Toward healthy aging: the preservation of health

Chronic disease has emerged in recent decades as the major cluster of health concerns of the American population. Increasing evidence indicates that, in most instances, these diseases have been present for long periods of time before becoming clinically manifest. In some instances, it is clear that they may begin in childhood and reach clinical expression only decades later. Furthermore, relevant risk factors for a number of these diseases have been identified and the beneficial effects of risk reduction defined. These disease characteristics translate into lengthy opportunities to identify, mitigate, or prevent serious chronic disorders. A useful framework invokes the health quantum, the "dose" of good health with which the individual is born and that is subjected to erosive forces at each stage of life from conception to old age. A coherent orientation toward the preservation of health across the lifespan is proposed, involving coordinated efforts by the individual, the clinical and public health communities, and the policy enterprise.     

Shared expectations for protection of identifiable health care information

OBJECTIVE: The Ethical Force Program is a collaborative effort to create performance measures for ethics in health care. This report lays out areas of consensus that may be amenable to performance measurement on protecting the privacy, confidentiality and security of identifiable health information. DESIGN: Iterative consensus development process. PARTICIPANTS: The program's oversight body and its expert panel on privacy include national leaders representing the perspectives of physicians, patients, purchasers, health plans, hospitals, and medical ethicists as well as public health, law, and medical informatics experts. METHODS AND MAIN RESULTS: The oversight body appointed a national Expert Advisory Panel on Privacy and Confidentiality in September 1998. This group compiled and reviewed existing norms, including governmental reports and legal standards, professional association policies, private organization statements and policies, accreditation standards, and ethical opinions. A set of specific and assessable expectations for ethical conduct in this domain was then drafted and refined through 7 meetings over 16 months. In the final 2 iterations, each expectation was graded on a scale of 1 to 10 by each oversight body member on whether it was: (1) important, (2) universally applicable, (3) feasible to measure, and (4) realistic to implement. The expectations that did not score more than 7 (mean) on all 4 scales were reconsidered and retained only if the entire oversight body agreed that they should be used as potential subjects for performance measurement. Consensus was achieved on 34 specific expectations. The expectations fell into 8 content areas, addressing the need for transparency of policies and practices, consent for use and disclosure of identifiable information, limitations on information that can be collected and by whom, individual access to one's own health records, security requirements for storage and transfer of information, provisions to ensure ongoing data quality, limitations on how identifiable information may be used, and provisions for meaningful accountability. CONCLUSIONS: This process established consensus on 34 measurable ethical expectations for the protection of privacy and confidentiality in health care. These expectations should apply to any organization with access to personally identifiable health information, including managed care organizations, physician groups, hospitals, other provider organizations, and purchasers. Performance measurement on these expectations may improve accountability across the health care system.     

某综合医院医生健康体检情况分析

目的获得人口学特征建立医生健康体检指标体系,评估医生常见病的流行趋势。方法选择某省级三甲综合性医院体检中心2008年至2012年4次的医生体检人群作为研究对象,对4个横断面现况资料进行分析。对健康档案资料内容包括心血管疾病方面指标、消化系统疾病指标、内分泌疾病指标、腹部B超、妇科B超、胸部X线等进行分析。结果 4次体检的医生中,甲状腺结节腹部B超诊断阳性最高,其次是脂肪肝、女性乳腺增生和子宫肌瘤。结论综合医院医生患慢性疾病为主,主要为甲状腺结节及脂肪肝。     

Healthy patients who perceive poor health and their use of primary care services

Objective:To determine what proportion of patients who have poor health perceptions are physically healthy and to explore why some patients perceive a healthy state while others perceive illness. Design:A prospective consecutive series of office patients completed the Rand Corporation’s General Health Perceptions Questionnaire, and their physicians rated their physical health. Their use of health care services was determined for the following 12 months. Setting:A rural teaching office practice. Patients:Of 243 adult patients asked to complete the questionnaire, 32 were excluded, for dementia (8), illiteracy (4), illness (8), incomplete questionnaires (6), and other reasons (6). 208 patients (86%) formed the final study group. Measurements and main results:62 of 208 patients had poor health perception scores. 39 of the 62 were rated by physicians as physically healthy and were not statistically different in physical health ratings or numbers of prescribed medications from the 146 patients who had higher health perception scores. However, these 39 patients had significantly more health-related worry, acute pain, and depression than did the other 146 patients. They also made more office visits and telephone calls and had higher total primary care charges. Conclusions:This study suggests that 21% of adult primary care patients (39 of 208) have health perceptions lower than expected for their levels of physical health. These low health perceptions are correlated with increased emotional distress and higher utilization of health care resources. Strategies to identify these patients and interventions to improve their views of their health could reduce utilization.     

Health literacy,dementia knowledge and perceived utility of digital health modalities among future health professionals

Objectives

Studies of dementia knowledge (including dementia risk reduction) in health-care trainees highlight varying levels of understanding across countries and disciplines. This draws attention to the need for a well-trained health workforce with the knowledge to champion and implement such strategies. This study (a) assessed dementia knowledge and health literacy among a sample of Australian health-care students, (b) identified modality preferences of digital health interventions addressing dementia prevention and (c) examined potential relationships among health literacy, dementia knowledge, dementia prevention knowledge and a student's preferences for different digital health modalities.

Methods

A cross-sectional survey assessed dementia knowledge and health literacy in 727 health students across 16 Australian universities representing both metropolitan and regional cohorts. The All Aspects of Health Literacy Scale and the Dementia Knowledge Assessment Scale were administered. Questions about the perceived effectiveness of strategies and preferred digital health modalities for dementia prevention/risk reduction were asked.

Results

The students had relatively high health literacy scores. However, dementia knowledge and evidence-based dementia prevention knowledge were average. Only 7% claimed knowledge of available dementia-related digital health interventions. Associations among health literacy, dementia knowledge and dementia prevention, with recommendations for different digital modalities, are presented.

Conclusions

Health-related degrees need to increase dementia knowledge, health literacy and knowledge of effective dementia-related digital health interventions. It is imperative to equip the future health workforce amid an ageing population with increased dementia rates and where evidence-based digital health interventions will increasingly be a source of support.     

Long-term economic growth stimulus of human capital preservation in the elderly

Health care is a crucial factor in US economic growth, because growing health care costs have made US corporations less competitive than their counterparts in countries where central governments assume most of those costs. In this paper we illustrate a second, possibly more powerful, effect of health care expenditures on the long term pace of US economic growth, i.e., that such investments in aging populations helps preserve human capital to later ages. In addition, as current investment in health care improves health and functional status, the future demand for health care as well as future health care costs will be constrained. These are crucial factors in countries experiencing rapid population aging. US labor force projections do not directly represent the effects of health care investment on the health of the future labor force, and federal health cost projections do not reflect the trajectory of health changes. Health dynamic projections suggest the effects of health care investment are large and growth stimulating. Projections done for the time period used by the Congressional Budget Office in budget mark-ups (2010–2020) are presented in the supporting information.     

Management of mutual health organizations in Ghana

OBJECTIVE: Mutual Health Organizations (MHO) emerged in Ghana in the mid-1990s. The organizational structure and financial management of private and public MHO hold important lessons for the development of national health insurance in Ghana, but there is little evidence to date on their features. This paper aims at filling this data gap, and at making recommendations to Ghanaian authorities on how to stimulate the success of MHO. METHODS: Survey among 45 private and public MHO in Ghana in 2004-2005, asking questions on their structure, financial management and financial position. RESULTS: Private MHO had more autonomy in setting premiums and benefit packages, and had higher community participation in meetings than public MHO. MHO in general had few measures in place to control moral hazard and reduce adverse selection, but more measures to control fraud and prevent cost escalation. The vast majority of schemes were managed by formally trained and paid staff. The financial results varied considerably. CONCLUSIONS: Ghanaian authorities regulate the newly established public MHO, but may do good by leaving them a certain level of autonomy in decision-making and secure community participation. The financial management of MHO is suboptimal, which indicates the need for technical assistance.     

全国结核病防治机构人力资源调查分析

目的 了解全国结核病防治机构人力资源现况,为进一步加强各级人力资源建设提供依据。方法 2007年9-10月国家结控中心将设计的调查表下发至各级结核病防治机构进行填写,各级结核病防治机构逐级汇总并上报,最后由国家结控中心对上报的数据进行核实、汇总和分析。 结果 全国共有结核病防治专职人员26 064人,有专业技术职称人员22 591人,人员数量和质量均比2005 年有一定的提高。结论 虽然人员的绝对数量有一定提高,但是人员配置达到规范要求的结核病防治机构较少,高学历、高职称的人员相对缺乏,部分机构人员梯队建设还有待提高,并需要一定数量的熟悉临床的结核病防治专业人员。     

Cost-Consequence Analysis of Multimodal Interventions with Environmental Components for Pediatric Asthma in the State of Maryland

Background. Applied environmental strategies for asthma control are often expensive, but may save longer-term healthcare costs. Whether these savings outweigh additional costs of implementing these strategies is uncertain. Methods. We conducted a systematic review to estimate the expenditures and savings of environmental interventions for asthma in the state of Maryland. Direct costs included hospitalizations, emergency room, and clinic visits. Indirect expenditures included costs of lost work productivity and travel incurred during the usage of healthcare services. We used decision analysis, assuming a hypothetical cohort of the approximated 49,290 pediatric individuals in Maryland with persistent asthma, to compare costs and benefits of environmental asthma interventions against the standard of care (no intervention) from the societal perspective. Results. Three interventions among nine articles met the inclusion criteria for the systematic review: 1) environmental education using medical professionals; 2) education using non-medical personnel; and 3) multi-component strategy involving education with non-medical personnel, allergen-impermeable covers, and pest management. All interventions were found to be cost-saving relative to the standard of care. Home environmental education using non-medical professionals yielded the highest net savings of $14.1 million (95% simulation interval (SI): $-.283 million, $19.4 million), while the multi-component intervention resulted in the lowest net savings of $8.1 million (95% SI: $-4.9 million, $15.9 million). All strategies were most sensitive to the baseline number of hospitalizations in those not receiving targeted interventions for asthma. Conclusions. Limited environmental reduction strategies for asthma are likely to be cost-saving to the healthcare system in Maryland and should be considered for broader scale-up in other economically similar settings.     

Oral and dental health of non-institutionalized elderly people in Spain

With aging of the populations, the oral health and hygiene of elderly people has become an important public health issue. In this cross-sectional study we investigated the prevalence of tooth decay and other periodontal diseases in a representative cohort of 480 non-institutionalized adults ≥65 years from the province of Valencia, Spain. Using a World Health Organization standard for an adult oral survey methodology, we obtained data on remnant teeth with the decayed, missing and filled teeth (DMFT) index, a Community Periodontal Index of Treatment Needs (CPTIN), attachment loss, and temporo-mandibular articulation (TMA) status. The prevalence of these conditions were compared by age and gender, using the Chi-square, and Student's t-, and ANOVA statistical tests. The mean number of remaining teeth were 17.1 in the total sample, which was higher for women (17.9 versus 15.7 in men; p = 0.04). This mean number decreased as age increased (p < 0.05). The overall DMFT index was 19%, showing a persistent increase with age from 14% (65-69-year) to 23% (≥80-year) (p = 0.118). Only 6% of participants had no periodontal pathology, while 26% had bleeding gums and 57% had calculus, while attachment loss was observed in 31%. TMA malfunction with a click was present in 6%, was painful in 5%, and was associated with reduced mouth-opening in 2%. The prevalence of oral health pathologies was high among these elderly people, who would benefit from optimal oral health care.     

Global cardiovascular health: urgent need for an intersectoral approach

Cardiovascular disease (CVD) is the leading cause of mortality worldwide, with more than 80% of CVD deaths occurring in low- and middle-income countries (LMICs). There have been several calls for action to address the global burden of CVD, but there remains insufficient investment in and implementation of CVD prevention and disease management efforts in LMICs. To catalyze the action needed to control global CVD, the Institute of Medicine recently produced a report, Promoting Cardiovascular Health in the Developing World: A Critical Challenge to Achieve Global Health. This paper presents a commentary of the Institute of Medicine's report, focusing specifically on the intersectoral nature of intervention approaches required to promote global cardiovascular health. We describe 3 primary domains of intervention to control global CVD: 1) policy approaches; 2) health communication programs; and 3) healthcare delivery interventions. We argue that the intersectoral nature of global CVD interventions should ideally occur at 2 levels: first, all 3 domains of intervention must be activated and engaged simultaneously, rather than only 1 domain at a time; and second, within each domain, a synergistic combination of interventions must be implemented. A diversity of public and private sector actors, representing multiple sectors such as health, agriculture, urban planning, transportation, finance, broadcasting, education, and the food and pharmaceutical industries, will be required to collaborate for policies, programs, and interventions to be optimally aligned. Improved control of global CVD is eminently possible but requires an intersectoral approach involving a diversity of actors and stakeholders.     

Utilization of coronary angioplasty and cost of angioplasty disposables in 14 western European countries

An inventory has been made of the practice of angioplasty in14 European countries from 1985 onwards. The numbers of proceduresperformed varied in 1985 from 3 to 186 per million inhabitants,in 1991 from 52 to 716. All countries showed a steady increase,but the highest performer, Belgium, achieved only 55% of thenumber of angioplasties performed in 1991 in the U.S.A. No relationwas found between the number of angioplasties and death ratefor ischaemic heart disease, national income, number of cardiologistsor spending on health care. The number of catheterization laboratorieswas related to the number of procedures. Prices of angioplasty disposables varied widely between countries.In 1989 Italy and Spain had very high costs, averaging almost2500 ECU and 2000 ECU for ACS and Schneider balloon cathetersrespectively, while Switzerland and the U.K. were cheap withcosts between 700 ECU and 500 ECU for the same products. In1991 average prices for balloon catheters fell by 25% in Spain,while in Switzerland average prices increased by 10%, bringingthe almost four-fold price difference in 1989, down to a differenceof 2.5 in 1991. If the U.S.A. is taken as a standard and set against the deathrate from ischaemic heart disease in Western Europe in 1991the number of ‘missing’ angioplasties was 215 500,the U.K. accounting for 42% of this deficit.     

A cross-sectional study of latent tuberculosis infection,insurance coverage,and usual sources of health care among non-US-born persons in the United States

More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons’ access to, and ability to pay for, health care.To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011–2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries’ high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.