[Prevalence of contraceptive use in Colombia: determinants and implications].
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Abortion, Induced↗
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Advantages of place as perceived by Sunbelt promoters.
A questionnaire was sent to 104 Chamber of Commerce executives in states and cities in the South and Southwest to evaluate the factors they perceive to be important in recruiting business and industrial migrants from the North. 81 respondents rates 33 locational factors on a scale of 1 to 5. Results show variation in the perceived importance of factors between Southeast, South Central, and Southwest states and the Border states. Patterns of perceived competition among cities reveal that Border cities view Southern cities as their most important competitors but Southern cities see their major competitors as other rapidly growing Southern cities. Large cities do not see smaller cities as competitors with the exception of the "high tech" research centers such as Raleigh, North Carolina.
Americas↗
Contraceptive continuation rates in Papua New Guinea.
Family planning records were analyzed for 18 urban and rural clinics throughout Papua New Guinea. From the record cards of 7443 women, contraceptive continuation rates for the first method used were calculated. Continuation rates after one year are 92 per cent with the IUD (intra-uterine device), 41 per cent with oral contraceptives and 54 per cent with injections. Differences associated with age, parity, and rural-versus-urban clinics are discussed. Continuation rates are used to give an estimate of current contraceptive use of less than seven per cent of Papua New Guinea women. Improvement in access to services for rural women is needed, as is better communication in the initial interview with a new acceptor.
Adolescent↗
Filling the gaps. Systems offer two models of care management: community outreach and inpatient care.
The growing number of vulnerable people, such as the elderly and people with long-term disabilities, calls for healthcare providers to offer more programs to ensure a continuum of care. Client-focused care management programs offer access to such a continuum. Care managers understand services and reimbursement and can pull it all together for the client. The Sisters of Charity Health Care Systems, Cincinnati, have two models of care management. St. Joseph Coordinated Care provides extensive outreach to a large, culturally diverse New Mexico community, serving urban and rural clients. Penrose-St. Francis Healthcare System offers inpatient medical care management in Colorado. Coordinated Care at St. Joseph Healthcare System in Albuquerque is comprehensive, covering a wide spectrum of client needs--medical, social, and psychological. The program's central goal is to help individuals remain safely at home. Persistence and devotion to the client are the hallmarks of effective care management and the foundation of the new geriatric care management program at Penrose-St. Francis Healthcare System in Colorado Springs, CO. The program's goals are to improve inpatient geriatric care, smooth the patient's transition to alternative care settings, and ensure efficient and effective resource use during the patient's hospital stay.
Aged↗
The national survey of children with special health care needs.
CONTEXT: The federal and state-level Children with Special Health Care Needs (CSHCN) programs are vested with the responsibility for planning and developing systems of care for children with special health care needs. To support achievement of this goal, the federal Maternal and Child Health Bureau (MCHB), in partnership with the National Center for Health Statistics (NCHS), has developed a new survey that will provide uniform national and state data on the prevalence and impact of special health care needs among children. PURPOSE: The National Survey of CSHCN is designed to produce reliable state- and national-level estimates of the prevalence of special health care needs using MCHB's definition of CSHCN. It will also provide baseline estimates for federal and state Title V Maternal and Child Health performance measures, for Healthy People 2010 national prevention objectives, and for each state's Title V needs assessment. In addition, it will provide a resource for researchers, advocacy groups, and other interested parties. It is anticipated that this survey will be repeated periodically, thereby making trend analysis possible. METHODS: This survey is being conducted using the State and Local Area Integrated Telephone Survey mechanism, which shares the random-digit-dial sampling frame of the National Immunization Survey (sponsored by the National Immunization Program and NCHS). Using the CSHCN Screener, developed under the auspices of the Foundation for Accountability, 750 children with special health care needs will be identified and selected from each state and from the District of Columbia. Parents or guardians of these children then complete a comprehensive battery of questions on demographics, health and functional status, health insurance coverage, adequacy of health insurance coverage, public program participation, access to care, utilization of health care services, care coordination, satisfaction with care, and the impact of the special need on the family. Data collection began in October 2000 and will continue through March 2002. Summary reports and electronic data files will be available to the public within 6 to 12 months following completion of data collection. CONCLUSIONS: The National Survey of CSHCN will offer a unique data source for individuals and organizations interested in understanding and improving service delivery for CSHCN. It is an accomplishment that reflects the contributions of state and federal Title V programs, family organizations, provider organizations, health services researchers, and the broader maternal and child health community.
Adolescent↗
Mexican immigration and health care: a political economy perspective.
This paper examines the case of Mexican immigrants in the United States and their access to medical services within a political economy of health framework. Such an approach stresses that the provision of health care is independent of health factors per se and that access to health care is not equally distributed throughout a population. The first section reviews the three major concepts influencing medical anthropologists working within a political economy framework: the social origins of illness; the allocation of health resources; and fieldwork in Third World countries. The analysis then focuses upon the reasons for limiting immigrants' access to health care, followed by an examination of the socioeconomic characteristics of Mexican immigrants, including an undocumented immigration status, which limit their access to health care. Finally, the consequences of limited access to health services are suggested, including a low utilization of preventive health services resulting from the high cost of care combined with the immigrants' generally low income, lack of medical insurance and fear of using U.S. health services.
California↗
Achieving sex education program outcomes: points of view from students and alumni.
Several inherent limitations to secondary school sex education program evaluations are: limited generalizability, lack of longitudinal research, and no clear consensus of program outcomes. With a Bureau of Health Education, Center for Disease Control study as the criterion for program outcomes, a study was undertaken to examine the immediate and long-term impact of sex education upon program participants. Two of the 20 schools in the CDC study identified as having exemplary sex education programs provided access to their students and alumni. Inventories which measured perceived achievement of 33 sex education outcomes were piloted for reliability and validity. Each inventory examined participant changes in knowledge, understanding of self, values, interaction skills, self-esteem, and fear of sex-related activities. Students were surveyed in school; alumni were surveyed through the mail. Response rates ranged from 30 to 100 percent for students and alumni at both schools. Overall there was no statistically significant difference between the perceptions of students and alumni as to achievement of investigated outcomes. Alumni responses at one school did, however, indicate some potentially weak areas of their school's program with respect to values and interaction skills outcomes. It appears that program impact may decrease with time. Thus, isolating and addressing the factors involved may be necessary. This would assist program planners and instructors to strengthen curricula and program activities in order to enhance the overall impact of sex education. The present study supports the notion that positive gains are achieved as a result of each school's sex education program, and these gains remained over time.
Adolescent↗
Living on the edge: dietary strategies of economically impoverished women in Cali, Colombia.
Economically impoverished women in Cali, Colombia, have restricted access to food in a city where food is abundant. Ethnographic observations, interviews and 2 day food records were used to better understand the coping strategies used by a group of these women (n = 85) to maintain adequate levels of energy intake. Anthropometric indicators of nutritional status were normal for the group. Interview data revealed that the ability to purchase food was a concern for 58% of the women. When faced with a restricted ability to purchase food, the women indicated they made compromises in meal composition, reduced portion sizes, and/or reduced the number of meals. They also relied on relatives, friends, neighbors, store credit, or local government programs for access to food. Changes in meal composition were identified in 17.1% of all diet records (n = 509). Low energy intake (defined as energy intake < or = 1.27 x BMR) was identified in 17.1% of all diet records. Carbohydrate consumption was significantly greater on low-energy intake days. The adequate nutritional status of this group of women suggests that their coping strategies are usually adequate to maintain energy intake, but the presence of uncertainty, the frequency of compromises in diet composition, and the frequency of low-energy intake days suggest that these women are at risk for undernutrition.
Adaptation, Psychological↗
The effect of access restrictions on the vintage of drugs used by Medicaid enrollees.
OBJECTIVE: To examine the extent to which recent Medicaid drug access restrictions, such as preferred drug lists (PDLs), may affect the vintage (or time since Food and Drug Administration approval) of 6 types of drugs used by Medicaid beneficiaries. STUDY DESIGN: Retrospective claims database analysis using National Drug Code pharmacy claims data. METHODS: A regression model was developed to analyze the effect that Medicaid access restrictions had on the vintage of medications prescribed in 6 different therapeutic categories. A "difference in differences" approach was used to compare the change in vintage of medications prescribed in Medicaid versus non-Medicaid patients between the January-June 2001 and July-December 2003 study periods. RESULTS: The results of the regression model showed that PDLs increased the age of Medicaid prescriptions by less than 1 year for drugs in 5 of the 6 therapeutic classes analyzed. In the case of pain management medications, the increase was more than 1.2 years. CONCLUSIONS: The results of the regression model suggest that Medicaid drug access restriction programs (e.g., PDLs) have resulted in an increase in the age of drugs prescribed for Medicaid beneficiaries versus non-Medicaid patients. Since previous research has suggested a clinical and economic advantage to utilizing newer versus older drugs, further research should be conducted to explore how these medication restriction policies may unduly affect Medicaid beneficiaries compared with privately insured patients.
Drug Prescriptions↗
Distance education programs: defining issues of assessment, accessibility, and accommodation.
Identification and resolution of a variety of issues is imperative to establishing effective distance education via telecommunications. In this first-hand experience, the authors describe selected issues and possible responses inherent in the development and implementation of a new teaching modality. The decision to pursue distance education by telecommunications should be made only after a thorough examination of the needs, the required resources, and the changes to be expected. Advance planning is essential for problem solving.
Education, Nursing, Baccalaureate↗
Integrated population-based surveillance of noncommunicable diseases: the Pakistan model.
The escalating burden of noncommunicable diseases (NCDs) worldwide warrants an urgent public health response. Resource constraints and other factors necessitate an integrated and concerted approach to the range of NCDs. A necessary prerequisite for effective planning, implementation, and evaluation of NCD prevention programs is access to reliable and timely information on mortality, morbidity, risk factors, and their socioeconomic determinants. However, there is limited experience in the setting up of integrated NCD surveillance models in low-resource settings. As part of the National Action Plan for the Prevention and Control of NCDs in Pakistan, an integrated, systematic, and sustainable population-based NCD surveillance system is being established, and will be maintained and expanded over time. This is a common population surveillance mechanism for all NCDs (with the exception of cancer). The model includes population surveillance of main risk factors that predict many NCDs and combines modules on population surveillance of injuries, mental health, and stroke. In addition, the model has been adapted for program evaluation; this will enable it to track implementation processes using appropriate indicators, facilitating an assessment of how interventions work and which components contribute most to success. This paper outlines the first activity in this sequential process, including its merits and limitations.
Adolescent↗
[An insight into new basic strategies for lowering mortality].
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Birth Intervals↗
Medicaid managed care: the next generation?
The author provides an overview of the motivation leading nearly every state to develop managed health care arrangements under the state and federally funded Medicaid program for the poor. With managed care already a reform movement in state Medicaid efforts, further expansions of similar types of organized systems of care are anticipated in the future U.S. health care system. The author explores the acceleration of state investment in managed care planning and operations in terms of what is happening and whether expectations are being met. Specific plan features representing two very different managed care models within the evolution of how these plans have developed over time--Arizona's statewide prepaid plan begun in 1982 and New York's recently expanded statewide program designed to enroll 50% of those eligible within five years--are described. The author raises questions about these programs based on recent literature and discussions with key informants. Are sufficient providers out there and are there optimum ways to organize delivery networks? What additional safeguards may be required to protect consumers under managed care arrangements, and what are the effects of such programs on access to services and quality of care? What obstacles do health plans that traditionally serve mainly poor women and children have to overcome when serving people with disabilities or those with chronic health conditions? The author considers other barriers faced by states, providers, and policymakers in meeting the high expectations for the current generation of state-supported managed care plans. These questions and issues will remain important for some time as the states' efforts to promote managed care continue their anticipated expansion under health care reform.
Arizona↗
Food store access and household fruit and vegetable use among participants in the US Food Stamp Program.
OBJECTIVE: Recent research on access to food among low-income populations in industrialised countries has begun to focus on neighbourhood food availability as a key determinant of dietary behaviour. This study examined the relationship between various measures of food store access and household fruit and vegetable use among participants in the Food Stamp Program, America's largest domestic food assistance programme. DESIGN: A secondary data analysis was conducted using the 1996-97 National Food Stamp Program Survey. The survey employed a 1-week food inventory method, including two at-home interviews, to determine household food use. Separate linear regression models were developed to analyse fruit and vegetable use. Independent variables included distance to store, travel time to store, ownership of a car and difficulty of supermarket access. All models controlled for a full set of socio-economic variables. SUBJECTS: A nationally representative sample of participants (n=963) in the Food Stamp Program. RESULTS: After controlling for confounding variables, easy access to supermarket shopping was associated with increased household use of fruits (84 grams per adult equivalent per day; 95% confidence interval 5, 162). Distance from home to food store was inversely associated with fruit use by households. Similar patterns were seen with vegetable use, though associations were not significant. CONCLUSIONS: Environmental factors are importantly related to dietary choice in a nationally representative sample of low-income households, reinforcing the importance of including such factors in interventions that seek to effect dietary improvements.
Adult↗
A case series of patients using medicinal marihuana for management of chronic pain under the Canadian Marihuana Medical Access Regulations.
The Canadian Marihuana Medical Access Regulations (MMAR) program allows Health Canada to grant access to marihuana for medical use to those who are suffering from grave and debilitating illnesses. This is a report on a case series of 30 patients followed at a tertiary care pain management center in Nova Scotia who have used medicinal marihuana for 1-5 years under the MMAR program. Patients completed a follow-up questionnaire containing demographic and dosing information, a series of 11-point numerical symptom relief rating scales, a side effect checklist, and a subjective measure of improvement in function. Doses of marihuana ranged from less than 1 to 5g per day via the smoked or oral route of administration. Ninety-three percent of patients reported moderate or greater pain relief. Side effects were reported by 76% of patients, the most common of which were increased appetite and a sense of well-being, weight gain, and slowed thoughts. Limitations of the study include self-selection bias, small size, and lack of a control group. The need for further study using controlled trials is discussed along with an overview of the MMAR program.
Adult↗
Explaining the relationship between race/ethnicity and pharmacy purchased syringes among injection drug users in New York City.
OBJECTIVE: Pharmacy syringe sales without a prescription became legal in New York State on January 1, 2001 through the Expanded Syringe Access Demonstration Program (ESAP). At the same time, Pharmacy use among Black and Hispanic injection drug users was found to be significantly lower when compared to Whites. The purpose of this study was to assess the factors that could explain the relationship between race/ethnicity and pharmacy use. DESIGN: Data were combined from 2 on-going injection drug user (IDU) studies in 2 New York City neighborhoods. Social and behavioral factors independently associated with ever purchasing a nonprescription syringe in the past 6 months and examined using cross-sectional logistic regression. RESULTS: Of 337 IDUs, the majority were male (79%), Hispanic (73%) and had a mean age of 35 years. In bivariate analysis, IDUs who reported pharmacy use were less likely to be Black or Hispanic, older, and to have reported recent syringe exchange program (SEP) attendance compared to non-pharmacy users. Additionally, pharmacy users were more likely to have knowledge of ESAP, and report discrimination by police in the past year compared to non-users. After adjustment for recent SEP attendance (adjusted odds ratio [AOR]=0.27; 95% confidence interval [CI]=0.14-0.55), ESAP knowledge (AOR=13.11; 95% CI=6.54-26.31), discrimination by police (AOR=3.56; 95% CI=1.73-7.35), and discrimination due to race (AOR=0.25, 95% CI=0.11-0.58), race/ethnicity was not a significant predictor of pharmacy use. CONCLUSIONS: Race/ethnicity may not be an important determinant of ESAP when more salient social circumstances, such as past discrimination, are considered. Educational efforts should be enhanced to reach those who continue to perceive barriers to ESAP.
Adult↗
Why women don't get sterilized: a follow-up of women in Honduras.
In 1980, a study to determine interest in and access to sterilization for females was initiated at two Ministry of Health hospitals in Honduras. Results of the baseline study showed that 42 percent of women desiring sterilization from the Tegucigalpa hospital and 21 percent from the San Pedro Sula hospital had had a tubal ligation. A second study was conducted two years later, following up the interested but unsterilized women from the baseline study. Results show that 33 percent of women in the Tegucigalpa group, compared to 15 percent in the San Pedro Sula group, had been sterilized. Part of this difference can be attributed to an increase in sterilization facilities in Tegucigalpa over the two years after the baseline study was conducted. Among the major reasons women gave for not having been sterilized were financial and time constraints. Over the two-year period, the authors estimate that, of women interested in sterilization at delivery, 52 percent in total were sterilized in Tegucigalpa and 29 percent in San Pedro Sula.
Adult↗