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Sample records for determines healthcare utilization

  1. Determinants of Maternal Healthcare Utilization in Nigeria ...

    African Journals Online (AJOL)

    Reproductive healthcare has remained a point of concern in sub-Saharan Africa due to the prevailing high maternal mortality rate. Despite the fact that the utilization of maternal healthcare services is a curbing solution, the records of utilization still remains low. This paper examined the determinants of the decision to use ...

  2. Determinants of elevated healthcare utilization in patients with COPD

    Directory of Open Access Journals (Sweden)

    Bernhard-Scharf Barbara J

    2011-01-01

    Full Text Available Abstract Background Chronic obstructive pulmonary disease (COPD imparts a substantial economic burden on western health systems. Our objective was to analyze the determinants of elevated healthcare utilization among patients with COPD in a single-payer health system. Methods Three-hundred eighty-nine adults with COPD were matched 1:3 to controls by age, gender and area of residency. Total healthcare cost 5 years prior recruitment and presence of comorbidities were obtained from a computerized database. Health related quality of life (HRQoL indices were obtained using validated questionnaires among a subsample of 177 patients. Results Healthcare utilization was 3.4-fold higher among COPD patients compared with controls (p Conclusion Comorbidity burden determines elevated utilization for COPD patients. Decision makers should prioritize scarce health care resources to a better care management of the "most costly" patients.

  3. Determinants of initial utilization of community healthcare services among patients with major non-communicable chronic diseases in South China.

    Directory of Open Access Journals (Sweden)

    Huajie Yang

    Full Text Available BACKGROUND: Although expected to act as gate-keeping primary care providers, as community health service (CHS facilities are severely under-utilized; Chinese people in both rural and urban areas used predominantly higher-tier facilities for primary care purpose, with significant financial and outcome consequences. This study intends to explore the determinants of initial utilization of CHS among patients with major non-communicable chronic diseases (NCDs in order to understand the care-seeking behavior among urban and rural residents in South China. METHODS: A multi-stage cluster random sampling methodology was adopted to create a sample of 19,466 adults with NCDs from 7,970 urban households and 32,035 adults with NCDs from 3,860 rural households in Guangdong, China. Interviews and physical examinations were conducted in 2010 to collect data on patient characteristics, medical conditions, and awareness and utilization of healthcare. Descriptive analysis and logistic regression analysis were performed to study utilization patterns and the factors associated with the patterns. RESULTS: Prevalence of major NCDs in urban areas was significantly higher than that in rural areas (12.55% vs. 8.70%; p<0.001. Second-tier district hospitals were most preferred for initial consultation (46.05% in rural areas vs. 45.32% in urban areas; p<0.001, followed by tertiary general or specialized hospitals (28.39% in rural areas vs. 33.89% in urban areas; p<0.001. The proportion of patients who had initial use of CHS was relatively low (25.56% in rural areas vs. 20.79% in urban areas; p<0.001. Awareness of self-care and the presence of medical insurance were leading factors associated with first contact of CHS facilities in both urban and rural areas. CONCLUSION: The study suggests that CHS facilities are not often used as the first contact for patients in both rural and urban areas in south China. Much effect must be made to enhance the gatekeeper system and improve

  4. 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.

  5. The Implications of Healthcare Utilization of Diabetes Disease Management

    National Research Council Canada - National Science Library

    Webb, Jonathan R

    2008-01-01

    ..., and $31 billion in excess general medical costs. The purpose of this study is to determine whether sustained hemoglobin HbA1c testing among patients is followed by reductions in healthcare utilization...

  6. Socio-Demographic Determinants of Maternal Health-Care Service Utilization Among Rural Women in Anambra State, South East Nigeria

    Science.gov (United States)

    Emelumadu, OF; Ukegbu, AU; Ezeama, NN; Kanu, OO; Ifeadike, CO; Onyeonoro, UU

    2014-01-01

    Background: Although, antenatal care (ANC) attendance in sub Saharan Africa is high, however this does not always translate into quality ANC care service utilization. Aim: This study therefore is aimed at exploring pattern of maternal health (MH) services utilization and the socio-demographic factors influencing it in Anambra State, South East Nigeria. Subjects and Methods: A total of 310 women of reproductive age with a previous history of gestation attending ANC services between September, 2007 and August, 2008 in selected Primary Health Centers in Anambra State were studied. Responses were elicited from the study participants using a pre-tested, semi-structured interviewer-administered questionnaire. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 17 (SPSS Inc, Chicago Illinois, USA). Association between socio-demographic characteristics and pattern of utilization of ANC and delivery services was measured using χ2-test, Regression analysis was done to identify factors associated with utilization of MH services. P < 0.05 was assumed to be significant. Results: Use of health facility was 293 (97.0%) and 277 (92,7%) out 302 women for ANC and delivery services respectively. Most women attended their first ANC consultation during the preceding pregnancy was after the first trimester and about 31% (94/298) of them had <4 ANC visits prior to delivery. Socio-demographic factors were found to be significantly associated with places where MH care services are accessed. Parity was found to be associated with timing of ANC booking and number of ANC attendance (χ2 = 9.49, P = 0.05). Odds of utilizing formal health facility for MH services were found to be significantly associated with increasing age (P < 0.01) and educational status of mothers (P < 0.001). Conclusions: The study revealed high maternal service utilization and 10% fetal loss, hence the need to address the gaps of late ANC booking and low ANC visits. PMID:24971212

  7. Methodological challenges collecting parent phone-call healthcare utilization data.

    Science.gov (United States)

    Moreau, Paula; Crawford, Sybil; Sullivan-Bolyai, Susan

    2016-02-01

    Recommendations by the National Institute of Nursing Research and other groups have strongly encouraged nurses to pay greater attention to cost-effectiveness analysis when conducting research. Given the increasing prominence of translational science and comparative effective research, cost-effective analysis has become a basic tool in determining intervention value in research. Tracking phone-call communication (number of calls and context) with cross-checks between parents and healthcare providers is an example of this type of healthcare utilization data collection. This article identifies some methodological challenges that have emerged in the process of collecting this type of data in a randomized controlled trial: Parent education Through Simulation-Diabetes (PETS-D). We also describe ways in which those challenges have been addressed with comparison data results, and make recommendations for future research. Copyright © 2015 Elsevier Inc. All rights reserved.

  8. Healthcare Cost and Utilization Project (HCUP) - National Inpatient Sample

    Data.gov (United States)

    U.S. Department of Health & Human Services — 2001 forward. The National (Nationwide) Inpatient Sample (NIS) is part of a family of databases and software tools developed for the Healthcare Cost and Utilization...

  9. The impact of HIV-associated lipodystrophy on healthcare utilization and costs

    Directory of Open Access Journals (Sweden)

    Lee Daniel

    2008-07-01

    Full Text Available Abstract Background HIV disease itself is associated with increased healthcare utilization and healthcare expenditures. HIV-infected persons with lipodystrophy have been shown to have poor self-perceptions of health. We evaluated whether lipodystrophy in the HIV-infected population was associated with increased utilization of healthcare services and increased healthcare costs. Objective To examine utilization of healthcare services and associated costs with respect to presence of lipodystrophy among HIV-infected patients. Methods Healthcare utilization and cost of healthcare services were collected from computerized accounting records for participants in a body image study among HIV-infected patients treated at a tertiary care medical center. Lipodystrophy was assessed by physical examination, and effects of lipodystrophy were assessed via body image surveys. Demographic and clinical characteristics were also ascertained. Analysis of healthcare utilization and cost outcomes was performed via between-group analyses. Multivariate modeling was used to determine predictors of healthcare utilization and associated costs. Results Of the 181 HIV-infected participants evaluated in the study, 92 (51% had clinical evidence of HIV-associated lipodystrophy according to physician examination. Total healthcare utilization, as measured by the number of medical center visits over the study period, was notably increased among HIV-infected subjects with lipodystrophy as compared to HIV-infected subjects without lipodystrophy. Similarly, total healthcare expenditures over the study period were $1,718 more for HIV-infected subjects with lipodystrophy than for HIV-infected subjects without lipodystrophy. Multivariate modeling demonstrated strong associations between healthcare utilization and associated costs, and lipodystrophy score as assessed by a clinician. Healthcare utilization and associated costs were not related to body image survey scores among HIV

  10. Predictors of Healthcare Service Utilization for Mental Health Reasons

    Directory of Open Access Journals (Sweden)

    Marie-Josée Fleury

    2014-10-01

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

  11. Capacity Utilization of Private Healthcare Facilities in Nigeria ...

    African Journals Online (AJOL)

    In ultra sound scan, Ondo had the best utilization rate followed by Anambra state, while Lagos state had the least capacity utilization rate. Conclusion: Capacity of private healthcare facilities in Anambra, Lagos and Ondo states was grossly underutilized. Ondo state was the worst grossly underutilized followed by Lagos state ...

  12. To assess the awareness, utilization and perception of healthcare ...

    African Journals Online (AJOL)

    2017-10-03

    Oct 3, 2017 ... Methods: A cross-sectional descriptive study among healthcare workers in a tertiary health institution in ... utilization not very encouraging. The study concluded that gender, marital status, having children and educational level were not significantly associated with awareness, perception and utilization of ...

  13. Healthcare Utilization and Costs of Systemic Lupus Erythematosus in Medicaid

    Directory of Open Access Journals (Sweden)

    Hong J. Kan

    2013-01-01

    Full Text Available Objective. Healthcare utilization and costs associated with systemic lupus erythematosus (SLE in a US Medicaid population were examined. Methods. Patients ≥ 18 years old with SLE diagnosis (ICD-9-CM 710.0x were extracted from a large Medicaid database 2002–2009. Index date was date of the first SLE diagnosis. Patients with and without SLE were matched. All patients had a variable length of followup with a minimum of 12 months. Annualized healthcare utilization and costs associated with SLE and costs of SLE flares were assessed during the followup period. Multivariate regressions were conducted to estimate incremental healthcare utilization and costs associated with SLE. Results. A total of 14,777 SLE patients met the study criteria, and 14,262 were matched to non-SLE patients. SLE patients had significantly higher healthcare utilization per year than their matched controls. The estimated incremental annual cost associated with SLE was $10,984, with the highest increase in inpatient costs (P<0.001. Cost per flare was $11,716 for severe flares, $562 for moderate flares, and $129 for mild flares. Annual total costs for patients with severe flares were $49,754. Conclusions. SLE patients had significantly higher healthcare resource utilization and costs than non-SLE patients. Patients with severe flares had the highest costs.

  14. Health Literacy Impact on National Healthcare Utilization and Expenditure

    Directory of Open Access Journals (Sweden)

    Rafia Rasu

    2015-11-01

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

  15. Healthcare utilization of patients accessing an African national treatment program

    Directory of Open Access Journals (Sweden)

    Wood Robin

    2007-06-01

    Full Text Available Abstract Background The roll-out of antiretroviral therapy (ART in Africa will have significant resource implications arising from its impact on demand for healthcare services. Existing studies of healthcare utilization on HAART have been conducted in the developed world, where HAART is commenced when HIV illness is less advanced. Methods This paper describes healthcare utilization from program entry by treatment-naïve patients in a peri-urban settlement in South Africa. Treatment criteria included a CD4 cell count Results 212 patients were followed for a median of 490 days. Outpatient visits per 100 patient years of observation (PYO, excluding scheduled primary-care follow-up, fell from 596 immediately prior to ART to 334 in the first 48 weeks on therapy and 245 thereafter. Total inpatient time fell from 2,549 days per 100 PYO pre-ART to 476 in the first 48 weeks on therapy and 73 thereafter. This fall in healthcare utilization occurred at every level of care. The greatest causes of utilization were tuberculosis, cryptococcal meningitis, HIV-related neoplasms and adverse reactions to stavudine. After 48 weeks on ART demand reverted to primarily non-HIV-related causes. Conclusion Utilization of both inpatient and outpatient hospital services fell significantly after commencement of ART for South African patients in the public sector, with inpatient demand falling fastest. Earlier initiation might reduce early on-ART utilization rates.

  16. Women's autonomy and maternal healthcare service utilization in Ethiopia.

    Science.gov (United States)

    Tiruneh, Fentanesh Nibret; Chuang, Kun-Yang; Chuang, Ying-Chih

    2017-11-13

    Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women's autonomy. We assessed whether women's autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women's decision-making power and permissive gender norms associated with wife beating. We used Spearman's correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women's autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively). In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14). The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Our study shows that women's autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman empowerment in national policies and programs would be the optimal solution.

  17. Is there equity in oral healthcare utilization: experience after achieving Universal Coverage.

    Science.gov (United States)

    Somkotra, Tewarit; Detsomboonrat, Palinee

    2009-02-01

    To assess the socioeconomic-related (in)equality and horizontal (in)equity in oral healthcare utilization among Thai adults after Universal Coverage (UC) policy implemented nationwide, and to decompose the source of inequality in utilization. Further, to identify the determinants that effect to out-of-pocket payments for oral healthcare. Using the data of 32748, Thai adults aged 15 years and over from nationally representative Health and Welfare Survey and Socio-Economic Survey in 2006. This study employs concentration index (CI) and horizontal inequity index (HI) to measure the socioeconomic-related inequality and horizontal inequity in oral healthcare utilization, respectively. Further, employing decomposition method to identify the sources of inequality comprising of a contribution of income, need determinants (i.e. self-assessed oral health, demographic characteristics), non-need determinants (i.e.working status, educational level attainment, type of insurance entitlement, geographic characteristics and marital status) and residual term. Two-part model is used to determine the factors effect to out-of-pocket payments for oral healthcare. There are the pro-rich inequality and inequity in oral healthcare utilization among Thais as indicated by significantly positive values of CI (=0.199) and HI (=0.206). The poor are more likely to access and utilize services at subsidized public facility particularly community hospital, as opposed to the better-off who tend to utilize services at private facility. Income and non-need determinants principally contribute to the pro-poor in public sector utilization, unlike pro-rich in private sector utilization. Need factors account for most of the pro-poor utilization. Type of treatment obtained and insurance used in the last visit are the substantial determinants effect to incurring out-of-pocket payments for oral healthcare. Notwithstanding the UC policy implementation made impressive strides toward improving of welfare

  18. Factors associated with increased healthcare utilization among adults with asthma.

    Science.gov (United States)

    Becerra, Monideepa Bhattacharya

    2017-05-01

    To evaluate determinants of increased emergency room (ER) visit and hospitalization among adults with asthma, with emphasis on the role of psychological distress, self-efficacy, and obesity. For analysis 2009, 2011/2012 California Health Interview Survey was used. Adults who reported lifetime asthma were selected. Association between ER and overnight hospital stay with population characteristics were conducted using chi-square analysis. Multivariable binary logistic regression models, taking into account control variables, were utilized to assess the relationship between ER visit or overnight hospital stay with that of psychological distress, self-efficacy, and obesity. Odds of ER visits were higher among those with mild-to-moderate psychological distress (adjusted odds ratio [aOR] = 1.94, 95% CI: 1.28, 2.94), and among those with serious psychological distress (aOR = 2.62, 95% CI: 1.65, 4.16). Mild-to-moderate distress was associated with two-fold increase in hospital overnight stay (aOR = 2.05, 95% CI: 1.29, 3.25). Adults with asthma who reported low self-efficacy had increased ER visits (aOR = 6.21, 95% CI: 3.63, 10.65) and hospitalization (aOR = 4.13, 95% CI: 2.63, 6.49). Finally, adults who had asthma and were obese had higher odds of ER visits (aOR = 1.60, 95% CI: 1.20, 2.13). Healthcare utilization is higher among asthma patients with psychological distress, low self-efficacy, and obesity. Interventions, such as incorporation of integrated care models, are critical to ensure early screening of mental health status among such patients. In addition, there is a need for patient education and improved weight management among adults with asthma.

  19. Socio-economic Inequalities and Healthcare Utilization in Ghana

    Directory of Open Access Journals (Sweden)

    Bashiru I.I. Saeed

    2013-07-01

    Full Text Available A socio-economic inequality in the use of healthcare services in Ghana is investigated in this paper. The data employed in the study were drawn from Global Ageing and Adult Health survey conducted in Ghana by SAGE and was based on the design for the World Health Survey (WHS, 2003. The survey was conducted in 2007 and collected data on socio-economic characteristics and other variables of the individuals interviewed. Using generalized logit model, the study found that health status is a very strong determinant of the type of healthcare services Ghanaians look for. In Ghana, there are still important socio-economic gradients in the use of some healthcare services. These differences may be due to socio-economic inequities but could also indicate that the existing health facilities are not always used in an optimal way. Patient factors may be more important than supply factors in explaining the differential use of health services.

  20. Does the distribution of healthcare utilization match needs in Africa?

    Science.gov (United States)

    Bonfrer, Igna; van de Poel, Ellen; Grimm, Michael; Van Doorslaer, Eddy

    2014-10-01

    An equitable distribution of healthcare use, distributed according to people's needs instead of ability to pay, is an important goal featuring on many health policy agendas worldwide. However, relatively little is known about the extent to which this principle is violated across socio-economic groups in Sub-Saharan Africa (SSA). We examine cross-country comparative micro-data from 18 SSA countries and find that considerable inequalities in healthcare use exist and vary across countries. For almost all countries studied, healthcare utilization is considerably higher among the rich. When decomposing these inequalities we find that wealth is the single most important driver. In 12 of the 18 countries wealth is responsible for more than half of total inequality in the use of care, and in 8 countries wealth even explains more of the inequality than need, education, employment, marital status and urbanicity together. For the richer countries, notably Mauritius, Namibia, South Africa and Swaziland, the contribution of wealth is typically less important. As the bulk of inequality is not related to need for care and poor people use less care because they do not have the ability to pay, healthcare utilization in these countries is to a large extent unfairly distributed. The weak average relationship between need for and use of health care and the potential reporting heterogeneity in self-reported health across socio-economic groups imply that our findings are likely to even underestimate actual inequities in health care. At a macro level, we find that a better match of needs and use is realized in those countries with better governance and more physicians. Given the absence of social health insurance in most of these countries, policies that aim to reduce inequities in access to and use of health care must include an enhanced capacity of the poor to generate income. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine

  1. Healthcare costs and utilization for Medicare beneficiaries with Alzheimer's

    Directory of Open Access Journals (Sweden)

    Kuo Tzu-Chun

    2008-05-01

    Full Text Available Abstract Background Alzheimer's disease (AD is a neurodegenerative disorder incurring significant social and economic costs. This study uses a US administrative claims database to evaluate the effect of AD on direct healthcare costs and utilization, and to identify the most common reasons for AD patients' emergency room (ER visits and inpatient admissions. Methods Demographically matched cohorts age 65 and over with comprehensive medical and pharmacy claims from the 2003–2004 MEDSTAT MarketScan® Medicare Supplemental and Coordination of Benefits (COB Database were examined: 1 25,109 individuals with an AD diagnosis or a filled prescription for an exclusively AD treatment; and 2 75,327 matched controls. Illness burden for each person was measured using Diagnostic Cost Groups (DCGs, a comprehensive morbidity assessment system. Cost distributions and reasons for ER visits and inpatient admissions in 2004 were compared for both cohorts. Regression was used to quantify the marginal contribution of AD to health care costs and utilization, and the most common reasons for ER and inpatient admissions, using DCGs to control for overall illness burden. Results Compared with controls, the AD cohort had more co-morbid medical conditions, higher overall illness burden, and higher but less variable costs ($13,936 s. $10,369; Coefficient of variation = 181 vs. 324. Significant excess utilization was attributed to AD for inpatient services, pharmacy, ER visits, and home health care (all p Conclusion Patients with AD have significantly more co-morbid medical conditions and higher healthcare costs and utilization than demographically-matched Medicare beneficiaries. Even after adjusting for differences in co-morbidity, AD patients incur excess ER visits and inpatient admissions.

  2. Secondhand smoke and asthma: what are the effects on healthcare utilization among children?

    Science.gov (United States)

    Jin, Yue; Seiber, Eric E; Ferketich, Amy K

    2013-08-01

    This study aims to examine the associations between asthma, secondhand smoke exposure and healthcare utilization in a nationally representative sample of children. Data from 5686 children aged 0-11 years were analyzed. Healthcare utilization, asthma diagnosis and demographic information came from the 2001 and 2006 Medical Expenditure Panel Surveys. Secondhand smoke exposure was measured during the 2000 and 2005 National Health Interview Surveys. Multivariable regression models were used to determine the association between secondhand smoke exposure, asthma diagnosis and healthcare utilization (hospitalizations, emergency department visits, outpatient visits and prescription medication use). Asthma modified the relationship between secondhand smoke exposure and hospitalizations, as exposure more than doubled the odds of hospitalization among children with asthma but had no effect on children without asthma. Secondhand smoke exposure increased the odds by 37% of emergency room visits (PSecondhand smoke exposure was associated with a greater utilization of hospitals and emergency departments, and the effect on hospitalizations was most pronounced among children with asthma. Reducing secondhand smoke exposure would help to reduce the burden on the healthcare system, especially among children with asthma. Copyright © 2013 Elsevier Inc. All rights reserved.

  3. Distribution and utilization of curative primary healthcare services in Lahej, Yemen.

    Science.gov (United States)

    Bawazir, A A; Bin Hawail, T S; Al-Sakkaf, K A Z; Basaleem, H O; Muhraz, A F; Al-Shehri, A M

    2013-09-01

    No evidence-based data exist on the availability, accessibility and utilization of healthcare services in Lahej Governorate, Yemen. The aim of this study was to assess the distribution and utilization of curative services in primary healthcare units and centres in Lahej. Cross-sectional study (clustering sample). This study was conducted in three of the 15 districts in Lahej between December 2009 and August 2010. Household members were interviewed using a questionnaire to determine sociodemographic characteristics and types of healthcare services available in the area. The distribution of health centres, health units and hospitals did not match the size of the populations or areas of the districts included in this study. Geographical accessibility was the main obstacle to utilization. Factors associated with the utilization of curative services were significantly related to the time required to reach the nearest facility, seeking curative services during illness and awareness of the availability of health facilities (P < 0.01). There is an urgent need to look critically and scientifically at the distribution of healthcare services in the region in order to ensure accessibility and quality of services. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.

  4. Utility measurement in healthcare: the things I never got to.

    Science.gov (United States)

    Torrance, George W

    2006-01-01

    The present article provides a brief historical background on the development of utility measurement and cost-utility analysis in healthcare. It then outlines a number of research ideas in this field that the author never got to. The first idea is extremely fundamental. Why is health economics the only application of economics that does not use the discipline of economics? And, more importantly, what discipline should it use? Research ideas are discussed to investigate precisely the underlying theory and axiom systems of both Paretian welfare economics and the decision-theoretical utility approach. Can the two approaches be integrated or modified in some appropriate way so that they better reflect the needs of the health field? The investigation is described both for the individual and societal levels. Constructing a 'Robinson Crusoe' society of only a few individuals with different health needs, preferences and willingness to pay is suggested as a method for gaining insight into the problem. The second idea concerns the interval property of utilities and, therefore, QALYs. It specifically concerns the important requirement that changes of equal magnitude anywhere on the utility scale, or alternatively on the QALY scale, should be equally desirable. Unfortunately, one of the original restrictions on utility theory states that such comparisons are not permitted by the theory. It is shown, in an important new finding, that while this restriction applies in a world of certainty, it does not in a world of uncertainty, such as healthcare. Further research is suggested to investigate this property under both certainty and uncertainty. Other research ideas that are described include: the development of a precise axiomatic basis for the time trade-off method; the investigation of chaining as a method of preference measurement with the standard gamble or time trade-off; the development and training of a representative panel of the general public to improve the completeness

  5. Determinants of late and/or inadequate use of prenatal healthcare in high-income countries: a systematic review

    NARCIS (Netherlands)

    Feijen-de Jong, E.I.; Jansen, D.E.M.C.; Baarveld, F.; van der Schans, C.P.; Schellevis, F.G.; Reijneveld, S.A.

    2012-01-01

    Background: Prenatal healthcare is likely to prevent adverse outcomes, but an adequate review of utilization and its determinants is lacking. Objective: To review systematically the evidence for the determinants of prenatal healthcare utilization in high-income countries. Method: Search of

  6. Impact on healthcare resource utilization of multiple sclerosis in Spain.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Ruíz-Beato, Elena; Navarro-Artieda, Ruth; Maurino, Jorge

    2017-12-29

    Multiple sclerosis (MS) is a chronic disease with a high socioeconomic impact. The aim of this study was to assess healthcare resources utilization and costs in a sample of patients with MS. A retrospective, cohort study was conducted using electronic medical records from 19 primary care centres in Asturias and Catalonia, Spain. Adult patients diagnosed with MS were distributed into two groups according to the Expanded Disability Status Scale (EDSS) score: 0-3.5 (no-moderate disability) and 4-9.5 (severe disability). Healthcare (direct cost) and non-healthcare costs (work productivity losses) were analysed. An analysis of covariance (ANCOVA) was used for correction, p < 0.05. A multiple regression model was performed to obtain the variables associated with costs. A total of 222 patients were analyzed; mean (SD) age: 45.5 (12.5) years, 64.4% female, and 62.2% presented a diagnosis of relapsing-remitting MS. Median EDSS score was 2.5, with 68.5% of the patients with no to moderate disability. The mean annual cost per MS patient was €25,103. For no-moderate and severe disability, the ANCOVA-adjusted mean annual cost was €23,157 and €29,242, respectively (p = 0.013). Direct costs and MS disease-modifying therapy accounted for 39.4% and 31.7% of the total costs, respectively. The total costs were associated with number of relapses (β = 0.135, p = 0.001), time since diagnosis (β = 0.281, p = 0.023), and age (β = 0.198, p = 0.037). Multiple sclerosis imposes a substantial economic burden on the Spanish National Health System, patients and society as a whole. Costs significantly correlated with disease progression.

  7. Factors Associated with Healthcare Utilization Among Arab Immigrants and Iraqi Refugees.

    Science.gov (United States)

    Elsouhag, D; Arnetz, B; Jamil, H; Lumley, M A; Broadbridge, C L; Arnetz, J

    2015-10-01

    Arab migrants-both immigrants and refugees-are exposed to pre- and post- migration stressors increasing their risk for health problems. Little is known, however, about rates of, or factors associated with, healthcare utilization among these two groups. A sample of 590 participants were interviewed approximately 1 year post-migration to the United States. Factors associated with healthcare utilization, including active and passive coping strategies, were examined using logistic regressions. Compared to national healthcare utilization data, immigrants had significantly lower, and refugees had significantly higher rates of healthcare utilization. Being a refugee, being married, and having health insurance were significantly associated with medical service utilization. Among refugees, less use of psychological services was associated with the use of medications and having problem-focused (active) strategies for dealing with stress. Healthcare utilization was significantly higher among refugees, who also reported a greater need for services than did immigrants.

  8. The determinants of home healthcare robots adoption: an empirical investigation.

    Science.gov (United States)

    Alaiad, Ahmad; Zhou, Lina

    2014-11-01

    Home healthcare robots promise to make clinical information available at the right place and time, thereby reducing error and increasing safety and quality. However, it has been frequently reported that more than 40% of previous information technology (IT) developments have failed or been abandoned due to the lack of understanding of the sociotechnical aspects of IT. Previous home healthcare robots research has focused on technology development and clinical applications. There has been little discussion of associated social, technical and managerial issues that are arguably of equal importance for robot success. To fill this knowledge gap, this research aims to understand the determinants of home healthcare robots adoption from these aspects by applying technology acceptance theories. We employed both qualitative and quantitative methods. The participants were recruited from home healthcare agencies located in the U.S. (n=108), which included both patients and healthcare professionals. We collected data via a survey study to test a research model. The usage intention of home healthcare robots is a function of social influence, performance expectancy, trust, privacy concerns, ethical concerns and facilitating conditions. Among them, social influence is the strongest predictor. Monitoring vital signs and facilitating communication with family and medication reminders are the most preferable tasks and applications for robots. Sociotechnical factors play a powerful role in explaining the adoption intention for home healthcare robots. The findings provide insights on how home healthcare service providers and robot designers may improve the success of robot technologies. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

  9. Utilization of healthcare services and renewal of health insurance membership: evidence of adverse selection in Ghana

    OpenAIRE

    Duku, Stephen Kwasi Opoku; Asenso-Boadi, Francis; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

    2016-01-01

    Background Utilization of healthcare in Ghana?s novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme?s financial sustainability. This paper investigates the presence of adverse selection by assessing the effect of healthcare utilization and frequency of use on NHIS renewal. Method Routine enrolment and utilization data from 2008 to 2013 in two regions in Ghana was analyzed. Pearson Chi-square test was per...

  10. Utilization of healthcare services and renewal of health insurance membership: Evidence of adverse selection in Ghana

    OpenAIRE

    Duku, Stephen Kwasi Opoku; Asenso-Boadi, Francis; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

    2016-01-01

    Background: Utilization of healthcare in Ghana's novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme's financial sustainability. This paper investigates the presence of adverse selection by assessing the effect of healthcare utilization and frequency of use on NHIS renewal. Method: Routine enrolment and utilization data from 2008 to 2013 in two regions in Ghana was analyzed. Pearson Chi-square test was p...

  11. Problem alcohol use and healthcare utilization among persons with cannabis use disorder in the United States.

    Science.gov (United States)

    John, William S; Wu, Li-Tzy

    2017-09-01

    The emergency department (ED) and hospital settings represent crucial opportunities for engaging treatment for cannabis use disorder (CUD). Thus, there is a need to identify factors associated with healthcare utilization among persons with CUD to improve screening and intervention approaches. Problematic alcohol use may be a salient risk factor. Using data from the 2005-2013 National Surveys on Drug Use and Health, we determined factors, including different patterns of alcohol use, associated with past-year ED admission and inpatient hospitalization among persons aged 12 years or older meeting criteria for CUD in the past year (N=16,757). We also determined the prevalence and correlates of problem alcohol use among persons with CUD to further inform its association with healthcare utilization. Among persons with CUD, 40.15% and 10.04% reported past-year ED admission and inpatient hospitalization, respectively. Severe alcohol use disorder (AUD) (≥6 AUD symptoms), female sex, Black race, low income, major depressive episode (MDE), and other substance use disorders were associated with increased odds of healthcare utilization; current (i.e., last month) alcohol use patterns were not. Persons with CUD that were males, ages 18-25 (vs. ages 12-17), Hispanic (vs. White), and with low income, other drug use disorders, or MDE had increased odds of AUD. Findings suggest that screening and intervention efforts for improving treatment initiation or engagement for CUD may target cannabis-using women, blacks, low-income adults or those with severe AUD in the past year, another substance use disorder, or MDE. Copyright © 2017 Elsevier B.V. All rights reserved.

  12. Healthcare utilization among Hispanic immigrants with diabetes: investigating the effect of US documentation status.

    Science.gov (United States)

    Do, Elizabeth K; Matsuyama, Robin K

    2014-04-01

    Previous studies have not examined whether documentation status has an effect on healthcare utilization among US Hispanic immigrants with diabetes. A secondary analysis was conducted using data from the Pew Hispanic Center and Robert Johnson Wood Foundation's 2007 Hispanic Healthcare Survey. Hispanic immigrants diagnosed with diabetes were included in analyses. The association between documentation status and healthcare utilization was assessed using logistic regressions. Of N = 577 Hispanic immigrants with diabetes, 80 % were documented immigrants and 81% reported having visited a healthcare provider in the last 6 months. Adjusting for confounders, those who were undocumented faced higher odds of having seen a healthcare provider more than 6 months ago or never when compared to those who were documented (OR = 1.79; 95% CI 1.01, 3.14). Unique opportunities in addressing healthcare disparities can be found in focusing on the Hispanic immigrant population living with diabetes.

  13. Utilization of maternal healthcare among adolescent mothers in urban India: evidence from DLHS-3

    Science.gov (United States)

    Kumar, Abhishek; Pranjali, Pragya

    2014-01-01

    Background. Low use of maternal healthcare services is one of the reasons why maternal mortality is still considerably high among adolescents mothers in India. To increase the utilization of these services, it is necessary to identify factors that affect service utilization. To our knowledge, no national level study in India has yet examined the issue in the context urban adolescent mothers. The present study is an attempt to fill this gap. Data and Methods. Using information from the third wave of District Level Household Survey (2007–08), we have examined factors associated with the utilization of maternal healthcare services among urban Indian married adolescent women (aged 13–19 years) who have given live/still births during last three years preceding the survey. The three outcome variables included in the analyses are ‘full antenatal care (ANC)’, ‘safe delivery’ and ‘postnatal care within 42 days of delivery’. We have used Chi-square test to determine the difference in proportion and the binary logistic regression to understand the net effect of predictor variables on the utilization of maternity care. Results. About 22.9% of mothers have received full ANC, 65.1% of mothers have had at least one postnatal check-up within 42 days of pregnancy. The proportion of mother having a safe delivery, i.e., assisted by skilled personnel, is about 70.5%. Findings indicate that there is considerable amount of variation in use of maternity care by educational attainment, household wealth, religion, parity and region of residence. Receiving full antenatal care is significantly associated with mother’s education, religion, caste, household wealth, parity, exposure to healthcare messages and region of residence. Mother’s education, full antenatal care, parity, household wealth, religion and region of residence are also statistically significant in case of safe delivery. The use of postnatal care is associated with household wealth, woman’s education, full

  14. Utilization of maternal healthcare among adolescent mothers in urban India: evidence from DLHS-3.

    Science.gov (United States)

    Singh, Aditya; Kumar, Abhishek; Pranjali, Pragya

    2014-01-01

    Background. Low use of maternal healthcare services is one of the reasons why maternal mortality is still considerably high among adolescents mothers in India. To increase the utilization of these services, it is necessary to identify factors that affect service utilization. To our knowledge, no national level study in India has yet examined the issue in the context urban adolescent mothers. The present study is an attempt to fill this gap. Data and Methods. Using information from the third wave of District Level Household Survey (2007-08), we have examined factors associated with the utilization of maternal healthcare services among urban Indian married adolescent women (aged 13-19 years) who have given live/still births during last three years preceding the survey. The three outcome variables included in the analyses are 'full antenatal care (ANC)', 'safe delivery' and 'postnatal care within 42 days of delivery'. We have used Chi-square test to determine the difference in proportion and the binary logistic regression to understand the net effect of predictor variables on the utilization of maternity care. Results. About 22.9% of mothers have received full ANC, 65.1% of mothers have had at least one postnatal check-up within 42 days of pregnancy. The proportion of mother having a safe delivery, i.e., assisted by skilled personnel, is about 70.5%. Findings indicate that there is considerable amount of variation in use of maternity care by educational attainment, household wealth, religion, parity and region of residence. Receiving full antenatal care is significantly associated with mother's education, religion, caste, household wealth, parity, exposure to healthcare messages and region of residence. Mother's education, full antenatal care, parity, household wealth, religion and region of residence are also statistically significant in case of safe delivery. The use of postnatal care is associated with household wealth, woman's education, full antenatal care, safe

  15. Utilization of maternal healthcare among adolescent mothers in urban India: evidence from DLHS-3

    Directory of Open Access Journals (Sweden)

    Aditya Singh

    2014-11-01

    Full Text Available Background. Low use of maternal healthcare services is one of the reasons why maternal mortality is still considerably high among adolescents mothers in India. To increase the utilization of these services, it is necessary to identify factors that affect service utilization. To our knowledge, no national level study in India has yet examined the issue in the context urban adolescent mothers. The present study is an attempt to fill this gap.Data and Methods. Using information from the third wave of District Level Household Survey (2007–08, we have examined factors associated with the utilization of maternal healthcare services among urban Indian married adolescent women (aged 13–19 years who have given live/still births during last three years preceding the survey. The three outcome variables included in the analyses are ‘full antenatal care (ANC’, ‘safe delivery’ and ‘postnatal care within 42 days of delivery’. We have used Chi-square test to determine the difference in proportion and the binary logistic regression to understand the net effect of predictor variables on the utilization of maternity care.Results. About 22.9% of mothers have received full ANC, 65.1% of mothers have had at least one postnatal check-up within 42 days of pregnancy. The proportion of mother having a safe delivery, i.e., assisted by skilled personnel, is about 70.5%. Findings indicate that there is considerable amount of variation in use of maternity care by educational attainment, household wealth, religion, parity and region of residence. Receiving full antenatal care is significantly associated with mother’s education, religion, caste, household wealth, parity, exposure to healthcare messages and region of residence. Mother’s education, full antenatal care, parity, household wealth, religion and region of residence are also statistically significant in case of safe delivery. The use of postnatal care is associated with household wealth, woman

  16. Clinical characteristics, healthcare costs, and resource utilization in hepatitis C vary by genotype.

    Science.gov (United States)

    Goolsby Hunter, Alyssa; Rosenblatt, Lisa; Patel, Chad; Blauer-Peterson, Cori; Anduze-Faris, Beatrice

    2017-05-01

    In the United States, approximately 3 million people are infected with hepatitis C virus (HCV). Genotypes of HCV variably affect disease progression and treatment response. However, the relationships between HCV genotypes and liver disease progression, healthcare resource utilization, and healthcare costs have not been fully explored. In this retrospective study of patients with chronic hepatitis C (CHC), healthcare claims from a large US health plan were used to collect data on patient demographic and clinical characteristics. Main outcome measures include healthcare resource utilization (HCRU) and healthcare costs. Linked laboratory data provided genotype and select measures to determine liver disease severity. The sample (mean age 50.6 years, 63.5% male) included 10,331 patients, of whom 79.1% had genotype (GT)1, 12.8% had GT2, and 8.1% had GT3. Descriptive analyses demonstrated variation by HCV genotype in liver and non-liver related comorbidities, liver disease severity, and healthcare costs. The highest percentage of patients with liver-related comorbidities and advanced liver disease was found among those with GT3. Meanwhile, patients with GT2 had lower HCRU and the lowest costs, and patients with GT1 had the highest total all-cause costs. These differences may reflect differing rates of non-liver-related comorbidities and all-cause care. Multivariable analyses showed that genotype was a significant predictor of costs and liver disease severity: compared with patients having GT1, those with GT3 were significantly more likely to have advanced liver disease. Patients with GT2 were significantly less likely to have advanced disease and more likely to have lower all-cause costs. Results may not be generalizable to patients outside the represented commercial insurance plans, and analysis of a prevalent population may underestimate HCRU and costs relative to a sample of treated patients. These results suggest that liver disease progression varies by genotype and

  17. Combining communication technology utilization and organizational innovation: evidence from Canadian healthcare decision makers.

    Science.gov (United States)

    Jbilou, Jalila; Landry, Réjean; Amara, Nabil; El Adlouni, Salaheddine

    2009-08-01

    Information and Communication Technology (ICT) and Organizational Innovation (OI) are seen as the miracle of post-modernity in organizations. In this way, they are supposed to resolve most organizational problems, efficiently and rapidly. OI is highly dependent on the capacity and the investment in knowledge management (internal and external) to support decision making process and to implement significant changes. We know what explains ICT utilization (ICTU) and what determines OI development (OID) in healthcare services. Moreover, the literature tends to link ICTU to OID and vice versa. However, this dependency has never been explored empirically through the lens of roles combination. To identify the existing combined roles profiles of ICTU and OID among healthcare decision makers and determine factors of the shift from a profile to another. We did the following: (1) a structured review of the literature on healthcare management by focusing on ICTU and OID which allowed us to build two indexes and a comprehensive framework; (2) a copula methodology to identify with high precision the thresholds for ICTU and OID; and (3) a cross-sectional study based on a survey done with a sample of 942 decision makers from Canadian healthcare organizations through a multinomial logit model to identify determinants of the shift. ICTU and OID are correlated at 22% (Kendal's Tau). The joint distribution (combination) of ICTU and OID shows that four major profiles exist among decision makers in Canadian healthcare organizations: the traditional decision maker, the innovative decision maker, the technologic decision maker and the contemporary decision maker. We found out that classic factors act as barriers to the shift from one profile to the desired profile (from 1 to 4, from 2 to 4 and from 3 to 4). We have identified that the attitude toward research and relational capital are transversal barriers of shift. We have also found that some factors have a specific impact such as

  18. 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

    OBJECTIVE: To study the associations between active choice of primary care provider and healthcare utilization, multimorbidity, age, and sex, comparing data from primary care and all healthcare in a Swedish population. DESIGN: Descriptive cross-sectional study using descriptive analyses including t...

  19. Physical Health, Medication, and Healthcare Utilization among 70-Year-Old People with Schizophrenia

    DEFF Research Database (Denmark)

    Brink, Maria; Green, Anders; Bojesen, Anders Bo

    2017-01-01

    OBJECTIVES: In light of the excess early mortality in schizophrenia, mainly due to physical illnesses, we investigated medical comorbidity, use of medication, and healthcare utilization among individuals with schizophrenia who survived into older ages to uncover potential factors contributing...

  20. Migrants' utilization of somatic healthcare services in Europe - a systematic review

    DEFF Research Database (Denmark)

    Nørredam, Marie Louise; Nielsen, Signe Smith; Krasnik, Allan

    2010-01-01

    Background: Utilization of services is an important aspect of migrants' access to healthcare. The aim was to review the European literature on utilization of somatic healthcare services related to screening, general practitioner, specialist, emergency room and hospital by adult first......-generation migrants. Our study question was: ‘Are there differences in migrants' utilization of somatic healthcare services compared to non-migrants?' Methods: Publications were identified by a systematic search of PUBMED and EMBASE. Appropriateness of the studies was judged independently by two researchers based...... on the abstracts. Additional searches were conducted via the references of the selected articles. The final number of studies included was 21. Results: The results suggested a diverging picture regarding utilization of somatic healthcare services by migrants compared to non-migrants in Europe. Overall, migrants...

  1. Migrants' utilization of somatic healthcare services in Europe - a systematic review

    DEFF Research Database (Denmark)

    Nørredam, Marie Louise; Nielsen, Signe Smith; Krasnik, Allan

    2010-01-01

    -generation migrants. Our study question was: ‘Are there differences in migrants' utilization of somatic healthcare services compared to non-migrants?' Methods: Publications were identified by a systematic search of PUBMED and EMBASE. Appropriateness of the studies was judged independently by two researchers based......Background: Utilization of services is an important aspect of migrants' access to healthcare. The aim was to review the European literature on utilization of somatic healthcare services related to screening, general practitioner, specialist, emergency room and hospital by adult first...... on the abstracts. Additional searches were conducted via the references of the selected articles. The final number of studies included was 21. Results: The results suggested a diverging picture regarding utilization of somatic healthcare services by migrants compared to non-migrants in Europe. Overall, migrants...

  2. Women’s autonomy and maternal healthcare service utilization in Ethiopia

    OpenAIRE

    Fentanesh Nibret Tiruneh; Kun-Yang Chuang; Ying-Chih Chuang

    2017-01-01

    Background Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women’s autonomy. We assessed whether women’s autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. Methods We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively) for measuring women’s...

  3. Inequality in the Utilization of Maternal Healthcare Services in Odisha, India

    Directory of Open Access Journals (Sweden)

    Ranjan Kumar Prusty

    2015-01-01

    Full Text Available Odisha, one of the socioeconomically disadvantaged states of India, registers high maternal deaths. The state features wide regional and sociodemographic diversity with the Koraput-Balangir-Kalahandi (KBK districts, dominated by disadvantaged tribal population. This study aims to assess the level and pattern of maternal healthcare services utilization among different subgroups of women in Odisha with a special focus on the regional, economic, and educational inequality using the latest District Level Household and Facility Survey (DLHS-III, 2007-08. Descriptive statistics and bivariate and multivariate analysis were used to understand the pattern of utilization of maternal healthcare services among women by different background characteristics. Concentration curve and decomposition analysis were used to understand the inequalities in utilization of maternal healthcare services and contribution of different socioeconomic factors. Results reveal wide regional variation in the utilization of maternal healthcare services. The utilization of maternal healthcare services is more concentrated among affluent households. Economic inequality in safe delivery is high. Decomposition analysis shows education as the leading contributor in explaining maternal healthcare services utilization. Enhancing literacy among women and improving of health infrastructure and its quality in rural and disadvantaged regions may be prioritized to improve the maternal health in Odisha.

  4. Utilization of mathematics amongst healthcare students towards problem solving during their occupational safety health internship

    Science.gov (United States)

    Umasenan a/l Thanikasalam

    2017-05-01

    Occupational safety health is a multidisciplinary discipline concentrating on the safety, health and welfare of workers in the working place. Healthcare Students undergoing Occupational Safety Health internships are required to apply mathematical in areas such as safety legislation, safety behavior, ergonomics, chemical safety, OSH practices, industrial hygiene, risk management and safety health practices as problem solving. The aim of this paper is to investigate the level of mathematics and logic utilization from these students during their internship looking at areas of Hazard identification, Determining the population exposed to the hazard, Assessing the risk of the exposure to the hazards and Taking preventive and control. A total of 142 returning healthcare students from their Occupational Safety Health, internship were given a questionnaire to measure their perceptions towards mathematical and logic utilization. The overall results indicated a strong positive skewed result towards the use of Mathematics during their internship. The findings showed that mathematics were well delivered by the students during their internship. Mathematics could not be separated from OSH practice as a needed precision in quantifying safety, health an d welfare of workers in addition to empiricism.

  5. Utilize common criteria methodology for secure ubiquitous healthcare environment.

    Science.gov (United States)

    Yu, Yao-Chang; Hou, Ting-Wei

    2012-06-01

    RFID technology is widely used in healthcare environments to ensure patient safety. Therefore, the testing of RFID tags, such as performance tests and security evaluations, is necessary to ensure inter-operational functional compatibility with standards. A survey of the literature shows that while standards that are around RFID performance tests have been addressed, but the same is not true for security evaluations. Therefore, in this paper, we introduce the Common Criteria security evaluation methodology, also known as ISO/IEC 15408, for the security evaluation of RFID tags and propose a framework as a minimal requirement for RFID tags to improve security assurance.

  6. Mobile healthcare information management utilizing Cloud Computing and Android OS.

    Science.gov (United States)

    Doukas, Charalampos; Pliakas, Thomas; Maglogiannis, Ilias

    2010-01-01

    Cloud Computing provides functionality for managing information data in a distributed, ubiquitous and pervasive manner supporting several platforms, systems and applications. This work presents the implementation of a mobile system that enables electronic healthcare data storage, update and retrieval using Cloud Computing. The mobile application is developed using Google's Android operating system and provides management of patient health records and medical images (supporting DICOM format and JPEG2000 coding). The developed system has been evaluated using the Amazon's S3 cloud service. This article summarizes the implementation details and presents initial results of the system in practice.

  7. The Impact of Patient Complexity on Healthcare Utilization

    Science.gov (United States)

    2017-10-27

    Primary Care Quality Metrics; Well Child Visits in First 15 Months of Life NQF 1392; Diabetes Mellitus NQF 0059; Colorectal Cancer Screening NQF 0034; Emergency Department Utilization; Alcohol and Drug Screening

  8. Healthcare workers' behaviors and personal determinants associated with providing adequate sexual and reproductive healthcare services in sub-Saharan Africa: a systematic review.

    Science.gov (United States)

    Jonas, Kim; Crutzen, Rik; van den Borne, Bart; Reddy, Priscilla

    2017-03-13

    Healthcare workers may affect the utilization of sexual and reproductive healthcare (SRH) services, and quality of care thereof, for example by their behaviours or attitudes they hold. This can become a hindrance to accessing and utilizing SRH services, particularly by young people, and thus a better understanding of these behaviours and associated factors is needed to improve access to and utilization of SRH services. A systematic review of literature was conducted to identify studies focusing on healthcare workers' behaviors and personal determinants associated with providing adequate SRH services in sub-Saharan Africa (January 1990 - October 2015). Five databases were searched until 30th October 2015, using a search strategy that was adapted based on the technical requirements of each specific database. Articles were independently screened for eligibility by two researchers. Of the 125-screened full-text articles, 35 studies met all the inclusion criteria. Negative behaviours and attitudes of healthcare workers, as well as other personal determinants, such as poor knowledge and skills of SRH services, and related factors, like availability of essential drugs and equipment are associated with provision of inadequate SRH services. Some healthcare workers still have negative attitudes towards young people using contraceptives and are more likely to limit access to and utilization of SRH by adolescents especially. Knowledge of and implementation of specific SRH components are below optimum levels according to the WHO recommended guidelines. Healthcare workers' negative behaviours and attitudes are unlikely to encourage women in general to access and utilize SRH services, but more specifically young women. Knowledge of SRH services, including basic emergency obstetric care (EmOC) is insufficient among healthcare workers in SSA. A protocol for this systematic review was registered with PROSPERO and the registration number is: CRD42015017509 .

  9. Beyond metrics? Utilizing 'soft intelligence' for healthcare quality and safety.

    Science.gov (United States)

    Martin, Graham P; McKee, Lorna; Dixon-Woods, Mary

    2015-10-01

    Formal metrics for monitoring the quality and safety of healthcare have a valuable role, but may not, by themselves, yield full insight into the range of fallibilities in organizations. 'Soft intelligence' is usefully understood as the processes and behaviours associated with seeking and interpreting soft data-of the kind that evade easy capture, straightforward classification and simple quantification-to produce forms of knowledge that can provide the basis for intervention. With the aim of examining current and potential practice in relation to soft intelligence, we conducted and analysed 107 in-depth qualitative interviews with senior leaders, including managers and clinicians, involved in healthcare quality and safety in the English National Health Service. We found that participants were in little doubt about the value of softer forms of data, especially for their role in revealing troubling issues that might be obscured by conventional metrics. Their struggles lay in how to access softer data and turn them into a useful form of knowing. Some of the dominant approaches they used risked replicating the limitations of hard, quantitative data. They relied on processes of aggregation and triangulation that prioritised reliability, or on instrumental use of soft data to animate the metrics. The unpredictable, untameable, spontaneous quality of soft data could be lost in efforts to systematize their collection and interpretation to render them more tractable. A more challenging but potentially rewarding approach involved processes and behaviours aimed at disrupting taken-for-granted assumptions about quality, safety, and organizational performance. This approach, which explicitly values the seeking out and the hearing of multiple voices, is consistent with conceptual frameworks of organizational sensemaking and dialogical understandings of knowledge. Using soft intelligence this way can be challenging and discomfiting, but may offer a critical defence against the

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

    Science.gov (United States)

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

    2018-01-01

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

  11. utilization of Western and Traditional healthcare services by farm

    African Journals Online (AJOL)

    PLOUGHMAN

    Agriculture is the main trust of National survival, employment and food in development countries like Nigeria. Ben, (2012) posits that ... its potential users. The questions remain, which of the traditional and orthodox Western health care services do farm families consider to be functional? How many farm families are utilizing.

  12. Determinants of patient loyalty to healthcare providers: An integrative review.

    Science.gov (United States)

    Zhou, Wei-Jiao; Wan, Qiao-Qin; Liu, Cong-Ying; Feng, Xiao-Lin; Shang, Shao-Mei

    2017-08-01

    Patient loyalty is key to business success for healthcare providers and also for patient health outcomes. This study aims to identify determinants influencing patient loyalty to healthcare providers and propose an integrative conceptual model of the influencing factors. PubMed, CINAHL, OVID, ProQuest and Elsevier Science Direct databases were searched. Publications about determinants of patient loyalty to health providers were screened, and 13 articles were included. Date of publication, location of the research, sample details, objectives and findings/conclusions were extracted for 13 articles. Thirteen studies explored eight determinants: satisfaction, quality, value, hospital brand image, trust, commitment, organizational citizenship behavior and customer complaints. The integrated conceptual model comprising all the determinants demonstrated the significant positive direct impact of quality on satisfaction and value, satisfaction on trust and commitment, trust on commitment and loyalty, and brand image on quality and loyalty. This review identifies and models the determinants of patient loyalty to healthcare providers. Further studies are needed to explore the influence of trust, commitment, and switching barriers on patient loyalty. © The Author 2017. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com

  13. The impact of healthcare-associated methicillin-resistant Staphylococcus aureus infections on post-discharge healthcare costs and utilization.

    Science.gov (United States)

    Nelson, Richard E; Jones, Makoto; Liu, Chuan-Fen; Samore, Matthew H; Evans, Martin E; Graves, Nicholas; Lee, Bruce; Rubin, Michael A

    2015-05-01

    Healthcare-associated methicillin-resistant Staphylococcus aureus (MRSA) infections are a major cause of morbidity, mortality, and cost among hospitalized patients. Little is known about their impact on post-discharge resource utilization. The purpose of this study was to estimate post-discharge healthcare costs and utilization attributable to positive MRSA cultures during a hospitalization. Our study cohort consisted of patients with an inpatient admission lasting longer than 48 hours within the US Department of Veterans Affairs (VA) system between October 1, 2007, and November 30, 2010. Of these patients, we identified those with a positive MRSA culture from microbiology reports in the VA electronic medical record. We used propensity score matching and multivariable regression models to assess the impact of positive culture on post-discharge outpatient, inpatient, and pharmacy costs and utilization in the 365 days following discharge. Our full cohort included 369,743 inpatients, of whom, 3,599 (1.0%) had positive MRSA cultures. Our final analysis sample included 3,592 matched patients with and without positive cultures. We found that, in the 12 months following hospital discharge, having a positive culture resulted in increases in post-discharge pharmacy costs ($776, Prisk of a readmission (odds ratio [OR]=1.396, Phealthcare cost and utilization. These findings indicate that financial benefits resulting from infection prevention efforts may extend beyond the initial hospital stay.

  14. Health insurance coverage and healthcare utilization among homeless young adults in Venice, CA.

    Science.gov (United States)

    Winetrobe, H; Rice, E; Rhoades, H; Milburn, N

    2016-03-01

    Homeless young adults are a vulnerable population with great healthcare needs. Under the Affordable Care Act, homeless young adults are eligible for Medicaid, in some states, including California. This study assesses homeless young adults' health insurance coverage and healthcare utilization prior to Medicaid expansion. All homeless young adults accessing services at a drop-in center in Venice, CA, were invited to complete a self-administered questionnaire; 70% of eligible clients participated (n = 125). Within this majority White, heterosexual, male sample, 70% of homeless young adults did not have health insurance in the prior year, and 39% reported their last healthcare visit was at an emergency room. Past year unmet healthcare needs were reported by 31%, and financial cost was the main reported barrier to receiving care. Multivariable logistic regression found that homeless young adults with health insurance were almost 11 times more likely to report past year healthcare utilization. Health insurance coverage is the sole variable significantly associated with healthcare utilization among homeless young adults, underlining the importance of insurance coverage within this vulnerable population. Service providers can play an important role by assisting homeless young adults with insurance applications and facilitating connections with regular sources of health care. © The Author 2015. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  15. Effects of women's autonomy on maternal healthcare utilization in Bangladesh: Evidence from a national survey.

    Science.gov (United States)

    Haider, Mohammad Rifat; Qureshi, Zaina P; Khan, M Mahmud

    2017-12-01

    This study aims to construct an index of women's autonomy to analyze its effect on maternal healthcare utilization in Bangladesh. Empirical modeling of the study used instrumental variable (IV) approach to correct for possible endogeneity of women's autonomy variable. Data from the Bangladesh Demographic and Health Survey (BDHS) 2011 was used for the study. Women's autonomy variable was obtained through factor analysis of variables related to autonomy in decision making regarding healthcare, financial autonomy and freedom of movement. Conditional mixed process (CMP) models were fitted for three maternal healthcare indicators: at least four antenatal care (ANC) by trained personnel, institutional delivery and postnatal care (PNC) by trained personnel. Study sample consisted of 8753 women with 5.5 mean years of schooling. Women with no formal education, of Islamic faith, from poorest wealth quintile, residing in rural areas and with low autonomy used the maternal healthcare least. Marginal effect shows that if women's autonomy score is increased by one unit, probability of maternal healthcare utilization will increase by 0.14 for ANC, 0.14 for institutional delivery, and 0.13 for PNC. Women's autonomy is an important driver of maternal healthcare utilization in Bangladesh. Results suggest that women participating in social and economic activities enhances their autonomy. Other factors affecting women's autonomy are female literacy, educational attainment and households' economic status. Copyright © 2017 Elsevier B.V. All rights reserved.

  16. Healthcare utilization and costs in primary care patients with dementia: baseline results of the DelpHi-trial.

    Science.gov (United States)

    Michalowsky, Bernhard; Flessa, Steffen; Eichler, Tilly; Hertel, Johannes; Dreier, Adina; Zwingmann, Ina; Wucherer, Diana; Rau, Henriette; Thyrian, Jochen René; Hoffmann, Wolfgang

    2018-01-01

    The objectives of this cross-sectional analysis were to determine healthcare resource utilization and cost for community-dwelling patients with dementia (PWD) from a payer's and societal perspective, and to analyze the associations between costs and sociodemographic and clinical variables. Analysis of healthcare costs from a payer's perspective was based on a sample of 425 PWD, analysis of healthcare costs from societal perspective on a subsample of 254 PWD and their informal caregivers. Frequency of healthcare resource utilization was assessed by means of questionnaires. Informal care and productivity losses were assessed by using the Resource Utilization in Dementia questionnaire (RUD). Costs were monetarized using standardized unit costs. To analyze the associations, multiple linear regression models were used. Total annual costs per PWD valued 7016€ from a payer's and 25,877€ from a societal perspective, meaning that societal cost is approximately three and a half times as much as payer's expenditures. Costs valuated 5456 € for medical treatments, 1559 € for formal care, 18,327€ for informal care. Productivity losses valued 1297€ for PWD caregivers. Informal care could vary substantially (-21%; +33%) concerning different valuation methods. Medical care costs decreased significantly with progression of dementia and with age. Costs of care double over the stages of dementia. Formal care costs were significantly higher for PWD living alone and informal care costs significantly lower for PWD with an employed caregiver. For all cost categories, deficits in daily living activities were major cost drivers.

  17. Determinants of conventional health service utilization among ...

    African Journals Online (AJOL)

    Objective: To assess the determinants of conventional health care utilization among pastoralist communities in northeast Ethiopia. Methods: The study employed a cross-sectional household survey conducted using structured questionnaires administered among 276 mobile and 262 settled subjects within the pastoral area.

  18. Analysis of outpatient healthcare utilization in the context of the universal healthcare coverage reform in Mexico.

    Directory of Open Access Journals (Sweden)

    Sergio Bautista-Arredondo

    2014-01-01

    Full Text Available Objective. Understand and quantify the relationship between socio-economic and health insurance profiles and the use of outpatient medical services in the context of universal health care in Mexico. Materials and methods. Using ENSANUT 2012 multinomial regression models were estimated to analyze the use of outpatient services and associated factors. Results. Population with greater poverty levels, lower educational level and living in highly marginalized areas have lower odds to use outpatient health services. In contrast, health insurance and higher income increase the odds to use health services and influence the choice of provider. Conclusions. Barriers to access to health care related to poverty and social protection persist. However, there is space to lower the effect of these barriers by addressing constraints linked to the supply and the perceived quality of healthcare services.

  19. [Analysis of outpatient healthcare utilization in the context of the universal healthcare coverage reform in Mexico].

    Science.gov (United States)

    Bautista-Arredondo, Sergio; Serván-Mori, Edson; Colchero, M Arantxa; Ramírez-Rodríguez, Baruch; Sosa-Rubí, Sandra G

    2014-01-01

    Understand and quantify the relationship between socio-economic and health insurance profiles and the use of outpatient medical services in the context of universal health care in Mexico. Using ENSANUT 2012 multinomial regression models were estimated to analyze the use of outpatient services and associated factors. Population with greater poverty levels, lower educational level and living in highly marginalized areas have lower odds to use outpatient health services. In contrast, health insurance and higher income increase the odds to use health services and influence the choice of provider. Barriers to access to health care related to poverty and social protection persist. However, there is space to lower the effect of these barriers by addressing constraints linked to the supply and the perceived quality of healthcare services.

  20. Determinants of healthcare provider recommendations for influenza vaccinations

    OpenAIRE

    Villacorta, Reginald; Sood, Neeraj

    2015-01-01

    Objective: Investigate determinants of receiving healthcare provider (HCP) recommendations for seasonal and H1N1 influenza vaccinations. Methods: Using a United States national sample of adults 18+ from the National 2009 H1N1 Flu Survey, multivariate regression models estimated the likelihood of receiving a HCP recommendation. Covariates included demographics, socioeconomic status, and Advisory Committee on Immunization Practices (ACIP) priority groups. Results: Adults age 55–64 and 65+...

  1. The relationship between health literacy with health status and healthcare utilization in 18-64 years old people in Isfahan.

    Science.gov (United States)

    Karimi, Saeed; Keyvanara, Mahmoud; Hosseini, Mohsen; Jazi, Marzie Jafarian; Khorasani, Elahe

    2014-01-01

    Today, much attention has been paid to the patient role as the central factor in the management of their own health. It is focused on the issue that the patient has a more critical role compared with the health-care provider in controlling the patient own health. defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The objective of this study was to determine health literacy, health status, healthcare utilization and the relationship between them in 18 - 64 years old people in Isfahan. This study was a descriptive analytical survey, which was conducted on 300 subjects of 18-64 years old in Isfahan with Multi-stage sampling method proportional to selected sample size. For collecting the data, questionnaire adapted from CHAP (Consumer Assessment of Healthcare Providers and Systems) health literacy questionnaire was used. Health status was measured based on an assessment of the physical and mental health over the past 6 months by 5° Likert scale. Data analysis was performed by using SPSS 18, descriptive statistics, Chi-square test and multivariate analysis of variance. There was no significant correlation between health literacy, health status and healthcare utilization. Utilization was less in the urban area No. 6 of the city. In the bachelor's degree group, the health status was lower than the other groups in these cases: Older ages, married, women, large family size, undergraduates, and urban area No. 14. Due to the average prevalence of health literacy in 18-64 years old individuals in Isfahan and low- healthcare utilization, the followings are recommended: Necessity of more attention to the issue of health literacy, improving the physician-patient relationship and community awareness, whether through health promotion programs or media for the optimum use of available resources.

  2. Association of obesity with healthcare resource utilization and costs in a commercial population.

    Science.gov (United States)

    Kamble, Pravin S; Hayden, Jennifer; Collins, Jenna; Harvey, Raymond A; Suehs, Brandon; Renda, Andrew; Hammer, Mette; Huang, Joanna; Bouchard, Jonathan

    2018-04-12

    To examine the association of obesity with healthcare resource utilization (HRU) and costs among commercially insured individuals. This retrospective observational cohort study used insured individuals' administrative claims from 1/1/2007 to 12/1/2013. The ICD-9-CM status codes (V85 hierarchy) from 2008 to 2012 classified body mass index (BMI) into the World Health Organizations' BMI categories. The date of first observed BMI code was defined as the index date and continuous eligibility for one year pre- and post- index date was ensured. Post-index claims determined individuals' HRU and costs. Sampling weights developed using the entropy balance method and National Health and Nutrition Examination Survey data ensured representation of the U.S. adult commercially insured population. Baseline characteristics were described across BMI classes and associations between BMI categories, and outcomes were examined using multivariable regression. The cohort included 9,651 individuals with BMI V85 codes. After weighting, the BMI distribution was: normal (31.1%), overweight (33.4%), obese class I (22.0%), obese class II (8.1%), and obese class III (5.4%). Increasing BMI was associated with greater prevalence of cardiometabolic conditions, including hypertension, type 2 diabetes, and metabolic syndrome. The use of antihypertensives, antihyperlipidemics, antidiabetics, analgesics, and antidepressants rose with increasing BMI. Greater BMI level was associated with increased inpatient, emergency department, and outpatient utilization and higher total healthcare, medical, and pharmacy costs. Increasing BMI was associated with higher prevalence of cardiometabolic conditions and higher HRU and costs. There is urgent need to address the epidemic of obesity and its clinical and economic impacts.

  3. Demographic, Operational, and Healthcare Utilization Factors Associated with Emergency Department Patient Satisfaction

    Science.gov (United States)

    Morgan, Matthew W.; Salzman, Joshua G.; LeFevere, Robert C.; Thomas, Avis J.; Isenberger, Kurt M.

    2015-01-01

    Introduction The primary aim of this study was to determine which objectively-measured patient demographics, emergency department (ED) operational characteristics, and healthcare utilization frequencies (care factors) were associated with patient satisfaction ratings obtained from phone surveys conducted by a third-party vendor for patients discharged from our ED. Methods This is a retrospective, observational analysis of data obtained between September 2011 and August 2012 from all English- and Spanish-speaking patients discharged from our ED who were contacted by a third-party patient satisfaction vendor to complete a standardized nine-item telephone survey by a trained phone surveyor. We linked data from completed surveys to the patient’s electronic medical record to abstract additional demographic, ED operational, and healthcare utilization data. We used univariate ordinal logistic regression, followed by two multivariate models, to identify significant predictors of patient satisfaction. Results We included 20,940 patients for analysis. The overall patient satisfaction ratings were as follows: 1=471 (2%); 2=558 (3%); 3=2,014 (10%), 4=5,347 (26%); 5=12,550 (60%). Factors associated with higher satisfaction included race/ethnicity (Non-Hispanic Black; Hispanic patients), age (patients ≥65), insurance (Medicare), mode of arrival (arrived by bus or on foot), and having a medication ordered in the ED. Patients who felt their medical condition did not improve, those treated in our ED behavioral health area, and those experiencing longer wait times had reduced satisfaction. Conclusion These findings provide a basis for development and evaluation of targeted interventions that could be used to improve patient satisfaction in our ED. PMID:26265963

  4. Women’s autonomy and maternal healthcare service utilization in Ethiopia

    Directory of Open Access Journals (Sweden)

    Fentanesh Nibret Tiruneh

    2017-11-01

    Full Text Available Abstract Background Most previous studies on healthcare service utilization in low-income countries have not used a multilevel study design to address the importance of community-level women’s autonomy. We assessed whether women’s autonomy, measured at both individual and community levels, is associated with maternal healthcare service utilization in Ethiopia. Methods We analyzed data from the 2005 and 2011 Ethiopia Demographic and Health Surveys (N = 6058 and 7043, respectively for measuring women’s decision-making power and permissive gender norms associated with wife beating. We used Spearman’s correlation and the chi-squared test for bivariate analyses and constructed generalized estimating equation logistic regression models to analyze the associations between women’s autonomy indicators and maternal healthcare service utilization with control for other socioeconomic characteristics. Results Our multivariate analysis showed that women living in communities with a higher percentage of opposing attitudes toward wife beating were more likely to use all three types of maternal healthcare services in 2011 (adjusted odds ratios = 1.21, 1.23, and 1.18 for four or more antenatal care visits, health facility delivery, and postnatal care visits, respectively. In 2005, the adjusted odds ratios were 1.16 and 1.17 for four or more antenatal care visits and health facility delivery, respectively. In 2011, the percentage of women in the community with high decision-making power was positively associated with the likelihood of four or more antenatal care visits (adjusted odds ratio = 1.14. The association of individual-level autonomy on maternal healthcare service utilization was less profound after we controlled for other individual-level and community-level characteristics. Conclusions Our study shows that women’s autonomy was positively associated with maternal healthcare service utilization in Ethiopia. We suggest addressing woman

  5. Tolerability and Healthcare Utilization in Maintenance Hemodialysis Patients Undergoing Treatment for Tuberculosis-Related Conditions.

    Science.gov (United States)

    Hamadah, Abdurrahman M; Beaulieu, Lynn M; Wilson, John W; Aksamit, Timothy R; Gregoire, James R; Williams, Amy W; Dillon, John J; Albright, Robert C; Onuigbo, Macaulay; Iyer, Venkateshwaran K; Hickson, LaTonya J

    2016-01-01

    The incidence of tuberculosis (TB) in end-stage renal disease is significantly higher than that in the general population. Among those with kidney dysfunction, anti-TB treatment is associated with increased side effects, but the effect on healthcare utilization is unknown. Methods/Aim: To assess patient-reported symptoms, adverse effects and describe changes in healthcare utilization patterns during treatment for TB, we conducted a case series (n = 12) of patients receiving maintenance hemodialysis (HD) from Mayo Clinic Dialysis Services and concurrent drug therapy for TB from January 2002 through May 2014. Healthcare utilization (hospitalizations and emergency department (ED) visits independent of hospital admission) was compared before and during treatment. Patients were treated for latent (n = 7) or active (n = 5) TB. The majority of patients with latent disease were treated with isoniazid (n = 5, 71%), while active-disease patients received a 4-drug regimen. Adverse effects were reported in 83% of patients. Compared to measurements prior to drug initiation, serum albumin and dialysis weights were similar at 3 months. Commonly reported anti-TB drug toxicities were described. More than half (58%) of the patients were hospitalized at least once. No ED or hospital admissions occurred in the period prior to drug therapy, but healthcare utilization increased during treatment in the latent disease group (hospitalization rate per person-month: pre 0 vs. post 1). Among HD patients, anti-TB therapy is associated with frequently reported symptoms and increased healthcare utilization. Among this subset, patients receiving treatment for latent disease may be those with greatest increase in healthcare use. Careful monitoring and early complication detection may help optimize medication adherence and minimize hospitalizations. © 2016 S. Karger AG, Basel.

  6. Healthcare Utilization by Older Age Groups in Northern States of Peninsular Malaysia: The Role of Predisposing, Enabling and Need Factors.

    Science.gov (United States)

    Samsudin, Shamzaeffa; Abdullah, Norehan

    2017-06-01

    Determining factors that affect healthcare utilization by the elderly is vital for the health system to be more responsive in providing care to this vulnerable group. The main objective of this paper is to identify the effect of the predisposing, enabling, and need factors on doctor visits and in-patient care for the elderly residing in the northern region of Malaysia. A multistage cluster sampling was used in selecting the sample for the study. A total of 1414 respondents aged 60 and over were interviewed face-to-face using a structured questionnaire. A probit model was used in estimating the utilization equations. At a significance level of 0.05, except for age, all predisposing and enabling factors were not statistically significant in affecting the doctor visits. On the other hand, being a male, smoker, medical insurance holder or had not actively involved in social interaction within the reference period increases the likelihood of being in-patient. Health-related variables remain the most significant factors that determine healthcare utilization, including both doctor visits and in-patient stays, in the area of study, which suggests that government policies to improve population health may influence the level of healthcare use in the future.

  7. Determinants of Maternity Care Services Utilization among Married Adolescents in Rural India

    Science.gov (United States)

    Singh, Prashant Kumar; Rai, Rajesh Kumar; Alagarajan, Manoj; Singh, Lucky

    2012-01-01

    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 targeting household

  8. Nationwide Healthcare utilization among children with epilepsy in the United States: 2003-2014.

    Science.gov (United States)

    Lekoubou, Alain; Bishu, Kinfe G; Ovbiagele, Bruce

    2018-02-27

    Epilepsy is particularly frequent among children, yet updated and nationwide healthcare utilization estimates are scanty in the United States. To analyze healthcare utilization among children with epilepsy. Data on children (≤17-year-old) were extracted from the Medical Expenditure Panel Survey (MEPS) 2003-2014. Epilepsy was identified using the clinical classification code 83. Healthcare utilization (Inpatient admission, outpatient visits, prescription medication including refill, emergency room visits, and home health provider visits) was compared between children with epilepsy and those without epilepsy. A negative binomial model was used to assess the relationship between epilepsy and healthcare utilizations accounting for the influence of extraneous factors. In all, a weighted 457,873 children (0.84%) had epilepsy in United States. The unadjusted proportion and the mean annual number of health care service utilization were higher in children with epilepsy compared to those without epilepsy. Children with epilepsy had almost 3.3 more outpatient visits (95% CI: 2.281-4.274), 7.9 more medication prescriptions including refills (95% CI: 6.058-9.662), nearly 0.4 more emergency department visits (95% CI: 0.278-0.438) and nearly 12 more home health provider visits (95% CI: 1.988-21.756) than those without epilepsy. The adjusted marginal effect of epilepsy on inpatient admission was not statistically significant. unadjusted and adjusted healthcare utilization is considerably higher in children with epilepsy compared to those without epilepsy in the United States with heterogeneity across individual services. Copyright © 2018 Elsevier B.V. All rights reserved.

  9. Home supply of emergency oral steroids and reduction in asthma healthcare utilization.

    Science.gov (United States)

    Sarzynski, Lisa M; Turner, Tiffany; Stukus, David R; Allen, Elizabeth

    2017-12-01

    To determine if children with moderate-to-severe persistent asthma have decreased healthcare utilization after receiving a prescription and instructions to use an at home emergency supply of oral steroids during asthma exacerbations. A quasi-experimental design study with a historical control from retrospective chart review was performed for patients aged 2-18 years seen in a tertiary care pediatric pulmonary clinic for moderate to severe persistent asthma. Baseline utilization of the emergency department, inpatient hospital, and pediatric intensive care unit for asthma exacerbations was collected from 24 months prior to initial prescription for at home steroids and compared with 12 months post-intervention using Poisson Regression. A subgroup analysis was performed for ages 6-18 evaluating school age children alone. Patients (N = 132) were averaged 10 years ± 3.9 years of age and 57% of patients were male. Emergency Department visit rates significantly declined in the 12 months after receiving a prescription and instructions for home emergency steroid supply compared with the 12 months prior to this intervention (0.39 visits/patient/year vs 0.67, P steroids into the home management plan of children with moderate-to-severe asthma can reduce asthma related Emergency Department visits. © 2017 Wiley Periodicals, Inc.

  10. Utilization of healthcare services and renewal of health insurance membership : evidence of adverse selection in Ghana

    NARCIS (Netherlands)

    Duku, Stephen Kwasi Opoku; Asenso-Boadi, Francis; Nketiah-Amponsah, Edward; Arhinful, Daniel Kojo

    2016-01-01

    Background: Utilization of healthcare in Ghana’s novel National Health Insurance Scheme (NHIS) has been increasing since inception with associated high claims bill which threatens the scheme’s financial sustainability. This paper investigates the presence of adverse selection by assessing the effect

  11. Temporal trends in healthcare utilization following primary melanoma diagnosis among Medicare beneficiaries.

    Science.gov (United States)

    Lott, J P; Wang, Q; Titus, L J; Onega, T; Nelson, H D; Weinstock, M A; Elmore, J G; Tosteson, A N A

    2017-09-01

    Little is known about the impact of primary melanoma diagnosis on healthcare utilization and changes in utilization over time. To evaluate population-based temporal trends in healthcare utilization following primary melanoma diagnosis. We conducted a before-and-after multiple time series study of Medicare beneficiaries aged ≥ 66 years with primary melanoma diagnoses between 2000 and 2009 using the Surveillance, Epidemiology, and End Results Medicare database. Primary exposure was time from primary melanoma diagnosis at 3-6 months and 6-24 months postdiagnosis. Covariates included tumour-, patient- and geographical-level characteristics and healthcare utilization in the 6 months before diagnosis. Poisson regression was used to estimate population-based risk-adjusted utilization rates for skin biopsies, benign skin excisions, internal medicine office visits and dermatology office visits. The study population included 56 254 patients with first diagnoses of primary melanoma. Most patients were ≥ 75 years old (56·8%), male (62·1%), and had in situ melanoma (42·4%) or localized invasive melanoma (45·9%). From 2000 to 2009, risk-adjusted skin biopsy rates 24 months postdiagnosis increased from 358·3 to 541·3 per 1000 person-years (P Trends in dermatology visits were similar. Utilization of skin biopsies and dermatology office visits following primary melanoma diagnosis has increased substantially over time. These results may inform optimization of care delivery for melanoma within the Medicare population. © 2017 British Association of Dermatologists.

  12. Increased healthcare service utilizations for patients with dementia: a population-based study.

    Directory of Open Access Journals (Sweden)

    Shiu-Dong Chung

    Full Text Available BACKGROUND: The majority of previous studies investigating the health care utilization of people with dementia were conducted in Western societies. There is little information on the economic burden on the healthcare system attributable to dementia in Asian countries. This study thus investigated differences in utilization of healthcare services between subjects with and those without a diagnosis of dementia using Taiwan's National Health Insurance population-based database. METHODS: This study comprised 5,666 subjects with a dementia diagnosis and 5,666 age- and gender-matched comparison subjects without a dementia diagnosis. We individually followed each subject for a 1-year period starting from their index date to evaluate their healthcare resource utilization. Healthcare resource utilization included the number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatments. In addition, we divided healthcare resource utilization into psychiatric and non-psychiatric services. RESULTS: As for utilization of psychiatric services, subjects with a dementia diagnosis had significantly more outpatient visits (2.2 vs. 0.3, p<0.001 and significantly higher outpatient costs (US$124 vs. US$16, p<0.001 than comparison subjects. For non-psychiatric services, subjects with a dementia diagnosis also had significantly more outpatient visits (34.4 vs. 31.6, p<0.001 and significantly higher outpatient costs (US$1754 vs. US$1322, p<0.001 than comparison subjects. For all healthcare services, subjects with a dementia diagnosis had significantly more outpatient visits (36.7 vs. 32.0, p<0.001 and significantly higher outpatient costs (US$1878 vs. US$1338, p<0.001 than comparison subjects. Furthermore, the total cost was about 2-fold greater for subjects with a dementia diagnosis than for comparison subjects (US$3997 vs. US$2409, p<0.001. CONCLUSIONS: We concluded that subjects who had received a clinical dementia diagnosis had

  13. Obstructive sleep apnea is associated with higher healthcare utilization in elderly patients

    Directory of Open Access Journals (Sweden)

    Karla Diaz

    2014-01-01

    Full Text Available Background: Obstructive sleep apnea (OSA is an important cause of morbidity in the elderly population. Limited data are available regarding the healthcare utilization and predisposing conditions related to OSA in the elderly. Our aim was to evaluate the healthcare utilization and the conditions associated with new and chronic diagnosis of OSA in a large cohort of elderly patients in the Veterans Health Administration (VHA. Materials and Methods: This retrospective cohort study used inpatient and outpatient VHA data to identify the individuals diagnosed with OSA using ICD-9 codes during the fiscal years 2003-2005. Primary outcomes were emergency department (ED visits and hospitalizations. Multivariable logistic regression analysis was performed to identify the demographic and clinical characteristics associated with new and chronic diagnosis of OSA. Results: Of 1,867,876 elderly veterans having 2 years of care, 82,178 (4.4% were diagnosed with OSA. Individuals with OSA were younger and more likely to have chronic diseases than those without OSA. Individuals with chronic OSA were more likely to have diagnoses of congestive heart failure (CHF, pulmonary circulation disorders, COPD, and obesity and less likely to have diagnoses of hypertension, osteoarthritis, and stroke than individuals with newly diagnosed OSA. The proportion of patients with new OSA diagnosis who required at least one ED visit was higher than the proportion of chronic OSA and no OSA patients (37%, 32%, and 15%, respectively; P-value <0.05. The proportion of new OSA patients who required at least one hospitalization was also higher than the proportion of chronic OSA and no OSA patients (24%, 17%, and 7%, respectively; P-value <0.05. Conclusion: Patients with OSA had a higher incidence of healthcare utilization compared to patients without OSA. New OSA patients had a higher rate of healthcare utilization in the year of diagnosis compared to chronic patients and patients without OSA

  14. Perceptions regarding utilization of meteorological information in healthcare in Korea: a qualitative study.

    Science.gov (United States)

    Ock, Minsu; Choi, Eun Young; Oh, Inbo; Yun, Seok Hyeon; Kim, Yoo-Keun; Kim, Hyunsu; Jo, Min-Woo; Lee, Jiho

    2018-01-01

    Health forecasting has been used in an attempt to provide timely and tailored meteorological information to patients and healthcare providers so that they might take appropriate actions to mitigate health risks and manage healthcare-related needs. This study examined the in-depth perceptions of healthcare providers and the general public regarding the utilization of meteorological information in the healthcare system in Korea. The COREQ (Consolidated Criteria for Reporting Qualitative Research) checklist was applied to this study. We conducted three focus group discussions in accordance with semi-structured guidelines developed to deal with various aspects of the utilization of meteorological information in healthcare settings. The verbatim transcriptions and field notes were analyzed according to content analysis. Six physicians, four nurses, three emergency medical technicians, and seven members of the general public participated in the focus group discussions. There were some individual discrepancies among most participants regarding the health effects of climate change. Although several physician participants felt that meteorological information utilization is not a prime concern during patient care, most of the general public participants believed that it should be used in the patient care process. The provision of meteorological information to patients undergoing care is expected to not only improve the effective management of climate-sensitive diseases, but also boost rapport between healthcare providers and patients. More attempts should be made to provide meteorological information to groups vulnerable to climate change, and the effects of this information should be evaluated in terms of effectiveness and inequality. The findings of this study will be helpful in countries and institutions trying to introduce health forecasting services.

  15. Healthcare Barriers and Utilization Among Adolescents and Young Adults Accessing Services for Homeless and Runaway Youth.

    Science.gov (United States)

    Chelvakumar, Gayathri; Ford, Nancy; Kapa, Hillary M; Lange, Hannah L H; McRee, Annie-Laurie; Bonny, Andrea E

    2017-06-01

    Homeless and runaway youth are at disproportionate risk for adverse health outcomes. Many barriers to accessing healthcare have been documented; however, the relative impact of discrete barriers on homeless youth healthcare utilization behavior is not firmly established. We administered a survey examining reported barriers and healthcare utilization among adolescents and young adults accessing services at three community centers for homeless and runaway youth. Of 180 respondents, 57 % were male, 80 % non-White, and 21 % identified as a sexual minority. Stepwise logistic regression models, controlling for age and study site, explored associations between barriers and 3 healthcare utilization outcomes (doctor visit in past 12 months; regular care provider; frequent emergency department (ED) visits). The most commonly reported barriers were "don't have a ride" (27.2 %), "no insurance" (23.3 %), and "costs too much" (22.8 %). All fear-based barriers (e.g., "I don't trust the doctors") were reported by homeless and runaway youth as the impact of discrete barriers varies depending on outcome of focus.

  16. Cross-sector emergency planning for water supply utilities and healthcare facilities.

    Science.gov (United States)

    Welter, Gregory; Socher, Myra; Needham, Patricia; Bieber, Steve; Bonnaffon, Heidi

    2013-01-01

    The purpose of this article is to outline the criticality of water supply in sustained operations of healthcare facilities, particularly during community emergencies, and to advocate for enhanced cross-sector support from the water utilities in meeting this need. Information and ideas presented here were developed in the course of a regional project sponsored by the Metropolitan Washington Council of Governments (MWCOG) for development of emergency water supply operations plans for critical water uses in the Washington, DC, area. © 2013 American Society for Healthcare Risk Management of the American Hospital Association.

  17. Healthcare utilization in adults with opioid dependence receiving extended release naltrexone compared to treatment as usual.

    Science.gov (United States)

    Soares, William E; Wilson, Donna; Rathlev, Niels; Lee, Joshua D; Gordon, Michael; Nunes, Edward V; O'Brien, Charles P; Friedmann, Peter D

    2018-02-01

    Opioid use disorders have reached epidemic proportions, with overdose now the leading cause of accidental death in the United States. Extended release naltrexone (XR-NTX) has emerged as a medication treatment that reduces opioid use and craving. However, the effect of XR-NTX therapy on acute healthcare utilization, including emergency department visits and inpatient hospitalizations, remains uncertain. The objective of the current study is to evaluate hospital-based healthcare resource utilization in adults involved in the criminal justice system with a history of opioid use disorder randomized to XR-NTX therapy compared with treatment as usual (TAU) during a 6-month treatment phase and 12months post-treatment follow up. This retrospective exploratory analysis uses data collected in a published randomized trial. Comparisons of the number of emergency department visits and hospital admissions (for drug detox, psychiatric care and other medical reasons) were performed using chi square tests for any admission and negative binomial models for number of admissions. Of the 308 participants randomized, 96% had utilization data (76% complete 6months, 67% complete follow up). No significant differences were seen in overall healthcare utilization (IRR=0.88, 95%CI 0.63-1.23, p=0.45), or substance use-related drug detox hospitalizations (IRR=0.83, 95%CI 0.32-2.16, p=0.71). Despite having more participants report chronic medical problems at baseline (43% vs. 32%, p=0.05), those receiving XR-NTX generally experienced equivalent or lower rates of healthcare utilization compared to TAU. The XR-NTX group had significantly lower medical/surgical related hospital admissions (IRR=0.55, 95%CI 0.30-1.00, p=0.05) during the course of the entire study. XR-NTX did not significantly increase rates of healthcare utilization compared to TAU. Provider concerns regarding healthcare utilization should not preclude the consideration of XR-NTX as therapy for opioid use disorders. Copyright © 2018

  18. Greater healthcare utilization and costs among Black persons compared to White persons with aphasia in the North Carolina stroke belt.

    Science.gov (United States)

    Ellis, Charles; Hardy, Rose Y; Lindrooth, Richard C

    2017-05-15

    To examine racial differences in healthcare utilization and costs for persons with aphasia (PWA) being treated in acute care hospitals in North Carolina (NC). NC Healthcare Cost and Utilization Project State Inpatient Database (HCUP-SID) data from 2011-2012 were analyzed to examine healthcare utilization and costs of care for stroke patients with aphasia. Analyses emphasized length of stay, charges and cost of general hospital services. Generalized linear models (GLM) were constructed to determine the impact of demographic characteristics, stroke/illness severity, and observed hospital characteristics on utilization and costs. Hospital fixed effects were included to yield within-hospital estimates of disparities. GLM models demonstrated that Blacks with aphasia experienced 1.9days longer lengths of stay compared to Whites with aphasia after controlling for demographic characteristics, 1.4days controlling for stroke/illness severity, 1.2days controlling for observed hospital characteristics, and ~1 extra day controlling for unobserved hospital characteristics. Similarly, Blacks accrued ~$2047 greater total costs compared to Whites after controlling for demographic characteristics, $1659 controlling for stroke/illness severity, $1338 controlling for observed hospital characteristics, and ~$1311 greater total costs after controlling for unobserved hospital characteristics. In the acute hospital setting, Blacks with aphasia utilize greater hospital services during longer hospitalizations and at substantially higher costs in the state of NC. A substantial portion of the adjusted difference was related to the hospital treating the patient. However, even after controlling for the hospital, the differences remained clinically and statistically significant. Copyright © 2017 Elsevier B.V. All rights reserved.

  19. Factors associated with utilization of reproductive healthcare services among migrant women workers in Chong Qing, China.

    Science.gov (United States)

    Su, Shu; Zhang, Fan; Liu, Qin; Wang, Yang; Wen, Jing; Tang, Xiaojun; Zhang, Lei

    2014-10-01

    To investigate the use of reproductive healthcare services among migrant women workers in Chong Qing, China, and provide suggestions to improve the utilization of these services by young women. In a qualitative interview-based study between March, 2013 and June, 2013, personal in-depth interviews were conducted among young women workers, factory doctors, healthcare service providers, and policy-makers in Chong Qing, China. Women workers seldom visited hospitals and did so only when their pain became unbearable. The workers' use of reproductive healthcare services was particularly influenced by the high cost of hospitalization and long waiting periods. Factory doctors could only solve minor problems. Public healthcare providers stated that migrant women had a higher morbidity rate from reproductive tract infections as compared with local women. The policy-makers considered that the health system was beneficial to women's reproductive health; however, few workers had good comprehension of government policies. Migrant women workers are vulnerable owing to lack of reproductive health care. The government and both social and health enterprise should consider the convenience of these women and the affordability of treatments when formulating reproductive healthcare policies. Effective measures should be taken to improve the use of these services by migrant women workers. Copyright © 2014 International Federation of Gynecology and Obstetrics. Published by Elsevier Ireland Ltd. All rights reserved.

  20. Validity of Self-reported Healthcare Utilization Data in the Community Health Survey in Korea

    Science.gov (United States)

    Rim, Hwayoung; Lee, Kunsei; Chang, Sounghoon; Hovell, Melbourne F; Kim, Young-Taek; Kim, Yuna; Kang, Gilwon; Tak, Yangju; Im, Jeehye

    2011-01-01

    To evaluate the sensitivity and specificity of Community Health Survey (CHS), we analyzed data from 11,217 participants aged ≥ 19 yr, in 13 cities and counties in 2008. Three healthcare utilization indices (admission, outpatient visits, dental visits) as comparative variables and the insurance benefit claim data of the Health Insurance Review & Assessment Service as the gold-standard were used. The sensitivities of admission, outpatient visits, and dental visits in CHS were 54.8%, 52.1%, and 61.0%, respectively. The specificities were 96.4%, 85.6%, and 82.7%, respectively. This is the first study to evaluate the validity of nationwide health statistics resulting from questionnaire surveys and shows that CHS needs a lot of efforts to reflect the true health status, health behavior, and healthcare utilization of the population. PMID:22065895

  1. Sociodemographics, Comorbidities, Healthcare Utilization and Work Productivity in Japanese Patients with Adult ADHD

    OpenAIRE

    Kirino, Eiji; Imagawa, Hideyuki; Goto, Taro; Montgomery, William

    2015-01-01

    Objectives This study compared the sociodemographic characteristics, comorbidities, healthcare resource utilization, and work productivity among Japanese adults who reported being diagnosed with attention-deficit/hyperactivity disorder (ADHD) to those of a non-ADHD control population. Methods Data for this study were captured from an online survey of adults in Japan conducted by Kantar Health using consumer panels. A total of 84 survey participants reported they had received a diagnosis of AD...

  2. Healthcare utilization and costs in patients beginning pharmacotherapy for generalized anxiety disorder: a retrospective cohort study

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    Berger Ariel

    2011-12-01

    Full Text Available Abstract Background Patterns of healthcare utilization and costs in patients beginning pharmacotherapy for generalized anxiety disorder (GAD have not been well characterized. Methods Using a large US health insurance database, we identified all patients with evidence of GAD (ICD-9-CM diagnosis code 300.02 who initiated pharmacotherapy with medications commonly used to treat GAD (eg, selective serotonin reuptake inhibitors [SSRIs], venlafaxine, benzodiazepines between 1/1/2003 and 12/31/2007. We examined healthcare utilization and costs over the 12-month periods preceding and following date of initial receipt of such therapy ("pretreatment" and "follow-up", respectively. Patients with incomplete data were excluded. Results A total of 10,275 patients met all study inclusion criteria. Forty-eight percent of patients received SSRIs; 34%, benzodiazepines; and 6%, venlafaxine. SSRIs and venlafaxine were about three times more likely to be used on a long-term basis (> 90 days than benzodiazepines (p Conclusions More than one-half of patients initiating pharmacotherapy for GAD receive either SSRIs or venlafaxine. Levels of healthcare utilization and costs are greater in the year following initiation of therapy than in the immediately preceding one.

  3. Intra-urban differentials in the utilization of reproductive healthcare in India, 1992-2006.

    Science.gov (United States)

    Kumar, Abhishek; Mohanty, Sanjay K

    2011-04-01

    This paper examines trends in three reproductive healthcare indicators- namely, antenatal care, medical assistance at delivery, and contraceptive use among the urban poor and non-poor in India using data from the National Family Health Surveys, 1992-1993 and 2005-2006. The urban poor and non-poor are derived from composite wealth indices based on a set of economic proxies. Results indicate that the estimates of poor and non-poor are reliable. During the last 14 years, the service coverage in all three indicators has increased in the country, among both the urban poor and non-poor. However, the utilization of reproductive health services is concentrated among the urban non-poor cutting across the states, with the exception of Kerala. While the non-poor/poor gap in antenatal care and medical assistance at delivery remained large over the years, the gap in contraceptive use has narrowed down cutting across states. After adjusting for other confounders, household poverty was found to be a significant barrier in the utilization of reproductive healthcare services across the states. It has been observed that the utilization of reproductive healthcare services followed a continuum of rural total, urban poor, and urban non-poor.

  4. Low health literacy and healthcare utilization among immigrants and non-immigrants in Switzerland.

    Science.gov (United States)

    Mantwill, Sarah; Schulz, Peter J

    2017-11-01

    This study aimed at investigating the association between functional health literacy and knowledge on when to seek medical help for potentially harmless (overutilization) or serious (underutilization) situations among immigrants and non-immigrants in Switzerland. Data was collected among three immigrant groups and the native population (N=1146) in the German- and Italian-speaking part of Switzerland. Health literacy was assessed with the Short Test of Functional Health Literacy (S-TOFHLA) and three Brief Health Literacy Screeners. Over- and underutilization of healthcare services was assessed with items asking participants about when to seek medical help for minor, respectively major, physical symptoms. Immigrants were more likely to seek medical help when unwarranted (overutilization). Health literacy, when assessed with the S-TOFHLA, was significantly associated with over- and underutilization. Yet, once controlled for covariates, the association between health literacy and overutilization was negative. Immigration background and micro-cultural differences emerged as important predictors of utilization. Results suggest that functional health literacy is directly related to healthcare utilization. The effects might be amplified by (micro-)cultural differences. Healthcare providers should be aware of differences in health literacy and utilization patterns among different population groups. Communication between patients and providers should be literacy and culturally sensitive. Copyright © 2017 Elsevier B.V. All rights reserved.

  5. Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization.

    Science.gov (United States)

    Stahl, James E; Dossett, Michelle L; LaJoie, A Scott; Denninger, John W; Mehta, Darshan H; Goldman, Roberta; Fricchione, Gregory L; Benson, Herbert

    2015-01-01

    Poor psychological and physical resilience in response to stress drives a great deal of health care utilization. Mind-body interventions can reduce stress and build resiliency. The rationale for this study is therefore to estimate the effect of mind-body interventions on healthcare utilization. Estimate the effect of mind body training, specifically, the Relaxation Response Resiliency Program (3RP) on healthcare utilization. Retrospective controlled cohort observational study. Major US Academic Health Network. All patients receiving 3RP at the MGH Benson-Henry Institute from 1/12/2006 to 7/1/2014 (n = 4452), controls (n = 13149) followed for a median of 4.2 years (.85-8.4 yrs). Utilization as measured by billable encounters/year (be/yr) stratified by encounter type: clinical, imaging, laboratory and procedural, by class of chief complaint: e.g., Cardiovascular, and by site of care delivery, e.g., Emergency Department. Subgroup analysis by propensity score matched pre-intervention utilization rate. At one year, total utilization for the intervention group decreased by 43% [53.5 to 30.5 be/yr] (p <0.0001). Clinical encounters decreased by 41.9% [40 to 23.2 be/yr], imaging by 50.3% [11.5 to 5.7 be/yr], lab encounters by 43.5% [9.8 to 5.6], and procedures by 21.4% [2.2 to 1.7 be/yr], all p < 0.01. The intervention group's Emergency department (ED) visits decreased from 3.6 to 1.7/year (p<0.0001) and Hospital and Urgent care visits converged with the controls. Subgroup analysis (identically matched initial utilization rates-Intervention group: high utilizing controls) showed the intervention group significantly reduced utilization relative to the control group by: 18.3% across all functional categories, 24.7% across all site categories and 25.3% across all clinical categories. Mind body interventions such as 3RP have the potential to substantially reduce healthcare utilization at relatively low cost and thus can serve as key components in any population health and

  6. Relaxation Response and Resiliency Training and Its Effect on Healthcare Resource Utilization.

    Directory of Open Access Journals (Sweden)

    James E Stahl

    Full Text Available Poor psychological and physical resilience in response to stress drives a great deal of health care utilization. Mind-body interventions can reduce stress and build resiliency. The rationale for this study is therefore to estimate the effect of mind-body interventions on healthcare utilization.Estimate the effect of mind body training, specifically, the Relaxation Response Resiliency Program (3RP on healthcare utilization.Retrospective controlled cohort observational study.Major US Academic Health Network.All patients receiving 3RP at the MGH Benson-Henry Institute from 1/12/2006 to 7/1/2014 (n = 4452, controls (n = 13149 followed for a median of 4.2 years (.85-8.4 yrs.Utilization as measured by billable encounters/year (be/yr stratified by encounter type: clinical, imaging, laboratory and procedural, by class of chief complaint: e.g., Cardiovascular, and by site of care delivery, e.g., Emergency Department. Subgroup analysis by propensity score matched pre-intervention utilization rate.At one year, total utilization for the intervention group decreased by 43% [53.5 to 30.5 be/yr] (p <0.0001. Clinical encounters decreased by 41.9% [40 to 23.2 be/yr], imaging by 50.3% [11.5 to 5.7 be/yr], lab encounters by 43.5% [9.8 to 5.6], and procedures by 21.4% [2.2 to 1.7 be/yr], all p < 0.01. The intervention group's Emergency department (ED visits decreased from 3.6 to 1.7/year (p<0.0001 and Hospital and Urgent care visits converged with the controls. Subgroup analysis (identically matched initial utilization rates-Intervention group: high utilizing controls showed the intervention group significantly reduced utilization relative to the control group by: 18.3% across all functional categories, 24.7% across all site categories and 25.3% across all clinical categories.Mind body interventions such as 3RP have the potential to substantially reduce healthcare utilization at relatively low cost and thus can serve as key components in any population health and

  7. Pain, health related quality of life and healthcare resource utilization in Spain.

    Science.gov (United States)

    Langley, Paul; Pérez Hernández, Concepción; Margarit Ferri, César; Ruiz Hidalgo, Domingo; Lubián López, Manuel

    2011-01-01

    The aim of this paper is to consider the relationship between the experience of pain, health related quality of life (HRQoL) and healthcare resource utilization in Spain. The analysis contrasts the contribution of pain severity and frequency of pain reported against respondents reporting no pain in the previous month. Data are from the 2010 National Health and Wellness Survey (NHWS) for Spain. Single equation generalized linear regression models are used to evaluate the association of pain with the physical and mental component scores of the SF-12 questionnaire as well as health utilities generated from the SF-6D. In addition, the role of pain is assessed in its association with self-reported healthcare provider visits, emergency room visits and hospitalizations in the previous 6 months. The results indicate that the experience of pain, notably severe and frequent pain, is substantial and is significantly associated with the SF-12 physical component scores, health utilities and all aspects of healthcare resource utilization, which far outweighs the role of demographic and socioeconomic variables, health risk factors (in particular body mass index) and the presence of comorbidities. In the case of severe daily pain, the marginal contribution of the SF-12 physical component score is a deficit of -17.86 compared to those reporting no pain (population average score 46.49), while persons who are morbidly obese report a deficit of only -6.63 compared to those who are normal weight. The corresponding association with health utilities is equally dramatic with a severe daily pain deficit of -0.186 compared to those reporting no pain (average population utility 0.71). The impact of pain on healthcare resource utilization is marked. Severe daily pain increases traditional provider visits by 208.8%, emergency room visits by 373.0% and hospitalizations by 348.5%. As an internet-based survey there is the possibility of bias towards those with internet access, although telephone

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

    Science.gov (United States)

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

    2016-04-01

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

  9. Factors associated with access to care and healthcare utilization in the homeless population of England.

    Science.gov (United States)

    Elwell-Sutton, Tim; Fok, Jonathan; Albanese, Francesca; Mathie, Helen; Holland, Richard

    2017-03-01

    People experiencing homelessness are known to have complex health needs, which are often compounded by poor access to healthcare. This study investigates the individual-level factors associated with access to care and healthcare utilization among homeless people in England. A cross-sectional sample of 2505 homeless people from 19 areas of England was used to investigate associations with access to care and healthcare utilization. Rough sleepers were much less likely to be registered with a general practitioner (GP) (odds ratio (OR) 0.45, 95% confidence interval (CI) 0.30-0.66) than single homeless in accommodation (reference group) or the hidden homeless (OR 1.48, 95% CI 0.88-2.50). Those who had recently been refused registration by a GP or dentist also had lower odds of being admitted to hospital (OR 0.67, 95% CI 0.49-0.91) or using an ambulance (OR 0.73, 95% CI 0.54-0.99). The most vulnerable homeless people face the greatest barriers to utilizing healthcare. Rough sleepers have particularly low rates of GP registration and this appears to have a knock-on effect on admission to hospital. Improving primary care access for the homeless population could ensure that some of the most vulnerable people in society are able to access vital hospital services which they are currently missing out on. © The Author 2016. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. Association of shared decision-making on patient-reported health outcomes and healthcare utilization.

    Science.gov (United States)

    Hughes, Tasha M; Merath, Katiuscha; Chen, Qinyu; Sun, Steven; Palmer, Elizabeth; Idrees, Jay J; Okunrintemi, Victor; Squires, Malcolm; Beal, Eliza W; Pawlik, Timothy M

    2018-01-31

    Shared decision-making (SDM) is a process that respects the rights of patients to be fully involved in decisions about their care. By evaluating all available healthcare options and weighing patients' personal values and preferences against available unbiased evidence, patients and healthcare professionals can make health-related decisions together, as partners. We sought to evaluate the impact of perceived SDM on patient-reported outcomes, healthcare quality, and healthcare utilization. Patients were identified from the 2010-2014 Medical Expenditure Panel Survey (MEPS) cohort. The Consumer Assessment of Healthcare Providers and Systems (CAHPS) survey was levied to create a weighted composite score of satisfaction with SDM on a 12-point scale, and then categorized as optimal, average or poor SDM based on weighted scores. Weighting and variance techniques were applied to assure results were representative of the U.S. civilian population. Chi-square analysis was used to estimate differences across SDM groupings and multivariate logistic regression was performed to generate odds ratios (OR) and confidence intervals (CI). The study cohort included 63,931 responses to the survey tool. Results of SDM satisfaction across the three categories were skewed, with 46.6% (n = 29,807) of the respondents reporting optimal SDM, 42.1% (n = 26,887) reporting average scores and only 11.3% (n = 7237) reporting poor perceived SDM. Non-white race, lower educational level, low socioeconomic status, non-married status, and uninsured or underinsured status were all associated with higher incidence of poor perceived SDM (p < .05). Poor SDM was associated with increased odds of poor physical health scores (OR: 1.17; 95% CI 1.01-1.36) and poor mental health scores (OR: 1.53; 95% CI 1.25-1.86). Poor SDM was associated with lower use of statins (OR: 0.77; 95% CI 0.68-0.87) and aspirin (OR: 0.86; 95% CI 0.77-0.95), both of which are established quality of care metrics. Poor SDM

  11. Determinants of U.S. poison center utilization.

    Science.gov (United States)

    Litovitz, Toby; Benson, Blaine E; Youniss, Jessica; Metz, Edward

    2010-06-01

    High poison center utilization has been associated with decreased emergency department usage and hospitalization rates. However, utilization requires awareness of the poison center. Penetrance, defined as the number of human poison exposures reported to a poison center per 1,000 population, has been used as a marker of poison center awareness. To identify factors that influence poison center penetrance to optimize the life- and cost-saving benefits of poison control centers. Human poison exposures that were reported to the National Poison Data System in 2001 were analyzed to identify and rank factors affecting poison center penetrance. Overall penetrance correlated with pediatric penetrance (R(2) = 0.75, p poison center that were already in or en route to a healthcare facility at the time of the call to the poison center (R(2) = 0.41, p poison center service populations were associated with lower penetrance (R(2) = 0.23, p poison center (multiple regression). Positive predictors included the percentage of the population younger than 5 years, the percentage of the adult population with a bachelor's degree, poison center certification, poison center educator FTEs (full time equivalents), Asian population percentage, and population density. The inverse correlation between pediatric penetrance and healthcare facility utilization supports prior observations of excessive healthcare utilization when a poison center is not called. Since race, language and distance are barriers to poison center utilization, and since healthcare utilization increases when poison center penetrance declines, low penetrance suggests a lack of awareness of the poison center rather than a low incidence of poisonings. Strategies to raise penetrance should be informed by an understanding of the barriers to utilization - language, Black/African American race, distance from the poison center, poverty, and lower education levels.

  12. Exploring differences in healthcare utilization of prisoners in the Canton of Vaud, Switzerland.

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    Karine Moschetti

    Full Text Available Prison healthcare is an important public health concern given the increasing healthcare needs of a growing and aging prison population, which accumulates vulnerability factors and suffers from higher disease prevalence than the general population. This study identifies the key factors associated with outpatient general practitioner (GP, nursing or psychiatric healthcare utilization (HCU within prisons. Cross-sectional data systematically collected by the prison medical staff were obtained for a sample of 1664 adult prisoners of the Canton of Vaud, Switzerland, for the year 2011. They contain detailed information on demographics (predisposing factors, diagnosed chronic somatic and psychiatric disorders (needs factors, as well as prison stay characteristics (contextual factors. For GP, nurse and psychiatric care, two-part regressions are used to model separately the probability and the volume of HCU. Predisposing factors are generally not associated with the probability to use healthcare services after controlling for needs factors. However, female inmates use higher volumes of care, and the volume of GP consultations increases with age. Chronic somatic and psychiatric conditions are the most important predictors of the probability of HCU, but associations with volumes differ in their magnitude and significance across disease groups. Infectious, musculoskeletal, nervous and circulatory diseases actively mobilize GP and nursing staff. Schizophrenia, illicit drug and pharmaceuticals abuse are strongly positively associated with psychiatric and nurse HCU. The occupancy rate displays positive associations among contextual factors. Prison healthcare systems face increasingly complex organizational, budgetary and ethical challenges. This study provides relevant insights into the HCU patterns of a marginalized and understudied population.

  13. Social health insurance, healthcare utilization, and costs in middle-aged and elderly community-dwelling adults in China.

    Science.gov (United States)

    Wang, Zhonghua; Li, Xiangjun; Chen, Mingsheng; Si, Lei

    2018-02-02

    Although many studies have analyzed health insurance worldwide, most focus on whole populations rather than specific vulnerable groups. There is a lack of studies that compare different schemes. This paper evaluates the impact of different types of social health insurance and other associated factors on healthcare utilization and costs among middle-aged and elderly Chinese adults. Data were obtained from a nationally representative middle-aged and elderly household survey, the China Health and Retirement Longitudinal Study, which was conducted in 2015. Middle-aged and elderly are defined as people who are ≥45 years. Descriptive statistics were used to show the prevalence of each variable. Both logistic and multiple linear regression models were used to evaluate the association between healthcare utilization/healthcare costs and health insurance in addition to other related factors. Although the rapid expansion of social health insurance coverage has significantly improved the healthcare utilization among middle-aged and elderly adults, the difference between three schemes is large. Urban Employee Medical Insurance (UEMI) has had a greater effect in improving healthcare utilization than New Cooperative Medical Insurance (NCMI) or Urban Resident Medical Insurance (URMI). Unification of health insurance programs and optimization of health resource allocations should be a practical way to alleviate healthcare utilization inequality across schemes. People having social health insurance spend more on total and out-of-pocket (OOP) healthcare costs than people not covered by social health insurance, suggesting that enrollment in social health insurance induces significant increases in both total and OOP healthcare expenses. UEMI for the urban employed has relatively higher funding criteria and reimbursement rate, which makes the greatest extent to induce increase in healthcare costs. Some demographic or socioeconomic factors significantly affect healthcare utilization

  14. Sociodemographics, Comorbidities, Healthcare Utilization and Work Productivity in Japanese Patients with Adult ADHD.

    Directory of Open Access Journals (Sweden)

    Eiji Kirino

    Full Text Available This study compared the sociodemographic characteristics, comorbidities, healthcare resource utilization, and work productivity among Japanese adults who reported being diagnosed with attention-deficit/hyperactivity disorder (ADHD to those of a non-ADHD control population.Data for this study were captured from an online survey of adults in Japan conducted by Kantar Health using consumer panels. A total of 84 survey participants reported they had received a diagnosis of ADHD from a physician. Survey responses pertaining to functional status and resource utilization from this ADHD group were compared to those from a non-ADHD control group of 100 participants. Comparisons between the ADHD and non-ADHD groups were made using chi-square tests for categorical variables and t-tests for continuous variables.Participants in the ADHD group were on average slightly younger with a higher proportion of males. ADHD respondents reported significantly more comorbid depression, sleep difficulties, headaches, and anxiety than non-ADHD controls. Over the previous 6 months, the ADHD group made more visits to healthcare providers and the emergency room, and had more hospitalizations than non-ADHD controls. The ADHD group also rated their overall health status lower than the non-ADHD control group. Respondents with ADHD reported a significantly higher degree of health-related work impairment compared to non-ADHD, with greater absenteeism and decreased work productivity. The ADHD group indicated their symptoms negatively impacted relationships, self-esteem, and regular daily activities.Japanese adults with ADHD face a substantial burden of illness, including lower overall health status, increased number of comorbidities, greater healthcare utilization, and significant health-related occupational impairment compared to those without ADHD. Additional research is needed to develop a better understanding of both the consequences and treatment approaches for Japanese

  15. Sociodemographics, Comorbidities, Healthcare Utilization and Work Productivity in Japanese Patients with Adult ADHD.

    Science.gov (United States)

    Kirino, Eiji; Imagawa, Hideyuki; Goto, Taro; Montgomery, William

    2015-01-01

    This study compared the sociodemographic characteristics, comorbidities, healthcare resource utilization, and work productivity among Japanese adults who reported being diagnosed with attention-deficit/hyperactivity disorder (ADHD) to those of a non-ADHD control population. Data for this study were captured from an online survey of adults in Japan conducted by Kantar Health using consumer panels. A total of 84 survey participants reported they had received a diagnosis of ADHD from a physician. Survey responses pertaining to functional status and resource utilization from this ADHD group were compared to those from a non-ADHD control group of 100 participants. Comparisons between the ADHD and non-ADHD groups were made using chi-square tests for categorical variables and t-tests for continuous variables. Participants in the ADHD group were on average slightly younger with a higher proportion of males. ADHD respondents reported significantly more comorbid depression, sleep difficulties, headaches, and anxiety than non-ADHD controls. Over the previous 6 months, the ADHD group made more visits to healthcare providers and the emergency room, and had more hospitalizations than non-ADHD controls. The ADHD group also rated their overall health status lower than the non-ADHD control group. Respondents with ADHD reported a significantly higher degree of health-related work impairment compared to non-ADHD, with greater absenteeism and decreased work productivity. The ADHD group indicated their symptoms negatively impacted relationships, self-esteem, and regular daily activities. Japanese adults with ADHD face a substantial burden of illness, including lower overall health status, increased number of comorbidities, greater healthcare utilization, and significant health-related occupational impairment compared to those without ADHD. Additional research is needed to develop a better understanding of both the consequences and treatment approaches for Japanese adults with ADHD.

  16. Impact of Bariatric Surgery on Healthcare Utilization and Costs among Patients with Diabetes

    Science.gov (United States)

    Bleich, Sara N.; Chang, Hsien-Yen; Lau, Bryan; Steele, Kimberly; Clark, Jeanne M.; Richards, Thomas; Weiner, Jonathan P; Wu, Albert W.; Segal, Jodi B.

    2011-01-01

    Background The effect of bariatric surgery on health care utilization and costs among individuals with type 2 diabetes remains unclear. Objective To examine healthcare utilization and costs in an insured cohort of individuals with type 2 diabetes after bariatric surgery. Research Design Cohort study derived from administrative data from 2002–2008 from 7 Blue Cross Blue Shield Plans. Subjects 7,806 individuals with type 2 diabetes who had bariatric surgery Measures Cost (inpatient, outpatient, pharmacy, other) and utilization (number of inpatient days, outpatient visits, specialist visits). Results Compared to pre-surgical costs, the ratio of hospital costs (excluding the initial surgery), among beneficiaries who had any hospital costs, was higher in years 2 through 6 of the post-surgery period and increased over time [post 1: OR = 0.58 (95% CI: 0.50, 0.67); post 6: OR = 3.43 (95% CI: 2.60, 4.53)]. In comparison to the pre-surgical period, the odds of having any healthcare costs was lower in the post-surgery period and remained relatively flat over time. Among those with hospitalizations, the adjusted ratio of inpatient days was higher after surgery [post 1: OR = 1.05 (95% CI: 0.94, 1.16); post 6: OR = 2.77 (95% CI: 1.57, 4.90)]. Among those with primary care visits, the adjusted odds ratio was lower after surgery [post 1: OR = 0.80 (95% CI: 0.78, 0.82); post 6: OR = 0.66 (95% CI: 0.57, 0.76)]. Conclusion In the six years following surgery, individuals with type 2 diabetes did not have lower healthcare costs than before surgery. PMID:22167064

  17. Home-Based Physical Activity Coaching, Physical Activity, and Healthcare Utilization in COPD: COPD-SMART Secondary Outcomes.

    Science.gov (United States)

    Coultas, David B; Jackson, Bradford E; Russo, Rennie; Peoples, Jennifer; Singh, Karan P; Sloan, John; Uhm, Minyong; Ashmore, Jamile A; Blair, Steven N; Bae, Sejong

    2017-12-28

    Physical inactivity among patients with chronic obstructive pulmonary disease (COPD) is associated with exacerbations requiring high-cost healthcare utilization including urgent, emergent, and hospital care. To examine the effectiveness of a behavioral lifestyle physical activity intervention combined with COPD self-management education to prevent high-cost healthcare utilization. This was an analysis of secondary outcomes of the Chronic Obstructive Pulmonary Disease Self-Management Activation Research Trial, a two-arm randomized trial of stable adult outpatients with COPD recruited from primary care and pulmonary clinics. Following a six-week self-management education run-in period, participants were randomized to usual care or to a telephone-delivered home-based health coaching intervention over 20 weeks. Secondary outcomes of physical activity and healthcare utilization were determined by self-report at 6-, 12-, and 18-months after randomization. Associations between treatment allocation arm and these secondary outcomes were examined using log-binomial and Poisson regression models. A total of 325 outpatients with stable COPD were enrolled in the trial. The average age of 70.3 years (standard deviation 9.5), and 50.5% were female; 156 were randomized to usual care and 149 to the intervention. A greater proportion of participants reported being persistently active over the 18-month follow-up period in the intervention group (73.6%) compared to the usual care group (57.8%) (mean difference=15.8%, 95% confidence interval [CI] 4.0%-27.7%)). This association varied by severity of FEV1 impairment (p for interaction = 0.09). Those in the intervention group with moderate impairment(FEV1=50%-70% predicted), more frequently reported being persistently active compared to the usual care (86.0% vs. 65.1%, mean difference=20.9%, 95% CI 5.7%-36.1%). Patients with severe and very severe FEV1 impairment (FEV1 home-based coaching intervention may decrease sedentary behavior and

  18. Dutch citizens of Turkish origin who utilize healthcare services in Turkey: a qualitative study on motives and contextual factors.

    Science.gov (United States)

    Şekercan, Aydın; Woudstra, Anke J; Peters, Ron J G; Lamkaddem, Majda; Akgün, Seval; Essink-Bot, Marie-Louise

    2018-04-17

    Dutch residents of Turkish origin frequently utilize healthcare in Turkey. To investigate their motives for doing so, we conducted a qualitative study among these healthcare users using semi-structured interviews. We complemented this with informal conversations with Turkish healthcare providers and observations at the registration offices and waiting rooms of outpatient clinics in several Turkish hospitals. Respondents believed their perceived needs for referral to specialist care and diagnostic assessments to quantify their health were not being met in the Netherlands. These mismatches in expectations of what constitutes "good care" led to dissatisfaction with Dutch primary care. Consequently, respondents utilized healthcare in Turkey if the opportunity arose, and were encouraged in this by their social networks. Establishing cross-border communication between healthcare providers is necessary, because there is currently no continuity of care for cross-border patients.

  19. Determinants of Healthcare Utilisation and Out-of-Pocket Payments in the Context of Free Public Primary Healthcare in Zambia

    Directory of Open Access Journals (Sweden)

    Felix Masiye

    2016-12-01

    Full Text Available Background Access to appropriate and affordable healthcare is needed to achieve better health outcomes in Africa. However, access to healthcare remains low, especially among the poor. In Zambia, poor access exists despite the policy by the government to remove user fees in all primary healthcare facilities in the public sector. The paper has two main objectives: (i to examine the factors associated with healthcare choices among sick people, and (ii to assess the determinants of the magnitude of out-of-pocket (OOP payments related to a visit to a health provider. Methods This paper employs a multilevel multinomial logistic regression to model the determinants of an individual’s choice of healthcare options following an illness. Further, the study analyses the drivers of the magnitude of OOP expenditure related to a visit to a health provider using a two-part generalised linear model. The analysis is based on a nationally representative healthcare utilisation and expenditure survey that was conducted in 2014. Results Household per capita consumption expenditure is significantly associated with increased odds of seeking formal care (odds ratio [OR] = 1.12, P = .000. Living in a household in which the head has a higher level of education is associated with increased odds of seeking formal healthcare (OR = 1.54, P = .000 and (OR = 1.55, P = .01, for secondary and tertiary education, respectively. Rural residence is associated with reduced odds of seeking formal care (OR = 0.706, P = .002. The magnitude of OOP expenditure during a visit is significantly dependent on household economic wellbeing, distance from a health facility, among other factors. A 10% increase in per capita consumption expenditure was associated with a 0.2% increase in OOP health expenditure while every kilometre travelled was associated with a K0.51 increase in OOP health expenditure. Conclusion Despite the removal of user fees on public primary healthcare in Zambia, access to

  20. Factors affecting costs and utilization of type 2 diabetes healthcare: a cross-sectional survey among 15 hospitals in urban China

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    Wang Weibing

    2010-08-01

    Full Text Available Abstract Background Type 2 Diabetes mellitus (T2DM affects persons of all ages, while also placing heavy economic burdens on national economies and healthcare systems. The study aims to investigate the determinants of direct medical cost (DMC, out-of-pocket (OOP proportion of the cost, and healthcare utilization associated with T2DM. Methods This cross-sectional study was conducted in four major cities in China. Eligible subjects were adult outpatients who received treatment at one of 15 sampled secondary or tertiary hospitals and consecutively enrolled between March 2007 and May 2007. Generalized estimating equations were used to determine impact factors associated with DMC and healthcare utilization. Results Insurance schemes and receiving insulin therapy were significantly associated with a higher annual DMC of T2DM. For each increase in number of complications, there was about 33% increase in annual DMC. Insurance schemes were significantly associated with the proportions of DMC from pocket. A 7% significantly lower proportion of DMC was paid and 23% more clinic visits (AOR = 1.232, P 2000 CNY/month paid 23% less from their pocket, compared with the lower income group. The number of complications also significantly increased the outpatient visits (AOR = 1.064, P Conclusions It implies that preventing complications through the use of more effective treatment regimens is important in order to control the healthcare expenditures of the diseases. Healthcare reform needs to be focused on the medical insurance system and redistribution of patients in hospitals of different levels.

  1. Satisfaction and Healthcare Utilization of Transgender and Gender Non-Conforming Individuals in NYC: A Community-Based Participatory Study.

    Science.gov (United States)

    Radix, Anita E; Lelutiu-Weinberger, Corina; Gamarel, Kristi E

    2014-12-01

    Transgender and gender non-conforming (TGNC) individuals face high levels of discrimination and mistreatment, including within social and medical service settings, which may lead to negative health and psychosocial sequelae. Given the many barriers to competent care, we sought to determine points of intervention by assessing the current needs, satisfaction, and health care utilization of TGNC individuals in New York City as reported by TGNC individuals. In January 2013, fifty TGNC individuals were recruited via flyers and direct referrals from healthcare professionals within community spaces and pertinent venues. We administered a brief survey and conducted four focus groups exploring participants' health care utilization and perceived barriers to care, routine care, hormone and silicone use, and recommendations for improving transgender services. Participants were 18- to 64-years-old, racially/ethnically diverse, and the majority were medically insured, underwent routine health care in the last year, and received an HIV test in their lifetime. A significant proportion reported taking hormones prescribed by a medical provider and were in the care of knowledgeable providers. Participants perceived four areas where barriers persisted: utilization of preventive services, access to transition-related procedures, access to legal assistance, and inclusion of TGNC individuals in public health education and campaigns. Structural interventions are needed, such as comprehensive provider training programs for all level staff to better serve the needs of TGNC individuals, increase service utilization and improve wellbeing, while effecting lasting institutional change. Service provision establishments should hire more TGNC staff and integrate transgender care into existing practices.

  2. Three methods to monitor utilization of healthcare services by the poor

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    Urni Farhana

    2009-08-01

    Full Text Available Abstract Background Achieving equity by way of improving the condition of the economically poor or otherwise disadvantaged is among the core goals of contemporary development paradigm. This places importance on monitoring outcome indicators among the poor. National surveys allow disaggregation of outcomes by socioeconomic status at national level and do not have statistical adequacy to provide estimates for lower level administrative units. This limits the utility of these data for programme managers to know how well particular services are reaching the poor at the lowest level. Managers are thus left without a tool for monitoring results for the poor at lower levels. This paper demonstrates that with some extra efforts community and facility based data at the lower level can be used to monitor utilization of healthcare services by the poor. Methods Data used in this paper came from two sources- Chakaria Health and Demographic Surveillance System (HDSS of ICDDR,B and from a special study conducted during 2006 among patients attending the public and private health facilities in Chakaria, Bangladesh. The outcome variables included use of skilled attendants for delivery and use of facilities. Rate-ratio, rate-difference, concentration index, benefit incidence ratio, sequential sampling, and Lot Quality Assurance Sampling were used to assess how pro-poor is the use of skilled attendants for delivery and healthcare facilities. Findings Poor are using skilled attendants for delivery far less than the better offs. Government health service facilities are used more than the private facilities by the poor. Benefit incidence analysis and sequential sampling techniques could assess the situation realistically which can be used for monitoring utilization of services by poor. The visual display of the findings makes both these methods attractive. LQAS, on the other hand, requires small fixed sample and always enables decision making. Conclusion With some

  3. Characteristics of immigrant Latino men who utilize formal healthcare services: baseline findings from the HoMBReS study.

    Science.gov (United States)

    Rhodes, Scott D; Hergenrather, Kenneth C; Zometa, Carlos; Lindstrom, Kristen; Montaño, Jaime

    2008-10-01

    Despite the burgeoning immigrant Hispanic/Latino community in the southeastern United States, little is known about the utilization of healthcare services by this population. We sought to identify demographic, behavioral and psychosocial characteristics of immigrant Hispanic/Latino men who report utilizing formal healthcare services. Using an interviewer-administered assessment, data were collected from a random sample of members of a multicounty adult Latino men's soccer league in North Carolina. Of the 222 participants, the mean (+/-SD) age was 29.8 +/-8.3, with a range of 18-71 years. More than half of the sample reported Mexico as their country of origin and grade < or =8 as their highest level of education. The mean length of time living in the United States was 8.8 (+/- 7.6) years. An increased likelihood of reporting having ever utilized formal healthcare services associated with decreased perceived barriers to utilization, increased acculturation, increased adherence to traditional notions of masculinity and increased coping. Effective strategies to increase the utilization of formal healthcare services among Hispanic/Latino men may include diffusing information about the availability of services and how to access services and linking healthcare utilization with positive aspects of what it means to be a man.

  4. PS1-35: Impact of an ADA-Accredited Diabetes Education on Healthcare Utilization

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    Basu, Rashmita; Allenson, Sarah; McLellan, Lynn; Hochhalter, Angela

    2012-01-01

    Background/Aims Diabetes self-management education delivered by certified diabetes educators (CDE) can improve persons’ self-management skills, self-efficacy for managing their diabetes, and clinical outcomes among patients with Type II diabetes. In addition, these education programs have the potential to reduce healthcare utilization, costs, and disabilities associated with the disease. Objective The purpose of this study was to measure the impact of Type 2 Diabetes BASICS education program (obtained from the International Diabetes Center in Minneapolis) on healthcare utilization among Scott & White SeniorCare members. The Diabetes Education site at Scott & White is nationally certified by the American Diabetes Association (ADA). Methods This was a retrospective cohort study of participants who attended the education program at a single program delivery site. Subjects were program participants who attended four BASICS class sessions over a six months period between January 2005 and July 2010 and were also enrolled in a Medicare Cost Contract product. About 349 subjects were included in the analysis. The key outcome variables were number of outpatient visits, number of inpatient hospitalization and length of inpatient stay. Differences in average number of outpatient visits, number of inpatient hospitalization, and length of inpatient stay were compared for the 12-months before participants began the education program and the 12-months after the completion. The unadjusted men differences were calculated using paired t-test. Adjusted mean difference in outpatient utilization was estimated from a linear regression and inpatient utilization by negative binomial regression adjusting for patient’s age and gender. Results On average, the number of outpatient visits decreased from 8.38 in the year before participants began the program to 7.70 (p=0.04) in the year after they finished the program. In addition, the unadjusted mean number of inpatient admissions per year

  5. The effect of hyperactive bladder severity on healthcare utilization and labor productivity.

    Science.gov (United States)

    Angulo, J C; Brenes, F J; Ochayta, D; Lizarraga, I; Arumí, D; Trillo, S; Rejas, J

    2014-05-01

    To explore the relationship between the severity of urinary urge incontinence (UUI) on healthcare resources utilization (HRU) and loss of labor productivity of subjects with overactive bladder (OAB) in the general population in Spain. Secondary analysis of a cross-sectional web-based study conducted in the general population >18 years, through a battery of HRU questions asked using an online method. Probable OAB subjects were identified using a previously validated algorithm and a score >8 in the OAB-V8 questionnaire. HRU questions included an assessment of concomitant medication used as a consequence of OAB/UUI, pad utilization, and medical office visits. Patients were grouped according to the number of UUI episodes into 0, 1, 2-3 or 4+ episodes. Of a total of 2,035 subjects participating from the general population, 396 patients [52.5% women, mean age: 55.3 (11.1) years, OAB-V8 mean score: 14.5 (7.9)] were analyzed; 203 (51.3%) with 0 episodes, 119 (30.1%) with 1, 52 (13.1%) with 2 or 3, and 22 (5.6%) with 4 or more episodes. A linear and significant adjusted association was observed between the number of UUI episodes and HRU; the higher the number of daily episodes the higher the HRU. Subjects with more episodes had medical visits more frequently at the primary care (P = .001) and specialist (P = .009) level as well. Consumption of day (P < .001) and night (P < .001) urinary absorbents, anxiolytic medicines (P = .021) and antibiotics (P = .05) was higher in patients with more UUI episodes. The severity of OAB in terms of frequency of daily urge incontinence episodes was significantly and linearly associated with higher healthcare resources utilization and a decrease in labor productivity in subjects with probable OAB in Spain. Copyright © 2013 AEU. Published by Elsevier Espana. All rights reserved.

  6. Healthcare Utilization and Spending for Constipation in Children With Versus Without Complex Chronic Conditions.

    Science.gov (United States)

    Stephens, John R; Steiner, Michael J; DeJong, Neal; Rodean, Jonathan; Hall, Matt; Richardson, Troy; Berry, Jay G

    2017-01-01

    The aim of the study was to examine the prevalence of diagnosis and treatment for constipation among children receiving Medicaid and to compare healthcare utilization and spending for constipation among children based on number of complex chronic conditions (CCCs). Retrospective cohort study of 4.9 million children ages 1 to 17 years enrolled in Medicaid from 2009 to 2011 in 10 states in the Truven Marketscan Database. Constipation was identified using International Classification of Disease, 9th revision codes for constipation (564.0x), intestinal impaction (560.3x), or encopresis (307.7). Outpatient and inpatient utilization and spending for constipation were assessed. CCC status was identified using validated methodology. A total of 267,188 children (5.4%) were diagnosed with constipation. Total constipation spending was $79.5 million. Outpatient constipation spending was $66.8 million (84.1%) during 406,814 visits, mean spending $120/visit. Among children with constipation, 1363 (0.5%) received inpatient treatment, accounting for $12.2 million (15.4%) of constipation spending, mean spending $7815/hospitalization. Of children hospitalized for constipation, 552 (40.5%) did not have an outpatient visit for constipation before admission. Approximately 6.8% of children in the study had ≥1 CCC; these children accounted for 33.5% of total constipation spending, 70.3% of inpatient constipation spending, and 19.8% of emergency department constipation spending. Constipation prevalence was 11.0% for children with 1 CCC, 16.6% with 2 CCCs, and 27.1% with ≥3 CCCs. Although the majority of pediatric constipation treatment occurs in the outpatient setting, inpatient care accounts for a sizable percentage of spending. Children with CCCs have a higher prevalence of constipation and account for a disproportionate amount of constipation healthcare utilization and spending.

  7. Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review.

    Science.gov (United States)

    Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

    2017-09-01

    Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: "Healthcare and Knowledge Management"; "Knowledge Management Tools in Healthcare" and "Community of Practices in healthcare". It was found that utilization of knowledge management in healthcare is encouraging. There exist numbers of opportunities for knowledge management implementation, though there are some barriers as well. Some of the opportunities that can transform healthcare are advances in health information and communication technology, clinical decision support systems, electronic health record systems, communities of practice and advanced care planning. Providing the right knowledge at the right time, i.e., at the point of decision making by implementing knowledge management in healthcare is paramount. To do so, it is very important to use appropriate tools for knowledge management and user-friendly system because it can significantly improve the quality and safety of care provided for patients both at hospital and home settings.

  8. Decrease in Healthcare Utilization and Costs for Opioid Users Following Residential Integrated Treatment for Co-Occurring Disorders.

    Science.gov (United States)

    Morse, Siobhan; Bride, Brian E

    2017-09-07

    Opioid use results in higher healthcare utilization and costs, particularly among those with co-occurring mental health disorders. Presumably, effective treatment would result in a reduction in healthcare utilization and costs. To date, research has not examined this question. As such, the purpose of this study was to estimate and compare pre- and post-treatment healthcare utilization and costs for individuals receiving residential integrated treatment for co-occurring mental health and opioid use disorders. A single-group, repeated measures design was used to examine changes in pre- and post-treatment healthcare utilization and costs among a sample of individuals with co-occurring mental health and opioid use disorders who received residential, integrated treatment. Significant reductions in emergency rooms visits, inpatient admissions, and resulting costs were observed in the six months following treatment. Residential, integrated treatment of co-occurring mental health and opioid use disorders can significantly decrease both utilization and cost of healthcare among opioid users with co-occurring mental health disorders.

  9. Health insurance benefit design and healthcare utilization in northern rural China.

    Directory of Open Access Journals (Sweden)

    Hong Wang

    Full Text Available BACKGROUND: Poverty due to illness has become a substantial social problem in rural China since the collapse of the rural Cooperative Medical System in the early 1980s. Although the Chinese government introduced the New Rural Cooperative Medical Schemes (NRCMS in 2003, the associations between different health insurance benefit package designs and healthcare utilization remain largely unknown. Accordingly, we sought to examine the impact of health insurance benefit design on health care utilization. METHODS AND FINDINGS: We conducted a cross-sectional study using data from a household survey of 15,698 members of 4,209 randomly-selected households in 7 provinces, which were representative of the provinces along the north side of the Yellow River. Interviews were conducted face-to-face and in Mandarin. Our analytic sample included 9,762 respondents from 2,642 households. In each household, respondents indicated the type of health insurance benefit that the household had (coverage for inpatient care only or coverage for both inpatient and outpatient care and the number of outpatient visits in the 30 days preceding the interview and the number of hospitalizations in the 365 days preceding the household interview. People who had both outpatient and inpatient coverage compared with inpatient coverage only had significantly more village-level outpatient visits, township-level outpatient visits, and total outpatient visits. Furthermore, the increased utilization of township and village-level outpatient care was experienced disproportionately by people who were poorer, whereas the increased inpatient utilization overall and at the county level was experienced disproportionately by people who were richer. CONCLUSION: The evidence from this study indicates that the design of health insurance benefits is an important policy tool that can affect the health services utilization and socioeconomic equity in service use at different levels. Without careful

  10. Long-term survival and healthcare utilization outcomes attributable to sepsis and pneumonia

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    Dick Andrew

    2012-11-01

    Full Text Available Abstract Background Hospital associated infections are major problems, which are increasing in incidence and very costly. However, most research has focused only on measuring consequences associated with the initial hospitalization. We explored the long-term consequences of infections in elderly Medicare patients admitted to an intensive care unit (ICU and discharged alive, focusing on: sepsis, pneumonia, central-line-associated bloodstream infections (CLABSI, and ventilator-associated pneumonia (VAP; the relationships between the infections and long-term survival and resource utilization; and how resource utilization was related to impending death during the follow up period. Methods Clinical data and one year pre- and five years post-index hospitalization Medicare records were examined. Hazard ratios (HR and healthcare utilization incidence ratios (IR were estimated from state of the art econometric models. Patient demographics (i.e., age, gender, race and health status and Medicaid status (i.e., dual eligibility were controlled for in these models. Results In 17,537 patients, there were 1,062 sepsis, 1,802 pneumonia, 42 CLABSI and 52 VAP cases. These subjects accounted for 62,554 person-years post discharge. The sepsis and CLABSI cohorts were similar as were the pneumonia and VAP cohorts. Infection was associated with increased mortality (sepsis HR = 1.39, P  Conclusions The infections had significant and lasting adverse consequences among the elderly. Yet, many of these infections may be preventable. Investments in infection prevention interventions are needed in both community and hospitals settings.

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

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

    2016-01-01

    The obesity epidemic is a significant public health issue with adverse impact on health and costs. Applying a life-course perspective to obesity may advance our understanding of the influence of obesity over time on patterns of healthcare utilization in young and middle-aged United States (US) adults.We identified baseline body mass index (BMI) and BMI trajectories, and assessed their association with outpatient visits, emergency department (ED) visits, and hospitalizations in a well-defined population of young and middle-aged US adults.Using the Rochester Epidemiology Project resources, we conducted a retrospective cohort study of adults (N = 23,254) aged 18 to 44 years, with at least 3 BMI measurements, residing in Olmsted County, MN from January 1, 2005 through December 31, 2012.We observed that 27.5% of the population was obese. Four BMI trajectories were identified. Compared to under/normal weight, obese class III adults had higher risk of outpatient visits (adjusted rate ratio [RR], 1.86; 95% confidence intervals [CIs], 1.67-2,08), ED visits (adjusted RR, 3.02; 95% CI, 2.74-3.34), and hospitalizations (adjusted RR, 1.67; 95% CI, 1.59-1.75). BMI trajectory was positively associated with ED visits after adjustment for age, sex, race, and Charlson Comorbidity Index (P young and middle-aged US adults, baseline BMI is positively associated with outpatient visits, ED visits, and hospitalizations, while BMI trajectory is positively associated with ED visits. These findings extend our understanding of the longitudinal influence of obesity on healthcare utilization in early to mid-adulthood.

  12. CONTINUOUS ANALYZER UTILIZING BOILING POINT DETERMINATION

    Science.gov (United States)

    Pappas, W.S.

    1963-03-19

    A device is designed for continuously determining the boiling point of a mixture of liquids. The device comprises a distillation chamber for boiling a liquid; outlet conduit means for maintaining the liquid contents of said chamber at a constant level; a reflux condenser mounted above said distillation chamber; means for continuously introducing an incoming liquid sample into said reflux condenser and into intimate contact with vapors refluxing within said condenser; and means for measuring the temperature of the liquid flowing through said distillation chamber. (AEC)

  13. Factors affecting maternal healthcare utilization in Afghanistan: secondary analysis of Afghanistan Health Survey 2012.

    Science.gov (United States)

    Shahram, Muhammad Shuaib; Hamajima, Nobuyuki; Reyer, Joshua A

    2015-11-01

    This study, a secondary analysis of data from Afghanistan Health Survey 2012, aimed to identify factors affecting maternal healthcare utilization in Afghanistan. Subjects were 5,662 women aged 15-49 years who had had one delivery in the two years preceding the survey. Odds ratio (OR) and 95% confidence interval (CI) were estimated by logistic regression analysis. The study found that 54.0% of mothers used antenatal care (ANC) at least one time, and 47.4% of births were assisted by skilled birth attendants (SBA). Adjusted OR of ANC use was 2.74 (95% CI, 2.08-3.60) for urban residency, 1.69 (95% CI, 1.26-2.27) for primary education relative to no education, 3.94 (95% CI, 3.51-4.42) for knowledge on danger signs of pregnancy, and 1.78 (95% CI, 1.47-2.15) for television and radio relative to no exposure. Adjusted OR of SBA utilization was 3.71 (95% CI, 2.65-5.18) for urban residency, 0.67 (95% CI, 0.48-0.91) for age women's education and knowledge about danger signs of pregnancy were significant factors of both ANC and SBA, educating women may be an effective step in promoting safe maternal health.

  14. Accounting for the Hierarchical Structure in Veterans Health Administration Data: Differences in Healthcare Utilization between Men and Women Veterans.

    Science.gov (United States)

    Allore, Heather G; Ning, Yuming; Brandt, Cynthia A; Goulet, Joseph L

    2013-01-01

    Women currently constitute 15% of active United States of America military service personnel, and this proportion is expected to double in the next 5 years. Previous research has shown that healthcare utilization and costs differ in women US Veterans Health Administration (VA) patients compared to men. However, none have accounted for the potential effects of clustering on their estimates of healthcare utilization. US Women Veterans are more likely to serve in specific military branches (e.g. Army), components (e.g. National Guard), and ranks (e.g. officer) than men. These factors may confer different risk and protection that can affect subsequent healthcare needs. Our study investigates the effects of accounting for the hierarchical structure of data on estimates of the association between gender and VA healthcare utilization. The sample consisted of data on 406,406 Veterans obtained from VA's Operation Enduring Freedom/Operation Iraqi Freedom roster provided by Defense Manpower Data Center - Contingency Tracking System Deployment File. We compared three statistical models, ordinary, fixed and random effects hierarchical logistic regression, in order to assess the association of gender with healthcare utilization, controlling for branch of service, component, rank, age, race, and marital status. Gender was associated with utilization in ordinary logistic and, but not in fixed effects hierarchical logistic or random effects hierarchical logistic regression models. This point out that incomplete inference could be drawn by ignoring the military structure that may influence combat exposure and subsequent healthcare needs. Researchers should consider modeling VA data using methods that account for the potential clustering effect of hierarchy.

  15. Direct and Indirect Healthcare Resource Utilization and Costs Among Migraine Patients in the United States.

    Science.gov (United States)

    Bonafede, Machaon; Sapra, Sandhya; Shah, Neel; Tepper, Stewart; Cappell, Katherine; Desai, Pooja

    2018-02-15

    The goal of this analysis was to provide a contemporary estimate of the burden of migraine, incorporating both direct and indirect costs, by comparing the costs of migraine patients to a matched group of patients without migraine in a large, nationally representative sample of commercially insured patients in the United States. Previous studies have shown that the economic burden of migraine in the United States is substantial for payers, patients, and employers. Despite the availability of multiple acute and preventive pharmacological treatment options and a relatively stable migraine prevalence in the United States, there has been a documented increase in migraine-related healthcare resource and pharmacy use. Given the frequently disabling nature of migraine and its high prevalence, especially during peak productive years, and the lack of recent estimates of the burden of migraine, there is a need to update the existing literature with more current data. This retrospective, observational cohort study identified migraine patients in the Truven Health Market Scan Research Databases between January 2008 and June 2013. Adult patients had 12 months of continuous enrollment before (baseline period) and after (follow-up period) the day they received migraine diagnoses and/or medications (index) and no diagnosis of HIV or malignancy during the study period. The patients with migraine were matched 1:1 to a group of patients without migraine on demographic variables and index date. Direct healthcare utilization and costs and indirect (absenteeism, short-term disability, and long-term disability) costs were assessed during the 12-month follow-up period and differences between patients with vs without migraine were assessed. Two additional multivariable logistic regression analyses were conducted. First, an analysis was conducted comparing the odds of having a short-term disability claim between patients with and without migraine after controlling for patient demographic and

  16. Postpartum depression and intimate partner violence in urban mothers: co-occurrence and child healthcare utilization.

    Science.gov (United States)

    Kornfeld, Benjamin D; Bair-Merritt, Megan H; Frosch, Emily; Solomon, Barry S

    2012-08-01

    To assess the prevalence, timing, and co-occurrence of positive screens for maternal postpartum depression and intimate partner violence and examine their relationships with children's healthcare utilization from birth to 2 years. Between February and March 2008, mothers bringing newborn, 2-, 4-, or 6-month-old children to an urban primary care clinic were screened for postpartum depression and intimate partner violence. A retrospective chart review abstracted demographic data, maternal responses on the postpartum depression/intimate partner violence screen at the initial and subsequent visits, and, from the child's birth to second birthday, adherence with well-child care and use of pediatric acute care and emergency department visits. Descriptive, bivariate, and multivariate analyses were conducted. A total of 173 mothers completed at least one postpartum depression/intimate partner violence screening survey. Overall, 26% screened positive for postpartum depression and 7% screened positive for intimate partner violence; most positive screens occurred at the initial visit. About 60% of mothers with a positive intimate partner violence screen also had a positive postpartum depression screen. Well-child care adherence and acute care visit utilization were not associated with maternal postpartum depression/intimate partner violence screening. Children of women with a positive screen for postpartum depression had greater emergency department utilization. The co-occurrence of postpartum depression and intimate partner violence is high in urban mothers. Primary care providers should routinely screen for both problems in this population and recognize the importance of screening for one problem if the other problem is identified. Copyright © 2012 Mosby, Inc. All rights reserved.

  17. Together Achieving More: Primary Care Team Communication and Alcohol-Related Healthcare Utilization and Costs.

    Science.gov (United States)

    Mundt, Marlon P; Zakletskaia, Larissa I; Shoham, David A; Tuan, Wen-Jan; Carayon, Pascale

    2015-10-01

    Identifying and engaging excessive alcohol users in primary care may be an effective way to improve patient health outcomes, reduce alcohol-related acute care events, and lower costs. Little is known about what structures of primary care team communication are associated with alcohol-related patient outcomes. Using a sociometric survey of primary care clinic communication, this study evaluated the relation between team communication networks and alcohol-related utilization of care and costs. Between May 2013 and December 2013, a total of 155 healthcare employees at 6 primary care clinics participated in a survey on team communication. Three-level hierarchical modeling evaluated the link between connectedness within the care team and the number of alcohol-related emergency department visits, hospital days, and associated medical care costs in the past 12 months for each team's primary care patient panel. Teams (n = 31) whose registered nurses displayed more strong (at least daily) face-to-face ties and strong (at least daily) electronic communication ties had 10% fewer alcohol-related hospital days (rate ratio [RR] = 0.90; 95% confidence interval [CI]: 0.84, 0.97). Furthermore, in an average team size of 19, each additional team member with strong interaction ties across the whole team was associated with $1,030 (95% CI: -$1,819, -$241) lower alcohol-related patient healthcare costs per 1,000 team patients in the past 12 months. Conversely, teams whose primary care practitioner (PCP) had more strong face-to-face communication ties and more weak (weekly or several times a week) electronic communication ties had 12% more alcohol-related hospital days (RR = 1.12; 95% CI: 1.03, 1.23) and $1,428 (95% CI: $378, $2,478) higher alcohol-related healthcare costs per 1,000 patients in the past 12 months. The analyses controlled for patient age, gender, insurance, and comorbidity diagnoses. Excessive alcohol-using patients may fair better if cared for by teams whose

  18. Influence of the social determinants of health on access to healthcare services among refugees in Australia.

    Science.gov (United States)

    Taylor, Jessica; Lamaro Haintz, Greer

    2018-03-01

    Refugees in Australia are not fully utilising the healthcare system for several reasons and this may be affecting their overall health outcomes. This qualitative systematic review examined the influence of the social determinants of health on refugees' access to healthcare services in Australia. Electronic databases were searched using terms relating to refugees, social determinants, healthcare services, barriers, enablers and Australia. Only peer-reviewed studies published in English since 2006, which focused on refugees and specifically discussed social determinants influencing refugees' access to healthcare services in Australia, were included. The studies were critically analysed using standard Critical Appraisal Skills Programme Tools. Eight studies were included in the review. Findings reveal multiple factors influence refugees' access to healthcare in Australia, and these can be conceptualised within a social-ecological model of health; that is, they operate across individual, interpersonal, environmental, organisational and policy levels. The novel finding of this review was the re-occurrence of similar influences across multiple healthcare service settings in Australia. The prevalence and re-occurring nature of the social determinants of health suggests that refugees are experiencing multilayered barriers to accessing Australian healthcare. All levels of a social-ecological model must be addressed in any attempt to break down these barriers.

  19. [Utilization of tacit knowledge by maternal healthcare providers: a systematic mapping of the literature].

    Science.gov (United States)

    Calderón Espinosa, Emmanuel; Becerril Montekio, Víctor; Alcalde Rabanal, Jacqueline; García Bello, Luis

    2016-01-01

    The search for efficient answers to strengthen maternal health care has included various sources of evidence for decision making. In this article, we present a systematic mapping of the scientific literature on the use of tacit knowledge in relation to maternal healthcare. A systematic mapping was conducted of scientific articles published in Spanish and English between 1971 and 2014 following the recommendations of the Preferred Reporting Items for Systematic Reviews and Meta-analyses guidelines. Of 793 articles, 30 met the inclusion criteria; 60% were from high-income countries and 66.7% were focused on health professionals. We identified a predominance of qualitative methodologies (62%). Four categories regarding the use of tacit knowledge were generated: proposals to improve the organization of the maternal care system (30%) and to improve the care provided to women during the continuum of pregnancy, childbirth and postpartum (26.7%), determination of health workers' perception and skill levels (26.7%) and the interactions between tacit and explicit knowledge in clinical decision making (16.7%). This mapping shows that tacit knowledge is an emerging, innovative and versatile research approach used primarily in high-income countries and that includes interesting possibilities for its use as evidence to improve maternal healthcare, particularly in middle- and low-income countries, where it needs to be strengthened. Copyright © 2015 SESPAS. Published by Elsevier Espana. All rights reserved.

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

    Directory of Open Access Journals (Sweden)

    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

  1. Integrating the 3Ds—Social Determinants, Health Disparities, and Health-Care Workforce Diversity

    Science.gov (United States)

    Pierre, Geraldine

    2014-01-01

    The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce. PMID:24385659

  2. Integrating the 3Ds--social determinants, health disparities, and health-care workforce diversity.

    Science.gov (United States)

    LaVeist, Thomas A; Pierre, Geraldine

    2014-01-01

    The established relationships among social determinants of health (SDH), health disparities, and race/ethnicity highlight the need for health-care professionals to adequately address SDH in their encounters with patients. The ethnic demographic transition slated to occur during the next several decades in the United States will have numerous effects on the health-care sector, particularly as it pertains to the need for a more diverse and culturally aware workforce. In recent years, a substantial body of literature has developed, exploring the extent to which diversity in the health-care workforce may be used as a tool to eliminate racial/ethnic disparities in health and health care in the U.S. We explore existing literature on this topic, propose a conceptual framework, and identify next steps in health-care policy for reducing and eliminating health disparities by addressing SDH and diversification of the health-care workforce.

  3. Resting anal pressure, not outlet obstruction or transit, predicts healthcare utilization in chronic constipation: a retrospective cohort analysis

    Science.gov (United States)

    Staller, Kyle; Barshop, Kenneth; Kuo, Braden; Ananthakrishnan, Ashwin N

    2015-01-01

    Background Chronic constipation is common and exerts a considerable burden on health-related quality of life and healthcare resource utilization. Anorectal manometry (ARM) and colonic transit testing have allowed classification of subtypes of constipation, raising promise of targeted treatments. There has been limited study of the correlation between physiological parameters and healthcare utilization. Methods All patients undergoing ARM and colonic transit testing for chronic constipation at two tertiary care centers from 2000 to 2014 were included in this retrospective study. Our primary outcomes included number of constipation-related and gastroenterology visits per year. Multivariate linear regression adjusting for confounders defined independent effect of measures of colonic and anorectal function on healthcare utilization. Key Results Our study included 612 patients with chronic constipation. More than 50% (n=333) of patients had outlet obstruction by means of balloon expulsion testing and 43.5% (n=266) had slow colonic transit. On unadjusted analysis, outlet obstruction (1.98 vs. 1.68), slow transit (2.40 vs 2.07) and high resting anal pressure (2.16 vs. 1.76) were all associated with greater constipation-related visits/year compared to patients without each of those parameters (Pconstipation-related visits/year (P=0.02) and gastroenterology visits/year (P=0.04). Conclusions and Inferences Among patients with chronic constipation, high resting anal pressure, rather than outlet obstruction or slow transit, predicts healthcare resource utilization. PMID:26172284

  4. Determination of iodine content of some commonly utilized leafy ...

    African Journals Online (AJOL)

    Determination of iodine content of some commonly utilized leafy vegetables: Spinacea oleracea Linn (spinach), Brassica oleracea Var (cabbage), Hibiscus sabdriffa Linn and Lactuca sativa L. (lettuce) found in Kano metropolis vegetable markets.

  5. Children with neurodevelopmental disorders and disabilities: a population-based study of healthcare service utilization using administrative data.

    Science.gov (United States)

    Arim, Rubab G; Miller, Anton R; Guèvremont, Anne; Lach, Lucyna M; Brehaut, Jamie C; Kohen, Dafna E

    2017-12-01

    The aim of this study was to identify children with neurodevelopmental disorders and disabilities (NDD/D) and compare their healthcare service utilization to children without NDD/D using provincial linked administrative data. The sample included children aged 6 to 10 years (n=183 041), who were registered with the British Columbia Medical Services Plan. Diagnostic information was used for the identification and classification of NDD/D in six functional domains. Healthcare service utilization included outcomes based on physician claims, prescription medication use, and hospitalization. Overall, 8.3% of children were identified with NDD/D. Children with NDD/D had higher healthcare service utilization rates than those without NDD/D. Effect sizes were: very large for the number of days a prescription medication was dispensed; large for the number of prescriptions; medium for the number of physician visits, different specialists visited, number of different prescription medications, and ever hospitalized; and small for the number of laboratory visits, X-ray visits, and number of days hospitalized. The findings have policy implications for service and resource planning. Given the high use of psychostimulants, specialized services for both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D. Future studies may examine patterns of physician behaviours and costs attributable to healthcare service utilization for children with NDD/D. Children with neurodevelopmental disorders and disabilities (NDD/D) have higher healthcare service utilization than those without. Based on provincial population-based linked administrative health data, a sizeable number of children are living with NDD/D. Given the high use of psychostimulants, specialized services for children with both NDD/D and psychiatric conditions may be the most needed services for children with NDD/D. © 2017 Mac Keith Press.

  6. Health care service utilization among patients with bladder pain syndrome/interstitial cystitis in a single payer healthcare system.

    Directory of Open Access Journals (Sweden)

    Shiu-Dong Chung

    Full Text Available BACKGROUND: This study aims to investigate the differences in the utilization of healthcare services between patients with bladder pain syndrome/interstitial cystitis (BPS/IC and patients without using a population-based database in Taiwan. METHODS: This study comprised of 350 patients with BPS/IC and 1,750 age-matched controls. Healthcare resource utilization was evaluated in the one-year follow-up period as follows: number of outpatient visits and inpatient days, and the mean costs of outpatient and inpatient treatment. A multivariate regression analysis was used to evaluate the relationship between BPS/IC and total costs of health care services. RESULTS: For urological services, patients with BPS/IC had a significantly higher number of outpatient visits (2.5 vs. 0.2, p<0.001 as well as significantly higher outpatient costs ($US166 vs. $US6.8, p<0.001 than the controls. For non-urologic services, patients with BPS/IC had a significantly high number of outpatient visits (35.0 vs. 21.3, p<0.001 as well as significantly higher outpatient cots ($US912 vs. $US675, p<0.001 as compared to the controls. Overall, patients with BPS/IC had 174% more outpatient visits and 150% higher total costs than the controls. Multiple-regression-analyses also showed that the patients with BPS/IC had significantly higher total costs for all healthcare services than the controls. CONCLUSIONS: This study found that patients with BPS/IC have a significantly higher number of healthcare related visits, and have significantly higher healthcare related costs than age-matched controls. The high level of healthcare services utilization accrued with BPS/IC was not necessarily exclusive for BPS/IC, but may have also been associated with medical co-morbidities.

  7. The Impact of Trauma Exposure and Post-Traumatic Stress Disorder on Healthcare Utilization Among Primary Care Patients

    Science.gov (United States)

    Kartha, Anand; Brower, Victoria; Saitz, Richard; Samet, Jeffrey H.; Keane, Terence M.; Liebschutz, Jane

    2009-01-01

    Background Trauma exposure and post-traumatic stress disorder (PTSD) increase healthcare utilization in veterans, but their impact on utilization in other populations is uncertain. Objectives To examine the association of trauma exposure and PTSD with healthcare utilization, in civilian primary care patients. Research Design Cross-sectional study. Subjects English speaking patients at an academic, urban primary care clinic. Measures Trauma exposure and current PTSD diagnoses were obtained from the Composite International Diagnostic Interview. Outcomes were nonmental health outpatient and emergency department visits, hospitalizations, and mental health outpatient visits in the prior year from an electronic medical record. Analyses included bivariate unadjusted and multivariable Poisson regressions adjusted for age, gender, income, substance dependence, depression, and comorbidities. Results Among 592 subjects, 80% had ≥1 trauma exposure and 22% had current PTSD. In adjusted regressions, subjects with trauma exposure had more mental health visits [incidence rate ratio (IRR), 3.9; 95% confidence interval (CI), 1.1–14.1] but no other increased utilization. After adjusting for PTSD, this effect of trauma exposure was attenuated (IRR, 3.2; 95% CI, 0.9–11.7). Subjects with PTSD had more hospitalizations (IRR, 2.2; 95% CI, 1.4–3.7), more hospital nights (IRR, 2.6; 95% CI, 1.4–5.0), and more mental health visits (IRR, 2.2; 95% CI, 1.1–4.1) but no increase in outpatient and emergency department visits. Conclusions PTSD is associated with more hospitalizations, longer hospitalizations, and greater mental healthcare utilization in urban primary care patients. Although trauma exposure is independently associated with greater mental healthcare utilization, PTSD mediates a portion of this association. PMID:18362818

  8. Applying multivariate clustering techniques to health data: the 4 types of healthcare utilization in the Paris metropolitan area.

    Directory of Open Access Journals (Sweden)

    Thomas Lefèvre

    Full Text Available Cost containment policies and the need to satisfy patients' health needs and care expectations provide major challenges to healthcare systems. Identification of homogeneous groups in terms of healthcare utilisation could lead to a better understanding of how to adjust healthcare provision to society and patient needs.This study used data from the third wave of the SIRS cohort study, a representative, population-based, socio-epidemiological study set up in 2005 in the Paris metropolitan area, France. The data were analysed using a cross-sectional design. In 2010, 3000 individuals were interviewed in their homes. Non-conventional multivariate clustering techniques were used to determine homogeneous user groups in data. Multinomial models assessed a wide range of potential associations between user characteristics and their pattern of healthcare utilisation.We identified four distinct patterns of healthcare use. Patterns of consumption and the socio-demographic characteristics of users differed qualitatively and quantitatively between these four profiles. Extensive and intensive use by older, wealthier and unhealthier people contrasted with narrow and parsimonious use by younger, socially deprived people and immigrants. Rare, intermittent use by young healthy men contrasted with regular targeted use by healthy and wealthy women.The use of an original technique of massive multivariate analysis allowed us to characterise different types of healthcare users, both in terms of resource utilisation and socio-demographic variables. This method would merit replication in different populations and healthcare systems.

  9. Reproductive healthcare utilization in urban poor settlements of Delhi: Baseline survey of ANCHUL (Ante Natal and Child Health care in Urban Slums) project.

    Science.gov (United States)

    Devasenapathy, Niveditha; Ghosh Jerath, Suparna; Allen, Elizebeth; Sharma, Saket; Shankar, Anuraj H; Zodpey, Sanjay

    2015-09-08

    Disparity in utilization of reproductive healthcare services between the urban poor and the urban non-poor households in the developing nations is well known. However, disparity may also exist within urban poor households. Our objective was to document the extent of disparity in reproductive healthcare utilization among the urban poor and to identify the socio-demographic determinants of underutilization with a view to characterizing this vulnerable subpopulation. A survey of 16,221 households was conducted in 39 clusters from two large urban poor settlements in Delhi. From 13,451 consenting households, socio-demographic data and information on births, maternal and child deaths within the previous year was collected. Details of antenatal care (ANC) was collected from 597 pregnant women. Information on ANC and postnatal care was also obtained from 596 recently delivered (within six months) mothers. All data were captured electronically using a customized and validated smart phone application. Households were categorized into quintiles of socio-economic position (SEP) based on dwelling characteristics and possession of durable assets using principal component analysis. Potential socio-demographic determinants of reproductive healthcare utilization were examined using random effects logistic regression. The prevalence of facility based birthing was 77% (n = 596 mothers). Of the 596 recently delivered mothers only 70% had an ANC registration card, 46.3% had ANC in their first trimester, 46% had visited a facility within 4 weeks post-delivery and 27% were using modern contraceptive methods. Low socio-economic position was the most important predictor of underutilization with a clear gradient across SEP quintiles. Compared to the poorest, the least poor women were more likely to be registered for ANC (OR 1.96, 95%CI 0.95-4.15) and more likely to have made ≥ 4 ANC visits (OR 5.86, 95%CI 2.82-12.19). They were more likely to have given birth in a facility (OR 4

  10. Mental Healthcare Utilization in Patients Seeking Bariatric Surgery : The Role of Attachment Behavior

    NARCIS (Netherlands)

    Aarts, Floor; Hinnen, Chris; Gerdes, Victor E. A.; Brandjes, Dees P. M.; Geenen, Rinie

    2013-01-01

    Obesity may be a factor contributing to mental health in patients seeking bariatric surgery. Whether a person uses mental healthcare may have its roots in attachment behavior. The present study (N=260) identified that attachment anxiety was associated with more mental healthcare visits (OR=1.86, 95%

  11. Perceived and normative needs, utilization of oral healthcare services, and barriers to utilization of dental care services at peripheral medical centre: Poonjeri, Mamallapuram, India

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    Prabhu Subramani

    2017-01-01

    Full Text Available Introduction: Dental care utilization is limited, and teeth are often left untreated or extracted in India. Several barriers exist for the utilization of dental services. The present study was undertaken to assess the oral healthcare needs, utilization pattern of oral healthcare services, and barriers to utilization of oral healthcare services among the outpatients of Peripheral Medical Centre, Poonjeri, Mamallapuram, India. Materials and Methods: Simple random sampling was conducted among outpatients and their attenders reporting to the health centre; demographic profile of the patients were recorded followed by interviewer-administered questionnaire for recording the self-perceived dental needs and barriers in utilizing dental care services followed by Type II clinical examination to assess normative dental treatment needs. Results: N =282 study participants participated in the present study; majority of the study participants were from upper lower class and lower middle class. Among the study subjects n = 124 (44% have not accessed any dentist, n = 112 (39.7% had visited dentist for toothache. Common reason cited as Self – perceived barriers for dental care are n = 184 (65.2% – 'Unaware of the dental problems' and n = 118 (41.8% 'Fear of dental treatment'. Logistic regression showed that significant difference was seen in gender, socioeconomic status, and barriers to dental care (P < 0.05 in influencing the utilization pattern of dental care. Conclusion: Perceived and normative dental needs were high among the study population due to problem-oriented care, and it is influenced by various barriers such as unawareness of dental problems, fear, cost, accessibility, and time.

  12. Healthcare Utilization and Expenditures Associated With Appropriate and Inappropriate Implantable Defibrillator Shocks.

    Science.gov (United States)

    Turakhia, Mintu P; Zweibel, Steven; Swain, Andrea L; Mollenkopf, Sarah A; Reynolds, Matthew R

    2017-02-01

    In patients with implantable cardioverter-defibrillators, healthcare utilization (HCU) and expenditures related to shocks have not been quantified. We performed a retrospective cohort study of patients with implantable cardioverter-defibrillators identified from commercial and Medicare supplemental claims databases linked to adjudicated shock events from remote monitoring data. A shock event was defined as ≥1 spontaneous shocks delivered by an implanted device. Shock-related HCU was ascertained from inpatient and outpatient claims within 7 days following a shock event. Shock events were adjudicated and classified as inappropriate or appropriate, and HCU and expenditures, stratified by shock type, were quantified. Of 10 266 linked patients, 963 (9.4%) patients (61.3±13.6 years; 81% male) had 1885 shock events (56% appropriate, 38% inappropriate, and 6% indeterminate). Of these events, 867 (46%) had shock-related HCU (14% inpatient and 32% outpatient). After shocks, inpatient cardiovascular procedures were common, including echocardiography (59%), electrophysiology study or ablation (34%), stress testing (16%), and lead revision (11%). Cardiac catheterization was common (71% and 51%), but percutaneous coronary intervention was low (6.5% and 5.0%) after appropriate and inappropriate shocks. Expenditures related to appropriate and inappropriate shocks were not significantly different. After implantable cardioverter-defibrillator shock, related HCU was common, with 1 in 3 shock events followed by outpatient HCU and 1 in 7 followed by hospitalization. Use of invasive cardiovascular procedures was substantial, even after inappropriate shocks, which comprised 38% of all shocks. Implantable cardioverter-defibrillator shocks seem to trigger a cascade of health care. Strategies to reduce shocks could result in cost savings. © 2017 American Heart Association, Inc.

  13. Trends in healthcare utilization among older Americans with colorectal cancer: A retrospective database analysis

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    Earle Craig C

    2009-12-01

    Full Text Available Abstract Background Analyses of utilization trends (cost drivers allow us to understand changes in colorectal cancer (CRC costs over time, better predict future costs, identify changes in the use of specific types of care (eg, hospice, and provide inputs for cost-effectiveness models. This retrospective cohort study evaluated healthcare resource use among US Medicare beneficiaries diagnosed with CRC between 1992 and 2002. Methods Cohorts included patients aged 66+ newly diagnosed with adenocarcinoma of the colon (n = 52,371 or rectum (n = 18,619 between 1992 and 2002 and matched patients from the general Medicare population, followed until death or December 31, 2005. Demographic and clinical characteristics were evaluated by cancer subsite. Resource use, including the percentage that used each type of resource, number of hospitalizations, and number of hospital and skilled nursing facility days, was evaluated by stage and subsite. The number of office, outpatient, and inpatient visits per person-year was calculated for each cohort, and was described by year of service, subsite, and treatment phase. Hospice use rates in the last year of life were calculated by year of service, stage, and subsite for CRC patients who died of CRC. Results CRC patients (mean age: 77.3 years; 44.9% male used more resources than controls in every category (P Conclusion Use of hospice care among CRC decedents increased substantially over the study period, while other resource use remained generally steady. Our findings may be useful for understanding CRC cost drivers, tracking trends, and forecasting resource needs for CRC patients in the future.

  14. Impact of China's Public Hospital Reform on Healthcare Expenditures and Utilization: A Case Study in ZJ Province.

    Science.gov (United States)

    Zhang, Hao; Hu, Huimei; Wu, Christina; Yu, Hai; Dong, Hengjin

    2015-01-01

    High drug costs due to supplier-induced demand (SID) obstruct healthcare accessibility in China. Drug prescriptions can generate markup-related profits, and the low prices of other medical services can lead to labor-force underestimations; therefore, physicians are keen to prescribe drugs rather than services. Thus, in China, a public hospital reform has been instituted to cancel markups and increase service prices. A retrospective pre/post-reform study was conducted in ZJ province to assess the impact of the reform on healthcare expenditures and utilization, ultimately to inform policy development and decision-making. The main indicators are healthcare expenditures and utilization. Post-reform, drug expenditures per visit decreased by 8.2% and 15.36% in outpatient and inpatient care, respectively; service expenditures per visit increased by 23.03% and 27.69% in outpatient and inpatient care, respectively. Drug utilization per visit increased by 5.58% in outpatient care and underwent no significant change in inpatient care. Both were lower than the theoretical drug-utilization level, which may move along the demand curve because of patient-initiated demand (PID); this indicates that SID-promoted drug utilization may decrease. Finally, service utilization per visit increased by 6% in outpatient care and by 13.10% in inpatient care; both were higher than the theoretical level moving along the demand curve, and this indicates that SID-promoted service utilization may increase. The reform reduces drug-prescription profits by eliminating drug markups; additionally, it compensates for service costs by increasing service prices. Post-reform, the SID of drug prescriptions decreased, which may reduce drug-resource waste. The SID of services increased, with potentially positive and negative effects: accessibility to services may be promoted when physicians provide more services, but the risk of resource waste may also increase. This warrants further research. It is

  15. Subsequent health-care utilization associated with early physical therapy for new episodes of low back pain in older adults.

    Science.gov (United States)

    Karvelas, Deven A; Rundell, Sean D; Friedly, Janna L; Gellhorn, Alfred C; Gold, Laura S; Comstock, Bryan A; Heagerty, Patrick J; Bresnahan, Brian W; Nerenz, David R; Jarvik, Jeffrey G

    2017-03-01

    The association between early physical therapy (PT) and subsequent health-care utilization following a new visit for low back pain is not clear, particularly in the setting of acute low back pain. This study aimed to estimate the association between initiating early PT following a new visit for an episode of low back pain and subsequent back pain-specific health-care utilization in older adults. This is a prospective cohort study. Data were collected at three integrated health-care systems in the United States through the Back Pain Outcomes using Longitudinal Data (BOLD) registry. We recruited 4,723 adults, aged 65 and older, presenting to a primary care setting with a new episode of low back pain. Primary outcome was total back pain-specific relative value units (RVUs), from days 29 to 365. Secondary outcomes included overall RVUs for all health care and use of specific health-care services including imaging (x-ray and magnetic resonance imaging [MRI] or computed tomography [CT]), emergency department visits, physician visits, PT, spinal injections, spinal surgeries, and opioid use. We compared patients who had early PT (initiated within 28 days of the index visit) with those not initiating early PT using appropriate, generalized linear models to adjust for potential confounding variables. Adjusted analysis found no statistically significant difference in total spine RVUs between the two groups (ratio of means 1.19, 95% CI of 0.72-1.96, p=.49). For secondary outcomes, only the difference between total spine imaging RVUs and total PT RVUs was statistically significant. The early PT group had greater PT RVUs; the ratio of means was 2.56 (95% CI of 2.17-3.03, plow back pain, the use of early PT is not associated with any statistically significant difference in subsequent back pain-specific health-care utilization compared with patients not receiving early PT. Copyright © 2016 Elsevier Inc. All rights reserved.

  16. Social and emotional difficulties in children with ADHD and the impact on school attendance and healthcare utilization

    Directory of Open Access Journals (Sweden)

    Classi Peter

    2012-10-01

    Full Text Available Abstract Background The objective of this study was to examine the impact of co-occurring social and emotional difficulties on missed school days and healthcare utilization among children with attention deficit/hyperactivity disorder (ADHD. Methods Data were from the 2007 U.S. National Health Interview Survey (NHIS and were based on parental proxy responses to questions in the Sample Child Core, which includes questions on demographics, health, healthcare treatment, and social and emotional status as measured by questions about depression, anxiety, and phobias, as well as items from the brief version of the Strength and Difficulties Questionnaire (SDQ. Logistic regression was used to assess the association between co-occurring social and emotional difficulties with missed school days and healthcare utilization, adjusting for demographics. Results Of the 5896 children aged 6–17 years in the 2007 NHIS, 432 (7.3% had ADHD, based on parental report. Children with ADHD and comorbid depression, anxiety, or phobias had significantly greater odds of experiencing > 2 weeks of missed school days, ≥ 6 visits to a healthcare provider (HCP, and ≥ 2 visits to the ER, compared with ADHD children without those comorbidities (OR range: 2.1 to 10.4. Significantly greater odds of missed school days, HCP visits, and ER visits were also experienced by children with ADHD who were worried, unhappy/depressed, or having emotional difficulties as assessed by the SDQ, compared with ADHD children without those difficulties (OR range: 2.2 to 4.4. Conclusions In children with ADHD, the presence of social and emotional problems resulted in greater odds of missed school days and healthcare utilization. These findings should be viewed in light of the limited nature of the parent-report measures used to assess social and emotional problems.

  17. Comparing treatment persistence, healthcare resource utilization, and costs in adult patients with major depressive disorder treated with escitalopram or citalopram.

    Science.gov (United States)

    Wu, Eric Q; Greenberg, Paul E; Ben-Hamadi, Rym; Yu, Andrew P; Yang, Elaine H; Erder, M Haim

    2011-03-01

    Major depressive disorder is the most common type of depression, affecting 6.6% of adults in the United States annually. Citalopram and escitalopram are common second-generation antidepressants used for the treatment of patients with this disorder. Because citalopram is available in generic forms that have lower acquisition costs compared with the branded escitalopram, some health plans may provide incentives to encourage the use of the generic option. Decisions based solely on drug acquisition costs may encourage the use of a therapy that is less cost-effective when treatment persistence, healthcare utilization, and overall costs are factored in. To compare, in a real-world setting, the treatment persistence, healthcare utilization, and overall costs of managing adult patients with major depressive disorder who are treated with escitalopram or citalopram. Administrative claims data (from January 1, 2003, to June 30, 2005) were analyzed for patients with major depressive disorder aged ≥18 years. Patients filled ≥1 prescriptions for citalopram or for escitalopram (first-fill time was defined as the index date) and had no second-generation antidepressant use during the 6-month preindex period. Treatment persistence, healthcare utilization, and healthcare costs were measured over the 6-month preindex and 6-month postindex periods and compared between patients treated with citalopram or escitalopram, using unadjusted and multivariate analyses. Patients receiving escitalopram (N = 10,465) were less likely to discontinue the treatment (hazard ratio 0.94; P = .005) and switch to another second-generation antidepressant (hazard ratio 0.83; P escitalopram were also less likely to have a hospital admission (odds ratio 0.88; P = .036) or an emergency department visit and had lower total healthcare costs (-$1174) and major depressive disorder-related costs (-$109; P escitalopram, patients treated with escitalopram had better treatment persistence, lower healthcare

  18. A European chart review study on early rheumatoid arthritis treatment patterns, clinical outcomes, and healthcare utilization.

    Science.gov (United States)

    Emery, Paul; Solem, Caitlyn; Majer, Istvan; Cappelleri, Joseph C; Tarallo, Miriam

    2015-11-01

    This retrospective medical chart review aimed to provide a current, real-world overview of biologic usage in patients with rheumatoid arthritis (RA) in Germany, Spain, and the UK, and estimate clinical and healthcare utilization outcomes associated with early versus late treatment. Adults (≥18 years) with a confirmed RA diagnosis between January 2008 and December 2010, who received biologic treatment for ≥3 months and had ≥12 months of follow-up were included. Early treatment was receipt of biologic agent ≤1 year after RA diagnosis. Outcomes included 28-joint disease activity score (DAS28) reduction of ≥1.2 from biologic start and remission (DAS28 < 2.6). Time to outcome was evaluated using Kaplan-Meier curves and log-rank tests. Of 328 patients enrolled (Germany [n = 111], Spain [n = 106], UK [n = 111]), 58.2 % received early biologic (Germany: 55.0 %, UK: 55.9 %, Spain: 64.2 %; p = 0.321). First-line biologics were more frequent in Spain (26.4 %) and Germany (19.8 %) versus the UK (7.2 %; p < 0.001). Late-treated patients were hospitalized more often than early-treated patients (10.5 vs 2.9 % [p = 0.006] for 9.0 vs 5.4 mean inpatient days [p = 0.408]). DAS28 was 5.1 at biologic initiation (n = 310); 73.5 % of patients had a DAS28 decrease of ≥1.2 and 44.5 % achieved remission. More patients had DAS28 decrease of ≥1.2 (79.2 vs 65.9 %; p = 0.009) and remission (51.1 vs 35.6 %; p = 0.007) with early versus late treatment, with a significant difference in Kaplan-Meier curves when indexing on time since diagnosis (p < 0.001) and biologic start (p = 0.024). In RA patients receiving biologic therapy, over half received biologic therapy early. Early initiation was associated with improved clinical outcomes and reduced hospitalization rates versus late treatment.

  19. Quality improvement in healthcare delivery utilizing the patient-centered medical home model.

    Science.gov (United States)

    Akinci, Fevzi; Patel, Poonam M

    2014-01-01

    Despite the fact that the United States dedicates so much of its resources to healthcare, the current healthcare delivery system still faces significant quality challenges. The lack of effective communication and coordination of care services across the continuum of care poses disadvantages for those requiring long-term management of their chronic conditions. This is why the new transformation in healthcare known as the patient-centered medical home (PCMH) can help restore confidence in our population that the healthcare services they receive is of the utmost quality and will effectively enhance their quality of life. Healthcare using the PCMH model is delivered with the patient at the center of the transformation and by reinvigorating primary care. The PCMH model strives to deliver effective quality care while attempting to reduce costs. In order to relieve some of our healthcare system distresses, organizations can modify their delivery of care to be patient centered. Enhanced coordination of services, better provider access, self-management, and a team-based approach to care represent some of the key principles of the PCMH model. Patients that can most benefit are those that require long-term management of their conditions such as chronic disease and behavioral health patient populations. The PCMH is a feasible option for delivery reform as pilot studies have documented successful outcomes. Controversy about the lack of a medical neighborhood has created concern about the overall sustainability of the medical home. The medical home can stand independently and continuously provide enhanced care services as a movement toward higher quality care while organizations and government policy assess what types of incentives to put into place for the full collaboration and coordination of care in the healthcare system.

  20. Determinants Of Poor Utilization Of Orthodox Health Facilities In A ...

    African Journals Online (AJOL)

    Objective: To determine some factors limiting the utilization of orthodox health care facilities in Enugu State Methods: Interview was conducted between September 2001 and November 2002 on 474 randomly selected pregnant women who received antenatal care in places other than the orthodox facilities in Nkanu.

  1. Socio-demographic determinants of antenatal clinic utilization in a ...

    African Journals Online (AJOL)

    Socio-demographic determinants of antenatal clinic utilization in a Nigerian university teaching hospital. ... CONCLUSION:Among other social factors female education improved women's ability to take decisions on reproductive matters. Poor education and low socioeconomic status not only increase women's vulnerability ...

  2. Determinants of poultry farmers' decision to utilize credit: A case ...

    African Journals Online (AJOL)

    This study analysed the determinants of poultry farmers' decision to utilize credit in Abia state, Nigeria. The study was based on primary data obtained using a multistage random sampling technique, 80 respondents were obtained. The data was analyzed using descriptive statistics, logit regression, cost and returns analysis ...

  3. Racial/Ethnic Differences in Cigarette Use: The Roles of Mental Illness and Health-Care Access/Utilization.

    Science.gov (United States)

    Lo, Celia C; Yang, Fan; Ash-Houchen, William; Cheng, Tyrone C

    2017-11-27

    Empirical evidence supports a hypothesis that cigarettes may be used to cope with mental illness. Little research, however, addresses how race/ethnicity is linked to mental health and cigarette use. This study applied the self-medication hypothesis. It asked whether mental status was associated, via health-care access/utilization, with the cigarette use outcomes of four racial/ethnic groups. It also tested whether race/ethnicity moderated any such associations. We used nationally representative data from the 2009-2010 and 2011-2012 National Health and Nutrition Examination Surveys to link cigarette use to mental status and health-care access/utilization. The final sample included 3827 White respondents, 1635 African-American respondents, 1144 Mexican-American respondents, and 781 Hispanic American (other than Mexican-American) respondents. Consistent with earlier research and the self-medication hypothesis, we observed a positive relationship between cigarette use and mental status. Associations of cigarette use and health-care access/utilization sometimes failed to take expected directions. We concluded from the findings that race/ethnicity's moderating role in associations between cigarette use and health-care access was generally more advantageous to Whites than other groups examined. Where treatment is delayed by lack of access to, or lack of trust in, care providers, mental health may worsen-and it is often minority Americans who lack access and trust. If minority Americans' health is to improve, shrinking racial health disparities, then access to adequate health care must be available to them, facilitating prompt treatment of mental and other illness.

  4. Determinants of RFID adoption in Malaysia's healthcare industry: occupational level as a moderator.

    Science.gov (United States)

    Zailani, Suhaiza; Iranmanesh, Mohammad; Nikbin, Davoud; Beng, Jameson Khoo Cheong

    2015-01-01

    With today's highly competitive market in the healthcare industry, Radio Frequency Identification (RFID) is a technology that can be applied by hospitals to improve operational efficiency and to gain a competitive advantage over their competitors. The purpose of this study is to investigate the factors that may effect RFID adoption in Malaysia's healthcare industry. In addition, the moderating role of occupational level was tested. Data was collected from 223 managers as well as healthcare and supporting staffs. This data was analyzed using the partial least squares technique. The results show that perceived ease of use and usefulness, government policy, top management support, and security and privacy concerns have an effect on the intent to adopt RFID in hospitals. There is a wide gap between managers and healthcare staff in terms of the factors that influence RFID adoption. The results of this study will help decision makers as well as managers in the healthcare industry to better understand the determinants of RFID adoption. Additionally, it will assist in the process of RFID adoption, and therefore, spread the usage of RFID technology in more hospitals.

  5. Physical Health, Medication, and Healthcare Utilization among 70-Year-Old People with Schizophrenia: A Nationwide Danish Register Study.

    Science.gov (United States)

    Brink, Maria; Green, Anders; Bojesen, Anders Bo; Lamberti, J Steven; Conwell, Yeates; Andersen, Kjeld

    2017-05-01

    In light of the excess early mortality in schizophrenia, mainly due to physical illnesses, we investigated medical comorbidity, use of medication, and healthcare utilization among individuals with schizophrenia who survived into older ages to uncover potential factors contributing to their longevity. A nationwide register-based case-control study comparing 70-year-olds with and without schizophrenia. Cases were drawn from the Danish Psychiatric Central Register. Age- and sex-matched controls were drawn from the general population via the Civil Registration System. All Danish inhabitants who were diagnosed and registered with early onset schizophrenia in 1970-1979 and still alive at age 70 years. Controls alive at age 70 years. Chronic medical comorbidity, medications, and inpatient and outpatient healthcare utilization extracted from Danish healthcare registers. Older adults with schizophrenia did not differ from controls with regard to registered chronic medical illnesses, but were significantly less likely to receive medication for cardiovascular diseases (OR: 0.65; 99.29% CI: 0.50, 0.83) and more likely to be treated with analgesics (OR: 1.46; 99.29% CI: 1.04, 2.05). Overall, hospital admissions and number of days hospitalized were equal to controls, but with significantly fewer general medical outpatient contacts (RR: 0.37; 98.75% CI: 0.24, 0.55). Because the literature suggests that excess mortality continues into old age, it is possible that medical diseases were under-registered and/or under-treated. Focus on adequate medical treatment, in particular for cardiovascular disease, is needed. Future integration of psychiatric and general medical healthcare, especially outpatient care, might further optimize health outcomes for older adults with schizophrenia. Copyright © 2017 American Association for Geriatric Psychiatry. Published by Elsevier Inc. All rights reserved.

  6. Socio-economic determinants of household out-of-pocket payments on healthcare in Pakistan

    Directory of Open Access Journals (Sweden)

    Muhammad Malik Ashar

    2012-09-01

    Full Text Available Abstract Background Out-of-pocket (OOP payment on healthcare is dominant mode of financing in developing countries. In Pakistan it is 67% of total expenditure on healthcare. Analysis of determinants of OOP health expenditure is a key aspect of equity in healthcare financing. It helps to formulate an effective health policy. Evidence on OOP in Pakistan is sparse. This paper attempts to fill this research gap. Methods We estimated determinants of OOP payments on healthcare in Pakistan. We used data sets of Pakistan Household Integrated Economic Survey (HIES and Pakistan Standard of Living Measurement (PSLM Survey for the year 2004-05. We developed a multiple regression model for the determinants of OOP payments using methods of Ordinary Least Square (OLS. We mainly used social, economic, demographic and health variables in our analysis. Results Median household OOP healthcare in the year 2004-05 was Pakistani Rupees (PKR 2500 (US$ 41.99 in 2004-05. Household non-food expenditure was the single highest significant predictor of household OOP health expenditure. Household features like literate head and spouse, at least one obstetric delivery in last three years, unsafe water, unhygienic toilet and household belonging to Khyber Pukhtonkhwa (KPK province were significant positive predictors of OOP payments. Households with male head, bricks used in housing construction, household with at least one child and no elderly, and head of household in a white collar profession were negative predictors of OOP payments. Conclusion Our analysis confirms earlier findings that economic status and number of old aged members are significant positive predictors of OOP payments. This association can direct government to enhance allocations to healthcare and to include program focusing on non-communicable diseases. Our findings suggest further research to explore beneficiaries of government healthcare programs and determinants of high OOP payments by household residing

  7. Determination of the best appropriate management methods for the health-care wastes in Istanbul

    International Nuclear Information System (INIS)

    Alagoez, Aylin Zeren; Kocasoy, Guenay

    2008-01-01

    Health-care waste management has been a significant problem in most economically developing countries as it is in Turkey. Most of the time, the main reason for the mismanagement of these wastes is the lack of appropriate legislation and effective control; other reasons are: financial strains and a lack of awareness. Being aware of the significance of the subject, in this paper the management of the health-care wastes in Istanbul, as a Metropolitan City of Turkey, was analyzed to create an integrated health-care waste management system in the city. Within the scope of the study, the existing situation and management practices such as the amount of the health-care wastes generated, segregation procedures, collection, temporary storage and transportation of the wastes within and outside of the institution were examined. Deficiencies, inconsistencies and improper applications were revealed. The existing Turkish Medical Wastes Control Regulation and institutional structure of the health-care waste management body were reviewed. After the evaluation and comparison with the requirements of other national and international organizations, items to be changed/added in the Regulation were identified. At the end of the study, the best management methods for the Istanbul City were determined and started to be applied at the institutions. After this study, the existing Regulation has been changed. The modified Regulation was published in 2005 and implementation has started. It is expected that by the application and implementation of the research outcomes, the management of health-care wastes in Istanbul and then in all over Turkey will be improved. The results obtained can also be used in most economically developing countries where there are similar environmental problems and strict budgets

  8. Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh

    Directory of Open Access Journals (Sweden)

    Rashidul Alam Mahumud

    2017-03-01

    Full Text Available Objectives As in many low-income and middle-income countries, out-of-pocket (OOP payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. Methods A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. Results The mean total OOP healthcare expenditures was US dollar (USD 27.66; while, the cost of medicines (USD 16.98 was the highest cost driver (61% of total OOP healthcare expenditure. In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. Conclusions The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

  9. Distribution and Determinants of Out-of-pocket Healthcare Expenditures in Bangladesh.

    Science.gov (United States)

    Mahumud, Rashidul Alam; Sarker, Abdur Razzaque; Sultana, Marufa; Islam, Ziaul; Khan, Jahangir; Morton, Alec

    2017-03-01

    As in many low-income and middle-income countries, out-of-pocket (OOP) payments by patients or their families are a key healthcare financing mechanism in Bangladesh that leads to economic burdens for households. The objective of this study was to identify whether and to what extent socioeconomic, demographic, and behavioral factors of the population had an impact on OOP expenditures in Bangladesh. A total of 12 400 patients who had paid to receive any type of healthcare services within the previous 30 days were analyzed from the Bangladesh Household Income and Expenditure Survey data, 2010. We employed regression analysis for identify factors influencing OOP health expenditures using the ordinary least square method. The mean total OOP healthcare expenditures was US dollar (USD) 27.66; while, the cost of medicines (USD 16.98) was the highest cost driver (61% of total OOP healthcare expenditure). In addition, this study identified age, sex, marital status, place of residence, and family wealth as significant factors associated with higher OOP healthcare expenditures. In contrary, unemployment and not receiving financial social benefits were inversely associated with OOP expenditures. The findings of this study can help decision-makers by clarifying the determinants of OOP, discussing the mechanisms driving these determinants, and there by underscoring the need to develop policy options for building stronger financial protection mechanisms. The government should consider devoting more resources to providing free or subsidized care. In parallel with government action, the development of other prudential and sustainable risk-pooling mechanisms may help attract enthusiastic subscribers to community-based health insurance schemes.

  10. Continuity of Care and Healthcare Utilization in Older Adults with Dementia in Fee-for-Service Medicare

    Science.gov (United States)

    Amjad, Halima; Carmichael, Donald; Austin, Andrea M; Chang, Chiang-Hua; Bynum, Julie PW

    2016-01-01

    Importance Poor continuity of care may contribute to high healthcare spending and adverse patient outcomes in dementia. Objective To examine the association between medical provider continuity and healthcare utilization, testing, and spending in older adults with dementia. Design Observational retrospective cohort from 2012 using inverse probability weighted analysis. Setting National sample in fee-for-service Medicare. Participants 1,416,369 continuously enrolled, community dwelling, fee-for-service Medicare beneficiaries age ≥ 65 with a claims-based dementia diagnosis and at least 4 ambulatory visits in 2012. Exposure Continuity of care score measured on patient visits across physicians over 12 months. A higher continuity score is assigned to visit patterns in which a larger share of the patient’s total visits are with fewer providers. Score range from 0 to 1 was examined in low, medium, and high continuity tertiles. Main Outcomes and Measures Outcomes include all-cause hospitalization, ambulatory care sensitive condition hospitalization, emergency department visit, imaging and lab testing (CT head, chest x-ray, urinalysis, and urine culture), and healthcare spending (overall, hospital and skilled nursing facility, and physician). Results Beneficiaries with dementia who had lower levels of continuity of care were younger, higher income, and had more comorbid medical conditions. Almost 50% of patients had at least one hospitalization and emergency department visit during the year. Utilization was lower with increasing level of continuity. Specifically comparing the highest versus lowest continuity groups, annual rates per beneficiary of hospitalization (0.83 vs 0.88), emergency department visits (0.84 vs 0.99), CT head (0.71 vs 0.83), urinalysis (0.72 vs 1.09), and healthcare spending (total spending $22,004 vs $24,371) were higher with lower continuity even after accounting for sociodemographic factors and comorbidity burden (all p values care sensitive

  11. Intra-urban Differentials in the Utilization of Reproductive Healthcare in India, 1992–2006

    OpenAIRE

    Kumar, Abhishek; Mohanty, Sanjay K.

    2011-01-01

    This paper examines trends in three reproductive healthcare indicators— namely, antenatal care, medical assistance at delivery, and contraceptive use among the urban poor and non-poor in India using data from the National Family Health Surveys, 1992–1993 and 2005–2006. The urban poor and non-poor are derived from composite wealth indices based on a set of economic proxies. Results indicate that the estimates of poor and non-poor are reliable. During the last 14 years, the service coverage in ...

  12. Determinants of Diabetes and Hypertension Control in Ambulatory Healthcare in Al Ain, United Arab Emirates

    Directory of Open Access Journals (Sweden)

    Latifa M. Baynouna

    2014-05-01

    Full Text Available bjectives: This study aims to study determinants for the control of diabetes and hypertension in Al Ain Ambulatory Healthcare patients. Method: This is a cross sectional observational study of patients attending ambulatory healthcare centers in Al Ain, United Arab Emirates in 2009. From a yearly audit evaluating the care of patients with diabetes and hypertension, the determinants for improved diabetes and hypertension outcomes were identified from a total of 512 patients and its association with glycemic and blood pressure control were studied. Results: From all variables studied, only the clinic where the patient was treated helped predict both improved blood sugar and blood pressure control. For patients with diabetes, poor control the year before (p<0.001, the number of chronic disease clinic visits (p=0.042 and triglyceride levels (p=0.007 predicted worse control of diabetes. A predictor of poor control of blood pressure (p<0.001 for patients with hypertension was poor control of blood pressure in the year before. Conclusion: In this population, the healthcare system and the team played major roles as determinants in the control of patient’s diabetes and blood pressure more than any of the other factors examined.

  13. A Way Forward for Healthcare in Madagascar?

    Science.gov (United States)

    Marks, Florian; Rabehanta, Nathalie; Baker, Stephen; Panzner, Ursula; Park, Se Eun; Fobil, Julius N; Meyer, Christian G; Rakotozandrindrainy, Raphaël

    2016-03-15

    A healthcare utilization survey was conducted as a component of the Typhoid Fever Surveillance in Africa Program (TSAP). The findings of this survey in Madagascar contrasted with those in other sites of the program; namely, only 30% of the population sought healthcare at the government-provided healthcare facilities for fever. These findings promoted us to determine the drivers and barriers in accessing and utilizing healthcare in Madagascar. Here we review the results of the TSAP healthcare utilization initiative and place them in the context of the current organization of the Madagascan healthcare system. Our work highlights the demands of the population for access to appropriate healthcare and the need for novel solutions that can quickly provide an affordable and sustainable basic healthcare infrastructure until a government-funded scheme is in place. © The Author 2016. Published by Oxford University Press for the Infectious Diseases Society of America. All rights reserved. For permissions, e-mail journals.permissions@oup.com.

  14. Ambulatory Healthcare Utilization in the United States: A System Dynamics Approach

    Science.gov (United States)

    Diaz, Rafael; Behr, Joshua G.; Tulpule, Mandar

    2011-01-01

    Ambulatory health care needs within the United States are served by a wide range of hospitals, clinics, and private practices. The Emergency Department (ED) functions as an important point of supply for ambulatory healthcare services. Growth in our aging populations as well as changes stemming from broader healthcare reform are expected to continue trend in congestion and increasing demand for ED services. While congestion is, in part, a manifestation of unmatched demand, the state of the alignment between the demand for, and supply of, emergency department services affects quality of care and profitability. The central focus of this research is to provide an explanation of the salient factors at play within the dynamic demand-supply tensions within which ambulatory care is provided within an Emergency Department. A System Dynamics (SO) simulation model is used to capture the complexities among the intricate balance and conditional effects at play within the demand-supply emergency department environment. Conceptual clarification of the forces driving the elements within the system , quantifying these elements, and empirically capturing the interaction among these elements provides actionable knowledge for operational and strategic decision-making.

  15. 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.

  16. 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.

  17. Utilization of health-care schemes: A ground reality of Indian scenario

    Directory of Open Access Journals (Sweden)

    Aditi Sharma

    2018-01-01

    Full Text Available Health-care system in a society must be built around the term of equity so that each individual should have equal opportunities for maintaining good health, but human societies are characterized by unevenness at every aspect, and it has even not spared the health-care system. Despite great improvements in the oral health status of population across the world, health problems continue to be a major public health concern. India's health system faces the ongoing challenge of responding to the needs of the most disadvantaged groups of the society. Thus, to reduce inequalities in health and ensuring equity in oral health care, India as one of the developing countries in the world have taken steps at center as well as state level to bridge the gap between poor and rich in terms of health care. These schemes are built to touch the lives of the remotest people in the country. The government is boosting its strategies and augmenting its reach mechanisms to ensure that not a soul is dispossessed of any benefits, which arise from the virtue of this scheme. The present review concludes that though these schemes appear to be pro-poor and are inclusive of disadvantaged minorities, the scheme suffers from adverse selection. These schemes have the potential to play an important role in India's move toward universal health coverage.

  18. Lessons from healthcare utilization in children with obstructive sleep apnoea syndrome.

    Science.gov (United States)

    Martinez-Beneyto, Paz; Soria Checa, Cristina E; Botella-Rocamora, Paloma; Rincon-Piedrahita, Inés; Garcia Callejo, Francisco J; Algarra, Jaime Marco

    Paediatric Obstructive Sleep Apnoea-Hypopnoea Syndrome (OSAS) is a multisystemic condition affecting child's health status that may be investigated analyzing demand for healthcare. to quantify the frequency of medical consultations in children with OSAS over a 5-year period, compared to a healthy population. A longitudinal, case-control, ambispective study was conducted at a hospital pertaining to the national public health system. 69 consecutive children referred for OSAS were recruited with no diseases other than OSAS so that healthcare demand was purely attributed to this condition. Matched healthy control children were selected to compare these data. Data regarding frequency of the medical consultations were obtained over 5 years: the year of the treatment ("Year0"), 1 and 2 years before ("Year -1" and "Year -2" respectively), and 1 and 2 years after treatment ("Year+1" and "Year+2") RESULTS: Frequentation Index (FI), as ratio between the use of health services by OSAS children and healthy controls was 1.89 during Year-2, and 2.15 during Year-1 (Pde Otorrinolaringología y Cirugía de Cabeza y Cuello. All rights reserved.

  19. Utilizing a Social Determinant of Health Framework as Determinants of Perceived Behavioral Control.

    Science.gov (United States)

    Maness, Sarah B; Branscum, Paul

    Health disparities reflect inequalities in health outcomes among different populations. As a planning tool for researchers and practitioners to address health disparities, multiple frameworks utilizing social determinants of health have been proposed. Perceived behavioral control, a construct within the Integrative Behavioral Model, reflects how much control one feels over a health behavior and how easy or difficult the behavior is to enact under internal and external barriers. The purpose of this commentary is to suggest how a unified social determinant of health framework can be utilized as a predictor and determinant of the construct perceived behavioral control.

  20. Matching prosthetics order records in VA National Prosthetics Patient Database to healthcare utilization databases.

    Science.gov (United States)

    Smith, Mark W; Su, Pon; Phibbs, Ciaran S

    2010-01-01

    The National Prosthetics Patient Database (NPPD) is the national Department of Veterans Affairs (VA) dataset that records characteristics of individual prosthetic and assistive devices. It remains unknown how well NPPD records can be matched to encounter records for the same individuals in major VA utilization databases. We compared the count of prosthetics records in the NPPD with the count of prosthetics-related procedures for the same individuals recorded in major VA utilization databases. We then attempted to match the NPPD records to the utilization records by person and date. In general, 40% to 60% of the NPPD records could be matched to outpatient utilization records within a 14-day window around the NPPD dataset entry date. Match rates for inpatient data were lower: 10% to 16% within a 14-day window. The NPPD will be particularly important for studies of certain veteran groups, such as those with spinal cord injury or blast-related polytraumatic injury. Health services researchers should use both the NPPD and utilization databases to develop a full understanding of prosthetics use by individual patients.

  1. Security Framework for Pervasive Healthcare Architectures Utilizing MPEG-21 IPMP Components

    Directory of Open Access Journals (Sweden)

    Anastasios Fragopoulos

    2009-01-01

    Full Text Available Nowadays in modern and ubiquitous computing environments, it is imperative more than ever the necessity for deployment of pervasive healthcare architectures into which the patient is the central point surrounded by different types of embedded and small computing devices, which measure sensitive physical indications, interacting with hospitals databases, allowing thus urgent medical response in occurrences of critical situations. Such environments must be developed satisfying the basic security requirements for real-time secure data communication, and protection of sensitive medical data and measurements, data integrity and confidentiality, and protection of the monitored patient's privacy. In this work, we argue that the MPEG-21 Intellectual Property Management and Protection (IPMP components can be used in order to achieve protection of transmitted medical information and enhance patient's privacy, since there is selective and controlled access to medical data that sent toward the hospital's servers.

  2. Inequity of healthcare utilization on mammography examination and Pap smear screening in Thailand: Analysis of a population-based household survey.

    Directory of Open Access Journals (Sweden)

    Sukanya Chongthawonsatid

    Full Text Available Healthcare in Thailand is not equally distributed, and not all people can equally access healthcare resources even if they are covered by health insurance. To examine factors associated with the utilization of mammography examination for breast cancer and Pap smear screening for cervical cancer, data from the national reproductive health survey conducted by the National Statistical Office of Thailand in 2009 was examined. The survey was carried out on 15,074,126 women aged 30-59 years. The results showed that the wealthier respondents had more mammograms than did the lower-income groups. The concentration index was 0.144. The data on Pap smears for cervical cancer also showed that the wealthier respondents were more likely to have had a Pap smear than their lower-income counterparts. The concentration index was 0.054. Determinants of mammography examination were education, followed by health welfare and wealth index, whereas the determinants of Pap smear screening were wealth index, followed by health welfare and education. The government should support greater education for women because education was associated with socioeconomic status and wealth. There should be an increase in the number of screening campaigns, mobile clinics, and low-cost mammograms and continued support for accessibility to mammograms, especially in rural areas and low-income communities.

  3. A tool to determine financial impact of adverse events in health care: healthcare quality calculator.

    Science.gov (United States)

    Yarbrough, Wendell G; Sewell, Andrew; Tickle, Erin; Rhinehardt, Eric; Harkleroad, Rod; Bennett, Marc; Johnson, Deborah; Wen, Li; Pfeiffer, Matthew; Benegas, Manny; Morath, Julie

    2014-12-01

    Hospital leaders lack tools to determine the financial impact of poor patient outcomes and adverse events. To provide health-care leaders with decision support for investments to improve care, we created a tool, the Healthcare Quality Calculator (HQCal), which uses institution-specific financial data to calculate impact of poor patient outcomes or quality improvement on present and future margin. Excel and Web-based versions of the HQCal were based on a cohort study framework and created with modular components including major drivers of cost and reimbursement. The Healthcare Quality Calculator (HQCal) compares payment, cost, and profit/loss for patients with and without poor outcomes or quality issues. Cost and payment information for groups with and without quality issues are used by the HQCal to calculate profit or loss. Importantly, institution-specific payment and cost data are used to calculate financial impact and attributable cost associated with poor patient outcomes, adverse events, or quality issues. Because future cost and reimbursement changes can be forecast, the HQCal incorporates a forward-looking component. The flexibility of the HQCal was demonstrated using surgical site infections after abdominal surgery and postoperative surgical airway complications. The Healthcare Quality Calculator determines financial impact of poor patient outcomes and the benefit of initiatives to improve quality. The calculator can identify quality issues that would provide the largest financial benefit if improved; however, it cannot identify specific interventions. The calculator provides a tool to improve transparency regarding both short- and long-term financial consequences of funding, or failing to fund, initiatives to close gaps in quality or improve patient outcomes.

  4. Patterns on the utilization of oral healthcare for children with HIV ...

    African Journals Online (AJOL)

    More than two-thirds (66.3%) of caregivers whose child experienced dental pain and/or or swelling sought treatment from the dental professional, 16.3% of them bought medicine from the chemist whilst 15.2% of caregivers utilized home remedy. However, only 11% of caregivers sought treatment in a timely manner, within ...

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

    NARCIS (Netherlands)

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

    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

  6. Short- and longer-term health-care resource utilization and costs associated with acute ischemic stroke

    Directory of Open Access Journals (Sweden)

    Johnson BH

    2016-02-01

    Full Text Available Barbara H Johnson,1 Machaon M Bonafede,1 Crystal Watson2 1Outcomes Research, Truven Health Analytics, Cambridge, MA, USA; 2Health Economics and Outcomes Research, Biogen, Cambridge, MA, USA Objectives: The mean lifetime cost of ischemic stroke is approximately $140,048 in the United States, placing stroke among the top 10 most costly conditions among Medicare beneficiaries. The objective of this study was to describe the health-care resource utilization and costs in the year following hospitalization for acute ischemic stroke (AIS.Methods: This retrospective claims analysis quantifies utilization and costs following inpatient admission for AIS among the commercially insured and Medicare beneficiaries in the Truven Health databases. Patients who were 18 years or older and continuously enrolled for 12 months before and after an AIS event occurring (index between January 2009 and December 2012 were identified. Patients with AIS in the year preindex were excluded. Demographic and clinical characteristics were evaluated at admission and in the preindex, respectively. Direct costs, readmissions, and inpatient length of stay (LOS were described in the year postindex.Results: The eligible populations comprised 20,314 commercially insured patients and 31,037 Medicare beneficiaries. Average all-cause costs were $61,354 and $44,929 (commercial and Medicare, respectively in the first year after the AIS. Approximately 50%–55% of total 12-month costs were incurred between day 31 and day 365 following the incident AIS. One quarter (24.6% of commercially insured patients and 38.8% of Medicare beneficiaries were readmitted within 30 days with 16.6% and 71.7% (commercial and Medicare, respectively of those having a principal diagnosis of AIS. The average AIS-related readmission length of stay was nearly three times that of the initial hospitalization for both commercially insured patients (3.8 vs 10.8 days and Medicare beneficiaries (4.0 vs 10.8 days

  7. Healthcare utilization and costs of children with attention deficit/hyperactivity disorder initiating atomoxetine versus extended-release guanfacine.

    Science.gov (United States)

    Molife, Cliff; Haynes, Virginia S; Nyhuis, Allen; Faries, Douglas E; Gelwicks, Steve; Kelsey, Douglas K; Alatorre, Carlos I

    2018-04-01

    To compare 1-year direct healthcare costs and utilization among children and adolescents initiating non-stimulant medications atomoxetine (ATX) or extended-release guanfacine (GXR). In this retrospective, observational cohort study, children and adolescents aged 6-17 years with attention deficit/hyperactivity disorder (ADHD) who had ≥1 prescription claim for ATX or GXR between December 31, 2009 and January 1, 2011 were identified in the MarketScan Commercial or Multi-State Medicaid claims databases. The first claim was set as the index. Patients with no claims for other ADHD medications that overlapped with the days' supply for the index therapy during the post-period were classified as initiating monotherapy. All-cause and ADHD-related utilization and costs (2011 US$) and treatment patterns (adherence and persistence) were evaluated during the 12 months following index. Propensity score adjustment accounted for differences in patient characteristics, and bootstrapping was used for comparisons. A total of 13,239 children and adolescents with ADHD met the study criteria (4,411 ATX initiators and 8,828 GXR initiators). There were 2,699 ATX monotherapy patients. In propensity-score-adjusted analyses, mean all-cause total costs were significantly less for monotherapy ATX initiators than for GXR initiators ($7,553 vs $10,639; difference = -$3,086, p < .0001), as were mean ADHD-related total costs ($3,213 vs $4,544; difference = -$1,330, p < .0001). Monotherapy ATX initiators had significantly fewer all-cause and ADHD-related total medical visits and ∼22 days shorter persistence to index therapy (p < .0001). Results were similar for secondary analyses comparing all ATX with all GXR initiators, regardless of monotherapy or combination regimen, and comparing only monotherapy initiators. Children and adolescents with ADHD who initiated ATX monotherapy incurred lower all-cause and ADHD-related total healthcare costs than patients who initiated GXR

  8. Immigrants' utilization of specialist mental healthcare according to age, country of origin, and migration history: a nation-wide register study in Norway.

    Science.gov (United States)

    Abebe, Dawit Shawel; Lien, Lars; Elstad, Jon Ivar

    2017-06-01

    As the immigrant population rises in Norway, it becomes ever more important to consider the responsiveness of health services to the specific needs of these immigrants. It has been questioned whether access to mental healthcare is adequate among all groups of immigrants. This study aims to examine the use of specialist mental healthcare services among ethnic Norwegians and specific immigrants groups. Register data were used from the Norwegian Patient Registry and Statistics Norway. The sample (age 0-59) consisted of 3.3 million ethnic Norwegians and 200,000 immigrants from 11 countries. Poisson regression models were applied to examine variations in the use of specialist mental healthcare during 2008-2011 according to country of origin, age group, reason for immigration, and length of stay. Immigrant children and adolescents had overall significantly lower use of specialist mental healthcare than ethnic Norwegians of the same age. A distinct exception was the high utilization rate among children and youth from Iran. Among adult immigrants, utilization rates were generally lower than among ethnic Norwegians, particularly those from Poland, Somalia, Sri Lanka, and Vietnam. Adult immigrants from Iraq and Iran, however, had high utilization rates. Refugees had high utilization rates of specialist mental healthcare, while labour immigrants had low use. Utilization rates of specialist mental healthcare are lower among immigrants than Norwegians. Immigrants from Poland, Somalia, Sri Lanka, and Vietnam, had generally quite low rates, while immigrants from Iran had high utilization rates. The findings suggest that specialist mental healthcare in Norway is underutilized among considerable parts of the immigrant population.

  9. Rotavirus vaccine and health-care utilization for rotavirus gastroenteritis in Tsu City, Japan

    Science.gov (United States)

    Kamiya, Hajime; Suga, Shigeru; Nagao, Mizuho; Ichimi, Ryoji; Fujisawa, Takao; Umemoto, Masakazu; Tanaka, Takaaki; Ito, Hiroaki; Tanaka, Shigeki; Ido, Masaru; Taniguchi, Koki; Ihara, Toshiaki; Nakano, Takashi

    2016-01-01

    Background Rotavirus vaccines were introduced in Japan in November 2011. We evaluated the subsequent reduction of the health-care burden of rotavirus gastroenteritis. Methods We conducted active surveillance for rotavirus gastroenteritis among children under 5 years old before and after the vaccine introduction. We surveyed hospitalization rates for rotavirus gastroenteritis in children in Tsu City, Mie Prefecture, Japan, from 2007 to 2015 and surveyed the number of outpatient visits at a Tsu City clinic from 2010 to 2015. Stool samples were obtained for rotavirus testing and genotype investigation. We assessed rotavirus vaccine coverage for infants living in Tsu City. Results In the pre-vaccine years (2007–2011), hospitalization rates for rotavirus gastroenteritis in children under 5 years old were 5.5, 4.3, 3.1 and 3.9 cases per 1000 person-years, respectively. In the post-vaccine years (2011–2015), the rates were 3.0, 3.5, 0.8 and 0.6 cases per 1000 person-years, respectively. The hospitalization rate decreased significantly in the 2013–2014 and 2014–2015 seasons compared to the average of the seasons before vaccine introduction (P gastroenteritis greatly decreased. PMID:28246579

  10. A study of perceived racial discrimination in Black men who have sex with men (MSM) and its association with healthcare utilization and HIV testing.

    Science.gov (United States)

    Irvin, R; Wilton, L; Scott, H; Beauchamp, G; Wang, L; Betancourt, J; Lubensky, M; Wallace, J; Buchbinder, S

    2014-07-01

    In HPTN 061, a study of Black men who have sex with men (MSM), we evaluated the association of healthcare-specific racial discrimination with healthcare utilization and HIV testing among 1167 HIV-negative participants. Median age was 38 years, 41 % were uninsured, and 38 % had an annual household income discrimination directed toward family, friend, or self; 61 % saw a healthcare provider in the previous 6 months and 81 % HIV tested within the past year. Healthcare-specific racial discrimination was positively associated with seeing a provider [adjusted odds ratio (AOR) = 1.4 (1.0, 2.0)] and HIV testing [AOR = 1.6 (1.1, 2.4)] suggesting that barriers other than racial discrimination may be driving health disparities related to access to medical care and HIV testing among Black MSM. These results contrast with previous studies, possibly due to measurement or cohort differences, strategies to overcome discrimination, or because of greater exposure to healthcare.

  11. Determinants related to gender differences in general practice utilization

    DEFF Research Database (Denmark)

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

    2016-01-01

    OBJECTIVE: This study aims to describe the determinants related to gender differences in the GP utilization in Danish population aged 50-65 years. DESIGN: Cohort-based cross-sectional study. SETTING: Danish general practice. SUBJECTS: Totally, 54,849 participants of the Danish Diet, Cancer...... and post-menopausal HT. In a fully adjusted model, subjects with hypertension (1.63; 1.59-1.67), mental illness (1.63; 1.61-1.66), diabetes (1.56; 1.47-1.65), angina pectoris (1.28; 1.21-1.34), and unemployed persons (1.19; 1.18-1.21) had highest rates of GP visits. CONCLUSIONS: Gravidity and HT use...

  12. Determination of internal resistance and electrocatalyst utilization of fuel cells

    Energy Technology Data Exchange (ETDEWEB)

    Garcia, J.A. [Thermodynamics and Kinetics Lab., Dept. of Mechanical Engineering, Toronto Univ., ON (Canada); Ward, C.A. [Thermodynamics and Kinetics Lab., Dept. of Mechanical Engineering, Toronto Univ., ON (Canada); Venter, R.D. [Thermodynamics and Kinetics Lab., Dept. of Mechanical Engineering, Toronto Univ., ON (Canada); Ho, S. [Thermodynamics and Kinetics Lab., Dept. of Mechanical Engineering, Toronto Univ., ON (Canada)

    1997-05-01

    Analytical methods have been proposed recently for determining both the internal resistance of fuel cell electrodes and the fraction of the electrocatalyst that is completely utilized. To apply these methods requires that the Tafel slope and the equilibrium exchange current for the electrolyte-electrocatalyst combination to be known when this combination is exposed to O{sub 2} and when it is exposed to H{sub 2}. The Tafel parameters have been previously reported for O{sub 2} and their measurement for H{sub 2} is reported herein. Also, to apply one of these analytical methods - maximum power method - requires that the current and potential to be measured when a fuel cell is operating at steady state and at maximum power. To apply the second method - approximate maximum power method - requires that the cell potential and slope of the potential versus current curve be measured at a current that is less than that corresponding to maximum power. To evaluate these methods, a series of porous carbon electrodes were constructed, and to give them different resistances nickel was electro-deposited on the one side of each. These electrodes were then assembled into fuel cells and tested. Their internal resistance was determined by the current-interrupt technique, and by using the analytical methods. These results agree to within the experimental error, 12%. Electro-depositing nickel on the gas side of the electrodes was found to decrease their internal resistance by an order of magnitude and increase the electrocatalyst utilization by a factor of three. (orig.)

  13. Healthcare avoidance: a critical review.

    Science.gov (United States)

    Byrne, Sharon K

    2008-01-01

    The purpose of this study is to provide a critical review and synthesis of theoretical and research literature documenting the impact of avoidance on healthcare behaviors, identify the factors that influence healthcare avoidance and delay in the adult population, and propose a direction for future research. The Theory of Reasoned Action, Theory of Planned Behavior, Theory of Care-Seeking Behavior, the Transtheoretical Model, and the Behavioral Model of Health Services Use/Utilization are utilized to elaborate on the context within which individual intention to engage in healthcare behaviors occurs. Research literature on the concept of healthcare avoidance obtained by using computerized searches of CINAHL, MEDLINE, PSYCH INFO, and HAPI databases, from 1995 to 2007, were reviewed. Studies were organized by professional disciplines. Healthcare avoidance is a common and highly variable experience. Multiple administrative, demographic, personal, and provider factors are related to healthcare avoidance, for example, distrust of providers and/or the science community, health beliefs, insurance status, or socioeconomic/income level. Although the concept is recognized by multiple disciplines, limited research studies address its impact on healthcare decision making. More systematic research is needed to determine correlates of healthcare avoidance. Such studies will help investigators identify patients at risk for avoidant behaviors and provide the basis for health-promoting interventions. Methodological challenges include identification of characteristics of individuals and environments that hinder healthcare behaviors, as well as, the complexity of measuring healthcare avoidance. Studies need to systematically explore the influence of avoidance behaviors on specific healthcare populations at risk.

  14. Effects of the West Africa Ebola Virus Disease on Health-Care Utilization - A Systematic Review.

    Science.gov (United States)

    Brolin Ribacke, Kim J; Saulnier, Dell D; Eriksson, Anneli; von Schreeb, Johan

    2016-01-01

    Significant efforts were invested in halting the recent Ebola virus disease outbreak in West Africa. Now, studies are emerging on the magnitude of the indirect health effects of the outbreak in the affected countries, and the aim of this study is to systematically assess the results of these publications. The methodology for this review adhered to the Prisma guidelines for systematic reviews. A total of 3354 articles were identified for screening, and while 117 articles were read in full, 22 studies were included in the final review. Utilization of maternal health services decreased during the outbreak. The number of cesarean sections and facility-based deliveries declined and followed a similar pattern in Guinea, Liberia, and Sierra Leone. A change in the utilization of antenatal and postnatal care and family planning services was also seen, as well as a drop in utilization of children's health services, especially in terms of vaccination coverage. In addition, the uptake of HIV/AIDS and malaria services, general hospital admissions, and major surgeries decreased as well. Interestingly, it was the uptake of health service provision by the population that decreased, rather than the volume of health service provision. Estimates from the various studies suggest that non-Ebola morbidity and mortality have increased after the onset of the outbreak in Sierra Leone, Guinea, and Liberia. Reproductive, maternal, and child health services were especially affected, and the decrease in facility deliveries, cesarean sections, and volume of antenatal and postnatal care visits might have significant adverse effects on maternal and newborn health. The impact of Ebola stretches far beyond Ebola cases and deaths. This review indicates that indirect health service effects are substantial and both short and long term, and highlights the importance of support to maintain routine health service delivery and the maintenance of vaccination programs as well as preventative and curative

  15. Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system.

    Science.gov (United States)

    Huntink, E; Wensing, M; Klomp, M A; van Lieshout, J

    2015-12-15

    Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary care in the Netherlands. We performed a qualitative study, using semi-structured interviews with healthcare professionals and patients with established cardiovascular diseases or at high cardiovascular risk. A framework analysis was used to cluster the determinants into seven domains: 1) guideline factors, 2) individual healthcare professional factors, 3) patient factors, 4) professional interaction, 5) incentives and recourses, 6) mandate, authority and accountability, and 7) social, political and legal factors. Twelve healthcare professionals and 16 patients were interviewed. Healthcare professionals and patients mentioned a variety of factors concerning all seven domains. Determinants of practice according to the health care professionals were related to communication between healthcare professionals, patients' lack of knowledge and self-management, time management, market mechanisms in the Dutch healthcare system and motivational interviewing skills of healthcare professionals. Patients mentioned determinants related to their knowledge of risk factors for cardiovascular diseases, medication adherence and self-management as key determinants. A key finding is the mismatch between healthcare professionals' and patients' views on patient's knowledge and self-management. Perceived determinants of cardiovascular risk management were mainly related to patient behaviors and (but only for health professionals) to the healthcare system. Though health care professionals and patients agree upon the importance of patients' knowledge and self-management, their judgment of the current state of knowledge and self-management is entirely different.

  16. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review.

    Science.gov (United States)

    Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh

    2017-01-01

    Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or

  17. Impact of Publicly Financed Health Insurance Schemes on Healthcare Utilization and Financial Risk Protection in India: A Systematic Review.

    Directory of Open Access Journals (Sweden)

    Shankar Prinja

    Full Text Available Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC. In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7 focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5 studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2, which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP

  18. Comparison of Disease-Modifying Therapies for the Management of Multiple Sclerosis: Analysis of Healthcare Resource Utilization and Relapse Rates from US Insurance Claims Data.

    Science.gov (United States)

    Nicholas, Jacqueline; Boster, Aaron; Wu, Ning; Yeh, Wei-Shi; Fay, Monica; Kendter, Jon; Huang, Ming-Yi; Lee, Andrew

    2018-03-01

    Data on comparative healthcare resource utilization and costs associated with the newer oral disease-modifying therapies (DMTs) for managing relapsing-remitting multiple sclerosis (MS) in routine clinical practice are limited. The purpose of this study was to estimate healthcare resource utilization, costs, and relapse rates in the year after initiating treatment with dimethyl fumarate (DMF), interferon (IFN)-β, glatiramer acetate (GA), teriflunomide, or fingolimod in routine clinical practice for patients with MS who did not receive a DMT in the previous year. Patients initiating DMF, IFNβ, GA, teriflunomide, or fingolimod were identified based on claims data from 2012 to 2015 in the Truven MarketScan Commercial Claims Databases (n = 4194). Healthcare resource utilization assessment included the proportion of patients who were hospitalized, or had emergency room (ER) or urgent care (UC) visits. Healthcare costs were estimated for 1 year before and 1 year after DMT initiation. Relapse episodes were identified based on a published claims-based algorithm and clinical input from the research investigators. After DMT initiation, significant reductions in the proportions of patients who were hospitalized or requiring ER/UC visits were observed in all patient cohorts (p use of outpatient services and inpatient hospital stays, and have the potential to partially offset DMT costs. DMT initiation is associated with reductions in healthcare resource utilization and non-prescription medical costs in routine clinical practice.

  19. The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature.

    Directory of Open Access Journals (Sweden)

    William J Hanney

    Full Text Available Low back pain (LBP is common and associated healthcare costs are significant. While clinical practice guidelines have been established in an attempt to reduce costs and healthcare utilization, it is unclear if adherence to physical therapy guidelines for those with LBP is efficacious. Therefore, the purpose of this study was to assess current evidence and evaluate the impact of physical therapy guideline adherence on subsequent healthcare costs and utilization for patients with LBP.An electronic search was conducted in PubMed, CINAHL (EBSCO Host, AMED (Ovid, and PEDro. Studies included in this review were published in peer reviewed journals and the primary mode of treatment was administered by a physical therapist. Also, the definition of adherence was clearly defined based on claims data and at least one measure of cost or utilization reported. Quality assessment was evaluated via a modified Downs and Black checklist. Due to the conceptual heterogeneity in variable measurements, data were qualitatively synthesized and stratified by reported utilization and cost measures.A total of 256 results were identified and after omitting duplicates, 4 articles were retained, which were all retrospective in nature. Quality scores ranged between 19 and 21 points out of a possible 26 on the modified Downs and Black checklist. All identified studies used the same definition of guideline adherence, which focused on billing active codes and minimizing use of passive codes. The results demonstrated trends that, with a few exceptions, suggested those patients with LBP that were treated with an adherent guideline program demonstrated decreased healthcare utilization and an overall healthcare savings.Preliminary evidence suggests that adherence to established clinical practice guidelines may assist with decreasing healthcare utilization and costs. Additional research based on prospective randomized controlled trials are needed to provide high quality evidence

  20. The Influence of Physical Therapy Guideline Adherence on Healthcare Utilization and Costs among Patients with Low Back Pain: A Systematic Review of the Literature

    Science.gov (United States)

    Liu, Xinliang; Kolber, Morey J.

    2016-01-01

    Background Low back pain (LBP) is common and associated healthcare costs are significant. While clinical practice guidelines have been established in an attempt to reduce costs and healthcare utilization, it is unclear if adherence to physical therapy guidelines for those with LBP is efficacious. Therefore, the purpose of this study was to assess current evidence and evaluate the impact of physical therapy guideline adherence on subsequent healthcare costs and utilization for patients with LBP. Methods An electronic search was conducted in PubMed, CINAHL (EBSCO Host), AMED (Ovid), and PEDro. Studies included in this review were published in peer reviewed journals and the primary mode of treatment was administered by a physical therapist. Also, the definition of adherence was clearly defined based on claims data and at least one measure of cost or utilization reported. Quality assessment was evaluated via a modified Downs and Black checklist. Due to the conceptual heterogeneity in variable measurements, data were qualitatively synthesized and stratified by reported utilization and cost measures. Results A total of 256 results were identified and after omitting duplicates, 4 articles were retained, which were all retrospective in nature. Quality scores ranged between 19 and 21 points out of a possible 26 on the modified Downs and Black checklist. All identified studies used the same definition of guideline adherence, which focused on billing active codes and minimizing use of passive codes. The results demonstrated trends that, with a few exceptions, suggested those patients with LBP that were treated with an adherent guideline program demonstrated decreased healthcare utilization and an overall healthcare savings. Conclusion Preliminary evidence suggests that adherence to established clinical practice guidelines may assist with decreasing healthcare utilization and costs. Additional research based on prospective randomized controlled trials are needed to provide

  1. The differences in healthcare utilization for dental caries based on the implementation of water fluoridation in South Korea.

    Science.gov (United States)

    Cho, Myung-Soo; Han, Kyu-Tae; Park, Sohee; Moon, Ki Tae; Park, Eun-Cheol

    2016-11-08

    There were some debates about the water fluoridation program in South Korea, even if the program had generally substantial effectiveness. Because the out-of-pocket expenditures for dental care were higher in South Korea than in other countries, an efficient solution was needed. Therefore, we examined the relationship between the implementation of water fluoridation and the utilization of dental care. We used the National Health Insurance Service National Sample Cohort. In this study, data finally included 472,250 patients who were newly diagnosed with dental caries during 2003-2013. We performed survival analysis using cox proportional hazard model, negative binomial-regression, and regression analyses using generalized estimating equation models. There were 48.49 % outpatient dental care visit during study period. Individuals with water fluoridation had a lower risk of dental care visits (HR = 0.949, 95 % CI = 0.928-0.971). Among the individuals who experienced a dental care visit, those with water fluoridation program had a lower number of dental care visits (β = -0.029), and the period of water fluoridation had an inverse association with the dental care expenditures. The implementation of water fluoridation programs and these periods are associated with reducing the utilization of dental health care. Considering these positive impacts, healthcare professionals must consider preventive strategies for activating water fluoridation programs, such as changes in public perception and relations, for the effective management of dental care in South Korea.

  2. Implementation of an acute venous thromboembolism clinical pathway reduces healthcare utilization and mitigates health disparities.

    Science.gov (United States)

    Misky, Gregory J; Carlson, Todd; Thompson, Elaina; Trujillo, Toby; Nordenholz, Kristen

    2014-07-01

    Acute venous thromboembolism (VTE) is prevalent, expensive, and deadly. Published data at our institution identified significant VTE care variation based on payer source. We developed a VTE clinical pathway to standardize care, decrease hospital utilization, provide education, and mitigate disparities. Target population for our interdisciplinary pathway was acute medical VTE patients. The intervention included order sets, system-wide education, follow-up phone calls, and coordinated posthospital care. Study data (n = 241) were compared to historical data (n = 234), evaluating outcomes of hospital admission, length of stay (LOS), and reutilization, stratified by payer source. A total of 241 patients entered the VTE clinical care pathway: 107 with deep venous thrombosis (44.4%) and 134 with a pulmonary embolism (55.6%). Within the pathway, uninsured VTE patients were admitted at a lower rate than insured patients (65.9 vs 79.1%; P = 0.032). LOS decreased from 4.4 to 3.1 days (P historical patients (9.4%, P = 0.254). Individual cost of care decreased from $7610 to $5295 (P cost, particularly among uninsured patients. Results of this novel study demonstrate a model for improving transitional care coordination with local community health clinics and delivering care to vulnerable populations. Other disease populations may benefit from the development of a similar model. © 2014 Society of Hospital Medicine.

  3. Knowledge Management Implementation and the Tools Utilized in Healthcare for Evidence-Based Decision Making: A Systematic Review

    OpenAIRE

    Shahmoradi, Leila; Safadari, Reza; Jimma, Worku

    2017-01-01

    Background Healthcare is a knowledge driven process and thus knowledge management and the tools to manage knowledge in healthcare sector are gaining attention. The aim of this systematic review is to investigate knowledge management implementation and knowledge management tools used in healthcare for informed decision making. Methods Three databases, two journals websites and Google Scholar were used as sources for the review. The key terms used to search relevant articles include: “Healthcar...

  4. Personality disorders and physical health: A longitudinal examination of physical functioning, healthcare utilization, and health-related behaviors in middle-aged adults

    Science.gov (United States)

    Powers, Abigail D.; Oltmanns, Thomas F.

    2011-01-01

    Personality disorders (PDs) have significant, long-term effects in many areas, including physical health outcomes such as increased risk for chronic disease and mortality. Although research has documented this detrimental impact in relation to long-term physical health, no one has explored the more immediate influence of disordered personality on aspects of physical functioning, such as pain level, or health-related behaviors, such as medication use. The present study examined the unique effects of PD features on physical functioning, medical resource utilization, and prescription medication use to determine potential risk associated with PDs. We studied an epidemiologically-based sample (N=608) of Saint Louis residents (ages 55–64) over two time points (6 months apart). We found that disordered personality was significantly predictive of worse physical functioning, role limitations, fatigue, and pain at both time points, even when current health problems, the presence of depression, and health behaviors (i.e., smoking, drinking, exercise) were controlled. PD features were also predictive of increased healthcare utilization and medication use at follow-up. These results suggest that the presence of disordered personality may be an important risk factor for worse functioning, regardless of actual health status. PMID:22867504

  5. Determinants of resource needs and utilization among refugees over time.

    Science.gov (United States)

    Wright, A Michelle; Aldhalimi, Abir; Lumley, Mark A; Jamil, Hikmet; Pole, Nnamdi; Arnetz, Judith E; Arnetz, Bengt B

    2016-04-01

    This study examined refugees' resource needs and utilization over time, investigated the relationships between pre-displacement/socio-demographic variables and resource needs and utilization, and explored the role of resource needs and utilization on psychiatric symptom trajectories. Iraqi refugees to the United States (N = 298) were assessed upon arrival and at 1-year intervals for 2 years for socio-demographic variables and pre-displacement trauma experiences, their need for and utilization of 14 different resources, and PTSD and depressive symptoms. Although refugees reported reduction of some needs over time (e.g., need for cash assistance declined from 99 to 71 %), other needs remained high (e.g., 99 % of refugees reported a need for health care at the 2-year interview). Generally, the lowest needs were reported after 2 years, and the highest utilization occurred during the first year post-arrival. Pre-displacement trauma exposure predicted high health care needs but not high health care utilization. Both high need for and use of health care predicted increasing PTSD and depressive symptoms. Specifically, increased use of psychological care across the three measurement waves predicted more PTSD and depression symptoms at the 2-year interview. Differences emerged between need for and actual use of resources, especially for highly trauma-exposed refugees. Resettlement agencies and assistance programs should consider the complex relationships between resource needs, resource utilization, and mental health during the early resettlement period.

  6. Anxiety and fear of cancer recurrence and its association with supportive care needs and health-care service utilization in cancer patients.

    Science.gov (United States)

    Sarkar, Susanne; Sautier, Leon; Schilling, Georgia; Bokemeyer, Carsten; Koch, Uwe; Mehnert, Anja

    2015-12-01

    We investigated the relationship between fear of cancer recurrence (FCR), anxiety, supportive care needs, and utilization of health-care services in a mixed sample of 335 cancer patients. We used validated questionnaires including the Fear of Progression Questionnaire-Short Form (FoP-Q-SF), the General Anxiety Disorder Scale (GAD-7) and the Supportive Care Needs Survey (SCNS-SF34). Health-care services utilization was measured by a self-constructed questionnaire recording the use of 22 health and supportive care offers. In our sample, 3.9% of patients were classified as having high anxiety and 5.1% had high FCR. Patients reported the highest unmet supportive care needs in the domain health system and information followed by psychological needs. Integrated care and complementary support services were the most frequently used (32%) followed by medical (31%), psychological (23%), spiritual and religious (8%) and other support services (9%). Whereas anxiety was related to both unmet psychological and physical/daily living needs (p anxiety and FCR were not related to higher utilization of health-care services. Our findings show that FCR plays a significant role in unmet supportive care needs in cancer patients but not for health-care service utilization. We recommend that clinicians monitor supportive care needs in patients struggling with FCR and anxiety.

  7. Determining the Arterial Blood Pressure of People Living in Yesilyurt Local Healthcare Office

    Directory of Open Access Journals (Sweden)

    Feyza Dereli

    2009-02-01

    Full Text Available AIM: Whereas the prevalance of arterial blood pressure which was a chronical health problem was 20%-25% among 30 year-old people, them showing an increase in aging, the percentage went as high as 50% in 60’s and later ages. What was that worrisome was that despite the high prevalance, only half of these received treathment. This is study was descriptively and cross-sectionally planned to determine whether the people asking their tensions to be measured in and around the Yesilyurt local healthcare office region. METHODS: The environment of the research consisted of 1400 people over 35 age and registered Yesilyurt Local healthcare Office and the whole of the environment were included in this sample. The study was conducted over 340 voluntaries. The data was collected by a questionnaire of 14 questions containing socio-demografic features and by measuring the arterial blood pressure, height and weight of the individuals. In the evaluation of the data, chi-square test was used and the level of significantly was accepted as 0.05. RESULTS: In this study, the rate of high sistolic blood pressure was found to be 21.47% and the rate of high diastolic blood pressure to be 8.23%. It was determined that age and body mass index varrieties were effective on sistolic hipertension. It was also found that in their behaviors of the use of hypertensive medicine, of regular arterial pressure controls and of having the hypertesion diagnosis significant differnces varied statistically on both sistolic and diastolic blood pressure people having. CONCLUSION: In order to improve the health, informative information abouth hypertension was provided for the participants for too days consisting of 4 sessions. [TAF Prev Med Bull 2009; 8(1.000: 53-58

  8. The Effect of Bariatric Surgery on Mobility, Health-Related Quality of Life, Healthcare Resource Utilization, and Employment Status.

    Science.gov (United States)

    Tarride, Jean-Eric; Breau, Ruth; Sharma, Arya M; Hong, Dennis; Gmora, Scott; Guertin, Jason R; O'Reilly, Daria; Xie, Feng; Mehran, Anvari

    2017-02-01

    A sub-study of the Ontario Bariatric Registry was conducted to evaluate the impact of bariatric surgery on mobility, health-related quality of life (HRQoL), healthcare resource utilization (HRU), and employment status. The 1-year change in mobility following bariatric surgery was evaluated using the mobility domain of the EuroQOL-5D-5L (EQ-5D-5L), which was self-administered at baseline and 1 year after bariatric surgery along with questions on HRU. Another questionnaire was used to document employment status at time of surgery and 1 year later. The population included 304 individuals (mean age = 46 years; 85 % female). At baseline, 68 % of participants had some problems in walking compared to 14 % at 1 year following surgery (p mobility and HRQoL. More research is warranted to understand the benefits, costs, and cost-effectiveness of bariatric surgery in Canada.

  9. [Deinstitutionalization of long-stay psychiatric patients in upper Austria -- utilization of healthcare resources and costs of outpatient care].

    Science.gov (United States)

    Haberfellner, Egon Michael; Grausgruber, Alfred; Grausgruber-Berner, Rosemarie; Ortmair, Margarethe; Schöny, Werner

    2006-03-01

    The study was intended to evaluate the therapeutic and healthcare services utilized by 116 former long-stay patients after an average of 42.9 months of deinstitutionalization during a follow-up time of (1/2) year and to calculate the costs thus incurred. 116 patients and their caregivers were interviewed during a period of 6 months using the German version of the Client Sociodemographic and Service Receipt Inventory. On average, 3.3 institutions/facilities were contacted per patient, most often by younger patients living in group homes and least often by patients in psychiatric nursing homes. During the 6-month follow-up time costs of euro 14,665 were incurred per patient. Of these costs, 87.2 % were for the residential facilities. The costs of outpatient care accounted for 41.4 % of the costs that would have been incurred for inpatient care in a psychiatric hospital. Deinstitutionalization of psychiatric long-stay patients in Upper Austria provided for considerable reductions in costs while maintaining a high quality of care.

  10. Utilization of healthcare services in postpartum women in the Philippines who delivered at home and the effects on their health: a cross-sectional analytical study

    Directory of Open Access Journals (Sweden)

    Yamashita T

    2017-09-01

    Full Text Available Tadashi Yamashita,1 Maria Teresa Reyes Tuliao,2 Magdalena Concel Meana,2 Sherri Ann Suplido,3 Cecilia L Llave,4 Yuko Tanaka,5 Hiroya Matsuo6 1Kobe City College of Nursing, Kobe, Japan; 2Health Department of Muntinlupa, Muntinlupa, Philippines; 3Department of Obstetrics and Gynecology, Philippine General Hospital, Manila, Philippines; 4College of Medicine (CM, University of the Philippine (UP, Manila, Philippines; 5Department of School of Health Sciences, Faculty of Medicine, Tokushima University Graduate School, Tokushima, Japan; 6Department of International Health, Kobe University Graduate School of Health Sciences, Kobe, Japan Background: A low ratio of utilization of healthcare services in postpartum women may contribute to maternal deaths during the postpartum period. The maternal mortality ratio is high in the Philippines. The aim of this study was to examine the current utilization of healthcare services and the effects on the health of women in the Philippines who delivered at home. Methods: This was a cross-sectional analytical study, based on a self-administrated questionnaire, conducted from March 2015 to February 2016 in Muntinlupa, Philippines. Sixty-three postpartum women who delivered at home or at a facility were enrolled for this study. A questionnaire containing questions regarding characteristics, utilization of healthcare services, and abnormal symptoms during postpartum period was administered. To analyze the questionnaire data, the sample was divided into delivery at home and delivery at a facility. Chi-square test, Fisher’s exact test, and Mann–Whitney U test were used. Results: There were significant differences in the type of birth attendant, area of residence, monthly income, and maternal and child health book usage between women who delivered at home and those who delivered at a facility (P<0.01. There was significant difference in the utilization of antenatal checkup (P<0.01 during pregnancy, whilst there was no

  11. Determinants of Capacity Utilization in Road Freight Transportation

    DEFF Research Database (Denmark)

    Abate, Megersa Abera

    2014-01-01

    Recent performance figures in the European road freight transport sector show that there is an excess capacity. To shed light on this phenomenon, this paper studies two aspects of capacity utilization in trucking: the extent of empty running and the load factor. The paper shows that they can...

  12. Using nutrient utilization patterns to determine the source of ...

    African Journals Online (AJOL)

    AJB SERVER

    isolates were predicted to be originating from the human source. The results indicate that livestock are the primary contributors to fecal pollution in this hypereutrophic Iowa lake. Key words: Nutrient utilization patterns, Escherichia coli, bacterial source tracking, Silver Lake, Delaware,. Iowa. INTRODUCTION. Surface water ...

  13. Using nutrient utilization patterns to determine the source of ...

    African Journals Online (AJOL)

    Identifying the sources of fecal contaminants in surface water bodies such as rivers, lakes and beaches is of importance for environmental safety, public health safety, food safety and regulatory purposes. Nutrient utilization patterns (NUPs) were used as a bacterial source tracking technique to identify the possible sources of ...

  14. The profesionalized patient. Sociocultural determinants of health services utilization.

    NARCIS (Netherlands)

    Albers, Jantina Flora

    1998-01-01

    To form a notion of the relative magnitude of health services utilization in Curaçao, patterns of use were compared with those in the Netherlands. Dutch reference data were chosen because of the strong political and historical ties between Curaçao and the Netherlands. Most care providers in Curaçao

  15. Determinants Of Antenatal Care Services Utilization In Emevor ...

    African Journals Online (AJOL)

    The difference is not significant (P > 0.05). A majority of the women who attained secondary education (69%), post-secondary education (96%), those whose husbands had secondary education (69%), postsecondary education (82%) and those who had income-yielding occupations (72%) utilized ante-natal care services.

  16. Key common determinants for adoption of wireless technology in healthcare for India and Pakistan: development of a conceptual model.

    Science.gov (United States)

    Hafeez-Baig, Abdul; Gururajan, Raj

    2010-01-01

    This study explores the perception and views of healthcare professionals in the subcontinent (India and Pakistan) towards the wireless handheld technology in the healthcare setting. A mixed methodology was adopted to explore the determinants of the wireless handheld devices in the healthcare setting. Interviews were conducted with 30 healthcare professionals to explore the initial themes. This was followed up with a survey instrument, specifically developed for this study, and distributed to 300 healthcare professionals in Pakistan and India. 200 usable surveys from India and 97 from Pakistan were received. The results of the study indicate that healthcare professionals felt that to use the wireless technology, the integration of the clinical and operational process is essential. Factor analysis through SPSS showed that any development of technological solutions for handheld devices would benefit, by considering the clinical, technological, and operational influences of the wireless technology in addition to clinical influences, clinical preference, training, and technical support. The study culminated in the development of an initial conceptual framework. The scope of this study is restricted to wireless handheld devices such as the smart phones, handheld PCs and PDAs.

  17. The effect of an active implementation of a disease management programme for chronic obstructive pulmonary disease on healthcare utilization--a cluster-randomised controlled trial.

    Science.gov (United States)

    Smidth, Margrethe; Christensen, Morten Bondo; Fenger-Grøn, Morten; Olesen, Frede; Vedsted, Peter

    2013-10-03

    The growing population living with chronic conditions calls for efficient healthcare-planning and effective care. Implementing disease-management-programmes is one option for responding to this demand. Knowledge is scarce about the effect of implementation processes and their effect on patients; only few studies have reported the effectiveness of disease-management-programmes targeting patients with chronic obstructive pulmonary disease (COPD). The objective of this paper was to determine the effect on healthcare-utilization of an active implementation model for a disease-management-programme for patients with one of the major multimorbidity diseases, COPD. The standard implementation of a new disease-management-programme for COPD was ongoing during the study-period from November 2008 to November 2010 in the Central Denmark Region. We wanted to test a strategy using Breakthrough Series, academic detailing and lists of patients with COPD. It targeted GPs and three hospitals serving approx. 60,000 inhabitants aged 35 or older and included interventions directed at professionals, organisations and patients. The study was a non-blinded block- and cluster-randomised controlled trial with GP-practices as the unit of randomisation. In Ringkoebing-Skjern Municipality, Denmark, 16 GP-practices involving 38 GPs were randomised to either the intervention-group or the control-group. A comparable neighbouring municipality acted as an external-control-group which included nine GP-practices with 25 GPs. An algorithm based on health-registry-data on lung-related contacts to the healthcare-system identified 2,736 patients who were alive at the end of the study-period. The population included in this study counted 1,372 (69.2%) patients who responded to the baseline questionnaire and confirmed their COPD diagnosis; 458 (33.4%) patients were from the intervention-group, 376 (27.4%) from the control-group and 538(39.2%) from the external-control-group. The primary outcome was

  18. Healthcare utilization in older patients using personal emergency response systems: an analysis of electronic health records and medical alert data : Brief Description: A Longitudinal Retrospective Analyses of healthcare utilization rates in older patients using Personal Emergency Response Systems from 2011 to 2015.

    Science.gov (United States)

    Agboola, Stephen; Golas, Sara; Fischer, Nils; Nikolova-Simons, Mariana; Op den Buijs, Jorn; Schertzer, Linda; Kvedar, Joseph; Jethwani, Kamal

    2017-04-18

    Personal Emergency Response Systems (PERS) are traditionally used as fall alert systems for older adults, a population that contributes an overwhelming proportion of healthcare costs in the United States. Previous studies focused mainly on qualitative evaluations of PERS without a longitudinal quantitative evaluation of healthcare utilization in users. To address this gap and better understand the needs of older patients on PERS, we analyzed longitudinal healthcare utilization trends in patients using PERS through the home care management service of a large healthcare organization. Retrospective, longitudinal analyses of healthcare and PERS utilization records of older patients over a 5-years period from 2011-2015. The primary outcome was to characterize the healthcare utilization of PERS patients. This outcome was assessed by 30-, 90-, and 180-day readmission rates, frequency of principal admitting diagnoses, and prevalence of conditions leading to potentially avoidable admissions based on Centers for Medicare and Medicaid Services classification criteria. The overall 30-day readmission rate was 14.2%, 90-days readmission rate was 34.4%, and 180-days readmission rate was 42.2%. While 30-day readmission rates did not increase significantly (p = 0.16) over the study period, 90-days (p = 0.03) and 180-days (p = 0.04) readmission rates did increase significantly. The top 5 most frequent principal diagnoses for inpatient admissions included congestive heart failure (5.7%), chronic obstructive pulmonary disease (4.6%), dysrhythmias (4.3%), septicemia (4.1%), and pneumonia (4.1%). Additionally, 21% of all admissions were due to conditions leading to potentially avoidable admissions in either institutional or non-institutional settings (16% in institutional settings only). Chronic medical conditions account for the majority of healthcare utilization in older patients using PERS. Results suggest that PERS data combined with electronic medical records data can

  19. Methods of determining incremental energy costs for economic dispatch and inter-utility interchange in Canadian utilities

    International Nuclear Information System (INIS)

    El-Hawary, M.E.; El-Hawary, F.; Mbamalu, G.A.N.

    1991-01-01

    A questionnaire was mailed to ten Canadian utilities to determine the methods the utilities use in determining the incremental cost of delivering energy at any time. The questionnaire was divided into three parts: generation, transmission and general. The generation section dealt with heat rates, fuel, operation and maintenance, startup and shutdown, and method of prioritizing and economic evaluation of interchange transactions. Transmission dealt with inclusion of transmission system incremental maintenance costs, and transmission losses determination. The general section dealt with incremental costs aspects, and various other economic considerations. A summary is presented of responses to the questionnaire

  20. Avoiding analgesic escalation and excessive healthcare utilization in severe irritable bowel syndrome: a role for intramuscular anticholinergics?

    Science.gov (United States)

    Pearson, James S; Pollard, Christine; Whorwell, Peter J

    2014-11-01

    In patients with severe irritable bowel syndrome (IBS), abdominal pain can be the predominant symptom impacting on all aspects of their lives and resulting in excessive healthcare utilization. Furthermore, the use of analgesics can become excessive in this group of patients, sometimes leading to opiate dependency. Typically, the pain is often described as spastic in nature and we have speculated that parenteral anticholinergics might provide effective relief when all other measures have failed. For several years, we have therefore been asking general practitioners to consider teaching such patients to administer intramuscular hyoscine butylbromide for pain episodes and this study is an audit of this approach. Patients in whom the use of intramuscular hyoscine butylbromide had been recommended to their general practitioner in the last three years were interviewed over the telephone in order to document the efficacy of this approach as well as any potential disadvantages. A total of 122 general practitioners were advised to try this approach, with 58 agreeing to teach the technique and prescribe the medication. Of the 58 patients who used the medication, 50 (86%) found it gave them pain relief, which was complete in six (10%), substantial in 36 (62%) and mild in eight (14%), with 15 (26%) decreasing the use of analgesics and 13 (32%) of the 41 taking opiates able to reduce or stop them completely. Side effects were few and largely consisted of those associated with anticholinergics. Only four patients stopped medication because of side effects and no major skin reactions were reported. The use of intramuscular hyoscine butylbromide shows promise in the management of IBS when severe unmanageable abdominal pain is a major problem. This approach appears to be safe and has the potential to reduce analgesic escalation, opiate dependency and attendances at accident and emergency departments.

  1. Healthcare costs and resource utilization of patients with binge-eating disorder and eating disorder not otherwise specified in the Department of Veterans Affairs.

    Science.gov (United States)

    Bellows, Brandon K; DuVall, Scott L; Kamauu, Aaron W C; Supina, Dylan; Babcock, Thomas; LaFleur, Joanne

    2015-12-01

    The objective of this study was to compare the one-year healthcare costs and utilization of patients with binge-eating disorder (BED) to patients with eating disorder not otherwise specified without BED (EDNOS-only) and to matched patients without an eating disorder (NED). A natural language processing (NLP) algorithm identified adults with BED from clinical notes in the Department of Veterans Affairs (VA) electronic health record database from 2000 to 2011. Patients with EDNOS-only were identified using ICD-9 code (307.50) and those with NLP-identified BED were excluded. First diagnosis date defined the index date for both groups. Patients with NED were randomly matched 4:1, as available, to patients with BED on age, sex, BMI, depression diagnosis, and index month. Patients with cost data (2005-2011) were included. Total healthcare, inpatient, outpatient, and pharmacy costs were examined. Generalized linear models were used to compare total one-year healthcare costs while adjusting for baseline patient characteristics. There were 257 BED, 743 EDNOS-only, and 823 matched NED patients identified. The mean (SD) total unadjusted one-year costs, in 2011 US dollars, were $33,716 ($38,928) for BED, $37,052 ($40,719) for EDNOS-only, and $19,548 ($35,780) for NED patients. When adjusting for patient characteristics, BED patients had one-year total healthcare costs $5,589 higher than EDNOS-only (p = 0.06) and $18,152 higher than matched NED patients (p < 0.001). This study is the first to use NLP to identify BED patients and quantify their healthcare costs and utilization. Patients with BED had similar one-year total healthcare costs to EDNOS-only patients, but significantly higher costs than patients with NED. © 2015 Wiley Periodicals, Inc.

  2. Determinants of job satisfaction of healthcare professionals in public hospitals in Belgrade, Serbia - cross-sectional analysis

    Directory of Open Access Journals (Sweden)

    Kuburović Nina B.

    2016-01-01

    Full Text Available Introduction. The quality of health care significantly depends on the satisfaction of the employees. Objective. The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. Method. Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade’s hospitals. Statistical analysis was performed using the Student’s t-test, χ2 test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. Results. This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals’ dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. Conclusion. There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.

  3. Determinants of job satisfaction of healthcare professionals in public hospitals in Belgrade, Serbia--Cross-sectional analysis.

    Science.gov (United States)

    Kuburović, Nina B; Dedić, Velimir; Djuricić, Slavisa; Kuburović, Vladimir

    2016-01-01

    The quality of health care significantly depends on the satisfaction of the employees. The objective of this study was to establish the level of professional satisfaction of healthcare professionals in state hospitals in Belgrade, Serbia, and to determine and to rank the factors which impact on their satisfaction or dissatisfaction. Professional satisfaction survey was designed and conducted as a cross-sectional study in 2008. Completed questionnaires were returned by 6,595 healthcare professionals from Belgrade's hospitals. Statistical analysis was performed using the Student's t-test, χ² test and ANOVA. Factor analysis was applied in order to define determinants of professional satisfaction, i.e. dissatisfaction. This study showed that the degree of professional satisfaction of Serbian healthcare professionals was low. The main causes of professionals'dissatisfaction were wages, equipment, the possibility of continuous medical education/training and the opportunities for professional development. Healthcare professionals with university education were more satisfied with all the individual aspects of job satisfaction than those with secondary school and college education. There were significantly more healthcare professionals satisfied with their job among males, older than 60 years, in the age group 50-59 years, with managerial function, and with 30 or more years of service. Development strategy of human resources in the Serbian health care system would significantly improve the professional satisfaction and quality of the provided health care.

  4. The profesionalized patient. Sociocultural determinants of health services utilization.

    OpenAIRE

    Albers, Jantina Flora

    1998-01-01

    To form a notion of the relative magnitude of health services utilization in Curaçao, patterns of use were compared with those in the Netherlands. Dutch reference data were chosen because of the strong political and historical ties between Curaçao and the Netherlands. Most care providers in Curaçao have received their vocational training in the Netherlands. Also, in many aspects the health care systems in Curaçao and the Netherlands are comparable. For example, in both systems the GP function...

  5. GYNECOLOGICAL HEALTHCARE SERVICE UTILIZATION IN RESPECT TO HABITS AND LIFESTYLES OF THE FEMALE UNIVERSITY STUDENTS IN SERBIA

    Directory of Open Access Journals (Sweden)

    Olivera Radulović

    2011-12-01

    Full Text Available The aim of the paper was to determine the frequency of gynecological examinations among the female university students in Serbia as well as a potential association with certain habits and lifestyles. The research was conducted at the three Serbian state universities in the period January-June in the academic year 2008/09 and included 1.164 female university students using a method of random sampling. In total, 18% of female university students said that they had never visited the gynecologist. The least concerned about their health when making the choice of food they eat and the least physically active were the females who had never visited the gynecologist. The females who had visited the gynecologist less than two times estimated themselves as healthier (p<0.05 as well as the girls who had the first gynecological examination before the age of 20. The girls who visited the gynecologist for the first time before they reached 20 years of age used condoms more consistently. Planning and organization of a broad spectrum of activities arranged at the faculties should focus the students' attention on the gynecological healthcare and adequately solve them.

  6. Healthcare Policy Statement on the Utility of Coronary Computed Tomography for Evaluation of Cardiovascular Conditions and Preventive Healthcare: From the Health Policy Working Group of the Society of Cardiovascular Computed Tomography.

    Science.gov (United States)

    Slim, Ahmad M; Jerome, Scott; Blankstein, Ron; Weigold, Wm Guy; Patel, Amit R; Kalra, Dinesh K; Miller, Ryan; Branch, Kelley; Rabbat, Mark G; Hecht, Harvey; Nicol, Edward D; Villines, Todd C; Shaw, Leslee J

    The rising cost of healthcare is prompting numerous policy and advocacy discussions regarding strategies for constraining growth and creating a more efficient and effective healthcare system. Cardiovascular imaging is central to the care of patients at risk of, and living with, heart disease. Estimates are that utilization of cardiovascular imaging exceeds 20 million studies per year. The Society of Cardiovascular CT (SCCT), alongside Rush University Medical Center, and in collaboration with government agencies, regional payers, and industry healthcare experts met in November 2016 in Chicago, IL to evaluate obstacles and hurdles facing the cardiovascular imaging community and how they can contribute to efficacy while maintaining or even improving outcomes and quality. The summit incorporated inputs from payers, providers, and patients' perspectives, providing a platform for all voices to be heard, allowing for a constructive dialogue with potential solutions moving forward. This article outlines the proceedings from the summit, with a detailed review of past hurdles, current status, and potential solutions as we move forward in an ever-changing healthcare landscape. Copyright © 2017 Society of Cardiovascular Computed Tomography. All rights reserved.

  7. 78 FR 69403 - South Tahoe Public Utility District; Notice of Preliminary Determination of a Qualifying Conduit...

    Science.gov (United States)

    2013-11-19

    ... Energy Regulatory Commission South Tahoe Public Utility District; Notice of Preliminary Determination of... November 4, 2013, the South Tahoe Public Utility District filed a notice of intent to construct a... along the existing C-Line export pipeline in South Tahoe Public Utility District's wastewater treatment...

  8. Potential determinants of health-care professionals' use of survivorship care plans: a qualitative study using the theoretical domains framework.

    Science.gov (United States)

    Birken, Sarah A; Presseau, Justin; Ellis, Shellie D; Gerstel, Adrian A; Mayer, Deborah K

    2014-11-15

    Survivorship care plans are intended to improve coordination of care for the nearly 14 million cancer survivors in the United States. Evidence suggests that survivorship care plans (SCPs) have positive outcomes for survivors, health-care professionals, and cancer programs, and several high-profile organizations now recommend SCP use. Nevertheless, SCP use remains limited among health-care professionals in United States cancer programs. Knowledge of barriers to SCP use is limited in part because extant studies have used anecdotal evidence to identify determinants. This study uses the theoretical domains framework to identify relevant constructs that are potential determinants of SCP use among United States health-care professionals. We conducted semi-structured interviews to assess the relevance of 12 theoretical domains in predicting SCP use among 13 health-care professionals in 7 cancer programs throughout the United States with diverse characteristics. Relevant theoretical domains were identified through thematic coding of interview transcripts, identification of specific beliefs within coded text units, and mapping of specific beliefs onto theoretical constructs. We found the following theoretical domains (based on specific beliefs) to be potential determinants of SCP use: health-care professionals' beliefs about the consequences of SCP use (benefit to survivors, health-care professionals, and the system as a whole); motivation and goals regarding SCP use (advocating SCP use; extent to which using SCPs competed for health-care professionals' time); environmental context and resources (whether SCPs were delivered at a dedicated visit and whether a system, information technology, and funding facilitated SCP use); and social influences (whether using SCPs is an organizational priority, influential people support SCP use, and people who could assist with SCP use buy into using SCPs). Specific beliefs mapped onto the following psychological constructs: outcome

  9. Determinants of utilization of maternity services in Gidan Igwe ...

    African Journals Online (AJOL)

    Background: The provision of antenatal care is regarded as the cornerstone of maternal and perinatal health care especially in developing nations and is expected to have a significant impact on achieving the fifth millennium development goal. The aim of this study was to assess the determinants of utilisation of maternity ...

  10. Determinants of skilled care utilization among pregnant women ...

    African Journals Online (AJOL)

    A pre-tested questionnaire was used for data collection, and data analysis was done using descriptive and inferential statistics. Results: SBA supervised 73.8% births. Determinants of skilled birth attendance at delivery include higher education (AOR; 10.94, 95% CI; 3.60-33.26), having only one child (AOR; 4.33, 95% CI; ...

  11. Investigating determinants of out-of-pocket spending and strategies for coping with payments for healthcare in southeast Nigeria

    Directory of Open Access Journals (Sweden)

    Okoronkwo Ijeoma

    2010-03-01

    Full Text Available Abstract Background Out-of-pocket spending (OOPS is the major payment strategy for healthcare in Nigeria. Hence, the paper assessed the determinants socio-economic status (SES of OOPS and strategies for coping with payments for healthcare in urban, semi-urban and rural areas of southeast Nigeria. This paper provides information that would be required to improve financial accessibility and equity in financing within the public health care system. Methods The study areas were three rural and three urban areas from Ebonyi and Enugu states in South-east Nigeria. Cross-sectional survey using interviewer-administered questionnaires to randomly selected householders was the study tool. A socio-economic status (SES index that was developed using principal components analysis was used to examine levels of inequity in OOPS and regression analysis was used to examine the determinants of use of OOPS. Results All the SES groups equally sought healthcare when they needed to. However, the poorest households were most likely to use low level and informal providers such as traditional healers, whilst the least poor households were more likely to use the services of higher level and formal providers such as health centres and hospitals. The better-off SES more than worse-off SES groups used OOPS to pay for healthcare. The use of own money was the commonest payment-coping mechanism in the three communities. The sales of movable household assets or land were not commonly used as payment-coping mechanisms. Decreasing SES was associated with increased sale of household assets to cope with payment for healthcare in one of the communities. Fee exemptions and subsidies were almost non-existent as coping mechanisms in this study Conclusions There is the need to reduce OOPS and channel and improve equity in healthcare financing by designing and implementing payment strategies that will assure financial risk protection of the poor such pre-payment mechanisms with

  12. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Science.gov (United States)

    Vered, Oded; Simon-Tuval, Tzahit; Yagupsky, Pablo; Malul, Miki; Cicurel, Assi; Davidovitch, Nadav

    2015-01-01

    Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU). Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS) enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470). Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410). HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391). Before diagnosis (baseline), the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05), however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001). Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001). Additional elevated costs were 3.6 times higher laboratory tests (P<0.001), 2.8 times higher emergency room visits (P<0.001), 1.8 times higher medication (P<0.001) and 1.3 times higher diagnostic procedures (P<0.001). We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  13. The Price of a Neglected Zoonosis: Case-Control Study to Estimate Healthcare Utilization Costs of Human Brucellosis.

    Directory of Open Access Journals (Sweden)

    Oded Vered

    Full Text Available Human brucellosis has reemerged as a serious public health threat to the Bedouin population of southern Israel in recent years. Little is known about its economic implications derived from elevated healthcare utilization (HCU. Our objective was to estimate the HCU costs associated with human brucellosis from the insurer perspective. A case-control retrospective study was conducted among Clalit Health Services (CHS enrollees. Brucellosis cases were defined as individuals that were diagnosed with brucellosis at the Clinical Microbiology Laboratory of Soroka University Medical Center in the 2010-2012 period (n = 470. Control subjects were randomly selected and matched 1:3 by age, sex, clinic, and primary physician (n = 1,410. HCU data, demographic characteristics and comorbidities were obtained from CHS computerized database. Mean±SD age of the brucellosis cases was 26.6±17.6 years. 63% were male and 85% were Bedouins. No significant difference in Charlson comorbidity index was found between brucellosis cases and controls (0.41 vs. 0.45, respectively, P = 0.391. Before diagnosis (baseline, the average total annual HCU cost of brucellosis cases was slightly yet significantly higher than that of the control group ($439 vs. $382, P<0.05, however, no significant differences were found at baseline in the predominant components of HCU, i.e. hospitalizations, diagnostic procedures, and medications. At the year following diagnosis, the average total annual HCU costs of brucellosis cases was significantly higher than that of controls ($1,327 vs. $380, respectively, P<0.001. Most of the difference stems from 7.9 times higher hospitalization costs (p<0.001. Additional elevated costs were 3.6 times higher laboratory tests (P<0.001, 2.8 times higher emergency room visits (P<0.001, 1.8 times higher medication (P<0.001 and 1.3 times higher diagnostic procedures (P<0.001. We conclude that human brucellosis is associated with elevated HCU costs. Considering these

  14. Moisture determination of tritium tracers utilizing near-infrared spectroscopy.

    Science.gov (United States)

    Marques, Rosemary; Waterhouse, David J; Helmy, Roy

    2016-06-15

    Tritium tracers are frequently used in biological assays during the drug discovery process because of their high specific activity and relative ease of synthesis. However, this high specific activity, along with other contributing factors, can lead to an increased rate of radiolytic decomposition. As a result, following long-term storage tritium tracers often require purification. Understanding the elements that cause radiolytic decomposition is extremely important to extend the storage life, and consequently reduce unnecessary inventory purifications. One of these elements is the presence of water in tritium tracers. Upon investigation, it was discovered that aside from the relatively common tritium/water exchange that could occur, residual water could also contribute significantly to the decomposition of tritium tracers. A near-infrared method was developed utilizing a portable device to measure the water content in tritium tracers rapidly and without sample destruction. This method proved to be quick, efficient, and achieved an error less than 5% compared to that of traditional Karl Fischer titration. Method validation was performed and good accuracy, linearity, limit of detection and quantitation were all established. Copyright © 2016 John Wiley & Sons, Ltd.

  15. Healthcare utilization and costs of Veterans Health Administration patients with schizophrenia treated with paliperidone palmitate long-acting injection or oral atypical antipsychotics.

    Science.gov (United States)

    Baser, Onur; Xie, Lin; Pesa, Jacqueline; Durkin, Mike

    2015-05-01

    This study aimed to compare real world healthcare costs and resource utilization between patients with schizophrenia treated with paliperidone palmitate long-acting injection (PP) and oral atypical antipsychotics (OAT). Patients (18-64 years) were selected from the Veterans Health Administration dataset (1 July 2007-31 May 2012). Patients with 2+ claims for PP or 2+ claims for the same OAT comprised the two study cohorts with the first prescription date designated as the index date. Participation in the VA healthcare system for 24 months pre- and 12 months post-index, schizophrenia diagnosis (International Classification of Disease 9th Revision Clinical Modification [ICD-9-CM] code 295.1x-6x, 295.8x-9x) and ≥1 claim for an antipsychotic medication during the baseline period were required. Propensity scores and Mahalanobis metric distances with calipers were used to create two matched cohorts. All-cause healthcare utilization and costs for the 12-month follow-up period were compared between matched cohorts. The matching process produced two cohorts of 335 patients with similar baseline characteristics. During the 12-month follow-up period, patients in the PP cohort had lower mean inpatient costs (18,560 vs $31,505, p = 0.002), lower frequency of hospitalization (34% vs 53%, p < 0.001) and fewer average inpatient days (13.24 vs 24.18, p = 0.002) vs matched OAT patients. While mean pharmacy costs were higher for the PP cohort ($10,063 vs $4167, p < 0.001), mean total healthcare costs were not significantly different ($45,529 vs $52,569, p = 0.128). VA patients, diagnosed with schizophrenia and treated with PP, had lower inpatient costs and admission rates compared to a matched cohort of OAT patients. Total healthcare costs were not significantly different.

  16. Workplace Determinants of Endotoxin Exposure in Dental Healthcare Facilities in South Africa

    Science.gov (United States)

    Singh, Tanusha S.; Bello, Braimoh; Mabe, Onnicah D.; Renton, Kevin; Jeebhay, Mohamed F.

    2010-01-01

    Objectives: Aerosols generated during dental procedures have been reported to contain endotoxin as a result of bacterial contamination of dental unit water lines. This study investigated the determinants of airborne endotoxin exposure in dental healthcare settings. Methods: The study population included dental personnel (n = 454) from five academic dental institutions in South Africa. Personal air samples (n = 413) in various dental jobs and water samples (n = 403) from dental handpieces and basin taps were collected. The chromogenic-1000 limulus amebocyte lysate assay was used to determine endotoxin levels. Exposure metrics were developed on the basis of individually measured exposures and average levels within each job category. Analysis of variance and multivariate linear regression models were constructed to ascertain the determinants of exposure in the dental group. Results: There was a 2-fold variation in personal airborne endotoxin from the least exposed (administration) to the most exposed (laboratory) jobs (geometric mean levels: 2.38 versus 5.63 EU m−3). Three percent of personal samples were above DECOS recommended exposure limit (50 EU m−3). In the univariate linear models, the age of the dental units explained the most variability observed in the personal air samples (R2 = 0.20, P < 0.001), followed by the season of the year (R2 = 0.11, P < 0.001). Other variables such as institution and total number of dental units per institution also explained a modest degree of variability. A multivariate model explaining the greatest variability (adjusted R2 = 0.40, P < 0.001) included: the age of institution buildings, total number of dental units per institution, ambient temperature, ambient air velocity, endotoxin levels in water, job category (staff versus students), dental unit model type and age of dental unit. Conclusions: Apart from job type, dental unit characteristics are important predictors of airborne endotoxin

  17. The utility of social capital in research on health determinants.

    Science.gov (United States)

    Macinko, J; Starfield, B

    2001-01-01

    Social capital has become a popular subject in the literature on determinants of health. The concept of social capital has been used in the sociological, political science, and economic development literatures, as well as in the health inequalities literature. Analysis of its use in the health inequalities literature suggests that each theoretical tradition has conceptualized social capital differently. Health researchers have employed a wide range of social capital measures, borrowing from several theoretical traditions. Given the wide variation in these measures and an apparent lack of consistent theoretical or empirical justification for their use, conclusions about the likely role of "social capital" on population health may be overstated or even misleading. Elements of a research agenda are proposed to further elucidate the potential role of factors currently subsumed under the rubric of "social capital."

  18. Healthcare utilization for arthritis by indigenous populations of Australia, Canada, New Zealand, and the United States: A systematic review☆.

    Science.gov (United States)

    Loyola-Sanchez, Adalberto; Hurd, Kelle; Barnabe, Cheryl

    2017-04-01

    Indigenous populations of Australia, Canada, New Zealand, and the United States of America (USA) experience a higher prevalence of arthritis conditions. Differences in clinical outcomes and mortality may reflect healthcare service use inequities. The objective of this study was to summarize healthcare service use patterns described in the existing literature in order to identify gaps and inform strategies to limit the pronounced negative impact of arthritis on Indigenous populations. Medline, EMBASE, CINAHL, and Indigenous-specific electronic databases (to June 2015) were used to identify cohort, case-control and cross-sectional studies describing healthcare service use by Indigenous populations with specified inflammatory arthritis, osteoarthritis, or rheumatic disease conditions. We extracted information on the study setting and methodology, primary outcome and assessed study quality, and risk of bias. In total, 19 studies were identified describing three types of healthcare service use: physician visits, hospitalizations, and surgeries. In Canada and New Zealand, Indigenous populations had 36-51% fewer visits to specialists than the non-Indigenous population. Indigenous populations in Canada, New Zealand, and the USA had 37-300% more hospitalizations due to arthritis complications than the non-Indigenous population. Indigenous populations in Australia, Canada, and New Zealand had 27-85% fewer arthroplasties for osteoarthritis than the non-Indigenous population. Indigenous populations had higher hospitalization rates but lower use of specialized services for arthritis conditions. Strategies to improve access to specialized arthritis services might reduce health outcome inequities. Copyright © 2017 The Authors. Published by Elsevier Inc. All rights reserved.

  19. Recruiting Rural Healthcare Providers Today: a Systematic Review of Training Program Success and Determinants of Geographic Choices.

    Science.gov (United States)

    MacQueen, Ian T; Maggard-Gibbons, Melinda; Capra, Gina; Raaen, Laura; Ulloa, Jesus G; Shekelle, Paul G; Miake-Lye, Isomi; Beroes, Jessica M; Hempel, Susanne

    2018-02-01

    Rural areas have historically struggled with shortages of healthcare providers; however, advanced communication technologies have transformed rural healthcare, and practice in underserved areas has been recognized as a policy priority. This systematic review aims to assess reasons for current providers' geographic choices and the success of training programs aimed at increasing rural provider recruitment. This systematic review (PROSPERO: CRD42015025403) searched seven databases for published and gray literature on the current cohort of US rural healthcare practitioners (2005 to March 2017). Two reviewers independently screened citations for inclusion; one reviewer extracted data and assessed risk of bias, with a senior systematic reviewer checking the data; quality of evidence was assessed using the GRADE approach. Of 7276 screened citations, we identified 31 studies exploring reasons for geographic choices and 24 studies documenting the impact of training programs. Growing up in a rural community is a key determinant and is consistently associated with choosing rural practice. Most existing studies assess physicians, and only a few are based on multivariate analyses that take competing and potentially correlated predictors into account. The success rate of placing providers-in-training in rural practice after graduation, on average, is 44% (range 20-84%; N = 31 programs). We did not identify program characteristics that are consistently associated with program success. Data are primarily based on rural tracks for medical residents. The review provides insight into the relative importance of demographic characteristics and motivational factors in determining which providers should be targeted to maximize return on recruitment efforts. Existing programs exposing students to rural practice during their training are promising but require further refining. Public policy must include a specific focus on the trajectory of the healthcare workforce and must consider

  20. RVUs, SGR, RUC, and Alphabet Soup: Utility of an iPad App to Teach Healthcare Economics.

    Science.gov (United States)

    Lourenco, Ana P; Baird, Grayson L; Ashkan, Mark; Slanetz, Priscilla J

    2016-07-01

    This study aimed to evaluate the effectiveness of an iPad app for teaching healthcare economics milestones. Institutional review board-approved, Health Insurance Portability and Accountability Act-compliant survey assessment of radiology residents' knowledge of healthcare economics before and following review of the Healthcare Economics iPad app was undertaken at two residencies. Residents received an electronic link to the pre survey, answered 13 general knowledge questions, rated their knowledge of healthcare economics milestones, and reported any prior economics/business background. During the conference, residents reviewed the app on their iPads. They then received a link to the post survey. Responses were entered using REDCap and a unique yet anonymous code was used to link each resident's pre and post results. A follow-up survey was completed at 3 months using REDCap. Sixty-two of 69 (90%) residents completed the pre survey. Mean and median age was 30 years. Thirty-two of 62 (52%) were men and 30/62 (48%) were women. Twenty-nine percent (18/62) were postgraduate year (PGY) 2, 24% (15/62) PGY 3, 19% (12/62) PGY 4, 26% (16/62) PGY 5, and 1.6% (1/62) PGY 6. Thirty-four percent (21/62) reported some economics/business background. Residents' mean self-assessment of their knowledge of healthcare economics milestones was fair on the pre survey, significantly improved on the post survey, and plateaued at 3 months. Fifty-nine residents completed the post survey; 60 completed the 3-month follow-up. Residents demonstrated a significant increase in healthcare economics knowledge on post survey. At 3-month follow-up, significant decreases in gained knowledge were observed only in residents for whom the material was not integrated into the curriculum. Teaching with iPad apps offers an alternative, effective way to teach basics of healthcare economics milestones. Copyright © 2016 The Association of University Radiologists. Published by Elsevier Inc. All rights reserved.

  1. Children and adolescents with chronic constipation: how many seek healthcare and what determines it?

    NARCIS (Netherlands)

    Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Benninga, Marc A.

    2012-01-01

    This island-wide cross-sectional survey was conducted to assess the healthcare consultations in Sri Lankan children with constipation. Children aged 10-16 years were randomly selected from five randomly selected schools in three randomly selected provinces of Sri Lanka. Data were collected using a

  2. Early comprehensive care of preterm infants-effects on quality of life, childhood development, and healthcare utilization: study protocol for a cohort study linking administrative healthcare data with patient reported primary data.

    Science.gov (United States)

    Schmitt, Jochen; Arnold, Katrin; Druschke, Diana; Swart, Enno; Grählert, Xina; Maywald, Ulf; Fuchs, Andreas; Werblow, Andreas; Schemken, Maryan; Reichert, Jörg; Rüdiger, Mario

    2016-07-22

    About 9 % of all children in Germany are born preterm. Despite significant improvements of medical care, preterm infants are at a greater risk to develop short and long term health complications. Negative consequences of preterm birth include neurodevelopmental disabilities, behavioral problems or learning disorders. Most data on effects of prematurity are derived from single or multi-center studies and not population-based. Since some of the long term problems of preterm delivery are associated with a disturbed parent-child interaction originating in the neonatal period, several intervention programs became available aiming to strengthen the early parent-child relationship. However, there is insufficient knowledge regarding the psychosocial and socioeconomic impact of these interventions. Prior to introducing them into routine care, those effects have to be rigorously evaluated. The population-based cohort study EcoCare-PIn (Early comprehensive Care of Preterm Infants-effects on quality of life, childhood development, and healthcare utilization) will investigate the following primary research questions: 1) What are the short- and long-term consequences of preterm birth with regard to parental stress, parent-child relationship, childhood development, quality of life and healthcare utilization including costs? 2) Does early family-centered psychosocial care prevent the hypothesized negative consequences of preterm birth on the above mentioned outcomes? EcoCare-PIn examines the research questions by means of a linkage of a) pseudonymized administrative individual-level claims data from the German statutory health insurance AOK PLUS on approximately 140,000 children born between 2007 and 2013 in Saxony, and b) primary data collected from the parents/caregivers of all very low birth weight (primary data is a novel approach in neonatal research and probably the only way to overcome shortcomings of studies solely relying on one data source. The study results are based

  3. A checklist for identifying determinants of practice: a systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice

    NARCIS (Netherlands)

    Flottorp, S.A.; Oxman, A.D.; Krause, J.; Musila, N.R.; Wensing, M.; Godycki-Cwirko, M.; Baker, R.; Eccles, M.P.

    2013-01-01

    BACKGROUND: Determinants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive,

  4. Quality of Life, Depression, and Healthcare Resource Utilization among Adults with Type 2 Diabetes Mellitus and Concomitant Hypertension and Obesity: A Prospective Survey

    Directory of Open Access Journals (Sweden)

    Andrew J. Green

    2012-01-01

    Full Text Available Background. This study compared quality of life, depression, and healthcare resource utilization among adults with type 2 diabetes mellitus (T2DM and comorbid hypertension (HTN and obesity with those of adults reporting T2DM alone. Methods. Respondents to the US SHIELD survey self-reported their height, weight, comorbid conditions, hospitalizations, and outpatient visits and completed the Short Form-12 (SF-12 and Patient Health Questionnaire (PHQ-9. Respondents reporting T2DM and HTN and obesity (body mass index, BMI, ≥30 kg/m2 were compared with a T2DM-alone group. Results. Respondents with T2DM, HTN, and obesity (n=1292 had significantly lower SF-12 Physical and Mental Component Summary scores (37.3 and 50.9, resp. than T2DM-alone respondents (n=349 (45.8 and 53.5, resp., P<0.0001. Mean PHQ-9 scores were significantly higher among T2DM respondents with comorbid HTN and obesity (5.0 versus 2.5, P<0.0001, indicating greater depression burden. Respondents with T2DM, HTN, and obesity had significantly more resource utilization with respect to physician visits and emergency room visits but not hospitalizations than respondents with T2DM alone (P=0.03. Conclusions. SHIELD respondents with comorbid conditions of T2DM, HTN, and obesity reported greater healthcare resource utilization, more depression symptoms, and lower quality of life than the T2DM-alone group.

  5. Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience.

    Science.gov (United States)

    Larsson, Markus; Ross, Michael W; Tumwine, Gilbert; Agardh, Anette

    2016-01-01

    Research from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited. To identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality. In 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about, or sexually engaged with someone of the same sex. Findings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.7-5.7; OR 2.0, 95% CI: 1.3-3.0, respectively). Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI: 2.1-4.8), exposure to sexual coercion (OR 2.6, 95% CI: 1.7-3.9), frequent heavy episodic drinking (OR 3.3, 95% CI: 1.9-5.8), and number of sexual partners (OR 1.9, 95% CI: 1.04-3.3). The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.1-8.5; AOR 2.8, 95% CI: 1.3-5.8) and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.6-7.1; AOR 2.7, 95% CI: 1.4-5.4) persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking. These findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of same-sex sexuality experienced students. Targeted interventions that integrate mental

  6. Determinants of unmet needs for healthcare and sexual health counselling among Ugandan university students with same-sex sexuality experience

    Science.gov (United States)

    Larsson, Markus; Ross, Michael W.; Tumwine, Gilbert; Agardh, Anette

    2016-01-01

    Background Research from sub-Saharan Africa has shown that persons with same-sex sexuality experience are at elevated risk for ill health due to sexual risk taking, stigma, and discrimination. However, studies of healthcare seeking among young people in this region with same-sex sexuality experience are limited. Objective To identify determinants of unmet healthcare and sexual health counselling needs, respectively, among Ugandan university students with experience of same-sex sexuality. Design In 2010, 1,954 Ugandan university students completed a questionnaire assessing socio-demographic factors, mental health, alcohol usage, sexual behaviours, and healthcare seeking. The study population consisted of those 570 who reported ever being in love with, sexually attracted to, sexually fantasised about, or sexually engaged with someone of the same sex. Results Findings showed that 56% and 30% reported unmet healthcare and sexual health counselling needs, respectively. Unmet healthcare needs were associated with poor mental health and exposure to sexual coercion (OR 3.9, 95% confidence intervals [CI]: 2.7–5.7; OR 2.0, 95% CI: 1.3–3.0, respectively). Unmet sexual health counselling needs were significantly associated with poor mental health (OR 3.2, 95% CI: 2.1–4.8), exposure to sexual coercion (OR 2.6, 95% CI: 1.7–3.9), frequent heavy episodic drinking (OR 3.3, 95% CI: 1.9–5.8), and number of sexual partners (OR 1.9, 95% CI: 1.04–3.3). The associations between poor mental health, sexual coercion, and unmet healthcare needs (AOR 4.2, 95% CI: 2.1–8.5; AOR 2.8, 95% CI: 1.3–5.8) and unmet needs for sexual health counselling (AOR 3.3, 95% CI: 1.6–7.1; AOR 2.7, 95% CI: 1.4–5.4) persisted after adjustment for socio-demographic factors, number of sexual partners, and frequent heavy episodic drinking. Conclusions These findings indicate that exposure to sexual coercion and poor mental health may influence healthcare seeking behaviours of same-sex sexuality

  7. Children and adolescents with chronic constipation: how many seek healthcare and what determines it?

    Science.gov (United States)

    Rajindrajith, Shaman; Devanarayana, Niranga Manjuri; Benninga, Marc A

    2012-08-01

    This island-wide cross-sectional survey was conducted to assess the healthcare consultations in Sri Lankan children with constipation. Children aged 10-16 years were randomly selected from five randomly selected schools in three randomly selected provinces of Sri Lanka. Data were collected using a pre-tested questionnaire based on Rome III criteria. Of the 2770 questionnaires distributed, 2694 (97.3%) properly filled questionnaires were included in the analysis. From 416 (15.4%) children with chronic constipation, only 16 (3.8%) had sought medical advice during the previous 12 months. Younger children and those with a similar family history were more likely to seek healthcare. The majority of children with symptoms indicating severe constipation such as painful defecation, large volume stool, faecal incontinence and blood stained stools had not sought medical help for their symptoms. Parents should pay more attention to bowel habits of their children to identify and treat constipation early to prevent complications.

  8. Functional Outcomes, Subsequent Healthcare Utilization, and Mortality of Stroke Postacute Care Patients in Taiwan: A Nationwide Propensity Score-matched Study.

    Science.gov (United States)

    Peng, Li-Ning; Lu, Wan-Hsuan; Liang, Chih-Kuang; Chou, Ming-Yueh; Chung, Chih-Ping; Tsai, Shu-Ling; Chen, Zhi-Jun; Hsiao, Fei-Yuan; Chen, Liang-Kung

    2017-11-01

    To evaluate the benefits of the national stroke postacute care (PAC) program on clinical outcomes and subsequent healthcare utilization. Propensity score-matched case-control study using the National Health Insurance data. A total of 1480 stroke cases receiving PAC services and 3159 matched controls with similar stroke severity but without PAC services. Demographic characteristics, functional outcomes (modified Rankin Scale, Barthel Index, Lawton-Brody Instrumental Activities of Daily Living, Functional Oral Intake Scale, Mini-Nutritional Assessment, Berg Balance Test, Usual Gait Speed Test, 6-Minute Walk Test, Fugl-Meyer Assessment (modified sensation and motor), Mini-Mental State Examination, Motor Activity Log, and the Concise Chinese Aphasia Test), subsequent healthcare utilization (90-day stroke re-admission and emergency department visits), and 90-day mortality. After propensity score matching, baseline characteristics, stroke severity, and status of healthcare utilization before index stroke admission were similar between cases and controls. After PAC services, the case group obtained significant improvement in all functional domains and may have reduced subsequent disability. Among all functional assessments, balance was the most significantly improved domain and was suggestive for the reduction of subsequent falls risk and related injuries. Compared with controls, patients receiving PAC services had significantly lower 90-day hospital re-admissions [11.1% vs 21.0%, adjusted odds ratio (aOR) 0.47 with 95% confidence interval (CI) 0.34-0.64], stroke-related re-admissions (2.1% vs 8.8%, aOR 0.22, 95% CI 0.12-0.41), and emergency department visits (13.5% vs 24.0%, aOR 0.49, 95% CI 0.37-0.65), but the 90-day mortality rate remained similar between groups (1.4% case group vs 2.0% control group, aOR 0.68, 95% CI 0.29-1.62). PAC significantly improved the recovery of stroke patients in all functional domains through the program, with universal interorganizational

  9. The critical determinants of improvement in healthcare and lessons for integrated care

    OpenAIRE

    Harnett, Patrick John

    2016-01-01

    Healthcare quality is a key concern for policy makers, regulators, care givers and patients (HIQA 2013, Harding-Clarke 2006, Francis 2014) with a current focus on integrated care as a solution (Knigs Fund 2015). Despite stated commitment to integration, progress has been slow, with significant consequences for vulnerable population cohorts, in particular frail older people, (Thompson, 2012, Silvester et al., 2014). Improvement has been examined from a variety of perspectives including accredi...

  10. Determination of reliability for Dacia 1304 1,9 D utility vehicle

    Science.gov (United States)

    Budiul Berghian, A.; Vasiu, T.

    2015-06-01

    The study analyses running and failure of Dacia 1304, 1,9D utility vehicle. The study comprises plotting the Pareto diagram in accordance with the data collected by observation of utility vehicle running/failure and determination of its reliability using the Weibull++8 specialized software of the company ReliaSoft, conclusions being presented in graphic form within this study.

  11. Utilization of health care services in rural and urban areas: a determinant factor in planning and managing health care delivery systems.

    Science.gov (United States)

    Oladipo, Jimoh Ayanda

    2014-06-01

    Disparities in use of healthcare services between rural and urban areas have been empirically attributed to several factors. This study explores the existence of this disparity and its implication for planning and managing healthcare delivery systems. The objectives determine the relative importance of the various predisposing, enabling, need and health services factors on utilization of health services; similarity between rural and urban areas; and major explanatory variables for utilization. A four-stage model of service utilization was constructed with 31 variables under appropriate model components. Data is collected using cross-sectional sample survey of 1086 potential health services consumers in selected health facilities and resident milieu via questionnaire. Data is analyzed using factor analysis and cross tabulation. The 4-stage model is validated for the aggregate data and data for the rural areas with 3-stage model for urban areas. The order of importance of the factors is need, enabling, predisposing and health services. 11 variables are found to be powerful predictors of utilization. Planning of different categories of health care facilities in different locations should be based on utilization rates while proper management of established facilities should aim to improve health seeking behavior of people.

  12. Determining the need for team-based training in delirium management: A needs assessment of surgical healthcare professionals.

    Science.gov (United States)

    Sockalingam, Sanjeev; Tehrani, Hedieh; Kacikanis, Anna; Tan, Adrienne; Hawa, Raed; Anderson, Ruthie; Okrainec, Allan; Abbey, Susan

    2015-01-01

    The high incidence of delirium in surgical units is a serious quality concern, given its impact on morbidity and mortality. While successful delirium management depends upon interdisciplinary care, training needs for surgical teams have not been studied. A needs assessment of surgical units was conducted to determine perceived comfort in managing delirium, and interprofessional training needs for team-based care. We administered a survey to 106 General Surgery healthcare professionals (69% response rate) with a focus on attitudes towards delirium and team management. Although most respondents identified delirium as important to patient outcomes, only 61% of healthcare professionals indicated that a team-based approach was always observed in practice. Less than half had a clear understanding of their role in delirium care, while just over half observed team communication of delirium care plans during handover. This is the first observation of clear gaps in perceived team performance in a General Surgery setting.

  13. Determination of maintainability for Dacia 1304, 1,9 D utility vehicle

    Science.gov (United States)

    Budiul Berghian, A.; Vasiu, T.; Birtok Baneasa, C.

    2018-01-01

    The study analyses the ability to be maintained or rehabilitation of Dacia 1304, 1,9D utility vehicle. The paper comprises the determination of its maintainability using the Weibull++8 specialized software.

  14. The association between use of mealtime insulin pens versus vials and healthcare charges and resource utilization in patients with type 2 diabetes: a retrospective cohort study.

    Science.gov (United States)

    Eby, Elizabeth L; Boye, Kristina S; Lage, Maureen J

    2013-10-01

    To compare all-cause and diabetes-related resource utilization and healthcare charges among adults with type 2 diabetes mellitus who initiated therapy with mealtime insulin disposable pens or vials. Data were obtained from the Innovus inVision database from January 1, 2006 through June 30, 2010. Generalized linear models with a gamma distribution and log link estimated the association between medical charges and use of mealtime insulin pens vs vials in the 1 year post-index date, while generalized linear models with a negative binomial distribution estimated resource utilization. Controlling for patient characteristics, general health, and patient copayments, insulin therapy initiation with disposable pens, compared to vials, was associated with significantly fewer all-cause hospitalizations (1.45 vs. 1.66; p charges ($3593 vs. $2755; p charges ($42,150 vs. $53,340; p charges ($12,722 vs. $14,540; p charges.

  15. Leveraging healthcare utilization to explore outcomes from musculoskeletal disorders: methodology for defining relevant variables from a health services data repository.

    Science.gov (United States)

    Rhon, Daniel I; Clewley, Derek; Young, Jodi L; Sissel, Charles D; Cook, Chad E

    2018-01-31

    Large healthcare databases, with their ability to collect many variables from daily medical practice, greatly enable health services research. These longitudinal databases provide large cohorts and longitudinal time frames, allowing for highly pragmatic assessment of healthcare delivery. The purpose of this paper is to discuss the methodology related to the use of the United States Military Health System Data Repository (MDR) for longitudinal assessment of musculoskeletal clinical outcomes, as well as address challenges of using this data for outcomes research. The Military Health System manages care for approximately 10 million beneficiaries worldwide. Multiple data sources pour into the MDR from multiple levels of care (inpatient, outpatient, military or civilian facility, combat theater, etc.) at the individual patient level. To provide meaningful and descriptive coding for longitudinal analysis, specific coding for timing and type of care, procedures, medications, and provider type must be performed. Assumptions often made in clinical trials do not apply to these cohorts, requiring additional steps in data preparation to reduce risk of bias. The MDR has a robust system in place to validate the quality and accuracy of its data, reducing risk of analytic error. Details for making this data suitable for analysis of longitudinal orthopaedic outcomes are provided. Although some limitations exist, proper preparation and understanding of the data can limit bias, and allow for robust and meaningful analyses. There is the potential for strong precision, as well as the ability to collect a wide range of variables in very large groups of patients otherwise not captured in traditional clinical trials. This approach contributes to the improved understanding of the accessibility, quality, and cost of care for those with orthopaedic conditions. The MDR provides a robust pool of longitudinal healthcare data at the person-level. The benefits of using the MDR database appear to

  16. Robustness of the healthcare utilization results from the Rotavirus Efficacy and Safety Trial (REST evaluating the human-bovine (WC3 reassortant pentavalent rotavirus vaccine (RV5

    Directory of Open Access Journals (Sweden)

    Van Damme Pierre

    2010-06-01

    Full Text Available Abstract Background The Rotavirus Efficacy and Safety Trial was a placebo-controlled Phase III study that evaluated the safety and efficacy of a three-dose pentavalent rotavirus vaccine (RV5 including its effect on healthcare utilization for rotavirus gastroenteritis (RVGE. The per-protocol (PP analyses, which counted events occurring 14 days after dose 3 among infants without protocol violations, have already been published. This paper evaluates the consistency of the healthcare utilization results based on the modified intention to treat (MITT analyses with the PP analyses. The MITT analyses include all infants receiving at least one dose of vaccine or placebo and follow-up begins after dose 1. The paper also explores the consistency of the results for different subgroups of the study population with different types of surveillance. Methods Data on healthcare utilization for acute gastroenteritis were collected via telephone interviews after administration of the first dose. Parents were either contacted every 6 weeks or every 2 weeks depending on the substudy in which they were enrolled. Those contacted every 2 weeks were also asked to complete symptom diaries. Poisson regression was used to evaluate the effect of RV5 on the rates of RVGE-associated healthcare encounters in all of the analyses. Results In the first 2 years after vaccination, RV5 reduced the combined rate of hospitalizations and emergency department (ED visits 88.9% (95% CI: 84.9, 91.9 for all RVGE regardless of serotype in the MITT analysis compared with a 94.5% (95% CI: 91.2, 96.6 reduction based on the G1-G4 PP analysis. By type of surveillance, the rate reductions for the G1-G4 PP analysis were 91.0% (95% CI: 81.7, 95.5 and 95.9% (95% CI: 92.2, 97.8 among parents contacted every 2 weeks (number evaluable = 4,451 and every 6 weeks (number evaluable = 52,683 respectively. Conclusions Our analyses demonstrated that the effect of RV5 on reducing the rate of hospitalizations

  17. Demographics, treatment patterns, and healthcare utilization and cost of repository corticotropin injection in patients with systemic lupus erythematosus or rheumatoid arthritis.

    Science.gov (United States)

    Wu, Bingcao; Deshpande, Gaurav; Gu, Tao; Popelar, Breanna; Philbin, Michael; Wan, George J

    2017-11-01

    To evaluate healthcare resource utilization (HRU) and costs among patients who initiated repository corticotropin injection (RCI; H.P. Acthar Gel) treatment for rheumatoid arthritis (RA) or systemic lupus erythematosus (SLE). Patients aged ≥18 years with ≥2 diagnoses for either RA or SLE between July 1, 2006 and April 30, 2015 were identified in the HealthCore Integrated Research Database. Index RCI date was the earliest date of a medical or pharmacy claim for RCI after diagnosis. Baseline characteristics, pre- and post-initiation HRU and costs were assessed using descriptive statistics. This study identified 180 RA patients (mean age = 60 years, 56% female) and 29 SLE patients (mean age = 45 years, 90% female) who initiated RCI. First RCI use averaged 7.1 and 22.6 months after the initial RA and SLE diagnosis, respectively. After RCI initiation, RA patients incurred significantly lower per-patient-per-month (PPPM) all-cause medical costs ($1,881 vs $682, p < .01) vs the pre-initiation period, driven by lower PPPM hospitalizations costs ($1,579 vs $503, p < .01). Overall PPPM healthcare costs were higher ($2,751 vs $5,487, p < .01) due to higher PPPM prescription costs ($869 vs $4,805, p < .01). Similarly, SLE patients had decreased PPPM hospitalization costs ($3,192 vs $799, p = .04) and increased PPPM prescription costs ($905 vs $7,443, p < .01) after initiating RCI; the difference in overall PPPM healthcare costs was not statistically significant likely, due to small sample size. This study, across a heterogeneous population of variable disease duration, described clinical and healthcare utilization and costs of RA and SLE patients initiating RCI in a real-world setting. We observed that patients receiving RCI had lower utilization and costs for medical services in both disease populations, which partially offset the increased prescription costs by 30% and 37%. Future research is needed to explore factors associated with RCI

  18. Long-term Effect of Home Nursing Intervention on Cost and Healthcare Utilization for Patients with Chronic Obstructive Pulmonary Disease: A Retrospective Observational Study.

    Science.gov (United States)

    Matsumura, Takuro; Takarada, Kana; Oki, Yutaro; Fujimoto, Yukari; Kaneko, Hiromi; Ohira, Mineko; Ishikawa, Akira

    2015-01-01

    The present study aimed to examine the long-term effects of a home nursing intervention on healthcare utilization and costs among patients with chronic obstructive pulmonary disease (COPD). A 3-year retrospective study. Eleven COPD patients who had received home nursing intervention after hospital discharge were enrolled. We retrospectively investigated their healthcare utilization and costs for 1 year before the intervention and during 2 years of the intervention. The number and length of hospitalizations decreased gradually from the pre-intervention period through the second year. The number of hospital and home nursing visits increased from the pre-intervention period through the first and second years. The hospitalization costs were decreased by approximately half from the pre-intervention period through the first year and from the first year through the second year. The total medical cost did not change significantly. Our home nursing intervention decreased the number and length of hospitalizations and the hospitalization costs; however, it did not affect the total medical cost. It is possible that the continuation of home nursing interventions may decrease the number of hospitalizations, number of home nursing visits, and the total medical cost by maintaining the health condition of patients. © 2014 Association of Rehabilitation Nurses.

  19. Disease burden of fractures among patients with osteoporosis in Japan: health-related quality of life, work productivity and activity impairment, healthcare resource utilization, and economic costs.

    Science.gov (United States)

    Fujiwara, Saeko; Zhao, Xiahong; Teoh, Cheryl; Jaffe, Dena H; Taguchi, Yurie

    2018-03-08

    Osteoporosis remains undertreated in Japan, and bone fractures are the most frequent complications imposing heavy burden on individuals and the community. This paper investigates the clinical and economic burden of fractures among osteoporosis patients in Japan. The Japan National Health and Wellness Survey 2012-2014 database was used for analysis. Respondents aged ≥ 50 years and indicated a physician diagnosis of osteoporosis (N = 1107) were categorized into three subgroups: no prior fracture (N = 693), single fracture (N = 242), and multiple (≥ 2) fractures (N = 172). Health-related quality of life (HRQoL), work productivity and activity impairment, healthcare resource utilization and associated direct and indirect costs were compared across three fracture subgroups adjusting for respondents' sociodemographic and clinical characteristics using generalized linear regression models. The estimated fracture prevalence among respondents with osteoporosis who were ≥ 50 years was 37.4%, of whom 41.5% had multiple fractures. Relative to osteoporosis respondents with no fracture and with single fracture, those with multiple fractures reported significant higher disability in HRQoL, more healthcare resource utilization, and were associated with higher direct costs. Improved treatment of fractures among osteoporosis patients is necessary and may help reduce the clinical and economic burden in this osteoporosis population.

  20. Obesity, health-care utilization, and health-related quality of life after fracture in postmenopausal women: Global Longitudinal Study of Osteoporosis in Women (GLOW).

    Science.gov (United States)

    Compston, Juliet E; Flahive, Julie; Hooven, Frederick H; Anderson, Frederick A; Adachi, Jonathan D; Boonen, Steven; Chapurlat, Roland D; Cooper, Cyrus; Díez-Perez, Adolfo; Greenspan, Susan L; LaCroix, Andrea Z; Lindsay, Robert; Netelenbos, J Coen; Pfeilschifter, Johannes; Roux, Christian; Saag, Kenneth G; Silverman, Stuart; Siris, Ethel S; Watts, Nelson B; Gehlbach, Stephen H

    2014-02-01

    Fractures may be associated with higher morbidity in obese postmenopausal women than in nonobese women. We compared health-care utilization, functional status, and health-related quality of life (HRQL) in obese, nonobese, and underweight women with fractures. Information from the GLOW study, started in 2006, was collected at baseline and at 1, 2, and 3 years. In this subanalysis, self-reported incident clinical fractures, health-care utilization, HRQL, and functional status were recorded and examined. Women in GLOW (n = 60,393) were aged ≥55 years, from 723 physician practices at 17 sites in 10 countries. Complete data for fracture and body mass index were available for 90 underweight, 3,270 nonobese, and 941 obese women with one or more incident clinical fractures during the 3-year follow-up. The median hospital length of stay, adjusted for age, comorbidities, and fracture type, was significantly greater in obese than nonobese women (6 vs. 5 days, p = 0.017). Physical function and vitality score were significantly worse in obese than in nonobese women, both before and after fracture; but changes after fracture were similar across groups. Use of antiosteoporosis medication was significantly lower in obese than in nonobese or underweight women. In conclusion, obese women with fracture undergo a longer period of hospitalization for treatment and have poorer functional status and HRQL than nonobese women. Whether these differences translate into higher economic costs and adverse effects on longer-term outcomes remains to be established.

  1. Perceived morbidity, healthcare-seeking behavior and their determinants in a poor-resource setting: observation from India.

    Directory of Open Access Journals (Sweden)

    Suman Kanungo

    Full Text Available To control the double burden of communicable and non-communicable diseases (NCDs, in the developing world, understanding the patterns of morbidity and healthcare-seeking is critical. The objective of this cross-sectional study was to determine the distribution, predictors and inter-relationship of perceived morbidity and related healthcare-seeking behavior in a poor-resource setting.Between October 2013 and July 2014, 43999 consenting subjects were recruited from 10107 households in Malda district of West Bengal state in India, through multistage random sampling, using probability proportional-to-size. Information on socio-demographics, behaviors, recent ailments, perceived severity and healthcare-seeking were analyzed in SAS-9.3.2.Recent illnesses were reported by 55.91% (n=24,600 participants. Among diagnosed ailments (n=23,626, 50.92% (n=12,031 were NCDs. Respiratory (17.28%, n=7605, gastrointestinal (13.48%, n=5929 and musculoskeletal (6.25%, n=2749 problems were predominant. Non-qualified practitioners treated 53.16% (n=13,074 episodes. Older children/adolescents [adjusted odds ratio for private healthcare providers (AORPri=0.76, 95% confidence interval=0.71-0.83 and for Govt. healthcare provider (AORGovt=0.80(0.68-0.95], females [AORGovt=0.80(0.73-0.88], Muslims [AORPri=0.85(0.69-0.76 and AORGovt=0.92(0.87-0.96], backward castes [AORGovt=0.93(0.91-0.96] and rural residents [AORPri=0.82(0.75-0.89 and AORGovt=0.72(0.64-0.81] had lower odds of visiting qualified practitioners. Apparently less severe NCDs [acid-peptic disorders: AORPri=0.41(0.37-0.46 & AORGovt=0.41(0.37-0.46, osteoarthritis: AORPri=0.72(0.59-0.68 & AORGovt=0.58(0.43-0.78], gastrointestinal [AORPri=0.28(0.24-0.33 & AORGovt=0.69(0.58-0.81], respiratory [AORPri=0.35(0.32-0.39 & AORGovt=0.46(0.41-0.52] and skin infections [AORPri=0.65(0.55-0.77] were also less often treated by qualified practitioners. Better education [AORPri=1.91(1.65-2.22 for ≥graduation], sanitation [AORPri=1

  2. Healthcare Resource Utilization and Costs Associated with Ketosis Events in Pediatric and Adult Patients with Type 1 Diabetes Mellitus in the UK.

    Science.gov (United States)

    Thalange, Nandu; Aldhouse, Natalie Valerie Jane; Kitchen, Helen; Howard, Daniel; Tutkunkardas, Deniz; Håkan-Bloch, Jonas

    2017-10-01

    Ketosis is a metabolic state associated with insulin deficiency. Untreated, it develops into diabetic ketoacidosis, a significant contributor to mortality and morbidity in people with type 1 diabetes mellitus (T1DM). Little is understood about how patients utilize healthcare resources during ketosis events. This study aimed to identify and quantify healthcare resource utilization and provide estimates of associated costs of ketosis events in T1DM, treated unaided or with healthcare professional (HCP) assistance in the UK. Qualitative interviews with adult patients, pediatric carers, and HCPs identified resources used by patients/carers during ketosis events. An online quantitative survey was then used to quantify patients/carers resource use during their/their child's most recent ketosis event, and HCPs estimated patient resource uptake to corroborate the findings. Associated costs estimated from UK data sources were applied to the survey results to calculate the cost of ketosis events in adults and children. Quantitative survey responses from 93 adults, 76 carers, and 52 HCPs were analyzed. Patients and carers monitored ketosis during and following the event with ketone strips and additional glucose strips, and administered treatment comprising insulin and pump set changes where appropriate. Additionally, patients/carers accessed phone services and many received follow-up medical appointments. In total, 70% (n = 65) of adult and 66% (n = 50) of pediatric ketosis events were managed at home, for which resource use costs per event were £23.87 and £38.00 respectively. Remaining events were treated in NHS facilities costing £217.57 per adult and £352.92 per child. Weighted averages identified that ketosis events cost £81.98 per adult and £142.97 per child. Indirect costs from work productivity loss increase these figures to £225.11 per adult and £256.88 per child. Healthcare resource use for ketosis events is high in adults and children with T1DM and

  3. Maternal depressive symptoms predict adolescent healthcare utilization and charges in youth with type 1 diabetes (T1D).

    Science.gov (United States)

    Clayton, Kyle M; Stewart, Sunita M; Wiebe, Deborah J; McConnel, Charles E; Hughes, Carroll W; White, Perrin C

    2013-09-01

    To examine whether maternal depressive symptoms predict diabetes-related health care utilization and charges in adolescents with Type 1 diabetes. Mothers of adolescents ages 11-18 with Type 1 diabetes completed the Center for Epidemiological Studies Depression Scale at enrollment and at 12-month follow-up. Demographic and disease-related variables, including HbA1c, were also assessed. Health care utilization data and charges for diabetes-related care (i.e., endocrine clinic visits, emergency room visits, and hospitalizations) for the period of 12 and 24 months following enrollment were assessed. Maternal depressive symptoms at enrollment predicted higher utilization/charges at 12- and 24-month follow-up, after controlling for demographic and disease-related variables and adolescent depressive symptoms. High maternal depressive symptoms at baseline were associated with $8,405 additional charges over the next 2 years. Adolescents of mothers with high depressive symptoms were twice as likely to have an emergency room visit and three times as likely to have a hospitalization. Maternal depressive symptoms are an independent predictor of health care utilization and charges in adolescents with Type 1 diabetes. Interventions aimed at identifying and treating depressive symptoms in mothers could not only enhance caregiver quality of life but could also be economically advantageous for payers and providers. PsycINFO Database Record (c) 2013 APA, all rights reserved.

  4. Change in healthcare utilization and costs following initiation of benzodiazepine therapy for long-term treatment of generalized anxiety disorder: a retrospective cohort study

    Directory of Open Access Journals (Sweden)

    Berger Ariel

    2012-10-01

    Full Text Available Abstract Background Selective serotonin reuptake inhibitors, serotonin-norepinephrine reuptake inhibitors, and benzodiazepine anxiolytics are used in the US to treat generalized anxiety disorder (GAD. While benzodiazepines typically provide rapid symptomatic relief, long-term use is not recommended due to risks of dependency, sedation, falls, and accidents. Methods Using a US health insurance database, we identified all persons with GAD (ICD-9-CM diagnosis code 300.02 who began a long-term course of treatment (≥90 days with a benzodiazepine anxiolytic between 1/1/2003 and 12/31/2007, We compared healthcare utilization and costs over the six-month periods preceding and following the date of treatment initiation (“pretreatment” and “post-treatment”, respectively, and focused attention on accident-related encounters (e.g., for treatment of fractures and care received for other reasons possibly related benzodiazepine use (e.g., sedation, dizziness. Results A total of 866 patients met all study entry criteria; 25% of patients began treatment on an add-on basis (i.e., adjunctive to escitalopram, paroxetine, sertraline, or venlafaxine, while 75% of patients did not receive concomitant therapy. Mean total healthcare costs increased by $2334 between the pretreatment and post-treatment periods (from $4637 [SD=$9840] to $6971 [$17,002]; p Conclusions Healthcare costs increase in patients with GAD beginning long-term (≥90 days treatment with a benzodiazepine anxiolytic; a substantial proportion of this increase is attributable to care associated with accidents and other known sequelae of long-term benzodiazepine use.

  5. Accounting utility for determining individual usage of production level software systems

    Science.gov (United States)

    Garber, S. C.

    1984-01-01

    An accounting package was developed which determines the computer resources utilized by a user during the execution of a particular program and updates a file containing accumulated resource totals. The accounting package is divided into two separate programs. The first program determines the total amount of computer resources utilized by a user during the execution of a particular program. The second program uses these totals to update a file containing accumulated totals of computer resources utilized by a user for a particular program. This package is useful to those persons who have several other users continually accessing and running programs from their accounts. The package provides the ability to determine which users are accessing and running specified programs along with their total level of usage.

  6. Is There Variation in Procedural Utilization for Lumbar Spine Disorders Between a Fee-for-Service and Salaried Healthcare System?

    Science.gov (United States)

    Schoenfeld, Andrew J; Makanji, Heeren; Jiang, Wei; Koehlmoos, Tracey; Bono, Christopher M; Haider, Adil H

    2017-12-01

    Whether compensation for professional services drives the use of those services is an important question that has not been answered in a robust manner. Specifically, there is a growing concern that spine care practitioners may preferentially choose more costly or invasive procedures in a fee-for-service system, irrespective of the underlying lumbar disorder being treated. (1) Were proportions of interbody fusions higher in the fee-for-service setting as opposed to the salaried Department of Defense setting? (2) Were the odds of interbody fusion increased in a fee-for-service setting after controlling for indications for surgery? Patients surgically treated for lumbar disc herniation, spinal stenosis, and spondylolisthesis (2006-2014) were identified. Patients were divided into two groups based on whether the surgery was performed in the fee-for-service setting (beneficiaries receive care at a civilian facility with expenses covered by TRICARE insurance) or at a Department of Defense facility (direct care). There were 28,344 patients in the entire study, 21,290 treated in fee-for-service and 7054 treated in Department of Defense facilities. Differences in the rates of fusion-based procedures, discectomy, and decompression between both healthcare settings were assessed using multinomial logistic regression to adjust for differences in case-mix and surgical indication. TRICARE beneficiaries treated for lumbar spinal disorders in the fee-for-service setting had higher odds of receiving interbody fusions (fee-for-service: 7267 of 21,290 [34%], direct care: 1539 of 7054 [22%], odds ratio [OR]: 1.25 [95% confidence interval 1.20-1.30], p service setting irrespective of the underlying diagnosis. These results speak to the existence of provider inducement within the field of spine surgery. This reality portends poor performance for surgical practices and hospitals in Accountable Care Organizations and bundled payment programs in which provider inducement is allowed to

  7. Implementation of a Brief Treatment Counseling Toolkit in Federally Qualified Healthcare Centers: Patient and Clinician Utilization and Satisfaction.

    Science.gov (United States)

    Brooks, Adam C; Chambers, Jaclyn E; Lauby, Jennifer; Byrne, Elizabeth; Carpenedo, Carolyn M; Benishek, Lois A; Medvin, Rachel; Metzger, David S; Kirby, Kimberly C

    2016-01-01

    The need to integrate behavioral health care within medical settings is widely recognized, and integrative care approaches are associated with improved outcomes for a range of disorders. As substance use treatment integration efforts expand within primary care settings, training behavioral health providers in evidence-based brief treatment models that are cost-effective and easily fit within the medical flow is essential. Guided by principles drawn from Diffusion of Innovations theory (Rogers, 2003) and the Consolidated Framework of Implementation Research (Damschroder et al., 2009), we adapted elements of Motivational Enhancement Therapy, cognitive-behavioral therapy, and 12-step facilitation into a brief counseling toolkit. The toolkit is a menu driven assortment of 35 separate structured clinical interventions that each include client takeaway resources to reinforce brief clinical contacts. We then implemented this toolkit in the context of a randomized clinical trial in three Federally Qualified Healthcare Centers. Behavioral Health Consultants (BHCs) used a pre-screening model wherein 10,935 patients received a brief initial screener, and 2011 received more in-depth substance use screening. Six hundred patients were assigned to either a single session brief intervention or an expanded brief treatment encompassing up to five additional sessions. We conducted structured interviews with patients, medical providers, and BHCs to obtain feedback on toolkit implementation. On average, patients assigned to brief treatment attended 3.29 sessions. Fifty eight percent of patients reported using most or all of the educational materials provided to them. Patients assigned to brief treatment reported that the BHC sessions were somewhat more helpful than did patients assigned to a single session brief intervention (p=.072). BHCs generally reported that the addition of the toolkit was helpful to their work in delivering screening and brief treatment. This work is significant

  8. Determinants of psychology service utilization in a palliative care outpatient population.

    Science.gov (United States)

    Azuero, Casey; Allen, Rebecca Sue; Kvale, Elizabeth; Azuero, Andres; Parmelee, Patricia

    2014-06-01

    Research has demonstrated that treating cancer patients' psychological and physical health leads to improved overall health. This may be especially true for palliative care patients facing serious illness. This study examines the proportion and determinants of psychology service utilization in an outpatient palliative care population. Data from an existing clinical database in an outpatient palliative clinic utilizing a collaborative care model to deliver psychology services were explored. This study was framed by Andersen's Behavioral Model of Health Service Use, which incorporates three main components: predisposing, enabling, and need factors to model health service utilization. The sample (N = 149) was majority middle aged, female, and White with a primary diagnosis of cancer. Cross-tabulations were conducted to determine how many patients who met screening criteria for depression or anxiety sought psychology services. Logistic regression analyses were conducted to assess for predisposing, enabling, and need factor determinants of psychology service utilization. Among patients who met criteria for moderate depression or anxiety, 50% did not access readily available psychology services. Enabling factors were the strongest determinant of psychology utilization. Factors associated with need for psychology services (i.e., emotional distress and psychological symptom burden) did not reach significance in determining psychology service use. This study extends current knowledge about psychology utilization to palliative care outpatients receiving care within a collaborative care model. Directions for future research include further investigation of care models that optimize enabling strategies to enhance access to these services, and examination of patient-reported barriers to receiving this care. Copyright © 2013 John Wiley & Sons, Ltd.

  9. No detectable association between frequency of marijuana use and health or healthcare utilization among primary care patients who screen positive for drug use.

    Science.gov (United States)

    Fuster, Daniel; Cheng, Debbie M; Allensworth-Davies, Donald; Palfai, Tibor P; Samet, Jeffrey H; Saitz, Richard

    2014-01-01

    Marijuana is the most commonly used illicit drug, yet its impact on health and healthcare utilization has not been studied extensively. To assess the cross-sectional association between frequency of marijuana use and healthcare utilization (emergency department and hospitalization) and health (comorbidity, health status), we studied patients in an urban primary care clinic who reported any recent (past 3-month) drug use (marijuana, opioids, cocaine, others) on screening. Frequency of marijuana use in the past 3 months was the main independent variable [daily/ almost daily, less than daily and no use (reference group)]. Outcomes assessed were past 3-month emergency department or hospital utilization, the presence of medical comorbidity (Charlson index ≥ 1), and health status with the EuroQol. We used separate multivariable regression models adjusting for age, sex, tobacco and other substance use. All 589 participants reported recent drug use: marijuana 84 % (29 % daily, 55 % less than daily), cocaine 25 %, opioid 23 %, other drugs 8 %; 58 % reported exclusive marijuana use. Frequency of marijuana use was not significantly associated with emergency department use {adjusted odds ratio [AOR] 0.67, [95 % confidence interval (CI) 0.36, 1.24] for daily; AOR 0.69 [95 % CI 0.40,1.18] for less than daily versus no use}, hospitalization [AOR 0.79 (95 % CI 0.35, 1.81) for daily; AOR 1.23 (95 % CI 0.63, 2.40) for less than daily versus no use], any comorbidity [AOR 0.62, (95 % CI 0.33, 1.18) for daily; AOR 0.67 (95 % CI 0.38, 1.17) for less than daily versus no use] or health status (adjusted mean EuroQol 69.1, 67.8 and 68.0 for daily, less than daily and none, respectively, global p = 0.78). Among adults in primary care who screen positive for any recent illicit or non-medical prescription drug use, we were unable to detect an association between frequency of marijuana use and health, emergency department use, or hospital utilization.

  10. Demographic Information Sources and Utilization as Determinants of Educational Policy Making in South Western Nigeria

    Science.gov (United States)

    Gbadamosi, Belau Olatunde

    2013-01-01

    The paper examines demographic information sources and utilization as determinants of educational policy making in South West Nigeria. Using validated and structured questionnaire, the study population of 398 officers in the ministries of education in the affected states were enumerated. The study establishes population census, vital registration,…

  11. HEALTHCARE RESOURCES UTILIZATION AND TEMPORARY DISABILITY IN POPULATION AGED 50-64 ACCORDING TO THE EPIDEMIOLOGICAL ESSE-RF STUDY

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    A. V. Kontsevaya

    2017-01-01

    Full Text Available Aim. To analyze health care resource utilization and temporary disability in people of pre-retirement age in the Russian population.Material and methods. The analysis was carried out on the basis of the ESSE-RF study materials (13 regions of the RF. Standard epidemiological survey methods and evaluation criteria were used. The analysis included results of a survey of the ESSE-RF study participants about health care resource utilization and temporary disability (TD during 12 months before the survey. The following characteristics were ascertained: a number and reasons of outpatient visits for medical assistance, hospital admissions (including duration of in-hospital treatment, emergency calls and temporary disability (a number of days and cases, their mean number per one study participant, mean number of cases and days of TD per 100 working participants, associations with social-demographic parameters, risk factors, chronic non-communicable diseases, stress and anxiety levels by the Hospital Anxiety and Depression Scale (HADS.Results. A total of 8334 people aged 50-64 years were examined: men – 2784 (33% and women – 5550 (67%. A share of the hospitalized (at least one time was 11% in the age group of 50-54 years, 12% – in the age group of 55-59 years and by the age of 60-64 this indicator increased to 15%. 20% of the participants at least one time were admitted to hospital and/or called an ambulance. A share of people who had utilized health care resources at least one time was increasing with age. Unemployed people were hospitalized more frequently than employed ones. Number of chronic non-communicable diseases correlated with the probability of hospitalization and/or emergency call. Categories 2 and 3 of disability, presence of diabetes mellitus, ischemic heart disease and hypertension were statistically significantly associated with the probability of hospitalization and/or emergency call. Smoking did not increase the probability of

  12. Microvascular reconstruction and tracheotomy are significant determinants of resource utilization in head and neck surgery.

    Science.gov (United States)

    Cohen, J; Stock, M; Chan, B; Meininger, M; Wax, M; Andersen, P; Everts, E

    2000-08-01

    Successful "critical pathway" design and implementation are dependent on appropriate patient stratification according to those factors that are primary determinants of resource utilization. To test the validity of our previously reported critical pathway design and to determine whether tracheotomy and microvascular reconstruction (MR) are primary determinants of resource utilization. Cost-effectiveness analysis. Tertiary referral academic institution. Retrospective analysis of data from 133 head and neck surgery cases in which the treatment regimen was based on critical pathways over a 26-month period. Length of stay and total patient charges were used as indices of resource utilization. One-way analysis of variance and t tests were used for statistical analysis of significance. Ninety patients (67.7%) underwent MR; 43 (32. 3%) did not. Seventy-five patients (56.4%) underwent tracheotomy; 58 (43.6%) did not. Four patient groups were constructed in decreasing order of complexity as follows: group 1, patients who underwent both tracheotomy and MR (n = 58); group 2, patients who underwent MR alone (n = 32); group 3, patients who underwent tracheotomy alone (n = 17); and group 4, patients who did not undergo either procedure (n = 26). Both tracheotomy and MR were found to be independent determinants of resource utilization and were additive when both were present. The length of stay varied from 8.4 days (in patients who underwent both procedures) to 6.7 days (in patients who did not undergo either procedure), with intermediate values in cases in which only 1 procedure was performed. The total charges varied in a similar manner from a high of $33,371 to a low of $19,994. Subanalysis with respect to intensive care unit, ward, and operating room charges showed a similar stratification. Tracheotomy and MR are both significant determinants of charges and length of stay in head and neck surgery cases and must be considered in the design of strategies to promote efficient

  13. The relationship between social determinants of health and utilization of tertiary rhinology care.

    Science.gov (United States)

    Samuelson, Madeleine B; Chandra, Rakesh K; Turner, Justin H; Russell, Paul T; Francis, David O

    2017-11-01

    Chronic rhinosinusitis (CRS) has a high prevalence and significant cost and quality of life implications. Many types of practitioners care for patients with rhinosinusitis; however, patients with chronic or complicated conditions are often referred for tertiary rhinology services. It is unclear how social determinants of health affect access and utilization of these services. A better understanding of social barriers to tertiary rhinology care is needed to reduce health care disparities and improve health outcomes. The aim of the present study was to measure whether income, insurance status, race, and education affect utilization of tertiary rhinology care. All adult patients diagnosed with CRS by rhinologists at a single tertiary care hospital were identified (2010-2014). Patient characteristics (age, gender, race, insurance status) were compared with population-level data from the hospital and from Davidson County, Tennessee, which includes Nashville. Rhinology utilization rates were calculated for each ZIP code within the county. The association between determinants of health (race, insurance status, education, median income) and tertiary rhinology utilization were measured by using multivariable regression analyses. A total of 1341 unique patients with CRS (median age, 50 years; 55% women, 80% white, 82% with private insurance) from Davidson County used tertiary rhinology services. These patients were significantly older and more likely to be female, white, and privately insured than patients seen hospital-wide or among the population of Davidson County (p education. However, in adjusted analysis, only attainment of a college education was independently associated with utilization of tertiary rhinology services. Utilization was 4% higher for every 1% increase in college-educated population (coefficient 0.04 [95% CI, 0.01-0.07]; p = 0.01). Results of this study indicated that some social determinants of health (race, income, educational level, insurance status

  14. Investigating the Determinants of Maternal Empowerment During Pregnancy: A Strategy for Prenatal Healthcare Promotion

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    Narjes Sadat Borghei

    2017-07-01

    Full Text Available Background: Empowerment of pregnant mothers promotes their health and pregnancy outcomes. Given the importance of empowerment of women during pregnancy, this study was conducted to determine the level of empowerment during pregnancy and its determinants. Method: This cross-sectional study was carried out on 161 pregnant mothers who were selected using random cluster sampling in Gorgan, North East of Iran in 2015. To measure the level and determinants of empowerment, Kameda’s prenatal empowerment scale was used. Data analysis was carried out using descriptive and inferential statistical tests including linear regression analysis. P< 0.05 was considered significant. Results: The regression analysis showed that age at first pregnancy (βeta standardized coefficient (β=0.474, marital satisfaction (β=0.239 and spiritual support (β=0.227 had the highest coefficient in the regression. However, the age of marriage, the size of family as well as experience of violence had negative impact on prenatal empowerment. Conclusion: Awareness of determinants of maternal empowerments could help policy makers to develop programs for promotion of mothers' empowerment during pregnancy. It seems that through developing counseling and educational programs with special focus on reducing domestic violence and enhancing marital satisfaction as well as offering spiritual support could promote prenatal empowerment and as a consequence facilitate moving towards safe motherhood.

  15. Determinants of patient satisfaction with cancer care delivered by the Danish healthcare system

    DEFF Research Database (Denmark)

    Heerdegen, Anne Christine Stender; Petersen, Gitte Stentebjerg; Jervelund, Signe Smith

    2017-01-01

    BACKGROUND: Patient-reported quality of care, which is often measured by patients' overall rating of care, is gaining more attention within the field of oncology. The aim of this study was to examine factors that determine adult cancer patients' overall rating of prediagnosis care (PDC) and care ...

  16. Determinants of Job Satisfaction among Healthcare Workers at a Tertiary Care Hospital

    Directory of Open Access Journals (Sweden)

    Roopalekha Jathanna

    2011-11-01

    Full Text Available Job satisfaction can be defined as "the extent to which people like or dislike their jobs". This definition suggests job satisfaction is a general or global affective reaction that individuals hold about their job. Family Roles are patterns of behavior by which individuals fulfill family functions and needs. Family role changes may affect their daily activities including a person’s work. Unlike traditional job satisfaction surveys, this study was trying to explore the correlation between employee’s personal profile and their satisfaction in their job. The personal profile determinants which were compared with overall job satisfaction were - Age, Gender, Work experience, marital status, dependent children and parents. It revealed that majority of the determinants studied were having positive impact on the job satisfaction. It is interesting to note that comparatively young employees with dependents were more satisfied with their job. They were feeling satisfied and motivated to work as they were contributing to the family.

  17. [Financing Regional Dementia Networks in Germany: Determinants of Sustainable Healthcare Networks].

    Science.gov (United States)

    Michalowsky, B; Wübbeler, M; Thyrian, J R; Holle, B; Gräske, J; Schäfer-Walkmann, S; Fleßa, S; Hoffmann, W

    2017-12-01

    Analysis of practice-based financing concepts in German dementia networks (DN); Provision of sustainable financing structures and their determinants in DN. Qualitative expert interviews with leaders of 13 DN were conducted. A semi-structured interview guide was used to analyse four main topics: Finance-related organization, cost, sources of funding and financial sustainability. DN were primarily financed by membership fees, earnings of services provided, public funds and payments by municipalities or health care providers. 63% of the DN reported a financial sustainability. Funds to support the interpersonal expanding, a mix of internal and external financing sources and investments of the municipality were determinants of a sustainable financing. Overall, DN in rural areas seemed to be disadvantaged due to a lack of potential linkable service providers. DN in urban regions are more likely able to gather sustainable funding resources. A minimum funding of 50.000 €/year for human resources coordinating the DN, seems to be a threshold for a sustainable DN. © Georg Thieme Verlag KG Stuttgart · New York.

  18. Determinants of uptake of hepatitis B testing and healthcare access by migrant Chinese in the England: a qualitative study

    Directory of Open Access Journals (Sweden)

    Andrew Chee Keng Lee

    2017-09-01

    Full Text Available Abstract Background Global migration from hepatitis B endemic countries poses a significant public health challenge in receiving low-prevalence countries. In the UK, Chinese migrants are a high risk group for hepatitis B. However, they are an underserved population that infrequently accesses healthcare. This study sought to increase understanding of the determinants of hepatitis B testing and healthcare access among migrants of Chinese ethnicity living in England. Methods We sought to obtain and integrate insights from different key stakeholders in the system. We conducted six focus group discussions and 20 in-depth interviews with community members and patients identifying themselves as ‘Chinese’, and interviewed 21 clinicians and nine health service commissioners. Data were thematically analysed and findings were corroborated through two validation workshops. Results Three thematic categories emerged: knowledge and awareness, visibility of the disease, and health service issues. Low disease knowledge and awareness levels among community members contributed to erroneous personal risk perception and suboptimal engagement with services. Limited clinician knowledge led to missed opportunities to test and inaccurate assessments of infection risks in Chinese patients. There was little social discourse and considerable stigma linked to the disease among some sub-sections of the Chinese population. A lack of visibility of the issue and the population within the health system meant that these health needs were not prioritised by clinicians or commissioners. Service accessibility was also affected by the lack of language support. Greater use of community outreach, consultation aids, ‘cultural competency’ training, and locally adapted testing protocols may help. Conclusions Hepatitis B among migrants of Chinese ethnicity in England can be characterised as an invisible disease in an invisible population. Multi-modal solutions are needed to tackle

  19. Comparative evaluation of treatment patterns and healthcare utilization of newly-diagnosed rheumatoid arthritis patients by anti-cyclic citrullinated peptide antibody status.

    Science.gov (United States)

    Lamerato, Lois; Price, Kwanza; Szymialis, Rick; Eaddy, Michael; Ogbonnaya, Augustina; Shih, Huai-Che; Ahmad, Harris

    2018-03-01

    Anti-cyclic citrullinated peptide (CCP) antibody positivity is an established diagnostic factor for severe disease activity and joint damage and a prognostic factor for aggressive disease in rheumatoid arthritis (RA). To compare RA-related treatment, healthcare utilization, and joint erosion between anti-CCP-positive and anti-CCP-negative RA patients. Newly-diagnosed RA patients were identified from the Henry Ford Health System database between January 1, 2009 and December 31, 2014; the date of the first RA diagnosis within the study period was the index date. Baseline anti-CCP test was used to categorize patients as anti-CCP-positive or anti-CCP-negative, and outcomes were evaluated in the 6 months post-index. There were 217 anti-CCP-positive and 191 anti-CCP-negative RA patients included in the study. A higher proportion of anti-CCP-positive patients were initiated on RA treatment than anti-CCP-negative patients (70.5% vs 23.0%; p CCP-positive patients received methotrexate (73.2% vs 56.8%; p = .0374), while more anti-CCP-negative patients received hydroxychloroquine (31.8% vs 13.1%; p = .0037) in first-line therapy. A higher proportion of anti-CCP-negative patients were tested for rheumatoid factor (RF) and erythrocyte sedimentation rate (ESR). Of those tested, there were more positive test results in the anti-CCP-positive cohort compared to the anti-CCP-negative cohort (RF: 84.4% vs 18.2%, p CCP-positive patients having any outpatient physician office visit (96.3% vs 77.5%, p CCP-negative patients. Among anti-CCP-positive (n = 113) and anti-CCP-negative (n = 58) patients with imaging results, more anti-CCP-positive patients had joint erosion compared to anti-CCP-negative patients (18.6% vs 8.6%; p = .0858); however, statistical significance was not reached. RA patients with positive anti-CCP antibodies had higher degrees of inflammation and disease activity as indicated by laboratory results, which likely contributed to their higher

  20. Exploring the social determinants of racial/ethnic disparities in prenatal care utilization and maternal outcome.

    Science.gov (United States)

    Gadson, Alexis; Akpovi, Eloho; Mehta, Pooja K

    2017-08-01

    Rates of maternal morbidity and mortality are rising in the United States. Non-Hispanic Black women are at highest risk for these outcomes compared to those of other race/ethnicities. Black women are also more likely to be late to prenatal care or be inadequate users of prenatal care. Prenatal care can engage those at risk and potentially influence perinatal outcomes but further research on the link between prenatal care and maternal outcomes is needed. The objective of this article is to review literature illuminating the relationship between prenatal care utilization, social determinants of health, and racial disparities in maternal outcome. We present a theoretical framework connecting the complex factors that may link race, social context, prenatal care utilization, and maternal morbidity/mortality. Prenatal care innovations showing potential to engage with the social determinants of maternal health and address disparities and priorities for future research are reviewed. Copyright © 2017 Elsevier Inc. All rights reserved.

  1. Quantitative determination of the crystalline phases of the ceramic materials utilizing the Rietveld method

    International Nuclear Information System (INIS)

    Kniess, C.T.; Prates, P.B.; Lima, J.C. de; Kuhnen, N.C.; Riella, H.G.; Maliska, A.M.

    2009-01-01

    Ceramic materials have properties defined by their chemical and micro-structural composition. The quantification of the crystalline phases is a fundamental stage in the determination of the structure, properties and applications of a ceramic material. Within this context, this study aims is the quantitative determination of the crystalline phases of the ceramic materials developed with addition of mineral coal bottom ash, utilizing the X ray diffraction technique, through the method proposed by Rietveld. For the formulation of the ceramic mixtures a {3,3} simplex-lattice design was used, giving ten formulations of three components (two different types of clays and coal bottom ash). The crystalline phases identified in the ceramic materials after sintering at 1150 deg C during two hours are: quartz, tridimite, mullite and hematite. The proposed methodology utilizing the Rietveld method for the quantification relating to crystalline phases of the materials was shown to be adequate and efficient. (author)

  2. Association of socioeconomic status with the use of chronic therapies and healthcare utilization in children with cystic fibrosis.

    Science.gov (United States)

    Schechter, Michael S; McColley, Susanna A; Silva, Stefanie; Haselkorn, Tmirah; Konstan, Michael W; Wagener, Jeffrey S

    2009-11-01

    To determine whether previously reported socioeconomic status (SES)-related disparities in cystic fibrosis (CF) health outcomes vary by the indicator used (median household income by zip code [MIZ], maternal educational attainment [MEA], and state insurance coverage [MA]), and whether these disparities can be explained by differences in medical treatment. A cross-sectional analysis of data on patients age <18 years from the Epidemiologic Study of Cystic Fibrosis (ESCF). Disease severity showed a similar inverse correlation with all 3 SES measures. The number of stable clinic visits was unrelated to SES. Patients with MA had more sick outpatient visits and more courses of intravenous (IV) antibiotics for pulmonary exacerbations, and were more likely to be prescribed all chronic therapies. Low-MIZ patients had slightly fewer sick visits and more courses of IV antibiotics, and were more likely to receive oral nutrition supplements but less likely to receive macrolide prescriptions. Low-MEA patients were less likely to receive IV antibiotics at home, more likely to receive oral nutrition supplements, but less likely to receive macrolide prescriptions. CF health outcomes are correlated with the SES spectrum, but these disparities are not explained by differential use of health services or prescription of chronic therapy. Future investigations should focus on the possible impact of environmental exposures and differences in disease self-management.

  3. PATIENT CHARACTERISITCS AND PHYSICIAN FACTORS DETERMINING THE UTILIZATION OF AUTOMATIC CLINICAL ANALYZER

    Directory of Open Access Journals (Sweden)

    Tri Juni Angkasawati

    2012-11-01

    Full Text Available The changing of disease patterns from infectious diseases to heart, cancer, and degenerative diseases needs advanced technologies to support diagnosis and to give therapies. The Automatic Clinical Analyzer (ACA is one of modem laboratory equipments which continuously developed to enhance patient service outcomes. Previous researches showed its utilization rates varied 20-46.6% from total capacities per year. It indicated low utilization problems. So this research aimed patient characteristics and physician factors determining the utilization of the ACA. This was a descriptive study with a to-cross sectional design. Data were collected by interview to patients visited laboratories and physicians who referred patients for determine laboratory examinations using the ACA. The study was conducted in 2 (two public hospital laboratories and 4(four private clinical laboratories in Surabaya and Malang, East Java Province. Data were analyzed descriptively. Results showed that the patient characteristics who used ACA were higher proportion of those with older aged, women and senior high school to above education levels. Access to the services was also a determining factor of the ACA use because further distance increased transportation cost to reach the facilities. It also showed that the higher patient income received more services from the ACA and likely to visit private laboratories. From the physician view points, the factor determining the ACA use were that exmination results supported diagnosis, quickly be knew or received and easy to get. The study recommends to conduct further ACA studies associated with feasibility and effective cost to respond equity problems and the efficiency of ACA use. Key words: utilization, Automatic Clinical Analyzer, patients, physicians

  4. Scientific Evaluation and Review of Claims in Health Care (SEaRCH): A Streamlined, Systematic, Phased Approach for Determining “What Works” in Healthcare

    Science.gov (United States)

    Crawford, Cindy; Hilton, Lara; Elfenbaum, Pamela

    2017-01-01

    Abstract Background: Answering the question of “what works” in healthcare can be complex and requires the careful design and sequential application of systematic methodologies. Over the last decade, the Samueli Institute has, along with multiple partners, developed a streamlined, systematic, phased approach to this process called the Scientific Evaluation and Review of Claims in Health Care (SEaRCH™). The SEaRCH process provides an approach for rigorously, efficiently, and transparently making evidence-based decisions about healthcare claims in research and practice with minimal bias. Methods: SEaRCH uses three methods combined in a coordinated fashion to help determine what works in healthcare. The first, the Claims Assessment Profile (CAP), seeks to clarify the healthcare claim and question, and its ability to be evaluated in the context of its delivery. The second method, the Rapid Evidence Assessment of the Literature (REAL©), is a streamlined, systematic review process conducted to determine the quantity, quality, and strength of evidence and risk/benefit for the treatment. The third method involves the structured use of expert panels (EPs). There are several types of EPs, depending on the purpose and need. Together, these three methods—CAP, REAL, and EP—can be integrated into a strategic approach to help answer the question “what works in healthcare?” and what it means in a comprehensive way. Discussion: SEaRCH is a systematic, rigorous approach for evaluating healthcare claims of therapies, practices, programs, or products in an efficient and stepwise fashion. It provides an iterative, protocol-driven process that is customized to the intervention, consumer, and context. Multiple communities, including those involved in health service and policy, can benefit from this organized framework, assuring that evidence-based principles determine which healthcare practices with the greatest promise are used for improving the public's health and

  5. Scientific Evaluation and Review of Claims in Health Care (SEaRCH): A Streamlined, Systematic, Phased Approach for Determining "What Works" in Healthcare.

    Science.gov (United States)

    Jonas, Wayne B; Crawford, Cindy; Hilton, Lara; Elfenbaum, Pamela

    2017-01-01

    Answering the question of "what works" in healthcare can be complex and requires the careful design and sequential application of systematic methodologies. Over the last decade, the Samueli Institute has, along with multiple partners, developed a streamlined, systematic, phased approach to this process called the Scientific Evaluation and Review of Claims in Health Care (SEaRCH™). The SEaRCH process provides an approach for rigorously, efficiently, and transparently making evidence-based decisions about healthcare claims in research and practice with minimal bias. SEaRCH uses three methods combined in a coordinated fashion to help determine what works in healthcare. The first, the Claims Assessment Profile (CAP), seeks to clarify the healthcare claim and question, and its ability to be evaluated in the context of its delivery. The second method, the Rapid Evidence Assessment of the Literature (REAL © ), is a streamlined, systematic review process conducted to determine the quantity, quality, and strength of evidence and risk/benefit for the treatment. The third method involves the structured use of expert panels (EPs). There are several types of EPs, depending on the purpose and need. Together, these three methods-CAP, REAL, and EP-can be integrated into a strategic approach to help answer the question "what works in healthcare?" and what it means in a comprehensive way. SEaRCH is a systematic, rigorous approach for evaluating healthcare claims of therapies, practices, programs, or products in an efficient and stepwise fashion. It provides an iterative, protocol-driven process that is customized to the intervention, consumer, and context. Multiple communities, including those involved in health service and policy, can benefit from this organized framework, assuring that evidence-based principles determine which healthcare practices with the greatest promise are used for improving the public's health and wellness.

  6. The frequency of asthma exacerbations and healthcare utilization in patients with asthma from the UK and USA.

    Science.gov (United States)

    Suruki, Robert Y; Daugherty, Jonas B; Boudiaf, Nada; Albers, Frank C

    2017-04-27

    Asthma exacerbations are frequent in patients with severe disease. This report describes results from two retrospective cohort studies describing exacerbation frequency and risk, emergency department (ED)/hospital re-admissions, and asthma-related costs by asthma severity in the US and UK. Patients with asthma in the US-based Clinformatics™ DataMart Multiplan IMPACT (2010-2011; WEUSKOP7048) and the UK-based Clinical Practice Research Datalink (2009-2011; WEUSKOP7092) databases were categorized by disease severity (Global Initiative for Asthma [GINA]; Step and exacerbation history) during the 12 months pre-asthma medical code (index date). Outcomes included: frequency of exacerbations (asthma-related ED visit, hospitalization, or oral corticosteroid use with an asthma medical code recorded within ±2 weeks) 12 months post-index, asthma-related ED visits/hospitalization, and asthma-related costs 30 days post-index. Risk of a subsequent exacerbation was determined by proportional hazard model. Of the 222,817 and 211,807 patients with asthma included from the US and UK databases, respectively, 12.5 and 8.4% experienced ≥1 exacerbation during the follow-up period. Exacerbation frequency increased with disease severity. Among the 5,167 and 2,904 patients with an asthma-related ED visit/hospitalization in the US and UK databases, respectively, 9.2 and 4.7% had asthma-related re-admissions within 30 days. Asthma-related re-admission rates and costs increased with disease severity, approximately doubling between GINA Step 1 and 5 and in patients with ≥2 versus <2 exacerbations in the previous year. Risk of a subsequent exacerbation increased 32-35% for an exacerbation requiring ED visit/hospitalization versus oral corticosteroids. Increased disease severity was associated with higher exacerbation frequency, ED/hospitalization re-admission, costs and risk of subsequent exacerbation, indicating that these patients require high-intensity post-exacerbation management.

  7. Phase retrieval from diffraction data utilizing pre-determined partial information

    International Nuclear Information System (INIS)

    Kim, S.S.; Marathe, S.; Kim, S.N.; Kang, H.C.; Noh, D.Y.

    2007-01-01

    We developed a phase retrieval algorithm that utilizes pre-determined partial phase information to overcome insufficient oversampling ratio in diffraction data. Implementing the Fourier modulus projection and the modified support projection manifesting the pre-determined information, a generalized difference map and HIO (Hybrid Input-Output) algorithms are developed. Optical laser diffraction data as well as simulated X-ray diffraction data are used to illustrate the validity of the proposed algorithm, which revealed the strength and the limitations of the algorithm. The proposed algorithm can expand the applicability of the diffraction based image reconstruction

  8. Adherence, healthcare resource utilization and Medicaid spending associated with once-monthly paliperidone palmitate versus oral atypical antipsychotic treatment among adults recently diagnosed with schizophrenia.

    Science.gov (United States)

    Pilon, Dominic; Muser, Erik; Lefebvre, Patrick; Kamstra, Rhiannon; Emond, Bruno; Joshi, Kruti

    2017-06-02

    Once-monthly paliperidone palmitate (PP1M) is a long-acting injectable antipsychotic that may increase adherence rates, reduce hospitalizations, and lower medical costs compared to oral atypical antipsychotics (OAAs) among schizophrenia patients. However, the impact of PP1M in recently diagnosed patients remains unknown. The present study compared adherence, healthcare resource utilization and Medicaid spending between schizophrenia patients initiating PP1M versus OAA, among patients recently diagnosed (defined using ages 18-25 years as a proxy) and among the overall population. Medicaid data from five states (09/2008-03/2015) were used to identify adults with schizophrenia initiated on PP1M or OAAs (index date) on or after 09/2009. Outcomes were compared between PP1M and OAA groups following inverse probability of treatment weighting (IPTW). Univariate linear and Poisson regression models with nonparametric bootstrap procedures were used to compare the 12-month healthcare resource utilization and costs using rate ratios (RRs) and mean monthly cost differences (MMCDs), respectively. Overall, patients initiated on PP1M (N = 2053) were younger (mean age: 41 vs. 44 years) and had more baseline antipsychotic use (88% vs. 62%) compared to OAA patients (N = 22,247). IPTW resulted in balanced baseline characteristics. Among recently diagnosed patients, PP1M was associated with better adherence (PDC ≥ 80%: 29% vs. 21%, P < 0.001) on the index medication as well as less use of other psychiatric medications, compared to OAAs. Adherence findings were similar for the overall cohort. Among recently diagnosed patients, lower medical costs associated with PP1M (MMCD = $-466; P = 0.028) outweighed the higher pharmacy costs (MMCD = $322; P < 0.001) resulting in similar total healthcare costs across groups (MMCD = $-144; P = 0.553). Overall, findings were similar but there was a trend toward a lower magnitude of medical cost savings (MMCD = $-286; P < 0

  9. Housing as a Social Determinant of Health in Singapore and Its Association with Readmission Risk and Increased Utilization of Hospital Services.

    Science.gov (United States)

    Low, Lian Leng; Wah, Win; Ng, Matthew Joo; Tan, Shu Yun; Liu, Nan; Lee, Kheng Hock

    2016-01-01

    Residence in public rental housing is an area-level measure of socioeconomic status, but its impact as a social determinant of health in Singapore has not been studied. We therefore aimed to examine the association of public rental housing with readmission risk and increased utilization of hospital services in Singapore. We conducted a retrospective cohort study using retrospective 2014 data from Singapore General Hospital's electronic health records. Variables known to affect readmission risk and health-care utilization were identified a priori and include patient demographics, comorbidities, health-care utilization in the preceding 1 year and clinical variables from the index admission in 2014. Multivariate logistic regression was used to evaluate public rental housing as an independent risk factor for admission risk, emergency department (ED), and specialist outpatient clinic attendances. A total of 14,457 unique patients were analyzed, and 2,163 patients (15.0%) were rental housing residents. Rental housing patients were significantly more likely to be male; required financial assistance; have chronic obstructive pulmonary disease; usage of anti-depressant and anti-psychotic medications; longer length of hospital stay during the index admission; and higher Charlson Comorbidity Index scores. After adjusting for demographics and clinical variables, staying in public rental housing remained an independent risk factor for readmission within 15 and 30 days, frequent hospital admissions and ED attendances in Singapore. Our study showed an association between public rental housing with readmission risk and increased utilization of hospital services in Singapore. A deeper understanding of the residents' social circumstances and health seeking behavior would be insightful.

  10. The effect of pharmacogenetic profiling with a clinical decision support tool on healthcare resource utilization and estimated costs in the elderly exposed to polypharmacy.

    Science.gov (United States)

    Brixner, D; Biltaji, E; Bress, A; Unni, S; Ye, X; Mamiya, T; Ashcraft, K; Biskupiak, J

    2016-01-01

    To compare healthcare resource utilization (HRU) and clinical decision-making for elderly patients based on cytochrome P450 (CYP) pharmacogenetic testing and the use of a comprehensive medication management clinical decision support tool (CDST), to a cohort of similar non-tested patients. An observational study compared a prospective cohort of patients ≥65 years subjected to pharmacogenetic testing to a propensity score (PS) matched historical cohort of untested patients in a claims database. Patients had a prescribed medication or dose change of at least one of 61 oral drugs or combinations of ≥3 drugs at enrollment. Four-month HRU outcomes examined included hospitalizations, emergency department (ED) and outpatient visits and provider acceptance of test recommendations. Costs were estimated using national data sources. There were 205 tested patients PS matched to 820 untested patients. Hospitalization rate was 9.8% in the tested group vs. 16.1% in the untested group (RR = 0.61, 95% CI = 0.39-0.95, p = 0.027), ED visit rate was 4.4% in the tested group vs. 15.4% in the untested group (RR = 0.29, 95% CI = 0.15-0.55, p = 0.0002) and outpatient visit rate was 71.7% in the tested group vs. 36.5% in the untested group (RR = 1.97, 95% CI = 1.74-2.23, p provider majority (95%) considered the test helpful and 46% followed CDST provided recommendations. Patients CYP DNA tested and treated according to the personalized prescribing system had a significant decrease in hospitalizations and emergency department visits, resulting in potential cost savings. Providers had a high satisfaction rate with the clinical utility of the system and followed recommendations when appropriate.

  11. Prevalence and factors associated with non-utilization of healthcare facility for childbirth in rural and urban Nigeria: Analysis of a national population-based survey.

    Science.gov (United States)

    Adewuyi, Emmanuel O; Zhao, Yun; Auta, Asa; Lamichhane, Reeta

    2017-08-01

    The aim of this study was to assess the rural-urban differences in the prevalence and factors associated with non-utilization of healthcare facility for childbirth (home delivery) in Nigeria. Dataset from the Nigeria demographic and health survey, 2013, disaggregated by rural-urban residence were analyzed with appropriate adjustment for the cluster sampling design of the survey. Factors associated with home delivery were identified using multivariable logistic regression analysis. In rural and urban residence, the prevalence of home delivery were 78.3% and 38.1%, respectively ( p urban residence (17.9%). The North-West region had the highest prevalence of home delivery, 93.6% and 70.5% in rural and urban residence, respectively. Low maternal as well as paternal education, low antenatal attendance, being less wealthy, the practice of Islam, and living in the North-East, North-West and the South-South regions increased the likelihood of home delivery in both rural and urban residences. Whether in rural or urban residence, birth order of one decreased the likelihood of home delivery. In rural residence only, living in the North-Central region increased the chances of home delivery. In urban residence only, maternal age ⩾ 36 years decreased the likelihood of home delivery, while 'Traditionalist/other' religion and maternal age urban Nigeria and the associated factors differ to varying degrees in the two residences. Future intervention efforts would need to prioritize findings in this study.

  12. Assessing Healthcare Utilization for Influenza-like Illness at an Emergency Department and a Student Health Service during the 2009–2010 H1N1 Pandemic

    Directory of Open Access Journals (Sweden)

    Ruchi Bhandari

    2013-01-01

    Full Text Available Estimates of healthcare utilization during an influenza pandemic are needed in order to plan for the allocation of staff and resources. The aim of this study was to assess the number, age, and arrival time of patients with influenza-like-illness (ILI, and associations between their symptoms during the 2009–2010 H1N1 pandemic. We conducted a cross-sectional analysis of electronic health records from the student health service (SHS and an emergency department (ED in Morgantown, West Virginia, between January 2009 and December 2010. During the 2009–2010 H1N1 pandemic, patient arrivals at SHS and ED varied over the week. SHS patients arrived early in the week and primarily in the afternoon. ED patient arrivals were more evenly distributed, with busier evenings and weekends. Those with fever were more likely to experience cough, sore throat, vomiting/nausea, chills, congestion, headache, and body-ache. These results can assist health professionals in preparing for an influenza pandemic.

  13. Utilizing health records to characterize obesity, comorbidities, and health-care services in one human service agency in the United States.

    Science.gov (United States)

    Fisher, Kathleen; Hardie, Thomas L; Ranjan, Sobhana; Peterson, Justin

    2017-12-01

    US surveys report higher prevalence of obesity in adults with intellectual disability. Health records of 40 adults with intellectual disability were retrospectively reviewed for data on health status, problem lists with International Classification of Diseases, Ninth Revision codes, medication lists, and health encounters over 18 months. Mean age was 49.5 years, 53% were males. Prevalence of overweight, obese, and morbidly obese was 28%, 58%, and 23%, respectively. Primary diagnosis was intellectual disability (50% mild, 33% moderate, 10% severe, and 8% profound), 85% had mental health disorders (67.5% with affective or mood and 42.5% had anxiety disorders). On average, residents consumed 2.63 psychotropic medications daily with additional 5.75 medications for axis 3 diagnoses and made 39.2 health visits over past 18 months. Our analysis supports increased prevalence of overweight/obesity, higher comorbidities, dual psychiatric diagnosis, substantial medication consumption, and higher utilization of health-care services in adults with intellectual disabilities. Targeted health interventions are therefore essential to improve their health and quality of life.

  14. Satisfaction Rate Regarding Health-care Services and Its Determinant Factors in South-West of Iran: A Population-based Study.

    Science.gov (United States)

    Lankarani, Kamran B; Maharlouei, Najmeh; Akbari, Mojtaba; Yazdanpanah, Dorna; Akbari, Maryam; Moghadami, Mohsen; Joulaei, Hassan

    2016-01-01

    The aim of this study was to evaluate clients' satisfaction regarding health-care services and its determinant factors in South-West of Iran. Totally, 3400 households were randomly selected for this cross-sectional study, carried out in Shiraz, Iran, from December 2013 to March 2014. Data were collected using a checklist that includes insurance status of the household, enrollment in family physician program, and client's satisfaction level with received health services. The level of statistical significance was set at P determinant role in dissatisfaction with health system. Results of the present study demonstrated a high level of satisfaction with the health-care system and family physician in Shiraz, Iran. Moreover, dissatisfaction with family physicians, socioeconomic status, scarcity and cost of drugs, and existing chronic disease(s) were important predictors for dissatisfaction with the health-care system.

  15. The effect of quitting smoking on costs and healthcare utilization in patients with chronic obstructive pulmonary disease: a comparison of current smokers versus ex-smokers in routine clinical practice.

    Science.gov (United States)

    Sicras-Mainar, Antoni; Rejas-Gutiérrez, Javier; Navarro-Artieda, Ruth; Ibáñez-Nolla, Jordi

    2014-08-01

    Chronic obstructive pulmonary disease (COPD) is a prevalent condition mainly related to smoking, which is associated with a substantial economic burden. The purpose was to compare healthcare resource utilization and costs according to smoking status in patients with COPD in routine clinical practice. A retrospective cohort nested case-control study was designed. The cohort was composed of male and female COPD outpatients, 40 years or older, covered by the Badalona Serveis Assistencials (a health provider) health plan. Cases were current smokers with COPD and controls (two per case) were former smokers with COPD (at least 12 months without smoking), matched for age, sex, duration of COPD, and burden of comorbidity. The index date was the last visit recorded in the database, and the analysis was performed retrospectively on healthcare resource utilization data for the 12 months before the index date. A total of 930 COPD records were analyzed: 310 current and 620 former smokers [mean age 69.4 years (84.6 % male)]. Cases had more exacerbations, physician visits of any type, and drug therapies related to COPD were more common. As a consequence, current smokers had higher average annual healthcare costs: €3,784 (1,888) versus €2,302 (2,451), p use of healthcare resources, mainly COPD drugs and physician visits, compared with former smokers who had abstained for at least 12 months. As a consequence, current smokers had higher healthcare costs to the National Health System in Spain than ex-smokers.

  16. Determinants of maternal health care services utilization in Pakistan: evidence from Pakistan demographic and health survey, 2012-13.

    Science.gov (United States)

    Zakar, Rubeena; Zakar, Muhammad Zakria; Aqil, Nauman; Chaudhry, Ashraf; Nasrullah, Muazzam

    2017-04-01

    The aim of this study was to determine the association between maternal utilisation of health-care services and socio-demographic factors among reproductive-age women in Pakistan. We used the sample of ever-married reproductive-age women (n = 7446) from the Pakistan Demographic and Health Survey (PDHS), 2012-13. We measured maternal utilisation of health-care services by using three dependent variables: number of antenatal care (ANC) visits, delivery assistance by a skilled health provider, and delivery in a health-care facility. Around 36.6% of women had made four or more ANC visits, 59% had received assistance from skilled health providers during delivery, and 55.3% had given birth in a health-care facility. On multivariable logistic regression, all three variables were positively associated with education and wealth, and negatively associated with birth order and women's autonomy. Policymakers and health planners may use our findings to develop efficient strategies, particularly for uneducated women and those with poor economic status, to improve the utilisation of maternal health-care services in Pakistan.

  17. Measurement of action forces and posture to determine the lumbar load of healthcare workers during care activities with patient transfers.

    Science.gov (United States)

    Theilmeier, Andreas; Jordan, Claus; Luttmann, Alwin; Jäger, Matthias

    2010-11-01

    Moving patients or other care activities with manual patient handling is characterized by high mechanical load on the lumbar spine of healthcare workers (HCWs). During the patient transfer activity, the caregivers exert lifting, pulling, and pushing forces varying over time with respect to amplitude and direction. Furthermore, the caregivers distinctly change their posture and frequently obtain postures asymmetrical to the median sagittal plane, including lateral bending and turning the trunk. This paper describes a procedure to determine lumbar load during patient transfer supported by measurement techniques and an exemplary application; this methodology represents the basis of a complex research project, the third 'Dortmund Lumbar Load Study (DOLLY 3)'. Lumbar load was determined by simulation calculations using a comprehensive biomechanical model ('The Dortmunder'). As the main influencing factors, the hand forces of the caregiver exerted during typical patient transfers and the posture and movements of the HCW were recorded in laboratory studies. The action forces were determined three-dimensionally with the help of a newly developed 'measuring bed', two different 'measuring chairs', a 'measuring bathtub', and a 'measuring floor'. To capture the forces during transfers in or at the bed, a common hospital bed was equipped with an additional framework, which is attached to the bedstead and connected to the bedspring frame via three-axial force sensors at the four corners. The other measuring systems were constructed similarly. Body movements were recorded using three-dimensional optoelectronic recording tools and video recordings. The posture and force data served as input data for the quantification of various lumbar-load indicators.

  18. Determinants of health service utilization among Pakistani immigrants in Maryland, USA.

    Science.gov (United States)

    Khan, Shahzad Ali; Manzoor, Khola

    2014-01-01

    Health of immigrants is challenge for any host country due to multiple reasons. Immigrants of Pakistani origin constitute a significant population in the USA and their population has doubled in last 10 years. This study was conducted to determine factors affecting health service utilization in the state of Maryland, USA. This was a descriptive study, utilizing mixed method research. A sample of 100 respondents from Pakistani immigrants in Maryland was selected through convenience sampling. A structured questionnaire was used for soliciting responses. Three focus group discussions were also conducted for qualitative assessment of health service utilization. Male gender, higher level of education, longer duration of stay, and higher income people had more utilization of health services. Those not having insurance had affordability issues as they had to pay out of pocket for treatment cost. A high proportion of uninsured were resorting to traditional home remedies for treatment. There was a concern on delays in appointment system and long waiting time for elective cases. Most respondents mentioned problem of language while interacting with doctors and need of English speaking family member in medical consultation. Many respondents reported difficulty in availing health services due to job commitments. They had to make arrangements for substitute at their workplaces, which affected their utilization of health services. Low-income immigrants in USA are less likely to have health insurance. Factors affecting service use are out of pocket costs, long waiting time, language problems and immigrants' job commitments. It is recommended to get a clear idea of health systems of USA before moving to US as immigrant.

  19. Association of Occupational Class with Healthcare Utilization among Economically Active Korean Adults from 2006 to 2014: A Repeated Cross-Sectional Study of Koreans Aged 19 Years and Older.

    Science.gov (United States)

    Kim, Jae-Hyun; Lee, Kwang Soo; Lee, Yunhwan; Park, Eun-Cheol

    2017-11-01

    To investigate the impact of indicators of occupational class on healthcare utilization by using longitudinal data from a nationally representative survey. Data were obtained from the Korean Welfare Panel Study conducted from 2006 (wave 1) through 2014 (wave 9). A total of 5,104 individuals were selected at baseline (2006). Analysis of variance and longitudinal data analysis were used to evaluate the following dependent variables: number of outpatient visits and number of days spent in the hospital per year. The number of annual outpatient visits was 4.298 days higher (Pclass IV, 0.438 days higher (P=0.027) in class III, and 0.335 days higher (P=0.035) in class II than in class I. The number of days spent in the hospital per year was 0.610 days higher (P=0.001) in class IV, 0.547 days higher (Pclass III, and 0.115 days higher (P=0.136) in class III than in class I. In addition, the number of days spent in the hospital in class IV patients with unmet healthcare needs showed an opposite trend to that predicted on the basis of socioeconomic status (estimate,-8.524; P-value=0.015). Patients whose jobs involved manual or physical labor were significantly associated with higher healthcare utilization. Thus, the results suggest that healthcare utilization in different occupational classes should be improved by monitoring work environments and promoting health-enhancing behaviors.

  20. Breast cancer genetic counseling among Dutch patients from Turkish and Moroccan descent : participation determinants and perspectives of patients and healthcare professionals

    NARCIS (Netherlands)

    Baars, J E; van Dulmen, A M; Velthuizen, M E; van Riel, E; Ausems, M G E M

    2017-01-01

    Lower participation rates in cancer genetic counseling are observed among different ethnic minorities. The goal of our study is to gain insight into determinants of Turkish and Moroccan patients' participation in breast cancer genetic counseling and DNA testing, from the point of view of healthcare

  1. Breast cancer genetic counseling among Dutch patients from Turkish and Moroccan descent: participation determinants and perspectives of patients and healthcare professionals

    NARCIS (Netherlands)

    Baars, J.E.; Dulmen, A.M. van; Velthuizen, M.E.; Riel, E. van; Ausems, M.G.E.M.

    2017-01-01

    Lower participation rates in cancer genetic counseling are observed among different ethnic minorities. The goal of our study is to gain insight into determinants of Turkish and Moroccan patients' participation in breast cancer genetic counseling and DNA testing, from the point of view of healthcare

  2. Determining and broadening the definition of impact from implementing a rational priority setting approach in a healthcare organization.

    Science.gov (United States)

    Cornelissen, Evelyn; Mitton, Craig; Davidson, Alan; Reid, Colin; Hole, Rachelle; Visockas, Anne-Marie; Smith, Neale

    2014-08-01

    Techniques to manage scarce healthcare resources continue to evolve in response to changing, growing and competing demands. Yet there is no standard definition in the priority setting literature of what might constitute the desired impact or success of resource management activities. In this 2006-09 study, using action research methodology, we determined the impact of implementing a formal priority setting model, Program Budgeting and Marginal Analysis (PBMA), in a Canadian health authority. Qualitative data were collected through post year-1 (n = 12) and year-2 (n = 9) participant interviews, meeting observation and document review. Interviews were analyzed using a constant comparison technique to identify major themes. Impact can be defined as effects at three levels: system, group, and individual. System-level impact can be seen in the actual selection of priorities and resource re-allocation. In this case, participants prioritized a list of $760,000 worth of investment proposals and $38,000 of disinvestment proposals; however, there was no clear evidence as to whether financial resources were reallocated as a result. Group and individual impacts, less frequently reported in the literature, included changes in priority setting knowledge, attitudes and practice. PBMA impacts at these three levels were found to be interrelated. This work argues in favor of attempts to expand the definition of priority setting success by including both desired system-level outcomes like resource re-allocation and individual or group level impacts like changes to priority setting knowledge, attitudes and practice. These latter impacts are worth pursuing as they appear to be intrinsic to successful system-wide priority setting. A broader definition of PBMA impact may also suggest conceptualizing PBMA as both a priority setting approach and as a tool to develop individual and group priority setting knowledge and practice. These results should be of interest to researchers and

  3. [Determinants of the use of different healthcare levels in the General System of Social Security in Health in Colombia and the Unified Health System in Brazil].

    Science.gov (United States)

    Garcia-Subirats, Irene; Vargas Lorenzo, Ingrid; Mogollón-Pérez, Amparo Susana; De Paepe, Pierre; da Silva, Maria Rejane Ferreira; Unger, Jean Pierre; Vázquez Navarrete, María Luisa

    2014-01-01

    To compare the use of different healthcare levels, and its determinants, in two different health systems, the General System of Social Security in Health (GSSSH) and the Unified Health System (UHS) in municipalities in Colombia and Brazil. A cross-sectional study was carried out, based on a population survey in two municipalities in Colombia (n=2163) and two in Brazil (n=2155). Outcome variables consisted of the use of primary care services, outpatient secondary care services, and emergency care in the previous 3 months. Explanatory variables were need and predisposing and enabling factors. Bivariate and multivariate logistic regression analyses were performed by healthcare level and country. The determinants of use differed by healthcare level and country: having a chronic disease was associated with a greater use of primary and outpatient secondary care in Colombia, and was also associated with the use of emergency care in Brazil. In Colombia, persons enrolled in the contributory scheme more frequently used the services of the GSSSH than persons enrolled with subsidized contributions in primary and outpatient secondary care and more than persons without insurance in any healthcare level. In Brazil, the low-income population and those without private insurance more frequently used the UHS at any level. In both countries, the use of primary care was increased when persons knew the healthcare center to which they were assigned and if they had a regular source of care. Knowledge of the referral hospital increased the use of outpatient secondary care and emergency care. In both countries, the influence of the determinants of use differed according to the level of care used, emphasizing the need to analyze healthcare use by disaggregating it by level of care. Copyright © 2014. Published by Elsevier Espana.

  4. Determinants of self-medication with antibiotics in Europe: the impact of beliefs, country wealth and the healthcare system.

    Science.gov (United States)

    Grigoryan, Larissa; Burgerhof, Johannes G M; Degener, John E; Deschepper, Reginald; Lundborg, Cecilia Stålsby; Monnet, Dominique L; Scicluna, Elizabeth A; Birkin, Joan; Haaijer-Ruskamp, Flora M

    2008-05-01

    Self-medication with antibiotics occurs among the population in Europe, particularly in southern and eastern countries. We studied the impact of predisposing factors (e.g. attitudes and knowledge concerning antibiotic use and self-medication) and enabling factors (country wealth and healthcare system factors) on self-medication with antibiotics in Europe. In this follow-up of a previous European survey, we interviewed a subsample of 1101 respondents. A multilevel analysis with two levels (respondent and country) was performed. Variables that were statistically significantly different between users and non-users of self-medication were considered for inclusion into the multilevel regression analyses. Predisposing factors included individual-level characteristics. High perceived appropriateness of self-medication with antibiotics for bronchitis and an attitude favouring antibiotic use for minor ailments were related to a higher likelihood of self-medication. Enabling factors included individual and country data. At the individual level, perceived availability of antibiotics without a prescription was related to increased probability of self-medication. At the country level, higher gross domestic product (wealth) and exact dispensation of prescribed tablet quantities by pharmacies were independently associated with lower likelihood of self-medication. Interventions aimed at preventing self-medication should include public education, enforcing regulations regarding the sale of antibiotics, and implementing laws for dispensing exact prescribed tablet quantities in pharmacies. With the included determinants, we explained almost all the variance at the country level, but not at the individual level. Future studies to increase our understanding of determinants of self-medication with antibiotics should focus on individual-level factors such as doctor-patient relationships and patient satisfaction.

  5. The contribution of ecosystem services to place utility as a determinant of migration decision-making

    International Nuclear Information System (INIS)

    Adams, Helen; Neil Adger, W

    2013-01-01

    Environment migration research has sought to provide an account of how environmental risks and resources affect migration and mobility. Part of that effort has focused on the role of the environment in providing secure livelihoods through provisioning ecosystem services. However, many of the models of environment migration linkages fail to acknowledge the importance of social and psychological factors in the decision to migrate. Here, we seek to provide a more comprehensive model of migration decision-making under environmental change by investigating the attachment people form to place, and the role of the environment in creating that attachment. We hypothesize that environmental factors enter the migration decision-making process through their contribution to place utility, defined as a function of both affective and instrumental bonds to location, and that ecosystem services, the aspects of ecosystems that create wellbeing, contribute to both components of place utility. We test these ideas in four rural highland settlements in Peru sampled along an altitudinal gradient. We find that non-economic ecosystem services are important in creating place attachment and that ecological place attachment exists independently of use of provisioning ecosystem services. Individuals’ attitudes to ecosystem services vary with the type of ecosystem services available at a location and the degree of rurality. While social and economic factors are the dominant drivers of migration in these locations, a loss of non-provisioning ecosystem services leads to a decrease in place utility and commitment to place, determining factors in the decision to migrate. The findings suggest that policy interventions encouraging migration as an adaptation to environmental change will have limited success if they only focus on provisioning services. A much wider set of individuals will experience a decrease in place utility, and migration will be unable to alleviate that decrease since the factors

  6. The contribution of ecosystem services to place utility as a determinant of migration decision-making

    Science.gov (United States)

    Adams, Helen; Adger, W. Neil

    2013-03-01

    Environment migration research has sought to provide an account of how environmental risks and resources affect migration and mobility. Part of that effort has focused on the role of the environment in providing secure livelihoods through provisioning ecosystem services. However, many of the models of environment migration linkages fail to acknowledge the importance of social and psychological factors in the decision to migrate. Here, we seek to provide a more comprehensive model of migration decision-making under environmental change by investigating the attachment people form to place, and the role of the environment in creating that attachment. We hypothesize that environmental factors enter the migration decision-making process through their contribution to place utility, defined as a function of both affective and instrumental bonds to location, and that ecosystem services, the aspects of ecosystems that create wellbeing, contribute to both components of place utility. We test these ideas in four rural highland settlements in Peru sampled along an altitudinal gradient. We find that non-economic ecosystem services are important in creating place attachment and that ecological place attachment exists independently of use of provisioning ecosystem services. Individuals’ attitudes to ecosystem services vary with the type of ecosystem services available at a location and the degree of rurality. While social and economic factors are the dominant drivers of migration in these locations, a loss of non-provisioning ecosystem services leads to a decrease in place utility and commitment to place, determining factors in the decision to migrate. The findings suggest that policy interventions encouraging migration as an adaptation to environmental change will have limited success if they only focus on provisioning services. A much wider set of individuals will experience a decrease in place utility, and migration will be unable to alleviate that decrease since the factors

  7. 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

  8. Economic inequality in eye care utilization and its determinants: a Blinder-Oaxaca decomposition.

    Science.gov (United States)

    Emamian, Mohammad Hassan; Zeraati, Hojjat; Majdzadeh, Reza; Shariati, Mohammad; Hashemi, Hassan; Fotouhi, Akbar

    2014-11-01

    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. 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. 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. 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.

  9. Determinants of use of supervised delivery care under Ghana's fee exemption policy for maternal healthcare: the case of the Central Region.

    Science.gov (United States)

    Asante-Sarpong, Henrietta; Owusu, Adobea Yaa; Saravanan, Sheela; Appiah, Ernest; Abu, Mumuni

    2016-07-19

    Improving access to supervised and emergency obstetric care resources through fee reduction/exemption maternity care initiatives has been touted as one major strategy to avoiding preventable maternal deaths. Evaluations on the effect of Ghana's fee exemption policy for maternal healthcare have largely focused on how it has influenced health outcomes and patterns of use of supervised care with little attention to understanding the main factors influencing use. This study therefore sought to explore the main individual and health system factors influencing use of delivery care services under the policy initiative in the Central Region. A cross-sectional study was conducted using 412 mothers with children aged less than one year in one largely rural and another largely urban districts in the Central Region of Ghana from September to December 2013. Data were collected using a questionnaire survey on the socio-demographic characteristics of mothers, their knowledge and use of care under the fee free policy. Chi-square and Binary Logistic Regression tests were used to evaluate the main determinants of delivery care use under the policy. Out of the 412 mothers interviewed, 268 (65 %) reported having delivered their most recent birth under the fee exemption policy even though awareness about the policy was almost universal 401 (97.3 %) among respondents. Utilization however differed for the two study districts. Respondents in the Cape Coast Metropolis (largely urban) used delivery service more (75.7 %) than those in the largely rural Assin North Municipal area (54.4 %). Binary logistic regression results identified maternal age, parity, religion, place of residence, awareness and knowledge about the fee exemption policy for maternal healthcare as significantly associated with the likelihood of delivery care use under the policy. The likelihood of using supervised delivery care under the policy was lower for mothers aged 20-29 compared to those in the age bracket of 40

  10. Acceptability and utility of an electronic psychosocial assessment (myAssessment) to increase self-disclosure in youth mental healthcare: a quasi-experimental study.

    Science.gov (United States)

    Bradford, Sally; Rickwood, Debra

    2015-12-01

    Technology is increasingly being used in youth mental healthcare to support service delivery and improve health outcomes. The current study trialed a new electronic psychosocial application (myAssessment) that aims to provide a holistic assessment of relevant risk and protective factors in youth mental healthcare. The study aimed to determine whether myAssessment was acceptable to all users, and whether it affected: reporting of certain behaviors and ratings of self-disclosure; youth ratings of control, fears of judgmental reactions or time-efficiency; clinician ratings of time-efficiency or their ability to formulate a treatment plan; and the therapeutic alliance. The application was tested at a youth mental health service using a quasi-experimental two phase Treatment-as-Usual/Intervention design. Three hundred thirty nine youth and 13 clinicians participated across both phases. Reporting of behaviors, self-disclosure, youth control, judgmental reactions, time efficiency, ability to formulate treatment plans, and the therapeutic alliance were compared between groups. myAssessment was found to be widely accepted by both young people and clinicians. Use of myAssessment resulted in reporting of behaviors that were 2.78 through 10.38 times higher for a variety of substances (use of tobacco, alcohol, cannabis, sedatives, hallucinogens, and opioids), in identifying non-heterosexual sexual orientation, having had sex, an STI check, sex without a condom, having felt pressured to have sex in the past, having self-harmed, and in having put themselves in an unsafe situation. Participants who used the application also reported being less likely to lie on past experiences of being bullied, substance use, and self-harm. Use of the application resulted in improved youth ratings of time efficiency in session. The application was found to have no impact on youth control, judgmental reactions, formulation of treatment plans, or the therapeutic alliance. Electronic psychosocial

  11. Utilization and patterns of community healthcare services for senior residents in long-term care facilities in Taiwan: A nationwide study

    Directory of Open Access Journals (Sweden)

    Hsiao-Ting Chang

    2013-01-01

    Conclusion: Whether or not the replacement of nasogastric tubes and urinary catheters among the LTCF senior resident population is an appropriate use of time and targeted medical resources needs further investigation. When addressing concerns about the community healthcare needs of senior residents of LTCFs, policymakers should carefully consider the current shortage of professional healthcare workers as they assess strategies to best meet the needs of the elderly in Taiwan.

  12. Determinants of utilization of dental services among 20- to 34-year-old Danes.

    Science.gov (United States)

    Scheutz, F; Heidmann, J

    2001-08-01

    Our aim was to identify determinants of utilization of dental services among 20- to 34-year-old Danes as outlined in a conceptual framework. Our sample consisted of a sample of 464 individuals who had been interviewed by 10 experienced interviewers from The Danish National Institute of Social Research. Our questionnaire comprised a battery of questions based on our conceptual model. The analysis was done in a hierarchical manner using a framework with three steps: Predisposing factors --> Enabling factors --> Need factors --> Utilization. Associations were evaluated with multivariate logistic regression analysis and expressed as odds ratios. The following factors were significantly associated with irregular use of dental services: age, sex, exercise habits, cost of dental treatment, dental anxiety, and perceived condition of teeth. Our findings suggest that a strategy aiming to increase young people's dental attendance should focus on the transition period that is, when the youngsters leave the public dental health care system and have to make use of the private system. The strategy should also take into account that young men are more likely to become non-users. A concerted effort could be dedicated to the non-negligible group of individuals with dental anxiety and dental phobia.

  13. Use of radio-active phosphorus in determining the efficiency of fertilizer utilization by cacao plantation

    International Nuclear Information System (INIS)

    Ahenkorah, Y.

    1975-01-01

    Both 32 P labelled phosphate solution and superphosphate were used in studying 1) in situ root distribution and activity of twenty year old Amelonado cacao (Theobroma Cacao L.) during wet and dry seasons, and 2) the efficiency of fertilizer utilization by the cacao plantation. The 32 P content of the leaves was used to determine patterns of root activity. Uptake of 32 P was greatest during the wet season and root activity highest within the upper 3 cm soil layer in both wet and dry seasons. Highest 32 P activity was obtained at a distance of 120-160 cm, and lowest at 91 cm from the base of the tree. For maximum utilization of phosphate fertilizer by a plantation of twenty year old Amelonado cacao, planted at 240 cm x 240 cm spacing, the fertilizer should be broadcast during the wet season. Under low soil moisture conditions, the placement of 32 P labelled superphosphate provides information on the relative availability of fertilizer or soil phosphorus and does not necessarily reflect the activity of the root profile. Active roots of cacao tend to be more extensive and are capable of exploring a much larger area than hitherto expected

  14. Healthcare resource utilization and cost among males with lower urinary tract symptoms with a predominant storage component in Spain: The epidemiological, cross-sectional MERCURY study.

    Science.gov (United States)

    Errando-Smet, Carlos; Müller-Arteaga, Carlos; Hernández, Marta; Lenero, Enrique; Roset, Montse

    2018-01-01

    To assess the relationship between storage-predominant LUTS and healthcare resource consumption and cost among males in Spain. In this non-interventional, cross-sectional study, urologists enrolled males with storage-predominant LUTS and recorded the consumption of healthcare resources (medical visits, diagnostic tests/monitoring, treatment, and hospitalizations) within the previous 6 months. The cost of healthcare resources was calculated from unit costs extracted from a Spanish eHealth database. Severity of LUTS was assessed by the Bladder Self-Assessment Questionnaire (BSAQ) and patients were stratified by symptom score (used more healthcare resources compared with patients with BSAQ symptom scores used as monotherapy (n = 229 [37.5%]) or in combination with antimuscarinics (n = 227 [37.2%]). The estimated median annual cost was €1070 per patient, consisting of diagnostic tests/monitoring (54.6%), medical visits (20.5%), and treatment (29.6%), and was higher in patients with BSAQ symptom score ≥6 (€1127) than in patients with BSAQ symptom score <6 (€920; P < 0.001). More severe LUTS are associated with higher healthcare consumption and cost. These findings highlight the importance of symptom management in LUTS patients to help minimize healthcare consumption and cost. © 2017 Wiley Periodicals, Inc.

  15. The Mental Health Parity and Addiction Equity Act evaluation study: Impact on specialty behavioral healthcare utilization and spending among enrollees with substance use disorders.

    Science.gov (United States)

    Friedman, Sarah; Xu, Haiyong; Harwood, Jessica M; Azocar, Francisca; Hurley, Brian; Ettner, Susan L

    2017-09-01

    The federal Mental Health Parity and Addiction Equity Act (MHPAEA) sought to eliminate historical disparities between behavioral health and medical health insurance benefits among the commercially insured. This study determines whether MHPAEA was associated with increased BH expenditures and utilization among a population with substance use disorder (SUD) diagnoses. Claims and eligibility data from 5,987,776 enrollees, 2008-2013, were obtained from a national, commercial, managed behavioral health organization. An interrupted time series study design with segmented regression analysis estimated time trends of per-member-per-month (PMPM) spending and use before (2008-2009), during (2010), and after (2011-2013) MHPAEA compliance. The study sample contained individuals with drug or alcohol use disorder diagnosis during study period (N=2,716,473 member-month observations). Outcomes included: total, plan, patient out-of-pocket spending; outpatient utilization (assessment/diagnostic evaluation visits; medication management; individual, group and family psychotherapy, and structured outpatient care); intermediate care utilization (day treatment; recovery home and residential); and inpatient utilization. Starting at the beginning of the post-parity period, MHPAEA was associated with increased levels of PMPM total and plan spending ($25.80 [p=0.01]; $28.33 [p=0.00], respectively), as well as the number of PMPM assessment/evaluation, individual psychotherapy, and group psychotherapy visits, and inpatient days (0.01 visits [p=0.01]; 0.02 visits [p=0.01]; 0.01 visits [p=0.03]; 0.01days [p=0.01], respectively). Following these initial level changes, MHPAEA was also associated with monthly increases in PMPM total, plan, and patent out-of-pocket spending ($2.56/month [p=0.00]; $2.25/month [p=0.00]; $0.27 [p=0.03], respectively), as well as structured outpatient visits and inpatient days (0.0012 visits/month [p=0.01]; 0.0012days/month [p=0.00]). MHPAEA was associated with modest

  16. Reduction in healthcare and societal resource utilization associated with cladribine tablets in patients with relapsing-remitting multiple sclerosis: analysis of economic data from the CLARITY Study.

    Science.gov (United States)

    Ali, Shehzad; Paracha, Noman; Cook, Stuart; Giovannoni, Gavin; Comi, Giancarlo; Rammohan, Kottil; Rieckmann, Peter; Sørensen, Per Soelberg; Vermersch, Patrick; Greenberg, Steven; Scott, David A; Joyeux, Alexandre

    2012-01-01

    Multiple sclerosis (MS) is a common, chronic, neurodegenerative condition associated with substantial healthcare and societal economic burden. Disease-modifying MS treatments have the potential to reduce health resource utilization (HRU), thereby reducing the attendant socioeconomic burden. This study aimed to compare health and societal resource use and productivity in patients with relapsing-remitting MS (RRMS) receiving cladribine tablets versus placebo over 96 weeks in the CLARITY study. The CLARITY study was a 96-week, randomized, double-blind, placebo-controlled study in patients with RRMS. HRU data, societal resource use and productivity data were collected at baseline and during scheduled patient visits, at 6-month intervals. The recall period for the HRU questionnaire was 3 months. The study was carried out at 155 sites across 32 countries worldwide. The intent-to-treat population comprised 1326 patients with RRMS randomized to cladribine 3.5 mg/kg (n = 433) or 5.25 mg/kg (n = 456) tablets or placebo (n = 437). Patient subgroups with high baseline disease activity were identified based on criteria of ≥2 relapses in the previous year (n = 392); ≥1 T1 gadolinium-enhancing (Gd+) lesion (n = 413); and ≥2 relapses in the previous year plus ≥1 T1 Gd+ lesion (n = 138). Cladribine tablets were administered in two (3.5 mg/kg group) or four (5.25 mg/kg group) short courses given at 4-week intervals at the start of a 48-week treatment period, followed by another two courses at the start of a subsequent 48-week re-treatment period. Interferon-β rescue therapy was permitted from week 24. Intravenous corticosteroids were available for the treatment of neurological relapses. HRU outcomes included mean number of hospital days and emergency room (ER), clinic and home visits during each study period. Societal resource use and productivity outcomes included mean number of hours and days of paid assistance, mean patient and carer work

  17. Policy-related determinants of child nutritional status in China: the effect of only-child status and access to healthcare.

    Science.gov (United States)

    Bredenkamp, Caryn

    2009-11-01

    This paper examines the determinants of child nutritional status in China, focusing specifically on those determinants related to health system reform and only-child status. Data are drawn from four waves of the China Health and Nutrition Survey (1991-2000). The empirical relationship between nutritional status, on the one hand, and income, access to quality healthcare and being an only-child, on the other hand, is investigated using ordinary least squares (OLS), random effects (RE), fixed effects (FE) and instrumental variables (IV) models. In the preferred model - a fixed effects model where income is instrumented - we find that being an only-child increases height-for-age z-scores by 0.12 of a standard deviation. By contrast, measures of access to quality healthcare are not found to be significantly associated with improved nutritional status.

  18. Pharmaco-economic analysis of direct medical costs of metastatic colorectal cancer therapy with XELOX or modified FOLFOX-6 regimens: implications for health-care utilization in Australia.

    Science.gov (United States)

    Tran, Giao; Hack, Stephen P; Kerr, Annette; Stokes, Leanne; Gibbs, Peter; Price, Timothy; Todd, Carlene

    2013-09-01

    The objective of this economic evaluation, which was based on patients from two randomized controlled clinical trials (NO16966 and NO16967), was to compare direct medical costs to the Australian health-care system of capecitabine plus oxaliplatin (XELOX) and bolus and/or infusional 5-fluorouracil (5-FU) plus folinic acid combined with oxaliplatin (modified [m] FOLFOX-6) in first-line and second-line treatment of advanced or metastatic colorectal cancer (mCRC). Direct medical costs were estimated for five treatment settings from a public and private hospital. The costs included in evaluation were for drug acquisition, preparation (oxaliplatin, bolus and infusional 5-FU), administration and wastage. The cost of drug acquisition was calculated based on dosage data and the mean number of treatment cycles from the pivotal studies NO16966 and NO16967. There were no costs associated with preparing capecitabine and leucovorin. An oncology grouping and costing study was performed to determine the relevant administration costs associated with central venous access devices, their placement, maintenance and removal (for oxaliplatin administration) and the continuous infusion of 5-FU via a continuous ambulatory delivery device pump or infuser. This economic evaluation has shown that treating mCRC patients with XELOX in the first and second-line settings results in average cost savings of $9110 and $7113, respectively, compared with mFOLFOX-6. A multi-way sensitivity analysis demonstrated that the use of XELOX remained cost-saving from an Australian government health budget perspective. The use of XELOX, compared with mFOLFOX-6, for the treatment of mCRC is cost-saving in the Australian government health budget. © 2012 Wiley Publishing Asia Pty Ltd.

  19. Lean healthcare.

    Science.gov (United States)

    Weinstock, Donna

    2008-01-01

    As healthcare organizations look for new and improved ways to reduce costs and still offer quality healthcare, many are turning to the Toyota Production System of doing business. Rather than focusing on cutting personnel and assets, "lean healthcare" looks to improve patient satisfaction through improved actions and processes.

  20. Comparison of cost determination of both resource consumption accounting and time-driven activity-based costing systems in a healthcare setting.

    Science.gov (United States)

    Özyapıcı, Hasan; Tanış, Veyis Naci

    2017-05-01

    Objective The aim of the present study was to explore the differences between resource consumption accounting (RCA) and time-driven activity-based costing (TDABC) systems in determining the costs of services of a healthcare setting. Methods A case study was conducted to calculate the unit costs of open and laparoscopic gall bladder surgeries using TDABC and RCA. Results The RCA system assigns a higher cost both to open and laparoscopic gall bladder surgeries than TDABC. The total cost of unused capacity under the TDABC system is also double that in RCA. Conclusion Unlike TDABC, RCA calculates lower costs for unused capacities but higher costs for products or services in a healthcare setting in which fixed costs make up a high proportion of total costs. What is known about the topic? TDABC is a revision of the activity-based costing (ABC) system. RCA is also a new costing system that includes both the theoretical advantages of ABC and the practical advantages of German costing. However, little is known about the differences arising from application of TDABC and RCA. What does this paper add? There is no study comparing both TDABC and RCA in a single case study based on a real-world healthcare setting. Thus, the present study fills this gap in the literature and it is unique in the sense that it is the first case study comparing TDABC and RCA for open and laparoscopic gall bladder surgeries in a healthcare setting. What are the implications for practitioners? This study provides several interesting results for managers and cost accounting researchers. Thus, it will contribute to the spread of RCA studies in healthcare settings. It will also help the implementers of TDABC to revise data concerning the cost of unused capacity. In addition, by separating costs into fixed and variable, the paper will help managers to create a blended (combined) system that can improve both short- and long-term decisions.

  1. The use of secure anonymised data linkage to determine changes in healthcare utilisation following severe open tibial fractures.

    Science.gov (United States)

    Page, Piers R J; Trickett, Ryan W; Rahman, Shakeel M; Walters, Angharad; Pinder, Leila M; Brooks, Caroline J; Hutchings, Hayley; Pallister, Ian

    2015-07-01

    Severe open fractures of the lower limbs are complex injuries requiring expert multidisciplinary management in appropriate orthoplastic centres. This study aimed to assess the impact of open fractures on healthcare utilisation and test the null hypotheses that there is no difference in healthcare utilisation between the year before and year after injury, and that there is no difference in healthcare utilisation in the year post-injury between patients admitted directly to an orthoplastic centre in keeping with the joint BOA/BAPRAS standards and those having initial surgery elsewhere. This retrospective cohort study utilising secure anonymised information linkage (SAIL), a novel databank of anonymised nationally pooled health records, recruited patients over 18 years of age sustaining severe open lower limb fractures managed primarily or secondarily at our centre and who had data available in the SAIL databank. 101 patients met inclusion criteria and 90 of these had records in the SAIL databank. The number of days in hospital, number of primary care attendances, number of outpatient attendances and number of emergency department attendances in the years prior and subsequent to injury were recorded. Patients sustaining open fractures had significantly different healthcare utilisation in the year after injury when compared with the year before, in terms of days spent in hospital (23.42 vs. 1.70, p=0.000), outpatient attendances (11.98 vs. 1.05, p=0.000), primary care attendances (29.48 vs. 11.99, p=0.000) and emergency department presentations (0.2 vs. 0.01, p=0.025). Patients admitted directly to orthoplastic centres had significantly fewer operations (1.78 vs. 3.31) and GP attendances (23.6 vs. 33.52) than those transferred in subsequent to initial management in other units. There is a significant increase in healthcare utilisation after open tibial fracture. Adherence to national standards minimises the impact of this on both patients and health services. Copyright

  2. Asthma-Like Symptoms in Homeless Children in the Greater Paris Area in 2013: Prevalence, Associated Factors and Utilization of Healthcare Services in the ENFAMS Survey.

    Directory of Open Access Journals (Sweden)

    Delphine Lefeuvre

    Full Text Available Asthma remains poorly studied in homeless children. We sought to estimate the prevalence of asthma-like symptoms (ALS and to identify the factors associated with ALS and healthcare service utilisation.A cross-sectional survey of a random sample of sheltered homeless families was conducted by interviewing 801 parents of children (0-12 years in 17 languages. ALS were defined as wheezing or night cough without fever during the previous year. Poisson regression models with robust error variance were used to compute prevalence ratios (PR for factors associated with ALS and healthcare service utilisation for ALS.The prevalence of ALS among the children was 19.9%. Poor housing sanitation was significantly associated with ALS, as being born in the European Union. Most of the children with ALS had used healthcare services (85.4%. The main barriers to accessing such services were having lived in France for less than 49 months, having difficulties in French and living in poor housing conditions.ALS prevalence seemed lower than in the general child population, possibly because of the children's origins. Environmental factors associated with ALS point to the need to improve the indoor environment of family shelters. The relatively high rate of healthcare service utilisation should not overshadow existing barriers.

  3. The determination of chromium-50 in human blood and its utilization for blood volume measurements

    International Nuclear Information System (INIS)

    Zeisler, R.; Young, I.

    1986-01-01

    Possible relationships between insufficient blood volume increases during pregnancy and infant mortality could be established with an adequate measurement procedure. An accurate and precise technique for blood volume measurements has been found in the isotope dilution technique using chromium-51 as a label for red blood cells. However, in a study involving pregnant women, only stable isotopes can be used for labeling. Stable chromium-50 can be determined in total blood samples before and after dilution experiments by neutron activation analysis (NAA) or mass spectrometry. However, both techniques may be affected by insufficient sensitivity and contamination problems at the inherently low natural chromium concentrations to be measured in the blood. NAA procedures involving irradiations with highly thermalized neutrons at a fluence rate of 2x10 13 n/cm 2 xs and low background gamma spectrometry are applied to the analysis of total blood. Natural levels of chromium-50 in human and animal blood have been found to be <0.1 ng/mL; i.e., total chromium levels of <3 ng/mL. Based on the NAA procedure, a new approach to the blood volume measurement via chromium-50 isotope dilution has been developed which utilizes the ratio of the induced activities of chromium-51 to the iron-59 in three blood samples taken from each individual, namely blank, labeled and diluted labeled blood. (author)

  4. [Individual determinants of dental care utilization among low-income adult and elderly individuals].

    Science.gov (United States)

    Baldani, Márcia Helena; Brito, Wanessa Hoffmann; Lawder, Juliana Aparecida de Campos; Mendes, Yasmine Bittencourt Emílio; da Silva, Francilene de Fátima Marcondes; Antunes, José Leopoldo Ferreira

    2010-03-01

    The utilization of dental care services results from the interaction of biological determinants with sociocultural, family and community variables, as well as from some characteristics of health systems. The objective of this study was to assess the individual factors associated with the use of dental care services among low-income adult and elderly individuals living in the catchment area of the Family Health Strategy, in Ponta Grossa, PR. The sample included 246 individuals, aged 35 years or over, who answered a questionnaire on socioeconomic conditions, perceived needs, and access to dental care services. Data analysis was performed according to a conceptual framework based on Andersen's Behavioral Model. Non-recent use of dental care services was considered as the dependent variable in the logistic regression analysis models. There were high prevalences of self-reported oral health diseases and teeth loss. About 40% of the adults and 67% of the elderly had not made any dental visit in the past 3 years. Individuals without ownership of the family home, with inadequate oral hygiene habits and who wore complete dentures had higher odds of having gone to the dentist longer ago. The fact of having a regular source of dental care was identified as a protective factor in the analysis. The conceptual framework confirmed the presence of social and psychosocial inequalities in the use of dental services among low-income adult and elderly individuals.

  5. Determinants of Mental Health Services Utilization Among Deployed Service Members and Their Families

    Science.gov (United States)

    2008-02-11

    Wegner in the Department of Healthcare Operations for helping me access and understand the data used for this study. I would also like to extend a...social well-being and not merely the absence of disease or infirmity" (1946). WHO further describes health care as all the goods and services designed...outpatient treatment and consultation related to the management of psychological issues associated with medical treatment and disease management, with a

  6. Behavioral determinants of immunization service utilization in Ethiopia: a cross-sectional community-based survey.

    Science.gov (United States)

    Ababu, Yohannes; Braka, Fiona; Teka, Aschalew; Getachew, Kinde; Tadesse, Tefera; Michael, Yohannes; Birhanu, Zewdie; Nsubuga, Peter; Assefa, Tersit; Gallagher, Kathleen

    2017-01-01

    According to the Ethiopian Health Sector Development Plan IV annual performance report (HSDP IV), Ethiopia targeted to reach 90% coverage with DPT-Hib-HepB 3 (Pentavalent3) vaccine and 86% coverage with measles vaccine in 2010- 2011. However, the actual performance fell-short of the intended targets due to several reasons. Therefore, a nationwide comprehensive study was conducted to examine the behavioral determinants of immunization practices in the Ethiopian context. The study employed the Modified Steps of Behavioral Change (SBC) Model as a theoretical lens. A cross-sectional study was conducted in May 2012 in all the nine regions and the two city administrations of Ethiopia. The study used a community-based quantitative survey design comprising of multistage cluster sampling to draw relevant data from a sample of 2,328 caretakers whose children were 12-23 months of age at the time of data collection. Overall, the multivariate analysis findings revealed that caretakers, who had high knowledge were 2.24 times more likely to vaccinate their children than participants had low knowledge (OR= 2.24, 95%CI: 1.68-2.98). Participants who had high approval were 2.45 times more likely to vaccinate their children than participants who had unfavorable approval (OR= 2.45, 95%CI: 1.67-3.59); and participants who had high intention were 6.49 times more likely to vaccinate their children with pentavalent3 vaccines than participants who had low intention(OR= 6.49, 95%CI: 4.83-8). Also, it was clear from the regression analysis that aspects of caretakers' demographic characteristics were significant predictors of their immunization practice for the sample group. We identified that caretakers' knowledge, approval, intention, parents' residence, and religious backgrounds were associated with immunization service utilization. To achieve sustainable behavioral change on immunization service utilization of the caretakers in Ethiopia, this study suggests investing in activities that

  7. An empirical study to determine factors that motivate and limit the implementation of ICT in healthcare environments.

    Science.gov (United States)

    Gururajan, Raj; Hafeez-Baig, Abdul

    2014-12-23

    The maturity and usage of wireless technology has influenced health services, and this has raised expectations from users that healthcare services will become more affordable due to technology growth. There is increasing evidence to justify this expectation, as telehealth is becoming more and more prevalent in many countries. Thus, health services are now offered beyond the boundaries of traditional hospitals, giving rise to many external factors dictating their quality. This has led us to investigate the factors that motivate and limit the implementation of ICT applications in the healthcare domain. We used a mixed method approach with the qualitative aspects leading the quantitative aspects. The main reason for this approach was to understand and explore the domain through the qualitative aspects as we could be part of the discussion. Then we conducted a quantitative survey to extract more responses in order to justify the claims explored in the qualitative process. We found that there are a number of internal and external factors influencing ICT adoption in the healthcare environment so that services can be provided via ICT tools. These factors were grouped under factors contributing to improved outcomes, efficiency and the management of technology. We conceptualised that these three groups of factors drive ICT implementation to assure health services. The main lesson learned from this research was that Information Systems discipline needs to urgently consider health informatics as a serious growth area. We also found that as IS researchers, we need to 'mix' with the health environment in order to understand the environment and then develop suitable methods to answer posited research questions.

  8. Individual determinants of research utilization by nurses: a systematic review update

    Science.gov (United States)

    2011-01-01

    Background Interventions that have a better than random chance of increasing nurses' use of research are important to the delivery of quality patient care. However, few reports exist of successful research utilization in nursing interventions. Systematic identification and evaluation of individual characteristics associated with and predicting research utilization may inform the development of research utilization interventions. Objective To update the evidence published in a previous systematic review on individual characteristics influencing research utilization by nurses. Methods As part of a larger systematic review on research utilization instruments, 12 online bibliographic databases were searched. Hand searching of specialized journals and an ancestry search was also conducted. Randomized controlled trials, clinical trials, and observational study designs examining the association between individual characteristics and nurses' use of research were eligible for inclusion. Studies were limited to those published in the English, Danish, Swedish, and Norwegian languages. A vote counting approach to data synthesis was taken. Results A total of 42,770 titles were identified, of which 501 were retrieved. Of these 501 articles, 45 satisfied our inclusion criteria. Articles assessed research utilization in general (n = 39) or kinds of research utilization (n = 6) using self-report survey measures. Individual nurse characteristics were classified according to six categories: beliefs and attitudes, involvement in research activities, information seeking, education, professional characteristics, and socio-demographic/socio-economic characteristics. A seventh category, critical thinking, emerged in studies examining kinds of research utilization. Positive relationships, at statistically significant levels, for general research utilization were found in four categories: beliefs and attitudes, information seeking, education, and professional characteristics. The only

  9. Individual determinants of research utilization by nurses: a systematic review update

    Directory of Open Access Journals (Sweden)

    Wallin Lars

    2011-01-01

    Full Text Available Abstract Background Interventions that have a better than random chance of increasing nurses' use of research are important to the delivery of quality patient care. However, few reports exist of successful research utilization in nursing interventions. Systematic identification and evaluation of individual characteristics associated with and predicting research utilization may inform the development of research utilization interventions. Objective To update the evidence published in a previous systematic review on individual characteristics influencing research utilization by nurses. Methods As part of a larger systematic review on research utilization instruments, 12 online bibliographic databases were searched. Hand searching of specialized journals and an ancestry search was also conducted. Randomized controlled trials, clinical trials, and observational study designs examining the association between individual characteristics and nurses' use of research were eligible for inclusion. Studies were limited to those published in the English, Danish, Swedish, and Norwegian languages. A vote counting approach to data synthesis was taken. Results A total of 42,770 titles were identified, of which 501 were retrieved. Of these 501 articles, 45 satisfied our inclusion criteria. Articles assessed research utilization in general (n = 39 or kinds of research utilization (n = 6 using self-report survey measures. Individual nurse characteristics were classified according to six categories: beliefs and attitudes, involvement in research activities, information seeking, education, professional characteristics, and socio-demographic/socio-economic characteristics. A seventh category, critical thinking, emerged in studies examining kinds of research utilization. Positive relationships, at statistically significant levels, for general research utilization were found in four categories: beliefs and attitudes, information seeking, education, and professional

  10. Mental Health Service Utilization among Black Youth; Psychosocial Determinants in a National Sample.

    Science.gov (United States)

    Assari, Shervin; Caldwell, Cleopatra Howard

    2017-05-17

    Racial disparity in mental health service utilization (MHSU) persists, and youths are not an exception to the underutilization of services. Very limited research has been conducted on the determinants of MHSU among Black youth. Using a national sample of American Black youth, the current study investigated the association between demographic factors, socioeconomic status, psychiatric disorders, and self-rated health (SRH) on MHSU. We also tested the heterogeneity of the effects of SRH and psychiatric disorders based on ethnicity, gender, and their intersection. We used data from the National Survey of American Life-Adolescents supplement (NSAL-A), 2003-2004. The study enrolled 1170 Black youth between 13 and 17 years old including 810 African Americans and 360 Caribbean Blacks. Age, gender, ethnicity, socioeconomic status, SRH, 12-month psychiatric disorders (Composite International Diagnostic Interview modified version), and MHSU (last year) were measured. Logistic regressions were used for data analysis. Ethnicity (odds ratio (OR) = 0.33, 95% confidence interval (CI) = 0.17-0.65), subjective socioeconomic status (OR = 1.43, 95% CI = 1.09-1.88), SRH (OR = 2.45, 95% CI = 1.00-6.37), and psychiatric disorders (OR = 2.17, 95% CI = 1.05-4.48) were associated with MHSU. Age, gender, and objective socioeconomic status were not associated with MHSU. Gender and ethnicity did not interact with SRH and psychiatric disorders on MHSU. Actual and perceived need both universally influence Black youths' likelihood of MHSU, regardless of their ethnicity and gender. Ethnicity and perceived socioeconomic status also play unique roles in MHSU. Future research is needed to understand pathways to MHSU for Black youth who both have and perceive mental health needs. There is also a need to find ways to promote MHSU for those with a need for mental health services.

  11. Determinants of inequity in health care services utilization in markazi province of iran.

    Science.gov (United States)

    Hassanzadeh, Jafar; Mohammadbeigi, Abolfazl; Eshrati, Babak; Rezaianzadeh, Abbas; Rajaeefard, Abdolreza

    2013-05-01

    National and international statistics from Iran have indicated that progresses and achievements have been made for most health indicators, but there are differences in some indicators in special groups and at the provincial level. Our aim was to assess the main predictors of inequity in seeking Health Care Utilities (HCU) locally. Data gathered from the HCU survey, which was conducted in the Markazi province of Iran during 2008, was used in the present study. A systematic sampling method, based on the Iranian household framework, was applied in order to choose 758 households as well as 2711 individuals. The household wealth index constructed by Principle Component Analysis (PCA) and robust login link function in Generalized Estimation Equation (GEE) model were used in order to determine the predictors of inequity. 66.4% of those in need sought outpatient health care from which 97.7% received appropriate services. After adjustment for the clustering effect of household as well as confounding effect of the covariates, GEE model showed that there were inequities in HCU for females (OR = 2.44, CI; 1.24- 4.81) and subjects with inpatient need (OR = 2.14, CI: 1.23-3.72). Being in the lowest quintile of household wealth index was associated with the lower use of outpatient health services (OR = 0.45, CI; 0.23- 0.88). In spite of improvements in the national health indicator, different groups of people use health care services differently, but these inequities in HCU are related to social and individual factors. Also, it is clear that health sector facilities and the accessibility to health services are not the only predictors.

  12. Utilizing an open-microcavity optoacoustic sensor for spectroscopic determination of methemoglobin concentration

    Science.gov (United States)

    Peterson, Ralph W.; Kadugodinandareddy, Kavya; Karunakaran, Vinitha; Whitney, Casey; Ling, Jian; Ye, Jing Yong

    2015-03-01

    We present a simple, non-destructive photoacoustic spectroscopy method utilizing a unique open-microcavity optoacoustic sensor to measure the concentration ratio of Methemoglobin (MetHb) in an optically scattering medium. Elevated levels of MetHb, present for example in the blood disorder Methemeglobinemia, cannot be detected by conventional pulse oximetry, and may result in inaccurate arterial oxygen saturation measurements. Samples with different ratios of Oxygenated Hemoglobin (HbO2), Deoxygenated Hemoglobin (HHb), and MetHb were obtained and mixed with nanoscale latex beads to present an optical scattering effect. Polymer encapsulated hemoglobin (PEH) samples were also studied. A sample chamber containing 20 μL of each sample was positioned directly underneath our patented optoacoustic sensor. Unlike a piezoelectric transducer, our optoacoustic sensor allows an excitation laser beam from an OPO laser to pass through and be absorbed by the sample to produce a photoacoustic signal. The cavity layer of the optoacoustic sensor is exposed directly to the resulting ultrasound signal, which causes an intensity modulation of a HeNe laser that is used to monitor the resonance condition of the sensor. A probe laser beam is total internally reflected off of the sensor and detected with a fiber-coupled APD detector. Three wavelengths are chosen for our excitation laser based on the absorption peaks and isobestic points of HHb, HbO2, and MetHb. Using established values of the molar extinction coefficients of HbO2, HHb, and MetHb a set of three simultaneous equations can be solved to accurately determine the concentration ratio of MetHb.

  13. Determination of the activity of pulmonary tuberculosis : the utility of high-resolution computed tomography

    International Nuclear Information System (INIS)

    Chung, Myung Hee; Lee, Hae Giu; Yu, Won Jong; Chung, Hong Jun; Yang, Bo Sung; Kwon, Soon Suck; Park, Seog Hee

    2000-01-01

    To evaluate the utility of high-resolution computed tomography (HRCT), as used to determine the activity of tuberculosis, and to analyze the HRCT findings in active and in inactive tuberculosis. We analyzed the HRCT findings of 100 patients (54 men, 46 women; average age, 54 years) who according to the results of chest radiography had pulmonary tuberculosis of undetermined activity. We assessed HRCT findings such as the presence of a centrilobular, macro-, or micronodule; consolidation, ground-glass opacity, cavity, interlobular septal thickening, irregular linear opacities, bronchial wall thickening, bronchovascular bundle distortion, bronchiectasis, atelectasis, and pericicatrical emphysema. We compared the ratio of the area of nodule and consolidation to that of whole lung, and compared the findings between active and inactive tuberculosis. Eleven of 100 patients were excluded because the final diagnosis was other than tuberculosis. In 59 patients, the presence of active pulmonary tuberculosis was proven by positive sputum smear and/or culture for mycobacterium tuberculosis. On the basis of the negative results of these tests, pulmonary tuberculosis was found to be inactive in 30 patients; serial chest radiographs indicated that their condition remained stable over a 6-month period. For HRCT, sensitivity was 96.6%, specificity 56.7%, positive predictive value 81.4%, negative predictive value 89.5%, and accuracy 83.1%. For active tuberculosis, the presence of centrilobular nodules, tree-in-bud, macronodules, cavity within the nodule, and consolidations was statistically significant, while for inactive tuberculosis, that of irregular linear opacities, micronodules, bronchiectasis, and cicatrization atectasis was similarly significant. The CT score for the area of nodules and consolidations was higher in active than in inactive tuberculosis, but only the nodule score showed statistical significance. HRCT can be a useful diagnostic tool for evaluating the activity

  14. Mental Health Service Utilization among Black Youth; Psychosocial Determinants in a National Sample

    Directory of Open Access Journals (Sweden)

    Shervin Assari

    2017-05-01

    Full Text Available Racial disparity in mental health service utilization (MHSU persists, and youths are not an exception to the underutilization of services. Very limited research has been conducted on the determinants of MHSU among Black youth. Using a national sample of American Black youth, the current study investigated the association between demographic factors, socioeconomic status, psychiatric disorders, and self-rated health (SRH on MHSU. We also tested the heterogeneity of the effects of SRH and psychiatric disorders based on ethnicity, gender, and their intersection. We used data from the National Survey of American Life-Adolescents supplement (NSAL-A, 2003–2004. The study enrolled 1170 Black youth between 13 and 17 years old including 810 African Americans and 360 Caribbean Blacks. Age, gender, ethnicity, socioeconomic status, SRH, 12-month psychiatric disorders (Composite International Diagnostic Interview modified version, and MHSU (last year were measured. Logistic regressions were used for data analysis. Ethnicity (odds ratio (OR = 0.33, 95% confidence interval (CI = 0.17–0.65, subjective socioeconomic status (OR = 1.43, 95% CI = 1.09–1.88, SRH (OR = 2.45, 95% CI = 1.00–6.37, and psychiatric disorders (OR = 2.17, 95% CI = 1.05–4.48 were associated with MHSU. Age, gender, and objective socioeconomic status were not associated with MHSU. Gender and ethnicity did not interact with SRH and psychiatric disorders on MHSU. Actual and perceived need both universally influence Black youths’ likelihood of MHSU, regardless of their ethnicity and gender. Ethnicity and perceived socioeconomic status also play unique roles in MHSU. Future research is needed to understand pathways to MHSU for Black youth who both have and perceive mental health needs. There is also a need to find ways to promote MHSU for those with a need for mental health services.

  15. Cerebral glucose utilization in pediatric neurological disorders determined by positron emission tomography

    International Nuclear Information System (INIS)

    Yanai, Kazuhiko; Tohoku Univ., Sendai; Iinuma, Kazuie; Miyabayashi, Shigeaki; Narisawa, Kuniaki; Tada, Keiya; Matsuzawa, Taiju; Tohoku Univ., Sendai; Ito, Masatoshi; Yamada, Kenji

    1987-01-01

    We measured local cerebral glucose utilization in 19 patients with Lennox-Gastaut syndrome (LG), partial seizures (PS), atypical and classical phenylketonuria (PKU), Leigh disease, and subacute sclerosing panencephalitis (SSPE), using positron emission tomography (PET). The mean values of regional glucose utilization in interictal scans of LG were significantly reduced in all brain regions when compared with that of PS (P<0.005). PET studies of glucose utilization in LG revealed more widespread hypometabolism than in PS. Two sibling with dihydropteridine reductase deficiency, a patient with classical PKU, and a boy with cytochrome c oxidase deficiency showed reduced glucose utilization in the caudate and putamen. A marked decrease in glucose utilization was found in the cortical gray matter of a patient with rapidly progressive SSPE, despite relatively preserved utilization in the caudate and putamen. The PET study of a patient with slowly progressive SSPE revealed patterns and values of glucose utilization similar to those of the control. Thus, PET provided a useful clue toward understanding brain dysfunction in LG, PS, PKU, Leigh disease, and SSPE. (orig.)

  16. Cerebral glucose utilization in pediatric neurological disorders determined by positron emission tomography

    Energy Technology Data Exchange (ETDEWEB)

    Yanai, Kazuhiko; Iinuma, Kazuie; Miyabayashi, Shigeaki; Narisawa, Kuniaki; Tada, Keiya; Matsuzawa, Taiju; Ito, Masatoshi; Yamada, Kenji

    1987-09-01

    We measured local cerebral glucose utilization in 19 patients with Lennox-Gastaut syndrome (LG), partial seizures (PS), atypical and classical phenylketonuria (PKU), Leigh disease, and subacute sclerosing panencephalitis (SSPE), using positron emission tomography (PET). The mean values of regional glucose utilization in interictal scans of LG were significantly reduced in all brain regions when compared with that of PS (P<0.005). PET studies of glucose utilization in LG revealed more widespread hypometabolism than in PS. Two sibling with dihydropteridine reductase deficiency, a patient with classical PKU, and a boy with cytochrome c oxidase deficiency showed reduced glucose utilization in the caudate and putamen. A marked decrease in glucose utilization was found in the cortical gray matter of a patient with rapidly progressive SSPE, despite relatively preserved utilization in the caudate and putamen. The PET study of a patient with slowly progressive SSPE revealed patterns and values of glucose utilization similar to those of the control. Thus, PET provided a useful clue toward understanding brain dysfunction in LG, PS, PKU, Leigh disease, and SSPE.

  17. Determinants of first-time utilization of long-term care services in the Netherlands: an observational record linkage study.

    Science.gov (United States)

    Slobbe, Laurentius C J; Wong, Albert; Verheij, Robert A; van Oers, Hans A M; Polder, Johan J

    2017-09-05

    Since in an ageing society more long-term care (LTC) facilities are needed, it is important to understand the main determinants of first-time utilization of (LTC) services. The Andersen service model, which distinguishes predisposing, enabling and need factors, was used to develop a model for first-time utilization of LTC services among the general population of the Netherlands. We used data on 214,821 persons registered in a database of general practitioners (NIVEL Primary Care Database). For each person the medical history was known, as well as characteristics such as ethnicity, income, home-ownership, and marital status. Utilization data from the national register on long-term care was linked at a personal level. Generalized Linear Models were used to determine the relative importance of factors of incident LTC-service utilization. Top 5 determinants of LTC are need, measured as the presence of chronic diseases, age, household size, household income and homeownership. When controlling for all other determinants, the presence of an additional chronic disease increases the probability of utilizing any LTC service by 45% among the 20+ population (OR = 1.45, 95% CI: 1.41-1.49), and 31% among the 65+ population (OR = 1.31, 95% CI: 1.27-1.36). With respect to the 20+ population, living in social rent (OR = 2.45, 95% CI = 2.25-2.67, ref. = home-owner) had a large impact on utilizing any LTC service. In a lesser degree this was the case for living alone (OR = 1.63, 95% CI = 1.52-1.75, ref. = not living alone). A higher household income was linked with a lower utilization of any LTC service. All three factors of the Anderson model, predisposing, enabling, and need determinants influence the likelihood of future LTC service utilization. This implies that none of these factors can be left out of the analysis of what determines this use. New in our analysis is the focus on incident utilization. This provides a better estimate of the effects of predictors

  18. Determining the Cost of Capital for Turkish Electricity Distribution Utilities: Analysis and Recommendations

    OpenAIRE

    Gözen, Mustafa

    2012-01-01

    Turkey has been transforming her electricity market to a competitive one since the electricity market law was approved by the parliament in 2001. As part of the new regime, electricity distribution activities are subject to incentive-based regulation by the energy regulator - EMRA. At the beginning of each implementation period, initial revenue is allowed by EMRA for a distribution utility in which a rate of return for investments in the utility is added. Setting a fair rate is relatively eas...

  19. Social Determinants of Equity in Access to Healthcare for Tuberculosis Patients in Republic of Macedonia – Results from a Case-Control Study

    Directory of Open Access Journals (Sweden)

    Dance Gudeva Nikovska

    2014-09-01

    Full Text Available Background Health is a complex phenomenon and equity as a basic human right an integral part of constitutions in almost all countries in the world. In Republic of Macedonia (RM, Tuberculosis (TB is clustered regionally and in certain ethnic groups. The main objective of this study was to analyze Social Determinants of Health (SDH and equity in access to healthcare services for TB patients in RM, aimed at complex analysis of factors that cause inequities. Methods Case-control study was conducted in the period March–December, 2013; “cases” are households of TB patients registered in the period July, 2012–June, 2013 and controls are households with no TB patients in their immediate vicinity. World Health Organization (WHO World Health Survey questionnaire was used to collect data. Results Analysis of SDH of TB patients shows that patients are mostly males, of lower socio-economic status, are less educated, unemployed and TB is clustered in certain ethnic groups. Analysis of access has identified these determinants as important barriers in access to health services. Conclusion The study has documented the basic SDH of TB patients in RM, as well as barriers in access to healthcare, providing useful baseline information to facilitate determination where to concentrate future efforts.

  20. Patients' Satisfaction with the Healthcare Services at a North Central ...

    African Journals Online (AJOL)

    BACKGROUND: This study sought to determine the level of satisfaction of patients with the healthcare services at Federal Medical Centre, Bida (FMCB) Nigeria and the factors associated with patients' satisfaction. METHODS: The study utilized exit interview of 480 patients, sampled at the 9 service points of the Centre.

  1. Status and determinants of health services utilization among elderly migrants in China.

    Science.gov (United States)

    Zhang, Xiaofang; Yu, Bin; He, Tiantian; Wang, Peigang

    2018-01-01

    The household registration system in China places migrants in a vulnerable status regarding access to local public services, including limited access to health services. Most studies on migrants' health services utilization targeted on working-age migrants, and there has been a paucity of studies conducted among elderly migrants. This study aims to investigate the status of health services utilization and its influential factors among elderly migrants. Data (13,043 participants, 52.4% male, mean age 66.22 ± 6.20) were derived from the 2015 Migrant Dynamics Monitoring Survey. The outcome variable in the study was health services utilization, consisting of doctor visits, hospitalization and local inpatient care. The Behavioral Model of Health Service Use was applied to categorize the influential factors into three components, including predisposing, enabling and need factors. Multivariate logistic regression analysis was used to investigate the influential factors of the three components of health services utilization. Of the total sample, 45.5% would visit a doctor when they were ill, 81.8% would prefer to be hospitalized when recommended by doctors, and 71.6% (those who were hospitalized) would choose to receive local inpatient care rather than going back to their hometown. Age, marital status, household income, years of residence, migration range, reasons for migration, size of friend network, health insurance type, local health insurance status and chronic disease status were significantly associated with health services utilization. A low level of local health services utilization was observed among elderly migrants. Enabling factors played important roles in promoting health services utilization among elderly migrants. Policy and decision makers may consider improving the capability for elderly migrants to access health services, such as increasing income and providing local health insurance.

  2. From Natural Monopoly to Public Utility: Technological Determinism and the Political Economy of Infrastructure in Progressive-Era America.

    Science.gov (United States)

    Plaiss, Adam

    In present-day debates regarding telecommunication policy, one frequently hears the terms natural monopoly and public utility. This article investigates the origins of these ideas, finding that Richard T. Ely-a celebrated American economist of the late nineteenth century-embedded in the term "natural monopoly" a narrative of technological determinism. By arguing that certain services had monopolizing tendencies hardwired into them, Ely argued for their regulation. Ely's theory of natural monopoly formed the basis of Wisconsin's 1907 public utilities law, which served as a model for many other states' regulatory policies. The modern notion of public utility thus carries with it the technological determinism of Ely's natural monopoly idea. By tracing the lineage of these two terms, this article recaptures the influence that activists and progressive politicians exercised over the formation of large technological systems during the Second Industrial Revolution.

  3. An analysis of trends and determinants of health insurance and healthcare utilisation in the Russian population between 2000 and 2004: the 'inverse care law' in action.

    Science.gov (United States)

    Perlman, Francesca; Balabanova, Dina; McKee, Martin

    2009-04-27

    The break-up of the USSR brought considerable disruption to health services in Russia. The uptake of compulsory health insurance rose rapidly after its introduction in 1993. However, by 2000 coverage was still incomplete, especially amongst the disadvantaged. By this time, however, the state health service had become more stable, and the private sector was growing. This paper describes subsequent trends and determinants of healthcare insurance coverage in Russia, and its relationship with health service utilisation, as well as the role of the private sector. Data were from the Russia Longitudinal Monitoring Survey, an annual household panel survey (2000-4) from 38 centres across the Russian Federation. Annual trends in insurance coverage were measured (2000-4). Cross-sectional multivariate analyses of the determinants of health insurance and its relationship with health care utilisation were performed in working-age people (18-59 years) using 2004 data. Between 2000 and 2004, coverage by the compulsory insurance scheme increased from 88% to 94% of adults; however 10% of working-age men remained uninsured. Compulsory health insurance coverage was lower amongst the poor, unemployed, unhealthy and people outside the main cities. The uninsured were less likely to seek medical help for new health problems. 3% of respondents had supplementary (private) insurance, and rising utilisation of private healthcare was greatest amongst the more educated and wealthy. Despite high population insurance coverage, a multiply disadvantaged uninsured minority remains, with low utilisation of health services. Universal insurance could therefore increase access, and potentially contribute to reducing avoidable healthcare-related mortality. Meanwhile, the socioeconomically advantaged are turning increasingly to a growing private sector.

  4. An analysis of trends and determinants of health insurance and healthcare utilisation in the Russian population between 2000 and 2004: the 'inverse care law' in action

    Directory of Open Access Journals (Sweden)

    Balabanova Dina

    2009-04-01

    Full Text Available Abstract Background The break-up of the USSR brought considerable disruption to health services in Russia. The uptake of compulsory health insurance rose rapidly after its introduction in 1993. However, by 2000 coverage was still incomplete, especially amongst the disadvantaged. By this time, however, the state health service had become more stable, and the private sector was growing. This paper describes subsequent trends and determinants of healthcare insurance coverage in Russia, and its relationship with health service utilisation, as well as the role of the private sector. Methods Data were from the Russia Longitudinal Monitoring Survey, an annual household panel survey (2000–4 from 38 centres across the Russian Federation. Annual trends in insurance coverage were measured (2000–4. Cross-sectional multivariate analyses of the determinants of health insurance and its relationship with health care utilisation were performed in working-age people (18–59 years using 2004 data. Results Between 2000 and 2004, coverage by the compulsory insurance scheme increased from 88% to 94% of adults; however 10% of working-age men remained uninsured. Compulsory health insurance coverage was lower amongst the poor, unemployed, unhealthy and people outside the main cities. The uninsured were less likely to seek medical help for new health problems. 3% of respondents had supplementary (private insurance, and rising utilisation of private healthcare was greatest amongst the more educated and wealthy. Conclusion Despite high population insurance coverage, a multiply disadvantaged uninsured minority remains, with low utilisation of health services. Universal insurance could therefore increase access, and potentially contribute to reducing avoidable healthcare-related mortality. Meanwhile, the socioeconomically advantaged are turning increasingly to a growing private sector.

  5. Determining utility values in patients with anterior cruciate ligament tears using clinical scoring systems

    Directory of Open Access Journals (Sweden)

    Szucs Thomas

    2011-08-01

    Full Text Available Abstract Background Several instruments and clinical scoring systems have been established to evaluate patients with ligamentous knee injuries. A comparison of individual articles in the literature is challenging, not only because of heterogeneity in methodology, but also due to the variety of the scoring systems used to document clinical outcomes. There is limited information about the correlation between used scores and quality of life with no information being available on the impact of each score on the utility values. The aim of this study was to compare the most commonly used scores for evaluating patients with anterior cruciate ligament (ACL injuries, and to establish corresponding utility values. These values will be used for the interpretation and comparison of outcome results in the currently available literature for different treatment options. Methods Four hypothetical vignettes were defined, based on different levels of activities after rupture of the ACL to simulate typical situations seen in daily practice. A questionnaire, including the Health Utility Index (HUI for utility values, the IKDC subjective score, the Lysholm and the Tegner score, was created and 25 orthopedic surgeons were asked to fill the questionnaire for each hypothetical patient as proxies for all patients they had treated and who would fit in that hypothetical vignette. Results The utility value as an indicator for quality of life increased with the level of activity. Having discomforts already during normal activities of daily living was rated with a mean utility value of 0.37 ± 0.19, half of that of a situation where mild sport activity was possible without discomfort (0.78 ± 0.11. All investigated scores were able to distinguish clearly (p Conclusions Here we report the correlation between the most commonly used scores for the assessment of patients with a ruptured ACL and utility values as an indicator of quality of life. Assumptions were based on expert

  6. Healthcare utilization and lost productivity due to infectious gastroenteritis, results from a national cross-sectional survey Australia 2008-2009.

    Science.gov (United States)

    Chen, Y; Ford, L; Hall, G; Dobbins, T; Kirk, M

    2016-01-01

    The aim of this study was to estimate the healthcare usage and loss of productivity due to gastroenteritis in Australia using the National Gastroenteritis Survey II. In 2008-2009, 7578 participants across Australia were surveyed about infectious gastroenteritis by telephone interview. A gastroenteritis case was defined as a person experiencing ⩾ 3 loose stools and/or ⩾ 2 vomits in a 24-h period, excluding cases with a non-infectious cause for their symptoms, such as pregnancy or consumption of alcohol. Lost productivity was considered any lost time from full- or part-time paid work due to having gastroenteritis or caring for someone with the illness. Interference with other daily activities was also examined along with predictors of healthcare-seeking practices using multivariable regression. Results were weighted to obtain nationally representative estimates using Stata v. 13·1. Of the 341 cases, 52 visited a doctor due to gastroenteritis, 126 reported taking at least one medication for their symptoms and 79 cases reported missing ⩾ 1 days' paid work due to gastroenteritis. Gastroenteritis results in a total of 13·1 million (95% confidence interval 6·7-19·5) days of missed paid work each year in Australia. The indirect costs of gastroenteritis are significant, particularly from lost productivity.

  7. Determination of natural radionuclide level in industrial waste slags and evaluation of comprehensive utilization

    International Nuclear Information System (INIS)

    Li Ruixiang; Liu Xinhua; Gan Lin

    1994-09-01

    Natural radionuclide contents were measured in various industrial waste slags in China by a low background HPGe γ spectrometer and the radiological impact was estimated for some comprehensive utilization of these slags. Most waste slags can be used for building materials except for tailing and waste rock form nuclear industry

  8. Criteria for determining the effectiveness of utility-initiated energy assistance

    Energy Technology Data Exchange (ETDEWEB)

    Costello, Ken

    2010-04-15

    The affordability of electricity and natural gas to all households requires some form of energy assistance, funded by utilities and their customers. Good regulation demands that EA initiatives have favorable benefit-cost ratios. Regulators should strive to assure that each dollar expended returns the highest possible dividend and that EA initiatives do not seriously impede other regulatory objectives. (author)

  9. [Analysis on status and determinants of outpatient service utilization of rural floating population in Beijing at different residence time].

    Science.gov (United States)

    2017-06-18

    To study the status and identify the determinants of outpatient service utilization of rural floating population in Beijing who have different accumulated residence time. The survey data of rural floating population health and health care services in Beijing in 2014 were used, and the migrant population aged 18 years and above were taken as the research object. Whether to use outpatient service within two weeks was taken as dependent variable, gender, age, education level, self-assessment score of socioeconomic status, accumulated residence time in Beijing, health insurance, average household income, suffering from high blood pressure or diabetes as independent variables. Logistic regression model was used to analyze the influencing factors. The average age of the research object was 36.7 years, with mostly secondary education. The average accumulated residence time in Beijing was 8.4 years. The two-week prevalence rate was 10.3%, the two-week visiting rate calculated by person-time was 6.0%. The Logistic regression model suggested that, socioeconomic status, accumulated residence time and suffering from high blood pressure or diabetes were statistically significant determinants of outpatient service utilization. The research object is a younger and less educated population, their health status is better and outpatient service utilization is lower. It is found that people who have longer accumulated residence time in Beijing have lower outpatient service utilization. This is because people with longer residence time have lower age-adjusted two-week prevalence rate. This is also because people with longer residence time have larger proportion of taking continuous measures under doctor's advice. It does not mean people with longer residence time have lower utilization of medical service. The residence time variable plays the role of proxy variable. It can solve the problem of variables' endoge-neity. At the same time, it can reflect the influence to outpatient

  10. 77 FR 46058 - Utility Scale Wind Towers From the Socialist Republic of Vietnam: Preliminary Determination of...

    Science.gov (United States)

    2012-08-02

    ... From the Socialist Republic of Vietnam: Preliminary Determination of Sales at Less Than Fair Value and..., or are likely to be, sold in the United States at less than fair value (``LTFV''), as provided in...., Notice of Final Determination of Sales at Less Than Fair Value and Affirmative Final Determination of...

  11. Initial nitrogen enrichment conditions determines variations in nitrogen substrate utilization by heterotrophic bacterial isolates.

    Science.gov (United States)

    Ghosh, Suchismita; Ayayee, Paul A; Valverde-Barrantes, Oscar J; Blackwood, Christopher B; Royer, Todd V; Leff, Laura G

    2017-04-04

    The nitrogen (N) cycle consists of complex microbe-mediated transformations driven by a variety of factors, including diversity and concentrations of N compounds. In this study, we examined taxonomic diversity and N substrate utilization by heterotrophic bacteria isolated from streams under complex and simple N-enrichment conditions. Diversity estimates differed among isolates from the enrichments, but no significant composition were detected. Substrate utilization and substrate range of bacterial assemblages differed within and among enrichments types, and not simply between simple and complex N-enrichments. N substrate use patterns differed between isolates from some complex and simple N-enrichments while others were unexpectedly similar. Taxonomic composition of isolates did not differ among enrichments and was unrelated to N use suggesting strong functional redundancy. Ultimately, our results imply that the available N pool influences physiology and selects for bacteria with various abilities that are unrelated to their taxonomic affiliation.

  12. Individual and Regional Determinants for Physical Therapy Utilization in Germany: Multilevel Analysis of National Survey Data.

    Science.gov (United States)

    Rommel, Alexander; Kroll, Lars Eric

    2017-05-01

    Physical therapy is included in many clinical guidelines and is a commonly used health service. However, access to its benefits should not strongly depend on social or demographic factors. The present study used the Andersen model to explain to what extent physical therapy utilization in Germany depends on factors beyond medical need. The German Health Interview and Examination Survey for Adults (DEGS, 2008-2011; target population, 18-79 years) is part of the German health-monitoring system. Two-stage stratified cluster sampling resulted in a sample of 8152 participants. Data were matched with district-related information on social structures and service supply. Following Andersen's Behavioral Model of Health Services Use, this study identified predisposing, enabling, and need factors for physical therapy utilization using multilevel logistic regression analyses. Physical therapy was used by 23.4% (95% CI: 22.0-24.8) of the German population within one year, with a higher proportion of females (26.8%; 95% CI: 25.1-28.6) than males (19.9%; 95% CI: 18.1-21.8) and an increase with age. Beyond medical need, physical therapy utilization depended on higher education, migrant background, nonsmoking (predisposing), social support, higher income, private health insurance, and gatekeeping service contact (enabling). Variation among districts partly reflected regional supply. Because the present study was cross-sectional, its findings provide representative information on physical therapy use but do not establish final causal links or identify whether utilization or supply in certain districts or population groups is adequate. Whether certain regions are under- or overserved and whether further regulations are needed is of political interest. Physicians and therapists should develop strategies to improve both adherence of hard-to-reach groups and supply in low-supply regions. © 2017 American Physical Therapy Association

  13. Migration and access to maternal healthcare: determinants of adequate antenatal care and institutional delivery among socio-economically disadvantaged migrants in Delhi, India.

    Science.gov (United States)

    Kusuma, Yadlapalli S; Kumari, Rita; Kaushal, Sonia

    2013-10-01

    To identify the determinants of adequate antenatal care (ANC) utilisation and institutional deliveries among socio-economically disadvantaged migrants living in Delhi, India. In a cross-sectional survey, 809 rural-urban migrant mothers with a child aged below 2 years were interviewed with a pretested questionnaire. Data on receiving antenatal, delivery and post-natal services, migration history and other social, demographic and income were collected. Recent migrants used the services significantly less than settled migrants. ANC was adequate only among 37% (35% of recent migrant women and 39% of settled migrants). Multinomial regression revealed that being a recent migrant, multiparous, illiterate and married to an unskilled worker were significant risk factors for receiving inadequate ANC. Around 53% of deliveries took place at home. ANC seeking has a strong influence on place of delivery: 70% of births to women who received inadequate ANC were at home. Women who are educated, had their first delivery after the age of 20 years and received adequate ANC were more likely to deliver their child in hospital. Post-natal care is grossly neglected among these groups. Migrant women, particularly recent migrants, are at the risk of not receiving adequate maternal healthcare. Because migration is a continuing phenomenon, measures to mitigate disadvantage due to migration need to be taken in the healthcare system. © 2013 John Wiley & Sons Ltd.

  14. Utilizing Home Healthcare Electronic Health Records for Telehomecare Patients With Heart Failure: A Decision Tree Approach to Detect Associations With Rehospitalizations.

    Science.gov (United States)

    Kang, Youjeong; McHugh, Matthew D; Chittams, Jesse; Bowles, Kathryn H

    2016-04-01

    Heart failure is a complex condition with a significant impact on patients' lives. A few studies have identified risk factors associated with rehospitalization among telehomecare patients with heart failure using logistic regression or survival analysis models. To date, there are no published studies that have used data mining techniques to detect associations with rehospitalizations among telehomecare patients with heart failure. This study is a secondary analysis of the home healthcare electronic medical record called the Outcome and Assessment Information Set-C for 552 telemonitored heart failure patients. Bivariate analyses using SAS and a decision tree technique using Waikato Environment for Knowledge Analysis were used. From the decision tree technique, the presence of skin issues was identified as the top predictor of rehospitalization that could be identified during the start of care assessment, followed by patient's living situation, patient's overall health status, severe pain experiences, frequency of activity-limiting pain, and total number of anticipated therapy visits combined. Examining risk factors for rehospitalization from the Outcome and Assessment Information Set-C database using a decision tree approach among a cohort of telehomecare patients provided a broad understanding of the characteristics of patients who are appropriate for the use of telehomecare or who need additional supports.

  15. A Method to Determine British Anti-Lewisite in Plasma Utilizing Gas Chromatography/Mass Spectrometry

    National Research Council Canada - National Science Library

    Byers, Christopher E; Holloway, Evan R; Korte, William D; Smith, John R; Capacio, Bebedict R

    2005-01-01

    British anti-Lewisite (BAL) (2,3-dimercapto-1-propanol) is a potential therapeutic compound against the effects of cutaneous sulfur mustard, and an method for its determination in plasma has been developed...

  16. Utilizing the Quantile Regression to Explore the Determinants on the Application of E-Learning

    OpenAIRE

    Quang Linh Huynh; Thuy Lan Le Thi

    2014-01-01

    In this research, the quantile regression is applied to investigate the affecting factors associated with the application of e-learning. The findings provide a comprehensive picture about the relationships between the application of e-learning and its determinants. It sheds light on these complicated relationships that, at the different quantiles of the conditional distribution of e-learning adopting levels, the influence of the determinants on the application of e-learning is different. More...

  17. Perceived determinants of cardiovascular risk management in primary care: disconnections between patient behaviours, practice organisation and healthcare system

    NARCIS (Netherlands)

    Huntink, E.; Wensing, M.; Klomp, M.A.; Lieshout, J. van

    2015-01-01

    BACKGROUND: Although conditions for high quality cardiovascular risk management in primary care in the Netherlands are favourable, there still remains a gap between practice guideline recommendations and practice. The aim of the current study was to identify determinants of cardiovascular primary

  18. Utilizing TOPSIS intensified with adjustment similarity factor to determine price of technology

    Directory of Open Access Journals (Sweden)

    Seyed Mohammad Seyedhosseini

    2012-08-01

    Full Text Available Technology transfer has been a very frequent activity in the industrial world nowadays. Technology valuation, and in particular technology pricing, has played a considerable role in these transactions, in spite of a huge amount of limitations in the pricing methodologies applied. Making a sound, traceable and reliable means for applying the price evaluation procedure, seems as a technological requirement to be traced for. The objective of delivering this paper is to introduce a new numerical technology pricing method to provide the two transacting parties a unique compromised price. A three-dimensional model for technology pricing is proposed and The TOPSPS algorithm has been utilized to select the most similar technologies to the intended one and the constructed scoring system is applied to calculate the final technology price accordingly.

  19. [Health care system utilization due to low back pain: sociodemographic, pain-related and psychosocial determinants].

    Science.gov (United States)

    Borys, Constanze; Wisch, Sabine; Heim, Dieter; Strauß, Bernhard

    2013-07-01

    The study's aim was to identify associations between socio-demographic, psychosocial and pain-related factors and health care utilization due to low back pain.In this cross-sectional Survey 372 hotel employees completed standardized questionnaires to examine pain characteristics, psychosocial (working) conditions and health care use in the previous 12 months. Data was analyzed using binary logistic regression. All together 79.8% of the subjects reported low back pain in the previous 12 months and slightly more then half of them were seeking care. Significant predictors for health care use were physical functioning, frequency of pain (periodic vs. permanent) and pain-related coping. Sufferer of low back pain without consultation had significant less pain-related functional disability and tended less to mal-adaptive Coping. Work satisfaction and endurance-strategies were not associated to health care use. © Georg Thieme Verlag KG Stuttgart · New York.

  20. Cobertura geográfica del sistema mexicano de salud y análisis espacial de la utilización de hospitales generales de la Secretaría de Salud en 1998 Geographical coverage of the Mexican Healthcare System and a spatial analysis of utilization of its General Hospitals in 1998

    Directory of Open Access Journals (Sweden)

    Juan E Hernández-Avila

    2002-11-01

    Full Text Available Objetivo. Determinar la cobertura geográfica del Sistema Mexicano de Salud y analizar la utilización en 1998 de los hospitales de la Secretaría de Salud (SSA. Material y métodos. Se desarrolló un Sistema de Información Geográfica (SIG con información sociodemográfica por localidad y ubicación espacial de unidades de atención de todo el sector salud, así como el registro de egresos por hospital de la SSA. Se determinó la utilización en 217 hospitales generales de la SSA mediante un modelo de estimación de máxima verosimilitud, que incluyó información sobre los recursos humanos, la infraestructura adicional y la población 25 km a la redonda. Resultados. En 1998, 10 806 localidades con 72 millones de habitantes contaban con al menos una unidad de atención de salud del sector público y 97.2% de la población se encontraba a menos de 50 km de una, pero más de 18 millones de personas vivían en localidades rurales sin unidades de atención. El promedio de ocupación fue de 48.5±28.5 por cada 100 camas/año, con gran variabilidad intra e interestatal. La utilización se asoció significativamente con el número de los médicos en la unidad, y en unidades del Instituto Mexicano del Seguro Social con la infraestructura adicional e índice de marginación. Conclusiones. La utilización del SIG eleva la capacidad analítica y proporciona estimadores más realistas de la cobertura y utilización de hospitales del sector.Objetive. To describe the geographical coverage of the Mexican Healthcare System (MHS services and to assess the utilization of its General Hospitals. Material and Methods. A Geographic Information System (GIS was used to include sociodemographic data by locality, the geographical location of all MHS healthcare services, and data on hospital discharge records. A maximum likelihood estimation model was developed to assess the utilization levels of 217 MHS General Hospitals. The model included data on human resources

  1. Disparities in Healthcare Access and Utilization among Children with Autism Spectrum Disorder from Immigrant Non-English Primary Language Households in the United States

    Directory of Open Access Journals (Sweden)

    Sue C. Lin, MS

    2015-09-01

    Full Text Available Background: The prevalence of autism spectrum disorder (ASD in United State (US has surged from 1 in 150 children in 2007 to 1 in 88 children in 2012 with substantial increase in immigrant minority groups including Hispanic and Somali children. Our study objective is to examine the associations between household language among children with ASD and national health quality indicators attainment. Methods: We conducted bivariate and multivariate logistic regression analyses using cross-sectional data from the publicly-available 2009-2010 National Survey of Children with Special Health Care Needs (NS-CSHCN to investigate the association between household language use and quality indicators of medical home, adequate insurance, and early and continuous screening. Results: Approximately, 28% of parents of children with ASD from non-English primary language (NEPL households reported their child having severe ASD as compared with 13% of parents from English primary language (EPL households. Older children were more likely to have care that met the early and continuous screening quality indicator, while lower income children and uninsured children were less likely to have met this indicator. Conclusions and Global Health Implications: Despite the lack of differences in the attainment of quality indicators by household language, the higher severity found in children in NEPL households suggests that they are exceptionally vulnerable. Enhanced early screening and identification for these children and supporting their parents in navigating the complex US health care delivery system would increase their participation in early intervention services. Immigration of children with special health care needs from around the world to the US has been increasing from countries with diverse healthcare systems. Our findings will help to inform policies and interventions to reduce health disparities for children with ASD from immigrant populations. As the prevalence of

  2. Determination of packaging induced 3D stress utilizing a piezocoefficient mapping device

    DEFF Research Database (Denmark)

    Richter, Jacob; Hyldgård, A.; Birkelund, Karen

    2007-01-01

    piezoresistor by contacts located near the perimeter of the resistor and do high impedance voltage measurements on contacts located near the centre of the resistor. By measuring the potential drops in these contacts we can determine the stress in the chip. The epoxy is potted in a polystyrene tube using...

  3. Gas Chromatographic Mass Spectrometric Determination of Myo-inositol in Humans Utilizing a Deuterated Internal Standard

    DEFF Research Database (Denmark)

    Andersen, Jan Rud; Larsen, Elfinn; Harbo, Helge

    1982-01-01

    The isotopic dilution technique was used for determining the content of myo-inositol in human urine, plasma and haemolysed erythrocyte samples. A deuterated myo-inositol, synthesized from inosose-2 by base-catalysed exchange of hydrogens by deuterium, followed by reduction of the inosose with 2H2...

  4. Health care utilization in the elderly Mexican population: Expenditures and determinants

    Directory of Open Access Journals (Sweden)

    García-Peña Carmen

    2011-03-01

    Full Text Available Abstract Background Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social or because of the increase that comes with older age (individual. Objective To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly. Methods A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT, 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age. Results Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization. Conclusions The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age

  5. Health care utilization in the elderly Mexican population: expenditures and determinants.

    Science.gov (United States)

    González-González, César; Sánchez-García, Sergio; Juárez-Cedillo, Teresa; Rosas-Carrasco, Oscar; Gutiérrez-Robledo, Luis M; García-Peña, Carmen

    2011-03-29

    Worldwide population aging has been considered one of the most important demographic phenomena, and is frequently referred as a determinant of health costs and expenditures. These costs are an effect either of the aging process itself (social) or because of the increase that comes with older age (individual). To analyze health expenditures and its determinants in a sample of Mexican population, for three dimensions acute morbidity, ambulatory care and hospitalization focusing on different age groups, particularly the elderly. A secondary analysis of the Mexican National Health and Nutrition Survey (ENSANUT), 2006 was conducted. A descriptive analysis was performed to establish a health profile by socio-demographic characteristics. Logistic regression models were estimated to determine the relation between acute morbidity, ambulatory care, hospitalization and age group; to establish the determinants of hospitalization among the population 60 years and older; and to determine hospitalization expenditures by age. Higher proportion of elderly reporting health problems was found. Average expenditures of hospitalization in households were $240.6 am dlls, whereas in households exclusively with elderly the expenditure was $308.9 am dlls, the highest among the considered age groups. The multivariate analysis showed higher probability of being hospitalized among the elderly, but not for risks for acute morbidity and ambulatory care. Among the elderly, older age, being male or living in a city or in a metro area implied a higher probability of hospitalization during the last year, with chronic diseases playing a key role in hospitalization. The conditions associated with age, such as chronic diseases, have higher weight than age itself; therefore, they are responsible for the higher expenditures reported. Conclusions point towards a differentiated use and intensity of health services depending on age. The projected increase in hospitalization and health care needs for this

  6. Determination of Aspartame and Caffeine in Carbonated Beverages Utilizing Electrospray Ionization-Mass Spectrometry

    Science.gov (United States)

    Bergen, H. Robert, III; Benson, Linda M.; Naylor, Stephen

    2000-10-01

    Mass spectrometry has undergone considerable changes in the past decade. The advent of "soft ionization" techniques such as electrospray ionization (ESI) affords the direct analysis of very polar molecules without need for the complex inefficient derivatization procedures often required in GC-MS. These ionization techniques make possible the direct mass spectral analysis of polar nonvolatile molecules such as DNA and proteins, which previously were difficult or impossible to analyze by MS. Compounds that readily take on a charge (acids and bases) lend themselves to ESI-MS analysis, whereas compounds that do not readily accept a charge (e.g. sugars) are often not seen or are seen only as inefficient adducts (e.g., M+Na+). To gain exposure to this state-of-the-art analytical procedure, high school students utilize ESI-MS in an analysis of aspartame and caffeine. They dilute a beverage sample and inject the diluted sample into the ESI-MS. The lab is procedurally simple and the results clearly demonstrate the potential and limitations of ESI-coupled mass spectrometry. Depending upon the instructional goals, the outlined procedures can be used to quantify the content of caffeine and aspartame in beverages or to understand the capabilities of electrospray ionization.

  7. Determinants of patterns of maternal and child health service utilization in a rural community in south eastern Nigeria

    Directory of Open Access Journals (Sweden)

    C. C. Agunwa

    2017-11-01

    Full Text Available Abstract Background Women and children constitute a large proportion of any population. They are the most vulnerable to morbidity and mortality especially in developing countries. In many situations the problem of poor maternal and child health stems from the poor use of available services even when they are not of optimum quality. This study seeks to describe the patterns of utilization of Maternal and Child health (MCH services in a rural area of Enugu State, and identify factors that are associated with and responsible for determining them. Methods The study used a cross sectional analytic design. Pretested semi structured questionnaires were administered by interviewers to 602 women from a rural community in Enugu state, South east Nigeria. Two focus group discussions (FGDs involving 8–10 men/ women each were conducted to identify factors affecting service utilization. Chi square analysis was done to identify factors associated with Maternal and Child Health services utilization. Logistic regression was used to identify determinants of utilization patterns. N vivo software was used to analyze findings of the FGDs. Results The study revealed that increasing age, educational level, monthly income, number of children and occupation of both women and their husbands were associated with increased MCH service utilization. Average monthly income (OR: 1.317, p = 0.048, CI: 0.073–0.986 and number of children (OR: 1.196, p < 0.01,CI: 1.563–7.000 were determinants of increased use of child care services while educational level (OR: 0.495, p < 0.001, CI: 1.244–2.164 and age (OR: 0.115, p < 0.001, CI: 0.838–0.948 determined better use of delivery and family planning services respectively. Conclusions Improved use of MCH services is related to socio economic challenges women face such as illiteracy and low income. Furthermore, the way health facilities and their staff are perceived by rural women affect how they use some of these

  8. Utility of telomere length measurements for age determination of humpback whales

    Directory of Open Access Journals (Sweden)

    Morten Tange Olsen

    2014-12-01

    Full Text Available This study examines the applicability of telomere length measurements by quantitative PCR as a tool for minimally invasive age determination of free-ranging cetaceans. We analysed telomere length in skin samples from 28 North Atlantic humpback whales (Megaptera novaeangliae, ranging from 0 to 26 years of age. The results suggested a significant correlation between telomere length and age in humpback whales. However, telomere length was highly variable among individuals of similar age, suggesting that telomere length measured by quantitative PCR is an imprecise determinant of age in humpback whales. The observed variation in individual telomere length was found to be a function of both experimental and biological variability, with the latter perhaps reflecting patterns of inheritance, resource allocation trade-offs, and stochasticity of the marine environment.

  9. Determinants of adherence to seasonal influenza vaccination among healthcare workers from an Italian region: results from a cross-sectional study.

    Science.gov (United States)

    Durando, P; Alicino, C; Dini, G; Barberis, I; Bagnasco, A M; Iudici, R; Zanini, M; Martini, M; Toletone, A; Paganino, C; Massa, E; Orsi, A; Sasso, L

    2016-05-17

    Notwithstanding decades of efforts to increase the uptake of seasonal influenza (flu) vaccination among European healthcare workers (HCWs), the immunisation rates are still unsatisfactory. In order to understand the reasons for the low adherence to flu vaccination, a study was carried out among HCWs of two healthcare organisations in Liguria, a region in northwest Italy. A cross-sectional study based on anonymous self-administered web questionnaires was carried out between October 2013 and February 2014. Through univariate and multivariate regression analysis, the study investigated the association between demographic and professional characteristics, knowledge, beliefs and attitudes of the study participants and (i) the seasonal flu vaccination uptake in the 2013/2014 season and (ii) the self-reported number of flu vaccination uptakes in the six consecutive seasons from 2008/2009 to 2013/2014. A total of 830 HCWs completed the survey. Factors statistically associated with flu vaccination uptake in the 2013/2014 season were: being a medical doctor and agreeing with the statements 'flu vaccine is safe', 'HCWs have a higher risk of getting flu' and 'HCWs should receive flu vaccination every year'. A barrier to vaccination was the belief that pharmaceutical companies influence decisions about vaccination strategies. All the above-mentioned factors, except the last one, were (significantly) associated with the number of flu vaccination uptakes self-reported by the respondents between season 2008/2009 and season 2013/2014. Other significantly associated factors appeared to be level of education, being affected by at least one chronic disease, and agreeing with mandatory flu vaccination in healthcare settings. This survey allows us to better understand the determinants of adherence to vaccination as a fundamental preventive strategy against flu among Italian HCWs. These findings should be used to improve and customise any future promotion campaigns to overcome identified

  10. Utilization of epithermal neutrons for the determination of molybdenum in the presence of uranium

    International Nuclear Information System (INIS)

    Oliveira Melo, M.A.M. de.

    1984-05-01

    Activation analysis by means of selective activation with epithermal neutrons is proposed for the determination of molybdenum in samples when uranium is present. Instrumental activation analysis with epithermal neutrons is advantageous for the determination of elements with large resonance integral, as compared to its thermal neutron activation cross section. The main reason for using this method is the serious interference caused by 99 Mo produced by fission of 235 U. This effect is strongly reduced by using the epicadmium irradiation technique. The filter efficiency has been investigated by irradiation experiments with bare and cadmium-covered samples. A solvent extraction process for uranium, before irradiation, is proposed to reduce sample background. The determination of Mo in leach samples is proposed in order to support the analytical needs of Figueira and Pocos de Caldas Mineral Prospection Programme of Departamento de Tecnologia Mineral from CDTN/NUCLEBRAS (MG,Brazil). The introduction of activation analysis with epithermal neutrons as a routine analytical tool in CDTN is our main goal. This method represents one more opportunity for exploring the analytical facilities available at TRIGA MARK I IPR-R1 nuclear reactor. (Author) [pt

  11. Utilization of tritiated water dilution technique in determination of nitrogen partitioning in cashmere goats

    International Nuclear Information System (INIS)

    Wang Linfeng; Yang Gaiqing; Liu Ping; Zhang Shijun

    2010-01-01

    In order to investigate nitrogen partitioning in local cashmere goats, six Inner Mogolia White Cashmere goats between 2 to 2.5 years old were used to determine the nitrogen partitioning in cashmere goats. The total retained nitrogen (TN) in body, distribution of body nitrgen and hair nitrogen were measured by general digestive and metabolism method combined with tritiated water dilution technique. Results showed that the combined methods were ideal for determining body nitrgen (BN) and hair nitrogen (fur nitrogen, FN) of Cashmere goats. There were obvious significance between BN and FN in different seasons. In telogen, BN and FN partitioning was 75.7% ± 0.62% and 24.3% ± 0.62%, respectively. Whereas, it changed to 66.6% ± 2.2% and 33.4% ± 2.2% in anagen. BN partitioning decreased when the season changed from telogen to anagen, while FN partitioning increased, which indicated that more nitrogen substance was partitioned to body growth in telogen, and more nitrogen substance was distribute to cashmere growth in anagen. These transformation were related to the changing of photoperiod and some hormones, such as melatonin (MT), prolactin (PRL) and IGF-I. It could be concluded that tritiated water dilution technique can be used to detect body protein content as well as BN, combining general digestive and metabolism experiment, FN partitoning can be determined. BN and FN partitoning varied with the season in cashmere goats because of hormones changing. (authors)

  12. Utilization of Integrated Assessment Modeling for determining geologic CO2 storage security

    Science.gov (United States)

    Pawar, R.

    2017-12-01

    Geologic storage of carbon dioxide (CO2) has been extensively studied as a potential technology to mitigate atmospheric concentration of CO2. Multiple international research & development efforts, large-scale demonstration and commercial projects are helping advance the technology. One of the critical areas of active investigation is prediction of long-term CO2 storage security and risks. A quantitative methodology for predicting a storage site's long-term performance is critical for making key decisions necessary for successful deployment of commercial scale projects where projects will require quantitative assessments of potential long-term liabilities. These predictions are challenging given that they require simulating CO2 and in-situ fluid movements as well as interactions through the primary storage reservoir, potential leakage pathways (such as wellbores, faults, etc.) and shallow resources such as groundwater aquifers. They need to take into account the inherent variability and uncertainties at geologic sites. This talk will provide an overview of an approach based on integrated assessment modeling (IAM) to predict long-term performance of a geologic storage site including, storage reservoir, potential leakage pathways and shallow groundwater aquifers. The approach utilizes reduced order models (ROMs) to capture the complex physical/chemical interactions resulting due to CO2 movement and interactions but are computationally extremely efficient. Applicability of the approach will be demonstrated through examples that are focused on key storage security questions such as what is the probability of leakage of CO2 from a storage reservoir? how does storage security vary for different geologic environments and operational conditions? how site parameter variability and uncertainties affect storage security, etc.

  13. [The living will declaration - expression of self-determination in health-care - and its legal validity for physicians].

    Science.gov (United States)

    Leisner, W G

    2010-11-01

    Since September 1st 2009, the Living Will Declaration is regulated by law as held in §§ 1901 a - c BGB. It does not need a certain format except for being in the written form. This must be distinguished from the right to choose a certain treatment according to the medical attendant and his intention to agree to or forbid a certain treatment. The Living Will Declaration binds the physician to certain clearly specified procedures that the patient has agreed to and is valid independently from the nature of the patient's illness or its stage because the basic right for self-determination (Art. 2 Abs. 2 GG) includes the right to die. As the physician is committed to observe the patient's will, he will have to face legal consequences in terms of liability and criminal law if he disregards the Living Will Declaration.

  14. Registry data for cross-country comparisons of migrants' healthcare utilization in the EU: a survey study of availability and content

    DEFF Research Database (Denmark)

    Nielsen, Signe Smith; Krasnik, Allan; Rosano, Aldo

    2009-01-01

    national health authorities in the 27 EU countries in 2008-9 as part of the Migrant and Ethnic Minority Health Observatory-project (MEHO). The information received was compared with information from a general survey on availability of survey and registry data on migrants conducted by Agency of Public...... countries: Austria, Belgium, Denmark, Finland, Greece, Italy, Luxembourg, the Netherlands, Poland, Slovenia, and Sweden. Data on hospital care, including surgical procedures, were most frequently available whereas only few countries had data on care outside the hospital. Regarding identification of migrants...... utilization, and the diversity in the definition of migrant status hampers cross-national comparisons and calls for an urgent establishment of registries, expansion of the existing registry information, and adoption of a common, generally acceptable definition and identification method of migrants across...

  15. Sick at work: prevalence and determinants among healthcare workers, western Ethiopia: an institution based cross-sectional study.

    Science.gov (United States)

    Mekonnen, Tesfaye Hambisa; Tefera, Mekuriaw Alemayewu; Melsew, Yayehirad Alemu

    2018-01-01

    Going to work despite feeling sick also known as sickness presenteeism is one of the emerging global occupational health challenges. Sickness presenteeism negatively affects both health of work forces and productivity of organizations in general. However, there is insufficient research exploring this situation in majority of the Sub-Saharan African countries, including Ethiopia. Thus this study intended to investigate the prevalence and determinant factors of sickness presenteeism among health care workers, Western Ethiopia. This study used an institution based cross-sectional quantitative study design. The study period was from February to March, 2017. We employed simple random sampling method to select 360 study samples. Data collection was performed by pre-tested structured and self- administered questionnaire. We used SPSS version 20 to carry out binary logistic regression analysis. Odds ratio with 95% confidence intervals was calculated and significance of associations was determined at p -value Educational status [AOR:2.1, 95%CI: (1.17,3.90)], financial problem [AOR:1.9,95%CI:(1.07,3.46)], sickness absenteeism [AOR:2.7,95% CI:(1.50,5.02)], lack of staff replacement [AOR:2.7,95%CI:(1.50,5.02)], absence of occupational health services [AOR:3.0,95%CI:(1.34,6.70)], and pressure from supervisor [AOR:1.8,95% CI:(1.01,3.31)] were significant predictors of the dependent variable. Relatively higher proportions of workers indicated sickness presenteeism as compared to other studies. Risk factors like educational status, personal financial problem, sickness absenteeism, lack of staff replacement, absence of occupational health services, and pressure from supervisors considerably increased the likely occurrence of employees' sick attendance. It is advisable for health care managers to hire adequate health care staffs, to implement basic occupational health services and to design strategies which reduce pressure from supervisors.

  16. Effect on healthcare utilization and costs of spinal manual therapy for acute low back pain in routine care: A propensity score matched cohort study.

    Directory of Open Access Journals (Sweden)

    Jochen Walker

    Full Text Available Spinal manual therapy (SMT is a popular treatment option for low back pain (LBP. The aim of our analysis was to evaluate the effects of manual therapy delivered by general practitioners and ambulatory orthopedic surgeons in routine care on follow up consultations, sick leave, health service utilization and costs for acute LBP compared to matched patients not receiving manual therapy. This is a propensity score matched cohort study based on health claims data. We identified a total of 113.652 adult patients with acute LBP and no coded red flags of whom 21.021 (18% received SMT by physicians. In the final analysis 17.965 patients in each group could be matched. Balance on patients' coded characteristics, comorbidity and prior health service utilization was achieved. The provision of SMT for acute LBP had no relevant impact on follow up visits and days of sick leave for LBP in the index billing period and the following year. SMT was associated with a higher proportion of imaging studies for LBP (30.6% vs. 23%, SMD: 0.164 [95% CI 0.143-0.185]. SMT did not lead to meaningful savings by replacing other health services for LBP. SMT for acute non-specific LBP in routine care was not clinically meaningful effective to reduce sick leave and reconsultation rates compared to no SMT and did not lead to meaningful savings by replacing other health services from the perspective of health insurance. This does not imply that SMT is ineffective but might reflect a problem with selection of suitable patients and the quality and quantity of SMT in routine care. National Manual Medicine societies should state clearly that imaging is not routinely needed prior to SMT in patients with low suspicion of presence of red flags and monitor the quality of provided services.

  17. Healthcare Lean.

    Science.gov (United States)

    Long, John C

    2003-01-01

    Lean Thinking is an integrated approach to designing, doing and improving the work of people that have come together to produce and deliver goods, services and information. Healthcare Lean is based on the Toyota production system and applies concepts and techniques of Lean Thinking to hospitals and physician practices.

  18. 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

  19. Utilization of shear stress for determination of activation energy of the defects created by neutron irradiation

    International Nuclear Information System (INIS)

    Gonzalez, Hector C.; Miralles, Monica

    1996-01-01

    This paper describes an experimental technique used for the determination thermodynamical parameters such as activation energy using the thermal annealing of increments of Critical resolved Shear Stress of the defects created by neutron irradiation at 77 K. The doses chosen for this work was 3.1 x 10 16 n/cm 2 since the defects are stable to plastic deformation and the cascades of atomic displacements do not overlap. Specimens without any prior deformation were used allowing then the single addition of the initial stress to that due to the created defects. (author)

  20. Real-world healthcare utilization in asthma patients using albuterol sulfate inhalation aerosol (ProAir® HFA with and without integrated dose counters

    Directory of Open Access Journals (Sweden)

    Kerwin EM

    2017-05-01

    Full Text Available Edward M Kerwin,1 Thomas J Ferro,2 Rinat Ariely,3 Debra E Irwin,4 Ruchir Parikh3 1Clinical Trials Division, Clinical Research Institute of Southern Oregon, PC, Medford, OR, 2Global Medical Affairs, 3Global Health Economics and Outcome Research, Teva Pharmaceuticals, Frazer, PA, 4Outcomes Research, Truven Health Analytics, Durham, NC, USA Background: Accurate tracking of the administered dose of asthma rescue inhalers is critical for optimal disease management and is related to reductions in rates of unscheduled health care utilization in asthma patients. There are few published data on the real-world impact of rescue inhalers with integrated dose counters (IDCs on health care resource utilization (HRU for asthma patients. This study evaluates HRU among users of ProAir® hydrofluoroalkane (HFA (albuterol sulfate inhalation aerosol, with IDC versus without IDC, in asthma patients.Methods: This was a retrospective administrative claims study of asthma patients receiving a new prescription for albuterol inhalation aerosol without IDC during 2 years (January 2011–December 2012 or with IDC during the first full year after IDC implementation in the USA (July 2013–July 2014. Six months of continuous enrollment with medical and prescription drug benefits were required before and after the first prescription during the study period. Data on respiratory-related hospitalizations and emergency department (ED visits were collected during the follow-up period.Results: A total of 135,305 (32% patients used albuterol inhalation aerosol with IDC, and 287,243 (68% patients received albuterol inhalation aerosol without IDC. After adjusting for baseline confounding factors, the odds ratio (OR for experiencing a respiratory-related hospitalization (OR=0.92; 95% confidence interval [CI] 0.88–0.96 or ED visit (OR=0.92; 95% CI 0.90–0.94 was significantly lower among patients using albuterol inhalation aerosol with IDC versus without IDC.Conclusion: In a real

  1. Socio-medical determinants of hospital utilization in Quebec, Canada, 1970-1975.

    Science.gov (United States)

    Wan, T T; Broida, J

    1986-01-01

    The relationship between ambulatory physician use and hospitalization was studied using aggregate data in the Province of Quebec, Canada. The analysis showed that the introduction of health insurance covering physician services had a negligible influence on hospitalization. The average length of short-term hospital stays was determined by the proportion of aged population, the proportion of English speaking persons, and the prior level of hospitalization in the medical market areas. Overall, hospital discharge rates remained very constant during the period of six years (1970-1975). There were, however, reductions in hospitalization for infectious diseases, diseases of the blood and blood-forming organs, respiratory diseases, and diseases of the skin and subcutaneous tissue, and increases in the hospitalization rates for neoplasms, circulatory system disorders, musculoskeletal conditions, congenital anomalies, and perinatal morbidity and mortality.

  2. A checklist for identifying determinants of practice: A systematic review and synthesis of frameworks and taxonomies of factors that prevent or enable improvements in healthcare professional practice

    Science.gov (United States)

    2013-01-01

    Background Determinants of practice are factors that might prevent or enable improvements. Several checklists, frameworks, taxonomies, and classifications of determinants of healthcare professional practice have been published. In this paper, we describe the development of a comprehensive, integrated checklist of determinants of practice (the TICD checklist). Methods We performed a systematic review of frameworks of determinants of practice followed by a consensus process. We searched electronic databases and screened the reference lists of key background documents. Two authors independently assessed titles and abstracts, and potentially relevant full text articles. We compiled a list of attributes that a checklist should have: comprehensiveness, relevance, applicability, simplicity, logic, clarity, usability, suitability, and usefulness. We assessed included articles using these criteria and collected information about the theory, model, or logic underlying how the factors (determinants) were selected, described, and grouped, the strengths and weaknesses of the checklist, and the determinants and the domains in each checklist. We drafted a preliminary checklist based on an aggregated list of determinants from the included checklists, and finalized the checklist by a consensus process among implementation researchers. Results We screened 5,778 titles and abstracts and retrieved 87 potentially relevant papers in full text. Several of these papers had references to papers that we also retrieved in full text. We also checked potentially relevant papers we had on file that were not retrieved by the searches. We included 12 checklists. None of these were completely comprehensive when compared to the aggregated list of determinants and domains. We developed a checklist with 57 potential determinants of practice grouped in seven domains: guideline factors, individual health professional factors, patient factors, professional interactions, incentives and resources

  3. Utilization of surface Plasmon resonance band of silver nanoparticles for determination of critical micelle concentration of cationic surfactants

    Science.gov (United States)

    Salem, Jamil K.; El-Nahhal, Issa M.; Najri, Bassam A.; Hammad, Talaat M.

    2016-11-01

    We have utilized surface Plasmon resonance (SPR) band sensitivity to surfactant concentration to investigate the critical micelle concentration (cmc) of CTAB, HY and CPB. The process is based upon an in situ formation of silver nanoparticles (AgNPs) through the reduction of silver ions (Ag+) by diethylene triamine (DETA) at 25 °C. In the presence of cationic surfactants, Ag+ ions can be reduced to AgNPs in a few minutes, accompanied by changes in intensity and wavelength of the SPR band. The spectral shifts of SPR band and the change of color have been used to determine CMC values of cationic surfactants.

  4. Determinants of Survival in Low Birth Weight Infants at a Tertiary Healthcare Facility in the South Eastern Nigeria

    Directory of Open Access Journals (Sweden)

    Ekwochi U

    2017-06-01

    Full Text Available Low birth weight (LBW babies account for a large number of neonatal deaths globally, with over 90% of these occurring in developing countries with low resources. Identifying factors that determine survival in these sub-groups of babies in such a low-resource setting will help clinicians prioritize care and improve outcomes. This study aims to bridge some knowledge gaps in this regard. This was a 45-month prospective study carried out at the Enugu State University Teaching Hospital (ESUTH, Enugu, Nigeria. All eligible newborns weighing between 500g and and lt;2500g that were seen in this period were enrolled and monitored. Data collected were analysed with SPSS Version 24, and significant associations identified using logistic regression models. A total of 166 LBW neonates were enrolled, and 68.2% of them survived. Asphyxia and episodes recurrent apnoea were recorded at least once in 78.8% and 68.4% of the babies respectively, with about two-thirds requiring respiratory support at one time or the other. Survival in these LBW newborns was negatively associated with gestational age at birth of less than 32 weeks (OR 0.17; CI 0.03-0.50; P and lt;0.01 as well as with episodes of recurrent apnoea (OR 0.07; CI 0.02-0.34; P and lt;0.01. However, intra-uterine exposure to malaria was associated with a 15 times higher likelihood of survival (OR 15.41; CI 2.22-106.91; P=0.01. No significant associations was found between survival and attendances to antenatal care, mode of delivery, birth weight and a number of neonatal morbidities like necrotizing enterocolitis, hypothermia, hypoglycaemia, septicaemia, anaemia and neonatal jaundice. Survival rate among low birth weight neonates in a low resource setting is decreased with delivery at less than 32 weeks completed gestation as well as recurrent episodes of apnoea, but is increased with in-utero exposure to malaria.

  5. Utilization of oxidation reactions for the spectrophotometric determination of captopril using brominating agents

    Science.gov (United States)

    El-Didamony, Akram M.; Erfan, Eman A. H.

    2010-03-01

    Three simple, accurate and sensitive methods (A-C) for the spectrophotometric assay of captopril (CPL) in bulk drug, in dosage forms and in the presence of its oxidative degradates have been described. The methods are based on the bromination of captopril with a solution of excess brominating mixture in hydrochloric acid medium. After bromination, the excess brominating mixture is followed by the estimation of surplus bromine by three different reaction schemes. In the first method (A), the determination of the residual bromine is based on its ability to bleach the indigo carmine dye and measuring the absorbance at 610 nm. Method B, involves treating the unreacted bromine with a measured excess of iron(II) and the remaining iron(II) is complexed with 1,10-phenanthroline and the increase in absorbance is measured at 510 nm. In method (C), the surplus bromine is treated with excess of iron(II) and the resulting iron(III) is complexed with thiocyanate and the absorbance is measured at 478 nm. In all the methods, the amount of bromine reacted corresponds to the drug content. The different experimental parameters affecting the development and stability of the color are carefully studied and optimized. Beer's law is valid within a concentration range of 0.4-6.0, 0.4-2.8 and 1.2-4.8 μg mL -1 for methods A, B and C, respectively. The calculated apparent molar absorptivity was found to be 5.16 × 10 4, 9.95 × 10 4 and 1.74 × 10 5 L mol -1 cm -1, for methods A, B and C, respectively. Sandell's sensitivity, correlation coefficients, detection and quantification limits are also reported. No interference was observed from common additives found in pharmaceutical preparations. The proposed methods are successfully applied to the determination of CPL in the tablet formulations with mean recoveries of 99.94-100.11% and the results were statistically compared with those of a reference method by applying Student's t- and F-test.

  6. Determinants of antenatal and delivery care utilization in Tigray region, Ethiopia: a cross-sectional study.

    Science.gov (United States)

    Tsegay, Yalem; Gebrehiwot, Tesfay; Goicolea, Isabel; Edin, Kerstin; Lemma, Hailemariam; Sebastian, Miguel San

    2013-05-14

    Despite the international emphasis in the last few years on the need to address the unmet health needs of pregnant women and children, progress in reducing maternal mortality has been slow. This is particularly worrying in sub-Saharan Africa where over 162,000 women still die each year during pregnancy and childbirth, most of them because of the lack of access to skilled delivery attendance and emergency care. With a maternal mortality ratio of 673 per 100,000 live births and 19,000 maternal deaths annually, Ethiopia is a major contributor to the worldwide death toll of mothers. While some studies have looked at different risk factors for antenatal care (ANC) and delivery service utilisation in the country, information coming from community-based studies related to the Health Extension Programme (HEP) in rural areas is limited. This study aims to determine the prevalence of maternal health care utilisation and explore its determinants among rural women aged 15-49 years in Tigray, Ethiopia. The study was a community-based cross-sectional survey using a structured questionnaire. A cluster sampling technique was used to select women who had given birth at least once in the five years prior to the survey period. Univariable and multivariable logistic regression analyses were carried out to elicit the impact of each factor on ANC and institutional delivery service utilisation. The response rate was 99% (n=1113). The mean age of the participants was 30.4 years. The proportion of women who received ANC for their recent births was 54%; only 46 (4.1%) of women gave birth at a health facility. Factors associated with ANC utilisation were marital status, education, proximity of health facility to the village, and husband's occupation, while use of institutional delivery was mainly associated with parity, education, having received ANC advice, a history of difficult/prolonged labour, and husbands' occupation. A relatively acceptable utilisation of ANC services but extremely

  7. Determinants of Ownership and Utilization of Insecticide-Treated Bed Nets for Malaria Control in Eastern Ethiopia

    Directory of Open Access Journals (Sweden)

    Sibhatu Biadgilign

    2012-01-01

    Full Text Available Background. Malaria remains a major cause of mortality and morbidity in the world, and particularly in sub-Saharan Africa. Objectives. The aim of this study was to determine ownership and utilization of ITNs among households with children under five in the previous night. Methods. A community based cross-sectional study was conducted in Gursum district in Eastern Ethiopia. A total of 335 households were surveyed using a pretested structured questionnaire administered though house-to-house interviews. Results. Household ownership for at least one mosquito net and use of nets were 62.4% (95% CI 57.2–67.6% and 21.5% (95% CI 17.1–25.9%, respectively. Households who received or were told about ITN in the last 6 months were three times more likely to have used it than those who were not (OR 3.25; 95% CI 1.5–7.10. Households whose heads were engaged as a farmer (adjusted OR 0.137; 95% CI: 0.04–0.50 and housewife (OR 0.26; 95% CI: 0.08–0.82 were less likely to use ITN than those of other occupations. Conclusion. The findings indicate low ITN ownership and utilization among the households. Intensive health education and community mobilization effort should be employed to increase the possession and proper utilization of insecticide treated bed nets.

  8. Public Health Services Utilization and Its Determinants among Internal Migrants in China: Evidence from a Nationally Representative Survey.

    Science.gov (United States)

    Zhang, Jingya; Lin, Senlin; Liang, Di; Qian, Yi; Zhang, Donglan; Hou, Zhiyuan

    2017-09-01

    There have been obstacles for internal migrants in China in accessing local public health services for some time. This study aimed to estimate the utilization of local public health services and its determinants among internal migrants. Data were from the 2014 and 2015 nationally representative cross-sectional survey of internal migrants in China. Multivariate logistic regressions were used to estimate the relationship between socioeconomic, migration, and demographic characteristics and public health services utilization. Our results showed that internal migrants in more developed eastern regions used less public health services. Those with higher socioeconomic status were more likely to use public health services. The years of living in the city of residence were positively associated with the utilization of public health services. Compared to migration within the city, migration across provinces significantly reduced the probability of using health records (OR = 0.88, 95% CI: 0.86-0.90), health education (OR = 0.97, 95% CI: 0.94-1.00), and health education on non-communicable diseases (OR = 0.92, 95% CI: 0.89-0.95) or through the Internet (OR = 0.96, 95% CI: 0.94-0.99). This study concludes that public health services coverage for internal migrants has seen great improvement due to government subsidies. Internal migrants with lower socioeconomic status and across provinces need to be targeted. More attention should be given to the local government in the developed eastern regions in order to narrow the regional gaps.

  9. Isolation, identification and growth determination of lactic acid-utilizing yeasts from the ruminal fluid of dairy cattle.

    Science.gov (United States)

    Sirisan, V; Pattarajinda, V; Vichitphan, K; Leesing, R

    2013-08-01

    Ruminal organic acid production, especially lactic acid, can be modified by feeding cattle highly concentrated diets, which have been shown to adversely affect dairy cattle health. Therefore, the use of lactic acid-utilizing organisms is considered to be a potential method for controlling lactic acid levels. This study was conducted to isolate and identify lactic acid-utilizing yeasts from the ruminal fluid of dairy cattle and to determine the specific growth rate and generation time when using lactic acid as a carbon source instead of glucose. Seventeen yeast isolates were examined in this study. Yeasts isolated from dairy cattle that were fed a high cassava pulp diet (HCP) had higher specific growth rates and shorter generation times than yeasts isolated from dairy cattle that were fed a high-concentrate diet (HC) and a mixed diet (M). The three most effective yeasts in terms of specific growth rate and generation time were Pichia kudriavzevii, Candida rugosa and Kodamaea ohmeri, with 99, 100 and 99% nucleotide identities, respectively. These three isolates could be used as potential probiotics in dairy cattle diets. This study demonstrates that yeasts isolated from the ruminal fluid of dairy cattle can utilize lactic acid as a carbon and energy source for growth. The isolated yeasts can be used as probiotic supplements for dairy cattle that are fed highly concentrated diets to reduce ruminal lactic acid production. © 2013 The Society for Applied Microbiology.

  10. Lessons from the surgical experience with simulators: incorporation into training and utilization in determining competency.

    Science.gov (United States)

    Fried, Gerald M

    2006-07-01

    Simulation technology in laparoscopic surgery has developed in response to a need to teach fundamental surgical skills in a safe environment. The skill set needed was defined carefully according to the classic educational model of needs assessment. Once defined, the skills were modeled in a simulator. The recognition that a simulator need not have high fidelity to achieve significant educational value was important in keeping costs reasonably low. Intrinsic to an effective simulation program is a set of metrics or measurements of performance. These metrics provide motivation for the student and allow comparison among students. Once shown to be reliable and valid, the simulator metrics can be used to set reasonable goals and standards for certification. Although simulators permit verification of learning, point simulation testing cannot by itself be used at present to ensure competence. Until the predictive value of these tests has been validated further, competence still needs to be determined by expert assessment of observed performance in real cases and by measurable outcome variables from real procedures. Simulation training is most beneficial when incorporated into a curriculum that teaches the accompanying knowledge and judgment essential for safe practice of the skills taught in the simulator. The FLS program distributed by the Society of American Gastrointestinal and Endoscopic Surgeons and the American College of Surgeons is an example of a carefully planned and validated program that incorporates these principles in laparoscopic surgery education. The lessons learned from development of the FLS program can be useful in designing a similar program for flexible gastrointestinal endoscopy.

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

    Directory of Open Access Journals (Sweden)

    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.

  12. Determinants of National Guard Mental Health Service Utilization in VA versus Non-VA Settings.

    Science.gov (United States)

    Gorman, Lisa A; Sripada, Rebecca K; Ganoczy, Dara; Walters, Heather M; Bohnert, Kipling M; Dalack, Gregory W; Valenstein, Marcia

    2016-10-01

    To determine associations between need, enabling, and predisposing factors with mental health service use among National Guard soldiers in the first year following a combat deployment to Iraq or Afghanistan. Primary data were collected between 2011 and 2013 from 1,426 Guard soldiers representing 36 units. Associations between Guard soldier factors and any mental health service use were assessed using multivariable logistic regression models in a cross-sectional study. Further analysis among service users (N = 405) assessed VA treatment versus treatment in other settings. Fifty-six percent of Guard soldiers meeting cutoffs on symptom scales received mental health services with 81 percent of those reporting care from the VA. Mental health service use was associated with need (mental health screens and physical health) and residing in micropolitan communities. Among service users, predisposing factors (middle age range and female gender) and enabling factors (employment, income above $50,000, and private insurance) were associated with greater non-VA services use. Overall service use was strongly associated with need, whereas sector of use (non-VA vs. VA) was insignificantly associated with need but strongly associated with enabling factors. These findings have implications for the recent extension of veteran health coverage to non-VA providers. © Health Research and Educational Trust.

  13. Societal cost of subcutaneous and intravenous trastuzumab for HER2-positive breast cancer - An observational study prospectively recording resource utilization in a Swedish healthcare setting.

    Science.gov (United States)

    Olofsson, Sara; Norrlid, Hanna; Karlsson, Eva; Wilking, Ulla; Ragnarson Tennvall, Gunnel

    2016-10-01

    Trastuzumab is part of the standard treatment for HER2-positive breast cancer. The aim of this study was to estimate the societal value of trastuzumab administered through subcutaneous (SC) injection compared to intravenous (IV) infusion. Female patients with HER2-positive breast cancer receiving SC or IV trastuzumab were consecutively enrolled from five Swedish oncology clinics from 2013 to 2015. Data on time and resource utilization was collected prospectively using patient and nurse questionnaires. Societal costs were calculated by multiplying the resource use by its corresponding unit price, including direct medical costs (pharmaceuticals, materials, nurse time, etc.), direct non-medical costs (transportation) and indirect costs (production loss, lost leisure time). Costs were reported separately for patients receiving trastuzumab for the first time and non-first time ("subsequent treatment"). In total, 101 IV and 94 SC patients were included in the study. The societal costs were lower with SC administration. For subsequent treatments the cost difference was €117 (IV €2099; SC €1983), partly explained by a higher time consumption both for nurses (14 min) and patients (23 min) with IV administration. Four IV and 16 SC patients received trastuzumab for the first time and were analysed separately, resulting in a difference in societal costs of €897 per treatment. A majority of patients preferred SC to IV administration. SC administration resulted in both less direct medical costs and indirect costs, and was consequently less costly than IV administration from a societal perspective in a Swedish setting. Copyright © 2016 Elsevier Ltd. All rights reserved.

  14. Experimental Determination of in Situ Utilization of Lunar Regolith for Thermal Energy Storage

    Science.gov (United States)

    Richter, Scott W.

    1993-01-01

    A Lunar Thermal Energy from Regolith (LUTHER) experiment has been designed and fabricated at the NASA Lewis Research Center to determine the feasibility of using lunar soil as thermal energy storage media. The experimental apparatus includes an alumina ceramic canister (25.4 cm diameter by 45.7 cm length) which contains simulated lunar regolith, a heater (either radiative or conductive), 9 heat shields, a heat transfer cold jacket, and 19 type B platinum rhodium thermocouples. The simulated lunar regolith is a basalt, mined and processed by the University of Minnesota, that closely resembles the lunar basalt returned to earth by the Apollo missions. The experiment will test the effects of vacuum, particle size, and density on the thermophysical properties of the regolith. The properties include melt temperature (range), specific heat, thermal conductivity, and latent heat of storage. Two separate tests, using two different heaters, will be performed to study the effect of heating the system using radiative and conductive heat transfer. The physical characteristics of the melt pattern, material compatibility of the molten regolith, and the volatile gas emission will be investigated by heating a portion of the lunar regolith to its melting temperature (1435 K) in a 10(exp -4) pascal vacuum chamber, equipped with a gas spectrum analyzer. A finite differencing SINDA model was developed at NASA Lewis Research Center to predict the performance of the LUTHER experiment. The analytical results of the code will be compared with the experimental data generated by the LUTHER experiment. The code will predict the effects of vacuum, particle size, and density has on the heat transfer to the simulated regolith.

  15. Utilizing dimensional analysis with observed data to determine the significance of hydrodynamic solutions in coastal hydrology

    Science.gov (United States)

    Swain, Eric D.; Decker, Jeremy D.; Hughes, Joseph D.

    2014-01-01

    In this paper, the authors present an analysis of the magnitude of the temporal and spatial acceleration (inertial) terms in the surface-water flow equations and determine the conditions under which these inertial terms have sufficient magnitude to be required in the computations. Data from two South Florida field sites are examined and the relative magnitudes of temporal acceleration, spatial acceleration, and the gravity and friction terms are compared. Parameters are derived by using dimensionless numbers and applied to quantify the significance of the hydrodynamic effects. The time series of the ratio of the inertial and gravity terms from field sites are presented and compared with both a simplified indicator parameter and a more complex parameter called the Hydrodynamic Significance Number (HSN). Two test-case models were developed by using the SWIFT2D hydrodynamic simulator to examine flow behavior with and without the inertial terms and compute the HSN. The first model represented one of the previously-mentioned field sites during gate operations of a structure-managed coastal canal. The second model was a synthetic test case illustrating the drainage of water down a sloped surface from an initial stage while under constant flow. The analyses indicate that the times of substantial hydrodynamic effects are sporadic but significant. The simplified indicator parameter correlates much better with the hydrodynamic effect magnitude for a constant width channel such as Miami Canal than at the non-uniform North River. Higher HSN values indicate flow situations where the inertial terms are large and need to be taken into account.

  16. Determining The Factors Causing Human Error Deficiencies At A Public Utility Company

    Directory of Open Access Journals (Sweden)

    F. W. Badenhorst

    2004-11-01

    Full Text Available According to Neff (1977, as cited by Bergh (1995, the westernised culture considers work important for industrial mental health. Most individuals experience work positively, which creates a positive attitude. Should this positive attitude be inhibited, workers could lose concentration and become bored, potentially resulting in some form of human error. The aim of this research was to determine the factors responsible for human error events, which lead to power supply failures at Eskom power stations. Proposals were made for the reduction of these contributing factors towards improving plant performance. The target population was 700 panel operators in Eskom’s Power Generation Group. The results showed that factors leading to human error can be reduced or even eliminated. Opsomming Neff (1977 soos aangehaal deur Bergh (1995, skryf dat in die westerse kultuur werk belangrik vir bedryfsgeestesgesondheid is. Die meeste persone ervaar werk as positief, wat ’n positiewe gesindheid kweek. Indien hierdie positiewe gesindheid geïnhibeer word, kan dit lei tot ’n gebrek aan konsentrasie by die werkers. Werkers kan verveeld raak en dit kan weer lei tot menslike foute. Die doel van hierdie navorsing is om die faktore vas te stel wat tot menslike foute lei, en wat bydra tot onderbrekings in kragvoorsiening by Eskom kragstasies. Voorstelle is gemaak vir die vermindering van hierdie bydraende faktore ten einde die kragaanleg se prestasie te verbeter. Die teiken-populasie was 700 paneel-operateurs in die Kragopwekkingsgroep by Eskom. Die resultate dui daarop dat die faktore wat aanleiding gee tot menslike foute wel verminder, of geëlimineer kan word.

  17. Determinants of utilization and expenditures for episodes of ambulatory physical therapy among adults.

    Science.gov (United States)

    Machlin, Steven R; Chevan, Julia; Yu, William W; Zodet, Marc W

    2011-07-01

    Comprehensive information on determinants and patterns of use and spending for ambulatory physical therapy services is needed to inform health planning and policy decisions. Most research in the literature on this topic is limited to specific payers, age groups, and conditions. The purpose of this study was to examine factors associated with the resource intensity of physical therapy episodes for adults in the United States as measured by number of visits and expenses per visit. This study was a secondary analysis of longitudinal survey data from the Medical Expenditure Panel Survey (MEPS) panels 9, 10, and 11. An analytic file was created based on data from the longitudinal data files for 3 MEPS panels and the annual office-based and hospital outpatient event files. A total of 1,377 episodes of physical therapy care were identified. Variation in both the total number of visits per episode and expenses per visit was examined by fitting regression models to evaluate the effects of selected independent variables classified into 4 categories: episode-level variables, demographic characteristics, geographic variables, and health status indicators. Average total expenses per episode (in 2007 dollars) were $1,184 (median=$651), with an average number of visits per episode of 9.6 (median=6.0) and average expenses per visit of $130 (median=$95). Significant variation by geographic characteristics, sex, and one comorbid condition (high blood pressure) was found in the number of visits model. In the expenditures model, expenses per visit were associated with age/insurance coverage, setting (hospital outpatient versus office based), primary condition category, and mental health status. Limitations Limitations include limited sample sizes of physical therapy users and lack of detailed clinical information. Variability in the resource intensity of physical therapy episodes is influenced to some degree by nonclinical variables.

  18. Determination of Dancoff correction thermal utilization and thermal disadvantage factors of HEU and LEU cores of an MNSR

    International Nuclear Information System (INIS)

    Ofori, Y. T.

    2013-07-01

    Ghana Research Reactor-1 (GHARR-1), an MNSR (Miniature Neutron Source Reactor) is to be converted from HEU (Highly Enriched Uranium) to LEU (Low Enriched Uranium) fuel, along with all current MNSRs in various other countries. The purpose of the conversion is to minimize the use of HEU for non-proliferation of high-grade nuclear fuel. In this research work, a comparative study has been performed for the determination of the Dancoff, thermal utilization and thermal disadvantage factors of highly enriched uranium (HEU) and potential low enriched uranium (LEU) cores of GHARR-1. A one group transport theory and collision probability based methodologies was used to develop mathematical formulations for thermal utilization factor and thermal disadvantage factor assuming isotropic scattering. This methodology was implemented in a FORTRAN 95 based computer program THERMCALC, which uses Bessell and BesselK as subroutines developed to calculate the modified Bessel functions I n and K n respectively using the polynomial approximation method. Furthermore, a Dancoff correction factor of 0.1519 thermal utilization factor of 0.9767 and a thermal disadvantage factor of 1.894 were obtained for the 90.2% highly enriched Uranium core of GHARR-1. The results compare favorably with literature. Thus THERMCALC can be used as a reliable tool for the calculation of Dancoff, thermal utilization and disadvantage factors of MNSR cores. Other potential LEU cores; UO 2 (with different fuel meat densities and enrichments) and U 3 Si 2 have also been analysed. UO 2 with 12.6% of Uranium-235 was chosen as the most potential LEU core for the GHARR-1. (au)

  19. Utilizing worldview theory to determine the factors influencing the understanding of evolutionary concepts

    Science.gov (United States)

    Hermann, Ronald S.

    2007-12-01

    The purpose of this study was to identify factors impacting students' ability to develop understanding of evolutionary theory. A novel approach to worldview theory was employed according to which individuals are seen as having one worldview that is comprised of many perspectives. One's worldview is comprised of numerous worldview assumptions, some of which coalesce to form worldview perspectives. Some assumptions are consistent with a scientific perspective while others are more consistent with a religious perspective. Scientific and religious perspectives were quantified based on participants' agreement with assumptions associated with each perspective. Participants completed a 103-item questionnaire addressing several variables: understanding of evolution, understanding of photosynthesis (non-confounding variable), strength of worldview perspectives and exposure to factors influencing the development of worldview perspectives. Increased exposure to factors influencing the development of a strong scientific worldview perspective was hypothesized to cause an increased understanding of evolution. The dependent variable understanding was measured by scores on two Likert-type measures. A causal-comparative study was conducted with 13 high school biology teachers and 67 high school biology students. To determine causation t-tests compared the mean scores on the variables measured. Extreme-group methods were used and data was analyzed for statistical differences between mean scores. Strong scientific worldview perspectives (t=1.003, p=3.19) and exposure to scientific factors (t=2.373, p=.02) were associated with a higher understanding of evolution. Strong religious worldview perspectives (t=-1.991, p=.05) and exposure to religious factors (t=-1.059, p=.31) were associated with a lower understanding of evolution. The results suggest that scientific worldview perspectives play an important role in increasing understanding of evolution; however, religious worldview

  20. Influenza vaccination coverage of healthcare workers and residents and their determinants in nursing homes for elderly people in France: a cross-sectional survey

    Directory of Open Access Journals (Sweden)

    Guthmann Jean-Paul

    2010-03-01

    Full Text Available Abstract Background Nursing home residents bear a substantial burden of influenza morbidity and mortality. Vaccination of residents and healthcare workers (HCWs is the main strategy for prevention. Despite recommendations, influenza vaccination coverage among HCWs remains generally low. Methods During the 2007-2008 influenza season, we conducted a nationwide survey to estimate influenza vaccination coverage of HCWs and residents in nursing homes for elderly people in France and to identify determinants of vaccination rates. Multivariate analysis were performed with a negative binomial regression. Results Influenza vaccination coverage rates were 33.6% (95% CI: 31.9-35.4 for HCWs and 91% (95% CI: 90-92 for residents. Influenza vaccination uptake of HCWs varied by occupational category. Higher vaccination coverage was found in private elderly care residences, when free vaccination was offered (RR: 1.89, 1.35-2.64, in small nursing homes (RR: 1.54, 1.31-1.81 and when training sessions and staff meetings on influenza were organized (RR: 1.20, 1.11-1.29. The analysis by occupational category showed that some determinants were shared by all categories of professionals (type of nursing homes, organization of training and staff meetings on influenza. Higher influenza vaccination coverage was found when free vaccination was offered to recreational, cleaning, administrative staff, nurses and nurse assistants, but not for physicians. Conclusions This nationwide study assessed for the first time the rate of influenza vaccination among residents and HCWs in nursing homes for elderly in France. Better communication on the current recommendations regarding influenza vaccination is needed to increase compliance of HCWs. Vaccination programmes should include free vaccination and education campaigns targeting in priority nurses and nurse assistants.

  1. The Hazards of Data Mining in Healthcare.

    Science.gov (United States)

    Househ, Mowafa; Aldosari, Bakheet

    2017-01-01

    From the mid-1990s, data mining methods have been used to explore and find patterns and relationships in healthcare data. During the 1990s and early 2000's, data mining was a topic of great interest to healthcare researchers, as data mining showed some promise in the use of its predictive techniques to help model the healthcare system and improve the delivery of healthcare services. However, it was soon discovered that mining healthcare data had many challenges relating to the veracity of healthcare data and limitations around predictive modelling leading to failures of data mining projects. As the Big Data movement has gained momentum over the past few years, there has been a reemergence of interest in the use of data mining techniques and methods to analyze healthcare generated Big Data. Much has been written on the positive impacts of data mining on healthcare practice relating to issues of best practice, fraud detection, chronic disease management, and general healthcare decision making. Little has been written about the limitations and challenges of data mining use in healthcare. In this review paper, we explore some of the limitations and challenges in the use of data mining techniques in healthcare. Our results show that the limitations of data mining in healthcare include reliability of medical data, data sharing between healthcare organizations, inappropriate modelling leading to inaccurate predictions. We conclude that there are many pitfalls in the use of data mining in healthcare and more work is needed to show evidence of its utility in facilitating healthcare decision-making for healthcare providers, managers, and policy makers and more evidence is needed on data mining's overall impact on healthcare services and patient care.

  2. The time to trade-off method versus the EQ-5D index to determine health utility in patients with rheumatoid arthritis

    Directory of Open Access Journals (Sweden)

    Dmitriy Vladimirovich Goryachev

    2010-01-01

    The values of the utility index calculated by TTO failed to correlate with those of HAQ and EQ-5D. The disease duration was unrelated to the values of the utility index calculated by any of the methods used. The association of TTO index was found only for VAS-GH "thermometer". Conclusion. EQ-5D index and VAS-GH are the methods of choice in determining health utility for a clinicoeconomic analysis in patients with RA.

  3. Determinants of adherence to seasonal influenza vaccination among healthcare workers from an Italian region: results from a cross-sectional study

    OpenAIRE

    Durando, P; Alicino, C; Dini, G; Barberis, I; Bagnasco, A M; Iudici, R; Zanini, M; Martini, M; Toletone, A; Paganino, C; Massa, E; Orsi, A; Sasso, L

    2016-01-01

    Objectives Notwithstanding decades of efforts to increase the uptake of seasonal influenza (flu) vaccination among European healthcare workers (HCWs), the immunisation rates are still unsatisfactory. In order to understand the reasons for the low adherence to flu vaccination, a study was carried out among HCWs of two healthcare organisations in Liguria, a region in northwest Italy. Methods A cross-sectional study based on anonymous self-administered web questionnaires was carried out between ...

  4. Estimation of Viable Biomass In Wastewater And Activated Sludge By Determination of ATP, Oxygen Utilization Rate And FDA Hydrolysis

    DEFF Research Database (Denmark)

    Jørgensen, Poul-Erik; Eriksen, T.; Jensen, B.K.

    1992-01-01

    ATP content, oxygen utilization rate (OUR) and fluorescein diacetate (FDA) hydrolysis were tested for the ability to express the amount of viable biomass in wastewater and activated sludge. The relationship between biomass and these activity parameters was established in growth cultures made...... with biomass, while FDA hydrolysis in the sludge failed to show any such correlation. Conversion factors of 3 mg ATP/g dw, 300 mg O2/h g dw and 0.4 A/h (mg dw/ml) for ATP, OUR and FDA methods, respectively, were calculated. When the methods were applied for in situ determinations in four different wastewater...... plants, it was found that ATP content and respiration rate estimated viable biomass to range from 81 to 293 mg dw/g SS for raw wastewater and from 67 to 187 mg dw/g SS for activated sludge with a rather weak correlation between ATP and respiration measurements. The FDA hydrolysis estimated viable biomass...

  5. Healthcare compunetics.

    Science.gov (United States)

    Marsh, Andy; Laxminarayan, Swamy; Bos, Lodewijk

    2004-01-01

    Changes in life expectancy, healthy life expectancy and health seeking behaviour are having an impact on the demand for care. Such changes could occur across the whole population, or for specific groups. Changes for specific groups will be particularly affected by policy initiatives, while both these and wider changes will be affected by people's levels of engagement with their health and the health service itself. Levels of education, income and media coverage of health issues are also important. These factors could also encourage an increase in people caring for themselves and their families or community. People are now expecting a patient-centred service with safe high quality treatment, comfortable accommodation services, fast access and an integrated joined-up system. The uptake of integrated Information and Communication technologies (ICT) will be crucial. Healthcare Compunetics, the combination of computing and networking customised for medical and care, will provide the common policy and framework for combined multi-disciplinary research, development, implementation and usage.

  6. Determination and analysis of neutron flux distribution on radial Piercing beam port for utilization of Kartini research reactor

    International Nuclear Information System (INIS)

    Widarto

    2002-01-01

    Determination and analysis of neutron flux measurements on radial piercing beam port have been done as completion experimental data document and progressing on utilization of the Kartini research reactor purposes. The analysis and determination of the neutron flux have been carried out by using Au foils detector neutron activation analysis method which put on the radius of cross section (19 cm) and a long of radial piercing beam port (310 cm) Based on the calculation, distribution of the thermal neutron flux is around (8.3 ± 0.9) x 10 5 ncm -2 s -1 to (6.8 ± 0.5) x 10 7 ncm -2 s -1 and fast neutron is (5.0 ± 0.2) x 10 5 ncm -2 s -1 to (1.43 ± 0.6) x 10 7 ncm -2 s -1 . Analyzing by means of curve fitting method could be concluded that the neutron flux distribution on radial piercing beam port has profiled as a polynomial curve. (author)

  7. Development of an polarization sensitive Fourier domain optical coherence tomography and it utilization on the Mueller matrix determination

    International Nuclear Information System (INIS)

    Raele, Marcus Paulo

    2009-01-01

    This study approached theoretical and experimental aspects related with the development of a polarization sensitive, Fourier domain, optical coherence tomography system (PS-FD-OCT) and its utilization on the Mueller Matrix determination. This work began with a bibliographic revision, which describes since the early studies to the actual state of the art of the technique. The mathematical formalism of Fourier domain low coherence interferometry and light polarization was performed as well. Studies based on numerical simulations, of three different algorithm types, responsible to recover the scattering profile, were done. The implemented algorithms were: Direct Fourier Transform, Interpolation and zero-filling. By the end of the simulation study, was possible to conclude that the algorithm zero-filling 2N presented better characteristics when compared with the others. In the experimental part, firstly different OCT setups were assembled and measurements were done in order to verify aspects related with the theory. Then, using a polymeric sample, birefringence images were performed, which allowed determining the sample birefringence quantitatively. Finally, images taken of different polarization states were collected, and through then images related with the Mueller Matrix elements were calculated, which were analyzed individually. (author)

  8. The utility of comparative models and the local model quality for protein crystal structure determination by Molecular Replacement

    Directory of Open Access Journals (Sweden)

    Pawlowski Marcin

    2012-11-01

    Full Text Available Abstract Background Computational models of protein structures were proved to be useful as search models in Molecular Replacement (MR, a common method to solve the phase problem faced by macromolecular crystallography. The success of MR depends on the accuracy of a search model. Unfortunately, this parameter remains unknown until the final structure of the target protein is determined. During the last few years, several Model Quality Assessment Programs (MQAPs that predict the local accuracy of theoretical models have been developed. In this article, we analyze whether the application of MQAPs improves the utility of theoretical models in MR. Results For our dataset of 615 search models, the real local accuracy of a model increases the MR success ratio by 101% compared to corresponding polyalanine templates. On the contrary, when local model quality is not utilized in MR, the computational models solved only 4.5% more MR searches than polyalanine templates. For the same dataset of the 615 models, a workflow combining MR with predicted local accuracy of a model found 45% more correct solution than polyalanine templates. To predict such accuracy MetaMQAPclust, a “clustering MQAP” was used. Conclusions Using comparative models only marginally increases the MR success ratio in comparison to polyalanine structures of templates. However, the situation changes dramatically once comparative models are used together with their predicted local accuracy. A new functionality was added to the GeneSilico Fold Prediction Metaserver in order to build models that are more useful for MR searches. Additionally, we have developed a simple method, AmIgoMR (Am I good for MR?, to predict if an MR search with a template-based model for a given template is likely to find the correct solution.

  9. Social marketing in healthcare.

    Science.gov (United States)

    Aras, Radha

    2011-01-01

    Social marketing is an important tool in the delivery of healthcare services. For any healthcare programme or project to be successful, community/consumer participation is required. The four principles of social marketing can guide policymakers and healthcare providers to successfully plan and implement health programmes. To review the existing literature in order to project the benefits of social marketing in healthcare. A search of periodical literature by the author involving social marketing and marketing concepts in health was carried out. Items were identified initially through health-oriented indexing services such as Medline, Health STAR and Cinahl, using the identifiers "social marketing" and "marketing in health". An extensive search was also carried out on educational database ERIC. A literature review of various studies on social marketing indicated that the selection of the right product (according to the community need) at the right place, with the right strategy for promotion and at the right price yields good results. However, along with technical sustainability (product, price, promotion and place), financial sustainability, institutional sustainability and market sustainability are conducive factors for the success of social marketing. The purpose of this literature review was to ascertain the likely effectiveness of social marketing principles and approaches and behaviour change communication towards health promotion. It is important for all healthcare workers to understand and respond to the public's desires and needs and routinely use consumer research to determine how best to help the public to solve problems and realise aspirations. Social marketing can optimise public health by facilitating relationship-building with consumers and making their lives healthier.

  10. Electronic healthcare information security

    CERN Document Server

    Dube, Kudakwashe; Shoniregun, Charles A

    2010-01-01

    The ever-increasing healthcare expenditure and pressing demand for improved quality and efficiency of patient care services are driving innovation in healthcare information management. The domain of healthcare has become a challenging testing ground for information security due to the complex nature of healthcare information and individual privacy. ""Electronic Healthcare Information Security"" explores the challenges of e-healthcare information and security policy technologies. It evaluates the effectiveness of security and privacy implementation systems for anonymization methods and techniqu

  11. A Study on Real-Time Scheduling for Holonic Manufacturing Systems - Determination of Utility Values Based on Multi-agent Reinforcement Learning

    Science.gov (United States)

    Iwamura, Koji; Mayumi, Norihisa; Tanimizu, Yoshitaka; Sugimura, Nobuhiro

    This paper deals with a real-time scheduling method for holonic manufacturing systems (HMS). In the previous paper, a real-time scheduling method based on utility values has been proposed and applied to the HMS. In the proposed method, all the job holons and the resource holons firstly evaluate the utility values for the cases where the holon selects the individual candidate holons for the next machining operations. The coordination holon secondly determine a suitable combination of the resource holons and the job holons which carry out the next machining operations, based on the utility values. Multi-agent reinforcement learning is newly proposed and implemented to the job holons and the resource holons, in order to improve their capabilities for evaluating the utility values of the candidate holons. The individual job holons and resource holons evaluate the suitable utility values according to the status of the HMS, by applying the proposed learning method.

  12. Measures and procedures utilized to determine the added value of microprocessor-controlled prosthetic knee joints: a systematic review.

    Science.gov (United States)

    Theeven, Patrick J R; Hemmen, Bea; Brink, Peter R G; Smeets, Rob J E M; Seelen, Henk A M

    2013-11-27

    The effectiveness of microprocessor-controlled prosthetic knee joints (MPKs) has been assessed using a variety of outcome measures in a variety of health and health-related domains. However, if the patient is to receive a prosthetic knee joint that enables him to function optimally in daily life, it is vital that the clinician has adequate information about the effects of that particular component on all aspects of persons' functioning. Especially information concerning activities and participation is of high importance, as this component of functioning closely describes the person's ability to function with the prosthesis in daily life. The present study aimed to review the outcome measures that have been utilized to assess the effects of microprocessor-controlled prosthetic knee joints (MPK), in comparison with mechanically controlled prosthetic knee joints, and aimed to classify these measures according to the components and categories of functioning defined by the International Classification of Functioning, Disability and Health (ICF). Subsequently, the gaps in the scientific evidence regarding the effectiveness of MPKs were determined. A systematic literature search in 6 databases (i.e. PubMed, CINAHL, Cochrane Library, Embase, Medline and PsychInfo) identified scientific studies that compared the effects of using MPKs with mechanically controlled prosthetic knee joints on persons' functioning. The outcome measures that have been utilized in those studies were extracted and categorized according to the ICF framework. Also, a descriptive analysis regarding all studies has been performed. A total of 37 studies and 72 outcome measures have been identified. The majority (67%) of the outcome measures that described the effects of using an MPK on persons' actual performance with the prosthesis covered the ICF body functions component. Only 31% of the measures on persons' actual performance investigated how an MPK may affect performance in daily life. Research also

  13. Towards the introduction of pneumococcal conjugate vaccines in Bhutan: A cost-utility analysis to determine the optimal policy option.

    Science.gov (United States)

    Dorji, Kinley; Phuntsho, Sonam; Pempa; Kumluang, Suthasinee; Khuntha, Sarayuth; Kulpeng, Wantanee; Rajbhandari, Sneha; Teerawattananon, Yot

    2018-03-20

    Due to competing health priorities and limited resources, many low-income countries, even those with a high disease burden, are not able to introduce pneumococcal conjugate vaccines. To determine the cost-utility of 10- and 13-valent pneumococcal conjugate vaccines (PCV10 and PCV13) compared to no vaccination in Bhutan. A model-based cost-utility analysis was performed in the Bhutanese context using a government perspective. A Markov simulation model with one-year cycle length was used to estimate the costs and outcomes of three options: PCV10, PCV13 and no PCV programmes for a lifetime horizon. A discount rate of 3% per annum was applied. Results are presented using an incremental cost-effectiveness ratio (ICER) in United State Dollar per quality-adjusted life year (QALY) gained (USD 1 = Ngultrum 65). A one-way sensitivity analysis and a probabilistic sensitivity analysis were conducted to assess uncertainty. Compared to no vaccination, PCV10 and PCV13 gained 0.0006 and 0.0007 QALYs with additional lifetime costs of USD 0.02 and USD 0.03 per person, respectively. PCV10 and PCV13 generated ICERs of USD 36 and USD 40 per QALY gained compared to no vaccination. In addition, PCV13 produced an ICER of USD 92 compared with PCV10. When including PCV into the Expanded Programme on Immunization, the total 5-year budgetary requirement is anticipated to increase to USD. 3.77 million for PCV10 and USD 3.75 million for PCV13. Moreover, the full-time equivalent (FTE) of one health assistant would increase by 2.0 per year while the FTE of other health workers can be reduced each year, particularly of specialist (0.6-1.1 FTE) and nurse (1-1.6 FTE). At the suggested threshold of 1xGDP per capita equivalent to USD 2708, both PCVs are cost-effective in Bhutan and we recommend that they be included in the routine immunization programme. Copyright © 2018 The Authors. Published by Elsevier Ltd.. All rights reserved.

  14. Licensed Healthcare Facilities

    Data.gov (United States)

    California Department of Resources — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  15. Licensed Healthcare Facilities

    Data.gov (United States)

    California Natural Resource Agency — The Licensed Healthcare Facilities point layer represents the locations of all healthcare facilities licensed by the State of California, Department of Health...

  16. Emergency Department Utilization and Determinants of Use by 0- to 6-Year-Old Children with Disabilities in Taipei

    Science.gov (United States)

    Hsu, Shang-Wei; Lin, Ya-Wen; Chwo, Miao-Ju; Huang, Hui-Chi; Yen, Chia-Feng; Lin, Lan-Ping; Wu, Jia-Ling; Lin, Jin-Ding

    2009-01-01

    Although many studies have explored emergency services for children, there are few published reports of the utilization of emergency services by children with disabilities. The present study attempts to provide data regarding the utilization of, and factors affecting, emergency department visits by disabled children in Taipei. A general census of…

  17. Utilization of information technology in eastern North Carolina physician practices: determining the existence of a digital divide.

    Science.gov (United States)

    Rosenthal, David A; Layman, Elizabeth J

    2008-02-13

    The United States Department of Health and Human Services (DHHS) has emphasized the importance of utilizing health information technologies, thus making the availability of electronic resources critical for physicians across the country. However, few empirical assessments exist regarding the current status of computerization and utilization of electronic resources in physician offices and physicians' perceptions of the advantages and disadvantages of computerization. Through a survey of physicians' utilization and perceptions of health information technology, this study found that a "digital divide" existed for eastern North Carolina physicians in smaller physician practices. The physicians in smaller practices were less likely to utilize or be interested in utilizing electronic health records, word processing applications, and the Internet.

  18. Nigerian Mental Healthcare Workers' Perception of Integration of ...

    African Journals Online (AJOL)

    Aims: The study aims to determine the perception of mental healthcare workers about the relevance of complementary and alternative mental healthcare (CAM) and their opinion on integrating CAM into the mainstream mental healthcare. Methods: One hundred and three mental healthcare workers at the Federal ...

  19. Determinants of modern contraceptive utilization among married women of reproductive age group in North Shoa Zone, Amhara Region, Ethiopia.

    Science.gov (United States)

    Mohammed, Abdurahman; Woldeyohannes, Desalegn; Feleke, Amsalu; Megabiaw, Berihun

    2014-02-03

    Ethiopia is the second most populous country in Africa with high fertility and fast population growth rate. It is also one of the countries with high maternal and child mortality rate in sub-Saharan Africa Family planning is a crucial strategy to halt the fast population growth, to reduce child mortality and improve maternal health (Millennium Development Goal 4 and 5). Therefore, this study aimed to assess the prevalence and determinants of modern contraceptive utilization among married women of reproductive age group. A community based cross-sectional study was conducted from August 15 to September 1, 2010 among married women aged 15-49 years in Debre Birhan District. Multistage sampling technique was used to select a total of 851 study participants. A pre-tested structured questionnaire was used for gathering data. Bivariate and multivariate logistic regression analyses were performed using SPSS version 16.0 statistical package. Modern contraceptive prevalence rate among currently married women was 46.9%. Injectable contraceptives were the most frequently used methods (62.9%), followed by intrauterine device (16.8%), pills (14%), norplant (4.3%), male condom (1.2%) and female sterilization (0.8%). Multiple logistic regression model revealed that the need for more children (AOR 9.27, 95% CI 5.43-15.84), husband approve (AOR 2.82, 95% CI 1.67-4.80), couple's discussion about family planning issues (AOR 7.32, 95% CI 3.60-14.86). Similarly, monthly family income and number of living children were significantly associated with the use of modern contraceptives. Modern contraceptive use was high in the district. Couple's discussion and husband approval of contraceptives use were significantly associated with the use of modern contraceptives. Therefore, district health office and concerned stakeholders should focus on couples to encourage communication and male involvement for family planning.

  20. Big Data Analytics in Healthcare.

    Science.gov (United States)

    Belle, Ashwin; Thiagarajan, Raghuram; Soroushmehr, S M Reza; Navidi, Fatemeh; Beard, Daniel A; Najarian, Kayvan

    2015-01-01

    The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined.

  1. Big Data Analytics in Healthcare

    Science.gov (United States)

    Belle, Ashwin; Thiagarajan, Raghuram; Soroushmehr, S. M. Reza; Beard, Daniel A.

    2015-01-01

    The rapidly expanding field of big data analytics has started to play a pivotal role in the evolution of healthcare practices and research. It has provided tools to accumulate, manage, analyze, and assimilate large volumes of disparate, structured, and unstructured data produced by current healthcare systems. Big data analytics has been recently applied towards aiding the process of care delivery and disease exploration. However, the adoption rate and research development in this space is still hindered by some fundamental problems inherent within the big data paradigm. In this paper, we discuss some of these major challenges with a focus on three upcoming and promising areas of medical research: image, signal, and genomics based analytics. Recent research which targets utilization of large volumes of medical data while combining multimodal data from disparate sources is discussed. Potential areas of research within this field which have the ability to provide meaningful impact on healthcare delivery are also examined. PMID:26229957

  2. Applying lean principles in healthcare.

    Science.gov (United States)

    Rinehart, Brenda

    2013-01-01

    Healthcare is charged to do more with less and improve patient satisfaction at the same time in order to balance the bottom line. Lean is a proven and effective way to remove waste, identify issues, and successfully implement change. The principle of Lean is based on the reality that there are value added and non-value added processes in every workflow. To improve quality and reduce loss, the non-value added processes need to be eliminated. In healthcare, value is determined from the perspective of the patient. While not exhaustive of the Lean processes that a healthcare system can employ, this article provides a general outline of Lean, definitions, and its benefits to any healthcare organization.

  3. Identifying determinants of socioeconomic inequality in health service utilization among patients with chronic non-communicable diseases in China.

    Directory of Open Access Journals (Sweden)

    Xin Xie

    Full Text Available BACKGROUND: People with chronic non-communicable diseases (NCD are particularly vulnerable to socioeconomic inequality due to their long-term expensive health needs. This study aimed to assess socioeconomic-related inequality in health service utilization among NCD patients in China and to analyze factors associated with this disparity. METHODS: Data were taken from the 2008 Chinese National Health Survey, in which a multiple stage stratified random sampling method was employed to survey 56,456 households. We analyzed the distribution of actual use, need-expected use, and need-standardized usage of outpatient services (over a two-week period and inpatient services (over one-year across different income groups in 27,233 adult respondents who reported as having a NCD. We used a concentration index to measure inequality in the distribution of health services, which was expressed as HI (Horizontal Inequity Index for need-standardized use of services. A non-linear probit regression model was employed to detect inequality across socio-economic groups. RESULTS: Pro-rich inequity in health services among NCD patients was more substantial than the average population. A higher degree of pro-rich inequity (HI = 0.253 was found in inpatient services compared to outpatient services (HI = 0.089. Despite a greater need for health services amongst those of lower socio-economic status, their actual use is much less than their more affluent counterparts. Health service underuse by the poor and overuse by the affluent are evident. Household income disparity was the greatest inequality factor in NCD service use for both outpatients (71.3% and inpatients (108%, more so than health insurance policies. Some medical insurance schemes, such as the MIUE, actually made a pro-rich contribution to health service inequality (16.1% for outpatient and 12.1% for inpatient. CONCLUSIONS: Inequality in health services amongst NCD patients in China remains largely

  4. Determination of feasibility and utility of microscope-integrated optical coherence tomography during ophthalmic surgery: the DISCOVER Study RESCAN Results.

    Science.gov (United States)

    Ehlers, Justis P; Goshe, Jeff; Dupps, William J; Kaiser, Peter K; Singh, Rishi P; Gans, Richard; Eisengart, Jonathan; Srivastava, Sunil K

    2015-10-01

    Optical coherence tomography (OCT) has transformed the clinical management of a myriad of ophthalmic conditions. Applying OCT to ophthalmic surgery may have implications for surgical decision making and patient outcomes. To assess the feasibility and effect on surgical decision making of a microscope-integrated intraoperative OCT (iOCT) system. Report highlighting the 1-year results (March 2014-February 2015) of the RESCAN 700 portion of the DISCOVER (Determination of Feasibility of Intraoperative Spectral Domain Microscope Combined/Integrated OCT Visualization During En Face Retinal and Ophthalmic Surgery) study, a single-site, multisurgeon, prospective consecutive case series regarding this investigational device. Participants included patients undergoing ophthalmic surgery. Data on clinical characteristics were collected, and iOCT was performed during surgical milestones, as directed by the operating surgeon. A surgeon questionnaire was issued to each surgeon and was completed after each case to evaluate the role of iOCT during surgery and its particular role in select surgical procedures. Percentage of cases with successful acquisition of iOCT (ie, feasibility). Percentage of cases in which iOCT altered surgical decision making (ie, utility). During year 1 of the DISCOVER study, a total of 227 eyes (91 anterior segment cases and 136 posterior segment cases) underwent imaging with the RESCAN 700 system. Successful imaging (eg, the ability to acquire an OCT image of the tissue of interest) was obtained for 224 of 227 eyes (99% [95% CI, 98%-100%]). During lamellar keratoplasty, the iOCT data provided information that altered the surgeon's decision making in 38% of the cases (eg, complete graft apposition when the surgeon believed there was interface fluid). In membrane peeling procedures, iOCT information was discordant with the surgeon's impression of membrane peel completeness in 19% of cases (eg, lack of residual membrane or presence of occult membrane), thus

  5. Identifying determinants of socioeconomic inequality in health service utilization among patients with chronic non-communicable diseases in China.

    Science.gov (United States)

    Xie, Xin; Wu, Qunhong; Hao, Yanhua; Yin, Hui; Fu, Wenqi; Ning, Ning; Xu, Ling; Liu, Chaojie; Li, Ye; Kang, Zheng; He, Changzhi; Liu, Guoxiang

    2014-01-01

    People with chronic non-communicable diseases (NCD) are particularly vulnerable to socioeconomic inequality due to their long-term expensive health needs. This study aimed to assess socioeconomic-related inequality in health service utilization among NCD patients in China and to analyze factors associated with this disparity. Data were taken from the 2008 Chinese National Health Survey, in which a multiple stage stratified random sampling method was employed to survey 56,456 households. We analyzed the distribution of actual use, need-expected use, and need-standardized usage of outpatient services (over a two-week period) and inpatient services (over one-year) across different income groups in 27,233 adult respondents who reported as having a NCD. We used a concentration index to measure inequality in the distribution of health services, which was expressed as HI (Horizontal Inequity Index) for need-standardized use of services. A non-linear probit regression model was employed to detect inequality across socio-economic groups. Pro-rich inequity in health services among NCD patients was more substantial than the average population. A higher degree of pro-rich inequity (HI = 0.253) was found in inpatient services compared to outpatient services (HI = 0.089). Despite a greater need for health services amongst those of lower socio-economic status, their actual use is much less than their more affluent counterparts. Health service underuse by the poor and overuse by the affluent are evident. Household income disparity was the greatest inequality factor in NCD service use for both outpatients (71.3%) and inpatients (108%), more so than health insurance policies. Some medical insurance schemes, such as the MIUE, actually made a pro-rich contribution to health service inequality (16.1% for outpatient and 12.1% for inpatient). Inequality in health services amongst NCD patients in China remains largely determined by patient financial capability. The current

  6. 77 FR 75984 - Utility Scale Wind Towers From the Socialist Republic of Vietnam: Final Determination of Sales at...

    Science.gov (United States)

    2012-12-26

    ... From the Socialist Republic of Vietnam: Final Determination of Sales at Less Than Fair Value AGENCY... preliminary determination of sales at less than fair value (``LTFV'') and postponement of final determination... Fair Value and Postponement of Final Determination, 77 FR 29315 (August 2, 2012) (``Preliminary...

  7. Healthcare seeking behaviour among Chinese elderly.

    Science.gov (United States)

    Lu, Hui; Wang, Wei; Xu, Ling; Li, Zhenhong; Ding, Yan; Zhang, Jian; Yan, Fei

    2017-04-18

    Purpose The Chinese population is rapidly ageing before they are rich. The purpose of this paper is to describe healthcare seeking behaviour and the critical factors associated with healthcare seeking behaviour. Design/methodology/approach Using a purposive sampling method, the authors recruited 44 adults aged 60 years or older from three provinces, representing the developed (Shanghai), undeveloped (Ningxia) regions and the regions in between (Hubei). From July to September 2008, using a semi-structured guide, the authors interviewed participants in focus group discussions. Findings The healthcare needs for chronic and catastrophic diseases were high; however, the healthcare demands were low and healthcare utilizations were even lower owing to the limited accessibility to healthcare services, particularly, in underdeveloped rural areas. "Too expensive to see a doctor" was a prime complaint, explaining substantial discrepancies between healthcare needs, demands and use. Care seeking behaviour varied depending on insurance availability, perceived performance, particularly hospital services, and prescription medications. Participants consistently rated increasing healthcare accessibility as a high priority, including offering financial aid, and improving service convenience. Improving social security fairness was the first on the elderly's wish list. Originality/value Healthcare demand and use were lower than needs, and were influenced by multiple factors, primarily, service affordability and efficiency, perceived performance and hospital service quality.

  8. Cognitive status is a determinant of health resource utilization among individuals with a history of falls: a 12-month prospective cohort study.

    Science.gov (United States)

    Davis, J C; Dian, L; Khan, K M; Bryan, S; Marra, C A; Hsu, C L; Jacova, P; Chiu, B K; Liu-Ambrose, T

    2016-03-01

    Falls are a costly public health problem worldwide. The literature is devoid of prospective data that identifies factors among fallers that significantly drive health care resource utilization. We found that cognitive function--specifically, executive functions--and cognitive status are significant determinants of health resource utilization among older fallers. Although falls are costly, there are no prospective data examining factors among fallers that drive health care resource utilization. We identified key determinants of health resource utilization (HRU) at 6 and 12 months among older adults with a history of falls. Specifically, with the increasing recognition that cognitive impairment is associated with increased falls risk, we investigated cognition as a potential driver of health resource utilization. This 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (n = 319) included participants with a history of at least one fall in the previous 12 months. Based on their cognitive status, participants were divided into two groups: (1) no mild cognitive impairment (MCI) and (2) MCI. We constructed two linear regression models with HRU at 6 and 12 months as the dependent variables for each model, respectively. Predictors relating to mobility, global cognition, executive functions, and cognitive status (MCI versus no MCI) were examined. Age, sex, comorbidities, depression status, and activities of daily living were included regardless of statistical significance. Global cognition, comorbidities, working memory, and cognitive status (MCI versus no MCI ascertained using the Montreal Cognitive Assessment (MoCA)) were significant determinants of total HRU at 6 months. The number of medical comorbidities and global cognition were significant determinants of total HRU at 12 months. MCI status was a determinant of HRU at 6 months among older adults with a history of falls. As such, efforts to minimize health care resource use related to falls

  9. Health care utilization in persons with spinal cord injury: part 2-determinants, geographic variation and comparison with the general population.

    Science.gov (United States)

    Ronca, E; Scheel-Sailer, A; Koch, H G; Gemperli, A

    2017-09-01

    Cross-sectional survey. To investigate annual rates and geographic variation of health care utilization in persons with spinal cord injury (SCI), and to identify factors associated with health care utilization. Community setting, entire country of Switzerland. Annual rates of planned and emergency visits to the general practitioner (GP), planned and emergency outpatient clinic visits and in-patient hospitalizations were compared between individuals with chronic SCI, over 16 years of age residing in Switzerland between late 2011 and early 2013 and a population sample (2012) of the Swiss general population. Risk factors for increased health service utilization were identified by means of regression models adjusted for spatial variation. Of 492 participants (86.2% response rate), 94.1% visited a health care provider in the preceding year, with most persons visiting GPs (88.4%) followed by outpatient clinics (53.1%) and in-patient hospitals (35.9%). The increase in utilization as compared with the general population was 1.3-, 4.0- and 2.9-fold for GP, outpatient clinic and in-patient hospital visit, respectively. GP utilization was highest in persons with low income (incidence rate ratio (IRR) 1.85) and old age (IRR 2.62). In the first 2 years post injury, health service visits were 1.7 (GP visits) to 5.8 times (emergency outpatient clinic visits) more likely compared with those later post injury. People with SCI more frequently use health services as compared with the general population, across all types of medical service institutions. GP services were used most often in areas where availability of specialized outpatient clinic services was low.

  10. 77 FR 75992 - Utility Scale Wind Towers From the People's Republic of China: Final Determination of Sales at...

    Science.gov (United States)

    2012-12-26

    ... From the People's Republic of China: Final Determination of Sales at Less Than Fair Value AGENCY... its preliminary determination of sales at less than fair value (``LTFV'') and postponement of final... the People's Republic of China: Preliminary Determination of Sales at Less Than Fair Value and...

  11. 78 FR 11150 - Utility Scale Wind Towers From the Socialist Republic of Vietnam: Amended Final Determination of...

    Science.gov (United States)

    2013-02-15

    ... From the Socialist Republic of Vietnam: Amended Final Determination of Sales at Less Than Fair Value... Department published the final determination of sales at less than fair value in the antidumping duty... the Socialist Republic of Vietnam: Final Determination of Sales at Less Than Fair Value, 77 FR 75984...

  12. Mental Illness, Healthcare, and Homelessness in Mississippi

    OpenAIRE

    Tamara Stewart

    2017-01-01

    Mental illness is prevalent among the homeless population and the rate of mentally ill homeless individuals has increased since deinstitutionalization. There is little information about homeless population mental health and access to mental healthcare. This study sought to describe the mental health status and utilization of mental healthcare services among homeless individuals in Mississippi. This is a cross-sectional study with 3,375 adults participants. There were 58% males, 42% females, 4...

  13. Mental Illness, Healthcare, and Homelessness in Mississippi

    Directory of Open Access Journals (Sweden)

    Tamara Stewart

    2017-09-01

    Full Text Available Mental illness is prevalent among the homeless population and the rate of mentally ill homeless individuals has increased since deinstitutionalization. There is little information about homeless population mental health and access to mental healthcare. This study sought to describe the mental health status and utilization of mental healthcare services among homeless individuals in Mississippi. This is a cross-sectional study with 3,375 adults participants. There were 58% males, 42% females, 45% Caucasian, 54% African Americans, and 1% other minorities (Asian, Indian, and Pacific Islander at intake into Mississippi United to End Homelessness' (MUTEH Homeless Management Information System (HMIS program. The data was collected during the initial screening of homeless individuals. The screening documented mental illness and utilization of healthcare. Frequency tables and Chi-SQ was used to test the relationship between mental illness and utilization of mental healthcare among the homeless in Mississippi. The result of the analysis revealed that 83% of the chronically homeless individual had a mental illness, and 78% of the chronically homeless participants were not receiving mental healthcare. Mental health services were successful in connecting mentally ill homeless individuals to mental healthcare in lieu of institutionalization. However, chronically homeless mentally ill individuals struggle with obtaining appropriate care.

  14. Measuring Value in Healthcare

    OpenAIRE

    Gardner, Christopher

    2008-01-01

    A statistical description and model of individual healthcare expenditures in the US has been developed for measuring value in healthcare. We find evidence that healthcare expenditures are quantifiable as an infusion-diffusion process, which can be thought of intuitively as a steady change in the intensity of treatment superimposed on a random process reflecting variations in the efficiency and effectiveness of treatment. The arithmetic mean represents the net average annual cost of healthcare...

  15. The quality of healthcare

    African Journals Online (AJOL)

    The quality of healthcare provided by a healthcare system is not always easily assessed. How can one assess the smile of reassurance from a nursing sister or the feeling of satisfaction of a patient when visiting a doctor in a resource-limited setting? There are, however, some objective measures of healthcare activity.

  16. The health status of Portuguese healthcare professionals.

    Science.gov (United States)

    Fronteira, Inês; Biscaia, André

    2007-01-01

    Several studies have shown that healthcare professionals are at greater risk than the rest of the population of having certain health problems due to the specificity of their workplace and the physical and psychological demands of their work. Additionally, healthcare professionals seem to behave differently when seeking health care. Several studies also indicate that the health of healthcare professionals has an impact on the performance of services and on the health of the population. The present paper analyzes morbidity patterns, health behaviors and lifestyles, self-perceived health status and health service utilization among healthcare professionals, by using the Portuguese 1999 National Health Survey. Results differ from those found in international studies. Portuguese healthcare professionals did not suffer more from some health problems than non-healthcare professionals. Healthcare professionals tended to assess their health as good and better as that of other workers. They also reported healthier behaviors (smoked less, drank less and practiced exercise more often) and missed fewer workdays due to sickness. The percentage of healthcare professionals suffering from back pain was lower than the percentage of other workers but they started to complain earlier.

  17. The Utilization of Nitrogen Gas as a Carrier Gas in the Determination of Hg Ions Using Cold Vapor-Atomic Absorption Spectrophotometer (CV-AAS)

    OpenAIRE

    Panggabean, Aman Sentosa; Pasaribu, Subur P; Kristiana, Farida

    2018-01-01

    The research about utilization of nitrogen gas as a carrier gas in the determination of Hg ions by using Cold Vapor-Atomic Absorption Spectrophotometer (CV-AAS) method has been conducted. To optimize the measurement results, several parameters that affect hydride generator have been studied. Some specified important parameters are SnCl2 concentration as reductant, acid concentration, and the analytical performance such as repeatability and reproducibility (% RSD), linearity (r), limits of det...

  18. The intersection of disability and healthcare disparities: a conceptual framework.

    Science.gov (United States)

    Meade, Michelle A; Mahmoudi, Elham; Lee, Shoou-Yih

    2015-01-01

    This article provides a conceptual framework for understanding healthcare disparities experienced by individuals with disabilities. While health disparities are the result of factors deeply rooted in culture, life style, socioeconomic status, and accessibility of resources, healthcare disparities are a subset of health disparities that reflect differences in access to and quality of healthcare and can be viewed as the inability of the healthcare system to adequately address the needs of specific population groups. This article uses a narrative method to identify and critique the main conceptual frameworks that have been used in analyzing disparities in healthcare access and quality, and evaluating those frameworks in the context of healthcare for individuals with disabilities. Specific models that are examined include the Aday and Anderson Model, the Grossman Utility Model, the Institute of Medicine (IOM)'s models of Access to Healthcare Services and Healthcare Disparities, and the Cultural Competency model. While existing frameworks advance understandings of disparities in healthcare access and quality, they fall short when applied to individuals with disabilities. Specific deficits include a lack of attention to cultural and contextual factors (Aday and Andersen framework), unrealistic assumptions regarding equal access to resources (Grossman's utility model), lack of recognition or inclusion of concepts of structural accessibility (IOM model of Healthcare Disparities) and exclusive emphasis on supply side of the healthcare equation to improve healthcare disparities (Cultural Competency model). In response to identified gaps in the literature and short-comings of current conceptualizations, an integrated model of disability and healthcare disparities is put forth. We analyzed models of access to care and disparities in healthcare to be able to have an integrated and cohesive conceptual framework that could potentially address issues related to access to

  19. Clinical utility of insulin-like growth factor 1 and 2; determination by high resolution mass spectrometry.

    Directory of Open Access Journals (Sweden)

    Cory Bystrom

    Full Text Available Measurement of insulin-like growth factor-1 (IGF-I has utility for the diagnosis and management of growth disorders, but inter-assay comparison of results has been complicated by a multitude of reference standards, antibodies, detection methods, and pre-analytical preparation strategies. We developed a quantitative LC-MS method for intact IGF-I, which has advantages in throughput and complexity when compared to mass spectrometric approaches that rely on stable isotope dilution analysis of tryptic peptides. Since the method makes use of full-scan data, the assay was easily extended to provide quantitative measurement of IGF-II using the same assay protocol. The validated LC-MS assay for IGF-I and IGF-II provides accurate results across the pediatric and adult reference range and is suitable for clinical use.

  20. Determinants of utilization of services under MMJSSA scheme in Jharkhand 'Client Perspective': a qualitative study in a low performing state of India.

    Science.gov (United States)

    Rai, Sanjay K; Dasgupta, Rajib; Das, M K; Singh, Sarita; Devi, Reema; Arora, N K

    2011-01-01

    Preventing maternal death associated with pregnancy and child birth is one of the greatest challenges for India. Approximately 55,000 women die in India due to pregnancy- and childbirth- related conditions each year. Increasing the coverage of maternal and newborn interventions is essential if Millennium Development Goals (MDG) 4 and 5 are to be reached. With a view to accelerate the reduction in maternal and neonatal mortality through institutional deliveries, Government of India initiated a scheme in 2005 called Janani Suraksha Yojna (JSY) under its National Rural Health Mission (NRHM). In Jharkhand the scheme is called the Mukhya Mantri Janani Shishu Swasthya Abhiyan (MMJSSA). This paper focuses on community perspectives, for indentifying key areas that require improvement for proper implementation of the MMJSSA in Jharkhand. Qualitative research method was used to collect data through in-depth interviews (IDIs) and focus group discussions (FGDs) in six districts of Jharkhand- Gumla, West Singhbhum, Koderma, Deoghar, Garhwa, and Ranchi. Total 300 IDIs (24 IDIs each from mother given birth at home and institution respectively; two IDIs each with members of Village Health and Sanitation Committees (VHSC) / Rogi Kalyan Samitis (RKS) from each district) and 24 FGDs (four FGDs were conducted from pools of husbands, mothers-in-law and fathers-in-law in each district) were conducted. Although people indicated willingness for institutional deliveries (generally perceived to be safe deliveries), several barriers emerged as critical obstacles. These included poor infrastructure, lack of quality of care, difficulties while availing incentives, corruption in disbursement of incentives, behavior of the healthcare personnel and lack of information about MMJSSA. Poor (and expensive) transport facilities and difficult terrain made geographical access difficult. The level of utilization of maternal healthcare among women in Jharkhand is low. There was an overwhelming demand for

  1. 77 FR 46034 - Utility Scale Wind Towers From the People's Republic of China: Preliminary Determination of Sales...

    Science.gov (United States)

    2012-08-02

    ... probative value by examining the reliability and relevance of the information. \\77\\ Id. \\78\\ Id. In order to... From the People's Republic of China: Preliminary Determination of Sales at Less Than Fair Value and... value (``LTFV''), as provided in section 733 of the Tariff Act of 1930, as amended (``the Act''). The...

  2. Argonaute Utilization for miRNA Silencing Is Determined by Phosphorylation-Dependent Recruitment of LIM-Domain-Containing Proteins

    Directory of Open Access Journals (Sweden)

    Katherine S. Bridge

    2017-07-01

    Full Text Available As core components of the microRNA-induced silencing complex (miRISC, Argonaute (AGO proteins interact with TNRC6 proteins, recruiting other effectors of translational repression/mRNA destabilization. Here, we show that LIMD1 coordinates the assembly of an AGO-TNRC6 containing miRISC complex by binding both proteins simultaneously at distinct interfaces. Phosphorylation of AGO2 at Ser 387 by Akt3 induces LIMD1 binding, which in turn enables AGO2 to interact with TNRC6A and downstream effector DDX6. Conservation of this serine in AGO1 and 4 indicates this mechanism may be a fundamental requirement for AGO function and miRISC assembly. Upon CRISPR-Cas9-mediated knockout of LIMD1, AGO2 miRNA-silencing function is lost and miRNA silencing becomes dependent on a complex formed by AGO3 and the LIMD1 family member WTIP. The switch to AGO3 utilization occurs due to the presence of a glutamic acid residue (E390 on the interaction interface, which allows AGO3 to bind to LIMD1, AJUBA, and WTIP irrespective of Akt signaling.

  3. Determination of l-glutamic acid and γ-aminobutyric acid in mouse brain tissue utilizing GC-MS/MS.

    Science.gov (United States)

    Farthing, Christine A; Farthing, Don E; Gress, Ronald E; Sweet, Douglas H

    2017-11-15

    A rapid and selective method for the quantitation of neurotransmitters, l-Glutamic acid (GA) and γ-Aminobutyric acid (GABA), was developed and validated using gas chromatography-tandem mass spectrometry (GC-MS/MS). The novel method utilized a rapid online hot GC inlet gas phase sample derivatization and fast GC low thermal mass technology. The method calibration was linear from 0.5 to 100μg/mL, with limits of detections of 100ng/mL and 250ng/mL for GA and GABA, respectively. The method was used to investigate the effects of deletion of organic anion transporter 1 (Oat1) or Oat3 on murine CNS levels of GA and GABA at 3 and 18 mo of age, as compared to age matched wild-type (WT) animals. Whole brain concentrations of GA were comparable between WT, Oat1 -/- , and Oat3 -/- 18 mo at both 3 and 18 mo of age. Similarly, whole brain concentrations of GABA were not significantly altered in either knockout mouse strain at 3 or 18 mo of age, as compared to WT. These results indicate that the developed GC-MS/MS method provides sufficient sensitivity and selectivity for the quantitation of these neurotransmitters in mouse brain tissue. Furthermore, these results suggest that loss of Oat1 or Oat3 function in isolation does not result in significant alterations in brain tissue levels of GA or GABA. Copyright © 2017 Elsevier B.V. All rights reserved.

  4. A path analysis study of retention of healthcare professionals in urban India using health information technology.

    Science.gov (United States)

    Bhattacharya, Indrajit; Ramachandran, Anandhi

    2015-07-31

    Healthcare information technology (HIT) applications are being ubiquitously adopted globally and have been indicated to have effects on certain dimensions of recruitment and retention of healthcare professionals. Retention of healthcare professionals is affected by their job satisfaction (JS), commitment to the organization and intention to stay (ITS) that are interlinked with each other and influenced by many factors related to job, personal, organization, etc. The objectives of the current study were to determine if HIT was one among the factors and, if so, propose a probable retention model that incorporates implementation and use of HIT as a strategy. This was a cross-sectional survey study covering 20 hospitals from urban areas of India. The sample (n = 586) consisted of doctors, nurses, paramedics and hospital administrators. Data was collected through a structured questionnaire. Factors affecting job satisfaction were determined. Technology acceptance by the healthcare professionals was also determined. Interactions between the factors were predicted using a path analysis model. The overall satisfaction rate of the respondents was 51 %. Based on factor analysis method, 10 factors were identified for JS and 9 factors for ITS. Availability and use of information technology was one factor that affected JS. The need for implementing technology influenced ITS through work environment and career growth. Also, the study indicated that nearly 70 % of the respondents had awareness of HIT, but only 40 % used them. The importance of providing training for HIT applications was stressed by many respondents. The results are in agreement with literature studies exploring job satisfaction and retention among healthcare professionals. Our study documented a relatively medium level of job satisfaction among the healthcare professionals in the urban area. Information technology was found to be one among the factors that can plausibly influence their job satisfaction and

  5. Determination of the zone of maximum probability of asphaltenes precipitation utilizing experimental data in an Iranian carbonate reservoir

    Energy Technology Data Exchange (ETDEWEB)

    Hamid, K.; Jamshidnezhad, M. [National Iranian South Oil Co. (Iran, Islamic Republic of)

    2005-07-01

    In the south Iranian Bangestan carbonate reservoirs, asphaltene precipitation within deep well tubing has been increasing. This is a major operational problem affecting oil production from these oil fields. Asphaltene precipitation can negatively impact the economics of oil production due to a reduction in well productivity or clogging of production facilities. This paper described the efforts to monitor this asphaltene flocculation and precipitation in oil well tubing. The monitoring technique to estimate the zone of maximum probability of asphaltene precipitation is based on the interpretation of the well flowing pressure data. Nodal analysis was used to determine pressure versus depth behavior at the well for different operational conditions. The most probable range of depth at which asphaltenes precipitation will occur was determined upon knowing the saturation pressure and the flocculation onset pressure. The purpose of this methodology is to determine the optimum operational conditions that maximize production at minimum risk of asphaltenes precipitation, and to select better preventive measures for each particular case to maintain control of the asphaltenes plugging problem. Field applications of the methodology were presented. Hydraulic fracturing is recommended to control asphaltene precipitation, depending on the depth range of asphaltenes precipitation. 6 refs., 2 tabs., 4 figs.

  6. Solid healthcare waste management in Anambra State of Nigeria ...

    African Journals Online (AJOL)

    Aim: This study aims at ascertaining the current healthcare waste management practices in Anambra State. It highlights the sources of healthcare waste, its classification, the hazards associated with it and the gold standard in its management. The specific objectives are: to determine current practice of healthcare waste ...

  7. Effect of Government-Community Healthcare Co-Financing on ...

    African Journals Online (AJOL)

    BACKGROUND: Effective maternal and child healthcare delivery requires a proper and adequate funding of the health sector. OBJECTIVE: To determine the effect of government-community healthcare co-financing on maternal and child healthcare services' delivery. METHODS: A descriptive, cross-sectional study with an ...

  8. Preferred drug lists: Potential impact on healthcare economics

    Directory of Open Access Journals (Sweden)

    Kimberly Ovsag

    2008-04-01

    Full Text Available Kimberly Ovsag, Sabrina Hydery, Shaker A MousaPharmaceutical Research Institute at Albany College of Pharmacy, Albany, New York, USAObjectives: To analyze the implementation of Medicaid preferred drug lists (PDLs in a number of states and determine its impact on quality of care and cost relative to other segments of healthcare.Methods: We reviewed research and case studies found by searching library databases, primarily MEDLINE and EBSCOHost, and searching pertinent journals. Keywords initially included “drug lists,” “prior authorization,” “prior approval,” and “Medicaid.” We added terms such as “influence use of other healthcare services,” “quality of care,” and “overall economic impact.” We mainly used primary sources.Results: Based on our literature review, we determined that there are a number of issues regarding Medicaid PDLs that need to be addressed. Some issues include: (a the potential for PDLs to influence the utilization of other healthcare services, (b criteria used by Medicaid for determining acceptance of drugs onto a PDL, (c the effect of PDL implementation on compliance to new regimens, (d the potential effects of restricting medication availability on quality of care, (e administrative costs associated with PDLs, and (f satisfaction rates among patients and medical providers. This review highlighted expected short-term cost savings with limited degree of compromised quality of PDL implementation, but raised the concern about the potential long-term decline in quality of care and overall economic impact.Conclusions: The number of concerns raised indicates that further studies are warranted regarding both short-term cost benefits as well as potential long-term effects of Medicaid PDL implementation. Objective analysis of these effects is necessary to ensure cost-effectiveness and quality of care.Keywords: preferred drug lists, medicaid, healthcare costs, managed care

  9. Utility usage forecasting

    Science.gov (United States)

    Hosking, Jonathan R. M.; Natarajan, Ramesh

    2017-08-22

    The computer creates a utility demand forecast model for weather parameters by receiving a plurality of utility parameter values, wherein each received utility parameter value corresponds to a weather parameter value. Determining that a range of weather parameter values lacks a sufficient amount of corresponding received utility parameter values. Determining one or more utility parameter values that corresponds to the range of weather parameter values. Creating a model which correlates the received and the determined utility parameter values with the corresponding weather parameters values.

  10. Determination of torque speed current characteristics of a brushless DC motor by utilizing back-EMF of non-energized phase

    Science.gov (United States)

    Jang, G. H.; Yeom, J. H.; Kim, M. G.

    2007-03-01

    This paper presents a method to determine the torque constant and the torque-speed-current characteristics of a brushless DC (BLDC) motor by utilizing back-EMF variation of nonenergized phase. It also develops a BLDC motor controller with a digital signal processor (DSP) to monitor its current, voltage and speed in real time. Torque-speed-current characteristics of a BLDC motor are determined by using the proposed method and the developed controller. They are compared with the torque-speed-current characteristics measured by dynamometer experimentally. This research shows that the proposed method is an effective method to determine the torque constant and the torque-speed-current characteristics of the BLDC motor without using dynamometer.

  11. Validation, Optimal Threshold Determination, and Clinical Utility of the Infant Risk of Overweight Checklist for Early Prevention of Child Overweight.

    Science.gov (United States)

    Redsell, Sarah A; Weng, Stephen; Swift, Judy A; Nathan, Dilip; Glazebrook, Cris

    2016-06-01

    Previous research has demonstrated the predictive validity of the Infant Risk of Overweight Checklist (IROC). This study further establishes the predictive accuracy of the IROC using data from the Avon Longitudinal Study of Parents and Children (ALSPAC) and examines the optimal threshold for determining high risk of childhood overweight. Using the IROC algorithm, we calculated the risk of being overweight, based on International Obesity Task Force criteria, in the first year of life for 980 children in the ALSPAC cohort at 5 years. Discrimination was assessed by the area under the receiver operating curve (AUC c-statistic). Net reclassification index (NRI) was calculated for risk thresholds ranging from 2.5% to 30%, which determine cutoffs for identifying infants at risk of becoming overweight. At 5 years of age, 12.3% of boys and 19.6% of girls were categorized overweight. Discrimination (AUC c-statistic) ranged from 0.67 (95% confidence interval [CI], 0.62-0.72) when risk scores were calculated directly to 0.93 (95% CI, 0.88-0.98) when the algorithm was recalibrated and missing values of the risk factor algorithm were imputed. The NRI showed that there were positive gains in reclassification using risk thresholds from 5% to 20%, with the maximum NRI being at 10%. This study confirms that the IROC has moderately good validity for assessing overweight risk in infants and offers an optimal threshold for determining high risk. The IROC algorithm has been imbedded into a computer program for Proactive Assessment of Obesity Risk during Infancy, which facilitates early overweight prevention through communication of risk to parents.

  12. Determination of the Viscosity by Means of the Optical Methods Utilizing the Bend Loss of the Vibrating Fiber

    Czech Academy of Sciences Publication Activity Database

    Fedorchenko, Alexander I.; Stachiv, Ivo

    2011-01-01

    Roč. 9, č. 2 (2011), s. 741-744 ISSN 1546-198X R&D Projects: GA AV ČR(CZ) IAA200760801; GA ČR GA106/09/1573 Institutional research plan: CEZ:AV0Z20760514; CEZ:AV0Z10100520 Keywords : viscosity determination * bend loss sensor * resonance Subject RIV: BK - Fluid Dynamics Impact factor: 0.819, year: 2011 http://www.ingentaconnect.com/content/asp/senlet/2011/00000009/00000002/art00059

  13. Utility of Charge Transfer and Ion-Pair Complexation for Spectrophotometric Determination of Eletriptan Hydrobromide in Pure and Dosage Forms

    Directory of Open Access Journals (Sweden)

    Ayman A. Gouda

    2013-01-01

    Full Text Available Three simple, sensitive, and accurate spectrophotometric methods have been developed for the determination of eletriptan hydrobromide (ELT in pure and dosage forms. The first two methods are based on charge transfer complex formation between ELT and chromogenic reagents quinalizarin (Quinz and alizarin red S (ARS producing charge transfer complexes which showed an absorption maximum at 569 and 533 nm for Quinz and ARS, respectively. The third method is based on the formation of ion-pair complex between ELT with molybdenum(V-thiocyanate inorganic complex in hydrochloric acid medium followed by extraction of the colored ion-pair with dichloromethane and measured at 470 nm. Different variables affecting the reactions were studied and optimized. Beer's law is obeyed in the concentration ranges 2.0–18, 1.0–8.0, and 2.0–32 μg mL−1 for Quinz, ARS, and Mo(V-thiocyanate, respectively. The molar absorptivity, Sandell sensitivity, detection, and quantification limits are also calculated. The correlation coefficients were ≥0.9994 with a relative standard deviation (R.S.D%. of ≤0.925. The proposed methods were successfully applied for simultaneous determination of ELT in tablets with good accuracy and precision and without interferences from common additives, and the validity is assessed by applying the standard addition technique, which is compared with those obtained using the reported method.

  14. Utilization of Chemometric Technique to Determine the Quality of Fresh and Used Palm, Corn and Coconut Oil

    International Nuclear Information System (INIS)

    Hamizah Mat Agil; Mohd Zuli Jaafar; Suzeren Jamil; Azwan Mat Lazim

    2014-01-01

    This study was conducted to evaluate the quality of natural oil and the deterioration of frying oil. A total of 12 different oil samples from palm oil, corn oil and coconut oil were used. The frying process was repeated four times at 180 degree Celsius in order to observe the stability of the oil towards oxidation. Three main parameters have been studied to determine oil qualities which were peroxide value, iodine value and acid value. This study emphasized on the usage of FTIR in the range of 4000-700 cm -1 . Alternatively, the chemometrics method based on pattern recognition has been used to determination the oil quality. Data analysis were conducted by using PCA and PLS method in the Matlab modeling. The PCA provided data classification according to types of oil while PLS predicted the oil quality of the parameters studied. For the classification of pure oil, the variance for PC1 was 70 % while PC2 was 15 %. For the fried/ used oil, PC1 gave 57 % while PC2 gave 25 %. By using PLS, the iodine the best model for pure oils value model variable based on correlation with R2CV > 0.984. Whereas, the peroxide value model for fried/ used oils, was the best obtained R 2 CV > 0.7423. (author)

  15. Utility of solid phase spectrophotometry for the modified determination of trace amounts of cadmium in food samples.

    Science.gov (United States)

    Amin, Alaa S; Gouda, Ayman A

    2012-05-01

    A modified selective, highly sensitive and accurate procedure for the determination of trace amounts of cadmium which reacts with 1-(2-benzothiazolylazo)-2-hydroxy-3-naphthoic acid (BTAHNA) to give a deep violet complex with high molar absorptivity (7.05×10(6)Lmol(-1) cm(-1), 3.92×10(7)Lmol(-1)cm(-1), 1.78×10(8)Lmol(-1)cm(-1), and 4.10×10(8)Lmol(-1)cm(-1)), fixed on a Dowex 1-X8 type anion-exchange resin for 10mL, 100mL, 500mL, and 1000mL, respectively. Calibration is linear over the range 0.2-3.5μgL(-1) with RSD of ⩽1.14% (n=10). The detection and quantification limits were calculated. Increasing the sample volume can enhance the sensitivity. The method has been successfully applied for the determination of Cd(II) in food samples, water samples and some salts samples without interfering effect of various cations and anions. Copyright © 2011 Elsevier Ltd. All rights reserved.

  16. Spectrophotometric and Spectrofluorimetric Studies on Azilsartan Medoxomil and Chlorthalidone to be Utilized in Their Determination in Pharmaceuticals

    Directory of Open Access Journals (Sweden)

    Walid M. Ebeid

    2014-01-01

    Full Text Available The recently approved angiotensin II receptor blocker, azilsartan medoxomil (AZL, was determined spectrophotometrically and spectrofluorimetrically in its combination with chlorthalidone (CLT in their combined dosage form. The UV-spectrophotometric technique depends on simultaneous measurement of the first derivative spectra for AZL and CLT at 286 and 257 nm, respectively, in methanol. The spectrofluorimetric technique depends on measurement of the fourth derivative of the synchronous spectra intensities of AZL in presence of CLT at 298 nm in methanol. The effects of different solvents on spectrophotometric and spectrofluorimetric responses were studied. For, the spectrofluorimetric study, the effect of pH and micelle-assisted fluorescence enhancement were also studied. Linearity, accuracy, and precision were found to be satisfactory over the concentration ranges of 8-50 μg mL −1 and 2-20 μg mL −1 for AZL and CLT, respectively, in the spectrophotometric method as well as 0.01-0.08 μg mL −1 for AZL in the spectrofluorimetric method. The methods were successfully applied for the determination of the studied drugs in their co-formulated tablets. The developed methods are inexpensive and simple for the quality control and routine analysis of the cited drugs in bulk and in pharmaceuticals.

  17. Knowledge management in Portuguese healthcare institutions.

    Science.gov (United States)

    Cruz, Sofia Gaspar; Ferreira, Maria Manuela Frederico

    2016-06-01

    Knowledge management imposes itself as a pressing need for the organizations of several sectors of the economy, including healthcare. to evaluate the perception of healthcare institution collaborators in relation to knowledge management in the institution where they operate and analyze the existence of differences in this perception, based on the institution's management model. a study conducted in a sample consisting of 671 collaborators from 10 Portuguese healthcare institutions with different models of management. In order to assess the knowledge management perception, we used a score designed from and based on items from the scores available in the literature. the perception of moderate knowledge management on the healthcare institutions and the statistically significant differences in knowledge management perception were evidenced in each management model. management knowledge takes place in healthcare institutions, and the current management model determines the way staff at these institutions manage their knowledge.

  18. Respiratory viral infections in infancy and school age respiratory outcomes and healthcare costs.

    Science.gov (United States)

    MacBean, Victoria; Drysdale, Simon B; Yarzi, Muska N; Peacock, Janet L; Rafferty, Gerrard F; Greenough, Anne

    2018-03-01

    To determine the impact of viral lower respiratory tract infections (LRTIs) in infancy including rhinovirus (RV) and infancy respiratory syncytial virus (RSV), on school age pulmonary function and healthcare utilization in prematurely born children. School age respiratory outcomes would be worse and healthcare utilization greater in children who had viral LRTIs in infancy. Prospective study. A cohort of prematurely born children who had symptomatic LRTIs during infancy documented, was recalled. Pulmonary function was assessed at 5 to 7 years of age and health related costs of care from aged one to follow-up determined. Fifty-one children, median gestational age 33 +6 weeks, were assessed at a median (IQR) age 7.03 (6.37-7.26) years. Twenty-one children had no LRTI, 14 RV LRTI, 10 RSV LRTI, and 6 another viral LRTI (other LRTI). Compared to the no LRTI group, the RV group had a lower FEV 1 (P = 0.033) and the other LRTI group a lower FVC (P = 0.006). Non-respiratory medication costs were higher in the RV (P = 0.018) and RSV (P = 0.013) groups. Overall respiratory healthcare costs in the RV (£153/year) and RSV (£27/year) groups did not differ significantly from the no LRTI group (£56/year); the other LRTI group (£431/year) had higher respiratory healthcare costs (P = 0.042). In moderately prematurely born children, RV and RSV LRTIs in infancy were not associated with higher respiratory healthcare costs after infancy. Children who experienced LRTIs caused by other respiratory viruses (including RV) had higher respiratory healthcare costs and greater pulmonary function impairment. © 2018 Wiley Periodicals, Inc.

  19. Breast cancer genetic counseling among Dutch patients from Turkish and Moroccan descent: participation determinants, and perspectives of patients and healthcare professionals.

    NARCIS (Netherlands)

    Baars, J.E.; Dulmen, S. van; Veldhuizen, M.E. van; Riel, E. van; Ausems, M.G.E.M.

    2017-01-01

    Abstract Lower participation rates in cancer genetic counseling are observed among different ethnic minorities. The goal of our study is to gain insight into determinants of Turkish and Moroccan patients’ participation in breast cancer genetic counseling and DNA testing, from the point of view of

  20. N- versus O-alkylation: utilizing NMR methods to establish reliable primary structure determinations for drug discovery.

    Science.gov (United States)

    LaPlante, Steven R; Bilodeau, François; Aubry, Norman; Gillard, James R; O'Meara, Jeff; Coulombe, René

    2013-08-15

    A classic synthetic issue that remains unresolved is the reaction that involves the control of N- versus O-alkylation of ambident anions. This common chemical transformation is important for medicinal chemists, who require predictable and reliable protocols for the rapid synthesis of inhibitors. The uncertainty of whether the product(s) are N- and/or O-alkylated is common and can be costly if undetermined. Herein, we report an NMR-based strategy that focuses on distinguishing inhibitors and intermediates that are N- or O-alkylated. The NMR strategy involves three independent and complementary methods. However, any combination of two of the methods can be reliable if the third were compromised due to resonance overlap or other issues. The timely nature of these methods (HSQC/HMQC, HMBC. ROESY, and (13)C shift predictions) allows for contemporaneous determination of regioselective alkylation as needed during the optimization of synthetic routes. Copyright © 2013 Elsevier Ltd. All rights reserved.

  1. The utility of ultrasonographic bone age determination in detecting growth disturbances; a comparative study with the conventional radiographic technique

    Energy Technology Data Exchange (ETDEWEB)

    Hajalioghli, Parisa; Tarzamni, Mohammad Kazem; Arami, Sara [Tabriz University of Medical Sciences, Department of Radiology, Imam Reza Teaching Hospital, Tabriz (Iran, Islamic Republic of); Fouladi, Daniel Fadaei [Tabriz University of Medical Sciences, Neurosciences Research Center, Tabriz (Iran, Islamic Republic of); Tabriz University of Medical Sciences, Imam Reza Teaching Hospital, Neurosciences Research Center, Tabriz (Iran, Islamic Republic of); Ghojazadeh, Morteza [Tabriz University of Medical Sciences, Department of Physiology, School of Medicine, Tabriz (Iran, Islamic Republic of)

    2015-09-15

    To test whether the conventional radiographic technique in determining bone age abnormalities can be replaced by ultrasonography. A total of 54 Caucasian subjects up to 7 years of age with clinically suspected growth problems underwent left hand and wrist radiographic and ultrasonographic bone age estimations with the use of the Greulich-Pyle atlas. The ultrasonographic scans targeted the ossification centers in the radius and ulna distal epiphysis, carpal bones, epiphyses of the first and third metacarpals, and epiphysis of the middle phalanx, as described in previous reports. The degree of agreement between the two sets of data, as well as the accuracy of the ultrasonographic method in detecting radiographically suggested bone age abnormities, was examined. The mean chronological age, radiographic bone age, and ultrasonographic bone age (all in months) were 41.96 ± 22.25, 26.68 ± 14.08, and 26.71 ± 13.50 in 28 boys and 43.62 ± 24.63, 30.12 ± 17.69, and 31.27 ± 18.06 in 26 girls, respectively. According to the Bland-Altman plot there was high agreement between the results of the two methods with only three outliers. The deviations in bone age from the chronological age taken by the two techniques had the same sign in all patients. Supposing radiography to be the method of reference, the sensitivity, specificity, positive predictive value, and negative predictive value of sonography in detecting growth abnormalities were all 100 % in males and 90.9, 100, 100, and 93.8 %, respectively, in females. The conventional radiographic technique for determining bone age abnormalities could be replaced by ultrasonography. (orig.)

  2. Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health

    Directory of Open Access Journals (Sweden)

    Ward Paul R

    2011-08-01

    Full Text Available Abstract Background In order to improve the health of the most vulnerable groups in society, the WHO Commission on Social Determinants of Health (CSDH called for multi-sectoral action, which requires research and policy on the multiple and inter-linking factors shaping health outcomes. Most conceptual tools available to researchers tend to focus on singular and specific social determinants of health (SDH (e.g. social capital, empowerment, social inclusion. However, a new and innovative conceptual framework, known as social quality theory, facilitates a more complex and complete understanding of the SDH, with its focus on four domains: social cohesion, social inclusion, social empowerment and socioeconomic security, all within the same conceptual framework. This paper provides both an overview of social quality theory in addition to findings from a national survey of social quality in Australia, as a means of demonstrating the operationalisation of the theory. Methods Data were collected using a national random postal survey of 1044 respondents in September, 2009. Multivariate logistic regression analysis was conducted. Results Statistical analysis revealed that people on lower incomes (less than $45000 experience worse social quality across all of the four domains: lower socio-economic security, lower levels of membership of organisations (lower social cohesion, higher levels of discrimination and less political action (lower social inclusion and lower social empowerment. The findings were mixed in terms of age, with people over 65 years experiencing lower socio-economic security, but having higher levels of social cohesion, experiencing lower levels of discrimination (higher social inclusion and engaging in more political action (higher social empowerment. In terms of gender, women had higher social cohesion than men, although also experienced more discrimination (lower social inclusion. Conclusions Applying social quality theory allows

  3. Complex problems require complex solutions: the utility of social quality theory for addressing the Social Determinants of Health.

    Science.gov (United States)

    Ward, Paul R; Meyer, Samantha B; Verity, Fiona; Gill, Tiffany K; Luong, Tini C N

    2011-08-05

    In order to improve the health of the most vulnerable groups in society, the WHO Commission on Social Determinants of Health (CSDH) called for multi-sectoral action, which requires research and policy on the multiple and inter-linking factors shaping health outcomes. Most conceptual tools available to researchers tend to focus on singular and specific social determinants of health (SDH) (e.g. social capital, empowerment, social inclusion). However, a new and innovative conceptual framework, known as social quality theory, facilitates a more complex and complete understanding of the SDH, with its focus on four domains: social cohesion, social inclusion, social empowerment and socioeconomic security, all within the same conceptual framework. This paper provides both an overview of social quality theory in addition to findings from a national survey of social quality in Australia, as a means of demonstrating the operationalisation of the theory. Data were collected using a national random postal survey of 1044 respondents in September, 2009. Multivariate logistic regression analysis was conducted. Statistical analysis revealed that people on lower incomes (less than $45000) experience worse social quality across all of the four domains: lower socio-economic security, lower levels of membership of organisations (lower social cohesion), higher levels of discrimination and less political action (lower social inclusion) and lower social empowerment. The findings were mixed in terms of age, with people over 65 years experiencing lower socio-economic security, but having higher levels of social cohesion, experiencing lower levels of discrimination (higher social inclusion) and engaging in more political action (higher social empowerment). In terms of gender, women had higher social cohesion than men, although also experienced more discrimination (lower social inclusion). Applying social quality theory allows researchers and policy makers to measure and respond to the

  4. Situation Analysis of Healthcare Service Delivery using ...

    African Journals Online (AJOL)

    ISML5

    Geography plays an important role in planning and allocation of healthcare resources for an effective and efficient ... utilization and gaps in resource allocation, and to develop propositions to support the health policy. Facility survey and .... Figure 2. Location of health centres against population density in Sironko district ...

  5. Workplace Bullying among Healthcare Workers

    Science.gov (United States)

    Ariza-Montes, Antonio; Muniz, Noel M.; Montero-Simó, María José; Araque-Padilla, Rafael Angel

    2013-01-01

    This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations—subgroup 22—(ISCO-08). The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers. PMID:23887621

  6. Workplace Bullying among Healthcare Workers

    Directory of Open Access Journals (Sweden)

    María José Montero-Simó

    2013-07-01

    Full Text Available This paper aims to assess consistent predictors through the use of a sample that includes different actors from the healthcare work force to identify certain key elements in a set of job-related organizational contexts. The utilized data were obtained from the 5th European Working Conditions Survey, conducted in 2010 by the European Foundation for the Improvement of Living and Working Conditions. In light of these objectives, we collected a subsample of 284 health professionals, some of them from the International Standard Classification of Occupations—subgroup 22—(ISCO-08. The results indicated that the chance of a healthcare worker referring to him/herself as bullied increases among those who work on a shift schedule, perform monotonous and rotating tasks, suffer from work stress, enjoy little satisfaction from their working conditions, and do not perceive opportunities for promotions in their organizations. The present work summarizes an array of outcomes and proposes within the usual course of events that workplace bullying could be reduced if job demands were limited and job resources were increased. The implications of these findings could assist human resource managers in facilitating, to some extent, good social relationships among healthcare workers.

  7. Personal utility in genomic testing: is there such a thing?

    Science.gov (United States)

    Bunnik, Eline M; Janssens, A Cecile J W; Schermer, Maartje H N

    2015-04-01

    In ethical and regulatory discussions on new applications of genomic testing technologies, the notion of 'personal utility' has been mentioned repeatedly. It has been used to justify direct access to commercially offered genomic testing or feedback of individual research results to research or biobank participants. Sometimes research participants or consumers claim a right to genomic information with an appeal to personal utility. As of yet, no systematic account of the umbrella notion of personal utility has been given. This paper offers a definition of personal utility that places it in the middle of the spectrum between clinical utility and personal perceptions of utility, and that acknowledges its normative charge. The paper discusses two perspectives on personal utility, the healthcare perspective and the consumer perspective, and argues that these are too narrow and too wide, respectively. Instead, it proposes a normative definition of personal utility that postulates information and potential use as necessary conditions of utility. This definition entails that perceived utility does not equal personal utility, and that expert judgment may be necessary to help determine whether a genomic test can have personal utility for someone. Two examples of genomic tests are presented to illustrate the discrepancies between perceived utility and our proposed definition of personal utility. The paper concludes that while there is room for the notion of personal utility in the ethical evaluation and regulation of genomic tests, the justificatory role of personal utility is not unlimited. For in the absence of clinical validity and reasonable potential use of information, there is no personal utility. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://group.bmj.com/group/rights-licensing/permissions.

  8. Consolidating a Distributed Compound Management Capability into a Single Installation: The Application of Overall Equipment Effectiveness to Determine Capacity Utilization.

    Science.gov (United States)

    Green, Clive; Taylor, Daniel

    2016-12-01

    Compound management (CM) is a critical discipline enabling hit discovery through the production of assay-ready compound plates for screening. CM in pharma requires significant investments in manpower, capital equipment, repairs and maintenance, and information technology. These investments are at risk from external factors, for example, new technology rendering existing equipment obsolete and strategic site closures. At AstraZeneca, we faced the challenge of evaluating the number of CM sites required to support hit discovery in response to site closures and pressure on our operating budget. We reasoned that overall equipment effectiveness, a tool used extensively in the manufacturing sector, could determine the equipment capacity and appropriate number of sites. We identified automation downtime as the critical component governing capacity, and a connection between automation downtime and the availability of skilled staff. We demonstrated that sufficient production capacity existed in two sites to meet hit discovery demand without the requirement for an additional investment of $7 million in new facilities. In addition, we developed an automated capacity model that incorporated an extended working-day pattern as a solution for reducing automation downtime. The application of this solution enabled the transition to a single site, with an annual cost saving of $2.1 million. © 2015 Society for Laboratory Automation and Screening.

  9. Demand for private healthcare in a universal public healthcare system: empirical evidence from Sri Lanka.

    Science.gov (United States)

    Pallegedara, Asankha; Grimm, Michael

    2017-11-01

    This paper examines healthcare utilization behaviour in Sri Lanka with special emphasis on the choice between costly private and free public healthcare services. We use a data set that combines nationwide household survey data and district level healthcare supply data. Our findings suggest that even with universal public healthcare policy, richer people tend to use private sector healthcare services rather than public services. We also find significant regional and ethnic discrepancies in healthcare access bearing the risk of social tensions if these are further amplified. Latent class analysis shows in addition that the choice between private and public sector healthcare significantly differs between people with and without chronic diseases. We find in particular that chronically ill people rely for their day-to-day care on the public sector, but for their inpatient care they turn more often than non-chronically ill people to the private sector, implying an additional financial burden for the chronically ill. If the observed trend continues it may not only increase further the health-income gradient in Sri Lanka but also undermine the willingness of the middle class to pay taxes to finance public healthcare. © The Author 2017. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

  10. A cross-sectional study to determine utility of childbirth fear screening in maternity practice - An Australian perspective.

    Science.gov (United States)

    Toohill, Jocelyn; Creedy, Debra K; Gamble, Jenny; Fenwick, Jennifer

    2015-12-01

    Low intensity anxiety in pregnancy is normal however high levels of fear affect between 20% and 25% of women, with around 10% suffering severe levels. Research from Scandinavian countries includes women with severe levels of fear, with little work undertaken in Australia. This paper explores predictors of fear and the relative benefits of screening women for childbirth fear at high or severe levels. A secondary analysis of data collected for the BELIEF study was conducted to determine differences for demographic, psycho-social and obstetric factors in women with severe fear (W-DEQ ≥85, n=68) compared to women with less or no fear (n=1318). Women with severe fear (W-DEQ ≥85, n=68) were also compared to those with high fear scores (W-DEQ ≥66-84, n=265). Logistic regression modelling was used to ascertain if screening for high or severe levels of fear is most optimal. 1386 women completed the W-DEQ. There were no differences on demographic variables between women with severe or high fear. Depression symptoms, decisional conflict and low self-efficacy predicted high and severe fear levels. Nulliparity was a predictor of high fear. A previous operative birth and having an unsupportive partner were predictors of high fear in multiparous women. Psychosocial factors were associated with both high and severe fear levels. Screening for severe fear may detect women with pre-existing mental health problems that are exacerbated by fear of birth. Australian women with high childbirth fear levels (W-DEQ ≥66) should be identified and provided appropriate support. Copyright © 2015 Australian College of Midwives. Published by Elsevier Ltd. All rights reserved.

  11. Utilizing NASA EOS to Assist in Determining Suitable Planting Locations for Bottomland Hardwood Trees in St. Bernard Parish, Louisiana

    Science.gov (United States)

    Reahard, R. R.; Arguelles, M.; Ewing, M.; Kelly, C.; Strong, E.

    2012-12-01

    St. Bernard Parish, located in southeast Louisiana, is rapidly losing coastal forests and wetlands due to a variety of natural and anthropogenic disturbances (e.g. subsidence, saltwater intrusion, low sedimentation, nutrient deficiency, herbivory, canal dredging, levee construction, spread of invasive species, etc.). After Hurricane Katrina severely impacted the area in 2005, multiple Non-Governmental Organizations (NGOs) have focused not only on rebuilding destroyed dwellings, but on rebuilding the ecosystems that once protected the citizens of St.