Hospital resource utilization among patients with sickle cell disease

In the United States, sickle cell disease primarily affects African Americans and carries a high risk of disability, making its sufferers particularly vulnerable. Sickle cell patients often experience unexpected, intermittent, and life-threatening complications leading to high levels of emergency room use and frequent hospitalizations. Using national discharge data from not-for-profit hospitals, this study explores the relationship between patient and hospital characteristics and hospital resource use by sickle cell patients. A random-effects least squares regression analysis was used to examine relationships between patient and hospital characteristics and hospital charges and length of stay. Patient characteristics, especially severity measures, related significantly to total hospital charges, length of stay, and average daily charges, but few hospital characteristics were associated significantly with these outcomes.     

Misconceptions about sickle cell disease (SCD) among lay people in Benin

Objective

The aim of this study was to determine the accuracy of people's ideas in Benin about the common affliction of sickle cell disease (SCD).

Methods

A questionnaire asking for the degree of agreement with 111 statements about SCD was given in 2011 to 6 physicians (the gold standard) and 178 lay people living in Cotonou, Benin. A misconception was defined as a statistically significant (p < 0.001) deviation of at least 2.5 points on the 0-10 response scale of the lay people's mean response from that of the physicians.

Results

Lay people tended not to be sufficiently aware that SCD is a hereditary illness, that a genetic test can detect the gene, that having it does not automatically lead to illness, that SCD may induce severe kidney, lung, heart, or cerebrovascular disorders, and that SCD cannot be cured by traditional healers. These misconceptions were greater among those who knew they had SCD or carried the gene than among those who knew they did not.

Conclusion

Major efforts are needed to overcome the educational and cultural barriers to accurate understanding of how to prevent and treat SCD among lay people in Benin, especially among those at greatest risk.     

Health status and access to health services among the urban homeless.

Self-reported health status and access to care were reported for 238 homeless adults in Los Angeles. One-third reported their health as fair or poor; women reported more health problems than men. Half (53 per cent) of the sample reported no regular source of care, and most (81 per cent) were without health insurance. Lack of financial resources and health insurance were reported as important barriers to care.     

Rural hospital closures and access to services

This article examines the implications resulting from the closure of 25 rural hospitals during 1990. The implications are evaluated by estimating travel distance and time to the nearest open hospitals. In addition, the types of services offered in the hospitals studied were measured to provide a view of potential change in access to services. The average travel distance and time to the nearest hospital after closure was 25.7 miles and 30.2 minutes, respectively. In most cases, the remaining hospitals offered a broader scope of services than did the hospitals that closed. A possible interpretation is that the hospital closures resulted in a tradeoff between breadth of services and rapid access for emergency conditions.     

Caregiver factors related to emergency department utilization for youth with sickle cell disease

This study addressed caregivers’ stress, adjustment, and mechanisms related to treatment-seeking for children (age 6 to 16) with sickle cell disease (SCD). We hypothesized cues to action (i.e., perceived pain burden) would mediate relationships between psychosocial factors (i.e., stress, adjustment) and emergency department (ED) utilization. Perceived pain burden mediated relationships between stress that caregivers experience (a) communicating about SCD to their child and/or medical providers and (b) providing medical care for their child with ED utilization. Results suggest caregivers of children with SCD could benefit from interventions that enhance stress-management and communication skills with their child and health care providers.     

Contraceptive usage among Jamaican women with sickle cell disease

Background

The usage of contraceptive methods in young women with sickle cell disease (SCD) and the factors affecting usage are unknown.

Study design

Young women (N=132) with SCD attending the Sickle Cell Unit were interviewed regarding their contraceptive usage. SPSS version 12 was used for data analysis.

Results

Sixty-four (48%) of women with SCD were using a contraceptive method. The more commonly used methods were condoms (n=25, 39%) and depot medroxyprogesterone acetate (DMPA) (n=18, 28%). Of the nonusers, 52% were not sexually active. The reasons for nonusage in sexually active women included the desire to become pregnant (17), belief that they were unable to get pregnant (11) and health concerns (7). A majority had been informed about contraceptive methods by a trained professional. Sixty-seven percent agreed with at least one of the common Jamaican myths regarding contraceptive usage.

Conclusions

This study demonstrates that 92% of these women with SCD were using contraceptive methods or had reason not to do so. Subjects had been educated about contraceptive methods and appeared to be uninfluenced by local myths regarding contraceptive usage.     

Medicaid's impact on access to and utilization of health care services among racial and ethnic minority children

Conclusion Numerous studies throughout the last 30 years and the results presented here from theKaiser/Commonwealth Five State Low Income Survey support Medicaid's role in improving access to care for poor minority children. Since minority children are affected disproportionately by the unavailability of health insurance, Medicaid's role as a financing source is particularly important to these groups. It is also clear that reducing financial barriers will not eliminate completely the inequalities in health care utilization and disparities in health status across different racial and ethnic groups. As discussed above, despite Medicaid's influence, minority children still exhibit poorer quality of health. Thus, strategies for the next century should focus on ensuring that all barriers to care are removed. This will involve not only the guarantee of universal health care coverage for all children, but also the elimination of social, cultural, and behavioral barriers to optimum health and health care as well.     

Predictors of employment status among African Americans with sickle cell disease

Adults living with sickle cell disease (SCD) have extremely high rates of unemployment; however, very little is known about factors that contribute to their vocational outcomes. This study examined demographic, illness perception, and psychological variables as predictors of employment status among 115 adult respondents who completed a cross-sectional survey as part of the Cooperative Study of Sickle Cell Disease. Logistic regression analysis indicated that gender, assertiveness, and perceived impact of SCD were unique predictors of employment status. Women were 2.88 times more likely to be employed than men, and the odds of being employed increased by a factor of 2.47 for each one unit decrease in assertiveness. More favorable perceptions of SCD were also associated with a two-fold increase in employment. The results suggest that demographic and psychosocial factors may play a more important role in predicting employment outcomes in adults with SCD than previously recognized.     

Rural-urban differences in access to Iowa child health services.

Indicators of access, utilization, and quality of available child health services as well as health status were obtained through a telephone survey of Iowa households with children under age six. These indicators were compared for rural-urban subsamples within an AFDC sample drawn from Iowa Department of Human Service files (N = 637), and within poverty (N = 129) and nonpoverty groups (N = 631) drawn from the population of all households in the state with children under age six. About 55 percent of all households studied were rural. Rural households were generally larger than urban households, more likely to be intact maritally, white, and earning a living from farming. The findings support the hypothesis that place of residence has an impact on access, utilization, and quality of child health services over and above family income, although not always to the disadvantage of rural children. Typical problems for rural children, irrespective of income, were access to pediatric care, greater travel time to providers, and discontinuity of well care and sick care. Rural children in all income groups had lower seat belt use than urban children; they were also less likely to have well visits and their providers showed less attentiveness to behavioral and developmental issues at these visits. Rural residency exacerbated problems in access to care for low income children, who were less likely to be eligible for AFDC/Medicaid than their urban counterparts. Medicaid coverage, however, did not eliminate rural-urban differences in receiving desired medical care.     

Perceived needs and unmet needs for formal services among people with HIV disease

This study presents estimates of the prevalence of perceived needs and unmet needs among people with HIV disease in the United States for six areas of community services: mental health, drug treatment, home care, housing, transportation, and entitlements. The prevalence of service needs and unmet needs within racial, gender, drug use history, and other subgroups was also examined. The study is based on a nonrandom cross-sectional sample of 907 people with HIV disease interviewed between November 1988 and May 1989 in nine major urban areas of the United States.Respondents reported high levels of need and unmet need across a variety of service areas. One third or more of all respondents reported a need for mental health services (57%), housing (39%), entitlements (34%), and transportation (32%). Within each of the six service areas, 40% or more reported unmet need. Women, people of color, and injected drug users were more likely to report unmet service need in a number of areas. Given the limitations of the sampling and the focus oncurrent needs, these estimates may represent a lower bound on the magnitude of service need and unmet need within this population.Dr. Piette is a Senior Research Associate at the Institute for Health Policy Studies, University of California-San Francisco. At the time this study was conducted, he served as the Project Coordinator for the Robert Wood Johnson Foundation (RWJF) Evaluation at Brown University. Dr. Fleishman is the Director of the RWJF Evaluation. Dr. Stein is Director of the HIV Clinic at Rhode Island Hospital, Providence Rhode Island. Dr. Mor is the Director of the Center for Gerontology and Health Care Research at Brown University. Dr. Mayer is Chief of Infectious Diseases, Memorial Hospital, Pawtucket, Rhode Island.This study was supported by a grant from the Robert Wood Johnson Foundation.     

昆明市某“城中村”本地村民与外来人口卫生服务需要与利用调查

[目的]了解“城中村”人群的卫生服务需要和利用情况,为合理配置卫生资源、有效开展卫生服务提供依据。[方法]采用案例研究（case study）的方法通过文献回顾、个人深入访谈和问卷调查,对选取的具有“城中村”特征的目标社区的1372名“城中村”人群进行调查。[结果]调查人群两周患病率为41．5‰,两周就诊率为42．2‰,慢性病患病率为24．8‰住院率为45．9‰,其中本地村民和外来人口除两周就诊率外,在两周患病率、慢性病患病率和住院率方面差异均有统计学意义。[结论]“城中村”人群卫生服务利用率较低,有明显的卫生服务需要,建议针对城中村特点,积极采职社会卫生政策来保障“城中村”人群健康。     

Rural,urban, and suburban differences in influenza vaccination coverage among children

Influenza vaccination is the primary way to prevent influenza, yet influenza vaccination coverage remains low in the United States. Previous studies have shown that children residing in rural areas have less access to healthcare and lower vaccination coverage for some vaccines. Influenza vaccination coverage among children 6 months–17 years by rural/urban residence during the 2011–12 through 2018–19 influenza seasons was examined using National Immunization Survey-Flu data. The Council of American Survey Research Organizations response rates for National Immunization Survey-Flu ranged from 48% to 65% (2011–12 through the 2017–18 seasons) for the landline sample and 20%–39% (2011–12 through the 2018–19 seasons) for the cellular telephone sample. Children residing in rural areas had influenza vaccination coverage that ranged from 7.9 (2012–13 season) to 12.6 (2016–17 season) percentage points lower than children residing in urban areas, and ranged from 4.5 (2012–13 season) to 7.4 (2016–17 season) percentage points lower than children residing in suburban areas. The differences in influenza vaccination coverage among rural, suburban, and urban children were consistent over the eight seasons studied. Lower influenza vaccination coverage was observed among rural children regardless of child’s age, mother’s education, household income, or number of children under 18 years of age in the household. Rural versus urban and suburban differences in influenza vaccination coverage remained statistically significant while adjusting for selected sociodemographic characteristics. A better understanding of the reasons for lower childhood influenza vaccination coverage for children in rural and suburban areas is needed.