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Pediatric Vaccination and Vaccine-Preventable Disease Acquisition: Associations with Care by Complementary and Alternative Medicine Providers

Downey, Lois; Tyree, Patrick T.; Huebner, Colleen E.; Lafferty, William E.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /11/2010 EN
Relevância na Pesquisa
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This study investigated provider-based complementary/alternative medicine use and its association with receipt of recommended vaccinations by children aged 1–2 years and with acquisition of vaccine-preventable disease by children aged 1–17 years. Results were based on logistic regression analysis of insurance claims for pediatric enrollees covered by two insurance companies in Washington State during 2000–2003. Primary exposures were use of chiropractic, naturopathy, acupuncture, or massage practitioner services by pediatric enrollees or members of their immediate families. Outcomes included receipt by children aged 1–2 years of four vaccine combinations (or their component vaccines) covering seven diseases, and acquisition of vaccine-preventable diseases by enrollees aged 1–17 years. Children were significantly less likely to receive each of the four recommended vaccinations if they saw a naturopathic physician. Children who saw chiropractors were significantly less likely to receive each of three of the recommended vaccinations. Children aged 1–17 years were significantly more likely to be diagnosed with a vaccine-preventable disease if they received naturopathic care. Use of provider-based complementary/alternative medicine by other family members was not independently associated with early childhood vaccination status or disease acquisition. Pediatric use of complementary/alternative medicine in Washington State was significantly associated with reduced adherence to recommended pediatric vaccination schedules and with acquisition of vaccine-preventable disease. Interventions enlisting the participation of complementary/alternative medicine providers in immunization awareness and promotional activities could improve adherence rates and assist in efforts to improve public health.

Do deficits in cardiac care influence high mortality rates in schizophrenia? A systematic review and pooled analysis

Mitchell, Alex J; Lord, Oliver
Fonte: SAGE Publications Publicador: SAGE Publications
Tipo: Artigo de Revista Científica
Publicado em /11/2010 EN
Relevância na Pesquisa
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We have previously documented inequalities in the quality of medical care provided to those with mental ill health but the implications for mortality are unclear. We aimed to test whether disparities in medical treatment of cardiovascular conditions, specifically receipt of medical procedures and receipt of prescribed medication, are linked with elevated rates of mortality in people with schizophrenia and severe mental illness. We undertook a systematic review of studies that examined medical procedures and a pooled analysis of prescribed medication in those with and without comorbid mental illness, focusing on those which recruited individuals with schizophrenia and measured mortality as an outcome. From 17 studies of treatment adequacy in cardiovascular conditions, eight examined cardiac procedures and nine examined adequacy of prescribed cardiac medication. Six of eight studies examining the adequacy of cardiac procedures found lower than average provision of medical care and two studies found no difference. Meta-analytic pooling of nine medication studies showed lower than average rates of prescribing evident for the following individual classes of medication; angiotensin converting enzyme inhibitors (n = 6, aOR = 0.779...

Access to Adequate Outpatient Depression Care for Mothers in the US: A Nationally Representative Population-Based Study

Witt, Whitney P.; Keller, Abiola; Gottlieb, Carissa; Litzelman, Kristin; Hampton, John; Maguire, Jonathan; Hagen, Erika W.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
16.61%
Maternal depression is often untreated, resulting in serious consequences for mothers and their children. Factors associated with receipt of adequate treatment for depression were examined in a population-based sample of 2,130 mothers in the USA with depression using data from the 1996-2005 Medical Expenditure Panel Survey. Chi-squared analyses were used to evaluate differences in sociodemographic and health characteristics by maternal depression treatment status (none, some, adequate). Multivariate regression was used to model the odds of receiving some or adequate treatment, compared to none. Results indicated that only 34.8% of US mothers with depression received adequate treatment. Mothers not in the paid workforce and those with health insurance were more likely to receive treatment, while minority mothers and those with less education were less likely to receive treatment. Understanding disparities in receipt of adequate treatment is critical to designing effective interventions, reducing treatment inequities, and ultimately improving the mental health and health of mothers and their families.

Assistive Technology Use of Older American Indians in a Southeastern Tribe: The Native Elder Care Study

Goins, R. Turner; Spencer, S. Melinda; Goli, Srikanth; Rogers, Joan C.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /11/2010 EN
Relevância na Pesquisa
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The objectives of this study were to examine the prevalence of assistive technology (AT) use, type of assistance used for each activity of daily living (ADL) limitation, and correlates of AT use among Native Indian aged 55 and older. Data were collected as part of a cross-sectional study of disability with 505 members of a federally recognized tribe using in-person interviewer administered surveys. Participants who reported difficulty with ADLs, including bathing, dressing, eating, transferring, walking, toileting, grooming, and getting outside, were asked about AT use. Other measures were demographics, living arrangements, receipt of personal care, Medicare and Medicaid beneficiary status, number of chronic conditions, lower body function, and personal mastery. Results indicated that 22.3% of participants aged 55 and older and 26.0% aged 65 and older reported AT use. Toileting had the largest percentage of participants who relied on AT only and getting outside had the largest percentage of participants relying on a combination of AT and personal care. Multiple variable logistic regression analysis identified receipt of personal care, having more chronic conditions, and poorer lower body function as significantly associated with higher odds of AT use. The results suggest that there is greater AT use in this sample than in same-aged adults in national samples. This greater use may be reflective of a combination of higher disability rates...

A Reappraisal of Saphenous Vein Grafting

Yuan, Shi-Min; Jing, Hua
Fonte: Medknow Publications Publicador: Medknow Publications
Tipo: Artigo de Revista Científica
Publicado em //2011 EN
Relevância na Pesquisa
16.61%
Autologous saphenous vein grafting has been broadly used as a bypass conduit, interposition graft, and patch graft in a variety of operations in cardiac, thoracic, neurovascular, general vascular, vascular access, and urology surgeries, since they are superior to prosthetic veins. Modified saphenous vein grafts (SVG), including spiral and cylindrical grafts, and vein cuffs or patches, are employed in vascular revascularization to satisfy the large size of the receipt vessels or to obtain a better patency. A loop SVG helps flap survival in a muscle flap transfer in plastic and reconstructive surgery. For dialysis or transfusion purposes, a straight or loop arteriovenous fistula created in the forearm or the thigh with an SVG has acceptable patency. The saphenous vein has even been used as a stent cover to minimize the potential complications of standard angioplasty technique. However, the use of saphenous vein grafting is now largely diminished in treating cerebrovascular disorders, superior vena cava syndrome, and visceral revascularization due to the introduction of angioplasty and stenting techniques. The SVG remains the preferable biomaterial in coronary artery bypass, coronary ostioplasty, free flap transfer, and surgical treatment of Peyronie disease. Implications associated with saphenous vein grafting in vascular access surgery for the purpose of dialysis and chemotherapy are considerable. Vascular cuffs and patches have been developed as an important and effective means of enhancing the patency rates of the grafts by linking the synthetic material to the receipt vessel. In addition...

Maternal Depressive Symptoms and Participation in Early Intervention Services for Young Children

Feinberg, Emily; Donahue, Sara; Bliss, Robin; Silverstein, Michael
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /02/2012 EN
Relevância na Pesquisa
16.61%
Many young children with developmental delay who are eligible for early intervention (EI) services fail to receive them. We assessed the relationship between depressive symptoms in mothers, a potentially modifiable risk, and receipt of EI services by their eligible children. We conducted multivariable analyses of a nationally representative sample of children eligible for EI services at 24 months using data from the Early Childhood Longitudinal Study-Birth Cohort. Maternal depressive symptoms were assessed at 9 and 24 months. Birthweight <1,000 g, genetic and medical conditions associated with developmental delay, or low scores on measures of developmental performance defined EI eligibility. Service receipt was ascertained from parental self-report. Models were adjusted for sociodemographic and child risk. Among the 650 children who were eligible to receive EI services as infants, 33.2% of children whose mothers were depressed received services compared to 27.0% whose mothers were not depressed (aOR 1.8; 95% CI 0.8, 4.0). Among the 650 children who became eligible to receive services as toddlers, 13.0% of children whose mothers were depressed received services compared to 2.6% whose mothers were not depressed (aOR 4.6, 95% CI 1.5, 14.6). Among children receiving EI services...

High-Risk Offenders Participating in Court-Supervised Substance Abuse Treatment: Characteristics, Treatment Received, and Factors Associated with Recidivism

Evans, Elizabeth; Huang, David; Hser, Yih-Ing
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/2011 EN
Relevância na Pesquisa
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High-risk offenders treated by California’s Proposition 36 court-supervised drug treatment initiative account for a disproportionate number of re-arrests (Hawken 2008) undermining the many successes of the program, yet little is known about their characteristics, treatment experiences, or factors that influence re-arrest. To better understand this group, self-reported and administrative data were analyzed on 78 high-risk (five or more convictions in the previous 5 years) and 1,009 low-risk offenders enrolled during 2004. At intake, high-risk offenders were younger, more were male, and more had prior contact with psychiatric and criminal justice systems. Treatment received and the proportion recidivated during the 30-months after treatment assessment were similar across groups, but high-risk offenders had a greater number of re-arrests. The number of re-arrests was increased by high-risk classification, but decreased by receipt of more treatment services and longer treatment length. Moreover, the number of re-arrests was highest among high-risk offenders with shorter treatment lengths, whereas it was similar to that among low-risk offenders if treatment length was longer. To reduce recidivism among high-risk offenders in court-supervised drug treatment...

Immediate effects of anterior to posterior talocrural joint mobilizations following acute lateral ankle sprain

Cosby, Nicole L; Koroch, Michael; Grindstaff, Terry L; Parente, William; Hertel, Jay
Fonte: Maney Publishing Publicador: Maney Publishing
Tipo: Artigo de Revista Científica
Publicado em /05/2011 EN
Relevância na Pesquisa
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Restrictions in ankle dorsiflexion range of motion (ROM) have been associated with decreased posterior talar glide in individuals with an acute lateral ankle sprain. Talocrural joint mobilizations may be used to restore joint arthrokinematics. Our purpose was to examine the effects of a single bout of anterior to posterior (AP) talocrural joint mobilization on self-reported function, dorsiflexion ROM, and posterior talar translation in individuals with an acute lateral ankle sprain. This single-blinded, randomized controlled trial utilized 17 volunteers (nine treatment and eight control) with an acute lateral ankle sprain (grade I/II) who were immobilized for a period of 1–7 days. The treatment group received a single 30-second bout of grade III AP talocrural joint mobilization the day their immobilization device was removed, while the control group did not receive any intervention. Active dorsiflexion ROM and posterior talar translation were assessed before, immediately after, and 24 hours after receipt of the treatment or control interventions. Self-reported function and pain were assessed before and 24 hours after the receipt of the treatment or control interventions using the foot and ankle disability index. Collectively all groups demonstrated improved dorsiflexion ROM and self-reported function. There was a significant decrease in pain perception at 24-hour follow-up for the treatment group. A single bout of AP talocrural joint mobilizations may not have an immediate effect on ankle dorsiflexion ROM...

WELFARE AND THE CHILDREN OF IMMIGRANTS: TRANSMISSION OF DEPENDENCE OR INVESTMENT IN THE FUTURE?

Balistreri, Kelly Stamper
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em /10/2010 EN
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The public concern that immigrant families might be using a disproportionate share of social benefits and transmitting some form of public dependency to their children, combined with the rising levels of immigrants entering the country, fueled the passage of the Personal Responsibility and Work Opportunity Reconciliation Act in 1996, which limited public assistance to many immigrant families. This paper uses the National Longitudinal Survey of Youth 1997 to explore the association between exposure to welfare and young adult outcomes of high school graduation, college enrollment and labor force participation with a focus on parental nativity status as well as broad country of origin group. Results indicate a persistent negative association between welfare legacy and high school graduation; a negative association that is most pronounced for children of natives. Results also show the largest positive effect of welfare receipt among the most disadvantaged group, the young adult children of immigrants from Mexican and Central American countries. The main finding of this study suggests that the negative impacts of welfare receipt might be lessened and in some cases reversed among the young adults from immigrant families. Such findings challenge the common notion that immigrant families use welfare as a crutch across generations and raise serious concern about U.S. immigration and welfare policies.

Correlates of 2009 H1N1 influenza vaccine acceptability among parents and their adolescent children

Painter, Julia E.; Gargano, Lisa M.; Sales, Jessica M.; Morfaw, Christopher; Jones, LaDawna M.; Murray, Dennis; DiClemente, Ralph J.; Hughes, James M.
Fonte: Oxford University Press Publicador: Oxford University Press
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
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School-aged children were a priority group for receipt of the pandemic (2009) H1N1 influenza vaccine. Both parental and adolescent attitudes likely influence vaccination behaviors. Data were collected from surveys distributed to middle- and high-school students and their parents in two counties in rural Georgia. Multivariable logistic regression analyses were conducted to assess correlates of parental acceptance of H1N1 influenza vaccination for their children and adolescents’ acceptance of vaccination for themselves. Concordance analyses were conducted to assess agreement between parent–adolescent dyads regarding H1N1 influenza vaccine acceptance. Parental acceptance of H1N1 influenza vaccination for their children was associated with acceptance of the vaccine for themselves and feeling motivated by the H1N1 influenza pandemic to get a seasonal influenza vaccine for their child. Adolescents’ acceptance was associated with receipt of a seasonal influenza vaccine in the past year, fear of getting H1N1 influenza, feeling comfortable getting the vaccine and parental acceptance of H1N1 influenza vaccine. Half (50%) of parent–adolescent pairs included both a parent and child who expressed H1N1 influenza vaccine acceptance, and 19% of pairs would not accept the vaccine. This research highlights the need for interventions that target factors associated with H1N1 influenza vaccine acceptance among both parents and adolescents.

Youth at Risk for Obesity Show Greater Activation of Striatal and Somatosensory Regions to Food

Stice, E; Yokum, S; Burger, KS; Epstein, LH; Small, DM
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
Publicado em 23/03/2011 EN
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Obese versus normal-weight humans have less striatal D2 receptors and striatal response to food intake, and weaker striatal response to food predicts weight gain for individuals at genetic risk for reduced dopamine (DA) signaling, consistent with the reward deficit theory of obesity. Yet these may not be initial vulnerability factors, as overeating reduces D2 receptor density, D2 sensitivity, reward sensitivity, and striatal response to food. Obese versus normal-weight humans also show greater striatal, amygdalar, orbitofrontal cortex, and somatosensory region response to food images, which predicts weight gain for those not at genetic risk for compromised dopamine signaling, consonant with the reward surfeit theory of obesity. However, after pairings of palatable food intake and predictive cues, DA signaling increases in response to the cues, implying that eating palatable food contributes to increased responsivity. We tested whether normal-weight adolescents at high- versus low-risk for obesity showed aberrant activation of reward circuitry in response to receipt and anticipated receipt of palatable food and monetary reward using fMRI. High-risk youth showed greater activation in the caudate, parietal operculum, and frontal operculum in response to food intake and in the caudate...

Disability Pension Rates Among Immigrants in Norway

Claussen, Bjørgulf; Smeby, Lisbeth; Bruusgaard, Dag
Fonte: Springer US Publicador: Springer US
Tipo: Artigo de Revista Científica
EN
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Immigrants from low-income countries are more likely than ethnic Norwegians to receive disability pensions. In a previous study in Oslo, we showed that occupational position probably accounted for all of this difference. The present article presents a study of the total population, with data on education and age at receipt of pension. Census and social security data for all persons living in Norway from 1992 to 2003 were used to identify new disability pensions to those aged 30–55 years and eligible in 1992, comprising 15.9% females and 11.4% males. Age-adjusted relative risk was 2.03 (95% CI 1.97–2.08) for non-Western males and 1.30 (1.26–1.36) for non-Western females compared with Westerners, and more than three times higher for males from North Africa/the Middle East. Education did not explain any of the risk differences, but when adjusting for age at pension receipt the differences disappeared completely. This is probably due to their being in predominantly unskilled occupations where there is also a low pension age among ethnic Norwegians.

Sexual Dimorphism in Hematocrit Response Following Red Blood Cell Transfusion of Critically Ill Surgical Patients

Pieracci, Fredric M.; Barnett, Carlton C.; Townsend, Nicole; Moore, Ernest E.; Johnson, Jeffery; Biffl, Walter; Bensard, Denis D.; Burlew, Clay C.; Gerber, Andrew; Silliman, Christopher C.
Fonte: International Scholarly Research Network Publicador: International Scholarly Research Network
Tipo: Artigo de Revista Científica
Publicado em 22/03/2012 EN
Relevância na Pesquisa
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The change in hematocrit (ΔHct) following packed red blood cell (pRBCs) transfusion is a clinically relevant measurement of transfusion efficacy that is influenced by post-transfusion hemolysis. Sexual dimorphism has been observed in critical illness and may be related to gender-specific differences in immune response. We investigated the relationship between both donor and recipient gender and ΔHct in an analysis of all pRBCs transfusions in our surgical intensive care unit (2006–2009). The relationship between both donor and recipient gender and ΔHct (% points) was assessed using both univariate and multivariable analysis. A total of 575 units of pRBCs were given to 342 patients; 289 (49.9%) donors were male. By univariate analysis, ΔHct was significantly greater for female as compared to male recipients (3.81% versus 2.82%, resp., P < 0.01). No association was observed between donor gender and ΔHct, which was 3.02% following receipt of female blood versus 3.23% following receipt of male blood (P = 0.21). By multivariable analysis, recipient gender remained associated significantly with ΔHct (P < 0.01). In conclusion, recipient gender is independently associated with ΔHct following pRBCs transfusion. This association does not appear related to either demographic or anthropomorphic factors...

Prevalence and Predictors of Service Utilization Among Racially and Ethnically Diverse Adolescents in Foster Care Diagnosed With Mental Health and Substance Abuse Disorders

GARCIA, ANTONIO; COURTNEY, MARK
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
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This study examined the prevalence of mental health and substance abuse disorders and service utilization among a racially and ethnically diverse group of foster youth. Self-report data on symptoms and service receipt were used to identify whether groups of adolescents defined by their race and ethnicity were equally likely to receive services given the presence of a mental health or substance use disorder. Study findings showed that Caucasians are more likely to receive mental health services than African Americans. Race was not a significant predictor of accessing substance abuse services. Hispanic ethnicity was not a predictor of receipt of mental health or substance abuse treatment services. Implications for future research, practice, and policy are discussed.

Clostridium difficile-Associated Disease in Allogeneic Hematopoietic Stem Cell Transplant Recipients: Risk Associations, Protective Associations, and Outcomes

Dubberke, Erik R.; Reske, Kimberly A.; Srivastava, Anand; Sadhu, Justin; Gatti, Robert; Young, Rebecca M.; Rakes, Lauren C.; Dieckgraefe, Brian; DiPersio, John; Fraser, Victoria J.
Fonte: PubMed Publicador: PubMed
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
16.61%
The purpose of this study was to evaluate risk factors, protective factors, and outcomes associated with Clostridium difficile-associated disease (CDAD) in allogeneic hematopoietic stem cell transplant (HSCT) recipients. A case-control study was performed with 37 CDAD cases and 67 controls. In the multivariable logistic regression analysis, receipt of a 3rd or 4th generation cephalosporin was associated with increased risk of CDAD (OR=4.6, 95% CI 1.6 – 13.1). Receipt of growth factors was associated with decreased risk of CDAD (OR=0.1, 95% CI 0.02 – 0.3). Cases were more likely to develop a blood stream infection after CDAD than were controls at any point before discharge (p<0.001). CDAD cases were more likely than controls to develop new onset GVHD (p<0.001), new onset severe GVHD (p<0.001), or new onset gut GVHD (p=0.007) after CDAD/discharge. Severe CDAD was a risk factor for death at 180 days in multivariable Cox proportional hazards regression (HR=2.6, 95% CI 1.1 – 6.2). CDAD is a significant cause of morbidity and mortality in allogeneic HSCT patients, but modifiable risk factors exist. Further study is needed to determine the best methods of decreasing patients’ risk of CDAD.

Trends in Nutrition and Exercise Counseling among Adolescents in the Health Care Environment

Peart, Tasha; Crawford, Patricia B.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
Relevância na Pesquisa
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Purpose. Obesity is a serious health threat, particularly among racial/ethnic minorities and those who are uninsured, yet little is known about the implementation of nutrition or exercise counseling or the combination of both among these groups. Trends in counseling by race/ethnicity and types of insurance were examined. Methods. Trend analyses were conducted with the California Health Interview Surveys among those ages 12–17 for the period 2003–2009. Results. Race/Ethnicity: Receipt of both counseling methods declined from 2003–2009 for all racial/ethnic groups, except Hispanics and Whites, for whom increases in counseling began after 2007. Hispanics and African Americans generally reported higher levels of nutrition than exercise counseling, while Whites generally reported higher levels of exercise than nutrition counseling for the study period. Insurance Type: Receipt of both counseling methods appeared to decline from 2003–2009 among all insurance types, although after 2007, a slight increase was observed for the low-cost/free insurance group. Those with private health insurance generally received more exercise counseling than nutrition counseling over the study period. Conclusions. Counseling among all racial/ethnic groups and insurance types is warranted...

Treatment Choices Based on OncotypeDx in the Breast Oncology Care Setting

Malo, Teri L.; Lipkus, Isaac; Wilson, Tobi; Han, Hyo S.; Acs, Geza; Vadaparampil, Susan T.
Fonte: Hindawi Publishing Corporation Publicador: Hindawi Publishing Corporation
Tipo: Artigo de Revista Científica
EN
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Introduction. This study aimed to evaluate whether OncotypeDx test results predict receipt of adjuvant chemotherapy in breast cancer patients who received an OncotypeDx recurrence score (RS). Materials and Methods. Pathology records were used to identify breast cancer patients who had OncotypeDx testing between December 2004 and January 2009 (n = 118). Patient sociodemographic information, tumor characteristics, RS, and treatment-specific data were collected via chart review. RS was classified as follows: low (RS ≤ 17), intermediate (RS = 18–30), or high (RS ≥ 31). Bivariate analyses were conducted to investigate the relationship between adjuvant chemotherapy receipt and each sociodemographic and clinical characteristic; significant sociodemographic and clinical variables were included in a multivariable logistic regression model. Results. In multivariable analysis controlling for tumor size, histologic grade, and nuclear grade, only RS remained significantly associated with chemotherapy uptake. Relative to low RS, an intermediate (adjusted odds ratio [AOR], 21.24; 95% confidence interval [CI], 3.62–237.52) or high (AOR, 15.07; 95% CI, 1.28–288.21) RS was associated with a greater odds of chemotherapy uptake. Discussion. Results indicate that RS was significantly associated with adjuvant chemotherapy uptake...

Narrowing the income gaps in preventive care for young children: Families in healthy steps

McLearn, Kathryn Taafe; Strobino, Donna M.; Minkovitz, Cynthia S.; Marks, Elisabeth; Bishai, David; Hou, William
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Publicado em /12/2004 EN
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Persistent unmet preventive and developmental health care needs of children in low-income families are a national concern. Recently, there have been efforts to promote developmental services as part of primary care for all young children. However, there is limited research to determine whether the neediest families are well in universal interventions. In our study, we assessed if disparities persist in utilization of developmental services, well child care, and satisfaction with care among low-, middle-, and high-income families participating in Healthy Steps for Young Children. Healthy Steps is a national experiment that incorporated developmental services into primary care for children from birth to 3 years of age. In the United States, 15 pediatric practices participated in this prospective study. At birth, 2,963 children were enrolled between September 1996 and November 1998 and followed through 33 months of age. The utilization of developmental services, satisfaction with care, and receipt of age-appropriate well child visits were measured at 30–33 months and adjusted for demographic and economic covariates. We found that the adjusted odds of low-income families did not differ from high-income families in receipt of four or more Healthy Steps services...

Access to health services in an urban community: Does source of care make a difference?

Merzel, Cheryl; Moon-Howard, Joyce
Fonte: Springer-Verlag Publicador: Springer-Verlag
Tipo: Artigo de Revista Científica
Publicado em /06/2002 EN
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16.61%
The importance of having a usual source of medical care is well established. Few studies, however, examine whether there are differences in health care utilization associated with the type of site used and whether having a primary clinician is more important than site in influencing utilization. The aim of this study was to examine these issues and assess the relative importance of usual source of care characteristics in determining access to a variety of health services. The study was based on a cross-sectional survey of a household probability sample of 695 adults from Central Harlem in New York City. Outcomes examined included use of hospitals as the regular source of care compared with other types of providers, having a usual clinician, receipt of various preventive health services, and illness-related utilization. Multiple logistic regression analysis indicated that men and people of lower socioeconomic status were significantly (P≤.05) more likely to rely on hospitals alone as the usual source of care. People who exclusively used hospitals for ambulatory services were 72% less likely to have a primary clinician compared with those using other types of medical care sources. Having a usual source of care of any type was a significant predictor of receipt of five of eight health care services examined; having a main clinician was associated with four of the services. However...

Using HIV Surveillance Data to Monitor Missed Opportunities for Linkage and Engagement in HIV Medical Care

Bertolli, Jeanne; Shouse, R Luke; Beer, Linda; Valverde, Eduardo; Fagan, Jennifer; Jenness, Samuel M; Wogayehu, Afework; Johnson, Christopher; Neaigus, Alan; Hillman, Daniel; Courogen, Maria; Brady, Kathleen A; Bolden, Barbara
Fonte: Bentham Open Publicador: Bentham Open
Tipo: Artigo de Revista Científica
Publicado em 07/09/2012 EN
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Monitoring delayed entry to HIV medical care is needed because it signifies that opportunities to prevent HIV transmission and mitigate disease progression have been missed. A central question for population-level monitoring is whether to consider a person linked to care after receipt of one CD4 or VL test. Using HIV surveillance data, we explored two definitions for estimating the number of HIV-diagnosed persons not linked to HIV medical care. We used receipt of at least one CD4 or VL test (definition 1) and two or more CD4 or VL tests (definition 2) to define linkage to care within 12 months and within 42 months of HIV diagnosis. In five jurisdictions, persons diagnosed from 12/2006-12/2008 who had not died or moved away and who had zero, or less than two reported CD4 or VL tests by 7/31/2010 were considered not linked to care under definitions 1 and 2, respectively. Among 13,600 persons followed up for 19-42 months; 1,732 (13%) had no reported CD4 or VL tests; 2,332 persons (17%) had only one CD4 or VL test and 9,536 persons (70%) had two or more CD4 or VL tests. To summarize, after more than 19 months, 30% of persons diagnosed with HIV had less than two CD4 or VL tests; more than half of them were considered to have entered care if entering care is defined as having one CD4 or VL test. Defining linkage to care as a single CD4 or VL may overestimate entry into care...