Receipt of preventive health care services by lesbians

BACKGROUND: We measured receipt of age-appropriate preventive health services by lesbians and assessed whether provider and individual characteristics, including disclosure of sexual orientation, are independently associated with receipt of these services. METHODS: A questionnaire was printed in a national biweekly gay, lesbian, and bisexual news magazine, and self-identified lesbians living in all U. S. states (N =6935) responded to the survey. Main outcome variables were receipt of a Pap smear within the preceding 1 and 2 years and, for women aged > or= 50, receipt of a mammogram within the past 1 and 2 years. RESULTS: Fifty-four percent had Pap smears within 1 year and 71% within 2 years, with increasing rates among older and more educated respondents. Seventy percent of respondents aged > or = 50 had a mammogram in the past year, and 83% within 2 years; rates did not vary significantly controlling for education. Sixty percent had disclosed their sexual orientation to their regular health care provider. Controlling for patient and provider characteristics, disclosure was independently associated with receipt of Pap smears, but not mammograms. CONCLUSIONS: It is important for providers to identify their lesbian patients' unmet needs for preventive health care. Additionally, it is important for providers to provide complete and appropriate preventive health care for their lesbian patients. Further research is needed to determine why lesbians are not receiving Pap smears at the recommended rate and whether this disparity is reflective of aspects of cervical cancer screening or indicates a more general problem with access to health care including receipt of preventive services.     

Surveillance for use of preventive health-care services by older adults, 1995-1997.

PROBLEM/CONDITION: In 1995, a total of 55 million persons aged > or =55 years lived in the United States. The members of this large and growing segment of the population are major consumers of health care. Their access to medical and dental preventive services contributes to their likelihood of healthy later years and influences their long-term impact on the health-care delivery system. REPORTING PERIOD: 1995-1997. DESCRIPTION OF SYSTEMS: This report summarizes data from the National Health Interview Survey (NHIS), the state-based Behavioral Risk Factor Surveillance System (BRFSS), and the Medicare Current Beneficiary Study (MCBS) to describe national, regional, and state-specific patterns of access to and use of preventive services among persons aged > or =55 years. RESULTS: During 1995-1997, approximately 90% of persons aged > or =55 years living in the United States reported having a regular source of health-care services. However, only 75%-80% reported receiving a routine checkup during the preceding 2 years. The estimated percentage of persons who reported not being able to receive medical care because of cost was highest for those aged 55-64 years. Within this age group, the percentage was highest among Hispanics (4%) and persons without a high school diploma. Approximately 11% of Medicare beneficiaries reported delaying care be cause of cost or because they had no particular source of care. Percentage estimates varied according to age, race/ethnicity, and sociodemographic status. Approximately 95% of persons aged > or =55 years reported having their blood pressure checked during the preceding 2 years, but only 85%-88% had received a cholesterol evaluation during the preceding 5 years. The percentage of women receiving breast and cervical cancer screening decreased with increasing age, and the percentage of persons aged > or =55 years who had received some form of screening for colorectal cancer was low approximately 25% for fecal occult blood testing (FOBT) and 45% for endoscopy. State-specific rates of compliance with vaccination recommendations among persons aged > or =65 years were higher for influenza vaccine (range: 54%-74%) than for pneumococcal vaccine (range: 32%-59%), and compliance increased with advancing age. State-specific estimates of the percentage of annual dental visits varied 40%-75%, and 41%-88% of persons aged > or =65 years reported not having dental insurance. INTERPRETATION: Access to medical services among adults living in the United States is greater for persons aged > or =65 years, compared with those aged <65 years, presumably because of Medicare coverage. In contrast, use of dental services decreased, despite increased need for preventive and restorative dental care. Although Medicare covers many medical services for older adults, financial, personal, and physical barriers to both medical and dental care create racial, regional, and sociodemographic disparities in health status and use of health services in the United States. PUBLIC HEALTH ACTION: Continued surveillance of access to and use of health services among older adults (i.e., persons aged > or =65 years), as well as among persons aged 55-64 years, will help health-care providers target underserved groups, make Medicare coverage decisions, and develop public health programs to ensure equitable access to services and improve the health of older adults.     

Cost-utility analyses of clinical preventive services: published ratios, 1976-1997

BACKGROUND: Cost-effectiveness analyses of clinical preventive services are a potential means to aid public health resource allocation. Cost-utility analysis (CUA) is a specific form of cost-effectiveness analysis where results are expressed in terms of cost per quality-adjusted life year (QALY) gained. To increase the transparency and comparability of CUAs, standardization of methods has been recommended. OBJECTIVES: The purposes of this study were as follows: (1) identify published articles with original CUAs of primary and secondary clinical preventive services, (2) summarize the ratios found in these analyses, (3) identify articles employing comparable methods, and (4) explore analytic methods employed over time. METHODS: As part of a larger study we conducted a comprehensive search of published CUAs in the area of clinical preventive services and systematically collected data on the results of the analyses and analytic methods employed. Cost-effectiveness ratios were standardized and organized into a table.Results: We found 50 CUAs pertaining to clinical preventive services (primary, n=22, 44%; and secondary, n=28, 56%) and 174 cost-effectiveness ratios. These ratios ranged from cost-savings up to $27,000,000/QALY, with a median of $14,000/QALY. Only three (6%) of the CUAs met minimum reference case requirements. There was no apparent improvement of methods over time. CONCLUSIONS: Immunizations and chemoprophylaxis have the most favorable cost-effectiveness ratios, and preventive services are more cost-effective when targeted at high-risk populations. However, there is wide variation in the methods used in these analyses. This study allows us to define where improvements in methodologic rigor need to occur, provides a base-line for future audits, and highlights disease areas in clinical preventive services that have been omitted or underevaluated.     

石渠县1997～2004年结核病防治情况分析

为了解四川省石渠县结核病防治的实际情况及效果,我们对1997~2004年结核病防治登记资料进行了整理和分析,现将结果报道如下。1材料和方法1·1资料来源1997~2004年肺结核病的痰涂片阳性数据、肺部X线拍片登记及疫情监测上报资料。1·2方法用描述流行病学方法,对所有结核病防治资料进行统计学分析。2结果2·1结核病患病率石渠县1997~2004年结核病初诊总人数856人,结核病确诊病例447例,患病率为99·20/10万;其中涂阳患者384例,涂阴患者63例,涂阳涂阴比例为1∶0·16。2·2流行特征2·2·1患者年龄、性别分布结核病患者年龄分布:病例数最多的年…     

Prevalence and control of trachoma in Australia, 1997-2004

This study aimed to document the prevalence of active trachoma and trichiasis from 1997 to 2003 and from 1987 to 2004, respectively, and to provide an overview of trachoma control activities in Australia in 2004. Prevalence data were obtained from state, territory and regional population health units and unpublished surveys. Information about trachoma control programs and activities currently implemented in Australia was obtained through structured interviews with staff involved in trachoma control. Active trachoma prevalence in Aboriginal and Torres Strait Islander children, ranging from 0-40 per cent, were reported from the Eastern Goldfields, Midwest-Murchison and Kimberley Population Health Units in Western Australia and the Northern Territory's Centre for Disease Control. Large differences in trachoma prevalence were reported within and between different regions and from different years in the same region. Recent surveys of trichiasis in Kimberley and Central Australian Aboriginal and Torres Strait Islander adults demonstrated a prevalence of 9-12 per cent in inland, desert areas. In contrast with developing countries where active trachoma and trichiasis are more common among adult women than men, Australian surveys have identified equal prevalence in both sexes. Interpretation of trachoma prevalence and inter-regional/state/national comparisons were hampered by lack of a uniform method of data collection and analysis. Trachoma control programs were implemented consistently in some communities, and irregularly and/or in piecemeal fashion in others. Trachoma control programs led by regional population health units working in collaboration with primary health care services were more likely to be consistently implemented over long periods of time. Trachoma is a significant public health issue in some Aboriginal communities within Australia. The Communicable Diseases Network Australia has developed guidelines for the public health management of trachoma which provide recommendations on trachoma screening, control and data collection trachoma for affected states and territories.     

广西东兴市1997～2004年艾滋病流行病学分析

目的分析东兴市1997~2004年艾滋病流行趋势,为制定防治措施提供科学依据。方法采用描述性流行病学的方法对东兴市1997~2004年HIV/AIDS疫情资料进行分析。结果东兴市1997~2004年共报告HIV/AIDS 62例,死亡25例,病死率为40.32%。1997~2003年共报告32例HIV/AIDS,年平均报告发病率为3.78/10万,2004年共报告30例HIV/AIDS,报告发病率为27.27/10万,HIV/AIDS疫情呈快速上升趋势。全市3个镇均有病例报告,病例以农民,21~35岁年龄段的青壮年为高发人群,男女发病性别比为3.8∶1;62例HIV/AIDS中有42例是经性途径感染,占总病例数的67.74%,19例经血液途径感染,1例是母婴传播。结论东兴市HIV/AIDS的疫情态势非常严峻,已从高危人群向一般人群扩散。全面落实艾滋病防控措施,建立健全艾滋病防控体系,推广安全套的使用是遏制东兴市艾滋病播散的关键措施。     

1997～2004年深圳市宝安区HIV/AIDS疫情分析

目的了解深圳市宝安区HIV/AIDS流行情况,为制定HIV/AIDS的防制措施提供科学依据。方法用描述流行病学方法分析宝安区1997~2004年HIV/AIDS流行特征。结果1997~2004年宝安区共报告HIV感染者328例,其中AIDS患者25例(死亡9例);2002、2003、2004年HIV/AIDS病例数分别为868、3、136,占总数的92.99%,328例HIV感染者中男性占272例、女性56例,男女性别比为4.9∶1;20~39岁占85.07%;待业者占52.44%:主要来源于广东省内(占46.95%),其次为广西(占17.99%)、四川(占10.67%)和河南(占8.54%);流动、暂住和常住人口分别占76.52%、19.21%和4.27%;经吸毒、性、血、母婴和不详途径传播分别占62.50%、17.07%、8.54%、0.92%和10.97%。结论宝安区HIV/AIDS流行情况愈趋严重和复杂,须加大防制力度。     

Effect of prevention measures on incidence of human listeriosis, France, 1987-1997.

To assess the impact of preventive measures by the food industry, we analyzed food monitoring data as well as trends in the incidence of listeriosis estimated through three independent sources: the National Reference Center of Listeriosis; a laboratory-based active surveillance network; and two consecutive nationwide surveys of public hospital laboratories. From 1987 to 1997, the incidence of listeriosis decreased by an estimated 68%. A substantial reduction in the proportion of Listeria monocytogenes-contaminated products was observed at the retail level. The temporal relationship between prevention measures by the food industry, reduction in L. monocytogenes-contaminated foodstuffs, and reduction in listeriosis incidence suggests a causal relationship and indicates that a substantial part of the reduction in illness is related to prevention efforts.     

Laboratory screening at preventive health exams: trend of testing, 1978-2004

BACKGROUND: Routine laboratory screening at preventive health exams continues to be a common practice despite expert opinion dating back to 1979 that supports only a few screening tests for apparently healthy adults. This report describes trends in such testing over a 27-year period. METHODS: Primary care physicians were surveyed five times between 1978 and 2004 at a yearly educational meeting in Colorado. Based on case vignettes describing two apparently healthy adults, physicians indicated which laboratory tests they would routinely order. RESULTS: Of a total of 2364 surveys collected during years 1978, 1983, 1988, 1999, and 2004, the corresponding percentage of physicians respondents who state they would order the following tests for a healthy man aged 35 years were: complete blood count (CBC) (87, 75, 73, 49, 46); urinalysis (UA) (93, 86, 79, 52, 44); chemistry panel (CHEM) (57, 48, 36, 43, 55); and electrocardiogram (ECG) (37, 27, 24, 9, 6). For a healthy woman aged 55 years, the corresponding percentages for each test were: CBC (89, 89, 86, 64, 67); UA (96, 93, 88, 62, 55); CHEM (70, 70, 66, 57, 76); ECG (63, 51, 51, 33, 29); and thyroid stimulating hormone (14, 20, 28, 42, 57). CONCLUSIONS: Although currently practicing physicians continue to report that they order screening tests for apparently healthy people, this practice appears to have decreased over the past 27 years. This trend may reflect expert guidelines and emphasis on medical cost containment.     

应用综合方法预防宫腔粘连分离术后再粘连的疗效分析

目的探讨宫腔粘连宫腔镜分离后宫腔再粘连的预防措施。方法对宫腔镜确诊的37例中、重度宫腔粘连患者行宫腔镜下粘连分离术,2009年3月以前的23例患者术后采用IUD治疗,2009年3月以后的14例患者术后采用宫腔内放置水囊＋宫腔内注入透明质酸钠＋IUD＋人工周期的综合方法治疗。结果IUD和综合方法预防宫腔膜性粘连再次粘连疗效相同。结论综合方法对肌性粘连及结缔组织性粘连再次粘连效果明显优于IUD疗法。     

Estimated time spent on preventive services by primary care physicians

Background  

Delivery of preventive health services in primary care is lacking. One of the main barriers is lack of time. We estimated the amount of time primary care physicians spend on important preventive health services.     

The use of preventive health services by disabled children

As a measure of the use of general pediatric health services we assessed disabled children's receipt of preventive health care in relation to a control group of nondisabled children, matched by age, family size, and region of residence. The study and control subjects were identified in a household survey conducted in Minnesota in 1976 and ranged in age from 1 to 18 years. The proportion who made a preventive health visit was nearly identical in both groups. Binary variable multiple regression showed that 9 percent of the variation in outcome was explained by the independent variables, which included demographic and socioeconomic characteristics and access to health care. Disability did not contribute significantly to the explained variation, but family structure, mother's education, and mother's use of preventive health services reached the 95 percent level of significance. The results suggest that children in a community who are identified as disabled are not at a disadvantage, in comparison with the nondisabled, in gaining access to preventive health services. The use of such services by all children appears to be low when information on using school health services is not available.     

Access to health-care and preventive services among Hispanics and non-Hispanics--United States, 2001-2002

Although Hispanics are the largest ethnic minority population in the United States, they are underserved by the health-care system. Hispanics are less likely to seek and receive health-care services, which might contribute to their poorer health status and higher rates of morbidity and mortality. To assess differences in access to health-care and preventive services between Hispanics and non-Hispanics, CDC analyzed 2001-2002 data from the Behavioral Risk Factor Surveillance System (BRFSS) surveys. This report summarizes the results of that analysis, which indicated that disparities exist in access to health-care and preventive services among Hispanics versus non-Hispanics. Public health authorities and health-care providers should implement strategies to reduce barriers to health-care and preventive services among Hispanics.     

上海市崇明县1997~2004年0~4岁儿童死亡分析

5岁以下儿童死亡率是国际上衡量一个国家和地区经济社会发展状况以及人民健康水平的重要指标之一。为了解上海市崇明县5岁以下儿童的死亡特点，为今后制定有效的防制干预措施提供依据，现将崇明县1997—2004年0—4岁儿童的死亡现状做如下分析。     

Acculturation, access to care and use preventive health services by Vietnamese women

PURPOSE OF THE PAPER. The purposes of this study were to examine the relationships between acculturation and (1) access to health services and (2) use of preventive services among Vietnamese women in western Massachusetts. METHODS. The telephone survey method was conducted with 141 Vietnamese women ages 18 years or over. PRINCIPAL FINDINGS. Of the acculturation variables, language acculturation was significantly related to having a routine place for health care and a regular provider. Women tended to have better access to health service with an increase in the length of residence in the US. Length of residence in the US was an independent predictor of prior use of Pap test and clinical breast examination. CONCLUSIONS. Utilization level of preventive health services among study group participants was low. The findings indicate that length of residence and increase in language capacity (more English usage) lead to more adequate access to health care. RELEVANCE TO ASIAN PACIFIC ISLANDER AMERICAN POPULATIONS. This study is particularly relevant to Vietnamese American women in the U.S. KEY WORDS. Vietnamese women; acculturation; preventive heaslth services; Massachusetts.     

Prevalence of receiving multiple preventive-care services among adults with diabetes--United States, 2002-2004

An estimated 7% of the U.S. population has diabetes; however, only 70% of these persons have had the disease diagnosed. Recommended preventive-care services such as annual foot and eye examinations can prevent or delay amputation and blindness. Measurement of glycosylated hemoglobin (A1C) two or more times per year is important for glycemic control and diabetes management. Three national health objectives for 2010 are to increase the proportion of adults with diabetes who have an annual dilated eye examination (objective no. 5-13; target: 75%), an annual foot examination (objective no. 5-14; target: 75%), and A1C measurements at least twice each year (objective no. 5-12; target: 50%). To determine the percentage of U.S. adults with diabetes receiving each of these three preventive-care services and the percentage receiving all three services, CDC analyzed data from Behavioral Risk Factor Surveillance System (BRFSS) surveys for 2002-2004. This report summarizes the results of that analysis, which determined that four in 10 U.S. adults with diabetes reported receiving all three preventive-care services; persons with recently diagnosed diabetes and current smokers were least likely to receive all three preventive-care services. Increased understanding of barriers to receiving multiple preventive-care services and continued interventions to ensure their delivery can improve the health status of persons with diabetes.     

Expanded state-funded family planning services: estimating pregnancies averted by the Family PACT Program in California, 1997-1998

OBJECTIVES: The California Family Planning, Access, Care, and Treatment Program was implemented in 1997 to provide family planning services for uninsured, low-income women and men. We estimated the impact on fertility of providing 500 000 women with contraceptives. METHODS: Paid claims and medical record review data were used to estimate pregnancies averted. Pregnancies women experienced while enrolled in the program and pregnancies they would have experienced given methods used before enrollment were modeled as a Markov process. RESULTS: One year of Family Planning, Access, Care, and Treatment services averted an estimated 108 000 unintended pregnancies that would have resulted in 50 000 unintended births and 41 000 induced abortions. CONCLUSIONS: Providing contraceptives to low income, medically indigent women significantly reduced the number of unintended pregnancies in California.