Tipologías de los madrileños ante la etapa final de la vida mediante un análisis de clusters

Objective

To establish typologies within Madrid's citizens (Spain) with regard to end-of-life by cluster analysis.

卫生体系分类方法的创新

本文研究的是卫生体系分类问题,希望得到比以往分析的卫生组织模式更深入的成果。从卫生服务的筹资方式看,可在标准三分法(据此可将卫生体系分为三类:自愿保险、社会医保和全民医保)基础上增加两种类型:强制国民医保和特殊人群医保计划。从保险方和服务提供方之间的服务提供和关系来看,有必要对垂直整合和独立的体系加以区分。本文与以往大部分研究的不同之处在于其潜在的逻辑。本文假设所有体系均为混合体系,主张抛开传统的卫生体系分类逻辑(即根据现行体系将各个国家分入不同类别),转而采用拼图逻辑。细分卫生服务或人口的概念,被证明对这一目标非常有用。     

Unintentional non-adherence and belief in medicines in older adults

Objective

To determine whether beliefs in medicines are associated with forgetfulness and carelessness in taking medications.

Methods

Using a survey research design, baseline data (N = 1220) and follow-up data (N = 1024) were collected through an Internet survey using a convenience sample from Medicare enrollees aged 65 and older and who were Internet users. Logistic regression models were used to determine if patient's beliefs about the necessity of taking prescribed medications and their concern beliefs regarding the potential consequences of taking medications were significant in predicting forgetfulness and carelessness in taking medications.

Results

Concern beliefs in medicines were a significant predictor of forgetfulness and carelessness in taking medications.

Conclusion

If all cases of forgetfulness and carelessness in taking medications are considered as unintentional non-adherence with no reference to the patient's beliefs in medicines; using cue based interventions such as phone reminders or alarms are not likely to reduce non-adherence. There was a strong association between patient belief in medications and non-adherence in older adults who were Medicare enrollees.

Practical implications

It is important that researchers consider the influence that patient medication beliefs have on patient adherence to develop better interventions to reduce non-adherence.     

Neighborhood environment profiles related to physical activity and weight status: a latent profile analysis

Background

Neighborhood built environments (BE) include combinations of co-existing stimuli influencing physical activity (PA). Dealing with numerous environmental variables and complexity presents a significant challenge. The current analysis explored whether a range of reported BE features associated with adults' physical activity produced distinct multivariate patterns, and tested whether adults' PA and body mass differed by BE profiles.

Methods

Participants (20-65 years, 48.2% female, 26% ethnic minority) were recruited between 2002 and 2005 from 32 neighborhoods from Seattle-King County, WA (N = 1287) and Baltimore, MD-Washington, DC regions (N = 912). Independent Latent Profile Analyses were conducted in each region with 11 environmental variables from the Neighborhood Environment Walkability Scale. Validity of the neighborhood profiles was examined by their relationship to PA (accelerometer-derived moderate-to-vigorous minutes/day, self-reported minutes/week of walking for transportation and leisure) and self-reported BMI using ANCOVA models.

Results

Neighborhood profiles for Seattle and Baltimore regions were visually similar, suggesting generalizability. High-walkable recreationally-dense neighborhoods differed significantly from other neighborhood types by as much as 13 MVPA minutes/day, almost 60 minutes/week of walking for transportation, and 75 min/week of leisure-time activity. Neighborhood profiles also differed significantly for BMI.

Discussion

These findings could help identify optimal patterns of environmental attributes that facilitate physical activity and improve weight status.     

Role of appetite-regulating peptides in alcohol craving: an analysis in respect to subtypes and different consumption patterns in alcoholism

BACKGROUND: A role of appetite-regulating peptides like leptin and ghrelin in the neurobiology of alcohol craving has been proposed by several studies. Aim of this analysis was to search for differences regarding an association between these peptides and alcohol craving with respect to different subtypes and beverage consumption patterns in patients with alcohol dependence. METHODS: We analyzed a sample of 188 patients at admission for alcohol detoxification regarding leptin and ghrelin (n=117) serum levels. Craving was measured using the Obsessive Compulsive Drinking Scale (OCDS). Patients were classified according to Lesch's typology of alcohol dependence and according to their preferred type of alcoholic beverage (beer, wine, spirits). RESULTS: Using general linear models to analyze a possible interaction between subtypes and leptin/ghrelin levels with respect to craving, we found a significant positive association for leptin in patients of Lesch's types 1 and 2, and in patients consuming beer or wine. Ghrelin levels showed a significant trend regarding an association with craving in patients of Lesch's type 1. In the other subgroups we found no significant results. CONCLUSIONS: Our findings show that appetite-regulating peptides may be of special importance regarding alcohol craving in subtypes of patients. This may explicate at least in part previous contradictory findings.