Relationship between health practices and education level in the rural Japanese population

Past studies in Europe and the USA have found that people with higher education levels have better health practices. The aim of this study was to examine the association between health practices and education level among people in a rural Japanese community. Data were derived from the Ohsaki National Health Insurance Cohort Study, which has been following 52,029 NHI beneficiaries, aged 40 to 79 years, in Miyagi Prefecture, Japan. The relationship between education level and seven health indices (smoking, drinking, body mass index, sleeping, exercise, breakfast, and snacks) was analyzed. Higher education was associated with shorter sleeping hours for both men and women, and lower BMI for women. In age groups younger than 70 years, people with higher education tended to exercise more. Smoking for women, alcohol consumption, and a Health Practices Index were not related to education levels. These results are different from those from Europe and the USA. This study suggest that the relationship between health practices and education level is weaker in Japan than in Europe and the USA.     

老年居民对社区卫生服务利用及满意度调查

目的 了解山西省太原市老年居民对社区卫生服务利用及满意情况,为开展社区卫生服务工作提供依据.方法 采用整群随机抽样方法对太原市4个社区卫生服务站257名65岁以上就诊老年居民进行面对面询问调查.采用SPSS 11.5统计软件描述频数分布,利用累加Logistic回归模型进行因素分析.结果 到社区卫生服务站就诊者中,老年女性、低文化程度、低家庭收入占多数,首选社区卫生服务机构就诊者中医疗费用负担方式以自费占绝大多数(71.8%).就诊目的以开药(80.2%)、诊疗(32.7%)、输液(32.7%)为主,就诊原因主要是快捷方便(60.0%)、离家近(45.9%)、解决小病(17.9%)、态度好(16.7%)等,对社区卫生服务机构总体满意度为46.3%.累加Logistic回归分析结果显示:影响老年人医疗服务满意度因素为性别、文化程度、经济收入、医疗费用负担方式、首诊地点选择.结论 社区老年居民对健康保健服务需求较高,对社区卫生服务较为满意认可,医疗服务质量有待进一步提高.     

Religion and preventative health care utilization among the elderly

Evidence supporting a relationship between religion and physical health has increased substantially in the recent past. One possible explanation for this relationship that has not received much attention in the literature is that health care utilization may differ by religious involvement or religious denomination. A nationally representative sample of older adults was used to estimate the effects of religious salience and denomination on six different types of preventative health care (i.e. flu shots, cholesterol screening, breast self-exams, mammograms, pap smears, and prostate screening). Findings show that both men and women who report high levels of religiosity are more likely to use preventative services. Denominational differences show that affiliated individuals, especially those who are Jewish, are significantly more likely to use each type of preventative care than non-affiliated individuals. The results of this study open the door to further exploration of this potentially important, but relatively neglected, link between religion and health.     

Distance and health care utilization among the rural elderly

This paper explores the relationship between distance and the utilization of health care by a group of elderly residents in rural Vermont. By drawing on recent work on the geography of health we frame the decision to visit a primary care physician in the context of the experience of place. The paper devises a test of this broader reading of the role of distance for utilization, and operationalizes this test using a custom designed survey. Using a randomized mail survey of elderly residents of Vermont's North East Kingdom we explore how grocery shopping, travel to work, home location relative to local services, access to private transportation, and living arrangements are associated with the number of doctor visits made to primary health care providers. Although the results confirm the idea that increased distance from provider does reduce utilization, they strongly suggest that distance to provider is a surrogate for location in a richer web of relations between residents and their local communities. We conclude by calling for further research that establishes links between place and the use of health facilities.     

健康素养与老年居民基本公共卫生服务利用的关系研究

目的了解城市老年居民的健康素养状况和基本公共卫生服务利用情况,探索健康素养与老年居民利用基本公共卫生服务的关系。方法采用两阶段整群系统抽样方法,对北京、宁波和厦门3城市的1947名65岁及以上老年人进行问卷调查。使用χ2检验和多因素Logistic回归分析健康素养与基本公共卫生服务利用的关系。结果 46.94%的调查对象建立了健康档案,41.35%能够利用健康教育服务。多变量Logistic回归结果显示,高健康素养与低健康素养者相比更倾向于建立健康档案（OR=1.573,95%CI：1.209~2.047）、接受健康教育（OR=1.308,95%CI：1.029~1.662）、接种流感疫苗（OR=1.691,95%CI：1.349~2.12）、参加免费体检（OR=1.544,95%CI：1.197~1.991）和生活方式指导（OR=2.401,95%CI：1.884~3.061）。结论健康素养水平可能影响到老年居民基本公共卫生服务的利用,建议开展更多旨在提高居民健康素养水平的活动,并减少低健康素养者利用基本公共卫生服务过程中的困难,进而增加居民对基本公共卫生服务的利用。     

陕西省老年人体质健康与高血压发病的关系

目的揭示陕西省老年人体质健康与高血压发病的内在联系,提升健康干预的针对性与有效性。方法以全科医学生为测量员,采用测量法等方法对陕西省城乡4 800名老年人高血压与体质健康状况进行调查分析。结果调查有效数据人数城市2 035名,乡村2 262名。城乡老年人静息心率（t=3.421）、体重指数（BMI）（t=4.324）、肌力（t=6.869）、柔韧性（t=8.304）组间比较,差异有统计学意义。陕西老年人高血压发病率为33.75%,高血压组与正常组老年人静息心率（t=2.420）、BMI（t=2.070）组间比较,差异有统计学意义。结论乡村老年人应针对心肺功能、BMI、柔韧性采取干预措施,以降低高血压发病率;维持较低静息心率与BMI是控制高血压发病的关键因素;老年人在体育锻炼过程中,应以有氧耐力运动为主,改善体质健康静息心率及BMI 2个关键指标。     

Relationship between job stress and self-rated health among Japanese full-time occupational physicians

Objective We investigated relationship between job stress and self-rated health among Japanese nese full-time occupational physicians (OPs). Methods In 2000, we mailed self-administrated questionnaires to 716 OPs. Of these OPs, 349 (49%) returned sufficiently completed questionnaires for analyses. oblique-rotated principal factor analysis of the job stress questionnaire extracted three components; low understanding of occupational health services in companies (low understanding), conflicts between occupational physicians and their coworkers (conflicts), and discrepancies between occupational physicians’ routine work and occupational health services (discrepancies). Results The model, in which low understanding contributed to self-rated health through job satisfaction and self-rated health was influenced by job satisfaction and discrepancies, provided a good fit to the data. Conclusions We found that a potential relationship between job stress and self-rated health among Japanese full-time OPs. The present results implied that among full-time OPs, low understanding contributed negatively to self-rated health through job satisfaction, and that self-rated health was influenced positively by job satisfaction and negatively by discrepancies.     

城市老年人社会支持与健康教育服务利用关系研究

目的 探索城市老年人社会支持与健康教育服务利用之间的关系。方法 通过两阶段随机抽样,选取北京市东城区1 530名65岁及以上老年人进行问卷调查,并借助安德森模型分析其社会支持与健康教育服务利用之间的关系。结果 调查对象健康教育服务的利用率为61.9%,社会支持得分M（P₂₅,P₇₅）为35.00（31.00,40.00）;随着社会支持的增加,老年人健康教育服务利用率也随之上升（趋势χ²检验Z=-6.74,P<0.001）。有序Logistic回归结果显示,在扣除了其他因素等的影响之后,较高的社会支持是老年人利用健康教育服务的促进因素,与社会支持得分下四分之一者相比,其他各组老年人经常利用健康教育服务的OR值分别为1.65（P=0.001）、1.99（P<0.001）、2.72（P<0.001）。将社会支持拆分为三个维度再次进行有序Logistic回归分析,结果显示客观支持水平越高,对支持的利用度越好,经常利用健康教育服务的可能性越高。结论 城市老年人社会支持的多少对其利用健康教育服务具有显著影响,在社会支持尤其是客观支持与对支持的利用度方面的干预具有重要意义。     

Determinants of health services utilization among the black and white elderly

Andersen's (1968) behavioral model was used to assess whether factors predictive of health services utilization are the same or different for elderly blacks and whites. We hypothesized that because the black elderly have fewer resources, lower psychological well-being, and are in worse health, situational and attitudinal factors suggested by the model have different effects for blacks and whites. Using three measures of utilization--physician contact, hospital contact, and nights hospitalized--our findings show some support for differential effects, particularly in the case of physician contact. Neither resource factors such as health insurance nor psychological well-being were predictive of utilization within the black population. We conclude with some suggestions for future research.     

Health status, health habits, utilization behaviour and health care utilization in an actively employed Japanese population

Healthcare utilization data from 1 February 1986 to 31 January1992 for 18601 local public service employees were analysedin relation to data on their perceived health status, healthhabits, health care utilization behaviour and health-relatedworries which were obtained from a questionnaire survey conductedin 1988. The results showed health care utilization behaviouras defined by the questionnaire responses to be the most importantpredictor of health care utilization as defined by claim rateand group utilization rate, followed by perceived health statusand certain health habits (ie caring about sleep, food and diet,watching body weight). Health-related worries, when used asa group variable, were not an independent predictor of utilization.The co-existence of ‘active’ utilization behaviouror the above-mentioned health habits with fair/poor perceivedhealth status was associated with the highest health care utilization.The implication of these findings is that if utilization behaviourmodification is incorporated into various worksite health programmesthat aim at improving employee health and containing healthcare utilization and costs, greater reduction can be achievedin employee health care utilization and costs.     

农村贫困人群健康状况及卫生服务利用调查

目的 了解山东省威海市贫困人群的现状和卫生服务利用情况,为制定解决农民因病致贫、因病返贫的有效措施提供依据.方法 按照分层随机整群抽样的方法抽取威海市居民4550人,用自制调查问卷进行调查;采用SPSS 13.0软件进行统计分析.结果 与普通人群比较,贫困人群自感健康状况差(P=0.00),医药费用占家庭生活消费的比例高(P=0.00),2周患病比例高6.7%(P=0.00),慢性病患病比例高16.5%(P=0.00),应住院未住院的比例高31%(P=0.00).结论 贫困人群自感健康状况差,卫生服务利用水平低,应制定措施以提高贫困人群卫生服务利用能力.     

Determinants of health service use and expenditure among the elderly Finnish population

Background: There is a need to identify significant determinantsof physician and public health nurse visits, hospital in-patientand home care, use of prescribed medication and total expenditureamong elderly people for planning of health policy. Methods:The data were obtained from three annual computer-assisted telephoneinterview surveys in 1992–1994. Each year a systematicsample of approximately 2,300 non-institutionalized people aged25-79 years were interviewed. The 60-79 year old respondentswere included in our analysis (n=1,707); the response ratesin this age group were approximately 75% each year. In thisstudy we tested the suitability of four regression models: Poisson,negative binomial, logit plus zero-truncated Poisson and logitplus zero-truncated negative binomial. Results: The use of servicesincreased with age, particularly hospital in-patient and homecare. Although women were more likely to use services, particularlyprimary care, their share of total expenditure was lower thanthat for men. Significant predictors of higher expenditure wereown personal doctor, other specific doctor, perceived healthstatus, psychosomatic symptoms, chronic illness and difficultiesin functional ability. Those living alone had significantlyhigher expenditures. Conclusion: It emerged that, while a largenumber of elderly people had used services, only a small minorityhad accounted for the majority of expenditure. Although thepersonal doctor system may produce high quality of care, itcannot achieve cost savings.     

Smoking, prevalence of disease and health service utilization among the Swiss population

The data of the 1981-83 Swiss National Health Survey "SOMIPOPS", based on a randomly selected sample of 4,235 individuals aged 20 or over representative of the whole Swiss population, were used to investigate the relation between smoking, prevalence of disease and frequency of health care utilization. The risks of several conditions, including hypertension, myocardial infarction and other heart diseases, asthma, tuberculosis and kidney disease were elevated among ex-smokers. The diseases showing elevated risks among current smokers and significantly positive dose-risk trends included acute bronchitis (relative risk, RR = 3.2 for heavy cigarette smokers vs never smokers), chronic bronchitis or lung emphysema (RR = 2.0), gastro-duodenal ulcer (RR = 1.8) and bone fractures (RR = 1.6). For respiratory conditions, the risk of pipe or cigar smokers was comparable to that of moderate cigarette smokers, whereas for ulcer (RR = 4.1) or fractures (RR = 2.0) the point estimates were even higher than for heavy cigarette smokers. Smokers tended to consult more frequently general practitioners, used more other outpatients services, and were more frequently admitted to hospital during the year preceding the interview. These effects were consistent across strata of age, socio-economic indicators, and persisted after allowance for major identified potential distorting factors. Thus, the results of this survey confirm that smoking is an important cause of morbidity and a major contributory factor to the use of health services.     

Social inequality in health and the utilization of health services among the elderly in Latin America]

OBJECTIVE: To learn if there is social inequality in health and in the utilization of health services among the elderly in six cities of Latin America: Buenos Aires, Argentina; S?o Paulo, Brazil; Santiago, Chile; Havana, Cuba; Mexico City, Mexico; and Montevideo, Uruguay. METHODS: This study used data from a project called Health, Well-being, and Aging in Latin America and the Caribbean (known as the SABE project). To investigate the presence of social inequality in health an ordinal probit model was used, with health status indicated by the following dependent variables: activities of daily living, instrumental activities of daily living, physical mobility, and self-rated health. To measure social inequality in the utilization of health services two characteristics were assessed: one for outpatient medical services (whether or not individuals received outpatient care, and how many times), and one for hospital admissions (whether or not individuals were hospitalized). For outpatient services, we estimated a negative binomial hurdle model, and for hospital admissions, a logit model was constructed. RESULTS: Our main results suggest the presence of social inequality in health in all the cities, with better-off socioeconomic groups having better health. The difference in health was less marked in Havana, Buenos Aires, and Montevideo, and it was more pronounced in S?o Paulo and Mexico City. With respect to the utilization of health services we found inequalities in the use of outpatient services in Santiago, Mexico City, and S?o Paulo. In Santiago and Mexico City, more schooling was associated with a higher number of expected outpatient medical visits; however, the opposite was found in S?o Paulo. For hospital admissions, inequality was found only in S?o Paulo, with individuals with more years of schooling being much more likely to be hospitalized. CONCLUSION: To a certain extent, our results reflect the socioeconomic and demographic characteristics of the countries in which each of the six cities is located. The cities in the countries with the worst social indicators (high income inequality and low human development index) tended to have the greatest inequalities in health and in the utilization of health services.     

财政分权与公共卫生政府间责任分担的现实选择

按照财政分权理论,公共卫生政府间责任分担的主要原则为受益原则、规模效应原则、收入再分配原则以及基本公共卫生服务可及原则。据此,对公共卫生政府间责任进行了理论划分;随后考虑财政分权理论假设与我国现实的差距,对公共卫生政府间责任的理论划分情况进行了调整。