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Schaffer, Lisa. "The Lived Experience of Transgender College-Aged Students Receiving Healthcare". ScholarWorks @ UVM, 2015. http://scholarworks.uvm.edu/graddis/318.
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Background
There is a relative dearth of information regarding transgender patient perceptions of healthcare provider interactions and experiences. Previous studies have examined the experiences of transgender patients across multiple generations.
Purpose
This research focuses on understanding the lived experience of transgender college-aged students receiving healthcare. The goal of this research is to help inform the practices of healthcare providers in order to improve care experiences.
Methods
Hermeneutic phenomenology was utilized to illuminate the lived experiences of three college-aged transgender patients receiving healthcare. Interviews were conducted with research participants. After transcription, interview content was read and re-read for significant statements. Significant statements were then grouped to identify themes.
Results
Theme 1: provider knowledge. Study participants noted that provider knowledge was associated with several behaviors and impacted their feelings regarding the experience and willingness to seek future healthcare. The trans-friendly provider was identified as a provider who uses preferred language, shares decision-making, and is aware of medical treatments.
Theme 2: being defined. Study participants felt defined through a variety of provider interactions. These included experiences wherein providers question timelines of transition and question the patient regarding their identity using static terminology.
Theme 3: loss of power. Participants noted the experience of loss of control when receiving healthcare. Loss of control was felt in a variety of ways including: loss of control over naming, identity, and care decisions.
Conclusions
This research begins to identify emerging themes expressed by transgender college-aged patients. By identifying these themes, future research can be conducted to further clarify patient feelings associated with their experiences in seeking healthcare in order to inform provider behaviors. More research is needed regarding transgender patient experiences receiving healthcare and whether these experiences impact health outcomes.
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Brooker, Jennifer Anne, i n/a. "The Influence of the Constructs of Ageing on Gerontic Nursing Practice and Education: Reviewing the Past and Suggesting the Future". Griffith University. School of Nursing, 2005. http://www4.gu.edu.au:8080/adt-root/public/adt-QGU20050906.140153.
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This narrative inquiry traces and recounts an epiphaffic experience of a registered nurse on entering gerontic nursing, and her subsequent three-decade journey through the complexities and mazes of this nurse specialty. Such inquiry seeks to enable a better understanding of the realities of ageing and caring for older adults by opening up thinking and beliefs underpinning gerontic nursing work. Modern aged healthcare involves complex gerontic nursing actions, requiring highly skilled nursing personnel, but on the whole, gerontic nursing is dimly perceived and misunderstood by professional colleagues and the general public. Much of this misunderstanding is a legacy of an outdated ideology of gerontic nursing; yet these public beliefs, attitudes and interpretations are extremely powerful in determining aged care policy. As the population ages and more elderly people access healthcare services, society will be faced with an array of complex political and socioeconomic factors. This thesis aims to untangle such choices by pursuing the questions of: How have the constructs of ageing impacted on gerontic nursing practice and education?, What type of gerontic nurse will be required to provide future elderly care? and How will these people be educationally prepared for their new roles? Many of the constructs explored are dialectical in nature; that is, they have developed by inner conflict, the scheme of which is thesis and antithesis, or an original tendency and its opposing tendency. Such dialectical thinking has underpinned much of this thesis and in many instances, particularly in chapter 7, has taken the next step to the unification of these opposing tendencies; that is, synthesis, to create new understanding or meaning. Issues explored relate to: the ontology of ageing; the meaning of life; gerontophobia; Australia's changing population profile; changing aged healthcare systems; gerontic nursing cultural dilemmas; workforce planning; elder health in the future and gerontic nursing practice and education shifts. In a theoretical and methodological context, increasing difficulty with conventional epistemologies and the science founded on them is leading nurse theorists ever nearer to a postmodernist position. Narrative becomes a means through which gerontic nursing can accumulate and express cultural knowledge and critique procedure. The thesis exemplifies narrative's profound potential for underpinning the reconceptualisation of gerontic nursing practice and education. It is narrative's capacity to foreground the relationship between daily practice and knowledge that makes it a critical tool for the future of gerontic nursing inquiry. Narrative facilitates the paradigm, or more ontological shift from the dominant medical model of aged healthcare and 'tender loving care' rhetoric, to a therapeutic, caring-healing approach which has been in the margins in gerontic nursing practice. In the context of gerontic nurse education, narrative pedagogy offers new ways of thinking even in the midst of oppressive practices. Many issues remain unresolved about how gerontic nurses can be educated for future gerontic nursing practice. It would seem that aged care in Australia is a site of such organisational and cultural change, it threatens to undermine knowledge, care and understanding and shift care to untrained staff. The thesis illustrates how such approaches cloak much of gerontic nursing practice and devalue the intimate work of caring intelligently, emotionally and physically for frail older adults. However, while such tensions abound in gerontic nursing practice, the 2l~ century offers skilled gerontic nurses the opportunity to become key components in the refigured and redesigned aged healthcare delivery system. Research indicates that because few know enough about the sum of the future to impede well-constructed attempts at engaging in any new model design, taking any action is infinitely better than none. It is on this premise that Chapter seven posits a new model design for residential long-term aged care for older adults, believing that by imagining a different future, it can then be created and become a reality.
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Leinaar, Edward, Leigh Johnson, Ruby Yadav, Abir Rahman i Arshmam Alamian. "Healthcare Access, Pregnancy Intention, and Contraceptive Practices Among Reproductive-Aged Women Receiving Opioid Agonist Therapy in Northeast Tennessee". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/etsu-works/8153.
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Objectives: Women with substance use disorders often experience unique challenges to obtaining contraception and adhering to user-dependent methods. As a result, this at-risk population of women tends to have higher than average rates of unintended pregnancy. The objective of this study was to describe contraceptive use, pregnancy intentions, and adequacy of access to reproductive healthcare among women receiving opioid agonist therapy in northeast Tennessee.
Methods: A cross-sectional survey was piloted among female patients aged 18 to 55 years from two opioid agonist therapy clinics. Descriptive analyses were conducted using logistic regression to evaluate the statistical significance of bivariate associations.
Results: Of 91 participants, 84% reported having health insurance, with 70% perceiving having adequate access to health care. More than half had a history of unwanted pregnancy (53%), among whom few (23.1%) reported the consistent use of contraception at time of conception. Although most desired to avoid pregnancy (90%), only 59% of women reported the current use of regular contraception. Most of those not using regular contraception believed that they were not at risk for pregnancy (54.3%).
Conclusions: Although most participants reported adequate access to health care and a desire to avoid pregnancy, few reported the consistent use of regular contraception. Furthermore, misperceptions regarding pregnancy risk were common among participants. Research is needed to identify barriers to contraceptive acceptance and causes of pregnancy risk misperceptions in this population of women at increased risk of unintended pregnancy.
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Kent, Seamus. "Healthcare use and costs in relation to body mass index in over one million middle-aged and older women in England". Thesis, University of Oxford, 2017. http://ora.ox.ac.uk/objects/uuid:ffee946d-46ce-4c15-8261-bc4a2e663a66.
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Rates of overweight and obesity worldwide have increased substantially in recent decades. In England, over 60% of adults are now overweight or obese. Because excess weight is associated with higher risks of chronic conditions, including type-2 diabetes, cardiovascular disease, osteoarthritis, and certain cancers, as well as with premature death, it constitutes a major health burden. It is also associated with higher total healthcare spending, but how the associations differ in different healthcare settings is not well understood. I undertook a systematic literature review of studies that used individual participant data to estimate annual healthcare costs in relation to body mass index (BMI; in kg/m2). Compared to adults at healthy weight (i.e. BMI 18.5 to <25 kg/m2), total annual healthcare costs were found to be 12% and 36% higher for overweight (BMI 25 to <30 kg/m2) and obese (BMI >=20 kg/m2) adults, respectively. The associations were strongest for costs of medications (18% for overweight and 68% for obese adults), followed by inpatient care costs (12% and 34%), and ambulatory care costs (4% and 26%). Most of these studies used data from the United States, and were based on small-to-moderate numbers of participants, limiting their ability to reliably estimate healthcare costs in relation to grades of obesity or for different health conditions. There was no reliable evidence from individual participant data pertaining directly to the United Kingdom. Using data on over one million middle-aged and older women in the prospective Million Women Study, linked to routine administrative data on deaths, inpatient and day-case admissions, and primary care services, I estimated annual rates and costs of hospital admissions, primary care consultations, prescription items issued, and monitoring and diagnostic tests in relation to body mass index. Every 2 kg/m2 higher BMI beyond 20 kg/m2 was associated with 7.4% higher annual hospital admission costs, 5.2% higher primary care consultation costs, and 9.9% higher prescription costs, but no clear association with test costs was identified. Projecting these results to the total population of women aged 55 to 79 years in England in 2013, 15% (£662 million) of hospital costs, 11% (£229 million) of primary care consultation costs, and 22% (£384 million) of prescription costs were attributable to overweight and obesity. Type-2 diabetes, and cardiovascular and musculoskeletal diseases were the major contributing conditions to the total excess weight attributable costs. These findings will be useful to healthcare policy makers, commissioners, and providers in making investment and prioritisation decisions, and underline calls for greater investments in cost-effective interventions to reduce excess weight and prevent weight gain.
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Boström, Anne-Marie. "Evidence-based care of older people - utopia or reality? : healthcare personnel's perceptions of using research in their daily practice /". Stockholm : Department of Neurobiology, Care Sciences and Society, Division of Nursing, Karolinska Institutet, 2007. http://diss.kib.ki.se/2007/978-91-7357-385-6/.
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Bull, Alister William. "The insights gained from a portfolio of spiritual assessment tools used with hospitalised school-aged children to facilitate the delivery of spiritual care offered by the healthcare chaplain". Thesis, University of Glasgow, 2013. http://theses.gla.ac.uk/4529/.
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A Spiritual Assessment Tool (SAT) for use with a child by a healthcare chaplain, requires a clear conceptual construct in order to convey a child’s spiritual profile to other professionals. The design of the tool, allied to the manner in which a chaplain engages with a patient, allows a child to easily share information which can be interpreted in terms of this construct. This thesis creates a new and accessible conceptual framework to describe the spirituality of children in a paediatric setting. It achieves this through the design and development of a portfolio of sorting cards and storyboards, referred to as a Spiritual Assessment Tool (SAT). The SAT encourages children to share information about their healthcare journey which is then interpreted in terms of the new framework. In addition, it identifies the competences required by a healthcare professional to obtain and interpret this information. In doing so, it necessarily discusses the wider implications of the theological insights which arise. The research involved the filming of interviews conducted with children aged between 6 and 13 years old in an acute paediatric healthcare setting. During these interviews sorting cards depicting different aspects of the children’s lives were used in conjunction with storyboards, in order to discover how the children described their lives while in hospital. The design of the SAT developed through two distinct stages before reaching a final model that achieved the goals of this thesis In order to describe and share the information expressed with other healthcare staff, a framework was developed to enable interpretation of how a child constructs meaning. This framework required a terminology that could clearly communicate the complexities of how children understand the meaning of their lives in the context of the hospital setting. By engaging with child development theory and the data gathered from the interviews, the term “connectedness” was adopted to better encapsulate the conceptual construct of what had, in the past, been described as “childhood spirituality”. The term draws four dimensions from the field of child development which help professionals to profile a child’s perspective of their lives while in hospital:; the momentum of connectedness; the awareness of connectedness; the resilience of connectedness; and the evaluative nature of connectedness. These dimensions take account of the contextual disruption experienced by the children and the way in which their level of development contributes to the perspective of their lives while in hospital. The theological implications the concept of ‘connectedness’ and the methodology of its application underline the dynamics of the competences involved. These can be applied in integrated theological reflective practice. The “Zone of Proximal Connectedness” (ZPC) is used to describe the space of an encounter between a healthcare professional and a paediatric patient when four features are present; hospitality, liminality, the significant other, and the co-construction of meaning. The ZPC forms the foundation for gathering information that serves as the basis for better spiritual care. The research findings provide insight into the dynamics required for a healthcare chaplain to relate to a child and to engage in integrated theological reflective practice which relates to the ZPC. The nature of the encounter outlined in this thesis, requires the quality of ‘mutuality’ to be present between assessor and child. The nature of the encounter outlined in this thesis between an assessor and a child requires the quality of ‘mutuality’. The presence of the quality of mutuality in this context, reveals that inThe implications of mutuality reveal that in the Christian Faith our concept of God’s nature involves a greater sense of mutuality. The wider implications of this reflection for the Christian faith and our understanding of God, Jesus and the Church are identified as an area for future theological exploration.
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Chalashika, Paphani. "Nutritional outcomes of Botswana infants and young children aged 6-24 months : a focus on birthweight, HIV-exposure, feeding practices and the role of caregivers, older family figures and healthcare workers". Thesis, University of Nottingham, 2018. http://eprints.nottingham.ac.uk/50081/.
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Background: A better understanding of the nutritional status of infants and young children who are HIV-Exposed-Uninfected (HEU) and HIV-Unexposed-Uninfected (HUU) during their first 1000 days is a key to improving population health, particularly in sub-Saharan Africa. Methods: A mixed-methods approach (explanatory sequential design) was utilised to compare the nutritional status, feeding practices and determinants of nutritional status of HEU and HUU infants and young children residing in representative selected districts in Botswana. In addition, themes associated with perceptions of caregivers, older family figures and healthcare workers in achieving optimal nutritional outcomes in these infants and young children were identified. In the quantitative strand (413 infants and young children, 37.3% HIV-exposed) aged 6-24 months attending routine child health clinics were recruited. In the qualitative strand 25 caregivers, 9 older family figures and 10 healthcare workers were interviewed using a semi-structured questionnaire. Quantitative data including anthropometric, 24-hour dietary intake and socio-demographic data was collected. Anthropometric z-scores were calculated using 2006 WHO growth standards. Modelling of the determinants of malnutrition was undertaken using logistic regression. Qualitative data was analysed using an inductive, interpretive/latent thematic analysis approach. Results: Overall, prevalence of stunting, wasting and underweight were 10.4%, 11.9% and 10.2% respectively. HEU infants and young children were significantly more likely to be underweight (15.6% vs. 6.9%), (p < 0.01) and stunted (15.6% vs. 7.3%), (p < 0.05) but not wasted (p= 0.14) than HUU infants and young children. HEU infants and young children tended to be formula fed (89.4%) whereas HUU infants and young children tended to breastfeed (89.6%) for the first six months (p < 0.001). In multivariate analysis, significant predictors of nutritional status were HIV exposure, birthweight, birth length, Apgar score and mother/caregiver’s education with little influence of socioeconomic status (p < 0.05). Qualitative thematic analysis revealed four themes; when “free choice” is an illusion: mother’s infant feeding decisions; “These people are dangerous.” negotiating access to healthcare services; “caring is how I show my baby love”; “our culture, our heritage”. Conclusions: HEU infants and young children aged 6-24 months had worse nutritional status compared to HUU infants and young children. Notably, birthweight was the main predictor of undernutrition in this population and, therefore optimisation of infants and young children’ nutritional status should focus on the nutrition and health of women in the pre- and antenatal period. These interventions should focus on equipping caregivers with skills and knowledge but also address external factors such as influence of the older family figure, community norms and cultures and experiences associated with accessing healthcare services.
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Ball, Stephen. "Investigating telemonitoring technologies for the detection of activities and the application of BLE in smart homes for elderly independent living". Thesis, Queensland University of Technology, 2017. https://eprints.qut.edu.au/123510/1/Stephen%20Ball%20Thesis.pdf.
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Due to the rise in the elderly population and the prevalence of chronic diseases, healthcare organizations around the world are faced with an economic burden which will continue to grow. For this reason there is an urgent demand to reduce the intake of elders in hospitals and nursing homes by allowing them to live independently for greater lengths of time. In response to this demand, researchers are strongly focusing on 'telemonitoring', which is the use of information technology (IT) to monitor the health status of an individual from a remote location (e.g. their home).
The first aim of this thesis was to investigate how telemonitoring technologies can detect elderly activities for health assessment purposes. To assess a patient's health status holistically, a wide variety of factors needed be considered by practitioners. Currently many telemonitoring technologies in research have addressed these factors/assessments by monitoring elderly activities. However based on the literature reviews, researchers have not been able to develop a comprehensive understanding of how these technologies support each assessment.
Therefore the first contribution in chapter 3 of this thesis addresses this gap. A literature review was conducted where 215 telemonitoring technologies were identified from 82 papers, published between 2000 and 2016. Six assessments which involve monitoring of activities were identified as (1) mobility, (2) nutrition, (3) safety, (4) cognitive, (5) social, and (6) routine. All included technologies were categorized into six tables according to the assessment that they supported. From assessing the contents of these tables, it was found that a significant portion of ITs relate to mobility, nutritional, safety and routine assessments. Many of the studies were found to assess technologies inside of laboratory setting and still require improvement before they are suited for real world application. It also found that many of the technologies were not equipped with wireless communication.
In recent years recently have been focusing been integrating wireless sensing technology into telemonitoring applications. Many of these wireless technologies are small, unobtrusive, and usually need to be powered by small batteries (e.g. coin cell) which have limited capacity. For this reason, researchers have had difficulties prolonging battery life to a duration that is practical. However the recent release of Bluetooth Low Energy (BLE) has the potential of resolving this issue due to its power saving qualities.
The 2nd aim of this thesis is to assess the performance of Bluetooth Low Energy (BLE) in telemonitoring frameworks using advertising mode. Advertising mode is often used for device discovery purposes, however it can also be used to send context data without the need for device connection establishment. This method has received little investigation from researchers and yet it has the potential of offering advantages such as reduction in power consumption and manufacturing costs. Therefore in this thesis, the performance of BLE advertising mode was used within two telemonitoring applications.
Firstly, a new device called 'BLUESOUND' is proposed. The device uses ultrasound sensing technology which can efficiently differentiate multiple residents in a home environment based on their height. The device consists of three sensing/communication modules: A Passive Infrared (PIR) occupancy module, an ultrasound array module and a BLE communication module. The PIR occupancy module is used to detect walking direction, while the ultrasound array measures the resident's height. The combination of these two technologies can also be used to detect a resident's velocity. BLE advertising mode is used to communicate acquired data to a smart phone gateway/database. A new embedded algorithm was able to increase the energy efficiency of the identification technology. Comprehensive modelling and experimentation was undertaken to assess the performance the BLUESOUND device. The BLUESOUND device was able to distinguish between multiple resident identities by measuring height accurately.
Currently researchers have developed various wearable ECG monitors as there is a demand to detect the onset of cardiac disease earlier in the elderly population. However most of these devices have only lasted a couple of days on a coin cell battery which is not practical. Therefore the performance of BLE advertising mode was explored using a virtual BLE based ECG model in MATLAB. To further minimize power consumption, an ECG extraction technique (based on the 'So and Chan' algorithm [1]) was used in the model to extract some of the most significant points on the signal. Based on three simulation trails, ECG data was transferred to a scanning device with high accuracy (average of 99.62%). It was estimated that the virtual system is approximately 13 times more energy efficient compared to sending ECG stream data continuously when a connection is established.
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Owens, Myra G. "Factorial Validity of the Team Skills Scale as used for Geriatric Interdisciplinary Team Training (GITT)". VCU Scholars Compass, 2006. http://hdl.handle.net/10156/1568.
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Reynaldo, Rizalyn. "Healthcare Leaders Under the Age of 40 - Successful Strategies and Practices for Leading Healthcare Organizations". Thesis, Pepperdine University, 2017. http://pqdtopen.proquest.com/#viewpdf?dispub=10622948.
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As millennials and young adults under the age of 40 become the growing majority, it is critical to understand their leadership profile, the workplace challenges they face, and their strategies for overcoming obstacles as young leaders. Specifically, in healthcare, the rapidly changing industry presents internal and external environmental challenges that must be handled in the most professional and proficient manner to be an effective leader. As such, the purpose of this study is to gather best strategies and practices that healthcare leaders under the age of 40 can adopt for their respective organizations. There are 4 research questions that address the research study’s purpose: (a) strategies and practices employed by healthcare leaders under 40, (b) challenges faced by healthcare leaders under 40, (c) definition and measurement of leadership success and organizational performance, and (d) recommendations for young aspiring leaders. 15 healthcare leaders under the age of 40 participated in the research study and responded to 12 questions in a semi-structured interview format. The results of the phenomenological qualitative study yielded 62 themes. In particular, the following emerged as top themes with regard to strategies and practices: servant leadership, authentic leadership, transformational leadership, emotional intelligence. Challenges faced by healthcare leaders included regulatory changes, healthcare reform, competing priorities, managing financial and human capital, and managing change. In terms of managing resistance to change, a four-part framework was developed through the following themes: educate people on the change, engage people in the process, listen and empathize, build a guiding coalition. As for obstacles experienced by young leaders, themes included proving credibility, perceptions of youth, lack of experience or knowledge. 60% stated that their definition of leadership success would be based on team development and success, followed by organizational success, personal achievement, and reduced staff turnover. A high performing organization focused on quality, engaging the workforce, patient experience, cost savings, financial growth and stability, and community outreach. To measure and track organizational performance, key performance indicators, dashboards, and balance scorecards were mentioned. The research study wrapped up with advice for young aspiring leaders with emotional intelligence emerging as a top theme.
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Chapnkem, Wenceslaw Chap. "Perceptions of Access to Healthcare in Cameroon by Women of Childbearing Age". ScholarWorks, 2019. https://scholarworks.waldenu.edu/dissertations/6981.
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Increased poverty and unemployment rates, minimal investment in social amenities, a shortage of healthcare professionals, poor infrastructure, inadequate social services, and poor institutional and political leadership have weakened the healthcare status of Cameroon's women who have reached the age of childbearing. The World Health Organization expressed increased urgency for healthcare providers and patients to develop new healthcare policies to eliminate health-related disparities. The aim of this phenomenological study was to examine the perceptions of women of childbearing age living in Mamfe rural community in regard to Cameroon's healthcare system and its impact on their lives. The theoretical foundation of the study was the healthcare utilization model. Interviews were conducted with 10 women participants, ages between 18 and 45. The data collected through semistructured interviews were analyzed using NVivo 11 and the Colaizzi 7-step processes to identify themes and subthemes. Study findings revealed systemic challenges that affected healthcare access which need to be adequately addressed to reduce maternal and child mortality among women of child-bearing age. The study findings could foster social change by improving the development of healthcare standards, as well as illustrating methods of increasing the level of access to healthcare services among women of childbearing age.
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de, Lavaine Scarlette. "The age of consent: digital photography and privacy in general healthcare practice". Thesis, de Lavaine, Scarlette (2016) The age of consent: digital photography and privacy in general healthcare practice. Honours thesis, Murdoch University, 2016. https://researchrepository.murdoch.edu.au/id/eprint/35142/.
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Digital photography can be invaluable in visually oriented medical practice. Providing a visual record, digital photographs aid diagnosis, monitor change and quantify response to therapy. Incorporating digital photography into general practice is growing easier. Widespread ownership of smartphones with inbuilt cameras has stimulated this practice. Smartphone cameras are simple and familiar to use, capture high resolution images that enhance the medical record, expedite advice and, ultimately, can improve patient care.
The development and use of the smartphone is part of a broad wave of accelerated technological change. That change, the information revolution of the last 30 years, has enabled the collection and dissemination of that information on a scale previously unimaginable. It has also changed how Australians treat personal privacy. Personal information can be instantaneously shared, with or without consent, with friends and strangers. Expectations of privacy in younger generations may have dropped, but for many Australians, protection of privacy has become more urgent.
In response, Australia has tried to unify its legal and regulatory approaches to privacy protection through recent amendments to the Privacy Act 1988 (Cth). The Australian Privacy Principles were introduced to clarify and govern how personal information, such as healthcare information, can be collected, used and disclosed. The central role of the doctor in the collection and use of healthcare information required specific guidance for the profession. This was achieved through the professional Code of Conduct regulated by the Australian Medical Board.
Despite these legislative and regulatory changes there appears to be a divergence between practitioners’ conduct and their legal and professional obligations when using clinical photography in their healthcare practice. Are doctors aware of the requirements of consent, use and disclosure, and storage security, as they apply to clinical photography? The relevant literature suggested they are not. To explore how technology has impacted privacy this paper examines how the Privacy Act 1988 (Cth) affects digital photography used in the clinical management of skin conditions. The paper will describe how well-delineated boundaries of clinical information sharing are blurred in practice, if not in law. It seeks to address the reasons for the apparent knowledge deficit of privacy obligations amongst practitioners.
Doctors looking to understand their privacy obligations will find it difficult; inconsistencies between laws and regulations making the regime challenging to traverse. This paper proposes possible solutions to raising awareness, promoting safer practices and can help mitigate privacy risks. Compliant use of digital photography is a value clinical tool which can facilitate patient care, while not endangering patient privacy.
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Onatolu, Busayo, Shimin Zheng, Hemang Panchal i Edward Leinaar. "Association of Age, Gender and Race in Chronic Kidney Disease Patients with and without Dialysis". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/23.
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ASSOCIATION OF AGE, GENDER AND RACE IN CHRONIC KIDNEY DISEASE PATIENTS WITH AND WITHOUT DIALYSIS
1Busayo Adeyemi Onatolu, 2Hemang Panchal, 3Edward Francis Leinaar, 1*Shimin Zheng, 2Timir K. Paul
1Department of Biostatistics and Epidemiology, College of Public Health, ETSU, Johnson City, TN 37614
2Department of Internal Medicine, Quillen College of Medicine, ETSU, Johnson City, TN, 37614
3Department of Health Services Management and Policy, CPH, ETSU, Johnson City, TN 37614
*Sponsoring faculty
Introduction:
Studies have shown that chronic kidney disease (CKD) is common among adults in the United States. The Centers for Disease Control and Prevention (CDC) states that 30 million people, or 15% of US adults, are estimated to have CKD. Forty-eight percent of those with severely reduced kidney function are not aware of having CKD, and therefore do not receive hemodialysis (HD).
Methods:
A nationwide inpatient sample database from 2012-2014 was used to identify all patients admitted to the hospital using International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes (n= 534,845). Patients with dialysis dependent CKD (n=8,100) and CKD without dialysis (n=51,285) were compared to non-CKD patients (n=475,460). Hierarchical logistic regression was performed and p
Results:
Of the 534,845 patients, 88.9% were without CKD and 9.59% had CKD without HD and 1.51% had CKD with HD. Among patients with CKD, 13.64% were on HD and 86.34% were non-HD patients. The result shows that a higher proportion of patients with CKD without HD in the ≥ 80 years age group (≥ 80 = 37.84%, 65-79 = 36.94%, 50-64 = 20.80%, 35-49 = 4.12% and 18-34 = 0.30%) and a higher proportion of patients with CKD with HD in the 65-79 years age (≥ 80 = 16.30%, 65-79 = 41.79%, 50-64 = 33.09%, 35-64 = 8.09% and 18-34 = 1.29%). The OR of age group 18-34 compared to ≥ 80 is 5.690, 95% CI: 4.202,7.705, OR 35-49 is 4.552, 95% CI: 4.552, 95% CI: 4.103, 5.050, OR of 50-64 is 3.693, 95% CI: 3.444, 3.961 and OR 65-79 is 2.626, 95% CI: 2.457, 2.807. Males had higher rates of CKD than females, without HD (Male= 63.12%, female= 36.88%, p
Conclusion:
From this study, males had higher rates of CKD with and without HD than females, the age group ≥ 80 years had higher proportion of CKD without HD and those between 65-79 years had higher number of CKD with HD. Whites had higher rates of CKD with and without HD than other races.
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Anderson, Sarah, i Loyd Lee Glenn. "Intentional Learning Orientation According To Gender, Age, Rurality, and Program Type". Digital Commons @ East Tennessee State University, 2019. https://dc.etsu.edu/asrf/2019/schedule/66.
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Several studies have found that learning styles differ based on gender, but others found no differences. There are no previous studies on gender differences in intentional learning styles. The purpose of this study, therefore, was to evaluate intentional learning style differences based on gender, demographics, and psychological characteristics.
The participants were junior level nursing students in a research course in two different semesters. The Learning Orientation Questionnaire of Martinez (2006) was administered in February of 2018 and 2019 to participants (n=198) and analyzed using ANOVA.
The LOQ score was significantly different between males and females (p= 0.013). Males had a mean of 2.76 + .89 SD (N=26) but females had an LOQ score of 2.40 + .52 SD (N=169). The LOQ score was not significantly different for students seeking different degrees (p= 0.16). 2nd Degree-seeking students had a mean of 2.43 + 0.37 SD (N=25), LPN-BSN students had a mean of 2.63 + 0.35 SD (N=2), Main BSN students had a mean of 2.44 + 0.62 SD (N=163), RN-BSN students had a mean of 2.5 + 0.70 SD (N=6). Other types of degrees had a mean of 3.5 + 0.35 SD (N=2). The LOQ score was not significantly different for distances that students had to travel to the nearest hospital (p=.54) Students with a distance of 15-30 minutes from their house had a mean of 2.5 + 0.67 SD (N=75). A distance of 30-45 minutes had a mean of 2.62 + 0.63 SD (N=15). A distance of 5-15 minutes had a mean of 2.42 + 0.54 SD (N=86) A distance of less than 5 minutes had a mean of 2.31 + 0.55 SD (N=12). A distance of greater than 45 minutes away had a mean of 2.29 + 0.45 SD (N=9). The LOQ score for the age of responders was not significantly different (p=0.71). Students who were 23 or less had a mean of 2.45+ 0.66 SD (N=103), students who are between 24-29 had a mean of 2.35 + 0.34 SD (N=15), students who are between the ages 30-39 had a mean of 2.63 + 0.38 SD (N=6), students who are older than 40 had a mean of 2.13 + 0.37 SD (N=4), students who preferred not the answer had a mean of 3.0 + SD not available (N=1).
The conclusion is that males and females have varied intentional learning styles. This supports previous studies that found differences in learning style in medicals students and practicing nurses.
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Williams, Faustine, i Emmanuel Thompson. "Disparities in Breast Cancer Stage at Diagnosis: Importance of Race, Poverty, and Age". Digital Scholarship@UNLV, 2018. https://digitalscholarship.unlv.edu/jhdrp/vol10/iss3/4.
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This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.
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Xu, Guo Dong. "Thoughts on Design Ethics Applied to Kitchen Management System in the Information and Digitization Age". University of Cincinnati / OhioLINK, 2018. http://rave.ohiolink.edu/etdc/view?acc_num=ucin1523633653648084.
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Maphalala, Gugu Petunia. "Epidemiology of rotatirus diarrhoea in children under five years years of age from selected healthcare facilities in Swaziland". Thesis, University of Limpopo (Medunsa Campus), 2013. http://hdl.handle.net/10386/1154.
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Thesis (MSc (Medical science in medical virology)) -- University of LimpopoBackground: It has been established that rotaviruses are the main cause of acute gastroenteritis in children worldwide, resulting in more than 453 000 deaths, with a high mortality still occurring in African countries and Asia. In Swaziland, diarrheal diseases are a common cause of morbidity and mortality among children <5 years of age. Approximately 10% of hospitalised Swazi children die due to diarrhoea every year. Through financial assistance from the World Health Organization (WHO), many African countries have conducted a lot of rotavirus disease studies. In Swaziland, the epidemiology of rotavirus infection is unknown due to lack of data. Thus, the study’s aim was to examine the epidemiology and characterize rotavirus strains in children <5 years of age, hospitalised and attending the outpatient departments of public and private healthcare facilities in Swaziland. Materials and methods: A total of 745 diarrheal stool specimens were collected from children <5 years of age from April 2009 to December 2010. Group A rotavirus antigen was detected using a commercially available enzyme immunoassay (EIA) kit (ProSpectTM, Oxoid Ltd, UK). Polyacrylamide gel electrophoresis (PAGE) was used to determine the electrophoretic pattern of rotavirus strains. The P and G genotypes were established by reverse transcription polymerase chain reaction (RT-PCR) and multiplex hemi-nested PCR amplification of the VP4 and VP7 genes respectively, using type-specific primers. Sequencing was performed on 35 specimens to confirm the circulating genotypes. The phylogenetic tree and similarity distances between genotypes were constructed using the neighbour joining method and the Kimura two-parameter model package in the MEGA version 5.05 software program. Results: Group A rotavirus was detected at 13.3% in 2009 (based on samples collected from April to December) and 23.4% in 2010 (based on one year collection) from children <5 years of age hospitalized and attending outpatient departments. The rotavirus infection was more frequently detected in the age group 0-11 months (22.2%). Gender did not play a major role in rotavirus infection, because both male (20.8%) and female (18.8%) children were equally affected. Of the children that were admitted in the hospital, 33.3% were affected by rotavirus infection compared to those attending the outpatient departments (13.5%). The rotavirus infection was observed during the cooler, drier months of the year. The three most predominant G and P genotypes detected were G2P[4] (30.4%), followed by G1P[8] (15.5%) and G9P[8] (8.8%). A significant number of uncommon rotavirus strains (32.4%), mixed infections (8.8%) and nontypeables (4.1%) were also detected. The circulating genotypes detected were classified into lineages and sub-lineages defined by phylogenetic analysis of nucleotide sequences. The Swaziland strains were found clustering with known African and global strains from the GenBank. Conclusion: The findings of this study reveal that group A rotaviruses are the etiological agents of severe diarrhoea in children under 5 years in Swaziland. The diversity of rotavirus strains that were detected highlights the importance of introducing the rotavirus vaccine in the country. The currently licensed vaccines may confer protection against the circulating strains detected in this study. Data on the burden of rotavirus disease in Swaziland will be used to convince the Ministry of Health and policy makers in the country to advocate for the introduction of the rotavirus vaccine. This is the first data on the epidemiology and characterization of rotavirus strains in Swaziland; therefore there is a need for continuing with the surveillance of rotavirus in the existing sentinel sites to determine the impact of rotavirus infection over time. It is also essential to continuously monitor the rotavirus strains circulating among Swazi children.
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Newman, Nicole Rae. "Cognitively impaired elderly individuals and durable powers of attorney for healthcare". CSUSB ScholarWorks, 1999. https://scholarworks.lib.csusb.edu/etd-project/1795.
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Locke, Tiffany. "Methicillin-resistant Staphylococcus Aureus in Canadian Hospitals from 1995 to 2007: A Comparison of Adult and Pediatric Inpatients". Thèse, Université d'Ottawa / University of Ottawa, 2013. http://hdl.handle.net/10393/26110.
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The literature directly comparing the epidemiology of MRSA among adult and pediatric hospitalized patients is strikingly minimal. The objective of this thesis was to identify any differences between these two patient groups. The Canadian Nosocomial Infections Surveillance Program MRSA data (1995 to 2007: n=1,262 pediatric and 35,907 adult cases) were used to compare MRSA clinical and molecular characteristics and rates. Hospital characteristics were modeled using repeated measures Poisson regressions. The molecular and epidemiological characteristics of MRSA differed significantly between adults and children. Compared to children, MRSA in adults was more likely to be healthcare-associated, colonization, SCCmec type II, PVL negative, and resistant to most antibiotics. Rates of MRSA in Canada increased in both populations over time but were significantly higher in adults. The hospital characteristics associated with increased MRSA rates differed in adult and pediatric facilities. Implications for infection prevention and control strategies are discussed.
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Queen, Courtney M. "Health Status and Access Disparities Among the Uninsured Working-Age Population in a Safety-Net Healthcare Network in Tarrant County, Texas". Thesis, University of North Texas, 2009. https://digital.library.unt.edu/ark:/67531/metadc12187/.
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The objective of this research was to determine if healthcare access disparities exist across race and gender in a publically funded safety-net healthcare system in Texas. Data were examined from a representative random sample of 1468 adults aged 18-64 who were patients in this safety-net system in July and August of 2000 and were analyzed using binary logistic regression and chi-square measures of significance. Major Findings: On measures of health status - overall health rating (p =.051), limited employment (p =.000), energy level (p =.001), and worry (p =.012) - Anglos reported the worst health; Mexican Americans, the best health; with African Americans intermediate. Mexican Americans were more likely to have never had health insurance, and to also have had insurance in the past year; Anglos were least likely to have ever had insurance (p =.015) or to have had insurance in the past year (p =.000). On use of EDs (p =.028), problems getting prescription medicines (p =.029), and foregoing other necessities of life to pay for healthcare, Mexican Americans were least disadvantaged with African Americans reporting greatest use of EDs among both men and women, and Anglos the most problems with prescription medicines and foregoing care, especially among women. Logistic regression revealed that health status was the strongest predictor of problems accessing healthcare in all groups; the poorer health status of safety-net patients, the more problems they had accessing care. Patterns of poor reported health status and greater problems accessing care among Anglos relative to other groups is discussed in terms of social drift and relative deprivation.
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Oliveira, Aline Azevedo de [UNIFESP]. "Conhecer para intervir: educação em saúde para cuidadores informais de idosos no Programa de Atenção à Saúde do Idoso – Envelhe-Ser – na cidade de Varginha/MG". Universidade Federal de São Paulo (UNIFESP), 2009. http://repositorio.unifesp.br/handle/11600/9247.
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Publico-00370.pdf: 1575217 bytes, checksum: e0d6c20f043901187ef8250a7463092e (MD5)O presente estudo justifica-se diante da rápida mudança do perfil demográfico brasileiro, com o aumento do número de idosos e, conseqüentemente de seus cuidadores, expondo o despreparo do setor público a esta nova realidade, sendo necessária a adoção de medidas que possam combater iniqüidades e desenvolver ações sob um olhar multidimensional. Além disso, a literatura aponta a importância de capacitação de recursos humanos para a assistência dessa população, tanto no âmbito profissional como no domiciliar, e a carência de um consenso sobre a educação de cuidadores e pouca produção sobre os programas na área de saúde do idoso. Nesse sentido, este trabalho procura investigar o processo de educação em saúde para cuidadores de idosos no Programa de Atenção à Saúde do Idoso – ENVELHE-SER - em Varginha - MG, apresentando assim a importância de se conhecer as reais necessidades dos cuidadores e os desafios enfrentados pela equipe multiprofissional central, visando a proposta de diretrizes para elaboração e implantação de grupos de atenção e apoio para cuidadores de idosos informais.. Neste contexto, a pesquisa tratou-se de um estudo quantitativo/qualitativo com foco no processo de educação em saúde para cuidadores de idosos, sob a ótica da equipe multiprofissional central e dos cuidadores de idosos inseridos no Programa de Atenção à Saúde do Idoso – ENVELHE-SER – na cidade de Varginha - MG. Para tanto, optou-se pela aplicação da entrevista semi-estruturada aos cuidadores informais de idosos compreendendo questões que possibilitaram conhecer o perfil dos idosos dependentes e cuidadores, a provisão de cuidados e a educação em saúde desenvolvida pelo programa. Posteriormente, utilizou-se a técnica de grupo focal com os profissionais da equipe do programa, conhecendo sob a visão deles a educação em saúde para cuidadores de idosos. Após a análise de dados, foi possível propor diretrizes para os grupos de atenção e apoio aos cuidadores de idosos a partir de 3 diretrizes referentes aos próprios cuidadores de idosos, aos profissionais de saúde envolvidos e as estruturas do setor público para tanto.
The study justifies itself due to the rapid change of the brazilian demographic profile caused by the increase of the elder’s population and additionally its caretakers, exposing the public sector’s lack of skills to tackle this new reality, being necessary the assumption of measures which can fight unfairness and develop actions under a multidimensional viewpoint. Moreover, the literature points out the importance of human resources qualification to look after that population either in the workplace or in their homes, the lack of agreement about the caretakers education and the low production of programs of elder’s health care. In this regard, this assignment investigates the education for elder caretakers of the Elder’s Health Care Program – ENVELHE-SER – in Varginha/MG, presenting the importance of knowing the actual caretakers’ needs and the challenges faced by the multi professional central crew aiming the proposal of policies for creation and implantation of attention groups and support for the informal elder’s caretakers. In this context, the research consists of a quantitative/qualitative study focusing on the process of the health education for elder’s caretakers under the point of view of the multi professional central crew and the elder’s caretakers of the Elder’s Health Care Program – ENVELHE-SER – of the city of Varginha/MG. To achieve it, a semi structured interview was applied to the informal elder’s caretakers which consists of questions that allowed to disclose the profile of the dependent elders and caretakers, the care provision and the process of health education of the program. Furthermore, the focal group technique was applied by the program crew professionals which allowed knowing their outlook on health education for elder’s caretakers. After data analysis it was possible to draw policies for the attention groups and give support for the elder’s caretakers from 3 proposals referred to the elder’s caretakers themselves, to the healthcare professionals in question and to the public sector structures required.
TEDE
BV UNIFESP: Teses e dissertações
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Williams, Faustine, i Emmanuel Thompson. "Disparities in Breast Cancer Stage at Diagnosis: Importance of Race, Poverty, and Age". Digital Commons @ East Tennessee State University, 2017. https://dc.etsu.edu/etsu-works/5342.
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This study investigated the association of race, age, and census tract area poverty level on breast cancer stage at diagnosis. The study was limited to women residing in Missouri, aged 18 years and older, diagnosed with breast cancer, and whose cases were reported to the Cancer Registry between 2003 and 2008. The risk, relative risk, and increased risk of late-stage at diagnosis by race, age, and census tract area poverty level were computed. We found that the odds of late-stage breast cancer among African-American women were higher when compared with their white counterpart (OR 1.433; 95% CI, 1.316, 1.560). In addition, the odds of advanced stage disease for women residing in high-poverty areas were greater than those living in low-poverty areas (OR 1.319; 95% CI 1.08; 1.201). To close the widening cancer disparities gap in Missouri, there is the need for effective and programmatic strategies to enable interventions to reach areas and populations most vulnerable to advanced stage breast cancer diagnosis.
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Queen, Courtney M. Yoder Kevin Allan. "Health status and access disparities among the uninsured working-age population in a safety-net healthcare network in Tarrant County, Texas". [Denton, Tex.] : University of North Texas, 2009. http://digital.library.unt.edu/ark:/67531/metadc12187.
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Thompson, Zirka. "Comparison of Risk Factors for Clostridium Difficile Infection Among Community Associated Cases and Healthcare Facility Associated Cases, September 2009- April 2011". Digital Archive @ GSU, 2012. http://digitalarchive.gsu.edu/iph_theses/217.
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Background
Clostridium difficile is a Gram-positive bacteria found in the large bowel or colon that causes mild to severe intestinal conditions and sometimes death. The primary risk factors for development of Clostridium difficile infection (CDI) include healthcare exposure and recent antimicrobial use. The purpose of this study is to compare risk factors associated with CDI occurring in the Community to those associated with Healthcare Facility Associated CDI in the metro Atlanta population from September 1, 2009 – April 30, 2011.
Methods
Patients were identified through C. difficile surveillance program of the Georgia Emerging Infections Program (EIP). Prospective, population based, laboratory based surveillance for all positive C. difficile cases in the Georgia Health District 3 (HD3). Due to the sampling scheme, for this analysis CO-HCFA and HCFO cases were combined to make a Healthcare Facility Associated (HCFA) classification. Using SAS, a logistic regression analysis was performed to compare the associated risks between CA and HCFA classifications.
Results
The rate of CDI in the HD3 counties in Georgia is 84 per 100,000. The median age of infection is 63 and the age range in this study is 1 to 102 years old. CA cases represented 38% of the sampled population. CDI cases 65 and older were more likely to have a Healthcare association compared to CA-CDI cases (p
Conclusion
This study supports literature about CDI and antimicrobial use and looks further in to the role underlying conditions play as a risk factor for HCFA-CDI cases.
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Teshome, Alexandra, i Elin Turborn. "Vårdpersonals attityder till smärtskattning av äldre : -en litteraturstudie". Thesis, Uppsala universitet, Institutionen för folkhälso- och vårdvetenskap, 2016. http://urn.kb.se/resolve?urn=urn:nbn:se:uu:diva-294563.
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Många personer över 65 år lever med smärta. Det ingår i sjuksköterskans arbetsuppgifter att bedöma och utvärdera smärta. Syfte: Syftet med denna litteraturstudie var att genom existerande forskning beskriva vårdpersonals kunskap och attityder till smärtbedömning och smärtskattning i sitt dagliga arbete vid vård av äldre. Metod: I denna litteraturstudie användes sökbaserna Cinahl och Pubmed. Resultat: Resultatet baseras på 10 artiklar, 7 kvantitativa , 2 kvalitativa och en artikel där båda metoderna användes. De faktorer som påverkar smärtskattningen sågs vara erfarenhet och utbildning, utbildning i smärtskattning visade sig öka självförtroendet hos personalen. Även olika hinder, så som kognitiv nedsättning hos patienten och tidsbrist för vårdpersonalen, ligger i vägen för en adekvat smärtskattning. Generellt hade vårdpersonalen en positiv inställning till utbildning inom området smärtbedömning och även en stor intention att smärtskatta och göra detta korrekt. Det kunde ses att vårdpersonalens fördomar och attityder till äldres smärta påverkade smärtbedömningen. Slutsats: Smärtskattning av den äldre patienten är av största vikt för att minska smärta, lidande och andra följdtillstånd som obehandlad smärta orsakar. Med stöd från den samlade litteraturen, anses även att utbildning av personalen är ett mycket viktigt sätt att utveckla och förbättra smärtbedömningen inom vården.Many people over the age of 65 are living with pain. It’s a part of the nurse profession to assess and evaluate pain. Purpose: The purpose of this literature review was by existing research explore nurses knowledge and attitudes towards pain assessment and pain measurement in the care of elderly patients. Methods: In this literature review the databases Cinahl and Pubmed were used. Results: The results in this study are based on 10 articles. 7 quantitative, 2 qualitative and 1 were both methods was used. Factors that influenced how the patients’ pain was assessed by the health care givers was experience and education, attitudes and different obstacles that made adequate assessments difficult, such as patients having cognitive impairment and lack of time to perform assessment. In general, the caregivers had a positive attitude towards education about pain assessment and a great intention to assess pain correctly. However, it could be shown that negative attitudes and prejudices against pain in the older patient and how it should manifest affected how the pain assessment was performed. Conclusions: Negative attitudes regarding aging that is still exists in our society is affecting the health care of the individual. The authors believe, in support of the reviewed literature, that education is an important way to improve and develop the pain assessment performance.
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Roberts, Erin. "Exploring the guidance and attitudes regarding infant feeding options provided by Healthcare workers (HCWs) to HIV positive mothers of infants 0 – 12 months of age in South Africa". University of the Western Cape, 2021. http://hdl.handle.net/11394/8014.
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Magister Public Health - MPHSouth Africa’s Infant and Young Child Feeding (IYCF) policy guidelines of 2013 and its 2017 amendments recommend that mothers, including those living with HIV, exclusively breastfeed their infants until 24 months of age, followed by their gradual weaning. The 2013 changed policy guidelines occurred to align with global WHO recommendations of six-month exclusive breastfeeding for all HIV positive mothers, and consequently no longer recommended free formula feed as an option for HIV-positive mothers attending public sector services, except in limited circumstances. Despite these policy guidelines, less than a third of South African mothers exclusively breastfeed their infants. The other two thirds of mothers either formula feed or mixed feed their infants. Mixed feeding or exclusive breastfeeding by HIV positive mothers who have either not been on antiretroviral therapy (ART) long enough or are insufficiently adherent to ART to suppress their viral loads, can potentially lead to increased risk of Mother to Child Transmission (MTCT) of the Human Immunodeficiency Virus (HIV). Since healthcare workers (HCWs) play a key role in promoting the IYCF policy guidelines and encouraging its practice among HIV-positive mothers, it is crucial to determine the extent to which HCWs understand and subscribe to this important policy. Using purposeful sampling and in-depth qualitative interview techniques, this qualitative study explored the attitudes of HCWs towards different infant feeding options, especially for HIV positive mothers, against the background of their understanding of the changes in IYCF policy guidelines between 2013 and 2017. The participants in this study included ten HCWs selected from three primary health care facilities in Khayelitsha (Western Cape, South Africa), and two programme coordinators based at the Western Cape’s Department of Health Khayelitsha substructure office. By interviewing this diverse sample of HCW cadre, the study aimed to explore their perceptions related to the factors which facilitate IYCF policy implementation versus those that hinder the implementation of this policy. The findings revealed that HCWs interviewed had good overall familiarity with the IYCF policy guidelines. However, their depth of understanding and acceptability of the policy varied, especially in the context of high HIV MTCT risk. Suboptimal implementation of the policy occurred due to inadequate policy dissemination, diverse views on the limitations of the policy, such as the promotion of only exclusive breastfeeding as an option and an unclear rationale for recent policy changes. Additionally, HCWs high workload and insufficient training on the changed 2017 guidelines were identified as barriers to effectively implementing the new infant feeding policy guidelines. HCW further perceived that personal, socio-cultural and health system factors influenced new mothers’ decisions and/or ability to breastfeed. These findings highlight that improved policy dissemination strategies and training should be used to increase HCWs knowledge regarding infant feeding counselling content, including HIV MTCT risk. Western Cape Department of Health alignment and implementation of relevant National Department of Health HIV policies should occur to decrease MTCT risk while breastfeeding. Peer support groups could provide maternal support for continued postnatal ART adherence and for sustained safer feeding practices. Finally, while exclusive breastfeeding is the optimal feeding choice generally for mothers, future revision of the 2017 IYCF policy should consider allowing HCW to act more flexibly in the maternal guidance they provide on infant feeding options. This could allow greater discretion for HCW in infant feeding counselling of mothers, particularly for those women who are HIV positive. This would promote improved patient-centred counselling that takes into account both maternal socio-cultural context and the right to make individualised decisions regarding infant feeding.
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Kowalczyk, Nina K. "The Impact Of Voluntariness, Gender, And Age On Subjective Norm And Intention To Use Digital Imaging Technology In A Healthcare Environment:Testing A Theoretical Model". The Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc_num=osu1226605857.
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Ore, Robert. "A POPULATION-BASED ANALYSIS OF PATIENT AGE AND OTHER DISPARITIES IN THE TREATMENT OF OVARIAN CANCER IN CENTRAL APPALACHIA AND KENTUCKY". UKnowledge, 2019. https://uknowledge.uky.edu/crd_etds/4.
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Objectives: Adherence to National Comprehensive Cancer Network (NCCN) guidelines for ovarian cancer treatment improves patient outcomes. The aim of this study was to assess disparities associated with ovarian cancer treatment in the state of Kentucky and central Appalachia.
Methods: Data on patients diagnosed as having ovarian cancer from 2007 through 2011 were extracted from administrative claims-linked Kentucky Cancer Registry data. NCCN compliance was defined by stage, grade, surgical procedure, and chemotherapy. Selection criteria were reviewed carefully to ensure data quality and accuracy. Descriptive analysis, logistic regression, and Cox regression analyses were performed to examine factors associated with guidelines compliance and survival.
Results: Most women were age 65 years or older (62.5%), had high grade (65.9%) and advanced stage (61.0%) ovarian cancer. Two-thirds of cases (65.9%) received NCCN-recommended treatment for ovarian cancer. The hazard ratio (HR) of death for women who did not receive NCCN-compliant care was 62% higher compared to the women who did receive NCCN compliant treatment (HR 1.62, 95% CI 1.11-2.35). Results from the logistic regression showed that NCCN-compliant treatment was more likely for: women age 65-74 years compared to age 20-49 (OR=3.32, 95% CI=1.32- 8.32), late stage compared to early stage cancers (OR 0.32, 95% CI 0.20-0.53), receipt of care at tertiary hospitals (OR=1.92, 95% CI=1.10-3.34), and privately insured compared to Medicaid (OR=0.31, 95% CI=0.13-0.77) or Medicare (OR=0.31, 95% CI=0.15-0.66).
Conclusions: When the treatment of ovarian cancer did not follow NCCN-recommendations, patients had a significantly higher risk of death. Women were less likely to receive NCCN-compliant care if they were of younger age (20-49 years), had early stage disease, were not privately insured, or had care provided at a non-tertiary hospital.
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Kowalczyk, Nina K. "The impact of voluntariness, gender, and age on subjective norm and intention to use digital imaging technology in a healthcare environment testing a theoretical model /". Columbus, Ohio : Ohio State University, 2008. http://rave.ohiolink.edu/etdc/view?acc%5Fnum=osu1226605857.
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Colwell, Kelly L. "Disseminating the Cost of the Empty Chair: Improving Healthcare Access and No-Show Rates Through Age and Disease-Specific Education in the Pediatric Asthma Patient Populations". Youngstown State University / OhioLINK, 2017. http://rave.ohiolink.edu/etdc/view?acc_num=ysu1495470628183933.
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Adhiambo, Oreje Joy Susan. "Assessment of prescribing patterns and availability of anti-malarial drugs to children under five years of age in a rural district in Kenya". University of Western Cape, 2013. http://hdl.handle.net/11394/3927.
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Magister Public Health - MPHAim: The aim of this study was to assess the prescribing practices and availability of antimalarial drugs to children under five years of age in primary health care facilities in Bondo district.
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McDonald, Ewan W. "Spatial-temporal analysis of endocrine disruptor pollution, neighbourhood stress, maternal age and related factors as potential determinants of birth sex ratio in Scotland". Thesis, University of Stirling, 2013. http://hdl.handle.net/1893/16044.
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Background: The human secondary sex ratio has been the subject of long-standing medical, environmental and social scientific curiosity and research. A decline in male birth proportion in some industrialised countries is linked to endocrine disruption and is validated by some empirical studies. Increasing parental age and population stress and associated decreases in sex ratio have also been demonstrated. A thorough literature review of 123 relevant and diverse studies provides context for these assessments. Methods: A spatial-temporal investigation of birth sex ratio in Scotland and potential determinants of endocrine disruptor pollution, socio-economic factors including neighbourhood stress, deprivation, smoking, and maternal age, was conducted. This involved review of national and regional sex ratio time trends, and stratified/spatial analysis of such factors, including the use of GIS tools. Secondary data were sourced from Scottish Government web portals including Scottish Neighbourhood Statistics and the Scottish Environmental Protection Agency. Results: Regional differences in sex ratio between 1973 and 2010 are observed which likely lever the national male birth proportion downwards, with the region of poorest air quality from industrial emissions, the Forth Valley, displaying the greatest sex ratio reduction. Further analysis shows significant upwards skewing in sex ratio for the population cohort experiencing the least and 2nd most deprivation. Localised reductions in sex ratio for areas of high modelled endocrine disruptor pollution within the Central Region in Scotland are also displayed. Discussion: Limitations of the analyses include the danger of ecological fallacy in interpreting from area-based measurement and the simplified pollution modelling adopted. Despite this, and given elevated incidence of testicular cancer in Scottish regions mirrors the study’s results, tentative confirmation of the endocrine disruptor hypothesis can be substantiated. Further, elucidation on advanced parental age as a contributory factor to secondary sex ratio change is also given. Recommendations are made with respect to environmental monitoring and health protection, and preventative health strategies in Scotland.
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Van, Soelen Nelda. "An evaluation of the cost-effectiveness of the introduction of an isoniazid prophylaxis treatment (IPT) register for tuberculosis contact management in children less than five years of age in a high-burden community healthcare clinic (CHC) setting in the Western Cape, South Africa". Thesis, Stellenbosch : Stellenbosch University, 2014. http://hdl.handle.net/10019.1/97286.
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Thesis (MBA)--Stellenbosch University, 2014.ENGLISH ABSTRACT: Childhood tuberculosis is an infectious disease that can cause serious illness and mortality in especially young children. Following contact with an infectious adult tuberculosis case, the disease is easily preventable through preventive isoniazid treatment, yet very few exposed and at-risk children currently access this healthcare service in most high-burden settings. Previous research pointed out the multifactorial and complex nature of the barriers to accessing preventive care. Specifically, the lack of a formalised recording and reporting tool, such as the universally used tuberculosis treatment registers, possibly contribute to the operational barriers of preventive care delivery to these children. The purpose of this research was to evaluate the cost-effectiveness of an isoniazid preventive treatment register tool used at community level. The study utilised previously reported data from the study population and other high-burden settings to construct a decision analysis model that included varying probabilities of isoniazid preventive treatment across three high risk age groups (<1 year of age, 1 – 2 years of age, 3 – 5 years of age), coupled with disease probabilities and associated treatment costs. The scenarios simulated included 1) the routine isoniazid preventive treatment service (3% started on treatment, 17% identified as eligible); and 2) an isoniazid preventive treatment service supported by a recording register (15% (adherent to six months of treatment) and 38% (started on IPT treatment)). In addition, two hypothetical simulations were included for 76% and 100% isoniazid preventive treatment uptake; these hypothetical simulations required additional community based healthcare worker resources in addition to the register tool. The observations from the literature indicated that more children were identified (24(17%) vs. 54(38%)) and started (4(3%, base case) vs. 54) on isoniazid preventive treatment following the implementation of the register. As expected, the mean number of tuberculosis cases prevented, increased as the proportion of eligible children that received isoniazid preventive treatment, improved; the change in the number of cases prevented per simulation showed incremental improvements which were all significantly better (p<0.01) than the base case.. The incremental cost-effectiveness ratios incurred savings for each of the scenarios simulated since the mean costs for each of the simulations were significantly less (p<0.01) than the costs associated with the base case. The current evidence suggests that the proposed isoniazid preventive treatment register tool is a cost-effective alternative to the current standard of care in place at community level for at-risk children exposed to tuberculosis. It is therefore recommended that the tool be used incrementally on a bigger scale, until such time that sufficient evidence has been generated to support widespread implementation.
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Nguyen, Hoa L. "Age and Sex Differences in Duration of Pre-Hospital Delay, Hospital Treatment Practices, and Short-Term Outcomes in Patients Hospitalized with an Acute Coronary Syndrome/Acute Myocardial Infarction: A Dissertation". eScholarship@UMMS, 2010. https://escholarship.umassmed.edu/gsbs_diss/471.
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BackgroundThe prompt seeking of medical care after the onset of symptoms suggestive of acute coronary syndromes (ACS)/acute myocardial infarction (AMI) is associated with the receipt of coronary reperfusion therapy, and effective cardiac medications in patients with an ACS/AMI and is crucial to reducing mortality and the risk of serious clinical complications in these patients. Despite declines in important hospital complications and short-term death rates in patients hospitalized with an ACS/AMI, several patient groups remain at increased risk for these adverse outcomes, including women and the elderly. However, recent trends in age and sex differences in extent of pre-hospital delay, hospital management practices, and short-term outcomes associated with ACS/AMI remain unexplored.
The objectives of this study were to examine the overall magnitude, and changing trends therein, of age and sex differences in duration of pre-hospital delay (1986-2005), hospital management practices (1999-2007), and short-terms outcomes (1975-2005) in patients hospitalized with ACS/AMI.
MethodsData from 13,663 residents of the Worcester, MA, metropolitan area hospitalized at all greater Worcester medical centers for AMI 15 biennial periods between 1975 and 2005 (Worcester Heart Attack Study), and from 50,096 patients hospitalized with an ACS in 106 medical centers in 14 countries participating in the Global Registry of Acute Coronary Events (GRACE) between 2000 and 2007 were used for this investigation.
Results In comparison with men years, patients in other age-sex strata exhibited significantly longer pre-hospital delay, with the exception of women < 65 years; had a significantly lower odds of receiving aspirin, angiotensin converting enzyme (ACE) inhibitors or angiotensin II receptor blockers (ARBs), beta blockers, statins, and undergoing coronary artery bypass graft surgery (CABG) surgery or percutaneous coronary intervention (PCI), and were significantly more likely to develop atrial fibrillation, cardiogenic shock, heart failure, and to die during hospitalization and in the first 30 days after admission. There was a significant interaction between age and sex in relation to the use of several medications and the development of several of these outcomes; in patients Conclusions Our results suggest that the elderly were more likely to experience longer prehospital delay, were less likely to be treated with evidence-based treatments during hospitalization for acute coronary syndrome, and were more likely to develop adverse outcomes compared to younger persons. Younger women were less likely to be treated with effective treatments and were more likely to develop adverse outcomes compared with younger men while there was no sex difference in these outcomes. Interventions targeted at older patients, in particular, are needed to encourage these high-risk patients to seek medical care promptly to maximize the benefits of currently available treatment modalities. More targeted treatment approaches during hospitalization for ACS/AMI for younger women and older patients are needed to improve their hospital prognosis.
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Amini, Reza. "Health-related Quality of Life and Social Engagement in Assisted Living Facilities". Thesis, University of North Texas, 2015. https://digital.library.unt.edu/ark:/67531/metadc804930/.
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This research project aims to clarify the factors that impact successful aging in Assisted Living facilities (ALFs) in Denton County, Texas. We hypothesize that social disengagement decreases physical and mental components of quality of life. This exploratory research project employed standardized questionnaires to assess residents in the following domains; HRQOL, social engagement status, level of cognition, depression, and the level of functioning. This study collected data from 75 participants living in five ALFs. The average of Physical Component Scale (PCS) and Mental Component Scale (MCS) was 35.33, and 53.62 respectively. None of the participants had five or more social contacts out of facilities, and two-third of them had two or less social contacts. On average, those participants who were more socially engaged had higher score of MCS compared with disengaged counterparts. The level of physical function significantly affects social engagement, when people with more disabilities are more likely to be socially disengaged. Social engagement and depression significantly impact MCS, when depression is a mediating factor between social engagement and mental component of quality of life. Considering the expansion in aging population in the United States within the next three decades, the demand for high quality long-term care will skyrocket consequently. This study reveals that external social engagement can sustain HRQOL of residents in assisted living facilities.
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Ocampo, Mascaró Javier, Salazar Vera Jimena Silva i Costa Bullón Abilio da. "Correlación entre conocimientos sobre consecuencias de la obesidad y grado de actividad física en universitarios". Bachelor's thesis, Universidad Peruana de Ciencias Aplicadas (UPC), 2015. http://hdl.handle.net/10757/621624.
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Introducción. El objetivo del presente estudio es determinar si existe correlación entre los conocimientos sobre las consecuencias de la obesidad y el grado de actividad física de las personas.
Métodos. Se realizó un estudio transversal analítico durante los años 2013 y 2014. Participaron 215 alumnos de pregrado seleccionados por conveniencia no relacionados a carreras del campo de la salud en una universidad de Lima, Perú. Se evaluó el grado de actividad física utilizando el International Physical Activity Questionnaire (IPAQ) y el nivel de conocimientos sobre consecuencias de la obesidad utilizando la escala Obesity Risk Knowledge-10 (ORK-10). También, se consignó las fuentes de información de donde obtuvieron el conocimiento para responder dicho cuestionario.
Resultados. La mediana de edad fue 20 (rango intercuartílico=4) y 63% eran mujeres. De acuerdo al IPAQ, 53,9% realizaban actividad física alta, 35,4%, moderada y 10,7%, leve. Se encontró una correlación muy baja (rs=0,06) entre el puntaje del ORK-10 y la cantidad de equivalentes metabólicos/minuto consumidos por semana, pero no era significativa (p=0,38). Las personas informadas por medios de comunicación y por personal de salud obtuvieron mayores puntajes en el ORK- 10 que quienes se informaron por otras vías (p<0,05).
Conclusiones. La correlación entre los conocimientos sobre consecuencias de la obesidad y el grado de actividad física es muy baja. Es necesario utilizar enfoques
multidisciplinarios que incluyan todos los determinantes de la realización de actividad física para poder lograr cambios en la conducta de la población.
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Yu-Pei, Chen, i 陳毓珮. "Pain and Healthcare Utilization in Middle-aged and Elder patients with Depression". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/fxq974.
Pełny tekst źródłaStreszczenie:
碩士亞洲大學
健康產業管理學系長期照護組
100
Objective: The elderly people with depression and pain have attracted an increasing attention. Rare study explored physical and mental illness related to pain for depression patients and middle-aged groups who are getting old in Taiwan. Therefore, this study aimed to explore physical pain on middle-aged and elderly patients with depression, and further detected the factors related to physical illness such as pain, as well as the medical utilization and expenses imposed on patients with depression. Method: This study employed the claim dataset of National Health Insurance from National Health Research Institutes. Patients had the first diagnosis of depressive disorder（ICD-9-CM code 296.2、296.3、300.4、311）and taking anti-depressant in 2003 as the study subjects. After determining study subjects, this study explored physical pain, physical illness and mental illness the patients suffering from, and analyzes medical utilization treatment and expenses in a year. Results: The number of study subjects in this study is 136,051 in which 84.4% middle-aged and aged depression patients suffer from physical pain. The average number of pains suffered by depression patients is 2.97, and common pains occur on head（53.2%）, gastric ulcer and gastritis（50.1%） and joint（45.3%）. Depression patients with one year history of mental illness positively correlative to pain such as physical illness（OR=6.0）, newly diagnosed depression（OR=1.1）, CVD（OR=1.8）, COPD （OR=1.8）and high cholesterol（OR=1.6） have higher probability of physical pain. It showed that middle-aged and elderly patients with depression had physical pain once sought medical service at non-psychiatric outpatient and emergency for about 23 times more than patients with no physical pain, with also 17,564 points higher for their total medical expenses in non-psychiatric emergency department, slightly 0.18 times higher for hospitalization, but related 58,185 points lower in terms of the expense of hospitalization. Conclusions: This study revealed that patients with depression had concurrent mental illness positively correlative to physical illness and pain have higher ratio of chief complaint of physical pain, and use more medical resources related to non-psychiatry. It is suggested for medical service providers to pay more attention to depression mentioned above, take the possibility of physical pains into consideration and provide appropriate treatment.
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Chuang, Wen-Chi, i 莊文綺. "A Study of the Middle-aged and Elderly Patients Switching Intention Towards Cloud Healthcare". Thesis, 2012. http://ndltd.ncl.edu.tw/handle/96228913173360649170.
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碩士國立中興大學
科技管理研究所
100
Due to the formation of ageing society, the demand of electronic healthcare is rising. “Cloud healthcare” is a system which combines healthcare with cloud computing, it enables older people with chronic illnesses to live independently and have easy access to healthcare services. For middle-aged and elderly people, they are not familiar with most of new technologies because of their acceptance of new technology is low. To investigate their switching intention has assumed a new importance in recent year, this study uses push pull mooring (PPM) model to analyze middle-aged and elderly patients’ switching intention. This PPM model consists of 6 variables: “Inconvenience”, “Low privacy and security”, “Habit”, “Uncertainty”, “Ubiquitous care” and “Responsiveness”. According to these variables, the author develops questionnaires and the respondents are asked to have used telehealthcare. The results show that push effect, mooring effect and pull effect have a significant direct effect on patients’ switching intention. Also, the mooring effect has a significant direct effect on the relationship between push effect and switching intentions. On the other hand, the mooring effect does not have significant direct influence on the relationship between pull effect and switching intentions. It will be convenient for patients, especially in remote areas, to use cloud healthcare. Cloud healthcare can improve medical efficiency and quality, so that the author hopes to find the factors that affect these patients’ switching intention. These findings will serve as a reference for healthcare industry.
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Yeh, Yu-Tso, i 葉昱佐. "Health Behaviors Clustering, Self-rated Health and Healthcare Services Utilization among Emerging Adulthood Aged 18~25 in Taiwan". Thesis, 2014. http://ndltd.ncl.edu.tw/handle/06406700162715928325.
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碩士國立臺灣師範大學
健康促進與衛生教育學系
102
Objective To examine the relationship between the health behavior clustering, self-rated health and health utilization including emergency, inpatient and outpatient services among emerging adulthood aged 18-25 in Taiwan. Data Sources The 2009 National Health Interview Survey was used in this study. After deleting the cases with missing value in four different subjects, the sample sizes are 2,679, 2,636, and 2,633 in the first three subjects respectively. In the fourth subject, the sample size are 2,633 and 2,631 for analyzing the relationships between the groups of clustering and emergency services and inpatient care utilizations and 2,631 for analyzing the relationships between the groups of clustering and outpatient care. Methods This study used the Two-step Cluster Analysis to identify groups of emerging adulthood with similar behavior patterns among emerging adulthood. Logistic regression was used to analyze the association between sociodemographic factors and groups of clustering. We used the ordered probit regression model to analyze the relationships between groups of clustering and self-rated health. As for healthcare utilization, logistic regression was used to analyze the relationships between groups of clustering and the probability of using emergcy services, outpatient services or inpatient care. Zero-inflated negative binomial regression model were used to investigate the association between groups of clustering and the number of visits of emergency services, outpatient healthcare services, as well as inpatient care. Results Three clusters were identified including the “smoking-alcohol” (n=637, 23.78%), “unbalance diet”(n=947, 35.35%), and “healthy lifestyle”(n=1,095, 40.87%) groups. When compared to the "healthy lifestyle” group, the "cigarette-alcohol” group and the " unbalance diet" group are more likely to report having worse health. Those who were classified in the “unbalance diet” group were more likely to use emergency services (OR=1.59; 95% CI=1.14-2.21) and those who were classified in the “unbalance diet” group were more likely to use more emergency services when compared to those in the “healthy lifestyle” group (IRR=1.49; 95% CI=1.08-2.05). This study found no relationships between groups of clustering and outpatient healthcare services, no matter whether in terms of usage or not, or in terms of the number of visits. Conclusions The groups of clustering can be generated based on smoking-alcohol and diet habit among the emerging adulthood. Those who were in the “smoking-acohol” and “unbalance diet” groups were more likely to self-report worse health. In addition, unhealth behavior clusters were found to be associated with a higher risk of using emergency care and more visits of emergency services. As the generation we discussed belongs to the the healthier group, and although we have found the relationships been groups of clustering and emergency services, we cannot know the main reason why these people used emergency service due to lack of detailed data. In addition, this cross-sectional study could not analyze the effects of clustering groups on outpatient or inpatient medical care utilizations. All in all, emerging adulthood is at a critical turning point from life-course perspective, therefore, it is an important task to develop a healthy lifestyle. Our study suggests that whether or not in college, university, or the workplace, health promotion programs could adopt an integrated approaches and tailor-made programs, when taking into account the common determinants across different types of health behaviors.
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Lin, Jia-Lin, i 林嘉琳. "The prevalence of the chronic diseases, survival, and healthcare utilization in the middle-aged and senior adult with vision impairment". Thesis, 2019. http://ndltd.ncl.edu.tw/handle/6348g3.
Pełny tekst źródłaStreszczenie:
碩士國立陽明大學
衛生福利研究所
107
Background: Previous studies had found that the prevalence of chronic diseases, mortality, and healthcare utilization in people with vision disability were higher than those without vision disability. However, there are few relevant studies in Taiwan. Objective: To investigate the prevalence of chronic diseases, mortality, and healthcare utilization in the middle-aged and senior adult with vision disability. Methods: Cross-sectional study design was used to evaluate the prevalence of chronic diseases, while retrospective cohort study design was used to evaluate mortality and healthcare utilization. Study population consisted of adults 35 years of age and older on April 1st, 2014 using the National Health Insurance Claims Data. Those presented in the Disabled Population Profile were classified as the case group. Reference group was composed of rest of the general population matched for age and sex in a 1:4 ratio. Chi-square was used to compare the prevalence of chronic diseases (including Diabetes Mellitus, Hypertension, Stroke, Heart failure, Coronary artery disease, Depression) between the two groups. Cox Proportional Hazard Model was used to analyze survival. Multivariable logistic regression was used to analyze difference in healthcare utilization (including outpatient clinic, emergency visit, hospitalization) between the two groups. Results: Those with vision disability had higher prevalence for Diabetes Mellitus, Hypertension, Stroke, Heart failure, Coronary artery disease, Depression than those without vision disability, and this difference was higher in the middle-aged adult group as compared to the senior adult group. In the middle-aged adult group, crude prevalence rate for Diabetes Mellitus was 3.67 times higher in those with vision disability than those without, while this was only 1.40 times in the senior adult group. As for the other chronic diseases, it was 2.13 times versus 1.10 times for Hypertension, 4.86 times versus 1.65 times for Stroke, 5.59 times versus 1.77 times for Heart failure, 2.34 times versus 1.15 times for Coronary artery disease, 2.20 times versus 1.40 times for Depression. Among the middle-aged adult group, those with vision disability had 4.91 times higher crude mortality rate than those without vision disability, and this was higher than that in the senior adult group. After matching and adjusting for potential confounding factors, those with vision disability had higher risk for Diabetes Mellitus, Hypertension, Stroke, Heart failure, Coronary artery disease, Depression than those without vision disability. The adjusted odds ratios (AORs) were higher for middle-aged adult group when compared to the senior adult group, with AOR=3.08 vs 1.66 for Diabetes Mellitus, AOR=1.73 vs 1.10 for Hypertension, AOR=3.01 vs 1.50 for Stroke, AOR=3.39 vs 1.36 for Heart failure, AOR=1.56 vs 1.09 for Coronary artery disease, and AOR=1.96 vs 1.50 for Depression. Those with vision disability also showed higher risk of death than those without vision disability. The AHRs was higher among middle-aged adult groups than senior adult groups, with AHR=1.59 and AHR=1.31, respectively. As for healthcare utilization, those with vision disability had higher utilization than those without vision disability. The middle-aged group showed a larger difference than the senior adult group; the average outpatient clinic expenditure (2.60 times versus 1.37 times), the average emergency visit frequency (2.17 times versus 1.33 times), the average emergency expenditure (2.80 times versus 1.44 times), the average hospitalization (2.06 times versus 1.28 times), the average hospitalization frequency (2.39 times versus 1.35 times), the average hospitalization duration (3.24 times versus 1.53 times), the average hospitalization expenditure (2.64 times versus 1.39 times). Conclusion: Significant difference was found in health status, mortality and healthcare utilization between those with vision disability and those without. Policies on chronic disease prevention should be reinforced, especially among the middle-aged population with vision disability, to minimize disease occurrence and allow early prevention. Psychological health support should be provided to lessen feelings of loneliness and depressed mood. Healthcare providers should emphasize on health education and disease management in order to control severity of diseases and avoid overuse of healthcare utilization. Those with vision disability should also have better self-management and health literacy in order to prevent or delay occurrence of chronic diseases.
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Huang, Wei-Ling, i 黃韋綾. "Medication adherence of Statins and Healthcare Utilization among the Middle-aged and Elderly with Coronary Heart Disease：A Cohort study in Taiwan". Thesis, 2015. http://ndltd.ncl.edu.tw/handle/3gxqu5.
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碩士國立中山大學
企業管理學系醫務管理碩士班
103
Objective： The purpose of this study is to explore the relationship of patients’ medication adherence with the statins therapy and inpatient visit the in Taiwan. Methods： A corhort study was implemented to use the National Health Insurance Research Database（NHIRD）between January 2001 and December 2007, to analysis the patient who had taken the medicine of statins at the first time and never had diagnosis of coronary heart disease（CHD）. The patient were followed until occurred first inpatient visit with coronary heart disease or end of study period（Dec. 31 2007）. The medication adherence was calculated as medication possession ratio（MPR）which was sum of days of supply of the statins medications divided by follow-up duration. Result： In the analyzed of 19371 patients who use statins therapy, 11642 patients（59.17%）had high medication adherence（MPR≧80％）and the rest patients（40.83%）had been included in low medication adherence（MPR＜80％）. There were significantly higher adherence for patients were male, elderly, CCI=1, in medical center and in rural area. The hospitalized risk increased with MPR<80 %, male, elderly, and more comorbidities. The hospitalization costs showed comorbidities with MPR<80 %, male, elderly, more comorbidities, patient in medical center, teaching-hoapital and suburban. Conclution： Lipid-lowering therapy, statins medication is well known to reduce cardiovascular risk across a wide range of patients. It is very important to follow-up and compliance with statins therapy. This study finded that good adherence to statin treatment was associated with lower risk of occurred CHD.
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"Spatial variation in the utilization of public healthcare services among the Hong Kong elderly in the last three years of life in relation to the service provision and their health outcome". 2010. http://library.cuhk.edu.hk/record=b5894480.
Pełny tekst źródłaStreszczenie:
Wong, King Moses."August 2010."
Thesis (M.Phil.)--Chinese University of Hong Kong, 2010.
Includes bibliographical references (leaves 158-172).
Abstracts in English and Chinese.
Chapter Chapter One: --- Introduction --- p.1
Chapter 1.1 --- Background --- p.1
Chapter 1.2 --- Research objectives --- p.5
Chapter 1.3 --- Research hypothesis --- p.7
Chapter 1.4 --- Research questions --- p.7
Chapter 1.5 --- Research structure --- p.9
Chapter Chapter Two: --- Literature Review --- p.10
Chapter 2.1 --- "Health geography: knowledge of population, people, places and health" --- p.10
Chapter 2.2 --- Understanding geographies of diseases: mapping and modeling diseases and health --- p.17
Chapter 2.3 --- Healthcare services provision and utilization --- p.22
Chapter 2.4 --- Hong Kong: facts and context --- p.31
Chapter 2.4.1 --- Demographics --- p.32
Chapter 2.4.2 --- Key challenges arising from population ageing --- p.37
Chapter 2.4.2.1 --- Implications to medico-social agenda --- p.38
Chapter 2.4.2.2 --- Implications to health status --- p.38
Chapter 2.4.2.3 --- Implications to disease pattern --- p.39
Chapter 2.4.3 --- Healthcare service delivery system in Hong Kong --- p.41
Chapter 2.4.3.1 --- Financing and expenditure --- p.42
Chapter 2.4.3.2 --- Organizational framework and healthcare policy --- p.44
Chapter 2.4.3.3 --- Healthcare resources --- p.49
Chapter 2.4.3.4 --- Utilization and provision of public healthcare services --- p.50
Chapter Chapter Three: --- Material & Methods --- p.55
Chapter 3.1 --- Background of main source of data --- p.55
Chapter 3.2 --- Sources of data --- p.57
Chapter 3.2.1 --- Hospital services utilization data --- p.57
Chapter 3.2.2 --- Healthcare resources data --- p.61
Chapter 3.2.3 --- Population data --- p.62
Chapter 3.3 --- Spatial scale of analysis --- p.62
Chapter 3.4 --- Statistical analyses --- p.63
Chapter 3.4.1 --- Service utilization ratios --- p.63
Chapter 3.4.2 --- Provision of healthcare resources to population --- p.65
Chapter 3.4.3 --- Adequacy of healthcare services provision --- p.65
Chapter 3.4.4 --- Mortality analysis --- p.67
Chapter 3.4.5 --- Multi-level analysis --- p.69
Chapter 3.4.6 --- Mapping of health services utilization ratio and mortality ratio --- p.70
Chapter 3.5 --- Statistical packages used --- p.73
Chapter 3.6 --- Cautions on interpretation --- p.74
Chapter 3.6.1 --- Confounding and ecological fallacy --- p.74
Chapter 3.6.2 --- Problem with the use of Standardized Mortality Ratio --- p.75
Chapter 3.6.3 --- Problem with mapping and visualization --- p.76
Chapter Chapter Four: --- Results --- p.78
Chapter 4.1 --- Socio-spatial variation in mortality --- p.78
Chapter 4.2 --- Statistical analysis and mapping of health services utilization ratio --- p.80
Chapter 4.3 --- Statistical and cartographic analysis in Standardized Mortality Ratio --- p.88
Chapter 4.4 --- Provision of healthcare resources to population --- p.91
Chapter 4.5 --- "Multi-level analysis of hospital services utilization, provision and mortality" --- p.92
Chapter 4.6 --- Further analysis --- p.95
Chapter Chapter Five: --- Discussion --- p.100
Chapter 5.1 --- Geographic variations in health services utilization ratios --- p.101
Chapter 5.2 --- Geographic variation in Standardized Mortality Ratio --- p.107
Chapter 5.3 --- "Multi-level models on health services utilization, provision and mortality" --- p.121
Chapter 5.3.1 --- Socio-demographic characteristics of health services utilization --- p.121
Chapter 5.3.1.1 --- Age --- p.121
Chapter 5.3.1.2 --- Gender --- p.124
Chapter 5.3.2 --- Health services utilization in relation to services provision --- p.129
Chapter 5.3.3 --- Health services utilization in relation to mortality --- p.132
Chapter 5.3.4 --- Adequacy of healthcare services provision --- p.134
Chapter 5.3.4.1 --- Adequacy of hospital care provision --- p.134
Chapter 5.3.4.2 --- Adequacy of primary care provision --- p.139
Chapter 5.4 --- Implications --- p.143
Chapter 5.5 --- Strengths of study --- p.146
Chapter 5.6 --- Limitations of study --- p.148
Chapter 5.7 --- Recommendations for future research --- p.151
Chapter Chapter Six: --- Conclusion --- p.154
References --- p.158
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McIntosh, Bryan, G. Cookson i S. Jones. "Cancelled surgeries and payment by results in the English National Health Service". 2012. http://hdl.handle.net/10454/6502.
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OBJECTIVES: To model the frequency of 'last minute' cancellations of planned elective procedures in the English NHS with respect to the patient and provider factors that led to these cancellations. METHODS: A dataset of 5,288,604 elective patients spell in the English NHS from January 1st, 2007 to December 31st, 2007 was extracted from the Hospital Episode Statistics. A binary dependent variable indicating whether or not a patient had a Health Resource Group coded as S22--'Planned elective procedure not carried out'--was modeled using a probit regression estimated via maximum likelihood including patient, case and hospital level covariates. RESULTS: Longer waiting times and being admitted on a Monday were associated with a greater rate of cancelled procedures. Male patients, patients from lower socio-economic groups and older patients had higher rates of cancelled procedures. There was significant variation in cancellation rates between hospitals; Foundation Trusts and private facilities had the lowest cancellation rates. CONCLUSIONS: Further research is needed on why Foundation Trusts exhibit lower cancellation rates. Hospitals with relatively high cancellation rates should be encouraged to tackle this problem. Further evidence is needed on whether hospitals are more likely to cancel operations where the procedure tariff is lower than the S22 tariff as this creates a perverse incentive to cancel. Understanding the underlying causes of why male, older and patients from lower socio-economic groups are more likely to have their operations cancelled is important to inform the appropriate policy response. This research suggests that interventions designed to reduce cancellation rates should be targeted to high-cancellation groups.
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Turnbull, Margaret. "Assessing the Regularity and Predictability of the Age-Trajectories of Healthcare Utilization". 2012. http://hdl.handle.net/10222/15441.
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This research examines the viability of a need-based approach that models the age-trajectories of healthcare utilization. We propose a fundamentally different way of treating age in modeling healthcare use. Rather than treating age as a need indicator, we refocus modeling efforts to predicting the age-trajectories of healthcare use. Using inpatient hospital utilization data from the Discharge Abstract Database, first, we model the age-trajectories of the rate of hospital use employing a common functional form. Second, we assess variation in these age-trajectories using growth curve modeling. Third, we explain variation in these age-trajectories using census variables. Our analysis shows that the regional variation in the age-trajectories of the rate of inpatient hospital use is sufficient to justify this method, and could be partially explained using census variables. This indicates that modeling age-trajectories of healthcare use is advantageous, and the current need-based approach may benefit from this new modeling strategy.
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Qiao, Nan. "Three Healthcare Topics: Adult Children's Informal Care to Aging Parents, Working Age Population's Marijuana Use, and Indigenous Adolescents' Suicidal Behaviors". Diss., 2019. http://hdl.handle.net/1805/18483.
Pełny tekst źródłaStreszczenie:
Indiana University-Purdue University Indianapolis (IUPUI)This dissertation examines three vulnerable groups’ health and healthcare access. The first research uses the 2002–2011 Health and Retirement Study data to estimate the effects of adult children’s employment on their caregiving to aging parents. State monthly unemployment rates are used as an instrument for employment. Results show that being employed affects neither male nor female adult children’s caregiving to aging parents significantly. The findings imply that the total amount of informal care provided by adult children might not be affected by changes in labor market participation trends of the two genders. The second research studies the labor impact of Colorado and Washington’s passage of recreational marijuana laws in December 2012. The difference-in-differences method is applied on the 2010–2013 National Survey on Drug Use and Health state estimates and the 2008–2013 Survey of Income and Program Participation data to estimate legalization’s effects on employment. The results show that legalizing recreational marijuana increases marijuana use and reduces the number of weeks employed in a given month by 0.090 among those aged 21 to 25. The laws’ labor effects are not significant on those aged 26 and above. To reduce legalization’s negative effects on employment, states may consider raising the minimum legal age for recreational marijuana use. The third research examines disparities in suicidal behaviors between indigenous and non-indigenous adolescents. The study analyzes the 2001–2013 Youth Risk Behavior Survey data. Oaxaca decomposition is applied to detect sources of disparities in suicide consideration, planning, and attempts. The study finds that the disparities in suicidal behaviors can be explained by differences in suicidal factors’ prevalence and effect sizes between the two groups. Suicidal behavior disparities might be reduced by protecting male indigenous adolescents from sexual abuse and depression, reducing female indigenous adolescents’ substance use, as well as involving male indigenous adolescents in sports teams.
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Kao, Mei Hua, i 高美華. "The Effects of Self-Management Intervention on Symptoms and Physical Function of Knee, Healthcare Outcomes and Quality of Life Among Middle-Age Adults With Knee Osteoarthritis". Thesis, 2014. http://ndltd.ncl.edu.tw/handle/gb3u7d.
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"Effects of health insurance benefit plan design on healthcare resource utilization, medication possession for oral antidiabetic medication, and receipt of appropriate process of care in adult working age patients with type 2 diabetes mellitus". Tulane University, 2010.
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