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Tarricone I, D'Andrea G, Galatolo M, Carloni AL, Descovich C, Muratori R. Psychiatric Admission Among Migrants Before and During Pandemic: a Retrospective Study in Acute Psychiatric Ward in Bologna, Italy. J Immigr Minor Health 2023; 25:507-521. [PMID: 36952152 PMCID: PMC10034892 DOI: 10.1007/s10903-023-01464-7] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Accepted: 02/10/2023] [Indexed: 03/24/2023]
Abstract
Previous evidence showed significant discrepancies in psychiatric services utilization between migrants and reference populations. Our study aims were to evaluate incidence and characteristics of psychiatric hospitalizations of migrant patients compared with reference populations and to assess how the COVID-19 pandemic affected admissions. All patients admitted to the psychiatric ward "SPDC-Malpighi" of the Bologna Mental Health Department from 01/01/2018 to 31/12/2020 were included. Differences in sociodemographic and clinical characteristics were tested by migrant status. Incidence rate ratios of hospital admissions by migrant status were estimated via Poisson regression considering population-at-risk, gender, and age-group. Migrants had higher hospitalization rates due to any psychiatric disorder (IRR = 1.16). The risk was especially pronounced among women (IRR = 1.25) and within the youngest age-group (IRR = 3.24). Young migrants had also a greater risk of compulsory admission (IRR = 3.77). Regarding admissions due to a specific diagnosis, we found relevant differences in hospitalization rates for psychosis, mood disorders, and personality disorders. Finally, migrants were more likely to be admitted via Emergency Department and less likely to be referred from a specialist. During the year of pandemic (2020) we observed an increase in the proportion of migrants admitted voluntarily or compulsorily. Migrants, especially those from the youngest age-group, had higher hospitalization rates for any disorder. Younger migrants were also at higher risk of compulsory treatment. The distribution of psychiatric admissions during the pandemic period seemed to have further increased discrepancies in mental healthcare needs and provision between migrants and the reference population. Tailored interventions and policies are urgently needed to address this issue.
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Affiliation(s)
- I Tarricone
- Department of Medical and Surgical Sciences (DIMEC), University of Bologna, Bologna, Italy
- Department of Mental Health and Pathological Addictions, Bologna Local Health Authority, Bologna, Italy
| | - G D'Andrea
- Department of BioMedical and NeuroMotor Sciences (DIBINEM), Section of Psychiatry, University of Bologna, Bologna, Italy
| | - M Galatolo
- Department of BioMedical and NeuroMotor Sciences (DIBINEM), Section of Psychiatry, University of Bologna, Bologna, Italy.
- Institute of Psychiatry, Bologna University, Viale Pepoli 5, 40123, Bologna, Italy.
| | - A L Carloni
- Department of BioMedical and NeuroMotor Sciences (DIBINEM), Section of Psychiatry, University of Bologna, Bologna, Italy
| | - C Descovich
- Clinical Governance and Quality Unit, Bologna Local Healthcare Authority Staff, Bologna, Italy
| | - R Muratori
- Department of Mental Health and Pathological Addictions, Bologna Local Health Authority, Bologna, Italy
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Shor E, Roelfs D. A Global Meta-analysis of the Immigrant Mortality Advantage. INTERNATIONAL MIGRATION REVIEW 2021. [DOI: 10.1177/0197918321996347] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
A large body of research on the “Healthy Immigrant Effect” (or “Paradox”) has reported an immigrant mortality advantage. However, other studies do not find such significant effects, and some even present contradictory evidence. This article is the first systematic meta-analysis that investigates the immigration-mortality relationship from a global perspective, examining 1,933 all-cause and cardiovascular mortality risk estimates from 103 publications. Our comprehensive analysis allows us to assess interactions between origin and destination regions and to reexamine, on a global scale, some of the most notable explanations for the immigrant mortality advantage, including suggestions that this paradox may be primarily the result of selection effects. We find evidence for the existence of a mild immigrant mortality advantage for working-age individuals. However, the relationship holds only for immigrants who moved between certain world regions, particularly those who immigrated from Northern Africa, Asia, and Southern Europe to richer countries. The results highlight the need in the broader migration literature for an increased focus on selection effects and on outcomes for people who chose not to migrate or who were denied entry into their planned destination country.
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Perrin R, Patel S, Lees A, Smith D, Woodcock T, Harris S, Fraser SDS. Predictors of children's health system use: cross-sectional study of linked data. Fam Pract 2020; 37:807-814. [PMID: 32632442 DOI: 10.1093/fampra/cmaa061] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
BACKGROUND Use of health services is increasing in many countries. Most health service research exploring determinants of use has focused on adults and on secondary care. Less is known about factors associated with the use of the emergency department (ED) and general practice (GP) among young children. OBJECTIVE To explore factors associated with GP consultations and ED attendances among children under 5 in a single UK city. METHODS Cross-sectional exploratory study using anonymized individual-level health service use data for children aged 0-4 from 21 GPs in Southampton, UK, linked to ED data, over a 1-year period. Univariate and multivariable logistic regression were used to explore the association of socio-demographic factors [using the 2015 Index of Multiple Deprivation (IMD) to define socio-economic status] with high service use (defined as more than eight GP consultations and/or two ED attendances respectively). RESULTS Among 11 062 children, there were 76 092 GP consultations and 6107 ED attendances. Three thousand two hundred thirty-three (29%) children were high users of GP and 564 (5%) of ED services. Greater socio-economic deprivation was independently associated with high use of GP and ED services separately [odds ratios (OR) for most versus least deprived IMD quintile 1.45 (95% confidence interval, CI 1.20-1.75) and 2.21 (95% CI 1.41-3.46), respectively], and together [OR 2.62 (95% CI 1.48-4.65)]. CONCLUSION Young children are frequent users of health services, particularly GP. Socio-economic deprivation is an important factor. Parents, carers and health services may benefit from interventions that support families in their management of children's health.
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Affiliation(s)
- Rebecca Perrin
- School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Sanjay Patel
- Department of Paediatric Infectious Diseases and Immunology, University Hospital Southampton NHS Foundation Trust, Southampton, UK
| | - Amanda Lees
- Health and Wellbeing Research Group, University of Winchester, Winchester, UK
| | - Dianna Smith
- School of Geography and Environmental Sciences, University of Southampton, Southampton, UK
| | - Tina Woodcock
- Primary Care, Southampton City Clinical Commissioning Group, Southampton, UK
| | - Scott Harris
- School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
| | - Simon D S Fraser
- School of Primary Care, Population Science and Medical Education, Faculty of Medicine, University of Southampton, Southampton General Hospital, Southampton, UK
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Jarvis S, Livingston J, Childs AM, Fraser L. Outpatient appointment non-attendance and unplanned health care for children and young people with neurological conditions: a retrospective cohort study. Dev Med Child Neurol 2019; 61:840-846. [PMID: 30370928 DOI: 10.1111/dmcn.14070] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Accepted: 08/23/2018] [Indexed: 11/29/2022]
Abstract
AIM To test the hypothesis that children and young people with neurological conditions who missed outpatient appointments have more emergency inpatient admissions and Accident and Emergency centre (A&E) visits than those who missed none. METHOD Retrospective cohort of individuals aged up to 19 years with neurological conditions, identified from routine hospital data in England, UK from April 1st, 2003 to March 31st, 2015 using an International Statistical Classification of Diseases and Related Health Problems, coding framework. Counts of emergency inpatient admissions and A&E visits per person per year were modelled (random intercept negative binomial regression) with outpatient attendance the independent variable of interest. RESULTS The cohort numbered 524 613 individuals. Those who missed outpatient appointments had 19 per cent (95% confidence interval [CI] 18-19) more emergency inpatient admissions and 16 per cent (95% CI 15-17) more A&E visits per year than those who missed none. 'Did not attends' had a larger increase in unplanned health care than patient or provider cancellations. If no appointments were missed, the models predict there would have been 107 000 fewer A&E visits from 2007/2008 to 2014/2015 and 104 000 fewer emergency inpatient admissions from 2003/2004 to 2014/2015. INTERPRETATION Missed outpatient appointments were associated with increased unplanned health care. Improving outpatient attendance may have the potential to reduce emergency inpatient admissions and A&E visits. WHAT THIS PAPER ADDS Missed outpatient appointments by children and young people with neurological conditions are associated with increased unplanned health care. Both emergency inpatient admissions and Accident and Emergency centre visits are increased. 'Did not attends' are more strongly associated with unplanned health care than cancellations.
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Affiliation(s)
- Stuart Jarvis
- Department of Health Sciences, University of York, York, UK
| | - John Livingston
- Department of Paediatric Neurology, Leeds Children's Hospital, Leeds, UK
| | - Anne-Marie Childs
- Department of Paediatric Neurology, Leeds Children's Hospital, Leeds, UK
| | - Lorna Fraser
- Department of Health Sciences, University of York, York, UK
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Hendrickx D, Bowen AC, Marsh JA, Carapetis JR, Walker R. Ascertaining infectious disease burden through primary care clinic attendance among young Aboriginal children living in four remote communities in Western Australia. PLoS One 2018; 13:e0203684. [PMID: 30222765 PMCID: PMC6141079 DOI: 10.1371/journal.pone.0203684] [Citation(s) in RCA: 17] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/10/2017] [Accepted: 08/24/2018] [Indexed: 11/18/2022] Open
Abstract
Infectious diseases contribute a substantial burden of ill-health in Australia’s Aboriginal children. Skin infections have been shown to be common in remote Aboriginal communities, particularly in the Northern Territory, Australia. However, primary care data on skin and other infectious diseases among Aboriginal children living in remote areas of Western Australia are limited. We conducted a retrospective review of clinic presentations of all children aged 0 to 5 years presenting to four clinics located in the Western Desert region of Western Australia between 2007 and 2012 to determine this burden at a local level. Infectious diseases accounted for almost 50% of all clinic presentations. Skin infections (sores, scabies and fungal infections) were the largest proportion (16%), with ear infections (15%) and upper respiratory infections (13%) also high. Skin infections remained high in all age groups; 72% of children presented at least once with skin infections. Scabies accounted for only 2% of all presentations, although one-quarter of children presented during the study for management of scabies. Skin sores accounted for 75% of the overall burden of skin infections. Improved public health measures targeting bacterial skin infections are needed to reduce this high burden of skin infections in Western Australia.
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Affiliation(s)
- David Hendrickx
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- NHMRC Centre for Research Excellence in Aboriginal Health and Wellbeing, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
- * E-mail:
| | - Asha C. Bowen
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- School of Medicine, University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
- Menzies School of Health Research, Charles Darwin University, Darwin, Northern Territory, Australia
| | - Julie A. Marsh
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
| | - Jonathan R. Carapetis
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Department of Infectious Diseases, Perth Children's Hospital, Perth, Western Australia, Australia
| | - Roz Walker
- Wesfarmers Centre for Vaccines and Infectious Diseases, Telethon Kids Institute, The University of Western Australia, Perth, Western Australia, Australia
- Centre for Child Health Research, University of Western Australia, Perth, Western Australia, Australia
- NHMRC Centre for Research Excellence in Aboriginal Health and Wellbeing, Telethon Kids Institute, University of Western Australia, Perth, Western Australia, Australia
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Jarvis SW, Livingston J, Childs AM, Fraser L. The impact of neurological disorders on hospital admissions for children and young people: a routine health data study. Int J Popul Data Sci 2018; 3:421. [PMID: 32935002 PMCID: PMC7299487 DOI: 10.23889/ijpds.v3i1.421] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022] Open
Abstract
Introduction Neurological conditions are a major and increasing cause of hospitalisation among children and young people, but little is known about the impact of neurological conditions on hospital services in England, nor the factors that influence length of stay and bed days per year. Objectives To quantify the hospital usage in children and young people related to neurological conditions, trends over time and variation by ethnicity and deprivation status. Methods An ICD10 coding framework identified a cohort of individuals aged 0-19 years with neurological conditions from linked routinely collected healthcare data from England (The Hospital Episode Statistics Admitted Patient Care dataset), from 1 April 2003 to 31 March 2015. Linked outpatient and accident and emergency data were used to supplement missing demographic data. Length of stay and bed days per year per person were calculated. These were separately modelled using random intercept multivariable negative binomial regressions with gender, age, ethnic group, diagnostic group, region of residence and deprivation category as predictors. Results 524,442 individuals were identified over the study period, increasing from 49,928 in 2003/04 to 102,840 in 2014/15. Neurological conditions account for 8.8% of inpatient bed days in the 0-14 year old age group. Length of stay and bed days per year vary primarily by age group - e.g. Under 1 year olds had 1.85 times (95%CI 1.83-1.86%) longer stays and over double (2.36 times, 95%CI 2.34-2.37 times) the number of bed days per person per year compared to 5 to 9 year olds - and main diagnostic group, with smaller variations by ethnic group, deprivation and region. Conclusions Neurological conditions in children and young people have a significant and increasing impact on the NHS in England. Falls in length of stay and bed days per person are more than offset by increasing numbers of children and young people with neurological diagnoses. Variations in length of stay and bed days per year by diagnostic group, ethnic group, age group, deprivation category and region should be taken into account in resource planning.
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Kashnitsky D, Demintseva E. "Kyrgyz Clinics" in Moscow: Medical Centers for Central Asian Migrants. Med Anthropol 2018; 37:401-411. [PMID: 29257903 DOI: 10.1080/01459740.2017.1417280] [Citation(s) in RCA: 9] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/18/2022]
Abstract
Social isolation limits migrants' access to health care, providing the context for the emergence of migrants' own medical infrastructure. In this article, we explore the so-called Kyrgyz clinics, private medical centers in Moscow founded by doctors from Kyrgyzstan and targeted specifically for labor migrants from Central Asian countries, particularly Kyrgyzstan, Uzbekistan, and Tajikistan. These Kyrgyz clinics both provide affordable medical services and enable migrant doctors to guide migrant patients through Russia's medical infrastructure, in the context of limited resources, lack of health insurance, low awareness of available services, and other barriers to care.
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Affiliation(s)
- Daniel Kashnitsky
- a Institute for Social Policy , National Research University, Higher School of Economics (HSE) , Moscow , Russia
| | - Ekaterina Demintseva
- a Institute for Social Policy , National Research University, Higher School of Economics (HSE) , Moscow , Russia
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West J, Kelly B, Collings PJ, Santorelli G, Mason D, Wright J. Is small size at birth associated with early childhood morbidity in white British and Pakistani origin UK children aged 0-3? Findings from the born in Bradford cohort study. BMC Pediatr 2018; 18:22. [PMID: 29390971 PMCID: PMC5796403 DOI: 10.1186/s12887-018-0987-0] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 01/03/2017] [Accepted: 01/16/2018] [Indexed: 12/20/2022] Open
Affiliation(s)
- Jane West
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
- School of Social & Community Medicine, University of Bristol, Bristol, UK
| | - Brian Kelly
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Paul J. Collings
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Gillian Santorelli
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - Dan Mason
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
| | - John Wright
- Bradford Institute for Health Research, Bradford Royal Infirmary, Duckworth Lane, Bradford, BD9 6RJ UK
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Abstract
During the past decade, increasing attention has been paid to the primary care level of service for children and adolescents with mental health problems. In particular, a number of national reports have advised service commissioners and providers to increase the amount of specialist child and adolescent mental health services (CAMHS) support to primary care colleagues (Department of Health/Department for Education/Social Services Inspectorate, 1995; National Health Service (NHS)/Health Advisory Service (HAS), 1995; Audit Commission, 1999).
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10
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Shor E, Roelfs D, Vang ZM. The "Hispanic mortality paradox" revisited: Meta-analysis and meta-regression of life-course differentials in Latin American and Caribbean immigrants' mortality. Soc Sci Med 2017; 186:20-33. [PMID: 28577458 DOI: 10.1016/j.socscimed.2017.05.049] [Citation(s) in RCA: 130] [Impact Index Per Article: 18.6] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/08/2016] [Revised: 04/10/2017] [Accepted: 05/24/2017] [Indexed: 10/19/2022]
Abstract
The literature on immigrant health has repeatedly reported the paradoxical finding, where immigrants from Latin American countries to OECD countries appear to enjoy better health and greater longevity, compared with the local population in the host country. However, no previous meta-analysis has examined this effect focusing specifically on immigrants from Latin America (rather than Hispanic ethnicity) and we still do not know enough about the factors that may moderate the relationship between immigration and mortality. We conducted meta-analyses and meta-regressions to examine 123 all-cause mortality risk estimates and 54 cardiovascular mortality risk estimates from 28 publications, providing data on almost 800 million people. The overall results showed that the mean rate ratio (RR) for immigrants vs. controls was 0.92 (95% CI, 0.84-1.01) for all-cause mortality and 0.73 (CI, 0.67-0.80) for cardiovascular mortality. While the overall results suggest no immigrant mortality advantage, studies that used only native born persons as controls did find a significant all-cause mortality advantage (RR, 0.86; 95% CI, 0.76-0.97). Furthermore, we found that the relative risk of mortality largely depends on life course stages. While the mortality advantage is apparent for working-age immigrants, it is not significant for older-age immigrants and the effect is reversed for children and adolescents.
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Affiliation(s)
- Eran Shor
- Department of Sociology, McGill University, 855 Sherbrooke Street West, Canada.
| | - David Roelfs
- Department of Sociology, University of Louisville, United States.
| | - Zoua M Vang
- Department of Sociology, McGill University, 855 Sherbrooke Street West, Canada.
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Ou L, Chen J, Hillman K. Socio-demographic disparities in the utilisation of general practice services for Australian children - Results from a nationally representative longitudinal study. PLoS One 2017; 12:e0176563. [PMID: 28448555 PMCID: PMC5407608 DOI: 10.1371/journal.pone.0176563] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/25/2016] [Accepted: 04/12/2017] [Indexed: 12/03/2022] Open
Abstract
Objective This study aimed to investigate the pattern of general practice services utilization for Australian children and to examine socio-demographic disparities in general practitioner (GP) visits. Methods We used the linked data from the nationally representative Longitudinal Study of Australian Children (LSAC) and the Medicare Australia claims data record. We used survey negative binomial and logistic regression to examine the socio-demographic factors associated with the utilisation of general practice services. Results The average number of annual GP visits gradually declined from 7.0 at 0–1 year old to 2.4 at 5–8 years (p< .001 for trend) in the infant cohort and from 3.5 at 2–4 years to 2.0 at 9–12 years (p < .001 for trend) in the child cohort. Girls were more likely to visit GPs than boys at 0–1 year old in the infant cohort (RR = 1.06, 95%CI: 1.02–1.11) and at 2–4 years in the child cohort (RR = 1.09, 95%CI: 1.04–1.14), but there were no differences at 2–4 to 5–8 year age periods in the infant cohort and at 5–8 to 9–12 year age period in the child cohort. Children from non-English speaking background were more likely to have a greater number of GP visits compared with their counterparts from English-speaking and Indigenous background up to eight year old in both cohorts (all p < .001). Children from families with the higher socio-economic position, children without private health insurance and children living in non-metropolitan were less likely to have GP consultations in both cohorts. Fair or poor parent-rated health status was associated with greater number of GP visits. Conclusion Socio-demographic disparities existed in the utilisation of general practice services and varied at different age periods. Family socio-economic position, private health insurance coverage and region of residence strongly associates with the utilisation disparities over all age period. Further policy interventions are called to minimise the disparities in GP utilisation for children in Australian context.
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Affiliation(s)
- Lixin Ou
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, New South Wales, Australia
- * E-mail:
| | - Jack Chen
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, New South Wales, Australia
| | - Ken Hillman
- Simpson Centre for Health Services Research, South Western Sydney Clinical School, University of New South Wales, Sydney, New South Wales, Australia
- Ingham Institute for Applied Medical Research, New South Wales, Australia
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Jarvis S, Parslow RC, Carragher P, Beresford B, Fraser LK. How many children and young people with life-limiting conditions are clinically unstable? A national data linkage study. Arch Dis Child 2017; 102:131-138. [PMID: 27682139 DOI: 10.1136/archdischild-2016-310800] [Citation(s) in RCA: 19] [Impact Index Per Article: 2.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/01/2016] [Revised: 08/03/2016] [Accepted: 09/03/2016] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To determine the clinical stage (stable, unstable, deteriorating or dying) for children and young people (CYP) aged 0-25 years in Scotland with life-limiting conditions (LLCs). DESIGN National cohort of CYP with LLCs using linked routinely collected healthcare data. SETTING Scotland. PATIENTS 20 436 CYP identified as having LLCs and resident in Scotland between 1 April 2009 and 31 March 2014. MAIN OUTCOME Clinical stage based on emergency inpatient and intensive care unit admissions and date of death. RESULTS Over 2200 CYP with LLCs in Scotland were unstable, deteriorating or dying in each year. Compared with 1-year-olds to 5-year-olds, children under 1 year of age had the highest risk of instability (OR 6.4, 95% CI 5.7 to 7.1); all older age groups had lower risk. Girls were more likely to be unstable than boys (OR 1.15, 95% CI 1.06 to 1.24). CYP of South Asian (OR 1.61, 95% CI 1.28 to 2.01), Black (OR 1.58, 95% CI 1.04 to 2.41) and Other (OR 1.33, 95% CI 1.02 to 1.74) ethnicity were more likely to experience instability than White CYP. Deprivation was not a significant predictor of instability. Compared with congenital abnormalities, CYP with most other primary diagnoses had a higher risk of instability; only CYP with a primary perinatal diagnosis had significantly lower risk (OR 0.23, 95% CI 0.19 to 0.29). CONCLUSIONS The large number of CYP with LLCs who are unstable, deteriorating or dying may benefit from input from specialist paediatric palliative care. The age group under 1 and CYP of South Asian, Black and Other ethnicities should be priority groups.
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Affiliation(s)
- Stuart Jarvis
- Department of Health Sciences, University of York, York, UK
| | - Roger C Parslow
- Division of Epidemiology and Biostatistics, University of Leeds, Leeds, UK
| | - Pat Carragher
- Children's Hospice Association Scotland, Edinburgh, UK
| | | | - Lorna K Fraser
- Department of Health Sciences, University of York, York, UK
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Brandon AD, Costanian C, El Sayed MF, Tamim H. Factors associated with difficulty accessing health care for infants in Canada: mothers' reports from the cross-sectional Maternity Experiences Survey. BMC Pediatr 2016; 16:192. [PMID: 27887580 PMCID: PMC5124240 DOI: 10.1186/s12887-016-0733-4] [Citation(s) in RCA: 4] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 11/19/2015] [Accepted: 11/16/2016] [Indexed: 11/10/2022] Open
Abstract
Background Approximately 13% of Canadian mothers report difficulty accessing health care for their infants, yet little is known about the factors associated with difficulty. Therefore, we examined factors associated with difficulty accessing non-routine health care for Canadian infants, from birth to 14 months of age, as reported by their mothers. Methods Data was drawn from the Maternity Experiences Survey (MES), a cross-sectional, nationally representative survey of mothers who gave birth between November 2005 and May 2006, aged 15 years or older, and lived with their infants at the time of survey administration. A multivariable logistic regression analysis was conducted to determine factors associated with reporting difficulty, with difficulty defined as a mother reporting it being somewhat or very difficult to access a health care provider. Results Analysis of 2832 mothers who reported needing to access a health care provider for their infant for a non-routine visit found that 13% reported difficulty accessing a provider. Factors associated with reporting difficulty were: residing in Quebec (aOR 1.89, 95% CI: 1.31–2.73), being an immigrant (aOR 1.58, 95% CI: 1.10–2.27), mistimed pregnancy (aOR 1.44, 95% CI: 1.05–1.98), low level of social support (aOR 1.69, 95% CI: 1.05–2.73), good health (aOR 1.88, 95% CI: 1.43–2.47), postpartum depression symptoms (aOR 1.55, 95% CI: 1.02–2.37) and a self-reported ‘too-short’ postpartum hospital stay (aOR 1.69, 95% CI: 1.21–2.35). Additionally, accessing care for an infant with a birth weight of 2500 g or more (aOR 2.43, 95% CI: 1.02–5.82), was associated with reporting difficulty. Household income, mothers’ level of education, marital status, Aboriginal ethnicity, and size of community of residence were not associated with difficulty accessing care. Conclusions Ease of health care access for Canadian infants is not equal, suggesting that efforts to improve access should be tailored to groups facing increased difficulties.
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Affiliation(s)
- Alisa D Brandon
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada.
| | - Christy Costanian
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
| | - Manal F El Sayed
- Division of Neonatology, Department of Pediatrics, McMaster University, Hamilton, ON, Canada
| | - Hala Tamim
- School of Kinesiology and Health Science, York University, Toronto, ON, Canada
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Toan N, Trong L, Höjer B, Persson L. Public health services use in a mountainous area, Vietnam: implications for health policy. Scand J Public Health 2016. [DOI: 10.1177/14034948020300020201] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
Aims : The aim of this study is to describe the use of public health services in different social and ethnic groups and to explore the implementation of user fee exemption in a mountainous area in Vietnam. Methods: A cross-sectional household survey with a structured questionnaire and a four-week diary were used to collect information on illnesses, health seeking behaviour and socioeconomic factors. Three communes in a mountainous district in Northern Vietnam were selected and a random sample of 1,452 individuals in 300 households was drawn. Results: Self-medication was most common (57%) while 30% used public health services when suffering from a health problem. Persons living far from health services attended public health services less frequently than the others (adjusted OR=0.28; 95% CI 0.15-0.51). This was especially the case for ethnic minorities who were less likely to use public health services than the others were (adjusted OR=0.47; 95% CI 0.25-0.87). Persons with mild conditions tended to use public health services less than those with more severe conditions (OR=0.19; 95% CI 0.10-0.37). Health services use was similar among women and men, but the total expenditure per visit was higher for men. Almost no patients supposed to get free attendance had been exempted from user fees. Conclusions : It was found that there was a geographical inequity in use of public health services while there was relatively equal use of these services between social, gender, and ethnic groups. Long distance in combination with failure of the fee exemption may increase inequity in use of health services in remote and isolated areas. These observations contribute to the basis for implementation of the Vietnamese health policy, emphasizing efficiency and equity.
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Affiliation(s)
- N.V. Toan
- Department of Epidemiology, Hanoi Medical University, Vietnam, Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | | | - B. Höjer
- Division of International Health, Department of Public Health Sciences, Karolinska Institutet, Stockholm, Sweden
| | - L.A. Persson
- Division of Epidemiology, Department of Public Health and Clinical Medicine, UmeÅ University, UmeÅ, Sweden, ICDDR, B: Centre for Health and Population Research, Dhaka, Bangladesh
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Health Trajectories in People with Cystic Fibrosis in the UK: Exploring the Effect of Social Deprivation. A LIFE COURSE PERSPECTIVE ON HEALTH TRAJECTORIES AND TRANSITIONS 2015. [DOI: 10.1007/978-3-319-20484-0_5] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 12/13/2022]
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16
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Inequalities in healthcare access by type of visa in a context of restrictive health insurance policy: the case of Ukrainians in Czechia. Int J Public Health 2014; 59:715-9. [DOI: 10.1007/s00038-014-0592-4] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2014] [Revised: 05/23/2014] [Accepted: 07/17/2014] [Indexed: 10/25/2022] Open
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Wilson C, Hogg R, Henderson M, Wilson P. Patterns of primary care service use by families with young children. Fam Pract 2013; 30:679-94. [PMID: 24115013 DOI: 10.1093/fampra/cmt057] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND In the UK, early years policy emphasizes that all families should have access to support tailored to their individual needs. Knowledge of the determinants of health service use should help to inform rational and equitable planning and delivery of services to parents. OBJECTIVES We seek to investigate the determinants of primary care service use in families with preschool children. METHODS Determinants of service use in two population cohorts (families with children aged 0-1 and 2-3 years) from the Growing Up in Scotland study are presented. Services related to use of the family doctor or health visitor for information on the child's health or behaviour in the last year. RESULTS A range of socio-demographic determinants were significant predictors of service use on multivariate analysis. Determinants of service use differed between the health visitor and family doctor. CONCLUSIONS The analysis provides an insight into the determinants and patterns of health service use by families with young children at two stages of development. While some of our findings are expected or supported by previous research, others highlight areas that require further investigation.
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Affiliation(s)
- Claire Wilson
- Faculty of Medicine, University of Glasgow, Wolfson Medical School Building, University Avenue, Glasgow, G12 8QQ
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Rask CU, Ørnbøl E, Fink PK, Skovgaard AM. Functional somatic symptoms and consultation patterns in 5- to 7-year-olds. Pediatrics 2013; 132:e459-67. [PMID: 23837183 DOI: 10.1542/peds.2013-0159] [Citation(s) in RCA: 27] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/24/2022] Open
Abstract
OBJECTIVE To investigate the frequency of and factors linked to medical consultation for functional somatic symptoms (FSS) among 5- to 7-year-old children. METHODS We assessed 1327 children from the Copenhagen Child Cohort 2000 for FSS at ages 5 to 7 years. Register data on past health care use in general practice were compared between children with and those without parent-reported medical consultation for FSS at the age of 5 to 7 years: respective consulters (n = 96) and nonconsulters (n = 211) and children without FSS (n = 1019). Degree of parental worries about the child's symptoms and parent-reported symptom characteristics and associated impacts were compared between consulters and nonconsulters. RESULTS Among 308 children with FSS, 31.1% were consulters. Being a consulter was significantly associated with multisymptomatic presentation, parental worries about the symptoms, symptom impact, and a higher past health care use in general practice. Multiple logistic regression analysis controlled for gender, comorbid physical disease, and symptom severity revealed that the number of face-to-face contacts in general practice during the child's first 4 years of life predicted being an consulter for FSS at 5 to 7 years (odds ratio 1.03, 95% confidence interval 1.00-1.06; odds ratio interpreted per unit change in number of contacts). CONCLUSIONS This study adds to our understanding of health care use for FSS in childhood by highlighting the influence of parents' early consultation patterns with their child and the influence of parental perceptions of their child's health and FSS-related impact on pediatric health care use for FSS. Management of health care use in children with FSS should address these aspects.
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Affiliation(s)
- Charlotte Ulrikka Rask
- Research Clinic for Functional Disorders and Psychosomatics, Aarhus University Hospital, Aarhus, Denmark.
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Cook EJ, Randhawa G, Large S, Guppy A, Chater A. Who uses telephone based helplines? Relating deprivation indices to users of NHS Direct. HEALTH POLICY AND TECHNOLOGY 2013. [DOI: 10.1016/j.hlpt.2013.03.002] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
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Ramesh Masthi N, Gangaboraiah, Kulkarni P. An exploratory study on socio economic status scales in a rural and urban setting. J Family Med Prim Care 2013; 2:69-73. [PMID: 24479048 PMCID: PMC3893998 DOI: 10.4103/2249-4863.109952] [Citation(s) in RCA: 12] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/09/2022] Open
Abstract
BACKGROUND There are many different scales to measure socioeconomic status (SES). The present study was conducted with the objective to compare the most commonly used SES in rural and urban setting. MATERIALS AND METHODS This exploratory study was conducted in the rural and urban field practice area of a medical college situated in Bangalore for a period of 3 months between January and April 2010. STATISTICAL ANALYSIS USED To measure the agreement between the scales spearman's rank correlations was applied. RESULTS A total of 120 families were included in the study. Among the 60 families surveyed at rural setting, it was observed that, majority 40 (67%) belonged to high class when the Standard of Living Index (SLI) scale was applied. Among the 60 families surveyed at urban setting, majority 30 (50%) belonged to high class when the SLI scale was applied. CONCLUSIONS The SLI scale gives a more accurate and realistic picture of the SES of the family and hence should be the scale recommended for classification of SES in urban and rural setting.
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Affiliation(s)
- N.R. Ramesh Masthi
- Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Gangaboraiah
- Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
| | - Praveen Kulkarni
- Department of Community Medicine, Kempegowda Institute of Medical Sciences, Bangalore, Karnataka, India
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Evaluation of a preventive program aiming at children with increased caries risk using ICDAS II criteria. Clin Oral Investig 2012; 17:2049-55. [PMID: 23242815 DOI: 10.1007/s00784-012-0907-x] [Citation(s) in RCA: 17] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/31/2012] [Accepted: 12/05/2012] [Indexed: 10/27/2022]
Abstract
OBJECTIVES A selective intensified prevention (SIP) was introduced at individual schools in deprived areas in Marburg County (Germany) in 1995. The outcome of the program was evaluated in sixth graders (mean age: 12.06 years) in comparison to a control region. MATERIALS AND METHODS Caries experience was recorded by applying International Caries Detection and Assessment System (ICDAS) II criteria. Tooth brushing habits and other independent variables were examined psychometrically. To compare the mean caries scores, non parametric tests were applied. The influence of various independent variables on caries experience was assessed by stepwise backward logistic regression analysis. The matching criteria age, gender, ethnicity and maternal education were used to parallelize the samples. RESULTS ICDAS scores of 2-6 were detected uniformly more often in the control region than in the test group. Combining ICDAS scores 3-6, children from the control region (mean D(3-6)MFT: 1.73) showed roughly double the caries experience compared to the test group (mean D(3-6)MFT: 0.88, p < 0.005). The D(5,6)MFT score of the test group amounted to 0.50, and the corresponding value of the reference group was 0.77 (p = 0.043). Multivariate analysis disclosed fissure sealants, early start of tooth brushing and topical fluoride application to be associated with the prevention of dental caries. High frequency of sugar intake was associated with the presence of dentine lesions. CONCLUSIONS The results of our study confirm the positive effect of SIP on the dental health of 12-year-old pupils living in deprived areas. CLINICAL RELEVANCE On the basis of ICDAS II, targeted preventive measures can be applied in children with increased caries risk. Frequent applications of fluoride varnish inhibit the progression of initial lesions in this group.
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Cook EJ, Randhawa G, Large S, Guppy A, Chater A. A U.K. case study of who uses NHS direct: investigating the impact of age, gender, and deprivation on the utilization of NHS direct. Telemed J E Health 2012; 18:693-8. [PMID: 23050800 DOI: 10.1089/tmj.2011.0256] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/12/2022] Open
Abstract
OBJECTIVES National Health Service (NHS) Direct provides a 24/7 telephone-based healthcare advice and information service to the public in England. Locally based studies have suggested variation in the uptake of this service among the United Kingdom's diverse population. This study seeks to examine this issue at a national level. SUBJECTS AND METHODS One month's period of national data was collected (July 2010) from the NHS Direct Clinical Assessment System for all 0845 4647 calls in England. Calls were matched to place of residence and were analyzed for age, gender, and deprivation using negative binominal regression. RESULTS Within the context of NHS Direct the pattern of calls was highest for children 5 years old and under, with lowest call rates found for males and older people (65+ years old). Furthermore, call rates were lowest in the most deprived areas for children (0-15 years old). Gender differences were noted, whereby male call rates were higher in the most deprived areas for all age groups. Furthermore, call rates for or on behalf of older females (60+ years old) were lower in areas of extreme deprivation. CONCLUSIONS The findings suggest there is variation in usage of NHS Direct. Such usage appears to be influenced by age, gender, and deprivation. Further research is required to examine the underlying factors that contribute to variation in uptake of these services. This will enable the development of future promotional campaigns that can target particular sections of the population to encourage use of telephone-based health services.
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Affiliation(s)
- Erica J Cook
- Department of Psychology, University of Bedfordshire, Luton, Bedfordshire, United Kingdom.
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Mårtensson S, Hansen KH, Olsen KR, Højmark TB, Petersen JH, Due P. Does participation in preventive child health care at the general practitioner minimise social differences in the use of specialist care outside the hospital system? Scand J Public Health 2012; 40:316-24. [PMID: 22786915 DOI: 10.1177/1403494812449080] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
INTRODUCTION The primary purposes of preventive child health care in Denmark are to help ensure a healthy childhood and to create preconditions for a healthy adult life. The aim of this study is to examine whether participation in age-appropriate preventative child health care affects the association between the socioeconomic position of the family and subsequent use of specialised health care outside the hospital system. METHODS The study population was children born in 1999 and living in Denmark between 1 January 2002 and 31 December 2006 (n=68,366). The study investigated whether the number of contacts with a specialist in 2006 was related to participation in preventive child health care between 2002 and 2005. To control for the potential effect of difference in GP behaviour the data were analysed using a multilevel Poisson model linking each child to the GP with whom he or she was listed. RESULTS If the children attended any preventive child health care visits, they had the same probability of contact with a specialist regardless of the parents' income. However, children from low-income families not participating in any preventive care had a lower probability of contact with a specialist than children from more affluent families. CONCLUSIONS Ensuring participation in preventive child health care at the GP may reduce the social gap in utilisation of specialised health care that exists between children from families of different income levels.
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Palacio-Vieira JA, Villalonga-Olives E, Valderas JM, Herdman M, Alonso J, Rajmil L. Predictors of the use of healthcare services in children and adolescents in Spain. Int J Public Health 2012; 58:207-15. [PMID: 22552748 DOI: 10.1007/s00038-012-0360-2] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.7] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2011] [Revised: 03/01/2012] [Accepted: 04/12/2012] [Indexed: 11/28/2022] Open
Abstract
OBJECTIVE To assess medium to long term predictors of healthcare services use in a population-based sample of children/adolescents in Spain. METHODS A sample of children and adolescents aged 8-18 and their parents were evaluated at baseline (2003) and follow-up (2006). Total use of healthcare services and visits to specialist and dentists at the follow-up were analyzed. RESULTS Four hundred fifty-four children/adolescents completed baseline and follow-up assessments (response rate 54 %). 90 % of respondents reported at least one visit during the 12 months previous to the follow-up. Low socioeconomic status (beta coefficient = 0.30; 95 % CI = 0.02-0.57), double healthcare coverage (0.41; 0.17-0.66), parental use of services, poor mental health and activity limitation were associated to the total number of visits. Access to specialist was associated to double healthcare coverage (OR = 1.77; 1.01-3.07) and parental primary level of education (OR = 0.51; 0.32-0.81). Age and low family affluence predicted visits to dentists (OR = 0.38; 0.19-0.73). CONCLUSION No barriers to healthcare services use were found. Family level of education, family affluence and double healthcare coverage predicted the use of specialists and dentists.
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Affiliation(s)
- Jorge-A Palacio-Vieira
- Catalan Agency for Pulic Health, Roc Boronat, 81-95 (3a planta), 08005, Barcelona, Spain.
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Mangrio E, Hansen K, Lindström M, Köhler M, Rosvall M. Maternal educational level, parental preventive behavior, risk behavior, social support and medical care consumption in 8-month-old children in Malmö, Sweden. BMC Public Health 2011; 11:891. [PMID: 22114765 PMCID: PMC3280332 DOI: 10.1186/1471-2458-11-891] [Citation(s) in RCA: 31] [Impact Index Per Article: 2.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/19/2011] [Accepted: 11/24/2011] [Indexed: 11/24/2022] Open
Abstract
Background The social environment in which children grow up is closely associated with their health. The aim of this study was to investigate the relationship between maternal educational level, parental preventive behavior, parental risk behavior, social support, and use of medical care in small children in Malmö, Sweden. We also wanted to investigate whether potential differences in child medical care consumption could be explained by differences in parental behavior and social support. Methods This study was population-based and cross-sectional. The study population was 8 month-old children in Malmö, visiting the Child Health Care centers during 2003-2007 for their 8-months check-up, and whose parents answered a self-administered questionnaire (n = 9,289 children). Results Exclusive breast feeding ≥4 months was more common among mothers with higher educational level. Smoking during pregnancy was five times more common among less-educated mothers. Presence of secondhand tobacco smoke during the first four weeks of life was also much more common among children with less-educated mothers. Less-educated mothers more often experienced low emotional support and low practical support than mothers with higher levels of education (>12 years of education). Increased exposure to unfavorable parental behavioral factors (maternal smoking during pregnancy, secondhand tobacco smoke and exclusive breastfeeding <4 months) was associated with increased odds of in-hospital care and having sought care from a doctor during the last 8 months. The odds were doubled when exposed to all three risk factors. Furthermore, children of less-educated mothers had increased odds of in-hospital care (OR = 1.34 (95% CI: 1.08, 1.66)) and having sought care from a doctor during the last 8 months (OR = 1.28 (95% CI: 1.09, 1.50)), which were reduced and turned statistically non-significant after adjustment for unfavorable parental behavioral factors. Conclusion Children of less-educated mothers were exposed to more health risks, fewer health-promoting factors, worse social support, and had higher medical care consumption than children with higher educated mothers. After adjustment for parental behavioral factors the excess odds of doctor's visits and in-hospital care among children with less-educated mothers were reduced. Improving children's health calls for policies targeting parents' health-related behaviors and social support.
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Affiliation(s)
- Elisabeth Mangrio
- Department of Clinical Sciences, Malmö, Social Medicine and Health Policy, Lund University, S-205 02 Malmö, Sweden
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Health care for immigrants in Europe: is there still consensus among country experts about principles of good practice? A Delphi study. BMC Public Health 2011; 11:699. [PMID: 21914194 PMCID: PMC3182934 DOI: 10.1186/1471-2458-11-699] [Citation(s) in RCA: 57] [Impact Index Per Article: 4.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/14/2011] [Accepted: 09/13/2011] [Indexed: 11/29/2022] Open
Abstract
Background European Member States are facing a challenge to provide accessible and effective health care services for immigrants. It remains unclear how best to achieve this and what characterises good practice in increasingly multicultural societies across Europe. This study assessed the views and values of professionals working in different health care contexts and in different European countries as to what constitutes good practice in health care for immigrants. Methods A total of 134 experts in 16 EU Member States participated in a three-round Delphi process. The experts represented four different fields: academia, Non-Governmental Organisations, policy-making and health care practice. For each country, the process aimed to produce a national consensus list of the most important factors characterising good practice in health care for migrants. Results The scoring procedures resulted in 10 to 16 factors being identified as the most important for each participating country. All 186 factors were aggregated into 9 themes: (1) easy and equal access to health care, (2) empowerment of migrants, (3) culturally sensitive health care services, (4) quality of care, (5) patient/health care provider communication, (6) respect towards migrants, (7) networking in and outside health services, (8) targeted outreach activities, and (9) availability of data about specificities in migrant health care and prevention. Although local political debate, level of immigration and the nature of local health care systems influenced the selection and rating of factors within each country, there was a broad European consensus on most factors. Yet, discordance remained both within countries, e.g. on the need for prioritising cultural differences, and between countries, e.g. on the need for more consistent governance of health care services for immigrants. Conclusions Experts across Europe asserted the right to culturally sensitive health care for all immigrants. There is a broad consensus among experts about the major principles of good practice that need to be implemented across Europe. However, there also is some disagreement both within and between countries on specific issues that require further research and debate.
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Hargreaves DS. Revised You're Welcome criteria and future developments in adolescent healthcare. J Clin Res Pediatr Endocrinol 2011; 3:43-50. [PMID: 21750630 PMCID: PMC3119439 DOI: 10.4274/jcrpe.v3i2.10] [Citation(s) in RCA: 20] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/11/2011] [Accepted: 05/13/2011] [Indexed: 12/27/2022] Open
Abstract
In 2011, the Department of Health (England) will publish revised You're Welcome criteria. This is the first comprehensive attempt to define good quality health services for young people (11-19 years) and provide a self-assessment tool applicable to all adolescent health services. It builds on a growing understanding of the distinctiveness and importance of adolescent health, and the demands placed on adolescent health services. This article reviews changing understandings of the nature of adolescence, including physical, psychological and social transition, evolving patterns of morbidity and mortality, adolescence as part of a life-course approach to health and health behaviours, and the specific needs of young people when using health services. We describe key features of the You're Welcome criteria and discuss the views of young people and professionals involved in revising them, as well as relevant published literature. Lastly, we discuss how the perspective of social paediatrics may be useful in guiding professionals towards a more holistic approach to adolescent care in the future.
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Affiliation(s)
- Dougal S Hargreaves
- Institute Child Health, General & Adolescent Paediatrics, London, United Kingdom.
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Ou L, Chen J, Hillman K. Health services utilisation disparities between English speaking and non-English speaking background Australian infants. BMC Public Health 2010; 10:182. [PMID: 20374663 PMCID: PMC2858120 DOI: 10.1186/1471-2458-10-182] [Citation(s) in RCA: 25] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/12/2009] [Accepted: 04/08/2010] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND To examine the differences in health services utilisation and the associated risk factors between infants from non-English speaking background (NESB) and English speaking background (ESB) within Australia. METHODS We analysed data from a national representative longitudinal study, the Longitudinal Study of Australian Children (LSAC) which started in 2004. We used survey logistic regression coupled with survey multiple linear regression to examine the factors associated with health services utilisation. RESULTS Similar health status was observed between the two groups. In comparison to ESB infants, NESB infants were significantly less likely to use the following health services: maternal and child health centres or help lines (odds ratio [OR] 0.56; 95% confidence intervals [CI], 0.40-0.79); maternal and child health nurse visits (OR 0.68; 95% CI, 0.49-0.95); general practitioners (GPs) (OR 0.58; 95% CI, 0.40-0.83); and hospital outpatient clinics (OR 0.54; 95% CI, 0.31-0.93). Multivariate analysis results showed that the disparities could not be fully explained by the socioeconomic status and language barriers. The association between English proficiency and the service utilised was absent once the NESB was taken into account. Maternal characteristics, family size and income, private health insurance and region of residence were the key factors associated with health services utilisation. CONCLUSIONS NESB infants accessed significantly less of the four most frequently used health services compared with ESB infants. Maternal characteristics and family socioeconomic status were linked to health services utilisation. The gaps in health services utilisation between NESB and ESB infants with regard to the use of maternal and child health centres or phone help, maternal and child health nurse visits, GPs and paediatricians require appropriate policy attentions and interventions.
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Affiliation(s)
- Lixin Ou
- Simpson Centre for Health Services Research, University of New South Wales, Sydney, Australia.
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Bissell P, Traulsen JM, Haugbølle LS. (6) Researching “race”, ethnicity and health: a critical review. INTERNATIONAL JOURNAL OF PHARMACY PRACTICE 2010. [DOI: 10.1211/0022357022151] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/31/2022]
Abstract
Abstract
In a previous article in this series, we posed some questions about the visibility of gender and the relevance of feminism for pharmacy practice research.1 Gendered distinctions are just one of the ways in which sociologists have attempted to categorise and explain the contours of the social world. Another obvious feature of modern societies is their “racialised” or multi-ethnic composition. Recognition of this has focused attention — if somewhat belatedly — on how to account for the health and illness experiences of ethnic or “racial” groups. In this paper, we describe and critique some of the health services and social science research which has explored these issues. Our focus has mainly been the UK literature. Our aim is to raise the profile of questions around “race” and ethnicity within pharmacy practice research, which have hitherto received scant attention.
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Affiliation(s)
- Paul Bissell
- Centre for Pharmacy, Health and Society, School of Pharmaceutical Sciences, University of Nottingham, England
| | | | - Lotte Stig Haugbølle
- Department of Social Pharmacy, The Danish University of Pharmaceutical Sciences, Copenhagen
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Beale N, Peart C, Kay H, Taylor G, Boyd A, Herrick D. 'ALSPAC' infant morbidity and Council Tax Band: doctor consultations are higher in lower bands. Eur J Public Health 2010; 20:403-8. [PMID: 20123685 DOI: 10.1093/eurpub/ckp211] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND The discrepancy between the occurrence of disease and the risk of consulting a doctor is well known, but whether or not it is socially governed is uncertain and could have important implications for primary care manpower and resource allocation. The aim of the study was to investigate whether (i) reported occurrence of common symptoms in infancy and (ii) consulting rates for those symptoms, are associated with socio-economic status as marked by Council Tax Valuation Band (CTVB). METHODS Compound cross-sectional analysis of data was obtained from sequential parental questionnaires. Data were taken from Avon Longitudinal Study of Parents and Children of over 14,000 responders from Avon county since 1991. Comparative analyses by CTVB and other covariables were carried out. RESULTS Final study group of nearly 10 000: diarrhoea, wheeze and accidental injuries moderately associated with CTVB but consulting behaviour for all morbidity bar earache strongly associated with CTVB, the lower the band the higher the clinical burden. CONCLUSION The children from more modest homes are more likely to be taken to a doctor for everyday symptoms: for infant morbidity, the lower the CTVB of home address, the higher the clinical burden for UK general practices.
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Affiliation(s)
- Norman Beale
- Northlands R & D Unit, The Old Stables, Blounts Court, Potterne, Devizes, Wiltshire, UK.
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Rob MI, Westbrook JI. The impact of ear, nose and throat surgery on children's subsequent use of health services: An 8-year cohort study. J Paediatr Child Health 2009; 45:747-53. [PMID: 19863705 DOI: 10.1111/j.1440-1754.2009.01606.x] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/30/2022]
Abstract
AIM High rates of paediatric ear, nose and throat (ENT) surgery persist. Little is known about its impact on health service utilisation. This study investigated whether children who had ENT surgery used more health services prior to surgery (excluding the perisurgery period), and, if so, whether surgery resulted in reduced utilisation. METHODS A retrospective population cohort study of health services use (measured by Medicare claims) by 6239 New South Wales children from the time of their birth in January 1990 until December 1997. We compared: (i) number of claims during the 8-year period for the 359 children who had privately-funded ENT surgery (tonsillectomy, myringotomy or adenoidectomy) with claims made by 5880 children who did not have ENT surgery; and (ii) among children who had surgery: we compared claims made before surgery with those made after surgery. RESULTS Children who had privately funded ENT surgery (comprising 59% of all paediatric ENT surgery) used significantly more services than other children in total (103.8 claims vs. 57.1 over 8 years) and in each three months of age from birth to eight years, including services for non-ENT-related conditions. Tonsillectomy resulted in a decline in claims, but not to the level of children who did not have surgery. Most children who had myringotomy continued high-level health services use following surgery. CONCLUSIONS High volume health services utilisation is a potential predictor of ENT surgery in this population. These results suggest a need to investigate non-clinical factors that influence service utilisation, which may include higher parental expectations or anxiety regarding their children's health.
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Affiliation(s)
- Marilyn I Rob
- The University of Sydney, Lidcombe, New South Wales, Australia
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Mladovsky P. A framework for analysing migrant health policies in Europe. Health Policy 2009; 93:55-63. [DOI: 10.1016/j.healthpol.2009.05.015] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.9] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/15/2008] [Revised: 05/21/2009] [Accepted: 05/25/2009] [Indexed: 10/20/2022]
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Uiters E, Devillé W, Foets M, Spreeuwenberg P, Groenewegen PP. Differences between immigrant and non-immigrant groups in the use of primary medical care; a systematic review. BMC Health Serv Res 2009; 9:76. [PMID: 19426567 PMCID: PMC2689181 DOI: 10.1186/1472-6963-9-76] [Citation(s) in RCA: 69] [Impact Index Per Article: 4.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/06/2008] [Accepted: 05/11/2009] [Indexed: 11/17/2022] Open
Abstract
Background Studies on differences between immigrant and non-immigrant groups in health care utilization vary with respect to the extent and direction of differences in use. Therefore, our study aimed to provide a systematic overview of the existing research on differences in primary care utilization between immigrant groups and the majority population. Methods For this review PubMed, PsycInfo, Cinahl, Sociofile, Web of Science and Current Contents were consulted. Study selection and quality assessment was performed using a predefined protocol by 2 reviewers independently of each other. Only original, quantitative, peer-reviewed papers were taken into account. To account for this hierarchical structure, logistic multilevel analyses were performed to examine the extent to which differences are found across countries and immigrant groups. Differences in primary care use were related to study characteristics, strength of the primary care system and methodological quality. Results A total of 37 studies from 7 countries met all inclusion criteria. Remarkably, studies performed within the US more often reported a significant lower use among immigrant groups as compared to the majority population than the other countries. As studies scored higher on methodological quality, the likelihood of reporting significant differences increased. Adjustment for health status and use of culture-/language-adjusted procedures during the data collection were negatively related to reporting significant differences in the studies. Conclusion Our review underlined the need for careful design in studies of differences in health care use between immigrant groups and the majority population. The results from studies concerning differences between immigrant and the majority population in primary health care use performed within the US might be interpreted as a reflection of a weaker primary care system in the US compared to Europe and Canada.
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Affiliation(s)
- Ellen Uiters
- NIVEL, Netherlands Institute for Health Services Research, Utrecht, The Netherlands.
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Spix C, Spallek J, Kaatsch P, Razum O, Zeeb H. Cancer survival among children of Turkish descent in Germany 1980-2005: a registry-based analysis. BMC Cancer 2008; 8:355. [PMID: 19040749 PMCID: PMC2628927 DOI: 10.1186/1471-2407-8-355] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/20/2008] [Accepted: 11/28/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND Little is known about the effect of migrant status on childhood cancer survival. We studied cancer survival among children of Turkish descent in the German Cancer Childhood Registry, one of the largest childhood cancer registries worldwide. METHODS We identified children of Turkish descent among cancer cases using a name-based approach. We compared 5-year survival probabilities of Turkish and other children in three time periods of diagnosis (1980-87, 1988-95, 1996-2005) using the Kaplan-Meier method and log-rank tests. RESULTS The 5-year survival probability for all cancers among 1774 cases of Turkish descent (4.76% of all 37.259 cases) was 76.9% compared to 77.6% in the comparison group (all other cases; p = 0.15). We found no age- or sex-specific survival differences (p-values between p = 0.18 and p = 0.90). For the period 1980-87, the 5-year survival probability among Turkish children with lymphoid leukaemia was significantly lower (62% versus 75.8%; p < 0.0001), this remains unexplained. For more recently diagnosed leukaemias, we saw no survival differences for Turkish and non-Turkish children. CONCLUSION Our results suggest that nowadays Turkish migrant status has no bearing on the outcome of childhood cancer therapies in Germany. The inclusion of currently more than 95% of all childhood cancer cases in standardised treatment protocols is likely to contribute to this finding.
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Affiliation(s)
- Claudia Spix
- German Childhood Cancer Registry (GCCR), Institute for Medical Biostatistics, Epidemiology and Informatics (IMBEI), Mainz, Germany.
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Lanting LC, Bootsma AH, Lamberts SWJ, Mackenbach JP, Joung IMA. Ethnic differences in internal medicine referrals and diagnosis in the Netherlands. BMC Public Health 2008; 8:287. [PMID: 18702812 PMCID: PMC2538538 DOI: 10.1186/1471-2458-8-287] [Citation(s) in RCA: 15] [Impact Index Per Article: 0.9] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/27/2007] [Accepted: 08/14/2008] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND As in other Western countries, the number of immigrants in the Netherlands is growing rapidly. In 1980 non-western immigrants constituted about 3% of the population, in 1990 it was 6% and currently it is more than 10%. Nearly half of the migrant population lives in the four major cities. In the municipality of Rotterdam 34% of the inhabitants are migrants. Health policy is based on the ideal that all inhabitants should have equal access to health care and this requires an efficient planning of health care resources, like staff and required time per patient. The aim of this study is to examine ethnic differences in the use of internal medicine outpatient care, specifically to examine ethnic differences in the reason for referral and diagnosis. METHODS We conducted a study with an open cohort design. We registered the ethnicity, sex, age, referral reasons, diagnosis and living area of all new patients that visited the internal medicine outpatient clinic of the Erasmus Medical Centre in Rotterdam (Erasmus MC) for one year (March 2002-2003). Additionally, we coded referrals according to the International Classification of Primary Care (ICPC) and categorised diagnosis according to the Diagnosis Treatment Combination (DTC). We analysed data by using Poisson regression and logistic regression. RESULTS All ethnic minority groups (Surinam, Turkish, Moroccan, Antillean/Aruban and Cape Verdean immigrants) living in Rotterdam municipality, make significantly more use of the outpatient clinic than native Dutch people (relative risk versus native Dutch people was 1.83, 1.97, 1.79, 1.65 and 1.88, respectively). Immigrant patients are more likely to be referred for analysis and treatment of 'gastro-intestinal signs & symptoms' and were less often referred for 'indefinite, general signs'. Ethnic minorities were more frequently diagnosed with 'Liver diseases', and less often with 'Analysis without diagnosis'. The increased use of the outpatient facilities seems to be restricted to first-generation immigrants, and is mainly based on a higher risk of being referred with 'gastro-intestinal signs & symptoms'. CONCLUSION These findings demonstrate substantial ethnic differences in the use of the outpatient care facilities. Ethnic differences may decrease in the future when the proportion of first-generation immigrants decreases. The increased use of outpatient health care seems to be related to ethnic background and the generation of the immigrants rather than to socio-economic status. Further study is needed to establish this.
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Affiliation(s)
- Loes C Lanting
- Erasmus MC, Department of Public Health, Rotterdam, The Netherlands
| | - Aart H Bootsma
- Erasmus MC, Department of Internal Medicine, Rotterdam, The Netherlands
| | | | | | - Inez MA Joung
- Erasmus MC, Department of Public Health, Rotterdam, The Netherlands
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Väänänen MH, Lyles A, Airaksinen M. Finnish immigrants' experience of community pharmacy services in Spain: an example of a developing E.U. issue. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2008; 38:293-312. [PMID: 18459282 DOI: 10.2190/hs.38.2.e] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Emigration within the European Union has increased, especially toward southern countries. This places complex demands on health care providers and community pharmacists, yet there is no E.U. policy that harmonizes health care services and pharmacy practice across member countries. This exploratory study examined immigrants' experiences with community pharmacy services. A survey of 1000 Finnish immigrants living in Spain's Costa del Sol region was performed in 2002, using a questionnaire that included structured and open-ended questions. Respondents were mostly satisfied with pharmacy services; however, some services had higher medication safety risks-related to medication counseling (for prescription and nonprescription medicines) and obtaining some prescription drugs without a prescription-due mainly to lack of a common language. Pharmacy services in the European Union may not provide adequate assurances of medication safety for immigrants. Consistent E.U.-wide minimum pharmacy practice standards for immigrant populations are needed.
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Stojanović-Spehar S, Blazeković-Milaković S, Bergman-Marković B, Matijasević I. Preschool children as frequent attenders in primary health care in Croatia: retrospective study. Croat Med J 2008; 48:852-9. [PMID: 18074420 DOI: 10.3325/cmj.2007.6.852] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/05/2022] Open
Abstract
AIM To define predictive factors for frequent attenders among preschool children in primary health care and investigate the association between socioeconomic factors and medical factors, as well as the reasons for child's appointment in the physician's office. METHODS This retrospective study was conducted in 7 primary health care offices (6 family physician practices and 1 pediatric practice) in Zagreb, Croatia. The study included 964 preschool children from 1-6 years who visited these practices during 2005. Children in the highest quartile of consultation frequency (n=255) were defined as frequent attenders, while the children in the lowest quartile of consultation frequency (n=302) represented the control group (non-frequent attenders). We collected data on consultation rate, socioeconomic factors, health care providers, prescriptions and referrals, symptoms, and diagnoses. Association of the parameters and the frequency of consultations was investigated by logistic regression analysis. RESULTS Frequent attenders sought for consultations 10 times per year (median, range 4-26), and they had the following characteristics: had 2-3 years, attended day care center, were treated by a pediatrician, and received more prescriptions and referrals. Their major complaints were: cough, nasal discharge, rash, fever, difficult breathing, earache, digestive problems, throat soreness, and injuries. Logistic regression analysis showed significant association between frequent attendance and age of 2-3, the symptom of nasal discharge, and diagnoses of infectious and parasitic diseases, middle ear diseases, respiratory system diseases, and skin and subcutaneous tissue diseases. CONCLUSION Socioeconomic characteristics, symptoms, and diagnoses were important predictors for defining preschool frequent attenders in primary health care.
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Vingilis E, Wade T, Seeley J. Predictors of adolescent health care utilization. J Adolesc 2008; 30:773-800. [PMID: 17141307 DOI: 10.1016/j.adolescence.2006.10.001] [Citation(s) in RCA: 59] [Impact Index Per Article: 3.7] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/29/2005] [Revised: 08/25/2006] [Accepted: 10/03/2006] [Indexed: 11/21/2022]
Abstract
This study, using Andersen's health care utilization model, examined how predisposing characteristics, enabling resources, need, personal health practices, and psychological factors influence health care utilization using a nationally representative, longitudinal sample of Canadian adolescents. Second, this study examined whether this process varies across physicians, non-physicians, and dentists. The results indicate that need and psychological factors were strong determinants of utilization. Predisposing factors were associated with utilization, although there were few enabling resources. Differences were found for utilization of different services. Females, adolescents who were older, from single parent families, with lower self-rated health, lower health status, higher disability, higher distress and involved in health compromizing practices were more likely to visit physicians and non-physicians. Higher dentist utilization was related to higher income, single parent status, being younger, having lower health status, and higher disability. Predisposing and enabling factors were not mediators of utilization. The findings suggest that health care providers could be an important source of counselling on psychological, lifestyle issues, and physical concerns.
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Affiliation(s)
- Evelyn Vingilis
- Population and Community Health Unit, Family Medicine, Schulich School of Medicine and Dentistry, University of Western Ontario, Dr. Don Rix Clinical Skills Learning Building, Room 2711, London, Ont., Canada N6A 5C1.
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Nikièma B, Zunzunegui MV, Séguin L, Gauvin L, Potvin L. Poverty and cumulative hospitalization in infancy and early childhood in the Quebec birth cohort: a puzzling pattern of association. Matern Child Health J 2007; 12:534-44. [PMID: 17690962 DOI: 10.1007/s10995-007-0259-3] [Citation(s) in RCA: 8] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/20/2006] [Accepted: 07/19/2007] [Indexed: 10/23/2022]
Abstract
OBJECTIVE We anticipate a negative gradient between income and hospitalization, since income is positively associated with good health. In a previous cross-sectional study, we reported an unexpected pattern of association between poverty and hospitalization for 5-month-old infants in Quebec. This study re-examines the poverty-hospitalization relationship within a longitudinal population study of the same birth cohort aged 3.5 years. METHOD Life table analysis, multivariable proportional hazard regression, and multivariable logistic regression were performed on data from the first four waves of the Quebec Longitudinal Study of Child Development (QLSCD). Probabilities of hospitalization were estimated by poverty status. The hazard ratios (HR) (Cox-regression) for duration of poverty (frequency of insufficient income) and severity of poverty (combining frequency and level of income insufficiency) were estimated, controlling for predisposing, enabling, and need determinants of hospitalization. RESULTS At 3.5 years, 31% of children had been hospitalized at least once. Compared with children whose families had constantly sufficient income, children with intermittent poverty exhibited higher hospitalization risks (HR = 1.30; 95%CI = 1.04-1.64) while chronically poor children exhibited comparable hospitalization hazards (HR = 0.97; 95%CI = 0.73-1.27). Hospitalization risks for children in the severest poverty group resembled that of the non-poor group (HR = 0.99; 95%CI = 0.66-1.49), while children in less severely poor families were more likely to be hospitalized (HR = 1.26; 95%CI = 0.99-1.60). CONCLUSION Results suggest hospitalization barriers for children living in chronic and severe poverty. If these barriers exist in a universal health care system, they may originate with primary care service organization or hospital care referral procedures.
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Affiliation(s)
- Béatrice Nikièma
- Groupe de Recherche Interdisciplinaire en Santé (GRIS), Département de Médecine Sociale et Préventive, Faculté de Médecine, Université de Montréal, Succursale Centre-Ville, CP 6128, Montreal, QC, Canada, H3C 3J7.
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Hanratty B, Zhang T, Whitehead M. How close have universal health systems come to achieving equity in use of curative services? A systematic review. INTERNATIONAL JOURNAL OF HEALTH SERVICES 2007; 37:89-109. [PMID: 17436987 DOI: 10.2190/ttx2-3572-ul81-62w7] [Citation(s) in RCA: 65] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 11/22/2022]
Abstract
Most governments in established market economies have developed universal systems of health care, but these are being increasingly threatened by widespread health sector reforms. Hence, it is more important than ever to monitor the effects of policy changes on the ability of universal systems to achieve their equity goals. This article provides evidence for such monitoring. The authors present the results of a systematic review of equity in use of curative health services in universal systems, together with a critical appraisal of the essential components of studies to address this question. Of the 79 studies identified that addressed the review question, only 26 met the inclusion criteria and adjusted for differential health need across socioeconomic groups. The authors found a pro-rich bias in use of specialist hospital services and a reasonably equitable access to primary health care by different socioeconomic groups. There was a wide inter-study variation in the difference in utilization rates between people of high and low socioeconomic groups. Improvements are needed in the way that equity in universal systems is monitored, with particular attention to how "need" is defined and to the impact on patients of indirect costs.
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Einhorn R, Eekhof JAH, Engelberts AC, Groeneveld Y, Verkerk PH, Wit JM. Referral patterns between the child health service, general practitioners, and secondary healthcare: A prospective descriptive study in the Netherlands. Eur J Gen Pract 2007; 13:225-30. [DOI: 10.1080/13814780701814853] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/22/2022] Open
Affiliation(s)
- Rubin Einhorn
- Department of Public Health and Primary Care, , Leiden, the Netherlands
| | - Just A. H. Eekhof
- Department of Public Health and Primary Care, , Leiden, the Netherlands
| | - Adele C. Engelberts
- Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands
| | - Ymte Groeneveld
- Department of Public Health and Primary Care, , Leiden, the Netherlands
| | | | - Jan M. Wit
- Department of Paediatrics, Leiden University Medical Centre, Leiden, the Netherlands
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Assessment of health care needs and utilization in a mixed public-private system: the case of the Athens area. BMC Health Serv Res 2006; 6:146. [PMID: 17081303 PMCID: PMC1635556 DOI: 10.1186/1472-6963-6-146] [Citation(s) in RCA: 56] [Impact Index Per Article: 3.1] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/27/2006] [Accepted: 11/02/2006] [Indexed: 11/10/2022] Open
Abstract
Background Given the public-private mix of the Greek health system, the purpose of this study was to assess whether variations in the utilisation of health services, both primary and inpatient care, were associated with underlying health care needs and/or various socio-economic factors. Methods Data was obtained from a representative sample (N = 1426) residing in the broader Athens area (response rate 70.6%). Perceived health-related quality of life (HRQOL), as measured by the physical and mental summary component scores of the SF-36 Health Survey, was used as a proxy of health care need. Health care utilization was measured by a) last-month visits to public sector physicians, b) last-month visits to private sector physicians, c) last-year visits to hospital emergency departments and d) last-year hospital admissions. Statistical analysis involved the implementation of logistic regression models. Results Health care need was the factor most strongly associated with all measures of health care utilization, except for visits to public physicians. Women, elderly, less wealthy and individuals of lower physical health status visited physicians contracted to their insurance fund (public sector). Women, well educated and those once again of lower physical health status were more likely to visit private providers. Visits to hospital emergency departments and hospital admissions were related to need and no socio-economic factor was related to the use of those types of care. Conclusion This study has demonstrated a positive relationship between health care need and utilisation of health services within a mixed public-private health care system. Concurrently, interesting differences are evident in the utilization of various types of services. The results have potential implications in health policy-making and particularly in the proper allocation of scarce health resources.
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Hart CN, Drotar D, Gori A, Lewin L. Enhancing parent-provider communication in ambulatory pediatric practice. PATIENT EDUCATION AND COUNSELING 2006; 63:38-46. [PMID: 16242291 DOI: 10.1016/j.pec.2005.08.007] [Citation(s) in RCA: 23] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 02/09/2005] [Revised: 08/05/2005] [Accepted: 08/19/2005] [Indexed: 05/03/2023]
Abstract
OBJECTIVE To address the need for interventions to enhance parent-provider communication, the present study evaluated the effectiveness of a brief intervention to enhance interpersonal communication skills by pediatric and internal medicine/pediatric residents with parents of children seen in ambulatory practice. METHODS In a within-subjects, repeated measures research design, residents (N=28) participated in a 1-112h intervention designed to increase the use of effective communication skills with their patients' families (N=92). Three pediatric visits (one prior to and two following the intervention) were audio-taped and coded using Roter's Interaction Analysis System. Parents' perceptions of residents' communication skills and satisfaction with care were gathered. RESULTS Residents used more effective interpersonal communication skills following the intervention (p<.05). Parent satisfaction with care also increased (p<.01) with parents reporting greater satisfaction with distress relief (p=.01) and communication following the intervention (p=.05). However, parents' perceptions of resident communication did not change over time. CONCLUSION These findings suggest that a relatively brief intervention shows promise in improving the quality of care provided within a pediatric ambulatory care setting. PRACTICE IMPLICATIONS Training residents to increase their use of praise, empathy, and collaboration with families can be done within a brief intervention and may be associated with increased parental satisfaction with care.
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Affiliation(s)
- Chantelle Nobile Hart
- Department of Psychology, Case University Medical School & Rainbow Babies & Children's Hospital, USA.
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Virtanen JI, Berntsson LT, Lahelma E, Köhler L. Children's use of general practitioner services in the five Nordic countries. J Epidemiol Community Health 2006; 60:162-7. [PMID: 16415268 PMCID: PMC2566148 DOI: 10.1136/jech.2005.042390] [Citation(s) in RCA: 7] [Impact Index Per Article: 0.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/03/2022]
Abstract
OBJECTIVE To compare socioeconomic, sociodemographic, and living area differences in children's use of GP services in five Nordic countries from the 1980s to the 1990s and to analyse trends during the period. DESIGN Cross sectional population surveys using random samples comprising 3000 children aged 2-17 years were conducted in 1984 and 1996 in five Nordic countries. Time trends in use of GP services were studied in each country by age, sex, parents' highest level of education, and living area. SETTING Five Nordic countries, Denmark, Finland, Iceland, Norway, and Sweden in 1984 and 1996. PARTICIPANTS A total sample of 15 000 children aged 2-17 years. Altogether 3000 children were selected at random from the national population registers of the national bureaus of statistics in each country. MAIN OUTCOME Health services utilisation on the basis of responses to a questionnaire item asking whether the parents had consulted a GP with regard to their children's health during the previous three months. MAIN RESULTS The prevalence of children's utilisation of GP services varied from 14% in 1984 in Sweden to 28% in 1996 in Iceland. A clear time trend towards increasing utilisation of GP services (p<0.05) was found in all countries except in Denmark. Odds ratios for time trends (1984 = 1.00) varied from 1.22 (1.02 to 1.46) in Sweden to 1.92 (1.62 to 2.30) in Norway. After adjusting for independent variables, a statistically borderline significant declining utilisation trend (OR = 0.85 (0.70 to 1.03)) was found for Denmark. CONCLUSION Children's use of GP services has increased significantly in four of the five Nordic countries.
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Affiliation(s)
- J I Virtanen
- Institute of DentistryPO Box 41, University of Helsinki, FIN-00014 Helsinki, Finland.
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Johnston JM, Leung G, Saing H, Kwok KO, Ho LM, Wong IOL, Tin KYK. Non-attendance and effective equity of access at four public specialist outpatient centers in Hong Kong. Soc Sci Med 2006; 62:2551-64. [PMID: 16305815 DOI: 10.1016/j.socscimed.2005.10.036] [Citation(s) in RCA: 10] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/05/2004] [Indexed: 10/25/2022]
Abstract
This study tests whether socio-economic status (SES), at either the individual or ecologic levels, exerts a direct impact on non-attendance or an indirect impact on attendance through longer waiting time for appointments and/or doctor-shopping behavior at four public specialist outpatient centers in Hong Kong. We collected information through three main sources, namely patients' referral letters, telephone interviews with both open- and closed-ended questions (e.g. doctor-shopping data) and hospital administrative databases from a total of 6495 attenders and non-attenders enrolled from July 2000 through October 2001. Individual-level SES was measured by education, occupation and monthly household income. Tertiary planning unit (TPU)-level SES data consisted of proportion unemployed, proportion with tertiary education, median income and Gini coefficient. Direct effects of SES on non-attendance were examined by logistic regression. Indirect contributions mediated through waiting time and doctor-shopping were analyzed by structural equation modeling. We found that SES, at the individual or ecologic level, did not exert a direct effect on non-attendance. Instead, TPU-level SES contributed positively to waiting time (beta=0.06+/-0.03, p=0.048), i.e. worse-off neighborhoods (and those with greater income inequality) had a shorter waiting time. Individual-level SES was also directly associated with the likelihood of doctor-shopping (beta=0.16+/-0.02, p<0.001), i.e. the poor were less likely to doctor-shop. Both waiting time (beta=0.12+/-0.02, p<0.001) and doctor-shopping (beta=0.37+/-0.02, p<0.001) were significantly related to non-attendance. Our findings suggest a highly equitable specialist ambulatory care public system in Hong Kong. Health care resources are appropriately targeted at the socially indigent, and the poor are not discriminated against and pushed to seek alternative sources of care by the system. These results should be confirmed using a prospective design.
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Affiliation(s)
- Janice M Johnston
- Department of Community Medicine, University of Hong Kong, Hong Kong
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Uiters E, Devillé WLJM, Foets M, Groenewegen PP. Use of health care services by ethnic minorities in The Netherlands: do patterns differ? Eur J Public Health 2006; 16:388-93. [PMID: 16641158 DOI: 10.1093/eurpub/ckl040] [Citation(s) in RCA: 78] [Impact Index Per Article: 4.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
BACKGROUND This article examines the nature of ethnic differences in health care utilisation by assessing patterns of use in addition to single service utilisation. METHODS Data were derived from the Second Dutch National Survey of General Practice. A nationally representative sample of 104 general practices participated in this survey. Data on health and health service utilisation were collected through face-to-face interviews. Based on a random sample per practice, a total of 12 699 Dutch-speaking people were interviewed, regardless of ethnic background. An additional study among a random sample of 1339 people from the four largest minority groups in The Netherlands was conducted. These four groups comprised people from Turkey, Surinam, Morocco, and The Netherlands Antilles. Multilevel analyses were performed to investigate ethnic differences in health care utilisation, adjusting for socio-economic status, health status, and level of urbanisation. RESULTS Differences in utilisation patterns were particularly marked for people with a Moroccan, Turkish, or Antillean background. Compared to the other groups, Surinamese were more likely to have had contact with any professional health care service. No evidence was found that the gate keeping role of general practitioners in The Netherlands functions less effectively among the ethnic minority groups as compared to the indigenous population. CONCLUSION The analysis of patterns of utilisation proved to supply useful information concerning the relationship between ethnicity and use of health care services in addition to figures concerning single service use only.
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Affiliation(s)
- Ellen Uiters
- Netherlands Institute for Health Services Research (NIVEL), Utrecht, The Netherlands
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Harmsen JAM, Bernsen RMD, Meeuwesen L, Pinto D, Bruijnzeels MA. Cultural Dissimilarities in General Practice: Development and Validation of a Patient’s Cultural Background Scale. J Immigr Minor Health 2006; 8:115-24. [PMID: 16649127 DOI: 10.1007/s10903-006-8520-6] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2022]
Abstract
Due to increased migration physicians encounter more communication difficulties due to poor language proficiency and different culturally defined views about illness. This study aimed to develop and validate a 'patient's cultural background scale' in order to classify patients based on culturally conditioned norms instead of on ethnicity. A total of 986 patients from 38 multi-ethnic general practices were included. From a list of 36 questions, non-contributing and non-consistent questions were deleted and from the remaining questions the scale was constructed by principal component analysis. Comparing the scale with two other methods of construction assessed internal validity. Comparing the found dimensions with known dimensions from literature assessed the construct validity. Criterion validity was determined by comparing the patient's score with criteria assumed or known to have relationship with cultural background. Criterion validity was reasonably good but poor for income. A valid patient's cultural background scale was developed, for use in large-scale quantitative studies.
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Affiliation(s)
- J A M Harmsen
- Department of Health Policy and Management, Erasmus MC, University Medical Center Rotterdam, Netherlands.
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Stirbu I, Kunst AE, Bos V, Mackenbach JP. Differences in avoidable mortality between migrants and the native Dutch in The Netherlands. BMC Public Health 2006; 6:78. [PMID: 16566833 PMCID: PMC1435889 DOI: 10.1186/1471-2458-6-78] [Citation(s) in RCA: 81] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/29/2005] [Accepted: 03/27/2006] [Indexed: 12/16/2022] Open
Abstract
Background The quality of the healthcare system and its role in influencing mortality of migrant groups can be explored by examining ethnic variations in 'avoidable' mortality. This study investigates the association between the level of mortality from 'avoidable' causes and ethnic origin in the Netherlands and identifies social factors that contribute to this association. Methods Data were obtained from cause of death and population registries in the period 1995–2000. We compared mortality rates for selected 'avoidable' conditions for Turkish, Moroccan, Surinamese and Antillean/Aruban groups to native Dutch. Results We found slightly elevated risk in total 'avoidable' mortality for migrant populations (RR = 1.13). Higher risks of death among migrants were observed from almost all infectious diseases (most RR > 3.00) and several chronic conditions including asthma, diabetes and cerebro-vascular disorders (most RR > 1.70). Migrant women experienced a higher risk of death from maternity-related conditions (RR = 3.37). Surinamese and Antillean/Aruban population had a higher mortality risk (RR = 1.65 and 1.31 respectively), while Turkish and Moroccans experienced a lower risk of death (RR = 0.93 and 0.77 respectively) from all 'avoidable' conditions compared to native Dutch. Control for demographic and socioeconomic factors explained a substantial part of ethnic differences in 'avoidable' mortality. Conclusion Compared to the native Dutch population, total 'avoidable' mortality was slightly elevated for all migrants combined. Mortality risks varied greatly by cause of death and ethnic origin. The substantial differences in mortality for a few 'avoidable' conditions suggest opportunities for quality improvement within specific areas of the healthcare system targeted to disadvantaged groups.
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Affiliation(s)
- I Stirbu
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - AE Kunst
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - V Bos
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
| | - JP Mackenbach
- Department of Public Health, Erasmus MC, University Medical Center Rotterdam, P.O. Box 1738, 3000 DR Rotterdam, The Netherlands
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Petrou S, Kupek E. Socioeconomic differences in childhood hospital inpatient service utilisation and costs: prospective cohort study. J Epidemiol Community Health 2005; 59:591-7. [PMID: 15965144 PMCID: PMC1757074 DOI: 10.1136/jech.2004.025395] [Citation(s) in RCA: 27] [Impact Index Per Article: 1.4] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/20/2022]
Abstract
STUDY OBJECTIVE To examine the association between socioeconomic position at the time of birth and the use and cost of hospital inpatient services during the first 10 years of life. DESIGN Analysis of a database of linked birth registrations, hospital records, and death certificates. Associations between the social class of the head of household and hospital inpatient service utilisation and costs during the first 10 years of life were analysed using multilevel multiple regression modelling. PARTICIPANTS AND SETTING All 117 212 children born to women who both lived and delivered in hospital in Oxfordshire or West Berkshire, southern England, during the period 1 January 1979 to 31 December 1988. MAIN RESULTS The study showed that children born into social classes II, III-NM, III-M, IV, and V were more likely to be admitted to hospital, spend longer in hospital overall, and generate greater hospital costs than children born into social class I. The adjusted effect regarding hospital inpatient admissions, days, and costs was 1.27 (95% CI: 1.26, 1.27), 1.20 (1.19, 1.21), and 1.50 (1.49, 1.53), respectively, for children born into social class V when compared with children born into social class I. The impact of social class on hospital inpatient admissions, days, and costs was most acutely felt during years 3-10 of life as compared with the first two years of life. CONCLUSIONS Health service decision makers need to be alert to the adverse sequelae that might result from socioeconomic disadvantage when planning health services for children. Particular attention should be paid to targeting deprived populations with prevention interventions that are known to be effective.
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Affiliation(s)
- Stavros Petrou
- National Perinatal Epidemiology Unit, University of Oxford (Old Road Campus), Old Road, Headington, Oxford OX3 7LF, UK.
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Ward AM, de Klerk N, Pritchard D, Firth M, Holman CDJ. Correlations of siblings' and mothers' utilisation of primary and hospital health care: a record linkage study in Western Australia. Soc Sci Med 2005; 62:1341-8. [PMID: 16242824 DOI: 10.1016/j.socscimed.2005.08.027] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/25/2004] [Accepted: 08/02/2005] [Indexed: 10/25/2022]
Abstract
A relationship between maternal and child use of general practitioners (GPs) has been shown to exist for some time, however, the reasons for this relationship are not clear and the extent to which this relationship extends to tertiary care is unknown. The aim of this study was to examine the relationships between the utilisation of health care by siblings and mothers over a 14 year period. A retrospective cohort study of 756 mothers and their 1494 children up to age 14 years was conducted in three general practices in Western Australia. Medicare claims and hospital morbidity records for 1984-1997 were linked using deterministic and probabilistic matching. Generalised Estimating Equations and correlations were used to examine the relationships between the utilisation of primary and hospital health care by family members. Significant correlations were found between hospital admissions of all participants and their GP visits, specialist visits, pathology and diagnostic imaging combined and hospital length of stay. There was a strong association between siblings' use of GPs. A child's rate of GP attendance increased with that of its mother. There was a weak but significant relationship between siblings' use of hospitals, and a child's hospital admission rate increased with that of its mother. It is concluded that there is a strong relationship between siblings' use of GPs and a weaker but still significant association between the hospital admissions of siblings. As expected, there were strong associations between mother and child visits to GPs. There was also an association between a mother's use of hospital and that of her children. This finding reduces the plausibility that the relationships found between utilisation of health care by siblings and mothers can be explained entirely by behavioural factors, and suggests the presence of intergenerational correlation of morbidity.
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Affiliation(s)
- Alison M Ward
- Department of Primary Health Care, University of Oxford, Rosemary Rue Building, Old Road Campus, Headington, Oxford, OX3 7LF, United Kingdom.
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