Key factors determining success of primary eye care through vision centres in rural India: Patients' perspectives

Aim : This paper intends to discuss the patients' perspective on the determinants of primary eye care services from vision centers (VC) in rural India. Materials and Methods : A retrospective study design and interview method was used on 127 randomly selected patients who accessed the 4 VCs in 2007. Factor analyses and linear regression models were used to predict the associations with patient satisfaction. Results : The three factors derived from factor analyses were: (1)-vision technician (VT), (2)-location of VC, and (3)-access to VC; explaining 60% of the variance in total patients' satisfaction with VC. The first model (R2 : 0.61; F 1,124=144.36, P <0.001), indicated that respondents who had 'difficulty to travel to the place of VC' and those who can afford to pay had less satisfaction with VT services. The second model (R2 =0.18; F 1,124=29.5, P <0.001) explained that respondents' difficulty to identify the building of VC had decreased patients' satisfaction and the third model (R2 =0.36; F 1,124=45.6, P <0.001) indicated that those who had to travel<5 km to the VC and had 0.38 units of increased satisfaction level with the services of VC. Conclusion : A good VT can enhance patient satisfaction. However, patient expectations are not only confined to the provider but also other factors such as ability to pay and convenient transportation that helps patients reach the location of the VC with ease.     

Determinants of cost-effectiveness in lumbar spinal fusion using the net benefit framework: a 2-year follow-up study among 695 patients

Up to one third of patients undergoing lumbar spinal fusion show no improvement after the procedure and thus, despite evidence from RCTs, there might be a rationale for observational studies clarifying indications. Similarly, selection of the right patients for the right procedure could have significant impact on cost-effectiveness, which in some countries, in turn, affects whether procedures are to be available through the National Health Service. The aim of this study was to investigate determinants of cost-effectiveness in lumbar spinal fusion. An observational cohort study with 2-year follow-up was conducted: 695 patients who underwent lumbar spinal fusion from 1996 to 2002 were included and followed for 2 years. Patients had a localized segmental pathology and were diagnosed with MRI-verified isthmic spondylolisthesis (26%) or disc degeneration (74%). The surgical techniques were non-instrumented posterolateral fusion (14%), instrumented posterolateral fusion (54%), and circumferential fusion (32%). Societal costs and improvement in functional disability (Dallas Pain Questionnaire) were transformed into a net benefit measure. Classical linear regression of the net benefit was conducted using predictors of age, sex, diagnosis, duration of pain, smoking habits, occupational status, severity of disability, emotional distress, surgical technique, and number of levels fused. The main results were that two determinants were found to negatively influence net benefit: smoking and diagnosis, whereas two others were found to be positively associated with the net benefit: severe disability and emotional distress. In conclusion, predicting net benefit reverses the picture usually seen in studies predicting clinical outcomes, because the response variable is based on improvement over time rather than end-point measures alone. Smoking habits, diagnosis, pre-operative disability, and pre-operative emotional distress were found to be significantly associated with the net benefit of spinal fusion.     

Conceptions and uses of public health ideas by New Zealand government policymakers: report on a five-agency survey

OBJECTIVES: This article describes New Zealand government policymakers' awareness of, attitudes toward and self-reported use of ideas about the determinants of health. Some comparison with an earlier Canadian study is provided. METHODS: Employees with policymaking and advisory responsibilities in government departments of health, social development, housing, education and finance were surveyed. RESULTS: More than half of the respondents (58%) were familiar with ideas about health determinants. Eighty percent felt that health determinants should be considered in all government policy, but that more practical information on effective policy interventions is needed. Commitment to the idea that the economy should take precedence over reducing health inequalities was low. CONCLUSIONS: There is a demand for literature on health determinants that is sector specific and which provides practical and proven information about effective interventions that influence health.     

Prognosis and treatment in patients admitted with acute myocardial infarction on weekends and weekdays from 1997 to 2009

Background

Less invasive treatment and poorer outcomes have been shown among patients admitted with acute myocardial infarction (AMI) on weekends compared to weekdays.

Objectives

To investigate the ‘weekend-effect’ on mortality in patients with AMI.

Methods

Using nationwide registers we identified 92,164 patients aged 30–90 years who were admitted to a Danish hospital with a first AMI from 1997 to 2009. Patients were stratified according to weekday- or weekend admissions and four time-periods to investigate for temporal changes. All-cause mortality at 2, 7, 30, and 365 days was investigated using proportional hazards Cox regression.

Results

Mortality rates were higher on weekends within seven days of admission in 1997–99 (absolute difference ranging from 0.8 to 1.1%). Weekend–weekday hazard-ratios were 1.13 (1.03–1.23) at day 2 and 1.10 (1.01–1.18) at day 7. There were no significant differences in 2000–09 and estimates suggested an attenuation of the initial ‘weekend-effect’.Overall, the use of coronary angiography (34.9% vs. 72.3%) and percutaneous coronary intervention (6.6% vs. 51.0%) within 30 days increased, as did the use of statins (49.9% vs. 80.1%.) and clopidogrel (26.7% vs. 72.7%). The cumulative mortality decreased during the study period from 5.4% to 2.5% at day of admission, from 19.5% to 11.0% at day 30 and from 28.0% to 19.0% at day 365 (all tests for trend p < 0.0001).

Conclusions

No persistent ‘weekend-effect’ on mortality was present in patients with AMI in 1997–2009. Overall, mortality rates have decreased concomitantly with an increased use of current guideline-recommended invasive and medical therapy.     

Patterns and risk factors associated with index Lower Extremity Amputations (LEA) among Type 2 Diabetes Mellitus (T2DM) patients in Fiji

AimTo describe patterns of index (first ever) Lower Extremity Amputations (LEA) and to determine factors associated with their occurrence amongst Type 2 Diabetes Mellitus (T2DM) patients in Fiji.MethodsThis cross-sectional study was conducted that adheres to the STROBE check lists for observational research among T2DM patients who experienced index LEA at the Colonial War Memorial Hospital (CWMH) in Fiji between 2011 and 2015. Demographic and clinical variables were extracted from patient folders. Univariate and multivariate logistic regression were used to determine factors associated with Major LEA. A p-value < 0.05 was considered significant.ResultsA total of 649 study participants were studied with the average age of index amputation was 58.4 years (±9.6 years, range 30–91 years). The average duration of T2DM was 9.5 ± 5.7 years. LEAs were more common amongst males (55%) and indigenous Fijians (71.8%). One-third of index LEA (33%) were major amputations. Factors associated with occurrence of Major LEA were poor Random Blood Sugar (RBS) levels (OR = 1.68, 95% CI: 1.01, 2.81), midfoot lesion (OR = 9.38 95% CI: 4.95, 19.52), septicaemia (OR = 2.42, 95% CI: 1.28, 4.57), low haemoglobin level (OR = 0.78 95% CI: 0.72, 0.86), and history of hypertension (OR = 0.58, 95% CI: 0.40, 0. 84).ConclusionsResults indicate that diabetic patients with foot infections present late to tertiary level care. Our findings also show an urgent need to strengthen primary care interventions and surveillance of both diabetes and diabetic LEA.