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.     

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。     

Human-resources strategies for managing HIV/AIDS: the case of the South African forestry industry

Previous work has focused on HIV prevalence among forestry workers and the impact of HIV/AIDS on the sustainability of forest resources. Following a review of work examining the impacts of HIV/AIDS on the South African economy, this article presents original qualitative research examining the responses of company management to the HIV epidemic across a range of enterprises in the South African forestry industry, including large companies, contractors and cooperatives. At the level of the enterprise, management occupies a critical nexus, at which the intersecting requirements of complex government legislation, the wellbeing of workers and the demands of the business must be met. The research demonstrates that large forestry companies tend to provide only a small fraction of their workforces with HIV/AIDS education, prevention or treatment services, as they have essentially outsourced the requirement through the use of labour-supply contractors who, by and large, provide workers with scant HIV/AIDS-related programmes or benefits. Moreover, the extent to which the different types of forestry enterprises incorporate the management of HIV/AIDS in the workforce with the management of the business is highly variable, and in most instances falls short of legislative requirements that have been in place for over a decade. The implications of this for the forestry industry in South Africa are acute.     

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.     

河北阜城县、山东冠县男性生殖保健服务提供与利用现状调查结果分析

目的了解县级、乡镇男性生殖保健机构的服务提供与利用状况。方法使用统一的结构式问卷调查河北阜城县和山东冠县男性生殖保健机构的管理者和服务提供者18人。结果两县共有县、乡两级生殖保健服务机构64个,其中11个（17.19%）能够提供不同水平的男性生殖保健服务,5个设有男科医生（共13名）,近5 a仅2个机构有少量生殖健康或者继续教育经费投入;近1 a男性患者构成比为15.04%;1个县仍施行男子绝育术,其中4个机构1 a共施行428例,平均男子绝育术构成比为28.25%。结论河北阜城县和山东冠县县级和乡镇基层男性生殖保健机构的服务提供与利用水平较低,需要采取干预措施以加强服务提供与利用能力。     

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.     

家庭结构与老年人身心健康关系的研究

随机抽取武汉市某社区中６０岁以上的老年人，采用个人访谈法对家庭结构类型与老年人的身心健康进行了初步研究。调查结果表明：老年人的家庭结构类型主要为联合型家庭（占５２．４％）、直系型家庭（占４．２％）、核心型家庭（占２４．５％）及单独生活型（占１８．９％）；大部分老年人同已婚或未婚的子女生活在一起，但单独生活的老年人比例也有所增加；ｔ检验结果表明：联合型家庭老人的生活满意度显著高于核心型家庭老人（Ｐ＜０．０５），三代同堂的联合型家庭老人的生活满意度显著高于单独生活型的一个独居老人（Ｐ＜０．０５）和核心型家庭无老伴的老人（Ｐ＜０．０３）；单独生活型老人无老伴者的抑郁症状显著多于有老伴者（Ｐ＝０．０５）和联合型家庭中有老伴的老人（Ｐ＜０．０５）；直系型家庭的老人对健康的自我评价显著好于核心型家庭（Ｐ＜０．０２）和单独生活型中一人独居的老人（Ｐ＜０．０５）。多元逐步回归分析结果表明：生活在联合型家庭和直系型家庭中的老人身心健康状况较好，而生活于核心型家庭及独身生活的老年人身心健康状况较差。     

The Neighborhood Food Resource Environment and the Health of Residents with Chronic Conditions

Background  Residence in disadvantaged neighborhoods is associated with poorer access to healthy foods. Objective  To understand associations between the neighborhood food resource environment and residents’ health status and body mass index (BMI) for adults with and without chronic conditions. Design  Cross-sectional multilevel analysis. Participants  2,536 adults from the 2000–2001 Los Angeles Family and Neighborhood Survey. Measurements  The food resource environment was defined as the number of chain supermarkets, independent supermarkets, small markets, or convenience stores per roadway miles in the census tract. The main dependent variables were self-rated health, dichotomized as excellent or fair/poor, and body mass index (BMI). Multilevel regression models examined the association between the food resource environment and both BMI and the odds of reporting excellent health after adjustment for neighborhood SES and individual characteristics. Results  More chain supermarkets per roadway mile in a census tract was associated with higher adjusted rates of reporting excellent health (33%, 38%, and 43% for those in the lowest, middle, and highest tertiles of chain supermarkets) and lower adjusted mean BMI (27, 26, and 25 kg/m²) for residents without a chronic condition, but not those with a chronic condition. In contrast, having more convenience stores per roadway mile was associated with lower health ratings only among adults with a chronic condition (39%, 32%, and 27% for the lowest to highest tertile of convenience stores). Conclusion  Health status and BMI are associated with the local food environment, but the associations differ by type of market and presence of a chronic condition.     

Rural-urban differences in medical care for nursing home residents with severe dementia at the end of life

OBJECTIVES: To identify factors associated with the use of selected medical services near the end of life in cognitively impaired residents of rural and urban nursing homes. DESIGN: Retrospective cohort study using Centers for Medicare and Medicaid Services administrative data for 1998 through 2002. SETTING: Minnesota and Texas nursing homes. PARTICIPANTS: Nursing home residents aged 65 and older with severe cognitive impairment who subsequently died during 2000/01. MEASUREMENTS: Minimum Data Set and Medicare Provider Analysis and Review, Hospice, and Denominator files were used to identify subjects and to assess medical service use. U.S. Department of Agriculture metro-nonmetro continuum county codes defined rural (codes 6-9) and urban (codes 0-2) nursing homes. Nursing home residents with hospice or health maintenance organization benefits were excluded. Use of hospital services at the end of life was adjusted for use of corresponding services before the last year of life. Outcome variables were feeding tube use, any hospitalization, more than 10 days of hospitalization, and intensive care unit (ICU) admission. RESULTS: The population included 3,710 subjects (1,886 rural, 1,824 urban). In multivariable logistic regression analyses (all P<.05), feeding tube use was more common in urban nursing home residents, whereas rural nursing home residents were at greater risk for hospitalization. CONCLUSION: Rural residence was also associated with lower risk of more than 10 days of hospitalization and ICU admission. Nonwhite race and stroke were associated with higher use of all services. Rural nursing home residence is associated with lower likelihood of use of the most-intensive medical services at the end of life.     

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.     

Community-based health insurance in developing countries: a study of its contribution to the performance of health financing systems

We studied the potential of community-based health insurance (CHI) to contribute to the performance of health financing systems. The international empirical evidence is analysed on the basis of the three health financing subfunctions as outlined in the World Health Report 2000: revenue collection, pooling of resources and purchasing of services. The evidence indicates that achievements of CHI in each of these subfunctions so far have been modest, although many CHI schemes still are relatively young and would need more time to develop. We present an overview of the main factors influencing the performance of CHI on these financing subfunctions and discuss a set of proposals to increase CHI performance. The proposals pertain to the demand for and the supply of health care in the community; to the technical, managerial and institutional set-up of CHI; and to the rational use of subsidies.     

Effect of the Japanese preventive-care version of the Minimum Data Set – Home Care on the health-related behaviors of community-dwelling, frail older adults and skills of preventive-care managers: A quasi-experimental study conducted in Japan

Aim:   To determine whether the Japanese preventive-care version of the Minimum Data Set-Home Care improves the health-related behaviors of older adults and the skills of preventive-care managers.
Methods:   Municipal preventive-care managers were instructed on the use of the Japanese preventive-care version of the Minimum Data Set – Home Care and asked to employ it in their interactions with clients during the intervention period (intervention group). The health-related behaviors of older adults (maintenance of self-care and consumption of a balanced diet) were assessed by self-rating methods. The skills of the preventive-care managers were assessed by considering the number of and variations in the needs of the clients, as reflected in the care plans formulated by the managers.
Results:   The clients' self-care levels were higher in the intervention group than in the control group ( P  < 0.05). A greater number of needs, as reflected in the care plans, were noted in the intervention group than in the control group ( P  < 0.05), and the variation in the assessed needs was greater in the former than in the latter.
Conclusion:   This study suggests that the Japanese preventive-care version of the Minimum Data Set – Home Care may improve the skills of preventive-care managers, and consequently, the health-related behaviors of frail older clients.     

Distrust of the health care system and self-reported health in the United States

CONTEXT: Despite theoretical concerns that health care related distrust may lead to poor health outcomes by interfering with effective health care, little is currently known about the prevalence or outcomes of distrust of the health care system in the United States.
OBJECTIVE: To investigate the association between distrust of the health care system and self-reported health status among the general population in the United States.
DESIGN: Random-digit-dialing telephone survey.
PARTICIPANTS: Nine hundred and sixty-one adult residents of the continental U.S.
PRIMARY MEASURES: Distrust of the health care system and self-reported health status.
RESULTS: Distrust of the health care system is relatively high in the United States, with between 20% and 80% of respondents reporting distrust for each item on the Health Care System Distrust scale and a median scale score of 31 (potential range from 10 to 50). Distrust of the health care system is strongly associated with self-reported fair/poor health (odds ratio [OR] 1.40%, 95% confidence interval [CI] 1.12 to 1.75 for each standard deviation increase in distrust), even after adjusting for sociodemographic characteristics, access to health care and trust in primary physicians. In contrast, low trust in one's primary physician is much lower (only 10% to 20% of respondents reported distrust for each item) and is not associated with health status.
CONCLUSIONS: Distrust of the health care system is relatively high in the general population in the United States and is strongly associated with worse self-reported health. Further studies are needed to assess the direction of this association and the mechanisms involved.