Characteristics of people living with HIV who use community-based services in Ontario, Canada: implications for service providers.

Community-based AIDS service organizations (CBAOs) direct services to multiple-needs people living with HIV/AIDS who are less likely to use mainstream health promotion services. As people live longer with HIV, the potential to enhance quality of life increases, yet little is known about who uses CBAOs or how this use affects other health and social services. This study of people living with AIDS in Ontario, Canada (n = 297) examined the demographic and health-related characteristics of people with AIDS who do and do not use CBAOs and their patterns of mainstream service utilization. It found that users of CBAOs were significantly less healthy, less able to sustain normal activities, and more often depressed. They reported physical disabilities significantly more often. Their quality of life was also lower along certain dimensions. They were significantly poorer and more reliant on government income supports. They consumed significantly more nonhospital health and social services and had significantly higher out-of-pocket costs. These results suggest CBAOs are being accessed appropriately by those most vulnerable. In an effort to strengthen CBAO capacity to recognize and address depression and physical health problems prevalent among their clients, links to other mainstream health promotion and social services is recommended.     

Living in poverty and its effects on health

Poverty has been identified as the greatest threat to health. Generally speaking, poor people are sick more often than wealthier people, and poor people die younger due to poorer economic, social, political and physical conditions. The article explains the difference between relative poverty and absolute poverty, before going on to explore various reasons why people living in relative poverty are more susceptible to ill health than their wealthier counterparts. The article delves into how poverty contributes to ill health by the effects of low income and poor health behaviours, with cigarette smoking being identified as the health behaviour with the largest negative impact on people living in relative poverty.     

Impact of support services provided by a community-based AIDS service organization on persons living with HIV/AIDS.

This study examined demographic, health-related, social support, and service utilization characteristics of clients with high and low use of a community-based AIDS service organization in Canada. The study confirmed that the organizations' services were reaching the most vulnerable persons living with HIV/AIDS. It found that a significantly greater number of high users compared with low users were single, lived alone, and reported poorer health. The similarity in functional health status and depression between user groups, despite high users' poorer health and greater social vulnerability, supports client reports that services have reduced client isolation and improved health-related quality of life. Finally, high users had lower expenditures for government-provided health and social services overall, particularly HIV specialists and AIDS medication, but significantly more expenditures for emergency room services and complementary therapies. The results suggest community-based services can enhance health-related quality of life for persons living with HIV/AIDS by increasing providers' capacity to identify and address client depression and its consequences.     

Dementia and serious coexisting medical conditions: a double whammy

Research-based information about the prevalence of other serious medical conditions in people with dementia has become available only recently, and the true prevalence is not known, primarily because many people with dementia do not have a diagnosis. The existing information is sufficient, however, to show that these other conditions are common in people with dementia. It is also clear that coexisting medical conditions increase the use and cost of health care services for people with dementia, and conversely, dementia increases the use and cost of health care services for people with other serious medical conditions. Nurses and other healthcare professionals should expect to see these relationships in their elderly patients. They should know how to recognize possible dementia and assess, or obtain an assessment of, the patient's cognitive status. They should expect the worsening of cognitive and related symptoms in acutely ill people with dementia and try to eliminate factors that cause this worsening, to the extent possible, while assuring the family that the symptoms are likely to improve once the acute phase of illness or treatment is over. Families, nurses, and other health care professionals are challenged by the complex issues involved in caring for a person with both dementia and other serious medical conditions. Greater attention to these issues by informed and thoughtful clinicians will improve outcomes for the people and their family and professional caregivers.     

Occupational therapy service use among people aging with multiple sclerosis

OBJECTIVE: We examined the use of occupational therapy services in a sample of people aging with multiple sclerosis (MS). METHOD: A total of 1,282 people with MS, ages 45 to 90, participated in telephone interviews to identify unmet health-related service needs. Occupational therapy was 1 of 22 services examined. Proportional odds models were used to examine factors associated with how recently services were used. RESULTS: Four hundred eighty-four participants (38.2%) had used occupational therapy services at some point since their diagnosis; 211 had used these services in the year before the interview. Recent users identified occupational therapy services as important to health and well-being. Satisfaction with services was high. Greater activity limitations and living in an urban or suburban area were associated with more recent use of occupational therapy services. CONCLUSION: The results raise questions about what constitutes appropriate levels of occupational therapy service use and how to ensure that these levels are achieved.     

Relationship between psychosocial factors and health behaviours for women experiencing menopause

This study investigated the psychosocial factors related to the health behaviours of women at menopause. These health behaviours included choice of intervention by women for menopause, particularly consultation of health professionals, use of hormone replacement therapy and preferred information sources. A postal questionnaire was distributed to a structured random population-based sample of 400 women in the 45-54 years age group living in south-east Queensland, Australia. Explanatory variables were: attitudes to menopause, social functioning, mental health, vitality, preventive health practices and lifestyle factors. This study found that information, preventive health practices, attitudes towards menopause, exercise, number of children living at home, years of formal education and working in paid employment, were related to the health behaviours of women at menopause. The study concludes that a number of related psychosocial factors not associated with hormonal changes may influence the health behaviours of menopausal women. It will be important for nurses, other health professionals and counsellors to decide how best to respond to these findings in consultation with the women affected by their decisions.     

Disability and health: perceptions of a sample of elderly people

The background to this work was the expected increase in the proportion of elderly people in the population, giving rise to a greater demand for services at a time of scarcity of healthcare resources. The aims of the study were to investigate disability and health in a sample of elderly people living at home in the community. We wished to obtain detailed information about physical disability and health then to explore individual perceptions of health and disability and, finally, to examine relationships between the objective assessments and individual, subjective perceptions. The results reported here represent only part of the work of a larger study which also investigated the use of health and social services in this sample of elderly people. In-depth interviews were undertaken with a random stratified population sample of 200 elderly people living at home. Analysis of interview data showed that, by use of a multidimensional scale of disability, just over one-third of the sample could be classified as ‘disabled’. The mobility status of the sample was, in general, good with only small numbers spending most of their time in a wheelchair. The total sample scored highly on activities of daily living, though those classified as disabled were significantly less independent. The mean number of reported health conditions was less than might have been expected in an elderly population. One-third of the subjects in the sample showed discrepancies between their own assessment of their disability and objective assessments. These discrepancies could partly be explained by a combination of individuals' assessment of their own abilities and their beliefs about factors influencing disability. Measures of disability, or activity associated with daily living, were related to perceptions of health, whereas the number of current health problems was not. The factors which determined perceptions of health or disability were: walking unaided and general levels of activity. Health was perceived in terms of what one could do rather than the presence of current diseases or conditions. The results suggested that when planning treatment for elderly people, physiotherapists and others should consider individual variability in perceptions of disability and health, as well as objective assessments. The importance of locomotion in the value systems of elderly people emphasises the high profile of physiotherapy in the care of elderly people. Copyright © 1996 Whurr Publishers Ltd.     

Health beliefs and their influence on United Kingdom nurses' health-related behaviours

BACKGROUND: Because there is a demonstrated empirical link between nurses' personal health habits and their tendency to raise health issues with clients, researchers suggest that nurses can improve their health promotion role if they adopt health-related behaviours. Few researchers, however, have identified the factors that influence nurses' health-related behaviours. AIMS: To describe nurses' beliefs about the importance of health-related behaviours, and investigate the relationship between these beliefs and their health-related behaviours. DESIGN: A cross-sectional survey from which nested-case control comparisons were made. SAMPLE: One hundred and thirteen nurses attending tertiary level education courses in London and Essex. MEASURES: Health Behaviour Survey and a scale measuring nurses' beliefs about the importance of health-related behaviours. RESULTS: Nurses' health beliefs significantly influenced the practice of 14 health-related behaviours. CONCLUSIONS: The findings from this study support the view that nurses' practice of many behaviours linked to health and longevity are influenced significantly by their beliefs about the importance of these behaviours. Changing nurses' beliefs about the importance of health-related behaviours through specific health promotion sessions are meaningful as they may improve nurses' health promotion role.     

Evaluation of services for people with HIV/AIDS in an inner-city health authority: perspectives of key service providers

This paper reports the findings of the first phase of a study designed to assess the needs of people with HIV and AIDS and the extent to which these needs are being met by services in Camberwell Health Authority in inner London The study involves collecting information and opinions from key service providers, clients with HIV/AIDS and their informal carers It is the service provider data which will be presented here Semi-structured interviews were conducted with 47 key service providers involved in the care and support of people with HIV/ AIDS in the Camberwell Health District Respondents were drawn from the local health services, local social services departments and a number of locally active voluntary organizations The aim was to gather respondents' views on their individual roles and the roles of the organizations they represented, the health and social needs of people with HIV/AIDS and the extent to which these were being met by current service provision and the co-ordination of services for people with HIV/AIDS The data showed that a broad range of services were utilized by people with HIV/AIDS, reflecting a wide variety of health and social care needs The majority of respondents felt that some of the needs of people with HIV/AIDS were similar to those of people living with other chronic illnesses (such as cancer) However, they also identified a number of problems which were either unique or more severe for people with the virus Services for people with HIV/AIDS were generally felt to be poorly coordinated and a number of areas of overlap and gaps in service provision were identified     

Health perceptions and health behaviours of poor urban Jordanian women

BACKGROUND: The economic recession and stringent economic adjustment programme that Jordan has gone through since the early 1980s have resulted in lower living standards and higher rates of poverty and unemployment. Poverty debilitates women and impairs their access to health care, proper nutrition and well-being in general. RATIONALE: Women's health behaviours and problems need to be analysed from the perspective of women themselves. The purpose of this study was to describe the health perceptions and health behaviours of poor urban Jordanian women aged 15-45 years in the context of the family and community in which they live. The sample consisted of 267 Jordanian women aged 18-45 years, whose household income was below the poverty line. METHOD: This was a community-based study that collected data using semi-structured interviews with women. Health perceptions were measured by asking the women to describe their health status, as they perceived it. Health behaviours were measured by asking the women about their personal hygiene, diet, activity and exercise, sleep, smoking, drinking alcohol, and safety and security. RESULTS: The average age of women was 33 years, 93% were or had been married, and 87.5% had received some form of education. Although the mean age at marriage was about 20 years, 13.6% were married when they were less than 16 years of age. Study women gave a lower rating of their health status than those reported in national studies. Although they reported bathing once a week, eating about three meals a day, and getting 8 hours sleep, there remain areas for improvement in their health behaviours in terms of performing regular exercise, carrying out regular health examinations, and the type and amount of food consumed. RECOMMENDATIONS: Implications for nursing, with a special focus on health education and meeting the health needs of these women, are presented.     

Health-related activities in the American Time Use Survey

OBJECTIVES: The Bureau of Labor Statistics' American Time Use Survey (ATUS), launched in 2003, offers the first comprehensive look at how individuals spend their time. Health services researchers can use it to study time spent on a variety of health-related activities. We explain the survey's structure and provide an overview of the health-related activities reported by 34,693 respondents in 2003-2004. METHODS: For the ATUS, computer-assisted phone interviewers ask respondents age 15 or older to report their activities during the day before the call (their "designated day"), including where they were and who was with them. Activities are assigned 6-digit codes, grouped into 17 major categories. Associated waiting and travel time have separate codes. Certain household types are oversampled to ensure reliable estimates. RESULTS: In 2003-2004, 11.3% of American adults reported spending time (mean, 108 minutes) on activities related to health on their designated day. Some 5.6% reported personal health self-care (86 minutes); 3.4% reported medical and care services (123 minutes); and about 1% each reported activities related to the health of household children, household adults, and nonhousehold adults (78-115 minutes). The prevalence of health-care related activities rose with age. Sports, exercise, and recreation were reported by 17.6% of respondents (114 minutes), with men more likely than women to report these activities. CONCLUSIONS: The ATUS, a new publicly available resource, allows researchers to explore factors that influence time devoted to health-related activities, and the relationships among them and other activities, in a nationally representative sample.     

A multimorbidity nurse practitioner-led clinic: Evaluation of health outcomes

BackgroundHealthcare services for people living with multiple chronic diseases have traditionally been organised around each condition, an approach which is neither resource-efficient nor convenient or effective for patients. The integrated nurse practitioner service reported here was developed to optimise patient experience and outcomes within a chronic disease self-management framework.AimTo evaluate patient outcomes following attendance at an integrated chronic disease nurse practitioner clinic for multimorbidity.MethodsA prospective service evaluation of adults with any combination of chronic kidney disease, diabetes and/or heart failure between June 2014 and December 2017. Demographic and clinical outcomes at entry and after 12 months of clinic attendance were collected from health records of all patients (n = 162); a subgroup also completed health-related quality of life and self-efficacy measures at entry and 12 months follow-up (n = 106).FindingsPatients attending the clinic had complex needs and poor health-related quality of life. Despite the complexity of their health problems, as a cohort blood pressure was well-controlled and self-efficacy for chronic disease management was relatively high. Over the first 12 months of integrated nurse practitioner care, there were large improvements in physical aspects of health-related quality of life and many patients achieved reductions in body mass index. Use of hospital inpatient and emergency services also decreased.DiscussionNurse practitioner-led services have the potential to reduce treatment burden and deliver integrated chronic disease management.ConclusionsThe multimorbidity clinic has improved health outcomes in this patient cohort and offers a model for enhanced primary care.     

Older people and falls: health status,quality of life,lifestyle, care networks,prevention and views on service use following a recent fall

Aim and objective. This study has investigated older people’s experiences of a recent fall, its impact on their health, lifestyle, quality of life, care networks, prevention and their views on service use. Background. Falls are common in older people and prevalence increases with age. Falls prevention is a major policy and service initiative. Design. An exploratory, qualitative design involving two time points. Method. A convenience sample of 27 older people from two primary care trusts who had a recent fall. Taped semi structured qualitative interviews were conducted and repeated at follow up to detect change over time and repeat falls. Data were collected on their experience of falls, health, activities of living, lifestyle, quality of life, use of services, prevention of falls, informal care and social networks. Content analysis of transcribed interviews identified key themes. Results. The majority of people fell indoors (n = 23), were repeat fallers (n = 22) with more than half alone when they fell (n = 15). For five people it was their first ever fall. Participants in primary care trust 1 had a higher mean age than those in primary care trust 2 and had more injurious falls (n = 12, mean age 87 years vs. n = 15, mean age 81 years). The majority of non‐injurious falls went unreported to formal services. Falls can result in a decline in health status, ability to undertake activities of living, lifestyle and quality of life. Conclusions. Local informal care and support networks are as important as formal care for older people at risk of falls or who have fallen. Access to falls prevention programmes and services is limited for people living in more rural communities. Relevance to practice. Falls prevention initiatives and services should work with local communities, agencies and informal carers to ensure equitable access and provision of information, resources and care to meet the needs of older people at risk or who have fallen.     

Child health records as a database for clinical practice, research and community planning

In considering health information systems, great hope is attached to the use of child health records as a data source for research and community planning. In order to test the completeness of child health records data and their agreement with other sources, information about living conditions, use of medical services and health problems in preschool children were studied in 707 child health centres' records. The results show a considerable number of deficiencies in the system which could, to a certain extent, be remedied by improved instructions to the staff. Health problems in the area of child care also need to be fully defined.     

Association between good work ability and health behaviours among unemployed: A cross-sectional survey

BackgroundThere has been relatively little research on the possible factors promoting good work ability among unemployed people. Consequently, the role of health behaviours in good work ability among the unemployed is unknown.PurposeTo explore the work ability and health behaviours of unemployed people through sociodemographic factors and examine the association between good work ability and health behaviours.DesignA cross-sectional survey.MethodsThe study is based on the Finnish nationwide Regional Health and Well-being Study using mailed and online questionnaires in 2014–2015. A total of 1973 unemployed or laid-off people between the ages of 20 and 65 responded to the survey. The associations of work ability with sociodemographic factors – gender, age, marital status, minors (i.e. under–18s) living in the household, education, living environment, and duration of unemployment – and health behaviours with sociodemographic factors were first explored using cross-tabulations. Health behaviours included body mass index, daily smoking, alcohol consumption, vegetable consumption, health promotion groups, physical exercise, and sitting in one's leisure time. Health behaviours were then examined using logistic regression analyses, in association with good work ability; the latter was measured with the Work Ability Score.ResultsBeing aged below 45, being married or cohabiting, having a high level of education, and short-term unemployment were associated with good work ability. A quarter of participants were daily smokers. A proportion of women with risk level alcohol use (79%) was higher than that of men (59.9%). A third of unemployed people participated in high-intensity physical activity. In regression analyses, high-intensity physical activity (OR 2.25, 95% CI 1.06–4.78) was associated with good work ability.ConclusionsUnemployed women and men widely exhibited unhealthy behaviours such as daily smoking and a risk level use of alcohol. Health promotion actions for enhancing a healthy lifestyle and good work ability among unemployed people, particularly in emphasizing the importance of physical activity, are highly recommended.     

Risk behaviours and health care needs of drug-using female prostitutes (part 1)

One hundred drug-using and 50 non-drug-using female prostitutes working in the Manchester area were interviewed about their working practices, drug use, levels of risk behaviours for HIV with clients and other sexual partners, and use of primary health care and specialist drug services. Results indicated high levels of sexual and drug risk behaviours among a proportion of women, particularly younger street-level drug users. Contact with health care providers and drug services by this group was sporadic and low. The value of developing health care and HIV prevention initiatives targeted at drug-using female prostitutes is discussed, together with the challenges this poses for primary health care providers, genitourinary medicine and specialist drugs services.     

The "Boston model" of managed care and spinal cord injury: a cross-sectional study of the outcomes of risk-based, prepaid, managed care

OBJECTIVE: To present preliminary data on the health-related consequences for people with spinal cord injury (SCI) of participation in a prepaid, risk-based, managed care plan. DESIGN: Baseline data from a longitudinal interview survey. SETTING: Massachusetts. PARTICIPANTS: Subjects were 114 independently living adults with SCI recruited from 6 independent living centers and 2 managed care plans; 45 received care from a risk-based prepaid managed care plan and 69 from other sources. MAIN OUTCOMES: Self-reports of use of health services; self-assessments of health, health at interview versus 12 months earlier; hospital admissions; numbers of secondary conditions, and experiences of specific secondary conditions (eg, pressure ulcers, depression, fatigue, and chronic pain). RESULTS: Persons in the managed care plan do not differ from their counterparts in terms of age, gender, education, level of SCI, number of comorbid conditions, activity of daily living profiles, household composition, and reliance upon health maintenance programs and routines (eg, bowel and bladder care). In terms of processes of care, they appear generally better-served. There also are a few differences in outcome that are statistically significant, or approach significance, and generally favor the managed care plan. CONCLUSION: Preliminary data suggest that thoughtfully and sensitively designed and implemented risk-based managed care may improve both access and outcomes.     

The effects of psychological distress and psychological well-being on use of medical services.

In this study, the authors determined whether mental health status affects the use of general medical services, with and without adjustment for the correlated effects of general health perceptions and physical health status on such use. Data were used from the RAND Health Insurance Experiment, which has information on up to 5 years of use of medical services by a nonelderly, civilian, general population. Health status and other covariates were assessed by self-administered questionnaires at enrollment. In the absence of statistical control for general and physical health status, worse mental health status-whether assessed by a global self-report measure or its two component parts, psychological well-being and psychological distress-significantly increased the use of both inpatient and outpatient general medical services. After controlling for general health perceptions, physical health status, demographic factors, and insurance plan coverage, the effects of mental health status on use are reduced, but not eliminated. Psychological distress and psychological well-being retained independent effects on total medical expenses.     

Utilization of mental health services among rural elderly

Rural elders are an undeserved and vulnerable population with compromised access to health and human services leading to premature institutionalization. Even though elders living in rural areas have psychiatric illnesses that would prompt them to use mental health services, their use of these services remains low. This study developed predictive models of psychiatric hospitalization, use of mental health services, and use of crisis intervention by rural elders participating in an outreach case-management program. A combination of demographic, health status, and organizational variables were used in stepwise multiple regression. Being married and having supplemental insurance in addition to Medicare predicted 23% of the variance for utilization of psychiatric hospitalization. Only one variable, Medicaid, predicted 14% of the variance for use of mental health services. Type of caregiver, marital status, household composition, and Medicaid insurance accounted for 23% of the variance in utilization of crisis intervention by rural elders. Overall, the two variables that most likely predicted use of psychiatric mental health services were marital status and type of insurance.