Universal health coverage in 'One ASEAN': are migrants included?

Science.gov (United States)

Guinto, Ramon Lorenzo Luis R; Curran, Ufara Zuwasti; Suphanchaimat, Rapeepong; Pocock, Nicola S

2015-01-01

As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC beyond the basis of

Decreasing health disparities for people with disabilities through improved communication strategies and awareness.

Science.gov (United States)

Sharby, Nancy; Martire, Katharine; Iversen, Maura D

2015-03-19

Factors influencing access to health care among people with disabilities (PWD) include: attitudes of health care providers and the public, physical barriers, miscommunication, income level, ethnic/minority status, insurance coverage, and lack of information tailored to PWD. Reducing health care disparities in a population with complex needs requires implementation at the primary, secondary and tertiary levels. This review article discusses common barriers to health care access from the patient and provider perspective, particularly focusing on communication barriers and how to address and ameliorate them. Articles utilized in this review were published from 2005 to present in MEDLINE and CINAHL and written in English that focused on people with disabilities. Topics searched for in the literature include: disparities and health outcomes, health care dissatisfaction, patient-provider communication and access issues. Ineffective communication has significant impacts for PWD. They frequently believe that providers are not interested in, or sensitive to their particular needs and are less likely to seek care or to follow up with recommendations. Various strategies for successful improvement of health outcomes for PWD were identified including changing the way health care professionals are educated regarding disabilities, improving access to health care services, and enhancing the capacity for patient centered care.

Radiation and nuclear safety included in the environmental health programme

International Nuclear Information System (INIS)

Salomaa, S.

1996-01-01

Finland is currently preparing a national environmental health programme, the objective of which is to chart the main environmental health problems in Finland, to identify means for securing a healthy environment, and to draw up a practical action programme for preventing and rectifying problems pertaining to environmental health. Radiation and nuclear safety form an essential part of preventive health care. The action programme is based on decisions and programmes approved at the WHO Conference on the Environment and Health, held in Helsinki in June 1994. In addition to the state of the Finnish environment and the health of the Finnish population, the programme addresses the relevant international issues, in particular in areas adjacent to Finland. The Committee on Environmental Health is expected to complete its work by the end of the year. A wide range of representatives from various branches of administration have contributed to the preparation of the programme. Besides physical, biological and chemical factors, the environmental factors affecting health also include the physical environment and the psychological, social and aesthetic features of the environment. Similarly, environmental factors that have an impact on the health of present or future generations, on the essential preconditions of life and on the quality of life are investigated. The serious risk to nature caused by human actions is also considered as a potential risk to human health. (orig.)

The need to include Health Impact Assessment at the International Monetary Fund.

Science.gov (United States)

Cave, Ben; Birley, Martin

2010-01-01

The lending and technical support provided by the International Monetary Fund affect the determinants of health and healthy equity. Most health determinants lie outside the control of the health sector, and thus non-health-sector policies have profound positive and negative effects on population health. Health Impact Assessment (HIA) is an instrument for identifying the effect of policies, plans, programs, and projects on population health and health equity. It is a feasible, cost-effective, and transparent process that has been adopted by several financial institutions, including members of the World Bank Group. Adopting HIA would assist the IMF in ensuring that the potential health consequences of its policies are identified and addressed.

Global agenda, local health: including concepts of health security in preparedness programs at the jurisdictional level.

Science.gov (United States)

Eby, Chas

2014-01-01

The Global Health Security Agenda's objectives contain components that could help health departments address emerging public health challenges that threaten the population. As part of the agenda, partner countries with advanced public health systems will support the development of infrastructure in stakeholder health departments. To facilitate this process and augment local programs, state and local health departments may want to include concepts of health security in their public health preparedness offices in order to simultaneously build capacity. Health security programs developed by public health departments should complete projects that are closely aligned with the objectives outlined in the global agenda and that facilitate the completion of current preparedness grant requirements. This article identifies objectives and proposes tactical local projects that run parallel to the 9 primary objectives of the Global Health Security Agenda. Executing concurrent projects at the international and local levels in preparedness offices will accelerate the completion of these objectives and help prevent disease epidemics, detect health threats, and respond to public health emergencies. Additionally, future funding tied or related to health security may become more accessible to state and local health departments that have achieved these objectives.

Health Consumers eHealth Literacy to Decrease Disparities in Accessing eHealth Information.

Science.gov (United States)

Park, Hyejin; Cormier, Eileen; Glenna, Gordon

2016-01-01

The purpose of this study was to assess the perceived eHealth literacy of a general health consumer population so that health care professionals can effectively address skills gaps in health consumers' ability to access and use high quality online health information. Participants were recruited from three public library branches in a Northeast Florida community. The eHealth literacy scale (eHEALS) was used. The majority of participants (n = 108) reported they knew how and where to find health information and how to use it to make health decisions; knowledge of what health resources were available and confidence in the ability to distinguish high from low quality information was considerably less. The findings suggest the need for eHealth education and support to health consumers from health care professionals, in particular, how to access and evaluate the quality of health information.

Cancer prehabilitation: an opportunity to decrease treatment-related morbidity, increase cancer treatment options, and improve physical and psychological health outcomes.

Science.gov (United States)

Silver, Julie K; Baima, Jennifer

2013-08-01

Cancer prehabilitation, a process on the continuum of care that occurs between the time of cancer diagnosis and the beginning of acute treatment, includes physical and psychological assessments that establish a baseline functional level, identifies impairments, and provides targeted interventions that improve a patient's health to reduce the incidence and the severity of current and future impairments. There is a growing body of scientific evidence that supports preparing newly diagnosed cancer patients for and optimizing their health before starting acute treatments. This is the first review of cancer prehabilitation, and the purpose was to describe early studies in the noncancer population and then the historical focus in cancer patients on aerobic conditioning and building strength and stamina through an appropriate exercise regimen. More recent research shows that opportunities exist to use other unimodal or multimodal prehabilitation interventions to decrease morbidity, improve physical and psychological health outcomes, increase the number of potential treatment options, decrease hospital readmissions, and reduce both direct and indirect healthcare costs attributed to cancer. Future research may demonstrate increased compliance with acute cancer treatment protocols and, therefore, improved survival outcomes. New studies suggest that a multimodal approach that incorporates both physical and psychological prehabilitation interventions may be more effective than a unimodal approach that addresses just one or the other. In an impairment-driven cancer rehabilitation model, identifying current and anticipating future impairments are the critical first steps in improving healthcare outcomes and decreasing costs. More research is urgently needed to evaluate the most effective prehabilitation interventions, and combinations thereof, for survivors of all types of cancer.

Including customers in health service design.

Science.gov (United States)

Perrott, Bruce E

2013-01-01

This article will explore the concept and meaning of codesign as it applies to the delivery of health services. The results of a pilot study in health codesign will be used as a research based case discussion, thus providing a platform to suggest future research that could lead to building more robust knowledge of how the consumers of health services may be more effectively involved in the process of developing and delivering the type of services that are in line with expectations of the various stakeholder groups.

Universal health coverage in ‘One ASEAN’: are migrants included?

Science.gov (United States)

Guinto, Ramon Lorenzo Luis R.; Curran, Ufara Zuwasti; Suphanchaimat, Rapeepong; Pocock, Nicola S.

2015-01-01

Background As the Association of South East Asian Nations (ASEAN) gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC) reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. Design A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. Results In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as they redefine UHC

Universal health coverage in ‘One ASEAN’: are migrants included?

Directory of Open Access Journals (Sweden)

Ramon Lorenzo Luis R. Guinto

2015-01-01

Full Text Available Background: As the Association of South East Asian Nations (ASEAN gears toward full regional integration by 2015, the cross-border mobility of workers and citizens at large is expected to further intensify in the coming years. While ASEAN member countries have already signed the Declaration on the Protection and Promotion of the Rights of Migrant Workers, the health rights of migrants still need to be addressed, especially with ongoing universal health coverage (UHC reforms in most ASEAN countries. This paper seeks to examine the inclusion of migrants in the UHC systems of five ASEAN countries which exhibit diverse migration profiles and are currently undergoing varying stages of UHC development. Design: A scoping review of current migration trends and policies as well as ongoing UHC developments and migrant inclusion in UHC in Indonesia, Malaysia, Philippines, Singapore, and Thailand was conducted. Results: In general, all five countries, whether receiving or sending, have schemes that cover migrants to varying extents. Thailand even allows undocumented migrants to opt into its Compulsory Migrant Health Insurance scheme, while Malaysia and Singapore are still yet to consider including migrants in their government-run UHC systems. In terms of predominantly sending countries, the Philippines's social health insurance provides outbound migrants with portable insurance yet with limited benefits, while Indonesia still needs to strengthen the implementation of its compulsory migrant insurance which has a health insurance component. Overall, the five ASEAN countries continue to face implementation challenges, and will need to improve on their UHC design in order to ensure genuine inclusion of migrants, including undocumented migrants. However, such reforms will require strong political decisions from agencies outside the health sector that govern migration and labor policies. Furthermore, countries must engage in multilateral and bilateral dialogue as

Comprehensive adolescent health programs that include sexual and reproductive health services: a systematic review.

Science.gov (United States)

Kågesten, Anna; Parekh, Jenita; Tunçalp, Ozge; Turke, Shani; Blum, Robert William

2014-12-01

We systematically reviewed peer-reviewed and gray literature on comprehensive adolescent health (CAH) programs (1998-2013), including sexual and reproductive health services. We screened 36 119 records and extracted articles using predefined criteria. We synthesized data into descriptive characteristics and assessed quality by evidence level. We extracted data on 46 programs, of which 19 were defined as comprehensive. Ten met all inclusion criteria. Most were US based; others were implemented in Egypt, Ethiopia, and Mexico. Three programs displayed rigorous evidence; 5 had strong and 2 had modest evidence. Those with rigorous or strong evidence directly or indirectly influenced adolescent sexual and reproductive health. The long-term impact of many CAH programs cannot be proven because of insufficient evaluations. Evaluation approaches that take into account the complex operating conditions of many programs are needed to better understand mechanisms behind program effects.

Including Health in Environmental Assessments of Major Transport Infrastructure Projects: A Documentary Analysis.

Science.gov (United States)

Riley, Emily; Harris, Patrick; Kent, Jennifer; Sainsbury, Peter; Lane, Anna; Baum, Fran

2018-05-10

Transport policy and practice impacts health. Environmental Impact Assessments (EIAs) are regulated public policy mechanisms that can be used to consider the health impacts of major transport projects before they are approved. The way health is considered in these environmental assessments (EAs) is not well known. This research asked: How and to what extent was human health considered in EAs of four major transport projects in Australia. We developed a comprehensive coding framework to analyse the Environmental Impact Statements (EISs) of four transport infrastructure projects: three road and one light rail. The coding framework was designed to capture how health was directly and indirectly included. We found that health was partially considered in all four EISs. In the three New South Wales (NSW) projects, but not the one South Australian project, this was influenced by the requirements issued to proponents by the government which directed the content of the EIS. Health was assessed using human health risk assessment (HHRA). We found this to be narrow in focus and revealed a need for a broader social determinants of health approach, using multiple methods. The road assessments emphasised air quality and noise risks, concluding these were minimal or predicted to improve. The South Australian project was the only road project not to include health data explicitly. The light rail EIS considered the health benefits of the project whereas the others focused on risk. Only one project considered mental health, although in less detail than air quality or noise. Our findings suggest EIAs lag behind the known evidence linking transport infrastructure to health. If health is to be comprehensively included, a more complete model of health is required, as well as a shift away from health risk assessment as the main method used. This needs to be mandatory for all significant developments. We also found that considering health only at the EIA stage may be a significant

Identifying Health Consumers' eHealth Literacy to Decrease Disparities in Accessing eHealth Information.

Science.gov (United States)

Park, Hyejin; Cormier, Eileen; Gordon, Glenna; Baeg, Jung Hoon

2016-02-01

The increasing amount of health information available on the Internet highlights the importance of eHealth literacy skills for health consumers. Low eHealth literacy results in disparities in health consumers' ability to access and use eHealth information. The purpose of this study was to assess the perceived eHealth literacy of a general health consumer population so that healthcare professionals can effectively address skills gaps in health consumers' ability to access and use high-quality online health information. Participants were recruited from three public library branches in a Northeast Florida community. The eHealth Literacy Scale was used. The majority of participants (n = 108) reported they knew how and where to find health information and how to use it to make health decisions; knowledge of what health resources were available and confidence in the ability to distinguish high- from low-quality information were considerably less. The findings suggest the need for eHealth education and support to health consumers from healthcare professionals, in particular, how to access and evaluate the quality of health information.

Decreased mental health care utilization following a psychosocial intervention in caregivers of hematopoietic stem cell transplant patients

Directory of Open Access Journals (Sweden)

Rita Ouseph

2014-03-01

Full Text Available Caregivers are known to experience increased morbidity when compared to non-caregivers. Does an intervention targeting caregiver distress affect their health care utilization? One hundred forty-eight caregivers of allogeneic hematopoietic stem cell transplant patients were randomized to treatment as usual (TAU or a psychoeducation, paced respiration, and relaxation (PEPRR intervention. Assessments of caregivers’ service utilization were collected at baseline and 1, 3, and 6 months post-transplant. During the first 30 days after patient transplant, caregiver medical and mental health professional service use decreased while support group attendance peaked. Mixed model regressions showed a significant decrease in mental health service use by the PEPRR group (P=0.001. At six months caregivers in TAU had predicted marginal probabilities of mental health services utilization over 10 times as high as caregivers in PEPRR (18.1% vs 1.5%. Groups failed to differ in medical service (P=0.861 or support group (P=0.067 use. We can conclude that participation in PEPRR compared to TAU was associated with reduced mental health service utilization. Caregiver psychosocial support services are critical to improve caregiver outcomes.

Chronic stress and decreased physical exercise: impact on weight for African American women.

Science.gov (United States)

Moore-Greene, Gracie M; Gross, Susan M; Silver, Kristi D; Perrino, Carrol S

2012-01-01

African American women continue to have the highest prevalence of obesity in the United States and in the state of Maryland they are disproportionately affected by overweight and obesity. There are many contributing factors including chronic stress and the use of health behaviors such as physical exercise that play a role in increased weight for African American women. We examined the relationship of stress to weight and the role of physical exercise in African American paraprofessional women. Cross-sectional study African American paraprofessionals were asked about their perspectives regarding association with chronic stress and physical exercise. The three most salient stressors for the women were finances (33%), work (28%) and family/friends (19%). Ninety percent of the women were overweight or obese. Significant predictors of increased BMI were lack of physical exercise (P = .004) and health compared to others (P = .006). Ethnic discrimination was a form of chronic stress (r = .319) but was not correlated with BMI (r = .095). Decreased physical exercise (P = .02) mediated the relationship between chronic stress and BMI. Findings regarding finance and work stress suggest the need for employers to consider the impact of job strain when implementing employee health programs to decrease stress and improve health. A focus on decreased physical exercise, unhealthy eating habits and misperceptions regarding increased risk for obesity related diseases with health status may be helpful to include in intervention strategies to decrease obesity for this population.

Optimal allocation of resources over health care programmes: dealing with decreasing marginal utility and uncertainty.

Science.gov (United States)

Al, Maiwenn J; Feenstra, Talitha L; Hout, Ben A van

2005-07-01

This paper addresses the problem of how to value health care programmes with different ratios of costs to effects, specifically when taking into account that these costs and effects are uncertain. First, the traditional framework of maximising health effects with a given health care budget is extended to a flexible budget using a value function over money and health effects. Second, uncertainty surrounding costs and effects is included in the model using expected utility. Other approaches to uncertainty that do not specify a utility function are discussed and it is argued that these also include implicit notions about risk attitude.

A conceptual model for worksite intelligent physical exercise training - IPET - intervention for decreasing life style health risk indicators among employees

DEFF Research Database (Denmark)

Sjøgaard, Gisela; Justesen, Just Bendix; Murray, Mike

2014-01-01

BACKGROUND: Health promotion at the work site in terms of physical activity has proven positive effects but optimization of relevant exercise training protocols and implementation for high adherence are still scanty.Methods/design: The aim of this paper is to present a study protocol with a conce......BACKGROUND: Health promotion at the work site in terms of physical activity has proven positive effects but optimization of relevant exercise training protocols and implementation for high adherence are still scanty.Methods/design: The aim of this paper is to present a study protocol...... parts, and functional training including balance training. The hypotheses of this research are that individually tailored worksite-based intelligent physical exercise training, IPET, among workers with inactive job categories will: 1) Improve cardiorespiratory fitness and/or individual health risk...... indicators, 2) Improve muscle strength and decrease musculoskeletal disorders, 3) Succeed in regular adherence to worksite and leisure physical activity training, and 3) Reduce sickness absence and productivity losses (presenteeism) in office workers. The present RCT study enrolled almost 400 employees...

The traditional Korean dietary pattern is associated with decreased risk of metabolic syndrome: findings from the Korean National Health and Nutrition Examination Survey, 1998-2009.

Science.gov (United States)

Lee, Kyung Won; Cho, Mi Sook

2014-01-01

The traditional Korean diet has several healthy components, including abundant vegetables, fermented foods, a variety of foodstuffs, and a balance of animal and vegetable food intake. Although the traditional Korean diet has many healthy components, few studies have been conducted on the health advantages of the Korean dietary pattern. This study is intended to clarify the relationship between Korean dietary patterns and chronic diseases using the Integrated Korean Dietary Pattern Score (I-KDPS). I-KDPS is an index for measuring Korean dietary patterns based on traditional Korean meals and reflects the complex and multifaceted characteristics of Korean food culture. I-KDPS is composed of seven items to measure the level of balance and adequacy of Korean food consumption, with a maximum score of 60. When I-KDPS was applied to the Korean National Health and Nutrition Examination Survey (1998-2009), a nationwide survey, I-KDPS was closely related to the risk of metabolic syndrome. Even though there were a few differences among the years surveyed, the risk of metabolic syndrome, obesity, hypertension, and hypertriglyceridemia significantly decreased as I-KDPS increased. These results indicate that risk of diseases, including metabolic syndrome, decreases in individuals adhering to traditional Korean dietary patterns in adequate levels and those who eat a balanced diet. The result of this study shows that the traditional Korean table setting, which comprises side dishes, including seasoned vegetables, grilled dishes, and fermented products with cooked rice (bap), soup (guk), and kimchi, contains traits that help prevent metabolic syndrome. I-KDPS coupled with the basic study of the healthfulness of the Korean dietary lifestyle is expected to help establish a foundation for continuous development of health promoting Korean foods and dietary culture.

Technology-Based Interventions for Asthma-Can They Help Decrease Health Disparities?

Science.gov (United States)

Baptist, Alan P; Islam, Nishat; Joseph, Christine L M

Asthma is a condition that has consistently demonstrated significant health outcome inequalities for minority populations. One approach used for care of patients with asthma is the incorporation of technology for behavioral modification, symptom monitoring, education, and/or treatment decision making. Whether such technological interventions can improve the care of black and inner-city patients is unknown. We reviewed all randomized controlled trial technological interventions from 2000 to 2015 performed in minority populations. A total of 16 articles met inclusion and exclusion criteria; all but 1 was performed in a childhood or adolescent age group. The interventions used MPEG audio layer-3 players, text messaging, computer/Web-based systems, video games, and interactive voice response. Many used tailored content and/or a specific behavior theory. Although the interventions were based on technology, most required additional special staffing. Subject user satisfaction was positive, and improvements were noted in asthma knowledge, medication adherence, asthma symptoms, and quality of life. Unfortunately, health care utilization (emergency department visits and/or hospitalizations) was typically not improved by the interventions. Although no single intervention modality was vastly superior, the computer-based interventions appeared to have the most positive results. In summary, technology-based interventions have a high level of user satisfaction among minority and urban/low-income individuals with asthma, and can improve asthma outcomes. Further large-scale studies are needed to assess whether such interventions can decrease health disparities in asthma. Copyright © 2016 American Academy of Allergy, Asthma & Immunology. Published by Elsevier Inc. All rights reserved.

Conducting Accessible Research: Including People With Disabilities in Public Health, Epidemiological, and Outcomes Studies.

Science.gov (United States)

Rios, Dianne; Magasi, Susan; Novak, Catherine; Harniss, Mark

2016-12-01

People with disabilities are largely absent from mainstream health research. Exclusion of people with disabilities may be explicit, attributable to poorly justified exclusion criteria, or implicit, attributable to inaccessible study documents, interventions, or research measures. Meanwhile, people with disabilities experience poorer health, greater incidence of chronic conditions, and higher health care expenditure than people without disabilities. We outline our approach to "accessible research design"-research accessible to and inclusive of people with disabilities. We describe a model that includes 3 tiers: universal design, accommodations, and modifications. Through our work on several large-scale research studies, we provide pragmatic examples of accessible research design. Making efforts to include people with disabilities in public health, epidemiological, and outcomes studies will enhance the interpretability of findings for a significant patient population.

Ergonomics work stations decreases the health impairment and saves electrical energy at the woodworking workshop in Bali, Indonesia.

Science.gov (United States)

Sudiajeng, Lilik; Adiputra, Nyoman; Leibbrandt, Richard

2012-12-01

This research was conducted to assess the positive effect of the ergonomics work station on the health impairment and electrical energy usage at the woodworking workshop in Bali, Indonesia. Woodworking workshops are dangerous, particularly when they are used improperly. Workers are exposed to health hazards that cause health impairment and inefficiencies in their work conditions. A preliminary study at a woodworking workshop at the Bali State Polytechnic showed that the work station was not suitable to body size of the participants and caused awkward postures. In addition, there was also an inappropriate physical work environment. Both inappropriate work station and physical work environment caused participants to be less active and motivated. This paper reports on an experimental study into the effects of an ergonomic intervention at this workshop. The participants were 2 groups of male students with 10 participants in each group. The first group performed the task with the original work station as a control group, while the second group performed the task with the new work station. The study found a significant difference between groups (p work station decreased the working heart rate (16.7%), the total score of musculoskeletal disorders (17.3%), and the total score of psychological fatigue (21.5%). Furthermore, it also decreased the electrical energy usage (38.7%). This shows that an ergonomics intervention on work station decreased the health impairment and saved electrical energy usage. It also protected the workers from woodworking hazards and allowed participants to perform their tasks in healthy, safe, convenient and efficient work conditions.

Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

Energy Technology Data Exchange (ETDEWEB)

ORAU' s Oak Ridge Institute for Science Education (HCTT-CHE)

2011-04-14

The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster - readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that - help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. This tool has been reviewed by a variety of key subject matter experts from federal, state, and local agencies and organizations. It also has been piloted with various communities that consist of different population sizes, to include large urban to small rural communities.

Health impact assessment of transport policies in Rotterdam: Decrease of total traffic and increase of electric car use.

Science.gov (United States)

Tobollik, Myriam; Keuken, Menno; Sabel, Clive; Cowie, Hilary; Tuomisto, Jouni; Sarigiannis, Denis; Künzli, Nino; Perez, Laura; Mudu, Pierpaolo

2016-04-01

Green house gas (GHG) mitigation policies can be evaluated by showing their co-benefits to health. Health Impact Assessment (HIA) was used to quantify co-benefits of GHG mitigation policies in Rotterdam. The effects of two separate interventions (10% reduction of private vehicle kilometers and a share of 50% electric-powered private vehicle kilometers) on particulate matter (PM2.5), elemental carbon (EC) and noise (engine noise and tyre noise) were assessed using Years of Life Lost (YLL) and Years Lived with Disability (YLD). The baseline was 2010 and the end of the assessment 2020. The intervention aimed at reducing traffic is associated with a decreased exposure to noise resulting in a reduction of 21 (confidence interval (CI): 11-129) YLDs due to annoyance and 35 (CI: 20-51) YLDs due to sleep disturbance for the population per year. The effects of 50% electric-powered car use are slightly higher with a reduction of 26 (CI: 13-116) and 41 (CI: 24-60) YLDs, respectively. The two interventions have marginal effects on air pollution, because already implemented traffic policies will reduce PM2.5 and EC by around 40% and 60% respectively, from 2010 to 2020. The evaluation of planned interventions, related to climate change policies, targeting only the transport sector can result in small co-benefits for health, if the analysis is limited to air pollution and noise. This urges to expand the analysis by including other impacts, e.g. physical activity and well-being, as a necessary step to better understanding consequences of interventions and carefully orienting resources useful to build knowledge to improve public health. Copyright © 2016 Elsevier Inc. All rights reserved.

Changes in Everyday and Digital Health Technology Use Among Seniors in Declining Health.

Science.gov (United States)

Levine, David M; Lipsitz, Stuart R; Linder, Jeffrey A

2018-03-14

U.S. seniors' digital health and everyday technology use when their health declines are unknown. Longitudinal cohort using the National Health and Aging Trends Study, a nationally representative, annually administered sample of community-dwelling Medicare beneficiaries (n = 4,037). We used difference-in-differences to assess the adjusted difference (AD) in technology use from 2011 to 2014 between those with and without health declines. Health decline measures included new-onset dementia; new-onset depression; decreases in activities of daily living (ADLs), short physical performance battery (SPPB), grip strength, and self-reported health; relocation to nursing facility; increased hospitalizations; and new-onset comorbidity. Digital health included use of the Internet to research health conditions, contact clinicians, fill prescriptions, and address insurance matters. Between 2011 and 2014, seniors experiencing health decline used various digital health technologies at low absolute rates (range: 1%-20%). Between 2011 and 2014, use of everyday technology decreased significantly among seniors with new-onset dementia (from 73% to 51%; AD, -26%), decreased ADLs (from 76% to 67%; AD, -10%), decreased SPPB (from 88% to 86%; AD, -3%), and relocation to a nursing facility (from 49% to 22%; AD, -31%) compared to seniors without comparable decline (all p seniors with new-onset probable dementia (from 9% to 4%; AD, -6%) and decreased SPPB (from 24% to 25%; AD, -4%; all p senior experiences predicts technology use, which may allow better targeting of digital health to specific seniors. Seniors with new dementia, relocation to a nursing home, and declining physical performance seem especially poor candidates for technology interventions.

Health impact assessment of transport policies in Rotterdam: Decrease of total traffic and increase of electric car use

International Nuclear Information System (INIS)

Tobollik, Myriam; Keuken, Menno; Sabel, Clive; Cowie, Hilary; Tuomisto, Jouni; Sarigiannis, Denis; Künzli, Nino; Perez, Laura; Mudu, Pierpaolo

2016-01-01

Background: Green house gas (GHG) mitigation policies can be evaluated by showing their co-benefits to health. Method: Health Impact Assessment (HIA) was used to quantify co-benefits of GHG mitigation policies in Rotterdam. The effects of two separate interventions (10% reduction of private vehicle kilometers and a share of 50% electric-powered private vehicle kilometers) on particulate matter (PM 2.5 ), elemental carbon (EC) and noise (engine noise and tyre noise) were assessed using Years of Life Lost (YLL) and Years Lived with Disability (YLD). The baseline was 2010 and the end of the assessment 2020. Results: The intervention aimed at reducing traffic is associated with a decreased exposure to noise resulting in a reduction of 21 (confidence interval (CI): 11–129) YLDs due to annoyance and 35 (CI: 20–51) YLDs due to sleep disturbance for the population per year. The effects of 50% electric-powered car use are slightly higher with a reduction of 26 (CI: 13–116) and 41 (CI: 24–60) YLDs, respectively. The two interventions have marginal effects on air pollution, because already implemented traffic policies will reduce PM 2.5 and EC by around 40% and 60% respectively, from 2010 to 2020. Discussion: The evaluation of planned interventions, related to climate change policies, targeting only the transport sector can result in small co-benefits for health, if the analysis is limited to air pollution and noise. This urges to expand the analysis by including other impacts, e.g. physical activity and well-being, as a necessary step to better understanding consequences of interventions and carefully orienting resources useful to build knowledge to improve public health. - Highlights: • We estimated co-benefits of greenhouse gas reduction policies from 2010 to 2020. • The city scale health impact assessment base on real transport policy scenarios. • Effects of particulate matter, elemental carbon and noise on health are assessed. • The effects are rather

Health impact assessment of transport policies in Rotterdam: Decrease of total traffic and increase of electric car use

Energy Technology Data Exchange (ETDEWEB)

Tobollik, Myriam, E-mail: mtobollik@uni-bielefeld.de [School of Public Health, Bielefeld University, Bielefeld (Germany); German Environment Agency, Section Exposure Assessment and Environmental Health Indicators, Corrensplatz 1, 14195 Berlin (Germany); Keuken, Menno [Netherlands Applied Research Organization (TNO), Utrecht (Netherlands); Sabel, Clive [School of Geographical Sciences, University of Bristol, Bristol (United Kingdom); Cowie, Hilary [Institute of Occupational Medicine, Edinburgh (United Kingdom); Tuomisto, Jouni [National Institute for Health and Welfare Kuopio, Kuopio (Finland); Sarigiannis, Denis [Aristotle University of Thessaloniki, Thessaloniki (Greece); Künzli, Nino; Perez, Laura [Swiss Tropical and Public Health Institute, Basel (Switzerland); University of Basel, Basel (Switzerland); Mudu, Pierpaolo, E-mail: mudup@ecehbonn.euro.who.int [WHO European Centre for Environment and Health, World Health Organization Regional Office for Europe, Bonn (Germany)

2016-04-15

Background: Green house gas (GHG) mitigation policies can be evaluated by showing their co-benefits to health. Method: Health Impact Assessment (HIA) was used to quantify co-benefits of GHG mitigation policies in Rotterdam. The effects of two separate interventions (10% reduction of private vehicle kilometers and a share of 50% electric-powered private vehicle kilometers) on particulate matter (PM{sub 2.5}), elemental carbon (EC) and noise (engine noise and tyre noise) were assessed using Years of Life Lost (YLL) and Years Lived with Disability (YLD). The baseline was 2010 and the end of the assessment 2020. Results: The intervention aimed at reducing traffic is associated with a decreased exposure to noise resulting in a reduction of 21 (confidence interval (CI): 11–129) YLDs due to annoyance and 35 (CI: 20–51) YLDs due to sleep disturbance for the population per year. The effects of 50% electric-powered car use are slightly higher with a reduction of 26 (CI: 13–116) and 41 (CI: 24–60) YLDs, respectively. The two interventions have marginal effects on air pollution, because already implemented traffic policies will reduce PM{sub 2.5} and EC by around 40% and 60% respectively, from 2010 to 2020. Discussion: The evaluation of planned interventions, related to climate change policies, targeting only the transport sector can result in small co-benefits for health, if the analysis is limited to air pollution and noise. This urges to expand the analysis by including other impacts, e.g. physical activity and well-being, as a necessary step to better understanding consequences of interventions and carefully orienting resources useful to build knowledge to improve public health. - Highlights: • We estimated co-benefits of greenhouse gas reduction policies from 2010 to 2020. • The city scale health impact assessment base on real transport policy scenarios. • Effects of particulate matter, elemental carbon and noise on health are assessed. • The effects are

Structured learning and self-reflection: strategies to decrease anxiety in the psychiatric mental health clinical nursing experience.

Science.gov (United States)

Ganzer, Christine Anne; Zauderer, Cheryl

2013-01-01

The purpose of this qualitative study was to test a teaching-learning strategy to help nursing students decrease stress and anxiety that may be brought about by the psychiatric mental health clinical experience. Undergraduate nursing students are known to experience affective stress prior to their first psychiatric mental health clinical practicum. A stressful learning environment can affect the success of the student's clinical performance. Thirty nursing students participated in this study. A structured preclinical workshop combined with self-reflection provided insight into students' perceptions of the psychiatric mental health clinical experience. Overall, students reported that participating in the teaching-learning strategy and self-reflection helped mitigate Combining structured learning with self-reflection is a useful tool for helping nursing students increase self-awareness and ease anxiety that may interfere with learning.

42 CFR 417.155 - How the HMO option must be included in the health benefits plan.

Science.gov (United States)

2010-10-01

... printed materials that meet the requirements of § 417.124(b). (ii) Access may not be more restrictive or... benefits plan. 417.155 Section 417.155 Public Health CENTERS FOR MEDICARE & MEDICAID SERVICES, DEPARTMENT... Organizations in Employee Health Benefits Plans § 417.155 How the HMO option must be included in the health...

Does cognitive decline decrease health utility value in older adult patients with cancer?

Science.gov (United States)

Akechi, Tatsuo; Aiki, Sayo; Sugano, Koji; Uchida, Megumi; Yamada, Atsuro; Komatsu, Hirokazu; Ishida, Takashi; Kusumoto, Shigeru; Iida, Shinsuke; Okuyama, Toru

2017-05-01

Cognitive decline is common among older adults with cancer. The present study aimed to investigate the impact of cognitive decline on health utility value in older adults suffering from cancer. Consecutive patients aged 65 years or older with a primary diagnosis of malignant lymphoma or multiple myeloma were recruited. Patients were asked to complete the EuroQoL-5 (EQ-5D) scale to measure health utility and the Mini-Mental State Examination to assess cognitive decline. The potential impact of cognitive decline was investigated with univariate analysis. A multivariate regression analysis was conducted to control for potential confounding factors. Complete data were obtained from 87 patients, 29% of whom had cognitive decline. The mean ± SE EQ-5D score for patients with cognitive decline was significantly lower than that for those without cognitive decline (0.67 ± 0.04 vs 0.79 ± 0.03, t = 2.38, P = 0.02). However, multiple regression analysis showed that cognitive decline was not significantly associated with EQ-5D scores. Female sex and lower performance scores (worse physical condition) were significantly associated with EQ-5D scores. Cognitive decline may be involved in decreased health utility value in older adult patients with cancer. However, this effect does not seem to be independent, and the patient's physical condition may be a relevant confounding factor. © 2016 The Authors. Psychogeriatrics © 2016 Japanese Psychogeriatric Society.

Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients.

Science.gov (United States)

Benditz, Achim; Greimel, Felix; Auer, Patrick; Zeman, Florian; Göttermann, Antje; Grifka, Joachim; Meissner, Winfried; von Kunow, Frederik

2016-01-01

The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking. All patients included in the study had undergone total hip arthroplasty (THA). Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project "Quality Improvement in Postoperative Pain Management" (QUIPS). A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward. From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0) on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2). Over time, the maximum pain score decreased (mean 3.0, ±2.0), whereas patient satisfaction significantly increased (mean 9.8, ±0.4; p benchmarking a standardized pain management concept. But regular benchmarking, implementation of feedback mechanisms, and staff education made the pain management concept even more successful. Multidisciplinary teamwork and flexibility in adapting processes seem to be highly important for successful pain management.

Community Assessment Tool for Public Health Emergencies Including Pandemic Influenza

Energy Technology Data Exchange (ETDEWEB)

HCTT-CHE

2011-04-14

The Community Assessment Tool (CAT) for Public Health Emergencies Including Pandemic Influenza (hereafter referred to as the CAT) was developed as a result of feedback received from several communities. These communities participated in workshops focused on influenza pandemic planning and response. The 2008 through 2011 workshops were sponsored by the Centers for Disease Control and Prevention (CDC). Feedback during those workshops indicated the need for a tool that a community can use to assess its readiness for a disaster—readiness from a total healthcare perspective, not just hospitals, but the whole healthcare system. The CAT intends to do just that—help strengthen existing preparedness plans by allowing the healthcare system and other agencies to work together during an influenza pandemic. It helps reveal each core agency partners' (sectors) capabilities and resources, and highlights cases of the same vendors being used for resource supplies (e.g., personal protective equipment [PPE] and oxygen) by the partners (e.g., public health departments, clinics, or hospitals). The CAT also addresses gaps in the community's capabilities or potential shortages in resources. While the purpose of the CAT is to further prepare the community for an influenza pandemic, its framework is an extension of the traditional all-hazards approach to planning and preparedness. As such, the information gathered by the tool is useful in preparation for most widespread public health emergencies. This tool is primarily intended for use by those involved in healthcare emergency preparedness (e.g., community planners, community disaster preparedness coordinators, 9-1-1 directors, hospital emergency preparedness coordinators). It is divided into sections based on the core agency partners, which may be involved in the community's influenza pandemic influenza response.

Breastfeeding Is Associated with Decreased Childhood Maltreatment.

Science.gov (United States)

Kremer, Kristen P; Kremer, Theodore R

Child maltreatment has serious implications for youth outcomes, yet its associations with early parenting practices are not fully understood. This study investigated whether breastfeeding practices are correlated with childhood maltreatment. Data were utilized from the National Longitudinal Study of Adolescent to Adult Health, a nationally representative and longitudinal study of adolescents. The analytic sample comprised 4,159 adolescents. The outcome variables included four subtypes of childhood maltreatment (neglect, inadequate supervision, physical abuse, and sexual abuse). The primary independent variable was breastfeeding duration. Covariates of the child, mother, and household were included in analyses. Logistic regression models were employed to predict odds of maltreatment subtypes from breastfeeding duration and covariates. Compared with adolescents never breastfed, adolescents breastfed 9 months or longer had a reduced odds of having experienced neglect (odds ratio [OR] = 0.54; 95% confidence interval [CI] = 0.35-0.83) and sexual abuse (OR = 0.47; 95% CI = 0.24-0.93) after controlling for covariates. Breastfeeding duration is significantly associated with decreased childhood neglect and sexual abuse. Breastfeeding practices should be explored as a consideration among clinicians when assessing maltreatment risk. Further research should examine whether a causal relationship exists between breastfeeding and decreased maltreatment.

Post-Polio Health International including International Ventilator Users Network

Science.gov (United States)

... PHI Annual Reports Contact Us Copyright EDUCATION Post-Polio Health newsletter Health Care Considerations Handbook on the Late Effects ... Late Effects of Polio Post-Polio Syndrome (PPS) About Acute Polio Major ...

Decreased work ability associated to indoor air problems--An intervention (RCT) to promote health behavior.

Science.gov (United States)

Vuokko, Aki; Selinheimo, Sanna; Sainio, Markku; Suojalehto, Hille; Järnefelt, Heli; Virtanen, Marianna; Kallio, Eila; Hublin, Christer; Karvala, Kirsi

2015-07-01

Indoor air problems may induce respiratory irritation and inflammation. In occupational settings, long-lasting non-specific building-related symptomatology, not fully medically explained, is encountered. The symptomatology may lead to illness, avoidance behavior and decreased work ability. In Finland, investigations of workers suspected of occupational asthma have revealed excess disability. There are no well-established clinical practices for the condition. The aim was to develop a clinical intervention for patients with non-specific indoor air-related symptoms and decreased work ability. A randomized controlled trial including psychoeducation and promotion of health behavior was carried out in 55 patients investigated for causal relationship between work-related respiratory symptoms and moisture damaged workplaces. Inclusion criteria for disability was the work ability score (WAS)≤7 (scale 0-10) and indoor air-related sick leave ≥14 days the preceding year. After medical evaluation and the 3-session counseling intervention, follow-up at 6-months was assessed using self-evaluated work-ability, sick leave days, quality of life, and illness worries as outcome measures. The mean symptom history was 55.5 months. 82% (45 out of 55) had asthma with normal lung function tests in most cases, although reporting abundant asthma symptoms. 81% of patients (39/48) had symptomatology from multiple organ systems without biomedical explanation, despite environmental improvements at work place. At the psychological counseling sessions, 15 (60%) patients of the intervention (INT, n=25) group showed concerns of a serious disease and in 5 (20%), concerns and fears had led to avoidance and restricted personal life. In the 6-month follow-up, the outcomes in the INT group did not differ from the treatment as usual group. No intervention effects were found. Patients shared features with medically unexplained symptoms and sick building syndrome or idiopathic environmental intolerance

[Effectiveness of mental health training including active listening for managers].

Science.gov (United States)

Ikegami, Kazunori; Tagawa, Yoshimasa; Mafune, Kosuke; Hiro, Hisanori; Nagata, Shoji

2008-07-01

significant increases post-training in "Job demands", "Worksite support by supervisor" and "Worksite support by co-worker", subscales of the BJSQ 12 items version. Particularly, the "Worksite support by supervisor" subscale increased significantly in 8 of the 47 sections in a comparison among sections. In this present study, we investigated the effectiveness of mental health training including Active Listening for managers, and suggest that to train Active Listening and use it at the worksite possibly strengthens "Worksite support by supervisor".

78 FR 12358 - Cardinal Health, Financial Shared Services West, Including On-Site Leased Workers From Aerotek...

Science.gov (United States)

2013-02-22

... office financial services from India and the Philippines. Based on these findings, the Department is..., Financial Shared Services West, Including On- Site Leased Workers From Aerotek, eXcel Staffing, Experis..., applicable to workers of Cardinal Health, Financial Shared Services West, including on-site leased workers...

Chronic Childhood Trauma, Mental Health, Academic Achievement, and School-Based Health Center Mental Health Services

OpenAIRE

Larson, S; Chapman, S; Spetz, J; Brindis, CD

2017-01-01

Children and adolescents exposed to chronic trauma have a greater risk for mental health disorders and school failure. Children and adolescents of minority racial/ethnic groups and those living in poverty are at greater risk of exposure to trauma and less likely to have access to mental health services. School-based health centers (SBHCs) may be one strategy to decrease health disparities.Empirical studies between 2003 and 2013 of US pediatric populations and of US SBHCs were included if rese...

Expanding Health Technology Assessments to Include Effects on the Environment.

Science.gov (United States)

Marsh, Kevin; Ganz, Michael L; Hsu, John; Strandberg-Larsen, Martin; Gonzalez, Raquel Palomino; Lund, Niels

2016-01-01

There is growing awareness of the impact of human activity on the climate and the need to stem this impact. Public health care decision makers from Sweden and the United Kingdom have started examining environmental impacts when assessing new technologies. This article considers the case for incorporating environmental impacts into the health technology assessment (HTA) process and discusses the associated challenges. Two arguments favor incorporating environmental impacts into HTA: 1) environmental changes could directly affect people's health and 2) policy decision makers have broad mandates and objectives extending beyond health care. Two types of challenges hinder this process. First, the nascent evidence base is insufficient to support the accurate comparison of technologies' environmental impacts. Second, cost-utility analysis, which is favored by many HTA agencies, could capture some of the value of environmental impacts, especially those generating health impacts, but might not be suitable for addressing broader concerns. Both cost-benefit and multicriteria decision analyses are potential methods for evaluating health and environmental outcomes, but are less familiar to health care decision makers. Health care is an important and sizable sector of the economy that could warrant closer policy attention to its impact on the environment. Considerable work is needed to track decision makers' demands, augment the environmental evidence base, and develop robust methods for capturing and incorporating environmental data as part of HTA. Copyright © 2016 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

A conceptual model for worksite intelligent physical exercise training--IPET--intervention for decreasing life style health risk indicators among employees: a randomized controlled trial.

Science.gov (United States)

Sjøgaard, Gisela; Justesen, Just Bendix; Murray, Mike; Dalager, Tina; Søgaard, Karen

2014-06-26

Health promotion at the work site in terms of physical activity has proven positive effects but optimization of relevant exercise training protocols and implementation for high adherence are still scanty. The aim of this paper is to present a study protocol with a conceptual model for planning the optimal individually tailored physical exercise training for each worker based on individual health check, existing guidelines and state of the art sports science training recommendations in the broad categories of cardiorespiratory fitness, muscle strength in specific body parts, and functional training including balance training. The hypotheses of this research are that individually tailored worksite-based intelligent physical exercise training, IPET, among workers with inactive job categories will: 1) Improve cardiorespiratory fitness and/or individual health risk indicators, 2) Improve muscle strength and decrease musculoskeletal disorders, 3) Succeed in regular adherence to worksite and leisure physical activity training, and 3) Reduce sickness absence and productivity losses (presenteeism) in office workers. The present RCT study enrolled almost 400 employees with sedentary jobs in the private as well as public sectors. The training interventions last 2 years with measures at baseline as well as one and two years follow-up. If proven effective, the intelligent physical exercise training scheduled as well as the information for its practical implementation can provide meaningful scientifically based information for public health policy. ClinicalTrials.gov, number: NCT01366950.

Decreased health-related quality of life in disease-free survivors of differentiated thyroid cancer in Korea

Directory of Open Access Journals (Sweden)

Kim Kwang-Won

2010-09-01

Full Text Available Abstract Background Concern regarding the health-related quality of life (HRQOL of long-term survivors of thyroid cancer has risen due to the rapid increase in the incidence of thyroid cancer, which generally has an excellent prognosis. The aim of this study was to evaluate the status of HRQOL in disease-free survivors of differentiated thyroid carcinoma (DTC and to evaluate the important determinants of HRQOL. Methods This was a cross-sectional study in which we interviewed consecutive disease-free survivors of DTC. Three different validated questionnaires ("EORTC QLQ-C30" for various functional domains, the "brief fatigue inventory (BFI" and the "hospital anxiety and depression scale" (HADS were used. Data from a large, population based survey of 1,000 people were used as a control. Results The response rate for the questionnaires was 78.9% (316/401. Disease-free survivors of DTC showed a decreased HRQOL in all five functional domains (physical, role, cognitive, emotional, and social on the EORTC QLQ-C30 compared with controls (P P Conclusions Although disease-free survivors of DTC are expected to have disease-specific survival comparable to the general population, they experience a significantly decreased HRQOL. Anxiety, depression, and fatigue were the major determinants of the decreased HRQOL. Supportive psychological care should be integrated into the management of long-term survivors of DTC.

Is the phototransformation of pharmaceuticals a natural purification process that decreases ecological and human health risks?

International Nuclear Information System (INIS)

Wang, Xiao-Huan; Lin, Angela Yu-Chen

2014-01-01

Sunlight photodegradation has long been considered a significant process in lowering the concentrations of pharmaceuticals in surface waters and thus decreasing the ecological risk. For the first time, this study identified the significance of investigating the environmental photodegradation of a pharmaceutical residue mixture (rather than a single compound) and the associated toxicity of transformation byproducts in environmental waters, including rivers, hospital wastewaters, and effluents from wastewater treatment plants and pharmaceutical production facilities. Pharmaceuticals undergo phototransformation rather than mineralization (11–23% in 34 h). Pharmaceutical mixtures could possibly act as dissolved organic matter for each individual compound and subsequently affect the photolysis rates. The increased toxicity of irradiated pharmaceutical mixtures challenges the validity of the current understanding of sunlight photolysis. The implications of this work suggest that current knowledge concerning the occurrence, natural attenuation, ecotoxicity, and human health risks of pharmaceuticals is far from complete; photolysis is not necessarily a purification process. -- Highlights: • Pharmaceutical mixtures could possibly act as DOMs for each other. • Pharmaceuticals underwent merely phototransformation rather than mineralization. • Increased toxicity from photo byproducts associated with the pharmaceutical mixture. • Phototransformation does not necessary mitigate the risk to human and the ecosystem. -- Transformation byproducts associated with a pharmaceutical mixture could be more toxic, and phototransformation does not necessary mitigate the risk to humans and the ecosystem

Health and economic benefits of reducing sugar intake in the USA, including effects via non-alcoholic fatty liver disease: a microsimulation model

Science.gov (United States)

Vreman, Rick A; Goodell, Alex J; Rodriguez, Luis A; Porco, Travis C; Lustig, Robert H; Kahn, James G

2017-01-01

Objectives Excessive consumption of added sugars in the human diet has been associated with obesity, type 2 diabetes (T2D), coronary heart disease (CHD) and other elements of the metabolic syndrome. Recent studies have shown that non-alcoholic fatty liver disease (NAFLD) is a critical pathway to metabolic syndrome. This model assesses the health and economic benefits of interventions aimed at reducing intake of added sugars. Methods Using data from US National Health Surveys and current literature, we simulated an open cohort, for the period 2015–2035. We constructed a microsimulation model with Markov chains for NAFLD (including steatosis, non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC)), body mass index, T2D and CHD. We assessed reductions in population disease prevalence, disease-attributable disability-adjusted life years (DALYs) and costs, with interventions that reduce added sugars consumption by either 20% or 50%. Findings The model estimated that a 20% reduction in added sugars intake will reduce prevalence of hepatic steatosis, NASH, cirrhosis, HCC, obesity, T2D and CHD. Incidence of T2D and CHD would be expected to decrease by 19.9 (95% CI 12.8 to 27.0) and 9.4 (95% CI 3.1 to 15.8) cases per 100 000 people after 20 years, respectively. A 20% reduction in consumption is also projected to annually avert 0.767 million (M) DALYs (95% CI 0.757M to 0.777M) and a total of US$10.3 billion (B) (95% CI 10.2B to 10.4B) in discounted direct medical costs by 2035. These effects increased proportionally when added sugars intake were reduced by 50%. Conclusions The decrease in incidence and prevalence of disease is similar to results in other models, but averted costs and DALYs were higher, mainly due to inclusion of NAFLD and CHD. The model suggests that efforts to reduce consumption of added sugars may result in significant public health and economic benefits. PMID:28775179

Public Health and Unconventional Oil and Gas Extraction Including Fracking: Global Lessons from a Scottish Government Review.

Science.gov (United States)

Watterson, Andrew; Dinan, William

2018-04-04

Unconventional oil and gas extraction (UOGE) including fracking for shale gas is underway in North America on a large scale, and in Australia and some other countries. It is viewed as a major source of global energy needs by proponents. Critics consider fracking and UOGE an immediate and long-term threat to global, national, and regional public health and climate. Rarely have governments brought together relatively detailed assessments of direct and indirect public health risks associated with fracking and weighed these against potential benefits to inform a national debate on whether to pursue this energy route. The Scottish government has now done so in a wide-ranging consultation underpinned by a variety of reports on unconventional gas extraction including fracking. This paper analyses the Scottish government approach from inception to conclusion, and from procedures to outcomes. The reports commissioned by the Scottish government include a comprehensive review dedicated specifically to public health as well as reports on climate change, economic impacts, transport, geology, and decommissioning. All these reports are relevant to public health, and taken together offer a comprehensive review of existing evidence. The approach is unique globally when compared with UOGE assessments conducted in the USA, Australia, Canada, and England. The review process builds a useful evidence base although it is not without flaws. The process approach, if not the content, offers a framework that may have merits globally.

Do Undergraduate Engineering Faculty Include Occupational and Public Health and Safety in the Engineering Curriculum?

Science.gov (United States)

Farwell, Dianna; And Others

1995-01-01

The purpose of this study was to determine whether and, if so, why engineering faculty include occupational and public health and safety in their undergraduate engineering courses. Data were collected from 157 undergraduate engineering faculty from 65 colleges of engineering in the United States. (LZ)

Interventions for preventing, delaying the onset, or decreasing the burden of frailty: an overview of systematic reviews.

Science.gov (United States)

Wilson, Michael G; Béland, François; Julien, Dominic; Gauvin, Lise; Guindon, G Emmanuel; Roy, Denis; Campbell, Kaitryn; Comeau, Donna G; Davidson, Heather; Raina, Parminder; Sattler, Deborah; Vrkljan, Brenda

2015-09-25

Many systematic reviews have evaluated the effectiveness of interventions to prevent, delay, or decrease frailty symptoms, but no effort has been made to identify, map, and synthesize the findings from reviews across the full spectrum of interventions. Our objectives are to (1) synthesize findings from all existing systematic reviews evaluating interventions for preventing, delaying the onset, or decreasing the burden of frailty symptoms; (2) examine different conceptualizations of frailty that have been used in the development and implementation of interventions; and (3) inform policy by convening a stakeholder dialogue with Canadian health-system leaders. We will conduct an overview of systematic reviews to identify and synthesize all of the systematic reviews addressing interventions to preventing, delaying the onset, or decreasing the burden of frailty symptoms. To identify relevant systematic reviews, we will conduct database searches for published and grey literature as well as contact key experts and search reference lists of included reviews. Two reviewers will independently review all search results for inclusion and then conceptually map, extract key findings (including the conceptualization/definition of frailty used) and assess the methodological quality of all included reviews. We will then synthesize the findings by producing a 'gap map' (i.e. mapping reviews in a matrix according to the interventions and outcomes assessed), and narratively synthesize the key messages across reviews related to type of interventions. Following the completion of the synthesis, we will use the findings to develop an evidence brief that mobilizes the best available evidence about the problem related to preventing, delaying the onset, or decreasing the burden of frailty symptoms in older adults, policy and programmatic options to address the problem and implementation considerations. The evidence brief will then be used as the input into a stakeholder dialogue, which will

Public Health and Unconventional Oil and Gas Extraction Including Fracking: Global Lessons from a Scottish Government Review

Directory of Open Access Journals (Sweden)

Andrew Watterson

2018-04-01

Full Text Available Unconventional oil and gas extraction (UOGE including fracking for shale gas is underway in North America on a large scale, and in Australia and some other countries. It is viewed as a major source of global energy needs by proponents. Critics consider fracking and UOGE an immediate and long-term threat to global, national, and regional public health and climate. Rarely have governments brought together relatively detailed assessments of direct and indirect public health risks associated with fracking and weighed these against potential benefits to inform a national debate on whether to pursue this energy route. The Scottish government has now done so in a wide-ranging consultation underpinned by a variety of reports on unconventional gas extraction including fracking. This paper analyses the Scottish government approach from inception to conclusion, and from procedures to outcomes. The reports commissioned by the Scottish government include a comprehensive review dedicated specifically to public health as well as reports on climate change, economic impacts, transport, geology, and decommissioning. All these reports are relevant to public health, and taken together offer a comprehensive review of existing evidence. The approach is unique globally when compared with UOGE assessments conducted in the USA, Australia, Canada, and England. The review process builds a useful evidence base although it is not without flaws. The process approach, if not the content, offers a framework that may have merits globally.

Public Health and Unconventional Oil and Gas Extraction Including Fracking: Global Lessons from a Scottish Government Review

Science.gov (United States)

Watterson, Andrew

2018-01-01

Unconventional oil and gas extraction (UOGE) including fracking for shale gas is underway in North America on a large scale, and in Australia and some other countries. It is viewed as a major source of global energy needs by proponents. Critics consider fracking and UOGE an immediate and long-term threat to global, national, and regional public health and climate. Rarely have governments brought together relatively detailed assessments of direct and indirect public health risks associated with fracking and weighed these against potential benefits to inform a national debate on whether to pursue this energy route. The Scottish government has now done so in a wide-ranging consultation underpinned by a variety of reports on unconventional gas extraction including fracking. This paper analyses the Scottish government approach from inception to conclusion, and from procedures to outcomes. The reports commissioned by the Scottish government include a comprehensive review dedicated specifically to public health as well as reports on climate change, economic impacts, transport, geology, and decommissioning. All these reports are relevant to public health, and taken together offer a comprehensive review of existing evidence. The approach is unique globally when compared with UOGE assessments conducted in the USA, Australia, Canada, and England. The review process builds a useful evidence base although it is not without flaws. The process approach, if not the content, offers a framework that may have merits globally. PMID:29617318

A conceptual model for worksite intelligent physical exercise training - IPET - intervention for decreasing life style health risk indicators among employees: a randomized controlled trial

Science.gov (United States)

2014-01-01

Background Health promotion at the work site in terms of physical activity has proven positive effects but optimization of relevant exercise training protocols and implementation for high adherence are still scanty. Methods/Design The aim of this paper is to present a study protocol with a conceptual model for planning the optimal individually tailored physical exercise training for each worker based on individual health check, existing guidelines and state of the art sports science training recommendations in the broad categories of cardiorespiratory fitness, muscle strength in specific body parts, and functional training including balance training. The hypotheses of this research are that individually tailored worksite-based intelligent physical exercise training, IPET, among workers with inactive job categories will: 1) Improve cardiorespiratory fitness and/or individual health risk indicators, 2) Improve muscle strength and decrease musculoskeletal disorders, 3) Succeed in regular adherence to worksite and leisure physical activity training, and 3) Reduce sickness absence and productivity losses (presenteeism) in office workers. The present RCT study enrolled almost 400 employees with sedentary jobs in the private as well as public sectors. The training interventions last 2 years with measures at baseline as well as one and two years follow-up. Discussion If proven effective, the intelligent physical exercise training scheduled as well as the information for its practical implementation can provide meaningful scientifically based information for public health policy. Trial Registration ClinicalTrials.gov, number: NCT01366950. PMID:24964869

Health Promotion Behavior of Chinese International Students in Korea Including Acculturation Factors: A Structural Equation Model.

Science.gov (United States)

Kim, Sun Jung; Yoo, Il Young

2016-03-01

The purpose of this study was to explain the health promotion behavior of Chinese international students in Korea using a structural equation model including acculturation factors. A survey using self-administered questionnaires was employed. Data were collected from 272 Chinese students who have resided in Korea for longer than 6 months. The data were analyzed using structural equation modeling. The p value of final model is .31. The fitness parameters of the final model such as goodness of fit index, adjusted goodness of fit index, normed fit index, non-normed fit index, and comparative fit index were more than .95. Root mean square of residual and root mean square error of approximation also met the criteria. Self-esteem, perceived health status, acculturative stress and acculturation level had direct effects on health promotion behavior of the participants and the model explained 30.0% of variance. The Chinese students in Korea with higher self-esteem, perceived health status, acculturation level, and lower acculturative stress reported higher health promotion behavior. The findings can be applied to develop health promotion strategies for this population. Copyright © 2016. Published by Elsevier B.V.

[Materiality Analysis of Health Plans Based on Stakeholder Engagement and the Issues Included at ISO 26000:2010].

Science.gov (United States)

Moyano Santiago, Miguel Angel; Rivera Lirio, Juana María

2017-01-18

Health plans of the Spanish autonomous communities can incorporate sustainable development criteria in its development. There have been no analysis or proposals about development and indicators. The goal is to add a contribution to help build better health plans aimed at sustainable development and help to manage economic, social and environmental impacts of health systems criteria. We used a variation of the RAND/UCLA or modified Delphi technique method. The process consisted of a bibliographical and context matters and issues related to health and social responsibility analysis based on ISO 26000: 2010. A survey by deliberately to a selection of 70 expert members of the identified stakeholders was carried out and a discussion group was held to determine the consensus on the issues addressed in the survey sample. The research was conducted in 2015. From the literature review 33 health issues included in ISO 26000:2010 were obtained. 7 survey proved relevant high consensus, 8 relevance and average consensus and 18 with less relevance and high level of dissent. The expert group excluded 4 of the 18 subjects with less consensus. 29 issues included 33 at work, divided into 7 subjects contained in the guide ISO 26000 of social responsibility, were relevant stakeholders regarding possible inclusion in health plans. Considering the direct relationship published by ISO (International Organization for Standardization) among the issues ISO 26000 and the economic, social and environmental indicators in GRI (Global Reporting Initiative) in its G4 version, a panel with monitoring indicators related to relevant issues were elaborated.

The need to include obstetric nurses in prenatal care visits in the public health system

Directory of Open Access Journals (Sweden)

Selma Aparecida Lagrosa Garcia

2010-06-01

Full Text Available Objective: To investigate, with a qualitative approach, the role of Obstetric Nurses at the primary level of care given to women’s health as a vital component of the multidisciplinary team, which today is fundamental for providing care, prevention as well as health education and promotion, especially in programs whose activities are geared towards primary care of pregnant, parturient, and puerpera women. Methods: Brazilian laws and the determinations of Nursing Councils in reference to the activities of the obstetric nurse were researched, including the nurse’s responsibilities and limits. The bibliographic search was conducted in health-related journals, lay publications, and the Internet. Results: The conflicts between professional physicians and nurses were discussed. Conclusions: It was concluded that the activities of the nurse, conducting low-risk prenatal clinical visits in the basic healthcare network, has legal and ethical support and provides true benefit to the clients.

A health impact assessment of a proposed bill to decrease speed limits on local roads in Massachusetts (U.S.A.).

Science.gov (United States)

James, Peter; Ito, Kate; Banay, Rachel F; Buonocore, Jonathan J; Wood, Benjamin; Arcaya, Mariana C

2014-10-02

Decreasing traffic speeds increases the amount of time drivers have to react to road hazards, potentially averting collisions, and makes crashes that do happen less severe. Boston's regional planning agency, the Metropolitan Area Planning Council (MAPC), in partnership with the Massachusetts Department of Public Health (MDPH), conducted a Health Impact Assessment (HIA) that examined the potential health impacts of a proposed bill in the state legislature to lower the default speed limits on local roads from 30 miles per hour (mph) to 25 mph. The aim was to reduce vehicle speeds on local roads to a limit that is safer for pedestrians, cyclists, and children. The passage of this proposed legislation could have had far-reaching and potentially important public health impacts. Lower default speed limits may prevent around 18 fatalities and 1200 serious injuries to motorists, cyclists and pedestrians each year, as well as promote active transportation by making local roads feel more hospitable to cyclists and pedestrians. While a lower speed limit would increase congestion and slightly worsen air quality, the benefits outweigh the costs from both a health and economic perspective and would save the state approximately $62 million annually from prevented fatalities and injuries.

Should CAM and CAM Training Programs Be Included in the Curriculum of Schools That Provide Health Education?

Directory of Open Access Journals (Sweden)

2016-12-01

Full Text Available Objectives: This study aimed to determine the knowledge levels and attitudes of School of Health and Vocational School of Health students toward complementary and alternative medicine (CAM. Methods: Three hundred thirty-three (333 students studying at the Mehmet Akif Ersoy University School of Health and the Golhisar Vocational School of Health in Burdur, Turkey, were included in the study. Research data were collected by using a survey method based on the expressed opinions of the participants. Results: Of the participants, 69.7% were female and 97% were single (unmarried. Of cigarette users and those with chronic illnesses, 46.8% and 47.8%, respectively, used CAM. Those using CAM were statistically more likely to be female (P < 0.021, to have higher grades (P < 0.007, to be single (P < 0.005, to be vocational school of health graduates (P < 0.008, and to have fathers at work (P < 0.021. While 9.6% of the students thought CAM to be nonsense, 10.8% thought that the methods of CAM should be tried before consulting a doctor. Conclusion: A majority of the students in the study population were found to use complementary and alternative medicine, but that they lacked information about its methods. As a way to address this, CAM should be included in the curriculum of schools that provide health education, and CAM training programs should be given to healthcare professionals to improve their knowledge of CAM. In Turkey, many more studies should be performed to determine nurses’ and doctors’ knowledge of and attitudes about CAM methods so that they can give correct guidance to society and take more active responsibility in improving patient safety.

Cost-Utility Analysis of Extending Public Health Insurance Coverage to Include Diabetic Retinopathy Screening by Optometrists.

Science.gov (United States)

van Katwyk, Sasha; Jin, Ya-Ping; Trope, Graham E; Buys, Yvonne; Masucci, Lisa; Wedge, Richard; Flanagan, John; Brent, Michael H; El-Defrawy, Sherif; Tu, Hong Anh; Thavorn, Kednapa

2017-09-01

Diabetic retinopathy (DR) is one of the leading causes of vision loss and blindness in Canada. Eye examinations play an important role in early detection. However, DR screening by optometrists is not always universally covered by public or private health insurance plans. This study assessed whether expanding public health coverage to include diabetic eye examinations for retinopathy by optometrists is cost-effective from the perspective of the health care system. We conducted a cost-utility analysis of extended coverage for diabetic eye examinations in Prince Edward Island to include examinations by optometrists, not currently publicly covered. We used a Markov chain to simulate disease burden based on eye examination rates and DR progression over a 30-year time horizon. Results were presented as an incremental cost per quality-adjusted life year (QALY) gained. A series of one-way and probabilistic sensitivity analyses were performed. Extending public health coverage to eye examinations by optometrists was associated with higher costs ($9,908,543.32) and improved QALYs (156,862.44), over 30 years, resulting in an incremental cost-effectiveness ratio of $1668.43/QALY gained. Sensitivity analysis showed that the most influential determinants of the results were the cost of optometric screening and selected utility scores. At the commonly used threshold of $50,000/QALY, the probability that the new policy was cost-effective was 99.99%. Extending public health coverage to eye examinations by optometrists is cost-effective based on a commonly used threshold of $50,000/QALY. Findings from this study can inform the decision to expand public-insured optometric services for patients with diabetes. Copyright © 2017 International Society for Pharmacoeconomics and Outcomes Research (ISPOR). Published by Elsevier Inc. All rights reserved.

Health and economic benefits of reducing sugar intake in the USA, including effects via non-alcoholic fatty liver disease: a microsimulation model.

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Vreman, Rick A; Goodell, Alex J; Rodriguez, Luis A; Porco, Travis C; Lustig, Robert H; Kahn, James G

2017-08-03

Excessive consumption of added sugars in the human diet has been associated with obesity, type 2 diabetes (T2D), coronary heart disease (CHD) and other elements of the metabolic syndrome. Recent studies have shown that non-alcoholic fatty liver disease (NAFLD) is a critical pathway to metabolic syndrome. This model assesses the health and economic benefits of interventions aimed at reducing intake of added sugars. Using data from US National Health Surveys and current literature, we simulated an open cohort, for the period 2015-2035. We constructed a microsimulation model with Markov chains for NAFLD (including steatosis, non-alcoholic steatohepatitis (NASH), cirrhosis and hepatocellular carcinoma (HCC)), body mass index, T2D and CHD. We assessed reductions in population disease prevalence, disease-attributable disability-adjusted life years (DALYs) and costs, with interventions that reduce added sugars consumption by either 20% or 50%. The model estimated that a 20% reduction in added sugars intake will reduce prevalence of hepatic steatosis, NASH, cirrhosis, HCC, obesity, T2D and CHD. Incidence of T2D and CHD would be expected to decrease by 19.9 (95% CI 12.8 to 27.0) and 9.4 (95% CI 3.1 to 15.8) cases per 100 000 people after 20 years, respectively. A 20% reduction in consumption is also projected to annually avert 0.767 million (M) DALYs (95% CI 0.757M to 0.777M) and a total of US$10.3 billion (B) (95% CI 10.2B to 10.4B) in discounted direct medical costs by 2035. These effects increased proportionally when added sugars intake were reduced by 50%. The decrease in incidence and prevalence of disease is similar to results in other models, but averted costs and DALYs were higher, mainly due to inclusion of NAFLD and CHD. The model suggests that efforts to reduce consumption of added sugars may result in significant public health and economic benefits. © Article author(s) (or their employer(s) unless otherwise stated in the text of the article) 2017. All

Community Health Worker Impact on Chronic Disease Outcomes Within Primary Care Examined Using Electronic Health Records.

Science.gov (United States)

Ingram, Maia; Doubleday, Kevin; Bell, Melanie L; Lohr, Abby; Murrieta, Lucy; Velasco, Maria; Blackburn, John; Sabo, Samantha; Guernsey de Zapien, Jill; Carvajal, Scott C

2017-10-01

To investigate community health worker (CHW) effects on chronic disease outcomes using electronic health records (EHRs). We examined EHRs of 32 147 patients at risk for chronic disease during 2012 to 2015. Variables included contact with clinic-based CHWs, vitals, and laboratory tests. We estimated a mixed model for all outcomes. Within-group findings showed statistically significant improvements in chronic disease indicators after exposure to CHWs. In health center 1, HbA1c (glycated hemoglobin) decreased 0.15 millimoles per mole (95% confidence interval [CI] = -0.24, -0.06), body mass index decreased 0.29 kilograms per meter squared (CI = -0.39, -0.20), and total cholesterol decreased 11.9 milligrams per deciliter (CI = -13.5, -10.2). In health center 2, HbA1c decreased 0.43 millimoles per mole (CI = -0.7, -0.17), body mass index decreased by 0.08 kilograms per meter squared (CI = -0.14, -0.02), and triglycerides decreased by 22.50 milligrams per deciliter (CI = -39.0, -6.0). Total cholesterol of 3.62 milligrams per deciliter (CI = -6.6, -0.6) in health center 1 was the only improvement tied to CHW contact. Although patients' chronic disease indicators consistently improved, between-group models provided no additional evidence of impact. EHRs' evolution may elucidate CHW contributions moving forward.

Expanding Health Technology Assessments to Include Effects on the Environment

DEFF Research Database (Denmark)

Marsh, Kevin; Ganz, Michael Lee; Hsu, John

2016-01-01

decision makers. Health care is an important and sizable sector of the economy that could warrant closer policy attention to its impact on the environment. Considerable work is needed to track decision makers' demands, augment the environmental evidence base, and develop robust methods for capturing......There is growing awareness of the impact of human activity on the climate and the need to stem this impact. Public health care decision makers from Sweden and the United Kingdom have started examining environmental impacts when assessing new technologies. This article considers the case...... and objectives extending beyond health care. Two types of challenges hinder this process. First, the nascent evidence base is insufficient to support the accurate comparison of technologies' environmental impacts. Second, cost-utility analysis, which is favored by many HTA agencies, could capture some...

Decreased Consumption of Branched-Chain Amino Acids Improves Metabolic Health

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Luigi Fontana

2016-07-01

Full Text Available Protein-restricted (PR, high-carbohydrate diets improve metabolic health in rodents, yet the precise dietary components that are responsible for these effects have not been identified. Furthermore, the applicability of these studies to humans is unclear. Here, we demonstrate in a randomized controlled trial that a moderate PR diet also improves markers of metabolic health in humans. Intriguingly, we find that feeding mice a diet specifically reduced in branched-chain amino acids (BCAAs is sufficient to improve glucose tolerance and body composition equivalently to a PR diet via metabolically distinct pathways. Our results highlight a critical role for dietary quality at the level of amino acids in the maintenance of metabolic health and suggest that diets specifically reduced in BCAAs, or pharmacological interventions in this pathway, may offer a translatable way to achieve many of the metabolic benefits of a PR diet.

Implementing a benchmarking and feedback concept decreases postoperative pain after total knee arthroplasty: A prospective study including 256 patients.

Science.gov (United States)

Benditz, A; Drescher, J; Greimel, F; Zeman, F; Grifka, J; Meißner, W; Völlner, F

2016-12-05

Perioperative pain reduction, particularly during the first two days, is highly important for patients after total knee arthroplasty (TKA). Problems are not only caused by medical issues but by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent benchmarking. All patients included into the study had undergone total knee arthroplasty. Outcome parameters were analyzed by means of a questionnaire on the first postoperative day. A multidisciplinary team implemented a regular procedure of data analyzes and external benchmarking by participating in a nationwide quality improvement project. At the beginning of the study, our hospital ranked 16 th in terms of activity-related pain and 9 th in patient satisfaction among 47 anonymized hospitals participating in the benchmarking project. At the end of the study, we had improved to 1 st activity-related pain and to 2 nd in patient satisfaction. Although benchmarking started and finished with the same standardized pain management concept, results were initially pure. Beside pharmacological treatment, interdisciplinary teamwork and benchmarking with direct feedback mechanisms are also very important for decreasing postoperative pain and for increasing patient satisfaction after TKA.

[Why is bread consumption decreasing?].

Science.gov (United States)

Rolland, M F; Chabert, C; Serville, Y

1977-01-01

In France bread plays a very special and ambivalent role among our foodstuffs because of the considerable drop in its consumption, its alleged harmful effects on our health and the respect in which it is traditionally held. More than half the 1 089 adults interviewed in this study say they have decreased their consumption of bread in the last 10 years. The reasons given vary according to age, body weight and urbanization level. The main reasons given for this restriction are the desire to prevent or reduce obesity, the decrease in physical activity, the general reduction in food consumption and the possibility of diversifying foods even further. Moreover, the decreasing appeal of bread in relation to other foods, as well as a modification in the structure of meals, in which bread becomes less useful to accompany other food, accentuate this loss of attraction. However, the respect for bread as part of the staple diet remains very acute as 95 p. 100 of those interviewed express a reluctance to throw bread away, more for cultural than economic reasons. Mechanization and urbanization having brought about a decrease in energy needs, the most common alimentary adaptation is general caloric restriction by which glucids, and especially bread, are curtailed.

Can consistent benchmarking within a standardized pain management concept decrease postoperative pain after total hip arthroplasty? A prospective cohort study including 367 patients

Directory of Open Access Journals (Sweden)

Benditz A

2016-12-01

Full Text Available Achim Benditz,1 Felix Greimel,1 Patrick Auer,2 Florian Zeman,3 Antje Göttermann,4 Joachim Grifka,1 Winfried Meissner,4 Frederik von Kunow1 1Department of Orthopedics, University Medical Center Regensburg, 2Clinic for anesthesia, Asklepios Klinikum Bad Abbach, Bad Abbach, 3Centre for Clinical Studies, University Medical Center Regensburg, Regensburg, 4Department of Anesthesiology and Intensive Care, Jena University Hospital, Jena, Germany Background: The number of total hip replacement surgeries has steadily increased over recent years. Reduction in postoperative pain increases patient satisfaction and enables better mobilization. Thus, pain management needs to be continuously improved. Problems are often caused not only by medical issues but also by organization and hospital structure. The present study shows how the quality of pain management can be increased by implementing a standardized pain concept and simple, consistent, benchmarking.Methods: All patients included in the study had undergone total hip arthroplasty (THA. Outcome parameters were analyzed 24 hours after surgery by means of the questionnaires from the German-wide project “Quality Improvement in Postoperative Pain Management” (QUIPS. A pain nurse interviewed patients and continuously assessed outcome quality parameters. A multidisciplinary team of anesthetists, orthopedic surgeons, and nurses implemented a regular procedure of data analysis and internal benchmarking. The health care team was informed of any results, and suggested improvements. Every staff member involved in pain management participated in educational lessons, and a special pain nurse was trained in each ward.Results: From 2014 to 2015, 367 patients were included. The mean maximal pain score 24 hours after surgery was 4.0 (±3.0 on an 11-point numeric rating scale, and patient satisfaction was 9.0 (±1.2. Over time, the maximum pain score decreased (mean 3.0, ±2.0, whereas patient satisfaction

Self-care essential extras: an integration of holistic nursing, functional medicine, and health coaching to promote therapeutic lifestyle change and decrease chronic disease.

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Scattergood, Donna M

2010-01-01

The Essential Vitality Program blends holistic nursing, functional medicine, and health coaching to promote lifestyle changes that modify risk factors of costly chronic disease. Karl is a client who experienced enhanced vitality, decreased chronic pain and medications use, and improved meaningful functioning, by partnering with a holistic nurse coach.

Innovations in occupational health nursing education, including a distance learning approach.

Science.gov (United States)

Lowis, A; Ellington, H

1991-07-01

The results of a survey in the United Kingdom in the late 1980s indicated that many occupational health nurses were not being sent for formal training because of the length of time nurses needed to be away from their employment and the difficulty employers had in finding nurse replacements during training. To meet the needs of occupational health nurses and their employers, the Robert Gordon Institute of Technology (RGIT) instituted a modular training course that offers full time attendance or distance learning options. RGIT's course consists of six modules over a 1 to 3 year period, which students can take in any order after completing a short Return to Study course. Using the innovative distance learning option, occupational health nurses can earn a Diploma in Occupational Health Nursing while completing most of their courses at the workplace, thus avoiding conflicts between training and work schedules.

Decreased health care utilization and health care costs in the inpatient and emergency department setting following initiation of ketogenic diet in pediatric patients: The experience in Ontario, Canada.

Science.gov (United States)

Whiting, Sharon; Donner, Elizabeth; RamachandranNair, Rajesh; Grabowski, Jennifer; Jetté, Nathalie; Duque, Daniel Rodriguez

2017-03-01

To assess the change in inpatient and emergency department utilization and health care costs in children on the ketogenic diet for treatment of epilepsy. Data on children with epilepsy initiated on the ketogenic diet (KD) Jan 1, 2000 and Dec 31, 2010 at Ontario pediatric hospitals were linked to province wide inpatient, emergency department (ED) data at the Institute for Clinical Evaluative Sciences. ED and inpatient visits and costs for this cohort were compared for a maximum of 2 years (730days) prior to diet initiation and for a maximum of 2 years (730days) following diet initiation. KD patient were compared to matched group of children with epilepsy who did not receive the ketogenic diet (no KD). Children on the KD experienced a mean decrease in ED visits of 2.5 visits per person per year [95% CI (1.5-3.4)], and a mean decrease of 0.8 inpatient visits per person per year [95% CI (0.3-1.3)], following diet initiation. They had a mean decrease in ED costs of $630 [95% CI (249-1012)] per person per year and a median decrease in inpatient costs of $1059 [IQR: 7890; pdiet experienced a mean reduction of 2.1 ED visits per child per year [95% CI (1.0-3.2)] and a mean decrease of 0.6 [95% CI (0.1-1.1)] inpatient visits per child per year. Patients on the KD experienced a reduction of $442 [95% CI (34.4-850)] per child per year more in ED costs than the matched group. The ketogenic diet group had greater median decrease in inpatient costs per child per year than the matched group [pketogenic diet, experienced decreased ED and inpatient visits as well as costs following diet initiation in Ontario, Canada. Copyright © 2017 Elsevier B.V. All rights reserved.

Dichloroacetate Decreases Cell Health and Activates Oxidative Stress Defense Pathways in Rat Alveolar Type II Pneumocytes

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Alexis Valauri-Orton

2015-01-01

Full Text Available Dichloroacetate (DCA is a water purification byproduct that is known to be hepatotoxic and hepatocarcinogenic and to induce peripheral neuropathy and damage macrophages. This study characterizes the effects of the haloacetate on lung cells by exposing rat alveolar type II (L2 cells to 0–24 mM DCA for 6–24 hours. Increasing DCA concentration and the combination of increasing DCA concentration plus longer exposures decrease measures of cellular health. Length of exposure has no effect on oxidative stress biomarkers, glutathione, SOD, or CAT. Increasing DCA concentration alone does not affect total glutathione or its redox ratio but does increase activity in the SOD/CAT oxidative stress defense pathway. These data suggest that alveolar type II cells rely on SOD and CAT more than glutathione to combat DCA-induced stress.

Human health-related externalities in energy system modelling the case of the Danish heat and power sector

DEFF Research Database (Denmark)

Zvingilaite, Erika

2011-01-01

and power sector verifies that it is cheaper for the society to include externalities in the planning of an energy system than to pay for the resulting damages later. Total health costs decrease by around 18% and total system costs decrease by nearly 4% when health externalities are included...

Breast cancer and breast health awareness as an evolving health promotion concept

International Nuclear Information System (INIS)

Plesnicar, A.; Kralj, B.; Kovac, V.

2004-01-01

Background. Breast cancer is the most frequent malignant disease in the majority of developed countries. In the last few years the introduction of mammography screening programmes has resulted in an improved survival of breast cancer patients. However, the incidence of the disease in these countries is still on the increase. Present focus on secondary breast cancer prevention activities, consisting of early detection and treatment, cannot ensure a decrease of breast cancer incidence. Improved breast health awareness could therefore represent a part of specific health promotion activities aimed at decreasing the incidence of breast cancer. Conclusions. In developed countries breast cancer is a significant health care issue. Secondary breast cancer prevention activities should therefore be complemented by specific health promotion activities in order to reduce its incidence in the future. Primary breast cancer prevention would include health promotion activities aimed at enhancement of the individual as well as collective breast health awareness. Properly enlightened members of the influential population groups could attain appropriate changes in the fields of legislation, taxation, customs and commercial regulations that would enable women to control their own breast health. (author)

Decreased health-related quality of life in angiodysplasia patients: A cross-sectional cohort.

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Karina V Grooteman

Full Text Available Gastrointestinal angiodysplasias may cause anemia. Quality of life (QoL is a valid patient reported outcome and improvement of QoL represents an important treatment goal. There is a paucity of data on the effect of angiodysplasias on QoL. Therefore, we aim to evaluate QoL and fatigue in angiodysplasia patients. We performed a cross-sectional patient-reported outcome study. We included patients with endoscopy proven angiodysplasias and measured QoL with Short Form-36 and level of fatigue using Multi Fatigue Inventory-20. We distinguished three subgroups of patients according to disease severity: 1 with treatment for angiodysplasias, 2 without treatment for angiodysplasias and 3 without recent hospital visits. The primary outcome was the physical component summary (PCS score on the SF-36. Multivariate regression analysis were performed to correct for differences at baseline. A total of 144 patients completed the questionnaires (response rate = 62%; mean age 68 years; 65% men. Angiodysplasia patients have a significant lower PCS compared to the age-matched general population (respectively 41.0 vs. 43.3, p = 0.01. Disease severity is independently associated with a negative outcome on QoL (ß -4.6, 95% CI -7.8--1.3. Similarly patients score lower on multiple QoL subdomains, i.e. role limitations due to physical health problems (40.8 vs. 44.0, p<0.01, general health (39.7 vs. 47.3, p<0.01. Angiodysplasia patients are more fatigued compared to the general population (male 56.1 vs. 48.5, p<0.01, female 59.2 vs. 51.5, p = 0.01. In conclusion, angiodysplasias are independently associated with clinically significant impairments in multiple domains of health-related QoL, especially in measures of functional limitation.

Educational level and decreases in leisure time physical activity: predictors from the longitudinal GLOBE study

OpenAIRE

Droomers, Mariël; Schrijvers, Carola; Mackenbach, Johan

2001-01-01

STUDY OBJECTIVE—This study describes educational differences in decreases in leisure time physical activity among an adult, physically active population and additionally attempts to identify predictors of these differences from information on health status and individual and environmental factors.
DESIGN—Prospective population based study. Baseline measurement were carried out in 1991 and follow up in 1997.
SETTING—South eastern part of the Netherlands.
PARTICIPANTS—The study included 3793 su...

A decrease in total bilirubin predicted hyper-LDL cholesterolemia in a health screening population.

Science.gov (United States)

Oda, Eiji

2014-08-01

To investigate cross-sectional and longitudinal associations between serum total bilirubin (TB) and LDL cholesterol. It is a retrospective observational study. Cross-sectional and longitudinal associations between TB and hyper-LDL cholesterolemia were investigated in a health screening population. Odds ratios (ORs) of coexisting hyper-LDL cholesterolemia for TB were calculated in 3,866 subjects, Spearman's correlation coefficients between baseline TB and LDL cholesterol at baseline and after 4 years were calculated in 1,735 subjects who did not use antihyperlipidemic drugs and hazard ratios (HRs) of incident hyper-LDL cholesterolemia for TB were calculated in 1,992 followed subjects. The ORs (p values) of coexisting hyper-LDL cholesterolemia for each 1 SD increase in TB was 1.04 (0.998) adjusted for sex, age, smoking, LDL cholesterol and other confounders. Spearman's correlation coefficients (p values) between baseline TB and LDL cholesterol at baseline and after 4 years and changes in LDL cholesterol were -0.026 (0.271), -0.078 (0.001) and -0.062 (0.010), respectively. Among 1,992 followed subjects, 481 developed hyper-LDL cholesterolemia during 4 years (60.4 per 1,000 person-years). The HRs (95% confidence intervals; p values) of incident hyper-LDL cholesterolemia for each 1 SD increase in TB was 0.86 (0.77-0.96; 0.006) adjusted for sex, age, smoking, LDL cholesterol, body mass index, triglycerides, HDL cholesterol, fasting glucose and other confounders. The quintiles of TB were significantly associated with the incident hyper-LDL cholesterolemia adjusted for the above covariates (p for trend = 0.008). A decrease in TB predicted incident hyper-LDL cholesterolemia in a health screening population. Copyright © 2014 Elsevier Ireland Ltd. All rights reserved.

Including public-health benefits of trees in urban-forestry decision making

Science.gov (United States)

Geoffrey H. Donovan

2017-01-01

Research demonstrating the biophysical benefits of urban trees are often used to justify investments in urban forestry. Far less emphasis, however, is placed on the non-bio-physical benefits such as improvements in public health. Indeed, the public-health benefits of trees may be significantly larger than the biophysical benefits, and, therefore, failure to account for...

The Impact of Including Immigrants without Permanent Residence Status in the Public Health Insurance System in the Czech Republic

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Tepperová Jana

2016-03-01

Full Text Available Whether an individual can or cannot participate in the Czech public health insurance system depends on several characteristics, one of which is whether he/she has permanent residence status in the Czech Republic, and a second whether he/she is employed. This means that those without permanent residence status, including self-employed migrants from third countries, their dependent relatives, and the dependent relatives of third country employees in the Czech Republic, cannot participate in the public health insurance system. Some argue that such migrants should be included in the system, since commercial health insurance is disadvantageous and the contributions they would pay into the public health insurance system would increase the public health insurance agencies’ income. We estimate the value of the contributions to public health insurance that would be paid by third country self-employed and non-working immigrants, if they were insured based on data from 2011 to 2013, and compare this to the assumed costs of their medical care. To calculate the contributions for self-employed migrants we use data on the distribution of the tax base for self-employed persons from personal income tax returns. Our estimation results in an overall negative balance of 22 million CZK on the data for 2012 and 2013. In the current system this deficit would be covered by the state, which would pay contributions to the system for certain (state insured persons amounting to 97 million CZK; overall therefore the inclusion of these immigrants would result in a positive balance of 75 million CZK.

Decreased muscle mass in Korean subjects with intracranial arterial stenosis: The Kangbuk Samsung Health Study.

Science.gov (United States)

Jung, Ho-Jung; Jung, Hwanseok; Lee, Taeyoung; Kim, Jongho; Park, Jongsin; Kim, Hacsoo; Cho, Junghwan; Lee, Won-Young; Park, Sung-Woo; Rhee, Eun-Jung; Oh, Hyung-Geun

2017-01-01

Intracranial arterial stenosis (ICAS) is a common cause of ischemic stroke in Asians. Decreased muscle mass is one of the major causes of chronic disease in adults. The purpose of this study was to analyze the relationship between muscle mass and ICAS in Korean adults. For this study, we selected a total of 10,530 participants (mean age, 43.3 years; 8558 men) in a health screening program, for whom transcranial Doppler (TCD) ultrasound was used to detect >50% ICAS based on criteria modified from the stroke outcomes and neuroimaging of intracranial atherosclerosis trial. Body composition was evaluated by bioelectrical impedance analysis (BIA). Skeletal muscle index (SMI) was calculated with muscle mass/weight (kg) * 100. Among the total patient population, 322 (3.1%) subjects had ICAS. Subjects with ICAS were older, and had higher mean values for fasting glucose, body mass index and blood pressure compared with those without ICAS. Subjects with ICAS had significantly lower muscle mass, SMI and higher percent body fat compared with those without ICAS. In logistic regression analysis, the subjects in the highest tertile of muscle mass had the lowest odds ratio for ICAS with the lowest tertile group of muscle mass as the reference group even after adjusting for age, systolic blood pressure, fasting blood glucose, sex, smoking and exercise (OR 0.650, 95% CI 0.442-0.955). Subjects with ICAS had significantly decreased muscle mass compared with those without ICAS in Korean adults. The risk for ICAS was lower in subjects with higher muscle mass. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Mobile health in China: a review of research and programs in medical care, health education, and public health.

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Corpman, David W

2013-01-01

There are nearly 1 billion mobile phone subscribers in China. Health care providers, telecommunications companies, technology firms, and Chinese governmental organizations use existing mobile technology and social networks to improve patient-provider communication, promote health education and awareness, add efficiency to administrative practices, and enhance public health campaigns. This review of mobile health in China summarizes existing clinical research and public health text messaging campaigns while highlighting potential future areas of research and program implementation. Databases and search engines served as the primary means of gathering relevant resources. Included material largely consists of scientific articles and official reports that met predefined inclusion criteria. This review includes 10 reports of controlled studies that assessed the use of mobile technology in health care settings and 17 official reports of public health awareness campaigns that used text messaging. All source material was published between 2006 and 2011. The controlled studies suggested that mobile technology interventions significantly improved an array of health care outcomes. However, additional efforts are needed to refine mobile health research and better understand the applicability of mobile technology in China's health care settings. A vast potential exists for the expansion of mobile health in China, especially as costs decrease and increasingly sophisticated technology becomes more widespread.

Decreased suicide rate after induced abortion, after the Current Care Guidelines in Finland 1987-2012.

Science.gov (United States)

Gissler, Mika; Karalis, Elina; Ulander, Veli-Matti

2015-02-01

Women with a recent induced abortion have a 3-fold risk for suicide, compared to non-pregnant women. The increased risk was recognised in unofficial guidelines (1996) and Current Care Guidelines (2001) on abortion treatment, highlighting the importance of a check-up 2 - 3 weeks after the termination, to monitor for mental health disorders. We studied the suicide trends after induced abortion in 1987 - 2012 in Finland. We linked the Register on Induced Abortions (N = 284,751) and Cause-of-Death Register (N = 3798 suicides) to identify women who had committed suicide within 1 year after an induced abortion (N = 79). The abortion rates per 100,000 person-years were calculated for 1987 - 1996 (period with no guidelines), 1997 - 2001 (with unofficial guidelines) and 2002 - 2012 (with Current Care Guidelines). The suicide rate after induced abortion declined by 24%, from 32.4/100,000 in 1987 - 1996 to 24.3/100,000 in 1997 - 2001 and then 24.8/100,000 in 2002 - 2012. The age-adjusted suicide rate among women aged 15 - 49 decreased by 13%; from 11.4/100,000 to 10.4/100,000 and 9.9/100,000, respectively. After induced abortions, the suicide rate increased by 30% among teenagers (to 25/100,000), stagnated for women aged 20 - 24 (at 32/100,000), but decreased by 43% (to 21/100,000) for women aged 25 - 49. The excess risk for suicide after induced abortion decreased, but the change was not statistically significant. Women with a recent induced abortion still have a 2-fold suicide risk. A mandatory check-up may decrease this risk. The causes for the increased suicide risk, including mental health prior to pregnancy and the social circumstances, should be investigated further. © 2014 the Nordic Societies of Public Health.

The Case to Include Brand of Moist Snuff in Health Surveys.

Science.gov (United States)

Timberlake, David S

2016-08-01

Brand of smokeless tobacco was added to the most recent Tobacco Use Supplement to the Current Population Survey (TUS-CPS), but deleted from the Centers for Disease Control's National Adult Tobacco Survey. The objective of this study was to assess the utility of brand in distinguishing users of moist snuff. The sample consisted of participants from the 2010-2011 TUS-CPS who reported having used one of 14 brands of moist snuff in the past month (n = 2334). The brands were categorized into one of three types: snus, discount snuff, premium snuff. Multinomial logistic regression was employed for testing for associations between brand type and a series of demographic and tobacco use measures. Females, metropolitan residents, current smokers, and moderate users of snuff had significantly greater odds of using snus relative to premium snuff in the adjusted model (P discount versus premium snuff. Separate analyses among current smokers (n = 470) and former smokers (n = 70) revealed positive associations between smoking cessation attempts and smokers' switch to discount snuff. Differences among the three categories of snuff users are likely attributed to variations in marketing campaigns. The differences are sufficient to warrant inclusion of snuff brand in health surveys because brand type could serve as a proxy measure for snuff use and dependence. Inclusion of brand of moist snuff in health surveys will enable researchers to categorize snuff users by brand type. Findings from this study indicate that brand type, defined according to cost (ie, discount vs. premium brands) and type of preferred snuff (ie, snus vs. other moist snuff), can distinguish snuff users by various demographic and tobacco use measures. Consequently, categorization by brand type could be used as a proxy measure for studies whose surveys do not include detailed information on snuff use and behavior. © The Author 2016. Published by Oxford University Press on behalf of the Society for Research on

Using patient reported outcome measures in health services: A qualitative study on including people with low literacy skills and learning disabilities

Directory of Open Access Journals (Sweden)

Jahagirdar Deepa

2012-11-01

Full Text Available Abstract Background Patient reported outcome measures (PROMs are self-report measures of health status increasingly promoted for use in healthcare quality improvement. However people with low literacy skills or learning disabilities may find PROMs hard to complete. Our study investigated stakeholder views on the accessibility and use of PROMs to develop suggestions for more inclusive practice. Methods Taking PROMs recommended for chronic obstructive pulmonary disease (COPD as an example, we conducted 8 interviews with people with low literacy skills and/or learning disabilities, and 4 focus groups with 20 health professionals and people with COPD. Discussions covered the format and delivery of PROMs using the EQ-5D and St George Respiratory Questionnaire as prompts. Thematic framework analysis focused on three main themes: Accessibility, Ease of Use, and Contextual factors. Results Accessibility included issues concerning the questionnaire format, and suggestions for improvement included larger font sizes and more white space. Ease of Use included discussion about PROMs’ administration. While health professionals suggested PROMs could be completed in waiting rooms, patients preferred settings with more privacy and where they could access help from people they know. Contextual Factors included other challenges and wider issues associated with completing PROMs. While health professionals highlighted difficulties created by the system in managing patients with low literacy/learning disabilities, patient participants stressed that understanding the purpose of PROMs was important to reduce intimidation. Conclusions Adjusting PROMs’ format, giving an explicit choice of where patients can complete them, and clearly conveying PROMs’ purpose and benefit to patients may help to prevent inequality when using PROMs in health services.

Health Literacy, Health Disparities, and Sources of Health Information in U.S. Older Adults.

Science.gov (United States)

Cutilli, Carolyn Crane; Simko, Lynn C; Colbert, Alison M; Bennett, Ian M

Low health literacy in older adults has been associated with poor health outcomes (i.e., mortality, decreased physical and cognitive functioning, and less preventive care utilization). Many factors associated with low health literacy are also associated with health disparities. Interaction with healthcare providers and sources of health information are influenced by an individual's health literacy and can impact health outcomes. This study examined the relationships between health literacy, sources of health information, and demographic/background characteristics in older adults (aged 65 years and older) related to health literacy and disparities. This descriptive, correlational study is a secondary analysis of the 2003 National Assessment of Adult Literacy, a large-scale national assessment. Older adults with lower health literacy have less income and education, rate their health as poor or fair, have visual or auditory difficulties, need help filling out forms, reading newspaper, or writing notes, and use each source of health information less (print and nonprint). Many of these characteristics and skills are predictive of health literacy and associated with health disparities. The results expand our knowledge of characteristics associated with health literacy and sources of health information used by older adults. Interventions to improve health outcomes including health disparities can focus on recognizing and meeting the health literacy demands of older adults.

Strategies to include sexual orientation and gender identity in health ...

African Journals Online (AJOL)

2015-05-04

May 4, 2015 ... Social justice and equity are important principles in African health sciences ... Courses that endeavour to develop students' skills in patient-provider .... (sexual and emotional attraction) and gender identity (one's sense of.

Severity of Lipodystrophy Is Associated with Decreased Health-Related Quality of Life

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Murri, Rita; Orlando, Gabriella; Giovanardi, Chiara; Squillace, Nicola; Vandelli, Marcella; Beghetto, Barbara; Nardini, Giulia; De Paola, Maria; Esposito, Roberto; Wu, Albert W.

2008-01-01

Abstract The impact of lipodystrophy (LD) on quality of life is high, but it has not been demonstrated in literature. The objective of the study was to assess the impact of LD on the health–related quality of life (HRQOL) in HIV-infected people on highly active antiretroviral therapy (HAART). Patients with LD phenotype defined by the Multicenter AIDS Cohort Study (MACS) were included. Three different methods were used to define LD severity: both patient and physician evaluation using the HIV Outpatient Study (HOPS) severity scales and the Lipodystrophy Case Definition (LDCD). The HRQOL was evaluated by MOS-HIV Health Survey. Four hundred one patients on HAART for a mean of 108 ± 52 months were evaluated for LD at the Metabolic Clinic of Modena and Reggio Emilia University were enrolled from January 2003 to July 2006. According to self-perceived or physician-based HOPS, 106 (26.5%) and 122 (30.4%) patients had severe LD. Females had significantly more severe LD. Few HRQOL scores correlated to LD severity using the physician-based score (both HOPSph and LDCD), while all the HRQOL scores correlated with LD severity when a patient-based score was used (HOPSpt). In multiple linear regression analysis, Mental Health HRQOL score, gender, body mass index, age, body image satisfaction were independent predictors of patient-based (HOPSpt) LD, while none of the HRQOL scores, but female gender, age, waist-to-hip ratio, limb fat, and body image satisfaction were correlated with physician-estimated HOPSph LD severity. HRQOL was strongly correlated with LD severity when a patient-based score was used. For an overall assessment of the impact of LD on HIV-infected people, both patient-based and physician-based measures are required. PMID:18647097

Decreasing child mortality, spatial clustering and decreasing disparity in North-Western Burkina Faso.

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Becher, Heiko; Müller, Olaf; Dambach, Peter; Gabrysch, Sabine; Niamba, Louis; Sankoh, Osman; Simboro, Seraphin; Schoeps, Anja; Stieglbauer, Gabriele; Yé, Yazoume; Sié, Ali

2016-04-01

Within relatively small areas, there exist high spatial variations of mortality between villages. In rural Burkina Faso, with data from 1993 to 1998, clusters of particularly high child mortality were identified in the population of the Nouna Health and Demographic Surveillance System (HDSS), a member of the INDEPTH Network. In this paper, we report child mortality with respect to temporal trends, spatial clustering and disparity in this HDSS from 1993 to 2012. Poisson regression was used to describe village-specific child mortality rates and time trends in mortality. The spatial scan statistic was used to identify villages or village clusters with higher child mortality. Clustering of mortality in the area is still present, but not as strong as before. The disparity of child mortality between villages has decreased. The decrease occurred in the context of an overall halving of child mortality in the rural area of Nouna HDSS between 1993 and 2012. Extrapolated to the Millennium Development Goals target period 1990-2015, this yields an estimated reduction of 54%, which is not too far off the aim of a two-thirds reduction. © 2016 John Wiley & Sons Ltd.

Job satisfaction survey among health centers staff

OpenAIRE

Shahnazi, Hossein; Daniali, Seyede Shahrbanoo; Sharifirad, Gholamreza

2014-01-01

Background: Due to the importance of health care organizations with significant responsibility for prevention and care, assessment of job satisfaction among health care staff is essential. Quality of health services will be decreased provided they are not satisfied. Materials and Methods: This study was a cross-sectional analysis of health care staff in Khomeinishahr (centers, buildings, and networks) If they had at least 6 months work experience, they could enter the study. Data included a t...

Economic reforms and health insurance in China.

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Du, Juan

2009-08-01

During the 1990s, Chinese state-owned enterprises (SOEs) and collective enterprises continually decreased coverage of public health insurance to their employees. This paper investigates this changing pattern of health insurance coverage in China using panel data from the China Nutrition and Health Survey (1991-2000). It is the first attempt in this literature that tries to identify precisely the effects of specific policies and reforms on health insurance coverage in the transitional period of China. The fixed effects linear model clustering at the province level is used for estimation, and results are compared to alternative models, including pooled OLS, random effects GLS model and fixed effects logit model. Strong empirical evidence is found that unemployment as a side effect of the Open Door Policy, and the deregulation of SOE and collective enterprises were the main causes for the decreasing trend. For example, urban areas that were highly affected by the Open Door Policy were associated with 17 percentage points decrease in the insurance coverage. Moreover, I found evidence that the gaps between SOE and non-SOE employees, collective and non-collective employees, urban and rural employees have considerably decreased during the ten years.

Examining relationships between multiple health risk behaviors, well-being, and productivity.

Science.gov (United States)

Evers, Kerry E; Castle, Patricia H; Prochaska, James O; Prochaska, Janice M

2014-06-01

Traditionally, the concept of health promotion has emphasized the reduction of health risk behaviors to reduce disease and impairment. Well-being research expands this focus to include positive constructs such as thriving, productivity, life-evaluation, and emotional and physical health. The objective of the present study was to examine the relationships between health risk behaviors and specific measures of individual well-being. Participants (N = 790) from 49 states completed a one-time online assessment that included the Life-Evaluation Index, Emotional and Physical Health Ladders, the Health Risk Intervention Assessment, and the Work Productivity and Activity Improvement Questionnaire for General Health. Life Evaluation and physical and emotional health were all inversely related to the number of health risk behaviors, with higher well-being scores associated with lower number of risk behaviors. Across the three Life Evaluation categories (Suffering, Struggling, and Thriving) the number of health risk behaviors decreased, productivity loss decreased, and emotional and physical health increased. The results add to previous research on how reducing multiple health risk behaviors can be combined with well-being, i.e., an emphasis on increasing life-evaluation, emotional and physical health, better functioning, and productivity.

Strategies to include sexual orientation and gender identity in health ...

African Journals Online (AJOL)

Various disciplines can teach sexual orientation and gender identity issues in their context by challenging heteronormativity and highlighting specific LGBTI health concerns, and can do so more successfully with interactive teaching approaches that hold more potential than formalised lectures. Rights-based teaching ...

The Economic Crisis and Public Health

Directory of Open Access Journals (Sweden)

Victor Sidel

2009-06-01

Full Text Available The current global economic crisis seriously threatens the health of the public. Challenges include increases in malnutrition; homelessness and inadequate housing; unemployment; substance abuse, depression, and other mental health problems; mortality; child health problems; violence; environmental and occupational health problems; and social injustice and violation of human rights; as well as decreased availability, accessibility, and affordability of quality medical and dental care. Health professionals can respond by promoting surveillance and documentation of human needs, reassessing public health priorities, educating the public and policymakers about health problems worsened by the economic crisis, advocating for sound policies and programs to address these problems, and directly providing necessary programs and services.

Prevalence of dental fluorosis in children taking part in an oral health programme including fluoride tablet supplements from the age of 2 years

DEFF Research Database (Denmark)

Eckersten, Charlotte; Pylvänen, Lena; Schröder, Ulla

2010-01-01

To investigate the prevalence of dental fluorosis in children who had participated in an oral health programme between the ages 2-5 years, including fluoride tablets from the age of 2 years.......To investigate the prevalence of dental fluorosis in children who had participated in an oral health programme between the ages 2-5 years, including fluoride tablets from the age of 2 years....

Mental health among young adult survivors of childhood cancer and their siblings including posttraumatic growth.

Science.gov (United States)

Kamibeppu, Kiyoko; Sato, Iori; Honda, Misato; Ozono, Shuichi; Sakamoto, Naoko; Iwai, Tsuyako; Okamura, Jun; Asami, Keiko; Maeda, Naoko; Inada, Hiroko; Kakee, Naoko; Horibe, Keizo; Ishida, Yasushi

2010-12-01

Few studies have addressed the mental health status of young adult childhood cancer survivors (CCSs) and their siblings (SIBs). This paper focuses on depression, anxiety, posttraumatic stress symptoms (PTSS), and posttraumatic growth (PTG) among Japanese CCSs and their SIBs. Adolescent and young adult CCSs (n=185), in remission for more than 1 year, their SIBs (n=72), and general controls (CONTs) (n=1,000) completed anonymous self-report questionnaires for depression, anxiety, PTSS, and PTG. The physicians in charge also completed an anonymous disease/treatment data sheet. CCSs were approximately 8 years old at diagnosis and approximately 23 years old at the time of the survey. Their diagnoses included leukemia (57%), lymphoma (12%), and solid tumors (30%). Thirty-eight percent underwent surgery and 25% received stem cell transplantation. No significant differences were found between CCSs and CONTs in terms of depression and anxiety. CCSs had significantly more PTSS and had remarkably greater PTG compared to CONTs. Although no significant differences were found between SIBs and CONTs regarding depression, anxiety, or PTSS, female SIBs exhibited greater PTG compared to female CONTs. To empower CCSs, they should be evaluated periodically regarding PTSS and PTG and should be provided appropriate care and feedback. The fact that the mental health status of young adult SIBs was similar to CONTs at 15 years after their siblings' diagnoses may help reassure parents who worry about mental health among the siblings of an affected child during and after his/her treatment.

Cost and benefit including value of life, health and environmental damage measured in time units

DEFF Research Database (Denmark)

Ditlevsen, Ove Dalager; Friis-Hansen, Peter

2009-01-01

Key elements of the authors' work on money equivalent time allocation to costs and benefits in risk analysis are put together as an entity. This includes the data supported dimensionless analysis of an equilibrium relation between total population work time and gross domestic product leading...... of this societal value over the actual costs, used by the owner for economically optimizing an activity, motivates a simple risk accept criterion suited to be imposed on the owner by the public. An illustration is given concerning allocation of economical means for mitigation of loss of life and health on a ferry...

Decreased prevalence of hypercholesterolaemia and stabilisation of obesity trends in 5-year-old children: possible effects of changed public health policies.

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Sedej, Katarina; Kotnik, Primož; Avbelj Stefanija, Magdalena; Grošelj, Urh; Širca Čampa, Andreja; Lusa, Lara; Battelino, Tadej; Bratina, Nataša

2014-02-01

Overweight/obesity in children is a worldwide public health problem. Together with hypercholesterolaemia they are associated with early atherosclerotic complications. In this study, we aimed to investigate the anthropometric characteristics and total cholesterol (TC) levels in a population of 5-year-old children, to determine trends in the prevalence of overweight/obesity and hypercholesterolaemia in 5-year-old children over a period of 8 years (2001-2009) and to assess the impact of modified national nutritional guidelines for kindergartens implemented in 2005. Cross-sectional studies of overweight/obesity prevalence in the years 2001, 2003-2005 and 2009, and hypercholesterolaemia in years 2001 and 2009, in 5-year-old children. Altogether, 12 832 (6308 girls/6524 boys) children were included. Overweight/obesity was defined by IOTF criteria. Hypercholesterolaemia was defined by TC level >5 mmol/l. Multivariable logistic regression models were used. NO CORRELATION BETWEEN BMI VALUES AND TC LEVELS WAS FOUND. OVERWEIGHT AND OBESITY PREVALENCE WERE STABILISED FROM 2001 TO 2009 (ODDS RATIO (OR) (95% CI): 1.13 (0.99-1.3) and 1.13 (0.89-1.42) respectively). Girls were more frequently overweight/obese than boys (OR (95% CI): 0.71 (0.65-0.79) and 0.75 (0.64-0.89) respectively). Prevalence of hypercholesterolaemia significantly decreased from 2001 to 2009 (OR (95% CI): 0.47 (0.41-0.55)). It was less frequent in boys than in girls (OR (95% CI): O.7 (0.61-0.8)). This is the first study to describe a negative trend in the prevalence of hypercholesterolaemia in pre-pubertal children. In addition, the prevalence of overweight/obesity in these children has been stabilised. Nationwide changes in public health policies could have influenced these observations.

Tinnitus retraining therapy for patients with tinnitus and decreased sound tolerance.

Science.gov (United States)

Jastreboff, Pawel J; Jastreboff, Margaret M

2003-04-01

Our experience has revealed the following: (1) TRT is applicable for all types of tinnitus, as well as for decreased sound tolerance, with significant improvement of tinnitus occurring in over 80% of the cases, and at least equal success rate for decreased sound tolerance. (2) TRT can provide cure for decreased sound tolerance. (3) TRT does not require frequent clinic visits and has no side effects; however, (4) Special training of health providers involved in this treatment is required for this treatment to be effective.

Theory, design, and operation of liquid metal fast breeder reactors, including operational health physics

International Nuclear Information System (INIS)

Adams, S.R.

1985-10-01

A comprehensive evaluation was conducted of the radiation protection practices and programs at prototype LMFBRs with long operational experience. Installations evaluated were the Fast Flux Test Facility (FFTF), Richland, Washington; Experimental Breeder Reactor II (EBR-II), Idaho Falls, Idaho; Prototype Fast Reactor (PFR) Dounreay, Scotland; Phenix, Marcoule, France; and Kompakte Natriumgekuhlte Kernreak Toranlange (KNK II), Karlsruhe, Federal Republic of Germany. The evaluation included external and internal exposure control, respiratory protection procedures, radiation surveillance practices, radioactive waste management, and engineering controls for confining radiation contamination. The theory, design, and operating experience at LMFBRs is described. Aspects of LMFBR health physics different from the LWR experience in the United States are identified. Suggestions are made for modifications to the NRC Standard Review Plan based on the differences

Theory, design, and operation of liquid metal fast breeder reactors, including operational health physics

Energy Technology Data Exchange (ETDEWEB)

Adams, S.R.

1985-10-01

A comprehensive evaluation was conducted of the radiation protection practices and programs at prototype LMFBRs with long operational experience. Installations evaluated were the Fast Flux Test Facility (FFTF), Richland, Washington; Experimental Breeder Reactor II (EBR-II), Idaho Falls, Idaho; Prototype Fast Reactor (PFR) Dounreay, Scotland; Phenix, Marcoule, France; and Kompakte Natriumgekuhlte Kernreak Toranlange (KNK II), Karlsruhe, Federal Republic of Germany. The evaluation included external and internal exposure control, respiratory protection procedures, radiation surveillance practices, radioactive waste management, and engineering controls for confining radiation contamination. The theory, design, and operating experience at LMFBRs is described. Aspects of LMFBR health physics different from the LWR experience in the United States are identified. Suggestions are made for modifications to the NRC Standard Review Plan based on the differences.

Age decreases quality of life in adolescents with intractable epilepsy

Directory of Open Access Journals (Sweden)

Prastiya Indra Gunawan

2015-12-01

Intractable epileptic adolescents have higher scores for physical functioning and health perception, but lower scores for social stigmatization. Social support has extremely low scores. Increasing age decreases quality of life in adolescents with intractable epilepsy.

Implementation of a Proactive Pilot Health Plan-Driven Opioid Tapering Program to Decrease Chronic Opioid Use for Conditions of the Back and Spine in a Medicaid Population.

Science.gov (United States)

Page, Julia; Traver, Robin; Patel, Sital; Saliba, Christopher

2018-03-01

In 2016, the Oregon Health Authority and the Health Evidence Review Commission implemented guidance for Oregon Medicaid members who were taking opioids for chronic pain related to conditions of the back and spine. This guidance required that an individualized taper plan be developed and initiated by January 1, 2017, and a discontinuation date for all chronic opioid therapy of January 1, 2018. This program evaluated the effect of a proactive and voluntary health plan-driven opioid tapering program on morphine equivalent daily dose (MEDD) before the implementation of governmental guidance. Two mailings were sent to the providers of the targeted members with a variety of resources to facilitate an opioid taper. Pharmacy claims were analyzed to measure member opioid use, in the form of MEDD, after the provider outreach to be compared with their MEDDs before the outreach. A total of 113 members met the study inclusion criteria for the second provider outreach. Of the 19 members' providers who submitted responses via fax to the health plan in response to this outreach, 6 indicated they would initiate taper plans. Of the 6 members with taper plans, 5 had decreases in MEDD (3.6%, 4.5%, 42.9%, 45.5%, and 46.1%) after the 3-month data collection period, while the sixth member had no change in MEDD. Of the 113 members, 16 members (14.2%) had a decrease in MEDD; 23 members (20.4%) had no change in MEDD; and 72 members (63.7%) had an increase in MEDD. This study demonstrated that when a physician agrees to enroll patients in a health-plan driven clinical program it may result in decreased opioid use as referenced by MEDD. However, the results also showed the progressive nature of opioid use in this population. While these initial taper results were promising, a larger sample size and longer follow-up duration are needed to validate long-term adherence to an opioid tapering program and confirm that these results are attributable to the program and not other factors. This study

Maternal and child health in Brazil: progress and challenges.

Science.gov (United States)

Victora, Cesar G; Aquino, Estela M L; do Carmo Leal, Maria; Monteiro, Carlos Augusto; Barros, Fernando C; Szwarcwald, Celia L

2011-05-28

In the past three decades, Brazil has undergone rapid changes in major social determinants of health and in the organisation of health services. In this report, we examine how these changes have affected indicators of maternal health, child health, and child nutrition. We use data from vital statistics, population censuses, demographic and health surveys, and published reports. In the past three decades, infant mortality rates have reduced substantially, decreasing by 5·5% a year in the 1980s and 1990s, and by 4·4% a year since 2000 to reach 20 deaths per 1000 livebirths in 2008. Neonatal deaths account for 68% of infant deaths. Stunting prevalence among children younger than 5 years decreased from 37% in 1974-75 to 7% in 2006-07. Regional differences in stunting and child mortality also decreased. Access to most maternal-health and child-health interventions increased sharply to almost universal coverage, and regional and socioeconomic inequalities in access to such interventions were notably reduced. The median duration of breastfeeding increased from 2·5 months in the 1970s to 14 months by 2006-07. Official statistics show stable maternal mortality ratios during the past 10 years, but modelled data indicate a yearly decrease of 4%, a trend which might not have been noticeable in official reports because of improvements in death registration and the increased number of investigations into deaths of women of reproductive age. The reasons behind Brazil's progress include: socioeconomic and demographic changes (economic growth, reduction in income disparities between the poorest and wealthiest populations, urbanisation, improved education of women, and decreased fertility rates), interventions outside the health sector (a conditional cash transfer programme and improvements in water and sanitation), vertical health programmes in the 1980s (promotion of breastfeeding, oral rehydration, and immunisations), creation of a tax-funded national health service in 1988

African-American and Latina Women Seeking Public Health Services: Cultural Beliefs regarding Pregnancy, including Medication-taking Behavior

Directory of Open Access Journals (Sweden)

Luz Dalia Sanchez, MD, MCP, MHA, PhD

2011-01-01

Full Text Available Objective: to describe cultural beliefs and medication-taking-behavior about pregnancy in African-American and Latina women. Design: qualitative study using phenomenological methodology; face-to-face, semi structured interviews and focus group. Thematic analysis was done to obtain themes consistent with the research objective. Setting: Maricopa County, Arizona, Department of Public-health Programs, November 2008 through April 2009.Participants: women seeking public-health services in the greater Phoenix, Arizona.Results: fifteen adult women representing two ethnic groups (seven African-Americans and eight Latinas participated. Themes derived from the interview data included: “The Dilemma: To Become or Not to Become Pregnant;” “The Ideal Stress-free World: Support System;” “Changing Worlds: Wanting Dependency;” and “The Health care System: Disconnection from Pregnancy to Postpartum.”Conclusions: based on the cultural themes: 1. pregnancies were not planned; 2. healthy life-style changes were not likely to occur during pregnancy; 3. basic facts about the biology of sexual intercourse and pregnancy were not understood, and there was no usage of any preconceptional or prenatal medications; and 4. professional health care was not desired or considered necessary (except during delivery. These cultural beliefs can contribute to negative birth outcomes, and need to be considered by pharmacists and other health-care providers. The information gained from this study can guide the implementation of educational programs developed by pharmacists that are more sensitive to the cultural beliefs and points of view of these particular women. Such programs would thus be more likely to be favorably received and utilized.

Health benefit from decreasing exposure to heavy metals and metalloid after strict pollution control measures near a typical river basin area in China.

Science.gov (United States)

Cao, Suzhen; Duan, Xiaoli; Ma, Yingqun; Zhao, Xiuge; Qin, Yanwen; Liu, Yan; Li, Sai; Zheng, Binghui; Wei, Fusheng

2017-10-01

The metal(loid) pollution still is a great concern due to the effects from urbanization and industrialization. While, the health risks from the toxic metal(loid)s could decrease if strict pollution control measures were adopted. However, few studies to date investigate the health risks of heavy metal(loid)s in a systematic river basin for the dependent residents, after taking pollution control measures. Thus, the contents of metal(loid)s (Cu, Pb, Zn, Cd, Mn, As) in surface water along a typical river basin were investigated in this study, and the potential non-carcinogenic and carcinogenic health risks posed to the residents were assessed. Although the soluble contents of Cu, Pb, Zn and Cd exceeded the respective thresholds in two sites located downstream the mine area, they were greatly decreased in comparison with previous contamination levels, and the soluble concentrations of all the metal(loid)s were within the relevant thresholds in the sites far away from the mining area. Moreover, the closer to the mining area, the higher the pollution levels of metal(loid)s. The total hazard index for non-carcinogenic risks of metal(loid)s were basically lower than the threshold (1) for the local population. Whereas, although the content of metal(loid)s were low (such as As), they could pose relative higher non-carcinogenic health risks. The result illustrated that pollution levels, toxicity of the contaminants and exposure behavior patterns all could contribute to the potential detrimental health risks. Additionally, the non-carcinogenic and carcinogenic risks from ingestion exposure were ∼2-∼4 orders of magnitude higher than those from dermal contact. The total carcinogenic risks were basically lower than the maximum tolerable levels (1.0 × 10 -4 ), indicating carcinogenic risks from most areas of the river could also be accepted. Among different population groups, heavy metal(loid)s posed relative higher non-carcinogenic and carcinogenic risks to the children in

[Health promotion and prevention in the economic crisis: the role of the health sector. SESPAS report 2014].

Science.gov (United States)

Márquez-Calderón, Soledad; Villegas-Portero, Román; Gosalbes Soler, Victoria; Martínez-Pecino, Flora

2014-06-01

This article reviews trends in lifestyle factors and identifies priorities in the fields of prevention and health promotion in the current economic recession. Several information sources were used, including a survey of 30 public health and primary care experts. Between 2006 and 2012, no significant changes in lifestyle factors were detected except for a decrease in habitual alcohol drinking. There was a slight decrease in the use of illegal drugs and a significant increase in the use of psychoactive drugs. Most experts believe that decision-making about new mass screening programs and changes in vaccination schedules needs to be improved by including opportunity cost analysis and increasing the transparency and independence of the professionals involved. Preventive health services are contributing to medicalization, but experts' opinions are divided on the need for some preventive activities. Priorities in preventive services are mental health and HIV infection in vulnerable populations. Most experts trust in the potential of health promotion to mitigate the health effects of the economic crisis. Priority groups are children, unemployed people and other vulnerable groups. Priority interventions are community health activities (working in partnership with local governments and other sectors), advocacy, and mental health promotion. Effective tools for health promotion that are currently underused are legislation and mass media. There is a need to clarify the role of the healthcare sector in intersectorial activities, as well as to acknowledge that social determinants of health depend on other sectors. Experts also warn of the consequences of austerity and of policies that negatively impact on living conditions. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

Designing serious video games for health behavior change: Current status and future directions

Science.gov (United States)

Serious video games for health are designed to entertain while changing a specific health behavior. This article identifies behavioral principles that can guide the development of serious video games focused on changing a variety of health behaviors, including those attempting to decrease risk of o...

Geographic variation in health IT and health care outcomes: A snapshot before the meaningful use incentive program began.

Science.gov (United States)

McLaughlin, Catherine G; Lammers, Eric

2015-03-01

The 2009 Health Information Technology for Economic and Clinical Health (HITECH) Act, which includes the Meaningful Use (MU) incentive program, was designed to increase the adoption of health information technology (IT) by physicians and hospitals. Policymakers hope that increased use of health IT to exchange health information will in turn enhance the quality and efficiency of health care delivery. In this study, we analyze the extent to which key outcomes vary based on the levels of health ITness among physicians and hospitals before the HITECH and MU programs led to increases in adoption and changes in use. Our findings provide an important baseline for a future evaluation of the impact of these programs on population-level outcomes. We constructed measures of the degree of hospital and physician adoption and use ("health ITness") at the level of the hospital referral region (HRR). We used data from the 2010 IT Supplement of the American Hospital Association (AHA) Annual Survey of Hospitals to capture hospital health ITness and data from the 2010 survey of ambulatory health care sites produced by SK&A Information Services for the physician measure. We conducted cross-sectional analyses of the relationship between market-level Medicare costs and use and three measures: (1) physician health ITness, (2) hospital health ITness, and (3) an overall measure of health ITness. In general, greater levels of physician health ITness are associated with decreasing costs and use. Many of these relationships lose statistical significance, however, when we control for population and market characteristics such as the average age and health status of Medicare beneficiaries, mean household income, and the HMO penetration rate. Several of the relationships also change according to the level of hospital health ITness. Our findings suggest that greater levels of physician health ITness are associated with decreasing costs and use for a number of services, including inpatient costs

[Is abortion a serious public health problem in Chile in the field of maternal-perinatal health?

Science.gov (United States)

Valenzuela, María Teresa; San-Martín P, Pamela; Cavada, Gabriel

2017-08-01

The World Health Organization, by 2014, estimates that approximately 22 million unsafe abortions take place every year in the world, almost all of them in developing countries. The Millennium Goals, as part of the fifth compendium, focused on maternal health by proposing that member states should reduce maternal mortality to 75% by 2015. To determine, using maternal health indicators, if abortion in Chile is a priority health problem. Data about maternal mortality and its causes between 1982 and 2014, was obtained from the databases available at the Chilean Ministry of Health. Trend analyzes were carried out using linear autoregressive models. Between 1982 and 2012, maternal mortality rates decreased from 51.8 to 18.3 per 100,000 live births. Complications of pregnancy, childbirth and puerperium were the first three causes and the last one is abortion. The proportion of abortions due to unspecified causes, including induced abortion, decreased from 36.6% to 26.1% between 2001 and 2012. Abortion is not a public health problem in Chile. To continue reducing maternal mortality, programs for the early detection of risks such as diabetes, obesity and hypertension should be implemented.

Including Youth with Intellectual Disabilities in Health Promotion Research: Development and Reliability of a Structured Interview to Assess the Correlates of Physical Activity among Youth

Science.gov (United States)

Curtin, Carol; Bandini, Linda G.; Must, Aviva; Phillips, Sarah; Maslin, Melissa C. T.; Lo, Charmaine; Gleason, James M.; Fleming, Richard K.; Stanish, Heidi I.

2016-01-01

Background: The input of youth with intellectual disabilities in health promotion and health disparities research is essential for understanding their needs and preferences. Regular physical activity (PA) is vital for health and well-being, but levels are low in youth generally, including those with intellectual disabilities. Understanding the…

Decreasing medication turnaround time with digital scanning technology in a canadian health region.

Science.gov (United States)

Neville, Heather; Nodwell, Lisa; Alsharif, Sahar

2014-11-01

Reducing medication turnaround time can improve efficiency, patient safety, and quality of care in the hospital setting. Digital scanning technology (DST) can be used to electronically transmit scanned prescriber orders to a pharmacy computer queue for verification and processing, which may help to improve medication turnaround time. To evaluate medication turnaround time before and after implementation of DST for all medications and for antibiotics only. Medication turnaround times were evaluated retrospectively for periods before (June 6-10, 2011) and after (September 26-30, 2011) implementation of DST at 2 hospital sites in 1 health region. Medication turnaround time was defined as the time from composition of a medication order by the prescriber to its verification by the pharmacy (phase 1) and the time from prescriber composition to administration to the patient by a nurse (total). Median turnaround times were analyzed with SPSS software using the Mann-Whitney U test. In total, 304 and 244 medication orders were audited before and after DST implementation, respectively. Median phase 1 turnaround time for all medications declined significantly, from 2 h 23 min before DST implementation to 1 h 33 min after DST implementation (p < 0.001). Antibiotics were also processed significantly faster (1 h 51 min versus 1 h 9 min, p = 0.015). However, total turnaround time for all medications did not differ significantly (5 h 15 min versus 5 h 0 min, p = 0.42). Implementation of DST was associated with a 50-min decrease in medication turnaround time for the period from when an order was prescribed to the time it was processed by the pharmacy. Regular evaluation of medication turnaround times is recommended to compare with benchmarks, to ensure that hospital standards are being met, and to measure the effects of policy changes and implementation of new technology on medication-use processes.

Primary care as a means of decreasing health care costs | van ...

African Journals Online (AJOL)

The study was focussedat furthering the health objectives of the Government\\'s Reconstruction and Development Programme in the area ofprimary care. The purpose of the study was to examine the possible reduction of medical scheme claims for cardiovascular disease by means of primary care, so that medical scheme ...

Five-year examination of utilization and drug cost outcomes associated with benefit design changes including reference pricing for proton pump inhibitors in a state employee health plan.

Science.gov (United States)

Johnson, Jill T; Neill, Kathryn K; Davis, Dwight A

2011-04-01

The Arkansas State Employee Benefits Division (EBD) is a self-insured program comprising public school and other state employees, their spouses, and dependents. Previous research published in JMCP (2006) showed drug cost savings of $2.20 per member per month (PMPM; 37.6%) or annualized savings of $3.4 million associated with a benefit design change and coverage of the proton pump inhibitor (PPI) omeprazole over-the-counter (OTC) beginning in March 2004. On May 1, 2005, brand esomeprazole was excluded from coverage, with current users grandfathered for 4 months until September 2005. Reference pricing for PPIs, including esomeprazole but excluding generic omeprazole, was implemented on September 1, 2005, and the beneficiary cost share for all PPIs except generic omeprazole was determined from comparison of the PPI actual price to the $0.90 omeprazole OTC reference price per unit. To examine PPI utilization and drug costs before and after (a) excluding esomeprazole from coverage (with grandfathering current users) and (b) implementing a therapeutic maximum allowable cost (TMAC), or reference-pricing benefit design, for the PPI class in a large state employee health plan with fairly stable enrollment of approximately 127,500 members in 2005 through 2008 and approximately 128,000 members in 2009 Q1. The pharmacy claims database for the EBD was used to examine utilization and cost data for PPIs in a longitudinal analysis for the 61-month period from March 1, 2004, through March 31, 2009. Pharmacy claims data were compared for the period 14 months prior to esomeprazole exclusion (preperiod), 4 months during the esomeprazole exclusion (postperiod 1), and the ensuing 43 months of PPI reference pricing (postperiod 2). PPI cost and utilization data for the intervention group of approximately 127,500 beneficiaries were compared with a group of 122 self-insured employers with a total of nearly 1 million beneficiaries whose pharmacy benefits did not include reference pricing for

Reducing total health burden from 2001 to 2009: an employer counter-trend success story and its implications for health care reform.

Science.gov (United States)

Allen, Harris; Rogers, William H; Bunn, William B; Pikelny, Dan B; Naim, Ahmad B

2012-08-01

To examine total health burden for an employer whose health-related focus is direct and indirect costs. To explore implications for the Final Rule for Accountable Care Organizations recently issued by the Centers for Medicare and Medicaid Services, whose focus includes direct but not indirect costs. Used 42 claims and survey-based measures to track this employer's continental US workforce burden in the aggregate and by healthy and selected disease designations from 2001-2002 to 2008-2009. Starting from equivalent baselines, this employer's aggregate total direct costs decreased 16% (8.5% adjusted) whereas comparable US per capita expenditures rose 22.1%. Even larger decreases were recorded in total indirect costs. The healthy and disease designations replicated this pattern. Minimal employee cost shifting occurred. Attention to direct and indirect costs helped put this employer's health care investment on a markedly more sustainable path than comparable national cost trends. Fully tapping the applicable lessons this and other purchasers have learned will be facilitated by amending the Final Rule to include measures of indirect costs.

Designing Serious Video Games for Health Behavior Change: Current Status and Future Directions

OpenAIRE

Thompson, Debbe

2012-01-01

Serious video games for health are designed to entertain while changing a specific health behavior. This article identifies behavioral principles that can guide the development of serious video games focused on changing a variety of health behaviors, including those attempting to decrease risk of obesity and type 2 diabetes. Guidelines discussed include how to develop video games that provide a solid foundation for behavior change by enhancing a player’s knowledge and skill, ways in which per...

Discourse versus practice: are traditional practices and beliefs in pregnancy and childbirth included or excluded in the Ecuadorian health care system?

Science.gov (United States)

Gallegos, Carlos Andres; Waters, William F; Kuhlmann, Anne Sebert

2017-03-01

Traditional beliefs, knowledge and practices are formally integrated into the Ecuadorian health system. We sought to understand whether they are integrated in practice. Qualitative data were collected in two rural parishes in the central highlands of Ecuador through four focus group discussions (30 participants), eight key informant interviews, three participatory exercises (24 participants), structured observations of health facilities and analysis of official documents. We found different levels of integration, coexistence, tolerance, and intolerance of traditional health beliefs and practices in health facilities. One parish has undergone dramatic social and cultural transformation, and the role of traditional birth attendants is limited. In the other parish, traditional indigenous norms and values persist, and traditional birth attendants are sought during pregnancy and childbirth. The degree to which traditional birth attendants, indigenous women and their families are included or excluded from public health services depends largely on decisions taken by local health professionals. Formal policies in Ecuador stipulate that health care should be intercultural, but the role of traditional birth attendants is not necessarily incorporated in practice. The integration of culturally-informed beliefs and practices is critical for providing appropriate health services to members of vulnerable populations. © The Author 2016. Published by Oxford University Press on behalf of Royal Society of Tropical Medicine and Hygiene. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Active Intervention Can Decrease Burnout In Ed Nurses.

Science.gov (United States)

Wei, Rong; Ji, Hong; Li, Jianxin; Zhang, Liyao

2017-03-01

The aim of this study was to evaluate whether active intervention can decrease job burnout and improve performance among ED nurses. This study was carried out in the emergency departments of 3 hospitals randomly selected from 8 comprehensive high-level hospitals in Jinan, China. A total of 102 nurses were enrolled and randomly divided into control and intervention groups. For 6 months, nurses in intervention groups were treated with ordinary treatment plus comprehensive management, whereas nurses in the control group were treated with ordinary management, respectively. Questionnaires were sent and collected at baseline and at the end of the study. The Student t test was used to evaluate the effect of comprehensive management in decreasing burnout. All ED nurses showed symptoms of job burnout at different levels. Our data indicated that comprehensive management significantly decreased emotional exhaustion and depersonalization (P burnout in ED nurses and contribute to relieving work-related stress and may further protect against potential mental health problems. Copyright © 2016 Emergency Nurses Association. Published by Elsevier Inc. All rights reserved.

Decreasing incidence rates of bacteremia

DEFF Research Database (Denmark)

Nielsen, Stig Lønberg; Pedersen, C; Jensen, T G

2014-01-01

BACKGROUND: Numerous studies have shown that the incidence rate of bacteremia has been increasing over time. However, few studies have distinguished between community-acquired, healthcare-associated and nosocomial bacteremia. METHODS: We conducted a population-based study among adults with first......-time bacteremia in Funen County, Denmark, during 2000-2008 (N = 7786). We reported mean and annual incidence rates (per 100,000 person-years), overall and by place of acquisition. Trends were estimated using a Poisson regression model. RESULTS: The overall incidence rate was 215.7, including 99.0 for community......-acquired, 50.0 for healthcare-associated and 66.7 for nosocomial bacteremia. During 2000-2008, the overall incidence rate decreased by 23.3% from 254.1 to 198.8 (3.3% annually, p incidence rate of community-acquired bacteremia decreased by 25.6% from 119.0 to 93.8 (3.7% annually, p

Decrease Hospital Spending: There's an App for That! A Retrospective Analysis of Implementation of a Mobile Resident Handbook on Hospital Costs and Disposition.

Science.gov (United States)

Holtkamp, Matthew D

2017-10-01

Patient care involves time sensitive decisions. Matching a patient's presenting condition with possible diagnoses requires proper assessment and diagnostic tests. Timely access to necessary information leads to improved patient care, better outcomes, and decreased costs. This study evaluated objective outcomes of the implementation of a novel Resident Handbook Application (RHAP) for smart phones. The RHAP included tools necessary to make proper assessments and to order appropriate tests. The RHAPs effectiveness was accessed using the Military Health System Military Mart database. This database includes patient specific aggregate data, including diagnosis, patient demographics, itemized cost, hospital days, and disposition status. Multivariable analysis was used to compare before and after RHAP implementation, controlling for patient demographics and diagnosis. Internal medicine admission data were used as a control group. There was a statistically significant decrease in laboratory costs and a strong trend toward statistically significant decreases in the cost of radiology performed after implementation of RHAP (p value of <0.02 and <0.07, respectively). There was also a decrease in hospital days (3.66-3.30 days), in total cost per admission ($18,866-$16,305), and in cost per hospital day per patient ($5,140-$4,936). During the same time period a Control group had no change or increases in these areas. The use of the RHAP resulted in decreases in costs in a variety of areas and a decrease in hospital bed days without any apparent negative effect upon patient outcomes or disposition status.

Expanding Pharmacists' Scope of Practice to Include Immunization in Nova Scotia

Directory of Open Access Journals (Sweden)

Beth O'Reilly

2017-07-01

Full Text Available On 10 December 2010 An Act to Amend Chapter 36 of the Acts of 2001, the Pharmacy Act (Bill 7 received Royal Assent in Nova Scotia, including an amendment that enabled an expanded scope of pharmacy practice. Expanding pharmacists' scope of practice came about from recommendations by various federal and provincial government bodies as an attempt to improve accessibility to health care and decrease costs. In 2013, pharmacists in Nova Scotia began administering the influenza vaccine as part of the publicly funded program in attempts to improve vaccine coverage rates. Preliminary evaluation in Nova Scotia has shown an increase in influenza vaccination coverage. Although pharmacist administration of influenza vaccination may improve vaccination coverage and reduce demand on physician time, there may be tension created among the professions, which needs to be addressed and managed.

Masturbation and Pornography Use Among Coupled Heterosexual Men With Decreased Sexual Desire: How Many Roles of Masturbation?

Science.gov (United States)

Carvalheira, Ana; Træen, Bente; Stulhofer, Aleksandar

2015-01-01

The relation between masturbation and sexual desire has not been systematically studied. The present study assessed the association between masturbation and pornography use and the predictors and correlates of frequent masturbation (several times a week or more often) among coupled heterosexual men who reported decreased sexual desire. Analyses were carried out on a subset of 596 men with decreased sexual desire (mean age = 40.2 years) who were recruited as part of a large online study on male sexual health in 3 European countries. A majority of the participants (67%) reported masturbating at least once a week. Among men who masturbated frequently, 70% used pornography at least once a week. A multivariate assessment showed that sexual boredom, frequent pornography use, and low relationship intimacy significantly increased the odds of reporting frequent masturbation among coupled men with decreased sexual desire. These findings point to a pattern of pornography-related masturbation that can be dissociated from partnered sexual desire and can fulfill diverse purposes. Clinical implications include the importance of exploring specific patterns of masturbation and pornography use in the evaluation of coupled men with decreased sexual desire.

CLOUD-POWERED e-HEALTH

Directory of Open Access Journals (Sweden)

Liviu Cristian STEFAN

2013-09-01

Full Text Available During the last years, the global economic crisis has affected all domains, including the health sector. Many governments have considered that the solution to this problem is to reduce public expenses on healthcare, to decrease the budgets for health services, to rationalize the medical plans for the population, to increase the share of health expenditure paid by patients and to select the products on the pharmaceutical market.In order to improve the medical service whilst maintaining reduced infrastructure costs, the new digital technologies offer the solution of cloud-based services for the e-health systems.In this paper we present the cloud-hosted healthcare applications concept, the advantages of using e-Health on distributed platforms and some considerations about the security levels. Also, we further present an experiment based on the free OpenEMR solution, which has also a cloud version, ZH-Services OpenEMR.

Decreasing Human Trafficking through Sex Work Decriminalization.

Science.gov (United States)

Albright, Erin; D'Adamo, Kate

2017-01-01

In order to decrease human trafficking, health care workers should support the full decriminalization of prostitution. Similar to trafficking in other forms of labor, preventing trafficking in the sex trade requires addressing the different forms of marginalization that create vulnerable communities. By removing punitive laws that prevent reporting of exploitation and abuse, decriminalization allows sex workers to work more safely, thereby reducing marginalization and vulnerability. Decriminalization can also help destigmatize sex work and help resist political, social, and cultural marginalization of sex workers. © 2017 American Medical Association. All Rights Reserved.

Effect on attendance by including focused information on spirometry in preventive health checks: study protocol for a randomized controlled trial.

Science.gov (United States)

Ørts, Lene Maria; Løkke, Anders; Bjerregaard, Anne-Louise; Maindal, Helle Terkildsen; Sandbæk, Annelli

2016-12-01

Early detection of lung diseases can help to reduce their severity. Lung diseases are among the most frequently occurring and serious diseases worldwide; nonetheless, many patients remain undiagnosed. Preventive health checks including spirometry can detect lung diseases at early stages; however, recruitment for health checks remains a challenge, and little is known about what motivates the attendance. The aim of the study is to examine whether focused information on spirometry in the invitation compared to general information will impact the attendance rate in preventive health checks. This randomized, controlled trial tests the effect of information on spirometry embedded in the Check your Health Preventive Program (CHPP). The CHPP is an open-label, household cluster-randomized, controlled trial offering a preventive health check to 30- to -49-year-olds in a Danish municipality from 2012 to 2017 (n = 26,216). During 2015-2016, 4356 citizens aged 30-49 years will be randomized into two groups. The intervention group receives an invitation which highlights the value and contents of spirometry as part of a health check and information about lung diseases. The comparison group receives a standard invitation containing practical information and specifies the contents of the general health check. Outcomes are (1) differences in attendance rates measured by the proportion of citizens attending each of the two study groups and (2) proportion of persons at risk defined by smoking status and self-reported lung symptoms in the study groups. The proportion of participants with abnormal spirometry assessed at the preventive health check will be compared between the two study groups. The results from the present study will inform future recruitment strategies to health checks. The developed material on content, value, and information about lung disease is feasible and transferable to other populations, making it easy to implement if effective. ClinicalTrials.gov: NCT

Improved functionality, health related quality of life and decreased burden of disease in patients with ADHD treated with OROS® MPH: is treatment response different between children and adolescents?

Directory of Open Access Journals (Sweden)

Rettig Klaus

2011-07-01

Full Text Available Abstract Background To compare clinical and health-related quality of life (HRQoL outcomes between children and adolescents with ADHD treated with OROS® MPH, using data from two large similarly-designed multicenter, prospective, open-label, single-arm, non-interventional studies. Methods Pooled analysis (42603ATT4037, 42603 - ATT - 4001 including patients (6 to 18 years with a confirmed diagnosis of ADHD. Patients were treated with OROS® MPH for 12 weeks; ADHD symptoms, functioning, HRQoL, safety and tolerability parameters were assessed. Results 822 patients (583 children [6-12 years], 239 adolescents [13-18 years] were included in the pooled analysis. Mean daily OROS® MPH starting doses in the child and adolescent subgroups were 29.0 ± 11.7 and 37.6 ± 15.6 mg, respectively (p ® MPH in 76.9%, 86.0% and 79.3% of children, adolescents and the total population, respectively, at study end (p = 0.029 between-age subgroups. 195 of 822 patients (23.7% experienced at least one treatment-emergent adverse event; most commonly reported AEs in the total group (≥4% were insomnia (7.2%, anorexia (4.3% and involuntary muscle contractions (4.1%. No clinically relevant changes in body weight or vital signs were observed. Conclusions Clinically relevant differences between children and adolescents with ADHD are present. Adolescents appeared to have a lower health related quality of life and functioning compared to children at baseline, however, they were able to reach comparable ratings at endpoint for most items. Similarly, burden of disease decreased in patients and their carers. OROS MPH was generally safe and well tolerated.

Impact of Home Health Care on Health Care Resource Utilization Following Hospital Discharge: A Cohort Study.

Science.gov (United States)

Xiao, Roy; Miller, Jacob A; Zafirau, William J; Gorodeski, Eiran Z; Young, James B

2018-04-01

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.

Take Action to Decrease Your Cancer Risk - Obesity and Its Role in Cancer Health Disparities

Science.gov (United States)

In support of this year’s National Minority Health Month theme “Prevention is Power: Taking Action for Health Equity!”, CRCHD is highlighting the role of obesity in cancer health disparities among diverse population groups in the U.S.

Municipal health expectancy in Japan: decreased healthy longevity of older people in socioeconomically disadvantaged areas

Directory of Open Access Journals (Sweden)

Takano Takehito

2005-06-01

Full Text Available Abstract Background Little is known about small-area variation in healthy longevity of older people and its socioeconomic correlates. This study aimed to estimate health expectancy at 65 years (HE65 at the municipal level in Japan, and to examine its relation to area socio-demographic conditions. Methods HE65 of municipalities (N = 3361 across Japan was estimated by a linear regression formula with life expectancy at 65 years and the prevalence of those certificated as needing nursing care. The relation between HE65 and area socio-demographic indicators was examined using correlation coefficients. Results The estimated HE65 (years ranged from 13.13 to 17.39 for men and from 14.84 to 20.53 for women. HE65 was significantly positively correlated with the proportion of elderly and per capita income, and negatively correlated with the percentage of households of a single elderly person, divorce rate, and unemployment rate. These relations were stronger in large municipalities (with a population of more than 100,000 than in small and medium-size municipalities. Conclusion A decrease in healthy longevity of older people was associated with a higher percentage of households of a single elderly person and divorce rate, and lower socioeconomic conditions. This study suggests that older people in urban areas are susceptible to socio-demographic factors, and a social support network for older people living in socioeconomically disadvantaged conditions should be encouraged.

Decreasing Prevalence of Obesity Among Young Children in Massachusetts From 2004 to 2008

Science.gov (United States)

Gillman, Matthew W.; Rifas-Shiman, Sheryl L.; Sherry, Bettylou; Kleinman, Ken; Taveras, Elsie M.

2012-01-01

OBJECTIVE: To examine whether the obesity prevalence is increasing, level, or decreasing among young US children (aged children) at a multisite pediatric practice in eastern Massachusetts during 1999–2008. By using the Centers for Disease Control and Prevention 2000 gender-specific growth charts, we defined obesity as weight-for-length ≥95th percentile for children aged children aged 24 to obesity trends in 2 separate periods, 1999–2003 and 2004–2008, adjusting for age group, race/ethnicity, health insurance, and practice site. RESULTS: From 1999 to 2003, the obesity prevalence was fairly stable among both boys and girls. From 2004 to 2008, the obesity prevalence substantially decreased among both boys and girls. The decline in obesity prevalence during 2004–2008 was more pronounced among children insured by non-Medicaid health plans than among those insured by Medicaid. CONCLUSIONS: Among children aged obesity prevalence decreased during 2004–2008, which is in line with national data showing no increase in prevalence during this time period. The smaller decrease among Medicaid-insured children may portend widening of socioeconomic disparities in childhood obesity. PMID:22529276

Births and deaths including fetal deaths

Data.gov (United States)

U.S. Department of Health & Human Services — Access to a variety of United States birth and death files including fetal deaths: Birth Files, 1968-2009; 1995-2005; Fetal death file, 1982-2005; Mortality files,...

How does social capital matter to the health status of older adults? Evidence from the China Health and Retirement Longitudinal Survey.

Science.gov (United States)

Liu, Gordon G; Xue, Xindong; Yu, Chenxi; Wang, Yafeng

2016-09-01

This paper uses longitudinal data from China to examine the causal relationship between structural social capital and health among Chinese older adults. We employ various econometric strategies to control for the potential endogeneity of social capital and account for the possible contextual confounding effects by including community-level social capital. We use three indicators to measure individuals' general, physical, and mental health. Results indicate that social capital has a significant and positive effect on general and physical health. Based on our primary IV findings, a one standard-deviation increase in social capital leads to a 4.9 standard-deviation decrease in the probability of having bad health and a 2.2 standard-deviation decrease in physical activity limitations. Our results are robust to a series of sensitivity checks. Further analysis suggests heterogeneous effects by age but not by gender or area of residence. Copyright © 2016 Elsevier B.V. All rights reserved.

Household characteristics affecting drinking water quality and human health

International Nuclear Information System (INIS)

Kausar, S.; Maann, A.A.; Zafar, I.; Ali, T.

2009-01-01

Pakistan's water crisis, especially serious water shortages have had a great impact on the health of the general population. Today majority of Pakistanis have no access to improved water sources which force people to consume polluted drinking water that results in the shape of waterborne diseases. In addition to this, household characteristics, includes mother's education and family income, also have an impact on drinking water quality and ultimately on human health. This study was conducted in three districts of Province Punjab both in urban and rural areas. The sample size of this study was 600 females of age group 20-60 years. From the data, it was concluded that mother's education and family income were affecting drinking water quality and human health. As the mother's years of education increased, the health issues decreased. Similarly, as the level of income increased, people suffered from water related diseases decreased. (author)

Widening the Aim of Health Promotion to Include the Most Disadvantaged: Vulnerable Adolescents and the Social Determinants of Health

Science.gov (United States)

Mohajer, Nicole; Earnest, Jaya

2010-01-01

Growing numbers of adolescents are marginalized by social factors beyond their control, leading to poor health outcomes for their families and future generations. Although the role of the social determinants of health has been recognized for many years, there is a gap in our knowledge about the strategies needed to address these factors in health…

Neonatal health including congenital malformation risk of 1072 children born after vitrified embryo transfer.

Science.gov (United States)

Belva, F; Bonduelle, M; Roelants, M; Verheyen, G; Van Landuyt, L

2016-07-01

Does vitrification of Day 3 and Day 5 embryos adversely affect birth outcomes of singletons and twins in comparison with peers born after fresh embryo transfer? Neonatal health parameters, including the prevalence of congenital malformations, in singletons and twins born after embryo vitrification are similar to or slightly better than after fresh embryo transfer. Although vitrification, rather than slow-freezing, of embryos is routine practice nowadays, convincing evidence regarding the safety for the offspring is sparse. Literature data comprise results from mostly small-sized studies or studies including only Day 3 or only Day 5 vitrified embryo transfers. Overall, better or comparable perinatal outcomes, in terms of higher birthweight and lower risk for small-for-gestational age or for low birthweight, have been reported for singletons born after vitrified embryo transfer compared with fresh embryo transfer. According to the single available study with sufficient sample size, the congenital malformation rate was found to be comparable after vitrified and fresh embryo transfers. Data were collected from 960 cycles after transfer of embryos vitrified on Day 3 (n = 457) or Day 5 (n = 503) and from 1644 cycles after fresh embryo transfer on Day 3 (n = 853) or Day 5 (n = 791), performed between 2008 and 2013 at the Centre for Reproductive Medicine of the university hospital UZ Brussel. Outcome measures were neonatal health in terms of birthweight, small-for-gestational age, prematurity rate, perinatal death and major/minor/total malformation rate. Perinatal health parameters of 11 stillborns and 1061 live borns (827 singletons and 234 twins) in the vitrified group and of 28 stillborns and 1838 live borns (1374 singletons and 464 twins) in the fresh embryo group are reported. Within 3 months after birth, children in the two study groups were assessed clinically with special attention to congenital malformations by a paediatrician blinded to the type of embryo

Social Media Use and Mental Health among Young Adults.

Science.gov (United States)

Berryman, Chloe; Ferguson, Christopher J; Negy, Charles

2018-06-01

In recent years many parents, advocates and policy makers have expressed concerns regarding the potential negative impact of social media use. Some studies have indicated that social media use may be tied to negative mental health outcomes, including suicidality, loneliness and decreased empathy. Other studies have not found evidence for harm, or have indicated that social media use may be beneficial for some individuals. The current correlational study examined 467 young adults for their time spent using social media, importance of social media in their lives and tendency to engage in vaguebooking (posting unclear but alarming sounding posts to get attention). Outcomes considered included general mental health symptoms, suicidal ideation, loneliness, social anxiety and decreased empathy. Results indicated that social media use was not predictive of impaired mental health functioning. However, vaguebooking was predictive of suicidal ideation, suggesting this particular behavior could be a warning sign for serious issues. Overall, results from this study suggest that, with the exception of vaguebooking, concerns regarding social media use may be misplaced.

Decreased health-related quality of life in patients with diabetic foot problems

Directory of Open Access Journals (Sweden)

Sothornwit J

2018-03-01

Full Text Available Jin Sothornwit,1 Gulapar Srisawasdi,2 Atchara Suwannakin,2 Apiradee Sriwijitkamol1 1Division of Endocrinology and Metabolism, Department of Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand; 2Foot Clinic, Department of Rehabilitation Medicine, Faculty of Medicine Siriraj Hospital, Mahidol University, Bangkok Noi, Bangkok, Thailand Purpose: The aim of this study was to investigate health-related quality of life (HRQoL in patients with diabetic foot problems and compare the HRQoL between diabetic patients with: 1 diabetic foot problems (DF, including diabetic foot ulcer (DFU or amputation (AMPU; 2 other diabetic complications (COM, such as diabetic retinopathy (DR, end-stage renal disease (ESRD, or coronary artery disease (CAD; and 3 no diabetic complication (CON.Patients and methods: A total of 254 diabetic patients were studied in a cross-sectional setting. HRQoL was evaluated using Thai version of the Euro Quality of Life Questionnaire (EuroQoL, with five dimensions and five-level scale (EQ-5D-5L. Utility scores were calculated using time trade-off methods.Results: A total of 141 patients in the DF group (98 DFU and 43 AMPU groups, 82 in the COM group (27 DR, 28 ESRD, and 27 CAD groups, and 31 in the CON group were interviewed. The mean age was 63.2±12.1 years, body mass index was 24.9±4.7 kg/m2, mean hemoglobin A1c was 7.7±2.1%, duration of diabetes was 13.1±9.9 years, and the mean utility scores were 0.799±0.25. After having DF, 21% of patients had lost their jobs. The COM group had lower utility scores than the CON group. Among the diabetic complications, the DF group had the lowest mean utility scores as compared to the COM and CON groups (0.703±0.28 in the DF group, 0.903±0.15 in the COM group, and 0.961±0.06 in the CON group, P<0.01. There was no difference in the mean utility scores between DFU and AMPU groups. Patients in the DF group reported moderate-to-severe problem in all

Including pathogen risk in life cycle assessment of wastewater management. 2. Quantitative comparison of pathogen risk to other impacts on human health.

Science.gov (United States)

Heimersson, Sara; Harder, Robin; Peters, Gregory M; Svanström, Magdalena

2014-08-19

Resource recovery from sewage sludge has the potential to save natural resources, but the potential risks connected to human exposure to heavy metals, organic micropollutants, and pathogenic microorganisms attract stakeholder concern. The purpose of the presented study was to include pathogen risks to human health in life cycle assessment (LCA) of wastewater and sludge management systems, as this is commonly omitted from LCAs due to methodological limitations. Part 1 of this article series estimated the overall pathogen risk for such a system with agricultural use of the sludge, in a way that enables the results to be integrated in LCA. This article (part 2) presents a full LCA for two model systems (with agricultural utilization or incineration of sludge) to reveal the relative importance of pathogen risk in relation to other potential impacts on human health. The study showed that, for both model systems, pathogen risk can constitute an important part (in this study up to 20%) of the total life cycle impacts on human health (expressed in disability adjusted life years) which include other important impacts such as human toxicity potential, global warming potential, and photochemical oxidant formation potential.

Workplace Health Promotion and Mental Health: Three-Year Findings from Partnering Healthy@Work.

Science.gov (United States)

Jarman, Lisa; Martin, Angela; Venn, Alison; Otahal, Petr; Blizzard, Leigh; Teale, Brook; Sanderson, Kristy

2016-01-01

This study aimed to investigate the association between mental health and comprehensive workplace health promotion (WHP) delivered to an entire state public service workforce (~28,000 employees) over a three-year period. Government departments in a state public service were supported to design and deliver a comprehensive, multi-component health promotion program, Healthy@Work, which targeted modifiable health risks including unhealthy lifestyles and stress. Repeated cross-sectional surveys compared self-reported psychological distress (Kessler-10; K10) at commencement (N = 3406) and after 3 years (N = 3228). WHP availability and participation over time was assessed, and associations between the K10 and exposure to programs estimated. Analyses were repeated for a cohort subgroup (N = 580). Data were weighted for non-response. Participation in any mental health and lifestyle programs approximately doubled after 3 years. Both male and female employees with poorer mental health participated more often over time. Women's psychological distress decreased over time but this change was only partially attributable to participation in WHP, and only to lifestyle interventions. Average psychological distress did not change over time for men. Unexpectedly, program components directly targeting mental health were not associated with distress for either men or women. Cohort results corroborated findings. Healthy@Work was successful in increasing participation across a range of program types, including for men and women with poorer mental health. A small positive association of participation in lifestyle programs with mental health was observed for women but not men. The lack of association of mental health programs may have reflected program quality, its universality of application or other contextual factors.

Dysfunctional health service conflict: causes and accelerants.

Science.gov (United States)

Nelson, H Wayne

2012-01-01

This article examines the causes and accelerants of dysfunctional health service conflict and how it emerges from the health system's core hierarchical structures, specialized roles, participant psychodynamics, culture, and values. This article sets out to answer whether health care conflict is more widespread and intense than in other settings and if it is, why? To this end, health care power, gender, and educational status gaps are examined with an eye to how they undermine open communication, teamwork, and collaborative forms of conflict and spark a range of dysfunctions, including a pervasive culture of fear; the deny-and-defend lawsuit response; widespread patterns of hierarchical, generational, and lateral bullying; overly avoidant conflict styles among non-elite groups; and a range of other behaviors that lead to numerous human resource problems, including burnout, higher staff turnover, increased errors, poor employee citizenship behavior, patient dissatisfaction, increased patient complaints, and lawsuits. Bad patient outcomes include decreased compliance and increased morbidity and mortality. Health care managers must understand the root causes of these problems to treat them at the source and implement solutions that avoid negative conflict spirals that undermine organizational morale and efficiency.

Exploring the determinants of secular decreases in dental caries among Korean children.

Science.gov (United States)

Lee, Hye-Ju; Han, Dong-Hun

2015-08-01

The aim of this study was to determine the contributions of sealant and water fluoridation to the time trends in dental caries from 2003 to 2010. Data were from three waves of the Korean National Oral Health Surveys between 2003 and 2010, including a total of 23 059 children (11 889 boys and 11 170 girls) aged 8, 10, and 12 years. The impacts of sealant and water fluoridation on dental caries were obtained by logistic regression for each age group of children. The contributions of sealant and water fluoridation to the time trends in the prevalence of dental caries were examined by a series of logistic regression models, and changes in the adjusted odds ratios for each survey year were also calculated. Over the past 7 years, the prevalence of dental caries decreased dramatically. Although sealant had a significant impact on dental caries in each survey year, remarkable decreases in dental caries from 2003 to 2010 were not explained by the secular changes in the dental sealant or water fluoridation factor. We observed important population declines in dental caries in Korea in children aged 8-12 years; however, the likely causes for these secular trends remain to be determined. © 2015 John Wiley & Sons A/S. Published by John Wiley & Sons Ltd.

THE LEGITIMACY OF INCLUDING THE SOCIAL PARAMETERS IN EVALUATING THE HEALTH STATUS IN THE SOCIAL ASSURANCE SYSTEM

Directory of Open Access Journals (Sweden)

MIHAI NEDELCU

2011-04-01

Full Text Available The social state crisis encouraged a reductionist tendency which had recently developed in the evaluations of the health status in the social assurance system. A holistic, psycho-medical approach, which took in consideration the implications of the social factors regarding disability, was confronted with a strictly medical model, in which the illness is exclusively considered a person’s problem; therefore, the references towards the „social” are irrelevant. In this context, the present paper states the question of the legitimacy of using some sociological concepts, in medical expertise, considered relevant in this area, such as: „occupational access” or the „social functioning of the person”. The present study doesn’t stop at offering as arguments of legitimacy the authority of some recommendations regarding the use of the social-medical model, including the evaluation of the health status, recommendations received from the behalf of OMS and the European Council (see CIF. The paper presents the construction of specific evaluation instruments and tries to identify the sense in which using the references regarding the „social” could influence the pressures in the social assurance system.

Estonia: health system review.

Science.gov (United States)

Lai, Taavi; Habicht, Triin; Kahur, Kristiina; Reinap, Marge; Kiivet, Raul; van Ginneken, Ewout

2013-01-01

This analysis of the Estonian health system reviews recent developments in organization and governance, health financing, health-care provision, health reforms and health system performance. Without doubt, the main issue has been the 2008 financial crisis. Although Estonia has managed the downturn quite successfully and overall satisfaction with the system remains high, it is hard to predict the longer-term effects of the austerity package. The latter included some cuts in benefits and prices, increased cost sharing for certain services, extended waiting times, and a reduction in specialized care. In terms of health outcomes, important progress was made in life expectancy, which is nearing the European Union (EU) average, and infant mortality. Improvements are necessary in smoking and alcohol consumption, which are linked to the majority of avoidable diseases. Although the health behaviour of the population is improving, large disparities between groups exist and obesity rates, particularly among young people, are increasing. In health care, the burden of out-of-pocket payments is still distributed towards vulnerable groups. Furthermore, the number of hospitals, hospital beds and average length of stay has decreased to the EU average level, yet bed occupancy rates are still below EU averages and efficiency advances could be made. Going forwards, a number of pre-crisis challenges remain. These include ensuring sustainability of health care financing, guaranteeing a sufficient level of human resources, prioritizing patient-centred health care, integrating health and social care services, implementing intersectoral action to promote healthy behaviour, safeguarding access to health care for lower socioeconomic groups, and, lastly, improving evaluation and monitoring tools across the health system. World Health Organization 2013 (acting as the host organization for, and secretariat of, the European Observatory on Health Systems and Policies).

Prescription for natural cures: a self-care guide for treating health problems with natural remedies including diet, nutrition, supplements, and other holistic methods

National Research Council Canada - National Science Library

Balch, James F; Stengler, Mark; Young-Balch, Robin

2011-01-01

.... You'll find easy-to-understand discussions of the symptoms and root causes of each health problem along with a proven, natural, customized prescription that may include supplements, herbal medicine...

The evolution of health status and chronic conditions in Catalonia, 1994-2006: the paradox of health revisited using the Blinder - Oaxaca decomposition.

Science.gov (United States)

García-Altés, Anna; Pinilla, Jaime; Ortún, Vicente

2011-05-23

The paradox of health refers to the improvement in objective measures of health and the increase in the reported prevalence of chronic conditions. The objective of this paper is to test the paradox of health in Catalonia from 1994 to 2006. Longitudinal cross-sectional study using the Catalonia Health Interview Survey of 1994 and 2006. The approach used was the three-fold Blinder - Oaxaca decomposition, separating the part of the differential in mean visual analogue scale value (VAS) due to group differences in the predictors (prevalence effect), due to differences in the coefficients (severity effect), and an interaction term. Variables included were the VAS value, education level, labour status, marital status, all common chronic conditions over the two cross-sections, and a variable for non-common chronic conditions and other conditions. Sample weights have been applied. Results show that there is an increase in mean VAS for men aged 15-44, and a decrease in mean VAS for women aged 65-74 and 75 and more. The increase in mean VAS for men aged 15-44 could be explained by a decrease in the severity effect, which offsets the increase in the prevalence effect. The decrease in mean VAS for women aged 65-74 and 75 and more could be explained by an increase in the prevalence effect, which does not offset the decrease in the severity effect. The results of the present analysis corroborate the paradox of health hypothesis for the population of Catalonia, and highlight the need to be careful when measuring population health over time, as well as their usefulness to detect population's perceptions.

Should catastrophic risks be included in a regulated competitive health insurance market?

NARCIS (Netherlands)

W.P.M.M. van de Ven (Wynand); F.T. Schut (Erik)

1994-01-01

textabstractIn 1988 the Dutch government launched a proposal for a national health insurance based on regulated competition. The mandatory benefits package should be offered by competing insurers and should cover both non-catastrophic risks (like hospital care, physician services and drugs) and

Decreases in tanning behaviors following a short online survey: Potential for prevention?

Directory of Open Access Journals (Sweden)

Rachel F. Rodgers

2015-01-01

Conclusions: Our study presents novel and compelling support for using brief online surveys for decreasing health-risk behaviors such as sunbed use. Such measures are extremely cost-effective and easy to disseminate and implement. Replication and extension of these findings are warranted.

Waking the health plan giant: Group Health Cooperative stops counting sheep and starts counting key tobacco indicators.

Science.gov (United States)

McAfee, T

1998-01-01

Implementing a comprehensive approach to decreasing tobacco use in a large health plan requires hard work and commitment on the part of many individuals. We found that major organisational change can be accomplished and sustained. Keys to our success included our decision to remove access barriers to our cessation programmes (including cost); obtaining top leadership buy-in; identifying accountable individuals who owned responsibility for change; measuring key processes and outcomes; and finally keeping at it tenaciously through multiple cycles of improvement.

Decreasing In-home Smoking of Adults-Results from a School-based Intervention Program in Viet Nam.

Science.gov (United States)

Huong, Le Thi Thanh; Long, Tran Khanh; Anh, Le Vu; Cook, Margaret; Capra, Mike

2016-01-01

It is indicated that children are involuntarily exposed to secondhand smoke from adults, mainly at their home environment. This study aimed at describing the effectiveness of the school-based intervention to decrease the in-home smoking situation of adults so as to decrease children's exposure to secondhand smoke at home during the year 2011-2012 in a rural district in Hanoi, Viet Nam. This school-based intervention program (intervention and control group) involved 804 children aged 8 to 11 years from August 2011 to May 2012 in a rural district of Hanoi, Viet Nam. Children were taught in class about the harmful effects of secondhand smoke and about how to negotiate with fathers not to smoke in-home. Then children applied what they learnt, including staying away from secondhand smoke and persuading fathers not to smoke in-home in order to decrease children's exposure to secondhand smoke. Chi square test, t-test and multinominal logistic regression were applied in data analysis. The results showed that children's reported their father's in-home smoking decreased from 83.0% pre-intervention to 59.8% post-intervention ( p Viet Nam to increase children's awareness on the adverse health effects of secondhand smoke and to help them to be able to avoid their exposure to secondhand smoke at their home environment.

Contribution of health workforce to health outcomes: empirical evidence from Vietnam.

Science.gov (United States)

Nguyen, Mai Phuong; Mirzoev, Tolib; Le, Thi Minh

2016-11-16

In Vietnam, a lower-middle income country, while the overall skill- and knowledge-based quality of health workforce is improving, health workers are disproportionately distributed across different economic regions. A similar trend appears to be in relation to health outcomes between those regions. It is unclear, however, whether there is any relationship between the distribution of health workers and the achievement of health outcomes in the context of Vietnam. This study examines the statistical relationship between the availability of health workers and health outcomes across the different economic regions in Vietnam. We constructed a panel data of six economic regions covering 8 years (2006-2013) and used principal components analysis regressions to estimate the impact of health workforce on health outcomes. The dependent variables representing the outcomes included life expectancy at birth, infant mortality, and under-five mortality rates. Besides the health workforce as our target explanatory variable, we also controlled for key demographic factors including regional income per capita, poverty rate, illiteracy rate, and population density. The numbers of doctors, nurses, midwives, and pharmacists have been rising in the country over the last decade. However, there are notable differences across the different categories. For example, while the numbers of nurses increased considerably between 2006 and 2013, the number of pharmacists slightly decreased between 2011 and 2013. We found statistically significant evidence of the impact of density of doctors, nurses, midwives, and pharmacists on improvement to life expectancy and reduction of infant and under-five mortality rates. Availability of different categories of health workforce can positively contribute to improvements in health outcomes and ultimately extend the life expectancy of populations. Therefore, increasing investment into more equitable distribution of four main categories of health workforce

Implementation of a simple electronic transfusion alert system decreases inappropriate ordering of packed red blood cells and plasma in a multi-hospital health care system.

Science.gov (United States)

Smith, Matthew; Triulzi, Darrell J; Yazer, Mark H; Rollins-Raval, Marian A; Waters, Jonathan H; Raval, Jay S

2014-12-01

Prescriber adherence to institutional blood component ordering guidelines can be low. The goal of this study was to decrease red blood cell (RBC) and plasma orders that did not meet institutional transfusion guidelines by using data within the laboratory information system to trigger alerts in the computerized order entry (CPOE) system at the time of order entry. At 10 hospitals within a regional health care system, discernment rules were created for RBC and plasma orders utilizing transfusion triggers of hemoglobin 1.6, respectively, with subsequent alert generation that appears within the CPOE system when a prescriber attempts to order RBCs or plasma on a patient whose antecedent laboratory values do not suggest that a transfusion is indicated. Orders and subsequent alerts were tracked for RBCs and plasma over evaluation periods of 15 and 10 months, respectively, along with the hospital credentials of the ordering health care providers (physician or nurse). Alerts triggered which were heeded remained steady and averaged 11.3% for RBCs and 19.6% for plasma over the evaluation periods. Overall, nurses and physicians canceled statistically identical percentages of alerted RBC (10.9% vs. 11.5%; p = 0.78) and plasma (21.3% vs. 18.7%; p = 0.22) orders. Implementing a simple evidence-based transfusion alert system at the time of order entry decreased non-evidence based transfusion orders by both nurse and physician providers. Copyright © 2014 Elsevier Ltd. All rights reserved.

Consumer Opinions of Health Information Exchange, e-Prescribing, and Personal Health Records.

Science.gov (United States)

Cochran, Gary L; Lander, Lina; Morien, Marsha; Lomelin, Daniel E; Brittin, Jeri; Reker, Celeste; Klepser, Donald G

2015-01-01

Consumer satisfaction is a crucial component of health information technology (HIT) utilization, as high satisfaction is expected to increase HIT utilization among providers and to allow consumers to become full participants in their own healthcare management. The primary objective of this pilot study was to identify consumer perspectives on health information technologies including health information exchange (HIE), e-prescribing (e-Rx), and personal health records (PHRs). Eight focus groups were conducted in seven towns and cities across Nebraska in 2013. Each group consisted of 10-12 participants. Discussions were organized topically in the following categories: HIE, e-Rx, and PHR. The qualitative analysis consisted of immersion and crystallization to develop a coding scheme that included both preconceived and emergent themes. Common themes across focus groups were identified and compiled for each discussion category. The study had 67 participants, of which 18 (27 percent) were male. Focus group findings revealed both perceived barriers and benefits to the adoption of HIT. Common HIT concerns expressed across focus groups included privacy and security of medical information, decreases in quality of care, inconsistent provider participation, and the potential cost of implementation. Positive expectations regarding HIT included better accuracy and completeness of information, and improved communication and coordination between healthcare providers. Improvements in patient care were expected as a result of easy physician access to consolidated information across providers as well as the speed of sharing and availability of information in an emergency. In addition, participants were optimistic about patient empowerment and convenient access to and control of personal health data. Consumer concerns focused on privacy and security of the health information, as well as the cost of implementing the technologies and the possibility of an unintended negative impact on the

Insurance choice and tax-preferred health savings accounts.

Science.gov (United States)

Cardon, James H; Showalter, Mark H

2007-03-01

We develop an infinite horizon utility maximization model of the interaction between insurance choice and tax-preferred health savings accounts. The model can be used to examine a wide range of policy options, including flexible spending accounts, health savings accounts, and health reimbursement accounts. We also develop a 2-period model to simulate various implications of the model. Key results from the simulation analysis include the following: (1) with no adverse selection, use of unrestricted health savings accounts leads to modest welfare gains, after accounting for the tax revenue loss; (2) with adverse selection and an initial pooling equilibrium comprised of "sick" and "healthy" consumers, introducing HSAs can, but does not necessarily, lead to a new pooling equilibrium. The new equilibrium results in a higher coinsurance rate, an increase in expected utility for healthy consumers, and a decrease in expected utility for sick consumers; (3) with adverse selection and a separating equilibrium, both sick and healthy consumers are better off with a health savings account; (4) efficiency gains are possible when insurance contracts are explicitly linked to tax-preferred health savings accounts.

Workplace Health Promotion and Mental Health: Three-Year Findings from Partnering Healthy@Work.

Directory of Open Access Journals (Sweden)

Lisa Jarman

Full Text Available This study aimed to investigate the association between mental health and comprehensive workplace health promotion (WHP delivered to an entire state public service workforce (~28,000 employees over a three-year period. Government departments in a state public service were supported to design and deliver a comprehensive, multi-component health promotion program, Healthy@Work, which targeted modifiable health risks including unhealthy lifestyles and stress. Repeated cross-sectional surveys compared self-reported psychological distress (Kessler-10; K10 at commencement (N = 3406 and after 3 years (N = 3228. WHP availability and participation over time was assessed, and associations between the K10 and exposure to programs estimated. Analyses were repeated for a cohort subgroup (N = 580. Data were weighted for non-response. Participation in any mental health and lifestyle programs approximately doubled after 3 years. Both male and female employees with poorer mental health participated more often over time. Women's psychological distress decreased over time but this change was only partially attributable to participation in WHP, and only to lifestyle interventions. Average psychological distress did not change over time for men. Unexpectedly, program components directly targeting mental health were not associated with distress for either men or women. Cohort results corroborated findings. Healthy@Work was successful in increasing participation across a range of program types, including for men and women with poorer mental health. A small positive association of participation in lifestyle programs with mental health was observed for women but not men. The lack of association of mental health programs may have reflected program quality, its universality of application or other contextual factors.

Pet ownership and physical health.

Science.gov (United States)

Matchock, Robert L

2015-09-01

Pet ownership and brief human-animal interactions can serve as a form of social support and convey a host of beneficial psychological and physiological health benefits. This article critically examines recent relevant literature on the pet-health connection. Cross-sectional studies indicate correlations between pet ownership and numerous aspects of positive health outcomes, including improvements on cardiovascular measures and decreases in loneliness. Quasi-experimental studies and better controlled experimental studies corroborate these associations and suggest that owning and/or interacting with a pet may be causally related to some positive health outcomes. The value of pet ownership and animal-assisted therapy (AAT), as a nonpharmacological treatment modality, augmentation to traditional treatment, and healthy preventive behavior (in the case of pet ownership), is starting to be realized. However, more investigations that employ randomized controlled trials with larger sample sizes and investigations that more closely examine the underlying mechanism of the pet-health effect, such as oxytocin, are needed.

Health Promotion Behavior of Chinese International Students in Korea Including Acculturation Factors: A Structural Equation Model

Directory of Open Access Journals (Sweden)

Sun Jung Kim, RN, PhD

2016-03-01

Conlcusions: The Chinese students in Korea with higher self-esteem, perceived health status, acculturation level, and lower acculturative stress reported higher health promotion behavior. The findings can be applied to develop health promotion strategies for this population.

Decreased health-related quality of life in patients with diabetic foot problems

Science.gov (United States)

Sothornwit, Jin; Srisawasdi, Gulapar; Suwannakin, Atchara; Sriwijitkamol, Apiradee

2018-01-01

Purpose The aim of this study was to investigate health-related quality of life (HRQoL) in patients with diabetic foot problems and compare the HRQoL between diabetic patients with: 1) diabetic foot problems (DF), including diabetic foot ulcer (DFU) or amputation (AMPU); 2) other diabetic complications (COM), such as diabetic retinopathy (DR), end-stage renal disease (ESRD), or coronary artery disease (CAD); and 3) no diabetic complication (CON). Patients and methods A total of 254 diabetic patients were studied in a cross-sectional setting. HRQoL was evaluated using Thai version of the Euro Quality of Life Questionnaire (EuroQoL), with five dimensions and five-level scale (EQ-5D-5L). Utility scores were calculated using time trade-off methods. Results A total of 141 patients in the DF group (98 DFU and 43 AMPU groups), 82 in the COM group (27 DR, 28 ESRD, and 27 CAD groups), and 31 in the CON group were interviewed. The mean age was 63.2±12.1 years, body mass index was 24.9±4.7 kg/m2, mean hemoglobin A1c was 7.7±2.1%, duration of diabetes was 13.1±9.9 years, and the mean utility scores were 0.799±0.25. After having DF, 21% of patients had lost their jobs. The COM group had lower utility scores than the CON group. Among the diabetic complications, the DF group had the lowest mean utility scores as compared to the COM and CON groups (0.703±0.28 in the DF group, 0.903±0.15 in the COM group, and 0.961±0.06 in the CON group, Pdiabetic foot care should be emphasized in clinical practice to prevent foot complications. PMID:29563821

Decreased health-related quality of life in patients with diabetic foot problems.

Science.gov (United States)

Sothornwit, Jin; Srisawasdi, Gulapar; Suwannakin, Atchara; Sriwijitkamol, Apiradee

2018-01-01

The aim of this study was to investigate health-related quality of life (HRQoL) in patients with diabetic foot problems and compare the HRQoL between diabetic patients with: 1) diabetic foot problems (DF), including diabetic foot ulcer (DFU) or amputation (AMPU); 2) other diabetic complications (COM), such as diabetic retinopathy (DR), end-stage renal disease (ESRD), or coronary artery disease (CAD); and 3) no diabetic complication (CON). A total of 254 diabetic patients were studied in a cross-sectional setting. HRQoL was evaluated using Thai version of the Euro Quality of Life Questionnaire (EuroQoL), with five dimensions and five-level scale (EQ-5D-5L). Utility scores were calculated using time trade-off methods. A total of 141 patients in the DF group (98 DFU and 43 AMPU groups), 82 in the COM group (27 DR, 28 ESRD, and 27 CAD groups), and 31 in the CON group were interviewed. The mean age was 63.2±12.1 years, body mass index was 24.9±4.7 kg/m 2 , mean hemoglobin A1c was 7.7±2.1%, duration of diabetes was 13.1±9.9 years, and the mean utility scores were 0.799±0.25. After having DF, 21% of patients had lost their jobs. The COM group had lower utility scores than the CON group. Among the diabetic complications, the DF group had the lowest mean utility scores as compared to the COM and CON groups (0.703±0.28 in the DF group, 0.903±0.15 in the COM group, and 0.961±0.06 in the CON group, P diabetic foot care should be emphasized in clinical practice to prevent foot complications.

Decreases in tanning behaviors following a short online survey: Potential for prevention?

Science.gov (United States)

Rodgers, Rachel F; Franko, Debra L; Gottlieb, Mark; Daynard, Richard

2015-01-01

To date, tanning prevention programs have led to limited success. The aim of the present study was to investigate potential unexpected prevention effects of completing an online survey focused on tanning attitudes, behaviors, and knowledge among female college tanners. A sample of 92 female undergraduate students from the USA, mean age = 20.09, SD = 1.41 years, who engaged in indoor tanning completed an online survey assessing awareness of tanning-related health risks, appearance-based motivations to tan and not to tan, media literacy related to tanning marketing, and tanning behaviors in 2013. Four months later, participants were invited to complete a follow-up survey assessing tanning intentions and behaviors since completing the initial survey. Fifty-one participants (55%) completed the follow-up questions, of whom 43 (84.3%) reported having decreased or ceased engaging in indoor tanning. In addition participants provided comments indicating that completing the survey had lead to decreases in their tanning behaviors. Our study presents novel and compelling support for using brief online surveys for decreasing health-risk behaviors such as sunbed use. Such measures are extremely cost-effective and easy to disseminate and implement. Replication and extension of these findings are warranted.

Decreased Libido

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... Center Pacientes y Cuidadores Hormones and Health The Endocrine System Hormones Endocrine Disrupting Chemicals (EDCs) Steroid and Hormone ... an Endocrinologist Clinical Trials Hormones and Health The Endocrine System Hormones Endocrine Disrupting Chemicals (EDCs) Steroid and Hormone ...

Sarcopenia as an Independent Risk Factor for Decreased BMD in COPD Patients: Korean National Health and Nutrition Examination Surveys IV and V (2008-2011)

Science.gov (United States)

Lee, Dong-Won; Choi, Eun-Young

2016-01-01

Background A decrease in bone mineral density (BMD) is a systemic consequence of chronic obstructive pulmonary disease (COPD). Past reports have rarely examined any correlation between sarcopenia and BMD. We investigated the relationship cross-sectionally between the presence of sarcopenia and BMD reduction in COPD patients. Methods COPD patients aged 50 or older with qualifying spirometry and dual-energy X-ray absorptiometry data were from participants in the Korean National Health and Nutrition Examination Surveys IV and V (2008–2011). Results There were 286 (33.3%) subjects in the sarcopenia group and 572 (66.7%) in the non-sarcopenia group. The sarcopenia group had lower T-scores than the non-sarcopenia group (femur: -0.73±0.88 vs. -0.18±0.97, p sarcopenia group and 45.6% and 13.3% in the non-sarcopenia group (both p sarcopenia associated with increased the risk of osteopenia, osteoporosis, and a low BMD (OR = 3.227, 95% CI = 2.125–4.899, p sarcopenia was associated with increased the risk for decreased BMD in COPD. PMID:27749901

A web-based intervention for health professionals and patients to decrease cardiovascular risk attributable to physical inactivity: development process.

Science.gov (United States)

Sassen, Barbara; Kok, Gerjo; Mesters, Ilse; Crutzen, Rik; Cremers, Anita; Vanhees, Luc

2012-12-14

Patients with cardiovascular risk factors can reduce their risk of cardiovascular disease by increasing their physical activity and their physical fitness. According to the guidelines for cardiovascular risk management, health professionals should encourage their patients to engage in physical activity. In this paper, we provide insight regarding the systematic development of a Web-based intervention for both health professionals and patients with cardiovascular risk factors using the development method Intervention Mapping. The different steps of Intervention Mapping are described to open up the "black box" of Web-based intervention development and to support future Web-based intervention development. The development of the Professional and Patient Intention and Behavior Intervention (PIB2 intervention) was initiated with a needs assessment for both health professionals (ie, physiotherapy and nursing) and their patients. We formulated performance and change objectives and, subsequently, theory- and evidence-based intervention methods and strategies were selected that were thought to affect the intention and behavior of health professionals and patients. The rationale of the intervention was based on different behavioral change methods that allowed us to describe the scope and sequence of the intervention and produced the Web-based intervention components. The Web-based intervention consisted of 5 modules, including individualized messages and self-completion forms, and charts and tables. The systematic and planned development of the PIB2 intervention resulted in an Internet-delivered behavior change intervention. The intervention was not developed as a substitute for face-to-face contact between professionals and patients, but as an application to complement and optimize health services. The focus of the Web-based intervention was to extend professional behavior of health care professionals, as well as to improve the risk-reduction behavior of patients with

A Web-Based Intervention for Health Professionals and Patients to Decrease Cardiovascular Risk Attributable to Physical Inactivity: Development Process

Science.gov (United States)

2012-01-01

Background Patients with cardiovascular risk factors can reduce their risk of cardiovascular disease by increasing their physical activity and their physical fitness. According to the guidelines for cardiovascular risk management, health professionals should encourage their patients to engage in physical activity. Objective In this paper, we provide insight regarding the systematic development of a Web-based intervention for both health professionals and patients with cardiovascular risk factors using the development method Intervention Mapping. The different steps of Intervention Mapping are described to open up the “black box” of Web-based intervention development and to support future Web-based intervention development. Methods The development of the Professional and Patient Intention and Behavior Intervention (PIB2 intervention) was initiated with a needs assessment for both health professionals (ie, physiotherapy and nursing) and their patients. We formulated performance and change objectives and, subsequently, theory- and evidence-based intervention methods and strategies were selected that were thought to affect the intention and behavior of health professionals and patients. The rationale of the intervention was based on different behavioral change methods that allowed us to describe the scope and sequence of the intervention and produced the Web-based intervention components. The Web-based intervention consisted of 5 modules, including individualized messages and self-completion forms, and charts and tables. Results The systematic and planned development of the PIB2 intervention resulted in an Internet-delivered behavior change intervention. The intervention was not developed as a substitute for face-to-face contact between professionals and patients, but as an application to complement and optimize health services. The focus of the Web-based intervention was to extend professional behavior of health care professionals, as well as to improve the risk

Electronic health record use, intensity of hospital care, and patient outcomes.

Science.gov (United States)

Blecker, Saul; Goldfeld, Keith; Park, Naeun; Shine, Daniel; Austrian, Jonathan S; Braithwaite, R Scott; Radford, Martha J; Gourevitch, Marc N

2014-03-01

Previous studies have suggested that weekend hospital care is inferior to weekday care and that this difference may be related to diminished care intensity. The purpose of this study was to determine whether a metric for measuring intensity of hospital care based on use of the electronic health record was associated with patient-level outcomes. We performed a cohort study of hospitalizations at an academic medical center. Intensity of care was defined as the hourly number of provider accessions of the electronic health record, termed "electronic health record interactions." Hospitalizations were categorized on the basis of the mean difference in electronic health record interactions between the first Friday and the first Saturday of hospitalization. We used regression models to determine the association of these categories with patient outcomes after adjusting for covariates. Electronic health record interactions decreased from Friday to Saturday in 77% of the 9051 hospitalizations included in the study. Compared with hospitalizations with no change in Friday to Saturday electronic health record interactions, the relative lengths of stay for hospitalizations with a small, moderate, and large decrease in electronic health record interactions were 1.05 (95% confidence interval [CI], 1.00-1.10), 1.11 (95% CI, 1.05-1.17), and 1.25 (95% CI, 1.15-1.35), respectively. Although a large decrease in electronic health record interactions was associated with in-hospital mortality, these findings were not significant after risk adjustment (odds ratio 1.74, 95% CI, 0.93-3.25). Intensity of inpatient care, measured by electronic health record interactions, significantly diminished from Friday to Saturday, and this decrease was associated with length of stay. Hospitals should consider monitoring and correcting temporal fluctuations in care intensity. Copyright © 2014 Elsevier Inc. All rights reserved.

Development of a hospital-based care coordination program for children with special health care needs.

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Petitgout, Janine M; Pelzer, Daniel E; McConkey, Stacy A; Hanrahan, Kirsten

2013-01-01

A hospital-based Continuity of Care program for children with special health care needs is described. A family-centered team approach provides care coordination and a medical home. The program has grown during the past 10 years to include inpatients and outpatients from multiple services and outreach clinics. Improved outcomes, including decreased length of stay, decreased cost, and high family satisfaction, are demonstrated by participants in the program. Pediatric nurse practitioners play an important role in the medical home, collaborating with primary care providers, hospital-based specialists, community services, and social workers to provide services to children with special health care needs. Copyright © 2013 National Association of Pediatric Nurse Practitioners. Published by Mosby, Inc. All rights reserved.

Child labor and health: a systematic literature review of the impacts of child labor on child's health in low- and middle-income countries.

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Ibrahim, Abdalla; Abdalla, Salma M; Jafer, Mohammed; Abdelgadir, Jihad; de Vries, Nanne

2018-02-02

To summarize current evidence on the impacts of child labor on physical and mental health. We searched PubMed and ScienceDirect for studies that included participants aged 18 years or less, conducted in low- and middle-income countries (LMICs), and reported quantitative data. Two independent reviewers conducted data extraction and assessment of study quality. A total of 25 studies were identified, the majority of which were cross-sectional. Child labor was found to be associated with a number of adverse health outcomes, including but not limited to poor growth, malnutrition, higher incidence of infectious and system-specific diseases, behavioral and emotional disorders, and decreased coping efficacy. Quality of included studies was rated as fair to good. Child labor remains a major public health concern in LMICs, being associated with adverse physical and mental health outcomes. Current efforts against child labor need to be revisited, at least in LMICs. Further studies following a longitudinal design, and using common methods to assess the health impact of child labor in different country contexts would inform policy making. © The Author(s) 2018. Published by Oxford University Press on behalf of Faculty of Public Health.

Changes in health and primary health care use of Moroccan and Turkish migrants between 2001 and 2005: a longitudinal study

Directory of Open Access Journals (Sweden)

Foets Marleen

2008-01-01

Full Text Available Abstract Background Social environment and health status are related, and changes affecting social relations may also affect the general health state of a group. During the past few years, several events have affected the relationships between Muslim immigrants and the non-immigrant population in many countries. This study investigates whether the health status of the Moroccan and Turkish immigrants in the Netherlands has changed in four years, whether changes in health status have had any influence on primary health care use, and which socio-demographic factors might explain this relationship. Methods A cohort of 108 Turkish and 102 Moroccan respondents were interviewed in 2001 and in 2005. The questionnaire included the SF-36 and the GP contact frequency (in the past two months. Interviews were conducted in the language preferred by the respondents. Data were analysed using multivariate linear regression. Results The mental health of the Moroccan group improved between 2001 and 2005. Physical health remained unchanged for both groups. The number of GP contacts decreased with half a contact/2 months among the Turkish group. Significant predictors of physical health change were: age, educational level. For mental health change, these were: ethnicity, age, civil status, work situation in 2001, change in work situation. For change in GP contacts: ethnicity, age and change in mental and physical health. Conclusion Changes in health status concerned the mental health component. Changes in health status were paired with changes in health care utilization. Among the Turkish group, an unexpected decrease in GP contacts was noticed, whilst showing a generally unchanged health status. Further research taking perceived quality of care into account might help shedding some light on this outcome.

Na+-glucose cotransporter SGLT1 protein in salivary glands: potential involvement in the diabetes-induced decrease in salivary flow.

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Sabino-Silva, R; Freitas, H S; Lamers, M L; Okamoto, M M; Santos, M F; Machado, U F

2009-03-01

Oral health complications in diabetes include decreased salivary secretion. The SLC5A1 gene encodes the Na(+)-glucose cotransporter SGLT1 protein, which not only transports glucose, but also acts as a water channel. Since SLC5A1 expression is altered in kidneys of diabetic subjects, we hypothesize that it could also be altered in salivary glands, contributing to diabetic dysfunction. The present study shows a diabetes-induced decrease (p salivary secretion, which was accompanied by enhanced (p diabetic rats revealed that SGLT1 protein expression increased in the luminal membrane of ductal cells, which can stimulate water reabsorption from primary saliva. Furthermore, SGLT1 protein was reduced in myoepithelial cells of the parotid from diabetic animals, and that, by reducing cellular contractile activity, might also be related to reduced salivary flux. Six-day insulin-treated diabetic rats reversed all alterations. In conclusion, diabetes increases SLC5A1 gene expression in salivary glands, increasing the SGLT1 protein content in the luminal membrane of ductal cells, which, by increasing water reabsorption, might explain the diabetes-induced decrease in salivary secretion.

Challenges and Opportunities for Advancing Work on Climate Change and Public Health.

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Gould, Solange; Rudolph, Linda

2015-12-09

Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113) with public health and climate change professionals and thematic analysis. Barriers to public health engagement in addressing climate change include individual perceptions that climate change is not urgent or solvable and insufficient understanding of climate change's health impacts and programmatic connections. Institutional barriers include a lack of public health capacity, authority, and leadership; a narrow framework for public health practice that limits work on the root causes of climate change and health; and compartmentalization within and across sectors. Opportunities include integrating climate change into current public health practice; providing inter-sectoral support for climate solutions with health co-benefits; and using a health frame to engage and mobilize communities. Efforts to increase public health sector engagement should focus on education and communications, building leadership and funding, and increasing work on the shared root causes of climate change and health inequities.

Challenges and Opportunities for Advancing Work on Climate Change and Public Health

Science.gov (United States)

Gould, Solange; Rudolph, Linda

2015-01-01

Climate change poses a major threat to public health. Strategies that address climate change have considerable potential to benefit health and decrease health inequities, yet public health engagement at the intersection of public health, equity, and climate change has been limited. This research seeks to understand the barriers to and opportunities for advancing work at this nexus. We conducted semi-structured in-depth interviews (N = 113) with public health and climate change professionals and thematic analysis. Barriers to public health engagement in addressing climate change include individual perceptions that climate change is not urgent or solvable and insufficient understanding of climate change’s health impacts and programmatic connections. Institutional barriers include a lack of public health capacity, authority, and leadership; a narrow framework for public health practice that limits work on the root causes of climate change and health; and compartmentalization within and across sectors. Opportunities include integrating climate change into current public health practice; providing inter-sectoral support for climate solutions with health co-benefits; and using a health frame to engage and mobilize communities. Efforts to increase public health sector engagement should focus on education and communications, building leadership and funding, and increasing work on the shared root causes of climate change and health inequities. PMID:26690194

Stages of change for physical activity and dietary habits in persons with type 2 diabetes included in a mobile health intervention: the Norwegian study in RENEWING HEALTH.

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Holmen, Heidi; Wahl, Astrid; Torbjørnsen, Astrid; Jenum, Anne Karen; Småstuen, Milada Cvancarova; Ribu, Lis

2016-01-01

The aim of this study was to investigate stages of change for physical activity and dietary habits using baseline data from persons with type 2 diabetes included in a mobile health intervention. We examined the associations between stages of change for physical activity change and dietary change, and between stages of change for each behavior and individual characteristics, health-related quality of life, self-management, depressive symptoms, and lifestyle. We examined 151 persons with type 2 diabetes with an glycated hemoglobin (HbA1c) level ≥7.1%, aged ≥18 years at baseline of a randomized controlled trial, before testing a mobile app with or without health counseling. Stages of change were dichotomized into 'pre-action' and 'action'. Self-management was measured using the Health Education Impact Questionnaire (heiQ) where a higher score reflects increased self-management, and health-related quality of life was measured with the Short-Form-36 (SF-36). Logistic regression modeling was performed. The median HbA1c level was 7.9% (7.1-12.4), 90% were overweight or obese, and 20% had ≥3 comorbidities. 58% were in the preaction stage for physical activity change and 79% in the preaction stage for dietary change. Higher scores of self-management were associated with an increased chance of being in the action stage for both dietary change and physical activity change. Higher body mass index was associated with an 8% reduced chance of being in the action stage for physical activity change (OR 0.92, 95% CI 0.86 to 0.99). Being in the action stage was associated with higher scores of self-management, crucial for type 2 diabetes. Over half of the participants were in the preaction stage for physical activity and dietary change, and many had a high disease burden with comorbidities and overweight. NCT01315756.

Protecting Bone Health in Pediatric Rheumatic Diseases: Pharmacological Considerations.

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Zhang, Yujuan; Milojevic, Diana

2017-06-01

Bone health in children with rheumatic conditions may be compromised due to several factors related to the inflammatory disease state, delayed puberty, altered life style, including decreased physical activities, sun avoidance, suboptimal calcium and vitamin D intake, and medical treatments, mainly glucocorticoids and possibly some disease-modifying anti-rheumatic drugs. Low bone density or even fragility fractures could be asymptomatic; therefore, children with diseases of high inflammatory load, such as systemic onset juvenile idiopathic arthritis, juvenile dermatomyositis, systemic lupus erythematosus, and those requiring chronic glucocorticoids may benefit from routine screening of bone health. Most commonly used assessment tools are laboratory testing including serum 25-OH-vitamin D measurement and bone mineral density measurement by a variety of methods, dual-energy X-ray absorptiometry as the most widely used. Early disease control, use of steroid-sparing medications such as disease-modifying anti-rheumatic drugs and biologics, supplemental vitamin D and calcium, and promotion of weight-bearing physical activities can help optimize bone health. Additional treatment options for osteoporosis such as bisphosphonates are still controversial in children with chronic rheumatic diseases, especially those with decreased bone density without fragility fractures. This article reviews common risk factors leading to compromised bone health in children with chronic rheumatic diseases and discusses the general approach to prevention and treatment of bone fragility.

Sexual Minority Stress, Coping, and Physical Health Indicators.

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Flenar, Delphia J; Tucker, Carolyn M; Williams, Jaime L

2017-12-01

Sexual minorities experience higher rates of several physical health problems compared to their heterosexual counterparts. The present study uses Meyer's Minority Stress Model (Psychological Bulletin, 129(5): 674-697, 2003) to examine physical health indicators among 250 adults who identified as sexual minorities. Study hypotheses include that sexual minority stress is predictive of two physical health indicators (i.e., engagement in a health-promoting lifestyle and number of physical health problems) and that planning (i.e., problem-focused) and social support coping will partially mediate the relationship between sexual minority stress and each physical health indicator. Results showed that as level of sexual minority stress increased, engagement in a health-promoting lifestyle decreased and the number of physical health problems increased. Planning and social support coping did not mediate these relationships; however, as levels of coping increased, engagement in a health-promoting lifestyle increased. These findings have implications for researchers and healthcare professionals in their efforts to promote the physical health of sexual minorities.

Community-based primary prevention programs decrease the rate of metabolic syndrome among socioeconomically disadvantaged women.

Science.gov (United States)

Gilstrap, Lauren Gray; Malhotra, Rajeev; Peltier-Saxe, Donna; Slicas, Donna; Pineda, Eliana; Culhane-Hermann, Catherine; Cook, Nakela; Fernandez-Golarz, Carina; Wood, Malissa

2013-04-01

Metabolic Syndrome (MetSyn) is one of the strongest predictors of type 2 diabetes (DM2) and cardiovascular disease (CVD). It is associated with a 4- to 10-fold increased risk of DM2 and a 2- to 3-fold increased risk of CVD. Low income and minority women have some of the highest rates of MetSyn. This study examines the effect of a unique, community based, primary prevention program on the rates of MetSyn and health habits. Sixty-four low income and minority women were enrolled in the HAPPY (Health Awareness and Primary Prevention in Your neighborhood) Heart Program in an eastern suburb of Boston. Over these 2 years, patients were evaluated by an interdisciplinary medical team: their primary physician, cardiologist, nutritionist, physical therapist, and health coach. The rate of MetSyn was measured at baseline, year 1, and year 2. Comparisons were made either using the paired t test for normally distributed variables or the Wilcoxon Sign test for non-normal variables. The rate of MetSyn fell from 64.7% at baseline to 34.9% at year 1 (p=0.01) and 28.2% at year 2 (p<0.001). This was driven by increases in high-density lipoprotein (HDL-C) (p<0.001) and decreases in blood pressure (p=0.05). Fasting blood glucose trended down, but the hemoglobin A1c (HbA1c) reached significance (decreasing from 6 to 5.8, p<0.01). Nutrition and exercise habits trended toward improvement. There were significant decreases in anxiety (p<0.001), depression (p=0.006) and stress (p=0.002). This lifestyle intervention program is effective at decreasing MetSyn in a socioeconomically disadvantaged, largely minority, female population. This program also decreases anxiety, stress, and depression among participants.

Addressing Stillbirth in India Must Include Men.

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Roberts, Lisa; Montgomery, Susanne; Ganesh, Gayatri; Kaur, Harinder Pal; Singh, Ratan

2017-07-01

Millennium Development Goal 4, to reduce child mortality, can only be achieved by reducing stillbirths globally. A confluence of medical and sociocultural factors contribute to the high stillbirth rates in India. The psychosocial aftermath of stillbirth is a well-documented public health problem, though less is known of the experience for men, particularly outside of the Western context. Therefore, men's perceptions and knowledge regarding reproductive health, as well as maternal-child health are important. Key informant interviews (n = 5) were analyzed and 28 structured interviews were conducted using a survey based on qualitative themes. Qualitative themes included men's dual burden and right to medical and reproductive decision making power. Wives were discouraged from expressing grief and pushed to conceive again. If not successful, particularly if a son was not conceived, a second wife was considered a solution. Quantitative data revealed that men with a history of stillbirths had greater anxiety and depression, perceived less social support, but had more egalitarian views towards women than men without stillbirth experience. At the same time fathers of stillbirths were more likely to be emotionally or physically abusive. Predictors of mental health, attitudes towards women, and perceived support are discussed. Patriarchal societal values, son preference, deficient women's autonomy, and sex-selective abortion perpetuate the risk for future poor infant outcomes, including stillbirth, and compounds the already higher risk of stillbirth for males. Grief interventions should explore and take into account men's perceptions, attitudes, and behaviors towards reproductive decision making.

The Microbiome and Metabolome of Preterm Infant Stool Are Personalized and Not Driven by Health Outcomes, Including Necrotizing Enterocolitis and Late-Onset Sepsis.

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Wandro, Stephen; Osborne, Stephanie; Enriquez, Claudia; Bixby, Christine; Arrieta, Antonio; Whiteson, Katrine

2018-06-27

The assembly and development of the gut microbiome in infants have important consequences for immediate and long-term health. Preterm infants represent an abnormal case for bacterial colonization because of early exposure to bacteria and frequent use of antibiotics. To better understand the assembly of the gut microbiota in preterm infants, fecal samples were collected from 32 very low birth weight preterm infants over the first 6 weeks of life. Infant health outcomes included health, late-onset sepsis, and necrotizing enterocolitis (NEC). We characterized bacterial compositions by 16S rRNA gene sequencing and metabolomes by untargeted gas chromatography-mass spectrometry. Preterm infant fecal samples lacked beneficial Bifidobacterium spp. and were dominated by Enterobacteriaceae , Enterococcus , and Staphylococcus organisms due to nearly uniform antibiotic administration. Most of the variance between the microbial community compositions could be attributed to the baby from which the sample derived (permutational multivariate analysis of variance [PERMANOVA] R 2 = 0.48, P PERMANOVA R 2 = 0.43, P < 0.001) and weakly associated with bacterial composition (Mantel statistic r = 0.23 ± 0.05, P < 0.05). No measured metabolites were found to be associated with necrotizing enterocolitis, late-onset sepsis, or a healthy outcome. Overall, preterm infant gut microbial communities were personalized and reflected antibiotic usage. IMPORTANCE Preterm infants face health problems likely related to microbial exposures, including sepsis and necrotizing enterocolitis. However, the role of the gut microbiome in preterm infant health is poorly understood. Microbial colonization differs from that of healthy term babies because it occurs in the NICU and is often perturbed by antibiotics. We measured bacterial compositions and metabolomic profiles of 77 fecal samples from 32 preterm infants to investigate the differences between microbiomes in health and disease. Rather than finding

Decreased Stress Levels in Nurses: A Benefit of Quiet Time.

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Riemer, Heather C; Mates, Joanna; Ryan, Linda; Schleder, Bonnie J

2015-09-01

The benefits of quiet time, a therapeutic method of improving the health care environment, have been evaluated in patients, but only a few studies have examined the effects of quiet time on intensive care nurses. To evaluate the effects of implementing quiet time in a medical-surgical intensive care unit on levels of light, noise, and nurses' stress. Quiet time consisted of turning down the unit lights for a designated time. Levels of light, noise, and nurses' stress were measured. Nurses' stress levels were measured by using a 100-point visual analog scale; unit noise, by using a digital sound level meter (model 407736, Extech Instruments); and unit light, by using an illumination light meter (model 615, Huygen Corporation). Measurements were obtained 30 minutes before and 30 minutes, 1 hour, and 2 hours after implementation of quiet time. Analysis of variance and comparisons of means indicated that both light levels and nurses' stress levels were significantly decreased after quiet time (both P quiet time, but the decrease was not significant (P = .08). Use of quiet time resulted in decreased light levels and decreased stress levels among nurses. Quiet time is an easily performed energy-saving intervention to promote a healthy work environment. ©2015 American Association of Critical-Care Nurses.

Does contact by a family nurse practitioner decrease early school absence?

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Kerr, Jill; Price, Marva; Kotch, Jonathan; Willis, Stephanie; Fisher, Michael; Silva, Susan

2012-02-01

Chronic early school absence (preschool through third grade) is associated with school failure. The presence of school nurses may lead to fewer absences, and nurse practitioners in school-based health centers (SBHCs) can facilitate a healthier population resulting in improved attendance. Efforts to get students back to school are unexplored in nursing literature. This article describes a nursing intervention to decrease early school absence in two elementary schools K-3 (N = 449) and a Head Start program (N = 130). The Head Start Family Nurse Practitioner (FNP) contacted families of chronically and excessively absent students by telephone, clinic visit at school, or home visit. The aggregate percentage attendance was evaluated by grades (preschool to third grade), schools (Head Start, Elementary Schools 1 and 2), and grades and schools and compared with publicly available school district aggregate data. There were statistically significant increases in attendance from Year 1 to Year 2 at p < .05 at the elementary level but not at the Head Start level. Student demographics, types of contacts, absence reasons (including sick child), and medical diagnoses are described.

Including the temporal change in PM{sub 2.5} concentration in the assessment of human health impact: Illustration with renewable energy scenarios to 2050

Energy Technology Data Exchange (ETDEWEB)

Gschwind, Benoit, E-mail: benoit.gschwind@mines-paristech.fr [Centre Observation, Impacts, Energy, MINES ParisTech, 1 rue Claude Daunesse, CS 10207, F-06904 Sophia Antipolis (France); Lefevre, Mireille, E-mail: mireille.lefevre@mines-paristech.fr [Centre Observation, Impacts, Energy, MINES ParisTech, 1 rue Claude Daunesse, CS 10207, F-06904 Sophia Antipolis (France); Blanc, Isabelle, E-mail: isabelle.blanc@mines-paristech.fr [Centre Observation, Impacts, Energy, MINES ParisTech, 1 rue Claude Daunesse, CS 10207, F-06904 Sophia Antipolis (France); Ranchin, Thierry, E-mail: thierry.ranchin@mines-paristech.fr [Centre Observation, Impacts, Energy, MINES ParisTech, 1 rue Claude Daunesse, CS 10207, F-06904 Sophia Antipolis (France); Wyrwa, Artur, E-mail: awyrwa@agh.edu.pl [AGH University of Science and Technology, Al. Mickiewicza 30, Krakow 30-059 (Poland); Drebszok, Kamila [AGH University of Science and Technology, Al. Mickiewicza 30, Krakow 30-059 (Poland); Cofala, Janusz, E-mail: cofala@iiasa.ac.at [International Institute for Applied Systems Analysis, Schlossplatz 1, 2067 Laxenburg (Austria); Fuss, Sabine, E-mail: fuss@mcc-berlin.net [International Institute for Applied Systems Analysis, Schlossplatz 1, 2067 Laxenburg (Austria); Mercator Research Institute on Global Commons and Climate Change, Torgauer Str. 12-15, 10829 Berlin (Germany)

2015-04-15

This article proposes a new method to assess the health impact of populations exposed to fine particles (PM{sub 2.5}) during their whole lifetime, which is suitable for comparative analysis of energy scenarios. The method takes into account the variation of particle concentrations over time as well as the evolution of population cohorts. Its capabilities are demonstrated for two pathways of European energy system development up to 2050: the Baseline (BL) and the Low Carbon, Maximum Renewable Power (LC-MRP). These pathways were combined with three sets of assumptions about emission control measures: Current Legislation (CLE), Fixed Emission Factors (FEFs), and the Maximum Technically Feasible Reductions (MTFRs). Analysis was carried out for 45 European countries. Average PM{sub 2.5} concentration over Europe in the LC-MRP/CLE scenario is reduced by 58% compared with the BL/FEF case. Health impacts (expressed in days of loss of life expectancy) decrease by 21%. For the LC-MRP/MTFR scenario the average PM{sub 2.5} concentration is reduced by 85% and the health impact by 34%. The methodology was developed within the framework of the EU's FP7 EnerGEO project and was implemented in the Platform of Integrated Assessment (PIA). The Platform enables performing health impact assessments for various energy scenarios. - Highlights: • A new method to assess health impact of PM{sub 2.5} for energy scenarios is proposed. • An algorithm to compute Loss of Life Expectancy attributable to exposure to PM{sub 2.5} is depicted. • Its capabilities are demonstrated for two pathways of European energy system development up to 2050. • Integrating the temporal evolution of PM{sub 2.5} is of great interest for assessing the potential impacts of energy scenarios.

Crime, violence, and behavioral health: collaborative community strategies for risk mitigation.

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Pinals, Debra A

2015-06-01

Criminal conduct is not always violent, and violence does not always lead to criminal charges. Moreover, crime and violence have multifaceted etiologies. Most violence in society is not attributable to mental illness. Where there is a small relationship between violence and mental illness, the risk of violence increases for individuals with substance use histories. Underlying trauma can also play a role. Antisocial attitudes, behaviors, and peer groups further increase the risk that individuals, including those with mental illness, will find themselves at risk of criminal recidivism. Criminal histories among public mental health populations, and mental health and substance use disorders among criminal populations are each higher than general population comparisons. Care within behavioral health settings should therefore target decreased criminal recidivism and decreased violence as part of recovery for those individuals at risk, using trauma-informed approaches and peer supports. Interventions that show promise bring criminal justice and behavioral health systems together, and include police-based diversion, specialty courts, court-based alternatives to incarceration, and coordinated re-entry programs. This article reviews these options along with specific risk management strategies, such as using risk, needs, and responsivity factors as a means of improving overall outcomes for persons with mental illness, while minimizing their risk of further criminalization and victimization.

A Systematic Review of Mobile Health Technology Use in Developing Countries.

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Alghamdi, Manal; Gashgari, Horeya; Househ, Mowafa

2015-01-01

In developing countries, patients are now more informed about their healthcare options as a result of their use of mobile health (mHealth) technologies. The purpose of this paper is to describe the opportunities and challenges in using mHealth technologies for developing countries. In April 2015, Google Scholar and PubMed were searched to identify articles discussing the types, advantages and disadvantages, effectiveness, evaluation of mHealth technologies, and examples of mHealth implementation in developing countries. A total number of 3,803 articles were retrieved from both databases. Articles reporting the benefits and risks, effectiveness, and evaluation of mHealth were included. Articles that were written in English and from developing countries were also included. We excluded papers that were published before 2005, not written in English, and that were technical in nature. After screening the articles using the inclusion and exclusion criteria, 27 articles were selected for inclusion in the study. Of the 27 papers included in the review, eight described opportunities and challenges relating to mHealth, four focused on smoking cessation, three focused on weight loss, and four papers focused on chronic diseases. We also identified four articles discussing mHealth evaluation and four discussing the use of mHealth as a health promotion tool. We conclude that mHealth can improve healthcare delivery for developing countries. Some of the advantages of mHealth include: patient education, health promotion, disease self-management, decrease in healthcare costs, and remote monitoring of patients. However, there are several limitations in using mHealth technologies for developing countries, which include: interoperability, lack of evaluation standards, and lack of a technology infrastructure.

Global Climate Change and Children's Health.

Science.gov (United States)

Ahdoot, Samantha; Pacheco, Susan E

2015-11-01

Rising global temperature is causing major physical, chemical, and ecological changes across the planet. There is wide consensus among scientific organizations and climatologists that these broad effects, known as climate change, are the result of contemporary human activity. Climate change poses threats to human health, safety, and security. Children are uniquely vulnerable to these threats. The effects of climate change on child health include physical and psychological sequelae of weather disasters, increased heat stress, decreased air quality, altered disease patterns of some climate-sensitive infections, and food, water, and nutrient insecurity in vulnerable regions. Prompt implementation of mitigation and adaptation strategies will protect children against worsening of the problem and its associated health effects. This technical report reviews the nature of climate change and its associated child health effects and supports the recommendations in the accompanying policy statement on climate change and children's health. Copyright © 2015 by the American Academy of Pediatrics.

Policy and system strategies in promoting child health information systems, including the role of Medicaid, the state children's health insurance program, and public financing.

Science.gov (United States)

MacTaggart, Patricia; Bagley, Bruce

2009-01-01

Government, through its unique roles as regulator, purchaser, provider, and facilitator, has an opportunity and an obligation to play a major role in accelerating the implementation of electronic health record systems and electronic health information exchange. Providers, who are expected to deliver appropriate care at designated locations at an appropriate cost, are dependent on health information technology for efficient effective health care. As state and federal governments move forward with health care purchasing reforms, they must take the opportunity to leverage policy and structure and to align incentives that enhance the potential for provider engagement in electronic health record adoption.

Plasma Cell Neoplasms (Including Multiple Myeloma)—Health Professional Version

Science.gov (United States)

There are several types of plasma cell neoplasms, including monoclonal gammopathy of undetermined significance (MGUS), isolated plasmacytoma of the bone, extramedullary plasmacytoma, and multiple myeloma. Find evidence-based information on plasma cell neoplasms treatment, research, and statistics.

The post-millennium development goals agenda: include 'end to all wars' as a public health goal!

Science.gov (United States)

Jayasinghe, Saroj

2014-09-01

The process of identifying global post-millennium development goals (post-MDGs) has begun in earnest. Consensus is emerging in certain areas (e.g. eliminating poverty) and conflicts and violence are recognized as key factors that retard human development. However, current discussions focus on tackling intra-state conflicts and individual-based violence and hardly mention eliminating wars as a goal. Wars create public health catastrophes. They kill, maim, displace and affect millions. Inter-state wars fuel intra-state conflicts and violence. The peace agenda should not be the monopoly of the UN Security Council, and the current consensus-building process setting the post-MDG agenda is a rallying point for the global community. The human rights approach will not suffice to eliminate wars, because few are fought to protect human rights. The development agenda should therefore commit to eliminating all wars by 2030. Targets to reduce tensions and discourage wars should be included. We should act now. © The Author(s) 2014.

The Frontlines of Medicine Project: a proposal for the standardized communication of emergency department data for public health uses including syndromic surveillance for biological and chemical terrorism.

Science.gov (United States)

Barthell, Edward N; Cordell, William H; Moorhead, John C; Handler, Jonathan; Feied, Craig; Smith, Mark S; Cochrane, Dennis G; Felton, Christopher W; Collins, Michael A

2002-04-01

The Frontlines of Medicine Project is a collaborative effort of emergency medicine (including emergency medical services and clinical toxicology), public health, emergency government, law enforcement, and informatics. This collaboration proposes to develop a nonproprietary, "open systems" approach for reporting emergency department patient data. The common element is a standard approach to sending messages from individual EDs to regional oversight entities that could then analyze the data received. ED encounter data could be used for various public health initiatives, including syndromic surveillance for chemical and biological terrorism. The interlinking of these regional systems could also permit public health surveillance at a national level based on ED patient encounter data. Advancements in the Internet and Web-based technologies could allow the deployment of these standardized tools in a rapid time frame.

Health services in Indonesia.

Science.gov (United States)

Kosen, S; Gunawan, S

In Indonesia, rapid economic development has led to a reduction in poverty among the 195 million inhabitants. While population increased more than 50% from 1971 to 1990, the annual growth rate, crude birth rate, and total fertility rates have declined rapidly. Life expectancy has increased from 45.7 years in 1971 to 62.7 in 1994 as crude death rates and infant and child mortality rates have declined. Causes of death have shifted from infectious to chronic diseases, but in 1992 major causes of death in children under 5 years old were preventable, and the maternal mortality rate was 425/100,000. Policies which guide the development of health care call for improvements in quality of life, adherence to humanitarian principles, use of scientifically approved traditional medicine, and provision of public health through a three-tiered system. Health care is financed by the government and the community, and managed care has been encouraged. Foreign aid has bolstered development in the health sector. Adequate sanitation has been achieved for 35% of the population, and 65% of urban and 35% of rural residents have reasonable access to clean water. Improvements in health indicators include 55% contraceptive prevalence, reduction in prevalence of anemia during pregnancy, 55.8% of pregnant women receiving prenatal care, a decrease in protein-energy malnutrition among children under five, and high vaccination coverage. Remaining public health problems include malaria, tuberculosis, dengue hemorrhagic fever, an increase in HIV/AIDS, iodine-deficiency, an increasing number of traffic fatalities, and an increasing number of smokers. New health policies have been instituted to meet these challenges as Indonesia's need for a productive and competitive labor force increases.

Integrating weight bias awareness and mental health promotion into obesity prevention delivery: a public health pilot study.

Science.gov (United States)

McVey, Gail L; Walker, Kathryn S; Beyers, Joanne; Harrison, Heather L; Simkins, Sari W; Russell-Mayhew, Shelly

2013-04-04

Promoting healthy weight is a top priority in Canada. Recent federal guidelines call for sustained, multisectoral partnerships that address childhood obesity on multiple levels. Current healthy weight messaging does not fully acknowledge the influence of social determinants of health on weight. An interactive workshop was developed and implemented by a team of academic researchers and health promoters from the psychology and public health disciplines to raise awareness about 1) weight bias and its negative effect on health, 2) ways to balance healthy weight messaging to prevent the triggering of weight and shape preoccupation, and 3) the incorporation of mental health promotion into healthy weight messaging. We conducted a full-day workshop with 342 Ontario public health promoters and administered a survey at preintervention, postintervention, and follow-up. Participation in the full-day workshop led to significant decreases in antifat attitudes and the internalization of media stereotypes and to significant increases in self-efficacy to address weight bias. Participants reported that the training heightened their awareness of their own personal weight biases and the need to broaden their scope of healthy weight promotion to include mental health promotion. There was consensus that additional sessions are warranted to help translate knowledge into action. Buy-in and resource support at the organizational level was also seen as pivotal. Professional development training in the area of weight bias awareness is associated with decreases in antifat attitudes and the internalization of media stereotypes around thinness. Health promoters' healthy weight messaging was improved by learning to avoid messages that trigger weight and shape preoccupation or unhealthful eating practices among children and youth. Participants also learned ways to integrate mental health promotion and resiliency-building into daily practice.

The Alpha value decrease when the annual individual effective dose decreases?

International Nuclear Information System (INIS)

Sordi, Gian M.; Marchiusi, Thiago; Sousa, Jefferson de J.

2008-01-01

A recent IAEA publication tells that a few entities took different alpha values for maxima individual doses. Beyond to disregard the international agencies, that recommend only one alpha value for each country, the alpha values decreases when the individual doses decreases and the practice happens exactly the conversely as we will show in this paper. We will prove that the alpha value increase when the maximum individual doses decreases in a four different manner. The first one we call the theoretical conception and it is linked to the emergent of the ALARA policy and to the purpose that led to the 3/10 of the annual limits, for to decrease the individual doses as a first resort and a 1/10 as a last resort. The second prove will be based in a small mine example used in the ICRP publication number 55 concerning to the optimization and the quantitative decision-aiding techniques in radiological protection where we will determine the alpha value ranges in which each radiological protection options becomes the analytical solution. The third prove will be based in the determination of the optimized thickness example of a plane shielding for a radiation source exposed in the ICRP publication number 37. We will use, also, the numerical example provided there. Eventually, as four prove we will show that the alpha value dos not only increases with the maximum individual dose decrease, but also, with the shielding geometry. (author)

Health Literacy and Health Information Technology Adoption: The Potential for a New Digital Divide.

Science.gov (United States)

Mackert, Michael; Mabry-Flynn, Amanda; Champlin, Sara; Donovan, Erin E; Pounders, Kathrynn

2016-10-04

Approximately one-half of American adults exhibit low health literacy and thus struggle to find and use health information. Low health literacy is associated with negative outcomes including overall poorer health. Health information technology (HIT) makes health information available directly to patients through electronic tools including patient portals, wearable technology, and mobile apps. The direct availability of this information to patients, however, may be complicated by misunderstanding of HIT privacy and information sharing. The purpose of this study was to determine whether health literacy is associated with patients' use of four types of HIT tools: fitness and nutrition apps, activity trackers, and patient portals. Additionally, we sought to explore whether health literacy is associated with patients' perceived ease of use and usefulness of these HIT tools, as well as patients' perceptions of privacy offered by HIT tools and trust in government, media, technology companies, and health care. This study is the first wide-scale investigation of these interrelated concepts. Participants were 4974 American adults (n=2102, 42.26% male, n=3146, 63.25% white, average age 43.5, SD 16.7 years). Participants completed the Newest Vital Sign measure of health literacy and indicated their actual use of HIT tools, as well as the perceived ease of use and usefulness of these applications. Participants also answered questions regarding information privacy and institutional trust, as well as demographic items. Cross-tabulation analysis indicated that adequate versus less than adequate health literacy was significantly associated with use of fitness apps (P=.02), nutrition apps (Pliteracy was significantly associated with greater perceived ease of use and perceived usefulness across all HIT tools after controlling for demographics. Regarding privacy perceptions of HIT and institutional trust, patients with greater health literacy often demonstrated decreased privacy

Impact of school staff health on work productivity in secondary schools in Massachusetts.

Science.gov (United States)

Alker, Heather J; Wang, Monica L; Pbert, Lori; Thorsen, Nancy; Lemon, Stephenie C

2015-06-01

Healthy, productive employees are an integral part of school health programs. There have been few assessments of work productivity among secondary school staff. This study describes the frequency of 3 common health risk factors--obesity, depressive symptoms, and smoking--and their impact on work productivity in secondary school employees. Employees of secondary schools in Massachusetts (N = 630) participated in a longitudinal weight gain prevention intervention study. Assessment completed at baseline, 1-year and 2-year follow-up included survey assessments of health risk factors as well as measurements for height, weight, and body mass index (BMI). The survey also included a depression inventory and Work Limitations Questionnaire. Data analysis included multivariate mixed effect models to identify productivity differences in relation to BMI, depressive symptoms, and smoking in this population stratified by position type (teacher and other school staff). The sample included 361 teachers and 269 other school staff. Obesity, depressive symptoms, and smoking were significantly associated with work productivity, including workdays missed because of health concerns (absenteeism) and decreases in on-the-job productivity because of health concerns (presenteeism). Three common health conditions, namely obesity, depressive symptoms, and smoking, adversely affect the productivity of high school employees. © 2015, American School Health Association.

Endogenous and exogenous testosterone and prostate cancer: decreased-, increased- or null-risk?

Science.gov (United States)

Lopez, David S; Advani, Shailesh; Tsilidis, Konstantinos K; Wang, Run; Canfield, Steven

2017-06-01

For more than 70 years, the contention that high levels of testosterone or that the use of testosterone therapy (TTh) increases the development and progression of prostate cancer (PCa) has been widely accepted and practiced. Yet, the increasing and emerging evidence on testosterone research seems to challenge that contention. To review literature on the associations of endogenous and exogenous testosterone with decreased-, increased-, or null-risk of PCa, and to further evaluate only those studies that reported magnitude of associations from multivariable modeling as it minimizes confounding effects. We conducted a literature search to identify studies that investigated the association of endogenous total testosterone [continuous (per 1 unit increment and 5 nmol/L increment) and categorical (high vs. low)] and use of TTh with PCa events [1990-2016]. Emphasis was given to studies/analyses that reported magnitude of associations [odds ratio (OR), relative risk (RR) and hazard ratios (HRs)] from multivariable analyses to determine risk of PCa and their statistical significance. Most identified studies/analyses included observational and randomized placebo-controlled trials. This review was organized in three parts: (I) association of endogenous total testosterone (per 1 unit increment and 5 nmol/L increment) with PCa; (II) relationship of endogenous total testosterone (categorical high vs. low) with PCa; and (III) association of use of TTh with PCa in meta-analyses of randomized placebo-controlled trials. The first part included 31 observational studies [20 prospective (per 5 nmol/L increment) and 11 prospective and retrospective cohort studies (per 1 unit increment)]. None of the 20 prospective studies found a significant association between total testosterone (5 nmol/L increment) and increased- or decreased-risk of PCa. Two out of the 11 studies/analyses showed a significant decreased-risk of PCa for total testosterone per 1 unit increment, but also two other

Music decreases aortic stiffness and wave reflections.

Science.gov (United States)

Vlachopoulos, Charalambos; Aggelakas, Angelos; Ioakeimidis, Nikolaos; Xaplanteris, Panagiotis; Terentes-Printzios, Dimitrios; Abdelrasoul, Mahmoud; Lazaros, George; Tousoulis, Dimitris

2015-05-01

Music has been related to cardiovascular health and used as adjunct therapy in patients with cardiovascular disease. Aortic stiffness and wave reflections are predictors of cardiovascular risk. We investigated the short-term effect of classical and rock music on arterial stiffness and wave reflections. Twenty healthy individuals (22.5±2.5 years) were studied on three different occasions and listened to a 30-min music track compilation (classical, rock, or no music for the sham procedure). Both classical and rock music resulted in a decrease of carotid-femoral pulse wave velocity (PWV) immediately after the end of music listening (all pclassical or rock music in a more sustained way (nadir by 6.0% and 5.8%, respectively, at time zero post-music listening, all pmusic preference was taken into consideration, both classical and rock music had a more potent effect on PWV in classical aficionados (by 0.20 m/s, p=0.003 and 0.13 m/s, p=0.015, respectively), whereas there was no effect in rock aficionados (all p=NS). Regarding wave reflections, classical music led to a more potent response in classical aficionados (AIx decrease by 9.45%), whereas rock led to a more potent response to rock aficionados (by 10.7%, all pMusic, both classical and rock, decreases aortic stiffness and wave reflections. Effect on aortic stiffness lasts for as long as music is listened to, while classical music has a sustained effect on wave reflections. These findings may have important implications, extending the spectrum of lifestyle modifications that can ameliorate arterial function. Copyright © 2015 Elsevier Ireland Ltd. All rights reserved.

Future of electronic health records: implications for decision support.

Science.gov (United States)

Rothman, Brian; Leonard, Joan C; Vigoda, Michael M

2012-01-01

The potential benefits of the electronic health record over traditional paper are many, including cost containment, reductions in errors, and improved compliance by utilizing real-time data. The highest functional level of the electronic health record (EHR) is clinical decision support (CDS) and process automation, which are expected to enhance patient health and healthcare. The authors provide an overview of the progress in using patient data more efficiently and effectively through clinical decision support to improve health care delivery, how decision support impacts anesthesia practice, and how some are leading the way using these systems to solve need-specific issues. Clinical decision support uses passive or active decision support to modify clinician behavior through recommendations of specific actions. Recommendations may reduce medication errors, which would result in considerable savings by avoiding adverse drug events. In selected studies, clinical decision support has been shown to decrease the time to follow-up actions, and prediction has proved useful in forecasting patient outcomes, avoiding costs, and correctly prompting treatment plan modifications by clinicians before engaging in decision-making. Clinical documentation accuracy and completeness is improved by an electronic health record and greater relevance of care data is delivered. Clinical decision support may increase clinician adherence to clinical guidelines, but educational workshops may be equally effective. Unintentional consequences of clinical decision support, such as alert desensitization, can decrease the effectiveness of a system. Current anesthesia clinical decision support use includes antibiotic administration timing, improved documentation, more timely billing, and postoperative nausea and vomiting prophylaxis. Electronic health record implementation offers data-mining opportunities to improve operational, financial, and clinical processes. Using electronic health record data

Joint cartilage thickness and automated determination of bone age and bone health in juvenile idiopathic arthritis.

Science.gov (United States)

Twilt, Marinka; Pradsgaard, Dan; Spannow, Anne Helene; Horlyck, Arne; Heuck, Carsten; Herlin, Troels

2017-08-10

BoneXpert is an automated method to calculate bone maturation and bone health index (BHI) in children with juvenile idiopathic arthritis (JIA). Cartilage thickness can also be seen as an indicator for bone health and arthritis damage. The objective of this study was to evaluate the relation between cartilage thickness, bone maturation and bone health in patients with JIA. Patients with JIA diagnosed according ILAR criteria included in a previous ultrasonography (US) study were eligible if hand radiographs were taken at the same time as the US examination. Of the 95 patients 67 met the inclusion criteria. Decreased cartilage thickness was seen in 27% of the examined joints. Decreased BHI was seen in half of the JIA patient, and delayed bone maturation was seen in 33% of patients. A combination of decreased BHI and bone age was seen in 1 out of 5 JIA patients. Decreased cartilage thickness in the knee, wrist and MCP joint was negatively correlated with delayed bone maturation but not with bone health index. Delayed bone maturation and decreased BHI were not related to a thinner cartilage, but a thicker cartilage. No relation with JADAS 10 was found. The rheumatologist should remain aware of delayed bone maturation and BHI in JIA patients with cartilage changes, even in the biologic era.

Appetite - decreased

Science.gov (United States)

Loss of appetite; Decreased appetite; Anorexia ... Any illness can reduce appetite. If the illness is treatable, the appetite should return when the condition is cured. Loss of appetite can cause weight ...

Lay health worker experiences administering a multi-level combination intervention to improve PMTCT retention.

Science.gov (United States)

DiCarlo, Abby; Fayorsey, Ruby; Syengo, Masila; Chege, Duncan; Sirengo, Martin; Reidy, William; Otieno, Juliana; Omoto, Jackton; Hawken, Mark P; Abrams, Elaine J

2018-01-10

The recent scale-up of prevention of mother-to-child transmission of HIV (PMTCT) services has rapidly accelerated antiretroviral therapy (ART) uptake among pregnant and postpartum women in sub-Saharan Africa. The Mother and Infant Retention for Health (MIR4Health) study evaluates the impact of a combination intervention administered by trained lay health workers to decrease attrition among HIV-positive women initiating PMTCT services and their infants through 6 months postpartum. This was a qualitative study nested within the MIR4Health trial. MIR4Health was conducted at 10 health facilities in Nyanza, Kenya from September 2013 to September 2015. The trial intervention addressed behavioral, social, and structural barriers to PMTCT retention and included: appointment reminders via text and phone calls, follow-up and tracking for missed clinic visits, PMTCT health education at home visits and during clinic visits, and retention and adherence support and counseling. All interventions were administered by lay health workers. We describe results of a nested small qualitative inquiry which conducted two focus groups to assess the experiences and perceptions of lay health workers administering the interventions. Discussions were recorded and simultaneously transcribed and translated into English. Data were analyzed using framework analysis approach. Study findings show lay health workers played a critical role supporting mothers in PMTCT services across a range of behavioral, social, and structural domains, including improved communication and contact, health education, peer support, and patient advocacy and assistance. Findings also identified barriers to the uptake and implementation of the interventions, such as concerns about privacy and stigma, and the limitations of the healthcare system including healthcare worker attitudes. Overall, study findings indicate that lay health workers found the interventions to be feasible, acceptable, and well received by clients. Lay

Statins Decrease Oxidative Stress and ICD Therapies

Directory of Open Access Journals (Sweden)

Heather L. Bloom

2010-01-01

Full Text Available Recent studies demonstrate that statins decrease ventricular arrhythmias in internal cardioverter defibrillator (ICD patients. The mechanism is unknown, but evidence links increased inflammatory and oxidative states with increased arrhythmias. We hypothesized that statin use decreases oxidation. Methods. 304 subjects with ICDs were surveyed for ventricular arrhythmia. Blood was analyzed for derivatives of reactive oxygen species (DROMs and interleukin-6 (IL-6. Results. Subjects included 252 (83% men, 58% on statins, 20% had ventricular arrhythmias. Average age was 63 years and ejection fraction (EF 20%. ICD implant duration was 29 ± 27 months. Use of statins correlated with lower ICD events (r=0.12, P=.02. Subjects on statins had lower hsCRP (5.2 versus 6.3; P=.05 and DROM levels (373 versus 397; P=.03. Other factors, including IL-6 and EF did not differ between statin and nonstatin use, nor did beta-blocker or antiarrhythmic use. Multivariate cross-correlation analysis demonstrated that DROMs, statins, IL-6 and EF were strongly associated with ICD events. Multivariate regression shows DROMs to be the dominant predictor. Conclusion. ICD event rate correlates with DROMs, a measure of lipid peroxides. Use of statins is associated with reduced DROMs and fewer ICD events, suggesting that statins exert their effect through reducing oxidation.

Premenstrual syndrome and life quality in Turkish health science students.

Science.gov (United States)

İşik, Hatice; Ergöl, Şule; Aynioğlu, Öner; Şahbaz, Ahmet; Kuzu, Ayşe; Uzun, Müge

2016-04-19

The purpose of the present study was to investigate the incidence of PMS, risk factors affecting PMS symptoms, and life quality in health science students. A total of 608 volunteer female students studying at the health campus of a state university in Turkey were included in the study. The participants were asked to fill out questionnaires on sociodemographic data, PMS symptoms, and SF-36 life quality tests. The overall frequency of PMS among participants was 84.5%. The average PMS and general health SF scores were 118.34 ± 37.3 and 20.03 ± 3.72, respectively. Students who had irregular breakfast, drank ≥2 cups of coffee/day, and consumed alcohol or fast food had higher PMS scores. Irregular menstruation and family history increased PMS scores and decreased life quality (P life quality of the students significantly decreased as the severity of PMS increased (P life quality, students should be informed about the symptoms, risk factors, and management options of PMS.

Integrating the health and mental health needs of the chronically ill: a group for individuals with depression and sickle cell disease.

Science.gov (United States)

Comer, Edna W

2004-01-01

Concerns about high rates of depression among persons with sickle cell disease and no effective interventions for treatment of this condition were the impetuses for the study described in this paper. A groupwork service using cognitive-behavioral and self-management techniques were integrated into health care services at a Comprehensive Sickle Cell Center to treat depression in a small group of patients. An interdisciplinary team that included health care and mental health providers from the Center and a social work researcher guided the endeavor. Principles of Intervention Research were applied in the development of the service and to evaluate its effectiveness. Among the findings were that study participants realized a decrease in depressive symptoms.

The effectiveness of workplace interventions to increase physical activity and decrease sedentary behaviour in adults: protocol for a systematic review.

Science.gov (United States)

Loitz, Christina C; Potter, Robert J; Walker, Jessica L; McLeod, Nicole C; Johnston, Nora J

2015-12-12

A physically active lifestyle plays a preventative role in the development of various chronic diseases and mental health conditions. Unfortunately, few adults achieve the minimum amount of physical activity and spend excessive time sitting. Developing targeted interventions to increase active living among adults is an important endeavour for public health. One plausible context to reach adults is the workplace. This systematic review aims to review the effectiveness of workplace interventions on increasing physical activity and decreasing sedentary behaviour in the workplace. An advisory group of practitioners will work in collaboration with the research team to inform the systematic review and knowledge mobilization. Fifteen electronic databases will be searched to identify studies examining the effectiveness of workplace interventions on physical activity and sedentary behaviour. All experimental designs and observational studies (non-experimental intervention studies) meeting the study criteria will be included. Studies examining generally healthy, employed, adult participants will be included for the review. Interventions will focus on increasing physical activity and/or decreasing sedentary behaviour from the individual to policy level. The primary outcome variables will be reported or observed physical activity and/or sedentary behaviour in the workplace. Secondary outcomes will include variables ranging from return on investment to quality of life. Study quality will be assessed for risk of bias following the protocol identified in the Cochrane Handbook for Systematic Reviews of Interventions and supplemented by the guidelines developed by the Cochrane Effective Practice and Organisation of Care group, using RevMan. The quality of the evidence will be assessed using the Grading of Recommendations, Assessment, Development and Evaluation approach. Meta-analyses, forest plots, and harvest plots will be used where appropriate to assess the direction, size, and

Educational level and decreases in leisure time physical activity: predictors from the longitudinal GLOBE study

NARCIS (Netherlands)

M. Droomers (Mariël); C.Th.M. Schrijvers (Carola); J.P. Mackenbach (Johan)

2001-01-01

textabstractSTUDY OBJECTIVE: This study describes educational differences in decreases in leisure time physical activity among an adult, physically active population and additionally attempts to identify predictors of these differences from information on health status

Quantification of decreasing of human health risk by bioremediation of a contaminated soil with petroleum hydrocarbons; Quantificacao do decrescimo de risco associado a biorremediacao de um solo contaminado por hidrocarbonetos de petroleo

Energy Technology Data Exchange (ETDEWEB)

Lima, Cristiane A.; Castilhos, Zuleica C.; Rizzo, Andrea C.L. [Centro de Tecnologia Mineral (CETEM), Rio de Janeiro, RJ (Brazil); Leite, Selma G.F. [Universidade Federal do Rio de Janeiro (UFRJ), RJ (Brazil). Escola de Quimica

2004-07-01

The main objective of this work was to evaluate the efficiency of four different bioremediation processes in the decrease of organic pollutants present in a soil contaminated with crude oil, using a toxicological approach based on the human health risk assessment methodology (USEPA, 1989). The different techniques of bioremediation utilized (biostimulation, bioaugmentation and addition of enzymatic solution) were efficient in the removal of the organic pollutants, especially of PAHs, considered highly recalcitrant. In the human health risk assessment, the exposure pathway that resulted in higher hazards of no-carcinogenic effects and risks of carcinogenic effects in the population (children and adult) was dermal contact with soil. The pollutant that contributed more in the different exposure pathways was benzo(a)pyrene. When carcinogenic and no-carcinogenic effects in children and adults were evaluated, the different treatments showed efficiency, once they were capable to reduce the risk and the hazard index (HI) bellow target levels (< 1 x 10{sup -4} and 1, respectively), showing that these treatments were efficient to decrease the potential damage in the exposed population. (author)

Including health economic analysis in pilot studies: lessons learned from a cost-utility analysis within the PROSPECTIV pilot study

Directory of Open Access Journals (Sweden)

Richéal M. Burns

2017-07-01

Full Text Available PurposeTo assess feasibility and health economic benefits and costs as part of a pilot study for a nurse-led, psychoeducational intervention (NPLI for prostate cancer in order to understand the potential for cost effectiveness as well as contribute to the design of a larger scale trial.MethodsMen with stable prostate cancer post-treatment were recruited from two cancer centres in the UK. Eighty-three men were randomised to the NLPI plus usual care or usual care alone (UCA (42 NLPI and 41 UCA; the NLPI plus usual care was delivered in the primary-care setting (the intervention and included an initial face-to-face consultation with a trained nurse, with follow-up tailored to individual needs. The study afforded the opportunity to undertake a short-term within pilot analysis. The primary outcome measure for the economic evaluation was quality of life, as measured by the EuroQol five dimensions questionnaire (EQ-5D (EQ-5D-5L instrument. Costs (£2014 assessed included health-service resource use, out-of-pocket expenses and losses from inability to undertake usual activities.ResultsTotal and incremental costs varied across the different scenarios assessed, with mean cost differences ranging from £173 to £346; incremental effect, as measured by the change in utility scores over the duration of follow-up, exhibited wide confidence intervals highlighting inconclusive effectiveness (95% CI: -0.0226; 0.0438. The cost per patient of delivery of the intervention would be reduced if rolled out to a larger patient cohort.ConclusionsThe NLPI is potentially cost saving depending on the scale of delivery; however, the results presented are not considered generalisable.

Increased errors and decreased performance at night: A systematic review of the evidence concerning shift work and quality.

Science.gov (United States)

de Cordova, Pamela B; Bradford, Michelle A; Stone, Patricia W

2016-02-15

Shift workers have worse health outcomes than employees who work standard business hours. However, it is unclear how this poorer health shift may be related to employee work productivity. The purpose of this systematic review is to assess the relationship between shift work and errors and performance. Searches of MEDLINE/PubMed, EBSCOhost, and CINAHL were conducted to identify articles that examined the relationship between shift work, errors, quality, productivity, and performance. All articles were assessed for study quality. A total of 435 abstracts were screened with 13 meeting inclusion criteria. Eight studies were rated to be of strong, methodological quality. Nine studies demonstrated a positive relationship that night shift workers committed more errors and had decreased performance. Night shift workers have worse health that may contribute to errors and decreased performance in the workplace.

What You Don't Know May Kill You: The Importance of Including Sexual Health in Premarital Counseling

Science.gov (United States)

Slater, LaTrina M.; Cummings Aholou, Tiffiany M.

2009-01-01

Sexual health is a widespread concern for intimate partners. As couples transition to marriage, it is vitally important to explore issues related to sexual health. Moreover, premarital counselors are encouraged to facilitate a sexual health discussion with premarital couples. This article presents the importance of raising the topic of sexual…

Using Health Conditions for Laughs and Health Policy Support: The Case of Food Allergies.

Science.gov (United States)

Abo, Melissa M; Slater, Michael D; Jain, Parul

2017-07-01

Health conditions are sometimes included in entertainment media comedies as a context for and as a source of humor. Food allergies are a typical case in point: They are potentially life-threatening yet may be used in humorous contexts. We conducted a content analysis of food allergies in entertainment media and tested the effects of humorous portrayals from an exemplar entertainment program. The content analysis confirmed that when food allergies were portrayed in television and the movies, it was most frequently in a humorous context and often contained inaccurate information. A follow-up experiment showed viewing a humorous portrayal of food allergies had an indirect negative effect on related health policy support via decreased perceived seriousness of food allergies. Inclusion of an educational video eliminated this effect on reduced policy support, with cognitive dissonance as a mediator. Findings support the hypothesis that portraying a health condition in a humorous context may reduce perceptions of seriousness and willingness to support public health policies to address risks associated with the condition, supporting and extending prior research findings.

Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population

OpenAIRE

Hay, Phillipa; Mitchison, Deborah; Collado, Abraham Ernesto Lopez; Gonz?lez-Chica, David Alejandro; Stocks, Nigel; Touyz, Stephen

2017-01-01

Background Little is known about the epidemiology and health related quality of life (HRQoL) of the new DSM-5 diagnoses, Binge Eating Disorder (BED) and Avoidant/Restrictive Food Intake Disorder (ARFID) in the Australian population. We aimed to investigate the prevalance and burden of these disorders. Methods We conducted two sequential population-based surveys including individuals aged over 15?years who were interviewed in 2014 (n?=?2732) and 2015 (n =3005). Demographic information and diag...

Nutrition in children with long-term health conditions

OpenAIRE

Westwood, A

2015-01-01

Long-term health conditions (LTHCs) in children may affect nutrition and growth by means of multiple mechanisms. Both undernutrition and overweight/obesity are risk factors. Direct effects of the condition that may cause undernutrition include increased resting energy expenditure, excess losses through malabsorption, difficulty ingesting food, and decreased appetite. Indirect effects of LTHCs may be mediated by learnt or adaptive behaviours, secondary anorexia, inappropriate diets, or conditi...

Health-related quality of life and hand eczema--a comparison of two instruments, including factor analysis.

Science.gov (United States)

Wallenhammar, Lena-Marie; Nyfjäll, Mats; Lindberg, Magnus; Meding, Birgitta

2004-06-01

Hand eczema is a disease of long duration, affecting the individual and society. The purpose of this study of 100 patients (51 females and 49 males) at an occupational dermatology clinic was to investigate whether the generic questionnaire Short Form-36 (SF-36), and the dermatology-specific Dermatology Life Quality Index (DLQI) are appropriate for assessing health-related quality of life (HRQL) in patients with hand eczema, and whether gender differences in HRQL could be detected. HRQL was affected by hand eczema, measured with both SF-36 and DLQI. The SF-36 showed more impaired HRQL for females than for males, in the mental health dimension, whereas no gender-related differences were detected with the DLQI. To compare the instruments we used factor analysis, with a polychoric correlation matrix as input, thus taking the ordinal aspect of the data into account. There was a high correlation between the instruments for physical health, but lower for mental health. In this context our interpretation of the factor analysis is that the SF-36 measures mental health better than the DLQI. The SF-36 therefore appears suitable for use in future studies for measuring HRQL, and gender differences in HRQL, in persons with reported hand eczema.

Predictors of decreased physical activity level over time among adults: a longitudinal study.

Science.gov (United States)

Dai, Sulan; Wang, Feng; Morrison, Howard

2014-08-01

Leisure-time physical activity (LTPA) plays a key role in chronic disease prevention and health promotion. The impact of life-changing events on LTPA among adults is unknown. To examine the association between life-changing events and decreased LTPA levels. Eight cycles of Canadian National Population Health Survey data were used for this study. A total of 12,901 respondents aged ≥18 years in 1994-1995 completed biannual follow-ups until 2008-2009. The association between life-changing events and decreased LTPA in any 2-year period was assessed with adjustment of potential confounding factors. Data were analyzed in 2012. From 1994-1995 to 2008-2009, nine of ten people changed their LTPA levels. Within each 2-year period, individuals were more likely to decrease their LTPA levels if they married within the 2-year period (men); became or remained overweight/obese (women); remained a regular smoker (men); became or remained unhealthy (men and women); developed or continued to have body pain (women); and acquired social support or remained without support (men). Most people change their LTPA levels or patterns, which are significantly influenced by life-changing events. An improved understanding of factors that influence LTPA may help better target those at high risk. Crown Copyright © 2014. Published by Elsevier Inc. All rights reserved.

Being Included and Excluded

DEFF Research Database (Denmark)

Korzenevica, Marina

2016-01-01

Following the civil war of 1996–2006, there was a dramatic increase in the labor mobility of young men and the inclusion of young women in formal education, which led to the transformation of the political landscape of rural Nepal. Mobility and schooling represent a level of prestige that rural...... politics. It analyzes how formal education and mobility either challenge or reinforce traditional gendered norms which dictate a lowly position for young married women in the household and their absence from community politics. The article concludes that women are simultaneously excluded and included from...... community politics. On the one hand, their mobility and decision-making powers decrease with the increase in the labor mobility of men and their newly gained education is politically devalued when compared to the informal education that men gain through mobility, but on the other hand, schooling strengthens...

Joint cartilage thickness and automated determination of bone age and bone health in juvenile idiopathic arthritis

DEFF Research Database (Denmark)

Twilt, Marinka; Pradsgaard, Dan; Spannow, Anne Helene

2017-01-01

BACKGROUND: BoneXpert is an automated method to calculate bone maturation and bone health index (BHI) in children with juvenile idiopathic arthritis (JIA). Cartilage thickness can also be seen as an indicator for bone health and arthritis damage. The objective of this study was to evaluate...... the relation between cartilage thickness, bone maturation and bone health in patients with JIA. METHODS: Patients with JIA diagnosed according ILAR criteria included in a previous ultrasonography (US) study were eligible if hand radiographs were taken at the same time as the US examination. Of the 95 patients...... 67 met the inclusion criteria. RESULTS: Decreased cartilage thickness was seen in 27% of the examined joints. Decreased BHI was seen in half of the JIA patient, and delayed bone maturation was seen in 33% of patients. A combination of decreased BHI and bone age was seen in 1 out of 5 JIA patients...

Does litigation increase or decrease health care quality? A national study of negligence claims against nursing homes

Science.gov (United States)

Stevenson, David G.; Spittal, Matthew J.; Studdert, David M.

2016-01-01

Background The tort system is supposed to help improve the quality and safety of health care, but whether it actually does so is controversial. Most previous studies modeling the effect of negligence litigation on quality of care are ecologic. Objective To assess whether the experience of being sued and incurring litigation costs affects the quality of care subsequently delivered in nursing homes. Research Design, Subjects, Measures We linked information on 6,471 negligence claims brought against 1,514 nursing homes between 1998 and 2010 to indicators of nursing home quality drawn from two U.S. national datasets (Online Survey, Certification, and Reporting system; Minimum Data Set Quality Measure/Indicator Reports). At the facility level, we tested for associations between 9 quality measures and 3 variables indicating the nursing homes’ litigation experience in the preceding 12–18 months (total indemnity payments; total indemnity payments plus administrative costs; ≥1 paid claims vs. none). The analyses adjusted for quality at baseline, case-mix, ownership, occupancy, year, and facility and state random effects. Results Nearly all combinations of the 3 litigation exposure measures and 9 quality measures—27 models in all—showed an inverse relationship between litigation costs and quality. However only a few of these associations were statistically significant, and the effect sizes were very small. For example, a doubling of indemnity payments was associated with a 1.1% increase in the number of deficiencies and a 2.2% increase in pressure ulcer rates. Conclusions Tort litigation does not increase the quality performance of nursing homes, and may decrease it slightly. PMID:23552438

Does litigation increase or decrease health care quality?: a national study of negligence claims against nursing homes.

Science.gov (United States)

Stevenson, David G; Spittal, Matthew J; Studdert, David M

2013-05-01

The tort system is supposed to help improve the quality and safety of health care, but whether it actually does so is controversial. Most previous studies modeling the effect of negligence litigation on quality of care are ecologic. To assess whether the experience of being sued and incurring litigation costs affects the quality of care subsequently delivered in nursing homes. We linked information on 6471 negligence claims brought against 1514 nursing homes between 1998 and 2010 to indicators of nursing home quality drawn from 2 US national datasets (Online Survey, Certification, and Reporting system; Minimum Data Set Quality Measure/Indicator Reports). At the facility level, we tested for associations between 9 quality measures and 3 variables indicating the nursing homes' litigation experience in the preceding 12-18 months (total indemnity payments; total indemnity payments plus administrative costs; ≥ 1 paid claims vs. none). The analyses adjusted for quality at baseline, case-mix, ownership, occupancy, year, and facility and state random effects. Nearly all combinations of the 3 litigation exposure measures and 9 quality measures--27 models in all--showed an inverse relationship between litigation costs and quality. However, only a few of these associations were statistically significant, and the effect sizes were very small. For example, a doubling of indemnity payments was associated with a 1.1% increase in the number of deficiencies and a 2.2% increase in pressure ulcer rates. Tort litigation does not increase the quality performance of nursing homes, and may decrease it slightly.

Hip Fractures: What Information Does the Evidence Show That Patients and Families Need to Decrease 30-Day Readmission?

Science.gov (United States)

Gardner, Kristin OʼMara

2015-01-01

The current bundled payment reimbursement from the Centers for Medicare & Medicaid Services will not cover the additional cost of hospital readmission for the same diagnosis, and patients with hip fractures have one of the highest cost-saving opportunities when compared with other admission reasons. Common reasons for readmission to the hospital after hip fracture include pneumonia, dehydration, and mobility issues. The learning modalities including visual, aural, read/write, and kinesthetic were used to make recommendations on how the education can be incorporated into the instruction of patients with hip fractures and their families. These learning techniques can be used to develop education to decrease possibility of 30-day readmission after hip fracture. Nurses must focus their education to meet the needs of each individual patient, adapting to different types of adult learners to increase the health literacy of patients with hip fractures and their families.

Social determinants of health, universal health coverage, and sustainable development: case studies from Latin American countries.

Science.gov (United States)

de Andrade, Luiz Odorico Monteiro; Pellegrini Filho, Alberto; Solar, Orielle; Rígoli, Félix; de Salazar, Lígia Malagon; Serrate, Pastor Castell-Florit; Ribeiro, Kelen Gomes; Koller, Theadora Swift; Cruz, Fernanda Natasha Bravo; Atun, Rifat

2015-04-04

Many intrinsically related determinants of health and disease exist, including social and economic status, education, employment, housing, and physical and environmental exposures. These factors interact to cumulatively affect health and disease burden of individuals and populations, and to establish health inequities and disparities across and within countries. Biomedical models of health care decrease adverse consequences of disease, but are not enough to effectively improve individual and population health and advance health equity. Social determinants of health are especially important in Latin American countries, which are characterised by adverse colonial legacies, tremendous social injustice, huge socioeconomic disparities, and wide health inequities. Poverty and inequality worsened substantially in the 1980s, 1990s, and early 2000s in these countries. Many Latin American countries have introduced public policies that integrate health, social, and economic actions, and have sought to develop health systems that incorporate multisectoral interventions when introducing universal health coverage to improve health and its upstream determinants. We present case studies from four Latin American countries to show the design and implementation of health programmes underpinned by intersectoral action and social participation that have reached national scale to effectively address social determinants of health, improve health outcomes, and reduce health inequities. Investment in managerial and political capacity, strong political and managerial commitment, and state programmes, not just time-limited government actions, have been crucial in underpinning the success of these policies. Copyright © 2015 Elsevier Ltd. All rights reserved.

Obstacles to implementing evidence-based practice in Belgium: a context-specific qualitative evidence synthesis including findings from different health care disciplines.

Science.gov (United States)

Hannes, K; Goedhuys, J; Aertgeerts, B

2012-01-01

A number of barriers to the implementation of evidence-based practice have already been inventoried. However, little attention has been given to their context-specific nature. This qualitative evidence synthesis examines commonalities in the obstacles perceived by different groups of health care practitioners working in the Belgian health care system and sets out to discuss potential strategies to bridge some of these barriers. We actively searched for primary studies addressing our topic of interest in international and national databases (1990 to May 2008), consulted experts and screened references of retrieved studies. We opted for the meta-aggregative approach, developed by the Joanna Briggs Institute, to analyse our findings. The findings indicate that (1) evidence might have a limited role in decision-making processes; (2) aspects other than quality of care steer the evidence-based practice agenda; (3) some health care providers benefit less from evidence-based practice than others and (4) there is a lack of competences to put the evidence-based principles in practice. Belgian policy makers might consider health care system characteristics from and strategies developed or suggested by others to respond to country-specific obstacles. Examples include but are not limited to; (a) providing incentives for patient-centred care coordination and patient communication, (b) supporting practitioners interested in applying research-related activities, (c) considering direct access systems and interprofessional learning to respond to the demand for autonomous decision-making from satellite professional groups, (d) systematically involving allied health professionals in important governmental advisory boards, (e) considering pharmaceutical companies perceived as 'the enemy' an ally in filling in research gaps, (f) embedding the evaluation of evidence-based knowledge and skills in examinations (g) moving from (in)formative learning to transformative learning and (h

E-health

DEFF Research Database (Denmark)

Elkjaer, Margarita

2012-01-01

decrease the use of endoscopy in some cases. The findings corresponded well with action plan for a European e-Health Area and could be a helpful tool to provide more efficient health care for UC patients. Widespread implementation of the "Constant-Care" is possible, but it may require a reshaping...

Oral Health Care in the Future: Expansion of the Scope of Dental Practice to Improve Health.

Science.gov (United States)

Lamster, Ira B; Myers-Wright, Noreen

2017-09-01

The health care environment in the U.S. is changing. The population is aging, the prevalence of non-communicable diseases (NCDs) is increasing, edentulism is decreasing, and periodontal infection/inflammation has been identified as a risk factor for NCDs. These trends offer an opportunity for oral health care providers to broaden the scope of traditional dental practice, specifically becoming more involved in the management of the general health of patients. This new practice paradigm will promote a closer integration with the larger health care system. This change is based on the realization that a healthy mouth is essential for a healthy life, including proper mastication, communication, esthetics, and comfort. Two types of primary care are proposed: screenings for medical conditions that are directly affected by oral disease (and may modify the provision of dental care), and a broader emphasis on prevention that focuses on lifestyle behaviors. Included in the former category are screenings for NCDs (e.g., the risk of cardiovascular disease and identification of patients with undiagnosed dysglycemia or poorly managed diabetes mellitus), as well as identification of infectious diseases, such as HIV or hepatitis C. Reducing the risk of disease can be accomplished by an emphasis on smoking cessation and dietary intake and the prevention of obesity. These activities will promote interprofessional health care education and practice. While change is always challenging, this new practice paradigm could improve both oral health and health outcomes of patients seen in the dental office. This article was written as part of the project "Advancing Dental Education in the 21 st Century."

Health beliefs, attitudes and service utilization among Haitians.

Science.gov (United States)

Allen, Jennifer D; Mars, Dana R; Tom, Laura; Apollon, Guy; Hilaire, Dany; Iralien, Gerald; Cloutier, Lindsay B; Sheets, Margaret M; Zamor, Riché

2013-02-01

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.

77 FR 38296 - Draft Public Health Action Plan-A National Public Health Action Plan for the Detection...

Science.gov (United States)

2012-06-27

... Prevention and Health Promotion, Division of Reproductive Health, Attn: National Public Health Action Plan... Disease Prevention and Health Promotion, Division of Reproductive Health, 4770 Buford Highway NE... topic's public health importance, existing challenges, and opportunities for action to decrease the...

Should catastrophic risks be included in a regulated competitive health insurance market?

Science.gov (United States)

van de Ven, W P; Schut, F T

1994-11-01

In 1988 the Dutch government launched a proposal for a national health insurance based on regulated competition. The mandatory benefits package should be offered by competing insurers and should cover both non-catastrophic risks (like hospital care, physician services and drugs) and catastrophic risks (like several forms of expensive long-term care). However, there are two arguments to exclude some of the catastrophic risks from the competitive insurance market, at least during the implementation process of the reforms. Firstly, the prospects for a workable system of risk-adjusted payments to the insurers that should take away the incentives for cream skimming are, at least during the next 5 years, more favorable for the non-catastrophic risks than for the catastrophic risks. Secondly, even if a workable system of risk-adjusted payments can be developed, the problem of quality skimping may be relevant for some of the catastrophic risks, but not for non-catastrophic risks. By 'quality skimping' we mean the reduction of the quality of care to a level which is below the minimum level that is acceptable to society. After 5 years of health care reforms in the Netherlands new insights have resulted in a growing support to confine the implementation of the reforms to the non-catastrophic risks. In drawing (and redrawing) the exact boundaries between different regulatory regimes for catastrophic and non-catastrophic risks, the expected benefits of a cost-effective substitution of care have to be weighted against the potential harm caused by cream skimming and quality skimping.

Apple phytochemicals and their health benefits

Directory of Open Access Journals (Sweden)

Liu Rui

2004-05-01

Full Text Available Abstract Evidence suggests that a diet high in fruits and vegetables may decrease the risk of chronic diseases, such as cardiovascular disease and cancer, and phytochemicals including phenolics, flavonoids and carotenoids from fruits and vegetables may play a key role in reducing chronic disease risk. Apples are a widely consumed, rich source of phytochemicals, and epidemiological studies have linked the consumption of apples with reduced risk of some cancers, cardiovascular disease, asthma, and diabetes. In the laboratory, apples have been found to have very strong antioxidant activity, inhibit cancer cell proliferation, decrease lipid oxidation, and lower cholesterol. Apples contain a variety of phytochemicals, including quercetin, catechin, phloridzin and chlorogenic acid, all of which are strong antioxidants. The phytochemical composition of apples varies greatly between different varieties of apples, and there are also small changes in phytochemicals during the maturation and ripening of the fruit. Storage has little to no effect on apple phytochemicals, but processing can greatly affect apple phytochemicals. While extensive research exists, a literature review of the health benefits of apples and their phytochemicals has not been compiled to summarize this work. The purpose of this paper is to review the most recent literature regarding the health benefits of apples and their phytochemicals, phytochemical bioavailability and antioxidant behavior, and the effects of variety, ripening, storage and processing on apple phytochemicals.

Stop signals decrease choices for palatable foods through decreased food evaluation

Science.gov (United States)

Veling, Harm; Aarts, Henk; Stroebe, Wolfgang

2013-01-01

The present study explores whether presenting specific palatable foods in close temporal proximity of stop signals in a go/no-go task decreases subsequent evaluations of such foods among participants with a relatively high appetite. Furthermore, we tested whether any decreased evaluations could mediate subsequent food choice. Participants first received a go/no-go task in which palatable foods were consistently linked to go cues or no-go cues within participants. Next, evaluation of the palatable foods was measured as well as food choice. Replicating previous work, results show that among participants with a relatively high appetite palatable foods associated with no-go cues are less often chosen as snacks compared to when these foods are associated with go cues, whereas this manipulation did not affect participants with a relatively low appetite. Moreover, this effect was completely mediated by decreased evaluation of the palatable foods that had been associated with the no-go cues, whereas evaluation of the foods associated with go cues did not mediate this effect. Results further showed that the devaluation effect of foods associated with no-go cues was independent of the amount of pairings (4 vs. 12 vs. 24) with the no-go cues. The current findings suggest that decreased food evaluation is a mechanism that explains effects of stop signals on food choice. PMID:24324451

Sociostructural factors influencing health behaviors of urban African-American men.

Science.gov (United States)

Plowden, Keith O; Young, Anthony E

2003-06-01

African-American men are suffering disproportionately from most illnesses. Seemingly, action is needed if health disparities that disproportionately affect African-American men as compared to their White and female counterparts are to be reduced or eliminated. An important step in decreasing common health disparities evidenced among African-American men is to understand social factors that act as motivators and barriers to seeking care for most of this vulnerable population. Following a constructionist epistemology, this study used ethnography to explore social structure factors that motivate urban African-American men to seek care. Leininger's Culture Care Diversity and Universality Theory guided this study. Qualitative interviews were conducted with urban African-American men and other individuals in the community to explore understanding, attitudes, and beliefs about health. Critical issues examined included social factors associated with health seeking behaviors. Themes that emerged from these data indicated that critical social factors include: 1) Kinship/significant others; 2) accessibility of resources; 3) ethnohealth belief; and 4) accepting caring environment. The data also indicated a relationship between these social factors and health seeking behaviors of urban African-American men.

Alcoholic Hepatitis Markedly Decreases the Capacity for Urea Synthesis.

Directory of Open Access Journals (Sweden)

Emilie Glavind

Full Text Available Data on quantitative metabolic liver functions in the life-threatening disease alcoholic hepatitis are scarce. Urea synthesis is an essential metabolic liver function that plays a key regulatory role in nitrogen homeostasis. The urea synthesis capacity decreases in patients with compromised liver function, whereas it increases in patients with inflammation. Alcoholic hepatitis involves both mechanisms, but how these opposite effects are balanced remains unclear. Our aim was to investigate how alcoholic hepatitis affects the capacity for urea synthesis. We related these findings to another measure of metabolic liver function, the galactose elimination capacity (GEC, as well as to clinical disease severity.We included 20 patients with alcoholic hepatitis and 7 healthy controls. The urea synthesis capacity was quantified by the functional hepatic nitrogen clearance (FHNC, i.e., the slope of the linear relationship between the blood α-amino nitrogen concentration and urea nitrogen synthesis rate during alanine infusion. The GEC was determined using blood concentration decay curves after intravenous bolus injection of galactose. Clinical disease severity was assessed by the Glasgow Alcoholic Hepatitis Score and Model for End-Stage Liver Disease (MELD score.The FHNC was markedly decreased in the alcoholic hepatitis patients compared with the healthy controls (7.2±4.9 L/h vs. 37.4±6.8 L/h, P<0.01, and the largest decrease was observed in those with severe alcoholic hepatitis (4.9±3.6 L/h vs. 9.9±4.9 L/h, P<0.05. The GEC was less markedly reduced than the FHNC. A negative correlation was detected between the FHNC and MELD score (rho = -0.49, P<0.05.Alcoholic hepatitis markedly decreases the urea synthesis capacity. This decrease is associated with an increase in clinical disease severity. Thus, the metabolic failure in alcoholic hepatitis prevails such that the liver cannot adequately perform the metabolic up-regulation observed in other stressful

A Home-Based Educational Intervention Improves Patient Activation Measures and Diabetes Health Indicators among Zuni Indians.

Directory of Open Access Journals (Sweden)

Vallabh O Shah

Full Text Available One in three people will be diagnosed with diabetes by 2050, and the proportion will likely be higher among Native Americans. Diabetes control is currently suboptimal in underserved populations despite a plethora of new therapies. Patient empowerment is a key determinant of diabetes control, but such empowerment can be difficult to achieve due to resource limitation and cultural, language and health literacy barriers. We describe a home-based educational intervention using Community Health Representatives (CHRs, leading to improvement in Patient Activation Measures scores and clinical indicators of diabetes control.Sixty participants with type 2 diabetes (T2D completed a baseline evaluation including physical exam, Point of Care (POC testing, and the Patient Activation Measure (PAM survey. Participants then underwent a one hour group didactic session led by Community Health Representatives (CHRs who subsequently carried out monthly home-based educational interventions to encourage healthy lifestyles, including diet, exercise, and alcohol and cigarette avoidance until follow up at 6 months, when clinical phenotyping and the PAM survey were repeated.PAM scores were increased by at least one level in 35 (58% participants, while 24 participants who started at higher baseline score did not change. Six months after intervention, mean levels of A1C decreased by 0.7 ± 1.2%; fasting blood glucose decreased by 24.0 ± 38.0 mg/dl; BMI decreased by 1.5 ± 2.1 kg/m2; total cholesterol decreased by 12.0 ± 28.0 mg/dl; and triglycerides decreased by 52.0 ± 71.0 mg/dl. All of these changes were statistically significant (p < 0.05.This six month, CHR led and community-oriented educational intervention helps inform standards of practice for the management of diabetes, engages diabetic populations in their own care, and reduces health disparities for the underserved population of Zuni Indians.ClinicalTrials.gov NCT02339311.

Web-Scale Discovery Services Retrieve Relevant Results in Health Sciences Topics Including MEDLINE Content

Directory of Open Access Journals (Sweden)

Elizabeth Margaret Stovold

2017-06-01

Full Text Available A Review of: Hanneke, R., & O’Brien, K. K. (2016. Comparison of three web-scale discovery services for health sciences research. Journal of the Medical Library Association, 104(2, 109-117. http://dx.doi.org/10.3163/1536-5050.104.2.004 Abstract Objective – To compare the results of health sciences search queries in three web-scale discovery (WSD services for relevance, duplicate detection, and retrieval of MEDLINE content. Design – Comparative evaluation and bibliometric study. Setting – Six university libraries in the United States of America. Subjects – Three commercial WSD services: Primo, Summon, and EBSCO Discovery Service (EDS. Methods – The authors collected data at six universities, including their own. They tested each of the three WSDs at two data collection sites. However, since one of the sites was using a legacy version of Summon that was due to be upgraded, data collected for Summon at this site were considered obsolete and excluded from the analysis. The authors generated three questions for each of six major health disciplines, then designed simple keyword searches to mimic typical student search behaviours. They captured the first 20 results from each query run at each test site, to represent the first “page” of results, giving a total of 2,086 total search results. These were independently assessed for relevance to the topic. Authors resolved disagreements by discussion, and calculated a kappa inter-observer score. They retained duplicate records within the results so that the duplicate detection by the WSDs could be compared. They assessed MEDLINE coverage by the WSDs in several ways. Using precise strategies to generate a relevant set of articles, they conducted one search from each of the six disciplines in PubMed so that they could compare retrieval of MEDLINE content. These results were cross-checked against the first 20 results from the corresponding query in the WSDs. To aid investigation of overall

Environmental health and health planning

International Nuclear Information System (INIS)

1975-07-01

Areas of environmental concern are identified and recommendations for improving environmental health are proposed by the Environmental Health Task Force of the Western Massachusetts Health Planning Council. Environmental health concerns in Western Massachusetts are in the areas of: air pollution; dental health and the specific problem of water flouridation; housing; injury control, including accidental death and disability; land use, and the specific problem of critical receptors; noise pollution; occupational hazards, specifically occupational accidents; pesticides; radiological exposure, particularly medical X-ray exposure and nuclear exposure; rural health care; sanitation; solid waste; and water quality including private and public water supplies, road salting, and rural sewerages. Each area of concern and specific problem are broken down into sections: background information; comments which incorporate recommendations for general problem-solving activities; and resources, including lists of key organization, individuals, laws and regulations, and publications relevant to the area of concern. Recommendations are presented based on long-term and short-term environmental goals. An inventory of environmental health organizations in Western Massachusetts is included. Appendices contain the charge to the Task Force, a definition of environmental health, sources of drinking water, the sanitation and sanitary codes, and housing and sanitation standards. Portions of this document are not fully legible

Emergency department case management: the dyad team of nurse case manager and social worker improve discharge planning and patient and staff satisfaction while decreasing inappropriate admissions and costs: a literature review.

Science.gov (United States)

Bristow, Darlene P; Herrick, Charlotte A

2002-01-01

A model of emergency department (ED) case management consisting of a social worker and a nurse case manager can prevent inappropriate admissions, improve discharge planning, decrease cost, and enhance patient satisfaction. The individual and combined roles of the dyad team of social worker and nurse case manager are discussed. A literature review includes how a case management dyad team of social worker and nurse case manager in the ED can decrease utilization of the ED for nonemergent visits, promote the use of community resources, and improve discharge planning to avoid excessive costs. The importance of the dyad team working with the interdisciplinary team in the ED, the primary care physician (PCP), and other community health care providers in order to provide a holistic approach to care is addressed. A discussion about the improvement of both patient and staff satisfaction demonstrates the results of case management strategies that support and advocate for patients to receive quality, cost-effective care across the health care continuum, while decreasing the use of the ED for nonemergent care.

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

DEFF Research Database (Denmark)

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

2012-01-01

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...

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of a health claim related to Vitis vinifera L. seeds extract and “helps to decrease swollen legs” pursuant to Article 13(5) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Tetens, Inge

Following an application from Nutrilinks Sarl, submitted pursuant to Article 13(5) of Regulation (EC) No 1924/2006 via the Competent Authority of Belgium, the Panel on Dietetic Products, Nutrition and Allergies (NDA) was asked to deliver an opinion on the scientific substantiation of a health claim...... related to Vitis vinifera L. seeds extract and “helps to decrease swollen legs”. The Panel considers that the food constituent which is the subject of the health claim is sufficiently characterised. Upon EFSA’s request for clarification, the applicant stated that the claimed effect was “helps to decrease...

45 CFR 1308.11 - Eligibility criteria: Hearing impairment including deafness.

Science.gov (United States)

2010-10-01

... OF HUMAN DEVELOPMENT SERVICES, DEPARTMENT OF HEALTH AND HUMAN SERVICES THE ADMINISTRATION FOR... impairment including deafness. (a) A child is classified as deaf if a hearing impairment exists which is so... hearing loss can include impaired listening skills, delayed language development, and articulation...

Endogenous and exogenous testosterone and prostate cancer: decreased-, increased- or null-risk?

Science.gov (United States)

Advani, Shailesh; Tsilidis, Konstantinos K.; Wang, Run; Canfield, Steven

2017-01-01

For more than 70 years, the contention that high levels of testosterone or that the use of testosterone therapy (TTh) increases the development and progression of prostate cancer (PCa) has been widely accepted and practiced. Yet, the increasing and emerging evidence on testosterone research seems to challenge that contention. To review literature on the associations of endogenous and exogenous testosterone with decreased-, increased-, or null-risk of PCa, and to further evaluate only those studies that reported magnitude of associations from multivariable modeling as it minimizes confounding effects. We conducted a literature search to identify studies that investigated the association of endogenous total testosterone [continuous (per 1 unit increment and 5 nmol/L increment) and categorical (high vs. low)] and use of TTh with PCa events [1990–2016]. Emphasis was given to studies/analyses that reported magnitude of associations [odds ratio (OR), relative risk (RR) and hazard ratios (HRs)] from multivariable analyses to determine risk of PCa and their statistical significance. Most identified studies/analyses included observational and randomized placebo-controlled trials. This review was organized in three parts: (I) association of endogenous total testosterone (per 1 unit increment and 5 nmol/L increment) with PCa; (II) relationship of endogenous total testosterone (categorical high vs. low) with PCa; and (III) association of use of TTh with PCa in meta-analyses of randomized placebo-controlled trials. The first part included 31 observational studies [20 prospective (per 5 nmol/L increment) and 11 prospective and retrospective cohort studies (per 1 unit increment)]. None of the 20 prospective studies found a significant association between total testosterone (5 nmol/L increment) and increased- or decreased-risk of PCa. Two out of the 11 studies/analyses showed a significant decreased-risk of PCa for total testosterone per 1 unit increment, but also two other

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to fructo-oligosaccharides (FOS) and decreasing potentially pathogenic gastro-intestinal microorganisms (ID 781), pursuant to Article 13(1) of Regulation (EC) No 1924/2006

DEFF Research Database (Denmark)

Tetens, Inge

claims in relation to fructo-oligosaccharides and decreasing potentially pathogenic gastro-intestinal microorganisms. The scientific substantiation is based on the information provided by the Member States in the consolidated list of Article 13 health claims and references that EFSA has received from......Following a request from the European Commission, the Panel on Dietetic Products, Nutrition and Allergies was asked to provide a scientific opinion on a list of health claims pursuant to Article 13 of Regulation (EC) No 1924/2006. This opinion addresses the scientific substantiation of health...... conclusions could be drawn for the scientific substantiation of the claim were provided. On the basis of the data presented, the Panel concludes that a cause and effect relationship has not been established between the consumption of fructo-oligosaccharides and decreasing potentially pathogenic gastro...

Inequality, wealth and health : Is decreasing income inequality the key to create healthier societies?

NARCIS (Netherlands)

Pop, I.A.; van Ingen, E.J.; van Oorschot, W.J.H.

2013-01-01

The idea that the level of stratification of societies contributes to the well-being of their members is gaining popularity. We contribute to this debate by investigating whether reducing inequalities in the income distribution of societies is a strategy for improving population health, especially

Decreasing Relative Risk Premium

DEFF Research Database (Denmark)

Hansen, Frank

relative risk premium in the small implies decreasing relative risk premium in the large, and decreasing relative risk premium everywhere implies risk aversion. We finally show that preferences with decreasing relative risk premium may be equivalently expressed in terms of certain preferences on risky......We consider the risk premium demanded by a decision maker with wealth x in order to be indifferent between obtaining a new level of wealth y1 with certainty, or to participate in a lottery which either results in unchanged present wealth or a level of wealth y2 > y1. We define the relative risk...... premium as the quotient between the risk premium and the increase in wealth y1–x which the decision maker puts on the line by choosing the lottery in place of receiving y1 with certainty. We study preferences such that the relative risk premium is a decreasing function of present wealth, and we determine...

Risk of mental health problems in adolescents skipping meals: The Korean National Health and Nutrition Examination Survey 2010 to 2012.

Science.gov (United States)

Lee, Gyungjoo; Han, Kyungdo; Kim, Hyunju

Adolescents frequently skip meals, doing so even more than once per day. This is associated with more mental health problems. This study identified mental health problems' associations with skipping meals and the frequency thereof among adolescents. This cross-sectional population-based study used a data set of 1,413 adolescents from the 2010 to 2012 Korean National Health and Nutrition Examination Survey. Hierarchical multivariable logistic regression was conducted to determine the risk of mental health problems, including stress, depressive mood, and suicidal ideation in relation to skipping meals and the frequency thereof per day. Breakfast skipping significantly increased the risks of stress and depressive mood. Stress, depressive mood, and suicidal ideation were significantly prevalent as the daily frequency of skipping meals increased. Specific strategies should be developed at government or school level to decrease the frequency of skipping meals per day, associated with serious mental health problems in adolescents. Copyright © 2017 Elsevier Inc. All rights reserved.

Use of Silver Diamine Fluoride for Dental Caries Management in Children and Adolescents, Including Those with Special Health Care Needs.

Science.gov (United States)

Crystal, Yasmi O; Marghalani, Abdullah A; Ureles, Steven D; Wright, John Timothy; Sulyanto, Rosalyn; Divaris, Kimon; Fontana, Margherita; Graham, Laurel

2017-09-15

This manuscript presents evidence-based guidance on the use of 38 percent silver diamine fluoride (SDF) for dental caries management in children and adolescents, including those with special health care needs. A guideline workgroup formed by the American Academy of Pediatric Dentistry developed guidance and an evidence-based recommendation regarding the application of 38 percent SDF to arrest cavitated caries lesions in primary teeth. The basis of the guideline's recommendation is evidence from an existing systematic review "Clinical trials of silver diamine fluoride in arresting caries among children: A systematic review." (JDR Clin Transl Res 2016;1[3]:201-10). A systematic search was conducted in PubMed®/MEDLINE, Embase®, Cochrane Central Register of Controlled Trials, and gray literature databases to identify randomized controlled trials and systematic reviews reporting on the effect of silver diamine fluoride and address peripheral issues such as adverse effects and cost. The Grading of Recommendations Assessment, Development, and Evaluation (GRADE) approach was used to assess the quality of the evidence and the evidence-to-decision framework was employed to formulate a recommendation. The panel made a conditional recommendation regarding the use of 38 percent SDF for the arrest of cavitated caries lesions in primary teeth as part of a comprehensive caries management program. After taking into consideration the low cost of the treatment and the disease burden of caries, panel members were confident that the benefits of SDF application in the target populations outweigh its possible undesirable effects. Per GRADE, this is a conditional recommendation based on low-quality evidence. Conclusions and practical implications: The guideline intends to inform the clinical practices involving the application of 38 percent SDF to enhance dental caries management outcomes in children and adolescents, including those with special health care needs. These recommended

Airplane radiation dose decrease during a strong Forbush decrease

Czech Academy of Sciences Publication Activity Database

Spurný, František; Kudela, K.; Dachev, T.

2004-01-01

Roč. 2, S05001 (2004), s. 1-4 ISSN 1542-7390 Grant - others:EC project(XE) FIGM-CT2000-00068 Institutional research plan: CEZ:AV0Z1048901 Keywords : airplane dose * Forbush decrease * cosmic rays Subject RIV: BG - Nuclear, Atomic and Molecular Physics, Colliders

76 FR 9283 - Medicaid Program; Payment Adjustment for Provider-Preventable Conditions Including Health Care...

Science.gov (United States)

2011-02-17

... on March 22, 1995) UTI Urinary tract infection I. Background Title XIX of the Social Security Act... Diabetes with Hyperosmolarity. Catheter-Associated Urinary Tract Infection (UTI). Vascular Catheter... for State Health Policy, the National Association of Children's Hospitals, the Joint Commission, and...

Massachusetts health reform and access for children with special health care needs.

Science.gov (United States)

Smith, Anna Jo; Chien, Alyna T

2014-08-01

Children with special health care needs (CSHCN) face unique challenges in accessing affordable health care. Massachusetts implemented major health reform in 2006; little is known about the impact of this state's health reform on uninsurance, access to care, and financial protection for privately and publicly insured CSHCN. We used a difference-in-differences (DD) approach to compare uninsurance, access to primary and specialty care, and financial protection in Massachusetts versus other states and Washington, DC before and after Massachusetts health reform. Parent-reported data were used from the 2005-2006 and 2009-2010 National Survey of Children with Special Health Care Needs and adjusted for age, gender, race/ethnicity, non-English language at home, and functional difficulties. Postreform, living in Massachusetts was not associated with significant decreases in uninsurance or increases in access to primary care for CSHCN. For privately insured CSHCN, Massachusetts was associated with increased access to specialists (DD = 6.0%; P ≤ .001) postreform. For publicly insured CSHCN, however, there was a significant decrease in access to prescription medications (DD = -7.2%; P = .003) postreform. Living in Massachusetts postreform was not associated with significant changes in financial protection compared with privately or publicly insured CSHCN in other states. Massachusetts health reform likely improved access to specialists for privately insured CSHCN but did not decrease instances of uninsurance, increase access to primary care, or improve financial protection for CSHCN in general. Comparable provisions within the Affordable Care Act may produce similarly modest outcomes for CSHCN. Copyright © 2014 by the American Academy of Pediatrics.

EFSA Panel on Dietetic Products, Nutrition and Allergies (NDA); Scientific Opinion on the substantiation of health claims related to foods with reduced lactose content and decreasing gastro-intestinal discomfort caused by lactose intake in lactose intolerant individuals (ID 646, 1224, 1238, 1339

DEFF Research Database (Denmark)

Tetens, Inge

claims in relation to foods with reduced lactose content and decreasing gastro-intestinal discomfort caused by lactose intake in lactose intolerant individuals. The scientific substantiation is based on the information provided by the Member States in the consolidated list of Article 13 health claims...... and references that EFSA has received from Member States or directly from stakeholders. The food constituent that is the subject of the health claim is lactose, which should be “decreased” or “reduced” in foods in order to obtain the claimed effect. The Panel considers that lactose is sufficiently characterised....... The claimed effects are “lactose intolerance”, “decrease lactose malabsorption symptoms” and “lactose digestion”. The target population is assumed to be lactose intolerant individuals. The Panel assumes that the claimed effects refer to decreasing gastro-intestinal discomfort caused by lactose intake...

Background, design and conceptual model of the cluster randomized multiple-component workplace study: FRamed Intervention to Decrease Occupational Muscle pain - "FRIDOM".

Science.gov (United States)

Christensen, Jeanette Reffstrup; Bredahl, Thomas Viskum Gjelstrup; Hadrévi, Jenny; Sjøgaard, Gisela; Søgaard, Karen

2016-10-24

Several RCT studies have aimed to reduce either musculoskeletal disorders, sickness presenteeism, sickness absenteeism or a combination of these among females with high physical work demands. These studies have provided evidence that workplace health promotion (WHP) interventions are effective, but long-term effects are still uncertain. These studies either lack to succeed in maintaining intervention effects or lack to document if effects are maintained past a one-year period. This paper describes the background, design and conceptual model of the FRIDOM (FRamed Intervention to Decrease Occupational Muscle pain) WHP program among health care workers. A job group characterized by having high physical work demands, musculoskeletal disorders, high sickness presenteeism - and absenteeism. FRIDOM aimed to reduce neck and shoulder pain. Secondary aims were to decrease sickness presenteeism, sickness absenteeism and lifestyle-diseases such as other musculoskeletal disorders as well as metabolic-, and cardiovascular disorders - and to maintain participation to regular physical exercise training, after a one year intervention period. The entire concept was tailored to a population of female health care workers. This was done through a multi-component intervention including 1) intelligent physical exercise training (IPET), dietary advice and weight loss (DAW) and cognitive behavioural training (CBT). The FRIDOM program has the potential to provide evidence-based knowledge of the pain reducing effect of a multi component WHP among a female group of employees with a high prevalence of musculoskeletal disorders and in a long term perspective evaluate the effects on sickness presenteeism and absenteeism as well as risk of life-style diseases. NCT02843269 , 06.27.2016 - retrospectively registered.

Self-stigma and its associations with stress, physical health, and health care satisfaction in adults who stutter.

Science.gov (United States)

Boyle, Michael P; Fearon, Alison N

2018-06-01

The aim of this study was to identify potential relationships between self-stigma (stigma awareness and stigma application) and stress, physical health, and health care satisfaction among a large sample of adults who stutter. It was hypothesized that both stigma awareness and stigma application would be inversely related to measures of physical health and health care satisfaction, and positively related to stress. Furthermore, it was anticipated that stress mediated the relationship between self-stigma and physical health. A sample of adults who stutter in the United States (n=397) completed a web survey that assessed levels of stigma awareness and stigma application, stress, physical health, and health care satisfaction. Correlational analyses were conducted to determine the relationships between these variables. Higher levels of stigma awareness and stigma application were associated with increased stress, decreased overall physical health, and decreased health care satisfaction (i.e., discomfort obtaining health care due to stuttering, and adverse health care outcomes due to stuttering), and these relationships were statistically significant. Stress was identified as a mediator between stigma application and physical health. Because adults who stutter with higher levels of self-stigma are at risk for decreased physical health through increased stress, and lower satisfaction with their health care experiences as a result of stuttering, it is important for professionals to assess and manage self-stigma in clients who stutter. Self-stigma has implications for not only psychological well-being, but stress, physical health, and health care satisfaction as well. Copyright © 2017 Elsevier Inc. All rights reserved.

Integrating mental health services: the Finnish experience

Directory of Open Access Journals (Sweden)

Ville Lehtinen

2001-06-01

Full Text Available The aim of this paper is to give a short description of the most important developments of mental health services in Finland during the 1990s, examine their influences on the organisation and provision of services, and describe shortly some national efforts to handle the new situation. The Finnish mental health service system experienced profound changes in the beginning of the 1990s. These included the integration of mental health services, being earlier under own separate administration, with other specialised health services, decentralisation of the financing of health services, and de-institutionalisation of the services. The same time Finland underwent the deepest economic recession in Western Europe, which resulted in cut-offs especially in the mental health budgets. Conducting extensive national research and development programmes in the field of mental health has been one typically Finnish way of supporting the mental health service development. The first of these national programmes was the Schizophrenia Project 1981–97, whose main aims were to decrease the incidence of new long-term patients and the prevalence of old long-stay patients by developing an integrated treatment model. The Suicide Prevention Project 1986–96 aimed at raising awareness of this special problem and decreasing by 20% the proportionally high suicide rate in Finland. The National Depression Programme 1994–98 focused at this clearly increasing public health concern by several research and development project targeted both to the general population and specifically to children, primary care and specialised services. The latest, still on-going Meaningful Life Programme 1998–2003 which main aim is, by multi-sectoral co-operation, to improve the quality of life for people suffering from or living with the threat of mental disorders. Furthermore, the government launched in 1999 a new Goal and Action Programme for Social Welfare and Health Care 2000–2003, in

Health behaviour changes and onset of chronic health problems in later life

Directory of Open Access Journals (Sweden)

Marijke Veenstra

2012-11-01

Full Text Available Objectives: To assess five-year changes in health behaviours in later life and associations with onset of chronic health problems. The results may inform policy and interventions to promote healthy life years in ageing populations.Methods: Data are derived from the Norwegian study on Life-course, Ageing and Generation (NorLAG, a five-year (2002-2007 panel survey comprising a nation wide community sample. The present analyses include a sample of 1,019 respondents aged 60 years and older. Five-year changes in smoking, alcohol use, physical exercise and Body Mass Index (BMI are assessed according to prevalent and incident chronic health problems. Multivariate logistic analyses of “healthy” behavioural changes are conducted.Results: A total of 453 respondents (45% reported at least one chronic condition and 13% (N=133 reported onset of chronic conditions in the course of the past five years. Over a five-year period, there was an overall reduction in smoking rates and a decrease in regular physical activity. Alcohol consumption in older people slightly increased over time, but the incidence of chronic health problems tended to reduce alcohol intake. Older persons experiencing chronic health problems were less likely to initiate physical activity.Conclusions: The results provide limited support for the assumption that the onset of a chronic health condition triggers improved health behaviours. This suggests that the health care system could do more in targeting a potential “window of opportunity” for individuals to adopt new healthy behaviours in later life.

Immunological Assays as an Opportunity of Assessment of Health Risks of Airborne Particle Mixture Including Nanoparticles

International Nuclear Information System (INIS)

Brzicová, Tána; Danihelka, Pavel; Micka, Vladimír; Lochman, Ivo; Lach, Karel; Lochmanová, Alexandra

2013-01-01

The aim of this pilot study was to evaluate perspectives of the assessment of nonspecific biological effects of airborne particulate matter including nanoparticles using appropriate immunological assays. We have selected various in vitro immunological assays to establish an array allowing us to monitor activation of the cell-mediated and humoral response of both the innate and adaptive immunity. To assess comprehensive interactions and effects, the assays were performed in whole blood cultures from healthy volunteers and we used an original airborne particle mixture from high pollution period in Ostrava region representing areas with one of the most polluted air in Europe. Even if certain effects were observed, the results of the immunological assays did not prove significant effects of airborne particles on immune cells' functions of healthy persons. However, obtained data do not exclude health risks of long-term exposure to airborne particles, especially in case of individuals with genetic predisposition to certain diseases or already existing disease. This study emphasizes the in vitro assessment of complex effects of airborne particles in conditions similar to actual ones in an organism exposed to particle mixture present in the polluted air.

Time feature of Chinese military personnel’s suicide ideation and its relationship with psychosomatic health

Directory of Open Access Journals (Sweden)

Li-yi ZHANG

2012-07-01

Full Text Available Objective To investigate the time feature of Chinese military personnel's suicide ideation and its relationship with psychosomatic health to provide scientific basis for formulation of mental health policy and intervention of related psychological crisis. Methods By random cluster sampling, a total of 11 362 military personnel including army, navy and air-force (1100 in 1980s, 8000 in 1990s, 2262 in year 2000 were tested by Chinese Psychosomatic Health Scale (CPSHS. SPSS statistic 17.0 program was used for data analysis, i.e., χ2-test, T-test and stepwise regression analysis. Results The incidence rate of military personnel's suicide ideation in the three decades from 1980 to 2000 was 10.27%, 7.09% and 2.83% respectively, which revealed a decreasing trend (P 0.05. Suicide ideation was selected into the regression equation of mental health, physical health, and total psychosomatic health scores, which could positively predict the level of military personnel's psychosomatic health (P=0.05 or 0.01. Conclusions Military personnel's suicide ideation presents a decreasing trend; the psychosomatic health of military personnel who have suicide ideation is worse than that of personnel without suicide ideation.

42 CFR 493.941 - Hematology (including routine hematology and coagulation).

Science.gov (United States)

2010-10-01

... 42 Public Health 5 2010-10-01 2010-10-01 false Hematology (including routine hematology and....941 Hematology (including routine hematology and coagulation). (a) Program content and frequency of challenge. To be approved for proficiency testing for hematology, a program must provide a minimum of five...

42 CFR 137.327 - May multiple projects be included in a single construction project agreement?

Science.gov (United States)

2010-10-01

... 42 Public Health 1 2010-10-01 2010-10-01 false May multiple projects be included in a single construction project agreement? 137.327 Section 137.327 Public Health PUBLIC HEALTH SERVICE, DEPARTMENT OF...-GOVERNANCE Construction Project Assumption Process § 137.327 May multiple projects be included in a single...

A decade review of publications in Families, Systems, & Health: 2005-2015.

Science.gov (United States)

Mendenhall, Tai J; Li, Yiting; Schulz, Catherine L

2016-09-01

The purpose of this investigation was to review recent publication content and trends in Families, Systems, & Health ( FSH ). How do the journal’s articles reflect current and emerging challenges in health care? We hope that our findings can guide special issues and content foci. All work published in FSH between 2005 and 2015 was included (n = 452); each piece was coded for article type, general foci, and specific foci. The most common type of article published over the 10-year time frame was research reports (43%; n = 195), followed by other types (e.g., tribute pieces, poems), commentaries, conceptual/theory papers, literature reviews, and case studies. The most common general focus included family health and/or functioning (28%; n = 128). The most common specific foci centered on children (15%; n = 55). Common themes found in FSH ’s most frequently cited publications included family relationships in care, chronic physical illnesses, and mental health. Marked trends in journal content included increases in articles targeting family health and/or functioning and primary care and decreased attention to theory. FSH’s emphasis on research reports to inform current and evolving interventions that target contemporary health challenges suggests that the journal is keeping stride with the most pressing issues in health care today. Future special issues can continue to serve and meet these needs. FSH’s robust inclusion of other article types sustains the journal’s mission to advance multiple ways of understanding health-care phenomena. PsycINFO Database Record (c) 2016 APA, all rights reserved

Decreased serum vitamin D in idiopathic benign paroxysmal positional vertigo.

Science.gov (United States)

Jeong, Seong-Hae; Kim, Ji-Soo; Shin, Jong Wook; Kim, Sungbo; Lee, Hajeong; Lee, Ae Young; Kim, Jae-Moon; Jo, Hyunjin; Song, Junghan; Ghim, Yuna

2013-03-01

Previous studies have demonstrated an association of osteopenia/osteoporosis with idiopathic benign paroxysmal positional vertigo (BPPV). Since vitamin D takes part in the regulation of calcium and phosphorus found in the body and plays an important role in maintaining proper bone structure, decreased bone mineral density in patients with BPPV may be related to decreased serum vitamin D. We measured the serum levels of 25-hydroxyvitamin D in 100 patients (63 women and 37 men, mean age ± SD = 61.8 ± 11.6) with idiopathic BPPV and compared the data with those of 192 controls (101 women and 91 men, mean age ± SD = 60.3 ± 11.3) who had lived in the same community without dizziness or imbalance during the preceding year. The selection of the controls and acquisition of clinical information were done using the data from the Fourth Korean National Health and Nutrition Examination Survey, 2008. The serum level of 25-hydroxyvitamin D was lower in the patients with BPPV than in the controls (mean ± SD = 14.4 ± 8.4 versus 19.1 ± 6.8 ng/ml, p = 0.001). Furthermore, patients with BPPV showed a higher prevalence of decreased serum vitamin D (diabetes, proteinuria, regular exercise and the existence of decreased bone mineral density demonstrated that vitamin D insufficiency (10-20 ng/ml) and deficiency (<10 ng/ml) were associated with BPPV with the odds ratios of 3.8 (95 % confidence interval = 1.51-9.38, p = 0.004) and 23.0 (95 % confidence interval = 6.88-77.05, p < 0.001). Our study demonstrated an association between idiopathic BPPV and decreased serum vitamin D. Decreased serum vitamin D may be a risk factor of BPPV.

Global issues in mental health across the life span: challenges and nursing opportunities.

Science.gov (United States)

Yearwood, Edilma L; DeLeon Siantz, Mary Lou

2010-12-01

This article describes what is known about mental health in children, adolescents, adults, and the elderly globally in high-, middle- and low-income countries. The social determinants of health are described as well as the paradigm shift from focusing on psychopathology to looking at ways in which individuals and communities can embrace mental health promotion to decrease stigma and provide care for all individuals in resource-rich and resource-poor environments. The need to expand the content in nursing curricula to include mental health concepts at all levels of training, foster mental health research, and promote international collaboration around best practices is also discussed. Copyright © 2010 Elsevier Inc. All rights reserved.

Reviewing and piloting methods for decreasing discount rates; someone, somewhere in time.

Science.gov (United States)

Parouty, Mehraj B Y; Krooshof, Daan G M; Westra, Tjalke A; Pechlivanoglou, Petros; Postma, Maarten J

2013-08-01

There has been substantial debate on the need for decreasing discounting for monetary and health gains in economic evaluations. Next to the discussion on differential discounting, a way to identify the need for such discounting strategies is through eliciting the time preferences for monetary and health outcomes. In this article, the authors investigate the perceived time preference for money and health gains through a pilot survey on Dutch university students using methods on functional forms previously suggested. Formal objectives of the study were to review such existing methods and to pilot them on a convenience sample using a questionnaire designed for this specific purpose. Indeed, a negative relation between the time of delay and the variance of the discounting rate for all models was observed. This study was intended as a pilot for a large-scale population-based investigation using the findings from this pilot on wording of the questionnaire, interpretation, scope and analytic framework.

Study on the air pollution in typical transportation microenvironment: Characteristics and health risks.

Science.gov (United States)

Weng, Mili; Jin, Xin

2015-01-01

The concentration of formaldehyde in micro-traffic atmospheric environment (including buses, cars, bus stations, and traffic artery) of Lin'an City was carefully investigated. The results showed that the formaldehyde average concentration was 0.0162 mg/m³ in the buses, 0.0225 mg/m³ in the cars, 0.0047 mg/m³ in the West Bus Stations, and 0.0133 mg/m³ in the East Bus Stations. The concentration of formaldehyde along the traffic artery decreased with the height increased. From 0 to 140 cm, the formaldehyde concentration decreased from 0.031 to 0.018 mg/m³. The formaldehyde concentration decreased when far away from the traffic artery. When the distance reached 200 m, the formaldehyde concentration decreased from 0.018 to 0.005 mg/m³. Based on the health risk assessment model, using 1 hr as the average retention time, the average health risk in buses, cars, and West/East Bus Stations was 2.106 × 10⁻⁴, 2.925 × 10⁻⁴, and 1.157 × 10⁻⁴, respectively.

Systematic review of sedentary behaviour and health indicators in school-aged children and youth

Directory of Open Access Journals (Sweden)

Goldfield Gary

2011-09-01

Full Text Available Abstract Accumulating evidence suggests that, independent of physical activity levels, sedentary behaviours are associated with increased risk of cardio-metabolic disease, all-cause mortality, and a variety of physiological and psychological problems. Therefore, the purpose of this systematic review is to determine the relationship between sedentary behaviour and health indicators in school-aged children and youth aged 5-17 years. Online databases (MEDLINE, EMBASE and PsycINFO, personal libraries and government documents were searched for relevant studies examining time spent engaging in sedentary behaviours and six specific health indicators (body composition, fitness, metabolic syndrome and cardiovascular disease, self-esteem, pro-social behaviour and academic achievement. 232 studies including 983,840 participants met inclusion criteria and were included in the review. Television (TV watching was the most common measure of sedentary behaviour and body composition was the most common outcome measure. Qualitative analysis of all studies revealed a dose-response relation between increased sedentary behaviour and unfavourable health outcomes. Watching TV for more than 2 hours per day was associated with unfavourable body composition, decreased fitness, lowered scores for self-esteem and pro-social behaviour and decreased academic achievement. Meta-analysis was completed for randomized controlled studies that aimed to reduce sedentary time and reported change in body mass index (BMI as their primary outcome. In this regard, a meta-analysis revealed an overall significant effect of -0.81 (95% CI of -1.44 to -0.17, p = 0.01 indicating an overall decrease in mean BMI associated with the interventions. There is a large body of evidence from all study designs which suggests that decreasing any type of sedentary time is associated with lower health risk in youth aged 5-17 years. In particular, the evidence suggests that daily TV viewing in excess of 2

Which Social Values Are Considered in Iranian Health System?

Science.gov (United States)

Rashidian, Arash; Arab, Mohammad; Vaez Mahdavi, Mohammadreza; Ashtarian, Koimars; Mostafavi, Hakimeh

2018-05-01

Health systems have a set of limited resources for meeting the needs of communities. Health priority setting based on criteria and values is inevitable in such situation. This paper aims to identify the social values that are considered in Iranian health system. This qualitative study was conducted in 3 steps including collecting national documents and literature review, interviewing key informants, and a 2 round Delphi. Interviews and documents were analyzed through thematic framework analysis. Statistical guidance was applied for determining consensus cut-off in Delphi technique. Five social values including freedom of choice, equity, solidarity, severity of disease(s), and burden of disease(s) were considered more important than other values in the health priority setting decisions. Moreover, 2 non-value based factors including conflict of interest and lobbying had a high effect on decision making. Most health policy makers decide based on Egalitarian school, but restriction of resources in the country decreases the outcome. Moreover, personal judgments and preferences sometimes affect their decisions. It seems that developing a value-based framework and making it as a national guidance could have affirmative effect on health administers decisions. © 2018 The Author(s). This is an open-access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.

Sleep apnea termination decreases cerebral blood volume: a near-infrared spectroscopy case study

Science.gov (United States)

Virtanen, Jaakko; Noponen, Tommi; Salmi, Tapani; Toppila, Jussi; Meriläinen, Pekka

2009-07-01

Medical near-infrared spectroscopy (NIRS) can be used to estimate cerebral haemodynamic changes non-invasively. Sleep apnea is a common sleep disorder where repetitive pauses in breathing decrease the quality of sleep and exposes the individual to various health problems. We have measured oxygenated and deoxygenated haemoglobin concentration changes during apneic events in sleep from the forehead of one subject using NIRS and used principal component analysis to extract extracerebral and cortical haemodynamic changes from NIRS signals. Comparison of NIRS signals with EEG, bioimpedance, and pulse oximetry data suggests that termination of apnea leads to decreases in cerebral blood volume and flow that may be related to neurological arousal via neurovascular coupling.

Decreasing patient identification band errors by standardizing processes.

Science.gov (United States)

Walley, Susan Chu; Berger, Stephanie; Harris, Yolanda; Gallizzi, Gina; Hayes, Leslie

2013-04-01

Patient identification (ID) bands are an essential component in patient ID. Quality improvement methodology has been applied as a model to reduce ID band errors although previous studies have not addressed standardization of ID bands. Our specific aim was to decrease ID band errors by 50% in a 12-month period. The Six Sigma DMAIC (define, measure, analyze, improve, and control) quality improvement model was the framework for this study. ID bands at a tertiary care pediatric hospital were audited from January 2011 to January 2012 with continued audits to June 2012 to confirm the new process was in control. After analysis, the major improvement strategy implemented was standardization of styles of ID bands and labels. Additional interventions included educational initiatives regarding the new ID band processes and disseminating institutional and nursing unit data. A total of 4556 ID bands were audited with a preimprovement ID band error average rate of 9.2%. Significant variation in the ID band process was observed, including styles of ID bands. Interventions were focused on standardization of the ID band and labels. The ID band error rate improved to 5.2% in 9 months (95% confidence interval: 2.5-5.5; P error rates. This decrease in ID band error rates was maintained over the subsequent 8 months.

Decreased bone mineral density in experimental myasthenia gravis in C57BL/6 mice.

Science.gov (United States)

Oshima, Minako; Iida-Klein, Akiko; Maruta, Takahiro; Deitiker, Philip R; Atassi, M Zouhair

2017-09-01

Experimental autoimmune myasthenia gravis (EAMG), an animal model of myasthenia gravis (MG), can be induced in C57BL/6 (B6, H-2  b ) mice by 2-3 injections with Torpedo californica AChR (tAChR) in complete Freund's adjuvant. Some EAMG mice exhibit weight loss with muscle weakness. The loss in body weight, which is closely associated with bone structure, is particularly evident in EAMG mice with severe muscle weakness. However, the relationship between muscle weakness and bone loss in EAMG has not been studied before. Recent investigations on bone have shed light on association of bone health and immunological states. It is possible that muscle weakness in EAMG developed by anti-tAChR immune responses might accompany bone loss. We determined whether reduced muscle strength associates with decreased bone mineral density (BMD) in EAMG mice. EAMG was induced by two injections at 4-week interval of tAChR and adjuvants in two different age groups. The first tAChR injection was either at age 8 weeks or at 15 weeks. We measured BMD at three skeletal sites, including femur, tibia, and lumbar vertebrae, using dual energy X-ray absorptiometry. Among these bone areas, femur of EAMG mice in both age groups showed a significant decrease in BMD compared to control adjuvant-injected and to non-immunized mice. Reduction in BMD in induced EAMG at a later-age appears to parallel the severity of the disease. The results indicate that anti-tAChR autoimmune response alone can reduce bone density in EAMG mice. BMD reduction was also observed in adjuvant-injected mice in comparison to normal un-injected mice, suggesting that BMD decrease can occur even when muscle activity is normal. Decreased BMD observed in both tAChR-injected and adjuvant-injected mice groups were discussed in relation to innate immunity and bone-related immunology involving activated T cells and tumour necrosis factor-related cytokines that trigger osteoclastogenesis and bone loss.

Legal action against health claims on foods and beverages marketed to youth.

Science.gov (United States)

Rutkow, Lainie; Vernick, Jon S; Edwards, Danielle M; Rodman, Sarah O; Barry, Colleen L

2015-03-01

The prevalence of obesity among US children raises numerous health concerns. One pathway to reduce childhood obesity is by decreasing energy intake through the ingestion of fewer calories. Yet, food and beverage manufacturers often promote energy-dense items for children via varied health claims. Deceptive health claims are prohibited, and may be addressed through litigation or governmental regulatory efforts. While the amount of legal action against these potentially deceptive claims has increased, no comprehensive assessment has been conducted. This article, which analyzes litigation and governmental regulatory activities, considers key factors that may influence decisions to take legal action against potentially deceptive health claims on foods and beverages, including scientific support, forum selection, selection of plaintiffs, and potential public health impact.

Have investments in on-reserve health services and initiatives promoting community control improved First Nations' health in Manitoba?

Science.gov (United States)

Lavoie, Josée Gabrielle; Forget, Evelyn L; Prakash, Tara; Dahl, Matt; Martens, Patricia; O'Neil, John D

2010-08-01

The objective of this study was to document the relationship between First Nation's community characteristics and the rates of hospitalization for Ambulatory Care Sensitive Conditions (ACSC) in the province of Manitoba, Canada. A population-based time trend analysis of selected ACSC was conducted using the de-identified administrative data housed at the Manitoba Centre for Health Policy, including vital statistics and health information. The study population included all Manitoba residents eligible under the universal Manitoba Health Services Insurance Plan and living on First Nation reserves between 1984/85 and 2004/05. Twenty-nine ACSC defined using 3, 4 and 5 digit ICD-9-CM and ICD-10-CM codes permitted cross-sectional and longitudinal comparison of hospitalization rates. The analysis used Generalized Estimated Equation (GEE) modeling. Two variables were significant in our model: level of access to primary health care on-reserve; and level of local autonomy. Communities with local access to a broader complement of primary health care services showed a lower rate of hospitalization for ACSC. We also examined whether there was a significant trend in the rates of hospitalization for ACSC over time following the signature of an agreement increasing local autonomy over resource allocation. We found the rates of hospitalization for ACSC decreased with each year following the signature of such an agreement. This article demonstrates that communities with better local access to primary health care consistently show lower rates of ACSC. Secondly, the longer community health services have been under community control, the lower its ACSC rate. (c) 2010 Elsevier Ltd. All rights reserved.

Decreasing mortality and changes in treatment patterns in patients with acromegaly from a nationwide study.

Science.gov (United States)

Esposito, Daniela; Ragnarsson, Oskar; Granfeldt, Daniel; Marlow, Tom; Johannsson, Gudmundur; Olsson, Daniel S

2018-05-01

New therapeutic strategies have developed for the management of acromegaly over recent decades. Whether this has improved mortality has not been fully elucidated. The primary aim was to investigate mortality in a nationwide unselected cohort of patients with acromegaly. Secondary analyses included time trends in mortality and treatment patterns. A total of 1089 patients with acromegaly were identified in Swedish National Health Registries between 1987 and 2013. To analyse time trends, the cohort was divided into three periods (1987-1995, 1996-2004 and 2005-2013) based on the year of diagnosis. Using the Swedish population as reference, standardized mortality ratios (SMRs) were calculated with 95% confidence intervals (CIs). Overall SMR was 2.79 (95% CI: 2.43-3.15) with 232 observed and 83 expected deaths. Mortality was mainly related to circulatory diseases (SMR: 2.95, 95% CI: 2.35-3.55), including ischemic heart disease (2.00, 1.35-2.66) and cerebrovascular disease (3.99, 2.42-5.55) and malignancy (1.76, 1.27-2.26). Mortality decreased over time, with an SMR of 3.45 (2.87-4.02) and 1.86 (1.04-2.67) during the first and last time period, respectively ( P  = .015). During the same time periods, the frequency of pituitary surgery increased from 58% to 72% ( P  acromegaly, mainly related to circulatory and malignant diseases. Although still high, mortality significantly declined over time. This could be explained by the more frequent use of pituitary surgery, decreased prevalence of hypopituitarism and the availability of new medical treatment options. © 2018 European Society of Endocrinology.

Reliability assessments in qualitative health promotion research.

Science.gov (United States)

Cook, Kay E

2012-03-01

This article contributes to the debate about the use of reliability assessments in qualitative research in general, and health promotion research in particular. In this article, I examine the use of reliability assessments in qualitative health promotion research in response to health promotion researchers' commonly held misconception that reliability assessments improve the rigor of qualitative research. All qualitative articles published in the journal Health Promotion International from 2003 to 2009 employing reliability assessments were examined. In total, 31.3% (20/64) articles employed some form of reliability assessment. The use of reliability assessments increased over the study period, ranging from qualitative articles decreased. The articles were then classified into four types of reliability assessments, including the verification of thematic codes, the use of inter-rater reliability statistics, congruence in team coding and congruence in coding across sites. The merits of each type were discussed, with the subsequent discussion focusing on the deductive nature of reliable thematic coding, the limited depth of immediately verifiable data and the usefulness of such studies to health promotion and the advancement of the qualitative paradigm.

[Cuts, austerity and health. SESPAS report 2014].

Science.gov (United States)

Segura Benedicto, Andreu

2014-06-01

Since 2009, the economic recession has led to cuts in spending on social welfare policy and in health care. The most important risks to health depend on negative changes in social determinants. Notable among these determinants are unemployment and the large proportion of people at risk of poverty, which affects 30% of children younger than 14 years. Social inequalities have increased significantly, much more than health inequalities, probably because the value of retirement pensions has been maintained until now. Most of the population is fairly satisfied with the public health system, although it is under considerable pressure. Mortality statistics have not been affected so far, but there has been an increase in mood disorders and mental health problems. Health services utilization has decreased and the number of publicly prescribed drugs has fallen dramatically. This restriction accounts for much of the decrease in public spending on health, since the hospital care budget has not decreased, despite the fall in primary care and public health spending. The crisis could encourage community health and the inclusion of health in all policies. It is the responsibility of professionals and public health institutions monitoring the trend in health problems and their determinants to avoid irreversible situations as far as possible. Copyright © 2013 SESPAS. Published by Elsevier Espana. All rights reserved.

The 21st Century Cures Act Implications for the Reduction of Racial Health Disparities in the US Criminal Justice System: a Public Health Approach.

Science.gov (United States)

Cole, Donna M; Thomas, Dawna Marie; Field, Kelsi; Wool, Amelia; Lipiner, Taryn; Massenberg, Natalie; Guthrie, Barbara J

2017-11-09

Past drug epidemics have disproportionately criminalized drug addiction among African Americans, leading to disparate health outcomes, increased rates of HIV/AIDS, and mass incarceration. Conversely, the current opioid addiction crisis in the USA focuses primarily on white communities and is being addressed as a public health problem. The 21st Century Cures Act has the potential to reduce racial health disparities in the criminal justice system through the Act's public health approach to addiction and mental health issues. The 21st Century Cures Act is a progressive step in the right direction; however, given the historical context of segregation and the criminalization of drug addiction among African Americans, the goals of health equity are at risk of being compromised. This paper discusses the implications of this landmark legislation and its potential to decrease racial health disparities, highlighting the importance of ensuring that access to treatment and alternatives to incarceration must include communities of color. In this paper, the authors explain the key components of the 21st Century Cures Act that are specific to criminal justice reform, including a key objective, which is treatment over incarceration. We suggest that without proper attention to how, and where, funding mechanisms are distributed, the 21st Century Cures Act has the potential to increase racial health disparities rather than alleviate them.

Healthy lifestyle and decreasing risk of heart failure in women: the Women's Health Initiative observational study.

Science.gov (United States)

Agha, Golareh; Loucks, Eric B; Tinker, Lesley F; Waring, Molly E; Michaud, Dominique S; Foraker, Randi E; Li, Wenjun; Martin, Lisa W; Greenland, Philip; Manson, JoAnn E; Eaton, Charles B

2014-10-28

The impact of a healthy lifestyle on risk of heart failure (HF) is not well known. The objectives of this study were to evaluate the effect of a combination of lifestyle factors on incident HF and to further investigate whether weighting each lifestyle factor has additional impact. Participants were 84,537 post-menopausal women from the WHI (Women's Health Initiative) observational study, free of self-reported HF at baseline. A healthy lifestyle score (HL score) was created wherein women received 1 point for each healthy criterion met: high-scoring Alternative Healthy Eating Index, physically active, healthy body mass index, and currently not smoking. A weighted score (wHL score) was also created in which each lifestyle factor was weighted according to its independent magnitude of effect on HF. The incidence of hospitalized HF was determined by trained adjudicators using standardized methodology. There were 1,826 HF cases over a mean follow-up of 11 years. HL score was strongly associated with risk of HF (multivariable-adjusted hazard ratio [HR] [95% confidence interval (CI)] 0.49 [95% CI: 0.38 to 0.62], 0.36 [95% CI: 0.28 to 0.46], 0.24 [95% CI: 0.19 to 0.31], and 0.23 [95% CI: 0.17 to 0.30] for HL score of 1, 2, 3, and 4 vs. 0, respectively). The HL score and wHL score were similarly associated with HF risk (HR: 0.46 [95% CI: 0.41 to 0.52] for HL score; HR: 0.48 [95% CI: 0.42 to 0.55] for wHL score, comparing the highest tertile to the lowest). The HL score was also strongly associated with HF risk among women without antecedent coronary heart disease, diabetes, or hypertension. An increasingly healthy lifestyle was associated with decreasing HF risk among post-menopausal women, even in the absence of antecedent coronary heart disease, hypertension, and diabetes. Weighting the lifestyle factors had minimal impact. Copyright © 2014 American College of Cardiology Foundation. Published by Elsevier Inc. All rights reserved.

Correlates and geographic patterns of knowledge that physical activity decreases cancer risk.

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Ramírez, A Susana; Finney Rutten, Lila J; Vanderpool, Robin C; Moser, Richard P; Hesse, Bradford W

2013-04-01

While many lifestyle-related cancer risk factors including tobacco use, poor diet, and sun exposure are well recognized by the general public, the role of physical activity in decreasing cancer risk is less recognized. Studies have demonstrated gender-, race/ethnicity-, and age-based disparities in cancer risk factor knowledge; however, beliefs and geographic factors that may be related to knowledge are under-examined. In this study, we analyzed data from the 2008 Health Information National Trends Survey to determine correlates of knowledge of the relationship between physical activity and reduced cancer risk in the adult US population. We generated geographic information system maps to examine the geographic distribution of this knowledge. Results revealed that there is confusion among US adults about the relationship between physical activity and cancer risk: Respondents who believed that cancer is not preventable had significantly lower odds of knowing that physical activity reduces cancer risk (p physical activity reduces cancer risk (p physical activity guidelines were also significantly more likely to know that physical activity reduces cancer risk (p physical inactivity. Correlates of cancer risk factor knowledge point to opportunities for targeted interventions.

The Role of Vitamin D Supplements in Women's Health

Directory of Open Access Journals (Sweden)

Tiffany M. Bohon

2013-01-01

Full Text Available Vitamin D is pivotal to the absorption of calcium and maximizing bone health. Women suffer great morbidity and mortality related to osteoporosis and fractures, which may be decreased by interventions such as vitamin D. In addition, extraskeletal benefits of vitamin D have been postulated including positive effects on cancer. Both the classical and nonclassical functions of vitamin D will be discussed here, with a focus on women.

A Community-Based Obesity Prevention Program Decreased the Body Mass Index of University-Affiliated Participants

Directory of Open Access Journals (Sweden)

Michelle L. Lee

2015-10-01

Full Text Available Obesity is a national health concern and the focus of many health promotion programs. The purpose of this study was to evaluate the behavioral impact of a 12-week obesity prevention program on a university campus. Participants were provided questionnaires with weights, heights, and body mass indices (BMIs determined at the pre-phase weigh-in and post-phase weigh-out. At the weigh-in, participants received pedometers and information about upcoming educational sessions to assist them with reaching their health behavior goals. A total of 247 (38.2% of 646 individuals (79.4% women completed the program. A mean weight loss of 1.8 kg caused a decrease in BMI from 29.3 at weigh-in to 28.7 at weigh-out (p = .002. Pre- and post-questionnaires indicated increases (p < 0.001 in physical activity; using pedometers; and intakes of fruits, vegetables, and water at the end of the program. The 6-month follow-up questionnaire (33.2% response rate indicated healthy habits were being maintained for fruit and vegetable consumption. Further intervention development to incorporate innovative strategies for promoting healthy behaviors among students and employees on university campuses could help decrease the prevalence of obesity.

The impact of shift and night work on health related quality of life of working women: findings from the Korea Health Panel.

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Kim, Woorim; Kim, Tae Hyun; Lee, Tae-Hoon; Choi, Jae Woo; Park, Eun-Cheol

2016-11-28

Night and shift work status has been associated with health related quality of life (HRQoL) in economically active women. This study aimed to investigate the association between night or shift work status and HRQoL of economically active women and to further analyze how marital status interplays in the objected relationship. Data were from the Korea Health Panel, 2011 to 2013. A total of 2238 working women were included for analysis. Work status was categorized into day work, night work, and rotating shift work and its association with HRQoL, measured using the EuroQol-5D (EQ-5D) index, was investigated using the generalized estimating equation (GEE) model. Compared to the day work reference group, the night work group (β: -0.9757, P = 0.0202) and the rotating shift work group (β: -0.7947, P = 0.0363) showed decreases in EQ-5D scores. This trend was maintained regardless of marital status, although decreases in health related quality of life were particularly pronounced among night shift workers with a spouse. Night and rotating shift work status was associated with HRQoL of economically active women as individuals working night and rotating shifts showed decreases in EQ-5D scores compared to individuals working day shifts. The findings of this study signify the importance of monitoring the HRQoL status of women working night and rotating shifts as these individuals may be comparatively vulnerable to reduced HRQoL.

Applying sensory modulation to mental health inpatient care to reduce seclusion and restraint

DEFF Research Database (Denmark)

Andersen, Charlotte; Kolmos, Anne; Andersen, Kjeld

2017-01-01

that is associated with reduced rates of seclusion and restraint in mental healthcare, but there is need for more research in this area. AIMS: Using SM to reduce restraint and seclusion in inpatient mental health care. METHODS: The study included two similar psychiatric units where one unit implemented SM and one...... unit served as the control group. In the very beginning of the study, a staff-training program in the use of SM including assessment tools and intervention strategies was established. Data on restraint and forced medicine were sampled post the course of the year of implementation and compared...... with the control group. RESULTS: The use of belts decreased with 38% compared to the control group. The use of forced medication decreased with 46% compared to the control group. Altogether the use of physical restraint and forced medication decreased significantly with 42% (p 

Decreased prefrontal cortical dopamine transmission in alcoholism.

Science.gov (United States)

Narendran, Rajesh; Mason, Neale Scott; Paris, Jennifer; Himes, Michael L; Douaihy, Antoine B; Frankle, W Gordon

2014-08-01

Basic studies have demonstrated that optimal levels of prefrontal cortical dopamine are critical to various executive functions such as working memory, attention, inhibitory control, and risk/reward decisions, all of which are impaired in addictive disorders such as alcoholism. Based on this and imaging studies of alcoholism that have demonstrated less dopamine in the striatum, the authors hypothesized decreased dopamine transmission in the prefrontal cortex in persons with alcohol dependence. To test this hypothesis, amphetamine and [11C]FLB 457 positron emission tomography were used to measure cortical dopamine transmission in 21 recently abstinent persons with alcohol dependence and 21 matched healthy comparison subjects. [11C]FLB 457 binding potential, specific compared to nondisplaceable uptake (BPND), was measured in subjects with kinetic analysis using the arterial input function both before and after 0.5 mg kg-1 of d-amphetamine. Amphetamine-induced displacement of [11C]FLB 457 binding potential (ΔBPND) was significantly smaller in the cortical regions in the alcohol-dependent group compared with the healthy comparison group. Cortical regions that demonstrated lower dopamine transmission in the alcohol-dependent group included the dorsolateral prefrontal cortex, medial prefrontal cortex, orbital frontal cortex, temporal cortex, and medial temporal lobe. The results of this study, for the first time, unambiguously demonstrate decreased dopamine transmission in the cortex in alcoholism. Further research is necessary to understand the clinical relevance of decreased cortical dopamine as to whether it is related to impaired executive function, relapse, and outcome in alcoholism.

Designing serious video games for health behavior change: current status and future directions.

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Thompson, Debbe

2012-07-01

Serious video games for health are designed to entertain while changing a specific health behavior. This article identifies behavioral principles that can guide the development of serious video games focused on changing a variety of health behaviors, including those attempting to decrease risk of obesity and type 2 diabetes. Guidelines discussed include how to develop video games that provide a solid foundation for behavior change by enhancing a player's knowledge and skill, ways in which personal mastery experiences can be incorporated into a video game environment, using game characters and avatars to promote observational learning, creating personalized experiences through tailoring, and the importance of achieving a balance between "fun-ness" and "seriousness." The article concludes with suggestions for future research needed to inform this rapidly growing field. © 2012 Diabetes Technology Society.

Extending FDA guidance to include consumer medication information (CMI) delivery on mobile devices.

Science.gov (United States)

Sage, Adam; Blalock, Susan J; Carpenter, Delesha

This paper describes the current state of consumer-focused mobile health application use and the current U.S. Food and Drug Administration (FDA) guidance on the distribution of consumer medication information (CMI), and discusses recommendations and considerations for the FDA to expand CMI guidance to include CMI in mobile applications. Smartphone-based health interventions have been linked to increased medication adherence and improved health outcomes. Trends in smartphone ownership present opportunities to more effectively communicate and disseminate medication information; however, current FDA guidance for CMI does not outline how to effectively communicate CMI on a mobile platform, particularly in regards to user-centered design and information sourcing. As evidence supporting the potential effectiveness of mobile communication in health care continues to increase, CMI developers, regulating entities, and researchers should take note. Although mobile-based CMI offers an innovative mechanism to deliver medication information, caution should be exercised. Specifically, considerations for developing mobile CMI include consumers' digital literacy, user experience (e.g., usability), and the quality and accuracy of new widely used sources of information (e.g., crowd-sourced reviews and ratings). Recommended changes to FDA guidance for CMI include altering the language about scientific accuracy to address more novel methods of information gathering (e.g., anecdotal experiences and Google Consumer Surveys) and including guidance for usability testing of mobile health applications. Copyright © 2016 Elsevier Inc. All rights reserved.

The influence of health care policies and health care system distrust on willingness to undergo genetic testing.

Science.gov (United States)

Armstrong, Katrina; Putt, Mary; Halbert, Chanita Hughes; Grande, David; Schwartz, Jerome Sanford; Liao, Kaijun; Marcus, Noora; Demeter, Mirar Bristol; Shea, Judy

2012-05-01

As the potential role of genetic testing in disease prevention and management grows, so does concern about differences in uptake of genetic testing across social and racial groups. Characteristics of how genetic tests are delivered may influence willingness to undergo testing and, if they affect population subgroups differently, alter disparities in testing. Conjoint analysis study of the effect of 3 characteristics of genetic test delivery (ie, attributes) on willingness to undergo genetic testing for cancer risk. Data were collected using a random digit dialing survey of 128 African American and 209 white individuals living in the United States. Measures included conjoint scenarios, the Revised Health Care System Distrust Scale (including the values and competence subscales), health insurance coverage, and sociodemographic characteristics. The 3 attributes studied were disclosure of test results to the health insurer, provision of the test by a specialist or primary care doctor, and race-specific or race-neutral marketing. In adjusted analyses, disclosure of test results to insurers, having to get the test from a specialist, and race-specific marketing were all inversely associated with willingness to undergo the genetic test, with the greatest effect for the disclosure attribute. Racial differences in willingness to undergo testing were not statistically significant (P=0.07) and the effect of the attributes on willingness to undergo testing did not vary by patient race. However, the decrease in willingness to undergo testing with insurance disclosure was greater among individuals with high values distrust (P=0.03), and the decrease in willingness to undergo testing from specialist access was smaller among individuals with high competence distrust (P=0.03). Several potentially modifiable characteristics of how genetic tests are delivered are associated with willingness to undergo testing. The effect of 2 of these characteristics vary according to the level of

Including a Client Sexual Health Pathway in a National Youth Mental Health Early Intervention Service--Project Rationale and Implementation Strategy

Science.gov (United States)

Edwards, C. A.; Britton, M. L.; Jenkins, L.; Rickwood, D. J.; Gillham, K. E.

2014-01-01

Young people have higher rates of sexually transmissible infections (STIs) than the general population. Research has shown that there is a clear link between emotional distress, depression, substance abuse and sexual risk taking behaviours in young people. "headspace" is a youth mental health early intervention service operating in more…

Projections of increased and decreased dengue incidence under climate change.

Science.gov (United States)

Williams, C R; Mincham, G; Faddy, H; Viennet, E; Ritchie, S A; Harley, D

2016-10-01

Dengue is the world's most prevalent mosquito-borne disease, with more than 200 million people each year becoming infected. We used a mechanistic virus transmission model to determine whether climate warming would change dengue transmission in Australia. Using two climate models each with two carbon emission scenarios, we calculated future dengue epidemic potential for the period 2046-2064. Using the ECHAM5 model, decreased dengue transmission was predicted under the A2 carbon emission scenario, whereas some increases are likely under the B1 scenario. Dengue epidemic potential may decrease under climate warming due to mosquito breeding sites becoming drier and mosquito survivorship declining. These results contradict most previous studies that use correlative models to show increased dengue transmission under climate warming. Dengue epidemiology is determined by a complex interplay between climatic, human host, and pathogen factors. It is therefore naive to assume a simple relationship between climate and incidence, and incorrect to state that climate warming will uniformly increase dengue transmission, although in general the health impacts of climate change will be negative.

Health-related quality of life and self-related health in patients with type 2 diabetes: effects of group-based rehabilitation versus individual counselling.

Science.gov (United States)

Vadstrup, Eva S; Frølich, Anne; Perrild, Hans; Borg, Eva; Røder, Michael

2011-12-07

Type 2 diabetes can seriously affect patients' health-related quality of life and their self-rated health. Most often, evaluation of diabetes interventions assess effects on glycemic control with little consideration of quality of life. The aim of the current study was to study the effectiveness of group-based rehabilitation versus individual counselling on health-related quality of life (HRQOL) and self-rated health in type 2 diabetes patients. We randomised 143 type 2 diabetes patients to either a six-month multidisciplinary group-based rehabilitation programme including patient education, supervised exercise and a cooking-course or a six-month individual counselling programme. HRQOL was measured by Medical Outcomes Study Short Form 36-item Health Survey (SF-36) and self-rated health was measured by Diabetes Symptom Checklist - Revised (DCS-R). In both groups, the lowest estimated mean scores of the SF36 questionnaire at baseline were "vitality" and "general health". There were no significant differences in the change of any item between the two groups after the six-month intervention period. However, vitality-score increased 5.2 points (p = 0.12) within the rehabilitation group and 5.6 points (p = 0.03) points among individual counselling participants.In both groups, the highest estimated mean scores of the DSC-R questionnaire at baseline were "Fatigue" and "Hyperglycaemia". Hyperglycaemic and hypoglycaemic distress decreased significantly after individual counselling than after group-based rehabilitation (difference -0.3 points, p = 0.04). No between-group differences occurred for any other items. However, fatigue distress decreased 0.40 points within the rehabilitation group (p = 0.01) and 0.34 points within the individual counselling group (p group cardiovascular distress decreased 0.25 points (p = 0.01). A group-based rehabilitation programme did not improve health-related quality of life and self-rated health more than an individual counselling programme

Restriction on an energy-dense diet improves markers of metabolic health and cellular aging in mice through decreasing hepatic mTOR activity.

Science.gov (United States)

Schloesser, Anke; Campbell, Graeme; Glüer, Claus-Christian; Rimbach, Gerald; Huebbe, Patricia

2015-02-01

Dietary restriction (DR) on a normal low-fat diet improves metabolic health and may prolong life span. However, it is still uncertain whether restriction of an energy-dense, high-fat diet would also be beneficial and mitigate age-related processes. In the present study, we determined biomarkers of metabolic health, energy metabolism, and cellular aging in obesity-prone mice subjected to 30% DR on a high-fat diet for 6 months. Dietary-restricted mice had significantly lower body weights, less adipose tissue, lower energy expenditure, and altered substrate oxidation compared to their ad libitum-fed counterparts. Hepatic major urinary proteins (Mup) expression, which is linked to glucose and energy metabolism, and biomarkers of metabolic health, including insulin, glucose, cholesterol, and leptin/adiponectin ratio, were likewise reduced in high-fat, dietary-restricted mice. Hallmarks of cellular senescence such as Lamp2a and Hsc70 that mediate chaperone-mediated autophagy were induced and mechanistic target of rapamycin (mTOR) signaling mitigated upon high-fat DR. In contrast to DR applied in low-fat diets, anti-oxidant gene expression, proteasome activity, as well as 5'-adenosine monophosphate-activated protein kinase (AMPK) activation were not changed, suggesting that high-fat DR may attenuate some processes associated with cellular aging without the induction of cellular stress response or energy deprivation.

Race/Ethnicity and Health-Related Quality of Life Among LGBT Older Adults

Science.gov (United States)

Kim, Hyun-Jun; Jen, Sarah; Fredriksen-Goldsen, Karen I.

2017-01-01

Purpose of the Study: Few existing studies have addressed racial/ethnic differences in the health and quality of life of lesbian, gay, bisexual, and transgender (LGBT) older adults. Guided by the Health Equity Promotion Model, this study examines health-promoting and health risk factors that contribute to racial/ethnic health disparities among LGBT adults aged 50 and older. Design and Methods: We utilized weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. By applying multiple mediator models, we analyzed the indirect effects of race/ethnicity on health-related quality of life (HRQOL) via demographics, lifetime LGBT-related discrimination, and victimization, and socioeconomic, identity-related, spiritual, and social resources. Results: Although African Americans and Hispanics, compared with non-Hispanic Whites, reported lower physical HRQOL and comparable psychological HRQOL, indirect pathways between race/ethnicity and HRQOL were observed. African Americans and Hispanics had lower income, educational attainment, identity affirmation, and social support, which were associated with a decrease in physical and psychological HRQOL. African Americans had higher lifetime LGBT-related discrimination, which was linked to a decrease in their physical and psychological HRQOL. African Americans and Hispanics had higher spirituality, which was associated with an increase in psychological HRQOL. Implications: Findings illustrate the importance of identifying both health-promoting and health risk factors to understand ways to maximize the health potential of racially and ethnically diverse LGBT older adults. Interventions aimed at health equity should be tailored to bolster identity affirmation and social networks of LGBT older adults of color and to support strengths, including spiritual resources. PMID:28087793

eHealth adoption factors in medical hospitals: A focus on the Netherlands.

Science.gov (United States)

Faber, Sander; van Geenhuizen, Marina; de Reuver, Mark

2017-04-01

Despite strong policy interest in eHealth, actual adoption in many European hospitals is low. This study develops and tests in a preliminary way an organisational eHealth adoption model rooted in several adoption frameworks to improve understanding of this phenomenon. The model is explored through a survey among hospitals in the Netherlands using a Structural Equation Modelling (SEM) approach. Specific attention is paid to measurement of organisational readiness and to adoption as a process including different stages. Our results suggest a sharp decrease in the adoption process by hospitals after the stage of interest/commitment. Adoption tends to be significantly affected by size of the hospital, organisational readiness including technical aspects, and top management support. eHealth adoption tends to be not a linear process nor a linear function of contextual antecedents. Organisational readiness is an important antecedent for eHealth adoption. The paper concludes with organisational strategies and policies to foster eHealth adoption in hospitals and suggestions for future study. Copyright © 2017 Elsevier B.V. All rights reserved.

Are health nudges coercive?

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Quigley, Muireann

2014-01-01

Governments and policy-makers have of late displayed renewed attention to behavioural research in an attempt to achieve a range of policy goals, including health promotion. In particular, approaches which could be labelled as 'nudges' have gained traction with policy-makers. A range of objections to nudging have been raised in the literature. These include claims that nudges undermine autonomy and liberty, may lead to a decrease in responsibility in decision-making, lack transparency, involve deception, and involve manipulation, potentially occasioning coercion. In this article I focus on claims of coercion, examining nudges within two of the main approaches to coercion-the pressure approach and the more recent enforcement approach. I argue that coercion entails an element of control over the behaviour of agents which is not plausibly displayed by the kinds of serious examples of nudges posited in the literature.

Decreasing Serial Cost Sharing

DEFF Research Database (Denmark)

Hougaard, Jens Leth; Østerdal, Lars Peter

The increasing serial cost sharing rule of Moulin and Shenker [Econometrica 60 (1992) 1009] and the decreasing serial rule of de Frutos [Journal of Economic Theory 79 (1998) 245] have attracted attention due to their intuitive appeal and striking incentive properties. An axiomatic characterization...... of the increasing serial rule was provided by Moulin and Shenker [Journal of Economic Theory 64 (1994) 178]. This paper gives an axiomatic characterization of the decreasing serial rule...

Decreasing serial cost sharing

DEFF Research Database (Denmark)

Hougaard, Jens Leth; Østerdal, Lars Peter Raahave

2009-01-01

The increasing serial cost sharing rule of Moulin and Shenker (Econometrica 60:1009-1037, 1992) and the decreasing serial rule of de Frutos (J Econ Theory 79:245-275, 1998) are known by their intuitive appeal and striking incentive properties. An axiomatic characterization of the increasing serial...... rule was provided by Moulin and Shenker (J Econ Theory 64:178-201, 1994). This paper gives an axiomatic characterization of the decreasing serial rule....

Background, design and conceptual model of the cluster randomized multiple-component workplace study: FRamed Intervention to Decrease Occupational Muscle pain - "FRIDOM"

Directory of Open Access Journals (Sweden)

Jeanette Reffstrup Christensen

2016-10-01

Full Text Available Abstract Background Several RCT studies have aimed to reduce either musculoskeletal disorders, sickness presenteeism, sickness absenteeism or a combination of these among females with high physical work demands. These studies have provided evidence that workplace health promotion (WHP interventions are effective, but long-term effects are still uncertain. These studies either lack to succeed in maintaining intervention effects or lack to document if effects are maintained past a one-year period. This paper describes the background, design and conceptual model of the FRIDOM (FRamed Intervention to Decrease Occupational Muscle pain WHP program among health care workers. A job group characterized by having high physical work demands, musculoskeletal disorders, high sickness presenteeism - and absenteeism. Methods FRIDOM aimed to reduce neck and shoulder pain. Secondary aims were to decrease sickness presenteeism, sickness absenteeism and lifestyle-diseases such as other musculoskeletal disorders as well as metabolic-, and cardiovascular disorders – and to maintain participation to regular physical exercise training, after a one year intervention period. The entire concept was tailored to a population of female health care workers. This was done through a multi-component intervention including 1 intelligent physical exercise training (IPET, dietary advice and weight loss (DAW and cognitive behavioural training (CBT. Discussion The FRIDOM program has the potential to provide evidence-based knowledge of the pain reducing effect of a multi component WHP among a female group of employees with a high prevalence of musculoskeletal disorders and in a long term perspective evaluate the effects on sickness presenteeism and absenteeism as well as risk of life-style diseases. Trial registration NCT02843269 , 06.27.2016 - retrospectively registered.

Accredited Health Department Partnerships to Improve Health: An Analysis of Community Health Assessments and Improvement Plans.

Science.gov (United States)

Kronstadt, Jessica; Chime, Chinecherem; Bhattacharya, Bulbul; Pettenati, Nicole

The Public Health Accreditation Board (PHAB) Standards & Measures require the development and updating of collaborative community health assessments (CHAs) and community health improvement plans (CHIPs). The goal of this study was to analyze the CHAs and CHIPs of PHAB-accredited health departments to identify the types of partners engaged, as well as the objectives selected to measure progress toward improving community health. The study team extracted and coded data from documents from 158 CHA/CHIP processes submitted as part of the accreditation process. Extracted data included population size, health department type, data sources, and types of partner organizations. Health outcome objectives were categorized by Healthy People 2020 Leading Health Indicator (LHI), as well as by the 7 broad areas in the PHAB reaccreditation framework for population health outcomes reporting. Participants included health departments accredited between 2013 and 2016 that submitted CHAs and CHIPs to PHAB, including 138 CHAs/CHIPs from local health departments and 20 from state health departments. All the CHAs/CHIPs documented collaboration with a broad array of partners, with hospitals and health care cited most frequently (99.0%). Other common partners included nonprofit service organizations, education, business, and faith-based organizations. Small health departments more frequently listed many partner types, including law enforcement and education, compared with large health departments. The majority of documents (88.6%) explicitly reference Healthy People 2020 goals, with most addressing the LHIs nutrition/obesity/physical activity and access to health services. The most common broad areas from PHAB's reaccreditation framework were preventive health care and individual behavior. This study demonstrates the range of partners accredited health departments engage with to collaborate on improving their communities' health as well as the objectives used to measure community health

Vinegar decreases allergenic response in lentil and egg food allergy.

Science.gov (United States)

Armentia, A; Dueñas-Laita, A; Pineda, F; Herrero, M; Martín, B

2010-01-01

Food allergy results from an atypical response of the mucosal immune system to orally consumed allergens. Antacid medication inhibits the digestion of dietary proteins and causes food allergy. A decrease of the gastric pH might enhance the function of digestion and reduce the risk of food allergy. To test a possible decrease in the allergenicity of powerful food allergens (egg, chicken, lentils) with the addition of vinegar during the cooking process. We included seven patients who suffered from anaphylaxis due to egg, chicken and lentils. We added vinegar to egg, chicken and lentil processed extracts used for skin prick tests (SPT) and compared the wheal areas obtained with the same extracts sources and the same way but without vinegar addition. Immunodetection was performed with the different processed extracts and patients' sera. Only one patient consented food challenge with vinegar-marinated-chicken. Wheal areas were significantly minor with the food extract with vinegar. Immunodetection showed a decrease of the response with vinegar processed extracts. Vinegar addition during the cooking process may decrease lentil and chicken allergenicity. Copyright 2009 SEICAP. Published by Elsevier Espana. All rights reserved.

Dietary intake of fiber, fruit and vegetables decreases the risk of incident kidney stones in women: A women's health initiative report

OpenAIRE

Sorensen, MD; Hsi, RS; Chi, T; Shara, N; Wactawski-Wende, J; Kahn, AJ; Wang, H; Hou, L; Stoller, ML

2014-01-01

© 2014 American Urological Association Education and Research, Inc. Results Mean age of the women was 64±7 years, 85% were white and 2,937 (3.5%) experienced a kidney stone in a median followup of 8 years. In women with no history of kidney stones higher total dietary fiber (6% to 26% decreased risk, p < 0.001), greater fruit intake (12% to 25% decreased risk, p < 0.001) and greater vegetable intake (9% to 22% decreased risk, p=0.002) were associated with a decreased risk of incident kidney...

Running as Interoceptive Exposure for Decreasing Anxiety Sensitivity: Replication and Extension.

Science.gov (United States)

Sabourin, Brigitte C; Stewart, Sherry H; Watt, Margo C; Krigolson, Olav E

2015-01-01

A brief, group cognitive behavioural therapy with running as the interoceptive exposure (IE; exposure to physiological sensations) component was effective in decreasing anxiety sensitivity (AS; fear of arousal sensations) levels in female undergraduates (Watt et al., Anxiety and Substance Use Disorders: The Vicious Cycle of Comorbidity, 201-219, 2008). Additionally, repeated exposure to running resulted in decreases in cognitive (i.e., catastrophic thoughts) and affective (i.e., feelings of anxiety) reactions to running over time for high AS, but not low AS, participants (Sabourin et al., "Physical exercise as interoceptive exposure within a brief cognitive-behavioral treatment for anxiety-sensitive women", Journal of Cognitive Psychotherapy, 22:302-320, 2008). A follow-up study including the above-mentioned intervention with an expanded IE component also resulted in decreases in AS levels (Sabourin et al., under review). The goals of the present process study were (1) to replicate the original process study, with the expanded IE component, and (2) to determine whether decreases in cognitive, affective, and/or somatic (physiological sensations) reactions to running would be related to decreases in AS. Eighteen high AS and 10 low AS participants completed 20 IE running trials following the 3-day group intervention. As predicted, high AS participants, but not low AS participants, experienced decreases in cognitive, affective, and somatic reactions to running over time. Furthermore, decreases in cognitive and affective, but not in somatic, reactions to running were related to decreases in AS levels. These results suggest that the therapeutic effects of repeated exposure to running in decreasing sensitivity to anxiety-related sensations are not related to decreasing the experience of somatic sensations themselves. Rather, they are related to altering the cognitive and affective reactions to these sensations.

Parental Mediation in the Digital Era: Increasing Children's Critical Thinking May Help Decrease Positive Attitudes toward Alcohol.

Science.gov (United States)

Radanielina Hita, Marie Louise; Kareklas, Ioannis; Pinkleton, Bruce

2018-01-01

We demonstrate in our research that discussion-based parental mediation may successfully decrease the negative effects that youth's engagement with alcohol brands on social media may have on attitudes toward alcohol through its effects on critical thinking. A clear pattern was found with positive mediation leading to unhealthy outcomes and negative mediation predicting healthier behaviors. Youth whose parents critiqued media messages reported more critical thinking skills, which predicted less interaction with alcohol brands on social media and fewer expectancies toward alcohol. On the other hand, youth whose parents endorsed media portrayals of drinking reported fewer critical thinking skills and were thus more likely to interact with alcohol brands on social media. Including a media literacy component in alcohol education that target parental strategies and that are conducive to discussion may lead to beneficial health outcomes in the digital era.

Nature-based experiences and health of cancer survivors.

Science.gov (United States)

Ray, Heather; Jakubec, Sonya L

2014-11-01

Although exposure to, and interaction with, natural environments are recognized as health-promoting, little is understood about the use of nature contact in treatment and rehabilitation for cancer survivors. This narrative review summarizes the literature exploring the influence of nature-based experiences on survivor health. Key databases included CINAHL, EMBASE, Medline, Web of Science, PubMed, PsycArticles, ProQuest, and Cancerlit databases. Sixteen articles met inclusion criteria and were reviewed. Four major categories emerged: 1) Dragon boat racing may enhance breast cancer survivor quality of life, 2) Natural environment may counteract attentional fatigue in newly diagnosed breast cancer survivors, 3) Adventure programs provide a positive experience for children and adolescent survivors, fostering a sense of belonging and self-esteem, and 4) Therapeutic landscapes may decrease state-anxiety, improving survivor health. This review contributes to a better understanding of the therapeutic effects of nature-based experiences on cancer survivor health, providing a point of entry for future study. Copyright © 2014 Elsevier Ltd. All rights reserved.

Accelerated increase and decrease in subjective age as a function of changes in loneliness and objective social indicators over a four-year period: results from the health and retirement study.

Science.gov (United States)

Ayalon, Liat; Palgi, Yuval; Avidor, Sharon; Bodner, Ehud

2016-07-01

The study examined the role of changes in loneliness and objective social indicators in the formation of changes in subjective age over a four-year period. The Health and Retirement Study is a US nationally representative study of older adults over 50 and their spouse of any age. We restricted the sample to individuals, 65 years of age and older (n = 2591). An accelerated increase in subjective age was defined as an increase in subjective age over the two waves greater than five years. An accelerated decrease in subjective age was defined as a difference that was lower than three years. These were examined against a change in subjective age in the range of three to five years (i.e., change consistent with the passage of time). For 23.4% of the sample, changes in subjective age were consistent with the passage of time. A total of 38.3% had an accelerated decrease in subjective age, whereas 38.3% had an accelerated increase. A decrease in loneliness over the two waves resulted in an accelerated decrease in subjective age, whereas an increase in depressive symptoms resulted in an accelerated increase in subjective age. Changes in objective social indicators, physical difficulties or medical comorbidity did not predict changes in subjective age. This is one of very few studies that examined changes in subjective age over time. Changes in subjective age represent an important construct that corresponding to other changes in subjective experiences.

Burnout of Physicians Working in Primary Health Care Centers under Ministry of Health Jeddah, Saudi Arabia.

Science.gov (United States)

Bawakid, Khalid; Abdulrashid, Ola; Mandoura, Najlaa; Shah, Hassan Bin Usman; Ibrahim, Adel; Akkad, Noura Mohammad; Mufti, Fauad

2017-11-25

Introduction The levels of physicians' job satisfaction and burnout directly affect their professionalism, punctuality, absenteeism, and ultimately, patients' care. Despite its crucial importance, little is known about professional burnout of the physicians in Saudi Arabia. The objectives of this research are two-fold: (1) To assess the prevalence of burnout in physicians working in primary health care centers under Ministry of Health; and (2) to find the modifiable factors which can decrease the burnout ratio. Methodology Through a cross-sectional study design, a representative sample of the physicians working in primary health care centers (PHCCs) Jeddah (n=246) was randomly selected. The overall burnout level was assessed using the validated abbreviated Maslach burnout inventory (aMBI) questionnaire. It measures the overall burnout prevalence based on three main domains i.e., emotional exhaustion, depersonalization, and personal accomplishment. Independent sample T-test, analysis of variance (ANOVA), and multivariate regression analysis were performed using Statistical Package for the Social Sciences (SPSS Version 22, IBM, Armonk, NY). Results Overall, moderate to high burnout was prevalent in 25.2% of the physicians. Emotional exhaustion was noted in 69.5%. Multivariate regression analysis showed that patient pressure/violence (p burnout. The patient's pressure/violence was the only significant independent predictor of overall burnout. Conclusion Emotional exhaustion is the most prominent feature of overall burnout in the physicians of primary health care centers. The main reasons include patient's pressure/violence, unorganized patient flow, less cooperative colleague doctors, fewer support services at the PHCCs, more paperwork, and less cooperative colleagues. Addressing these issues could lead to a decrease in physician's burnout.

Wealth inequality and health: a political economy perspective.

Science.gov (United States)

Nowatzki, Nadine R

2012-01-01

Despite a plethora of studies on income inequality and health, researchers have been unable to make any firm conclusions as a result of methodological and theoretical limitations. Within this body of research, there has been a call for studies of wealth inequality and health. Wealth is far more unequally distributed than income and is conceptually unique from income. This paper discusses the results of bivariate cross-sectional analyses of the relationship between wealth inequality (Gini coefficient) and population health (life expectancy and infant mortality) in 14 wealthy countries. The results confirm that wealth inequality is associated with poor population health. Both unweighted and weighted correlations between wealth inequality and health are strong and significant, even after controlling for a variety of potential aggregate-level confounders, including gross domestic product per capita, and after excluding the United States, the most unequal country. The results are strongest for female life expectancy and infant mortality. The author outlines potential pathways through which wealth inequality might affect health, using specific countries to illustrate. The article concludes with policy recommendations that could contribute to a more equitable distribution of wealth and, ultimately, decreased health disparities.

Human resources for health and burden of disease: an econometric approach.

Science.gov (United States)

Castillo-Laborde, Carla

2011-01-26

The effect of health workers on health has been proven to be important for various health outcomes (e.g. mortality, coverage of immunisation or skilled birth attendants). The study aim of this paper is to assess the relationship between health workers and disability-adjusted life years (DALYs), which represents a much broader concept of health outcome, including not only mortality but also morbidity. Cross-country multiple regression analyses were undertaken, with DALYs and DALYs disaggregated according to the three different groups of diseases as the dependent variable. Aggregate health workers and disaggregate physicians, nurses, and midwives were included as independent variables, as well as a variable accounting for the skill mix of professionals. The analysis also considers controlling for the effects of income, income distribution, percentage of rural population with access to improved water source, and health expenditure. This study presents evidence of a statistically negative relationship between the density of health workers (especially physicians) and the DALYs. An increase of one unit in the density of health workers per 1000 will decrease, on average, the total burden of disease between 1% and 3%. However, in line with previous findings in the literature, the density of nurses and midwives could not be said to be statistically associated to DALYs. If countries increase their health worker density, they will be able to reduce significantly their burden of disease, especially the burden associated to communicable diseases. This study represents supporting evidence of the importance of health workers for health.

Using Mental Health Consultation to Decrease Disruptive Behaviors in Preschoolers: Adapting an Empirically-Supported Intervention

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Williford, Amanda P.; Shelton, Terri L.

2008-01-01

Background: This study examined the effectiveness of an adaptation of an empirically-supported intervention delivered using mental health consultation to preschoolers who displayed elevated disruptive behaviors. Method: Ninety-six preschoolers, their teachers, and their primary caregivers participated. Children in the intervention group received…

Conceptualizing ORGANIZATIONAL HEALTH - Public health management and leadership perspectives

DEFF Research Database (Denmark)

Orvik, Arne

The thesis introduces a new conceptual model of organizational health and discusses its implications for public health management and leadership. It is developed with reference to organizational theories and ideologies, including New Public Management, the use of which has coincided with increasing...... as the disintegration of such values. Possible implications for public health management and leadership include four different forms. The application of the conceptual model can potentially draw attention to value conflicts and help to clarify contradictory, institutional logics. It can also potentially support health...... workplace health problems in health care organizations. The model is based on empirical research and theories in the fields of public health, health care organization and management, and institutional theory. It includes five dimensions and defines organizational health in terms of how an organization...

Decreasing Intestinal Parasites in Recent Northern California Refugees

Science.gov (United States)

Chang, Alicia H.; Perry, Sharon; Du, Jenny N. T.; Agunbiade, Abdulkareem; Polesky, Andrea; Parsonnet, Julie

2013-01-01

Beginning in 2005, the Centers for Disease Control and Prevention (CDC) expanded the overseas presumptive treatment of intestinal parasites with albendazole to include refugees from the Middle East. We surveyed the prevalence of helminths and protozoa in recent Middle Eastern refugees (2008–2010) in comparison with refugees from other geographical regions and from a previous survey (2001–2004) in Santa Clara County, California. Based on stool microscopy, helminth infections decreased, particularly in Middle Eastern refugees (0.1% versus 2.3% 2001–2004, P = 0.01). Among all refugees, Giardia intestinalis was the most common protozoan found. Protozoa infections also decreased somewhat in Middle Eastern refugees (7.2%, 2008–2010 versus 12.9%, 2001–2004, P = 0.08). Serology for Strongyloides stercoralis and Schistosoma spp. identified more infected individuals than stool exams. Helminth infections are increasingly rare in refugees to Northern California. Routine screening stool microscopy may be unnecessary in all refugees. PMID:23149583

Associations between poor sleep quality and stages of change of multiple health behaviors among participants of employee wellness program

Directory of Open Access Journals (Sweden)

Siu-kuen Azor Hui

2015-01-01

Conclusions: The present study demonstrated that poor sleep quality was associated with an elevated likelihood of contemplating or initiating behavior change, but a decreased likelihood of maintaining healthy behavior change. It is important to include sleep improvement as one of the lifestyle management interventions offered in EWP to comprehensively reduce health risks and promote the health of a large employee population.

Do health care workforce, population, and service provision significantly contribute to the total health expenditure? An econometric analysis of Serbia.

Science.gov (United States)

Santric-Milicevic, M; Vasic, V; Terzic-Supic, Z

2016-08-15

In times of austerity, the availability of econometric health knowledge assists policy-makers in understanding and balancing health expenditure with health care plans within fiscal constraints. The objective of this study is to explore whether the health workforce supply of the public health care sector, population number, and utilization of inpatient care significantly contribute to total health expenditure. The dependent variable is the total health expenditure (THE) in Serbia from the years 2003 to 2011. The independent variables are the number of health workers employed in the public health care sector, population number, and inpatient care discharges per 100 population. The statistical analyses include the quadratic interpolation method, natural logarithm and differentiation, and multiple linear regression analyses. The level of significance is set at P Total health expenditure increased by 1.21 standard deviations, with an increase in health workforce growth rate by 1 standard deviation. Furthermore, this rate decreased by 1.12 standard deviations, with an increase in (negative) population growth rate by 1 standard deviation. Finally, the growth rate increased by 0.38 standard deviation, with an increase of the growth rate of inpatient care discharges per 100 population by 1 standard deviation (P < 0.001). Study results demonstrate that the government has been making an effort to control strongly health budget growth. Exploring causality relationships between health expenditure and health workforce is important for countries that are trying to consolidate their public health finances and achieve universal health coverage at the same time.

Current stress and poor oral health.

Science.gov (United States)

Vasiliou, A; Shankardass, K; Nisenbaum, R; Quiñonez, C

2016-09-02

Psychological stress appears to contribute to poor oral health systemically in combination with other chronic diseases. Few studies directly examine this relationship. Data from a cross-sectional study of 2,412 participants between the ages of 25-64 years old living in the City of Toronto between 2009 and 2012 were used to examine the relationship between current stress and two self-rated oral health outcomes (general oral health and oral pain). Dental care utilization and access to dental insurance were examined as effect modifiers. A positive relationship between current stress and poor oral health was observed for both outcomes (oral pain coefficient 0.32, 95 % CI 0.26-0.38; general oral health coefficient 0.28, 95 % CI 0.19-0.36). Effects on oral pain were stronger for the uninsured, while effects on general oral health were stronger with decreasing socioeconomic position. Our findings suggest that individuals with greater perceived stress also report poorer oral health, and that this relationship is modified by dental insurance and socioeconomic position. These findings warrant a greater focus on the role of psychological stress in the development of oral disease, including how perceived stress contributes to health inequities in self-reported oral health status. Patients experiencing stressful lives may differentially require closer monitoring and more vigilant maintenance of their oral health, above and beyond that which is needed to achieve a state of health in the oral environment of less stressed individuals. There may be health promoting effects of addressing psychosocial concerns related to dental care - particularly for the poor and uninsured.

Study of Effectiveness of Human Factors Engineering Interference in Cumulative Trauma Disorders Rate Decreasing in the Tehran South Health Center 2005-2006

Directory of Open Access Journals (Sweden)

M. Noorisepehr

2012-04-01

Full Text Available Introduction: Up to now accomplished many investigations about cumulative trauma disorders (CTD accession. For the most part sitting pattern and unsuitable task posture has been specified reason of these complications. In the publicized stats from a foreign source ambit of 44 percent of people who worked with computer has been afflict to the CTD's. The aim of this paper is to find and measurement of CTD and ergonomic intervention and investigation rate of this intervention's effect in the Tehran south health center. This center use paperless system. Methods: In this research Nordic questionnaire distribute between 68 persons of the center to determine CTD's. By technical expert inspection specified reason of complications. Observantly to state methods reason which create more severity and frequency CTD's has been recognized and interference with human factors engineering. For the more efficiency of interference Anthropometry has been used for all of Work stations and for any person designed a significant posture. Results: results that obtained before interference indicate that were CTD's complications at more of employees which 90 percent of them suffered of up spine pain. Also 27.4 percent of them had shoulder pain and 20.4 percent had neck pain. After the interference these measures decreased. And complaint of employee decreased 40.8 percent to up spine pain. Also for the shoulder pain it reached to 22 and neck pain 17.6 percent. With state test identified that there are significant difference between CTD after and before of intervention (p<0.005. Conclusion: Being unsuitable task posture is main cause of CTD's in the Work stations. We can prevent to increasing these complications in the work place by simple approach like adjustment in the desk and chair height, correct performance working training and doing simple exercise.

Health and health promotion

NARCIS (Netherlands)

Kingma, E.M.

2012-01-01

Much of our social and political effort, including a portion of the research in this university, is directed towards the promotion of one goal: health. But what is health? Or rather, how should we define health so that it is an identifiable goalpost for our social policies and technological

Health and the 2008 economic recession: evidence from the United Kingdom.

Directory of Open Access Journals (Sweden)

Thomas Astell-Burt

Full Text Available The economic recession which began in 2008 has resulted in a substantial increase in unemployment across many countries, including the United Kingdom. Strong association between unemployment and poor health status among individuals is widely recognised. We investigated whether the prevalence of poor health at a population level increased concurrent to the rise in unemployment during the economic recession, and whether the impact on health varied by geographical and socioeconomic circumstances.Health, demographic and socioeconomic measures on 1.36 million survey responses aged 16-64 were extracted from the Quarterly Labour Force Survey of the United Kingdom, collected every three months, from January 2006 to December 2010. The likelihood of self-reporting poor health status and specific types of health problems (depression, mental illness, cardiovascular and respiratory across time were estimated separately using logistic regression. Explanatory variables included economic status (International Labour Organization definition, occupational class, age, gender, country of birth, ethnicity, educational qualifications, couple status, household tenure, number of dependents, and geographical region.Unemployment (age-gender adjusted rose from 4.5% in January 2008 to 7.1% by September 2009. The reporting of poor health status increased from 25.7% in July 2009 to 29.5% by December 2010. Similar increases were found for cardiovascular and respiratory health problems; not depression or mental illness. The prevalence of poor health status among the unemployed decreased from 28.8% in July 2008, to 24.9% by March 2009; but this was followed by an increase in poor health experienced across all regions and by all socioeconomic groups, including those who remained employed, regardless of their occupational class.Although our study found no exacerbation of pre-recession health inequalities, the rise in poor health status not only for the unemployed, but also among

77 FR 28883 - Draft Public Health Action Plan-A National Public Health Action Plan for the Detection...

Science.gov (United States)

2012-05-16

... Disease Control and Prevention, National Center for Chronic Disease Prevention and Health Promotion... Promotion, Division of Reproductive Health, 4770 Buford Highway NE., Mailstop K-34, Atlanta, Georgia 30341... health importance, existing challenges, and opportunities for action to decrease the impact of...

Radon and health

International Nuclear Information System (INIS)

Chobanova, Nina

2016-01-01

Radon is radioactive noble gas that can be found in soil, water, outdoor and indoor air. Since environmental radon on average accounts for about half of all human exposure to radiation from natural sources, increasing attention has been paid to exposure to radon and its associated health risks. Many countries have introduced regulations to protect their population from radon in dwellings and workplaces. In this article are discussed main characteristics of radon, including sources of exposure, variation in radon exposure, how managing risks from radon exposure, how to measure the concentration of radon. There are results of measurements conducted under the 'National radon programme' in Bulgaria also. Key words: radon, sources of exposure, risk, cancer, measure to decrease the concentration [bg

Do textured breast implants decrease the rate of capsular contracture compared to smooth implants?

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Cifuentes, Ignacio; Dagnino, Bruno; Rada, Gabriel

2017-08-31

The use of breast implants for aesthetic and reconstructive purposes has become one of the most common procedures performed by plastic surgeons. Several breast implants models exist. They differ in their size, filling, shape and characteristic of the shell, which can be smooth or textured. Capsular contracture is one of the main complications of breast implants. It has been suggested that the use of textured implants could reduce the incidence of capsular contracture. To answer this question, we used Epistemonikos, the largest database of systematic reviews in health, which is maintained by screening multiple information sources, including MEDLINE, EMBASE, Cochrane, among others. We identified 15 studies overall, of which 13 were randomized trials relevant for the question of interest. We extracted data from the systematic reviews, reanalyzed data of primary studies, conducted a meta-analysis and generated a summary of findings table using the GRADE approach. We concluded the use of textured breast implants probably decreases the risk of capsular contracture, however, they might be associated to an increased risk of anaplastic large cell lymphoma.

Analysis of an inventory model for both linearly decreasing demand and holding cost

Science.gov (United States)

Malik, A. K.; Singh, Parth Raj; Tomar, Ajay; Kumar, Satish; Yadav, S. K.

2016-03-01

This study proposes the analysis of an inventory model for linearly decreasing demand and holding cost for non-instantaneous deteriorating items. The inventory model focuses on commodities having linearly decreasing demand without shortages. The holding cost doesn't remain uniform with time due to any form of variation in the time value of money. Here we consider that the holding cost decreases with respect to time. The optimal time interval for the total profit and the optimal order quantity are determined. The developed inventory model is pointed up through a numerical example. It also includes the sensitivity analysis.

The influence of source term release parameters on health effects

International Nuclear Information System (INIS)

Jeong, Jong Tae; Ha, Jae Joo

1998-08-01

In this study, the influence of source term release parameters on the health effects was examined. This is very useful in identifying the relative importance of release parameters and can be an important factor in developing a strategy for reducing offsite risks. The release parameters investigated in this study are release height, heat content, fuel burnup, release time, release duration, and warning time. The health effects affected by the change of release parameters are early fatalities, cancer fatalities, early injuries, cancer injuries, early fatality risk, population weighted early fatality risk, population weighted cancer fatality risk, effective whole body population dose, population exceeding an early acute red bone marrow dose of 1.5 Sv, and distance at which early fatalities are expected to occur. As release height increases, the values of early health effects such as early fatalities and injuries decrease. However, the release height dose not have significant influences on late health effects. The values of both early and late health effects decrease as heat content increases. The increase fuel burnup, i.e., the increase of core inventories increases the late health effects, however, has small influence on the early health effects. But, the number of early injuries increases as the fuel burnup increases. The effects of release time increase shows very similar influence on both the early and late health effects. As the release time increases to 2 hours, the values of health effects increase and then decrease rapidly. As release duration increases, the values of late health effects increase slightly, however, the values of early health effects decrease. As warning time increases to 2 hours, the values of late health effects decrease and then shows no variation. The number of early injuries decreases rapidly as the warning time increases to 2 hours. However, the number of early fatalities and the early fatality risk increase as the warning time increases

Employee weight management through health coaching.

Science.gov (United States)

Merrill, R M; Aldana, S G; Bowden, D E

2010-01-01

This study will evaluate the effectiveness of an interactive health coaching intervention at lowering weight. The study involved 5405 overweight or obese employees aged 18-85, who entered the program sometime during 2001-2008. Average body mass index (BMI) significantly decreased from 32.1 at baseline to 31.4 at 3 months, 31.0 at 6 months, and 30.6 at 12 months. Decreasing BMI was more pronounced in older age groups and among women, those using weight loss medication, those with higher BMI, and those with higher motivation and confidence to make behavior changes. When the effects of these variables on the decreasing trend in BMI were simultaneously estimated, only baseline classifications of BMI, health status, and confidence remained significant. Change in BMI through 12 months was -0.7% for those with normal weight, -2.0% for overweight, -3.6% for obese, and -7.1% for morbidly obese individuals at baseline. Among morbidly obese individuals, decrease in BMI through 12 months was -7.6% for those with "high" confidence to lose weight at baseline vs -4.4% for those with low confidence. Better health status at baseline was also related to more pronounced weight loss. Interactive health coaching significantly lowered BMI among participants through 3, 6, and 12 months of follow-up.

Sedentary behavior, physical activity, and psychological health of Korean older adults with hypertension: effect of an empowerment intervention.

Science.gov (United States)

Chang, Ae Kyung; Fritschi, Cynthia; Kim, Mi Ja

2013-04-01

The aim of this study was to determine the effect of an 8-week empowerment intervention on sedentary behavior, physical activity, and psychological health in Korean older adults with hypertension. Using a quasi-experimental design, older adults participated in either an experimental group (n = 27) or control group (n = 21). The experimental group received an empowerment intervention including lifestyle modification education, group discussion, and exercise training for 8 weeks, and the control group received standard hypertension education. After 8 weeks, participants in the experimental group had significantly decreased sedentary behavior, increased physical activity, increased self-efficacy for physical activity, and increased perceived health (p decreasing sedentary behavior and increasing physical activity, self-efficacy for physical activity, and perceived health in Korean older adults with hypertension. Copyright 2013, SLACK Incorporated.

An exploratory study of 2 parenting styles and family health behaviors.

Science.gov (United States)

Sterrett, Emma M; Williams, Joel; Thompson, Kirsten; Johnson, Knowlton; Bright, Mikia; Karam, Eli; Jones, V Faye

2013-07-01

To examine the relationships between 2 parenting styles and family nutrition and physical activity. Parents of elementary/primary school children in the southeastern United States (N = 145) completed surveys regarding family relationships and health behaviors. Parents exhibiting a laissez-faire parenting style reported lower levels of family nutrition and physical activity. In addition, parent BMI moderated the relationship between laissez-faire parenting and these health behaviors. This study indicates that family-oriented nutrition and physical activity programs may benefit from including a focus on decreasing laissez-faire parenting, as well as helping overweight parents reduce their BMIs.

Prevalence and associated factors for decreased appetite among patients with stable heart failure.

Science.gov (United States)

Andreae, Christina; Strömberg, Anna; Årestedt, Kristofer

2016-06-01

To explore the prevalence of decreased appetite and factors associated with appetite among patients with stable heart failure. Decreased appetite is an important factor for the development of undernutrition among patients with heart failure, but there are knowledge gaps about prevalence and the factors related to appetite in this patient group. Observational, cross-sectional study. A total of 186 patients with mild to severe heart failure were consecutively recruited from three heart failure outpatient clinics. Data were obtained from medical records (heart failure diagnosis, comorbidity and medical treatment) and self-rated questionnaires (demographics, appetite, self-perceived health, symptoms of depression and sleep). Blood samples were taken to determine myocardial stress and nutrition status. Heart failure symptoms and cognitive function were assessed by clinical examinations. The Council on Nutrition Appetite Questionnaire was used to assess self-reported appetite. Bivariate correlations and multivariate linear regression analyses were conducted to explore factors associated with appetite. Seventy-one patients (38%) experienced a loss of appetite with a significant risk of developing weight loss. The final multiple regression model showed that age, symptoms of depression, insomnia, cognitive function and pharmacological treatment were associated with appetite, explaining 27% of the total variance. In this cross-sectional study, a large share of patients with heart failure was affected by decreased appetite, associated with demographic, psychosocial and medical factors. Loss of appetite is a prevalent problem among patients with heart failure that may lead to undernutrition. Health care professionals should routinely assess appetite and discuss patients' experiences of appetite, nutrition intake and body weight and give appropriate nutritional advice with respect to individual needs. © 2016 John Wiley & Sons Ltd.

Why even active people get fatter--the asymmetric effects ofincreasing and decreasing exercise

Energy Technology Data Exchange (ETDEWEB)

Williams, Paul T.

2006-01-06

Background: Public health policies for preventing obesityneed guidelines for active individuals who are at risk due to exerciserecidivism. Methods: Changes in adiposity were compared to the runningdistances at baseline and follow-up in men and women whose reportedexercise increased (N=4,632 and 1,953, respectively) or decreased (17,280and 5,970, respectively) during 7.7 years of follow-up. Results: PerDelta km/wk, decreases in running distance caused over four-fold greaterweight gain between 0-8 km/wk (slope+-SE, males: -0.068+ -0.005 kg/m2,females: -0.080+-0.01 kg/m2) than between 32-48 km/wk (-0.017+-0.002 and-0.010+-0.005 kg/m2, respectively). In contrast, increases in runningdistance produced the smallest weight losses between 0-8 km/wk andstatistically significant weight loss only above 16 km/wk in males and 32km/wk in females. Above 32 km/wk (30 kcal/kg) in men and 16 km/wk (15kcal/kg) in women, weight loss from increasing exercise was equal to orgreater than weight gained with decreasing exercise, otherwise weightgain exceeded weight loss. Substantial weight gain occurred in runnerswho quit running, which would be mostly retained with resumed activity.Conclusion: Public health recommendations should warn against the risksof irreversible weight gain with exercise cessation. Weight gained due toreductions in exercise below 30 kcal/kg in men and 15 kcal/kg in womenmay not be reversed by resuming prior activity. Current IOM guidelines(i.e., maintain total energy expenditure at 160 percent of basal) agreewith the men s exercise threshold for symmetric weight change withchanging exercise levels.

Effect of an Integrated Health Management Program Based on Successful Aging in Korean Women.

Science.gov (United States)

Ahn, Okhee; Cha, Hye Gyeong; Chang, Soo Jung; Cho, Hyun-Choul; Kim, Hee Sun

2015-01-01

This study evaluates the efficacy of an integrated health management program (IHMP) based on successful aging in older women. A single group pretest and posttest research design was employed, with a sample of 33 older Korean women over 60 years registered in a public health center. The intervention, including exercise, health education, and social activities, was performed 3 hr per week for 12 weeks. Demographic characteristics, body composition, physical fitness, biomarkers, depression, and social support were measured. Data were analyzed with a Wilcoxon signed-rank test, statistical significance levels were set at p test (p < .001) were significantly improved. Systolic blood pressure (p < .003), diastolic blood pressure (p = .030), and blood cholesterol (p = .011) were significantly decreased. Depression (p = .043) was significantly decreased, and social support (p < .001) was significantly increased. Adopting and maintaining an IHMP can be useful to promote physical, psychological, and social functioning that lead to successful aging in older Korean women. © 2014 Wiley Periodicals, Inc.

Mental health service use for adult patients with co-occurring depression and physical chronic health care needs, 2007-2010.

Science.gov (United States)

Jolles, Mónica Pérez; Haynes-Maslow, Lindsey; Roberts, Megan C; Dusetzina, Stacie B

2015-08-01

Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3000 physicians in office-based settings. Office visits from 2007 to 2010 were pooled for adults aged 35-85 with a depression diagnosis at the time of visit (N=3659 visits). Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least 1 physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (Phealth conditions, particularly as the health care system moves toward an integrated care model.

X-33/RLV System Health Management/Vehicle Health Management

Science.gov (United States)

Mouyos, William; Wangu, Srimal

1998-01-01

To reduce operations costs, Reusable Launch Vehicles (RLVS) must include highly reliable robust subsystems which are designed for simple repair access with a simplified servicing infrastructure, and which incorporate expedited decision-making about faults and anomalies. A key component for the Single Stage To Orbit (SSTO) RLV system used to meet these objectives is System Health Management (SHM). SHM incorporates Vehicle Health Management (VHM), ground processing associated with the vehicle fleet (GVHM), and Ground Infrastructure Health Management (GIHM). The primary objective of SHM is to provide an automated and paperless health decision, maintenance, and logistics system. Sanders, a Lockheed Martin Company, is leading the design, development, and integration of the SHM system for RLV and for X-33 (a sub-scale, sub-orbit Advanced Technology Demonstrator). Many critical technologies are necessary to make SHM (and more specifically VHM) practical, reliable, and cost effective. This paper will present the X-33 SHM design which forms the baseline for the RLV SHM, and it will discuss applications of advanced technologies to future RLVs. In addition, this paper will describe a Virtual Design Environment (VDE) which is being developed for RLV. This VDE will allow for system design engineering, as well as program management teams, to accurately and efficiently evaluate system designs, analyze the behavior of current systems, and predict the feasibility of making smooth and cost-efficient transitions from older technologies to newer ones. The RLV SHM design methodology will reduce program costs, decrease total program life-cycle time, and ultimately increase mission success.

Perceptions of cardiovascular health in underserved communities.

Science.gov (United States)

Bryant, Lucinda L; Chin, Nancy P; Cottrell, Lesley A; Duckles, Joyce M; Fernandez, I Diana; Garces, D Marcela; Keyserling, Thomas C; McMilin, Colleen R; Peters, Karen E; Samuel-Hodge, Carmen D; Tu, Shin-Ping; Vu, Maihan B; Fitzpatrick, Annette L

2010-03-01

Cardiovascular disease is the leading cause of deaths and illnesses in US adults, and the prevalence is disproportionately high in underserved populations. In this study, we assessed respondents' understanding of context-specific differences in knowledge and perceptions of disease, risk, and prevention in 6 underserved communities, with the longer-term goal of developing appropriate interventions. Thirty-nine small-group sessions and 14 interviews yielded data from 318 adults. Each site's researchers coded, analyzed, and extracted key themes from local data. Investigators from all sites synthesized results and identified common themes and differences. Themes clustered in 3 areas (barriers to cardiovascular health, constraints related to multiple roles, and suggestions for effective communications and programs). Barriers spanned individual, social and cultural, and environmental levels; women in particular cited multiple roles (eg, competing demands, lack of self-care). Programmatic suggestions included the following: personal, interactive, social context; information in language that people use; activities built around cultural values and interests; and community orientation. In addition, respondents preferred health-related information from trusted groups (eg, AARP), health care providers (but with noticeable differences of opinion), family and friends, and printed materials. Interventions to decrease barriers to cardiovascular health are needed; these strategies should include family and community context, small groups, interactive methods, culturally sensitive materials, and trusted information sources. New-immigrant communities need culturally and linguistically tailored education before receiving more substantive interventions.

Resistome diversity in cattle and the environment decreases during beef production.

Science.gov (United States)

Noyes, Noelle R; Yang, Xiang; Linke, Lyndsey M; Magnuson, Roberta J; Dettenwanger, Adam; Cook, Shaun; Geornaras, Ifigenia; Woerner, Dale E; Gow, Sheryl P; McAllister, Tim A; Yang, Hua; Ruiz, Jaime; Jones, Kenneth L; Boucher, Christina A; Morley, Paul S; Belk, Keith E

2016-03-08

Antimicrobial resistant determinants (ARDs) can be transmitted from livestock systems through meat products or environmental effluents. The public health risk posed by these two routes is not well understood, particularly in non-pathogenic bacteria. We collected pooled samples from 8 groups of 1741 commercial cattle as they moved through the process of beef production from feedlot entry through slaughter. We recorded antimicrobial drug exposures and interrogated the resistome at points in production when management procedures could potentially influence ARD abundance and/or transmission. Over 300 unique ARDs were identified. Resistome diversity decreased while cattle were in the feedlot, indicating selective pressure. ARDs were not identified in beef products, suggesting that slaughter interventions may reduce the risk of transmission of ARDs to beef consumers. This report highlights the utility and limitations of metagenomics for assessing public health risks regarding antimicrobial resistance, and demonstrates that environmental pathways may represent a greater risk than the food supply.

Health promotion: An effective tool for global health

Directory of Open Access Journals (Sweden)

Sanjiv Kumar

2012-01-01

Full Text Available Health promotion is very relevant today. There is a global acceptance that health and social wellbeing are determined by many factors outside the health system which include socioeconomic conditions, patterns of consumption associated with food and communication, demographic patterns, learning environments, family patterns, the cultural and social fabric of societies; sociopolitical and economic changes, including commercialization and trade and global environmental change. In such a situation, health issues can be effectively addressed by adopting a holistic approach by empowering individuals and communities to take action for their health, fostering leadership for public health, promoting intersectoral action to build healthy public policies in all sectors and creating sustainable health systems. Although, not a new concept, health promotion received an impetus following Alma Ata declaration. Recently it has evolved through a series of international conferences, with the first conference in Canada producing the famous Ottawa charter. Efforts at promoting health encompassing actions at individual and community levels, health system strengthening and multi sectoral partnership can be directed at specific health conditions. It should also include settings-based approach to promote health in specific settings such as schools, hospitals, workplaces, residential areas etc. Health promotion needs to be built into all the policies and if utilized efficiently will lead to positive health outcomes.

Disability and health-related rehabilitation in international disaster relief

Science.gov (United States)

Reinhardt, Jan D.; Li, Jianan; Gosney, James; Rathore, Farooq A.; Haig, Andrew J.; Marx, Michael; Delisa, Joel A.

2011-01-01

Background Natural disasters result in significant numbers of disabling impairments. Paradoxically, however, the traditional health system response to natural disasters largely neglects health-related rehabilitation as a strategic intervention. Objectives To examine the role of health-related rehabilitation in natural disaster relief along three lines of inquiry: (1) epidemiology of injury and disability, (2) impact on health and rehabilitation systems, and (3) the assessment and measurement of disability. Design Qualitative literature review and secondary data analysis. Results Absolute numbers of injuries as well as injury to death ratios in natural disasters have increased significantly over the last 40 years. Major impairments requiring health-related rehabilitation include amputations, traumatic brain injuries, spinal cord injuries (SCI), and long bone fractures. Studies show that persons with pre-existing disabilities are more likely to die in a natural disaster. Lack of health-related rehabilitation in natural disaster relief may result in additional burdening of the health system capacity, exacerbating baseline weak rehabilitation and health system infrastructure. Little scientific evidence on the effectiveness of health-related rehabilitation interventions following natural disaster exists, however. Although systematic assessment and measurement of disability after a natural disaster is currently lacking, new approaches have been suggested. Conclusion Health-related rehabilitation potentially results in decreased morbidity due to disabling injuries sustained during a natural disaster and is, therefore, an essential component of the medical response by the host and international communities. Significant systematic challenges to effective delivery of rehabilitation interventions during disaster include a lack of trained responders as well as a lack of medical recordkeeping, data collection, and established outcome measures. Additional development of health

Decreased heart rate variability responses during early postoperative mobilization

DEFF Research Database (Denmark)

Jans, Øivind; Brinth, Louise; Kehlet, Henrik

2015-01-01

in relation to postural change. METHODS: A standardized mobilization protocol before, 6 and 24 h after surgery was performed in 23 patients scheduled for elective THA. Beat-to-beat arterial blood pressure was measured by photoplethysmography and HRV was derived from pulse wave interbeat intervals and analysed......BACKGROUND: Intact orthostatic blood pressure regulation is essential for early mobilization after surgery. However, postoperative orthostatic hypotension and intolerance (OI) may delay early ambulation. The mechanisms of postoperative OI include impaired vasopressor responses relating...... and postural responses in arterial pressures decreased compared to preoperative conditions. During standing HF variation increased by 16.7 (95 % CI 8.0-25.0) normalized units (nu) at 6 h and 10.7 (2.0-19.4) nu at 24 h compared to the preoperative evaluation. At 24 h the LF/HF ratio decreased from 1.8 (1...

The influence of mastery on mother's health in middle years: Moderating role of stressful life context.

Science.gov (United States)

King, Victoria; Wickrama, K A S; Klopack, Erick; Lorenz, Frederick O

2018-06-07

Using data from 416 middle-aged mothers gathered over the course of a decade, this study examined the influence of mastery trajectories (the initial level and change), on change in physical health. Mastery is defined as one's ability to control and influence his/her life and environment to reach a desired outcome or goal. Both the initial level and change in mastery from 1991 to 1994 were associated with decreased physical health problems over the middle years (1991-2001). Contextual moderation of this association by stressful life contexts including negative life events and work-family conflict was investigated. Moderation analysis showed that under conditions of low contextual life stressors, the level and increase in mastery significantly contributed to decreases in physical health problems in middle-aged mothers. Alternatively, conditions of high contextual life stressors inhibited the ability of mastery to influence physical health of mothers, suggesting that the positive health impact of mastery on physical health is mitigated by stressful life experiences. Implications for the need to maintain important personal resources, such as mastery, during times of stress are discussed. Copyright © 2018 John Wiley & Sons, Ltd.

GOOD HOMOSEXUAL BEHAVIOUR DECREASE PREVALENCE OF SEXUAL TRANSMITTED DISSEASE

Directory of Open Access Journals (Sweden)

Purwaningsih Purwaningsih

2017-07-01

Full Text Available Introduction: The homosexual behaviour were become indicators of sexually transmitted diseases’s (STDs prevalencies. Prevalence of sexually transmitted diseases in homosexual community was very high but until recently study it was conducted sporadically. The objective of this study was to analyze the correlation of homosexual behaviour with prevalence of sexually transmitted diseases (STDs in Mobile Clinic Community Centre of IGAMA collaborating with Public Health Centre Sumberpucung of Malang Regency. Method:  Analytic design with cross sectional methode was used in this study. The population were all visitors of Mobile Clinic Community Centre of IGAMA collaborating with Public Health Centre Sumberpucung of Malang Regency (353 people. Sample were 40 people who met to the inclusion criteria. The independent variable was homosexual behaviour and the dependent variable was prevalence of sexually transmitted diseases (STDs. Data for homosexual behaviour were collected by using questionnaire and indhept interview with content analyze and data for prevalence of sexually transmitted diseases (STDs were collected by using laboratorium test for STDs. Result: The research result was presented in the form diagram, table of cross tabulation and analyzed by using Spearman Rho with significance level ρ=0.005. The result showed that there was correlation of homosexual knowledge (ρ=0.001, attitude (ρ=0.000 and  practice (ρ=0.000 with prevalence of STDs. Dsicussion:  It can be concluded that the better knowledge, attitude and practice of homosexual could be decrease prevalence of STDs. Futher studies are recomended to analyze the correlation between homosexual behaviour and prevalence of STDs with Health Believe approach.

Do the health benefits of cycling outweigh the risks?

NARCIS (Netherlands)

de Hartog, J.J.|info:eu-repo/dai/nl/288354850; Boogaard, H.|info:eu-repo/dai/nl/314406522; Nijland, H.; Hoek, G.|info:eu-repo/dai/nl/069553475

2010-01-01

BACKGROUND: Although from a societal point of view a modal shift from car to bicycle may have beneficial health effects due to decreased air pollution emissions, decreased greenhouse gas emissions, and increased levels of physical activity, shifts in individual adverse health effects such as higher

Decrease in Prostate Cancer Testing Following the US Preventive Services Task Force (USPSTF) Recommendations.

Science.gov (United States)

Li, Jun; Berkowitz, Zahava; Hall, Ingrid J

2015-01-01

To assess changes of prostate-specific antigen (PSA) testing following recent US Preventive Services Task Force (USPSTF) prostate cancer screening recommendations using 2005 to 2013 National Health Interview Survey data. We calculated the percentage of PSA testing among men ≥40 years by age group and age-adjusted race for each survey year. Differences between years were assessed with linear contrasts after combining all years' data. The overall percentage of PSA testing was highest in 2008 and decreased significantly in 2013. Compared with 2008, each age group had significantly lower screening percentages in 2013, especially men ≥75 years old (-14.0% points; P testing percentages were highest in 2008 and decreased significantly in 2013. Only white men had a significantly lower percentage in 2013 than in 2010. Significant declines in PSA testing from 2008 to 2013 in men ≥75 years old may reflect the impact of the 2008 USPSTF recommendations. While the cause of the decreases in PSA testing between 2010 and 2013 among men aged 50 to 74 years old and white men is unknown, the decreases may suggest the early effects of the 2012 recommendations. © Copyright 2015 by the American Board of Family Medicine.

Changes to Workflow and Process Measures in the PICU During Transition From Semi to Full Electronic Health Record.

Science.gov (United States)

Salib, Mina; Hoffmann, Raymond G; Dasgupta, Mahua; Zimmerman, Haydee; Hanson, Sheila

2015-10-01

Studies showing the changes in workflow during transition from semi to full electronic medical records are lacking. This objective study is to identify the changes in workflow in the PICU during transition from semi to full electronic health record. Prospective observational study. Children's Hospital of Wisconsin Institutional Review Board waived the need for approval so this study was institutional review board exempt. This study measured clinical workflow variables at a 72-bed PICU during different phases of transition to a full electronic health record, which occurred on November 4, 2012. Phases of electronic health record transition were defined as follows: pre-electronic health record (baseline data prior to transition to full electronic health record), transition phase (3 wk after electronic health record), and stabilization (6 mo after electronic health record). Data were analyzed for the three phases using Mann-Whitney U test with a two-sided p value of less than 0.05 considered significant. Seventy-two bed PICU. All patients in the PICU were included during the study periods. Five hundred and sixty-four patients with 2,355 patient days were evaluated in the three phases. Duration of rounds decreased from a median of 9 minutes per patient pre--electronic health record to 7 minutes per patient post electronic health record. Time to final note decreased from 2.06 days pre--electronic health record to 0.5 days post electronic health record. Time to first medication administration after admission also decreased from 33 minutes pre--electronic health record and 7 minutes post electronic health record. Time to Time to medication reconciliation was significantly higher pre-electronic health record than post electronic health record and percent of medication reconciliation completion was significantly lower pre--electronic health record than post electronic health record and percent of medication reconciliation completion was significantly higher pre

Competition between health maintenance organizations and nonintegrated health insurance companies in health insurance markets.

Science.gov (United States)

Baranes, Edmond; Bardey, David

2015-12-01

This article examines a model of competition between two types of health insurer: Health Maintenance Organizations (HMOs) and nonintegrated insurers. HMOs vertically integrate health care providers and pay them at a competitive price, while nonintegrated health insurers work as indemnity plans and pay the health care providers freely chosen by policyholders at a wholesale price. Such difference is referred to as an input price effect which, at first glance, favors HMOs. Moreover, we assume that policyholders place a positive value on the provider diversity supplied by their health insurance plan and that this value increases with the probability of disease. Due to the restricted choice of health care providers in HMOs a risk segmentation occurs: policyholders who choose nonintegrated health insurers are characterized by higher risk, which also tends to favor HMOs. Our equilibrium analysis reveals that the equilibrium allocation only depends on the number of HMOs in the case of exclusivity contracts between HMOs and providers. Surprisingly, our model shows that the interplay between risk segmentation and input price effects may generate ambiguous results. More precisely, we reveal that vertical integration in health insurance markets may decrease health insurers' premiums.

The Relationship Between Shift Work and Men's Health.

Science.gov (United States)

Deng, Nanfu; Kohn, Taylor P; Lipshultz, Larry I; Pastuszak, Alexander W

2018-01-19

More than 21 million Americans and nearly 20% of the U.S. workforce are shift workers. Non-standard shift work, defined as work that falls outside of 6 am-6 pm, can lead to poor diet, exercise, and sleep habits that lead to decreased productivity, increased workplace accidents, and a variety of negative health outcomes. To investigate the associations between shift work exposure and chronic medical conditions such as metabolic syndromes, cardiovascular disease, gastrointestinal disturbances, and depression as well as urologic complications including hypogonadism, male infertility, lower urinary tract symptoms, and prostate cancer with a focus on the effects of shift work sleep disorder (SWSD) on the severity of these negative health outcomes. We reviewed the literature examining effects of shift work and SWSD on general and urologic health. We produced a summary of effects of shift work on health with focus on the increased risk of negative health outcomes in non-standard shift workers, particularly those with SWSD, when compared to daytime workers or workers without SWSD. Studies have associated non-standard shift work schedules and poor health outcomes, including increased risks of diabetes mellitus, dyslipidemia, hypertension, heart disease, peptic ulcer disease, and depression, in shift workers. However, few studies have focused on the role that shift work plays in men's urologic health. Current evidence supports associations between non-standard shift work and increased hypogonadal symptoms, poor semen parameters, decreased fertility, lower urinary tract symptoms, and prostate cancer. These associations are strengthened by the presence of SWSD, which affects up to 20% of shift workers. Unfortunately, interventions, such as planned naps, timed light exposure, melatonin, and sedative hypnotics, aimed at alleviating excessive nighttime sleepiness and daytime insomnia in non-standard shift workers experiencing SWSD, are limited and lack strong evidence to support

Self-Reported Health Experiences of Children Living with Congenital Heart Defects: Including Patient-Reported Outcomes in a National Cohort Study.

Science.gov (United States)

Knowles, Rachel Louise; Tadic, Valerija; Hogan, Ailbhe; Bull, Catherine; Rahi, Jugnoo Sangeeta; Dezateux, Carol

2016-01-01

Understanding children's views about living with congenital heart defects (CHDs) is fundamental to supporting their successful participation in daily life, school and peer relationships. As an adjunct to a health and quality of life outcomes questionnaire, we asked school-age children who survived infant heart procedures to describe their experiences of living with CHDs. In a UK-wide cohort study, children aged 10 to 14 years with CHDs self-completed postal questionnaires that included an open question about having a 'heart problem'. We compared the characteristics of children with more and less severe cardiac diagnoses and, through collaborative inductive content analysis, investigated the subjective experiences and coping strategies described by children in both clinical severity groups. Text and/or drawings were returned by 436 children (246 boys [56%], mean age 12.1 years [SD 1.0; range 10-14]); 313 had less severe (LS) and 123 more severe (MS) cardiac diagnoses. At the most recent hospital visit, a higher proportion of the MS group were underweight (more than two standard deviations below the mean for age) or cyanosed (underweight: MS 20.0%, LS 9.9%; cyanosed: MS 26.2%, LS 3.5%). Children in the MS group described concerns about social isolation and feeling 'different', whereas children with less severe diagnoses often characterised their CHD as 'not a big thing'. Some coping strategies were common to both severity groups, including managing health information to avoid social exclusion, however only children in the LS group considered their CHD 'in the past' or experienced a sense of survivorship. Children's reported experiences were not dependent on their cardiac diagnosis, although there were clear qualitative differences by clinical severity group. Children's concerns emphasised social participation and our findings imply a need to shift the clinical focus from monitoring cardiac function to optimising participation. We highlight the potential for informing

Interleukin-1 Antagonism Decreases Cortisol Levels in Obese Individuals

OpenAIRE

Urwyler, Sandrine Andrea; Schuetz, Philipp; Ebrahimi, Fahim; Donath, Marc Y.; Christ-Crain, Mirjam

2017-01-01

Increased cortisol levels in obesity may contribute to the associated metabolic syndrome. In obesity, the activated innate immune system leads to increased interleukin (IL)-1β, which is known to stimulate the release of adrenocorticotropin hormone (ACTH).; We hypothesized that in obesity IL-1 antagonism would result in downregulation of the hypothalamo-pituitary-adrenal axis, leading to decreased cortisol levels.; In this prospective intervention study, we included 73 patients with obesity (b...

Revolving Loan Fund: A Novel Approach to Increasing Access to Long-Acting Reversible Contraception Methods in Community Health Centers.

Science.gov (United States)

Evans, Megan L; Breeze, Janis L; Paulus, Jessica K; Meadows, Audra

The aim of this study was to assess the impact of a revolving loan fund (RLF) on timing of device insertion and long-acting reversible contraception (LARC) access among a high-risk urban population at 3 Boston community health centers. Three health centers were identified to implement a RLF. Each clinic received $5000 from the RLF to purchase LARC devices. Data collected through medical record review retrospectively 1 year prior to start of the RLF and prospectively for 1 year thereafter included patient demographics, type of LARC selected, patient's date of documented interest in a LARC device, and date of insertion. The effect of a RLF on delay to LARC insertion was tested using negative binomial regression, controlling for site and potential confounding variables between the pre- and post-RLF periods. Three urban community health centers. Reproductive-aged women who received family planning services at the 3 participating health centers. Increasing access to LARC and decreasing wait times to LARC insertion after implementation of the RLF. Data on 133 patients in the pre-RLF group and 205 in the post-RLF group were collected. There were no statistically significant differences in demographic or clinical characteristics between the 2 time periods. LARC uptake increased significantly from the pre- to post-RLF period, specifically among implant users. There was a statistically significant decrease in the mean number of days in delay from interest to insertion from the pre- to post-RLF period (pre-RLF: 31.3 ± 50.6 days; post-RLF: 13.6 ± 16.7 days, adjusted P < .001). The reasons for the delay did not differ significantly between the 2 time periods. The RLF decreased wait time for the devices and increased overall insertion rates. This may serve as a promising solution to improve LARC access in community health centers. This project could be expanded to include more health centers, creating a city wide RLF. This expansion could allow for further data analysis

Income-related inequality in health and health care utilization in Chile, 2000-2009.

Science.gov (United States)

Vásquez, Felipe; Paraje, Guillermo; Estay, Manuel

2013-02-01

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

The association of health management with the health of elderly people.

Science.gov (United States)

Nakanishi, N; Tatara, K; Takashima, Y; Fujiwara, H; Takamori, Y; Takabayashi, H; Scott, R

1995-07-01

To assess the effect of health management on the health of a community-based sample of people aged 65 years and over, a cross-sectional survey was carried out of 1491 people aged 65 years and over (22.3%) randomly drawn from the computerized age-sex register in Settsu City, Osaka. A total of 1473 people were contacted and complete responses were obtained from 1383 of these (a response rate of 93.9%). The proportion of the sample who had been receiving regular health checks or had been taking care of their health decreased with a decline in Activities of Daily Living (ADL). This trend was more pronounced among the younger subjects aged 65-74 years. For disability, those who had been receiving regular health checks had lower overall severity scores in both the 65-74 years and 75 years and over age groups. There were no significant differences in the severity scores for those practising health maintenance (watching diet and exercise) in both age groups, but those practising health maintenance tended to have less disability. The percentage of those who were socially active and thought life worth living also decreased with the decline in ADL for both age groups. These psycho-social factors were also associated with a lower overall severity score. A multiple linear regression analysis showed that health checks, social activity and the presence of aspects of life subjectively evaluated as making it worth living (Ikigai) were shown to have statistically significant negative associations with disability when other factors were controlled for.

Global health and global health ethics

National Research Council Canada - National Science Library

Benatar, S. R; Brock, Gillian

2011-01-01

...? What are our responsibilities and how can we improve global health? Global Health and Global Health Ethics addresses these questions from the perspective of a range of disciplines, including medicine, philosophy and the social sciences...

Price of forest chips decreasing

International Nuclear Information System (INIS)

Hakkila, P.

2001-01-01

Use of forest chips was studied in 1999 in the national Puuenergia (Wood Energy) research program. Wood combusting heating plants were questioned about are the main reasons restricting the increment of the use of forest chips. Heating plants, which did not use forest chips at all or which used less than 250 m 3 (625 bulk- m 3 ) in 1999 were excluded. The main restrictions for additional use of forest chips were: too high price of forest chips; lack of suppliers and/or uncertainty of deliveries; technical problems of reception and processing of forest chips; insufficiency of boiler output especially in winter; and unsatisfactory quality of chips. The price of forest chips becomes relatively high because wood biomass used for production of forest chips has to be collected from wide area. Heavy equipment has to be used even though small fragments of wood are processed, which increases the price of chips. It is essential for forest chips that the costs can be pressed down because competition with fossil fuels, peat and industrial wood residues is hard. Low market price leads to the situation in which forest owner gets no price of the raw material, the entrepreneurs operate at the limit of profitability and renovation of machinery is difficult, and forest chips suppliers have to sell the chips at prime costs. Price of forest chips has decreased significantly during the past decade. Nominal price of forest chips is now lower than two decades ago. The real price of chips has decreased even more than the nominal price, 35% during the past decade and 20% during the last five years. Chips, made of small diameter wood, are expensive because the price includes the felling costs and harvesting is carried out at thinning lots. Price is especially high if chips are made of delimbed small diameter wood due to increased the work and reduced amount of chips. The price of logging residue chips is most profitable because cutting does not cause additional costs. Recovery of chips is

The total customer relationship in health care: broadening the bandwidth.

Science.gov (United States)

Berwick, D M

1997-05-01

The health care system is in the midst of a market revolution, driven by cost containment but also fully charged by the idea that competition among providers will lead to reforms that neither the government nor the professions have been able to achieve by themselves. An agenda of "reports to consumers" has been advanced as a bright new hope for improving the health care system. An alternative to this notion of consumerism is far broader--that is the concept of total relationship. In the hands of masters outside the health care domain, the total customer relationship embraces several elements that can be imported into health care and that offer more promise than "report cards," including the following: Customers as assistants in decreasing waste; Mass customization and stratification of need; Shaping demand; Immediate recovery; Delight as the objective; and Customer knowledge and innovation. A CREDO: The next phase of development of total customer relationship might well be guided by a credo including several tenets about the wisdom of those the health care system serves and the nature of its purpose: 1. In a helping profession, the ultimate judge of performance is the person helped. 2. Most people, including sick people, are reasonable most of the time. 3. Different people have different, legitimate needs. 4. Pain and fear produce anxiety in both the victim and the helper. 5. Meeting needs without waste is a strategic and moral imperative.

Health-Related Quality of Life: Expanding a Conceptual Framework to Include Older Adults Who Receive Long-Term Services and Supports

Science.gov (United States)

Zubritsky, Cynthia; Abbott, Katherine M.; Hirschman, Karen B.; Bowles, Kathryn H.; Foust, Janice B.; Naylor, Mary D.

2013-01-01

For older adults receiving long-term services and supports (LTSS), health-related quality of life (HRQoL) has emerged as a critical construct to examine because of its focus on components of well-being, which are affected by progressive changes in health status, health care, and social support. HRQoL is a health-focused quality of life (QOL)…

[Current status of occupational health activities and the way that occupational health services should be offered to small- and medium-scale enterprises].

Science.gov (United States)

Kayashima, Kotaro

2013-10-01

Activating occupational safety and health activities among Small- and Medium-scale Enterprises (SMEs) is a major issue because more than 80% of Japanese workers belong to these enterprises, in which the number of workers are less than 300 people. However, as the size of the enterprise decreases, the occurrence of problems of safety and health management systems and safety and health activities increases. Reasons for this include both the limitations of investments shortages of human resources. Occupational health services in SMEs has been provided by the cooperation of the following institutions: public associations (such as Regional Occupational Health Centers, Occupational Health Promotion Centers, Japan Industrial Safety and Health Association (JISHA)), occupational health agencies which provide checkup services, health insurance associations, and regional medical services. In contrast to the low coverage of occupational health services among SMEs in Japan, there are some countries in Europe in which this coverage is almost 100%. This is because of the development of occupational health services outside the company. To show the benefits of the safety and health activities to managers of SMEs, and to motivate them to take advantage of the services, it is important to consider measurements. Also, establishing systems that provide those services, improving the quality of specialists such as occupational physicians, and educating human resources, are all necessary.

Beyond reproduction: women's health in today's developing world.

Science.gov (United States)

Raymond, Susan U; Greenberg, Henry M; Leeder, Stephen R

2005-10-01

The concept of women's health is tethered strongly to reproductive health. At present, international attention and resources are focused on obstetric events and, recently, HIV/AIDS because of the significance of these problems in the least developed nations. This limited concept of women's health, however, is decreasingly relevant to the global community, and needs to be revisited in the light of decreasing fertility and increasing life expectancy in many countries where it was previously applicable. It should be expanded to embrace the full spectrum of health experienced by women, and preventive and remedial approaches to the major conditions that afflict women. Allocation of health service resources should be aligned with the epidemiological realities of these threats to women's health. Cause of death data for women aged 15-34 years and 35-44 years were examined for nine less developed countries. Deaths associated with pregnancy and child birth, and HIV were compared with deaths due to three chronic disease categories (cancer, cardiovascular disease, and diabetes). The women's health research literature for developing countries appearing in the American Journal of Public Health and British Medical Journal was also examined. In seven out of the nine countries, among women aged 15-34 years, chronic diseases caused over 20% of deaths, while reproductive causes and HIV together accounted for approximately 10% of deaths, in all countries except in India. Among women aged 35-44 years, in all but India, chronic diseases accounted for over four times the deaths attributable to reproductive causes and HIV. The causes of death were not related to the level of development in these countries as measured by GNI PPP. Papers pertaining to women's health published in public health and medical research journals focused principally on reproduction. Extending the definition of women's health to include a concern for chronic diseases is critical if the needs of women in less

Facilitators of and Barriers to mHealth Adoption in Older Adults With Heart Failure.

Science.gov (United States)

Cajita, Maan Isabella; Hodgson, Nancy A; Lam, Katherine Wai; Yoo, Sera; Han, Hae-Ra

2018-05-04

The purpose of this descriptive, exploratory study was to assess the perceptions of older adults with heart failure regarding the use of mobile technology and to identify potential facilitators of and barriers to mHealth adoption. Semistructured interviews were used to collect data. Transcripts were analyzed using qualitative content analysis. The findings indicated that older adults do not base their intention to use mHealth solely on perceived ease of use and perceived usefulness, as outlined in the Technology Acceptance Model. The following themes emerged from the content analysis: facilitators included previous experience with mobile technology, willingness to learn mHealth, ease of use, presence of useful features, adequate training, free equipment, and doctor's recommendation; barriers included lack of knowledge regarding how to use mHealth, decreased sensory perception, lack of need for technology, poorly designed interface, cost of technology, and limited/fixed income. Overall, the findings suggest that older adults are willing to use mobile health technology, albeit with reservations. Future researchers who seek to implement mHealth-based interventions should address person-related, technology-related, and contextual barriers, and simultaneously capitalize on the influence of potential facilitators, such as a physician's recommendation, to promote mHealth adoption.

Does Health Coaching Grow Capacity in Cancer Survivors? A Systematic Review.

Science.gov (United States)

Barakat, Suzette; Boehmer, Kasey; Abdelrahim, Marwan; Ahn, Sangwoo; Al-Khateeb, Abdulrahman A; Villalobos, Neri Álvarez; Prokop, Larry; Erwin, Patricia J; Fleming, Kirsten; Serrano, Valentina; Spencer-Bonilla, Gabriela; Murad, Mohammad Hassan

2018-02-01

Interventions that grow patient capacity to do the work of health care and life are needed to support the health of cancer survivors. Health coaching may grow capacity. This systematic review of health coaching interventions explored coaching's ability to grow capacity of cancer survivors. The authors included randomized trials or quasi-experimental studies comparing coaching to alternative interventions, and adhered to PRISMA reporting guidelines. Data were analyzed using the Theory of Patient Capacity (BREWS: Capacity is affected by factors that influence ability to reframe Biography ["B"], mobilize or recruit Resources ["R"], interact with the Environment of care ["E"], accomplish Work ["W"]), and function Socially ["S"]). The authors reviewed 2210 references and selected 12 studies (6 randomized trials and 6 pre-post). These studies included 1038 cancer survivors, mean age 57.2 years, with various type of cancers: breast, colorectal, prostate, and lung. Health coaching was associated with improved quality of life, mood, and physical activity but not self-efficacy. Classified by potential to support growth in patient capacity, 67% of included studies reported statistically significant outcomes that support "B" (quality of life, acceptance, spirituality), 75% "R" (decreased fatigue, pain), 67% "W" (increased physical activity), and 33% "S" (social deprivation index). None addressed changing the patient's environment of care. In cancer survivors, health coaching improved quality of life and supported patient capacity by several mechanisms, suggesting an important role for "Capacity Coaching." Future interventions that improve self-efficacy and patients' environments of care are needed. Capacity Coaching may improve health and quality of life of cancer survivors.

Human resources for health and burden of disease: an econometric approach

Directory of Open Access Journals (Sweden)

Castillo-Laborde Carla

2011-01-01

Full Text Available Abstract Background The effect of health workers on health has been proven to be important for various health outcomes (e.g. mortality, coverage of immunisation or skilled birth attendants. The study aim of this paper is to assess the relationship between health workers and disability-adjusted life years (DALYs, which represents a much broader concept of health outcome, including not only mortality but also morbidity. Methods Cross-country multiple regression analyses were undertaken, with DALYs and DALYs disaggregated according to the three different groups of diseases as the dependent variable. Aggregate health workers and disaggregate physicians, nurses, and midwives were included as independent variables, as well as a variable accounting for the skill mix of professionals. The analysis also considers controlling for the effects of income, income distribution, percentage of rural population with access to improved water source, and health expenditure. Results This study presents evidence of a statistically negative relationship between the density of health workers (especially physicians and the DALYs. An increase of one unit in the density of health workers per 1000 will decrease, on average, the total burden of disease between 1% and 3%. However, in line with previous findings in the literature, the density of nurses and midwives could not be said to be statistically associated to DALYs. Conclusions If countries increase their health worker density, they will be able to reduce significantly their burden of disease, especially the burden associated to communicable diseases. This study represents supporting evidence of the importance of health workers for health.

Colostrum and milk pasteurization improve health status and decrease mortality in neonatal calves receiving appropriate colostrum ingestion.

Science.gov (United States)

Armengol, Ramon; Fraile, Lorenzo

2016-06-01

The objective of the study was to evaluate if on-farm heat treatment of colostrum and bulk tank milk can improve calf health status and morbidity and mortality rates during the first 21d of life in neonatal Holstein calves receiving appropriate colostrum ingestion. A total of 587 calves were randomly assigned to 2 groups of males and females over 18mo. The nonpasteurized group (n=287, 143 males and 144 females) was fed frozen (-20°C) colostrum (6-8L during the first 12h of life) that was previously reheated up to 40°C. They were also fed refrigerated (4°C) raw milk from the bulk tank that was also reheated up to 40°C (1.8L every 12h). The pasteurized group (n=300, 150 males and 150 females) was also fed colostrum and milk, but both were pasteurized before freezing. Blood samples were drawn from all calves to obtain serum at 2 to 5d of life. Serum total protein (g/dL) was determined using a commercially available refractometer. Colostrum and milk underwent routine bacteriological analysis to determine total plate counts (cfu/mL) and total coliform counts (cfu/mL). All the calves underwent clinical examination every 24h during the first 21d of life. Every day, calves were clinically diagnosed either as being healthy or suffering from respiratory disease, neonatal calf diarrhea, or suffering other diseases. On-farm heat treatment for colostrum and milk reduced total plate counts and total coliform counts between 1 and 2 log10. Pasteurization of colostrum and milk significantly decreased the morbidity and mortality (5.2 and 2.8%) in comparison with calves receiving nonpasteurized colostrum and milk (15.0 and 6.5%), respectively, during the first 21d of life, even in animals receiving appropriate colostrum ingestion. Copyright © 2016 American Dairy Science Association. Published by Elsevier Inc. All rights reserved.

Completed Research in Health, Physical Education, Recreation & Dance; Including International Sources. Volume 27. 1985 Edition.

Science.gov (United States)

Freedson, Patty S., Ed.

This compilation lists research completed in the areas of health, physical education, recreation, dance, and allied areas during 1984. The document is arranged in two parts. In the index, references are arranged under the subject headings in alphabetical order. Abstracts of master's and doctor's theses from institutions offering graduate programs…

Workplace Violence in Health Care-It's Not "Part of the Job".

Science.gov (United States)

Wax, Joseph R; Pinette, Michael G; Cartin, Angelina

2016-08-01

While health care workers comprise just 13% of the US workforce, they experience 60% of all workplace assaults. This violence is the second leading cause of fatal occupational injury. Women comprise 45% of the US labor force but 80% of health care workers, the highest proportion of females in any industry. The purpose was to describe the prevalence, forms, and consequences of health care workplace violence (WPV). The role and components of prevention programs for avoiding or mitigating violence are discussed, including opportunities for participation by obstetrician-gynecologists. A search of PubMed from 1990 to February 1, 2016, identified relevant manuscripts. Additional studies were found by reviewing the manuscripts' references. Government Web sites were visited for relevant data, publications, and resources. Health care WPV continues to rise despite an overall decrease in US WPV. While workers are most likely to be assaulted by clients or patients, they are most frequently bullied and threatened by coworkers. All incidents are markedly underreported in the absence of physical injury or lost work time. Sequelae include physical and psychological trauma, adverse patient outcomes, and perceived lower quality of care. The human, societal, and economic costs of health care WPV are enormous and unacceptable. Comprehensive prevention, planning, and intervention offer the best means of mitigating risks. As women's health physicians and health care workers, obstetrician-gynecologists should be encouraged to participate in such efforts.

A Performance Analysis of Public Expenditure on Maternal Health in Mexico.

Science.gov (United States)

Servan-Mori, Edson; Avila-Burgos, Leticia; Nigenda, Gustavo; Lozano, Rafael

2016-01-01

We explore the relationship between public expenditure, coverage of adequate ANC (including timing, frequent and content), and the maternal mortality ratio--adjusted by coverage of adequate ANC--observed in Mexico in 2012 at the State level. Additionally, we examine the inequalities and concentration of public expenditure between populations with and without Social Security. Results suggest that in the 2003-2011 period, the public expenditure gap between women with and without Social Security decreased 74%, however, the distribution is less equitable among women without Social Security, across the States. Despite high levels of coverage on each dimension of ANC explored, coverage of adequate ANC was lower among Social Security than non-Social Security women. This variability results in differences up to 1.5 times in State-adjusted maternal mortality rate at the same level of expense and maternal mortality rate, respectively. The increase in the economic resources is only a necessary condition for achieving improved health outcomes. Providing adequate health services and achieving efficient, effective and transparent use of resources in health, are critical elements for health systems performance. The attainment of universal effective coverage of maternal health and reducing maternal mortality in Mexico, requires the adjustment of policy innovations including the rules of allocation and execution of health resources. Health policies should be designed on a more holistic view promoting a balance between accessibility, effective implementation and rigorous stewardship.

Current and emerging occupational safety and health (OSH) issues in the healthcare sector, including home and community care

NARCIS (Netherlands)

Jong, T. de; Bos, E.; Pawlowska-Cyprysiak, K.; Hildt-Ciupinska, K.; Malinska, M.; Nicolescu, G.; Trifu, A.

2014-01-01

This report gives an overview of the current and emerging OSH issues for health- and social care workers and how these affect their safety and health at work and influence the quality of care they provide. It combines a literature review and the responses received to a questionnaire sent to OSH

High dietary fiber intake is associated with decreased inflammation and all-cause mortality in patients with chronic kidney disease

OpenAIRE

Raj Krishnamurthy, Vidya M.; Wei, Guo; Baird, Bradley C.; Murtaugh, Maureen; Chonchol, Michel B.; Raphael, Kalani L.; Greene, Tom; Beddhu, Srinivasan

2011-01-01

Chronic kidney disease is considered an inflammatory state and a high fiber intake is associated with decreased inflammation in the general population. Here, we determined whether fiber intake is associated with decreased inflammation and mortality in chronic kidney disease, and whether kidney disease modifies the associations of fiber intake with inflammation and mortality. To do this, we analyzed data from 14,543 participants in the National Health and Nutrition Examination Survey III. The ...

Changes in public health workforce composition: proportion of part-time workforce and its correlates, 2008-2013.

Science.gov (United States)

Leider, Jonathon P; Shah, Gulzar H; Castrucci, Brian C; Leep, Carolyn J; Sellers, Katie; Sprague, James B

2014-11-01

State and local public health department infrastructure in the U.S. was impacted by the 2008 economic recession. The nature and impact of these staffing changes have not been well characterized, especially for the part-time public health workforce. To estimate the number of part-time workers in state and local health departments (LHDs) and examine the correlates of change in the part-time LHD workforce between 2008 and 2013. We used workforce data from the 2008 and 2013 National Association of County and City Health Officials (n=1,543) and Association of State and Territorial Health Officials (n=24) profiles. We employed a Monte Carlo simulation to estimate the possible and plausible proportion of the workforce that was part-time, over various assumptions. Next, we employed a multinomial regression assessing correlates of the change in staffing composition among LHDs, including jurisdiction and organizational characteristics, as well measures of community involvement. Nationally representative estimates suggest that the local public health workforce decreased from 191,000 to 168,000 between 2008 and 2013. During that period, the part-time workforce decreased from 25% to 20% of those totals. At the state level, part-time workers accounted for less than 10% of the total workforce among responding states in 2013. Smaller and multi-county jurisdictions employed relatively more part-time workers. This is the first study to create national estimates regarding the size of the part-time public health workforce and estimate those changes over time. A relatively small proportion of the public health workforce is part-time and may be decreasing. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Decreasing asthma morbidity

African Journals Online (AJOL)

1994-12-12

Dec 12, 1994 ... Apart from the optimal use of drugs, various supplementary methods have been tested to decrease asthma morbidity, usually in patients from reiatively affluent socio-economic backgrounds. A study of additional measures taken in a group of moderate to severe adult asthmatics from very poor socio- ...

Marital violence and women's reproductive health care in Uttar Pradesh, India.

Science.gov (United States)

Sudha, S; Morrison, Sharon

2011-01-01

Although the impact of marital violence on women's reproductive health is recognized globally, there is little research on how women's experience of and justification of marital violence in developing country settings is linked to sexually transmitted infection (STI) symptom reporting, and seeking care for the symptoms. This study analyzes data on 9,639 currently married women from India's 2006-2007 National Family Health Survey-3 from the Central/Northern Indian state of Uttar Pradesh. The likelihood of currently married women's reporting STIs or symptoms, and the likelihood of seeking care for these, are analyzed using multivariate logistic regression techniques. Currently married women's experience of physical, sexual, and emotional marital violence in the last 12 months was significantly associated with greater likelihood of reporting a STI or symptom (odds ratio [OR], 1.364 [95% confidence interval (CI), 1.171-1.588] for physical violence; OR, 1.649 [95% CI, 1.323-2.054] for sexual violence; OR, 1.273 [95% CI, 1.117-1.450] for emotional violence). Experience of physical violence (OR, 0.728; 95% CI, 0.533-0.994) and acceptance of any justification for physical violence (OR, 0.590; 95% CI, 0.458-0.760) were significantly associated with decreased chance of seeking care, controlling for other factors. This study suggests that experiencing marital violence may have a negative impact on multiple aspects of women's reproductive health, including increased self-report of STI symptoms. Moreover, marital physical violence and accepting justification for such violence are associated with decreased chance of seeking care. Thus, policies and programs to promote reproductive health should incorporate decreasing gender-based violence, and overcoming underlying societal gender inequality. Copyright © 2011 Jacobs Institute of Women's Health. Published by Elsevier Inc. All rights reserved.

Profiling of the Tox21 Chemical Collection for Mitochondrial Function to Identify Compounds that Acutely Decrease Mitochondrial Membrane Potential

Science.gov (United States)

Attene-Ramos, Matias S.; Huang, Ruili; Michael, Sam; Witt, Kristine L.; Richard, Ann; Tice, Raymond R.; Simeonov, Anton; Austin, Christopher P.

2014-01-01

Background: Mitochondrial dysfunction has been implicated in the pathogenesis of a variety of disorders including cancer, diabetes, and neurodegenerative and cardiovascular diseases. Understanding whether different environmental chemicals and druglike molecules impact mitochondrial function represents an initial step in predicting exposure-related toxicity and defining a possible role for such compounds in the onset of various diseases. Objectives: We sought to identify individual chemicals and general structural features associated with changes in mitochondrial membrane potential (MMP). Methods: We used a multiplexed [two end points in one screen; MMP and adenosine triphosphate (ATP) content] quantitative high throughput screening (qHTS) approach combined with informatics tools to screen the Tox21 library of 10,000 compounds (~ 8,300 unique chemicals) at 15 concentrations each in triplicate to identify chemicals and structural features that are associated with changes in MMP in HepG2 cells. Results: Approximately 11% of the compounds (913 unique compounds) decreased MMP after 1 hr of treatment without affecting cell viability (ATP content). In addition, 309 compounds decreased MMP over a concentration range that also produced measurable cytotoxicity [half maximal inhibitory concentration (IC50) in MMP assay/IC50 in viability assay ≤ 3; p Tice RR, Simeonov A, Austin CP, Xia M. 2015. Profiling of the Tox21 chemical collection for mitochondrial function to identify compounds that acutely decrease mitochondrial membrane potential. Environ Health Perspect 123:49–56; http://dx.doi.org/10.1289/ehp.1408642 PMID:25302578

Implementing a Public Health Approach to Addressing Mental Health Needs in a University Setting: Lessons and Challenges

Science.gov (United States)

Parcover, Jason; Mays, Sally; McCarthy, Amy

2015-01-01

The mental health needs of college students are placing increasing demands on counseling center resources, and traditional outreach efforts may be outdated or incomplete. The public health model provides an approach for reaching more students, decreasing stigma, and addressing mental health concerns before they reach crisis levels. Implementing a…

State of Health and Quality of Life of Women at Advanced Age

Science.gov (United States)

Pinkas, Jarosław; Gujski, Mariusz; Humeniuk, Ewa; Raczkiewicz, Dorota; Bejga, Przemysław; Owoc, Alfred; Bojar, Iwona

2016-01-01

Background Evaluation of the state of health, quality of life, and the relationship between the level of the quality of life and health status in a group of women at an advanced age (90 years of age and older) in Poland. Material/Methods The study was conducted in 2014 in an all-Polish sample of 870 women aged 90 years and older. The research instruments were: the authors’ questionnaire and several standardized tests: Katz Index of Independence in Activities of Daily Living (Katz ADL), Abbreviated Mental Test Score (AMTS), and the World Health Organization Quality of Life (WHOQOL)-BREF. The results of the study were statistically analyzed using significant t-test for mean and regression analysis. Results The majority of women at an advanced age suffered from chronic pain (76%) and major geriatric problems such as hypoacusis (81%), visual disturbances (69%) and urinary incontinence (60%); the minority of women at an advanced age suffered from falls and fainting (39%), stool incontinence (17%), severe functional impairment (24%), and cognitive impairment (10%). On a scale of 1 to 5, women at an advanced age assessed positively for overall quality of life (mean 3.3), social relationships (3.5), and environment (3.2), but negatively for general health, physical health, and psychological health (2.7, 2.7, and 2.8, respectively). The presence of chronic pain and geriatric problems, including urinary and stool incontinences, falls and faint ing, visual disturbances and hypoacusis, significantly decreased overall quality of life; general health, physical health, psychological health, social relationships, and environment. Overall quality of life, general health, physical health, psychological health, social relationships, and environment was correlated with functional and cognitive impairments. Conclusions Quality of life of women at an advanced age decreased if chronic pain, major geriatric problems, or functional or cognitive impairments occurred. PMID:27580565

Strategies for decreasing nitrous oxide emissions from agricultural sources

Energy Technology Data Exchange (ETDEWEB)

Oenema, O. [AB-DLO, Wageningen (Netherlands)

1999-08-01

Following the Kyoto Conference of 1997, declaring the urgency of implementing strategies for decreasing greenhouse gas emissions, there are several valid arguments to examine the opportunities for reducing nitrous oxide emissions from agriculture. This paper provides a review of the state-of-the-art of emission reduction, discusses two strategies for decreasing emissions and identifies various gaps in current knowledge in this field and the need for relevant scientific research. The two strategies discussed are (1) increasing the nitrogen use efficiency toward the goal of lowering total nitrogen input, and (2) decreasing the release of nitrous oxide per unit of nitrogen from the processes of nitrification and denitrification. Increasing nitrogen use efficiency is thought to be the most effective strategy. To that end, the paper discusses several practical actions and measures based on decisions at tactical and operational management levels. Knowledge gaps identified include (1) incomplete understanding of nitrogen cycling in farming systems, (2) incomplete quantitative understanding of emission controlling factors, (3) information gap between science and policy, and (4) information gap between science and practice. Appropriate research needs are suggested for each of these areas. It is suggested that the highest priority should be given to improving the understanding of emission controlling factors in the field and on the farm. 23 refs., 2 figs.

Effects of health information technology on malpractice insurance premiums.

Science.gov (United States)

Kim, Hye Yeong; Lee, Jinhyung

2015-04-01

The widespread adoption of health information technology (IT) will help contain health care costs by decreasing inefficiencies in healthcare delivery. Theoretically, health IT could lower hospitals' malpractice insurance premiums (MIPs) and improve the quality of care by reducing the number and size of malpractice. This study examines the relationship between health IT investment and MIP using California hospital data from 2006 to 2007. To examine the effect of hospital IT on malpractice insurance expense, a generalized estimating equation (GEE) was employed. It was found that health IT investment was not negatively associated with MIP. Health IT was reported to reduce medical error and improve efficiency. Thus, it may reduce malpractice claims from patients, which will reduce malpractice insurance expenses for hospitals. However, health IT adoption could lead to increases in MIPs. For example, we expect increases in MIPs of about 1.2% and 1.5%, respectively, when health IT and labor increase by 10%. This study examined the effect of health IT investment on MIPs controlling other hospital and market, and volume characteristics. Against our expectation, we found that health IT investment was not negatively associated with MIP. There may be some possible reasons that the real effect of health IT on MIPs was not observed; barriers including communication problems among health ITs, shorter sample period, lower IT investment, and lack of a quality of care measure as a moderating variable.

Increased physical activity decreases periodontitis risk in men

International Nuclear Information System (INIS)

Merchant, Anwar T.; Pitiphat, Waranuch; Rimm, Eric B.; Joshipura, Kaumudi

2003-01-01

Background: Increased physical activity improves insulin sensitivity and glucose metabolism, and may therefore affect incidence of periodontitis. Methods: We studied the association of physical activity, walking and periodontitis in 39,461 male, US based, health professionals, 40-75 years old at baseline, more than half of whom were dentists, being followed up continuously since 1986. Participants were free of periodontitis, coronary heart disease and stroke at the start of follow-up. Physical activity and periodontitis were measured by validated questionnaires (expressed in metabolic equivalents - METs); the first report of professionally diagnosed periodontitis was considered a case. Results: Periodontitis risk decreased by 3% for every 10-MET increase in average physical activity after adjustment for age, smoking, diabetes, BMI, alcohol consumption and total calories (RR = 0.97; 95% CI: 0.95-0.99). The inverse trend remained significant in the categorical analysis. Compared to men in the lowest quintile of physical activity, those in the highest quintile had a 13% lower risk of periodontitis (RR = 0.87; 95% CI: 0.76-1.01, p-value, test for trend = 0.02). In a sub-sample of men with radiographs (n = 137) the physically active had less average bone loss (β = -0.29, p-value = 0.03) after multivariate adjustment compared to those inactive. Conclusions: In this large-scale prospective study, we found an inverse, linear association between sustained physical activity and periodontitis independent of known risk factors. The benefits of a physically active lifestyle may extend to periodontal health

Increasing help-seeking and referrals for individuals at risk for suicide by decreasing stigma: the role of mass media.

Science.gov (United States)

Niederkrotenthaler, Thomas; Reidenberg, Daniel J; Till, Benedikt; Gould, Madelyn S

2014-09-01

Increasing help-seeking and referrals for at-risk individuals by decreasing stigma has been defined as Aspirational Goal 10 in the National Action Alliance for Suicide Prevention's Research Prioritization Task Force's 2014 prioritized research agenda. This article reviews the research evidence on the impact of mass media awareness campaigns on reducing stigma and increasing help-seeking. The review will focus on both beneficial and iatrogenic effects of suicide preventive interventions using media campaigns to target the broad public. A further focus is on collaboration between public health professionals and news media in order to reduce the risk of copycat behavior and enhance help-seeking behavior. Examples of multilevel approaches that include both mass media interventions and individual-level approaches to reduce stigma and increase referrals are provided as well. Multilevel suicide prevention programs that combine various approaches seem to provide the most promising results, but much more needs to be learned about the best possible composition of these programs. Major research and practice challenges include the identification of optimal ways to reach vulnerable populations who likely do not benefit from current awareness strategies. Caution is needed in all efforts that aim to reduce the stigma of suicidal ideation, mental illness, and mental health treatment in order to avoid iatrogenic effects. The article concludes with specific suggestions for research questions to help move this line of suicide research and practice forward. Copyright © 2014 American Journal of Preventive Medicine. Published by Elsevier Inc. All rights reserved.

Slow improvements of metal exposure, health- and breeding conditions of pied flycatchers (Ficedula hypoleuca) after decreased industrial heavy metal emissions

International Nuclear Information System (INIS)

Berglund, A.M.M.; Nyholm, N.E.I.

2011-01-01

The environment around metal industries, such as smelters, is often highly contaminated due to continuous deposition of metals. We studied nest box breeding populations of pied flycatchers (Ficedula hypoleuca) in a well-studied pollution gradient from a sulfide ore smelter in Northern Sweden, after reduced aerial metal emissions (by 93-99%) from the smelter. The deposition of arsenic, cadmium, copper and zinc (based on moss samples) reflected the reduced emissions fairly well. However, nestling pied flycatchers had similar concentrations of these elements and mercury in tissues (bone, liver and blood) and feces in the 2000s, as in the 1980s, when the emissions were substantially higher. The exposure to high metal concentrations in the close vicinity of the smelter resulted in inhibited ALAD activities, depressed hemoglobin and hematocrit levels and increased mortality of nestlings. Our results indicate that in the highly contaminated environment around the smelter, nestlings reflected the slowly cycling soil pool, rather than the atmospheric deposition, and the concentration in soils plays an important role for the response of pied flycatchers to reduced atmospheric deposition. - Highlights: → Pied flycatchers were studied in a pollution gradient from a sulfide smelter. → Metal emissions from the smelter have decreased substantially. → Nestling birds still had high metal concentrations in tissues. → Health and survival rates of nestlings were negatively affected. → Recovery of birds is not expected in the near future.

Slow improvements of metal exposure, health- and breeding conditions of pied flycatchers (Ficedula hypoleuca) after decreased industrial heavy metal emissions

Energy Technology Data Exchange (ETDEWEB)

Berglund, A.M.M., E-mail: asa.berglund@emg.umu.se; Nyholm, N.E.I.

2011-09-15

The environment around metal industries, such as smelters, is often highly contaminated due to continuous deposition of metals. We studied nest box breeding populations of pied flycatchers (Ficedula hypoleuca) in a well-studied pollution gradient from a sulfide ore smelter in Northern Sweden, after reduced aerial metal emissions (by 93-99%) from the smelter. The deposition of arsenic, cadmium, copper and zinc (based on moss samples) reflected the reduced emissions fairly well. However, nestling pied flycatchers had similar concentrations of these elements and mercury in tissues (bone, liver and blood) and feces in the 2000s, as in the 1980s, when the emissions were substantially higher. The exposure to high metal concentrations in the close vicinity of the smelter resulted in inhibited ALAD activities, depressed hemoglobin and hematocrit levels and increased mortality of nestlings. Our results indicate that in the highly contaminated environment around the smelter, nestlings reflected the slowly cycling soil pool, rather than the atmospheric deposition, and the concentration in soils plays an important role for the response of pied flycatchers to reduced atmospheric deposition. - Highlights: {yields} Pied flycatchers were studied in a pollution gradient from a sulfide smelter. {yields} Metal emissions from the smelter have decreased substantially. {yields} Nestling birds still had high metal concentrations in tissues. {yields} Health and survival rates of nestlings were negatively affected. {yields} Recovery of birds is not expected in the near future.

Multidisciplinary program for stress-related disease in primary health care

Directory of Open Access Journals (Sweden)

Eva Ekvall Hansson

2009-05-01

Full Text Available Eva Ekvall Hansson1, Eva Håkansson2, Annelie Raushed2, Anders Håkansson1 1Lund University, Department of Clinical Sciences in Malmö/General Practice, Malmö, Sweden; 2Primary Health Care Malmö, SwedenObjective: To describe a multidisciplinary program, given by an occupational therapist and a physiotherapist, for patients with stress-related disease in primary health care and to measure the effect of this program in terms of self-perceived health, degree of burnout, physical activity, symptoms, recreational activities, and psychological and physical well-being.Method: Retrospective study.Results: At measures after three months, the thirteen patients included in this study had improved in self-estimated health, measured with EuroQol-5D Visual Analogue Scale (p = 0.000, and in degree of burnout, measured with the Shirom–Melamed Burnout Questionnaire (p = 0.001. There was also a decrease in presence of headache, in physical activity and in satisfaction with leisure time, although not statistically significant. After six months, the improvements remained for all measures except physical activity. The patients were also satisfied with the program to a high degree, measured with Client Satisfaction Questionnaire (median 3.7.Conclusion: This descriptive study shows that a stress-management program, provided by a team including an occupational therapist and a physiotherapist in primary health care, is both feasible and effective in terms of self-estimated health, degree of burnout, and patient satisfaction. Keywords: stress-related health, burnout, occupational therapy, physiotherapy

Social inequalities in mental health in Norway: possible explanatory factors

Directory of Open Access Journals (Sweden)

Dalgard Odd

2008-12-01

Full Text Available Abstract Background It is well known that there is a social gradient in mental health, the prevalence of mental disorders stepwise increasing by lower social status. The reason for this, however, is not clear, and the purpose of the present study was to explore possible mediating factors between social status and mental health. Methods The study has a cross-sectional design, and was based on a nationwide survey in Oslo, Norway, counting 12 310 people in the age of 30–60 years. Immigrants from non-western countries were excluded. Socio-demographic data were gathered from existing registers, whereas data on health, psychosocial variables and life style were gathered by structured interview. As indicator of mental health was used a 10-items version of Hopkins Symptom Checklist, measuring psychological distress. Measures of general self-efficacy and sense of powerlessness was used as indicators of control of own life situation. Results A strong social gradient in mental health was found, the prevalence of psychological distress increasing by decreasing social status. Psychosocial factors, including self-efficacy, sense of powerlessness, control of work, social support and negative life events, in particular economic problems, as well as life style factors (physical exercise, BMI, smoking and somatic health, likewise showed a social gradient, all risk factors increasing by decreasing social status. When adjusting for the risk factors in multivariate statistical analyses, the social gradient in mental health was eliminated. Low self-efficacy and sense of powerlessness emerged as important explanatory factors, alongside with poor social support, economic problems, smoking and somatic disorder. Conclusion Both individual characteristics, supposedly linked to the personality, like low self-efficacy, and factors related to the actual life situation, like economic problems and a feeling of powerlessness, contribute to the social gradient in mental health

Measuring population health in Moldova: health expectancies

Directory of Open Access Journals (Sweden)

Cristina Avram

2018-05-01

Full Text Available Health measures are decisive for the development and implementation of population health policies. Monitoring health indicators can lead to improvements in health and decrease in the inequalities among subpopulations. The life expectancy at birth for the Moldovan population did not increase considerably during the last decades, due to the social and economic crisis which led to high mortality and poor health. In Moldova, no aggregated health indicators are utilized for health monitoring. Therefore, the authors calculated health indicators to assess the population health and argue their importance. Mortality and subjective data on self-perceived health and self-rated morbidity from the Household Budget Survey was used for constructing period morbidity-mortality tables. Thus, the authors applied Sullivan’s method to calculate the life expectancy in very good/good/fair health and the life expectancy without chronic morbidity for the period 2006 - 2015. The life expectancies in very good/good/fair health showed a compression of morbidity in the older ages for both sexes, and for rural and urban types of residence. The life expectancies without chronic morbidity for males and for urban dwellers demonstrated an expansion of morbidity. Although the life expectancy is slowly increasing, the trends in population health are contradictory, depending on the applied measures. The health expectancy indicators, based on self-perceived health, depict the actual situation in the population health. These indicators are becoming more essential with the ageing process and can be used for the tailoring of social and health policies and services to the real needs of the population.

The effect of community-based health management on the health of the elderly: a randomized controlled trial from China

Directory of Open Access Journals (Sweden)

Chao Jianqian

2012-12-01

Full Text Available Abstract Background An aging population poses significant challenges to health care in China. Health management has been implemented to reduce the costs of care, raise health service utilization, increase health knowledge and improve quality of life. Several studies have tried to verify the effectiveness of health management in achieving these goals worldwide. However, there have been insufficient randomized control trials (RCTs to draw reliable conclusions. The few small-scale studies conducted in China include mostly the general population rather than the elderly. Our study is designed to evaluate the impact of community-based health management on the health of the elderly through an RCT in Nanjing, China. Methods Two thousand four hundred participants, aged 60 or older and who gave informed consent, were randomly allocated 1:1 into management and control groups, the randomization schedule was concealed from community health service center staff until allocation. Community-based health management was applied in the former while the latter was only given usual care. After 18 months, three categories of variables (subjective grading health indices, objective health indices and health service utilization were measured based on a questionnaire, clinical monitoring and diagnostic measurements. Differences between the two groups were assessed before and after the intervention and analyzed with t-test, χ2-test, and multiple regression analysis. Results Compared with the control group, the management group demonstrated improvement on the following variables (P Conclusion Community-based health management improved both subjective grading health indices, objective health indices and decreased the number of outpatient clinic visits, demonstrating effectiveness in improving elderly health. Trial registration ChiCTR-OCH-11001716

Burden and health-related quality of life of eating disorders, including Avoidant/Restrictive Food Intake Disorder (ARFID), in the Australian population.

Science.gov (United States)

Hay, Phillipa; Mitchison, Deborah; Collado, Abraham Ernesto Lopez; González-Chica, David Alejandro; Stocks, Nigel; Touyz, Stephen

2017-01-01

Little is known about the epidemiology and health related quality of life (HRQoL) of the new DSM-5 diagnoses, Binge Eating Disorder (BED) and Avoidant/Restrictive Food Intake Disorder (ARFID) in the Australian population. We aimed to investigate the prevalance and burden of these disorders. We conducted two sequential population-based surveys including individuals aged over 15 years who were interviewed in 2014 ( n  = 2732) and 2015 ( n =3005). Demographic information and diagnostic features of DSM-5 eating disorders were asked including the occurrence of regular (at least weekly over the past 3 months) objective binge eating with levels of distress, extreme dietary restriction/fasting for weight/shape control, purging behaviors, overvaluation of shape and/or weight, and the presence of an avoidant/restrictive food intake without overvaluation of shape and/or weight. In 2014 functional impact or role performance was measured with the 'days out of role' question and in 2015, Health Related Quality of Life (HRQoL) was assessed with the Short Form -12 item questionnaire (SF-12v1). The 2014 and 2015 3-month prevalence of eating disorders were: anorexia nervosa-broad 0.4% (95% CI 0.2-0.7) and 0.5% (0.3-0.9); bulimia nervosa 1.1% (0.7-1.5) and 1.2% (0.9-1.7); ARFID 0.3% (0.1-0.5) and 0.3% (0.2-0.6). The 2015 3-month prevalence rates were: BED-broad 1.5% (1.1-2.0); Other Specified Feeding or Eating Disorder (OSFED) 3.2 (2.6-3.9); and Unspecified Feeding or Eating Disorder (UFED) 10.4% (0.9-11.5). Most people with OSFED had atypical anorexia nervosa and majority with UFED were characterised by having recurrent binge eating without marked distress. Eating disorders were represented throughout sociodemographic groups and those with bulimia nervosa and BED-broad had mean weight (BMI, kg/m 2 ) in the obese range. Mental HRQoL was poor in all eating disorder groups but particularly poor for those with BED-broad and ARFID. Individuals with bulimia nervosa, BED

Measurement properties of tools measuring mental health knowledge: a systematic review.

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Wei, Yifeng; McGrath, Patrick J; Hayden, Jill; Kutcher, Stan

2016-08-23

Mental health literacy has received great attention recently to improve mental health knowledge, decrease stigma and enhance help-seeking behaviors. We conducted a systematic review to critically appraise the qualities of studies evaluating the measurement properties of mental health knowledge tools and the quality of included measurement properties. We searched PubMed, PsycINFO, EMBASE, CINAHL, the Cochrane Library, and ERIC for studies addressing psychometrics of mental health knowledge tools and published in English. We applied the COSMIN checklist to assess the methodological quality of each study as "excellent", "good", "fair", or "indeterminate". We ranked the level of evidence of the overall quality of each measurement property across studies as "strong", "moderate", "limited", "conflicting", or "unknown". We identified 16 mental health knowledge tools in 17 studies, addressing reliability, validity, responsiveness or measurement errors. The methodological quality of included studies ranged from "poor" to "excellent" including 6 studies addressing the content validity, internal consistency or structural validity demonstrating "excellent" quality. We found strong evidence of the content validity or internal consistency of 6 tools; moderate evidence of the internal consistency, the content validity or the reliability of 8 tools; and limited evidence of the reliability, the structural validity, the criterion validity, or the construct validity of 12 tools. Both the methodological qualities of included studies and the overall evidence of measurement properties are mixed. Based on the current evidence, we recommend that researchers consider using tools with measurement properties of strong or moderate evidence that also reached the threshold for positive ratings according to COSMIN checklist.

The relationship between employer health insurance characteristics and the provision of employee assistance programs.

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Zarkin, G A; Garfinkel, S A

1994-01-01

Workplace drug and alcohol abuse imposes substantial costs on employers. In response, employers have implemented a variety of programs to decrease substance abuse in the workplace, including drug testing, health and wellness programs, and employee assistance programs (EAPs). This paper focuses on the relationship between enterprises' organizational and health insurance characteristics and the firms' decisions to provide EAPs. Using data from the 1989 Survey of Health Insurance Plans (SHIP), sponsored by the Health Care Financing Administration (HCFA), we estimated the prevalence of EAPs by selected organizational and health insurance characteristics for those firms that offer health insurance to their workers. In addition, we estimated logistic models of the enterprises' decisions to provide EAPs as functions of the extent of state substance abuse and mental health insurance mandates, state-level demographic variables, and organizational and health insurance characteristics. Our results suggest that state mandates and demographic variables, as well as organizational and health insurance characteristics, are important explanatory variables of enterprises' decisions to provide EAPs.

Persistent work-life conflict and health satisfaction - a representative longitudinal study in Switzerland.

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Knecht, Michaela K; Bauer, Georg F; Gutzwiller, Felix; Hämmig, Oliver

2011-04-29

The objectives of the present study were (1) to track work-life conflict in Switzerland during the years 2002 to 2008 and (2) to analyse the relationship between work-life conflict and health satisfaction, examining whether long-term work-life conflict leads to poor health satisfaction. The study is based on a representative longitudinal database (Swiss Household Panel), covering a six-year period containing seven waves of data collection. The sample includes 1261 persons, with 636 men and 625 women. Data was analysed by multi-level mixed models and analysis of variance with repeated measures. In the overall sample, there was no linear increase or decrease of work-life conflict detected, in either its time-based or strain-based form. People with higher education were more often found to have a strong work-life conflict (time- and strain-based), and more men demonstrated a strong time-based work-life conflict than women (12.2% vs. 5%). A negative relationship between work-life conflict and health satisfaction over time was found. People reporting strong work-life conflict at every wave reported lower health satisfaction than people with consistently weak work-life conflict. However, the health satisfaction of those with a continuously strong work-life conflict did not decrease during the study period. Both time-based and strain-based work-life conflict are strongly correlated to health satisfaction. However, no evidence was found for a persistent work-life conflict leading to poor health satisfaction.

Occupational health hazards among health care workers of Shahid Sadoughi Hospital

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F. Ghavidel

2007-04-01

Full Text Available Background and AimsBiological hazards exist throughout all healthcare settings and include airborne and blood borne pathogens. Health care workers are also subject to exposure to hazardous chemicals such as disinfectants and sterilizing agents. In addition to the traditional aforementioned categories of occupational hazards, health care workers experience the stress of being directly responsible for the care of very sick and dying patients, which, coupled with  increasing workloads, can seriously threaten their health and well-being.MethodsThe study population was all hospital staff (# 207, of whom198 health care workers eventually participated in the study. The questionnaires were administered to doctors, nurses and ward orderlies in Shahid Sadoughi Teaching Hospital Yazd, Iran. Data were analyzed by SPSS11.5 software using Fisher's exact and Chi square tests.ResultsThe common occupational health hazards were work-related stress (60.1%, bloodstains on skin (51%, needle-stick injuries (42.9%, assault from patients (21.2%, skin reaction (19.2%, sleep disturbance (15.2%, stew blood on mucosal (3.1% and use of drugs (4.5%. Nearly 4.5% of the staff used tranquilizers to cope with the work stress. A greater percentage of doctors compared to nurses and ward orderlies used safety precautions such as gloves, facemasks and aprons. 70.2% staff employed regular hand-washing after various procedures 68.2% of staff adopted regularly proper disposal of needles and sharps into separate puncture resistant containers. About 55.6% of the staff recap used needles.ConclusionIn according to frequent types of occupational related dangers, corporation between chiefs and members of health care center to decrease these seems wishful and we recommend preparing and distributing necessary guidelines with related awareness among these groups.

Home interventions are effective at decreasing indoor nitrogen dioxide concentrations.

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Paulin, L M; Diette, G B; Scott, M; McCormack, M C; Matsui, E C; Curtin-Brosnan, J; Williams, D L; Kidd-Taylor, A; Shea, M; Breysse, P N; Hansel, N N

2014-08-01

Nitrogen dioxide (NO2 ), a by-product of combustion produced by indoor gas appliances such as cooking stoves, is associated with respiratory symptoms in those with obstructive airways disease. We conducted a three-armed randomized trial to evaluate the efficacy of interventions aimed at reducing indoor NO2 concentrations in homes with unvented gas stoves: (i) replacement of existing gas stove with electric stove; (ii) installation of ventilation hood over existing gas stove; and (iii) placement of air purifiers with high-efficiency particulate air (HEPA) and carbon filters. Home inspection and NO2 monitoring were conducted at 1 week pre-intervention and at 1 week and 3 months post-intervention. Stove replacement resulted in a 51% and 42% decrease in median NO2 concentration at 3 months of follow-up in the kitchen and bedroom, respectively (P = 0.01, P = 0.01); air purifier placement resulted in an immediate decrease in median NO2 concentration in the kitchen (27%, P kitchen (20%, P = 0.05). NO2 concentrations in the kitchen and bedroom did not significantly change following ventilation hood installation. Replacing unvented gas stoves with electric stoves or placement of air purifiers with HEPA and carbon filters can decrease indoor NO2 concentrations in urban homes. Several combustion sources unique to the residential indoor environment, including gas stoves, produce nitrogen dioxide (NO2), and higher NO2 concentrations, are associated with worse respiratory morbidity in people with obstructive lung disease. A handful of studies have modified the indoor environment by replacing unvented gas heaters; this study, to our knowledge, is the first randomized study to target unvented gas stoves. The results of this study show that simple home interventions, including replacement of an unvented gas stove with an electric stove or placement of HEPA air purifiers with carbon filters, can significantly decrease indoor NO2 concentrations. © 2013 John Wiley & Sons A

A Big Five approach to self-regulation: personality traits and health trajectories in the Hawaii longitudinal study of personality and health.

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Hampson, Sarah E; Edmonds, Grant W; Barckley, Maureen; Goldberg, Lewis R; Dubanoski, Joan P; Hillier, Teresa A

2016-01-01

Self-regulatory processes influencing health outcomes may have their origins in childhood personality traits. The Big Five approach to personality was used here to investigate the associations between childhood traits, trait-related regulatory processes and changes in health across middle age. Participants (N = 1176) were members of the Hawaii longitudinal study of personality and health. Teacher assessments of the participants' traits when they were in elementary school were related to trajectories of self-rated health measured on 6 occasions over 14 years in middle age. Five trajectories of self-rated health were identified by latent class growth analysis: Stable Excellent, Stable Very Good, Good, Decreasing and Poor. Childhood Conscientiousness was the only childhood trait to predict membership in the Decreasing class vs. the combined healthy classes (Stable Excellent, Stable Very Good and Good), even after controlling for adult Conscientiousness and the other adult Big Five traits. The Decreasing class had poorer objectively assessed clinical health measured on one occasion in middle age, was less well-educated, and had a history of more lifespan health-damaging behaviors compared to the combined healthy classes. These findings suggest that higher levels of childhood Conscientiousness (i.e. greater self-discipline and goal-directedness) may prevent subsequent health decline decades later through self-regulatory processes involving the acquisition of lifelong healthful behavior patterns and higher educational attainment.

Perceived health competence predicts health behavior and health-related quality of life in patients with cardiovascular disease.

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Bachmann, Justin M; Goggins, Kathryn M; Nwosu, Samuel K; Schildcrout, Jonathan S; Kripalani, Sunil; Wallston, Kenneth A

2016-12-01

Evaluate the effect of perceived health competence, a patient's belief in his or her ability to achieve health-related goals, on health behavior and health-related quality of life. We analyzed 2063 patients hospitalized with acute coronary syndrome and/or congestive heart failure at a large academic hospital in the United States. Multivariable linear regression models investigated associations between the two-item perceived health competence scale (PHCS-2) and positive health behaviors such as medication adherence and exercise (Health Behavior Index) as well as health-related quality of life (5-item Patient Reported Outcome Information Measurement System Global Health Scale). After multivariable adjustment, perceived health competence was highly associated with health behaviors (pperceived health competence was associated with a decrease in health-related quality of life between hospitalization and 90days after discharge (pPerceived health competence predicts health behavior and health-related quality of life in patients hospitalized with cardiovascular disease as well as change in health-related quality of life after discharge. Patients with low perceived health competence may be at risk for a decline in health-related quality of life after hospitalization and thus a potential target for counseling and other behavioral interventions. Copyright © 2016 Elsevier Ireland Ltd. All rights reserved.

Iron supplementation decreases severity of allergic inflammation in murine lung.

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Laura P Hale

Full Text Available The incidence and severity of allergic asthma have increased over the last century, particularly in the United States and other developed countries. This time frame was characterized by marked environmental changes, including enhanced hygiene, decreased pathogen exposure, increased exposure to inhaled pollutants, and changes in diet. Although iron is well-known to participate in critical biologic processes such as oxygen transport, energy generation, and host defense, iron deficiency remains common in the United States and world-wide. The purpose of these studies was to determine how dietary iron supplementation affected the severity of allergic inflammation in the lungs, using a classic model of IgE-mediated allergy in mice. Results showed that mice fed an iron-supplemented diet had markedly decreased allergen-induced airway hyperreactivity, eosinophil infiltration, and production of pro-inflammatory cytokines, compared with control mice on an unsupplemented diet that generated mild iron deficiency but not anemia. In vitro, iron supplementation decreased mast cell granule content, IgE-triggered degranulation, and production of pro-inflammatory cytokines post-degranulation. Taken together, these studies show that iron supplementation can decrease the severity of allergic inflammation in the lung, potentially via multiple mechanisms that affect mast cell activity. Further studies are indicated to determine the potential of iron supplementation to modulate the clinical severity of allergic diseases in humans.

The impact of the minimum wage on health.

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Andreyeva, Elena; Ukert, Benjamin

2018-03-07

This study evaluates the effect of minimum wage on risky health behaviors, healthcare access, and self-reported health. We use data from the 1993-2015 Behavioral Risk Factor Surveillance System, and employ a difference-in-differences strategy that utilizes time variation in new minimum wage laws across U.S. states. Results suggest that the minimum wage increases the probability of being obese and decreases daily fruit and vegetable intake, but also decreases days with functional limitations while having no impact on healthcare access. Subsample analyses reveal that the increase in weight and decrease in fruit and vegetable intake are driven by the older population, married, and whites. The improvement in self-reported health is especially strong among non-whites, females, and married.

Pelvic Belt Effects on Health Outcomes and Functional Parameters of Patients with Sacroiliac Joint Pain

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Hammer, Niels; Möbius, Robert; Schleifenbaum, Stefan; Hammer, Karl-Heinz; Klima, Stefan; Lange, Justin S.; Soisson, Odette; Winkler, Dirk; Milani, Thomas L.

2015-01-01

Introduction The sacroiliac joint (SIJ) is a common source of low back pain. However, clinical and functional signs and symptoms correlating with SIJ pain are widely unknown. Pelvic belts are routinely applied to treat SIJ pain but without sound evidence of their pain-relieving effects. This case-control study compares clinical and functional data of SIJ patients and healthy control subjects and evaluates belt effects on SIJ pain. Methods 17 SIJ patients and 17 healthy controls were included in this prospective study. The short-form 36 survey and the numerical rating scale were used to characterize health-related quality of life in patients in a six-week follow-up and the pain-reducing effects of pelvic belts. Electromyography data were obtained from the gluteus maximus, biceps femoris, rectus femoris and medial vastus. Alterations of muscle activity, variability and gait patterns were compared in patients and controls along with the belts’ effects in a dynamic setting when walking. Results Significant improvements were observed in the short-form 36 survey of the SIJ patients, especially in the physical health subscores. Minor declines were also observed in the numerical rating scale on pain. Belt-related changes of muscle activity and variability were similar in patients and controls with one exception: the rectus femoris activity decreased significantly in patients with belt application when walking. Further belt effects include improved cadence and gait velocity in patients and controls. Conclusions Pelvic belts improve health-related quality of life and are potentially attributed to decreased SIJ-related pain. Belt effects include decreased rectus femoris activity in patients and improved postural steadiness during locomotion. Pelvic belts may therefore be considered as a cost-effective and low-risk treatment of SIJ pain. Trial Registration ClinicalTrials.gov NCT02027038 PMID:26305790

Decreasing harsh discipline in mothers at risk for maltreatment: a randomized control trial.

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Pereira, Mariana; Negrão, Mariana; Soares, Isabel; Mesman, Judi

2014-01-01

This study tested the effectiveness of the attachment-based program Video-feedback Intervention to promote Positive Parenting and Sensitive Discipline (VIPP-SD; F. Juffer, M.J. Bakermans-Kranenburg, & M.H. van IJzendoorn, 2008) in decreasing harsh discipline of 43 mothers and their 1- to 4-year-old-children from severely deprived families. Based on previous studies, parenting stress was tested as a potential moderator of intervention effects on harsh discipline. Using a randomized control design, maternal harsh discipline was observed during home visits at the pretest and posttest, and mothers filled in questionnaires at both assessments. The VIPP-SD proved to be effective in decreasing maternal harsh discipline, but only for mothers who experienced higher levels of parenting stress at intake. These findings provide support for the program's ability to improve parenting in families who are most at risk for harsh parenting and for potentially maltreating child-parent interactions. The results are discussed in terms of the VIPP-SD elements most relevant to decreasing harsh discipline, and the challenges of parenting interventions in severely deprived populations. © 2014 Michigan Association for Infant Mental Health.

Reading About the Flu Online: How Health-Protective Behavioral Intentions Are Influenced by Media Multitasking, Polychronicity, and Strength of Health-Related Arguments.

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Kononova, Anastasia; Yuan, Shupei; Joo, Eunsin

2017-06-01

As health organizations increasingly use the Internet to communicate medical information and advice (Shortliffe et al., 2000; World Health Organization, 2013), studying factors that affect health information processing and health-protective behaviors becomes extremely important. The present research applied the elaboration likelihood model of persuasion to explore the effects of media multitasking, polychronicity (preference for multitasking), and strength of health-related arguments on health-protective behavioral intentions. Participants read an online article about influenza that included strong and weak suggestions to engage in flu-preventive behaviors. In one condition, participants read the article and checked Facebook; in another condition, they were exposed only to the article. Participants expressed greater health-protective behavioral intentions in the media multitasking condition than in the control condition. Strong arguments were found to elicit more positive behavioral intentions than weak arguments. Moderate and high polychronics showed greater behavioral intentions than low polychronics when they read the article in the multitasking condition. The difference in intentions to follow strong and weak arguments decreased for moderate and high polychronics. The results of the present study suggest that health communication practitioners should account for not only media use situations in which individuals typically read about health online but also individual differences in information processing, which puts more emphasis on the strength of health-protective suggestions when targeting light multitaskers.

Aging and decreased glomerular filtration rate: An elderly population-based study.

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Regina C R M Abdulkader

Full Text Available Although a reduced glomerular filtration rate (GFR in old people has been attributed to physiologic aging, it may be associated with kidney disease or superimposed comorbidities. This study aims to assess the prevalence of decreased GFR in a geriatric population in a developing country and its prevalence in the absence of simultaneous diseases.This is a cross-sectional study of data from the Saúde, Bem-Estar e Envelhecimento cohort study (SABE study[Health, Well-Being and Aging], a multiple cohorts study. A multistage cluster sample composed of 1,253 individuals representative of 1,249,388 inhabitants of São Paulo city aged ≥60 years in 2010 was analyzed. The participants answered a survey on socio-demographic factors and health, had blood pressure measured and urine and blood samples collected. GFR was estimated and defined as decreased when 0.20 g/g.The prevalence of GFR <60 mL/min/1.73m2 was 19.3%. Individuals with GFR <60 mL/min/1.73m2 were older (75±1 versus 69±1 years, p<0.001, had lower schooling (18 versus 30% with complete 8-year basic cycle, p = 0.010, and higher prevalence of hypertension (82 versus 63%, p<0.001, diabetes (34 versus 26%, p = 0.021, cardiovascular disease (43 versus 24%, p<0.001 and kidney damage (35% versus 15%, p<0.001. Only 0.7% of the entire studied population had GFR <60 mL/min/1.73m2 without simultaneous diseases or kidney damage. Among the individuals with GFR <60 mL/min/1.73m2, 3.5% had neither renal damage nor associated comorbidities, whereas among those with GFR ≥60 mL/min/1.73m2, 11.0% had none of these conditions. Logistic regression showed that older age, cardiovascular disease and hypertension were associated with GFR<60 mL/min/1.73m2.Decreased GFR was highly prevalent among the geriatric population in a megalopolis of a developing country. It was rarely present without simultaneous chronic comorbidities or kidney damage.

Race/Ethnicity and Health-Related Quality of Life Among LGBT Older Adults.

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Kim, Hyun-Jun; Jen, Sarah; Fredriksen-Goldsen, Karen I

2017-02-01

Few existing studies have addressed racial/ethnic differences in the health and quality of life of lesbian, gay, bisexual, and transgender (LGBT) older adults. Guided by the Health Equity Promotion Model, this study examines health-promoting and health risk factors that contribute to racial/ethnic health disparities among LGBT adults aged 50 and older. We utilized weighted survey data from Aging with Pride: National Health, Aging, and Sexuality/Gender Study. By applying multiple mediator models, we analyzed the indirect effects of race/ethnicity on health-related quality of life (HRQOL) via demographics, lifetime LGBT-related discrimination, and victimization, and socioeconomic, identity-related, spiritual, and social resources. Although African Americans and Hispanics, compared with non-Hispanic Whites, reported lower physical HRQOL and comparable psychological HRQOL, indirect pathways between race/ethnicity and HRQOL were observed. African Americans and Hispanics had lower income, educational attainment, identity affirmation, and social support, which were associated with a decrease in physical and psychological HRQOL. African Americans had higher lifetime LGBT-related discrimination, which was linked to a decrease in their physical and psychological HRQOL. African Americans and Hispanics had higher spirituality, which was associated with an increase in psychological HRQOL. Findings illustrate the importance of identifying both health-promoting and health risk factors to understand ways to maximize the health potential of racially and ethnically diverse LGBT older adults. Interventions aimed at health equity should be tailored to bolster identity affirmation and social networks of LGBT older adults of color and to support strengths, including spiritual resources. © The Author 2017. Published by Oxford University Press on behalf of The Gerontological Society of America. All rights reserved. For permissions, please e-mail: journals.permissions@oup.com.

Mental Health Service Use for Patients with Co-occurring Mental and Physical Chronic Health Care Needs in Primary Care Settings

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Haynes-Maslow, Lindsey; Roberts, Megan C.; Dusetzina, Stacie B.

2016-01-01

Background Individuals with mental illness experience poor health and may die prematurely from chronic illness. Understanding whether the presence of co-occurring chronic physical health conditions complicates mental health treatment is important, particularly among patients seeking treatment in primary care settings. Objectives Examine (1) whether the presence of chronic physical conditions is associated with mental health service use for individuals with depression who visit a primary care physician, and (2) whether race modifies this relationship. Research Design Secondary analysis of the National Ambulatory Medical Care Survey, a survey of patient-visits collected annually from a random sample of 3,000 physicians in office-based settings. Subjects Office visits from 2007–2010 were pooled for adults ages 35–85 with a depression diagnosis at the time of visit (N=3,659 visits). Measures Mental health services were measured using a dichotomous variable indicating whether mental health services were provided during the office visit or a referral made for: (1) counseling, including psychotherapy and other mental health counseling and/or (2) prescribing of psychotropic medications. Results Most patient office visits (70%) where a depression diagnosis was recorded also had co-occurring chronic physical conditions recorded. The presence of at least one physical chronic condition was associated with a 6% decrease in the probability of receiving any mental health services (pneeded on medical care delivery among patients with co-occurring health conditions, particularly as the health care system moves towards an integrated care model. PMID:26147863

Decreased Time from 9-1-1 Call to PCI among Patients Experiencing STEMI Results in a Decreased One Year Mortality.

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Studnek, Jonathan R; Infinger, Allison; Wilson, Hadley; Niess, Gary; Jackson, Patrick; Swanson, Doug

2018-03-29

The impact on mortality due to prompt recognition of ST-segment Elevation Myocardial Infarction (STEMI) patients by EMS has not been well described. The objective of this study was to describe the association between the time interval, 9-1-1 call to percutaneous intervention (PCI), and mortality at one year. This retrospective analysis included patients that were transported by EMS as a "code STEMI" and underwent PCI.  Total time from 9-1-1 call to PCI was calculated for each patient and was the independent variable of interest. Each patient's mortality status at one year was the outcome variable, collected by querying medical records and the national death index. Confounding variables were abstracted from hospital records. Logistic regression was conducted to determine the likelihood of survival given differences in time to PCI. A total of 550 patients were included in the analyses of which 68% were male with an average age 59.8 (SD 12.8). Mean reperfusion time was 81.8 min (SD 20.0) and was significantly lower in patients alive at one year (80.8 min, SD 19.7) vs. deceased at one year (93.9 min, SD 19.6), respectively. Odds of survival at one year decreased by 3% (OR 0.97; 95% CI 0.96-0.99) for every one minute increase in time to PCI. This relationship practically represents a 30% increase in mortality for every 10 minute delay from 9-1-1 call to PCI. The model produced suggests that a linear relationship exists between time to PCI and mortality in the prehospital environment with the probability of survival decreasing significantly as time to PCI increases.

Can formalizing links among community health workers, accredited drug dispensing outlet dispensers, and health facility staff increase their collaboration to improve prompt access to maternal and child care? A qualitative study in Tanzania.

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Dillip, Angel; Kimatta, Suleiman; Embrey, Martha; Chalker, John C; Valimba, Richard; Malliwah, Mariam; Meena, John; Lieber, Rachel; Johnson, Keith

2017-06-19

In Tanzania, progress toward achieving the 2015 Millennium Development Goals for maternal and newborn health was slow. An intervention brought together community health workers, health facility staff, and accredited drug dispensing outlet (ADDO) dispensers to improve maternal and newborn health through a mechanism of collaboration and referral. This study explored barriers, successes, and promising approaches to increasing timely access to care by linking the three levels of health care provision. The study was conducted in the Kibaha district, where we applied qualitative approaches with in-depth interviews and focus group discussions. In-depth interview participants included retail drug shop dispensers (36), community health workers (45), and health facility staff members (15). We conducted one focus group discussion with district officials and four with mothers of newborns and children under 5 years old. Relationships among the three levels of care improved after the linkage intervention, especially for ADDO dispensers and health facility staff who previously had no formal communication pathway. The study participants perceptions of success included improved knowledge of case management and relationships among the three levels of care, more timely access to care, increased numbers of patients/customers, more meetings between community health workers and health facility staff, and a decrease in child and maternal mortality. Reported challenges included stock-outs of medicines at the health facility, participating ADDO dispensers who left to work in other regions, documentation of referrals, and lack of treatment available at health facilities on the weekend. The primary issue that threatens the sustainability of the intervention is that local council health management team members, who are responsible for facilitating the linkage, had not made any supervision visits and were therefore unaware of how the program was running. The study highlights the benefits of

The Impact of Health Care Restructuring on Nosocomial Infections and Transmission of Antimicrobial Resistant Organisms

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J Conly

2001-01-01

Full Text Available The past decade has seen a dramatic change in Canadian health care as the treatment of many patients shifts from the hospital setting to the home or other alternative health care settings (1. Complex advances in technology and significant changes in the funding environment have also precipitated many changes in the functional capacity of our health care system. The portion of the total Canadian health care expenditures that has been allocated to hospitals and other institutions has declined steadily over the past two decades (2,3. This reduction in institutional-based funding reflects the need to develop a system that improves the use of out-of-hospital sites for delivery of health care services and decreases reliance on the specific institutional component of the health care sector. Recent data reveal that Canadian hospital discharge rates have decreased by 14% between 1994 and 1998, and there has been a reduction in the length of stay from 7.4 to 7 days (4. In conjunction with a reduction in the number of hospital beds, there has been a massive shift in the proportion of surgeries that are performed on an outpatient basis. Further developments in the delivery of care include the increased use of telehealth, which allows health care professionals to provide increasingly complex services centralized hospital sites to outlying areas.

Health and Disability: Partnerships in Health Care

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Tracy, Jane; McDonald, Rachael

2015-01-01

Background: Despite awareness of the health inequalities experienced by people with intellectual disability, their health status remains poor. Inequalities in health outcomes are manifest in higher morbidity and rates of premature death. Contributing factors include the barriers encountered in accessing and receiving high-quality health care.…

Can changes in psychosocial factors and residency explain the decrease in physical activity during the transition from high school to college or university?

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Van Dyck, Delfien; De Bourdeaudhuij, Ilse; Deliens, Tom; Deforche, Benedicte

2015-04-01

When students make the transition from high school to college or university, their physical activity (PA) levels decrease strongly. Consequently, it is of crucial importance to identify the determinants of this decline in PA. The study aims were to (1) examine changes in psychosocial factors in students during the transition from high school to college/university, (2) examine if changes in psychosocial factors and residency can predict changes in PA, and (3) investigate the moderating effects of residency on the relationship between changes in psychosocial factors and changes in PA. Between March 2008 and October 2010, 291 Flemish students participated in a longitudinal study, with baseline measurements during the final year of high school and follow-up measurements at the start of second year of college/university. At both time points, participants completed a questionnaire assessing demographics, active transportation, leisure-time sports, psychosocial variables, and residency. Repeated measures MANOVA analyses and multiple moderated hierarchic regression analyses were conducted. Modeling, self-efficacy, competition-related benefits, and health-related, external and social barriers decreased, while health-related benefits and time-related barriers increased from baseline to follow-up. Decreases in modeling and time-related barriers were associated with a decrease in active transportation (adjusted R(2) = 3.2%); residency, decreases in self-efficacy, competition-related benefits, and increases in health- and time-related barriers predicted a decrease in leisure-time sports (adjusted R(2) = 29.3%). Residency only moderated two associations between psychosocial factors and changes in PA. Residency and changes in psychosocial factors were mainly important to explain the decrease in leisure-time sports. Other factors such as distance to college/university are likely more important to explain the decrease in active transportation; these are worth exploring in

Consumer health information seeking in social media: a literature review.

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Zhao, Yuehua; Zhang, Jin

2017-12-01

The objective of this literature review was to summarise current research regarding how consumers seek health-related information from social media. Primarily, we hope to reveal characteristics of existing studies investigating the health topics that consumers have discussed in social media, ascertaining the roles social media have played in consumers' information-seeking processes and discussing the potential benefits and concerns of accessing consumer health information in social media. The Web of Science Core Collection database was searched for existing literature on consumer health information seeking in social media. The search returned 214 articles, of which 21 met the eligibility criteria following review of full-text documents. Between 2011 and 2016, twenty-one studies published explored various topics related to consumer information seeking in social media. These ranged from online discussions on specific diseases (e.g. diabetes) to public health concerns (e.g. pesticide residues). Consumers' information needs vary depending on the health issues of interest. Benefits of health seeking on social media, in addition to filling a need for health information, include the social and emotional support health consumers gain from peer-to-peer interactions. These benefits, however, are tempered by concerns of information quality and authority and lead to decreased consumer engagement. © 2017 Health Libraries Group.

Do the health benefits of cycling outweigh the risks?

OpenAIRE

Hartog,Jeroen Johan de; Boogaard,Hanna; Nijland,Hans; Hoek,Gerard

2011-01-01

BACKGROUND: Although from a societal point of view a modal shift from car to bicycle may have beneficial health effects due to decreased air pollution emissions, decreased greenhouse gas emissions, and increased levels of physical activity, shifts in individual adverse health effects such as higher exposure to air pollution and risk of a traffic accident may prevail.Objective: We describe whether the health benefits from the increased physical activity of a modal shift for urban commutes outw...

Impact of the 2008 global financial crisis on the health of Canadians: repeated cross-sectional analysis of the Canadian Community Health Survey, 2007-2013.

Science.gov (United States)

Nour, Sabrina; Labonté, Ronald; Bancej, Christina

2017-04-01

Despite a clear impact on the Canadian economy, little is known about the subsequent health impacts of the 2008 global financial crisis (GFC) in this country. This study fills this gap in knowledge by conducting a repeated cross-sectional analysis of the Canadian Community Health Survey (CCHS). Data from 7 cycles (2007-2013) of the CCHS were combined to form a large data set representative of the Canadian working-age population (15-64 years) residing in 1 of 10 provinces. A logistic regression model was used to determine whether exposure to various periods of the GFC resulted in increased odds of reporting poor mental health. Exposure was categorised into 4 periods based on political and economic indicators, as follows: precrisis period (baseline), initial crisis period, stimulus period and austerity period. Other outcomes investigated included: anxiety disorders (AD), mood disorders (MD), poor physical health and health-related behaviours (heavy alcohol drinking (HAD) and decreased fruit/vegetable consumption (FVC)). A significant increased odds of reporting poor mental health was observed during the austerity period compared with the precrisis period (OR=1.26 (1.16 to 1.32)); findings remain significant when adjusted for sex, marital status and education. Exposure to the austerity period was also significantly associated with increased odds of reporting AD, MD, HAD and decreased odds of FVC. No significant associations were observed for the poor self-perceived physical health variable. Statistically significant associations were observed between several negative health outcomes and the austerity period when compared with the precrisis period. Austerity has been linked to worsening health in other studies and represents an example of how the policy response can have greater detrimental impact on health than the financial crisis itself. Published by the BMJ Publishing Group Limited. For permission to use (where not already granted under a licence) please go to

Breaking down the silos to decrease internal diversions and patient flow delays.

Science.gov (United States)

Driscoll, Molly; Tobis, Kristen; Gurka, David; Serafin, Frederick; Carlson, Elizabeth

2015-01-01

Hospitals strive to admit patients to the units where caregiver competencies align with the patient's condition. When the hospital's census peaks, internal diversions and the associated risks increase, which are intensified when silos exist, as segregated care negatively impacts collaboration and patient safety. In this study, a 600+-bed academic, tertiary care specialty hospital experienced an increase in internal diversions. Within the neuroscience service line, emergent neuroscience transfers from outside hospitals had been declined or internally diverted because of capacity limitations. Formalized processes for improving collaboration between health care providers related to capacity issues were required to decrease internal diversions and improve patient flow and patient safety. A pilot project was conducted on neuroscience units during a process improvement initiative. A hospital-wide internal diversion plan was developed, identifying primary and secondary placement options for all patients requiring hospitalization to support patient flow and patient safety. Forecasting tools were developed to provide units' leadership with current information on expected admissions. Daily capacity huddles were instituted to increase collaboration between patient care units. The interventions trialed during the pilot decreased internal diversions and improved patient flow. The improved collaboration resulted in an 80% decrease in declinations of emergent intensive care unit transfers from outside hospitals due to capacity limitations and a 50% decrease in the number of these patients being internally diverted to alternate intensive care units. The interventions implemented minimized internal diversions and improved patient flow. The transparency of the patient placement process led to an increased collaboration between all participants.