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PubMed2002

Does career dissatisfaction affect the ability of family physicians to deliver high-quality patient care?

OBJECTIVES: A usual source of care is associated with better health outcomes. Dissatisfaction among family physicians and general practitioners (FP/GPs) may compromise the accessibility of a usual source of care and the quality of services. We examined the association between FP/GP dissatisfaction and an inability to deliver high-quality care. STUDY DESIGN: We performed a secondary data analysis of the Community Tracking Study (CTS) Physician Survey (1996-1997). POPULATION: The study included a nationally representative sample of more than 12,000 nonfederal physicians practicing direct patient care in the United States. OUTCOMES MEASURED: We measured associations of career dissatisfaction with physicians&amprsquo perceptions of their ability to provide high-quality care as defined by 6 survey items. Multivariate analyses controlled for the effects of personal, professional, and practice characteristics. RESULTS: Among FP/GPs in 1996-1997, more than 17% were dissatisfied. Age was the most significant personal factor associated with dissatisfaction; 25.1% of those aged 55 to 64 years reported dissatisfaction compared with only 10.1% of those younger than 35 years. Other personal or professional characteristics significantly associated with FP/GP dissatisfaction included osteopathic training, graduation from a foreign medical school, full practice ownership, and an income of less than $100,000. Physicians dissatisfied with their careers were much more likely to report difficulties in caring for patients, strongly disagreeing (vs strongly agreeing, odds ratio [OR] 1.0) that they had enough clinical freedom (OR 7.89; 95% confidence interval [CI], 4.86-12.83); continuous patient relationships (OR 7.11; 95% CI, 4.90-10.33); no financial penalties for clinical decisions (OR 4.44; 95% CI, 3.13-6.31); adequate time with patients (OR 4.42; 95% CI, 2.84-6.87); ability to provide quality care (OR 4.26; 95% CI, 2.88-6.31); and sufficient communication with specialists (OR 3.57; CI, 2.20-5.80). CONCLUSIONS: An inability to care for patients is significantly associated with career dissatisfaction. This relationship has implications for the achievement of policy objectives related to access, having a usual source of care, and quality.

Adult↗

PubMed2002

The effects of organizational culture on nursing professionalism: implications for health resource planning.

The organizational structure of many hospitals conflicts with the practice of professional nursing, adversely affecting patient outcomes. The ability of nurses to practise in a professional manner may be influenced by the organizational culture of their work environment. Personal attributes may also play a role. Patient outcomes depend on the identification and promotion of scarce health resources. Personal investment theory was used as the conceptual foundation for this study because of its ability to blend environmental context and personal behaviours associated with motivation. Secondary data analysis was undertaken to determine whether organizational culture and personal sense of accomplishment can predict nursing professionalism. Multiple regression analysis showed that organizational culture predicted over 16% of the variance in nursing professionalism. Therefore, nursing professionalism and hospital environment featuring a strong organizational culture are two health resources that can promote improved patient outcomes.

Adult↗

PubMed2002

Are women with an unintended pregnancy less likely to breastfeed?

OBJECTIVE: To examine the association between unintended pregnancy and the initiation and duration of breastfeeding. STUDY DESIGN: This was a secondary data analysis of the 1995 Cycle 5 of the National Survey of Family Growth. POPULATION: We studied 6733 first singleton live births to US women aged 15 years to 44 years. OUTCOMES: Using the 1995 Institute of Medicine definitions, pregnancies were classified as intended or unintended; unintended pregnancies were further categorized as either mistimed or unwanted. We measured initiation of breastfeeding and duration of nonexclusive breastfeeding for at least 16 weeks. RESULTS: In this study, 51.5% of women never breastfed, 48.5% initiated breastfeeding, and 26.4% of all women continued breastfeeding for at least 16 weeks. US women with unwanted unintended pregnancies were more likely not to initiate breastfeeding (odds ratio [OR] = 1.76; 95% CI, 1.26-2.44) and more likely not to continue breastfeeding (OR = 1.69; 95% CI, 1.12-2.55) than women with intended pregnancies. White women with unwanted unintended pregnancies were more likely not to breastfeed than those with intended ones (initiation: OR = 2.50; 95% CI, 1.54-4.05; continuation: OR = 2.56; 95% CI, 1.34-4.87). This finding was not seen for black or Hispanic women. CONCLUSIONS: In the United States, women with unwanted pregnancies were less likely either to initiate or to continue breastfeeding than women with intended pregnancies. A strong inverse association between unwanted pregnancies and breastfeeding was observed only for white women. Education for women with unintended pregnancies may improve breastfeeding rates and subsequently, the health of women and infants.

Adolescent↗

PubMed2001

The association between risk-taking behavior and the use of safety devices in adolescents.

The purpose of this research study was to measure the association between risk taking behavior in adolescents and their use of safety devices. The study focused on three safety devices: seat belts, motorcycle helmets, and bicycle helmets. This is a secondary data analysis using data from the Youth Risk Behavior Survey conducted by the Centers for Disease Control and Prevention. The results of this study indicate that risky behavior in adolescents is associated with their non-use of safety devices. In general, risky behavior was more associated with the non-use of seatbelts than the use of other safety devices. The results of this study suggest that a comprehensive approach to reducing risky behaviors in adolescent should be considered when planning injury prevention programs.

Adolescent↗

PubMedDate not supplied

Neighborhood disorder, individual protective factors, and the risk of adolescent delinquency.

Traditionally, violent and delinquent behaviors have been addressed by the criminal justice system, with the focus being secondary and tertiary interventions. During the last decade, the focus on violence as a public health issue has increased. The purpose of this research was to examine how individual protective factors for adolescent delinquency varied according to neighborhood quality. The researcher conducted a secondary data analysis, using data from the National Youth Survey A total of 1,621 adolescents comprised the sample. The majority of the respondents participated in some type of delinquent behavior, with more Blacks reporting participation in violent behaviors. There was a positive relationship between academic history and no participation in delinquent behavior. The regression model for violent delinquency accounted for 10% of the variance in the disordered neighborhoods. Primary prevention efforts, commonly used by public health nurses, should be aimed at eliminating risk factors such as those found in disordered neighborhoods.

Adolescent↗

PubMedDate not supplied

Socioeconomic status, sense of coherence and health in Canadian women.

OBJECTIVE: The purpose of this study was to explore the role of sense of coherence (SOC) in the relationship between household income and self-rated health among Canadian women. SOC is a global orientation that enables one to perceive events of the world as comprehensible, manageable, and meaningful. METHODS: A secondary data analysis was conducted using the National Population Health Survey 1994-95. Only women between the ages of 20 and 64 (n = 6748) were selected for this study. Data were analysed using multivariate path analyses. RESULTS: SOC is a psychosocial factor that intervenes in the income and health relationship. It did not function, however, as an interaction buffer to ameliorate the adverse effects of low income on health. CONCLUSION: This study lends support for public health interventions that target the socioeconomic conditions that influence health, and for strategies that foster the development of a strong SOC.

Adult↗

PubMed2003

Economics of suboptimal drug use: cost-savings of using JNC-recommended medications for management of uncomplicated essential hypertension.

OBJECTIVES: To quantify potential cost-savings associated with better compliance with the guidelines of the Joint National Committee on Detection, Evaluation, and Treatment of High Blood Pressure UNC V) and to determine whether suboptimal utilization of medications is associated with higher costs for other health services. STUDY DESIGN: Secondary data analysis using the Medical Expenditure Panel Survey (MEPS) conducted by the Agency for Healthcare Research and Quality and the National Center for Health Statistics. A complex sampling design was used to provide nationally representative estimates. METHODS: From interviews with a population-based and nationally representative sample of 22 601 individuals, 1588 patients with essential hypertension without other comorbid cardiovascular conditions were selected, representing 19.6 million patients in the United States in 1996. All medical treatments for essential hypertension in 1996 were extracted from the MEPS. Using the JNC V guidelines, prescriptions used in treating essential hypertension were categorized into first-line drugs (diuretics and beta-blockers), second-line drugs (calcium-channel blockers and angiotensin-converting enzyme inhibitors), and third-line (nonrecommended) drugs. Nonprescription expenditures were calculated. Multivariate analyses were performed to determine whether use of the first-line drugs was associated with cost-savings. RESULTS: Compliance rate with the JNC guidelines was low. About 36%, 67%, and 87% of patients in the nation received first-, second-, and third-line drugs, respectively, at some point during 1996. Prescription expenditure constituted more than 67% of the total expenditures for treating essential hypertension. The use of first-line drugs (vs second-line drugs) was associated with expenditures that were dollar 2.6 billion to dollar 3.2 billion lower. CONCLUSIONS: Compliance with the JNC guidelines for treating essential hypertension may reduce the costs of prescriptions and other medical services. Raising awareness of the JNC guidelines is crucial to achieve cost effectiveness in choosing treatment alternatives.

Antihypertensive Agents↗

PubMed2003

[Awareness and periconceptional use of folic acid among non-western and western women in the Netherlands following the 1995 publicity campaign].

OBJECTIVE: To investigate the influence of ethnicity on the awareness and use of folic acid by pregnant women. DESIGN: Secondary data analysis. METHOD: Using the data on 1555 women, collected during a cross-sectional study conducted among pregnant women with good knowledge of the Dutch language in 1996, the authors determined what was known about the recommendation to use folic acid around the time of conception and what the actual use was. Women were defined as either 'western' or 'non-western' on the basis of the place of birth of the woman and her parents. RESULTS: Of the 1555 pregnant women, 74 (5%) were non-western or of non-western descent. Non-western women more often had a lower educational level than western women (51% versus 34%; p = 0.002) and more often had an unintended pregnancy (24% versus 8%; p < 0.0001). 41% of the non-western women had heard of the recommendation to use folic acid before pregnancy, compared to 79% of the western women (p < 0.0001). However, the use of folic acid was not significantly different between non-western and western women (56% versus 69%) if they had been aware of the recommendation to use folic acid before pregnancy. Awareness of the recommendation to use folic acid was higher in older women (OR: 1.46; 95% CI: 1.13-1.89), women of western descent (0.27; 0.16-0.47), women with a higher level of education (0.35; 0.27-0.45) and in case of planned pregnancy (0.45; 0.31-0.67). The use of folic acid, restricted to women who were aware of the recommendation to use folic acid before their pregnancy, was higher in older women (1.37; 1.05-1.80) and lower in those with more previous pregnancies (0.57; 0.43-0.75) and in case of an unplanned pregnancy (0.55; 0.34-0.88). CONCLUSION: Although non-western women had less knowledge of the recommendation to use folic acid than western women, the use of folic acid was not significantly different from that by western women if they had been aware of the recommendation to use folic acid before pregnancy. Continued education on folic acid targeting non-western and western women is important.

Adolescent↗

PubMed1992

Side effects associated with lithium and placebo administration in aggressive children.

This study represents a secondary data analysis of two double-blind and placebo-controlled clinical trials of lithium, performed to contrast side effects associated with lithium administration to those associated with placebo. The sample consisted of 91 hospitalized children, aged 5.12 to 12.92 years (mean 9.16), diagnosed as having conduct disorder characterized by severe aggressiveness and explosiveness. Daily doses of lithium ranged from 250 to 2100 mg. During the entire treatment period, more side effects were seen in the lithium group than in the placebo group, whereas during the therapeutic dose period, the difference between side effects in the two groups diminished. The most common side effects seen exclusively with lithium administration included enuresis, fatigue, and ataxia. Increased aggressiveness was observed in 4 children who received placebo. Vomiting, headache, and stomachache were the most common side effects experienced by patients in both lithium and placebo groups. However, more patients experienced these side effects in the lithium group than in the placebo group.

Aggression↗

PubMedDate not supplied

Health status of older Chinese in Canada: findings from the SF-36 health survey.

BACKGROUND: Despite the fact that the Chinese belong to the largest visible minority group in Canada, there is little research findings on their health status, particularly the aging adults. This research aimed at bridging the knowledge gap by examining the health status of this population and comparing the health status between the Chinese aging population and the general aging population in Canada. METHODS: Secondary data analysis of data obtained from a multi-site study, Health and Well Being of Older Chinese in Canada, and from the Medical Outcomes Study 36-item Short Form (SF-36). The SF-36 published scores obtained from the same age cohorts in the Canadian Multicentre Osteoporosis Study were used for comparison purposes. Independent samples t-tests were used to compare the statistical significance of the two groups. RESULTS: Overall, older Chinese-Canadians reported better physical health than all older adults in the Canadian population. However, the older Chinese in all age and gender groups scored lower in the mental component summary (MCS). Despite the age differences, Chinese women reported statistically poorer health than the Chinese men in all of the 8 health domains. CONCLUSION: The data are useful for forming baselines for monitoring the effectiveness of future health interventions for this population. Efforts by service providers to address the health needs of older Chinese-Canadian women, the most vulnerable subgroup in this study, are essential. Interventions are also needed to address the poor mental health status in this ethnic minority group.

Age Distribution↗

PubMed2003

Predictors of health-promoting behavior of African-American and white caregivers of impaired elders.

Several longitudinal studies have examined declines in health of caregivers, but few have explored the health-promoting behavior Because caregivers neglect their health, they are at risk for developing a number of physical and psychological problems. What is not well known are the factors that contribute to increased health-promoting behavior ultimately preventing poor health and premature death. Therefore, the purpose of this study was to explore the predictors and the change in predictors of health-promoting behavior in African-American and White caregivers over a 3-year period. Pender, Murdaugh, and Parsons' (2002) health promotion model guided the study. This present study is a secondary data analysis of a larger study aimed at examining predictors of health-promoting behavior among 66 African-American (n=66) and 110 (n=110) and White caregivers of impaired older adults recruited primarily through random digit dialing. The larger data set consisted of 391 (N=391) subjects (n=136 African-American; n=255 White). The larger prospective study was based on face-to-face interviews. In the original study, trained interviewers collected data on depression, psychological distress, self-perceived health, religiosity, number of chronic conditions, and demographic characteristics using well-established instruments. Data in this present study were collected at three time points over a three-year period with one-year intervals at Time1 (T1), Time2 (T2), and Time3 (T3). Analysis of the data in this present study suggested that, although, the number of health-promoting behaviors significantly differed for African-American and White caregivers at T1, T2, and T3, no predictors were significantly associated with a change in health-promoting behavior over time. Nonetheless, this finding suggests that nurses can develop useful information in helping to focus more attention on the health of caregivers in the future.

Adult↗

PubMed2004

Case payment and the adoption of new technology: an empirical study of cataract surgery in Taiwan.

BACKGROUND: Case payment for cataract surgery with Government Employee Insurance (GEI) was implemented at Chang Gung Memorial Hospital (CGMH) in March 1994, and fee-for-service (FFS) was retained for cataract inpatients with or without other health insurance. We examined the impact of this change in the reimbursement policy from FFS to case payment on the health care provider's practice behavior towards a new emerging technology, using cataract surgery as an example. METHODS: Secondary data analysis was performed using 1 year of CGMH data before (period 1, from March 1993 to February 1994) and after (period 2, from March 1994 to February 1995) implementing the new policy. Inpatient records for cataract surgery using either extracapsular cataract extraction (ECCE, the old technology) or phacoemulsification (Phaco, the new technology) were included. Logistic regression models were employed to assess how case payment affected the health care provider's adoption of new technology. RESULTS: The percentage of cases treated using the new Phaco technology grew from period 1 (6.6%) to period 2 (23.6%) among all 4 study groups, despite Phaco being more expensive than ECCE. More importantly, the increment ratio of Phaco use from periods 1 to 2 was the smallest for GEI patients (3.26-fold) when compared with the other 3 groups (4.16-5.29-fold). CONCLUSIONS: Both new technology and cost containment strategies should be taken into account when setting up a reimbursement policy.

Adult↗

PubMed2004

[Body-mass index cut-off values for underweight in Dutch children].

OBJECTIVE: To determine the cut-off values for the body-mass index (BMI) for underweight and serious underweight in children up to 18 years of age based on the Dutch growth standards of 1980, and to determine the prevalence of underweight and serious underweight in the 1997 Dutch growth-study figures. DESIGN: Secondary data analysis. METHOD: Cut-off values for underweight were determined by first calculating the percentage of 18-years old with a BMI < 18.5 kg/m2 in 1980, followed by a calculation of the BMI at younger ages under which the same percentage fell. Serious underweight in 18-year olds was defined as a BMI < 17.0 kg/m2. RESULTS: Between 1980 and 1997 the prevalence of serious underweight increased in children aged between 2 and 6 years from 1.5% to 3.6% and from 2.9% to 3.3%, in boys and girls respectively. In older children (7-18 years) the prevalence decreased from 1.5% to 1.4% for boys and from 2.9% to 1.7% for girls. CONCLUSION: Not only did the median weight of the population increase between 1980 and 1997, but there was also a rise in the variation of the weights at any given age. The latter could reflect more marked health differences.

Adolescent↗

PubMedDate not supplied

Screening for infants' and toddlers' dietary quality through maternal diet.

PURPOSE: To investigate the relationship of mothers' dietary quality to that of their infants and toddlers in limited-income families at risk for poor health. STUDY DESIGN AND METHODS: Secondary data analysis was conducted of dietary quality from 24-hour dietary recalls collected from 113 mother-infant/toddler pairs in limited-income families with a child at age 6 months and again at age 14 months. Dietary quality of mothers was evaluated on the basis of eating breakfast and having at least one serving of the five food groups from the Food Guide Pyramid. Diet quality of infants was determined by comparison to the Women, Infants, and Children feeding guidelines for their ages; the diet quality of the mother was then compared to that of her infant and, later, toddler. RESULTS: Most mothers and their infants had poor diet quality at the first interview. By 14 months most mothers still had poor diet quality, but diet quality for the children improved such that only about one-half remained poor. Poor diet quality of mothers was useful to detect poor diet quality for her infant or toddler showing high concordance at both interviews. CLINICAL IMPLICATIONS: A consistent marker for infants at risk for poor diet quality is having a mother who skipped breakfast and omitted fruits, vegetables, or dairy products. This could be a quick indicator to identify those at greatest risk for not following recommended guidelines in feeding their infants and toddlers.

Adult↗

PubMed2004

Prevalence of overweight, obesity, and comorbid conditions among U.S. and Kentucky adults, 2000-2002.

INTRODUCTION: Obesity rates for adults in Kentucky are regularly among the highest in the nation. Since 1991, adult obesity in Kentucky and the United States has nearly doubled. This trend is of great concern because excess weight has been associated with several chronic diseases and conditions. This paper reports on the prevalence of overweight and obesity among adults in Kentucky between 2000 and 2002. The estimates produced by this study will provide baseline figures for developing Kentucky's statewide obesity action plan. METHODS: A secondary data analysis was performed using the Centers for Disease Control and Prevention's Behavioral Risk Factor Surveillance System. Prevalence estimates and odds ratios were calculated for the United States and Kentucky. RESULTS: In Kentucky, 24.2% of adults were obese, compared with 21.9% nationally (P < .001). There were also significantly more overweight adults in Kentucky than there were nationwide (P < .001). Logistic regression showed that overweight and obese adults were more likely to report various comorbid conditions. CONCLUSION: Overweight and obesity estimates in Kentucky were significantly higher than nationwide figures. However, overweight/obese adults in Kentucky were no more likely than their U.S. counterparts to report selected comorbid conditions.

Adolescent↗

PubMed2005

Relationship of C-reactive protein and bone mineral density in community-dwelling elderly females.

OBJECTIVE: Inflammatory cytokines have been shown to play an important role in bone remodeling. We hypothesized that higher levels of C-reactive protein (CRP) are associated with low bone mineral density (BMD) in elderly females. DESIGN: Secondary data analysis of the Third National Health and Nutrition Examination Survey. PARTICIPANTS: 2,807 females 65 years and older. RESULTS: CRP was associated with BMD in the bivariate sis (p<0.001) but not in the multivariate analysis (p=0.23) Age, ethnicity, body mass index (BMI), hormone replacement therapy (HRT) and immobility were independently associated with BMD. CONCLUSIONS: CRP may be useful in screening for osteoporosis among community-dwelling elderly females. However, CRP appears to act as a surrogate for other factorsdirectly associated with osteoporosis. Further studies are needed to validate these findings.

Aged↗

PubMed2005

Does provision of health counseling differ by patient race?

BACKGROUND AND OBJECTIVES: Empirical data on health counseling provided to patients of different racial groups in primary care settings are limited, and existing studies have yielded inconsistent findings. This study's purpose was to use a national medical care survey to examine whether the visit-based rates of health counseling/education differed between black and white patients in primary care practice settings. METHODS: We performed secondary data analysis of visits to primary care providers made by black and white adult patients in the National Ambulatory Medical Care Survey (NAMCS). RESULTS: From 1997 to 2000, visits by adult patients to their own primary care providers accounted for 41% of all ambulatory care visits. White patients made approximately 961 million of these visits, and black patients made about 120 million visits. Black patients were more likely to get health counseling for diet (odds ratio [OR]=1.2, 95% confidence interval [CI]=1.1-1.4), exercise (OR=1.3, 95% CI=1.1-1.5), and human immune deficiency virus/sexually transmitted disease (HIV/STD) (OR=3, 95% CI=1.7-5.1) but less likely to get mental health counseling (OR=0.6, 95% CI=0.4-.09) as compared with white patients. Stratifying by visit type, blacks had lower rates of receiving exercise counseling during non-illness care visits (18.9% versus 14.8%). There were no statistically significant differences in dietary or exercise counseling between black and white patients with diabetes or hypertension. CONCLUSIONS: Black patients received similar or higher rates of certain types of health counseling than whites during the clinical encounters with their primary care providers. However, there was a significantly lower rate of mental health counseling provided to black patients. Reasons for this disparity require further investigation.

Adolescent↗

PubMed2005

Racial disparities in prescription drug use for mental illness among population in US.

BACKGROUND: Racial minorities are a rapidly growing portion of the US population. Research suggests that racial minorities are more vulnerable to mental illness due to risk factors, such as higher rates of poverty. Given that the burden of mental illnesses is significant, equal likelihood of mental health services utilization is important to reduce such burden. Racial minorities have been known to use mental health services less than Whites. However, it is unclear whether racial disparity in prescription drug use for mental illnesses exists in a nationally representative sample. For a valid estimation of prescription drug use patterns, the characteristic in the distribution of prescription drug use should be accounted for in the estimation model. AIMS OF THE STUDY: This study is intended to document whether there was a disparity in psychiatric drug use in both extensive and intensive margins between Whites and three racial minorities: Blacks, Hispanics, and Asian-Indians. The study looked at several specified mental illnesses, controlling for underlying health status and other confounding factors. METHODS: Secondary data analysis was conducted using the multiyear Medical Expenditure Panel Survey (MEPS), a nationally representative panel sample from 1996 through 2000. This analysis provides estimates of the actual expenditure on prescription drug use for people with specified mental illnesses for this study, based on comparison of Whites and other racial minorities. We derived the estimates from the two-part model, a framework that adjusts the likelihood of using prescription drugs for the specified mental illnesses while estimating the total actual expenditures on prescription drugs among the users. RESULTS: This study found that Blacks, Hispanics, and Asian-Indians were less likely than Whites to use prescription drugs by 8.3, 6.1 and 23.6 percentage points, respectively, holding other factors constant in the sample, with at least one of the specified mental illnesses. The expenditure on prescription drugs for the specified mental illnesses differs between each of racial minorities (Blacks, Hispanics, and Asian-Indians) and Whites even after adjusting for the different likelihood of using those prescription drugs. Blacks, Hispanics, and Asian-Indians with the specified mental illnesses were estimated to spend 606.53 US dollars, 9.83 US dollars and 179.60 US dollars less per year, respectively, on their actual prescription drugs than Whites. DISCUSSION: This study concludes that three racial minorities: Blacks, Hispanics, and Asian-Indians, with the specified mental illnesses are less likely to use psychiatric drugs than Whites. Among users, racial minorities use less psychiatric drugs than Whites in terms of actual spending on those drugs. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: There is a need to focus on a program to reach out to racial minorities with a diagnosis of mental illnesses, and this program should consider the cultural specificity of each minority group regarding mental illnesses. IMPLICATIONS FOR HEALTH POLICIES: In the development of mental health policy, it is crucial to understand the underlying non-socioeconomic factors which may significantly determine the access to mental health service. Also, education programs or other outreach programs for racial minorities are necessary to understand the different distribution of mental health services for racial minorities. IMPLICATIONS FOR FURTHER RESEARCH: Future research should examine the causes for racial disparity in the use of prescription drugs for mental illness both in the extensive and intensive margins. An in-depth analysis is needed to map out the attributes for the observed disparity between Whites and racial minorities in mental health service use.

Adolescent↗