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2.
J Occup Environ Med ; 61(7): 610-616, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31090678

RESUMEN

OBJECTIVE: Estimate and compare the prevalence of Gulf War Illness (GWI) in male and female Gulf War veterans using Centers for Disease Control and Prevention (CDC) and modified Kansas case definitions. METHODS: Data from the landmark CDC Air Force Study of GW Air Force veterans is used. RESULTS: Nearly half of the deployed veterans met the GWI CDC case definition compared with 14% of non-deployed veterans. Only 29% met the definition using the modified Kansas criteria compared with 8% of non-deployed veterans. Deployed veterans and female veterans exhibited significantly higher GWI risk. Female GW veterans had higher rates of severe and mild-to-moderate cases of GWI. CONCLUSION: Results suggest increased GWI rates based on CDC and modified Kansas criteria among deployed and female veterans. Further research is needed to examine the chronic health outcomes of female GW veterans independently.

3.
Med Care ; 57(6): 407-409, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-30994524

RESUMEN

BACKGROUND: A high volume of emergency department (ED) visits in the rural United States may be the result of barriers to accessing primary care. The Affordable Care Act (ACA) increased the number of insured, which may improve patient access to primary care and therefore reduce ED utilization. The objective of this study is to estimate the trends and cost of ED utilization pre-ACA and post-ACA implementation in a rural United States. DATA AND METHODS: We use 2009-2013 ED utilization data from a rural Georgia hospital to estimate trends and costs by demographic characteristics, referring source, and payor information. T tests and log-linear regression models are used to assess the sociodemographic factors impacting ED inflation-adjusted costs before (2009-2010) and after ACA (2011-2013) implementation. RESULTS: During 2009-2013, 39,970 ED encounters were recorded with an average cost (AC) of $2002 per visit. Results indicate that during pre-ACA, on average, 8702 encounters were recorded per year with an AC of $1759. During post-ACA, there were 7521 annual visits, with an annual AC of $2241. Regression model results indicate that AC were significantly higher for men, older adults, nonblack patients, those with private insurance, and during the post-ACA period. CONCLUSIONS: Results suggest that post-ACA, declining ED visits may be due to more patients with insurance accessing primary care instead of ED. We further hypothesize that increased AC during this period may be due to ED visits being of an emergent nature, which require more resources to treat. Further comprehensive investigation is warranted to study the impact of ACA on ED utilization for nonemergency purposes among rural and nonrural hospitals.


Asunto(s)
Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Hospitales Rurales/economía , Hospitales Rurales/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Georgia , Humanos , Patient Protection and Affordable Care Act , Estados Unidos , Revisión de Utilización de Recursos
4.
Am J Occup Ther ; 73(1): 7301345010p1-7301345010p6, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-30839271

RESUMEN

OBJECTIVE: We investigated occupational therapy faculty beliefs about and perceptions of interprofessional education (IPE) and to identify differences in faculty positions on IPE between programs affiliated with an on-campus academic health care center (AHC) and programs not affiliated with an on-campus AHC. METHOD: Online surveys were distributed by email to 1,466 faculty at programs accredited by the Accreditation Council for Occupational Therapy Education. The results were described using descriptive statistics and cross-tabulations. RESULTS: Faculty responses supported the need for IPE. Ethics was ranked as the most important IPE competency among both the AHC and the non-AHC groups. IPE was more commonly included in the curriculum of programs with an on-campus AHC than in the curriculum of those without an AHC. CONCLUSION: The majority of occupational therapy faculty supported the need for IPE; however, many reported limitations with faculty or time constraints as barriers to IPE.


Asunto(s)
Docentes , Relaciones Interprofesionales , Terapia Ocupacional/educación , Curriculum , Humanos , Percepción
5.
Cyberpsychol Behav Soc Netw ; 22(1): 76-81, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30421985

RESUMEN

One of the most recent trends in technology field is the 360° technology. In order to investigate its potentiality for the evaluation of memory function, we compared participants' performance in two memory tasks between an encoding delivered through an immersive 360° environment and a non-immersive 360° one. Specifically, we investigated if the immersive 360° environment would facilitate memory encoding in comparison to the non-immersive 360° one. Forty-two participants visualized two 360° pictures of a bedroom containing specific items and items shared by the two rooms, either in the "non-immersive → immersive" order or in the "immersive → non-immersive" one. Results showed that the immersive set-up was able to strengthen the mnestic trace only when participants performed the tasks in the "non-immersive → immersive" order. A possible explanation is a potential familiarity with the technologies used to explore the 360° environments. Overall, these results only partially supported the effectiveness of immersive 360° technology in facilitating episodic memory encoding; future studies should further explore the potentiality of this innovative technology.


Asunto(s)
Memoria/fisiología , Pruebas Neuropsicológicas , Realidad Virtual , Humanos
6.
Am J Emerg Med ; 37(8): 1476-1481, 2019 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-30413364

RESUMEN

OBJECTIVES: Emergency Department (ED) utilization accounts for a large portion of healthcare services in the US. Disturbance of circadian rhythms may affect mental and behavioral health (MBH) conditions, which could result in increased ED visits and subsequent hospitalizations, thus potentially inducing staffing shortages and increasing ED wait time. Predicting the burden of ED admissions helps to better plan care at the EDs and provides significant benefits. This study investigates if increased ED visits for MBH conditions are associated with seasonality and changes in daylight savings time. METHODS: Using ED encounter data from a large academic medical center, we have examined univariate and multivariate associations between ED visits for MBH conditions and the annual time periods during which MBH conditions are more elevated due to changes in the seasons. We hypothesize that ED visits for MBH conditions increase within the 2-week period following the daylight savings time changes. RESULTS: Increased MBH ED visits were observed in certain seasons. This was especially true for non-bipolar depressive illness. We saw no significant changes in MBH visits as associated with changes in the daylight savings time. CONCLUSIONS: Data do not provide conclusive evidence of a uniform seasonal increase in ED visits for MBH conditions. Variation in ED MBH visits may be due to secular trends, such as socioeconomic factors. Future research should explore contemporaneous associations between time-driven events and MBH ED visits. It will allow for greater understanding of challenges regarding psychiatric patients and opportunities for improvement.

7.
Artículo en Inglés | MEDLINE | ID: mdl-29863176

RESUMEN

Background: There has been increasing interest in the use of web portals by patients with type 2 diabetes mellitus (T2DM). Studies of web portal use by patients with pre-diabetes have not been reported. To plan studies of web portal use by adult clinic patients seen for pre-diabetes and T2DM at an academic medical center, we examined characteristics of those who had or had not registered for a web portal. Methods: Electronic records were reviewed to identify web portal registration by patients treated for pre-diabetes or T2DM by age, sex, race and ethnicity. Results: A total of 866 patients with pre-diabetes and 2,376 patients with T2DM were seen in a family medicine outpatient clinic. About 41.5% of patients with pre-diabetes and 34.7% of those with T2DM had registered for the web portal. In logistic regression analysis, web portal registration among patients with T2DM was significantly associated with age 41-45 years, and with Hispanic ethnicity. Similar results were obtained for pre-diabetes except that the positive association with age 41-45 years and inverse association with Hispanic ethnicity were not statistically significant. Among patients with pre-diabetes or T2DM, Black men and Black women were less likely to have registered than their white counterparts. Patients who were aged 18-25 and >65 years were less likely to have registered for the web portal than those 26-65 years. Conclusions: Additional research is needed to identify portal design features that improve health outcomes for patients with pre-diabetes and T2DM and interventions that will increase use of patient portals by pre-diabetic and diabetic patients, especially among Black patients and older patients.

8.
BMC Health Serv Res ; 18(1): 401, 2018 06 04.
Artículo en Inglés | MEDLINE | ID: mdl-29866154

RESUMEN

BACKGROUND: The Government of Turkey has initiated a series of major health reforms in 2003 with an objective of increasing access to health care services and improving efficiency of public and private hospitals. This study attempts to understand the technical efficiency of public and private hospitals in Turkey to better guide hospital reform. METHODS: We use data from 1079 public and private hospitals and translog stochastic production frontier was adopted to estimate technical inefficiency of hospitals. RESULTS: Results indicate that there is no statistically significant difference in the degree of inefficiency of hospitals by geographic location or its level of economic development. Efficiency scores vary significantly across hospital types with Ministry of Health (MoH) General Hospitals being the most efficient followed by MoH teaching hospitals. Better performance of MoH hospitals may be due to successful implementation of 2003 health reforms in Turkey, which intended to improve resource utilization within and across MoH hospitals. Among MoH hospital types, integrated county hospitals were the least efficient. Since the hospital outcome measure did not include the value of medical training, efficiency scores of university hospitals became relatively low. Wide variability of efficiency scores of private general hospitals implies the existence of both highly efficient and inefficient hospitals in the private sector. CONCLUSIONS: Efficiency differences of various hospital types can be leveraged to guide future reforms by emphasizing the strengths of general hospitals and improving the referral system from county hospitals to general hospitals. Encouraging resource sharing across hospitals, as being done by the 2011 reforms, should further improve hospital efficiency. Promoting private hospitals may not necessarily be efficiency enhancing due to high variability of private hospitals in terms of efficiency scores. Similarly, implementation of common productivity standards and quality control measures are likely to improve hospital technical efficiency scores further.


Asunto(s)
Eficiencia Organizacional/normas , Reforma de la Atención de Salud , Hospitales Privados/organización & administración , Hospitales Públicos/organización & administración , Estudios Transversales , Eficiencia Organizacional/economía , Recursos en Salud , Hospitales Privados/economía , Hospitales Públicos/economía , Humanos , Innovación Organizacional/economía , Turquia
9.
Int J Med Inform ; 113: 43-48, 2018 05.
Artículo en Inglés | MEDLINE | ID: mdl-29602432

RESUMEN

OBJECTIVES: There is limited evidence about the association between health literacy and use of patient web portals in patients with chronic illnesses. The objective of this review was to learn more about health literacy and use of patient web portals. METHODS: Bibliographic searches were conducted in PubMed and CINAHL using relevant MeSH search terms and Boolean algebra commands. RESULTS: Qualitative studies and studies with a cross-sectional, cohort, or pre-/post-test design have shown that persons with limited health literacy are less likely to use patient web portals, although there is inconsistency in the association across studies. CONCLUSIONS: The conflicting findings may be partially due to racial and ethnic differences in health literacy or level of comfort in sharing private health information using mobile technologies. Several opportunities exist to improve the usability and acceptability of web portals for patients with limited health literacy including enhancements in the design of the portals, patient and provider education and training, and engagement of proxies such as caregivers and close family members.


Asunto(s)
Alfabetización en Salud , Registros de Salud Personal , Portales del Paciente , Humanos , Participación del Paciente
10.
Artículo en Inglés | MEDLINE | ID: mdl-29377041

RESUMEN

Background: To determine the number of adult clinic patients seen for type 2 diabetes mellitus (T2DM) at an academic medical center and to examine characteristics of those who had or had not registered for a web portal. Methods: Electronic records were reviewed to identify web portal registration by patients treated for T2DM by age, sex, race and Hispanic ethnicity, and service (General Internal Medicine, Endocrinology). Results: A total of 1,401 patients with T2DM were seen in General Internal Medicine and Endocrinology outpatient clinics. Less than one third (32%) had registered for the web portal. Women were more likely to have registered for the web portal than men [odds ratio (OR) =1.25; 95% CI, 0.99-1.57; P<0.063]. Black patients were less likely to have registered than whites (OR =0.40; 95% CI, 0.31-0.51; P<0.001). Patients who were 18-25 years of age were less likely to have registered for the web portal, along with those who were 56 to 60 and >66 years of age. In multivariate analysis, a statistically significant association was observed between web portal registration and General Internal Medicine clinic vs. Endocrinology clinic (OR =2.96, P<0.001). Inverse associations were observed with age >18-25 years, male sex (adjusted OR =0.71, P=0.006), and Black race (OR =0.33, P<0.001). Conclusions: Additional research is needed to identify portal design features that improve glycemic control and interventions that will increase use of patient portals, especially among Black patients with T2DM and those with low health literacy or computer literacy.

11.
Clinicoecon Outcomes Res ; 9: 677-683, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29138585

RESUMEN

Background: Catheter ablation of atrioventricular nodal reentrant tachycardia (AVNRT) is a commonly performed electrophysiology (EP) procedure. Few data exist comparing conventional (CONV) versus novel ablation strategies from both clinical and direct cost perspectives. We sought to investigate the disposable costs and clinical outcomes associated with three different ablation methodologies used in the ablation of AVNRT. Methods: We performed a retrospective review of AVNRT ablations performed at Augusta University Medical Center from 2006 to 2014. A total of 183 patients were identified. Three different ablation techniques were compared: CONV manual radiofrequency (RF) (n=60), remote magnetic navigation (RMN)-guided RF (n=67), and cryoablation (CRYO) (n=56). Results: Baseline demographics did not differ between the three groups except for a higher prevalence of cardiomyopathy in the RMN group (p<0.01). The clinical end point of interest was recurrent AVNRT following the index ablation procedure. A significantly higher number of recurrent AVNRT cases occurred in the CRYO group as compared to CONV and RMN (p=0.003; OR =7.75) groups. Cost-benefit analysis showed both CONV and RMN to be dominant compared to CRYO. Cost-minimization analysis demonstrated the least expensive ablation method to be CONV (mean disposable catheter cost = CONV US$2340; CRYO US$3515; RMN US$5190). Despite comparable clinical outcomes, the incremental cost of RMN over CONV averaged US$3094 per procedure. Conclusion: AVNRT ablation using either CONV or RMN techniques is equally effective and associated with lower AVNRT recurrence rates than CRYO. CONV ablation carries significant disposable cost savings as compared to RMN, despite similar efficacy.

12.
Artículo en Inglés | MEDLINE | ID: mdl-29034324

RESUMEN

INTRODUCTION: In the 25 years since the 1990-1991 Gulf War (GW), studies have evaluated Gulf War Illness (GWI), sometimes referred to as medically unexplained multi symptom illness, and other medical and neurological conditions in women GW veterans. MATERIALS AND METHODS: In this article, we review epidemiologic studies of the health of women who served in the 1990-1991 GW based upon bibliographic searches in PubMed and CINAHL with relevant search terms through September 2015. RESULTS: A total of 56 articles were identified in the bibliographic searches. By screening abstracts or full-text articles, a total of 21 relevant studies were identified. Results from some studies, but not all, suggest that GWI is more common in women GW veterans than their male counterparts. Few studies of GW veterans focused on women's health. A small number of studies suggested excess rates of woman's health problems, e.g., breast cysts, abnormal Papanicolaou (Pap) smears, yeast infections, and bladder infections. Several studies have identified significantly elevated rates of birth defects and adverse reproductive outcomes among GW veterans. However, findings have varied with different study designs and sample sizes, with some studies showing elevated risks of stillbirths, miscarriages, and/or birth defects and others have not. In some studies, participants reported increased risks of ectopic pregnancies and spontaneous abortions. CONCLUSION: Further research is needed to provide a comprehensive picture of the health of women GW veterans and to examine a broad range of women's health issues including adverse reproductive outcomes. Some deployment-related health problems only become apparent decades later and other conditions may worsen or improve over time. Assessments are needed of current health status, changes in health symptoms and conditions over time, and possible differences in health outcomes associated with specific experiences and exposures during the war. Future studies would be strengthened by assessing GWI symptom patterns that may be specific to women veterans, examine diagnosed medical conditions among women veterans, and evaluate changes in women's health over time, including changes potentially associated with menopause and age.

13.
Risk Manag Healthc Policy ; 10: 33-40, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-28435342

RESUMEN

BACKGROUND: Efforts aimed at health care reform and continued advances in information technologies have prompted interest among providers and researchers in patient web portals. Patient web portals are password-protected online websites that offer the patients 24-hour access to personal health information from anywhere with an Internet connection. METHODS: This article, which is based upon bibliographic searches in PubMed, reviews important developments in web portals for primary and secondary disease prevention, including patient web portals tethered to electronic medical records, disease-specific portals, health disparities, and health-related community web portals. RESULTS: Although findings have not been uniformly positive, several studies of the effectiveness of health care system patient portals in chronic disease management have shown promising results with regard to patient outcomes. Patient web portals have also shown promising results in increasing adherence with screening recommendations. Racial and ethnic minorities, younger persons, and patients who are less educated or have lower health literacy have been found to be less likely to use patient portals. CONCLUSION: Additional studies are needed of the utility and effectiveness of different elements of web portals for different patient populations. This should include additional diseases and health topics such as smoking cessation and weight management.

14.
Respir Care ; 62(7): 873-881, 2017 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-28292972

RESUMEN

BACKGROUND: Interprofessional education (IPE) improves collaboration and patient care through joint education between health professions. Respiratory therapy (RT) faculty were surveyed to evaluate their knowledge and attitudes toward IPE. We report current opportunities for IPE from faculty and compare responses from associate's, bachelor's, and master's degree programs and profit versus nonprofit institutions. METHODS: We developed an online survey based on IPE literature and questions modified for the RT discipline. The survey was distributed by email to 874 faculty from the Commission on Accreditation for Respiratory Care accredited programs. RESULTS: The response rate was 33%. Faculty identified IPE as an important component of RT education (n = 207, 80%) but reported challenges in integrating IPE into current curriculum. Overall, communication was ranked as the most important IPE competency (n = 104, 39%) and ethics least important (n = 131, 49%). When asked how many credit hours are required to teach IPE, 48% of respondents reported that they were unsure of an appropriate time requirement. Significant differences between associate's and bachelor's/master's degree program faculty were found on the following topics: institutional resources needed for IPE (P < .001), faculty availability (P < .001), curriculum availability for IPE (P = .02), and importance of including IPE at academic health center campuses (P < .001). CONCLUSIONS: IPE is recognized as an important component of RT education by all faculty respondents. However, significant differences in knowledge and attitudes toward IPE exist between faculty in associate's versus bachelor's/master's degree programs. Revisiting the current accreditation standards program may allow IPE to take a more prominent role in RT curricula.


Asunto(s)
Actitud del Personal de Salud , Curriculum , Docentes/psicología , Relaciones Interprofesionales , Terapia Respiratoria/educación , Docentes/educación , Humanos , Encuestas y Cuestionarios
15.
Mhealth ; 3: 50, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-29354642

RESUMEN

Background: An increasing number of studies have examined the use of information technology to improve diabetes care and patient self-management. The goal of the current study was to determine the number of veterans seen for diabetes at a large medical center in the southeastern region of the U.S. and to examine whether they had registered for VA's My HealtheVet patient web portal according to selected characteristics. Methods: Existing patient records were reviewed including My HealtheVet web portal registration by veterans treated for diabetes (ICD-10 code for type 2 diabetes) at the Charlie Norwood VAMC. Number of outpatient clinic patients seen for diabetes who had or had not registered for My HealtheVet were examined by age categories, sex, race, Hispanic ethnicity, and era of military service. Results: A total of 49,341 veterans receive care at the Charlie Norwood VAMC. Of those patients, 10,950 have been seen for diabetes. Of the 49,341 patients, 21,372 patients (43.3%) are using My HealtheVet and 10,465 patients (21.2%) have used secure messages. Of 10,950 diabetic patients, only 1,256 (11.5%) have registered for My HealtheVet. Women with diabetes were more likely to be registered for My HealtheVet than their male counterparts [13.92% vs. 11.24%; odds ratio (OR)=1.28; 95% confidence interval (CI): 1.05-1.55). Veterans with diabetes who served during WW II or the Korean War were less likely to use My HealtheVet than those who served during more recent eras (OR=0.33; 95% CI: 0.24-0.44). Use of the patient portal was highest among diabetic patients ages 51-55 years (15.6%). Conclusions: A low percentage of Veterans with diabetes are active users of My HealtheVet. Studies are needed to identify My HealtheVet portal design features and veteran characteristics that will increase use of this patient portal which may improve diabetes care.

16.
J Public Health Manag Pract ; 23(4): 364-369, 2017.
Artículo en Inglés | MEDLINE | ID: mdl-27798526

RESUMEN

CONTEXT: American youth are insufficiently active, and minigrant programs have been developed to facilitate implementation of evidence-based interventions in communities. However, little is known about the cost-effectiveness of targeted minigrant programs for the implementation of physical activity (PA) promoting strategies for youth. OBJECTIVE: To determine the cost-effectiveness of a minigrant program to increase PA among youth. DESIGN: Twenty community grantees were pair-matched and randomized to receive funding at the beginning of year 1 (2010-2011) or year 2 (2011-2012) to implement interventions to increase PA in youth. Costs were calculated by examining financial reports provided by the granting organization and grantees. SETTING: Twenty counties in North Carolina. PARTICIPANTS: A random sample of approximately 800 fourth- to eighth-grade youth (per year) from the approximately 6100 youth served by the 20 community-based interventions. MAIN OUTCOME MEASURE: Cost-effectiveness ratios (CERs) were calculated at the county and project levels to determine the cost per child-minute of moderate-to-vigorous PA (MVPA) increased by wave. Analyses were conducted utilizing cost data from 20 community grantees and accelerometer-derived PA from the participating youth. RESULTS: Of the 20 participating counties, 18 counties displayed increased youth MVPA between at least 2 waves of observation. Of those 18 counties, the CER (US dollars/MVPA minutes per day) ranged from $0.02 to $1.86 (n = 13) in intervention year 1, $0.02 to $6.19 (n = 15) in intervention year 2, and $0.02 to $0.58 (n = 17) across both years. CONCLUSION: If utilized to implement effectual behavior change strategies, minigrants can be a cost-effective means of increasing children's MVPA, with a low monetary cost per minute of MVPA.


Asunto(s)
Participación de la Comunidad/métodos , Ejercicio , Organización de la Financiación/economía , Organización de la Financiación/métodos , Promoción de la Salud/economía , Adolescente , Participación de la Comunidad/economía , Análisis Costo-Beneficio , Estudios Transversales , Femenino , Promoción de la Salud/métodos , Humanos , Masculino , North Carolina
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