<p>Vårt syfte med denna studie är att få ökad kunskap om och förståelse för vilka upplevelser och erfarenheter de äldre själva har fått i samband med förebyggande hembesök. Metoden vi använt oss av är en kvalitativ intervjuundersökning med halvstrukturerade frågor. Studien genomfördes under hösten 2009 och sex äldre intervjuades.  Av dessa respondenter var det en man och fem kvinnor alla födda 1924.Resultatet visar tydligt att de äldre upplever att det förebyggande arbetet är mycket värdefullt för deras åldrande och vill se detta arbete fortskrida. Alla respondenter påpekade att besöket var en positiv händelse i deras liv och de fick en känsla av att någon bryr sig om dem och vet att de finns.De äldre som tackat ja till att få förebyggande hembesök påtalade att de nu vet vart de ska vända sig den dagen de är i behov av hjälp. De har med hjälp av kommunen fått information och vägledning för att klara av framtida händelser.Vår slutsats är att kommunerna med det förebyggande hembesöket som redskap hjälper de äldre att skapa bra förutsättningar för att bibehålla ett bra åldrande och fortsatt god livskvalitet.</p> / <p>The purpose of our study is to increase our knowledge of and understanding for how elderly may experience preventive home visits.To reach our purpose we have conducted qualitative interviews containing half structured questions. All of our respondents were born in 1924. Six interviews in total, with one male and five females were carried out in the autumn of 2009.The result of the study clearly indicates that the preventive work is appreciated and valuable to the elderly. They wish this kind of home visits to be continued. All respondents claimed that the visit was a positive event in their lives and they got the feeling that someone cares about them and know they exist.The elderly who accepted to receive preventive home visits claimed that they now know where to turn the day they are in need of help. They have with the municipality received information and guidance for coping with future events.Our conclusion is that preventive home care activities give elderly better conditions for satisfactory ageing and for retaining a good quality of life.</p>

Aims: To introduce the concepts “quality assurance”, “rational drug prescribing” and “outreach visits” in general practice in Storstrøm County, Denmark and study the effect of unsolicited mailed feedback and outreach visits on drug prescribing. Methods: The first step was to generate standardised charts displaying the county variations of drug volume prescribing within 13 major drug groups at the second ATC-level. The charts were mailed unsolicited to the 94 general practices in the county. Each practice could identify its position within the county prescribing variation. This procedure was repeated every six months from 1992 to 1998. In 1998 annual outreach visit were offered to general practice and 88 of 94 practices accepted. The awareness of prescribing profiles was monitored during the visits in 1998 and 1999. In 2000 a randomised controlled trial allocating practices into two parallel arms was launched. Effects of two desk guides on rational drug prescribing promoted during outreach visits were evaluated. Results: During the period of mailed feedback, there was a large variation in drug prescribing volumes between practices but little within-practice variation over time. No significant change was detected. Practitioners’ assessment of their own prescribing profiles improved significantly through the outreach visits. The prescribing of antibiotics was significantly affected by the desk guide whereas no effect was detected on the prescribing of non-steroid anti-inflammatory drugs. Conclusions: Semi-annually mailed feedback over a seven-year period had no significant effect on prescribing volumes or variations in prescribing volumes, but some effect on the practitioners’ awareness of their own prescribing profiles. Outreach visits significantly improved the awareness. A randomised controlled trial using outreach visits combined with a simple desk guide affected the prescribing of some antibacterial drugs as intended whereas the similar intervention had no detectable effect on the prescribing of non-steroid anti-inflammatory drugs.

Vårt syfte med denna studie är att få ökad kunskap om och förståelse för vilka upplevelser och erfarenheter de äldre själva har fått i samband med förebyggande hembesök. Metoden vi använt oss av är en kvalitativ intervjuundersökning med halvstrukturerade frågor. Studien genomfördes under hösten 2009 och sex äldre intervjuades.  Av dessa respondenter var det en man och fem kvinnor alla födda 1924.Resultatet visar tydligt att de äldre upplever att det förebyggande arbetet är mycket värdefullt för deras åldrande och vill se detta arbete fortskrida. Alla respondenter påpekade att besöket var en positiv händelse i deras liv och de fick en känsla av att någon bryr sig om dem och vet att de finns.De äldre som tackat ja till att få förebyggande hembesök påtalade att de nu vet vart de ska vända sig den dagen de är i behov av hjälp. De har med hjälp av kommunen fått information och vägledning för att klara av framtida händelser.Vår slutsats är att kommunerna med det förebyggande hembesöket som redskap hjälper de äldre att skapa bra förutsättningar för att bibehålla ett bra åldrande och fortsatt god livskvalitet. / The purpose of our study is to increase our knowledge of and understanding for how elderly may experience preventive home visits.To reach our purpose we have conducted qualitative interviews containing half structured questions. All of our respondents were born in 1924. Six interviews in total, with one male and five females were carried out in the autumn of 2009.The result of the study clearly indicates that the preventive work is appreciated and valuable to the elderly. They wish this kind of home visits to be continued. All respondents claimed that the visit was a positive event in their lives and they got the feeling that someone cares about them and know they exist.The elderly who accepted to receive preventive home visits claimed that they now know where to turn the day they are in need of help. They have with the municipality received information and guidance for coping with future events.Our conclusion is that preventive home care activities give elderly better conditions for satisfactory ageing and for retaining a good quality of life.

<p>What are the effects of political information on public opinion, political participation, and electoral outcomes? In this dissertation, I address these questions and investigate the ways that people acquire and incorporate information based on their levels of political knowledge and attentiveness. I examine the effects of political information among three groups whom we would expect to learn differently: those people with little knowledge or interest in politics; the potentially interested who possess some, but not much, knowledge; and the attentive experts. </p><p>In my first chapter, I look at the effects of information on people with little or no knowledge of politics by asking, "Do candidate visits affect voting decisions and candidate evaluations?" I link survey data with the location and topics of all speeches given by George W. Bush and John Kerry in 2004 to empirically test the conventional wisdom that candidate appearances change electoral outcomes. I find that candidate visits do provide information to voters and that those effects are conditioned on consumption of local media. In my second chapter, I look at people with some knowledge of politics: college students. I ask, "How does the information that students 'incidentally' encounter in electronic social networks like Facebook.com shape their knowledge of current political events and their participation?" To answer these questions, I conducted a survey with an embedded experiment. I find that students do learn from Facebook, though the effects are small and vary across groups. My third chapter investigates the ways that the politically attentive incorporate information by asking, "What campaign information matters? Which campaign events are actually informative?" I develop a new measure of information flow using data from a political prediction market and a Bayesian estimation technique that adapts models from the economics literature. This measure offers a reliable way to describe the importance of campaign events that does not suffer from either post hoc judgments or reports from the principals involved in the campaign. Together, these projects address the consequences of political information in contemporary politics.</p> / Dissertation

BACKGROUND: Streptococcus pneumoniae is the primary causative agent of pneumonia in older adults. Vaccination is the only tool to protect against pneumococcal infection; however, vaccination rates remain far below the Healthy People 2010 objective of 90% coverage. The number one reason for such low rates is attributed to controversy over the protective efficacy of the vaccine in preventing nonbacteremic pneumonia (eg, community-acquired pneumonia [CAP]). OBJECTIVES: The primary objectives of this study were to assess the incidence of pneumonia, pneumonia requiring hospitalization, and pneumonia hospitalization costs. METHODS: In this retrospective cohort study of Medicare beneficiaries aged 65 years in 2003, subjects were selected based on exposure status. Exposure was defined as receipt of the 23-valent pneumococcal polysaccharide vaccine (PPV23). Vaccinated persons were then matched 1:1 on gender and the presence of any comorbidity to unvaccinated persons. Subjects were followed up for 1 year (January 1, 2004 through December 31, 2004). The primary outcomes were pneumonia, pneumonia requiring hospitalization, and hospitalization costs. Mantel-Haenszel chi-square or logit was used to estimate the relative risk (RR) associated with vaccination and each outcome and Proc Ttest was used to test the difference between mean hospital costs of the vaccinated and non-vaccinated. RESULTS: During the follow-up period, 443 patients were diagnosed with pneumonia; 266 had previously been vaccinated and 177 had no documented receipt of prior vaccination. Results of the Chi-square analysis revealed a significant association between vaccination and the risk of pneumonia, as the vaccinated were 50% more likely to develop pneumonia than were the non-vaccinated (Adjusted RR: 1.50; 95% CI: 1.25, 1.81). Approximately 67% of patients diagnosed with pneumonia required hospitalization; of which, 183 were previously vaccinated and 115 had no documented receipt of prior vaccination. There was no association between vaccination and risk of pneumonia requiring hospitalization (P value 0.4001). However, the vaccine was associated with a significant reduction in hospital costs (P value 0.004). CONCLUSIONS: The results of this study suggest that use of the vaccine may be associated with cost savings due to a reduction in hospitalization.

The question of whether or not campaigns have an impact on vote choice and mobilization has been debated by a number of scholars. In this dissertation, I explore this question using data from presidential nomination elections, as I argue this setting allows us to better understand campaign effects than the general election. Due to the intra-party nature of nomination contests, voters are not able to rely on partisanship in making their decision among candidates. Instead voters need to use some other source of information in making their decisions about 1) whether or not to vote and 2) which candidate to vote for. I explore these two decisions in depth in my dissertation, focusing mainly on the effect visits have on both. I have compiled data on both the timing and location of all of the candidate visits throughout the presidential nominating contests of 2008, across both the invisible primary and election year campaigns. Using this unique dataset, I explore the different ways in which state visits affect presidential nomination outcomes. Specifically, I investigate the strategy behind the visits, whether or not visits increase turnout, and how visits affect vote choice. By examining these different aspects of nominating campaigns, I am able to address a number of different literatures and theories, including those focused on candidate strategy, presidential nominations, political communication, and whether or not campaigns matter.

BACKGROUND: A growing body of research has suggested that exposure to traffic-related emissions is associated with numerous adverse health effects including prevalence and severity of symptoms of asthma, hospitalizations for acute myocardial infarctions, and cardiovascular-related mortality. No previous studies have assessed the association between proximity to traffic and respiratory and cardiovascular outcomes across all age groups. OBJECTIVE: The purpose of this study was to assess the association between proximity to traffic emissions within the City of Atlanta and respiratory and cardiovascular 911 Emergency Management Service (EMS) calls and subsequent emergency department (ED) visits. METHODS: Case and control diagnostic groups were established for 5,450 EMS calls received between 2004 and 2008 from residents of the City of Atlanta based on ICD-9 codes assigned within the ED. Case diagnostic groups included asthma, cardiovascular outcomes, and stroke. Gastrointestinal diagnostic groups were selected as controls. Cumulative traffic within a 100 m buffer of the call origination location was used as an indicator of exposure to traffic emissions. Using a case-control study design, the associations between exposure to traffic emissions and the case diagnostic groups were evaluated using logistic regression, controlling for potential confounding factors including age, gender, ethnicity, and socio-economic status (SES). Subgroup analyses were performed to evaluate differences by select age categories, gender, and SES. P-values of <0.05 and 95% confidence intervals (CI) were used to determine statistical significance. RESULTS: Increased cumulative traffic near the call location was associated with an increase in the odds of an EMS call and ED visit for cardiovascular outcomes compared to the control diagnostic group even after adjustment for confounding factors (OR = 1.07; 95% CI ,1.01-1.12). The strongest effects were among men and individuals aged 40-75 years. Increased cumulative traffic was also associated with an increased odds of an EMS call and ED visit for stroke among individuals aged 18-39 years after adjusting for confounding (OR = 1.16; 95% CI, 1.01-1.34). No statistically significant associations were found between increased cumulative traffic and the odds of an EMS call and ED visit for asthma. CONCLUSION: These results provide additional evidence that proximity to traffic is associated with adverse cardiovascular outcomes and stroke in certain age groups.

Background: The effectiveness of paraprofessional home-visitations on improving the circumstances of disadvantaged families is unclear. The purpose of this paper is to systematically review the effectiveness of paraprofessional home-visiting programs on developmental and health outcomes of young children from disadvantaged families. Methods: A comprehensive search of electronic databases (e.g., CINAHL PLUS, Cochrane, EMBASE, MEDLINE) from1990 through May 2012 was supplemented by reference lists to search for relevant studies. Through the use of reliable tools, studies were assessed in duplicate. English language studies of paraprofessional home-visiting programs assessing specific outcomes for children (0-6 years) from disadvantaged families were eligible for inclusion in the review. Data extraction included the characteristics of the participants, intervention, outcomes and quality of the studies. <p>Results: Studies that scored 13 or greater out of a total of 15 on the validity tool (n = 21) are the focus of this review. All studies are randomized controlled trials and most were conducted in the United States. Significant improvements to the development and health of young children as a result of a home-visiting program are noted for particular groups. These include: (a) prevention of child abuse in some cases, particularly when the intervention is initiated prenatally; (b) developmental benefits in relation to cognition and problem behaviours, and less consistently with language skills; and (c) reduced incidence of low birth weights and health problems in older children, and increased incidence of appropriate weight gain in early childhood. However, overall home-visiting programs are limited in improving the lives of socially high-risk children who live in disadvantaged families.</p> <p>Conclusions: Home visitation by paraprofessionals is an intervention that holds promise for socially high-risk families with young children. Initiating the intervention prenatally and increasing the number of visits improves development and health outcomes for particular groups of children. Future studies should consider what dose of the intervention is most beneficial and address retention issues.</p> / http://www.biomedcentral.com/1471-2458/13/17

The aim of this thesis is to contribute to existing knowledge. If the knowledge is not useful in building society it has limited value. In order to be a tool for decision-makers, Preventive Home Visits (PHVs) are described and discussed according to a realist synthesis approach. The premise of this approach is that a single trial cannot tell the whole story and that understanding theoutcome pattern is much more important than seeking regularities in results across different trials. In order to understand the o utcome pattern, the PHV strategy in Nordmaling is examined against other trials and scientific work, and also in grey literature such as reports and workingpapers. An increasing population of seniors means that resources for health and elderly care are being scrutinised in order to achieve the best possible health for the money invested. PHVs represent one strategy that attempts to promote health among independent seniors. This thesis is a multidisciplinary study aiming to gain knowledge about the effects of PHVs and to understand the mechanisms of importance when implementing this particular strategy. The point of departure is a study conducted in Nordmaling in the north of Sweden among healthy seniors aged 75 years and over. The study, conducted as a controlled trial during 2000 and 2001, showed a decrease in mortality as well as the utilisation of care, and an improvement in indicators of perceived health. Cost analyses showed significant savings for the municipality following a reduction in the use of home help. These and other savings combined with costs of the intervention were related to saved life years and used to conduct health economic analyses. Medical and social records from the primary health centre and the municipality, along with official registers provided information for modelling health economic analyses from a lifetime perspective. Results showed that the costs of PHVs were less than 10 000 Euros per gained life year, against an acceptable level of cost effectiveness of 50 000 Euros. Using a shorter time perspective, the result was even more favourable for PHVs. It was evident that the time window used in the analyses, the normative choice of including future healthcare costs or not, and how to handle the value of the seniors’ production were important factors in determining the results. Two years after the trial, in-depth interviews were conducted with 5 seniors who had experienced PHVs, in order to gain understanding of the outcome of the PHV trial in Nordmaling. Participants were selected with respect to their health and how they responded to advice given during the PHV trial. Grounded Theory was used to analyse the interviews. Seniors who used autonomous coping strategies in everyday life gained less from PHVs than other seniors. All participants could benefit from PHVs, but in order for these to be successful it was important for the home visitor to be professional and to understand how the different coping strategies of seniors worked. Taken together, the different aspects of this study raised normative questions that are discussed in this thesis. One, whether the production of seniors has any monetary value in health economic analyses conducted from a societal perspective, was addressed in a smaller diary study where 23 seniors were asked to keep a diary in order to identify everything they did over a oneweek period. It was evident that most of the respondents “produced” a lot, however the production of seniors is rarely taken into account in health economic analyses. The concept of “senior production” includes both the market value of what seniors do, as well as the value of what society can avoid doing if the seniors are independent and healthy.

This study assessed how early motherhood influences maternal behavior and infant healthin Ethiopia. Data from the Ethiopian Demographic and Health Survey 2011 were used.Descriptive and Multinomial analysis were performed to observe the determinants of antenatalcare visits and birth weight. Cox regression model was employed for analyzing the risk of infantmortality. Findings clearly show that young maternal age at birth was associated with asignificantly lower number of ANC visits and increased the risk of infant mortality. However,there was no significant difference in the incidence of having babies with a low birth weight byage. Apart from maternal age at birth, education, wealth status, place of residence and ethnicityhad a stronger significant effect on outcome variables.In conclusion, this study demonstrated that young age at birth has an effect on utilizationof ANC service and infant health. For a favorable maternal behavior and infant health outcomewe strongly suggest that the following should be considered-: strong enforcement of minimumage at marriage abided by law, promoting young women’s education, and adequate andaffordable health care services in remote rural areas where health clinics are inaccessible.