Elderly people's ratings of the importance of health-related factors to their self-assessments of health

Identifying the bases for self-assessed health (SAH) has interested researchers in their attempts to understand its validity as a predictor of future health outcomes. Quantitative approaches typically used statistical methods to identify correlates of SAH while qualitative approaches asked people to elaborate on the reasons underlying their rating of health. The current study used a quantitative methodology, asking 487 elderly people to rate the importance of 42 health-related factors as bases for their SAH judgment. Factors indicating overall functioning/vitality were rated highly by all participants. Factors indicating current disease were rated highly by people reporting poor/fair SAH while risk factors and positive indicators were rated highly by those reporting good, very good, or excellent health. Thus, there seems to be a clear distinction between poor and fair SAH that reflect levels of illness, and higher levels of SAH that reflect levels of health.     

Use of medical consultations and the occurrence of systemic arterial hypertension in urban and rural areas of Brazil, according to PNAD data 2008

The use of medical consultations is influenced by determinants such as healthcare needs and service characteristics, which depend on whether the environment is urban or rural. The scope was to estimate the proportions of individuals attending medical consultations over the previous 12 months with and without self-reported systemic arterial hypertension (SAH) living in urban and rural areas, and to analyze the patterns of consultation use and associations. This was a sectional study, using PNAD 2008. Logistic regression was performed to obtain crude and adjusted odds ratios (ORs), according to self-reported SAH and household situation. 70.6% of adult Brazilians consult physicians. The association between the presence of SAH and attending medical consultations was 3.63 (OR) times greater in urban areas. The incidence of consultation with physicians was greater among women, individuals using continuous medication or who had health insurance plans or funding for the last consultation, people who reported a disease or restriction in mobility and those with self-reported poor health, in all strata. Multivariate analysis modified the associations of all variables. The differences between the two areas suggested that access policies need to be implemented, with the aim of reducing inequalities.     

Teenagers' use of sexual health services: perceived need, knowledge and ability to access

INTRODUCTION: An individual teenager's use of services may depend on perceived need, on knowledge of sexual health and local services, and on ability to access. This paper presents the first UK large-scale quantitative analysis of these factors, comparing those who use services with those who do not. METHODS: 15/16-year-olds (n = 5747) were questioned about their use of sexual health services in the SHARE trial of a school sex education programme in 25 schools in Lothian and Tayside, Scotland, UK. Multilevel statistical models examined the role of different factors on service use. RESULTS: One-third of teenagers had used a service, and use was strongly related to sexual experience. In addition, some family influences and being a school leaver were associated with service use, although we found no evidence for class, ethnic or religious barriers to use. Proximity to specialist clinics was linked with greater use, while low spending money and high parental monitoring were associated with less use. Teenagers with better knowledge, who rated their school sex education as effective, who were comfortable talking about sex and who had discussed contraception with peers were more likely to have used services. Differences in use relating to sexual experience, knowledge, feeling comfortable talking about sex and talking with peers helped to explain gender differences in service uptake. CONCLUSION: There is potential to influence service use through better knowledge and confidence imparted through school sex education, and by improving the links between services and schools.     

Self-rated health status in an urban indigenous primary care setting: implications for clinicians and public health policy

Background: Self‐rated health status provides insights into the health beliefs of a population. This will be important for framing public health messages in the context of the need to ‘close the gap’ for Australian Indigenous people. Our primary objectives were to describe the self‐rated health status of Indigenous people attending the Inala Indigenous Health service, identify associations with positive and negative self‐rated health status and identify targets for public health awareness raising activity. Methods: Using a convenience sample, we approached all Indigenous patients attending the Inala Indigenous Health Service for an Indigenous adult health check between June 2007 and July 2008. From Indigenous adult health check data we analysed self‐rated health status and chronic disease risk factors. Results: Out of a possible 509, 413 patients were recruited (response rate 81%). The number of participants who rated their health as fair or poor was 47%. The association of greatest magnitude and statistical significance with Indigenous patients’ self rated health status (negative versus positive) was waist circumference followed by smoking, depression and age. Chronic disease risk factors not associated with self‐rated health status included systolic blood pressure, harmful alcohol use, marijuana use, presence of diabetes and lack of exercise. Conclusions: High rates of negative self‐rated health status were found. Public health awareness‐raising for Indigenous audiences should consider targeting chronic disease risk factors such as systolic blood pressure, harmful alcohol use, marijuana use, presence of diabetes and lack of exercise.     

Self-rated oral health among Brazilian adults and older adults in Southeast Brazil: results from the SB-Brasil Project, 2003

The aim of this study was to determine which characteristics (predisposing and enabling, oral health, perceived need for dental treatment, and behavior) are independently associated with self-rated oral health among adults and older adults in Southeast Brazil. The study was based on 3,240 participants in the SB-Brasil Project/ Southeast. The characteristics of those who rated their oral health as good/very good were compared to those who rated it as fair, poor, or very poor. The following characteristics were significantly and independently associated with better self-rated oral health among adults: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, place of residence in cities with > 50,000 inhabitants, and visit to the dentist > 3 years previously. Among older adults the factors were: monthly household income > US 60.00 dollars, no current perceived need for dental treatment, and 1-19 permanent teeth. Our results confirm those observed in other countries, showing associations between self-rated oral health and predisposing and enabling factors, oral health, perceived need for dental treatment, and behavior.     

An Economic Analysis of Psychotherapy for Borderline Personality Disorder Patients

BACKGROUND: BPD is a serious mental illness in which psychotherapy has been shown to improve patient outcomes and reduce the use of health services. In most studies of psychotherapy, lower use of health services has been taken to imply lower health service costs. However, the costs of psychotherapy can offset any cost savings due to reduced use of other health services. AIMS OF THE STUDY: To estimate the net costs of health service use in a group of BPD patients receiving intensive psychotherapy. METHODS: Data on use of inpatient hospital, emergency hospital, ambulatory care, diagnostic tests and medications were collected for the twelve months before psychotherapy and the twelve months after the completion of treatment. Cost estimates were developed using standardised unit costs. RESULTS: There was a saving of approximately $670,000 in health service use over the thirty patients compared to a cost of $130,000 for psychotherapy, giving a net cost saving of $18,000 per patient. Most of this was due to reduced hospital admissions. Cost saving was higher in those patients who were high users of hospital services. Sensitivity analyses were performed; overall, the findings consistently show a reduction in the cost of health services used. DISCUSSION: The group studied consisted of 30 patients and comprised a before/after design. Therefore it does not overcome criticisms of other work in this area, that is of observational studies and small sample sizes. Nonetheless, the results were based on detailed costing of service use, using conservative assumptions and subject to sensitivity analysis. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: The use of intensive psychotherapy in BPD patients who are high users of health services, particularly those who have had multiple hospital admissions, is probably warranted until more evidence is available. IMPLICATIONS FOR HEALTH POLICIES: There is little rigorous evidence on the effectiveness and cost-effectiveness of psychotherapy. BPD patients appear to generate high service costs so it is important to establish effective and cost-effective modes of treatment. IMPLICATIONS FOR FURTHER RESEARCH: Further research is warranted to establish accurate patterns of service use in BPD patients, and to identify those groups who will most benefit from intensive psychotherapy. erans.     

Single mothers: their health and health service use.

STUDY OBJECTIVE: The aim of the study was to investigate differences in reported health and health service use in single mothers. DESIGN: The study was a survey of data derived from the General Household Surveys conducted by the Office of Population Censuses and Surveys (OPCS). SETTING: The OPCS data are derived from samples of households throughout Great Britain. PARTICIPANTS: OPCS data for 1983 and 1984 were used, comprising approximately 60,000 individuals, of whom 793 were single mothers. MEASUREMENTS AND MAIN RESULTS: Five different health outcomes were examined, two on perceived morbidity and three on the use of health services. The chief determinants of health and health services use among single mothers were housing tenure, employment status and the age of the youngest child. Single mother status did not consistently contribute to self reported morbidity and uptake of care when adjusted for other social variables, but there was a difference between categories of single mother, with those who were separated/divorced and those who were widowed reporting more acute illness than those who were married. CONCLUSION: The findings suggest that single mothers do not form a homogeneous group and that, if special consideration is to be given to them when planning and allocating health service resources, this needs to be taken into account in the context of other socioeconomic factors.     

Nutrition program for the elderly: participants' perception of food quality by type of food service system

A survey of 1028 clients who participated in 21 nutrition sites for the elderly funded by the Suburban Cook County Area Agency on Aging in Chicago, Illinois revealed that participants who received meals prepared on-site were more satisfied with the quality of the meals than participants who received meals that were satellited as hot bulk food or as preplated cook/freeze meals. Participants who judged the meals as fair or poor were more likely than those who rated the food as excellent or good to respond that they would increase their donation if the food were improved. Data from a national survey used as a standard for judging participant satisfaction of food service are presented in this article.     

Computerized telephone nurse triage. An evaluation of service quality and cost

The current reimbursement structure of health care in the United States motivates the providers of health care services to deliver these services with a cost-conscious mentality without compromising quality. This has led to the development of alternative methods of delivering health care services, one of which is computerized telephone nurse triage. This study investigates service quality from the perception of callers who used this system on behalf of a pediatric client. Cost was evaluated by comparing what the caller would have done if they did not speak with nurse triage with what they actually did after their interaction. A modified version of the SERVQUAL tool was administered via telephone survey to members of a managed health care plan who recently used nurse triage services for a pediatric patient. Findings were that the majority of callers--employed female parents--rated the level of service quality very highly. Education, employment status, age of the caller, child gender, birth order among siblings, and age of child did not affect the rating of service quality. Relationship to the child had an effect on the rating of service quality as men/fathers rated the level of service quality slightly lower than their female/mother counterparts. The evaluation of cost revealed that the action taken by the caller after they spoke with the nurse resulted in significant cost savings. Computerized telephone nurse triage is a well-accepted cost-saving alternative method of health care delivery that can effectively serve a variety of callers and pediatric patients.     

Screening for depleted uranium in the United Kingdom armed forces: who wants it and why?

BACKGROUND: Depleted uranium (DU) use has been implicated in the poor health of many service personnel who have served in the Gulf and the Balkans. Although the health related risks are thought to be small the UK government has offered to set up a voluntary screening programme for service personnel. This study aimed to find out the characteristics and possible exposures to DU for those personnel who desire DU screening. METHODS: This study looks at 2369 UK service personnel who were asked if they wanted to be screened for DU. Subjects were asked about their perceived exposure to deployment associated risks including DU and a number of psychological health measures. RESULTS: The study found that 24% of the cohort wanted screening, a figure that if extrapolated to all those who have been offered screening would represent 36720 requests for screening. Those who wanted DU screening were younger, of lower rank, and more likely to be from the Royal Navy or Army rather than the Royal Air Force. Those requesting DU screening reported poorer health both subjectively and as measured by the GHQ-12 and a symptom checklist. They also reported more exposure to DU and to other deployment associated risks while in military service. Using combat exposure as a proxy for a significant risk of having been exposed to DU, there was a significant correlation. CONCLUSIONS: This study found that the desire for DU screening is more closely linked to current health status rather than plausible exposure to DU.     

Utilization of dental services among the elderly in Brazil]

OBJECTIVE: To investigate the pattern of dental services use and its determinants among the elderly in Brazil. METHODS: The study included the elderly participating in the Ministry of Health of Brazil's oral health survey carried out in 2002 and 2003 who had used dental services at least once in their lifetime. Dentulous and edentulous individuals were compared and analyzed separately using multiple logistic regression. RESULTS: Of 5,009 participants, 46.0% were dentulous and 54.0% edentulous. The prevalence of dental services use in the year right before the survey was 26.6% and 10.4%, respectively. Among dentulous participants, the utilization rate was higher in those with more years of schooling, those who perceived their chewing as poor/very poor, and those who reported feeling oral pain; and lower in those who did not have information on oral health, who perceived their oral health as poor/very poor, those with lower per capita income, those who required prostheses and used them, and who required prostheses and did not use them, those with periodontal problems, and with a higher number of extracted teeth. Among edentulous participants, the utilization rate was higher in those with more years of schooling and those reporting oral pain; and lower in non-whites and in those who did not have information on oral health. CONCLUSIONS: The oral health of the elderly in Brazil is deficient and the use of dental services was lower among those who needed them most. The factors associated with dental services utilization differ for dentulous and edentulous individuals. The only similarities are schooling, having information on oral health, and having experienced pain in the teeth and gums in the previous three months. Public investment in oral health is needed to turn around this scenario.     

Health status, needs, and health care barriers among the homeless

Perceived health status, health conditions, and access and barriers to care are important predictors of mortality and the use of services among the homeless. This study assesses these issues by structured interview of 128 homeless adults from San Francisco. Of these adults, 21.1 percent were women (mean age 37 compared to 42 for men). In terms of ethnicity, 38 percent were white; 30 percent were African American; 17 percent were Latino; and 15 percent were Asian/Pacific Islander, Native American/Alaskan, or of mixed ethnicity. Of these adults, 49 percent rated health as poor or fair. Men were four times as likely as women to report their health status as excellent or good. Persons of color were more likely to report unmet needs for shelter, regular meals, employment, and job skills/training. These findings add information on those homeless not often included in research and indicate that these marginalized individuals may be in the poorest health.     

城市流动人口卫生服务利用及影响因素研究

目的了解城市流动人口卫生服务利用的现状,分析其影响因素,为改善流动人口健康状况提供依据。方法在流动人口聚集地采用分层整群随机抽样的方法进行调查,调查内容包括个人基本情况、患病就诊情况及就医意向和对非法行医的认知等。结果流动人口两周患病未就诊比例将近40.00%,并随着经济收入的增高而降低;患病后到无证诊所就诊的比例高达30.00%,原因主要是就诊方便和费用便宜。结论城市流动人口对卫生服务利用的水平较低,选择就诊机构的层次不高,卫生服务需求得不到满足。     

Health care access,use, and satisfaction among disabled Medicaid beneficiaries

Despite being a vulnerable and costly population, little is known about disabled Medicaid beneficiaries. Using data from a 1999-2000 survey, we describe the population and their health care experiences in terms of access, use, and satisfaction with care. Results indicate that disabled beneficiaries are a unique population with wide-ranging circumstances and health conditions. Our results on access to care were indeterminate: by some measures, they had good access, but by others they did not. Beneficiaries' assessments of their health care were more clear: The bulk of the sample rated one or more area of care as being fair or poor.     

The influence of child abuse on the pattern of expenditures in women's adult health service utilization in Ontario, Canada

Childhood maltreatment is a common and serious problem for women, particularly in relation to impairment in adulthood. To our knowledge, no system-wide study has addressed the influence of childhood maltreatment on the cost of these women's adult health service utilization. This paper examines this relationship. The 1990 Ontario Health Survey (OHS) gathered information regarding determinants of physical health status and the use of health services. The 1991 Ontario Mental Health Supplement (OHSUP) examined a variety of childhood experiences as well as the prevalence of psychiatric disorders from a sample of OHS respondents. These were province-wide population health surveys of a probability-based sample of persons aged 15 years and older living in household dwellings in Ontario. The OHSUP randomly selected one member from each participating OHS household to be interviewed regarding personal experiences and mental health. This analysis used data from women aged 15-64 who participated in both the OHS and OHSUP. Self-reported health service utilization was collected in four groups of women--those who reported no history of child abuse, those with a history of physical abuse only, those who reported sexual abuse only, and those who reported both physical and sexual (combined) abuse. We hypothesized that a history of child abuse would result in greater adult health care costs. The results indicated that having a history of combined abuse nearly doubles mean annual ambulatory self-reported health care costs to 775 dollars (95% CI 504 dollars-1045 dollars) compared to a mean cost of 400 dollars with no abuse (95% CI 357 dollars-443 dollars). Median annual ambulatory self-reported health care costs were also increased in the combined abuse group, to 314 dollars (95% CI 220 dollars-429 dollars), compared to 138 dollars (95% CI 132 dollars-169 dollars) in those with no abuse. We conclude that child abuse in women is significantly associated with increased adult self-reported health care costs.     

Community support for young physically handicapped people

This study examined the cost of home and hospital care for individuals who are severely physically handicapped and who may have many years to live. In addition to quantifying the overall level of these services and their costs, factors which might influence the level of service were identified and their use related to the diagnosis, duration and severity of disability, and number of unpaid carers. Costs of health and social service community support increased with severity of disability, and were mostly incurred by individuals with a Barthel score of less than 50 (more severe handicap). Costs, except for those individuals with cerebral palsy, were independent of the number of careers, and for those of school and university age the costs of special educational facilities were significant.     

Hmong Adults Self-Rated Oral Health: A Pilot Study

Since 1975, the Hmong refugee population in the U.S. has increased over 200%. However, little is known about their dental needs or self-rated oral health (SROH). The study aims were to: (1) describe the SROH, self-rated general health (SRGH), and use of dental/physician services; and (2) identify the factors associated with SROH among Hmong adults. A cross-sectional study design with locating sampling methodology was used. Oral health questionnaire was administered to assess SROH and SRGH, past dental and physician visits, and language preference. One hundred twenty adults aged 18–50+ were recruited and 118 had useable information. Of these, 49% rated their oral health as poor/fair and 30% rated their general health as poor/fair. Thirty-nine percent reported that they did not have a regular source of dental care, 46% rated their access to dental care as poor/fair, 43% visited a dentist and 66% visited a physician within the past 12 months. Bivariate analyses demonstrated that access to dental care, past dental visits, age and SRGH were significantly associated with SROH (P < 0.05). Multivariate analyses demonstrated a strong association between access to dental care and good/excellent SROH. About half of Hmong adults rated their oral health and access to dental care as poor. Dental insurance, access to dental care, past preventive dental/physician visits and SRGH were associated with SROH.     

Interaction among body composition, self-rated health and functional status of the elderly in an Indian population

The present study examined the relationship among body composition, measures of self-rated health and activities of daily living in a group of free living poor elderly aged >or = 60 years with a sample size of 147 subjects (82 males, 65 females) from Tirupati suburbs of Andhra Pradesh, India. The subjects were divided into three age groups i.e. 60-69, 70-79 and >or =80 years for comparison. Mean height, weight, circumferences of waist and hip and waist hip ratio (WHR) were higher in males than females with no difference in body mass index (BMI). However, none of the anthropometric variables showed significant association with age. The majority of the subjects rated themselves as 'poor' or 'fair' self-rated health and this corresponds well with the lower mean values of anthropometry as well as activities of daily living, well-being and memory and cognitive function, impaired health aids and in general health. Polytomous logistic regression showed that subjects with the highest score on well-being compared to the lowest score rated 0.325 times (CI: 0.124, 0.851; P<0.05) good vs fair. The odds ratio was 0.519 times (CI: 0.206, 1.306) between good vs poor. Regarding BMI, subjects who rated their health as good/fair tended to have BMI in the normal range. In the poor self-rated health group a maximum of 55% of males and 47% of females were below 19 units of BMI, which was reflected in the increase in odds ratio of 1.361 in males and 1.134 in females between good vs poor health ratings. The findings reveal that well-being and BMI are related to self-reported health status.     

The relationship between self-rated health and health care service use among women veterans in a primary care clinic.

This study examined whether self-rated health predicted health service use among women in an equal access primary care clinic setting. Women veterans (n = 139), 23-76 years of age were administered the PRIME-MD questionnaire at their outpatient clinic (OPC) visit which included a self-rated health item and assessment of symptoms. Number of prospective OPC visits was the outcome variable. Women who had poor/fair health were significantly more likely (OR = 3.25) to have more (>12) OPC visits than women who reported excellent/very good health. We conclude that poor perception of one's health is an important predictor of health care use among women veterans.