. The framework focuses on expenditures at the disease level that are decomposed between price and utilization. We find that both price and utilization differences are important contributors to expenditure differences across commercial markets. Further examination shows that for some diseases utilization drives variation while for others price is more important. Finally, when disease-specific measures are aggregated across diseases, much of the important disease-specific variation is masked, leading to much smaller measures of aggregate variation.

  1. Can Walmart make us healthier? Prescription drug prices and health care utilization.

    Science.gov (United States)

    Borrescio-Higa, Florencia

    2015-12-01

    This paper analyzes how prices in the retail pharmaceutical market affect health care utilization. Specifically, I study the impact of Walmart's $4 Prescription Drug Program on utilization of antihypertensive drugs and on hospitalizations for conditions amenable to drug therapy. Identification relies on the change in the availability of cheap drugs introduced by Walmart's program, exploiting variation in the distance to the nearest Walmart across ZIP codes in a difference-in-differences framework. I find that living close to a source of cheap drugs increases utilization of antihypertensive medications by 7 percent and decreases the probability of an avoidable hospitalization by 6.2 percent.

  2. 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.

  3. Treatment patterns, health state, and health care resource utilization of patients with radioactive iodine refractory differentiated thyroid cancer

    Science.gov (United States)

    Gianoukakis, Andrew G; Flores, Natalia M; Pelletier, Corey L; Forsythe, Anna; Wolfe, Gregory R; Taylor, Matthew H

    2016-01-01

    Background Patients with differentiated thyroid cancer (DTC) often respond well to treatment but some become refractory to radioactive iodine (RAI) treatment, and treatment options are limited. Despite the humanistic and economic burden RAI refractory disease imposes on patients, published research concerning treatment patterns and health care resource utilization is sparse. Methods Data were collected from an online retrospective chart review study in the US and five European Union (EU) countries (France, Germany, Italy, Spain, and UK) with physicians recruited from an online panel. Physicians (N=211) provided demographics, disease history, treatment information, and health care resource utilization for one to four of their patients with radioactive iodine refractory differentiated thyroid cancer (RR-DTC). Results The majority of the patients with RR-DTC (N=623) were female (56%), and their mean age was 58.2 years. In this sample, 63.2% had papillary thyroid cancer and 57.0% were in Stage IV when deemed RAI refractory. Patients with RR-DTC experienced regional recurrence in the thyroid bed/central neck area (25.3%) and had distant metastatic disease (53.6%). At the time data were collected, 50.7% were receiving systemic treatment. Of those, 78.5% were on first-line treatment and 62.7% were receiving multikinase inhibitors. Regional differences for prescribed treatments were observed; the US was more likely to have patients receiving multikinase inhibitors (79.2%) compared with UK (41.2%) and Italy (17.1%). Additional details regarding treatment patterns and resource utilization are discussed. Conclusion The current study aimed to obtain a greater understanding of RR-DTC treatment globally. These results can assist in the development and implementation of treatment guidelines and ultimately enhance the care of patients with RR-DTC. PMID:27313476

  4. Long-term effects of oral clefts on health care utilization

    DEFF Research Database (Denmark)

    Pedersen, Morten Saaby; Wehby, George L; Pedersen, Dorthe Almind;

    2015-01-01

    Oral clefts are among the most common birth defects affecting thousands of newborns each year, but little is known about their potential long-term consequences. In this paper, we explore the impact of oral clefts on health care utilization over most of the lifespan. To account for time-invariant ......Oral clefts are among the most common birth defects affecting thousands of newborns each year, but little is known about their potential long-term consequences. In this paper, we explore the impact of oral clefts on health care utilization over most of the lifespan. To account for time...... clefts use more health services than their unaffected siblings. Additional results show that the effects are driven primarily by congenital malformation-related hospitalizations and intake of anti-infectives. Although the absolute differences in most health care utilization diminish over time, affected...... individuals have slightly higher utilization of some health care services in adulthood (particularly for diseases of the nervous and respiratory system). These results have important implications for affected individuals, their families, and their health professionals....

  5. Drug utilization pattern in geriatric inpatients of medicine department in a Tertiary Care Teaching Hospital

    Directory of Open Access Journals (Sweden)

    Swapna R. Nayaka

    2015-06-01

    Conclusion: Thus, irrational prescribing and polypharmacy were prevalent among elderly. Drug utilization data can help in assessing the quality of care given to the geriatric patients and promote rational use of medicines. [Int J Basic Clin Pharmacol 2015; 4(3.000: 568-573

  6. DISABILITY AND DEPRESSION AMONG HIGH UTILIZERS OF HEALTH-CARE - A LONGITUDINAL ANALYSIS

    NARCIS (Netherlands)

    VONKORFF, M; ORMEL, J; KATON, W; LIN, EHB

    1992-01-01

    We evaluated, among depressed medical patients who are high utilizers of health care, whether improved vs unimproved depression is associated with differences in the course of functional disability. At baseline, 6 months, and 12 months, depression and disability were assessed among a sample of enrol

  7. Health care utilization and symptom severity in Ghanaian children--a cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Ralf Krumkamp

    Full Text Available The aim of this study was to identify factors influencing health care utilization behavior for children with mild or severe disease symptoms in rural Ghana. Between March and September 2008 a cross-sectional health care utilization survey was conducted and 8,715 caregivers were interviewed regarding their intended behavior in case their children had mild or severe fever or diarrhea. To show associations between hospital attendance and further independent factors (e.g. travel distance or socio-economic status prevalence ratios were calculated for the four disease symptoms. A Poisson regression model was used to control for potential confounding. Frequency of hospital attendance decreased constantly with increasing distance to the health facility. Being enrolled in the national health insurance scheme increased the intention to attend a hospital. The effect of the other factors diminished in the Poisson regression if modeled together with travel distance. The observed associations weakened with increasing severity of symptoms, which indicates that barriers to visit a hospital are less important if children experience a more serious illness. As shown in other studies, travel distance to a health care provider had the strongest effect on health care utilization. Studies to identify local barriers to access health care services are important to inform health policy making as they identify deprived populations with low access to health services and to early treatment.

  8. Evaluating components of dental care utilization among adults with diabetes and matched controls via hurdle models

    Directory of Open Access Journals (Sweden)

    Chaudhari Monica

    2012-07-01

    Full Text Available Abstract Background About one-third of adults with diabetes have severe oral complications. However, limited previous research has investigated dental care utilization associated with diabetes. This project had two purposes: to develop a methodology to estimate dental care utilization using claims data and to use this methodology to compare utilization of dental care between adults with and without diabetes. Methods Data included secondary enrollment and demographic data from Washington Dental Service (WDS and Group Health Cooperative (GH, clinical data from GH, and dental-utilization data from WDS claims during 2002–2006. Dental and medical records from WDS and GH were linked for enrolees continuously and dually insured during the study. We employed hurdle models in a quasi-experimental setting to assess differences between adults with and without diabetes in 5-year cumulative utilization of dental services. Propensity score matching adjusted for differences in baseline covariates between the two groups. Results We found that adults with diabetes had lower odds of visiting a dentist (OR = 0.74, p  0.001. Among those with a dental visit, diabetes patients had lower odds of receiving prophylaxes (OR = 0.77, fillings (OR = 0.80 and crowns (OR = 0.84 (p 0.005 for all and higher odds of receiving periodontal maintenance (OR = 1.24, non-surgical periodontal procedures (OR = 1.30, extractions (OR = 1.38 and removable prosthetics (OR = 1.36 (p  Conclusions Patients with diabetes are less likely to use dental services. Those who do are less likely to use preventive care and more likely to receive periodontal care and tooth-extractions. Future research should address the possible effectiveness of additional prevention in reducing subsequent severe oral disease in patients with diabetes.

  9. The history and global market of oral home-care products

    OpenAIRE

    Juliana Jobim Jardim; Luana Severo Alves; Marisa Maltz

    2009-01-01

    This literature review reports the history and the current market of oral home-care products. It provides information extending from the products used by our ancestors to those currently available, as well as on the changes in the supply and consumption of these products. Although the scientific knowledge about oral diseases has improved greatly in recent years, our ancestors had already been concerned with cleaning their teeth. A variety of rudimentary products and devices were used since be...

  10. Primary care physicians' use of family history for cancer risk assessment

    OpenAIRE

    Stockdale Alan; Ashikaga Takamaru; Wood Marie E; Flynn Brian S; Dana Greg S; Naud Shelly

    2010-01-01

    Abstract Background Family history (FH) assessment is useful in identifying and managing patients at increased risk for cancer. This study assessed reported FH quality and associations with physician perceptions. Methods Primary care physicians practicing in two northeastern U.S. states were surveyed (n = 880; 70% response rate). Outcome measures of FH quality were extent of FH taken and ascertaining age at cancer diagnosis for affected family members. Predictors of quality measured in this s...

  11. Transition experiences and health care utilization among young adults with type 1 diabetes

    Directory of Open Access Journals (Sweden)

    Garvey KC

    2013-08-01

    Full Text Available Katharine C Garvey,1 Jonathan A Finkelstein,2,3 Lori M Laffel,1,4 Victoria Ochoa,1 Joseph I Wolfsdorf,1 Erinn T Rhodes1 1Division of Endocrinology, Boston Children's Hospital, 2Division of General Pediatrics, Boston Children's Hospital, 3Department of Population Medicine, Harvard Pilgrim Health Care Institute, 4Pediatric, Adolescent and Young Adult Section, Joslin Diabetes Center, Boston, MA, USA Background: The purpose of this study was to describe the current status of adult diabetes care in young adults with type 1 diabetes and examine associations between health care transition experiences and care utilization. Methods: We developed a survey to assess transition characteristics and current care in young adults with type 1 diabetes. We mailed the survey to the last known address of young adults who had previously received diabetes care at a tertiary pediatric center. Results: Of 291 surveys sent, 83 (29% were undeliverable and three (1% were ineligible. Of 205 surveys delivered, 65 were returned (response rate 32%. Respondents (mean age 26.6 ± 3.0 years, 54% male, 91% Caucasian transitioned to adult diabetes care at a mean age of 19.2 ± 2.8 years. Although 71% felt mostly/completely prepared for transition, only half received recommendations for a specific adult provider. Twenty-six percent reported gaps exceeding six months between pediatric and adult diabetes care. Respondents who made fewer than three diabetes visits in the year prior to transition (odds ratio [OR] 4.5, 95% confidence interval [CI] 1.2–16.5 or cited moving/relocation as the most important reason for transition (OR 6.3, 95% CI 1.3–31.5 were more likely to report gaps in care exceeding six months. Patients receiving current care from an adult endocrinologist (79% were more likely to report at least two diabetes visits in the past year (OR 6.0, 95% CI 1.5–24.0 compared with those receiving diabetes care from a general internist/adult primary care doctor (17%. Two

  12. A Systematic Review of Factors Associated With Utilization of Monitored Anesthesia Care for Gastrointestinal Endoscopy

    Science.gov (United States)

    Saleh, Ashraf; Rubenstein, Joel H.

    2016-01-01

    Utilization of monitored anesthesia care (MAC) for gastrointestinal endoscopy has increased markedly over the past decade, leading to significant additional health care expenditures. However, the extent to which certain patient-, provider-, and facility-level factors lead to MAC utilization is unclear. A systematic review of 13 studies evaluating influential factors associated with MAC utilization for colonoscopy and/or esophagogastroduodenoscopy was conducted. Multiple studies revealed significant increases in MAC utilization since the early 2000s, with substantial regional variation. The most influential patient-related factors associated with MAC utilization include female sex and diagnostic procedural indication. Other patient-related factors with weaker associations or conflicting evidence include older age, comorbidity, higher patient income, and white/non-Hispanic race. The impact of patient substance use and/or prescription medication use has been minimally studied. The strongest provider- and facility-level factors associated with MAC use are a surgeon endoscopist and nonhospital site of service. Other factors with weaker associations include facility endoscopy volume and endoscopist years of experience. Further qualitative and quantitative health services research is needed to better understand the root cause of the rising trend of MAC utilization and to develop policies for encouraging appropriate use of MAC. PMID:27493596

  13. The Meaningful Use of Electronic Health Records and Health Care Utilization.

    Science.gov (United States)

    Kern, Lisa M; Edwards, Alison; Kaushal, Rainu

    2016-07-01

    This study sought to determine the effects on health care utilization of meaningful use (MU) of electronic health records (EHRs) compared to typical use of EHRs without MU. This was a cohort study of primary care physicians in New York State (2010-2011). A total of 7 outcomes (primary care visits, specialist visits, laboratory tests, radiology tests, emergency department visits, admissions and readmissions) and 11 potential confounders were considered. The study sample included 213 physicians (50% of whom had achieved MU) and 127 353 patients. There were 17 fewer primary care visits and 61 fewer laboratory tests for every 100 patients whose physicians achieved MU, compared with patients whose physicians did not achieve MU (P EHR use. PMID:25712134

  14. Rearing history and allostatic load in adult western lowland gorillas (Gorilla gorilla gorilla) in human care.

    Science.gov (United States)

    Edes, Ashley N; Wolfe, Barbara A; Crews, Douglas E

    2016-03-01

    Disrupted rearing history is a psychological and physical stressor for nonhuman primates, potentially resulting in multiple behavioral and physiological changes. As a chronic, soma-wide stressor, altered rearing may be best assessed using a holistic tool such as allostatic load (AL). In humans, AL estimates outcomes of lifetime stress-induced damage. We predicted mother-reared gorillas would have lower AL than nursery-reared and wild-caught conspecifics. We estimated AL for 27 gorillas housed at the Columbus Zoo and Aquarium between 1956 and 2014. AL estimates were calculated using biomarkers obtained during previous anesthetic events. Biomarkers in the high-risk quartile were counted toward a gorilla's AL. Rearing history was categorized as mother-reared, nursery-reared, and wild-caught. Using ANCOVA, rearing history and AL are significantly associated when age and sex are entered as covariates. Wild-caught gorillas have significantly higher AL than mother-reared gorillas. Neither wild-caught nor mother-reared gorillas are significantly different from nursery-reared gorillas. When examined by sex, males of all rearing histories have significantly lower AL than females. We suggest males face few stressors in human care and ill effects of rearing history do not follow. Wild-caught females have significantly higher AL than mother-reared females, but neither is significantly different from nursery-reared females. Combined with our previous work on AL in this group, wherein females had twofold higher AL than males, we suggest females in human care face more stressors than males. Disrupted rearing history may exacerbate effects of these stressors. Providing opportunities for females to choose their distance from males may help reduce their AL. Zoo Biol. 35:167-173, 2016. © 2016 Wiley Periodicals, Inc. PMID:26881840

  15. Perceptions and utilization of primary health care services in Iraq: findings from a national household survey

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    Burnham Gilbert

    2011-12-01

    Full Text Available Abstract Background After many years of sanctions and conflict, Iraq is rebuilding its health system, with a strong emphasis on the traditional hospital-based services. A network exists of public sector hospitals and clinics, as well as private clinics and a few private hospitals. Little data are available about the approximately 1400 Primary Health Care clinics (PHCCs staffed with doctors. How do Iraqis utilize primary health care services? What are their preferences and perceptions of public primary health care clinics and private primary care services in general? How does household wealth affect choice of services? Methods A 1256 household national survey was conducted in the catchment areas of randomly selected PHCCs in Iraq. A cluster of 10 households, beginning with a randomly selected start household, were interviewed in the service areas of seven public sector PHCC facilities in each of 17 of Iraq's 18 governorates. A questionnaire was developed using key informants. Teams of interviewers, including both males and females, were recruited and provided a week of training which included field practice. Teams then gathered data from households in the service areas of randomly selected clinics. Results Iraqi participants are generally satisfied with the quality of primary care services available both in the public and private sector. Private clinics are generally the most popular source of primary care, however the PHCCs are utilized more by poorer households. In spite of free services available at PHCCs many households expressed difficulty in affording health care, especially in the purchase of medications. There is no evidence of informal payments to secure health services in the public sector. Conclusions There is widespread satisfaction reported with primary health care services, and levels did not differ appreciably between public and private sectors. The public sector PHCCs are preferentially used by poorer populations where they are

  16. Public and private health care utilization differences between socioeconomic strata in Jamaica

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    Paul A Bourne

    2010-09-01

    Full Text Available Paul A Bourne1, Denise Eldemire-Shearer1, Tomlin J Paul1, Janet LaGrenade1, Christopher AD Charles21Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica; 2King Graduate School, Monroe College, New York and Center for Victim Support, Harlem Hospital Center, New York, NY, USAObjective: To assess trends in the use of private and public health care services among Jamaicans over a 15-year period (1991–2007.Design and methods: Statistics on the use of health care services were taken from the Jamaica Survey of Living Conditions (JSLC for the 15-year period 1993 to 2007. Use of hospital services were represented in income quintiles and compared for private and public facilities. The difference in percentage use between public and private was compared by quintiles over the period and the variability in those differentials assessed.Results: This study highlights the increasing use of private services by increasing wealth, exaggerated for the wealthiest quintile. There is a widening of the differences in utilization between public and private centers as income level increases (P < 0.001.Conclusions: Internal and external economic conditions influence the use of private and public health care services in Jamaica. Although the relative increase in the cost (to the user of public health care is more than that for private health care, the actual cost to use the public health care system is still significantly cheaper than using the private system. Lower income health care users tend to take the lesser cost option.Keywords: health care utilization, public–private health differentials

  17. Utilization of preventive care services and their effect on cardiovascular outcomes in the United States

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    Varun Vaidya

    2011-01-01

    Full Text Available Varun Vaidya, Gautam Partha, Jennifer HowePharmacy Health Care Administration, Department of Pharmacy Practice, University of Toledo College of Pharmacy, Toledo, OH, USAObjective: To describe and analyze utilization of preventive care services and their effect on cardiovascular outcomes in the United States.Methods: Data from the 2007 Medical Expenditure Panel Survey (MEPS were used to analyze utilization of preventive care services and their effect on cardiovascular outcomes. Recommendations by the Seventh Report of the Joint Committee on Prevention, Detection, Evaluation and Treatment of High Blood Pressure and the National Cholesterol Education Program were used to determine appropriate levels of preventive care utilization. Utilization of blood pressure screening and cholesterol checkup services were used as the dependent variable, while age, gender, race, ethnicity, insurance status, and perceived health status were used as independent variables. Since guidelines differ for people with elevated blood pressure, respondents with elevated blood pressure were identified in the MEPS database by self-reported diagnosis. Descriptive statistics were used to describe the population, while a multivariate logistic regression model was built to predict odds of utilizing appropriate levels of preventive services.Results: Total number of adult respondents for which data were available for blood pressure checkup and cholesterol checkup was 20,523 and 15,784, respectively. Overall, MEPS respondents were found to adhere to guideline recommendations for preventive care utilization. Multivariate logistic regression showed that odds of utilization of preventive care services were higher for elderly patients (age >65 years for blood pressure (odds ratio [OR] = 2.39, 95% confidence interval [CI]: 1.92–2.97 and cholesterol (OR = 3.05, 95% CI: 2.18–4.27 preventive services compared with younger population (age 18–54 years. Males had much lower odds of

  18. Chronic pain disorders in HIV primary care: clinical characteristics and association with healthcare utilization.

    Science.gov (United States)

    Jiao, Jocelyn M; So, Eric; Jebakumar, Jebakaran; George, Mary Catherine; Simpson, David M; Robinson-Papp, Jessica

    2016-04-01

    Chronic pain is common in HIV, but incompletely characterized, including its underlying etiologies, its effect on healthcare utilization, and the characteristics of affected patients in the HIV primary care setting. These data are needed to design and justify appropriate clinic-based pain management services. Using a clinical data warehouse, we analyzed one year of data from 638 patients receiving standard-of-care antiretroviral therapy in a large primary care HIV clinic, located in the Harlem neighborhood of New York City. We found that 40% of patients carried one or more chronic pain diagnoses. The most common diagnoses were degenerative musculoskeletal disorders (eg, degenerative spinal disease and osteoarthritis), followed by neuropathic pain and headache disorders. Many patients (16%) had multiple chronic pain diagnoses. Women, older patients, and patients with greater burdens of medical illness, and psychiatric and substance use comorbidities were disproportionately represented among those with chronic pain diagnoses. Controlling for overall health status, HIV patients with chronic pain had greater healthcare utilization including emergency department visits and radiology procedures. In summary, our study demonstrates the high prevalence of chronic pain disorders in the primary care HIV clinic. Colocated interventions for chronic pain in this setting should not only focus on musculoskeletal pain but also account for complex multifaceted pain syndromes, and address the unique biopsychosocial features of this population. Furthermore, because chronic pain is prevalent in HIV and associated with increased healthcare utilization, developing clinic-based pain management programs could be cost-effective.

  19. Pathologists' roles in clinical utilization management. A financing model for managed care.

    Science.gov (United States)

    Zhao, J J; Liberman, A

    2000-03-01

    In ancillary or laboratory utilization management, the roles of pathologists have not been explored fully in managed care systems. Two possible reasons may account for this: pathologists' potential contributions have not been defined clearly, and effective measurement of and reasonable compensation for the pathologist's contribution remains vague. The responsibilities of pathologists in clinical practice may include clinical pathology and laboratory services (which have long been well-defined and are compensated according to a resource-based relative value system-based coding system), laboratory administration, clinical utilization management, and clinical research. Although laboratory administration services have been compensated with mechanisms such as percentage of total service revenue or fixed salary, the involvement of pathologists seems less today than in the past, owing to increased clinical workload and time constraints in an expanding managed care environment, especially in community hospital settings. The lack of financial incentives or appropriate compensation mechanisms for the services likely accounts for the current situation. Furthermore, the importance of pathologist-driven utilization management in laboratory services lacks recognition among hospital administrators, managed care executives, and pathologists themselves, despite its potential benefits for reducing cost and enhancing quality of care. We propose a financial compensation model for such services and summarize its advantages.

  20. Status of Equities in Prenatal Care Utilization and Changing Patterns among Women in China

    Institute of Scientific and Technical Information of China (English)

    Ying-hui LIU; Rong-wei YE; Jian-meng LIU; Ai-guo REN; Song LI; Zhu LI

    2006-01-01

    Objective To assess the extent and relative changes of the equities in prenatal care utilization among women with different educational attainment in some areas of China.Methods Data were collected in 13 counties/cities covered by Perinatal Health Care Surveillance System established by Institute of Reproductive and Child Health, Peking University. The study population consisted of 103 704 women who delivered single live births in 1994 and 2000. Chi-square and multiple Logistic regression were employed to compare the administrative rates and relative risks. Concentration index was used to assess the relative changes of equities in prenatal care utilization. SPSS 11.5 and Microsoft Excel 2003 were used for analysis.Results The total systematic management rate was 22.1% in 1994 and 57.4% in 2000.The concentration index was -0.046 in 1994 and 0.066 in 2000. In northern areas,the concentration index increased from 0.015 in 1994 to 0.295 in 2000, while it increased from -0.015 in 1994 to 0.062 in 2000 in southern areas. In rural areas, the concentration index increased from 0.002 in 1994 to 0.026 in 2000, while it decreased from 0.042 in 1994 to 0.019 in 2000 in urban areas.Conclusion Inequities in prenatal care utilization in 2000 become more obvious than in 1994, especially in northern areas. More attention should be paid to solve the inequities.

  1. Women's Satisfaction of Maternity Care in Nepal and Its Correlation with Intended Future Utilization

    Science.gov (United States)

    Paudel, Yuba Raj; Mehata, Suresh; Paudel, Deepak; Dariang, Maureen; Aryal, Krishna Kumar; Poudel, Pradeep; King, Stuart; Barnett, Sarah

    2015-01-01

    The impact of rapid increase in institutional birth rate in Nepal on women's satisfaction and planned future utilization of services is less well known. This study aimed to measure women's satisfaction with maternity care and its correlation with intended future utilisation. Data came from a nationally representative facility-based survey conducted across 13 districts in Nepal and included client exit interviews with 447 women who had either recently delivered or had experienced complications. An eight-item quality of care instrument was used to measure client satisfaction. Multivariate probit model was used to assess the attribution of different elements of client satisfaction with intended future utilization of services. Respondents were most likely to suggest maintaining clean/hygienic health facilities (42%), increased bed provision (26%), free services (24%), more helpful behaviour by health workers (18%), and better privacy (9%). Satisfaction with the information received showed a strong correlation with the politeness of staff, involvement in decision making, and overall satisfaction with the care received. Satisfaction with waiting time (p = 0.035), information received (p = 0.02), and overall care in the maternity care (<0.001) showed strong associations with willingness to return to facility. The findings suggest improving physical environment and interpersonal communication skills of service providers and reducing waiting time for improving client satisfaction and intention to return to the health facility. PMID:26640814

  2. Women’s Satisfaction of Maternity Care in Nepal and Its Correlation with Intended Future Utilization

    Directory of Open Access Journals (Sweden)

    Yuba Raj Paudel

    2015-01-01

    Full Text Available The impact of rapid increase in institutional birth rate in Nepal on women’s satisfaction and planned future utilization of services is less well known. This study aimed to measure women’s satisfaction with maternity care and its correlation with intended future utilisation. Data came from a nationally representative facility-based survey conducted across 13 districts in Nepal and included client exit interviews with 447 women who had either recently delivered or had experienced complications. An eight-item quality of care instrument was used to measure client satisfaction. Multivariate probit model was used to assess the attribution of different elements of client satisfaction with intended future utilization of services. Respondents were most likely to suggest maintaining clean/hygienic health facilities (42%, increased bed provision (26%, free services (24%, more helpful behaviour by health workers (18%, and better privacy (9%. Satisfaction with the information received showed a strong correlation with the politeness of staff, involvement in decision making, and overall satisfaction with the care received. Satisfaction with waiting time (p = 0.035, information received (p = 0.02, and overall care in the maternity care (<0.001 showed strong associations with willingness to return to facility. The findings suggest improving physical environment and interpersonal communication skills of service providers and reducing waiting time for improving client satisfaction and intention to return to the health facility.

  3. Women's Satisfaction of Maternity Care in Nepal and Its Correlation with Intended Future Utilization.

    Science.gov (United States)

    Paudel, Yuba Raj; Mehata, Suresh; Paudel, Deepak; Dariang, Maureen; Aryal, Krishna Kumar; Poudel, Pradeep; King, Stuart; Barnett, Sarah

    2015-01-01

    The impact of rapid increase in institutional birth rate in Nepal on women's satisfaction and planned future utilization of services is less well known. This study aimed to measure women's satisfaction with maternity care and its correlation with intended future utilisation. Data came from a nationally representative facility-based survey conducted across 13 districts in Nepal and included client exit interviews with 447 women who had either recently delivered or had experienced complications. An eight-item quality of care instrument was used to measure client satisfaction. Multivariate probit model was used to assess the attribution of different elements of client satisfaction with intended future utilization of services. Respondents were most likely to suggest maintaining clean/hygienic health facilities (42%), increased bed provision (26%), free services (24%), more helpful behaviour by health workers (18%), and better privacy (9%). Satisfaction with the information received showed a strong correlation with the politeness of staff, involvement in decision making, and overall satisfaction with the care received. Satisfaction with waiting time (p = 0.035), information received (p = 0.02), and overall care in the maternity care (health facility. PMID:26640814

  4. Psychological Distress, Service Utilization, and Prescribed Medications among Youth with and without Histories of Involvement with Child Protective Services

    Science.gov (United States)

    Hamilton, Hayley A.; Paglia-Boak, Angela; Wekerle, Christine; Danielson, Anna Marie; Mann, Robert E.

    2011-01-01

    The objective of this study was to examine differences in psychological distress, service utilization, and prescriptions for medications between adolescents with histories of family involvement with child protective services (CPS) and adolescents without such involvement. Data on 3,497 students were obtained from the 2009 cycle of the Ontario…

  5. The Patient Protection and Affordable Care Act and Utilization of Preventive Health Care Services

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    Victor Eno

    2016-02-01

    Full Text Available We examined how (a health insurance coverage, and (b familiarity with the Patient Protection and Affordable Care Act (ACA’s or ObamaCare mandate of cost-free access to preventive health services, affect the use of preventive services by residents of a minority community. It was based on primary data collected from a survey conducted during March to April 2012 among a sample of self-identified African American adults in Tallahassee-Leon County area of northwest Florida. The Statistical Package for the Social Sciences (SPSS Version 22 was used for running frequency analysis on the data set and multivariable regression modeling. The results showed that of 524 respondents, 382 (73% had health insurance while 142 (27% lacked insurance. Majority of insured respondents, 332 (87%, used preventive health services. However, the remaining 13% of respondents did not use preventive services because they were unfamiliar with the ACA provision of free access to preventive services for insured people. Regression analysis showed a high (91.04% probability that, among the insured, the use of preventive health services depended on the person’s age, income, and education. For uninsured residents, the lack of health insurance was the key reason for non-use of preventive health services, while among the insured, lack of knowledge about the ACA benefit of free access contributed to non-use of preventive services. Expansion of Medicaid eligibility can increase insurance coverage rates among African Americans and other minority populations. Health promotion and awareness campaigns about the law’s benefits by local and state health departments can enhance the use of preventive services.

  6. 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.

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    Christine Ritchie

    Full Text Available 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.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.152 high-risk patients (≥5 ED visits or ≥2 hospitalizations in the past 12 months enrolled from four medical clinics from 4/29/2013 to 5/31/2014.Patients received a comprehensive in-home assessment by a nurse practitioner/social worker (NP/SW team, who then met with a larger interdisciplinary team to develop an individualized care plan. In consultation with the primary care team, standardized care protocols were activated to address relevant key issues as needed.A process evaluation based on the Consolidated Framework for Implementation Research identified key adaptations of the original model, which included streamlining of standardized protocols, augmenting mental health interventions and performing some assessments in the clinic. A summative evaluation found a significant decline in the median number of ED visits (5.5 to 0, p = 0.015 and hospitalizations (5.5 to 0, p<0.001 6 months before enrollment in Care Support compared to 6 months after enrollment. In addition, the percent of patients reporting better self-rated health increased from 31% at enrollment to 64% at 9 months (p = 0.002. Semi-structured interviews with Care Support team members identified patients with multiple, complex conditions; little community support; and mild anxiety as those who appeared to benefit the most from the program.It was feasible to implement GRACE/Care Support at an academic medical center by making adaptations based on local needs. Care Support patients experienced significant reductions in acute care utilization and significant improvements

  7. Short-run Effects of Job Loss on Health Conditions, Health Insurance, and Health Care Utilization

    OpenAIRE

    Jessamyn Schaller; Ann Huff Stevens

    2014-01-01

    Job loss in the United States is associated with long-term reductions in income and long-term increases in mortality rates. This paper examines the short- to medium-term changes in health, health care access, and health care utilization after job loss that lead to these long-term effects. Using a sample with more than 9800 individual job losses and longitudinal data on a wide variety of health-related measures and outcomes, we show that job loss results in worse self-reported health, includin...

  8. Assessing the context of health care utilization in Ecuador: A spatial and multilevel analysis

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    Chi Chunhuei

    2010-03-01

    Full Text Available Abstract Background There are few studies that have analyzed the context of health care utilization, particularly in Latin America. This study examines the context of utilization of health services in Ecuador; focusing on the relationship between provision of services and use of both preventive and curative services. Methods This study is cross-sectional and analyzes data from the 2004 National Demographic and Maternal & Child Health dataset. Provider variables come from the Ecuadorian System of Social Indicators (SIISE. Global Moran's I statistic is used to assess spatial autocorrelation of the provider variables. Multilevel modeling is used for the simultaneous analysis of provision of services at the province-level with use of services at the individual level. Results Spatial analysis indicates no significant differences in the density of health care providers among Ecuadorian provinces. After adjusting for various predisposing, enabling, need factors and interaction terms, density of public practice health personnel was positively associated with use of preventive care, particularly among rural households. On the other hand, density of private practice physicians was positively associated with use of curative care, particularly among urban households. Conclusions There are significant public/private, urban/rural gaps in provision of services in Ecuador; which in turn affect people's use of services. It is necessary to strengthen the public health care delivery system (which includes addressing distribution of health workers and national health information systems. These efforts could improve access to health care, and inform the civil society and policymakers on the advances of health care reform.

  9. Determinants of maternity care services utilization among married adolescents in rural India.

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    Prashant Kumar Singh

    Full Text Available BACKGROUND: Coupled with the largest number of maternal deaths, adolescent pregnancy in India has received paramount importance due to early age at marriage and low contraceptive use. The factors associated with the utilization of maternal healthcare services among married adolescents in rural India are poorly discussed. METHODOLOGY/PRINCIPAL FINDINGS: Using the data from third wave of National Family Health Survey (2005-06, available in public domain for the use by researchers, this paper examines the factors associated with the utilization of maternal healthcare services among married adolescent women (aged 15-19 years in rural India. Three components of maternal healthcare service utilization were measured: full antenatal care, safe delivery, and postnatal care within 42 days of delivery for the women who gave births in the last five years preceding the survey. Considering the framework on causes of maternal mortality proposed by Thaddeus and Maine (1994, selected socioeconomic, demographic, and cultural factors influencing outcome events were included as the predictor variables. Bi-variate analyses including chi-square test to determine the difference in proportion, and logistic regression to understand the net effect of predictor variables on selected outcomes were applied. Findings indicate the significant differences in the use of selected maternal healthcare utilization by educational attainment, economic status and region of residence. Muslim women, and women belonged to Scheduled Castes, Scheduled Tribes, and Other Backward Classes are less likely to avail safe delivery services. Additionally, adolescent women from the southern region utilizing the highest maternal healthcare services than the other regions. CONCLUSIONS: The present study documents several socioeconomic and cultural factors affecting the utilization of maternal healthcare services among rural adolescent women in India. The ongoing healthcare programs should start

  10. Utilization of the organ care system as ex-vivo lung perfusion after cold storage transportation.

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    Mohite, P N; Maunz, O; Popov, A-F; Zych, B; Patil, N P; Simon, A R

    2015-11-01

    The Organ Care System (OCS) allows perfusion and ventilation of the donor lungs under physiological conditions. Ongoing trials to compare preservation with OCS Lung with standard cold storage do not include donor lungs with suboptimal gas exchange and donor lungs treated with OCS following cold storage transportation. We present a case of a 48-yr-old man who received such lungs after cold storage transportation treated with ex-vivo lung perfusion utilizing OCS.

  11. The Role of Demand Factors in Utilization of Professional Care during Childbirth: Perspectives from Yemen

    OpenAIRE

    Töres Theorell; Annica Kempe; Fatoom Noor-Aldin Alwazer

    2011-01-01

    Background. Utilization of professional care during childbirth by women in low-income countries is important for the progress towards MDG 5. In Yemen, home births have decreased minimally during the past decades. Objective. The study investigates the influence of socio-demographic, birth outcome and demand factors on women's future preference of a home or institutional childbirth. Method. We interviewed 220 women with childbirth experience in urban/rural Yemen. We performed bivariate chi-squa...

  12. Propensity score methodology for confounding control in health care utilization databases

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    Elisabetta Patorno

    2013-06-01

    Full Text Available Propensity score (PS methodology is a common approach to control for confounding in nonexperimental studies of treatment effects using health care utilization databases. This methodology offers researchers many advantages compared with conventional multivariate models: it directly focuses on the determinants of treatment choice, facilitating the understanding of the clinical decision-making process by the researcher; it allows for graphical comparisons of the distribution of propensity scores and truncation of subjects without overlapping PS indicating a lack of equipoise; it allows transparent assessment of the confounder balance achieved by the PS at baseline; and it offers a straightforward approach to reduce the dimensionality of sometimes large arrays of potential confounders in utilization databases, directly addressing the “curse of dimensionality” in the context of rare events. This article provides an overview of the use of propensity score methodology for pharmacoepidemiologic research with large health care utilization databases, covering recent discussions on covariate selection, the role of automated techniques for addressing unmeasurable confounding via proxies, strategies to maximize clinical equipoise at baseline, and the potential of machine-learning algorithms for optimized propensity score estimation. The appendix discusses the available software packages for PS methodology. Propensity scores are a frequently used and versatile tool for transparent and comprehensive adjustment of confounding in pharmacoepidemiology with large health care databases.

  13. Explaining health care utilization for panic attacks using cusp catastrophe modeling.

    Science.gov (United States)

    Katerndahl, David

    2008-10-01

    Despite increased health care utilization, patients with panic disorder continue to report unmet needs. The objective was to compare the fit of linear and Cusp Catastrophe Modeling in explaining changes in utilization of emergency, general and mental health settings, and self-treatments for panic symptoms. This community-based study surveyed 97 subjects with panic attacks drawn from a sample of randomly-selected adults from randomly-selected households. The stressor (splitting) variable used was Phobic Anxiety while predisposing variables included Family Health Care Utilization, Perceived Life Threat and Need For Treatment, and Treatment Experience. Outcomes consisted of the number of sites and self-treatments used for panic symptoms when first seeking care and during the 2 months prior to survey. Use of mental health sites and self-treatments demonstrated superior modeling with cusp catastrophe approaches using treatment experience as the predisposing variable, accounting for 47% and 38% of variances respectively, improving the fit by over 20% compared to the best linear models in both cases. Cusp catastrophe modeling accounted for more variance than all linear models when describing use of mental health settings and self-treatments. Cusp catastrophe may explain bimodal distributions in behavior, delays in behavior change, and sudden shifts in behavior in stressful situations. PMID:18765074

  14. Does distrust in providers affect health-care utilization in China?

    Science.gov (United States)

    Duckett, Jane; Hunt, Kate; Munro, Neil; Sutton, Matt

    2016-01-01

    How trust affects health-care utilization is not well-understood, especially in low- and middle-income countries. This article focuses on China, a middle-income country where low trust in health-care settings has become a prominent issue, but actual levels of distrust and their implications for utilization are unknown. We conducted a nationally representative survey of the Chinese population (November 2012 to January 2013), which resulted in a sample of 3680 adult men and women. Respondents rated their trust in different types of health-care providers. Using multivariate logistic and negative binomial regression models, we estimated the association between distrust in clinics and respondents’ hospital visits in the last year; whether they had sought hospital treatment first for two common symptoms (headache, cold) in the last 2 months; and whether they said they would go first to a hospital if they had a minor or major illness. We analysed these associations before and after adjusting for performance evaluations of clinics and hospitals, controlling for sex, age, education, income, insurance status, household registration and self-assessed health. We found that distrust in hospitals is low, but distrust in clinics is high and strongly associated with increased hospital utilization, especially for minor symptoms and illnesses. Further research is needed to understand the reasons for distrust in clinics because its effects are not fully accounted for by poor evaluations of their competence. PMID:27117483

  15. Financial Incentives, Workplace Wellness Program Participation, and Utilization of Health Care Services and Spending.

    Science.gov (United States)

    Fronstin, Paul; Roebuck, M Christopher

    2015-08-01

    This paper analyzes data from a large employer that enhanced financial incentives to encourage participation in its workplace wellness programs. It examines, first, the effect of financial incentives on wellness program participation, and second, it estimates the impact of wellness program participation on utilization of health care services and spending. The Patient Protection and Affordable Care Act of 2010 (PPACA) allows employers to provide financial incentives of as much as 30 percent of the total cost of coverage when tied to participation in a wellness program. Participation in health risk assessments (HRAs) increased by 50 percentage points among members of unions that bargained in the incentive, and increased 22 percentage points among non-union employees. Participation in the biometric screening program increased 55 percentage points when financial incentives were provided. Biometric screenings led to an average increase of 0.31 annual prescription drug fills, with related spending higher by $56 per member per year. Otherwise, no significant effects of participation in HRAs or biometric screenings on utilization of health care services and spending were found. The largest increase in medication utilization as a result of biometric screening was for statins, which are widely used to treat high cholesterol. This therapeutic class accounted for one-sixth of the overall increase in prescription drug utilization. Second were antidepressants, followed by ACE inhibitors (for hypertension), and thyroid hormones (for hypothyroidism). Biometric screening also led to significantly higher utilization of biologic response modifiers and immunosuppressants. These specialty medications are used to treat autoimmune diseases, such as rheumatoid arthritis and multiple sclerosis, and are relatively expensive compared with non-specialty medications. The added spending associated with the combined increase in fills of 0.02 was $27 per member per year--about one-half of the

  16. A study on coverage utilization and quality of maternal care services

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    Neeraj Agarwal, Abhiruchi Galhotra, H M Swami

    2011-01-01

    Full Text Available The objectives of the study were yo assess the utilization of various maternal services and to compare the quality of services provided by doctors and health workers in terms of components and advice received by pregnant women during antenatal period. It was a Cross-sectional Study conducted in a village on the border of Chandigarh (U.T. and Mohali (Punjab. All the women who had delivered in the past three years in the village Palsora were included in the study. 92.4% of the pregnancies were registered, 53.2% of which received antenatal care by a Doctor and 46.8% by a health worker. The measuring of blood pressure was significantly higher by the doctor than the health workers who recorded weight more significantly. The advice provided by doctors was significantly higher than health workers regarding diet, danger signs, newborn care, family planning and natal care.

  17. Differences in health care utilization between parents who perceive their child as vulnerable versus overprotective parents.

    Science.gov (United States)

    Thomasgard, M; Metz, W P

    1996-06-01

    While a parental perception of child vulnerability to illness/injury is often used interchangeably with parental overprotection, research suggests that they are independent constructs. We hypothesized more frequent pediatric nonwell-child visits for perceived child vulnerability, but not for parental overprotection. The parents of 300 children, ages 2-5 years, enrolled in a health maintenance organization, were sampled. For children without medical conditions, there were no differences in nonwell-child care visits between the high perceived vulnerability and high parental protection groups (Wilcoxon Rank Sum Test, WRST, P = .31). As expected, high parental protection was not significantly associated with increased nonwell-child care visits compared with the low parental protection group (WRST, P = .14). These findings suggest that markers other than health care utilization are required to identify these forms of parent-child relationship disorders. PMID:8782954

  18. EXPLAINING THE GAP IN ANTENATAL CARE SERVICE UTILIZATION BETWEEN YOUNGER AND OLDER MOTHERS IN GHANA.

    Science.gov (United States)

    Boamah, Sheila A; Amoyaw, Jonathan; Luginaah, Isaac

    2016-05-01

    Over two-thirds of pregnant women (69%) have at least one antenatal care (ANC) coverage contact in sub-Saharan Africa. However, to achieve the full life-saving potential that ANC promises for women and babies, a nuanced understanding of age-specific gaps in utilization of ANC services is required. Using the 2008 Ghana Demographic and Health Survey of 1456 individuals, this study examined the disparities in the use of ANC services between younger and older mothers by applying four counterfactual decomposition techniques. The results show that cross-group differences in the explanatory variables largely account for the differentials in ANC service utilization between younger and older mothers. Birth order (parity) accounts for the largest share of the contribution to the overall explained gap in ANC utilization between the younger and older mothers, suggesting that ANC differentials between the two groups are probably due to biosocial factors. To a lesser extent, wealth status of the two groups also contributes to the overall explained gap in ANC service utilization. The policy implications of these findings are that in order to bridge the ANC service utilization gap between the two groups, policymakers must systematically address gaps in cross-group differences in the explanatory variables in order to increase the utilization of ANC to attain the minimum recommendation of four visits as per World Health Organization guidelines. PMID:26160032

  19. Lean Six Sigma in Health Care: Improving Utilization and Reducing Waste.

    Science.gov (United States)

    Almorsy, Lamia; Khalifa, Mohamed

    2016-01-01

    Healthcare costs have been increasing worldwide mainly due to over utilization of resources. The savings potentially achievable from systematic, comprehensive, and cooperative reduction in waste are far higher than from more direct and blunter cuts in care and coverage. At King Faisal Specialist Hospital and Research Center inappropriate and over utilization of the glucose test strips used for whole blood glucose determination using glucometers was observed. The hospital implemented a project to improve its utilization. Using the Six Sigma DMAIC approach (Define, Measure, Analyze, Improve and Control), an efficient practice was put in place including updating the related internal policies and procedures and the proper implementation of an effective users' training and competency check off program. That resulted in decreasing the unnecessary Quality Control (QC) runs from 13% to 4%, decreasing the failed QC runs from 14% to 7%, lowering the QC to patient testing ratio from 24/76 to 19/81.

  20. Lean Six Sigma in Health Care: Improving Utilization and Reducing Waste.

    Science.gov (United States)

    Almorsy, Lamia; Khalifa, Mohamed

    2016-01-01

    Healthcare costs have been increasing worldwide mainly due to over utilization of resources. The savings potentially achievable from systematic, comprehensive, and cooperative reduction in waste are far higher than from more direct and blunter cuts in care and coverage. At King Faisal Specialist Hospital and Research Center inappropriate and over utilization of the glucose test strips used for whole blood glucose determination using glucometers was observed. The hospital implemented a project to improve its utilization. Using the Six Sigma DMAIC approach (Define, Measure, Analyze, Improve and Control), an efficient practice was put in place including updating the related internal policies and procedures and the proper implementation of an effective users' training and competency check off program. That resulted in decreasing the unnecessary Quality Control (QC) runs from 13% to 4%, decreasing the failed QC runs from 14% to 7%, lowering the QC to patient testing ratio from 24/76 to 19/81. PMID:27350502

  1. A Review of the Construct of Demoralization: History, Definitions, and Future Directions for Palliative Care.

    Science.gov (United States)

    Robinson, Sophie; Kissane, David W; Brooker, Joanne; Burney, Susan

    2016-02-01

    Demoralization has been the subject of discussion in relation to end-of-life care. It is characterized by hopelessness and helplessness due to a loss of purpose and meaning. The purpose of this review was to consolidate the conceptual understanding of demoralization and argue for its existence as a psychiatric syndrome. The history of the construct is explored, including the nature of existential distress and related psychological conditions that precipitate demoralization. Recent definitions of demoralization are described and differentiated from similar constructs. Future directions are highlighted, specifically in relation to the assessment, diagnosis, and treatment of demoralization in palliative care. Overall, demoralization is a clinically useful construct for those facing existential threat, guiding the clinician toward efforts to restore morale, meaning, and purpose.

  2. Regulatory Skill as a Resilience Factor for Adults With a History of Foster Care: A Pilot Study

    OpenAIRE

    Johnson, Angela J; Tottenham, Nim

    2014-01-01

    Individuals with a history of foster care (FC) are at elevated risk for emotion regulation-related mental illness. The purpose of the current study was to characterize regulatory function in a group of adults with a history of FC (N = 26) relative to those without a history of FC (N = 27) and how regulatory function moderates adverse caregiving-related outcomes (daily cortisol production and trait anxiety). Self-report items (anxiety, emotion regulation strategies, inhibitory control, caregiv...

  3. Development and perceived utility and impact of a skin care Internet intervention

    Directory of Open Access Journals (Sweden)

    Michelle Hilgart

    2014-07-01

    Full Text Available Pressure ulcers (PrUs in people with spinal cord injury (SCI are a common, mostly preventable, skin complication with serious health consequences. This paper presents the development, theoretical bases, and perceived usefulness and effectiveness data for iSHIFTup.org, a skin care Internet intervention to prevent pressure ulcers in adults with SCI. Participants (n = 7 were, on average, 36 years old (SD = 10.09, tetraplegic (71%, paraplegic (29%, and caucasian (86%, with an average time since injury of 10.43 years (SD = 9.64 years. During the six weeks of program access, participants' usage of the program was tracked and analyzed. Participants subsequently completed measures focused on usability, likeability, and usefulness (the Internet Evaluation and Utility Questionnaire; IEUQ, and on their perceptions of the impact of the program on targeted behaviors (using the Internet Impact and Effectiveness Questionnaire; IIEQ. Participants generally reported positive experiences using iSHIFTup, indicating it to be useful, effective, easy to use, and understandable. All participants reported that iSHIFTup helped them to manage their skin care, improved their skin care routine, and supported healthy skin care activities. A majority of users indicated that they were able to implement program recommendations, and all users believed the Internet was a good method for delivering pressure ulcer prevention programs. This is the first paper to focus on a skin care Internet intervention for adults with SCI.

  4. Geographical, Ethnic and Socio-Economic Differences in Utilization of Obstetric Care in the Netherlands.

    Directory of Open Access Journals (Sweden)

    Anke G Posthumus

    Full Text Available All women in the Netherlands should have equal access to obstetric care. However, utilization of care is shaped by demand and supply factors. Demand is increased in high risk groups (non-Western women, low socio-economic status (SES, and supply is influenced by availability of hospital facilities (hospital density. To explore the dynamics of obstetric care utilization we investigated the joint association of hospital density and individual characteristics with prototype obstetric interventions.A logistic multi-level model was fitted on retrospective data from the Netherlands Perinatal Registry (years 2000-2008, 1.532.441 singleton pregnancies. In this analysis, the first level comprised individual maternal characteristics, the second of neighbourhood SES and hospital density. The four outcome variables were: referral during pregnancy, elective caesarean section (term and post-term breech pregnancies, induction of labour (term and post-term pregnancies, and birth setting in assumed low-risk pregnancies.Higher hospital density is not associated with more obstetric interventions. Adjusted for maternal characteristics and hospital density, living in low SES neighbourhoods, and non-Western ethnicity were generally associated with a lower probability of interventions. For example, non-Western women had considerably lower odds for induction of labour in all geographical areas, with strongest effects in the more rural areas (non-Western women: OR 0.78, 95% CI 0.77-0.80, p<0.001.Our results suggest inequalities in obstetric care utilization in the Netherlands, and more specifically a relative underservice to the deprived, independent of level of supply.

  5. The history and global market of oral home-care products.

    Science.gov (United States)

    Jardim, Juliana Jobim; Alves, Luana Severo; Maltz, Marisa

    2009-01-01

    This literature review reports the history and the current market of oral home-care products. It provides information extending from the products used by our ancestors to those currently available, as well as on the changes in the supply and consumption of these products. Although the scientific knowledge about oral diseases has improved greatly in recent years, our ancestors had already been concerned with cleaning their teeth. A variety of rudimentary products and devices were used since before recorded history, like chewing sticks, tree twigs, bird feathers, animal bones, tooth powder and home-made mouth rinses. Today, due to technological improvements of the cosmetic industry and market competition, home-use oral care products available in the marketplace offer a great variety of options. An increase in the consumption of oral care products has been observed in the last decades. Estimates show that Latin America observed a 12% increase in hygiene and beauty products sales between 2002 and 2003, whereas the observed global rate was approximately 2%. A significant increase in the per capita consumption of toothpaste, toothbrush, mouthrinse and dental floss has been estimated from 1992 to 2002, respectively at rates of 38.3%, 138.3%, 618.8% and 177.2%. Pertaining to this increased supply and consumption of oral care products, some related questions remain unanswered, like the occurrence of changes in disease behavior due to the use of new compounds, their actual efficacy and correct indications, and the extent of the benefits to oral health derived from consuming more products. PMID:19838554

  6. The history and global market of oral home-care products

    Directory of Open Access Journals (Sweden)

    Juliana Jobim Jardim

    2009-06-01

    Full Text Available This literature review reports the history and the current market of oral home-care products. It provides information extending from the products used by our ancestors to those currently available, as well as on the changes in the supply and consumption of these products. Although the scientific knowledge about oral diseases has improved greatly in recent years, our ancestors had already been concerned with cleaning their teeth. A variety of rudimentary products and devices were used since before recorded history, like chewing sticks, tree twigs, bird feathers, animal bones, tooth powder and home-made mouth rinses. Today, due to technological improvements of the cosmetic industry and market competition, home-use oral care products available in the marketplace offer a great variety of options. An increase in the consumption of oral care products has been observed in the last decades. Estimates show that Latin America observed a 12% increase in hygiene and beauty products sales between 2002 and 2003, whereas the observed global rate was approximately 2%. A significant increase in the per capita consumption of toothpaste, toothbrush, mouthrinse and dental floss has been estimated from 1992 to 2002, respectively at rates of 38.3%, 138.3%, 618.8% and 177.2%. Pertaining to this increased supply and consumption of oral care products, some related questions remain unanswered, like the occurrence of changes in disease behavior due to the use of new compounds, their actual efficacy and correct indications, and the extent of the benefits to oral health derived from consuming more products.

  7. Documenting nursing and health care history in the mid-Atlantic region.

    Science.gov (United States)

    Weinberg, D M

    1993-01-01

    The records of health care institutions can be of great value to library patrons. Yet, librarians rarely provide these unique resources because records must be collected, arranged, and described before they can be useful to patrons. The University of Pennsylvania's Center for the Study of the History of Nursing conducted a survey of health care agencies in the mid-Atlantic region to locate records created by area health care institutions. The goals of this project were to develop a database of primary source materials, to place organizational records with enduring value at suitable repositories, and to assist in the development of in-house archival programs at agencies keeping records. In-house programs provide health care institutions with a systematic way to preserve their records for administrative, legal, fiscal, and research use. Such programs also facilitate access to information, reduce cost through records management, and promote an institution through preservation and use of its historical records. The survey demonstrated that record keeping is not coordinated in most institutions, and that institutional awareness of the organization or content of records is minimal.

  8. Day care attendance in early life, maternal history of asthma, and asthma at the age of 6 years

    NARCIS (Netherlands)

    Celedon, JC; Wright, RJ; Litonjua, AA; Sredl, D; Ryan, L; Weiss, ST; Gold, DR

    2003-01-01

    Among children not selected on the basis of a parental history of atopy, day care attendance in early life is inversely associated with asthma at school age. We examined the relation between day care in the first year of life and asthma, recurrent wheezing, and eczema at the age of 6 years and wheez

  9. America's Women Veterans: Military Service History and VA Benefit Utilization Statistics

    Data.gov (United States)

    Department of Veterans Affairs — This comprehensive report chronicles the history of women in the military and as Veterans, profiles the characteristics of women Veterans in 2009, illustrates how...

  10. Disparate British Breast Reconstruction Utilization: Is Universal Coverage Sufficient to Ensure Expanded Care?

    Science.gov (United States)

    Offodile, Anaeze C.

    2016-01-01

    Summary: Our intent is to improve the understanding of the ability of healthcare providers to deliver high-quality care as we approach an era of universal coverage. We adopted 2 unique vantage points in this article: (1) the mandated coverage for immediate breast reconstruction (IBR) surgery as a microcosmic surrogate for universal coverage overall and (2) we then scrutinized the respective IBR utilization rates in a contemporaneous system of 2 healthcare delivery models in the United Kingdom, that is, the public National Health Service trust versus private-sector hospitals. A literature review was performed for IBR rates across public trust and private-sector hospitals in the United Kingdom. The IBR rate among public trust hospitals was 17% compared with 43% in the private sector. In the trust hospital setting, the enactment of 2 government mandates, intended to increase the access to cancer care, seemed to fall short in maximizing the ability of surgical practitioners to deliver quality care to patients. Among women who did not receive IBR, 65% felt that they had received the sufficient amount of information to appropriately inform their decision. In addition, only 46% of this same cohort reported a consultation with a reconstructive surgeon preoperatively. Private-sector hospitals delivered better IBR care because of the likely presence of infrastructure and financial incentives for physicians. These results serve as a call for a better alignment between policy initiatives designed to expand care access and the perogatives of physicians to ensure an optimized delivery of the expanded care such policy mandates.

  11. Disparate British Breast Reconstruction Utilization: Is Universal Coverage Sufficient to Ensure Expanded Care?

    Science.gov (United States)

    Offodile, Anaeze C; Guo, Lifei

    2016-06-01

    Our intent is to improve the understanding of the ability of healthcare providers to deliver high-quality care as we approach an era of universal coverage. We adopted 2 unique vantage points in this article: (1) the mandated coverage for immediate breast reconstruction (IBR) surgery as a microcosmic surrogate for universal coverage overall and (2) we then scrutinized the respective IBR utilization rates in a contemporaneous system of 2 healthcare delivery models in the United Kingdom, that is, the public National Health Service trust versus private-sector hospitals. A literature review was performed for IBR rates across public trust and private-sector hospitals in the United Kingdom. The IBR rate among public trust hospitals was 17% compared with 43% in the private sector. In the trust hospital setting, the enactment of 2 government mandates, intended to increase the access to cancer care, seemed to fall short in maximizing the ability of surgical practitioners to deliver quality care to patients. Among women who did not receive IBR, 65% felt that they had received the sufficient amount of information to appropriately inform their decision. In addition, only 46% of this same cohort reported a consultation with a reconstructive surgeon preoperatively. Private-sector hospitals delivered better IBR care because of the likely presence of infrastructure and financial incentives for physicians. These results serve as a call for a better alignment between policy initiatives designed to expand care access and the perogatives of physicians to ensure an optimized delivery of the expanded care such policy mandates. PMID:27482486

  12. Socioeconomic factors affecting patients′ utilization of primary care services at a Tertiary Teaching Hospital in Riyadh, Saudi Arabia

    Directory of Open Access Journals (Sweden)

    Abdulaziz M Alsubaie

    2016-01-01

    Full Text Available Background: Primary care services utilization is dependent on socioeconomic factors. It is proven that variation in socioeconomic factors result in discrepancies in the use of such services. Admittedly, research is limited on the socioeconomic factors affecting the utilization of primary care services in Saudi Arabia. Objectives: The aim of this research was to study the effect of the main socioeconomic factors affecting patients′ utilization of primary care services at a tertiary teaching hospital, Riyadh, Saudi Arabia. Materials and Methods: A cross-sectional study was conducted from January to February 2014 in a primary care clinic of a tertiary teaching hospital in Riyadh city; subjects selected using a random consecutive sampling technique. A self-administered questionnaire in Arabic was given to the participants to collect the data which comprised sociodemographic data, utilization measures, and health needs. The data were analyzed using SPSS version 21. Results: A total of 358 subjects participated in the study. The main factors that best determine the utilization of primary health care clinic in a tertiary teaching hospital were the possession of a health insurance (P = 0.046, odds ratio [OR] = 8.333, and bad self-health-perception (P < 0.014, OR: 2.088. Chronic illness was also associated with higher utilization (OR = 2.003. Conclusion: Our results reveal that chronic health problems, self-health-perception, and health insurance are the most significant socioeconomic factors affecting the utilization of primary care services.

  13. Gender differences in health care utilization and outcome of respiratory tuberculosis in Alexandria.

    Science.gov (United States)

    Kamel, M I; Rashed, S; Foda, N; Mohie, A; Loutfy, M

    2003-07-01

    A study of gender differences in health care utilization and outcome of respiratory tuberculosis was carried out in Alexandria, Egypt. A cohort of 334 patients was followed-up for 8 months; 69.2% of cases were males. The pattern of tuberculosis symptoms was similar for both sexes. Women started treatment earlier than men. Women had significantly lower scores in knowledge, beliefs and attitudes about tuberculosis than men. Compliance was unsatisfactory for both sexes. Men tended to be more adherent to drugs and to sputum and X-ray examinations but there were no sex differences in compliance with health education and medical examinations. No significant sex differences in treatment outcome were found: the overall cure rate was 60.5% and treatment failure was 4.8%. Multiple regression analysis showed satisfaction with medical care was the only significant predictor of treatment failure. PMID:15748071

  14. Health care utilization among Medicare-Medicaid dual eligibles: a count data analysis

    Directory of Open Access Journals (Sweden)

    Shin Jaeun

    2006-04-01

    Full Text Available Abstract Background Medicare-Medicaid dual eligibles are the beneficiaries of both Medicare and Medicaid. Dual eligibles satisfy the eligibility conditions for Medicare benefit. Dual eligibles also qualify for Medicaid because they are aged, blind, or disabled and meet the income and asset requirements for receiving Supplement Security Income (SSI assistance. The objective of this study is to explore the relationship between dual eligibility and health care utilization among Medicare beneficiaries. Methods The household component of the nationally representative Medical Expenditure Panel Survey (MEPS 1996–2000 is used for the analysis. Total 8,262 Medicare beneficiaries are selected from the MEPS data. The Medicare beneficiary sample includes individuals who are covered by Medicare and do not have private health insurance during a given year. Zero-inflated negative binomial (ZINB regression model is used to analyse the count data regarding health care utilization: office-based physician visits, hospital inpatient nights, agency-sponsored home health provider days, and total dental visits. Results Dual eligibility is positively correlated with the likelihood of using hospital inpatient care and agency-sponsored home health services and the frequency of agency-sponsored home health days. Frequency of dental visits is inversely associated with dual eligibility. With respect to racial differences, dually eligible Afro-Americans use more office-based physician and dental services than white duals. Asian duals use more home health services than white duals at the 5% statistical significance level. The dual eligibility programs seem particularly beneficial to Afro-American duals. Conclusion Dual eligibility has varied impact on health care utilization across service types. More utilization of home healthcare among dual eligibles appears to be the result of delayed realization of their unmet healthcare needs under the traditional Medicare-only program

  15. Uses of ambulatory health/mental health utilization data in organized health care settings.

    Science.gov (United States)

    Burns, B J; Goldberg, I D; Hankin, J; Hoeper, E W; Jacobson, A M; Regier, D A

    1982-01-01

    A follow-up assessing uses of findings from NIMH-supported research on health and mental health services utilization in organized health care settings revealed a range of applications across the study sites. The research, conducted primarily for national policy purposes, had an impact on study sites in the following areas: clinician perceptions and attitudes about mental health services provided; program directions; fiscal policy; and further related research. Research team composition and dissemination of study findings are discussed in relation to the applications made. PMID:10260970

  16. How does an integrated primary care approach for patients in deprived neighbourhoods impact utilization patterns? An explorative study

    OpenAIRE

    Dionne S Kringos; van den Broeke, Jennifer R.; van der Lee, Arnold P. M.; Plochg, Thomas; Stronks, Karien

    2016-01-01

    Background To explore changes in utilization patterns for general practice (GP) and hospital care of people living in deprived neighbourhoods when primary care providers work in a more coherent and coordinated manner by applying an integrated approach. Methods We compared expected (based on consumption patterns of a health insurers’ total population) and actual utilization patterns in a deprived Dutch intervention district in the city of Utrecht (Overvecht) with control districts 1 (Noordwest...

  17. Primary health care utilization by the mexican indigenous population: the role of the Seguro popular in socially inequitable contexts.

    Directory of Open Access Journals (Sweden)

    Rene Leyva-Flores

    Full Text Available OBJECTIVE: To analyze the relationship between primary health care utilization and extended health insurance coverage under the Seguro Popular (SP among Mexican indigenous people. METHODOLOGY: A cross-sectional analysis was conducted using data from the Mexican National Nutrition Survey 2012 (n = 194,758. Quasi-experimental matching methods and nonlinear regression probit models were used to estimate the influence of SP on primary health care utilization. RESULTS: 25% of the Mexican population reported having no health insurance coverage, while 59% of indigenous versus 35% of non-indigenous reported having SP coverage. Health problems were reported by 13.9% of indigenous vs. 10.5% of non-indigenous; of these, 52.8% and 57.7% respectively, received primary health care (p<0.05. Economic barriers were the most frequent reasons for not using primary health care services. The probability of utilizing primary health care services was 11.5 percentage points higher (p<0.01 for indigenous SP affiliates in comparison with non-indigenous, in similar socioeconomic conditions. CONCLUSION: Socioeconomic conditions, not ethnicity per-se, determine whether people utilize primary health care services. Therefore, SP can be conceived as a public policy strategy which acts as a social buffer by enhancing health care utilization regardless of ethnicity. Further analysis is required to explore the potential gaps as a result of SP coverage among socially vulnerable groups.

  18. Utilization and expenditures of veterans obtaining primary care in community clinics and VA medical centers: an observational cohort study

    Directory of Open Access Journals (Sweden)

    Chapko Michael

    2007-04-01

    Full Text Available Abstract Background To compare VA inpatient and outpatient utilization and expenditures of veterans seeking primary care in community-based outpatient clinics (CBOCs and VA medical centers (VAMCs in fiscal years 2000 (FY00 and 2001. Methods The sample included 25,092 patients who obtained primary care exclusively from 108 CBOCs in FY00, 26,936 patients who obtained primary care exclusively from 72 affiliated VAMCs in FY00, and 11,450 "crossover" patients who obtained primary care in CBOCs and VAMCs in FY00. VA utilization and expenditure data were drawn from the VA's system-wide cost accounting system. Veteran demographic characteristics and a 1999 Diagnostic Cost Group risk score were obtained from VA administrative files. Outpatient utilization (primary care, specialty care, mental health, pharmacy, radiology and laboratory and inpatient utilization were estimated using count data models and expenditures were estimated using one-part or two-part models. The second part of two-part models was estimated using generalized linear regressions. Results CBOC patients had a slightly more primary care visits per year than VAMC patients (p Conclusion CBOCs provided veterans improved access to primary care and other services, but expenditures were contained because CBOC patients who sought health care had fewer visits and hospital stays than comparable VAMC patients. These results suggest a more complex pattern of health care utilization and expenditures by CBOC patients than has been found in prior studies. This study also illustrates that CBOCs continue to be a critical primary care and mental health access point for veterans.

  19. Travel time to maternity care and its effect on utilization in rural Ghana: a multilevel analysis.

    Science.gov (United States)

    Masters, Samuel H; Burstein, Roy; Amofah, George; Abaogye, Patrick; Kumar, Santosh; Hanlon, Michael

    2013-09-01

    Rates of neonatal and maternal mortality are high in Ghana. In-facility delivery and other maternal services could reduce this burden, yet utilization rates of key maternal services are relatively low, especially in rural areas. We tested a theoretical implication that travel time negatively affects the use of in-facility delivery and other maternal services. Empirically, we used geospatial techniques to estimate travel times between populations and health facilities. To account for uncertainty in Ghana Demographic and Health Survey cluster locations, we adopted a novel approach of treating the location selection as an imputation problem. We estimated a multilevel random-intercept logistic regression model. For rural households, we found that travel time had a significant effect on the likelihood of in-facility delivery and antenatal care visits, holding constant education, wealth, maternal age, facility capacity, female autonomy, and the season of birth. In contrast, a facility's capacity to provide sophisticated maternity care had no detectable effect on utilization. As the Ghanaian health network expands, our results suggest that increasing the availability of basic obstetric services and improving transport infrastructure may be important interventions.

  20. Diabetes, minor depression and health care utilization and expenditures: a retrospective database study

    Directory of Open Access Journals (Sweden)

    McCollum Marianne

    2007-04-01

    Full Text Available Abstract Background To estimate the prevalence of minor depression among US adults with diabetes, health care resource utilization, and expenditures by people with diabetes with and without minor depression. Methods Among adult 2003 Medical Expenditure Panel Survey respondents, diabetes was identified by diagnosis code and self-report. Depression was identified by diagnosis code plus ≥ one antidepressant prescription. Odds of having depression was estimated in people with diabetes and the general population, adjusted for sociodemographic variables (e.g., age, sex, race/ethnicity. Multivariate regressions evaluated factors associated with utilization and log-transformed expenditures for ambulatory care, hospitalizations, emergency visits, and prescriptions. Results In 2003, 1932 respondents had diabetes, 435/1932 had diabetes and minor depression. Adults with diabetes were more likely than the general population to have depression (adjusted OR 1.81, 95% CI 1.56, 2.09. People with diabetes with versus without comorbid depression were more likely to be women, have lower incomes and health status, and more diabetes complications (all p Conclusion People with diabetes are twice as likely to have depression as the general population. Screening for and treatment of depression is warranted, as is additional research into a causal relationship between diabetes and depression.

  1. Travel time to maternity care and its effect on utilization in rural Ghana: a multilevel analysis.

    Science.gov (United States)

    Masters, Samuel H; Burstein, Roy; Amofah, George; Abaogye, Patrick; Kumar, Santosh; Hanlon, Michael

    2013-09-01

    Rates of neonatal and maternal mortality are high in Ghana. In-facility delivery and other maternal services could reduce this burden, yet utilization rates of key maternal services are relatively low, especially in rural areas. We tested a theoretical implication that travel time negatively affects the use of in-facility delivery and other maternal services. Empirically, we used geospatial techniques to estimate travel times between populations and health facilities. To account for uncertainty in Ghana Demographic and Health Survey cluster locations, we adopted a novel approach of treating the location selection as an imputation problem. We estimated a multilevel random-intercept logistic regression model. For rural households, we found that travel time had a significant effect on the likelihood of in-facility delivery and antenatal care visits, holding constant education, wealth, maternal age, facility capacity, female autonomy, and the season of birth. In contrast, a facility's capacity to provide sophisticated maternity care had no detectable effect on utilization. As the Ghanaian health network expands, our results suggest that increasing the availability of basic obstetric services and improving transport infrastructure may be important interventions. PMID:23906132

  2. How Managed Care Affects Medicaid Utilization : A Synthetic Difference-in-Difference Zero-Inflated Count Model

    NARCIS (Netherlands)

    Freund, D.A.; Kniesner, T.J.; LoSasso, A.T.

    1996-01-01

    We develop a synthetic difference-in-differences statistical design to apply to experimental data for adult women living in Hennepin County, Minnesota, to estimate the impact of Medicaid managed care on various modes of medical care use.Because the outcomes of interest are utilization counts with ma

  3. Association between obesity, quality of life, physical activity and health service utilization in primary care patients with osteoarthritis.

    NARCIS (Netherlands)

    Rosemann, T.J.; Grol, R.P.T.M.; Herman, K.; Wensing, M.J.P.; Szecsenyi, J.

    2008-01-01

    ABSTRACT: OBJECTIVE: To assess the association of obesity with quality of life, health service utilization and physical activity in a large sample of primary care patients with osteoarthritis (OA). METHODS: Data were retrieved from the PraxArt project, representing a cohort of 1021 primary care pati

  4. Self-reported Health Care Utilization of Patients with Inflammatory Bowel Disease Correlates Perfectly with Medical Records

    NARCIS (Netherlands)

    Severs, Mirjam; Petersen, Roosmarijn E.; Siersema, Peter D.; Mangen, Marie Josee J; Oldenburg, Bas

    2015-01-01

    Studies on the costs of health care in patients with inflammatory bowel disease (IBD) are increasingly conducted through the collection of self-reported data. We aimed to assess the concordance between estimated annual costs based on self-reported health care utilization and administrative data in I

  5. Study of drug utilization pattern of antihyperglycemic agents in a South Indian tertiary care teaching hospital

    Directory of Open Access Journals (Sweden)

    Sayed Aliul Hasan Abdi

    2012-01-01

    Full Text Available Objective: To determine the drug utilization pattern of antihyperglycemic agents (AHA in a tertiary care teaching hospital. Materials and Methods: This was a prospective observational study. All the relevant data were collected and drug utilization pattern of AHA was determined. Direct cost associated with the use of antihyperglycemic medicines was calculated and consumption of the antihyperglycemic medicines was measured as defined daily dose (DDD/100 bed-days. The adverse drug reactions (ADRs related to anti-diabetic medicines were monitored. Statistical Analysis Used: Chi square test (χ2 , mean±standard deviation. Results: During the study period, 350 patients diagnosed as diabetes mellitus (DM were admitted. Insulin was prescribed as monotherapy to 81% and to 52% patients during hospital stay and discharge, respectively. Increase in utilization of insulin was recorded in majority of the patients due to presence of co-morbid conditions or resistance to oral hypoglycemic drugs. Use of insulin at the time of discharge decreased significantly (P<0.05 by 29%. Among the oral AHA, combination of glimepiride with metformin was more prevalent during hospital stay and at the time of discharge monotherapy of metformin followed by glimepiride was more prevalent. During hospital stay, cost of AHA was found to be Rs. 95.27 ± 119.03. The total antihyperglycemic drug consumption in the medicine ward during study period was 13.42 DDD/100 bed-days. Fifty ADRs were reported and descriptions of ADRs were found to be only hypoglycemia. Conclusion: The study exhibited a significant increase in the utilization of two drug combination therapies and monotherapy of oral AHA and decrease in the utilization of insulin at the time of discharge.

  6. Study of utilization of antenatal care services iin tribal area of Thane district

    Directory of Open Access Journals (Sweden)

    Kalpalata Abhiman Bhaisare

    2015-04-01

    Full Text Available Background: Many health problems among pregnant women are preventable, detectable or treatable through visits to health facility before birth. This enables women to receive important services, such as tetanus vaccinations and screening and treatment for infections, as well as potentially life-saving information on warning signs during pregnancy.2 The objective of this study is to understand the current status of utilization of maternal health services in rural area by elucidating the various factors influencing the use of these services. Methods: It is a community based, cross sectional study carried out in a primary health centre in tribal area of Thane district. Results: 93% women received ANC care for 3 or more than 3 times. 73% women received recommended antenatal care. 68% women received ANC care exclusively from public health facility. Conclusions: Inspite of implementation of various programmes like Janani Suraksha Yojana, Matrutva Anudan Yojana and NRHM in the area percentage of registration during first trimester was less. There was lack of awareness and motivation in study subjects to come on their own to PHC for early registration of pregnancy. Though the coverage of ANC services was good it was not of good quality. [Int J Reprod Contracept Obstet Gynecol 2015; 4(2.000: 378-383

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

    Directory of Open Access Journals (Sweden)

    Lin J

    2014-07-01

    Full Text Available Junji Lin,1 Yunfeng Li,2 Haijun Tian,2 Michael J Goodman,1 Susan Gabriel,2 Tara Nazareth,2 Stuart J Turner,2,3 Stephen Arcona,2 Kristijan H Kahler21Department of Pharmacotherapy, University of Utah, Salt Lake City, UT, USA; 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, NJ, USA; 3Ernest Mario School of Pharmacy, Rutgers University, New Brunswick, NJ, USA Background: Patients with chronic obstructive pulmonary disease (COPD are at increased risk for lung infections and other pathologies (eg, pneumonia; however, few studies have evaluated the impact of pneumonia on health care resource utilization and costs in this population. The purpose of this study was to estimate health care resource utilization and costs among COPD patients with newly acquired pneumonia compared to those without pneumonia. Methods: A retrospective claims analysis using Truven MarketScan® Commercial and Medicare databases was conducted. COPD patients with and without newly acquired pneumonia diagnosed between January 1, 2004 and September 30, 2011 were identified. Propensity score matching was used to create a 1:1 matched cohort. Patient demographics, comorbidities (measured by Charlson Comorbidity Index, and medication use were evaluated before and after matching. Health care resource utilization (ie, hospitalizations, emergency room [ER] and outpatient visits, and associated health care costs were assessed during the 12-month follow-up. Logistic regression was conducted to evaluate the risk of hospitalization and ER visits, and gamma regression models and two-part models compared health care costs between groups after matching. Results: In the baseline cohort (N=467,578, patients with newly acquired pneumonia were older (mean age: 70 versus [vs] 63 years and had higher Charlson Comorbidity Index scores (3.3 vs 2.6 than patients without pneumonia. After propensity score matching, the pneumonia cohort was nine times more likely

  8. Antipsychotic adherence, switching, and health care service utilization among Medicaid recipients with schizophrenia

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    Douglas L Noordsy

    2010-07-01

    Full Text Available Douglas L Noordsy1, Glenn A Phillips2, Daniel E Ball2, Walter T Linde-Zwirble31Department of Psychiatry, Dartmouth Medical School, Lebanon, NH, USA; 2Global Health Outcomes, Eli Lilly and Company, Indianapolis, IN, USA; 3ZD Associates, Perkasie, PA, USAObjective: To evaluate health care resource utilization in patients with schizophrenia who continued newly prescribed antipsychotic medications, compared with those switching to ­different treatments.Methods: Adults with schizophrenia in the California Medicaid (MediCal database who ­initiated treatment with index medications in 1998–2001, were classified as having: 1 ­abandoned antipsychotic medications; 2 switched to another medication; or 3 continued with the index antipsychotic, for up to 6 months after the index date.Results: Of 2300 patients meeting eligibility criteria, 1382 (60.1% continued index medications, 480 (20.9% switched, and 438 (19.0% abandoned antipsychotic treatment. Utilization in several resource categories occurred significantly more frequently among patients whose regimens were switched (vs those continuing index medications. These included using psychiatric (24.2% vs 14.5%; P < 0.001 or nonpsychiatric (31.5% vs 24.3%; P < 0.05 emergency services; being admitted to a hospital (10.6% vs 7.4%; P < 0.05; making nonpsychiatric outpatient hospital visits (43.3% vs 36.4%; P < 0.05 or nonpsychiatric physician visits (62.7% vs 56.4%; P < 0.05; and using other outpatient psychiatric (53.3% vs 40.7%; P < 0.001 or nonpsychiatric (82.7% vs 74.6%; P < 0.001 services.Conclusions: Switching antipsychotic medications is associated with significantly increased health care resource utilization (vs continuing treatment.Keywords: antipsychotics, drug therapy, resource use, treatment adherence

  9. Predicting utility of exercise tests based on history/holter in patients with premature ventricular contractions.

    Science.gov (United States)

    Robinson, Brad; Xie, Li; Temple, Joel; Octavio, Jenna; Srayyih, Maytham; Thacker, Deepika; Kharouf, Rami; Davies, Ryan; Gidding, Samuel S

    2015-01-01

    Premature ventricular contractions (PVCs) are considered benign in patients with structurally normal hearts, particularly if they suppress with exercise. Catecholaminergic polymorphic ventricular tachycardia (CPVT) requires exercise testing to unmask the malignant phenotype. We studied risk factors and Holter monitor variables to help predict the necessity of exercise testing in patients with PVCs. We retrospectively reviewed 81 patients with PVCs that suppressed at peak exercise and structurally normal hearts referred to the exercise laboratory in 2011. We reviewed 11 patients from 2003 to 2012 whose PVCs were augmented at peak exercise (mean age 13 ± 4 years; 52 % male, 180 exercise studies). We recorded clinical risk factors and comorbidities (family history of arrhythmia or sudden unexpected death [SUD], presence of syncope) and Holter testing parameters. Family history of VT or SUD (P = 0.011) and presence of VT on Holter (P = 0.011) were significant in predicting failure of PVCs to suppress at peak heart rate on exercise testing. Syncope was not statistically significant in predicting suppression (P = 0.18); however, CPVT was diagnosed in four patients with syncope during exercise. Quantity of PVCs, Lown grade, couplets on Holter, monomorphism, and PVC elimination at peak heart rate on Holter were not predictors of PVC suppression on exercise testing. Patients with syncope during exercise, family history of arrhythmia or SUD, or a Holter monitor showing VT warrant exercise testing to assess for CPVT.

  10. Utilization of traditional birth attendants in MCH care in rural Malaysia.

    Science.gov (United States)

    Yadav, H

    1987-12-01

    Training of the traditional birth attendants (TBAs) in Malaysia was preceded by a KAP study, and the results have been a tremendous improvement in maternal-child health care. Although Malaysia has an extensive health care system composed of government sponsored midwife clinics, health centers and sub-centers, regional hospitals, private general practitioners and estate clinics, which are utilized by 94% for prenatal care, 40% of women still called in TBAs for delivery. TBAs are popular because they provide a full range of traditional customs, are available locally, and well known to local women. 100 active TBAs in the Krian District, an area of 157,649 people in northwestern Malaysia, were surveyed. 89% had primary education; 76% were over 55 years of age; 82% had over 10 years of experience; 60% had received family planning training. They had favorable attitudes toward modern medicine, advised women to attend prenatal care, advised them on traditional diet, and performed such procedures as abdominal massage and heat fomentation. They tended to take all cases regardless of risk. The training consisted of practical demonstrations and flip charts for 6 consecutive saturdays conducted by public health nurses. TBAs were taken to meet staff and see hospital facilities and received a UN midwifery kit as an incentive. After training, hospital deliveries rose from 29.5% in 1976 to 35.9% in 1983; government midwives attended 40.2% compared to 23.3% of deliveries; deliveries conducted by TBAs fell from 47.2% to 19.4%; and more high risk cases were referred to hospitals. During the period maternal mortality declined from 1.46-1.98 in the 1970s to 0.84-1.09 in the 1980s.

  11. CHARACTERISTICS OF PRIMARY HEALTH CARE UTILIZATION OF MILITARY STAFF AND THEIR FAMILIES IN TURKISH ARMED FORCES

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    Ozlem Ozkan

    Full Text Available Aim: The study was conducted to define characteristics of primary health care utilization of military staff and their families in Turkish Army Forces. Material-Method: A cross-sectional survey method was used. This study has carried out in 10 primary health care institutions in Ankara Military Zone which is tied to Turkish Armed Forces Land Forces Commandership in 1998. The data have been obtained from the application reasons of Turkish Armed Forces’ (TAF staff members and their families to main medical units and the results got after they have applied to those units and the physician’s intervention that have been written down on a form prepared by the researcher for a period of three months (January –March 1998. The data got from practices have been assessed by percentage Results:TAF’sstaff members commissioned in the detachment (4.0 and their families in dispensaries (8.7 have major application rate. While sergeants/corporals-privates in the detachment infirmary, and TSK staff members and their families in dispensaries have mostly applied to primary health care units for complaints (68.5%, 76.9%, 72.8%, the staff members working at the quatrain infirmary and their families have mostly applied to main medical units for the purpose of prescribing a medicine (59.8%, 90%. The most frequent diseases seen in military staff and their families in TAF are; diagnosed acute respiratory system infections, ankilosis acquired bone and muscle disorders, gastritis-duedonititis-ulcer, influenza, enteritis and diseases connected with diarrhoea, tonsillitis, parazitis-other infection diseases and bronchitis. Conclusion suggestions: These diseases are acute, preventable, high contagious diseases and the problems that occur related to these diseases could be eliminated within full-equipped primary health care services. Moreover, among the proposals of the research are the appointment of registered nurses to units health care to act as a public health nurses

  12. The History of Antithrombotic Therapy: The Discovery of Heparin, the Vitamin K Antagonists, and the Utility of Aspirin.

    Science.gov (United States)

    Handin, Robert I

    2016-10-01

    The administration of intravenous heparin to postoperative patients by Barritt and Jordan reduced the incidence of fatal and nonfatal pulmonary embolism and established heparin as the standard for parenteral anticoagulation. The coumarin family of vitamin K antagonists quickly became the standard for long-term oral anticoagulation. Aspirin became a widely used antithrombotic agent after the discovery that chronic oral administration reduced the incidence of secondary strokes and myocardial infarction. This article gives a brief history of antithrombotic therapy, including the discovery of heparin, the vitamin k antagonists, and the utility of aspirin. PMID:27637302

  13. Drug utilization study of gynecology OPD: In a tertiary care hospital.

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    Baig MS, Bagle TR,Gadappa SN, Deshpande Sonali, Doifode SM

    2013-04-01

    Full Text Available Background: The treatment of diseases by use of essential medicines, prescribed by generic names, has been emphasized by WHO and National Health Policy of India. Drugs used in gynaecology are one of the top selling drugs in India; however they are least studied with respect to drug utilization. Thus present study was undertaken to analyze drug utilization pattern of gynecology OPD in a tertiary care hospital. Materials and Methods: A retrospective, cross sectional, observational study of prescriptions in Gynecology OPD. Data was obtained from an electronic medical record database of patients that attended Gynecology OPD during the study period. Prescription records of patients were screened as per inclusion and exclusion criteria and 300 prescriptions were randomly selected by Openepi software. Patient related and drug related information was collected on a customized data collection sheet. Results: The mean age of patients was 30.19+9.83 years and common age of presentation was >18-30 years. In infective cases, vaginal discharge (10.33% was common, and in non-infective cases, menstrual disorders (24% were common. The average number of drugs per prescription was 3.47+1.53. In drug category, minerals (30.94% were most commonly prescribed, followed by antimicrobials (24.98%, and NSAIDs (13.37%. Polypharmacy was observed in 96.33% of the prescriptions. Conclusion: It is only by drug utilization studies that burden of diseases and corresponding utilization of drugs in gynecology can be measured. In our study majority of the drugs prescribed were generic which were from the essential medical list NLEM and WHO.

  14. Inequity in Hospitalization Care: A Study on Utilization of Healthcare Services in West Bengal, India

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    Montu Bose

    2015-01-01

    Full Text Available Background Out of eight commonly agreed Millennium Development Goals (MDG, six are related to the attainment of Universal Health Coverage (UHC throughout the globe. This universalization of health status suggests policies to narrow the gap in access and benefit sharing between different socially and economically underprivileged classes with that of the better placed ones and a consequent expansion of subsidized healthcare appears to be a common feature for most of the developing nations. The National Health Policy in India (2002 suggests expansion of market-based care for the affording class and subsidized care for the deserving class of the society. So, the benefit distribution of this limited public support in health sector is important to examine to study the welfare consequences of the policy. This paper examines the nature of utilizationto inpatient care by different socio-economic groups across regions and gender in West Bengal (WB, India. The benefit incidence of public subsidies across these socio-economic groups has also been verified for different types of services like medicines, diagnostics and professional care etc. Methods National Sample Survey Organization (NSSO has collected information on all hospitalized cases (60th round, 2004 with a recall period of 365 days from the sampled households through stratified random sampling technique. The data has been used to assess utilization of healthcare services during hospitalization and the distribution of public subsidies among the patients of different socio-economic background; a Benefit Incidence Analysis (BIA has also been carried out. Results Analysis shows that though the rate of utilization of public hospitals is quite high, other complementary services like medicine, doctor and diagnostic tests are mostly purchased from private market. This leads to high Out-of-Pocket (OOP expenditure. Moreover, BIA reveals that the public subsidies are mostly enjoyed by the relatively better

  15. Development and first assessment of a questionnaire for health care utilization and costs for cardiac patients

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    Hahmann Harry

    2008-09-01

    Full Text Available Abstract Background The valid and reliable measurement of health service utilization, productivity losses and consequently total disease-related costs is a prerequisite for health services research and for health economic analysis. Although administrative data sources are usually considered to be the most accurate, their use is limited as some components of utilization are not systematically captured and, especially in decentralized health care systems, no single source exists for comprehensive utilization and cost data. The aim of this study was to develop and test a questionnaire for the measurement of disease-related costs for patients after an acute cardiac event (ACE. Methods To design the questionnaire, the literature was searched for contributions to the assessment of utilization of health care resources by patient-administered questionnaires. Based on these findings, we developed a retrospective questionnaire appropriate for the measurement of disease-related costs over a period of 3 months in ACE patients. Items were generated by reviewing existing guidelines and by interviewing medical specialists and patients. In this study, the questionnaire was tested on 106 patients, aging 35–65 who were admitted for rehabilitation after ACE. It was compared with prospectively measured data; selected items were compared with administrative data from sickness funds. Results The questionnaire was accepted well (response rate = 88%, and respondents completed the questionnaire in an average time of 27 minutes. Concordance between retrospective and prospective data showed an intraclass correlation (ICC ranging between 0.57 (cost of medical intake and 0.9 (hospital days with the other main items (physician visits, days off work, medication clustering around 0.7. Comparison between self-reported and administrative data for days off work and hospitalized days were possible for n = 48. Respective ICCs ranged between 0.92 and 0.94, although differences in

  16. Direct Release of Test Results to Patients Increases Patient Engagement and Utilization of Care.

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    Francesca Pillemer

    Full Text Available An important focus for meaningful use criteria is to engage patients in their care by allowing them online access to their health information, including test results. There has been little evaluation of such initiatives. Using a mixed methods analysis of electronic health record data, surveys, and qualitative interviews, we examined the impact of allowing patients to view their test results via patient portal in one large health system. Quantitative data were collected for new users and all users of the patient portal. Qualitative interviews occurred with patients who had received an HbA1c or abnormal Pap result. Survey participants were active patient portal users. Our main measures were patient portal usage, factors associated with viewing test results and utilizing care, and patient and provider experiences with patient portal and direct release. Usage data show 80% of all patient portal users viewed test results during the year. Of survey respondents, 82.7% noted test results to be a very useful feature and 70% agreed that patient portal has made their provider more accessible to them. Interviewed patients reported feeling they should have direct access to test results and identified the ability to monitor results over time and prepare prior to communicating with a provider as benefits. In interviews, both patients and physicians reported instances of test results leading to unnecessary patient anxiety. Both groups noted the benefits of results released with provider interpretation. Quantitative data showed patient utilization to increase with viewing test results online, but this effect is mitigated when results are manually released by physicians. Our findings demonstrate that patient portal access to test results was highly valued by patients and appeared to increase patient engagement. However, it may lead to patient anxiety and increase rates of patient visits. We discuss how such unintended consequences can be addressed and larger

  17. Health Seeking Behavior and Utilization of Health Care Services in Eastern Hilly Region of Nepal

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    Sailesh Bhattarai

    2015-11-01

    Full Text Available noBackground & Objectives: Preventive, promotive, curative, and rehabilitative health care services depend not only in availability & accessibility of it but also on awareness and attitude of the people and various inter-woven social structure that determines in making choice. The objective of this study was to explore health seeking behavior and utilization of health care services in the rural places in VDCs of Ilam district of Eastern Nepal.Materials & Methods: A cross sectional study was conducted in between period of March 25th 2013 to April 10th 2013 Fikkal and Pashupatinagar VDCs in Ilam district with sample of 300 people. Data was collected using a semi-structured questionnaire.Results: One fifth of the populations were found to be seeking traditional healers’ service and 80 percent among modern treatment system were relying on private treatment facility for treating sickness. People who had lived more than 20 years in that place and who felt modern health services were costly were likely to use service of traditional healers. Similarly people suffering from chronic illness, having health facility more than 30 minutes and using stretcher or walking as means of transportation were using government health centers more compared to private services.Conclusion: Significant people still use traditional healers’ service and the government health facility utilization was low as compared to private. The people living for longer period in that place and having the concept that modern health centers are costly were primary user of traditional healing system. Health facility nearby or people who could afford for automobile travel facilities were using costly private health centers.JCMS Nepal. 2015; 11(2:8-16

  18. Institutional delivery and postnatal care services utilizations in Abuna Gindeberet District, West Shewa, Oromiya Region, Central Ethiopia: A Community-based cross sectional study

    OpenAIRE

    Darega, Birhanu; Dida, Nagasa; Tafese, Fikru; Ololo, Shimeles

    2016-01-01

    Background Delivery at health institutions under the care of trained health-care providers and utilization of postnatal cares services plays vital roles in promoting child survival and reducing the risk of maternal mortality. More than 80 % of maternal deaths can be prevented if pregnant women access to essential maternity cares like antenatal care, institutional delivery and postnatal care services. Thus, this study aimed to assess institutional delivery and postnatal care services utilizati...

  19. Acculturation and health care utilization among Mexican heritage women in the United States.

    Science.gov (United States)

    Bermúdez-Parsai, Mónica; Mullins Geiger, Jennifer L; Marsiglia, Flavio F; Coonrod, Dean V

    2012-08-01

    With the increasing Latino population in the United States, it is critical to examine the influence of the process of acculturation on health care practices and utilization. The purpose of this study was to evaluate the relationship between acculturation level and post-partum visit (PPV) compliance among Latinas participating in a larger psycho-educational intervention aimed at encouraging women to engage in positive healthcare practices. Acculturation was measured with the Bicultural Involvement Questionnaire which assigned participants to five categories: Assimilated, Separated, Moderate, Bicultural and Alienation. Logistic Regression analyses were conducted to predict post-partum visit attendance. Odds ratios and relative risk of not attending the post-partum visit are presented. Results suggest women in the Separation and Assimilation groups were less likely than bicultural group members to attend the PPV. The only other variable that was significant in this analysis is the group condition, indicating that the intervention group was more likely to attend the PPV than the control group. Women identifying as bicultural seem to participate more actively in their own healthcare as they draw on the cultural assets that have a positive influence on informal health practices, such as healthy eating and refraining from drug use. Bicultural group members can also use formal skills related to language and knowledge of the dominant culture to help effectively navigate the healthcare system. Implications for research, intervention and practice are discussed to improve healthcare practices and increase utilization among Latinas.

  20. Improving Intensive Care Unit and Ward Utilization by Adapting Master Surgery Schedules.

    Science.gov (United States)

    Fügener, Andreas; Edenharter, Guenther Michael; Kiefer, Paskal; Mayr, Ulrike; Schiele, Julian; Steiner, Fabian; Kolisch, Rainer; Blobner, Manfred

    2016-03-15

    With increasing organizational and financial pressure on hospitals, each individual surgical treatment has to be reviewed and planned thoroughly. Apart from the expensive operating room facilities, proper staffing and planning of downstream units, like the wards or the intensive care units (ICUs), should be considered as well. In this article, we outline the relationship between a master surgery schedule (MSS), i.e., the assignment of surgical blocks to medical specialties, and the bed demand in the downstream units using an analytical model. By using historical data retrieved from the clinical information system and a patient flow model, we applied a recently developed algorithm for predicting bed demand based on the MSSs for patients of 3 surgical subspecialties of a hospital. Simulations with 3 different MSSs were performed. The impact on the required amount of beds in the downstream units was analyzed. We show the potential improvements of the current MSS considering 2 main goals: leveling workload among days and reduction of weekend utilization. We discuss 2 different MSSs, one decreasing the weekend ICU utilization by 20% and the other one reducing maximum ward bed demand by 7%. A test with 12 months of real-life data validates the results. The application of the algorithm provides detailed insights for the hospital into the impact of MSS designs on the bed demand in downstream units. It allowed creating MSSs that avoid peaks in bed demand and high weekend occupancy levels in the ICU and the ward.

  1. Radwaste cost savings ampersand mixed waste volume reduction achieved with CO2 decontamination - actual utility history

    International Nuclear Information System (INIS)

    Non-Destructive Cleaning Mobile CO2 Decontamination Facilities have more than 100 months of operational time conducting decontamination at Nuclear Power Stations. During this time we have compiled an extensive database on what has been decontaminated and the cost savings realized. This paper will discuss the following: (1) how the CO2 decontamination process works; (2) what kinds of items have been decontaminated, ranging from tools to underwater TV cameras, and from electric motors to lead shielding; (3) liquid radwaste volume reduction; (4) mixed waste volume reduction; and (5) ALARA dose reduction achievements. In all of these areas, the paper will discuss the actual volumes of materials decontaminated, the DF's achieved, the amounts and types of things free released, and the actual cost savings in all of these areas. All of the data presented will be actual utility data and not the vendor's data. All the experiences presented will be actual power plant experiences. This paper will bring the audience current with the developments and achievements realized with this state-of-the-art decontamination technique. Furthermore, it will give the audience real utility data on cost savings, worker dose reduction, radwaste volume reduction, and mixed waste volume reduction

  2. Nurse telephone triage in Dutch out-of-hours primary care: the relation between history taking and urgency estimation.

    NARCIS (Netherlands)

    Huibers, A.M.J.; Giesen, P.H.; Smits, M.; Mokkink, H.G.A.; Grol, R.P.T.M.; Wensing, M.J.

    2012-01-01

    OBJECTIVE: In the Netherlands, a patient's first contact with a general practitioner cooperative, an out-of-hours primary-care center, is usually with a triage nurse. Previous research has shown that nurses sometimes underestimate the level of urgency, which may be caused by incomplete history takin

  3. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care

    NARCIS (Netherlands)

    Wagemakers, H.P.; Luijsterburg, P.A.; Boks, S.S.; Heintjes, E.M.; Berger, M.Y.; Verhaar, J.A.; Koes, B.W.; Bierma-Zeinstra, S.M.

    2010-01-01

    Wagemakers HP, Luijsterburg PA, Boks SS, Heintjes EM, Berger MY, Verhaar JA, Koes BK, Bierma-Zeinstra SM. Diagnostic accuracy of history taking and physical examination for assessing anterior cruciate ligament lesions of the knee in primary care. Arch Phys Med Rehabil 2010;91:1452-9. Objective: To a

  4. Use of the method oral history in qualitative research: contributions for the mental helth care thematic abstract

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    Mara Cristina Ribeiro

    2014-09-01

    Full Text Available The qualitative research in mental health have been prioritizing investigations over the perceived care within a conjecture of social, political, cultural, ideological and behavioral changes that have been marking the mental health field in the past years. The article aims to discuss the Oral History methodology since its conception until the present days and its possible contributions to the qualitative research in mental health within this new context. The history of psychiatry assistance has always been permeated by experiences of exclusion and stigmatization, and the usage of this methodology allows ones to give voice to those who for years were silenced, as well as narrates the history of the transformations of the care offered in mental health in the perspective of the new protagonists of attention.

  5. Differential utilization of primary health care services among older immigrants and Norwegians: a register-based comparative study in Norway

    OpenAIRE

    Díaz, Esperanza; Kumar, Bernadette N.

    2014-01-01

    Background: Aging in an unfamiliar landscape can pose health challenges for the growing numbers of immigrants and their health care providers. Therefore, better understanding of how different immigrant groups use Primary Health Care (PHC), and the underlying factors that explain utilization is needed to provide adequate and appropriate public health responses. Our aim is to describe and compare the use of PHC between elderly immigrants and Norwegians. Methods: Registry-based study using me...

  6. The effect of Channeling on in-home utilization and subsequent nursing home care: a simultaneous equation perspective.

    OpenAIRE

    Rabiner, D J; Stearns, S C; Mutran, E

    1994-01-01

    OBJECTIVE. This study explored the relationship between participation in a home/community-based long-term care case management intervention (known as the Channeling demonstration), use of formal in-home care, and subsequent nursing home utilization. STUDY DESIGN. Structural analysis of the randomized Channeling intervention was conducted to decompose the total effects of Channeling on nursing home use into direct and indirect effects. DATA COLLECTION METHOD. Secondary data analysis of the Nat...

  7. Integrated remote sensing data utilization for investigating structural and tectonic history of the Ghadames Basin, Libya

    Science.gov (United States)

    Saadi, N. M.; Zaher, M. Abdel; El-Baz, F.; Watanabe, K.

    2011-10-01

    This study was initiated to constrain the geological structure of the Ghadames Basin in northwest Libya. Detailed analysis was based on digital integration of surface data, including SRTM DEM, ETM+ and geologic maps with subsurface data, including well logs and potential field data. Integrated analysis of remotely sensed data of the SRTM and ETM+ were utilized to identify geologic lineaments in the area. Ground-based verification of the remote sensing data was achieved with field work. Interpretation and analysis of the lineaments indicate that the Ghadames Basin is controlled by four main fault systems that trend WNW, NNW, NW and ENE. Well logs and potential field data were used to delineate a detailed picture of the subsurface structure. The potential field data reveal two NE and NNE trending sedimentary basins. The depth of the basement inside the main basin ranges from 2 to 6 km. A two-dimensional (2-D) schematic model shows that the basin gradually deepens towards the southwest. The applied data integration gave new insight into the tectonic and structure patterns of the Ghadames Basin and the adjacent areas of northwest Libya.

  8. Antenatal Care Services Utilization in Yobe State, Nigeria: Examining Predictors and Barriers

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    Abubakar Sadiq Umar, MBBS, MPH, MHPM, FWACP

    2015-10-01

    Full Text Available Objective: In Nigeria, wide disparities exist between the different parts of the country, with the states in the North East zone having poor health resources. The objective of this study is to assess whether women’s biological, sociocultural, and economic characteristics are associated with utilization of ante natal care services as measured by number of antenatal care (ANC visits in Yobe State. Methods: This is a secondary data analysis of the 2008 Nigeria Demographic and Health Survey with records from 33,385 women between 15-49 years who had given birth between January 2003 and December 2008 in Yobe State. Bivariate Pearson’s Chi square test and two stages of Multivariate regression analysis were conducted. Results: Women with at least primary level education (adjusted OR (AOR = 2.40; CI 1.24 – 4.67, belonging to professional employment category (AOR = 12.07; CI 0.19 – 75.74 and those who had access to skilled health workers (AOR = 5.13; CI 2.50 – 10.52 are more likely to make the required number of ANC visits compared to those who are illiterates, unemployed and had no access to skilled health workers. Conclusion and Global Health Implications: This study demonstrated that educational level, family wealth income, and availability of skilled health worker were consistently associated with the number of ANC visits even after controlling for covariates. These three covariates are in tandem with the Millenium Development Goals (MDG 1 – eradication of extreme poverty and hunger; MDG 2 – universal basic education; MDG 3 – gender equality; and MDG 4 – maternal mortality. There is the need for inter-sectoral holistic intervention approach.

  9. Drug utilization study in the otorhinolaryngology department in a tertiary care hospital

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    S. A. Sridevi

    2013-06-01

    Full Text Available Background: Drug utilization is defined by the World Health Organization (WHO as the marketing, distribution, prescription, and use of drugs in society, with special emphasis on the resulting medical, social, and economic consequences. The aim of this study was to evaluate the pattern of prescription and then drug utilization in outpatient (OPD of the Department of Otolaryngology in a tertiary care teaching hospital. Methods: This was a retrospective study conducted at the A.C.S. medical college and hospital, Chennai for a period of 7 months. All the patients who attended the Ear Nose and Throat (ENT OPD were included. The total number who attended the OPD was 10,249 which include 6,956 new cases and 3313 old cases. Results: The antibacterials commonly used were β Lactams (56%, macrolides (14%, fluoroquinolones (12%, aminoglycosides (8%. Among the penicillin group, the commonest drug prescribed was a combination of amoxicillin and clavulanic acid (27%, in cephalosporins was cefixime + clavulanic acid (19%. Aminoglycosides include gentamycin in refractory cases. Fluoroquinolones include ciprofloxacin and levofloxacin. Others Drugs like antihistamines and mucolytics were prescribed in 27%, anti- ulcer drugs in 36% cases, analgesics in 33% cases and herbal medicines in 4%. The average number of drugs used in each prescription was 3.20. All the drugs were prescribed with brand names. The average cost per prescription per day for OPD patients is 37 Rupees. Conclusions: β Lactams were commonly used antibacterials in the otorhinolaryngology department. [Int J Basic Clin Pharmacol 2013; 2(3.000: 306-310

  10. Better Quality of Care or Healthier Patients? Hospital Utilization by Medicare Advantage and Fee-for-Service Enrollees.

    Science.gov (United States)

    Nicholas, Lauren Hersch

    2013-05-15

    Do differences in rates of use among managed care and Fee-for-Service Medicare beneficiaries reflect selection bias or successful care management by insurers? I demonstrate a new method to estimate the treatment effect of insurance status on health care utilization. Using clinical information and risk-adjustment techniques on data on acute admission that are unrelated to recent medical care, I create a proxy measure of unobserved health status. I find that positive selection accounts for between one-quarter and one-third of the risk-adjusted differences in rates of hospitalization for ambulatory care sensitive conditions and elective procedures among Medicare managed care and Fee-for-Service enrollees in 7 years of Healthcare Cost and Utilization Project State Inpatient Databases from Arizona, Florida, New Jersey and New York matched to Medicare enrollment data. Beyond selection effects, I find that managed care plans reduce rates of potentially preventable hospitalizations by 12.5 per 1,000 enrollees (compared to mean of 46 per 1,000) and reduce annual rates of elective admissions by 4 per 1,000 enrollees (mean 18.6 per 1,000).

  11. Regulatory skill as a resilience factor for adults with a history of foster care: a pilot study.

    Science.gov (United States)

    Johnson, Angela J; Tottenham, Nim

    2015-01-01

    Individuals with a history of foster care (FC) are at elevated risk for emotion regulation-related mental illness. The purpose of the current study was to characterize regulatory function in a group of adults with a history of FC (N = 26) relative to those without a history of FC (N = 27) and how regulatory function moderates adverse caregiving-related outcomes (daily cortisol production and trait anxiety). Self-report items (anxiety, emotion regulation strategies, inhibitory control, caregiving history) were collected along with more objective measures (computerized task and salivary cortisol). Inhibitory control was assessed via self-report and a computerized task (emotional face go/nogo). Results showed that for adults with a history of FC, higher levels of inhibitory control were associated with higher accuracy on the emotional face go/nogo task and greater reported use of the emotion regulation strategy cognitive reappraisal. Greater use of cognitive reappraisal in turn was associated with healthier stress-related outcomes (decreased trait anxiety and steeper sloped cortisol production throughout the day). Dose-response associations were observed between self-reported regulatory skills and FC experiences (i.e., number of placements and age when exited foster care). These findings suggest that adverse caregiving can have long-term influences on mental health that extend into adulthood; however, individual differences in regulatory skills moderate these outcomes and may be an important target for intervention following caregiving adversity. PMID:25270099

  12. Does Frailty Predict Health Care Utilization in Community-Living Older Romanians?

    Directory of Open Access Journals (Sweden)

    Marinela Olaroiu

    2016-01-01

    Full Text Available Background. The predictive value of frailty assessment is still debated. We analyzed the predictive value of frailty of independent living elderly. The outcomes variables were visits to the general practitioner, hospital admission, and occurrence of new health problems. Methods. A one-year follow-up study was executed among 215 community-living old Romanians. General practitioners reported the outcome variables of patients, whose frailty was assessed one year before, using the Groningen Frailty Indicator. The predictive validity is analyzed by descriptive and regression analysis. Results. Three-quarters of all participants visited their general practitioner three times more last year and one-third were at least once admitted to a hospital. Patients who scored frail one year before were more often admitted to a hospital. Visits to the general practitioner and occurrence of new health problems were not statistically significant related to frailty scores. The frailty items polypharmacy, social support, and activities in daily living were associated with adverse outcomes. Conclusions. The predictive value of frailty instruments as the Groningen Frailty Indicator is still limited. More research is needed to predict health outcomes, health care utilization, and quality of life of frailty self-assessment instruments. Validation research on frailty in different “environments” is recommended to answer the question to what extent contextual characteristics influence the predictive value.

  13. Utility of immunochromatographic assay as a rapid point of care test for screening of antenatal syphilis

    Directory of Open Access Journals (Sweden)

    Bineeta Kashyap

    2015-01-01

    Full Text Available Background and Objectives: Syphilis is one of the most common preventable causes of adverse effects during pregnancy. Antenatal screening prevents the delay between diagnosis and treatment there by reducing the risk of congenital syphilis. The objective of this study was to evaluate the utility of an immunochromatographic assay as a point of care test for antenatal screening of syphilis. Materials and Methods: Sera of 200 antenatal mothers were evaluated for serodiagnosis of syphilis by the venereal disease research laboratory (VDRL, Treponema pallidum hemagglutination assay (TPHA and SD BIOLINE Syphilis 3.0 test. The performance of SD BIOLINE Syphilis 3.0 test was compared with VDRL as screening assay and TPHA as a confirmatory test. Results: The antenatal prevalence of syphilis was found to be 2% by both VDRL and TPHA. The sensitivity, specificity, positive predictive value, and the negative predictive value of SD BIOLINE Syphilis 3.0 test were 75%, 100%, 100%, and 99.45%, respectively. Conclusions: Antenatal screening and treatment of maternal syphilis are cost-effective health interventions even under the low prevalence of infection. SD BIOLINE Syphilis 3.0 test, although having less sensitivity than the existing testing strategy, can have a tremendous impact on the disease burden if used prudently for the screening of antenatal mothers in peripheral health settings.

  14. The impact of response bias on estimates of health care utilization in a metropolitan area: The use of administrative data

    NARCIS (Netherlands)

    Reijneveld, S.A.; Stronks, K.

    1999-01-01

    Background. Surveys among the general population are an important method for collecting epidemiological data on health and utilization of health care in that population. Selective non-response may affect the validity of these data. This study examines the impact of response bias on estimates of heal

  15. Review of Reports to COSPAR: COSPAR Policy and Guidelines for the Utilization and Care of Animals Used in Space Research

    Science.gov (United States)

    Dunlap, Alex

    The purpose of this session is to review the reports by the various countries that have flown animals in space during the proceeding 2 years to be in compliance with the Cospar resolution: Cospar Policy and Guidelines for the Utilization and Care of Animals Used in Space Research.

  16. Veterans Health Administration and Medicare Outpatient Health Care Utilization by Older Rural and Urban New England Veterans

    Science.gov (United States)

    Weeks, William B.; Bott, David M.; Lamkin, Rebecca P.; Wright, Steven M.

    2005-01-01

    Older veterans often use both the Veterans Health Administration (VHA) and Medicare to obtain health care services. The authors sought to compare outpatient medical service utilization of Medicare-enrolled rural veterans with their urban counterparts in New England. The authors combined VHA and Medicare databases and identified veterans who were…

  17. Eating Disorders in the General Practice : A Case-Control Study on the Utilization of Primary Care

    NARCIS (Netherlands)

    Van Son, Gabrielle E.; Hoek, Hans W.; Van Hoeken, Daphne; Schellevis, Francois G.; Van Furth, Eric F.

    2012-01-01

    Objective To investigate primary care utilization between patients with an eating disorder (ED) and other patient groups, and between the ED subgroups anorexia nervosa (AN) and bulimia nervosa (BN). Method The present study was an observational casecontrol study. In total, 167 patients with ED were

  18. Impact of Utilization of Maternal Health care services: A study of Ganda Community in urban slums in Raipur, Chhattisgarh

    Directory of Open Access Journals (Sweden)

    N. Thakur

    2015-07-01

    Full Text Available Objectives: 1.To study the impact of utilization of maternal health care services among the Ganda mothers an urban slums community. 2. To find out the factors influencing the utilization of maternal health care services. Study Design: Cross sectional study. Setting: 6 urban slums of Raipur Districts. Sample size: All 160 available lactating mothers (15-49 years age. Statistical Analysis: Proportions and Chi-square. Observation: Most (63% mothers received full antenatal check-up, 76.2% had received 2 dose of TT injection, and only 29% consumed prescribed IFA tablets. Majority (80.6% of mothers had delivered at home and 91.4 % of the deliveries were conducted by senior ladies. The important factors associated with low utilization of antenatal care services were belonging to mother’s education, occupation and parity. Conclusion: The present study revealed low utilization of maternal health care practices among the study population; especially in case of consumption of IFA tables and delivery practices. The study can provide new insight for policy makers to devote resources for achieving the best possible quality of maternal and child health services.

  19. Utility of electroencephalogram in altered states of consciousness in intensive care unit patients

    Directory of Open Access Journals (Sweden)

    Kapadia F

    2005-01-01

    Full Text Available BACKGROUND: EEG is an investigative tool for assessing cerebral activity. Although certain EEG patterns may have a specific diagnostic or prognostic inference, they may not be precise for any sole etiology in majority of cases and may need clinical correlation. OBJECTIVE: Aim of this study was to assess the severity and prognosis of cerebral dysfunction in patients admitted to Intensive Care Unit (ICU and to evaluate the incidence of non-convulsive status epilepticus (NCSE. DESIGN: A prospective study, wherein we analyzed EEG characteristics in a series of 70 patients. SETTING: A tertiary care hospital in Mumbai, India. PATIENTS: EEG characteristics of 70 patients admitted in ICU over a period of 9 months were comprehensively analyzed. These patients were clinically examined and a questionnaire was completed without knowledge of the EEG findings. EEGs were requested for by neurologist or intensivist and our inclusion criteria were (i patients with altered sensorium of varying etiology, (ii unconscious patients at risk for non-convulsive status epilepticus (those with a history of epilepsy, and (iii unconscious patients with involuntary jerky eye movements. RESULTS: Of the various clinical presentations on ICU admission, there were 20 patients with seizures, 15 with metabolic disorders, 13 with infective causes, 9 with hypoxia, 9 with cerebro-vascular accident on presentation, 1 patient with alcohol/drug overdose, 2 with intra-cerebral space occupying lesion and 1 with ambiguous etiology on admission (there being an overlap among the presentation. Mean duration from presentation to performing EEG was 13 hours. 64 (91.42% patients had abnormal EEGs. 32(50% patients had EEG slowing and 4(6.25% patient had electro cerebral inactivity. Eleven (21.87% patients had epileptiform activity on the EEG of which seven did not have overt seizures (NCSE. Follow-up EEGs of these patients showed resolution of the epileptiform activity. CONCLUSIONS: EEG is useful

  20. The History of Winter Thermochron Mission: Utilizing An Innovative Technology to Promote Science Research in the Classroom.

    Science.gov (United States)

    Bender, K. J.

    2007-12-01

    The goal of the Thermochron Mission, an embedded strand of the NASA Goddard Space Flight Center History of Winter (HOW) Program, is to engage participants actively in research methods while focusing on the observation and analysis of changes in ambient temperature. Through experiential learning opportunities, peer coaching, and expert instruction sessions, participants including in-service teachers, pre-service teachers, and ultimately their K-12 students, enhance their understanding of the processes and methods of science research. The initial engagement and exploration training has been provided to participants in the History of Winter (HOW) workshop since 2004. Supportive web-based multimedia resources utilized through modeling within the training program are available to participants online for continued later use within a classroom setting. The Thermochron Mission echoes the learning cycle embedded within the History of Winter Program. Emphasized are critical aspects of inquiry investigation including active and immersive experiences, opportunities for comparison and analysis of data, application of findings to new situations, and the communication of information in an appropriate forum. As a result, past HOW participants have utilized the Thermochron in settings as different as environmental studies through an outdoor education center and the study of acid mine drainage and its effect on local stream. In 2007, we collaborated with the FINNMARK 2007 and the GO NORTH expeditions, providing snow collection information and Thermochrons to gather a continual temperature record during these remote expeditions to the Arctic region. Both FINNMARK2007 and the POLAR Husky GoNorth 2007 dog sled expeditions took a complement of Thermochrons with multimedia instructions and the tools and protocols of the Global Snowflake Network (GSN), an International Polar Year project of the History of Winter Program, to measure temperature and the shape and characteristics of snow

  1. Implementation of an electronic genomic and family health history tool in primary prenatal care.

    Science.gov (United States)

    Edelman, Emily A; Lin, Bruce K; Doksum, Teresa; Drohan, Brian; Edelson, Vaughn; Dolan, Siobhan M; Hughes, Kevin S; O'Leary, James; Galvin, Shelley L; Degroat, Nicole; Pardanani, Setul; Feero, W Gregory; Adams, Claire; Jones, Renee; Scott, Joan

    2014-03-01

    "The Pregnancy and Health Profile," (PHP) is a free genetic risk assessment software tool for primary prenatal providers that collects patient-entered family (FHH), personal, and obstetrical health history, performs risk assessment, and presents the provider with clinical decision support during the prenatal encounter. The tool is freely available for download at www.hughesriskapps.net. We evaluated the implementation of PHP in four geographically diverse clinical sites. Retrospective chart reviews were conducted for patients seen prior to the study period and for patients who used the PHP to collect data on documentation of FHH, discussion of cystic fibrosis (CF) and hemoglobinopathy (HB) carrier screening, and CF and HB interventions (tests, referrals). Five hundred pre-implementation phase and 618 implementation phase charts were reviewed. Documentation of a 3-generation FHH or pedigree improved at three sites; patient race/ethnicity at three sites, father of the baby (FOB) race/ethnicity at all sites, and ancestry for the patient and FOB at three sites (P < 0.001-0001). CF counseling improved for implementation phase patients at one site (8% vs. 48%, P < 0.0001) and CF screening/referrals at two (2% vs. 14%, P < 0.0001; 6% vs. 14%; P = 0.05). Counseling and intervention rates did not increase for HB. This preliminary study suggests that the PHP can improve documentation of FHH, race, and ancestry, as well as the compliance with current CF counseling and intervention guidelines in some prenatal clinics. Future evaluation of the PHP should include testing in a larger number of clinical environments, assessment of additional performance measures, and evaluation of the system's overall clinical utility.

  2. The differences in health care utilization between Medical Aid and health insurance: a longitudinal study using propensity score matching.

    Directory of Open Access Journals (Sweden)

    Jae-Hyun Kim

    Full Text Available Health care utilization has progressively increased, especially among Medical Aid beneficiaries in South Korea. The Medical Aid classifies beneficiaries into two categories, type 1 and 2, on the basis of being incapable (those under 18 or over 65 years of age, or disabled or capable of working, respectively. Medical Aid has a high possibility for health care utilization due to high coverage level. In South Korea, the national health insurance (NHI achieved very short time to establish coverage for the entire Korean population. However there there remaine a number of problems to be solved. Therefore, the objective of this study was to investigate the differences in health care utilization between Medical Aid beneficiaries and Health Insurance beneficiaries.Data were collected from the Korean Welfare Panel Study from 2008 to 2012 using propensity score matching. Of the 2,316 research subjects, 579 had Medical Aid and 1,737 had health insurance. We also analyzed three dependent variables: days spent in the hospital, number of outpatient visits, and hospitalizations per year. Analysis of variance and longitudinal data analysis were used.The number of outpatient visits was 1.431 times higher (p<0.0001 in Medical Aid beneficiaries, the number of hospitalizations per year was 1.604 times higher (p<0.0001 in Medical Aid beneficiaries, and the number of days spent in the hospital per year was 1.282 times higher (p<0.268 for Medical Aid beneficiaries than in individuals with Health Insurance. Medical Aid patients had a 0.874 times lower frequency of having an unmet needs due to economic barrier (95% confidence interval: 0.662-1.156.Health insurance coverage has an impact on health care utilization. More health care utilization among Medical Aid beneficiaries appears to have a high possibility of a moral hazard risk under the Health Insurance program. Therefore, the moral hazard for Medical Aid beneficiaries should be avoided.

  3. 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.

  4. Health care utilization and expenditures among Medicaid beneficiaries with neuropathic pain following spinal cord injury

    Directory of Open Access Journals (Sweden)

    Margolis JM

    2014-07-01

    Full Text Available Jay M Margolis,1 Paul Juneau,1 Alesia Sadosky,2 Joseph C Cappelleri,3 Thomas N Bryce,4 Edward C Nieshoff5 1Truven Health Analytics, Bethesda, MD, USA; 2Pfizer Inc., New York, NY, USA; 3Pfizer Inc., Groton, CT, USA; 4Department of Rehabilitation Medicine, The Icahn School of Medicine at Mount Sinai, New York, NY, USA; 5Department of Physical Medicine and Rehabilitation, Wayne State University School of Medicine, Detroit, MI, USA Background: The study aimed to evaluate health care resource utilization (HRU and costs for neuropathic pain (NeP secondary to spinal cord injury (SCI among Medicaid beneficiaries. Methods: The retrospective longitudinal cohort study used Medicaid beneficiary claims with SCI and evidence of NeP (SCI-NeP cohort matched with a cohort without NeP (SCI-only cohort. Patients had continuous Medicaid eligibility 6 months pre- and 12 months postindex, defined by either a diagnosis of central NeP (ICD-9-CM code 338.0x or a pharmacy claim for an NeP-related antiepileptic or antidepressant drug within 12 months following first SCI diagnosis. Demographics, clinical characteristics, HRU, and expenditures were compared between cohorts. Results: Propensity score-matched cohorts each consisted of 546 patients. Postindex percentages of patients with physician office visits, emergency department visits, SCI- and pain-related procedures, and outpatient prescription utilization were all significantly higher for SCI-NeP (P<0.001. Using regression models to account for covariates, adjusted mean expenditures were US$47,518 for SCI-NeP and US$30,150 for SCI only, yielding incremental costs of US$17,369 (95% confidence interval US$9,753 to US$26,555 for SCI-NeP. Factors significantly associated with increased cost included SCI type, trauma-related SCI, and comorbidity burden. Conclusion: Significantly higher HRU and total costs were incurred by Medicaid patients with NeP secondary to SCI compared with matched SCI-only patients. Keywords: spinal

  5. COPD exacerbation frequency and its association with health care resource utilization and costs

    Directory of Open Access Journals (Sweden)

    Dhamane AD

    2015-12-01

    Full Text Available Amol D Dhamane,1 Chad Moretz,2 Yunping Zhou,2 Kate Burslem,1 Kim Saverno,2 Gagan Jain,1 Andrew Renda,3 Shuchita Kaila1 1Boehringer Ingelheim Pharmaceuticals Inc., Ridgefield, CT, USA; 2Comprehensive Health Insights Inc., Louisville, KY, USA; 3Humana Inc., Louisville, KY, USA Background: Chronic obstructive pulmonary disease (COPD exacerbations account for a substantial proportion of COPD-related costs.Objective: To describe COPD exacerbation patterns and assess the association between exacerbation frequency and health care resource utilization (HCRU and costs in patients with COPD in a Medicare population.Methods: A retrospective cohort study utilizing data from a large US national health plan was conducted including patients with a COPD diagnosis during January 1, 2007 to December 31, 2012, aged 40–89 years and continuously enrolled in a Medicare Advantage Prescription Drug plan. Exacerbation frequency, HCRU, and costs were assessed during a 24-month period following the first COPD diagnosis (follow-up period. Four cohorts were created based on exacerbation frequency (zero, one, two, and ≥three. HCRU and costs were compared among the four cohorts using chi-square tests and analysis of variance, respectively. A trend analysis was performed to assess the association between exacerbation frequency and costs using generalized linear models.Results: Of the included 52,459 patients, 44.3% had at least one exacerbation; 26.3%, 9.5%, and 8.5% had one, two, and ≥three exacerbations in the 24-month follow-up period, respectively. HCRU was significantly different among cohorts (all P<0.001. In patients with zero, one, two, and ≥three exacerbations, the percentages of patients experiencing all-cause hospitalizations were 49.7%, 66.4%, 69.7%, and 77.8%, respectively, and those experiencing COPD-related hospitalizations were 0%, 40.4%, 48.1%, and 60.5%, respectively. Mean all-cause total costs (medical and pharmacy were more than twofold greater in

  6. Health Care Utilization and Access to Human Immunodeficiency Virus (HIV) Testing and Care and Treatment Services in a Rural Area with High HIV Prevalence, Nyanza Province, Kenya, 2007

    OpenAIRE

    Ackers, Marta-Louise; Hightower, Allen; Obor, David; Ofware, Peter; Ngere, Lilian; Kubaje, Adazu; Laserson, Kayla F.

    2014-01-01

    We present health and demographic surveillance system data to assess associations with health care utilization and human immunodeficiency virus (HIV) service receipt in a high HIV prevalence area of western Kenya. Eighty-six percent of 15,302 residents indicated a facility/clinician for routine medical services; 60% reported active (within the past year) attendance. Only 34% reported a previous HIV test, and self-reported HIV prevalence was 6%. Active attendees lived only slightly closer to t...

  7. [Art, mental health, and public healthcare: profile of a care culture in the history of São Paulo city].

    Science.gov (United States)

    Galvanese, Ana Tereza Costa; D'Oliveira, Ana Flávia Pires Lucas; Lima, Elizabeth Maria Freire de Araújo; Pereira, Lygia Maria de França; Nascimento, Ana Paula; Nascimento, Andréia de Fátima

    2016-01-01

    By studying the inclusion of artistic and cultural activities in the care provided throughout the history of public mental healthcare in greater São Paulo, Brazil, we can better understand and characterize the practices adopted in the Psychosocial Care Centers in the city today. Experiments carried out between the 1920s and 1990s are investigated, based on bibliographic research. The contemporary data were obtained from research undertaken at 126 workshops at 21 Psychosocial Care Centers in the same city between April 2007 and April 2008. The findings indicate that the current trend in mental healthcare, whose clinical perspective spans the realms of art and mental health and has territorial ramifications, has maintained some of the features encountered in earlier mental healthcare experiments.

  8. [Social history of open care of the mentally ill--from the municipal asylum to social psychiatric care].

    Science.gov (United States)

    Haselbeck, H

    1985-09-01

    Outpatient psychiatric care linked to a hospital or institution is as old as psychiatry defining itself as a science. During the time of the Liberal Movement in Germany and the various revolutions that took place in several European countries (including Austria and various German states) in 1848, people were full of ideas and sociorevolutionary projects. It was then that they became conscious of the need to meet mentally ill persons in their own environment in order to help them in an adequate manner. Griesinger described in great detail such work as envisaged by him for his projected "municipal asylum" or "city asylum". However, all efforts in this direction were quashed in 1868 by a majority decision on the part of psychiatrics in favour of large-scale lunatic asyluma located far away from the densely populated areas. At the turn of the century, social awareness again began to grow; the asylums were overcrowded; and costs had risen tremendously. This resulted in building up a non-institutionalised "open service and care" for the insane. On the one hand, it was an outpatient care system in close co-operation with the asylum, i.e. the patients were looked up in their homes (Erlangen Model), whereas in several big cities the community Public Health Office was responsible for such psychiatric care (Gelsenkirchen Model). In the German Republic that existed from 1919 to 1933, "open" psychiatric care was extended, and the psychiatrist who advocated it were gradually drawn into a maelstrom of a sociodarwinistic type of racialism.(ABSTRACT TRUNCATED AT 250 WORDS) PMID:3903811

  9. Antimicrobial agents' utilization and cost pattern in an Intensive Care Unit of a Teaching Hospital in South India

    Directory of Open Access Journals (Sweden)

    Nikhilesh Anand

    2016-01-01

    Full Text Available Background and Aims: High utilization and inappropriate usage of antimicrobial agents (AMAs in an Intensive Care Unit (ICU increases resistant organisms, morbidity, mortality, and treatment cost. Prescription audit and active feedback are a proven method to check the irrational prescription. Measuring drug utilization in DDD/100 bed-days is proposed by the WHO to analyze and compare the utilization of drugs. Data of AMAs utilization are required for planning an antibiotic policy and for follow-up of intervention strategies. Hence, in this study, we proposed to evaluate the utilization pattern and cost analysis of AMA used in the ICU. Methodology: A prospective observational study was conducted for 1 year from January 1, 2014, to December 31, 2014, and the data were obtained from the ICU of a tertiary care hospital. The demographic data, disease data, relevant investigation, the utilization of different classes of AMAs (WHO-ATC classification as well as individual drugs and their costs were recorded. Results: One thousand eight hundred and sixty-two prescriptions of AMAs were recorded during the study period with an average of 1.73 ± 0.04 prescriptions/patient. About 80.4% patients were prescribed AMAs during admission. Ceftriaxone (22.77% was the most commonly prescribed AMA followed by piperacillin/tazobactam (15.79%, metronidazole (12%, amoxicillin/clavulanic acid (6.44%, and azithromycin (4.34%. Ceftriaxone, piperacillin/tazobactam, metronidazole, and linezolid were the five maximally utilized AMAs with 38.52, 19.22, 14.34, 8.76, and 8.16 DDD/100 bed-days respectively. An average cost of AMAs used per patient was 2213 Indian rupees (INR. Conclusion: A high utilization of AMAs and a high cost of treatment were noticed which was comparable to other published data, though an increased use of newer AMAs such as linezolid, clindamycin, meropenem, colistin was noticed.

  10. A political economic history of medical and dental care in Nunavut, Canada

    OpenAIRE

    Quiñonez, Carlos R.

    2012-01-01

    Objectives. To describe the historical development of medical and dental care in the territory of Nunavut, Canada. Study design. Ethnographic case study using political economy as a mode of explanation. Methods. Participant observations, document reviews and stakeholder interviews, conducted over a four-year period. Results. There is a clear and now long-term movement from state and professionally controlled health care delivery to Indigenous control over care. Conclusions. Indigenous groups ...

  11. 5 CFR 792.218 - Does the law apply only to on-site Federal child care centers that are utilized by Federal families?

    Science.gov (United States)

    2010-01-01

    ... 5 Administrative Personnel 2 2010-01-01 2010-01-01 false Does the law apply only to on-site Federal child care centers that are utilized by Federal families? 792.218 Section 792.218 Administrative... law apply only to on-site Federal child care centers that are utilized by Federal families? The...

  12. Association of socio-economic status with diabetes prevalence and utilization of diabetes care services

    OpenAIRE

    Svenson Lawrence W; Southern Danielle A; Edwards Alun L; Rabi Doreen M; Sargious Peter M; Norton Peter; Larsen Eric T; Ghali William A

    2006-01-01

    Abstract Background Low income appears to be associated with a higher prevalence of diabetes and diabetes related complications, however, little is known about how income influences access to diabetes care. The objective of the present study was to determine whether income is associated with referral to a diabetes centre within a universal health care system. Methods Data on referral for diabetes care, diabetes prevalence and median household income were obtained from a regional Diabetes Educ...

  13. Health care utilization among rural women of child-bearing age: a Nigerian experience

    OpenAIRE

    Odetola, Titilayo Dorothy

    2015-01-01

    Introduction Despite the availability of primary health care services in virtually every community and village in Nigeria, clients travel long distances to reach secondary and tertiary health care institutions. Against this backdrop, the researcher sought to find the factors that influence choice of health institutions among pregnant women. Methods A descriptive study was carried out across three levels of health care institutions with a total sample size of 160 clients who were randomly sele...

  14. Utilizing RxNorm to Support Practical Computing Applications: Capturing Medication History in Live Electronic Health Records

    CERN Document Server

    Bennett, Casey

    2012-01-01

    RxNorm was utilized as the basis for direct-capture of medication history data in a live EHR system deployed in a large, multi-state outpatient behavioral healthcare provider in the United States serving over 75,000 distinct patients each year across 130 clinical locations. This tool incorporated auto-complete search functionality for medications and proper dosage identification assistance. The overarching goal was to understand if and how standardized terminologies like RxNorm can be used to support practical computing applications in live EHR systems. We describe the stages of implementation, approaches used to adapt RxNorm's data structure for the intended EHR application, and the challenges faced. We evaluate the implementation using a four-factor framework addressing flexibility, speed, data integrity, and medication coverage. RxNorm proved to be functional for the intended application, given appropriate adaptations to address high-speed input/output (I/O) requirements of a live EHR and the flexibility r...

  15. The skeleton in the closet: should historians of science care about the history of mathematics?

    Science.gov (United States)

    Alexander, Amir

    2011-09-01

    Up until the 1950s, the history of mathematics was an integral part of the history of science. To George Sarton and his contemporaries, mathematics was the rational skeleton that organized science and held it together, and its history was a fundamental component of the broader history of science. But when historians began focusing on the cultural roots of science rather than its rational structure, the study of mathematics was marginalized and ultimately excluded from the history of science. The alienation between the two fields is detrimental to both, and in recent years there has been a sustained effort to reestablish meaningful communication between the two. This time, however, mathematics is seen not as the static skeleton of science but, instead, as a dynamic and historically evolving field in its own right-just like science itself. The new approach allows for a culturally sensitive study of mathematics, as well as a new and fruitful relationship between the history of science and the history of mathematics. The essays in this Focus section offer a sampling of the new approaches, opening the way to a rapprochement between fields that have gone their separate ways but should by rights be closely interconnected.

  16. An Analysis of Foster Care Placement History and Post-Secondary Graduation Rates

    Science.gov (United States)

    Day, Angelique; Dworsky, Amy; Feng, Wenning

    2013-01-01

    Prior research has document significant disparities in post-secondary educational attainment between young adults who had been in foster care and their peers in the general population. This study uses survival analysis to compare the four-year college graduation rate of students who had been in foster care to the graduation rate of first…

  17. Evaluation of Access, a Primary Care Program for Indigent Patients: Inpatient and Emergency Room Utilization.

    Science.gov (United States)

    Davidson, Richard A.; Giancola, Angela; Gast, Andrea; Ho, Janice; Waddell, Rhondda

    2003-01-01

    Evaluated the impact of Accessing Community Care through Eastside Social Services (ACCESS), a program that provided indigent patients with free primary care, on inpatient admissions, emergency room (ER) visits, and subsequent charges. Data on 19 people before and after program enrollment showed significant decreases in ER visits following…

  18. 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...

  19. Utilization of In-Hospital Care among Foreign-Born Compared to Native Swedes 1987–1999

    Directory of Open Access Journals (Sweden)

    Björn Albin

    2012-01-01

    Full Text Available In previous longitudinal studies of mortality and morbidity among foreign-born and native-born Swedes, increased mortality and dissimilarities in mortality pattern were found. The aim of this study is to describe, compare, and analyse the utilization of in-hospital care among deceased foreign- and Swedish-born persons during the years 1987–1999 with focus on four diagnostic categories. The study population consisted of 361,974 foreign-born persons aged 16 years and upward who were registered as living in Sweden in 1970, together with 361,974 matched Swedish controls for each person. Data from Statistics Sweden (SCB and the National Board of Health and Welfare Centre for Epidemiology, covering the period 1970–1999, was used. Persons were selected if they were admitted to hospital during 1987–1999 and the cause of death was in one of four ICD groups. The results indicate a tendency towards less health care utilization among migrants, especially men, as regards Symptoms, signs, and ill-defined conditions and Injury and poisoning. Further studies are needed to explore the possible explanations and the pattern of other diseases to see whether migrants, and especially migrant men, are a risk group with less utilization of health care.

  20. Knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia

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    Yisma Engida

    2013-01-01

    Full Text Available Abstract Background Globally, there was an estimated number of 287,000 maternal deaths in 2010. Eighty five percent (245,000 of these deaths occurred in Sub-Saharan Africa and Southern Asia. Among the causes of these deaths were obstructed and prolonged labour which could be prevented by cost effective and affordable health interventions like the use of the partograph. The Use of the partograph is a well-known best practice for quality monitoring of labour and subsequent prevention of obstructed and prolonged labour. However, a number of cases of obstructed labour do happen in health facilities due to poor quality of intrapartum care. Methods A cross-sectional quantitative study assessed knowledge and utilization of partograph among obstetric care givers in public health institutions of Addis Ababa, Ethiopia using a structured interviewer administered questionnaire. The collected data was analyzed using SPSS version 16.0. Logistic regression analysis was used to identify factors associated with knowledge and use of partograph among obstetric care givers. Results Knowledge about the partograph was fair: 189 (96.6% of all the respondents correctly mentioned at least one component of the partograph, 104 (53.3% correctly explained the function of alert line and 161 (82.6% correctly explained the function of action line. The study showed that 112 (57.3% of the obstetric care givers at public health institutions reportedly utilized partograph to monitor mothers in labour. The utilization of the partograph was significantly higher among obstetric care givers working in health centres (67.9% compared to those working in hospitals (34.4% [Adjusted OR = 3.63(95%CI: 1.81, 7.28]. Conclusions A significant percentage of obstetric care givers had fair knowledge of the partograph and why it is necessary to use it in the management of labour and over half of obstetric care givers reported use of the partograph to monitor mothers in labour. Pre-service and

  1. Epidemiology and cost of hospital care for Lyme borreliosis in Germany: lessons from a health care utilization database analysis.

    Science.gov (United States)

    Lohr, B; Müller, I; Mai, M; Norris, D E; Schöffski, O; Hunfeld, K-P

    2015-02-01

    To date, relatively little is known about the economic and medical impact of Lyme borreliosis (LB) on European health care systems, especially for the inpatient sector. This retrospective analysis is based on data provided for the years 2007-2011 by a German statutory health insurance company (DAK-Gesundheit) covering approximately 6 million insured. Total cost was calculated for a 1-year period both from the third-party payers and from the societal perspective, respectively. In our cohort the incident diagnosis of LB was coded for 2163 inpatient cases during the years 2008-2011. The median inpatient time was 9 days resulting in a median direct medical cost per hospital stay of 3917€ for adolescents and 2843€ for adults. Based on extrapolation of our findings to the German population, we would expect an average hospital admission of 5200 adults and 2300 adolescents (<18 years) for LB treatment incurring direct medical costs of more than 23 million Euro annually. The annual indirect costs due to loss of productivity would add up to more than 7 million Euro as assessed by the human capital method. Cases tended to accumulate between June and September with remarkable changes in disease manifestations in the course of the year documented in the coded secondary diagnoses. Also specific differences in the disease pattern of adolescents and adults became obvious. Age-specific incidence showed male predominance and a bimodal distribution. Incidence was highest in children aged between 3 and 17 (highest mean incidence of 29 cases/100,000 inhabitants in 6-9 year olds) with a second peak in 60-79 year old individuals. During the study period the nationwide inpatient incidence was 9/100,000 with marked regional variability. In summary, our study is one of the first European investigations on hospital care for LB inpatients and identifies LB as a possibly underestimated socioeconomic factor for health care in Germany.

  2. The History of the Animal Care Program at NASA Johnson Space Center

    Science.gov (United States)

    Khan-Mayberry, Noreen; Bassett, Stephanie

    2010-01-01

    This slide presentation reviews the work of the Animal Care Program (ACP). Animals have been used early in space exploration to ascertain if it were possible to launch a manned spacecraft. The program is currently involved in many studies that assist in enhancing the scientific knowledge of the effect of space travel. The responsibilities of the ACP are: (1) Organize and supervise animal care operations & activities (research, testing & demonstration). (2) Maintain full accreditation by the International Association for the Assessment and Accreditation of Laboratory Animal Care (AAALAC) (3) Ensure protocol compliance with IACUC recommendations (4) Training astronauts for in-flight animal experiments (5) Maintain accurate & timely records for all animal research testing approved by JSC IACUC (6) Organize IACUC meetings and assist IACUC members (7) Coordinate IACUC review of the Institutional Program for Humane Care and Use of Animals (every 6 mos)

  3. Impact of exacerbations on health care cost and resource utilization in chronic obstructive pulmonary disease patients with chronic bronchitis from a predominantly Medicare population

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    Pasquale MK

    2012-11-01

    Full Text Available Margaret K Pasquale,1 Shawn X Sun,2 Frank Song,1 Heather J Hartnett,1 Stephen A Stemkowski11Competitive Health Analytics, Louisville, KY, USA; 2Health Economics and Outcomes Research, Forest Research Institute, Jersey City, NJ, USABackground: Exacerbations of chronic obstructive pulmonary disease (COPD lead to significant increases in resource utilization and cost to the health care system. COPD patients with chronic bronchitis and a history of exacerbations pose an additional burden to the system. This study examined health care utilization and cost among these patients.Methods: For this retrospective analysis, data were extracted from a large national health plan with a predominantly Medicare population. This study involved patients who were aged 40–89 years, had been enrolled continuously for 24 months or more, had at least two separate insurance claims for COPD with chronic bronchitis (International Classification of Diseases, Ninth Revision, Clinical Modification code 491.xx, and had pharmacy claims for COPD maintenance medications between January 1, 2007, and March 31, 2009. Two years of data were examined for each patient; the index date was defined as the first occurrence of COPD. Baseline characteristics were obtained from the first year of data, with health outcomes tracked in the second year. Severe exacerbation was defined by COPD-related hospitalization or death; moderate exacerbation was defined by oral or parenteral corticosteroid use. Adjusted numbers of exacerbations and COPD-related costs per patient were estimated controlling for demographic and clinical characteristics.Results: The final study sample involved 8554 patients; mean age was 70.1 ± 8.6 years and 49.8% of the overall population had exacerbation, 13.9% had a severe exacerbation only, 29.1% had a moderate exacerbation only, and 6.8% had both a severe and moderate exacerbation. COPD-related mean annual costs were $4069 (all figures given in US dollars for the

  4. Utilization of Maternal Care Services in Urban area: Still an Issue of Modern World

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    Neha Bavarva, Prakash Patel, R K Bansal

    2015-01-01

    Conclusion: Though the overall rate of home delivery was less, most of the reasons cited for the home delivery are avoidable, especially when most mothers came into contact of health care system at least once."

  5. The Spillover Effects of Medicare Managed Care: Medicare Advantage and Hospital Utilization

    OpenAIRE

    Katherine Baicker; Michael Chernew; Jacob Robbins

    2013-01-01

    More than a quarter of Medicare beneficiaries are enrolled in Medicare Advantage, which was created in large part to improve the efficiency of health care delivery by promoting competition among private managed care plans. This paper explores the spillover effects of the Medicare Advantage program on the traditional Medicare program and other patients, taking advantage of changes in Medicare Advantage payment policy to isolate exogenous increases in Medicare Advantage enrollment and trace out...

  6. Utilization and cost of a new model of care for managing acute knee injuries: the Calgary acute knee injury clinic

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    Lau Breda HF

    2012-12-01

    Full Text Available Abstract Background Musculoskeletal disorders (MSDs affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC. The goal of this paper is to evaluate and report on the appropriateness, efficiency, and effectiveness of the C-AKIC through healthcare utilization and costs associated with acute knee injuries. Methods This quasi-experimental study measured and evaluated cost and utilization associated with specific healthcare services for patients presenting with acute knee injuries. The goal was to compare patients receiving care from two clinical care pathways: the existing pathway (i.e. comparison group and a new model, the C-AKIC (i.e. experimental group. This was accomplished through the use of a Healthcare Access and Patient Satisfaction Questionnaire (HAPSQ. Results Data from 138 questionnaires were analyzed in the experimental group and 136 in the comparison group. A post-hoc analysis determined that both groups were statistically similar in socio-demographic characteristics. With respect to utilization, patients receiving care through the C-AKIC used significantly less resources. Overall, patients receiving care through the C-AKIC incurred 37% of the cost of patients with knee injuries in the comparison group and significantly incurred less costs when compared to the comparison group. The total aggregate average cost for the C-AKIC group was $2,549.59 compared to $6,954.33 for the comparison group (p Conclusions The Calgary Acute Knee Injury Clinic was able to manage and treat knee injured patients for less cost than the existing state of healthcare delivery. The

  7. When homogeneity meets heterogeneity: the geographically weighted regression with spatial lag approach to prenatal care utilization.

    Science.gov (United States)

    Shoff, Carla; Chen, Vivian Yi-Ju; Yang, Tse-Chuan

    2014-05-01

    Using geographically weighted regression (GWR), a recent study by Shoff and colleagues (2012) investigated the place-specific risk factors for prenatal care utilisation in the United States of America (USA) and found that most of the relationships between late or no prenatal care and its determinants are spatially heterogeneous. However, the GWR approach may be subject to the confounding effect of spatial homogeneity. The goal of this study was to address this concern by including both spatial homogeneity and heterogeneity into the analysis. Specifically, we employed an analytic framework where a spatially lagged (SL) effect of the dependent variable is incorporated into the GWR model, which is called GWR-SL. Using this framework, we found evidence to argue that spatial homogeneity is neglected in the study by Shoff et al. (2012) and that the results change after considering the SL effect of prenatal care utilisation. The GWR-SL approach allowed us to gain a placespecific understanding of prenatal care utilisation in USA counties. In addition, we compared the GWR-SL results with the results of conventional approaches (i.e., ordinary least squares and spatial lag models) and found that GWR-SL is the preferred modelling approach. The new findings help us to better estimate how the predictors are associated with prenatal care utilisation across space, and determine whether and how the level of prenatal care utilisation in neighbouring counties matters. PMID:24893033

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

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    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.

  9. Pressure ulcer status and post-discharge health care resource utilization among older adults with activity limitations.

    Science.gov (United States)

    Allman, R M; Damiano, A M; Strauss, M J

    1996-01-01

    In a prospective cohort study, we evaluated post-discharge health care utilization for patients 65 years of age or older whose activity was limited to bed or chair at the time of hospital admission. Post-discharge health care utilization was compared for those who did and those who did not develop a pressure ulcer during the hospital stay. Resource utilization was assessed using Medicare charges and payments reported for 1 year following the date of discharge. Pressure ulcer status during the index hospitalization was determined by study nurses. Sociodemographic data (age, gender, race, marital status) were recorded from the medical record. During the hospital stay, measures of severity of illness, occurrence of infections and other complications, service type (medical or surgical), ICU admission, and major and minor surgery were documented. At the time of discharge, the primary care nurse noted whether the patient was still confined to bed or chair and whether he or she was discharged to a nursing home. The study patients used substantial health care resources in the year following the index hospitalization, with mean Medicare charges and payments of $24,027 and $11,123, respectively. Eleven percent of the patients had developed pressure ulcers during the index hospitalization. These patients incurred Medicare payments during the 12-month post-discharge period that were, on average, $13 higher per day of follow-up than those of patients who had been at risk for, but did not develop, pressure ulcers during the index hospitalization (p = .02). Multivariate analyses suggested that activity limitation to bed or chair is an independent predictor of Medicare payments post-discharge. The in-hospital development of pressure ulcers is associated with higher daily Medicare payments in the year post-discharge, but this association does not remain statistically significant after adjusting for activity level at the time of hospital discharge. PMID:8845997

  10. Janani Suraksha Yojana : Its utilization and perception among mothers and health care providers in a rural area of North India

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    Vikas Kumar

    2015-04-01

    Full Text Available Background: Janani Suraksha Yojana (JSY is a maternal protection scheme that promotes institutional delivery by providing cash incentive to the mothers who deliver their babies in a health facility. With the purpose of improving maternal and neo-natal mortality and morbidity indicators, the investment and emphasis on JSY is continued. Utilization pattern and perception in the community regarding a particular health program is important to study for assessing the success or failure of the program. Objectives: To assess the utilization of JSY and its perception among mothers and health care providers. Materials and Methods: A descriptive, cross-sectional, community based study was Conducted at Agra district of Uttar Pradesh, among 246 married women of reproductive age group who had childbirth after JSY implementation for assessing their utilization pattern and perception regarding JSY services. Perception regarding the strengths and weaknesses of JSY among the health care providers was also studied. Results: Nearly half (53.25% of the mothers studied had an institutional delivery and were eligible for the JSY benefits. Postnatal home visits by Accredited Social Health Activists were done in 48% of home and 100% of institutional deliveries. Nearly half (48.09% of the beneficiaries were benefited by free transport facility under JSY. Although all of the health care providers perceived JSY as beneficial for improving maternal health, 44% of them had the notion that cash incentives under JSY can have a negative effect on family planning practices. Conclusion: The utilization rate of the JSY services was found to be low in certain aspects like institutional deliveries, transport facility etc., and there is scope for improvement.

  11. Drug utilization pattern of analgesics in various departments of a tertiary care teaching rural dental hospital

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    Nirav N. Patel

    2014-10-01

    Conclusions: Drug utilization data can help to formulate appropriate clinical guidelines for drug use and facilitate rational use of medicines in population. [Int J Basic Clin Pharmacol 2014; 3(5.000: 804-806

  12. Physical activity history and end-of-life hospital and long-term care

    DEFF Research Database (Denmark)

    von Bonsdorff, Mikaela B; Rantanen, Taina; Leinonen, Raija;

    2009-01-01

    persons aged 66-98 years at death, who, on average 5.8 years prior to death, had participated in an interview about their current and earlier physical activity. Data on the use of care in the last year of life are register-based data and complete. RESULTS: Men needed on average 96 days (SD 7.0) and women......BACKGROUND: Little is known about the early predictors of need for care in late life. The purpose of this study was to investigate whether physical activity from midlife onward was associated with hospital and long-term care in the last year of life. METHODS: We studied a decedent population of 846...... 138 days (SD 6.2) of inpatient care in the last year of life. Among men, the risk for all-cause hospital care in the last year of life was higher for those who had been sedentary since midlife (adjusted incidence rate ratio [IRR] 1.98, 95% confidence interval [CI] 1.14-3.42) compared with those who...

  13. Seasonal pattern of psychiatry service utilization in a tertiary care hospital

    OpenAIRE

    Singh, Gurvinder Pal; Chavan, B.S.; Arun, Priti; Sidana, Ajeet

    2007-01-01

    Background: Seasonal and monthly variations in utilization of psychiatric services have been inadequately studied in India. Aims: This study sought to determine the pattern of psychiatric services utilization by patients with four broad categories of diagnosis (mood disorders (F30-39): neurotic stress-related and somatoform disorders (F40-48), schizophrenia, schizotypal and delusional disorders (F20-29) and mental and behavioral disorders due to psychoactive substance use (F10-19) in differen...

  14. Inequity in maternal health care service utilization in Gujarat: analyses of district-level health survey data

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    Dileep V. Mavalankar

    2013-03-01

    Full Text Available Background: Two decades after the launch of the Safe Motherhood campaign, India still accounts for at least a quarter of maternal death globally. Gujarat is one of the most economically developed states of India, but progress in the social sector has not been commensurate with economic growth. The purpose of this study was to use district-level data to gain a better understanding of equity in access to maternal health care and to draw the attention of the policy planers to monitor equity in maternal care. Methods: Secondary data analyses were performed among 7,534 ever-married women who delivered since January 2004 in the District Level Household and Facility Survey (DLHS-3 carried out during 2007–2008 in Gujarat, India. Based on the conceptual framework designed by the Commission on the Social Determinants of Health, associations were assessed between three outcomes – Institutional delivery, antenatal care (ANC, and use of modern contraception – and selected intermediary and structural determinants of health using multiple logistic regression. Results: Inequities in maternal health care utilization persist in Gujarat. Structural determinants like caste group, wealth, and education were all significantly associated with access to the minimum three antenatal care visits, institutional deliveries, and use of any modern method of contraceptive. There is a significant relationship between being poor and access to less utilization of ANC services independent of caste category or residence. Discussion and conclusions: Poverty is the most important determinant of non-use of maternal health services in Gujarat. In addition, social position (i.e. caste has a strong independent effect on maternal health service use. More focused and targeted efforts towards these disadvantaged groups needs to be taken at policy level in order to achieve targets and goals laid out as per the MDGs. In particular, the Government of Gujarat should invest more in basic

  15. Thinking and Caring about Indigenous Peoples' Human Rights: Swedish Students Writing History beyond Scholarly Debate

    Science.gov (United States)

    Nygren, Thomas

    2016-01-01

    According to national and international guidelines, schools should promote historical thinking and foster moral values. Scholars have debated, but not analysed in depth in practice, whether history education can and should hold a normative dimension. This study analyses current human rights education in two Swedish senior high school groups, in…

  16. Utilizing Trigger Films to Enhance Communication Skills of Home Care Clinicians.

    Science.gov (United States)

    Brennan-Cook, Jill; Molloy, Margory A

    2016-01-01

    The purpose of this article is to describe an innovative method to help home care clinicians better communicate with older adults experiencing normal physiologic changes that impact their ability to communicate effectively. Developmental changes such as hearing, speech, vision, and cognition profoundly impede an older adult's ability to communicate with others, potentially undermining the quality of care delivered. The use of trigger films as an educational intervention can assist home care clinicians to improve communication with their patients. Trigger films are 2- to 4-minute video clips that end abruptly, encouraging learners to analyze clinical situations in a safe environment, such as a staff conference room. Trigger films are easy to make with the use of a smart phone and two staff members portraying the role of home care clinician and patient. Allowing discussion after viewing the trigger film places clinicians in an active learning role, thus fostering the sharing of ideas and best practice. Addressing age-related barriers to communication with this modality serves to improve patient interaction and healthcare outcomes. The use of trigger films is another tool that empowers the clinician to provide improved care for patients with communication deficits.

  17. Utilizing Trigger Films to Enhance Communication Skills of Home Care Clinicians.

    Science.gov (United States)

    Brennan-Cook, Jill; Molloy, Margory A

    2016-01-01

    The purpose of this article is to describe an innovative method to help home care clinicians better communicate with older adults experiencing normal physiologic changes that impact their ability to communicate effectively. Developmental changes such as hearing, speech, vision, and cognition profoundly impede an older adult's ability to communicate with others, potentially undermining the quality of care delivered. The use of trigger films as an educational intervention can assist home care clinicians to improve communication with their patients. Trigger films are 2- to 4-minute video clips that end abruptly, encouraging learners to analyze clinical situations in a safe environment, such as a staff conference room. Trigger films are easy to make with the use of a smart phone and two staff members portraying the role of home care clinician and patient. Allowing discussion after viewing the trigger film places clinicians in an active learning role, thus fostering the sharing of ideas and best practice. Addressing age-related barriers to communication with this modality serves to improve patient interaction and healthcare outcomes. The use of trigger films is another tool that empowers the clinician to provide improved care for patients with communication deficits. PMID:27348031

  18. Socio-economic and Demographic Determinants of Antenatal Care Services Utilization in Central Nepal

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    Srijana Pandey, PhD

    2014-09-01

    Full Text Available Background/Objective: The importance of maternal health services in lessening maternal mortality and morbidity as well as neonatal deaths has received substantial recognition in the past decade. The lack of antenatal care has been identified as a risk factor for maternal mortality and other adverse pregnancy outcomes. The purpose of this study was to determine the factors affecting attendance of antenatal care services in Nepal. Methods: This is a cross-sectional descriptive study carried out in Central Nepal. Using semi-structured questionnaire, interviews were conducted with married women aged between 15-49 years, who had delivered their babies within one year. Systematic random sampling method was used to select the sample. Results were obtained by frequency distribution and cross-tabulation of the variables. Results: More than half of the women were not aware of the consequences of lack of antenatal care. Age, education, income, type of family were strongly associated with the attendance at antenatal care service. Conclusions and Public Health Implications: In Nepal and in other developing countries, maternal mortality and morbidity continue to pose challenges to the health care delivery system. Variety of factors including socio-demographic, socio-economic, cultural and service availability as well as accessibility influences the use of maternal health services.

  19. Inequalities in maternal health care utilization in sub-Saharan African countries: a multiyear and multi-country analysis.

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    Nazmul Alam

    Full Text Available To assess social inequalities in the use of antenatal care (ANC, facility based delivery (FBD, and modern contraception (MC in two contrasting groups of countries in sub-Saharan Africa divided based on their progress towards maternal mortality reduction. Six countries were included in this study. Three countries (Ethiopia, Madagascar, and Uganda had 4.5% average annual reduction rate while another three (Cameroon, Zambia, and Zimbabwe had >550 MMR in 2010 with only <1.5% average annual reduction rate. All of these countries had at least three rounds of Demographic and Health Surveys (DHS before 2012. We measured rate ratios and differences, as well as relative and absolute concentration indices in order to examine within-country geographical and wealth-based inequalities in the utilization of ANC, FBD, and MC. In the countries which have made sufficient progress (i.e. Ethiopia, Madagascar, and Uganda, ANC use increased by 8.7, 9.3 and 5.7 percent, respectively, while the utilization of FBD increased by 4.7, 0.7 and 20.2 percent, respectively, over the last decade. By contrast, utilization of these services either plateaued or decreased in countries which did not make progress towards reducing maternal mortality, with the exception of Cameroon. Utilization of MC increased in all six countries but remained very low, with a high of 40.5% in Zimbabwe and low of 16.1% in Cameroon as of 2011. In general, relative measures of inequalities were found to have declined overtime in countries making progress towards reducing maternal mortality. In countries with insufficient progress towards maternal mortality reduction, these indicators remained stagnant or increased. Absolute measures for geographical and wealth-based inequalities remained high invariably in all six countries. The increasing trend in the utilization of maternal care services was found to concur with a steady decline in maternal mortality. Relative inequality declined overtime in countries

  20. Managing schizophrenia in primary care: the utility of remission criteria as outcome indicators.

    Science.gov (United States)

    Fear, Christopher; Yeomans, David; Moore, Bryan; Taylor, Mark; Ford, Keith; Currie, Alan; Hynes, Joanne; Sullivan, Gary; Whale, Richard; Burns, Tom

    2009-06-01

    The shared management of patients with schizophrenia in primary care can only succeed if underpinned by valid, easily administered and clinically relevant outcome measures. While conditions such as depression and anxiety lend themselves to this approach through the development, over a number of years, of patient- and observer-rated scales, schizophrenia still lacks the capacity for meaningful outcome measures. Recently, two international working groups have developed the concept of remission in schizophrenia and recommended a simple, brief and clinically valid measure based upon improvement in key symptoms over a specified time period. The authors consider this concept and its application to primary care both as a commissioning tool and to facilitate shared care of this chronic medical condition. PMID:22477899

  1. Are Husbands Involving in Their Spouses' Utilization of Maternal Care Services?: A Cross-Sectional Study in Yangon, Myanmar.

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    Kyi Mar Wai

    Full Text Available Husbands can play a crucial role in pregnancy and childbirth, especially in patriarchal societies of developing countries. In Myanmar, despite the critical influence of husbands on the health of mothers and newborns, their roles in maternal health have not been well explored. Therefore, the aim of this study was to identify the factors associated with husbands' involvement in maternal health in Myanmar. This study also examined the associations between husbands' involvement and their spouses' utilization of maternal care services during antenatal, delivery and postnatal periods.A community-based, cross sectional study was conducted with 426 husbands in Thingangyun Township, Yangon, Myanmar. Participants were husbands aged 18 years or older who had at least one child within two years at the time of interview. Face to face interviews were conducted using a pretested structured questionnaire. Factors associated with the characteristics of husband's involvement as well as their spouses' utilization of maternal care services were analyzed by multivariable logistic regression models.Of 426 husbands, 64.8% accompanied their spouses for an antenatal visit more than once while 51.6% accompanied them for a postnatal visit. Husbands were major financial supporters for both antenatal (95.8% and postnatal care (68.5%. Overall, 69.7% were involved in decision making about the place of delivery. Regarding birth preparedness, the majority of husbands prepared for skilled birth attendance (91.1%, delivery place (83.6%, and money saving (81.7% before their spouses gave birth. In contrast, fewer planned for a potential blood donor (15.5% and a safe delivery kit (21.1%. In the context of maternal health, predictors of husband's involvement were parity, educational level, type of marriage, decision making level in family, exposure to maternal health education and perception of risk during pregnancy and childbirth. Increased utilization of maternal health services

  2. "Finding a way out": Case histories of mental health care-seeking and recovery among long-term internally displaced persons in Georgia.

    Science.gov (United States)

    Singh, Namrita S; Jakhaia, Nino; Amonashvili, Nino; Winch, Peter J

    2016-04-01

    Trajectories of illness and recovery are ongoing and incomplete processes cocreated by individuals, their informal support networks, formal care-givers and treatment contexts, and broader social systems. This analysis presents two case histories of care-seeking for, and recovery from, mental illness and psychosocial problems in the context of protracted internal displacement. These case histories present individuals with experiences of schizophrenia and depression drawn from a sample of adult long-term internally displaced persons (IDPs) in Georgia, a country in the South Caucasus. Dimensions of care-seeking were compiled into a matrix for analysis. Interviews were open coded, and codes were linked with matrix dimensions to construct each case history. Findings illustrated that individuals moved cyclically among self-care, household support, lay care, and formal services domains to understand and manage their problems. Living with mental illness and within displacement are experiences that intersect at various points, including in the recognition and perceived causes of illness, stressors such as discrimination and isolation, the affordability and availability of services, and the capacity of social networks to provide informal care. Interventions are needed to support informal care-givers and build lay referral networks, as well as to identify intervention points within care-seeking processes. Interventions that target the mental health needs of displaced persons have the potential to contribute to the development of an innovative community mental health care system in Georgia.

  3. "Finding a way out": Case histories of mental health care-seeking and recovery among long-term internally displaced persons in Georgia.

    Science.gov (United States)

    Singh, Namrita S; Jakhaia, Nino; Amonashvili, Nino; Winch, Peter J

    2016-04-01

    Trajectories of illness and recovery are ongoing and incomplete processes cocreated by individuals, their informal support networks, formal care-givers and treatment contexts, and broader social systems. This analysis presents two case histories of care-seeking for, and recovery from, mental illness and psychosocial problems in the context of protracted internal displacement. These case histories present individuals with experiences of schizophrenia and depression drawn from a sample of adult long-term internally displaced persons (IDPs) in Georgia, a country in the South Caucasus. Dimensions of care-seeking were compiled into a matrix for analysis. Interviews were open coded, and codes were linked with matrix dimensions to construct each case history. Findings illustrated that individuals moved cyclically among self-care, household support, lay care, and formal services domains to understand and manage their problems. Living with mental illness and within displacement are experiences that intersect at various points, including in the recognition and perceived causes of illness, stressors such as discrimination and isolation, the affordability and availability of services, and the capacity of social networks to provide informal care. Interventions are needed to support informal care-givers and build lay referral networks, as well as to identify intervention points within care-seeking processes. Interventions that target the mental health needs of displaced persons have the potential to contribute to the development of an innovative community mental health care system in Georgia. PMID:26698164

  4. Maternal Health Care Utilization Among HIV-Positive Female Adolescents in Kenya

    NARCIS (Netherlands)

    H. Birungi; F. Obare; A. van der Kwaak; J.H. Namwebya

    2011-01-01

    CONTEXT: Given the health risks of HIV/AIDS and the risks of teenage pregnancy in general, pregnant HIV-positive adolescents in Kenya need maternal health care services that account for their HIV status. However, research on their access to and use of these services is scant. METHODS: To examine mat

  5. First-Year Residents' Caring, Medical Knowledge, and Clinical Judgment in Relation to Laboratory Utilization.

    Science.gov (United States)

    Yarnold, Paul R.; And Others

    1994-01-01

    A study of 36 first-year Northwestern University (Illinois) medical residents found that students' medical knowledge was a predictor of increased laboratory test use, that clinical judgment was a predictor of decreased laboratory use, and that level of caring was statistically unrelated to amount of laboratory use. (Author/MSE)

  6. Drug utilization study in postoperative patients in obstetrics and gynaecology ward of tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Rajeshwari Neela

    2016-04-01

    Conclusions: The present study provides valuable insight about the overall pattern of drug used in postoperative patients. The study is useful in decreasing the irrational prescription, which helps to decrease the morbidity and health care burden in the society. [Int J Basic Clin Pharmacol 2016; 5(2.000: 329-334

  7. Importance of healthcare utilization and multimorbidity level in choosing a primary care provider in Sweden

    DEFF Research Database (Denmark)

    Ranstad, Karin; Midlöv, Patrik; Halling, Anders

    2014-01-01

    -test, correlations, and logistic regression modelling in four separate models. SETTING AND SUBJECTS: The population (151 731) and all healthcare in Blekinge in 2007. MAIN OUTCOME MEASURE: Actively or passively listed in primary care, registered on 31 December 2007. RESULTS: Number of consultations (OR 1.31, 95% CI 1...

  8. 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.

  9. Application of Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS) to psychiatric practice in Japan: a preliminary assessment of validity and sensitivity to change.

    Science.gov (United States)

    Kimura, Taku; Yagi, Fukashi; Yoshizumi, Akira

    2013-08-01

    We applied an American medical necessity scale, Level of Care Utilization System for Psychiatric and Addiction Services (LOCUS), to psychiatric practice in Japan. This is an exploratory analysis of empirical data of 272 patients. We examined the relationships between levels of care of LOCUS and clinical variables, contribution of care levels on admission decision, and changes in care levels over time. Inpatients showed significantly higher levels of care than outpatients. Levels of care showed significant strong inverse correlations to Global Assessment Scale (GAS) scores, and significant moderate correlations to admission types, care environment, and diagnostic subgroups in almost all groups. Levels of care contributed as much to the admission decision as GAS scores. Levels of care significantly decreased from the time of admission to discharge. Our preliminary evidence indicates that LOCUS is valid and sensitive to change, and applicable for clinical use in Japan.

  10. Clinical Utility of Subtyping Binge Eating Disorder by History of Anorexia or Bulimia Nervosa in a Treatment Sample

    Science.gov (United States)

    Utzinger, Linsey M.; Mitchell, James E.; Cao, Li; Crosby, Ross D.; Crow, Scott J.; Wonderlich, Stephen A.; Peterson, Carol B.

    2016-01-01

    Objective This study examined whether having a history of anorexia nervosa (AN) or bulimia nervosa (BN) is associated with response to treatment in adults with binge eating disorder (BED). Method Data from 189 adults diagnosed with BED who were randomly assigned to one of three group cognitive-behavioral (CBT) treatments were analyzed to compare those with and without a history of AN/BN. Results A total of 16% of the sample had a history of AN/BN. The BED subgroup with a history of AN/BN presented with higher rates of mood disorders and greater eating-related symptom severity at baseline. Participants with a history of AN/BN also had higher global eating disorder (ED) symptoms at end of treatment (EOT), and more frequent objective binge-eating episodes at EOT and 12-month follow-up. Discussion These findings suggest that in adults with BED, a history of AN/BN is predictive of greater eating-related symptom severity following group-based CBT and poorer short- and long-term binge-eating outcomes. These findings suggest that considering ED history in the treatment of adults with BED may be clinically useful. PMID:25959549

  11. A review of factors associated with the utilization of healthcare services and strategies for improving postpartum care in Africa

    Directory of Open Access Journals (Sweden)

    Yugbare Belemsaga Danielle

    2015-12-01

    Full Text Available Reducing maternal mortality continues to be a major challenge for African countries. We conducted a literature review to identify the factors associated with the utilization of maternal and child healthcare services during the postpartum period and the strategies for strengthening postpartum healthcare in Africa. We carried out an electronic search in several databases of texts published between 1995 and 2012 related to maternal and child health. Seventy-five publications fitted the eligibility criteria. Our analysis shows that to a large extent the socio-economic context was dominant among the factors associated with the quality and utilization of postpartum services. The best interventions were those on immediate postpartum maternal care combining several intervention packages such as community mobilization and provision of services, community outreach services and health training. The integration within health facilities of mother and child clinics was shown to contribute significantly to improving the frequency of mothers’ postpartum visits.

  12. Who cares about a financially healthy electric utility industry. Finding future answers

    International Nuclear Information System (INIS)

    Forecasts on the rate of growth of electricity supply and demand were given. Emphasis was placed on the economic stability of electric utilities and their ability to raise necessary capital. The role of nuclear power in America's future was also discussed

  13. Health and Utilities in Patients With Gout Under the Care of a Rheumatologist

    NARCIS (Netherlands)

    Spaetgens, B.; Tran-Duy, A.; Wijnands, J. M. A.; van der Linden, S.; Boonen, A.

    2015-01-01

    ObjectiveTo compare limitations in health between Dutch patients with gout and the general population and to determine factors influencing societal and patient values for health as assessed with different utility approaches. MethodsA cross-sectional study was done among 110 patients with gout under

  14. The Effect of Increased Travel Reimbursement Rates on Health Care Utilization in the VA

    Science.gov (United States)

    Nelson, Richard E.; Hicken, Bret; West, Alan; Rupper, Randall

    2012-01-01

    Purpose: The reimbursement rate that eligible veterans receive for travel to Department of Veterans Affairs (VA) facilities increased from 11 to 28.5 cents per mile on February 1, 2008. We examined the effect of this policy change on utilization of outpatient, inpatient, and pharmacy services, stratifying veterans based on distance from a VA…

  15. Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls

    Science.gov (United States)

    Phelan, Elizabeth A.; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M.

    2016-01-01

    A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice. PMID:27660753

  16. Adoption of Evidence-Based Fall Prevention Practices in Primary Care for Older Adults with a History of Falls.

    Science.gov (United States)

    Phelan, Elizabeth A; Aerts, Sally; Dowler, David; Eckstrom, Elizabeth; Casey, Colleen M

    2016-01-01

    A multifactorial approach to assess and manage modifiable risk factors is recommended for older adults with a history of falls. Limited research suggests that this approach does not routinely occur in clinical practice, but most related studies are based on provider self-report, with the last chart audit of United States practice published over a decade ago. We conducted a retrospective chart review to assess the extent to which patients aged 65+ years with a history of repeated falls or fall-related health-care use received multifactorial risk assessment and interventions. The setting was an academic primary care clinic in the Pacific Northwest. Among the 116 patients meeting our inclusion criteria, 48% had some type of documented assessment. Their mean age was 79 ± 8 years; 68% were female, and 10% were non-white. They averaged six primary care visits over a 12-month period subsequent to their index fall. Frequency of assessment of fall-risk factors varied from 24% (for home safety) to 78% (for vitamin D). An evidence-based intervention was recommended for identified risk factors 73% of the time, on average. Two risk factors were addressed infrequently: medications (21%) and home safety (24%). Use of a structured visit note template independently predicted assessment of fall-risk factors (p = 0.003). Geriatrics specialists were more likely to use a structured note template (p = 0.04) and perform more fall-risk factor assessments (4.6 vs. 3.6, p = 0.007) than general internists. These results suggest opportunities for improving multifactorial fall-risk assessment and management of older adults at high fall risk in primary care. A structured visit note template facilitates assessment. Given that high-risk medications have been found to be independent risk factors for falls, increasing attention to medications should become a key focus of both public health educational efforts and fall prevention in primary care practice. PMID:27660753

  17. Enabling Remote Health-Caring Utilizing IoT Concept over LTE-Femtocell Networks

    OpenAIRE

    M N Hindia; T. A. Rahman; H. Ojukwu; Hanafi, E. B.; Fattouh, A.

    2016-01-01

    As the enterprise of the "Internet of Things" is rapidly gaining widespread acceptance, sensors are being deployed in an unrestrained manner around the world to make efficient use of this new technological evolution. A recent survey has shown that sensor deployments over the past decade have increased significantly and has predicted an upsurge in the future growth rate. In health-care services, for instance, sensors are used as a key technology to enable Internet of Things oriented health-car...

  18. 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...

  19. UTILIZATION OF HEALTH CARE SERVICES AMONG ADULTS ATTENDING A HEALTH FAIR IN SOUTH LOS ANGELES COUNTY

    OpenAIRE

    Macias, Eduardo P.; Morales, Leo S.

    2000-01-01

    A bilingual survey was developed to collect information regarding socio-demographics, access to medical and dental care, health insurance coverage, perceived health status, and use of folk medicine providers from 70 adults presenting to a health fair in South Los Angeles County. Ninety-seven percent of respondents were foreign-born. Seventy-nine percent reported having no health insurance during the year prior to survey. Of the uninsured, 61 percent lacked a doctor visit and 76 percent lacked...

  20. Managing schizophrenia in primary care: the utility of remission criteria as outcome indicators

    OpenAIRE

    Fear, Christopher; Yeomans, David; Moore, Bryan; Taylor, Mark; Ford, Keith; Currie, Alan; Hynes, Joanne; Sullivan, Gary; Whale, Richard; Burns, Tom

    2009-01-01

    The shared management of patients with schizophrenia in primary care can only succeed if underpinned by valid, easily administered and clinically relevant outcome measures. While conditions such as depression and anxiety lend themselves to this approach through the development, over a number of years, of patient- and observer-rated scales, schizophrenia still lacks the capacity for meaningful outcome measures. Recently, two international working groups have developed the concept of remission ...

  1. Association of socio-economic status with diabetes prevalence and utilization of diabetes care services

    Directory of Open Access Journals (Sweden)

    Svenson Lawrence W

    2006-10-01

    Full Text Available Abstract Background Low income appears to be associated with a higher prevalence of diabetes and diabetes related complications, however, little is known about how income influences access to diabetes care. The objective of the present study was to determine whether income is associated with referral to a diabetes centre within a universal health care system. Methods Data on referral for diabetes care, diabetes prevalence and median household income were obtained from a regional Diabetes Education Centre (DEC database, the Canadian National Diabetes Surveillance System (NDSS and the 2001 Canadian Census respectively. Diabetes rate per capita, referral rate per capita and proportion with diabetes referred was determined for census dissemination areas. We used Chi square analyses to determine if diabetes prevalence or population rates of referral differed across income quintiles, and Poisson regression to model diabetes rate and referral rate in relation to income while controlling for education and age. Results There was a significant gradient in both diabetes prevalence (χ2 = 743.72, p 2 = 168.435, p Conclusion Low income is associated with a higher prevalence of diabetes and a higher population rate of referral to this regional DEC. After accounting for diabetes prevalence, however, the equal proportions referred to the DEC across income groups suggest that there is no access bias based on income.

  2. Connecting the dots: examining transgender women's utilization of transition-related medical care and associations with mental health, substance use, and HIV.

    Science.gov (United States)

    Wilson, Erin C; Chen, Yea-Hung; Arayasirikul, Sean; Wenzel, Conrad; Raymond, H Fisher

    2015-02-01

    Findings on access to general healthcare for transgender people have emerged, but little is known about access to transition-related medical care for transwomen (i.e., hormones, breast augmentation, and genital surgery). Transgender women have low access to general medical care and are disproportionately at risk for substance use, mental illness, and HIV. We conducted an analysis to determine if utilization of transition-related medical care is a protective factor for health risks to transgender women and to investigate if care differs by important demographic factors and HIV status. A secondary analysis was conducted using data from a 2010 HIV surveillance study using respondent-driven sampling to recruit 314 transwomen in San Francisco. Survey-corrected logistic regression models were used to estimate odds ratios for six psychosocial health problems-binge drinking, injection drug use, anxiety, depression, suicidal ideation, and high-risk intercourse-comparing various levels of utilization of transition-related medical care. Odds ratios were also calculated to determine if utilization of transition-related medical care was related to less overlap of risk domains. We found that Latina and African American transwomen had significantly lower estimated utilization of breast augmentation and genital surgery, as did transwomen who identified as transgender rather than female. Overall, utilization of transition-related medical care was associated with significantly lower estimated odds of suicidal ideation, binge drinking, and non-injection drug use. Findings suggest that utilization of transition-related medical care may reduce risk for mental health problems, especially suicidal ideation, and substance use among transwomen. Yet, important racial/ethnic and gender identity disparities in utilization of transition-related medical care need to be addressed. PMID:25476958

  3. Prevalence of undiagnosed airflow obstruction among people with a history of smoking in a primary care setting

    Directory of Open Access Journals (Sweden)

    Fu SN

    2016-09-01

    Full Text Available Sau Nga Fu,1 Wai Cho Yu,2 Carlos King-Ho Wong,3 Margaret Choi-Hing Lam1 1Department of Family Medicine and Primary Health Care, Kowloon West Cluster, Hospital Authority, 2Department of Medicine and Geriatrics, Princess Margaret Hospital, 3Department of Family Medicine and Primary Care, Li Ka Shing Faculty of Medicine, University of Hong Kong, Hong Kong SAR Purpose: The purpose of this study was to define the prevalence of undiagnosed airflow obstruction (AO among subjects with a history of smoking but no previous diagnosis of chronic lung disease. The finding of AO likely represents diagnosis of chronic obstructive pulmonary disease. Patients: People aged ≥30 years with a history of smoking who attended public outpatient clinics for primary care services were included in this study.Methods: A cross-sectional survey in five clinics in Hong Kong using the Breathlessness, Cough, and Sputum Scale, the Lung Function Questionnaire, and office spirometry was conducted.Results: In total, 731 subjects (response rate =97.9% completed the questionnaires and spiro­metry tests. Most of the subjects were men (92.5% in the older age group (mean age =62.2 years; standard deviation =11.7. Of the 731 subjects, 107 had AO, giving a prevalence of 14.6% (95% confidence interval =12.1–17.2; 45 subjects with AO underwent a postbronchodilator test. By classifying the severity of chronic obstructive pulmonary disease using the Global Initiative for Chronic Obstructive Lung Disease, 27 (60% were considered to be in mild category and 18 (40% in moderate category. None of them belonged to the severe or very severe category. The total score of Lung Function Questionnaire showed that majority of the subjects with AO also had chronic cough, wheezing attack, or breathlessness, although most did not show any acute respiratory symptoms in accordance with the Breathlessness, Cough, and Sputum Scale. Diagnosis of AO was positively associated with the number of years of

  4. Telemedicine, the effect of nurse-initiated telephone follow up, on health status and health-care utilization in COPD patients : A randomized trial

    NARCIS (Netherlands)

    Berkhof, Farida F.; van den Berg, Jan W. K.; Uil, Steven M.; Kerstjens, Huib A. M.

    2015-01-01

    Background and objectiveTelemedicine, care provided by electronic communication, may serve as an alternative or extension to traditional outpatient visits. This pilot study determined the effects of telemedicine on health-care utilization and health status of chronic obstructive pulmonary disease (C

  5. "Beating osteoARThritis": Development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis

    NARCIS (Netherlands)

    Smink, A.J.; Ende, C.H.M. van den; Vliet Vlieland, T.P.M.; Swierstra, B.A.; Kortland, J.H.; Bijlsma, J.W.J.; Voorn, T.B.; Schers, H.J.; Bierma-Zeinstra, S.M.; Dekker, J.

    2011-01-01

    Inadequacies in health care practices have been reported despite existing guidelines to manage hip or knee osteoarthritis. To facilitate guideline implementation and improve utilization of non-surgical treatment options a care strategy should be developed. This study describes the development of an

  6. "Beating osteoARThritis" : Development of a stepped care strategy to optimize utilization and timing of non-surgical treatment modalities for patients with hip or knee osteoarthritis

    NARCIS (Netherlands)

    Smink, Agnes J.; van den Ende, Cornelia H. M.; Vlieland, Thea P. M. Vliet; Swierstra, Bart A.; Kortland, Joke H.; Bijlsma, Johannes W. J.; Voorn, Theo B.; Schers, Henk J.; Bierma-Zeinstra, Sita M. A.; Dekker, Joost

    2011-01-01

    Inadequacies in health care practices have been reported despite existing guidelines to manage hip or knee osteoarthritis. To facilitate guideline implementation and improve utilization of non-surgical treatment options a care strategy should be developed. This study describes the development of an

  7. The utilization of antenatal care among rural-to-urban migrant women in Shanghai:a hospital-based cross-sectional study

    Directory of Open Access Journals (Sweden)

    Zhao Qi

    2012-11-01

    Full Text Available Abstract Background Improving utilization of antenatal care is a critical strategy for achieving China’s Millennium Development Goal of decreasing the maternal mortality ratio (MMR. While overall utilization has increased recently in China, an urban vs. rural disparity in access remains. Here we aim to assess utilization of antenatal care in rural-to-urban migrant women and identify its risk and protective factors. Methods Migrant women who had been living in Shanghai for more than six months, delivered in one of the two study hospitals between August 2009 and February 2010, and provided written consent were interviewed using a structured questionnaire. Results Of 767 women, 90.1% (691 made at least one antenatal care visit, while 49.7% (381 had adequately utilized antenatal care (i.e., made five or more antenatal care visits. Only 19.7% of women visited an antenatal care center during the first trimester (12 weeks. Women between the ages of 25 and 30 and women older than 30 were more likely than younger women to have adequately utilized antenatal care (AOR=2.2 and 1.9, 95%CI=1.4-3.5 and 1.1-3.2, respectively. Women whose husbands held Shanghai residency status (AOR=4.9, 95%CI=2.2-10.9 or who had more than 10 years of education (AOR=1.8, 95%CI=1.2-2.9, previously experienced a miscarriage or abortion (AOR=2.2, 95%CI=1.3-3.8, had higher household income (AOR=1.6, 95%CI=1.0-2.5 were more likely to have adequately utilized antenatal care. Women from high-income households were also more likely to receive antenatal care during the first 12 weeks (AOR=3.5, 95%CI=1.7-5.5. Conclusions Many migrant women in Shanghai did not receive adequate antenatal care and initiated antenatal care later than the optimal first 12 weeks of pregnancy. Poor antenatal care utilization was associated with low socioeconomic status, education, and certain demographic factors. Tailored health education for both migrant women and their husbands should be strengthened to

  8. Public and private health care utilization differences between socioeconomic strata in Jamaica

    OpenAIRE

    Bourne, Paul

    2010-01-01

    Paul A Bourne1, Denise Eldemire-Shearer1, Tomlin J Paul1, Janet LaGrenade1, Christopher AD Charles21Department of Community Health and Psychiatry, Faculty of Medical Sciences, University of the West Indies, Mona, Kingston, Jamaica; 2King Graduate School, Monroe College, New York and Center for Victim Support, Harlem Hospital Center, New York, NY, USAObjective: To assess trends in the use of private and public health care services among Jamaicans over a 15-year period (1991–2007).Des...

  9. Gender differences in the utilization of health-care services among the older adult population of Spain

    Directory of Open Access Journals (Sweden)

    Banegas José

    2006-06-01

    Full Text Available Abstract Background Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly. Methods Cross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status, need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL and enabling factors (educational level, marital status, head-of-family employment status and social network. Relative differences in the use of each service between women and men were summarized using odds ratios (OR, obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables. Results As compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL: 1.07–1.44, received home medical visits (OR: 1.67; 95% CL: 1.34–2.10 and took ≥3 medications (OR: 1.54; 95% CL: 1.34–1.79, but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL of women versus men for ingestion of ≥3 medications was 1.24 (1.06–1.45. After adjustment for HRQL, the OR was 1.03 (0.89–1.21 for visits to medical practitioners, 1.24 (0.98–1.58 for home medical visits, 0.71 (0.58–0.87 for hospitalization, and 1.14 (0.97–1.33 for intake of ≥3 medications. After adjustment for the

  10. Knowledge, perception and utilization of postnatal care of mothers in Gondar Zuria District, Ethiopia: a cross-sectional study.

    Science.gov (United States)

    Tesfahun, Fikirte; Worku, Walelegn; Mazengiya, Fekadu; Kifle, Manay

    2014-12-01

    Mothers and their newborns are vulnerable to illnesses and deaths during the postnatal period. More than half a million women each year die of causes related to pregnancy and childbirth. The majority of deaths occur in less developed countries. Utilization of postnatal care (PNC) service in Ethiopia is low due to various factors. These problems problem significantly hold back the goal of decreasing maternal and child mortality. To assess mothers' knowledge, perception and utilization of PNC in the Gondar Zuria District, Ethiopia. Our study is a community-based, cross-sectional study supported by a qualitative study conducted among 15-49 years mothers who gave birth during the last year. A multistage sampling technique was used to selected participants; structured questionnaires and focus group discussions were used to collect data. Data were entered into EPI info version 3.5.1 and exported into SPSS version 16.0 for the quantitative study and thematic framework analysis was applied to the qualitative portion. The majority of the women (84.39 %) were aware and considered PNC necessary (74.27 %); however, only 66.83 % of women obtained PNC. The most frequent reasons for not obtaining PNC were lack of time (30.47 %), long distance to a provider (19.25 %), lack of guardians for children care (16.07 %), and lack of service (8.60 %). Based on the multivariate analysis, place of residence (AOR 2.68; 95 % CI 1.45-4.98), distance from a health institution (AOR 2.21; 95 % CI 1.39-3.51), antenatal care visit (AOR 2.60; 95 % CI 1.40-5.06), and having decision-making authority for utilization (AOR 1.86; 95 % CI 1.30-2.65) were factors found to be significantly associated with PNC utilization. Mothers in the study area had a high level of awareness and perception about the necessity of PNC. Urban women and those who displayed higher levels of autonomy were more likely to use postnatal health services.

  11. Enabling Remote Health-Caring Utilizing IoT Concept over LTE-Femtocell Networks.

    Directory of Open Access Journals (Sweden)

    M N Hindia

    Full Text Available As the enterprise of the "Internet of Things" is rapidly gaining widespread acceptance, sensors are being deployed in an unrestrained manner around the world to make efficient use of this new technological evolution. A recent survey has shown that sensor deployments over the past decade have increased significantly and has predicted an upsurge in the future growth rate. In health-care services, for instance, sensors are used as a key technology to enable Internet of Things oriented health-care monitoring systems. In this paper, we have proposed a two-stage fundamental approach to facilitate the implementation of such a system. In the first stage, sensors promptly gather together the particle measurements of an android application. Then, in the second stage, the collected data are sent over a Femto-LTE network following a new scheduling technique. The proposed scheduling strategy is used to send the data according to the application's priority. The efficiency of the proposed technique is demonstrated by comparing it with that of well-known algorithms, namely, proportional fairness and exponential proportional fairness.

  12. Enabling Remote Health-Caring Utilizing IoT Concept over LTE-Femtocell Networks.

    Science.gov (United States)

    Hindia, M N; Rahman, T A; Ojukwu, H; Hanafi, E B; Fattouh, A

    2016-01-01

    As the enterprise of the "Internet of Things" is rapidly gaining widespread acceptance, sensors are being deployed in an unrestrained manner around the world to make efficient use of this new technological evolution. A recent survey has shown that sensor deployments over the past decade have increased significantly and has predicted an upsurge in the future growth rate. In health-care services, for instance, sensors are used as a key technology to enable Internet of Things oriented health-care monitoring systems. In this paper, we have proposed a two-stage fundamental approach to facilitate the implementation of such a system. In the first stage, sensors promptly gather together the particle measurements of an android application. Then, in the second stage, the collected data are sent over a Femto-LTE network following a new scheduling technique. The proposed scheduling strategy is used to send the data according to the application's priority. The efficiency of the proposed technique is demonstrated by comparing it with that of well-known algorithms, namely, proportional fairness and exponential proportional fairness. PMID:27152423

  13. The association between the utilization of long-term care services and mortality in elderly Koreans.

    Science.gov (United States)

    Choi, Jung-Kyu; Joung, Euisin

    2016-01-01

    It is necessary to confirm the effect of long-term care insurance (LTCI) by identifying changes in mortality, whether benefits are used or not, as well as the effects of in-home and institutional services on mortality. The goal of this study was to identify the association between service use and the mortality rate in elderly Koreans. We used Cox proportional hazard regression models and the Kaplan-Meier survival curve method to estimate the hazard ratio and survival probability for death while adjusting for covariates. We detected a 27.8% mortality rate at the 40-month follow-up period. Male gender, advanced age and activities of daily living were risk factors for mortality. In all models, the hazard ratio of participant death of those using long-term care services was significantly lower than for those who did not use these services. Among the service users, the hazard ratio for participant death of institutional service users was significantly higher than it was for in-home service users. This study also identified the impact of the transition from in-home services to institutional services. A primary goal of LTCI is to promote health and life stabilization in the elderly. To both delay and prevent institutionalization, it is necessary to develop assistive devices and effective in-home services and ensure access of these for elderly patients. PMID:27017418

  14. Enabling Remote Health-Caring Utilizing IoT Concept over LTE-Femtocell Networks.

    Science.gov (United States)

    Hindia, M N; Rahman, T A; Ojukwu, H; Hanafi, E B; Fattouh, A

    2016-01-01

    As the enterprise of the "Internet of Things" is rapidly gaining widespread acceptance, sensors are being deployed in an unrestrained manner around the world to make efficient use of this new technological evolution. A recent survey has shown that sensor deployments over the past decade have increased significantly and has predicted an upsurge in the future growth rate. In health-care services, for instance, sensors are used as a key technology to enable Internet of Things oriented health-care monitoring systems. In this paper, we have proposed a two-stage fundamental approach to facilitate the implementation of such a system. In the first stage, sensors promptly gather together the particle measurements of an android application. Then, in the second stage, the collected data are sent over a Femto-LTE network following a new scheduling technique. The proposed scheduling strategy is used to send the data according to the application's priority. The efficiency of the proposed technique is demonstrated by comparing it with that of well-known algorithms, namely, proportional fairness and exponential proportional fairness.

  15. Accuracy of self-reports of mental health care utilization and calculated costs compared to hospital records.

    Science.gov (United States)

    Heinrich, Sven; Deister, Arno; Birker, Thomas; Hierholzer, Cornelia; Weigelt, Ina; Zeichner, Dirk; Angermeyer, Matthias C; Roick, Christiane; König, Hans-Helmut

    2011-01-30

    Assessments of service utilization is often based on self-reports. Concerns regarding the accuracy of self-reports are raised especially in mental health care. The purpose of this study was to analyze the accuracy of self-reports and calculated costs of mental health services. In a prospective cohort study in Germany, self-reports regarding psychiatric inpatient and day-care use collected by telephone interviews based on the Client Socio-Demographic and Service Receipt Inventory (CSSRI) as well as calculated costs were compared to computerized hospital records. The sample consisted of patients with mental and behavioral disorders resulting from alcohol (ICD-10 F10, n=84), schizophrenia, schizophrenic and delusional disturbances (F2, n=122) and affective disorders (F3, n=124). Agreement was assessed using the concordance correlation coefficient (CCC), mean difference (95% confidence intervals (CI)) and the 95% limits of agreement. Predictors for disagreement were derived. Overall agreement of mean total costs was excellent (CCC=0.8432). Costs calculated based on self-reports were higher than costs calculated based on hospital records (15 EUR (95% CI -434 to 405)). Overall agreement of total costs for F2 patients was CCC=0.8651, for F3 CCC=0.7850 and for F10 CCC=0.6180. Depending on type of service, measure of service utilization and costs agreement ranged from excellent to poor and varied substantially between individuals. The number of admissions documented in hospital records was significantly associated with disagreement. Telephone interviews can be an accurate data collection method for calculating mean total costs in mental health care. In the future more standardization is needed.

  16. Nurses in Supportive Housing are Associated With Decreased Health Care Utilization and Improved HIV Biomarkers in Formerly Homeless Adults.

    Science.gov (United States)

    Dobbins, Sarah K; Cruz, Marissa; Shah, Saima; Abt, Lyndsey; Moore, Jamie; Bamberger, Joshua

    2016-01-01

    A San Francisco study conducted in 2008 showed that the permanent supportive housing program, Direct Access to Housing, dramatically decreased the risk of death in people living with HIV. In our study, we compared the health care utilization patterns and HIV-related biological markers of formerly homeless adults with HIV before and during two types of permanent supportive housing: (a) housing with on-site nursing care for residents, and (b) housing without on-site nursing care. Using nearest-neighbor matching with propensity scoring, the difference in outcomes was calculated. In the matched analysis, adjusted for adherence to combination antiretroviral therapy, people housed at sites with nurses had 4.8 fewer emergency department visits per person (SE: 1.53, p < .01), and they had an increased mean CD4+ T cell count (101.14 cells per person [SE: 55.10, p < .05]) compared to those who lived at sites without nurses. PMID:26861866

  17. Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

    Directory of Open Access Journals (Sweden)

    Sharad Onta

    2014-08-01

    Full Text Available Background: Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design: We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results: Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs, distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions: Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps.

  18. Perceptions of users and providers on barriers to utilizing skilled birth care in mid- and far-western Nepal: a qualitative study

    Science.gov (United States)

    Onta, Sharad; Choulagai, Bishnu; Shrestha, Binjwala; Subedi, Narayan; Bhandari, Gajananda P.; Krettek, Alexandra

    2014-01-01

    Background Although skilled birth care contributes significantly to the prevention of maternal and newborn morbidity and mortality, utilization of such care is poor in mid- and far-western Nepal. This study explored the perceptions of service users and providers regarding barriers to skilled birth care. Design We conducted 24 focus group discussions, 12 each with service users and service providers from different health institutions in mid- and far-western Nepal. All discussions examined the perceptions and experiences of service users and providers regarding barriers to skilled birth care and explored possible solutions to overcoming such barriers. Results Our results determined that major barriers to skilled birth care include inadequate knowledge of the importance of services offered by skilled birth attendants (SBAs), distance to health facilities, unavailability of transport services, and poor availability of SBAs. Other barriers included poor infrastructure, meager services, inadequate information about services/facilities, cultural practices and beliefs, and low prioritization of birth care. Moreover, the tradition of isolating women during and after childbirth decreased the likelihood that women would utilize delivery care services at health facilities. Conclusions Service users and providers perceived inadequate availability and accessibility of skilled birth care in remote areas of Nepal, and overall utilization of these services was poor. Therefore, training and recruiting locally available health workers, helping community groups establish transport mechanisms, upgrading physical facilities and services at health institutions, and increasing community awareness of the importance of skilled birth care will help bridge these gaps. PMID:25119066

  19. Drug Utilization Pattern In Psychiatry Outdoor Patients At Tertiary Care Teaching Hospital Of Bastar Region

    Directory of Open Access Journals (Sweden)

    Ahmed Tabish

    2015-04-01

    Full Text Available Background: Psychotropic drugs have had a remarkable impact in psychiatric practice. However, their utilization in actualClinical practice, effectiveness and safety in real life situation need continuous study.Aim: To evaluate the utilization pattern of antipsychotics drugs in the OPD of Psychiatry department.Materials and Methods: A prospective cross-sectional study was     undertaken for a period of three months.   The total number of prescriptions that were analyzed were 264. Patients of all ages and both sexes were included in the study while inpatients,Referred patients and patients of epilepsy were excluded.Results: Out of 264 patients, 180(68.18% were males and84 (31.81% were females. Depression (30.6% was the commonest psychotic ailment. Fluoxetine (34% was the most common antidepressant prescribed for its treatment.Anxiety comprised the second commonest category of psychotic disorder (24.4% followed by Schizophrenia (22%. Lorazepam (43.4% was the most prescribed anxiolytic whereas      Risperidone (46.6% was used to treat it.Conclusion:  Depression was the commonest psychotic ailment followed by anxiety and schizophrenia. Polypharmacy was found in 45% of prescriptions. Risperidone + Trihexyphenidyl was the commonest fixed dose combination used for Schizophrenia and Psychosis followed by amitriptyline+Chlordiazepoxide for anxiety and depression.

  20. The effect of medication adherence on health care utilization in bipolar disorder.

    Science.gov (United States)

    Lew, Kim H; Chang, Eunice Y; Rajagopalan, Krithika; Knoth, Russell L

    2006-09-01

    A retrospective analysis of electronic prescription and medical claims representing approximately 1.4 million managed care commercial health plan members with mental health benefits was conducted. The effect of patient adherence to traditional mood-stabilizer therapy (lithium, valproate, carbamazepine, lamotrigine, or oxcarbazepine) for bipolar disorder on mental health-related hospitalization was assessed among 1,399 patients (mean age, 42.9 yr; 66.3% female) studied. Reduced adherence to traditional mood-stabilizing therapy (< 80%) in patients with bipolar disorder was associated with significantly greater risk of mental health-related, emergency room visits (odds ratio, 1.98; 95% confidence interval, 1.38-2.84) and inpatient hospitalizations (odds ratio, 1.71; 95% confidence interval, 1.27-2.32), even after adjusting for age, gender, and comorbidity. PMID:17017312

  1. The Educational Utilization of Elements of the History of Natural Sciences (19th Century): Highlighting the Cognitive Continuity with Antiquity

    Science.gov (United States)

    Maniati, Helen A.

    2005-01-01

    In the current paper, the reasons why the late 19th century Greek university community of natural scientists used elements from the History of Natural sciences which refer exclusively to ancient Greek science, and the consequences of such a choice are evaluated. Emphasis will be given to the speech delivered by the Dean, Professor of Chemistry, A.…

  2. Bedside point of care toxicology screens in the ED: Utility and pitfalls.

    Science.gov (United States)

    Bhalla, Ashish

    2014-07-01

    Exposure to drugs and toxins is a major cause for patients' visits to the emergency department (ED). For most drugs-of-abuse intoxication, ED physicians are skeptical to rely on results of urine drug testing for emergent management decisions. This is partially because immunoassays, although rapid, have limitations in sensitivity and specificity and chromatographic assays, which are more definitive, are more labor intensive. Testing for toxic alcohols is needed, but rapid commercial assays are not available. ED physicians need stat assays for acetaminophen, salicylates, co-oximetry, cholinesterase, iron, and some therapeutic drugs that could be used as agents of self-harm. In this review, we look at the potential limitations of these screening tests and suggest improvements and innovations needed for better clinical utilization. New drugs of abuse should be sought and assays should be developed to meet changing abuse patterns. PMID:25337490

  3. [A history of primary health care policy in the Federal District, Brazil (1960-2007): an analysis based on the theoretical framework of historical neo-institutionalism].

    Science.gov (United States)

    Göttems, Leila Bernardo Donato; Evangelista, Maria do Socorro Nantua; Pires, Maria Raquel Gomes Maia; Silva, Aline Ferreira Melgaço da; Silva, Priscila Avelino da

    2009-06-01

    This article analyzes the history of primary health care policy in the Federal District, Brazil, based on the theoretical framework of historical neo-institutionalism, identifying the predominant configurations and trends in the various administrations of the State Health Secretariat (SES-DF) from 1960 to 2007. The study indicates that the characteristics of the Federal District's health policy are dependent on the history of the original health system plans for setting priorities and goals, as well as for the health system's implementation. This influence, in addition to the centralization of decision-making processes and limited political participation, can contribute to making primary care ancillary to hospital care, thus jeopardizing its potential to produce change in the health care model.

  4. Health Behaviors, Mental Health, and Health Care Utilization Among Single Mothers After Welfare Reforms in the 1990s.

    Science.gov (United States)

    Basu, Sanjay; Rehkopf, David H; Siddiqi, Arjumand; Glymour, M Maria; Kawachi, Ichiro

    2016-03-15

    We studied the health of low-income US women affected by the largest social policy change in recent US history: the 1996 welfare reforms. Using the Behavioral Risk Factor Surveillance System (1993-2012), we performed 2 types of analysis. First, we used difference-in-difference-in-differences analyses to estimate associations between welfare reforms and health outcomes among the most affected women (single mothers aged 18-64 years in 1997; n = 219,469) compared with less affected women (married mothers, single nonmothers, and married nonmothers of the same age range in 1997; n = 2,422,265). We also used a synthetic control approach in which we constructed a more ideal control group for single mothers by weighting outcomes among the less affected groups to match pre-reform outcomes among single mothers. In both specifications, the group most affected by welfare reforms (single mothers) experienced worse health outcomes than comparison groups less affected by the reforms. For example, the reforms were associated with at least a 4.0-percentage-point increase in binge drinking (95% confidence interval: 0.9, 7.0) and a 2.4-percentage-point decrease in the probability of being able to afford medical care (95% confidence interval: 0.1, 4.8) after controlling for age, educational level, and health care insurance status. Although the reforms were applauded for reducing welfare dependency, they may have adversely affected health. PMID:26946395

  5. The history and politics of US health care policy for American Indians and Alaskan Natives.

    Science.gov (United States)

    Kunitz, S J

    1996-10-01

    This paper traces the development of the US federal government's program to provide personal and public health services to American Indians and Alaska Natives since the 1940s. Minimal services had been provided since the mid 19th century through the Bureau of Indian Affairs of the Department of the Interior. As a result of attempts by western congressmen to weaken and destroy the bureau during the 1940s, responsibility for health services was placed with the US Public Health Service. The transfer thus created the only US national health program for civilians, providing virtually the full range of personal and public health services to a defined population at relatively low cost. Policy changes since the 1970s have led to an emphasis on self-determination that did not exist during the 1950s and 1960s. Programs administered by tribal governments tend to be more expensive than those provided by the Indian Health Service, but appropriations have not risen to meet the rising costs, nor are the appropriated funds distributed equitably among Indian Health Service regions. The result is likely to be an unequal deterioration in accessibility and quality of care.

  6. Improving the management of people with a family history of breast cancer in primary care: before and after study of audit-based education.

    OpenAIRE

    Rafi, I.; Chowdhury, S.; Chan, T.; Jubber, I; Tahir, M.; de Lusignan, S.

    2013-01-01

    Background In England, guidance from National Institute for Clinical Excellence (NICE) states women with a family history of breast cancer presenting to primary care should be reassured or referred. We reviewed the evidence for interventions that might be applied in primary care and conducted an audit of whether low risk women are correctly advised and flagged. Methods We conducted a literature review to identify modifiable risk factors. We extracted routinely collected data from the computer...

  7. Patient and primary care provider experience using a family health history collection, risk stratification, and clinical decision support tool: a type 2 hybrid controlled implementation-effectiveness trial

    OpenAIRE

    Wu, R. Ryanne; Orlando, Lori A.; Himmel, Tiffany L; Buchanan, Adam H; Powell, Karen P; Hauser, Elizabeth R.; Agbaje, Astrid B; Henrich, Vincent C.; Ginsburg, Geoffrey S.

    2013-01-01

    Background Family health history (FHH) is the single strongest predictor of disease risk and yet is significantly underutilized in primary care. We developed a patient facing FHH collection tool, MeTree©, that uses risk stratification to generate clinical decision support for breast cancer, colorectal cancer, ovarian cancer, hereditary cancer syndromes, and thrombosis. Here we present data on the experience of patients and providers after integration of MeTree© into 2 primary care practices. ...

  8. Utilization of potentially inappropriate medications in elderly patients in a tertiary care teaching hospital in India

    Directory of Open Access Journals (Sweden)

    Binit N Jhaveri

    2014-01-01

    Full Text Available Aim: To evaluate the use of potentially inappropriate medicines in elderly inpatients in a tertiary care teaching hospital. Materials and Methods: Retrospective analysis was performed for cases of elderly patients admitted between January 2010 and December 2010. Data on age, gender, diagnosis, duration of hospital stay, treatment, and outcome were collected. Prescriptions were assessed for the use of potentially inappropriate medications in geriatric patients by using American Geriatric Society Beer′s criteria (2012 and PRISCUS list (2010. Results: A total of 676 geriatric patients (52.12% females were admitted in the medicine ward. The average age of geriatric patients was 72.69 years. According to Beer′s criteria, at least one inappropriate medicine was prescribed in 590 (87.3% patients. Metoclopramide (54.3%, alprazolam (9%, diazepam (8%, digoxin > 0.125 mg/day (5%, and diclofenac (3.7% were the commonly used inappropriate medications. Use of nonsteroidal anti-inflammatory drugs (NSAIDs in heart and renal failure patients was the commonly identified drug-disease interaction. According to PRISCUS list, at least one inappropriate medication was prescribed in 210 (31.06% patients. Conclusion: Use of inappropriate medicines is highly prevalent in elderly patients.

  9. Incorporating ulipristal acetate in the care of symptomatic uterine fibroids: a Canadian cost-utility analysis of pharmacotherapy management

    Directory of Open Access Journals (Sweden)

    Tsoi B

    2015-04-01

    Full Text Available Bernice Tsoi,1,2 Gord Blackhouse,1,2 Simon Ferrazzi,3 Clare J Reade,4 Innie Chen,5,6 Ron Goeree1,2,7 1Department of Clinical Epidemiology and Biostatistics, McMaster University, Hamilton, ON, Canada; 2Programs for Assessment of Technology in Health (PATH Research Institute, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada; 3Independent Consultant, Oakville, ON, Canada; 4Division of Gynecologic Oncology, University of Toronto, Toronto, ON, Canada; 5Department of Obstetrics and Gynaecology, University of Ottawa, 6Ottawa Hospital Research Institute, Ottawa, ON, Canada; 7Centre for Evaluation of Medicines (CEM, St Joseph's Healthcare Hamilton, Hamilton, ON, Canada Objective: To present a Canadian economic evaluation on the cost-utility of ulipristal acetate (5 mg orally daily compared to leuprolide acetate (3.75 mg intramuscular monthly in the treatment of moderate-to-severe symptoms of uterine fibroids in women eligible for surgery. Methods: A probabilistic decision tree was constructed to model the pre-operative pharmacological management of uterine fibroids under the primary perspective of the Ontario public payer. The model parameterized data from clinical trials, observational studies, and public costing databases. The outcome measure was the incremental cost-utility ratio. Uncertainty in the model was explored through sensitivity and scenario analyses. Results: Ulipristal was associated with faster control of excessive menstrual bleeding, fewer symptoms of hot flashes and lower health care resource consumption. The ulipristal strategy dominated leuprolide as it provided patients with more quality-adjusted life years (0.177 versus 0.165 at a lower cost ($1,273 versus $1,366. Across a range of sensitivity analyses, the results remained robust except to the dose of the comparator drug. If leuprolide was administered at 11.25 mg, once every 3 months, the expected cost for the leuprolide strategy would decline and the associated incremental

  10. Utilization pattern of drugs among dermatological outpatients in a tertiary care hospital of eastern India

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    Jeetendra Kumar

    2016-09-01

    Full Text Available Objectives: Drug utilization study enables us to describe the pattern of prescribed drugs as well as to detect the problems in drug prescribing and use. This study was undertaken to reveal the same among dermatological outpatient practice with an objective to provide remedial messages to prescribers and to provide the baseline data to drug and health policy makers and planners.Methods: A total of 325 prescriptions from dermatological outpatients were randomly selected and analysed using the guidelines of World Health Organization (WHO to find the various parameters of prescribing indicators and the pattern of prescribed drugs.Results: The average number of drugs per encounter was 2.28. Drugs prescribed by their generic name were 15.07% and those prescribed from national essential medicines list were 23.42%.  Antihistamines, antifungals, corticosteroids and antibiotics were four most frequently prescribed therapeutic classes. One systemic as well as one topical medicine belonging to same therapeutic class was prescribed on about one-third of totally analyzed prescriptions. Cetrizine was the most common individually prescribed drug and fluconazole was the most commonly prescribed antifungal.Conclusions: Polypharmacy, inclination for branded medicines and prescribing out of     essential medicines list are the common problems that need proper attention of dermatological doctors to rationalize their practice. Educational and managerial interventions can minimize these problems.

  11. Negative thoughts and health: associations among rumination, immunity, and health care utilization in a young and elderly sample

    DEFF Research Database (Denmark)

    Thomsen, Dorthe Kirkegaard; Mehlsen, Mimi Yung; Hokland, Marianne;

    2004-01-01

    OBJECTIVE: In the present study, it was tested whether rumination-negative, recurrent thoughts-would be associated with immune parameters and health care utilization. Because rumination has been associated with sadness and subjective sleep quality, it was tested whether these factors mediated...... displayed a positive association with total leukocyte count, total lymphocyte count, and number of B cells among the elderly, and this was not mediated by sadness or subjective sleep quality. Rumination was also positively associated with number of telephone consultations during the follow...... associations were found for the young participants. CONCLUSION: The results suggest that rumination may be associated with health-related measures in the elderly. Thus, negative thoughts may be detrimental to health, independently of negative affect....

  12. Racial and Ethnic Variations in Preventive Dental Care Utilization among Middle-aged and Older Americans, 1999-2008

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    Bei eWu

    2013-12-01

    Full Text Available Objective: This study examined recent trends of preventive dental care utilization among Americans aged 50 and above, focusing on variations across racial and ethnic groups including Whites, Blacks, Hispanics, American Indians/Alaska Natives, and Asians. Methods: Self-reported information on oral health behaviors was collected from 644,635 participants in the Behavioral Risk Factor Surveillance System (BRFSS between 1999 and 2008.Results: Despite a significant upward trend of frequency of dental cleaning from 1999 to 2008 (OR=1.02, in 2008 still only 56 to 77% of any ethnic or racial group reported having had a dental cleaning in the previous 12 months. Relative to Whites, Blacks (OR=.64 were less likely to have a dental cleaning in the previous 12 months. These variations persisted even when SES, health conditions, health behaviors, and number of permanent teeth were controlled. In contrast, Hispanics, Asians, and American Indians/Alaskan Natives did not differ from Whites in dental cleanings. Discussion: This is the first study to provide national estimates of the frequency of dental cleaning and associated trends over time for five major ethnic groups aged 50 and above in the U.S. simultaneously. Our findings suggest that public health programs with an emphasis on educating middle-aged and older minority populations on the benefits of oral health could have a large impact, as there is much room for improvement. Given the importance of oral health and a population that is rapidly becoming older and more diverse, the need for improved dental care utilization is significant.

  13. Effect of User Charges on Secondary Level Surgical Care Utilization and Out-of-Pocket Expenditures in Haryana State, India.

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    Deepak Balasubramanian

    Full Text Available Generation of resources for providing health care services is an important issue in developing countries. User charges in the form of Surgical Package Program (SPP were introduced in all district hospitals of Haryana to address this problem. We evaluate the effect of this SPP program on surgical care utilization and out-of-pocket (OOP expenditures.Data on 25437 surgeries, from July 2006 to June 2013 in 3 districts of Haryana state, was analyzed using interrupted time series analysis to assess the impact of SPP on utilization of services. Adjustment was made for presence of any autocorrelation and seasonality effects. A cross sectional survey was undertaken among 180 patients in District hospital, Panchkula during June 2013 to assess the extent of out of pocket (OOP expenditure incurred, financial risk protection and methods to cope with OOP expenditure. Catastrophic health expenditure, estimated as any expenditure in excess of 10% of the household consumption expenditure, was used to assess the extent of financial risk protection.User charges had a negative effect on the number of surgeries in public sector district hospitals in all the 3 districts. The mean out-of-pocket expenditure incurred by the patients was Rs.4564 (USD 74.6. The prevalence of catastrophic expenditure was 5.6%. A higher proportion among the poorest 20% population coped through borrowing money (47.2%, while majority (86.1% of those belonging to richest quintile paid from their monthly income or savings, or had insurance.There is a need to increase the public financing for curative services and it should be based on the needs of population. Any form of user charge in public sector hospitals should be removed.

  14. Study of drug utilization, morbidity pattern and cost of hypolipidemic agents in a tertiary care hospital

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    Kamlesh P. Patel

    2013-08-01

    Full Text Available Background: Data on the extent of use and costs of lipid-lowering agents are not widely available. Our aim was to study the drug utilization and morbidity pattern, cost of different hypolipidemic drugs along with the risk assessment for coronary heart disease. Methods: After approval of protocol by the Institutional Review Board, an observational, prospective study was carried out in 300 patients using NCEP and ATP III Guidelines-2002 for evaluation of presence or absence of risk factors for coronary heart diseases. Data were analysed using SPSS software version 16.0and WHO Core Drug Prescribing Indicators. Results: Patient’s morbidity pattern revealed that 62%, 49.3%, 28% suffered from ischemic heart disease, hypertension and type 2 diabetes mellitus respectively. On risk assessment, 48%, 13.3% patients had borderline and high level of total cholesterol respectively; 42%, 22.7% had borderline and high triglyceride levels respectively; 71.1% men and 62% women had low HDL cholesterol levels while 17.3%, 6% and 2.7% patients had borderline high, high and very high level of LDL cholesterol levels respectively. Frequency of prescriptions was atorvastatin (82%, rosuvastatin (9.3% and simvastatin (4.7% among the most frequently prescribed statins drug group. The mean number of drugs per prescription was 7.34. Drugs prescribed by generic name and from essential drugs list was 24.96% and 71.81% respectively. Mean cost of hypolipidemic agents/prescription/day was 10.74 (±1.96 Indian Rupees with rosuvastatin being the costliest. Conclusion: Rational use of hypolipidemic agents with an increasing trend of statins prescriptions will significantly reduce the morbidity and mortality from coronary heart diseases. [Int J Basic Clin Pharmacol 2013; 2(4.000: 470-475

  15. Residential Stability Reduces Unmet Health Care Needs and Emergency Department Utilization among a Cohort of Homeless and Vulnerably Housed Persons in Canada.

    Science.gov (United States)

    Jaworsky, Denise; Gadermann, Anne; Duhoux, Arnaud; Naismith, Trudy E; Norena, Monica; To, Matthew J; Hwang, Stephen W; Palepu, Anita

    2016-08-01

    This study examined the association of housing status over time with unmet physical health care needs and emergency department utilization among homeless and vulnerably housed persons in Canada. Homeless and vulnerably housed individuals completed interviewer-administered surveys on housing, unmet physical health care needs, health care utilization, sociodemographic characteristics, substance use, and health conditions at baseline and annually for 4 years. Generalized logistic mixed effects regression models examined the association of residential stability with unmet physical health care needs and emergency department utilization, adjusting for potential confounders. Participants were from Vancouver (n = 387), Toronto (n = 390), and Ottawa (n = 396). Residential stability was associated with lower odds of having unmet physical health needs (adjusted odds ratio (AOR), 0.82; 95 % confidence interval (CI), 0.67, 0.98) and emergency department utilization (AOR, 0.74; 95 % CI, 0.62, 0.88) over the 4-year follow-up period, after adjusting for potential confounders. Residential stability is associated with fewer unmet physical health care needs and lower emergency department utilization among homeless and vulnerably housed individuals. These findings highlight the need to address access to stable housing as a significant determinant of health disparities. PMID:27457795

  16. Which health care facilities do adult malawian antiretroviral therapy patients utilize during intercurrent illness? a cross sectional study

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    Masangalawe Caroline

    2011-12-01

    Full Text Available Abstract Background Antiretroviral therapy (ART clinic populations have expanded enormously in the successful Malawi ART scale-up programme. Overcrowding, long waiting times and living far away from the clinic may affect the extent to which patients use their ART clinic for intercurrent illnesses. Methods We interviewed patients of a large urban ART clinic in Blantyre, Malawi, during routine visits about the choice of health care facility during recent illness episodes. Results Out of 346 enrolled adults, mean age 39.8 (range 18-70 years, 54.3% female, 202 (58% reported one or more illness in the past 6 months, during which 85 (42.1%; 95%-confidence interval: 36.9-47.3% did not utilize their own clinic. Long distance to the clinic was the main subjective reason, while low education attainment, rural residence, perceived mild illness and dissatisfaction with the ART service were associated with not using their own clinic in multivariate analyses. Of all participants, 83.6% were satisfied with the service provided; only 6.1% were aware of the full service package of the ART clinic. Conclusions ART patients often seek health care outside their own clinic, which may have detrimental effects, and has consequences for ART counseling content and reporting of ART information in health passports.

  17. Prescription auditing and drug utilization pattern in a tertiary care teaching hospital of western UP

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    Afroz Abidi

    2012-06-01

    Full Text Available Background: In India, a proper reporting of medication errors in the hospital is not available. Drugs worth crores of rupee are consumed every year but a substantial part of these drugs are irrationally prescribed. In order to promote rational drug usage standard policies on use of drugs must be set, and this can be done only after the current prescription practices have been audited. The prescriptions were analyzed based on the objectives of the study in order to promote rational use of drugs in a population. Methods: The study was carried out prospectively over a period of two months and 15 days in general medicine OPD of our tertiary care hospital. A specially designed performa was used with pre-inserted carbons. Results: Two hundred and thirty seven prescriptions were analyzed. Total no. of drugs in 237 prescriptions were 1001. Therefore average number of drugs/prescription is 4.22. Drugs were prescribed by generic names in 3.79% of cases, drugs on EDL are only 53.25% and fixed dose combinations are 26.87% of total drugs. Dosage forms used were mostly oral -93.51%. Injectables were only 6.19% and topical forms were least 0.299%. Doctors profile indicates that maximum number i.e. 93.67% were general practitioners. Basic information of patient was written in 72.57% prescriptions. Complete diagnoses were written in 70.04% prescriptions. Only 88.61% prescriptions were legible and only 76.79% prescriptions were complete in terms of dose, route, strength, frequency and dosage forms. Disease pattern seen was variable. Diseases of respiratory system were maximum 44.72 % followed by infectious and parasitic diseases - 16.03 % and diseases of digestive system - 13.92 %. The most common drug groups prescribed were NSAIDs± serratiopeptidases, antibiotics, antihistaminics, multivitamins, minerals, enzymes and expectorants & bronchodilators. The incidence of polypharmacy was also common with maximum number of drugs which were prescribed per prescription

  18. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care.

    Science.gov (United States)

    Jones, Craig; Finison, Karl; McGraves-Lloyd, Katharine; Tremblay, Timothy; Mohlman, Mary Kate; Tanzman, Beth; Hazard, Miki; Maier, Steven; Samuelson, Jenney

    2016-06-01

    Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by -$482 relative to the comparison (95% CI, -$573 to -$391; P < .001). The lower costs were driven primarily by inpatient (-$218; P < .001) and outpatient hospital expenditures (-$154; P < .001), with associated changes in inpatient and outpatient hospital utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P < .001). Participants maintained higher rates on 9 of 11 effective and preventive care measures. These results suggest that Vermont's community-oriented medical home model is associated with improved outcomes for a general population at lower expenditures and utilization. (Population Health Management 2016;19:196-205). PMID:26348492

  19. Region-specific study of the electric utility industry: financial history and future power requirements for the VACAR region

    International Nuclear Information System (INIS)

    Financial data for the period 1966 to 1981 are presented for the four investor-owned electric utilities in the VACAR (Virginia-Carolinas) region. This region was selected as representative for the purpose of assessing the availability, reliability, and cost of electric power for the future in the United States. The estimated demand for power and planned additions to generating capacity for the region through the year 2000 are also given

  20. Rules implementing Sections 201 and 210 of the Public Utility Regulatory Policies Act of 1978: a regulatory history

    Energy Technology Data Exchange (ETDEWEB)

    Danziger, R.N.; Caples, P.W.; Huning, J.R.

    1980-09-15

    An analysis is made of the rules implementing Sections 201 and 210 of the Public Utility Regulatory Policies Act of 1978 (PURPA). The act provides that utilities must purchase power from qualifying producers of electricity at nondiscriminatory rates, and it exempts private generators from virtually all state and Federal utility regulations. Most of the analysis presented is taken from the perspective of photovoltaics (PV) and solar thermal electric point-focusing distributed receivers (pfdr). It is felt, however, that the analysis is applicable both to cogeneration and other emerging technologies. Chapters presented are: The FERC Response to Oral Comments on the Proposed Rules Implementing Sections 201 and 210 of PURPA; Additional Changes Made or Not Made That Were Addressed in Other Than Oral Testimony; View on the Proposed Rules Implementing Sections 201 and 210 of PURPA; Response to Comments on the Proposed 201 and 210 Rules; and Summary Analysis of the Environmental Assessment of the Rules. Pertinent reference material is provided in the Appendices, including the text of the rules. (MCW)

  1. Treatment patterns and health care resource utilization associated with dalfampridine extended release in multiple sclerosis: a retrospective claims database analysis

    Directory of Open Access Journals (Sweden)

    Guo A

    2016-05-01

    Full Text Available Amy Guo,1 Michael Grabner,2 Swetha Rao Palli,2 Jessica Elder,1 Matthew Sidovar,1 Peter Aupperle,1 Stephen Krieger3 1Acorda Therapeutics Inc., Ardsley, New York, NY, USA; 2HealthCore Inc., Wilmington, DE, USA; 3Corinne Goldsmith Dickinson Center for MS, Icahn School of Medicine at Mount Sinai, New York, NY, USA Background: Although previous studies have demonstrated the clinical benefits of dalfampridine extended release (D-ER tablets in patients with multiple sclerosis (MS, there are limited real-world data on D-ER utilization and associated outcomes in patients with MS. Purpose: The objective of this study was to evaluate treatment patterns, budget impact, and health care resource utilization (HRU associated with D-ER use in a real-world setting. Methods: A retrospective claims database analysis was conducted using the HealthCore Integrated Research DatabaseSM. Adherence (measured by medication possession ratio, or [MPR] and persistence (measured by days between initial D-ER claim and discontinuation or end of follow-up were evaluated over 1-year follow-up. Budget impact was calculated as cost per member per month (PMPM over the available follow-up period. D-ER and control cohorts were propensity-score matched on baseline demographics, comorbidities, and MS-related resource utilization to compare walking-impairment-related HRU over follow-up. Results: Of the 2,138 MS patients identified, 1,200 were not treated with D-ER (control and 938 were treated with D-ER. Patients were aged 51 years on average and 74% female. Approximately 82.6% of D-ER patients were adherent (MPR >80%. The estimated budget impact range of D-ER was $0.014–$0.026 PMPM. Propensity-score-matched D-ER and controls yielded 479 patients in each cohort. Postmatching comparison showed that the D-ER cohort was associated with fewer physician (21.5% vs 62.4%, P<0.0001 and other outpatient visits (22.8% vs 51.4%, P<0.0001 over the 12-month follow-up. Changes in HRU from follow

  2. Health care utilization and outpatient, out-of-pocket costs for active convulsive epilepsy in rural northeastern South Africa: a cross-sectional Survey

    OpenAIRE

    Wagner, Ryan G.; Bertram, Melanie Y; Gómez-Olivé, F. Xavier; Tollman, Stephen M; Lindholm, Lars; Charles R. Newton; Hofman, Karen J.

    2016-01-01

    Background Epilepsy is a common neurological disorder, with over 80 % of cases found in low- and middle-income countries (LMICs). Studies from high-income countries find a significant economic burden associated with epilepsy, yet few studies from LMICs, where out-of-pocket costs for general healthcare can be substantial, have assessed out-of-pocket costs and health care utilization for outpatient epilepsy care. Methods Within an established health and socio-demographic surveillance system in ...

  3. Utilizing spatial demographic and life history variation to optimize sustainable yield of a temperate sex-changing fish.

    Directory of Open Access Journals (Sweden)

    Scott L Hamilton

    Full Text Available Fish populations vary geographically in demography and life history due to environmental and ecological processes and in response to exploitation. However, population dynamic models and stock assessments, used to manage fisheries, rarely explicitly incorporate spatial variation to inform management decisions. Here, we describe extensive geographic variation in several demographic and life history characteristics (e.g., size structure, growth, survivorship, maturation, and sex change of California sheephead (Semicossyphus pulcher, a temperate rocky reef fish targeted by recreational and commercial fisheries. Fish were sampled from nine locations throughout southern California in 2007-2008. We developed a dynamic size and age-structured model, parameterized separately for each location, to assess the potential cost or benefit in terms of fisheries yield and conservation objectives of changing minimum size limits and/or fishing mortality rates (compared to the status quo. Results indicate that managing populations individually, with location-specific regulations, could increase yield by over 26% while maintaining conservative levels of spawning biomass. While this local management approach would be challenging to implement in practice, we found statistically similar increases in yield could be achieved by dividing southern California into two separate management regions, reflecting geographic similarities in demography. To maximize yield, size limits should be increased by 90 mm in the northern region and held at current levels in the south. We also found that managing the fishery as one single stock (the status quo, but with a size limit 50 mm greater than the current regulations, could increase overall fishery yield by 15%. Increases in size limits are predicted to enhance fishery yield and may also have important ecological consequences for the predatory role of sheephead in kelp forests. This framework for incorporating demographic variation

  4. Impact of roflumilast on exacerbations of COPD, health care utilization, and costs in a predominantly elderly Medicare Advantage population

    Directory of Open Access Journals (Sweden)

    Moll K

    2015-03-01

    Full Text Available Keran Moll,1 Shawn X Sun,2 Jeffrey J Ellis,1 Andrew Howe,1 Alpesh Amin3 1Comprehensive Health Insights, Inc., Humana, Louisville, KY, USA; 2Health Economics and Outcomes Research, Forest Laboratories, LLC, an affiliate of Actavis, Inc., Jersey City, NJ, USA; 3Department of Medicine, University of California-Irvine, Orange, CA, USA Background: Chronic obstructive pulmonary disease (COPD exacerbations are associated with declining lung function and health-related quality of life, and increased hospitalization and mortality. Clinical trials often poorly represent the elderly and thus have only partial applicability to their clinical care. Objective: To compare exacerbations, COPD-related health care utilization (HCU, and costs in a predominantly elderly Medicare COPD population initiated on roflumilast versus those not initiated on roflumilast.Methods: Deidentified administrative claims data from a large, national payer were utilized. Medicare patients aged 40–89 years with at least one COPD diagnosis from May 1, 2010 to December 31, 2012 were included. Members with at least one roflumilast pharmacy claim (index were assigned to the roflumilast group and those without were assigned to the non-roflumilast group. Proxy index dates for the non-roflumilast group were randomly assigned for similar distribution of all patients’ time at risk. Subjects with at least one pre-index COPD exacerbation had to be continuously enrolled for ≥365 days pre-index and post-index. Unadjusted and adjusted difference-in-difference (DID analyses contrasted pre-index with post-index changes in exacerbations, HCU, and costs of roflumilast treatment compared with non-roflumilast treatment.Results: A total of 500 roflumilast and 60,145 non-roflumilast patients were included (mean age 69.7 and 72.3 years, respectively; P<0.0001. Unadjusted DID favored roflumilast for all exacerbations, with greater pre-index to post-index reductions in mean per 30-day COPD

  5. Utilization of postnatal care for newborns and its association with neonatal mortality in India: An analytical appraisal

    Directory of Open Access Journals (Sweden)

    Singh Abhishek

    2012-05-01

    Full Text Available Abstract Background 39% of neonatal deaths in India occur on the first day of life, and 57% during the first three days of births. However, the association between postnatal care (PNC for newborns and neonatal mortality has not hitherto been examined. The paper aims to examine the association of PNC for newborns with neonatal mortality in India. Methods Data from District Level Household Survey, waive three (DLHS-3 conducted in 2007–08 is utilized in the study. We used conditional logit regression models to examine the association of PNC with neonatal mortality. The matching variables included birth order and the age of the mother at the birth of the newborn. Results The findings suggest no association between check-up of newborns within 24 hours of birth and neonatal mortality. However, the place where the newborns were examined was significantly associated with neonatal mortality. Moreover, findings do reveal that children of mothers who were advised on ‘keeping baby warm (kangaroo care after birth’ during their antenatal sessions were significantly less likely to die during the neonatal period compared to those children whose mothers were not advised about the same. Conclusions The findings are relevant because ‘keeping baby warm’ is one of the most cost-effective and easiest interventions to save babies from dying during the neonatal period. Though randomized controlled trials have already demonstrated the effectiveness of ‘keeping baby warm’, for the first time this has been found effective in a large-scale population-based study. The findings are of immense value for a country like India where the neonatal mortality rates are unacceptably high.

  6. Evaluation of the Apache II and the oncologic history, as indicative predictions of mortality in the unit of intensive care of the INC September 1996 -December 1997

    International Nuclear Information System (INIS)

    They are multiple the indexes of severity that have been carried out to value the predict and the quality of a patient's life, especially when this it enters to the unit of intensive care (UIC); however, the oncologic patient presents particularities in their mobility, that it supposes a different behavior in the results of the Indexes. Presently work is compared the Apache scale and the oncologic history like morbid mortality as predictors in the UCI. 207 patients were included that entered the UCI between September of 1996 and December of 1997. It was a mortality of 29%, the stay of most of this group of patient smaller than 24 hours or bigger than 8 days. To the entrance, 50% of the patients presented superior averages at 15 in the Apache Scale and at the 48 hours, alone 30.4% continued with this value. The patients with hematologic neoplasia presented superior average at 15 in 87%, with a mortality of 63.3% with average between 15 and 24 to the entrance, the risk of dying was 9.8 times but that with inferior average. In the hematologic patient, the risk of dying was 5.7 times but regarding the solid tumors. The system but altered it was the breathing one, with an increase in the risk of dying from 2,8 times for each increment utility in the scale. Contrary to described in the literature, the oncologic diagnoses and the neoplasia statistic they didn't influence in the mortality of the patients

  7. Utilization of maternal health care services with special emphasis on Janani Suraksha Yojana in a slum of Kolkata, West Bengal

    Directory of Open Access Journals (Sweden)

    Sutanuka Santra

    2015-07-01

    Full Text Available Introduction: Maternal health issues continue to be a forefront of national and global health policies. Janani Suraksha Yojana (JSY was launched under the umbrella of National Rural Health Mission to increase the number of institutional deliveries and decrease the maternal and neonatal mortality. Objective: The aim was to assess the utilization of maternal health care services including JSY among the mothers of under-five children in a slum at Baghbazar, Kolkata. Materials and Methods: A descriptive, cross-sectional study was conducted at Baghbazar slum, which is under the Urban Training Centre of R.G. Kar Medical College, Kolkata from 1 st to 28 th February, 2014. A total of 72 mothers of under-five children were interviewed using a predesigned, pretested and semi-structured schedule. Results: About 74% mothers were in the age group of 20-30 years and 56.8% mothers were from class IV socioeconomic status (Modified Prasad scale, 2013. Illiterate mothers were 4.2%. Three-fourth of the mothers heard about JSY. Around 47% mothers got cash benefit. Lack of eligibility document (42.1% and ignorance (34.2% were main causes of nonreceiving of the benefit. About 76% mothers had antenatal registration within the first trimester. About 99% were institutional deliveries. At least one postnatal check-up was received by 77% mothers. Only 33.3% mothers initiated breast feeding within 1 hr of delivery. Natural method (30.6% and condom (30.6% were main contraceptive methods accepted by them at the time of conducting study. Conclusion: Information, Education and Communication activities should be carried out to increase awareness regarding JSY utilization.

  8. Understanding the barriers to the utilization of primary health care in a low-income setting: implications for health policy and planning

    Directory of Open Access Journals (Sweden)

    Kurfi Abubakar Muhammed

    2013-06-01

    Full Text Available The essence of primary health care is the provision of essential health services and commodities to individuals and communities using available, acceptable and sustainable resources. However, there has been a growing lack of confidence by the populace as evidenced by poor utilization of the services. This study sought to identify the predominant barriers affecting the utilization of primary health care services in Batsari Local Government in Katsina State, Nigeria. A cluster of 30 households was surveyed in the catchment of the 21 health primary health facilities. A catchment been defined as a household located within 5 km of a primary health center. Using a three digit randomly generated numbers a household was selected. Once selected the start house and twenty-nine contiguous houses were visited. a total of 630 households were surveyed. In all households, questions were asked on the predominant health problems, as well as the major determinants of access and utilization of primary health care services .The results were computed and analyzed using the Statistical Package for Social Sciences software SPSS. Version 17.0 The findings from all the respondents (n=630 showed that majority of the people preferred to seek care from the patent medicine stores (53.63% as against only 7.6% who utilized the primary health care services. The commonest reasons why respondents do not utilize these services were lack of essential drugs, high cost of services as well as inadequate infrastructure in primary healthcare facilities. The study has highlighted some of the multiple factors affecting the utilization of primary healthcare services. It is expected that these findings will guide policy makers in improving healthcare delivery particularly where the need is greatest- at the grassroots-in line with the national health policy and national health strategic development plan.

  9. Utilization of health care services for childhood morbidity and associated factors in India: a national cross-sectional household survey.

    Directory of Open Access Journals (Sweden)

    Chandrashekhar T Sreeramareddy

    Full Text Available BACKGROUND: Information about utilization of health services and associated factors are useful for improving service delivery to achieve universal health coverage. METHODS: Data on a sample of ever-married women from India Demographic and Health survey 2005-06 was used. Mothers of children aged 0-59 months were asked about child's illnesses and type of health facilities where treatment was given during 15 days prior to the survey date. Type of health facilities were grouped as informal provider, public provider and private provider. Factors associated with utilization of health services for diarrhea and fever/cough was assessed according to Andersen's health behavior model. Multinomial logistic regression analyses were done considering sampling weights for complex sampling design. RESULTS: A total of 48,679 of ever-married women reported that 9.1% 14.8% and 17.67% of their children had diarrhea, fever and cough respectively. Nearly one-third of the children with diarrhea and fever/cough did not receive any treatment. Two-thirds of children who received treatment were from private health care providers (HCPs. Among predisposing factors, children aged 1-2 years and those born at health facility (public/private were more likely to be taken to any type of HCP during illness. Among enabling factors, as compared to poorer household, wealthier households were 2.5 times more likely to choose private HCPs for any illness. Children in rural areas were likely to be taken to any type of HCP for diarrhea but rural children were less likely to utilize private HCP for fever/cough. 'Need' factors i.e. children having severe symptoms were 2-3 times more likely to be taken to any type of HCP. CONCLUSION: Private HCPs were preferred for treatment of childhood illnesses. Involvement of private HCPs may be considered while planning child health programs. Health insurance scheme for childhood illnesses may to protect economically weaker sections from out

  10. Neighborhood socioeconomic disadvantage, individual wealth status and patterns of delivery care utilization in Nigeria: a multilevel discrete choice analysis

    Directory of Open Access Journals (Sweden)

    Aremu O

    2011-07-01

    .Conclusion: Home delivery, which cuts across all socioeconomic strata, is a common practice among women in Nigeria. Initiatives that would encourage the appropriate use of healthcare facilities at little or no cost to the most disadvantaged should be accorded the utmost priority.Keywords: delivery care, maternal health services utilization, multilevel discrete choice, Nigeria, socioeconomic disadvantaged, neigborhood, health policy

  11. Psychological needs, service utilization and provision of care in a specialist mental health clinic for young refugees: a comparative study.

    Science.gov (United States)

    Michelson, Daniel; Sclare, Irene

    2009-04-01

    This study addressed psychological needs, patterns of service utilization and provision of care in a specialist mental health service for young refugees and asylum seekers in London. Comparisons were made between two groups with different levels of postulated mental health need: unaccompanied minors (UAMs; n = 49) and children accompanied to the UK by one or more primary caregivers (n = 29). Significant differences were observed in referral pathways, with UAMs more likely to be referred by social services and less likely to be referred from medical agencies. UAMs also attended fewer sessions during treatment, and missed a greater proportion of scheduled appointments. Contrary to prediction, group comparisons revealed similar levels of post-migration stress and overall psychological morbidity. However, UAMs experienced significantly more traumatic events prior to resettlement, and were more likely to exhibit symptoms of post-traumatic stress disorder (PTSD) than their accompanied peers. Despite their elevated risk of PTSD, UAMs were less likely than accompanied children to have received trauma-focused interventions. UAMs were also significantly less likely to have been treated using cognitive therapy, anxiety management and parent/carer training, as well as receiving fewer types of practical assistance with basic social needs. The clinical and service implications of these findings are discussed. PMID:19293323

  12. The effect of user fee exemption on the utilization of maternal health care at mission health facilities in Malawi.

    Science.gov (United States)

    Manthalu, Gerald; Yi, Deokhee; Farrar, Shelley; Nkhoma, Dominic

    2016-11-01

    The Government of Malawi has signed contracts called service level agreements (SLAs) with mission health facilities in order to exempt their catchment populations from paying user fees. Government in turn reimburses the facilities for the services that they provide. SLAs started in 2006 with 28 out of 165 mission health facilities and increased to 74 in 2015. Most SLAs cover only maternal, neonatal and in some cases child health services due to limited resources. This study evaluated the effect of user fee exemption on the utilization of maternal health services. The difference-in-differences approach was combined with propensity score matching to evaluate the causal effect of user fee exemption. The gradual uptake of the policy provided a natural experiment with treated and control health facilities. A second control group, patients seeking non-maternal health care at CHAM health facilities with SLAs, was used to check the robustness of the results obtained using the primary control group. Health facility level panel data for 142 mission health facilities from 2003 to 2010 were used. User fee exemption led to a 15% (P services, however, other determinants may be more important.

  13. Influence of self-perceived oral health and socioeconomic predictors on the utilization of dental care services by schoolchildren.

    Science.gov (United States)

    Piovesan, Chaiana; Antunes, José Leopoldo Ferreira; Guedes, Renata Saraiva; Ardenghi, Thiago Machado

    2011-01-01

    The influence of socioeconomic factors and self-rated oral health on children's dental health assistance was assessed. This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. A dental examination provided information on the prevalence of dental caries (DMFT index). Data about the use of dental service, socioeconomic status, and self-perceived oral health were collected by means of structured interviews. These associations were assessed using Poisson regression models (prevalence ratio; 95% confidence interval). The prevalence of regular use of dental service was 47.8%. Children from low socioeconomic backgrounds and those who rated their oral health as "poor" used the service less frequently. The distribution of the kind of oral healthcare assistance used (public/private) varied across socioeconomic groups. The better-off children were less likely to have used the public service. Clinical, socioeconomic, and psychosocial factors were strong predictors for the utilization of dental care services by schoolchildren. PMID:21359493

  14. Influence of self-perceived oral health and socioeconomic predictors on the utilization of dental care services by schoolchildren

    Directory of Open Access Journals (Sweden)

    Chaiana Piovesan

    2011-04-01

    Full Text Available The influence of socioeconomic factors and self-rated oral health on children's dental health assistance was assessed. This study followed a cross-sectional design, with a multistage random sample of 792 12-year-old schoolchildren from Santa Maria, a city in southern Brazil. A dental examination provided information on the prevalence of dental caries (DMFT index. Data about the use of dental service, socioeconomic status, and self-perceived oral health were collected by means of structured interviews. These associations were assessed using Poisson regression models (prevalence ratio; 95% confidence interval. The prevalence of regular use of dental service was 47.8%. Children from low socioeconomic backgrounds and those who rated their oral health as "poor" used the service less frequently. The distribution of the kind of oral healthcare assistance used (public/private varied across socioeconomic groups. The better-off children were less likely to have used the public service. Clinical, socioeconomic, and psychosocial factors were strong predictors for the utilization of dental care services by schoolchildren.

  15. Utilization and costs of home-based and community-based care within a social HMO: trends over an 18-year period

    Directory of Open Access Journals (Sweden)

    Walter Leutz

    2005-10-01

    Full Text Available Purpose: Our objective was to describe the utilization and costs of services from 1985 to 2002 of a Social Health Maintenance Organization (SHMO demonstration project providing a benefit for home-based and community-based as well as short-term institutional (HCB care at Kaiser Permanente Northwest (KPNW, serving the Portland, Oregon area. The HCB care benefit was offered by KPNW as a supplement to Medicare's acute care medical benefits, which KPNW provides in an HMO model. KPNW receives a monthly per capita payment from Medicare to provide medical benefits, and Medicare beneficiaries who choose to join pay a supplemental premium that covers prescription drugs, HCB care benefits, and other services. A HCB care benefit of up to $12,000 per year in services was available to SHMO members meeting requirement for nursing home certification (NHC. Methods: We used aggregate data to track temporal changes in the period 1985 to 2002 on member eligibility, enrollment in HCB care plans, age, service utilization and co-payments. Trends in the overall costs and financing of the HCB care benefit were extracted from quarterly reports, management data, and finance data. Results: During the time period, 14,815 members enrolled in the SHMO and membership averaged 4,531. The proportion of SHMO members aged 85 or older grew from 12 to 25%; proportion meeting requirements for NHC rose from 4 to 27%; and proportion with HCB care plans rose from 4 to 18%. Costs for the HCB care benefit rose from $21 per SHMO member per month in 1985 to $95 in 2002. The HCB care costs were equivalent to 12% to 16% of Medicare reimbursement. The HCB program costs were covered by member premiums (which rose from $49 to $180 and co-payments from members with care plans. Over the 18-year period, spending shifted from nursing homes to a range of community services, e.g. personal care, homemaking, member reimbursement, lifeline, equipment, transportation, shift care, home nursing, adult day

  16. The utilization and perceived usefulness of health care and other support services by people exposed to traumatic events related to the war in the Balkans

    NARCIS (Netherlands)

    T. Frančišković; Z. Šuković; Z. Tovilović; D. Ajduković; M. Bogić; A. Kučukalić; D. Lečić-Toševski; N. Morina; M. Popovski; S. Priebe

    2013-01-01

    Objective: To explore which health care and other support services people exposed to traumatic events related to the war use, how helpful they perceive them in the course of their post-war adaptation and whether utilization and perceived usefulness depend on the mental health status of participants.

  17. Morbidity of "DSM-IV" Axis I Disorders in Patients with Noncardiac Chest Pain: Psychiatric Morbidity Linked with Increased Pain and Health Care Utilization

    Science.gov (United States)

    White, Kamila S.; Raffa, Susan D.; Jakle, Katherine R.; Stoddard, Jill A.; Barlow, David H.; Brown, Timothy A.; Covino, Nicholas A.; Ullman, Edward; Gervino, Ernest V.

    2008-01-01

    The present study examined current and lifetime psychiatric morbidity, chest pain, and health care utilization in 229 patients with noncardiac chest pain (NCCP), angina-like pain in the absence of cardiac etiology. Diagnostic interview findings based on the "Diagnostic and Statistical Manual of Mental Disorders" (4th ed.; "DSM-IV"; American…

  18. Health status and health care utilization following collective trauma: a 3-year national study of the 9/11 terrorist attacks in the United States.

    Science.gov (United States)

    Holman, E Alison; Silver, Roxane Cohen

    2011-08-01

    The September 11, 2001 terrorist attacks (9/11) presented a unique opportunity to assess the physical health impact of collective stress in the United States. This study prospectively examined rates of physical ailments and predictors of health care utilization in a U.S. nationally representative sample over three years following the attacks. A sample of adults (N = 2592) completed a survey before 9/11/01 that assessed MD-diagnosed physical and mental health ailments. Follow-up surveys were administered at one (N = 1923), two (N = 1576), and three (N = 1950) years post-9/11 to assess MD-diagnosed physical health ailments (e.g., cardiovascular, endocrine) and health care utilization. Reports of physical ailments increased 18% over three years following 9/11. 9/11-related exposure, lifetime and post-9/11 stress, MD-diagnosed depression/anxiety, smoking status, age, and female gender predicted increased incidence of post-9/11 ailments, after controlling for pre-9/11 health. After adjusting for covariates (demographics, somatization, smoking status, pre-9/11 mental and physical health, lifetime and post-9/11 stress, and degree of 9/11-related exposure), increases in MD-diagnosed cardiovascular, endocrine, gastrointestinal, and hematology-oncology ailments predicted greater utilization of health care services over two years. After the collective stress of 9/11, rates of physical ailments increased and predicted greater health care utilization in a U.S. national sample. PMID:21839560

  19. Combining data on health care utilization and socioeconomic status of a defined population: use of a population oriented health information system for regional planning.

    Science.gov (United States)

    Brommels, M; Heinonen, M O; Tuomola, S

    1987-01-01

    Health services planning on a regional or national level needs information on health care utilization as well as data on the population to be served. Health or hospital information systems usually cover services provision and utilization, and population data for planning purposes must be obtained from other sources. In the health information system presented, hospital performance data are combined with census and socioeconomic data of the population. That makes cautious analysis of reasons for variation in health care utilization within the planning area possible. The HIS is regional, including 11 health care providers, and population based, linking data to municipality (38 in all). The system is described, including its structure, input registration, file content and output formats. An output example is presented. Necessary conditions for use of the HIS in planning activities are that the corresponding health care delivery system is comprehensive, the population served well defined, and that good control of patient flow and user behaviour is achieved. Use is limited by the character of information stored in the HIS: it is registered retrospectively and by routine. In a system covering various hospitals and municipalities, engaging different types of clerical and health care personnel, data reliability is also a critical issue.

  20. Cost-Utility Analysis of Three U.S. HIV Linkage and Re-engagement in Care Programs from Positive Charge.

    Science.gov (United States)

    Jain, Kriti M; Zulliger, Rose; Maulsby, Cathy; Kim, Jeeyon Janet; Charles, Vignetta; Riordan, Maura; Holtgrave, David

    2016-05-01

    Linking and retaining people living with HIV in ongoing, HIV medical care is vital for ending the U.S. HIV epidemic. Yet, 41-44 % of HIV+ individuals are out of care. In response, AIDS United initiated Positive Charge, a series of five HIV linkage and re-engagement projects around the U.S. This paper investigates whether three Positive Charge programs were cost effective and calculates a return on investment for each program. It uses standard methods of cost utility analysis and WHO-CHOICE thresholds. All three projects were found to be cost effective, and two were highly cost effective. Cost utility ratios ranged from $4439 to $137,271. These results suggest that HIV linkage to care programs are a productive and efficient use of public health funds. PMID:26563760

  1. Cost-Utility Analysis of Three U.S. HIV Linkage and Re-engagement in Care Programs from Positive Charge.

    Science.gov (United States)

    Jain, Kriti M; Zulliger, Rose; Maulsby, Cathy; Kim, Jeeyon Janet; Charles, Vignetta; Riordan, Maura; Holtgrave, David

    2016-05-01

    Linking and retaining people living with HIV in ongoing, HIV medical care is vital for ending the U.S. HIV epidemic. Yet, 41-44 % of HIV+ individuals are out of care. In response, AIDS United initiated Positive Charge, a series of five HIV linkage and re-engagement projects around the U.S. This paper investigates whether three Positive Charge programs were cost effective and calculates a return on investment for each program. It uses standard methods of cost utility analysis and WHO-CHOICE thresholds. All three projects were found to be cost effective, and two were highly cost effective. Cost utility ratios ranged from $4439 to $137,271. These results suggest that HIV linkage to care programs are a productive and efficient use of public health funds.

  2. The epic of the Swiss electric utilities: the entry into a new era of the Swiss history

    International Nuclear Information System (INIS)

    Until the 19th century the only resources of Switzerland were wood and hydraulic energy. Their exploitation was adequate to produce heat and useful mechanical energy. The electrification of the country was introduced in the second half of the 19th century in the form of hydropower in DC. The potential is very important, with a gigantic buffer constituted by the glaciers, estimated to be 50 TWh a year. Today, it is used at around 65-85% (for the time being, annual hydropower generation varies from 42.3 TWh in 2001 to only 32.6 in 2006). The standardization of power distribution in AC was realized during World War I: public and private lighting, space heating and hot water, mechanical power, drive propulsion system in replacement of gas, coal and vapour, e.g. with the electrification of the national railway network. Between 1875 and 1914 more than 1000 electric utilities have been established. The first law concerning hydropower was decided in 1916. During World War II the restrictions on fossil fuel import were an incentive for the development of new hydropower plants: it was the epic of the dams. The high voltage network (220 kV) was developed in order to enable interconnection with the neighbour countries France, Germany and Italy. Since 1958 this interconnection is established on the whole European level. Switzerland was entrusted with the frequency adjustment of the European network and the controlling of the exchanges in the framework of a special European agreement on electricity. From the Swiss point of view the international trade of electricity is very profitable: thanks to its accumulation lakes Switzerland can sell expensive peak load energy to whole Europe. Since the mid 50ies it was clear that the exploitation of all economically available hydropower would not be enough to cover the increasing demand of the country. A first experimental nuclear power plant was decided in 1961, built from 1962 on and turned into operation in 1968 (30 MWth and 6 MWel

  3. [Clinical study using activity-based costing to assess cost-effectiveness of a wound management system utilizing modern dressings in comparison with traditional wound care].

    Science.gov (United States)

    Ohura, Takehiko; Sanada, Hiromi; Mino, Yoshio

    2004-01-01

    In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness. PMID:14999922

  4. [Clinical study using activity-based costing to assess cost-effectiveness of a wound management system utilizing modern dressings in comparison with traditional wound care].

    Science.gov (United States)

    Ohura, Takehiko; Sanada, Hiromi; Mino, Yoshio

    2004-01-01

    In recent years, the concept of cost-effectiveness, including medical delivery and health service fee systems, has become widespread in Japanese health care. In the field of pressure ulcer management, the recent introduction of penalty subtraction in the care fee system emphasizes the need for prevention and cost-effective care of pressure ulcer. Previous cost-effectiveness research on pressure ulcer management tended to focus only on "hardware" costs such as those for pharmaceuticals and medical supplies, while neglecting other cost aspects, particularly those involving the cost of labor. Thus, cost-effectiveness in pressure ulcer care has not yet been fully established. To provide true cost effectiveness data, a comparative prospective study was initiated in patients with stage II and III pressure ulcers. Considering the potential impact of the pressure reduction mattress on clinical outcome, in particular, the same type of pressure reduction mattresses are utilized in all the cases in the study. The cost analysis method used was Activity-Based Costing, which measures material and labor cost aspects on a daily basis. A reduction in the Pressure Sore Status Tool (PSST) score was used to measure clinical effectiveness. Patients were divided into three groups based on the treatment method and on the use of a consistent algorithm of wound care: 1. MC/A group, modern dressings with a treatment algorithm (control cohort). 2. TC/A group, traditional care (ointment and gauze) with a treatment algorithm. 3. TC/NA group, traditional care (ointment and gauze) without a treatment algorithm. The results revealed that MC/A is more cost-effective than both TC/A and TC/NA. This suggests that appropriate utilization of modern dressing materials and a pressure ulcer care algorithm would contribute to reducing health care costs, improved clinical results, and, ultimately, greater cost-effectiveness.

  5. Estimation of the Optimal Brachytherapy Utilization Rate in the Treatment of Gynecological Cancers and Comparison With Patterns of Care

    Energy Technology Data Exchange (ETDEWEB)

    Thompson, Stephen R., E-mail: stephen.thompson@sesiahs.health.nsw.gov.au [Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney (Australia); Department of Radiation Oncology, Prince of Wales Hospital, Sydney (Australia); University of New South Wales, Sydney (Australia); Delaney, Geoff P. [Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney (Australia); University of New South Wales, Sydney (Australia); University of Western Sydney, Sydney (Australia); Gabriel, Gabriel S. [Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney (Australia); University of New South Wales, Sydney (Australia); Jacob, Susannah; Das, Prabir [Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney (Australia); Barton, Michael B. [Collaboration for Cancer Outcomes Research and Evaluation, Liverpool Hospital, Sydney (Australia); University of New South Wales, Sydney (Australia)

    2013-02-01

    Purpose: We aimed to estimate the optimal proportion of all gynecological cancers that should be treated with brachytherapy (BT)-the optimal brachytherapy utilization rate (BTU)-to compare this with actual gynecological BTU and to assess the effects of nonmedical factors on access to BT. Methods and Materials: The previously constructed inter/multinational guideline-based peer-reviewed models of optimal BTU for cancers of the uterine cervix, uterine corpus, and vagina were combined to estimate optimal BTU for all gynecological cancers. The robustness of the model was tested by univariate and multivariate sensitivity analyses. The resulting model was applied to New South Wales (NSW), the United States, and Western Europe. Actual BTU was determined for NSW by a retrospective patterns-of-care study of BT; for Western Europe from published reports; and for the United States from Surveillance, Epidemiology, and End Results data. Differences between optimal and actual BTU were assessed. The effect of nonmedical factors on access to BT in NSW were analyzed. Results: Gynecological BTU was as follows: NSW 28% optimal (95% confidence interval [CI] 26%-33%) compared with 14% actual; United States 30% optimal (95% CI 26%-34%) and 10% actual; and Western Europe 27% optimal (95% CI 25%-32%) and 16% actual. On multivariate analysis, NSW patients were more likely to undergo gynecological BT if residing in Area Health Service equipped with BT (odds ratio 1.76, P=.008) and if residing in socioeconomically disadvantaged postcodes (odds ratio 1.12, P=.05), but remoteness of residence was not significant. Conclusions: Gynecological BT is underutilized in NSW, Western Europe, and the United States given evidence-based guidelines. Access to BT equipment in NSW was significantly associated with higher utilization rates. Causes of underutilization elsewhere were undetermined. Our model of optimal BTU can be used as a quality assurance tool, providing an evidence-based benchmark against

  6. Association between oral 5-ASA adherence and health care utilization and costs among patients with active ulcerative colitis

    Directory of Open Access Journals (Sweden)

    Mitra Debanjali

    2012-09-01

    Full Text Available Abstract Background Observational cohort study to assess the association between adherence to oral 5-aminosalicylates (5-ASAs and all-cause costs and health care utilization among patients with active ulcerative colitis (UC in the United States. Methods Retrospective analysis of insurance claims from June 1997 to August 2006 in the LifeLink Database. Patient criteria: aged 18 or older with one or more claim(s between June 1997 and August 2005 for a UC diagnosis and at least one oral 5-ASA prescription on or after the first observed UC diagnosis; continuous enrollment for at least 6 months prior to and 12 months following 5-ASA initiation (index date. As a proxy for active disease, patients needed to have at least two UC-specific non-pharmacy claims, at least 30 days of 5-ASA treatment and at least one corticosteroid prescription within the 12-month post-index period. Cumulative exposure to oral 5-ASAs over the 12-month period was calculated using the medication possession ratio (MPR. Patients with an MPR of at least 0.80 were classified as adherent. All-cause medical and pharmacy resource utilization and costs were computed over the 12-month post-index period and compared between adherent and nonadherent patients. Results 1,693 UC patients met study inclusion criteria: 72% were nonadherent to 5-ASA treatment (n = 1,217 and 28% were adherent (n = 476 in the 12-month study period. Compared with nonadherent patients, adherent patients had 31% fewer hospitalizations (P = 0.0025 and 34% fewer emergency department admissions (P = 0.0016. Adherent patients had 25% more pharmacy prescriptions overall (P P P = 0.0002. After adjusting for covariates, total all-cause costs were 29% higher for nonadherent patients than for adherent patients (mean [95% confidence interval]: $13,465 [$13,094, $13,835] vs $17,339 [$17,033, $17,645]. Conclusions Approximately three-quarters of patients with active UC were not adherent with their

  7. A study of morbidity and drug utilization pattern in indoor patients of high risk pregnancy at tertiary care hospital

    Directory of Open Access Journals (Sweden)

    Kamlesh P. Patel

    2013-06-01

    Full Text Available Background: Pregnancy represents a special physiological state during which the use of drug is of growing concern due to risk of teratogenicity. High risk pregnancy is common threat to mother and foetus. Therefore, our aim was to study the drug utilization and morbidity pattern in high risk pregnancy in hospitalized pregnant women. Methods: An observational, prospective study was carried out in 250 patients for 6 months in the tertiary care hospital. Protocol was approved by the Institutional Review Board (IRB. The data were collected in a pre-designed proforma. Data were analysed by using SPSS version 20.0 Software. Results: Among 250 patients, 19 (7.6%, 218 (87.2% and 13 (5.2% were of less than 20, 20 to 30 and more than 30 years of age respectively. About 68.8% women had complained of abdominal pain and 67.6% had weakness followed by headache / body ache (47.2%, oedema (26.4% and vomiting (18.8%. Iron (91.2% and calcium (84.5% were the commonest drugs prescribed followed by folic acid (59.6%, protein powder (54.8%, vitamin C (46.8% and isoxsuprine (26.6%. As per FDA Drug Risk Category, Category-A (82.21% was most frequently prescribed followed by Category-B (15.64% and Category-C (2.15%. Percentage of drugs prescribed by generic name and from essential drug list was 62.80% and 80.79%. Conclusion: Iron, Calcium and Folic acid were most commonly prescribed drugs. There is lesser number of drugs prescribed by generic name suggesting need for sincere efforts to improve situation. [Int J Reprod Contracept Obstet Gynecol 2013; 2(3.000: 372-378

  8. 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.

  9. Automated Telephone Self-Management Support for Diabetes in a Low-Income Health Plan: A Health Care Utilization and Cost Analysis.

    Science.gov (United States)

    Quan, Judy; Lee, Alexandra K; Handley, Margaret A; Ratanawongsa, Neda; Sarkar, Urmimala; Tseng, Samuel; Schillinger, Dean

    2015-12-01

    The objective was to determine whether automated telephone self-management support (ATSM) for low-income, linguistically diverse health plan members with diabetes affects health care utilization or cost. A government-sponsored managed care plan for low-income patients implemented a demonstration project between 2009 and 2011 that involved a 6-month ATSM intervention for 362 English-, Spanish-, or Cantonese-speaking members with diabetes from 4 publicly funded clinics. Participants were randomized to immediate intervention or a wait-list. Medical and pharmacy claims used in this analysis were obtained from the managed care plan. Medical claims included hospitalizations, ambulance use, emergency department visits, and outpatient visits. In the 6-month period following enrollment, intervention participants generated half as many emergency department visits and hospitalizations (rate ratio 0.52, 95% CI 0.26, 1.04) compared to wait-listed participants, but these differences did not reach statistical significance (P=0.06). With adjustment for prior year cost, intervention participants also had a nonsignificant reduction of $26.78 in total health care costs compared to wait-listed individuals (P=0.93). The observed trends suggest that ATSM could yield potential health service benefits for health plans that provide coverage for chronic disease patients in safety net settings. ATSM should be further scaled up to determine whether it is associated with a greater reduction in health care utilization and costs. PMID:26102298

  10. Factors associated with utilization of insecticide-treated nets in children seeking health care at a Ugandan hospital: perspective of child caregivers.

    Science.gov (United States)

    Nankinga, Ziadah; Muliira, Joshua Kanaabi; Kalyango, Joan; Nankabirwa, Joaniter; Kiwuwa, Steven; Njama-Meya, Denise; Karamagi, Charles

    2012-10-01

    In Uganda malaria causes more morbidity and mortality than any other disease and children below 5 years contribute the biggest percentage of malaria related mortality. Insecticide treated nets (ITNs) are currently one of the most cost effective option for reducing malaria-related morbidity and mortality, however the factors affecting their utilization in Uganda are still not well understood. This study examined the prevalence and factors associated with ITN utilization among children of age 0-12 years seeking health care from a Ugandan hospital using caregiver's reports. A cross sectional design was used to collect data using a semi-structured questionnaire from 418 participants. Binary logistic regression was employed to determine predictors of ITN utilization. Results show that the prevalence of ITN utilization among children seeking health care was 34.2%. ITN utilization was higher among children of age <5 years [37.0, 95% CI 31.81-42.21] as compared to children aged ≥5 years [22.9, 95% CI 13.77-32.01]. Source of mosquito net (OR = 13.53, 95% CI = 6.47-28.27), formal employment by head of household (OR = 6.00, 95% CI = 1.95-18.48), sharing a bed with parent (s) (OR = 2.61, 95% CI = 1.21-5.63) and number of children below 12 years in a household (OR = 0.80, 95% CI = 0.65-0.99), were significant predictors of utilization. ITN utilization among children was below the set national target. The predictors identified by this study reveal opportunities that can be taken advantage of by malaria control programs to achieve the desired rates of utilization and subsequently malaria prevention in children. PMID:22323100

  11. Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study

    Directory of Open Access Journals (Sweden)

    Miteku Andualem Limenih

    2016-01-01

    Full Text Available Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34, place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79, outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19, delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54, and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28 were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

  12. Postnatal Care Service Utilization and Associated Factors among Women Who Gave Birth in the Last 12 Months prior to the Study in Debre Markos Town, Northwestern Ethiopia: A Community-Based Cross-Sectional Study.

    Science.gov (United States)

    Limenih, Miteku Andualem; Endale, Zerfu Mulaw; Dachew, Berihun Assefa

    2016-01-01

    Improving maternal and newborn health through proper postnatal care services under the care of skilled health personnel is the key strategy to reduce maternal and neonatal mortality. However, there were limited evidences on utilization of postnatal care services in Ethiopia. A community based cross-sectional study was conducted in Debremarkos town, Northwest Ethiopia. Cluster sampling technique was used to select 588 study participants. Bivariate and multivariable logistic regression model was fitted to identify factors associated with postnatal care utilization. Odds ratio with 95% confidence interval was computed to determine the level of significance. Postnatal care service utilization was found to be 33.5%. Awareness about maternal complication (AOR: 2.72, 95% CI (1.71, 4.34)), place of delivery of last child (AOR: 1.68, 95% CI: (1.01, 2.79)), outcome of birth (AOR: 2.71, 95% CI (1.19, 6.19)), delivery by cesarean section (AOR: 4.82, 95% CI (1.86, 12.54)), and delivery complication that occurred during birth (AOR: 2.58, 95% CI (1.56, 4.28)) were factors associated with postnatal care service utilization. Postnatal care service utilization was found to be low. Increasing awareness about postnatal care, preventing maternal and neonatal complication, and scheduling mothers based on the national postnatal care follow-up protocol would increase postnatal care service utilization.

  13. 利用产前保健服务的影响因素及干预措施%Analysis of the influential factors and intervention methods of utilization for antenatal health care service

    Institute of Scientific and Technical Information of China (English)

    张敏; 郝艳青; 柳韦华; 孙铮

    2013-01-01

    目的 了解产前保健服务利用现状并探讨主要影响因素及其干预方法.方法 采用简单随机抽样方法,选择2011年1月至2012年7月住院的1685例孕产妇为研究对象,采用自行设计的问卷进行调查,并从孕产妇及其病历中收集相关资料,内容包括:一般人口学特征、医疗费用的支付方式、产前保健知识认知程度、就诊便利性、家庭成员对孕产妇的重视程度,产前保健服务利用情况等.结果 产前保健服务的利用率为81.19%.多因素Logistic回归分析显示:不同年龄、医疗费用支付方式、孕次、产前保健知识认知程度、家庭成员重视程度的孕产妇间,产前保健服务的利用率有显著差异.结论 本地区产前保健服务利用率偏低,改善产前保健服务模式;加大健康教育宣传力度;完善医疗保障制度;强化社区保健服务的意识及技术的提高是提高产前保健服务利用率的关键.%Objective To investigate utilization of antenatal health care service,analyze its influential factors and intervention methods.Methtods 1685 pregnant women who were in hospitalization from January 2011 to July 2012 were selected.A self-designed questionnaire was conducted and case history information were collected,including general information,medical costs means,awareness of prenatal care knowledge,whether convenient to see doctor,the degree of attention paid to pregnant women,the utilization of antenatal health care.Results 81.19%(1368/1685)of the pregnant women used antenatal health care service.Multiple Logistic regression analysis showed that the difference between diverse age,medical costs means,the number of pregnancies,level of awareness of prenatal care knowledge,the degree of attention paid to pregnant women was significant.Conclusions The utilization of antenatal health care service in this area is on the low side.The critical of improving the utilization of prenatal care services is improving

  14. Complex Care Management to Decrease Emergency Department Utilization: A Case Study of the Homeless Patient Aligned Care Team Demonstration Project at VA Greater Los Angeles Healthcare System

    OpenAIRE

    Patel, Beena Ishwar

    2013-01-01

    This quality improvement (QI) dissertation is a case study of the homeless-oriented Patient Centered Medical Home demonstration program, referred to as the Homeless Patient Aligned Care Team (HPACT) at West Los Angeles VA Medical Center (WLA). The WLA HPACT program was implemented to address the complex needs of the homeless and at-risk for homelessness population using the Patient Centered Medical Home model (PCMH) - a multi-disciplinary, team-based approach to primary care. Unlike tradition...

  15. The utilization and perceived usefulness of health care and other support services by people exposed to traumatic events related to the war in the Balkans

    Directory of Open Access Journals (Sweden)

    Tanja Frančišković

    2013-05-01

    Full Text Available Objective. To explore which health care and other support services people exposed to traumatic events related to the war use, how helpful they perceive them in the course of their post-war adaptation and whether utilization and perceived usefulness depend on the mental health status of participants. Methods. A community sample of 3304 adults exposed to at least one war-related traumatic event was randomly selected in different regions in the former Yugoslavia. A specifically designed instrument, the Matrix for the Assessment of Community and Healthcare Services, was used to record service utilization and their perceived usefulness. The mental health status of participants was assessed using the Mini International Neuropsychiatric Interview. Results. Primary health care was the most frequently used type of service (80.5%. Services providing help with leisure activities, social support and social contacts were perceived as most helpful. Participants with current post-traumatic stress disorder used all types of health care services and employment support services significantly more often than participants without mental disorders and participants with other mental disorders. They were more satisfied with primary health care services than participants without mental disorders and less satisfied with financial and material support services as compared to participants with other mental disorders. Conclusions. The frequency of utilization of different types of services varies greatly in war affected communities. Medical services are widely used and therefore have a central role in the care provision following a war. Services providing help with leisure activities and social support are most appreciated and may be more widely established.

  16. Association of oxytocin level and less severe forms of childhood maltreatment history among healthy Japanese adults involved with child care

    OpenAIRE

    Rie eMizuki; Takeo eFujiwara

    2015-01-01

    Background: Oxytocin (OT) is known to play a role in stress regulation. The association between childhood maltreatment history and neuropeptide OT concentration is inconsistent due to the varying degrees of severity of childhood maltreatment, among other contributing factors. Less severe forms of childhood maltreatment history might enhance OT concentrations as a response to coping with social stress within the family. The purpose of this study is to investigate the association between less s...

  17. A Cross-Sectional Study to Examine Factors Associated with Primary Health Care Service Utilization among Older Adults in the Irbid Governorate of Jordan

    Directory of Open Access Journals (Sweden)

    Abdullah Alkhawaldeh

    2014-01-01

    Full Text Available Background. Recently, the percentage of older adults in developing countries has increased significantly. Objective. This study examined patterns and factors associated with primary health care services utilization in the past 1, 6, and 12 months. Method. A cross-sectional study design was used to collect data from 190 older adults in the Irbid governorate of Jordan. Results. Primary health care services were used by less than half of the participants in the past 1 month, by 68.4% in the past 6 months, and by 73.8% in the past 12 months. Primary health care (PHC services use was associated with age, education level, tobacco use, chronic illnesses, perceived general health status today, a physical component summary score, employment, and perceived general health status in the past 6 and 12 months. The primary predictor of PHC services use at 1, 6, and 12 months was chronic illnesses (OR=13.32, (OR=19.63, and (OR=17.91, respectively. Conclusion. Although many factors were associated with PHC service utilization, the strongest predictor of PHC service utilization was chronic illnesses.

  18. The status and effect factors of prenatal health care utilization of migrant pregnant women in Nanjing%南京地区流动孕产妇产前保健利用状况及其影响因素

    Institute of Scientific and Technical Information of China (English)

    刘秀蓉; 吕伶

    2011-01-01

    Objective: To understand the status and effect factors of prenatal health care utilization of migrant pregnant women in Nanjing, provide a basis for making related health care policies for floating population. Methods: 409 migrant pregnant women were selected by stratified random sampling method, then they were surveyed by a questionnaire, the investigation contents included demographical characteristics, histories of pregnancy and delivery, examination at the first trimester of pregnancy and the times of prenatal examination. Results:The average gestationai weeks of the first prenatal examination in migrant pregnant women was (21. 1 ± 9. 1 ) weeks, the rate of early prenatal examination was 24. 9%, the average times of prenatal examination was (6. 2 ±3.6) times; 56. 2% of the women received prenatal examination for 5 times or more than 5 times. The main effect factors of prenatal health care utilization timeliness included per capita monthly income and multiparity or not; the main effect factors of prenatal health care utilization sufficiency included marriage, educational level, working or not of their spouses, per capita monthly income and multiparity or not. Conclusion: The utilization rate of prenatal health care in migrant pregnant women is low, the main effect factors of prenatal health care utilization include marriage, educational level, working or not of their spouses, multiparity or not and economic factor.%目的:了解影响流动人口孕产妇产前保健服务利用现状及其影响因素,为今后制定相关卫生工作政策提供参考依据.方法:分层随机抽取409例流动产妇进行问卷调查,调查内容包括社会人口学特征、孕产史、孕早期检查及产前检查次数等情况.结果:调查结果显示,流动人口中孕产妇初次产前检查平均孕周为(21.1±9.1)周,早期检查率仅为24.9%,平均产前检查次数为(6.2±3.6)次,≥5次的产前检查率为56.2%.影响产前保健利用及时性的主

  19. Species and life-history affects the utility of otolith chemical composition to determine natal stream-of-origin in Pacific salmon

    Science.gov (United States)

    Zimmerman, Christian E.; Swanson, Heidi K.; Volk, Eric C.; Kent, Adam J.R.

    2013-01-01

    To test the utility of otolith chemical composition as a tool for determining the natal stream of origin for salmon, we examined water chemistry and otoliths of juvenile and adult Chum Salmon Oncorhynchus keta and Coho Salmon O. kisutch from three watersheds (five rivers) in the Norton Sound region of Alaska. The two species are characterized by different life histories: Coho Salmon rear in freshwater for up to 3 years, whereas Chum Salmon emigrate from freshwater shortly after emergence. We used laser ablation (LA) inductively coupled plasma (ICP) mass spectrometry (MS) to quantify element: Ca ratios for Mg, Mn, Zn, Sr, and Ba, and we used multicollector LA-ICP-MS to determine 87Sr:86Sr ratios in otolith regions corresponding to the period of freshwater residence. Significant differences existed in both water and otolith elemental composition, suggesting that otolith composition could be used to discriminate the natal origin of Coho Salmon and Chum Salmon but only when 87Sr:86Sr ratios were included in the discriminant function analyses. The best discriminant model included 87Sr:86Sr ratios, and without 87Sr:86Sr ratios it was difficult to discriminate among watersheds and rivers. Classification accuracy was 80% for Coho Salmon and 68% for Chum Salmon, indicating that this method does not provide sufficient sensitivity to estimate straying rates of Pacific salmon at the scale we studied.

  20. Utilization and cost of a new model of care for managing acute knee injuries: the Calgary acute knee injury clinic

    OpenAIRE

    Lau Breda HF; Lafave Mark R; Mohtadi Nicholas G; Butterwick Dale J

    2012-01-01

    Abstract Background Musculoskeletal disorders (MSDs) affect a large proportion of the Canadian population and present a huge problem that continues to strain primary healthcare resources. Currently, the Canadian healthcare system depicts a clinical care pathway for MSDs that is inefficient and ineffective. Therefore, a new inter-disciplinary team-based model of care for managing acute knee injuries was developed in Calgary, Alberta, Canada: the Calgary Acute Knee Injury Clinic (C-AKIC). The g...

  1. Time and Money: The True Costs of Health Care Utilization for Patients Receiving "Free" HIV/Tuberculosis Care and Treatment in Rural KwaZulu-Natal

    NARCIS (Netherlands)

    Chimbindi, N.; Bor, J.; Newell, M.L.; Tanser, F.; Baltussen, R.M.P.M.; Hontelez, J.; Vlas, S.J. de; Lurie, M.; Pillay, D.; Barnighausen, T.

    2015-01-01

    BACKGROUND: HIV and tuberculosis (TB) services are provided free of charge in many sub-Saharan African countries, but patients still incur costs. METHODS: Patient-exit interviews were conducted in primary health care clinics in rural South Africa with representative samples of 200 HIV-infected patie

  2. Women health seeking behaviour and its influence on their fertility performance: utilization of prenatal and postnatal care

    International Nuclear Information System (INIS)

    Evidences regarding the effect of pre- and postnatal care on women fertility were scanty and rarely explored in countries struggling to curtail high population growth. This specialized health care enabled women for regular consultation with the health professionals and discussions with fellow women visiting clinics. It enhances their awareness, knowledge and understating about mother-child welfare during pre- and postnatal cares. This improves their control on subsequent fertility and underlines the need to explore the hidden dimension of female fertility. A doctoral level study on the determinants of marital fertility was conducted in district Faisalabad, Pakistan. It also examined the influence of pre- and postnatal care on family size in terms of children ever born. A random sample of 1051 married women was studied from 18 villages and 18 urban localities through formal survey. The study concluded that at least 5 prenatal and 2 postnatal cares proved effective in reducing marital fertility. Improved women access to specialized care, motivation through mass media, involvement of female representatives at union council level and effective use of primary support groups are the measures suggested to enhance women control on their fertility in Pakistan. (author)

  3. Association between muscle atrophy/weakness and health care costs and utilization among patients receiving total knee replacement surgery: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Chen SY

    2013-08-01

    Full Text Available Shih-Yin Chen,1 Ning Wu,1 Yuan-Chi Lee,1 Yang Zhao21Health Economics and Epidemiology, Evidera, Lexington, Massachusetts, 2Health Economics and Outcomes Research, Novartis Pharmaceuticals Corporation, East Hanover, New Jersey, USAPurpose: The aim of the study reported here was to examine health care resource utilization, costs, and risk of rehospitalization for total knee replacement (TKR patients with and without muscle atrophy/weakness (MAW.Patients and methods: Individuals aged 50–64 years with commercial insurance or 65+ years with Medicare Supplemental Insurance (Medicare who had a hospitalization for TKR between January 1, 2006 and September 30, 2009 were identified from a large US claims database. First hospitalization for TKR was defined as the index stay. All patients were classified into three cohorts according to when MAW was diagnosed relative to TKR: pre-MAW, post-MAW, and no MAW. The association between MAW and health care costs over the 12-month post-index period and the probability of rehospitalization were assessed via multivariate regressions.Results: The study sample included 53,696 Medicare and 46,058 commercial insurance TKR patients. Controlling for cross-cohort differences, both the pre- and post-MAW cohorts had significantly higher total health care costs (Medicare US$4,201 and US$9,404 higher, commercial insurance US$2,737 and US$6,640 higher, respectively than the no MAW cohort (all P < 0.05. The post-MAW cohort in both populations was also more likely to have any all-cause or replacement-related rehospitalization compared with the no MAW cohort.Conclusion: Among US patients undergoing TKR, those with MAW had higher health care utilization and costs than patients without MAW.Keywords: rehospitalization, resource utilization, Medicare, health insurance, USA

  4. Analysis of the utilization history and the planning and the participation profiles of the shaft plant Asse II. Final report; Analyse der Nutzungsgeschichte und der Planungs- und Beteiligungsformen der Schachtanlage Asse II. Endbericht

    Energy Technology Data Exchange (ETDEWEB)

    Ipsen, Detlev; Kost, Susanne; Weichler, Holger

    2010-03-08

    The report on the utilization history of Asse II covers the following issues: Historical facts of the purchase of the shaft plant Asse II, decision sequences and line of arguments, research mine or final repository? Emplacement of radioactive materials (inventory), stability of the mine layout and water ingress, risk assessment - accident analysis, communication and public information, conclusions and recommendations.

  5. Utilization of specialty mental health care among persons with severe mental illness: the roles of demographics, need, insurance, and risk.

    OpenAIRE

    McAlpine, D D; Mechanic, D.

    2000-01-01

    OBJECTIVE: To examine the sociodemographic, need, risk, and insurance characteristics of persons with severe mental illness and the importance of these characteristics for predicting specialty mental health utilization among this group. DATA SOURCE: The Healthcare for Communities survey, a national study that tracks alcohol, drug, and mental health services utilization. Data come from a telephone survey of adults from 60 communities across the United States, and from a supplemental geographic...

  6. Effectiveness of community based safe motherhood promoters in improving the utilization of obstetric care. The case of Mtwara Rural District in Tanzania

    Directory of Open Access Journals (Sweden)

    Jahn Albrecht

    2010-04-01

    Full Text Available Abstract Background In Tanzania, maternal mortality ratio remains unacceptably high at 578/100,000 live births. Despite a high coverage of antenatal care (96%, only 44% of deliveries take place within the formal health services. Still, "Ensure skilled attendant at birth" is acknowledged as one of the most effective interventions to reduce maternal deaths. Exploring the potential of community-based interventions in increasing the utilization of obstetric care, the study aimed at developing, testing and assessing a community-based safe motherhood intervention in Mtwara rural District of Tanzania. Method This community-based intervention was designed as a pre-post comparison study, covering 4 villages with a total population of 8300. Intervention activities were implemented by 50 trained safe motherhood promoters (SMPs. Their tasks focused on promoting early and complete antenatal care visits and delivery with a skilled attendant. Data on all 512 deliveries taking place from October 2004 to November 2006 were collected by the SMPs and cross-checked with health service records. In addition 242 respondents were interviewed with respect to knowledge on safe motherhood issues and their perception of the SMP's performance. Skilled delivery attendance was our primary outcome; secondary outcomes included antenatal care attendance and knowledge on Safe Motherhood issues. Results Deliveries with skilled attendant significantly increased from 34.1% to 51.4% (ρ Conclusion The study has demonstrated the effectiveness of community-based safe motherhood intervention in promoting the utilization of obstetric care and a skilled attendant at delivery. This improvement is attributed to the SMPs' home visits and the close collaboration with existing community structures as well as health services.

  7. The return of the Pholela experiment: medical history and primary health care in post-Apartheid South Africa.

    Science.gov (United States)

    Phillips, Howard

    2014-10-01

    I examine why South Africa's pioneering Pholela model of primary health care, dating from the 1940s, held such appeal for the country's new policymakers after 1994, and why those policymakers have failed to make it the basis of an effective public health care system since then. In the 1940s, the innovative Pholela experiment had served as such a model, to be replicated gradually throughout the country until a new health care system in its image was finally in place. However, this vision was dashed by the hostility of the mainstream medical profession and, after 1948, even more so by the new apartheid government, causing the idea to wither and become no more than a vanishing memory. In the 1990s, the model resurfaced as part of the country's transition to democracy, eliciting great enthusiasm among a new generation of health policymakers. I conclude by looking at the fate to date of this second coming of the Pholela experiment.

  8. Association of oxytocin level and less severe forms of childhood maltreatment history among healthy Japanese adults involved with child care

    Directory of Open Access Journals (Sweden)

    Rie eMizuki

    2015-06-01

    Full Text Available Background: Oxytocin (OT is known to play a role in stress regulation. The association between childhood maltreatment history and neuropeptide OT concentration is inconsistent due to the varying degrees of severity of childhood maltreatment, among other contributing factors. Less severe forms of childhood maltreatment history might enhance OT concentrations as a response to coping with social stress within the family. The purpose of this study is to investigate the association between less severe forms of childhood maltreatment history and OT concentrations among healthy adults.Method: Eighty-one adults (50 women and 31 men with 18- to 48-month-old children were recruited using a snowball sample in Tokyo, Japan. Urine samples were collected for OT measurement. Less severe (low and moderate childhood maltreatment history, including physical abuse, physical neglect, emotional abuse, emotional neglect, and sexual abuse, was assessed using the self-report questionnaire, the Childhood Trauma Questionnaire. Results: Less severe physical abuse was significantly associated with higher OT concentration after adjusting for age (p=0.014. Also, less severe forms of physical abuse were independently significantly associated with higher OT concentration after controlling for other types of childhood maltreatment (p=0.027. A positive dose-response association between the number of less severe childhood maltreatment types and OT concentration was observed (p=0.031. Conclusion: A history of less severe forms of childhood physical abuse was associated with higher OT concentration in healthy adults. Poly-victimization of several types of less severe childhood maltreatment was also associated with higher OT concentrations. Less severe forms of childhood maltreatment might enhance OT concentrations in order to cope with social stress.

  9. Postnatal care utilization and local understandings of contagion among HIV-infected and uninfected women in rural, southern Zambia.

    Science.gov (United States)

    Sacks, Emma; Moss, William J; Winch, Peter J; Thuma, Philip; van Dijk, Janneke H; Mullany, Luke C

    2016-08-01

    Postnatal care is essential for ensuring the optimal health of newborns and necessary for the prevention of maternal-to-child human immunodeficiency virus (HIV) transmission as well as the early diagnosis and treatment of HIV-infected infants. However, coverage of postnatal care is low in many rural areas of sub-Saharan Africa. We examined women's experiences of accessing formal postnatal care for their HIV-exposed newborns, comparing reports of HIV-infected and uninfected women in an HIV-endemic area of rural southern Zambia. We conducted 24 qualitative in-depth interviews with recently delivered women in a rural region of southern Zambia, including 8 with women who were willing to disclose their HIV infection status and answer additional questions. Data were transcribed, coded and analyzed using thematic analysis techniques. HIV-infected women identified more disincentives and reported more negative experiences accessing postnatal care than HIV-uninfected women. A local notion of contagion holds that healthy infants may become sick with chibele, a fatal, febrile illness, if exposed to another infant who is taking "strong medicine", such as antiretroviral drugs. Thus, HIV-uninfected women expressed objections to sharing clinics with women and infants who were presumed to be under treatment. Additionally, women reported receiving better treatment from staff at HIV clinics compared to general pediatric clinics. Due to these tensions, HIV-infected women were less likely to visit a clinic for newborn care if the clinic or waiting area was a common space used by HIV-uninfected women and their children. When integrating programs for HIV with maternal and child health care, these nuanced tensions between groups of patients must be recognized and resolved. PMID:27064444

  10. Postnatal care utilization and local understandings of contagion among HIV-infected and uninfected women in rural, southern Zambia.

    Science.gov (United States)

    Sacks, Emma; Moss, William J; Winch, Peter J; Thuma, Philip; van Dijk, Janneke H; Mullany, Luke C

    2016-08-01

    Postnatal care is essential for ensuring the optimal health of newborns and necessary for the prevention of maternal-to-child human immunodeficiency virus (HIV) transmission as well as the early diagnosis and treatment of HIV-infected infants. However, coverage of postnatal care is low in many rural areas of sub-Saharan Africa. We examined women's experiences of accessing formal postnatal care for their HIV-exposed newborns, comparing reports of HIV-infected and uninfected women in an HIV-endemic area of rural southern Zambia. We conducted 24 qualitative in-depth interviews with recently delivered women in a rural region of southern Zambia, including 8 with women who were willing to disclose their HIV infection status and answer additional questions. Data were transcribed, coded and analyzed using thematic analysis techniques. HIV-infected women identified more disincentives and reported more negative experiences accessing postnatal care than HIV-uninfected women. A local notion of contagion holds that healthy infants may become sick with chibele, a fatal, febrile illness, if exposed to another infant who is taking "strong medicine", such as antiretroviral drugs. Thus, HIV-uninfected women expressed objections to sharing clinics with women and infants who were presumed to be under treatment. Additionally, women reported receiving better treatment from staff at HIV clinics compared to general pediatric clinics. Due to these tensions, HIV-infected women were less likely to visit a clinic for newborn care if the clinic or waiting area was a common space used by HIV-uninfected women and their children. When integrating programs for HIV with maternal and child health care, these nuanced tensions between groups of patients must be recognized and resolved.

  11. Children's tooth decay in a public health program to encourage low-income pregnant women to utilize dental care

    OpenAIRE

    Shirtcliff R Mike; Sutherland Marilynn; Milgrom Peter; Ludwig Sharity; Smolen Darlene

    2010-01-01

    Abstract Background A community-based public health program to provide a dental home for women covered by the Oregon Health Plan (Medicaid) in Klamath County, Oregon USA was instituted with the long-term goal to promote preventive oral care for both mothers and their new infants provided by dental managed care companies. Methods As part of the evaluation of the program, children in Klamath and comparable non-program counties were examined in their 2nd year of life to begin to determine if ben...

  12. Community Care for People with Chronic Conditions: An Analysis of Nine Studies of Health and Social Service Utilization in Ontario

    OpenAIRE

    Watt, Susan; Browne, Gina; Gafni, Amiram; Roberts, Jacqueline; Byrne, Carolyn

    1999-01-01

    A series of studies conducted in the same region found that programmatic, community-based health and social service interventions have a positive impact on client well-being. These proactive interventions, designed to address the full range of health and social needs, were usually provided at the same–or even lower–costs as uncoordinated, illness-focused care. The results of this series suggest that across-the-board health care reduction, atleast in a system of national health insurance, will...

  13. Using transprofessional care in the emergency department to reduce patient admissions: A retrospective audit of medical histories.

    Science.gov (United States)

    Morphet, Julia; Griffiths, Debra Lee; Crawford, Kimberley; Williams, Allison; Jones, Tamsin; Berry, Belinda; Innes, Kelli

    2016-01-01

    The demand for emergency department (ED) services has increased significantly, due to our increasingly ageing population and limited access to primary care. This article reports outcomes from a transprofessional model of care in an ED in Victoria, Australia. Nurses, physiotherapists, social workers, and occupational therapists undertook additional education to increase the range of services they could provide and thereby expedite patient flow through the ED. One hundred patients who received this service were matched against 50 patients who did not. The most common reasons for patient admission were limb injury/limb pain (n = 47, 23.5%) and falls (n = 46, 23.0%). Transprofessional interventions included applying supportive bandages, slings, zimmer splints and controlled ankle motion (CAM) boots, and referral to new services such as case management and mental health teams. The rate of hospital admissions was significantly lower in the transprofessional group (n = 27, 18.0%) than in the reference group (n = 19, 38%, p = 0.005). This group also had a slightly lower re-presentation rate (n = 4, 2.7%) than patients in the reference group (n = 2, 4.0%). There are many benefits that support this model of care that in turn reduces ED overcrowding and work stress. A transprofessional model may offer a creative solution to meeting the varied needs of patients presenting for emergency care. PMID:26954260

  14. Computer-assisted history-taking systems (CAHTS in health care: benefits, risks and potential for further development

    Directory of Open Access Journals (Sweden)

    Yannis Pappas

    2011-06-01

    Conclusions Our review shows that for CAHTS to be adopted in mainstream health care, important changes should take place in how we conceive, plan and conduct primary and secondary research on the topic so that we provide the framework for a comprehensive evaluation that will lead to an evidence base to inform policy and practice.

  15. The Birmingham Burn Centre archive: A photographic history of post-war burn care in the United Kingdom.

    Science.gov (United States)

    Hardwicke, Joseph; Kohlhardt, Angus; Moiemen, Naiem

    2015-06-01

    The Medical Research Council Burns and Industrial Injuries Unit at the Birmingham Accident Hospital pioneered civilian burn care and research in the United Kingdom during the post-war years. A photographic archive has been discovered that documents this period from 1945 to 1975. The aim of this project was to sort, digitize and archive the images in a secure format for future reference. The photographs detail the management of burns patients, from injury causation and surgical intervention, to nursing care, rehabilitation and long-term follow-up. A total of 2650 images files were collected from over 600 patients. Many novel surgical, nursing, dressing and rehabilitation strategies are documented and discussed. We have chosen to report part of the archive under the sections of (1) aseptic and antimicrobial burn care; (2) burn excision and wound closure; (3) rehabilitation, reconstruction and long-term outcomes; (4) accident prevention; and (5) response to a major burns incident. The Birmingham collection gives us a valuable insight into the approach to civilian burn care in the post-war years, and we present a case from the archive to the modern day, the longest clinical photographic follow-up to date.

  16. Implementation of the ‘BeweegKuur’ in practice: utilization of care of a lifestyle intervention in the Netherlands.

    NARCIS (Netherlands)

    Barte, J.C.M.; Hendriks, M.R.C.; Rutten, G.; Veenhof, C.; Bemelmans, W.J.E.

    2014-01-01

    This study investigates the delivered care in a multidisciplinary lifestyle intervention by dieticians and physiotherapists compared to the protocol of this intervention. Participants with a body mass index (BMI) between 25 and 40 kgm22 were divided over three different programs depending on their B

  17. Implementation of the 'BeweegKuur' in practice: Utilization of care of a lifestyle intervention in the Netherlands

    NARCIS (Netherlands)

    Barte, J.C.M.; Hendriks, M.R.C.; Rutten, G.M.; Veenhof, C.; Bemelmans, W.J.E.

    2014-01-01

    This study investigates the delivered care in a multidisciplinary lifestyle intervention by dieticians and physiotherapists compared to the protocol of this intervention. Participants with a body mass index (BMI) between 25 and 40 kg m− 2 were divided over three different programs depending on their

  18. Self-help groups can improve utilization of post-natal care by HIV-positive mothers

    NARCIS (Netherlands)

    T.A. Nguyen; P. Oosterhoff; P.N. Yen; P. Wright; A. Hardon

    2009-01-01

    HIV prevention within maternal-child health services has increased in many developing countries, but many HIV-infected women in developing countries still receive insufficient postnatal care. This study explored the experience of 30 HIV-infected women in Vietnam in accessing HIV-related postnatal ca

  19. The impact of Ethiopia’s pilot community based health insurance scheme on healthcare utilization and cost of care

    NARCIS (Netherlands)

    A.D. Mebratie (Anagaw); R.A. Sparrow (Robert); Z.Y. Debebe (Zelalem); D. Abebaw Ejigie (Degnet); G. Alemu (Getnet ); A.S. Bedi (Arjun Singh)

    2014-01-01

    textabstractIn recent years there has been a proliferation of Community Based Health Insurance (CBHI) schemes designed to enhance access to modern health care services and provide financial protection to workers in the informal and rural sectors. In June 2011, the Government of Ethiopia introduced a

  20. Computer-assisted history-taking systems (CAHTS) in health care: benefits, risks and potential for further development

    OpenAIRE

    Yannis Pappas; Chantelle Anandan; Joseph Liu; Josip Car; Aziz Sheikh; Azeem Majeed

    2011-01-01

    Background A computer-assisted history-taking system (CAHTS) is a tool that aids clinicians in gathering data from patients to inform a diagnosis or treatment plan. Despite the many possible applications and even though CAHTS have been available for nearly three decades, these remain underused in routine clinical practice. Objective Through an interpretative review of the literature, we provide an overview of the field of CAHTS, which also offers an understanding of the impact of these sys...

  1. Estimating Utility

    DEFF Research Database (Denmark)

    Arndt, Channing; Simler, Kenneth R.

    2010-01-01

    A fundamental premise of absolute poverty lines is that they represent the same level of utility through time and space. Disturbingly, a series of recent studies in middle- and low-income economies show that even carefully derived poverty lines rarely satisfy this premise. This article proposes...... an information-theoretic approach to estimating cost-of-basic-needs (CBN) poverty lines that are utility consistent. Applications to date illustrate that utility-consistent poverty measurements derived from the proposed approach and those derived from current CBN best practices often differ substantially...

  2. Utilization of collaborative practice agreements between physicians and pharmacists as a mechanism to increase capacity to care for hematopoietic stem cell transplant recipients.

    Science.gov (United States)

    Merten, Julianna A; Shapiro, Jamie F; Gulbis, Alison M; Rao, Kamakshi V; Bubalo, Joseph; Lanum, Scott; Engemann, Ashley Morris; Shayani, Sepideh; Williams, Casey; Leather, Helen; Walsh-Chocolaad, Tracey

    2013-04-01

    Survival after hematopoietic stem cell transplantation (HSCT) has improved and the number of allogeneic HSCTs performed annually in the United States is expected to reach 10,000 by 2015. The National Marrow Donor Program created the System Capacity Initiative to formulate mechanisms to care for the growing number of HSCT recipients. One proposed method to increase capacity is utilization of pharmacists to manage drug therapy via collaborative practice agreements (CPAs). Pharmacists have managed drug therapy in oncology patients with CPAs for decades; however, there are limited HSCT centers that employ this practice. Engaging in collaborative practice and billing agreements with credentialed pharmacists to manage therapeutic drug monitoring, chronic medical conditions, and supportive care in HSCT recipients may be cost-effective and enable physicians to spend more time on new or more complex patients. The goal of this paper is to provide a framework for implementation of a CPA and address how it may improve HSCT program capacity. PMID:23419976

  3. The Affordable Care Act and the Burden of High Cost Sharing and Utilization Management Restrictions on Access to HIV Medications for People Living with HIV/AIDS.

    Science.gov (United States)

    Zamani-Hank, Yasamean

    2016-08-01

    The HIV/AIDS epidemic continues to be a critical public health issue in the United States, where an estimated 1.2 million individuals live with HIV infection. Viral suppression is one of the primary public health goals for People Living with HIV/AIDS (PLWHA). A crucial component of this goal involves adequate access to health care, specifically anti-retroviral HIV medications. The enactment of the Affordable Care Act (ACA) in 2010 raised hopes for millions of PLWHA without access to health care coverage. High cost-sharing requirements enacted by health plans place a financial burden on PLWHA who need ongoing access to these life-saving medications. Plighted with poverty, Detroit, Michigan, is a center of attention for examining the financial burden of HIV medications on PLWHA under the new health plans. From November 2014 to January 2015, monthly out-of-pocket costs and medication utilization requirements for 31 HIV medications were examined for the top 12 insurance carriers offering Qualified Health Plans on Michigan's Health Insurance Marketplace Exchange. The percentage of medications requiring quantity limits and prior authorization were calculated. The average monthly out-of-pocket cost per person ranged from $12 to $667 per medication. Three insurance carriers placed all 31 HIV medications on the highest cost-sharing tier, charging 50% coinsurance. High out-of-pocket costs and medication utilization restrictions discourage PLWHA from enrolling in health plans and threaten interrupted medication adherence, drug resistance, and increased risk of viral transmission. Health plans inflicting high costs and medication restrictions violate provisions of the ACA and undermine health care quality for PLWHA. (Population Health Management 2016;19:272-278). PMID:26565514

  4. Will sacubitril-valsartan diminish the clinical utility of B-type natriuretic peptide testing in acute cardiac care?

    DEFF Research Database (Denmark)

    Mair, Johannes; Lindahl, Bertil; Giannitsis, Evangelos;

    2016-01-01

    Since the approval of sacubitril-valsartan for the treatment of chronic heart failure with reduced ejection fraction, a commonly raised suspicion is that a wider clinical use of this new drug may diminish the clinical utility of B-type natriuretic peptide testing as sacubitril may interfere with ...

  5. Study on drug utilization pattern of antibiotics among dermatology in-patients of a tertiary care teaching hospital, Karaikal, Puducherry

    Directory of Open Access Journals (Sweden)

    C. M. Divyashanthi

    2014-12-01

    Conclusion: Our study provided an idea about the prevalence of dermatological disorders in a coastal area of Karaikal, Puducherry, the drug utilization strategy of antibiotics, the rationality behind usage and has given useful suggestions to achieve treatment success through judicious use of antibiotics. [Int J Basic Clin Pharmacol 2014; 3(6.000: 1072-1077

  6. An evaluation of the impact of patient cost sharing for antihypertensive medications on adherence, medication and health care utilization, and expenditures

    Directory of Open Access Journals (Sweden)

    Pesa JA

    2012-01-01

    Full Text Available Jacqueline A Pesa1, Jill Van Den Bos2, Travis Gray2, Colleen Hartsig2, Robert Brett McQueen3, Joseph J Saseen3, Kavita V Nair31Janssen Scientific Affairs, LLC, Louisville, CO, USA; 2Milliman, Inc, Denver, CO, USA; 3University of Colorado Anschutz Medical Campus, Aurora, CO, USAObjective: To assess the impact of patient cost-sharing for antihypertensive medications on the proportion of days covered (PDC by antihypertensive medications, medical utilization, and health care expenditures among commercially insured individuals assigned to different risk categories.Methods: Participants were identified from the Consolidated Health Cost Guidelines (CHCG database (January 1, 2006–December 31, 2008 based on a diagnosis (index claim for hypertension, continuous enrollment ≥12 months pre- and post-index, and no prior claims for antihypertensive medications. Participants were assigned to: low-risk group (no comorbidities, high-risk group (1+ selected comorbidities, or very high-risk group (prior hospitalization for 1+ selected comorbidities. The relationship between patient cost sharing and PDC by antihypertensive medications was assessed using standard linear regression models, controlling for risk group membership, and various demographic and clinical factors. The relationship between PDC and health care service utilization was subsequently examined using negative binomial regression models.Results: Of the 28,688 study patients, 66% were low risk. The multivariate regression model supported a relationship between patient cost sharing per 30-day fill and PDC in the following year. For every US$1.00 increase in cost sharing, PDC decreased by 1.1 days (P < 0.0001. Significant predictors of PDC included high risk, older age, gender, Charlson Comorbidity Index score, geography, and total post-index insurer- and patient-paid costs. An increase in PDC was associated with a decrease in all-cause and hypertension-related inpatient, outpatient, and emergency

  7. Predictive value and utility of oral steroid testing for treatment of COPD in primary care: the COOPT study

    Directory of Open Access Journals (Sweden)

    Niels H Chavannes

    2009-11-01

    Full Text Available Niels H Chavannes1,2, Tjard RJ Schermer3, Emiel FM Wouters4, Reinier P Akkermans3, Richard PN Dekhuijzen5, Jean WM Muris2, Chris van Weel3, Onno CP van Schayck21Department of Public Health and Primary Care, Leiden University Medical Center, The Netherlands; 2Caphri Research Institute, Department of General Practice, Maastricht University, The Netherlands; 3Department of Primary and Community Care, Radboud University Nijmegen Medical Center, The Netherlands; 4Department of Pulmonary Diseases, University Hospital Maastricht, The Netherlands; 5Department of Pulmonary Diseases, Radboud University Nijmegen Medical Center, The NetherlandsBackground: The oral prednisolone test is widely used to distinguish chronic obstructive pulmonary disease (COPD patients who might benefit from inhaled steroid treatment. Previous studies used selected patient groups that did not represent the large COPD population in primary care.Methods: The study included smokers and exsmokers with chronic bronchitis or COPD from primary care, who underwent prednisolone testing (30 mg for 14 days before randomization in a three-year follow-up randomized controlled trial (COOPT Study. Spirometry was performed before and after the test. Responders and nonresponders were classified according to international criteria. Effectiveness of inhaled fluticasone relative to placebo was compared in terms of health status (Chronic Respiratory Disease Questionnaire, exacerbations, and postbronchodilator forced expiratory volume in one second (FEV1, using repeated measurement analysis.Results: Two hundred eighty-six patients recruited from 44 primary care practices were randomized. Nine percent to 16% of the COPD population was classified as responder, depending on the international guideline criteria used. On average, responders did not reach the minimum clinically important difference in health status (0.29 points/year, P = 0.05, although a borderline significant effect of inhaled fluticasone

  8. 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...

  9. Just truth? Carefully applying history, philosophy and sociology of science to the forensic use of CCTV images.

    Science.gov (United States)

    Edmond, Gary

    2013-03-01

    Using as a case study the forensic comparison of images for purposes of identification, this essay considers how the history, philosophy and sociology of science might help courts to improve their responses to scientific and technical forms of expert opinion evidence in ways that are more consistent with legal system goals and values. It places an emphasis on the need for more sophisticated models of science and expertise that are capable of helping judges to identify sufficiently reliable types of expert evidence and to reflexively incorporate the weakness of trial safeguards and personnel into their admissibility decision making.

  10. Vermont's Community-Oriented All-Payer Medical Home Model Reduces Expenditures and Utilization While Delivering High-Quality Care

    Science.gov (United States)

    Jones, Craig; Finison, Karl; McGraves-Lloyd, Katharine; Tremblay, Timothy; Tanzman, Beth; Hazard, Miki; Maier, Steven; Samuelson, Jenney

    2016-01-01

    Abstract Patient-centered medical home programs using different design and implementation strategies are being tested across the United States, and the impact of these programs on outcomes for a general population remains unclear. Vermont has pursued a statewide all-payer program wherein medical home practices are supported with additional staffing from a locally organized shared resource, the community health team. Using a 6-year, sequential, cross-sectional methodology, this study reviewed annual cost, utilization, and quality outcomes for patients attributed to 123 practices participating in the program as of December 2013 versus a comparison population from each year attributed to nonparticipating practices. Populations are grouped based on their practices' stage of participation in a calendar year (Pre-Year, Implementation Year, Scoring Year, Post-Year 1, Post-Year 2). Annual risk-adjusted total expenditures per capita at Pre-Year for the participant group and comparison group were not significantly different. The difference-in-differences change from Pre-Year to Post-Year 2 indicated that the participant group's expenditures were reduced by −$482 relative to the comparison (95% CI, −$573 to −$391; P utilization. Medicaid participants also had a relative increase in expenditures for dental, social, and community-based support services ($57; P utilization. (Population Health Management 2016;19:196–205) PMID:26348492

  11. Conducting the Medical History

    Science.gov (United States)

    Finkel, Martin A.; Alexander, Randell A.

    2011-01-01

    A key portion of the medical evaluation of child sexual abuse is the medical history. This differs from interviews or histories obtained by other professionals in that it is focuses more on the health and well-being of the child. Careful questions should be asked about all aspects of the child's medical history by a skilled, compassionate,…

  12. Somatic Care with a Psychotic Disorder. Lower Somatic Health Care Utilization of Patients with a Psychotic Disorder Compared to Other Patient Groups and to Controls Without a Psychiatric Diagnosis.

    Science.gov (United States)

    Swildens, Wilma; Termorshuizen, Fabian; de Ridder, Alex; Smeets, Hugo; Engelhard, Iris M

    2016-09-01

    Patients with non-affective psychotic disorders (NAPD) face higher risk of somatic problems and early natural death compared to the general population. Therefore, treatment guidelines for schizophrenia and psychosis stress the importance of monitoring somatic risk factors. This study examined somatic Health Care utilization (HCu) of patients with NAPD compared to non-psychiatric controls and patients with depression, anxiety or bipolar disorders using a large Health Insurance database. Results show lower specialist somatic HCu of patients with NAPD compared to matched controls and also lower percentages for prescribed somatic medication and general practitioner consultations for patients aged ≥60 years and after longer illness duration. PMID:26411564

  13. Diagnosing dengue at the point-of-care: utility of a rapid combined diagnostic kit in Singapore.

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    Gan, Victor C; Tan, Li-Kiang; Lye, David C; Pok, Kwoon-Yong; Mok, Shi-Qi; Chua, Rachel Choon-Rong; Leo, Yee-Sin; Ng, Lee-Ching

    2014-01-01

    WHO recommendations for dengue diagnosis require laboratory facilities. Antibody-based rapid diagnostic tests (RDTs) have performed poorly, and clinical diagnosis remains the mainstay in dengue-endemic countries. We evaluated a combination antigen-antibody RDT for point-of-care testing in a high-prevalence setting. In this prospective cohort study, adults were enrolled from a tertiary infectious disease centre for evaluation of undifferentiated febrile illness from October 2011 to May 2012. SD Bioline Dengue Duo was evaluated at point-of-care against a WHO-based reference standard of viral isolation, RT-PCR, NS1-, IgM-, and IgG-ELISA. 246 adults were enrolled (median age 34 years, range 18-69), of which 197 could be confirmed definitively as either dengue or non-dengue. DENV-2 was the predominant serotype (79.5%) and the ratio of primary to secondary cases was 1∶1.1. There were no test failures and minimal interobserver variation with a Fleiss' kappa of 0.983 (95% CI 0.827-1.00). Overall sensitivity and specificity were 93.9% (95% CI 88.8-96.8%) and 92.0% (95% CI 81.2-96.9%) respectively. Using WHO clinical criteria alone for diagnosis had similar sensitivities (95.9%, 95% CI 91.4-98.1%) and lower specificities (20.0%, 95% CI 11.2-33.0%). No significant difference in performance was found when testing early versus late presenters, primary versus secondary cases, or DENV-1 versus DENV-2 infections. The use of a combination RDT fulfills WHO ASSURED criteria for point-of-care testing and can enhance dengue diagnosis in an endemic setting. This has the potential to markedly improve clinical management of dengue in the field.

  14. Diagnosing dengue at the point-of-care: utility of a rapid combined diagnostic kit in Singapore.

    Directory of Open Access Journals (Sweden)

    Victor C Gan

    Full Text Available WHO recommendations for dengue diagnosis require laboratory facilities. Antibody-based rapid diagnostic tests (RDTs have performed poorly, and clinical diagnosis remains the mainstay in dengue-endemic countries. We evaluated a combination antigen-antibody RDT for point-of-care testing in a high-prevalence setting. In this prospective cohort study, adults were enrolled from a tertiary infectious disease centre for evaluation of undifferentiated febrile illness from October 2011 to May 2012. SD Bioline Dengue Duo was evaluated at point-of-care against a WHO-based reference standard of viral isolation, RT-PCR, NS1-, IgM-, and IgG-ELISA. 246 adults were enrolled (median age 34 years, range 18-69, of which 197 could be confirmed definitively as either dengue or non-dengue. DENV-2 was the predominant serotype (79.5% and the ratio of primary to secondary cases was 1∶1.1. There were no test failures and minimal interobserver variation with a Fleiss' kappa of 0.983 (95% CI 0.827-1.00. Overall sensitivity and specificity were 93.9% (95% CI 88.8-96.8% and 92.0% (95% CI 81.2-96.9% respectively. Using WHO clinical criteria alone for diagnosis had similar sensitivities (95.9%, 95% CI 91.4-98.1% and lower specificities (20.0%, 95% CI 11.2-33.0%. No significant difference in performance was found when testing early versus late presenters, primary versus secondary cases, or DENV-1 versus DENV-2 infections. The use of a combination RDT fulfills WHO ASSURED criteria for point-of-care testing and can enhance dengue diagnosis in an endemic setting. This has the potential to markedly improve clinical management of dengue in the field.

  15. Looking to Hume for justice: on the utility of Hume's view of justice for American health care reform.

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    Churchill, L R

    1999-08-01

    This essay argues that Hume's theory of justice can be useful in framing a more persuasive case for universal access in health care. Theories of justice derived from a Rawlsian social contract tradition tend to make the conditions for deliberation on justice remote from the lives of most persons, while religiously-inspired views require superhuman levels of benevolence. By contrast, Hume's theory derives justice from the prudent reflections of socially-encumbered selves. This provides a more accessible moral theory and a more realistic path to the establishment of universal access.

  16. Comparison of health care resource utilization and costs among patients with GERD on once-daily or twice-daily proton pump inhibitor therapy

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    Mody R

    2013-04-01

    Full Text Available Reema Mody,1 Debra Eisenberg,2 Likun Hou,2 Siddhesh Kamat,2 Joseph Singer,2 Lauren B Gerson3 1Takeda Pharmaceuticals International Inc, Deerfield, IL, 2HealthCore Inc, Wilmington, DE, 3Stanford University School of Medicine, Stanford, CA, USA Background: The purpose of this study was to assess differences in health care resource utilization and costs associated with once-daily and twice-daily proton pump inhibitor (PPI therapy. Most patients with gastroesophageal reflux disease (GERD achieve symptom control on once-daily PPI therapy, but approximately 20%–30% require twice-daily dosing. Methods: Patients were ≥18 years of age with at least one medical claim for GERD and at least two PPI claims from HealthCore's Integrated Research Database (HIRDSM during 2004–2009. Patients were continuously eligible for 12 months before and after the index date (date of first PPI claim. Based on PPI dosing throughout the post-index period (quantity of medication dispensed/number of days supply, patients were classified as once-daily (dose ≤ 1.5 pills per day or twice-daily (≥1.5 PPI users. Results: The study cohort included 248,386 patients with GERD (mean age 52.8 ± 13.93 years, 56% females of whom 90% were once-daily and 10% were twice-daily PPI users. The Deyo-Charlson Comorbidity Index for once-daily and twice-daily PPI users was 0.70 ± 1.37 and 0.89 ± 1.54, respectively (P < 0.05. More once-daily patients had claims for Barrett's esophagus (5% versus 2%, P < 0.0001 than twice-daily patients. Post-index, higher proportions of twice-daily patients had at least one GERD-related inpatient visit (7% versus 5%, outpatient visit (60% versus 49%, and office visit (48% versus 38% versus once-daily patients (P < 0.0001. Mean total GERD-related health care costs were $2065 ± $6636 versus $3749 ± $11,081 for once-daily and twice-daily PPI users, respectively (P < 0.0001. Conclusion: Patients receiving twice-daily PPI therapy were likely to have more

  17. Productivity loss and resource utilization, and associated indirect and direct costs in individuals providing care for adults with schizophrenia in the EU5

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    Gupta S

    2015-11-01

    Full Text Available Shaloo Gupta,1 Gina Isherwood,2 Kevin Jones,3 Kristel Van Impe4 1Kantar Health, Princeton, NJ, USA; 2Kantar Health, Epsom, Surrey, UK; 3European Federation of Associations of Families of People with Mental Illness, Diestsevest, Leuven, Belgium; 4Janssen-Cilag GmbH, Neuss, Germany Objective: This study aimed to understand the impact of providing care for adults with schizophrenia on productivity, resource utilization, and costs in the EU5 (France, Germany, Italy, Spain, and UK. Methods: Data from the 2010, 2011, and 2013 EU5 National Health and Wellness Survey, an online questionnaire of a nationwide sample of adults, were analyzed. Schizophrenia caregivers (n=398 were matched to noncaregivers (n=158,989 and other caregivers (n=14,341 via propensity scores. Outcome measures included health care utilization, Work Productivity and Activity Impairment questionnaire-based scores, and associated direct and indirect costs (estimated from the literature. Significant differences between schizophrenia caregivers vs noncaregivers and other caregivers (eg, cancer and Alzheimer's disease were examined. Results: After matching, schizophrenia caregivers reported greater activity impairment (38.4% vs 26.1%, provider visits (8.0 vs 5.7, emergency room visits (0.9 vs 0.2, hospitalizations (0.8 vs 0.1, and direct costs (€2,258 vs €617 than noncaregivers, all P<0.001. Employed schizophrenia caregivers reported greater absenteeism, presenteeism, overall work impairment (35.0% vs 20.7%, and indirect costs (€6,667 vs €3,795 than noncaregivers, all P<0.001. Schizophrenia caregivers (vs other caregivers reported greater activity impairment (38.4% vs 32.3% and provider visits (8.0 vs 6.6, P<0.05. A greater proportion of schizophrenia caregivers (vs other caregivers reported at least one emergency room visit (26.1% vs 20.2% and hospitalization (20.4% vs 14.3%, P<0.05. Employed schizophrenia caregivers incurred greater indirect costs than other caregivers (€6

  18. Children's tooth decay in a public health program to encourage low-income pregnant women to utilize dental care

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    Shirtcliff R Mike

    2010-02-01

    Full Text Available Abstract Background A community-based public health program to provide a dental home for women covered by the Oregon Health Plan (Medicaid in Klamath County, Oregon USA was instituted with the long-term goal to promote preventive oral care for both mothers and their new infants provided by dental managed care companies. Methods As part of the evaluation of the program, children in Klamath and comparable non-program counties were examined in their 2nd year of life to begin to determine if benefits accrued to the offspring of the mothers in Klamath County. Results Eighty-five and 58.9% of the children were caries free in the Klamath and comparison county samples, respectively (RR = 1.48, 95% CI 1.13, 1.93. The mean (SD number of teeth with any decay was .75 (2.5 in the test population and 1.6 (2.5 in the comparison population (t = 2.08, p = .04. Conclusions The assessment showed that children of mothers in the Klamath County program were about one and a half times more likely to be caries free than children in the comparison counties. Additional controlled studies are being undertaken.

  19. Life history trade-offs and behavioral sensitivity to testosterone: an experimental test when female aggression and maternal care co-occur.

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    Kimberly A Rosvall

    Full Text Available Research on male animals suggests that the hormone testosterone plays a central role in mediating the trade-off between mating effort and parental effort. However, the direct links between testosterone, intrasexual aggression and parental care are remarkably mixed across species. Previous attempts to reconcile these patterns suggest that selection favors behavioral insensitivity to testosterone when paternal care is essential to reproductive success and when breeding seasons are especially short. Females also secrete testosterone, though the degree to which similar testosterone-mediated trade-offs occur in females is much less clear. Here, I ask whether testosterone mediates trade-offs between aggression and incubation in females, and whether patterns of female sensitivity to testosterone relate to female life history, as is often the case in males. I experimentally elevated testosterone in free-living, incubating female tree swallows (Tachycineta bicolor, a songbird with a short breeding season during which female incubation and intrasexual aggression are both essential to female reproductive success. Testosterone-treated females showed significantly elevated aggression, reduced incubation temperatures, and reduced hatching success, relative to controls. Thus, prolonged testosterone elevation during incubation was detrimental to reproductive success, but females nonetheless showed behavioral sensitivity to testosterone. These findings suggest that the relative importance of both mating effort and parental effort may be central to understanding patterns of behavioral sensitivity in both sexes.

  20. User-driven health care: answering multidimensional information needs in individual patients utilizing post-EBM approaches: an operational model.

    Science.gov (United States)

    Biswas, Rakesh; Maniam, Jayanthy; Lee, Edwin Wen Huo; Gopal, Premalatha; Umakanth, Shashikiran; Dahiya, Sumit; Ahmed, Sayeed

    2008-10-01

    The hypothesis in the conceptual model was that a user-driven innovation in presently available information and communication technology infrastructure would be able to meet patient and health professional users information needs and help them attain better health outcomes. An operational model was created to plan a trial on a sample diabetic population utilizing a randomized control trial design, assigning one randomly selected group of diabetics to receive electronic information intervention and analyse if it would improve their health outcomes in comparison with a matched diabetic population who would only receive regular medical intervention. Diabetes was chosen for this particular trial, as it is a major chronic illness in Malaysia as elsewhere in the world. It is in essence a position paper for how the study concept should be organized to stimulate wider discussion prior to beginning the study.

  1. Cost-utility of a walking programme for moderately depressed, obese, or overweight elderly women in primary care: a randomised controlled trial

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    Herrera Emilio

    2008-07-01

    Full Text Available Abstract Background There is a considerable public health burden due to physical inactivity, because it is a major independent risk factor for several diseases (e.g., type 2 diabetes, cardiovascular disease, moderate mood disorders neurotic diseases such as depression, etc.. This study assesses the cost utility of the adding a supervised walking programme to the standard "best primary care" for overweight, moderately obese, or moderately depressed elderly women. Methods One-hundred six participants were randomly assigned to an interventional group (n = 55 or a control group (n = 51. The intervention consisted of an invitation, from a general practitioner, to participate in a 6-month walking-based, supervised exercise program with three 50-minute sessions per week. The main outcome measures were the healthcare costs from the Health System perspective and quality adjusted life years (QALYs using EuroQol (EQ-5D. Results Of the patients invited to participate in the program, 79% were successfully recruited, and 86% of the participants in the exercise group completed the programme. Over 6 months, the mean treatment cost per patient in the exercise group was €41 more than "best care". The mean incremental QALY of intervention was 0.132 (95% CI: 0.104–0.286. Each extra QALY gained by the exercise programme relative to best care cost €311 (95% CI, €143–€394. The cost effectiveness acceptability curves showed a 90% probability that the addition of the walking programme is the best strategy if the ceiling of inversion is €350/QALY. Conclusion The invitation strategy and exercise programme resulted in a high rate of participation and is a feasible and cost-effective addition to best care. The programme is a cost-effective resource for helping patients to increase their physical activity, according to the recommendations of general practitioners. Moreover, the present study could help decision makers enhance the preventive role of primary care

  2. Protocol for Past BP: a randomised controlled trial of different blood pressure targets for people with a history of stroke of transient ischaemic attack (TIA in primary care

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    Greenfield Sheila

    2010-08-01

    Full Text Available Abstract Background Blood pressure (BP lowering in people who have had a stroke or transient ischaemic attack (TIA leads to reduced risk of further stroke. However, it is not clear what the target BP should be, since intensification of therapy may lead to additional adverse effects. PAST BP will determine whether more intensive BP targets can be achieved in a primary care setting, and whether more intensive therapy is associated with adverse effects on quality of life. Methods/Design This is a randomised controlled trial (RCT in patients with a past history of stroke or TIA. Patients will be randomised to two groups and will either have their blood pressure (BP lowered intensively to a target of 130 mmHg systolic, (or by 10 mmHg if the baseline systolic pressure is between 125 and 140 mmHg compared to a standard group where the BP will be reduced to a target of 140 mmHg systolic. Patients will be managed by their practice at 1-3 month intervals depending on level of BP and followed-up by the research team at six monthly intervals for 12 months. 610 patients will be recruited from approximately 50 general practices. The following exclusion criteria will be applied: systolic BP The primary outcome will be change in systolic BP over twelve months. Secondary outcomes include quality of life, adverse events and cardiovascular events. In-depth interviews with 30 patients and 20 health care practitioners will be undertaken to investigate patient and healthcare professionals understanding and views of BP management. Discussion The results of this trial will inform whether intensive blood pressure targets can be achieved in people who have had a stroke or TIA in primary care, and help determine whether or not further research is required before recommending such targets for this population. Trial Registration ISRCTN29062286

  3. [Beyond the treatment and care: the History of the doctor-patient relationship as a source to think the nurse-patient relationship in the XXIst century].

    Science.gov (United States)

    Poisson, Michel

    2015-09-01

    The history of the relationship between doctors and patients shows that it is possible to find traces of attention from doctors towards patients as far back as the Antiquity. Nevertheless, at that time, this solicitude is made essentially in the name of nature through the sick individual. With the Middle Ages and the rise and growing importance of Christianity, the notion of person appeared, rising beyond the physical limits of the individual. At that time, the solicitude is then made in the name of God transcending, in that way, the sick person. It is only at the end of the XIXth century, with the movement of social transformation and secularization of the medical care, that it is possible to detect the notion of subject in the medical relation as proved by the emergence of the psychoanalysis. But at the same time, the spectacular evolution of medicine in its scientific component and its increasing importance during the next century made that it focused mainly on a naturalistic vision of the world of the medical care, to the detriment, most of the time, of a personal vision taking into account the deep-rooted social characters of the sick subject. From then on, the nursing profession could be seen, at the beginning of the XXIth century, as complementary to the medicine, through the development and the implementation of a dominant personal relation type without neglecting the naturalistic relation type. This prospect could be possible on the condition of developing the scientific knowledge allowing to give consistency and thickness to this way of seeing and acting centered on the person. An approach doubtless inspired by the care, yet going further its emotional and ethical meaning, in order to understand and to act better. PMID:26685551

  4. Factor Structure, Reliability and Measurement Invariance of the Alberta Context Tool and the Conceptual Research Utilization Scale, for German Residential Long Term Care

    Science.gov (United States)

    Hoben, Matthias; Estabrooks, Carole A.; Squires, Janet E.; Behrens, Johann

    2016-01-01

    We translated the Canadian residential long term care versions of the Alberta Context Tool (ACT) and the Conceptual Research Utilization (CRU) Scale into German, to study the association between organizational context factors and research utilization in German nursing homes. The rigorous translation process was based on best practice guidelines for tool translation, and we previously published methods and results of this process in two papers. Both instruments are self-report questionnaires used with care providers working in nursing homes. The aim of this study was to assess the factor structure, reliability, and measurement invariance (MI) between care provider groups responding to these instruments. In a stratified random sample of 38 nursing homes in one German region (Metropolregion Rhein-Neckar), we collected questionnaires from 273 care aides, 196 regulated nurses, 152 allied health providers, 6 quality improvement specialists, 129 clinical leaders, and 65 nursing students. The factor structure was assessed using confirmatory factor models. The first model included all 10 ACT concepts. We also decided a priori to run two separate models for the scale-based and the count-based ACT concepts as suggested by the instrument developers. The fourth model included the five CRU Scale items. Reliability scores were calculated based on the parameters of the best-fitting factor models. Multiple-group confirmatory factor models were used to assess MI between provider groups. Rather than the hypothesized ten-factor structure of the ACT, confirmatory factor models suggested 13 factors. The one-factor solution of the CRU Scale was confirmed. The reliability was acceptable (>0.7 in the entire sample and in all provider groups) for 10 of 13 ACT concepts, and high (0.90–0.96) for the CRU Scale. We could demonstrate partial strong MI for both ACT models and partial strict MI for the CRU Scale. Our results suggest that the scores of the German ACT and the CRU Scale for nursing

  5. The interactive web-based program MSmonitor for self-management and multidisciplinary care in multiple sclerosis: utilization and valuation by patients

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    Jongen PJ

    2016-03-01

    Full Text Available Peter Joseph Jongen,1,2 Ludovicus G Sinnige,3 Björn M van Geel,4 Freek Verheul,5 Wim I Verhagen,6 Ruud A van der Kruijk,7 Reinoud Haverkamp,8 Hans M Schrijver,9 Jacoba C Baart,10 Leo H Visser,11 Edo P Arnoldus,12 Herman Jacobus Gilhuis,13 Paul Pop,14 Monique Booy,15 Marco Heerings,16 Anton Kool,17 Esther van Noort17 1Department of Community and Occupational Medicine, University Medical Center Groningen, University of Groningen, Groningen, 2MS4 Research Institute, Nijmegen, 3Multiple Sclerosis Centre Leeuwarden, Medical Centre Leeuwarden, Leeuwarden, 4Department of Neurology, Medical Centre Alkmaar, Alkmaar, 5Department of Neurology, Groene Hart Hospital, Gouda, 6Department of Neurology, Canisius Wilhelmina Hospital, Nijmegen, 7Department of Neurology, Slingeland Hospital, Doetinchem, 8Department of Neurology, Zuwe Hofpoort Hospital, Woerden, 9Multiple Sclerosis Centre, Westfries Gasthuis, Hoorn, 10Department of Neurology, Ziekenhuisgroep Twente, Almelo-Hengelo, 11Multiple Sclerosis Centre Midden Brabant, St Elisabeth Hospital, Tilburg, 12Multiple Sclerosis Centre Midden Brabant, Tweesteden Hospital, 13Department of Neurology, Reinier de Graaf Gasthuis, Delft, 14Department of Neurology, Viecuri Medical Centre, Venlo-Venray, 15Multiple Sclerosis Centre, Amphia Hospital, Breda, 16MH Advies en organisatiebureau, Assen, 17Curavista bv, Geertruidenberg, the Netherlands Background: MSmonitor is an interactive web-based program for self-management and integrated, multidisciplinary care in multiple sclerosis.Methods: To assess the utilization and valuation by persons with multiple sclerosis, we held an online survey among those who had used the program for at least 1 year. We evaluated the utilization and meaningfulness of the program’s elements, perceived use of data by neurologists and nurses, and appreciation of care, self-management, and satisfaction.Results: Fifty-five persons completed the questionnaire (estimated response rate 40%. The

  6. Utilization of Prevention of Mother-to-Child Transmission of HIV Services and Associated Factors among Antenatal Care Attending Mothers in Sebeta Town, Central Ethiopia

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    Hailu Merga

    2016-01-01

    Full Text Available Background. HIV transmission from mother to child continues to be the major source of HIV infection among children under the age of fifteen. Targeting pregnant women attending antenatal clinics provides a unique opportunity for implementing prevention of mother-to-child transmission (PMTCT programs against HIV infection of newborn babies. This study assessed utilization of PMTCT service of HIV and associated factors among ANC attending mothers. Methods. An institutional based cross-sectional study was conducted from February 20 to March 30, 2015, using exit interviews with 377 ANC attendees using consecutive sampling method. In-depth interviews with service provider were conducted to complement the quantitative data. Data were entered and analysed using EpiData and SPSS, respectively. Results. The prevalence of PMTCT service utilization was 86.9% in this study. Only 8.6% of respondents attended the facility for HCT. After controlling confounders using logistic regression, PMTCT service utilization was associated with age (25–34 of respondents (AOR (95% CI = 0.46 (0.22, 0.97, mother’s occupational status (being merchant AOR (95% CI = 0.31 (0.12, 0.83, government employee AOR (95% CI = 0.05 (0.01, 0.28, student AOR (95% CI = 0.1 (0.01, 0.44, and daily laborer AOR (95% CI = 0.13 (0.05, 0.33, husband’s educational status (lack of formal education (AOR (95% CI = 3.3 (1.1, 9.9, having discussion with husband (AOR (95% CI = 6.1 (2.6, 14.1, partner tested (AOR (95% CI = 8.2 (1.9, 34.46, and being not satisfied with the service (AOR (95% CI = 0.46 (0.2, 0.99. Conclusions. This study revealed that utilization of HIV counseling and testing during antenatal care was high among pregnant women in Sebeta town. It highlights that focusing on improvement of quality and coverage of health services has significant effects on PMTCT service utilization. Effective use or uptake of ARV drug among HIV-positive pregnant women should be further investigated so that

  7. A review on laboratory tests’ utilization: A trigger for cutting costs and quality improvement in health care settings

    Science.gov (United States)

    Meidani, Zahra; Farzandipour, Mehrdad; Farrokhian, Alireza; Haghighat, Masomeh

    2016-01-01

    Background: Considering the role of laboratory tests as a central part of controlling health expenditure, this study intends to investigate laboratory tests overutilization in Iran to pave the way for future interventions. Methods: Inappropriate laboratory utilization was reviewed in a cross-sectional survey through the retrospective analysis of 384 medical records at a tertiary center. To pave the way for future intervention, overutilization tests were classified into two categories, inappropriate and inefficient, and then they were analyzed. Frequency analysis was used to analysis patient’s age, gender, hospital wards, length of stay, and diagnosis as well as inappropriate test and inefficient tests. Results: A total of 143 (1.50 %) of the tests were inefficient and was ordered due to laboratory errors including hemolysis, inefficient sampling, or absurd results. 2522 (26.40%) of the tests were inappropriate and stem from failure to meet medical/clinical appropriateness criteria. Conclusion: Whereas, inappropriate test ordering was more frequent than inefficient tests, the initial improvement strategy should focus on physicians’ test ordering behavior through conducting proper teaching strategies, ongoing audit and educational feedback, implementing health information technology tools and employing laboratory practice guidelines (LPGs) and testing algorithms. Conducting continuous quality improvement cycle for laboratory services and training of personnel involved in blood sampling is recommended for inefficient tests. PMID:27493909

  8. Health care costs and utilization of a large insured female population with advanced or metastatic breast cancer by receipt of HER2-targeted agents

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    Meyer N

    2015-04-01

    Full Text Available Nicole Meyer,1 Yanni Hao,2 Pamela Landsman-Blumberg,1 William Johnson,1 Paul Juneau,3 Jaqueline Willemann Rogerio2 1Truven Health Analytics, Cambridge, MA, USA; 2Novartis Pharmaceuticals, East Hanover, NJ, USA; 3Truven Health Analytics, Washington, DC, USA Background: This retrospective administrative claims study of women diagnosed with advanced or metastatic breast cancer compared health care costs by receipt of HER2-targeted agents and by disease stage and age group among patients using HER2-targeted agents. Methods: Women aged ≥18 years and diagnosed with stage III or IV breast cancer were selected from the 2008–2012 Truven Health MarketScan® databases (Truven Health Analytics Inc., Cambridge, MA, USA databases using ICD-9-CM (International Classification of Diseases, 9th Revision, Clinical Modification codes for nondiagnostic medical claims corresponding to breast cancer and local or distant metastases (earliest diagnosis of stage III or stage IV metastasis was designated as the index date. The 12 months prior to the index date were defined as the pre-index period. The post-index period was variable in length, beginning on the index date and continuing through the end of enrolment, inpatient death, or December 31, 2012, whichever occurred first. Receipt of HER2-targeted agents was defined as at least one claim for trastuzumab or lapatinib in the pre-index or post-index period. The study cohorts were women using or not using HER2-targeted agents, women with stage III or IV breast cancer using HER2-targeted agents, and women using HER2-targeted agents and aged 18–44 years, 45–64 years, or 65+ years at index. Health care costs and utilization were calculated on a per patient per month basis for all-cause and breast cancer-related services by place of service. Generalized linear models were used to estimate total all-cause and breast cancer-related costs. Results: A total of 30,660 eligible women met the study selection criteria, 14

  9. Utility of Papanicolaou test in diagnosis of cervical lesions: a study in a tertiary care centre of western Uttar Pradesh

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    Mithila Bisht

    2015-05-01

    Full Text Available Background: Cervical cancer is the most common cancer among females in India. It is also one of the major causes of deaths among them. Papanicolaou (Pap cytological test helps in detecting the early epithelial abnormalities in cervical cells. The morbidity and mortality due to cervical cancer has come down in countries with well-established screening programmes at national level. This study was conducted to emphasize the value of cervical screening as a tool for early detection of non-neoplastic and neoplastic lesions of cervix. Slide positivity rate was computed and clinico-pathological correlation was done. Methods: This cross-sectional study was conducted from January 2012 to December 2014 (3 years, on 2202 women aged between 20-70 years coming for a Pap smear examination in a tertiary care hospital in Bareilly, India. After staining with conventional Papanicolaou technique, all cases were classified as per Bethesda nomenclature (2001. Results: Out of 2202 cases, 85.16% slides were found to be negative for intraepithelial abnormalities and 14.84% slides were labelled as positive for epithelial lesions. 97.67% of high grade lesions were found in women more than 40 years. Smears with epithelial cell abnormality were found more common in older age groups whereas smears negative for epithelial cell abnormality were found more common in young age groups. Conclusion: Pap test is a cost effective cancer screening and is a simple method to detect various lesions of cervix, non-neoplastic as well as neoplastic. High risk screening programmes should be directed to all women >40 years. Pap test is especially useful to diagnose precancerous lesions of cervix, thereby early detection of these lesions and subsequent proper treatment can be helpful in prevention of cervical cancer. [Int J Res Med Sci 2015; 3(5.000: 1070-1076

  10. Utilization of Health Care Coalitions and Resiliency Forums in the United States and United Kingdom: Different Approaches to Strengthen Emergency Preparedness.

    Science.gov (United States)

    Walsh, John; Swan, Allan Graeme

    2016-02-01

    The process for developing national emergency management strategies for both the United States and the United Kingdom has led to the formulation of differing approaches to meet similar desired outcomes. Historically, the pathways for each are the result of the enactment of legislation in response to a significant event or a series of events. The resulting laws attempt to revise practices and policies leading to more effective and efficient management in preparing, responding, and mitigating all types of natural, manmade, and technological hazards. Following the turn of the 21st century, each country has experienced significant advancements in emergency management including the formation and utilization of 2 distinct models: health care coalitions in the United States and resiliency forums in the United Kingdom. Both models have evolved from circumstances and governance unique to each country. Further in-depth study of both approaches will identify strengths, weaknesses, and existing gaps to meet continued and future challenges of our respective disaster health care systems. PMID:26878309

  11. Utility of the point of care CD4 analyzer, PIMA, to enumerate CD4 counts in the field settings in India

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    Thakar Madhuri

    2012-09-01

    Full Text Available Abstract Background In resource limited settings non-availability of CD4 count facility at the site could adversely affect the ART roll out programme. Point of care CD4 enumerating equipments can make the CD4 count available at the site of care and improve the patients’ management considerably. This study is aimed at determining the utility of a Point of Care PIMA CD4 analyzer (Alere, Germany in the field settings in India. Method The blood samples were collected from 1790 participants at 21 ART centers from different parts of the country and tested using PIMA and the reference methods (FACSCalibur, FACSCount and CyFlow SL3. The paired finger prick and venous blood samples from 175 participants were tested by the PIMA CD4 Analyzer and then by FACSCalibur. Result The CD4 counts obtained by PIMA CD4 analyzer showed excellent correlation with the counts obtained by the reference methods; for venous blood the Pearson’s r was 0.921, p 500 cells/mm3, the differences in the median CD4 counts obtained by the reference method and the PIMA analyzer were not significant (P > 0.05 and the relative bias were low (−7 to 5.1%. The Intermachine comparison showed variation within the acceptable limit of%CV of 10%. Conclusion In the field settings, the POC PIMA CD4 analyzer gave CD4 counts comparable to the reference methods for all CD4 ranges. The POC equipment could identify the patients eligible for ART in 91% cases. Adequate training is necessary for finger prick sample collection for optimum results. Decentralization of CD4 testing by making the CD4 counts available at primary health centers, especially in remote areas with minimum or no infrastructure would reduce the missed visits and improve adherence of the patients.

  12. The Effects of a Locally Developed mHealth Intervention on Delivery and Postnatal Care Utilization; A Prospective Controlled Evaluation among Health Centres in Ethiopia

    Science.gov (United States)

    Shiferaw, Solomon; Spigt, Mark; Tekie, Michael; Abdullah, Muna; Fantahun, Mesganaw; Dinant, Geert-Jan

    2016-01-01

    Background Although there are studies showing that mobile phone solutions can improve health service delivery outcomes in the developed world, there is little empirical evidence that demonstrates the impact of mHealth interventions on key maternal health outcomes in low income settings. Methods A non-randomized controlled study was conducted in the Amhara region, Ethiopia in 10 health facilities (5 intervention, 5 control) together serving around 250,000 people. Health workers in the intervention group received an android phone (3 phones per facility) loaded with an application that sends reminders for scheduled visits during antenatal care (ANC), delivery and postnatal care (PNC), and educational messages on dangers signs and common complaints during pregnancy. The intervention was developed at Addis Ababa University in Ethiopia. Primary outcomes were the percentage of women who had at least 4 ANC visits, institutional delivery and PNC visits at the health center after 12 months of implementation of the intervention. Findings Overall 933 and 1037 women were included in the cross-sectional surveys at baseline and at follow-up respectively. In addition, the medical records of 1224 women who had at least one antenatal care visit were followed in the longitudinal study. Women who had their ANC visit in the intervention health centers were significantly more likely to deliver their baby in the same health center compared to the control group (43.1% versus 28.4%; Adjusted Odds Ratio (AOR): 1.98 (95%CI 1.53–2.55)). A significantly higher percentage of women who had ANC in the intervention group had PNC in the same health center compared to the control health centers (41.2% versus 21.1%: AOR: 2.77 (95%CI 2.12–3.61)). Conclusions Our findings demonstrated that a locally customized mHealth application during ANC can significantly improve delivery and postnatal care service utilization possibly through positively influencing the behavior of health workers and their

  13. Trends in resource utilization by children with neurological impairment in the United States inpatient health care system: a repeat cross-sectional study.

    Directory of Open Access Journals (Sweden)

    Jay G Berry

    2012-01-01

    Full Text Available BACKGROUND: Care advances in the United States (US have led to improved survival of children with neurological impairment (NI. Children with NI may account for an increasing proportion of hospital resources. However, this assumption has not been tested at a national level. METHODS AND FINDINGS: We conducted a study of 25,747,016 US hospitalizations of children recorded in the Kids' Inpatient Database (years 1997, 2000, 2003, and 2006. Children with NI were identified with International Classification of Diseases, 9th Revision, Clinical Modification diagnoses resulting in functional and/or intellectual impairment. We assessed trends in inpatient resource utilization for children with NI with a Mantel-Haenszel chi-square test using all 4 y of data combined. Across the 4 y combined, children with NI accounted for 5.2% (1,338,590 of all hospitalizations. Epilepsy (52.2% [n = 538,978] and cerebral palsy (15.9% [n = 164,665] were the most prevalent NI diagnoses. The proportion of hospitalizations attributable to children with NI did not change significantly (p = 0.32 over time. In 2006, children with NI accounted for 5.3% (n = 345,621 of all hospitalizations, 13.9% (n = 3.4 million of bed days, and 21.6% (US$17.7 billion of all hospital charges within all hospitals. Over time, the proportion of hospitalizations attributable to children with NI decreased within non-children's hospitals (3.0% [n = 146,324] in 1997 to 2.5% [n = 113,097] in 2006, p<.001 and increased within children's hospitals (11.7% [n = 179,324] in 1997 to 13.5% [n = 209,708] in 2006, p<0.001. In 2006, children with NI accounted for 24.7% (2.1 million of bed days and 29.0% (US$12.0 billion of hospital charges within children's hospitals. CONCLUSIONS: Children with NI account for a substantial proportion of inpatient resources utilized in the US. Their impact is growing within children's hospitals. We must ensure that the current health care system is staffed, educated, and equipped to

  14. Determinantes de la utilización de servicios de salud en Costa Rica Determinants of health care utilization in Costa Rica

    Directory of Open Access Journals (Sweden)

    Melvin Morera Salas

    2010-10-01

    Full Text Available Objetivo: Realizar una primera aproximación a los determinantes de la utilización de consultas médicas en Costa Rica. Método: Los datos proceden de la Encuesta Nacional de Salud para Costa Rica 2006. En el análisis econométrico se utilizó un modelo binomial negativo estándar ligado al enfoque de producción de salud de Grossman y un modelo en dos partes congruente con el enfoque agente-principal. Resultados: Los factores determinantes de la utilización de consultas médicas fueron el nivel educativo, el estado de salud percibida, el número de enfermedades crónicas declaradas y la región de residencia. Conclusiones: El hecho de que las variables de necesidad de salud expliquen de forma significativa la probabilidad de contacto con las consultas médicas y que, además, no se registren diferencias significativas de utilización entre quintiles de ingreso y situación de seguro, es un resultado esperable y deseable en un sistema público solidario y casi universal como el costarricense. No se obtienen resultados concluyentes de la influencia del médico en la frecuencia de utilización de las consultas que postula el modelo de agente-principal.Objective: To analyze the determinants of health care utilization (visits to the doctor in Costa Rica using an econometric approach. Methods: Data were drawn from the National Survey of Health for Costa Rica 2006. We modeled the Grossman approach to the demand for health services by using a standard negative binomial regression, and used a hurdle model for the principal-agent specification. Results: The factors determining healthcare utilization were level of education, self-assessed health, number of declared chronic diseases and geographic region of residence. Conclusion: The number of outpatient visits to the doctor depends on the proxies for medical need, but we found no multivariate association between the use of outpatient visits and income or insurance status. This result suggests that

  15. Utilization of delivery care among rural women in china: does the health insurance make a difference? a cross-sectional study

    Directory of Open Access Journals (Sweden)

    Wang Duolao

    2010-11-01

    Full Text Available Abstract Background Since 2003, the New Cooperative Medical Scheme (NCMS has been implemented throughout rural China, usually covering delivery services in its benefit package. The objective of this study was to compare the difference of utilization of delivery services, expenditures, and local women's perceived affordability between women with and without reimbursement from NCMS. Methods A cross-sectional survey was carried out in two rural counties in Shaanxi province, China, during December 2008-March 2009. Women giving birth from April 2008 to March 2009 were interviewed by a structured questionnaire to collect information on utilization of delivery services. Multivariable analyses were used to compare the differences in outcomes between women with and without reimbursement from NCMS. Results Of the total 1613 women interviewed, 747(46.3% got reimbursement to cover their expenditure on delivery care (NCMS group and 866(53.7% paid delivery services entirely out of their own pocket (Non-NCMS group. Compared with the Non-NCMS group, the NCMS group had significantly more women who delivered at hospital. The rate of Caesarean section (CS, proportion of women seeking higher level services, and length of hospitalization were similar between the two groups. The total hospital costs for delivery services in the NCMS group was significantly smaller and after being reimbursed, the out-of-pocket payment in the NCMS group was less than a half of that in the Non-NCMS group. Fewer women in the NCMS group than in the Non-NCMS group considered their payment for delivery services expensive. Conclusions There was no evidence of overuse delivery services among the women reimbursed by NCMS. Total hospital costs and women's costs for delivery services were found lower in the NCMS group, subsequently alleviation on women's perceived financial affordability.

  16. Retrospective analysis of drug utilization, health care resource use, and costs associated with IFN therapy for adjuvant treatment of malignant melanoma

    Directory of Open Access Journals (Sweden)

    Zhang Y

    2015-07-01

    Full Text Available ≥Ying Zhang,1 Trong Kim Le,1 James W Shaw,2 Srividya Kotapati31Center for Observational Research and Data Sciences, Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Hopewell, NJ, USA; 2Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Princeton, NJ, USA; 3Worldwide Health Economics and Outcomes Research, Bristol-Myers Squibb Research and Development, Wallingford Center, CT, USABackground: This study examines real-world drug utilization patterns, health care resource use, and costs among patients receiving adjuvant treatment with IFN versus patients receiving no treatment ("observation" for malignant melanoma following surgery.Methods: A retrospective cohort study was conducted using administrative claims from Truven Health Analytics (MarketScan® to identify all adjuvant melanoma patients (aged ≥18 years diagnosed between June 2007 and June 2011 who had a lymph node dissection (ie, index surgery and were treated with IFN or subsequently observed. Health care resource use and costs of services were converted to 2012 US dollars and were evaluated and compared using multivariable regression.Results: Of 1,999 eligible subjects with melanoma surgery claims, 179 (9.0% were treated with IFN and 1,820 (91.0% were observed. The median duration (days and number of doses of IFN therapy were 73 and 36, respectively. Among IFN-treated patients, only 10.6% completed ≥80% of maintenance therapy. The total average cost for patients treated with IFN was US$60,755±$3,972 (n=179; significantly higher than for patients undergoing observation ($31,641±$2,471; P<0.0001. Similar trends were observed when evaluating total cost components, including melanoma-related and non-melanoma–related medical costs. Among the melanoma-related medical costs, outpatient services, including office visits and laboratory testing, represented between 33% and 53% of total costs and

  17. Utilization of cervical cancer screening services and trends in screening positivity rates in a 'screen-and-treat' program integrated with HIV/AIDS care in Zambia.

    Directory of Open Access Journals (Sweden)

    Mulindi H Mwanahamuntu

    Full Text Available BACKGROUND: In the absence of stand-alone infrastructures for delivering cervical cancer screening services, efforts are underway in sub-Saharan Africa to dovetail screening with ongoing vertical health initiatives like HIV/AIDS care programs. Yet, evidence demonstrating the utilization of cervical cancer prevention services in such integrated programs by women of the general population is lacking. METHODS: We analyzed program operations data from the Cervical Cancer Prevention Program in Zambia (CCPPZ, the largest public sector programs of its kind in sub-Saharan Africa. We evaluated patterns of utilization of screening services by HIV serostatus, examined contemporaneous trends in screening outcomes, and used multivariable modeling to identify factors associated with screening test positivity. RESULTS: Between January 2006 and April 2011, CCPPZ services were utilized by 56,247 women who underwent cervical cancer screening with visual inspection with acetic acid (VIA, aided by digital cervicography. The proportion of women accessing these services who were HIV-seropositive declined from 54% to 23% between 2006-2010, which coincided with increasing proportions of HIV-seronegative women (from 22% to 38% and women whose HIV serostatus was unknown (from 24% to 39% (all p-for trend<0.001. The rates of VIA screening positivity declined from 47% to 17% during the same period (p-for trend <0.001, and this decline was consistent across all HIV serostatus categories. After adjusting for demographic and sexual/reproductive factors, HIV-seropositive women were more than twice as likely (Odds ratio 2.62, 95% CI 2.49, 2.76 to screen VIA-positive than HIV-seronegative women. CONCLUSIONS: This is the first 'real world' demonstration in a public sector implementation program in a sub-Saharan African setting that with successful program scale-up efforts, nurse-led cervical cancer screening programs targeting women with HIV can expand and serve all women

  18. Utility of point of care test devices for infectious disease testing of blood and oral fluid and application to rapid testing in the field

    Science.gov (United States)

    Lee, Stephen R.; Kardos, Keith W.; Yearwood, Graham D.; Guillon, Geraldine B.; Kurtz, Lisa A.; Mokkapati, Vijaya K.

    2008-04-01

    Rapid, point of care (POC) testing has been increasingly deployed as an aid in the diagnosis of infectious disease, due to its ability to deliver rapid, actionable results. In the case of HIV, a number of rapid test devices have been FDA approved and CLIA-waived in order to enable diagnosis of HIV infection outside of traditional laboratory settings. These settings include STD clinics, community outreach centers and mobile testing units, as well as identifying HIV infection among pregnant women and managing occupational exposure to infection. The OraQuick ® rapid test platform has been widely used to identify HIV in POC settings, due to its simplicity, ease of use and the ability to utilize oral fluid as an alternative specimen to blood. More recently, a rapid test for antibodies to hepatitis C virus (HCV) has been developed on the same test platform which uses serum, plasma, finger-stick blood, venous blood and oral fluid. Clinical testing using this POC test device has shown that performance is equivalent to state of the art, laboratory based tests. These devices may be suitable for rapid field testing of blood and other body fluids for the presence of infectious agents.

  19. ChMP: A collaborative medical history portal.

    Science.gov (United States)

    Zimmerman, Noah H; Zimmerman, Noah; Patel, Chirag; Chen, David P; Chen, David Pei-Ann

    2008-11-06

    Family medical histories play an invaluable role in disease prevention, diagnosis and treatment. Self reported medical histories frequently contain incorrect or incomplete information, severely diminishing the quality of care and clinical outcome of the patient. While tools for obtaining and analyzing medical histories are available to medical professionals, no system exists to allow families to actively participate in the collection and utilization of medical history data. We have developed a free web-based service (http://www.inherithealth.com) that allows a family to collaboratively capture and store medical history information relevant to breast cancer. The service is built on a custom framework that enables the integration of existing breast cancer risk assessment models with web-based software to communicate evidence-based risk assessment to consumers. Preliminary user evaluations indicate that consumers find the tool usable, and are interested in learning about their breast cancer risk.

  20. The Affordable Care Act and integrated behavioral health programs in community health centers to promote utilization of mental health services among Asian Americans.

    Science.gov (United States)

    Huang, Susan; Fong, Susana; Duong, Thomas; Quach, Thu

    2016-06-01

    The Affordable Care Act has greatly expanded health care coverage and recognizes mental health as a major priority. However, individuals suffering from mental health disorders still face layered barriers to receiving health care, especially Asian Americans. Integration of behavioral health services within primary care is a viable way of addressing underutilization of mental health services. This paper provides insight into a comprehensive care approach integrating behavioral health services into primary care to address underutilization of mental health services in the Asian American population. True integration of behavioral health services into primary care will require financial support and payment reform to address multi-disciplinary care needs and optimize care coordination, as well as training and workforce development early in medical and mental health training programs to develop the skills that aid prevention, early identification, and intervention. Funding research on evidence-based practice oriented to the Asian American population needs to continue. PMID:27188196

  1. 初中历史资源的开发与利用%Development and Utilization of Resources of Junior Middle School History

    Institute of Scientific and Technical Information of China (English)

    刘爱莲

    2014-01-01

    Fully exploring the historical resources,the textbook in the bright spot,can mobilize the enthusiasm of students. At present, most junior high schools use of historical resources is not enough,mainly reflected in resource development content of single subject,no depth and breadth,the lack of effective practice. In order to improve the efficiency of classroom of history,teacher can make full use of cyber source,the modern information technology,community resources,parents resource and teaching material resources.%充分发掘历史资源,发掘教材里的亮点,可以调动学生的学习积极性。目前,大部分初中学校对历史资源的利用还不够充分,主要体现在资源主体单一,开发内容没有深度和广度,缺少有效实践。为了提高历史课堂效率,教师可以充分利用网络资源、现代信息技术、社区资源、家长资源和教材资源。

  2. Contraceptive utilization and associated factors among HIV positive women on chronic follow up care in Tigray Region, Northern Ethiopia: a cross sectional study.

    Directory of Open Access Journals (Sweden)

    Yohannes Adama Melaku

    Full Text Available BACKGROUND: In sub-Sahara Africa, more than 60% of all new HIV infections are occurring in women, infants and young children. Maternal to child transmission is responsible for 90% of childhood HIV infection. Preventing unwanted pregnancy among HIV positive women is imperative to reduce maternal and infant morbidity and mortality. METHODS: A cross-sectional survey was conducted among 964 HIV positive women in selected 12 health centers of Tigray region. In this paper, analysis was restricted only for 847 women who were sexually active and non-pregnant. In each health center the number of study participants was allocated proportionally to the load of HIV positive women in chronic care clinics. The data were entered into EpiData version 3.1, and cleaned and analyzed using Stata version 11.1. Descriptive summary of data and logistic regression were used to identify possible predictors using odds ratio with 95% confidence interval and P-value of 0.05. FINDINGS: Three hundred ninety four (46.5% of all HIV positive women had intension to have more children. Three hundred seventy five (44.3% were using contraceptive methods at time of survey. Injectable (70.7% and male condom (47.6% were most commonly used type of contraceptives. In the multivariable analysis, women who were urban dwellers (AOR = 2.55; 95% CI: 1.27, 5.02, completed primary education (AOR = 2.27; 95% CI: 1.12, 2.86 and those openly discussed about contraceptive methods with their husbands or sexual partners (AOR = 6.3; 95% CI: 3.42, 11.76 were more likely to use contraceptive. Women who have one or more living children were also more likely to use contraceptive compared with women with no child. CONCLUSION: Less than half of women used contraceptive methods. The use of condoms could impact unintended pregnancies and reduced risks of vertical and sexual transmission. Efforts to increase contraceptive utilization focusing on the barrier methods should be strengthen in HIV

  3. Parents as Partners in Obtaining the Medication History

    OpenAIRE

    Porter, Stephen C.; Isaac S Kohane; Goldmann, Donald A.

    2005-01-01

    Objective: Patient-centered information management may overcome barriers that impede high-quality, safe care in the emergency department (ED). The utility of parents' report of medication data via a multimedia, touch screen interface, the asthma kiosk, was investigated. Our specific aims were (1) to estimate the validity of parents' electronically entered medication history for asthma and (2) to compare the parents' kiosk entries regarding medications to the documentation of ED physicians and...

  4. Testing for the Endogenous Nature between Women’s Empowerment and Antenatal Health Care Utilization: Evidence from a Cross-Sectional Study in Egypt

    OpenAIRE

    2014-01-01

    Women's relative lack of decision-making power and their unequal access to employment, finances, education, basic health care, and other resources are considered to be the root causes of their ill-health and that of their children. The main purpose of this paper is to examine the interactive relation between women's empowerment and the use of maternal health care. Two model specifications are tested. One assumes no correlation between empowerment and antenatal care while the second specificat...

  5. Out of pocket expenditure on utilization of ante-natal and delivery care services in India: analysis based on NSSO 60th round

    OpenAIRE

    Saraswati Kerketta

    2015-01-01

    Background: Maternal mortality is a major concern in India; it can be reduced by providing reproductive health care services to the pregnant women. Out of pocket expenditure is a major barrier to the mothers in access to the maternal care services in India. Methods: Data has been extracted from NSSO 60th round. Univariate and multivariate analysis has been carried out to examine the pattern and factors affecting out of pocket expenditure on ante natal and delivery care services in India. ...

  6. Intellectual History, Social History, Cultural History...and Our History.

    Science.gov (United States)

    Nord, David Paul

    1990-01-01

    Defines and explores the links among intellectual, social, and cultural history. Warns that an adequate foundation must be laid in the economic and institutional social history of mass media before communication historians jump into cultural history. (SR)

  7. Medication use patterns, health care resource utilization, and economic burden for patients with major depressive disorder in Beijing, People’s Republic of China

    Directory of Open Access Journals (Sweden)

    Zhang L

    2016-04-01

    Full Text Available Ling Zhang,1–4 Yun Chen,5 Li Yue,5 Qingjing Liu,6 William Montgomery,7 Lihua Zhi,5 Wanqi Wang51Mood Disorders Center, Beijing Anding Hospital, Capital Medical University, 2China Clinical Research Center for Mental Disorders, 3China Center of Depression, Beijing Institute for Brain Disorders, 4Department of Psychiatry, Capital Medical University, Beijing, 5Medical Department, Lilly Suzhou Pharmaceutical Company, Ltd, Shanghai, 6Pharmacoeconomics and Outcomes Research, Beijing Brainpower Pharma Consulting Co, Ltd, Beijing, People’s Republic of China; 7Medical Department, Eli Lilly Australia Pty, Ltd, Sydney, NSW, AustraliaObjective: The objective of the study was to investigate medication usage patterns, health care resource utilization, and direct medical costs of patients with major depressive disorder (MDD in Beijing, People’s Republic of China.Methods: Data were extracted from a random sample of the Beijing Urban Employee Basic Medical Insurance database. Patients aged ≥18 years, with ≥1 primary diagnosis of MDD and 12-month continuous enrollment after their first observed MDD diagnosis between 2012 and 2013 were identified. Those with a diagnosis of schizophrenia, bipolar disorder, or cancer during the analysis period were excluded.Results: In total 8,484 patients, with mean age of 57.2 years, were included and 63% were female. The top three commonly observed comorbidities were hypertension (70.9%, anxiety disorder (68.6%, and coronary heart disease (65.1%. Furthermore, 71.4% of patients were treated with antidepressant medications, including 60.5% of patients treated with selective serotonin reuptake inhibitors, followed by noradrenergic and specific serotonergic antidepressants (9.0% and serotonin–norepinephrine reuptake inhibitors (8.3%. The proportions of patients who discontinued their initial antidepressant within the first and second months after the index date were 45.4% and 77.0%, respectively. Concomitant

  8. Increased health care utilization by survivors of childhood lymphoblastic leukemia is confined to those treated with cranial or total body irradiation: a case cohort study

    International Nuclear Information System (INIS)

    Previous studies have indicated that survivors of childhood acute lymphoblastic leukemia (ALL) have an increased morbidity measured in terms of health care utilization. However, earlier studies have several potentially important limitations. To overcome some of these, we investigated hospital contact rates, and predictors thereof, among 5-year survivors of ALL in a population-based setting, and compared them to a control cohort regarding outcome measures from a comprehensive nation-wide health register. All individuals diagnosed with ALL before the age of 18 in Southern Sweden during 1970–1999 and alive January 2007 (n = 213; male = 107) were identified through the Swedish Cancer Register. Each subject was matched to fifty controls, identified in the Swedish Population Register. All study subjects were linked to the National Hospital Register and detailed information was obtained on all hospital contacts (hospital admissions and outpatients visits) starting five years after cancer diagnosis, and the corresponding date for the controls, until 2009. The median follow-up among the 5-year survivors of ALL was 16 years (range 5–33), accruing a total of 3,527 person-years. Of the 213 5-year survivors, 105 (49.3%) had at least one hospital contact compared to 3,634 (34.1%) of the controls (p < 0.001). Survivors had more hospital contacts (3 [1–6] vs. 2 [1–4] contacts, p < 0.001) and more total days in hospital (6 [2–18] vs. 3 [1–7] days, p < 0.001) than the controls during the study period. Logistic regression analysis showed that survivors treated with cranial irradiation and/or total body irradiation (45% and 7%, respectively) had an increased risk of at least one hospital contact (OR 2.3, 95%CI; 1.5–3.6 and OR 11.0, 95%CI; 3.2–50.7, respectively), while there was no significant difference between the non-irradiated survivors and controls. We show that irradiated survivors of childhood ALL have an increased morbidity measured in terms of hospital

  9. A Game-Based Simulation Utilizing Virtual Humans to Train Physicians to Screen and Manage the Care of Patients with Mental Health Disorders.

    Science.gov (United States)

    Albright, Glenn; Adam, Cyrille; Goldman, Ron; Serri, Deborah

    2013-10-01

    Every year, one in four American adults suffers from a diagnosable mental disorder, yet most of them go untreated, creating a significant public health challenge. This challenge is compounded by large-scale disasters, which can cause an influx of primary care patients presenting with physical symptoms that mask mental health disorders. Primary care providers (PCPs) are usually the first point of contact for those patients; thus there exist crucial opportunities to detect and address nonphysical disorders in primary care settings that would improve patient outcomes and quality of care. Unfortunately, many PCPs view mental health as separate from the services that they provide, and the majority of them have received little training during or after medical or nursing school about risk factors, symptoms, and treatment options. To help integrate behavioral health into primary care, Kognito Interactive developed "At-Risk in Primary Care," an online game-based simulation that integrates role-play conversations with virtual humans to train PCPs to screen patients for mental health disorders, perform brief behavioral interventions using motivational interviewing (MI), refer patients, and integrate behavioral health into their treatment while building patients' intrinsic motivation to adhere to it. Preliminary findings on the implementation of this game in New York City show significant increases in skill and motivation to screen patients, conduct behavioral interventions, and refer patients to specialized care. These results show the promise of innovative technology-based solutions to integrate mental health training in primary care. PMID:26196927

  10. Cost-effectiveness and cost-utility analyses of hospital-based home care compared to hospital-based care for children diagnosed with type 1 diabetes; a randomised controlled trial; results after two years’ follow-up

    OpenAIRE

    Tiberg, Irén; Lindgren, Björn; Carlsson, Annelie; Hallström, Inger

    2016-01-01

    Background Practices regarding hospitalisation of children at diagnosis of type 1 diabetes vary both within countries and internationally, and high-quality evidence of best practice is scarce. The objective of this study was to close some of the gaps in evidence by comparing two alternative regimens for children diagnosed with type 1 diabetes: hospital-based care and hospital-based home care (HBHC), referring to specialist care in a home-based setting. Methods A randomised controlled trial, i...

  11. Bohmian Histories and Decoherent Histories

    OpenAIRE

    Hartle, James B.

    2002-01-01

    The predictions of the Bohmian and the decoherent (or consistent) histories formulations of the quantum mechanics of a closed system are compared for histories -- sequences of alternatives at a series of times. For certain kinds of histories, Bohmian mechanics and decoherent histories may both be formulated in the same mathematical framework within which they can be compared. In that framework, Bohmian mechanics and decoherent histories represent a given history by different operators. Their ...

  12. Diet History Questionnaire II: Database Utility Program

    Science.gov (United States)

    If you need to modify the standard nutrient database, a single nutrient value must be provided by gender and portion size. If you have modified the database to have fewer or greater demographic groups, nutrient values must be included for each group.

  13. Diet History Questionnaire: Database Utility Program

    Science.gov (United States)

    If you need to modify the standard nutrient database, a single nutrient value must be provided by gender and portion size. If you have modified the database to have fewer or greater demographic groups, nutrient values must be included for each group.

  14. Testing for the endogenous nature between women's empowerment and antenatal health care utilization: evidence from a cross-sectional study in Egypt.

    Science.gov (United States)

    Zaky, Hassan H M; Armanious, Dina M; Hussein, Mohamed Ali

    2014-01-01

    Women's relative lack of decision-making power and their unequal access to employment, finances, education, basic health care, and other resources are considered to be the root causes of their ill-health and that of their children. The main purpose of this paper is to examine the interactive relation between women's empowerment and the use of maternal health care. Two model specifications are tested. One assumes no correlation between empowerment and antenatal care while the second specification allows for correlation. Both the univariate and the recursive bivariate probit models are tested. The data used in this study is EDHS 2008. Factor Analysis Technique is also used to construct some of the explanatory variables such as the availability and quality of health services indicators. The findings show that women's empowerment and receiving regular antenatal care are simultaneously determined and the recursive bivariate probit is a better approximation to the relationship between them. Women's empowerment has significant and positive impact on receiving regular antenatal care. The availability and quality of health services do significantly increase the likelihood of receiving regular antenatal care. PMID:25140310

  15. Testing for the Endogenous Nature between Women’s Empowerment and Antenatal Health Care Utilization: Evidence from a Cross-Sectional Study in Egypt

    Directory of Open Access Journals (Sweden)

    Hassan H. M. Zaky

    2014-01-01

    Full Text Available Women’s relative lack of decision-making power and their unequal access to employment, finances, education, basic health care, and other resources are considered to be the root causes of their ill-health and that of their children. The main purpose of this paper is to examine the interactive relation between women’s empowerment and the use of maternal health care. Two model specifications are tested. One assumes no correlation between empowerment and antenatal care while the second specification allows for correlation. Both the univariate and the recursive bivariate probit models are tested. The data used in this study is EDHS 2008. Factor Analysis Technique is also used to construct some of the explanatory variables such as the availability and quality of health services indicators. The findings show that women’s empowerment and receiving regular antenatal care are simultaneously determined and the recursive bivariate probit is a better approximation to the relationship between them. Women’s empowerment has significant and positive impact on receiving regular antenatal care. The availability and quality of health services do significantly increase the likelihood of receiving regular antenatal care.

  16. Making Questionnaire for Studying Barriers of Utilizing the Scientific Evidence in Health Care System in Islamic Republic of Iran from the View point of Decision Makers

    OpenAIRE

    Mohammad Zakaria Pezeshki; Hossein Jabbari; Barmak Yaaghoobian

    2013-01-01

    Introduction: Inappropriate utilization of scientific evidence in health systems has led to a motivation for designing different studies by various stakeholders to identify the dimensions of this problem and the proper solution for them. In health system of Islamic republic of Iran, among the most important stakeholders are senior and middle managers whose opinions about barriers of utilization of scientific evidence can be studied by questionnaire. This study has been done to make this quest...

  17. Utility of Flexible Bronchoscopy in Intensive Care Unit: Experience of Türkiye Yüksek İhtisas Education and Research Hospital

    Directory of Open Access Journals (Sweden)

    Sema Turan

    2010-12-01

    Full Text Available Objective: Fiberoptic bronchoscopy (FOB is the most frequently used tool for invasive pulmonary evaluation with high diagnostic yield and low incidence of major complications. These advantages led to increasing use of FOB in intensive care units. In this article, we discussed our experiences of FOB applications in mechanical ventilated critically ill patients. Materials and Methods: We investigated FOB procedures of 118 patients on mechanical ventilation for respiratory failure in intensive care unit retrospectively. All patients’ demographic data, indications, complications and arterial blood gas analyses belong to before and after bronchoscopy were evaluated. Results: FOB indications of the patients were 55.1% for mucoid plug clearance, 9.3% for treatment of atelectasia, 7.6% for identifying hemorrhagic foci, 17.8% for tracheostomy management, 6.8% for bronchoalveolar lavage and 3.4% for exploratory purposes. Overall complication rate of FOB was 11.9%. Arterial blood gas analyses statistically improved after FOB. Conclusion: In this study, we observed that FOB is being performed with many different indications and acceptable complication rates in our intensive care unit and also contributes to diagnose and treatment of intensive care patients. (Journal of the Turkish Society of Intensive Care 2010; 8: 48-53

  18. What work has to be done to implement collaborative care for depression? Process evaluation of a trial utilizing the Normalization Process Model

    Directory of Open Access Journals (Sweden)

    Lankshear Annette J

    2010-02-01

    Full Text Available Abstract Background There is a considerable evidence base for 'collaborative care' as a method to improve quality of care for depression, but an acknowledged gap between efficacy and implementation. This study utilises the Normalisation Process Model (NPM to inform the process of implementation of collaborative care in both a future full-scale trial, and the wider health economy. Methods Application of the NPM to qualitative data collected in both focus groups and one-to-one interviews before and after an exploratory randomised controlled trial of a collaborative model of care for depression. Results Findings are presented as they relate to the four factors of the NPM (interactional workability, relational integration, skill-set workability, and contextual integration and a number of necessary tasks are identified. Using the model, it was possible to observe that predictions about necessary work to implement collaborative care that could be made from analysis of the pre-trial data relating to the four different factors of the NPM were indeed borne out in the post-trial data. However, additional insights were gained from the post-trial interview participants who, unlike those interviewed before the trial, had direct experience of a novel intervention. The professional freedom enjoyed by more senior mental health workers may work both for and against normalisation of collaborative care as those who wish to adopt new ways of working have the freedom to change their practice but are not obliged to do so. Conclusions The NPM provides a useful structure for both guiding and analysing the process by which an intervention is optimized for testing in a larger scale trial or for subsequent full-scale implementation.

  19. Communication About Sexuality in Advanced Illness Aligns With a Palliative Care Approach to Patient-Centered Care.

    Science.gov (United States)

    Leung, Margaret W; Goldfarb, Shari; Dizon, Don S

    2016-02-01

    Treatment-related sexual complications are common in cancer patients although rarely discussed in the palliative care setting. Sexuality is an important survivorship issue and remains relevant even in the terminal setting. There are multiple barriers in dialoguing about intimacy and sexual functioning from the patient and provider perspectives. Palliative care providers, while not expected to be sexual health experts, can provide comprehensive patient-centered care by including sexual health as part of their evaluation. They can explore how sexual dysfunction can impair functioning and utilize an interdisciplinary approach to manage symptoms. Palliative care providers can help patients identify their goals of care and explore what anticipated sexual changes and treat-related side effects are tolerable and intolerable to the patient's quality of life. Principles on addressing sexuality in the palliative setting and practical ways of incorporating sexual history into the palliative care assessment are provided.

  20. Out of pocket expenditure on utilization of ante-natal and delivery care services in India: analysis based on NSSO 60th round

    Directory of Open Access Journals (Sweden)

    Saraswati Kerketta

    2015-12-01

    Conclusions: The out of pocket expenditure is the main barrier in access to the health care services to the pregnant women. The government must ensure a free of cost institutional delivery especially to the poor mothers so that the maternal mortality can be reduced. [Int J Reprod Contracept Obstet Gynecol 2015; 4(6.000: 1704-1709

  1. Drug utilization pattern of antimicrobial agents in an outpatient department of otorhinolaryngology in a tertiary care hospital: a prospective, cross-sectional study

    Directory of Open Access Journals (Sweden)

    Sanket B. Sathiya

    2016-02-01

    Conclusions: Our study shows some rational prescription patterns like less utilization of antimicrobials in ENT infections and were according to standard treatment guideline. The results of this study will be useful in future for making standard treatment guidelines. It also promotes the rational prescription and rational use of drugs. [Int J Basic Clin Pharmacol 2016; 5(1.000: 65-69

  2. Social class inequalities in the utilization of health care and preventive services in Spain, a country with a national health system

    NARCIS (Netherlands)

    M. Garrido-Cumbrera; C. Borrell; L. Palencia; A. Espelt; M. Rodriguez-Sanz; M.I. Pasarin; A. Kunst

    2010-01-01

    In Spain, despite the existence of a National Health System ( NHS), the utilization of some curative health services is related to social class. This study assesses ( 1) whether these inequalities are also observed for preventive health services and ( 2) the role of additional private health insuran

  3. Perception and utilization of traditional birth attendants by pregnant women attending primary health care clinics in a rural Local Government Area in Ogun State, Nigeria

    OpenAIRE

    Ebuehi OM; Akintujoye IA

    2012-01-01

    Olufunke M Ebuehi, IA AkintujoyeReproductive and International Health Unit, Department of Community Health and Primary Care, College of Medicine, University of Lagos, Lagos, NigeriaBackground: In developing countries, most childbirth occurs at home and is not assisted by skilled attendants. This situation increases the risk of death for both mother and child and has severe maternal and neonatal health complications. The purpose of this study was to explore pregnant women’s perceptio...

  4. The utility of clinical care pathways in determining perinatal outcomes for women with one previous caesarean section; a retrospective service evaluation

    Directory of Open Access Journals (Sweden)

    Karuga Robinson N

    2010-10-01

    Full Text Available Abstract Background The rising rates of primary caesarean section have resulted in a larger obstetric population with scarred uteri. Subsequent pregnancies in these women are risk-prone and may complicate. Besides ensuring standardised management, care pathways could be used to evaluate for perinatal outcomes in these high risk pregnancies. We aim to demonstrate the use of a care pathway for vaginal birth after caesarean section as a service evaluation tool to determine perinatal outcomes. Methods A retrospective service evaluation by review of delivery case notes and records was undertaken at the Aga Khan University Hospital, Nairobi, Kenya between January 2008 and December 2009 Women with ≥2 previous caesarean sections, previous classical caesarean section, multiple gestation, breech presentation, severe pre-eclampsia, transverse lie, placenta praevia, conditions requiring induction of labour and incomplete records were excluded. Outcome measures included the proportion of eligible women who opted for test of scar (ToS, success rate of vaginal birth after caesarean section (VBAC; proportion on women opting for elective repeat caesarean section (ERCS and their perinatal outcomes. Results A total of 215 women with one previous caesarean section were followed up using a standard care pathway. The median parity (minimum-maximum was 1.01234. The other demographic characteristics were comparable. Only 44.6% of eligible mothers opted to have a ToS. The success rate for VBAC was 49.4% with the commonest (31.8% reason for failure being protracted active phase of labour. Maternal morbidity was comparable for the failed and successful VBAC group. The incidence of hemorrhage was 2.3% and 4.4% for the successful and failed VBAC groups respectively. The proportion of babies with acidotic arterial PH ( Conclusions Besides ensuring standardised management, care pathways could be objective audit and service evaluation tools for determining perinatal outcomes.

  5. Condicionantes en la utilización de los servicios de atención primaria: Evidencias empíricas e inconsistencias metodológicas Factors conditioning primary care services utilization: Empirical evidence and methodological inconsistencies

    Directory of Open Access Journals (Sweden)

    M. Sáez

    2003-10-01

    : problemas de diseño, errores de medida, errores de especificación y métodos estadísticos inadecuados. Como vías de solución citaríamos el diseño de cuasi experimentos, la utilización de grandes bases de datos administrativos, así como de fuentes de datos primarios (diseño; la distinción entre distintos tipos de utilización y entre unidades de análisis alternativas a la visita, y la corrección de errores de medida en las variables explicativas (errores de medida; la consideración de variables explicativas relevantes (errores de especificación, y la utilización de modelos multinivel (métodos estadísticos inadecuados.Introduction: In Spain, the degree and characteristics of primary care services utilization have been the subject of analysis since at least the 1980s. One of the main reasons for this interest is to assess the extent to which utilization matches primary care needs. In fact, the provision of an adequate health service for those who most need it is a generally accepted priority. Factors conditioning use: The evidence shows that individual characteristics, mainly health status, are the factors most closely related to primary care utilization. Other personal characteristics, such as gender and age, could act as modulators of health care need. Some family and/or cultural variables, as well as factors related to the health care professional and institutions, could explain some of the observed variability in primary care services utilization. Socioeconomic variables, such as income, reveal a paradox. From an aggregate perspective, income is the main determinant of utilization as well as of health care expenditure. When data are analyzed for individuals, however, income is not related to primary health utilization. Methodological inconsistencies: The situation is controversial, with methodological implications and, above all, consequences for the assessment of the efficiency in primary care utilization. Review of the literature reveals certain

  6. Prevention of low back pain: effect, cost-effectiveness, and cost-utility of maintenance care - study protocol for a randomized clinical trial

    DEFF Research Database (Denmark)

    Eklund, Andreas; Axén, Iben; Kongsted, Alice;

    2014-01-01

    are collected at baseline and at follow-up as well as weekly, using SMS text messages. DISCUSSION: This study investigates a manual strategy (chiropractic maintenance care) for recurrent and persistent LBP and aims to answer questions regarding the effect and cost-effectiveness of this preventive approach...... of deterioration (tertiary prevention), is equally important. Research has largely focused on treatment methods for symptomatic episodes, and little is known about preventive treatment strategies. METHODS: This study protocol describes a randomized controlled clinical trial in a multicenter setting investigating...

  7. Retrospective US database analysis of drug utilization patterns, health care resource use, and costs associated with adjuvant interferon alfa-2b therapy for treatment of malignant melanoma following surgery

    Directory of Open Access Journals (Sweden)

    Krishna A

    2012-06-01

    Full Text Available Michelle D Hackshaw,1 Arun Krishna,2 David J Mauro31,2Global Health Outcomes, Merck, Sharpe and Dohme Corporation, Whitehouse Station, NJ, USA; 3Clinical Research, Merck Research Laboratories, Upper Gwynedd, PA, USABackground: The purpose of this study was to identify a real-world US population having undergone surgery for malignant melanoma and describe treatment patterns, health care resource utilization, and costs for patients who subsequently received interferon alfa-2b (IFN therapy or other standard of care chemotherapies.Methods: A retrospective cohort study was conducted using administrative claims from MarketScan® databases among melanoma patients diagnosed between 2004 and 2008 who had surgery and were subsequently treated with IFN or other chemotherapies. Health care resource utilization and costs of services (converted to 2009 dollars were evaluated. Cost refers to the amount paid to providers associated with the health service.Results: Of 18,075 subjects with melanoma surgery claims, 1525 (8.4% were treated with IFN and 1194 (6.6% with other chemotherapies. Median duration (days and number of doses of IFN therapy were 29 and 20, respectively. Approximately half of patients who received IFN discontinued therapy within or after the one-month induction phase. For IFN therapy patients, average total cost per patient for the last melanoma-related surgery prior to start of therapy, including costs of the surgery itself, pathology, anesthesia, and hospital care, was $2219. The average total cost per patient related to IFN therapy was $1188; this included costs for drug, office visits, blood work, and infusions. Other chemotherapy costs ranged from $146 to $2678.Conclusion: There is an unmet treatment need, considering that this study observed that melanoma patients on IFN therapy post-surgery do not complete the recommended one-year course of treatment which may compromise its full therapeutic benefits. Further study to investigate reasons

  8. Cost - utility analysis of parenteral antibiotics prescribed in medical wards in a tertiary care health facility in southern province of Sri Lanka

    Directory of Open Access Journals (Sweden)

    Lukshmy Menik Hettihewa

    2012-10-01

    Full Text Available Introduction: Parenteral antibiotic (PA prescription pattern in a hospital will directly influence the annual budget allocation, development of bacterial resistance and occurrence of unnecessary adverse drug reactions if it is done with poor adherence to the standard guidelines of prescription. As specialist in the field we understand the need of conducting economic studies in relation to the cost and utility of PA prescription pattern. It will be helpful to predict the drug procurement plan for the next year and also to prevent unnecessary complications mentioned above. Objective: Our main objective was to analyze the cost/utility relationship of PA drugs which were used in medical wards in this hospital according to the top ten of the cost (TTTC and the top ten of the consumption (TTCS. Materials and method : Aggregate data from the pharmacy record books were collected for year 2010 from indoor pharmacy. Unit prize was obtained from medical supplies division. Total quantity consumed by each medical ward was considered for analysis of the cost /utility relationship. Two top ten lists were prepared according to the cost and the consumption respectively for medical wards and the correlation was analyzed using non parametric testing with spearman test. Results: Regarding PA drugs used in this hospital, 7/10 PA drugs in TTTC are not included in the TTCS. Out of the total cost for TTTC, 82.6% of the cost had been spent for the PA drugs which are not in the TTCS and 17.5% of the cost of TTTC was used to purchase only three drugs from the TTCS. But these three drugs had contributed only 28% of top ten consumption. 72% of the PA drugs in TTCS were not costly drugs and highly consumed in medical wards. Correlation was significantly positive between cost and utility of PA drugs. ( r=-0.91,p<0.001 Conclusion: Majority of the consumed PA drugs are non-costly and it indicates the prescriptions had been done according to the rational guidelines including

  9. Learning history

    NARCIS (Netherlands)

    Peters, Richard

    2015-01-01

    Hilary speaks here with Professor Rik Peters an historian-philosopher who develops the Learning History as a method for engaging with socially relevant action in Holland. Thinking of history as a way to bridge to practical scenario planning, he is helping cities in Holland grapple with integration o

  10. Intellectual History

    DEFF Research Database (Denmark)

    In the 5 Questions book series, this volume presents a range of leading scholars in Intellectual History and the History of Ideas through their answers to a brief questionnaire. Respondents include Michael Friedman, Jacques le Goff, Hans Ulrich Gumbrecht, Jonathan Israel, Phiip Pettit, John Pocock...

  11. Romerrigets historie

    DEFF Research Database (Denmark)

    Christiansen, Erik

    Romerrigets historie fra Roms legendariske grundlæggelse i 753 f.v.t. til Heraklios' tronbestigelse i 610 e.v.t.......Romerrigets historie fra Roms legendariske grundlæggelse i 753 f.v.t. til Heraklios' tronbestigelse i 610 e.v.t....

  12. Maryland Day Care Voucher System.

    Science.gov (United States)

    Hildebrand, Joan M.

    This manual was written to assist States and other governmental units wishing to replicate the Maryland Day Care Voucher Program, a system of providing child care subsidies to eligible families. Chapter I provides brief histories of day care in Maryland and that State's grant to demonstrate the viability of a day care voucher system. Chapter II…

  13. Rural Drug Users: Factors Associated with Substance Abuse Treatment Utilization

    Science.gov (United States)

    Oser, Carrie B.; Leukefeld, Carl G.; Tindall, Michele Staton; Garrity, Thomas F.; Carlson, Robert G.; Falck, Russel; Wang, Jichuan; Booth, Brenda M.

    2010-01-01

    The purpose of this study is to use a modified version of Andersen’s (1968, 1995) Behavioral Model of Health Services Use to identify the correlates of the number of substance abuse treatment episodes received by rural drug users. Data were collected from face-to-face interviews with 711 drug users in rural areas of Ohio, Arkansas, and Kentucky. Descriptive analyses examine rural drug users’ substance use histories and retrospective substance abuse treatment service utilization patterns. A negative binomial regression model indicated that selected predisposing, historical health, and enabling factors were significantly associated with the utilization of substance abuse treatment among rural drug users. Despite high levels of recent and lifetime self-reported substance use among these rural drug users, treatment services were underutilized. Future studies are needed to examine the impact of the health care system and characteristics of the external environment associated with rural substance abuse treatment in order to increase utilization among drug users. PMID:20463206

  14. Patient-Physician Relationship and Service Utilization: Preliminary Findings.

    Science.gov (United States)

    Nagel, Rollin W.; McGrady, Angele; Lynch, Denis J.; Wahl, Elmer F.

    2003-02-01

    BACKGROUND: Difficult physician-patient encounters pose a challenge in all aspects of health care. Characteristics of both physicians and patients affect the office encounter and utilization of services. The objectives of this study were to explore the impact of patients' characteristics and the patient-physician relationship on service utilization. METHOD: A sample of 22 family practice patients and their physicians completed questionnaires prior to and/or after an office visit. Chart review yielded demographic information and history. The number of office visits and phone calls were obtained from billing records. RESULTS: The number of patient-reported physical problems was correlated with negative affect (r = 0.63, p perception of the physician's warmth (r = 0.48, p physical complaints, and the patients' perception of their physician impact utilization. Armed with information about patient characteristics prior to the office visit, the physician can increase efficiency and facilitate a more productive encounter.

  15. Integrating Spirituality as a Key Component of Patient Care

    Directory of Open Access Journals (Sweden)

    Suzette Brémault-Phillips

    2015-04-01

    Full Text Available Patient care frequently focuses on physical aspects of disease management, with variable attention given to spiritual needs. And yet, patients indicate that spiritual suffering adds to distress associated with illness. Spirituality, broadly defined as that which gives meaning and purpose to a person’s life and connectedness to the significant or sacred, often becomes a central issue for patients. Growing evidence demonstrates that spirituality is important in patient care. Yet healthcare professionals (HCPs do not always feel prepared to engage with patients about spiritual issues. In this project, HCPs attended an educational session focused on using the FICA Spiritual History Tool to integrate spirituality into patient care. Later, they incorporated the tool when caring for patients participating in the study. This research (1 explored the value of including spiritual history taking in clinical practice; (2 identified facilitators and barriers to incorporating spirituality into person-centred care; and (3 determined ways in which HCPs can effectively utilize spiritual history taking. Data were collected using focus groups and chart reviews. Findings indicate positive impacts at organizational, clinical/unit, professional/personal and patient levels when HCPs include spirituality in patient care. Recommendations are offered.

  16. Health care utilization among older mexicans: health and socioeconomic inequalities Utilización de servicios de salud entre adultos mayores en México: desigualdades socioeconómicas y en salud

    Directory of Open Access Journals (Sweden)

    Rebeca Wong

    2007-01-01

    Full Text Available OBJECTIVE: To examine the determinants of the utilization of health care services among the population of older adults in Mexico. Three types of health care services are analyzed: preventive care, visits to the doctor, and hospitalizations. MATERIAL AND METHODS: Data was used from the 2001 Mexican Health and Aging Study (MHAS/ENASEM and estimates were made using multivariate probit regression methods. RESULTS: Socioeconomic factors, health conditions reported by the individuals, and the availability of health insurance are significant determinants of the differential use of services by older adults. CONSLUSION: Specific health conditions are important determinants of use of the various types of health care services. For all three types, however, the availability of health insurance is an enabling factor of health care use. Older age is associated with greater propensity to use health care services but its effect is small when controlling for health conditions.OBJETIVO: Examinar los determinantes del uso de servicios de salud de la población de adultos de 50 años de edad o más en México. Se analizan tres tipos de servicios de salud: cuidados preventivos, visitas al médico y hospitalizaciones. MATERIAL Y MÉTODOS: Se usan datos del Estudio Nacional sobre Salud y Envejecimiento en México (MHAS/ENASEM del año 2001 y se aplican métodos de regresión multivariada probit. RESULTADOS: Factores socioeconómicos, las condiciones de salud reportadas y la disponibilidad de derechohabiencia son factores determinantes de la propensión diferencial a usar servicios entre la población. CONCLUSIÓN: Diferentes condiciones de salud están asociadas con el uso de los varios tipos de servicios de salud. Para los tres tipos, sin embargo, es primordial la derechohabiencia a servicios de salud para fomentar la utilización de servicios. Asimismo, mayor edad se asocia con mayor uso de servicios pero su efecto es pequeño una vez que la salud se toma en cuenta.

  17. Utility of sepsis biomarkers and the infection probability score to discriminate sepsis and systemic inflammatory response syndrome in standard care patients.

    Directory of Open Access Journals (Sweden)

    Franz Ratzinger

    Full Text Available Physicians are regularly faced with severely ill patients at risk of developing infections. In literature, standard care wards are often neglected, although their patients frequently suffer from a systemic inflammatory response syndrome (SIRS of unknown origin. Fast identification of patients with infections is vital, as they immediately require appropriate therapy. Further, tools with a high negative predictive value (NPV to exclude infection or bacteremia are important to increase the cost effectiveness of microbiological examinations and to avoid inappropriate antibiotic treatment. In this prospective cohort study, 2,384 patients with suspected infections were screened for suffering from two or more SIRS criteria on standard care wards. The infection probability score (IPS and sepsis biomarkers with discriminatory power were assessed regarding their capacity to identify infection or bacteremia. In this cohort finally consisting of 298 SIRS-patients, the infection prevalence was 72%. Bacteremia was found in 25% of cases. For the prediction of infection, the IPS yielded 0.51 ROC-AUC (30.1% sensitivity, 64.6% specificity. Among sepsis biomarkers, lipopolysaccharide binding protein (LBP was the best parameter with 0.63 ROC-AUC (57.5% sensitivity, 67.1% specificity. For the prediction of bacteremia, the IPS performed slightly better with a ROC-AUC of 0.58 (21.3% sensitivity, 65% specificity. Procalcitonin was the best discriminator with 0.78 ROC-AUC, 86.3% sensitivity, 59.6% specificity and 92.9% NPV. Furthermore, bilirubin and LBP (ROC-AUC: 0.65, 0.62 might also be considered as useful parameters. In summary, the IPS and widely used infection parameters, including CRP or WBC, yielded a poor diagnostic performance for the detection of infection or bacteremia. Additional sepsis biomarkers do not aid in discriminating inflammation from infection. For the prediction of bacteremia procalcitonin, and bilirubin were the most promising parameters, which

  18. Cultural history and aesthetics of nursing care La historia cultural y la estética de los cuidados de enfermería A história cultural e a estética dos cuidados de enfermagem

    Directory of Open Access Journals (Sweden)

    José Siles González

    2011-10-01

    Full Text Available The aim of this study was to clarify the role of aesthetics in the organization and motivation of care through history. The guiding questions were: What values and aesthetic feelings have supported and motivated pre-professional and professional care? and Based on what structures has pre-professional and professional care been historically socialized? Primary and secondary sources were consulted, selected according to established criteria with a view to avoiding search and selection bias. Data analysis was guided by the categories: "habitus" and "logical conformism". It was found that the relation between social structures and pre-professionals (motherhood, religiosity and professional aesthetic standards (professionalism, technologism of care through history is evidenced in the caregiving activity of the functional unit, in the functional framework and the functional element. In conclusion, in social structures, through the socialization process, "logical conformism" and "habitus" constitute the aesthetic standards of care through feelings like motherhood, religiosity, professionalism, technologism and humanism.El objetivo de este artículo fue clarificar el papel de la estética en la organización y la motivación de los cuidados en la historia. La preguntas orientadoras fueron: ¿En qué valores y sentimientos estéticos se han fundamentado y motivado los cuidados preprofesionales y profesionales? y ¿En qué estructuras, los cuidados preprofesionales y profesionales, se han socializado históricamente? Se consultaron fuentes secundarias y primarias seleccionadas de acuerdo con criterios establecidos para evitar sesgos de búsqueda y selección. El análisis de los datos se guió con las categorías: "habitus" y "conformismo lógico". Se encontró que la relación entre las estructuras sociales y los patrones estéticos preprofesionales (maternidad, religiosidad y profesionales (profesionalismo, tecnologicismo de los cuidados a través de la

  19. Who Seeks Care Where? Utilization of Mental Health and Substance Use Disorder Treatment in Two National Samples of Individuals with Alcohol Use Disorders

    Science.gov (United States)

    Edlund, Mark J.; Booth, Brenda M.; Han, Xiaotong

    2012-01-01

    Objective: Only a fraction of individuals with alcohol use disorders (AUDs) receive any AUD treatment during a given year. If a substantial proportion of individuals with unmet need for AUD treatment are receiving mental health treatment, accessibility of AUD treatment could potentially be improved by implementing strategies to ensure that individuals receiving mental health care are referred to the AUD sector or by increasing rates of AUD treatment in individuals receiving mental health treatment. Method: We assessed patterns and predictors of mental health treatment and AUD treatment among individuals with 12-month AUDs, using secondary data analyses from two national surveys, the National Survey on Drug Use and Health (NSDUH; n = 4,545 individuals with AUDs) and the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC; n = 3,327 individuals with AUDs). Results: In both NSDUH and NESARC, 8% of individuals with AUDs reported past-year AUD treatment. Among individuals with AUDs, mental health treatment was more common than AUD treatment, with 20% of NSDUH respondents and 11% of NESARC respondents reporting receiving mental health treatment. Greater mental health morbidity increased the odds of mental health treatment, and AUD severity increased the odds of AUD treatment. Mental health morbidity also increased the odds of AUD treatment, mainly by increasing the odds of receiving the category of both AUD and mental health treatment. Conclusions: Because individuals with AUDs are more likely to receive mental health treatment than AUD treatment, a key opportunity to improve the overall accessibility of treatment for AUDs may be to focus on improving AUD treatment among individuals receiving mental health treatment. PMID:22630802

  20. A novel photo-grafting of acrylamide onto carboxymethyl starch. 1. Utilization of CMS-g-PAAm in easy care finishing of cotton fabrics.

    Science.gov (United States)

    El-Sheikh, Manal A

    2016-11-01

    The photosensitized grafting of vinyl monomers onto a range of polymeric substrates has been the subject of particular interest in the recent past. Carboxymethyl starch (CMS)-poly acrylamide (PAAm) graft copolymer (CMS-g-PAAm) with high graft yield was successfully prepared by grafting of acrylamide onto CMS using UV irradiation in the presence of the water soluble 4-(trimethyl ammoniummethyl) benzophenone chloride photoinitiator. CMS-g-PAAm with nitrogen content of 8.3% and grafting efficiency up to 98.9% was obtained using 100% AAm, a material: liquor ratio of 1:14 and 1% photinitiator at 30°C for 1h of UV irradiation. The synthesis of CMS-g-PAAm was confirmed by FTIR and Nitrogen content (%). Surface morphology of CMS and surface morphological changes of CMS after grafting with AAm were studied using SEM. Thermal properties of both CMS and CMS-g-PAAm were studied using TGA and DSC. To impart easy care finishing to cotton fabrics, aqueous formulations of: CMS-g-PAAm, dimethylol dihydroxy ethylene urea (DMDHEU), CMS-g-PAAm-DMDHEU mixture or methylolated CMS-g-PAAm were used. Cotton fabrics were padded in these formulations, squeezed to a wet pick up 100%, dried at 100°C for 5min, cured at 150°C for 5min, washed at 50°C for 10min and air-dried. CRA (crease recovery angle) of untreated fabrics and fabrics finished with a mixture of 2% CMS-g-PAAm and 10% DMDHEU or methylolated CMS-g-PAAm (10% formaldehyde) were: 136°, 190°, 288° respectively. Increasing the number of washing cycles up to five cycles results in an insignificant decrease in the CRA and a significant decrease in RF (releasable formaldehyde) of finished fabric samples. The morphologies of the finished and unfinished cotton fabrics were performed by SEM. PMID:27516255

  1. Report of the 1st RCM on Radiation Curing of Composites for Enhancing the Features and Utility in Health Care and Industry. Working Material

    International Nuclear Information System (INIS)

    Composite materials combine properties of the individual components in a synergetic manner to produce a variety of materials in an efficient and cost effective manner. Thus, composite materials today are being used in various applications from sports equipment, automotive and aerospace industries to food packaging and artificial organs. Materials reinforced with nanoscale components are adding new dimensions to composite materials and enable further major improvements in functional and structural properties. The incorporation of only a few percent of nano-sized particles can make dramatic property changes that may result in sensing, actualization or self-healing properties of the resulting composite. Several major issues need to be addressed to utilize the full potential of such nanofillers, and among them: (i) incompatibility or weak interfacial bonding between the matrix and the nanoscale component, and (ii) agglomeration of nanosized component during processing resulting in inhomogeneous distribution. According to the results of ongoing investigation and products preparation in several Member States institutions, radiation technology offers a way of overcoming these challenges by grafting of appropriate monomers/polymers onto the nanofiller surface thereby fixing their morphology and at the same time making them compatible with the host polymer. Additionally, radiation techniques offer the possibility for simultaneous synthesis of the nanoparticle component and crosslinking of the matrix of the composite that is not possible to achieve by other techniques. With the availability of lower cost self-shielded low energy electron beam accelerators, this process is increasingly becoming available for developing member states. In order to use the advantages of radiation techniques and address the needs of Member States for producing advanced composite materials, this CRP has been formulated based on the recommendations of the Consultant’s Meeting “meeting on

  2. Neogene Tectonic History of the Sierra San Pedro Mártir, Baja California Revealed by Careful Pairing of Cosmogenic Sampling with Topographic Analysis

    Science.gov (United States)

    Rossi, M. W.; Quigley, M.; Fletcher, J. M.; Whipple, K. X.; Díaz-Torres, J. J.; Seiler, C.; Fifield, L. K.; Heimsath, A. M.

    2015-12-01

    The Sierra San Pedro Mártir (SSPM), MX defines a prominent section of the Main Gulf Escarpment that marks the breakaway fault of the Gulf of California rift. The SSPM is an uplifted rift shoulder that has the highest topography and relief in Baja California, with local elevations exceeding 3,000 m and range relief (summit to baselevel) ranging from ~500 to 2,500 m. Prior studies report Eocene apatite fission track ages from the base of the escarpment and indicate low total exhumation, thus limiting the use of low-temperature thermochronology to constrain the timing and pattern of Neogene faulting of this important structure. However, topography is expected to record tectonic, climatic, and rock strength controls on long-term denudation rates in active margins, and morphometric analysis offers an alternative approach, particularly when combined with cosmogenic 10Be-derived, catchment-averaged denudation rates. Denudation rates and topographic metrics in the SSPM record along-strike gradients in rock uplift that increase asymmetrically from fault tips to a maximum within the northern half of the range. Surface uplift of an Eocene paleo-erosion surface and slope-break knickpoints found at increasingly higher elevations in northern segments of the SSPM fault system suggest that range asymmetry is due to a recent northward acceleration in rock uplift rate. By characterizing the relationship between channel steepness and 10Be-derived denudation rates, we extrapolate millennial-scale denudation rates to million-year time-scales to estimate ages for the transient increase in rock uplift rates as well as the initial onset of faulting. From this, we predict that the SSPM fault system initiated during the Middle Miocene (~16-14 Ma) in the center of the range and ~11-8 Ma ago near the fault tips. These age estimates are consistent with independent, regional geologic constraints and show that careful pairing of cosmogenic denudation rates with topographic analysis can be used

  3. Burr Utility

    NARCIS (Netherlands)

    Ikefuji, M.; Laeven, R.J.A.; Magnus, J.R.; Muris, C.H.M.

    2010-01-01

    This note proposes the Burr utility function. Burr utility is a flexible two-parameter family that behaves approximately power-like (CRRA) remote from the origin, while exhibiting exponential-like (CARA) features near the origin. It thus avoids the extreme behavior of the power family near the origi

  4. Primary Care's Dim Prognosis

    Science.gov (United States)

    Alper, Philip R.

    2010-01-01

    Given the chorus of approval for primary care emanating from every party to the health reform debate, one might suppose that the future for primary physicians is bright. Yet this is far from certain. And when one looks to history and recognizes that primary care medicine has failed virtually every conceivable market test in recent years, its…

  5. Associations of quality of life, pain, and self-reported arthritis with age, employment, bleed rate, and utilization of hemophilia treatment center and health care provider services: results in adults with hemophilia in the HERO study

    Directory of Open Access Journals (Sweden)

    Forsyth AL

    2015-10-01

    Full Text Available Angela L Forsyth,1 Michelle Witkop,2 Angela Lambing,3 Cesar Garrido,4 Spencer Dunn,5 David L Cooper,6 Diane J Nugent7 1BioRx, Cincinnati, OH, USA; 2Munson Medical Center, Traverse City, MI, USA; 3Henry Ford Hospital, Detroit, MI, USA; 4Asociacion Venezolana para la Hemofilia, Caracas, Venezuela; 5Center for Inherited Blood Disorders, Orange, CA, USA; 6Novo Nordisk Inc., Plainsboro, NJ, USA; 7Children’s Hospital of Orange County, Center for Inherited Blood Disorders, Orange, CA, USA Introduction: Severe hemophilia and subsequent hemophilic arthropathy result in joint pain and impaired health-related quality of life (HRQoL. Assessment of HRQoL in persons with hemophilia (PWH, including underlying factors that drive HRQoL differences, is important in determining health care resource allocation and in making individualized clinical decisions.Aim: To examine potential associations between HRQoL, pain interference, and self-reported arthritis and age, employment, activity, bleed frequency, and hemophilia treatment center and health care professional utilization.Methods: PWH (age ≥18 years from ten countries completed a 5-point Likert scale on pain interference over the previous 4 weeks, the EQ-5D-3L scale (mobility, usual activities, self-care, pain/discomfort, anxiety/depression including a health-related visual analog scale (0–100, coded as an 11-point categorical response.Results: Pain interference (extreme/a lot was higher in PWH aged >40 years (31% compared to those aged 31–40 years (27% or ≤30 years (21%. In an analysis of eight countries with home treatment, PWH who reported EQ-5D mobility issues were less likely to be employed (53% vs 79%, with no mobility issues. Median annual bleed frequency increased with worsening EQ-5D pain or discomfort. The percentage of PWH with inhibitors reporting visual analog scale scores of 80–90–100 was lower (20% than those without inhibitors (34%. Median bleed frequency increased with pain

  6. 济南市农村居民住院服务利用率及费用影响因素%Utilization and cost of inpatient care and their determinants among rural residents in Ji'nan city

    Institute of Scientific and Technical Information of China (English)

    李友卫; 王健; 汪洋; 郭娜; 张国杰

    2012-01-01

    目的 了解济南市农村居民的住院服务利用率、住院费用及其影响因素,为合理利用住院服务、有效控制住院费用上涨提供依据.方法 采用分层随机抽样方法对在济南市抽取的章丘市、长清区、平阴县3个市(县、区)共3458名居民进行问卷调查.结果 济南市农村居民2006和2008年的住院服务利用率分别为4.89%和3.90%,次均住院费用分别为6385.74和7127.08元,日均住院费分别为459.34和534.17元,新农合补偿费用分别为701.49和914.82元,新农合补偿比例分别为10.99%和12.84%,自付费用比例分别为89.01%和87.16%;不同特征农村居民比较,不同性别、年龄、职业、文化程度、自评健康状况、吸烟、饮酒情况的农村居民的住院服务利用率间差异均有统计学意义(P<0.05),不同地区、经济收入居民的住院服务利用率间差异均无统计学意义(P>0.05);多因素回归分析结果表明,自评健康状况较差是济南市农村居民住院概率的危险因素,年龄15 ~24岁是农村居民住院概率的保护因素;住院天数、新农合补偿费用、住院机构、住院疾病和地区是农村居民住院费用的主要影响因素.结论 济南市农村居民住院服务利用率较低,住院费用较高,新农合补偿较少;完善各级医疗机构分流制度、缩短住院时间、加大新农合补偿力度是控制住院费用、减轻农民经济负担的有效手段.%Objective To examine the utilization and cost of inpatient care and their determinants among rural residents in Ji'nan municipality,Shandong province and to provide evidence for rational utilization and cost control of inpatient care. Methods Three counties of Ji' nan municipality were selected with stratified random sampling method and 3 458 residents were surveyed. Results In 2006 and 2008, the proportion of inpatients among the rural residents was 4. 89% and 3.90% . Hospitalization cost for per

  7. Linjefaget historie

    DEFF Research Database (Denmark)

    Rasch-Christensen, Andreas

    Afhandlingen er en undersøgelse af linjefaget historie ved læreruddannelsen. Med fokus på subjektperspektivet peger afhandlingen på en række afgørende udviklingsperspektiver for læreruddannelsen, uddannelsen af historielærere og folkeskolens historieundervisning.......Afhandlingen er en undersøgelse af linjefaget historie ved læreruddannelsen. Med fokus på subjektperspektivet peger afhandlingen på en række afgørende udviklingsperspektiver for læreruddannelsen, uddannelsen af historielærere og folkeskolens historieundervisning....

  8. Matematikkens historie

    DEFF Research Database (Denmark)

    Hansen, Vagn Lundsgaard

    2009-01-01

    Matematikkens historie i syv kapitler: 1. Matematik i støbeskeen; 2. Matematikkens græske arv; 3. Den gyldne tidsalder for hinduer og arabere; 4. Matematik i Kina; 5. Renæssancens matematik; 6. Regning med infinitesimaler ser dagens lys; 7. Matematik i det tyvende århundrede.......Matematikkens historie i syv kapitler: 1. Matematik i støbeskeen; 2. Matematikkens græske arv; 3. Den gyldne tidsalder for hinduer og arabere; 4. Matematik i Kina; 5. Renæssancens matematik; 6. Regning med infinitesimaler ser dagens lys; 7. Matematik i det tyvende århundrede....

  9. Environmental history

    DEFF Research Database (Denmark)

    Pawson, Eric; Christensen, Andreas Aagaard

    2016-01-01

    Environmental history is an interdisciplinary pursuit that has developed as a form of conscience to counter an increasingly powerful, forward-looking liberal theory of the environment. It deals with the relations between environmental ideas and materialities, from the work of the geographers George...... risks”. These are exposed by environmental history’s focus on long-run analysis and its narrative form that identifies the stories that we tell ourselves about nature. How a better understanding of past environmental transformations helps to analyse society and agency, and what this can mean...... for solutions and policies, is the agenda for an engaged environmental history from now on....

  10. Health care delivery systems.

    OpenAIRE

    Stevens, F; Zee, J. van der

    2007-01-01

    A health care delivery system is the organized response of a society to the health problems of its inhabitants. Societies choose from alternative health care delivery models and, in doing so, they organize and set goals and priorities in such a way that the actions of different actors are effective, meaningful, and socially accepted. From a sociological point of view, the analysis of health care delivery systems implies recognition of their distinct history over time, their specific values an...

  11. Cultural history as polyphonic history

    Directory of Open Access Journals (Sweden)

    Burke, Peter

    2010-06-01

    Full Text Available This texts offers a reflection on the origins and actual development of the field of cultural history through a comparison with the term that has served as title for this seminar: “polyphonic history”. The author provides an overview of the themes that have structured the seminar (the history of representations, the history of the body and the cultural history of science with the aim of making explicit and clarifying this plurality of voices in the field of history as well as its pervasiveness in other research areas.

    En este texto se ofrece una reflexión sobre el origen y actual desarrollo del campo de la historia cultural a través de una comparación con el término que ha dado título a este seminario: “historia polifónica”. El autor propone un recorrido por las áreas temáticas que han conformado la estructura del seminario (la historia de las representaciones, la historia del cuerpo y la historia cultural de la ciencia con el objeto de explicitar y explicar esta pluralidad de voces en el campo de la historia, así como su repercusión en otras áreas del conocimiento.

  12. Quality assessment of child care services in primary health care settings of Central Karnataka (Davangere District

    Directory of Open Access Journals (Sweden)

    Rashmi

    2010-01-01

    Full Text Available Background: Infectious disease and malnutrition are common in children. Primary health care came into being to decrease the morbidity. Quality assessment is neither clinical research nor technology assessment. It is primarily an administrative device used to monitor performance to determine whether it continues to remain within acceptable bounds. Aims and Objectives: To assess the quality of service in the delivery of child health care in a primary health care setting. To evaluate client satisfaction. To assess utilization of facilities by the community. Materials and Methods: Study Type: Cross-sectional community-based study. Quality assessment was done by taking 30-50%, of the service provider. Client satisfaction was determined with 1 Immunization and child examination-90 clients each. Utilization of services was assessed among 478 households. Statistical Analysis: Proportions, Likert′s scale to grade the services and Chi-square. Results: Immunization service: Identification of needed vaccine, preparation and care was average. Vaccination technique, documentation, EPI education, maintenance of cold chain and supplies were excellent. Client satisfaction was good. Growth monitoring: It was excellent except for mother′s education andoutreach educational session . Acute respiratory tract infection care: History, physical examination, ARI education were poor. Classification, treatment and referral were excellent. Client satisfaction was good. Diarrheal disease care: History taking was excellent. But examination, classification, treatment, ORT education were poor. Conclusion: Mothers education was not stressed by service providers. Service providers′ knowledge do not go with the quality of service rendered. Physical examination of the child was not good. Except for immunization other services were average.

  13. Why History?

    Science.gov (United States)

    Duffy, Robert E.

    1988-01-01

    Examines the way in which studying history contributes to intellectual development. Identifies five mental attributes it enhances: perspective--gained from placing people, events, institutions against larger background; encounter--confronting great ideas, personalities, etc.; relativism in a pluralistic world--developed from immersion in other…

  14. Business History

    DEFF Research Database (Denmark)

    Hansen, Per H.

    2012-01-01

    This article argues that a cultural and narrative perspective can enrich the business history field, encourage new and different questions and answers, and provide new ways of thinking about methods and empirical material. It discusses what culture is and how it relates to narratives. Taking...

  15. Potted history

    OpenAIRE

    Dijk, T. van

    2010-01-01

    The Jordan Valley was once populated by a people, now almost forgotten by historians, with whom the pharaoh of Egypt sought favour. That is the conclusion reached by Niels Groot, the first researcher to take a PhD at the Delft-Leiden Centre for Archaeology, Art History and Science.

  16. An exploration of the utility of mathematical modeling predicting fatigue from sleep/wake history and circadian phase applied in accident analysis and prevention: the crash of Comair Flight 5191.

    Science.gov (United States)

    Pruchnicki, Shawn A; Wu, Lora J; Belenky, Gregory

    2011-05-01

    On 27 August 2006 at 0606 eastern daylight time (EDT) at Bluegrass Airport in Lexington, KY (LEX), the flight crew of Comair Flight 5191 inadvertently attempted to take off from a general aviation runway too short for their aircraft. The aircraft crashed killing 49 of the 50 people on board. To better understand this accident and to aid in preventing similar accidents, we applied mathematical modeling predicting fatigue-related degradation in performance for the Air Traffic Controller on-duty at the time of the crash. To provide the necessary input to the model, we attempted to estimate circadian phase and sleep/wake histories for the Captain, First Officer, and Air Traffic Controller. We were able to estimate with confidence the circadian phase for each. We were able to estimate with confidence the sleep/wake history for the Air Traffic Controller, but unable to do this for the Captain and First Officer. Using the sleep/wake history estimates for the Air Traffic Controller as input, the mathematical modeling predicted moderate fatigue-related performance degradation at the time of the crash. This prediction was supported by the presence of what appeared to be fatigue-related behaviors in the Air Traffic Controller during the 30 min prior to and in the minutes after the crash. Our modeling results do not definitively establish fatigue in the Air Traffic Controller as a cause of the accident, rather they suggest that had he been less fatigued he might have detected Comair Flight 5191's lining up on the wrong runway. We were not able to perform a similar analysis for the Captain and First Officer because we were not able to estimate with confidence their sleep/wake histories. Our estimates of sleep/wake history and circadian rhythm phase for the Air Traffic Controller might generalize to other air traffic controllers and to flight crew operating in the early morning hours at LEX. Relative to other times of day, the modeling results suggest an elevated risk of fatigue

  17. História oral: a experiência das doulas no cuidado à mulher Historia Oral: la experiencia de las doulas en el cuidado a la mujer Oral History: experience of doulas in the care of women

    Directory of Open Access Journals (Sweden)

    Karla Romana Ferreira de Souza

    2010-01-01

    : This is a qualitative study conducted at a municipal public maternity hospital in the city of Recife, in Pernambuco state, where the program has been institutionalized for four years. The research instrument used was the interview with nine doulas, analyzed according to the oral history. RESULTS: Two main themes emerged that show the experience of the doulas in caring for women: a way to humanize and welcoming and creating links. CONCLUSION: The speeches revealed that doulas provide care that contains an active listening based on attitudes of respect, foster care, technical knowledge and love.

  18. Ildens historier

    DEFF Research Database (Denmark)

    Lassen, Henrik Roesgaard

    have been written by Andersen. In several chapters the curiously forgotten history of fire-lighting technology is outlined, and it is demonstrated that "Tællelyset" is written by a person with a modern perspective on how to light a candle - among other things. The central argument in the book springs......In December 2012 a manuscript entitled "Tællelyset" ['The Tallow Candle'] was discovered in an archive. The story was subsequently presented to the world as Hans Christian Andersen's first fairy tale and rather bombastically celebrated as such. In this book it is demonstrated that the text cannot...... from a point-by-point tracing of 'the origins and history' of Hans Christian Andersen's famous fairy tales. Where did the come from? How did they become the iconic texts that we know today? On this background it becomes quite clear that "Tællelyset" is a modern pastiche and not a genuine Hans Christian...

  19. Sommerferiens historie

    DEFF Research Database (Denmark)

    Lützen, Karin

    2011-01-01

    Summer holiday is a pleasure which did not become available to many people until the 20th Century. The article describes the early mountain rambles of the bourgeoisie and their holidays in seaside boarding houses. Outdoor pursuits and stays in boarding houses at bathing resorts also became favour...... pattern. Finally, the history of the special holiday camps is told, which were established by American Jews because they were excluded from many hotels....

  20. Computer assisted medical history taking

    NARCIS (Netherlands)

    M.J. Quaak; A.P.M. Hasman (Arie)

    1988-01-01

    textabstractIn this thesis a study is described which was performed to explore the possibilities of computer-assisted history taking to support patient care. A system was developed by which the patient himself enters his medical data into a computer. The system enables an unexperienced user, i.e. a

  1. Multiattribute Utility Theory without Expected Utility Foundations

    NARCIS (Netherlands)

    A.M. Stiggelbout; P.P. Wakker

    1995-01-01

    Methods for determining the form of utilities are needed for the implementation of utility theory in specific decisions. An important step forward was achieved when utility theorists characterized useful parametric families of utilities, and simplifying decompositions of multiattribute utilities. Th

  2. Multiattribute utility theory without expected utility foundations

    NARCIS (Netherlands)

    P.P. Wakker; J. Miyamoto

    1996-01-01

    Methods for determining the form of utilities are needed for the implementation of utility theory in specific decisions. An important step forward was achieved when utility theorists characterized useful parametric families of utilities, and simplifying decompositions of multiattribute utilities. Th

  3. Uncovering History for Future History Teachers

    Science.gov (United States)

    Fischer, Fritz

    2010-01-01

    The art of history teaching is at a crossroads. Recent scholarship focuses on the need to change the teaching of history so students can better learn history, and insists that history teachers must move beyond traditional structures and methods of teaching in order to improve their students' abilities to think with history. This article presents…

  4. Guri power complex; Operation history

    Energy Technology Data Exchange (ETDEWEB)

    Izaguirre, J. (C.V.G. Electrification del Caroni, C.A., Edelca (VE)); Deniz, O. (Harza Engineering Company International, Guri (VE))

    1989-01-01

    This paper presents the main construction features of the Guri project, describes the concept of staged construction and gives the operating history of the major equipment in the two powerhouses. Some of the major operating problems that were encountered are identified and the remedies that were utilized to overcome the problems are discussed.

  5. "Anslingerian" Politics: The History of Anti-Marijuana Sentiment in Federal law and How Harry Anslinger's Anti-Marijuana Politics Continue to Prevent the FDA and other Medical Experts from Studying Marijuana's Medical Utility

    OpenAIRE

    Ransom, Jesse J.

    1999-01-01

    This paper is intended to demonstrate how the Federal Bureau of Narcotics’s propagation of negative images associating marijuana with the anti-social behavior of marginal socio-economic groups in the 1930’s still influences the federal government’s marijuana policies today. This paper traces the history of marijuana’s legal, from its legal status America’s infancy, where many colonies considered mar...

  6. The atom in human thought history

    International Nuclear Information System (INIS)

    This book speaks of atom history. From the ancient Greece until now, science debated around the question for or against the atom conception of universe. In this book of sciences history, the author goes over the major events of this intellectual joust with a real pedagogic care, from Democrite, Aristote, Platon to Planck, Bohr, Einstein, Schroedinger and some others

  7. "Uberizing" home care in Ontario.

    Science.gov (United States)

    Wojtak, Anne; Stark, Linda

    2016-07-01

    This article looks at home care in Ontario and its role as a foundation for a sustainable healthcare system in the future. Beginning with the history and evolution of the service delivery model, it examines current challenges and opportunities to unleash the potential of home care within a more integrated model for patient-centred care for the future. An in-depth look at how to better coordinate, integrate, and fund care for patients is highlighted. PMID:27269814

  8. History repeats itself: the family medication history and pharmacogenomics.

    Science.gov (United States)

    Smith, Thomas R; Kearney, Elizabeth; Hulick, Peter J; Kisor, David F

    2016-05-01

    Related to many drug gene-product interactions, application of pharmacogenomics can lead to improved medication efficacy while decreasing or avoiding adverse drug reactions. However, utilizing pharmacogenomics without other information does not allow for optimal medication therapy. Currently, there is a lack of documentation of family medication history, in other words, inefficacy and adverse reactions across family members throughout generations. The family medication history can serve as an impetus for pharmacogenomic testing to explain lack of medication efficacy or an adverse drug reaction and pre-emptive testing can drive recognition and documentation of medication response in family members. We propose combining the family medication history via pedigree construction with pharmacogenomics to further optimize medication therapy. We encourage clinicians to combine family medication history with pharmacogenomics.

  9. History repeats itself: the family medication history and pharmacogenomics.

    Science.gov (United States)

    Smith, Thomas R; Kearney, Elizabeth; Hulick, Peter J; Kisor, David F

    2016-05-01

    Related to many drug gene-product interactions, application of pharmacogenomics can lead to improved medication efficacy while decreasing or avoiding adverse drug reactions. However, utilizing pharmacogenomics without other information does not allow for optimal medication therapy. Currently, there is a lack of documentation of family medication history, in other words, inefficacy and adverse reactions across family members throughout generations. The family medication history can serve as an impetus for pharmacogenomic testing to explain lack of medication efficacy or an adverse drug reaction and pre-emptive testing can drive recognition and documentation of medication response in family members. We propose combining the family medication history via pedigree construction with pharmacogenomics to further optimize medication therapy. We encourage clinicians to combine family medication history with pharmacogenomics. PMID:27143300

  10. 上海市两区流动人口孕产妇利用保健服务的障碍因素%The barriers of maternal health care utilization of migrant pregnant women in two districts of Shanghai

    Institute of Scientific and Technical Information of China (English)

    蒋伊石; 刘萌; 许洁霜; 钱序

    2011-01-01

    Objective: To analyze the barriers of maternal health care utilization of migrant pregnant women in Minhang District and Songjiang District of Shanghai. Methods: Quantitative survey: two outpatient clinics for planned immunization were selected from Minhang District and Songjiang District of Shanghai, respectively; on the day of investigation, 195 migrant women with under -3 -year children were selected as study objects, a self-designed questionnaire was used to survey their health status during pregnancy. Qualitative interview:4 health care providers from a designated - delivery hospital, 4 migrant women and 2 management staff were interviewed. Results: For educational level, 56. 4% of the subjects were at junior secondary school level or below. For monthly income per capita, 40. 0% of the subjects were below minimum wage standard in Shanghai. 61.0% of the subjects participated in one of national basic health insurance schemes. The rate of pregnancy registration was 74. 9%. The rate of prenatal examination was 97. 9%, and the finishing rate of 9 - time prenatal examination was 42. 1%. The incidence of anemia during pregnancy was 36. 4%, the rate of hospital delivery was 98. 5%, but the rate of cesarean section was 44. 6%, the incidence of low birth weight infants was 2. 6%. The rate of complete postpartum visit was 18. 5%. Municipal government provided a series of policies for maternal health care of migrant pregnant women, but 73. 3% of the subjects expressed complete ignorance of all policies. Conclusion: The barriers of maternal health care utilization of migrant pregnant women include: the low educational level of migrant pregnant women induces unconsciousness of health care; low health insurance coverage and un -disseminated incentive pelicy, the shortage of health human resource at community level can not to meet the increasing health demand of migrant pregnant women.%目的:分析上海市闵行区和松江区流动孕产妇利用

  11. Development and Utilization of Water Transportation in Ancient Yellow River Channel in History%历史上黄河故道水运功能的开发与利用

    Institute of Scientific and Technical Information of China (English)

    陈隆文

    2014-01-01

    According to literature statistics,the Yellow River course changed frequently. Frequent divagation was not only the result of natural envi-ronment variation in the Yellow River basin,but also the effect that human activity on natural environment. For the ancient Yellow River channel, we should fully realize the historical processes and characteristics of their formation and evolution,seize the potential utilization value,and give service to sustainable development of economic society in the Yellow River basin. Cao Cao excavated Baigou River in the Wei and Jin dynasties and Suiyang Emperor excavated Yongji Canal in Sui Dynasty,which provided experiences for utilization of the ancient Yellow River course.%对于黄河改道所遗留的故道,应该充分认识其形成、演变的历史过程和特点,挖掘故道的潜在利用价值,服务当今黄河流域经济社会的可持续发展。魏晋时期曹操开白沟和隋朝隋炀帝凿永济渠过程中对前代黄河故道利用的成功案例为后人提供了宝贵的经验。

  12. Fatores associados à realização de consultas médicas de crianças menores de 5 anos Factors associated to outpatient care utilization by children (under five years of age

    Directory of Open Access Journals (Sweden)

    Antônio Augusto Moura da Silva

    1999-08-01

    Full Text Available A utilização de consultas médicas por crianças foi estimada por inquérito domiciliar transversal, em amostra aleatória por conglomerados em múltiplos estágios, no município de São Luís, Maranhão, Brasil, em 1994. Foi aplicado questionário padronizado em entrevistas com 711 mães ou responsáveis por crianças de 3 a 59 meses de idade. Pretendeu-se identificar demanda reprimida, estudar alguns fatores associados à não realização de consultas e verificar se a implantação do SUS (Sistema Único de Saúde e a expansão da rede de ambulatórios públicos reduziram a desigualdade na utilização dos serviços de saúde. Mais de dois terços, 67,2% das crianças realizaram consulta médica com finalidade curativa no último trimestre. Destas, 74,9% foram atendidas no SUS. Um percentual muito reduzido, 0,7%, procurou e não obteve consultas, caracterizando baixa repressão à demanda. Após o ajuste para fatores de confusão, pela regressão de Cox adaptada para estudos transversais, os fatores predisponentes, como escolaridade materna, sexo e idade da criança, idade materna, número de irmãos e ocupação do chefe de família explicaram pouco a não realização de consultas. Os fatores facilitadores, como renda familiar e posse de seguro-saúde, não foram preditores. O preditor mais importante da não realização de consultas foi a não necessidade, pois as crianças cujas mães referiram não estar doentes apresentaram maior risco de não serem consultadas. A expansão do atendimento público contribuiu para reduzir ou anular o peso das diferenças sociais na utilização de consultas curativas.Children outpatient health care utilization was estimated by a cross-sectional household survey using multi-stage cluster sampling in the city of São Luís, in the State of Maranhão, Brazil. 711 mothers or caretakers of children aged from 3 to 59 months answered a standardized questionnaire. The aim was to study factors associated with

  13. 42 CFR 456.614 - Inspections by utilization review committee.

    Science.gov (United States)

    2010-10-01

    ... 42 Public Health 4 2010-10-01 2010-10-01 false Inspections by utilization review committee. 456... HUMAN SERVICES (CONTINUED) MEDICAL ASSISTANCE PROGRAMS UTILIZATION CONTROL Inspections of Care in Intermediate Care Facilities and Institutions for Mental Diseases § 456.614 Inspections by utilization...

  14. [Prenatal care in the border city of Tijuana, Mexico].

    Science.gov (United States)

    Ramírez-Zetina, M; Richardson, V; Avila, H; Caraveo, V E; Salomón, R E; Bacardí, M; Jiménez-Cruz, A

    2000-02-01

    This study was intended to explore the conditions under which prenatal care is delivered in the border city of Tijuana, Baja California, Mexico, and to assess the possible associations between that care and neonatal results in terms of birthweight, health of the neonate, and prematurity. Seven hospitals serving persons from different socioeconomic strata were chosen, and between December 1993 and March 1994 interviews were conducted with 279 women who were in the first 24 to 48 hours of puerperium. During the interviews data were collected on socioeconomic level; the mothers' knowledge, attitudes, and practices concerning obstetric health; the mothers' perceptions of access to prenatal care; the quality of prenatal care visits (evaluated in terms of having blood and urine tested and weight and blood pressure measured); and the gynecological and obstetric and health history of the mother. A database was created using the SPSS statistics software package. Possible associations were explored, with prenatal care as the independent variable and various dependent variables, by means of contingency tables and a two-tailed Fisher's exact test. None of the neonates was premature, ill, or had a birthweight of 3,000 g. A significant (P women, 15 (5.4%) had received no prenatal care. None of these 15 women reported they had encountered difficulties that prevented them from obtaining prenatal care, but only 7 of those women answered that question. The prenatal care was of good quality in 190 of the cases (68%). Both the number and the timing of the prenatal visits were adequate in 142 of the cases (50%). The mother's having worked during pregnancy or before had a positive predictive value in terms of utilization of prenatal care services. Additional studies are needed to evaluate the possible relationship between domestic violence and the lack of prenatal care or a delay in seeking such care. PMID:10748660

  15. 中山市小榄地区妇科疾病现状调查和妇女保健服务利用持续改进%Investigation of current situation of gynaecological diseases and continuous improvement of women's health care service utilization in Xiaolan area of Zhongshan city

    Institute of Scientific and Technical Information of China (English)

    黄凤有; 黄蓉华; 顾秀兰; 潘婉婷; 罗飞平; 张燕玲

    2014-01-01

    目的:探讨中山市小榄地区已婚妇女保健服务利用的影响因素。方法随机选取中山市小榄地区20~54岁已婚育龄妇女530例,采用流行病学调查方法进行问卷调查,调查妇女保健服务利用状况与健康状况,分析妇女保健服务利用状况与妇科疾病发生的关系,以及影响妇女保健服务利用的因素。结果530例妇女中利用保健服务者164例,占30.94%(利用组),未利用保健服务者366例,占69.06%(未利用组)。利用组妇科疾病发病率为13.41%(22/164),明显低于未利用组的46.17%(169/366),差异具有统计学意义(P<0.05)。Logistic回归分析结果显示,收入水平、就医便利程度、医疗保障、保健意识对妇女保健服务利用具有明显影响(P<0.05)。结论中山市小榄地区已婚妇女保健服务利用率较低,应加强妇女保健服务宣传力度,增强保健意识,提供便利就医环境,提高医疗保障水平,降低医疗花费,以降低妇科疾病发病率,提高妇女健康水平。%Objective To explore the influence factors of women's health care service utilization in Xiaolan area of Zhongshan city. Methods A total of 530 women aged 24~54 years old in Xiaolan area of Zhongshan city were randomly selected. Questionnaire survey with epidemiological investigation method were conducted for the sta-tus of women's health care service utilization and health status, and then the relationship between health care service utilization and gynecological disease was analyzed. Furthermore, the influence factors of women's health care service utilization were summarized. Results 164 women (30.94%) used the health care services were grouped as the use group, and 366 women (69.06%) did not use the health care services were grouped as unused group. Incidence of gyne-cological disease of the use group (22/164, 13.41%) was lower than that in unused group (169/366, 46.17%) with a sta-tistically significant

  16. Multiattribute Utility Theory without Expected Utility Foundations

    OpenAIRE

    Miyamoto, John; Wakker, Peter

    1996-01-01

    textabstractMethods for determining the form of utilities are needed for the implementation of utility theory in specific decisions. An important step forward was achieved when utility theorists characterized useful parametric families of utilities and simplifying decompositions of multiattribute utilities. The standard development of these results is based on expected utility theory which is now known to be descriptively invalid. The empirical violations of expected utility impair the credib...

  17. Medicare Provider Utilization and Payment Data

    Data.gov (United States)

    U.S. Department of Health & Human Services — As part of the Obama administrations work to make our health care system more affordable and accountable, data are being released that summarize the utilization and...

  18. Healthcare Cost and Utilization Project (HCUP)

    Science.gov (United States)

    The Healthcare Cost and Utilization Project is a family of health care databases and related software tools and products developed through a Federal-State-Industry partnership and sponsored by the Agency for Healthcare Research and Quality.

  19. Computer assisted medical history taking

    OpenAIRE

    Quaak, M J; Hasman, Arie

    1988-01-01

    textabstractIn this thesis a study is described which was performed to explore the possibilities of computer-assisted history taking to support patient care. A system was developed by which the patient himself enters his medical data into a computer. The system enables an unexperienced user, i.e. a patient, to answer questions asked to him by an "intelligent" computerized questionnaire. In developing this system, use has been made of a fourthgeneration programming package. The system appeared...

  20. History of Disaster Medicine.

    Science.gov (United States)

    Suner, Selim

    2015-10-01

    Erik Noji, mentioned, tongue in cheek, Noah as the first disaster manager during a lecture in 2005. The canonical description of "The Genesis Flood" does describe Noah as a master planner and executer of an evacuation of biblical proportions. After gaining knowledge of a potential catastrophic disaster he planned and executed an evacuation to mitigate the effects of the "Genesis Flood" by building the Ark and organizing a mass exodus. He had to plan for food, water, shelter, medical care, waste disposal and other needs of all the evacuees. Throughout history, management of large disasters was conducted by the military. Indeed, the military still plays a large role in disaster response in many countries, particularly if the response is overseas and prolonged. The histories of emergency preparedness, disaster management and disaster medicine have coevolved and are inextricably intertwined. While disaster management in one form or another existed as long as people started living together in communities, the development of disaster medicine took off with the emergence of modern medicine. Similar to disaster management, disaster medicine also has roots in military organizations.