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PubMed2002

[The relationship between undergoing a basic health checkup based on the Health and Medical Services Law for the Aged and medical expenditure covered under the National Health Insurance in Japan].

OBJECTIVES: This study examined the relationship between undergoing the basic health checkup based on the Health and Medical Services Law for the Aged among urban residents and medical expenditure covered under the National Health Insurance in Japan. METHODS: The subjects were all residents of a city with a population of three hundred and fifty thousand, covered by National Health Insurance and over forty years of age. Medical expenditure was compared by age and sex between examinees who had undergone the basic health checkup for the past three years running and non-examinees who had had no checkup. In addition, from the results of a questionnaire survey of randomly sampled citizens, we compared the living habits of the above two groups, the examinees and non-examinees. RESULTS: For outpatients, the medical expenditure per case, the medical expenditure per capita for seniors, and the medical expenditure per day were lower, and the number of examination days per case and the examination rate (the number of receipts per capita) were higher in the examinee group than in the non-examinee group. For inpatients, the medical expenditure per case, the medical expenditure per capita, the medical expenditure per day for seniors, the number of examination days per case, and the examination rate were lower in the examinee group compared to the non-examinee group. The increase in medical expenditure with age was less in the examinee group than in the non-examinee group. In men, the examinees had significantly better living habits (especially exercise and meals) than the non-examinees. No differences in living habits were found in women. CONCLUSIONS: Medical expenditure was lower among examinees than non-examinees. In men, regular examinees had better living habits than non-examinees.

Adult↗
PubMed1988

Dental public health: the past, present, and future. American Association of Public Health Dentistry. American Board of Dental Public Health.

The continued recognition process of dental public health as a specialty of dentistry served as an opportunity for the specialty to rediscover and reevaluate itself. What it found was a discipline that has evolved for 38 years to address the issues of a dynamic society. Dr. Abraham Kobren, ADA past-president has stated that public health dentistry stands as the dental conscience of the nation. The changes in dental public health mirror both changes in society and the technical changes occurring in dentistry. Identifying diseases in children is giving way to identifying diseases in adults. Prevention for adults is taking on as much importance as is prevention in children. Access to dental care for the poor and homeless is as much a problem as is access to care for people with infectious diseases. Infection control, technology transfer, national oral health objectives, and a myriad of new financing mechanisms are some areas of change. What has remained constant is the specialty's goal to improve the oral health of the public, and its commitment to work through "organized community efforts" to achieve this goal.

Acquired Immunodeficiency Syndrome↗
PubMedDate not supplied

Strengthening the role of primary health care in health promotion by bridging cultures in aboriginal health.

This paper advocates strengthening the role of primary health care in health promotion by bridging cultures in Aboriginal health. It encourages health care providers to consider the need for cross-cultural awareness in order to provide more effective health promotion. It suggests a number of strategies for overcoming structural barriers and individual factors which may hinder positive personal and professional cross-cultural communications.

Attitude of Health Personnel↗
PubMed1991

Urbanisation and women's health in Khayelitsha. Part II. Health status and use of health services.

A study was conducted among women in Khayelitsha to determine the relationship between urbanisation, health status and use of health services; 722 households were visited, and 659 female respondents provided information on acute and chronic illness for the 3,229 individuals who were members of their households. In addition, they provided information concerning their reproductive health, AIDS awareness, knowledge of cervical smears and use and knowledge of health services. Acute illness was reported for 4.3% of the study population, the commonest complaints being diarrhoea, abdominal pain and upper respiratory infections; 4.4% reported chronic illness, the commonest complaints being hypertension and tuberculosis; 16.2% of women reported gynaecological illness; 86% had of heard of AIDS (although their knowledge of transmission and prevention was poor); and 45% had heard of cervical smears. Patterns of illness and knowledge and use of health services vary in the different areas of residence of Khayelitsha. This appears to be related to urbanisation, age, and environmental and socio-economic factors.

Black or African American↗
PubMed1989

[Health care for the children population in Asturias based on levels and health care areas. Primary health care].

The resources available to the public health network in Asturias are presented for each health area in the level of pediatric primary care. Demographic analysis, age distribution and density of the ageing index for health areas are reported. In addition, the coverage, the number of families and children of care per physician, the rate of children per family, the care demand and the frequentation are evaluated. Imbalances are disclosed between the health centers and the outpatients clinics and between the health areas. The most important changes to be effected are pointed out.

Adolescent↗
PubMed1995

[Cooperation between the public health office and federal health insurance in the area of health promotion].

During the last few years several health projects were realised in cooperation with health insurance societies. One of the projects concerned the sports possibilities for people suffering from chronic diseases. Another one supplied information on symptoms of cardiac infarction. Cholesterol levels were analysed, height an body weight were determined and blood pressure was measured. Additionally, several data on anamnesis were stored anonymously as data files. One of the projects was performed with a normal part of the population in the office of a bank. During this arrangement many young people were also examined. Another event was a "doctor-patient-seminar" on the subject of cardiac infarction. We wanted to demonstrate a few interesting differences between the two groups that were examined. We found a circadian difference in the means of blood samples taken at 1-hour intervals, in respect of the cholesterol levels, the time difference being approximately two hours after the last ingestion. The cooperation with health insurance societies is a good possibility in view of the difficult situation of local or communal finances, to realise health education projects with financial support by health insurance societies. The statistical difference between the two examined populations for special risks shows that population groups with coronary insults in their anamnesis and hence treated "on target", yield statistically significantly better results in respect of cholesterol, systolic and diastolic blood pressure, than the group defined as a normal population.

Adult↗
PubMed1997

Health gain through health checks: improving access to primary health care for people with intellectual disability.

People with intellectual disability were identified through the local register and through liaison with general practitioners (GPs). A consultation exercise was conducted with users and carers to ascertain their experiences and perspectives of primary health care (GP services). A comprehensive health check was devised and administered to about 120 people to detect physical disorders, especially cardiovascular risk factors. A standardized checklist was used to determine the population of people with psychological and psychiatric problems. Case notes were reviewed after nearly one year to determine physical and psychological health gain. Significant gains were noted with regard to physical disorders. In contrast, mental health problems were underreported and participants had achieved few gains on follow-up. The reasons and implications for future service planning are discussed.

Body Mass Index↗
PubMed2001

Health for All in the Twenty-First Century, World Health Organization renewal, and equity in health: a commentary.

Health for All in the Twenty-first Century is the document presenting the global health policy adopted by the World Health Organization (WHO) in 1998, which reaffirms and updates the vision of Alma-Ata. This article provides a synopsis of the document and a commentary, concentrating on the issue of equity, which is central to WHO policy, and discussing cultural differences that underpin the notion of equity. The meaning of "equity" implies measurement, and the authors develop an approach to definitions of social strata and data issues that are used to quantify health differences. Finally, they discuss the way in which policies invoking equity are implemented into programs and present a rights-based approach as a case study of one way in which policy is being translated into action.

Health Plan Implementation↗
PubMed1999

Health insurance, health reform, and outpatient mental health treatment: who benefits?

This research examines how extending health insurance coverage to the previously uninsured impacts outpatient mental health treatment use among adults with different needs. Using data from the Epidemiologic Catchment Area Study and the 1987 National Medical Expenditure Survey, I develop simulations based on estimates of treatment demand. I find that insurance substantially increases demand by the mentally ill, but increased coverage alone cannot meet their treatment needs. Those in better mental health account for significant proportions of additional demand when coverage is expanded. Policies intended to increase access to mental health treatment among targeted groups should carefully consider the costs of increased use by other people.

Adult↗
PubMed2005

Disparities in mental health treatment following the World Trade Center Disaster: implications for mental health care and health services research.

To assess disparities in mental health treatment in New York City (NYC) after the World Trade Center Disaster (WTCD) reported previously related to care access, we conducted analyses among a cross-sectional survey of adults who had posttraumatic stress disorder (PTSD) or major depression (N = 473) one year after the event. The dependent variables examined were use of mental health services, in general, and use of mental health services related to the WTCD. Similar dependent variables were developed for medication usage. Although a number of bivariate results were statistically significant for postdisaster mental health visits, in a multivariate logistic regression model, only WTCD exposure remained significant. For service utilization related to the WTCD, the multivariate results indicated that African Americans were less likely to have had these visits compared to Whites, while those with a regular doctor, who had greater exposure to WTCD events, and those who had a perievent panic attack were more likely to have had such visits. In terms of medication use, multivariate results suggested that African Americans were less likely to use postdisaster medications, whereas persons 45 + years old and those with a regular doctor, were more likely to use them. For WTCD-related medication use, multivariate models indicated that African Americans were less likely to use medications, relative to Whites, while those between 45 and 64 years old, those with a regular doctor, those exposed to more WTCD events, and those who had a perievent panic attack, were more likely to have taken medications related to the disaster. The primary reason respondents gave for not seeking treatment (55% of subsample) was that they did not believe that they had a problem (73%). Other reasons were that they wanted to solve the problem on their own (5%), had problems accessing services (6%), had financial problems (4%), or had a fear of treatment (4%). Despite the availability of free mental health services offered in a supportive and potentially less stigmatizing environment post disaster, there still appeared to be barriers to receiving postdisaster services among those presumably in need of care.

Health Services Needs and Demand↗
PubMed1997

Health effects of caregiving: the caregiver health effects study: an ancillary study of the Cardiovascular Health Study.

We propose that two related sources of variability in studies of caregiving health effects contribute to an inconsistent pattern of findings: the sampling strategy used and the definition of what constitutes caregiving. Samples are often recruited through self-referral and are typically comprised of caregivers experiencing considerable distress. In this study, we examine the health effects of caregiving in large population-based samples of spousal caregivers and controls using a wide array of objective and self-report physical and mental health outcome measures. By applying different definitions of caregiving, we show that the magnitude of health effects attributable to caregiving can vary substantially, with the largest negative health effects observed among caregivers who characterize themselves as being strained. From an epidemiological perspective, our data show that approximately 80% of persons living with a spouse with a disability provide care to their spouse, but only half of care providers report mental or physical strain associated with caregiving.

Activities of Daily Living↗
PubMed2006

Subjective health complaints, health-related quality of life and physician visits: results of the study of health in Pomerania (SHIP).

OBJECTIVES: To investigate the relationship between subjective health complaints (SHCs), health-related quality of life and physician visits. METHOD: 3'773 participants of the Study of Health in Pomerania (SHIP) filled questionnaires and were interviewed. Data consisted of 1) 38 statements concerning SHCs, 2) the SF12, and 3) statements concerning visits to 11 different groups of physicians. Factor analysis was done on the SHC data, with a subsequent varimax rotation. Relationships between resulting factors and remaining variables were analysed using 1) the cumulative logit model for the first SF12 item (overall health evaluation), 2) linear regression for the physical and mental sum scores of the SF12, and 3) logistic regression for physician visits. RESULTS: Eight factors have eigenvalues greater than one and together explain 54.2% of total variance. Varimax rotated factors can be interpreted easily. Altogether, these factors, sex and age significantly affect the first SF12 item (Nagelkerke's R2 = 0.27), both sum scores (physical: R2adj. = 0.40; mental: R2adj. = 0.36), and all physician visits (Nagelkerke's R2 between 0.03 and 0.23). CONCLUSIONS: Subjective health complaints are important. Total sum scores of typical SHC questionnaires do not reflect all relevant aspects of SHCs.

Adult↗
PubMed2005

The health workforce: managing the crisis ethical international recruitment of health professionals: will codes of practice protect developing country health systems?

Many countries are using the strategy of international recruitment to make up for shortages of health professionals to the detriment of health systems in the poorest parts of the world. This study reviewed the potential impact of eight national level and international codes of practice or similar instruments that are being introduced to encourage ethical recruitment in order to protect these countries. Whilst effective dissemination of the instruments is generally in place, support systems, incentives and sanctions and monitoring systems necessary for effective implementation and sustainability are currently weak or have not been planned. If such codes or instruments are to be used to protect developing country health systems, lessons should be learnt from the early adopters; the focus of protecting developing country health systems needs to be emphasised in instruments with multiple objectives; the process of implementing the instruments strengthened; and internal and external pressure needs to be increased to ensure the codes and instruments lead to ethical recruitment and help to protect developing country health systems.

Codes of Ethics↗
PubMed2006

Toward a VA Women's Health Research Agenda: setting evidence-based priorities to improve the health and health care of women veterans.

The expansion of women in the military is reshaping the veteran population, with women now constituting the fastest growing segment of eligible VA health care users. In recognition of the changing demographics and special health care needs of women, the VA Office of Research & Development recently sponsored the first national VA Women's Health Research Agenda-setting conference to map research priorities to the needs of women veterans and position VA as a national leader in Women's Health Research. This paper summarizes the process and outcomes of this effort, outlining VA's research priorities for biomedical, clinical, rehabilitation, and health services research.

Delivery of Health Care↗
PubMedDate not supplied

Income effects of reduced health and health effects of reduced income: implications for health-state valuation.

There is increasing use of multiattribute health-state utility systems, such as the Health Utilities Index and the EuroQol (now EQ-5D), to estimate quality-adjusted life years (QALYs) for cost-utility analysis. Whereas the preferences elicited from individuals using willingness-to-pay techniques for cost-benefit analysis would be expected to reflect those individuals' income levels, it is often suggested that cost-utility analysis can avoid this income effect by not valuing health in monetary terms. Contrary to this view, the authors argue that income can influence the measurement of utilities used to estimate QALYs. In the context of multiattribute utility instruments, two income effects can take place: 1) when individuals are asked to value health states to generate the set of utilities to apply in subsequent evaluation studies; 2) when those multiattribute systems are used to categorize individuals' (usually patients') health status in the field in applied evaluation studies. The authors review the most popular utility systems regarding how these income effects are handled and assess the implications for the measurement of utilities using these systems.

Canada↗
PubMed1999

Ensuring force readiness and beneficiary health through health promotion and preventive medicine in the Military Health System: a position paper.

The evolution of the Military Health System (MHS) from a traditional model to a system of managed care precipitated a fundamental shift in the design and delivery of health care. This paper will propose the elements of a health system that delivers health promotion and preventive medicine as a focal point, describe the transition of the MHS to a prevention model, and discuss the work that needs to be done to achieve an accountable, comprehensive prevention-oriented system. The MHS has the opportunity to emerge as a model health care delivery system.

Health Promotion↗
PubMed2003

How mental health providers spend their time: a survey of 10 Veterans Health Administration mental health services.

BACKGROUND: Allocation of provider time across clinical, administrative, educational, and research activities may influence job satisfaction, productivity, and quality of care, yet we know little about what determines time allocation. AIMS: To investigate factors associated with time allocation, we surveyed all mental health providers in one Veterans Health Administration (VHA) network. We hypothesized that both facility characteristics (academic affiliation, type of organization of services, serving as a hub for treatment of severely mentally ill, facility size) and individual provider characteristics (discipline, length of time in job, having an academic appointment) would influence time allocation. METHODS: Eligible providers were psychiatrists, psychologists, social workers, physician assistants, registered or licensed practical nurses or other providers (psychology technicians, addiction therapists, nursing assistants, rehabilitation, recreational, occupational therapists) who were providing care in mental health services. A brief self-report survey was collected from all eligible providers at ten VHA facilities in late 1998 (N = 997). Data regarding facility characteristics were obtained by site visits and interviews with managers. Multilevel modeling was used to examine factors associated with three dependent variables: (i) total time allocation by activity (clinical, administrative, educational, research); (ii) clinical time allocation by treatment setting (inpatient vs. outpatient); and (iii) clinical time allocation by type of care (mental vs. physical). Licensed Practical Nurses (LPNs) were used as the reference group for all analyses because LPNs were expected to spend the majority of their time on clinical activities. RESULTS: Overall, providers spent most of their time on clinical activities (77%), followed by administrative (11%), and educational (10%). Surprisingly, research activities accounted for only 2% of their time. Multilevel analysis indicated none of the facility-level variables were significant in explaining facility variance in time allocation, but individual characteristics were associated with time allocation. The model for predicting time allocation by inpatient or outpatient settings explained 16-18% of the variance in the dependent variable. In all models, provider discipline and length of time in job played an important role. Having an academic appointment was important only in the model examining total time allocation by activity type. DISCUSSION: These simple models explained only a small amount of variance in the three dependent variables which were intended to capture issues related to time allocation; and the low number of facilities limited our power to examine effects of facility-level factors. Our models performed better in predicting allocation of clinical time to treatment setting and type of treatment than in predicting overall time allocation. Discipline and length of time in job were significant across all models. In contrast, having an academic appointment was associated with allocating significantly less time to clinical activities and more time to administrative activities but not to any significant difference in time spent in either research or education. IMPLICATIONS: While a gold standard of optimal time allocation does not exist, it is striking that research, a stated mission of the VHA, accounted for so little of providers' time. The lack of involvement of clinicians in research has implications for recruitment and retention of high-quality mental health providers in this network and for the education of future providers. Without involvement of clinicians, research conducted in the network by nonclinicians may be less relevant to "real-world" clinical issues. Reductions of funds available to mental health, coupled with increased clinical demands, may have prompted this pattern of time allocation, and these findings attest to the challenges faced by large institutions that are charged with balancing many often seemingly competing missions.

Health Services Research↗
PubMedDate not supplied

[Public health education and health promotion in Hungary: the role of Canada. The TEMPUS consortium for a New Public Health in Hungary].

The economy of Hungary is undergoing a major transition. The prevalence of behavioural and environmental risk factors is high. The population's health status is among the worst in Europe, and has declined in recent years. The Prussian-style curriculum in the medical universities was rigid and dictated from Budapest and Moscow. The teaching of public health was didactic, there was an emphasis on subjects such as dialectic materialism and hygiene. "Development of Medical Education for a New Public Health in Hungary", a three-year project funded by the European Community's TEMPUS program, is established to develop undergraduate and graduate education. It is a joint program between the five Hungarian medical schools and ten universities in Western countries including Canada. The reformation includes a shift from didactic teaching methods to problem-based learning techniques and greater emphasis on health promotion and population health. Communication within the project is facilitated through an electronic 'list server' based in London, Ontario.

Canada↗