北京市食源性胃肠炎的疾病负担

目的 了解北京市食源性胃肠炎的疾病负担,为食源性疾病的防治提供依据。方法 采用多阶段分层随机抽样方法,选取北京市6个监测地区内9885人,进行入户面对面调查,了解其过去4周急性胃肠炎的发病、就诊情况以及因急性胃肠炎产生的各类费用,计算急性胃肠炎的疾病负担;根据文献报道的急性胃肠炎的食源性比例,推算食源性胃肠炎疾病负担。结果 急性胃肠炎的年发病率为0.15次/人年(95%CI 0.13～0.16),估算调查期间北京市食源性胃肠炎发病人数为911 975人次。每年约有290 190人次就诊,9120人住院。北京市食源性胃肠炎的总经济负担为1.47亿元,约占全市年生产总值的0.07‰;其中直接费用1.07亿元(医疗费用0.94亿元,非医疗费用0.12亿元),间接费用0.40亿元。结论 北京市人群食源性胃肠炎的疾病负担不容忽视,应进一步完善食源性疾病主动监测体系,更准确地评估食源性疾病对社会和健康造成的影响。     

Female veterans seeking medical care at Veterans Affairs primary care clinics: psychiatric and medical illness burden and service use

OBJECTIVE: To examine rates of medical and psychiatric disorders among 187 female veterans recruited at four Veterans Affairs Medical Centers (VAMCs), the recognition of such disorders by VAMC care providers, and the use of relevant medical and mental health services by women both within and outside of the VA setting. METHODS: We used a cross-sectional, epidemiological design incorporating self-report measures, structured interviews, and chart reviews to obtain relevant information for analyses. RESULTS: Forty-four percent (43.9%) of women met criteria for at least one psychiatric disorder; 34.0% of these women met criteria for two or more additional psychiatric diagnoses, and concordance rates between interview and chart diagnoses were low. Ninety-five percent (95.2%) of women had a medical condition noted in their charts; 86.6% had two or more additional medical conditions, and a significant number of women had both medical and psychiatric diagnoses. Forty-four percent (43.9%) of women with an identified mental health condition received specialized mental health care by the VA in the past year. CONCLUSIONS: Findings from this study suggest that female veterans treated in VAMCs had significant medical and psychiatric problems, and these women might not be getting their health care needs adequately met through the VA health care system. In light of our findings, we discuss relevant implications and future directions for research.     

Sex differences in factors associated with use of medical care and alternative illness behaviors

In many previous investigations of illness behavior the dependent variable has been restricted to use or nonuse of physicians' services. The purpose of this study was to determine how males and females differ in the tendency to respond to their symptoms when self-treatment and lay consultation as well as medical care are considered. The sample consisted of all white, married individuals (n = 532) participating in a household survey who reported at least one symptom episode during a 4-week recall period. An important feature of this survey data set is that there were no proxy respondents. Similar distributions of behavioral responses to symptom episodes were found for men and women. Multinomial logit analysis was used to identify the factors associated with specific illness behaviors. The independent variables were: characteristics of the individual and family such as number of children, social class and employment status; characteristics and perceptions of the symptom episode including discomfort, disability and belief that a physician could do something to relieve it; and access to, and attitudes toward medical care. Belief that a physician could do something to relieve the symptoms, number of days of disability and number of component symptoms in the complex were positively related to use of medical care and duration of the symptom episode was negatively related to use of medical care for both men and women. Several of the independent variables affected only one sex group or had differential effects on males and females. Sex differences were most pronounced with respect to use of lay consultants.(ABSTRACT TRUNCATED AT 250 WORDS)     

Factors associated with disability in a sample of adults with arthritis

BackgroundArthritis is the most common cause of disability among US adults. Few studies have comprehensively examined factors associated with disability in this population.ObjectiveTo investigate the relationship between a number of disease and non-disease related factors and disability in sample of adults with self-reported doctor-diagnosed arthritis.MethodsParticipants (n = 396) taking part in a randomized controlled trial of arthritis self-management completed a comprehensive survey assessing a number of demographic, arthritis-specific, health-related, behavioral, and psychological variables at baseline. Disability, as measured by the Health Assessment Questionnaire (HAQ), was also measured. Hierarchical regression models examined the independent associations between blocks of variables and disability.ResultsDemographic variables (R² = 0.13), arthritis-specific demographics (i.e., type, medication use; ΔR² = 0.16), physical health-related variables (ΔR² = 0.06), arthritis-specific symptoms (ΔR² = 0.12), health behaviors (ΔR² = 0.00), and psychological variables (ΔR² = 0.03) explained 50% of the variance in disability score (R² = 0.50). With the exception of health behaviors, the addition of each block of variables significantly improved the model, explaining additional variance in HAQ scores (p < 0.0001). In the final model, older age, less than a high school education, rheumatoid arthritis, greater arthritis duration, taking steroids, taking narcotics, greater pain, greater stiffness, greater depressive symptoms, and lower arthritis self-efficacy were associated with greater disability whereas male gender, fibromyalgia, and excellent/very good health were associated with less disability.ConclusionsA number of disease and non-disease related variables were associated with disability. These findings suggest that disability in adults with arthritis may be a complicated phenomenon; such complexity may make decreasing disability in this population challenging.     

Factors associated with chronic illness among the elderly in a rural community in Malaysia

Chronic illness is one of the major causes of mortality and morbidity among the elderly. To determine the prevalence and factors associated with chronic illness among the elderly in a rural community setting. A cross sectional study design was used. Stratified proportionate cluster sampling method was used to select respondents in Mukim Sepang, Sepang, Selangor, Malaysia. Out of 263 elderly residents (6.2% of the total population), 223 agreed to participate in the study giving a response rate of 84.8%. The prevalence of chronic illness among the elderly in Mukim Sepang was 60.1%. Out of 223 respondents, 134 were diagnosed as having chronic illness such as hypertension, diabetes mellitus, ischaemic heart disease, bronchial asthma or gout. Chronic illness was found to be significantly associated with functional dependence among the elderly (chi2=6.863, df=1, p<0.05). The prevalence of chronic illness among the elderly in the rural community is very high. Problems facing this age-group should be addressed comprehensively in order to formulate appropriate programmes for the health care of the elderly.     

Estimating the burden of foodborne diseases in Japan

ObjectiveTo assess the burden posed by foodborne diseases in Japan using methods developed by the World Health Organization’s Foodborne Disease Burden Epidemiology Reference Group (FERG).MethodsExpert consultation and statistics on food poisoning during 2011 were used to identify three common causes of foodborne disease in Japan: Campylobacter and Salmonella species and enterohaemorrhagic Escherichia coli (EHEC). We conducted systematic reviews of English and Japanese literature on the complications caused by these pathogens, by searching Embase, the Japan medical society abstract database and Medline. We estimated the annual incidence of acute gastroenteritis from reported surveillance data, based on estimated probabilities that an affected person would visit a physician and have gastroenteritis confirmed. We then calculated disability-adjusted life-years (DALYs) lost in 2011, using the incidence estimates along with disability weights derived from published studies.FindingsIn 2011, foodborne disease caused by Campylobacter species, Salmonella species and EHEC led to an estimated loss of 6099, 3145 and 463 DALYs in Japan, respectively. These estimated burdens are based on the pyramid reconstruction method; are largely due to morbidity rather than mortality; and are much higher than those indicated by routine surveillance data.ConclusionRoutine surveillance data may indicate foodborne disease burdens that are much lower than the true values. Most of the burden posed by foodborne disease in Japan comes from secondary complications. The tools developed by FERG appear useful in estimating disease burdens and setting priorities in the field of food safety.     

Factors associated with hospitalization in a sample of chronic hemodialysis patients.

This study examines the hospitalization experience of a sample of chronic hemodialysis patients, using primary data sources. There were multiple causes of hospitalization over the six-month tracking period, with stays extending from 1 to 87 days. Patients were more likely to be hospitalized if they had a negative hepatitis antigen, lower functional status scores, lower phosphate and protein levels, repeated access procedures, other cardiovascular conditions, arthritis, psychiatric disorders, ischemic peripheral vascular disease, lung disease, or larger households. Hospitalization for access-related problems was associated with arthritis, previous access procedures, and blood pressure levels. Sociodemographic and treatment characteristics did not have a significant influence on the risk of hospitalization. Improved management in these clinical areas may improve the quality of life of chronic hemodialysis patients and reduce the high level of expenditures associated with delivering inpatient services to this segment of the Medicare population.     

Rate-difference method proved satisfactory in estimating the influenza burden in primary care visits

OBJECTIVE: To compare different methods to estimate the disease burden of influenza, using influenza and respiratory syncytial virus-(RSV) associated primary care data as an example. STUDY DESIGN AND SETTING: In a retrospective study in the Netherlands over 1997-2003, primary care attended respiratory episodes and national viral surveillance data were used to compare the rate-difference method to other, more complex methods. RESULTS: The influenza-associated excess estimated by the different methods varied. The estimates provided by the rate-difference model lay well within this range. According to the rate-difference method, influenza-associated primary care consultations were present for all ages, including low-risk adults. The highest influenza-associated burden was demonstrated for children below the age of 5 years. The RSV-associated primary care burden was highest in the youngest age category and well above that associated with influenza. Significant RSV-associated excess was also recorded among adults, particularly in high-risk adults and the elderly. CONCLUSION: The straightforward rate-difference model seemed satisfactory to estimate the influenza-associated burden. Significant influenza-associated excess was demonstrated among persons not yet recommended for influenza vaccination in The Netherlands. The RSV-associated burden was highest for the youngest children, but also significant for adults.     

Factors associated with caregiver burden among caregivers of patients with cancer in a hospice setting

Purpose: Previous research has examined caregiver burden in the context of chronic illness, but little is known about this problem in hospice settings. The objective of this project was to identify factors associated with caregiver perceptions of burden among those caring for the terminally ill, with a long-term goal of better understanding the links between the level of burden and the risk of adverse medical and psychological outcomes. Our expectation was that certain groups (e.g., older women) would experience greater burden.Methods: We conducted a cross-sectional survey of primary caregivers in a hospice setting. Among 388 caregivers of patients with cancer admitted between October 1999 and September 2000, 200 (52%) agreed to participate. In-person interviews were conducted to ascertain data on the caregivers' socio-demographic characteristics, self-reported health status, support systems, religiosity, and amount of assistance they provided to their patients. Using this information, we also calculated a composite social network index, incorporating marital status, religious activities, contact with friends, and participation in community groups. Caregiver burden was measured using a 9-item subset of the Zarit burden inventory, and the summary scores were dichotomized at the upper quartile. Using logistic regression, unadjusted and adjusted analyses identified factors significantly associated with increased burden scores.Results: We found that increased caregiver burden was related to younger age (OR 1.49, CI 1.12–1.99), a worse score on the social network index (OR 1.43, CI 1.05–1.95), and the number of activities in which the caregivers themselves were restricted due to their caregiving responsibilities (OR 1.32, CI 1.11–1.58).Conclusions: Although several factors were associated with caregiver feelings of burden, the specific results we found were not anticipated. Future research should examine these factors, as well as others that might be more easily modifiable, when evaluating increased risk among caregivers.     

Factors associated with hospital service satisfaction in a sample of Arab subjects with schizophrenia

Background  

Assessment of patients' satisfaction with health care services could help to identify the strengths and weaknesses of the system and provide guidance for further development. The study's objectives were to: (i) assess the pattern of satisfaction with hospital care for a sample of people with schizophrenia in Kuwait, using the Verona Service Satisfaction Scale (VSSS-EU); ii) compare the pattern of satisfaction with those of similar studies; and iii) assess the association of VSSS seven domains with a number of variables representing met and unmet needs for care, family caregiver burden, severity of psychopathology, level of psychosocial functioning, socio-demographic characteristics, psychological well-being and objective quality of life.     

Predictors of post-rape medical care in a national sample of women

BACKGROUND: Rape has a negative impact on physical and mental health, health-related behaviors, and health service utilization. Timely medical care is important for preventive services. METHODS: Cross-sectional data were obtained from a larger 2-year longitudinal study, the National Women's Study (NWS). A total of 3006 adult women participated in the final data collection wave of the NWS. During a structured telephone interview, women who reported a most-recent or only rape incident during adulthood were asked about rape characteristics, reporting to authorities, medical care, and rape-related concerns. The main outcome measures were receipt and timing of medical care received after an adult rape, and factors influencing whether or not medical care was received. RESULTS: Of the sample, 214 (7.1%) had experienced a most-recent or only rape as an adult (aged >/=18), and 56 (26.2%) received rape-related medical care following that incident. The final model multivariable logistic regression indicated that reporting the crime to police or other authorities (odds ratio [OR], 9.45; 95% confidence interval [CI]=3. 34-26.70) and fear of sexually transmitted diseases (OR, 8.61; 95% CI=3.12-23.72) were significant predictors of receipt of post-rape medical care. CONCLUSIONS: One in five victims reported an adult rape to police or other authorities; these women were nine times more likely to receive medical care than those who did not. Public health efforts are needed to increase the proportion of rape victims who receive immediate post-rape medical care.     

Factors associated with changes in satisfaction with care

OBJECTIVE: Satisfaction with care is an important outcome for evaluating the effectiveness of medical care. Many factors can influence satisfaction, including disease state, healthcare utilization, and health-status changes. However, few studies have investigated the association between these factors and changes in satisfaction. DESIGN: This study examined the influence of personal characteristics, type of health plan, disease states, and healthcare utilization on changes in satisfaction with care in a prospective cohort over a 12-month period through two surveys, baseline and follow-up. PARTICIPANTS: Enrollees in one of three different commercial health plans: point-of-service product, an unrestricted fee-for-service product, and a preferred-provider organization product. MEASUREMENTS AND MAIN RESULTS: Two multivariate logistic regression models were constructed. The first model evaluated factors that predicted increased satisfaction with care between the two surveys. Compared with respondents who reported no change in health status, both those with improved health status (odds ratio [OR], 1.29, 95% confidence interval [CI95], 1.03-1.61) and those with declines in health (OR, 1.29, CI95, 1.03-1.61) were significantly more likely to report an increase in satisfaction with care. Those with a history of hospitalization were also more likely to report an increase in satisfaction with care (OR, 1.27, CI95, 1.01-1.59). The second multivariate logit model evaluated factors that predicted decreases in satisfaction with care from the baseline survey. Those with reported declines in health status were more likely to report decreases in satisfaction with medical care (OR, 1.43, CI95, 1.13-1.79). Neither age, gender, race, type of health plan, disease state, nor doctor's office visits were related to observed changes in satisfaction with medical care. CONCLUSION: Changes in satisfaction with care appear to be related to changes in health status. However, the relation between these two attributes is not intuitively apparent.     

Factors associated with effective contraceptive use among a sample of Latina women

Unintended pregnancy disproportionately affects Latina women. One factor contributing to unintended pregnancy among Latinas is the low rate of contraceptive use. This study examined correlates of effective contraceptive use among a sample of Latina women (n=202) at increased risk for HIV. In addition to traditional intrapersonal variables (i.e., perceived risk of pregnancy, motivation to avoid pregnancy), the present study examined the role of the male partner and relationship factors (i.e., relationship commitment, duration, pregnancy prevention decision-making) on contraceptive use. Participants were recruited from clinics and community locations in East Los Angeles and administered a 60-minute in-person interview. Multivariate logistic regression was used to compare women who consistently used effective contraceptives (36%) to women using no method or an ineffective method. Women in relationships of 1 to 2 years were nearly 3 times more likely to use an effective contraceptive compared to women in relationships of less than 1 year (odds ratio (OR)=2.7, 95% CI 1.1, 6.7). Women were more than twice as likely to use an effective method if they reported a high level of involvement in decision-making about whether to use contraception (OR=2.3, 95% CI 1.1, 4.7) or had discussed contraception with their partner (OR=2.4, 95% CI 1.03, 5.6). This study provides additional information about the importance of male partners and relationship factors in contraceptive use among Latina women. Efforts to prevent unintended pregnancy need to address the role of relationship factors in the sexual risk and protective behaviors of Latinas.     

Factors associated with seeking emergency treatment following suspected chemical contamination of a leisure pool

A leisure pool was evacuated when children complained of breathing difficulties, cough, and eye irritation subsequently thought to be due to high chloramine levels. The duration of the suspected contamination before the evacuation was unknown: it was suggested that some subsequent attendances at accident and emergency (A&E) departments had been prompted by news reports of the incident. The extent and nature of symptoms, the cause of the incident, and the impact of media reporting were investigated with the help of a postal questionnaire. One hundred and thirty-seven people (all but six under 20 years of age) attended A&E departments after the incident, most commonly with sore eyes (79%), cough (76%), and sore throat (71%). The number of different symptoms was associated with the length of time spent at the pool, but not with being present at the time of the evacuation or with having heard about the incident on radio or television.