No description available.

The intent of this study was to examine the perceived resources and obstacles which were related to the utilization of mental health services by chronically mentally ill Mexican American clients. Specifically, the study identified resources and obstacles encountered by six chronically mentally ill clients and six family members as they accessed various mental health services. The study was conducted in the fall of 1985 from clients currently receiving services from La Frontera Center, Inc., Tucson, Arizona. Data were interpreted through content analysis to conceptualize and categorize client and family member responses. Chronically mentally ill clients relied heavily on individuals such as friends, therapist and priest as resources for mental health service support. In contrast, family members focused primarily on institutions for resource support. Financial resources, institutional policies, denial, and the lack of personal direction were listed as obstacles to seeking mental health services by clients and family members. Study results suggested that the perceptions of traditional and nontraditional obstacles and resources by Mexican American clients and family members continue to strongly influence utilization of mental health services In particular, the issue of "stigma" and the personal qualities and abilities of the therapist emerged as significant descriptors in client and family member self statements.

No description available.

This dissertation involved linking a clinical cystic fibrosis (CF) data registry with administrative databases to evaluate clinical, demographic, and geographical predictors of hospitalization in CF patients living in Ontario over a 10 year period. In addition, this work assessed the ability of administrative data to identify individuals with CF using the clinical registry as the reference standard. Sex was an independent predictor of hospitalization rates for individuals with CF. Females had a significantly higher hospitalization rate compared to males even after adjusting for important clinical factors suggesting that this finding is not simply due to worse CF disease. In those between 7 and 19 years of age, the adjusted hospitalization rate was 38% higher in females (rate ratio[RR] 1.38, 95% confidence interval [CI] 1.11-1.73). Similarly in those over the age of 19, females had a 30% higher hospitalization rate compared to males (RR 1.30, 95% CI 1.06-1.59). Other significant predictors associated with higher hospitalization rates in both age groups were lower lung function, worse nutritional status, pancreatic insufficiency, and the presence of CF-related diabetes. The presence of Burkholderia cepacia complex in the sputum was a significant predictor in those over the age of 19 years (RR 1.54, 95% CI 1.26-1.89). Distance to CF centre, community size and socioeconomic status were not significant predictors of hospitalization rates in either age group. There was no significant trend in hospitalization rates over time once rates were adjusted for markers of disease severity (p=0.08). Comparing administrative data with the CF registry data, administrative data captured hospitalizations more comprehensively. Despite CF being a specific diagnosis, health administrative databases alone were insufficient to reliably and accurately identify individuals with CF unless they had been hospitalized. The reason for the gender disparity seen within this dissertation is likely multifactorial. There may be differences in outpatient management between the sexes, hormonal influences may modulate disease severity causing higher hospitalization rates, and patient and provider-level influences may affect the decision to hospitalize a patient. Further research is needed in this area to elucidate the factors contributing to this gender gap.

A Atenção Básica (AB), através da Estratégia Saúde da Família (ESF), caracteriza-se por um conjunto de ações de saúde, no âmbito individual e coletivo, que abrangem a promoção e a proteção da saúde, a prevenção de agravos, o diagnóstico, o tratamento. A AB fundamenta-se em quatro atributos essenciais: atenção ao primeiro contato, coordenação do cuidado, integralidade e longitudinalidade, que operados, possibilitam o acesso, a produção do cuidado e a identificação do perfil da população do território de adscrição. Considerando que dentro do território municipal encontram-se grupos heterogêneos, com perfis e necessidades particulares, traçar as características sociais e as singularidades do adoecer dos territórios de adscrição das ESF pode permitir adequar os serviços da equipe a essas necessidades. O objetivo do presente trabalho epidemiológico, é caracterizar, através do perfil de morbidade e sócio demográfico, os grupos cadastrados nas diferentes equipes e territórios de implantação da Estratégia Saúde da Família, tendo como campo de estudo o município de Patrocínio/MG. Nele existem 16 equipes da ESF, das quais três localizam-se na área central, uma na área rural e 12 na região periférica da cidade (três estratos). A fonte de dados foi os prontuários de pacientes usuários destas unidades assistenciais. Após calculado o tamanho amostral em 596 prontuários, o processo de amostragem ocorreu em múltiplas etapas. Foi feita uma amostragem estratificada das ESF com partilha proporcional entre os estratos, e dentro de cada ESF feita uma amostragem sistemática dos prontuários familiares. Um sorteio casual simples permitiu que fosse selecionado um indivíduo daquela família. Nos prontuários foram coletados os seguintes dados: idade, sexo, ocupação, escolaridade e diagnósticos referentes a última consulta médica realizada no ano de 2010. As variáveis foram transferidas para um banco de dados e descritas posteriormente. Os 564 prontuários analisados, trouxeram os seguintes resultados: na região periférica predominaram mulheres, na faixa etária de 40 60, maioria alfabetizadas (82%), com ocupações consideradas fora da População Economicamente Ativa (PEA) e uma maior freqüência das doenças do aparelho circulatório (18%). Na região central predominaram as mulheres, na faixa etária dos 20 40, pessoas alfabetizadas (92%), aposentados e doenças do aparelho circulatório. Na região rural houve maior prevalência de mulheres, idosos, alfabetizados (94%), fora da PEA e as doenças do aparelho circulatório também prevaleceram. Apesar das regiões apresentarem características parecidas, os achados posteriores de idades, ocupações e morbidades foram diferentes, o que confirma a idéia de diferenças regionais dentro de um mesmo município. Os resultados podem servir de instrumento para um melhor planejamento direcionado das ações em saúde. / Primary Care (PC), through the Family Health Strategy (FHS), is characterized by a set of health actions, both individually and collectively, covering the promotion and protection of health, disease prevention, diagnosis and the disease treatment. The PC is based on four essential attributes: attention to the first contact, care coordination, comprehensiveness and longitudinality. If worked properly, these attributes provide access to care production and helps to identify the population profile of the territory of ascription. Considering that within the municipal area there are heterogeneous groups, with different profiles and particular needs, outline the characteristics and peculiarities of the illness of the ascription territories allows the FHS team to adapt the services to its population profile of the health area. The aim of this epidemiological study, with a transversal nature, is to characterized, by the morbidity and social profiles, the groups registered in different teams and territories of the Family Health Strategy launching, having as a field study the city of Patrocínio / MG. In such study there are 16 teams of FHS, of which two are located in the central area, two in rural areas and 12 in the peripheral region of the city (three strata). The data source was the medical records of patients using these assistance units. After calculating the sample size of 596 records, the sampling process occurred in multiple steps. We conducted a stratified sampling with proportional share of the FHS between the strata, and within each FHS it was made a systematic sampling of family records. A simple casual draw permitted that it was selected one individual of each family. In the records it was collected the following data: age, sex, occupation, education, and diagnostics for the final medical evaluation conducted in 2010. Variables were transferred to a database and were described later. The 564 records analyzed, brought the following results: in the peripheral region there were the predominance of women, aged 40 60, most literate (82%), with occupations considered outside Economically active population (brasilian classification), and a higher frequency of cardiovascular diseases (18%). In the central region there were the predominance of women, aged 20 40, literate (92%), with a higher frequency of retirees and the circulatory diseases showed a higher frequency. In the country region, remembering that it has a small sample, there is a higher prevalence of women, the elderly (aged 60 90), literate (94%), outside of the PEA and circulatory diseases also prevailed. Although at first glance, the regions present similar characteristics, the later findings of ages, occupations and morbidity were different, which confirms the idea of regional differences within the same municipality. The results can serve as a tool for a better planning of directed health actions.

A Atenção Básica (AB), através da Estratégia Saúde da Família (ESF), caracteriza-se por um conjunto de ações de saúde, no âmbito individual e coletivo, que abrangem a promoção e a proteção da saúde, a prevenção de agravos, o diagnóstico, o tratamento. A AB fundamenta-se em quatro atributos essenciais: atenção ao primeiro contato, coordenação do cuidado, integralidade e longitudinalidade, que operados, possibilitam o acesso, a produção do cuidado e a identificação do perfil da população do território de adscrição. Considerando que dentro do território municipal encontram-se grupos heterogêneos, com perfis e necessidades particulares, traçar as características sociais e as singularidades do adoecer dos territórios de adscrição das ESF pode permitir adequar os serviços da equipe a essas necessidades. O objetivo do presente trabalho epidemiológico, é caracterizar, através do perfil de morbidade e sócio demográfico, os grupos cadastrados nas diferentes equipes e territórios de implantação da Estratégia Saúde da Família, tendo como campo de estudo o município de Patrocínio/MG. Nele existem 16 equipes da ESF, das quais três localizam-se na área central, uma na área rural e 12 na região periférica da cidade (três estratos). A fonte de dados foi os prontuários de pacientes usuários destas unidades assistenciais. Após calculado o tamanho amostral em 596 prontuários, o processo de amostragem ocorreu em múltiplas etapas. Foi feita uma amostragem estratificada das ESF com partilha proporcional entre os estratos, e dentro de cada ESF feita uma amostragem sistemática dos prontuários familiares. Um sorteio casual simples permitiu que fosse selecionado um indivíduo daquela família. Nos prontuários foram coletados os seguintes dados: idade, sexo, ocupação, escolaridade e diagnósticos referentes a última consulta médica realizada no ano de 2010. As variáveis foram transferidas para um banco de dados e descritas posteriormente. Os 564 prontuários analisados, trouxeram os seguintes resultados: na região periférica predominaram mulheres, na faixa etária de 40 60, maioria alfabetizadas (82%), com ocupações consideradas fora da População Economicamente Ativa (PEA) e uma maior freqüência das doenças do aparelho circulatório (18%). Na região central predominaram as mulheres, na faixa etária dos 20 40, pessoas alfabetizadas (92%), aposentados e doenças do aparelho circulatório. Na região rural houve maior prevalência de mulheres, idosos, alfabetizados (94%), fora da PEA e as doenças do aparelho circulatório também prevaleceram. Apesar das regiões apresentarem características parecidas, os achados posteriores de idades, ocupações e morbidades foram diferentes, o que confirma a idéia de diferenças regionais dentro de um mesmo município. Os resultados podem servir de instrumento para um melhor planejamento direcionado das ações em saúde. / Primary Care (PC), through the Family Health Strategy (FHS), is characterized by a set of health actions, both individually and collectively, covering the promotion and protection of health, disease prevention, diagnosis and the disease treatment. The PC is based on four essential attributes: attention to the first contact, care coordination, comprehensiveness and longitudinality. If worked properly, these attributes provide access to care production and helps to identify the population profile of the territory of ascription. Considering that within the municipal area there are heterogeneous groups, with different profiles and particular needs, outline the characteristics and peculiarities of the illness of the ascription territories allows the FHS team to adapt the services to its population profile of the health area. The aim of this epidemiological study, with a transversal nature, is to characterized, by the morbidity and social profiles, the groups registered in different teams and territories of the Family Health Strategy launching, having as a field study the city of Patrocínio / MG. In such study there are 16 teams of FHS, of which two are located in the central area, two in rural areas and 12 in the peripheral region of the city (three strata). The data source was the medical records of patients using these assistance units. After calculating the sample size of 596 records, the sampling process occurred in multiple steps. We conducted a stratified sampling with proportional share of the FHS between the strata, and within each FHS it was made a systematic sampling of family records. A simple casual draw permitted that it was selected one individual of each family. In the records it was collected the following data: age, sex, occupation, education, and diagnostics for the final medical evaluation conducted in 2010. Variables were transferred to a database and were described later. The 564 records analyzed, brought the following results: in the peripheral region there were the predominance of women, aged 40 60, most literate (82%), with occupations considered outside Economically active population (brasilian classification), and a higher frequency of cardiovascular diseases (18%). In the central region there were the predominance of women, aged 20 40, literate (92%), with a higher frequency of retirees and the circulatory diseases showed a higher frequency. In the country region, remembering that it has a small sample, there is a higher prevalence of women, the elderly (aged 60 90), literate (94%), outside of the PEA and circulatory diseases also prevailed. Although at first glance, the regions present similar characteristics, the later findings of ages, occupations and morbidity were different, which confirms the idea of regional differences within the same municipality. The results can serve as a tool for a better planning of directed health actions.

Adverse childhood experiences (ACEs) are linked to increased mental health problems in children, but their association with mental health services utilization is not well known. This secondary analysis used 2016 National Survey of Children’s Health data from two samples: children aged 6-17-years-old with a mental or behavioral condition in need of treatment or counseling (N = 5,723); and a subsample of children who experienced at least one ACE (n = 3,812). Multiple logistic regression and latent class analysis (LCA) were performed to examine the association between ACEs and mental health services utilization. Multiple logistic regressions also examined the associations of parent/caretaker vulnerability, school-system, and medical-system factors on mental health services utilization for children with ACEs using the Gelberg-Andersen Behavioral Model for Vulnerable Populations and a Systems of Care approach as the framework for model building. Children with increased ACE scores did not have higher odds of utilizing mental health services compared to children at lower levels of or no ACEs. For children who experienced adversity, increased parent/caretaker vulnerability was associated with lower odds and the current receipt of special education services with increased odds of mental health services utilization in adjusted models. Strengths of this study included the large dataset and generalizability to the U.S. population. There were limitations to the measurement of ACEs and other key variables. The current study identified children who experienced adversity as an underserviced population for mental health services.

This study was unique in that it focused on the rural elderly of both Black and White ethnicity's, explored differences between groups by comparing use and knowledge of health services, and controlled for gender, income, educational attainment, health status, age, and health beliefs - the independent variables of the study. Knowledge and use of health services were dependent factors. The Anderson behavioral model (Anderson, 1995) has been extensively used to examine health service utilization. It conceptualizes health care use as the outcome of a complex pattern of interactions between predisposing, enabling, and need-for care characteristics. The literature has supported the utility of the behavioral model for assessing the health care practices of rural older adults. Four questions were posed. These were translated into hypotheses for statistical testing purposes. Black and White elderly residents of one rural county in South Carolina comprised the target population. A sample of 150 elderly residents, 75 Black and 75 White, were randomly selected for participation. The multidimensional health locus of control scales were modified and used in the test instrument to assess health beliefs (both internal and external). Descriptive and background data were gathered from administration of the survey. Data were analyzed using SPSS statistical software. Analysis of variance (ANOVA) and the LSD (least significant differences) test, in addition to regression analysis, were used to compute and identify differences between and among groups of data. This research concluded that there was no correlation between use of services and knowledge of facilities. There were differences in utilization by race, with Whites making greater use of health care facilities. Educational levels, health status, income, household composition, type of insurance, and age influenced health care use. It was not influenced by gender, distance from facilities, and health beliefs. There was a statistically significant difference between knowledge and race, with Blacks having higher knowledge scores. Gender, health status, income, distance from facilities, and health beliefs did not influence knowledge. However, educational attainment, type of insurance, household composition, and age did. Service use and knowledge were adequate, in contrast to findings in the literature. Recommendations for further study were formulated. / Graduation date: 1999

The main objectives of this dissertation were to examine the effects of bariatric surgery on medication and health services utilization among a cohort of Commercial and Medicare insured members from a large health benefits organization in the U.S.. A total of 1,492 members with morbid obesity underwent gastric bypass (n=785) or gastric banding (n=707) procedure between January 2005 and June 2008. Administrative claims databases were accessed and three data files including a member file, a medical file and a pharmacy file were merged at the member level. Non-parametric Wilcoxon signed rank tests revealed that the average number of all prescription claims were significantly lower during the 12 months post-surgery, compared to the 12 months pre surgery (p<0.0001). Moreover, McNemar’s Chi Square analyses showed that after the surgery, there was a statistically significant (p=<0001) decline in the proportion of members utilizing antihypertensives, antidiabetics and antihyperlipidemics. Our results also showed that the average number of prescription claims for each of these medication groups significantly declined during the 12-month post-surgery period, among members who had at least one prescription for these medications before the surgery (p<0.0001). Logistic regression modeling revealed that members who underwent bypass procedures were more likely to discontinue antihypertensives (OR=2.04; 95% CI= 1.30-3.23) , antihyperlipidemics (OR=3.25; 95% CI 1.96-5.40) and antidiabetics (OR=1.89; 95% CI 1.13–3.08) post-surgery than members who underwent banding procedures. In terms of medical services utilization, our results showed a significant decline in the average number of medical claims for all outpatient services overall from the 12 months pre to the 12 months post-surgery (p<0.0001). In contrast, the average number of medical claims for emergency room and inpatient hospitalizations were significantly increased from the pre to the post-surgery period (p<0.01). Logistic regression modeling revealed that the type of bariatric surgery was a significant positive predictor for inpatient hospitalizations post-surgery (OR =2.33; 95% CI= 1.76-3.08; p<0.0001) but not for emergency room visits (OR=1.23; 95% CI 0.97–1.56). The implications of the findings from a managed care perspective are discussed, along with limitation and future directions.

This research investigated the racial/ethnic differences in hospice utilization and the effect of hospice in reducing the risk of hospital death at the end of life among non-Hispanic Black and non-Hispanic White dual-eligible (Medicare and Medicaid) older adults residing in a nursing home setting. The final study population included 30,765 non-Hispanic Black and non-Hispanic White nursing home residents who died between state fiscal years 2000-2002 in Florida.The behavioral model of health services use successfully predicted group membership in hospice use. In the full model, seven variables - female gender, non-Hispanic White race/ethnicity, being married, urban area of residence, and cancer and dementia/Alzheimer's disease as causes of death -- predicted increased likelihood of hospice use. This study also found that race/ethnicity moderates the strength of the effect of the illness on the likelihood of using hospice. Among residents who died of cancer, no difference in hospice use was found between the two racial/ethnic groups while hospice utilization rate among non-cancer residents was lower for non-Hispanic Blacks than non-Hispanic Whites.The same predisposing, enabling and need factors tested in predicting hospice use were examined for association with the probability of survival time since hospice admission. The poor model fit and the small number of factors found to significantly affect the probability of survival time from the initial hospice enrollment suggest that the survival time might be influenced by external factors other than covariates examined in this study.This study found hospice to be a powerful predictor of place of death among nursing home residents. After controlling for other factors, hospice nurs ing home residents were 91 percent less likely to die in a hospital. At the same time, non-Hispanic Black residents were still 76 percent more likely to die in a hospital even after adjusting for the effect of hospice use and other variables.