A survey of social, economic, and demographic causes for changes in rural fertility in Xianyang.
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Asia↗
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Results for “HOME ECONOMICS”
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Developing home health services in rural communities--an innovative solution to a thorny problem.
Developing financially sound home health agencies in isolated rural communities is a continuing problem. This article discusses the use of a little known provision of the Rural Health Clinics Act, P. L. 95-210, as a vehicle for creating an economically viable home health program in an isolated mountain community of Northern California.
California↗
A survey of students who chose Family Practice residencies.
This paper presents the results of questionnaires sent to medical students at Wayne State University who chose family practice residency programs. It discusses three main areas: (1) choice of family practice as a specialty, (2) choice of a particular family practice residency program, and (3) future plans. Role models, the student's family, student membership in the American Academy of Family Physicians, the student's hometown, and Family Practice Club meetings were all important factors in the decision to become a family physician. The current residents' opinions of their program, the residency director, the quality of the current residents, and the location of the program were rated as quite important in the choice of a particular residency program. Most residents served their residency in their home state. Economic factors and university affiliation were not felt to be influential in program choice. A typical student plans to pursue family practice in a group that employs physician's assistants or nurse practitioners. He/she would also like to practice in his/her home state in either a rural area or a small city. Very few students were interested in either solo practice or academic family medicine.
Adult↗
Health and functional status in elderly patients living in nursing homes.
Socio-economic background, functional status, multiple pathology and medical conditions requiring care have been evaluated in 506 elderly subjects living in nursing homes in Turin (Italy). In the sample 78.8% are women, mean age 84.2 years, only 21.2% are men, mean age 76.3 years. Particularly in the oldest age classes women are more represented than men. Most subjects (94.3%) require help in at least one Activity of Daily Living (ADL). Part of the sample (21.2%) comes from home, 13.2% from acute wards, 9.1% from long term care wards, 6.3% from mental hospitals, 26.3% from residential homes. Education level is rather low. Before retirement, many men were workmen (38.3%), while many women were housewives (46.6%). Multiple pathology is very common: 23.7% of patients suffer from 4 pathologies, more than 5 diseases are present in 18.8%, while only 4.7% of subjects have less than two pathologies. Half of the sample (52.6%) is affected by dementia, 37.6% by cardiovascular diseases, 29.1% by chronic obstructive lung disease and 25.5% by stroke. Bone fractures are present in 22.1% of the subjects. Severe impairments in strength and/or motility in at least two limbs affect 43.7% of patients, double incontinence 49.2%, severe disturbances in speech and communication 35.4%. The prevalence of care needs is higher in women compared with men. More females than males need aid in walking, help in eating, diapers, pressure sores prevention and bedposts.
Journal Article↗
Home health care: some social and economic considerations.
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Cost-Benefit Analysis↗
Entry and competition in the home health care industry.
Home health care is the fastest growing segment in the health care industry today. This article provides an understanding of the home health industry and a template of analysis that can be applied to other industries of interest to the health care strategist. The Porter model is used as the basis of this analysis.
Economic Competition↗
"How could I even think of a job?"--Ambiguities in working life in a group of female patients with undefined musculoskeletal pain.
OBJECTIVE: To explore the meaning of working life for a group of women sick-listed because of undefined, musculoskeletal pain disorders. DESIGN: Repeated thematic interviews, analysed qualitatively according to grounded theory. SETTING AND PARTICIPANTS: Twenty female patients, impaired by biomedically undefined pain and musculoskeletal disorders, were successively recruited at an urban primary health care centre in northern Sweden. MAIN FINDINGS: There were discrepancies between work aspirations and work experiences concerning economic maintenance, social interaction, and personal recognition. The women had low-income jobs in fields threatened by redundancy, such as cleaning, care, and service. Family considerations had a strong impact on organization and priorities in paid work. In a situation of pain and sick leave, family orientation strengthened and work aspirations declined. Social and personal recognition was sought in the unpaid duties at home, and economic refuge in 'the state as supporter'. IMPLICATIONS: To understand women with undefined musculoskeletal pain as patients, we must also understand their aspirations and experiences as workers, mothers, and spouses. 'Family considerations', 'diminishing paid work', and 'the state as supporter' are important concepts for understanding the women's sick role process.
Adult↗
Burned children: a socioeconomic profile for focused prevention programs.
A review of 197 consecutive admissions of children 16 years of age and under to the Western Pennsylvania Hospital Burn/Trauma Center during a 28-month period (January 1984-April 1986) found that the majority of these children came from economically disadvantaged homes and that scalding was the most frequent mechanism of injury. Black children, poor children, and children of single parents were disproportionally represented in the study population compared with a similar-aged population in the hospital's referral area. By identifying a specific group of children who are at highest risk of being burned, and by determining the burn injuries these children are most likely to sustain, the study makes it possible to realistically tailor burn prevention programs to meet the specific social and economic characteristics of the group at highest risk.
Adolescent↗
The role of emergency services in health care for the elderly: a review.
The hospital emergency department (ED) has become an important means of access to health care for the elderly. Inadequacies in the current health care system for the elderly are reflected in their high utilization rates of the ED, continuing questions about the appropriateness of elderly ED patients, differences in the ED care offered the elderly versus the young, and poor coordination of care to and from the ED. Evidence of potential misuse of emergency services exists for both the ED and the emergency medical transport (EMS) systems. The increasing number of nursing home patients sent to the ED with nonemergent problems further emphasizes inadequacies of primary care in the nursing home setting. Economic, legal, and ethical issues that have changed the way medicine is practiced in other settings are finally reaching the sector of emergency services. The current and future roles of emergency medicine services, and the impact these issues will have on the practice of emergency medicine, are discussed.
Aged↗
Derivation and confirmation of scales measuring medical directors' attitudes about the hospitalization of nursing home residents.
OBJECTIVE: To derive and confirm scales measuring medical director's attitudes about hospitalization of nursing home residents. METHOD: The authors surveyed nursing facility medical directors about the necessity of hospitalizing residents for eight clinical conditions and compared the ratings to those obtained from an expert panel to derive a relative hospitalization score. They also asked about factors that might influence hospitalization decisions. They performed a factor analysis to derive scales that measure attitudinal determinants of hospitalization and used the relative hospitalization score to confirm the scales. RESULTS: The survey had a 79% response rate. The relative hospitalization score demonstrated that medical directors were slightly less likely to recommend hospitalization than expert panel physicians. Factor analyses yielded 10 scales focusing on nursing home functioning, economics, resident specific considerations, and physician attitudes. Eight of the 10 scales had significant bivariable associations with the relative hospitalization score, and 6 had significant multivariable associations. DISCUSSION: Medical directors identify multiple determinants of hospitalization for nursing facility residents across several domains. Hospitalization decisions for nursing facility residents are complex and involve clinical and nonclinical factors.
Attitude of Health Personnel↗
Cost-effectiveness of long-term care services in South Korea.
This study examines the economic validity of home health-care and nursing-home care with the aim of providing guidelines for efficient use of limited health-care resources. Data collection took place over 8 months in 2001 (from May to December) at six institutions: two home health-care service providers and four nursing homes. A total of 99 stroke patients (49 from home health-care service providers and 50 from nursing homes) participated in the study. The findings indicate that patients with a lower level of physical/cognitive dependency (activities of daily living (ADL) >or= 9.3, cognitive performance scale (CPS) >or= 3.3) tend to benefit more from home health-care service, while those with a high dependency level (ADL < 9.3, CPS < 3.3) receive more suitable care at nursing homes. The study confirms that the economic value of health-care providers varies with the level of physical/cognitive function of the patients. That is, higher efficiency is achieved when those with a lower and higher levels of dependency are provided with home health-care services and nursing-home care, respectively. When assigning long-term care services, it is suggested that the level of physical/cognitive function of patients should be taken into consideration.
Activities of Daily Living↗
[What kind of family makes a case difficult? Public health nurses' views on home care for the frail elderly].
OBJECTIVE: Public health nurses (PHNs) played the major role in providing care management for the frail elderly before the Long-term Care Insurance started in 2000. Although the role of care management has now shifted to care managers, PHNs are still consulted by such care managers, service providers and families of the elderly about long-term home care. The purpose of this study was to explore the factors that make a case difficult to deal with from PHNs' viewpoint. This study focuses on the factors related to family living in the same household (living-together family). SUBJECTS AND METHODS: The informants of this study were seven PHNs who worked for a city with a population of 67,000 (proportion of elderly in the whole population is 19%) in Nagano Prefecture. First, a focus group interview (about 90 minutes) with the six PHNs was conducted to extract an outline of difficult cases. Next, semi-structured interviews (about 60 minutes each) with five PHNs were conducted to obtain detailed information on difficult cases. The interviews were tape-recorded and transcribed verbatim. KJ analysis was conducted by defining characteristics, finding similar factors, and grouping these together to form categories. RESULTS: Categories of family related problems emerged for each of two major categories: family characteristics and care related problems. Firstly, existing family characteristics, including the existence of mental or psychological disorders, low motivation towards providing long-term care, conflictual familial relationships, objections to having service providers in the home, and economic difficulties contribute to problems in providing long-term care with living-together families. These characteristics can lead to a second set of problems, relating to the actual provision of care by the living-together family to frail elderly patients. These care related problems include including insufficient care, rejection of formal care services, and deviation from care directives, including to the point of physical mistreatment. CONCLUSION: This study points to the need for care providers to consider the living-together family's background and the potential for the phenomena, indicated in this study, to negatively impact on the provision of care for the frail elderly.
Aged↗
The impact of health care changes on home health.
OBJECTIVES: To provide an overview of the economic impact of changes on home care services. DATA SOURCES: Published articles and organizational and government reports pertaining to home care and health care economics. CONCLUSIONS: In general, home care organizations are struggling to survive and retain fiscal stability. Understanding the economic impact of change on home care services is facilitated by a better understanding of three major components: the insurance company, the home health service agency, and the client. IMPLICATIONS FOR NURSING PRACTICE: The home health nurse who chose this care setting for role autonomy and family-centered direct care must now be concerned about productivity, costs, and reimbursement. Oncology nurses need to provide administrators and financial officers with the information to provide services in the most cost-effective manner, and be advocates for the provision of quality care.
Home Care Services↗
Poverty and eosinophilia are risk factors for endomyocardial fibrosis (EMF) in Uganda.
OBJECTIVE: To determine the relative risks of socio-demographic, dietary, and environmental factors for endomyocardial fibrosis (EMF) in Uganda. METHOD: Unmatched case control study in Mulago Hospital, Kampala. Cases (n = 61) were sequential patients hospitalized with an echocardiographic diagnosis of EMF from June 1995 to March 1996. Controls (n = 120) were concurrent patients with other forms of heart disease (heart controls, n = 59) and subjects admitted for trauma or elective surgery (hospital controls, n = 61). All consenting subjects answered a structured questionnaire administered by trained interviewers. Complete blood counts, malaria films and stool examination for ova and parasites were performed. Questionnaires elicited information on home address, economic circumstances, variables concerned with environmental exposures and usual diet before becoming ill. RESULTS: After adjustment for age and sex, cases were significantly more likely than controls to have Rwanda/Burundi ethnic origins (P = 0.008). Compared with controls, cases had a lower level of education (P < 0.001 for heart controls and P = 0.07 for hospital controls), were more likely to be peasants (P < 0.001), and to come from Luwero or Mukono Districts (P = 0.003). After further adjustment for peasant occupation, cases were more likely than controls to walk barefoot (P = 0.015), consume cassava as their staple food (P < 0.001) and to lack fish or meat in dietary sauces (P = 0.02). Cases were more likely to exhibit absolute eosinophilia (P = 0.006). The effect of cassava diet was more marked in the younger age group, while the effect of eosinophilia was greater in adults. Socio-economic disadvantage is a risk for EMF. Absolute eosinophilia is a putative cause of EMF, a finding not explained by parasitism. CONCLUSION: Data indicate that relative poverty and environmental factors triggering eosinophilia appear to act in a geographically restricted region of Uganda in the aetiology of EMF.
Adolescent↗
The political and economic implications of training nursing home aides.
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Humans↗
Social life factors affecting suicide in Japanese men and women.
To clarify the social life factors affecting suicide mortality in Japanese men and women, the relationship between a wide variety of social and demographic indicators and age-adjusted suicide mortality was assessed in 46 prefectures in Japan by stepwise multiple-regression analysis after classification of the indicators by factor analysis. The findings indicated that rural residence was the major factor for male mortality in both 1970 and 1975; over the interval between these years, a serious economic crisis (the oil crisis) took place, and the mortality significantly increased. In addition, in 1970 (a time of high economic growth), home help for the elderly (a possible indicator of social isolation in old people), depopulation by social mobility, and urban residence were positively associated with male mortality. In women, on the other hand, both the 5-year increase in suicide mortality and the effects of the social life factors were less significant. The unique position of Japan in comparison with Western countries regarding social risk factors for suicide is discussed in the light of these findings.
Adolescent↗
Economic evaluation of hospital at home versus hospital care: cost minimisation analysis of data from randomised controlled trial.
OBJECTIVES: To compare the costs of admission to a hospital at home scheme with those of acute hospital admission. DESIGN: Cost minimisation analysis within a pragmatic randomised controlled trial. SETTING: Hospital at home scheme in Leicester and the city's three acute hospitals. PARTICIPANTS: 199 consecutive patients assessed as being suitable for admission to hospital at home for acute care during the 18 month trial period (median age 84 years). INTERVENTION: Hospital at home or hospital inpatient care. MAIN OUTCOME MEASURES: Costs to NHS, social services, patients, and families during the initial episode of treatment and the three months after admission. RESULTS: Mean (median) costs per episode (including any transfer from hospital at home to hospital) were similar when analysed by intention to treat-hospital at home 2569 pounds sterling (1655 pounds sterling), hospital ward 2881 pounds sterling (2031 pounds sterling), bootstrap mean difference -305 (95% confidence interval -1112 to 448). When analysis was restricted to those who accepted their allocated place of care, hospital at home was significantly cheaper-hospital at home 2557 pounds sterling(1710 pounds sterling), hospital ward 3660 pounds sterling (2903 pounds sterling), bootstrap mean difference -1071 (-1843 to -246). At three months the cost differences were sustained. Costs with all cases included were hospital at home 3671 pounds sterling (2491 pounds sterling), hospital ward 3877 pounds sterling (3405 pounds sterling), bootstrap mean difference -210 (-1025 to 635). When only those accepting allocated care were included the costs were hospital at home 3698 pounds sterling (2493 pounds sterling), hospital ward 4761 pounds sterling (3940 pounds sterling), bootstrap mean difference -1063 (-2044 to -163); P=0.009. About 25% of the costs for episodes of hospital at home were incurred through transfer to hospital. Costs per day of care were higher in the hospital at home arm (mean 207 pounds sterling v 134 pounds sterling in the hospital arm, excluding refusers, P<0.001). CONCLUSIONS: Hospital at home can deliver care at similar or lower cost than an equivalent admission to an acute hospital.
Aged↗