Andersen's Model Research Articles

The systematic medical appraisal, referral and treatment (SMART) mental health programme: Formative research informing a cluster randomized controlled trial

BackgroundGaps exist between prevalence and treatment options for mental disorders in India. Limited awareness, poor help-seeking, scarcity of trained mental health professionals, limited mental health services and stigma are few examples of reasons contributing to treatment gap. AimsThis paper highlights findings from formative research of a primary mental healthcare model comprising of a preliminary feasibility testing of the Electronic Decision Support System (EDSS) to provide care using mobile based applications, perceptions of the community towards mental health and incorporating cultural adaptations for pre-existing anti-stigma campaign materials. MethodsA cross-sectional mixed methods approach tested the user acceptability of the electronic decision support system EDSS for accredited social health activists (ASHAs) and Primary Health Centre (PHC) doctors using tablets in two villages and two PHCs in rural Haryana (Northern India). Five focus groups and six in-depth interviews along with non-participant observations were used to ascertain community perceptions about various aspects related to mental health. Findings of the study were analyzed and interpreted against the key themes of Andersen's model. ResultsOut of a total of 553 individuals screened for common mental disorders, 51 (9.2%) were screened positive and 32 visited PHC doctors for treatment. There was limited knowledge about common mental disorders amongst community; need to train primary health workers to identify and treat mental disorders; and incorporate cultural adaptation of anti-stigma awareness materials. ConclusionsThe EDSS was found to be acceptable and feasible by primary and community health workers. The findings guided refining of the intervention prior to implementation of a large-scale cluster randomized controlled trial.

Assessment of Factors Influencing Utilization of Maternal and Child Health Services in The Federal Capital Territory (FCT), Abuja, Nigeria

Background: Although Nigeria has made progress in attaining the third sustainable development goal, maternal and child mortality remains a challenge to attaining universal health coverage. Utilization of maternal and child health services (MCH) is not uniform in the country, with the southern region outperforming the northern region, and within the northern region, the north central is outperforming the North West and east. Even in the north central, majority of state lag behind the federal capital territory (FCT), Abuja, in the uptake of MCH services. This study aimed to understand the determinants of maternal and child health service uptake in FCT. The evidence generated should help expand MCH services delivery in the FCT and other similar settings in Nigeria and beyond. Methodology: The research adopted a cross-sectional, mixed methods design in Bwari and Kuje Area Councils of Abuja, using a synthesis of the Ensor and Cooper demand and supply paradigm of health service uptake and the Andersen and Newman Behavioural Model for health service utilization. Qualitative data was obtained through Key Informant Interviews, In-Depth Interviews, and Focus group discussions with parents of under-five year children, pregnant women, health workers, program managers and community leaders. Quantitative data was collected through a household survey of women of childbearing age, using modified WHO Health Access and Use household survey questionnaire. Thematic analysis of the qualitative data was done to determine patterns relevant study objectives using Dedoose software. Quantitative analysis involved univariate descriptive analysis of respondents’ socio-demographics and multivariate logistic regression to determine the predictive value and relative importance of the predisposing, enabling, and needs determinants of MCH uptake. Result: Factors that favoured the uptake of MCH services included service availability, affordable cost of care, accessibility and proximity of health facilities, and perceived good knowledge and capacity of health workers. No religious or cultural barrier to MCH service uptake was reported. Education and employment status were statistically significant determinants of ANC uptake. Religion, level of education, and employment were statistically significant predisposing determinants of having skilled birth attendance (SBA). Also, employment and educational status were statistically significant predisposing factors of immunization uptake. Financial barriers, poor knowledge of availability services, previous negative experience with service utilization, poor perception on the value of MCH services were factors limiting uptake of MCH services. Conclusion: The study concludes that both demand and supply determinants of MCH services utilization were functionally demonstrated in the study area. However, the lack of health insurance scheme is a key limitation for universal coverage of MCH services in the study area. We recommend continuous improvement in health facility infrastructure and human resources capacity building by public authorities, to sustain and improve the current level of MCHs services delivery in the area. Furthermore, government should scale up the roll out of its national health insurance scheme to cover more enrollees.

Using Andersen’s behavioral model of health care use for intermittent preventive treatment of malaria in pregnancy in Nigeria

BackgroundStudies in Nigeria and elsewhere in sub-Saharan Africa (sSA) have explored factors influencing usage of intermittent preventive treatment of malaria in pregnancy (IPTp). Most studies, however, are not model or theory-based, which provides less satisfactory guidance to malaria control programming. This study fills the knowledge gap by adapting Andersen’s behavioral model of health care use to IPTp usage in Nigeria.MethodsThis study adopted a cross-sectional design that utilized secondary data extracted from the 2018 Nigeria Demographic and Health Survey (NDHS). A weighted sample of 4,772 women who had given birth in the past year preceding the survey, was analyzed. Outcome variable was usage of IPTp, dichotomized into optimal or otherwise. Explanatory variables cut across individual and community levels and were divided into predisposing, enabling and need factors in line with the theoretical constructs of the Andersen model. Two multilevel mixed-effects logistic regression models were fitted to identify factors which influenced optimal usage of IPTp. Analyses were performed using STATA 14. Statistical significance was set at 5%.ResultsRealised level of optimal IPTp usage was 21.8%. Factors that either predispose or enable pregnant women to take optimal doses of IPTp were maternal education, being employed, being autonomous in their own healthcare, health insurance enrolment, partner education, receiving antenatal care in public health facilities, rural residence, being resident in northern geo-political zones, community literacy level and community perception of the consequences of malaria. Two significant need factors affecting optimal usage of IPTp were timing of the first antenatal care visit and sleeping under mosquito bed nets.ConclusionOptimal usage of IPTp is low among pregnant women in Nigeria. There is a need to devise additional public health educational programs promoting IPTp usage through the formation of Advocacy, Communication and Social Mobilisation (ACSM) in every ward in all local government areas, particularly in the rural and northern parts of the country. In addition, health planners should adopt the Andersen model for assessing key determinants of IPTp usage among childbearing women in Nigeria.

Factors affecting the use of herbal medicines for weight loss in overweight and obese adolescents.

Herbal medicine (HM) is widely used to treat obesity in adolescents worldwide since the currently available interventions have low compliance and lack long-term effects and safety data. This study aimed to analyze the factors affecting HM use for weight loss in overweight and obese adolescents. A total of 46,336 adolescents were included in this cross-sectional study based on the Korea Youth Risk Behavior Web-Based Survey. Three models of HM use for weigh loss were developed by sequentially adding predisposing, enabling, and need factors according to Andersen's model using multiple logistic regression analyses considering the complex sampling design. Male and female high school students and students from low perceived household economic status were less likely to use HM for weight loss. Students whose fathers had a college degree or higher, depressed mood, and two or more chronic allergic diseases were more likely to use HM. Male students who perceived their body image as fat or very fat tended to use HM less than those who perceived their body image as very thin, thin, or moderate. Obese female students tended to use HM more than overweight female students. These results can be used as the bases to promote HM use, provide ideas for future research, and strengthen the health insurance coverage extension for weight loss interventions.

Performance improvement in neutron-shielding ultra-high performance mortar prepared with alkaline-treated boron carbide

Boron-containing compounds are known for their excellent radiation shielding capability against slow neutrons. To prepare an unalkaline and alkaline-treated industrial-grade boron carbide neutron-shielding radiation ultra-high performance mortar (UHPM) with varying cement replacement ratios, a modified Andreasen＆Andersen (A&A) model was employed for ratio optimization based on the tightest stacking design theory. The performance levels, compressive strengths, microstructures, pore structures, and other properties of the specimens were subsequently tested. The researchers utilized Monte Carlo simulation software (MCNP) to simulate the transmission rate, half-value layer, and macroscopic cross-section of the boron carbide UHPM and then evaluate its neutron radiation shielding capability. The results of this study indicate that the addition of unalkalized industrial-grade boron carbide decreased the compressive strength of the specimen, retained good flowability, and increased porosity. In contrast, alkaline-treated boron carbide overcame the adverse effects caused by the acid (at a 10% replacement rate, the strength of the alkaline-treated boron carbide UHPM increased by 20.8% relative to the unalkalized boron carbide) and optimized the pore structure. The addition of boron carbide significantly improved shielding in the UHPM specimens against slow neutrons but had limited effects on the shielding against fast neutrons. Thus, alkaline-treated boron carbide could be an effective and promising material for preparing high-strength neutron-shielding mortars.

Can government subsidies and public mechanisms alleviate the physical and mental health vulnerability of China’s urban and rural residents?

BackgroundPoverty vulnerability has been defined as the likelihood of a family falling into poverty in the upcoming months. Inequality is a major cause of poverty vulnerability in developing countries. There is evidence that establishing effective government subsidies and public service mechanisms significantly reduces health poverty vulnerability. One of the ways to study poverty vulnerability is by using empirical data such as income elasticity of demand to perform the analysis. Income elasticity refers to the extent to which changes in consumers’ income affect changes in demand for commodities or public goods. In this work, we assess health poverty vulnerability in rural and urban China. We provide two levels of evidence on the marginal effects of the design and implementation of government subsidies and public mechanisms in reducing health poverty vulnerability, before and after incorporating the income elasticity of demand for health.MethodsMultidimensional physical and mental health poverty indexes, according to the Oxford Poverty & Human Development Initiative and the Andersen model, were implemented to measure health poverty vulnerability by using the 2018 China Family Panel Survey database (CFPS) as the data source for empirical analysis. The income elasticity of demand for health care was used as the key mediating variable of impact. Our assessment was conducted by a two-level multidimensional logistic regression using STATA16 software.ResultsThe first level regression indicates that the marginal utility of public mechanism (PM) in reducing urban and rural vulnerability as expected poverty on physical and mental health (VEP-PH&MH) was insignificant. On the other hand, government subsidies (GS) policies had a positive suppression effect on VEP-PH&MH to a relatively low degree. The second level regression found that given the diversity of health needs across individual households, i.e., the income elasticity of demand (HE) for health care products, PM and GS policies have a significant effect in reducing VEP-PH&MH in rural and urban areas. Our analysis has verified the significant positive impact of enacting accurate GS and PM policies on effectively reducing VEP-PH&MH in rural as well as urban areas.ConclusionsThis study shows that implementing government subsidies and public mechanisms has a positive marginal effect on reducing VEP-PH&MH. Meanwhile, there are individual variations in health demands, urban-rural disparities, and regional disparities in the effects of GS and PM on inhibiting VEP-PH&MH. Therefore, special consideration needs to be given to the differences in the degree of health needs of individual residents among urban and rural areas and regions with varying economic development. Furthermore, considerations of this approach in the current worldwide scenario are analyzed.

Suicidal ideation and mental health care: Predisposing, enabling and need factors associated with general and specialist mental health service use in France.

Population-based studies have shown that less than one in two individuals reporting suicidal ideation also report past-year mental health service use. Only a few studies have looked at different types of providers consulted. There is a need to better understand the factors associated with different provider combinations of mental health service use in representative samples of individuals with suicidal ideation. The aim of the current study is to assess, using Andersen's model of healthcare seeking behaviors, the predisposing, enabling and need factors associated with type of mental health service use in adults with past-year suicidal ideation. Data were drawn from the 2017 Health Barometer survey, a representative sample of the general population aged 18 to 75 years, among whom 1,128 respondents had reported suicidal ideation in the past year were analyzed. Past-year outpatient mental health service use (MHSU) was categorized into mutually exclusive groups as no use, general practitioner (GP) only; mental health professional (MHP) only; and both GP and MHP. Multinomial regression analyses were used to model mental health service use as a function of predisposing, enabling and need factors. Overall, 44.3% reported past-year MHSU and this was higher in females than males (49.0% vs. 37.6%). Prevalence of GP only use in the overall sample was 8.7%, consulting with GP and MHP was 21.3%, consulting with MHP only was 14.3%. Higher education was associated with increased MHP use. Residing in a rural area was associated with increased GP only use. Presence of a suicide attempt within the year, a major depressive episode and role impairment were associated with consulting a GP and MHP, and MHP only, but not GP only. When controlling for need and predisposing factors, socio-economic factors related to employment and income were associated with higher levels of consulting with mental health professionals.

Delay in seeking health care from community residents during a time with low prevalence of COVID-19: A cross-sectional national survey in China.

The pandemic of COVID-19 has significant implications on health resources allocation and health care delivery. Patients with non-COVID illness may have to change their care seeking behaviors to mitigate the risk of infections. The research aimed to investigate potential delay of community residents in seeking health care at a time with an overall low prevalence of COVID-19 in China. An online survey was conducted in March 2021 on a random sample drawn from the registered survey participants of the survey platform Wenjuanxing. The respondents who reported a need for health care over the past month (n = 1,317) were asked to report their health care experiences and concerns. Logistic regression models were established to identify predictors of the delay in seeking health care. The selection of independent variables was guided by the Andersen's service utilization model. All data analyses were performed using SPSS 23.0. A two-sided p value of <0.05 was considered as statistically significant. About 31.4% of respondents reported delay in seeking health care, with fear of infection (53.5%) as a top reason. Middle (31-59 years) age (AOR = 1.535; 95% CI, 1.132 to 2.246), lower levels of perceived controllability of COVID-19 (AOR = 1.591; 95% CI 1.187 to 2.131), living with chronic conditions (AOR = 2.008; 95% CI 1.544 to 2.611), pregnancy or co-habiting with a pregnant woman (AOR = 2.115; 95% CI 1.154 to 3.874), access to Internet-based medical care (AOR = 2.529; 95% CI 1.960 to 3.265), and higher risk level of the region (AOR = 1.736; 95% CI 1.307 to 2.334) were significant predictors of the delay in seeking health care after adjustment for variations of other variables. Medical consultations (38.7%), emergency treatment (18.2%), and obtainment of medicines (16.5%) were the top three types of delayed care, while eye, nose, and throat diseases (23.2%) and cardiovascular and cerebrovascular diseases (20.8%) were the top two conditions relating to the delayed care. Self-treatment at home was the most likely coping strategy (34.9%), followed by Internet-based medical care (29.2%) and family/friend help (24.0%). Delay in seeking health care remained at a relatively high level when the number of new COVID-19 cases was low, which may present a serious health risk to the patients, in particular those living with chronic conditions who need continuous medical care. Fear of infection is the top reason for the delay. The delay is also associated with access to Internet-based medical care, living in a high risk region, and perceived low controllability of COVID-19.

Effect of ceramic waste tile as a fine aggregate on the mechanical properties of low-carbon ultrahigh performance concrete

Overmining of sand from natural resources has seriously impacted the environment, hindering the sustainable development of concrete. Ceramic waste tile has a chemical component similar to that of sand and can be a potentially excellent substitute for sand. Therefore, this study uses 20 %, 40 %, 60 %, 80 %, and 100 % ceramic waste tile aggregate (CTWA) to replace sand in equal amounts to produce low-carbon ultrahigh performance concrete (UHPC). The workability and mechanical properties of UHPC with varying CTWA content is explored. Additionally, the interface transition area (ITZ) and pore structure of UHPC are characterized by scanning electron microscopy (SEM) and mercury intrusion porosimetry (MIP), respectively. Finally, the modified Andersen and Andresen (MAA) model is employed to evaluate the effect of CTWA on the UHPC packing compactness. The results show that the incorporation of CTWA reduces the flowability of UHPC. However, the spread flow for UHPC with 100 % CTWA can also reach a value of 398 mm. The UHPC with 100 % CTWA exhibits better mechanical properties, as reflected by an improvement in compressive strength and flexural strength of 15.5 % and 26.5 %, respectively, at a curing age of 28 d. Moreover, the addition of CTWA shows no significant negative effect on the fracture toughness of UHPC. Microstructure analysis demonstrates that the ITZ and pore structure of UHPC with CTWA are effectively improved due to the internal curing and better particle gradation of CTWA. Therefore, CTWA, with economic and environmental advantages, is a practicable alternative fine aggregate for UHPC.

Evaluation of status quo and determinants of catastrophic health expenditure among empty-nest elderly in China: evidence from the China health and retirement longitudinal survey (CHARLS).

The aging society and the empty nest of the elderly have become issues that cannot be ignored by the Chinese government. Not only does the physical function of the empty-nest elderly (ENE) decline, and the incidence and prevalence of chronic diseases increase significantly, but they are also more likely to have loneliness, low life satisfaction, mental health problems, and even a much greater possibility of suffering from depression than the nonempty-nest elderly, besides the possibility of catastrophic health expenditure (CHE) which is also greatly increased. This paper aims to evaluate the status quo of dilemma and determinants of a vast sample of subjects based on the national level. Data were obtained from the latest 2018's data of the China Health and Retirement Longitudinal Study (CHARLS). Under the guidance of Andersen's model of health services utilization, this study clarified the overall and different demographic characteristics and prevalence of CHE among ENE and further built the Logit and Tobit model to explore the determinants of CHE occurrence and its intensity. A total of 7,602 ENE were included in the analysis, and the overall incidence of CHE among them was 21.20%. Poor self-reported health status (OR=2.03, 95% CI: 1.71-2.35), suffering from three or more chronic diseases simultaneously (OR=1.79, 95% CI: 1.42-2.15), low life satisfaction (OR=1.44, 95% CI: 1.20-1.68) and advanced age played the leading role in accounting for its high risk, and its intensity increased 0.0311 (SE=0.005), 0.0234 (SE=0.007), and 0.0178 (SE=0.005), respectively. In contrast, the leading drop in the probability of CHE among ENE was those whose monthly income was over 20,000 CNY (OR=0.46, 95% CI: 0.38-0.55), whose intensity declined 0.0399 (SE=0.005), whose monthly income was between 2,000 and 20,000 CNY (OR=0.78, 95% CI: 0.66-0.90) and whose intensity declined 0.021 (SE=0.005), and who were married during the survey period (OR=0.82, 95% CI: 0.70-0.94). Simultaneously, rural ENE showed more vulnerability and higher risk of CHE when confronted with these factors compared with the urban ones. More attention should be paid for ENE in China. The priority, including the relevant health insurance or social security measurements, should be further strengthened.

A comparative examination of the role of need in the relationship between dental service use and socio-economic status across respondents with distinct needs using data from the Scottish Health Survey

BackgroundDisparities in oral health and distinct patterns in service use related to socio-economic status have been shown to exist in the United Kingdom. A number of studies have used the Andersen behavioural model to better understand the factors that influence utilization and thereby inform policies aimed at improving service uptake. As the nature of need may differ across distinct types of patients, however, so too may the distribution of enabling and pre-disposing factors and observed relationships between need, other factors and service use. In this study we compare samples with distinct self-assessed needs in terms of their characteristics and patterns of service use to compare application of the Andersen model to dental services among respondents to a population based survey.Materials and methodsData were taken from the Scottish Health Survey, for 2019. Data on service use, oral hygiene habits, perceived treatment need, and socio-demographic characteristics were extracted. Data were analysed using descriptive statistics, t-tests and ordered logistic regression analyses.ResultsTwo thousand one hundred forty-eight usable responses were obtained from the survey, 74.95% of the sample had visited the dentist less than a year ago, 11.82% between 1 year and up to 2 years ago, 7.12% between 2 and 5 years ago and 6.10% more than 5 years. Descriptive statistics, t-tests and ordered logistic regression analyses revealed distinct patterns of service use when the sample was partitioned based on perceived treatment need. Specifically those with self-assessed treatment need were older, more likely to smoke, be male and be less likely to have a degree than those who did not. While service use was positively related to age (predisposing) among those who did not have self-assessed treatment need, it was negatively related for those with perceived treatment need. Distinct patterns were also evident with respect to sugar exposure (need) and ease with which time off work could be organised (enabling).DiscussionThe study shows common and distinct patterns of service use related to enabling and predisposing factors across groups differentiated by self-perceived treatment need. If inequalities in health and healthcare use are to be addressed, it is important to understand their origins. Conflation of distinct types of need that may correlate with predisposing and enabling factors complicates this.ConclusionIn applying the Andersen model, it is important to take account of potential differences in the types of need expressed where possible to understand the role of other variables in service use.

Study on the related factors of antiviral treatment in previously reported hepatitis C patients based on the Andersen model

Objective: To understand the basic characteristics of previously reported patients with hepatitis C and analyze the related factors affecting their antiviral treatment. Methods: A convenient sampling method was adopted. Patients who had been previously diagnosed with hepatitis C in the Wenshan Prefecture of Yunnan Province and Xuzhou City of Jiangsu Province were contacted by telephone for an interview study. The Andersen health service utilization behavior model and related literature were used to design the research framework for antiviral treatment in previously reported hepatitis C patients. A step-by-step multivariate regression analysis was used in previously reported hepatitis C patients treated with antiviral therapy. Results: A total of 483 hepatitis C patients, aged 51.73 ± 12.06 years, were investigated. The proportion of male, agricultural occupants who were registered permanent residents, farmers and migrant workers was 65.24%, 67.49%, and 58.18%, respectively. Han ethnicity (70.81%), married (77.02%), and junior high school and below educational level (82.61%) were the main ones. Multivariate logistic regression analysis results showed that married patients with hepatitis C (OR = 3.19, 95% CI: 1.93-5.25, compared with unmarried, divorced, and widowed patients) with high school education or above (OR = 2.54, 95% CI: 1.54-4.20, compared with patients with junior high school education or below) were more likely to receive antiviral treatment in the predisposition module. Patients with severe self-perceived hepatitis C in the need factor module (compared with patients with mild self-perceived disease, OR = 3.36, 95% CI: 2.09-5.40) were more likely to receive treatment. In the competency module, the family's per capita monthly income was more than 1,000 yuan (compared with patients with per capita monthly income below 1,000 yuan, OR = 1.59, 95% CI: 1.02-2.47), and the patients had a high level of awareness of hepatitis C knowledge (compared with patients with a low level of knowledge, OR = 1.54, 95% CI: 1.01-2.35), and the family members who knew the patient's infection status (compared with patients with an unknown infection status, OR = 4.59, 95% CI: 2.24-9.39) were more likely to receive antiviral treatment. Conclusion: Different income, educational, and marital statuses are related to antiviral treatment behavior in hepatitis C patients. Family support of hepatitis C patients receiving hepatitis C-related knowledge and their families knowing the infection status is more important in promoting the antiviral treatment of patients, suggesting that in the future, we should further strengthen the hepatitis C knowledge of hepatitis C patients, especially the family support of hepatitis C patients' families in treatment.

Understanding traditional healer utilisation for hypertension care using the Andersen model: A qualitative study in Mwanza, Tanzania

ABSTRACT Hypertension disproportionately affects people living in African countries, where there are many challenges to appropriate diagnosis and treatment, and many people with hypertension utilise traditional healers as their primary source of healthcare. In this study, we sought to understand factors driving healer utilisation among people with hypertension. We conducted 52 semi-structured interviews with traditional healers, patients and healthcare providers in the Mwanza region of Tanzania. We used the Andersen model of healthcare utilisation to organise our findings on factors driving utilisation of traditional healers for hypertension care. Traditional healers routinely provide care to hypertensive patients and are a critical component of the healthcare landscape. However, healers also operate independently of the biomedical healthcare system, and biomedical providers may hold negative perceptions of healers. Further, healers were described as preferential by patients due to the convenient locations of their practices and perceived improvement of hypertension symptoms with traditional treatment. Finally, healers expressed a desire for more formal collaboration with biomedicine to improve patient care. Our findings may guide future interventions in Tanzanian communities and elsewhere where traditional healers may act as partners to allopathic providers and patients in the continuum of hypertension care.

Applying Andersen's healthcare utilization model to assess factors influencing patients' expectations for diagnostic tests at emergency department visits during the COVID-19 pandemic.

The uncertainties surrounding the COVID-19 pandemic led to a surge in non-urgent emergency department (ED) attendance among people presenting with upper respiratory tract infection (URTI) symptoms. These non-urgent visits, often manageable in primary care, exacerbated ED overcrowding, which could compromise the quality of ED services. Understanding patients' expectations and the reasons for these ED visits is imperative to mitigate the problem of ED overcrowding. Hence, we assessed the factors influencing patients' expectations for diagnostic tests during their ED visits for uncomplicated URTI during different phases of the pandemic. We conducted a cross-sectional study on adults with URTI symptoms seeking care at four public EDs in Singapore between March 2021 and March 2022. We segmented the study period into three COVID-19 pandemic phases-containment, transition, and mitigation. The outcome variables are whether patients expected (1) a COVID-19-specific diagnostic test, (2) a non-COVID-19-specific diagnostic test, (3) both COVID-19-specific and non-COVID-19-specific diagnostic tests, or (4) no diagnostic test. We built a multinomial regression model with backward stepwise selection and classified the findings according to Andersen's healthcare utilization model. The mean age of participants was 34.5 (12.7) years. Factors (adjusted odds ratio [95% confidence interval]) influencing expectations for a COVID-19-specific diagnostic test in the ED include younger age {21-40 years: (2.98 [1.04-8.55])}, no prior clinical consultation (2.10 [1.13-3.89]), adherence to employer's health policy (3.70 [1.79-7.67]), perceived non-severity of illness (2.50 [1.39-4.55]), being worried about contracting COVID-19 (2.29 [1.11-4.69]), and during the transition phase of the pandemic (2.29 [1.15-4.56]). Being non-employed influenced the expectation for non-COVID-19-specific diagnostic tests (3.83 [1.26-11.66]). Factors influencing expectations for both COVID-19-specific and non-COVID-19-specific tests include younger age {21-40 years: (3.61 [1.26-10.38]); 41-60 years: (4.49 [1.43-14.13])}, adherence to employer's health policy (2.94 [1.41-6.14]), being worried about contracting COVID-19 (2.95 [1.45- 5.99]), and during the transition (2.03 [1.02-4.06]) and mitigation (2.02 [1.03-3.97]) phases of the pandemic. Patients' expectations for diagnostic tests during ED visits for uncomplicated URTI were dynamic across the COVID-19 pandemic phases. Expectations for COVID-19-specific diagnostic tests for ED visits for uncomplicated URTI were higher among younger individuals and those worried about contracting COVID-19 during the COVID-19 pandemic. Future studies are required to enhance public communications on the availability of diagnostic services in primary care and public education on self-management of emerging infectious diseases such as COVID-19.

Access for those who want or for those who can? Equity in the use of doctor's appointments in Portugal based on the HIS 2019.

Horizontal equity in the use of healthcare implies equal use for equal needs, regardless of other factors - be they predisposing or enabling (Andersen's model). This study aimed to assess equity in the use of doctor's appointments in Portugal in 2019, comparing the results with those obtained in a previous study, based on data from 2014. Data were retrieved from the Health Interview Survey 2019 (HIS 2019). Healthcare is measured by the number of doctor's appointments. Our study adopted the Negative Binomial Model to assess the factors affecting use. The concentration index was calculated to quantify income-related inequality/inequity. Compared to 2014, the effects of self-assessed health, limitations in daily living activities, and longstanding illnesses are more pronounced, and the region, income, household type and marital status are significant for appointments scheduled with a General Practitioner. In the case of appointments with specialists, health insurance lost statistical significance and the effect of education dropped; however, income became significant. The inequity index is not significant for appointments scheduled with a General Practitioner, as in 2014, but the (significant) value of this index increased for appointments with other specialists.

Fredrickson–Andersen model in two dimensions

The present article overviews recent mathematical advances on the Fredrickson–Andersen kinetically constrained spin model in two dimensions. It was introduced in physics as a toy model for recovering the glassy phenomenology in supercooled liquids close to the glass transition via dynamic constraints as opposed to static interactions.

Factors associated with recent and regular non-use of dental services by students from a university in southeastern Brazil: a cross-sectional study

BackgroundLack of use of dental services can be a risk factor for oral health. In addition to recent visits to dental services, it is important to assess the regularity of use of these services, as well as the motivations for visiting the dentist. There is a gap in literature studies on the patterns of use of oral health services by the young university students. The goal of this study was to assess the factors associated with recent and regular non-use of dental services by young university students, using the Andersen model as a reference.MethodsThis was a cross-sectional study with 477 university students between 18 and 24 years old, carried out as a web survey, through which predisposing, enabling and need variables were collected, according to the model proposed by Andersen, to test the factors associated with recent and regular non-use of dental services. Bivariate analyses and robust Poisson regression were performed, with estimation of crude and adjusted prevalence ratios, using confidence intervals of 95%. The variables with p < 0.05 remained in the final model.ResultsThe prevalence of recent non-use was of 19.5% (95% CI 16.0–23.3%), and of regular non-use, of 53.5% (95% CI 48.9–58.0%). After the adjusted analysis, the following were found to be associated with the outcome of recent non-use: type of service used (PR = 0.91; 95% CI 0.85–0.98) and perceived need for dental treatment (PR = 0.98; 95% CI 0.97–0.99); and the following variables were associated with regular non-use: father’s level of education (PR = 0.86; 95% CI 0.78–0.96), area of study (PR = 1.08; 95% CI 1.02–1.15), reason for last dental appointment (PR = 0.81; 95% CI 0.75–0.88), use of dental services throughout childhood (PR = 0.92; 95% CI 0.86–0.97), self-perceived oral health (PR = 0.86; 95% CI 0.76–0.88), and toothaches over the last 2 years (PR = 0.93; 95% CI 0.87–0.99).ConclusionThe motivation for young university students to use dental services are curative treatment needs, not prevention. The results point to the need to implement health prevention and promotion policies in higher education institutions and to expand access to dental services for this young population.

Barriers and enablers to help-seeking behaviour for mental health reasons among community dwelling older adults with anxiety: Mixed-methods systematic review

• There is no one model that can depict the complexity of help-seeking behaviour. • Help-seeking is affected by contextual, interpersonal and individual factors. • Help-seeking represents a dynamic self-regulatory system. • Individual need factors play an important role in help-seeking. • Coherence between representations of illness, actions, immediate and higher-order goals is important. Despite their high prevalence and negative consequences, anxiety disorders in older adults remain underdiagnosed and undertreated, creating an ‘anxiety treatment gap’. To address this treatment gap, it is essential to identify barriers and enablers to help-seeking behaviour among this population. This mixed-methods systematic review used Andersen's Model and Leventhal's’ Common Sense Model (CSM) in a “best-fit” framework synthesis to explore barriers and enablers to help-seeking behaviour for mental health reasons among older adults with anxiety. A comprehensive search of six databases, last updated on 6 April 2022, led to the inclusion of thirteen records published 2011-2022. Quantitative data were synthesised using Andersen's Model, summarised using vote counting based on direction of effect, and focused mainly on factors at the individual level. Qualitative synthesis generated an extended conceptual model which includes a priori themes derived from Andersen's Model and Leventhal's CSM and new themes identified via inductive analysis. The role of individual need factors on help-seeking behaviour was corroborated by both quantitative and qualitative evidence. The overarching theme is ‘coherence’ as a multilevel concept. It was not possible to aggregate effect estimates extracted from quantitative records. The internal validity of the review is affected by scant evidence, quality of the qualitative records and lack of triangulation of evidence. There is no one model that can depict the complexity of help-seeking behaviour among older adults with anxiety. A better understanding of the role of need factors and the multi-level concept of ‘coherence’ on help-seeking behaviour is required. Conceptual Model representing the elements, phases and processes underlying illness-seeking behaviour among older adults with anxiety (print in colour)

Utilisation willingness for institutional care by the disabled elderly and its influencing factors based on Andersen’s model: a cross-sectional survey of Henan, China

ObjectiveTo explore the factors that influence institutional care for the disabled elderly in China and the key factors that influence individuals based on the Andersen model.DesignCross-sectional survey.SettingThe research was conducted...

An Approach of Producing Ultra-High-Performance Concrete with High Elastic Modulus by Nano-Al2O3: A Preliminary Study.

Ultra-high-performance concrete (UHPC) has promising applications in civil engineering. However, the elastic modulus of UHPC is relatively low compared with its compressive strength, which may result in insufficient stiffness in service. This work was carried out to explore the feasibility of producing UHPC with high elastic modulus by nano-Al2O3 (NA). Based on particle densely packing theory, the initial mixture of UHPC was designed via the modified Andreasen and Andersen model. An experimental investigation was conducted to systematically examine the effects of NA on different properties of UHPC, including its fluidity, mechanical properties, durability, and microstructure. It was found that: (1) Compared with UHPC without NA, the flexural strength, compressive strength, and elastic modulus of UHPC were improved by 7.38-16.87%, 4.08-20.58%, and 2.89-14.08%, respectively, because of the incorporation of NA; (2) the addition of NA had a prohibiting impact on the threshold pore diameter and porosity of UHPC, which suggested that NA could be conducive to its pore structure; (3) the incorporation of NA led to a decline of 2.9-11.76% in the dry shrinkage of UHPC, which suggested that incorporating NA in a proper amount could reduce the risk of cracking and alleviate the dry shrinkage of UHPC; (4) the optimal amount of NA in UHPC was 1.0%, considering the effects of NA on workability, mechanical properties, microstructure, and the durability of UHPC.