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1.
Bettina Meinow Marti G. Parker Ingemar Kåreholt Mats Thorslund 《European journal of ageing》2006,3(2):98-106
Most studies on health trends in the elderly population focus on specific conditions, studied one at a time. However, health problems are often interrelated and exist simultaneously in late life. Individuals with health problems in several domains present special challenges to care services. To estimate future needs for care it may be relevant to study trends of complex health problems as well as single health items. This study identified serious problems in three domains (diseases/symptoms, mobility, cognition/communication) in two representative samples of the Swedish population aged 77 and older (1992: n=537; 2002: n=561). People with serious problems in two or three domains were considered to have complex health problems. Changes between 1992 and 2002 in the prevalence of persons having serious problems in no, one and two/three domains were analyzed with logistic regressions. When examining each domain separately all three showed a significant increase of serious problems. For diseases/symptoms the increase remained significant after controlling for different age and gender distributions in the two surveys. Results showed a significant increase in the prevalence of having problems in one domain, as well as having problems in two or three domains (complex problems). Results persisted when adjusting for different distributions in age, gender and education between 1992 and 2002. Results suggest a worsening of health during the 10-year period and an increase of complex problems. This emphasizes the necessity of cooperation and collaboration between different kinds of medical and social services for elderly people. 相似文献
2.
Although mortality in older ages generally declined in most countries during the past decades less is known about mortality
trends among the most vulnerable subset of the oldest old. The aim of this study was to investigate possible changes between
1992 and 2002 in the relation of complex health problems and mortality in two representative samples of the Swedish population
aged 77+ (1992: n = 537; 2002: n = 561). Further, it was examined if trends differed by sex, education, and age. Serious problems in three health domains
were identified (diseases/symptoms, mobility, cognition/communication). People with serious problems in two or three domains
were considered to have complex health problems. Four-year mortality was analyzed using Cox proportional hazard regressions.
Controlled for age, sex, education, and health status mortality risk decreased by 20% during the 10-year period. Complex health
problems strongly predicted 4-year mortality in both 1992 and 2002. No single dimension explained the decrease. Men with complex
health problems accounted for most of the decrease in mortality risk, so much that the gender difference in mortality risk
was almost eliminated among elderly people with complex health problems 2002. A considerable decrease in the mortality risk
among men with complex health problems has implications for the individual who may face longer periods of complex health problems
and dependency. It will also place increasing demands upon medical and social services as well as informal caregivers. 相似文献
3.
Shang-Jyh Chiou Kuomeng Liao Yu-Tung Huang Wender Lin Chi-Jeng Hsieh 《Journal of diabetes investigation.》2021,12(5):819-827
Aims/IntroductionThis study investigated whether participation by patients with type 2 diabetes in Taiwan’s pay‐for‐performance (P4P) program and maintaining good continuity of care (COC) with their healthcare provider reduced the likelihood of future complications, such as retinopathy.Materials and MethodsThe analysis used longitudinal panel data for newly diagnosed type 2 diabetes from the National Health Insurance claims database in Taiwan. COC was measured annually from 2003 to 2013, and was used to allocate the patients to low, medium and high groups. Cox regression analysis was used with time‐dependent (time‐varying) covariates in a reduced model (with only P4P or COC), and the full model was adjusted with other covariates.ResultsDespite the same significant effects of treatment at primary care, the Diabetes Complications Severity Index scores were significantly associated with the development of retinopathy. After adjusting for these, the hazard ratios for developing retinopathy among P4P participants in the low, medium and high COC groups were 0.594 (95% confidence interval [CI] 0.398–0.898, P = 0.012), 0.676 (95% CI 0.520–0.867, P = 0.0026) and 0.802 (95% CI 0.603–1.030, P = 0.1062), respectively. Thus, patients with low or median COC who participated in the P4P program had a significantly lower risk of retinopathy than those who did not.ConclusionsDiabetes care requires a long‐term relationship between patients and their care providers. Besides encouraging patients to participate in P4P programs, health authorities should provide more incentives for providers or patients to regularly survey patients’ lipid profiles and glucose levels, and reward the better interpersonal relationship to prevent retinopathy. 相似文献
4.
5.
Katz ML Broder-Oldach B Fisher JL King J Eubanks K Fleming K Paskett ED 《Journal of general internal medicine》2012,27(9):1135-1141
BACKGROUND
Colorectal cancer (CRC) screening rates remain low among low-income minority populations.OBJECTIVE
To evaluate informed decision making (IDM) elements about CRC screening among low-income minority patients.DESIGN
Observational data were collected as part of a patient-level randomized controlled trial to improve CRC screening rates. Medical visits (November 2007 to May 2010) were audio-taped and coded for IDM elements about CRC screening. Near the end of the study one provider refused recording of patients’ visits (33 of 270 patients). Among all patients in the trial, agreement to be audio taped was 43.5 % (103/237). Evaluable patient (n = 100) visits were assessed for CRC screening discussion occurrence, IDM elements, and who initiated discussion of each IDM element.PARTICIPANTS
Patients were African American (72.2 %), female (63.7 %), with annual household incomes <$20,000 (60.7 %), without health insurance (57.0 %), and limited health literacy (53.7 %).KEY RESULTS
Although CRC screening was mentioned during 48 (48 %) visits, no further discussion about screening occurred in 23 visits (19 times mentioned by the participant with no response from providers). During any visit, the maximum number of IDM elements was five; however, only two visits included five elements. The most common IDM element discussed in addition to the nature of the decision was the assessment of the patient’s understanding in 16 (33.3 %) of the visits that included a CRC discussion.CONCLUSIONS
A patient activation intervention initiated CRC screening discussions with health care providers; however, limited IDM occurred about CRC screening during medical visits of minority and low-income patients.KEY WORDS: colorectal cancer, cancer screening, communication, decision making 相似文献6.
General practitioners are faced with the complex medical care of an increasing number of older people. Traditional demand led care is not able to provide optimal management for this age group, since it has been shown that many important health problems remain unknown or not optimally treated. Preventive geriatric assessment offers primary health care providers new opportunities to focus their management on the particular health problems of older people. A European concerted action involving seven countries formed to develop a "standard assessment for elderly people in primary care (STEP)". The aim was threefold: 1) to identify important and preventable health problems in old age, 2) to supply health care planners and providers with scientific evidence of the corresponding preventive procedures, and 3) to initiate a practical assessment framework for use in European primary care practices. Using a strict methodological protocol, 33 health problems were identified that potentially improve health outcomes in preventive programs for older people. A summary of the evidence is given for each of the included health areas. Taking the best available evidence, patients' preferences, and practice conditions into account, a preventive assessment program was developed containing validated and accepted instruments. The approach is algorithmic with a simple problem identification level and a further diagnostic stage. All recommended procedures are harmonized for common European use. An evidence-based preventive assessment program is expected not only to prevent disease and minimize disability and handicap, but it also offers health care planners a European data set of older peoples' needs for optimized resource allocation. 相似文献
7.
Yi‐Sun Yang Yueh‐Chu Wu Ying‐Li Lu Edy Kornelius Yu‐Tze Lin Yu‐Ju Chen Ching‐Lu Li Hui‐Wen Hsiao Chiung‐Huei Peng Chien‐Ning Huang 《Journal of diabetes investigation.》2015,6(6):662-669
Aims/Introduction
The purpose of the present study was to examine glycemic control in suboptimally controlled type 2 diabetes provided by a structured education group using the Diabetes Conversation Map™ (CM™) vs usual care in a university-based hospital primary care clinic.Materials and Methods
This was a randomized, pragmatic clinical trial. Patients with type 2 diabetes were randomly assigned to structured education or usual care groups. The primary outcome was the difference in the mean change of glycated hemoglobin (HbA1c) from baseline to 12 months. Secondary outcomes included the percentage achieving therapeutic HbA1c goal and self-behavioral changes.Results
A total of 245 patients were randomly assigned to two groups (CM™ group n = 121; usual care group, n = 116). The absolute reduction of HbA1c was significantly greater in the CM™ group at 3 and 6 months (Δ = −0.59% and Δ = −1.13%, P < 0.01), but the difference was no longer statistically significant at 9 and 12 months (Δ = −0.43% and Δ = −0.49%), based on an intention-to-treat analysis. A per-protocol analysis showed the significant change was maintained at 12 months (Δ = −0.67%). In the intervention group, greater percentages of patients achieved their American Association of Diabetes Educators Self-Care Behaviours™ framework (AADE7) behavioral goals at 3 months, in particular being active, problem-solving, reducing risk and health coping.Conclusions
In type 2 diabetic patients with suboptimally controlled glucose, there were greater improvements in glucose control and self-care behavioral goals in those who underwent the CM™ education program compared with outcomes achieved in patients receiving usual care. 相似文献8.
9.
Lauren A. Peccoralo MD MPH Sean Tackett MD Lawrence Ward MD MPH Alex Federman MD MPH Ira Helenius MD MPH Colleen Christmas MD David C. Thomas MD MHPE 《Journal of general internal medicine》2013,28(8):1020-1027
Background
The quality of the continuity clinic experience for internal medicine (IM) residents may influence their choice to enter general internal medicine (GIM), yet few data exist to support this hypothesis.Objective
To assess the relationship between IM residents’ satisfaction with continuity clinic and interest in GIM careers.Design
Cross-sectional survey assessing satisfaction with elements of continuity clinic and residents'' likelihood of career choice in GIM.Participants
IM residents at three urban medical centers.Main Measures
Bivariate and multivariate associations between satisfaction with 32 elements of outpatient clinic in 6 domains (clinical preceptors, educational environment, ancillary staff, time management, administrative, personal experience) and likelihood of considering a GIM career.Key Results
Of the 225 (90 %) residents who completed surveys, 48 % planned to enter GIM before beginning their continuity clinic, whereas only 38 % did as a result of continuity clinic. Comparing residents’ likelihood to enter GIM as a result of clinic to likelihood to enter a career in GIM before clinic showed that 59 % of residents had no difference in likelihood, 28 % reported a lower likelihood as a result of clinic, and 11 % reported higher likelihood as a result of clinic. Most residents were very satisfied or satisfied with all clinic elements. Significantly more residents (p ≤ 0.002) were likely vs. unlikely to enter GIM if they were very satisfied with faculty mentorship (76 % vs. 53 %), time for appointments (28 % vs. 11 %), number of patients seen (33 % vs. 15 %), personal reward from work (51 % vs. 23 %), relationship with patients (64 % vs. 42 %), and continuity with patients (57 % vs. 33 %). In the multivariate analysis, being likely to enter GIM before clinic (OR 29.0, 95 % CI 24.0–34.8) and being very satisfied with the continuity of relationships with patients (OR 4.08, 95 % CI 2.50–6.64) were the strongest independent predictors of likelihood to enter GIM as a result of clinic.Conclusions
Resident satisfaction with most aspects of continuity clinic was high; yet, continuity clinic had an overall negative influence on residents’ attitudes toward GIM careers. Targeting resources toward improving ambulatory patient continuity, workflow efficiency and increasing pre-residency interest in primary care may help build the primary care workforce.Key Words: medical education—career choice, medical education—graduate, primary care, ambulatory medicine 相似文献10.
Sheldon W. Tobe Karen Yeates Norm R. C. Campbell Marion A. Maar Nancy Perkins Peter P. Liu Jessica Sleeth Colin McAllister Diane Hua‐Stewart George Wells Jordan Bernick 《Journal of clinical hypertension (Greenwich, Conn.)》2019,21(1):29-36
Hypertension, the leading cause of cardiovascular morbidity and mortality, affects more than 1 billion people globally. The rise in mobile health in particular the use of mobile phones and short message service (SMS) to support disease management provides an opportunity to improve hypertension awareness, treatment, and control, in remote and vulnerable patient populations. The primary objective of this randomized controlled study was to assess the effect of active (with hypertension specific management SMS) or passive (health behaviors SMS alone) on the difference in blood pressure (BP) reduction between the active and passive SMS groups in hypertensive Canadian First Nations people from six rural and remote communities. Pragmatic features of the study included shifting of BP measures to non‐medical health workers. Despite an overall reduction in BP over the study, there was no difference in the BP change between groups from baseline to final for systolic 0.8 (95% CI −4.2 to 5.8 mm Hg) or diastolic −1.0 (95% CI −3.7 to 1.8 mm Hg, P = 0.5) BP. Achieved BP control was 37.5% (25.6%‐49.4%, 95% CI) in the active group and 32.8% (20.6%‐44.8%, 95% CI) in the passive group (difference in proportions −4.74% (−21.7% to 12.2%, 95% CI, P = 0.6). The study looked at changes in health services delivery, mobile health technologies, and patient engagement to support better management of hypertension in Canadian First Nations communities. The active hypertension specific SMS did not lead to improvements in BP control. 相似文献
11.
Ahacic K Kåreholt I Thorslund M Parker MG 《Aging clinical and experimental research》2007,19(3):187-193
BACKGROUND AND AIMS: Studies of health trends suggest that various components of health and disability follow different trends over time. This in turn suggests that the relations between different health outcomes may change. This study explores associations between three kinds of outcomes (symptoms, physical capacity, activity limitations) in order to evaluate whether relationships between them had changed over the past decade. METHODS: Ordered logistic regressions evaluated the relationships between variables in two collapsed representative samples of the Swedish oldest old (77+) in 1992 and 2002, living at home and in institutions (n=1115, non-response 15%, proxy interviews 13%). Interviews included symptoms (fatigue, pain and dizziness), physical capacity (tests of lung function + physical performance, and mobility, i.e., walking, running, and climbing stairs) and activity limitations (IADL, ADL). RESULTS: Prevalence of symptoms and poor capacity was higher in 2002 than in 1992, whereas the prevalence of activity limitations did not change. All symptoms were related to physical capacity. Fatigue and pain were related to activity limitations with adjustments for physical capacity, as well as independently. All capacity measures had independent relationships with activity limitations. The relationship of fatigue with ADL was weaker in 2002 than in 1992. Adjusted for performance and lung function, the relationship of mobility with ADL was also weaker. Otherwise, relationships were not significantly different (p>0.05). CONCLUSIONS: Among old people, symptoms are closely associated with activity limitations. Identifying the role of symptoms may enhance development of early interventions. The weakened relationship between ADL and functional limitations indicate that they follow different trends. 相似文献
12.
Mariko Oishi Katsuya Yamazaki Fuminobu Okuguchi Hidekatsu Sugimoto Azuma Kanatsuka Atsunori Kashiwagi Japan Diabetes Clinical Data Management Study Group 《Journal of diabetes investigation.》2014,5(5):581-587
Aims/Introduction
Six kinds of oral antidiabetic drugs (OADs), including the new dipeptidyl peptidase 4 (DPP‐4) inhibitors, are available. The present study aimed to define trends within the prescribing patterns of OADs, as well as changes in glycemic control in Japan over a 10‐year period from 2002 to 2011.Materials and Methods
We carried out a cross‐sectional study using data of type 2 diabetes mellitus patients from 24 clinics for 2002, 2005, 2008 and 2011. OAD use was analyzed combined with clinical data.Results
Sulfonylureas (SUs) were the most commonly used OAD, but their use for monotherapy markedly decreased over the study period. Biguanides (BGs) were the second most commonly used OAD, and their prescribing rate increased both for mono‐ and combination therapy. DPP‐4 inhibitors (DPP‐4I), released in 2009, were the third most commonly prescribed OAD in 2011 both for mono‐ and combination therapy. Among combination therapies, two OADs were mostly prescribed, but the use of three OADs and four OADs in 2011 was two‐ and 14.8‐fold those in 2002. These trends were accompanied by an improvement in average glycated hemoglobin from 7.5 ± 1.2% in 2002 to 7.1 ± 0.9% in 2011.Conclusions
The OAD prescribing trend has moved away from monotherapy with SUs and toward combination therapies to achieve better glycemic control. Increased use of BGs and DPP‐4I was predominant in 2011. These trends were accompanied by an improvement of the glycated hemoglobin level. 相似文献13.
Jean Yoon PhD MHS Danielle E. Rose PhD MPH Ismelda Canelo MPA Anjali S. Upadhyay MS Gordon Schectman MD Richard Stark MD Lisa V. Rubenstein MD MSPH Elizabeth M. Yano PhD MSPH 《Journal of general internal medicine》2013,28(9):1188-1194
Background
As the Veterans Health Administration (VHA) reorganizes providers into the patient-centered medical home, questions remain whether this model of care can demonstrate improved patient outcomes and cost savings.Objective
We measured adoption of medical home features by VHA primary care clinics prior to widespread implementation of the patient-centered medical home and examined if they were associated with lower risk and costs of potentially avoidable hospitalizations.Design
Secondary patient data was linked to clinic administrative and survey data. Patient and clinic factors in the baseline year (FY2009) were used to predict patient outcomes in the follow-up year.Participants
2,853,030 patients from 814 VHA primary care clinicsMain Measures
Patient outcomes were measured by hospitalizations for an ambulatory care sensitive condition (ACSC) and their costs and identified through diagnosis and procedure codes from inpatient records. Clinic adoption of medical home features was obtained from the American College of Physicians Medical Home Builder®.Key Results
The overall mean home builder score in the study clinics was 88 (SD = 13) or 69 %. In adjusted analyses an increase of 10 points in the medical home adoption score in a clinic decreased the odds of an ACSC hospitalization for patients by 3 % (P = 0.032). By component, higher access and scheduling (P = 0.004) and care coordination and transitions (P = 0.020) component scores were related to lower risk of an ACSC hospitalization, and higher population management was related to higher risk (P = 0.023). Total medical home features was not related to ACSC hospitalization costs among patients with at least one (P = 0.074).Conclusion
Greater adoption of medical home features by VHA primary care clinics was found to be significantly associated with lower risk of avoidable hospitalizations with access and scheduling and care coordination/transitions in care as key factors.KEY WORDS: medical home, avoidable hospitalizations, access, care coordination 相似文献14.
Dr Lynne Jones OBE MRCPsych Joseph B Asare GM FRCPsych Mustafa El Masri MD Andrew Mohanraj MBBS Hassen Sherief MD Mark van Ommeren PhD 《Lancet》2009,374(9690):654-661
People with severe mental disorders are a neglected and vulnerable group in complex emergencies. Here, we describe field experiences in establishing mental health services in five humanitarian settings. We show data to quantify the issue, and suggest reasons for this neglect. We then outline the actions needed to establish services in these settings, including the provision of practical training, medication, psychosocial supports, and, when appropriate, work with traditional healers. We have identified some persisting problems locally, nationally, and internationally, and suggest some solutions. Protection and care of people with severe mental disorders in complex emergencies is a humanitarian responsibility. 相似文献
15.
Daniel K. Y. Chan Eric Diu K. Florence Loh M. Hossain Dev Verick Huong Van Nguyen 《European journal of ageing》2013,10(3):257-260
Falls are a significant cause of morbidity and mortality in older people. There is an increased frequency of falls in older adults with cognitive impairment and dementia which may be due to impaired judgement of self capability to mobilise safely. This case control study assessed 53 Aged Care subjects aged 75+ years that were hospitalised post fall, from January 2008–December 2009, and compared these subjects’ responses to those of 26 non-fallers to a standard question: ‘While you are in the hospital, what would you do if you need to go to the toilet later?’ This hypothetical scenario question was designed to assess judgement based on self-toileting behaviour and mobility. The study group and control group were similar in age (83.9 ± 4.7 vs. 82.0 ± 4.6 years respectively, p = 0.081) but the study group had statistically lower MMSE results when compared to controls (median 23 vs. 26.5 respectively, p = 0.031). Impaired judgement, defined as an unsafe/inappropriate response to the scenario question, was significantly more prevalent in the study group (fallers) compared to the control group (non-fallers) (41.5 vs. 15.4 %, p = 0.020). Impaired judgement was also more common with lower MMSE scores with 80.9 % of unsafe/inappropriate responses given by participants with MMSE of ≤20. The authors suggest there may be an association between impaired judgement, evidenced by responses to a standardised question, and falls history in older subjects, particularly in those with cognitive impairment or dementia. Ultimately, this may lead to identification of people at increased risk of falls and possibly effective falls prevention strategies in this population. 相似文献
16.
This study investigates the developmental trajectories of long-term care needs and utilisation in older people aged 65 years and over in England. The data came from the English Longitudinal Survey of Ageing (ELSA, waves 6–9, 2012–2018, N = 13,425). We conducted dual trajectory analyses to cluster people’s trajectories of care needs (measured by functional disability) and utilisation into distinct groups. We conducted logistic regression analyses to identify the factors associated with trajectory memberships. We identified three trajectories of long-term needs (low, medium, and high) and three trajectories of care utilisation (low, medium, and high). Both care needs and care hours increased with age, but the speed of increase varied by trajectory. Females, minority ethnic groups, people with low wealth, and those experiencing housing problems were more likely to follow the joint trajectories characterised by higher care needs and higher care intensity. People with low or medium care needs stayed in the same trajectories of care utilisation. In contrast, people in the high-needs trajectory followed divergent trajectories of care utilisation: 63% of them followed the trajectory of high care intensity and the rest (37%) followed the trajectory of medium care intensity. Lack of spouse care was the leading predictor of trajectory divergence (OR = 3.57, p < 0.001). Trajectories of care needs and utilisation are highly heterogeneous in later life, which indicates persistent inequalities over time. Single people with multiple functional limitations face an acute and enduring risk of inadequate care and unmet needs. The amount of support is as important as the availability of support.Supplementary InformationThe online version contains supplementary material available at 10.1007/s10433-022-00723-0. 相似文献
17.
Marie Smith 《Journal of diabetes science and technology》2009,3(1):175-179
Today there are significant gaps between reaching the goal of “optimal medication therapy” and the current state of medication use in the United States. Pharmacists are highly accessible and well-trained—yet often underutilized—key health care professionals who can move us closer toward achieving better medication therapy outcomes for patients. Diabetes medication management programs led by pharmacists are described. This is consistent with the “medical home” concept of care that promotes primary care providers working collaboratively to coordinate patient-centered care. Pharmacists utilize their clinical expertise in monitoring and managing diabetes medication plans to positively impact health outcomes and empower patients to actively manage their health. In addition, pharmacists can serve as a resource to other health care providers and payers to assure safe, appropriate, cost-effective diabetes medication use. 相似文献
18.
Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS): guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings
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H. C. Price K. Ismail the Joint British Diabetes Societies for Inpatient Care 《Diabetic medicine》2018,35(8):997-1004
The Royal College of Psychiatrists Liaison Faculty & Joint British Diabetes Societies (JBDS) for Inpatient Care guidelines for the management of diabetes in adults and children with psychiatric disorders in inpatient settings are available in full at: www.diabetes.org.uk/joint-british-diabetes-society and https://abcd.care/joint-british-diabetes-societies-jbds-inpatient-care-group . This article summarizes the guidelines and recommendations. Commissioners are urged to ensure that the needs of people with diabetes and severe mental illness are specifically addressed in contracts with providers of inpatient care, and to avoid financial or other barriers to cross‐organizational working and to ensure that patient‐structured education is commissioned to meets the complex needs of people with diabetes and severe mental illness. Acute trusts are asked to develop joint pathways with mental health providers and facilitate multidisciplinary working and to screen for mental ill health in those admitted with acute complications of diabetes whose aetiology is unclear or not medically explained. Mental health trusts should create a diabetes register, screen for diabetes, particularly in those prescribed second‐generation antipsychotics and ensure that staff are trained in managing and avoiding hypoglycaemia, and the safe use of insulin. Finally, clinical teams should ensure that all staff can access training in diabetes and mental health to support them to care for people with both diabetes and severe mental illness, develop local pathways for joint working and ensure best practice tariff criteria are met for diabetic ketoacidosis and hypoglycaemia, and for children and young people with diabetes. 相似文献
19.
Noelle M. Cocoros Timothy L. Lash Alfred DeMaria Jr Michael Klompas 《Influenza and other respiratory viruses》2014,8(1):25-32
Background
Obesity was recognized as in independent risk factor for influenza during the 2009 H1N1 influenza pandemic.Objectives
We evaluated the association between body mass index (BMI) and influenza-like illness (ILI) during two non-pandemic influenza seasons (2003–2004 and 2004–2005) and during the spring and fall waves of the 2009 H1N1 pandemic.Methods
Adults with severe (inpatient) and mild (outpatient) ILI were compared to those without ILI using a case-cohort design. The study was nested among those insured by a single health insurance company, receiving care from a large multispecialty practice. Data were collected from insurance claims and the electronic health record. The primary exposure was obesity (BMI ≥ 30·0 kg/m2).Results
Across three seasons, the crude and adjusted ORs for obesity and severe ILI were 1·65 (95% CI 1·31, 2·08) and 1·23 (95% CI 0·97, 1·57), respectively. An association was observed for those aged 20–59 years (adjusted OR 1·92, 95% CI 1·26, 2·90), but not for those 60 and older (adjusted OR 1·08, 95% CI 0·80, 1·46). The adjusted ORs for obesity and severe ILI in 2003–2004, 2004–2005, and during H1N1 were 1·14 (95% CI 0·80, 1·64), 1·24 (95% CI 0·86, 1·79), and 1·76 (95% CI 0·91, 3·42), respectively. Among those with a Charlson Comorbidity Index score of zero, the adjusted ORs for 2003–2004, 2004–2005, and H1N1 were 1·60 (95% CI 0·93, 2·76), 1·43 (95% CI 0·80, 2·56), and 1·90 (95% CI 0·68, 5·27), respectively.Conclusions
Our results suggest a small to moderate association between obesity and hospitalized ILI among adults. 相似文献20.
《AIDS alert》1996,11(5):49-52
As managed care becomes the primary delivery mode for health maintenance organizations and more states try to shift Medicaid programs to managed care, HIV-positive patients and providers should become active in making sure their states formulate adequate Medicaid managed care plans. People with HIV have experienced problems with Medicaid managed care plans, including restricted access to HIV-experienced providers and specialists, restricted availability of drugs through the plan, and limited coverage of pharmaceuticals. AIDS advocates helped to reject Medicaid waiver proposals in New York City and New York State by showing that managed care companies were not prepared to provide adequate care to HIV-positive patients. The shift to managed care has created opportunities to improve health care. The first Medicaid managed care program specifically for AIDS patients was created last year in Los Angeles and is now operating successfully. A New York state law implemented this year is designed to make it easier for people with AIDS and other chronic diseases to join health maintenance organizations and to see specialists without referrals, in exchange for higher premiums and copayments. 相似文献