Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen
OBJECTIVE: To estimate health status utility (preference) weights for hereditary angioedema (HAE) during an attack and between attacks using data from the Hereditary Angioedema Burden of Illness Study in Europe (HAE-BOIS-Europe) survey. Utility measures quantitatively describe the net impact of a...
Iecovich, Esther; Carmel, Sara
To examine differences in health and functional status and in utilization of health services between holocaust survivors and their counterparts; and (b) to investigate if holocaust survivor status is a significant predictor of health status, functional status, and utilization of health services. The study included 1255 respondents of whom 272 were holocaust survivors. Interviews were conducted face-to-face at the respondents' homes. Participants were asked about their health (self-rated health and comorbidity) and functional (ADL and IADL) status, utilization of inpatient and outpatient health care services, age, gender, education, marital status, length of residence in Israel, and if they were holocaust survivors. Holocaust survivors, who were frailer and more chronically ill compared to their counterparts, visited their family physician and the nurse at the health care clinic more often than their counterparts did, and received more homecare services. Yet, there were no differences between them in the utilization of other health care services such as visits to specialists, emergency department, and hospitalizations. Holocaust survivors are more homebound due to more morbidity and functional limitations and therefore receive more health home care services that offset the utilization of other health services. Copyright © 2010 Elsevier Ireland Ltd. All rights reserved.
Glover, Saundra; Bellinger, Jessica D.; Bae, Sejong; Rivers, Patrick A.; Singh, Karan P.
Objective: The objective of this study is to determine racial and ethnic variations in specialty care utilization based on (a) perceived health status and (b) chronic disease status. Methods: Variations in specialty care utilization, by perceived health and chronic disease status, were examined using the Commonwealth Fund Health Care Quality…
Aguilar-Palacio, Isabel; Carrera-Lasfuentes, Patricia; Solsona, Sofía; Sartolo, M Teresa; Rabanaque, M José
to explore health-care utilization (primary and specialized health-care, hospitalizations, day hospital and emergency services) and overuse in elderly in Spain, considering the influence of health status, sex, social class and its temporal trend. cross sectional study in two phases. Spain. people surveyed in the National Health Surveys 2006 and 2011-12. Health status was measured using self-rated and diagnosed health (number and diagnoses). Social class was obtained from the last occupation of the main supporter (manual and non-manual workers). Logistic regression analyses were conducted adjusting by sex, age, health status, social class and year, obtaining its predictive capacity. the percentage of elderly population with health-care utilization decreased during the period analyzed. Women who belonged to the manual workers category presented the highest prevalence of low health (low self-rated health in 2006: 70.6%). Low health status was associated with a higher utilization of health-care services. Self-rated health was a better predictor of health-care utilization and overuse than diagnosed health, getting the highest predictive capacity for specialized health-care (C = 0.676). Old people from low social class used with higher frequency primary health-care and emergency services. On the other hand, specialized health-care and day hospital were more used by high social classes. inequalities in health and health-care utilization have been observed in elderly according social class. It is necessary to consider self-rated health as a health-care utilization predictor and to review our health-care services accessibility and equity. Copyright © 2015 Elsevier España, S.L.U. All rights reserved.
Shakeel, Sadia; Nesar, Shagufta; Rahim, Najia; Iffat, Wajiha; Ahmed, Hafiza Fouzia; Rizvi, Mehwish; Jamshed, Shazia
Aims: Despite an increased popularity of print and electronic media applications, there is a paucity of data reflecting doctors’ opinions regarding efficient utilization of these resources for the betterment of public health. Hence, this study aimed to investigate the perception of physicians toward the effect of electronic and print media on the health status of patients. Setting and Design: The current research is a cross-sectional study conducted from January 2015 to July 2015. The study p...
Sadia Shakeel; Shagufta Nesar; Najia Rahim; Wajiha Iffat; Hafiza Fouzia Ahmed; Mehwish Rizvi; Shazia Jamshed
Aims: Despite an increased popularity of print and electronic media applications, there is a paucity of data reflecting doctors’ opinions regarding efficient utilization of these resources for the betterment of public health. Hence, this study aimed to investigate the perception of physicians toward the effect of electronic and print media on the health status of patients. Setting and Design: The current research is a cross-sectional study conducted from January 2015 to July 2015. The study p...
Karimi, Saeed; Keyvanara, Mahmoud; Hosseini, Mohsen; Jazi, Marzie Jafarian; Khorasani, Elahe
Today, much attention has been paid to the patient role as the central factor in the management of their own health. It is focused on the issue that the patient has a more critical role compared with the health-care provider in controlling the patient own health. defines health literacy as the degree to which individuals have the capacity to obtain, process, and understand basic health information and services needed to make appropriate health decisions. The objective of this study was to determine health literacy, health status, healthcare utilization and the relationship between them in 18 - 64 years old people in Isfahan. This study was a descriptive analytical survey, which was conducted on 300 subjects of 18-64 years old in Isfahan with Multi-stage sampling method proportional to selected sample size. For collecting the data, questionnaire adapted from CHAP (Consumer Assessment of Healthcare Providers and Systems) health literacy questionnaire was used. Health status was measured based on an assessment of the physical and mental health over the past 6 months by 5° Likert scale. Data analysis was performed by using SPSS 18, descriptive statistics, Chi-square test and multivariate analysis of variance. There was no significant correlation between health literacy, health status and healthcare utilization. Utilization was less in the urban area No. 6 of the city. In the bachelor's degree group, the health status was lower than the other groups in these cases: Older ages, married, women, large family size, undergraduates, and urban area No. 14. Due to the average prevalence of health literacy in 18-64 years old individuals in Isfahan and low- healthcare utilization, the followings are recommended: Necessity of more attention to the issue of health literacy, improving the physician-patient relationship and community awareness, whether through health promotion programs or media for the optimum use of available resources.
Saeed, Bashiru Ii; Xicang, Zhao; Yawson, Alfred Edwin; Nguah, Samuel Blay; Nsowah-Nuamah, Nicholas N N
This study attempts to examine the impact of socioeconomic and medical conditions in health and healthcare utilization among older adults in Ghana. Five separate models with varying input variables were estimated for each response variable. Data (Wave 1 data) were drawn from the World Health Organization Global Ageing and Adult Health (SAGE) conducted during 2007-2008 and included a total of 4770 respondents aged 50+ and 803 aged 18-49 in Ghana. Ordered logits was estimated for self-rated health, and binary logits for functional limitation and healthcare utilization. Our results show that the study provides enough grounds for further research on the interplay between socioeconomic and medical conditions on one hand and the health of the aged on the other. Controlling for socioeconomic status substantially contributes significantly to utilization. Also, aged women experience worse health than men, as shown by functioning assessment, self-rated health, chronic conditions and functional limitations. Women have higher rates of healthcare utilization, as shown by significantly higher rates of hospitalization and outpatient encounters. Expansion of the national health insurance scheme to cover the entire older population--for those in both formal and informal employments--is likely to garner increased access and improved health states for the older population.
Espallargues, Mireia; Czoski-Murray, Carolyn J; Bansback, Nicholas J; Carlton, Jill; Lewis, Grace M; Hughes, Lindsey A; Brand, Christopher S; Brazier, John E
To estimate health status utility values in patients with age-related macular degeneration (ARMD) associated with visual impairments, by using preference-based measures of health. This was a cross-sectional study involving patients with unilateral or bilateral ARMD who attended a large teaching hospital. Patients underwent visual tests (near and distant visual acuity [VA] and contrast sensitivity [CS]) and completed health status questionnaires including the Index of Visual Function (VF)-14 and three preference-based measures (the Health Utilities Index Mark III [HUI-3], the EuroQoL Health Questionnaire [EQ-5D], and the Short Form 6D Health Status Questionnaire [SF-6D]) and the time tradeoff (TTO). The mean health status is presented for five groups, defined according to the VA in the better-seeing eye and for four CS groups. Two hundred nine patients were recruited with substantial loss of visual function as obtained by visual tests (mean decimal VA in the better-seeing eye: 0.2) and self-report (mean VF-14 score: 41.5). The mean (+/-SD) utilities were 0.34 +/- 0.28 for HUI-3, 0.66 +/- 0.14 for SF-6D, 0.72 +/- 0.22 for EQ-5D, and 0.64 +/- 0.31 for TTO. The HUI-3 had the highest correlation with VA and CS (0.40 and -0.34), followed by TTO (0.25 and -0.21). Across the VA and CS groups, only HUI3 and TTO had a significant linear trend (P preference-based measures used. The HUI-3 seems to be the instrument of choice for use in economic evaluations in which community data are needed. It may be more appropriate to base economic models on CS or some combination of CS and VA rather than on VA alone.
Full Text Available Relative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries.The analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth.Efforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1, universal primary education (MDG 2, and women's empowerment (MDG 3.
Ahmed, Saifuddin; Creanga, Andreea A; Gillespie, Duff G; Tsui, Amy O
Relative to the attention given to improving the quality of and access to maternal health services, the influence of women's socio-economic situation on maternal health care use has received scant attention. The objective of this paper is to examine the relationship between women's economic, educational and empowerment status, introduced as the 3Es, and maternal health service utilization in developing countries. The analysis uses data from the most recent Demographic and Health Surveys conducted in 31 countries for which data on all the 3Es are available. Separate logistic regression models are fitted for modern contraceptive use, antenatal care and skilled birth attendance in relation to the three covariates of interest: economic, education and empowerment status, additionally controlling for women's age and residence. We use meta-analysis techniques to combine and summarize results from multiple countries. The 3Es are significantly associated with utilization of maternal health services. The odds of having a skilled attendant at delivery for women in the poorest wealth quintile are 94% lower than that for women in the highest wealth quintile and almost 5 times higher for women with complete primary education relative to those less educated. The likelihood of using modern contraception and attending four or more antenatal care visits are 2.01 and 2.89 times, respectively, higher for women with complete primary education than for those less educated. Women with the highest empowerment score are between 1.31 and 1.82 times more likely than those with a null empowerment score to use modern contraception, attend four or more antenatal care visits and have a skilled attendant at birth. Efforts to expand maternal health service utilization can be accelerated by parallel investments in programs aimed at poverty eradication (MDG 1), universal primary education (MDG 2), and women's empowerment (MDG 3).
Aygören-Pürsün, Emel; Bygum, Anette; Beusterien, Kathleen; Hautamaki, Emily; Sisic, Zlatko; Boysen, Henrik B; Caballero, Teresa
To estimate health status utility (preference) weights for hereditary angioedema (HAE) during an attack and between attacks using data from the Hereditary Angioedema Burden of Illness Study in Europe (HAE-BOIS-Europe) survey. Utility measures quantitatively describe the net impact of a condition on a patient's life; a score of 0.0 reflects death and 1.0 reflects full health. The HAE-BOIS-Europe was a cross-sectional survey conducted in Spain, Germany, and Denmark to assess the real-world experience of HAE from the patient perspective. Survey items that overlapped conceptually with the EuroQol 5-Dimensions (EQ-5D) domains (pain/discomfort, mobility, self-care, usual activities, and anxiety/depression) were manually crosswalked to the corresponding UK population-based EQ-5D utility weights. EQ-5D utilities were computed for each respondent in the HAE-BOIS-Europe survey for acute attacks and between attacks. Overall, a total of 111 HAE-BOIS-Europe participants completed all selected survey items and thus allowed for computation of EQ-5D-based utilities. The mean utilities for an HAE attack and between attacks were 0.44 and 0.72, respectively. Utilities for an acute attack were dependent on the severity of pain of the last attack (0.61 for no pain or mild pain, 0.47 for moderate pain, and 0.08 for severe pain). There were no significant differences across countries. Mean utilities derived from the study approach compare sensibly with other disease states for both acute attacks and between attacks. The impacts of HAE translate into substantial health status disutilities associated with acute attacks as well as between attacks, documenting that the detrimental effects of HAE are meaningful from the patient perspective. Results were consistent across countries with regard to pain severity and in comparison to similar disease states. The results can be used to raise awareness of HAE as a serious disease with wide-ranging personal and social impacts.
Full Text Available Emel Aygören-Pürsün,1 Anette Bygum,2 Kathleen Beusterien,3 Emily Hautamaki,4 Zlatko Sisic,5 Henrik B Boysen,6 Teresa Caballero7 1Angioedema Centre, Department for Children and Adolescents, University Hospital Frankfurt, Goethe University, Frankfurt, Germany; 2Hereditary Angioedema Centre Denmark, Department of Dermatology and Allergy Centre, Odense University Hospital, Odense, Denmark; 3Outcomes Research Strategies in Health, Washington, DC, 4Patient Reported Outcomes, Oxford Outcomes Inc., an ICON plc company, Bethesda, MD, USA; 5ViroPharma Incorporated, Chatsworth House, Maidenhead, UK; 6HAEi – Hereditary Angioedema International Patient Organization for C1 Inhibitor Deficiencies, Skanderborg, Denmark; 7Allergy Department, Hospital La Paz Institute for Health Research (IdiPaz, Biomedical Research Network on Rare Diseases U754 (CIBERER, University Hospital La Paz, Madrid, Spain Objective: To estimate health status utility (preference weights for hereditary angioedema (HAE during an attack and between attacks using data from the Hereditary Angioedema Burden of Illness Study in Europe (HAE-BOIS-Europe survey. Utility measures quantitatively describe the net impact of a condition on a patient’s life; a score of 0.0 reflects death and 1.0 reflects full health.Study design and methods: The HAE-BOIS-Europe was a cross-sectional survey conducted in Spain, Germany, and Denmark to assess the real-world experience of HAE from the patient perspective. Survey items that overlapped conceptually with the EuroQol 5-Dimensions (EQ-5D domains (pain/discomfort, mobility, self-care, usual activities, and anxiety/depression were manually crosswalked to the corresponding UK population-based EQ-5D utility weights. EQ-5D utilities were computed for each respondent in the HAE-BOIS-Europe survey for acute attacks and between attacks.Results: Overall, a total of 111 HAE-BOIS-Europe participants completed all selected survey items and thus allowed for computation
Kevany, Sebastian; Murima, Oliver; Singh, Basant; Hlubinka, Daniel; Kulich, Michal; Morin, Stephen F; Sweat, Michael
Zimbabwe's HIV epidemic is amongst the worst in the world, and disproportionately effects poorer rural areas. Access to almost all health services in Zimbabwe includes some form of cost to the client. In recent years, the socio-economic and employment status of many Zimbabweans has suffered a serious decline, creating additional barriers to HIV treatment and care. We aimed to assess the impact of i) socio-economic status (SES) and ii) employment status on the utilization of health services in rural Zimbabwe. Data were collected from a random probability sample household survey conducted in the Mutoko district of north-western Zimbabwe in 2005. We selected variables that described the economic status of the respondent, including: being paid to work, employment status, and SES by assets. Respondents were also asked about where they most often utilized healthcare when they or their family was sick or hurt. Of 2,874 respondents, all forms of healthcare tended to be utilized by those of high or medium-high SES (65%), including private (65%), church-based (61%), traditional (67%), and other providers (66%) (P=0.009). Most respondents of low SES utilized government providers (74%) (P=0.009). Seventy-one percent of respondents utilizing health services were employed. Government (71%), private (72%), church (71%), community-based (78%) and other (64%) health services tended to be utilized by employed respondents (P=0.000). Only traditional health services were equally utilized by unemployed respondents (50%) (P=0.000). A wide range of health providers are utilized in rural Zimbabwe. Utilization is strongly associated with SES and employment status, particularly for services with user fees, which may act as a barrier to HIV treatment and care access. Efforts to improve access in low-SES, high HIV-prevalence settings may benefit from the subsidization of the health care payment system, efforts to improve SES levels, political reform, and the involvement of traditional
The purpose of this study was to describe the current status of utilization and costs of home health nursing care by the levels of medical institutes in Korea. A secondary analysis of existing data was used from the national electronic data information(EDI) of 148 home health agencies for 6 months from May to Oct 2005 in total. The 148 agencies had multiple services in cerebral infaction, essential hypertension, sequela of cerebrovascular disease, type 2 diabetes mellitus, etc.. The highest 10 rankings of 76 categories of home health nursing services were composed of 96.4% of the total services, such as simple treatment, inflammatory treatment, urethra & bladder irrigation, inserting indwelling catheter etc., in that order. The highest 20 rankings of 226 categories of home examination services were composed of 77.0% of the total home examination services. In addition, the average cost of home health care per visit was 46,088 Won ( approximately 48 $, 1 $=960 Won). The costs ranged from 74,523 Won ( approximately 78 $, loss of chronic kidney function, N18) to 32,270 Won ( approximately 34 $, other cerebrovascular diseases, I67). Results suggest that client characteristics of hospital based HHNC are not different from community based HHNC or visiting nursing services for elderly. The national results will contribute to baseline data used to establish a policy for the home health nursing care system and education.
Full Text Available Aims: Despite an increased popularity of print and electronic media applications, there is a paucity of data reflecting doctors’ opinions regarding efficient utilization of these resources for the betterment of public health. Hence, this study aimed to investigate the perception of physicians toward the effect of electronic and print media on the health status of patients. Setting and Design: The current research is a cross-sectional study conducted from January 2015 to July 2015. The study population comprised physicians rendering their services in different hospitals of Karachi, Pakistan, selected by the nonprobability convenience sampling technique. In this study, 500 questionnaires were distributed through email or direct correspondence. Methods and Materials: Physicians’ perception toward the impact of electronic and print media on the health status of patients was assessed with a 20-item questionnaire. Different demographic characteristics, such as age, gender, institution, position, and experience of respondents, were recorded. Quantitative data were analyzed with the use of Statistical Package for Social Sciences, version 20.0 (SPSS, Chicago, IL. The association of the demographic characteristics of the responses of physicians was determined by one-way ANOVA using 0.05 level of significance. Results: In this study, 254 physicians provided consent to show their responses for research purposes. A response rate of 50.8% was obtained. Nearly one-third of the respondents negated that patients get health benefit using electronic and print media. The majority did not consider electronic and print media as lifestyle-modifying factors. Physicians thought that patients particularly do not rely on mass media for acquiring health information and consider healthcare professionals as unswerving information resource. Conclusions: Mass media can be productive resources to augment awareness among patients, although physicians seem unconvinced about
Shakeel, Sadia; Nesar, Shagufta; Rahim, Najia; Iffat, Wajiha; Ahmed, Hafiza Fouzia; Rizvi, Mehwish; Jamshed, Shazia
Despite an increased popularity of print and electronic media applications, there is a paucity of data reflecting doctors' opinions regarding efficient utilization of these resources for the betterment of public health. Hence, this study aimed to investigate the perception of physicians toward the effect of electronic and print media on the health status of patients. The current research is a cross-sectional study conducted from January 2015 to July 2015. The study population comprised physicians rendering their services in different hospitals of Karachi, Pakistan, selected by the nonprobability convenience sampling technique. In this study, 500 questionnaires were distributed through email or direct correspondence. Physicians' perception toward the impact of electronic and print media on the health status of patients was assessed with a 20-item questionnaire. Different demographic characteristics, such as age, gender, institution, position, and experience of respondents, were recorded. Quantitative data were analyzed with the use of Statistical Package for Social Sciences, version 20.0 (SPSS, Chicago, IL). The association of the demographic characteristics of the responses of physicians was determined by one-way ANOVA using 0.05 level of significance. In this study, 254 physicians provided consent to show their responses for research purposes. A response rate of 50.8% was obtained. Nearly one-third of the respondents negated that patients get health benefit using electronic and print media. The majority did not consider electronic and print media as lifestyle-modifying factors. Physicians thought that patients particularly do not rely on mass media for acquiring health information and consider healthcare professionals as unswerving information resource. Mass media can be productive resources to augment awareness among patients, although physicians seem unconvinced about the extended usage of print/electronic media.
Burke, Sara E.; Dovidio, John F.; Levina, Olga S.; Uusküla, Anneli; Niccolai, Linda M.; Heimer, Robert
Marked overlap between the HIV and injection drug use epidemics in St. Petersburg, Russia, puts many people in need of health services at risk for stigmatization based on both characteristics simultaneously. The current study examined the independent and interactive effects of internalized HIV and drug stigmas on health status and health service utilization among 383 people with HIV who inject drugs in St. Petersburg. Participants self-reported internalized HIV stigma, internalized drug stigma, health status (subjective rating and symptom count), health service utilization (HIV care and drug treatment), sociodemographic characteristics, and health/behavioral history. For both forms of internalized stigma, greater stigma was correlated with poorer health and lower likelihood of service utilization. HIV and drug stigmas interacted to predict symptom count, HIV care, and drug treatment such that individuals internalizing high levels of both stigmas were at elevated risk for experiencing poor health and less likely to access health services. PMID:26050155
Tsala Dimbuene, Zacharie; Amo-Adjei, Joshua; Amugsi, Dickson; Mumah, Joyce; Izugbara, Chimaraoke O; Beguy, Donatien
There is an abundant literature on the relationship between women's education and maternal and child outcomes, including antenatal and postnatal care, onset of antenatal care and skilled birth attendance. However, few studies have adopted the 'equity' lens, despite increasing evidence that inequities between rich and poor are increasing although maternal and child mortality is declining. This study examined the differential effects of women's education within different socioeconomic strata in Africa. The most recent Demographic and Health Surveys (DHS) conducted in the Democratic Republic of the Congo, Egypt, Ghana, Nigeria and Zimbabwe were used. In each country, the original sample was stratified into three socioeconomic groups: poor, middle and rich. For each maternal health service utilization variable, the gross and net effects of women's education, controlling for age, parity, religion, marital status, health insurance, access to health facilities, partner's education and current place of residence, were estimated using logistic regression, taking into account the complex sampling design of the DHS. The findings revealed country-specific variations in maternal health service utilization, and for most indicators there was a clear gradient among socioeconomic strata: women living in better-off households exhibited greater access to, and utilization of, maternal health services. Multivariate analyses revealed that women's education had a positive association with type of antenatal care provider, timing and frequency of antenatal care visits, place of delivery and presence of a skilled birth attendant at delivery. Many other factors were found to be significantly associated with maternal health service utilization. For instance, parity had a negative and significant association with timing of first antenatal care visit. Likewise, partner's education was positively and statistically associated with timing of first antenatal care visit. It is argued that an over
Lu, Liming; Zeng, Jingchun; Zeng, Zhi
Inequalities in demographic, socio-economic and health status for China labor force place them at greater health risks, and marginalized them in the utilization of healthcare services. This paper identifies the inequalities which limit the utilization of health services among China labor force, and provides a reference point for health policy. Data were collected from 23,505 participants aged 15 to 65, from the 2014 China Labor Force Dynamic Survey (a nationwide cross-sectional survey covering 29 provinces with a multi-stage cluster, and stratified, probability sampling strategy) conducted by Sun Yat-sen University. Logistic regression models were used to study the effects of demographic (age, gender, marital status, type of hukou and migration status), socio-economic (education, social class and insurance) and health status (self-perceived general health and several chronic illnesses) variables on the utilization of health services (two-week visiting and hospitalization during the past 12 months). Goodness of fit was assessed using Hosmer-Lemeshow test. Discrimination ability was assessed based on the area under the receiver operating curve (AUC). Migrants with more than 1 (OR 2.80, 95% CI 1.01 ~ 7.82) or none chronic illnesses (OR 1.26, 95% CI 1.01 ~ 7.82) are more likely to be two week visiting to the clinic than non-migrants; migrants with none chronic illnesses (OR 0.61, 95% CI 0.45 ~ 0.82) are less likely to be in hospitalization during the past 12 months than non-migrants. Female, elder, hukou of non-agriculture, higher education level, higher social class, purchasing more insurance and poorer self-perceived health were predictors for more utilization of health service. More insurance benefited more two-week visiting (OR 1.12, 95% CI 1.06 ~ 1.17) and hospitalization during the past 12 months (OR 1.12, 95% CI 1.07 ~ 1.18) for individuals with none chronic illness but not ≥1 chronic illnesses. All models achieved good calibration
Hernández-Quevedo, Cristina; Jiménez-Rubio, Dolores
The increasing proportion of immigrants in Spanish society is placing pressure on the National Health Care System to accommodate the needs of this population group while keeping costs under control. In the year 2000, a law was approved in Spain according to which all people, regardless of their nationality, are entitled to use health care services under the same conditions as Spanish citizens, provided that they are registered in the local population census. However, empirical evidence about differences in health status and health care utilization between the immigrant and the Spanish population is insufficient. This paper uses the 2003 and 2006 Spanish National Health Surveys to explore the existence of inequalities in health and in the access to health services for the immigrant population living in Spain, relative to that of Spaniards. Our results show that there are different patterns in the level of health and the medical care use between the national and the foreign population in Spain: while immigrants' self-reported health relative to that of the Spanish population depends upon individual nationality, all immigrants, regardless of their nationality, seem to face barriers of entry to specialized care. Further research is needed to understand the nature of these barriers in order to design more effective health policies.
Hwang, Stephen W; Gogosis, Evie; Chambers, Catharine; Dunn, James R; Hoch, Jeffrey S; Aubry, Tim
Supportive housing, defined as subsidized housing in conjunction with site-based social services, may help improve the health and residential stability of highly disadvantaged individuals. This study examined changes in health status, quality of life, substance use, health care utilization, and residential stability among 112 homeless and vulnerably housed individuals who applied to a supportive housing program in Toronto, Canada, from December 2005 to June 2007. Follow-up interviews were conducted every 6 months for 18 months. Comparisons were made between individuals who were accepted into the program (intervention) and those who were wait-listed (usual care) using repeated-measures analyses. Individuals who were accepted into the housing program experienced significantly greater improvements in satisfaction with living situation compared with individuals in the usual care group (time, F(3,3,261) = 47.68, p life measures, health status, health care utilization, or substance use between the two groups over time. Significant improvement in residential stability occurred over time, independent of assigned housing group (time, F(3,3,261) = 9.96, p housing on homeless individuals was limited by the small number of participants who were literally homeless at baseline and by the large number of participants who gained stable housing during the study period regardless of their assigned housing status. Nonetheless, this study shows that highly disadvantaged individuals with a high prevalence of poor physical and mental health and substance use can achieve stable housing.
Mišurec, J.; Kopáčková, V.; Lhotáková, Z.; Hanuš, Jan; Weyermann, J.; Entcheva-Campbel, P.; Albrechtová, J.
Roč. 6, JUN 2012 (2012), 63545-1-63545-25 ISSN 1931-3195 R&D Projects: GA ČR GA205/09/1989 Institutional research plan: CEZ:AV0Z60870520 Keywords : chlorophyll * optical indices * Norway spruce * continuum removal * HyMap * actual physiological status * Sokolov basin * forest management Subject RIV: CE - Biochemistry Impact factor: 0.876, year: 2012
Full Text Available Abstract Background Comparisons between refugees receiving health care in settlement-based facilities and persons living in host communities have found that refugees have better health outcomes. However, data that compares utilization of health services between refugees and the host population, and across refugee settlements, countries and regions is limited. The paper will address this information gap. The analysis in this paper uses data from the United Nations High Commissioner of Refugees (UNHCR Health Information System (HIS. Methods Data about settlement populations and the use of outpatient health services were exported from the UNHCR health information system database. Tableau Desktop was used to explore the data. STATA was used for data cleaning and statistical analysis. Differences in various indicators of the use of health services by region, gender, age groups, and status (host national vs. refugee population were analyzed for statistical significance using generalized estimating equation models that adjusted for correlated data within refugee settlements over time. Results Eighty-one refugee settlements were included in this study and an average population of 1.53 million refugees was receiving outpatient health services between 2008 and 2009. The crude utilization rate among refugees is 2.2 visits per person per year across all settlements. The refugee utilization rate in Asia (3.5 was higher than in Africa on average (1.8. Among refugees, females have a statistically significant higher utilization rate than males (2.4 visits per person per year vs. 2.1. The proportion of new outpatient attributable to refugees is higher than that attributable to host nationals. In the Asian settlements, only 2% outpatient visits, on average, were attributable to host community members. By contrast, in Africa, the proportion of new outpatient (OPD visits by host nationals was 21% on average; in many Ugandan settlements, the proportion of outpatient
Weiss, William M; Vu, Alexander; Tappis, Hannah; Meyer, Sarah; Haskew, Christopher; Spiegel, Paul
Comparisons between refugees receiving health care in settlement-based facilities and persons living in host communities have found that refugees have better health outcomes. However, data that compares utilization of health services between refugees and the host population, and across refugee settlements, countries and regions is limited. The paper will address this information gap. The analysis in this paper uses data from the United Nations High Commissioner of Refugees (UNHCR) Health Information System (HIS). Data about settlement populations and the use of outpatient health services were exported from the UNHCR health information system database. Tableau Desktop was used to explore the data. STATA was used for data cleaning and statistical analysis. Differences in various indicators of the use of health services by region, gender, age groups, and status (host national vs. refugee population) were analyzed for statistical significance using generalized estimating equation models that adjusted for correlated data within refugee settlements over time. Eighty-one refugee settlements were included in this study and an average population of 1.53 million refugees was receiving outpatient health services between 2008 and 2009. The crude utilization rate among refugees is 2.2 visits per person per year across all settlements. The refugee utilization rate in Asia (3.5) was higher than in Africa on average (1.8). Among refugees, females have a statistically significant higher utilization rate than males (2.4 visits per person per year vs. 2.1). The proportion of new outpatient attributable to refugees is higher than that attributable to host nationals. In the Asian settlements, only 2% outpatient visits, on average, were attributable to host community members. By contrast, in Africa, the proportion of new outpatient (OPD) visits by host nationals was 21% on average; in many Ugandan settlements, the proportion of outpatient visits attributable to host community members
Background Comparisons between refugees receiving health care in settlement-based facilities and persons living in host communities have found that refugees have better health outcomes. However, data that compares utilization of health services between refugees and the host population, and across refugee settlements, countries and regions is limited. The paper will address this information gap. The analysis in this paper uses data from the United Nations High Commissioner of Refugees (UNHCR) Health Information System (HIS). Methods Data about settlement populations and the use of outpatient health services were exported from the UNHCR health information system database. Tableau Desktop was used to explore the data. STATA was used for data cleaning and statistical analysis. Differences in various indicators of the use of health services by region, gender, age groups, and status (host national vs. refugee population) were analyzed for statistical significance using generalized estimating equation models that adjusted for correlated data within refugee settlements over time. Results Eighty-one refugee settlements were included in this study and an average population of 1.53 million refugees was receiving outpatient health services between 2008 and 2009. The crude utilization rate among refugees is 2.2 visits per person per year across all settlements. The refugee utilization rate in Asia (3.5) was higher than in Africa on average (1.8). Among refugees, females have a statistically significant higher utilization rate than males (2.4 visits per person per year vs. 2.1). The proportion of new outpatient attributable to refugees is higher than that attributable to host nationals. In the Asian settlements, only 2% outpatient visits, on average, were attributable to host community members. By contrast, in Africa, the proportion of new outpatient (OPD) visits by host nationals was 21% on average; in many Ugandan settlements, the proportion of outpatient visits attributable
Yun, Katherine; Fuentes-Afflick, Elena; Curry, Leslie A; Krumholz, Harlan M; Desai, Mayur M
Our objective was to examine the association between parental immigration status and child health and health care utilization. Using data from a national sample of immigrant adults who had recently become legal permanent residents (LPR), children (n = 2,170) were categorized according to their parents' immigration status prior to LPR: legalized, mixed-status, refugee, temporary resident, or undocumented. Logistic regression with generalized estimating equations was used to compare child health and health care utilization by parental immigration status over the prior 12 months. Nearly all children in the sample were reported to be in good to excellent health. Children whose parents had been undocumented were least likely to have had an illness that was reported to have required medical attention (5.4 %). Children whose parents had been either undocumented or temporary residents were most likely to have a delayed preventive annual exam (18.2 and 18.7 %, respectively). Delayed dental care was most common among children whose parents had come to the US as refugees (29.1 %). Differences in the preventive annual exam remained significant after adjusting for socioeconomic characteristics. Parental immigration status before LPR was not associated with large differences in reported child health status. Parental immigration status before LPR was associated with the use of preventive annual exams and dental services. However, no group of children was consistently disadvantaged with respect to all measures.
Paul, Alexander; Nilsson, Anton
This paper estimates the effect of cost-sharing on the demand for children’s and adolescents’ use of medical care. We use a large population-wide registry dataset including detailed information on contacts with the health care system as well as family income. Two different estimation strategies...... caused by factors other than cost-sharing. We find that when care is free of charge, individuals increase their number of doctor visits by 5–10%. Effects are similar in middle childhood and adolescence, and are driven by those from low-income families. The differences across income groups cannot...... are used: regression discontinuity design exploiting age thresholds above which fees are charged, and difference- in-differences models exploiting policy changes. We also estimate combined regression discontinuity difference-in-differences models that take into account discontinuities around age thresholds...
Davis, J C; Dian, L; Khan, K M; Bryan, S; Marra, C A; Hsu, C L; Jacova, P; Chiu, B K; Liu-Ambrose, T
Falls are a costly public health problem worldwide. The literature is devoid of prospective data that identifies factors among fallers that significantly drive health care resource utilization. We found that cognitive function--specifically, executive functions--and cognitive status are significant determinants of health resource utilization among older fallers. Although falls are costly, there are no prospective data examining factors among fallers that drive health care resource utilization. We identified key determinants of health resource utilization (HRU) at 6 and 12 months among older adults with a history of falls. Specifically, with the increasing recognition that cognitive impairment is associated with increased falls risk, we investigated cognition as a potential driver of health resource utilization. This 12-month prospective cohort study at the Vancouver Falls Prevention Clinic (n = 319) included participants with a history of at least one fall in the previous 12 months. Based on their cognitive status, participants were divided into two groups: (1) no mild cognitive impairment (MCI) and (2) MCI. We constructed two linear regression models with HRU at 6 and 12 months as the dependent variables for each model, respectively. Predictors relating to mobility, global cognition, executive functions, and cognitive status (MCI versus no MCI) were examined. Age, sex, comorbidities, depression status, and activities of daily living were included regardless of statistical significance. Global cognition, comorbidities, working memory, and cognitive status (MCI versus no MCI ascertained using the Montreal Cognitive Assessment (MoCA)) were significant determinants of total HRU at 6 months. The number of medical comorbidities and global cognition were significant determinants of total HRU at 12 months. MCI status was a determinant of HRU at 6 months among older adults with a history of falls. As such, efforts to minimize health care resource use related to falls
Full Text Available Abstract Purpose To assess the cross-sectional construct validity of the Health Utilities Index Mark 3 (HUI3 in lung transplantation. Methods Two hundred and thirteen patients (103 pre-transplant and 110 post-transplant with mean age 53 years old (SD 13 were recruited during a randomized controlled clinical trial at the out-patient clinic in a tertiary institution. At baseline, patients self-completed measures that included the HUI3, EuroQol EQ-5D, Hospital Anxiety and Depression Scale (HADS and socio-demographic questionnaire. Six-minute walk test scores and forced expiratory volume in 1 second data were collected from patient's medical records. A priori hypotheses were formulated by members of the transplant team about the expected degree of association between the measures. Correlation coefficients of Results Of the ninety predictions made, forty three were correct but in 31 the correlation was slightly lower than predicted and in 7 the correlations were much higher than predicted. In 48% of the cases, predicted and observed associations were in agreement. Predictions of associations were off by one category in 42% of the cases; in 10% of the cases the predictions were off by two categories. Conclusions This is the first study providing evidence of cross-sectional construct validity of HUI3 in lung transplantation. Results indicate that the HUI3 was able to capture the burden of lung disease before transplantation and that post-transplant patients enjoyed higher health-related quality of life than pre-transplant patients.
Berkhof, Farida F; van den Berg, Jan W K; Uil, Steven M; Kerstjens, Huib A M
Telemedicine, care provided by electronic communication, may serve as an alternative or extension to traditional outpatient visits. This pilot study determined the effects of telemedicine on health-care utilization and health status of chronic obstructive pulmonary disease (COPD) patients. One hundred and one patients were randomized, 52 patients received telemedicine care and 49 had traditional outpatient visits. The primary outcome was COPD-specific health status, measured with the Clinical COPD Questionnaire (CCQ). Secondary outcomes included St. George's Respiratory Questionnaire (SGRQ) and the Short Form-36 (SF-36) and resource use in primary and secondary care. The mean age of the participants was 68 ± 9 years and the mean per cent of predicted forced expiratory volume in 1 s was 40.4 ± 12.5. The CCQ total score deteriorated by 0.14 ± 0.13 in the telemedicine group, and improved by -0.03 ± 0.14 in the control group (difference 0.17 ± 0.19, 95% confidence interval (CI): -0.21-0.55, P = 0.38). The CCQ symptom domain showed a significant and clinically relevant difference in favour of the control group, 0.52 ± 0.24 (95% CI: 0.04-0.10, P = 0.03). Similar results were found for the SGRQ, whereas results for SF-36 were inconsistent. Patients in the control group had significantly fewer visits to the pulmonologist in comparison to patients in the telemedicine group (P = 0.05). The same trend, although not significant, was found for exacerbations after 6 months. This telemedicine model of initiated phone calls by a health-care provider had a negative effect on health status and resource use in primary and secondary care, in comparison with usual care and therefore cannot be recommended in COPD patients in its current form. © 2014 Asian Pacific Society of Respirology.
Probabilistic mapping of descriptive health status responses onto health state utilities using Bayesian networks: an empirical analysis converting SF-12 into EQ-5D utility index in a national US sample.
Le, Quang A; Doctor, Jason N
As quality-adjusted life years have become the standard metric in health economic evaluations, mapping health-profile or disease-specific measures onto preference-based measures to obtain quality-adjusted life years has become a solution when health utilities are not directly available. However, current mapping methods are limited due to their predictive validity, reliability, and/or other methodological issues. We employ probability theory together with a graphical model, called a Bayesian network, to convert health-profile measures into preference-based measures and to compare the results to those estimated with current mapping methods. A sample of 19,678 adults who completed both the 12-item Short Form Health Survey (SF-12v2) and EuroQoL 5D (EQ-5D) questionnaires from the 2003 Medical Expenditure Panel Survey was split into training and validation sets. Bayesian networks were constructed to explore the probabilistic relationships between each EQ-5D domain and 12 items of the SF-12v2. The EQ-5D utility scores were estimated on the basis of the predicted probability of each response level of the 5 EQ-5D domains obtained from the Bayesian inference process using the following methods: Monte Carlo simulation, expected utility, and most-likely probability. Results were then compared with current mapping methods including multinomial logistic regression, ordinary least squares, and censored least absolute deviations. The Bayesian networks consistently outperformed other mapping models in the overall sample (mean absolute error=0.077, mean square error=0.013, and R overall=0.802), in different age groups, number of chronic conditions, and ranges of the EQ-5D index. Bayesian networks provide a new robust and natural approach to map health status responses into health utility measures for health economic evaluations.
Yampolskaya, Svetlana; Sharrock, Patty J; Clark, Colleen; Hanson, Ardis
This longitudinal study examined the parallel trajectories of mental health service use and mental health status among children placed in Florida out-of-home care. The results of growth curve modeling suggested that children with greater mental health problems initially received more mental health services. Initial child mental health status, however, had no effect on subsequent service provision when all outpatient mental health services were included. When specific types of mental health services, such as basic outpatient, targeted case management, and intensive mental health services were examined, results suggested that children with compromised functioning during the baseline period received more intensive mental health services over time. However, this increased provision of intensive mental health services did not improve mental health status, rather it was significantly associated with progressively worse mental health functioning. These findings underscore the need for regular comprehensive mental health assessments focusing on specific needs of the child.
Jacobsen, Christian Bøtcher; Andersen, Lotte Bøgh; Serritzlew, Søren
An important task in governing health services is to control costs. The literatures on both costcontainment and supplier induced demand focus on the effects of economic incentives on health care costs, but insights from these literatures have never been integrated. This paper asks how economic cost...... containment measures affect the utilization of health services, and how these measures interact with the number of patients per provider. Based on very valid register data, this is investigated for 9.556 Danish physiotherapists between 2001 and 2008. We find that higher (relative) fees for a given service...... make health professionals provide more of this service to each patient, but that lower user payment (unexpectedly) does not necessarily mean higher total cost or a stronger association between the number of patients per supplier and the health care utilization. This implies that incentives...
Kurtz Landy, Christine; Sword, Wendy; Ciliska, Donna
Postpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services. This study examined socioeconomically disadvantaged (SED) postpartum women's health, and health service needs and utilization patterns in the first four weeks post hospital discharge, and compared them to more socioeconomically advantaged (SEA) postpartum women's health, health service needs and utilization patterns. Data collected as part of a large Ontario cross-sectional mother-infant survey were analyzed. Women (N = 1000) who had uncomplicated vaginal births of single 'at-term' infants at four hospitals in two large southern Ontario, Canada cities were stratified into SED and SEA groups based on income, social support and a universally administered hospital postpartum risk screen. Participants completed a self-administered questionnaire before hospital discharge and a telephone interview four weeks after discharge. Main outcome measures were self-reported health status, symptoms of postpartum depression, postpartum service needs and health service use. When compared to the SEA women, the SED women were more likely to be discharged from hospital within the first 24 hours after giving birth [OR 1.49, 95% CI (1.01-2.18)], less likely to report very good or excellent health [OR 0.48, 95% CI (0.35-0.67)], and had higher rates of symptoms of postpartum depression [OR 2.7, 95% CI(1.64-4.4)]. No differences were found between groups in relation to self reported need for and ability to access services for physical and mental health needs, or in use of physicians, walk-in clinics and emergency departments. The SED group were more likely to accept public health nurse home visits [OR 2.24, 95% CI(1.47-3.40)]. Although SED women experienced poorer mental and overall health they reported similar health service needs and utilization patterns to more SEA women
Full Text Available Abstract Background Postpartum women who experience socioeconomic disadvantage are at higher risk for poor health outcomes than more advantaged postpartum women, and may benefit from access to community based postpartum health services. This study examined socioeconomically disadvantaged (SED postpartum women's health, and health service needs and utilization patterns in the first four weeks post hospital discharge, and compared them to more socioeconomically advantaged (SEA postpartum women's health, health service needs and utilization patterns. Methods Data collected as part of a large Ontario cross-sectional mother-infant survey were analyzed. Women (N = 1000 who had uncomplicated vaginal births of single 'at-term' infants at four hospitals in two large southern Ontario, Canada cities were stratified into SED and SEA groups based on income, social support and a universally administered hospital postpartum risk screen. Participants completed a self-administered questionnaire before hospital discharge and a telephone interview four weeks after discharge. Main outcome measures were self-reported health status, symptoms of postpartum depression, postpartum service needs and health service use. Results When compared to the SEA women, the SED women were more likely to be discharged from hospital within the first 24 hours after giving birth [OR 1.49, 95% CI (1.01–2.18], less likely to report very good or excellent health [OR 0.48, 95% CI (0.35–0.67], and had higher rates of symptoms of postpartum depression [OR 2.7, 95% CI(1.64–4.4]. No differences were found between groups in relation to self reported need for and ability to access services for physical and mental health needs, or in use of physicians, walk-in clinics and emergency departments. The SED group were more likely to accept public health nurse home visits [OR 2.24, 95% CI(1.47–3.40]. Conclusion Although SED women experienced poorer mental and overall health they reported similar
Williams, E R; Guthrie, E; Mackway-Jones, K; James, M; Tomenson, B; Eastham, J; McNally, D
Seventy-seven frequent attenders at an emergency department (ED) in an inner-city hospital in the UK (defined as seven or more visits in the previous 12 months) were compared with 182 patients who were attending the same department on a routine basis. Patients completed the Schedules for Clinical Assessment in Neuropsychiatry (SCAN) and the Short Form (SF)-36. Information was obtained on 64% of the frequent attenders and 45% underwent a detailed psychiatric assessment. Of the frequent attenders, 45% had psychiatric disorder and 49% had some form of an alcohol-related disorder. Compared with routine attenders, frequent attenders reported lower health status, had more psychiatric disorder (odds ratio: OR=8.2, 95% confidence interval: CI=3.8--18.1), had more general hospital admissions (OR=19.9, 95% CI=8.3--47.8), more psychiatric admissions (OR=167.5, 95% CI=9.5--2959.0), and more GP visits (95% CI for difference=-10.2 to -5.7). There was no evidence that frequent attenders had more somatisation than routine attenders. Specific treatment and management strategies need to be developed for this group of patients, although a substantial proportion may be difficult to engage in the treatment process.
Present development of radiation utilization in Thailand covers two main areas, i.e. (1) production and utilization of radioisotopes and (2) radiation processing and technology. Radioisotope production from 2 megawatts Thai Research Reactor (TRR1/M1) is being studied, directed toward expanding the varieties of radioisotopes, improvement of quality, and technological development on quantity producing to meet the total national needs. However a large amount of radioisotopes is also imported mainly for industrial and medical applications. Radioisotopes and radiations are utilized in nuclear medicine for diagnosis and therapy from 30 hospitals and institutions. X-ray photographing, X-ray computer tomography and others are typical use for medical examination purposes, while Co-60 gamma rays and electron beam are in used for curing. Since 1972, Thailand has been participated to the IAEA/RCA Industrial Project, through the liaison of the Office of Atomic Energy for Peace (OAEP), and increases the awareness of industry to the economic benefits through the uses of nuclear technology. More than 60 companies are using radioisotopes for gauging, examination purposes and production controls, while these radioisotopes are mostly imported. Nuclear techniques in agriculture are addressed concerns with optimizing fertilizer application, determination soil-water-nitrogen fixation relationships, improving animal health and reproduction, measurement of toxic residues, appropriated food preservation techniques and breeding plant for better yield and disease resistance. The eradication of fruit flies by Sterile Insect Technique (SIT) with gamma rays has been successfully applied in northern and middle part of Thailand. The progress and present status of radiation utilization and processing in Thailand will be introduced. (author)
Can the Medical-nursing Combined Care Promote the Accessibility of Health Services for the Elderly in Nursing Home? A Study Protocol of Analysis of the Effectiveness Regarding Health Service Utilization, Health Status and Satisfaction with Care.
Bao, J; Wang, X-J; Yang, Y; Dong, R-Q; Mao, Z-F
Currently, segmentation of healthcare and daily care for the elderly living in nursing homes usually results in the elderly not getting medical treatment timely and effectively. The medical-nursing combined care, which has been put into practice in several areas in China, is developed to enhance the accessibility of healthcare for the elderly. The aim of the study is to explore the effectiveness of the new care service, based on Andersen model, regarding health service utilization, health status and service satisfaction. The effectiveness of medical-nursing combined care will be measured in a cross-sectional study in nine nursing homes in Jianghan District, Wuhan, China, with 1067 old residents expected to participate. The questionnaire containing items of demographics, health service use, service satisfaction and instrument of SF-36 V2 is developed based on the conceptual framework of Andersen behaviour model of health service utilization. Descriptive analysis, variance analysis, multiple factors analysis, and correlation analysis will be performed to compare the sociological characteristics, health service use, health status and service satisfaction of the elderly living in different modes of nursing homes, to explore the influence factors of care effectiveness, as well as to study the relationship between health behaviour and health outcomes. The study design of analysing the effects of medical-nursing combined care and performing the horizontal comparison among the nursing homes under the framework of Andersen model is blazing new trails. Recruitment and design of questionnaire are important issues. Successful data collection and quality control are also necessary. Taking these into account, this study is estimated to provide evidence for the effectiveness of medical-nursing combined care service in China.
Fieldston, Evan S; Shah, Samir S; Hall, Matthew; Hain, Paul D; Alpern, Elizabeth R; Del Beccaro, Mark A; Harding, John; Macy, Michelle L
Observation status, in contrast to inpatient status, is a billing designation for hospital payment. Observation-status stays are presumed to be shorter and less resource-intensive, but utilization for pediatric observation-status stays has not been studied. The goal of this study was to describe resource utilization characteristics for patients in observation and inpatient status in a national cohort of hospitalized children in the Pediatric Health Information System. This study was a retrospective cohort from 2010 of observation- and inpatient-status stays of ≤2 days; all children were admitted from the emergency department. Costs were analyzed and described. Comparison between costs adjusting for age, severity, and length of stay were conducted by using random-effect mixed models to account for clustering of patients within hospitals. Observation status was assigned to 67 230 (33.3%) discharges, but its use varied across hospitals (2%-45%). Observation-status stays had total median costs of $2559, including room costs and $678 excluding room costs. Twenty-five diagnoses accounted for 74% of stays in observation status, 4 of which were used for detailed analyses: asthma (n = 6352), viral gastroenteritis (n = 4043), bronchiolitis (n = 3537), and seizure (n = 3289). On average, after risk adjustment, observation-status stays cost $260 less than inpatient-status stays for these select 4 diagnoses. Large overlaps in costs were demonstrated for both types of stay. Variability in use of observation status with large overlap in costs and potential lower reimbursement compared with inpatient status calls into question the utility of segmenting patients according to billing status and highlights a financial risk for institutions with a high volume of pediatric patients in observation status.
Chiu, Maria; Amartey, Abigail; Wang, Xuesong; Kurdyak, Paul
The purpose of this study was to compare the prevalence of self-reported mental health factors, mental health service use, and unmet needs across the 4 largest ethnic groups in Ontario, Canada: white, South Asian, Chinese, and black groups. The study population was derived from the Canadian Community Health Survey, using a cross-sectional sample of 254,951 white, South Asian, Chinese, and black residents living in Ontario, Canada, between 2001 and 2014. Age- and sex-standardized prevalence estimates for mental health factors, mental health service use, and unmet needs were calculated for each of the 4 ethnic groups overall and by sociodemographic characteristics. We found that self-reported physician-diagnosed mood and anxiety disorders and mental health service use were generally lower among South Asian, Chinese, and black respondents compared to white respondents. Chinese individuals reported the weakest sense of belonging to their local community and the poorest self-rated mental health and were nearly as likely to report suicidal thoughts in the past year as white respondents. Among those self-reporting fair or poor mental health, less than half sought help from a mental health professional, ranging from only 19.8% in the Chinese group to 50.8% in the white group. The prevalence of mental health factors and mental health service use varied widely across ethnic groups. Efforts are needed to better understand and address cultural and system-level barriers surrounding high unmet needs and to identify ethnically tailored and culturally appropriate clinical supports and practices to ensure equitable and timely mental health care.
Bareilly district, Uttar Pradesh to cover maximum number of women. All currently ... inequalities in the utilization of maternal health care services have been ..... With regard to work status, one study made in four Indian states supports our ...
Kim, Hark Rho; Lee, Choong Sung; Sohn, Jae Min; Park, Kyung Bae
The HANARO (High-flux Advanced Neutron Application Research Reactor) is now operating at 24 MW to meet the user's demands in a variety of utilization fields. The most active field is the neutron scattering and diffraction using the currently available HRPD (High Resolution Powder Diffraction), FCD (Four Circle Diffraction), RSI (Residual Stress Instrument), and SANS (Small Angle Neutron Scattering). Using these instruments, we have been investigating such characteristics as materials' crystal structure and phase transition, residual stress, texture, and hard and soft matters. Through examination and inspection of the test specimens, NRF (Neutron Radiography Facility) is contributing to such fields as the nuclear industry, ordnance industry, aerospace industry, and archaeology. The second utilization field is the fuel and material irradiation test. KAERI (Korea Atomic Energy Research Institute) has developed atomized fuel powder and provided it to USA, France and Argentina. Under the RERTR program, KAERI has been contributing to the development of research reactor fuels of better quality. To test the reactor materials and fuels, instrumented and non-instrumented capsules are widely being used. To produce and supply RIs and pharmaceuticals for medical and industrial purposes, HANARO and its RIPF (Radioisotope Production Facility) has been fully complying with demands so that the national welfare might be enhanced by our efforts. NAA (Neutron Activation Analysis) is assisting the nuclear industry, environmental research and the promotion of the health area. To support all active utilizations, HANARO operators have been making every effort to not only improve the systems, if needed, but also to avoid the inadvertent reactor trip. Based upon this stable neutron supply, we have been developing and expanding the utilization fields and facilities. The PNS(Polarized Neutron Spectrometer) is under construction and the reflectometer is in preparation. The BNCT(Boron Neutron
Harmon, C; Nolan, B
The numbers buying private health insurance in Ireland have continued to grow, despite a broadening in entitlement to public care. About 40% of the population now have insurance, although everyone has entitlement to public hospital care. In this paper, we examine in detail the growth in insurance coverage and the factors underlying the demand for insurance. Attitudinal responses reveal the importance of perceptions about waiting times for public care, as well as some concerns about the quality of that care. Individual characteristics, such as education, age, gender, marital status, family composition and income all influence the probability of purchasing private insurance. We also examine the relationship between insurance and utilization of hospital in-patient services. The positive effect of private insurance appears less than that of entitlement to full free health care from the state, although the latter is means-tested, and may partly represent health status. Copyright 2001 John Wiley & Sons, Ltd.
Jun 15, 1991 ... and measles is an important preventive health care strategy. I. In southern Africa, recent ... on pr~vious in-depth investigations. The reasons for ..... of the recent M immunisation campaign in Cape Town/ coupled with access to ...
Jun 15, 1991 ... or population classification.3 In this anicle we have end~avou~ed to complement this ... distribution of services parallels this political divide.8. ,9. Department of .... Cape Town City Council Technical Management. Services .... Health, City of Cape Town, for his co-operation; and to Dr Derek. Yach, of the ...
Fujihara, Kazuya; Sugawara, Ayumi; Heianza, Yoriko; Sairenchi, Toshimi; Irie, Fujiko; Iso, Hiroyasu; Doi, Mikio; Shimano, Hitoshi; Watanabe, Hiroshi; Sone, Hirohito; Ota, Hitoshi
The levels of lipids, especially triglycerides (TG), and obesity are associated with diabetes mellitus (DM). Although typically measured in fasting individuals, non-fasting lipid measurements play an important role in predicting future DM. This study compared the predictive efficacy of lipid variables according to the fasting status and body mass index (BMI) category. Data were collected for 39,196 nondiabetic men and 87,980 nondiabetic women 40-79years of age who underwent health checkups in Ibaraki-Prefecture, Japan in 1993 and were followed through 2007. The hazard ratios (HRs) for DM in relation to sex, the fasting status and BMI were estimated using a Cox proportional hazards model. A total of 8,867 participants, 4,012 men and 4,855 women, developed DM during a mean follow-up of 5.5 years. TG was found to be an independent predictor of incident DM in both fasting and non-fasting men and non-fasting women. The multivariable-adjusted HR for DM according to the TG quartile (Q) 4 vs. Q1 was 1.18 (95% confidence interval (CI): 1.05, 1.34) in the non-fasting men with a normal BMI (18.5-24.9). This trend was also observed in the non-fasting women with a normal BMI. That is, the multivariable-adjusted HRs for DM for TG Q2, Q3 and Q4 compared with Q1 were 1.07 (95% CI: 0.94, 1.23), 1.17 (95%CI: 1.03, 1.34) and 1.48 (95%CI: 1.30, 1.69), respectively. The fasting and non-fasting TG levels in men and non-fasting TG levels in women are predictive of future DM among those with a normal BMI. Clinicians must pay attention to those individuals at high risk for DM.
Seminars on utilization of research reactors were held to enhance experience exchanging among institutes and universities in China. The status of CARR (China Advanced Research Reactor) project is briefly described. The progress in BNCT program in China is introduced. (author)
Tzoumaka-Bakoula, C G; Lovel, H J
A household study of all families with children under age 6 in 3 villages in rural northwest Greece was conducted during August-September 1981. 94 mothers were interviewed about each of their children to find out who they had consulted seeking advice and care during pregnancy, for delivery, during the postnatal period, for child immunization, and in cases of mild or severe child illness. All 142 children were examined physically and developmentally. Information was also collected on the socioeconomic status of the family. Particular causes for concern were the findings that 30% of the mothers said they experienced at least 1 induced abortion; 5% had delivered without the help of any trained birth attendant; most of those who delivered in the district town (usually the more affluent) had not received postnatal care; 37% of the children had not seen a doctor during their 1st year of life either for sickness or for a developmental assessment. Only 41% of the children were fully immunized for their age, and 23% of those who should have begun their immunizations had not. Most of the 30 children who had been severely or chronically ill had bypassed the local doctor and sought services in the district town. There was clear variation in the pattern of health services use and socioeconomic status as shown by the availability of household facilities including water and electricity. The poorer mothers (30% of the sample) were more likely than the more affluent mothers to have delivered at home. Many had had the help of the local midwife, but those who had no help from a trained attendant came from poorer families. Postnatal care was provided to most (79%) of the families by the midwife. The poorer the family, the more likely that a sick child would be treated with a home remedy. Children from poor families were likely never to have seen a doctor and if a child did go, it was likely to be older at the time of the 1st visit. Very few poor families had ever consulted a
Oct 11, 2007 ... of the expectant women did not deliver at a health facility ... health service utilization for childbirth such as education5-8, maternal age 3,6, parity6,8, economic status7, cultural factors and beliefs, lack of skilled staff at primary.
Maternal health care service utilization from health personnel was significantly associated with age at marriage ≥18 years, family size ≤3, birth order ≤2, nuclear family and higher socio‑economic status. Most of the pregnancy related complications were found among women aged >30 years, with birth order ≥3, having ...
In 1978 the Danish government and the Danish Ministry of Trade asked ELSAM and ELKRAFT to accomplish phase two of the evaluation of the possibilities of disposal of high-level radioactive wastes from Danish nuclear power plants in a Danish salt dome. A status is given of the work up til September 1980. 5 salt domes have been evaluated. The field work comprises geophysical investigations, deep test drillings, and hydrogeological investigations. 2 types of repositories are considered, a deep hole repository and a pit repository. Main emphasis is placed on the first type. At the commencement of 1981 all measuring results and investigations will be completed, and the final report is planned to be given to the authorities in April 1981. (BP)
Singh, M [Banaras Hindu Univ. (India)
Utilization of radioisotopes were reviewed briefly in a categorized manner. In plant biochemistry, long lived radioactive carbon ,/sup 14/C, was applied to clarify such metabolic processes as photosynthesis, respiration and protein synthesis, etc., while radioactive oxygen ,/sup 18/O, was used to study the O/sub 2/ generation mechanism. Radioactive phosphorus ,/sup 32/P, was used to detect the amount, grain size of phosphatic fertilizer as well as the time and depth for better utilization. Radioactive sulphur ,/sup 35/S, and nitrogen ,/sup 15/N, could be of use in studies of protein metabolism in plants. Radioactive tracers of other minerals such as N, P, K, Ca, Mg, Zn, Mo, B, and Co were also used to detect their specific role in plants. Use of radioactive isotopes in protein synthesis and transfer of genetic information was described. Radioactive iodine ,/sup 131/I, binding capacity of milk proteins, and radio trace studies in the iodine turn over in the use of radioactive iodine were summarized.
Robards, James; Evandrou, Maria; Falkingham, Jane; Vlachantoni, Athina
Marital status and living arrangements, along with changes in these in mid-life and older ages, have implications for an individual's health and mortality. Literature on health and mortality by marital status has consistently identified that unmarried individuals generally report poorer health and have a higher mortality risk than their married counterparts, with men being particularly affected in this respect. With evidence of increasing changes in partnership and living arrangements in older ages, with rising divorce amongst younger cohorts offsetting the lower risk of widowhood, it is important to consider the implications of such changes for health in later life. Within research which has examined changes in marital status and living arrangements in later life a key distinction has been between work using cross-sectional data and that which has used longitudinal data. In this context, two key debates have been the focus of research; firstly, research pointing to a possible selection of less healthy individuals into singlehood, separation or divorce, while the second debate relates to the extent to which an individual's transitions earlier in the life course in terms of marital status and living arrangements have a differential impact on their health and mortality compared with transitions over shorter time periods. After reviewing the relevant literature, this paper argues that in order to fully account for changes in living arrangements as a determinant of health and mortality transitions, future research will increasingly need to consider a longer perspective and take into account transitions in living arrangements throughout an individual's life course rather than simply focussing at one stage of the life course. Copyright © 2012 Elsevier Ireland Ltd. All rights reserved.
Subjective social status (SSS) predicts health outcomes above and beyond traditional objective measures of social status, such as education, income and occupation. This review summarizes and integrates recent findings on SSS and health. Current studies corroborate associations between low SSS and poor health indicators by extending previous findings to further populations and biological risk factors, providing meta-analytic evidence for adolescents and by demonstrating that negative affect may not confound associations between SSS and self-rated health. Recent findings also highlight the relevance of SSS changes (e.g. SSS loss in immigrants) and the need to consider cultural/ethnical differences in psychological mediators and associations between SSS and health. SSS is a comprehensive measure of one's social position that is related to several poor health outcomes and risk factors for disease. Future investigation, particularly prospective studies, should extend research on SSS and health to further countries/ethnic groups, also considering additional psychological and biological mediators and dynamic aspects of SSS. Recently developed experimental approaches to manipulate SSS may also be promising.
Choi, Y H; Kim, M S; Byon, Y S; Won, J S
This Study was done to design and test an instrument to measure the health status of the elderly including physical, psychological and social dimensions. Data collection was done from July 18 to August 17, 1990. Subjects were 412 older persons in Korea. A convenience sample was used but the place of residence was stratified into large, medium and small city and rural areas. Participants located in Sudaemun-Gu, Mapo-Gu, and Kangnam-Gu, Seoul were interviewed by brained nursing students, and those in Chungju, Jonju, Chuncheon, and Jinju by professors of nursing colleges. Rural residents were interviewed by community health practitioners working in Kungsang-Buk-Do, Kyngsang-Nam-Do, Jonla Buk-Do, and Kyung Ki-Do. The tool developed for this study was a structured questionnaire based on previous literature and then tested for reliability and validity. This tool contained 20 physical health status items, 17 mental-emotional health status items and 38 social health status items. Physical health status items clustered in to six factors such as personal hygiene, activity, home management, digestive, sexual, sensory, and climatization functions. Mental-emotional health status items clustered into two factors, mental health and emotional health. Social health status items clustered into seven factors, grandparent, parent, spouse, friend, kinships, group member and religious role functions. Data analysis included percentage, average, S.D., t-test and ANOVA. The results of the analysis were as follows: 1. The tool measuring the health status of the elderly and developed for this research had a relatively high reliability indicated by a Cronbach = 0.97793. 2. Average score of the subjects physical health status was 4,054 in a 5 point likert scale, mental-emotional health status was 3.803, social health status was 2.939 and the total average was 3.521. The social status of the subjects was the lowest and the next was mental-emotional health status; physical health status was the
Full Text Available Abstract This is a review of the Health Utilities Index (HUI® multi-attribute health-status classification systems, and single- and multi-attribute utility scoring systems. HUI refers to both HUI Mark 2 (HUI2 and HUI Mark 3 (HUI3 instruments. The classification systems provide compact but comprehensive frameworks within which to describe health status. The multi-attribute utility functions provide all the information required to calculate single-summary scores of health-related quality of life (HRQL for each health state defined by the classification systems. The use of HUI in clinical studies for a wide variety of conditions in a large number of countries is illustrated. HUI provides comprehensive, reliable, responsive and valid measures of health status and HRQL for subjects in clinical studies. Utility scores of overall HRQL for patients are also used in cost-utility and cost-effectiveness analyses. Population norm data are available from numerous large general population surveys. The widespread use of HUI facilitates the interpretation of results and permits comparisons of disease and treatment outcomes, and comparisons of long-term sequelae at the local, national and international levels.
Vingilis, Evelyn; Wade, Terrance; Seeley, Jane
This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process…
Buss, T F; Beres, C; Hofstetter, C R; Pomidor, A
Selected health status data for elderly populations from similar industrial cities-Youngstown, Ohio, USA, and Debrecen, Hungary-were compared. Because of their impoverished health care system, unregulated heavily industrialized society, and unhealthful life-styles Hungarians were hypothesized to have poorer health status than Americans, even after taking into account demographic mediating factors. The study provides a health status baseline for elderly Hungarians shortly after communism's fall in 1989-1990 and shows how great a gap exists between Hungarian health status and that in the West. Hungarians were in much poorer health as measured by functional status, symptomatology, medical condition, depression, and subjective health status. Distinctions persisted when controlling for gender, age, and education. Poverty-level (and income) did not explain health status differences. The paper concludes that Hungary should pay more attention to health promotion, prevention, and primary care, as well as to reforming patient management in hospitals, nursing homes, and home care programs.
Keshvari, Mahrokh; Yamani, Niko; Adibi, Peyman; Shahnazi, Hossein
Media play crucial role in disseminating health information. Due to the importance of accurate health news reports, and the national need to professionalism in health journalism, this study aimed to investigate the characteristics of health journalists, and health reporting status and the challenges involved. Using consensus sampling, this descriptive cross-sectional study was conducted on all health news reporters in Isfahan (34 journalists) in 2015-2016. Data collection was done via a researcher-made questionnaire. Content validity of the questionnaire was determined by qualitative method and based on the opinions of six experts. The test-retest reliability coefficient was 98.0. Data analysis was done by Statistical Package for the Social Sciences, version 16 and descriptive statistics and content analysis were used for analyzing the responses to two open questions. Among 34 journalists, 56% were women and 44% men; the majority of journalists (65%) had no specialized training on health reporting, 35% of journalists were not able to understand the health issues, and the knowledge of medical terminology in 59% of them was moderate to low. The most important required skill for reporters was the ability to interpret medical research reports (88%), 97% were eager to participate in specialized health education. Our study showed that health journalists lacked knowledge and specialized training for dissemination of health news. This has brought about serious challenges. Thus, development and implementation of training courses in close collaboration with educational department of the Ministry of Health and news programs professionals at Islamic Republic of Iran Broadcasting is highly recommended.
The status and prospects of radioisotope utilization in Canada was reviewed. It consisted of the history of 60 Co utilization in the past 30-year period and the increase in the annual export of 60 Co in a period 1965-80 and the areas of utilization, such as food irradiation, radiation treatment of human and animal waste, and radiation inactivation of bacteria and viruses in the bioeffluent. The progress of application to nuclear medicine was described in reference to the use of RI including 60 Co and recently developed Canadian positron ECT and Therascan 3128. (Chiba, N.)
HIV/AIDS Care and Treatment in Specialized Teaching Hospitals of. Ethiopia, 2016. Senait Samuel Bramo. 1. , Tesfamichael Alaro Agago. 2*. OPEN ACCESS. Citation: Senait Samuel Bramo,. Tesfamichael Alaro Agago. Utilization. Status of Electronic Information Sources. (EIS) for HIV/AIDS Care and Treatment.
Ben Halima, Mohamed Ali; Rococo, Emeline
Many OECD countries have implemented anti-discrimination laws in recent decades. However, according to the annual report published in 2010 by the French High Authority for the Fight against Discrimination and for Equality, the second most commonly cited factor in discrimination claims since 2005 is a handicap or health status. The aim of this research is to estimate the level of unexplained components in the wage gap that can be attributed to wage discrimination based on health status in France in 2010 utilizing data from the Health, Healthcare and Insurance survey among 1594 individuals. Three health indicators are used: self-perceived health status, activity limitations and long-term chronic illness. To measure the wage gap according to an individual's health status, the analysis considers the endogenous selection of health status and unobserved differences in productivity. The results demonstrate that wage discrimination is experienced by individuals in poor health regardless of the health indicator utilized. The hourly wage rate among individuals with poor self-assessed health status is on average 14.2% lower than among individuals with good self-assessed health status. However, for individuals suffering from a long-term chronic illness or an activity limitation, the gap is 6.3% and 4.5%, respectively. The decomposition performed on wage differences according to health status by correcting for health status selection bias and controlling for unobserved differences in productivity indicates that the 'unexplained component' that can be attributed to wage discrimination is equal to 50%. Copyright © 2014 Elsevier Ltd. All rights reserved.
Full Text Available The older population is increasing worldwide and in many countries older people will outnumber younger people in the near future. This projected growth in the older population has the potential to place significant burdens on healthcare and support services. Meeting the diet and nutrition needs of older people is therefore crucial for the maintenance of health, functional independence and quality of life. While many older adults remain healthy and eat well those in poorer health may experience difficulties in meeting their nutritional needs. Malnutrition, encompassing both under and over nutrition increases health risks in the older population. More recently the increase in obesity, and in turn the incidence of chronic disease in older adults, now justifies weight management interventions in obese older adults. This growing population group is becoming increasingly diverse in their nutritional requirements. Micro-nutrient status may fluctuate and shortfalls in vitamin D, iron and a number of other nutrients are relatively common and can impact on well-being and quality of life. Aging presents a number of challenges for the maintenance of good nutritional health in older adults.
Conclusion: Neoplasm, diseases of the circulatory system, congenital malformations, and poor socioeconomic status were significantly associated with a higher rate of CT utilization. The distribution of disease patterns varied with gender, age groups, salary levels, and health care region's household income levels. Further study is needed to better understand the nature of the findings.
Levy, Moshe; Nir, Adi Rizansky
Tradeoffs between health and wealth are among the most important decisions individuals make, and are central to social and economic policy. Yet, only a few studies have investigated the utility of health and wealth empirically. This paper investigates this utility function both theoretically and empirically. We conduct detailed personal interviews with 180 cancer patients, and also obtain questionnaires from 132 diabetes patients. We find strong support for the utility function U(h, w)=h·log(w), where h denotes health and w denotes wealth. Copyright © 2012 Elsevier B.V. All rights reserved.
Dickson, Eric S
The expected utility theory of decision making under uncertainty, a cornerstone of modern economics, assumes that humans linearly weight "utilities" for different possible outcomes by the probabilities with which these outcomes occur. Despite the theory's intuitive appeal, both from normative and from evolutionary perspectives, many experiments demonstrate systematic, though poorly understood, patterns of deviation from EU predictions. This paper offers a novel theoretical account of such patterns of deviation by demonstrating that EU violations can emerge from evolutionary selection when individual "status" affects inclusive fitness. In humans, battles for resources and social standing involve high-stakes decision making, and assortative mating ensures that status matters for fitness outcomes. The paper therefore proposes grounding the study of decision making under uncertainty in an evolutionary game-theoretic framework.
Park, Chan Hee; Lee, Seung Hyun; Kim, Na Kyung; Kim, Kon Wuk
The use of radiation and radioisotopes in Korea has been increasing each year, and its impact on economy and industry is expected to be increasing progressively following the development of industrial technology and the expansion of their usage. To establish and supporting policies for industries using radiation and radioisotopes, it is necessary to check the status of related industries accurately, as well as to gather data required to establish plans for industrial development by studying both revenues and economic scale (contributing to revenue). o analyze the status of utilization, surveys were carried out on 6,621 organizations engaged in nuclear operations handling radiation and radioisotopes pursuant to the Nuclear Safety Act as of end 2014, on 33,471 medical institutions using radiation generators for medical and diagnostic purposes pursuant to the Medical Service Act, and on 2,218 organizations using radiation generators for animal diagnostics pursuant to the Veterinary License Act. he overall status of the domestic radiation market including the number of user organizations, that of employees, and the size of distributions (imports, productions, and exports) with which the scale of domestic radiation market can be judged showed a growth trend compared to the previous year, though the number of employees for radiation operation in industrial sector, research sector, education sector, military sector, and power plants (nuclear power plants) and the size of imports was reduced somewhat. t is expected that data acquired through periodic surveys on the status of utilization would be utilized practically in establishing governmental policies related to the promotion of usage of radiation and radioisotopes, and also be utilized widely in cultivating and developing the industry efficiently to invigorate the related industries
Park, Chan Hee; Lee, Seung Hyun; Kim, Na Kyung; Kim, Kon Wuk [Business Innovation Office, Korean Association for Radiation Application, Seoul (Korea, Republic of)
The use of radiation and radioisotopes in Korea has been increasing each year, and its impact on economy and industry is expected to be increasing progressively following the development of industrial technology and the expansion of their usage. To establish and supporting policies for industries using radiation and radioisotopes, it is necessary to check the status of related industries accurately, as well as to gather data required to establish plans for industrial development by studying both revenues and economic scale (contributing to revenue). o analyze the status of utilization, surveys were carried out on 6,621 organizations engaged in nuclear operations handling radiation and radioisotopes pursuant to the Nuclear Safety Act as of end 2014, on 33,471 medical institutions using radiation generators for medical and diagnostic purposes pursuant to the Medical Service Act, and on 2,218 organizations using radiation generators for animal diagnostics pursuant to the Veterinary License Act. he overall status of the domestic radiation market including the number of user organizations, that of employees, and the size of distributions (imports, productions, and exports) with which the scale of domestic radiation market can be judged showed a growth trend compared to the previous year, though the number of employees for radiation operation in industrial sector, research sector, education sector, military sector, and power plants (nuclear power plants) and the size of imports was reduced somewhat. t is expected that data acquired through periodic surveys on the status of utilization would be utilized practically in establishing governmental policies related to the promotion of usage of radiation and radioisotopes, and also be utilized widely in cultivating and developing the industry efficiently to invigorate the related industries.
Vásquez, Felipe; Paraje, Guillermo; Estay, Manuel
To measure and explain income-related inequalities in health and health care utilization in the period 2000 - 2009 in Chile, while assessing variations within the country and determinants of inequalities. Data from the National Socioeconomic Characterization Survey for 2000, 2003, and 2009 were used to measure inequality in health and health care utilization. Income-related inequality in health care utilization was assessed with standardized concentration indices for the probability and total number of visits to specialized care, generalized care, emergency care, dental care, mental health care, and hospital care. Self-assessed health status and physical limitations were used as proxies for health care need. Standardization was performed with demographic and need variables. The decomposition method was applied to estimate the contribution of each factor used to calculate the concentration index, including ethnicity, employment status, health insurance, and region of residence. In Chile, people in lower-income quintiles report worse health status and more physical limitations than people in higher quintiles. In terms of health service utilization, pro-rich inequities were found for specialized and dental visits with a slight pro-rich utilization for general practitioners and all physician visits. All pro-rich inequities have decreased over time. Emergency room visits and hospitalizations are concentrated among lower-income quintiles and have increased over time. Higher education and private health insurance contribute to a pro-rich inequity in dentist, general practitioner, specialized, and all physician visits. Income contributes to a pro-rich inequity in specialized and dentist visits, whereas urban residence and economic activity contribute to a pro-poor inequity in emergency room visits. The pattern of health care utilization in Chile is consistent with policies implemented in the country and in the intended direction. The significant income inequality in the
Proctor, Susan P
.... The objectives are to: 1) describe the current health status of this ARNG cohort, 2) examine to what extent the job strain of ARNG service affects the relationship between Civilian job strain and health and job performance outcomes and, 3...
Kaylor, Mary B; Polivka, Barbara J; Chaudry, Rosemary; Salsberry, Pamela; Wee, Alvin G
For women of childbearing age, oral health not only affects their physical and psychological well-being but also that of their children. This study used the 2003-2004 Ohio Family Health Survey (N = 9,819) to examine dental need and utilization by women in Ohio. Predisposing, enabling, and need variables were examined as they effect dental health service utilization by women of childbearing age at different socioeconomic status (SES) levels. The proportion of women in the low SES group self reporting a dental need (18%) was 3 times that of the proportion of women in the higher SES group with a self reported need (6%). Results of bivariate analysis showed that having a dental visit in the past year varied significantly by SES, race, insurance status, provider density, and need. A racial disparity in dental service utilization was noted in the bivariate analysis of the middle SES group. While dental need and type of dental coverage varied by SES, both were significantly associated with utilization of dental services within all 3 SES categories in the logistic regressions. These results suggest that measures need to be implemented to meet the goal of increasing access and utilization of dental health services by low-income populations.
Availability and utilization of health data among council health management teams for health care ... Open Access DOWNLOAD FULL TEXT ... The study focused on knowledge, and skills in data analysis, the level at which ... If this phenomena is not immidiately addressed Health Care Planning will not meet intended results.
Jan 31, 2014 ... High blood pressure and abnormal body mass have been observed to correlate negatively with health status. Of interest in this study, is the impact such health status have on visual function indicated by near point of convergence. In this community based cross sectional study, 250 randomly selected ...
Essink-Bot, M L; van Royen, L; Krabbe, P; Bonsel, G J; Rutten, F F
PROBLEMS: What is the effect of migraine on health status, defined as the patient's physical, psychological, and social functioning? And, suppose that the health status of migraine sufferers appears to be impaired, to what extent is this a consequence of migraine-associated comorbidity rather than
Essink-Bot, M. L.; van Royen, L.; Krabbe, P.; Bonsel, G. J.; Rutten, F. F.
PROBLEMS--What is the effect of migraine on health status, defined as the patient's physical, psychological, and social functioning? And, suppose that the health status of migraine sufferers appears to be impaired, to what extent is this a consequence of migraine-associated comorbidity rather than
Many public health practitioners and organizations view themselves as engaged in the promotion or achievement of equity. However, discussions around public health frequently assume that practitioners and policy-makers take a utilitarian approach to this work. I argue that public health is better understood as a social justice endeavor. I begin by presenting the utility view of public health and then discuss the equity view. This is a theoretical argument, which should help public health to justify interventions for communicable and non-communicable diseases equally, and which contributes to breaking down the 'old/new' public health divide. This argument captures practitioners' views of the work they are engaged in and allows for the moral and policy justification of important interventions in communicable and non-communicable diseases. Systemic interventions are necessary to remedy high rates of disease among certain groups and, generally, to improve the health of entire populations. By viewing diseases as partly the result of failures of health protective systems in society, public health may justify interventions in communicable and non-communicable diseases equally. Public health holds a duty to improve the health of the worst-off in society; by prioritizing this group, the health of the whole community may improve. © The Author(s) 2017. Published by Oxford University Press on behalf of Faculty of Public Health. All rights reserved. For permissions, please e-mail: firstname.lastname@example.org
Utilization of maternal health services in rural primary health centers in Sub- Saharan Africa. ... their pregnancies were normal during antenatal care visits, hostile attitude of health workers, poverty and mode of payment. Majority of the PHCs provided antenatal, normal delivery, and post natal services. Rural mothers lacked ...
Background: data from different studies showed health care behaviour and estimated per capita health care expenditure for the general population, but the specific data for infants at different levels of care are lacking. The objectives of this study were to describe mothers' health service utilization during pregnancy and ...
Nobles, Jenna; Ritterman Weintraub, Miranda; Adler, Nancy
Subjective status, an individual’s perception of her socioeconomic standing, is a robust predictor of physical health in many societies. To date, competing interpretations of this correlation remain unresolved. Using longitudinal data on 8,430 older adults from the 2000 and 2007 waves of the Indonesia Family Life Survey, we test these oft-cited links. As in other settings, perceived status is a robust predictor of self-rated health, and also of physical functioning and nurse-assessed general health. These relationships persist in the presence of controls for unobserved traits, such as difficult-to-measure aspects of family background and persistent aspects of personality. However, we find evidence that these links likely represent bi-directional effects. Declines in health that accompany aging are robust predictors of declines in perceived socioeconomic status, net of observed changes to the economic profile of respondents. The results thus underscore the social value afforded good health status. PMID:23453318
Rosenberger, J.; van Dijk, J.P.; Nagyova, I.; Roland, R.; Geckova, A.M.; van den Heuvel, W.J.; Groothoff, J.W.
Background. Quality of life and perceived health status (PHS) are important indicators of patient care together with morbidity, mortality and health-care resource utilization. The aim of this study is to explore how various medical conditions might influence perceived health status. Methods. The
Wang, Wenjuan; Temsah, Gheda; Mallick, Lindsay
While research has assessed the impact of health insurance on health care utilization, few studies have focused on the effects of health insurance on use of maternal health care. Analyzing nationally representative data from the Demographic and Health Surveys (DHS), this study estimates the impact of health insurance status on the use of maternal health services in three countries with relatively high levels of health insurance coverage-Ghana, Indonesia and Rwanda. The analysis uses propensity score matching to adjust for selection bias in health insurance uptake and to assess the effect of health insurance on four measurements of maternal health care utilization: making at least one antenatal care visit; making four or more antenatal care visits; initiating antenatal care within the first trimester and giving birth in a health facility. Although health insurance schemes in these three countries are mostly designed to focus on the poor, coverage has been highly skewed toward the rich, especially in Ghana and Rwanda. Indonesia shows less variation in coverage by wealth status. The analysis found significant positive effects of health insurance coverage on at least two of the four measures of maternal health care utilization in each of the three countries. Indonesia stands out for the most systematic effect of health insurance across all four measures. The positive impact of health insurance appears more consistent on use of facility-based delivery than use of antenatal care. The analysis suggests that broadening health insurance to include income-sensitive premiums or exemptions for the poor and low or no copayments can increase use of maternal health care. © The Author 2016. Published by Oxford University Press in association with The London School of Hygiene and Tropical Medicine.
Ferguson H Bruce
Full Text Available Abstract Background Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH service provider organizations in Ontario, Canada. Methods A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. Results There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use – access, assess, adapt, and apply – research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. Conclusion These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.
Barwick, Melanie A; Boydell, Katherine M; Stasiulis, Elaine; Ferguson, H Bruce; Blase, Karen; Fixsen, Dean
Children with emotional and behavioural disorders should be able to count on receiving care that meets their needs and is based on the best scientific evidence available, however, many do not receive these services. Implementation of evidence-based practice (EBP) relies, in part, on the research utilization practices of mental health care providers. This study reports on a survey of research utilization practices among 80 children's mental health (CMH) service provider organizations in Ontario, Canada. A web-based survey was distributed to 80 CMH service provider organizations, to which 51 executive directors and 483 children's mental health practitioners responded. Research utilization was assessed using questions with Likert-type responses based on the Canadian Health Services Research Foundation's Four-A's approach: access, assess, adapt, apply. There was general agreement among executive directors and practitioners regarding the capacity of their organizations to use - access, assess, adapt, and apply - research evidence. Overall, both groups rated their organizations as using research information 'somewhat well.' The low response rate to the practitioner survey should be noted. These findings provide a useful benchmark from which changes in reported research utilization in the Ontario CMH sector can be tracked over time, as a function of EBP training and implementation initiatives, for instance. The need to improve access to research evidence should be addressed because it relates to the eventual implementation and uptake of evidence-based practices. Communities of practice are recommended as a strategy that would enable practitioners to build capacity in their adaptation and application of research evidence.
Lee, Shoou-Yih D.; Arozullah, Ahsan M.; Cho, Young Ik; Crittenden, Kathleen; Vicencio, Daniel
The study examines whether social support interacts with health literacy in affecting the health status of older adults. Health literacy is assessed using the short version of the Test of Functional Health Literacy in Adults. Social support is measured with the Medical Outcome Study social support scale. Results show, unexpectedly, that rather…
Leslie, Wilma; Hankey, Catherine
The older population is increasing worldwide and in many countries older people will outnumber younger people in the near future. This projected growth in the older population has the potential to place significant burdens on healthcare and support services. Meeting the diet and nutrition needs of older people is therefore crucial for the maintenance of health, functional independence and quality of life. While many older adults remain healthy and eat well those in poorer health may experienc...
Background: A good school health programme is necessary to optimize the educational opportunities and make appropriate adjustments for optimal development of the school child. This study was done to determine some haematological parameters as a correlate of health status of new entrants in two mission owned ...
Bassford, T L
Hispanic elders living in the United States compose a rapidly increasing population. They are underinsured and more likely to be living in poverty. Health care is hindered in this population by lower access to health services and less use of preventive services. Barriers to access are primarily socioeconomic. Acculturation exerts an effect, primarily through its association with language skills, employment, and education. Cardiovascular disease is the leading cause of mortality for Hispanics, who have a higher prevalence of risk factors for cardiovascular disease, such as diabetes mellitus, obesity, and hyperlipidemia. Although neoplasia is the second most frequent cause of death among Hispanics, as it is in whites who are not Hispanic, Hispanics have an overall lower cancer rate. Cancer rates are increasing, however. Non-insulin-dependent diabetes mellitus is a significant cause of morbidity and mortality in the Hispanic population, affecting nearly a quarter of adult Puerto Ricans and Mexican Americans. Although higher prevalence of obesity in the Hispanic population accounts for some of this difference, some data suggest the possibility of a genetic component as well. Assessment of psychological health in Hispanic elders is impeded by the lack of instruments designed for this population. Distress is often expressed as somatic symptoms. Values traditional to Hispanic culture, such as respeto, allocentrism, and familialism, are important to US Hispanic elders, many of whom were born in rural Mexico. Our knowledge of determinants of healthy aging in this population is still preliminary, but rapidly expanding, in part, because of increased attention to ethnicity in health reporting.
Barbosa, Paulo Cesar Ribeiro; Mizumoto, Suely; Bogenschutz, Michael P; Strassman, Rick J
Ayahuasca is a psychedelic brew originally used for magico-religious purposes by Amerindian populations of the western Amazon Basin. Throughout the last four decades, the use of ayahuasca spread towards major cities in all regions of Brazil and abroad. This trend has raised concerns that regular use of this N,N-dimethyltryptamine- and harmala-alkaloid-containing tea may lead to mental and physical health problems associated typically with drug abuse. To further elucidate the mental and physical health of ayahuasca users, we conducted a literature search in the international medical PubMed database. Inclusion criteria were evaluation of any related effect of ayahuasca use that occurred after the resolution of acute effects of the brew. Fifteen publications were related to emotional, cognitive, and physical health of ayahuasca users. The accumulated data suggest that ayahuasca use is safe and may even be, under certain conditions, beneficial. However, methodological bias of the reviewed studies might have contributed to the preponderance of beneficial effects and to the few adverse effects reported. The data up to now do not appear to allow for definitive conclusions to be drawn on the effects of ayahuasca use on mental and physical health, but some studies point in the direction of beneficial effects. Additional studies are suggested to provide further clarification. Copyright © 2012 John Wiley & Sons, Ltd.
Watts, Delma-Jean; Friedman, Jennifer F; Vivier, Patrick M; Tompkins, Christine E A; Alario, Anthony J
Refugee children can have significant health problems. Our objective was to describe health status and health care utilization of refugee children after resettlement. A retrospective chart review of refugee children was performed. Initial laboratory data was extracted. Primary care visits, emergency room visits, and subspecialty referrals in the first 15 months from arrival were recorded. The sample included 198 refugees, many with positive initial screening tests. After arrival, 21% had an emergency department visit, 40% had a primary care sick visit, and 71% had a primary care follow-up. Mean number of visits ranged from 0.3 for emergency department to 1.9 for follow-up. Fifty-seven percent were referred to at least one subspecialist. Refugee children had substantial disease burden at arrival. Most had primary care follow-up visits and subspecialty referral after resettlement. These visits were largely for problems identified on initial screening and for general pediatric illnesses.
Liu, Yong-Bing; Liu, Liu; Li, Yan-Fei; Chen, Yan-Li
Background: Despite the large volume of research dedicated to health-related behavior change, chronic disease costs continue to rise, thus creating a major public health burden. Health literacy, the ability to seek, understand, and utilize health information, has been identified as an important factor in the course of chronic conditions. Little research has been conducted on the relationship between health literacy and health-related behaviors and health status in elderly Chinese. The aim of this study was to elucidate the relationship between health literacy and health-related behaviors and health status in China. Methods: The subjects enrolled in this study were selected based on a stratified cluster random sampling design. Information involving >4500 older adults in 44 pension institutions in Urumqi, Changji, Karamay, and Shihezi of Xinjiang between September 2011 and June 2012 was collected. The Chinese Citizen Health Literacy Questionnaire (China Health Education Centre, 2008) and a Scale of the General Status were administered and the information was obtained through face-to-face inquiries by investigators. A total of 1452 respondents met the inclusion criteria. A total of 1452 questionnaires were issued and the valid response rate was 96.14% (1396 of 1452). Factors affecting health literacy and the relationship to health literacy were identified by one-way ANOVA and a multiple linear regression model. Results: The average health literacy level of the elderly in nursing homes was relatively low (71.74 ± 28.35 points). There were significant differences in the health literacy score among the factors of age, gender, race, education level, household income, marital conditions, and former occupation (p 0.05). Multiple linear regression analysis showed that the independent influencing factors of health literacy included education level, race, former occupation, household income, age, physical exercise, health examination, smoking, and health information access (p
Burgette, J M; Lee, J Y; Baker, A D; Vann, W F
The objectives of this study were to examine the pattern of association between dental utilization and oral health literacy (OHL). As part of the Carolina Oral Health Literacy Project, clients in the Women, Infants, and Children's Special Supplemental Nutrition Program completed a structured 30-min in-person interview conducted by 2 trained interviewers at 9 sites in 7 counties in North Carolina. Data were collected on clients' OHL, sociodemographics, dental utilization, self-efficacy, and dental knowledge. The outcome, OHL, was measured with a dental word recognition test (30-item Rapid Estimate of Adult Literacy in Dentistry). Descriptive and multiple linear regression methods were used to examine the distribution of OHL and its association with covariates. After adjusting for age, education, race, marital status, self-efficacy, and dental knowledge, multiple linear regression showed that dental utilization was not a significant predictor of OHL (P > 0.05). Under the conditions of this study, dental utilization was not a significant predictor of OHL. © International & American Associations for Dental Research 2015.
Hollifield, M; Paine, S; Tuttle, L; Kellner, R
The authors determined the different effects of hypochondriasis and somatization on health perceptions, health status, and service utilization in a primary care population. The subjects with hypochondriacal responses (HR) on the Illness Attitudes Scales or high somatic concern (HSC) on the Symptom Questionnaire had a worse perception of health and variably used more health services than the control subjects, even though the HR and HSC subjects had the same level of chronic medical disorders. Regression analyses determined that somatization contributed more to negative health perception and service utilization than did hypochondriasis, although an interaction between the two contributed to the use of psychiatric care. The authors discuss the boundary between hypochondriasis and somatization for its implications for research and clinical practice.
Malhotra, Chetna; Malhotra, Rahul; Østbye, Truls; Subramanian, S V
The objective of this study was to examine the association of maternal autonomy with preventive and curative child health care utilization in India. Data from the National Family Health Survey 2005-2006 were used to ascertain association of maternal autonomy (in 3 dimensions: decision making, access to financial resources, freedom of movement) with child's primary immunization status (indicative of preventive health care use) and treatment seeking for child's acute respiratory infection (indicative of curative health care use). Low maternal freedom of movement was associated with higher odds of incomplete primary immunization of the child and for not seeking treatment for the child's acute respiratory infection. Low maternal financial access was associated with increased odds for incomplete primary immunization of the child. The findings show that improvement in autonomy of Indian mothers, especially their freedom of movement, may help improve utilization of health care for their children. © 2012 APJPH.
Connop, P J
Health care services for registered "band" Indians in Ontario are provided primarily by the Canadian Federal Government. Complex management methods preclude the direct involvement of Indian people in the decisions for their health resource allocation. Health indicators, need, and health status indexes are reviewed. The biostatistics of mortality and demography of the Indian and reference populations are aggregated with hospitalization/morbidity experience as the Chen G'1 Index, as an indicator of normative and comparative need. This is weighted by linear measurements of perceived need for preventive medicine programs, as ranked and scaled values of priorities, Zj. These were determined by community survey on 11 Indian reserves using a non-probabilistic psychometric method of "pair comparisons," based upon "Thurstone's Law of Comparative Judgement.," The calculation of the aggregate single unit Indian Health Status Index [Log.G'1].Zj and its potential application in a "zero-base" budget is described.
Marshall, Vanessa J; Kalu, Nnenna; Kwagyan, John; Scott, Denise M; Cain, Gloria E; Hill, Karen; Hesselbrock, Victor; Ferguson, Clifford L; Taylor, Robert E
Ethnic and cultural differences in patterns of alcohol use disorders must be understood in order to address improvement in prevention of such disorders and accessibility to health care services. The purpose of this study was to evaluate factors that influence the utilization of medical and mental health services among alcohol-dependent and non-alcohol-dependent African Americans. A cohort of 454 African Americans was evaluated. Alcohol-dependent participants were recruited from various inpatient treatment facilities in the Washington, DC, metropolitan area and through advertisement and word of mouth. Non-alcohol-dependent participants were recruited by advertisements. Each participant was administered the Semi-Structured Assessment for the Genetics of Alcoholism to assess alcohol dependency and the Family History Assessment module to access family history of alcoholism. Xl Test and analysis of variance were used to analyze the data. Alcohol dependence was more prevalent among men, those with lower income, those with less education, and they utilized mental health counseling as opposed to medical-based therapy. Increased reports of medical conditions such as migraine (p<.001), loss of consciousness (p=.001), and sexually transmitted diseases: (p<.001) were also associated with alcohol dependency. Other factors, including visits to inpatient treatment programs, were directly related to incidence of alcohol dependency regardless of gender status (p<.001). This study suggests an association exists among alcohol dependence, medical conditions, health care, and mental care utilization among African Americans. Future research may benefit from investigating if an association exists between alcohol use disorders and health care utilization for other ethnic groups.
López-Cevallos, Daniel F; Chi, Chunhuei
To examine the relationship between migration and migrant remittances and health care utilization in Ecuador, and to identify any potential equalizing effects. Using data from the 2004 National Demographic and Maternal & Child Health Survey (ENDEMAIN), a multilevel multivariate analysis was conducted to assess the relationship of two migrant predictors (households with an international migrant; use of migrant remittances) with use of preventive care, number of curative visits, hospitalization, and use of antiparasitic medicines. Relevant predisposing, enabling, and need factors were included following Andersen's Model of Health Care Utilization Behavior. Interaction terms were included to assess the potential equalizing effects of migration and remittances by ethnicity, area of residence, and economic status. Migrant predictors were strongly associated with use of antiparasitic medicines, and to a lesser extent, with curative visits, even after adjusting for various predisposing, enabling, and need factors. Interaction models showed that having an international migrant increased use of these services among low-income Ecuadorians (quintiles 1 and 2). No significant relationship was found between migrant predictors and use of preventive services. Migration and remittances seem to have an equalizing effect on access to antiparasitic medicines, and to a lesser extent, curative health care services. Health care reform efforts should take into account the scope of this effect when developing public policy.
Vacková, Jitka; Brabcová, Iva
The aim of this article is to acquaint the general public with select socioeconomic status (SES) parameters (type of work, education level, employment category, and net monthly income) of select nationalities (Ukrainians, Slovaks, Vietnamese, Poles, and Russians) from a total of 1,014 immigrants residing in the Czech Republic. It will also present a subjective assessment of socioeconomic status and its interconnection with subjective assessment of health status. This work was carried out as part of the "Social determinants and their impact on the health of immigrants living in the Czech Republic" project (identification number LD 13044), which was conducted under the auspices of the European Cooperation in Science and Technology (COST) agency. Quantitative methodology in the form of a questionnaire was selected to facilitate the research aim. Data was processed using the Statistical Package for Social Sciences (SPSS), version 16.0 (SPSS, Inc., Chicago, IL, USA). Statistical analyses were performed using the Pearson chi-square test, adjusted residual analysis, and multivariate correspondence analysis. The results of these tests demonstrated a statistically significant relationship between subjective assessments of socioeconomic status and the following related select characteristics: type of work performed (manual/intellectual), employment categories, education, and net monthly income. Results indicate that those situated lowest on the socioeconomic ladder feel the poorest in terms of health; not only from a subjective perspective, but also in terms of objective parameter comparisons (e.g. manual laborers who earn low wages). As the level of subjective SES assessment increases, the level of subjective health assessment increases, as well. Thus, the relationship has a natural gradient, as was described by Wilkinson and Marmot in 2003. Our study found no evidence of a healthy immigrant effect. Therefore, it was not possible to confirm that health status deteriorates
Objective: The health status of most people living in developing countries of the world remains poor. Linked to this are some factors, of which low utilization of PHC facilities remain a major issue. This study therefore aimed to determine the utilization of PHC services in a sub-urban community in a developing country in West ...
Shaikh, Babar T; Hatcher, Juanita
There is a growing literature on health seeking behaviours and the determinants of health services utilization especially in the context of developing countries. However, very few focused studies have been seen in Pakistan in this regard. This paper presents an extensive literature review of the situation in developing countries and relates the similar factors responsible for shaping up of a health seeking behaviour and health service utilization in Pakistan. The factors determining the health behaviours may be seen in various contexts: physical, socio-economic, cultural and political. Therefore, the utilization of a health care system, public or private, formal or non-formal, may depend on socio-demographic factors, social structures, level of education, cultural beliefs and practices, gender discrimination, status of women, economic and political systems environmental conditions, and the disease pattern and health care system itself. Policy makers need to understand the drivers of health seeking behaviour of the population in an increasingly pluralistic health care system. Also a more concerted effort is required for designing behavioural health promotion campaigns through inter-sectoral collaboration focusing more on disadvantaged segments of the population.
Iqbal, S.; Qureshi, A.; Iqbal, N.; Khan, A.A.
Diabetes causes numerous oral and salivary changes leading to cariogenic and gingival lesions. The present study was designed to elucidate the role of diabetes mellitus in oral health. A cross-sectional study including 60 diabetic children (case group) and 30 non diabetic children (control group) of age 3-14 years was conducted. HbA1c and blood glucose level was measured along with the oral health including gingival status and dental caries status was visually assessed. Gingival status was coded for healthy, marginal gingivitis and calculus. Dental caries status (decayed and filled) for both deciduous and permanent dentition was assessed. Data was recorded in a pre-coded oral health proforma, which was then entered and analyzed in SPSS version 10.0. Descriptive analysis such as percentage frequencies and means was performed. Exact Chi-square test was used to analyze any significant changes observed amongst the study population, where level of significance was p < 0.05 with confidence interval 95%. The results show important difference between both groups of children. Dental caries level is significantly higher in diabetic children both in deciduous and permanent dentition than in non-diabetic children (p <0.05). Gingival health was also observed to be debilitated in diabetic children than nondiabetic children (p < 0.05). Conclusion: The study highlights that special preventive measures must be adopted to maintain a good oral health of the diabetic children. (author)
Khaled, Salma M; Shockley, Bethany; Abdul Rahim, Hanan F
To explore the role of citizenship status as a predictor of general satisfaction with healthcare services in Qatar, including potential interaction with utilization and health insurance coverage type. A cross-sectional survey conducted in 2012. A household survey in the State of Qatar in the Arab Gulf. A nationally representative sample of 2750 citizens and noncitizens aged 18 years and older. General satisfaction status with Qatar's healthcare system. Citizenship status, healthcare utilization, health insurance type. Citizens were significantly less likely to be satisfied with Qatar's healthcare system than noncitizens (odds ratio (OR) = 0.30, P citizenship (P citizenship groups. These differences may stem from different expectations with respect to healthcare services. Understanding these expectations may have important policy implications for cross-cultural contexts. © The Author 2016. Published by Oxford University Press in association with the International Society for Quality in Health Care. All rights reserved. For permissions, please e-mail: email@example.com
Abellan-Perpiñan, Jose Maria; Bleichrodt, Han; Pinto-Prades, Jose Luis
Most health care evaluations today still assume expected utility even though the descriptive deficiencies of expected utility are well known. Prospect theory is the dominant descriptive alternative for expected utility. This paper tests whether prospect theory leads to better health evaluations than expected utility. The approach is purely descriptive: we explore how simple measurements together with prospect theory and expected utility predict choices and rankings between more complex stimuli. For decisions involving risk prospect theory is significantly more consistent with rankings and choices than expected utility. This conclusion no longer holds when we use prospect theory utilities and expected utilities to predict intertemporal decisions. The latter finding cautions against the common assumption in health economics that health state utilities are transferable across decision contexts. Our results suggest that the standard gamble and algorithms based on, should not be used to value health.
Herrmann, W.J.; Haarmann, A.; Baerheim, A.
Traditional measurement models of health care utilization are not able to represent the complex structure of health care utilization. In this qualitative study, we, therefore, developed a new model to represent the health care utilization structure. In Norway and Germany, we conducted episodic
Medina, Carmen; Salvador, Xavier; Faixedas, M Teresa; Gallo, Pedro
The purpose of this article is disclose services utilization patterns among the Catalan population with particular emphasis on primary care, specialised care, hospital care and emergency care. A number of logistic regression models were used to explain the utilization of the various types of services. Variables in the analysis included self-perceived need, lifestyles, and sociodemographic variables. Separate analyses were performed for male, female, adults, and children as well as for the general population. Women use all types of services more often than men. Children and people over 64 are more frequent users of primary care. Primary care is also associated to lower socioeconomic conditions. Young adults and the migrant population in general are found to be under users of services, except of emergency care services. The use of specialised care is associated to the better-off, to those with university level education attainment, individual private insurance, and those living in the city of Barcelona. Hospital care is largely associated to need variables. The use of health services is explained by self-perceived need as well as by demographic, socioeconomic and geographical factors. Copyright © 2011 Elsevier España S.L. All rights reserved.
Ferrer, R; Palmer, R
Objectives: To analyse the variability in health status within as well as between socioeconomic groups. What is the range of individual variability in the health effects of socioeconomic status? Is the adverse effect of lower socioeconomic status uniform across the entire distribution of health status?
Su, Dejun; Wang, Daphne
Health services from Mexico constitute an important source of care for U.S. residents living along the U.S.-Mexico border. Data from The Cross-Border Utilization of Health Care Survey (n = 966) were used to estimate logit models that related acculturation, as measured by generational status, to the use of medication, physician, dental, and inpatient services from Mexico by U.S. residents in the Texas border region. Relative to first-generation Mexican immigrants, later-generation Mexican-Americans were progressively less likely to go to Mexico for health services. This finding holds with or without adjusting for the effects of selected demographic and socioeconomic variables. Addressing unmet needs in medical care in the southwestern U.S. border area should go beyond a simple expansion of health insurance coverage--it is also important to deliver health services that are sensitive to generational differences within the population in terms of linguistic and cultural barriers to health care access.
Full Text Available Background: Despite the large volume of research dedicated to health-related behavior change, chronic disease costs continue to rise, thus creating a major public health burden. Health literacy, the ability to seek, understand, and utilize health information, has been identified as an important factor in the course of chronic conditions. Little research has been conducted on the relationship between health literacy and health-related behaviors and health status in elderly Chinese. The aim of this study was to elucidate the relationship between health literacy and health-related behaviors and health status in China. Methods: The subjects enrolled in this study were selected based on a stratified cluster random sampling design. Information involving >4500 older adults in 44 pension institutions in Urumqi, Changji, Karamay, and Shihezi of Xinjiang between September 2011 and June 2012 was collected. The Chinese Citizen Health Literacy Questionnaire (China Health Education Centre, 2008 and a Scale of the General Status were administered and the information was obtained through face-to-face inquiries by investigators. A total of 1452 respondents met the inclusion criteria. A total of 1452 questionnaires were issued and the valid response rate was 96.14% (1396 of 1452. Factors affecting health literacy and the relationship to health literacy were identified by one-way ANOVA and a multiple linear regression model. Results: The average health literacy level of the elderly in nursing homes was relatively low (71.74 ± 28.35 points. There were significant differences in the health literacy score among the factors of age, gender, race, education level, household income, marital conditions, and former occupation (p < 0.001. The health literacy score was significantly associated with smoking, drinking, physical exercise, and health examination (p < 0.001. The elderly with higher health literacy scores were significantly less likely to have risky behaviors
Taichman, L Susan; Griggs, Jennifer J; Inglehart, Marita R
This population-based analysis examined the prevalence of periodontal diseases along with the self-perceived oral health and patterns of dental care utilization of breast cancer survivors in the United States. Data from the 1999-2004 National Health and Nutrition Surveys were utilized, examining information from 3,354 women between 50 and 85 years of age. Primary outcomes were gingivitis and periodontitis, self-perceived oral health, and dental care utilization. Logistic regression analyses were used to estimate relationships of breast cancer diagnosis and primary outcomes while controlling for confounding factors. Breast cancer survivors were more likely to be older than 55 years, white, nonsmokers, have higher levels of education and income, and a higher prevalence of osteoporosis. Breast cancer survivors were significantly less likely to have dental insurance (P = 0.04). Utilization of dental services and reason for last dental visit did not significantly differ between groups. A history of a breast cancer diagnosis did not increase the odds of gingivitis [odds ratio (OR): 1.32; 95 percent confidence interval (CI): 0.53-3.63], periodontitis (OR: 1.82; 95 percent CI: 0.89-4.01), or poor self-perceived oral health (OR: 0.89; 95 percent CI: 0.61-1.33) after adjusting for age, race, education, dental care utilization, and smoking status. In this sample, a history of breast cancer does not significantly impact periodontal health, self-perceived oral health, and dental care utilization. However, efforts should be made to assure that breast cancer survivors have dental insurance. © 2015 American Association of Public Health Dentistry.
Bains, Ranbir M; Cusson, Regina; White-Frese, Jesse; Walsh, Stephen
We summarize utilization patterns for mental health services in school-based health centers. Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were stratified by sex, ethnicity/race, and insurance status. Mental health visits accounted for the highest proportion of visits (31.8%). The proportion of mental health visits was highest at 8 years (42.8%) and at 13 years (39.0%). The proportion of mental health visits among boys (38.4%) was higher than among girls (26.7%). Hispanic students had a lower proportion of mental health visits than black students (23.5% vs 35.8%) in all but 2 age groups. Students in the white/other ethnicity category had higher proportions of mental health visits than Hispanic and black students between ages 12 and 15. Students with no health insurance (22.5%) had lower proportions of mental health visits than students covered by Medicaid (34.3%) or private insurance (33.9%). The percentage of mental health visits by students with private insurance was highest (37.2%-49%) in the 13-15 age range. Usage patterns for mental health issues show pronounced, nonrandom variation relative to age and other demographic characteristics especially with 8-year-old boys. © 2017, American School Health Association.
Jacobi, Catharina E.; Mol, Geert D.; Boshuizen, Hendriek C.; Rupp, Ines; Dinant, Huibert J.; van den Bos, Geertrudis A. M.
Objective. To quantify the impact of socioeconomic status (SES) among patients with rheumatoid arthritis on 1) health outcomes and related health care utilization in relation to disease duration and 2) changes in health outcomes and related health care utilization over a 2-year period. Methods. A
Jan 16, 2013 ... Objective: To determine students' perception of health care services provided in a tertiary institution and ... evaluation of health services utilization among students in the .... African culture and health. ... Asian Am Pac Isl J.
... definition of exempt wholesale generator or foreign utility company (including stating the location of its... obtaining exempt wholesale generator and foreign utility company status. 366.7 Section 366.7 Conservation of... THE PUBLIC UTILITY HOLDING COMPANY ACT OF 2005, FEDERAL POWER ACT AND NATURAL GAS ACT BOOKS AND...
Schachter, Ariela; Kimbro, Rachel T; Gorman, Bridget K
Bilingual immigrants appear to have a health advantage, and identifying the mechanisms responsible for this is of increasing interest to scholars and policy makers in the United States. Utilizing the National Latino and Asian American Study (NLAAS; n = 3,264), we investigate the associations between English and native-language proficiency and usage and self-rated health for Asian and Latino U.S. immigrants from China, the Philippines, Vietnam, Mexico, Cuba, and Puerto Rico. The findings demonstrate that across immigrant ethnic groups, being bilingual is associated with better self-rated physical and mental health relative to being proficient in only English or only a native language, and moreover, these associations are partially mediated by socioeconomic status and family support but not by acculturation, stress and discrimination, or health access and behaviors.
Untawale, A.G.; Dhargalkar, V.K.
various applied aspects like evaluation of seaweed resources, utilization, management, harvesting techniques and conservation in India. there seems to be a vast potential of using seaweeds for food, feed, fertilization and medicine in the 21st century...
.... Therefore, health status is an increasingly important concept in the management of HF. In fact, most symptomatic patients are more concerned about their everyday health status than the length of their life...
Lui, Li-Yung; McCulloch, Charles E.; Cauley, Jane A.; Paudel, Misti L.; Taylor, Brent; Schousboe, John T.; Ensrud, Kristine E.
Background: Although there are several consensus definitions of sarcopenia, their association with health care utilization has not been studied. Methods: We included women from the prospective Study of Osteoporotic Fractures with complete assessment of sarcopenia by several definitions at the Study of Osteoporotic Fractures Year 10 (Y10) exam (1997–1998) who also had available data from Medicare Fee- For-Service Claims (N = 566) or Kaiser Encounter data (N = 194). Sarcopenia definitions evaluated were: International Working Group, European Working Group for Sarcopenia in Older Persons, Foundation for the NIH Sarcopenia Project, Baumgartner, and Newman. Hurdle models and logistic regression were used to assess the relation between sarcopenia status (the summary definition and the components of slowness, weakness and/or lean mass) and outcomes that included hospitalizations, cumulative inpatient days/year, short-term (part A paid) skilled nursing facility stay in the 3 years following the Y10 visit. Results: None of the consensus definitions, nor the definition components of weakness or low lean mass, was associated with increased risk of hospitalization or greater likelihood of short-term skilled nursing facility stay. Women with slowness by any criterion definition were about 50% more likely to be hospitalized; had a greater rate of hospitalization days amongst those hospitalized; and had 1.8 to 2.1 times greater likelihood of a short-term skilled nursing facility stay than women without slowness. There was the suggestion of a protective association of low lean mass by the various criterion definitions on short-term skilled nursing facility stay. Conclusion: Estimated effects of sarcopenia on health care utilization were negligible. However, slowness was associated with greater health care utilization. PMID:27402050
Results: Mother's age at birth, mother's educational level, sex of head of household, household wealth status, employment/work status of mothers, region, religion, birth order and partner's/husband's level of educational were found to be predictors of utilization of delivery care and postnatal care services. Religion and sex of ...
Background: Information on health service utilization is crucial for planning, organizing and evaluation of health services. Objective: Assess perceived morbidity and examine the factors associated with utilization of health services by a sample of the population of the Amhara Region. Methods: Questionnaire was ...
The level of accessibility increases with increasing utilization. Distance was a barrier to the utilization of health facilities due to the uneven distribution of health facilities and the inability of patients to overcome economic distance. Greater investment by government in the health sector would guarantee more equitable access ...
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Background: Inequalities in reproductive and child health (RCH exist, in general, in different regions of India. The present study aims to investigate the current status of RCH and examine the factors responsible for it in different parts of India.
Methods: This study utilized data obtained from two Indian studies – (i National Family Health Survey – 3 (NFHS- 2005-06 and (ii District Level Household Survey (DLHS – 2002-04. Reproductive Health Index was computed on the basis of five variables such as total fertility rate, infant mortality rate, birth order, delivery care and female educational attainment.
Results: In terms of reproductive and child health, a wide range of variation exists in India in its different regions. The study reveals that among Indian states, 13 states have an index value less than the national average. On the basis of the reproductive health index, the Indian states can be divided into three categories, namely; progressive states, semi progressive states and backward states.
Conclusions: The interstate differences in healthcare utilization are partly due to variations in the implementation of maternal health care programs as well as differences in availability of and accessibility to healthcare between Indian states.
Benítez-Silva, Hugo; Ni, Huan
Expected longevity is an important factor influencing older individuals’ decisions such as consumption, savings, purchase of life insurance and annuities, claiming of Social Security benefits, and labor supply. It has also been shown to be a good predictor of actual longevity, which in turn is highly correlated with health status. A relatively new literature on health investments under uncertainty, which builds upon the seminal work by Grossman (1972), has directly linked longevity with characteristics, behaviors, and decisions by utility maximizing agents. Our empirical model can be understood within that theoretical framework as estimating a production function of longevity. Using longitudinal data from the Health and Retirement Study, we directly incorporate health dynamics in explaining the variation in expected longevities, and compare two alternative measures of health dynamics: the self-reported health change, and the computed health change based on self-reports of health status. In 38% of the reports in our sample, computed health changes are inconsistent with the direct report on health changes over time. And another 15% of the sample can suffer from information losses if computed changes are used to assess changes in actual health. These potentially serious problems raise doubts regarding the use and interpretation of the computed health changes and even the lagged measures of self-reported health as controls for health dynamics in a variety of empirical settings. Our empirical results, controlling for both subjective and objective measures of health status and unobserved heterogeneity in reporting, suggest that self-reported health changes are a preferred measure of health dynamics. PMID:18187217
Mommersteeg, Paula M C; Denollet, Johan; Spertus, John A
Patient-perceived health status is receiving increased recognition as a patient-centered outcome in chronic heart failure (CHF) and coronary artery disease (CAD), but poor health status is also associated with adverse prognosis. In this systematic review, we examined current evidence...... on the influence of health status on prognosis in CHF and CAD....
Park, So-Youn; Cho, Sunhee; Park, Yeddi; Bernstein, Kunsook S.; Shin, Jinah K.
This study adapted Andersen's Health Belief Model to examine the predictors of mental health services utilization among Korean American (KA) immigrants. A cross-sectional survey was used to gather data on 363 KA immigrants 18 years and older residing in New York City. Predisposing factors included gender, age, marital status, education, length of stay in the US, and religion; the need factor was depression; and enabling factors included health insurance, English proficiency, income, and perceived need for help. Approximately 8.5 % of participants reported having utilized mental health services, while 23 % reported having depressive symptoms. Shorter duration of residence in the US, lower income, and the presence of perceived need for help were significantly related to use of mental health services. The perceived need for help mediated the relationship between depression and mental health service utilization. Failure to perceive the need for psychological help continues to be a major reason that KA immigrants do not use mental health services. PMID:23417654
The present status and prospects of RI and radiation utilization in Indonesia, which developed under the Government's assistance and supervision since the opening of the research reactor in 1965, was reviewed. Utilization of short half-life RI in various fields was described. Utilization in medicine, sterilization of medical supplies, the industrial world and hydrology was detailed. Annual changes in these fields were shown and tables were presented. The status of various types of radiation and RI utilization in Indonesia, which included nuclear analytical techniques in industry and various laboratories in agriculture, industry and biology, was reported. Finally, the plan of construction of a third research reactor was referred to. (Chiba, N.)
Strategies Utilized by Professional Nurses in the Primary Health Care Facilities Regarding Adherence of Patients to Anti-Retroviral Therapy (ART) in Capricorn District, Limpopo Province, South Africa.
Conclusions: Although high FeNO levels suggested the existence of AC, lower FeNO levels had limited diagnostic significance. Atopic status affects the utility of FeNO levels in the differential diagnosis of prolonged and chronic cough.
Qian, Yuyan; Zhou, Zhongliang; Yan, Ju'e; Gao, Jianmin; Wang, Yuping; Yang, Xiaowei; Xu, Yongjian; Li, Yanli
The Chinese government has long been committed to eliminating the inequality in the utilization of health services; however, it still lacks an analysis or measurement of the economy-related inequality in the utilization of women's health services. The economy-related utilization of health services in women aged 15 years and above was assessed by the horizontal inequity index of a two-week outpatient rate and annual inpatient rate from the 5th National Health Service Survey of Shaanxi Province. The concentration index of each factor was decomposed into the contribution of each factor to the economic-related inequality of health service utilization based on the Probit regression model. The horizontal inequity indexes of the two-week outpatient rate was 0.0493, and the horizontal inequity indexes of the annual impatient rate was 0.0869. The contributions of economic status to the two indexes were 190.71% and 115.80%, respectively. Economic status, age, basic medical insurance, educational status, marital status, urban/rural area, and self-rated health were the main impact factors that affected the inequality in women's health services utilization in Shaanxi. Health service utilization was different between women with different social demographic characteristics, and unequal health service utilization is evident among women in Shaanxi.
Kim, Bong Goo; Lee, Chang-Hee; Lee, Chung Young
Since the commencement of HANARO operations in 1995, some parts of the reactor systems have been gradually improved for a stable operation of the reactor, while the operation mode has been flexibly adjusted to meet users and customers' demands. During the same period, a significant number of experimental facilities have been developed and installed for the use of the 32 vertical holes and the 7 horizontal beam ports. Owing to a stable operation of the reactor and a rapid proliferation in the utilization fields, more experimental facilities are continuously being added to satisfy the increasing and new research needs arising. As a nation-wide neutron research facility, HANARO is now successfully utilized in various fields including neutron beam research, fuel and material tests, radioisotope production, neutron activation analysis, and neutron transmutation doping, etc. (Author)
Berbey, Pierre; Hedin, Francois
In 1991 5 major European Utilities participating in the US ALWR program decided to develop together a common specification that would contribute to keep the nuclear option open. The European Utility Requirements (EUR) are addressed to the designers and suppliers of LWR plants in order to allow the development of standards designs that can be build and licensed in several European countries with only minor variations. The EUR organization has kept enlarging; today 16 utilities are members of the EUR organization. Seven compliance analyses dedicated respectively to the BWR90, EPR, EPP, ABWR, SWR1000, AP1000 and to the AES92 projects have been already published. The revised version of the EPR subset of the EUR volume 3 was finalized in mid 2009. New LWR projects of potential interest for the EUR utilities are being contemplated. For instance a preliminary assessment of compliance of MHI's APWR project has been worked out in the first months of 2008. Recently EUR organization has decided to launch coordinated actions with other industry groups and other stakeholders. In particular EUR and ENISS organizations have decided to join their efforts in their relations with the IAEA and WENRA organizations with respect to the LWR Gen3 designs. In addition EUR and CORDEL (Cooperation in Reactor Design Evaluation and Licensing), which is a WNA (World Nuclear Association) working group decided also to coordinate their efforts for the industry benefit, in relation with the MDEP (Multinational Design Evaluation Program) initiative of safety nuclear regulators. Contacts have been also initiated with ENEN and the WNU in order to develop new courses for young professionals. (orig.)
In Japan Atomic Energy Research Institute, Takasaki Radiation Chemistry Research Establishment is in charge of the utilization of irradiation, and Tokai Research Establishment is in charge of the production and utilization of radioisotopes. As for the utilization of irradiation the development of new polymers, the development of environment preservation technology such as flue gas treatment, and by using various ion beams from four accelerators, the development of the materials used for space environment, nuclear fusion and new functional materials, the research on the radiation application to biotechnology, the development of the production and utilization of new radioisotopes have been carried out. As for the production and utilization of radioisotopes, the development of new products and new utilization techniques, the technology of producing and using a large amount of tritium, and the research on the chemical behavior of tritium have been carried out. The international cooperations have been promoted positively. In this report, the research activities in 1994 are described. (K.I.)
M. Yu. Arkhipova
Full Text Available The health status was analyzed in extremely preterm infants at a postconceptual age of 38–40 weeks and in the first year of life. All the infants in the analyzed group were shown to have respiratory disorders, severe perinatal CNS lesions, and the high incidence of bronchopulmonary dysplasia and infectious and inflammatory diseases. In the first year of life, these children belonged to a group of the frequently ill. Dysfunction of the digestive system and intestinal microflora and residual signs of rickets were detected in the majority of the patients; the manifestations of bronchopulmonary dysplasia persisted in 50%. 40% of the infants had disabling complications.
Adrian, Molly; Charlesworth-Attie, Sarah; Vander Stoep, Ann; McCauley, Elizabeth; Becker, Linda
The purpose of this study is to estimate the proportion of adolescents meeting Healthy People 2020 health behavior recommendations for the prevention of chronic disease and to determine the association between mental health status (depression and/or conduct problems) and the likelihood of meeting these recommendations. The data used for this study are from the 2010 Washington State Healthy Youth Survey. Descriptive statistics and linear regression were utilized to estimate the proportion of adolescents meeting recommendations and associations between youth mental health status indicators and health-promoting behaviors. A small minority (5.8 %) of youth met all six recommendations in domains of tobacco abstinence, substance use abstinence, daily physical activity, breakfast consumption, weight below obese levels, and adequate sleep, though most (84.3 %) met at least three. At the aggregate level, the proportion of Washington State youth who met Healthy People 2020 guidelines exceeded targets, with the exception of substance use abstinence. A minority of youth reported guideline levels of daily physical activity (23.3 %) and sleep (39.8 %). Mental health status was strongly associated with the number of health-promoting behaviors adolescents endorsed. Interventions to increase the adoption of sleep hygiene and exercise habits should be added to an integrative positive youth development framework within school-, community-, and primary care-based adolescent health initiatives. Attention to adolescent mental health and shared risk factors may be critical for reducing barriers to healthy behavior.
Clewley, Derek; Rhon, Dan; Flynn, Tim; Koppenhaver, Shane; Cook, Chad
Physical therapists' familiarity, perceptions, and beliefs about health services utilization and health seeking behaviour have not been previously assessed. The purposes of this study were to identify physical therapists' characteristics related to familiarity of health services utilization and health seeking behaviour, and to assess what health seeking behaviour factors providers felt were related to health services utilization. We administered a survey based on the Andersen behavioural model of health services utilization to physical therapists using social media campaigns and email between March and June of 2017. In addition to descriptive statistics, we performed binomial logistic regression analysis. We asked respondents to rate familiarity with health services utilization and health seeking behaviour and collected additional characteristic variables. Physical therapists are more familiar with health services utilization than health seeking behaviour. Those who are familiar with either construct tend to be those who assess for health services utilization, use health services utilization for a prognosis, and believe that health seeking behaviour is measurable. Physical therapists rated need and enabling factors as having more influence on health services utilization than predisposing and health belief factors. Physical therapists are generally familiar with health services utilization and health seeking behaviour; however, there appears to be a disconnect between what is familiar, what is perceived to be important, and what can be assessed for both health services utilization and health seeking behaviour. Copyright © 2018 Associação Brasileira de Pesquisa e Pós-Graduação em Fisioterapia. All rights reserved.
Angelidaki, Irini; Treu, Laura; Tsapekos, Panagiotis
Biogas production is an established sustainable process for simultaneous generation of renewable energy and treatment of organic wastes. The increasing interest of utilizing biogas as substitute to natural gas or its exploitation as transport fuel opened new avenues in the development of biogas...... upgrading techniques. The present work is a critical review that summarizes state-of-the-art technologies for biogas upgrading and enhancement with particular attention to the emerging biological methanation processes. The review includes comprehensive description of the main principles of various biogas...
Khaled, Salama M.; Shockley, Bethany; Abdul Rahim, Hanan F.
Objective: To explore the role of citizenship status as a predictor of general satisfaction with healthcare services in Qatar, including potential interaction with utilization and health insurance coverage type. Design: A cross-sectional survey conducted in 2012. Setting: A household survey in the State of Qatar in the Arab Gulf. Participants: A nationally representative sample of 2750 citizens and noncitizens aged 18 years and older. Main Outcome: General satisfaction st...
Mayer, Joni A.; Gabbard, Susan; Kronick, Richard G.; Roesch, Scott C.; Malcarne, Vanessa L.; Zuniga, Maria L.
Objectives. We examined individual-, environmental-, and policy-level correlates of US farmworker health care utilization, guided by the behavioral model for vulnerable populations and the ecological model. Methods. The 2006 and 2007 administrations of the National Agricultural Workers Survey (n = 2884) provided the primary data. Geographic information systems, the 2005 Uniform Data System, and rurality and border proximity indices provided environmental variables. To identify factors associated with health care use, we performed logistic regression using weighted hierarchical linear modeling. Results. Approximately half (55.3%) of farmworkers utilized US health care in the previous 2 years. Several factors were independently associated with use at the individual level (gender, immigration and migrant status, English proficiency, transportation access, health status, and non-US health care utilization), the environmental level (proximity to US–Mexico border), and the policy level (insurance status and workplace payment structure). County Federally Qualified Health Center resources were not independently associated. Conclusions. We identified farmworkers at greatest risk for poor access. We made recommendations for change to farmworker health care access at all 3 levels of influence, emphasizing Federally Qualified Health Center service delivery. PMID:21330594
Beusterien Kathleen M
Full Text Available Abstract Objective Obtain utilities (preferences for a generalizable set of health states experienced by older children and adolescents who receive therapy for chronic health conditions. Methods A health state classification system, the Adolescent Health Utility Measure (AHUM, was developed based on generic health status measures and input from children with Hunter syndrome and their caregivers. The AHUM contains six dimensions with 4–7 severity levels: self-care, pain, mobility, strenuous activities, self-image, and health perceptions. Using the time trade off (TTO approach, a UK population sample provided utilities for 62 of 16,800 AHUM states. A mixed effects model was used to estimate utilities for the AHUM states. The AHUM was applied to trial NCT00069641 of idursulfase for Hunter syndrome and its extension (NCT00630747. Results Observations (i.e., utilities totaled 3,744 (12*312 participants, with between 43 to 60 for each health state except for the best and worst states which had 312 observations. The mean utilities for the best and worst AHUM states were 0.99 and 0.41, respectively. The random effects model was statistically significant (p Discussion The AHUM health state classification system may be used in future research to enable calculation of quality-adjust life expectancy for applicable health conditions.
Youn Ho Shin
Full Text Available Vitamin D is an essential component of bone and mineral metabolism; its deficiency causes growth retardation and skeletal deformities in children and osteomalacia and osteoporosis in adults. Hypovi taminosis D (vitamin D insufficiency or deficiency is observed not only in adults but also in infants, children, and adolescents. Previous studies suggest that sufficient serum vitamin D levels should be maintained in order to enhance normal calcification of the growth plate and bone mineralization. Moreover, emerging evidence supports an association between 25hydroxyvitamin D (25[OH]D levels and immune function, respiratory diseases, obesity, metabolic syndrome, insulin resistance, infection, allergy, cancers, and cardiovascular diseases in pediatric and adolescent populations. The risk factors for vitamin D insufficiency or deficiency in the pediatric population are season (winter, insufficient time spent outdoors, ethnicity (nonwhite, older age, more advanced stage of puberty, obesity, low milk consumption, low socioeconomic status, and female gender. It is recommended that all infants, children, and adolescents have a minimum daily intake of 400 IU (10 μg of vitamin D. Since the vitamin D status of the newborn is highly related to maternal vitamin D levels, optimal vitamin D levels in the mother during pregnancy should be maintained. In conclusion, given the important role of vitamin D in childhood health, more time spent in outdoor activity (for sunlight exposure and vitamin D supplementation may be necessary for optimal health in infants, children, and adolescents.
Sanz-Barbero, Belén; Rey, Lourdes; Otero-García, Laura
To describe the prevalence of intimate partner violence (IPV) in Spain in the last year and at some point during the lifetime, to determine health status in women according to whether they had experienced IPV or not, and to analyze the individual variables associated with IPV in Spain. A cross-sectional study was performed of the database, Macrosurvey on Gender Violence in Spain 2011. This database includes data on 7,898 women older than 18 years old. The dependent variables were IPV-last year, IPV-ever in life. Covariates consisted of sociodemographic characteristics, socioeconomic status, maternal experience of IPV, social support, and self-care. The measure of association used was the OR with its 95% confidence interval (95% CI). A total of 3.6% of women had experienced IPV-last year and 12.2% ever in life. Female victims of IPV had poorer health than women who had not experienced IPV. Immigrant women living in Spain for 6 years or more were more likely to experience IPV-ever in life than Spanish women [OR (95% CI): 1.95 (1.50, 2.53)]. An interaction was found between nationality and the existence of children under 18 years old. Among women with children under 18 years old, immigrant women were more likely to experience IPV-last year than Spanish women [OR (95% CI): 1.99 (1.25, 3.17)]. Other variables associated with IPV were age, low socioeconomic status, low social support and having a mother who had experienced IPV. In Spain, some women have a higher probability of experiencing IPV. The variables associated with greater vulnerability to IPV should be taken into account when implementing measures to prevent or alleviate IPV. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.
Duc, Nguyen Huu Chau; Nakamura, Keiko; Kizuki, Masashi; Seino, Kaoruko; Rahman, Mosiur
This study aimed to examine changes in utilization of reproductive health services by wealth status from 2000 to 2011 in Vietnam. Data from the Vietnam Multiple Indicator Cluster Surveys in 2000, 2006, and 2011 were used. The subjects were 550, 1023, and 1363 women, respectively, aged between 15 and 49 years who had given birth in the previous one or two years. The wealth index, a composite measure of a household's ownership of selected assets, materials used for housing construction, and types of water access and sanitation facilities, was used as a measure of wealth status. Main utilization indicators were utilization of antenatal care services, receipt of a tetanus vaccine, receipt of blood pressure measurement, blood examination and urine examination during antenatal care, receipt of HIV testing, skilled birth attendance at delivery, health-facility-based delivery, and cesarean section delivery. Inequalities by wealth index were measured by prevalence ratios, concentration indices, and multivariable adjusted regression coefficients. Significant increase in overall utilization was observed in all indicators (all p skilled birth attendance, 0.29 in 2006 and 0.12 in 2011 for blood examination, and 0.18 in 2006 and 0.09 in 2011 for health-facility-based delivery. The multivariable adjusted regression coefficients of reproductive health service utilization by wealth category were 0.06 in 2000 and 0.04 in 2011 for antenatal care, 0.07 in 2000 and 0.05 in 2011 for skilled birth attendance, and 0.07 in 2006 and 0.05 in 2011 for health-facility-based delivery. More women utilized reproductive health services in 2011 than in 2000. Inequality by wealth status in utilization of antenatal care, skilled birth attendance, and health-facility-based delivery had been reduced.
Full Text Available Chronic obstructive pulmonary disease (COPD is associated with primary respiratory impairment, disability and handicap, as well as with secondary impairments not necessarily confined to the respiratory system. Because the primary goals of managing patients with COPD include relief of dyspnea and the improvement of health-related quality of life (HRQL, a direct measurement of HRQL is important. Fourteen disease-specific and nine generic questionnaires (four health profiles and five utility measures most commonly used to measure health status in patients with COPD were reviewed. The measures were classified according to their domain of interest, and their measurement properties - specifications, validity, reliability, responsiveness and interpretability - were described. This review suggests several findings. Currently used health status instruments usually refer to the patients’ perception of performance in three major domains of HRQL - somatic sensation, physical and occupational function, and psychological state. The choice of a questionnaire must be related to its purpose, with a clear distinction being made between its evaluative and discriminative function. In their evaluative function, only a few instruments fulfilled the criteria of responsiveness, and the interpretability of most questionnaires is limited. Generic questionnaires should not be used alone in clinical trials as evaluative instruments because of their inability to detect change over time. Further validation and improved interpretability of existing instruments would be of greater benefit to clinicians and scientists than the development of new questionnaires.
Zwaanswijk, Marieke; Ende, J. van der; Verhaak, P.F.M.; Bensing, J.; Verhulst, F.C.
Objective: To determine the association of parent, family, and adolescent variables with adolescent mental health service need and utilization. Method: Correlates of adolescent mental health service utilization, self-perceived need and unmet need were investigated in a general population sample of
Patents and licences were part of normal JRC activity since its origin: the new feature of this programme is that through an increased JRC activity in this field as well as a structured support to D.G. XIII, the process of utilization can be started at an earlier stage, with the deliberate purpose of achieving practical results as early as possible, through an adequate R and D effort. Key element of this process is the systematic identification, within JRC programme, of those research areas, concepts, ideas, that might present interest for industry and for the public sector. In this respect D.G. XIII by its market survey and contacts with industry is providing JRC with the essential information to carry out this programme
Tsuruta, H.; Niiho, T.; Matsuura, H.; Iida, K.; Ikeda, Y.; Funayama, Y.
Japan Research Reactor No.4 (JRR-4) is a swimming pool type research reactor, 93% enriched uranium ETR-type fuel used, light water moderated and cooled. It was initially constructed to pursue mainly shielding experiments for nuclear ship. Today, it is widely utilized for many researches and experiments and reactor operation training of Nuclear Engineering School students. The construction of JRR-4 started in June 1962 and the initial criticality reached on January 28, 1965. The maximum power of JRR-4 was raised to 3500 kW in October 1976. The reactor has been operated satisfactorily for about 23 years since the initial criticality. In this paper, a general description is given on the JRR-4 including future plans. (author)
Groenewold, W G F; van Ginneken, J K
To examine if, and to what extent, disparities in health status exist between ethnic Russians and the native majority populations of four former Soviet Republics; and to determine to what extent indicators of socio-economic status and lifestyle behaviours explain variations in health status. Data from the World Health Organization's World Health Surveys of former Soviet Republics that include information on ethnicity (i.e. Estonia, Latvia, Ukraine, Kazakhstan and Russia) were used. Russia was included as the benchmark population as it is the country of origin of ethnic Russians. Data were collected from respondents aged ≥25 years in 2001-2003. Principal component analysis was used to derive the Health Status Index and Household Wealth Index. Multiple classification analysis was applied to examine the effects of the determinants on health status, including ethnic group membership. In Estonia and Kazakhstan, ethnic Russians have, on average, a lower health status than members of the majority population, while their health status is higher in Ukraine. Higher levels of material wealth, educational attainment and physical activity were associated with a higher health status. The association of these variables with health status was often stronger than the association between ethnic group membership and health status. Differences in health status between Russian ethnic minorities and the majority populations were found in Estonia and Kazakhstan, but were non-existent in Latvia and were the opposite of what was expected in Ukraine. Use of the Health Status Index in combination with multiple classification analysis proved to be a useful approach to examine health status differentials, and to identify and profile vulnerable groups in a society. Copyright © 2011 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Fujikawa, D.G.; Dwyer, B.E.; Lake, R.R.; Wasterlain, C.G.
The effect of bicuculline-induced status epilepticus (SE) on local cerebral metabolic rates for glucose (LCMRglc) was studied in 2-wk-old ketamine-anesthetized marmoset monkeys, using the 2-[ 14 C]-deoxy-D-glucose autoradiographical technique. To estimate LCMRglc in cerebral cortex and thalamus during SE, the lumped constant (LC) for 2-deoxy-D-glucose (2-DG) and the rate constants for 2-DG and glucose were calculated for these regions. The control LC was 0.43 in frontoparietal cortex, 0.51 in temporal cortex, and 0.50 in thalamus; it increased to 1.07 in frontoparietal cortex, 1.13 in temporal cortex, and 1.25 in thalamus after 30 min of seizures. With control LC values, LCMRglc in frontoparietal cortex, temporal cortex, and dorsomedial thalamus appeared to increase four to sixfold. With seizure LC values, LCMRglc increased 1.5- to 2-fold and only in cortex. During 45-min seizures, LCMRglc in cortex and thalamus probably increases 4- to 6-fold initially and later falls to the 1.5- to 2-fold level as tissue glucose concentrations decrease. Together with our previous results demonstrating depletion of high-energy phosphates and glucose in these regions, the data suggest that energy demands exceed glucose supply. The long-term effects of these metabolic changes on the developing brain remain to be determined
Efforts are to be continuously devoted to establish and upgrade HTGR technology in the world. Japan Atomic Energy Research Institute (JAERI) has conducted the R and D of HTGRs since the 1960's in Japan, focusing on mainly the construction of High Temperature engineering Test Reactor (HTTR) which is an HTGR with a maximum helium gas temperature of 950 o C at the reactor outlet and HTGR utilization systems. The HTTR achieved first criticality on November 10, 1998 and will restart from January in 2001. In the R and D program of HTGR utilization systems, JAERI has conducted hydrogen production systems with HTGR to demonstrate the applicability of nuclear heat for extensive energy demands besides the electric power generation. JAERI has developed a hydrogen production system by steam reforming process of natural gas using nuclear heat supplied from the HTTR. Prior to the demonstration test of HTTR hydrogen production system, a 1/30-scale out-of-pile test facility is under construction for safety review and detailed design of the system. The out-of-pile test facility will be started in 2001 and will be continued about 4 years. The hydrogen permeation and corrosion tests have been carried out since 1997. Check and review for the demonstration program in the HTTR hydrogen production system will be made in 2001. Then the HTTR hydrogen production system is scheduled to be constructed from 2003 and demonstratively operated from around 2006. In parallel with the R and D of the HTTR hydrogen production system, hydrogen production method by thermochemical water splitting, so-called IS process, has been studied in JAERI. The IS process is placed as one of future candidates of the heat utilization systems of the HTTR following the steam reforming system. Continuous and stoichiometric production of hydrogen and oxygen for 48 hours was successfully achieved with a laboratory-scale apparatus mainly made of glass. Following this achievement, the study has been continued with a larger
By analyzing the relationship between socio-economic status, health, and health care use for a variety of developed countries (with a main focus on Europe), this thesis attempts to address several questions: • What are the socio-economic factors driving the use of health care services: income,
Barbos, D.; Ciocanescu, M.; Paunoiu, C.
Institute for Nuclear Research is the owner of the largest family TRIGA research reactor, TRIGA14 MW research reactor. TRIGA14 MW reactor was designed to be operated with HEU nuclear fuel but now the reactor core was fully converted to LEU nuclear fuel. The full conversion of the core was a necessary step to ensure the continuous operation of the reactor. The core conversion took place gradually, using fuel manufactured in different batches by two qualified suppliers based on the same well qualified technology for TRIGA fuel, including some variability which might lead to a peculiar behaviour under specific conditions of reactor utilization. After the completion of the conversion a modernization program for the reactor systems was initiated in order to achieve two main objectives: safe operation of the reactor and reactor utilization in a competitive environment to satisfy the current and future demands and requirements. The 14 MW TRIGA research reactor operated by the Institute for Nuclear Research in Pitesti, Romania, is a relatively new reactor, commissioned 37 years ago. It is expected to operate for another 15-20 years, sustaining new fuel and testing of materials for future generations of power reactors, supporting radioisotopes production through the development of more efficient new technologies, sustaining research or enhanced safety, extended burn up and verification of new developments concerning nuclear power plants life extension, to sustain neutron application in physics research, thus becoming a centre for instruction and training in the near future. A main objective of the TRIGA14MW research reactor is the testing of nuclear fuel and nuclear material. The TRIGA 14 MW reactor is used for medical and industrial radioisotopes production ( 131 I, 125 I, 192 Ir etc.) and a method for 99 Mo- 99 Tc production from fission is under development. For nuclear materials properties investigation, neutron radiography methods have been developed in the INR. The
Ranjbar Ezzatabadi, Mohammad; Khosravi, Ameneh; Bahrami, Mohammad Amin; Rafiei, Sima
Purpose Developing country workers mainly face important challenges when examining equality in health services utilization among the population and identifying influential factors. The purpose of this paper us to: understand health service use among households with different socio-economic status in Isfahan province; and to investigate probable inequality determinants in service utilization. Design/methodology/approach Almost 1,040 households living in Isfahan province participated in this cross-sectional study in 2013. Data were collected by a questionnaire with three sections: demographic characteristics; socio-economic status; and health services utilization. The concentration index was applied to measure inequality. Analysts used STATA 11. Findings Economic status, educational level, insurance coverage and household gender were the most influential factors on health services utilization. Those with a high socio-economic level were more likely to demand and use such services; although self-medication patterns showed an opposite trend. Practical implications Female-headed families face with more difficulties in access to basic human needs including health. Supportive policies are needed to meet their demands. Originality/value The authors used principle component analysis to assess households' economic situation, which reduced the variables into a single index.
Ock, Minsu; Park, Jeong-Yeol; Son, Woo-Seung; Lee, Hyeon-Jeong; Kim, Seon-Ha; Jo, Min-Woo
A cost-utility study of a human papilloma virus (HPV) vaccine requires that the utility weights for HPV-related health states (i.e., cervical intraepithelial neoplasia (CIN), cervical cancer, and condyloma) be evaluated. The aim of the present study was to determine the utility weights for HPV-related health states. Hypothetical standardised health states related to HPV were developed based on patient education material and previous publications. To fully reflect disease progression from diagnosis to prognosis, each health state comprised four parts (diagnosis, symptoms, treatment, and progression and prognosis). Nine-hundred members from the Korean general population evaluated the HPV-related health states using a visual analogue scale (VAS) and a standard gamble (SG) approach, which were administered face-to-face via computer-assisted interview. The mean utility values were calculated for each HPV-related health state. According to the VAS, the highest utility (0.73) was HPV-positive status, followed by condyloma (0.66), and CIN grade I (0.61). The lowest utility (0.18) was cervical cancer requiring chemotherapy without surgery, followed by cervical cancer requiring chemoradiation therapy (0.42). SG revealed that the highest utility (0.83) was HPV-positive status, followed by condyloma (0.78), and CIN grade I (0.77). The lowest utility (0.43) was cervical cancer requiring chemotherapy without surgery, followed by cervical cancer requiring chemoradiation therapy (0.60). This study was based on a large sample derived from the general Korean population; therefore, the calculated utility weights might be useful for evaluating the economic benefit of cancer screening and HPV vaccination programs.
Rudra, Shalini; Subramanian, S V
Against the backdrop of population aging, this paper presents the analysis of need-standardised health care utilization among elderly in India. Based on nationally representative morbidity and health care survey 2004, we demonstrate that the need for health care utilization is indeed pro-poor in nature. However, the actual health care utilization is concentrated among richer sections of the population. Further, the decomposition analysis reveals that income has a very strong role in shifting the distribution of health care away from the poor elderly. The impact of income on utilization is well-demonstrated even at the ecological-level as states with higher per capita incomes have higher elderly health care utilization even as the levels of need-predicted distribution across these states are similar. We also find that the distribution of elderly across social groups and their educational achievements favours the rich and significantly contributes to overall inequality. Nevertheless, contribution of need-related self-assessed health clearly favours pro-poor inequality. In concluding, we argue that to reduce such inequities in health care utilization it is necessary to increase public investments in health care infrastructure including geriatric care particularly in rural areas and underdeveloped regions to enhance access and quality of health care for the elderly. PMID:26617450
Radioisotopes, such as Co-60 and Cs-137, and accelerators for electrically generating radiations are widely used as radiation sources for industrial radiation exposure applications. It is estimated that about 100 electron accelerators are in use in Japan as of 1985 in the industrial and R and D fields while about 300 - 400 accelerators and more than 130 Co-60 irradiation systems have been installed over the world. In the field of materials development, accelerators are currently utilized for production of cross-linked, high-temperature resistant cable cladding, production of heat-shrinkable polymer materials, pre-crosslinking of rubber sheet for tier, production of expanded polyethylene, graft copolymerization for producing diaphragms for battery, electron-beam surface coating, and lithography for semiconductor manufacturing. In the field of environmental protection, accelerators are employed for removal of sulfur dioxide and nitrogen oxides from gas emission, sterilization and composting of sludge, and electron treatment of water. Radiations are also used for sterilization of medical instruments. In addition, high-energy ion beam irradiation has already come into practical use in the field of semiconductor manufacturing and metallic surface treatment. (Nogami, K.)
In this case study, I present descriptive findings with regard to immigrant incorporation and health service utilization. Using focus groups and survey of Korean immigrant women in Wisconsin, I examine whether the ways in which they adapt to the U.S. society is relevant to their health services utilization and the alternatives they seek when available health services are less than satisfactory. The findings suggest that adherence to Korean identity appears to be associated with health service utilization. This is evident in the immigrants' evaluation of the U.S. health services as compared to those of Korea, and the consideration given by these immigrants to seeking health services in Korea instead of the United States. Such concerns on the part of these immigrants have important implications for health researchers, as they highlight the significance of immigrants' transnational experiences and their sense of personal agency in the use of health care.
Lebrun-Harris, Lydie A; Baggett, Travis P; Jenkins, Darlene M; Sripipatana, Alek; Sharma, Ravi; Hayashi, A Seiji; Daly, Charles A; Ngo-Metzger, Quyen
Objective To examine health status and health care experiences of homeless patients in health centers and to compare them with their nonhomeless counterparts. Data Sources/Study Setting Nationally representative data from the 2009 Health Center Patient Survey. Study Design Cross-sectional analyses were limited to adults (n = 2,683). We compared sociodemographic characteristics, health conditions, access to health care, and utilization of services among homeless and nonhomeless patients. We also examined the independent effect of homelessness on health care access and utilization, as well as factors that influenced homeless patients' health care experiences. Data Collection Computer-assisted personal interviews were conducted with health center patients. Principal Findings Homeless patients had worse health status—lifetime burden of chronic conditions, mental health problems, and substance use problems—compared with housed respondents. In adjusted analyses, homeless patients had twice the odds as housed patients of having unmet medical care needs in the past year (OR = 1.98, 95 percent CI: 1.24–3.16) and twice the odds of having an ED visit in the past year (OR = 2.00, 95 percent CI: 1.37–2.92). Conclusions There is an ongoing need to focus on the health issues that disproportionately affect homeless populations. Among health center patients, homelessness is an independent risk factor for unmet medical needs and ED use. PMID:23134588
Qayumi, Karim; Pachev, George; Zheng, Bin; Ziv, Amitai; Koval, Valentyna; Badiei, Sadia; Cheng, Adam
Simulation is rapidly penetrating the terrain of health care education and has gained growing acceptance as an educational method and patient safety tool. Despite this, the state of simulation in health care education has not yet been evaluated on a global scale. In this project, we studied the global status of simulation in health care education by determining the degree of financial support, infrastructure, manpower, information technology capabilities, engagement of groups of learners, and research and scholarly activities, as well as the barriers, strengths, opportunities for growth, and other aspects of simulation in health care education. We utilized a two-stage process, including an online survey and a site visit that included interviews and debriefings. Forty-two simulation centers worldwide participated in this study, the results of which show that despite enormous interest and enthusiasm in the health care community, use of simulation in health care education is limited to specific areas and is not a budgeted item in many institutions. Absence of a sustainable business model, as well as sufficient financial support in terms of budget, infrastructure, manpower, research, and scholarly activities, slows down the movement of simulation. Specific recommendations are made based on current findings to support simulation in the next developmental stages. PMID:25489254
Sánchez, Sebastián; Rincon, Fred
Status epilepticus (SE) is defined as a continuous clinical and/or electrographic seizure activity lasting five minutes or more or recurrent seizure activity without return to baseline. There is a paucity of epidemiological studies of SE, as most research is derived from small population studies. The overall incidence of SE is 9.9 to 41 per 100,000/year, with peaks in children and the elderly and with febrile seizures and strokes as its main etiologies. The etiology is the major determinant of mortality. Governments and the academic community should predominantly focus on the primary prevention of etiologies linked to SE, as these are the most important risk factors for its development. This review describes the incidence, prevalence, etiology, risk factors, outcomes and costs of SE and aims to identify future research and public health needs. PMID:27537921
Background: Health care workers (HCWs) from an important component of the health care system of any nation. Adequate knowledge regarding oral health is also mandatory as it is directly related to general health. Aim: The present study was undertaken to assess oral health status and treatment needs of the health ...
Weiss, Robert L.; Aved, Barbara M.
Results indicate correlation between physical health status and depression was greater for wives than husbands. For wives, marital satisfaction and depression were related through uncontrolled variance in physical health status. For husbands, significant relationship between marital satisfaction and depression remained when physical health was…
Maximova, Katerina; Krahn, Harvey
This paper sought to examine which pre- and post-migration factors might be associated with changes in refugees' health status. Using linear regression, the associations between pre- and post-migration factors and changes in self-rated mental and physical health status were examined in 525 refugees from the 1998 Settlement Experiences of Refugees in Alberta study. Having spent time in a refugee camp and having held professional/managerial jobs in one's home country were associated with a greater decline in mental health status since arrival in Canada. Having completed a university degree in one's home country was associated with a greater decline in physical health status. Being employed was associated with greater improvements in mental health status. Perceived economic hardship was associated with greater declines in physical health status. A higher number of settlement services received during the first year in Canada was associated with greater improvements in both mental and physical health status. Longer residence in Canada was associated with greater declines in physical health status but not in mental health status. While little can be done to alter refugees' pre-migration experiences, public policies can affect many post-migration experiences in order to mitigate the negative health consequences associated with resettlement. Results of this study point to the need for continued provision of settlement services to assist refugees with job training, labour market access, and credential recognition, as well as counseling for refugees who experienced the trauma of living in a refugee camp.
Ara, Roberta; Brazier, John
When health state utility values for comorbid health conditions are not available, data from cohorts with single conditions are used to estimate scores. The methods used can produce very different results and there is currently no consensus on which is the most appropriate approach. The objective of the current study was to compare the accuracy of five different methods within the same dataset. Data collected during five Welsh Health Surveys were subgrouped by health status. Mean short-form 6 dimension (SF-6D) scores for cohorts with a specific health condition were used to estimate mean SF-6D scores for cohorts with comorbid conditions using the additive, multiplicative, and minimum methods, the adjusted decrement estimator (ADE), and a linear regression model. The mean SF-6D for subgroups with comorbid health conditions ranged from 0.4648 to 0.6068. The linear model produced the most accurate scores for the comorbid health conditions with 88% of values accurate to within the minimum important difference for the SF-6D. The additive and minimum methods underestimated or overestimated the actual SF-6D scores respectively. The multiplicative and ADE methods both underestimated the majority of scores. However, both methods performed better when estimating scores smaller than 0.50. Although the range in actual health state utility values (HSUVs) was relatively small, our data covered the lower end of the index and the majority of previous research has involved actual HSUVs at the upper end of possible ranges. Although the linear model gave the most accurate results in our data, additional research is required to validate our findings. Copyright © 2011 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.
Albritton, Tashuna; Angley, Meghan; Gibson, Crystal; Sipsma, Heather; Kershaw, Trace
Mental health issues often become apparent as adolescents emerge into young adulthood. The use of mental health services is low among adolescents and young adults, and use is particularly low among minorities. In this study, we examine mental health utilization among diverse young parenting couples. The sample consisted of 296 couples. We used the social-personal framework to examine personal, family, partner relationship, and environmental predictors for using mental health services. We used the Actor-Partner Interdependence Model to assess actor and partner effects on mental health utilization. We also examined moderator effects for gender and internalizing and externalizing behaviors. We found that being female, being White, higher income, more conduct problems, and less anxious romantic attachment predicted mental health utilization. Significant moderator effects included depression × gender, depression × medical insurance, and stress × Latino. Implications for community mental health practice include conducting mental health assessments during medical visits and systematic mental health follow-up for individuals and couples with identified mental health and support needs. Future research should include married couples and the spouse's influence on mental health use and examine relevant parenting factors that may also predict mental health utilization among couples.
Health Data Recording, Reporting and Utilization Practices Among Primary Health Care Workers in Enugu State, South Eastern Nigeria. ... of PHC workers used notepads, 52.3% used notebooks while only 47.7% used health management information system (HMIS) forms to record data. ... AJOL African Journals Online.
Jessica J. Vandeleest
Full Text Available Background Although a wealth of literature points to the importance of social factors on health, a detailed understanding of the complex interplay between social and biological systems is lacking. Social status is one aspect of social life that is made up of multiple structural (humans: income, education; animals: mating system, dominance rank and relational components (perceived social status, dominance interactions. In a nonhuman primate model we use novel network techniques to decouple two components of social status, dominance rank (a commonly used measure of social status in animal models and dominance certainty (the relative certainty vs. ambiguity of an individual’s status, allowing for a more complex examination of how social status impacts health. Methods Behavioral observations were conducted on three outdoor captive groups of rhesus macaques (N = 252 subjects. Subjects’ general physical health (diarrhea was assessed twice weekly, and blood was drawn once to assess biomarkers of inflammation (interleukin-6 (IL-6, tumor necrosis factor-alpha (TNF-α, and C-reactive protein (CRP. Results Dominance rank alone did not fully account for the complex way that social status exerted its effect on health. Instead, dominance certainty modified the impact of rank on biomarkers of inflammation. Specifically, high-ranked animals with more ambiguous status relationships had higher levels of inflammation than low-ranked animals, whereas little effect of rank was seen for animals with more certain status relationships. The impact of status on physical health was more straightforward: individuals with more ambiguous status relationships had more frequent diarrhea; there was marginal evidence that high-ranked animals had less frequent diarrhea. Discussion Social status has a complex and multi-faceted impact on individual health. Our work suggests an important role of uncertainty in one’s social status in status-health research. This work also
Webster, I W; Rawson, G K
A comparison of health status between 779 Seventh-day Adventists, who have a strong commitment to heal-related life styles, and two other groups of people--8363 persons referred by general practitioners and 9825 volunteers--was made. The Seventh-day Adventists showed less impairment of systolic and diastolic blood pressures, of plasma cholesterol and plasma urate concentrations, and of lung ventilatory capacity; and less obesity at most specific ages. With increasing age, the level of breathlessness, reported heart disease, hypertension, and hypertensive and diuretic therapy in this sample approached that of the comparative groups, possibly because of natural attrition of high-risk persons in the latter. Depression, sleeplessness, use of sedatives and tranquillizers were lower in the Seventh-day Adventists; although, once again, a drawing together of the three groups in older age categories was evident. It is concluded that the life style of Seventh-day Adventists is conducive to lessened morbidity, delayed mortality, and decreased call on health services in comparison with the general population.
Liao, Pei-An; Chang, Hung-Hao; Yang, Fang-An
Purpose: To assess the impact of the introduction of Taiwan's National Health Insurance (NHI) on urban-rural inequality in health service utilization among the elderly. Methods: A longitudinal data set of 1,504 individuals aged 65 and older was constructed from the Survey of Health and Living Status of the Elderly. A difference-in-differences…
Tarasuk, Valerie; Cheng, Joyce; Gundersen, Craig; de Oliveira, Claire; Kurdyak, Paul
To determine the relationship between household food insecurity status over a 12-month period and adults' use of publicly funded health care services in Ontario for mental health reasons during this period. Data for 80,942 Ontario residents, 18 to 64 years old, who participated in the Canadian Community Health Survey in 2005, 2007-2008, 2009-2010, or 2011-2012 were linked to administrative health care data to determine individuals' hospitalizations, emergency department visits, and visits to psychiatrists and primary care physicians for mental health reasons. Household food insecurity over the past 12 months was assessed using the Household Food Security Survey Module. Logistic regression models were used to estimate the odds of mental health service utilization in the past 12 months by household food insecurity status, adjusting for sociodemographic factors and prior use of mental health services. In our fully adjusted models, in comparison to food-secure individuals, the odds of any mental health care service utilization over the past 12 months were 1.15 (95% confidence interval [CI], 1.04 to 1.29) for marginally food-insecure individuals, 1.39 (95% CI, 1.19 to 1.42) for moderately food-insecure individuals, and 1.50 (95% CI, 1.35 to 1.68) for severely food-insecure individuals. A similar pattern persisted across individual types of services, with odds of utilization highest with severe food insecurity. Household food insecurity status is a robust predictor of mental health service utilization among working-age adults in Ontario. Policy interventions are required to address the underlying causes of food insecurity and the particular vulnerability of individuals with mental illness.
Despite this, India is still struggling with a high maternal mortality and morbidity ..... care utilization and the mothers' age, religion and caste. However, women .... health care system and presents an opportunity to evaluate the mother's overall ...
Predictors on utilization of maternal, newborn and child health services among rural women in Manicaland Zimbabwe. ... Central African Journal of Medicine ... The study targeted women of child bearing age (15-49 years) who were either ...
Flora, Otieno Careena; Margaret, Kaseje; Dan, Kaseje
Health information systems (HIS) are considered fundamental for the efficient delivery of high quality health care. However, a large number of legal and practical constraints influence the design and introduction of such systems. The inability to quantify and analyse situations with credible data and to use data in planning and managing service delivery plagues Africa. Establishing effective information systems and using this data for planning efficient health service delivery is essential to district health systems' performance improvement. Community Health Units in Kenya are central points for community data collection, analysis, dissemination and use. In Kenya, data tend to be collected for reporting purposes and not for decision-making at the point of collection. This paper describes the perspectives of local users on information use in various socio-economic contexts in Kenya. Information for this study was gathered through semi-structured interviews. The interviewees were purposefully selected from various community health units and public health facilities in the study area. The data were organized and analysed manually, grouping them into themes and categories. Information needs of the community included service utilization and health status information. Dialogue was the main way of information utilization in the community. However, health systems and personal challenges impeded proper collection and use of information. The challenges experienced in health information utilization may be overcome by linkages and coordination between the community and the health facilities. The personal challenges can be remedied using a motivational package that includes training of the Community Health Workers.
Background: A good health program is necessary to optimize health care opportunities so as to make appropriate adjustments for optimal service delivery by our health workers in all health sectors. Aim: To determine some hepatic function parameters as a correlate of health status amongst staff of Niger Delta University ...
Russel J REITER; Fatih GULTEKIN; Luis J FLORES; Ma Pilar TERRON; Dun-Xian TAN
Full Text Available This review summarizes the beneficial actions of melatonin in various experimental conditions/diseases and identifies where the use of melatonin may be helpful in improving public health. The nightly use of melatonin supplements by humans often improves their sleep and helps correct the circadian dyssynchronization associated with “jet lag”. Additionally, melatonin has been found effective in curtailing the growth of a variety of experimental cancers. Mechanistically, this is achieved by melatonin’s ability to limit fatty acid uptake, especially linoleic acid, by tumor cells. Fatty acids are growth factors for many tumors. Additionally, melatonin inhibits the elevated telomerase activity of tumor cells thus making them more fragile and vulnerable to chemotherapies. Melatonin also may inhibit angiogenesis in tumors by suppressing endothelin-1 production and the indole interferes with the stimulatory action of steroids on hormone-responsive tumors. As an ubiquitously-acting antioxidant, melatonin reduces cardiac damage during ischemia/reperfusion (I/R injury (heart attack and during I/R to the brain (stroke. Melatonin also limits the toxicity of amyloid peptide and of neurofibrillary tangles, two of the cardinal signs of Alzheimer’s disease. Collectively, these data suggest supplementation with melatonin, whose endogenous levels decrease with age, may improve the quality of life in the aged and, as a consequence, be beneficial for public health generally. [TAF Prev Med Bull 2006; 5(2.000: 131-158
Full Text Available Abstract Background Universal access is one of the major aims in public health and social care. Services should be provided on the basis of individual needs. However, municipal autonomy and the fragmentation of services may jeopardize universal access and lead to variation between municipalities in the delivery of services. This paper aims to identify patient-level characteristics and municipality-level service patterns that may have an influence on the use and costs of health and social services of frail elderly patients. Methods Hierarchical analysis was applied to estimate the effects of patient and municipality-level variables on services utilization. Results The variation in the use of health care services was entirely due to patient-related variables, whereas in the social services, 9% of the variation was explained by the municipality-level and 91% by the patient-level characteristics. Health-related quality of life explained a major part of variation in the costs of health care services. Those who had reported improvement in their health status during the preceding year were more frequent users of social care services. Low informal support, poor functional status and poor instrumental activities of daily living, living at a residential home, and living alone were associated with higher social services expenditure. Conclusions The results of this study showed municipality-level variation in the utilization of social services, whereas health care services provided for frail elderly people seem to be highly equitable across municipalities. Another important finding was that the utilization of social and health services were connected. Those who reported improvement in their health status during the preceding year were more frequently also using social services. This result suggests that if municipalities continue to limit the provision of support services only for those who are in the highest need, this saving in the social sector may, in
Sortsø, Camilla; Lauridsen, Jørgen; Emneus, Martha
Understanding socioeconomic inequalities in health care is critical for achieving health equity. The aim of this paper is threefold: 1) to quantify inequality in diabetes health care service utilization; 2) to understand determinants of these inequalities in relation to socio-demographic and clin......Understanding socioeconomic inequalities in health care is critical for achieving health equity. The aim of this paper is threefold: 1) to quantify inequality in diabetes health care service utilization; 2) to understand determinants of these inequalities in relation to socio...... differences in inequality estimates. While income, alike other measures of labor market attachment, to a certain extent is explained by morbidity and thus endogenous, education is more decisive for patients' ability to take advantage of the more specialized services provided in a universal health care system....
Rim, Hwayoung; Lee, Kunsei; Chang, Sounghoon; Hovell, Melbourne F; Kim, Young-Taek; Kim, Yuna; Kang, Gilwon; Tak, Yangju; Im, Jeehye
To evaluate the sensitivity and specificity of Community Health Survey (CHS), we analyzed data from 11,217 participants aged ≥ 19 yr, in 13 cities and counties in 2008. Three healthcare utilization indices (admission, outpatient visits, dental visits) as comparative variables and the insurance benefit claim data of the Health Insurance Review & Assessment Service as the gold-standard were used. The sensitivities of admission, outpatient visits, and dental visits in CHS were 54.8%, 52.1%, and 61.0%, respectively. The specificities were 96.4%, 85.6%, and 82.7%, respectively. This is the first study to evaluate the validity of nationwide health statistics resulting from questionnaire surveys and shows that CHS needs a lot of efforts to reflect the true health status, health behavior, and healthcare utilization of the population. PMID:22065895
poverty aside from physical capital (Strauss J and Thomas D, 1998). ... factors on health status of children across poverty groups and sector. ...... Decomposing Inequalities in Nutritional Status of ... The causal effect of health on social and.
Graetz, V.; Rechel, B.; Groot, W.
: Compared with previous systematic reviews, the results indicate a clearer picture of the differences in health service utilization between migrants and non-migrants in Europe. Areas timely for developing research: A comprehensive comparison across European countries is impossible because the number......Introduction: Our study reviewed the empirical evidence on the utilization of health care services by migrants in Europe, and on differences in health service utilization between migrants and non-migrants across European countries. Sources of data: A systematic literature review was performed......, searching the databases Medline, Cinahl and Embase and covering the period from January 2009 to April 2016. The final number of articles included was 39. Areas of agreement: Utilization of accident and emergency services and hospitalizations were higher among migrants compared with non-migrants in most...
Peltzer, Karl; Pengpid, Supa
The aim of this study was to investigate dental health status and oral health behavior and associated factors among university students in five ASEAN countries (Indonesia, Malaysia, Myanmar, Thailand and Vietnam). Using anonymous questionnaires, data were collected from 3,344 undergraduate university students (mean age 20.5, SD=1.6; 58.3% female) from five ASEAN countries. Results indicate that 27.7% of students reported to have sometimes, most of the time or always having tooth ache in the past 12 months, 39.4% reported to have one or more cavities, 20.3% did not brush their teeth twice or more times a day, and 30.9% had never been to a dentist (or did not know it). In multivariate logistic regression analysis, older age, living in a lower middle income country, consumption of chocolate or candy, having made a dental care visit, and poor mental health was associated with tooth ache in the past 12 months. Being male, being 20 to 21 years old, coming from a wealthier family background, living in a lower middle income country, frequent consumption of soft drinks, not having consulted with a dentist in the past 12 months and weak beliefs in the benefits of tooth brushing were associated with inadequate tooth brushing frequency (health status and oral health behaviors were found and various risk factors identified that can be utilized to guide interventions to improve oral health programs among university students.
Groenewold, W.G.F.; van Ginneken, J.K.S.
Objectives: To examine if, and to what extent, disparities in health status exist between ethnic Russians and the native majority populations of four former Soviet Republics; and to determine to what extent indicators of socio-economic status and lifestyle behaviours explain variations in health
Abstract. Objective: To determine the perceived oral health status and treatment needs of Nigerian dental therapists in students from Federal School of Dental Therapy and Technology Enugu, Nigeria was conducted using self-administered questionnaire to obtain information on demography, self-reported oral health status, ...
Cress, Eileen McKenna
Vitamin D deficiency is considered to be a pandemic with implications for compromised bone health and other chronic diseases. Few studies have examined vitamin D status in college-aged individuals where prevention of future health consequences is still possible. Serum vitamin D 25(OH)D status and vitamin D intake were examined in 98 college…
van Stel, Henk F.; Busschbach, Jan J. V.; Hunink, M. G. Myriam; Buskens, Erik
Objectives: Estimates regarding the impact of secondary cardiovascular events on health status in patients treated for cardiovascular disease are scarce and of limited accuracy. Methods: We obtained individual patient data on health status (EuroQol five-dimensional questionnaire) and secondary
This paper intends to develop health status index among drug abuse prison inmates in Malaysia. A self-admistered questionnaire distributed to 1753 respondents. In this study, to calculate the health status index number of drug abuse inmates, descriptive and factor analyses applied. The data based on 10 indicators of ...
Donners, A.; Bury, D.; Fernstrand, A.; Garssen, J.; Roth, T.; Verster, J.
Introduction: Impaired sleep can have a significant impact on perceived health status. The aim of the current study was to examine the relationship between perceived health status and sleep quality, total sleep time, and insomnia. Materials and methods: A survey was conducted among Dutch university
van den Berge, Jan C.; Dulfer, Karolijn; Utens, Elisabeth M. W. J.; Hartman, Eline M. J.; Daemen, Joost; van Geuns, Robert J.; van Domburg, Ron T.
Subjective health status is an increasingly important parameter to assess the effect of percutaneous coronary intervention (PCI) in clinical practice. Aim of this study was to determine medical and psychosocial predictors of poor subjective health status over a 10 years' post-PCI period. We included
Pewa, Preksha; Garla, Bharath K; Dagli, Rushabh; Bhateja, Geetika Arora; Solanki, Jitendra
In rural India, dental diseases occur due to many factors, which includes inadequate or improper use of fluoride and a lack of knowledge regarding oral health and oral hygiene, which prevent proper screening and dental care of oral diseases. The objective of the study was to evaluate the dental attendance, awareness and utilization of dental services in public health center. A cross-sectional study was conducted among 251 study subjects who were visiting dental outpatient department (OPD) of public health centre (PHC), Guda Bishnoi, and Jodhpur using a pretested proforma from month of July 2014 to October 2014. A pretested questionnaire was used to collect the data regarding socioeconomic status and demographic factors affecting the utilization of dental services. Pearson's Chi-square test and step-wise logistic regression were applied for the analysis. Statistically significant results were found in relation to age, educational status, socioeconomic status and gender with dental attendance, dental awareness and felt needs. p-value dental services, thereby increasing the oral health status of the population.
... Renewable Energy Infrastructure FC12-10-000 Limited Partnership. Project AMBG2 LP FC12-11-000 SunBridge Wind... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [Docket Nos. EG12-108-000, et al.] Notice of Effectiveness of Exempt Wholesale Generator or Foreign Utility Company Status [[Page 73647...
... DEPARTMENT OF ENERGY Federal Energy Regulatory Commission [EG12-43-000, EG12-53-000, EG12-54-000, et al.] Notice of Effectiveness of Exempt Wholesale Generator or Foreign Utility Company Status Docket Nos. Sherbino I Wind Farm LLC EG12-43-000 Eagle Point Power Generation LLC....... EG12-53-000...
Background: Health insurance is a social security system that aims to facilitate fair financing of health costs through pooling and judicious utilization of financial resources, in order to provide financial risk protections and cost burden sharing for people against high cost of healthcare through various prepayment methods ...
Maternal health service utilization in urban slums of selected towns in Ethiopia: Qualitative study. ... Reasons were found to be attributed to individual characteristics, perceived capacities of health facilities and friendliness of service providers and socio-cultural factors including socially sanctioned expectations at community ...
Assessment of utilization of maternal health care provisions in Orumba North Local Government Area of Anambra State, Nigeria. ... care facilities (52%). This study therefore, recommends equipping modern health care facilities with both human and material resources to enhance their performance. Also, periodic training of ...
utilization of health services and associated factors in Jimma zone, south west Ethiopia. METHODS: A cross .... The sample size was calculated using Epi-Info 3.3.2 ... Before the start of data collection, the proposal was submitted to the ... Table 1. Health services access in Jimma zone, Southwest Ethiopia, February 2007.
Full Text Available This study was designed to identify: (1 predictors of 12-month healthcare service utilization for mental health reasons, framed by the Andersen model, among a population cohort in an epidemiological catchment area; and (2 correlates associated with healthcare service utilization for mental health reasons among individuals with and without mental disorders respectively. Analyses comprised univariate, bivariate, and multiple regression analyses. Being male, having poor quality of life, possessing better self-perception of physical health, and suffering from major depressive episodes, panic disorder, social phobia, and emotional problems predicted healthcare service utilization for mental health reasons. Among individuals with mental disorders, needs factors (psychological distress, impulsiveness, emotional problems, victim of violence, and aggressive behavior and visits to healthcare professionals were associated with healthcare service utilization for mental health reasons. Among individuals without mental disorders, healthcare service utilization for mental health reasons is strongly associated with enabling factors such as social support, income, environmental variables, and self-perception of the neighborhood. Interventions facilitating social cohesion and social solidarity in neighborhood settings may reduce the need to seek help among individuals without mental disorders. Furthermore, in their capacity as frontline professionals, general practitioners should be more sensitive in preventing, detecting, and treating mental disorders in routine primary care.
Hamad, Rita; Modrek, Sepideh; Kubo, Jessica; Goldstein, Benjamin A; Cullen, Mark R
Investigators across many fields often struggle with how best to capture an individual's overall health status, with options including both subjective and objective measures. With the increasing availability of "big data," researchers can now take advantage of novel metrics of health status. These predictive algorithms were initially developed to forecast and manage expenditures, yet they represent an underutilized tool that could contribute significantly to health research. In this paper, we describe the properties and possible applications of one such "health risk score," the DxCG Intelligence tool. We link claims and administrative datasets on a cohort of U.S. workers during the period 1996-2011 (N = 14,161). We examine the risk score's association with incident diagnoses of five disease conditions, and we link employee data with the National Death Index to characterize its relationship with mortality. We review prior studies documenting the risk score's association with other health and non-health outcomes, including healthcare utilization, early retirement, and occupational injury. We find that the risk score is associated with outcomes across a variety of health and non-health domains. These examples demonstrate the broad applicability of this tool in multiple fields of research and illustrate its utility as a measure of overall health status for epidemiologists and other health researchers.
Fenger, Morten Munthe; Mortensen, Erik Lykke; Poulsen, Stig Bernt
Background Psychotherapeutic treatment is associated with significant reduction of symptoms in patients, and it is generally assumed that treatment improves health and decreases the need for additional health care. The present study investigates the long-term changes in utilization of health care...... services for patients referred to psychotherapeutic treatment in 2004 and 2005. Method The study was a matched control study, which included 716 consecutive patients and 15,220 matched controls. Data from a comprehensive set of health care services were collected from central registries for an observation...... period of four years before intake and four years after ended treatment. Changes in utilization of health care services in eight health parameters were analyzed with t-test and with ANCOVA one and four year pre-post treatment. Results Of the 761 patients, 216 patients did not show up for treatment, while...
Amandus, H.E.; Petersen, M.R.; Richards, T.B.
In 1984-1985, medical examinations consisting of a chest radiograph, spirometry test, and questionnaire on work history, respiratory symptoms, and smoking history were administered to 1,061 white males who were employed at 31 coal cleaning plants and strip coal mines in the anthracite coal region of northeastern Pennsylvania. The prevalence of radiographic evidence of International Labour Office (ILO) category 1 or higher small opacities was 4.5% in 516 men who had never been employed in a dusty job other than in surface coal mining. Among these 516 workers, all 4 cases of ILO radiographic category 2 or 3 rounded opacities and 1 case of large opacities had been employed as a highwall drill operator or helper. The prevalence of category 1 or higher opacities increased with tenure as a highwall drill operator or helper (2.7% for 0 y, 6.5% for 1-9 yr, 25.0% for 10-19 y, and 55.6% for greater than or equal to 20 y drilling). Radiographic evidence of small rounded opacities, dyspnea, and decreases in FEV1.0, FVC, and peak flow were significantly related to tenure at drilling operations after adjusting for age, height, cigarette smoking status, and exposures in dusty jobs other than in surface coal mining. However, tenure in coal cleansing plants and other surface coal mine jobs were not related to significant health effects. The apparent excess prevalence of radiographic small rounded opacities in anthracite surface coal mine drillers suggests that quartz exposures have been increased. Average respirable quartz concentrations at surface coal mine drilling operations should be evaluated to determine whether exposures are within existing standards, and dust exposures should be controlled
Conard, Mark W
Smoking is a major risk factor for the development of heart failure (HF). Yet, little is known about smoking\\'s effects on the health status of established HF patients. HF patients were recruited from outpatient clinics across North America. The Kansas City Cardiomyopathy Questionnaire (KCCQ) was used to assess disease-specific health status. Smoking behaviors were classified as never having smoked, prior smoker, and as having smoked within the past 30 days. Risk-adjusted multivariable regression was used to evaluate the association of smoking status with baseline and 1-year KCCQ overall summary scores. Smoking was not associated with baseline health status. However, a significant effect was observed on 1-year health status among outpatients with HF with current smokers reporting significantly lower KCCQ scores than never smokers or ex-smokers. These findings highlight an additional adverse consequence of smoking in HF patients not previously discussed.
Full Text Available Research Problem: What is the quality of life of the elderly people, as also the available support system, in rural areas? Objectives:i To determine the demographic profile of elderly ii To assess the socio-economic, nutritional, health, morbidity and dependency status, and health care utilization. Study Design: Population based cross sectional study. Setting: Community Development Block - Lakhanmajra Participants: Persons above the age of 65 years. Sample Size: 809 elderly above the age of 65 years. Study Variables: Demographic profile, Literacy, Occupation, Health, Nutrition, Mobility, Dependency, Substance abuse, Support system. Statistical Analysis: By simple proportions. Result: In this study, majority ofthe elderly were self reliant and mobile, being an asset to the family and led socially useful and productive lives. Their predominant problems were visual impairment, joint pains, respiratory diseases and hearing impairment. Joint family and government pension was the major support system to the elderly. However, there is an imperative need to organize education, training and special service programmes for the elderly at the village level.
Depression and diminished health status are common in adults with diabetes, but few studies have investigated associations with socio-economic environment. The objective of this manuscript was to evaluate the relationship between neighborhood-level SES and health status and depression. Individual-le...
Whitehead, J; Shaver, John; Stephenson, Rob
Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
Full Text Available Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers.LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and "outness," and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals' demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas.Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men.The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients' disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas.
Whitehead, J.; Shaver, John; Stephenson, Rob
Background Prior studies have noted significant health disadvantages experienced by LGBT (lesbian, gay, bisexual, and transgender) populations in the US. While several studies have identified that fears or experiences of stigma and disclosure of sexual orientation and/or gender identity to health care providers are significant barriers to health care utilization for LGBT people, these studies have concentrated almost exclusively on urban samples. Little is known about the impact of stigma specifically for rural LGBT populations, who may have less access to quality, LGBT-sensitive care than LGBT people in urban centers. Methodology LBGT individuals residing in rural areas of the United States were recruited online to participate in a survey examining the relationship between stigma, disclosure and “outness,” and utilization of primary care services. Data were collected and analyzed regarding LGBT individuals’ demographics, health care access, health risk factors, health status, outness to social contacts and primary care provider, and anticipated, internalized, and enacted stigmas. Results Higher scores on stigma scales were associated with lower utilization of health services for the transgender & non-binary group, while higher levels of disclosure of sexual orientation were associated with greater utilization of health services for cisgender men. Conclusions The results demonstrate the role of stigma in shaping access to primary health care among rural LGBT people and point to the need for interventions focused towards decreasing stigma in health care settings or increasing patients’ disclosure of orientation or gender identity to providers. Such interventions have the potential to increase utilization of primary and preventive health care services by LGBT people in rural areas. PMID:26731405
Park, Keeho; Park, Jong-Hyock; Park, Jae-Hyun; Kim, Hui-Jeong; Park, Bo-Yoon
We analyzed information surveyed from a community-based sample of Korean women older than 40 years of age to understand the relationships between health status and screening behavior. In a cross-sectional population-based study, a two-stage, geographically stratified household-based sampling design was used for assembly of a probability sample of women aged 40-69 years living in Gunpo in Korea, resulting in a total sample size of 503 women. The primary outcome variable for this analysis was the respondent's intention to obtain a mammogram. Predictor variables included health status and other factors known to influence the use of cancer screening, such as age, education, income, marital status and the presence of co-morbid illnesses. Health status was assessed by using the EuroQol (EQ-5D). The median EQ visual analogue scale score was 75.0, ranging from 20 to 100. In bivariate analyses, the percentage of women reporting to have intention toward mammography use decreased with worsening health status. Women who had problems with mobility or anxiety/depression showed lower intention to undergo future screening mammography. Multivariate logistic regression confirmed that health status was significantly associated with intention toward mammography use. Anxiety or depression was an independent predictor of future screening mammography use. Health status is significantly associated with intention regarding screening mammography use. Physicians or other health professionals should be aware that health status is an important component for health promotion, and should pay more attention to clients' possible vulnerability in screening mammography use due to their poor health status. (author)
Cordoba, Juan Carlos; Ripoll, Marla
We document various limitations of the expected utility model for the study of health and longevity. The model assumes individuals are indifferent between early and late resolution of uncertainty. This assumption gives rise to predictions regarding the economic value of life that are inconsistent with relevant evidence. For example, poor individuals would price life below the present value of foregone income or even negatively. We show that a non-expected utility model disentangling intertemp...
Prakash, Ravi; Kumar, Abhishek
Drawing upon data from the third round of the National Family Health Survey (NFHS-3) conducted in India during 2005-06, this study compares the utilization of selected maternal and child health care services between the urban poor and non-poor in India and across selected Indian states. A wealth index was created, separately for urban areas, using Principal Component Analysis to identify the urban poor. The findings suggest that the indicators of maternal and child health care are worse among the urban poor than in their non-poor counterparts. For instance, the levels of antenatal care, safe delivery and childhood vaccinations are much lower among the urban poor than non-poor, especially in socioeconomically disadvantageous states. Among all the maternal and child health care indicators, the non-poor/poor difference is most pronounced for delivery care in the country and across the states. Other than poverty status, utilization of antenatal services by mothers increases the chances of safe delivery and child immunization at both national and sub-national levels. The poverty status of the household emerged as a significant barrier to utilization of health care services in urban India.
Lahana, Eleni; Pappa, Evelina; Niakas, Dimitris
Equal utilization of health services for equal need, is one of the main targets for public health systems. Given the public-private structure of the Greek NHS, the main aim of the study was to investigate the impact of underlying factors, such as health care needs, socio-demographic characteristics and ethnicity, on the utilization of primary and hospital health care in an urban and rural population of the Greek region, Thessaly. A cross-sectional study was carried out in 2006 in Thessaly, a Greek region of Central Greece, in a representative sample of 1372 individuals (18+ years old, response rate 91.4%) via face-to-face interview. Health care needs were determined by self-perceived health status estimated by the SF-36 Health Survey, using the summary scores of physical and mental health. The utilization of primary care was measured by last month visits to 1) primary public services and 2) private practitioners visits and utilization of secondary care was measured by past year visits to 3) public hospital emergency departments and 4) admissions to public hospitals. Multivariable stepwise logistic regression analysis was applied in the whole sample and separately for the urban and rural population, in order to determine the predictors of health services utilization. Statistical significance was determined with a p value services utilization in both the urban and rural areas. Poor physical and mental health was associated with higher likelihood of use. In the urban areas middle-aged, elderly and Greeks were more likely to use primary health services, whereas primary education was associated with more visits to the emergency departments. Wealthier individuals were two times more likely to be admitted to hospitals. Individuals from the rural areas with university education visited more the public primary services, while wealthier individuals visited more the private practitioners. Immigrants had a higher likelihood of visiting emergency departments. Although health
Systematic violations of expected utility theory (EU) have been reported in the context of both money and health outcomes. Rank-dependent utility theory (RDU) is currently the most popular and influential alternative theory of choice under circumstances of risk. This paper reports a test of the descriptive performance of RDU compared to EU in the context of health. When one of the options is certain, violations of EU that can be explained by RDU are found. When both options are risky, no evidence that RDU is a descriptive improvement over EU is found, though this finding may be due to the low power of the tests. Copyright 2002 John Wiley & Sons, Ltd.
Karim, Rizwanul M; Abdullah, Mamun S; Rahman, Anisur M; Alam, Ashraful M
Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 community clinics. Since most of the outcome indicators focus mainly on women and children, women having children less than 2 years of age were randomly assigned and interviewed for the study purpose. Data were collected through FGD, Key informants interview and a pretested semi- structured questionnaire. About 95 % of the respondents were Muslims and 5 % were Hindus. The average age of the respondents was 23.38 (SD 4.15) and almost all of them are home makers. The average monthly expenditure of their family was 95US $ (SD 32US$). At the beginning of the study, two psychometric research instruments; 24 items perceived quality of primary care services PQPCS scale (chronbach's α = .89) and 22 items community clinic service satisfaction CCSS scale (chronbach's α = .97), were constructed and validated. This study showed less educated, poor, landless mothers utilized the community clinic services more than their educated and wealthier counterpart. Women who lived in their own residence used the community clinic services more frequently than those who lived in a rental house. Perceptions concerning skill and competence of the health care provider and satisfaction indicating interpersonal communication and attitude of the care provider were important predictors for community clinic service utilization
Reddy, Kommuri Sahithi; Doshi, Dolar; Kulkarni, Suhas; Reddy, Bandari Srikanth; Reddy, Madupu Padma
The sense of coherence (SOC) has been suggested to be highly applicable concept in the public health area because a strong SOC is stated to decrease the likelihood of perceiving the social environment as stressful. This reduces the susceptibility to the health-damaging effect of chronic stress by lowering the likelihood of repeated negative emotions to stress perception. The demographic data and general information of subjects' oral health behaviors such as frequency of cleaning teeth, aids used to clean teeth, and dental attendance were recorded in the self-administered questionnaire. The SOC-related data were obtained using the short version of Antonovsky's SOC scale. The periodontal status was recorded based on the modified World Health Organization 1997 pro forma. The total of 780 respondents comprising 269 (34.5%) males and 511 (65.5%) females participated in the study. A significant difference was noted among the subjects for socioeconomic status based on gender ( P = 0.000). The healthy periodontal status (community periodontal index [CPI] code 0) was observed for 67 (24.9%) males and 118 (23.1%) females. The overall SOC showed statistically negative correlation with socioeconomic status scale ( r = -0.287). The CPI and loss of attachment (periodontal status) were significantly and negatively correlated with SOC. The present study concluded that a high level of SOC was associated with good oral health behaviors, periodontal status, and socioeconomic status.
address not only the problems of undernutrition, but also to monitor the weight and health ..... women of low socio-economic status were found to be at the greatest risk of an .... Public Health, Harvard University Press. 1996. 2. World Health ...
Kevin M. Potter; Barbara L. Conkling
The annual national report of the Forest Health Monitoring (FHM) Program of the Forest Service, U.S. Department of Agriculture, presents forest health status and trends from a national or multi-State regional perspective using a variety of sources, introduces new techniques for analyzing forest health data, and summarizes results of recently completed Evaluation...
Kevin M. Potter; Barbara L. Conkling
The annual national report of the Forest Health Monitoring (FHM) Program of the Forest Service, U.S. Department of Agriculture, presents forest health status and trends from a national or multi-State regional perspective using a variety of sources, introducesnew techniques for analyzing forest health data, and summarizes results of recently completed...
Kevin M. Potter; Barbara L. Conkling
The annual national report of the Forest Health Monitoring (FHM) Program of the Forest Service, U.S. Department of Agriculture, presents forest health status and trends from a national or multi-State regional perspective using a variety of sources, introduces new techniques for analyzing forest health data, and summarizes results of recently completed Evaluation...
Choi, Young Myung; Oh, Keun Bae; Lee, Kwang Seok; Ham, Cheol Hoon; Lee, Byeong Uk; Lee, Jae Seong; Choi, Yeong Rok; Ko, Han Seong
The objective of this project is to propose strategies and tactics for nuclear cooperation between the South and the North in the perspective of the unification of the Korean Peninsula, based on proper and objective understanding of the status of nuclear development and utilization activities in North Korea, especially those for peaceful purposes. This study analyzes the nuclear development and utilization status of North Korea in terms of nuclear development history and policies, nuclear research and development, nuclear power generation, nuclear fuel cycle, production and uses of radiation and isotopes, manufacturing of equipment and components of nuclear power plants, and international nuclear cooperation. Based on the analysis, this study proposes basic directions for nuclear cooperation between South and North Korea. (Author)
van de Mheen, H.; Stronks, K.; Looman, C. W.; Mackenbach, J. P.
The purpose of this study is to assess to what extent the effect of childhood socioeconomic status on adult health could be explained by a higher prevalence of unhealthy behaviour among those with lower childhood socioeconomic status. Data were obtained from the baseline of a prospective cohort
H. van de Mheen (Dike); K. Stronks (Karien); C.W.N. Looman (Caspar); J.P. Mackenbach (Johan)
textabstractBACKGROUND: The purpose of this study is to assess to what extent the effect of childhood socioeconomic status on adult health could be explained by a higher prevalence of unhealthy behaviour among those with lower childhood socioeconomic status. METHODS:
Muneera Abdalkareem Alshdefait; Mohammad . S. Alzboon
This study aimed at finding out the status of utilizing social media networks in the teaching-learning process at public Jordanian Universities. To achieve the goal of the study, the descriptive developmental method was used and a questionnaire was developed, consisting of (35) statements. The questionnaire was checked for its validity and reliability. Then it was distributed to a sample of (382) male and female students from the undergraduate and graduate levels. The study results showed tha...
identify and bring under control at workplaces all health risks; provide ... on the status of occupational safety among hospital workers in Tanzania. ..... The assistance from the IPC/IS. National ... tions of the Healthcare Infection Prevention.
The study of Health Status of Military Women and Men in the Total Force will obtain comprehensive probability-based epidemiological data for women and men across all pay grades for active-duty Army...
Hildebrandt, Thomas; Thiel, Falk C; Fasching, Peter A; Graf, Christiane; Bani, Mayada R; Loehberg, Christian R; Schrauder, Michael G; Jud, Sebastian M; Hack, Carolin C; Beckmann, Matthias W; Lux, Michael P
Cost increases in the healthcare system are leading to a need to distribute financial resources in accordance with the value of each service performed. Health-economic decision-making models can support these decisions. Due to the previous unavailability of health utilities in Germany (scored states of health as a basis for calculating quality-adjusted life-years, QALYs) for women undergoing treatment, international data are often used for such models. However, these may widely deviate from the values for a woman actually living in Germany. It is, therefore, necessary to collect and analyze health utilities in Germany. In a questionnaire survey, health utilities were collected, along with data for a healthy control group, for 580 female patients receiving treatment in the fields of mastology and gynecological oncology using a German version of the EuroQol questionnaire (EQ-5D) and a visual analogue scale (VAS). Data were also collected for the patients' medical history, tumor disease, and treatment. Significant differences with regard to quality of life were measured in relation to the individual tumor entities and in comparison to the controls. Apart from the healthy control group, patients with breast or cervical carcinoma had the best quality of life. In patients with recurrent and metastatic disease, those with breast carcinoma experienced the greatest impairment of their quality of life. According to current treatment, the most important impairment of life quality occurred in patients under radiotherapy and after surgical treatment. There are significant differences from the health utilities recorded for other countries - for example, the state of health declines much more markedly in patients with metastatic disease among American women with breast carcinoma than among German women, in whom recurrent disease and a first diagnosis of metastasis were comparable. Overall, the VAS was able to distinguish more adequately than the EQ-5D questionnaire between the
Shell in collaboration with four communities in Obio-Akpor LGA, Port Harcourt, started a Community Health Insurance Scheme in February 2010. An evaluation of enrollees' utilization and perception of the services provided was done. Methodology: Quantitative data were collected by the use of structured interviewer ...
de Haan, A.M.; Boon, A.E.; Vermeiren, R.R.J.M.; de Jong, J.T.V.M.
Objectives. There is an overall underutilization of youth mental health care (YMHC). It is unknown whether underutilization differs per ethnic group. Therefore, this study is aimed at gaining insight into the effects of ethnicity, age and gender on this utilization. Design. The sample consisted of
Kohlmann, Thomas; Wang, Cheng; Lipinski, Jens; Hadker, Nandini; Caffrey, Elizabeth; Epstein, Michael; Sadasivan, Ravi; Gondek, Kathleen
Leading multiple sclerosis (MS) therapies have patient support programs (PSPs) aimed at improving patients' lives. There is limited knowledge about what drives patient satisfaction with PSPs and little evidence about its impact on patient-reported health status or health-related quality of life. The aims of this study were to evaluate patient needs and the PSP's role in meeting those needs; understand the drivers of PSP satisfaction and loyalty; and assess whether a MS PSP provides quantifiable, incremental benefit to patients, as measured by patient-reported health status, health state utility, and/or health-related quality of life. An Internet survey was conducted among 1,123 adult German MS patients currently enrolled in Bayer's German BETAPLUS PSP. Health status, health state utility, and health-related quality of life were measured using the EQ-5D Visual Analog Scale, the EQ-5D Index, and Short Form-12 Health Survey, respectively. MS patient needs vary by disease severity, duration of disease, and gender. Patients with greater self-reported needs and lower health status, health state utility, and health-related quality of life value and use the PSP more than other patients. Drivers of PSP satisfaction include use of patient hotline, nurse telephone calls, and mail education. Patients estimate that their health status would be 15 points lower if the PSP ceased to exist (translating to 0.15 on the time trade-off utility scale). This impact is significant, as it is nearly two times the minimally important difference. MS patients place inherent value on PSPs. From a patient's viewpoint, PSPs provide real incremental benefit in patient-reported health status at all stages of MS.
Allen, Jennifer D; Mars, Dana R; Tom, Laura; Apollon, Guy; Hilaire, Dany; Iralien, Gerald; Cloutier, Lindsay B; Sheets, Margaret M; Zamor, Riché
Understanding the factors that influence health beliefs, attitudes, and service use among Haitians in the United States is increasingly important for this growing population. We undertook a qualitative analysis to explore the factors related to cancer screening and utilization of health services among Haitians in Boston. Key informant interviews (n=42) and nine focus groups (n=78) revealed that Haitians experience unique barriers to health services. These include language barriers, unfamiliarity with preventive care, confidentiality concerns, mistrust and stigma concerning Western medicine, and a preference for natural remedies. Results suggest that many Haitians could benefit from health system navigation assistance, and highlight the need for comprehensive, rather than disease-focused programs, to decrease stigma and increase programmatic reach. Faith-based organizations, social service agencies, and Haitian media were identified as promising channels for disseminating health information. Leveraging positive cultural traditions and existing communication networks could increase the impact of Haitian health initiatives.
Clarke, Tainya C; Arheart, Kristopher L; Muennig, Peter; Fleming, Lora E; Caban-Martinez, Alberto J; Dietz, Noella; Lee, David J
To examine indicators of health care access and utilization among children of working and nonworking single mothers in the United States, the authors used data on unmarried women participating in the 1997-2008 National Health Interview Survey who financially supported children under 18 years of age (n = 21,842). Stratified by maternal employment, the analyses assessed health care access and utilization for all children. Outcome variables included delayed care, unmet care, lack of prescription medication, no usual place of care, no well-child visit, and no doctor's visit. The analyses reveal that maternal employment status was not associated with health care access and utilization. The strongest predictors of low access/utilization included no health insurance and intermittent health insurance in the previous 12 months, relative to those with continuous private health insurance coverage (odds ratio ranges 3.2-13.5 and 1.3-10.3, respectively). Children with continuous public health insurance compared favorably with those having continuous private health insurance on three of six access/utilization indicators (odds ratio range 0.63-0.85). As these results show, health care access and utilization for the children of single mothers are not optimal. Passage of the U.S. Healthcare Reform Bill (HR 3590) will probably increase the number of children with health insurance and improve these indicators.
Joosten, Koen; van der Velde, Kelly; Joosten, Pieter; Rutten, Hans; Hulst, Jessie; Dulfer, Karolijn
In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the association between nutritional status and subjective health status in chronically ill children attending special schools. Overall, 642 children, median age 9.8 years (IQR 7.7-11.5), 60 % male, 72 % Caucasian, were included in this prospective study in nine special schools for chronically ill children in the Netherlands. Overall malnutrition was assessed as: acute malnutrition (nutritional risk-screening tool STRONGkids. Subjective health status was assessed with EQ-5D. Overall, 16 % of the children had overall malnutrition: 3 % acute and 13 % chronic malnutrition. Nurses reported 'some/severe problems' on the health status dimensions mobility (15 %), self-care (17 %), usual activities (19 %), pain/discomfort (22 %), and anxiety/depression (22 %) in chronically ill children. Their mean visual analogue scale score (VAS) was 73.0 (SD 11.1). Malnutrition, medication usage, and younger age explained 38 % of the variance of the VAS score. The presence of overall malnutrition in chronically ill children attending special schools was associated with lower subjective health status, especially in younger children and in those with chronic medication usage. Therefore, it is important to develop and use profile-screening tools to identify these children.
Roysden, Nathaniel; Wright, Adam
Mental health problems are an independent predictor of increased healthcare utilization. We created random forest classifiers for predicting two outcomes following a patient’s first behavioral health encounter: decreased utilization by any amount (AUROC 0.74) and ultra-high absolute utilization (AUROC 0.88). These models may be used for clinical decision support by referring providers, to automatically detect patients who may benefit from referral, for cost management, or for risk/protection ...
Roysden, Nathaniel; Wright, Adam
Mental health problems are an independent predictor of increased healthcare utilization. We created random forest classifiers for predicting two outcomes following a patient's first behavioral health encounter: decreased utilization by any amount (AUROC 0.74) and ultra-high absolute utilization (AUROC 0.88). These models may be used for clinical decision support by referring providers, to automatically detect patients who may benefit from referral, for cost management, or for risk/protection factor analysis.
Cinnamon S. Bloss
short-term increases or decreases in health care costs or utilization associated with monitoring chronic health conditions using mobile health or digital medicine technologies. Among secondary outcomes there was some evidence of improvement in health self-management which was characterized by a decrease in the propensity to view health status as due to chance factors in the intervention group.
Bains, Ranbir M.; Cusson, Regina; White-Frese, Jesse; Walsh, Stephen
Background: We summarize utilization patterns for mental health services in school-based health centers. Methods: Administrative data on school-based health center visits in New Haven, Connecticut were examined for the 2007-2009 school years. Relative frequencies of mental health visits by age were calculated as a percentage of all visits and were…
Goodridge, Donna; Hawranik, Pamela; Duncan, Vicky; Turner, Hollie
Home health care services are expanding at a rapid pace in order to meet the needs of the growing population of older adults and those with chronic illnesses. Because of current restrictions on home health care as an insured service in some countries, individuals may be required to pay for some or all of their home care services out of pocket. These payments may potentially limit access to needed home care services for persons in the lowest socioeconomic strata. Previous research demonstrates a clear socioeconomic gradient in access to acute and primary care services, where those most in need of services are the most disadvantaged and under-serviced. There has been little attention paid thus far, however, to the way in which socioeconomic status may affect the receipt of home health care services. To determine what is known from existing literature about socioeconomic disparities in home health care access and utilization. A scoping review was used to map the extent and nature of the literature in this area. A search of the databases CINAHL, Medline, SocIndex and Sociological Abstracts as well as Dissertations International. A total of 206 potentially relevant articles were published between 2000 and April 2011. Two reviewers independently reviewed the articles, leaving 15 research articles to be included in the scoping review. The majority of articles reported secondary analyses of administrative datasets related to utilization of home health care. Several studies examined access and utilization using qualitative approaches. The distinction between professional and supportive home care services was not always clear in the articles. Individual and composite measures of socioeconomic status were reported, with the most frequently used indicator being income. Several studies used more complex composite ecological indicators of socieconomic status. There was general agreement that utilization of home health services favored persons with greater economic disadvantage
Peeters, Yvette; Ranchor, Adelita V.; Vlieland, Thea P. M. Vliet; Stiggelbout, Anne M.
Background: In cost-utility analyses gain in health can be measured using health state utilities. Health state utilities can be elicited from members of the public or from patients. Utilities given by patients tend to be higher than utilities given by members of the public. This difference is often
Rasu, Rafia S; Bawa, Walter Agbor; Suminski, Richard; Snella, Kathleen; Warady, Bradley
Health literacy presents an enormous challenge in the delivery of effective healthcare and quality outcomes. We evaluated the impact of low health literacy (LHL) on healthcare utilization and healthcare expenditure. Database analysis used Medical Expenditure Panel Survey (MEPS) from 2005-2008 which provides nationally representative estimates of healthcare utilization and expenditure. Health literacy scores (HLSs) were calculated based on a validated, predictive model and were scored according to the National Assessment of Adult Literacy (NAAL). HLS ranged from 0-500. Health literacy level (HLL) and categorized in 2 groups: Below basic or basic (HLS Healthcare utilization expressed as a physician, nonphysician, or emergency room (ER) visits and healthcare spending. Expenditures were adjusted to 2010 rates using the Consumer Price Index (CPI). A P value of 0.05 or less was the criterion for statistical significance in all analyses. Multivariate regression models assessed the impact of the predicted HLLs on outpatient healthcare utilization and expenditures. All analyses were performed with SAS and STATA® 11.0 statistical software. The study evaluated 22 599 samples representing 503 374 648 weighted individuals nationally from 2005-2008. The cohort had an average age of 49 years and included more females (57%). Caucasian were the predominant racial ethnic group (83%) and 37% of the cohort were from the South region of the United States of America. The proportion of the cohort with basic or below basic health literacy was 22.4%. Annual predicted values of physician visits, nonphysician visits, and ER visits were 6.6, 4.8, and 0.2, respectively, for basic or below basic compared to 4.4, 2.6, and 0.1 for above basic. Predicted values of office and ER visits expenditures were $1284 and $151, respectively, for basic or below basic and $719 and $100 for above basic (P healthcare utilization and expenditure. Individuals with below basic or basic HLL have greater healthcare
Ng, Sor Tho; Tengku-Aizan, Hamid; Tey, Nai Peng
This article investigates the influence of perceived health status on the daily activity participation of older Malaysians. Data from the Survey on Perceptions of Needs and Problems of the Elderly, which was conducted in 1999, were used. The negative binomial regression results show that older persons with good perceived health status reported more varieties of daily activity participation, especially among the uneducated and those with below-average self-esteem. The multinomial logistic regression model suggests that older persons with good perceived health status tended to engage daily in paid work only or with leisure activities, whereas those perceived to have poor health were more likely to engage in leisure activities only or leisure and family role activities. Promotion of a healthy lifestyle at a younger age encourages every person to monitor and take responsibility for their own health, which is a necessary strategy to ensure active participation at an older age, and thus improve their well-being.
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.
Reproductive health is an essential aspect of the wellbeing of adolescents. Therefore reproductive health knowledge and sexual behaviour deservedly attract the attention of researchers, programme planners and policy implementers working with young people. Yet in Nigeria, little is known about the effect of migration ...
Full Text Available Recent trends place an emphasis on school health care, the ultimate goal of which is to protect,maintain, and promote students’ health. School health care is a program that integrates health careservices, health education, health counseling, and local social health services. The student healthexamination (SHE system is a part of school health care and schools and communities must beavailable to provide professional health services. Pediatricians also have important roles as experts inboth school health care and the SHE system. In this article, the history of school health care, its legalbasis, and the current status of the SHE system in Korea are reviewed. Furthermore, sample surveysfrom the past few years are reviewed. Through this holistic approach, future directions are proposed forthe improvement of SHE and school health care.
Asenso-Okyere, W.K.; Asante, F.A.; Nube, M.
The data set of the Ghana Living Standards Survey (GLSS, round 1, 1987/1988) was utilized to analyse the principal determinants (publicly and privately) of health and nutrition of children under five in Ghana. While in most health and nutrition studies the emphasis is either on health-related
Pyle Donald N
Full Text Available Abstract Background Appalachia is characterized by poor health behaviors, poor health status, and health disparities. Recent interventions have not demonstrated much success in improving health status or reducing health disparities in the Appalachian region. Since one's perception of personal health precedes his or her health behaviors, the purpose of this project was to evaluate the self-rated health of Appalachian adults in relation to objective health status and current health behaviors. Methods Appalachian adults (n = 1,576 were surveyed regarding health behaviors - soda consumer (drink ≥ 355 ml/d, or non-consumer (drink 30 min > 1 d/wk and sedentary (exercise Results Respondents reported being healthy, while being sedentary (65%, hypertensive (76%, overweight (73%, or hyperlipidemic (79%. Between 57% and 66% of the respondents who considered themselves healthy had at least two disease conditions or poor health behaviors. Jaccard Binary Similarity coefficients and odds ratios showed the probability of reporting being healthy when having a disease condition or poor health behavior was high. Conclusions The association between self-rated health and poor health indicators in Appalachian adults is distorted. The public health challenge is to formulate messages and programs about health and health needs which take into account the current distortion about health in Appalachia and the cultural context in which this distortion was shaped.
Derakhshan, Adeeb; Miller, Jacob; Lubelski, Daniel; Nowacki, Amy S; Wells, Brian J; Milinovich, Alex; Benzel, Edward C; Mroz, Thomas E; Steinmetz, Michael P
Few studies have examined the general correlation between socioeconomic status and imaging. This study is the first to analyze this relationship in the spine patient population. To assess the effect of socioeconomic status on the frequency with which imaging studies of the lumbar spine are ordered and completed. Patients that were diagnosed with lumbar radiculopathy and/or myelopathy and had at least 1 subsequent lumbar magnetic resonance imaging (MRI), computed tomography (CT), or X-ray ordered were retrospectively identified. Demographic information and the number of ordered and completed imaging studies were among the data collected. Patient insurance status and income level (estimated based on zip code) served as representations of socioeconomic status. A total of 24,105 patients met the inclusion criteria for this study. Regression analyses demonstrated that uninsured patients were significantly less likely to have an MRI, CT, or X-ray study ordered (P socioeconomic characteristics such as insurance status and income level highlight a critical gap in access to health care. Physicians should work to mitigate the influence of such factors when deciding whether to order imaging studies, especially in light of the ongoing shift in health policy in the United States.
Harber, Philip; Leroy, Gondy
Assess feasibility and potential utility of natural language processing (NLP) for storing and analyzing occupational health data. Basic NLP lexical analysis methods were applied to 89,000 Mine Safety and Health Administration (MSHA) free text records. Steps included tokenization, term and co-occurrence counts, term annotation, and identifying exposure-health effect relationships. Presence of terms in the Unified Medical Language System (UMLS) was assessed. The methods efficiently demonstrated common exposures, health effects, and exposure-injury relationships. Many workplace terms are not present in UMLS or map inaccurately. Use of free text rather than narrowly defined numerically coded fields is feasible, flexible, and efficient. It has potential to encourage workers and clinicians to provide more data and to support automated knowledge creation. The lexical method used is easily generalizable to other areas. The UMLS vocabularies should be enhanced to be relevant to occupational health.
De Marchi, Renato José; Hugo, Fernando Neves; Hilgert, Juliana Balbinot; Padilha, Dalva Maria Pereira
Evidence suggests that older people with partial tooth loss and edentulism change their diet and lack specific nutrients, but few studies have assessed whether poor oral status is associated with risk of malnutrition and malnutrition in independent-living older people. We evaluated if poor oral status was associated with risk of malnutrition and malnutrition in this population. A random sample of 471 south Brazilians > or =60 y of age was evaluated. Measurements included a questionnaire to assess sociodemographic, behavioral, general, and oral health data; nutritional status assessment, according to the Mini-Nutritional Assessment (MNA); and oral status assessment, by means of oral examinations assessing the number of teeth and use of dental prostheses. Correlates of risk of malnutrition/malnutrition according to the MNA were assessed by means of multivariate logistic regression. Participants who reported dissatisfaction with their gingival health and edentulous persons wearing only one denture were more likely to be at risk of malnutrition, according to the screening MNA. Dissatisfaction with gingival health was a risk indicator, whereas having one to eight natural teeth was protective against the risk of malnutrition/malnutrition according to the full MNA. In the present study, older people with a compromised oral status had higher odds for risk of malnutrition. The maintenance of a few teeth had a crucial role in increasing the chance of maintaining an adequate nutritional status in the studied population. In cases where edentulism was present, complete dental prosthetic use was associated with better nutritional status.
Rider, G Nicole; McMorris, Barbara J; Gower, Amy L; Coleman, Eli; Eisenberg, Marla E
Transgender and gender nonconforming (TGNC) adolescents have difficulty accessing and receiving health care compared with cisgender youth, yet research is limited by a reliance on small and nonrepresentative samples. This study's purpose was to examine mental and physical health characteristics and care utilization between youth who are TGNC and cisgender and across perceived gender expressions within the TGNC sample. Data came from the 2016 Minnesota Student Survey, which consisted of 80 929 students in ninth and 11th grade ( n = 2168 TGNC, 2.7%). Students self-reported gender identity, perceived gender expression, 4 health status measures, and 3 care utilization measures. Chi-squares and multiple analysis of covariance tests (controlling for demographic covariates) were used to compare groups. We found that students who are TGNC reported significantly poorer health, lower rates of preventive health checkups, and more nurse office visits than cisgender youth. For example, 62.1% of youth who are TGNC reported their general health as poor, fair, or good versus very good or excellent, compared with 33.1% of cisgender youth (χ 2 = 763.7, P presentation was perceived as very congruent with their birth-assigned sex were less likely to report poorer health and long-term mental health problems compared with those with other gender presentations. Health care utilization differs between TGNC versus cisgender youth and across gender presentations within TGNC youth. With our results, we suggest that health care providers should screen for health risks and identify barriers to care for TGNC youth while promoting and bolstering wellness within this community. Copyright © 2018 by the American Academy of Pediatrics.
Brault, Marie A; Brewster, Amanda L; Bradley, Elizabeth H; Keene, Danya; Tan, Annabel X; Curry, Leslie A
The social environment influences health outcomes for older adults and could be an important target for interventions to reduce costly medical care. We sought to understand which elements of the social environment distinguish communities that achieve lower health care utilization and costs from communities that experience higher health care utilization and costs for older adults with complex needs. We used a sequential explanatory mixed methods approach. We classified community performance based on three outcomes: rate of hospitalizations for ambulatory care sensitive conditions, all-cause risk-standardized hospital readmission rates, and Medicare spending per beneficiary. We conducted in-depth interviews with key informants (N = 245) from organizations providing health or social services. Higher performing communities were distinguished by several aspects of social environment, and these features were lacking in lower performing communities: 1) strong informal support networks; 2) partnerships between faith-based organizations and health care and social service organizations; and 3) grassroots organizing and advocacy efforts. Higher performing communities share similar social environmental features that complement the work of health care and social service organizations. Many of the supportive features and programs identified in the higher performing communities were developed locally and with limited governmental funding, providing opportunities for improvement.
Full Text Available The forests of North America provide a variety of benefits including water, recreation, wildlife habitat, timber, and other forest products. However, they continue to face many biotic and abiotic stressors including fires, native and invasive pests, fragmentation, and air pollution. Forest health specialists have been monitoring the health of forests for many years. This paper highlights some of the most damaging forest stressors affecting North American forests in recent years and provides some projections of future risks.
Running Bear, Ursula; Croy, Calvin D; Kaufman, Carol E; Thayer, Zaneta M; Manson, Spero M
American Indian (AI) boarding school attendance is related to poor physical health status; however, little is known about how specific aspects of this experience contribute to poor health. Five experiences (age of first attendance, limited family visits, forced church attendance, prohibition on practicing AI culture and traditions, and punishment for use of AI language) may be independently associated with physical health status in adulthood. We expected the effect to be greater for those who began boarding school at older ages. Data on AI boarding school attenders (n = 771) came from the AI-Service Utilization, Psychiatric Epidemiology, Risk and Protective Factors Project. Multiple linear regression models examined the association of these five experiences with physical health status. Additionally, we conducted a separate set of regressions to test for an interaction effect of age of first attendance. Each of the five experiences noted above were independently associated with poorer physical health status compared to those who did not have these experiences. An interaction effect for those punished for use of AI language and who were aged 8 or older was confirmed. Findings are consistent with reports that boarding school attendance is related to poor AI adult health. To inform AI health programs, the relationship of specific diseases and boarding school attendance should be considered.
Hibbard, J H; Pope, C R
This study examines the characteristics of jobs held by women as compared to men during the 1970s and assesses associations between job characteristics and family status with health status by sex. Sex differences in perceptions about the meaning of work, commitment to the work role, and stresses and rewards are considered. Survey data on 1490 employed men and women, ages 18-64, drawn from a random sample of enrollees of a large health maintenance organization in 1970-71 are linked with medical record data covering seven years of outpatient and inpatient services. The findings suggest important differences in the characteristics of jobs held by men and women and in the relative importance of these job characteristics in relation to health. Men held jobs with higher quality intrinsic work characteristics and perceived their jobs to be less stressful and less physically and mentally tiring than did women. Social support and integration through work and occupational status were significantly related to health status for both sexes, however, family responsibilities interact with job characteristics to affect health status for women. Single motherhood, in combination with low social support and integration through work, was related to poor health among women.
Full Text Available Abstract Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance.
Introduction Health care financing reforms in both China and Vietnam have resulted in greater financial difficulties in accessing health care, especially for the rural poor. Both countries have been developing rural health insurance for decades. This study aims to evaluate and compare equity in access to health care in rural health insurance system in the two countries. Methods Household survey and qualitative study were conducted in 6 counties in China and 4 districts in Vietnam. Health insurance policy and its impact on utilization of outpatient and inpatient service were analyzed and compared to measure equity in access to health care. Results In China, Health insurance membership had no significant impact on outpatient service utilization, while was associated with higher utilization of inpatient services, especially for the higher income group. Health insurance members in Vietnam had higher utilization rates of both outpatient and inpatient services than the non-members, with higher use among the lower than higher income groups. Qualitative results show that bureaucratic obstacles, low reimbursement rates, and poor service quality were the main barriers for members to use health insurance. Conclusions China has achieved high population coverage rate over a short time period, starting with a limited benefit package. However, poor people have less benefit from NCMS in terms of health service utilization. Compared to China, Vietnam health insurance system is doing better in equity in health service utilization within the health insurance members. However with low population coverage, a large proportion of population cannot enjoy the health insurance benefit. Mutual learning would help China and Vietnam address these challenges, and improve their policy design to promote equitable and sustainable health insurance. PMID:22376290
Breastfeeding pattern, anthropometry and health status of infants attending child welfare clinics of a teaching hospital in Nigeria. ... Maternal older age, multiparity and delivery at a government health facility were positively associated with higher rates of EBF (p < 0.05). Only 110 (48.2%) babies were put to the breast ...
Rajan, R.; Satyanarayan, C.; Raghunathan, C.; Koya, S.S.; Ravindran, J.; Manikandan, B.; Venkataraman, K.
Status of reef health incorporating species-wise cover of scleractinians has been reported covering 61 stations in 29 reef locations of the four major reef regions in India as of March 2011, alongside a review of available reef health data since...
population's smoking status, their knowledge of the health ... the highest smoking rates are the Northern Cape (55%), ... expense of tobacco products and because of a medical ... tobacco excise tax if the money is used for health .... Although not shown in ... (35%) and cost of tobacco products (17%). ..... International tourist.
Gulis, Gabriel; Mulumba, J.A.A.; Juma, Olivia; Kakosova, Beatrica
The objective of this study was to describe the health status of people living in the slums of Nairobi. It was designed as a cross-sectional study based on data from visitors at a clinic at Trnava University located in Mukuru slum in Nairobi. There were about 16,000 visits registered at Mary Immaculate Clinic of Trnava University in Nairobi during 2 years of operation. A random 5% sample was drawn from the paper-card database of this clinic to assess basic characteristics and health complaints of visitors. Both self-reported health complaints and diagnoses written by physicians were used to assess health status of participants. More females with average age (by slum) ranging from 20.46 to 21.30 years than males with average age ranging from (by slum) 15.86 to 19.49 years are the visitors of the clinic. The major self-reported health complaints of visitors were cough, abdominal pain, and headache for both sexes. The most frequent diagnoses were consequently virosis, acute respiratory infections, and bronchitis. Differences in health complaints by slums were observed and are described herein. The major health complaints and diagnoses in addition to the differences in health complaints and diagnoses by slum show that environmental conditions can have major influences on health status. Therefore, environmental improvements are important in the improvement of health status. A very high prevalence of respiratory complaints and gastrointestinal problems signify that improvements in air pollution reduction, drinking water provision, and waste management in slums can lead to more significant and sustainable improvements in health status than just simple treatment. This fact should be taken into account when planning future relief programs
Kataoka-Yahiro, Merle R
The purpose of this exploratory study was to describe the relationships between roles, acculturation, and perceived health status among 47 FA grandparent caregivers who were providing extensive caregiving to their grandchildren. Role satisfaction was significantly related to perceived health status. Role occupancy was significantly related to years lived in the U.S. and employment. Role integration and role stress were significantly related to gender and income. Acculturation was significantly related to role involvement, years lived in the U.S., language spoken, and education. The findings of this health disparities research study will lead to more contextual work in this area of study.
Muneera Abdalkareem Alshdefait
Full Text Available This study aimed at finding out the status of utilizing social media networks in the teaching-learning process at public Jordanian Universities. To achieve the goal of the study, the descriptive developmental method was used and a questionnaire was developed, consisting of (35 statements. The questionnaire was checked for its validity and reliability. Then it was distributed to a sample of (382 male and female students from the undergraduate and graduate levels. The study results showed that the participants gave a low score to the status of utilizing social media networks in the teaching-learning process at public Jordanian universities. The results also showed that there were statistically significant differences between the participants of the study according to the academic rank attributed to the graduate students, and according to gender attributed to male students at the instrument macro level and on all dimensions of the two variables. In light of these results, the study recommended that public universities should utilize modern technology in the educational process, urge and encourage the teaching staff members to use the social media networks in the teaching-learning process and raise the students' awareness about the benefits of using social media networks. Keywords: Social media networks, Teaching-learning process, Public Jordanian Universities
Lee, Hyukki; Kim, Soohyung; Kim, Jong Wook; Chung, Yon Dohn
Publishing raw electronic health records (EHRs) may be considered as a breach of the privacy of individuals because they usually contain sensitive information. A common practice for the privacy-preserving data publishing is to anonymize the data before publishing, and thus satisfy privacy models such as k-anonymity. Among various anonymization techniques, generalization is the most commonly used in medical/health data processing. Generalization inevitably causes information loss, and thus, various methods have been proposed to reduce information loss. However, existing generalization-based data anonymization methods cannot avoid excessive information loss and preserve data utility. We propose a utility-preserving anonymization for privacy preserving data publishing (PPDP). To preserve data utility, the proposed method comprises three parts: (1) utility-preserving model, (2) counterfeit record insertion, (3) catalog of the counterfeit records. We also propose an anonymization algorithm using the proposed method. Our anonymization algorithm applies full-domain generalization algorithm. We evaluate our method in comparison with existence method on two aspects, information loss measured through various quality metrics and error rate of analysis result. With all different types of quality metrics, our proposed method show the lower information loss than the existing method. In the real-world EHRs analysis, analysis results show small portion of error between the anonymized data through the proposed method and original data. We propose a new utility-preserving anonymization method and an anonymization algorithm using the proposed method. Through experiments on various datasets, we show that the utility of EHRs anonymized by the proposed method is significantly better than those anonymized by previous approaches.
Full Text Available Seon-Ha Kim,1 Min-Woo Jo,2 Minsu Ock,2 Hyeon-Jeong Lee,2 Jong-Won Lee3,4 1Department of Nursing, College of Nursing, Dankook University, Cheonan, 2Department of Preventive Medicine, University of Ulsan College of Medicine, Seoul, 3Department of Breast and Endocrine Surgery, Asan Medical Center, Seoul, 4Department of Surgery, University of Ulsan College of Medicine, Seoul, South Korea Purpose: The aim of this study is to determine the utility of breast cancer health states using the standard gamble (SG and visual analog scale (VAS methods in the Korean general population.Materials and methods: Eight hypothetical breast cancer health states were developed based on patient education material and previous publications. Data from 509 individuals from the Korean general population were used to evaluate breast cancer health states using the VAS and the SG methods, which were obtained via computer-assisted personal interviews. Mean utility values were calculated for each human papillomavirus (HPV-related health state.Results: The rank of health states was identical between two valuation methods. SG values were higher than VAS values in all health states. The utility values derived from SG were 0.801 (noninvasive breast cancer with mastectomy and followed by reconstruction, 0.790 (noninvasive breast cancer with mastectomy only, 0.779 (noninvasive breast cancer with breast-conserving surgery and radiation therapy, 0.731 (invasive breast cancer with surgery, radiation therapy, and/or chemotherapy, 0.610 (locally advanced breast cancer with radical mastectomy with radiation therapy, 0.587 (inoperable locally advanced breast cancer, 0.496 (loco-regional recurrent breast cancer, and 0.352 (metastatic breast cancer.Conclusion: Our findings might be useful for economic evaluation of breast cancer screening and interventions in general populations. Keywords: breast neoplasm, Korea, quality-adjusted life years, quality of life
Chan, Catherine Qiu Hua; Lee, Kheng Hock; Low, Lian Leng
It is well-established that low socioeconomic status (SES) influences one's health status, morbidity and mortality. Housing type has been used as an indicator of SES and social determinant of health in some studies. In Singapore, home ownership is among the highest in the world. Citizens who have no other housing options are offered heavily subsidised rental housings. Residents staying in such rental housings are characterised by low socioeconomic status. Our aim is to review studies on the association between staying in public rental housing in Singapore and health status. A PubMed and Scopus search was conducted in January 2017 to identify suitable articles published from 1 January 2000 to 31 January 2017. Only studies that were done on Singapore public rental housing communities were included for review. A total of 14 articles including 4 prospective studies, 8 cross-sectional studies and 2 retrospective cohort studies were obtained for the review. Topics addressed by these studies included: (1) Health status; (2) Health seeking behaviour; (3) Healthcare utilisation. Staying in public rental housing was found to be associated with poorer health status and outcomes. They had lower participation in health screening, preferred alternative medicine practitioners to western-trained doctors for primary care, and had increased hospital utilisation. Several studies performed qualitative interviews to explore the causes of disparity and concern about cost was one of the common cited reason. Staying in public rental housing appears to be a risk marker of poorer health and this may have important public health implications. Understanding the causes of disparity will require more qualitative studies which in turn will guide interventions and the evaluation of their effectiveness in improving health outcome of this sub-population of patients.
Butina, Michelle; Brooks, Donna; Dominguez, Paul J; Mahon, Gwendolyn M
Multiple technology based tools have been used to enhance skill development in allied health education, which now includes virtual learning environments. The purpose of this study was to explore whether, and how, this latest instructional technology is being adapted in allied health education. An online survey was circulated to all Association of Schools of Allied Health Professions (ASAHP) member institutions and focused on three broad areas of virtual learning environments: the uses of, the perceived pros and cons of, and the outcomes of utilizing them. Results show 40% (17 of 42) of the respondent use some form of the technology. The use of virtual learning technology in other healthcare professions (e.g., medicine) demonstrates the potential benefits to allied health education.
Apolinar Membrillo Luna
Full Text Available Family Health (FH has three main elements: individual health, life material conditions and family functioning. Its main actors are the individual, the family and society. A common framework is the basis of FH, as each one of these elements is extremely important. Currently, in Mexico two aspects are considered: epidemiological studies and those inherent to the family medicine specialty. That latter has a residency and an integrated specialty curriculum, as well as certification from the corresponding board. All of this allows us to apply the HF approach to each and every family and individual that is cared for.
There was no statistical significant association in the utilization of health services with regard to gender (p=0.889, OR=1.04; 0.55-2.00), educational level (p=0.707, OR=1.16; 0.50-2.79) and age (p=0.839, OR=0.94; 0.51-1.72). Community perceptions of poor quality and inadequacy of available services, however, ...
Full Text Available Health is an issue that manages to provide many top ics in various fields (medicine, geography, sociology, psychology. This study aims to highlight the territorial disparities in health status of Ialomi ţ a county, to identify the health determinants and to make a preliminary analysis of the relationships between the lifestyle and the health status, using an objective assessment (statistics and a subjective evaluation (health surveys. There were analyzed elements such as mortality and morbidity, using health indic ators (mortality rate, infant mortality rate, specific mortality rate and specific morbidity rate and an aggregate index (health index. Combining statistic analysis and spatial analysis, t he study offers the possibility of comparing the rural areas with urban area, and it can be a base f or further studies. The health services, ageing and the characteristics of lifestyle could explain the territorial disparities in health status. A health study can reveal important details about eco nomic features, social behavior, mentality and social environment.
Ezoe, S; Morimoto, K
Lifestyle factors, sometimes associated with physical health and mortality, have also been known to be associated with mental health status. This study seeks to correlate behavioral lifestyles with major components of mental health among Japanese factory workers. We administered the 28-item version of the General Health Questionnaire (GHQ-28) and a questionnaire concerning eight personal health practices to 2,132 male and 668 female factory workers at a camera-manufacturing company in Japan. There were strong negative relationships of a higher total number of favorable lifestyles as indicated by the Health Practice Index (HPI) to psychological distress and its components: somatic symptoms, anxiety-insomnia, and social dysfunction. After controlling for the effects of confounding factors that included age, marital status, and somatic condition, multiple logistic regression analysis indicated that five of the eight health factors among male workers--mental stress, nutritional balance, eating breakfast regularly, physical exercise, and working hours--were significantly related to the grade of psychological distress or its three components. Among female workers, five health practices, i.e., mental stress, physical exercise, sleeping hours, working hours, and cigarette smoking, were significantly associated with the grade of psychological distress or its three components. Good health practices might be individually and as a whole associated with better mental health status in factory workers.
Williams, David R; Kontos, Emily Z; Viswanath, K; Haas, Jennifer S; Lathan, Christopher S; MacConaill, Laura E; Chen, Jarvis; Ayanian, John Z
Objective To illustrate the complex patterns that emerge when race/ethnicity, socioeconomic status (SES), and gender are considered simultaneously in health care disparities research and to outline the needed research to understand them by using disparities in lung cancer risks, treatment, and outcomes as an example. Principal Findings SES, gender, and race/ethnicity are social categories that are robust predictors of variations in health and health services utilization. These are usually considered separately, but intersectionality theory indicates that the impact of each depends on the others. Each reflects historically and culturally contingent variations in social, economic, and political status. Distinct patterns of risk and resilience emerge at the intersections of multiple social categories and shape the experience of health, health care access, utilization, quality, and outcomes where these categories intersect. Intersectional approaches call for greater attention to understand social processes at multiple levels of society and require the collection of relevant data and utilization of appropriate analytic approaches to understand how multiple risk factors and resources combine to affect the distribution of disease and its management. Conclusions Understanding how race/ethnicity, gender, and SES are interactive, interdependent, and social identities can provide new knowledge to enhance our efforts to effectively address health disparities. PMID:22568674
Tumin, Dmitry; Drees, David; Miller, Rebecca; Wrona, Sharon; Hayes, Don; Tobias, Joseph D; Bhalla, Tarun
The population prevalence of pediatric chronic pain is not well characterized, in part due to lack of nationally representative data. Previous research suggests that pediatric chronic pain prolongs inpatient stay and increases costs, but the population-level association between pediatric chronic pain and health care utilization is unclear. We use the 2016 National Survey of Children's Health to describe the prevalence of pediatric chronic pain, and compare health care utilization among children ages 0-17 years according to the presence of chronic pain. Using a sample of 43,712 children, we estimate the population prevalence of chronic pain to be 6%. On multivariable analysis, chronic pain was not associated with increased odds of primary care or mental health care use, but was associated with greater odds of using other specialty care (OR=2.01, 95% CI: 1.62, 2.47; pcomplementary and alternative medicine (OR=2.32, 95% CI: 1.79, 3.03; pchronic pain were more likely to use specialty care but not mental health care. The higher likelihood of emergency care use in this group raises the question of whether better management of pediatric chronic pain could reduce emergency department use. Copyright © 2018. Published by Elsevier Inc.
Christoph F. Kurz
Full Text Available Abstract Background The statistical analysis of health care cost data is often problematic because these data are usually non-negative, right-skewed and have excess zeros for non-users. This prevents the use of linear models based on the Gaussian or Gamma distribution. A common way to counter this is the use of Two-part or Tobit models, which makes interpretation of the results more difficult. In this study, I explore a statistical distribution from the Tweedie family of distributions that can simultaneously model the probability of zero outcome, i.e. of being a non-user of health care utilization and continuous costs for users. Methods I assess the usefulness of the Tweedie model in a Monte Carlo simulation study that addresses two common situations of low and high correlation of the users and the non-users of health care utilization. Furthermore, I compare the Tweedie model with several other models using a real data set from the RAND health insurance experiment. Results I show that the Tweedie distribution fits cost data very well and provides better fit, especially when the number of non-users is low and the correlation between users and non-users is high. Conclusion The Tweedie distribution provides an interesting solution to many statistical problems in health economic analyses.
Tarekegn, Shegaw Mulu; Lieberman, Leslie Sue; Giedraitis, Vincentas
health service utilization in Ethiopia is very low. Socio-demographic and accessibility related factors are major determinants of service utilization. There is a high inequality in service utilization among women with differences in education, household wealth, autonomy and residence. ANC is an important entry point for subsequent use of delivery and PNC services. Strategies that aim improving maternal health service utilization should target improvement of education, economic status and empowerment of women.
Lum, O M
The elder Asian or Pacific-Island American presents a dynamic, interactive paradigm of forces beyond medical practice that includes religious, societal, and historical factors of delivering health care. The cultural characteristics of family and function, perception of time and healing, and the anthropologic factors of health beliefs on health behaviors can add to understanding our medical patients. Some important trends of environmental factors on expression of genetic predisposition to certain illnesses, such as diabetes and gout, can be used in health prevention. The significance of diet on certain cancers can be better understood using nativity factors. Many of the mental illnesses borne by immigrants can be recognized and treated. Significant clinical research directions imply an ability of American medicine to target at-risk Asians and Pacific Islanders for specific prevention and early diagnoses. The base knowledge of differential physiologic changes for aging and disease due to genetic predisposition and the correlates of social, cultural, and behavioral factors of diseases can then be improved.
Doocy, Shannon; Lyles, Emily; Akhu-Zaheya, Laila; Burton, Ann; Burnham, Gilbert
The influx of Syrian refugees into Jordan presents an immense burden to the Jordanian health system. Changing lifestyles and aging populations are shifting the global disease burden towards increased non-infectious diseases including chronic conditions, co-morbidities, and injuries which are more complicated and costly to manage. The strain placed on health systems threatens the ability to ensure the health needs of both refugees and host country populations are adequately addressed. In light of the increasing challenges facing host governments and humanitarian actors to meet health needs of Syrian refugees and affected host communities, this study was undertaken to assess utilization of health services among Syrian refugees in non-camp settings. A survey of Syrian refugees in Jordan was undertaken in June 2014 to characterize health seeking behaviors and issues related to accessing care. A cluster design with probability proportional to size sampling was used to attain a nationally representative sample of 1550 non-camp Syrian refugee households. Differences in household characteristics by geographic region, facility type, and sector utilized were examined using chi-square and t-test methods. Care-seeking was high with 86.1 % of households reporting an adult sought medical care the last time it was needed. Approximately half (51.5 %) of services were sought from public sector facilities, 38.7 % in private facilities, and 9.8 % in charity/NGO facilities. Among adult care seekers, 87.4 % were prescribed medication during the most recent visit, 89.8 % of which obtained the medication. Overall, 51.8 % of households reported out-of-pocket expenditures for the consultation or medications at the most recent visit (mean US$39.9, median US$4.2). Despite high levels of care-seeking, cost was an important barrier to health service access for Syrian refugees in Jordan. The cessation of free access to health care since the time of the survey is likely to have worsened
Meagher-Stewart, Donna; Underwood, Jane; MacDonald, Mary; Schoenfeld, Bonnie; Blythe, Jennifer; Knibbs, Kristin; Munroe, Val; Lavoie-Tremblay, Mélanie; Ehrlich, Anne; Ganann, Rebecca; Crea, Mary
Optimal utilization of public health nurses (PHNs) is important for strengthening public health capacity and sustaining interest in public health nursing in the face of a global nursing shortage. To gain an insight into the organizational attributes that support PHNs to work effectively, 23 focus groups were held with PHNs, managers, and policymakers in diverse regions and urban and rural/remote settings across Canada. Participants identified attributes at all levels of the public health system: government and system-level action, local organizational culture of their employers, and supportive management practices. Effective leadership emerged as a strong message throughout all levels. Other organizational attributes included valuing and promoting public health nursing; having a shared vision, goals, and planning; building partnerships and collaboration; demonstrating flexibility and creativity; and supporting ongoing learning and knowledge sharing. The results of this study highlight opportunities for fostering organizational development and leadership in public health, influencing policies and programs to optimize public health nursing services and resources, and supporting PHNs to realize the full scope of their competencies.
Kopec, Jacek A; Sayre, Eric C; Rogers, Pamela; Davis, Aileen M; Badley, Elizabeth M; Anis, Aslam H; Abrahamowicz, Michal; Russell, Lara; Rahman, Md Mushfiqur; Esdaile, John M
The CAT-5D-QOL is a previously reported item response theory (IRT)-based computerized adaptive tool to measure five domains (attributes) of health-related quality of life. The objective of this study was to develop and validate a multiattribute health utility (MAHU) scoring method for this instrument. The MAHU scoring system was developed in two stages. In phase I, we obtained standard gamble (SG) utilities for 75 hypothetical health states in which only one domain varied (15 states per domain). In phase II, we obtained SG utilities for 256 multiattribute states. We fit a multiplicative regression model to predict SG utilities from the five IRT domain scores. The prediction model was constrained using data from phase I. We validated MAHU scores by comparing them with the Health Utilities Index Mark 3 (HUI3) and directly measured utilities and by assessing between-group discrimination. MAHU scores have a theoretical range from -0.842 to 1. In the validation study, the scores were, on average, higher than HUI3 utilities and lower than directly measured SG utilities. MAHU scores correlated strongly with the HUI3 (Spearman ρ = 0.78) and discriminated well between groups expected to differ in health status. Results reported here provide initial evidence supporting the validity of the MAHU scoring system for the CAT-5D-QOL. Copyright © 2015 Elsevier Inc. All rights reserved.
Bas-Sarmiento, Pilar; Fernández-Gutiérrez, Martina; Albar-Marín, M A Jesús; García-Ramírez, Manuel
To identify and describe the needs and problems of the immigrant population related to access and utilization of health services. A descriptive, qualitative, phenomenological study was conducted using focus groups. The study area was the county of Campo de Gibraltar (Spain), which represents the gateway to Europe for immigration from Africa. The final sample size (51 immigrants from 11 countries) was determined by theoretical saturation. A narrative analysis was conducted with QSR NVivo9 software. Immigrants' discourse showed four categories of analysis: response to a health problem, system access, knowledge of social and health resources, and health literacy needs. Responses to health problems and the route of access to the health care system differed according to some sociodemographic characteristics (nationality/culture of origin, length of residence, and economic status). In general, immigrants primarily used emergency services, hampering health promotion and prevention. The health literacy needs identified concerned language proficiency and the functioning of the health system. There is a need to promote interventions to enhance health literacy among immigrants. These interventions should take into account diversity and length of residence, and should be based on an action-participation methodology. Copyright © 2014 SESPAS. Published by Elsevier Espana. All rights reserved.
Zhang, Jingya; Lin, Senlin; Liang, Di; Qian, Yi; Zhang, Donglan; Hou, Zhiyuan
There have been obstacles for internal migrants in China in accessing local public health services for some time. This study aimed to estimate the utilization of local public health services and its determinants among internal migrants. Data were from the 2014 and 2015 nationally representative cross-sectional survey of internal migrants in China. Multivariate logistic regressions were used to estimate the relationship between socioeconomic, migration, and demographic characteristics and public health services utilization. Our results showed that internal migrants in more developed eastern regions used less public health services. Those with higher socioeconomic status were more likely to use public health services. The years of living in the city of residence were positively associated with the utilization of public health services. Compared to migration within the city, migration across provinces significantly reduced the probability of using health records (OR = 0.88, 95% CI: 0.86-0.90), health education (OR = 0.97, 95% CI: 0.94-1.00), and health education on non-communicable diseases (OR = 0.92, 95% CI: 0.89-0.95) or through the Internet (OR = 0.96, 95% CI: 0.94-0.99). This study concludes that public health services coverage for internal migrants has seen great improvement due to government subsidies. Internal migrants with lower socioeconomic status and across provinces need to be targeted. More attention should be given to the local government in the developed eastern regions in order to narrow the regional gaps.
Yen, Louis; Schultz, Alyssa; Schnueringer, Elaine; Edington, Dee W
The objective of this study was to examine the health risk-related excess costs of time away from work, medical claims, pharmacy claims, and total costs with and without considering the prevalence of health risks. A total of 2082 of 4266 employees of a Midwest utility participated in a health risk appraisal (HRA). Individuals were classified by their HRA participation status and also by 15 health risks. Total and excess costs were analyzed for all employees. There were significant excess costs due to individual risks and overall excess health risks in all cost measures. Both excess cost per risk and prevalence of the risk were important factors in determining the excess costs in the population. As compared with low-risk participants, HRA nonparticipants and the medium- and high-risk participants were 1.99, 2.22, and 3.97 times more likely to be high cost status. Approximately one third of corporate costs in medical claims, pharmacy claims, and time away from work could be defined as excess costs associated with excess health risks.
Kristiansson, Charlotte; Gotuzzo, Eduardo; Rodriguez, Hugo
ABSTRACT: BACKGROUND: Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drug...... be indicated. Caregivers frequently paid for health services as well as antibiotics, even though all children in the study qualified for free health care and medicines. The implementation of the Seguro Integral de Salud health insurance must be improved.......ABSTRACT: BACKGROUND: Access to affordable health care is limited in many low and middle income countries and health systems are often inequitable, providing less health services to the poor who need it most. The aim of this study was to investigate health seeking behavior and utilization of drugs...... in Yurimaguas and 793 children of the same age in Moyobamba were included in the study. Caregivers were interviewed on health care seeking strategies (public/private sectors; formal/informal providers), and medication for their children in relation to reported symptoms and socio-economic status. Self...
Versteeg, Henneke; Spek, Viola; Pedersen, Susanne S.
Background: Knowledge of the factors associated with individual differences in patient-reported outcomes is essential to identify high-risk patients and improve secondary prevention. Design: In this meta-analysis, we examined the association between Type D personality and the individual differences...... in patient-reported physical and mental health status among cardiovascular patients. Methods: A computerized search of the literature through PUBMED and PsychINFO (from 1995 to May 2011) was performed and prospective studies were selected that analysed the association between Type D personality and health...... status in cardiovascular patients. Two separate meta-analyses were performed for the association of Type D personality with physical and mental health status, respectively. Results: Of all identified studies, ten studies met the selection criteria. The meta-analyses showed that Type D was associated...
Matthews, Karen A.; Gallo, Linda C.
Low socioeconomic status (SES) is a reliable correlate of poor physical health. Rather than treat SES as a covariate, health psychology has increasingly focused on the psychobiological pathways that inform understanding why SES is related to physical health. This review assesses the status of research that has examined stress and its associated distress, and social and personal resources as pathways. It highlights work on biomarkers and biological pathways related to SES that can serve as intermediate outcomes in future studies. Recent emphasis on the accumulation of psychobiological risks across the life course is summarized and represents an important direction for future research. Studies that test pathways from SES to candidate psychosocial pathways to health outcomes are few in number but promising. Future research should test integrated models rather than taking piecemeal approaches to evidence. Much work remains to be done, but the questions are of great health significance. PMID:20636127
Hansen, Kristian Schultz; Enemark, Ulrika; Foldspang, Anders
, 1997-2003. Data were extracted from administrative registries including information on individual use of emergency services and other hospital care, contact with GPs and socioeconomic background. Health services' use by the Morsø population was measured before reduction in emergency room opening hours...... of substitute health services. By contrast, Morsø women compared to the rest of Viborg county reduced their use of GP services in terms of face-to-face visits (β = -0.08, P = 0.020), telephone consultations (β = -0.11, P = 0.007), home visits (β = -0.48, P = 0.009), and their inpatient hospital utilization (β...... = -0.12, P = 0.022) during the period when emergeny services were only available in the daytime. CONCLUSIONS: Emergency services at neighbouring hospitals (40 kilometres distance) were able to compensate, in part, for the decreased local emergency service provision. Concurrent changes in health care...
Parente, Stephen T; Feldman, Roger; Chen, Song
To compare pharmaceutical spending and utilization in a consumer driven health plan (CDHP) with a three-tier pharmacy benefit design, and to examine whether the CDHP creates incentives to reduce pharmaceutical spending and utilization for chronically ill patients, generic or brand name drugs, and mail-order drugs. Retrospective insurance claims analysis from a large employer that introduced a CDHP in 2001 in addition to a point of service (POS) plan and a preferred provider organization (PPO), both of which used a three-tier pharmacy benefit. Difference-in-differences regression models were estimated for drug spending and utilization. Control variables included the employee's income, age, and gender, number of covered lives per contract, election of flexible spending account, health status, concurrent health shock, cohort, and time trend. Results. CDHP pharmaceutical expenditures were lower than those in the POS cohort in 1 year without differences in the use of brand name drugs. We find limited evidence of less drug consumption by CDHP enrollees with chronic illnesses, and some evidence of less generic drug use and more mail-order drug use among CDHP members. The CDHP is cost-neutral or cost-saving to both the employer and the employee compared with three-tier benefits with no differences in brand name drug use. © Health Research and Educational Trust.
Robertson-James, Candace; Nunez, Ana
The health and well-being of incarcerated women is a significant public health concern. Compared with non-incarcerated women, incarcerated women in the United States are more often from minority populations, younger (between the ages of 18 and 34 years), of low socioeconomic status, unemployed and mothers to children under 18 years of age. More…
Nelson, Richard E; Hicken, Bret; Cai, Beilei; Dahal, Arati; West, Alan; Rupper, Randall
To improve access to care, the Veterans Health Administration (VHA) increased its patient travel reimbursement rate from 11 to 28.5 cents per mile on February 1, 2008, and again to 41.5 cents per mile on November 17, 2008. We identified characteristics of veterans more likely to receive travel reimbursements and evaluated the impact of these increases on utilization of the benefit. We examined the likelihood of receiving any reimbursement, number of reimbursements, and dollar amount of reimbursements for VHA patients before and after both reimbursement rate increases. Because of our data's longitudinal nature, we used multivariable generalized estimating equation models for analysis. Rurality and categorical distance from the nearest VHA facility were examined in separate regressions. Our cohort contained 214,376 veterans. During the study period, the average number of reimbursements per veteran was higher for rural patients compared to urban patients, and for those living 50-75 miles from the nearest VHA facility compared to those living closer. Higher reimbursement rates led to more veterans obtaining reimbursement regardless of urban-rural residence or distance traveled to the nearest VHA facility. However, after the rate increases, urban veterans and veterans living reimbursement utilization slightly more than other patients. Our findings suggest an inverted U-shaped relationship between veterans' utilization of the VHA travel reimbursement benefit and travel distance. Both urban and rural veterans responded in roughly equal manner to changes to this benefit. © 2013 National Rural Health Association.
Nguyen, Hoang Thuy Linh; Nakamura, Keiko; Seino, Kaoruko; Vo, Van Thang
The rapid and widespread development of mass media sources including the Internet is occurring worldwide. Users are being confronted with a flood of health information through a wide availability of sources. Studies on how the availability of health information has triggered users' interest in utilizing health care services remain limited within the Vietnamese population. This study examined the associations between the wider availability of sources for health information and health care utilization in Vietnam after adjusting for potential confounding variables. The data for this study were drawn from a cross-sectional study conducted over a 6-month period in Hue, a city in central Vietnam. The participants were 993 randomly selected adults aged between 18 and 60 years. Information was collected through face-to-face interviews on the types of information sources that were consulted, including traditional media (television), Internet, and health education courses, as well as the impact of such information on health care use (emergency department visits, hospitalizations, doctor visits). Multivariable logistic regression analyses were performed at a 95% confidence level. The prevalence of watching television, using the Internet, and attending health education courses to obtain health information were 50.9% (505/993), 32.9% (327/993), and 8.7% (86/993), respectively. After further adjustments for self-reported health status, the presence of health insurance, and monthly income, respondents who watched television and used the Internet to obtain health information were 1.7 times more likely to visit a doctor (television: adjusted odds ratio [AOR] 1.69, 95% CI 1.30-2.19; Internet: AOR 1.64, 95% CI 1.23-2.19), and also significantly associated with inpatient hospitalization (P=.003). The use of widely available mass media sources (eg, television and the Internet) to obtain health information was associated with higher health care utilization. How this interest in health
Listen as Dr. Machell Town, a branch chief and statistician with CDC's Division of Population Health, talks about her team's study on self-perceived health and reported mental distress among working-aged adults.
Xiao, Hong; Barber, Janet P
To examine the effect of perceived health status on three components of patient satisfaction. The Household Component of the 1999 Medical Expenditure Panel Survey for people 35-64 years of age was used to examine the effect of perceived health status on patient satisfaction measured in terms of access to care, provider quality and quality of care. Descriptive statistics and multivariate regression were used to describe the subjects and to examine the relationship between patient satisfaction and perceived health status controlling for patient demographic factors, health factors and provider characteristics. All analyses used STATA 8.0 which is designed to analyze weighted data. A total of 4,417 patients (71% women) met the inclusion criteria for the study. Patients who rated their health excellent or good scored higher on the three dimensions of patient satisfaction. Higher scores on one or more components of patient satisfaction were associated with being older, married, better educated and having higher income, health insurance and good mental health. Seeing the health-care provider for an old problem resulted in lower levels of patient satisfaction. Provider characteristics significantly related to patient satisfaction were listening to the patient, being a specialist, seeing patients in an office setting and being located in the South. This study has shown that patient satisfaction is influenced by a person's self-perceived health status and other personal characteristics that are external to the delivery of health care. These findings suggest that patient satisfaction data should be used judiciously because a significant portion of the variation may be attributed to factors endogenous to the patient and therefore are not amenable to provider intervention.
Negeri, Gutema; Haile Mariam,Damen
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 stud...
Azodo, Clement C; Ehizele, Adebola O; Umoh, Agnes; Ojehanon, Patrick I; Akhionbare, Osagie; Okechukwu, Robinson; Igbinosa, Lawrence
To determine the perceived oral health status and treatment needs of Nigerian dental therapists in training and dental technology students. A descriptive cross-sectional study of students from Federal School of Dental Therapy and Technology Enugu, Nigeria was conducted using self-administered questionnaire to obtain information on demography, self-reported oral health status, knowledge of impact of oral health on daily life activity, dental attendance and perceived dental need. The perception of oral health status and treatment need of the two groups of dental auxiliaries was the same. Fewer respondents (27.3%) rated their oral health as excellent, while 50.4% rated their oral health as good. Majority (95.5%) agreed that oral health is a part of general health and 94.6% agreed that oral health has a role in daily life. Out of 81.4% that had previous dental treatment, scaling and polishing accounted for 66.1%. Presently, 48.8% think they need dental treatment ranging from scaling and polishing (33.9%), tooth restoration (10.3%), to extraction (1.2%). This survey revealed that most of the students are aware that oral health is a component of general health and that it has an impact on an individual's daily life. More than half of the students perceived their oral health as good, but only a few knew that there is a need for a preventive approach to oral health as evident by the percentage that perceived scaling and polishing as a treatment need.
Clement C. Azodo
Full Text Available Objective: To determine the perceived oral health status and treatment needs of Nigerian dental therapists in training and dental technology students. Methods: A descriptive cross-sectional study of students from Federal School of Dental Therapy and Technology Enugu, Nigeria was conducted using self-administered questionnaire to obtain information on demography, self-reported oral health status, knowledge of impact of oral health on daily life activity, dental attendance and perceived dental need. Results: The perception of oral health status and treatment need of the two groups of dental auxiliaries was the same. Fewer respondents (27.3% rated their oral health as excellent, while 50.4% rated their oral health as good. Majority (95.5% agreed that oral health is a part of general health and 94.6% agreed that oral health has a role in daily life.Out of 81.4% that had previous dental treatment, scaling and polishing accounted for 66.1%. Presently, 48.8% think they need dental treatment ranging from scaling and polishing (33.9%, tooth restoration (10.3%, to extraction (1.2%. Conclusion: This survey revealed that most of the students are aware that oral health is a component of general health and that it has an impact on an individual's daily life. More than half of the students perceived their oral health as good, but only a few knew that there is a need for a preventive approach to oral health as evident by the percentage that perceived scaling and polishing as a treatment need.
Grossbard, Joel R; Lehavot, Keren; Hoerster, Katherine D; Jakupcak, Matthew; Seal, Karen H; Simpson, Tracy L
Although many risk behaviors peak during young adulthood, little is known about health risk factors and access to care. This study assessed health indicators and health care access in a national sample of young adult veterans and civilians. Data were from the 2010 Behavioral Risk Factor Surveillance System, a national telephone survey. Of 27,471 participants, ages 19-30 years, 2.2% were veterans (74.6% were male) and 97.7% were civilians (37.6% were male). Gender-stratified comparisons assessed health indicators and health care access by veteran status. Multivariate logistic regression was used to examine health indicators and health care access as a function of gender and veteran status. In the overall sample, women were more likely than men to have insurance, to have a regular physician, and to have had a routine checkup and yet were more likely to report financial barriers to care. Women also were more likely than men to report general medical and mental distress and higher lifetime anxiety and depressive disorders, whereas men were more likely to be overweight or obese and to report tobacco use and high-risk drinking. Adjusted analyses revealed a higher likelihood of general medical distress and higher rates of lifetime anxiety disorders among veterans compared with civilians, although there were no differences between veterans and civilians regarding health care utilization and hazardous drinking. Findings extend the literature on health care status and modifiable risk factors for young adults by identifying differences between men and women and between veterans and civilians. Interventions may need to be tailored on the bases of gender and veteran status because of several differences in mental health and general health needs.
John T Schousboe
Full Text Available The association of weight loss with health care costs among older women is uncertain. Our study aim was to examine the association of objectively measured weight change with subsequent total health care (THC costs and other health care utilization among older women. Our study population included 2,083 women (mean age 80.2 years enrolled in the Study of Osteoporotic Fractures and U.S. Medicare Fee for Service. Weight loss and gain were defined, respectively, as ≥5% decrease and ≥5% increase in body weight, and weight maintenance as <5% change in body weight over a period of 4.5 years. THC costs, outpatient costs, hospitalizations, and skilled nursing facility [SNF] utilization were estimated from Medicare claims for 1 year after the period during which weight change was measured. The associations of weight change with THC and outpatient costs were estimated using generalized linear models with gamma variance and log link functions, and with hospitalizations and SNF utilization using logistic models. Adjusted for age and current body mass index (BMI, weight loss compared with weight maintenance was associated with a 35% increase in THC costs ($2148 [95% CI, 745 to 3552], 2014 U.S. dollars, a 15% increase in outpatient costs ($329 [95% C.I. -1 to 660], and odds ratios of 1.42 (95% CI, 1.14 to 1.76 for ≥1 hospital stay and 1.45 (95% CI, 1.03 to 2.03 for ≥1 SNF stay. These associations did not vary by BMI category. After additional adjustment for multi-morbidity and functional status, associations of weight loss with all four outcomes were no longer significant. In conclusion, ≥5% weight loss among older women is not associated with increased THC and outpatient costs, hospitalization, and SNF utilization, irrespective of BMI category after accounting for multi-morbidity and impaired functional status that accompany weight loss.
Sun, Jian; Luo, Hongye
China is faced with a daunting challenge to equality and efficiency in health resources allocation and health services utilization in the context of rapid economic growth. This study sought to evaluate the equality and efficiency of health resources allocation and health services utilization in China. Demographic, economic, and geographic area data was sourced from China Statistical Yearbook 2012-2016. Data related to health resources and health services was obtained from China Health Statistics Yearbook 2012-2016. Furthermore, we evaluated the equality of health resources allocation based on Gini coefficient. Concentration index was used to measure the equality in utilization of health services. Data envelopment analysis (DEA) was employed to assess the efficiency of health resources allocation. From 2011 to 2015, the Gini coefficients for health resources by population ranged between 0.0644 and 0.1879, while the Gini coefficients for the resources by geographic area ranged from 0.6136 to 0.6568. Meanwhile, the concentration index values for health services utilization ranged from -0.0392 to 0.2110. Moreover, in 2015, 10 provinces (32.26%) were relatively efficient in terms of health resources allocation, while 7 provinces (22.58%) and 14 provinces (45.16%) were weakly efficient and inefficient, respectively. There exist distinct regional disparities in the distribution of health resources in China, which are mainly reflected in the geographic distribution of health resources. Furthermore, the people living in the eastern developed areas are more likely to use outpatient care, while the people living in western underdeveloped areas are more likely to use inpatient care. Moreover, the efficiency of health resources allocation in 21 provinces (67.74%) of China was low and needs to be improved. Thus, the government should pay more attention to the equality based on geographic area, guide patients to choose medical treatment rationally, and optimize the resource
Dong, Xiaoxin; liu, Ling; Cao, Shiyi; Yang, Huajie; Song, Fujian; Yang, Chen; Gong, Yanhong; Wang, Yunxia; Yin, Xiaoxu; Xie, Jun; Sun, Yi; Lu, Zuxun
Background Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents. Methods Multistage sa...
Roche, Adeline; Ogden, Jane
Samaritan listening volunteers provide emotional support to people in distress or suicidal. Samaritans' has high volunteer turnover, which may be due to burnout. This study evaluated the role of demographic and psychosocial factors in predicting Samaritans listening volunteers' burnout and health status. Samaritans' listening volunteers (n = 216) from seven branches across UK completed an online survey to assess their levels of burnout (emotional exhaustion, depersonalisation, personal accomplishment), subjective health status, coping, empathy and social support. Overall, listeners showed low levels of burnout and good health. Regression analysis revealed that higher emotional exhaustion was predicted by younger age and avoidant coping style; higher depersonalisation was predicted by lower empathy fantasy and higher avoidant coping style; lower personal accomplishment scores were predicted by higher empathy personal distress and worse health status was predicted by more hours per week spent on listening duties, lower social support and higher avoidant coping style. Overall, different factors influenced different facets of burnout. However, higher use of avoidant coping style consistently predicted higher burnout and worse health status, suggesting avoidant coping is an important target for intervention.
Reda, Seif Magdy; Krois, Joachim; Reda, Sophie Franziska; Thomson, William Murray; Schwendicke, Falk
Regular and/or preventive dental services utilization is an indicator of healthcare access and associated with improved health outcomes. We assessed the proportion of individuals regularly/preventively utilizing dental services, and how this was affected by demographic, health-related and social factors. Three electronic databases (Medline, Embase, Central) were searched (2005-2017). We included observational studies investigating the association between preventive/regular dental service utilization and age, oral and general health, edentulism, family structure and health literacy. The proportion of individuals with regular/preventive utilization overall and in different sub-groups were extracted. Random-effects meta-analyses, with subgroup analyses by region, were performed. Meta-regression was used to assess whether and how associations changed with time and countries' human developmental status (HDI). 103 studies on 7,395,697 participants from 28 countries were included. The global mean (95% CI) proportion of individuals regularly/preventively utilizing dental services was 54% (50-59%). In countries with higher HDI, more individuals regularly/preventively utilized services (p Age did not have a significant impact on utilization in adults (OR = 1.00; 0.89-1.12). Utilization was significantly lower in younger than older children (OR = 0.52; 0.46-0.59), individuals with poorer general health (OR = 0.73; 0.65-0.80) and poorer oral health (OR = 0.64; 0.52-0.75), edentulous individuals (OR = 0.32; 0.23-0.41), and individuals with less supportive family structures (OR = 0.81; 0.73-0.89) or poor health literacy (OR = 0.41; 0.01-0.81). The observed differences within populations did not significantly change with time and were universally present. Regular/preventive utilization varied widely between and within countries. Understanding and tackling the reasons underlying this may help to consistently improve utilization. Higher developmental
K.F.M. Joosten (Koen); K. van der Velde (Kelly); P. Joosten (Pieter); H. Rutten (Hans); J.M. Hulst (Jessie); K. Dulfer (Karolijn)
textabstractPurpose: In hospitalized children with a chronic disease, malnutrition was associated with a lower subjective health status. In outpatient children with a chronic disease attending special schools, this association has never been studied. The aim of this study was to assess the
Krokavcova, Martina; Nagyova, Iveta; Rosenberger, Jaroslav; Gavelova, Miriam; Middel, Berrie; Gdovinova, Zuzana; Groothoff, Johan W.; van Dijk, Jitse P.
This study explores how employment is associated with perceived physical and mental health status in people with multiple sclerosis (MS) adjusted for sociodemographic and clinical variables stratified by age. The sample consisted of 184 MS patients divided into a younger (less than 45 years) and an older (greater than or equal to 45 years) age…
Richmond, Peter; Roehner, Bertrand M.
The Farr-Bertillon law states that the mortality rate of single and widowed persons is about three times the rate of married people of same age. This excess mortality can be measured with good accuracy for all ages except for young widowers. The reason is that, at least nowadays, very few people become widowed under the age of 30. Here we show that disability data from census records can also be used as a reliable substitute for mortality rates. In fact excess-disability and excess-mortality go hand in hand. Moreover, as there are about ten times more cases of disability than deaths, the disability variable is able to offer more accurate measurements in all cases where the number of deaths is small. This allows a more accurate investigation of the young widower effect; it confirms that, as already suspected from death rate data, there is a huge spike between the ages of 20 and 30. By using disability rates we can also study additional features not accessible using death rate data. For example we can examine the health impact of a change in living place. The observed temporary inflated disability rate confirms what could be expected by invoking the ;Transient Shock; conjecture formuladted by the authors in a previous paper. Finally, in another observation it is shown that the disability rate of newly married persons is higher than for those who have been married for more than one year, a result which comes in confirmation of the ;newly married couple; effect reported in an earlier paper.
The world population has exceeded 5 billion, today, and it is estimated to reach 10 billion in the middle of the twenty first century. Because of such rapid increase of population, the world energy consumption is estimated to increase tremendously. Furthermore, there are problems of limited energy resources from oil and coal down, how to respond to environment problems such as global warming, acid rain caused by fossil fuel burning, followed by carbon dioxide discharge. Under such circumstances of global scale problems, the nuclear power generation that is excellent in stable nature of supply, economic advantage, less effect to the environment, supplies about 20 % of the total power generation in the world. In our country, some 30 % of the total power generation relies on the nuclear power, as an indispensable power source. Radiation utilization, together with the nuclear power generation, is an important pillar of development and utilization of nuclear energy, and has penetrated deeply in the life of the people, in the fields of industry, agriculture, medicine and environmental protection, and it is contributing to realize affluent life to a great extent. Thus, expectations to the nuclear energy seem to grow larger and larger in future. The publication introduces present status and future potential of the development and utilization of the nuclear energy in Japan, including the basic idea and concrete plans shown in the Long-Term Program. (J.P.N.)
Today, world energy demands continue to increase, and over the middle and long-term, access to petroleum supplies may become difficult. At the same time, such serious environmental problems as global warming and acid rain, which are caused by the burning of fossil fuels, have drawn great public attention, and the international community has urged that solutions to them should be found. Because nuclear power offers an economically efficient, stable supply of energy whose production has little adverse effect on the environment, the world has recognized the necessity of continuing to develop and use it. The changing international political situation, however, has complicated nuclear energy matters. In Japan, particularly the collapse of the former Soviet Union and North Korea's announcement of its intention to withdraw from the Nuclear Weapons Non-Proliferation Treaty have been cause for concern. Under these circumstances, it has become increasingly important for Japan to secure stable sources of energy, since Japan is dependent on imports for its energy supply. To that end, Japan has steadily promoted the development and utilization of nuclear energy. In fiscal 1992, nuclear power accounted for 28.2 % of the total power generated by Japanese electric utilities. Japan has also worked steadily to develop a nuclear fuel cycle, which is important to the long-term stability of the energy supply. This publication describes the present status of nuclear energy development and utilization in Japan. (J.P.N.)
Regidor, Enrique; Sanz, Belén; Pascual, Cruz; Lostao, Lourdes; Sánchez, Elisabeth; Díaz Olalla, José Manuel
To compare health services utilization between the immigrant and indigenous populations in Spain. We used information provided by the following four health surveys carried out around 2005: Catalonia 2005; city of Madrid 2005, Canary Islands 2004 and the Autonomous Community of Valencia 2005. The health services studied were general practice, specialist services, emergency services, hospitalization, and two preventive services: pap smear test and mammography. In general, most health services were less frequently used by the immigrant population than by the Spanish population. The health services showing the least differences between the two populations were general practice and hospitalization, while the greatest differences were found in the use of specialist and preventive services. The most heterogeneous results were found in general practice and hospitalization, since some immigrant groups showed a relatively high frequency of use in some geographical areas and a relatively low frequency in other areas. The results of the present study reproduce those found in other studies carried out in countries with similar social and economic characteristics to Spain. Like previous results, the present results are difficult to explain. Future research should aim to use other study designs and to test hypotheses not put forward by the scientific community to date.
Adane, Metadel; Mengistie, Bezatu; Mulat, Worku; Kloos, Helmut; Medhin, Girmay
Background Information on health-seeking behavior and utilization of health facilities in slums of Addis Ababa is scarce, impeding the implementation of effective interventions. The purpose of this study is to assess the status of health facilities utilization and predictors for health-seeking behavior of mothers/caregivers of under-five children with acute diarrhea in slums of Addis Ababa, Ethiopia. Methods A community-based cross-sectional study design was employed in five rounds of surveys...
Karim, R M; Abdullah, M S; Rahman, A M; Alam, A M
Bangladesh is one among the few countries of the world that provides free medical services at the community level through various public health facilities. It is now evident that, clients' perceived quality of services and their expectations of service standards affect health service utilization to a great extent. The aim of the study was to develop and validate the measures for perception and satisfaction of primary health care quality in Bangladesh context and to identify their aspects on the utilization status of the Community Clinic (CC) services. This mixed method cross sectional survey was conducted from January to June 2012, in the catchment area of 12 Community Clinics (CCs). Since most of the outcome indicators focus mainly on women and children, women having children less than two years of age were randomly assigned and interviewed for the study purpose. Data for the development of perceived service quality and satisfaction tools were collected through Focus Group Discussion (FGD), key informants interview and data for measuring the utilization status were collected by an interviewer administered pretested semi-structured questionnaire. About 95% of the respondents were Muslims and 5% were Hindus. The average age of the respondents was 23.38 (SD ± 4.15) years and almost all of them are home makers. The average monthly expenditure of their family was 7462.92 (SD ± 2545) BDT equivalent to 95 (SD ± 32) US$. To measure lay peoples' perception and satisfaction regarding primary health care service quality two scales e.g. Slim Haddad's 20-item scale for measuring perceived quality of primary health care services (PQPCS) validated in Guinea and Burkina Fuso and primary care satisfaction survey for women (PCSSW) developed by Scholle and colleagues 2004; is a 24-item survey tool validated in Turkey were chosen as a reference tools. Based on those, two psychometric research instruments; 24 items PQPCS scale (chronbach's α =0.89) and 22-items Community Clinic
Full Text Available Aim: Physical, psychological and social changes occurring in adolescence period may be cause for concern. In this study, it was aimed to determine concerns on growth and development in adolescence period, related factors and utilization of health services. Methods: In this study, data related youths' concerns, utilization of health services and socio-demographic variables obtained from multi-purpose cross-sectional survey named Needs Assesment of Seasonal Agricultural Worker Families Survey-2011 were used. Survey framework was consisted of aged 15-24 young people of families who worked as a seasonal agricultural farmworker in the year of research conducted. Survey was completed in 1021 households total 915 youths selected by probability cluster sampling method of 1200 households by Turkish Statistical Institution (Response rates were 90,7% in women, and 77,2% in men. and lsquo;Woman and Men Questionnaires' were applied by face to face interview. University Research Ethics Committee approval was obtained. Data entry and analysis performed using SPSS 11.5 software, descriptive statistics, t-test, chi-square test and logistic regression analysis were conducted. Results: Of participants 63,6% of female and 46,6% of male adolescents reported at least one concern related to growth and development inadolescent period. While having any concern prevalence in women were changed working time in the fields and health perception, marital status and education level with adolescent's concerns were related in men significantly (P <0,05. 13,8% of females and 10,9% of males utilized the health services because of concerns. Conclusion: By Family Health Centers at this risky young group during their period of residence in their address, adolescent follow-up should be done, should be asked concerns and given early diagnosis and treatment. On the other hand, health education programs on adolescence period by Community Health Centers will be useful. [TAF Prev Med Bull
Full Text Available Abstract Background Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Methods Data was obtained from a representative sample (N = 1426 residing in the broader Athens area (response rate 70.6%. Perceived health-related quality of life (HRQOL, as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a last-month visits to public sector physicians, b last-month visits to private sector physicians, c last-year visits to hospital emergency departments and d last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Results Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector. Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. Conclusion This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.
Pappa, Evelina; Niakas, Dimitris
Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.
Deitz, Diane; Cook, Royer; Hersch, Rebekah
This article reports findings from a workplace substance abuse prevention program designed to investigate best practices. The study sought to assess the effects of the worksite wellness program and employee assistance program (EAP) on healthcare utilization and costs, identify predictors of outpatient costs and visits, and assess the effect of the intervention on health attitudes, behaviors, and behavioral health-related costs and visits. Results indicated that visits to the EAP increased as did overall healthcare visits, that utilization of healthcare services and costs were higher in the population receiving substance abuse prevention intervention, and that employees in the substance abuse prevention intervention reported lower heavy drinking and binge drinking. Data suggest that substance abuse prevention may result in higher healthcare costs and utilization in the short term, but a reduction in health risk behaviors such as heavy drinking may result in lower healthcare costs and utilization in the long term.
García-Pérez, Lidia; Aguiar-Ibáñez, Raquel; Pinilla-Domínguez, Pilar; Arvelo-Martín, Alejandro; Linertová, Renata; Rivero-Santana, Amado
Currently, there is no registry of utility values for the Spanish population that could potentially be used in economic evaluations. Consequently, a systematic review of utilities or preferences for health states in the Spanish population was conducted. The results related to mental health are reported. A systematic review of the literature was conducted. The main databases searched were MEDLINE, CRD, Embase, PsycINFO, CINAHL, and Cochrane. The search strategy combined terms related to utilities and Spain. The inclusion criteria comprised the resident population in Spain, whether affected by any disease or not; the reported utilities had to be evaluated through a tool validated in Spain (i.e., EQ-5D, HUI, SF-6D) and/or following accepted techniques (e.g., time trade-off, standard gamble, or the visual analog scale). A narrative synthesis of articles was undertaken and the results related to mental health summarized. A total of 103 articles were finally included, from which 742 utility values were extracted. Sixty-nine utility values related to mental health and behavioral disorders were extracted from 12 studies. The most widely used tool was the E5-QD questionnaire. Most of the excluded articles evaluated quality of life but did not provide an estimation of utilities. This review adds value to research on utilities in Spain by gathering values to be included in economic evaluations, as well as by identifying research gaps in this field. The utility values related to mental health identified in this study are similar to those reported in international publications. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.
Aims: The aim of the present study was to comparatively analyze oral health status and influential factors in children with autism living in the Western Mediterranean Region of Turkey. Subjects and Methods: This cross‑sectional study was conducted in two steps: 1 ‑ questionnaire and 2 ‑ interview. This study was conducted ...
Objectives: The objective of the study was to determine the oral health status and diet habits of institutionalized elders in Lagos, Nigeria Materials and Methods: This cross-sectional study was conducted among institutionalized elders in Lagos State, Nigeria. Age and sex matched non-institutionalized elderly were also ...
Smoking, alcohol consumption and diet were among the criteria selected to screen health status among the residents of the urban migrant council-built hostels of Langa, Nyanga and. Guguletu outside Cape Town. Smoking patterns fell within the range found elsewhere. Problems associated with alcohol consumption were ...
Health status based on lifestyle-related disease is a concern in many developing countries, including Kenya. Factors related to such disease conditions, are important in ensuring economic sustainability in future. Currently there is limited research in this area. The main objective of this study was to determine the relationship ...
The study aimed at investigating the causes of poor nutritional and health status of students in higher institutions in Nigeria and the measures for improvement for sustainable national development. The population comprised nurses, medical doctors, nutritionists, Home Economics lecturers, post graduate students; ...
Holtslag, H. R.; Post, M. W.; Lindeman, E.; Van der Werken, Chr.
Background: Studies of the consequences of major trauma have traditionally focused on mortality rates. The aims of this study were, firstly, to investigate the long-term functional health status in a large, unselected group of severely injured patients and to compare this with normative data, and
Here a high infant mortality rate is examined against a low prevalence of diabetes, hypertension and syphilis and some of the effects of migrant labour on the health status of migrant hostel dwellers are identified. The low prevalence of disease among the Cape Town hostel residents suggests that migrant labour, by sifting ...
Schiffer, Angélique A; Denollet, Johan; Pedersen, Susanne S.
Cardiac resynchronization therapy (CRT) is a promising treatment in chronic heart failure (CHF). However, a subgroup of patients still report impaired health status, cardiac symptoms, and feelings of disability following CRT. The aims of this study were to examine (1) whether CHF patients treated...
Cailhol, L; Thalamas, C; Garrido, C; Birmes, P; Lapeyre-Mestre, M
Borderline personality disorder (BPD) is characterized by a pervasive pattern of instability and impulsivity. Several North American prospective studies support the high level of mental health care utilization in this population. There is little data in other systems of health organization, such as France. Furthermore, little is known on the variables associated with the mental health service utilization among BPD patients. The main objective was to compare the utilization of mental health care among BPD patients, to the general population and patients with another personality disorder (PD) and to describe the demographic and clinical factors associated with the group of patients who use the most health care. A multi-center (5 public and private centers), epidemiological study. Data were collected prospectively (database of an insurance fund covering 80% of the population) and viewed, retrospectively. We used the data collected during the five years previously to the inclusion. Inclusion criteria were age (18-60 years) and membership in the health insurance fund targeted. Patients on legal protection, forced hospitalization, with a chronic psychotic disorder, manic, mental retardation, or not reading French were excluded. First, four groups were composed: BPD, other PD, control groups for PD and other PD. The first two groups were recruited from a screening of inpatients including a self-administered questionnaire (Personality Disorder Questionnaire 4+). Assessment by a psychologist including the Structured Interview for DSM-IV Personality Disorders (SIDP-IV) was given straight to those who had a score above 28. This questionnaire allowed us to distinguish one group of subjects with BPD and a group with other PD (without BPD). Clinical evaluation included Axis I (MINI), Axis II (SIDP-IV), psychopathological features (YSQ-I, DSQ-40), demographic variables and therapeutic alliance (Haq-II). Matched controls (age, sex) composed the 3rd and 4th group (BPD control and
Jacquet, Gabrielle A; Kirsch, Thomas; Durrani, Aqsa; Sauer, Lauren; Doocy, Shannon
Introduction The 2010 floods submerged more than one-fifth of Pakistan's land area and affected more than 20 million people. Over 1.6 million homes were damaged or destroyed and 2,946 direct injuries and 1,985 deaths were reported. Infrastructure damage was widespread, including critical disruptions to the power and transportation networks. Hypothesis Damage and loss of critical infrastructure will affect the population's ability to seek and access adequate health care for years to come. This study sought to evaluate factors associated with access to health care in the aftermath of the 2010 Pakistan floods. A population-proportional, randomized cluster-sampling survey method with 80 clusters of 20 (1,600) households of the flood-affected population was used. Heads of households were surveyed approximately six months after flood onset. Multivariate analysis was used to determine significance. A total of 77.8% of households reported needing health services within the first month after the floods. Household characteristics, including rural residence location, large household size, and lower pre- and post-flood income, were significantly associated (Pfloods was associated with urban residence location, suggesting that locating health care providers in rural areas may be difficult. Access to health services also was associated with post-flood income level, suggesting health resources are not readily available to households suffering great income losses. Jacquet GA , Kirsch T , Durrani A , Sauer L , Doocy S . Health care access and utilization after the 2010 Pakistan floods. Prehosp Disaster Med. 2016;31(5):485-491.
Jiang, Shu-Qiang; Zhang, Jian-Ling
Objective: To observe the influences of mental health promotion and mental intervention on mental health status of professionals. Method: 2878 professionals for physical examination were selected and randomly divided into treatment group and control group, with 1443 professionals and 1435 professionals, respectively. Then, the difference of mental health status before and after mental intervention between two groups was compared. Results: In treatment group, the proportion of people with heal...
Van Houtven, Courtney Harold; Jeffreys, Amy S.; Coffman, Cynthia J.
Purpose: The Veterans Affairs or VA health care system is in the process of significantly expanding home health care (HOC) nationwide. We describe VA HHC use in 2003 for all VA HHC users from 2002; we examine whether VA utilization across a broad spectrum of services differed for a sample of VA HHC users and their propensity-score-matched…
Jung, Minsoo; Ramanadhan, Shoba; Viswanath, Kasisomayajula
Social determinants, such as socioeconomic status (SES) and race/ethnicity are linked to striking health disparities across the cancer continuum. One important mechanism linking social determinants and health disparities may be communication inequalities that are caused by differences in accessing, processing and utilizing cancer information. In this context, we examined health information-seeking/avoidance as a potential mediator between social determinants and self-rated health (SRH) status among cancer survivors. Data came from the 2008 well-informed, thriving and surviving (WITS) study of post-treatment cancer survivors (n=501). We examined the mediating effect of health communication-related behavior between SES and disparities in SRH. The likelihood of belonging to the Low SRH group was higher among patients who had avoided health information and whose family members had not sought health information on behalf of the survivor, those in the lowest household income bracket, and those who had high school or less education after adjusting for potential confounders. Differences in SRH among cancer survivors are associated with SES as well as communication inequalities. It is necessary to provide a supportive environment in which health information is made available if disparities in health-related quality of life among cancer survivors are to be reduced. Copyright © 2013 Elsevier Ireland Ltd. All rights reserved.
Dunbar, Michael S; Sontag-Padilla, Lisa; Ramchand, Rajeev; Seelam, Rachana; Stein, Bradley D
College students are at high risk for mental health problems, yet many do not receive treatment even when services are available. Treatment needs may be even higher among sexual minority students, but little is known about how these students differ from heterosexual peers in terms of mental health needs and service utilization. A total of 33,220 California college students completed an online survey on mental health needs (e.g., current serious psychological distress and mental health-related academic impairment) and service utilization. Using logistic regressions, we examined differences in student characteristics, mental health service use, and perceived barriers to using on-campus services by sexual minority status. Approximately 7% of students self-identified as sexual minorities. Compared with heterosexual students, sexual minority students endorsed higher rates of psychological distress (18% vs. 26%, p mental health-related academic impairment (11% vs. 17%, p mental health services. Sexual minority students were also more likely to report using off-campus services and to endorse barriers to on-campus service use (e.g., embarrassed to use services and uncertainty over eligibility for services). Sexual minority individuals represent a sizeable minority of college students; these students use mental health services at higher rates than heterosexual peers but have high rates of unmet treatment need. Efforts to address commonly reported barriers to on-campus service use, foster sexual minority-affirmative campus environments, and promote awareness of campus services may help reduce unmet treatment need in this population. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Nunez Lopez, Omar; Jupiter, Daniel C; Bohanon, Fredrick J; Radhakrishnan, Ravi S; Bowen-Jallow, Kanika A
Bariatric surgery represents an appropriate treatment for adolescent severe obesity, but its utilization remains low in this patient population. We studied the impact of race and sex on preoperative characteristics, outcomes, and utilization of adolescent bariatric surgery. Retrospective analysis (2007-2014) of adolescent bariatric surgery using the Bariatric Outcomes Longitudinal Database, a national database that collects bariatric surgical care data. We assessed the relationships between baseline characteristics and outcomes (weight loss and remission of obesity-related conditions [ORCs]). Using the National Health and Nutrition Examination Survey and U.S. census data, we calculated the ratio of severe obesity and bariatric procedures among races and determined the ratio of ratios to assess for disparities. About 1,539 adolescents underwent bariatric surgery. Males had higher preoperative body mass index (BMI; 51.8 ± 10.5 vs. 47.1 ± 8.7, p adolescents underwent bariatric surgery at a higher proportion than blacks and Hispanics (2.5 and 2.3 times higher, respectively). Preoperative characteristics vary according to race and sex. Race and sex do not impact 12-month weight loss or ORC's remission rates. Minority adolescents undergo bariatric surgery at lower-than-expected rates. Copyright © 2017 Society for Adolescent Health and Medicine. Published by Elsevier Inc. All rights reserved.
Sala Farré, Maria Rosa; Osorio Sánchez, Dimelza; Arias Varela, Cesar; Simó Sanahuja, Maria; Recasens Recasens, Assumpta; Pérez Jové, Josefa
In Catalonia the current surveillance systems do not allow to know the true incidence or the health care utilization of acute gastroenteritis (AGE) caused by Campylobacter and Salmonella infections. The aim of this study is to analyze these characteristics. Descriptive study of Campylobacter and Salmonella infections reported in 2002 and 2012 in Catalonia, Spain. We included cases isolated and reported by the laboratory to a regional Surveillance Unit. The estimated incidence of Salmonella and Campylobacter AGE decreased by almost 50% and 20% respectively in 2012. Children between one and 4 years old were the most affected in both years. Significant differences in the clinical characteristics and disease duration were observed between Campylobacter and Salmonella. Visits to the Emergency Department and hospitalization rates were 63.7% and 15%, being more frequent among salmonellosis cases. The estimated incidence of Campylobacter and Salmonella infections has decreased, however rates are still important, as well as it is the health care utilization in both diseases. Current surveillance systems need appropriateness improvements to reach a better control of these infections. Copyright © 2014 Elsevier España, S.L.U. All rights reserved.
Målqvist, Mats; Lincetto, Ornella; Du, Nguyen Huy; Burgess, Craig; Hoa, Dinh Thi Phuong
To investigate changes that took place between 2006 and 2010 in the inequity gap for antenatal care attendance and delivery at health facilities among women in Viet Nam. Demographic, socioeconomic and obstetric data for women aged 15-49 years were extracted from Viet Nam's Multiple Indicator Cluster Survey for 2006 (MICS3) and 2010-2011 (MICS4). Multivariate logistic regression was performed to determine if antenatal care attendance and place of delivery were significantly associated with maternal education, maternal ethnicity (Kinh/Hoa versus other), household wealth and place of residence (urban versus rural). These independent variables correspond to the analytical framework of the Commission on Social Determinants of Health. Large discrepancies between urban and rural populations were found in both MICS3 and MICS4. Although antenatal care attendance and health facility delivery rates improved substantially between surveys (from 86.3 to 92.1% and from 76.2 to 89.7%, respectively), inequities increased, especially along ethnic lines. The risk of not giving birth in a health facility increased significantly among ethnic minority women living in rural areas. In 2006 this risk was nearly five times higher than among women of Kinh/Hoa (majority) ethnicity (odds ratio, OR: 4.67; 95% confidence interval, CI: 2.94-7.43); in 2010-2011 it had become nearly 20 times higher (OR: 18.8; 95% CI: 8.96-39.2). Inequity in maternal health care utilization has increased progressively in Viet Nam, primarily along ethnic lines, and vulnerable groups in the country are at risk of being left behind. Health-care decision-makers should target these groups through affirmative action and culturally sensitive interventions.
Trisolini, M G; Thomas, C P; Cashman, S B; Payne, S M
Resource utilization in home health care has become an issue of concern due to rising costs and recent initiatives to develop prospective payment systems for home health care. A number of issues remain unresolved for the development of prospective reimbursement in this sector, including the types of variables to be included as payment variables and appropriate measures of resource use. This study supplements previous work on home health case-mix by analyzing the factors affecting one aspect of resource use for skilled nursing visits--visit length--and explores the usefulness of several specially collected variables which are not routinely available in administrative records. A data collection instrument was developed with a focus group of skilled nurses, identifying a range of variables hypothesized to affect visit length. Five categories of variables were studied using multiple regression analysis: provider-related; patient's socio-economic status; patient's clinical status; patient's support services; and visit-specific. The final regression model identifies 9 variables which significantly affect visit time. Five of the 9 are visit-specific variables, a significant finding since these are not routinely collected. Case-mix systems which include visit time as a measure of resource use will need to investigate visit-specific variables, as this study indicates they could have the largest influence on visit time. Two other types of resources used in home health care, supplies and security drivers, were also investigated in less detail.
Yamamoto, Nobuo; Kinoshita, Naoki; Kabuto, Shoji; Tanaka, Takayuki
Tandetron Accelerator Mass Spectrometer in the Japan Atomic Energy Agency Mutsu office (JAEA AMS Mutsu: High Voltage Engineering Europa product, Model 4130-AMS) consists of 3MV tandem type accelerator and the 2 beam lines for measurement of isotope ratio for carbon and iodine. Steady operation of carbon beam line was started in December, 1999 and that of iodine beam line was started in May, 2003. This facility was initially used for studies on transport processes of radionuclides in marine environment. From the fiscal year 2006, this facility became a shared facility to provide data for various projects at JAEA and others. This paper describes the status of recent utilization of JAEA AMS MUTSU, and the revision of the charge from fiscal year 2010. (author)
Sado, Lantona; Spaho, Alma; Hotchkiss, David R
Women in Albania receive antenatal care and postnatal care at lower levels than in other countries in Europe. Moreover, there are large socio-economic and regional disparities in maternal health care use. Previous research in low- and middle-income countries has found that women's status within the household can be a powerful force for improving the health, longevity, and mental and physical capacity of mothers and the well-being of children, but there is very little research on this issue in the Balkans. The aim of this paper is to investigate the influence of women's empowerment within the household on antenatal and postnatal care utilization in Albania. The research questions are explored through the use of bivariate and multivariate analyses based on nationally representative data from the 2008-09 Albania Demographic and Health Survey. The linkages between women's empowerment and maternal health care utilization are analyzed using two types of indicators of women's empowerment: decision making power and attitudes toward domestic violence. The outcome variables are indicators of the utilization of antenatal care and postnatal care. The findings suggest that use of maternal health care services is influenced by women's roles in decision-making and the attitudes of women towards domestic violence, after controlling for a number of socio-economic and demographic factors which are organized at individual, household, and community level. The study results suggest that policy actions that increase women's empowerment at home could be effective in helping assure good maternal health. Copyright © 2014 Elsevier Ltd. All rights reserved.
Vishnu Rekha, C; Arangannal, P; Shahed, H
To assess the oral health status of autistic children in Chennai. Oral health status was assessed for 483 children with autism, solicited from special education schools, autistic child centres and therapy centres. Conditions assessed were plaque accumulation, gingival health, dental caries, malocclusion, developmental anomalies, oral injuries and restorations. Chi-square and Fisher's exact tests of significance were used to compare groups. Proportions test was used to compare the significance of the parameters between boys and girls. Autistic children with primary dentition showed significantly higher incidence of dental caries (24%), when compared to other oral conditions. Children with mixed dentition had more gingivitis (50%) and children with permanent dentition had more gingivitis (48.96%) and malocclusion (71.15%). All the oral conditions were seen more in boys than girls. Autistic children have significantly poor oral hygiene and higher incidence of malocclusion and dental caries when compared to other oral conditions.
Agarwal, Vibhu; Zhang, Liangliang; Zhu, Josh; Fang, Shiyuan; Cheng, Tim; Hong, Chloe; Shah, Nigam H
Background By recent estimates, the steady rise in health care costs has deprived more than 45 million Americans of health care services and has encouraged health care providers to better understand the key drivers of health care utilization from a population health management perspective. Prior studies suggest the feasibility of mining population-level patterns of health care resource utilization from observational analysis of Internet search logs; however, the utility of the endeavor to the...
Gundala, Rupasree; Chava, Vijay K.
Background: The health model which forms the basis is knowledge, attitude, temporary, and permanent behaviors. Currently, more emphasis has been directed towards the combined influence of lifestyle, education, levels and socioeconomic factors, instead of regular risk factors in dealing with chronic illnesses. The present study is conducted to correlate the periodontal health of people with reference to lifestyle, education level, and socioeconomic status. Materials and Methods: A cross-sectional study was conducted in the Department of Periodontics, Narayana Dental College and Hospital, Nellore. A total of 1350 subjects were examined and 948 patients were randomly selected from out patient department. Information about their lifestyle, education level, and socioeconomic status were recorded using a questionnaire and correlated with the periodontal status. Results: The statistical analysis showed significant decrease in periodontitis when income and education levels increased. Also the prevalence of periodontitis associated with a healthy lifestyle is significantly lower when compared to an unhealthy lifestyle. Conclusions: There is a strong association of lifestyle, education level, and socioeconomic status with periodontal health. PMID:22114373
Greiner, Wolfgang; Klose, Kristina
Measuring health-related quality of life is an important aspect in economic evaluation of health programmes. The development of utility-based (preference-based) measures is advanced by the discipline of health economics. Different preference measures are applied for valuing health states to produce a weighted health state index. Those preference weights should be derived from a general population sample in case of resource allocation on a collective level (as in current valuation studies of the EuroQol group). Copyright © 2014. Published by Elsevier GmbH.
Nguyen, Kim Yen T; Smallidge, Dianne L; Boyd, Linda D; Rainchuso, Lori
Purpose: Infrequent use of the Western health care by the Vietnamese may be explained by deeply-rooted traditional oral health beliefs and practices unique to the Asian culture. This study investigated Vietnamese oral health beliefs and practices and their relationship to the utilization of Western preventive oral health care services among Vietnamese-Americans. Methods: An exploratory, cross-sectional survey design with a convenience sample of 140 par-ticipants (n = 140) was used for this study. Participants were recruited on site of a Vietnamese-owned business, with questionnaires consisting of 28 questions that were distributed in hard copy by the principal investigator (PI) on multiple occasions and at various times of the day. Results: Spearman Rank Correlations tests showed participants who agreed with the statement, "Regular dental visits will help prevent dental problems," were more likely to utilize medical health services (pissues. No statistical significance was found between age, gender, pri-mary language, years spent in the United States, education level, religion and the Vietnamese survey participants' individual oral beliefs and practices. Conclusion: The results suggest that Vietnamese Americans holding the belief that dental visits help prevent oral health problems, were more likely to utilize Western health care services. The study also supports existing literature that Vietnamese oral health beliefs and practices impact the use of Western health care services. Copyright © 2017 The American Dental Hygienists’ Association.
Petrelli, Alessio; Di Napoli, Anteo; Rossi, Alessandra; Gargiulo, Lidia; Mirisola, Concetta; Costanzo, Gianfranco
to evaluate self-perceived health status of immigrants in Italy. cross-sectional study based on the representative national samples of the multipurpose surveys "Health conditions and use of health services" conducted in 2005 and 2013 by the Italian National Institute of Statistics (Istat). the study was conducted on the age group of 18-64: No. 80,661 in 2005, among which 3.2% were immigrants, and No. 72,476 in 2013, among which 7.1% were immigrants. prevalence rate ratios (PRR) calculated through log-binomial regression models, stratified by survey edition and gender, by evaluating the association between the Physical Component Score (PCS), the Mental Component Score (MCS), and the overall health index and citizenship. Adjustment for the following confounding factors was performed: age, educational level, working condition, perceived economic resources, body mass index (BMI). in 2005, immigrants had a lower probability of poor-perceived physical health, both among men (PRR: 0.79; 95%CI 0.70-0.89) and women (PRR: 0.89; 95%CI 0.82- 0.97), compared to Italians. In 2013, the perceived health advantage of immigrants was reduced for both genders (PRR males: 0.87; 95%CI 0.80-0.95; PRR females: 0.94; 95%CI 0.88-0.99). In the considered period, the prevalence of people with worse mental health conditions increases, with lower PRR among immigrants, compared to Italians. Higher probability of «NOT good» overall perceived health was also observed among immigrants residing in Italy for at least 10 years (PRR men: 1.24; PRR women: 1.15) and among immigrants men from America (PRR: 1.35). from 2005 to 2013, immigrants seemed to maintain a better perception of health status than Italians. Nevertheless, study results show a decrease in self-perceived health, particularly mental health, in the considered period - apart from demographic, socioeconomic, and lifestyle factors - as well as a worse overall self-perceived health status among immigrants who stayed in Italy longer. Such
Msengi, Clementine M.; Msengi, Israel G.; Harris, Sandra; Hopson, Michael
The purpose of this study was to assess the health status and physical health of international students at five American universities. International students in the United States were asked to compare the status of their health before and after coming to the United States. Findings suggested that health status of international students declined…
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. H. M. Mahmudur Rahman
Full Text Available Child and maternal nutritional and health status is a very much concerning issue of Bangladesh. To summarize the specific conditions of Bangladeshi child and maternal health and related issues. This is a descriptive review and overall analysis and description of the literature was done regarding child and maternal health of the general population living in Bangladesh. The evidence reflected that infant, child, and maternal mortality in Bangladesh have declined gradually at least over the past years. It is found that infant mortality 2 times, child mortality 6 times, and under five mortality rates 3 times declined comparatively than the last two decades but it is noted that maternal assassination circumstance has not declined. Knowledge on child and maternal health carries an important role in education. Health knowledge index significantly improve child and maternal health although differentially. It is obvious that poverty is one of the root causes that have led to a high child and maternal mortalities and morbidities faced by the people of Bangladesh. The requirement for socio economic relief for those living in rural Bangladesh remains one of the core issues. Recently, Bangladesh is successfully declining the total number of childhood and nutrition related mortalities despites various complexities, but maternal health status is not improving at the same pace. Nongovernment and government funded organizations and policymakers should come forward for running some effective programs to conquer the situation completely in Bangladesh.
Cundiff, Jenny M; Matthews, Karen A
Both social stratification (e.g., social rank) as well as economic resources (e.g., income) are thought to contribute to socioeconomic health disparities. It has been proposed that subjective socioeconomic status (an individual's perception of his or her hierarchical rank) provides increased predictive utility for physical health over and above more traditional, well-researched socioeconomic constructs such as education, occupation, and income. PsycINFO and PubMed databases were systematically searched for studies examining the association of subjective socioeconomic status (SES) and physical health adjusting for at least 1 measure of objective SES. The final sample included 31 studies and 99 unique effects. Meta-analyses were performed to: (a) estimate the overlap among subjective and objective indicators of SES and (b) estimate the cumulative association of subjective SES with physical health adjusting for objective SES. Potential moderators such as race and type of health indicator assessed (global self-reports vs. more specific and biologically based indicators) were also examined. Across samples, subjective SES shows moderate overlap with objective indicators of SES, but associations are much stronger in Whites than Blacks. Subjective SES evidenced a unique cumulative association with physical health in adults, above and beyond traditional objective indicators of SES (Z = .07, SE = .01, p Subjective SES may provide unique information relevant to understanding disparities in health, especially self-rated health. (PsycINFO Database Record (c) 2017 APA, all rights reserved).
Roos, E; Lahelma, E; Saastamoinen, P; Elstad, J-I
The Nordic countries have relatively equal employment participation between men and women, but some differences between countries exist in labour market participation. The aim was to examine the association between employment status and health among women and men in Denmark, Finland, Norway, and Sweden, and analyse whether this association is modified by marital status and parental status. The data come from nationally representative cross-sectional surveys carried out in Denmark (n = 2,209), Finland (n = 4,604), Norway (n = 1,844) and Sweden (n = 5,360) in 1994-95. Women and men aged 25-49 were included. Employment status was categorized into full-time employed, part-time employed, unemployed, and housewives among women and into employed and unemployed among men. Health was measured by perceived health and limiting longstanding illness. Logistic regression analysis was used, adjusting for age and education. Marital status and parental status were analysed as modifying factors. The non-employed were more likely to report perceived health as below good and limiting longstanding illness than the employed among both women and men. The association between employment status and perceived health remained unchanged when marital status and parental status were adjusted for among all men and Finnish women, but the association was slightly strengthened among Danish and Swedish women, with the housewives becoming more likely to report ill health than employed women. The association between employment status and limiting longstanding illness was slightly strengthened among women, and slightly weakened among Norwegian men when marital and parental status were adjusted for. Non-employment was associated with poorer health in all countries, although there are differences in the employment patterns between the countries. Among women marital status and parental status showed a modest or no influence on the association between employment status and health. Among men there was no
Abraído-Lanza, Ana F; White, Kellee; Armbrister, Adria N; Link, Bruce G
To document disparities in health status, activity limitations, and disability in work and housework between Latinos and non-Latino whites with arthritis. We examined whether sociodemographic factors (age, income, and education) account for the disparities between the ethnic groups, and whether comorbid conditions, disease duration, health care utilization, and functional abilities predict health status, activity limitations, and work and housework disability after controlling for sociodemographic variables. We analyzed data from the Condition file of the 1994 National Health Interview Survey on Disability, Phase I. The risk of worse health, activity limitations, and work and housework disability was >2 times greater among Latinos compared with non-Latino whites. In the regression models accounting for potential confounders, Latino ethnicity remained significantly associated with poorer health status, but not activity limitations or disability in work or housekeeping. Of the socioeconomic status variables, education had a significant protective effect on work disability and health status. Comorbid conditions and health care utilization increased the likelihood of worse health, activity limitations, and work disability. Limitations in physical function were associated with poorer health and disability in work and homemaking. Social status differences between Latinos and non-Latinos may account for disparities in activity limitations and disability in work and housework. Education may provide various health benefits, including access to a range of occupations that do not require physical demands. The findings help to address the great gap in knowledge concerning factors related to the health and disability status of Latinos with arthritis.
Dien, Nguyen Nhi; Hai, Nguyen Canh
radiation hardness of electronics components, and other researches. Because of lacking of budget, another two beam tubes are still empty and we have no chance to set up some other facilities for neutron beam study, such as small angle neutron scattering (SANS) facility, neutron diffractometers at the beam tubes, as well as boron neutron capture therapy (BNCT) facility at the thermal column. This report presents the status of neutron beam facility at the Dalat reactor and its utilization for some typical research activities. An outlook on possibility for participation in the FNCA co-operation program on the utilization of the research reactors has also been given. (author)
Full Text Available Aims of the Study: This study was carried out to determine the effective factors in environmental health status of grocery stores in the city of Qom (located in the center of Iran. Materials & Methods: In this cross-sectional study, 283 grocery stores from 3 different regions were selected randomly using stratified sampling. Data were gathered through observation, interview, and questionnaire. The questionnaire consisted of two sections: section 1 dealt with some shop managers’ features including the age, educational level, job satisfaction, passing “food and occupational hygiene training courses”, store ownership, duration of employment, and features of stores including their location (Region and environmental health condition. And section 2 dealt with the important aspects of regulations of Article 13. The data analyzed using statistical procedures such as Spearman Rank Correlation and Multivariate Regression Analysis. P-values less than 0.05 were considered as statistically significant. Results: Among the investigated factors, the manager’s educational level had a greater impact on the environmental health conditions of grocery stores. The ownership status of grocery stores, Job satisfaction and passing “food and occupational hygiene training courses” were next in the ranking, respectively (p <0.001 for all measures, except for shop ownership, for which p-value was <0.02. Conclusions: Planning and implementation of effective operational and strategic programs addressing the above mentioned issues seems to be necessary. Such programs will improve the health status of the stores over time.
Platt, Lisa F; Wolf, Julia Kay; Scheitle, Christopher P
Prior studies of the utilization of mental health professionals by sexual minority populations have relied on data that are now dated or not nationally representative. These studies have also provided mixed findings regarding gender differences in the utilization of mental health professionals among sexual minority individuals. Using data from the 2013-2015 National Health Interview Surveys, this study investigates (1) how sexual minority individuals compare to heterosexual participants in their utilization of mental health professionals; and (2) gender differences in that utilization. The results indicate sexual minority individuals utilize mental health care professionals at higher rates than heterosexual individuals even after controlling for measures of mental health and other demographic characteristics; this is true for both men and women. However, gender moderates the sexual minority effect on utilization rates. Sexual minority men utilize mental health professionals at a high rate, such that their utilization rates are similar to sexual minority women, contrary to the gender gap seen among heterosexuals.
Gagné, Thierry; Ghenadenik, Adrian E
The Scandinavian Journal of Public Health recently reiterated the importance of addressing social justice and health inequalities in its new editorial policy announcement. One of the related challenges highlighted in that issue was the limited use of sociological theories able to inform the complexity linking the resources and mechanisms captured by the concept of socioeconomic status. This debate article argues that part of the problem lies in the often unchallenged reliance on a generic conceptualization and operationalization of socioeconomic status. These practices hinder researchers' capacity to examine in finer detail how resources and circumstances promote the unequal distribution of health through distinct yet intertwined pathways. As a potential way forward, this commentary explores how research practices can be challenged through concrete publication policies and guidelines. To this end, we propose a set of recommendations as a tool to strengthen the study of socioeconomic status and, ultimately, the quality of health inequality research. Authors, reviewers, and editors can become champions of change toward the implementation of sociological theory by holding higher standards regarding the conceptualization, operationalization, analysis, and interpretation of results in health inequality research.
Ribera, Berta; Casal, Bruno; Cantarero, David; Pascual, Marta
Because of the progressive increase in the number of immigrants and the uncertainty about the capacity of the Spanish health service to deal with the quantitative and qualitative increases in demand, the possibility of introducing changes to adapt our services to the new situation should be considered. Beginning with an analysis of the factors that influence health status and use of the health service, based on the National Health Survey (NHS), the European Statistics on Income and Living Conditions (EU-SILC) and the European Community Household Panel (ECHP), we compare the health profiles and patterns of medical resources utilization between the national and foreign populations. The pattern of demand for health services in the immigrant population corresponds basically to the needs of a young population in good health. According to NHS data, resource utilization among immigrants can even be lower than that among the national population. Assessing the link between health status and demand for healthcare from a dynamic point of view, by identifying variations in patterns of health and patterns of demand for healthcare, is important to identify imbalances in resources and to establish an appropriate hierarchy of preventive and treatment priorities.
Yun, Young Ho; Sim, Jin Ah; Park, Eun-Gee; Park, June Dong; Noh, Dong-Young
To perform a comparison between health behaviors and health status of employees with those of the general population, to evaluate the association between employee health behaviors, health status, and absenteeism. Cross-sectional study enrolled 2433 employees from 16 Korean companies in 2014, and recruited 1000 general population randomly in 2012. The distribution of employee health behaviors, health status, and association with absenteeism were assessed. Employees had significantly worse health status and low rates of health behaviors maintenance compared with the general population. Multiple logistic regression model revealed that regular exercise, smoking cessation, work life balance, proactive living, religious practice, and good physical health status were associated with lower absenteeism. Maintaining health behaviors and having good health status were associated with less absenteeism. This study suggests investment of multidimensional health approach in workplace health and wellness (WHW) programs.
... 45 CFR Part 147 Group Health Plans and Health Insurance Coverage Relating to Status as a... for Group Health Plans and Health Insurance Coverage Relating to Status as a Grandfathered Health Plan... and Insurance Oversight, Department of Health and Human Services. ACTION: Interim final rules with...
Sato, Keiko; Yamazaki, Shin; Hayashino, Yasuaki; Takegami, Misa; Tokuda, Yasuharu; Takahashi, Osamu; Shimbo, Takuro; Hinohara, Shigeaki; Fukui, Tsuguya; Fukuhara, Shunichi
To investigate the association between hours worked, symptoms experienced, and health resource utilization. Data were collected from a nationally representative sample of households in Japan. We studied full-time male workers aged 18-65 yr who worked 100 h or more per month. First, we examined the association between hours worked and symptoms experienced. Second, we examined the association between hours worked and the type of health resource utilized, such as physician visits, over-the-counter (OTC) medication use, dietary supplement use, and complementary and alternative medicine (CAM) provider visits. We used a multivariable negative binominal model in each analysis. Of the 762 male workers, 598 reported experiencing symptoms at least once a month. We categorized participants based on the number of hours worked per month (h/mo): 100-200 h/mo, 201-250 h/mo, and over 250 h/mo. Compared with those working 201-250 h/mo, those working 100-200 h/mo had more frequent physician visits (rate ratio:1.67, 95% CI: 1.17 to 2.38) and those working over 250 h/mo had significantly lower rates of CAM provider visits and tended to use dietary supplements for symptoms. Participants who worked 201-250 h/mo used OTC medication most frequently. No significant association was observed between the number of hours worked and number of symptoms experienced. The more hours worked by full-time male workers, the more likely they were to use health resources that had a lower time requirement. Greater attention should be paid to patterns of health resource utilization among workers and their consequent influence on long-term health status.
Haider, Mohammad Rifat; Rahman, Mohammad Masudur; Moinuddin, Md; Rahman, Ahmed Ehsanur; Ahmed, Shakil; Khan, M Mahmud
Despite remarkable progress in maternal and child health, inequity persists in maternal care utilization in Bangladesh. Government of Bangladesh (GOB) with technical assistance from United Nation Population Fund (UNFPA), United Nation Children's Fund (UNICEF) and World Health Organization (WHO) started implementing Maternal and Neonatal Health Initiatives in selected districts of Bangladesh (MNHIB) in 2007 with an aim to reduce inequity in healthcare utilization. This study examines the effect of MNHIB on inequity in maternal care utilization. Two surveys were carried out in four districts in Bangladesh- baseline in 2008 and end-line in 2013. The baseline survey collected data from 13,206 women giving birth in the preceding year and in end-line 7,177 women were interviewed. Inequity in maternal healthcare utilization was calculated pre and post-MNHIB using rich-to-poor ratio and concentration index. Mean age of respondents were 23.9 and 24.6 years in 2008 and 2013 respectively. Utilization of pregnancy-related care increased for all socioeconomic strata between these two surveys. The concentration indices (CI) for various maternal health service utilization in 2013 were found to be lower than the indices in 2008. However, in comparison to contemporary BDHS data in nearby districts, MNHIB was successful in reducing inequity in receiving ANC from a trained provider (CI: 0.337 and 0.272), institutional delivery (CI: 0.435 in 2008 to 0.362 in 2013), and delivery by skilled personnel (CI: 0.396 and 0.370). Overall use of maternal health care services increased in post-MNHIB year compared to pre-MNHIB year and inequity in maternal service utilization declined for three indicators out of six considered in the paper. The reductions in CI values for select maternal care indicators imply that the program has been successful not only in improving utilization of maternal health services but also in lowering inequality of service utilization across socioeconomic groups
A Health Risk Assessment (HRA) was conducted for the proposed joint Hennepin County/Municipal Services Corporation (MSC) MSW Ash Utilization Demonstration Project, in which combined HERC ash was shipped to the MSC Pilot Plan near Atlanta, Georgia and used in the production of a synthetic aggregate. The synthetic aggregate, or TAP, will serve as a partial replacement for natural aggregates in a section of bituminous pavement that is proposed to be constructed on Pioneer Trail in the City of Corcoran, Minnesota. In this paper, the assessment compares the following three scenarios: a section of roadway paved using the MSC synthetic aggregate product (TAP) as a replacement for 30 percent of the natural aggregates used in bituminous pavement; a section of regular bituminous (asphalt) pavement; and a section of unpaved road currently in place at the site
Deitelzweig, Steven; Amin, Alpesh; Christian, Rudell; Friend, Keith; Lin, Jay; Lowe, Timothy J
Hyponatremia is associated with higher morbidity and mortality rates among hospitalized patients. Our study evaluated health care utilization and associated costs of patients hospitalized with a primary diagnosis of hyponatremia. Hospitalized patients with a primary discharge diagnosis of hyponatremia (aged ≥ 18 years) were identified from the Premier Perspective™ database (January 1, 2007-March 31, 2010) and matched to non-hyponatremic (non-HN) patients using a combination of exact patient characteristic matching and propensity score matching. Univariate and multivariate statistics were used to compare hospital resource usage, costs, and 30-day readmission rates between cohorts. Hospital length of stay (LOS) (± standard deviation) (3.78 ± 3.19 vs 3.54 ± 3.26 days; P ratio, 1.89, confidence limits, 1.72, 2.07; P ratio, 4.76; confidence limits, 4.31, 5.26; P profitability due to the increased likelihood of 30-day readmission.
Mohler-Kuo, Meichun; Wydler, Hans; Zellweger, Ueli; Gutzwiller, Felix
OBJECTIVE: Very few studies specifically have examined the health status of 20-year-olds. The purpose of the present study is to examine the changes in health status and behaviour among young Swiss adults between 1993 and 2003. METHODS: The present study used data from the Swiss Federal Surveys of Adolescents, conducted in 1993 and 2003 among 20-year-olds in Switzerland. The study sample included military recruits and a representative community cohort. More than 20,000 subjects participate...
Calvert, Melanie; Duffy, Helen; Freemantle, Nick; Davis, Russell; Lip, Gregory YH; Gill, Paramjit
Abstract Background Population health status scores are routinely used to inform economic evaluation and evaluate the impact of disease and/or treatment on health. It is unclear whether the health status in black and minority ethnic groups are comparable to these population health status data. The aim of this study was to evaluate health-status in South Asian and African-Caribbean populations. Methods Cross-sectional study recruiting participants aged ≥ 45 years (September 2006 to July 2009) ...
Isacco, Laurie; Duché, Pascale; Boisseau, Nathalie
metabolism, but this depends on how the treatment is administered (orally vs transdermally). To better understand the role of ovarian hormones in substrate oxidation, studies have made use of animal protocols to investigate cellular mechanisms. Estradiol and progesterone seem to have opposite effects, with greater lipid oxidation when estradiol is used alone. However, the concentrations used (physiological levels or pharmacological doses) may considerably modify fuel selection. In cases where conflicting data are observed in studies of substrate utilization and prolonged exercise in women, methodological reasons must be called into question. Too many parameters, which oftentimes are not specified, may modulate substrate utilization and metabolic and hormonal responses to prolonged exercise. Although information is generally provided about the type of exercise, its duration and the subjects' training level, detailed information is not always given about the subjects' nutritional state and, more specifically, the hormonal status of female subjects. The primary purpose of this review was to identify the impact of hormonal status on substrate oxidation among female subjects at rest and during exercise. A second aim was to describe gender differences in substrate utilization during exercise.
Bastos, Gisele Alsina Nader; Duca, Giovâni Firpo Del; Hallal, Pedro Curi; Santos, Iná S
To estimate the prevalence and analyze factors associated with the utilization of medical services in the public health system. Cross-sectional population-based study with 2,706 individuals aged 20-69 years carried out in Pelotas, Southern Brazil, in 2008. A systematic sampling with probability proportional to the number of households in each sector was adopted. The outcome was defined by the combination of the questions related to medical consultation in the previous three months and place. The exposure variables were: sex, age, marital status, level of schooling, family income, self-reported hospital admission in the previous year, having a regular physician, self-perception of health, and the main reason for the last consultation. Descriptive analysis was stratified by sex and the analytical statistics included the use of the Wald test for tendency and heterogeneity in the crude analysis and Poisson regression with robust variance in the adjusted analysis, taking into consideration cluster sampling. The prevalence of utilization of medical services in the three previous months was 60.6%, almost half of these (42.0%, 95%CI: 36.6;47.5) in public services. The most utilized public services were the primary care units (49.5%). In the adjusted analysis stratified by sex, men with advanced age and young women had higher probability of using the medical services in the public system. In both sexes, low level of schooling, low per capita family income, not having a regular physician and hospital admission in the previous year were associated with the outcome. Despite the expressive reduction in the utilization of medical health services in the public system in the last 15 years, the public services are now reaching a previously unassisted portion of the population (individuals with low income and schooling).
Walter, Angela Wangari; Yuan, Yiyang; Cabral, Howard J
Mental illness in children increases the risk of developing mental health disorders in adulthood, and reduces physical and emotional well-being across the life course. The Mental Health Parity and Addiction Equity Act (MHPAEA, 2008) aimed to improve access to mental health treatment by requiring employer-sponsored health plans to include insurance coverage for behavioral health services. Investigators used IBM Watson/Truven Analytics MarketScan claims data (2007-2013) to examine: (1) the distribution of mental illness; (2) trends in utilization and out-of-pocket expenditures; and (3) the overall effect of the MHPAEA on mental health services utilization and out-of-pocket expenditures among privately-insured children aged 3 to 17 with mental health disorders. Multivariate Poisson regression and linear regression modeling techniques were used. Mental health services use for outpatient behavioral health therapy (BHT) was higher in the years after the implementation of the MHPAEA (2010-2013). Specifically, before the MHPAEA implementation, the annual total visits for BHT provided by mental health physicians were 17.1% lower and 2.5% lower for BHT by mental health professionals, compared to years when MHPAEA was in effect. Children covered by consumer-driven and high-deductible plans had significantly higher out-of-pocket expenditures for BHT compared to those enrolled PPOs. Our findings demonstrate increased mental health services use and higher out-of-pocket costs per outpatient visit after implementation of the MHPAEA. As consumer-driven and high-deductible health plans continue to grow, enrollees need to be cognizant of the impact of health insurance benefit designs on health services offered in these plans. Copyright © 2017 by the American Academy of Pediatrics.
Asbu, Eyob Zere; Masri, Maysoun Dimachkie; Kaissi, Amer
Since the declaration of the Millennium Development Goals (MDGs) in 1990, many countries of the Middle East and North Africa (MENA) region made some improvements in maternal and child health and in tackling communicable diseases. The transition to the global agenda of Sustainable Development Goals brings new opportunities for countries to move forward toward achieving progress for better health, well-being, and universal health coverage. This study provides a profile of health status and health financing approaches in the MENA region and their implications on universal health coverage. Time-series data on socioeconomics, health expenditures, and health outcomes were extracted from databases and reports of the World Health Organization, the World Bank and the United Nations Development Program and analyzed using Stata 12 statistical software. Countries were grouped according to the World Bank income categories. Descriptive statistics, tables and charts were used to analyze temporal changes and compare the key variables with global averages. Non-communicable diseases (NCDs) and injuries account for more than three quarters of the disability-adjusted life years in all but two lower middle-income countries (Sudan and Yemen). Prevalence of risk factors (raised blood glucose, raised blood pressure, obesity and smoking) is higher than global averages and counterparts by income group. Total health expenditure (THE) per capita in most of the countries falls short of global averages for countries under similar income category. Furthermore, growth rate of THE per capita has not kept pace with the growth rate of GDP per capita. Out-of-pocket spending (OOPS) in all but the high-income countries in the group exceeds the threshold for catastrophic spending implying that there is a high risk of households getting poorer as a result of paying for health care. The alarmingly high prevalence of NCDs and injuries and associated risk factors, health spending falling short of the GDP
Toda, Masahiro; Morimoto, Kanehisa; Fukuda, Sanae; Hayakawa, Kazuo
The relations between salivary variables, lifestyle and mental health status were investigated for 61 healthy female university students. The salivary secretion rates were significantly higher in the good lifestyle groups compared with the poor lifestyle groups. Among the 8 lifestyle items tested. “eating breakfast” and “mental stress” were significantly related to the salivary secretion rates. The present findings suggest that the acquisition of a good lifestyle is also very important from t...
Osondu, Chukwuemeka U; Aneni, Ehimen C; Valero-Elizondo, Javier; Salami, Joseph A; Rouseff, Maribeth; Das, Sankalp; Guzman, Henry; Younus, Adnan; Ogunmoroti, Oluseye; Feldman, Theodore; Agatston, Arthur S; Veledar, Emir; Katzen, Barry; Calitz, Chris; Sanchez, Eduardo; Lloyd-Jones, Donald M; Nasir, Khurram
To examine the association of favorable cardiovascular health (CVH) status with 1-year health care expenditures and resource utilization in a large health care employee population. Employees of Baptist Health South Florida participated in a health risk assessment from January 1 through September 30, 2014. Information on dietary patterns, physical activity, blood pressure, blood glucose level, total cholesterol level, and smoking were collected. Participants were categorized into CVH profiles using the American Heart Association's ideal CVH construct as optimal (6-7 metrics), moderate (3-5 metrics), and low (0-2 metrics). Two-part econometric models were used to analyze health care expenditures. Of 9097 participants (mean ± SD age, 42.7±12.1 years), 1054 (11.6%) had optimal, 6945 (76.3%) had moderate, and 1098 (12.1%) had low CVH profiles. The mean annual health care expenditures among those with a low CVH profile was $10,104 (95% CI, $8633-$11,576) compared with $5824 (95% CI, $5485-$6164) and $4282 (95% CI, $3639-$4926) in employees with moderate and optimal CVH profiles, respectively. In adjusted analyses, persons with optimal and moderate CVH had a $2021 (95% CI, -$3241 to -$801) and $940 (95% CI, -$1560 to $80) lower mean expenditure, respectively, than those with low CVH. This trend remained even after adjusting for demographic characteristics and comorbid conditions as well as across all demographic subgroups. Similarly, health care resource utilization was significantly lower in those with optimal CVH profiles compared with those with moderate or low CVH profiles. Favorable CVH profile is associated with significantly lower total medical expenditures and health care utilization in a large, young, ethnically diverse, and fully insured employee population. Copyright © 2017 Mayo Foundation for Medical Education and Research. Published by Elsevier Inc. All rights reserved.
Full Text Available Thalassemia major is a genetic blood disorder that is detected by the symptoms of chronic and severe anemia, enlarged liver and spleen, failure to thrive and bone deformities in particular deformed face and bulging forehead. Due to changes in physical appearance, the disease can influence on other aspects of the patient's life, so the disease can have a strong impact on the mental health of these patients and their families. Previous studies showed that 80% of patients with thalassemia major have at least one psychiatric disorder. The aim of this paper was to review the mental health status of patients with Beta-thalassemia major in Iran.
Mojica, Cynthia M; Flores, Bertha; Ketchum, Norma S; Liang, Yuanyuan
Cancer screening reduces mortality rates for breast, cervical, and colon cancer. Yet cancer screening rates for Latina women are lower than for non-Latino Whites, and below Healthy People 2020 goals. Additionally, Latinos face many health care access barriers. This study examined health care access and utilization in relation to cancer screening among low-income Latina women recruited from a high-risk area and enrolled in a navigation-plus-education intervention. Latina women considered rarely or never screened for breast, cervical, or colorectal cancer were recruited from community-based organizations and events (N = 691). We gathered self-reported survey data on insurance status, usual source of care, health care utilization, and cancer screening behavior. We conducted multivariable logistic regression models to estimate odds ratios of receipt of at least one cancer screening test. Overall, 28% of women received at least one cancer screening test. Results indicated that women without insurance (odds ratio [OR] = 2.08; confidence interval [CI] = 1.09, 3.98) and without a doctor's visit in the past year (OR = 2.02; CI = 1.28, 3.18), compared with their counterparts, had greater odds of receiving at least one screening test. Findings highlight the continued need to explore ways to support uninsured individuals' screening efforts and further investigate barriers among insured women who are not up-to-date with screenings.
Full Text Available Background: Maternal health care utilization continues to focus on the agenda of health care planners around the world, with high attention being paid to the developing countries. The devastating effect of maternal death at birth on the affected families is untold. This study examines the utilization of obstetric care in the Democratic Republic of Congo. Methods: We have used the nationally representative data from the 2007. Democratic Republic of Congo Demographic and Health Survey. Multilevel regression analysis has been applied to a nationally representative sample of 6,695 women, clustered around 299 communities in the country. Results: The results show that there are variations in the use of antenatal care and delivery care. Individual-level characteristics, such as women′s occupation and household wealth status are shown to be associated with the use of antenatal care. Uptake of facility-based delivery has been seen to be dependent on the household wealth status, women′s education, and partner′s education. The effect of the neighborhoods′ socioeconomic disadvantage on the use of antenatal care and facility-based delivery are the same. Women from highly socioeconomically disadvantaged communities, compared to their counterparts from less socioeconomically disadvantaged neighborhoods, are less likely to utilize both the antenatal services and healthcare facility for child delivery. The result of this study has shown that both individual and contextual socioeconomic status play an important role in obstetric care uptake. Conclusion: Thus, intervention aimed at improving the utilization of obstetrics care should target both the individual economic abilities of the women and that of their environment when considering the demand side.
Background: The assessment of oral health status of children in government and private schools provide data on the oral health status of children from different socio‑economic background. Aim: The aim of the following study is to assess and to compare the oral hygiene status, gingival status and caries experience between ...
Tucker, Larry A.; Clegg, Alan G.
Examined the relationship between lifestyle-related health risks and health care costs and utilization among young adults. Data collected at a primarily white collar worksite in over 2 years indicated that health risks, particularly obesity, stress, and general lifestyle, were significant predictors of health care costs and utilization among these…
Popejoy, Lori L; Jaddoo, Julie; Sherman, Jan; Howk, Christopher; Nguyen, Raymond; Parker, Jerry C
This initial article describes the development of a health care coordination intervention and documentation system designed using the Agency for Healthcare Research and Quality (AHRQ) Care Coordination Atlas framework for Centers for Medicare & Medicaid-funded innovation project, Leveraging Information Technology to Guide High-Tech, High-Touch Care (LIGHT). The study occurred at an academic medical center that serves 114 counties. Twenty-five registered nurse care managers (NCMs) were hired to work with 137 providers in 10 family community and internal medicine clinics. Patients were allocated into one of the four tiers on the basis of their chronic medical conditions and health care utilization. Using a documentation system on the basis of the AHRQ domains developed for this study, time and touch data were calculated for 8,593 Medicare, Medicaid, or dual-eligible patients. We discovered through the touch and time analysis that the majority of health care coordination activity occurred in the AHRQ domains of communication, assess needs and goals, and facilitate transitions, accounting for 79% of the NCM time and 61% of the touches. As expected, increasing tier levels resulted in increased use of NCM resources. Tier 3 accounted for roughly 16% of the patients and received 159 minutes/member (33% of total minutes), and Tier 4 accounted for 4% of patients and received 316 minutes/member (17% of all minutes). In contrast Tier 2, which did not require routine touches per protocol, had 5,507 patients (64%), and those patients received 5,246 hours of health care coordination, or 57 minutes/member, and took 48% of NCM time. 1. The AHRQ Care Coordination Atlas offered a systematic way to build a documentation system that allowed for the extraction of data that was used to calculate the amount of time and the number of touches that NCMs delivered per member. 2. Using a framework to systematically guide the work of health care coordination helped NCMs to think strategically
Gordon, Adam Lee; Franklin, Matthew; Bradshaw, Lucy; Logan, Pip; Elliott, Rachel; Gladman, John R F
UK care home residents are often poorly served by existing healthcare arrangements. Published descriptions of residents' health status have been limited by lack of detail and use of data derived from surveys drawn from social, rather than health, care records. to describe in detail the health status and healthcare resource use of UK care home residents a 180-day longitudinal cohort study of 227 residents across 11 UK care homes, 5 nursing and 6 residential, selected to be representative for nursing/residential status and dementia registration. Barthel index (BI), Mini-mental state examination (MMSE), Neuropsychiatric index (NPI), Mini-nutritional index (MNA), EuroQoL-5D (EQ-5D), 12-item General Health Questionnaire (GHQ-12), diagnoses and medications were recorded at baseline and BI, NPI, GHQ-12 and EQ-5D at follow-up after 180 days. National Health Service (NHS) resource use data were collected from databases of local healthcare providers. out of a total of 323, 227 residents were recruited. The median BI was 9 (IQR: 2.5-15.5), MMSE 13 (4-22) and number of medications 8 (5.5-10.5). The mean number of diagnoses per resident was 6.2 (SD: 4). Thirty per cent were malnourished, 66% had evidence of behavioural disturbance. Residents had contact with the NHS on average once per month. residents from both residential and nursing settings are dependent, cognitively impaired, have mild frequent behavioural symptoms, multimorbidity, polypharmacy and frequently use NHS resources. Effective care for such a cohort requires broad expertise from multiple disciplines delivered in a co-ordinated and managed way.
Dickerson, Faith B.; Brown, Clayton H.; Daumit, Gail L.; LiJuan, Fang; Goldberg, Richard W.; Wohlheiter, Karen; Dixon, Lisa B.
We examined indices of the health of persons with serious mental illness. A sample of 100 adults with schizophrenia and 100 with major mood disorder were recruited from randomly selected outpatients who were receiving community-based psychiatric treatment. Participants were surveyed about health indicators using items from the National Health and Nutrition Examination Study III and the National Health Interview Survey. Their responses were compared with those of matched samples from the general population surveys. A total of 1% of persons with serious mental illness, compared with 10% from the general population sample, met criteria for all 5 of selected health indicators: nonsmoker, exercise that meets recommended standards, good dentition, absence of obesity, and absence of serious medical co-occurring illness. Within the mentally ill group, educational level, but not a diagnosis of schizophrenia versus mood disorder, was independently associated with a composite measure of health behaviors. We conclude that an examination of multiple health indicators may be used to measure overall health status in persons with serious mental illness. PMID:16469943
Samnieng, Patcharaphol; Ueno, Masayuki; Zaitsu, Takashi; Shinada, Kayoko; Wright, Fredrick A C; Kawaguchi, Yoko
This study aims to analyse the relationship between seven health practices, oral health behaviors, and oral health status in community dwelling elderly Thai. The subjects were 612 elderly people (mean age = 68.8 ± 5.9 years). Questionnaires survey about sociodemographics, self-reported seven health practices and oral health behaviors were conducted by trained interviewers. Oral examinations investigated the number of teeth present, decayed teeth, periodontal status and functional tooth units (FTUs). Oral malodor was assessed by Organoleptic Test, and unstimulated saliva was collected for 5 min. Five health practices (smoking, drinking, physical activity, breakfast and weight maintenance) were significantly related with oral health behaviors. ancova analysis demonstrated the following significant associations: (i) smoking behavior with number of teeth present, number of FTUs, decayed teeth, periodontal disease, oral malodor and salivary flow rate, (ii) drinking alcohol behavior with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (iii) eating breakfast behavior with periodontal disease, oral malodor and salivary flow rate, (iv) eating between-meal snack with number of teeth present, number of FTUs, decayed teeth and periodontal disease, (v) maintaining weight with number of teeth present, number of FTUs, periodontal disease and oral malodor, (vi) sleeping with number of teeth present, number of FTUs, periodontal disease, oral malodor and salivary flow rate, (vii) physical activity with periodontal disease and salivary flow rate. Good health practices were related with good oral health behaviors. Moreover, general health practices were associated with the clinical oral health status such as number of teeth present, decayed teeth, FTUs, periodontal disease, oral malodor and salivary flow rate. The elderly with good general health practices were considered to have good oral health status. Improving general health
Storgaard, Filip Holst; Pedersen, Christina Gravgaard; Jensen, Majbritt Lykke
Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome.......Physiotherapy improves patient reported shoulder function and health status in patients with subacromial impingement syndrome....
Sanchón-Macias, Ma Visitación; Bover-Bover, Andreu; Prieto-Salceda, Dolores; Paz-Zulueta, María; Torres, Blanca; Gastaldo, Denise
This qualitative study was carried out to better understand factors that determine the subjective social status of Latin Americans in Spain. The study was conducted following a theoretical framework and forms part of broader study on subjective social status and health. Ten immigrant participants engaged in semi-structured interviews, from which data were collected. The study results show that socioeconomic aspects of the crisis and of policies adopted have shaped immigrant living conditions in Spain. Four major themes that emerged from the analysis were related to non-recognition of educational credentials, precarious working conditions, unemployment and loneliness. These results illustrate the outcomes of current policies on health and suggest a need for health professionals to orient practices toward social determinants, thus utilizing evaluations of subjective social status to reduce inequalities in health.
Waweru, Catherine; Steenrod, Anna; Wolff, Claudia; Eggington, Simon; Wright, David Jay; Wyrwich, Kathleen W
To estimate health resource utilization (HRU) associated with the management of pacemaker complications in various healthcare systems. Electrophysiologists (EPs) from four geographical regions (Western Europe, Australia, Japan, and North America) were invited to participate. Survey questions focused on HRU in the management of three chronic pacemaker complications (i.e. pacemaker infections requiring extraction, lead fractures/insulation breaches requiring replacement, and upper extremity deep venous thrombosis [DVT]). Panelists completed a maximum of two web-based surveys (iterative rounds). Mean, median values, and interquartile ranges were calculated and used to establish consensus. Overall, 32 and 29 panelists participated in the first and second rounds of the Delphi panel, respectively. Consensus was reached on treatment and HRU associated with a typical pacemaker implantation and complications. HRU was similar across regions, except for Japan, where panelists reported the longest duration of hospital stay in all scenarios. Infections were the most resource-intensive complications and were characterized by intravenous antibiotics days of 9.6?13.5 days and 21.3?29.2 days for pocket and lead infections respectively; laboratory and diagnostic tests, and system extraction and replacement procedures. DVT, on the other hand, was the least resource intensive complication. The results of the panel represent the views of the respondents who participated and may not be generalizable outside of this panel. The surveys were limited in scope and, therefore, did not include questions on management of acute complications (e.g. hematoma, pneumothorax). The Delphi technique provided a reliable and efficient approach to estimating resource utilization associated with chronic pacemaker complications. Estimates from the Delphi panel can be used to generate costs of pacemaker complications in various regions.
Yu, M Y; Sarri, R
This paper examines the health status of women in China by reviewing levels and trends of female mortality at several phases of a woman's life cycle focusing on infancy girlhood, childbearing and old age. The mortality rates of Chinese women and men are compared for the period 1950-1990 as are comparisons with women in selected countries. The cause-specific death rate, expressed as a percentage of all deaths, and the burden of disease, measured in terms of the disability-adjusted life years (DALYs), are used to reflect the changing patterns of female diseases and causes of deaths. Significant improvement in the health status of Chinese women since 1950 is widely acknowledged as a major achievement for a developing country with the largest population in the world, but the differentials in women's health by region and urban/rural areas are considerable. The Physical Quality of Life Index (PQLI) indicates that the overall level of physical well-being of Chinese women has increased in recent decades, but disparity in health between men and women still exists. The Gender-Related Development Index (GDI) further reveals that China has achieved significant progress in women's health during the past four decades, but far less has been achieved with respect to gender equality overall. The final sections of the paper focus on the discussion of some health problems faced by the female population during the process of economic reform since the 1980 s. In order to promote gender equality between women and men, concerns on women's health care needs are highlighted.
Xiao, Roy; Miller, Jacob A; Zafirau, William J; Gorodeski, Eiran Z; Young, James B
As healthcare costs rise, home health care represents an opportunity to reduce preventable adverse events and costs following hospital discharge. No studies have investigated the utility of home health care within the context of a large and diverse patient population. A retrospective cohort study was conducted between 1/1/2013 and 6/30/2015 at a single tertiary care institution to assess healthcare utilization after discharge with home health care. Control patients discharged with "self-care" were matched by propensity score to home health care patients. The primary outcome was total healthcare costs in the 365-day post-discharge period. Secondary outcomes included follow-up readmission and death. Multivariable linear and Cox proportional hazards regression were used to adjust for covariates. Among 64,541 total patients, 11,266 controls were matched to 6,363 home health care patients across 11 disease-based Institutes. During the 365-day post-discharge period, home health care was associated with a mean unadjusted savings of $15,233 per patient, or $6,433 after adjusting for covariates (p Home health care independently decreased the hazard of follow-up readmission (HR 0.82, p home health care most benefited patients discharged from the Digestive Disease (death HR 0.72, p home health care was associated with significant reduction in healthcare utilization and decreased hazard of readmission and death. These data inform development of value-based care plans. Copyright © 2018 Elsevier Inc. All rights reserved.
Thorium has gained substantial attention as a potential energy source that could rival and eventually replace fossil fuels as humanity's primary energy source. This could not have come at a more opportune time as concerns about global climate change from CO 2 emissions and the approaching spectre of finite fossil fuel resources create serious challenges for the continuation of our advanced industrial societies, which are reliant on readily available and affordable energy. Thorium also potentially represents the catalyst with which the nuclear industry could reinvent itself and finally gain widespread public acceptance. There are many opinions on how to utilize thorium as a fuel, but the question of what constitutes an 'ideal' pathway has mostly been under-emphasized. Many specific characteristics of the thorium fuel cycle can differ significantly depending on the conditions and methodologies of utilization; characteristics such as safety, efficiency, waste profile and volume, and fissile protection can vary greatly according to reactor design and utilization philosophy. With thorium, we have been given an opportunity to start over, a blank slate. Therefore, in imagining the 'Thorium Economy' to come, it behoves the scientific and engineering communities to consider the most 'elegant' solution physically possible-what constitutes the 'ideal' and is it possible to reconcile it with what is both economically and technically practical? The characteristics desired of an 'ideal' nuclear reactor, in the areas of safety, efficiency, economy, and sustainability, and the 5 key design choices that could enable such a reactor will be discussed. This will be followed by an overview of the Liquid Fluoride Thorium Reactor, a 2-fluid Molten Salt Reactor currently under development by Flibe Energy in the United States. LFTR is a direct descendant of the MSRE, which was developed at Oak Ridge National Laboratory (ORNL) in the
Galvin Alaan Galeon
Full Text Available Background: Between the school years of 2009-2012, the turnover record of the University of San Jose-Recoletos (USJ-R, Cebu City, Philippines showed that permanent faculty members who left the institution were all midlifers. Their reasons varied from health issues to greener pasture elsewhere. Materials and Methods: This study then sought to explore the health statuses of the faculty midlifers of the USJ-R. The data were collected through survey conducted among the 106 faculty midlifers of the university. This study applied multivariate analyses to the survey data using Pearson-moment of correlation to determine the relationship between the sociodemographic profile of the research participants and their health statuses. Results: This research revealed that faculty midlifers are generally well physically. They showed emotional maturity and have positive outlook toward midlife. More so, their health conditions are significantly related with their sex, age, years of teaching, educational attainment, and income. Conclusion: At midlife, the faculty members of USJ-R can still generally be considered physically well. Thus, if they are well-managed, they can become relevant and better contributors to the attainment of the basic goals and objectives of the educational institution and the educational system in general.
Nguyen Nhi Dien; Le Van So
The Dalat Nuclear Research Reactor (DNRR) is a 500 kW swimming pool type reactor using the Soviet WWR-SM fuel assembly with 36% enrichment of U-235. It was upgraded from the USA 250 kW TRIGA Mark-II reactor. The first criticality of the renovated reactor was in November 1983 and its regular operation at nominal power of 500 kW has been since March 1984. The DNRR is operated mainly in continuous runs of 100 hrs, once every 4 weeks, for radioisotope production, neutron activation analyses and research purposes. The remaining time between two continuous runs is devoted to maintenance activities and also to short run for physics experiments and training purpose. From the first start-up to the end of December 2002, it totaled about 24,700 hrs of operation and the total energy released was 490 MWd. After 10 years of operation with the core of 89-fuel assembly configuration, in April 1994, the first refueling work was done and the 100-fuel assembly configuration was set-up. The second fuel reloading was executed in March 2002. At present time, the working configuration of the reactor core consists of 104 fuel assemblies. This fuel reloading will ensure efficient exploitation of the reactor for about 3 years with 1200-1300 hrs per year at nominal power. The current status of operation and utilization and some activities related to the reactor core management of the DNRR are presented and discussed in this paper. (author)
Nguyen Nhi Dien
The Dalat Nuclear Research Reactor (DNRR) is a 500 kW pool-type reactor using the Soviet VVR-M2 fuel assembly with 36% enrichment of U-235. It was renovated and upgraded from the USA 250 kW TRIGA Mark-II reactor. The first criticality of the renovated reactor was in November 1983 and its regular operation at nominal power of 500 kW has been since March 1984. The DNRR is operated mainly in continuous runs of 100 hrs, once every 4 weeks, for radioisotope production, neutron activation analysis, scientific research and training. The remaining time between two continuous runs is devoted to maintenance activities and also to short run for reactor physics and thermal hydraulics experiments. From the first start-up to the end of December 2003, it totaled about 26,000 hrs of operation and the total energy released was about 515 MWd. After 10 years of operation with the core of 89-fuel assembly configuration, in April 1994, the first refueling work was done and the 100-fuel assembly configuration was set-up. The second fuel reloading was executed in March 2002. At present time, the working configuration of the reactor core consists of 104 fuel assemblies. The next fuel reloading has been planned at the end of 2004. The current status of operation and utilization of the DNRR is presented and discussed in this paper. (author)
Momsen, Anne-Mette H.; Stapelfeldt, Christina Malmose; Nielsen, Claus Vinther
) and odds ratio (OR) were used as measures of associations. Results were adjusted for gender, age, educational level, work ability and previous sick leave. Results: Among all responders we found no effect of the intervention on RTW. Among participants with low health anxiety, the one-year probability of RTW......Background: The aim of the RCT study was to investigate if the effect of a multidisciplinary intervention on return to work (RTW) and health care utilization differed by participants’ self-reported health status at baseline, defined by a) level of somatic symptoms, b) health anxiety and c) self......-reported general health. Methods: A total of 443 individuals were randomized to the intervention (n = 301) or the control group (n = 142) and responded to a questionnaire measuring health status at baseline. Participants were followed in registries measuring RTW and health care utilization. Relative risk (RR...
P, Basavaraj; Singla, Ashish; Kote, Sunder; Singh, Shilpi; Jain, Swati; Singh, Khushboo; Vashishtha, Vaibhav
Introduction: Violence against women is one of the major public health and human rights problem in the world today. Hence, the present study was conducted with the aim to assess the effect of domestic violence on oral health behavior and oral health status of females attending community outreach programmes in and around Modinagar. Materials and Methods: A cross-sectional study was conducted through the community outreach programmes organized in Modinagar. A structured questionnaire was used to illicit information regarding socio demographic characteristics, oral health behavior and domestic violence. The dental health examination was done to record dental health status, intraoral and extraoral soft tissue injury, tooth fracture and tooth avulsion due to the injury. Results: Out of the total 304 women, 204(67.1%) reported positive domestic violence. Psychological violence was found to be severe whereas sexual violence was found to be mild in most of the cases. Significant difference was found between oral hygiene aids used , frequency of tooth brushing, periodontal status, missing teeth, intraoral soft tissue injuries and fractures between both the groups (p<0.05). Conclusion: The present study confirmed that domestic violence had significant influence on oral health behavior and oral health status of women. Thus, the dental professionals also should make an attempt to help victims gain access to support and referral services and to provide adequate treatment to them so as to make a positive difference in their lives. PMID:25584297
Bozorgmehr, Elham; Hajizamani, Abolghasem; Malek Mohammadi, Tayebeh
Introduction. It is widely acknowledged that the behavior of parents affects their children's health. This study aimed to evaluate the relationship between oral health behavior of parents and oral health status and behavior of their children in a sample of preschool children in Iran. Method and Material. A random sample of over-five-year-old preschool children and their parents were enrolled in the study. Selection of schools was by clustering method. Parents were asked to fill a piloted questionnaire which included demographic characteristics, socioeconomic status, oral health behaviors of children and their parents. Oral health status of children was examined. The parent and their children oral health relationship were tested using regression and correlation analysis. Results. About 222 parents and children participated in the study. There was a significant relationship between history of having dental problems in parents and dmft index in their children (P = 0.01). There was a significant relationship between parental frequency of tooth brushing and child frequency of tooth brushing (P = 0.05); however, there was no significant relationship between parental frequency of dental visits and those of their children (P = 0.1). Conclusion. The study concluded that some important health behaviors in parents, such as tooth brushing habits are important determinants of these behaviors in their young children. So promoting parent knowledge and attitude could affect their children oral health behavior and status.
Lee, Jae Eun; Fos, Peter J; Zuniga, Miguel A; Kastl, Peter R; Sung, Jung Hye
This study was conducted to assess the presence and/or absence of cross-cultural differences or similarities between Korean and United States cataract patients. A systematic assessment was performed using utility and psychometric measures in the study population. A cross-sectional study design was used to examine the comparison of preoperative outcomes measures in cataract patients in Korea and the United States. Study subjects were selected using non-probabilistic methods and included 132 patients scheduled for cataract surgery in one eye. Subjects were adult cataract patients at Samsung and Kunyang General Hospital in Seoul, Korea, and Tulane University Hospital and Clinics in New Orleans, Louisiana. Preoperative utility was assessed using the verbal rating scale and standard reference gamble techniques. Current preoperative health status was assessed using the SF-36 and VF-14 surveys. Current preoperative Snellen visual acuity was used as a clinical measure of vision status. Korean patients were more likely to be younger (p = 0.001), less educated (p = 0.001), and to have worse Snellen visual acuity (p = 0.002) than United States patients. Multivariate analysis of variance (MANOVA) revealed that in contrast to Korean patients, United States patients were assessed to have higher scoring in general health, vitality, VF-14, and verbal rating for visual health. This higher scoring trend persisted after controlling for age, gender, education and Snellen visual acuity. The difference in health-related quality of life (HRQOL) between the two countries was quite clear, especially in the older age and highly educated group. Subjects in Korea and the United States were significantly different in quality of life, functional status and clinical outcomes. Subjects in the United States had more favorable health outcomes than those in Korea. These differences may be caused by multiple factors, including country-specific differences in economic status, health care system
Conclusions: The results of the currents study suggested that the cirrhosis status has had the most negative effect on patients, and that patients had a lower utility rate than their family members and caretakers.
Young, Rosalie F.; And Others
Interviews were conducted with refugees from Poland, Rumania, Iraq, and Vietnam to assess their health care utilization and health service use barriers. The results showed good overall health. The areas of greatest need were dental health, prenatal care, and mental health. Language was a barrier to health service utilization. (VM)
Oliveira, Paula; Costa, Maria Emilía
This study examined associations between adult attachment dimensions, perceived health status and worrying (coping strategy with chronic pain), and explored whether worrying mediated observed relationships between attachment dimensions and health outcomes within a sample of 128 Portuguese female fibromyalgia patients. Physical health status was inversely correlated with dependence and worrying; mental health status was positively correlated with trust, and inversely related to attachment-related ambivalence, dependence and worrying. Finally, worrying mediated relationships between dependence and both physical and mental health status; moreover, worrying partially mediated the relationship between ambivalence and mental health status. Implications of the findings are discussed.
Parker, R David; Dykema, Shana
This cross-sectional pilot project measured differences by HIV status in chronic health conditions, primary care and emergency department use, and high-risk behaviors of homeless persons through self-report. Using selective random sampling, 244 individuals were recruited from a homeless shelter. The reported HIV prevalence was 6.56% (n = 16), with the odds of HIV higher in persons reporting crack cocaine use. HIV-infected persons were more likely to report a source of regular medical care and less likely to use the emergency department than uninfected persons. Validation of findings through exploration of HIV and health care access in homeless persons is needed to confirm that HIV-infected homeless persons are more likely to have primary care. Distinctions between primary care and specialty HIV care also need to be explored in this context. If findings are consistent, providers who care for the homeless could learn more effective ways to engage homeless patients. Copyright © 2014 Association of Nurses in AIDS Care. Published by Elsevier Inc. All rights reserved.
Murata, Chiyoe; Kondo, Takaaki; Tamakoshi, Koji; Yatsuya, Hiroshi; Toyoshima, Hideaki
The purpose of this study was to investigate factors related to self-rated health and to mortality among 2490 community-living elderly. Respondents were followed for 7.3 years for all-cause mortality. To compare the relative impact of each variable, we employed logistic regression analysis for self-rated health and Cox hazard analysis for mortality. Cox analysis stratified by gender, follow-up periods, age group, and functional status was also employed. Series of analysis found that factors associated with self-rated health and with mortality were not identical. Psychological factors such as perceived isolation at home or 'ikigai (one aspect of psychological well-being)' were associated with self-rated health only. Age, functional status, and social relations were associated both with self-rated health and mortality after controlling for possible confounders. Illnesses and functional status accounted for 35-40% of variances in the fair/poor self-rated health. Differences by gender and functional status were observed in the factors related to self-rated health. Overall, self-rated health effect on mortality was stronger for people with no functional impairment, for shorter follow-up period, and for young-old age group. Although, illnesses and functional status were major determinants of self-rated health, economical, psychological, and social factors were also related to self-rated health.
Wilke, Sarah; Jones, Paul W; Müllerova, H
BACKGROUND: Poor health status has been associated with morbidity and mortality in patients with COPD. To date, the impact of changes in health status on these outcomes remains unknown. AIMS: To explore the relationship of clinically relevant changes in health status with exacerbation, hospitalis...
Full Text Available The article highlights the new data on the prevalence and structure of the children's disablement in the Russian federation. Among the causes of the children's disablement, the authors mark dominance of the infectious and somatic diseases, neuropathies, mental diseases and congenital growth anomalies, in particular. They show the role of medical and biological, social and hygienic, medical and organizational and economical factors, defining the health formation and conducing to the children's incapacitation. The researchers characterize the health status of the disabled children in respect of the major indices: physical and neuropsychic growth, psychological personality peculiarities, sickness rate and quality of life. The article depicts many issues, arising within the family of an incapacitated child.Key words: disablement, children, prevalence, structure, causes, health indices.
Wang, Tian; Chen, Jieyu; Sun, Xiaomin; Xiang, Lei; Zhou, Lin; Li, Fei; Lin, Changsong; Jiang, Pingping; Wu, Shengwei; Xiao, Ya; Cheng, Jingru; Luo, Ren; Liu, Yanyan; Zhao, Xiaoshan
To explore the effects of traditional Chinese medicine constitution (TCMC) on transformation of good health status to suboptimal health status (SHS), we conducted a nested case-control study among college students in China. During the 18-month mean follow-up time, 543 cases of SHS (42.7%) occurred in 1273 healthy students. There was a significant (P = 0.000) and marked reduction in SHMS V1.0 total score in the case group at the 18-month follow-up (69.32 ± 5.45) compared with baseline (78.60 ± 4.70), but there was no significant change in the control group. Conditional logistic regression analysis showed that respondents reporting Yin-deficiency and Qi-deficiency were, respectively, 2.247 and 2.198 times more likely to develop SHS, while tendency to Yin-deficiency and tendency to Damp-heat were, respectively, 1.642 and 1.506 times more likely to develop SHS. However, the Balanced Constitution was a significant protective factor (OR 0.649; P < 0.05). Altogether, these findings demonstrate that Yin-deficiency, Qi-deficiency, tendency to Yin-deficiency, and tendency to Damp-heat appeared to induce a change in health status to SHS, while the Balanced Constitution seemed to restrain this change. We conclude that regulating the unbalanced TCMC (such as Yin-deficiency and Qi-deficiency) may prevent a healthy status developing into SHS or lead to the regression of SHS. PMID:26346320
Full Text Available To explore the effects of traditional Chinese medicine constitution (TCMC on transformation of good health status to suboptimal health status (SHS, we conducted a nested case-control study among college students in China. During the 18-month mean follow-up time, 543 cases of SHS (42.7% occurred in 1273 healthy students. There was a significant (P=0.000 and marked reduction in SHMS V1.0 total score in the case group at the 18-month follow-up (69.32 ± 5.45 compared with baseline (78.60 ± 4.70, but there was no significant change in the control group. Conditional logistic regression analysis showed that respondents reporting Yin-deficiency and Qi-deficiency were, respectively, 2.247 and 2.198 times more likely to develop SHS, while tendency to Yin-deficiency and tendency to Damp-heat were, respectively, 1.642 and 1.506 times more likely to develop SHS. However, the Balanced Constitution was a significant protective factor (OR 0.649; P<0.05. Altogether, these findings demonstrate that Yin-deficiency, Qi-deficiency, tendency to Yin-deficiency, and tendency to Damp-heat appeared to induce a change in health status to SHS, while the Balanced Constitution seemed to restrain this change. We conclude that regulating the unbalanced TCMC (such as Yin-deficiency and Qi-deficiency may prevent a healthy status developing into SHS or lead to the regression of SHS.
Full Text Available This study seeks to understand distance from health facilities as a barrier to maternal and child health service uptake within a rural Liberian population. Better understanding the relationship between distance from health facilities and rural health care utilization is important for post–Ebola health systems reconstruction and for general rural health system planning in sub–Saharan Africa.
Percheski, Christine; Bzostek, Sharon
Objectives To estimate the impacts of public health insurance coverage on health care utilization and unmet health care needs for children in immigrant families. Methods We use survey data from National Health Interview Survey (NHIS) (2001-2005) linked to data from Medical Expenditures Panel Survey (MEPS) (2003-2007) for children with siblings in families headed by at least one immigrant parent. We use logit models with family fixed effects. Results Compared to their siblings with public insurance, uninsured children in immigrant families have higher odds of having no usual source of care, having no health care visits in a 2 year period, having high Emergency Department reliance, and having unmet health care needs. We find no statistically significant difference in the odds of having annual well-child visits. Conclusions for practice Previous research may have underestimated the impact of public health insurance for children in immigrant families. Children in immigrant families would likely benefit considerably from expansions of public health insurance eligibility to cover all children, including children without citizenship. Immigrant families that include both insured and uninsured children may benefit from additional referral and outreach efforts from health care providers to ensure that uninsured children have the same access to health care as their publicly-insured siblings.
McHugh, Joanna Edel; Lawlor, Brian A
Perceived health status does not always reflect actual health status. We investigated the association between objective and self-rated measures of health status and hours of exercise per week in older adults. As part of the TRIL clinic assessment, we gathered information from 473 community dwelling adults over the age of 65, regarding hours spent per week exercising, depression, personality, perceived health status, and objective health status (in the form of a comorbidity count). Regression analyses were performed on these data to investigate whether perceived health status, objective health status, personality and mood are associated with hours of exercise per week. Perceived and objective health status were significantly but weakly correlated. Both perceived and objective health status, as well as depression, were independently associated with hours of exercise per week. We conclude that exercise uptake in older adults is contingent on both perceived and objective health status, as well as depression. Perceived health status has a stronger association with exercise uptake in older adults with lower depression levels. The current findings have implications for designing exercise interventions for older adults.
Prinja, Shankar; Chauhan, Akashdeep Singh; Karan, Anup; Kaur, Gunjeet; Kumar, Rajesh
Several publicly financed health insurance schemes have been launched in India with the aim of providing universalizing health coverage (UHC). In this paper, we report the impact of publicly financed health insurance schemes on health service utilization, out-of-pocket (OOP) expenditure, financial risk protection and health status. Empirical research studies focussing on the impact or evaluation of publicly financed health insurance schemes in India were searched on PubMed, Google scholar, Ovid, Scopus, Embase and relevant websites. The studies were selected based on two stage screening PRISMA guidelines in which two researchers independently assessed the suitability and quality of the studies. The studies included in the review were divided into two groups i.e., with and without a comparison group. To assess the impact on utilization, OOP expenditure and health indicators, only the studies with a comparison group were reviewed. Out of 1265 articles screened after initial search, 43 studies were found eligible and reviewed in full text, finally yielding 14 studies which had a comparator group in their evaluation design. All the studies (n-7) focussing on utilization showed a positive effect in terms of increase in the consumption of health services with introduction of health insurance. About 70% studies (n-5) studies with a strong design and assessing financial risk protection showed no impact in reduction of OOP expenditures, while remaining 30% of evaluations (n-2), which particularly evaluated state sponsored health insurance schemes, reported a decline in OOP expenditure among the enrolled households. One study which evaluated impact on health outcome showed reduction in mortality among enrolled as compared to non-enrolled households, from conditions covered by the insurance scheme. While utilization of healthcare did improve among those enrolled in the scheme, there is no clear evidence yet to suggest that these have resulted in reduced OOP expenditures or
Full Text Available Introduction: Few studies have evaluated the impact of depression in terms of losses to both premature mortality and health-related quality of life (HRQOL on the overall population. Health-adjusted life expectancy (HALE is a summary measure of population health that combines both morbidity and mortality into a single summary statistic that describes the current health status of a population. Methods: We estimated HALE for the Canadian adult population according to depression status. National Population Health Survey (NPHS participants 20 years and older (n = 12 373 were followed for mortality outcomes from 1994 to 2009, based on depression status. Depression was defined as having likely experienced a major depressive episode in the previous year as measured by the Composite International Diagnostic Interview Short Form. Life expectancy was estimated by building period abridged life tables by sex and depression status using the relative risks of mortality from the NPHS and mortality data from the Canadian Chronic Disease Surveillance System (2007-2009. The Canadian Community Health Survey (2009/10 provided estimates of depression prevalence and Health Utilities Index as a measure of HRQOL. Using the combined mortality, depression prevalence and HRQOL estimates, HALE was estimated for the adult population according to depression status and by sex. Results: For the population of women with a recent major depressive episode, HALE at 20 years of age was 42.0 years (95% CI: 40.2-43.8 compared to 57.0 years (95% CI: 56.8-57.2 for women without a recent major depressive episode. For the population of Canadian men, HALE at 20 was 39.0 years (95% CI: 36.5-41.5 for those with a recent major depressive episode compared to 53.8 years (95% CI: 53.6-54.0 for those without. For the 15.0-year difference in HALE between women with and without depression, 12.3 years can be attributed to the HRQOL gap and the remaining 2.7 years to the mortality gap. The 14.8 fewer
Bozorgmehr, Elham; Hajizamani, Abolghasem; Malek Mohammadi, Tayebeh
Introduction. It is widely acknowledged that the behavior of parents affects their children's health. This study aimed to evaluate the relationship between oral health behavior of parents and oral health status and behavior of their children in a sample of preschool children in Iran. Method and Material. A random sample of over-five-year-old preschool children and their parents were enrolled in the study. Selection of schools was by clustering method. Parents were asked to fill a piloted ques...
García-Moya, Irene; Morgan, Antony
Twenty years have passed since the publication of the seminal paper 'The salutogenic model as a theory to guide health promotion' (Health Promot Int 1996;11:11-18.), in which Antonovsky proposed salutogenesis and its central construct sense of coherence as a way of boosting the theoretical basis for health promotion activities. Since then there has been a notable amount of conceptual and empirical work carried out to further explore its significance. The aim of this paper is to critically assess the current theoretical status of salutogenesis and its utility to advance effective health promotion practice for young people. The assessment was carried out in the context of contemporary international policy agendas on well-being. An analytic framework was developed using the previous literature on the definition and function of theory. This organizing framework comprised four criteria: description, explanation, prediction and measurability. The paper concludes with a perspective on the status of salutogenesis as a theory and how it can be further developed. Specifically, the critical assessment highlighted that salutogenesis has been subjected to considerable empirical testing over the last few decades resulting in convincing evidence of the relevance and subsequent advancement of the idea. However, less emphasis seems to have been placed on a systematic process of testing and iteration to develop its theoretical basis. The paper identifies a number of aspects that should be developed to support the progression of salutogenesis to the next level. A research-practice cycle approach is proposed that can facilitate that important next step. © The Author 2016. Published by Oxford University Press. All rights reserved. For Permissions, please email: firstname.lastname@example.org.
Full Text Available Abstract Background New pharmacological therapies are challenging the healthcare systems, and there is an increasing need to assess their therapeutic value in relation to existing alternatives as well as their potential budget impact. Consequently, new models to introduce drugs in healthcare are urgently needed. In the metropolitan health region of Stockholm, Sweden, a model has been developed including early warning (horizon scanning, forecasting of drug utilization and expenditure, critical drug evaluation as well as structured programs for the introduction and follow-up of new drugs. The aim of this paper is to present the forecasting model and the predicted growth in all therapeutic areas in 2010 and 2011. Methods Linear regression analysis was applied to aggregate sales data on hospital sales and dispensed drugs in ambulatory care, including both reimbursed expenditure and patient co-payment. The linear regression was applied on each pharmacological group based on four observations 2006-2009, and the crude predictions estimated for the coming two years 2010-2011. The crude predictions were then adjusted for factors likely to increase or decrease future utilization and expenditure, such as patent expiries, new drugs to be launched or new guidelines from national bodies or the regional Drug and Therapeutics Committee. The assessment included a close collaboration with clinical, clinical pharmacological and pharmaceutical experts from the regional Drug and Therapeutics Committee. Results The annual increase in total expenditure for prescription and hospital drugs was predicted to be 2.0% in 2010 and 4.0% in 2011. Expenditures will increase in most therapeutic areas, but most predominantly for antineoplastic and immune modulating agents as well as drugs for the nervous system, infectious diseases, and blood and blood-forming organs. Conclusions The utilisation and expenditure of drugs is difficult to forecast due to uncertainties about the rate
Full Text Available To analyze the relationship of nutritional status with oral health status among visual impairment. The subjects were 146 elderly people (70 males and 76 females aged 20-72 years (mean 48.8±6.2 years, Phitsanulok, Thailand. Mini Nutritional Assessment (MNA questionnaires were administered. Oral examinations investigated the number of present teeth, DMFT and Functional Tooth Units (FTUs. According to the MNA score, 44.5% of subjects were categorized as normal nutrition, 47.3% as questionable, and 8.2 % as malnutrition. The mean numbers of present teeth and FTUs were 17.8±6.9 and 6.9±3.2, respectively. Subjects with malnutrition had lower numbers of present teeth (10.7±1.4 and FTUs (4.3±1.7 than those with normal nutrition (20.2±0.7 and 12.3±0.5 (p≤0.05. Nutritional status of visual impaired Thai was associated with mean numbers of present teeth and FTUs. Keeping many natural teeth or having appropriate numbers of FTUs by replacing missing teeth with dentures would prevention malnutrition.
Dey, Michelle; Wang, Jen; Jorm, Anthony Francis; Mohler-Kuo, Meichun
To compare children with mental and physical health problems regarding (1) perceived disease severity; (2) the impact of their condition on their families; (3) their utilization of health care services (including satisfaction with care); and (4) parents' health literacy about their child's condition and its treatment. Furthermore, we examined whether parents' health literacy differs between types of mental health condition. Parental reports about their 9- to 14-year-old children with mental (n = 785) or physical health problems (n = 475) were analyzed from the population-based National Survey of Children with Special Health Care Needs in Switzerland. Mental health problems were perceived as being more severe (p mental health problem mentioned having a particular person or place to contact if they needed information or advice regarding the child's condition (p = 0.004) and were satisfied with the health care services their child received (p mental health problems vs. parents of children with physical health problems (OR in the adjusted model = 1.92; 95 % CI 1.47-2.50; p mental health problem (although only a trend was observable for internalizing problems). The large impact of children's mental health conditions on themselves and their families might be reduced by adapting the provision of health care and by increasing parents' health literacy.
Wang, Qing; Zhang, Huyang; Rizzo, John A; Fang, Hai
Childhood health in China was poor in the 1950s and 1960s because of limited nutrition. In the last three decades, China has distinguished itself through its tremendous economic growth and improvements in health and nutrition. However, prior to such growth, access to good nutrition was more variable, with potentially important implications, not only for childhood health, but also for adult health, because of its long-term effects lasting into adulthood. To shed light on these issues, this study examined the long-run association between childhood health and adult health outcomes among a middle-aged Chinese population and addresses the endogeneity of childhood health. A nationwide database from the 2011 China Health and Retirement Longitudinal Study (CHARLS) was employed. Three adult health outcomes variables were used: self-reported health status, cognition, and physical function. The local variation in grain production in the subjects' fetal period and the first 24 months following birth was employed as an instrument for childhood health in order to correct for its endogeneity. Childhood health recalled by the respondents was positively and significantly associated with their adult health outcomes in terms of self-reported health status, cognition, and physical function in single-equation estimates that did not correct for the endogeneity of childhood health. A good childhood health status increased the probabilities of good adult health, good adult cognitive function, and good adult physical function by 16% (95% CI: 13-18%), 13% (95% CI: 10-15%), and 14% (95% CI: 12-17%), respectively. After correcting for endogeneity, the estimated effects of good childhood health were consistent but stronger. We also studied the male and female populations separately, finding that the positive effects of childhood health on adult health were larger for males. In China, childhood health significantly affects adult health. This suggests that early interventions to promote
Chin, Luzy Siu-Hei; Chan, Joanne Chung-Yan
Objectives: This is an exploratory study to examine the relations among self-esteem, oral health behaviours and clinical oral health status in Chinese adults. In addition, gender differences in clinical oral health status and oral health behaviours were explored. Methods: Participants were 192 patients from a private dental clinic in Hong Kong…
Green, Jamie A; Mor, Maria K; Shields, Anne Marie; Sevick, Mary Ann; Arnold, Robert M; Palevsky, Paul M; Fine, Michael J; Weisbord, Steven D
Although limited health literacy is common in hemodialysis patients, its effects on clinical outcomes are not well understood. Observational study. 260 maintenance hemodialysis patients enrolled in a randomized clinical trial of symptom management strategies from January 2009 through April 2011. Limited health literacy. Dialysis adherence (missed and abbreviated treatments) and health resource utilization (emergency department visits and end-stage renal disease [ESRD]-related hospitalizations). We assessed health literacy using the Rapid Estimate of Adult Literacy in Medicine (REALM) and used negative binomial regression to analyze the independent associations of limited health literacy with dialysis adherence and health resource utilization over 12-24 months. 41 of 260 (16%) patients showed limited health literacy (REALM score, ≤60). There were 1,152 missed treatments, 5,127 abbreviated treatments, 552 emergency department visits, and 463 ESRD-related hospitalizations. Limited health literacy was associated independently with an increased incidence of missed dialysis treatments (missed, 0.6% vs 0.3%; adjusted incidence rate ratio [IRR], 2.14; 95% CI, 1.10-4.17), emergency department visits (annual visits, 1.7 vs 1.0; adjusted IRR, 1.37; 95% CI, 1.01-1.86), and hospitalizations related to ESRD (annual hospitalizations, 0.9 vs 0.5; adjusted IRR, 1.55; 95% CI, 1.03-2.34). Generalizability and potential for residual confounding. Patients receiving maintenance hemodialysis who have limited health literacy are more likely to miss dialysis treatments, use emergency care, and be hospitalized related to their kidney disease. These findings have important clinical practice and cost implications. Copyright © 2013 National Kidney Foundation, Inc. All rights reserved.
Kim, Kyoung Bae; Lee, Man Jae
Magnetic Resonance Imaging(MRI) is one of the most expensive and sophisticated diagnostic tool and has been hailed as the most exciting event in medical imaging 'since the introduction of X-rays', but a major disadvantage, high cost, is coming into focus especially in our country. To determine the status of distribution of MR imagers in Korea and to serve as a basic material for an efficient utilization of this imaging machine, a retrospective survey of nationwide and regional(3 hospitals in Pusan) installations was performed. The results were as follows: 1. As of April 30, 1991, a total of 33 MRI units(24 for superconducting, 6 for permanent and 3 for resistive units) were set up and operated. 91 % of the units were distributed in big cities with no one installation in 7 provinces among 12 provinces in our country. 85% of the units were imported. 2. Although 42.4% of the units were operated in Seoul, Taejeon had the best condition for the distribution of this imaging machine per population, hospital, and bed in Korea. 3. In Pusan: a) 5 units were operated with all superconducting magnet and medium magnetic field in type of machine. b) 80.1 % of the examinations were central nervous system (CNS). c) MRI examination occupied 1.4% of all radiographic examinations and the patients referred from other hospitals were composed of 23.4% of all patients. 4. The average days under operating of MRI unit a week in Pusan were higher(5.5) than that of Seoul(4.5), but the average number of examinations and hours a week and a day, respectively(33, 8.4), was less than that of Seoul(57, 12.9). 5. The patients with positive MRI findings in a hospital(B) in Pusan was 74.5 % on an average
Curtis, Randall; Baker, Judith; Riske, Brenda; Ullman, Megan; Niu, Xiaoli; Norton, Kristi; Lou, Mimi; Nichol, Michael B
Improvements in hemophilia care over the last several decades might lead to expectations of a near-normal quality of life for young adults with hemophilia. However, few published reports specifically examine health status indicators in this population. To remedy this knowledge gap, we examined the impact of hemophilia on physical and social functioning and quality of life among a national US cohort of 141 young men with hemophilia aged 18-34 years of age who received care at 10 geographically diverse, federally funded hemophilia treatment centers in 11 states between 2005 and 2013 and enrolled in the Hemophilia Utilization Group Studies. Indicators studied included educational achievement, employment status, insurance, health-related quality of life, and prevalence of the following comorbidities: pain, range of motion limitation, overweight/obesity, and viral status. The cohort was analyzed to compare those aged 18-24 to those aged 25-34 years. When compared to the general US adult population, this nationally representative cohort of young US adults with hemophilia experienced significant health and social burdens: more liver disease, joint damage, joint pain, and unemployment as well as lower high-school graduation rates. Nearly half were overweight or obese. Conversely, this cohort had higher levels of health insurance and equivalent mental health scores. While attention has typically focused on newborns, children, adolescents, and increasingly, on older persons with hemophilia, our findings suggest that a specific focus on young adults is warranted to determine the most effective interventions to improve health and functioning for this apparently vulnerable age group. © 2015 Wiley Periodicals, Inc.
Reuben, Cynthia A; Pastor, Patricia N
Past studies have shown that specific child conditions are associated with poor school outcomes. A national health survey with noncategorical measures of health and indicators of school functioning offers the opportunity to examine this association. To compare links between two health measures (children with special health care needs and general health status) and multiple school outcomes. The analysis was based on 59,440 children aged 6-17 years from the 2007 National Survey of Children's Health. Child health was assessed using the Children with Special Health Care Needs (CSHCN) screener and a question on general health status. CSHCN were classified by the complexity of their health care needs. Indicators of school functioning included special education use, many problem reports, repeated a grade, lack of school engagement, and many missed school days. Overall 22% of children were identified as CSHCN: 13% with more complex needs (C-CSHCN) and 9% with medication use only (CSHCN-RX). Approximately 17% of children were in less than optimal health. After controlling for a child's sociodemographic characteristics C-CSHCN had an increased risk of all of the negative school outcomes compared to children without SHCN, while CSHCN-RX had an increased risk of only one school outcome (many missed school days). Children in less than optimal health were at an increased risk of all negative school outcomes compared to children in optimal health. The CSHCN screener and health status question identify related, but distinct, groups of children with worse outcomes on the indicators of school functioning. Published by Elsevier Inc.
Khalaila, R N Rabia
Socioeconomic inequalities in health are well documented. Recently, researchers have shown interest in exploring the mechanisms by which measures of SES operate through it to impact SRH, such as material, psychosocial and behavioral factors. To examine the relationships between SES indicators and self-rated health (SRH); and to determine whether health behaviors and obesity mediate the association between SES indicators and SRH. A secondary analysis of data previously collected through the third survey of socioeconomic and health status of the Arab population in Israel, in which the SRH of 878 Arab-Israelis age 50 or older were analyzed using logistic regression. The results showed that higher education level and current employment in old age are associated with better SRH. However, neither subjective economic status nor family income was associated with SRH. Greater physical activity was found to be related to good\\very good SRH, while obesity was associated with less than good SRH. Finally, health behaviors (physical activity) and obesity were revealed as mediators between SES indicators (education and employment status) and SRH. The results highlight the importance of high education level and employment status in old age to reduce health inequalities. The findings also show that the relationship between SES and SRH can operate through behavioral mechanisms (i.e., physical activity) and their consequences (i.e., obesity), that can, however, be changed in old age.
Swan, J H; Benjamin, A E
Rapid increases in the size and costs of the home health market, unknown impacts of Medicare's DRG hospital reimbursement on the posthospital market, and general lack of knowledge about factors that explain interstate variation in home health utilization all suggest the importance of developing and testing models of Medicare home health use. This article proposes and tests a model of state home health utilization as a function of the nursing home market. This model proposes that home health u...
Gil-Montoya, J A; Subirá, C; Ramón, J M; González-Moles, M A
This study examines whether oral health-related quality of life (OHRQoL) is associated with malnutrition risk in the elderly. A cross-sectional study was designed using a representative sample of Spaniards over 65 years old. Data on sociodemographics and oral health status were gathered by interview and examination. Oral health-related quality of life was evaluated using the Geriatric Oral Health Assessment Index (GOHAI), and malnutrition risk using the Mini Nutritional Assessment (MNA). The final sample included 2,860 elderly, 41.7 percent males and 58.3 percent females, with a mean age of 73.7 +/- 6.8 years. Mean GOHAI score was 52.1 +/- 7.2, with 70.7 percent of the sample needing oral health care according to this index. The mean MNA score was 24.0 +/- 3.31; 3.5 percent of the elderly were malnourished, 31.5 percent were at risk of malnutrition, and 65.0 percent were considered adequately nourished. A strong association was found between mean GOHAI and MNA scores.
Wikman, Johan Michael; Nistrup, Anne; Vorup Petersen, Jacob
that the men in the floorball group improved in the SF-12 composite score for mental health, as well as the HADS subscales anxiety and depression, compared to the men in the petanque group. In addition, 21 interviews were conducted with a sample of the men engaged in floorball. According to the statements...... by many of the men as the main reason for their participation throughout the 12-week period. The statistical results and the interview findings suggest that participation in a ball game such as floorball has several benefits regarding health status, psychological health and social capital and in addition......This article presents the results of a multidisciplinary study which investigated the effects of a period with floorball training on health status, psychological health and social capital of older men. Thirty-nine untrained men aged 69.9 ± 0.6 (range: 65–76) were randomized into a group playing...
the determinants influencing women's use of public health facilities at the time they give birth. Results: Of .... due to distance between their places of abode and health care facilities ..... care: what works for safe motherhood: Bull World Health.
Nuclear power is recognized as a safe, reliable and competitive energy source in Japan as Japan's 55 nuclear power plants supply about a third of the country's electricity and contribute to the rise in her degree of self-sufficiency in primary energy supply from 4% to 17%. It is also a practical and effective mean to observe the promise of the Kyoto Protocol to reduce CO2 emissions into atmosphere. The development of nuclear science and engineering, on the other hand, contributes not only to the advancement of science and technology in various fields but also to the improvement of health and living standards of the people as well as to the industrial prosperity through the application of radiation to medical diagnosis, cancer treatment, insect pest control, production of semi-conductors, radial tiers, etc. Major goal of current nuclear energy policy in Japan is to enrich the basic measures that compose the basis for the utilization of nuclear energy technologies in civil society and encourage academia and industries to innovate themselves to grapple the challenge, while sustaining the share of nuclear power in electricity generation after the year 2030 at the level equal to or greater than the current level of 30-40% based on the strategy to recycle uranium and plutonium from nuclear spent fuels, in addition to the expansion of the use of radiation technologies. Major policy areas are the improvement of institutional and financial arrangements to promote safe and effective utilization of nuclear energy technology including radiation technologies, the promotion of effective and efficient research and development activities, and the promotion of bilateral and multilateral cooperative activities necessary and or useful for facilitating these activities, in addition to nurturing the international political and institutional environment suitable for the sound promotion of nuclear energy utilization in the world. To pursue these goals, Japanese government and industries
The basic strategy of the Ministry of Health to achieve Health For All In Indonesia 2010 is through health paradigm, decentralization, professionalism and health service management. Community health centers play an important role to achieve the goal. Unfortunately, underutilization of community health centers is still a problem in Purworejo. The purpose of this study was to know the utilization of community health centers using a sociological health approach. Qualitative research by observati...
Atkinson, David J.; James, Mark L.; Martin, R. G.
Briefly discussed here are the spacecraft and ground systems monitoring process at the Jet Propulsion Laboratory (JPL). Some of the difficulties associated with the existing technology used in mission operations are highlighted. A new automated system based on artificial intelligence technology is described which seeks to overcome many of these limitations. The system, called the Spacecraft Health Automated Reasoning Prototype (SHARP), is designed to automate health and status analysis for multi-mission spacecraft and ground data systems operations. The system has proved to be effective for detecting and analyzing potential spacecraft and ground systems problems by performing real-time analysis of spacecraft and ground data systems engineering telemetry. Telecommunications link analysis of the Voyager 2 spacecraft was the initial focus for evaluation of the system in real-time operations during the Voyager spacecraft encounter with Neptune in August 1989.
Atkinson, David J.; James, Mark L.; Martin, R. Gaius
Briefly discussed here are the spacecraft and ground systems monitoring process at the Jet Propulsion Laboratory (JPL). Some of the difficulties associated with the existing technology used in mission operations are highlighted. A new automated system based on artificial intelligence technology is described which seeks to overcome many of these limitations. The system, called the Spacecraft Health Automated Reasoning Prototype (SHARP), is designed to automate health and status analysis for multi-mission spacecraft and ground data systems operations. The system has proved to be effective for detecting and analyzing potential spacecraft and ground systems problems by performing real-time analysis of spacecraft and ground data systems engineering telemetry. Telecommunications link analysis of the Voyager 2 spacecraft was the initial focus for evaluation of the system in real-time operations during the Voyager spacecraft encounter with Neptune in August 1989.
da Silva Dalben, Gisele; Teixeira das Neves, Lucimara; Ribeiro Gomide, Marcia
There is a lack of data on the oral health status of individuals with craniofacial syndromes. A group of 15 children with Treacher Collins syndrome, aged 5 to 15 years old, was examined and evaluated for plaque, caries and gingival problems. The ability of the patients to clean their teeth was also investigated. A high plaque index and poor efficacy of tooth-brushing was recorded. The caries and gingival indexes were not proportionally as high as the plaque accumulation. There was no association between the gingival index and presence of mouth breathing. There was predominance of the D component in both the dmft and DMFT indexes; this was associated with a need for restorative dental treatment in 60% of the patients, which indicated the need for dental care for these patients. Caretakers should be informed of the importance of oral health and oral hygiene and encouraged to take responsibility for the oral care of the children living at home.
Arnold, C W
Race, ethnicity, and gender are significant indicators of occupational status, general health status, and thus, occupational health status. Although African-American women constitute only 6.8% of the total U.S. labor force, they hold 20% of the jobs in the health care industry and are disproportionately represented in those jobs that have the highest levels of workplace exposure to hazards. As a result, they are therefore more likely to be at greater exposure and risk to the spectrum of occupational health problems. In order to gain insight into the effects of race and gender on the occupational health status of African-American women health care workers, this article uses three data sources that provide different but complementary sources of information on the demographic characteristics of workers, location of categories of occupations, working conditions of jobs, and other job and worker characteristics. Given the concentration of African-American women in health care positions where there exists a greater likelihood of being exposed to occupational hazards, it is therefore both logical and appropriate for primary care physicians, especially those engaged in office-based practices, to identify this target population for special services and to be more aware of the type of health issues with which these patients are more likely to present and to experience during their working lives. Health care providers have a responsibility to assess occupational factors related to a patient's health problems and to incorporate this information into their treatment protocols and into the design and explanation of each patient's care plan.
A significant gap in evidence characterizes the process of establishing patient-centered health priorities for older men. A cross-sectional postal survey of 2325 Canadian community dwelling men aged 55-97 years old was conducted in 2008 to gauge older men's level of concern for 24 different health items, to determine the impact of age, education and health status on these perceptions, and to ascertain whether men perceive that their health concerns are being attended to. Health issues of greatest concern to men were mobility impairment (64% of respondents), memory loss (64%), and medication side effects (63%). Respondents with lower educational attainment expressed greater concern about their health and were almost 2-fold times more likely to report being concerned about stroke, heart disease and prostate disorders in analyses that controlled for age and health status. Physical and mental health were independently associated with various concerns about health, but old age was not a reliable predictor, with only younger men (erectile dysfunction. Health items of greatest concern to men tended to be those with the lowest screening or counseling rates: these included incontinence, osteoporosis, mobility impairment, falls, anxiety issues, memory loss and depression. An improved consumer-guided agenda for addressing older men's health in the coming decade is urgently required.
reported significantly worse mental and physical health status and worse health utilities relative to insomnia-free matched controls (all P<0.05. Annual per-employee indirect costs were also significantly higher ($4,328 vs $3,000; P<0.05. Among only MOTN awakenings respondents, 74.6% were considered only symptomatic (ie, they did not report having insomnia or having been diagnosed with insomnia. Conclusion: These findings collectively highlight the prevalence and socioeconomic impact of specific types of insomnia symptoms, including MOTN awakenings, experienced by adults in the US. Keywords: insomnia, nocturnal awakenings, work productivity, health outcomes, sleep quality, sleep symptoms
Merglova, Vlasta; Hecova, Hana; Stehlikova, Jaroslava; Chaloupka, Pavel
The aim of this study was to investigate the oral health status of women with high-risk pregnancies. A case-control study of 142 pregnant women was conducted. The case group included 81 pregnant women with high-risk pregnancies, while 61 women with normal pregnancies served as controls. The following variables were recorded for each woman: age, general health status, DMF, CPITN, and PBI index, amounts of Streptococcus mutans in the saliva and dental treatment needs. The Mann-Whitney test, Kruskal-Wallis test, t-test and chi-squared test were used for statistical analyses. Statistically significant differences were detected between the PBI indices and dental treatment needs of the two groups. Out of the entire study cohort, 77% of the women in the case group and 52% of the women in the control group required dental treatment. In this study, women with complications during pregnancy had severe gingivitis and needed more frequent dental treatment than those in the control group.
Jong Ju Seon
Full Text Available The effect of employment insecurity on employee health is an important public health issue due to the recent effects of neoliberalism and the global financial crisis (2007-2008 on labor markets. This study aims to evaluate the differences in cardiovascular health status and the use of preventive screening services between standard and nonstandard workers.Waged employees (N = 5,338 between the ages of 20 and 64 were grouped into standard (full-time, permanent and nonstandard (part-time, temporary, or daily employees. Data from the Fourth Korea National Health and Nutrition Examination Survey, 2007-2009, a nationwide representative survey, were examined, including cardiovascular health risk behaviors (tobacco, alcohol, physical inactivity, measured morbidities (blood pressure, blood glucose level, lipid profiles, body mass index, and the use of screening services for hypertension and diabetes mellitus.Female nonstandard employees tended to have higher blood pressure than did female standard employees (adjusted odds ratio, aOR 1.42, 95% confidence interval, CI 1.02 to 1.98. However, nonstandard employees (both men and women were less likely to use preventive screening services for hypertension (aOR 0.72, 95% CI 0.54 to 0.94 in men; aOR 0.56, 95% CI 0.43 to 0.73 in women and diabetes (aOR 0.58, 95% CI 0.43 to 0.79 in men; aOR 0.55, 95% CI 0.43 to 0.71 in women.Nonstandard work is associated with the underuse of screening services and poorer cardiovascular health in a specific population. Policies to reduce employment insecurity and encourage nonstandard employees to receive health screening services should be prioritized.
Fernández-Niño, Julián Alfredo; Ramírez-Valdés, Carlos Jacobo; Cerecero-Garcia, Diego; Bojorquez-Chapela, Ietza
OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required. PMID:25119943
Seon, Jong Ju; Lim, Yu Jin; Lee, Hae Won; Yoon, Jae Moon; Kim, Sang June; Choi, Seulggie; Kawachi, Ichiro; Park, Sang Min
The effect of employment insecurity on employee health is an important public health issue due to the recent effects of neoliberalism and the global financial crisis (2007-2008) on labor markets. This study aims to evaluate the differences in cardiovascular health status and the use of preventive screening services between standard and nonstandard workers. Waged employees (N = 5,338) between the ages of 20 and 64 were grouped into standard (full-time, permanent) and nonstandard (part-time, temporary, or daily) employees. Data from the Fourth Korea National Health and Nutrition Examination Survey, 2007-2009, a nationwide representative survey, were examined, including cardiovascular health risk behaviors (tobacco, alcohol, physical inactivity), measured morbidities (blood pressure, blood glucose level, lipid profiles, body mass index), and the use of screening services for hypertension and diabetes mellitus. Female nonstandard employees tended to have higher blood pressure than did female standard employees (adjusted odds ratio, aOR 1.42, 95% confidence interval, CI 1.02 to 1.98). However, nonstandard employees (both men and women) were less likely to use preventive screening services for hypertension (aOR 0.72, 95% CI 0.54 to 0.94 in men; aOR 0.56, 95% CI 0.43 to 0.73 in women) and diabetes (aOR 0.58, 95% CI 0.43 to 0.79 in men; aOR 0.55, 95% CI 0.43 to 0.71 in women). Nonstandard work is associated with the underuse of screening services and poorer cardiovascular health in a specific population. Policies to reduce employment insecurity and encourage nonstandard employees to receive health screening services should be prioritized.
Kioulos, K T; Bergiannaki, J D; Glaros, A; Vassiliadou, M; Alexandri, Z; Papadimitriou, G
The quest for existential meaning constitutes a universal phenomenon traditionally manifested in official religions (religiosity) or personal modes of transcendence (spirituality). Religiosity and spirituality have been found to be associated with a variety of mental health and illness parameters. In the last decades there is an increasing number of publications with interesting results on the relationship between religiosity and mental health, both on a theoretical and a clinical level. Recent research suggests the presence of clinically important interactions between religious beliefs and mental health, although the exact nature of the associations remains unclear. The aim of the present study is to investigate subjective health status in relation to specific dimensions of religiosity and spirituality in Greek students; 202 students of the faculty of Theology of the University of Athens were interviewed using the Brief Multidimensional Measurement of Religiousness/Spirituality (BMMRS), which assesses the dimensions of "daily spiritual experiences", "meaning", "values/beliefs", "forgiveness", "private religious practices", "religious/spiritual coping", "religious support", "religious/ spiritual history", "commitment", "organizational religiousness", and "religious preferences". Subjective health status was measured by the General Health Questionnaire (GHQ-28) which examines four areas of health in the following sub-scales: (a) somatic symptoms, (b) anxiety and insomnia, (c) social dysfunction and (d) severe depression. Pearson correlations coefficients and linear regression analyses were used to estimate the associations of GHQ-28 subscales with religiosity dimensions. High scores in each dimension of BMMRS corresponded to a low level of religiosity. The dimension of "daily spiritual experiences" was positively correlated with the subscales of anxiety/ insomnia, social dysfunction and severe depression, while the dimension of "values/beliefs" with social
Medicine, School of Public Health, College of Health Sciences, Addis Ababa University, Addis Ababa, Ethiopia; ... still women in urban settings do not use available maternal health services. Especially ... health services, safe water supplies, poor sanitation and .... selected cities are confined to crowded places, lack of.
Therefore, in-service training and updating of staff involved in health information system (HIS) at district, strengthening health information system inputs, timely and concrete feedbacks with establishment of functional health management information system (HMIS). KEY WORDS: Health Management Information System, ...
Background: The aim of this study is to determine the oral health status of a sample of prisoners at the Federal Prison in Enugu. The health status of inmates in the prison system needs to be incorporated into data and reports that summarize the state of the nation's health; this will encourage the provision of health care to ...
Background: Oral health is an important and often neglected component of an older person's general health and well- being. Objectives: To determine the oral health status of elderly persons in Ile-Ife, Nigeria. Methods: The oral health status of 95 elderly patients who presented at the General outpatient clinic of the Obafemi ...
Goodman, Elizabeth; Huang, Bin; Schafer-Kalkhoff, Tara; Adler, Nancy E.
Purpose The cognitive, social, and biological transitions of adolescence suggest that subjective perceptions of social position based on the socioeconomic hierarchy may undergo important changes during this period, yet how such perceptions develop is poorly understood and no studies assess if changes in such perceptions influence adolescents’ health. This study describes adolescents’ subjective perceptions of familial socioeconomic status (SSS), how SSS changes over time, and how age, race, and objective socioeconomic status (SES) indicators influence SSS. In addition, the study determines if SSS independently influences adolescents’ self-rated health, an important predictor of morbidity and health service utilization. Methods 1179 non-Hispanic black and white baseline 7–12th graders from a Midwestern public school district completed a validated, teen-specific measure of SSS annually for 4 consecutive years. A parent provided information on SES. Markov modeling assessed transitions in SSS over time. Results SSS declined with age (p=.001) and stabilized among older teens. In addition to age, SES and race, but not gender, were significant correlates of SSS, but the relationships between these factors were complex. In cross-sectional and longitudinal analyses, black teens from families with low parent education had higher SSS than white teens from similarly educated families, while white teens from highly educated families had higher SSS than black teens from highly educated families. Lower SSS and changes in SSS predicted poor self rated health even when adjusting for race and objective SES measures. Conclusion Subjective evaluations of socioeconomic status predict adolescents’ global health ratings even when adjusting for the sociodemographic factors which shape them. PMID:17950168
Ghatak, S; Singh, B B
Veterinary public health (VPH) assumes huge significance in developing countries such as India. However, the implementation of VPH services throughout the country is still in its infancy. From 1970 onwards, many institutes, national and international organisations, professional societies, policies and personalities have contributed towards the development of VPH in India. Nevertheless, there is an urgent need to develop VPH still further as there are many issues, such as high population density, the re-emergence of zoonotic pathogens, environmental pollution and antimicrobial resistance, that require attention. The time has surely come to involve all stakeholders, ranging from primary producers (e.g., farmers) to policy-makers, so as to garner support for the holistic implementation of VPH services in India. To improve VPH activities and services, science-based policies enforced through stringent regulation are required to improve human, animal and environmental health. The emergence of the 'One Health' concept has ushered in new hopes for the resurrection of VPH in India. Applying tools such as the World Organisation for Animal Health (OlE) Day One Competencies and the OlE Tool for the Evaluation of Performance of Veterinary Services (PVS Tool) is essential to improve the quality of national Veterinary Services and to identify gaps and weaknesses in service provision, which can be remedied to comply with the OlE international standards. VPH initiatives started modestly but they continue to grow. The present review is focused on the current status and future needs of VPH in India.
Depoorter, Pieter; Van Huffel, Xavier; Diricks, Herman; Imberechts, Hein; Dewulf, Jeroen; Berkvens, Dirk; Uyttendaele, Mieke
The development of an animal health barometer, an instrument to measure the general health of the Belgian livestock population on a yearly basis and to monitor its evolution over time, is described. The elaboration of a set of 13 animal health indicators (AHIs) as the basis for the animal health barometer is discussed. These indicators were weighted by experts - including scientists, policy makers and agro-industrial representatives - to determine their relative weight in the barometer. The result of the barometer is expressed as a comparison with a previous year. Based on the results of the 13 AHIs, it is concluded that general animal health in Belgium shows a positive evolution since 2008. The animal health barometer provides a composite view of the status of livestock health in Belgium and is a tool to communicate in an intelligible, comprehensible manner on aspects of animal health to consumers and professional stakeholders in the animal production and food chain. Together with the food safety barometer (Baert et al., 2011. Food Res. Int. 44, 940) and the plant health barometer (Wilmart et al., 2014. Eur. J. Plant Pathol. doi: 10.1007/s10658-014-0547-x), the animal health barometer is one of the three instruments to provide a holistic view on the overall status of the safety of the food chain in Belgium. Copyright © 2014 Elsevier B.V. All rights reserved.
Nipp, Ryan D; El-Jawahri, Areej; Moran, Samantha M; D'Arpino, Sara M; Johnson, P Connor; Lage, Daniel E; Wong, Risa L; Pirl, William F; Traeger, Lara; Lennes, Inga T; Cashavelly, Barbara J; Jackson, Vicki A; Greer, Joseph A; Ryan, David P; Hochberg, Ephraim P; Temel, Jennifer S
Patients with advanced cancer often experience frequent and prolonged hospitalizations; however, the factors associated with greater health care utilization have not been described. We sought to investigate the relation between patients' physical and psychological symptom burden and health care utilization. We enrolled patients with advanced cancer and unplanned hospitalizations from September 2014-May 2016. Upon admission, we assessed physical (Edmonton Symptom Assessment System [ESAS]) and psychological symptoms (Patient Health Questionnaire 4 [PHQ-4]). We examined the relationship between symptom burden and healthcare utilization using linear regression for hospital length of stay (LOS) and Cox regression for time to first unplanned readmission within 90 days. We adjusted all models for age, sex, marital status, comorbidity, education, time since advanced cancer diagnosis, and cancer type. We enrolled 1,036 of 1,152 (89.9%) consecutive patients approached. Over one-half reported moderate/severe fatigue, poor well being, drowsiness, pain, and lack of appetite. PHQ-4 scores indicated that 28.8% and 28.0% of patients had depression and anxiety symptoms, respectively. The mean hospital LOS was 6.3 days, and the 90-day readmission rate was 43.1%. Physical symptoms (ESAS: unstandardized coefficient [B], 0.06; P cancer experience a high symptom burden, which is significantly associated with prolonged hospitalizations and readmissions. Interventions are needed to address the symptom burden of this population to improve health care delivery and utilization. Cancer 2017;123:4720-4727. © 2017 American Cancer Society. © 2017 American Cancer Society.
Tountas, Yannis; Oikonomou, Nikolaos; Pallikarona, Georgia; Dimitrakaki, Christine; Tzavara, Chara; Souliotis, Kyriakos; Mariolis, Anargiros; Pappa, Evelina; Kontodimopoulos, Nick; Niakas, Dimitris
The purpose of the study was to estimate the demographic and socioeconomic determinants of utilization of the Greek primary and hospital health care services. Data were obtained from the cross-sectional nationwide household survey Hellas Health I (2006). The sample (N = 1005) was representative of the Greek adult population in terms of age and residency, and was selected by means of a three-stage, proportional-to-size sampling design. The presence of a family doctor was reported in a higher degree by participants of higher social classes and private insurance. After adjusting for self-perceived general health and chronic illness, contacts with health care professionals during the past four weeks were found less for residents of rural areas, while contacts with health care professionals during the past 12 months were found less for men than women, for individuals without private insurance and for individuals of lower education. More out-of-pocket payments were reported by the 34-44 age group, rural area residents and individuals with private insurance. Higher use of private health care services was reported by participants of higher social classes and residents of rural areas and private insurance. Only hospital admissions were not directly influenced by demographic and socioeconomic factors. The findings imply the existence of inequities in access and use of primary health services with clear implications to related policies.
Graves, Janessa M; Fulton-Kehoe, Deborah; Jarvik, Jeffrey G; Franklin, Gary M
Early magnetic resonance imaging (MRI) for acute low back pain (LBP) has been associated with increased costs, greater health care utilization, and longer disability duration in workers' compensation claimants. To assess the impact of a state policy implemented in June 2010 that required prospective utilization review (UR) for early MRI among workers' compensation claimants with LBP. Interrupted time series. In total, 76,119 Washington State workers' compensation claimants with LBP between 2006 and 2014. Proportion of workers receiving imaging per month (MRI, computed tomography, radiographs) and lumbosacral injections and surgery; mean total health care costs per worker; mean duration of disability per worker. Measures were aggregated monthly and attributed to injury month. After accounting for secular trends, decreases in early MRI [level change: -5.27 (95% confidence interval, -4.22 to -6.31); trend change: -0.06 (-0.01 to -0.12)], any MRI [-4.34 (-3.01 to -5.67); -0.10 (-0.04 to -0.17)], and injection [trend change: -0.12 (-0.06 to -0.18)] utilization were associated with the policy. Radiograph utilization increased in parallel [level change: 2.46 (1.24-3.67)]. In addition, the policy resulted in significant decreasing changes in mean costs per claim, mean disability duration, and proportion of workers who received disability benefits. The policy had no effect on computed tomography or surgery utilization. The UR policy had discernable effects on health care utilization, costs, and disability. Integrating evidence-based guidelines with UR can improve quality of care and patient outcomes, while reducing use of low-value health services.
Mark D Eisner
Full Text Available Mark D Eisner1,3, Carlos Iribarren3, Edward H Yelin2, Stephen Sidney3, Patricia P Katz2, Gabriela Sanchez3, Paul D Blanc11Division of Occupational and Environmental Medicine and Division of Pulmonary and Critical Care Medicine; 2Institute for Health Policy Studies, Department of Medicine, University of California, San Francisco, CA, USA; 3Division of Research, Kaiser Permanente, Oakland, CA, USAAbstract: Secondhand smoke (SHS is a major contributor to indoor air pollution. Because it contains respiratory irritants, it may adversely influence the clinical course of persons with chronic obstructive pulmonary disease (COPD. We used data from nonsmoking members of the FLOW cohort of COPD (n = 809 to elucidate the impact of SHS exposure on health status and exacerbations (requiring emergency department visits or hospitalization. SHS exposure was measured by a validated survey instrument (hours of exposure during the past week. Physical health status was measured by the SF-12 Physical Component Summary Score and disease-specific health-related quality of life (HRQL by the Airways Questionnaire 20-R. Health care utilization for COPD was determined from Kaiser Permanente Northern California computerized databases. Compared to no SHS exposure, higher level SHS exposure was associated with poorer physical health status (mean score decrement −1.78 points; 95% confidence interval [CI] −3.48 to −0.074 points after controlling for potential confounders. Higher level SHS exposure was also related to poorer disease-specific HRQL (mean score increment 0.63; 95% CI 0.016 to 1.25 and less distance walked during the Six-Minute Walk test (mean decrement −50 feet; 95% CI −102 to 1.9. Both lower level and higher level SHS exposure was related to increased risk of emergency department (ED visits (hazard ratio [HR] 1.40; 95% CI 0.96 to 2.05 and HR 1.41; 95% CI 0.94 to 2.13. Lower level and higher level SHS exposure were associated with a greater risk of
Differences in Health Care Needs, Health Care Utilization, and Health Care Outcomes Among Children With Special Health Care Needs in Ohio: A Comparative Analysis Between Medicaid and Private Insurance.
Sarkar, Madhurima; Earley, Elizabeth R; Asti, Lindsey; Chisolm, Deena J
This study explores comparative differentials in health care needs, health care utilization, and health status between Medicaid and private/employer-sponsored insurance (ESI) among a statewide population of children with special health care needs (CSHCN) in Ohio. We used data from the 2012 Ohio Medicaid Assessment Survey to examine CSHCN's health care needs, utilization, status, and health outcomes by insurance type. Adjusted multivariable logistic regression models were used to explore associations between public and private health insurance, as well as the utilization and health outcome variables. Bivariate analyses indicate that the Medicaid population had higher care coordination needs (odds ratio [OR] = 1.6; 95% confidence interval [CI], 1.1-2.2) as well as need for mental/educational health care services (OR = 1.5; 95% CI; 1.1-2.0). They also reported higher unmet dental care needs (OR = 2.2; 95% CI, 1.2-4.0), higher emergency department (ED) utilization (OR = 2.3; 95% CI, 1.7-3.2), and worse overall health (OR = 0.6; 95% CI, 0.4-0.7), oral health (OR = 0.4; 95% CI, 0.3-0.5), and vision health (OR = 0.4; 95% CI, 0.2-0.6). After controlling for demographic variables, CSHCN with Medicaid insurance coverage were more likely to need mental health and education services (adjusted odds ratio [AOR] = 1.8; 95% CI; 1.2-2.6), had significantly more ED visits (AOR = 2.3; 95% CI, 1.5-3.5), and were less likely to have excellent overall health (AOR = 0.64; 95% CI, 0.4-0.9), oral health (AOR = 0.43; 95% CI, 0.3-0.7), and vision health (AOR = 0.38; 95% CI, 0.2-0.6) than those with private insurance/ESI. The CSHCN population is a highly vulnerable population. While Ohio's Medicaid provides greater coverage to CSHCN, disparities continue to exist within access and services that Medicaid provides versus the ones provided by private insurance/ESI.
Dien, Nguyen Nhi
research reactors used Russia fuels was submitted to Russian Government though IAEA. After that, the Russian Research Reactor Fuel Return (RRRFR) Program was established and trilateral discussions among the United State, the Russian Federation and the IAEA started. In this aspect, the Dalat reactor core has been considered to insert fresh LEU FAs instead of fresh HEU FAs. It means the mixed core of HEU and LEU FAs may be used in the coming years. For these purposes, neutronics and thermal hydraulics calculations and safety analyses should be done. The current status of the reactor operation and utilization as well as some results on in-core fuel management of the DNRR are presented in this paper. Some activities to participating in the project on Research Reactor Technology for Effective Utilization are proposed for discussions. (author)
Li, Zhihui; Li, Mingqiang; Fink, Günther; Bourne, Paul; Bärnighausen, Till; Atun, Rifat
The impact of user-fee policies on the equity of health care utilization and households' financial burdens has remained largely unexplored in Latin American and the Caribbean, as well as in upper-middle-income countries. This paper assesses the short- and long-term impacts of Jamaica's user-fee-removal for children in 2007. This study utilizes 14 rounds of data from the Jamaica Survey of Living Conditions (JSLC) for the periods 1996 to 2012. JSLC is a national household survey, which collects data on health care utilization and among other purposes for planning. Interrupted time series (ITS) analysis was used to examine the immediate impact of the user-fee-removal policy on children's health care utilization and households' financial burdens, as well as the impact in the medium- to long-term. Immediately following the implementation of user-fee-removal, the odds of seeking for health care if the children fell ill in the past 4 weeks increased by 97% (odds ratio 2.0, 95% confidence interval (CI) 1.1 to 3.5, P = 0.018). In the short-term (2007-2008), health care utilization increased at a faster rate among children not in poverty than children in poverty; while this gap narrowed after 2008. There was minimal difference in health care utilization across wealth groups in the medium- to long-term. The household's financial burden (health expenditure as a share of household's non-food expenditures) reduced by 6 percentage points (95% CI: -11 to -1, P = 0.020) right after the policy was implemented and kept at a low level. The difference in financial burden between children in poverty and children not in poverty shrunk rapidly after 2007 and remained small in subsequent years. User-fee-removal had a positive impact on promoting health care utilization among children and reducing their household health expenditures in Jamaica. The short-term and the medium- to long-term results have different indications: In the short-term, the policy deteriorated the equity of
Health status of the under-fives. Fifty-nine (87%) of the 68 children were examined, and 29% were found to have a condition considered as requiring medical treatment. These were: upper respiratory infections in 5, scabies in 4~ impetigo in 4, and severe malnutrition in 4 children. Three children had Tinea capiris infections.
U.S. Department of Health & Human Services — Community Health Status Indicators (CHSI) to combat obesity, heart disease, and cancer are major components of the Community Health Data Initiative. This dataset...
.... This audit topic was the result of a coordinated effort by the Joint Audit Planning Group for Health Care and representatives from the Office of the Assistant Secretary of Defense (Health Affairs) (OASD(HA...
husband's level of ... countries, where women have access to basic health care, ... Democratic Republic of Congo, Ethiopia, India, ... existing information gap about maternal health care by providing empirical evidence-based on the data of the.
Jul 5, 2013 ... Background: Health insurance is a social security system that aims to ... civil servants have no appreciable advantage in terms of access to and cost of health .... self‑medication, pharmaceutical shops, traditional healers,.
Full Text Available Under the Japan – Indonesia Economic Partnership Agreement, more than 1,000 of Indonesian health care workers have migrated to Japan. Social adjustment during the process of migration is linked to mental health changes. This study aimed to figure out the strongest predictor that influences the change in mental health status as a result of migration. Baseline data were collected in Jakarta in 2013 during pre-departure orientation. Follow-up study was conducted one year after the study participants migrated to Japan in 2014. Using longitudinal design, this study employed 92 participants consisting of nurse and certified care worker candidates. The multiple linear regression analysis was conducted to figure out the predictors that influence the change in mental health status. The prediction model expected to explain 39.9% of the change in mental health status, p value < 0.01, while sex (b = 0.201, p value < 0.05, economic conditions in pre-migration (b = -0.200, p value < 0.05, and the socio cultural adaptation competency (b = -0.238, p value < 0.05. This finding assumed that female candidates and those who have economic constraint in pre-migration stage, and those who have declining in socio-cultural adaptation competency tend to have lower mental health one year after the migration.
Hoek, van de E.; Jansman, A.J.M.; Borne, van den J.J.G.C.; Peet-Schwering, van der C.M.C.; Beers-Schreurs, van H.M.G.; Gerrits, W.J.J.
Background: During immune system activation, partitioning of amino acids (AAs) changes between protein gain and use by the immune system. Objective: We determined the effects of health status and dietary AA deficiency on nitrogen retention and AA utilization in pigs. Methods: Barrows (55 d of age)
Compston, Juliet E; Flahive, Julie; Hooven, Frederick H; Anderson, Frederick A; Adachi, Jonathan D; Boonen, Steven; Chapurlat, Roland D; Cooper, Cyrus; Díez-Perez, Adolfo; Greenspan, Susan L; LaCroix, Andrea Z; Lindsay, Robert; Netelenbos, J Coen; Pfeilschifter, Johannes; Roux, Christian; Saag, Kenneth G; Silverman, Stuart; Siris, Ethel S; Watts, Nelson B; Gehlbach, Stephen H
Fractures may be associated with higher morbidity in obese postmenopausal women than in nonobese women. We compared health-care utilization, functional status, and health-related quality of life (HRQL) in obese, nonobese, and underweight women with fractures. Information from the GLOW study, started in 2006, was collected at baseline and at 1, 2, and 3 years. In this subanalysis, self-reported incident clinical fractures, health-care utilization, HRQL, and functional status were recorded and examined. Women in GLOW (n = 60,393) were aged ≥55 years, from 723 physician practices at 17 sites in 10 countries. Complete data for fracture and body mass index were available for 90 underweight, 3,270 nonobese, and 941 obese women with one or more incident clinical fractures during the 3-year follow-up. The median hospital length of stay, adjusted for age, comorbidities, and fracture type, was significantly greater in obese than nonobese women (6 vs. 5 days, p = 0.017). Physical function and vitality score were significantly worse in obese than in nonobese women, both before and after fracture; but changes after fracture were similar across groups. Use of antiosteoporosis medication was significantly lower in obese than in nonobese or underweight women. In conclusion, obese women with fracture undergo a longer period of hospitalization for treatment and have poorer functional status and HRQL than nonobese women. Whether these differences translate into higher economic costs and adverse effects on longer-term outcomes remains to be established.
... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... of Consumer Information and Insurance Oversight of the U.S. Department of Health and Human Services... health insurance coverage offered in connection with a group health plan under the Employee Retirement...
... Group Health Plans and Health Insurance Coverage Rules Relating to Status as a Grandfathered Health Plan... contracts of insurance. The temporary regulations provide guidance to employers, group health plans, and health insurance issuers providing group health insurance coverage. The IRS is issuing the temporary...
Lee, Yun Jong; Park, Tae Jin; Kuk, Il Hiun
The objectives of this study is derivation of important indices for establishing government policy to promote radiation and radioisotope utilization and for setting up effective strategy o develop related industries, on the basis of utilization data, and deduction of economic scale induced by using radiation and radioisotope, through the analysis of economic contribution by multi-variate model. Uses of radiation and radioisotopes are increasing annually in Korea, and the effect of utilization to economy and industry is continuously enlarged in accordance with technology development and expansion of radiation and radioisotope uses. Indices related to radiation nd radioisotope uses, which are useful for the promotion of utilization and establishment of development strategy, have to be derived and updated every year. Important indices related to radiation and radioisotope utilization are derived through the study. The indices are useful for planning establishing, and revising policies to promote radiation and radioisotope utilization, and re furthermore valuable for public acceptance nuclear energy
Garza, Jeremiah R; Glenn, Beth A; Mistry, Rashmita S; Ponce, Ninez A; Zimmerman, Frederick J
Subjective social status is associated with a range of health outcomes. Few studies have tested the relevance of subjective social status among Latinos in the U.S.; those that have yielded mixed results. Data come from the Latino subsample of the 2003 National Latino and Asian American Study (N = 2554). Regression models adjusted for socioeconomic and demographic factors. Stratified analyses tested whether nativity status modifies the effect of subjective social status on health. Subjective social status was associated with better health. Income and education mattered more for health than subjective social status among U.S.-born Latinos. However, the picture was mixed among immigrant Latinos, with subjective social status more strongly predictive than income but less so than education. Subjective social status may tap into stressful immigrant experiences that affect one's perceived self-worth and capture psychosocial consequences and social disadvantage left out by conventional socioeconomic measures.
Full Text Available Background: People at or over the age of 60, constitute above 7.7% of total population. Traditionally this segment of population depends on their children for their health and social welfare, However owing to the social and cultural changes that are taking place within the Indian society, this support may not be as readily available, as it is believed. With the changing demography of India, there is urgent need to look at the health status of elderly for planning appropriate health facilities for them. Objectives: To study biosocial, nutritional and chronic disease risk factor profile of elderly population. Methods: Cross-sectional Study was conducted in Doiwala block of Dehradun district, Uttarakhand. 122 elderly persons of age 60 years and above were interviewed on predesigned questionnaire by house to house visit in the selected village. Results: Overall prevalence of risk factors found to be higher amongst elderly females. Unutrition was higher amongst elderly males. In all, 48.6% elderly were underweight ,10.3% were overweight and 5.6% cases were in obese category. As per the Waist and hip ratio 47.2% elderly belonged to the moderate to high risk category. 30.8% people were hypertensive. Conclusions: Prevalence of high-risk factors for chronic diseases is quite high amongst elderly population, especially amongst elderly females.
Mental health problems are an independent predictor of increased healthcare utilization. We created random forest classifiers for predicting two outcomes following a patient’s first behavioral health encounter: decreased utilization by any amount (AUROC 0.74) and ultra-high absolute utilization (AUROC 0.88). These models may be used for clinical decision support by referring providers, to automatically detect patients who may benefit from referral, for cost management, or for risk/protection ...
Tarekegn, Shegaw Mulu; Lieberman, Leslie Sue; Giedraitis, Vincentas
Background Antenatal Care (ANC), use of skilled delivery attendants and postnatal care (PNC) services are key maternal health services that can significantly reduce maternal mortality. Understanding the factors that affect service utilization helps to design appropriate strategies and policies towards improvement of service utilization and thereby reduce maternal mortality. The objective of this study was to identify factors that affect utilization of maternal health services in Ethiopia. Met...
Zhang, Yi; Zhou, Zhongliang; Si, Yafei
China has a large population of children under 18 years of age, whose health is of great concern to the Chinese health care system. However, few studies have been conducted to analyze the factors associated with children's unnecessary health care utilization in China. The objective of this study is to provide some empirical evidence on this issue by investigating the role of parental health care utilization in children's unnecessary health care use. The data were obtained from the fifth Health Service Survey of Shaanxi province in 2013. We employed three dependent variables to measure children's health care utilization: the number of children's outpatient visits during the past 2 weeks, whether or not infusion was used if the child had any outpatient visits during the past 2 weeks, and the number of children's inpatient visits during last year. Based on specific characteristics of these outcome variables, negative binomial models were used for the non-negative numbers of outpatient and inpatient visits, while a probit model was used for the zero-one indicator variable showing whether infusion was used during outpatient visits. Based on a sample of 11,024 children, our results of multivariate analysis showed that children whose parents used outpatient care were estimated to have a larger number of outpatient visits than those whose parents did not have outpatient visits in the past 2 weeks (with a difference of 0.0393 visits). Among children having outpatient visits in the last 2 weeks, the probability of obtaining infusion was 57.01 percentage points higher for children whose parents used infusion in the past 2 weeks than the probability for those whose parents did not use infusion. The predicted number of inpatient visits was higher for children whose parents used inpatient services in the last year, compared with the group whose parents did not use (with a difference of 0.0567 visits). Moreover, we noted that the positive association between parental and
Zinner, Norman; Noe, Les; Rasouliyan, Lawrence; Marshall, Thomas; Seifeldin, Raafat
Assess changes in resource utilization, work and activity impairment, and health utility among OAB patients continuing to have urgency symptoms with tolterodine ER 4 mg and willing to try solifenacin 5/10 mg. This was an open-label, non-comparative, flexible-dosing, multicenter, 12-week study assessing the efficacy and safety of solifenacin 5/10 mg/day. Patients receiving tolterodine ER 4 mg/day for >/=4 weeks but continuing to experience residual urgency symptoms (>/=3 urgency episodes/24 h) were enrolled into the study. After a 14-day washout, patients began treatment with solifenacin 5 mg/day with dosing adjustments allowed at Weeks 4 and 8. Outcomes were assessed using the Work Productivity and Activity Impairment Questionnaire - Specific Health Problem (WPAI-SHP), Health Utilities Index (HUI), and a resource utilization questionnaire administered at Pre-Washout and Week 12. Patients (n=440) reported significantly fewer physician office visits (pwork time missed (p=0.0017), less impairment while working (pwork impairment (pwork productivity, activity participation, and reduced medical care use in OAB patients who continued to have urgency symptoms with tolterodine ER 4 mg/day and wished to switch to solifenacin 5/10 mg. This was an open-label, non-comparative study; therefore, further research is needed to confirm these results.
Westaway, M S; Viljoen, E; Rudolph, M J
Interviews were conducted with 294 black residents (155 females and 138 males) of a peri-urban informal settlement in Gauteng to ascertain utilisation of oral health services, oral health needs and oral health status. Only 37 per cent of the sample had consulted a dentist or medical practitioner, usually for extractions. Teenagers and employed persons were significantly less likely to utilise dentists than the older age groups and unemployed persons. Forty per cent were currently experiencing oral health problems such as a sore mouth, tooth decay and bleeding/painful gums. Two hundred and twelve (73 per cent) interviewees wanted dental treatment or advice. Residents who rated their oral health status as fair or poor appeared to have the greatest need for oral health services. The use of interviews appears to be a cost-effective method of determining oral morbidity.
H. Bleichrodt (Han)
textabstractThis thesis studies the applicability of quality-adjusted life years (QALYs) and other utility based outcome measures in medical decision making and health economics. The main conclusion will be that utility based measures are more useful to model health related behaviour than has
Dorn, T.; Yzermans, J.; Kerssens, J.; Veen, P. ten
Background: Although crucial for the management of the post-disaster phase, the impact of disasters on primary health care utilization is largely unknown. Often, pre-disaster base-line data is lacking. The current study quantified primary health care utilization after a major fire disaster in The
Studnicki, James; Fisher, John W.
Introduction: The determination of priorities is an essential component of community health status assessment. Yet, there is an acknowledged need for a systematic method which will utilize data in standardized comparisons to yield priorities based on objective analyses. Method: We have deployed a web-based system with: a flexible online analytic processing (OLAP) interface; multiple sources of event-level data conformed to common definitions in a data warehouse structure; and, centralized technical infrastructure with distributed analytical capabilities. The PRIORITIZATION TOOL integrated into the system takes full advantage of the granularity of multidimensional sources of data to: apply a series of defined objective criteria; vary the weight of those criteria and detect the reordering of the rankings in real-time; and, apply the prioritization algorithm to different categories of health status outcomes. Results: In our example, mortality outcomes for Miami-Dade County, Florida, were considered with three different weighting combinations of the four primary ranking criteria. The resultant analyses return markedly different mortality priority rankings based upon the selection and weighting of the criteria. Conclusion: Rankings of community health outcomes based on a static set of criteria with fixed weighting factors may not provide sufficient information necessary for priority setting and may, in fact, be misleading. PMID:23923094
Studnicki, James; Fisher, John W
The determination of priorities is an essential component of community health status assessment. Yet, there is an acknowledged need for a systematic method which will utilize data in standardized comparisons to yield priorities based on objective analyses. We have deployed a web-based system with: a flexible online analytic processing (OLAP) interface; multiple sources of event-level data conformed to common definitions in a data warehouse structure; and, centralized technical infrastructure with distributed analytical capabilities. The PRIORITIZATION TOOL integrated into the system takes full advantage of the granularity of multidimensional sources of data to: apply a series of defined objective criteria; vary the weight of those criteria and detect the reordering of the rankings in real-time; and, apply the prioritization algorithm to different categories of health status outcomes. In our example, mortality outcomes for Miami-Dade County, Florida, were considered with three different weighting combinations of the four primary ranking criteria. The resultant analyses return markedly different mortality priority rankings based upon the selection and weighting of the criteria. Rankings of community health outcomes based on a static set of criteria with fixed weighting factors may not provide sufficient information necessary for priority setting and may, in fact, be misleading.
Full Text Available Yanni Hao,1 Verena Wolfram,2 Jennifer Cook2 1Novartis Pharmaceuticals, East Hanover, NJ, USA; 2Adelphi Values, Bollington, UK Background: Health utilities are increasingly incorporated in health economic evaluations. Different elicitation methods, direct and indirect, have been established in the past. This study examined the evidence on health utility elicitation previously reported in advanced/metastatic breast cancer and aimed to link these results to requirements of reimbursement bodies. Methods: Searches were conducted using a detailed search strategy across several electronic databases (MEDLINE, EMBASE, Cochrane Library, and EconLit databases, online sources (Cost-effectiveness Analysis Registry and the Health Economics Research Center, and web sites of health technology assessment (HTA bodies. Publications were selected based on the search strategy and the overall study objectives. Results: A total of 768 publications were identified in the searches, and 26 publications, comprising 18 journal articles and eight submissions to HTA bodies, were included in the evidence review. Most journal articles derived utilities from the European Quality of Life Five-Dimensions questionnaire (EQ-5D. Other utility measures, such as the direct methods standard gamble (SG, time trade-off (TTO, and visual analog scale (VAS, were less frequently used. Several studies described mapping algorithms to generate utilities from disease-specific health-related quality of life (HRQOL instruments such as European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Core 30 (EORTC QLQ-C30, European Organization for Research and Treatment of Cancer Quality of Life Questionnaire – Breast Cancer 23 (EORTC QLQ-BR23, Functional Assessment of Cancer Therapy – General questionnaire (FACT-G, and Utility-Based Questionnaire-Cancer (UBQ-C; most used EQ-5D as the reference. Sociodemographic factors that affect health utilities, such as age, sex
Toda, Masahiro; Morimoto, Kanehisa; Fukuda, Sanae; Hayakawa, Kazuo
The relations between salivary variables, lifestyle and mental health status were investigated for 61 healthy female university students. The salivary secretion rates were significantly higher in the good lifestyle groups compared with the poor lifestyle groups. Among the 8 lifestyle items tested. "eating breakfast" and "mental stress" were significantly related to the salivary secretion rates. The present findings suggest that the acquisition of a good lifestyle is also very important from the viewpoint of the prevention of oral disease.A highly significant correlation (r=0.97; p<0.01) between the salivary cortisol levels and the cortisol secretion rates when controlled for the salivary secretion rates was also observed. This suggests that there is a high correlation between the intact salivary cortisol levels and the total cortisol quantity per unit time. Therefore, both these values can be used as a good index for the salivary cortisol determination.
Varì, Rosaria; Scazzocchio, Beatrice; D'Amore, Antonio; Giovannini, Claudio; Gessani, Sandra; Masella, Roberta
Consistent epidemiological and clinical evidence strongly indicates that chronic non-communicable diseases are largely associated with four lifestyle risk factors: inadequate diet, physical inactivity, tobacco use, and excessive alcohol use. Notably, obesity, a worldwide-growing pathological condition determined by the combination between inadequate diet and insufficient physical activity, is now considered a main risk factor for most chronic diseases. Dietary habits and physical activity are strongly influenced by gender attitudes and behaviors that promote different patterns of healthy or unhealthy lifestyles among women and men. Furthermore, different roles and unequal relations between genders strongly interact with differences in social and economic aspects as well as cultural and societal environment. Because of the complex network of factors involved in determining the risk for chronic diseases, it has been promoting a systemic approach that, by integrating sex and gender analysis, explores how sex-specific biological factors and gender-related social factors can interact to influence the health status.
One problem in studies of social inequality in health is that traditional socio-economic indicators are unsuitable for groups finding themselves on the outside of those societal arenas from which measures of education, income and occupation are generated. A measure of subjective social position has accordingly been proposed as an addition to the traditional objective socio-economic measures. The present study investigates this concepts' usefulness as an addition to objective SES markers in a sample of prison inmates, known for their marginalized position in society as well as their poor health. Analyses are based on the male part (n = 225) of a nationally representative sample of prison inmates in Norway. Outcome measures are self-rated health, long-standing illness or disability, mental health problems, perceived change in health status and drug use. Analyses of correlation as well as multivariate logistic regression analyses were performed. Subjective social status was bivariately related to all of the health outcomes, except long-standing illness. Multivariate analyses indicated that subjective social status influenced the odds of experiencing mental health problems, but not any of the other health outcomes when controlling for the other independent variables. Subjective social status may add important information to our understanding of the relationship between social disadvantage and mental health in a marginalized social group such as prison inmates.
Dong, Xiaoxin; Liu, Ling; Cao, Shiyi; Yang, Huajie; Song, Fujian; Yang, Chen; Gong, Yanhong; Wang, Yunxia; Yin, Xiaoxu; Xu, Xing; Xie, Jun; Sun, Yi; Lu, Zuxun
Community health service in China is designed to provide a convenient and affordable primary health service for the city residents, and to promote health equity. Based on data from a large national study of 35 cities across China, we examined the characteristics of the patients and the utilization of community health institutions (CHIs), and assessed the role of community health service in promoting equity in health service utilization for community residents. Multistage sampling method was applied to select 35 cities in China. Four CHIs were randomly chosen in every district of the 35 cities. A total of 88,482 visitors to the selected CHIs were investigated by using intercept survey method at the exit of the CHIs in 2008, 2009, 2010, and 2011. Descriptive analyses were used to analyze the main characteristics (gender, age, and income) of the CHI visitors, and the results were compared with that from the National Health Services Survey (NHSS, including CHIs and higher levels of hospitals). We also analyzed the service utilization and the satisfactions of the CHI visitors. The proportions of the children (2.4%) and the elderly (about 22.7%) were lower in our survey than those in NHSS (9.8% and 38.8% respectively). The proportion of the low-income group (26.4%) was apparently higher than that in NHSS (12.5%). The children group had the lowest satisfaction with the CHIs than other age groups. The satisfaction of the low-income visitors was slightly higher than that of the higher-income visitors. The utilization rate of public health services was low in CHIs. The CHIs in China appears to fulfill the public health target of uptake by vulnerable populations, and may play an important role in promoting equity in health service utilization. However, services for children and the elderly should be strengthened.
Full Text Available Abstract Background Compared to men, women report greater morbidity and make greater use of health-care services. This study examines potential determinants of gender differences in the utilization of health-care services among the elderly. Methods Cross-sectional study covering 3030 subjects, representative of the non-institutionalized Spanish population aged 60 years and over. Potential determinants of gender differences in the utilization of health services were classified into predisposing factors (age and head-of-family status, need factors (lifestyles, chronic diseases, functional status, cognitive deficit and health-related quality of life (HRQL and enabling factors (educational level, marital status, head-of-family employment status and social network. Relative differences in the use of each service between women and men were summarized using odds ratios (OR, obtained from logistic regression. The contribution of the variables of interest to the gender differences in the use of such services was evaluated by comparing the OR before and after adjustment for such variables. Results As compared to men, a higher percentage of women visited a medical practitioner (OR: 1.24; 95% confidence limits (CL: 1.07–1.44, received home medical visits (OR: 1.67; 95% CL: 1.34–2.10 and took ≥3 medications (OR: 1.54; 95% CL: 1.34–1.79, but there were no gender differences in hospital admission or influenza vaccination. Adjustment for need or enabling factors led to a reduction in the OR of women compared to men for utilization of a number of services studied. On adjusting for the number of chronic diseases, the OR (95% CL of women versus men for ingestion of ≥3 medications was 1.24 (1.06–1.45. After adjustment for HRQL, the OR was 1.03 (0.89–1.21 for visits to medical practitioners, 1.24 (0.98–1.58 for home medical visits, 0.71 (0.58–0.87 for hospitalization, and 1.14 (0.97–1.33 for intake of ≥3 medications. After adjustment for the
Mautner, Dawn; Peterson, Bridget; Cunningham, Amy; Ku, Bon; Scott, Kevin; LaNoue, Marianna
Health locus of control may be an important predictor of health care utilization. We analyzed associations between health locus of control and frequency of emergency department visits and hospital admissions, and investigated self-rated health as a potential mediator. Overall, 863 patients in an urban emergency department completed the Multidimensional Health Locus of Control instrument, and self-reported emergency department use and hospital admissions in the last year. We found small but significant associations between Multidimensional Health Locus of Control and utilization, all of which were mediated by self-rated health. We conclude that interventions to shift health locus of control may change patients' perceptions of their own health, thereby impacting utilization.
Moore, Danielle Collingridge; Barron, Lynn; Stow, Daniel; Hanratty, Barbara
findings. Main Results. The literature search retrieved 26 077 citations, 126 of which met inclusion criteria. Data were reported across 226 678 participants from 19 countries. We identified strong evidence of an association between weaker social relationships and increased rates of readmission to hospital (75% of high-quality studies reported evidence of an association in the same direction). In evidence of moderate strength, according to 2 high-quality and 3 medium-quality studies, smaller social networks were associated with longer hospital stays. When we considered received and perceived social support separately, they were not linked to health care use. Overall, the evidence did not indicate that older patients with weaker social relationships place greater demands on ambulatory care (including physician visits and community- or home-based services) than warranted by their needs. Authors’ Conclusions. Current evidence does not support the view that, independently of health status, older patients with lower levels of social support place greater demands on ambulatory care. Future research on social relationships would benefit from a consensus on clinically relevant concepts to measure. Public Health Implications. Our findings are important for public health because they challenge the notion that lonely older adults are a burden on all health and social care services. In high-income countries, interventions aimed at reducing social isolation and loneliness are promoted as a means of preventing inappropriate service use. Our review cautions against assuming that reductions in care utilization can be achieved by intervening to strengthen social relationships. PMID:29470115
Valtorta, Nicole K; Moore, Danielle Collingridge; Barron, Lynn; Stow, Daniel; Hanratty, Barbara
. Data were reported across 226 678 participants from 19 countries. We identified strong evidence of an association between weaker social relationships and increased rates of readmission to hospital (75% of high-quality studies reported evidence of an association in the same direction). In evidence of moderate strength, according to 2 high-quality and 3 medium-quality studies, smaller social networks were associated with longer hospital stays. When we considered received and perceived social support separately, they were not linked to health care use. Overall, the evidence did not indicate that older patients with weaker social relationships place greater demands on ambulatory care (including physician visits and community- or home-based services) than warranted by their needs. Current evidence does not support the view that, independently of health status, older patients with lower levels of social support place greater demands on ambulatory care. Future research on social relationships would benefit from a consensus on clinically relevant concepts to measure. Public Health Implications. Our findings are important for public health because they challenge the notion that lonely older adults are a burden on all health and social care services. In high-income countries, interventions aimed at reducing social isolation and loneliness are promoted as a means of preventing inappropriate service use. Our review cautions against assuming that reductions in care utilization can be achieved by intervening to strengthen social relationships.
Emelumadu, OF; Ukegbu, AU; Ezeama, NN; Kanu, OO; Ifeadike, CO; Onyeonoro, UU
Background: Although, antenatal care (ANC) attendance in sub Saharan Africa is high, however this does not always translate into quality ANC care service utilization. Aim: This study therefore is aimed at exploring pattern of maternal health (MH) services utilization and the socio-demographic factors influencing it in Anambra State, South East Nigeria. Subjects and Methods: A total of 310 women of reproductive age with a previous history of gestation attending ANC services between September, 2007 and August, 2008 in selected Primary Health Centers in Anambra State were studied. Responses were elicited from the study participants using a pre-tested, semi-structured interviewer-administered questionnaire. Data collected were analyzed using Statistical Package for Social Sciences (SPSS) version 17 (SPSS Inc, Chicago Illinois, USA). Association between socio-demographic characteristics and pattern of utilization of ANC and delivery services was measured using χ2-test, Regression analysis was done to identify factors associated with utilization of MH services. P < 0.05 was assumed to be significant. Results: Use of health facility was 293 (97.0%) and 277 (92,7%) out 302 women for ANC and delivery services respectively. Most women attended their first ANC consultation during the preceding pregnancy was after the first trimester and about 31% (94/298) of them had <4 ANC visits prior to delivery. Socio-demographic factors were found to be significantly associated with places where MH care services are accessed. Parity was found to be associated with timing of ANC booking and number of ANC attendance (χ2 = 9.49, P = 0.05). Odds of utilizing formal health facility for MH services were found to be significantly associated with increasing age (P < 0.01) and educational status of mothers (P < 0.001). Conclusions: The study revealed high maternal service utilization and 10% fetal loss, hence the need to address the gaps of late ANC booking and low ANC visits. PMID:24971212
Danasekaran, Raja; Raja, Pavithra; Ranganathan, Karnaboopathy
Considering the global and national level commitments in improving the maternal health as well as reducing the maternal mortality, assessment of factors influencing the delivery of antenatal healthcare services becomes essential. The aim is to assess the utilization of antenatal health services and to identify the factors influencing their utilization among women of fishermen population in Kanchipuram district, Tamil Nadu. The cross-sectional study was carried out among the mothers in Kovalam area of Kanchipuram district. Details were collected using a pretested questionnaire and analyzed using statistical software. The study included 284 mothers, of which 35% were illiterates. Nearly 60.21% have got registered with the Government sector, 59.51% of the mothers had three or more antenatal visits, 64.08% have received two doses of tetanus toxoid, and 73.24% have taken iron and folic acid tablets. Factors which were identified to have statistically significant association with better utilization of antenatal health services were age >30 years, higher educational status, skilled workers, those having their first child, and higher socioeconomic class. This study has reported the fact that antenatal healthcare services were not utilized fully by the community and the fishermen population being a special group has to be given the needed attention from the healthcare delivery system.
Chen, Jie-Yu; Yang, Le-Bin; Jiang, Ping-Ping; Sun, Xiao-Min; Yu, Ke-Qiang; Li, Fei; Wu, Sheng-Wei; Ji, Yan-Zhao; Zhao, Xiao-Shan; Luo, Ren
To investigate associations between health-promoting lifestyle and suboptimal health status (SHS) in the population of Guangdong province. A cross-sectional survey was conducted in a clustered sample of 24 159 individuals aged 12-80 years from 2012 to 2013. Health-promoting lifestyle was assessed via the Health-Promoting Lifestyle Profile (HPLP-II), and SHS was evaluated using the medical examination report and Sub-health Measurement Scale V1.0 (SHMS V1.0). Of the 24159 participants, subjects with SHS (46.0%) and disease status (35.2%) accounted for a much higher percentage than healthy subjects (18.8%). Regression analyses revealed a significant association between health status and healthy lifestyle (PUnhealthy lifestyle was an important risk factor for SHS and disease, especially the former. Compared with the participants with a healthy lifestyle (minimal exposure), after demographic adjustment, subjects with a 'poor' lifestyle (maximal exposure) were at a 43 times higher risk of developing SHS (OR: 42.825, 95% CI: 30.567-59.997), those with a general lifestyle were at a 21 times higher risk of SHS (OR: 21.072, 95%CI: 17.258-25.729), and those with a suboptimal lifestyle had a 4 times higher risk (OR: 4.085, 95%CI: 3.352-4.979). In the general population, the major risk factors for SHS included poor stress management, poor self-actualization, inactive exercise and poor interpersonal relationship. s Unhealthy lifestyles are significantly related to an increased risk of SHS. Intervention of unhealthy lifestyles, controlling the risk factors of SHS, and rigorous management of the time window of SHS are necessary to promote the heath status.
Serper, Marina; Patzer, Rachel E; Curtis, Laura M; Smith, Samuel G; O'Conor, Rachel; Baker, David W; Wolf, Michael S
Objective To investigate whether previously noted associations between health literacy and functional health status might be explained by cognitive function. Data Sources/Study Setting Health Literacy and Cognition in Older Adults (“LitCog,” prospective study funded by National Institute on Aging). Data presented are from interviews conducted among 784 adults, ages 55–74 years receiving care at an academic general medicine clinic or one of four federally qualified health centers in Chicago from 2008 to 2010. Study Design Study participants completed structured, in-person interviews administered by trained research assistants. Data Collection Health literacy was measured using the Test of Functional Health Literacy in Adults, Rapid Estimate of Adult Literacy in Medicine, and Newest Vital Sign. Cognitive function was assessed using measures of long-term and working memory, processing speed, reasoning, and verbal ability. Functional health was assessed with SF-36 physical health summary scale and Patient Reported Outcomes Measurement Information System short form subscales for depression and anxiety. Principal Findings All health literacy measures were significantly correlated with all cognitive domains. In multivariable analyses, inadequate health literacy was associated with worse physical health and more depressive symptoms. After adjusting for cognitive abilities, associations between health literacy, physical health, and depressive symptoms were attenuated and no longer significant. Conclusions Cognitive function explains a significant proportion of the associations between health literacy, physical health, and depression among older adults. Interventions to reduce literacy disparities in health care should minimize the cognitive burden in behaviors patients must adopt to manage personal health. PMID:24476068
Helms, Sarah W.; Choukas-Bradley, Sophia; Widman, Laura; Giletta, Matteo; Cohen, Geoffrey L.; Prinstein, Mitchell J.
Most peer influence research examines socialization between adolescents and their best friends. Yet, adolescents also are influenced by popular peers, perhaps due to misperceptions of social norms. This research examined the extent to which out-group and in-group adolescents misperceive the frequencies of peers' deviant, health risk, and adaptive behaviors in different reputation-based peer crowds (Study 1) and the prospective associations between perceptions of high status peers' and adolescents' own substance use over 2.5 years (Study 2). Study 1 examined 235 adolescents' reported deviant (vandalism, theft), health risk (substance use, sexual risk), and adaptive (exercise, studying) behavior, and their perceptions of Jocks', Populars', Burnouts', and Brains' engagement in the same behaviors. Peer nominations identified adolescents in each peer crowd. Jocks and Populars were rated as higher status than Brains and Burnouts. Results indicated that peer crowd stereotypes are caricatures. Misperceptions of high status crowds were dramatic, but for many behaviors, no differences between Populars'/Jocks' and others' actual reported behaviors were revealed. Study 2 assessed 166 adolescents' substance use and their perceptions of popular peers' (i.e., peers high in peer perceived popularity) substance use. Parallel process latent growth analyses revealed that higher perceptions of popular peers' substance use in Grade 9 (intercept) significantly predicted steeper increases in adolescents' own substance use from Grade 9 to 11 (slope). Results from both studies, utilizing different methods, offer evidence to suggest that adolescents misperceive high status peers' risk behaviors, and these misperceptions may predict adolescents' own risk behavior engagement. PMID:25365121
Helms, Sarah W; Choukas-Bradley, Sophia; Widman, Laura; Giletta, Matteo; Cohen, Geoffrey L; Prinstein, Mitchell J
Most peer influence research examines socialization between adolescents and their best friends. Yet, adolescents also are influenced by popular peers, perhaps due to misperceptions of social norms. This research examined the extent to which out-group and in-group adolescents misperceive the frequencies of peers' deviant, health risk, and adaptive behaviors in different reputation-based peer crowds (Study 1) and the prospective associations between perceptions of high-status peers' and adolescents' own substance use over 2.5 years (Study 2). Study 1 examined 235 adolescents' reported deviant (vandalism, theft), health risk (substance use, sexual risk), and adaptive (exercise, studying) behavior, and their perceptions of jocks', populars', burnouts', and brains' engagement in the same behaviors. Peer nominations identified adolescents in each peer crowd. Jocks and populars were rated as higher status than brains and burnouts. Results indicated that peer crowd stereotypes are caricatures. Misperceptions of high-status crowds were dramatic, but for many behaviors, no differences between populars'/jocks' and others' actual reported behaviors were revealed. Study 2 assessed 166 adolescents' substance use and their perceptions of popular peers' (i.e., peers high in peer perceived popularity) substance use. Parallel process latent growth analyses revealed that higher perceptions of popular peers' substance use in Grade 9 (intercept) significantly predicted steeper increases in adolescents' own substance use from Grade 9 to 11 (slope). Results from both studies, utilizing different methods, offer evidence to suggest that adolescents misperceive high-status peers' risk behaviors, and these misperceptions may predict adolescents' own risk behavior engagement. PsycINFO Database Record (c) 2014 APA, all rights reserved.
Gunsam, P. Pugo; Banka, S.
Purpose: This paper seeks to assess the oral health status and behaviour of a sample of the Mauritian population visiting private dental clinics. Design/methodology/approach: Oral health status was determined using the World Health Organization (Decayed, Missing, Filled Teeth (DMFT) index indicating the prevalence of caries, and factors associated…
Tishuk, E A; Plavunov, N F; Soboleva, N P
Based on vast comprehensive medical statistical database, the authors analyze the health status of the population and the efficacy of public health service in Moscow. The pre-crisis tendencies and the modern status of public health under modern socioeconomic conditions are noted.
Shippee, Tetyana P; Rowan, Kathleen; Sivagnanam, Kamesh; Oakes, J Michael
This study examines the role of mother's health and socioeconomic status on daughter's self-rated health using data spanning three decades from the National Longitudinal Surveys of Mature Women and Young Women (N = 1,848 matched mother-daughter pairs; 1,201 White and 647 African American). Using nested growth curve models, we investigated whether mother's self-rated health affected the daughter's self-rated health and whether socioeconomic status mediated this relationship. Mother's health significantly influenced daughters' self-rated health, but the findings were mediated by mother's socioeconomic status. African American daughters reported lower self-rated health and experienced more decline over time compared with White daughters, accounting for mother's and daughter's covariates. Our findings reveal maternal health and resources as a significant predictor of daughters' self-rated health and confirm the role of socioeconomic status and racial disparities over time. © The Author(s) 2015.
Kwon, Joseph; Kim, Sung Wook; Ungar, Wendy J; Tsiplova, Kate; Madan, Jason; Petrou, Stavros
A common feature of most reviews or catalogues of health utilities has been their focus on adult health states or derivation of values from adult populations. More generally, utility measurement in or on behalf of children has been constrained by several methodological concerns. The objective of this study was to conduct the first comprehensive systematic review and meta-analysis of primary utility data for childhood conditions and descriptors, and to determine the effects of methodological factors on childhood utilities. The review followed PRISMA guidelines. PubMed, Embase, Web of Science, PsycINFO, EconLit, CINAHL and Cochrane Library were searched for primary studies reporting health utilities for childhood conditions or descriptors using direct or indirect valuation methods. The Paediatric Economic Database Evaluation (PEDE) Porject was also searched for cost-utility analyses with primary utility values. Mean or median utilities for each of the main samples were catalogued, and weighted averages of utilities for each health condition were estimated, by valuation method. Mixed-effects meta-regression using hierarchical linear modeling was conducted for the most common valuation methods to estimate the utility decrement for each health condition category relative to general childhood population health, as well as the independent effects of methodological factors. The literature searches resulted in 272 eligible studies. These yielded 3,414 utilities when all sub-groups were considered, covering all ICD-10 chapters relevant to childhood health, 19 valuation methods, 12 respondent types, 8 modes of administration, and data from 36 countries. A total of 1,191 utility values were obtained when only main study samples were considered, and these were catalogued by health condition or descriptor, and methodological characteristics. 1,073 mean utilities for main samples were used for fixed-effects meta-analysis by health condition and valuation method. Mixed
Full Text Available Crystal Watson,1 Christine Prosser,2 Sebastian Braun,2 Pamela B Landsman-Blumberg,3 Erika Gleissner,4 Sarah Naoshy1 1Health Economics and Outcomes Research, Global Market Access, Biogen, Cambridge, MA, USA; 2Real World Evidence, Xcenda GmbH, Hanover, Germany; 3Applied Data Analytics, Xcenda LLC, Palm Harbor, FL, USA; 4Market Access, Biogen, Ismaning, Germany Background: Multiple sclerosis (MS, a progressive neurodegenerative disease, greatly impacts the quality of life and economic status of people affected by this disease. In Germany, the total annual cost of MS is estimated at €40,000 per person with MS. Natalizumab has shown to slow MS disease progression, reduce relapses, and improve the quality of life of people with MS.Objective: To evaluate MS-related and all-cause health care resource utilization and costs among German MS patients during the 12 months before and after initiation of natalizumab in a real-world setting.Methods: The current analysis was conducted using the Health Risk Institute research database. Identified patients were aged ≥18 years with ≥1 diagnosis of MS and had initiated natalizumab therapy (index, with 12-month pre– and post–index-period data. Patients were stratified by prior disease-modifying therapy (DMT usage or no DMT usage in the pre-index period. Outcome measures included corticosteroid use and number of sick/disability days, inpatient stays, and outpatient visits. Health care costs were calculated separately for pre- and post-index periods on a per-patient basis and adjusted for inflation.Results: In a final sample of 193 natalizumab-treated patients, per-patient MS-related corticosteroid use was reduced by 62.3%, MS-related sick days by 27.6%, and inpatient costs by 78.3% from the pre- to post-index period. Furthermore, the proportion of patients with MS-related hospitalizations decreased from 49.7% to 14.0% (P<0.001; this reduction was seen for patients with and without prior DMT use
Emerson, E; Brigham, P
The authors sought to: (1) estimate the prevalence of health behaviours, mental health and exposure to social determinants of poorer health among parents with and without intellectual disability; and (2) determine the extent to which between-group differences in health behaviours/status may be attributable to differential exposure to social determinants of poorer health. Cross sectional survey. Secondary analysis of confidentialized needs analysis data collected in three Primary Care Trusts in England on 46,023 households with young children. Households containing a parent with intellectual disabilities are at increased risk of: (1) poorer parental mental health, parental drug and alcohol abuse and smoking; (2) exposure to a range of environmental adversities. Controlling for the latter eliminated the increased risk of poorer health for single parent households headed by a person with intellectual disabilities. For two parent headed households, risk of poorer parental mental health remained elevated. The poorer health of parents with intellectual disability may be accounted for by their markedly greater risk of exposure to common social determinants of poorer health rather than being directly attributable to their intellectual disability. Copyright © 2013 The Royal Society for Public Health. Published by Elsevier Ltd. All rights reserved.
Foster, Stephen; Sage, Rob
The relevance of groundwater science to water-utility operations is analysed from a broad international perspective, identifying key concerns and specific opportunities for the future. The strategic importance worldwide of water utilities assuming the role of lead stakeholders for integrated groundwater resource management, recognizing their often considerable technical know-how and highly significant data holdings, is emphasized. Concurrently, the utilities themselves will need an ever-closer appreciation of groundwater-system behaviour if they are to manage efficiently their water-supply and wastewater operations.
Williams, Kristi; Umberson, Debra
We work from a life course perspective to assess the impact of marital status and marital transitions on subsequent changes in the self-assessed physical health of men and women. Our results suggest three central conclusions regarding the association of marital status and marital transitions with self-assessed health. First, marital status differences in health appear to reflect the strains of marital dissolution more than they reflect any benefits of marriage. Second, the strains of marital ...
Santander, Jaime T; Pinedo, José P; Repetto, Paula L
Physicians should be exposed, during their training to basic concepts in psychology. To describe the current status of the formal teaching of health psychology or medical psychology in Chilean medical schools. We reviewed the programs of the courses including topics of Medical Psychology, Health Psychology and Behavioral Medicine at 18 medical schools in Chile, using a focused coding method. The contents and the time spent on these courses were considered and analyzed. Eighty three percent of medical schools have a Medical Psychology or related program, 56.3% are carried out during the first year of medical School teaching and the weekly load has an average of 4 hours. The contents are mixed and predominantly concerning general and developmental psychology, but also address specific issues of Medical Psychology in most cases. There is little clarity about the training issues to be addressed in medical psychology for medical students in Chile. It is necessary to define the minimum content that all medical graduates should learn.
Pilić, Leta; Dzakula, Aleksandar
Based on the previous research, there is strong association between low socioeconomic status (SES) and high morbidity and mortality rates. Even though association between SES and risky health behaviors as the main factors influencing health has been investigated in Croatian population, some questions are yet to be answered. The aim of this study was to investigate the presence of unhealthy diet, physical inactivity, smoking and excessive drinking in low, middle, and high socioeconomic group of adult Croatian population included in the cohort study on regionalism of cardiovascular health risk behaviors. We also investigated the association between SES measured by income, education and occupation, as well as single SES indicators, and risky health behaviors. We analyzed data on 1227 adult men and women (aged 19 and older at baseline) with complete data on health behaviors, SES and chronic diseases at baseline (2003) and 5-year follow up. Respondents were classified as being healthy or chronically ill. SES categories were derived from answers to questions on monthly household income, occupation and education by using two-step cluster analysis algorithm. At baseline, for the whole sample as well as for healthy respondents, SES was statistically significantly associated with unhealthy diet (whole sample/healthy respondents: p = 0.001), physical inactivity (whole sample/healthy respondents p = 0.44/ p = 0.007), and smoking (whole sample/healthy respondents p < 0.001/p = 0.002). The proportion of respondents with unhealthy diet was greatest in the lowest social class, smokers in the middle and physically inactive in the high social class. During the follow up, smoking and physical inactivity remained statis