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1.
BMC Public Health ; 19(1): 1460, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694609

RESUMO

BACKGROUND: Monitoring inequalities in chronic disease prevalence and their preventive care can help build effective strategies to improve health equality. Using hypertension and diabetes as a model, this study measures and decomposes socioeconomic inequalities in their prevalence and preventive care among Chinese adults aged 45 years and older in Shaanxi Province, an underdeveloped western region of China. METHODS: Data of 27,728 respondents aged 45 years and older who participated in the fifth National Health Services Survey conducted in 2013 in Shaanxi Province were analyzed. The relative indexes of inequalities based on Poisson regressions were used to assess disparities in the prevalence of hypertension and diabetes and their preventive care between those with the lowest and the highest socioeconomic status, and the concentration index was used to measure the magnitude of the socioeconomic-related inequality across the entire socioeconomic spectrum. The contribution of each factor to the inequality was further estimated via the concentration index decomposition. RESULTS: Our results indicate a higher prevalence of hypertension and diabetes among the rich than the poor individuals aged 45 years and older in Shaanxi Province, China. Among individuals with hypertension or diabetes, significant inequalities favoring the rich were observed in the use of preventive care, i.e. in adequate use of medication and of blood pressure/blood glucose monitoring. Furthermore, economic status, educational level, employment status, and urban-rural areas were identified as the key socioeconomic indicators for monitoring the inequalities in the patient preventive care. CONCLUSIONS: Our study suggests that the existence of clear inequities in the prevalence of chronic diseases and preventive care among adults aged 45 and older in Shaanxi Province, China. These inequalities in chronic diseases could be as much a cause as a consequence of socioeconomic inequalities.


Assuntos
Doença Crônica/epidemiologia , Disparidades nos Níveis de Saúde , Serviços Preventivos de Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Inquéritos e Questionários
3.
BMC Public Health ; 19(1): 1183, 2019 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-31462261

RESUMO

BACKGROUND: Early detection of lung disease may help reduce disease development. Detection through preventive health checks may be beneficial. Nevertheless, the knowledge is sparse on how to enhance the participation rate in health checks among citizens at risk of developing lung disease. This study investigates if focused information on spirometry can increase the participation rate in a general health check. METHODS: We conducted an open-label, household cluster-randomised trial with a two-group parallel design including 4407 citizens aged 30-49 years in Denmark and an average cluster size of 1.55 citizens per household. The control group (n = 2213) received a standard invitation describing the content of the general health check and containing practical information. The intervention group (n = 2194) received an extended invitation highlighting the benefits of early detection and prevention of lung disease. The primary outcome was difference in participation rate between the two groups. The secondary outcome was the proportion of participants at risk of lung disease in both groups. Risk profile was defined as current smoking or self-reported lung symptoms. The inclusion period was 25 November 2015-3 February 2017. RESULTS: No major difference in participation rate was seen between the intervention group (53.4%) and the control group (52.0%). Participants had statistically significantly higher education level compared to non-participants. A total of 24.2% of the participants were at risk of developing lung disease, but no difference was found between the intervention group and the control group. CONCLUSION: This study revealed no effect on participation rate of including focused spirometry information in the health check invitation. TRIAL REGISTRATION: ClinicalTrials.gov: NCT02615769 . Registered on 25 November 2015. The trial protocol has been published.


Assuntos
Pneumopatias/diagnóstico , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/estatística & dados numéricos , Espirometria , Adulto , Dinamarca , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autorrelato
4.
PLoS One ; 14(7): e0219813, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31339919

RESUMO

BACKGROUND: Despite considerable efforts to prevent HIV and other sexually transmitted infections (STI) among female sex workers (FSW), other sexual and reproductive health (SRH) needs, such preventing unintended pregnancies, among FSW have received far less attention. Programs targeting FSW with comprehensive, accessible services are needed to address their broader SRH needs. This study tested the effectiveness of an intervention to increase dual contraceptive method use to prevent STIs, HIV and unintended pregnancy among FSW attending services in drop-in centers (DIC) in two cities in Kenya. The intervention included enhanced peer education, and routine screening for family planning (FP) needs plus expanded non-condom FP method availability in the DIC. METHODS: We conducted a two-group, pre-/posttest, quasi-experimental study with 719 FSW (360 intervention group, 359 comparison group). Participants were interviewed at baseline and 6 months later to examine changes in condom and non-condom FP method use. RESULTS: The intervention had a significant positive effect on non-condom, FP method use (OR = 1.38, 95%CI (1.04, 1.83)), but no effect on dual method use. Consistent condom use was reported to be high; however, many women also reported negotiating condom use with both paying and non-paying partners as difficult or very difficult. The strongest predictor of consistent condom use was partner type (paying versus non-paying/emotional); FSW reported both paying and non-paying partners also influence non-condom contraceptive use. Substantial numbers of FSW also reported experiencing sexual violence by both paying and non-paying partners. CONCLUSIONS: Self-reported difficulties with consistent condom use and the sometimes dangerous conditions under which they work leave FSW vulnerable to unintended pregnancy STIs/HIV. Adding non-barrier FP methods to condoms is crucial to curb unintended pregnancies and their potential adverse health, social and economic consequences. Findings also highlight the need for additional strategies beyond condoms to reduce HIV and STI risk among FSW. TRIAL REGISTRATION: Clinicaltrials.gov NCT01957813.


Assuntos
Síndrome de Imunodeficiência Adquirida/prevenção & controle , Anticoncepção/normas , Serviços Preventivos de Saúde/normas , Educação Sexual/normas , Profissionais do Sexo/estatística & dados numéricos , Adolescente , Adulto , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Humanos , Quênia , Pessoa de Meia-Idade , Gravidez , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/estatística & dados numéricos , Saúde Reprodutiva , Profissionais do Sexo/educação
5.
BMC Health Serv Res ; 19(1): 392, 2019 Jun 17.
Artigo em Inglês | MEDLINE | ID: mdl-31208422

RESUMO

BACKGROUND: The Patient Protection and Affordable Care Act (ACA) eliminated the cost-sharing requirement for several preventive cancer screenings. This study examined the cancer screening utilization of mammogram, Pap smear and colonoscopy in Medicare fee-for-service (FFS) under the ACA. METHODS: The primary data were the 2007-2013 Medicare Current Beneficiary Survey linked to FFS claims. The effect of the cost-sharing removal on the probability of receiving a preventive cancer screening test was estimated using a logistic regression, separately for each screening test, adjusting for the complex survey design. The model was also separately estimated for different socioeconomic and race/ethnic groups. The study sample included beneficiaries with Part B coverage for the entire calendar year, excluding beneficiaries in Medicaid or Medicare Advantage plans. Beneficiaries with a claims-documented or self-reported history of targeted cancers, who were likely to have diagnostic tests or have surveillance screenings were excluded. The screening measures were constructed separately following Medicare coverage and U.S. Preventive Services Task Force (USPSTF) recommendations. We measured the screening utilization outcome drawing from claims data, as well as using the self-reported survey data. RESULTS: After the cost-sharing removal policy, we found no statistically significant difference in a beneficiary's probability of receiving a colonoscopy (transition period: OR = 1.08, 95% CI = 0.90-1.29; post-policy period: OR = 1.08, 95% CI = 0.83-1.42), a mammogram (transition period: OR = 1.03, 95% CI = 0.91-1.17; post-policy period: OR = 1.07, 95% CI = 0.88-1.30), or a biennial Pap smear (transition period: OR = 0.87, 95% CI = 0.69-1.09; post-policy period: OR = 0.72, 95% CI = 0.51-1.03) in claims-based measures following Medicare coverage. Similarly, we found null effects of the policy change on utilization of colonoscopy among enrollees 50-75 years old, biennial mammograms by women 50-74, and triennial Pap smear tests among women 21-65 in claims-based measures according to USPSTF. The findings from survey-based measures were consistent with the estimates from claims-based measures, except that the use of Pap smear declined since 2011. Further, the policy change did not increase utilization in patients with disadvantaged socioeconomic characteristics. Yet the disparate patterns in adjusted screening rates by socioeconomic status and race/ethnicity persisted over time. CONCLUSIONS: Removing out-of-pocket costs for screenings did not provide enough incentives to increase the screening rates among Medicare beneficiaries.


Assuntos
Detecção Precoce de Câncer/economia , Detecção Precoce de Câncer/estatística & dados numéricos , Medicare/economia , Neoplasias/diagnóstico , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde , Idoso , Custo Compartilhado de Seguro , Análise Custo-Benefício , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Cobertura do Seguro , Masculino , Pessoa de Meia-Idade , Neoplasias/economia , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/estatística & dados numéricos , Estados Unidos
6.
Artigo em Inglês | MEDLINE | ID: mdl-31083535

RESUMO

BACKGROUND: As the average age of the population continues to rise in the 21st century, chronic illnesses have become the most prominent threats to human health. Research has shown that early screenings for chronic diseases are an effective way of lowering incidence and mortality rates. However, low participation rates for health screening is one of the main challenges for preventive medicine. The objective of this study was to determine the primary drivers which: (1) first motivate people to participate in community-based health screening for chronic diseases; and (2) increase their willingness to continue to participate. METHODS: A total of 440 individuals between 30 and 75 years of age were invited to undergo a health screening and then complete an interview questionnaire. Screenings and interviews were conducted in four regions in northern Taiwan. The questionnaire was separated into three sections, which explored sociodemographic differences, drivers of willingness to participate, and willingness to continue to participate respectively. Raw data was analyzed using the statistical software package SPSS (SPSS Inc., Chicago, IL, USA). MAIN OUTCOME MEASURES: Effects of sociodemographic factors on health screening participation rate, drivers of willingness to participate, and willingness to continue to participate. RESULTS: Seventy-three percent of participants responded that they would be willing to continue to join in future health screenings. Notably, elderly people and married people were respectively more likely to participate in preventive health screening than were younger people and people who were single, divorced, separated, or widowed. Level of education was another key driver of willingness to participate in health screening for chronic diseases, as were the concern of relatives/friends and the provision of participation incentives. DISCUSSION: Some of our findings, such as the key drivers of willingness to continue to participate in health screening that we identified, were different from findings of many previous studies conducted in other countries. The current study also found that a higher percentage of participants would be willing to join a similar health screening in the future if the service design is considered in advance and is well-implemented.


Assuntos
Doença Crônica/psicologia , Centros Comunitários de Saúde/estatística & dados numéricos , Programas de Rastreamento/psicologia , Programas de Rastreamento/estatística & dados numéricos , Motivação , Serviços Preventivos de Saúde/estatística & dados numéricos , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Taiwan
7.
Public Health Rep ; 134(4): 371-378, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112071

RESUMO

OBJECTIVES: Studies of sexually transmitted disease (STD) clinics have been limited by the lack of a national list for representative sampling. We sought to establish the number, type, and distribution of STD clinics and describe selected community characteristics associated with them. METHODS: We conducted a 2-phased, multilevel, online search from September 2014 through March 2015 and from May through October 2017 to identify STD clinics in all 50 US states and the District of Columbia. We obtained data on clinic name, address, contact information, and 340B funding status (which requires manufacturers to provide outpatient drugs at reduced prices). We classified clinics by type. We also obtained secondary county-level data to compare rates of chlamydia and HIV, teen births, uninsurance and unemployment, and high school graduation; ratios of primary care physician to population; health care costs; median household income; and percentage of population living in rural areas vs nonrural areas. We used t tests to examine mean differences in characteristics between counties with and without STD clinics. RESULTS: We found 4079 STD clinics and classified them into 10 types; 2530 (62.0%) clinics were affiliated with a local health department. Of 3129 counties, 1098 (35.1%) did not have an STD clinic. Twelve states had an STD clinic in every county, and 34 states had ≥1 clinic per 100 000 population. Most STD clinics were located in areas of high chlamydia morbidity and where other surrogate needs were greatest; rural areas were underserved by STD clinics. CONCLUSIONS: This list may aid in more comprehensive national studies of clinic services, STD clinic adaptation to external policy changes (eg, in public financing or patient access policy), and long-term clinic survival, with special attention to clinic coverage in rural areas.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Geografia , Serviços Preventivos de Saúde/organização & administração , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/terapia , Adulto , District of Columbia , Feminino , Humanos , Masculino , Serviços Preventivos de Saúde/estatística & dados numéricos , Estados Unidos
8.
Salud Publica Mex ; 61(2): 106-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30958953

RESUMO

OBJECTIVE: To evaluate the combined use of IMSS preventive health services (PHS) and the practice of physical activity (PA) in order to determine their association with the perceived health-related quality of life (HRQoL) of older adults. MATERIALS AND METHODS: A survey-based cross-sectional study was conducted at nine primary health care units (PHCUs) in Mexico City. The 36-Item Short-Form Health Survey evaluated the HRQoL, while PA and PHS use were assessed through self-report. Linear regression analyses were performed to determine the relationship between these three variables. RESULTS: Of the 1 085 older adults who participated in the study, 36.8% used PHS, and 23.3% reported that they engage in PA. After controlling for possible effects due to sociodemographic and health differences, we found that participants who were physically active and used PHS reported better perceived HRQoL scores. CONCLUSIONS: The combined use of preventive practices such as the use of PHS and the practice of PA can help improve the perceived HRQoL of older adults.


Assuntos
Exercício , Nível de Saúde , Serviços Preventivos de Saúde/estatística & dados numéricos , Qualidade de Vida , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Análise de Regressão , Distribuição por Sexo , Fatores Sexuais , Fatores Socioeconômicos
9.
PLoS One ; 14(4): e0215635, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31013303

RESUMO

INTRODUCTION: The concept of continuum of care has gained attention as measures to improve maternal, newborn, and child health. However, little is known about the factors associated with the coverage level of continuum of care in Lao PDR. Therefore, this study was conducted 1) to investigate the coverage level of continuum of care and 2) to identify barriers and promoting factors that are associated with mothers' continuation in receiving services in rural Lao PDR. METHODS: A community-based, cross sectional study was conducted in a rural district in Khammouane Province, Lao PDR, using a structured questionnaire. The outcome to the express continuum of care was assessed by the modified composite coverage index (CCI) that reflects ten maternal and child health services. RESULTS: In total, 263 mothers were included in the final analyses. Only 6.8% of mothers continued to receive all MNCH services. Five factors were shown to have statistically significant associations with modified CCI score: higher educational attainment (B = 0.070, p<0.001), being a farmer (B = -0.078, p = 0.003), receiving the first antenatal care within the first trimester (B = 0.109, p<0.001), longer distance from district hospital (B = -0.012, p<0.001), and discussion with husband or family members (B = 0.057, p = 0.022). CONCLUSIONS: In this study, we introduced the modified CCI to better explain the utilization of preventive maternal and child health services along with the continuum of care. By utilizing the modified CCI, we identified five factors as determinants of continuum of care. Furthermore, new and modifiable promoting factors were identified for continuum of care: receiving the first antenatal care within the first trimester and family and male involvement. Such demand side actions should be encouraged to improve the continuity of MNCH service use.


Assuntos
Continuidade da Assistência ao Paciente/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/organização & administração , Serviços Preventivos de Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Adulto , Saúde da Criança , Estudos Transversais , Feminino , Humanos , Lactente , Laos , Masculino , Saúde Materna , Serviços de Saúde Materno-Infantil/estatística & dados numéricos , Gravidez , Serviços Preventivos de Saúde/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
10.
Inquiry ; 56: 46958019841514, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31018737

RESUMO

This policy brief examines preventive services state legislation trends in the United States during uncertainty regarding the Affordable Care Act (ACA), which requires certain coverage of 4 evidence-based preventive services categories without additional patient costs under §2713. We used a legal mapping approach to search for and analyze state legislation related to preventive services proposed or enacted over a 25-month period of ACA uncertainty. We screened 1231 bills and coded the 76 screened-in bills. Next, we determined their characteristics and examined trends. Bills originated in 28 states, and 69.7% were not enacted. Only 3.9% contained requirements contingent on ACA modifications. About 56.6% referenced services covered by §2713, but usually not entire §2713 categories. Bills also mentioned preventive services in general (53.9%) and services outside §2713's scope (21.1%). About 55.3% applied to private insurance, and 75.0% only to one patient group. Bills generally promoted access, and 51.3% specifically prohibited cost-sharing. But 26.3% of the bills limited access to preventive services. State-level legislation targets preventive services, usually expanding, but sometimes limiting, access. Most bills single out specific services without fully incorporating evidence-based recommendations. State legislation may therefore promote access to preventive services but can favor certain services, deviate from experts' recommendations, and increase nationwide variability. State legislation can function as an important lever for access to preventive services across patient groups. This may be especially important during uncertainty about federal policy. However, the design of state-level proposals is critical for maximizing access to preventive services.


Assuntos
Reforma dos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde , Serviços Preventivos de Saúde/normas , Incerteza , Humanos , Cobertura do Seguro/tendências , Patient Protection and Affordable Care Act/legislação & jurisprudência , Serviços Preventivos de Saúde/legislação & jurisprudência , Serviços Preventivos de Saúde/estatística & dados numéricos , Governo Estadual
12.
BMC Fam Pract ; 20(1): 42, 2019 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-30836945

RESUMO

BACKGROUND: The general health check, which includes the periodic health visit and annual physical exam, is not recommended to maintain the health of asymptomatic adults with no risk factors. Different funding mechanisms for primary care may be associated with the provision of service delivery according to recommended guidelines. We sought to determine how use of the periodic health visit for healthy individuals without comorbidities, despite evidence against its use, differed by primary care model. METHODS: Population-based cross-sectional study using linked health and administrative datasets in Ontario, Canada, where most residents are insured for physician services through Ontario's single payer, provincially funded Ontario Health Insurance Plan. Participants included all living adults (> 19 years) in Ontario on January 1st, 2014, eligible for the Ontario Health Insurance Plan. Primary care enrollment model was the main exposure and included traditional fee-for-service, enhanced fee-for-service, capitation, team-based care, other (including salaried), and unenrolled. The main outcome measure was receipt of a periodic health visit during 2014. Age-sex standardized rates of periodic health visits performed during the one-year study period were analyzed by number of comorbid conditions. RESULTS: Of 10,712,804 adults in Ontario, 2,350,386 (21.9%) had a periodic health visit in 2014. The age-sex standardized rate was 6.1% (95% confidence interval [CI] 6.0, 6.1%) for healthy individuals. In the traditional fee-for-service model, the periodic health visit was performed for 55.3% (95% CI 54.4, 56.3%) of healthy individuals versus 10.2% (95% CI 10.0, 10.3%) in team-based care. Periodic health visit rates varied by primary care provider models. Traditional and enhanced fee-for-service models had higher rates across all comorbidity groups. CONCLUSIONS: Patients whose primary care physicians are funded exclusively through fee-for-service had the highest rates of periodic health visits in healthy individuals. Primary care reform initiatives must consider the influence of remuneration on providing evidence-based primary care.


Assuntos
Assistência à Saúde/organização & administração , Serviços Preventivos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/organização & administração , Adulto , Idoso , Capitação , Bases de Dados Factuais , Planos de Pagamento por Serviço Prestado , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Ontário , Equipe de Assistência ao Paciente , Adulto Jovem
13.
BMC Health Serv Res ; 19(1): 172, 2019 Mar 18.
Artigo em Inglês | MEDLINE | ID: mdl-30885199

RESUMO

BACKGROUND: Rural residents are less likely to receive screening for colorectal cancer (CRC) than urban residents. However, the mechanisms underlying this disparity, especially among people aged 50-64 years old with private health insurance, are not well understood. We examined the impact of travel time on stage at CRC diagnosis. METHODS: This retrospective cohort study used data from the Blue Cross and Blue Shield of Nebraska. Members of this private insurance company aged 50-64 years, diagnosed with CRC during the period 2012-2016, and continuously enrolled in the insurance plan for at least 6 months prior to CRC diagnosis, were selected for this study. Using Google Maps, we estimated patients' travel time from their home ZIP code to the ZIP code of their colonoscopy provider. Using logistic regression, we analyzed the association between stage at CRC diagnosis, travel time, use of preventive services (i.e., check-ups or counseling to prevent or detect illness at an early stage) and patient characteristics. RESULTS: A total of 307 subjects met the inclusion criteria. People who had not used preventive services 6 months prior to CRC diagnosis had 2.80 (95% CI, 1.00-7.90) times the odds of metastatic CRC compared to those who had used these services. No statistically significant association was found between travel time and metastatic CRC diagnosis (P = 0.99; 95% CI, 0.98-1.01). CONCLUSIONS: The fact that 13% of the study population presented with metastatic CRC suggests some noncompliance with preventive services such as screening guidelines. To increase screening uptake and reduce metastatic cases, employers should offer incentives for their employees to make use of preventive services such as CRC screening.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Estadiamento de Neoplasias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Viagem , Colonoscopia , Neoplasias Colorretais/patologia , Feminino , Humanos , Seguro Saúde , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , População Rural , Fatores de Tempo
15.
Public Health Rep ; 134(3): 249-254, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30912999

RESUMO

OBJECTIVE: The Centers for Disease Control and Prevention's Prevention Research Centers (PRCs) collaborate on public health activities with community agencies and organizations. We evaluated these collaborations by studying the relationships between co-authors from the PRCs and community agencies that published at least 1 article together in the first year of the program. METHODS: We identified all the authors of articles published by PRCs and collaborating members in peer-reviewed journals between September 2014 and September 2015 and constructed a network showing the links between and among all the authors. We characterized the network with 4 measures of social structure (network components, network density, average clustering coefficient, average distance) and 3 measures of individual author performances (degree-, betweenness-, and closeness-centrality). RESULTS: The 413 articles had 1804 individual authors and 7995 co-authorship relationships (links) in 212 peer-reviewed journals. These authors and co-authors formed 44 separate, nonoverlapping groups (components). The largest "giant" component containing most of the links involved 66.3% (n = 1196) of the authors and 73.7% (n = 5889) of the links. We identified 136 "information brokers" (authors with high closeness centrality: those who have the shortest links to the most authors). Two authors with high betweenness centrality (who had the highest number of co-authors; 104 and 107) had the greatest ability to mediate co-authorships. Network density was low; only 0.5% of all potential co-authorships were realized (7995 actual co-authorship/1 628 110 potential co-authorships). CONCLUSION: Information brokers and co-authorship mediators should be encouraged to communicate more with each other to increase the number of collaborations between network members and, hence, the number of co-authorships.


Assuntos
Academias e Institutos/estatística & dados numéricos , Autoria , Comportamento Cooperativo , Revisão da Pesquisa por Pares , Serviços Preventivos de Saúde/estatística & dados numéricos , /estatística & dados numéricos , Pesquisa sobre Serviços de Saúde/estatística & dados numéricos , Humanos , Revisão por Pares , Estados Unidos
16.
Clin Pediatr (Phila) ; 58(6): 647-655, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-30789004

RESUMO

In 2014, Family Success Alliance (FSA) was formed as a place-based initiative to build a pipeline of programs to reduce the impact of poverty on outcomes for children living in Orange County, North Carolina. In this study, FSA parents' perception of child health, parent and child adverse childhood experiences (ACEs), and resilience were obtained by parent interview. Receipt of recommended health services were abstracted from primary care medical records of FSA children. Correlation coefficients investigated relationships among health, ACEs, and resilience. Among 87 parent-child dyads, 65% were Spanish speaking. At least 1 of the 7 ACEs measured was reported in 37% of children and 70% of parents. Parent perceptions of child health were lower than national averages. Routine preventive services included the following: autism screening at 18 months (15%) and 24 months (31%); ≥4 fluoride varnish applications (10%); lead screening (66%); and receipt of immunizations (94%). Parent perception of child health was moderately correlated with resilience.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Saúde da Criança/estatística & dados numéricos , Bem-Estar da Criança , Nível de Saúde , Pais/psicologia , Pobreza/prevenção & controle , Resiliência Psicológica , Adulto , Criança , Pré-Escolar , Utilização de Instalações e Serviços/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , North Carolina , Percepção , Pobreza/psicologia , Serviços Preventivos de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde
17.
Can J Diabetes ; 43(5): 322-328, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-30782471

RESUMO

OBJECTIVES: Healthy user bias, whereby health-seeking patients are more likely to initiate preventive therapies and engage in healthy lifestyle behaviours, is well known in observational studies, particularly with statins. However, its influence in studies of oral antihyperglycemic therapies is unknown. We sought to explore the healthy user effects in metformin users vs. nonusers on various health outcomes that should not be associated with metformin use. METHODS: We conducted a retrospective cohort study using data from Alberta, between 2008 and 2015, to examine the association between metformin use and various health outcomes. RESULTS: We identified 135,301 new users of oral antihyperglycemic agents. The mean age was 55 years, 75,949 (56%) were men and 130,725 (97%) had had at least 1 metformin prescription during a mean follow-up period of 3.4 years. Metformin users were less likely to be involved in accident-related events (adjusted hazard ratio [aHR] 0.90; 95% CI 0.85 to 0.96), were more likely to have preventive screening services (aHR 1.16; 95% CI 1.11 to 1.21), were less likely to experience other clinical events, such as asthma and gout attacks (aHR 0.90; 95% CI 0.84 to 0.97), and had lower risks for all-cause mortality (aHR 0.57; 95% CI 0.51 to 0.63) compared to nonusers. CONCLUSIONS: Our results suggest that metformin users are more likely to initiate preventive therapies and engage in other healthy behaviours. Failure to account for these behaviours may introduce healthy user bias into studies evaluating the effects of oral antihyperglycemic therapies.


Assuntos
Biomarcadores/análise , Diabetes Mellitus Tipo 2/tratamento farmacológico , Comportamentos Relacionados com a Saúde , Hipoglicemiantes/administração & dosagem , Programas de Rastreamento/estatística & dados numéricos , Metformina/administração & dosagem , Serviços Preventivos de Saúde/estatística & dados numéricos , Administração Oral , Adulto , Asma/prevenção & controle , Glicemia/análise , Diabetes Mellitus Tipo 2/psicologia , Quimioterapia Combinada , Feminino , Seguimentos , Hemoglobina A Glicada/análise , Gota/prevenção & controle , Humanos , Masculino , Pessoa de Meia-Idade , Prognóstico , Estudos Retrospectivos
18.
NCHS Data Brief ; (331): 1-8, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30707670

RESUMO

In 2016, most Americans had a usual place to receive health care (86% of adults and 96% of children) (1,2). The majority of children and adults listed a doctor's office as the usual place they received care (1,2). In 2016, there were an estimated 883.7 million office-based physician visits in the United States (3,4). This report examines visit rates by age and sex. It also examines visit characteristics-including insurance status, reason for visit, and services-by age. Estimates use data from the 2016 National Ambulatory Medical Care Survey (NAMCS).


Assuntos
Visita a Consultório Médico/estatística & dados numéricos , Consultórios Médicos/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Criança , Pré-Escolar , Doença Crônica/epidemiologia , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Lactente , Recém-Nascido , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/estatística & dados numéricos , Distribuição por Sexo , Estados Unidos , Ferimentos e Lesões/epidemiologia , Adulto Jovem
19.
Salud Publica Mex ; 61(1): 46-53, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30753772

RESUMO

OBJECTIVE: Determine the effect of Seguro Popular (SP) on preventive care utilization among low-income SP beneficiaries and uninsured elders in Mexico. MATERIALS AND METHODS: Fixed-effects instrumental-variable (FE-IV) pseudo-panel estimation from three rounds of the Mexican National Health and Nutrition Survey (2000, 2006 and 2012). RESULTS: Our findings suggest that SP has no significant effect on the use of preventive services, including screening for diabetes, hypertension, breast cancer and cervical cancer, by adults aged 50 to 75 years. CONCLUSIONS: Despite the evidence that suggests that SP has increased access to health insurance for the poor, inequalities in healthcare access and utilization still exist in Mexico. The Mexican government must keep working on extending health insurance coverage to vulnerable adults. Additional efforts to increase health care coverage and to support preventive care are needed to reduce persistent disparities in healthcare utilization.


Assuntos
Cobertura do Seguro/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Idoso , Redução de Custos , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Feminino , Inquéritos Epidemiológicos , Hospitalização/estatística & dados numéricos , Humanos , Hipertensão/diagnóstico , Hipertensão/epidemiologia , Hipertensão/terapia , Masculino , Programas de Rastreamento/estatística & dados numéricos , México/epidemiologia , Pessoa de Meia-Idade , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Pobreza , Utilização de Procedimentos e Técnicas , Amostragem , Fatores Socioeconômicos
20.
PLoS One ; 14(1): e0209314, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30625177

RESUMO

BACKGROUND: Cardiovascular disease (CVD) risk prediction models are often used to identify individuals at high risk of CVD events. Providing preventive treatment to these individuals may then reduce the CVD burden at population level. However, different prediction models may predict different (sets of) CVD outcomes which may lead to variation in selection of high risk individuals. Here, it is investigated if the use of different prediction models may actually lead to different treatment recommendations in clinical practice. METHOD: The exact definition of and the event types included in the predicted outcomes of four widely used CVD risk prediction models (ATP-III, Framingham (FRS), Pooled Cohort Equations (PCE) and SCORE) was determined according to ICD-10 codes. The models were applied to a Dutch population cohort (n = 18,137) to predict the 10-year CVD risks. Finally, treatment recommendations, based on predicted risks and the treatment threshold associated with each model, were investigated and compared across models. RESULTS: Due to the different definitions of predicted outcomes, the predicted risks varied widely, with an average 10-year CVD risk of 1.2% (ATP), 5.2% (FRS), 1.9% (PCE), and 0.7% (SCORE). Given the variation in predicted risks and recommended treatment thresholds, preventive drugs would be prescribed for 0.2%, 14.9%, 4.4%, and 2.0% of all individuals when using ATP, FRS, PCE and SCORE, respectively. CONCLUSION: Widely used CVD prediction models vary substantially regarding their outcomes and associated absolute risk estimates. Consequently, absolute predicted 10-year risks from different prediction models cannot be compared directly. Furthermore, treatment decisions often depend on which prediction model is applied and its recommended risk threshold, introducing unwanted practice variation into risk-based preventive strategies for CVD.


Assuntos
Doenças Cardiovasculares/etiologia , Doenças Cardiovasculares/prevenção & controle , Medição de Risco/métodos , Estudos de Coortes , Determinação de Ponto Final , Humanos , Modelos Cardiovasculares , Modelos Estatísticos , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/estatística & dados numéricos , Medição de Risco/estatística & dados numéricos , Fatores de Risco
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