Control malaria to help defeat poverty, says WHO.
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Humans↗
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Results for “Poverty--prevention and control”
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Quality of life of Iranian kidney "donors".
PURPOSE: The quality of life of Iranian kidney vendors was clarified. MATERIALS AND METHODS: A questionnaire was completed by 300 kidney vendors 6 to 132 months postoperatively (median 61). Interviews and living conditions were videotaped. In addition, the 300 vendors and 100 controls that underwent nephrectomy for benign disease completed the RAND 36-Item Health Survey (SF-36). RESULTS: Poverty prevented 79% of vendors from attending followup visits, and vending caused negative effects on employment in 65%. Of the families 68% strongly disagreed with vending, which caused rejection of 43% and increased marital conflicts in 73% of vendors, including 21% who divorced. There were 70% of vendors isolated from society, and 71% had severe de novo postoperative depression and 60% anxiety. Vending caused somewhat (20%) to very (66%) negative financial effects. It also had negative effects on the physical abilities in 60% of vendors who were mainly unskilled laborers, and 80% were dissatisfied with postoperative physical stamina, which was decreased mostly by depression. Of the vendors 37% concealed the truth of kidney sale from anyone, 14% disclosed it only to spouses, 43% to first generation relatives and 94% were unwilling to be known as donors. The mental preoccupation with kidney loss was usually (30%) to always (57%) present and interfered negatively with vendor life, and 62% reported negative effects on sense of being useful. Effects on general health were somewhat (22%) to very (58%) negative. When thinking about vending, the majority cited negative feelings. They responded that if they had another chance 85% would definitely not vend again, and 76% strongly discouraged potential vendors from "repeating their error." Half the vendors were ready to lose greater than 10 years of life and 76% to 100% of properties to regain kidneys. Compared to controls, vendors had significantly lower scores on all SF-36 scales (p <0.001). CONCLUSIONS: Our sample is a good representative of Iranian kidney vendors, with the majority having psychosocial complications. Globally, the medical community should focus more attention on motivations, quality of life, health and opinions of kidney vendors.
Adult↗
Medicaid managed care: can it work for children?
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Child↗
Modern concepts of prevention in community health.
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Adolescent↗
Enhancing adherence following abnormal Pap smears among low-income minority women: a preventive telephone counseling strategy.
BACKGROUND: Although the incidence of precancerous conditions of the cervix has recently been increasing, prompt initial and long-term follow-up care can effectively reduce unnecessary morbidity and mortality. For example, the 4-year survival rates among those individuals at greatest risk for cervical cancer (i.e., minority women of low socioeconomic status) approach 95% with early detection. Women who present with advanced disease have a much poorer outlook (0%-39% survival). Yet, high-risk individuals are least likely to adhere to recommended diagnostic regimens. PURPOSE: We tested the effectiveness of a brief telephone counseling intervention directed to low-income, inner-city women after they had received an abnormal Pap smear result. The women were counseled on the importance of having an initial and 6-month repeat follow-up diagnostic procedure (i.e., colposcopic examination of the cervix). METHODS: A randomized trial design was used to compare the effects on these women of telephone counseling with (n = 192) or without (n = 203) a booster counseling telephone call prior to the appointment for a repeat colposcopy 6 months later, with a telephone appointment confirmation/reminder call (n = 216) and with standard care (i.e., no telephone contact) (n = 217). The telephone counseling protocol probed for and addressed three psychologic barriers to adherence (i.e., attendance at appointment for colposcopy examination): 1) encoding/expectancy (e.g., did the patient understand her risk of developing cervical cancer?); 2) affective/emotional (e.g., was the woman worried about the condition and its consequences?); and 3) self-regulatory/practical (e.g., was the woman likely to forget medical appointments?). Logistic regression was used to analyze the effects of the intervention group and the type of psychologic barriers elicited on colposcopy adherence. RESULTS: The results of logistic regression analysis (using those who received an appointment confirmation/reminder telephone call as the comparison group) revealed that telephone counseling produced significantly higher adherence rates to the initial colposcopy visit compared with telephone confirmation (300 [76%] of 395 women versus 147 [68%] of 216; odds ratio [OR] = 1.50; 95% confidence interval [CI] = 1.04-2.17). Additionally, standard care resulted in significantly lower adherence rates than did telephone confirmation (109 [50%] of 217 women versus 147 [68%] of 216; OR = 0.47; 95% CI = 0.32-0.73). Regarding attendance at the 6-month repeat colposcopy appointments, the 80 patients who had received telephone counseling prior to the initial visit (and were recommended for follow-up colposcopy) were significantly more likely to adhere than were the 47 patients who had received telephone confirmation (49 [61%] of 80 women versus 17 [36.2%] of 47; OR = 2.70; 95% CI = 1.15-6.51). The 6-month adherence rates for patients in the telephone confirmation group and the standard care group (n = 30) were low and did not differ significantly (17 [36.2%] of 47 women versus nine [30.0%] of 30; OR = 1.08; 95% CI = 0.40-2.89). Forgetting medical appointments (OR = 0.31; 95% CI = 0.19-0.51) and having scheduling conflicts (OR = 0.45; 95% CI = 0.28-0.72) were also associated with lower rates of adherence. CONCLUSION: The use of telephone counseling appears to be an effective strategy for enhancing initial and long-term adherence to a follow-up cervical diagnostic procedure in a traditionally underserved population. Patients who respond to a positive Pap test result with a particular profile of psychologic barriers may require more intensive and targeted counseling interventions.
Colposcopy↗
[Psychosocial distress and its moderating factors in patients living in precarious socioeconomic conditions consulting in a preventive health and social work center].
BACKGROUND: The effects of a precarious socioeconomic condition on mental health have already been widely described. Nevertheless, sociodemographic, biographical, and mainly psychological determinants of psychosocial distress in these populations are still incompletely known. METHODS: 2315 consecutive subjects, aged 16 to 59, consulting for a free work-up in a preventive health center supported by the National French Health Insurance system, were invited to fill out a series of questionnaires, mainly the GHQ-28 (psychosocial distress), the LOT (dispositional optimism) and the WCCL (coping mechanisms). Socioeconomic and administrative criteria were adopted to define populations living in precarious conditions. RESULTS: A total of 78.9% complete records could be analyzed: 55% of the studied population constituted the precarious condition group (44.5% males and 55.5% females; mean age 36.2+/-11). This group was characterized by higher psychosocial distress and higher sub-scores of anxiety, social dysfunction and depression, but not somatisation, as well as by increased emotion focused coping and impaired optimism. Globally, GHQ score was positively correlated with emotion focused coping (r=0.36) and negatively with problem focused coping (r=-0.17) and with optimism (r=-0.39). In a multivariate analysis a set of 9 independent variables explained 38% of GHQ-28 total variance: perceived stress, optimism, emotion focused coping, problem focused coping, age, educational degree, precariousness, money problems and parental quarrels during youth. Introducing precariousness in the model constituted of the set of the remaining variables could explain only 2% of additional variance. CONCLUSION: These results confirm the presence of higher levels of psychosocial distress in subjects living in precarious conditions and underline the moderating role of several psychological variables. They could guide support interventions aimed at helping subjects living in precarious conditions, focused on enhancing their coping resources.
Adaptation, Psychological↗
New concepts in primary care: prevention as policy.
Prevention is a key element of primary health care, as defined by the Alma-Ata Conference and promoted by the World Health Organization. Developed as well as developing countries are giving renewed emphasis to prevention in the planning of health care. Israel has much to gain by placing high priority on prevention in its health policy.
Accident Prevention↗
Cancer prevention in rural primary care. An academic-practice partnership.
BACKGROUND: Cancer screening rates are particularly low among poor, minority, and rural women, those segments of the population with the highest cancer mortality risk. Therefore, targeted strategies to increase screening in these population groups are needed. METHODS: This paper describes a partnership between the University of Alabama at Birmingham (UAB) and Family HealthCare of Alabama, a nonprofit health care agency, initiated to promote cancer control and prevention in a predominantly low-income, African-American population in rural western Alabama. The partnership has collaborated in the development of two research proposals designed specifically to evaluate cancer control strategies within the context of routine health care delivery. RESULTS: The UAB/Family HealthCare partnership is conducting two randomized treatment outcome studies funded by the National Cancer Institute to evaluate theory-based patient management strategies to promote patient adherence to screening recommendations for cervical cancer and breast cancer. CONCLUSIONS: The success of this academic-practice partnership can be seen in the funded research projects, the enhancement of preventive services in rural primary care, and in the potential to disseminate theory-based cancer control strategies throughout an extended primary care network.
Academic Medical Centers↗
The estimation of the health production function for low-income working men.
Health is an important variable that determines an individual's economic as well as noneconomic well-being. A healthy individual will be more productive, will contribute more toward a nation's economy, and, keeping other things constant, will have a better life overall than a sick individual. But for a low-income individual, health could be even more crucial since it could be a major factor in perpetuating his poverty. If, as a part of our social policy, we would want to improve the economic well-being of poor people, their health in general would need attention. This paper studies the production of health and the demand for medical care of low-income working men. Low-income working men are "medically indigent" because they are not eligible for Medicaid and are not adequately covered by insurance. This study provides insight into what role medical, preventive, and curative care--as well as other socioeconomic variables, such as income and education--plays in the production of the health of low-income men. It also shows the impact of price, income, and other control variables on the demand for medical care.
Adolescent↗
Adolescent decision making: a broadly based theory and its application to the prevention of early pregnancy.
The purpose of this paper is to present a broadly based theory of adolescent decision making including all the necessary components of the subject: cognitive development, social and psychological factors, and, perhaps most importantly, cultural and societal influences. Previous theories and applications have often focused on only one or two aspects. This theory is then applied to the problem of prevention of early pregnancy at an inner-city high school. Use of this theory, combined with an open-ended data-gathering format made possible some of the unexpected findings of this study: most of the young women at this school desire their pregnancies; many of them prefer single parenthood to traditional family structure; and low academic skills and poverty often result in pregnancy, rather than pregnancy causing high school dropouts and a life of poverty. Prevention programs will necessarily differ for sexually active adolescents who do and do not want pregnancy and for younger versus older adolescents. In designing such programs, we need to focus on pregnancy as the problem rather than on adolescent sexuality.
Adolescent↗
General theory of paradigms in health.
In Costa Rica, three sequential health paradigms have been identified over the last 50 years. The first began to develop during the 40's and has been called that of the deficiency diseases, since with a diachronic approach it placed excessive emphasis on malnutrition. The second began in 1970 and it is known as that of the infectious diseases, since through a holistic or synchronic approach, it underlined the importance of infections in high rates of morbidity and mortality. The third and last is the paradigm of the chronic diseases, it appeared in the 80's and is presently in process, doing battle with the chronic ailments, life styles, and environment, and it also utilizes a holistic approach. The recognition of these three paradigms has permitted Costa Rica a rapid advance in improving the health of its population, to the point that with a per capita outlay of $130 (US dollars), it has indices similar to those of the industrialized nations. This particular experience could be useful for other less-developed countries that are still applying the paradigm of the deficiency diseases.
Adult↗
Increasing the cancer screening of the medically underserved in south Florida.
Diagnosis and treatment of cancers at advanced stages have contributed to a significantly lower survival rate among individuals of low socioeconomic status compared with those in higher brackets. In an effort to increase the accessibility and acceptability of cancer screening among such individuals in Dade County, Florida, the Cancer Control Division of the Sylvester Comprehensive Cancer Center at the University of Miami School of Medicine initiated a pilot early detection program in 1987. The program initially provided breast cancer screening for women, aged 40 and older, who attended ten community health care centers located in low-income neighborhoods. With the selection of Miami by the American Cancer Society as one of three sites for conducting a screening demonstration project for the socioeconomically disadvantaged, this program has recently been expanded to include pelvic screening for women, aged 40 and older, and prostate screening for men, aged 65 and older.
Adult↗
Prevention and changing demographics. The underserved and cancer.
This paper illustrates the complexity of the "cancer control in the underserved" problem, especially as it is affected currently, and will be in the future, by the multiple demographic changes in the United States. It does so by extensively quoting from four rather different articles by authors from a variety of backgrounds in health, management, and economics. Another issue is that although the articles quoted refer mainly to secondary and tertiary prevention, they do apply equally to primary prevention and health promotion. Furthermore, the twin issues of priority and ethnic/cultural differences need to be addressed insofar as they affect health risks, risk reduction efforts, early diagnosis, treatment, and rehabilitation/disability reduction. Finally, the point is made that social and structural change of this magnitude cannot occur in the health care system and society at large without the allocation of discrete private and public sector resources.
Demography↗
Prepaid versus traditional Medicaid plans: effects on preventive health care.
Prepaid, case managed systems have been proposed as a method of controlling costs in Medicaid populations. We investigated the utilization of preventive services in two prepaid Medicaid Competition Demonstration programs in Santa Barbara County, Calif., and Jackson County, Mo. (containing the city of Kansas City). Care in the demonstration sites was compared with care given in similar counties functioning under a traditional fee-for-service Medicaid system--Ventura County, Calif., and St Louis, Mo. We tested the hypothesis that preventive care would be less in the capitated demonstrations. 2735 Children's and 3389 adult's charts were abstracted for care received during the calendar year 1985, after the prepaid demonstration had been in place for more than 1 year. No significant differences were found between the demonstration and comparison counties in the proportion of children with complete DPT or OPV immunizations at 1 year of age, with 56% complete in both California counties and 69 and 65% complete in Jackson County and St Louis, respectively. Regression analysis demonstrated a slight, but statistically significant trend towards more immunizations in the demonstration counties. Pap smear use in women of 15-44 years of age was little different in the California counties, but significantly greater in the Jackson County demonstration in Missouri (64 vs 45%). Physician breast examinations were somewhat more likely to occur in the prepaid, case managed demonstration counties. Capitated, case managed systems for the AFDC Medicaid population appear to result in no diminution of preventive services. Substantial problems exist in this, as in other poor populations, in childhood immunizations.
Adolescent↗
Increasing nursing involvement in cancer prevention and control among the economically disadvantaged: the nursing challenge.
The American Cancer Society sponsored a series of hearings to document the magnitude of the problems faced by the poor in seeking cancer care. The findings reflected that economically disadvantaged Americans are often forced to accept substandard health care services and face numerous problems when seeking preventive care and treatment. The glimpse from inside the circle of poverty (statements from the hearings) provides an opportunity to better understand the problems faced by the poor in accessing health care and to better recommend strategies for effecting a positive change.
Attitude to Health↗
Case management and preventive services among infants from low-income families.
To determine the impact of an experimental approach to case management on use of child health clinic and immunization services, a nonequivalent control group with covariate measures design was employed in a sample of 98 infants from low-income families. The innovative pattern of care featured continuity of care; a single public health nurse (PHN) provided child health care to an infant by integrating case management and preventive services. In contrast, the customary pattern of child health care was characterized by fragmentation of services. Case management was segregated from preventive services, and multiple PHNs delivered care to an infant. As predicted, experimental-group infants (44%) were more likely to achieve adequate child health clinic services than control-group infants (8%) (p < 0.001). Moreover, the cost-effectiveness (C/E) ratio (dollar cost per effective intervention) for adequate child health clinic visits in continuous care ($523) was one-fifth of that in fragmented care ($2,900). The C/E ratio related to adequate immunization was 8% less in continuous care ($359) than in the fragmented approach ($386), although the difference in rates of adequate immunization was nonsignificant (experimental group, 64%; control group, 60%). These findings suggest that continuous PHN care with integrated case management is a more effective, cost-efficient approach to critical child preventive services than the customary, segregated case-management approach.
Chi-Square Distribution↗
Delivery of preventive services to older black patients using neighborhood health centers.
OBJECTIVES: Older black patients are at risk for underutilization of preventive services. Our objectives were to assess the delivery of five preventive services in Title 330-funded health centers in low income neighborhoods in Cleveland, Ohio, and to determine the association of health system factors and health status with the delivery of these services. DESIGN: A cross-sectional study. SETTING: Four neighborhood health centers in low income neighborhoods of Cleveland, Ohio. PARTICIPANTS: A total of 683 black men and women, aged 70 and older, who regarded the health center as their primary source of outpatient care. MEASUREMENTS: Demographic characteristics, independence in basic and instrumental activities of daily living, comorbidity scores, and perceived access were determined by telephone interview. We reviewed charts to determine whether each of five preventive service goals were obtained: influenza vaccination within 1 year; pneumococcal vaccination at any time; mammography within 2 years; Papanicolau screening within 1 year or twice at any time in the past with documentation of normal results; and fecal occult blood testing within 2 years. RESULTS: The defined goals for influenza vaccination, pneumococcal vaccination, mammography, Papanicolau screening, and fecal occult blood testing were achieved for 59%, 64%, 59%, 51%, and 17% of patients, respectively. Influenza and pneumococcal vaccines were obtained more often in persons with greater comorbidity. Mammography and Papanicolau smear were obtained more often in patients without of ADL or IADL impairments. The four clinical sites varied substantially in the delivery of each preventive service. More frequent office visits were associated with greater delivery of all five preventive services. This relationship persisted in multivariable analyses controlling for health status and clinical site. CONCLUSIONS: This study shows that Title 330 federally supported neighborhood health center sites providing primary care to older blacks in Cleveland achieved high rates of performance in four of the five recommended preventive services. In addition, preventive services practices were associated with prognostically relevant health status information. The frequency of office visits was related strongly and consistently to the performance of the various preventive services, indicating that more, not fewer, office visits may be necessary to achieve Healthy People 2000 targets. J Am Geriatr Soc 48:124-130, 2000. Key words: preventive services; blacks; access to care; geriatrics; primary care
Activities of Daily Living↗
History strikes again: two 20th-century reform ventures.
There are striking parallels between the rise and decline of the health center movement of the early decades of this century and the community mental health center movement of the sixties. Four ideas that dominated the early health center movement--district location, preventive care, community participation, and bureaucratic organization--were also important in the development of community mental health centers. Both movements initially were expressions of the reform spirit of the times and later were undermined by the shift to conservative domestic politics.
Community Health Services↗