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PubMed1996

Inpatient utilization by undocumented immigrants without insurance.

Data collected from a large county hospital in Miami, Florida were used to study the severity of illness (using the Case Mix Severity Index) and resource use (measured by average length of stay, procedures, and/or diagnostic tests performed) of undocumented persons from Dade Country, Florida in an inpatient setting. Compared with native-born populations and those with permanent residency status (insured by Medicaid or of uninsured status) admitted to the same hospital, undocumented immigrants had a higher Case Mix Severity Index but a lower adjusted average length of stay. Undocumented immigrants and uninsured residents of the United States had a similar number of adjusted procedures/ tests performed, but less than Medicaid beneficiaries. Policy issues are discussed.

Adult↗
PubMed1999

Minimum Data Set and Resident Assessment Instrument. Can using standardized assessment improve clinical practice and outcomes of care?

Regulating and standardizing the assessment of residents was envisioned by the 1986 Committee on Nursing Home Reform to have many advantages for facility management, government regulatory agencies, and clinical staff to evaluate changes in resident status and adjust the care plans accordingly. Standardized assessment data was viewed as a source of management information to be used to track case mix (i.e., acuity) of residents, allocate resources such as staff, and evaluate care quality. The Resident Assessment Instrument is a clinically relevant assessment process that can facilitate effective care planning, interventions, and quality improvement. It is a clinically complex process requiring care delivery systems developed by RNs to support the implementation of individualized care.

Aged↗
PubMed1994

Eastern equine encephalomyelitis virus in relation to the avian community of a coastal cedar swamp.

Eastern equine encephalomyelitis virus (EEEV) is perpetuated in eastern North America in a mosquito-wild bird maintenance cycle that involves Culiseta melanura (Coquillett) as the principal enzootic vector and passerine birds as the primary amplifying hosts. We examined the role of birds in the EEEV cycle at a site in southern New Jersey where EEEV cycles annually at high levels. Birds and mosquitoes were sampled during three epiornitics and one season of limited virus activity. We examined antibody prevalence in birds in relation to eight physical and natural history characteristics. Our goal was to compare EEEV cycling in C. melanura and the primary avian hosts better to understand the mechanisms that initiate annual epiornitics. Antibody prevalence was highest in the Blue Jay (62%), Wood Thrush (60%), and Tufted Titmouse (44%). Resident status of birds was the natural history characteristic most closely linked to participation in the EEEV cycle. Species spending the greatest amount of time at our study site (permanent residents, summer residents) had the highest antibody rates. We captured viremic birds as early as 25 May, 51 d before we first detected virus in C. melanura. We recaptured 10 after hatching year adults and one hatching year (HY) bird that seroconverted before we detected virus in C. melanura. We also found EEEV antibody in 15 HY birds up to 31 d before we isolated EEEV from C. melanura. We provide evidence that a cryptic cycle develops weeks before epiornitic cycling is detected in C. melanura by traditional laboratory techniques, indicating that the early season cycle is initiated by the recrudescence of latent virus in previously infected birds.

Animals↗
PubMed2006

[Health monitoring of the Swiss migrant population].

With the health monitoring of the Swiss migrant population, a database was created on migrants' health state, their health behaviour and utilization of health services. Thanks to this database, it is now possible to draw representative conclusions on the health status of migrants compared to the indigenous population. Based on the Swiss Health Survey, a questionnaire was developed and translated into several languages. A survey of the foreign population permanently resident in Switzerland as well as of asylum seekers and those temporarily settled in Switzerland was conducted through phone interviews. The interviewees could choose the survey language: in their mother tongue or one of the Swiss languages. A first description of the data is available. The analyses show that the results found for migrants of West European countries are comparable to those of the Swiss population. All other migrants come off worse with regard to health and social indicators. For example, they assess their self-perceived health state more often as "average" or "bad", they feel emotionally less balanced, or visit a doctor more frequently than the Swiss population does. Significant differences can be found within the data of the surveyed migrant population, for example depending on gender, age, residence status or nationality.

Adolescent↗
PubMed1995

Black and white female nursing home residents: does health status differ?

BACKGROUND: There will be greater numbers of Black female nursing home residents in the future, but past emphasis has been on the study of Black older adults in the community. The purpose of this study was to assess the health status stability of newly admitted female nursing home residents and to analyze Black-White differences in health status and health status stability. METHODS: Health status (mental status, activities of daily living [ADLs], self-reported mood, self-reported health) of Black (n = 98) and White (n = 260) female nursing home residents was evaluated during their first two weeks of residence. Time, race, and their interaction effects on health status were analyzed using repeated measures multivariate analysis of variance. RESULTS: All health status data showed stability or improvement, but there were significant race differences in both health status and health status stability. Black female residents had worse mental status and worse ADLs, and reported less alert mood, less tired mood, and better health. Race differences in stability were evident for hygiene, dressing, ambulation, and transferring ADLs: Black female residents were less likely to show improvements over time. CONCLUSION: Black female residents are an at-risk population for special care needs in nursing homes.

Activities of Daily Living↗
PubMed2000

Predictive characteristics of users of alternative medicine.

BACKGROUND: The use of alternative medicine has become an important factor in health care delivery. OBJECTIVES: To evaluate patient characteristics, morbidity, functional status, quality of life, satisfaction with care, practice characteristics and health care utilisation in general practice patients using alternative medicine. DESIGN: Cross-sectional survey of GP patients completing a self-administered questionnaire. SETTING: A stratified sample of 36 GP offices in Slovenia. MAIN OUTPUT DATA: Patient's age, sex, educational status, residence, presence of chronic condition, incidence of anxiety or depressive symptoms, incidence of patient-expressed need for emergency care in one year, data on self-care, data on functional status, quality of life, satisfaction with care, incidence of use of out-of-hours services and specialist or hospital services in users versus non-users. RESULTS: 115/1753 patients (6.6%) reported visits to alternative practitioners in 1997. Users of alternative medicine were from midlife age groups, were more likely to have a chronic condition, had a lower perception of life quality and a higher incidence of anxiety and depressive symptoms, and had had more need for emergency treatment. They are heavier users of primary as well as secondary care services; they have changed their GP recently but are not significantly dissatisfied with their current regular GP. CONCLUSIONS: Use of alternative medicine appears to be characteristic of patients with a more active approach to managing their problems. GPs should enquire about the use of alternative medicine by their patients, especially those more likely to seek such help. Raising the question of alternative medicine will improve doctor-patient communication and help to resolve underlying health problems.

Adult↗
PubMed2000

Observational study of home visits in Slovene general practice: patient characteristics, practice characteristics and health care utilization.

BACKGROUND: Home visits are an important way of delivering primary health care, but there is a long-term decrease in home visit rates in many countries. OBJECTIVE: The aim of this study was to evaluate patient characteristics, morbidity, functional status, quality of life, satisfaction with care, practice characteristics and health care utilization in general practice patients visited at home at least once in a study year. METHODS: The design of the study was a cross-sectional survey of the patients of a stratified sample of 36 GP offices in Slovenia using a self-administered questionnaire. Sixty consecutive patients in sampled practices contacting the doctor in the office in the study period in March 1998 were included in the analysis. The age, sex, educational status, residence, presence of chronic condition, measures of anxiety or depressive symptoms, rates of patients who expressed a need for emergency care in 1 year, rates of self-care, measures of functional status, quality of life, satisfaction with care, rates of using GP practice visits and out-of-hours services and rates of using specialist or hospital services were recorded in a home-visited group versus a non-visited group. RESULTS: A total of 277 patients (15.4%) were reported to have at least one visit in the study year. Patients visited in their homes were older, predominantly female, better educated, had lower perceptions of their functional status and well-being and they used primary health services more frequently than others. Their GPs were more likely to be males, and were more likely to practise in rural areas, in solo practices as private practitioners. CONCLUSION: Home visits remain an important part of GP work in countries in transition, such as Slovenia, especially for more seriously ill patients.

Activities of Daily Living↗
PubMed2001

Factors associated with pilot fatality in work-related aircraft crashes, Alaska, 1990-1999.

Work-related aircraft crashes are the leading cause of occupational fatality in Alaska, with civilian pilots having the highest fatality rate (410/100,000/year). To identify factors affecting survivability, the authors examined work-related aircraft crashes that occurred in Alaska in the 1990s (1990-1999), comparing crashes with pilot fatalities to crashes in which the pilot survived. Using data from National Transportation Safety Board reports, the authors carried out logistic regression analysis with the following variables: age, flight experience, use of a shoulder restraint, weather conditions (visual flight vs. instrument flight), light conditions (daylight vs. darkness), type of aircraft (airplane vs. helicopter), postcrash fire, crash location (airport vs. elsewhere), and state of residence. In the main-effects model, significant associations were found between fatality and postcrash fire (adjusted odds ratio (AOR) = 6.43, 95% confidence interval (CI): 2.38, 17.37), poor weather (AOR = 4.11, 95% CI: 2.15, 7.87), and non-Alaska resident status (AOR = 2.10, 95% CI: 1.05, 4.20). Protective effects were seen for shoulder restraint use (AOR = 0.40, 95% CI: 0.21, 0.77) and daylight versus darkness (AOR = 0.50, 95% CI: 0.25, 0.99). The finding that state of residence was associated with survivability offers new information on pilot survivability in work-related aircraft crashes in Alaska. These results may be useful in targeting safety interventions for pilots who fly occupationally in Alaska or in similar environments.

Accidents, Aviation↗
PubMed2006

The nursing home versus the hospital as the place of dying for nursing home residents in Japan.

OBJECTIVES: To determine the characteristics of nursing home residents that are associated with dying in a nursing home versus a hospital in Japan. DESIGN: Retrospective case-control study. SETTING: A nonprofit nursing home with 110 beds in Tokyo, Japan. PARTICIPANTS: Eighty-six nursing home residents who died in the nursing home (n=43) or in a hospital (n=43) between 1 April 1999 and 30 September 2004. MEASUREMENTS: Nursing home records were reviewed to gain information regarding the following domains: demography, the family decision-maker, health status, resident and family preference for nursing home end-of-life care, and presence of a full-time physician. RESULTS: The variables older age [adjusted odds ratio (adjusted OR)=1.08, 95% confidence interval (95% CI)=1.01-1.17], the family decision-maker's preference for nursing home end-of-life care (adjusted OR=3.95, 95% CI=1.21-12.84), and presence of a full-time physician (adjusted OR=3.74, 95% CI=1.03-13.63) were associated with dying in the nursing home. CONCLUSION: Older age, the family's preference for nursing home end-of-life care, and the presence of a full-time physician were significantly related to dying in the nursing home versus in a hospital.

Aged, 80 and over↗
PubMed1992

Estimates of long-term immigration to the United States: moving US statistics toward United Nations concepts.

US immigration data are revised to reflect the UN demographic concept of long-term immigration. Long-term immigration is measured by the number of new immigrants (permanent resident aliens) arriving in the year, temporary migrant arrivals (nonimmigrants) who subsequently adjust to permanent resident status, arrivals of asylees and refugees, and nonimmigrants who arrive during the year and stay for more than twelve months before departing. The estimates of long-term immigration for 1983 are compared to official INS statistics on alien immigration. Significant differences emerge according to country of origin, age, and state of intended residence. A method of producing current estimates of long-term immigration is illustrated.

Age Factors↗
PubMed1998

Determinants of tuberculosis in an immigrant population in Rome: a case-control study.

SETTING: An out-patient clinic for immigrants in Rome, Italy. OBJECTIVE: To determine risk factors for tuberculosis among immigrants in Italy. DESIGN: Case-control study. Cases comprised 44 individuals aged 15-55 years who had a first diagnosis of tuberculosis between 1989 and 1994 at the clinic. Controls comprised 264 individuals randomly recruited among immigrants who attended the clinic for other reasons within seven days before or after the case was diagnosed. Subject information included country of origin, date of first arrival in Italy, level of education, knowledge of the Italian language, and legal resident status. RESULTS: An increase of tuberculosis risk was observed with increasing tuberculosis incidence in the country of origin. Multivariate analysis showed an increased risk for those coming from Central and South America (odds ratio [OR] 5.5; 95% confidence interval [CI] 1.6-18.7). The adjusted odds ratio by time since entry in Italy increased during the second year of residence (OR 2.8; 95% CI 1.1-7.0), but decreased after that period. A trend toward increasing risk with decreasing educational level was observed. CONCLUSIONS: These results demonstrate the need for a public health policy in Italy for tuberculosis control among immigrants which includes screening, prophylaxis and treatment.

Adolescent↗
PubMed2001

Sex preference and contraceptive behaviour among men in Mbeya region, Tanzania.

While recent studies confirm parental child sex preference in less developed countries, its pattern varies. Son preference is especially prevalent in Bangladesh, China, India, and Pakistan. Sex preference in sub-Saharan Africa is a neglected area of enquiry. Completed research focuses on women's views to the neglect of men, despite the latter's importance as primary decision-makers. This study identifies factors influencing contraceptive behaviour among men in Mbeya region, Tanzania, demonstrating how it is affected by their preferred family sex composition. Data used were collected from a cross-sectional survey of 600 men aged 16-50 and six focus groups conducted in the region's rural and urban areas. Using single statements and Coombs' Scales, sex preference was found to be prevalent in the study area, with sons strongly preferred to daughters. Sex preference is significantly associated with the number of existing daughters a man has, his marital status, residence and occupation. Findings suggest programmes should be initiated to challenge men's attitudes towards one-sex family composition. Men should be educated about the advantages of small family sizes and persuaded that both children's sexes are equally important. Such measures can assist men in reconsidering their desired family sizes, reduce biases towards one sex, minimise marital problems and improve women's status. Efforts to increase contraceptive use in Tanzania will be hampered, however, if men maintain their preference for sons over daughters.

Adolescent↗
PubMed2004

Cognitive status and analgesic provision in nursing home residents.

BACKGROUND: Although it is becoming acknowledged that pain management is generally poor for older people, little is known about pain management for nursing home residents in the United Kingdom, and the specific problems for those with cognitive impairments. AIMS: This section of a larger study of pain aimed to explore analgesic prescription and administration according to nursing home residents' cognitive status. DESIGN OF STUDY: A survey of nursing home residents and their medication documentation. SETTING: The sample included 113 nursing home residents from 15 nursing homes in large city in the north of England. METHOD: Residents' cognitive status was assessed using the mini-mental state examination (MMSE). Pain was measured with a four-point verbal rating scale and a 10-point horizontal numeric rating scale. Residents' medications--including name, dose, and frequency of administration--were noted, as well as provision within the previous 24 hours. RESULTS: There were no statistically significant differences in pain scores according to level of cognitive impairment. The prescription and administration of opioid and non-opioid analgesics were highest for residents with low cognitive impairment; these decreased as impairment increased. Those who were prescribed neither opioid nor non-opioid analgesics had significantly lower MMSE scores than those who were. A low MMSE score indicates a high level of cognitive impairment. CONCLUSION: It is not clear why those with greater cognitive impairment received fewer analgesics than others. More research is needed into the relationships between pain assessment, pain experience, cognitive impairment, and analgesic provision. It is likely that improvements in carers' knowledge of pain assessment and the risks and benefits of commonly used analgesics could improve analgesic provision.

Aged↗
PubMed2003

Regional variations in mortality rates of pancreatic cancer in China: results from 1990-1992 national mortality survey.

AIM: To examine the regional variations in mortality rates of pancreatic cancer in China. METHODS: Aggregated mortality data of pancreatic cancer were extracted from the 1990-1992 national death of all causes and its mortality survey in China. Age specific and standardized mortality rates were calculated at both national and provincial levels with selected characteristics including sex and residence status. RESULTS: Mortality of pancreatic cancer ranked the ninth and accounted for 1.38 percent of the total malignancy deaths. The crude and age standardized mortality rates of pancreatic cancer in China in the period of 1990-1992 were 1.48/100,000 and 1.30/100,000, respectively. Substantial regional variations in mortality rates across China were observed with adjusted mortality rates ranging from 0.43/100,000 to 3.70/100,000 with an extremal value of 8.7. Urban residents had significant higher pancreatic mortality than rural residents. CONCLUSION: The findings of this study show different mortality rates of this disease and highlight the importance of further investigation on factors, which might contribute to the observed epidemiological patterns.

Adolescent↗
PubMedDate not supplied

Cultural influences on health care use: two regional groups in India.

While health care services are increasingly being seen as a major proximate determinant of decreased mortality in a population, it also seems to be the case that the mere provision of services does not lead to their better utilization. However, in general, it is difficult to explore differences in utilization because the availability of services itself varies so greatly. This report presents the results of a study in India of two distinct regional groups of similar socioeconomic status, residing in the same locality and, therefore, theoretically exposed to the same health services. Both groups share a strong faith in modern medicine (especially if it is obtained from a private practitioner) for the treatment of most common illnesses. However, important cultural differentials exist in the medical services sought for childbirth and in the treatment of morbidity in children of different ages and sexes. These cultural commonalities and differentials are described, their possible causes--primary among these being the status of women--explored, and some policy recommendations made.

Aged↗
PubMed2003

Association of region of residence and immigrant status with hypertension, renal failure, cardiovascular disease, and stroke, among African-American participants in the third National Health and Nutrition Examination Survey (NHANES III).

OBJECTIVE: To determine whether current region of residence and immigrant status (born in the United States [US] vs abroad), are associated with the prevalence of hypertension (HTN), uncontrolled HTN, and HTN-related target-organ damage, among African Americans. METHODS: We studied the survey and physical examination data from a nationally representative cohort of 3,369 self-designated Black participants, aged 30-79 years, in the third National Health and Nutrition Examination Survey (NHANES III), which took place during 1988-1994. We calculated the age-adjusted prevalence rates of HTN, uncontrolled HTN, and history of HTN-related target-organ damage in US-born northern African Americans, US-born southern African Americans, and foreign-born African Americans. RESULTS: Hypertension (HTN) was more common among southern African-American men and women, compared to northern African-American men and women (42.2% vs 34.1%, P<.002 for men; 42.7% vs 37.2%, P=.02 for women). Uncontrolled HTN was also more common among hypertensive southern African-American women compared to hypertensive northern African-American women (79.8% vs 70.4%, P=.05). Among women, hypertensive Black immigrants had lower rates of HTN-related target-organ damage than either hypertensive US-born southern and northern African Americans (3.3% vs 16.3% and 15.8%, respectively, P=.05). CONCLUSIONS: In this nationally representative cohort, immigrant status and geographic region of residence were associated with HTN prevalence, rates of blood pressure control, and HTN-related target-organ damage. Further examination of environmental exposures, cultural issues, and access to care, factors that can differ between groups, may yield important information about modifiable risk factors associated with HTN and target organ damage.

Black or African American↗
PubMed2006

Diverticular disease and migration--the influence of acculturation to a Western lifestyle on diverticular disease.

BACKGROUND: Diverticular disease of the colon is more common in the Western world, compared with non-Western countries. AIM: To investigate the risk of diverticular disease in immigrants of diverse ethnicity and in different phases of acculturation. METHODS: Socio-demographic indicators and the risk of diverticular disease were investigated. The study population was a prospectively followed national cohort of 4 million residents born between 1925 and 1965. Risk ratios (RRs) of hospital admissions and deaths because of diverticular disease and acute diverticulitis from 1991 through 2000 were calculated. RESULTS: The risk of hospital admission because of diverticular disease, after adjustment for age, sex and socio-economic indicators, was lower in non-Western immigrants (RRs = 0.5-0.7) compared with natives and the risk increased with time after the settlement. Women of all origins had a higher risk compared with men (RR = 1.5). This sex-difference increased with age (P < 0.001). Socio-economic status, residency or housing situation were not risk factors. CONCLUSION: This population-based study found that immigrants from non-Westernized countries had lower relative risks for hospitalization because of diverticular disease than natives, but the risk increased during a relatively short period of time after settlement. Diverticular disease of the colon appears to be an acquired disorder and acculturation to a Western lifestyle has an impact on the risk.

Acculturation↗
PubMed2004

Nutrient adequacy and dietary diversity in rural Mali: association and determinants.

OBJECTIVE: To examine the association between nutrient adequacy and dietary diversity, and to assess and compare the determinants for the two constructs in an adult population in rural Mali. DESIGN: Cross-sectional study assessing food intake by a validated 7-day quantitative food frequency questionnaire. Two different dietary diversity indexes were created: food variety score (FVS), a simple count of food items, and diet diversity score (DDS) a count of food groups. Mean adequacy ratio, the mean ratio of intake to recommended intake (each truncated at one) of energy and nine nutrients, was calculated as an indicator of nutrient adequacy. Information on household and individual characteristics, including demography, socioeconomic conditions and food production strategies was obtained using precoded questionnaires. SETTING: Bafoulabé district, Kayes region, Western Mali. SUBJECTS: In total, 502 subjects (55% women) aged 15-45 y from 319 different households. RESULTS: Both FVS and DDS had a positive correlation with mean adequacy ratio (MAR). Multivariate analysis (linear regression) showed that the most important factors explaining MAR was the number of milk products, vegetables and green leaves consumed, as well as sex and the number of crops produced in the household. Dietary diversity was associated with socioeconomic status, residence and age. CONCLUSION: Dietary diversity is useful as an indicator of nutrient adequacy. It is important to examine how various food groups contribute to the nutrient adequacy of the diet in an area.

Adolescent↗