1
|
Yang L, Wang L. From rationality to identity: the impact of using community health services for the aged on the well-being of older adults in China. Front Public Health 2024; 12:1447217. [PMID: 39381770 PMCID: PMC11458453 DOI: 10.3389/fpubh.2024.1447217] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2024] [Accepted: 09/12/2024] [Indexed: 10/10/2024] Open
Abstract
Objectives To better understand the outcome benefits of community health services for the aged (CHSA) and provide bottom-up identity for development, this study examined the impact of using CHSA on well-being of older adults from both objective and subjective dimensions. Methods Data from 1,411 people aged 60+ in Shaanxi, China was used in this study. The OLS estimate was used to analyze the impact of using CHSA on well-being of older adults. Then, the instrumental variable estimate was further hired to examine associations among variables to address the potential endogeneity concerns. The heterogeneity among disabled and non-disabled group was also estimated. Results For objective well-being, the mental health (β = 0.44) and financial well-being (β = 0.59) of older people using CHSA were significantly higher than those not using any service. The impact on objective well-being were more significant in non-disabled group. For subjective well-being, life meaning (β = 0.54) and security (β = 0.72) were positively associated with CHSA utilization, while independence index (β = -0.33) was negatively related with CHSA utilization. The subjective well-being of disabled group using services increased more than non-disabled group. Conclusion Findings underscore the positive, albeit group-selective, role of CHSA in improving well-being of older people in China and imply the necessity of high-quality development of CHSA and the targeted differentiation strategy.
Collapse
Affiliation(s)
| | - Lijian Wang
- School of Public Policy and Administration, Xi’an Jiaotong University, Xi’an, China
| |
Collapse
|
2
|
Lenzen S, Gannon B, Rose C, Norton EC. The relationship between physical activity, cognitive function and health care use: A mediation analysis. Soc Sci Med 2023; 335:116202. [PMID: 37713774 DOI: 10.1016/j.socscimed.2023.116202] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/05/2023] [Revised: 07/27/2023] [Accepted: 08/30/2023] [Indexed: 09/17/2023]
Abstract
Physical activity is known to provide substantial health benefits and subsequently reduce health care use among older people, but little is known about how much of this effect is due to improved cognitive function as opposed to physical improvements in health. We study the direct and indirect effect of physical activity on health care use using the word recall task as a measure of cognitive function in a mediation framework. We use data from eight waves of the US Health and Retirement Study (HRS) (2004 - 2018) of people aged 65 and older and exploit genetic variations between individuals as an instrumental variable (IV) for cognitive function, a local health care supply measure as IV for health care use, and neighbourhood physical activity as IV for individual physical activity in our simultaneous three-equation model. We find small but negative direct and indirect effects of physical activity through improved cognitive function on the probability to see a GP and being admitted to a hospital, as well as the number of GP visits and the hospital length of stay. Improved cognitive function explains between 5% to 17% of the total effect of physical activity on the reduction in health care use.
Collapse
Affiliation(s)
- Sabrina Lenzen
- Centre for the Business and Economics of Health, Sir Llew Edwards Building (Building 14), Level 5, Room 513a, The University of Queensland, Faculty of Business, Economics and Law, QLD, St Lucia 4072, Australia.
| | - Brenda Gannon
- Centre for the Business and Economics of Health, Sir Llew Edwards Building (Building 14), Level 5, Room 513a, The University of Queensland, Faculty of Business, Economics and Law, QLD, St Lucia 4072, Australia; School of Economics, Colin Clark Building (Building 39), The University of Queensland, Faculty of Business, Economics and Law, QLD, St Lucia 4072, Australia.
| | - Christiern Rose
- School of Economics, Colin Clark Building (Building 39), The University of Queensland, Faculty of Business, Economics and Law, QLD, St Lucia 4072, Australia.
| | - Edward C Norton
- Department of Health Management and Policy, University of Michigan, M3108 SPH II 1415 Washington Heights Ann Arbor, MI 48109-2029, United States of America; Department of Economics, University of Michigan, United States of America; Population Studies Center, United States of America; National Bureau of Economic Research, United States of America.
| |
Collapse
|
3
|
Natalucci V, Marmondi F, Biraghi M, Bonato M. The Effectiveness of Wearable Devices in Non-Communicable Diseases to Manage Physical Activity and Nutrition: Where We Are? Nutrients 2023; 15:nu15040913. [PMID: 36839271 PMCID: PMC9966298 DOI: 10.3390/nu15040913] [Citation(s) in RCA: 6] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2023] [Revised: 01/28/2023] [Accepted: 02/07/2023] [Indexed: 02/16/2023] Open
Abstract
Wearable devices are increasingly popular in clinical and non-clinical populations as a tool for exercise prescription, monitoring of daily physical activity and nutrition, and health-related parameters management. In this regard, smart devices not only assist people in pursuing a healthier lifestyle, but also provide a constant stream of physiological and metabolic data for management of non-communicable diseases (NCDs). Although the benefits of lifestyle-based interventions (exercise and nutrition) for NCDs are well known, the potential of wearable devices to promote healthy behaviors in clinical populations is still controversial. In this narrative review, we aimed to discuss the current application of wearable devices in NCDs, highlighting their role in prescribing and monitoring daily physical activity and dietary habits in the population living with chronic diseases. None of the studies considered specifically addressed the efficacy of the use of wearable devices, and limited are those that incorporate monitoring of both physical activity and nutrition for NCDs. However, there is evidence that such devices have helped improve physical activity levels, physical fitness, body composition, and metabolic and psychological parameters. Therefore, the authors believe that the benefits obtained from the use of wearable devices are likely to translate to public health and represent one of the important tools for the development of prevention plans in everyday life and clinical practice for optimal patient management.
Collapse
Affiliation(s)
- Valentina Natalucci
- Department of Biomolecular Sciences, Division of Exercise and Health Sciences, University of Urbino Carlo Bo, 61029 Urbino, Italy
- Correspondence:
| | - Federica Marmondi
- Department of Infection Diseases, IRCCS San Raffaele Scientific Institute, 20132 Milan, Italy
| | - Michele Biraghi
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20122 Milan, Italy
| | - Matteo Bonato
- Department of Biomedical Sciences for Health, Università degli Studi di Milano, 20122 Milan, Italy
- IRCCS Istituto Ortopedico Galeazzi, 20161 Milan, Italy
| |
Collapse
|
4
|
Associations Between Physical Activity Vital Sign in Patients and Health Care Utilization in a Health Care System, 2018-2020. J Phys Act Health 2023; 20:28-34. [PMID: 36493760 DOI: 10.1123/jpah.2022-0266] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/17/2022] [Revised: 09/29/2022] [Accepted: 10/12/2022] [Indexed: 12/13/2022]
Abstract
BACKGROUND Physical inactivity is a risk factor for many chronic conditions. This retrospective cohort study examined associations between physical activity (PA) with health care utilization (HU). METHODS A PA vital sign was recorded in clinics from January 2018 to December 2020. Patients were categorized as inactive, insufficiently active, or sufficiently active by US PA aerobic guidelines. Associations between PA vital sign and visits (inpatient admissions, emergency department, urgent care, and primary care) were estimated using population average regression by visit type. RESULTS 23,721 patients had at least one PA vital sign recorded, with a mean age of 47.3 years and mean body mass index (BMI) of 28; 52% were female and 63% were White. Sufficiently active patients were younger, male, White, and had lower BMI than insufficiently active patients. Achieving 150 minutes per week of moderate to vigorous PA per 1000 patient years was associated with 34 fewer emergency department visits (P < .001), 19 fewer inpatient admissions (P < .001), and 38 fewer primary care visits (P < .001) compared with inactive patients. Stronger associations between lower PA and higher HU were present among those who were older or had a higher comorbidity. BMI, sex, ethnicity, and race did not modify the association between PA and HU. CONCLUSIONS Meeting aerobic guidelines was associated with reduced HU for inpatient, primary care, and emergency department visits.
Collapse
|
5
|
Associations between Physical Activity Level and Health Services Use in Spanish Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19148867. [PMID: 35886715 PMCID: PMC9321179 DOI: 10.3390/ijerph19148867] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/14/2022] [Revised: 07/15/2022] [Accepted: 07/18/2022] [Indexed: 11/16/2022]
Abstract
One of the main concerns of governments and organisations worldwide is the cost and burden of health services, with sedentary lifestyles being a significant impacting factor, and physical activity is one of the potential solutions. Therefore, this study aims to analyse the possible associations between the physical activity level, hospitalisation prevalence, and the use and number of visits to emergency services in the Spanish population, examining potential differences between sex and age groups. This is a cross-sectional study based on data from the Spanish National Health Survey 2017 (ENSE 2017), the last one before the COVID-19 pandemic, with 17,199 participants. A descriptive analysis was performed using median and interquartile range (continuous variables) and absolute and relative frequencies (ordinal variables). Intergroup differences were analysed with non-parametric tests: chi-square and z-test for independent proportions (categorical variables), and Kruskal−Wallis and Mann−Whitney U (continuous variables). Spearman’s rho was used to study correlations between variables. A multiple binary regression analysis was performed to predict hospitalisations. Hospitalisations and emergency services use showed a dependence relation with the physical activity level (p < 0.001): those who performed moderate and/or vigorous physical activity used those services less than sedentary individuals and those whose only activity was walking. Thus, associations could be drawn between the hospitalisation prevalence, the use and number of visits to emergency departments, and the physical activity level in the Spanish population aged 18−69 years in the pre-pandemic period.
Collapse
|
6
|
Jemna DV, David M, Depret MH, Ancelot L. Physical activity and healthcare utilization in France: evidence from the European Health Interview Survey (EHIS) 2014. BMC Public Health 2022; 22:1355. [PMID: 35840906 PMCID: PMC9288017 DOI: 10.1186/s12889-022-13479-0] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/28/2021] [Accepted: 05/18/2022] [Indexed: 12/27/2022] Open
Abstract
Background A growing need and focus on preventing and controlling the diseases and promoting a healthier lifestyle is more evident at global, regional, and national levels. In this respect, it is well-known the positive association between physical activity and population’s health, but also its negative association with the demand of healthcare, which could lead to lower spending on healthcare systems. In France, a lack of physical activity, a high prevalence of sedentary behaviours, and a continuous deterioration of these behaviours are observed since 2006. Therefore, promoting and increasing physical activities could contribute to major societal issues. Within this context, the study aims to analyse how the use of different healthcare services are related to physical activity in a nationally representative sample of French population. Methods The data used was retrieved from the second wave of the EHIS-ESPS 2014. The relationship between physical activity and healthcare utilization, controlled by a set of socioeconomic, demographic, and health behaviour factors, was explored both at the level of the entire population and separately for two age groups (less than 65 years, 65 years and older), employing probit and recursive multivariate probit models. Results Our findings underline that the relation between healthcare utilization and physical activity depends on the type of healthcare services and age group. In this respect, only among adult respondents, we observe a significant negative association between physical activity and prescribed medicines consumption and day hospitalization, while preventive services use is positively related to physical activity. Common to both age groups, the positive association of physical activity with general physician services and non-prescribed medicines reveal that moderately and highly active adults and elders may be more health conscious and therefore may seek referrals to generalist and other prevention measures more frequently than their inactive counterparts. This explanation is also sustained by the negative association between physical activity and overnight hospitalization or home healthcare services. Conclusions This study highlights the double role of physical activity on health as preventive measure and treatment and thus support the implementation of public health policies aimed at increasing the level of physical activity in French population. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-022-13479-0.
Collapse
Affiliation(s)
- Dănuț-Vasile Jemna
- Faculty of Economics and Business Administration, "Alexandru Ioan Cuza" University of Iași, Iași, Romania
| | - Mihaela David
- "Gh. Zane" Institute for Economic and Social Research - Romanian Academy, Iași Branch; "Alexandru Ioan Cuza" University of Iași, Iași, Romania.
| | - Marc-Hubert Depret
- Centre de Recherche sur l'Intégration Economique et Financière, Institut des Risques Industriels, Assurantiels et Financiers, University of Poitiers, Poitiers, France
| | - Lydie Ancelot
- Centre de Recherche sur l'Intégration Economique et Financière, Institut des Risques Industriels, Assurantiels et Financiers, University of Poitiers, Poitiers, France
| |
Collapse
|
7
|
Gender differences in physical activity status and knowledge of Irish University staff and students. SPORT SCIENCES FOR HEALTH 2022. [DOI: 10.1007/s11332-022-00898-0] [Citation(s) in RCA: 2] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/25/2022]
Abstract
Abstract
Objectives
The aim of this study is to examine gender differences in physical activity status and knowledge of physical activity guidelines in University staff and students.
Methods
820 survey respondents, 419 males and 401 females (Age: mean 30 ± 12, median 24 years; Weight: mean 73.4 ± 15.8 kg; Stature: mean 172.1 ± 10.2 cm) were recruited via internal email. All participants completed a self-administered online format of the Global Physical activity Questionnaire.
Results
Less females were regularly active than males in students (p ≤ 0.001; Cramer’s V = 0.232 [small]), and staff (p = 0.003; Cramer’s V = 0.249 [small]). Overweight BMI incidence was greater among male students (p = 0.014; Cramer’s V = 0.13 [small]), and staff (p = 0.007; Cramer’s V = 0.31 [large]). A total of 43% of males and 29% of females were overweight or obese. No significant difference between genders for PA recommendations knowledge was observed (students; p = 0.174; Cramer’s V = 0.054 [trivial], staff; p = 0.691; Cramer’s V = 0.035 [trivial]). No significant difference between genders for disease incidence was observed (students; p = 0.894; Cramer’s V = 0.005 [trivial], staff; p = 0.237, Cramer's V = 0.101 [small]).
Conclusions
Males had greater levels of PA participation and incidence of overweight BMI compared to females. These findings suggest PA status alone does not determine BMI status. Further investigation is needed to determine factors related to BMI status.
Collapse
|
8
|
Park Y, Lee S, Park S. Differences in Park Walking, Comparing the Physically Inactive and Active Groups: Data from mHealth Monitoring System in Seoul. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 19:395. [PMID: 35010655 PMCID: PMC8744669 DOI: 10.3390/ijerph19010395] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Figures] [Subscribe] [Scholar Register] [Received: 10/30/2021] [Revised: 12/16/2021] [Accepted: 12/20/2021] [Indexed: 06/14/2023]
Abstract
Despite the overall increase in physical activities and park uses, the discrepancies between physically inactive and active people have increasing widened in recent times. This paper aims to empirically measure the differences in walking activity in urban parks between the physically inactive and active. As for the dataset, 22,744 peoples' 550,234 walking bouts were collected from the mHealth system of the Seoul government, using the smartphone healthcare app, WalkOn, from September to November 2019, in Seocho-gu district, Seoul, Korea. We classified the physically inactive and active sample groups, based on their regular walking (≥150 min of moderate-to-vigorous walking activity a week), and analyzed their park walking activities. We found that while there was no significant difference in walking measures of non-park walking between the sample groups, the difference did exist in park walking. The park walking average in the physically active group had more steps (p = 0.021), longer time (p = 0.008), and higher intensity (p < 0.001) of walking than that in the inactive group. Each park also revealed differences in its on-site park walking quantity and quality, based on which we could draw the list of 'well-walked parks', which held more bouts and more moderate-to-vigorous physical activities (MVPAs) than other parks in Seocho-gu district. This paper addresses how park walking of physically inactive and active people is associated with multiple differences in everyday urban walking.
Collapse
|
9
|
Okamoto S, Kamimura K, Shiraishi K, Sumita K, Komamura K, Tsukao A, Chijiki S, Kuno S. Daily steps and healthcare costs in Japanese communities. Sci Rep 2021; 11:15095. [PMID: 34301997 PMCID: PMC8302729 DOI: 10.1038/s41598-021-94553-2] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2020] [Accepted: 07/09/2021] [Indexed: 11/14/2022] Open
Abstract
Physical inactivity is a pandemic that requires intensive, usually costly efforts for risk reduction of related chronic diseases. Nevertheless, it is challenging to determine the effectiveness of physical activity in healthcare cost reduction based on existing literature. Therefore, this study aimed to investigate the impact of physical activity (daily steps) on healthcare costs utilising the data retrieved from a health promotion project (the e-wellness Project, held in three municipalities in Japan). Evaluating the effects of daily steps, measured by pedometers, on healthcare costs by a quasi-experimental approach among participants aged 40–75 years (about 4000 person-years of observation, between 2009 and 2013), we found that a one-step-increase in the annual average daily step reduced outpatient healthcare costs by 16.26 JPY (≒ 0.11 GBD) in the short run. Based on the assumption of a dynamic relationship between the health statuses in multiple years, the long-run effects of daily steps on healthcare costs were estimated at 28.24 JPY (≒ 0.20 GBD). We determined the health benefits of walking in a sample of middle-aged and older Japanese adults by our findings that an increase in step counts reduced healthcare costs.
Collapse
Affiliation(s)
- Shohei Okamoto
- Research Team for Social Participation and Community Health, Tokyo Metropolitan Institute of Gerontology, 35-2 Sakae-cho, Itabashi-ku, Tokyo, 173-0015, Japan. .,Institute for Global Health Policy Research, National Centre for Global Health and Medicine, Tokyo, Japan.
| | | | - Kenichi Shiraishi
- Department of Social Welfare, Gunma University of Health and Welfare , Gunma, Japan
| | - Kazuto Sumita
- Department of International Economics, Toyo University , Tokyo, Japan
| | | | | | | | - Shinya Kuno
- R&D Center for Smart Wellness City Policies, University of Tsukuba , Ibaraki, Japan
| |
Collapse
|
10
|
Kumagai N, Tajika A, Hasegawa A, Kawanishi N, Fujita H, Tsujino N, Jinnin R, Uchida M, Okamoto Y, Akechi T, Furukawa TA. Assessing recurrence of depression using a zero-inflated negative binomial model: A secondary analysis of lifelog data. Psychiatry Res 2021; 300:113919. [PMID: 33864960 DOI: 10.1016/j.psychres.2021.113919] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/15/2020] [Accepted: 03/28/2021] [Indexed: 11/27/2022]
Abstract
When studying recurrence of depression, researchers should pay attention to cases where physicians' assessment corresponds to the patients' perception. However, they should also focus on potential signs of recurrence when the recurrence is suspected by the physicians but not the patients (false-negative zeros). Because false negatives can delay diagnosis and treatment, we aimed to investigate "sitting idly" as a predictor influencing no alert sign of recurrence and estimated the counts of recurrence of depression. A smartphone application and a wearable device were used to collect lifelog data from 89 remitted depressive patients over one year. Recurrent depression was defined using the Japanese version of the Kessler Psychological Distress Scale and Patient Health Questionnaire-9 scores. Estimates of the population-averaged parameters indicated that daily hours of sitting idly increased the chances of recurrent depression occurring two to four weeks later. Exposure to daily ultraviolet light reduced depression relapse. Although long sleep was a determinant of zero outcome of the recurrence of depression after two to four weeks, daily hours of sitting idly can negate it. Thus, daily hours of sitting idly could reduce overdispersion of the recurrence of depression, and we could measure recurrent depression accurately by considering changes in sitting idly.
Collapse
Affiliation(s)
| | - Aran Tajika
- Department of Psychiatry, Kyoto University Hospital, Kyoto, Japan.
| | - Akio Hasegawa
- Advanced Telecommunications Research Institute International, Kyoto, Japan
| | | | - Hirokazu Fujita
- Center to Promote Creativity in Medical Education, Kochi Medical School, Kochi University, Kochi, Japan
| | - Naohisa Tsujino
- Department of Neuropsychiatry, School of Medicine, Toho University, Tokyo, Japan; Department of Psychiatry, Saiseikai Yokohama-shi Tobu Hospital, Kanagawa, Japan
| | - Ran Jinnin
- Department of Psychiatry & Neurosciences, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Megumi Uchida
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Yasumasa Okamoto
- Department of Psychiatry & Neurosciences, Graduate School of Biomedical & Health Sciences, Hiroshima University, Hiroshima, Japan
| | - Tatsuo Akechi
- Department of Psychiatry and Cognitive-Behavioral Medicine, Nagoya City University Graduate School of Medical Sciences, Nagoya, Japan
| | - Toshi A Furukawa
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine / School of Public Health, Kyoto, Japan
| |
Collapse
|
11
|
Yusuf M, Dey P, Callaghan M, Relph N, Gichuru P, Pinner S, Ashbrook J, Ashman J, Goodwin P, Macdonald R, Selfe J. Validation and utilisation of a digital version of the survey instrument for natural history, Aetiology and Prevalence of Patellofemoral pain studies (eSNAPPS). Phys Ther Sport 2021; 50:82-88. [PMID: 33940555 DOI: 10.1016/j.ptsp.2021.04.002] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/05/2021] [Revised: 04/03/2021] [Accepted: 04/06/2021] [Indexed: 01/25/2023]
Abstract
OBJECTIVE This study validated the newly adapted electronic SNAPPS (eSNAPPS) against the original paper SNAPPS. Subsequently, the study estimated the prevalence of PFP in running participants and spectators attending three mass-participant running events in the United Kingdom by using the eSNAPPS tool. DESIGN This study had two parts. Firstly, a validation of the original paper version of the SNAPPS tool. Secondly, if validation was achieved, eSNAPPS was used in a prevalence study. PARTICIPANTS A convenience sample of running participants and spectators aged 18-40 years attending the mass participation running events. MAIN OUTCOME MEASURE The 12-month prevalence of PFP. RESULTS eSNAPPS was valid in identifying those with PFP (ICC 0.99 for Overall agreement, p < 0.0001). In the prevalence study, a total of 1080 running participants and spectators completed the eSNAPPS. The overall prevalence of PFP was 17.4% (95%CI: 15.2%, 19.8%); 20.5% of males (16.5, 24.9) and 15.7% of females (13.1, 18.7) had PFP. Prevalence was 17.4% (15.2, 19.8) in spectators and 16.7% in running participants (14.5, 19.0). CONCLUSION The overall PFP prevalence in this study was slightly smaller than those previously reported in the literature. Findings also show that there were similar prevalence estimates in spectators and running participants.
Collapse
Affiliation(s)
- Mohamed Yusuf
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK.
| | - Paola Dey
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | - Michael Callaghan
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Nicola Relph
- Faculty of Health, Social Care and Medicine, Edge Hill University, Ormskirk, UK
| | | | - Susan Pinner
- Musculoskeletal Science and Sports Medicine Research Centre, Department of Sport and Exercise Sciences, Manchester Metropolitan University, Manchester, UK
| | - Jane Ashbrook
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Joanne Ashman
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Peter Goodwin
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - Ruth Macdonald
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| | - James Selfe
- Faculty of Health, Psychology and Social Care, Manchester Metropolitan University, Manchester, UK
| |
Collapse
|
12
|
Pardo-Garcia I, Amo-Saus E, Moya-Martinez P. Socioeconomic and Lifestyle Factors Related to Cost and Frequency of Hospitalization in European Older Adults. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:2833. [PMID: 33802180 PMCID: PMC7998278 DOI: 10.3390/ijerph18062833] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 02/11/2021] [Revised: 03/06/2021] [Accepted: 03/08/2021] [Indexed: 11/16/2022]
Abstract
Individuals' lifestyles play an important role in healthcare costs. A large part of these costs is derived from hospitalizations. With the aim of determine the relationship between lifestyle and the likelihood of hospitalization and associate costs in older adults, this study used the Survey of Health, Aging, and Retirement in Europe. Generalized regression models for panel data were developed and adjusted hospitalization costs derived from the length of hospital stay were also estimated. The average adjusted cost of hospitalization was I$ 9901.50 and the analyses showed that performing weekly physical activity significantly reduces the probability of hospitalization (OR: 0.624) and its costs (I$ 2594.5 less per person per year than subjects who never performed physical activity). Muscle strength plays an important role in this relationship and eating habits are not of great significance. Furthermore, we found interesting differences in the frequency and costs of hospitalization between subjects by country.
Collapse
Affiliation(s)
- Isabel Pardo-Garcia
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), 02071 Albacete, Spain;
- Sociosanitary Research Center, 16071 Cuenca, Spain;
- Research Group of Economy, Food and Society, Castilla La Mancha University, 02071 Albacete, Spain
| | - Elisa Amo-Saus
- School of Economics and Business Administration, Castilla-La Mancha University (UCLM), 02071 Albacete, Spain;
- Research Group of Economy, Food and Society, Castilla La Mancha University, 02071 Albacete, Spain
| | - Pablo Moya-Martinez
- Sociosanitary Research Center, 16071 Cuenca, Spain;
- Research Group of Economy, Food and Society, Castilla La Mancha University, 02071 Albacete, Spain
- School of Social Sciences, Castilla- La Mancha University (UCLM), 16071 Cuenca, Spain
| |
Collapse
|
13
|
Disease prevalence and number of health care visits among members of a nationwide sports organization compared to matched controls. BMC Public Health 2021; 21:455. [PMID: 33676474 PMCID: PMC7937278 DOI: 10.1186/s12889-021-10466-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/03/2020] [Accepted: 02/17/2021] [Indexed: 11/14/2022] Open
Abstract
Background Physical activity has positive effects on several diseases and may reduce the risk of morbidity and the mortality rate. Whether the prevalence of disease and health care consumption differ between the members of sports organizations and the general population has not been established. Hence, this pilot study aimed to compare the prevalence of diseases known to be associated with physical inactivity and health care consumption in members of a large non-profit sports organization and an age-, sex- and geographically matched random sample from the general population. Methods Subjects in two Swedish cities who exercised at least once a week and had been members for at least two years in the non-profit sports organization Friskis&Svettis were invited. A randomized age-, sex- and geographically matched sample was drawn from the general population. Data on disease prevalence (by International Statistical Classification of Diseases and Related Health Problems, Tenth Revision (ICD-10) codes) and health care consumption were retrieved using the members’ personal identification numbers through a regional health care database. Between-group differences in the prevalence of disease were compared using chi2-tests and logistic regression between members and controls. Health care consumption was defined as the number of visits, stratified by primary and hospital care, and was compared using chi2-tests and Mann-Whitney U-tests. Results In total, 3015 subjects were included in each group (response rate 11%). Controls had higher prevalence rates of musculoskeletal diseases (13.3% vs. 11.6%, p = 0.047), metabolic disease (10.4% vs. 5.4%, p < 0.001), hypertension (16.6% vs. 11.7%, p < 0.001), psychiatric diseases (8.9% vs. 7.1%, p = 0.012) and lung cancer (0.4% vs. 0%, p = 0.001) than the members. The total number of health care contacts was 22% higher in the controls than in the members, whereas the proportion of subjects with at least one health care visit was larger in the members (89% vs. 79%, p < 0.001). Conclusions The prevalence rates of lifestyle diseases related to musculoskeletal, metabolic and psychiatric diseases, hypertension and lung cancer, and the overall health care consumption, were lower among members of a sports organization than among controls. However, longitudinal studies are needed to establish a cause-effect relationship between membership and disease development. Supplementary Information The online version contains supplementary material available at 10.1186/s12889-021-10466-9.
Collapse
|
14
|
Lee BK. Comparison of Prevalence of Hyperlipidemia, Medical Expenses, Inpatient, Emergency and Outpatient According to the Level of Physical Activity of Korean Adults: A Cross-Sectional Study of 2018 Korea Medical Panel. THE ASIAN JOURNAL OF KINESIOLOGY 2021. [DOI: 10.15758/ajk.2021.23.1.34] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
OBJECTIVES The purpose of this study is to compare the difference in the prevalence of hyperlipidemia according to the level of physical activity in adults, and to compare the difference between annual personal medical expenses, hospitalization, emergency and outpatient use depending on the level of physical activity for hyperlipidemia patients.METHODS The 2018 Korea medical panel data was used (14,489 adults and 2,559 Hyperlipidemia). Physical activity was measured with short form of IPAQ and converted to MET-minutes per week. The days of hospitalization, and personal medical expenses were compared, and frequency analysis, logistic regression, ANOVA and chi-square were performed.RESULTS The prevalence of hyperlipidemia based on the inactive group were decreased both minimally active group (OR = 0.94) and the active group (OR = 0.74, p<0.01). Annual personal medical expenses I (p<.01) and II (p<.01) with hyperlipidemia were all showed significant differences depending on the level of physical activity. On active group basis, medical expenses showed slight differences of 3.0 to 3.2% with the minimally activity group, but that of the inactive group were 19.3 ~ 21.7% higher. The annual days of hospitalization were 6.8 ± 7.2 days in activity group, minimally activity group 7.1 ± 7.2 days, inactive group 11.7 ± 26.0 days. There was no significant difference in the annual days of hospitalization and emergency between the three groups. In particular, the annual days of outpatient increased sharply at the inactive group. Participation in physical activity has been shown to have a significant effect on hospitalization and decreasing use of emergency rooms.CONCLUSIONS Hyperlipidemia prevalence was similar to inactive groups and minimally activity groups, and that of activity groups was 0.74. On medical expenses of hyperlipidemia, the activity and minimally activity group was similar, the inactivity group was 19.3 to 21.7% higher. Physical activity was found to have a positive effect on hospitalization and emergency use reduction.
Collapse
|
15
|
Beletsioti C, Niakas D. Health services utilization and its determinants in the context of recession: evidence from Greece. J Public Health (Oxf) 2020; 44:332-341. [PMID: 33253388 DOI: 10.1093/pubmed/fdaa200] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/14/2020] [Revised: 10/04/2020] [Accepted: 10/12/2020] [Indexed: 11/14/2022] Open
Abstract
BACKGROUND In 2009, Greece entered a prolonged economic recession and adopted austerity reforms, which have profoundly affected many aspects of health sector, including health services use. The objective of this study was to investigate healthcare utilization in the Greek population in the context of austerity and its determinants. METHODS Two National Health Surveys of the population aged 15 and over, conducted in 2009 and 2014-before and after the adoption of austerity measures-, were used to analyse possible changes in healthcare utilization and its determinants applying chi-square tests, Mann-Whitney U-tests and generalized linear models. RESULTS Between 2009 and 2014, the share of those who had visited a specialist decreased, whereas that of those who had visited a general practitioner or had been hospitalized did not change significantly. The number of outpatient consultations decreased and the number of nights spent in hospital did not change significantly. The strongest predictors were self-rated health, presence of chronic diseases and experiencing pain. CONCLUSIONS Identifying the procyclical or counter-cyclical nature of healthcare utilization and the association between utilization and its determinants in different settings is an important priority in order to improve access and promote health equity.
Collapse
Affiliation(s)
- Chrysoula Beletsioti
- Department of Health Economics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| | - Dimitris Niakas
- Department of Health Economics, School of Medicine, National and Kapodistrian University of Athens, 11527 Athens, Greece
| |
Collapse
|
16
|
Spika S, Breyer F. Domain-specific effects of physical activity on the demand for physician visits. Int J Public Health 2020; 65:583-591. [PMID: 32377755 PMCID: PMC7360656 DOI: 10.1007/s00038-020-01376-5] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/23/2019] [Revised: 02/24/2020] [Accepted: 04/18/2020] [Indexed: 11/27/2022] Open
Abstract
OBJECTIVES To assess domain-specific effects of physical activity (PA) in the relationship with health care utilization and to investigate whether a measure that aggregates PA across domains (leisure, transport, work) is appropriate. METHODS Data were retrieved from a longitudinal cohort study conducted in Southern Germany (women n = 1330, men n = 766). The number of physician visits was regressed on total PA and on PA differentiated by the domains leisure time, travel time and working time in a negative binomial model. RESULTS For women, no association with physician visits is found for total PA, while high leisure time physical activity (LTPA) is associated with 22% more visits. The effect of high LTPA is statistically different from the effect of high total PA. For men, no significant associations are found for both measures. CONCLUSIONS The specific, positive effect of high LTPA on physician visits among women shows that using an aggregate measure of PA is inappropriate for analyzing the relation between PA and health care utilization. Further, the positive relationship should be considered in attempts to promote physical activity.
Collapse
Affiliation(s)
- Simon Spika
- Department of Economics, University of Konstanz, Box 135, 78457, Konstanz, Germany.
| | - Friedrich Breyer
- Department of Economics, University of Konstanz, Box 135, 78457, Konstanz, Germany
| |
Collapse
|
17
|
Da'ar OB, Zaatreh YA, Saad AA, Alkaiyat M, Pasha T, Ahmed AE, Bustami R, Alkattan K, Jazieh AR. The Burden, Future Trends, And Economic Impact Of Lung Cancer In Saudi Arabia. CLINICOECONOMICS AND OUTCOMES RESEARCH 2019; 11:703-712. [PMID: 31819562 PMCID: PMC6875252 DOI: 10.2147/ceor.s224444] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.2] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/24/2019] [Accepted: 10/31/2019] [Indexed: 11/23/2022] Open
Abstract
Background Incidence of cancer in Saudi Arabia has increased for the last two decades, ratcheting up to global levels. Yet, there is a dearth of research on the burden of lung cancer. This study examined the association between new cases of lung cancer and factors such as gender, age, and year of diagnosis; and forecast new cases and extrapolated future economic burden to 2030. Methods This a national-level cohort study that utilized the Saudi Cancer Registry data from 1999 to 2013. Multivariate regression was used; new lung cancer cases forecast and economic burden extrapolated to 20130. Sensitivity analysis was conducted to assess the impact of a range of epidemiologic and economic factors on the economic burden. Results Of the 166,497 new cancer cases (1999–2013), 3.8% was lung cancer. Males and Saudis had over threefold higher cases compared with females and non-Saudis, respectively. While the age group ≥65 years had 1.14 times or 14% increase in new cases, under-30 years had 97.2% fewer cases compared with age group 45–59. Compared with 1999, the period 2011–2013 had a 106% average increase. The years 2002–2010 registered an average 50% rise in new cases compared to 1999. New cases would rise to 1058 in 2030, an upsurge of 87% from 2013. The future economic burden was estimated at $2.49 billion in 2015 value, of which $520 million was attributable to care management and $1.97 billion in lost productivity. The economic burden for the period 2015–2030 will be $50.16 billion. The present value of this burden in 2015 values will be $34.60 billion, of which 21% will be attributable to care management. Estimates were robust to uncertainty, but the aged-standardized rate and 5-year survival rate would account for much of the variability compared with the economic factors. Conclusion Findings reveal an upsurge of lung cancer burden in incidence and potential economic burden, which may inform cancer control measures.
Collapse
Affiliation(s)
- Omar B Da'ar
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | | | - Aida A Saad
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Mohammad Alkaiyat
- Oncology Department, King Abdulaziz Medical City, National Guards Health Affairs Riyadh, Riyadh, Saudi Arabia
| | - Tabrez Pasha
- Oncology Department, King Abdulaziz Medical City, National Guards Health Affairs Riyadh, Riyadh, Saudi Arabia
| | - Anwar E Ahmed
- College of Public Health and Health Informatics, King Saud bin Abdulaziz University for Health Sciences, Riyadh, Saudi Arabia
| | - Rami Bustami
- College of Business, Alfaisal University, Riyadh, Saudi Arabia
| | - Khaled Alkattan
- College of Medicine, Alfaisal University, Riyadh, Saudi Arabia
| | - Abdul Rahman Jazieh
- Oncology Department, King Abdulaziz Medical City, National Guards Health Affairs Riyadh, Riyadh, Saudi Arabia
| |
Collapse
|
18
|
Dohrn IM, Welmer AK, Hagströmer M. Accelerometry-assessed physical activity and sedentary time and associations with chronic disease and hospital visits - a prospective cohort study with 15 years follow-up. Int J Behav Nutr Phys Act 2019; 16:125. [PMID: 31818303 PMCID: PMC6902520 DOI: 10.1186/s12966-019-0878-2] [Citation(s) in RCA: 24] [Impact Index Per Article: 4.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2019] [Accepted: 11/06/2019] [Indexed: 01/11/2023] Open
Abstract
Background Associations of objectively assessed physical activity in different intensities and risk of developing chronic disease that requires hospital care have not yet been examined in long term population-based studies. Studies addressing the link between physical activity and sedentary time and subsequent hospital admissions are lacking. Objective To examine the prospective associations between physical activity and sedentary time with morbidity defined as: 1) a registered main diagnosis of cardiovascular disease, cancer, type-2 diabetes, dementia, obesity or depression; 2) number of in- and outpatient hospital visits; and 3) number of in-hospital days. Methods In total, 1220 women and men, 18–75 years, from the population-based Sweden Attitude Behaviour and Change study 2000–2001 were included. Time spent sedentary, in light-intensity physical activity and in moderate-to-vigorous physical activity, and total accelerometer counts were assessed using the ActiGraph 7164 accelerometer. Morbidity data were obtained 2016 from Swedish registers. Cox proportional hazards models estimated hazard ratios (HR) of morbidity with 95% confidence intervals (CI) and negative binomial regression estimated incidence rate ratio (IRR) with 95% CI for number of hospital visits, and length of hospital stay. Results Over a follow-up of 14.4 years (SD = 1.6), 342 persons had at least one registered hospital visit due to any of the included diagnoses. Higher moderate-to-vigorous physical activity was associated with significant risk reductions for combined morbidity (all included diagnoses) (HR: 0.65, 95% CI: 0.48–0.88) and cardiovascular disease (HR: 0.52, 95% CI: 0.33–0.82). Higher total counts showed similar results, and was also associated with fewer hospital visits (IRR = 0.56, 95% CI: 0.37–0.85). Higher sedentary time increased the risk of in-hospital days. (IRR = 2.38, 95% CI: 1.20–4.74). Conclusion This study supports the importance of moderate-to-vigorous physical activity for preventing chronic disease that requires hospital care, especially cardiovascular disease. High volumes of sedentary behavior may increase the risk of future hospitalization. Our results support the public health message “sit less and move more”.
Collapse
Affiliation(s)
- Ing-Mari Dohrn
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Aging Research Center, Tomtebodavägen 18A, SE-171 65, Solna, Sweden.
| | - Anna-Karin Welmer
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Aging Research Center, Tomtebodavägen 18A, SE-171 65, Solna, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, SE-171 76 Solna, Sweden.,Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Division of Physiotherapy, Alfred Nobels allé 23, SE-141 52, Huddinge, Sweden
| | - Maria Hagströmer
- Department of Neurobiology, Care Sciences and Society (NVS), Karolinska Institutet, Aging Research Center, Tomtebodavägen 18A, SE-171 65, Solna, Sweden.,Functional Area Occupational Therapy and Physiotherapy, Karolinska University Hospital, SE-171 76 Solna, Sweden.,Department of Health Promoting Science, Sophiahemmet University, Valhallavägen 91, SE-114 86, Stockholm, Sweden
| |
Collapse
|
19
|
Lee BK. Comparison of Prevalence of Diabetes Mellitus, Medical Expenses, Inpatient, Emergency and Outpatient According to the Level of Physical Activity of Korean Adults: A Cross-Sectional Study. THE ASIAN JOURNAL OF KINESIOLOGY 2019. [DOI: 10.15758/ajk.2019.21.3.1] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022] Open
|
20
|
Kjær T, Højgaard B, Gyrd-Hansen D. Physical exercise versus shorter life expectancy? An investigation into preferences for physical activity using a stated preference approach. Health Policy 2019; 123:790-796. [PMID: 31200947 DOI: 10.1016/j.healthpol.2019.05.015] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/14/2018] [Revised: 03/18/2019] [Accepted: 05/21/2019] [Indexed: 10/26/2022]
Abstract
The positive life-prolonging effect of physical activity is often used as a promotion argument to motivate people to change their behaviour. Yet the decision of investing in health by exercising depends not only on the potential health effect but also on the costs of physical activity including time costs and the individual's (dis)utility of performing physical activity. The objective of this study was to investigate the trade-off between costs and benefits of engaging in physical activity. A web-based stated preference experiment was conducted to elicit individual preferences for physical activity among a representative sample of the Danish population, 18-60 years of age, categorised as moderately physically active or physically inactive. The results of the study suggest that perceived negative quality of life impact of physical activity is an important predictor of the choice of not attending physical activity, and hence should be acknowledged as a barrier to engaging in physical activity. Furthermore, we find time costs to have a significant impact on stated uptake. For individuals categorised as moderately active, the marginal health effect of physical activity is significant but minor. For inactive individuals, this effect is insignificant suggesting that information on long-term health effects does not work as motivation for engaging in exercise for this group. Instead, focus should be on reducing the perceived disutility of physical activity.
Collapse
Affiliation(s)
- Trine Kjær
- DaCHE - Danish Center for Health Economic Research, Department of Public Health, University of Southern Denmark, Winsløwsvej 9b, 1., 5230 Odense M, Denmark.
| | - Betina Højgaard
- VIVE, Danish Institute of Applied Social Science, Herluf Trolles Gade 11, 1052 København K, Denmark.
| | - Dorte Gyrd-Hansen
- DaCHE - Danish Center for Health Economic Research, Department of Public Health, University of Southern Denmark, Winsløwsvej 9b, 1., 5230 Odense M, Denmark.
| |
Collapse
|
21
|
Lee BK. Comparison of Prevalence of Hypertension and Medical Expenses According to the Level of Physical Activity of Korean Adults. THE ASIAN JOURNAL OF KINESIOLOGY 2018. [DOI: 10.15758/ajk.2018.20.4.43] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
|
22
|
Špacírová Z, Epstein D, García-Mochón L, Aparicio VA, Borges-Cosic M, López Del Amo MP, Martín-Martín JJ. Cost-effectiveness of a primary care-based exercise intervention in perimenopausal women. The FLAMENCO Project. GACETA SANITARIA 2018; 33:529-535. [PMID: 30340794 DOI: 10.1016/j.gaceta.2018.05.012] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/15/2017] [Revised: 05/14/2018] [Accepted: 05/23/2018] [Indexed: 11/19/2022]
Abstract
OBJECTIVE Adequate physical activity levels and a healthy lifestyle may prevent all kinds of non-communicable diseases, promote well-being and reduce health-care costs among perimenopausal women. This study assessed an exercise programme for perimenopausal women. METHOD A total of 150 women (aged 45-64 years) not engaged in regular physical activity were randomly assigned to either a 16 week exercise intervention or to the control group. The study was conducted from the perspective of the National Health System. Health outcomes were quality-adjusted life years (QALYs), measured by the EuroQol-5D-5L questionnaire. The total direct costs of the programme were the costs of visits to primary care, specialty care, emergency, medicines, instructor cost and infrastructure cost. The results were expressed as the incremental cost-effectiveness ratio. Sensitivity analysis was undertaken to test the robustness of the analysis. RESULTS Mean QALYs over 16 weeks were.228 in the control group and.230 in the intervention group (mean difference: .002; 95% confidence interval [95%CI]: -0.005 to 0.009). Improvements from baseline were greater in the intervention group in all dimensions of the EuroQol-5D-5L but not statistically significant. The total costs at the end of the intervention were 160.38 € in the control group and 167.80 € in the intervention group (mean difference: 7.42 €; 95%CI: -47 to 62). The exercise programme had an incremental cost-effectiveness ratio of 4,686 €/QALY. CONCLUSIONS The programme could be considered cost-effective, although the overall difference in health benefits and costs was very modest. Longer term follow-up is needed.
Collapse
Affiliation(s)
- Zuzana Špacírová
- Department of Applied Economics, Faculty of Economics, University of Granada, Granada, Spain.
| | - David Epstein
- Department of Applied Economics, Faculty of Economics, University of Granada, Granada, Spain
| | | | - Virginia A Aparicio
- Department of Physiology, Faculty of Pharmacy, Faculty of Sport Sciences, and Institute of Nutrition and Food Technology, University of Granada, Granada, Spain; VU University and EMGO+ Institute for Health and Care Research, Amsterdam, The Netherlands
| | - Milkana Borges-Cosic
- Department of Physical Education and Sport, Faculty of Sport Sciences, University of Granada, Granada, Spain
| | - M Puerto López Del Amo
- Department of Applied Economics, Faculty of Economics, University of Granada, Granada, Spain
| | - José J Martín-Martín
- Department of Applied Economics, Faculty of Economics, University of Granada, Granada, Spain
| |
Collapse
|
23
|
Vagnoni E, Biavati GR, Felisatti M, Pomidori L. Moderating healthcare costs through an assisted physical activity programme. Int J Health Plann Manage 2018; 33:1146-1158. [PMID: 30074649 DOI: 10.1002/hpm.2596] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/24/2017] [Accepted: 07/04/2018] [Indexed: 11/08/2022] Open
Abstract
BACKGROUND During the last decades, physical inactivity has become increasingly important due to its effects on health; in the medical field, it has been highlighted that physical inactivity is one of the leading cause of death. Moreover, the increasing trend in a sedentary lifestyle has also led to economic concerns; for this reason, the need to develop healthcare programmes to raise awareness of the benefits of physical exercise among the global population has arisen. OBJECTIVE This paper analyses the relationship between moderate physical activity, cost of pharmaceuticals and health services utilization with regard to a primary care community programme based on moderate exercise intervention. The study highlights the effect of an exercise programme for people in sheltered accommodation in terms of effects on their quality of life and in terms of economic sustainability. METHODOLOGY A randomized controlled trial of an exercise programme was designed. A total of 150 patients were randomized in two groups. The intervention group was recruited from Centro Esercizio Vita whereas the participants of the control group were recruited from general practitioners. RESULTS At 9 months after randomization, the exercise-based group presented a lower average cost for drugs (p-value 0.039), an overall better health status perception (p-value 0.0019) and accessed general practitioners less frequently (p-value 0.058). CONCLUSIONS Our study shows that assisted physical activity practiced on the basis of an exercise programme, over a period of nine months, has overall positive consequences in terms of reduction in health expenditure and quality of life.
Collapse
Affiliation(s)
- Emidia Vagnoni
- University of Ferrara, Department of Economics and Management, Ferrara, Italy
| | - Giulia Rita Biavati
- University of Ferrara, Department of Economics and Management, Ferrara, Italy
| | | | | |
Collapse
|
24
|
Lowe A, Littlewood C, McLean S. Understanding physical activity promotion in physiotherapy practice: A qualitative study. Musculoskelet Sci Pract 2018; 35:1-7. [PMID: 29413948 DOI: 10.1016/j.msksp.2018.01.009] [Citation(s) in RCA: 36] [Impact Index Per Article: 6.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/09/2017] [Revised: 01/12/2018] [Accepted: 01/24/2018] [Indexed: 12/17/2022]
Abstract
OBJECTIVE Physical inactivity is a major public health issue and healthcare professionals are encouraged to promote physical activity during routine patient contacts in order to reduce non-communicable diseases and enhance individuals' quality of life. Little is known about physical activity promotion in physiotherapy practice in the UK. The aim of this study was to better understand physiotherapists' experience of physical activity promotion in clinical practice. DESIGN A qualitative study was undertaken comprising 12 telephone interviews with participants using a quota sampling approach. The qualitative data was analysed using a thematic analysis approach and written up according to COREQ guidelines. FINDINGS Four themes were identified (1) Current physiotherapy practice (2) Barriers to, and facilitators of physical activity promotion, (3) Exercise or physical activity? and (4) Functional restoration versus general wellbeing. CONCLUSIONS Physiotherapists use routine clinical contacts to discuss physical activity. However, brief interventions are not consistently used and no common framework to guide physical activity promotion was identified. Approaches appear to be inconsistent and informal and focus largely on short-term restoration of function rather than health promotion. There is scope to improve practice in line with current guidance to maximise potential impact on inactivity.
Collapse
Affiliation(s)
- Anna Lowe
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, S10-2BP, UK.
| | - Chris Littlewood
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, ST5 5BG, UK. https://twitter.com/PhysioChris
| | - Sionnadh McLean
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, S10-2BP, UK. https://twitter.com/SionnadhMcLean
| |
Collapse
|
25
|
Peirce NS, Ranson C. Preventing recreational sports injuries: practicalities and governance. Med J Aust 2018; 208:253-254. [DOI: 10.5694/mja18.00132] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/06/2018] [Accepted: 02/12/2018] [Indexed: 11/17/2022]
Affiliation(s)
- Nicholas S Peirce
- National Cricket Performance Centre, England and Wales Cricket Board, London, United Kingdom
| | - Craig Ranson
- English Institute of Sport, Manchester, United Kingdom
| |
Collapse
|
26
|
Diallo AO, Diop A, Dupuy JF. Analysis of multinomial counts with joint zero-inflation, with an application to health economics. J Stat Plan Inference 2018. [DOI: 10.1016/j.jspi.2017.09.005] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
|
27
|
Corbett DB, Fennell C, Peroutky K, Kingsley JD, Glickman EL. The effects of a 12-week worksite physical activity intervention on anthropometric indices, blood pressure indices, and plasma biomarkers of cardiovascular disease risk among university employees. BMC Res Notes 2018; 11:80. [PMID: 29378632 PMCID: PMC5789547 DOI: 10.1186/s13104-018-3151-x] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2017] [Accepted: 01/09/2018] [Indexed: 01/08/2023] Open
Abstract
BACKGROUND To determine the effectiveness of a low-cost 12-week worksite physical activity intervention targeting a goal of 10,000 steps per day on reducing anthropometric indices, blood pressure indices, and plasma biomarkers of cardiovascular disease (CVD) risk among the employees of a major university. METHODS Fifty university employees (n = 43 female, n = 7 male; mean age = 48 ± 10 years) participated in the 12-week physical activity intervention (60 min, 3 day/week). Each session included both aerobic (cardiorespiratory endurance) and muscle-strengthening (resistance) physical activity using existing university facilities and equipment. Anthropometric indices, blood pressure indices, and plasma biomarkers of CVD risk assessed included those for obesity (body mass index), hypertension (systolic blood pressure, SBP; diastolic blood pressure, DBP), dyslipidemia (high-density lipoprotein, HDL; low-density lipoprotein, LDL; total serum cholesterol), and prediabetes (impaired fasting glucose, IFG). Steps per day were assessed using a wrist-worn activity monitor. Participants were given the goal of 10,000 steps per day and categorized as either compliers (≥ 10,000 steps per day on average) or non-compliers (< 10,000 steps per day on average) based on their ability to achieve this goal. RESULTS Overall, 34% of participants at baseline were already at an elevated risk of CVD due to age. On average, 28% of participants adhered to the goal of 10,000 steps per day. After 12-weeks, participants in both groups (compliers and non-compliers) had lower BMI scores (p < 0.001), lower HDL scores (p < 0.034), and higher IFG scores (p < 0.001). The non-compliers had a greater reduction of BMI scores than the compliers (p = 0.003). Participants at risk for CVD had greater reductions than those not at risk for several risk factors, including SBP (p = 0.020), DBP (p = 0.028), IFG (p = 0.002), LDL (p = 0.006), and total serum cholesterol (p = 0.009). CONCLUSION While the physical activity intervention showed mixed results overall with both favorable changes in anthropometric indices yet unfavorable changes in plasma biomarkers, it was particularly beneficial in regards to both blood pressure indices and plasma biomarkers among those already at risk of CVD. Trial registration ClinicalTrials.gov NCT03385447; retrospectively registered.
Collapse
Affiliation(s)
- Duane B. Corbett
- Department of Aging and Geriatric Research, College of Medicine, University of Florida, Gainesville, FL 32611 USA
| | - Curtis Fennell
- Department of Kinesiology, College of Education, University of Montevallo, Montevallo, AL 35115 USA
| | - Kylene Peroutky
- Department of Exercise Physiology, School of Health Sciences, Kent State University, Kent, OH 44240 USA
| | - J. Derek Kingsley
- Department of Exercise Physiology, School of Health Sciences, Kent State University, Kent, OH 44240 USA
| | - Ellen L. Glickman
- Department of Exercise Physiology, School of Health Sciences, Kent State University, Kent, OH 44240 USA
| |
Collapse
|
28
|
Losina E, Smith SR, Usiskin IM, Klara KM, Michl GL, Deshpande BR, Yang HY, Smith KC, Collins JE, Katz JN. Implementation of a workplace intervention using financial rewards to promote adherence to physical activity guidelines: a feasibility study. BMC Public Health 2017; 17:921. [PMID: 29195494 PMCID: PMC5709939 DOI: 10.1186/s12889-017-4931-2] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2017] [Accepted: 11/20/2017] [Indexed: 11/14/2022] Open
Abstract
Background We designed and implemented the Brigham and Women’s Wellness Initiative (B-Well), a single-arm study to examine the feasibility of a workplace program that used individual and team-based financial incentives to increase physical activity among sedentary hospital employees. Methods We enrolled sedentary, non-clinician employees of a tertiary medical center who self-reported low physical activity. Eligible participants formed or joined teams of three members and wore Fitbit Flex activity monitors for two pre-intervention weeks followed by 24 weeks during which they could earn monetary rewards. Participants were rewarded for increasing their moderate-to-vigorous physical activity (MVPA) by 10% from the previous week or for meeting the Centers for Disease Control and Prevention (CDC) physical activity guidelines (150 min of MVPA per week). Our primary outcome was the proportion of participants meeting weekly MVPA goals and CDC physical activity guidelines. Secondary outcomes included Fitbit-wear adherence and factors associated with meeting CDC guidelines more consistently. Results B-Well included 292 hospital employees. Participants had a mean age of 38 years (SD 11), 83% were female, 38% were obese, and 62% were non-Hispanic White. Sixty-three percent of participants wore the Fitbit ≥4 days per week for ≥20 weeks. Two-thirds were satisfied with the B-Well program, with 79% indicating that they would participate again. Eighty-six percent met either their personal weekly goal or CDC physical activity guidelines for at least 6 out of 24 weeks, and 52% met their goals or CDC physical activity guidelines for at least 12 weeks. African Americans, non-obese subjects, and those with lower impulsivity scores reached CDC guidelines more consistently. Conclusions Our data suggest that a financial incentives-based workplace wellness program can increase MVPA among sedentary employees. These results should be reproduced in a randomized controlled trial. Trial registration Clinicaltrials.gov, NCT02850094. Registered July 27, 2016 [retrospectively registered].
Collapse
Affiliation(s)
- Elena Losina
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA. .,Harvard Medical School, Boston, MA, USA. .,Department of Biostatistics, Boston University School of Public Health, Boston, MA, USA.
| | - Savannah R Smith
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA
| | - Ilana M Usiskin
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA
| | - Kristina M Klara
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA
| | - Griffin L Michl
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA
| | - Bhushan R Deshpande
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Heidi Y Yang
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA
| | - Karen C Smith
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA
| | - Jamie E Collins
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA
| | - Jeffrey N Katz
- Orthopaedic and Arthritis Center for Outcomes Research, Policy and Innovation Evaluation in Orthopaedic Treatments (PIVOT) Center, Department of Orthopaedic Surgery, Brigham and Women's Hospital, 75 Francis Street, BTM 5-016, Boston, MA, 02115, USA.,Harvard Medical School, Boston, MA, USA.,Division of Rheumatology, Immunology, and Allergy, Brigham and Women's Hospital, Boston, MA, USA.,Departments of Epidemiology and Environmental Health, Harvard T. H. Chan School of Public Health, Boston, MA, USA
| |
Collapse
|
29
|
Lowe A, Littlewood C, McLean S, Kilner K. Physiotherapy and physical activity: a cross-sectional survey exploring physical activity promotion, knowledge of physical activity guidelines and the physical activity habits of UK physiotherapists. BMJ Open Sport Exerc Med 2017; 3:e000290. [PMID: 29119004 PMCID: PMC5663264 DOI: 10.1136/bmjsem-2017-000290] [Citation(s) in RCA: 53] [Impact Index Per Article: 7.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 09/01/2017] [Indexed: 01/09/2023] Open
Abstract
Objective Physical inactivity is a public health priority and embedding promotion of physical activity (PA) within healthcare systems is an important lever for change. Many factors influence PA promotion in routine healthcare practice; these include the PA habits of healthcare professionals and also their knowledge of the PA guidelines. Little is known about the extent to which PA is currently promoted in physiotherapy practice or the factors that influence it. Methods Following ethical approval, a cross-sectional survey of UK physiotherapists was conducted. Findings were analysed and reported in accordance with STROBE (STrengthening the Reporting of OBservational studies in Epidemiology) guidelines. Results There were 522 respondents, 514 of whom were physiotherapists. Seventy-seven per cent of respondents routinely discussed PA with patients and 68% routinely delivered brief interventions. Assessment of PA status was not routine practice, neither was signposting to further sources of PA support. Only 16% of respondents correctly answered questions about the content of the PA guidelines. Only 38% of respondents met current PA recommendations. Clinicians' PA levels were not associated with PA promotion activity. Conclusion Despite the promising finding that some form of PA promotion is integrated into most respondents' practice, we report a poor understanding of brief interventions and poor knowledge of the PA guidelines. Additionally, the majority of respondents were not sufficiently active to meet current PA recommendations.
Collapse
Affiliation(s)
- Anna Lowe
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Chris Littlewood
- Arthritis Research UK Primary Care Centre, Research Institute for Primary Care and Health Sciences and Keele Clinical Trials Unit, David Weatherall Building, Keele University, Staffordshire, UK
| | - Sionnadh McLean
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| | - Karen Kilner
- Centre for Health and Social Care Research, Sheffield Hallam University, Sheffield, UK
| |
Collapse
|
30
|
|
31
|
Kang SW, Xiang X. Physical activity and health services utilization and costs among U.S. adults. Prev Med 2017; 96:101-105. [PMID: 28040516 DOI: 10.1016/j.ypmed.2016.12.043] [Citation(s) in RCA: 20] [Impact Index Per Article: 2.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/17/2016] [Revised: 12/20/2016] [Accepted: 12/23/2016] [Indexed: 11/28/2022]
Abstract
The objective of this study was to examine the relationship between physical activity and health services utilization and costs among adults aged 18 or older in the U.S. Data came from the Medical Expenditure Panel Survey-Household component from 2007 through 2011 (n=117,361). Regular physical activity was defined as spending half an hour or more in moderate or vigorous physical activity at least three times a week. The following categories of self-reported health services utilization and costs were examined: preventive, office-based, outpatient, inpatient, emergency department, home health, and prescription medicines. The association of physical activity and health services utilization and costs was estimated using two-part models. Adults who engaged in regular physical activity were more likely to use preventive (ORs ranged from 1.06 to 1.34, p<0.05) and office-based services (OR=1.05, 95% CI=1.01-1.10, p<0.05). Combining results from both parts of the two-part models, physically active adults incurred significantly lower utilization of inpatient (0.09 vs 0.12 visit per person), emergency room (0.18 vs 0.19 visit per person), home health care (1.21 vs 1.92 visit per person), and prescription medicines (12.66 vs 13.75 number of prescriptions per person) and spent $27 less per capita expenditures for office-based visits, $351 less for inpatient visits, and $52 less for home health care visits. Promoting regular physical activity may reduce health care costs through decreasing demand for secondary and tertiary care services.
Collapse
Affiliation(s)
- Sung-Wan Kang
- School of Social Work, University of Illinois at Urbana-Champaign, 1010 W. Nevada, Urbana, IL 61801, USA.
| | - Xiaoling Xiang
- Center for Education in Health Sciences, Northwestern University Feinberg School of Medicine, 633 N Saint Clair Street, Chicago, IL 60611, USA.
| |
Collapse
|
32
|
Sari N, Muhajarine N, Froehlich Chow A. The Saskatchewan/New Brunswick Healthy Start-Départ Santé intervention: implementation cost estimates of a physical activity and healthy eating intervention in early learning centers. BMC Health Serv Res 2017; 17:57. [PMID: 28103861 PMCID: PMC5247800 DOI: 10.1186/s12913-017-1978-9] [Citation(s) in RCA: 10] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2016] [Accepted: 01/04/2017] [Indexed: 11/21/2022] Open
Abstract
Background Participation in daily physical activity and consuming a balanced diet high in fruits and vegetables and low in processed foods are behaviours associated with positive health outcomes during all stages of life. Previous literature suggests that the earlier these behaviours are established the greater the health benefits. As such, early learning settings have been shown to provide an effective avenue for exploring and influencing the physical activity and healthy eating behaviours of children before school entry. However, in addition to improving individual level health of children, such interventions may also result in a number of social benefits for the society. In fact, research among adult populations has shown that sufficient participation in physical activity can significantly lower hospital stays and physician visits, in turn leading to positive economic outcomes. To our knowledge there is very limited literature about economic evaluations of interventions implemented in early learning centers to increase physical activity and healthy eating behaviours among children. The primary purpose of this paper is to identify inputs and costs needed to implement a physical activity and healthy eating intervention (Healthy Start-Départ Santé (HS-DS)) in early learning centres throughout Saskatchewan and New Brunswick over the course of three years. In doing so, implementation cost is estimated to complete the first phase of a social return on investment analysis of this intervention. Methods In order to carry out this evaluation the first step was to identify the inputs and costs needed to implement the intervention, along with the corresponding outputs. With stakeholder interviews and using existing database, we estimated the implementation cost by measuring, valuing and monetizing each individual input. Results Our results show that the total annual cost of implementing HS-DS was $378,753 in the first year, this total cost decreased slightly in the second year ($356,861) and again in the third year ($312,179). On average, the total annual cost is about $350,000 which implies an annual cost of $285 per child. Among all inputs, time–cost accounted for the larger share of total resources need to implement the intervention. Overall, administration and support services accounted for the largest portion of the total implementation cost each year: 74% (year 1), 79% (year 2), and 75% (year 3). Conclusions The results from this study shed lights for future implementation of similar interventions in this context. It also helps to assess the cost effectiveness of future interventions. Electronic supplementary material The online version of this article (doi:10.1186/s12913-017-1978-9) contains supplementary material, which is available to authorized users.
Collapse
Affiliation(s)
- Nazmi Sari
- Department of Economics, University of Saskatchewan, Arts 815, 9 Campus Drive, Saskatoon, SK, S7N 5A5, Canada.
| | - Nazeem Muhajarine
- Community Health & Epidemiology and Saskatchewan Population Health and Evaluation Research Unit University of Saskatchewan, Saskatoon, SK, S7N 5A5, Canada
| | | |
Collapse
|
33
|
Gonzalo-Almorox E, Urbanos-Garrido RM. Decomposing socio-economic inequalities in leisure-time physical inactivity: the case of Spanish children. Int J Equity Health 2016; 15:106. [PMID: 27406235 PMCID: PMC4942941 DOI: 10.1186/s12939-016-0394-9] [Citation(s) in RCA: 18] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/09/2016] [Accepted: 07/04/2016] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Physical inactivity is associated with an increased risk of all-cause mortality and entails a substantial economic burden for health systems. Also, the analysis of inequality in lifestyles for young populations may contribute to reduce health inequalities during adulthood. This paper examines the income-related inequality regarding leisure-time physical inactivity in Spanish children. METHODS In this cross-sectional study based on the Spanish National Health Survey for 2011-12, concentration indices are estimated to measure socioeconomic inequalities in leisure-time physical inactivity. A decomposition analysis is performed to determine the factors that explain income-related inequalities. RESULTS There is a significant socioeconomic gradient favouring the better-off associated with leisure-time physical inactivity amongst Spanish children, which is more pronounced in the case of girls. Income shows the highest contribution to total inequality, followed by education of the head of the household. The contribution of several factors (education, place of residence, age) significantly differs by gender. CONCLUSIONS There is an important inequity in the distribution of leisure-time physical inactivity. Public policies aimed at promoting physical activity for children should prioritize the action into the most disadvantaged subgroups of the population. As the influence of determinants of health styles significantly differ by gender, this study points out the need of addressing the research on income-related inequalities in health habits from a gender perspective.
Collapse
Affiliation(s)
| | - Rosa M. Urbanos-Garrido
- />Department of Public Finance, School of Economics, Complutense University of Madrid, Campus de Somosaguas s/n, 28223 Pozuelo de Alarcón, Spain
| |
Collapse
|
34
|
Wasfi RA, Dasgupta K, Orpana H, Ross NA. Neighborhood Walkability and Body Mass Index Trajectories: Longitudinal Study of Canadians. Am J Public Health 2016; 106:934-40. [PMID: 26985612 DOI: 10.2105/ajph.2016.303096] [Citation(s) in RCA: 46] [Impact Index Per Article: 5.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/04/2022]
Abstract
OBJECTIVES To assess the impact of neighborhood walkability on body mass index (BMI) trajectories of urban Canadians. METHODS Data are from Canada's National Population Health Survey (n = 2935; biannual assessments 1994-2006). We measured walkability with the Walk Score. We modeled body mass index (BMI, defined as weight in kilograms divided by the square of height in meters [kg/m(2)]) trajectories as a function of Walk Score and sociodemographic and behavioral covariates with growth curve models and fixed-effects regression models. RESULTS In men, BMI increased annually by an average of 0.13 kg/m(2) (95% confidence interval [CI] = 0.11, 0.14) over the 12 years of follow-up. Moving to a high-walkable neighborhood (2 or more Walk Score quartiles higher) decreased BMI trajectories for men by approximately 1 kg/m(2) (95% CI = -1.16, -0.17). Moving to a low-walkable neighborhood increased BMI for men by approximately 0.45 kg/m(2) (95% CI = 0.01, 0.89). There was no detectable influence of neighborhood walkability on body weight for women. CONCLUSIONS Our study of a large sample of urban Canadians followed for 12 years confirms that neighborhood walkability influences BMI trajectories for men, and may be influential in curtailing male age-related weight gain.
Collapse
Affiliation(s)
- Rania A Wasfi
- Rania A. Wasfi is with the Department of Geography, McGill University, Montreal, Quebec. Kaberi Dasgupta is with the Department of Medicine, Division of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism, McGill University. Heather Orpana is with the School of Psychology, University of Ottawa, Ottawa, Ontario. Nancy A. Ross is with the Department of Geography and Department of Epidemiology and Biostatistics, McGill University
| | - Kaberi Dasgupta
- Rania A. Wasfi is with the Department of Geography, McGill University, Montreal, Quebec. Kaberi Dasgupta is with the Department of Medicine, Division of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism, McGill University. Heather Orpana is with the School of Psychology, University of Ottawa, Ottawa, Ontario. Nancy A. Ross is with the Department of Geography and Department of Epidemiology and Biostatistics, McGill University
| | - Heather Orpana
- Rania A. Wasfi is with the Department of Geography, McGill University, Montreal, Quebec. Kaberi Dasgupta is with the Department of Medicine, Division of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism, McGill University. Heather Orpana is with the School of Psychology, University of Ottawa, Ottawa, Ontario. Nancy A. Ross is with the Department of Geography and Department of Epidemiology and Biostatistics, McGill University
| | - Nancy A Ross
- Rania A. Wasfi is with the Department of Geography, McGill University, Montreal, Quebec. Kaberi Dasgupta is with the Department of Medicine, Division of Internal Medicine, Clinical Epidemiology, and Endocrinology and Metabolism, McGill University. Heather Orpana is with the School of Psychology, University of Ottawa, Ottawa, Ontario. Nancy A. Ross is with the Department of Geography and Department of Epidemiology and Biostatistics, McGill University
| |
Collapse
|
35
|
Kolu P, Raitanen J, Nygård CH, Tomás E, Luoto R. Cost-effectiveness of physical activity among women with menopause symptoms: findings from a randomised controlled trial. PLoS One 2015; 10:e0135099. [PMID: 26258804 PMCID: PMC4530885 DOI: 10.1371/journal.pone.0135099] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/19/2015] [Accepted: 07/16/2015] [Indexed: 11/22/2022] Open
Abstract
Menopause is a period that may predispose one to a decrease in muscle strength, cardiorespiratory fitness, and quality of life. A study was carried out to evaluate the cost-effectiveness of physical activity among women displaying symptoms of menopause. The cost-effectiveness analysis was based on data from a six-month randomised controlled trial (n = 151). The women in the intervention group engaged in an unsupervised session of at least 50 minutes of physical activity four times a week. The control group continued their physical activity as before. An incremental cost-effectiveness ratio (ICER) was calculated in terms of maximal oxygen consumption, lean muscle mass, and quality-adjusted life years (QALYs) gained. A bootstrap technique was utilised to estimate uncertainty around the point estimate for ICER associated with the intervention. The mean total cost in the intervention group was €1,307 (SEM: €311) and in the control group was €1,253 (SEM: €279, p = 0.10) per person. The mean intervention cost was €208 per person. After six months of the behaviour-change intervention, the ICER was €63 for a 1 ml/kg/min improvement in cardiorespiratory fitness, the additional cost per one-gram increase in lean muscle mass was €126, and the cost per QALY gained was €46. According to the findings, physical activity among menopausal women was cost-effective for cardiorespiratory fitness, for lean muscle mass, and for QALYs gained, since the intervention was more effective than the actions within the control group and the additional effects of physical activity were gained at a very low price. From the societal perspective, the intervention used may promote ability to work and thereby save on further costs associated with early retirement or disability pension if the physical-activity level remains at least the same as during the intervention.
Collapse
Affiliation(s)
- Päivi Kolu
- UKK Institute for Health Promotion; Tampere, Finland
- * E-mail:
| | - Jani Raitanen
- UKK Institute for Health Promotion; Tampere, Finland
- School of Health Sciences, University of Tampere; Tampere, Finland
| | | | - Eija Tomás
- Tampere University Hospital; Tampere, Finland
| | - Riitta Luoto
- UKK Institute for Health Promotion; Tampere, Finland
| |
Collapse
|
36
|
Fisher KL, Harrison EL, Reeder BA, Sari N, Chad KE. Is Self-Reported Physical Activity Participation Associated with Lower Health Services Utilization among Older Adults? Cross-Sectional Evidence from the Canadian Community Health Survey. J Aging Res 2015; 2015:425354. [PMID: 26347491 PMCID: PMC4541001 DOI: 10.1155/2015/425354] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/12/2014] [Accepted: 03/17/2015] [Indexed: 11/18/2022] Open
Abstract
Purpose. To examine relationships between leisure time physical activity (LTPA) and health services utilization (H) in a nationally representative sample of community-dwelling older adults. Methods. Cross-sectional data from 56,652 Canadian Community Health Survey respondents aged ≥ 50 years (48% M; 52% F; mean age 63.5 ± 10.2 years) were stratified into three age groups and analysed using multivariate generalized linear modeling techniques. Participants were classified according to PA level based on self-reported daily energy expenditure. Nonleisure PA (NLPA) was categorized into four levels ranging from mostly sitting to mostly lifting objects. Results. Active 50-65-year-old individuals were 27% less likely to report any GP consultations (ORadj = 0.73; P < 0.001) and had 8% fewer GP consultations annually (IRRadj = 0.92; P < 0.01) than their inactive peers. Active persons aged 65-79 years were 18% less likely than inactive respondents to have been hospitalized overnight in the previous year (ORadj = 0.82, P < 0.05). Higher levels of NLPA were significantly associated with lower levels of HSU, across all age groups. Conclusion. Nonleisure PA appeared to be a stronger predictor of all types of HSU, particularly in the two oldest age groups. Considering strategies that focus on reducing time spent in sedentary activities may have a positive impact on reducing the demand for health services.
Collapse
Affiliation(s)
- Koren L. Fisher
- Department of Kinesiology, California State University, Fullerton 800 N. State College Boulevard, Fullerton, CA 92831, USA
- Department of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, Canada S7N 5B2
| | - Elizabeth L. Harrison
- School of Physical Therapy, University of Saskatchewan, 1121 College Drive, Saskatoon, SK, Canada S7N 0W3
| | - Bruce A. Reeder
- Department of Community Health and Epidemiology, University of Saskatchewan, Box 7, Health Science Building, 107 Wiggins Road, Saskatoon, SK, Canada S7N 5E5
| | - Nazmi Sari
- Department of Economics, University of Saskatchewan, Arts 815, 9 Campus Drive, Saskatoon, SK, Canada S7N 5A5
| | - Karen E. Chad
- Department of Kinesiology, University of Saskatchewan, 87 Campus Drive, Saskatoon, SK, Canada S7N 5B2
| |
Collapse
|
37
|
Linardakis M, Papadaki A, Smpokos E, Micheli K, Vozikaki M, Philalithis A. Relationship of behavioral risk factors for chronic diseases and preventive health services utilization among adults, aged 50+, from eleven European countries. J Public Health (Oxf) 2015. [DOI: 10.1007/s10389-015-0683-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
38
|
Adams T, Burns D, Forehand JW, Spurlock A. A community-based walking program to promote physical activity among African American women. Nurs Womens Health 2015; 19:26-35. [PMID: 25690813 DOI: 10.1111/1751-486x.12173] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 06/04/2023]
Abstract
The death rate from cardiovascular disease (CVD) is substantially higher among African American women than for white women. Physical activity has been linked to decreased risk factors and deaths related to CVD. Despite the health benefits of physical activity, reports show most African American women have low levels of physical activity. Home- or community-based walking interventions are effective strategies to promote increased levels of physical activity among African American women. This article describes the implementation of one such program.
Collapse
|
39
|
Yom Din G, Zugman Z, Khashper A. The impact of preventive health behaviour and social factors on visits to the doctor. Isr J Health Policy Res 2014; 3:41. [PMID: 25584186 PMCID: PMC4290136 DOI: 10.1186/2045-4015-3-41] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/07/2014] [Accepted: 12/02/2014] [Indexed: 01/13/2023] Open
Abstract
BACKGROUND The aim of this study is to examine the joint impact of preventive health behavior (PHB) and social and demographic factors on the utilization of primary and secondary medical care under a universal health care system, as measured by visits to the doctor, who were categorized as either a General Practitioner (GP) or Specialist Doctor (SD). METHODS An ordered probit model was utilized to analyze data obtained from the 2009 Israeli National Health Survey. The problem of endogeneity between PHB factors and visits to GP was approached using the two-stage residuals inclusion and instrumental variables method. RESULTS We found a positive effect of PHB on visits to the doctor while the addition of the PHB factors to the independent variables resulted in important changes in explaining visits to GP (in values of the estimates, in their sign, and in their statistical significance), and only in slight changes for visits to SD. A 1% increase in PHB factors results in increasing the probability to visit General Practitioner in the last year in 0.6%. The following variables were identified as significant in explaining frequency of visits to the doctor: PHB, socio-economic status (pro-poor for visits to GP, pro-rich for visits to SD), location (for visits to SD), gender, age (age 60 or greater being a negative factor for visits to GP and a positive factor for visits to SD), chronic diseases, and marital status (being married was a negative factor for visits to GP and a positive factor for visits to SD). CONCLUSIONS There is a need for allowing for endogeneity in examining the impact of PHB, social and demographic factors on visits to GP in a population under universal health insurance. For disadvantaged populations with low SES and those living in peripheral districts, the value of IndPrev is lower than for populations with high SES and living in the center of the country. Examining the impact of these factors, significant differences in the importance and sometimes even in the sign of their influence on visits to different categories of doctors - GP and SD, are found.
Collapse
Affiliation(s)
- Gregory Yom Din
- />The Open University of Israel, Raanana, Israel, Faculty of Exact Sciences, Tel-Aviv University, Tel-Aviv, Israel
| | | | | |
Collapse
|
40
|
Miles TP, Allegra JC, Ezeamama A, Simpson C, Gerst-Emerson K, Elkins J. In a Longevity Society, Loss and Grief Are Emerging Risk Factors for Health Care Use: Findings From the Health and Retirement Survey Cohort Aged 50 to 70 Years. Am J Hosp Palliat Care 2014; 33:41-6. [PMID: 25258335 DOI: 10.1177/1049909114552125] [Citation(s) in RCA: 9] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
In a society of long lives, parent and child life can overlap by as much as 50 years. Most children now experience the death of their parents as adults. Many of the 2.5 million deaths each year in the United States are parents. Parental loss is a risk factor for subsequent illness. The Health and Retirement Survey is a representative cohort of persons aged 50 to 70 years. Using the 2010 cohort data, we estimate risk for use of health care after the death of a parent. Loss is a near universal experience in the cohort (87%). A report of any loss increases risk of health care utilization by 20% to 30%. For a longevity society, preventing loss-related hospitalization is a measurable outcome for bereavement care.
Collapse
Affiliation(s)
- Toni P Miles
- Institute of Gerontology, College of Public Health, University of Georgia, Athens, GA, USA
| | - Joseph C Allegra
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | - Amara Ezeamama
- Department of Epidemiology and Biostatistics, University of Georgia, Athens, GA, USA
| | | | - Kerstin Gerst-Emerson
- Institute of Gerontology, College of Public Health, University of Georgia, Athens, GA, USA
| | - Jennifer Elkins
- School of Social Work, University of Georgia, Athens, GA, USA
| |
Collapse
|
41
|
The effect of a four-week fitness program on satisfaction with health and life. Int J Public Health 2014; 60:41-7. [PMID: 25173964 DOI: 10.1007/s00038-014-0601-7] [Citation(s) in RCA: 18] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/28/2014] [Revised: 08/19/2014] [Accepted: 08/25/2014] [Indexed: 10/24/2022] Open
Abstract
OBJECTIVES To examine the effect of a 4-week fitness program on the participants' satisfaction with life and health. METHODS The threefold study design comprised a physical entry test accompanied by a pre-survey, a fitness program (six strength exercises; two times 30 min per week over a 4-week period), and an exit test accompanied by a post-survey. Participants (69.9% female; mean age = 46.4; mean BMI = 25.9; N = 10,386) self-selected in the program in 316 fitness clubs across Germany. Regression analysis was used to isolate the effect of the fitness program while controlling for gender, age, age squared, education, income, motivation, physical performance, month, and state. RESULTS Physical performance improved significantly (p < 0.001). The reported level of satisfaction with life and health was significantly higher after participation in the 4-week fitness program. CONCLUSIONS Significant positive effects on subjective well-being can already be observed after a period as short as 4 weeks. Policy makers should support the provision of such time-efficient programs which are appealing to overweight population groups.
Collapse
|
42
|
Esteban C, Arostegui I, Aburto M, Moraza J, Quintana JM, Aizpiri S, Basualdo LV, Capelastegui A. Influence of changes in physical activity on frequency of hospitalization in chronic obstructive pulmonary disease. Respirology 2014; 19:330-8. [PMID: 24483954 DOI: 10.1111/resp.12239] [Citation(s) in RCA: 53] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/14/2013] [Revised: 06/02/2013] [Accepted: 10/25/2013] [Indexed: 11/30/2022]
Abstract
BACKGROUND AND OBJECTIVE To evaluate whether changes in regular physical activity (PA) in patients with chronic obstructive pulmonary disease (COPD) affect the rate of hospitalizations for COPD exacerbation (eCOPD). METHODS Five hundred forty-three ambulatory clinic patients being treated for COPD were prospectively identified. PA was self-reported by patients, and the level was established by the distance they walked (km/day) at least 3 days per week. Hospitalizations were recorded from hospital databases. All patients with at least a 2-year follow-up after enrollment were included in the analysis. The response variable was the number of hospitalizations for eCOPD within the 3-year period from 2 to 5 years after study enrollment. RESULTS Three hundred ninety-one survivors were studied. Mean forced expiratory volume in 1 s was 52% (±14%) of the predicted value. Patients who maintained a lower level of PA had an increased rate of hospitalization (odds ratio 1.901; 95% confidence interval 1.090-3.317). After having had the highest level of PA, those patients who decreased their PA in the follow-up showed an increasing rate of hospitalizations (odds ratio 2.134; 95% confidence interval 1.146-3.977). CONCLUSIONS Patients with COPD with a low level of PA or who reduced their PA over time were more likely to experience a significant increase in the rate of hospitalization for eCOPD. Changes to a higher level of PA or maintaining a moderate or high level of PA over time, with a low intensity activity such as walking for at least 3-6 km/day, could reduce the rate of hospitalizations for eCOPD.
Collapse
Affiliation(s)
- Cristóbal Esteban
- Respiratory Service, Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain; Network of Research on Health Services and Chronic Diseases (REDISSEC), Hospital Galdakao-Usansolo, Galdakao, Bizkaia, Spain
| | | | | | | | | | | | | | | |
Collapse
|
43
|
Humphreys BR, McLeod L, Ruseski JE. Physical activity and health outcomes: evidence from Canada. HEALTH ECONOMICS 2014; 23:33-54. [PMID: 23364850 DOI: 10.1002/hec.2900] [Citation(s) in RCA: 100] [Impact Index Per Article: 10.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/29/2011] [Revised: 11/07/2012] [Accepted: 12/03/2012] [Indexed: 06/01/2023]
Abstract
Health production models include participation in physical activity as an input. We investigate the relationship between participation in physical activity and health using a bivariate probit model. Participation is identified with an exclusion restriction on a variable reflecting sense of belonging to the community. Estimates based on data from Cycle 3.1 of the Canadian Community Health Survey indicate that participation in physical activity reduces the reported incidence of diabetes, high blood pressure, heart disease, asthma, and arthritis as well as being in fair or poor health. Increasing the intensity above the moderate level and frequency of participation in physical activity appears to have a diminishing marginal impact on adverse health outcomes. Our results provide support for guidelines about engaging in exercise regularly to achieve health benefits.
Collapse
Affiliation(s)
- Brad R Humphreys
- Department of Economics, University of Alberta, Edmonton, AB, Canada
| | | | | |
Collapse
|
44
|
Baetschmann G, Winkelmann R. Modeling zero-inflated count data when exposure varies: With an application to tumor counts. Biom J 2013; 55:679-86. [PMID: 24003010 DOI: 10.1002/bimj.201200021] [Citation(s) in RCA: 11] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/16/2012] [Revised: 07/05/2013] [Accepted: 07/29/2013] [Indexed: 11/07/2022]
Abstract
This paper is concerned with the analysis of zero-inflated count data when time of exposure varies. It proposes a modified zero-inflated count data model where the probability of an extra zero is derived from an underlying duration model with Weibull hazard rate. The new model is compared to the standard Poisson model with logit zero inflation in an application to the effect of treatment with thiotepa on the number of new bladder tumors.
Collapse
|
45
|
Staub KE, Winkelmann R. Consistent estimation of zero-inflated count models. HEALTH ECONOMICS 2013; 22:673-686. [PMID: 22623339 DOI: 10.1002/hec.2844] [Citation(s) in RCA: 22] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 08/08/2011] [Revised: 03/23/2012] [Accepted: 04/24/2012] [Indexed: 06/01/2023]
Abstract
Applications of zero-inflated count data models have proliferated in health economics. However, zero-inflated Poisson or zero-inflated negative binomial maximum likelihood estimators are not robust to misspecification. This article proposes Poisson quasi-likelihood estimators as an alternative. These estimators are consistent in the presence of excess zeros without having to specify the full distribution. The advantages of the Poisson quasi-likelihood approach are illustrated in a series of Monte Carlo simulations and in an application to the demand for health services.
Collapse
|
46
|
Wasfi RA, Ross NA, El-Geneidy AM. Achieving recommended daily physical activity levels through commuting by public transportation: unpacking individual and contextual influences. Health Place 2013; 23:18-25. [PMID: 23732403 DOI: 10.1016/j.healthplace.2013.04.006] [Citation(s) in RCA: 62] [Impact Index Per Article: 5.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/15/2012] [Revised: 04/09/2013] [Accepted: 04/16/2013] [Indexed: 10/26/2022]
Abstract
This paper estimates the amount of daily walking associated with using public transportation in a large metropolitan area and examines individual and contextual characteristics associated with walking distances. Total walking distance to and from transit was calculated from a travel diary survey for 6913 individuals. Multilevel regression modelling was used to examine the underlying factors associated with walking to public transportation. The physical activity benefits of public transportation varied along gender and socio-economic lines. Recommended minutes of daily physical activity can be achieved for public transportation users, especially train users living in affluent suburbs.
Collapse
Affiliation(s)
- Rania A Wasfi
- Department of Geography, McGill University, 805 Sherbrooke St. West, Montreal, QC, Canada H3A2K6.
| | | | | |
Collapse
|
47
|
Disparities in health care utilization by smoking status in Canada. Int J Public Health 2013; 58:913-25. [DOI: 10.1007/s00038-013-0452-7] [Citation(s) in RCA: 15] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/25/2011] [Revised: 02/01/2013] [Accepted: 02/06/2013] [Indexed: 10/27/2022] Open
|
48
|
Physical Activity and Health Service Utilization Among Older People. J Am Med Dir Assoc 2013; 14:125-9. [DOI: 10.1016/j.jamda.2012.10.023] [Citation(s) in RCA: 33] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/16/2012] [Revised: 10/29/2012] [Accepted: 10/30/2012] [Indexed: 11/20/2022]
|
49
|
What belongs where? Variable selection for zero-inflated count models with an application to the demand for health care. Comput Stat 2012. [DOI: 10.1007/s00180-012-0388-z] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/27/2022]
|
50
|
Kim J, Park S. [Impact of level of physical activity on healthcare utilization among Korean adults]. J Korean Acad Nurs 2012; 42:199-206. [PMID: 22699169 DOI: 10.4040/jkan.2012.42.2.199] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022]
Abstract
PURPOSE This study was done to identify the impact of physical activity on healthcare utilization among Korean adults. METHODS Drawing from the 2008 Korean National Health and Nutrition Examination Survey (NHANES IV-2), data from 6,521 adults who completed the Health Interview and Health Behavior Surveys were analyzed. Association between physical activity and healthcare utilization was tested using the χ²-test. Multiple logistic regression analysis was used to calculate the odds ratios of using outpatient and inpatient healthcare for different levels of physical activity after adjusting for predisposing, enabling, and need factors. A generalized linear model applying a negative binomial distribution was used to determine how the level of physical activity was related to use of outpatient and inpatient healthcare. RESULTS Physically active participants were 16% less likely to use outpatient healthcare (OR, 0.84; 95% CI, 0.74-0.97) and 23% less likely to use inpatient healthcare (OR, 0.77; 95% CI, 0.63-0.93) than physically inactive participants. Levels of outpatient and inpatient healthcare use decreased as levels of physical activity increased, after adjusting for relevant factors. CONCLUSION An independent association between being physically active and lower healthcare utilization was ascertained among Korean adults indicating a need to develop nursing intervention programs that encourage regular physical activity.
Collapse
Affiliation(s)
- Jiyun Kim
- Department of Nursing, Gachon University, Seongnam, Korea
| | | |
Collapse
|