Health effects models for off-site radiological consequence analysis of nuclear reactor accidents

International Nuclear Information System (INIS)

Togawa, Orihiko; Homma, Toshimitsu; Matsuzuru, Hideo; Kobayashi, Sadayoshi

1991-02-01

A first version of models has been developed for predicting the number of occurrences of health effects induced by radiation exposure in nuclear reactor accidents. The models are based on the health effects models developed originally by Harvard University (NUREG/CR-4214). These models are revised on the basis of the new information on risk estimates by the reassessment of the radiation dosimetry in Hiroshima and Nagasaki. The models deal with the following effects: (1) early effects models for bone marrow, lungs, gastrointestinal tract, central nervous system, thyroid, skin and reproductive organs, using the Weibull function, (2) late somatic effects models including leukemia and cancers of breast, lungs, thyroid, gastrointestinal tract and so forth, on the basis of the information derived from epidemiological studies on the atomic bomb survivors of Hiroshima and Nagasaki, (3) models for late and developmental effects due to exposure in utero. (author)

Explanatory models concerning the effects of small-area characteristics on individual health.

Science.gov (United States)

Voigtländer, Sven; Vogt, Verena; Mielck, Andreas; Razum, Oliver

2014-06-01

Material and social living conditions at the small-area level are assumed to have an effect on individual health. We review existing explanatory models concerning the effects of small-area characteristics on health and describe the gaps future research should try to fill. Systematic literature search for, and analysis of, studies that propose an explanatory model of the relationship between small-area characteristics and health. Fourteen studies met our inclusion criteria. Using various theoretical approaches, almost all of the models are based on a three-tier structure linking social inequalities (posited at the macro-level), small-area characteristics (posited at the meso-level) and individual health (micro-level). No study explicitly defines the geographical borders of the small-area context. The health impact of the small-area characteristics is explained by specific pathways involving mediating factors (psychological, behavioural, biological). These pathways tend to be seen as uni-directional; often, causality is implied. They may be modified by individual factors. A number of issues need more attention in research on explanatory models concerning small-area effects on health. Among them are the (geographical) definition of the small-area context; the systematic description of pathways comprising small-area contextual as well as compositional factors; questions of direction of association and causality; and the integration of a time dimension.

A Bayesian localized conditional autoregressive model for estimating the health effects of air pollution.

Science.gov (United States)

Lee, Duncan; Rushworth, Alastair; Sahu, Sujit K

2014-06-01

Estimation of the long-term health effects of air pollution is a challenging task, especially when modeling spatial small-area disease incidence data in an ecological study design. The challenge comes from the unobserved underlying spatial autocorrelation structure in these data, which is accounted for using random effects modeled by a globally smooth conditional autoregressive model. These smooth random effects confound the effects of air pollution, which are also globally smooth. To avoid this collinearity a Bayesian localized conditional autoregressive model is developed for the random effects. This localized model is flexible spatially, in the sense that it is not only able to model areas of spatial smoothness, but also it is able to capture step changes in the random effects surface. This methodological development allows us to improve the estimation performance of the covariate effects, compared to using traditional conditional auto-regressive models. These results are established using a simulation study, and are then illustrated with our motivating study on air pollution and respiratory ill health in Greater Glasgow, Scotland in 2011. The model shows substantial health effects of particulate matter air pollution and nitrogen dioxide, whose effects have been consistently attenuated by the currently available globally smooth models. © 2014, The Authors Biometrics published by Wiley Periodicals, Inc. on behalf of International Biometric Society.

Estimated effect of alcohol pricing policies on health and health economic outcomes in England: an epidemiological model.

Science.gov (United States)

Purshouse, Robin C; Meier, Petra S; Brennan, Alan; Taylor, Karl B; Rafia, Rachid

2010-04-17

Although pricing policies for alcohol are known to be effective, little is known about how specific interventions affect health-care costs and health-related quality-of-life outcomes for different types of drinkers. We assessed effects of alcohol pricing and promotion policy options in various population subgroups. We built an epidemiological mathematical model to appraise 18 pricing policies, with English data from the Expenditure and Food Survey and the General Household Survey for average and peak alcohol consumption. We used results from econometric analyses (256 own-price and cross-price elasticity estimates) to estimate effects of policies on alcohol consumption. We applied risk functions from systemic reviews and meta-analyses, or derived from attributable fractions, to model the effect of consumption changes on mortality and disease prevalence for 47 illnesses. General price increases were effective for reduction of consumption, health-care costs, and health-related quality of life losses in all population subgroups. Minimum pricing policies can maintain this level of effectiveness for harmful drinkers while reducing effects on consumer spending for moderate drinkers. Total bans of supermarket and off-license discounting are effective but banning only large discounts has little effect. Young adult drinkers aged 18-24 years are especially affected by policies that raise prices in pubs and bars. Minimum pricing policies and discounting restrictions might warrant further consideration because both strategies are estimated to reduce alcohol consumption, and related health harms and costs, with drinker spending increases targeting those who incur most harm. Policy Research Programme, UK Department of Health. Copyright 2010 Elsevier Ltd. All rights reserved.

The modelling of health effects in COSYMA

International Nuclear Information System (INIS)

Ehrhardt, J.; Steinhauer, C.

1991-01-01

The presentation gives a brief overview of the types of health effects considered in each of the three subsystems of COSYMA, the way that the corresponding models are implemented and their present default parameter values. The risk of early effects is calculated using hazard functions, as recently recommended by US Nuclear Regulatory Commission and NRPB. The early fatal effects specified in COSYMA comprise those following the irradiation of the bone marrow (hematopoietic syndrome), the lung (pulmonary syndrome), the GI-tract (gastrointestinal syndrome) and skin (skin burns). In addition the mortality of pre-and neonates after exposure in utero is quantified. Of the possible non-fatal effects the only ones included are those which lead to a severe disability of the affected person for the rest of their life or which require medical treatment and/or social care

Hails from the crypt: a terror management health model investigation of the effectiveness of health-oriented versus celebrity-oriented endorsements.

Science.gov (United States)

McCabe, Simon; Vail, Kenneth E; Arndt, Jamie; Goldenberg, Jamie L

2014-03-01

Interfacing the terror management health model with the meaning transfer model, we offer novel hypotheses concerning the effectiveness of celebrity and medical endorsements for consumer products and health behavior decisions. Studies 1 and 2 revealed that, compared with control topic primes, death thoughts in focal attention increased the effectiveness of health-oriented (doctor) endorsers but not culture-oriented (celebrity) endorsers, whereas death thoughts outside of focal attention increased the effectiveness of culture-oriented endorsers but not health-oriented endorsers. Studies 3 and 4 then focus more specifically on the valence and specificity of culture-oriented endorsements, revealing that death thoughts outside focal attention increase the effectiveness of culture-oriented endorsers only on the behaviors specifically endorsed and only when the endorser is characterized as possessing cultural value. Discussion focuses on everyday management of existential concerns and implications for persuasive communications in the health domain.

Health effects models for nuclear power plant accident consequence analysis: Low LET radiation

International Nuclear Information System (INIS)

Evans, J.S.

1990-01-01

This report describes dose-response models intended to be used in estimating the radiological health effects of nuclear power plant accidents. Models of early and continuing effects, cancers and thyroid nodules, and genetic effects are provided. Weibull dose-response functions are recommended for evaluating the risks of early and continuing health effects. Three potentially lethal early effects -- the hematopoietic, pulmonary, and gastrointestinal syndromes -- are considered. In addition, models are included for assessing the risks of several nonlethal early and continuing effects -- including prodromal vomiting and diarrhea, hypothyroidism and radiation thyroiditis, skin burns, reproductive effects, and pregnancy losses. Linear and linear-quadratic models are recommended for estimating cancer risks. Parameters are given for analyzing the risks of seven types of cancer in adults -- leukemia, bone, lung, breast, gastrointestinal, thyroid, and ''other.'' The category, ''other'' cancers, is intended to reflect the combined risks of multiple myeloma, lymphoma, and cancers of the bladder, kidney, brain, ovary, uterus and cervix. Models of childhood cancers due to in utero exposure are also developed. For most cancers, both incidence and mortality are addressed. The models of cancer risk are derived largely from information summarized in BEIR III -- with some adjustment to reflect more recent studies. 64 refs., 18 figs., 46 tabs

Health effects models for nuclear power plant accident consequence analysis: Low LET radiation

Energy Technology Data Exchange (ETDEWEB)

Evans, J.S. (Harvard Univ., Boston, MA (USA). School of Public Health)

1990-01-01

This report describes dose-response models intended to be used in estimating the radiological health effects of nuclear power plant accidents. Models of early and continuing effects, cancers and thyroid nodules, and genetic effects are provided. Weibull dose-response functions are recommended for evaluating the risks of early and continuing health effects. Three potentially lethal early effects -- the hematopoietic, pulmonary, and gastrointestinal syndromes -- are considered. In addition, models are included for assessing the risks of several nonlethal early and continuing effects -- including prodromal vomiting and diarrhea, hypothyroidism and radiation thyroiditis, skin burns, reproductive effects, and pregnancy losses. Linear and linear-quadratic models are recommended for estimating cancer risks. Parameters are given for analyzing the risks of seven types of cancer in adults -- leukemia, bone, lung, breast, gastrointestinal, thyroid, and other.'' The category, other'' cancers, is intended to reflect the combined risks of multiple myeloma, lymphoma, and cancers of the bladder, kidney, brain, ovary, uterus and cervix. Models of childhood cancers due to in utero exposure are also developed. For most cancers, both incidence and mortality are addressed. The models of cancer risk are derived largely from information summarized in BEIR III -- with some adjustment to reflect more recent studies. 64 refs., 18 figs., 46 tabs.

How robust are the estimated effects of air pollution on health? Accounting for model uncertainty using Bayesian model averaging.

Science.gov (United States)

Pannullo, Francesca; Lee, Duncan; Waclawski, Eugene; Leyland, Alastair H

2016-08-01

The long-term impact of air pollution on human health can be estimated from small-area ecological studies in which the health outcome is regressed against air pollution concentrations and other covariates, such as socio-economic deprivation. Socio-economic deprivation is multi-factorial and difficult to measure, and includes aspects of income, education, and housing as well as others. However, these variables are potentially highly correlated, meaning one can either create an overall deprivation index, or use the individual characteristics, which can result in a variety of pollution-health effects. Other aspects of model choice may affect the pollution-health estimate, such as the estimation of pollution, and spatial autocorrelation model. Therefore, we propose a Bayesian model averaging approach to combine the results from multiple statistical models to produce a more robust representation of the overall pollution-health effect. We investigate the relationship between nitrogen dioxide concentrations and cardio-respiratory mortality in West Central Scotland between 2006 and 2012. Copyright © 2016 The Authors. Published by Elsevier Ltd.. All rights reserved.

Developing a model for effects of climate change on human health and health-environment interactions: Heat stress in Austin, Texas

Science.gov (United States)

Background/Question/Methods In December, 2010, a consortium of EPA, Centers for Disease Control, and state and local health officials convened in Austin, Texas for a “participatory modeling workshop” on climate change effects on human health and health-environment interactions. ...

An Effective Model for Improving Global Health Nursing Competence

OpenAIRE

Sunjoo Kang

2016-01-01

This paper proposed an effective model for improving global health nursing competence among undergraduate students. A descriptive case study was conducted by evaluation of four implemented programs by the author. All programs were conducted with students majoring in nursing and healthcare, where the researcher was a program director, professor, or facilitator. These programs were analyzed in terms of students’ needs assessment, program design, and implementation and evaluation factors. The co...

Projection models for health-effects assessment in populations exposed to radioactive and nonradioactive pollutants. Volume I. Introduction to the SPAHR demographic model for health risk

Energy Technology Data Exchange (ETDEWEB)

Collins, J.J.; Lundy, R.T.; Grahn, D.; Ginevan, M.E.

1982-09-01

The Simulation Package for the Analysis of Health Risk (SPAHR) is a computer software package based upon a demographic model for health risk projections. The model extends several health risk projection models by making realistic assumptions about the population at risk, and thus represents a distinct improvement over previous models. Complete documentation for use of SPAHR is contained in this five-volume publication. The demographic model in SPAHR estimates population response to environmental toxic exposures. Latency of response, changing dose level over time, competing risks from other causes of death, and population structure can be incorporated into SPAHR to project health risks. Risks are measured by morbid years, number of deaths, and loss of life expectancy. Comparisons of estimates of excess deaths demonstrate that previous health risk projection models may have underestimated excess deaths by a factor of from 2 to 10, depending on the pollutant and the exposure scenario. The software supporting the use of the demographic model is designed to be user oriented. Complex risk projections are made by responding to a series of prompts generated by the package. The flexibility and ease of use of SPAHR make it an important contribution to existing models and software packages. The first volume presents the theory behind the SPAHR health risk projection model and several applications of the model to actual pollution episodes. The elements required for an effective health risk projection model are specified, and the models that have been used to date in health risk projections are outlined. These are compared with the demographic model, whose formulation is described in detail. Examples of the application of air pollution and radiation dose-response functions are included in order to demonstrate the estimation of future mortality and morbidity levels and the range of variation in excess deaths that occurs when populations structure is changed.

Projection models for health-effects assessment in populations exposed to radioactive and nonradioactive pollutants. Volume I. Introduction to the SPAHR demographic model for health risk

International Nuclear Information System (INIS)

Collins, J.J.; Lundy, R.T.; Grahn, D.; Ginevan, M.E.

1982-09-01

The Simulation Package for the Analysis of Health Risk (SPAHR) is a computer software package based upon a demographic model for health risk projections. The model extends several health risk projection models by making realistic assumptions about the population at risk, and thus represents a distinct improvement over previous models. Complete documentation for use of SPAHR is contained in this five-volume publication. The demographic model in SPAHR estimates population response to environmental toxic exposures. Latency of response, changing dose level over time, competing risks from other causes of death, and population structure can be incorporated into SPAHR to project health risks. Risks are measured by morbid years, number of deaths, and loss of life expectancy. Comparisons of estimates of excess deaths demonstrate that previous health risk projection models may have underestimated excess deaths by a factor of from 2 to 10, depending on the pollutant and the exposure scenario. The software supporting the use of the demographic model is designed to be user oriented. Complex risk projections are made by responding to a series of prompts generated by the package. The flexibility and ease of use of SPAHR make it an important contribution to existing models and software packages. The first volume presents the theory behind the SPAHR health risk projection model and several applications of the model to actual pollution episodes. The elements required for an effective health risk projection model are specified, and the models that have been used to date in health risk projections are outlined. These are compared with the demographic model, whose formulation is described in detail. Examples of the application of air pollution and radiation dose-response functions are included in order to demonstrate the estimation of future mortality and morbidity levels and the range of variation in excess deaths that occurs when populations structure is changed

Multipollutant health effect simulations

Data.gov (United States)

U.S. Environmental Protection Agency — Resulting betas (health effects) from a variety of copollutant epidemiologic models used to analyze the impact of exposure measurement error on health effect...

Modeling Health Care Expenditures and Use.

Science.gov (United States)

Deb, Partha; Norton, Edward C

2018-04-01

Health care expenditures and use are challenging to model because these dependent variables typically have distributions that are skewed with a large mass at zero. In this article, we describe estimation and interpretation of the effects of a natural experiment using two classes of nonlinear statistical models: one for health care expenditures and the other for counts of health care use. We extend prior analyses to test the effect of the ACA's young adult expansion on three different outcomes: total health care expenditures, office-based visits, and emergency department visits. Modeling the outcomes with a two-part or hurdle model, instead of a single-equation model, reveals that the ACA policy increased the number of office-based visits but decreased emergency department visits and overall spending.

Financial Effect of a Drug Distribution Model Change on a Health System.

Science.gov (United States)

Turingan, Erin M; Mekoba, Bijan C; Eberwein, Samuel M; Roberts, Patricia A; Pappas, Ashley L; Cruz, Jennifer L; Amerine, Lindsey B

2017-06-01

Background: Drug manufacturers change distribution models based on patient safety and product integrity needs. These model changes can limit health-system access to medications, and the financial impact on health systems can be significant. Objective: The primary aim of this study was to determine the health-system financial impact of a manufacturer's change from open to limited distribution for bevacizumab (Avastin), rituximab (Rituxan), and trastuzumab (Herceptin). The secondary aim was to identify opportunities to shift administration to outpatient settings to support formulary change. Methods: To assess the financial impact on the health system, the cost minus discount was applied to total drug expenditure during a 1-year period after the distribution model change. The opportunity analysis was conducted for three institutions within the health system through chart review of each inpatient administration. Opportunity cost was the sum of the inpatient administration cost and outpatient administration margin. Results: The total drug expenditure for the study period was $26 427 263. By applying the cost minus discount, the financial effect of the distribution model change was $1 393 606. A total of 387 administrations were determined to be opportunities to be shifted to the outpatient setting. During the study period, the total opportunity cost was $1 766 049. Conclusion: Drug expenditure increased for the health system due to the drug distribution model change and loss of cost minus discount. The opportunity cost of shifting inpatient administrations could offset the increase in expenditure. It is recommended to restrict bevacizumab, rituximab, and trastuzumab through Pharmacy & Therapeutics Committees to outpatient use where clinically appropriate.

The Effect of Occupational Stress on Health and Illness: A Model.

Science.gov (United States)

Taylor, William L.; Cangemi, Joseph P.

1988-01-01

Examines brief history of stress research and concludes that psychological factors can affect job satisfaction, work adjustment, work attitudes, and overall well-being in the work environment. Establishes relationship between mental and physiological functioning disturbances. Presents model relating effect of stress on health and illness. (Author)

Developing a model for effects of climate change on human health and health-environment interactions: Heat stress in Austin, Texas presentation

Science.gov (United States)

Background/Question/Methods In December, 2010, a consortium of EPA, Centers for Disease Control, and state and local health officials convened in Austin, Texas for a “participatory modeling workshop” on climate change effects on human health and health-environment int...

Cost-effectiveness of screening for HIV in primary care: a health economics modelling analysis.

Science.gov (United States)

Baggaley, Rebecca F; Irvine, Michael A; Leber, Werner; Cambiano, Valentina; Figueroa, Jose; McMullen, Heather; Anderson, Jane; Santos, Andreia C; Terris-Prestholt, Fern; Miners, Alec; Hollingsworth, T Déirdre; Griffiths, Chris J

2017-10-01

Early HIV diagnosis reduces morbidity, mortality, the probability of onward transmission, and their associated costs, but might increase cost because of earlier initiation of antiretroviral treatment (ART). We investigated this trade-off by estimating the cost-effectiveness of HIV screening in primary care. We modelled the effect of the four-times higher diagnosis rate observed in the intervention arm of the RHIVA2 randomised controlled trial done in Hackney, London (UK), a borough with high HIV prevalence (≥0·2% adult prevalence). We constructed a dynamic, compartmental model representing incidence of infection and the effect of screening for HIV in general practices in Hackney. We assessed cost-effectiveness of the RHIVA2 trial by fitting model diagnosis rates to the trial data, parameterising with epidemiological and behavioural data from the literature when required, using trial testing costs and projecting future costs of treatment. Over a 40 year time horizon, incremental cost-effectiveness ratios were £22 201 (95% credible interval 12 662-132 452) per quality-adjusted life-year (QALY) gained, £372 207 (268 162-1 903 385) per death averted, and £628 874 (434 902-4 740 724) per HIV transmission averted. Under this model scenario, with UK cost data, RHIVA2 would reach the upper National Institute for Health and Care Excellence cost-effectiveness threshold (about £30 000 per QALY gained) after 33 years. Scenarios using cost data from Canada (which indicate prolonged and even higher health-care costs for patients diagnosed late) suggest this threshold could be reached in as little as 13 years. Screening for HIV in primary care has important public health benefits as well as clinical benefits. We predict it to be cost-effective in the UK in the medium term. However, this intervention might be cost-effective far sooner, and even cost-saving, in settings where long-term health-care costs of late-diagnosed patients in high

Critical review of the reactor-safety study radiological health effects model. Final report

Energy Technology Data Exchange (ETDEWEB)

Cooper, D.W.; Evans, J.S.; Jacob, N.; Kase, K.R.; Maletskos, C.J.; Robertson, J.B.; Smith, D.G.

1983-03-01

This review of the radiological health effects models originally presented in the Reactor Safety Study (RSS) and currently used by the US Nuclear Regulatory Commission (NRC) was undertaken to assist the NRC in determining whether or not to revise the models and to aid in the revision, if undertaken. The models as presented in the RSS and as implemented in the CRAC (Calculations of Reactor Accident Consequences) Code are described and critiqued. The major elements analyzed are those concerning dosimetry, early effects, and late effects. The published comments on the models are summarized, as are the important findings since the publication of the RSS.

Critical review of the reactor-safety study radiological health effects model. Final report

International Nuclear Information System (INIS)

Cooper, D.W.; Evans, J.S.; Jacob, N.; Kase, K.R.; Maletskos, C.J.; Robertson, J.B.; Smith, D.G.

1983-03-01

This review of the radiological health effects models originally presented in the Reactor Safety Study (RSS) and currently used by the US Nuclear Regulatory Commission (NRC) was undertaken to assist the NRC in determining whether or not to revise the models and to aid in the revision, if undertaken. The models as presented in the RSS and as implemented in the CRAC (Calculations of Reactor Accident Consequences) Code are described and critiqued. The major elements analyzed are those concerning dosimetry, early effects, and late effects. The published comments on the models are summarized, as are the important findings since the publication of the RSS

Health effects models for nuclear power plant accident consequence analysis. Part 1, Introduction, integration, and summary: Revision 2

Energy Technology Data Exchange (ETDEWEB)

Evans, J.S. [Harvard School of Public Health, Boston, MA (United States); Abrahmson, S. [Wisconsin Univ., Madison, WI (United States); Bender, M.A. [Brookhaven National Lab., Upton, NY (United States); Boecker, B.B.; Scott, B.R. [Inhalation Toxicology Research Inst., Albuquerque, NM (United States); Gilbert, E.S. [Battelle Pacific Northwest Lab., Richland, WA (United States)

1993-10-01

This report is a revision of NUREG/CR-4214, Rev. 1, Part 1 (1990), Health Effects Models for Nuclear Power Plant Accident Consequence Analysis. This revision has been made to incorporate changes to the Health Effects Models recommended in two addenda to the NUREG/CR-4214, Rev. 1, Part 11, 1989 report. The first of these addenda provided recommended changes to the health effects models for low-LET radiations based on recent reports from UNSCEAR, ICRP and NAS/NRC (BEIR V). The second addendum presented changes needed to incorporate alpha-emitting radionuclides into the accident exposure source term. As in the earlier version of this report, models are provided for early and continuing effects, cancers and thyroid nodules, and genetic effects. Weibull dose-response functions are recommended for evaluating the risks of early and continuing health effects. Three potentially lethal early effects -- the hematopoietic, pulmonary, and gastrointestinal syndromes are considered. Linear and linear-quadratic models are recommended for estimating the risks of seven types of cancer in adults - leukemia, bone, lung, breast, gastrointestinal, thyroid, and ``other``. For most cancers, both incidence and mortality are addressed. Five classes of genetic diseases -- dominant, x-linked, aneuploidy, unbalanced translocations, and multifactorial diseases are also considered. Data are provided that should enable analysts to consider the timing and severity of each type of health risk.

Statistical Models to Assess the Health Effects and to Forecast Ground Level Ozone

Czech Academy of Sciences Publication Activity Database

Schlink, U.; Herbath, O.; Richter, M.; Dorling, S.; Nunnari, G.; Cawley, G.; Pelikán, Emil

2006-01-01

Roč. 21, č. 4 (2006), s. 547-558 ISSN 1364-8152 R&D Projects: GA AV ČR 1ET400300414 Institutional research plan: CEZ:AV0Z10300504 Keywords : statistical models * ground level ozone * health effects * logistic model * forecasting * prediction performance * neural network * generalised additive model * integrated assessment Subject RIV: BB - Applied Statistics, Operational Research Impact factor: 1.992, year: 2006

Description of the CEEH health effect model. CEEH scientific report no. 7a

Energy Technology Data Exchange (ETDEWEB)

Boenloekke, J.H.; Sigsgaard, T. (Aarhus Univ. Dept. of of Public Health, AArhus (Denmark)); Brandt, J.; Frohn, L.M. (Aarhus Univ. National Environmental Research Institute, Dept. of Atmospheric Environment, Roskilde (Denmark)); Flachs, E.M.; Broennum-Hansen, H. (Univ. of Southern Denmark. National Institute of Public Health, Copenhagen (Denmark)); Siggaard-Andersen4, M.-L. (Univ. of Copenhagen. Niels Bohr Institute, Copenhagen (Denmark))

2011-11-15

This report is based on a number of up-to-date reviews of the existing literature on health effects from air pollution at the population level and conclude with recommendations for CEEH. The pollutants in the CEEH models have been selected based on the following criteria: 1) They stem from combustion sources either directly or via chemical transformations. This may include evaporation or dust from the energy sources themselves (i.e. from wear and tear). Other pollution derived from energy production but not liberated to the air is not included (e.g. heavy metals in soil deposits). However, heavy metals, dioxins and possibly PAHs that are emitted to the air, deposit on soil or in water and end up by being ingested should ideally be covered by CEEH. 2) Be possible to model in the CEEH settings both in terms of emissions, chemical transformations and transport. 3) Be sufficiently investigated in terms of documented health effects and in terms of the costs associated with these health effects. Combustion sources and accordingly combustion products are highly diverse and widespread. In practice, therefore, not all sources that contribute to health effects in humans can be included in the CEEH models. Other sources than combustion contribute some of the pollutants and as a result a brief discussion of the relevance and effect of such non-combustion derived air pollutants is included in this report. For a more comprehensive discussion of secondary pollutants from e.g. agricultural activities the reader is referred to CEEH report no. 3. The EVA model was based on existing European models such as EcoSense 4.0 from ExternE and used the same air pollution products as these in the versions available in 2003-4. With time EVA has changed independently from its predecessors. A more recent version of the ExternE methods is now available (ExternE, 2005). The pollutants ontained by ExternE are provided in table 1. Pollutants originally included in EVA are the following: SO2, O3, PM2

The Fixed-Effects Zero-Inflated Poisson Model with an Application to Health Care Utilization

NARCIS (Netherlands)

Majo, M.C.; van Soest, A.H.O.

2011-01-01

Response variables that are scored as counts and that present a large number of zeros often arise in quantitative health care analysis. We define a zero-in flated Poisson model with fixed-effects in both of its equations to identify respondent and health-related characteristics associated with

The Effect of Health Beliefs, Media Perceptions, and Communicative Behaviors on Health Behavioral Intention: An Integrated Health Campaign Model on Social Media.

Science.gov (United States)

Yoo, Sun-Wook; Kim, Jarim; Lee, Yeunjae

2018-01-01

Social media have recently gained attention as a potential health campaign tool. This study examines this line of expectation concerning the role social media may play in health campaigns by testing an integrated health campaign model that combines insights from research on social media-specific perceptions and communicative behaviors in order to predict health behaviors. Specifically, this study aims to (a) develop a more holistic social media campaign model for predicting health behaviors in the social media context, (b) investigate how social media channel-related perceptions affect preventive health behaviors, and (c) investigate how communicative behaviors mediate perceptions and behavioral intention. The study conducted an online survey of 498 females who followed the Purple Ribbon Twitter campaign (@pprb), a cervical cancer prevention campaign. The results indicated that information acquisition mediated perceived risk's effect on intention. Information acquisition also mediated the relationships between intention and information selection and information transmission. On the other hand, social media-related perceptions indirectly impacted behavioral intention through communicative behaviors. The findings' theoretical and practical implications are discussed.

Prediction of health effects of cross-border atmospheric pollutants using an aerosol forecast model.

Science.gov (United States)

Onishi, Kazunari; Sekiyama, Tsuyoshi Thomas; Nojima, Masanori; Kurosaki, Yasunori; Fujitani, Yusuke; Otani, Shinji; Maki, Takashi; Shinoda, Masato; Kurozawa, Youichi; Yamagata, Zentaro

2018-08-01

Health effects of cross-border air pollutants and Asian dust are of significant concern in Japan. Currently, models predicting the arrival of aerosols have not investigated the association between arrival predictions and health effects. We investigated the association between subjective health symptoms and unreleased aerosol data from the Model of Aerosol Species in the Global Atmosphere (MASINGAR) acquired from the Japan Meteorological Agency, with the objective of ascertaining if these data could be applied to predicting health effects. Subjective symptom scores were collected via self-administered questionnaires and, along with modeled surface aerosol concentration data, were used to conduct a risk evaluation using generalized estimating equations between October and November 2011. Altogether, 29 individuals provided 1670 responses. Spearman's correlation coefficients were determined for the relationship between the proportion of the participants reporting the maximum score of two or more for each symptom and the surface concentrations for each considered aerosol species calculated using MASINGAR; the coefficients showed significant intermediate correlations between surface sulfate aerosol concentration and respiratory, throat, and fever symptoms (R = 0.557, 0.454, and 0.470, respectively; p < 0.01). In the general estimation equation (logit link) analyses, a significant linear association of surface sulfate aerosol concentration, with an endpoint determined by reported respiratory symptom scores of two or more, was observed (P trend = 0.001, odds ratio [OR] of the highest quartile [Q4] vs. the lowest [Q1] = 5.31, 95% CI = 2.18 to 12.96), with adjustment for potential confounding. The surface sulfate aerosol concentration was also associated with throat and fever symptoms. In conclusion, our findings suggest that modeled data are potentially useful for predicting health risks of cross-border aerosol arrivals. Copyright © 2018 Elsevier Ltd

Modeled PM2.5 removal by trees in ten US cities and associated health effects

Science.gov (United States)

David J. Nowak; Satoshi Hirabayashi; Allison Bodine; Robert. Hoehn

2013-01-01

Urban particulate air pollution is a serious health issue. Trees within cities can remove fine particles from the atmosphere and consequently improve air quality and human health. Tree effects on PM2.5 concentrations and human health are modeled for 10 U.S. cities. The total amount of PM2.5 removed annually by...

The use of random-effects models to identify health care center-related characteristics modifying the effect of antipsychotic drugs

Directory of Open Access Journals (Sweden)

Nordon C

2017-12-01

Full Text Available Clementine Nordon,1 Constance Battin,1 Helene Verdoux,2 Josef Maria Haro,3 Mark Belger,4 Lucien Abenhaim,1 Tjeerd Pieter van Staa5 On behalf of the IMI GetReal WP2 Group 1Epidemiological Research, Analytica LASER, Paris, 2Population Health Research Center, Team Pharmaco-Epidemiology, UMR 1219, Bordeaux-2 University, INSERM, Bordeaux, France; 3Parc Sanitari Sant Joan de Deu, CIBERSAM, University of Barcelona, Barcelona, Spain; 4Eli Lilly and Company Limited, Erl Wood Manor, Windlesham, 5Farr Institute, University of Manchester, Manchester, UK Purpose: A case study was conducted, exploring methods to identify drugs effects modifiers, at a health care center level.Patients and methods: Data were drawn from the Schizophrenia Outpatient Health Outcome cohort, including hierarchical information on 6641 patients, recruited from 899 health care centers from across ten European countries. Center-level characteristics included the following: psychiatrist’s gender, age, length of practice experience, practice setting and type, countries’ Healthcare System Efficiency score, and psychiatrist density in the country. Mixed multivariable linear regression models were used: 1 to estimate antipsychotic drugs’ effectiveness (defined as the association between patients’ outcome at 3 months – dependent variable, continuous – and antipsychotic drug initiation at baseline – drug A vs other antipsychotic drug; 2 to estimate the similarity between clustered data (using the intra-cluster correlation coefficient; and 3 to explore antipsychotic drug effects modification by center-related characteristics (using the addition of an interaction term.Results: About 23% of the variance found for patients’ outcome was explained by unmeasured confounding at a center level. Psychiatrists’ practice experience was found to be associated with patient outcomes (p=0.04 and modified the relative effect of “drug A” (p<0.001, independent of center- or patient

An effective model for store and retrieve big health data in cloud computing.

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Goli-Malekabadi, Zohreh; Sargolzaei-Javan, Morteza; Akbari, Mohammad Kazem

2016-08-01

The volume of healthcare data including different and variable text types, sounds, and images is increasing day to day. Therefore, the storage and processing of these data is a necessary and challenging issue. Generally, relational databases are used for storing health data which are not able to handle the massive and diverse nature of them. This study aimed at presenting the model based on NoSQL databases for the storage of healthcare data. Despite different types of NoSQL databases, document-based DBs were selected by a survey on the nature of health data. The presented model was implemented in the Cloud environment for accessing to the distribution properties. Then, the data were distributed on the database by applying the Shard property. The efficiency of the model was evaluated in comparison with the previous data model, Relational Database, considering query time, data preparation, flexibility, and extensibility parameters. The results showed that the presented model approximately performed the same as SQL Server for "read" query while it acted more efficiently than SQL Server for "write" query. Also, the performance of the presented model was better than SQL Server in the case of flexibility, data preparation and extensibility. Based on these observations, the proposed model was more effective than Relational Databases for handling health data. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Taxes and Subsidies for Improving Diet and Population Health in Australia: A Cost-Effectiveness Modelling Study.

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Cobiac, Linda J; Tam, King; Veerman, Lennert; Blakely, Tony

2017-02-01

An increasing number of countries are implementing taxes on unhealthy foods and drinks to address the growing burden of dietary-related disease, but the cost-effectiveness of combining taxes on unhealthy foods and subsidies on healthy foods is not well understood. Using a population model of dietary-related diseases and health care costs and food price elasticities, we simulated the effect of taxes on saturated fat, salt, sugar, and sugar-sweetened beverages and a subsidy on fruits and vegetables, over the lifetime of the Australian population. The sizes of the taxes and subsidy were set such that, when combined as a package, there would be a negligible effect on average weekly expenditure on food (beverage tax (12,000 [95% UI: 2,100 to 21,000] DALYs). The fruit and vegetable subsidy (-13,000 [95% UI: -44,000 to 18,000] DALYs) was a cost-effective addition to the package of taxes. However, it did not necessarily lead to a net health benefit for the population when modelled as an intervention on its own, because of the possible adverse cross-price elasticity effects on consumption of other foods (e.g., foods high in saturated fat and salt). The study suggests that taxes and subsidies on foods and beverages can potentially be combined to achieve substantial improvements in population health and cost-savings to the health sector. However, the magnitude of health benefits is sensitive to measures of price elasticity, and further work is needed to incorporate potential benefits or harms associated with changes in other foods and nutrients that are not currently modelled, such as red and processed meats and fibre. With potentially large health benefits for the Australian population and large benefits in reducing health sector spending on the treatment of non-communicable diseases, the formulation of a tax and subsidy package should be given a more prominent role in Australia's public health nutrition strategy.

The effects of the Danish saturated fat tax on food and nutrient intake and modelled health outcomes

DEFF Research Database (Denmark)

Smed, Sinne; Scarborough, P.; Rayner, M.

2016-01-01

Integrated ModEl)) to estimate the effect of these changes on non-communicable diseases (NCDs) and mortality. Results: The tax resulted in a 4.0% reduction in saturated fat intake. Vegetable consumption increased, and salt consumption increased for most individuals, except younger females. We find a modelled......Background/Objective: The World Health Organisation recommends governments to consider the use of fiscal policies to promote healthy eating. However, there is very limited evidence of the effect of food taxation in a real-life setting, as most evidence is based on simulation studies. The objective...... reduction in mortality with 123 lives saved annually, 76 of them below 75 years equal to 0.4% of all deaths from NCDs. Conclusions: Modelling the effect of the changes in diet on health outcomes suggests that the saturated fat tax made a positive, but minor, contribution to public health in Denmark....

The use of random-effects models to identify health care center-related characteristics modifying the effect of antipsychotic drugs.

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Nordon, Clementine; Battin, Constance; Verdoux, Helene; Haro, Josef Maria; Belger, Mark; Abenhaim, Lucien; van Staa, Tjeerd Pieter

2017-01-01

A case study was conducted, exploring methods to identify drugs effects modifiers, at a health care center level. Data were drawn from the Schizophrenia Outpatient Health Outcome cohort, including hierarchical information on 6641 patients, recruited from 899 health care centers from across ten European countries. Center-level characteristics included the following: psychiatrist's gender, age, length of practice experience, practice setting and type, countries' Healthcare System Efficiency score, and psychiatrist density in the country. Mixed multivariable linear regression models were used: 1) to estimate antipsychotic drugs' effectiveness (defined as the association between patients' outcome at 3 months - dependent variable, continuous - and antipsychotic drug initiation at baseline - drug A vs other antipsychotic drug); 2) to estimate the similarity between clustered data (using the intra-cluster correlation coefficient); and 3) to explore antipsychotic drug effects modification by center-related characteristics (using the addition of an interaction term). About 23% of the variance found for patients' outcome was explained by unmeasured confounding at a center level. Psychiatrists' practice experience was found to be associated with patient outcomes ( p =0.04) and modified the relative effect of "drug A" ( p <0.001), independent of center- or patient-related characteristics. Mixed models may be useful to explore how center-related characteristics modify drugs' effect estimates, but require numerous assumptions.

Integrating health belief model and technology acceptance model: an investigation of health-related internet use.

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Ahadzadeh, Ashraf Sadat; Pahlevan Sharif, Saeed; Ong, Fon Sim; Khong, Kok Wei

2015-02-19

Today, people use the Internet to satisfy health-related information and communication needs. In Malaysia, Internet use for health management has become increasingly significant due to the increase in the incidence of chronic diseases, in particular among urban women and their desire to stay healthy. Past studies adopted the Technology Acceptance Model (TAM) and Health Belief Model (HBM) independently to explain Internet use for health-related purposes. Although both the TAM and HBM have their own merits, independently they lack the ability to explain the cognition and the related mechanism in which individuals use the Internet for health purposes. This study aimed to examine the influence of perceived health risk and health consciousness on health-related Internet use based on the HBM. Drawing on the TAM, it also tested the mediating effects of perceived usefulness of the Internet for health information and attitude toward Internet use for health purposes for the relationship between health-related factors, namely perceived health risk and health consciousness on health-related Internet use. Data obtained for the current study were collected using purposive sampling; the sample consisted of women in Malaysia who had Internet access. The partial least squares structural equation modeling method was used to test the research hypotheses developed. Perceived health risk (β=.135, t1999=2.676) and health consciousness (β=.447, t1999=9.168) had a positive influence on health-related Internet use. Moreover, perceived usefulness of the Internet and attitude toward Internet use for health-related purposes partially mediated the influence of health consciousness on health-related Internet use (β=.025, t1999=3.234), whereas the effect of perceived health risk on health-related Internet use was fully mediated by perceived usefulness of the Internet and attitude (β=.029, t1999=3.609). These results suggest the central role of perceived usefulness of the Internet and

Home modification to reduce falls at a health district level: Modeling health gain, health inequalities and health costs.

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Nick Wilson

Full Text Available There is some evidence that home safety assessment and modification (HSAM is effective in reducing falls in older people. But there are various knowledge gaps, including around cost-effectiveness and also the impacts at a health district-level.A previously established Markov macro-simulation model built for the whole New Zealand (NZ population (Pega et al 2016, Injury Prevention was enhanced and adapted to a health district level. This district was Counties Manukau District Health Board, which hosts 42,000 people aged 65+ years. A health system perspective was taken and a discount rate of 3% was used for both health gain and costs. Intervention effectiveness estimates came from a systematic review, and NZ-specific intervention costs were extracted from a randomized controlled trial. In the 65+ age-group in this health district, the HSAM program was estimated to achieve health gains of 2800 quality-adjusted life-years (QALYs; 95% uncertainty interval [UI]: 547 to 5280. The net health system cost was estimated at NZ$8.44 million (95% UI: $663 to $14.3 million. The incremental cost-effectiveness ratio (ICER was estimated at NZ$5480 suggesting HSAM is cost-effective (95%UI: cost saving to NZ$15,300 [equivalent to US$10,300]. Targeting HSAM only to people age 65+ or 75+ with previous injurious falls was estimated to be particularly cost-effective (ICERs: $700 and $832, respectively with the latter intervention being cost-saving. There was no evidence for differential cost-effectiveness by sex or by ethnicity: Māori (Indigenous population vs non-Māori.This modeling study suggests that a HSAM program could produce considerable health gain and be cost-effective for older people at a health district level. Nevertheless, comparisons may be desirable with other falls prevention interventions such as group exercise programs, which also provide social contact and may prevent various chronic diseases.

An Effective Model for Improving Global Health Nursing Competence.

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Kang, Sun-Joo

2016-01-01

This paper proposed an effective model for improving global health nursing competence among undergraduate students. A descriptive case study was conducted by evaluation of four implemented programs by the author. All programs were conducted with students majoring in nursing and healthcare, where the researcher was a program director, professor, or facilitator. These programs were analyzed in terms of students' needs assessment, program design, and implementation and evaluation factors. The concept and composition of global nursing competence, identified within previous studies, were deemed appropriate in all of our programs. Program composition varied from curricular to extracurricular domains. During the implementation phase, some of the programs included non-Korean students to improve cultural diversity and overcome language barriers. Qualitative and quantitative surveys were conducted to assess program efficacy. Data triangulation from students' reflective journals was examined. Additionally, students' awareness regarding changes within global health nursing, improved critical thinking, cultural understanding, and global leadership skills were investigated pre- and post-program implementation. The importance of identifying students' needs regarding global nursing competence when developing appropriate curricula is discussed.

An Effective Model for Improving Global Health Nursing Competence

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Sunjoo Kang

2016-09-01

Full Text Available This paper developed an effective model for improving global health nursing competence among undergraduate students. A descriptive case study was conducted by implementing four programs. All programs were conducted with students majoring nursing and healthcare, where the researcher was a program director, professor, or facilitator. These programs were analyzed in terms of students’ needs assessment, program design, and implementation and evaluation factors. The concept and composition of global nursing competence, identified within previous studies, were deemed appropriate in all of our programs. Program composition varied from curricular to extracurricular domains. During the implementation phase, most of the programs included non-Korean students to improve cultural diversity and overcome language barriers. Qualitative and quantitative surveys were conducted to assess program efficacy. Data triangulation from students’ reflective journals was examined. Additionally, students’ awareness regarding changes within global health nursing, improved critical thinking, cultural understanding, and global leadership skills were investigated pre and post-program implementation. We discuss how identifying students’ needs regarding global nursing competence when developing appropriate curricula.

The application of the health effects models to the severe accident consequence analysis of nuclear power plants

International Nuclear Information System (INIS)

Yang Ling; Yeung, M.R.

1998-01-01

Health Effect Model (HEM) is an important model used in the analysis of severe accidents consequence of the Nuclear Power Plants (NPP). The accuracy of HEM affects the reliability of the assessment for the accidents consequences, and furthermore, the effectiveness of the emergency countermeasures taken for the health protection of the public around the NPPs. Based on the NUREG/CR4214 series reports, the paper sets appropriate parameters for HEM by studying both early and late HEMs used for domestic NPP accident consequence analysis. In the study, the Guangdong Daya Bay NPP is chosen as an example study to calculate the health risk of the Hong Kong population caused by Daya Bay NPP

Letter to the Editor: Applications Air Q Model on Estimate Health Effects Exposure to Air Pollutants

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Gholamreza Goudarzi

2016-02-01

Full Text Available Epidemiologic studies in worldwide have measured increases in mortality and morbidity associated with air pollution (1-3. Quantifying the effects of air pollution on the human health in urban area causes an increasingly critical component in policy discussion (4-6. Air Q model was proved to be a valid and reliable tool to predicts health effects related to criteria  pollutants (particulate matter (PM, ozone (O3, nitrogen dioxide (NO2, sulfur dioxide (SO2, and carbon monoxide (CO, determinate  the  potential short term effects of air pollution  and allows the examination of various scenarios in which emission rates of pollutants are varied (7,8. Air Q software provided by the WHO European Centre for Environment and Health (ECEH (9. Air Q model is based on cohort studies and used to estimates of both attributable average reductions in life-span and numbers of mortality and morbidity associated with exposure to air pollution (10,11. Applications

Development of a health information technology acceptance model using consumers' health behavior intention.

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Kim, Jeongeun; Park, Hyeoun-Ae

2012-10-01

For effective health promotion using health information technology (HIT), it is mandatory that health consumers have the behavioral intention to measure, store, and manage their own health data. Understanding health consumers' intention and behavior is needed to develop and implement effective and efficient strategies. To develop and verify the extended Technology Acceptance Model (TAM) in health care by describing health consumers' behavioral intention of using HIT. This study used a cross-sectional descriptive correlational design. We extended TAM by adding more antecedents and mediating variables to enhance the model's explanatory power and to make it more applicable to health consumers' behavioral intention. Additional antecedents and mediating variables were added to the hypothetical model, based on their theoretical relevance, from the Health Belief Model and theory of planned behavior, along with the TAM. We undertook structural equation analysis to examine the specific nature of the relationship involved in understanding consumers' use of HIT. Study participants were 728 members recruited from three Internet health portals in Korea. Data were collected by a Web-based survey using a structured self-administered questionnaire. The overall fitness indices for the model developed in this study indicated an acceptable fit of the model. All path coefficients were statistically significant. This study showed that perceived threat, perceived usefulness, and perceived ease of use significantly affected health consumers' attitude and behavioral intention. Health consumers' health status, health belief and concerns, subjective norm, HIT characteristics, and HIT self-efficacy had a strong indirect impact on attitude and behavioral intention through the mediators of perceived threat, perceived usefulness, and perceived ease of use. An extended TAM in the HIT arena was found to be valid to describe health consumers' behavioral intention. We categorized the concepts in

Modeling the mental health effects of victimization among homeless persons

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Perron, Brian Edward; Alexander-Eitzman, Ben; Gillespie, David F.; Pollio, David

2014-01-01

Homeless persons are victims of violent and non-violent crime at higher rates than housed populations. While studies have suggested that victimization can induce or exacerbate mental health problems, there is very little known about factors that may buffer the effects of victimization. This cross-sectional study examined the influence of victimization on depressive symptoms in over 9600 homeless and mentally ill adults participating in the Access to Community Care and Effective Services and Supports study (ACCESS) conducted in multiple cities across the USA relationships between victimization, depressive symptoms, and perceived safety were tested within a structural equation modeling framework using data collected at the baseline interview. The overall model exhibited a good fit with the data. Non-physical victimization was associated with higher levels of depressive symptoms, and physical victimization was associated with lower levels of perceived safety. As hypothesized, perceived safety was a significant partial mediator of depressive symptoms. These results underscore the complexity of the relationships between victimization and depression in homeless adults and the importance of addressing different types of victimization in homeless and mentally ill adults. PMID:18703266

Modeling the mental health effects of victimization among homeless persons.

Science.gov (United States)

Perron, Brian Edward; Alexander-Eitzman, Ben; Gillespie, David F; Pollio, David

2008-11-01

Homeless persons are victims of violent and non-violent crime at higher rates than housed populations. While studies have suggested that victimization can induce or exacerbate mental health problems, there is very little known about factors that may buffer the effects of victimization. This cross-sectional study examined the influence of victimization on depressive symptoms in over 9600 homeless and mentally ill adults participating in the Access to Community Care and Effective Services and Supports study (ACCESS) conducted in multiple cities across the USA relationships between victimization, depressive symptoms, and perceived safety were tested within a structural equation modeling framework using data collected at the baseline interview. The overall model exhibited a good fit with the data. Non-physical victimization was associated with higher levels of depressive symptoms, and physical victimization was associated with lower levels of perceived safety. As hypothesized, perceived safety was a significant partial mediator of depressive symptoms. These results underscore the complexity of the relationships between victimization and depression in homeless adults and the importance of addressing different types of victimization in homeless and mentally ill adults.

Spatial Temporal Modelling of Particulate Matter for Health Effects Studies

Science.gov (United States)

Hamm, N. A. S.

2016-10-01

Epidemiological studies of the health effects of air pollution require estimation of individual exposure. It is not possible to obtain measurements at all relevant locations so it is necessary to predict at these space-time locations, either on the basis of dispersion from emission sources or by interpolating observations. This study used data obtained from a low-cost sensor network of 32 air quality monitoring stations in the Dutch city of Eindhoven, which make up the ILM (innovative air (quality) measurement system). These stations currently provide PM10 and PM2.5 (particulate matter less than 10 and 2.5 m in diameter), aggregated to hourly means. The data provide an unprecedented level of spatial and temporal detail for a city of this size. Despite these benefits the time series of measurements is characterized by missing values and noisy values. In this paper a space-time analysis is presented that is based on a dynamic model for the temporal component and a Gaussian process geostatistical for the spatial component. Spatial-temporal variability was dominated by the temporal component, although the spatial variability was also substantial. The model delivered accurate predictions for both isolated missing values and 24-hour periods of missing values (RMSE = 1.4 μg m-3 and 1.8 μg m-3 respectively). Outliers could be detected by comparison to the 95% prediction interval. The model shows promise for predicting missing values, outlier detection and for mapping to support health impact studies.

A simple model for discounting radiation health effects risks with time

International Nuclear Information System (INIS)

Sandquist, G.M.; Rogers, V.C.

1988-01-01

In estimating human health effects resulting from ionizing radiation exposures, it is often assumed that the age of the person at the time of exposure and the latency period for the appearance of any associated health effects are values that maximize the consequences of the exposure. Such assumptions are obviously conservative, but they can result in distortions and errors when nondiscounted radiation-related health effects arising from nonradiation-related risks. Human life expectancy obviously decreases with age, and the latency period for radiation-related health effects can range from a few years to several decades. For example, if a man is 45 yr old at the time of exposure and this exposure results in a lethal health effect 20 yr after exposure, then the expected number of years of life loss is ∼5 yr and not 70 yr, as is commonly assumed in radiation risk assessment studies. If one full-health effect is equivalent to 70 person-yr, then this example exposure results in only 0.07 full-health effects

Modeling the Health Effects of Expanding e-Cigarette Sales in the United States and United Kingdom

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Kalkhoran, Sara; Glantz, Stanton A.

2015-01-01

IMPORTANCE The prevalence of electronic cigarette (e-cigarette) use is increasing. Population health effects will depend on cigarette smoking behaviors, levels of dual use with conventional cigarettes, and e-cigarette toxicity. OBJECTIVE To evaluate potential health effects of various scenarios of increasing promotion and use of e-cigarettes. DESIGN, SETTING, AND PARTICIPANTS A base case model was developed using data on actual cigarette and e-cigarette use patterns that quantifies transitions from an initial state of no cigarette or e-cigarette use to 1 of 5 final states: never use of cigarettes or e-cigarettes, cigarette use, e-cigarette use, dual use of cigarettes and e-cigarettes, or quit. Seven scenarios were created that cover a range of use patterns, depending on how the e-cigarette market might develop, as well as a range of possible long-term health effects of e-cigarette use. Scenarios for changes from the base case were evaluated using Monte Carlo simulations. Separate sets of base case model parameters were evaluated for the US and UK populations. MAIN OUTCOMES AND MEASURES We assigned unitless health “costs” for each final state on a scale of 0 to 100. Population health “costs” were compared with the base case (status quo) assuming e-cigarette use health “costs” from 1% to 50% as dangerous as conventional cigarette use health costs. RESULTS Compared with the base case, a harm reduction scenario in which e-cigarette use increases only among smokers who are interested in quitting with more quit attempts and no increased initiation of e-cigarette use among nonsmokers, and another scenario in which e-cigarettes are taken up only by youth who would have smoked conventional cigarettes, had population-level health benefits regardless of e-cigarette health costs in both the United States and United Kingdom. Conversely, scenarios in which e-cigarette promotion leads to renormalization of cigarette smoking or e-cigarettes are used primarily by youth

Rat Models of Cardiometabolic Diseases: Baseline Clinical Chemistries, and Rationale for their Use in Examining Air Pollution Health Effects

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This is the first of a series of 8 papers examining susceptibility of various rodent cardiometabolic disease models to ozone induced health effects. Individuals with cardiovascular and metabolic diseases (CVD) are shown to be more susceptible to adverse health effects o...

Health Professionals' Explanations of Suicidal Behaviour: Effects of Professional Group, Theoretical Intervention Model, and Patient Suicide Experience.

Science.gov (United States)

Rothes, Inês Areal; Henriques, Margarida Rangel

2017-12-01

In a help relation with a suicidal person, the theoretical models of suicidality can be essential to guide the health professional's comprehension of the client/patient. The objectives of this study were to identify health professionals' explanations of suicidal behaviors and to study the effects of professional group, theoretical intervention models, and patient suicide experience in professionals' representations. Two hundred and forty-two health professionals filled out a self-report questionnaire. Exploratory principal components analysis was used. Five explanatory models were identified: psychological suffering, affective cognitive, sociocommunicational, adverse life events, and psychopathological. Results indicated that the psychological suffering and psychopathological models were the most valued by the professionals, while the sociocommunicational was seen as the least likely to explain suicidal behavior. Differences between professional groups were found. We concluded that training and reflection on theoretical models in general and in communicative issues in particular are needed in the education of health professionals.

Effect of Education by Text Messaging Based on Health Belief Model on Food Handling Behaviors in Health Volunteers\\' Yazd City

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MA Morowatisharifabad

2016-05-01

Full Text Available Introduction: The text message can be presented as a way to change patterns of behavior-based prevention programs, such as the theory of planned behavior and health belief model to be used., And as an alternative approach to the individual and group training programs should be considered. The present study examined the effectiveness of this new method in promoting food handling behavior of a team of health volunteers on health belief model was based. Methods: This study was an evaluation of an intervention in which 16 health centers, 200 health volunteers who were actively involved Yazd city who were randomly divided into two groups. After the initial test, chi-square test, t test were analyzed. The intervention group received an educational package on the SMS regarding  food handling behavior on health Belief Model was designed for codification; wantonly within a month and a half a day and after 8 weeks of the last SMS sent from any intervention and control groups was performed in a secondary assessment. Tool for data gathering questionnaire consisting of structures of health belief model including demographic variables, respectively. Data were using 18spss and employing applied, statistical tests of non-parametric Wilcoxon, Mann-Whitney and Kruskal-Wallis, Chi-square and correlation coefficient the analysis was. Results: The overall food handling behavior, after training significantly increased in the intervention group (p =0/01, while the control group was not significant (p=0/21. Cooling behavior after training in the experimental group and the control group was significantly increased (p =0/00. Cooking behavior, after training in the intervention group (p =0/11 and control group( p =0/17 was not significantly increased. Individual health behavior, after training in the intervention group (p =0/13 and control group (p =0/07 was not significantly increased. Separation behavior after training has not significantly increased in the

Health effects estimation code development for accident consequence analysis

International Nuclear Information System (INIS)

Togawa, O.; Homma, T.

1992-01-01

As part of a computer code system for nuclear reactor accident consequence analysis, two computer codes have been developed for estimating health effects expected to occur following an accident. Health effects models used in the codes are based on the models of NUREG/CR-4214 and are revised for the Japanese population on the basis of the data from the reassessment of the radiation dosimetry and information derived from epidemiological studies on atomic bomb survivors of Hiroshima and Nagasaki. The health effects models include early and continuing effects, late somatic effects and genetic effects. The values of some model parameters are revised for early mortality. The models are modified for predicting late somatic effects such as leukemia and various kinds of cancers. The models for genetic effects are the same as those of NUREG. In order to test the performance of one of these codes, it is applied to the U.S. and Japanese populations. This paper provides descriptions of health effects models used in the two codes and gives comparisons of the mortality risks from each type of cancer for the two populations. (author)

Modeling the acute health effects of astronauts from exposure to large solar particle events.

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Hu, Shaowen; Kim, Myung-Hee Y; McClellan, Gene E; Cucinotta, Francis A

2009-04-01

Radiation exposure from Solar Particle Events (SPE) presents a significant health concern for astronauts for exploration missions outside the protection of the Earth's magnetic field, which could impair their performance and result in the possibility of failure of the mission. Assessing the potential for early radiation effects under such adverse conditions is of prime importance. Here we apply a biologically based mathematical model that describes the dose- and time-dependent early human responses that constitute the prodromal syndromes to consider acute risks from SPEs. We examine the possible early effects on crews from exposure to some historically large solar events on lunar and/or Mars missions. The doses and dose rates of specific organs were calculated using the Baryon radiation transport (BRYNTRN) code and a computerized anatomical man model, while the hazard of the early radiation effects and performance reduction were calculated using the Radiation-Induced Performance Decrement (RIPD) code. Based on model assumptions we show that exposure to these historical events would cause moderate early health effects to crew members inside a typical spacecraft or during extra-vehicular activities, if effective shielding and medical countermeasure tactics were not provided. We also calculate possible even worse cases (double intensity, multiple occurrences in a short period of time, etc.) to estimate the severity, onset and duration of various types of early illness. Uncertainties in the calculation due to limited data on relative biological effectiveness and dose-rate modifying factors for protons and secondary radiation, and the identification of sensitive sites in critical organs are discussed.

Aligning health information technologies with effective service delivery models to improve chronic disease care.

Science.gov (United States)

Bauer, Amy M; Thielke, Stephen M; Katon, Wayne; Unützer, Jürgen; Areán, Patricia

2014-09-01

Healthcare reforms in the United States, including the Affordable Care and HITECH Acts, and the NCQA criteria for the Patient Centered Medical Home have promoted health information technology (HIT) and the integration of general medical and mental health services. These developments, which aim to improve chronic disease care, have largely occurred in parallel, with little attention to the need for coordination. In this article, the fundamental connections between HIT and improvements in chronic disease management are explored. We use the evidence-based collaborative care model as an example, with attention to health literacy improvement for supporting patient engagement in care. A review of the literature was conducted to identify how HIT and collaborative care, an evidence-based model of chronic disease care, support each other. Five key principles of effective collaborative care are outlined: care is patient-centered, evidence-based, measurement-based, population-based, and accountable. The potential role of HIT in implementing each principle is discussed. Key features of the mobile health paradigm are described, including how they can extend evidence-based treatment beyond traditional clinical settings. HIT, and particularly mobile health, can enhance collaborative care interventions, and thus improve the health of individuals and populations when deployed in integrated delivery systems. Copyright © 2014 Elsevier Inc. All rights reserved.

Six challenges in modelling for public health policy

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C.J.E. Metcalf

2015-03-01

Full Text Available The World Health Organisation's definition of public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole (World Health Organization, 2014. Mathematical modelling plays an increasingly important role in helping to guide the most high impact and cost-effective means of achieving these goals. Public health programmes are usually implemented over a long period of time with broad benefits to many in the community. Clinical trials are seldom large enough to capture these effects. Observational data may be used to evaluate a programme after it is underway, but have limited value in helping to predict the future impact of a proposed policy. Furthermore, public health practitioners are often required to respond to new threats, for which there is little or no previous data on which to assess the threat. Computational and mathematical models can help to assess potential threats and impacts early in the process, and later aid in interpreting data from complex and multifactorial systems. As such, these models can be critical tools in guiding public health action. However, there are a number of challenges in achieving a successful interface between modelling and public health. Here, we discuss some of these challenges.

The Relationship between Spiritual Health and other Dimensions of Health: Presentation of a Model

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Akram Heidari

2016-06-01

Full Text Available Attitudes to humankind will have different effects on health service delivery. Health might used to be intended to provide physical health in the past; today, however, many researchers and clinicians consider the concept health to be beyond physical health. In support of this claim, it is enough to indicate that the bio-psycho-social model has for years been held by scientific communities to be a fully admitted model. However, the missing ring in this model, as suggested by many, is the spiritual health. In recent years, the relationship between spirituality and clinical interventions with a comprehensive focus on health has been under increasing scrutiny. Although different models have been presented for investigation of the relationship between spiritual health and other dimensions, the fundamental challenge in this regard is the actual place of spiritual health compared with other dimensions. In this article, attempts are made to address the position and weight of spiritual health from the Islam’s point of view.

Construction of a case for expert judgement of uncertainty in early health effects models

International Nuclear Information System (INIS)

Grupa, J.

1997-11-01

The contribution of ECN to a joint study of the European Commission (EC) and the US Nuclear Regulatory Commission (NRC), in which the uncertainty in risks and consequences of severe accidents at nuclear power plants are evaluated, is described. The procedure used to obtain these uncertainties is called expert judgement. In a formal expert judgement procedure a panel of experts has provided quantitative information about the uncertainty in given observables: a quantity that describes an observation concerning the phenomenon of interest, in this paper the relation between dose and health effects, without information or assumptions about any model describing this phenomenon. The observables are defined in a case structure, a questionnaire provided to all experts. ECN has contributed to the selection of the experts for the early health effects panel, and provided assistance for drafting the case structure for this panel. This paper describes the radiological information provided by ECN and the analyses necessary for constructing the case structure. The deliverables of the expert elicitation are uncertainty distributions of the observables requested in the case structure. The results are intended to be unbiased, i.e. it should be applicable to any model describing the relation between dose and health effects. They will be published by the project team in a joint publication of the NRC and the EC. In this way the resulting uncertainty distributions are available for further work in the joint project and available to a more general public. 2 figs., 4 refs

Disaster Reintegration Model: A Qualitative Analysis on Developing Korean Disaster Mental Health Support Model

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Yun-Jung Choi

2018-02-01

Full Text Available This study sought to describe the mental health problems experienced by Korean disaster survivors, using a qualitative research method to provide empirical resources for effective disaster mental health support in Korea. Participants were 16 adults or elderly adults who experienced one or more disasters at least 12 months ago recruited via theoretical sampling. Participants underwent in-depth individual interviews on their disaster experiences, which were recorded and transcribed for qualitative analysis, which followed Strauss and Corbin’s (1998 Grounded theory. After open coding, participants’ experiences were categorized into 130 codes, 43 sub-categories and 17 categories. The categories were further analyzed in a paradigm model, conditional model and the Disaster Reintegration Model, which proposed potentially effective mental health recovery strategies for disaster survivors, health providers and administrators. To provide effective assistance for mental health recovery of disaster survivors, both personal and public resilience should be promoted while considering both cultural and spiritual elements.

Taxes and Subsidies for Improving Diet and Population Health in Australia: A Cost-Effectiveness Modelling Study.

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Linda J Cobiac

2017-02-01

Full Text Available An increasing number of countries are implementing taxes on unhealthy foods and drinks to address the growing burden of dietary-related disease, but the cost-effectiveness of combining taxes on unhealthy foods and subsidies on healthy foods is not well understood.Using a population model of dietary-related diseases and health care costs and food price elasticities, we simulated the effect of taxes on saturated fat, salt, sugar, and sugar-sweetened beverages and a subsidy on fruits and vegetables, over the lifetime of the Australian population. The sizes of the taxes and subsidy were set such that, when combined as a package, there would be a negligible effect on average weekly expenditure on food (<1% change. We evaluated the cost-effectiveness of the interventions individually, then determined the optimal combination based on maximising net monetary benefit at a threshold of AU$50,000 per disability-adjusted life year (DALY. The simulations suggested that the combination of taxes and subsidy might avert as many as 470,000 DALYs (95% uncertainty interval [UI]: 420,000 to 510,000 in the Australian population of 22 million, with a net cost-saving of AU$3.4 billion (95% UI: AU$2.4 billion to AU$4.6 billion; US$2.3 billion to the health sector. Of the taxes evaluated, the sugar tax produced the biggest estimates of health gain (270,000 [95% UI: 250,000 to 290,000] DALYs averted, followed by the salt tax (130,000 [95% UI: 120,000 to 140,000] DALYs, the saturated fat tax (97,000 [95% UI: 77,000 to 120,000] DALYs, and the sugar-sweetened beverage tax (12,000 [95% UI: 2,100 to 21,000] DALYs. The fruit and vegetable subsidy (-13,000 [95% UI: -44,000 to 18,000] DALYs was a cost-effective addition to the package of taxes. However, it did not necessarily lead to a net health benefit for the population when modelled as an intervention on its own, because of the possible adverse cross-price elasticity effects on consumption of other foods (e.g., foods high in

Six challenges in modelling for public health policy.

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Metcalf, C J E; Edmunds, W J; Lessler, J

2015-03-01

The World Health Organisation's definition of public health refers to all organized measures to prevent disease, promote health, and prolong life among the population as a whole (World Health Organization, 2014). Mathematical modelling plays an increasingly important role in helping to guide the most high impact and cost-effective means of achieving these goals. Public health programmes are usually implemented over a long period of time with broad benefits to many in the community. Clinical trials are seldom large enough to capture these effects. Observational data may be used to evaluate a programme after it is underway, but have limited value in helping to predict the future impact of a proposed policy. Furthermore, public health practitioners are often required to respond to new threats, for which there is little or no previous data on which to assess the threat. Computational and mathematical models can help to assess potential threats and impacts early in the process, and later aid in interpreting data from complex and multifactorial systems. As such, these models can be critical tools in guiding public health action. However, there are a number of challenges in achieving a successful interface between modelling and public health. Here, we discuss some of these challenges. Copyright © 2014 The Authors. Published by Elsevier B.V. All rights reserved.

Air Pollution Exposure Modeling for Health Studies | Science ...

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Dr. Michael Breen is leading the development of air pollution exposure models, integrated with novel personal sensor technologies, to improve exposure and risk assessments for individuals in health studies. He is co-investigator for multiple health studies assessing the exposure and effects of air pollutants. These health studies include participants with asthma, diabetes, and coronary artery disease living in various U.S. cities. He has developed, evaluated, and applied novel exposure modeling and time-activity tools, which includes the Exposure Model for Individuals (EMI), GPS-based Microenvironment Tracker (MicroTrac) and Exposure Tracker models. At this seminar, Dr. Breen will present the development and application of these models to predict individual-level personal exposures to particulate matter (PM) for two health studies in central North Carolina. These health studies examine the association between PM and adverse health outcomes for susceptible individuals. During Dr. Breen’s visit, he will also have the opportunity to establish additional collaborations with researchers at Harvard University that may benefit from the use of exposure models for cohort health studies. These research projects that link air pollution exposure with adverse health outcomes benefit EPA by developing model-predicted exposure-dose metrics for individuals in health studies to improve the understanding of exposure-response behavior of air pollutants, and to reduce participant

Applications of system dynamics modelling to support health policy.

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Atkinson, Jo-An M; Wells, Robert; Page, Andrew; Dominello, Amanda; Haines, Mary; Wilson, Andrew

2015-07-09

The value of systems science modelling methods in the health sector is increasingly being recognised. Of particular promise is the potential of these methods to improve operational aspects of healthcare capacity and delivery, analyse policy options for health system reform and guide investments to address complex public health problems. Because it lends itself to a participatory approach, system dynamics modelling has been a particularly appealing method that aims to align stakeholder understanding of the underlying causes of a problem and achieve consensus for action. The aim of this review is to determine the effectiveness of system dynamics modelling for health policy, and explore the range and nature of its application. A systematic search was conducted to identify articles published up to April 2015 from the PubMed, Web of Knowledge, Embase, ScienceDirect and Google Scholar databases. The grey literature was also searched. Papers eligible for inclusion were those that described applications of system dynamics modelling to support health policy at any level of government. Six papers were identified, comprising eight case studies of the application of system dynamics modelling to support health policy. No analytic studies were found that examined the effectiveness of this type of modelling. Only three examples engaged multidisciplinary stakeholders in collective model building. Stakeholder participation in model building reportedly facilitated development of a common 'mental map' of the health problem, resulting in consensus about optimal policy strategy and garnering support for collaborative action. The paucity of relevant papers indicates that, although the volume of descriptive literature advocating the value of system dynamics modelling is considerable, its practical application to inform health policy making is yet to be routinely applied and rigorously evaluated. Advances in software are allowing the participatory model building approach to be extended to

A relational model of sexual minority mental and physical health: The negative effects of shame on relationships, loneliness, and health.

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Mereish, Ethan H; Poteat, V Paul

2015-07-01

Sexual minorities (e.g., lesbians, gay men, bisexual individuals) are at an increased risk for poorer mental and physical health outcomes than heterosexuals, and some of these health disparities relate to minority stressors such as discrimination. Yet, there is little research elucidating pathways that predict health or that promote resiliency among sexual minorities. Building on the minority stress model, the present study utilized relational cultural theory to situate sexual minority health within a relational framework. Specifically, the study tested mediators of the relationships between distal (i.e., discrimination, rejection, victimization) and proximal stressors (i.e., internalized homophobia, sexual orientation concealment) and psychological and physical distress for sexual minorities. Among 719 sexual minority adults, structural equation modeling analyses were used to test 4 models reflecting the mediating effects of shame, poorer relationships with a close peer and the lesbian/gay/bisexual/transgender (LGBT) community, and loneliness on the associations between minority stressors and psychological distress (i.e., depression and anxiety) and physical distress (i.e., distressing physical symptoms). As hypothesized, the associations between distal and proximal minority stressors and distress were mediated by shame, poorer relationships with a close peer and the LGBT community, and loneliness. Findings underscore the possible relational and interpersonal mechanisms by which sexual minority stressors lead to psychological and physical distress. (c) 2015 APA, all rights reserved).

Modeling patients' acceptance of provider-delivered e-health.

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Wilson, E Vance; Lankton, Nancy K

2004-01-01

Health care providers are beginning to deliver a range of Internet-based services to patients; however, it is not clear which of these e-health services patients need or desire. The authors propose that patients' acceptance of provider-delivered e-health can be modeled in advance of application development by measuring the effects of several key antecedents to e-health use and applying models of acceptance developed in the information technology (IT) field. This study tested three theoretical models of IT acceptance among patients who had recently registered for access to provider-delivered e-health. An online questionnaire administered items measuring perceptual constructs from the IT acceptance models (intrinsic motivation, perceived ease of use, perceived usefulness/extrinsic motivation, and behavioral intention to use e-health) and five hypothesized antecedents (satisfaction with medical care, health care knowledge, Internet dependence, information-seeking preference, and health care need). Responses were collected and stored in a central database. All tested IT acceptance models performed well in predicting patients' behavioral intention to use e-health. Antecedent factors of satisfaction with provider, information-seeking preference, and Internet dependence uniquely predicted constructs in the models. Information technology acceptance models provide a means to understand which aspects of e-health are valued by patients and how this may affect future use. In addition, antecedents to the models can be used to predict e-health acceptance in advance of system development.

The short-term effects of an integrated care model for the frail elderly on health, quality of life, health care use and satisfaction with care

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Wilhelmina Mijntje Looman

2014-12-01

Full Text Available Purpose: This study explores the short-term value of integrated care for the frail elderly by evaluating the effects of the Walcheren Integrated Care Model on health, quality of life, health care use and satisfaction with care after three months. Intervention: Frailty was preventively detected in elderly living at home with the Groningen Frailty Indicator. Geriatric nurse practitioners and secondary care geriatric nursing specialists were assigned as case managers and co-ordinated the care agreed upon in a multidisciplinary meeting. The general practitioner practice functions as a single entry point and supervises the co-ordination of care. The intervention encompasses task reassignment between nurses and doctors and consultations between primary, secondary and tertiary care providers. The entire process was supported by multidisciplinary protocols and web-based patient files. Methods: The design of this study was quasi-experimental. In this study, 205 frail elderly patients of three general practitioner practices that implemented the integrated care model were compared with 212 frail elderly patients of five general practitioner practices that provided usual care. The outcomes were assessed using questionnaires. Baseline measures were compared with a three-month follow-up by chi-square tests, t-tests and regression analysis. Results and conclusion: In the short term, the integrated care model had a significant effect on the attachment aspect of quality of life. The frail elderly patients were better able to obtain the love and friendship they desire. The use of care did not differ despite the preventive element and the need for assessments followed up with case management in the integrated care model. In the short term, there were no significant changes in health. As frailty is a progressive state, it is assumed that three months are too short to influence changes in health with integrated care models. A more longitudinal approach is

Multivariate determinants of self-management in Health Care: assessing Health Empowerment Model by comparison between structural equation and graphical models approaches

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Filippo Trentini

2015-03-01

Full Text Available Backgroung. In public health one debated issue is related to consequences of improper self-management in health care.  Some theoretical models have been proposed in Health Communication theory which highlight how components such general literacy and specific knowledge of the disease might be very important for effective actions in healthcare system.  Methods. This  paper aims at investigating the consistency of Health Empowerment Model by means of both graphical models approach, which is a “data driven” method and a Structural Equation Modeling (SEM approach, which is instead “theory driven”, showing the different information pattern that can be revealed in a health care research context.The analyzed dataset provides data on the relationship between the Health Empowerment Model constructs and the behavioral and health status in 263 chronic low back pain (cLBP patients. We used the graphical models approach to evaluate the dependence structure in a “blind” way, thus learning the structure from the data.Results. From the estimation results dependence structure confirms links design assumed in SEM approach directly from researchers, thus validating the hypotheses which generated the Health Empowerment Model constructs.Conclusions. This models comparison helps in avoiding confirmation bias. In Structural Equation Modeling, we used SPSS AMOS 21 software. Graphical modeling algorithms were implemented in a R software environment.

A generalized measurement model to quantify health: the multi-attribute preference response model.

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Krabbe, Paul F M

2013-01-01

After 40 years of deriving metric values for health status or health-related quality of life, the effective quantification of subjective health outcomes is still a challenge. Here, two of the best measurement tools, the discrete choice and the Rasch model, are combined to create a new model for deriving health values. First, existing techniques to value health states are briefly discussed followed by a reflection on the recent revival of interest in patients' experience with regard to their possible role in health measurement. Subsequently, three basic principles for valid health measurement are reviewed, namely unidimensionality, interval level, and invariance. In the main section, the basic operation of measurement is then discussed in the framework of probabilistic discrete choice analysis (random utility model) and the psychometric Rasch model. It is then shown how combining the main features of these two models yields an integrated measurement model, called the multi-attribute preference response (MAPR) model, which is introduced here. This new model transforms subjective individual rank data into a metric scale using responses from patients who have experienced certain health states. Its measurement mechanism largely prevents biases such as adaptation and coping. Several extensions of the MAPR model are presented. The MAPR model can be applied to a wide range of research problems. If extended with the self-selection of relevant health domains for the individual patient, this model will be more valid than existing valuation techniques.

Mathematical models for radiation effects on human health

International Nuclear Information System (INIS)

Negi, U.S.; Petwal, K.C.

2015-01-01

In this paper, we are proposing a theoretical approach of basic mathematical models for radiation effect on human health. The largest natural sources of radiation exposure to humans are radon gas. While radon gas has always been in the environment, awareness of its contribution to human radiation exposure has increased in recent years. Radon's primary pathway is through air space in soil and rock. Pressure differences between the soil and the inside of buildings may cause radon gas to move indoors. Radon decays to radon daughters, some of which emit alpha radiation. Alpha-emitting radon daughters are adsorbed on to dust particles which, when inhaled, are trapped in the lungs and may cause gene damage, mutations and finally cancer. Exposure to excess UV radiation increases risk of skin cancer but there is also a dark side. The incidence of all types of skin cancer is related to exposure to UV radiation. Non-melanoma skin cancer, eye melanoma, and lip cancer have also been related to natural UV light

Modeled PM2.5 removal by trees in ten U.S. cities and associated health effects

International Nuclear Information System (INIS)

Nowak, David J.; Hirabayashi, Satoshi; Bodine, Allison; Hoehn, Robert

2013-01-01

Urban particulate air pollution is a serious health issue. Trees within cities can remove fine particles from the atmosphere and consequently improve air quality and human health. Tree effects on PM 2.5 concentrations and human health are modeled for 10 U.S. cities. The total amount of PM 2.5 removed annually by trees varied from 4.7 tonnes in Syracuse to 64.5 tonnes in Atlanta, with annual values varying from $1.1 million in Syracuse to $60.1 million in New York City. Most of these values were from the effects of reducing human mortality. Mortality reductions were typically around 1 person yr −1 per city, but were as high as 7.6 people yr −1 in New York City. Average annual percent air quality improvement ranged between 0.05% in San Francisco and 0.24% in Atlanta. Understanding the impact of urban trees on air quality can lead to improved urban forest management strategies to sustain human health in cities. -- Highlights: •Paper provides the first broad-scale estimates of city-wide tree impacts on PM 2.5 . •Trees improve overall air quality by intercepting particulate matter. •Particle resuspension can lead to short-term increases in pollutant concentrations. •Urban trees produce substantial health improvements and values. -- Air pollution modeling reveals broad-scale impacts of pollution removal by urban trees on PM 2.5 concentrations and human health

The role of Patient Health Engagement Model (PHE-model in affecting patient activation and medication adherence: A structural equation model.

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Guendalina Graffigna

Full Text Available Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed.To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model in this pathway.This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i patient activation (Patient Activation Measure 13 -short form; ii Patient Health Engagement model (Patient Health Engagement Scale; iii patient adherence (4 item-Morinsky Medication Adherence Scale; iv the quality of the patients' emotional feelings (Manikin Self Assessment Scale; v the quality of the patient/doctor relationship (Health Care Climate Questionnaire. Structural equation modeling was used to test the hypotheses proposed.According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis.Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in

The role of Patient Health Engagement Model (PHE-model) in affecting patient activation and medication adherence: A structural equation model.

Science.gov (United States)

Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea

2017-01-01

Increasing bodies of scientific research today examines the factors and interventions affecting patients' ability to self-manage and adhere to treatment. Patient activation is considered the most reliable indicator of patients' ability to manage health autonomously. Only a few studies have tried to assess the role of psychosocial factors in promoting patient activation. A more systematic modeling of the psychosocial factors explaining the variance of patient activation is needed. To test the hypothesized effect of patient activation on medication adherence; to test the the hypothesized effects of positive emotions and of the quality of the patient/doctor relationship on patient activation; and to test the hypothesized mediating effect of Patient Health Engagement (PHE-model) in this pathway. This cross-sectional study involved 352 Italian-speaking adult chronic patients. The survey included measures of i) patient activation (Patient Activation Measure 13 -short form); ii) Patient Health Engagement model (Patient Health Engagement Scale); iii) patient adherence (4 item-Morinsky Medication Adherence Scale); iv) the quality of the patients' emotional feelings (Manikin Self Assessment Scale); v) the quality of the patient/doctor relationship (Health Care Climate Questionnaire). Structural equation modeling was used to test the hypotheses proposed. According to the theoretical model we hypothesized, research results confirmed that patients' activation significantly affects their reported medication adherence. Moreover, psychosocial factors, such as the patients' quality of the emotional feelings and the quality of the patient/doctor relationship were demonstrated to be factors affecting the level of patient activation. Finally, the mediation effect of the Patient Health Engagement model was confirmed by the analysis. Consistently with the results of previous studies, these findings demonstrate that the Patient Health Engagement Model is a critical factor in enhancing

Communication models in environmental health.

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Guidotti, Tee L

2013-01-01

Communication models common in environmental health are not well represented in the literature on health communication. Risk communication is a systematic approach to conveying essential information about a specific environmental issue and a framework for thinking about community risk and the alternatives for dealing with it. Crisis communication is intended to provide essential information to people facing an emergency in order to mitigate its effects and to enable them to make appropriate decisions, and it is primarily used in emergency management. Corporate communication is intended to achieve a change in attitude or perception of an organization, and its role in environmental health is usually public relations or to rehabilitate a damaged reputation. Environmental health education is a more didactic approach to science education with respect to health and the environment. Social marketing uses conventional marketing methods to achieve a socially desirable purpose but is more heavily used in health promotion generally. Communication models and styles in environmental health are specialized to serve the needs of the field in communicating with the community. They are highly structured and executed in different ways but have in common a relative lack of emphasis on changing personal or lifestyle behavior compared with health promotion and public health in general and a tendency to emphasize content on specific environmental issues and decision frameworks for protecting oneself or the community through collective action.

Spatial modelling of arsenic distribution and human health effects in Lake Victoria basin, Tanzania

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Ijumulana, Julian; Mtalo, Felix; Bhattacharya, Prosun

2016-04-01

Increasing incidences of naturally occurring geogenic pollutants in drinking water sources and associated human health risks are the two major challenges requiring detailed knowledge to support decision making process at various levels. The presence, location and extent of environmental contamination is needed towards developing mitigation measures to achieve required standards. In this study we are developing a GIS-based model to detect and predict drinking water pollutants at the identified hotspots and monitor its variation in space. In addition, the mobility of pollutants within the affected region needs to be evaluated using topographic and hydrogeological data. Based on these geospatial data on contaminant distribution, spatial relationship of As and F contamination and reported human health effects such as dental caries, dental fluorosis, skeletal fluorosis and bone crippling, skin and other cancers etc. can be modeled for potential interventions for safe drinking water supplies.

Health effects of unemployment benefit program generosity.

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Cylus, Jonathan; Glymour, M Maria; Avendano, Mauricio

2015-02-01

We assessed the impact of unemployment benefit programs on the health of the unemployed. We linked US state law data on maximum allowable unemployment benefit levels between 1985 and 2008 to individual self-rated health for heads of households in the Panel Study of Income Dynamics and implemented state and year fixed-effect models. Unemployment was associated with increased risk of reporting poor health among men in both linear probability (b=0.0794; 95% confidence interval [CI]=0.0623, 0.0965) and logistic models (odds ratio=2.777; 95% CI=2.294, 3.362), but this effect is lower when the generosity of state unemployment benefits is high (b for interaction between unemployment and benefits=-0.124; 95% CI=-0.197, -0.0523). A 63% increase in benefits completely offsets the impact of unemployment on self-reported health. Results suggest that unemployment benefits may significantly alleviate the adverse health effects of unemployment among men.

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

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Ekwaru, John Paul; Ohinmaa, Arto; Tran, Bach Xuan; Setayeshgar, Solmaz; Johnson, Jeffrey A; Veugelers, Paul J

2017-01-01

The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools) has been recognized as a "best practice" in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project's cost-effectiveness following a life-course approach. We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY), from a school system's cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate. The incremental cost-effectiveness ratio(ICER) of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICERSchool-based health promotion, such as APPLE Schools is a cost-effective intervention for obesity prevention and reduction of chronic disease risk over the lifetime. Expanding the coverage and allocating resources towards school-based programs like the APPLE Schools program, is likely to reduce the public health burden of obesity and chronic diseases.

An integrated model of decision-making in health contexts: the role of science education in health education

Science.gov (United States)

Arnold, Julia C.

2018-03-01

Health education is to foster health literacy, informed decision-making and to promote health behaviour. To date, there are several models that seek to explain health behaviour (e.g. the Theory of Planned Behaviour or the Health Belief Model). These models include motivational factors (expectancies and values) that play a role in decision-making in health contexts. In this theoretical paper, it is argued that none of these models makes consequent use of expectancy-value pairs. It is further argued that in order to make these models fruitful for science education and for informed decision-making, models should systematically incorporate knowledge as part of the decision-making process. To fill this gap, this theoretical paper introduces The Integrated Model of Decision-Making in Health Contexts. This model includes three types of knowledge (system health knowledge, action-related health knowledge and effectiveness health knowledge) as influencing factors for motivational factors (perceived health threat, attitude towards health action, attitude towards health outcome and subjective norm) that are formed of expectancy-value pairs and lead to decisions. The model's potential for health education in science education as well as research implications is discussed.

A Relational Model of Sexual Minority Mental and Physical Health: The Negative Effects of Shame on Relationships, Loneliness, and Health

Science.gov (United States)

Mereish, Ethan H.; Poteat, V. Paul

2015-01-01

Sexual minorities (e.g., lesbians, gay men, bisexual individuals) are at higher risk for mental and physical health disparities than heterosexuals, and some of these disparities relate to minority stressors such as discrimination. Yet, there is little research elucidating pathways that predict health or that promote resiliency among sexual minorities. Building on the minority stress model, the present study utilized relational cultural theory to situate sexual minority health within a relational framework. Specifically, the study tested mediators of the relationships between distal (i.e., discrimination, rejection, victimization) and proximal stressors (i.e., internalized homophobia, sexual orientation concealment) and psychological and physical distress for sexual minorities. Among 719 sexual minority adults, structural equation modeling analyses were used to test four models reflecting the mediating effects of shame, poorer relationships with a close peer and the LGBT community, and loneliness on the associations between minority stressors and psychological distress (i.e., depression and anxiety) and physical distress (i.e., distressing physical symptoms). As hypothesized, the associations between distal and proximal minority stressors and distress were mediated by shame, poorer relationships with a close peer and the LGBT community, and loneliness. Findings underscore the possible relational and interpersonal mechanisms by which sexual minority stressors lead to psychological and physical distress. PMID:26010289

Evidence synthesis to inform model-based cost-effectiveness evaluations of diagnostic tests: a methodological review of health technology assessments

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Bethany Shinkins

2017-04-01

Full Text Available Abstract Background Evaluations of diagnostic tests are challenging because of the indirect nature of their impact on patient outcomes. Model-based health economic evaluations of tests allow different types of evidence from various sources to be incorporated and enable cost-effectiveness estimates to be made beyond the duration of available study data. To parameterize a health-economic model fully, all the ways a test impacts on patient health must be quantified, including but not limited to diagnostic test accuracy. Methods We assessed all UK NIHR HTA reports published May 2009-July 2015. Reports were included if they evaluated a diagnostic test, included a model-based health economic evaluation and included a systematic review and meta-analysis of test accuracy. From each eligible report we extracted information on the following topics: 1 what evidence aside from test accuracy was searched for and synthesised, 2 which methods were used to synthesise test accuracy evidence and how did the results inform the economic model, 3 how/whether threshold effects were explored, 4 how the potential dependency between multiple tests in a pathway was accounted for, and 5 for evaluations of tests targeted at the primary care setting, how evidence from differing healthcare settings was incorporated. Results The bivariate or HSROC model was implemented in 20/22 reports that met all inclusion criteria. Test accuracy data for health economic modelling was obtained from meta-analyses completely in four reports, partially in fourteen reports and not at all in four reports. Only 2/7 reports that used a quantitative test gave clear threshold recommendations. All 22 reports explored the effect of uncertainty in accuracy parameters but most of those that used multiple tests did not allow for dependence between test results. 7/22 tests were potentially suitable for primary care but the majority found limited evidence on test accuracy in primary care settings

Health effects of home energy efficiency interventions in England: a modelling study

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Milner, James; Chalabi, Zaid; Das, Payel; Jones, Benjamin; Shrubsole, Clive; Davies, Mike; Wilkinson, Paul

2015-01-01

Objective To assess potential public health impacts of changes to indoor air quality and temperature due to energy efficiency retrofits in English dwellings to meet 2030 carbon reduction targets. Design Health impact modelling study. Setting England. Participants English household population. Intervention Three retrofit scenarios were modelled: (1) fabric and ventilation retrofits installed assuming building regulations are met; (2) as with scenario (1) but with additional ventilation for homes at risk of poor ventilation; (3) as with scenario (1) but with no additional ventilation to illustrate the potential risk of weak regulations and non-compliance. Main outcome Primary outcomes were changes in quality adjusted life years (QALYs) over 50 years from cardiorespiratory diseases, lung cancer, asthma and common mental disorders due to changes in indoor air pollutants, including secondhand tobacco smoke, PM2.5 from indoor and outdoor sources, radon, mould, and indoor winter temperatures. Results The modelling study estimates showed that scenario (1) resulted in positive effects on net mortality and morbidity of 2241 (95% credible intervals (CI) 2085 to 2397) QALYs per 10 000 persons over 50 years follow-up due to improved temperatures and reduced exposure to indoor pollutants, despite an increase in exposure to outdoor-generated particulate matter with a diameter of 2.5 μm or less (PM2.5). Scenario (2) resulted in a negative impact of −728 (95% CI −864 to −592) QALYs per 10 000 persons over 50 years due to an overall increase in indoor pollutant exposures. Scenario (3) resulted in −539 (95% CI −678 to -399) QALYs per 10 000 persons over 50 years follow-up due to an increase in indoor exposures despite the targeting of pollutants. Conclusions If properly implemented alongside ventilation, energy efficiency retrofits in housing can improve health by reducing exposure to cold and air pollutants. Maximising the health benefits requires careful

The effectiveness of health communication strategies in health education in Kushima, Japan.

Science.gov (United States)

Ebina, Ryoko; Kawasaki, Fumiko; Taniguchi, Izumi; Togari, Taisuke; Yamazaki, Yoshihiko; Sparks, Michael

2010-03-01

Japan's 2008 health policy focuses more than ever on health education for behaviour change and outcome measures for physical health status. This is at odds with contemporary health promotion and health education, which frame health as a resource for everyday life and indicate that the evaluation of interventions should measure broader aspects of health rather than just physical aspects. The application of a combination of different health communication models and theories allows for a customized approach, depending on the types of change that are being sought, and can lead to increased relevance as well as a better fit when it comes to evaluating the achievement of broad health promotion goals. This article explores the application of the Outcome Model for Health Promotion to a two-year health education intervention in Kushima, Japan. This model measures program effectiveness from four aspects: physical health outcomes; intermediate health outcomes; health promotion outcomes; and health promotion actions. A quantitative and qualitative longitudinal, mixed model study design and methods were used for the analysis. Data was taken from health exams, structured interviews, and participant observations collected from 67 participants at four times over two years. This intervention relied primarily on health education and communication to achieve mental and social health outcomes more significantly and faster than physical health outcomes. The importance of moving outcome measurement beyond direct health achievements is discussed in light of the relationships between physical, mental, and social health and its determinants, and our results.

Task force report on health effects assessment

International Nuclear Information System (INIS)

Anderson, C.; Hushon, J.

1978-08-01

From April to August, 1978 MITRE supported the Health Effects Assessment Task Force sponsored by the Office of the Assistant Secretary for the Environment at DOE. The findings of that Task Force are incorporated in this report and include a detailed definition of health effects assessment, a survey of the mandates for health effects assessments within DOE/EV, a review of current DOE-EV health effects assessment activities, an analysis of the constraints affecting the health effects assessment process and a discussion of the Task Force recommendations. Included as appendices are summaries of two workshops conducted by the Task Force to determine the state-of-the-art of health effects assessment and modeling and a review of risk assessment activities in other federal agencies. The primary recommendation of the panel was that an office be designated or created under the Office of the Assistant Secretary for the Environment to coordinate the Health Effects Risk Assessment effort covering up to 40 program and policy areas; a similar need was expressed for the environmental effects assessment area. 1 tab

A national prediction model for PM2.5 component exposures and measurement error-corrected health effect inference.

Science.gov (United States)

Bergen, Silas; Sheppard, Lianne; Sampson, Paul D; Kim, Sun-Young; Richards, Mark; Vedal, Sverre; Kaufman, Joel D; Szpiro, Adam A

2013-09-01

Studies estimating health effects of long-term air pollution exposure often use a two-stage approach: building exposure models to assign individual-level exposures, which are then used in regression analyses. This requires accurate exposure modeling and careful treatment of exposure measurement error. To illustrate the importance of accounting for exposure model characteristics in two-stage air pollution studies, we considered a case study based on data from the Multi-Ethnic Study of Atherosclerosis (MESA). We built national spatial exposure models that used partial least squares and universal kriging to estimate annual average concentrations of four PM2.5 components: elemental carbon (EC), organic carbon (OC), silicon (Si), and sulfur (S). We predicted PM2.5 component exposures for the MESA cohort and estimated cross-sectional associations with carotid intima-media thickness (CIMT), adjusting for subject-specific covariates. We corrected for measurement error using recently developed methods that account for the spatial structure of predicted exposures. Our models performed well, with cross-validated R2 values ranging from 0.62 to 0.95. Naïve analyses that did not account for measurement error indicated statistically significant associations between CIMT and exposure to OC, Si, and S. EC and OC exhibited little spatial correlation, and the corrected inference was unchanged from the naïve analysis. The Si and S exposure surfaces displayed notable spatial correlation, resulting in corrected confidence intervals (CIs) that were 50% wider than the naïve CIs, but that were still statistically significant. The impact of correcting for measurement error on health effect inference is concordant with the degree of spatial correlation in the exposure surfaces. Exposure model characteristics must be considered when performing two-stage air pollution epidemiologic analyses because naïve health effect inference may be inappropriate.

The Effect of Puberty Health Education based on Health Belief Model on Health Behaviors and Preventive among Teen Boys in Marivan, North West of Iran

Directory of Open Access Journals (Sweden)

Rohollah Valizade

2016-08-01

Full Text Available Background Maturity and its related sexual and mental changes are one of the most important events in the life of every individual. The purpose of this study was to determine the effect of puberty health education based on Health Belief Model on health behaviors and preventive among students boy first secondary school in Marivan city in 2015. Materials and Methods This research is an experimental intervention study that was conducted in 2015. The study participants were 64 male students of second year of first secondary school boys who were selected randomly with cluster sampling from two schools among 12 schools in first grade of high school in the Marivan city. Totally 32 students were selected randomly in the intervention group in the one of the schools and 32 students in the control group in the other school. The data collection instrument was a questionnaire developed by the researchers based on the health belief model. The validity and reliability of questionnaire was confirmed. Statistical analysis was carried out using SPSS version 17, Chi square, descriptive statistics and independent t-tests. Results Results showed significance differences after educational intervention in the mean scores of awareness, perceived susceptibility, perceived severity, perceived benefits, cues to action and performance in the intervention group (p

The effect of health shocks on smoking and obesity.

Science.gov (United States)

Sundmacher, Leonie

2012-08-01

To investigate whether negative changes in their own health (i.e. health shocks) or in that of a smoking or obese household member, lead smokers to quit smoking and obese individuals to lose weight. The study is informed by economic models ('rational addiction' and 'demand for health' models) which offer hypotheses on the relationship between health shocks and health-related behaviour. Each hypothesis was tested applying a discrete-time hazard model with random effects using up to ten waves of the German Socioeconomic Panel (GSOEP) and statistics on cigarette, food and beverage prices provided by the Federal Statistical Office. Health shocks had a significant positive impact on the probability that smokers quit during the same year in which they experienced the health shock. Health shocks of a smoking household member between year t-2 and t-1 also motivated smoking cessation, although statistical evidence for this was weaker. Health shocks experienced by obese individuals or their household members had, on the other hand, no significant effect on weight loss, as measured by changes in Body Mass Index (BMI). The results of the study suggest that smokers are aware of the risks associated with tobacco consumption, know about effective strategies to quit smoking, and are willing to quit for health-related reasons. In contrast, there was no evidence for changes in health-related behaviour among obese individuals after a health shock.

Can Economic Model Transparency Improve Provider Interpretation of Cost-effectiveness Analysis? Evaluating Tradeoffs Presented by the Second Panel on Cost-effectiveness in Health and Medicine.

Science.gov (United States)

Padula, William V; McQueen, Robert Brett; Pronovost, Peter J

2017-11-01

The Second Panel on Cost-Effectiveness in Health and Medicine convened on December 7, 2016 at the National Academy of Medicine to disseminate their recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses (CEAs). Following its summary, panel proceedings included lengthy discussions including the field's struggle to disseminate findings efficiently through peer-reviewed literature to target audiences. With editors of several medical and outcomes research journals in attendance, there was consensus that findings of cost-effectiveness analyses do not effectively reach other researchers or health care providers. The audience members suggested several solutions including providing additional training to clinicians in cost-effectiveness research and requiring that cost-effectiveness models are made publicly available. However, there remains the questions of whether making economic modelers' work open-access through journals is fair under the defense that these models remain one's own intellectual property, or whether journals can properly manage the peer-review process specifically for cost-effectiveness analyses. In this article, we elaborate on these issues and provide some suggested solutions that may increase the dissemination and application of cost-effectiveness literature to reach its intended audiences and ultimately benefit the patient. Ultimately, it is our combined view as economic modelers and clinicians that cost-effectiveness results need to reach the clinician to improve the efficiency of medical practice, but that open-access models do not improve clinician access or interpretation of the economics of medicine.

A Global Model for Effective Use and Evaluation of e-Learning in Health

Science.gov (United States)

Farrington, Conor; Brayne, Carol

2013-01-01

Abstract Healthcare systems worldwide face a wide range of challenges, including demographic change, rising drug and medical technology costs, and persistent and widening health inequalities both within and between countries. Simultaneously, issues such as professional silos, static medical curricula, and perceptions of “information overload” have made it difficult for medical training and continued professional development (CPD) to adapt to the changing needs of healthcare professionals in increasingly patient-centered, collaborative, and/or remote delivery contexts. In response to these challenges, increasing numbers of medical education and CPD programs have adopted e-learning approaches, which have been shown to provide flexible, low-cost, user-centered, and easily updated learning. The effectiveness of e-learning varies from context to context, however, and has also been shown to make considerable demands on users' motivation and “digital literacy” and on providing institutions. Consequently, there is a need to evaluate the effectiveness of e-learning in healthcare as part of ongoing quality improvement efforts. This article outlines the key issues for developing successful models for analyzing e-health learning. PMID:23472702

A global model for effective use and evaluation of e-learning in health.

Science.gov (United States)

Ruggeri, Kai; Farrington, Conor; Brayne, Carol

2013-04-01

Healthcare systems worldwide face a wide range of challenges, including demographic change, rising drug and medical technology costs, and persistent and widening health inequalities both within and between countries. Simultaneously, issues such as professional silos, static medical curricula, and perceptions of "information overload" have made it difficult for medical training and continued professional development (CPD) to adapt to the changing needs of healthcare professionals in increasingly patient-centered, collaborative, and/or remote delivery contexts. In response to these challenges, increasing numbers of medical education and CPD programs have adopted e-learning approaches, which have been shown to provide flexible, low-cost, user-centered, and easily updated learning. The effectiveness of e-learning varies from context to context, however, and has also been shown to make considerable demands on users' motivation and "digital literacy" and on providing institutions. Consequently, there is a need to evaluate the effectiveness of e-learning in healthcare as part of ongoing quality improvement efforts. This article outlines the key issues for developing successful models for analyzing e-health learning.

Health Insurance, Medical Care, and Health Outcomes: A Model of Elderly Health Dynamics

Science.gov (United States)

Yang, Zhou; Gilleskie, Donna B.; Norton, Edward C.

2009-01-01

Prescription drug coverage creates a change in medical care consumption, beyond standard moral hazard, arising both from the differential cost-sharing and the relative effectiveness of different types of care. We model the dynamic supplemental health insurance decisions of Medicare beneficiaries, their medical care demand, and subsequent health…

Managing structural uncertainty in health economic decision models: a discrepancy approach

OpenAIRE

Strong, M.; Oakley, J.; Chilcott, J.

2012-01-01

Healthcare resource allocation decisions are commonly informed by computer model predictions of population mean costs and health effects. It is common to quantify the uncertainty in the prediction due to uncertain model inputs, but methods for quantifying uncertainty due to inadequacies in model structure are less well developed. We introduce an example of a model that aims to predict the costs and health effects of a physical activity promoting intervention. Our goal is to develop a framewor...

The health effects of fetal microchimerism can be modeled in companion dogs.

Science.gov (United States)

Kumar, Senthil R; Hansen, Sarah A; Axiak-Bechtel, Sandra M; Bryan, Jeffrey N

2013-01-01

Fetal microchimerism (FMC) has been described to have a range of effects on health and disease. Y-chromosomal DNA has been detected in Golden Retrievers suggesting persistent FMC. In that report, nine dogs had evidence of microchimerism without prior pregnancy. To further understand this finding, a dam with prior male live births giving birth to her fourth litter of puppies, all females, was evaluated for FMC along with two of her daughters. All three female dogs had evidence of Y-chromosomal DNA in their blood. This suggests that male cells carried by the dam from previous pregnancy trafficked to her daughters to establish microchimerism in younger siblings. Companion dogs share many of the same cancers as humans, have out-bred genetics, and share the human environment, making them optimal models of human disease. Understanding the impact of FMC on health and disease of dogs could elucidate mechanisms useful for clinical interventions in humans.

Assessment of the effect of visual impairment on mortality through multiple health pathways: structural equation modeling.

Science.gov (United States)

Christ, Sharon L; Lee, David J; Lam, Byron L; Zheng, D Diane; Arheart, Kristopher L

2008-08-01

To estimate the direct effects of self-reported visual impairment (VI) on health, disability, and mortality and to estimate the indirect effects of VI on mortality through health and disability mediators. The National Health Interview Survey (NHIS) is a population-based annual survey designed to be representative of the U.S. civilian noninstitutionalized population. The National Death Index of 135,581 NHIS adult participants, 18 years of age and older, from 1986 to 1996 provided the mortality linkage through 2002. A generalized linear structural equation model (GSEM) with latent variable was used to estimate the results of a system of equations with various outcomes. Standard errors and test statistics were corrected for weighting, clustering, and stratification. VI affects mortality, when direct adjustment was made for the covariates. Severe VI increases the hazard rate by a factor of 1.28 (95% CI: 1.07-1.53) compared with no VI, and some VI increases the hazard by a factor of 1.13 (95% CI: 1.07-1.20). VI also affects mortality indirectly through self-rated health and disability. The total effects (direct effects plus mediated effects) on the hazard of mortality of severe VI and some VI relative to no VI are hazard ratio (HR) 1.54 (95% CI: 1.28-1.86) and HR 1.23 (95% CI: 1.16-1.31), respectively. In addition to the direct link between VI and mortality, the effects of VI on general health and disability contribute to an increased risk of death. Ignoring the latter may lead to an underestimation of the substantive impact of VI on mortality.

Cost-effectiveness of a school-based health promotion program in Canada: A life-course modeling approach.

Directory of Open Access Journals (Sweden)

John Paul Ekwaru

Full Text Available The Alberta Project Promoting active Living and healthy Eating in Schools (APPLE Schools has been recognized as a "best practice" in preventing childhood obesity. To inform decision making on the economic implications of APPLE Schools and to justify investment, we evaluated the project's cost-effectiveness following a life-course approach.We developed a state transition model for the lifetime progression of body weight status comparing elementary school students attending APPLE Schools and control schools. This model quantified the lifetime impact of APPLE Schools in terms of prevention of excess body weight, chronic disease and improved quality-adjusted life years (QALY, from a school system's cost perspective. Both costs and health outcomes were discounted to their present value using 3% discount rate.The incremental cost-effectiveness ratio(ICER of APPLE schools was CA$33,421 per QALY gained, and CA$1,555, CA$1,709 and CA$14,218 per prevented person years of excess weight, obesity and chronic disease, respectively. These estimates show that APPLE Schools is cost effective at a threshold of ICER < CA$50,000. In probabilistic sensitivity analysis, APPLE Schools was cost effective more than 64% of the time per QALY gained, when using a threshold of ICERhealth promotion, such as APPLE Schools is a cost-effective intervention for obesity prevention and reduction of chronic disease risk over the lifetime. Expanding the coverage and allocating resources towards school-based programs like the APPLE Schools program, is likely to reduce the public health burden of obesity and chronic diseases.

Why Business Modeling is Crucial in the Development of eHealth Technologies

Science.gov (United States)

van Gemert-Pijnen, Julia EWC; Nijland, Nicol; Ossebaard, Hans C; Hendrix, Ron MG; Seydel, Erwin R

2011-01-01

The impact and uptake of information and communication technologies that support health care are rather low. Current frameworks for eHealth development suffer from a lack of fitting infrastructures, inability to find funding, complications with scalability, and uncertainties regarding effectiveness and sustainability. These issues can be addressed by defining a better implementation strategy early in the development of eHealth technologies. A business model, and thus business modeling, help to determine such an implementation strategy by involving all important stakeholders in a value-driven dialogue on what the technology should accomplish. This idea also seems promising to eHealth, as it can contribute to the whole development of eHealth technology. We therefore suggest that business modeling can be used as an effective approach to supporting holistic development of eHealth technologies. The contribution of business modeling is elaborated in this paper through a literature review that covers the latest business model research, concepts from the latest eHealth and persuasive technology research, evaluation and insights from our prior eHealth research, as well as the review conducted in the first paper of this series. Business modeling focuses on generating a collaborative effort of value cocreation in which all stakeholders reflect on the value needs of the others. The resulting business model acts as the basis for implementation. The development of eHealth technology should focus more on the context by emphasizing what this technology should contribute in practice to the needs of all involved stakeholders. Incorporating the idea of business modeling helps to cocreate and formulate a set of critical success factors that will influence the sustainability and effectiveness of eHealth technology. PMID:22204896

Why business modeling is crucial in the development of eHealth technologies.

Science.gov (United States)

van Limburg, Maarten; van Gemert-Pijnen, Julia E W C; Nijland, Nicol; Ossebaard, Hans C; Hendrix, Ron M G; Seydel, Erwin R

2011-12-28

The impact and uptake of information and communication technologies that support health care are rather low. Current frameworks for eHealth development suffer from a lack of fitting infrastructures, inability to find funding, complications with scalability, and uncertainties regarding effectiveness and sustainability. These issues can be addressed by defining a better implementation strategy early in the development of eHealth technologies. A business model, and thus business modeling, help to determine such an implementation strategy by involving all important stakeholders in a value-driven dialogue on what the technology should accomplish. This idea also seems promising to eHealth, as it can contribute to the whole development of eHealth technology. We therefore suggest that business modeling can be used as an effective approach to supporting holistic development of eHealth technologies. The contribution of business modeling is elaborated in this paper through a literature review that covers the latest business model research, concepts from the latest eHealth and persuasive technology research, evaluation and insights from our prior eHealth research, as well as the review conducted in the first paper of this series. Business modeling focuses on generating a collaborative effort of value cocreation in which all stakeholders reflect on the value needs of the others. The resulting business model acts as the basis for implementation. The development of eHealth technology should focus more on the context by emphasizing what this technology should contribute in practice to the needs of all involved stakeholders. Incorporating the idea of business modeling helps to cocreate and formulate a set of critical success factors that will influence the sustainability and effectiveness of eHealth technology.

Effectiveness of Education Based on the Health Belief Model on Performing Preventive Measures for Breast Cancer Among Female Teachers in Zahedan

Directory of Open Access Journals (Sweden)

Khadijeh Kalan-Farmanfarma

2014-06-01

Full Text Available Introduction: Preventive behaviors such as screening tests have an important role in prevention and control of breast cancer. Therefore, this study aimed to determine the effect of educational programs on preventive behaviors of breast cancer based on the health belief model among female teachers of guidance schools in Zahedan city. Materials and Methods: This quasi-experimental study was performed on 240 female teachers from (120 participants in each of the control and intervention groups Zahedan guidance schools. The data-gathering tool was a multipart questionnaire containing demographic variables, knowledge and health belief model structures. An educational program was performed based on the health belief model in five sessions through lectures, training videos, question and answer session for participants in the intervention group. Questionnaires were filled before and two months after the intervention in the two groups. Data was analyzed by independent T-test, chi-square and multiple linear regressions using SPSS-15 software. Results: There was no meaningful difference in the mean scores of knowledge, health belief model constructs, and performance between the two groups before the educational intervention, but the mean scores of variables increased significantly after the intervention (P< 0.05. Conclusion: The health belief model was effective to promote preventive behaviors. Hence, educational interventions with an emphasis on raising awareness, change in beliefs and improving self-efficacy regarding breast cancer are recommended

Modeling the Health Effects of Expanding e-Cigarette Sales in the United States and United Kingdom: A Monte Carlo Analysis.

Science.gov (United States)

Kalkhoran, Sara; Glantz, Stanton A

2015-10-01

The prevalence of electronic cigarette (e-cigarette) use is increasing. Population health effects will depend on cigarette smoking behaviors, levels of dual use with conventional cigarettes, and e-cigarette toxicity. To evaluate potential health effects of various scenarios of increasing promotion and use of e-cigarettes. A base case model was developed using data on actual cigarette and e-cigarette use patterns that quantifies transitions from an initial state of no cigarette or e-cigarette use to 1 of 5 final states: never use of cigarettes or e-cigarettes, cigarette use, e-cigarette use, dual use of cigarettes and e-cigarettes, or quit. Seven scenarios were created that cover a range of use patterns, depending on how the e-cigarette market might develop, as well as a range of possible long-term health effects of e-cigarette use. Scenarios for changes from the base case were evaluated using Monte Carlo simulations. Separate sets of base case model parameters were evaluated for the US and UK populations. We assigned unitless health "costs" for each final state on a scale of 0 to 100. Population health "costs" were compared with the base case (status quo) assuming e-cigarette use health "costs" from 1% to 50% as dangerous as conventional cigarette use health costs. Compared with the base case, a harm reduction scenario in which e-cigarette use increases only among smokers who are interested in quitting with more quit attempts and no increased initiation of e-cigarette use among nonsmokers, and another scenario in which e-cigarettes are taken up only by youth who would have smoked conventional cigarettes, had population-level health benefits regardless of e-cigarette health costs in both the United States and United Kingdom. Conversely, scenarios in which e-cigarette promotion leads to renormalization of cigarette smoking or e-cigarettes are used primarily by youth who never would have smoked showed net health harms across all e-cigarette health costs. In other

The Brazilian Unified National Health System: Proposal of a Cost-effectiveness Evaluation Model

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Lilian Ribeiro de Oliveira

2016-04-01

Full Text Available The Brazilian Unified National Health System (Sistema Único de Saúde [SUS] is in a prominent position compared to the existing social policies. One of the new tools used by SUS is known as Performance Index of the Unified Health System (Índice de Desempenho do Sistema Único de Saúde [IDSUS], which is intended to measure the performance of each municipality. Therefore, the aim of this study was to propose a model of cost-effectiveness to compare IDSUS performance against total revenues achieved in Homogeneous Group 2, consisting of 94 municipalities and analysed using data from IDSUS and the System Information of the Public Budget for Health Care (Sistema de Informação do Orçamento Público em Saúde [SIOPS] for the year 2011. After structuring this data, we carried out descriptive statistical and cluster analysis in order to group similar municipalities in accordance with established variables: IDSUS performance, population and total revenue in health per capita. Even with the division of municipalities into homogeneous groups and after using variables such as population and revenue to regroup them, the results showed there are municipalities with heterogeneous characteristics. Another finding is in the use and intersection of two distinct databases (IDSUS and SIOPS, which allowed for visualizing the impact of health care revenue on the municipalities performance.

The effectiveness of clinical teaching of mental health courses in nursing using clinical supervision and Kirkpatrick's model.

Science.gov (United States)

Maddineshat, Maryam; Hashemi, Mitra; Besharati, Reza; Gholami, Sepideh; Ghavidel, Fatemeh

2018-01-01

Clinical experience associated with the fear and anxiety of nursing students in the psychiatric unit. Mental health nursing instructors find it challenging to teach nursing students to deal with patients with mental disorders in an environment where they need to provide patient teaching and clinical decision-making based on evidence and new technology. To measure the effectiveness of clinical teaching of mental health courses in nursing using clinical supervision and Kirkpatrick's model evaluation in the psychiatry unit of Imam Reza Hospital, Bojnurd, Iran. This cross-sectional study was carried out from 2011 to 2016 on 76 nursing students from a university as part of a clinical mental health course in two semesters. The students were selected by a non-probable convenient sampling method. After completing their clinical education, each student responded to checklist questions based on the four-level Kirkpatrick's model evaluation and open questions relating to clinical supervision. Finally, all data was analyzed using the SPSS version 16. The students have evaluated clinical supervision as a useful approach, and appreciated the instructor's supportive behavior during teaching and imparting clinical skills. This has made them feel relaxed at the end of the clinical teaching course. In addition, in the evaluation through Kirkpatrick's model, more than 70% of the students have been satisfied with the method of conducting the teaching and average score of nursing students' attitude toward mental health students: Their mean self-confidence score was 18.33±1.69, and the mean score of their performance in the study was evaluated to be 93.74±5.3 from 100 points. The results of clinical mental health teaching through clinical supervision and Kirkpatrick's model evaluation show that the satisfaction, self-esteem, attitude, and skill of nursing students are excellent, thereby portraying the effectiveness of clinical teaching. But this program still needs to be reformed. To

Quantification of health effects of breastfeeding - Review of the literature and model simulation

NARCIS (Netherlands)

Rossum CTM van; Buchner FL; Hoekstra J; CVG

2006-01-01

Breastfeeding has positive health effects, with the largest health gain realized through policy that focuses on encouraging all mothers to start breastfeeding. A literature review shows that breastfeeding has beneficial health effects in both the short and the longer term. There is convincing

An Innovative School Health Education Model Designed for Student Achievement.

Science.gov (United States)

Rohwer, John; Wandberg, Bob

New threats to the health of American children, often psychosocial in nature due to societal changes, must be addressed. The Minnesota School Health Education Model is based on the integration of four primary components: (1) school health education goals aimed at health promotion, disease prevention, and long-term positive health effects on…

A public health decision support system model using reasoning methods.

Science.gov (United States)

Mera, Maritza; González, Carolina; Blobel, Bernd

2015-01-01

Public health programs must be based on the real health needs of the population. However, the design of efficient and effective public health programs is subject to availability of information that can allow users to identify, at the right time, the health issues that require special attention. The objective of this paper is to propose a case-based reasoning model for the support of decision-making in public health. The model integrates a decision-making process and case-based reasoning, reusing past experiences for promptly identifying new population health priorities. A prototype implementation of the model was performed, deploying the case-based reasoning framework jColibri. The proposed model contributes to solve problems found today when designing public health programs in Colombia. Current programs are developed under uncertain environments, as the underlying analyses are carried out on the basis of outdated and unreliable data.

The Culture-Work-Health Model and Work Stress.

Science.gov (United States)

Peterson, Michael; Wilson, John F.

2002-01-01

Examines the role of organizational culture in the etiology of workplace stress through the framework of the Culture-Work- Health model. A review of relevant business and health literature indicates that culture is an important component of work stress and may be a key to creating effective organizational stress interventions. (SM)

Simulation Models for Socioeconomic Inequalities in Health: A Systematic Review

Directory of Open Access Journals (Sweden)

Niko Speybroeck

2013-11-01

Full Text Available Background: The emergence and evolution of socioeconomic inequalities in health involves multiple factors interacting with each other at different levels. Simulation models are suitable for studying such complex and dynamic systems and have the ability to test the impact of policy interventions in silico. Objective: To explore how simulation models were used in the field of socioeconomic inequalities in health. Methods: An electronic search of studies assessing socioeconomic inequalities in health using a simulation model was conducted. Characteristics of the simulation models were extracted and distinct simulation approaches were identified. As an illustration, a simple agent-based model of the emergence of socioeconomic differences in alcohol abuse was developed. Results: We found 61 studies published between 1989 and 2013. Ten different simulation approaches were identified. The agent-based model illustration showed that multilevel, reciprocal and indirect effects of social determinants on health can be modeled flexibly. Discussion and Conclusions: Based on the review, we discuss the utility of using simulation models for studying health inequalities, and refer to good modeling practices for developing such models. The review and the simulation model example suggest that the use of simulation models may enhance the understanding and debate about existing and new socioeconomic inequalities of health frameworks.

The effect of a rehabilitation nursing intervention model on improving the comprehensive health status of patients with hand burns.

Science.gov (United States)

Li, Lin; Dai, Jia-Xi; Xu, Le; Huang, Zhen-Xia; Pan, Qiong; Zhang, Xi; Jiang, Mei-Yun; Chen, Zhao-Hong

2017-06-01

To observe the effect of a rehabilitation intervention on the comprehensive health status of patients with hand burns. Most studies of hand-burn patients have focused on functional recovery. There have been no studies involving a biological-psychological-social rehabilitation model of hand-burn patients. A randomized controlled design was used. Patients with hand burns were recruited to the study, and sixty patients participated. Participants were separated into two groups: (1) The rehabilitation intervention model group (n=30) completed the rehabilitation intervention model, which included the following measures: enhanced social support, intensive health education, comprehensive psychological intervention, and graded exercise. (2) The control group (n=30) completed routine treatment. Intervention lasted 5 weeks. Analysis of variance (ANOVA) and Student's t test were conducted. The rehabilitation intervention group had significantly better scores than the control group for comprehensive health, physical function, psychological function, social function, and general health. The differences between the index scores of the two groups were statistically significant. The rehabilitation intervention improved the comprehensive health status of patients with hand burns and has favorable clinical application. The comprehensive rehabilitation intervention model used here provides scientific guidance for medical staff aiming to improve the integrated health status of hand-burn patients and accelerate their recovery. What does this paper contribute to the wider global clinical community? Copyright © 2017 The Authors. Published by Elsevier Ltd.. All rights reserved.

A simplified model for calculating atmospheric radionuclide transport and early health effects from nuclear reactor accidents

International Nuclear Information System (INIS)

Madni, I.K.; Cazzoli, E.G.; Khatib-Rahbar, M.

1995-01-01

During certain hypothetical severe accidents in a nuclear power plant, radionuclides could be released to the environment as a plume. Prediction of the atmospheric dispersion and transport of these radionuclides is important for assessment of the risk to the public from such accidents. A simplified PC-based model was developed that predicts time-integrated air concentration of each radionuclide at any location from release as a function of time integrated source strength using the Gaussian plume model. The solution procedure involves direct analytic integration of air concentration equations over time and position, using simplified meteorology. The formulation allows for dry and wet deposition, radioactive decay and daughter buildup, reactor building wake effects, the inversion lid effect, plume rise due to buoyancy or momentum, release duration, and grass height. Based on air and ground concentrations of the radionuclides, the early dose to an individual is calculated via cloudshine, groundshine, and inhalation. The model also calculates early health effects based on the doses. This paper presents aspects of the model that would be of interest to the prediction of environmental flows and their public consequences

Alternate Models of Sibling Status Effects on Health in Later Life

Science.gov (United States)

Falbo, Toni; Kim, Sunghun; Chen, Kuan-yi

2009-01-01

Although siblings are thought to be influential in child development, little is known about the influence of sibling status on the health of older adults. Using structural equation modeling, the authors created and tested a series of models with data from a sample (N = 3,968) of 1957 high school graduates from the Wisconsin Longitudinal Study. The…

Economic modeling of surgical disease: a measure of public health interventions.

Science.gov (United States)

Corlew, D Scott

2013-07-01

The measurement of the burden of disease and the interventions that address that burden can be done in various units. Reducing these measures to the common denominator of economic units (i.e., currency) enables comparison with other health entities, interventions, and even other fields. Economic assessment is complex, however, because of the multifactorial components of what constitutes health and what constitutes health interventions, as well as the coupling of those data to economic means. To perform economic modeling in a meaningful manner, it is necessary to: (1) define the health problem to be addressed; (2) define the intervention to be assessed; (3) define a measure of the effect of the health entity with and without the intervention (which includes defining the counterfactual); and (4) determine the appropriate method of converting the health effect to economics. This paper discusses technical aspects of how economic modeling can be done both of disease entities and of interventions. Two examples of economic modeling applied to surgical problems are then given.

The economic costs of radiation-induced health effects: Estimation and simulation

International Nuclear Information System (INIS)

Nieves, L.A.; Tawil, J.J.

1988-08-01

This effort improves the quantitative information available for use in evaluating actions that alter health risks due to population exposure to ionizing radiation. To project the potential future costs of changes in health effects risks, Pacific Northwest Laboratory (PNL) constructed a probabilistic computer model, Health Effects Costs Model (HECOM), which utilizes the health effect incidence estimates from accident consequences models to calculate the discounted sum of the economic costs associated with population exposure to ionizing radiation. Application of HECOM to value-impact and environmental impact analyses should greatly increase the quality of the information available for regulatory decision making. Three major types of health effects present risks for any population sustaining a significant radiation exposure: acute radiation injuries (and fatalities), latent cancers, and impairments due to genetic effects. The literature pertaining to both incidence and treatment of these health effects was reviewed by PNL and provided the basis for developing economic cost estimates. The economic costs of health effects estimated by HECOM represent both the value of resources consumed in diagnosing, treating, and caring for the patient and the value of goods not produced because of illness or premature death due to the health effect. Additional costs to society, such as pain and suffering, are not included in the PNL economic cost measures since they do not divert resources from other uses, are difficult to quantify, and do not have a value observable in the marketplace. 83 refs., 3 figs., 19 tabs

The economic costs of radiation-induced health effects: Estimation and simulation

Energy Technology Data Exchange (ETDEWEB)

Nieves, L.A.; Tawil, J.J.

1988-08-01

This effort improves the quantitative information available for use in evaluating actions that alter health risks due to population exposure to ionizing radiation. To project the potential future costs of changes in health effects risks, Pacific Northwest Laboratory (PNL) constructed a probabilistic computer model, Health Effects Costs Model (HECOM), which utilizes the health effect incidence estimates from accident consequences models to calculate the discounted sum of the economic costs associated with population exposure to ionizing radiation. Application of HECOM to value-impact and environmental impact analyses should greatly increase the quality of the information available for regulatory decision making. Three major types of health effects present risks for any population sustaining a significant radiation exposure: acute radiation injuries (and fatalities), latent cancers, and impairments due to genetic effects. The literature pertaining to both incidence and treatment of these health effects was reviewed by PNL and provided the basis for developing economic cost estimates. The economic costs of health effects estimated by HECOM represent both the value of resources consumed in diagnosing, treating, and caring for the patient and the value of goods not produced because of illness or premature death due to the health effect. Additional costs to society, such as pain and suffering, are not included in the PNL economic cost measures since they do not divert resources from other uses, are difficult to quantify, and do not have a value observable in the marketplace. 83 refs., 3 figs., 19 tabs.

The Effect of Education Based on the Health Belief Model on Osteoporosis Prevention Behaviors in Female High School Students

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Mousaviasl

2016-09-01

Full Text Available Background Osteoporosis is one of the most common metabolic bone diseases and is the silent epidemic of this era. Objectives This study evaluates the effect of education that is based on the health belief model on promoting osteoporosis prevention behaviors among female high school students. Methods In this two-group interventional study, 172 students age 11 to 14 years (experimental group = 86 subjects; control group = 86 subjects were randomly selected from Khorramshahr high schools using multistage sampling. Data were collected before the intervention and two months after its completion using a researcher-made questionnaire with four parts: demographic questions, knowledge questions, questions related to the health belief model constructs, and questions regarding preventive behaviors. Data was analyzed using SPSS 22 software and by applying the Mann-Whitney test, the analysis of covariance procedure, and the Wilcoxon statistical test. Results After the intervention, significant statistical differences were seen between the experimental and control groups in mean scores of knowledge, health belief model constructs, and preventive behaviors. Conclusions The education based on health belief model plays an important role in increasing knowledge and improving osteoporosis prevention behaviors in students.

Health informatics model for helminthiasis in Thailand.

Science.gov (United States)

Nithikathkul, C; Trevanich, A; Wongsaroj, T; Wongsawad, C; Reungsang, P

2017-09-01

At the beginning of the new millennium, helminth infections continue to be prevalent, particularly among impoverished populations. This study attempts to create the first health informatics model of helminthiasis in Thailand. The authors investigate how a health informatics model could be used to predict the control and eradication in a national control campaign. Fish-borne helminthiasis caused by Opisthorchis viverrini remains a major public health problem in many parts of South-East Asia, including Thailand, Lao PDR, Vietnam and Cambodia. The epicentre of this disease is located in north-east Thailand, where high prevalence coexists with a high incidence of cholangiocarcinoma (CHCA). The current report was conducted to determine a mathematical model of surveillance for helminthiasis while also using a geographic information system. The fish-borne helminthiasis model or the predicted equation was Y1 = 3.028 + 0.020 (elevation) - 2.098 (clay). For soil-transmitted helminthiasis, the mathematical model or the predicted equation was Y2 = -1.559 + 0.005 (rainfall) + 0.004 (elevation) - 2.198 (clay). The Ministry of Public Health has concluded that mass treatment for helminthiasis in the Thai population, targeting high-risk individuals, may be a cost-effective way to allocate limited funds. This type of approach, as well as further study on the correlation of clinical symptoms with environmental and geographic information, may offer a novel strategy to the helminth crisis.

The Effectiveness of Education Based on BASNEF Model Program in Promotion of Preventive Behavior of Leishmaniasis among Health Workers and Families under Health Centers Coverage

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Ali Khani Jeihooni

2012-06-01

Full Text Available Background & Objective: Intervention of educational training in order to prevent the leishmaniasis in endemic areas seems necessary. This study was implemented with the aim of assessing the effectiveness of education based on BASNEF Model program in promotion of preventive behavior of leishmaniasis among Health workers and families under the coverage of Health centers. Materials & Methods: An intervention study was carried out in rural health centers during 2009. Questionnaires were completed by 20 health- workers of two rural health centers. Also 20 families under the coverage of this health centers were randomly selected to complete the questionnaire. Then four training sessions for health workers and 2 training sessions for the influential individuals were conducted to increase the enabling factors and solving their problems, weekly meetings was held with health workers representatives. After three months of health workers training the data were collected again and analyzed via Chi- Square, T Independent, T pair, Regression and Mann- Whitney statistics. Results: The mean score for to knowledge, attitude, behavior intension, enabling factors and health workers behaviors significantly increased after educational intervention in experimental group and influential individuals. The mean scores for knowledge, attitude, behavior intension, enabling factors and the behavior of attendant families under coverage also increased significantly. Conclusion: Educational program of BASNEF Model, leads to behavior change of health workers and eventually their training behavior leads to preventive actions in families under coverage.

MODELS SELECTED FOR CALCULATION OF DOSES, HEALTH EFFECTS AND ECONOMIC COSTS DUE TO ACCIDENTAL RADIONUCLIDE RELEASES FROM NUCLEAR POWER PLANTS

Energy Technology Data Exchange (ETDEWEB)

Strenge, D L; Baker, D A; Droppo, J G; McPherson, R B; Napier, B A; Nieves, L A; Soldat, J K

1980-05-01

Models are described for use in site-specific environmental consequence analysis of nuclear reactor accidents of Classes 3 through 9. The models presented relate radioactivity released to resulting doses, health effects, and costs of remedial actions. Specific models are presented for the major exposure pathways of airborne releases, waterborne releases and direct irradiation from activity within the facility buildings, such as the containment. Time-dependent atmospheric dispersion parameters, crop production parameters and other variable parameters are used in the models. The environmental effects are analyzed for several accident start times during the year.

Modeling the effects of LID practices on streams health at watershed scale

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Shannak, S.; Jaber, F. H.

2013-12-01

Increasing impervious covers due to urbanization will lead to an increase in runoff volumes, and eventually increase flooding. Stream channels adjust by widening and eroding stream bank which would impact downstream property negatively (Chin and Gregory, 2001). Also, urban runoff drains in sediment bank areas in what's known as riparian zones and constricts stream channels (Walsh, 2009). Both physical and chemical factors associated with urbanization such as high peak flows and low water quality further stress aquatic life and contribute to overall biological condition of urban streams (Maxted et al., 1995). While LID practices have been mentioned and studied in literature for stormwater management, they have not been studied in respect to reducing potential impact on stream health. To evaluate the performance and the effectiveness of LID practices at a watershed scale, sustainable detention pond, bioretention, and permeable pavement will be modeled at watershed scale. These measures affect the storm peak flows and base flow patterns over long periods, and there is a need to characterize their effect on stream bank and bed erosion, and aquatic life. These measures will create a linkage between urban watershed development and stream conditions specifically biological health. The first phase of this study is to design and construct LID practices at the Texas A&M AgriLife Research and Extension Center-Dallas, TX to collect field data about the performance of these practices on a smaller scale. The second phase consists of simulating the performance of LID practices on a watershed scale. This simulation presents a long term model (23 years) using SWAT to evaluate the potential impacts of these practices on; potential stream bank and bed erosion, and potential impact on aquatic life in the Blunn Watershed located in Austin, TX. Sub-daily time step model simulations will be developed to simulate the effectiveness of the three LID practices with respect to reducing

Evaluation of a Digital Game-Based Learning Program for Enhancing Youth Mental Health: A Structural Equation Modeling of the Program Effectiveness.

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Huen, Jenny My; Lai, Eliza Sy; Shum, Angie Ky; So, Sam Wk; Chan, Melissa Ky; Wong, Paul Wc; Law, Y W; Yip, Paul Sf

2016-10-07

Digital game-based learning (DGBL) makes use of the entertaining power of digital games for educational purposes. Effectiveness assessment of DGBL programs has been underexplored and no attempt has been made to simultaneously model both important components of DGBL: learning attainment (ie, educational purposes of DGBL) and engagement of users (ie, entertaining power of DGBL) in evaluating program effectiveness. This study aimed to describe and evaluate an Internet-based DGBL program, Professor Gooley and the Flame of Mind, which promotes mental health to adolescents in a positive youth development approach. In particular, we investigated whether user engagement in the DGBL program could enhance their attainment on each of the learning constructs per DGBL module and subsequently enhance their mental health as measured by psychological well-being. Users were assessed on their attainment on each learning construct, psychological well-being, and engagement in each of the modules. One structural equation model was constructed for each DGBL module to model the effect of users' engagement and attainment on the learning construct on their psychological well-being. Of the 498 secondary school students that registered and participated from the first module of the DGBL program, 192 completed all 8 modules of the program. Results from structural equation modeling suggested that a higher extent of engagement in the program activities facilitated users' attainment on the learning constructs on most of the modules and in turn enhanced their psychological well-being after controlling for users' initial psychological well-being and initial attainment on the constructs. This study provided evidence that Internet intervention for mental health, implemented with the technologies and digital innovations of DGBL, could enhance youth mental health. Structural equation modeling is a promising approach in evaluating the effectiveness of DGBL programs.

Health Externalities and Heat savings in Energy System Modelling

DEFF Research Database (Denmark)

Zvingilaite, Erika

Energy consumption and production can cause air pollution with global impact, such as CO2, and local/regional air pollutants, such as SO2, NOx and PM2.5, as a result of fuel combustion. Use of fossil fuels leads to global CO2 emissions and causes global warming effects, regardless place or height......-related external costs can be internalised, for instance, in energy system modelling. External costs of global warming and human health damage can be of comparable magnitude.However, in contrast to global CO2 impacts, air pollution damage to human health depends on a number of factors, related to location...... and included in an energy system optimisation model. The performed analysis of the Danish heat and power sector concludes that accounting for spatial variation of health damage costs in heat and power system optimisation model has an effect on the optimal technology mix and distribution of energy plants among...

Effect of Preconception Care Education by Health Volunteers on Knowledge and Attitudes of Women: Application of the Health Belief Model

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Nasrin Fazeli

2018-04-01

Full Text Available Preconception care identifies and modifies the risk factors for pregnancy and childbirth. The present study aimed to determine the effects a preconception care education program, which was based on the Health Belief Model (HBM and implemented by health volunteers, on knowledge and attitudes of women. A semi-experimental study was conducted using 22 health volunteers and 110 women aged 15-49 years selected from two comprehensive health centers of Mashhad, Iran, in 2016. The convenience sampling method was employed for selecting the volunteers and the regular random sampling method for choosing the women. For data collection, we applied a researcher-made tool with verified validity and reliability. HBM-based education was implemented by the volunteers during three sessions. Data analysis was performed in SPSS using Mann-Whitney test, Friedman, and Spearman's rank correlation coefficient; repeated measures data analysis was carried out at the significance level of 0.05. The mean age of the women was 30.6±6.6 years in the intervention group and 31.6±6.5 years in the control group. The mean levels of knowledge and attitude increased significantly after the intervention (P

The recovery model and complex health needs: what health psychology can learn from mental health and substance misuse service provision.

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Webb, Lucy

2012-07-01

This article reviews key arguments around evidence-based practice and outlines the methodological demands for effective adoption of recovery model principles. The recovery model is outlined and demonstrated as compatible with current needs in substance misuse service provision. However, the concepts of evidence-based practice and the recovery model are currently incompatible unless the current value system of evidence-based practice changes to accommodate the methodologies demanded by the recovery model. It is suggested that critical health psychology has an important role to play in widening the scope of evidence-based practice to better accommodate complex social health needs.

Global and regional health effects of future food production under climate change: a modelling study.

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Springmann, Marco; Mason-D'Croz, Daniel; Robinson, Sherman; Garnett, Tara; Godfray, H Charles J; Gollin, Douglas; Rayner, Mike; Ballon, Paola; Scarborough, Peter

2016-05-07

One of the most important consequences of climate change could be its effects on agriculture. Although much research has focused on questions of food security, less has been devoted to assessing the wider health impacts of future changes in agricultural production. In this modelling study, we estimate excess mortality attributable to agriculturally mediated changes in dietary and weight-related risk factors by cause of death for 155 world regions in the year 2050. For this modelling study, we linked a detailed agricultural modelling framework, the International Model for Policy Analysis of Agricultural Commodities and Trade (IMPACT), to a comparative risk assessment of changes in fruit and vegetable consumption, red meat consumption, and bodyweight for deaths from coronary heart disease, stroke, cancer, and an aggregate of other causes. We calculated the change in the number of deaths attributable to climate-related changes in weight and diets for the combination of four emissions pathways (a high emissions pathway, two medium emissions pathways, and a low emissions pathway) and three socioeconomic pathways (sustainable development, middle of the road, and more fragmented development), which each included six scenarios with variable climatic inputs. The model projects that by 2050, climate change will lead to per-person reductions of 3·2% (SD 0·4%) in global food availability, 4·0% (0·7%) in fruit and vegetable consumption, and 0·7% (0·1%) in red meat consumption. These changes will be associated with 529,000 climate-related deaths worldwide (95% CI 314,000-736,000), representing a 28% (95% CI 26-33) reduction in the number of deaths that would be avoided because of changes in dietary and weight-related risk factors between 2010 and 2050. Twice as many climate-related deaths were associated with reductions in fruit and vegetable consumption than with climate-related increases in the prevalence of underweight, and most climate-related deaths were projected to

Health care models guiding mental health policy in Kenya 1965 - 1997

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Jenkins Rachel

2010-04-01

Full Text Available Abstract Background Mental health policy is needed to set the strategy and direction for the provision of mental health services in a country. Policy formulation does not occur in a vacuum, however, but is influenced by local and international factors in the health sector and other sectors. Methods This study was carried out in 1997 to examine the evolution of mental health policy in Kenya between 1965 and 1997 in the context of changing international concepts of health and development. Qualitative content analysis of policy documents was combined with interviews of key policy makers. Results The study showed that during the period 1965-1997 the generic health policy in Kenya changed from one based on the Medical Model in the 1960s and 1970s to one based on the Primary Health Care Model in the late 1970s and the 1980s and finally to one based on the Market Model of health care in the 1990s. The mental health policy, on the other hand, evolved from one based on the Medical Model in the 1960s to one based on the Primary Health Care Model in the 1990s, but did not embrace the Market Model of health care. This resulted in a situation in the 1990s where the mental health policy was rooted in a different conceptual model from that of the generic health policy under which it was supposed to be implemented. This "Model Muddlement" may have impeded the implementation of the mental health policy in Kenya. Conclusions Integration of the national mental health policy with the general health policy and other sector policies would be appropriate and is now underway.

The Health Equity Promotion Model: Reconceptualization of Lesbian, Gay, Bisexual, and Transgender (LGBT) Health Disparities

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Fredriksen-Goldsen, Karen I.; Simoni, Jane M.; Kim, Hyun-Jun; Lehavot, Keren; Walters, Karina L.; Yang, Joyce; Hoy-Ellis, Charles P.

2015-01-01

National health initiatives emphasize the importance of eliminating health disparities among historically disadvantaged populations. Yet, few studies have examined the range of health outcomes among lesbian, gay, bisexual, and transgender (LGBT) people. To stimulate more inclusive research in the area, we present the Health Equity Promotion Model—a framework oriented toward LGBT people reaching their full mental and physical health potential that considers both positive and adverse health-related circumstances. The model highlights (a) heterogeneity and intersectionality within LGBT communities; (b) the influence of structural and environmental context; and (c) both health-promoting and adverse pathways that encompass behavioral, social, psychological, and biological processes. It also expands upon earlier conceptualizations of sexual minority health by integrating a life course development perspective within the health-promotion model. By explicating the important role of agency and resilience as well as the deleterious effect of social structures on health outcomes, it supports policy and social justice to advance health and well-being in these communities. Important directions for future research as well as implications for health-promotion interventions and policies are offered. PMID:25545433

Reviewing model application to support animal health decision making.

Science.gov (United States)

Singer, Alexander; Salman, Mo; Thulke, Hans-Hermann

2011-04-01

Animal health is of societal importance as it affects human welfare, and anthropogenic interests shape decision making to assure animal health. Scientific advice to support decision making is manifold. Modelling, as one piece of the scientific toolbox, is appreciated for its ability to describe and structure data, to give insight in complex processes and to predict future outcome. In this paper we study the application of scientific modelling to support practical animal health decisions. We reviewed the 35 animal health related scientific opinions adopted by the Animal Health and Animal Welfare Panel of the European Food Safety Authority (EFSA). Thirteen of these documents were based on the application of models. The review took two viewpoints, the decision maker's need and the modeller's approach. In the reviewed material three types of modelling questions were addressed by four specific model types. The correspondence between tasks and models underpinned the importance of the modelling question in triggering the modelling approach. End point quantifications were the dominating request from decision makers, implying that prediction of risk is a major need. However, due to knowledge gaps corresponding modelling studies often shed away from providing exact numbers. Instead, comparative scenario analyses were performed, furthering the understanding of the decision problem and effects of alternative management options. In conclusion, the most adequate scientific support for decision making - including available modelling capacity - might be expected if the required advice is clearly stated. Copyright © 2011 Elsevier B.V. All rights reserved.

Health effects of radiation damage

International Nuclear Information System (INIS)

Gasimova, K; Azizova, F; Mehdieva, K.

2012-01-01

Full text : A summary of the nature of radiactive contamination would be incomplete without some mention of the human health effects relatied to radioactivity and radioactive materials. Several excellent reviews at the variety of levels of detail have been written and should be consulted by the reader. Internal exposures of alpha and beta particles are important for ingested and inhaled radionuclides. Dosimetry models are used to estimate the dose from internally deposited radioactive particles. As mentioned above weighting parameters that take into account the radiation type, the biological half-life and the tissue or organ at risk are used to convert the physically absorbed dose in units of gray (or red) to the biologically significant committed equivalent dose and effective dose, measured in units of Sv (or rem). There is considerable controversy over the shape of the dose-response curve at the chronic low dose levels important for enviromental contamination. Proposed models include linear models, non-linear models and threshold models. Because risks at low dose must be extrapolated from available date at high doses, the shape of the dose-response curve has important implications for the environmental regulations used to protect the general public. The health effect of radiation damage depends on a combination of events of on the cellular, tissue and systemic levels. These lead to mutations and cellular of the irradiated parent cell. The dose level at which significant damage occurs depends on the cell type. Cells that reproduce rapidily, such as those found in bone marrow or the gastrointestinal tract, will be more sensitive to radiation than those that are longer lived, such as striated muscle or nerve cells. The effects of high radiation doses on an organ depends on the various cell types it contains

Population health improvement: a community health business model that engages partners in all sectors.

Science.gov (United States)

Kindig, David A; Isham, George

2014-01-01

Because population health improvement requires action on multiple determinants--including medical care, health behaviors, and the social and physical environments--no single entity can be held accountable for achieving improved outcomes. Medical organizations, government, schools, businesses, and community organizations all need to make substantial changes in how they approach health and how they allocate resources. To this end, we suggest the development of multisectoral community health business partnership models. Such collaborative efforts are needed by sectors and actors not accustomed to working together. Healthcare executives can play important leadership roles in fostering or supporting such partnerships in local and national arenas where they have influence. In this article, we develop the following components of this argument: defining a community health business model; defining population health and the Triple Aim concept; reaching beyond core mission to help create the model; discussing the shift for care delivery beyond healthcare organizations to other community sectors; examining who should lead in developing the community business model; discussing where the resources for a community business model might come from; identifying that better evidence is needed to inform where to make cost-effective investments; and proposing some next steps. The approach we have outlined is a departure from much current policy and management practice. But new models are needed as a road map to drive action--not just thinking--to address the enormous challenge of improving population health. While we applaud continuing calls to improve health and reduce disparities, progress will require more robust incentives, strategies, and action than have been in practice to date. Our hope is that ideas presented here will help to catalyze a collective, multisectoral response to this critical social and economic challenge.

Innovation in health economic modelling of service improvements for longer-term depression: demonstration in a local health community.

Science.gov (United States)

Tosh, Jonathan; Kearns, Ben; Brennan, Alan; Parry, Glenys; Ricketts, Thomas; Saxon, David; Kilgarriff-Foster, Alexis; Thake, Anna; Chambers, Eleni; Hutten, Rebecca

2013-04-26

The purpose of the analysis was to develop a health economic model to estimate the costs and health benefits of alternative National Health Service (NHS) service configurations for people with longer-term depression. Modelling methods were used to develop a conceptual and health economic model of the current configuration of services in Sheffield, England for people with longer-term depression. Data and assumptions were synthesised to estimate cost per Quality Adjusted Life Years (QALYs). Three service changes were developed and resulted in increased QALYs at increased cost. Versus current care, the incremental cost-effectiveness ratio (ICER) for a self-referral service was £11,378 per QALY. The ICER was £2,227 per QALY for the dropout reduction service and £223 per QALY for an increase in non-therapy services. These results were robust when compared to current cost-effectiveness thresholds and accounting for uncertainty. Cost-effective service improvements for longer-term depression have been identified. Also identified were limitations of the current evidence for the long term impact of services.

Estimated Effects of Different Alcohol Taxation and Price Policies on Health Inequalities: A Mathematical Modelling Study.

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Petra S Meier

2016-02-01

Full Text Available While evidence that alcohol pricing policies reduce alcohol-related health harm is robust, and alcohol taxation increases are a WHO "best buy" intervention, there is a lack of research comparing the scale and distribution across society of health impacts arising from alternative tax and price policy options. The aim of this study is to test whether four common alcohol taxation and pricing strategies differ in their impact on health inequalities.An econometric epidemiological model was built with England 2014/2015 as the setting. Four pricing strategies implemented on top of the current tax were equalised to give the same 4.3% population-wide reduction in total alcohol-related mortality: current tax increase, a 13.4% all-product duty increase under the current UK system; a value-based tax, a 4.0% ad valorem tax based on product price; a strength-based tax, a volumetric tax of £0.22 per UK alcohol unit (= 8 g of ethanol; and minimum unit pricing, a minimum price threshold of £0.50 per unit, below which alcohol cannot be sold. Model inputs were calculated by combining data from representative household surveys on alcohol purchasing and consumption, administrative and healthcare data on 43 alcohol-attributable diseases, and published price elasticities and relative risk functions. Outcomes were annual per capita consumption, consumer spending, and alcohol-related deaths. Uncertainty was assessed via partial probabilistic sensitivity analysis (PSA and scenario analysis. The pricing strategies differ as to how effects are distributed across the population, and, from a public health perspective, heavy drinkers in routine/manual occupations are a key group as they are at greatest risk of health harm from their drinking. Strength-based taxation and minimum unit pricing would have greater effects on mortality among drinkers in routine/manual occupations (particularly for heavy drinkers, where the estimated policy effects on mortality rates are as

Estimated Effects of Different Alcohol Taxation and Price Policies on Health Inequalities: A Mathematical Modelling Study.

Science.gov (United States)

Meier, Petra S; Holmes, John; Angus, Colin; Ally, Abdallah K; Meng, Yang; Brennan, Alan

2016-02-01

While evidence that alcohol pricing policies reduce alcohol-related health harm is robust, and alcohol taxation increases are a WHO "best buy" intervention, there is a lack of research comparing the scale and distribution across society of health impacts arising from alternative tax and price policy options. The aim of this study is to test whether four common alcohol taxation and pricing strategies differ in their impact on health inequalities. An econometric epidemiological model was built with England 2014/2015 as the setting. Four pricing strategies implemented on top of the current tax were equalised to give the same 4.3% population-wide reduction in total alcohol-related mortality: current tax increase, a 13.4% all-product duty increase under the current UK system; a value-based tax, a 4.0% ad valorem tax based on product price; a strength-based tax, a volumetric tax of £0.22 per UK alcohol unit (= 8 g of ethanol); and minimum unit pricing, a minimum price threshold of £0.50 per unit, below which alcohol cannot be sold. Model inputs were calculated by combining data from representative household surveys on alcohol purchasing and consumption, administrative and healthcare data on 43 alcohol-attributable diseases, and published price elasticities and relative risk functions. Outcomes were annual per capita consumption, consumer spending, and alcohol-related deaths. Uncertainty was assessed via partial probabilistic sensitivity analysis (PSA) and scenario analysis. The pricing strategies differ as to how effects are distributed across the population, and, from a public health perspective, heavy drinkers in routine/manual occupations are a key group as they are at greatest risk of health harm from their drinking. Strength-based taxation and minimum unit pricing would have greater effects on mortality among drinkers in routine/manual occupations (particularly for heavy drinkers, where the estimated policy effects on mortality rates are as follows: current tax

Alcohol and cannabis: Comparing their adverse health effects and regulatory regimes.

Science.gov (United States)

Hall, Wayne

2017-04-01

The claim that the adverse health effects of cannabis are much less serious than those of alcohol has been central to the case for cannabis legalisation. Regulators in US states that have legalised cannabis have adopted regulatory models based on alcohol. This paper critically examines the claim about adverse health effects and the wisdom of regulating cannabis like alcohol. First, it compares what we know about the adverse health effects of alcohol and cannabis. Second, it discusses the uncertainties about the long term health effects of sustained daily cannabis use. Third, it speculates about how the adverse health effects of cannabis may change after legalisation. Fourth, it questions the assumption that alcohol provides the best regulatory model for a legal cannabis market. Fifth, it outlines the major challenges in regulating cannabis under the liberal alcohol-like regulatory regimes now being introduced. Copyright © 2016 Elsevier B.V. All rights reserved.

Effect of Educational Intervention on Oral Health Behaviour based on Health Belief Model in Female Secondary School Students of Paveh in 2011

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Mostafa Hosseini

2014-04-01

Full Text Available Introduction: Education is a powerful tool in reducing dental diseases. It is known as an essential part of oral health services. This study evaluated the impact of education on oral health behavior of students based on health belief model. Methods: This educational intervention study was carried out on secondary school girls of Paveh, Iran in 2011. A standard questionnaire was used to collect the data, including demographic characteristics, dimensions of health belief model and performance of students before and after intervention. The educational intervention was conducted over three sessions. To examine differences between groups in terms of demographic factors, dimensions of health belief model and performance status before and after the intervention, Chi-square test and logistic regression were used. P0.05. Conclusion: The importance of education caused promoting dental health behaviors of students. It also emphasized adopting more appropriate methods for oral health training.

Gut Health of Pigs: Challenge Models and Response Criteria with a Critical Analysis of the Effectiveness of Selected Feed Additives - A Review.

Science.gov (United States)

Adewole, D I; Kim, I H; Nyachoti, C M

2016-07-01

The gut is the largest organ that helps with the immune function. Gut health, especially in young pigs has a significant benefit to health and performance. In an attempt to maintain and enhance intestinal health in pigs and improve productivity in the absence of in-feed antibiotics, researchers have evaluated a wide range of feed additives. Some of these additives such as zinc oxide, copper sulphate, egg yolk antibodies, mannan-oligosaccharides and spray dried porcine plasma and their effectiveness are discussed in this review. One approach to evaluate the effectiveness of these additives in vivo is to use an appropriate disease challenge model. Over the years, researchers have used a number of challenge models which include the use of specific strains of enterotoxigenic Escherichia coli, bacteria lipopolysaccharide challenge, oral challenge with Salmonella enteric serotype Typhimurium, sanitation challenge, and Lawsonia intercellularis challenge. These challenge models together with the criteria used to evaluate the responses of the animals to them are also discussed in this review.

Randomized evaluation and cost-effectiveness of HIV and sexual and reproductive health service referral and linkage models in Zambia

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Paul C. Hewett

2016-08-01

Full Text Available Abstract Background Provision of HIV prevention and sexual and reproductive health services in Zambia is largely characterized by discrete service provision with weak client referral and linkage. The literature reveals gaps in the continuity of care for HIV and sexual and reproductive health. This study assessed whether improved service delivery models increased the uptake and cost-effectiveness of HIV and sexual and reproductive health services. Methods Adult clients 18+ years of age accessing family planning (females, HIV testing and counseling (females and males, and male circumcision services (males were recruited, enrolled and individually randomized to one of three study arms: 1 the standard model of service provision at the entry point (N = 1319; 2 an enhanced counseling and referral to add-on service with follow-up (N = 1323; and 3 the components of study arm two, with the additional offer of an escort (N = 1321. Interviews were conducted with the same clients at baseline, six weeks and six months. Uptake of services for HIV, family planning, male circumcision, and cervical cancer screening at six weeks and six months were the primary endpoints. Pairwise chi-square and multivariable logistic regression statistical tests assessed differences across study arms, which were also assessed for incremental cost-efficiency and cost-effectiveness. Results A total of 3963 clients, 1920 males and 2043 females, were enrolled; 82 % of participants at six weeks were tracked and 81 % at six months; follow-up rates did not vary significantly by study arm. The odds of clients accessing HIV testing and counseling, cervical cancer screening services among females, and circumcision services among males varied significantly by study arm at six weeks and six months; less consistent findings were observed for HIV care and treatment. Client uptake of family planning services did not vary significantly by study arm. Integrated services were found

Modelling the effect of hydrological change on estuarine health: An Australian Perspective. (Invited)

Science.gov (United States)

Bruce, L. C.; Adiyanti, S.; Ruibal, A. L.; Hipsey, M. R.

2013-12-01

Estuaries provide an important role in the filtering and transformation of carbon and nutrients from coastal catchments into the marine environment. Global trends including climate change, increased population, industrialization and agriculture have led to the rapid deterioration of estuarine ecosystems across the world. Within the Australian context, a particular concern is how changes to hydrological regimes, due to both water diversions and climate variability, are contributing to increased stress and consequent decline in estuarine health. In this study we report the modeling output of five Australian estuaries, each with different hydrological regimes and alternative management issues relating to altered hydrology: 1) The Yarra River estuary is a highly urbanized system, also receiving agriculturally derived nutrients, where the concern is the role of periodic hypoxia in reducing the assimilation capacity of nitrogen and thus increased risk of algal blooms forming in the coastal environment; 2) The upper Swan River estuary in Western Australia, which experiences persistent anoxia and hypoxia brought about by reduced flows has led to the commissioning of several oxygenation plants to alleviate stress on biodiversity and overall estuarine health; 3) The health of the Caboolture estuary in Queensland has deteriorated in the past decade with the aim of model development to quantify the various sources of surface and groundwater derived nutrients; 4) The construction of an additional channel to increase flushing in the Peel Harvey estuary in Western Australia was designed to control persistent harmful algal blooms; and 5) The Lower River Murray estuary experienced a prolonged drought that led to the development of acid sulfate soils and acid drainage deteriorating water quality. For these applications we applied 3-D hydrodynamic-biogeochemical models to determine underlying relationships between altered flow regimes, increased temperatures and the response of

Applying the Health Belief Model to college students' health behavior

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Kim, Hak-Seon; Ahn, Joo

2012-01-01

The purpose of this research was to investigate how university students' nutrition beliefs influence their health behavioral intention. This study used an online survey engine (Qulatrics.com) to collect data from college students. Out of 253 questionnaires collected, 251 questionnaires (99.2%) were used for the statistical analysis. Confirmatory Factor Analysis (CFA) revealed that six dimensions, "Nutrition Confidence," "Susceptibility," "Severity," "Barrier," "Benefit," "Behavioral Intention to Eat Healthy Food," and "Behavioral Intention to do Physical Activity," had construct validity; Cronbach's alpha coefficient and composite reliabilities were tested for item reliability. The results validate that objective nutrition knowledge was a good predictor of college students' nutrition confidence. The results also clearly showed that two direct measures were significant predictors of behavioral intentions as hypothesized. Perceived benefit of eating healthy food and perceived barrier for eat healthy food to had significant effects on Behavioral Intentions and was a valid measurement to use to determine Behavioral Intentions. These findings can enhance the extant literature on the universal applicability of the model and serve as useful references for further investigations of the validity of the model within other health care or foodservice settings and for other health behavioral categories. PMID:23346306

A Methodology of Health Effects Estimation from Air Pollution in Large Asian Cities

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Keiko Hirota

2017-09-01

Full Text Available The increase of health effects caused by air pollution seems to be a growing concern in Asian cities with increasing motorization. This paper discusses methods of estimating the health effects of air pollution in large Asian cities. Due to the absence of statistical data in Asia, this paper carefully chooses the methodology using data of the Japanese compensation system. A basic idea of health effects will be captured from simple indicators, such as population and air quality, in a correlation model. This correlation model enables more estimation results of respiratory mortality caused by air pollution to be yielded than by using the relative model. The correlation model could be an alternative method to estimate mortality besides the relative risk model since the results of the correlation model are comparable with those of the relative model by city and by time series. The classification of respiratory diseases is not known from the statistical yearbooks in many countries. Estimation results could support policy decision-making with respect to public health in a cost-effective way.

Development of Health Parameter Model for Risk Prediction of CVD Using SVM

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P. Unnikrishnan

2016-01-01

Full Text Available Current methods of cardiovascular risk assessment are performed using health factors which are often based on the Framingham study. However, these methods have significant limitations due to their poor sensitivity and specificity. We have compared the parameters from the Framingham equation with linear regression analysis to establish the effect of training of the model for the local database. Support vector machine was used to determine the effectiveness of machine learning approach with the Framingham health parameters for risk assessment of cardiovascular disease (CVD. The result shows that while linear model trained using local database was an improvement on Framingham model, SVM based risk assessment model had high sensitivity and specificity of prediction of CVD. This indicates that using the health parameters identified using Framingham study, machine learning approach overcomes the low sensitivity and specificity of Framingham model.

The effectiveness of an integrated collaborative care model vs. a shifted outpatient collaborative care model on community functioning, residential stability, and health service use among homeless adults with mental illness: a quasi-experimental study.

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Stergiopoulos, Vicky; Schuler, Andrée; Nisenbaum, Rosane; deRuiter, Wayne; Guimond, Tim; Wasylenki, Donald; Hoch, Jeffrey S; Hwang, Stephen W; Rouleau, Katherine; Dewa, Carolyn

2015-08-28

Although a growing number of collaborative mental health care models have been developed, targeting specific populations, few studies have utilized such interventions among homeless populations. This quasi-experimental study compared the outcomes of two shelter-based collaborative mental health care models for men experiencing homelessness and mental illness: (1) an integrated multidisciplinary collaborative care (IMCC) model and (2) a less resource intensive shifted outpatient collaborative care (SOCC) model. In total 142 participants, 70 from IMCC and 72 from SOCC were enrolled and followed for 12 months. Outcome measures included community functioning, residential stability, and health service use. Multivariate regression models were used to compare study arms with respect to change in community functioning, residential stability, and health service use outcomes over time and to identify baseline demographic, clinical or homelessness variables associated with observed changes in these domains. We observed improvements in both programs over time on measures of community functioning, residential stability, hospitalizations, emergency department visits and community physician visits, with no significant differences between groups over time on these outcome measures. Our findings suggest that shelter-based collaborative mental health care models may be effective for individuals experiencing homelessness and mental illness. Future studies should seek to confirm these findings and examine the cost effectiveness of collaborative care models for this population.

The role of decision analytic modeling in the health economic assessment of spinal intervention.

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Edwards, Natalie C; Skelly, Andrea C; Ziewacz, John E; Cahill, Kevin; McGirt, Matthew J

2014-10-15

Narrative review. To review the common tenets, strengths, and weaknesses of decision modeling for health economic assessment and to review the use of decision modeling in the spine literature to date. For the majority of spinal interventions, well-designed prospective, randomized, pragmatic cost-effectiveness studies that address the specific decision-in-need are lacking. Decision analytic modeling allows for the estimation of cost-effectiveness based on data available to date. Given the rising demands for proven value in spine care, the use of decision analytic modeling is rapidly increasing by clinicians and policy makers. This narrative review discusses the general components of decision analytic models, how decision analytic models are populated and the trade-offs entailed, makes recommendations for how users of spine intervention decision models might go about appraising the models, and presents an overview of published spine economic models. A proper, integrated, clinical, and economic critical appraisal is necessary in the evaluation of the strength of evidence provided by a modeling evaluation. As is the case with clinical research, all options for collecting health economic or value data are not without their limitations and flaws. There is substantial heterogeneity across the 20 spine intervention health economic modeling studies summarized with respect to study design, models used, reporting, and general quality. There is sparse evidence for populating spine intervention models. Results mostly showed that interventions were cost-effective based on $100,000/quality-adjusted life-year threshold. Spine care providers, as partners with their health economic colleagues, have unique clinical expertise and perspectives that are critical to interpret the strengths and weaknesses of health economic models. Health economic models must be critically appraised for both clinical validity and economic quality before altering health care policy, payment strategies, or

The effect of individual factors on health behaviors among college students: the mediating effects of eHealth literacy.

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Hsu, WanChen; Chiang, ChiaHsun; Yang, ShuChing

2014-12-12

College students' health behavior is a topic that deserves attention. Individual factors and eHealth literacy may affect an individual's health behaviors. The integrative model of eHealth use (IMeHU) provides a parsimonious account of the connections among the digital divide, health care disparities, and the unequal distribution and use of communication technologies. However, few studies have explored the associations among individual factors, eHealth literacy, and health behaviors, and IMeHU has not been empirically investigated. This study examines the associations among individual factors, eHealth literacy, and health behaviors using IMeHU. The Health Behavior Scale is a 12-item instrument developed to measure college students' eating, exercise, and sleep behaviors. The eHealth Literacy Scale is a 12-item instrument designed to measure college students' functional, interactive, and critical eHealth literacy. A nationally representative sample of 525 valid college students in Taiwan was surveyed. A questionnaire was administered to collect background information about participants' health status, degree of health concern, major, and the frequency with which they engaged in health-related discussions. This study used Amos 6.0 to conduct a confirmatory factor analysis to identify the best measurement models for the eHealth Literacy Scale and the Health Behavior Scale. We then conducted a multiple regression analysis to examine the associations among individual factors, eHealth literacy, and health behaviors. Additionally, causal steps approach was used to explore indirect (mediating) effects and Sobel tests were used to test the significance of the mediating effects. The study found that perceptions of better health status (t520=2.14-6.12, PeHealth literacy and adoption of healthy eating, exercise, and sleep behaviors. Moreover, eHealth literacy played an intermediary role in the association between individual factors and health behaviors (Sobel test=2.09-2.72, PeHealth

Children’s Environmental Health Faculty Champions Initiative: A Successful Model for Integrating Environmental Health into Pediatric Health Care

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Rogers, Bonnie; McCurdy, Leyla Erk; Slavin, Katie; Grubb, Kimberly; Roberts, James R.

2009-01-01

Background Pediatric medical and nursing education lack the environmental health content needed to properly prepare health care professionals to prevent, recognize, manage, and treat environmental exposure–related diseases. The need for improvements in health care professionals’ environmental health knowledge has been expressed by leading institutions. However, few studies have evaluated the effectiveness of programs that incorporate pediatric environmental health (PEH) into curricula and practice. Objective We evaluated the effectiveness of the National Environmental Education Foundation’s (NEEF) Children’s Environmental Health Faculty Champions Initiative, which is designed to build environmental health capacity among pediatric health care professionals. Methods Twenty-eight pediatric health care professionals participated in a train-the-trainer workshop, in which they were educated to train other health care professionals in PEH and integrate identified PEH competencies into medical and nursing practice and curricula. We evaluated the program using a workshop evaluation tool, action plan, pre- and posttests, baseline and progress assessments, and telephone interviews. Results During the 12 months following the workshop, the faculty champions’ average pretest score of 52% was significantly elevated (p < 0.0001) to 65.5% on the first posttest and to 71.5% on the second posttest, showing an increase and retention of environmental health knowledge. Faculty champions trained 1,559 health care professionals in PEH, exceeding the goal of 280 health care professionals trained. Ninety percent of faculty champions reported that PEH had been integrated into the curricula at their institution. Conclusion The initiative was highly effective in achieving its goal of building environmental health capacity among health care professionals. The faculty champions model is a successful method and can be replicated in other arenas. PMID:19478972

Testing the Electronic Personal Health Record Acceptance Model by Nurses for Managing Their Own Health

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Trinkoff, A.M.; Storr, C.L.; Wilson, M.L.; Gurses, A.P.

2015-01-01

Summary Background To our knowledge, no evidence is available on health care professionals’ use of electronic personal health records (ePHRs) for their health management. We therefore focused on nurses’ personal use of ePHRs using a modified technology acceptance model. Objectives To examine (1) the psychometric properties of the ePHR acceptance model, (2) the associations of perceived usefulness, ease of use, data privacy and security protection, and perception of self as health-promoting role models to nurses’ own ePHR use, and (3) the moderating influences of age, chronic illness and medication use, and providers’ use of electronic health record (EHRs) on the associations between the ePHR acceptance constructs and ePHR use. Methods A convenience sample of registered nurses, those working in one of 12 hospitals in the Maryland and Washington, DC areas and members of the nursing informatics community (AMIA and HIMSS), were invited to respond to an anonymous online survey; 847 responded. Multiple logistic regression identified associations between the model constructs and ePHR use, and the moderating effect. Results Overall, ePHRs were used by 47%. Sufficient reliability for all scales was found. Three constructs were significantly related to nurses’ own ePHR use after adjusting for covariates: usefulness, data privacy and security protection, and health-promoting role model. Nurses with providers that used EHRs who perceived a higher level of data privacy and security protection had greater odds of ePHR use than those whose providers did not use EHRs. Older nurses with a higher self-perception as health-promoting role models had greater odds of ePHR use than younger nurses. Conclusions Nurses who use ePHRs for their personal health might promote adoption by the general public by serving as health-promoting role models. They can contribute to improvements in patient education and ePHR design, and serve as crucial resources when working with their

Implementation strategies for collaborative primary care-mental health models.

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Franx, Gerdien; Dixon, Lisa; Wensing, Michel; Pincus, Harold

2013-09-01

Extensive research exists that collaborative primary care-mental health models can improve care and outcomes for patients. These programs are currently being implemented throughout the United States and beyond. The purpose of this study is to review the literature and to generate an overview of strategies currently used to implement such models in daily practice. Six overlapping strategies to implement collaborative primary care-mental health models were described in 18 selected studies. We identified interactive educational strategies, quality improvement change processes, technological support tools, stakeholder engagement in the design and execution of implementation plans, organizational changes in terms of expanding the task of nurses and financial strategies such as additional collaboration fees and pay for performance incentives. Considering the overwhelming evidence about the effectiveness of primary care-mental health models, there is a lack of good studies focusing on their implementation strategies. In practice, these strategies are multifaceted and locally defined, as a result of intensive and required stakeholder engagement. Although many barriers still exist, the implementation of collaborative models could have a chance to succeed in the United States, where new service delivery and payment models, such as the Patient-Centered Medical Home, the Health Home and the Accountable Care Organization, are being promoted.

Ancillary health effects of climate mitigation scenarios as drivers of policy uptake: a review of air quality, transportation and diet co-benefits modeling studies

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Chang, Kelly M.; Hess, Jeremy J.; Balbus, John M.; Buonocore, Jonathan J.; Cleveland, David A.; Grabow, Maggie L.; Neff, Roni; Saari, Rebecca K.; Tessum, Christopher W.; Wilkinson, Paul; Woodward, Alistair; Ebi, Kristie L.

2017-11-01

Background: Significant mitigation efforts beyond the Nationally Determined Commitments (NDCs) coming out of the 2015 Paris Climate Agreement are required to avoid warming of 2 °C above pre-industrial temperatures. Health co-benefits represent selected near term, positive consequences of climate policies that can offset mitigation costs in the short term before the beneficial impacts of those policies on the magnitude of climate change are evident. The diversity of approaches to modeling mitigation options and their health effects inhibits meta-analyses and syntheses of results useful in policy-making. Methods/Design: We evaluated the range of methods and choices in modeling health co-benefits of climate mitigation to identify opportunities for increased consistency and collaboration that could better inform policy-making. We reviewed studies quantifying the health co-benefits of climate change mitigation related to air quality, transportation, and diet published since the 2009 Lancet Commission ‘Managing the health effects of climate change’ through January 2017. We documented approaches, methods, scenarios, health-related exposures, and health outcomes. Results/Synthesis: Forty-two studies met the inclusion criteria. Air quality, transportation, and diet scenarios ranged from specific policy proposals to hypothetical scenarios, and from global recommendations to stakeholder-informed local guidance. Geographic and temporal scope as well as validity of scenarios determined policy relevance. More recent studies tended to use more sophisticated methods to address complexity in the relevant policy system. Discussion: Most studies indicated significant, nearer term, local ancillary health benefits providing impetus for policy uptake and net cost savings. However, studies were more suited to describing the interaction of climate policy and health and the magnitude of potential outcomes than to providing specific accurate estimates of health co-benefits. Modeling

Modeling minority stress effects on homelessness and health disparities among young men who have sex with men.

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Bruce, Douglas; Stall, Ron; Fata, Aimee; Campbell, Richard T

2014-06-01

Sexual minority youth are more likely to experience homelessness, and homeless sexual minority youth report greater risk for mental health and substance abuse symptoms than homeless heterosexual youth, yet few studies have assessed determinants that help explain the disparities. Minority stress theory proposes that physical and mental health disparities among sexual minority populations may be explained by the stress produced by living in heterosexist social environments characterized by stigma and discrimination directed toward sexual minority persons. We used data from a sample of 200 young men who have sex with men (YMSM) (38 % African American, 26.5 % Latino/Hispanic, 23.5 % White, 12 % multiracial/other) to develop an exploratory path model measuring the effects of experience and internalization of sexual orientation stigma on depression and substance use via being kicked out of home due to sexual orientation and current homelessness. Direct significant paths were found from experience of sexual orientation-related stigma to internalization of sexual orientation-related stigma, having been kicked out of one's home, experiencing homelessness during the past year, and major depressive symptoms during the past week. Having been kicked out of one's home had a direct significant effect on experiencing homelessness during the past 12 months and on daily marijuana use. Internalization of sexual orientation-related stigma and experiencing homelessness during the past 12 months partially mediated the direct effect of experience of sexual orientation-related stigma on major depressive symptoms. Our empirical testing of the effects of minority stress on health of YMSM advances minority stress theory as a framework for investigating health disparities among this population.

Training tomorrow's global health leaders: applying a transtheoretical model to identify behavior change stages within an intervention for health leadership development.

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Daniels, Joseph; Farquhar, Carey; Nathanson, Neal; Mashalla, Yohana; Petracca, Frances; Desmond, Michelle; Green, Wendy; Davies, Luke; O'Malley, Gabrielle

2014-12-01

Training health professionals in leadership and management skills is a key component of health systems strengthening in low-resource settings. The importance of evaluating the effectiveness of these programs has received increased attention over the past several years, although such evaluations continue to pose significant challenges. This article presents evaluation data from the pilot year of the Afya Bora Fellowship, an African-based training program to increase the leadership capacity of health professionals. Firstly, we describe the goals of the Afya Bora Fellowship. Then, we present an adaptation of the transtheoretical model for behavior change called the Health Leadership Development Model, as an analytical lens to identify and describe evidence of individual leadership behavior change among training participants during and shortly after the pilot year of the program. The Health Leadership Development Model includes the following: pre-contemplation (status quo), contemplation (testing and internalizing leadership), preparation - (moving toward leadership), action (leadership in action), and maintenance (effecting organizational change). We used data from surveys, in-depth interviews, journal entries and course evaluations as data points to populate the Health Leadership Development Model. In the short term, fellows demonstrated increased leadership development during and shortly after the intervention and reflected the contemplation, preparation and action stages of the Health Leadership Development Model. However, expanded interventions and/or additional time may be needed to support behavior change toward the maintenance stages. We conclude that the Health Leadership Development Model is useful for informing health leadership training design and evaluation to contribute to sustainable health organizational change. © The Author(s) 2014.

The effects of constraints and mastery on mental and physical health: Conceptual and methodological considerations.

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Infurna, Frank J; Mayer, Axel

2015-06-01

Perceived control and health are closely interrelated in adulthood and old age. However, less is known regarding the differential implications of 2 facets of perceived control, constraints and mastery, for mental and physical health. Furthermore, a limitation of previous research testing the pathways linking perceived control to mental and physical health is that mediation was tested with cross-sectional designs and not in a longitudinal mediation design that accounts for temporal ordering and prior confounds. Using data from the Health and Retirement Study (HRS; n = 7,612, M age = 68, SD = 10.66; 59% women) we examined the effect of constraints and mastery on 4-year changes in mental and physical health and whether physical activity mediated such effects in a longitudinal mediation design. Using confirmatory factor analysis, we modeled the 2-factor structure of perceived control that consisted of constraints and mastery. In our longitudinal mediation model, where we accounted for possible confounders (e.g., age, gender, education, neuroticism, conscientiousness, memory, and health conditions), constraints showed a stronger total effect on mental and physical health, than mastery, such that more constraints were associated with 4-year declines in mental and physical health. Physical activity did not mediate the effect of constraints and mastery on mental and physical health (indirect effect). To demonstrate the importance of a longitudinal mediation model that accounts for confounders, we also estimated the mediated effect using 2 models commonly used in the literature: cross-sectional mediation model and longitudinal mediation model without accounting for confounders. These mediation models indicated a spurious indirect effect that cannot be causally interpreted. Our results showcase that constraints and mastery have differential implications for mental and physical health, as well as how a longitudinal mediation design can illustrate (or not) pathways in

Gut Health of Pigs: Challenge Models and Response Criteria with a Critical Analysis of the Effectiveness of Selected Feed Additives — A Review

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Adewole, D. I.; Kim, I. H.; Nyachoti, C. M.

2016-01-01

The gut is the largest organ that helps with the immune function. Gut health, especially in young pigs has a significant benefit to health and performance. In an attempt to maintain and enhance intestinal health in pigs and improve productivity in the absence of in-feed antibiotics, researchers have evaluated a wide range of feed additives. Some of these additives such as zinc oxide, copper sulphate, egg yolk antibodies, mannan-oligosaccharides and spray dried porcine plasma and their effectiveness are discussed in this review. One approach to evaluate the effectiveness of these additives in vivo is to use an appropriate disease challenge model. Over the years, researchers have used a number of challenge models which include the use of specific strains of enterotoxigenic Escherichia coli, bacteria lipopolysaccharide challenge, oral challenge with Salmonella enteric serotype Typhimurium, sanitation challenge, and Lawsonia intercellularis challenge. These challenge models together with the criteria used to evaluate the responses of the animals to them are also discussed in this review. PMID:26954144

A Participatory Model for Multi-Document Health Information Summarisation

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Dinithi Nallaperuma

2017-03-01

Full Text Available Increasing availability and access to health information has been a paradigm shift in healthcare provision as it empowers both patients and practitioners alike. Besides awareness, significant time savings and process efficiencies can be achieved through effective summarisation of healthcare information. Relevance and accuracy are key concerns when generating summaries for such documents. Despite advances in automated summarisation approaches, the role of participation has not been explored. In this paper, we propose a new model for multi-document health information summarisation that takes into account the role of participation. The updated IS user participation theory was extended to explicate these roles. The proposed model integrates both extractive and abstractive summarisation processes with continuous participatory inputs to each phase. The model was implemented as a client-server application and evaluated by both domain experts and health information consumers. Results from the evaluation phase indicates the model is successful in generating relevant and accurate summaries for diverse audiences.

Estimated Effects of Different Alcohol Taxation and Price Policies on Health Inequalities: A Mathematical Modelling Study

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Meier, Petra S.; Holmes, John; Angus, Colin; Ally, Abdallah K.; Meng, Yang; Brennan, Alan

2016-01-01

Introduction While evidence that alcohol pricing policies reduce alcohol-related health harm is robust, and alcohol taxation increases are a WHO “best buy” intervention, there is a lack of research comparing the scale and distribution across society of health impacts arising from alternative tax and price policy options. The aim of this study is to test whether four common alcohol taxation and pricing strategies differ in their impact on health inequalities. Methods and Findings An econometric epidemiological model was built with England 2014/2015 as the setting. Four pricing strategies implemented on top of the current tax were equalised to give the same 4.3% population-wide reduction in total alcohol-related mortality: current tax increase, a 13.4% all-product duty increase under the current UK system; a value-based tax, a 4.0% ad valorem tax based on product price; a strength-based tax, a volumetric tax of £0.22 per UK alcohol unit (= 8 g of ethanol); and minimum unit pricing, a minimum price threshold of £0.50 per unit, below which alcohol cannot be sold. Model inputs were calculated by combining data from representative household surveys on alcohol purchasing and consumption, administrative and healthcare data on 43 alcohol-attributable diseases, and published price elasticities and relative risk functions. Outcomes were annual per capita consumption, consumer spending, and alcohol-related deaths. Uncertainty was assessed via partial probabilistic sensitivity analysis (PSA) and scenario analysis. The pricing strategies differ as to how effects are distributed across the population, and, from a public health perspective, heavy drinkers in routine/manual occupations are a key group as they are at greatest risk of health harm from their drinking. Strength-based taxation and minimum unit pricing would have greater effects on mortality among drinkers in routine/manual occupations (particularly for heavy drinkers, where the estimated policy effects on

Mental Health Effects of Stress over the Life Span of Refugees.

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Hollifield, Michael; Warner, Teddy D; Krakow, Barry; Westermeyer, Joseph

2018-02-06

Information about the relative impact of stressful events across the lifespan on the mental health of refugees is needed. Cross-sectional data from a community sample of 135 Kurdish and 117 Vietnamese refugees were fit to a path model about the effects of non-war stress, war-related stress, and post-migration stress on mental health. Kurdish and Vietnamese data were generally consistent with the model. However, war-related stress produced no direct but a large indirect effect through post-migration stress on mental health in Kurds. Vietnamese data indicated a modest direct war-related stress effect but no indirect influence through post-migration stress. Different types of stressful events lead to adverse mental health of displaced refugees in a somewhat group-dependent manner. Implications for prevention and treatment are discussed.

Mental Health Effects of Stress over the Life Span of Refugees

Directory of Open Access Journals (Sweden)

Michael Hollifield

2018-02-01

Full Text Available Information about the relative impact of stressful events across the lifespan on the mental health of refugees is needed. Cross-sectional data from a community sample of 135 Kurdish and 117 Vietnamese refugees were fit to a path model about the effects of non-war stress, war-related stress, and post-migration stress on mental health. Kurdish and Vietnamese data were generally consistent with the model. However, war-related stress produced no direct but a large indirect effect through post-migration stress on mental health in Kurds. Vietnamese data indicated a modest direct war-related stress effect but no indirect influence through post-migration stress. Different types of stressful events lead to adverse mental health of displaced refugees in a somewhat group-dependent manner. Implications for prevention and treatment are discussed.

Evaluating the effectiveness of health care teams.

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Mickan, Sharon M

2005-05-01

While it is recognised that effective health care teams are associated with quality patient care, the literature is comparatively sparse in defining the outcomes of effective teamwork. This literature review of the range of organisational, team and individual benefits of teamwork complements an earlier article which summarised the antecedent conditions for (input) and team processes (throughput) of effective teams. This article summarises the evidence for a range of outcome measures of effective teams. Organisational benefits of teamwork include reduced hospitalisation time and costs, reduced unanticipated admissions, better accessibility for patients, and improved coordination of care. Team benefits include efficient use of health care services, enhanced communication and professional diversity. Patients report benefits of enhanced satisfaction, acceptance of treatment and improved health outcomes. Finally, team members report enhanced job satisfaction, greater role clarity and enhanced well-being. Due to the inherent complexity of teamwork, a constituency model of team evaluation is supported where key stakeholders identify and measure the intended benefits of a team.

Toward a humanistic model in health communication.

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Werder, Olaf

2017-03-01

Since the key to effective health communication lies in its ability to communicate well, some of its core problems are those that relate to the sharing of meaning between communicators. In elaborating on these problems, this paper offers two key propositions: one, health communication has to pass through the filter of a particular world view that creates a discrepancy between expected and actual message reception and response. Two, the assumption of a rational human actor made implicitly by most health psychological models is a contestable issue, as many times message recipients do not follow a cognitive judgment process. The phenomenon of resisting health messages by reasonable people asks the question whether we ought to rethink our adherence to a particular vision of human health as many times the adverse reaction to behaviour modification occurs as the result of a particular dialogical or discursive situation. At the same time, most motivational decisions in people's daily routines are automatic and use a concept known as self-identity to give stability to their behaviour patterns. Finally, health communication as part of organised government practices adheres to predominant value perspectives within health promotion practice that affect the manner in which health issues become problematised. This paper proposes a humanistic model that aims to pay attention to the intricacies of human communication by addressing all of the above problems in turn. It interprets the sharing of meaning element in human communication and addresses the question of how the idea of health is created through discourse. As such, it offers a complementary and constructive paradigm and set of approaches to understand health, its meanings and communication.

Work stress and health effects among university personnel.

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Donders, N C G M; van der Gulden, J W J; Furer, J W; Tax, B; Roscam Abbing, E W

2003-10-01

(1) To investigate the contribution of job characteristics and personal characteristics to the explanation of health effects among university personnel; (2) to investigate the differences between scientific personnel (SP) and non-scientific personnel (NSP); (3) to investigate whether health effects occurred one after another. The well being at work of employees at a Dutch university (n=2,522) was investigated by means of a questionnaire. A model was constructed in which several job and personal characteristics were set out against health effects. The latter were assumed to occur in phases: decreased "job satisfaction" as an early effect, followed by increased "tension" and "emotional exhaustion", and possibly also by increased "perceived health complaints". The contribution of job and personal characteristics to the explanation of health effects was investigated by means of linear regression analysis, with separate analyses for SP and NSP. Positive job characteristics, especially professional expertise and work variety, contributed to the explanation of "job satisfaction". The major contributors to "tension" and "emotional exhaustion" were negative characteristics, such as work pressure. Besides the negative aspects, the major contributors to the explanation of "perceived health complaints" were sex, age and other health effects. In NSP, social support contributed to the explanation of "tension" and "emotional exhaustion", but not in SP. The explained variance of "job satisfaction" by the positive job characteristics in NSP was much higher than that in SP. To investigate whether health effects occurred one after another, we considered explained variance. Explained variance in "job satisfaction" was much higher than in "perceived health complaints". "Emotional exhaustion" and "tension" were in between. Contrary to expectations, decision latitude and social support played only minor roles. Also, the differences between SP and NSP were smaller than expected. As

Valuing Health Effect on Air Pollution : WTP Approach Using CVM

Energy Technology Data Exchange (ETDEWEB)

Kim, Tae Yoo; Um, Mi Jung [Seoul National University, Seoul (Korea); Kwak, Seung Jun [Korea University, Seoul (Korea)

1998-09-01

Cost-benefit is required for improving air quality efficiently. Benefit in connection with air quality has influence on health effects, a barrier to administration, aesthetic value, and material loss. Among these, health effects are occupying most of them. In this study, the economic value by the people in Seoul was estimated about symptoms of eye irritation, heartburn, and asthma among health effects relating to air pollution by using conditional value measurement (CVM). As a result, 2,580 won/day for eye irritation, 9,000 won/day for heartburn, and 55,400 won/day for asthma were measured. Moreover, in the case of carrying out several CV questions in one survey, it was found out that the estimated results of single variation model and dual variation model were different. (author). 21 refs., 7 tabs.

[Study protocol on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain].

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Pérez, Glòria; Gotsens, Mercè; Palència, Laia; Marí-Dell'Olmo, Marc; Domínguez-Berjón, M Felicitas; Rodríguez-Sanz, Maica; Puig, Vanessa; Bartoll, Xavier; Gandarillas, Ana; Martín, Unai; Bacigalupe, Amaia; Díez, Elia; Ruiz, Miguel; Esnaola, Santiago; Calvo, Montserrat; Sánchez, Pablo; Luque Fernández, Miguel Ángel; Borrell, Carme

The aim is to present the protocol of the two sub-studies on the effect of the economic crisis on mortality and reproductive health and health inequalities in Spain. Substudy 1: describe the evolution of mortality and reproductive health between 1990 and 2013 through a longitudinal ecological study in the Autonomous Communities. This study will identify changes caused by the economic crisis in trends or reproductive health and mortality indicators using panel data (17 Autonomous Communities per study year) and adjusting Poisson models with random effects variance. Substudy 2: analyse inequalities by socioeconomic deprivation in mortality and reproductive health in several areas of Spain. An ecological study analysing trends in the pre-crisis (1999-2003 and 2004-2008) and crisis (2009-2013) periods will be performed. Random effects models Besag York and Mollié will be adjusted to estimate mortality indicators softened in reproductive health and census tracts. Copyright © 2016 SESPAS. Publicado por Elsevier España, S.L.U. All rights reserved.

Noise effects on the health status in a dynamic failure model for living organisms

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Kang, H.; Jo, J.; Choi, M. Y.; Choi, J.; Yoon, B.-G.

2007-03-01

We study internal and external noise effects on the healthy-unhealthy transition and related phenomena in a dynamic failure model for living organisms. It is found that internal noise makes the system weaker, leading to breakdown under smaller stress. The discontinuous healthy-unhealthy transition in a system with global load sharing below a critical point is naturally explained in terms of the bistability for the health status. External noise present in constant stress gives similar results; further, it induces resonance in response to periodic stress, regardless of load transfer. In the case of local load sharing, such periodic stress is revealed more hazardous than the constant stress.

Modeling per capita state health expenditure variation: state-level characteristics matter.

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Cuckler, Gigi; Sisko, Andrea

2013-01-01

In this paper, we describe the methods underlying the econometric model developed by the Office of the Actuary in the Centers for Medicare & Medicaid Services, to explain differences in per capita total personal health care spending by state, as described in Cuckler, et al. (2011). Additionally, we discuss many alternative model specifications to provide additional insights for valid interpretation of the model. We study per capita personal health care spending as measured by the State Health Expenditures, by State of Residence for 1991-2009, produced by the Centers for Medicare & Medicaid Services' Office of the Actuary. State-level demographic, health status, economic, and health economy characteristics were gathered from a variety of U.S. government sources, such as the Census Bureau, Bureau of Economic Analysis, the Centers for Disease Control, the American Hospital Association, and HealthLeaders-InterStudy. State-specific factors, such as income, health care capacity, and the share of elderly residents, are important factors in explaining the level of per capita personal health care spending variation among states over time. However, the slow-moving nature of health spending per capita and close relationships among state-level factors create inefficiencies in modeling this variation, likely resulting in incorrectly estimated standard errors. In addition, we find that both pooled and fixed effects models primarily capture cross-sectional variation rather than period-specific variation.

Quantal health effects of three toxic agents combined

International Nuclear Information System (INIS)

Seiler, F.A.

1988-01-01

Quantal health effects such as cancer, correlated with the combined action of three toxic agents, are considered. Data on the combined effects of two agents are scarce and no such data exist for three toxicants, yet concerns have arisen about simultaneous exposure of radiation workers to three different agents. Using models developed from the analysis of health effects involving two toxicants, equations for the combined effects of three agents are derived from a more general formalism. An application of practical interest is the incidence of cancer of the esophagus and its correlation with concurrent exposures to alcohol, tobacco, and either low- or high-LET radiation. (author)

Business Models for Successfully Maintaining Games for Health.

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Baranowski, Moderator Tom; Isaac, Participants Fikry; Ashford, Chris; Goldman, Ron; Lenihan, David J; Poole, Brent; Buday, Richard; van Rijswijk, Jurriaan

2013-04-01

Videogames for health provide innovative, exciting, and possibly highly effective new media for helping players change their behaviors or otherwise benefit their health. Getting the right videogames into the hands of players who can benefit most in a way that pays for the continued innovation and creation of such games is a current challenge. Entertainment videogame companies, which create games primarily to enhance players' enjoyment, have used the general business marketplace (e.g., online stores, walk-in stores, app stores) to deliver their products directly to consumers and earn enough capital to invest in making new products. No one believes, however, that enough kids or adults would use the general business marketplace to purchase games for health in sufficient volume to provide the down payment for the innovation and creation of new games for health. A successful business model is critical to the financial future of games for health. We asked members of our Editorial Board who are in health-related companies (Fikry Isaac, MD, MPH), in several game development companies (Chris Ashford, Ron Goldman, David J. Lenihan, Brent Poole, and Richard Buday, FAIA), and the head of the Games for Health Europe Foundation (Jurriaan van Rijswijk, MSc) to address questions in a roundtable about the current and possible future business models for games for health.

Modeling the effects of functional performance and post-transplant comorbidities on health-related quality of life after heart transplantation.

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Butler, Javed; McCoin, Nicole S; Feurer, Irene D; Speroff, Theodore; Davis, Stacy F; Chomsky, Don B; Wilson, John R; Merrill, Walter H; Drinkwater, Davis C; Pierson, Richard N; Pinson, C Wright

2003-10-01

Health-related quality of life and functional performance are important outcome measures following heart transplantation. This study investigates the impact of pre-transplant functional performance and post-transplant rejection episodes, obesity and osteopenia on post-transplant health-related quality of life and functional performance. Functional performance and health-related quality of life were measured in 70 adult heart transplant recipients. A composite health-related quality of life outcome measure was computed via principal component analysis. Iterative, multiple regression-based path analysis was used to develop an integrated model of variables that affect post-transplant functional performance and health-related quality of life. Functional performance, as measured by the Karnofsky scale, improved markedly during the first 6 months post-transplant and was then sustained for up to 3 years. Rejection Grade > or =2 was negatively associated with health-related quality of life, measured by Short Form-36 and reversed Psychosocial Adjustment to Illness Scale scores. Patients with osteopenia had lower Short Form-36 physical scores and obese patients had lower functional performance. Path analysis demonstrated a negative direct effect of obesity (beta = - 0.28, p or =2 had a negative direct effect on this measure (beta = -0.29, p < 0.05). Either directly or through effects mediated by functional performance, moderate-to-severe rejection, obesity and osteopenia negatively impact health-related quality of life. These findings indicate that efforts should be made to devise immunosuppressive regimens that reduce the incidence of acute rejection, weight gain and osteopenia after heart transplantation.

World Organisation for Animal Health: strengthening Veterinary Services for effective One Health collaboration.

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Corning, S

2014-08-01

To effectively reduce health risks at the animal-human-ecosystems interface, a One Health strategy is crucially important to create strong national and regional animal health systems that are well coordinated with strong public health systems. Animal diseases, particularly those caused by new and emerging zoonotic pathogens, must be effectively controlled at their source to reduce their potentially devastating impact upon both animal and human health. As the international organisation responsible for developing standards, guidelines and recommendations for animal health, the World Organisation for Animal Health (OIE) plays an important role in minimising animal and public health risks attributable to zoonoses and other animal diseases, which can have severe consequences for global food safety and security. National Veterinary Services, which implement OIE animal health and welfare standards and other measures, are the first line of defence against these diseases, and must have the capacity to meet the core requirements necessary for their diagnosis and control. The OIE works collaboratively with the World Health Organization and Food and Agriculture Organization of the United Nations to improve the ability of national animal and public health systems to respond to current and emerging animal health risks with public health consequences. In addition to improving and aligning national laboratory capacities in high-risk areas, the OIE collaborates on One Health-oriented projects for key diseases, establishing model frameworks which can be applied to manage other existing and emerging priority diseases. This article reviews the role and activities of the OIE in strengthening the national Veterinary Services of its Member Countries for a more effective and sustainable One Health collaboration.

The effects of the Danish saturated fat tax on food and nutrient intake and modelled health outcomes: an econometric and comparative risk assessment evaluation.

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Smed, S; Scarborough, P; Rayner, M; Jensen, J D

2016-06-01

The World Health Organisation recommends governments to consider the use of fiscal policies to promote healthy eating. However, there is very limited evidence of the effect of food taxation in a real-life setting, as most evidence is based on simulation studies. The objective of this study is to evaluate the effect of the Danish tax on saturated fat in terms of changes in nutritional quality of the diet, that is, changes in saturated fat consumption, as well as other non-targeted dietary measures, and to model the associated changes in mortality for different age groups and genders. On the basis of household scanner data, we estimate the impact of the tax on consumption of saturated fat, unsaturated fat, salt, fruit, vegetables and fibre. The resultant changes in dietary quality are then used as inputs into a comparative risk assessment model (PRIME (Preventable Risk Integrated ModEl)) to estimate the effect of these changes on non-communicable diseases (NCDs) and mortality. The tax resulted in a 4.0% reduction in saturated fat intake. Vegetable consumption increased, and salt consumption increased for most individuals, except younger females. We find a modelled reduction in mortality with 123 lives saved annually, 76 of them below 75 years equal to 0.4% of all deaths from NCDs. Modelling the effect of the changes in diet on health outcomes suggests that the saturated fat tax made a positive, but minor, contribution to public health in Denmark.

Cross-country variation in additive effects of socio-economics, health behaviors, and comorbidities on subjective health of patients with diabetes.

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Assari, Shervin

2014-02-21

This study explored cross-country differences in the additive effects of socio-economic characteristics, health behaviors and medical comorbidities on subjective health of patients with diabetes. The study analyzed data from the Research on Early Life and Aging Trends and Effects (RELATE). The participants were 9,179 adults with diabetes who were sampled from 15 countries (i.e. China, Costa Rica, Puerto Rico, United States, Mexico, Argentina, Barbados, Brazil, Chile, Cuba, Uruguay, India, Ghana, South Africa, and Russia). We fitted three logistic regressions to each country. Model I only included socio-economic characteristics (i.e. age, gender, education and income). In Model II, we also included health behaviors (i.e. smoking, drinking, and exercise). Model III included medical comorbidities (i.e. hypertension, respiratory disease, heart disease, stroke, and arthritis), in addition to the previous blocks. Our models suggested cross-country differences in the additive effects of socio-economic characteristics, health behaviors and comorbidities on perceived health of patients with diabetes. Comorbid heart disease was the only condition that was consistently associated with poor subjective health regardless of country. Countries show different profiles of social and behavioral determinants of subjective health among patients with diabetes. Our study suggests that universal programs that assume that determinants of well-being are similar across different countries may be over-simplistic. Thus instead of universal programs that use one protocol for health promotion of patients in all countries, locally designed interventions should be implemented in each country.

Modeling energy efficiency to improve air quality and health effects of China’s cement industry

International Nuclear Information System (INIS)

Zhang, Shaohui; Worrell, Ernst; Crijns-Graus, Wina; Krol, Maarten; Bruine, Marco de; Geng, Guangpo; Wagner, Fabian; Cofala, Janusz

2016-01-01

Highlights: • An integrated model was used to model the co-benefits for China’s cement industry. • PM_2_._5 would decrease by 2–4% by 2030 through improved energy efficiency. • 10,000 premature deaths would be avoided per year relative to the baseline scenario. • Total benefits are about two times higher than the energy efficiency costs. - Abstract: Actions to reduce the combustion of fossil fuels often decrease GHG emissions as well as air pollutants and bring multiple benefits for improvement of energy efficiency, climate change, and air quality associated with human health benefits. The China’s cement industry is the second largest energy consumer and key emitter of CO_2 and air pollutants, which accounts for 7% of China’s total energy consumption, 15% of CO_2, and 14% of PM_2_._5, respectively. In this study, a state-of-the art modeling framework is developed that comprises a number of different methods and tools within the same platform (i.e. provincial energy conservation supply curves, the Greenhouse Gases and Air Pollution Interactions and Synergies, ArcGIS, the global chemistry Transport Model, version 5, and Health Impact Assessment) to assess the potential for energy savings and emission mitigation of CO_2 and PM_2_._5, as well as the health impacts of pollution arising from China’s cement industry. The results show significant heterogeneity across provinces in terms of the potential for PM_2_._5 emission reduction and PM_2_._5 concentration, as well as health impacts caused by PM_2_._5. Implementation of selected energy efficiency measures would decrease total PM_2_._5 emissions by 2% (range: 1–4%) in 2020 and 4% (range: 2–8%) by 2030, compared to the baseline scenario. The reduction potential of provincial annual PM_2_._5 concentrations range from 0.03% to 2.21% by 2030 respectively, when compared to the baseline scenario. 10,000 premature deaths are avoided by 2020 and 2030 respectively relative to baseline scenario. The

Modeling the Personal Health Ecosystem.

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Blobel, Bernd; Brochhausen, Mathias; Ruotsalainen, Pekka

2018-01-01

Complex ecosystems like the pHealth one combine different domains represented by a huge variety of different actors (human beings, organizations, devices, applications, components) belonging to different policy domains, coming from different disciplines, deploying different methodologies, terminologies, and ontologies, offering different levels of knowledge, skills, and experiences, acting in different scenarios and accommodating different business cases to meet the intended business objectives. For correctly modeling such systems, a system-oriented, architecture-centric, ontology-based, policy-driven approach is inevitable, thereby following established Good Modeling Best Practices. However, most of the existing standards, specifications and tools for describing, representing, implementing and managing health (information) systems reflect the advancement of information and communication technology (ICT) represented by different evolutionary levels of data modeling. The paper presents a methodology for integrating, adopting and advancing models, standards, specifications as well as implemented systems and components on the way towards the aforementioned ultimate approach, so meeting the challenge we face when transforming health systems towards ubiquitous, personalized, predictive, preventive, participative, and cognitive health and social care.

Perspectives on quality mental health care from Brazilian and Cape Verdean outpatients: implications for effective patient-centered policies and models of care.

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De Jesus, Maria; Earl, Tara R

2014-01-01

Mental health providers are increasingly coming into contact with large and growing multi-racial/ethnic and immigrant patient populations in the United States. Knowledge of patient perspectives on what constitutes quality mental health care is necessary for these providers. The aim of this study was to identify indicators of quality of mental health care that matter most to two underrepresented immigrant patient groups of Portuguese background: Brazilians and Cape Verdeans. A qualitative design was adopted using focus group discussions. Six focus groups of patients (n=24 Brazilians; n=24 Cape Verdeans) who received outpatient mental health treatment through public safety net clinics in the northeast region of the United States were conducted. The Consensual Qualitative Research analytic method allowed us to identify three quality of care domains: provider performance, aspects of mental health care environment, and effectiveness of mental health care treatment. Provider performance was associated with five categories: relational, communication, linguistic, cultural, and technical competencies. Aspects of mental health care environment were linked to two categories: psychosocial and physical environment. Effectiveness of mental health care treatment was related to two categories: therapeutic relationship and treatment outcomes. Study findings provide useful data for the development of more culturally appropriate and effective patient-centered models and policies in mental health care.

Models selected for calculation of doses, health effects and economic costs due to accidental radionuclide releases from nuclear power plants. Technical report

International Nuclear Information System (INIS)

Strenge, D.L.; Acharya, S.; Baker, D.A.; Droppo, J.G.; McPherson, R.B.

1980-05-01

Models are described for use in site-specific environmental consequence analysis of nuclear reactor accidents of Classes 3 through 9. The models presented relate radioactivity released to resulting doses, health effects, and costs of remedial actions. Specific models are presented for the major exposure pathways of airborne releases, waterborne releases and direct irradiation from activity within the facility buildings, such as the containment. Time-dependent atmospheric dispersion parameters, crop production parameters, and other variable parameters are used in the models. The environmental effects are analyzed for several accident start times during the year. Several remedial actions are considered

Health Effects of Climate Change (Environmental Health Student Portal)

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... change can affect your health. Read About It Climate Change and Human Health (Public Broadcasting Services (including their teacher resources)) - Web ... Health Sciences) - Overview of the potential effects of climate change on human health. Climate and Health Program: Health Effects (Centers for ...

Job Stress, Employee Health, and Organizational Effectiveness: A Facet Analysis, Model, and Literature Review.

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Beehr, Terry A.; Newman, John E.

1978-01-01

The empirical research on job stress and employee health is reviewed within the context of six facets (environmental, personal, process, human consequences, organizational consequences, and time) of a seven facet conceptualization of the job stress-employee health research domain. Models are proposed for tying the facets together. (Author/SJL)

Application of PIP data in health economic models for market access

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Nadine van Dongen

2010-11-01

Full Text Available Nadine van Dongen1, Mark JC Nuijten21Van Dongen Research Ltd, London, UK; 2Ars Accessus Medica, Amsterdam, The NetherlandsAbstract: Cost-effectiveness data from a state of the art health economic analysis should permit reliable, reproducible, and verifiable insights into the effectiveness of a drug and the possible savings that might be achieved relative to other drugs and/or treatments. The data for a model may come from a variety of sources and are subject to varying degrees of uncertainty. The reliability of the estimates depends on the choice of the data sources. Data sources for the variables being used in a model may be clinical trials, databases, medical records, and Delphi panels. A limitation of these data sources is that they often lack the input from the patient’s perspective. Patient Intelligence applications can provide data to be used in health economic models for any given situation regarding treatment of persons suffering from a disorder, disease, or complaint. The objective of this paper to explore the opportunity of integrating patient data generated by Patient Intelligence applications as an alternative data source for a Delphi panel and databases in health economic models.Keywords: effectiveness, Patient Intelligence, data source, Delphi panel

Climate Effects on Health

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... Guidance and Trainings Webinars Data and Tools Publications Climate Effects on Health Recommend on Facebook Tweet Share ... effects has been excerpted from the Third National Climate Assessment’s Health Chapter . Additional information regarding the health ...

Exploration of an allied health workforce redesign model: quantifying the work of allied health assistants in a community workforce.

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Somerville, Lisa; Davis, Annette; Milne, Sarah; Terrill, Desiree; Philip, Kathleen

2017-07-25

The Victorian Assistant Workforce Model (VAWM) enables a systematic approach for the identification and quantification of work that can be delegated from allied health professionals (AHPs) to allied health assistants (AHAs). The aim of the present study was to explore the effect of implementation of VAWM in the community and ambulatory health care setting. Data captured using mixed methods from allied health professionals working across the participating health services enabled the measurement of opportunity for workforce redesign in the community and ambulatory allied health workforce. A total of 1112 AHPs and 135 AHAs from the 27 participating organisations took part in the present study. AHPs identified that 24% of their time was spent undertaking tasks that could safely be delegated to an appropriately qualified and supervised AHA. This equates to 6837h that could be redirected to advanced and expanded AHP practice roles or expanded patient-centred service models. The VAWM demonstrates potential for more efficient implementation of assistant workforce roles across allied health. Data outputs from implementation of the VAWM are vital in informing strategic planning and sustainability of workforce change. A more efficient and effective workforce promotes service delivery by the right person, in the right place, at the right time. What is known about this topic? There are currently workforce shortages that are predicted to grow across the allied health workforce. Ensuring that skill mix is optimal is one way to address these shortages. Matching the right task to right worker will also enable improved job satisfaction for both allied health assistants and allied health professionals. Workforce redesign efforts are more effective when there is strong data to support the redesign. What does this paper add? This paper builds on a previous paper by Somerville et al. with a case study applying the workforce redesign model to a community and ambulatory health care

Development and Psychometrics of Health Belief Model Instrument about HIV/AIDS

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Mohammad Masod Vakili

2012-09-01

Full Text Available Background: With no effective vaccine for prevention or a definite cure for treatment, health education is considered the most effective intervention against HIV. Using a valid tool to evaluate the effect of health education interventions is an inevitable necessity. The aim of this study was to design a tool and to assess its validity and reliability based on native culture characterization in order to evaluate the health belief model constructs about AIDS. Materials and Methods: 480 women covered by health bases of the city of Zanjan, in the age group of 20-30 years, married, and with at least first middle school education participated in this cross-sectional study. After reviewing the literature, the tool was designed and its validity and reliability was approved based on psychometric processes and feedback from the target group and a panel of experts through calculating the content validity ratio, content validity index, exploratory factor analysis, and determining internal consistency.Results: The validity of 37 items were assessed and selected through calculating the index score of the item effect above 1.5, content validity index ratio greater than 0.49, and content validity index higher than 0.79 and by using exploratory factor analysis with a special value greater than 1; seven factors and 34 items were kept and classified into five categories based on literature review and content items. The reliability of the research tool was calculated with Cronbach’s alpha equal to 0.82.Conclusion: The results of this study provide appropriate evidence about the strength of structural factors and the reliability of the assessment tool for structures of health belief models about AIDS, and the creation of accessibility to a reliable tool for assessing the structures of health belief model.

Conceptual Models in Health Informatics Research: A Literature Review and Suggestions for Development.

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Gray, Kathleen; Sockolow, Paulina

2016-02-24

Contributing to health informatics research means using conceptual models that are integrative and explain the research in terms of the two broad domains of health science and information science. However, it can be hard for novice health informatics researchers to find exemplars and guidelines in working with integrative conceptual models. The aim of this paper is to support the use of integrative conceptual models in research on information and communication technologies in the health sector, and to encourage discussion of these conceptual models in scholarly forums. A two-part method was used to summarize and structure ideas about how to work effectively with conceptual models in health informatics research that included (1) a selective review and summary of the literature of conceptual models; and (2) the construction of a step-by-step approach to developing a conceptual model. The seven-step methodology for developing conceptual models in health informatics research explained in this paper involves (1) acknowledging the limitations of health science and information science conceptual models; (2) giving a rationale for one's choice of integrative conceptual model; (3) explicating a conceptual model verbally and graphically; (4) seeking feedback about the conceptual model from stakeholders in both the health science and information science domains; (5) aligning a conceptual model with an appropriate research plan; (6) adapting a conceptual model in response to new knowledge over time; and (7) disseminating conceptual models in scholarly and scientific forums. Making explicit the conceptual model that underpins a health informatics research project can contribute to increasing the number of well-formed and strongly grounded health informatics research projects. This explication has distinct benefits for researchers in training, research teams, and researchers and practitioners in information, health, and other disciplines.

A successful model for longitudinal community-engaged health research: the 2040 Partners for Health Student Program.

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Redman, Romany M; Reinsvold, Magdalena C; Reddy, Anireddy; Bennett, Paige E; Hoerauf, Janine M; Puls, Kristina M; Ovrutsky, Alida R; Ly, Alexandra R; White, Gregory; McNeil, Owetta; Meredith, Janet J

2017-06-01

Community-based participatory research [CBPR] is an emerging approach to collaborative research aimed at creating locally effective and sustainable interventions. The 2040 Partners for Health student program was developed as a unique model of longitudinal CBPR. Analysis of this program and its components illuminates both the challenges and the opportunities inherent in community engagement. The program rests on a foundation of a community-based, non-profit organization and a supportive academic university centre. Inter-professional health students and community members of underserved populations work together on different health projects by employing an adapted CBPR methodology. Three successful examples of sustainable CBPR projects are briefly described. The three projects are presented as primary outcomes resulting from this model. Benefits and challenges of the model as an approach to community-engaged research are discussed as well as secondary benefits of student participation. The 2040 Partners for Health student program represents a successful model of CBPR, illuminating common challenges and reiterating the profound value of community-engaged research. © The Author 2017. Published by Oxford University Press. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Effects of zinc and "health belief model" education on upper respiratory infections in hajj travelers: a randomized clinical trial

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Mahmoudian S.A

2007-09-01

Full Text Available Background: The common cold is the most prevalent sickness and an important cause of absence from job. Furthermore, it often disturbs travel, including the practice of hajj, causing the use of many inappropriate drugs by these travelers. The health belief model is a psychological model that attempts to explain and predict health behaviors. The purpose of this study was to determine the effects of zinc and health belief model based educational intervention on the behavior of hajj travelers with regard to viral upper respiratory tract infections (URTI.Methods: This double-blinded randomized controlled trial was performed among hajj travelers in 2005. Preventive measures were randomly allocated to four groups: 1- education + zinc sulfate. 2- education + placebo. 3- zinc sulfate only 4- placebo only. Data regarding incidence and duration of URTIs, background disorders, vaccination and health behaviors for cold were gathered by questionnaire by physicians and finally analyzed by SPSS 11.5 software using chi-square, t-test and independent samples t-test.Results: A total of 646 travelers were studied. The incidence of common cold in groups receiving zinc were significantly less than that for those receiving the placebo. (P=0.05. However, incidence was statistically the same for those who received education versus those who did not. Use of handkerchief was the most prevalent behavior and use of mask was the least prevalent behavior. Mean duration of symptoms was less in those receiving zinc and education (3.7 days comparing to those who received placebo and education (5.6 days.  Conclusions: This study showed that zinc consumption can decrease the incidence and duration of the common cold. Health belief model based education could promote some preventive behaviors although most people do not take advantage of them. We recommend the use of zinc by those attending hajj.

The development of a model for dealing with secondary traumatic stress in mental health workers in Rwanda

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Jean D. Iyamuremye

2015-10-01

Aim: To develop a comprehensive model to manage the effects of STS in mental health workers operating in Rwanda. Method: An action research project was initiated to develop this model and data for the model was collected through individual interviews with mental health workers (nurses, doctors, psychologists, trauma counsellors and social workers as well as a quantitative tool measuring secondary traumatic stress (Trauma Attachment Belief Scale in these health workers. Results: The Intervention Model to Manage Secondary Traumatic Stress (IMMSTS was synthesised from these findings and includes preventive, evaluative and curative strategies to manage STS in mental health workers in Rwanda at the individual, social and organisational levels. Conclusion: The model will offer mental health professionals an effective framework for addressing the issue of STS.

Cost-effectiveness of the Mental Health and Development model for schizophrenia-spectrum and bipolar disorders in rural Kenya.

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de Menil, V; Knapp, M; McDaid, D; Raja, S; Kingori, J; Waruguru, M; Wood, S K; Mannarath, S; Lund, C

2015-10-01

The treatment gap for serious mental disorders across low-income countries is estimated to be 89%. The model for Mental Health and Development (MHD) offers community-based care for people with mental disorders in 11 low- and middle-income countries. In Kenya, using a pre-post design, 117 consecutively enrolled participants with schizophrenia-spectrum and bipolar disorders were followed-up at 10 and 20 months. Comparison outcomes were drawn from the literature. Costs were analysed from societal and health system perspectives. From the societal perspective, MHD cost Int$ 594 per person in the first year and Int$ 876 over 2 years. The cost per healthy day gained was Int$ 7.96 in the first year and Int$ 1.03 over 2 years - less than the agricultural minimum wage. The cost per disability-adjusted life year averted over 2 years was Int$ 13.1 and Int$ 727 from the societal and health system perspectives, respectively, on par with antiretrovirals for HIV. MHD achieved increasing returns over time. The model appears cost-effective and equitable, especially over 2 years. Its affordability relies on multi-sectoral participation nationally and internationally.

Legislative and Policy Developments and Imperatives for Advancing the Primary Care Behavioral Health (PCBH) Model.

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Freeman, Dennis S; Hudgins, Cathy; Hornberger, Joel

2018-03-05

The Primary Care Behavioral Health (PCBH) practice model continues to gain converts among primary care and behavioral health professionals as the evidence supporting its effectiveness continues to accumulate. Despite a growing number of practices and organizations using the model effectively, widespread implementation has been hampered by outmoded policies and regulatory barriers. As policymakers and legislators begin to recognize the contributions that PCBH model services make to the care of complex patients and the expansion of access to those in need of behavioral health interventions, some encouraging policy initiatives are emerging and the policy environment is becoming more favorable to implementation of the PCBH model. This article outlines the necessity for policy change, exposing the policy issues and barriers that serve to limit the practice of the PCBH model; highlights innovative approaches some states are taking to foster integrated practice; and discusses the compatibility of the PCBH model with the nation's health care reform agenda. Psychologists have emerged as leaders in the design and implementation of PCBH model integration and are encouraged to continue to advance the model through the demonstration of efficient and effective clinical practice, participation in the expansion of an appropriately trained workforce, and advocacy for the inclusion of this practice model in emerging healthcare systems and value-based payment methodologies.

The effects of health promotion model-based educational program on self-care behaviors in patients undergoing coronary artery bypass grafting in Iran

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Mohsenipouya, Hossein; Majlessi, Fereshteh; Ghafari, Rahman

2018-01-01

Background and aim Post-operative self-care behaviors, have positive effects on increase in adaptability, and reduce cardiac surgery patients’ disability. The present study is carried out aimed at determining the effect of education based on a health promotion model on the patients’ self-care behaviors after coronary artery bypass surgery. Methods This is a semi-experimental study carried out in Mazandaran (Iran) in 2016. Two hundred and twenty patients who participated in the study were selected using a simple random sampling method from a population of postoperative patients, and divided into control and experimental groups (110 patients in each) using block (AABB) randomization. Self-designed self-care questionnaires based on a health promotion model were distributed among the patients once before and three months after intervention. The data were analyzed by SPSS-22, Chi-Square tests, Mann-Whitney and ANCOVA at the significance level of ppromotion model can enhance self-care behaviors and reduce the number of admissions in patients after cardiac surgery. PMID:29588828

Urban systems complexity in sustainability and health: an interdisciplinary modelling study

Directory of Open Access Journals (Sweden)

Nici Zimmermann, PhD

2018-05-01

Full Text Available Background: Improving urban health and sustainability raises complex questions that are best addressed through interdisciplinary and even transdisciplinary approaches, in which scientific research and analysis and stakeholder engagement have important roles. In this study we report pilot work in Nairobi (Kenya and London (UK that uses innovative methods to integrate qualitative and quantitative modelling to provide evidence to support policy development for health and sustainability in these cities. Methods: We used two primary modelling methods, system dynamics and microsimulation, and sought to understand the value of these tools in combination to support policy decisions. System dynamics was used to establish an aggregated and non-linear causal map of the interconnections between diverse variables, and thus to gain insight into the policies and specific processes that need to be examined in further depth. System dynamics was a key tool for city-level stakeholder engagement. In part informed by the outcome of the system dynamics process, microsimulation was then used to quantify local effects on health of selected policy options. The results were mapped using geographic information systems methods. Findings: The combination of system dynamics and microsimulation models provided a framework that enhanced collective knowledge about the interrelationships of policy decisions, funding, public awareness, and environmental and health effects. Our initial participatory system dynamics work on air pollution in Nairobi found that a combination of policies that focus on households and outdoor air could reduce household air pollution by about 50%, leaving it still above WHO-recommended levels. Yet, the investments in monitoring and health impact assessment have the potential to trigger reinforcing mechanisms that create synergies among existing policies and increase the return on investment. Preliminary 106-year microsimulation runs of the effects of PM2

An empirical investigation of the efficiency effects of integrated care models in Switzerland

Directory of Open Access Journals (Sweden)

Oliver Reich

2012-01-01

Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency. Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model. Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection. Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

An empirical investigation of the efficiency effects of integrated care models in Switzerland

Directory of Open Access Journals (Sweden)

Oliver Reich

2012-01-01

Full Text Available Introduction: This study investigates the efficiency gains of integrated care models in Switzerland, since these models are regarded as cost containment options in national social health insurance. These plans generate much lower average health care expenditure than the basic insurance plan. The question is, however, to what extent these total savings are due to the effects of selection and efficiency.Methods: The empirical analysis is based on data from 399,274 Swiss residents that constantly had compulsory health insurance with the Helsana Group, the largest health insurer in Switzerland, covering the years 2006 to 2009. In order to evaluate the efficiency of the different integrated care models, we apply an econometric approach with a mixed-effects model.Results: Our estimations indicate that the efficiency effects of integrated care models on health care expenditure are significant. However, the different insurance plans vary, revealing the following efficiency gains per model: contracted capitated model 21.2%, contracted non-capitated model 15.5% and telemedicine model 3.7%. The remaining 8.5%, 5.6% and 22.5% respectively of the variation in total health care expenditure can be attributed to the effects of selection.Conclusions: Integrated care models have the potential to improve care for patients with chronic diseases and concurrently have a positive impact on health care expenditure. We suggest policy makers improve the incentives for patients with chronic diseases within the existing regulations providing further potential for cost-efficiency of medical care.

Health literacy and public health: A systematic review and integration of definitions and models

LENUS (Irish Health Repository)

Sorensen, Kristine

2012-01-25

Abstract Background Health literacy concerns the knowledge and competences of persons to meet the complex demands of health in modern society. Although its importance is increasingly recognised, there is no consensus about the definition of health literacy or about its conceptual dimensions, which limits the possibilities for measurement and comparison. The aim of the study is to review definitions and models on health literacy to develop an integrated definition and conceptual model capturing the most comprehensive evidence-based dimensions of health literacy. Methods A systematic literature review was performed to identify definitions and conceptual frameworks of health literacy. A content analysis of the definitions and conceptual frameworks was carried out to identify the central dimensions of health literacy and develop an integrated model. Results The review resulted in 17 definitions of health literacy and 12 conceptual models. Based on the content analysis, an integrative conceptual model was developed containing 12 dimensions referring to the knowledge, motivation and competencies of accessing, understanding, appraising and applying health-related information within the healthcare, disease prevention and health promotion setting, respectively. Conclusions Based upon this review, a model is proposed integrating medical and public health views of health literacy. The model can serve as a basis for developing health literacy enhancing interventions and provide a conceptual basis for the development and validation of measurement tools, capturing the different dimensions of health literacy within the healthcare, disease prevention and health promotion settings.

Adverse health effects of high-effort/low-reward conditions.

Science.gov (United States)

Siegrist, J

1996-01-01

In addition to the person-environment fit model (J. R. French, R. D. Caplan, & R. V. Harrison, 1982) and the demand-control model (R. A. Karasek & T. Theorell, 1990), a third theoretical concept is proposed to assess adverse health effects of stressful experience at work: the effort-reward imbalance model. The focus of this model is on reciprocity of exchange in occupational life where high-cost/low-gain conditions are considered particularly stressful. Variables measuring low reward in terms of low status control (e.g., lack of promotion prospects, job insecurity) in association with high extrinsic (e.g., work pressure) or intrinsic (personal coping pattern, e.g., high need for control) effort independently predict new cardiovascular events in a prospective study on blue-collar men. Furthermore, these variables partly explain prevalence of cardiovascular risk factors (hypertension, atherogenic lipids) in 2 independent studies. Studying adverse health effects of high-effort/low-reward conditions seems well justified, especially in view of recent developments of the labor market.

Health effects of radon

International Nuclear Information System (INIS)

Easterly, C.

1994-01-01

Exposure of people to radon has taken on increased interest during the last decade because of the understanding that buildings can serve to trap radon and its daughters, and thereby build up undesirable concentrations of these radioactive elements. Numerous studies of underground miners (often uranium miners) have shown an increased risk of lung cancer in comparison with nonexposed populations. Laboratory animals exposed to radon daughters also develop lung cancer. The abundant epidemiological and experimental data have established the carcinogenicity of radon progeny. Those observations are of considerable importance, because uranium, from which radon and its progeny arise, is ubiquitous in the earth's crust, including coal mines. Risk estimates of the health effects of long-term exposures at relatively low levels require continued development, especially to address the potential health effects of radon and radon daughters in homes and occupational settings where the exposure levels are less than levels in underground uranium and other metal mines that have been the subject of epidemiological studies. Two approaches can be used to characterize the lung-cancer risks associated with radon-daughter exposure: mathematical representations of the respiratory tract that model radiation doses to target cells and epidemiological investigation of exposed populations, mainly underground uranium miners. The mathematically-based dosimetric approach provides an estimate of lung cancer risk related to radon-daughter exposure based specifically on modeling of the dose to target cells. The various dosimetric models all require assumptions, some of which are not subject to direct verification, as to breathing rates; the deposition of radon daughters in the respiratory tract; and the type, nature, and location of the target cells for cancer induction. The most recent large committee effort drawn together to evaluate this issue was sponsored by the National Research Council

JERM model of care: an in-principle model for dental health policy.

Science.gov (United States)

Lam, Raymond; Kruger, Estie; Tennant, Marc

2014-01-01

Oral diseases are the most prevalent conditions in the community. Their economic burden is high and their impact on quality of life is profound. There is an increasing body of evidence indicating that oral diseases have wider implications beyond the confines of the mouth. The importance of oral health has not been unnoticed by the government. The Commonwealth (Federal) government under the Howard-led Coalition in 2004 had broken tradition by placing dentistry in its universal health insurance scheme, Medicare. Known as the Chronic Disease Dental Scheme (CDDS), the program aimed to manage patients with chronic conditions as part of the Enhanced Primary Care initiative. This scheme was a landmark policy for several reasons. Besides being the first major dental policy under Medicare, the program proved to be the most expensive and controversial. Unfortunately, cost containment and problems with service provision led to its cessation in 2012 by the Gillard Labor Government. Despite being seen as a failure, the CDDS provided a unique opportunity to assess national policy in practice. By analysing the policy-relevant effects of the CDDS, important lessons can be learnt for policy development. This paper discusses these lessons and has formulated a set of principles recommended for effective oral health policy. The JERM model represents the principles of a justified, economical and research-based model of care.

Mediating effects of emotional exhaustion on the relationship between job demand–control model and mental health.

Science.gov (United States)

Huang, Yu-Hwa; Du, Pey-Ian; Chen, Chin-Hui; Yang, Chin-Ann; Huang, Ing-Chung

2011-04-01

This study attempted to investigate the role of emotional exhaustion as a mediator on the relationship between job demands-control (JDC) model and mental health. Three-wave data from 297 employees were collected. The results showed that job demands were positively related to emotional exhaustion, and increasing job demands will increase the level of emotional exhaustion. Job control was negatively associated with emotional exhaustion; therefore, increasing job control will decrease the level of emotional exhaustion. Emotional exhaustion was negatively related to mental health. Emotional exhaustion fully mediated the relationship between job demands and mental health, and partially mediated the positive relationship between job control and mental health. In addition, job control was positively associated with mental health directly. The remarkable finding of the present study was that emotional exhaustion served as the key mediator between the JDC model and mental health. Theoretical and managerial implications and limitations were discussed.

On Medical Progress and Health Care Demand: A Ces Perspective Using the Grossman Model of Health Status.

Science.gov (United States)

Batinti, Alberto

2015-12-01

I propose an application of the pure-consumption version of the Grossman model of health care demand, where utility depends on consumption and health status and health status on medical care and health technology. I derive the conditions under which an improvement in health care technology leads to an increase/decrease in health care consumption. In particular, I show how the direction of the effect depends on the relationship between the constant elasticity of substitution parameters of the utility and health production functions. I find that, under the constancy assumption, the ratio of the two elasticity of substitution parameters determines the direction of a technological change on health care demand. On the other hand, the technology share parameter in the health production function contributes to the size but not to the direction of the technological effect. I finally explore how the ratio of the elasticity of substitution parameters work in measurement and practice and discuss how future research may use the theoretical insight provided here. Copyright © 2014 John Wiley & Sons, Ltd.

Leadership models in health care - a case for servant leadership.

Science.gov (United States)

Trastek, Victor F; Hamilton, Neil W; Niles, Emily E

2014-03-01

Our current health care system is broken and unsustainable. Patients desire the highest quality care, and it needs to cost less. To regain public trust, the health care system must change and adapt to the current needs of patients. The diverse group of stakeholders in the health care system creates challenges for improving the value of care. Health care providers are in the best position to determine effective ways of improving the value of care. To create change, health care providers must learn how to effectively lead patients, those within health care organizations, and other stakeholders. This article presents servant leadership as the best model for health care organizations because it focuses on the strength of the team, developing trust and serving the needs of patients. As servant leaders, health care providers may be best equipped to make changes in the organization and in the provider-patient relationship to improve the value of care for patients. Copyright © 2014 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.

Patients’ Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test

Science.gov (United States)

Dou, Kaili; Yu, Ping; Liu, Fang; Guan, YingPing; Li, Zhenye; Ji, Yumeng; Du, Ningkai; Lu, Xudong; Duan, Huilong

2017-01-01

Background Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. Objective The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients’ acceptance of smartphone health technology for chronic disease management. Methods Multiple theories and factors that may influence patients’ acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients’ acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients’ actual use of a smartphone health app. The partial least square method was used to test the theoretical model. Results The model accounted for .412 of the variance in patients’ intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients’ smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients’ intentions to use the technology. Age and gender had no significant influence on patients’ acceptance of smartphone technology. The study also

Public Health Activist Skills Pyramid: A Model for Implementing Health in All Policies.

Science.gov (United States)

Damari, Behzad; Ehsani Chimeh, Elham

2017-01-01

Affecting public health for society requires various competencies. In fact, the prerequisite for the implementation of health in all policies should be effectiveness of public health activists (PHAs) in these competencies. This study aims to determine the competencies of the activists in public health. The present qualitative study reviewed the literature and adopted qualitative methods like content analysis, stakeholder interviews, and conducted focus group discussions with related experts. In each stage, the required competencies were extracted through drawing the main action processes of a PHA. Thereafter, the authors reached an ultimately best-suited working model by classifying and approving extracted competencies. The competencies comprise a pyramid set of three main categories of basic, specialized/professional, and individual updating competencies. Personal management, communication, teamwork, project management, ability to apply principles and concepts of public health, anatomy, physiology, and pathology in the organizations of the society should be included in the basic category. Specialized skills should include ability to plan, public participation, intersectoral collaboration, social marketing, working with the media/media friendly attitude, advocacy, research management and knowledge translation, evaluation of health programs, network establishment and management, deployment and institutionalization, operational research, empowerment and consultation, and protocol and service pack design. Last but not least, individual updating is defined as being informed of the latest scientific articles and reports about health and its situation in different countries as well as determinants that affect health. Implementation of this pyramid requires design and establishment of specific centers for transferring effective public health competencies. This pyramid has also functional use for the revision of educational curriculums in all health study fields. Moreover

The health effects of climate change: a survey of recent quantitative research.

Science.gov (United States)

Grasso, Margherita; Manera, Matteo; Chiabai, Aline; Markandya, Anil

2012-05-01

In recent years there has been a large scientific and public debate on climate change and its direct as well as indirect effects on human health. In particular, a large amount of research on the effects of climate changes on human health has addressed two fundamental questions. First, can historical data be of some help in revealing how short-run or long-run climate variations affect the occurrence of infectious diseases? Second, is it possible to build more accurate quantitative models which are capable of predicting the future effects of different climate conditions on the transmissibility of particularly dangerous infectious diseases? The primary goal of this paper is to review the most relevant contributions which have directly tackled those questions, both with respect to the effects of climate changes on the diffusion of non-infectious and infectious diseases, with malaria as a case study. Specific attention will be drawn on the methodological aspects of each study, which will be classified according to the type of quantitative model considered, namely time series models, panel data and spatial models, and non-statistical approaches. Since many different disciplines and approaches are involved, a broader view is necessary in order to provide a better understanding of the interactions between climate and health. In this respect, our paper also presents a critical summary of the recent literature related to more general aspects of the impacts of climate changes on human health, such as: the economics of climate change; how to manage the health effects of climate change; the establishment of Early Warning Systems for infectious diseases.

Smoking within the Household: Spousal Peer Effects and Children's Health Implications

OpenAIRE

Canta, Chiara; Dubois, Pierre

2011-01-01

This paper studies spousal peer effects on the smoking behaviour and their implication for the health of children through passive smoking. Smoking decisions are modeled as equilibrium strategies of an incomplete information game within the couple. Using data from the French Health Survey 2002-2003, we identify two distinct effects linked to spousal behaviour: a smoking enhancing effect of smoking partners and a smoking deterring effect of non smoking partners. On the one hand, ...

From intermediate to final behavioral endpoints : Modeling cognitions in (cost-)effectiveness analyses in health promotion

NARCIS (Netherlands)

Prenger, Hendrikje Cornelia

2012-01-01

Cost-effectiveness analyses (CEAs) are considered an increasingly important tool in health promotion and psychology. In health promotion adequate effectiveness data of innovative interventions are often lacking. In case of many promising interventions the available data are inadequate for CEAs due

Game Maturity Model for Health Care.

Science.gov (United States)

de Boer, Jan C; Adriani, Paul; van Houwelingen, Jan Willem; Geerts, A

2016-04-01

This article introduces the Game Maturity Model for the healthcare industry as an extension to the general Game Maturity Model and describes the usage by two case studies of applied health games. The Game Maturity Model for healthcare provides a practical and value-adding method to assess existing games and to determine strategic considerations for application of applied health games. Our forecast is that within 5 years the use and development of applied games will have a role in our daily lives and the way we organize health care that will be similar to the role social media has today.

The effect of safety education based on Health Belief Model (HBM on the workers practice of Borujen industrial town in using the personal protection respiratory equipments

Directory of Open Access Journals (Sweden)

A. Hasanzadeh

2008-04-01

Full Text Available Background and aims   Every year 50-158 million occupational diseases and job accidents occur in the world. Studies on the job injuries show that about 150000 injuries occur annually in  Iran. Unhealthy behaviors are important problems in public health. Education is one of the best ways to change unhealthy behaviors. Interventions based on model and theories have many  capacities for behavior change. Health Belief Model is one of the health education models that are  useful for behavior change. This research has been performed in order to assess the effect of health  education program based on health belief model (HBM to prevent occupational respiratory   diseases in workers.   Methods   Aquasi-experimental design was used for this interventional study, in which 88 of workers of Borujen industrial town participated, who were randomly assigned to experimental and control group. Data collecting tool were a self-administered questionnaire including 53 questions based on health belief model that was completed by the workers, in addition to the performance check list which was conducted by researcher via insensible controlling the workers' safety behaviour. Validity and reliability of the tools were examined prior to the study. Educational  intervention was conducted in the first stage following by the second data collection one month  later. The data of both experimental and control group were compared statistically before and  after the intervention.   Results   The results showed that the mean of the grade of all parts of health belief model  (HBM and performance mark of the workers about safety and use of personal respiratory  preventive equipment in experimental group after educational intervention compared to prior the  study and also compared to control group were significantly increased.   Conclusion   The results of this survey showed that by enhancement of health belief model (HBM components including

Health Effects of Air Pollution

Science.gov (United States)

... Health effects of air pollution Health effects of air pollution Breathing air that is not clean can hurt ... important to know about the health effects that air pollution can have on you and others. Once you ...

THE EFFECT OF FAMILY THERAPY WITH SPIRITUAL APPROACH TOWARD FAMILY’S HEALTH BELIEF MODEL IN TAKING CARE OF PATIENT WITH SCHIZOPHRENIA

Directory of Open Access Journals (Sweden)

Ah. Yusuf

2017-04-01

Full Text Available Introduction: Schizophrenia is the problem with kognitive, mal-adaptive thought and behavior. Family who have a member with mental disorder can experience serious conflict, become an objective and subjective burden, blame each other, get involved in hostility among family members. Various negative effect faced by family can caused by wrong family’s health belief model about Schizophrenia, hence the failure on choosing the treatment and taking care of patient at home. Someone with severe stress will seek comfort and strength from God. But so far, the most effective spiritual models to improve the health belief model of the family in caring for patients with schizophrenia has not been found. Method: Design used in this study was experimental (pre post test control group design. The population was every family of patient with mental disorder in Menur Mental Hospital along the year of 2010, chosen by alocation simple random. Samples were 13 persons in each treatment and control group. The intervention was given in 60–120 minute in 8 times meeting with average interval about 1 week. Data analysis was done using paired t-test and independent t-test. Results: There were significant changes in total of family’s health belief model (p=0,004, there was significantly change in aspects of (1 perceptions about bene fi ts (p=0,009, (2 perception about barriers (p=0,035 and perception about self efficacy (p=0,002. There were no significant changing in perception about susceptibility and severity (p=0,052. Discussion: Family believes that all events experienced by the patient and the family is God's will, hoping the patient can be more independent, and believe mental disorders can be changed for the better. The conclusion of this study is that family therapy with a spiritual approach can improve the health belief model of the family in caring for patients with mental disorders.

A cooperative reduction model for regional air pollution control in China that considers adverse health effects and pollutant reduction costs.

Science.gov (United States)

Xie, Yujing; Zhao, Laijun; Xue, Jian; Hu, Qingmi; Xu, Xiang; Wang, Hongbo

2016-12-15

How to effectively control severe regional air pollution has become a focus of global concern recently. The non-cooperative reduction model (NCRM) is still the main air pollution control pattern in China, but it is both ineffective and costly, because each province must independently fight air pollution. Thus, we proposed a cooperative reduction model (CRM), with the goal of maximizing the reduction in adverse health effects (AHEs) at the lowest cost by encouraging neighboring areas to jointly control air pollution. CRM has two parts: a model of optimal pollutant removal rates using two optimization objectives (maximizing the reduction in AHEs and minimizing pollutant reduction cost) while meeting the regional pollution control targets set by the central government, and a model that allocates the cooperation benefits (i.e., health improvement and cost reduction) among the participants according to their contributions using the Shapley value method. We applied CRM to the case of sulfur dioxide (SO 2 ) reduction in Yangtze River Delta region. Based on data from 2003 to 2013, and using mortality due to respiratory and cardiovascular diseases as the health endpoints, CRM saves 437 more lives than NCRM, amounting to 12.1% of the reduction under NCRM. CRM also reduced costs by US $65.8×10 6 compared with NCRM, which is 5.2% of the total cost of NCRM. Thus, CRM performs significantly better than NCRM. Each province obtains significant benefits from cooperation, which can motivate them to actively cooperate in the long term. A sensitivity analysis was performed to quantify the effects of parameter values on the cooperation benefits. Results shown that the CRM is not sensitive to the changes in each province's pollutant carrying capacity and the minimum pollutant removal capacity, but sensitive to the maximum pollutant reduction capacity. Moreover, higher cooperation benefits will be generated when a province's maximum pollutant reduction capacity increases. Copyright �

Effects of Health Literacy and Social Capital on Health Information Behavior.

Science.gov (United States)

Kim, Yong-Chan; Lim, Ji Young; Park, Keeho

2015-01-01

This study aimed to examine whether social capital (bonding and bridging social capital) attenuate the effect of low functional health literacy on health information resources, efficacy, and behaviors. In-person interviews were conducted with 1,000 residents in Seoul, Korea, in 2011. The authors found that respondents' functional health literacy had positive effects on the scope of health information sources and health information self-efficacy but not health information-seeking intention. Respondents' social capital had positive effects on the scope of health information sources, health information efficacy, and health information-seeking intention. The authors found (a) a significant moderation effect of bridging social capital on the relation between health literacy and health information self-efficacy and (b) a moderation effect of bonding social capital on the relation between health literacy and health information-seeking intention.

Enhancing the Effectiveness of Consumer-Focused Health Information Technology Systems Through eHealth Literacy

DEFF Research Database (Denmark)

Kayser, Lars; Kushniruk, Andre; Osborne, Richard H

2015-01-01

BACKGROUND: eHealth systems and applications are increasingly focused on supporting consumers to directly engage with and use health care services. Involving end users in the design of these systems is critical to ensure a generation of usable and effective eHealth products and systems. Often...... the end users engaged for these participatory design processes are not actual representatives of the general population, and developers may have limited understanding about how well they might represent the full range of intended users of the eHealth products. As a consequence, resulting information...... model with the domains of a new concept of eHealth literacy. METHODS: This approach expands an existing method for supporting health IT system development, which advocates use of a three-dimensional user-task-context matrix to comprehensively identify the users of health IT systems, and what their needs...

Predicting longitudinal trajectories of health probabilities with random-effects multinomial logit regression.

Science.gov (United States)

Liu, Xian; Engel, Charles C

2012-12-20

Researchers often encounter longitudinal health data characterized with three or more ordinal or nominal categories. Random-effects multinomial logit models are generally applied to account for potential lack of independence inherent in such clustered data. When parameter estimates are used to describe longitudinal processes, however, random effects, both between and within individuals, need to be retransformed for correctly predicting outcome probabilities. This study attempts to go beyond existing work by developing a retransformation method that derives longitudinal growth trajectories of unbiased health probabilities. We estimated variances of the predicted probabilities by using the delta method. Additionally, we transformed the covariates' regression coefficients on the multinomial logit function, not substantively meaningful, to the conditional effects on the predicted probabilities. The empirical illustration uses the longitudinal data from the Asset and Health Dynamics among the Oldest Old. Our analysis compared three sets of the predicted probabilities of three health states at six time points, obtained from, respectively, the retransformation method, the best linear unbiased prediction, and the fixed-effects approach. The results demonstrate that neglect of retransforming random errors in the random-effects multinomial logit model results in severely biased longitudinal trajectories of health probabilities as well as overestimated effects of covariates on the probabilities. Copyright © 2012 John Wiley & Sons, Ltd.

Cost-effectiveness of public-health policy options in the presence of pretreatment NNRTI drug resistance in sub-Saharan Africa: a modelling study.

Science.gov (United States)

Phillips, Andrew N; Cambiano, Valentina; Nakagawa, Fumiyo; Revill, Paul; Jordan, Michael R; Hallett, Timothy B; Doherty, Meg; De Luca, Andrea; Lundgren, Jens D; Mhangara, Mutsa; Apollo, Tsitsi; Mellors, John; Nichols, Brooke; Parikh, Urvi; Pillay, Deenan; Rinke de Wit, Tobias; Sigaloff, Kim; Havlir, Diane; Kuritzkes, Daniel R; Pozniak, Anton; van de Vijver, David; Vitoria, Marco; Wainberg, Mark A; Raizes, Elliot; Bertagnolio, Silvia

2018-03-01

There is concern over increasing prevalence of non-nucleoside reverse-transcriptase inhibitor (NNRTI) resistance in people initiating antiretroviral therapy (ART) in low-income and middle-income countries. We assessed the effectiveness and cost-effectiveness of alternative public health responses in countries in sub-Saharan Africa where the prevalence of pretreatment drug resistance to NNRTIs is high. The HIV Synthesis Model is an individual-based simulation model of sexual HIV transmission, progression, and the effect of ART in adults, which is based on extensive published data sources and considers specific drugs and resistance mutations. We used this model to generate multiple setting scenarios mimicking those in sub-Saharan Africa and considered the prevalence of pretreatment NNRTI drug resistance in 2017. We then compared effectiveness and cost-effectiveness of alternative policy options. We took a 20 year time horizon, used a cost effectiveness threshold of US$500 per DALY averted, and discounted DALYs and costs at 3% per year. A transition to use of a dolutegravir as a first-line regimen in all new ART initiators is the option predicted to produce the most health benefits, resulting in a reduction of about 1 death per year per 100 people on ART over the next 20 years in a situation in which more than 10% of ART initiators have NNRTI resistance. The negative effect on population health of postponing the transition to dolutegravir increases substantially with higher prevalence of HIV drug resistance to NNRTI in ART initiators. Because of the reduced risk of resistance acquisition with dolutegravir-based regimens and reduced use of expensive second-line boosted protease inhibitor regimens, this policy option is also predicted to lead to a reduction of overall programme cost. A future transition from first-line regimens containing efavirenz to regimens containing dolutegravir formulations in adult ART initiators is predicted to be effective and cost-effective in

Holistic self-management education and support: a proposed public health model for improving women's health in Zimbabwe.

Science.gov (United States)

Kanchense, Jane Handina Murigwa

2006-08-01

The primary health care model of public health has been implemented in many countries around the globe since the Declaration of Alma Ata in 1978, without pilot testing the primary health care model. Therefore, many public health researchers have sought methods of improving primary health care by creating evidence-based models. Many of these researchers recognize the role of behavioral models in public health. These offshoots of primary health care include the ecological, care, central human capabilities, and the SPECIES models. Holistic self-management education and support is a capacity-building philosophy that ensures active involvement of consumers of health care in the planning and implementation and evaluation of health care services. It helps consumers of health care to achieve the desired improved quality of health and life in managing and sustaining their health at the grassroots level. The care model addresses disease management ideals of the in the original primary health care model. The SPECIES model addresses those aspects of the primary health care model that include the cultural and social factors, as well as individual health education and support in the original primary health care model. The ecological model offers an improvement of the socioeconomic ideal in the original primary health care model. Improving the health of individuals will prevent illness, thereby reducing health care costs and lessening the current strain on an overburdened health care system in Zimbabwe. Holistic self-management education and support links health care delivery systems with social processes. It is a best practices model that could better serve Zimbabwean girls and women by contributing positively to the national challenges in health care, thereby meeting the Zimbabwean primary health care and safe motherhood goals. It is here recommended that holistic self-management education and support must be pilot tested before being adopted as the most appropriate model for

The Health Effects of Climate Change: A Survey of Recent Quantitative Research

Directory of Open Access Journals (Sweden)

Anil Markandya

2012-04-01

Full Text Available In recent years there has been a large scientific and public debate on climate change and its direct as well as indirect effects on human health. In particular, a large amount of research on the effects of climate changes on human health has addressed two fundamental questions. First, can historical data be of some help in revealing how short-run or long-run climate variations affect the occurrence of infectious diseases? Second, is it possible to build more accurate quantitative models which are capable of predicting the future effects of different climate conditions on the transmissibility of particularly dangerous infectious diseases? The primary goal of this paper is to review the most relevant contributions which have directly tackled those questions, both with respect to the effects of climate changes on the diffusion of non-infectious and infectious diseases, with malaria as a case study. Specific attention will be drawn on the methodological aspects of each study, which will be classified according to the type of quantitative model considered, namely time series models, panel data and spatial models, and non-statistical approaches. Since many different disciplines and approaches are involved, a broader view is necessary in order to provide a better understanding of the interactions between climate and health. In this respect, our paper also presents a critical summary of the recent literature related to more general aspects of the impacts of climate changes on human health, such as: the economics of climate change; how to manage the health effects of climate change; the establishment of Early Warning Systems for infectious diseases.

Systems modelling and simulation in health service design, delivery and decision making.

Science.gov (United States)

Pitt, Martin; Monks, Thomas; Crowe, Sonya; Vasilakis, Christos

2016-01-01

The ever increasing pressures to ensure the most efficient and effective use of limited health service resources will, over time, encourage policy makers to turn to system modelling solutions. Such techniques have been available for decades, but despite ample research which demonstrates potential, their application in health services to date is limited. This article surveys the breadth of approaches available to support delivery and design across many areas and levels of healthcare planning. A case study in emergency stroke care is presented as an exemplar of an impactful application of health system modelling. This is followed by a discussion of the key issues surrounding the application of these methods in health, what barriers need to be overcome to ensure more effective implementation, as well as likely developments in the future. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to http://www.bmj.com/company/products-services/rights-and-licensing/

The chronic care model and relationships to patient health status and health-related quality of life.

Science.gov (United States)

Hung, Dorothy Y; Glasgow, Russell E; Dickinson, L Miriam; Froshaug, Desireé B; Fernald, Douglas H; Balasubramanian, Bijal A; Green, Larry A

2008-11-01

The chronic care model (CCM) is a system-level framework used to guide quality improvement efforts in health care. However, little is known about its relationship to patient-level health measures. This study describes the implementation of the CCM as adapted for prevention and health behavior counseling in primary care practices, and examines relationships between the CCM and patient health measures, including general health status and health-related quality of life (HRQOL). Baseline data from Round 2 of the Prescription for Health initiative (2005-2007) were used to assess CCM implementation in 57 practices located nationwide. Relationships between the CCM and three separate measures of health among 4735 patients were analyzed in 2007. A hierarchical generalized linear modeling approach to ordinal regression was used to estimate categories of general health status, unhealthy days, and activity-limiting days, adjusting for patient covariates and clustering effects. Outcome variances were significantly accounted for by differences in practice characteristics (pPractices that used individual or group planned visits were more likely to see patients in lower health categories across all measures (OR=0.74-0.81, pPractices that used patient registries, health promotion champions, evidence-based guidelines, publicly reported performance measures, and support for behavior change were associated with higher patient health levels (OR=1.28-1.98, ppractice's implementation of the CCM was significantly related to patient health status and HRQOL. Adapting the CCM for prevention may serve to reorient care delivery toward more proactive behavior change and improvements in patient health outcomes.

Patients' Acceptance of Smartphone Health Technology for Chronic Disease Management: A Theoretical Model and Empirical Test.

Science.gov (United States)

Dou, Kaili; Yu, Ping; Deng, Ning; Liu, Fang; Guan, YingPing; Li, Zhenye; Ji, Yumeng; Du, Ningkai; Lu, Xudong; Duan, Huilong

2017-12-06

Chronic disease patients often face multiple challenges from difficult comorbidities. Smartphone health technology can be used to help them manage their conditions only if they accept and use the technology. The aim of this study was to develop and test a theoretical model to predict and explain the factors influencing patients' acceptance of smartphone health technology for chronic disease management. Multiple theories and factors that may influence patients' acceptance of smartphone health technology have been reviewed. A hybrid theoretical model was built based on the technology acceptance model, dual-factor model, health belief model, and the factors identified from interviews that might influence patients' acceptance of smartphone health technology for chronic disease management. Data were collected from patient questionnaire surveys and computer log records about 157 hypertensive patients' actual use of a smartphone health app. The partial least square method was used to test the theoretical model. The model accounted for .412 of the variance in patients' intention to adopt the smartphone health technology. Intention to use accounted for .111 of the variance in actual use and had a significant weak relationship with the latter. Perceived ease of use was affected by patients' smartphone usage experience, relationship with doctor, and self-efficacy. Although without a significant effect on intention to use, perceived ease of use had a significant positive influence on perceived usefulness. Relationship with doctor and perceived health threat had significant positive effects on perceived usefulness, countering the negative influence of resistance to change. Perceived usefulness, perceived health threat, and resistance to change significantly predicted patients' intentions to use the technology. Age and gender had no significant influence on patients' acceptance of smartphone technology. The study also confirmed the positive relationship between intention to use

Evidence for the credibility of health economic models for health policy decision-making

DEFF Research Database (Denmark)

Søgaard, Rikke; Lindholt, Jes S.

2012-01-01

OBJECTIVE: To investigate whether the credibility of health economic models of screening for abdominal aortic aneurysms for health policy decision-making has improved since 2005 when a systematic review by Campbell et al. concluded that reporting standards were poor and there was divergence between...... benefited from general advances in health economic modelling and some improvements in reporting were noted. However, the low level of agreement between studies in model structures and assumptions, and difficulty in justifying these (convergent validity), remain a threat to the credibility of health economic...... models. Decision-makers should not accept the results of a modelling study if the methods are not fully transparent and justified. Modellers should, whenever relevant, supplement a primary report of results with a technical report detailing and discussing the methodological choices made....

Study protocol for two randomized controlled trials examining the effectiveness and safety of current weekend allied health services and a new stakeholder-driven model for acute medical/surgical patients versus no weekend allied health services.

Science.gov (United States)

Haines, Terry P; O'Brien, Lisa; Mitchell, Deb; Bowles, Kelly-Ann; Haas, Romi; Markham, Donna; Plumb, Samantha; Chiu, Timothy; May, Kerry; Philip, Kathleen; Lescai, David; McDermott, Fiona; Sarkies, Mitchell; Ghaly, Marcelle; Shaw, Leonie; Juj, Genevieve; Skinner, Elizabeth H

2015-04-02

Disinvestment from inefficient or ineffective health services is a growing priority for health care systems. Provision of allied health services over the weekend is now commonplace despite a relative paucity of evidence supporting their provision. The relatively high cost of providing this service combined with the paucity of evidence supporting its provision makes this a potential candidate for disinvestment so that resources consumed can be used in other areas. This study aims to determine the effectiveness, cost-effectiveness and safety of the current model of weekend allied health service and a new stakeholder-driven model of weekend allied health service delivery on acute medical and surgical wards compared to having no weekend allied health service. Two stepped wedge, cluster randomised trials of weekend allied health services will be conducted in six acute medical/surgical wards across two public metropolitan hospitals in Melbourne (Australia). Wards have been chosen to participate by management teams at each hospital. The allied health services to be investigated will include physiotherapy, occupational therapy, speech therapy, dietetics, social work and allied health assistants. At baseline, all wards will be receiving weekend allied health services. Study 1 intervention will be the sequential disinvestment (roll-in) of the current weekend allied health service model from each participating ward in monthly intervals and study 2 will be the roll-out of a new stakeholder-driven model of weekend allied health service delivery. The order in which weekend allied health services will be rolled in and out amongst participating wards will be determined randomly. This trial will be conducted in each of the two participating hospitals at a different time interval. Primary outcomes will be length of stay, rate of unplanned hospital readmission within 28 days and rate of adverse events. Secondary outcomes will be number of complaints and compliments, staff absenteeism

Environmental Justice and Health Effects of Urban Air Pollution.

Science.gov (United States)

Stewart, John A; Mitchell, Mark A; Edgerton, Victor S; VanCott, Robert

2015-02-01

Minority communities often bear the burden of "hosting" pollution sources. This report assesses whether there are any health effects from living near such pollution sources and whether health effects of pollution vary by sex, ethnicity, or income. The air pollution emissions from Hartford area, point sources are modeled and exposures are estimated for the residents who participated in a geographically-based health survey. The pollution intensities and other individual and neighborhood characteristics are used to predict an individual's reported respiratory problems. The results indicate that respiratory problems are correlated significantly with pollution levels, especially sulfur dioxide from the local trash-to-energy incinerator-the fifth largest one in the U.S. The effects of a given pollution level tend to be more serious for specific subgroups based upon sex, ethnicity, poverty, and age. Even when controlling for other factors, air pollution levels are significantly correlated with health problems, especially for Hispanics. This air pollution may contribute to health disparities. © 2015 National Medical Association. Published by Elsevier Inc. All rights reserved.

Effect of an Educational Program Based on the Health Belief Model to Reduce Cell Phone Usage During Driving in Taxi drivers

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Babak Moeini

2014-09-01

Full Text Available Introduction: Cell phone usage during driving has become a threat to traffic safety. This study aimed to determine the effectiveness of an educational program based on the health belief model to reduce cell phone usage during driving in taxi drivers of Tuyserkan. Materials and Methods: In this quasi-experimental study, 110 taxi drivers younger than 35 years were randomly divided into two experimental and control groups in Tuyserkan, Iran. Data was collected using a questionnaire including the health belief model constructs, knowledge, behaviors of using cell phone and demographic variables. The questionnaires were self-reported. Intervention was three sessions applied in the experimental group. Both groups were followed for two months after the intervention. Finally, data analysis was performed using SPSS- 19 by Chi-square, Independent T-test, Paired T-test and McNemar. Results: The mean scores for the constructs of health belief model (perceived susceptibility, severity, barriers, perceived benefits, self-efficacy and cues to action, knowledge and desired behaviors about the use of cell phone during driving showed no significant differences between the two groups before the intervention. After the educational intervention, significant differences were observed in experimental group compared to control group. After educational intervention, cell phone usage reduced by 35.14% in the experimental group. Conclusion: An educational intervention based on the health belief model could reduce cell phone usage during driving in taxi drivers.

“Skill of Generalized Additive Model to Detect PM2.5 Health ...

Science.gov (United States)

Summary. Measures of health outcomes are collinear with meteorology and air quality, making analysis of connections between human health and air quality difficult. The purpose of this analysis was to determine time scales and periods shared by the variables of interest (and by implication scales and periods that are not shared). Hospital admissions, meteorology (temperature and relative humidity), and air quality (PM2.5 and daily maximum ozone) for New York City during the period 2000-2006 were decomposed into temporal scales ranging from 2 days to greater than two years using a complex wavelet transform. Health effects were modeled as functions of the wavelet components of meteorology and air quality using the generalized additive model (GAM) framework. This simulation study showed that GAM is extremely successful at extracting and estimating a health effect embedded in a dataset. It also shows that, if the objective in mind is to estimate the health signal but not to fully explain this signal, a simple GAM model with a single confounder (calendar time) whose smooth representation includes a sufficient number of constraints is as good as a more complex model.Introduction. In the context of wavelet regression, confounding occurs when two or more independent variables interact with the dependent variable at the same frequency. Confounding also acts on a variety of time scales, changing the PM2.5 coefficient (magnitude and sign) and its significance ac

Modeling the effects of influenza vaccination of health care workers in hospital departments

NARCIS (Netherlands)

van den Dool, C.; Bonten, M. J. M.; Hak, E.; Wallinga, J.

2009-01-01

Nowadays health care worker (HCW) vaccination is widely recommended. Although the benefits of this strategy have been demonstrated in long-term care settings, no studies have been performed in regular hospital departments. We adapt a previously developed model of influenza transmission in a

Health effects associtated with unit radonuclide releases to the environment

International Nuclear Information System (INIS)

Helton, J.C.

1983-01-01

Simple models are presented for the estimation of individual and population health effects (i.e., latent cancer fatalities) for long-term radionuclide releases to the surface environment. These models were suggested by techniques employed by the Environmental Protection Agency in the development of a proposed standard for the disposal of high-level radioactive waste. The modeling approach is based on the use of asymptotic solutions to mixed-cell models in conjunction with appropriate usage rates, dose factors, risk factors, and population estimates. Although the models are simple, it is felt that they can be used in preliminary investigations of topics in high-level waste disposal such as potential importance of individual radionuclides, relative importance of different release patterns or exposure pathways, and relationships between individual and population exposures. The use of the models is illustrated by calculating the population health effects along various exposure pathways for the radionuclides considered in the proposed Environmental Protection Agency Standard. The results of these calculations are compared with the calculated population exposures on which the proposed Environmental Protection Agency Standard is based

Eradicating Barriers to Mental Health Care Through Integrated Service Models: Contemporary Perspectives for Psychiatric-Mental Health Nurses.

Science.gov (United States)

Ellis, Horace; Alexander, Vinette

2016-06-01

There has been renewed, global interest in developing new and transformative models of facilitating access to high-quality, cost-effective, and individually-centered health care for severe mentally-ill (SMI) persons of diverse racial/ethnic, cultural and socioeconomic backgrounds. However, in our present-day health-service delivery systems, scholars have identified layers of barriers to widespread dispersal of well-needed mental health care both nationally and internationally. It is crucial that contemporary models directed at eradicating barriers to mental health services are interdisciplinary in context, design, scope, sequence, and best-practice standards. Contextually, nurses are well-positioned to influence the incorporation and integration of new concepts into operationally interdisciplinary, evidence-based care models with measurable outcomes. The aim of this concept paper is to use the available evidence to contextually explicate how the blended roles of psychiatric mental health (PMH) nursing can be influential in eradicating barriers to care and services for SMI persons through the integrated principles of collaboration, integration and service expansion across health, socioeconomic, and community systems. A large body of literature proposes that any best-practice standards aimed at eliminating barriers to the health care needs of SMI persons require systematic, well-coordinated interdisciplinary partnerships through evidence-based, high-quality, person-centered, and outcome-driven processes. Transforming the conceptual models of collaboration, integration and service expansion could be revolutionary in how care and services are coordinated and dispersed to populations across disadvantaged communities. Building on their longstanding commitment to individual and community care approaches, and their pivotal roles in research, education, leadership, practice, and legislative processes; PMH nurses are well-positioned to be both influential and instrumental in

[Structural Equation Modeling of Quality of Work Life in Clinical Nurses based on the Culture-Work-Health Model].

Science.gov (United States)

Kim, Miji; Ryu, Eunjung

2015-12-01

The purpose of this study was to construct and test a structural equation model of quality of work life for clinical nurses based on Peterson and Wilson's Culture-Work-Health model (CWHM). A structured questionnaire was completed by 523 clinical nurses to analyze the relationships between concepts of CWHM-organizational culture, social support, employee health, organizational health, and quality of work life. Among these conceptual variables of CWHM, employee health was measured by perceived health status, and organizational health was measured by presenteeism. SPSS21.0 and AMOS 21.0 programs were used to analyze the efficiency of the hypothesized model and calculate the direct and indirect effects of factors affecting quality of work life among clinical nurses. The goodness-of-fit statistics of the final modified hypothetical model are as follows: χ²=586.03, χ²/df=4.19, GFI=.89, AGFI=.85, CFI=.91, TLI=.90, NFI=.89, and RMSEA=.08. The results revealed that organizational culture, social support, organizational health, and employee health accounted for 69% of clinical nurses' quality of work life. The major findings of this study indicate that it is essential to create a positive organizational culture and provide adequate organizational support to maintain a balance between the health of clinical nurses and the organization. Further repeated and expanded studies are needed to explore the multidimensional aspects of clinical nurses' quality of work life in Korea, including various factors, such as work environment, work stress, and burnout.

The public health nutrition intervention management bi-cycle: a model for training and practice improvement.

Science.gov (United States)

Hughes, Roger; Margetts, Barrie

2012-11-01

The present paper describes a model for public health nutrition practice designed to facilitate practice improvement and provide a step-wise approach to assist with workforce development. The bi-cycle model for public health nutrition practice has been developed based on existing cyclical models for intervention management but modified to integrate discrete capacity-building practices. Education and practice settings. This model will have applications for educators and practitioners. Modifications to existing models have been informed by the authors' observations and experiences as practitioners and educators, and reflect a conceptual framework with applications in workforce development and practice improvement. From a workforce development and educational perspective, the model is designed to reflect adult learning principles, exposing students to experiential, problem-solving and practical learning experiences that reflect the realities of work as a public health nutritionist. In doing so, it assists the development of competency beyond knowing to knowing how, showing how and doing. This progression of learning from knowledge to performance is critical to effective competency development for effective practice. Public health nutrition practice is dynamic and varied, and models need to be adaptable and applicable to practice context to have utility. The paper serves to stimulate debate in the public health nutrition community, to encourage critical feedback about the validity, applicability and utility of this model in different practice contexts.

Assessing the effects of noise abatement measures on health risks: A case study in Istanbul

International Nuclear Information System (INIS)

Ongel, Aybike; Sezgin, Fatih

2016-01-01

In recent decades, noise pollution caused by industrialization and increased motorization has become a major concern around the world because of its adverse effects on human well-being. Therefore, transportation agencies have been implementing noise abatement measures in order to reduce road traffic noise. However, limited attention is given to noise in environmental assessment of road transportation systems. This paper presents a framework for a health impact assessment model for road transportation noise emissions. The model allows noise impacts to be addressed with the health effects of air pollutant and greenhouse gas emissions from road transportation. The health damages assessed in the model include annoyance, sleep disturbance, and cardiovascular disease in terms of acute myocardial infarction. The model was applied in a case study in Istanbul in order to evaluate the change in health risks from the implementation of noise abatement strategies. The noise abatement strategies evaluated include altering pavement surfaces in order to absorb noise and introducing speed limits. It was shown that significant improvements in health risks can be achieved using open graded pavement surfaces and introducing speed limits on highways. - Highlights: • Transportation noise has a significant effect on health. • Noise should be included in the environmental assessment of transportation systems. • Traffic noise abatement measures include noise reducing pavements and speed limits. • Noise abatement measures help reduce the health risks of transportation noise. • Speed limit reduction on uncongested roads is an effective way to reduce health risks.

Assessing the effects of noise abatement measures on health risks: A case study in Istanbul

Energy Technology Data Exchange (ETDEWEB)

Ongel, Aybike, E-mail: aybike.ongel@eng.bahcesehir.edu.tr [Bahcesehir University, Department of Civil Engineering, Istanbul 34353 (Turkey); Sezgin, Fatih, E-mail: fatih.sezgin@ibb.gov.tr [Istanbul Metropolitan Municipality, Environmental Protection Agency, Istanbul 34169 (Turkey)

2016-01-15

In recent decades, noise pollution caused by industrialization and increased motorization has become a major concern around the world because of its adverse effects on human well-being. Therefore, transportation agencies have been implementing noise abatement measures in order to reduce road traffic noise. However, limited attention is given to noise in environmental assessment of road transportation systems. This paper presents a framework for a health impact assessment model for road transportation noise emissions. The model allows noise impacts to be addressed with the health effects of air pollutant and greenhouse gas emissions from road transportation. The health damages assessed in the model include annoyance, sleep disturbance, and cardiovascular disease in terms of acute myocardial infarction. The model was applied in a case study in Istanbul in order to evaluate the change in health risks from the implementation of noise abatement strategies. The noise abatement strategies evaluated include altering pavement surfaces in order to absorb noise and introducing speed limits. It was shown that significant improvements in health risks can be achieved using open graded pavement surfaces and introducing speed limits on highways. - Highlights: • Transportation noise has a significant effect on health. • Noise should be included in the environmental assessment of transportation systems. • Traffic noise abatement measures include noise reducing pavements and speed limits. • Noise abatement measures help reduce the health risks of transportation noise. • Speed limit reduction on uncongested roads is an effective way to reduce health risks.

A Health Production Model with Endogenous Retirement

Science.gov (United States)

Galama, Titus; Kapteyn, Arie; Fonseca, Raquel; Michaud, Pierre-Carl

2012-01-01

We formulate a stylized structural model of health, wealth accumulation and retirement decisions building on the human capital framework of health and derive analytic solutions for the time paths of consumption, health, health investment, savings and retirement. We argue that the literature has been unnecessarily restrictive in assuming that health is always at the “optimal” health level. Exploring the properties of corner solutions we find that advances in population health decrease the retirement age, while at the same time individuals retire when their health has deteriorated. This potentially explains why retirees point to deteriorating health as an important reason for early retirement, while retirement ages have continued to fall in the developed world, despite continued improvements in population health and mortality. In our model, workers with higher human capital invest more in health and because they stay healthier retire later than those with lower human capital whose health deteriorates faster. PMID:22888062

The Preventable Risk Integrated ModEl and Its Use to Estimate the Health Impact of Public Health Policy Scenarios

Directory of Open Access Journals (Sweden)

Peter Scarborough

2014-01-01

Full Text Available Noncommunicable disease (NCD scenario models are an essential part of the public health toolkit, allowing for an estimate of the health impact of population-level interventions that are not amenable to assessment by standard epidemiological study designs (e.g., health-related food taxes and physical infrastructure projects and extrapolating results from small samples to the whole population. The PRIME (Preventable Risk Integrated ModEl is an openly available NCD scenario model that estimates the effect of population-level changes in diet, physical activity, and alcohol and tobacco consumption on NCD mortality. The structure and methods employed in the PRIME are described here in detail, including the development of open source code that will support a PRIME web application to be launched in 2015. This paper reviews scenario results from eleven papers that have used the PRIME, including estimates of the impact of achieving government recommendations for healthy diets, health-related food taxes and subsidies, and low-carbon diets. Future challenges for NCD scenario modelling, including the need for more comparisons between models and the improvement of future prediction of NCD rates, are also discussed.

Prediction Model for Demands of the Health Meteorological Information Using a Decision Tree Method

Directory of Open Access Journals (Sweden)

Jina Oh, RN, PhD

2010-09-01

Conclusions: It can be effectively used as a reference model for future studies and is a suggested direction in health meteorological information service and policy development. We suggest health forecasting as a nursing service and a primary health care network for healthier and more comfortable life.

Modeling of Food and Nutrition Surveillance in Primary Health Care

Directory of Open Access Journals (Sweden)

Santuzza Arreguy Silva VITORINO

Full Text Available ABSTRACT Objective: To describe the modeling stages of food and nutrition surveillance in the Primary Health Care of the Unified Health Care System, considering its activities, objectives, and goals Methods: Document analysis and semi-structured interviews were used for identifying the components, describe the intervention, and identify potential assessment users. Results: The results include identification of the objectives and goals of the intervention, the required inputs, activities, and expected effects. The intervention was then modeled based on these data. The use of the theoretical logic model optimizes times, resources, definition of the indicators that require monitoring, and the aspects that require assessment, identifying more clearly the contribution of the intervention to the results Conclusion: Modeling enabled the description of food and nutrition surveillance based on its components and may guide the development of viable plans to monitor food and nutrition surveillance actions so that modeling can be established as a local intersectoral planning instrument.

Effects of education based on the health belief model on screening behavior in high risk women for breast cancer, Tehran, Iran.

Science.gov (United States)

Hajian, Sepideh; Vakilian, Katayon; Najabadi, Khadijeh Mirzaii; Hosseini, Jalil; Mirzaei, Hamid Reza

2011-01-01

Breast cancer is the most common malignancy in women. Early diagnosis allows efficient treatment and increases survival, but the efficacy of breast self examination (BSE) is not sufficiently well established. The American Cancer Society aims to give women the opportunity to recognize the utility, limitations and adverse effects of breast cancer screening through education models based on psychological theories. With the Health Belief Model, people's health perceptions and attitudes influence their practices, for example with screening. The purpose of this randomized controlled clinical trial was to determine the effect of education based on this model on breast cancer screening in high risk Iranian women. Participants were women with a family history of breast cancer (mother, sister, and daughter). After explanation of the study objectives to participants, they were recruited on obtaining oral consent and each filled out the study questionnaire based on the Health Belief Model. Allocation was into two groups by computerized randomization, control and intervention, receiving education on breast cancer screening. Perceived susceptibility to and seriousness of breast cancer, perceived usefulness of and barriers to BSE, clinical breast examination, and mammography, and self-efficacy in the ability to perform these, were assessed, with comparison of scores for BSE practice before and after education and doing mammography and clinical examination by a physician in intervention and control group. The mean age was 37.8 ± 11.7 (range 19-60). The mean rank in the intervention group significantly differed before and after the education, but except for " perceived threat" and "perceived usefulness of breast self examination", we did not find any significant differences from the control group. After educational sessions, breast self examination and clinical examination practice rates were elevated. Health education based on well known psychological theories for breast cancer

High-resolution modelling of health impacts from air pollution using the integrated model system EVA

Science.gov (United States)

Brandt, Jørgen; Andersen, Mikael S.; Bønløkke, Jakob; Christensen, Jesper H.; Geels, Camilla; Hansen, Kaj M.; Jensen, Steen S.; Ketzel, Matthias; Plejdrup, Marlene S.; Sigsgaard, Torben; Silver, Jeremy D.

2014-05-01

we have used a coupling of two chemistry transport models to calculate the air pollution concentration at different scales; the Danish Eulerian Hemispheric Model to calculate the air pollution levels with a resolution down to 5.6 km x 5.6 km and the Urban Background Model to further calculate the air pollution at 1 km x 1 km resolution using results from DEHM as boundary conditions. Both the emission data as well as the population density has been represented in the model system with the same high resolution. Previous health impact assessments related to air pollution have been made on a lower resolution. In this study, the integrated model system, EVA, has been used to estimate the health impacts and related external cost for Denmark over a 20 year period (1990-2010) at a 1 km x 1 km resolution. Furthermore, a sensitivity study of the health impact using coarse and fine resolutions in the model system has been carried out to evaluate the effect of improved description of the geographical population distribution with respect to location of local emissions. Brandt, J., J. D. Silver, J. H. Christensen, M. S. Andersen, J. Bønløkke, T. Sigsgaard, C. Geels, A. Gross, A. B. Hansen, K. M. Hansen, G. B. Hedegaard, E. Kaas and L. M. Frohn, 2013. Contribution from the ten major emission sectors in Europe to the Health-Cost Externalities of Air Pollution using the EVA Model System - an integrated modelling approach. Atmospheric Chemistry and Physics, Vol. 13, pp. 7725-7746, 2013. Brandt, J., J. D. Silver, J. H. Christensen, M. S. Andersen, J. Bønløkke, T. Sigsgaard, C. Geels, A. Gross, A. B. Hansen, K. M. Hansen, G. B. Hedegaard, E. Kaas and L. M. Frohn, 2013. Assessment of Past, Present and Future Health-Cost Externalities of Air Pollution in Europe and the contribution from international ship traffic using the EVA Model System. Atmospheric Chemistry and Physics. Vol. 13, pp. 7747-7764, 2013.

A model for managing cold-related health and safety risks at workplaces.

Science.gov (United States)

Risikko, Tanja; Mäkinen, Tiina M; Påsche, Arvid; Toivonen, Liisa; Hassi, Juhani

2003-05-01

Cold conditions increase health and safety risks at work in several ways. The effects of cold have not been sufficiently taken into consideration in occupational safety and health practices. A systematic model and methods were developed for managing cold-related health and safety risks at workplaces. The development work was performed, in a context-bound manner, in pilot industries and workplaces. The model can be integrated into the company's occupational health and safety management system, such as OHSAS 18001. The cold risks are identified and assessed by using a checklist. The preventive measures are systematically planned in a written form specifically produced for cold workplaces. It includes the organisational and technical preventive measures, protective clothing and personal protective equipment, as well as training and information of the personnel. According to the model, all the workers, foremen, occupational safety personnel and occupational health care personnel are trained to recognise the cold risks and to conduct preventive actions. The developed model was evaluated in the context of cold outdoor (construction) and indoor work (fish processing), and by occupational health and safety professionals. According to the feedback, the model and methods were easy to use after a one-day introduction session. The continuum between the cold risk assessment and management worked well, although there was some overlap in the documentation. The cold risk management model and its methods form an essential part of ISO CD 15743 Strategy for risk assessment, management and work practice in cold environments.

Effects of exercise dependence on psychological health of Chinese college students.

Science.gov (United States)

Li, Menglong; Nie, Jingsong; Ren, Yujia

2015-12-01

The aim of this study was to investigate the effects of exercise dependence on the psychological health of Chinese college students. A total of 1601 college students from three universities in Hunan, China, were selected as research subjects. Several measurement scales, including the Exercise Addiction Inventory, the State-Trait Anxiety Inventory, the Center for Epidemiologic Studies Depression Scale, and the Subjective Well-being Scale, were used to survey the psychological health problem of these students and to analyze the effects of exercise dependence on their psychological health. Exercise dependence, based on the structural equation model analysis, can positively influence state anxiety (Pexercise dependence negatively influences students' self-satisfaction (PExercise dependence adversely affects the psychological health of college students. Further research using multi-dimensional exercise addiction scales should be conducted to identify all the negative effects of exercise addiction factors on psychological health.

Evaluating the Effect of Software Quality Characteristics on Health Care Quality Indicators

Directory of Open Access Journals (Sweden)

Sakineh Aghazadeh

2015-07-01

Full Text Available Introduction: Various types of software are used in health care organizations to manage information and care processes. The quality of software has been an important concern for both health authorities and designers of Health Information Technology. Thus, assessing the effect of software quality on the performance quality of healthcare institutions is essential. Method: The most important health care quality indicators in relation to software quality characteristics are provided via an already performed literature review. ISO 9126 standard model is used for definition and integration of various characteristics of software quality. The effects of software quality characteristics and sub-characteristics on the healthcare indicators are evaluated through expert opinion analyses. A questionnaire comprising of 126 questions of 10-point Likert scale was used to gather opinions of experts in the field of Medical/Health Informatics. The data was analyzed using Structural Equation Modeling. Results: Our findings showed that software Maintainability was rated as the most effective factor on user satisfaction (R2 =0.89 and Functionality as the most important and independent variable affecting patient care quality (R2 =0.98. Efficiency was considered as the most effective factor on workflow (R2 =0.97, and Maintainability as the most important factor that affects healthcare communication (R2 =0.95. Usability and Efficiency were rated as the most effectual factor affecting patient satisfaction (R2 =0.80, 0.81. Reliability, Maintainability, and Efficiency were considered as the main factors affecting care costs (R2 =0.87, 0.74, 0.87. Conclusion: We presented a new model based on ISO standards. The model demonstrates and weighs the relations between software quality characteristics and healthcare quality indicators. The clear relationships between variables and the type of the metrics and measurement methods used in the model make it a reliable method to assess

Indoor Air Nuclear, Biological, and Chemical Health Modeling and Assessment System

Energy Technology Data Exchange (ETDEWEB)

Stenner, Robert D.; Hadley, Donald L.; Armstrong, Peter R.; Buck, John W.; Hoopes, Bonnie L.; Janus, Michael C.

2001-03-01

Indoor air quality effects on human health are of increasing concern to public health agencies and building owners. The prevention and treatment of 'sick building' syndrome and the spread of air-borne diseases in hospitals, for example, are well known priorities. However, increasing attention is being directed to the vulnerability of our public buildings/places, public security and national defense facilities to terrorist attack or the accidental release of air-borne biological pathogens, harmful chemicals, or radioactive contaminants. The Indoor Air Nuclear, Biological, and Chemical Health Modeling and Assessment System (IA-NBC-HMAS) was developed to serve as a health impact analysis tool for use in addressing these concerns. The overall goal was to develop a user-friendly fully functional prototype Health Modeling and Assessment system, which will operate under the PNNL FRAMES system for ease of use and to maximize its integration with other modeling and assessment capabilities accessible within the FRAMES system (e.g., ambient air fate and transport models, water borne fate and transport models, Physiologically Based Pharmacokinetic models, etc.). The prototype IA-NBC-HMAS is designed to serve as a functional Health Modeling and Assessment system that can be easily tailored to meet specific building analysis needs of a customer. The prototype system was developed and tested using an actual building (i.e., the Churchville Building located at the Aberdeen Proving Ground) and release scenario (i.e., the release and measurement of tracer materials within the building) to ensure realism and practicality in the design and development of the prototype system. A user-friendly "demo" accompanies this report to allow the reader the opportunity for a "hands on" review of the prototype system's capability.

Attributability of health effects at low radiation doses

International Nuclear Information System (INIS)

Gonzalez, Abel

2008-01-01

Full text: A controversy still persists on whether health effects can be alleged from radiation exposure situations involving low radiation doses (e.g. below the international dose limits for the public). Arguments have evolved around the validity of the dose-response representation that is internationally used for radiation protection purposes, namely the so-called linear-non-threshold (LNT) model. The debate has been masked by the intrinsic randomness of radiation interaction at the cellular level and also by gaps in the relevant scientific knowledge on the development and expression of health effects. There has also been a vague use, abuse, and misuse of radiation-related risk concepts and quantities and their associated uncertainties. As a result, there is some ambiguity in the interpretation of the phenomena and a general lack of awareness of the implications for a number of risk-causation qualities, namely its attributes and characteristics. In particular, the LNT model has been used not only for protection purposes but also for blindly attributing actual effects to specific exposure situations. The latter has been discouraged as being a misuse of the model, but the supposed incorrectness has not been clearly proven. The paper will endeavour to demonstrate unambiguously the following thesis in relation to health effects due to low radiation doses: 1) Their existence is highly plausible. A number of epidemiological statistical assessments of sufficiently large exposed populations show that, under certain conditions, the prevalence of the effects increases with dose. From these assessments, it can be hypothesized that the occurrence of the effects at any dose, however small, appears decidedly worthy of belief. While strictly the evidence does not allow to conclude that a threshold dose level does not exist either. In fact, a formal quantitative uncertainty analysis, combining the different uncertain components of estimated radiation-related risk, with and

Attributability of Health Effects at Low Radiation Doses

International Nuclear Information System (INIS)

Gonzalez, A.J.

2011-01-01

Full text: A controversy still persists on whether health effects can be alleged from radiation exposure situations involving low radiation doses (e.g. below the international dose limits for the public). Arguments have evolved around the validity of the dose response representation that is internationally used for radiation protection purposes, namely the so-called linear-non-threshold (LNT) model. The debate has been masked by the intrinsic randomness of radiation interaction at the cellular level and also by gaps in the relevant scientific knowledge on the development and expression of health effects. There has also been a vague use, abuse, and misuse of radiation-related risk concepts and quantities and their associated uncertainties. As a result, there is some ambiguity in the interpretation of the phenomena and a general lack of awareness of the implications for a number of risk-causation qualities, namely its attributes and characteristics. In particular, the LNT model has been used not only for protection purposes but also for blindly attributing actual effects to specific exposure situations. The latter has been discouraged as being a misuse of the model, but the supposed incorrectness has not been clearly proven. The paper will endeavour to demonstrate unambiguously the following thesis in relation to health effects due to low radiation doses: (i) Their existence is highly plausible. A number of epidemiological statistical assessments of sufficiently large exposed populations show that, under certain conditions, the prevalence of the effects increases with dose. From these assessments, it can be hypothesized that the occurrence of the effects at any dose, however small, appears decidedly worthy of belief. While strictly the evidence does not allow to conclude that a threshold dose level does not exist either In fact, a formal quantitative uncertainty analysis, combining the different uncertain components of estimated radiation-related risk, with and

Ensemble prediction of air quality using the WRF/CMAQ model system for health effect studies in China

Science.gov (United States)

Hu, Jianlin; Li, Xun; Huang, Lin; Ying, Qi; Zhang, Qiang; Zhao, Bin; Wang, Shuxiao; Zhang, Hongliang

2017-11-01

Accurate exposure estimates are required for health effect analyses of severe air pollution in China. Chemical transport models (CTMs) are widely used to provide spatial distribution, chemical composition, particle size fractions, and source origins of air pollutants. The accuracy of air quality predictions in China is greatly affected by the uncertainties of emission inventories. The Community Multiscale Air Quality (CMAQ) model with meteorological inputs from the Weather Research and Forecasting (WRF) model were used in this study to simulate air pollutants in China in 2013. Four simulations were conducted with four different anthropogenic emission inventories, including the Multi-resolution Emission Inventory for China (MEIC), the Emission Inventory for China by School of Environment at Tsinghua University (SOE), the Emissions Database for Global Atmospheric Research (EDGAR), and the Regional Emission inventory in Asia version 2 (REAS2). Model performance of each simulation was evaluated against available observation data from 422 sites in 60 cities across China. Model predictions of O3 and PM2.5 generally meet the model performance criteria, but performance differences exist in different regions, for different pollutants, and among inventories. Ensemble predictions were calculated by linearly combining the results from different inventories to minimize the sum of the squared errors between the ensemble results and the observations in all cities. The ensemble concentrations show improved agreement with observations in most cities. The mean fractional bias (MFB) and mean fractional errors (MFEs) of the ensemble annual PM2.5 in the 60 cities are -0.11 and 0.24, respectively, which are better than the MFB (-0.25 to -0.16) and MFE (0.26-0.31) of individual simulations. The ensemble annual daily maximum 1 h O3 (O3-1h) concentrations are also improved, with mean normalized bias (MNB) of 0.03 and mean normalized errors (MNE) of 0.14, compared to MNB of 0.06-0.19 and

The Effectiveness of Health Care Information Technologies: Evaluation of Trust, Security Beliefs, and Privacy as Determinants of Health Care Outcomes

Science.gov (United States)

2018-01-01

Background The diffusion of health information technologies (HITs) within the health care sector continues to grow. However, there is no theory explaining how success of HITs influences patient care outcomes. With the increase in data breaches, HITs’ success now hinges on the effectiveness of data protection solutions. Still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance. Objective The objective of this study was to study the effectiveness of HITs using the DeLone and McLean Information Systems Success Model (DMISSM). We examined the role of information assurance constructs (ie, the role of information security beliefs, privacy concerns, and trust in health information) as measures of HIT effectiveness. We also investigated the relationships between information assurance and three aspects of system success: attitude toward health information exchange (HIE), patient access to health records, and perceived patient care quality. Methods Using structural equation modeling, we analyzed the data from a sample of 3677 cancer patients from a public dataset. We used R software (R Project for Statistical Computing) and the Lavaan package to test the hypothesized relationships. Results Our extension of the DMISSM to health care was supported. We found that increased privacy concerns reduce the frequency of patient access to health records use, positive attitudes toward HIE, and perceptions of patient care quality. Also, belief in the effectiveness of information security increases the frequency of patient access to health records and positive attitude toward HIE. Trust in health information had a positive association with attitudes toward HIE and perceived patient care quality. Trust in health information had no direct effect on patient access to health records; however, it had an indirect relationship through privacy concerns. Conclusions Trust in health information and belief in the effectiveness of

The Effectiveness of Health Care Information Technologies: Evaluation of Trust, Security Beliefs, and Privacy as Determinants of Health Care Outcomes.

Science.gov (United States)

Kisekka, Victoria; Giboney, Justin Scott

2018-04-11

The diffusion of health information technologies (HITs) within the health care sector continues to grow. However, there is no theory explaining how success of HITs influences patient care outcomes. With the increase in data breaches, HITs' success now hinges on the effectiveness of data protection solutions. Still, empirical research has only addressed privacy concerns, with little regard for other factors of information assurance. The objective of this study was to study the effectiveness of HITs using the DeLone and McLean Information Systems Success Model (DMISSM). We examined the role of information assurance constructs (ie, the role of information security beliefs, privacy concerns, and trust in health information) as measures of HIT effectiveness. We also investigated the relationships between information assurance and three aspects of system success: attitude toward health information exchange (HIE), patient access to health records, and perceived patient care quality. Using structural equation modeling, we analyzed the data from a sample of 3677 cancer patients from a public dataset. We used R software (R Project for Statistical Computing) and the Lavaan package to test the hypothesized relationships. Our extension of the DMISSM to health care was supported. We found that increased privacy concerns reduce the frequency of patient access to health records use, positive attitudes toward HIE, and perceptions of patient care quality. Also, belief in the effectiveness of information security increases the frequency of patient access to health records and positive attitude toward HIE. Trust in health information had a positive association with attitudes toward HIE and perceived patient care quality. Trust in health information had no direct effect on patient access to health records; however, it had an indirect relationship through privacy concerns. Trust in health information and belief in the effectiveness of information security safeguards increases

Projection models for health effects assessment in populations exposed to radioactive and nonradioactive pollutants. Volume IV. SPAHR user's guide

International Nuclear Information System (INIS)

Collins, J.J.; Lundy, R.T.

1982-09-01

The Simulation Package for the Analysis of Health Risk (SPAHR) is a computer software package based upon a demographic model for health risk projections. The model extends several health risk projection models by making realistic assumptions about the population at risk, and thus represents a distinct improvement over previous models. Complete documentation for use of SPAHR is contained in this five-volume publication. The demographic model in SPAHR estimates population response to environmental toxic exposures. Latency of response, changing dose level over time, competing risks from other causes of death, and population structure can be incorporated into SPAHR to project health risks. Risks are measured by morbid years, number of deaths, and loss of life expectancy. Comparisons of estimates of excess deaths demonstrate that previous health risk projection models may have underestimated excess deaths by a factor of from 2 to 10, depending on the pollutant and the exposure scenario. The software supporting the use of the demographic model is designed to be user oriented. Complex risk projections are made by responding to a series of prompts generated by the package. The flexibility and ease of use of SPAHR make it an important contribution to existing models and software packages. This volume gives the more advanced user of the SPAHR computer package the information required to create tailor-made programs for addressing specific issues not covered by the three interactive packages. It assumes that the user is familiar with the concepts and terms relating to demography and health risk assessment

Statistical challenges in modelling the health consequences of social mobility: the need for diagonal reference models.

Science.gov (United States)

van der Waal, Jeroen; Daenekindt, Stijn; de Koster, Willem

2017-12-01

Various studies on the health consequences of socio-economic position address social mobility. They aim to uncover whether health outcomes are affected by: (1) social mobility, besides, (2) social origin, and (3) social destination. Conventional methods do not, however, estimate these three effects separately, which may produce invalid conclusions. We highlight that diagonal reference models (DRMs) overcome this problem, which we illustrate by focusing on overweight/obesity (OWOB). Using conventional methods (logistic-regression analyses with dummy variables) and DRMs, we examine the effects of intergenerational educational mobility on OWOB (BMI ≥ 25 kg/m 2 ) using survey data representative of the Dutch population aged 18-45 (1569 males, 1771 females). Conventional methods suggest that mobility effects on OWOB are present. Analyses with DRMs, however, indicate that no such effects exist. Conventional analyses of the health consequences of social mobility may produce invalid results. We, therefore, recommend the use of DRMs. DRMs also validly estimate the health consequences of other types of social mobility (e.g. intra- and intergenerational occupational and income mobility) and status inconsistency (e.g. in educational or occupational attainment between partners).

An investigation on the effect of Health Belief Model-based education on refusal skills in high risk situations among female students.

Science.gov (United States)

Boroumandfar, Khadijeh; Shabani, Fatemeh; Ghaffari, Mohtasham

2012-03-01

Various studies show an association between lack of social skills in adolescents and the future incidence of behavioral disorders. If girls, as future mothers, lack adequate health, awareness, self confidence and social skills, they may act as a source of many social problems. Therefore, the present study has tried to educate this group on one of the most essential social skills, refusal skill in high risk situation. This is a field quasi experimental study conducted on 145 female students in middle schools in Arak, Iran in 2010-2011. The schools were randomly selected. The subjects were selected through systematic random sampling from the schools' log book. The data were collected by questionnaires containing personal and familial characteristics, three health belief model structures, and behavioral intention in high risk situations. The data were analyzed by descriptive statistical tests (frequency distribution, mean, SD) and inferential tests of repetitive variance analysis and T-test through SPSS. In the present study, repetitive variance analysis showed that education by use of a health belief model had a positive effect on refusal skills in high risk situations as well as perceived barriers (p = 0.007), self-efficacy (p = 0.015), behavioral intention (p = 0.048) after educational intervention in the study group, but not on perceived benefits (p = 0.180). The results showed that education significantly increased refusal skills in high risk situations in the study group through the health belief model. With regard to the results, it is essential to equip the students with preventive behaviors to guarantee their physical, emotional and social health.

Developing explanatory models of health inequalities in childhood dental caries

DEFF Research Database (Denmark)

Pine, Cynthia M; Adair, Pauline M; Petersen, Poul Erik

2004-01-01

OBJECTIVE: Long-term aim is to determine optimum interventions to reduce dental caries in children in disadvantaged communities and minimise the effects of exclusion from health care systems, of ethnic diversity, and health inequalities. DESIGN: Generation of initial explanatory models, study...... in developing and delivering this multi-centre study. Experience gained will support the development of substantive trials and longitudinal studies to address the considerable international health disparity of childhood dental caries....... protocol and development of two standardised measures. First, to investigate how parental attitudes may impact on their children's oral health-related behaviours and second, to assess how dentists' attitudes may impact on the provision of dental care. SUBJECTS: Core research team, lead methodologists, 44...

Common and Critical Components Among Community Health Assessment and Community Health Improvement Planning Models.

Science.gov (United States)

Pennel, Cara L; Burdine, James N; Prochaska, John D; McLeroy, Kenneth R

Community health assessment and community health improvement planning are continuous, systematic processes for assessing and addressing health needs in a community. Since there are different models to guide assessment and planning, as well as a variety of organizations and agencies that carry out these activities, there may be confusion in choosing among approaches. By examining the various components of the different assessment and planning models, we are able to identify areas for coordination, ways to maximize collaboration, and strategies to further improve community health. We identified 11 common assessment and planning components across 18 models and requirements, with a particular focus on health department, health system, and hospital models and requirements. These common components included preplanning; developing partnerships; developing vision and scope; collecting, analyzing, and interpreting data; identifying community assets; identifying priorities; developing and implementing an intervention plan; developing and implementing an evaluation plan; communicating and receiving feedback on the assessment findings and/or the plan; planning for sustainability; and celebrating success. Within several of these components, we discuss characteristics that are critical to improving community health. Practice implications include better understanding of different models and requirements by health departments, hospitals, and others involved in assessment and planning to improve cross-sector collaboration, collective impact, and community health. In addition, federal and state policy and accreditation requirements may be revised or implemented to better facilitate assessment and planning collaboration between health departments, hospitals, and others for the purpose of improving community health.

Estimation of health effects (morbidity and mortality attributed to PM10 and PM2.5 exposure using an Air Quality model in Bukan city, from 2015-2016 exposure using air quality model

Directory of Open Access Journals (Sweden)

Bahram Kamarehie

2017-08-01

Full Text Available Background: Air Quality software is a useful tool for assessing the health risks associated with air pollutants. Quantifying the effects of exposure to air pollutants in terms of public health has become a critical component of policy discussion. The present study purposed to quantify the health effects of particulate matters on mortality and morbidity in a Bukan city hospital from 2015-2016. Methods: Information regarding coordinates, exposed population, number of stations used in profiling, mean and maximum concentrations (annual, winter, and summer, annual 98th percentile, baseline incidence (BI per 100 000 per year, and relative risk was needed for use with the software. Results: The average particulate matter concentration was higher in summer than in winter. The concentrations of PM10 in summer and winter were 84.37 and 74.86 μg m-3, respectively. The Air Quality model predicted that total mortality rates related to PM10 and PM2.5 were 33.3 and 49.8 deaths, respectively. As a result, 3.79% of the total mortality was due to PM10. In Bukan city, 2.004% of total deaths were due to cardiovascular mortality. The Air Quality model predicted that the deaths of 92.2 people were related to hospital admissions for respiratory disease. Conclusion: The continual evaluation of air quality data is necessary for investigating the effect of pollutants on human health.

The link between health governance models and global health innovation: an exploration of OECD nations.

Science.gov (United States)

Schnarr, Karin; Snowdon, Anne; Cramm, Heidi; Cohen, Jason; Alessi, Charles

2015-01-01

While there is established research that explores individual innovations across countries or developments in a specific health area, there is less work that attempts to match national innovations to specific systems of health governance to uncover themes across nations. We used a cross-comparison design that employed content analysis of health governance models and innovation patterns in eight OECD nations (Australia, Britain, Canada, France, Germany, The Netherlands, Switzerland, and the United States). Country-level model of health governance may impact the focus of health innovation within the eight jurisdictions studied. Innovation across all governance models has targeted consumer engagement in health systems, the integration of health services across the continuum of care, access to care in the community, and financial models that drive competition. Improving our understanding of the linkage between health governance and innovation in health systems may heighten awareness of potential enablers and barriers to innovation success.

Complexity of Choice: Teachers' and Students' Experiences Implementing a Choice-Based Comprehensive School Health Model

Science.gov (United States)

Sulz, Lauren; Gibbons, Sandra; Naylor, Patti-Jean; Wharf Higgins, Joan

2016-01-01

Background: Comprehensive School Health models offer a promising strategy to elicit changes in student health behaviours. To maximise the effect of such models, the active involvement of teachers and students in the change process is recommended. Objective: The goal of this project was to gain insight into the experiences and motivations of…

Dosimetry and health effects self-teaching curriculum: illustrative problems to supplement the user's manual for the Dosimetry and Health Effects Computer Code

International Nuclear Information System (INIS)

Runkle, G.E.; Finley, N.C.

1983-03-01

This document contains a series of sample problems for the Dosimetry and Health Effects Computer Code to be used in conjunction with the user's manual (Runkle and Cranwell, 1982) for the code. This code was developed at Sandia National Laboratories for the Risk Methodology for Geologic Disposal of Radioactive Waste program (NRC FIN A-1192). The purpose of this document is to familiarize the user with the code, its capabilities, and its limitations. When the user has finished reading this document, he or she should be able to prepare data input for the Dosimetry and Health Effects code and have some insights into interpretation of the model output

Quantal health effects for a combination of several toxic agents

Energy Technology Data Exchange (ETDEWEB)

Seiler, F A

1988-12-01

Quantal health effects caused by the combined action of a number of toxic agents are modeled using the information available for each toxicant acting in isolation. Two basic models are used; one assumes no interaction, the other postulates a separable kind of interaction in which each agent contributes an enhancement factor independent of all other agents. These two models provide yardsticks by which to measure synergisms and antagonisms in the interaction between the effects of toxic agents. Equations are given in approximations for small and large values of the risk. (author)

Quantal health effects for a combination of several toxic agents

International Nuclear Information System (INIS)

Seiler, F.A.

1988-01-01

Quantal health effects caused by the combined action of a number of toxic agents are modeled using the information available for each toxicant acting in isolation. Two basic models are used; one assumes no interaction, the other postulates a separable kind of interaction in which each agent contributes an enhancement factor independent of all other agents. These two models provide yardsticks by which to measure synergisms and antagonisms in the interaction between the effects of toxic agents. Equations are given in approximations for small and large values of the risk. (author)

Towards a Unified Theory of Health-Disease: I. Health as a complex model-object

Directory of Open Access Journals (Sweden)

Naomar Almeida-Filho

2013-06-01

Full Text Available Theory building is one of the most crucial challenges faced by basic, clinical and population research, which form the scientific foundations of health practices in contemporary societies. The objective of the study is to propose a Unified Theory of Health-Disease as a conceptual tool for modeling health-disease-care in the light of complexity approaches. With this aim, the epistemological basis of theoretical work in the health field and concepts related to complexity theory as concerned to health problems are discussed. Secondly, the concepts of model-object, multi-planes of occurrence, modes of health and disease-illness-sickness complex are introduced and integrated into a unified theoretical framework. Finally, in the light of recent epistemological developments, the concept of Health-Disease-Care Integrals is updated as a complex reference object fit for modeling health-related processes and phenomena.

The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths.

Science.gov (United States)

Lister, Cameron; Payne, Hannah; Hanson, Carl L; Barnes, Michael D; Davis, Siena F; Manwaring, Todd

2017-01-01

Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM) as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

The Public Health Innovation Model: Merging Private Sector Processes with Public Health Strengths

Directory of Open Access Journals (Sweden)

Cameron Lister

2017-08-01

Full Text Available Public health enjoyed a number of successes over the twentieth century. However, public health agencies have arguably been ill equipped to sustain these successes and address the complex threats we face today, including morbidity and mortality associated with persistent chronic diseases and emerging infectious diseases, in the context of flat funding and new and changing health care legislation. Transformational leaders, who are not afraid of taking risks to develop innovative approaches to combat present-day threats, are needed within public health agencies. We propose the Public Health Innovation Model (PHIM as a tool for public health leaders who wish to integrate innovation into public health practice. This model merges traditional public health program planning models with innovation principles adapted from the private sector, including design thinking, seeking funding from private sector entities, and more strongly emphasizing program outcomes. We also discuss principles that leaders should consider adopting when transitioning to the PHIM, including cross-collaboration, community buy-in, human-centered assessment, autonomy and creativity, rapid experimentation and prototyping, and accountability to outcomes.

Factors affecting patients' online health information-seeking behaviours: The role of the Patient Health Engagement (PHE) Model.

Science.gov (United States)

Graffigna, Guendalina; Barello, Serena; Bonanomi, Andrea; Riva, Giuseppe

2017-10-01

To identify the variables affecting patients' online health information-seeking behaviours by examining the relationships between patient participation in their healthcare and online health information-seeking behaviours. A cross-sectional survey of Italian chronic patients (N=352) was conducted on patient's online health information-seeking behaviours and patient participation-related variables. Structural equation modeling analysis was conducted to test the hypothesis. This study showed how the healthcare professionals' ability to support chronic patients' autonomy affect patients' participation in their healthcare and patient's online health information-seeking behaviours. However, results do not confirm that the frequency of patients' online health-information seeking behavior has an impact on their adherence to medical prescriptions. Assuming a psychosocial perspective, we have discussed how patients' engagement - conceived as the level of their emotional elaboration of the health condition - affects the patients' ability to search for and manage online health information. To improve the effectiveness of patients' online health information-seeking behaviours and to enhance the effectiveness of technological interventions in this field, healthcare providers should target assessing and improving patient engagement and patient empowerment in their healthcare. It is important that health professionals acknowledge patients' online health information-seeking behaviours that they discuss the information offered by patients and guide them to reliable and accurate web sources. Copyright © 2017 Elsevier B.V. All rights reserved.

Work overload, burnout, and psychological ill-health symptoms: a three-wave mediation model of the employee health impairment process.

Science.gov (United States)

de Beer, Leon T; Pienaar, Jaco; Rothmann, Sebastiaan

2016-07-01

The study reported here investigated the causal relationships in the health impairment process of employee well-being, and the mediating role of burnout in the relationship between work overload and psychological ill-health symptoms, over time. The research is deemed important due to the need for longitudinal evidence of the health impairment process of employee well-being over three waves of data. A quantitative survey design was followed. Participants constituted a longitudinal sample of 370 participants, at three time points, after attrition. Descriptive statistics and structural equation modeling methods were implemented. Work overload at time one predicted burnout at time two, and burnout at time two predicted psychological ill-health symptoms at time three. Indirect effects were found between work overload time one and psychological ill-health symptoms time three via burnout time two, and also between burnout time one and psychological ill-health symptoms time three, via burnout time two. The results provided supportive evidence for an "indirect-only" mediation effect, for burnout's causal mediation mechanism in the health impairment process between work overload and psychological ill-health symptoms.

Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: A cost-effectiveness and equity analysis.

Science.gov (United States)

Lal, Anita; Mantilla-Herrera, Ana Maria; Veerman, Lennert; Backholer, Kathryn; Sacks, Gary; Moodie, Marjory; Siahpush, Mohammad; Carter, Rob; Peeters, Anna

2017-06-01

A sugar-sweetened beverage (SSB) tax in Mexico has been effective in reducing consumption of SSBs, with larger decreases for low-income households. The health and financial effects across socioeconomic groups are important considerations for policy-makers. From a societal perspective, we assessed the potential cost-effectiveness, health gains, and financial impacts by socioeconomic position (SEP) of a 20% SSB tax for Australia. Australia-specific price elasticities were used to predict decreases in SSB consumption for each Socio-Economic Indexes for Areas (SEIFA) quintile. Changes in body mass index (BMI) were based on SSB consumption, BMI from the Australian Health Survey 2011-12, and energy balance equations. Markov cohort models were used to estimate the health impact for the Australian population, taking into account obesity-related diseases. Health-adjusted life years (HALYs) gained, healthcare costs saved, and out-of-pocket costs were estimated for each SEIFA quintile. Loss of economic welfare was calculated as the amount of deadweight loss in excess of taxation revenue. A 20% SSB tax would lead to HALY gains of 175,300 (95% CI: 68,700; 277,800) and healthcare cost savings of AU$1,733 million (m) (95% CI: $650m; $2,744m) over the lifetime of the population, with 49.5% of the total health gains accruing to the 2 lowest quintiles. We estimated the increase in annual expenditure on SSBs to be AU$35.40/capita (0.54% of expenditure on food and non-alcoholic drinks) in the lowest SEIFA quintile, a difference of AU$3.80/capita (0.32%) compared to the highest quintile. Annual tax revenue was estimated at AU$642.9m (95% CI: $348.2m; $1,117.2m). The main limitations of this study, as with all simulation models, is that the results represent only the best estimate of a potential effect in the absence of stronger direct evidence. This study demonstrates that from a 20% tax on SSBs, the most HALYs gained and healthcare costs saved would accrue to the most disadvantaged

Modelled health benefits of a sugar-sweetened beverage tax across different socioeconomic groups in Australia: A cost-effectiveness and equity analysis

Science.gov (United States)

Mantilla-Herrera, Ana Maria; Veerman, Lennert; Backholer, Kathryn; Moodie, Marjory; Siahpush, Mohammad; Carter, Rob; Peeters, Anna

2017-01-01

Background A sugar-sweetened beverage (SSB) tax in Mexico has been effective in reducing consumption of SSBs, with larger decreases for low-income households. The health and financial effects across socioeconomic groups are important considerations for policy-makers. From a societal perspective, we assessed the potential cost-effectiveness, health gains, and financial impacts by socioeconomic position (SEP) of a 20% SSB tax for Australia. Methods and findings Australia-specific price elasticities were used to predict decreases in SSB consumption for each Socio-Economic Indexes for Areas (SEIFA) quintile. Changes in body mass index (BMI) were based on SSB consumption, BMI from the Australian Health Survey 2011–12, and energy balance equations. Markov cohort models were used to estimate the health impact for the Australian population, taking into account obesity-related diseases. Health-adjusted life years (HALYs) gained, healthcare costs saved, and out-of-pocket costs were estimated for each SEIFA quintile. Loss of economic welfare was calculated as the amount of deadweight loss in excess of taxation revenue. A 20% SSB tax would lead to HALY gains of 175,300 (95% CI: 68,700; 277,800) and healthcare cost savings of AU$1,733 million (m) (95% CI: $650m; $2,744m) over the lifetime of the population, with 49.5% of the total health gains accruing to the 2 lowest quintiles. We estimated the increase in annual expenditure on SSBs to be AU$35.40/capita (0.54% of expenditure on food and non-alcoholic drinks) in the lowest SEIFA quintile, a difference of AU$3.80/capita (0.32%) compared to the highest quintile. Annual tax revenue was estimated at AU$642.9m (95% CI: $348.2m; $1,117.2m). The main limitations of this study, as with all simulation models, is that the results represent only the best estimate of a potential effect in the absence of stronger direct evidence. Conclusions This study demonstrates that from a 20% tax on SSBs, the most HALYs gained and healthcare costs

Building a regional health equity movement: the grantmaking model of a local health department.

Science.gov (United States)

Baril, Nashira; Patterson, Meghan; Boen, Courtney; Gowler, Rebekah; Norman, Nancy

2011-01-01

The Boston Public Health Commission's Center for Health Equity and Social Justice provides grant funding, training, and technical assistance to 15 organizations and coalitions across New England to develop, implement, and evaluate community-based policy and systems change strategies that address social determinants of health and reduce racial and ethnic health inequities. This article describes Boston Public Health Commission's health equity framework, theory of change regarding the elimination of racial and ethnic health inequities, and current grantmaking model. To conclude, the authors evaluate the grant model and offer lessons learned from providing multiyear regional grants to promote health equity.

Food quality, effects on health and sustainability today: a model case report.

Science.gov (United States)

Borroni, Vittorio Natale; Fargion, Silvia; Mazzocchi, Alessandra; Giachetti, Marco; Lanzarini, Achille; Dall'Asta, Margherita; Scazzina, Francesca; Agostoni, Carlo

2017-02-01

The Fondazione IRCCS Ca' Granda Ospedale Maggiore Policlinico is a five-century institution that, besides the unique clinical role in the center of Milan, may rely on benefactor donations such as fields and farming houses not far from the city, for a total of 8500 ha, all managed by the "Sviluppo Ca' Granda' Foundation". Presently, the main products of these fields are represented by rice and cow's milk. During the latest years, farmers and managers have developed a model of sustainable food production, with great attention to the product quality based on compositional analysis and functional nutritional characteristics. This experience represents a new holistic model of food production and consumption, taking great care of both sustainability and health.

Indirect Effects of Social Skills on Health Through Stress and Loneliness.

Science.gov (United States)

Segrin, Chris

2017-10-20

The social skills deficit vulnerability model predicts that people with inadequate social skills are at risk for a range of psychosocial problems, especially when confronted with stress. People with poor social skills often experience stress and loneliness and these two constructs were tested as potential pathways by which the poor social skills confer a risk for compromised mental and physical health. An online survey was completed by 775 adults, aged 18-91. The sample matched national demographics for race/ethnicity and age, among those over 18. Structural equation modeling revealed indirect effects of social skills on both mental and physical health through both stress and loneliness. The models showed that poor social skills were associated with poor mental and physical health through elevated stress and increased loneliness. The findings reveal that social skills deficits are associated with physical as well as mental health problems.

Finding Resolution for the Responsible Transparency of Economic Models in Health and Medicine.

Science.gov (United States)

Padula, William V; McQueen, Robert Brett; Pronovost, Peter J

2017-11-01

The Second Panel on Cost-Effectiveness in Health and Medicine recommendations for conduct, methodological practices, and reporting of cost-effectiveness analyses has a number of questions unanswered with respect to the implementation of transparent, open source code interface for economic models. The possibility of making economic model source code could be positive and progressive for the field; however, several unintended consequences of this system should be first considered before complete implementation of this model. First, there is the concern regarding intellectual property rights that modelers have to their analyses. Second, the open source code could make analyses more accessible to inexperienced modelers, leading to inaccurate or misinterpreted results. We propose several resolutions to these concerns. The field should establish a licensing system of open source code such that the model originators maintain control of the code use and grant permissions to other investigators who wish to use it. The field should also be more forthcoming towards the teaching of cost-effectiveness analysis in medical and health services education so that providers and other professionals are familiar with economic modeling and able to conduct analyses with open source code. These types of unintended consequences need to be fully considered before the field's preparedness to move forward into an era of model transparency with open source code.

Effect of health development assistance on health status in sub-Saharan Africa

Directory of Open Access Journals (Sweden)

Negeri KG

2016-04-01

Full Text Available Keneni Gutema Negeri,1 Damen Halemariam,21School of Public and Environmental Health, Health Service Management Unit, College of Medicine and Health Sciences, Hawassa University, Hawassa, 2College of Medicine and Health Sciences, School of Public Health, Addis Ababa University, Addis Ababa, Ethiopia Introduction: Data on the effect of health aid on the health status in developing countries are inconclusive. Moreover, studies on this issue in sub-Saharan Africa are scarce. Therefore, this study aims to analyze the effect of health development aid in sub-Saharan Africa. Methods: Using panel data analytic method, as well as infant mortality rate as a proxy for health status, this study examines the effect of health aid on infant mortality rate in sub-Saharan Africa. The panel was constructed from data on 43 countries for the period 1990–2010. Fixed effect, random effect, and first difference generalized method of moments estimator were used for estimation. Results: Health development aid has a statistically significant positive effect. A 1% increase of health development assistance per capita saves the lives of two infants per 1,000 live births (P=0.000 in the region. Conclusion: Contrary to health aid pessimists’ view, this study observes the fact that health development assistance has strong favorable effect in improving health status in sub-Saharan Africa. Keywords: health aid, infant mortality, developing countries, panel data

A national quitline service and its promotion in the mass media: modelling the health gain, health equity and cost-utility.

Science.gov (United States)

Nghiem, Nhung; Cleghorn, Christine L; Leung, William; Nair, Nisha; Deen, Frederieke S van der; Blakely, Tony; Wilson, Nick

2017-07-24

Mass media campaigns and quitlines are both important distinct components of tobacco control programmes around the world. But when used as an integrated package, the effectiveness and cost-effectiveness are not well described. We therefore aimed to estimate the health gain, health equity impacts and cost-utility of the package of a national quitline service and its promotion in the mass media. We adapted an established Markov and multistate life-table macro-simulation model. The population was all New Zealand adults in 2011. Effect sizes and intervention costs were based on past New Zealand quitline data. Health system costs were from a national data set linking individual health events to costs. The 1-year operation of the existing intervention package of mass media promotion and quitline service was found to be net cost saving to the health sector for all age groups, sexes and ethnic groups (saving $NZ84 million; 95%uncertainty interval 60-115 million in the base-case model). It also produced greater per capita health gains for Māori (indigenous) than non-Māori (2.2 vs 0.73 quality-adjusted life-years (QALYs) per 1000 population, respectively). The net cost saving of the intervention was maintained in all sensitivity and scenario analyses for example at a discount rate of 6% and when the intervention effect size was quartered (given the possibility of residual confounding in our estimates of smoking cessation). Running the intervention for 20 years would generate an estimated 54 000 QALYs and $NZ1.10 billion (US$0.74 billion) in cost savings. The package of a quitline service and its promotion in the mass media appears to be an effective means to generate health gain, address health inequalities and save health system costs. Nevertheless, the role of this intervention needs to be compared with other tobacco control and health sector interventions, some of which may be even more cost saving. © Article author(s) (or their employer(s) unless otherwise

Training healthcare professionals for the future: internationalism and effective inclusion of global health training.

Science.gov (United States)

Eaton, Deborah Murdoch; Redmond, Anthony; Bax, Nigel

2011-01-01

There has been a continuing rise in recent years of the number of medical schools in the developed world offering 'global health' teaching to its students. Yet, the term itself is used in a number of contexts and as yet no clear consensus on what constitutes an appropriate or successful global health education programme has been reached. Approaches to sustainable internationalisation of medical curricula include the expansion of not only opportunities for training in specific global health topics, but also the development of broader generic graduate attributes including global citizenship and ethical, cultural and social responsibility. Key components for successful implementation of such an educational framework includes a breadth of educational approach to effect truly integrated and effective curricular internationalisation. That such programmes can offer benefits is appreciated by both faculty and students alike, but there is also a burgeoning concern about potential negative effects of socially and culturally insensitive programmes. We explore three potential pedagogic approaches to the subject; Model A: an 'additive' or contributory model of global health content (the commonest current approach), Model B: an 'integrated' approach and Model C: the more challenging 'transformative' approach requiring institutional as well as programme flexibility.

Investigating the effect of continuous care model on social health status of family caregivers in hospitalized patients undergoing coronary artery bypass graft surgery

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T NasrAbadi

2016-09-01

Full Text Available Introduction: Chronic patient care causes  some problems, including pressure or burden of care, reducing the time for routine activities and self care, also causes compatibility decline in deal with stress and disorders of physical and mental health, emotional, social and financial prosperity of caregivers. The aim of this study was to determine the effect of continuous care model on social health status of  family caregivers in patients  underwent coronary artery bypass surgeries. Methods: This study was  one-group clinical trial research, the samples consisted 48 family caregiver of  the patients  underwent coronary artery bypass graft  surgeries, who  were selected using purposive sampling method. Data collection tools included the standard questionnaire Data collection tool was Novak and Guest caring burden inventory (CBI s as well as demographic questionnaire, which  was  measured at the baseline and 8 weeks after intervention.  Data were analyzed using  descriptive  and analytic statistic (paired t-test, and covariance analysis with SPSS version 16. Results: The mean score of  caring burden realated  to  the social health status before intervention was 3.86±6.11 and after intervention was 1.81±2.33. In examining five dimensions burden of care,  continuous care model had an impact on all aspects of the  caring burden and it led to the reduction of the burden of care  in  all aspects.  So,  it had a significant decrease  in the social health status (p <0.01. Conclusion: Implementation of continuous care model as the intervention of cheaper and available,  can be an effective step inreducing the burden of care of the  patients with  coronary artery disease in health status of social.

The theory of reasoned action as parallel constraint satisfaction: towards a dynamic computational model of health behavior.

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Mark G Orr

Full Text Available The reasoned action approach, although ubiquitous in health behavior theory (e.g., Theory of Reasoned Action/Planned Behavior, does not adequately address two key dynamical aspects of health behavior: learning and the effect of immediate social context (i.e., social influence. To remedy this, we put forth a computational implementation of the Theory of Reasoned Action (TRA using artificial-neural networks. Our model re-conceptualized behavioral intention as arising from a dynamic constraint satisfaction mechanism among a set of beliefs. In two simulations, we show that constraint satisfaction can simultaneously incorporate the effects of past experience (via learning with the effects of immediate social context to yield behavioral intention, i.e., intention is dynamically constructed from both an individual's pre-existing belief structure and the beliefs of others in the individual's social context. In a third simulation, we illustrate the predictive ability of the model with respect to empirically derived behavioral intention. As the first known computational model of health behavior, it represents a significant advance in theory towards understanding the dynamics of health behavior. Furthermore, our approach may inform the development of population-level agent-based models of health behavior that aim to incorporate psychological theory into models of population dynamics.

The theory of reasoned action as parallel constraint satisfaction: towards a dynamic computational model of health behavior.

Science.gov (United States)

Orr, Mark G; Thrush, Roxanne; Plaut, David C

2013-01-01

The reasoned action approach, although ubiquitous in health behavior theory (e.g., Theory of Reasoned Action/Planned Behavior), does not adequately address two key dynamical aspects of health behavior: learning and the effect of immediate social context (i.e., social influence). To remedy this, we put forth a computational implementation of the Theory of Reasoned Action (TRA) using artificial-neural networks. Our model re-conceptualized behavioral intention as arising from a dynamic constraint satisfaction mechanism among a set of beliefs. In two simulations, we show that constraint satisfaction can simultaneously incorporate the effects of past experience (via learning) with the effects of immediate social context to yield behavioral intention, i.e., intention is dynamically constructed from both an individual's pre-existing belief structure and the beliefs of others in the individual's social context. In a third simulation, we illustrate the predictive ability of the model with respect to empirically derived behavioral intention. As the first known computational model of health behavior, it represents a significant advance in theory towards understanding the dynamics of health behavior. Furthermore, our approach may inform the development of population-level agent-based models of health behavior that aim to incorporate psychological theory into models of population dynamics.

Growth and welfare effects of health care in knowledge-based economies.

Science.gov (United States)

Kuhn, Michael; Prettner, Klaus

2016-03-01

We study the effects of labor intensive health care within a research and development (R&D) driven growth model with overlapping generations. Health care increases longevity, labor participation, and productivity, while it also diverts labor away from production and R&D. We examine under which conditions expanding health care enhances growth and welfare and establish mild conditions under which the provision of health care beyond the growth-maximizing level is Pareto superior. Copyright © 2016 Elsevier B.V. All rights reserved.

Preditive Models And Health Sciences: A Brief Analysis

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Jair Sales Paulino, Msc

2017-07-01

Full Text Available Background: Predictive Models are an important tool in event predicting and health planning. Despite this, there are few works focusing this area. Thus, the analysis of the real benefits of these models in Health Sciences is necessary to be performed. Results: Predictive techniques largely evolved in second half of XX century. The development of AR, MA, ARMA, ARIMA and SARIMA models, through Box-Jenkins methodology, constitute a robust conjunct of mechanisms able to help in solution of epidemiological modeling problems, mainly in Health Sciences, once it allows to evaluate individual characteristics of living beings and its correlation with pathologies in the same space-time. Nevertheless, AR, MA and ARMA does not have tendency in seasonality, which weakens the analysis. Conclusions: To predict the natural history of endemic/epidemic and its health-disease processes in a determined population is a sine que non condition to its adequate management in Public Health context and in adoption of affirmative measures concerning health promotion. Thus, the predictive models, with emphasis in ARIMA, SARIMA, Artificial Neural Networks and Formalism of Copulas are alternatives that can be feasible.

Potential impact of climate change on air pollution-related human health effects.

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Tagaris, Efthimios; Liao, Kuo-Jen; Delucia, Anthony J; Deck, Leland; Amar, Praveen; Russell, Armistead G

2009-07-01

The potential health impact of ambient ozone and PM2.5 concentrations modulated by climate change over the United States is investigated using combined atmospheric and health modeling. Regional air quality modeling for 2001 and 2050 was conducted using CMAQ Modeling System with meteorology from the GISS Global Climate Model, downscaled regionally using MM5,keeping boundary conditions of air pollutants, emission sources, population, activity levels, and pollution controls constant. BenMap was employed to estimate the air pollution health outcomes at the county, state, and national level for 2050 caused by the effect of meteorology on future ozone and PM2.5 concentrations. The changes in calculated annual mean PM2.5 concentrations show a relatively modest change with positive and negative responses (increasing PM2.5 levels across the northeastern U.S.) although average ozone levels slightly decrease across the northern sections of the U.S., and increase across the southern tier. Results suggest that climate change driven air quality-related health effects will be adversely affected in more then 2/3 of the continental U.S. Changes in health effects induced by PM2.5 dominate compared to those caused by ozone. PM2.5-induced premature mortality is about 15 times higher then that due to ozone. Nationally the analysis suggests approximately 4000 additional annual premature deaths due to climate change impacts on PM2.5 vs 300 due to climate change-induced ozone changes. However, the impacts vary spatially. Increased premature mortality due to elevated ozone concentrations will be offset by lower mortality from reductions in PM2.5 in 11 states. Uncertainties related to different emissions projections used to simulate future climate, and the uncertainties forecasting the meteorology, are large although there are potentially important unaddressed uncertainties (e.g., downscaling, speciation, interaction, exposure, and concentration-response function of the human health studies).

Modeled effects of an improved building insulation scenario in Europe on air pollution, health and societal costs

DEFF Research Database (Denmark)

Bønløkke, Jakob Hjort; Holst, Gitte Juel; Sigsgaard, Torben

2015-01-01

scenario in Europe would have substantial benefits on health through improvements in air pollution. Health effects and societal cost savings may significantly counterbalance investment costs and should be taken into account when evaluating strategies for mitigation of global warming....... with extensions. Mean annual changes in the main air pollutants were derived for each country. World Health Organization (WHO) and European Union (EU) data on populations and on impacts of pollutants were used to derive health effects and costs. Effects on indoor air quality were not assessed. Results: Projected...... 78678 LY in Europe. A total of 7173 cases of persistent chronic bronchitis could be avoided annually. Several other health outcomes improved similarly. The saved societal costs totaled 6.64 billion € annually. Conclusions: In addition to carbon emission reductions, an improved building insulation...

Health effects of radiation and the implications for radiation safety

International Nuclear Information System (INIS)

Gonzalez, A.J.; Anderer, J.

1991-01-01

In this Paper two elements of a multiphase analysis of radiation exposures in the living environment - the human health effects of ionizing radiation and the implications for radiation safety policy and practices - are presented. Part 1 draws together the current state of scientific knowledge and insight about the human health effects of radiation, describing these in terms of known cause-related deterministic effects and of the estimated incidence of stochastic effects as defined by biostatistics and biological models. The 1988 UNSCEAR report provides an authoritative basis for such an examination. Part 2 explores some of the major implications that the state-of-the-art of radiation biology has - or should have - for radiation safety policy and practices. (author)

Testing the Quality Health Outcomes Model Applied to Infection Prevention in Hospitals.

Science.gov (United States)

Gilmartin, Heather M; Sousa, Karen H

2016-01-01

To test the Quality Health Outcomes Model to investigate the relationship between health care-associated infection (HAI) prevention interventions, organizational context, and HAI outcomes using structural equation modeling. Variables for adherence to the central line bundle, organizational context, and central line-associated bloodstream infections (CLABSIs) were selected for this secondary data analysis from 614 US hospitals that participated in the Prevention of Nosocomial Infection and Cost-effectiveness-Refined study. One half of the dataset was used for exploration of the concepts, the second half for confirmation of the measurement models and testing of the structural model. The final model resulted in a good fit to the data (χ (1215) = 1906.86, P preventing HAIs, ongoing research is needed to reveal the exact aspects of context that influence interventions and outcomes.

Modeling The Effects of Mother’s Age at First Birth on Child Health at Birth

OpenAIRE

Mbu Daniel Tambi

2014-01-01

This study models the impact of mother’s age at first birth on child health at birth in Cameroon. The objectives are: (1) investigate the implication of mother’s age at first birth on child health at birth; (2) examine the impact of mother’s age groups on birth weight, and (3) suggest economic policies to ameliorate the mother’s age – child health relationship. We make used of the control function approach to determine the relationship between mother’s age at first birth and birth...

Understanding gender differences in m-health adoption: a modified theory of reasoned action model.

Science.gov (United States)

Zhang, Xiaofei; Guo, Xitong; Lai, Kee-Hung; Guo, Feng; Li, Chenlei

2014-01-01

Mobile health (m-health) services are becoming increasingly popular in healthcare, but research on m-health adoption is rare. This study was designed to obtain a better understanding of m-health adoption intention. We conducted an empirical research of a 481-respondent sample consisting of 44.7% women and 55.3% men and developed a modified theory of reasoned action (TRA) model by incorporating the nonlinearities between attitude and subjective norms and the moderating effect of gender. The results indicate that, based on the study population in China: (1) facilitating conditions, attitude, and subjective norms are significant predictors of m-health adoption intention; (2) the model including the nonlinearities enhances its explanatory ability; (3) males enjoy a higher level of m-health adoption intention compared with females; (4) the modified TRA model can predict men's behavior intention better than that of women; and (5) males have an Edgeworth-Pareto substitutability between attitude and subjective norms in predicting m-health adoption intention. Thus, we found gender differences in m-health adoption from the perspective of social psychology.

Calibration of a stochastic health evolution model using NHIS data

Science.gov (United States)

Gupta, Aparna; Li, Zhisheng

2011-10-01

This paper presents and calibrates an individual's stochastic health evolution model. In this health evolution model, the uncertainty of health incidents is described by a stochastic process with a finite number of possible outcomes. We construct a comprehensive health status index (HSI) to describe an individual's health status, as well as a health risk factor system (RFS) to classify individuals into different risk groups. Based on the maximum likelihood estimation (MLE) method and the method of nonlinear least squares fitting, model calibration is formulated in terms of two mixed-integer nonlinear optimization problems. Using the National Health Interview Survey (NHIS) data, the model is calibrated for specific risk groups. Longitudinal data from the Health and Retirement Study (HRS) is used to validate the calibrated model, which displays good validation properties. The end goal of this paper is to provide a model and methodology, whose output can serve as a crucial component of decision support for strategic planning of health related financing and risk management.

Modeling Medical Services with Mobile Health Applications

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Zhenfei Wang

2018-01-01

Full Text Available The rapid development of mobile health technology (m-Health provides unprecedented opportunities for improving health services. As the bridge between doctors and patients, mobile health applications enable patients to communicate with doctors through their smartphones, which is becoming more and more popular among people. To evaluate the influence of m-Health applications on the medical service market, we propose a medical service equilibrium model. The model can balance the supply of doctors and demand of patients and reflect possible options for both doctors and patients with or without m-Health applications in the medical service market. In the meantime, we analyze the behavior of patients and the activities of doctors to minimize patients’ full costs of healthcare and doctors’ futility. Then, we provide a resolution algorithm through mathematical reasoning. Lastly, based on artificially generated dataset, experiments are conducted to evaluate the medical services of m-Health applications.

Health effects

International Nuclear Information System (INIS)

Mahieu, L.

1998-01-01

The main objectives of research in the field of health effects at the Belgian Nuclear Research Centre SCK-CEN are: (1) to study cancer mortality and morbidity in nuclear workers in Belgium; (2) to document the feasibility of retrospective cohort studies in Belgium; (3) to participate in the IARC study; (4) to elucidate the mechanisms of the effects of ionizing radiation on the mammalian embryo during the early phases of its development; (5) to assess the genetic risks of material exposure to ionizing radiation; (6) to elucidate the cellular mechanisms leading to brain damage after prenatal irradiation; (7) to advise authorities and to provide the general population with adequate information concerning the health risk arising from radiation exposure. Progress and major achievements in these topical areas for 1997 are reported

Health effects

Energy Technology Data Exchange (ETDEWEB)

Mahieu, L

1998-07-01

The main objectives of research in the field of health effects at the Belgian Nuclear Research Centre SCK-CEN are: (1) to study cancer mortality and morbidity in nuclear workers in Belgium; (2) to document the feasibility of retrospective cohort studies in Belgium; (3) to participate in the IARC study; (4) to elucidate the mechanisms of the effects of ionizing radiation on the mammalian embryo during the early phases of its development; (5) to assess the genetic risks of material exposure to ionizing radiation; (6) to elucidate the cellular mechanisms leading to brain damage after prenatal irradiation; (7) to advise authorities and to provide the general population with adequate information concerning the health risk arising from radiation exposure. Progress and major achievements in these topical areas for 1997 are reported.

Contribution of modern medical imaging technology to radiation health effects in exposed populations

International Nuclear Information System (INIS)

Fabrikant, J.I.

1980-11-01

The introduction of technically-advanced imaging systems in medicine carries with it potential health hazards, particularly from ionizing and nonionizing radiation exposure of human populations. This paper will discuss what we know and what we do not know about the health effects of low-level radiation, how the risks of radiation-induced health effects may be estimated, the sources of the scientific data, the dose-response models used, the uncertainties which limit precision of estimation of excess health risks from low-level radiation, and what the implications might be for radiation protection in medicine and public health policy

Projection models for health-effects assessment in populations exposed to radioactive and nonradioactive pollutants. Volume III. SPAHR interactive package guide

International Nuclear Information System (INIS)

Collins, J.J.

1982-09-01

The Simulation Package for the Analysis of Health Risk (SPAHR) is a computer software package based upon a demographic model for health risk projectons. The model extends several health risk projection models by making realistic assumptions about the population at risk, adn thus represents a distinct improvement over previous models. Complete documentation for use of SPAHR is contained in this five-volume publication. The demographic model in SPAHR estimates population response to environmental toxic exposures. Latency of response, changing dose level over time, competing risks from other causes of death, and population structure can be incorporated into SPAHR to project health risks. Risks are measured by morbid years, number of deaths, and loss of life expectancy. Comparisons of estimates of excess deaths demonstrate that previous health risk projection models may have underestimated excess deaths by a factor of from 2 to 10, depending on the pollutant and the exposure scenario. The software supporting the use of the demographic model is designed to be user oriented. Complex risk projections are made by responding to a series of prompts generated by the package. The flexibility and ease of use of SPAHR make it an important contribution to existing models and software packages. This manual outlines the use of the interactive capabilities of SPAHR. SPAHR is an integrated system of computer programs designed for simulating numerous health risk scenarios using the techniques of demographic modeling. This system of computer programs has been designed to be very flexible so as to allow the user to simulate a large variety of scenarios. It provides the user with an integrated package for projecting the impacts on human health of exposure to various hazards, particularly those resulting from the effluents related to energy production

On models of health assistance and the program of family health of the Brazilian Health Department

Directory of Open Access Journals (Sweden)

Claudia Hausman Silveira

2008-08-01

Full Text Available The article makes reference to the three models that have inspired the construction of the Program of Family Health in Brazil (Cuban, English and Canadian, observing their differences and similarities and comparing them with the Brazilian case. Therefore, an associative line is also constructed between the Only System of Health (SUS and the necessity of a practice which allows the functioning of its lines of direction and organization principles. Thus, we reach the conclusion that the Program of Family Health in Brazil, for its multi professional work proposal in interdisciplinary teams, in accordance with the SUS, can help keep the law of health in the Country. Key-words: SUS; Program of Family Health; Interdisciplinary; Medical care model; Sanitary practice

The salutogenic model of health in health promotion research.

Science.gov (United States)

Mittelmark, Maurice B; Bull, Torill

2013-06-01

Despite health promotion's enthusiasm for the salutogenic model of health, researchers have paid little attention to Antonovsky's central ideas about the ease/dis-ease continuum, defined in terms of 'breakdown' (the severity of pain and functional limitations, and the degree medical care is called for, irrespective of specific diseases). Rather, salutogenesis research has a strong focus on how sense of coherence relates to a wide range of specific diseases and illness endpoints. We address two questions: Why has Antonovsky's health concept failed to stimulate research on breakdown, and how can the present emphasis on disease be complemented by an emphasis on positive well-being in the salutogenic model? We show that (i) the breakdown concept of health as specified by Antonovsky is circular in definition, (ii) it is not measured on the 'required' ease/dis-ease continuum, (iii) it is not measureable by any validated or reliability-tested assessment tool, and (iv) it has not so much been rejected by health promotion, as it has not been considered at all. We show that Antonovsky came to view breakdown as but one aspect of well-being. He was open to the idea of well-being as something more positive than the absence of pain, suffering and need for medical care. We suggest ways to move salutogenesis research in the direction of well-being in its positive sense.

Simulation modeling for the health care manager.

Science.gov (United States)

Kennedy, Michael H

2009-01-01

This article addresses the use of simulation software to solve administrative problems faced by health care managers. Spreadsheet add-ins, process simulation software, and discrete event simulation software are available at a range of costs and complexity. All use the Monte Carlo method to realistically integrate probability distributions into models of the health care environment. Problems typically addressed by health care simulation modeling are facility planning, resource allocation, staffing, patient flow and wait time, routing and transportation, supply chain management, and process improvement.

Modelling the results of health promotion activities in Switzerland: development of the Swiss Model for Outcome Classification in Health Promotion and Prevention.

Science.gov (United States)

Spencer, Brenda; Broesskamp-Stone, Ursel; Ruckstuhl, Brigitte; Ackermann, Günter; Spoerri, Adrian; Cloetta, Bernhard

2008-03-01

This paper describes the Model for Outcome Classification in Health Promotion and Prevention adopted by Health Promotion Switzerland (SMOC, Swiss Model for Outcome Classification) and the process of its development. The context and method of model development, and the aim and objectives of the model are outlined. Preliminary experience with application of the model in evaluation planning and situation analysis is reported. On the basis of an extensive literature search, the model is situated within the wider international context of similar efforts to meet the challenge of developing tools to assess systematically the activities of health promotion and prevention.

Three models of community mental health services In low-income countries

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De Silva Mary

2011-01-01

Full Text Available Abstract Objective To compare and contrast three models of community mental health services in low-income settings. Data Sources/Study Setting Primary and secondary data collected before, during, and after site visits to mental health programs in Nigeria, the Philippines, and India. Study Design Qualitative case study methodology. Data Collection Data were collected through interviews and observations during site visits to the programs, as well as from reviews of documentary evidence. Principal Findings A set of narrative topics and program indicators were used to compare and contrast three community mental health programs in low-income countries. This allowed us to identify a diversity of service delivery models, common challenges, and the strengths and weaknesses of each program. More definitive evaluations will require the establishment of data collection methods and information systems that provide data about the clinical and social outcomes of clients, as well as their use of services. Conclusions Community mental health programs in low-income countries face a number of challenges. Using a case study methodology developed for this purpose, it is possible to compare programs and begin to assess the effectiveness of diverse service delivery models.

Shifting physician prescribing to a preferred histamine-2-receptor antagonist. Effects of a multifactorial intervention in a mixed-model health maintenance organization.

Science.gov (United States)

Brufsky, J W; Ross-Degnan, D; Calabrese, D; Gao, X; Soumerai, S B

1998-03-01

This study was undertaken to determine whether a program of education, therapeutic reevaluation of eligible patients, and performance feedback could shift prescribing to cimetidine from other histamine-2 receptor antagonists, which commonly are used in the management of ulcers and reflux, and reduce costs without increasing rates of ulcer-related hospital admissions. This study used an interrupted monthly time series with comparison series in a large mixed-model health maintenance organization. Physicians employed in health centers (staff model) and physicians in independent medical groups contracting to provide health maintenance organization services (group model) participated. The comparative percentage prescribed of specific histamine-2 receptor antagonists (market share), total histamine-2 receptor antagonist prescribing, cost per histamine-2 receptor antagonist prescription, and the rate of hospitalization for gastrointestinal illness were assessed. In the staff model, therapeutic reevaluation resulted in a sudden increase in market share of the preferred histamine-2 receptor antagonist cimetidine (+53.8%) and a sudden decrease in ranitidine (-44.7%) and famotidine (-4.8%); subsequently, cimetidine market share grew by 1.1% per month. In the group model, therapeutic reevaluation resulted in increased cimetidine market share (+9.7%) and decreased prescribing of other histamine-2 receptor antagonists (ranitidine -11.6%; famotidine -1.2%). Performance feedback did not result in further changes in prescribing in either setting. Use of omeprazole, an expensive alternative, essentially was unchanged by the interventions, as were overall histamine-2 receptor antagonist prescribing and hospital admissions for gastrointestinal illnesses. This intervention, which cost approximately $60,000 to implement, resulted in estimated annual savings in histamine-2 receptor antagonist expenditures of $1.06 million. Annual savings in histamine-2 receptor antagonist expenditures

Identifying best-fitting inputs in health-economic model calibration: a Pareto frontier approach.

Science.gov (United States)

Enns, Eva A; Cipriano, Lauren E; Simons, Cyrena T; Kong, Chung Yin

2015-02-01

To identify best-fitting input sets using model calibration, individual calibration target fits are often combined into a single goodness-of-fit (GOF) measure using a set of weights. Decisions in the calibration process, such as which weights to use, influence which sets of model inputs are identified as best-fitting, potentially leading to different health economic conclusions. We present an alternative approach to identifying best-fitting input sets based on the concept of Pareto-optimality. A set of model inputs is on the Pareto frontier if no other input set simultaneously fits all calibration targets as well or better. We demonstrate the Pareto frontier approach in the calibration of 2 models: a simple, illustrative Markov model and a previously published cost-effectiveness model of transcatheter aortic valve replacement (TAVR). For each model, we compare the input sets on the Pareto frontier to an equal number of best-fitting input sets according to 2 possible weighted-sum GOF scoring systems, and we compare the health economic conclusions arising from these different definitions of best-fitting. For the simple model, outcomes evaluated over the best-fitting input sets according to the 2 weighted-sum GOF schemes were virtually nonoverlapping on the cost-effectiveness plane and resulted in very different incremental cost-effectiveness ratios ($79,300 [95% CI 72,500-87,600] v. $139,700 [95% CI 79,900-182,800] per quality-adjusted life-year [QALY] gained). Input sets on the Pareto frontier spanned both regions ($79,000 [95% CI 64,900-156,200] per QALY gained). The TAVR model yielded similar results. Choices in generating a summary GOF score may result in different health economic conclusions. The Pareto frontier approach eliminates the need to make these choices by using an intuitive and transparent notion of optimality as the basis for identifying best-fitting input sets. © The Author(s) 2014.

A model for oral health gradients in children: using structural equation modeling.

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Behbahanirad, A; Joulaei, H; Jamali, J; Vossoughi, M; Golkari, A

2017-03-01

Detecting the underlying socioeconomic and behavioral determinants is essential for reducing oral health disparities in children. To test a conceptual model in children to explore the interaction amongst social, environmental, behavioral factors and oral health outcomes. This analytic cross-sectional study was performed in 2014-2015 in Shiraz, Iran. The sampling was conducted using a multistage stratified design to represent the whole 6-year-olds in Shiraz County. Participants were 830, 6-year-old first grade primary schoolchildren and their parents. Children were examined to register decayed, missing and filled teeth (dmft) and simplified oral hygiene index (OHI-S). Parents were asked for data on socio-cultural risk factors, oral health behaviors and children's oral health related quality of life (C-OHRQoL). Data on environmental risk factors were collected from several sources. The proposed model, a development of Peterson's, was tested using structural equation modeling (SEM). The tested model could empirically demonstrate the wide range of social and behavioral factors affecting C-OHRQoL. Socioeconomic status (SES) affected the OHRQoL of children through several pathways. Tooth brushing frequency, use of oral health services and consuming cariogenic foods were the mediators, through which SES affected dmft and subsequently C-OHRQoL. Using the modified Petersen's model and SEM, the paths in which different distal and proximal factors affect oral health outcomes in children could be clearly identified. It showed that addressing the underlying social, economic and behavioral determinants is essential for reducing oral health disparities among Iranian children. Copyright© 2017 Dennis Barber Ltd.

Public health impact and cost effectiveness of routine childhood vaccination for hepatitis a in Jordan: a dynamic model approach.

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Hayajneh, Wail A; Daniels, Vincent J; James, Cerise K; Kanıbir, Muhammet Nabi; Pilsbury, Matthew; Marks, Morgan; Goveia, Michelle G; Elbasha, Elamin H; Dasbach, Erik; Acosta, Camilo J

2018-03-07

As the socioeconomic conditions in Jordan have improved over recent decades the disease and economic burden of Hepatitis A has increased. The purpose of this study is to assess the potential health and economic impact of a two-dose hepatitis A vaccine program covering one-year old children in Jordan. We adapted an age-structured population model of hepatitis A transmission dynamics to project the epidemiologic and economic impact of vaccinating one-year old children for 50 years in Jordan. The epidemiologic model was calibrated using local data on hepatitis A in Jordan. These data included seroprevalence and incidence data from the Jordan Ministry of Health as well as hospitalization data from King Abdullah University Hospital in Irbid, Jordan. We assumed 90% of all children would be vaccinated with the two-dose regimen by two years of age. The economic evaluation adopted a societal perspective and measured benefits using the quality-adjusted life-year (QALY). The modeled vaccination program reduced the incidence of hepatitis A in Jordan by 99%, 50 years after its introduction. The model projected 4.26 million avoided hepatitis A infections, 1.42 million outpatient visits, 22,475 hospitalizations, 508 fulminant cases, 95 liver transplants, and 76 deaths over a 50 year time horizon. In addition, we found, over a 50 year time horizon, the vaccination program would gain 37,502 QALYs and save over $42.6 million in total costs. The vaccination program became cost-saving within 6 years of its introduction and was highly cost-effective during the first 5 years. A vaccination program covering one-year old children is projected to be a cost-saving intervention that will significantly reduce the public health and economic burden of hepatitis A in Jordan.

Parenting Stress, Mental Health, Dyadic Adjustment: A Structural Equation Model

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Luca Rollè

2017-05-01

Full Text Available Objective: In the 1st year of the post-partum period, parenting stress, mental health, and dyadic adjustment are important for the wellbeing of both parents and the child. However, there are few studies that analyze the relationship among these three dimensions. The aim of this study is to investigate the relationships between parenting stress, mental health (depressive and anxiety symptoms, and dyadic adjustment among first-time parents.Method: We studied 268 parents (134 couples of healthy babies. At 12 months post-partum, both parents filled out, in a counterbalanced order, the Parenting Stress Index-Short Form, the Edinburgh Post-natal Depression Scale, the State-Trait Anxiety Inventory, and the Dyadic Adjustment Scale. Structural equation modeling was used to analyze the potential mediating effects of mental health on the relationship between parenting stress and dyadic adjustment.Results: Results showed the full mediation effect of mental health between parenting stress and dyadic adjustment. A multi-group analysis further found that the paths did not differ across mothers and fathers.Discussion: The results suggest that mental health is an important dimension that mediates the relationship between parenting stress and dyadic adjustment in the transition to parenthood.

The Shifting Landscape of Health Care: Toward a Model of Health Care Empowerment

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2011-01-01

In a rapidly changing world of health care information access and patients’ rights, there is limited conceptual infrastructure available to understand how people approach and engage in treatment of medical conditions. The construct of health care empowerment is defined as the process and state of being engaged, informed, collaborative, committed, and tolerant of uncertainty regarding health care. I present a model in which health care empowerment is influenced by an interplay of cultural, social, and environmental factors; personal resources; and intrapersonal factors. The model offers a framework to understand patient and provider roles in facilitating health care empowerment and presents opportunities for investigation into the role of health care empowerment in multiple outcomes across populations and settings, including inquiries into the sources and consequences of health disparities. PMID:21164096

Ensemble prediction of air quality using the WRF/CMAQ model system for health effect studies in China

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J. Hu

2017-11-01

Full Text Available Accurate exposure estimates are required for health effect analyses of severe air pollution in China. Chemical transport models (CTMs are widely used to provide spatial distribution, chemical composition, particle size fractions, and source origins of air pollutants. The accuracy of air quality predictions in China is greatly affected by the uncertainties of emission inventories. The Community Multiscale Air Quality (CMAQ model with meteorological inputs from the Weather Research and Forecasting (WRF model were used in this study to simulate air pollutants in China in 2013. Four simulations were conducted with four different anthropogenic emission inventories, including the Multi-resolution Emission Inventory for China (MEIC, the Emission Inventory for China by School of Environment at Tsinghua University (SOE, the Emissions Database for Global Atmospheric Research (EDGAR, and the Regional Emission inventory in Asia version 2 (REAS2. Model performance of each simulation was evaluated against available observation data from 422 sites in 60 cities across China. Model predictions of O3 and PM2.5 generally meet the model performance criteria, but performance differences exist in different regions, for different pollutants, and among inventories. Ensemble predictions were calculated by linearly combining the results from different inventories to minimize the sum of the squared errors between the ensemble results and the observations in all cities. The ensemble concentrations show improved agreement with observations in most cities. The mean fractional bias (MFB and mean fractional errors (MFEs of the ensemble annual PM2.5 in the 60 cities are −0.11 and 0.24, respectively, which are better than the MFB (−0.25 to −0.16 and MFE (0.26–0.31 of individual simulations. The ensemble annual daily maximum 1 h O3 (O3-1h concentrations are also improved, with mean normalized bias (MNB of 0.03 and mean normalized errors (MNE of 0.14, compared to MNB

Model for teaching population health and community-based care across diverse clinical experiences.

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Van Dyk, Elizabeth J; Valentine-Maher, Sarah K; Tracy, Janet P

2015-02-01

The pillars constructivist model is designed to offer a unifying clinical paradigm to support consistent learning opportunities across diverse configurations of community and public health clinical sites. Thirty-six students and six faculty members participated in a mixed methods evaluation to assess the model after its inaugural semester of implementation. The evaluation methods included a rating scale that measures the model's ability to provide consistent learning opportunities at both population health and direct care sites, a case study to measure student growth within the five conceptual pillars, and a faculty focus group. Results revealed that the model served as an effective means of clinical education to support the use of multiple, small-scale public health sites. Although measurements of student growth within the pillars are inconclusive, the findings suggest efficacy. The authors recommend the continued use of the pillars constructivist model in baccalaureate programs, with further study of the author-designed evaluation tools. Copyright 2015, SLACK Incorporated.

Assessment and development of implementation models of health ...

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Assessment and development of implementation models of health-related ... The Contribution of Civil Society Organizations in Achieving Health for All ... Health Information for Maternal and Child Health Planning in Urban Bangladesh.

Estimating the effect of lay knowledge and prior contact with pulmonary TB patients, on health-belief model in a high-risk pulmonary TB transmission population.

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Zein, Rizqy Amelia; Suhariadi, Fendy; Hendriani, Wiwin

2017-01-01

The research aimed to investigate the effect of lay knowledge of pulmonary tuberculosis (TB) and prior contact with pulmonary TB patients on a health-belief model (HBM) as well as to identify the social determinants that affect lay knowledge. Survey research design was conducted, where participants were required to fill in a questionnaire, which measured HBM and lay knowledge of pulmonary TB. Research participants were 500 residents of Semampir, Asemrowo, Bubutan, Pabean Cantian, and Simokerto districts, where the risk of pulmonary TB transmission is higher than other districts in Surabaya. Being a female, older in age, and having prior contact with pulmonary TB patients significantly increase the likelihood of having a higher level of lay knowledge. Lay knowledge is a substantial determinant to estimate belief in the effectiveness of health behavior and personal health threat. Prior contact with pulmonary TB patients is able to explain the belief in the effectiveness of a health behavior, yet fails to estimate participants' belief in the personal health threat. Health authorities should prioritize males and young people as their main target groups in a pulmonary TB awareness campaign. The campaign should be able to reconstruct people's misconception about pulmonary TB, thereby bringing around the health-risk perception so that it is not solely focused on improving lay knowledge.

Effects of supplementary private health insurance on physician visits in Korea.

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Kang, Sungwook; You, Chang Hoon; Kwon, Young Dae; Oh, Eun-Hwan

2009-12-01

The coverage of social health insurance has remained limited, despite it being compulsory in Korea. Accordingly, Koreans have come to rely upon supplementary private health insurance (PHI) to cover their medical costs. We examined the effects of supplementary PHI on physician visits in Korea. This study used individual data from 11,043 respondents who participated in the Korean Labor and Income Panel Survey in 2001. We conducted a single probit model to identify the relationship between PHI and physician visits, with adjustment for the following covariates: demographic characteristics, socioeconomic status, health status, and health-related behavior. Finally, we performed a bivariate probit model to examine the true effect of PHI on physician visits, with adjustment for the above covariates plus unobservable covariates that might affect not only physician visit, but also the purchase of PHI. We found that about 38% of all respondents had one or more private health plans. Forty-five percent of all respondents visited one or more physicians, and 49% of those who were privately insured had physician visits compared with 42% of the uninsured. The single probit model showed that those with PHI were about 14 percentage points more likely to visit physicians than those who do not have PHI. However, this distinction disappears in the bivariate probit model. This result might have been a consequence of the nature of private health plans in Korea. Private insurance companies pay a fixed amount directly to their enrollees in case of illness/injury, and the individuals are responsible subsequently for purchasing their own healthcare services. This study demonstrated the potential of Korean PHI to address the problem of moral hazard. These results serve as a reference for policy makers when considering how to finance healthcare services, as well as to contain healthcare expenditure.