Effect of GNI on Infant Mortality Rate in Low Income, Lower Middle Income, Upper Middle Income and High Income Countries.

Global disparities in health form a complex issue adversely affecting much of the world's population. What has been found is that national income and other general socio-economic factors are strong determinants of population health (Houweling, 2005 & Schell, 2007). In countries where resources are less, people are much less healthy than people living in rich countries. In wealthier countries that have made immense progress in health indicators, the resulting change in age structure and morbidity and mortality patterns portends even greater financial demands on the health sector. This study noted the trends in several health indicators versus economic indicators and related it to low income, lower middle income, upper middle income and high income countries. We noted that there is improvement in all health indicators along with an increasing GNI per Capita and GDP. In low income regions though, the rate of improvement is slower as opposed to high income countries. However, there is progress, which is leading to an increase in aging population.

QUANTITATIVE ASSESSMENT OF SOME PREVENTIVE HEALTH SERVICES PROVIDED FOR ADOLESCENT INDIVIDUALS IN DUBAI.

The United Arab Emirate (UAE) of Dubai, faces significant adolescent health problems. In 2009, evidence based clinical guidelines were developed for primary health care professionals in Dubai to help reduce adolescent health problems. This research study explores adolescents' self-reports about health education services received between 2008 and 2010. The sample consisted of 730 public high school students in grades 10 through 12 between the ages of 15 and 19. 357 (48.9%) of the sample were males and 373 (51.1%) were female. The major language spoken in the home was Arabic (77.4%). All students completed a 27-item survey in Arabic that was adapted from the Young Adult Health Care Survey (YAHCS). The YAHCS is a 56-item research instrument traditionally administered in English and Spanish. The sample reported they had received little or no health education from their health care providers. 94.2% reported receiving no information about using a helmet for bicycle and motorbike safety; 88.2% reported receiving no information about drug use; and 81.9% reported that they received no information about smoking. The instrument also explored the health education material students received within the last 12 months. 65.5% of the sample reported seeing and/or hearing safety tips; 84.9% reported hearing and/or seeing health information about healthy diet, physical activity and exercise; and 79.2% reported seeing and/or hearing information about the risks of smoking and substance abuse.

Health policies and intervention strategies: a description of current issues and approaches to care of the public health and health care system in the United Arab emirates.

The demographic factors of the United Arab Emirates (UAE) have changed drastically within one generation. This is evident in how quickly it has moved from a developing nation, where fishing was once the main source of income, to a country that is quite developed, competing on a global level. From one perspective, socio-economic progress has brought many benefits to the population. These include improved education, better access to health care, and safe drinking water. However, on the other hand, economic development has been the cause for changes in lifestyles, eating habits, and traditional societal and family structures. Over time, these changes have added up, creating an unprecedented impact on the population's health. This impact has crept up onto the society until suddenly a notable epidemic has become recognized in the country. According to the UAE Ministry of Health, 19.5 percent of the UAE population has diabetes, making it the second highest rate in the world. The structure and responsibilities of the current UAE health care systems along with other cultural factors were investigated in order to determine their impact on the growing epidemic.

Health insurance reform and the development of health insurance plans: the case of the Emirate of Abu Dhabi, UAE.

INTRODUCTION: The Emirate of Abu Dhabi has taken concrete steps to reform health insurance by improving the access to health providers as well as freedom of choice. The growing cost of health care and the impact of the global financial crisis have meant that countries are no longer able to solely bear the cost. As a result many countries have sought to overhaul their health care system so as to share the burden of provision with the private sector whether it is health care plan providers or employers. OBJECTIVES: This article explores and discusses how the policy issues inherent in private health care schemes have been dealt with by the Emirate of Abu Dhabi. METHODS: Data was collected in early 2013 on health care plans in Abu Dhabi from government sources. RESULTS: The Abu Dhabi model has private sector involvement but the government sets prices and benefits. The Abu Dhabi model adequately deals with the problem of adverse selection through making insurance coverage a mandatory requirement. There are issues with moral hazards, which are a combination of individual and medical practitioner behavior that might affect the efficiency of the system. Over time there is a general increase in the usage of medical services, which may be reflective of greater awareness of the policy and its benefits as well as lifestyle change. CONCLUSION: Although the current health care system level of usage is adequate for the current population, as the level of usage increases, the government may face a financial burden. Therefore, the government needs to place safeguards in order to limit its exposure. The market for medical treatment needs to be made more competitive to reduce monopolistic behavior. The government needs to make individuals aware of a healthier lifestyle and encourage precautionary actions.

Estimating the unit costs of public hospitals and primary healthcare centers.

BACKGROUND: Many factors have affected the rise of health expenditures, such as high-cost medical technologies, changes in disease patterns and increasing demand for health services. All countries allocate a significant portion of resources to the health sector. In 2008, the gross domestic product of Palestine was estimated to be at $6.108bn (current price) or about $1697 per capita. Health expenditures are estimated at 15.6% of the gross domestic product, almost as much as those of Germany, Japan and other developed countries. The numbers of hospitals, hospital beds and primary healthcare centers in the country have all increased. The Ministry of Health (MOH) currently operates 27 of 76 hospitals, with a total of 3074 beds, which represent 61% of total beds of all hospitals in the Palestinian Authorities area. Also, the MOH is operating 453 of 706 Primary Health Care facilities. By 2007, about 40 000 people were employed in different sectors of the health system, with 33% employed by the MOH. AIM: This purpose of this study was to develop a financing strategy to help cover some or all of the costs involved in operating such institutions and to estimate the unit cost of primary and secondary programs and departments. METHODS: A retrospective study was carried out on data from government hospitals and primary healthcare centers to identify and analyze the costs and output (patient-related services) and to estimate the unit cost of health services provided by hospitals and PHCs during the year 2008. All operating costs are assigned and allocated to the departments at MOH hospitals and primary health care centers (PPHCs) and are identified as overhead departments, intermediate-service and final-service departments. Intermediate-service departments provide procedures and services to patients in the final-service departments. The costs of the overhead departments are distributed to the intermediate-service and final-service departments through a step-down method, according to allocation criteria devised to resemble as closely as possible the actual use of resources by each of the departments. The data were analyzed using spss. Data cleaning was carried out by cross-validating the results through conducting cross-tabulations between the hospital/center and section/program to identify errors from the data collection or entry process. Depreciation of assets and the consumption of capital costs are ignored in this study, as it is difficult to evaluate the MOH facilities owing to a lack of recording of depreciation of assets or other costs of servicing capital assets. RESULTS: Inpatient costs contributed about 75% of all costs, whereas outpatient services contributed the remaining 25% of total costs. The average cost per visit was $13.00 for outpatient departments, whereas the average cost per patient day for inpatient departments was $90.00. As for the unit cost for each department, intensive care unit and intermediate care unit services were the highest among all categories of daily hospital services ($208.00). This is in contrast to surgical operations ($124.00), specialized surgeries ($106.00), delivery department ($99.00), orthopedics ($98.50) and general surgery ($85.00). The lowest unit cost was found in the neonatology department ($72.00). In PHCs, the unit cost per visit was highest for psychiatry programs ($26.00), followed by other programs ($21.50), chronic diseases ($21.00), maternal and child health ($11.50), preventive programs ($9.00) and general medicine ($6.50). The exchange rate listed by The Wall Street Journal as of Wednesday August 25, 2010 is 1 US dollar = 3.82 new Israeli shekel (NIS). CONCLUSION: The findings have implications for policy and decision making in the health sector in Palestine concerning the cost of services provided by hospitals and PHCs. The availability of a standardized data set for cost assessment would greatly enhance and improve the quality of financial information as well as efficiency in the use of scarce resources.

The impact of computerized physician order entry on medication errors and adverse drug events.

OBJECTIVES: Medication errors and adverse drug events (ADEs) are common, costly, and clinically important problems. This research was conducted to determine whether computerized physician order entry (CPOE) improves the quality of care by increasing patient safety and decreasing medication errors at the King Fahad Medical City Hospital (KFMCH) of the Kingdom of Saudi Arabia (KSA). METHODS: The study utilized a cross-sectional research design. Questionnaires were distributed to physicians in various departments who used the system for more than six months. The study was conducted in Riyadh at KFMCH, which is the largest medical complex hospital in the Middle East, in the outpatient setting. KEY FINDINGS: Ninety-three physicians participated in the study; the response rate was 31 percent. Only descriptive analyses were conducted. Results showed that 88 percent of the physicians agreed that the use of CPOE improved their performance and 76 percent reported that the use of CPOE increased their productivity. In addition, 56 percent of the participants agreed that CPOE was a simple system and 64 percent reported that it was easy to use. However, 44 percent of the physicians agreed that CPOE lacked a user guide during medication ordering and 55 percent reported that it created new types of errors. Results showed that 234 physicians always changed their order, 179 physicians changed their order often, 175 physicians rarely changed their order, and 74 physicians never changed their order. Furthermore, 72 percent of the physicians agreed that CPOE helped them to decrease ADEs. Finally, 91 percent of the physicians agreed that CPOE reduced errors related to hand-written prescriptions.

Competition among Turkish hospitals and its effect on hospital efficiency and service quality.

The level of competition among hospitals in Turkey was analyzed for the years 1990 through 2006 using the Herfindahl-Hirschman Index (HHI). Multiple and simple regression analyses were run to observe the development of competition among hospitals over this period of time, to examine likely determinants of competition, and to calculate the effects of competition on efficiency and quality in individual hospitals. This study found that the level of competition among hospitals in Turkey has increased throughout the years. Also, competition has had a positive effect on the efficiency of hospitals; however, it did not have a significant positive effect on their quality. Moreover, there are important differences in the level of competition among hospitals that vary according to the geographical region, the type of ownership, and the type of hospital. This study is one of the first to evaluate the effects of health policies on competition as well as the effects of increasing competition on hospital quality and efficiency in Turkey.

Estimation of health care costs and cost recovery: the case of Rafidya Hospital in Palestine.

The purpose of this study is to develop an estimation model for health care costs and cost recovery, and evaluate service sustainability under an uncertain environment. The Palestinian National Authority's recent focus on improving financial accountability supports the need to research health care costs in the Palestinian territories. We examine data from Rafidya Hospital from 2005-2009 and use step-down allocation to distribute overhead costs. We use an ingredient approach to estimate the costs and revenues of health services, and logarithmic estimation to prospectively estimate the demand for 2011. Our results indicate that while cost recovery is generally insufficient for long-term sustainability, some services can recover their costs in the short run. Our results provide information useful for health care policy makers in setting multiple-goal policies related to health care financing in Palestine, and provide an important initiative in the estimation of health service costs.

Adopting customers' empowerment and social networks to encourage participations in e-health services.

The aim of this article is to present an e-health model that embeds empowerment and social network intervention that may extend the role of customers in health care settings. A 25-item Likert-type survey instrument was specifically developed for this study and administered to a sample of 108 participants in Indonesia from October to November 2012. The data were analyzed to provide ideas on how to move forward with the e-health initiative as a means to improve e-health services. The survey revealed that there is a high demand for customers' empowerment and involvement in social networks to improve their health literacy and customer satisfaction. Regardless of the limitations of the study, the participants have responded with great support for the abilities of the prototype systems drawn from the survey. The survey results were used as requirements to develop a system prototype that incorporates the expectations of the people. The prototype (namely Clinic 2.0) was derived from the model and confirmed from the survey. Participants were selected to use the system for three months, after which we measured its impact towards their health literacy and customer satisfaction. The results show that the system intervention through Clinic 2.0 leads to a high level of customer satisfaction and health literacy.

Evaluating the Financial Performances of the Publicly Held Healthcare Companies in Crisis Periods in Türkiye.

The purpose of this study was to evaluate the financial performances of the publicly held healthcare companies in crisis periods in Türkiye. The 2018 economic crisis and the COVID-19 pandemic crisis were included in the study as the crisis periods. We collected the financial data of the publicly held healthcare companies and calculated three liquidity, three turnover, three leverage and three profitability ratios through ratio analysis to use as financial performance indicators. We then conducted Wilcoxon signed-rank tests and we performed separate analyses for the 2018 economic crisis and the COVID-19 pandemic crisis. The results of the analyses showed that there were no statistically significant differences between the publicly held healthcare companies' liquidity, turnover, leverage, profitability ratios and thus their financial performances before the crises and after the crises. While the results are reassuring and give valuable insights to managers and policy makers to determine the areas that needs to be strengthened to be better prepared for possible future crises, our sample was limited. Therefore, this study presents an exploratory foundation for future studies which are needed to make a case for financial stability for the publicly held healthcare companies before and after the crisis periods.

A comparative analysis of the CVP structure of nonprofit teaching and for-profit non-teaching hospitals.

Due to the market turbulence facing the hospital industry, the financial viability of teaching hospitals has been severely threatened. Their missions of education, research, and patient care even strengthen this crisis. Therefore, the objective of this study is to conduct a comparative analysis of the cost, volume, and profit (CVP) structure between large nonprofit urban teaching hospitals and small for-profit rural/suburban non-teaching hospitals. The following two hypotheses were developed: (1) large nonprofit urban teaching hospitals tend to have higher fixed cost, lower variable cost, lower total revenue adjusted by case mix index (CMI), and lower return on total assets (ROA); and (2) small for-profit rural/suburban non-teaching hospitals tend to have lower fixed cost, higher variable cost, higher total revenue adjusted by CMI, and higher ROA. Using 117 teaching hospitals and 102 non-teaching hospitals selected from the Medicare Cost Report database in 2005, the results from multiple regression indicated that large nonprofit teaching hospitals located in urban areas are more likely to have higher fixed cost and lower variable cost. While such cost structure doesn't necessarily affect their total revenue adjusted by CMI, it does lead to a lower return on hospitals' total assets. The results support our hypotheses in terms of fixed cost percentage, variable cost percentage, and ROA, but not total revenue adjusted by CMI. The results suggest that cost structure is significantly associated with hospitals' performance. Also, as teaching hospitals' portfolios of services and programs increase (e.g., provision of uncompensated care to Medicare and Medicaid patients and doing research), it becomes strategically necessary and critical to manage the allocation of resources or investments into the fixed capital that supports the business.

The Associations between Childhood Experiences and Occupational Choice Capability, and the Mediation of Societal Gender Roles.

Experiences in family, school, and social life during childhood are associated with gender roles and occupational choice capability. This study examines how competent individuals are in occupational choice capability and the relationships of childhood experiences and gender roles with their competencies in occupational choice capability. The research is composed of 805 individuals aged 18 and older, who reside in Turkey. In the research, we used the Personal Information Form, Childhood Experiences Scale, Gender Roles Attitude Scale, and The Scale of Occupational Choice Capability. The SPSS 25 program and PROCESS-Macro were used to analyze the variables. The relationship between the scales was investigated using Pearson correlation analysis and multiple regression analysis. According to the findings we obtained, individuals' family and school life were positively correlated with their career choices, and family function sexism harmed their choice of profession. We also found gender roles had a mediating role in the relationship between school life and career choice.

Cost-volume-profit analysis and expected benefit of health services: a study of cardiac catheterization services.

AIM: Academic research investigating health care costs in the Palestinian region is limited. Therefore, this study examines the costs of the cardiac catheterization unit of one of the largest hospitals in Palestine. We focus on costs of a cardiac catheterization unit and the increasing number of deaths over the past decade in the region due to cardiovascular diseases (CVDs). METHODS: We employ cost-volume-profit (CVP) analysis to determine the unit's break-even point (BEP), and investigate expected benefits (EBs) of Palestinian government subsidies to the unit. RESULTS: Findings indicate variable costs represent 56 percent of the hospital's total costs. Based on the three functions of the cardiac catheterization unit, results also indicate that the number of patients receiving services exceed the break-even point in each function, despite the unit receiving a government subsidy. CONCLUSIONS: Our findings, although based on one hospital, will permit hospital management to realize the importance of unit costs in order to make informed financial decisions. The use of break-even analysis will allow area managers to plan minimum production capacity for the organization. The economic benefits for patients and the government from the unit may encourage government officials to focus efforts on increasing future subsidies to the hospital.

The Psychological Consequences of COVID-19 Fear and the Moderator Effects of Individuals' Underlying Illness and Witnessing Infected Friends and Family.

The COVID-19 virus has become a fearful epidemic for people all over the world. In Turkey, long quarantine periods and curfews have increased both physical and psychological problems. Due to the rapid spread and substantial impact of the COVID-19 virus, different psychological effects were observed among different segments of society, such as among young people, elderly people, and active workers. Because of fear caused by the COVID-19 virus, it is thought that depression, stress, and anxiety levels have increased. It is estimated that there are more psychological issues for people with poor health and others whose friends or family became ill or have died because of COVID-19. To explore and test the situation mentioned above, we conducted a cross-sectional study in Turkey with 3287 participants above 16 years old. We measured COVID-19 fear, along with anxiety, stress, and depression levels (DASS21) and demographics. Firstly, we tested whether COVID-19 fear predicts stress, anxiety, and depression. Secondly, we investigated if the effect of COVID-19 fear is stronger for those who have underlying illness and for those whose friends or family became ill or have died because of COVID-19. The results showed that women and 16-25 years old youths have higher COVID-19-related fear, anxiety, depression, and stress. Furthermore, we found a significant relationship between COVID-19 fear and stress, anxiety, and depression, as well as significant moderation effects of having an underlying illness and having friends or family who were infected or have died. These results show the importance of implementing specific implementations, particularly for vulnerable groups, to minimize the psychological problems that may arise with the pandemic.

Why Are Turkish University Students Addicted to the Internet? A Moderated Mediation Model.

Internet addiction has become a significant problem that primarily affects young people. It has an essential effect on the individual's self-perception and assessment of their competencies. This study aimed to reveal whether there is a significant relationship between the level of internet addiction of university students and their age and self-esteem. For this purpose, internet addiction and self-esteem scales were used in addition to questions such as age, gender, the purpose of internet use, and internet daily usage time. We used a quantitative research method to obtain cross-sectional data from 400 Turkish young people using online surveys. Correlation, regression, mediation, and moderation analyses were performed using SPSS and the PROCESS macro plugin for data analysis. Internet addiction was significantly associated with self-esteem, gender, age, and daily internet usage. In addition, we discovered that self-esteem and daily usage time played a mediation role in the effect of the age variable on internet addiction. Moreover, the moderation roles of social networks, gender, and location in the impact of self-esteem on internet addiction were determined. With this study, we understood that as age increases, self-esteem triggers the decrease of internet addiction. In this sense, policies should be developed to increase self-esteem among young people to ensure the conscious use of the internet.

The Mediating Role of Gaming Disorder in the Effect of Narcissism on Happiness in Children.

We aimed to determine the relationship between gaming disorder, narcissism, and happiness levels of children between the ages of 9 and 15. This study was based on the compensation theory. The sample consists of 461 boys who continue their education in public schools in Istanbul. In the study, a mixed research design, which nests qualitative data into quantitative, was used. In addition to the scales and sociodemographic form, the Draw-a-Person test was also used to better understand children's inner world. According to the findings, there is a significant relationship between gaming disorder and narcissism and happiness levels in children. Accordingly, as narcissism increases in children, the gaming disorder level increases, and happiness decreases. We also found a mediation effect in the impact of narcissism on happiness through gaming disorder. According to the results, we think that the problem is not caused by the individual but by society. For a solution, we recommend making more macro-level social work interventions within the framework of system theory instead of the current medical model in combating gaming disorder.

The Role of Family Influence and Academic Satisfaction on Career Decision-Making Self-Efficacy and Happiness.

Careers are a reality of life that need to be considered as multi-dimensional in today's modern societies. Choosing a career is a complex process that coincides with high school and university ages, creating psycho-social stress. Considering the literature, the effects of different environmental factors have been revealed in separate studies. This study examines both individual and environmental factors together. By adopting a quantitative research method, we collected cross-sectional data through online questionnaires from 1130 university students. The association of family influence and academic satisfaction with happiness through career decision self-efficacy was meaningful using gender, age, income, and parents' education as control variables. Family influence and academic satisfaction were positively correlated with career decision self-efficacy and happiness. In conclusion, we found that family influence and support, students' work, and academic satisfaction are positively significant in terms of the career process and happiness. It was understood that the career reality should be considered with a holistic view that includes family, school, and work experience.

Investigation of the Effect of Social Media Addiction on Adults with Depression.

This study aimed to investigate the effects of social media addiction on depression in adult individuals. For this purpose, the researchers analyzed whether social media dependence had differing impacts according to various variables (age, gender, the highest level of education, duration of daily use of social media, frequency of social media use, etc.). A sample population of 419 people who live in different provinces in Turkey between 18 and 62 years of age participated in the research. The questionnaire form was developed to obtain the Social Media Dependence Scale (SMDS), Beck Depression Inventory scores, and demographic information from the participants. The research was conducted according to the general screening model. Significant differences were found between depression and social media dependency in variables such as the number of children, age, and income. As a result of the study, when social media addiction was examined in terms of gender among socio-demographic variables, no significant difference was found.

Disparities in adequate mental health care for past-year major depressive episodes among white and non-white youth.

OBJECTIVE: Following efforts made in recent years to have effective mental health treatments based on evidence-based guidelines, a working-definition of a minimum level of 'adequate mental health care (AMHC)' for serious mental illness (SMI) was developed in the literature. However, little is known about racial/ethnic disparities in receipt of adequate mental health care for SMI. The objective of this study was to examine disparities among Whites and non-Whites in receiving adequate mental health care for past-year major depressive episodes (MDE). METHODS: The study sample was 1,688 US youth 12 to 17 years old affected by MDE in the 2005 National Survey on Drug Use and Health. We estimated the percentages of Whites and non-Whites that received adequate mental health care for MDE and estimated the correlates of receipt of adequate mental health care for the full sample and by racial/ethnic groups. RESULTS: About 34 percent of the sample received adequate mental health care; but separate analyses indicate that a significantly higher proportion of Whites (36 percent) received adequate mental health care relative to non-Whites (28 percent). The odds of receiving adequate mental health care for past-year MDE for Whites were 1.5 times that of non-Whites (p = 0.01). CONCLUSION: As more adolescents of diverse racial/ethnic backgrounds are identified to access mental health Treatment services, it might be important to examine the degree to which treatment should be tailored to engage and retain specific racial/ethnic groups to get the minimum of adequate mental health care.

A psychosocial approach to dentistry for the underserved: incorporating theory into practice.

BACKGROUND: Dentistry for the underserved is more than an egalitarian social issue--it is a key factor in the health and social progress of our nation. The first signs or manifestations of several diseases such as varicella (i.e., chicken pox and shingles), STDs, and influenza become apparent in the oral cavity. The value of access to quality dentistry is an immeasurable factor in maintaining general medical health of people and fulfilling their psychosocial needs of pain reduction and enhanced cosmetics. In the United States, for the most part, only the middle and upper classes receive non-extraction, restorative, and prosthetic dentistry that is economically within their ability to pay. In addition, uninsured and poverty-level individuals often must face overwhelming long waiting lists, unnecessary referrals, lack of choice, and bureaucratic hurdles when seeking primary dental care. Therefore, it seems pertinent to put forth the question: What are the critical values and beliefs of psychosocial theory that can underscore the practice of dentistry for underserved populations in the United States? METHODS: The widely employed public health theory, the health belief model (HBM), is applied to evaluate psychosocial factors in dental care for the underserved. The HBM is used to predict and explain behavioral changes in dental health and associated belief patterns. RESULTS: The HBM as applied to dentistry for the underserved predicts self-perceptions of susceptibility and seriousness of dental disease, health status, cues to action, and self-efficacy. Furthermore, patients can make judgments about benefits, costs, and risks of dental treatment. CONCLUSIONS: A theoretical approach to dentistry employing the HBM, mediated by values and culture, can provide significant insights into patient thinking, beliefs, and perceptions. These insights can mediate access to and use of primary care dental services by underserved populations. PRACTICE IMPLICATIONS: Evidence-based practice (i.e., based on research using the scientific method) has been put forth as the future of modern dentistry. However, the practice of dentistry need not just be evidence-based, but have its roots clearly grounded in theory.