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Amardeep Thind

Publications and source records attributed to Amardeep Thind.

15 recordsLinked to original sources
PubMed2006

The surgeon-patient interaction in older women with breast cancer: what are the determinants of a helpful discussion?

BACKGROUND: Surgery is a key modality in the treatment of breast cancer. The patient-physician interaction is a key determinant of a range of outcomes, but there is little work examining the surgeon-breast cancer patient interaction. We analyzed data from 240 women with a new breast cancer diagnosis to better understand this interaction and to delineate the patient, surgeon, and surgeon-patient interaction-level characteristics affecting this interaction. METHODS: A cross-sectional survey was conducted in Los Angeles County of 240 women with a new breast cancer diagnosis aged>or=55 years. Women were asked to rate on a scale of 0 to 10 how helpful overall the way their surgeon discussed their breast cancer with them was. Logistic regression models were constructed to assess the relationship of patient, surgeon, and surgeon-patient interaction characteristics to the outcome variable. RESULTS: Forty-four percent of women said that they found the way their surgeon discussed their breast cancer with them extremely helpful. Women with a higher level of perceived self-efficacy, a longer consultation time with the surgeon, a higher interactive information-giving score, and a higher participatory decision-making score had significantly higher odds of reporting the discussion to be "extremely helpful." CONCLUSIONS: Our results indicate that strategies to improve the patient's perceived self-efficacy (preparing questions beforehand, practicing, watching a role model, and so on) will improve the surgeon-patient discussion. At a systems level, adequate time should be budgeted for the consultation, and we must ensure that adequate communication skills are imparted to surgeons during their educational training.

Aged↗
PubMed2006

Cost/DALY averted in a small hospital in Sierra Leone: what is the relative contribution of different services?

BACKGROUND: A cost-effective analysis (CEA) can be a useful tool to guide resource allocation decisions. However, there is a dearth of evidence on the cost/disability-adjusted life year (DALY) averted by health facilities in the developing world. METHODS: We conducted a study to calculate the costs and the DALYs averted by an entire hospital in Sierra Leone, using the method suggested by McCord and Chowdhury (Int J Gynaecol Obstet 2003;81:83-92). RESULTS: For the 3-month study period, total costs were calculated to be dollar 369,774. Using the approach of McCord and Chowdhury, we calculated that 11,282 DALYs were averted during the study period, resulting in a cost/DALY averted of dollar 32.78. This figure compares favorably to other non-surgical health interventions in developing countries. We found that while surgery accounts for 63% of total caseload, it contributes to 38% of the total DALYs averted. CONCLUSIONS: Surgical treatment of some common pathologies in developing countries may be more cost-effective than previously thought, and our results provide evidence for the inclusion of surgery as part of the basic public health armamentarium in developing countries. However, these results are highly context-specific, and more research is needed from developing countries to further refine the methodology and analysis.

Cost Savings↗
PubMed2005

Analysis of health services use for respiratory illness in Indonesian children: implications for policy.

Respiratory illness continues to be a leading cause of paediatric morbidity and mortality in Indonesia. The Indonesian government is moving towards a more managed care-based approach as it reforms its health care system following the 1997 financial crisis. In order to better design contractual relationships between the payor and different providers, there needs to be a better understanding of the patterns and predictors of health services utilization for respiratory illness. This study uses the Indonesia Demographic and Health Survey to study the determinants of private, public and non-formal provider utilization for respiratory illness. Multinomial logistic regression models for predicting use were constructed using the Andersen Behavioural Model as the conceptual framework. The findings indicate that age, household size, maternal education, religion, the asset index, location and illness severity play a role in determining use of private, public or non-formal providers. The results indicate that from a policy perspective, the Indonesian government needs be inclusive rather than exclusive in the choice of providers that are contracted by the managed care plans, in order to safeguard the health of the under-five population.

Child Health Services↗
PubMed2005

Determinants of tetanus toxoid immunization in pregnancy in rural Bihar.

In order to increase the uptake of tetanus toxoid (TT) vaccination, we need to understand the factors that underlie the decision of the pregnant woman to undergo vaccination, especially in rural areas, where 75% of India's population resides. This paper constructs a model from a data-set of 2398 women in order to understand the determinants ofTTvaccine immunization by women during their most recent pregnancy and applies it to the National Family Health Survey-2 data. The object of the model is to predict the likelyhood of a pregnant woman receiving the recommended two doses of TT vaccine subject to other factors such as birth order, maternal education, prenatal care provider, household standard of living, health-care-seeking decision-maker and service availability. Policy implications of these findings are discussed.

Adult↗
PubMed2005

Female sterilisation in rural Bihar: what are the acceptor characteristics?

OBJECTIVE: The National Population Policy aims to expand voluntary and informed use of contraceptive services. This paper examines the determinants of use of female sterilisation versus other contraceptive methods in rural Bihar, one of the most socially and economically deprived states in India. METHODS: Data for 1378 ever-married women aged 15-49 years in rural Bihar, who are currently using contraception, were abstracted from the Second National Family Health Survey. A logistic regression model was developed to understand the determinants of use of female sterilisation versus other contraceptive methods. RESULTS: Maternal age, the number of living sons, religion, scheduled caste/tribe/backward class status, exposure to mass media and household standard of living are statistically significant determinants of the choice between sterilisation and other contraceptive methods. CONCLUSION: The study underscores the need to significantly broaden the contraceptive choice for women in rural Bihar.

Adolescent↗
PubMed2005

Pipeline, profession, and practice program: evaluating change in dental education.

This article describes the conceptual and analytical framework that will be used to assess the effectiveness of the Pipeline, Profession, and Practice: Community-Based Dental Education Program. The evaluation will use a mixed method qualitative and quantitative data collection, analysis, and triangulation. Baseline measures are reported using data from the 2003 ADEA survey of dental school seniors. Baseline measures show the dental schools are confronting a major recruitment challenge that will require short and long pipeline efforts to attract and retain underrepresented and low-income (URM/LI) persons. Gaps were found between the perceptions of URM and non-URM students in the adequacy of the curricula. The majority of all seniors described the current extramural clinical rotations as positive experiences, but URMs were more likely to report the experience improved their ability to care for diverse groups.

Community Dentistry↗
PubMed2005

What determines positive student perceptions of extramural clinical rotations? An analysis using 2003 ADEA Senior Survey data.

Extramural clinical rotations are an integral part of many dental school curricula. Schools in The Robert Wood Johnson Foundation/The California Endowment Pipeline, Profession, and Practice program are increasing student extramural opportunities to expose students to patients of different needs, cultures, and dental delivery modes. Using data from the American Dental Education Association (ADEA) 2003 Senior Survey, the Pipeline, Profession, and Practice National Evaluation Team studied graduating dental students' perceptions about their extramural rotations. This analysis was designed to determine the factors associated with students' perception of their extramural clinical rotations: was it a positive experience in their dental education, and did it improve students' perceptions of their ability to provide care for racially, ethnically, and culturally diverse groups? The respondents were 2,950 graduating seniors who reported at least one week of extramural rotation experience. After controlling for both individual and school level characteristics, this study found that race/ethnicity, a stronger socially conscious attitudes score, number of weeks spent in extramural rotations, and the student's rating of time spent in extramural rotations were significant determinants of the extramural rotations being reported as positive experiences. With respect to improving students' ability to provide care to racially, ethnically, and culturally diverse groups, more positive student socially conscious attitudes, a greater number of weeks spent in the rotations, a stronger service orientation for selecting dentistry as a career, and the students' rating of their time spent in extramural rotations were significant determinants. In conclusion, there is some evidence that time spent in extramural rotations may be perceived as positive dental school experiences and, for some students, may prepare them to work effectively with culturally diverse patients by the time of dental school graduation.

Adult↗
PubMed2004

Home deliveries in Indonesia: who provides assistance?

Indonesia has set an ambitious target of reducing its maternal mortality rate to 125 maternal deaths per 100,000 live births by the year 2010. This poses formidable challenges in a geographically diverse country where the majority of births occur at home. One option for the Indonesian government in order to reduce its maternal mortality would be to increase rates of skilled assistance for home deliveries. In order to design appropriate policies to achieve this, it is imperative to understand the determinants of use of birth attendants by mothers delivering at home. We use the Andersen Behavioral Model as a theoretical framework to understand the determinants of the use of a trained provider, traditional birth attendant, or no trained assistance during home deliveries in Indonesia. The 1997 Indonesia Demographic and Health Survey (IDHS) was used, and data from the most recent home delivery was abstracted for analysis. Out of a total sample of 10,692 home deliveries, a majority (53%) used the services of a TBA, 40% had a doctor, nurse or midwife in attendance, and only 7% delivered with the help of family and/or friends. A multinomial logit model was used to predict determinants of use. Our results indicate that maternal education, religion, asset index quartile and number of antenatal visits are significant determinants among all choice sets.

Adult↗
PubMed2004

Health service use by children in rural Bihar.

Bihar is one of the most economically deprived states in India. Home to nearly 10 per cent of India's population, it consistently ranks poorly on a variety of development and health-related indicators. In order to improve child survival and decrease childhood mortality, it is important to understand the determinants of healthcare use so that appropriate policies may be developed to maximize health services utilization. This paper undertakes such as analysis. It uses the Andersen Behavioral Model to understand determinants of health services utilization for children suffering from diarrhea and respiratory illness in rural Bihar. Data were abstracted from the Second National Family Health Survey (NFHS-2). Out of 2703 children under 3 years of age in the dataset, 840 had an episode of diarrhea and/or respiratory illness in the preceding 2 weeks. A majority (69 per cent) had utilized healthcare services for their illness. The results indicate that controlling for other factors, sex of the child, household standard of living, service availability and need, are significant determinants of health service utilization. The analysis highlights the usefulness of the NFHS-2 data as a tool to conduct health services research and analyses at the state level, and in developing policies to safeguard and improve the health of vulnerable population groups in India.

Child Health Services↗
PubMed2003

Respiratory illness in the Dominican Republic: what are the predictors for health services utilization of young children?

Respiratory illness and diarrhoea continue to be the leading causes of paediatric morbidity and mortality in the Dominican Republic. An important first step in alleviating this disease burden is to understand patterns and predictors of health services utilization for these conditions. This study examines the predictors of (a) health services utilization, and (b) public versus private sector use, for respiratory illness in the under-five population in the Dominican Republic. The DHS-2 dataset (1991) was utilized for analysis. Logistic regression models for predicting use and non-use, and for predicting private versus public sector use, were constructed using the Andersen Behavioural Model as the conceptual framework. Our findings indicate that sex, location and possession index quartile are factors that influence the decision to seek care or not for respiratory illness in under-fives. In contrast, the choice between the public and private sector is determined by location and insurance status. From the policy perspective, if the Dominican Republic were to undertake steps to increase private insurance coverage, our results indicate that this would lead to increased utilization of private sector providers for respiratory illness by children having private insurance, but would not have an impact on overall utilization (i.e. use vs. non-use). On the other hand, one of the ways to deliver cost-effective interventions by the publicly financed system would be to improve facilities in the rural areas.

Child Health Services↗
PubMed2003

Diarrhea in the Dominican Republic: determinants of the utilization of children's health services.

Diarrhea is a leading cause of pediatric morbidity and mortality in the Dominican Republic. A potential policy option for reducing the burden of this disease would be to utilize the public and private sector health resources of the country in a co-ordinated fashion. To do so requires an understanding of the determinants of health services' utilization for this disease. This study examines the predictors of (a) health services' utilization, and (b) public vs. private sector use, for diarrhea in the under-five population in the Dominican Republic. The DHS-2 dataset (1991) was utilized for analysis. Logistic regression models for predicting use and non-use, and for predicting private vs. public sector use were constructed. Age, nutritional status, rural location, higher maternal education and duration of illness greater than 2 days were significant predictors of use of health services. Nutritional status, private insurance and higher maternal education were found to be significant predictors of private sector utilization rather than public sector utilization. Such disease-specific sector utilization should be kept in mind when attempts are made to adjust the public/private mix in health sector reform.

Child Health Services↗
PubMed2003

Determinants of children's health services utilization in the Philippines.

Respiratory illness and diarrhea are the two most important causes of death in children under the age of 5 in the Philippines. The government has accorded high priority to reducing the number of deaths caused by these illnesses as it attempts to reform its healthcare system. In order to re-design health systems, policy makers need to have a good understanding not only of overall health services utilization, but also of the use of public and private sectors. We used the 1998 Philippines National Demographic and Health Survey dataset to understand the service utilization patterns of children under 5 with diarrhea and/or respiratory illness. Using the Andersen Model as the conceptual framework, a nested logit regression approach was used to determine predictors of health services use, and of public vs. private use in this population. Our results indicate that maternal education and number of illnesses determine the decision to seek care. Once the decision has been made to seek care, the choice between a public or private provider is affected by the family's economic status and size of the household. Policy makers can use such information for future health planning and reform, in order to increase access to healthcare for this vulnerable population in the Philippines.

Adolescent↗
PubMedDate not supplied

What is managed care? A conceptual primer.

Managed care is a new concept for many health policymakers. Developed in the USA as a response to increasing healthcare costs, it is being exported across the world, and many countries are incorporating elements of managed care into their health systems. In the absence of a basic understanding of managed care, reality may not meet expectations. This article explains what managed care is, traces its development in the context of the American healthcare system, discusses its achievements (or lack thereof) to date and considers its relevance to healthcare delivery in India.

Health Care Costs↗
PubMedDate not supplied

Injection safety and its impact in India: a literature analysis.

Unsafe injection practices have been implicated in the worldwide spread of hepatitis B, hepatitis C, HIV or any parasitic disease with a blood phase, such as malaria, filaria and syphilis. Review of injection safety in India also revealed that use of injection is often inappropriate, injections are administered with unreliable safety measures. Studies in India have documented the association of injection use and spread of hepatitis C and kala-azar also. Some measures to address the issue are also discussed.

Hepatitis C↗