Health Service utilization Research Papers (original) (raw)

2025, Ijcams Publication

The purpose of this research paper is to investigate the challenges and opportunities of the Mahatma Jyotiba Phule Jan Arogya Yojana (MJPJAY) which was launched in 2013-2020 to provide healthcare benefits to families below the poverty line (BPL). The research methodology employed in this paper is a comprehensive literature review of the literature available on the MJPJAY, including policy documents, academic papers, and news articles. The findings of the review indicate that there are numerous challenges facing the MJPJAY, including inadequate infrastructure, weak financial management, and low awareness among BPL families. However, the MJPJAY also presents several opportunities, such as increased access to healthcare services, improved quality of care, and cost savings. This paper concludes that, while there are challenges in the implementation of the MJPJAY, with proper management and public awareness, the MJPJAY can be a successful and beneficial program for BPL families.

2025, Atención Primaria

Participantes. Se seleccionó a 20 sujetos enfermos a través de un muestreo aleatorio. Mediciones y resultados principales. Se realizaron entrevistas en profundidad. Los datos se analizaron empleando la técnica del análisis de contenido. La mayoría de los participantes viven con 2 o más enfermedades crónicas. Los servicios médicos utilizados se combinan con los de otros sistemas de atención. Los participantes también suelen combinar diversos tipos de atención médica. Se encontraron cuatro categorías de utilización de los servicios de salud: frecuente, ocasional, periódica y abandono. Aquellos que hacen uso frecuente de los servicios de salud tienen trayectorias de la patología oscilatorias o deteriorantes, se ven apoyados por miembros de sus familias y se trata fundamentalmente de mujeres y varones ancianos/jubilados. Quienes abandonan los servicios de salud tiene trayectorias estables, son los principales proveedores de su familia y evitan dejar de trabajar para recibir atención médica; pero algunos otros presentan trayectorias deteriorantes y sus molestias no mejoran con dicha atención. Conclusiones. Los patrones de utilización de los servicios de salud se explican por diferentes factores desde la óptica de los sujetos enfermos. Tales patrones tienen serias implicaciones en la organización de los servicios de salud. Palabras clave: Utilización de servicios de salud. Enfermedad crónica. Investigación cualitativa. Perspectiva del paciente. HEALTH SERVICES UTILIZATION: THE PERSPECTIVE OF INDIVIDUALS WITH DIABETES Aims. This paper reports findings of a qualitative study whose focus is health services use among individuals with chronic illness. Design. Qualitative research with an ethnographic orientation. Setting. A low income neighborhood of Guadalajara, Mexico. Subjects. Twenty subjects selected through a theoretical sample. Measurements and main results. Open-ended interviews. The data were content-analyzed. Most diabetic sufferers live with two or more chronic illnesses. Medical services use is combined with that of other healing systems. Participants also combine different types of health care services. Four health care use categories were found: frequent, occasional, periodical, and abandonment. Those who use health services frequently have oscillating or deteriorating illness trajectories, are supported by family members and are primarily women and elderly/retired men. Those who abandon health services have stable trajectories, they are their families primary providers, and cannot stop work to receive medical care; but some others have deteriorating illness trajectories and their symptoms do not ameliorate with consultations. Conclusions. Different factors explain patterns of health services utilization. Such patterns of use have serious implications in the health care reorganization.

2025, BMC Health Services Research

Background: The roll-out of antiretroviral therapy (ART) in Africa will have significant resource implications arising from its impact on demand for healthcare services. Existing studies of healthcare utilization on HAART have been conducted in the developed world, where HAART is commenced when HIV illness is less advanced. Methods: This paper describes healthcare utilization from program entry by treatment-naïve patients in a peri-urban settlement in South Africa. Treatment criteria included a CD4 cell count <200 cells/µl or an AIDS-defining illness. Data on health service utilization were collected retrospectively from the primary-care clinic and secondary and tertiary referral hospitals. Hospital visits were reviewed to determine the clinical reason for each visit. Results: 212 patients were followed for a median of 490 days. Outpatient visits per 100 patient years of observation (PYO), excluding scheduled primary-care follow-up, fell from 596 immediately prior to ART to 334 in the first 48 weeks on therapy and 245 thereafter. Total inpatient time fell from 2,549 days per 100 PYO pre-ART to 476 in the first 48 weeks on therapy and 73 thereafter. This fall in healthcare utilization occurred at every level of care. The greatest causes of utilization were tuberculosis, cryptococcal meningitis, HIV-related neoplasms and adverse reactions to stavudine. After 48 weeks on ART demand reverted to primarily non-HIV-related causes. Utilization of both inpatient and outpatient hospital services fell significantly after commencement of ART for South African patients in the public sector, with inpatient demand falling fastest. Earlier initiation might reduce early on-ART utilization rates.

2025, Arifa Turabali

ABSTRACT Utilization of essential services is vital to strengthen service delivery and improve the life of a population for a healthy nation. Health care utilization is 73.4% for the people who are sick. Cost (12.7%), medical supplies,... more

2025, Social Science & Medicine

Several recent studies have examined the connection between religion and medical service utilization. This relationship is complicated because religiosity may be associated with beliefs that either promote or hinder medical helpseeking. The current study uses structural equation modeling to examine the relationship between religion and fertility-related helpseeking using a probability sample of 2183 infertile women in the United States. We found that, although religiosity is not directly associated with helpseeking for infertility, it is indirectly associated through mediating variables that operate in opposing directions. More specifically, religiosity is associated with greater belief in the importance of motherhood, which in turn is associated with increased likelihood of helpseeking. Religiosity is also associated with greater ethical concerns about infertility treatment, which are associated with decreased likelihood of helpseeking. Additionally, the relationships are not linear throughout the helpseeking process. Thus, the influence of religiosity on infertility helpseeking is indirect and complex. These findings support the growing consensus that religiously-based behaviors and beliefs are associated with levels of health service utilization.

2025, International Journal of Geriatric Psychiatry

BackgroundThe quality of care and overuse of neuroleptic medication in care environments are major issues in the care of elderly people with dementia.MethodThe quality of care (Dementia Care Mapping), the severity of Behavioural and Psychological Symptoms (BPSD—Neuropsychiatric Inventory), expressive language skills (Sheffield Acquired Language Disorder scale), service utilization and use of neuroleptic drugs was compared over 9 months between six care facilities receiving a psychiatric liaison service and three facilities receiving the usual clinical support, using a single blind design.ResultsThere was a significant reduction in neuroleptic usage in the facilities receiving the liaison service (McNemar test p < 0.0001), but not amongst those receiving standard clinical support (McNemar test p = 0.07). There were also significantly less GP contacts (t = 3.9 p = 0.0001) for residents in the facilities receiving the liaison service, and a three fold reduction in psychiatric in‐pat...

2025, The Primary Care Companion For CNS Disorders

Background: Difficult physician-patient encounters pose a challenge in all aspects of health care. Characteristics of both physicians and patients affect the office encounter and utilization of services. The objectives of this study were to explore the impact of patients' characteristics and the patient-physician relationship on service utilization. Method: A sample of 22 family practice patients and their physicians completed questionnaires prior to and/or after an office visit. Chart review yielded demographic information and history. The number of office visits and phone calls were obtained from billing records. Results: The number of patient-reported physical problems was correlated with negative affect (r = 0.63, p < .002), the number of phone calls to the office (r = 0.52, p < .02), and the difficulty of the encounter as perceived by the physician (r = 0.58, p < .005). The number of phone calls also correlated with the number of life events (r = 0.43, p < .05) and the patient's perception of the physician's warmth (r = 0.48, p < .03) and understanding (r = 0.44, p < .04). Conclusion: Life stress, negative affect, physical complaints, and the patients' perception of their physician impact utilization. Armed with information about patient characteristics prior to the office visit, the physician can increase efficiency and facilitate a more productive encounter.

2025, Archives of Physical Medicine and Rehabilitation

This article serves as an introduction to this issue of the Archives of Physical Medicine and Rehabilitation that is devoted to current research findings of the Spinal Cord Injury Model Systems (SCIMS) program. The SCIMS program began in 1970, with funding from the National Institute on Disability and Rehabilitation Research in the U.S. Department of Education, to demonstrate a comprehensive care system for spinal cord injury (SCI) and also to conduct research to improve the health and quality of life of persons with SCI. Over the last 20 years, similar collaborative efforts for the dissemination of SCIMS research outcomes have produced conference proceedings in 1990, a book in 1995, and dedicated journal issues in 1999 and 2004. The collection of 24 articles in this issue shows the depth and breadth of work being carried out by the SCIMS investigators, from descriptive epidemiology to a randomized controlled trial, from neurologic recovery to community reintegration, and from health services utilization to assistive technology for mobility. Herein, we provide a brief overview of the SCIMS program, highlight the research initiatives currently underway, and describe the important findings of the original research articles contained in this issue.

2025, Health Services Management Research

This study analyses how both ambulatory care groups (ACGs) and physician characteristics explain the variability in health-service use among primary care patients in Spain. During the period 1996-1997, data derived from 52 152 patients and their 38 respective primary care physicians were collected. The response variables were as follows: number of visits; diagnostic tests requested; and referrals to a specialist. ACGs are an important variable that should be taken into account in order to explain health-service utilization. As for professionals, age and the post they hold are essential factors. Most of the unexplained variability is caused by patient characteristics.

2025, Atención Primaria

Hiperconsumidor; Utilizacio ´n de servicios sanitarios; Complejidad casuı ´stica; Ajuste de riesgos Resumen Objetivo: Identificar pacientes hiperconsumidores de farmacia en atencio ´n primaria, describir las diferencias epidemiolo ´gicas entre pacientes normoconsumidores e hiperconsumidores e investigar la capacidad explicativa del sistema de ajuste de riesgos ACG (Adjusted Clinical Groups) sobre la variabilidad del gasto farmace ´utico para ambos grupos de pacientes. Disen ˜o: Estudio observacional retrospectivo. Emplazamiento: 23 centros de salud de Arago ´n, Baleares y Catalun ˜a. Participantes: Se incluyeron 286.450 pacientes atendidos al menos una vez en 2005. Mediciones: Se analizaron variables demogra ´ficas, de consumo farmace ´utico y de casuı ´stica (ACG s 7.1). Se identificaron pacientes hiperconsumidores a partir del rango intercuartı ´lico. Se construyo ´un modelo de regresio ´n lineal, para conocer la capacidad explicativa del ACG sobre el consumo farmace ´utico. El mismo modelo se aplico ´para la estratificacio ´n segu ´n variables del profesional, centro de salud y comunidad auto ´noma. Resultados: Uno de cada 10 pacientes se clasifico ´como hiperconsumidor. Este grupo fue el causante del 60% del gasto farmace ´utico. Se trata de pacientes con 26,3 an ˜os ma ´s y con mayor comorbilidad que los pacientes normoconsumidores. La capacidad explicativa del ACG sobre el gasto farmace ´utico fue llamativamente inferior para el grupo de hiperconsumidores (3 frente a 26% en pacientes normoconsumidores). Conclusiones: Han de investigarse las causas que provocan la falta de adaptacio ´n de los ACG al grupo de pacientes hiperconsumidores. Puede que haya circunstancias sociales que influyen sobre la situacio ´n clı ´nica de estos pacientes. O, ma ´s probablemente, el me ´todo

2025, Journal of Immigrant and Minority Health

Objective-To qualitatively evaluate the views of Haitian immigrants on cancer and the influence of cultural and socio-ecological factors on cancer screening behavior. Methods-Six focus groups, consisting of 4-10 individuals each, were conducted among Haitian adults at average risk for colorectal cancer. The interviews were conducted in Haitian Creole and featured questions that addressed beliefs and attitudes about general health, access to health care, colon cancer, and screening practices. Results-The focus groups provided insight into the health service utilization patterns in the Haitian community, as well as the factors driving them including language and the pattern of accessing healthcare only for emergencies. Conclusions-Many misconceptions regarding cancer and its development were evident in the discussions. However participants were willing to follow the recommendations of a physician. This highlighted the importance in this community of disseminating information at every opportunity about preventative care, including colorectal cancer screening.

2025

This article examines the aspects that influence productivity in distant service systems during times of request congestion. At the same time, the issue of enhancing system server efficiency without the use of additional hardware or software has been investigated. It has been found that service system efficiency declines during traffic congestion because requests are processed in multiple stages, each with a different service order. Hence, to enhance system efficiency during traffic congestion, a proposal is made to prioritize users whose requests have been successfully served at least once. A physical model of the service process was constructed to assess the efficacy of the proposed approach.The research conducted using this model contributed to an average increase in the efficiency of service systems by 6%.

2025, Drug and Alcohol Dependence

Aim-Individuals who have both substance use disorders and mental health problems have poorer treatment outcomes. This study examines the relationship of service utilization and 12-step participation to outcomes at 1 and 5 years for patients treated in one of two integrated service delivery systems: the Department of Veterans Affairs (VA) system and a health maintenance organization (HMO). Methods-Subsamples from each system were selected using multiple criteria indicating severity of mental health problems at admission to substance use disorder treatment (VA = 401; HMO = 331). Separate and multiple-group structural equation model analyses used baseline characteristics, service use, and 12-step participation as predictors of substance use and mental health outcomes at 1 and 5 years following admission. Results-Substance use and related problems showed stability across time, however, these relationships were stronger among VA patients. More continuing care substance use outpatient visits were associated with reductions in mental health symptoms in both groups, whereas receipt of outpatient mental health services was associated with more severe psychological symptoms. Participation in 12-step groups had a stronger effect on reducing cocaine use among VA patients,

2025, Canadian Journal on Aging / La Revue canadienne du vieillissement

ABSTRACTA rapidly growing older population has led to changes in health care, including a community health movement with an emphasis on community collaboration, self-help, and capacity building. This study examined factors in the lives of older individuals that influenced their ability and willingness to participate in a health-related community-capacity-building project to help their frailer, older neighbours. Using cross-sectional survey methodology, 107 volunteers who lived in a high density seniors' apartment complex known for its high health service utilization were compared with a random sample of 74 non-volunteers from the same community. Factors associated with volunteer involvement included age, activity level, functional ability, life satisfaction and certain personality characteristics. The study suggests that, within a community, the “younger-old” may be able to support their frailer, older neighbours so that they can remain living in the community.

2025, AIDS and Behavior

This product is part of the RAND Corporation reprint series. RAND reprints present previously published journal articles, book chapters, and reports with the permission of the publisher. RAND reprints have been formally reviewed in accordance with the publisher's editorial policy, and are compliant with RAND's rigorous quality assurance standards for quality and objectivity. This PDF document was made available from www.rand.org as a public service of the RAND Corporation.

2025, Clinical Therapeutics

Background: Clinical, health, and economic outcomes in patients with type 2 diabetes may be influenced by self-management behaviors and type of pharmacotherapy. Objective: This study examined differences in medication adherence and total health care costs among patients with type 2 diabetes who initiated or converted to insulin administration with a pen device in comparison with a vial/syringe as add-on therapy to oral antidiabetic drugs. Methods: This study evaluated patients with type 2 diabetes who were enrolled in the North Carolina Medicaid program from September 24, 2001, to July 18, 2006. Patients receiving insulin with a vial/syringe who converted to pen therapy were compared with those who remained on vial/syringe in both unmatched comparisons (n = 560 and n = 9988, respectively) and after pair-matching (both cohorts, n = 560) with the use of propensity scores. In a second analysis, patients who initiated insulin with vial/syringe (n = 1162) were compared with a cohort that initiated insulin pen therapy (n = 168) after controlling for covariates in a multivariate regression model. All included patients had complete enrollment for at least 24 months of followup. Multiple linear regression models were used to predict the comparative impact on total health care costs and medication adherence for each cohort. Adjusted means were calculated to determine the group differences for each outcome. Results: Diabetes-related and overall medication adherence was comparable for patients initiating insulin with a pen versus a syringe (53% vs 50% and 94% vs 94%, respectively). However, total annualized health care costs were significantly lower for patients using pen therapy than for those using a syringe

2025, Medical Care

The aging of the pediatric HIV cohort and advances in antiretroviral therapy for children may have resulted in recent changes in patterns of healthcare utilization. Objectives: The objectives of this study were to examine inpatient and outpatient HIV-related health service utilization in a multistate sample of HIV-infected children, and to assess sociodemographic and clinical correlates of utilization. Design: Cohort study of pediatric patients with HIV. Demographic, clinical, and resource utilization data were collected from medical records for 2000 and 2001. Setting: This study was conducted at 4 U.S. HIV primary pediatric and specialty care sites in different geographic regions. Patients: Three hundred three HIV-positive children with at least one outpatient visit or CD4 test in either 2000 or 2001 were studied. Main Outcome Measures: Mean outcome measures were number of hospital admissions, mean length of hospital stay, and number of outpatient clinic/office visits. Results: Hospitalization rates decreased significantly from 39.2 (95% confidence interval ͓CI͔, 28.4 -50.1) to 25.3 (95% CI, 16.4 -34.3) admissions per 100 patients between 2000 and 2001. Hospitalizations were higher among patients with greater immunosuppression, those 2 years and under, and those with AIDS, but were not significantly related to receipt of highly active antiretroviral therapy. Mean outpatient visits did not change significantly between 2000 and 2001 from 9.09 (95% CI, 8.3-9.9) to 9.06 (95% CI, 8.4 -9.7) visits per child per year. Children 2 years and under, those on highly active antiretroviral therapy, those with AIDS, and those with Medicaid had significantly higher outpatient utilization. Those with higher HIV-1 RNA had higher outpatient utilization than those with less advanced disease. Conclusion: Inpatient utilization significantly decreased between 2000 and 2001, but outpatient utilization did not change over time. Compared with prior studies, utilization rates appear to be declining over time. Unlike adults, racial/ethnic or gender disparities in healthcare utilization are less pronounced for HIV-infected children.

2025, Health and Quality of Life Outcomes

The 12-item Health Survey (SF-12) was developed as a shorter alternative to the SF-36 for use in large-scale studies, particularly when overall physical and mental health are the outcomes of interest instead of the typical eight-scale profile. The main purpose of this study was to assess the validity of the Greek version of the SF-12. A stratified representative sample (N = 1005) of the Greek general population was interviewed. The survey included the SF-36, the EQ-5D and questions on socio-demographic and health-related characteristics. SF-12 summary scores were derived using the standard US algorithm. Factor analysis was used to confirm the hypothesized component structure of the SF-12 items. Construct validity was investigated with "known groups" validity testing and via convergent and divergent validity, which in turn were assessed by the correlations with the EQ-5D dimensions. Concurrent validity was assessed by comparisons with SF-36 summary scores. Results: SF-12 summary scores distinguished well, and in the expected manner, between groups of respondents on the basis of gender, age, education, socio-economic status, self-reported health problems and health services utilization, thus providing evidence of construct validity. Effect size differences between SF-36 and SF-12 summary scores were generally small (<0.2), supporting concurrent (criterion) validity. Significantly lower mean PCS-12 and MCS-12 scores were observed for respondents reporting chronic conditions compared to those without (P < 0.001). Convergent and divergent validity were supported by expected relationships with the EQ-5D. Reporting a problem in an EQ dimension was associated with lower SF-12 summary scores, supporting concurrent validity. Sensitivity of the Greek SF-12 and replication of the original measurement and conceptual model were demonstrated. The results provide evidence on the validity of the Greek SF-12 and, in conjunction to future studies addressing test-retest reliability and responsiveness, support its use in Greek health status studies as a brief, yet valid, alternative to the SF-36. In medical research and evaluation, there is an increasing interest in instruments used to measure health-related quality of life (HRQOL) in general population surveys, as

2025, European Journal of Clinical Pharmacology

To analyze, in a multivariate framework, how socio-demographic, health service utilization, health needs and lifestyle risk factors influence drug utilization and polypharmacy (PP) in a general population in Greece. The cross-sectional study took place in 2006. In total 1,005 individuals (>18 years old), out of 1,388 approached (response rate 72.4%), were interviewed by trained interviewers. Thirty seven subjects reported only OTC and they were excluded. The final sample was 968 subjects. Multivariable logistic regression and multinomial regression analyses were conducted to determine the predictors of drug use and PP at a significance level of p<0.05. The results revealed a high rate of drug use and PP. Drug use and PP were more common among women and increased with age. Advanced age 65+ (OR: 11.6), university education (OR:2.3), visits to physician (OR: 2.2), comorbidity (OR: 6.8) or poor physical and mental health were associated with higher likelihood of using drugs. Minor (2-3 drugs) and major (4+ drugs) PP depended on comorbidity, physical health and increased age. Furthermore, visits to physicians, (O.R.:1.1), smoking (O.R.:3.0) and obesity (OR:3.8) increased the likelihood of major PP. Overall, drug utilization and PP depended on health needs followed by education, utilization of health services and age. Social disparities do persist and, after adjustments for health needs and obesity, had a significant influence on PP.

2024

The last few years we have seen the emergence of pervasive and mobile computing technologies. At the same time the Grid has become the de facto standard for distributed and high performance computing. A lightweight Grid infrastructure may well provide a solid foundation for pervasive computing. For this to happen, we must rethink our design goals, and provide support for mobility, resource limited and non-dedicated environments, and redesign the process communication models to reflect the dynamic conditions of the system. In this paper we try to identify the requirements for supporting service and session mobility in lightweight Grid systems; review current approaches and discuss their limitations; and present our ideas for an integrated platform that meets these requirements.

2024, Journal of Advanced Nursing

Aim. This paper is a report of part of a larger study exploring rural Ghanaian women's experiences of seeking reproductive health care. The aim of this part of the study was to describe rural women's perspectives on their experiences in seeking reproductive care from professional nurses. Background. Nurses' relationships with childbearing women have been linked to women's reproductive healthcare-seeking behaviour and service utilization. However, few researchers have studied women's perspectives on their relationships with nurses when seeking health care. In Ghana, the high rates of maternal mortality raise concerns about a number of factors, including nurses' relational practices. Methods. Data were collected in 2007 with a convenience sample of 27 Ghanaian women via in-depth interviews, focus groups and participant observation. Women's ages ranged from 15 to 49 years. The translated and transcribed data were thematically analyzed. Findings. Healthcare providers' relational practice influenced women's healthcareseeking behaviours. Major themes from women's stories were: (a) experiences of intimidation and being scolded, (b) experiences of limited choices, (c) receiving silent treatment, and experiences of lack of privacy. Women emphasized the importance of their relationships with nurses and the impact of these relationships on their healthcare-seeking. Conclusion. Nursing education in Ghana must place emphasis on basic relational practices. Structural changes to health clinics and routine nursing practices are necessary to create conditions for privacy to address women's health concerns. Women's perspectives must be considered for service improvement. Further research is needed to examine nurses' perspectives on relational care.

2024

dissemination of electronic healthcare records in distributed wireless environments

2024, Frontiers in health policy research

Medicare, which provides health insurance to Americans over the age of 65 and to Americans living with disabilities, is one of the government's largest social programs. It accounts for 12 percent of federal on-and off-budget outlays, and in fiscal year 1999, $212 bfflion in Medicare benefits were paid. The largest shares of spending are for inpatient hospital services (48 percent) and physician services (27 percent). In thirty years, the number of Americans covered by Medicare will nearly double to 77 million, or 22 percent of the U.S. population.

2024, International Journal of Public Health Science (IJPHS)

In order to improve efficiency in health service delivery in Kenya, the Ministry of Health has developed structures through inter-sectoral collaboration at various levels. Despite efforts by the government and key stakeholders to improve health sector, utilization of health services still remains a major challenge. The purpose of the study was to investigate factors that influence utilization of health services in Homa Bay County, Kenya. The study employed survey design and focused on health beneficiaries, District Health Management Team and other key health stakeholders, and used both quantitative and qualitative data. Quantitative data was collected through household interviews of 384 respondents and qualitative data was generated through Key Informant Interviews of 16 respondents. The study reveals that health financing, service delivery, quality, accessibility and equity influence utilization of health services in Homa Bay County. It is for these reasons that the study recommends that the government should allocate adequate budget towards health services, avail adequate trained health workers, and improve infrastructure in health facilities as well as drugs and other supplies. There is also need for further research on cultural factors influencing utilization of health services.

2024, Center for the …

EXECUTIVE SUMMARY INTRODUCTION This report provides a comprehensive review of current knowledge regarding (1) the characteristics and needs of family caregivers;(2) caregiver support interventions and their outcomes, particularly... more

2024

After several years of decline, the number of Americans without health insurance is climbing rapidly. Meanwhile erosion in tax revenues is driving states to cut funding for Medicaid. Both trends are hitting all health care providers hard, as they are simultaneously attempting to cope with a nursing shortage, escalating labor costs, and the adoption of expensive new technologies. These forces are felt the most in the health care safety net. These providers of care for the poor, uninsured and other vulnerable populations have not had to face such a confluence of challenges in recent memory. They must survive in an industry in upheaval, while attempting to serve the ballooning numbers of our fellow Americans in need. They must also continue to provide a set of highly specialized services, such as burn, trauma and neonatal care to a broad swath of their local communities. It is against this backdrop that we have assessed the "state of the safety net" in Memphis. Due to the foresight of the Robert Wood Johnson Foundation, a team of researchers at The George Washington University Medical Center led by Marsha Regenstein, PhD, MCP, has assessed the health of the safety net in ten United States communities. In each community we worked with a Community Partner-a local organization that helped us to identify the key issues and stakeholders. In Memphis, we are deeply indebted to the University of Tennessee Health Sciences Center. These community partners have also committed to convening opinion leaders and others in their region to discuss the implications of the reports' findings. All of this was done as part of the Urgent Matters project, a national program designed to spur awareness of safety net issues while finding practical ways to relieve one symptom of distress-crowded emergency departments. Our goal is to provide new analysis and information on what is happening today in the critical systems of care for the underserved in these communities. By doing so we seek to inform the health care discussions in these places and the nation, and to lay a foundation for rational change and improvement. We do not presume to know all the answers. But we believe that an objective analysis by an unbiased team can be immensely helpful to communities in need of a critical analysis of their safety net. This report seeks to meet this need.

2024, Acta Paediatrica

was unknown, they have been tested upon admission to the delivery room. If HBsAg was positive, the parents were counseled and the newborns received vaccination and HBIG after birth. The prevalence of HBsAg (+) in 467 women was 3.85% (18). Women of Greek origin (65.95%-308) had a prevalence of HBsAg (+) 1.62% (5), women born in other countries who live in Greece (18.84%-88) have a significantly higher prevalence of HBsAg carrier status 4.55% (4). Women of rom origin (15.20%-71) have a high prevalence of HBsAg (+) 12.68% (9). HBsAg (+) is more prevalent in rural region than in urban region (4.59% vs 2.72%). The incidence of HBV among pregnant women in Ilia district is higher than hitherto expected, as well as than in other regions of Greece. Also, HBsAg (+) is more prevalent in rural region and in rom women.

2024, International Journal for Equity in Health

Background: Healthcare utilization has particular relevance as a public health and development issue. Unlike material and human capital, there is little empirical evidence on the utility of social resources in overcoming barriers to healthcare utilization in a developing country context. We sought to assess the relevance of social resources in overcoming barriers to healthcare utilization. Study Objective: To explore community perceptions among three different wealth categories on factors influencing healthcare utilization in Eastern Uganda. Methods: We used a qualitative study design using Focus Group Discussions (FGD) to conduct the study. Community meetings were initially held to identify FGD participants in the different wealth categories, ('least poor', 'medium' and 'poorest') using poverty ranking based on ownership of assets and income sources. Nine FGDs from three homogenous wealth categories were conducted. Data from the FGDs was analyzed using content analysis revealing common barriers as well as facilitating factors for healthcare service utilization by wealth categories. The Health Access Livelihood Framework was used to examine and interpret the findings. Results: Barriers to healthcare utilization exist for all the wealth categories along three different axes including: the health seeking process; health services delivery; and the ownership of livelihood assets. Income source, transport ownership, and health literacy were reported as centrally useful in overcoming some barriers to healthcare utilization for the 'least poor' and 'poor' wealth categories. The 'poorest' wealth category was keen to utilize free public health services. Conversely, there are perceptions that public health facilities were perceived to offer low quality care with chronic gaps such as shortages of essential supplies. In addition to individual material resources and the availability of free public healthcare services, social resources are perceived as important in overcoming utilization barriers. However, there are indications that having access to social resources may compensate for the lack of material resources in relation to use of health care services mainly for the least poor wealth category.

2024

Due to heterogeneity in Data and Processes, healthcare systems are facing the challenge of interoperability. This heterogeneity results in different healthcare workflows of each individual organization. The compatibility of these heterogeneous workflows is possible when standards are followed. HL7 is one of the standards that is used for communicating medical data between healthcare systems. Its newer version V3 is providing semantic interoperability which is lacking in V2. The interoperability in HL7 V3 is only limited to data level and process level interoperability needs to be catered. The process level interoperability is achieved only when heterogeneous workflows are aligned. These workflows are very complex in nature due to continuous change in medical data resulting in problems related to maintenance and degree of automation. Semantic technologies plays important role in resolving the above mentioned problems. This research work is based on the integration of semantic technology in HL7 V3 standard to achieve semantic process interoperability. Web Service Modeling Framework (WSMF) is used for incorporating semantics in HL7 V3 processes and achieves seamless communication. Interaction Ontology represents the process artifacts of HL7 V3 and helps in achieving automation.

2024, ed Res 2024;4(2): This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non-Commercial-ShareAlike 4.0 International License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is g...

Background: Myocardial infarction (MI) can have significant physical and mental consequences. Depression is a prevalent psychiatric condition after MI which can reduce the quality of life and increase the mortality rates of patients. The link between depression and poor cardiac outcomes has prompted clinical trials investigating the impact of treating depression on both outcomes. Methods: In this paper, we discussed about post Myocardial infarction depression, its Prevalence, pathophysiologic mechanisms, such as neurobiological mechanisms of post-MI depression, Hypothalamic-pituitary-adrenal axis and autonomic nervous system, environmental factors, like lack of social support, lifestyle changes, economic status and health related anxiety. Results: By 2030, depressive disorders are projected to become the first leading cause of disease burden in high-income countries and the second leading cause globally. Depression is prospectively linked to negative cardiac outcomes, regardless of other cardiovascular risk factors. In individuals who are initially healthy, depression is correlated with a greater likelihood of developing heart disease compared to those without depression. Conclusion: We have concluded that several factors including the dysregulation of the autonomic nervous system and Hypothalamicpituitary-adrenal axis, various environmental factors, and genetics can be contributed to the correlation between Myocardial infarction and depression.

2024, Med Res 2024;4(2): This is an open access journal, and articles are distributed under the terms of the Creative Commons Attribution-Non-Commercial-ShareAlike 4.0 International License, which allows others to remix, tweak, and build upon the work non-commercially, as long as appropriate credit is ...

2024, Disability and Health Journal

initiated the study, had overall responsibility for the study design and data analysis, and drafted the manuscript. Donato Papini participated in the design of the study, designed the data retrieval requests for AUSL 11, reviewed and translated the all of the data headings, played a key role in data analysis and help prepare the manuscript. Francesco Benvenuti participated in the design of the study, reviewed the data, participated in the data analysis and interpretation of data, and edited the manuscript. Marco Nerattini participated in the design of the study, designed the data retrieval requests for AUSL 10, and participated in the data analysis. Enrico Roccato, Velio Macellari, Steven Stanhope, and Richard Macko participated in the design of the study, reviewed the data analysis and edited the manuscript. Michael Weinrich participated in the design of the study, assisted in data analysis and helped prepare the manuscript.

2024

in this series aim to provide a vehicle for publishing preliminary and unpolished results on HNP topics to encourage discussion and debate. The findings, interpretations, and conclusions expressed in this paper are entirely those of the author(s) and should not be attributed in any manner to the World Bank, to its affiliated organizations or to members of its Board of Executive Directors or the countries they represent. Citation and the use of material presented in this series should take into account this provisional character. For free copies of papers in this series please contact the individual authors whose name appears on the paper. Enquiries about the series and submissions should be made directly to

2024, Reaching the Poor with …

9 India: Assessing the Reach of Three SEWA Health Services among the Poor M. Kent Ranson, Palak Joshi, Mittal Shah, and Yasmin Shaikh The Self-Employed Women's Association (SEWA), a trade union of informal women workers, was founded... more

2024

This paper presents a new Java oriented monitoring infrastructure that enables tools to observe, analyze and manipulate the execution of distributed Java applications independent of implementation details like instrumentation of monitored entities, hardware platform and application libraries. Tools can access the monitored application via a standardized interface defined by an On-Line Monitoring Interface Specification (OMIS) and extended by a set of new Java-specific services relating to garbage collection, class loading, remote method invocation, etc. The new monitoring functionality can be applied for building various kinds of tools and for adapting the already existing ones, such as performance analyzers, debuggers, etc., working in the on-line mode.

2024, PubMed

Objective To investigate the relation between decentralization and equity of resource allocation in Colombia and Chile. Methods The ''decision space'' approach and analysis of expenditures and utilization rates were used to provide a comparative analysis of decentralization of the health systems of Colombia and Chile. Findings Evidence from Colombia and Chile suggests that decentralization, under certain conditions and with some specific policy mechanisms, can improve equity of resource allocation. In these countries, equitable levels of per capita financial allocations at the municipal level were achieved through different forms of decentralization-the use of allocation formulae, adequate local funding choices and horizontal equity funds. Findings on equity of utilization of services were less consistent, but they did show that increased levels of funding were associated with increased utilization. This suggests that improved equity of funding over time might reduce inequities of service utilization. Conclusion Decentralization can contribute to, or at least maintain, equitable allocation of health resources among municipalities of different incomes.

2024

Contents Acknowledgements Section one: background, method and summary of results Background Method: search strategy and results Summary of the literature reviewed References Section two: the research literature Layout of the review 2.1) General and miscellaneous health and social care services 2.2) Asthma 2.3) Cardiovascular health 2.4) Children 2.5) Dental service use 2.6) Diabetes and hypertension 2.7) Disability 2.8) Ethnic elders 2.9) Eye conditions 2.10) HIV/AIDS 2.11) Head injury 2.12) Hospice and palliative care 2.13) Mental health 2.14) Renal care 2.15) Sickle cell and thalassaemia 2.16) Substance use and abuse 2.17) Travellers 2.18) Women's sexual and reproductive health AgeInfo-an information service about old age and ageing provided by the Library and Information Service of the Centre for Policy on Ageing (UK). Includes a bibliographic database based on written material in the library catalogue. ASSIA-Applied Social Sciences Indexes and Abstracts (USA). CareData-abstract database of relevant social work and social care literature. Developed by the National Institute of Social work (UK). Community WISE-contains seven databases on social policy and welfare issues worldwide, from data provided by Barnardo's, Community Development Foundation, National Centre for Volunteering and the National Youth Agency (UK). EMBASE-Excerpta Medica database, renowned for its international coverage of drug-related research literature. It covers all aspects of human medicine and related biomedical research with an emphasis on European-based research. IBSS-International Bibliography of the Social Sciences via BIDS (USA). ISI Web of Science (Social Sciences Citation Index)the Social Sciences Citation Index is a multidisciplinary database indexing more than 1,725 journals spanning 50 disciplines. MEDLINE-corresponds to three printed indexes: Index Medicus, International Nursing Index, and Index to Dental Literature. Accessed via the NLM's PubMed portal and including PreMedline.

2024, The Journal of Rural Health

Context-Mexico Purpose-Using the health care service utilization model as a framework, this paper will analyze the differences in health care service use among older Mexicans living in urban and rural areas in Mexico. Methods-The Mexican Health and Aging Survey (MHAS) data were used to test the applicability of Andersen's "model of health services" of predisposing (ie, age, sex, etc.), enabling (education, insurance coverage, etc.) and need factors (diabetes, hypertension, etc.) to predict ever being in the hospital and physician visits in the past year by place of residence (urban, rural, semirural). Findings-Results showed that older Mexicans living in the most rural areas (populations of 2500 or fewer) were significantly less likely to have been hospitalized in the previous year and visited the physician less often (P < .0001) than their urban counterparts. The significant difference in hospitalization between rural and urban residing older Mexicans was largely accounted for by having health care coverage. Certain need factors such as diabetes, previous heart attack, hypertension, depression, and functional limitations predicted frequency of physician visits and hospitalization, but they did not explain variations between rural and urban older Mexicans. Conclusions-Not having insurance coverage was associated with a lower likelihood of spending an overnight visit in the hospital and visiting a physician for older Mexicans. This lower utilization may be due to barriers to access rather than better health. Keywords hospitalization; insurance; Mexico; rural; urban The epidemiological transition has progressed through much of Mexico and, as a result, the population in Mexico is aging quickly.1 Mexico has now reached the juncture where health and quality of life in older age are a public health focus, yet little effort has been made to

2024, Archives of Gerontology and Geriatrics

2024, BMC Health Services Research

Background The reliability of self-report regarding health care utilization in inflammatory bowel disease (IBD) is unknown. If proven reliable, it could help justify self-report as a means of determining health care utilization and associated costs. Methods The Manitoba IBD Cohort Study is a population-based longitudinal study of participants diagnosed within 7 years of enrollment. Health care utilization was assessed through standardized interview. Participants (n = 352) reported the total number of nights hospitalized, frequency of physician contacts in the prior 12 months and whether the medical contacts were for IBD-related reasons or not. Reports of recent antibiotic use were also recorded. Actual utilization was drawn from the administrative database of Manitoba Health, the single comprehensive provincial health insurer. Results According to the administrative data, 15% of respondents had an overnight hospitalization, while 10% had an IBD-related hospitalization. Self-report c...

2024, Health and Quality of Life Outcomes

Background: The 12-item Health Survey (SF-12) was developed as a shorter alternative to the SF-36 for use in large-scale studies, particularly when overall physical and mental health are the outcomes of interest instead of the typical eight-scale profile. The main purpose of this study was to assess the validity of the Greek version of the SF-12. Methods: A stratified representative sample (N = 1005) of the Greek general population was interviewed. The survey included the SF-36, the EQ-5D and questions on socio-demographic and health-related characteristics. SF-12 summary scores were derived using the standard US algorithm. Factor analysis was used to confirm the hypothesized component structure of the SF-12 items. Construct validity was investigated with "known groups" validity testing and via convergent and divergent validity, which in turn were assessed by the correlations with the EQ-5D dimensions. Concurrent validity was assessed by comparisons with SF-36 summary scores. Results: SF-12 summary scores distinguished well, and in the expected manner, between groups of respondents on the basis of gender, age, education, socioeconomic status, self-reported health problems and health services utilization, thus providing evidence of construct validity. Effect size differences between SF-36 and SF-12 summary scores were generally small (<0.2), supporting concurrent (criterion) validity. Significantly lower mean PCS-12 and MCS-12 scores were observed for respondents reporting chronic conditions compared to those without (P < 0.001). Convergent and divergent validity were supported by expected relationships with the EQ-5D. Reporting a problem in an EQ dimension was associated with lower SF-12 summary scores, supporting concurrent validity. Sensitivity of the Greek SF-12 and replication of the original measurement and conceptual model were demonstrated. Conclusion: The results provide evidence on the validity of the Greek SF-12 and, in conjunction to future studies addressing test-retest reliability and responsiveness, support its use in Greek health status studies as a brief, yet valid, alternative to the SF-36.

2024, Social Psychiatry and Psychiatric Epidemiology

2024, INFLUENCE OF VITAMIN C ON ETOMIDATE-INDUCED ADRENAL SUPPRESSION: A LITERATURE REVIEW (Atena Editora)

Introduction: The use of etomidate has been limited due to its ability to induce adrenal suppression, and cortisol is known to play a fundamental role in maintaining hemodynamic stability. Vitamin C appears to promote the formation of cortisol in patients with etomidate-induced adrenal suppression, since it plays an important role in the synthesis of endogenous cortisol. Objectives: To summarize the outcomes of clinical trials conducted to date to evaluate the influence of vitamin C administration on etomidate-induced adrenal suppression. Methods: This is a descriptive bibliographical research based on a free literature review. The articles and texts used for analysis were published in the last 10 years in the PubMED, Cochrane Library, Embase and Scielo databases, using the Boolean operators “AND” and “OR”, and 13 works were selected. Results: Randomized clinical trials corroborate this finding, evaluating control groups (induced with etomidate) and intervention groups (induced with etomidate and administration of vitamin C), and finding statistically significant values (p<0.01) in serum cortisol levels. In addition, a recent meta-analysis associated the use of etomidate with mortality, and suggests that adrenal suppression is an important factor in this process. Conclusion: The administration of vitamin C appears safe and effective in maintaining serum cortisol levels, and it may be possible that it promotes a reduction in negative outcomes. However, some limitations, such as the low number of randomized clinical trials, make it difficult to consolidate the findings. The present study suggests that new clinical trials be conducted for elucidation purposes.

2024, European Journal of Pain

Guidelines portray low back pain (LBP) as a benign self-limiting disease which should be managed mainly by primary care physicians. For the German health care system we analyze which factors are associated with receiving specialist care and how this affects treatment. This is a longitudinal prospective cohort study. General practitioners recruited consecutive adult patients presenting with LBP. Data on physical function, on depression, and on utilization of health services were collected at the first consultation and at follow-up telephone interviews for a period of 12 months. Logistic regression models were calculated to investigate predictors for specialist consultations and use of specific health care services. Large proportions (57%) of the 1342 patients were seeking additional specialist care. Although patients receiving specialist care had more often chronic LBP and a positive depression score, the association was weak. A total of 623 (46%) patients received some form of imaging, 654 (49%) physiotherapy and 417 (31%) massage. Consulting a specialist remained the strongest predictor for imaging and therapeutic interventions while disease-related and socio-demographic factors were less important. Our results suggest that the high use of specialist care in Germany is due to the absence of a functioning primary care gate keeping system for patient selection. The high dependence of health care service utilization on providers rather than clinical factors indicates an unsystematic and probably inadequate management of LBP.

2024, The Clinical Journal of Pain

Objective: Epidemiologic surveys frequently show that women more often and are more affected by low back pain (LBP). The aim of this secondary analysis of a randomized controlled study was to explore whether presentation and course of LBP of women is different from men, and if sex affects the use of healthcare services for LBP. Methods: Data from 1342 [778 (58%) women] patients presenting with LBP in 116 general practices were collected. Patients completed standardized questionnaires before and after consultation and were contacted by phone 4 weeks, 6 months, and 12 months later for standardized interviews by study nurses. Functional capacity was assessed with Hannover Functional Ability Questionnaire (HFAQ). Logistic regression modelsadjusting for sociodemographic and disease-related data-were conducted to investigate the effect of sex for the use of healthcare services. Results: Women had on average a lower functional capacity at baseline and after 12 months. They were more likely to have recurrent or chronic LBP and to have a positive depression score. Being female was associated with a low functional capacity after 12 months (odds ratio: 1.7, 95% confidence interval: 1.2-2.3), but baseline functional capacity, chronicity, and depression were stronger predictors. In univariate analysis, women had a tendency of higher use of healthcare services. Those differences disappeared after adjustment. Discussion: Our findings confirm that women are more severely affected by LBP and have a worse prognosis. Utilization of healthcare services cannot be fully explained by female sex, but rather by a higher impairment by back pain and pain in other parts of the body characteristic of the female population.

2024, National Journal of Community Medicine

Introduction: Multi Indicator Cluster Survey (MICS) method is popular for assessment of health service coverage. Aims and objectives: To know utilization of health care services among women who delivered in last year (2010-11).... more

2024, Health Services Research

Objective. To analyze the relationships between illicit drug use and three types of health services utilization: emergency room utilization, hospitalization, and medical attention required due to injury(s). Data. Waves 1 and 2 (11,253 males and 13,059 females) from the National Epidemiologic Survey on Alcohol and Related Conditions (NESARC). Study Design. We derive benchmark estimates by employing standard cross-sectional data models to pooled waves of NESARC data. To control for potential bias due to time-invariant unobserved individual heterogeneity, we reestimate the relationships with fixed-effects models. Principal Findings. The cross-sectional data models suggest that illicit drug use is positively and significantly related to health services utilization in almost all specifications. Conversely, the only significant (po.05) relationships in the fixed-effects models are the odds of receiving medical attention for an injury and the number of injuries requiring medical attention for men, and the number of times hospitalized for men and women. Conclusions. Failing to control for time-invariant individual heterogeneity could lead to biased coefficients when estimating the effects of illicit drug use on health services utilization. Moreover, it is important to distinguish between types of drug user (casual versus heavy) and estimate gender-specific models.

2024, Social Science & Medicine

Calls for household surveys to provide information on service utilization in less developed countries raise questions regarding the accuracy and reliability of reporting. This paper compares reported to recorded health service utilization for diarrhoea and any other morbidity over a 2-week and 3-month period for information obtained from a household survey in Grenada, West Indies. A sensitivity analysis is used to derive minimum and maximum estimates of the accuracy of reported utilization. Over-reporting utilization was found to be between 33 and 62% for diarrhoea and 49 and 81% for any other morbidity. Under-reporting of all utilization was estimated to be between 47 and 65%. These results cast doubt on the utility of household surveys as a reliable source of information regarding service utilization.

2024

XML is spreading quickly as a format for electronic documents and messages. As a consequence, greater importance is being placed on the XML security technology. Against this background research and development efforts into XML security are being energetically pursued. This paper discusses the W3C XML Signature and XML Encryption specifications, which represent the fundamental technology of XML security, as well as other related technologies originally developed by NEC. Web Service Transactions are done mainly through plain-text XML formats like SOAP and WSDL, hence hacking them is not a tedious task. XML Signature and XML Encryption ensure security to XML documents as well as retain the structure of the documents, thereby making it easy to implement them. These two methods are evaluated on the parameters of authentication, authorization, integration, confidentiality and non-repudiation.