What do patients expect from consultations for upper respiratory tract infections?

BACKGROUND AND OBJECTIVE: A cross-sectional survey was conducted amongst patients whoconsulted for upper respiratory tract infections (URTI) at 22private practitioners' offices. METHOD: A total of 505 adult patients and 504 guardians (parents orgrandparents of child patients) completed a self-administeredquestionnaire. RESULTS: The majority thought that URTI would not resolve on its own,while half thought that injections would speed recovery. But78% disagreed with the statement that "taking multiple medicationsmeans faster recovery". Although 91% consulted for medicines,only 36% went specifically for antibiotics and 20% for injections.More than half would accept it if the doctor advised no medicine.More guardians (85%) than adult patients (69%) went for reassuranceand to exclude complications. Using logistic regression analysis,the more educated respondents and the working guardians hadhigher knowledge scores, while the working guardians and respondentswho knew the viral cause were less likely to worry and to demandantibiotics and injections. CONCLUSION: Much patient education and a change in doctors' prescribinghabits in the management of URTI are needed in Hong Kong. Keywords. Respiratory tract infection, knowledge, attitudes, health service demand, general practice.     

Nutrition support in the United States, what is the current practice?

Clinical nutrition in the United States encompasses a vast continuum of nutrition: from the process of identification of malnutition to the management and prevention of obesity. This presentation with focus on the current pratice of nutrition support in the United States. Nutrition support is the provision of specially formulated and/or delivered parenteral or enteral nutrients to maintain or restore optimal nutrition status.     

Drowning Mortality in the United States, 1999–2006

Drowning is the fifth leading cause of unintentional fatalities in the US. Our study described demographics and trend analysis of unintentional drowning mortality in the US from 1999 to 2006, and identifies the changes in deaths for specific population subgroups. Mortality data came from the CDC’s Web-based Injury Statistics Query and Reporting System. Trends during 1999–2006 were analyzed by gender, age group and race. Annual percentage change in deaths/rates and simple linear regression was used for time-trend analysis from 1999 to 2006, and examines its significance. During 1999–2006, there were 27,514 deaths; 21,668 (78.8%) males, 21,380 (77.7%) whites, and 4,241 (15.4%) aged 00–04 years. The annual number of drowning mortality varied from a high of 3,529 in 1999 to a low of 3,281 in 2001. Overall, deaths were increased 1.4% from 3,529 during 1999 to 3,579 deaths during 2006 however, the overall mortality rate decreased by 5%. The proportion of deaths was significantly greater among males than females (27.4 vs. 13.7%: p < 0.001) and blacks than among all other races combined (32.5 vs. 21.3%: p < 0.001). Fatalities reported from California (n = 3,234; 11.75%), Florida (n = 2,852; 10.37%) and Texas (n = 2,395; 8.70%) accounted for 30.82% of all such deaths in the US. Sub-group analyses showed that drowning mortality decreased 0.72% for males but increased 9.52% for females, the trend differ significantly among males and females (p < 0.001). Males, American Indians, and blacks appear to have higher risk of drowning mortality. The trend varied among sexes, age and racial groups from 1999 to 2006. Preventive measures and continuous surveillance is warranted to further decrease these drowning mortalities.     

Nutrition support in the United States, what is the current practice？

Clinical nutrition in the United States encompasses a vast continuum of nutrition:from the process of identification of malnutition to the management and prevention of obesity. This presentation with focus on the current pratice of nutrition support in the United States. Nutrition support is the provision of specially formulated and/or delivered parenteral or enteral nutrients to maintain or restore optimal nutrition status.     

Socioeconomic inequality of obesity in the United States: do gender, age, and ethnicity matter?

This study introduces the concentration index (CI) to assess socioeconomic inequality in the distribution of obesity among American adults aged 18-60 years old. The CI provides a summary measure of socioeconomic inequality, and enabled comparisons across gender, age, and ethnicity. Data from the National Health and Nutrition Examination Survey III, 1988-1994 (NHANES III) were used. The degree of socioeconomic inequality in obesity varied considerably across gender, age, and ethnic groups. Among women, we found a stronger, inverse association between socioeconomic status (SES) and obesity compared with men, as well as greater socioeconomic inequality among middle-aged adults (41-49) compared to other age groups. Consistent with previous studies, we found remarkable ethnic differences in the relationship between SES and obesity. Although the extant literature documented a higher prevalence of obesity among minorities than in whites, our results presented a lower socioeconomic inequality in obesity within minority groups. Our analyses suggested that gender, age, and ethnicity could be important factors on socioeconomic inequality in obesity.     

Nutrition initiatives in the context of population aging: where does the United States stand?

In 2011, the earliest segment of the baby boom generation turned 65 years of age. This event marks the beginning of a new phase of growth of the older adult population in the United States and is in line with what is referred to worldwide as "population aging." By 2030, older adults will comprise 20% of the U.S. population. With the impending increase in the older adult population, the United States is unprepared to handle the accompanying social and economic impact of growing rates of age-related diseases such as diabetes, hypertension, and cardiovascular disease. These diseases have nutritional determinants and, as such, they signify the need for effective preventive nutrition initiatives to address population aging in the United States. Comparatively, the European Union (EU) is projected to reach an older adult population of 24% by 2030. In this special article we evaluate nutrition initiatives for older adults in the United States and also examine nutrition initiatives in the European Union in search of an ideal model. However, we found that available data for EU initiatives targeted at population aging were limited. We conclude by offering the proposal of a physician-based model that establishes the primary care physician as the initiator of nutrition screening, education, referrals, and follow-up for the older adult population in the United States as a long-term goal. Apropos of the immediate future, we consider barriers that underscore the establishment of a physician-based model and suggest objectives that are attainable. Although the data are limited for the European Union, this model may serve to guide management of chronic diseases with a nutritional component in economies similar to the United States worldwide.     

Universal mandatory health insurance in the Netherlands: a model for the United States?

Policy analysts consider the Netherlands health system a possible model for the United States. Since 2006 all Dutch citizens have to buy standardized individual health insurance coverage from a private insurer. Consumers have an annual choice among insurers, and insurers can selectively contract or integrate with health care providers. Subsidies make health insurance affordable for everyone. A Risk Equalization Fund compensates insurers for enrollees with predictably high medical expenses. The reform is a work in progress. So far the emphasis has been on the health insurance market. The challenge is now to successfully reform the market for the provision of health care.     

Stroke and active life expectancy in the United States, 1999–2009

BackgroundStroke reduces active life expectancy, both years lived and their proportion without disability. However, active life expectancy studies have provided limited information about strokes in the United States, those occurring throughout older life, or those affecting African Americans.ObjectiveTo measure associations between strokes throughout older life and active life expectancy for African American and White women and men.MethodsUsing data from the Panel Study of Income Dynamics, 1999–2009 (n = 1862, 13,603 person-years), we estimated monthly probabilities of death and disability in activities of daily living with multinomial logistic Markov models adjusted for age, sex, ethnicity, stroke in the past two years, earlier stroke, and education. A random effect accounted for the panel data repeated measures. Microsimulation created large populations with stroke incidence throughout older life, identifying life expectancy and the proportions of remaining life with and without disability. We matched individuals with strokes with randomly selected persons without strokes by age at first stroke, sex, ethnicity, and previous disability.ResultsAverage age at first stroke was higher for women, lower for African Americans. African American and White women were disabled for about two-thirds of life after stroke; results for men were 61.8% for African Americans and 37.2% for Whites. Compared to matched participants, those with strokes lived 33% fewer remaining years (95% confidence interval, CI 30.9%–34.7%) with a 31.6% greater proportion of remaining life with disability (CI 14.4%–55.6%).ConclusionsStroke greatly reduces both life expectancy and the proportion of life without disability, particularly for women and African Americans.     

Who is Hispanic? Implications for epidemiologic research in the United States

The most recent U.S. Census reported that Hispanics are now the nation's largest minority group. At the same time, increasing attention has focused on the inherent heterogeneity of the U.S. Hispanic population. Such a rapidly growing but heterogeneous minority poses potential challenges to population-based research. To understand those challenges better, we first considered the history of the demographers' question: "Who is Hispanic?" We then considered the implications of differing Hispanic identity criteria for disease surveillance. Although relevant to political and socioeconomic considerations, the Hispanic ethnic category may not be specifically useful for understanding most disease processes. For epidemiologic studies, there is need for more transparent criteria to classify subpopulations. Those criteria must be regularly subjected to analysis and validation.     

The risk-benefit balance in the United States: who decides?

A health policy decision often requires a balancing of risks, costs, and benefits. In this paper we illustrate that there is no uniform answer in the United States to the question of who decides the risk-benefit balance. We use a wide range of case examples from medicine and public health to show the different approaches that are used to allocate decision-making responsibility. Our ultimate purpose is to urge the U.S. health policy community to develop a more consistent way of thinking about how risk-benefit decisions could be guided by general principles.     

Physician unionization in the United States: fad or phenomenon?

This article explores the current trends and issues surrounding physician unionization in the United States, using data from secondary sources and nine interviews with leaders of organizations at the forefront of physician unionizing efforts. Several key points are supported by these data and prior unionization research. First, unions should become a viable organizing alternative for the almost 50% of doctors who are salaried employees because of fewer legal barriers to collective representation, the involvement of national labor unions with resources to spend on organizing, more physicians belonging to demographic groups less hostile to organized labor. and work-related pressures faced by physician-employee under managed care. A second key point is that unions will find it difficult to represent self-employed physicians because of the influence of organized medicine and legal barriers to gaining collective bargaining rights for this group. This discussion is intended to raise awareness of the physician union issue among health care policy-makers and researchers.     

Urban-Rural Differences in Coronary Heart Disease Mortality in the United States: 1999–2009

Objective

Coronary heart disease (CHD) mortality has declined in the past few decades; however, it is unclear whether the reduction in CHD deaths has been similar across urbanization levels and in specific racial groups. We describe the pattern and magnitude of urban-rural variations in CHD mortality in the U.S.

Methods

Using data from the National Center for Health Statistics, we examined trends in death rates from CHD from 1999 to 2009 among people aged 35–84 years, in each geographic region (Northeast, Midwest, West, and South) and in specific racial-urbanization groups, including black and white people in large and medium metropolitan (urban) areas and in non-metropolitan (rural) areas. We also examined deaths from early-onset CHD in females aged <65 years and males aged <55 years.

Results

From 1999 to 2009, there was a 40% decline in age-adjusted CHD mortality. The trend was similar in black and white people but was more pronounced in urban than in rural areas, resulting in a crossover in 2007, when rural areas began showing a higher CHD mortality than urban areas. White people in large metropolitan areas had the largest decline (43%). Throughout the study period, CHD mortality remained higher in black people than in white people, and, in the South, it remained higher in rural than in urban areas. For early-onset CHD, the mortality decline was more modest (30%), but overall trends by urbanization and region were similar.

Conclusion

Favorable national trends in CHD mortality conceal persisting disparities for some regions and population subgroups (e.g., rural areas and black people).Coronary heart disease (CHD) is the leading cause of death for most racial groups in the United States, accounting for approximately 600,000 total deaths annually.¹ CHD remains the leading cause of morbidity and mortality despite the fact that CHD death rates have declined by more than 30% since the 1990s.² This decline has been attributed to a combination of primary and secondary prevention efforts, with a reduction in the level of risk factors, such as blood pressure, smoking, and blood cholesterol, and continuing improvements in diagnosis and treatment.^3–6Although encouraging, the overall decline in CHD mortality rates in the U.S. may conceal less favorable trends in certain regions and demographic groups. Urbanization level is a key characteristic when studying health disparities. One-fifth of the U.S. population resides in rural areas, which rank poorly on 21 of 23 selected population health indicators, behaviors, and risk factors.^7–9 Urban-rural differences provide opportunities for optimizing health-care resources and improving prevention targeting areas of highest need.Few previous studies have described regional differences in CHD mortality in the U.S. and trends over time in recent years.^10–12 There is an ongoing need to monitor the distribution of death rates from specific causes to help reduce preventable diseases and deaths and improve the health of all groups.¹³ This study describes the pattern and magnitude of urban-rural differences in CHD mortality rates by geographic region in the U.S. from 1999 to 2009. The extent to which the decline applies to early CHD mortality is also examined. Deaths from early-onset CHD translate into a large number of years of potential life lost with substantial impact on families and society. Thus, the study of potential determinants of early-onset CHD is important but often neglected.