SOAR—the solution to the high prevalence of heart disease in Appalachian Kentucky

Journal of Public Health - Many diseases affect the population of Appalachian Kentucky, but none more than heart disease. The purpose of this article is to address the alarmingly high prevalence of...     

Who are the high hospital users? A Canadian case study

OBJECTIVES: Researchers have taken two different approaches to understanding high use of hospital services, one focusing on the large proportion of services used by a small minority and a second focusing on the poor health status and high hospital use of the poor. This work attempts to bridge these two widely researched approaches to understanding health care use. METHODS: Administrative data from Winnipeg, Manitoba covering all hospitalizations in 1995 were combined with public use Census measures of socio-economic status (neighbourhood household income). High users were defined as the 1% of the population who spent the most days in hospital in 1995 (n = 6487 hospital users out of population of 648715 including non-users). RESULTS: One per cent of the Winnipeg population consumed 69% of the hospital days in 1995. Thirty-one per cent of the highest users were among the 20% of residents of neighbourhoods with the lowest household incomes, and 10% of the highest users were among the 20% from neighbourhoods with the highest household incomes. However, on most other dimensions, including gender, age, average days in hospital, average admissions, percentage who died in hospital and diagnostic reasons for being hospitalized, the similarities between high users, regardless of their socio-economic group, were striking. CONCLUSIONS: The lower the socio-economic status, the more likely an individual is to make high demands on hospitals. However, patterns of use as well as the diseases and accidents that produce high use among residents of low income neighbourhoods are not much different from those that produce high use among residents of high income neighbourhoods.     

Pointing the finger. Who's to blame for high healthcare costs?

Who's to blame for soaring healthcare costs? How can we gain control of the problem? Is it time for rationing? Who'll pay for universal access? These are some of the questions posed in a poll of consumers, employers, physicians and hospital executives conducted for Modern Healthcare. While the results showed the four groups had common concerns regarding the scope of the problem, consensus was in short supply when it came to solutions.     

Is the high mortality risk in sentenced offenders independent of previous imprisonment?

The mortality in prisoners is high. However, our knowledge about the mortality in convicted offenders, irrespective of incarceration history, is limited. Our aim was to investigate possible predictors for over-all and cause specific mortality in a nation-wide study of convicted offenders with and without previous imprisonment. This case–control study drew random samples of deceased and living offenders (N = 1,112) from four complete cohorts of convicted offenders, two male (born 1967 and 1977, respectively), and two female (born 1967–70 and 1977–80, respectively). All criminal records were systematized and information about date and cause of death was collected on those deceased. Multivariable analyses demonstrated that age at first court conviction (OR = 0.88, 95% CI = 0.84–0.93), drug related crimes (OR = 1.99, 95% CI = 1.23–3.22), and crime diversity (1.51, 95% CI = 1.07–2.13) were significant predictors of premature death in males. In females, age at first court conviction (OR = 0.92, 95% CI = 0.88–0.97), drug related crimes (OR = 2.24, 95% CI = 1.37–3.69) and belonging to the oldest cohort (OR = 2.10, 95% CI = 1.35–3.26) were significant predictors of premature death. Age at first court conviction remained a significant predictor for death in all cause specific multivariable mortality analyses. In addition, having committed drug related crimes and high crime diversity were strong predictors for substance related deaths. Males did more often die in accidents or commit suicide. Somatic deaths were most often encountered in the oldest cohort. Incarceration did not remain a significant predictor for premature death in any of the multivariable analyses. Measures intended to prevent premature death in convicted offenders should target wider populations than hitherto acknowledged.     

Do patients choose hospitals with high quality ratings? Empirical evidence from the market for angioplasty in the Netherlands

A necessary condition for competition to promote quality in hospital markets is that patients are sensitive to differences in hospital quality. In this paper we examine the relationship between hospital quality, as measured by publicly available quality ratings, and patient hospital choice for angioplasty using individual claims data from a large health insurer. We find that Dutch patients have a high propensity to choose hospitals with a good reputation, both overall and for cardiology, and a low readmission rate after treatment for heart failure. Relative to a mean readmission rate of 8.5% we find that a 1%-point lower readmission rate is associated with a 12% increase in hospital demand. Since readmission rates are not adjusted for case-mix they may not provide a correct signal of hospital quality. Insofar patients base their hospital choice on such imperfect quality information, this may result in suboptimal choices and risk selection by hospitals.     

亲子同乐high起来

5月15日下午,《家庭·育儿》妈咪俱乐部走进了南开区居华里幼儿园,开展了"家园共育·亲子同乐"活动。幼儿园小班的宝宝和家长们一起参与了本次活动。活动共分"抱球冲冲冲"和"三人四脚大步走"两个游戏。头戴福娃标志的宝宝,在爸爸妈妈的协助下,都顺利地     

沙滩派对high起来

正暑假来了,去海边撒个欢浪一浪吧!此时此刻,少不了沙滩装备和玩具来助阵。有了这些"小伙伴",你的沙滩派对才够high!     

Use of selected high‐fat foods by Hispanic adults in the Northeastern US

Objective. To add to the limited information of dietary fat intake of US Hispanic adults, in particular for subgroups other than Mexican Americans.

Methods. The frequency of eating 13 high‐fat food items commonly consumed in the US was examined in 665 Hispanic adults 20–74 years old in Connecticut and Long Island, New York, sampled from Spanish‐surname telephone listings and surveyed by telephone in 1992.

Results. Mean estimated fat intake from the 13 items was significantly greater for the 357 men than the 308 women; the largest gender differences were for hamburgers/ cheeseburgers and French fries. Whole milk was an important contributor to the fat intake of persons with the highest fat intakes. In multiple linear regression analyses, age (negative association) and gender, but not education and acculturation (based on language spoken, read and written), were statistically significant predictors of fat intake from the 13 items.

Conclusions. Longitudinal studies using diet diaries are needed in these Hispanic populations.     

Does high income buffer the association between adverse working conditions and ill health?

AIM: A study was undertaken to analyse the possible interaction between work environment and income for the probability of self-rated health being less than good. METHODS: Data from the Swedish Survey of Living Conditions for the years 1998 and 1999 were analysed. Employed 20- to 64-year-olds with a registered wage were included (n=5982). The synergy index (SI) was applied, using odds ratios from logistic regressions for men, women, and all. Low and high levels of physical demands, decision authority, skill discretion and psychological demands were separately combined with low- and high-wage income (median split). Full-time work and four sociodemographic factors were controlled for. RESULTS: Significant synergy was found for women when they were exposed to low income and a low level of skill discretion (SI=1.46 [1.01-2.13]), although this was attenuated by education level (SI=1.47 [0.96-2.25]). In general (both sexes), poor health caused by low income and unfavourable work is additive rather than multiplicatively exaggerating the risk among the jointly exposed. CONCLUSION: Work exposures in the form of high physical load, low levels of decision authority and skill discretion, or a high level of psychological demands were significantly related to poor health also when income was high, suggesting that high income does not seem to buffer the detrimental effects of adverse working conditions. As nearly half of employed women were found to be in circumstances marked by synergy, it seems a relevant public health issue to improve these women's conditions at work, by simultaneously increasing, for example, job variety and wages.     

Why the high rate of dropout from individualized cognitive-behavior therapy for bulimia nervosa?

OBJECT: To investigate predictors of dropout from cognitive-behavior therapy for bulimia nervosa. METHOD: Pretreatment assessment measures were examined including the Eating Disorder Inventory-2, Body Satisfaction Questionnaire, Beck Depression Inventory, Beck Hopelessness Scale, the Locus of Control of Behavior Scale, and demographic and behavioral measures. RESULTS: Forty-three percent (n = 14) of clients with a DSM-IV diagnosis of bulimia nervosa dropped out of treatment prematurely. No differences were found between treatment completers and dropouts with respect to the initial severity of bulimia-related symptoms. Noncompleters were, however, found to have significantly higher depression and hopelessness scores as well as elevated levels of external locus of control. Discriminate analysis showed that these variables resulted in a 90% prediction accuracy of individuals who prematurely dropped out of treatment. DISCUSSION: Results suggest a need to focus treatment directly on factors such as hopelessness and depression in addition to standard bulimia procedures to ensure clients are able to engage in therapy.     

Surgical treatment of primary hyperparathyroidism: how high do we place the crossbar?

Minimally-invasive parathyroidectomy has improved to a level that has made it the operation of first choice in the treatment of primary hyperparathyroidism. A gamma probe should be used when the radio-guided technique is performed and quick intra-operative parathormone testing should be used with all other minimally-invasive techniques. This not only serves as an instrument for quality control but also improves the expertise necessary to consistently obtain good results. Although minimally-invasive parathyroidectomy is now regarded as the preferred procedure, it has not completely replaced conventional neck exploration, which was once the standard operation. When used in combination--minimally-invasive parathyroidectomy when possible and conventional neck exploration when necessary--virtually every patient with primary hyperparathyroidism can look forward to a successful surgical outcome.