凉山彝族自治州艾滋病高流行地区HIV阳性孕产妇家庭灾难性卫生支出分析

目的:分析凉山彝族自治州(简称“凉山州”)艾滋病高流行地区HIV阳性孕产妇家庭收入及家庭灾难性卫生支出情况。方法:于2018年12月至2019年1月,从凉山州17个县(县级市)中的2个高流行县招募孕产妇,共纳入250名孕产妇,HIV阳性和阴性孕产妇分别有133、117名。问卷调查收集孕产妇个人基本情况、家庭基本情况、2017年家庭年收入、2017年家庭卫生年支出、2017年孕产相关支出等信息,分析家庭灾难性卫生支出发生率及平均差距和相对差距。结果:HIV阳性孕产妇家庭平均年收入为7 000元、家庭卫生平均支出为2 000元,HIV阴性家庭分别为10 000元和3 000元。在15%、25%和40%的界定标准下,HIV阳性孕产妇家庭灾难性卫生支出发生率分别为39.10%、33.83%和27.82%,其平均差距分别为34.84%、31.17%和26.65%;HIV阴性孕产妇家庭灾难性卫生支出发生率分别为38.46%、33.33%和23.93%,其平均差距分别为31.68%、28.35%和24.22%。结论:凉山州艾滋病高疫情地区灾难性卫生支出发生率整体较高且影响严重,其中HIV阳性孕产妇家庭可能更严重。建议加大医疗保险补偿和医疗救助力度,以减少灾难性卫生支出对其的影响。     

Self-reported patterns of health services utilisation: an urban-rural comparison in South Australia

Objective: To compare self‐reported patterns of health service utilisation among residents of urban and rural South Australia. Design, setting and main outcome measures: Secondary analysis of data generated by computer‐assisted telephone interviews of 7377 adults done in 1995–6. Respondents were asked if they had used each of 18 different health services during the previous 12 months. Residence was classified in three ways: (1) capital city versus rest of the state, (2) by the Rural, Remote and Metropolitan Areas classification (RRMA) and (3) by the Accessibility and Remoteness Index for Australia classification (ARIA). Results: General practitioner services were most frequently used, by approximately 89% of respondents. Only 4% reported not using any service. Comparing capital city with rest of the state, modest but statistically significant differences in utilisation (P < 0.01) were measured for nine services. In eight of these nine, utilisation was higher among rural residents. Analysing by RRMA, eight services were reportedly used differently and seven of these were the same as those identified from the capital city versus rest of state comparison. Across the five ARIA categories, six previously identified services were reported as being used differentially. Overall, rural residents had a higher than expected rate of moderate and high level of health service use. Conclusions: Self‐reported use of a range of health services was broadly similar across urban and rural South Australia, with most cases of higher use were reported from rural areas rather than urban areas. Similar results were obtained when residence was classified in the three different ways. What is already known on this subject: It is widely reported that the health status of and access to health services for rural Australians is worse than their urban counterparts. However, while this is clearly the case for some conditions and some groups, further data is needed to understand rural–urban health differentials better. Few explicit comparisons of different methods of classifying rurality (RRMA, ARIA and capital city vs. the rest) have been published. What does this study add: This study demonstrates that the self‐reported utilisation of a wide range of health services in South Australia is no worse, and is often greater, among rural residents compared to those in Adelaide. The same conclusions are reached irrespective of the method of classifying rurality.     

农村贫困家庭灾难性卫生支出风险及影响因素研究——基于2018年CHARLS数据

灾难性卫生支出是衡量健康公平性的重要指标。本文基于2018年中国健康与养老追踪调查数据(CHARLS),采用Logit、Tobit模型分别对农村贫困家庭的灾难性卫生支出发生率、发生强度进行分析。研究结果表明:我国农村贫困家庭灾难性卫生支出发生率为28.20%,平均强度为0.076,因病致贫率为32.40%。家庭规模较小、有65岁以上老人、被访者无工作、有慢性病患者、残疾人的农村贫困家庭灾难性卫生支出风险显著更高;而家庭人均收入、是否有5岁以下儿童,被访者的受教育水平、居民医保的人均保障水平对贫困家庭的灾难性卫生支出无显著影响。因此,本文建议以灾难性卫生支出风险为标准建立医疗费用支出型救助制度,帮助农村贫困家庭摆脱因病致贫、因病返贫的困境。     

滕州市农村居民灾难性卫生支出影响因素研究

目的:研究滕州市农村居民灾难性卫生支出的密度和强度,分析灾难性卫生支出重要影响因素。方法:多阶段整群抽样调查181户家庭,二分类Logistic回归模型用来分析家庭灾难性卫生的影响因素。结果:在卫生支出占家庭支付能力40%时,滕州市农村家庭灾难性卫生发生率26.51%,家庭年纯收入、家庭内是否有慢性病患者、家庭是否负债是不同标准灾难性卫生支出的影响因素。结论:贫困人群灾难性卫生支出率发生较高,需要进一步完善新农合医疗保障制度和加大中央财政转移支付力度,减少农村家庭灾难性卫生支出的发生。     

Inequities in access to health care in South Africa

Achieving equitable universal health coverage requires the provision of accessible, necessary services for the entire population without imposing an unaffordable burden on individuals or households. In South Africa, little is known about access barriers to health care for the general population. We explore affordability, availability, and acceptability of services through a nationally representative household survey (n = 4668), covering utilization, health status, reasons for delaying care, perceptions and experiences of services, and health-care expenditure. Socio-economic status, race, insurance status, and urban-rural location were associated with access to care, with black Africans, poor, uninsured and rural respondents, experiencing greatest barriers. Understanding access barriers from the user perspective is important for expanding health-care coverage, both in South Africa and in other low- and middle-income countries.     

Ethnic differences in women’s use of mental health services: do social networks play a role? Findings from a national survey

Objectives: The reasons for ethnic differences in women’s mental health service use in England remain unclear. The aims of this study were to ascertain: ethnic differences in women’s usage of mental health services, if social networks are independently associated with service use, and if the association between women’s social networks and service use varies between ethnic groups.

Design: Logistic regression modelling of nationally representative data from the Ethnic Minority Psychiatric Illness Rates in the Community (EMPIRIC) survey conducted in England. The analytic sample (2260 women, aged 16–74 years) was drawn from the representative subsample of 2340 women in EMPIRIC for whom data on mental health services, and social networks were available.

Results: Pakistani and Bangladeshi women were less likely than White women to have used mental health services (Pakistani OR?=?0.23, CI?=?0.08–0.65, p?=?.005; Bangladeshi OR?=?0.25, CI?=?0.07–0.86, p?=?.027). Frequent contact with relatives reduced mental health service use (OR?=?0.45, CI?=?0.23–0.89, p?=?.023). An increase in perceived inadequate support in women’s close networks was associated with increased odds of using mental health services (OR?=?1.91, CI?=?1.11–3.27, p?=?.019). The influence of social networks on mental health service use did not differ between ethnic groups.

Conclusions: The differential treatment of women from Pakistani and Bangladeshi ethnic groups in primary care settings could be a possible reason for the observed differences in mental health service use.     

HPV genotyping in biopsies of HSIL and invasive cervical cancers in women living with HIV: A cohort- and a nested -case control study

ObjectiveTo characterize HPV genotype distribution in HSIL and ICC- biopsies, of WLWH, in Europe, as compared to HIV-negative women.DesignCohort- and nested -case control study.MethodWe characterized HPV genotype distribution by performing PCR on HSIL and ICC biopsies from WLWH (n = 170); 85 cases were compared to 85 HIV-negative matched controls. The proportion of patients that might be protected by HPV vaccines was estimated.ResultsAmong WLWH (median age 36 years-old, median duration of HIV infection 70,5 months, 79% under cART): the most frequently detected HPV were HPV16 (30%), HPV35 (16%), HPV58 (14,7%), HPV31 (13,5%), and HPV52 (11,7%). HPV16 was less frequently found in WLWH, originating from Central Africa (20,5%) compared to other African regions (35,5%) (p = 0,05) or world regions (38,8%) (p = 0,007). Multiple versus single high-risk HPV infections were associated with younger age (≤35 years)(odds ratio (OR) 2,65 (95%IC: 1,3–5,2,p = 0,002), lymphocyte CD4 count < 350 cells / µL (OR 2,7 (95%IC: 2–8,5; p = 0,005), use of cART for < 18 month OR 2,2 (95%IC: 1,1–4,5),p = 0,04) or a cumulative time with undetectable HIV viral load of less than 12 months (OR 4,2 (95%IC: 2–8.5,p = 0,001). HPV 31, 33 and 35 were more frequently detected in samples from WLWH than in HIV-negative controls (p < 0,05). The 9-valent vaccine would increase HPV protection, in HIV-positive and negative women (p < 0,001).ConclusionWLWH are more frequently infected with high-risk HPV other than 16 and 18 than HIV-negative ones. The use of 9-valent vaccine may prevent HSIL or ICC in up to 85% of the women. Adding HPV 35 to the HPV vaccine panel, might improve vaccine effectiveness in WLWH.     

Determinants of healthcare utilisation for low back pain: A population‐based study in Ethiopia

Low back pain (LBP) remains one of the major public health problems worldwide. However, in low‐income countries, such as those in Africa, the epidemiological data on healthcare utilisation for LBP are lacking due to more pressing problems such as infectious diseases, to which the majority of health resources are channelled. Therefore, this study aimed at investigating the determinants of healthcare utilisation for LBP in the general population of Ethiopia. A population‐based cross‐sectional study was conducted in South‐West Shewa zone of Ethiopia from June to November 2018. The data were collected by interviewing adults with LBP (n = 1812, randomly selected) using a psychometrically tested and validated instrument, analysed using R version 3.5.1. A log‐binomial regression model was used to determine the prevalence ratio with a 95% confidence interval (CI) in identifying factors associated with healthcare utilisation for LBP. Estimates of population parameters were also presented with 95% CIs and p values. For all applications of inferential statistics, a p value of ≤.05 was taken as the significance level. The lifetime prevalence of healthcare utilisation for LBP was 36.1%, 95% CI: 33.9–38.1, while the annual prevalence rate was 30%, 95% CI: 27.9–32.2. Of those with a 1‐year history of healthcare utilisation, while 7.4%, 95% CI: 4.9–10.3 rural and 36.6%, 95% CI: 29.5–44 urban populations utilised healthcare from general hospitals, 1.4%, 95% CI: 0.3–2.7 rural and 6.8%, 95% CI: 3.1–10.8 urban populations utilised healthcare from specialised hospitals. Several sociodemographic factors, modifiable health behaviours/lifestyle habits, pain interrelated factors, and specific factors such as beliefs about the pain, depressive symptoms and insomnia were associated with healthcare utilisation for LBP. The implications of this research are that it may be prudent for the Ethiopian healthcare policy makers to develop the necessary strategies to meet the health needs of both urban and rural populations with LBP.     

Is family relations related to health service utilisation among older immigrants: Evidence from Chinese elderly in the United States

The family is the key for survival and success of the 4.6 million older immigrants in the United States. It is also an overlooked context to understand older immigrants’ health service utilisation. Most prior studies on this topic either focus on individual or institutional factors that affect how older immigrants use formal health services. Using data from 2011 Population Study of Chinese Elderly in Chicago (N = 3,159), this study examined potential linkages between family relationships and health service utilisation among US Chinese elderly. Negative binomial and logistic regressions were carried out to investigate whether health service use of these older immigrants are related to positive family relations, negative family relations, and health‐related communications among family members. The findings showed that positive spousal or family relations were not associated with either physician visits or hospital stays. However, respondents with more negative family relations had more doctor visits (β = 0.065, p < 0.05) and were marginally more likely to use inpatient services (OR = 1.15, CI: 0.88–1.04, p = 0.08). Respondents who talked to their spouse for medical concerns were less likely to use inpatient services (OR = 0.68, CI: 0.46–0.99, p < 0.05). The findings showed that family relations play a role in Chinese older immigrants’ health service use. In addition, family conflict seems to be more influential than close family relations in predicting service use. Practitioners need to thoroughly assess family dynamics to fully understand the resources and barriers for health service utilisation among the older immigrant populations.