居家老年髋部骨折照护者专业化照护需求及影响因素分析

目的 探讨居家老年髋部骨折照护者专业化照护需求及影响因素.方法 采用方便抽样法,抽取解放军总医院出院6个月内的63例老年髋部骨折患者及其照护者为调查对象.应用自制一般资料调查表、居家照护者需求量表展开调查.结果 居家老年髋部骨折照护者专业化照护需求总分为(14.54±1.84)分,后续医疗服务维度总分为(3.65±0....     

孕前保健服务利用及影响因素调查分析

目的:了解我国孕前保健服务需求和利用现状,探讨影响孕前保健服务利用的关键因素。方法:随机选择2009年7～12月在山东、河南、甘肃分娩的产后妇女并应用自行设计的调查问卷进行调查,利用统计学方法对孕前保健服务利用的影响因素进行分析。结果:多因素logistic回归分析结果显示,年龄、民族、居住地、文化程度以及对孕前优生健康检查的重视程度等是影响孕前保健服务利用的重要因素。结论:应该加大对育龄人群的宣传力度,完善基层医疗条件和合作医疗制度,提高群众对服务的可及性,有针对性地开展孕前保健服务工作。     

城市老年人社区居家养老模式知晓度及影响因素研究——以徐州市为例

目的 了解徐州市区老年人对社区居家养老模式的知晓度及影响因素。方法 采用分层整群随机抽样的方法,抽取徐州市区1 250老年人进行问卷调查,采用SPSS18.0进行单因素分析和二元logistic回归分析。结果 徐州市区老年人社区居家养老模式知晓率为29.6%,70~79周岁(OR=1.455,P=0.04)、老伴已过世(OR=1.974,P=0.026)、月收入4 000元以上(OR=2.465,P=0.004)、独生子女(OR=2.252,P=0.007)、养老方式为社区居家养老(OR=5.131,P<0.001),所在社区有居家养老服务中心(OR=5.405,P<0.001)、接受过社区居家养老服务(OR=3.460,P<0.001)的老年人的知晓度较高。结论 现阶段徐州市社区居家养老模式的宣传力度亟待提高,提高老年人对社区居家养老模式的认知是促进社区居家养老模式长久发展重要的基础和前提。     

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.     

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.     

Acute health care service use among elderly home care clients

Utilization of acute health care services accounts for a substantial proportion of health expenditures in Canada, and is associated with compromised health and autonomy for older persons. Using the Resident Assessment Instrument for Home Care (RAI-HC), this cross-sectional study of 683 elderly home care recipients sought to distinguish clients who were more likely to use acute health care services; i.e., hospital admissions, emergency room visits. Clients with nutritional problems were 2.58 times more likely to have used acute health care services than clients without nutritional problems. Among clients with a poor social support system, those with nutrition problems were 5.95 times as likely to have used acute health care services. Poor self-rated health, and greater functional dependency were also signif- icantly associated with acute health care use. This study provides a profile of elderly home care clients who are at risk of using acute health care services, which may facilitate targeted efforts to prevent unplanned acute health care use.     

Factors influencing antenatal care service utilization in hadiya zone

Background

In Ethiopia, the levels of maternal and infant morbidity and mortality are among the highest in the world. This is attributed to, among other factors, none use of modern health care services by women in Ethiopia. According to the 2005 Ethiopian Demographic Health Survey, more than seven in ten mothers did not receive antenatal care at all. Therefore, the objective of this study was to explore factors influencing antenatal care services utilization in Southern Ethiopia.

Methods

A community-based cross sectional study was conducted in Hadiya Zone of Southern Ethiopia from January to February 2009. A multi stage sampling technique was used to select the study population in one urban and five rural kebeles. Analysis was done using SPSS for windows version 16.

Result

This study revealed that antenatal care service utilization in the study area was 86.3%. However, from those who attended antenatal care service 406 (68.2%) started antenatal care visit during the second trimester of pregnancy and significant proportion 250 (42%) had less than four visits. Maternal age, husband attitude, family size, maternal education, and perceived morbidity were major predictors of antenatal care service utilization.

Conclusion

Though the antenatal care service utilization is high in the study population, four in ten of the mothers did not have the minimum number of visits recommended by World Health Organization. Promoting information, education and communication in the community is recommended to favorably affect the major predictors of antenatal care service utilization.     

Factors influencing rural health care professionals' access to continuing professional education

OBJECTIVES: The purposes of this study were to explore the perceived barriers and challenges to continuing professional education (CPE) access for Canadian health care professionals and to identify best practices for improving access to CPE. DESIGN: Key informant interviews and Web-based online surveys were conducted. PARTICIPANTS: Key informant interviews were conducted with national CPE accreditation bodies and health professional associations. An online survey was distributed to health professional education programs, as well as provincial professional associations, licensing and professional regulatory bodies. MAIN OUTCOME MEASURES: The perceived barriers and challenges to CPE access for Canadian health care professionals and best practices for improving access to CPE. RESULTS AND CONCLUSIONS: Geographic isolation and poor technological and telecommunications infrastructure were identified as key barriers to CPE delivery and access. Financial factors, such as funding to support travel or cost of attendance, were also identified as major challenges. Tele-education programming was identified as a best practice approach to improve CPE access, as were regional CPE activities and self-directed learning programs. Employer-sponsored initiatives, including staff coverage or locum support, remuneration for time off and paid travel expenses for CPE participation were also identified as best practice approaches.     

Adequacy of nutrient intake among elderly persons receiving home care

This study examines the adequacy of the dietary intake based on age, sex, and level of nutritional risk among 98 frail elderly persons receiving home care through Community Care Access Centres. The dietary intakes were measured using 24-hour recalls and were compared with the dietary reference intake. The participants' intakes of both macronutrients and micronutrients were found to be inadequate. On average, elderly persons were consuming more than the recommended amount of protein, but the average intakes of many vitamins and minerals were less than optimal based on the average intakes. Paradoxically, more than half of elderly participants were overweight or obese. The results highlight the need for appropriate nutrition, education, and support for elderly persons receiving home care.     

慢性病老年人养老方式选择的影响因素研究

目的 了解慢性病老年人养老方式选择的影响因素,为其提供合适的养老方式。方法 通过多阶段分层抽样调查厦门市60岁及以上常住老年人的人口学资料、养老方式选择及慢性病患病情况等,采用χ2检验和多分类Logistic回归分析慢性病老年人养老方式选择的影响因素。结果 1 276名老年人中慢性病患病率为61.4%,慢性病老年人（相比未患慢性病老年人）选择社区居家养老和机构养老的比例均较高。以家庭养老为参照,慢性病老年人选择社区居家养老与机构养老的影响因素分别是与子女关系、居住地、文化程度、婚姻、孤独感,独居、与子女关系、文化程度、年龄、居住地。结论 慢性病老年人养老方式选择仍以家庭养老为主,但较未患慢性病老年人低。独居、年龄、婚姻、居住地、孤独感是慢性病老年人养老方式选择特有的影响因素。     

The functional status and utilization of care of elderly people living at home

A postal questionnaire was used to obtain information on the functional status of and the utilization of care by elderly people living at home. The aim of the questionnaire was to enable the investigators to select elderly people for a further interview to identify the factors that lead to a demand for professional care. The questionnaire provided relevant information as to the prevalence of physical limitations in elderly people and their use of professional and informal care. The information obtained was reliable and valid as is shown by comparison with information given in subsequent interviews. It appears that the prevalence of limitations was of the same size as that found in other studies, both national and international.The more limitations, the higher the proportion of professional care utilization. The factors use of informal care and not living alone were inversely related to the utilization of professional care.The amount of informal care provided was very high among elderly people with handicaps. Rather than being a substitute, it seems that informal care is a condition for professional home care to be successful.The postal questionnaire appeared to be an efficient means of investigating the functional status of and utilization of care by elderly people living at home. As such it could be used for planning and allocation of home care.Carla M.A. Frederiks M.Sc. M.P.H. is a senior staff member of the Department of Epidemiology and Health Care Research, University of Limburg, P.O. Box 616, 6200 MD Maastricht, Netherlands. Margreet J.M. te Wierik M.A. is a junior staff member of the same department. Adriaan Ph. Visser M.A. Ph.D. is a senior investigator in the research project Services for the elderly and a senior staff member of the Department of Health Economics at the same university. Ferd Sturmans M.D. Ph.D. is professor at the Department of Epidemiology and Health Care Research at the same university.     

Factors associated with health care utilization by the elderly in a public health care system

OBJECTIVE: The objective was to determine the factors associated with the use of health care services by the elderly residing in the community. METHODS: A cross-sectional study on 787 elderly people over 64 years of age from Albacete City (Castilla-La Mancha, Spain). The study was carried out by personal home interviews during a 9-month period. The dependent variables were: health care utilization, and characteristics. The independent variables were: self-reported health status, self-reported morbidity, medication use, functional status, mental health, lifestyle habits, social support, and sociodemographic status. RESULTS: The health care services were used by 74.5% in the last 3 months of which 59.4% were general practitioner visits, 18.4% were to nursing staff, and 16.5% were specialist visits. Laboratory tests were performed in 39.2% and radiological examinations in 24.9%. Emergency visits accounted for 2.4%, and hospitalization, 2.9%. Users of health care services among the elderly population were objectively more ill, although there was a group of healthy individuals who also visited the physician and a large group of elderly with considerable health problems who never saw their physician. In the multivariate analysis, general practitioner utilization was independently associated with a perceived unmet need for care (OR = 3.15), a negative self-reported health status (OR = 2.51), and a lower educational level (OR = 2.41). CONCLUSIONS: Subjective factors as perceived need for care, a negative self-reported health status and lower educational level are important factors that influence in the utilization of health care services.     

上海市某养老院老年人生活质量的影响因素分析

目的了解上海市某养老院老年人的生活质量及其影响因素,为行业管理部门制定养老服务的相关政策提供依据。方法2011年12月应用简明健康状况调查表（SF-36）、社会支持评定量表、老年抑郁量表（GDS）和孤独量表（UCLA—LS）对养老院内160名老年人进行调查,分析影响养老院老年人生活质量的因素以及生活质量与社会支持、抑郁、孤独的相关性。结果总调查人数160名,占该养老院老人总数的76．2％,年龄分布范围为60—98岁,平均年龄（82．0±8．8）岁。逐步多元线性回归分析显示,养老院老人生活质量中与生理功能明显相关的影响因素有3个,分别是有无子女、参加体育活动频率、自我健康状况评价;与生理职能、社会功能、活力及情感职能明显相关的影响因素有3个,分别是有年龄、参加体育活动频率、自我健康状况评价;与躯体疼痛明显相关的影响因素有2个,分别是性别、自我健康状况评价;与总体健康明显相关的影响因素有4个,分别是年龄、参加体育活动频率、慢性病数目、自我健康状况评价;与精神健康明显相关的影响因素有4个,分别是年龄、居住状况、参加体育活动频率、自我健康状况评价。Spearman秩相关分析显示,养老院老人客观支持与生活质量量表中情感职能、精神健康呈正相关,其主观支持、对社会支持利用度、社会支持总分与生活质量量表各维度均呈正相关;养老院老人其抑郁分值、孤独分值与生活质量量表各维度均呈负相关。结论影响养老院内老年人生活质量的因素众多,社会及家庭应予以关注。     

The Kansas Medicaid Buy-In: Factors influencing enrollment and health care utilization

BackgroundMedicaid Buy-Ins are optional programs states may implement to create work incentives for people with disabilities. These programs allow participants to increase earnings without losing Medicaid eligibility—potentially moving them out of poverty without risking loss of health care coverage. They also provide the opportunity for beneficiaries to offset some of their medical costs to the federal and state governments through premiums for coverage and increased taxes paid. State and federal policy makers and administrators have speculated about who might enroll, how they might use the benefits, and whether positive health outcomes for persons with disabilities would result.ObjectiveWe compared characteristics and health care utilization of 184 enrollees and 158 eligible nonenrollees in Kansas' Medicaid Buy-In.ResultsEnrollees were older and significantly more likely to have more than one disability, with mental illness being more prevalent than physical disabilities, and to have both higher Social Security and earned income. A majority of the sample was dually eligible for Medicare and Medicaid with Medicaid paying most costs. Home health service costs were the primary difference between enrollee and nonenrollee expenditures.ConclusionsIncreased Medicaid Buy-In enrollment could prevent long-term dependence on federal disability benefits.     

Factors associated with reproductive health care utilization among Ghanaian women

Background

This study investigates factors determining the timing of antenatal care (ANC) visit and the type of delivery assistant present during delivery among a national representative sample of Ghanaian women.

Method

Data for the study was drawn from the women questionnaire (N=4,916) of the 2008 Ghana Demographic and Health Survey among 15–49-years-old women. Multivariate logistic regression analysis was used to explore factors determining the type of delivery assistance and timing of ANC visit for live births within five years prior to the survey.

Results

Majority of Ghanaian women attended ANC visit (96.5%) but many (42.7%) did so late (after the first trimester), while 36.5% had delivery without the assistance of a trained personnel (30.6%) or anyone (5.9%). Age (OR=1.5, CI=1.1-1.9, OR for 25-34-year-olds compared to 15-24-year-olds), religion (OR=1.8, CI=1.2-2.8, OR for Christians versus Traditional believers) wealth index (OR=2.6, CI=1.7-3.8, OR for the richest compared to the poorest) were independently associated with early ANC visit. Likewise, age, place of residence, education and partner’s education were associated with having a delivery assisted by a trained assistant. Also, Christians (OR=1.8, CI=1.1-3.0) and Moslems (OR=1.9, CI=1.1-3.3) were more likely to have trained delivery assistants compared to their counterparts who practised traditional belief. Furthermore, the richer a woman the more likely that she would have delivery assisted by a trained personnel (OR=8.2, CI= 4.2-16.0, OR for the richest in comparison to the poorest).

Conclusions

Despite the relatively high antenatal care utilisation among Ghanaian women, significant variations exist across the socio-demographic spectrum. Furthermore, a large number of women failed to meet the WHO recommendation to attend antenatal care within the first trimester of pregnancy. These findings have important implications for reducing maternal mortality ratio by three-quarters by the year 2015.

     

Factors influencing mammography use among women in Medicare managed care

This article presents findings about the mammography screening experience of Medicare members of a health maintenance organization (HMO). Based on a mail survey of 309 women, we assessed factors that may be facilitators or barriers to this service for older women. The results indicate that these respondents generally are receiving timely mammograms; over three-quarters (79 percent) reported having a mammogram in the past 2 years. Multivariate analysis showed that women who were younger (under 75 years of age), believed in the importance of screening, had been told by a physician to obtain a mammogram, and were more satisfied with their physician and more likely to report mammography use.     

Factors influencing the turnover of Swedish professional drivers

The aim of the study was to investigate the occupational turnover among Swedish professional drivers in order to explain if there is a health-based dropout from the job. The retrospective study covered the period from 1974 to 1985 and included 1,731 male members of the Swedish Transport Workers' Union in 1974. A questionnaire concerning occupation since 1974 was sent 1986 to 1,567 subjects (91% of the sample); 84% replied, of whom 55% were still working as professional drivers, 29% had switched to another trade, and 14% had retired. An AID analysis showed that the variables age and education reduced the variance of the number of change of job most between 30 and 54 years of age and the variable location at the age of 29 or younger. The most common reasons for leaving the trade were irregular working hours, musculoskeletal complaints and dissatisfaction with the salary. Older drivers often stated health factors such as musculoskeletal complaints and cardiovascular diseases as reasons for leaving the trade.