SEARCH · Search PubMed

Results for “Personal utility”

Search indexed PubMed citations on genomics, clinical trials, systematic reviews and public health. Explore titles, authors and supplied subject terms, then open the PubMed record.

SourceResearch connectionFrom yearThrough year

Quote a phrase for an exact phrase match. Source license links do not imply unrestricted reuse.

At least 73 records · Page 4Linked to original sources

PubMedDate not supplied

Excess costs of diabetes in the Aboriginal population of Manitoba, Canada.

OBJECTIVE: We developed a measure of the cost of diabetes for general and North American Indian populations of Manitoba and estimated the excess costs of diabetes which are attributable to diabetes prevalence rates and per person utilization of health services. RESEARCH DESIGN AND METHODS: We obtained data from the Manitoba Medicare database and the Manitoba Diabetes Database. We estimated costs for each service and cost per person for four populations: Indian and general population groups with and without diabetes. Excess cost formulas were estimated. RESULTS: Prevalence and utilization were considerably higher for the North American Indian population. As a first approximation, excess costs due to disease prevalence added 15.9% to total costs, while excess costs due to utilization add 14.6%. CONCLUSIONS: Disease prevalence indicates a need to focus on primary preventive measures. High utilization indicates complications, and suggests a need for secondary prevention.

Adolescent↗

PubMed2005

Clinical utility of dimensional models for personality pathology.

Clinical utility is defined as the extent to which the DSM assists clinical decision makers in fulfilling the various clinical functions of a psychiatric classification system. Distinction is made between elements of diagnostic validity that are more or less conditional to utility (i.e., coverage, and consistency with etiology and prognosis) and components of clinical utility in the narrow sense of the term (i.e., user acceptability and accuracy, communication, reliability, subtlety, and clinical decision making). Clinical utility is often considered the driving force behind the respective revisions of the DSM system, yet it has been difficult if not impossible to obtain reasonable levels of clinical utility within categorical classifications of personality disorders. This paper presents evidence that a dimensional diagnostic system will substantially improve clinical utility, especially with respect to coverage, reliability, subtlety, and clinical decision making. In addition, some evidence suggests that the purely dimensional models outperform the so-called hybrid models (i.e., dimensional profiling of categories) with respect to coverage, consistency with etiology, subtlety, and clinical decision making. Several research options that might inform future revisions, including the choice or development of a dimensional classification, are suggested.

Diagnosis, Differential↗

PubMed1996

Utilization of a personal health record in a general medicine clinic.

To determine the baseline use of personal medical records maintained by patients, to initiate utilization of a personal health record (PHR), and to assess outcomes associated with its use, a survey, intervention, and outcome study was conducted with follow-up at 2, 7, and 14 months. One hundred randomly selected adult patients of the General Medicine Clinic at The University of Iowa Hospitals and Clinics were evaluated. At onset, 44% maintained no records. At 14-month follow-up, 69% maintained the PHR. The change in documentation was statistically significant (p = .013 x 10(-8), McNemar's Test for Paired Data; 95% confidence interval 0.065, 0.54). The baseline use of personal medical records was poor, but it was improved following introduction of the PHR, and most patients continued using the record 14 months later.

Documentation↗

PubMed2000

Functional brain imaging and age-related changes in cognition.

There are a number of age-related structural and physiological changes in the brain that could have implications for cognitive function in the elderly. The impact of these age-related changes in the brain on cognition has been studied using neuroimaging to examine brain activity during tasks of memory, perception and attention, and determine how this activity differs between young and older individuals. It has often been found that older individuals utilize different areas of the brain than do young subjects when carrying out the same cognitive task. This has led some researchers to suggest that older persons utilize different functional brain networks, perhaps to compensate for reductions of efficiency in task-related brain areas. However, data collected to date on this issue are still limited, so although the evidence is intriguing, the definitive interpretation of these findings must await further experiments.

Adult↗

PubMedDate not supplied

Brain imaging and age-related changes in cognition.

Although there is currently some debate as to the degree of structural changes in the brain that occur with age, there is little doubt that such changes occur. There also are physiological changes in many areas that could have implications for cognitive function in the elderly. One way to study the impact of these age-related changes in the brain on cognition is to use neuroimaging techniques to examine brain activity during the performance of various tasks, and determine how this activity differs between young and older individuals. This approach has been used to study functions such as memory, perception, and attention, and it has generally been found that older individuals utilize different areas of the brain than do young subjects when carrying out the same cognitive task. This has led some researchers to suggest that older persons utilize different functional brain networks, perhaps to compensate for reductions of efficiency in some brain areas. The areas of the brain most often found to be more active during cognitive tasks in the elderly are the frontal lobes. Studies that have directly examined the functional networks utilized during cognition have found that older people do indeed have different functional interactions involving the frontal lobes, and therefore, utilize different functional networks. In some cases this differential activity has been accompanied by cognitive performance in the older participants that is equivalent to that seen in the young, suggesting that greater reliance on this brain region is related in some way to the maintained ability of the older individuals to perform the task. However, data collected to date on this issue are still limited, so although the evidence is intriguing, the definitive interpretation of these findings must await further experiments.

Aging↗

PubMedDate not supplied

The person with a learning disability as a minority group member.

Last semester, while concluding an autobiography for a class assignment, the author came to the realization that being a person with a learning disability constitutes a strong connection to people of other minority groups. This article will develop that theme, searching relevant issues through applied sociological principles and utilizing personal commentaries by members of those groups.

Achievement↗

PubMedDate not supplied

Evaluating the special needs of functional neuromuscular stimulation research candidates.

A psychological screening protocol for individuals with paraplegia who, through functional neuromuscular stimulation (FNS), might develop stance and gait control is described. The efficacy of criteria to maximize the appropriate involvement of research candidates is reported. Accurate assessment of special needs for all participants, including persons referred prior to application of the screening protocol, was made based on histories of research involvement. Test and interview data identified two candidates who were inappropriate. Continued monitoring is planned to assess the relationship between FNS utilization, personal and environmental characteristics of participants, and consequences of research involvement. The value of providing social-environmental resources to maximize research outcome is emphasized.

Adaptation, Psychological↗

PubMedDate not supplied

[Evaluation of ambulatory medical care in Milan].

Ambulatory procedures are an essential component of health care both for their number and for their cost. We aim therefore to identify and to quantify the volume of ambulatory procedures performed in Milan during 2003. The data come from the Outpatient Care Information Report that collect much information by characteristics of patient, health care institution and procedure categories. The analyses in this report are based on absolute measures, utilization rates and concentration index. During the year 2003 nearly 20 millions of ambulatory procedures were performed in the public and private outpatient facilities of Milan for the resident population. The average annual rate was 15 procedures per person. Utilization varied according to patient age and sex, higher in women and in the elderly group, statistically significant variability is observed (p<0.001). Outpatient care accounts for high density supply (124 specialty points for 100,000 inhabitants). Utilization rate was not homogenous both for the medical specialties and for the geographical district distribution, all that, it seems depending on the activity concentration differences and complexity supply of services than on a different distribution of health needs. This analysis may be useful as methodological starting point for further investigating current outpatient care data and for identifying those sectors in need of corrective actions.

Adolescent↗

PubMed1987

Psychiatric emergency services: evolution, adaptation and proliferation.

This paper traces the dramatic rise of psychiatric emergency services (PES) and crisis intervention services over recent decades. It examines three processes--the evolution of such services, their adaptation to diverse settings, and the striking increase both in the number of programs and their utilization. PES first evolved along three disparate lines--makeshift psychiatric emergency care in the emergency room of the general hospital, ad hoc after-care services in the psychiatric hospital, and the community mental health movement. Community mental health legislation of the 1960s not only provided funds for PES but led to the merging of the three lines. PES have adapted to and are found in a great variety of settings. The latter include small general hospitals and huge medical centers; county, state, and private mental hospitals; free clinics; telephone hot-lines, and others. Their adaptability appears due to their flexible personnel requirements and lack of need for an elaborate technology. Although fewer than 160 facilities were known to offer PES in 1963, their number exceeded 2000 by the early 1980s. Available piecemeal data indicate constantly increasing utilization of PES. This is a result of many factors, including deinstitutionalization. Although PES were initially visualized as resources for acute mental health care and continue to serve as such, they have become increasingly chronicized, consequent on the deinstitutionalized abandonment of many chronically ill persons. Changes are also occurring in the social and demographic characteristics of persons utilizing PES and in the ways in which the services are perceived and utilized. The early development of unlabeled and makeshift psychiatric emergency care in the general hospital's emergency room and the psychiatric hospital were instances of 'evolutionary planning'.(ABSTRACT TRUNCATED AT 250 WORDS)

Community Mental Health Services↗

PubMed2004

Refining the measurement of the economic burden of chronic diseases in Canada.

This article presents an analysis of the economic burden of a number of chronic diseases in Canada. In the analysis, we adjusted our measure of utilization of physician and hospital services for co-existing chronic diseases, which we found to be widely prevalent and to have an impact on resource use. Using data from the 1999 National Population Health Survey, we developed resource use rankings for several chronic conditions and decomposed these measures into prevalence and per-person utilization components. Our results indicate that, for the diseases with the greatest impact, resource use measures are driven more by disease prevalence than intensity of resource use. The diseases with the highest overall degree of resource use are back pain, arthritis or rheumatism, high blood pressure and migraines for people under 60; and arthritis or rheumatism and high blood pressure for people over 60. Our methods can be used to forecast the overall relative impact of resource use due to disease prevalence and per-person resource use intensity for various conditions.

Adult↗

PubMedDate not supplied

Cost-effectiveness and the socialization of health care.

The more health care is socialized, the more cost-effectiveness is an appropriate criterion for expenditure. Utility-maximizing individuals, facing divisibility of health care purchases and declining marginal health gains, and complete information about probable health improvements, should buy health care according to its cost-effectiveness. Absent these features, individual health spending will not be cost-effective; and in any case, differences in personal utilities and risk aversion will not lead to the same ranking of health care interventions for everyone. Private insurance frees consumers from concern for cost, which undermines cost-effectiveness, but lets them emphasize effectiveness, which favors value for money. This is most important for costly and cost-effective interventions, especially for poor people. Cost-effectiveness is more appropriate and easier to achieve under second-party insurance. More complete socialization of health care, via public finance, can yield greater efficiency by making insurance compulsory. Cost-effectiveness is also more attractive when taxpayers subsidize others' care: needs (effectiveness) take precedence over wants (utility). The gain in effectiveness may be greater, and the welfare loss from Pareto non-optimality smaller, in poor countries than in rich ones.

Cost-Benefit Analysis↗

PubMed1996

Goal orientations and perceived purposes of training among elite athletes.

The goal perspective theories of motivated behavior are primarily concerned with the social, psychological, and behavioral antecedents and consequences of two goal perspectives of task orientation and ego orientation. According to Nicholls, goal perspectives may also influence the way individuals perceive the purpose of their involvement in achievement contexts. This study examined among elite athletes the relation of goal orientations to perceived purposes of their involvement in training. Canonical correlation analysis showed that ego-oriented athletes strongly endorsed status reasons for participation in training, whereas those task-involved reported a high preference for social purposes. The results suggest that the personal utility value of practicing in sport as perceived by elite athletes to some extent is different dependent upon their motivational goal perspectives.

Achievement↗

PubMed1997

Utilization of home care among people with HIV infection.

OBJECTIVE: To examine factors affecting the utilization of formal and informal home care services by people with HIV infection. DATA SOURCES AND STUDY SETTING: Study participants are adults with HIV infection receiving services at major providers of medical care in ten U.S. cities. Six interviews were conducted over an 18-month period (March 1991 to September 1992). DATA COLLECTION METHODS: Data on home care utilization, personal background characteristics, insurance status, and functional status are based on self-report. Disease stage is based on medical record data. STUDY DESIGN: This is an observational study using a panel survey design. Cross-tabular and longitudinal regression analyses (N = 1,727) were conducted to determine the effects of sociodemographic factors, functional status, disease stage, and insurance status on the receipt of home care from nurses, paraprofessionals, other professional providers, household residents, nonresident family and friends, and volunteers. PRINCIPAL FINDINGS: Over a 12-month period, 16 percent of respondents received home nursing visits; 11 percent received paraprofessional care (e.g., nurse's aides, helpers); 4 percent received help from volunteers; 11 percent from non-resident family or friends, and 21 percent from household members. Among the subgroup with AIDS (n = 837), corresponding percentages were 29, 20, 7, 17, and 29 percent for each provider type. In multivariate analyses, illness stage and functional status had strong effects on odds of utilization. Blacks and Hispanics were less likely than whites to have nursing care, but racial/ethnic group did not affect receipt of informal care. CONCLUSIONS: Home care utilization is concentrated among people with AIDS, compared to those at less advanced disease stages. In addition to functional limitations, fatigue is associated with the use of home care. Nursing and non-nursing home care have somewhat different correlates. Medicaid may provide better coverage of personal care services than private insurance.

Activities of Daily Living↗

PubMed1994

Correlates of medical service utilization among people with HIV infection.

OBJECTIVE: To examine factors affecting the use of inpatient, outpatient, and emergency room services by people with HIV infection. DATA SOURCES AND STUDY SETTING: Study participants are adults with HIV infection receiving services at major providers of medical care in ten U.S. cities. Six interviews were conducted over an 18-month period (March 1991 to September 1992). DATA COLLECTION METHODS: Data on service utilization, personal background characteristics, insurance status, and functional status are based on self-report. Disease stage is based on medical record data. STUDY DESIGN: This is an observational study using a panel survey design. Linear and Poisson regression analyses were conducted to determine the effects of need, enabling, and predisposing factors on the dependent variables of ambulatory visits, emergency room visits, inpatient admissions, and average length of inpatient stay. Analyses use 1,449 respondents who completed the second and third interviews. Independent variables were measured as of the second interview, while dependent variables were measured in the third and fourth interview periods. PRINCIPAL FINDINGS: Service utilization was higher among respondents with AIDS than among those at earlier stages of HIV infection. Functional limitations, experienced pain, and negative mood each were associated with increased service use, over and above disease stage. Black respondents reported more hospital admissions and longer lengths of inpatient stays than white respondents. Lack of insurance was related to reduced service use. The effects of disease stage and functional limitations were reduced among people with public, compared to private, insurance. CONCLUSIONS: While disease stage affects use of medical care, the experience of adverse HIV-related conditions, such as pain or functional limitations, has an additional effect on service use. Persistent racial differences in utilization remain to be explained. Lack of insurance impedes use directly and also modifies the effects of disease stage and functioning.

Activities of Daily Living↗

PubMed1986

Psychological vulnerability to alcoholism: studies in internal scanning deficit.

Three studies considered the predispositional role of impaired internal scanning in alcoholism. Scanning represents the person's sensitivity to internal stimulation and the extent to which the person utilizes internally generated information. The first study found that more acute alcoholic patients displayed poorer scanning than more chronic alcoholics. This finding contra-indicates deficit scanning as an effect of alcoholism and suggests that this impairment antecedes the alcoholic disorder. Two further studies tested the possible antecedent status of deficit scanning. Adolescent wards of the juvenile court, judged to be more at risk for alcoholism, were poorer scanners than their counterparts with fewer drinking-related problems. Male college students with a greater number of alcohol-related problems also proved to be poorer scanners. It is proposed that limited scanning contributes to alcoholic vulnerability by depriving the person of information vital to the control of drinking behaviour.

Adolescent↗

PubMed2006

Evaluation of internal medicine residents as exercise role models and associations with self-reported counseling behavior, confidence, and perceived success.

BACKGROUND: Patients perceive physicians who practice healthy personal behaviors as more credible and better able to motivate patients to make healthy lifestyle choices. PURPOSES: To evaluate internal medicine resident physicians as role models for promoting exercise by an assessment of physician physical activity behavior, cardiovascular fitness, physical activity knowledge, personal use of behavior modification techniques, attitudes toward personal physical activity practice, and confidence (i.e., self-efficacy) in the knowledge and personal utilization of behavior modification techniques and to explore the associations with self-reported patient counseling behavior, confidence, and perceived success. METHODS: Cross-sectional study of internal medicine resident physicians with a self-administered survey, treadmill fitness testing, and a 7-day physical activity recall. RESULTS: Fifty-one resident physicians agreed to participate (response rate = 81%). Fitness levels were below average for 60%, average for 25%, and above average or excellent for 15%. The mean energy expenditure was 234 kcal/kg/week, with 41% of physicians meeting recommended physical activity guidelines. Few reported high self-efficacy (33%) or perceived success (25%) in the ability to be regularly active. Few demonstrated adequate knowledge useful for patient counseling (e.g., listing 3 ways to integrate physical activity into daily life [27%], calculating target heart rate [29%], and identifying personal exercise stages of change [25%]). Personal use of behavior modification techniques was reported infrequently. Although 88% reported confidence in the knowledge of exercise benefits, less than half reported confidence in the knowledge of local facilities, American College of Sports Medicine (ACSM) guidelines, and behavior modification techniques. Multiple linear regression demonstrated that a higher level of training (p = .02) and a greater confidence in the knowledge of ACSM guidelines (p = .048, total R2 = .21) independently predicted more frequent self-reported counseling. Sex (i.e., male; p = .01) and greater physical activity self-efficacy (p = .017, total R2 = .23) independently predicted greater perceived counseling success. Greater physical activity enjoyment (p = .03) and greater perceived success at engaging in regular physical activity (p = .028, total R2 = .28) independently predicted greater counseling self-efficacy. CONCLUSIONS: Most internal medicine resident physicians may not be adequate role models for promoting exercise adherence. Confidence in the knowledge of current guidelines, personal physical activity enjoyment, and perceived success and self-efficacy in engaging in regular physical activity may be useful targets for enhancing resident physician physical activity counseling for their patients.

Adult↗

PubMed1999

The organization of vocational rehabilitation: the structure of success.

Focusing on vocational rehabilitation goals provides an understanding of the underlying structural and behavioural factors affecting successful employment outcomes. Two types of vocational centres having contrasting rehabilitation employment orientations are examined. Both types have similar end goals but organizational structures shaping divergent means toward the gainful employment of disabled persons. Utilizing a split sample of 14 vocational rehabilitation programmes in Israel, 7 sheltered and 7 supported programmes, a structured questionnaire of key administrative personnel and employees was generated. Success was based on six consensus measures. Clear differences between administrative, organizational and programme goals emerge, which affect goal priority and source of success measurement. Employing regression models, three keys to success are detected which stress the interplay between internal and external organization reference criteria in affecting success attainment. The results suggest that the organization of vocational rehabilitation has a direct impact on rehabilitation success.

Adult↗

PubMed2003

International comparison of health resource utilization in subjects with diabetes: an analysis of Canadian and American national health surveys.

OBJECTIVE: To compare health resource utilization in patients with diabetes between the U.S. and Canada. RESEARCH DESIGN AND METHODS: We combined measures of health care utilization, personal, demographic, health status, functional status, and comorbid conditions from the current National Health Interview Survey (U.S.) and the National Public Health Survey (Canada). A binary logistic regression analysis was used to examine how country of residence influences the probability of accessing health care resources in adult Caucasian subjects after controlling for potential confounders. RESULTS: Subjects from Canada (n = 521) were more likely to have contact with a general physician (odds ratio [OR] 4.01, 95% CI 2.26-7.14), eye specialists (1.46, 1.08-1. 98), and any physician (3.02, 1.03-8.84) in the past year than their American counterparts (n = 825) but were less likely to have had contact with other medical specialists (0.33, 0.24-0.46). Subjects in Canada were also more likely to have been hospitalized overnight (1.79, 1.17-2.75) or to have contact with a health care professional in the previous 12 months (3.35, 1.01-12.81). CONCLUSIONS: Significant disparities exist in health service utilization for adult Caucasian individuals with diabetes in Canada versus the U.S. after controlling for various confounders. From what is known regarding optimal treatment of diabetes, those with diabetes in the U.S. have a greater chance of not receiving recommended care.

Adult↗