Association between fee-for-service expenditures and morbidity burden in primary care

Background

In primary care, fee-for-services (FFS) tariffs are often based on political negotiation rather than costing systems. The potential for comprehensive measures of patient morbidity to explain variation in negotiated FFS expenditures has not previously been examined.

Objectives

To examine the relative explanatory power of morbidity measures and related general practice (GP) clinic characteristics in explaining variation in politically negotiated FFS expenditures.

Methods

We applied a multilevel approach to consider factors that explain FFS expenditures among patients and GP clinics. We used patient morbidity characteristics such as diagnostic markers, multimorbidity casemix adjustment based on resource utilisation bands (RUB) and related GP clinic characteristics for the year 2010. Our sample included 139,527 patients visiting GP clinics.

Results

Out of the individual expenditures, 31.6 % were explained by age, gender and RUB, and around 18 % were explained by RUB. Expenditures increased progressively with the degree of resource use (RUB0–RUB5). Adding more patient-specific morbidity measures increased the explanatory power to 44 %; 3.8–9.4 % of the variation in expenditures was related to the GP clinic in which the patient was treated.

Conclusions

Morbidity measures were significant patient-related FFS expenditure drivers. The association between FFS expenditure and morbidity burden appears to be at the same level as similar studies in the hospital sector, where fees are based on average costing. However, our results indicate that there may be room for improvement of the association between politically negotiated FFS expenditures and morbidity in primary care.     

孕早期不良饮食因素与抑郁的关联性

目的  探究孕早期妇女不良饮食因素与抑郁的关系。 方法  对7 976名参与中国孕产妇队列研究协和项目并在2017年7月25日-2018年7月24日纳入的孕早期妇女进行研究;采用χ²检验描述两组的基线分布差异;在孕早期分别采用定性食物频率测量法和爱丁堡产后抑郁量表测量妇女的饮食摄入频率和抑郁状况;采用Log-binomial回归分析饮食与抑郁的关联性,计算现患比（prevalence ratio,PR）及其95%可信区间（95% confidence interval,95% CI）。 结果  Log-binomial回归结果显示,孕早期饮食规律（PR=0.45,95% CI：0.38~0.54,P < 0.001）、经常吃早餐（PR=0.80,95% CI：0.72~0.90,P < 0.001）的孕妇有较低的抑郁发生风险;而妊娠早期经常食用油炸食品（PR=1.25,95% CI：1.03~1.53,P=0.027）、西式快餐（PR=1.36,95% CI：1.06~1.74,P=0.015）、膨化食品（PR=1.37,95% CI：1.11~1.70,P=0.003）,经常饮用含糖饮料（PR=1.37,95% CI：1.17~1.61,P < 0.001）和葡萄酒（PR=1.60,95% CI：1.26~2.01,P < 0.001）、饮用白酒（PR=1.26,95% CI：1.00~1.59,P=0.047）的孕妇则有较高的抑郁发生风险。 结论  孕早期不良饮食因素与抑郁存在关联性,孕妇应主动了解健康饮食方式,减少不健康饮食的摄入频率,以减少妊娠期间抑郁的发生。     

Association between health beliefs and health behavior in early pregnancy

Folate-supplementation significantly reduces the risk of neural tube defects. The aim of this research was to reveal associations between health beliefs and folate -supplementation as well as other elements of health behavior among Hungarian women early in their pregnancy. Three-hundred and seven women in early pregnancy completed the second part of Health and Illness Scale. Factor structure of health beliefs was established and associations of factors with pregnancy planning, folate-intake, vitamin-intake, smoking-habits and alcohol-consumption were tested. A six factor health model was formulated; the factor named ‘mental capacities and abilities’ was associated with greater chance on folate-intake, vitamin-intake and prepared pregnancy, as well as a reduced chance of smoking. The factors ‘destiny’, ‘measures aiming at prevention’, and ‘relatives and acquaintances’ related to lower chance on folate-intake. The health belief factor representing Internal Health Locus of Control was associated with more than one component of healthy behavior, while factors of external dimensions (Powerful Others Health Locus of Control and Chance Health Locus of Control) were predictive on unhealthy behavioral tendencies. New approaches aiming to shift one’s health beliefs and health locus of control from external causes to internal dimensions are needed in order to reach greater openness towards health-improving interventions.     

Association between indoor renovation activities and eczema in early childhood

BACKGROUND: Other factors besides a genetic disposition seem to play a role in the development of allergic disorders. Exposure to risk factors such as indoor air pollution is becoming increasingly interesting, especially during early childhood. METHODS: Within an epidemiological study (LISS: Leipzig infection, allergy and airway diseases study among school starters, involving 2536 children, birth cohort 1991/92, carried out in 1997/98) the effect of indoor exposure on physician-confirmed eczema and allergic symptoms has been investigated. The exposure situation has been characterized on hand of the redecoration activities (painting, floor covering and new furniture) before birth and in the first years of life. RESULTS: Highly exposed children showed a significant effect on allergic disorders. The lifetime prevalences without any vs. all three redecoration activities were for allergic symptoms 9.3% vs. 17.2% and for eczema 11.5% vs. 20.4%. Adjusted for confounders, the redecoration associated burden led to odds ratios of 1.8 (95% CI: 1.3-2.6) for allergic symptoms and 1.9 (95% CI: 1.4-2.7) for eczema. CONCLUSION: Exposure emissions due to redecoration activities seem to be associated with the risk of eczema and allergic symptoms. Thus, prevention of allergic disorders should include the avoidance of such activities around birth and in the first year of life.     

Association between chronic periodontitis and serum lipid levels

Regarding the high prevalence of hyperlipidaemia, which is one of the major risk factors of cardiovascular disease, and uncertain reports about the relation between periodontal disease and serum lipid profile, this study was conducted to assess this relation. The historical cohort study was conducted on 52 cases including 26 persons with chronic periodontitis as case group, and 26 healthy subjects as control group. Both groups had the same age and weight ranges, sex, and diet, without any periodontal treatment history in the past six months, underling systemic disease such as diabetes, anti-hyperlipidemic drugs or active tobacco smoking history. Low Density Lipoprotein (LDL), High Density Lipoprotein (HDL), Triglyceride (TG) and Total Cholesterol (CHOL) were measured by direct enzymatic assay. TG level was 128.4 +/- 71.1 mg/dl in control group and 165.2 +/- 83.7 in case group indicating a significantly higher level in case group (P<0.05). In control group, 30.8 percent and in case group, 61.5 percent had abnormal serum cholesterol levels, which presents a significantly higher level in case group (P<0.03). Other serum level indices did not show any significant difference. Although it seems that patients with chronic periodontal disease are more susceptible to hyperlipidemia, it is doubtful that the former causes an increase in serum lipid levels, so we suggest studying the effects of treating chronic periodontitis on serum lipid level.     

幽门螺杆菌感染与慢性胰腺炎的相关性分析

目的探讨幽门螺杆菌感染(Helicobacter pylori,Hp)与慢性胰腺炎(chronic panceratitis,CP)发生的相关性,为临床防治提供相关基础。方法纳入60例入住某院消化内科的CP患者作为病例组,同时从门诊人群中随机抽取81例无胰腺病史的观察对象作为对照组,所有观察对象均记录CP的传统危险因素。先以单因素非条件Logistic回归分析筛选出有统计学意义的危险因素,再应用多因素非条件Logistic回归分析Hp与CP发生的相关性。结果单因素分析表明:饮酒史、吸烟史、BMI、高甘油三酯血症、胆源性疾病史、自身免疫性疾病史及Hp感染与CP患者呈正相关(P﹤0.05)。进一步行多因素分析表明:饮酒史、吸烟史、胆源性疾病史、自身免疫性疾病史及Hp感染均是CP患者的独立危险因素(P﹤0.05)。结论 Hp感染是CP发生的独立危险因素,因此对于Hp感染患者需谨慎其发生CP的风险,对该类人群Hp感染进行必要的干预具有重要的意义。     

Housing tenure and early retirement for health reasons in Sweden

AIMS: To assess the association between housing tenure and early retirement for health reasons in Sweden with a view to psychosocial vs. material values of home ownership. METHODS: The data come from linked registers that cover all people resident in Sweden during 1990-2000. The study population consists of 449,233 people aged 40-63 years in 1997. Of these, 19,350 retired early for health reasons in 1998-99. The remaining 429,883 continued their employment without extended sick leave or income decline. None moved during 1990-2000. We calculated the odds of early retirement for four forms of juridical relationship to one's housing (private owner; part owner in a cooperative; private rental; rental from a public housing company), for men and women separately, controlling for age, education, employment income, household disposable income, region, foreign birth, and housing type. RESULTS: Men in cooperative ownership had lower odds of early retirement than those in the three other tenure forms, for which the odds were similar. Among women, public and private renters had similar odds of early retirement, which were higher than those of women in private or cooperative ownership. For both genders, inclusion of housing type in the model after housing tenure explained little additional variance. CONCLUSIONS: The odds of early retirement for health reasons varied across different housing tenure forms in Sweden in 1998-99. The pattern of associations differed as a function of gender. Home ownership appears to involve health resources independent of basic socio-physical factors captured with differences in housing type.     

Association between betelnut chewing and chronic kidney disease in adults

OBJECTIVE: This study was conduced to access the association between betelnut chewing and chronic kidney disease (CKD) in adults. METHODS: We retrospectively reviewed 3,552 participants (1,418 men and 2,134 women) younger than 65 in this hospital-based cross-sectional study from 2003 to 2006. RESULTS: A total of 198 (5.6%) participants were found to have CKD and 287 (8.1%) participants (268 male and 19 female) reported a history of betelnut use. The prevalence (9.4%) of CKD in betelnut users was significantly higher than that (5.2%) of participants without betelnut use (P = 0.003). In multivariate logistic regression with adjustment for age, sex, hypertension, and diabetes, betelnut use and body mass index were independently associated with CKD (P = 0.026 and P = 0.038). CONCLUSIONS: Betelnut use is associated with chronic kidney disease in adults younger than 65.     

医改前后陕西省农村家庭灾难性卫生支出及其影响因素研究

  目的  了解四川省富顺县农村家庭灾难性卫生支出现状及其影响因素,为健全和完善新农合报销制度提供参考依据。  方法  采用灾难性卫生支出发生率和灾难性卫生支出差距等指标分析农村家庭灾难性卫生支出的现状,应用logistic回归分析方法探讨灾难性卫生支出的影响因素。  结果  新农合报销后,四川省富顺县的灾难性卫生支出发生率为18.02 %,平均差距为3.62 %,相对差距为20.11 %,比新农合报销前分别下降了30.77 %、38.44 %和11.64 %;因住院费用或门诊费用而导致的灾难性卫生支出发生率在新农合报销后的下降幅度分别为41.59 %和8.18 %;家庭成员住院次数、抚养比、家庭人均年收入、是否有慢性病患者是灾难性卫生支出的影响因素。  结论  新农合在一定程度上降低了农村地区灾难性卫生支出发生的密度和强度;新农合对住院费用的补偿作用好于对门诊费用的补偿作用;农村慢性病家庭和低收入家庭更容易发生灾难性卫生支出。     

久坐行为与成年人多种慢性疾病的关联研究

目的 了解成年人久坐行为现状,探讨久坐行为与多种慢性病之间的关系。 方法 2018年采用多阶段分层整群抽样方法,对四川省15394名常住居民进行问卷调查,获得人口社会学、健康及相关行为等信息,采用logistic回归模型分析久坐行为与多种慢性病的关系。 结果 共纳入14073人,平均年龄为（53.10±15.65）岁,日静坐时间>7h占8.08%,5~7h占22.51%,3~5h占34.02%,<3h占35.39%。日静坐时间越长的居民患高血压、糖尿病、骨关节疾病、慢性阻塞性肺病和消化系统疾病的几率更高。本研究发现在控制了社会人口学特征、体力活动及共病等因素的影响后,日静坐时长3h以上易增加骨关节疾病（OR=1.352,95%CI:1.168~1.563）及消化系统疾病（OR=1.469,95%CI:1.144~1.887）的患病几率。日静坐时长5h以上易增加糖尿病（OR=1.302,95%CI:1.023~1.657）的患病几率。日静坐时长7h以上易增加高血压（OR=1.293,95%CI:1.068~1.565）及慢性阻塞性肺病（OR=2.046,95%CI:1.591~2.630）的患病几率。日静坐时间越长、患多种慢性病的可能性越高。 结论 成年人的久坐行为与多种慢性病发生相关,减少久坐行为可能有助于降低成年人患慢性病的几率。     

Association of outdoor air pollution with chronic respiratory morbidity in an industrial town in northern India

A cross-sectional study was performed in one industrial (study) and one non-industrial (reference) town in Punjab State, northern India. Ambient air quality samples were collected and analyzed each week for 2 yr. Subjects were 3,603 individuals >15 yr old who were interviewed and whose lung functions were measured spirometrically. Their biomarkers were categorized in terms of obstructive or restrictive defects. Levels of total suspended particulates, nitrogen oxides, sulfur oxides, carbon monoxide, and ozone were significantly higher in the study town than in the reference town. The prevalence of chronic respiratory symptoms (cough, phlegm, breathlessness, or wheezing) was 27.9 and 20.3% in the study and reference towns, respectively (p < 0.05). That of obstructive ventilatory defect was 24.9 and 11.8% (p < 0.05), respectively. Logistic regression analysis showed that residence in the study town was independently associated with chronic respiratory symptoms (odds ratio [OR] = 1.5; 95% confidence interval [CI] = 1.2, 1.8; p < 0.001) and spirometric ventilatory defect (OR = 2.4; 95% CI = 2.0, 2.9; p < 0.001) after controlling for other demographic effects.     

生命早期饥荒暴露与成年期体质指数的关联分析

目的 研究生命早期饥荒暴露对成年期BMI的影响。方法 研究对象来自中国慢性病前瞻性研究的基线调查,共94 052名研究对象纳入分析。将出生于1956年10月至1958年9月、1959年10月至1961年9月和1962年10月至1964年9月的研究对象分别划分为饥荒前出生组、饥荒期内出生组和饥荒后出生组（对照组）。采用线性回归模型计算饥荒暴露组成年期BMI的回归系数及其95%CI。采用似然比检验计算吸烟、饮酒和体力活动与饥荒暴露交互作用的P值。结果 在调整了其他影响因素后,仅在女性中发现,与饥荒后出生组相比,饥荒期内出生组成年期BMI较高（β=0.12,95%CI：0.03～0.22）。吸烟、饮酒均对饥荒与BMI间的关联存在效应修饰作用（交互作用均P<0.001）,体力活动不存在（交互作用P=0.077）。结论 生命早期经历饥荒,尤其是胎儿期经历饥荒的女性成年期BMI较高。因此,保证生命早期营养水平对预防成年后超重/肥胖的发生具有重要意义。     

慢性阻塞性肺病与胃食道反流的相关性研究

目的　通过抗反流治疗探讨慢性阻塞性肺病 (COPD)与胃食道反流 (GER)的相关性。方法　对 6 4例临床确诊COPD患者及 30例健康者进行消化道症状 (反酸、反食、烧心、咽部异物感和腹胀等 1 8种症状 )发病情况问卷调查 ,以总分≥ 6分为症状性GER的诊断标准。当至少符合以下其中之一时 ,异常GER诊断成立。 (1 ) 2 4h食道pH监测远端电极Demeester总积分≥ 1 4 .72分。 (2 )远端电极Demeester总积分虽小于 1 4 .72分 ,但食道上、下电极至少有 1个咳喘症状相关概率 (SAP)大于 75 %。 (3)酸反流试验阳性。胃肠钡餐透视作为辅助诊断。GER诊断确立后以多潘立酮和麦滋林抗反流治疗 6周。结果　 (1 )治疗前 6 4例COPD患者中有 5 2例GER ,4 8例为异常GER ;健康组GER只有 8例 ,两组GER有显著性差异 (P <0 .0 1 )。对 4 8例异常GER抗反流治疗后发现各项观察指标均有明显改善。 (2 ) 1 1例轻型COPD患者咳嗽气促症状完全消失 ;9例中度COPD患者症状有明显减轻 ,SAP >90 %;2 0例患者临床症状完全控制。 (3)酸反流阳性试验全部阴转 ,肺功能检查发现治疗前后有显著性差异 ,P <0 .0 1。结论　对症状性GER的抗反流治疗 ,可以有效减轻部分COPD患者长期咳嗽气促症状 ,证实了COPD与GER之间的密切相关性。     

Association between measures of morbidity and locomotor disability: diagnosis alone is not enough

This study examines the relationship between different measures of morbidity and locomotor disability in early old age. Data from a community health survey of 858 people aged approximately 58 years living in the West of Scotland were examined for associations between morbidity and locomotor disability. The relationships between presence of chronic conditions, severity and pain from chronic conditions, reported symptoms, self-reported health and locomotor disability were examined using logistic regression. After adjusting for several measures of morbidity, sex and social class, frequency of pain from cardiovascular conditions (OR 5.49, 95%CI 2.64-11.39), frequency of pain from musculo-skeletal conditions (OR 2.79, 95% CI 1.76-4.44) and self-assessed health compared to other people the same age (OR 2.76, 95% CI 1.64-4.65) were the most important predictors of locomotor disability. Inclusion of frequency of pain greatly increased the strength of associations of chronic conditions with locomotor disability. Simple measures of morbidity may mask important associations between particular conditions and locomotor disability. In particular the findings suggest that for surveys of the correlates of locomotor disability, collateral information on the frequency of pain associated with chronic conditions and self-reported health relative to other people of the same age provides additional explanatory power.     

哈萨克族牧民2周患病率和慢性病患病率比较

目的比较新疆新源县新型农村合作医疗实施前后哈萨克族牧民健康状况和卫生服务需要的变化,为进一步的科学研究提供基础,为医药卫生体制改革提供相应的参考依据。方法利用2006年及2008年哈萨克牧区居民卫生服务调查中有关2周患病、半年慢性病的相关数据进行描述性统计分析。结果 2006年、2008年新源县哈萨克族牧民2周患病率分别为8.05%、11.78%,差异有统计学意义(χ2=21.02,P<0.05);慢性病患病率分别为15.97%、24.27%,差异有统计学意义(χ2=57.88,P<0.05);类风湿性关节炎、高血压病是影响哈萨克牧民健康的主要疾病。结论新疆新源县哈萨克牧民慢性疾病患病率有明显增加趋势,与其生产生活环境、民族习俗、膳食结构等有关,适宜的健康教育和提供适宜的卫生服务可提高牧民对健康的关注程度。     

孕早期妇女睡眠质量与抑郁的关联性研究

目的 了解孕早期妇女抑郁和睡眠质量的现状及其影响因素,分析抑郁症状与睡眠质量及其各维度的关系.方法 以中国孕产妇队列研究·协和项目中5210名孕早期妇女为研究对象,该项目选择了15个省/自治区/直辖市的24家医院作为调研现场,根据研究方案,项目于2017年7月25日—2018年7月24日,招募处于孕早期妇女.纳入研究对...