Socioeconomic development, family income, and psychosocial risk factors: a study of families with children in public elementary school

This article aims to evaluate the effects of Brazil's recent economic growth on the monetary income, consumption patterns, and risk exposures of families with children enrolled in the public elementary school system in S?o Gon?alo, Rio de Janeiro State, Brazil. The article analyzes the following information on families of 447 children that participated in two waves in a longitudinal study: social stratum, per capita family income, evolution in income over a three-year period, and psychosocial factors. The findings showed a 74.8% increase in the families' income, accompanied by an increase in the consumption of material assets and access to health services. This increase should not be interpreted as a guarantee of improved living and health conditions, since it was spent on basic products and needs that do not substantially affect the families' form of social inclusion. Psychosocial risk factors were frequent among the families, but decreased during the study period, which may either reflect the improved family situation or result from the later stage in child development.     

Nutritional supplement utilization in an urban family practice center

A survey of 128 patients in an urban family health center examined their use of nutritional supplements and found that 31 percent currently used supplements, primarily multivitamins and other vitamins. The patients' desire to increase their energy and to ensure good nutrition were the major reasons for their taking supplements, along with prevention of illness, desire for strength, and dealing with stress. Patients reported that they were influenced by their physicians' advice and were willing to change their supplement use upon physician recommendation. The resident physicians who cared for these patients were also surveyed, and they estimated that an average of 23 percent of their patients used nutritional supplements. Residents did not consider discussion of nutritional supplements to be of high priority, nor did they usually discuss them with their patients. Discussion about the use of nutritional supplements can contribute to the role family physicians play in nutrition education.     

Early infant feeding practice: Socioeconomic factors and health visiting support

A survey of health visitor and child health clinic records revealed an association between place of residence and socioeconomic factors and early infant feeding practice. Bottle feeding was associated with poor social circumstance while breast feeding was associated with higher social classes and their socioeconomic attributes. Health visiting home support was limited in its extent and there was no statistical evidence of positive discrimination towards bottle- or breast-feeding families. However, breast-feeding parents made significantly greater use of the child health clinics and so sought more health professional support in the early months of their infants' lives.     

Consultant utilization by family physicians in a university hospital practice

All inpatient consultations obtained by family physicians at a university hospital were monitored for 2 1/2 years to determine the number and types of consultations obtained. Overall, 1,017 consultations were obtained on 2,155 patients (0.47 consultations per patient). The consultation rate, however, gradually decreased from 0.56 consultations per patient at the beginning of the study to 0.36 consultations per patient at the end of the study, probably corresponding to cost-containment pressures placed on physicians by increasing involvement with prepaid health care plans. The specialties most frequently consulted were cardiology, gastroenterology, neurology, and pulmonary medicine, which together accounted for more than one third of all consultations obtained.     

Pediatric practice in public emergency services and factors affecting care

This qualitative empirical study discusses the material and organizational conditions of work by pediatricians in a public emergency service, with the aim of identifying factors that affect care. The work was studied using group interviews and direct observation in the emergency unit. The results were compared with statistical and historical data from documental research. Forty-four pediatricians from seven teams were interviewed, and seven of the pediatricians were observed while on duty. The precarious referral and counter-referral system was a determinant factor leading to the heavy demand on the emergency unit. Agglomeration of patients and families at the entrance to the emergency service led to time pressure and interfered directly in the pediatric care. The study identified informal strategies devised and implemented by these physicians in attempts to guarantee the quality of care in keeping with pediatric principles.     

Prevalence of lifestyle risk factors in a family practice

The prevalence of eight adverse lifestyle risk factors which are linked to increased morbidity and mortality was determined. Smoking, excess alcohol use, obesity, lack of exercise, lack of seatbelt use, use of hazardous transportation vehicles, and inadequate rest were studied. A random sample of 147 patients from a private family practice were selected in a cross-sectional survey. Data were collected by mailed questionnaire. The most prevalent adverse habits were lack of seatbelt use (71%) and sedentary lifestyle (44%). Patients with multiple adverse health habits had poorer self-reported physical as well as emotional well-being. Using a factor analysis of the correlations among eight habits, no significant clustering of habits emerged as indicators of high risk. Thus, no abbreviated list of adverse lifestyle risk factors for clinical use was found that could replace a complete review of risk factors.     

The effect of an on-site radiology facility on radiologic utilization in family practice

Family physicians around the world are increasing their use of diagnostic x-ray examinations at a time of controversy about radiologic overutilization. To explore the role of accessibility in utilization, a study was undertaken testing the hypothesis that on-site radiology facilities are an important determinant of usage. Using a historical cohort design with chart review, rates in selected groups of patients were compared between two teaching family medicine centers, one with an on-site radiology service and one without. After controlling for confounding variables, patients with chest-related diagnoses were 2.4 times more likely (P less than .05) to have a chest film in the presence of on-site facilities. Rates for the off-site examination, upper gastrointestinal series, in patients with abdominal-related diagnoses were similar (relative risk 1.34, P greater than .5) at both centers. Higher usage brought no short-term clinical benefit. It was also observed that residents overinterpreted one quarter of chest films when compared with radiologists' reports.     

北京市西城区居民家庭卫生服务利用的影响因素分析

目的：探讨北京城镇居民家庭卫生服务利用的影响因素。方法：采用多阶段整群随机抽样方法,2011年在北京市西城区14个居委会抽取1424户常住家庭进行入户调查。结果：单因素和logistie回归分析结果显示,影响家庭卫生服务的因素包括家庭成员自我健康评价水平、患病与否、家庭经济收入、医疗自付比例和是否借钱。结论：经济困难还是低收入家庭卫生服务利用低的主要原因,提示政府在考虑提供卫生服务时应更多地考虑低收入家庭,以增强社会公平性;居民自我健康评价低和健康状态差对应的卫生服务利用率低,其主要原因是经济困难,提示健康状况和经济水平存在一定关联。     

Health characteristics and utilization of public sector health facilities among migrant agricultural workers in Orange County, New York

Publicly subsidized medical clinics were established to provide migrant farmworkers with minimal access to mainstream medical care. Nevertheless, migrant farmworkers delay treatment of health problems and refrain totally from use of medical facilities. The present study explores the health status and utilization of subsidized migrant clinics by farmworkers in a vegetable production county (Orange County) in upstate New York. Multivariate analysis indicated that economic resources, mental health status, health insurance coverage, language, education and utilization of acute care facilities are important predictors of these decisions.     

流动老人基本公共卫生服务利用及影响因素研究

目的:了解流动老人基本公共卫生服务利用情况及其影响因素,为促进公共卫生服务均等化提供数据支持。方法:以安德森卫生服务利用模型为理论基础,使用2015年全国流动人口动态监测数据,结合深度访谈,对影响流动老人卫生服务利用的人群特征及环境因素进行分析。结果:流动老人基本公共卫生服务利用率偏低并在群体内存在差异;户籍类型、居住时长、流动范围是影响流动老人卫生服务利用的主要因素;基层卫生服务机构存在经费拨付与工作量不一致、数据不清、工作不被理解等方面的困难。结论:流动老人基本公共卫生服务可及性较差、健康意识薄弱,应加强健康教育宣传;对农村户籍、居住时间短和流动跨度大的老人给予重点关注;卫生部门应加强针对流动老人的数据统计,改变基本公共卫生服务经费拨付方式,优化信息化建设顶层设计,促进流动老人基本公共卫生服务利用。