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PubMed2006

The epidemiology of nonspecific psychological distress in New York City, 2002 and 2003.

The 30-day prevalence of nonspecific psychological distress (NPD) is 3%, nationwide. Little is known about the prevalence and correlates of NPD in urban areas. This study documents the prevalence of NPD among adults in New York City (NYC) using population-based data from the 2002 and 2003 NYC Community Health Surveys (CHS) and identifies correlates of NPD in this population. We examined two cross-sectional random-digit-dialed telephone surveys of NYC adults (2002: N = 9,764; 2003: N = 9,802). Kessler's K6 scale was used to measure NPD. Age-adjusted 30-day prevalence of NPD declined from 6.4% [95% Confidence Interval (CI): 5.8-7.0] in 2002 to 5.1% [95% CI: 4.5-5.6] in 2003. New Yorkers who were poor, in poor health, chronically unemployed, uninsured, and formerly married had the highest prevalence of NPD. Declines occurred among those who were married, white, recently unemployed, and female. NPD prevalence in NYC is higher than national estimates. A stronger economy and recovery from September 11th attacks may have contributed to the 2003 decline observed among selected subgroups. The excess prevalence of NPD may be associated with substantial economic and societal burden. Research to understand the etiology of this high prevalence and interventions to promote mental health in NYC are indicated.

Adolescent↗
PubMed2001

Major depression: prevalence, treatment utilization and age in Canada.

OBJECTIVE: To determine the relationships between age, prevalence of major depression and antidepressant treatment in Canadian populations by using data from three health surveys. BACKGROUND: Major depression is an important disorder, and there is a concern that treatment for it may be underutilized. Age may have an impact on treatment use. METHODS: Two of the surveys incorporated into the present analysis were random digit dial telephone surveys, with sample sizes of 2542 subjects and 796 subjects, respectively. The third data source was the National Population Health Survey (n=73,402), which used some face to face and some telephone-based data collection methods. In each of these studies, major depression was evaluated using a short form version of the Composite International Diagnostic Interview for Major Depression. Diagnostic status was evaluated in relation to current use of antidepressant medications, age and other relevant factors. All analyses accounted for unequal selection probabilities and clustering inherent in the sampling procedures. RESULTS: The prevalence of major depression was consistently found to be highest in subjects under the age of 45 years. However, older subjects were more likely to report having depression diagnosed. Antidepressant treatment was found to be less frequent in young subjects, despite these subjects being in the group with the highest prevalence of depression. Younger respondents were less likely to see a physician about their depressive symptoms, and when they did they were less likely to be told that they had a depressive disorder. CONCLUSIONS: The data presented indicate that antidepressant medications tend to be used less frequently in younger than older age groups in Canada. Additional studies are needed to confirm optimal use rates in relation to age.

Adolescent↗
PubMed1998

Local health care system utilizing the LPG (liquid propane gas) network.

JAC's LPG monitoring network system is mainly provided in mountain villages. However, by using this system, it will be possible to start a Digital Network Program for the Elderly while maintaining superior economic feasibility and public benefit using existing information infrastructures. This project also has the capabilities for the creation of a fire/disaster monitoring system, as well as a health care system by using conventional LPG monitoring systems. Telemedicine is an option for the future, as well, by connecting medical equipment and a tele-conferencing system.

Aged↗
PubMed2004

[Statements of general practitioners on cooperation with specialists and a future health care system].

BACKGROUND AND PURPOSE: Ideas of general practitioners (GPs) could be of value for the restructuring of the German ambulant health care system. The way managed care is seen by GPs is of particular interest. The aim of this study was to record opinions of GPs, working in Berlin, in regard to several aspects of their daily work. METHODS: 14 female and 16 male GPs from Berlin participated in a qualitative survey. These 30 GPs were interviewed about their attitude toward cooperation with specialized colleagues and their opinions on a future medical care system. The interviews performed were summarized, structured and analyzed according to the qualitative content analysis by Mayring. RESULTS: From the GPs' point of view, ambulant cooperation is facilitated by knowing specialized colleagues, by staying in close contact to them via telephone and by being able to arrange short-term appointments with these specialists. A closer cooperation with specialists in a network as well as an advanced use of digital information systems for accessing patients' data were considered to be vital elements for a future health care system. CONCLUSION: An important reason for choosing the cooperation with specialists is to find quick comprehensive treatment strategies for patients. It may be concluded that ambulant managed care of patients could be optimized with the creation of medical networks.

Adult↗
PubMed1999

Development of record linkage of hospital discharge data for the study of neonatal readmission.

Computerized record linkage has been used increasingly in epidemiologic studies. We developed a multistage, deterministic matching algorithm using various combinations of key variables. Then, from the records for March 1, 1993, to March 31, 1996, contained in the discharge abstract database of the Canadian Institute for Health Information (CIHI), we examined the relation between length of hospital stay at birth and neonatal readmission. A combined use of province/territory of occurrence, 6-digit postal code of residence, date of birth and sex (step 1) matched 88.5% of 26,629 eligible neonatal readmission records with their birth records. Additional use of institution code and chart number or health card number combined with date of birth and sex (step 2 and step 3) increased the matching rate to 93.0%. Compared with the gold standard, step 1 correctly matched 94.4% of the records. We conclude that this deterministic matching algorithm is a feasible and convenient approach to data linkage for the study of neonatal readmission. The linkage strategy may also be helpful in epidemiologic studies of other short-term events

Algorithms↗
PubMedDate not supplied

Complete health: prevalence and predictors among U.S. adults in 1995.

PURPOSE: To operationalize, estimate the prevalence, and ascertain the epidemiology of complete health. DESIGN: Cross-sectional analyses of self-reported survey data collected via a telephone interview and a self-administered questionnaire. SETTING: Households in the 48 contiguous states in the United States in 1995. SUBJECTS: Random-digit dialing sample of 3032 adults between the ages of 25 and 74, with a response rate of 61%. MEASURES: Physical illness and health were measured with a total of 37 items--a checklist of 29 chronic health conditions, a six-item scale of limitations of daily living, and a single item for perceived current health and for perceived 5-year change in energy. Mental illness and health were measured with the Composite International Diagnostic Interview Short Form diagnostic scale of major depression, panic, and generalized anxiety disorders and three established multi-item scales of subjective well-being (emotional, psychological, and social well-being). Completely healthy adults have high levels of physical and mental health and low levels of physical and mental illnesses; completely unhealthy adults have high levels of physical and mental illnesses and low levels of physical and mental health. Incompletely healthy adults consisted of two groups: one group is physically healthy (high physical health and low physical illness) and mentally unhealthy, and the second group is mentally healthy (high mental health and low mental illness) and physically unhealthy. RESULTS: Nineteen percent of adults were completely healthy, 18.8% were completely unhealthy, and 62.2% had a version of incomplete health. Compared with completely unhealthy adults, completely healthy adults are likely to be young (25-34 years of age) or old (55-64 and 65-74 years), are married, are male, are college educated, and have higher household incomes. CONCLUSIONS: Operationalizing complete health highlights objectives for increasing the prevalence of complete health, and reducing the prevalence of complete ill-health and incomplete health.

Activities of Daily Living↗
PubMed2003

Changes in substance use associated with emergency room and primary care services utilization in the United States general population: 1995-2000.

OBJECTIVE: The purpose of this study was to compare changes in the prevalence of heavy problem drinking and drug use among those obtaining emergency room (ER), primary care, and other health care services between 1995 and 2000 in the U.S. general population. METHOD: Data analyzed are from the Alcohol Research Group's 1995 (n = 4925) and 2000 (n = 7612) National Alcohol Surveys. Data for the 1995 survey was based on face-to-face interviews in respondents' homes in the 48 contiguous states, while the 2000 interview was a random-digit dialing computer-assisted telephone interview of the household population in all 50 states. RESULTS: Those reporting any health services utilization were less likely to report heavy drinking, two or more alcohol problems, and symptoms of alcohol dependence during the previous year in 2000 compared with 1995, but heavy or problem drinking was not predictive of health services utilization at either time. Controlling for demographic characteristics and health insurance coverage, illicit drug users were almost twice as likely [odds ratio (OR) = 1.85] compared with nonusers, to report ER utilization, and one and a half times more likely (OR = 1.55) to report primary care utilization during the past year in the 2000 survey, but drug use was not significantly predictive of health services utilization in 1995. CONCLUSIONS: These data suggest that while those alcohol-involved individuals were no more likely than others to use ER and primary care services in either 1995 or 2000, those drug-involved individuals were more likely to do so in 2000, perhaps related to the fact that these individuals may be incurring more health problems associated with their drug use that require medical attention. While identification and intervention with problem drinkers in clinical settings has received a great deal of attention, drug users may be overrepresented in health service settings, and such settings also may provide a window of opportunity for screening and intervention for a reduction in drug-related problems.

Adolescent↗
PubMed1995

Los Angeles County after the 1992 civil disturbances: degree of exposure and impact on mental health.

The impact of the 1992 Los Angeles (L.A.) civil disturbances on psychosocial functioning was assessed as part of a larger project investigating the views and attitudes of residents in L.A. County. Random digit dialing methodology identified a household probability sample of 1,200 adults (age 18 or older) from L.A. County. Respondents completed a telephone interview 6 to 8 months after the disturbances. Respondents' degree of exposure to the disturbances, mental health impact of the disturbances, and mental health effects of chronic versus acute exposure to violence were assessed. Consistent with hypotheses, the impact of the disturbances was the worst in the South Central communities. Higher rates of posttraumatic stress disorder (PTSD; both diagnostic level and subclinical symptomatology) were found among respondents who reported disturbance-related experiences. Exposure to an acute event (i.e., the disturbances) was predictive of current PTSD symptomatology after controlling for demographics, lifetime trauma, and other types of stressful events.

Adolescent↗
PubMed2004

Cardiovascular risk factors and cognitive function in adults 30-59 years of age (NHANES III).

In the Third National Health and Nutrition Examination Survey (NHANES III), three measures of cognitive function [Simple Reaction Time Test (SRTT), Symbol Digit Substitution Test (SDST), and Serial Digit Learning Test (SDLT)] were administered to a half-sample of 3,385 adult men and nonpregnant women 30-59 years of age with no history of stroke. We used multiple linear regression analysis to determine whether there was an independent association between performance on each cognitive function measure and defined hypertension (HTN) alone, type 2 diabetes mellitus (DM) alone, and coexistent HTN and DM after adjustment for demographic and socioeconomic variables and selected health behaviors. After adjustment for the sociodemographic variables, the combination of HTN + DM, but not HTN alone or DM alone, was significantly associated with worse performance on the SRTT (p = 0.031) and the SDST (p = 0.011). A similar pattern was observed for SDLT performance, but the relationship did not reach statistical significance (p = 0.101). We conclude that HTN in combination with DM is associated with detectable cognitive decrements in persons under age 60.

Adult↗
PubMedDate not supplied

HEDIS: implementation issues.

Historically, employers have asked health plans to measure performance in terms of quality, utilization, satisfaction, and cost. As organizations collected these data, employers realized that rarely were all the data comparable. Several employers, such as Xerox Corporation, Digital Equipment Corporation, and Bull HN Information Systems, Inc., agreed to work together to create reporting criteria that would standardize measurement. This collaboration resulted in the Health Plan Employer Data Information Set (HEDIS) criteria. This article reviews some of the implementation issues and decisions that a plan must resolve to gather accurate HEDIS data.

Data Collection↗
PubMed2004

Health related virtual communities and electronic support groups: systematic review of the effects of online peer to peer interactions.

OBJECTIVE: To compile and evaluate the evidence on the effects on health and social outcomes of computer based peer to peer communities and electronic self support groups, used by people to discuss health related issues remotely. DESIGN AND DATA SOURCES: Analysis of studies identified from Medline, Embase, CINAHL, PsycINFO, Evidence Based Medicine Reviews, Electronics and Communications Abstracts, Computer and Information Systems Abstracts, ERIC, LISA, ProQuest Digital Dissertations, Web of Science. SELECTION OF STUDIES: We searched for before and after studies, interrupted time series, cohort studies, or studies with control groups; evaluating health or social outcomes of virtual peer to peer communities, either as stand alone interventions or in the context of more complex systems with peer to peer components. MAIN OUTCOME MEASURES: Peer to peer interventions and co-interventions studied, general characteristics of studies, outcome measures used, and study results. RESULTS: 45 publications describing 38 distinct studies met our inclusion criteria: 20 randomised trials, three meta-analyses of n of 1 trials, three non-randomised controlled trials, one cohort study, and 11 before and after studies. Only six of these evaluated "pure" peer to peer communities, and one had a factorial design with a "peer to peer only" arm, whereas 31 studies evaluated complex interventions, which often included psychoeducational programmes or one to one communication with healthcare professionals, making it impossible to attribute intervention effects to the peer to peer community component. The outcomes measured most often were depression and social support measures; most studies did not show an effect. We found no evidence to support concerns over virtual communities harming people. CONCLUSIONS: No robust evidence exists of consumer led peer to peer communities, partly because most peer to peer communities have been evaluated only in conjunction with more complex interventions or involvement with health professionals. Given the abundance of unmoderated peer to peer groups on the internet, research is required to evaluate under which conditions and for whom electronic support groups are effective and how effectiveness in delivering social support electronically can be maximised.

Clinical Trials as Topic↗
PubMedDate not supplied

Bodies in motion: monitoring daily activity and exercise with motion sensors in people with chronic pulmonary disease.

A primary goal of pulmonary rehabilitation is to improve health and life quality by encouraging participants to engage in exercise and to increase daily physical activity. The recent advent of motion sensors, including digital pedometers and accelerometers that measure motion as a continuous variable, have added precision to the measurement of free-living daily activity. Daily activity and exercise are variables of keen interest to proponents of the national health agenda, epidemiologists, clinical researchers, and rehabilitation interventionists. This paper summarizes issues related to conceptualizing and monitoring activity in the rehabilitation setting; reviews motion sensor methodology; compares motion-sensing devices; presents analysis issues and current and potential applications to the pulmonary rehabilitation setting; and gives practical applications and limitations.

Exercise↗
PubMedDate not supplied

A comprehensive smoking cessation program for the San Francisco Bay Area Latino community: Programa Latino Para Dejar de Fumar.

Background. Prevalence of cigarette smoking among Latinos compared to whites is higher among men (30.9% versus 27.9%), but lower among women (16.3% versus 23.5%). More acculturated Latina women, however, smoke more. Compared to other smokers, Latinos report consuming about half the average number of cigarettes per day. Up to a quarter of Latino smokers of less than 10 cigarettes per day may be underreporting consumption. The association between smoking and depression has also been found in Latinos. Program Goals. The Programa Latino Para Dejar de Fumar (Programa) goals are: 1) to evaluate attitudinal, behavioral, and cultural differences between Latino and white smokers; 2) to integrate these findings into a comprehensive, culturally-appropriate smoking cessation intervention; and 3) to implement the intervention in a defined community in order to decrease cigarette smoking prevalence, increase behaviors that may lead smokers to quit, and promote a nonsmoking environment. Program Components. Heightened concern about health effects of smoking, the importance of social smoking, and the influence of the family on behavior are integrated in the Programa components: 1) the promotion of a full-color, Spanish-language, self-help, smoking cessation guide (Guia), distributed at no charge; 2) an anti-smoking, Spanish-language, electronic media campaign; 3) community involvement; 4) quit smoking contests; 5) smoking cessation, individual, telephone consultations (consultas); and 6) collaboration with health care personnel. Results. Effectiveness of the Programa is being evaluated by annual, cross-sectional, random digit dialing telephone surveys compared to two baseline surveys. After 19 months of intervention, the proportion who had heard of the Programa increased from 18.5% to 44.0%, and over one third of less acculturated smokers had the Guia. Future directions will emphasize smoking prevention among youth, prevention of relapse among quitters, and depression prevention.

Acculturation↗
PubMedDate not supplied

Job-based health benefits in 2002: some important trends.

Based on a national survey of 2,014 randomly selected public and private firms with three or more workers, this paper reports changes in employer-based health insurance from spring 2001 to spring 2002. The cost of health insurance rose 12.7 percent, the highest rate of growth since 1990. Employee contributions for health insurance rose in 2002, from $30 to $38 for single coverage and from $150 to $174 for family coverage. Deductibles and copayments rose also, and employers adopted formularies and three-tier cost-sharing formulas to control prescription drug expenses. PPO and HMO enrollment rose, while the percentage of small employers offering health benefits fell. Because increasing claims expenses rather than the underwriting cycle are the major driver of rising premiums, double-digit growth appears likely to continue.

Cost Sharing↗