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At least 793 records · Page 44Linked to original sources
PubMed2000

Oral contraceptive use.

OBJECTIVES: This article profiles Canadian women aged 15 to 49 who use oral contraceptives (OCs), and compares certain of their characteristics with those of non-users. It also examines associations between OC use and selected characteristics, including cardiovascular risk factors. DATA SOURCE: The data are from the cross-sectional household component of Statistics Canada's 1996/97 National Population Health Survey. The analysis is based on a sample of 21,996 women aged 15 to 49, weighted to represent an estimated 7.6 million women. ANALYTICAL TECHNIQUES: Cross-tabulations were used to estimate the percentage of women aged 15 to 49 who use OCs and to compare selected health behaviours of users and non-users. A multiple logistic regression model was used to model relationships between selected characteristics and OC use. MAIN RESULTS: An estimated 1.3 million women aged 15 to 49, or 18%, reported using OCs in 1996/97. OC use was significantly associated with being young, unmarried, sexually active, and having prescription drug insurance and relatively high education. About one-third of OC users also smoked.

Adolescent↗
PubMed2000

Living at home or in an institution: what makes the difference for seniors?

OBJECTIVES: This article examines some of the health and socio-demographic factors associated with living in long-term health care facilities rather than in private households, for elderly people with various levels of disability. DATA SOURCE: The data are from the 1996/97 National Population Health Survey conducted by Statistics Canada. Data from a sample of 1,711 people aged 65 or older living in long-term health care facilities and 13,363 in private households were weighted to represent about 185,100 and 3.4 million seniors, respectively. ANALYTICAL TECHNIQUES: Descriptive data were produced using bivariate frequencies. Multiple logistic regression models were used to examine associations between living in long-term health care facilities and selected health and socio-demographic characteristics for seniors with self-reported severe, moderate or no disability. MAIN RESULTS: While health status was strongly associated with residence in a long-term health care facility, the absence of a spouse, low income, low education, and advanced age were also significant.

Aged↗
PubMed2000

Do longer postpartum stays reduce newborn readmissions? Analysis using instrumental variables.

OBJECTIVE: To determine the effect of postpartum length of stay on newborn readmission. DATA SOURCES: Secondary data set consisting of newborns born in Washington state in 1989 and 1990. The data set contains information about the characteristics of the newborn and its parents, physician, hospital, and insurance status. STUDY DESIGN: Analysis of the effect of length of stay on the probability of newborn readmission using hour of birth and method of delivery as instrumental variables (IVs) to account for unobserved heterogeneity. Of approximately 150,000 newborns born in Washington in 1989 and 1990, 108,551 (72 percent) were included in our analysis. PRINCIPAL FINDINGS: Newborns with different lengths of stay differ in unmeasured characteristics, biasing estimates based on standard statistical methods. The results of our analyses show that a 12-hour increase in length of stay is associated with a reduction in the newborn readmission rate of 0.6 percentage points. This is twice as large as the estimate obtained using standard statistical (non-IV) methods. CONCLUSION: An increase in the length of postpartum hospital stays may result in a decline in newborn readmissions. The magnitude of this decline in readmissions may be larger than previously thought.

Bias↗
PubMed2001

Differences in the structure of CAHPS measures among the medicare fee-for-service, medicare managed care, and privately insured populations.

OBJECTIVE: To confirm in a new population, the Medicare fee-for-service population, the factor structure previously found in two Consumer Assessment of Health Plans Study (CAHPS) field-test surveys with Medicare HMO and adult privately insured populations. DATA SOURCES: Primary data were collected in the fall of 1998. Survey responses from the Medicare Fee-for-Service CAHPS survey field test were compared to results from the Medicare HMO and adult privately insured field-test studies conducted in the fall of 1996. STUDY DESIGN: Respondents for the field-test survey were a random sample of Medicare beneficiaries in five states who had opted for the original Medicare plan (fee-for-service). DATA COLLECTION: Data were collected by a mailed survey with a telephone follow-up survey to those who did not return the mailed survey. PRINCIPAL FINDINGS: A confirmatory factor analysis in two different samples of Medicare fee-for-service beneficiaries provided basic support for a previously reported three-factor structure underlying the CAHPS reports and rating items: (1) quality of provider or staff communications; (2) timely access to quality health care; and (3) quality of plan administration. An exploratory factor analysis revealed a variant three-factor structure. CONCLUSION: Because of differences in the factor structures among the different populations discussed, caution needs to be exercised in any composite development, based on factor analysis or any other basis, by which cross-population comparisons will be made. Comparisons should only be made on composites representing stable structure across all populations concerned.

Consumer Behavior↗
PubMed2001

Racial and ethnic differences in parents' assessments of pediatric care in Medicaid managed care.

OBJECTIVE: This study examines whether parents' reports and ratings of pediatric health care vary by race/ethnicity and language in Medicaid managed care. DATA SOURCES: The data analyzed are from the National Consumer Assessment of Health Plans (CAHPS) Benchmarking Database 1.0 and consist of 9,540 children enrolled in Medicaid managed care plans in Arkansas, Kansas, Minnesota, Oklahoma, Vermont, and Washington state from 1997 to 1998. DATA COLLECTION: The data were collected by telephone and mail, and surveys were administered in Spanish and English. The mean response rate for all plans was 42.1 percent. STUDY DESIGN: Data were analyzed using multiple regression models. The dependent variables are CAHPS 1.0 ratings (personal doctor, specialist, health care, health plan) and reports of care (getting needed care, timeliness of care, provider communication, staff helpfulness, plan service). The independent variables are race/ethnicity (white, African American, American Indian, Asian, and Hispanic), Hispanic language (English or Spanish), and Asian language (English or other), controlling for gender, age, education, and health status. PRINCIPAL FINDINGS: Racial/ethnic minorities had worse reports of care than whites. Among Hispanics and Asians language barriers had a larger negative effect on reports of care than race/ethnicity. For example, while Asian non-English-speakers had lower scores than whites for staff helpfulness (beta = -20.10), timeliness of care (beta = -18.65), provider communication (beta = -17.19), plan service (beta = -10.95), and getting needed care (beta = -8.11), Asian English speakers did not differ significantly from whites on any of the reports of care. However, lower reports of care for racial/ethnic groups did not translate necessarily into lower ratings of care. CONCLUSIONS: Health plans need to pay increased attention to racial/ethnic differences in assessments of care. This study's finding that language barriers are largely responsible for racial/ethnic disparities in care suggests that linguistically appropriate health care services are needed to address these gaps.

Adolescent↗
PubMed2001

Differences in CAHPS adult survey reports and ratings by race and ethnicity: an analysis of the National CAHPS benchmarking data 1.0.

OBJECTIVE: To examine racial/ethnic group differences in adults' reports and ratings of care using data from the National Consumer Assessment of Health Plans (CAHPS) survey Benchmarking Database (NCBD) 1.0. DATA SOURCE: Adult data from the NCBD 1.0 is comprised of CAHPS 1.0 survey data from 54 commercial and 31 Medicaid health plans from across the United States. A total of 28,354 adult respondents (age > or = 18 years) were included in this study. Respondents were categorized as belonging to one of the following racial/ethnic groups: Hispanic (n = 1,657), white (n = 20,414), black or African American (n = 2,942), Asian and Pacific Islander (n = 976), and American Indian or Alaskan native (n = 588). STUDY DESIGN: Four single-item global ratings (personal doctor, specialty care, overall rating of health plan, and overall rating of health care) and five multiple-item report composites (access to needed care, provider communication, office staff helpfulness, promptness of care, and health plan customer service) from CAHPS 1.0 were examined. Statistical Analyses. Multiple regression models were estimated to assess differences in global ratings and report composites between whites and members of other racial/ethnic groups, controlling for age, gender, perceived health status, educational attainment, and insurance type. PRINCIPAL FINDINGS: Members of racial/ethnic minority groups, with the exception of Asians/Pacific Islanders, reported experiences with health care similar to those of whites. However, global ratings of care by Asians/Pacific Islanders are similar to those of whites. CONCLUSIONS: Improvements in quality of care for Asians/Pacific Islanders are needed. Comparisons of care in racially and ethnically diverse populations based on global ratings of care should be interpreted cautiously.

Adult↗
PubMed2000

Chronic back problems among workers.

OBJECTIVES: This article examines associations between selected work- and non-work-related factors and the incidence of chronic back problems over the next two years. DATA SOURCE: The data are from the longitudinal household component of the National Population Health Survey, conducted by Statistics Canada. The analysis is based on 3,234 male and 3,129 female respondents who, in 1994/95, were aged 16 or older, employed, rated their health as good, very good or excellent, and reported no diagnosed chronic back problems. ANALYTICAL TECHNIQUES: All analyses were weighted to represent the Canadian population in 1994/95. Unadjusted cross-tabulations and multiple logistic regression were used to examine the associations between respondents' characteristics in 1994/95 and newly diagnosed chronic back problems in 1996/97. MAIN RESULTS: More than 1 million (9%) Canadian workers aged 16 or older developed chronic back problems between 1994/95 and 1996/97. Back injury, chronic stress, depression, and being aged 40 to 49 were significantly associated with subsequent chronic back problems.

Activities of Daily Living↗
PubMed2000

Teenage pregnancy.

OBJECTIVES: This article examines trends in teenage pregnancy in Canada, focussing on induced abortions, live births and fetal loss among women aged 15 to 19 in 1997. DATA SOURCES: The data come from the Hospital Morbidity Data Base and the Canadian Vital Statistics Data Base at Statistics Canada, and the annual Therapeutic Abortion Survey, conducted by the Canadian Institute for Health Information. Data on abortions performed on Canadian residents in the United States are from an annual survey of selected states. International data are from the Alan Guttmacher Institute. ANALYTICAL TECHNIQUES: Pregnancy rates, abortion rates, live birth rates and fetal loss rates are calculated using population counts of women in the age groups 15 to 17, 18 to 19, and 15 to 19. The percentages of pregnancies that ended in the three outcomes are also calculated for these years. MAIN RESULTS: The teenage pregnancy rate declined from 1994 to 1997, reflecting lower teenage birth and fetal loss rates. Through this period the abortion rate remained stable, with the result that slightly more than half of all teenage pregnancies ended in abortion by 1997. Younger teens are more likely to have an abortion than to give birth. The majority of pregnancies among older teens end in a live birth, although the number of live births is decreasing.

Abortion, Legal↗
PubMed2001

Hospital registered nurse shortages: environmental, patient, and institutional predictors.

OBJECTIVE: To examine the characteristics of acute-care hospitals that report registered nurse shortages when a widespread shortage exists and when a widespread shortage is no longer evident. DATA SOURCE: Secondary data from the American Hospital Association's Nursing Personnel Survey from 1990 and 1992 were used. The study population was all acute-care hospitals in the United States. STUDY DESIGN: Outcome variables included whether a hospital experienced a shortage in 1990, when many hospitals reported a nursing shortage, or whether a hospital reported a shortage in both 1990 and 1992. Predictor variables included environmental, patient, and institutional characteristics. Associations between predictor and outcome variables were investigated using probit analyses. PRINCIPAL FINDINGS: Location in the South, a high percentage of nonwhite county residents, a high percentage of patients with Medicaid or Medicare as payer, a higher patient acuity, and use of team or functional nursing care delivery consistently predicted hospitals reporting shortages both when there was a widespread shortage and when there was no widespread shortage. CONCLUSIONS: Although some characteristics under the direct control of hospitals, such as nursing care delivery model, are associated with their reporting a shortage of nurses, shortage is also strongly associated with broader population characteristics such as minority communities and a public insurance payer mix. Awareness of these broader factors may help inform policies to improve the distribution of nurse supply.

Aged↗
PubMed2001

Preference diversity and the breadth of employee health insurance options.

OBJECTIVE: To examine the effect of worker heterogeneity, firm size, and establishment size on the breadth of employer health insurance offerings. DATA SOURCES: The data were drawn from the 1993 Robert Wood Johnson Foundation Employer Health Insurance Survey of 22,000 business establishments selected randomly from ten states. STUDY DESIGN: The analysis was cross-sectional, using ordered probit models to relate the breadth of plan offerings to firm characteristics. PRINCIPAL FINDINGS: Firms with more diverse workforces offered a more diverse set of health insurance options. Firm and establishment size independently influenced the breadth of plan offerings. CONCLUSIONS: Employers are responsive to worker heterogeneity when determining the breadth of their health insurance offerings. However, diseconomies of scale in the purchase and administration of health insurance appear to limit the extent to which small employers can accommodate diverse worker preferences.

Cross-Sectional Studies↗
PubMed2001

Recognition and management of atlanto-occipital dislocation: improving survival from an often fatal condition.

OBJECTIVE: To provide an overview of atlanto-occipital dislocation and associated occipital condyle fracturcs so as to alert physicians to this rare injury and potentially improve patient outcome. The pertinent anatomy, mechanism of injury, clinical and radiologic evaluation and the management of these rare injuries are discussed in an attempt to alert physicians to this type of injury and to improve outcome. DATA SOURCES: The data were obtained from a MEDLINE search of the English literature from 1966 to 1999 and the experience of 4 spine surgeons at a quaternary care acute spinal cord injury unit. STUDY SELECTION: Detailed anatomic and epidemiologically sound radiology studies were identified and analyzed. Only small retrospective studies or case series were available in the literature. DATA EXTRACTION: Valid anatomic, biomechanical and radiologic evaluation was extracted from studies. Clinical data came from limited studies and expert opinion. DATA SYNTHESIS: Early diagnosis is essential and is facilitated by a detailed clinical examination and strict adherence to an imaging algorithm that includes CT and MRI scanning. When the dislocation is identified, timely gentle reduction and prompt stabilization throuigh nonoperative or operative means is found to optimize patient outcome. CONCLUSIONS: Atlanto-occipital dislocation should be suspected in any patient involved in a high speed motor vehicle or pedestrian collision. Once suspected, proper imaging and appropriate management of these once fatal injuries can improve survival and neurologic outcome.

Atlanto-Occipital Joint↗
PubMed2000

Progress in malaria control in China.

PURPOSE: To summarize the main achievements of the control of malaria in the People's Republic of China. DATA SOURCES: The data are from national case reporting system (1955-1998), and bibliographic reviews of textbooks and review articles. STUDY SELECTION: Successes in control and research of malaria were identified and selected to address the stated purpose. DATA EXTRACTION: In the past 50 years, large-scale malaria control activities were conducted in the country, relying on primary health care networks and community participation. The control of malaria was implemented according to the time- and locality-oriented approaches. As a result, remarkable success has been achieved. By the end of 1998, there were 31.3 thousand malaria cases in China, with a morbidity of 0.25 per ten thousand, which dropped by 99% in comparison with that in the 1950s. RESULTS: Most of the original hyper-endemic areas became meso- or hypo-endemic and for most of the previously meso- or hypo-endemic areas, the disease became sporadic. Malaria distribution and epidemic pattern also demonstrated great changes. CONCLUSIONS: Malaria control in China has been considerably successful in the past 50 years, which coincides with the target of the World Health Organization's "Health for all by the year 2000".

China↗
PubMed2000

Retrospect on the research of the cultivation of Gastrodia elata Bl, a rare traditional Chinese medicine.

PURPOSE: To review the research on the cultivation of Gastrodia elata Bl, a rare traditional Chinese medicine. DATA SOURCES: The data come from our previous research and published review articles on G. elata cultivation. STUDY SELECTION: After reviewing the research results on G. elata from 1960 to 1995, we selected the core research on G. elata and a complete cultivation technique of rare traditional Chinese medicine G. elata. DATA EXTRACTION: Some important data were arranged in different tables, and new cultivation methods were reviewed. RESULTS: A. mellea has been found to have inhibiting effects on G. elata seed germination. The seeds are able to sprout only when a nutritional relationship exists between G. elata and a fungus of the same genus as M. osmundicola. The sprouted tubers have to set up a symbiotic relationship with A. mellea during their clone propagation period so as to grow normally. CONCLUSIONS: G. elata has to symbiosize with M. osmundicola and A. mellea so as to complete its life cycle from seed to seed. These findings have revealed the secret of the life cycle of G. elata that has been puzzling biological circles for years.

Drugs, Chinese Herbal↗
PubMed2002

Combining location and expression data for principled discovery of genetic regulatory network models.

We develop principled methods for the automatic induction (discovery) of genetic regulatory network models from multiple data sources and data modalities. Models of regulatory networks are represented as Bayesian networks, allowing the models to compactly and robustly capture probabilistic multivariate statistical dependencies between the various cellular factors in these networks. We build on previous Bayesian network validation results by extending the validation framework to the context of model induction, leveraging heuristic simulated annealing search algorithms and posterior model averaging. Using expression data in isolation yields results inconsistent with location data so we incorporate genomic location data to guide the model induction process. We combine these two data modalities by allowing location data to influence the model prior and expression data to influence the model likelihood. We demonstrate the utility of this approach by discovering genetic regulatory models of thirty-three variables involved in S. cerevisiae pheromone response. The models we automatically generate are consistent with the current understanding regarding this regulatory network, but also suggest new directions for future experimental investigation.

Bayes Theorem↗
PubMed1999

Health effects of physical activity.

OBJECTIVES: This article examines the potential protective effect of leisure-time physical activity on the incidence of heart disease and depression. DATA SOURCE: The data are from the household longitudinal component of the 1994/95 and 1996/97 cycles of the National Population Health Survey, conducted by Statistics Canada. Results are based on two subsamples: 7,158 respondents aged 20 or older who were healthy and free of heart disease in 1994/95, and 7,593 respondents aged 12 or older who were healthy and free of depression in 1994/95. ANALYTICAL TECHNIQUES: Multiple logistic regression was used to estimate the effects of leisure-time physical activity on the incidence of heart disease and depression, while controlling for selected characteristics. MAIN RESULTS: Individuals who were healthy and free of heart disease or depression in 1994/95 and who engaged in regular physical activity at a moderate level of energy expenditure had lower odds of reporting a diagnosis of heart disease or an episode of depression in 1996/97 than those who were less active.

Adolescent↗
PubMed1999

Body mass index and health.

OBJECTIVES: This article describes the prevalence of the four international body mass index (BMI) categories--underweight (18.5 or less), acceptable weight (18.6 to 24.9), overweight (25 to 29.9) and obese (30 or more)--by selected socio-demographic and lifestyle characteristics. It also examines the association between BMI and selected health problems. DATA SOURCE: The data are from the household component of the 1996/97 National Population Health Survey, conducted by Statistics Canada. Results are based on a sample of 50,347 respondents aged 20 to 64. ANALYTICAL TECHNIQUES: Prevalence estimates of BMI categories were calculated. Multivariate analyses were used to examine associations between BMI and various health conditions by smoking status, while controlling for age and sex. MAIN RESULTS: In 1996/97, about half of Canadian adults were in the acceptable weight range; 34% were overweight; 12%, obese; and 2%, underweight. Being overweight or obese was associated with asthma, arthritis, back problems, high blood pressure, diabetes and thyroid disorders, although this varied with smoking status. Underweight smokers had high odds of reporting cancer, bowel disorders, ulcers, and migraine.

Adult↗
PubMed1999

Dental insurance and use of dental services.

OBJECTIVES: This article examines socioeconomic differences in insurance for dental services among Canadians aged 15 or older and factors associated with the use of dental services. DATA SOURCE: The data on dental insurance coverage and use of dental services are from the cross-sectional file of Statistics Canada's 1996/97 National Population Health Survey. The sample size of respondents aged 15 or older was 70,884. ANALYTICAL TECHNIQUES: Logistic regression analysis was used to model variables related to dental insurance coverage and to dental visits in the past year. A weighted bootstrap resampling procedure was used to derive variance estimates. MAIN RESULTS: In 1996/97, 53% of the population aged 15 or older reported having dental insurance, and 59% said they had visited a dentist in the past year. But even when they had insurance, individuals with low incomes and low educational attainment had much lower odds of visiting a dentist than those with higher incomes and more education.

Adolescent↗
PubMed1999

Mortality in metropolitan areas.

OBJECTIVES: This article examines differences in all causes mortality rates and rates for the leading causes of death (heart disease, cancer and cerebrovascular disease) by census metropolitan area (CMA). DATA SOURCE: The data are from the Canadian Vital Statistics Data Base maintained by Statistics Canada. ANALYTICAL TECHNIQUES: Annualized age-standardized mortality rates were calculated for Canada and for each CMA for the three-year period from 1994 to 1996. Differences between the CMA rates and the national rate were examined. MAIN RESULTS: Mortality rates tend to be high in CMAs in the Atlantic provinces and Québec and low in CMAs in the Prairies and British Columbia. Ontario contains CMAs with some of the highest mortality rates in Canada, as well as others whose rates are among the lowest. The pattern of mortality for specific causes also differs within CMAs: a CMA may have a high death rate for one cause, but a low rate for another.

British Columbia↗