Levels Of Health Service Utilization Research Articles

Effect of community based health insurance on healthcare services utilization in Ethiopia: a systematic review and meta-analysis

BackgroundCommunity based health insurance (CBHI) is characterized by voluntary involvement, pooling of health risks and of funds occur within a community. It is becoming increasingly popular way to increase the use of healthcare services in low- and middle-income nations. Understanding the effect of CBHI on the level of health services utilization is a paramount for evidence based decision making. Hence, this study aimed to estimate the pooled effect of CBHI on health services utilization in Ethiopia.MethodsStudies were searched from PubMed, Google scholar, Web of Science, Research4life, Science Direct, African Journal Online and national websites for grey literatures. We were adhered to the PRISMA guidelines. Cross sectional and quasi experimental studies were included. Studies were screened, and critically appraised for quality using Joanna Briggs Institute Critical Appraisal tools. The data were extracted using Microsoft excel and exported to STATA 17 and RevMan 5.4.1 for further analysis. Heterogeneity between studies was assessed using Cochran’s Q statistic and quantified with I2. A random-effects model was used to estimate the pooled effect size. Subgroup analysis was done to show variations of the effect sizes across study years.ResultA total of 1501 studies were identified, out of which only 14 of them were included in the final meta-analysis. Health services utilization among CBHI members and non-members was 69.1% [95%CI (57.1–81.1%)] versus 50.9% [95%CI (40.6–61.3%)] respectively (difference in the effect was 18.2%). The CBHI members were nearly three folds more likely to utilize health services as compared with their counterparts [OR = 2.54, 95%CI: (1.81, 3.57). On average, CBHI users had 1.14 increased health facility visits as compared to non-insured, mean difference (MD) = 1.14 visits with 95% CI (0.65–1.63).ConclusionThe CBHI has a significantly increased health service utilization in Ethiopia. Hence, it will have a great contribution to meet the health for all agenda in resource limited countries.

Utilization and Satisfaction of Community-based Health Care Services among Older Adults

The COVID-19 pandemic has a significant impact on the capacity of health systems to continue to provide critical services. As healthcare systems around the world face a growing demand for care for patients with COVID-19, it is vital to maintain preventive and curative services, especially for the most vulnerable populations, the elderly and the elderly living with chronic diseases. The purpose of this study was to determine the level of health service utilization and satisfaction of older adults amidst COVID-19 pandemic. The study used a descriptive- correlational research design that was conducted in a selected barangay in the city of Caloocan. The purposive and snowball sampling method was used to select respondents and must meet the following criteria: elderly between the ages of 60 and 74, and using health care services. The data collection was carried out through a series of questionnaires with an informed consent form through online platforms. Based from the data gathered, the strength of the relationship is indicated by the correlation coefficient with a score of. 795, which is greater than 0.70 shows a high correlation between the two variables. This means that when the level of utilization of community-based services of the respondent is high, their level of satisfaction with health care services increases as well. Overall, it is important to prioritize the level of utilization and satisfaction in community-based healthcare among older adults as it is used as an indicator for measuring the quality of healthcare. The level of utilization among older adults is inclined to their level of satisfaction, in which respondents are highly satisfied with their usage of services in terms of accessibility, availability and affordability of the community-based services. Moreover, demographic profile of respondents has no significant difference, which indicates that respondent’s level of satisfaction in community-based services is affected by their level of utilization of services in their barangay health center. Health services, if used by the elderly, can lead to satisfaction. Therefore, the promotion of the various health services is strongly encouraged to reach not only a few, but the whole population.

Exploring the factors influencing the use of health services by people with diabetes in Northwest China: an example from Gansu Province

BackgroundDiabetes is associated with high morbidity, mortality and quality-of-life impairment in patients. In China, the number of people suffering from diabetes ranks first in the world. Gansu Province is located in northwest China and is an economically underdeveloped region of China. By analyzing the level of health service utilization of people with diabetes in Gansu Province, the degree of equity in health service utilization and its influencing factors were studied to provide scientific data to support the promotion of health equity for people with diabetes and the introduction of relevant policies by relevant authorities.MethodsA sample of 282 people with diabetes who were 15 years old and above was chosen by multi-stage stratified sampling method. A structured questionnaire survey was conducted via face-to-face interviews. Random forest and logistic regression analysis were used to demonstrate the effects of the explanatory variables on health seeking behaviors from predisposing, enabling and need variables. The concentration index was used to indicate the equity of health service utilization across households of different economic levels.ResultsThe outpatient rate for the diabetic population surveyed was 92.91%, with 99.87% of urban patients, higher than the 90.39% of rural patients. The average number of hospital days per person was 3.18 days, with 5.03 days per person in urban areas, which was higher than the 2.51 days per person in rural areas. The study showed that the factors most likely to influence patients to seek outpatient services were frequency of taking diabetic medication, whether or not they were contracted to a household doctor, and living environment; the top three factors most likely to influence patients with diabetes to seek inpatient services were number of non-communicable chronic disease, self-assessment of health status, medical insurance. The concentration index for outpatient service utilization and inpatient service utilization were − 0.241 and 0.107, respectively, indicating that outpatient services were concentrated on patients at lower income levels and patients at higher income levels tended to favor inpatient services.ConclusionThis study found that the low level of health care resources available to people with diabetes, whose health status is suboptimal, makes it difficult to meet their health needs. Patients' health conditions, comorbidities of people with diabetes, and the level of protection were still important factors that hindered the use of health services. It is necessary to promote the rational use of health services by diabetic patients and further improve the corresponding policies to achieve the goal of chronic disease prevention and control in “Health China 2030”.

Health Service Utilization and Out-of-Pocket Expenditure among the Social Health Insurance Policy Holders in Kaski District, Nepal

Introduction: Nepal has a low health service utilization among the people where ten percent of people face the burden of catastrophic health expenditure and spends more than 10.71% of the total household on health facilities. To reduce Out-of-Pocket expenditure (OOPE) and to improve the access and utilization of health services, Social Health Insurance Program could be a vital health financing mechanism. Objectives: This study aims to assess the status of health service utilization and percent of household expenditure of respondents (OOPE) insured through the Social Health Insurance Program in Kaski district.
 Methods: A descriptive cross-sectional survey was conducted among 210 sampled people of Kaski district who were enrolled in National Social Health Insurance. The study was conducted from June to December 2018 to assess the level of health service utilization and out-of-pocket expenditure among the insured population.
 Results: Out of 210 participants enrolled in the Social Health Insurance program, four-fifth (80.5%) participants had utilized the services. Out-of-pocket expenditure for healthcare was 69 percent despite being insured through SHI. There was no statistical relationship observed between socio-demographic characteristics and health service utilization. However, socio-demographic variables such as sex, types of family, number of elderly members in the family were significantly associated with out-of-pocket expenditure among participants.
 Conclusion: Majority of participants had utilized health services after buying SHI. Out-of-pocket expenditures have been decreased in the treatment and diagnosis of the diseases but not in medicine cost. There is a need for further study with larger sample size and population coverage to have a better understanding of the effectiveness and effect of the Social Health Insurance Program over Health Service Utilization and Out-of-Pocket expenditure.

Community‐Based Health Insurance scheme implementation in Ethiopia: A mini‐review on the experience and its implementation process

AbstractThe Community‐Based Health Insurance (CBHI) scheme was introduced in Ethiopia to overcome the population's over‐reliance on direct out‐of‐pocket expenditures for health care and the associated low level of health service utilization. CBHI is an advance payment arrangement, established on the household level, and targeted mainly at informal sectors in rural areas. After a successful 3‐year pilot implementation, the Ethiopian government decided to expand the CBHI scheme implementation. It has received wide interest among community members, especially those living with chronic diseases and perceived impaired family health status. Low enrollment to the scheme was the barrier to its initial expansion due to limited awareness and misconceptions about the program, financial constraints to paying premiums, and dissatisfaction with the health services. The evaluation of CBHI scheme implementation and future implications in Ethiopia could be better seen from both the learning experience during the implementation process and achievements of the policy objectives.

Utilization of health services and associated factors among fee waiver beneficiaries in Dawunt district, North Wollo zone, Ethiopia

ObjectiveThis study aimed to assess the utilization of health services and associated factors among fee waiver beneficiaries in Dawunt district, Ethiopia, in 2020. Study designA community-based cross-sectional study was used. MethodsUsing an interviewer-administered questionnaire, data were collected from 550 randomly selected households. EpiData version 4.6 was used to enter data, and SPSS version 23 was used to analyze it. Multivariable logistic regression analysis was applied to identify the associated factors with health service utilization. ResultsThe overall health service utilization among fee waiver beneficiaries was 60.98% (95% confidence interval [CI]: 56.4–64.4%). Being an urban resident (adjusted odds ratio [AOR]: 3.2, 95% CI: 1.41–7.28), family size (AOR: 3.17, 95% CI: 1.49–6.75), perceived health status (AOR: 6.26, 95% CI: 3.76–10.41), travel time (AOR: 2.75, 95% CI: 1.25–6.06), perceived distance (AOR: 13.69, 95% CI: 5.22–35.91), and perceived medium (AOR: 3.07, 95% CI: 1.71–5.52) and cheap (AOR: 3.02, 95%CI: 1.43–6.36) transport costs were significantly associated with utilization of health services. ConclusionsThis study revealed that the level of health service utilization among beneficiaries in the Dawunt district was 60.98%. Residence, family size, perceived health status, travel time to the nearest Health Facility (HF), perceived distance, and travel cost to reach the HFs were significantly associated with Health Services Utilization (HSU). Therefore, improving physical accessibility of health services and availability of necessary health services at an affordable cost will possibly result in better utilization of healthcare services.

Factors associated with postnatal care utilization among postpartum women in Ethiopia: a multi-level analysis of the 2016 Ethiopia demographic and health survey

BackgroundMost postpartum women and newborns do not utilize postnatal care due to less emphasis given especially in developing countries. Understanding individual and community-level factors associated with postnatal care will help to design appropriate strategies and policies for improving service utilization. Therefore, this study aimed to assess individual and community-level factors associated with postnatal care utilization in Ethiopia.MethodThis study used the Ethiopian Demographic and Health Survey (EDHS) data of 2016. A total of 4489 women who gave birth 2 years before the survey were included. Two-stage stratified cluster sampling technique was used. The analysis was done using Stata version 14.0 after checking for basic assumptions of multilevel logistic regression. Multilevel mixed-effects logistic regression was used to identify determinants of postnatal care utilization. An adjusted odds ratio with a 95% confidence interval was used to show the strength and direction of the association.ResultsHusband with secondary education [AOR = 0.17, 95% CI = (0.04, 0.68)], four or more antenatal care visit [AOR = 10.77, 95% CI = (2.65, 43.70)], middle wealth quintile [AOR = 3.10, 95% CI = (1.12, 8.58)] were individual level factors. Community level education [AOR = 2.53, 95% CI = (1.06, 6.06)] and community level of health service utilization [AOR = 2.32, 95% CI = (1.14, 4.73)] were the predictors at community level.ConclusionWealth index, number of antenatal care visits, husband education, community level of education and health service utilization were significantly associated with PNC service utilization. Provision of quality antenatal care, improvement of the educational status of women and husband involvement in PNC are important strategies to increase PNC service utilization.

A236 REAL LIFE HEALTH CARE UTILIZATION IN PEDIATRIC PATIENTS WITH INFLAMMATORY BOWEL DISEASE IN THE ERA OF BIOLOGICS

Abstract Background The burden associated with the management of pediatric patients with inflammatory bowel disease (IBD) has been rising over the past years as the incidence of IBD is increasing in children. In addition, the widespread use of biologics and a treat-to-target approach also contributes to the increase of healthcare utilization. Aims The purpose of this study was to assess the health care services utilization and the associated factors in a prospective cohort of children diagnosed with IBD in Quebec. Methods Patients diagnosed from 2013 to 2015 and followed up until the transfer to adult care were identified in our IBD database. Data on IBD related services and treatments: imaging procedures, hospitalizations and outpatient visits, medications from diagnosis to transition was extracted. We analyzed the healthcare utilization according to the baseline disease severity (pediatric Crohn’s disease activity index (PCDAI) or pediatric ulcerative colitis activity index (PUCAI)) at diagnosis, and according to exposition to intravenous biologics. Results A total of 144 patients were included in the study [(77 males), Crohn’s disease (98), Ulcerative Colitis (31) and IBD-unclassified (15); median (interquartile(IQR)) age at diagnosis 15.2(14.3–16.3)]. The median(IQR) duration of follow up at the IBD clinic was 2.9 (1.8–3.9) years. The median (min-max) number of imaging procedures varied largely: esophagogastroduodenoscopy 1(0–2), Colonoscopy 1(1–6), abdominal ultrasound 1(0–13), abdominal MRI 1(0–4), tomodensitometry 0(0–2), Bone densitometry 1(0–5). Patients had various follow-up encounters (median (min-max)): outpatient visits 9 (1–28), IBD nurses phone follow-up 4(0–33). A total of 64.6% of patients had at least one hospitalization [median(min-max) number 1(0–10); median duration 4(0–150 days)] and 35.41% had at least one emergency room visit. Baseline disease severity did not predict the disease burden: the mean number of encounters was 3.0 /year in the moderate/severe group as compared to 2.5/year in the mild group; P= 0.61. Among the, 63.5% of patients exposed to an intravenous biologic (Infliximab or Vedolizumab), those exposed earlier (<3 months after diagnosis) used more health care services (mean = 3.3/year) than those exposed later (mean =2.23/year); P <0.0001. In addition, the median (interquartile (IQR)) cumulative days of healthcare utilization (missing school days) for patients treated with intravenous biologics was 48.5 (32.4–67.9) days during pediatric care. Conclusions Adolescents with IBD have several encounters between the diagnosis and transition to adult care. Disease severity at diagnosis was not related to a higher level of health services utilization during follow-up. However, treatment with intravenous biologics was associated with a high health service utilization and school missing during follow-up. Funding Agencies None

Characteristics of people brought in dead at the Ndola Teaching Hospital in Zambia between 2012 and 2016

Background: Death is the end spectrum of everyone's life. From a policy maker's point of view, the cause of death and the place of death are important variables as they have a bearing on the diagnostic capacity of a health system and the level of health services utilization by a population respectively. A study done in Zambia showed that 51 per cent of the adult deaths occurred in a health facility, 41.5% occurred at home and 7.7% happened elsewhere. This finding contrasted those of a systematic review of statistics on cause of deaths in hospitals: strengthening the evidence for policy makers by the WHO which reported that more than 50% of deaths in most developing countries occur outside hospitals. It is common to see people brought in dead (BID) in hospitals in Zambia. A literature review showed that no study has been done to characterize the people who are brought into health facilities already dead in Zambia. Our study proposes to collect the age and sex distribution of the people brought in dead, as well as their area of residence and cause of death as is captured in the registers.
 Objectives1. To describe the sex and age distribution of the people brought in dead in Ndola Teaching Hospital
 2. To determine the areas of residence of these cases
 3. To establish the causes of death for these cases of BID
 4. To assess the completeness of the information recorded in the register
 Methods: This study was done at the Ndola Teaching Hospital in the Copper-belt province of Zambia. It was a cross sectional, retrospective record review of the mortuary registers where all people brought in dead or dying within 24 hours of admission to Ndola Teaching Hospital are recorded. All cases of BIDs recorded in the Mortuary registers of Ndola Teaching Hospital between 2012 and 2016 were eligible. The age, sex, area of residence and the recorded cause of death were entered on a standardized form designed for the study. The data was entered on an excel sheet and double checked for completeness. It was then analyzed using excel
 Results: There were 6931 cases of brought in dead at the Ndola Teaching Hospital between 2012 and 2016 with the average number of 1386 cases per year. The age group affected most was 24-55 years (60.34%), mainly comprised of males (61.81%) and coming from densely populated areas (81.50%). 96.75% of cases had undetermined mode of death while 2.35% of cases died of road traffic accidents
 Conclusion: A big number of people are still dying outside health facilities or within 24 hours of admission to hospitals in Zambia today. The most affected group is males in their most productive period of their lives and mainly residing in densely populated areas. Additionally, our data capturing tools are not adequate and need revision.

Association between CANCA1C gene rs1034936 polymorphism and alcohol dependence in bipolar disorder

IntroductionBipolar disorder (BD) is a highly heritable and disabling mental illness, commonly associated with substance abuse, being alcohol abuse the most frequent. Comorbid BD and substance abuse disorders are often associated with high levels of health service utilization and destabilization of the course of illness resulting in poor treatment outcomes. Although recent genome-wide association studies have detected a number of risk genes for BD, the data is still sparse and inconclusive for those genes that may contribute to the increased risk of comorbid alcohol abuse (AA) in BD. The primary aim of the present study was to investigate the effects of 46 single-nucleotide polymorphisms (SNPs) within eight genes on different phenotypes of BD patients, such as comorbid alcohol abuse. We further assessed clinical variables associated with AA. MethodsOne-hundred fifty-eight BD I and II patients were enrolled in a naturalistic cohort study. Genomic DNA of 92 patients was extracted from whole blood using standard procedures and 46 tag SNPs in eight genes of interest (ANK, CACNA1C, CACNB2, FKBP5, GRM7, ITIH3, SYNE1 and TCF4) were genotyped. ResultsSeventy-one patients out of 158 (45%) satisfied diagnostic criteria for comorbid AA.Among 46 SNPs analyzed, the only SNP associated with comorbid AA was rs1034936 polymorphism in the CANCA1C gene. This polymorphism was also associated with lifetime cocaine abuse, manic switch and current atypical antipsychotics. ConclusionsOur findings suggest a role of rs1034936 CACNA1C gene variant in BD-AA group. Despite their preliminary nature, the present results may provide new insight on mechanisms underlying AA in BD.

Disparities in Health Care Utilization Between Asian Immigrant Women and Non-Hispanic White Women in the United States.

Background: Asians accounted for 30% of all U.S. immigrants in 2014, of which 53% were women. Foreign-born Asian immigrant (FBAI) women experience difficulties in obtaining timely and needed health care due to multifaceted barriers. This study examined factors influencing health service utilization among FBAI women compared with native-born (non-Hispanic) White American (NBWA) women. Materials and Methods: A secondary data analysis was conducted using the 2014-2015 California Health Interview Survey. Guided by a modified version of Andersen's behavioral model of health service utilization, FBAI women aged 18 to 64 (n = 1,021) were compared with NBWA women of the same ages (n = 7,086). Outcome variables included having at least one doctor's visit in the past year and having an emergency room (ER) visit in the past year. Analyses included descriptive statistics, t-tests, chi-square tests, and multivariate logistic regressions. Results: FBAI women were significantly less likely to have at least one doctor's visit in the past year and were less likely to have a usual source of care than NBWA women. Significant predictors of having at least one doctor's visit for FBAI women were having high school education, having a usual source of care, having medical insurance, and having a chronic disease. The only significant predictor of having an ER visit for FBAI women was having a chronic disease. Conclusions: Health care providers must be aware of lower levels of health service utilization among FBAI women than NBWA women regardless of whether or not the FBAI women have chronic conditions. It is important to educate these women on the importance of regular health care visits.

Sex Differences in Quality of Life and Health Services Utilization among Elderly People in Rural Vietnam.

As in much of the world, the elderly population in Vietnam is growing rapidly with two-thirds of them currently living in rural areas. Besides limited access to quality healthcare services, they also have unique health profiles and needs due to various factors, including the highly skewed sex ratio of more women residing in rural areas. However, the relationship between gender, health-seeking behaviors, and health outcomes in this under-served population has not been well characterized. This study sought to explore the associations of gender with health-related quality of life and health-seeking behavior among the elderly in Soc Son, a rural district of Hanoi, Vietnam. A cross-sectional design was used; elderly individuals were surveyed across the domains of socioeconomic information, health status, and healthcare service utilization. We found that overall, women had poorer health and quality of life even though gender difference did not appear to significantly influence their levels of health services utilization. A greater understanding of the systemic, sociocultural, and psychological factors underlying such differences may help better inform future healthcare service delivery strategies targeting this growing population in rural areas.

Observational study of drug use pattern in indoor patients suffering from major depression admitted in psychiatry department of tertiary care teaching hospital

Background: Mental illness is associated with high levels of health service utilization and associated costs. India is among one of the countries with the highest number of people suffering from depression. The data on antidepressant drug utilization in India is sparse. Hence, we planned to analyse the drug use pattern in patients of major depression as per the WHO recommended indicators of drug use.Methods: This prospective observational study was done to analyze the prescription pattern of hospital psychiatrist in indoor major depression patients. All the patients admitted in psychiatry indoor patient department (I. P. D.) of Dr. D. Y. Patil Hospital, Navi Mumbai were included.Results: Data of 97 patients was analysed. 55.67% of the cases were from the age group 31-50 years. Total number of antidepressants prescribed was 102(36.82%). Out of antidepressant agents, Selective Serotonin Reuptake Inhibitors (SSRIs) were the most commonly prescribed drugs 70 (68.62%). The most commonly prescribed antidepressant was Sertraline in 35 (34.3%).Conclusions: The findings of our study were similar to those of other studies conducted to evaluate the use of antidepressants.

AN OBSERVATIONAL STUDY OF DRUG UTILISATION PATTERN AND PHARMACOVIGILANCE OF ANTIPSYCHOTICS

Objective: Drug Utilization Research (DUR) was defined by the WHO in 1977 as “The marketing, distribution, prescription, and use of drugs in a society, with special emphasis on the resulting medical, social and economic implications”. The main aim of conducting drug utilisation research is to facilitate rational use of drugs I,e the prescription of a well documented drug together with correct information at an affordable cost. Psychiatric disorders form an important public health priority among which psychotic disorders are the chief contributors to disability adjusted life years [DALYs] and are associated with high levels of health service utilization and treatment cost. Without the knowledge of how drugs are being prescribed and used it is difficult to initiate a discussion on rational drug use or to suggest measures to improve prescribing patterns. To analyse the drug utilization pattern by using standard parameters.Methods: After getting approval from the institutional human ethics committee and consent from the patients willing to participate in this study, a total of 79 prescriptions containing atleast one antipsychotic drug was collected in one year period from patients attending psychiatric OPD. The patients were given a one month follow up and the adverse effects which arise out of therapy are noted and analysed.Results: Out of the 79 participants, 59.49% were males and 40.51% were females. Regarding the morbidity distribution, Schizophrenia contributes to 50.63% and bipolar disorder contributes to 29.11% of diagnosis. Based on the analysis by WHO/INRUD standard guidelines, the average number of drugs and antipsychotic drugs per prescription were 3.32 and 1.38 respectively. The utilsation of antipsychotic drugs assessed by PDD/DDD ratio is equal to one for haloperidol and aripiprazole while it is less than one for other antipsychotic drugs. The adverse effects commonly encountered while treating psychotic cases are sedation, extra pyramidal symptoms, weight gain and anticholinergic side effects like constipation and urinary retention.Conclusion: The age and morbidity distribution of the participants are similar to the outcomes of many studies. The antipsychotic drugs haloperidol and aripiprazole are utilised appropriately while there is under utilisation of other antipsychotics. The volume of use of haloperidol, olanzapine benzodiazepines should be judicious considering their adverse effects.

Inequity in level of healthcare utilization before and after universal health coverage reforms in China: evidence from household surveys in Sichuan Province.

BackgroundChina has since the beginning of this millennium engaged in substantial Universal Health Coverage (UHC) reforms. This paper adds evidence on how equity in level of health service utilization changed after UHC reforms.MethodsOur study was based on household survey data from 30 counties in Sichuan province in 2004 and 2011. We introduce an unusual outcome variable, namely level of healthcare utilization. Concentration index (CI) was used to measure income based inequality in level of healthcare utilization. Horizontal index (HI) was used to assess whether inequalities are inequitable. We decomposed the concentration index to measure the factors contributing to inequality in level of utilization. Oaxaca type decomposition was applied to control whether identified changes were attributable to changed inequality or to other factors.ResultsPro-rich inequity in level of healthcare utilization increased after UHC reforms. Overall, a higher proportion of users sought services at county hospitals or higher in 2011 compared with 2004. Richer users were considerably more likely than the poor to seek care at hospitals rather than at clinics or health centers, and the pro-rich inequality in level of healthcare utilization was highly inequitable. Insurance enrollment became the main driver of pro-rich inequity in level of healthcare utilization after reforms, while health needs became less important for determining level of care, all disfavoring low income groups.ConclusionsAssessments of equity should pay attention to inequalities in level of healthcare utilization. Our results indicate that in China, wide insurance coverage is insufficient to ensure equity in level of healthcare utilization. On the contrary, type of insurance enrollment has become a main driver of inequity in level of utilization. Hence, equalizing health insurance schemes would be of crucial importance in order to improve health equity in China. Moreover, UHC reforms should strengthen the primary sector and limit non-needs based use of high-level hospitals in order to promote equitable use of healthcare services.

Examining the relationship between Attention-Deficit/Hyperactivity Disorder and overweight in children and adolescents

Although a higher prevalence of overweight/obesity was reported in clinical samples of patients with Attention-Deficit/Hyperactivity Disorder (ADHD), an association between overweight and ADHD has yet not been established in the general population in childhood. As both disorders are common and significantly affect psychosocial functioning, we investigated the prevalence of ADHD in overweight/obese youth and vice versa. In a cross-sectional nationally representative and community based survey 2,863 parents and their children aged 11-17 years rated symptoms on the Diagnostic and Statistical Manual of Mental Disorders-based German ADHD Rating scale. Weight and height were assessed by professionals. Body mass index was categorized according to national age and sex specific reference values. Overall, 4.2% of the respondents met criteria for ADHD. The prevalence of ADHD was significantly higher for overweight/obese (7%) than for normal weight (3.5%) and underweight (4.9%) children. In a logistic regression analysis controlling for age, gender, and socio-economic status, overweight/obese children were twice as likely to have an ADHD diagnosis (OR = 2.0). Vice versa, adjusting for all covariates, children with ADHD had an OR of 1.9 for overweight/obesity status. For all weight-status groups, children with ADHD more frequently reported eating problems as compared to their non-clinical counterparts. Overweight/obese respondents with ADHD displayed the highest level of health services utilization. A clinician should be aware of the significant risk for a child with ADHD to become overweight and for an overweight child to have ADHD. Longitudinal studies are needed to better understand the mechanisms underlying the association between ADHD and overweight/obesity.

Specifying the effects of religion on medical helpseeking: The case of infertility

Several recent studies have examined the connection between religion and medical service utilization. This relationship is complicated because religiosity may be associated with beliefs that either promote or hinder medical helpseeking. The current study uses structural equation modeling to examine the relationship between religion and fertility-related helpseeking using a probability sample of 2183 infertile women in the United States. We found that, although religiosity is not directly associated with helpseeking for infertility, it is indirectly associated through mediating variables that operate in opposing directions. More specifically, religiosity is associated with greater belief in the importance of motherhood, which in turn is associated with increased likelihood of helpseeking. Religiosity is also associated with greater ethical concerns about infertility treatment, which are associated with decreased likelihood of helpseeking. Additionally, the relationships are not linear throughout the helpseeking process. Thus, the influence of religiosity on infertility helpseeking is indirect and complex. These findings support the growing consensus that religiously-based behaviours and beliefs are associated with levels of health service utilization.

Determinants of conventional health service utilization among pastoralists in northeast Ethiopia

Background: Health service utilization pattern among pastoralists in Ethiopia is not well documented. Available data are very few and mostly institution based. Objective: To assess the determinants of conventional health care utilization among pastoralist communities in northeast Ethiopia. Methods: The study employed a cross-sectional household survey conducted using structured questionnaires administered among 276 mobile and 262 settled subjects within the pastoral area. In addition, reviews of outpatient and inpatient records for the previous year at the local health facilities, as well as focus group discussions among the study communities were conducted to supplement the household survey data. Results: Analysis of the collected data revealed steep distance decay in level of health service utilization, in addition to statistically significant difference in the service utilization between the settled and the mobile pastoralist communities (the odd ratio and 95% CI for utilizing health services of settlers over mobile ones were 1.38 (1.138,1.667) with P value

The Influence of Israel Health Insurance Law on the Negev Bedouin Population — A Survey Study

The extension of universal health service insurance to national populations is a relatively new phenomenon. Since 1995, the Israeli National Health Insurance Law (NHIL) has provided universal health services to every resident, but the effect of this law on health and health services among minorities has not been examined sufficiently. The goals of this study were to track some of the first changes engendered by the NHIL among the Negev Bedouin Arabs to examine the effects of universal health care services. Methods included analysis of historical and health policy documents, three field appraisals of health care services (1994, 1995, 1999), a region-wide interview survey of Negev Bedouins (1997), and key informant interviews. For the interview survey, a sample of 515 households was chosen from different Bedouin localities representing major sedentarization stages. Results showed that prior to the NHIL, a substantial proportion of the Negev Bedouins were uninsured with limited, locally available health service. Since 1995, health services, particularly primary care clinics and health manpower, have dramatically expanded. The initial expansion appears to have been a marketing ploy, but real improvements have occurred. There was a high level of health service utilization among the Bedouins in the Negev, especially private medical services, hospitals, and night ambulatory medical services. The NHIL brought change to the structure of health services in Israel, namely the institution of a national health system based on proportional allocation of resources (based on size and age) and open competition in the provision of quality health care. The expansion of the pool of potential members engendered by the new universal coverage had profound effects on the Health Funds' attitudes towards Negev Bedouins. In addition, real consumer choice was introduced for the first time. Although all the health care needs of this rapidly growing population have yet to be met fully, the assurances under the Law and the new level of competition promise a higher level of service in the future.

Health service utilization and benzodiazepine use among heroin users: findings from the Australian Treatment Outcome Study (ATOS).

To determine levels of health service utilization among heroin users, the types of prescription drugs obtained by heroin users and the contribution of benzodiazepine use in health service utilization and prescribed drug use. Cross-sectional survey. Sydney, Australia. A total of 615 current heroin users recruited for the Australian Treatment Outcome Study (ATOS). Sixty per cent of subjects had consulted a general practitioner (GP) and 7% a specialist in the preceding month. An ambulance had attended 11% of subjects in the preceding month. Forty-eight per cent of subjects had prescriptions dispensed for medication in the preceding month. Thirty-nine per cent of participants had prescriptions dispensed for psychotropic medications, representing 80% of all prescriptions. Twenty per cent of subjects had prescriptions dispensed for non-psychotropic medications (20% of prescriptions). The most commonly prescribed drugs were benzodiazepines (59% of prescriptions), which had been obtained by 30% of subjects. Benzodiazepine users had more GP and psychiatrist visits, were more likely to have had an ambulance attendance and had significantly more dispensed prescriptions. There were high levels of health utilization among heroin users. Prescription drug use was common, and dominated by psychotropic drugs. Benzodiazepine use was a dominant factor in the use of services and in prescriptions dispensed. Despite increased awareness of the harms associated with benzodiazepines, they continue to be prescribed widely to heroin users.