Regular Doctor Research Articles

Depression as a Risk Factor for Physical Illness and Multimorbidity in a Cohort with No Prior Comorbidity.

This study examines whether depression is associated with the development of physical illness and multimorbidity, after controlling for socioeconomic, behavioral, and other potential confounders. This is a retrospective cohort study in which adult respondents to three nationally representative population health surveys were linked to health administrative databases in Ontario, Canada, and followed for 10 years from survey index. Respondents with any of the study outcome conditions at baseline were excluded to create a final cohort of 29,838 participants. The main exposure of interest was depression, measured using the Composite International Diagnostic Interview-Short Form for Major Depression. We controlled for age, body mass index, marital status, immigrant status, annual household income, smoking, alcohol consumption, physical activity, health status, and having a regular doctor. The outcome measure was the development of physical illness over 10 years of follow-up, defined as 1 of 15 common chronic conditions using administrative data. Among the 29,838 participants (15,259 [51%] female), 8% of females and 4% of males had depression at baseline. In this cohort with no comorbidities at baseline, even in the fully adjusted model, depression increased the risk of developing a first physical illness for females (hazard ratio [HR] 1.16; 95% CI, 1.07 to 1.26) and males (HR 1.20; 95% CI, 1.07 to 1.36) and increased the risk of developing a second physical illness for females (HR 1.16; 95% CI, 1.02 to 1.33) over 10 years of follow-up. For individuals with no prior comorbidities, depression is associated with a greater risk of developing subsequent physical illness and multimorbidity over time. Thus, depression identifies a population of people who may benefit from early identification, additional screening, and intervention. Further study needs to be done to determine whether interventions to manage and support people with depression can prevent or delay the increased risk of multimorbidity.

Barriers to Patient Portal Access and Use: Evidence from the Health Information National Trends Survey.

Patient access to their medical records through patient portals (PPs) facilitates information exchange and provision of quality health care. Understanding factors that characterize patients with limited access to and use of PPs is needed. Data were from the 2017-2018 Health Information National Trends Survey 5, Cycles 1 and 2, a nationally representative survey of US adults ≥ 18 years old (n = 6789). Weighted multivariate logistic regressions modeled the associations between patient characteristics and access to, facilitators of use, and use of PPs and their functions. Individuals without (vs with) a regular doctor (adjusted odds ratio [aOR], 0.4; CI, 0.3-0.5) or health insurance (aOR, 0.4; CI, 0.2-0.7), those with high school (aOR 0.4; CI, 0.3-0.5) or with vocational/some college (aOR, 0.5; CI, 04.-0.7) education (vs college/postgraduate), or those with limited English proficiency (vs those who speak English very well) (aOR, 0.7; CI, 0.5-0.9) were less likely to report accessing their personal medical records. Women (vs men) were more likely to report accessing their medical records (aOR, 1.5; CI, 1.2-1.8). Similar patterns were found for PPs access and facilitators of use. Less consistent associations emerged between patient characteristics and use of PP functionalities. PP access and use are low. Having a primary care clinician, patient's educational attainment, and being a woman were factors associated with PP access and use, but not race/ethnicity. Once access was achieved, use of PP functionalities was generally uniform across demographic segments. Facilitating PP access and use among all patient populations is warranted.

Respiratory Health and Suspected Asthma among Hired Latinx Child Farmworkers in Rural North Carolina.

The aim of this study was to evaluate respiratory health problems, including suspected asthma, and healthcare provider utilization among a sample of Latinx hired child farmworkers in rural North Carolina (n = 140). In 2018, a respiratory health questionnaire and breathing tests were collected from Latinx child (11–19 years) farmworkers (35.0% girls and 65.0% boys). Overall, 21.4% of children reported having been told by a medical provider that they had asthma, yet based on a combination of responses to respiratory survey questions, 36.4% or 15% more were identified as having suspected asthma. While 56.4% reported having a regular medical doctor, 38% had not had a medical exam in the past year. Respiratory dysfunction, including suspected, or uncontrolled asthma was prevalent among this group. Latinx children working in agriculture are vulnerable to occupational hazards and exposures and require assurances that they will receive access to high quality healthcare services that include routine respiratory health screenings.

Emergency Department Overcrowding: A Retrospective Spatial Analysis and the Geocoding of Accesses. A Pilot Study in Rome

The overcrowding of first aid facilities creates considerable hardship and problems which have repercussions on patients’ wellbeing, the time needed for a diagnosis, and on the quality of the assistance. The basic objective of this contribution, based on the data collected by the Hospital Policlinico Umberto I in Rome (Lazio region, Italy), is to carry out a territorial screening of the municipality using GIS applications and spatial analyses aimed at reducing—in terms of triage—code white (inappropriate) attendances, after having identified the areas of greatest provenance of improperly used emergency room access. Working in a GIS environment and using functions for geocoding, we have tested an experimental model aimed at giving a close-up geographical-sanitary look at the situation: recognizing the territorial sectors in Rome which contribute to amplifying the Policlinico Umberto I emergency room overcrowding; leading up to an improvement of the situation; promoting greater awareness and knowledge of the services available on the territory, a closer relationship between patient and regular doctor (general practitioner, GP) or Local Healthcare Unit and a more efficient functioning of the emergency room. In particular, we have elaborated a “source” map from which derive all the others and it is a dot map on which all the codes white have been geolocalized on a satellite image through geocoding. We have produced three sets made up of three digital cartographic elaborations each, constructed on the census sections, the census areas and the sub-municipal areas, according to data aggregation, for absolute and relative values, and using different templates. Finally, following the same methodology and steps, we elaborated another dot map about all the codes red to provide another kind of information and input for social utility. In the near future, this system could be tested on a platform that spatially analyzes the emergency department (ED) accesses in near-real-time in order to facilitate the identification of critical territorial issues and intervene in a shorter time to regulate the influx of patients to the ED.

Spatial Access by Public Transport and Likelihood of Healthcare Consultations at Hospitals

As healthcare is a right in Canada, analyzing the distribution of spatial access to medical consultations, which are crucial for the prevention, diagnosis, and early treatment of illnesses, is fundamental to understanding health equity. Spatial accessibility can influence whether individuals can reasonably reach the services they seek. However, as an indicator of potential access, it does not guarantee realized access because of predisposing and need factors. This study examines the relationship between spatial accessibility to hospitals and the likelihood of consulting with a healthcare professional at a hospital in eight Canadian metropolitan regions while controlling for individual characteristics through multilevel regression modeling. Spatial accessibility was computed using the two-step floating catchment area (2SFCA) method. Self-reported consultations and socio-demographic characteristics were obtained from the Canadian Community Health Survey. We found that the likelihood of consultations differed between genders (female OR: 1.133, CI: 1.023–1.255; compared with male) and followed a positive household income gradient (high-income OR: 1.236, CI: 1.094–1.397; middle-income OR: 1.039, CI: 0.922–1.172; compared with low-income), but is not influenced by age. Living in areas with higher spatial accessibility was positively linked to consultations (OR: 1.014, CI: 1.000–1.028), even after controlling for perceived health (OR: 0.540, CI: 0.471–0.621), chronic conditions (OR: 1.738, CI: 1.587–1.904), and having a regular doctor (OR: 1.313, CI: 1.187–1.452). Policies that may improve spatial accessibility to healthcare services through increasing supply, managing demand, and enhancing level of public transport service should be considered to improve individuals’ ability to consult healthcare professionals, potentially leading to better health outcomes.

The relationship between mood disorder diagnosis and experiencing an unmet health-care need in Canada: findings from the 2014 Canadian Community Health Survey

Background Despite Canada’s universal health-care system, millions of Canadians experience unmet health-care needs (UHCN). People with mood disorders may be at higher risk of UHCN due to barriers such as stigma and gaps in health-care services. Aim We aimed to examine the relationship between having a diagnosed mood disorder and experiencing UHCN using a recent, nationally representative survey. Methods Using the 2014 Canadian Community Health Survey, we used multivariate logistic regression to estimate the association between mood disorder and UHCN in the past 12 months, adjusting for sociodemographic variables and health status. Results Among 52,825 respondents, 11.8% reported UHCN. Respondents with a diagnosed mood disorder were more likely to report UHCN [adjusted odds ratio (OR) 1.61, 95% confidence interval (CI) 1.38, 1.89]. Among respondents with a regular doctor, people with mood disorders were still more likely to report UHCN (OR 1.63, 95% CI 1.38, 1.93). Sensitivity analyses using propensity score and missing data imputation approaches resulted in similar estimates. Conclusions Adults diagnosed with a mood disorder are more likely to report UHCN in the past year, even those with a regular doctor. Our findings suggest that barriers beyond physician attachment may impact access to care for people with mood disorders.

APA Health CARE: A Student-Led Initiative Addressing Health Care Barriers Faced by the Asian and Pacific Islander American Immigrant Population in Los Angeles.

Asian and Pacific Islander Americans face cultural, linguistic, and financial barriers to accessing health care. APA Health CARE (APAHC), a UCLA student-led organization, attempts to bridge these disparities through free community health screenings, health education seminars, and follow-up procedures. From 2011 to 2018, participants' demographic and health-related information were recorded during health fairs and follow-up phone calls. Trends in participant characteristics were analyzed overtime. Health fair data were compared to data from follow-up phone calls to assess the effectiveness of health fair education and referral practices. 5635 participants from 69 health fairs were screened over the 8-year period. Follow-up contact was attempted for 2258 participants, of which 555 responded. Overtime, a greater proportion of participants reported higher income, health insurance, and access to a regular doctor. Of those contacted at follow-up, 32.3% reported visiting a doctor, 50.2% reported making lifestyle changes, and 68.0% of those who were uninsured at health fairs reported obtaining health insurance within 1month of attendance. Despite an observed increase in the proportion of participants having insurance and a regular doctor, health fair attendance remained consistent, possibly due to Asian American immigrants' preference for services that are convenient and linguistically and culturally accessible. Attendees reported visiting a physician, making lifestyle changes, and obtaining health insurance based on health fair referrals, suggesting measurable success with referral uptake and follow through. Student-led initiatives similar to APAHC can serve as catalysts to increase health literacy and motivate communities to seek health insurance and care.

Yaşlı Tip 2 Diyabetli Bireylerde Diyabet Yükünün İncelenmesi: Zonguldak İli Örneği

Amaç: Bu çalışma ile Zonguldak İli’nde yaşayan yaşlı tip 2 diyabetli bireylerde diyabet yükünün incelenmesi amaçlanmıştır. Gereç ve Yöntemler: Tanımlayıcı-kesitsel tipte tasarlanan bu çalışma, Ocak 2020-Mart 2020 tarihleri arasında yapılmıştır. Çalışma için Zonguldak’ın toplam nüfusu baz alınmış (2019 yılı nüfusu 596.053 kişi) araştırma evrenini temsil edecek örneklem büyüklüğü % 95 güven aralığı ve α=0.05 için 384 kişi olarak belirlenmiştir. Çalışma, 65 yaş ve üzeri, tip 2 diyabeti olan, görme ve işitme sorunu olmayan, sözlü iletişim kurabilen, çalışmaya katılmaya gönüllü, Standardize Mini Mental Test’ten 23 puan ve üzerinde alan 395 kişi ile tamamlanmıştır. Veriler, araştırmacılar tarafından literatür taranarak hazırlanan Tip 2 Diyabetli Tanılama Formu ve Yaşlılarda Diyabetin Yükü Ölçeği kullanılarak yüz yüze görüşme yöntemi ile toplanmıştır. Bulgular: Yaşlı tip 2 diyabetli bireylerin diyabet yükü ölçeği toplam puan ortalaması 54,24±15,18 puan olarak bulunmuş olup, ölçekten alınabilecek en düşük (18 puan) ve en yüksek (88 puan) puanlar dikkate alındığında katılımcıların diyabet yükünün orta düzeyde olduğu görülmüştür. Katılımcıların sosyo-demografik özellikleri incelendiğinde; yaş ilerledikçe diyabet yükünün arttığı (p<0,001), eğitim durumu yüksek olan, evli olan, eş ve çocukları ile yaşayan, sağlık ve gelir durumunu iyi olarak belirtenlerin diyabet yüklerinin daha az olduğu tespit edilmiştir (p<0,001). Katılımcıların diyabete ilişkin özelliklerine bakıldığında ise; diyabet tanı süreleri arttıkça, başka bir kronik hastalığı varsa, kullandıkları ilaç sayıları fazla ise ve diyabete bağlı komplikasyon gelişmişse diyabet yüklerinin daha fazla olduğu belirlenmiştir (p<0,001). Ayrıca ailesinde başka diyabetli olan, düzenli doktor kontrolüne gidemeyen, düzenli egzersiz yapamayan, ilaçlarını kendi alamayan ve diyabetle ilgili bilgi/eğitime gereksinim duyan katılımcıların da diyabet yüklerinin daha fazla olduğu belirlenmiştir (p<0,001). Sonuç: Zonguldak ilinde yaşayan yaşlı tip 2 diyabetli bireylerin diyabet yüklerinin orta düzeyde olduğu saptanmıştır. Buna göre, yaşlı tip 2 diyabetli bireylerin ek hastalıklarının ve komplikasyonların kontrol altına alınması ile, düzenli doktor kontrolüne gitmelerinin ve düzenli egzersiz yapmalarının sağlanması ile yaşadıkları diyabet yüklerinin azaltılabileceği düşünülmektedir.

Why people select the outpatient clinic of medical centers: a nationwide analysis in Taiwan.

IntroductionIn contrast to other countries, Taiwan’s National Health Insurance (NHI) program allows patients to freely select the specialists and tiers of medical care facility without a referral. Some medical centers in Taiwan receive over 10,000 outpatients per day. In the NHI program, the co-payment was increased for high-tier facilities for outpatient visits in 2002, 2005, and 2017. However, the policies only mildly reduced the use of high-tier medical care facilities. The main purpose of this study was to evaluate the factors contributing to the patients’ selection of the outpatient clinic of medical centers without a referral.MethodsAn online anonymous survey was conducted by using the Google Forms platform utilizing a self-constructed questionnaire from September to October 2018. A nationwide sample in Taiwan was recruited using convenience sampling through social media. Based on a literature review and a focus group, 20 factors that may affect the choice of the outpatient institution were constructed. The associations between items that affect the patients selection of outpatient clinics were assessed using exploratory factor analysis. Principal axis factoring was performed to identify the major factors affecting the decision. Multiple logistic regression was performed to determine which factors satisfactorily explained “visiting the outpatient clinic of the medical center for an illness without a referral.”ResultsDuring the survey period, 5,060 people browsed the online survey, and 1,003 responded and completed the online questionnaire. Therefore, the response rate was 19.8%. A total of 987 valid responses was collected. Exploratory factor analysis revealed that three main factors, namely the “physician factor”, “image and reputation factor”, and “facility and medication factor”, affected the selection of outpatient clinics. A series of logistic regressions indicated that patients who reported that hospital facilities, high-quality drugs, and diverse specialties were very important were more likely to select the outpatient clinic of a medical center (OR = 2.218, 95% CI [1.514–3.249]). Patients who reported that physician factors were very important were less likely to select a medical center (OR = 0.717, 95% CI [0.523–0.984]). Patients who were previously satisfied with their experience of the primary clinics or had a regular family doctor were less likely to choose a medical center (OR = 0.509, 95% CI -0.435–0.595] and OR = 0.676, 95% CI [0.471–0.969]).ConclusionIn Taiwan, patients with good primary medical experience and regular family physicians had significantly lower rates by selecting the outpatient clinic of a medical center. The results of this study support that the key to establishing graded medical care is to prioritize the strengthening of the primary medical system.

Evolution of the determinants of unmet health care needs in a universal health care system: Canada, 2001-2014.

While ensuring adequate access to care is a central concern in countries with universal health care coverage, unmet health care needs remain prevalent. However, subjective unmet health care needs (SUN) can arise from features of a health care system (system reasons) or from health care users' choices or constraints (personal reasons). Furthermore, investigating the evolution of SUN within a health care system has rarely been carried out. We investigate whether health needs, predisposing factors and enabling factors differentially affect SUN for system reasons and SUN for personal reasons, and whether these influences are stable over time, using representative data from the Canadian Community Health Surveys from 2001 to 2014. While SUN slightly decreased overall during our period of observation, the share of SUN for system reasons increased. Some key determinants appear to consistently increase SUN reporting over all our observation periods, in particular being a woman, younger, in poorer health or not having a regular doctor. The distinction between personal and system reasons is important to better understand individual experiences. Notably, women report more SUN for system reasons and less for personal reasons, and reporting system reasons increases with age. Given this stability over time, our results may inform health policymakers on which subpopulations to target to ensure access to health care is universal.

Factors associated with not adopting healthy behavior among hypertensive individuals: a population-based study in Brazil.

Adoption of a healthy lifestyle is strongly recommended for the control of hypertension, but professional advice alone does not ensure uptake of healthy behavior. Therefore, this study aimed to investigate the factors-associated with non-adoption of healthy behaviors among individuals with a medical diagnosis of hypertension. It was a cross-sectional study using data from the National Health Survey (PNS) carried out in Brazil in 2013, based on interviews with adults (≥18 years) (n = 60,202). The outcome variable was the non-adoption-two or fewer-of healthy behaviors (regular physical activity, recommended consumption of fruit and vegetables, no excessive alcohol consumption, no smoking, and very low/low salt intake [self-perceived]). A logistic regression model was used to verify the factors-associated with non-adoption of healthy behaviors. Approximately 64% of the study sample did not adopt healthy behaviors, i.e., they adopted two or fewer healthy habits. The most frequently mentioned healthy behaviors were not drinking excessively (91.5%), followed by not smoking (86%). Short time since disease diagnosis (OR = 1.20, 95% CI: 1.01-1.43), not using antihypertensive medication (OR = 1.38, 95% CI: 1.13-1.68), not making regular doctor visits (OR = 1.43, 95% CI: 1.23-1.65), and good self-rated health (OR = 1.16, 95% CI: 1.01-1.36) increased the chance of individuals not adopting healthy behaviors compared with their respective reference categories, independently of gender, age, schooling, and economic status. Counseling strategies should consider patient particularities, and health professionals need to be aware of issues that can interfere with the adoption of healthy behaviors of hypertensive patients.

Clinical and organizational assessment of endovascular care accessibility at the regional level

The world health care system´s concern of inequalities in treatment of receiving the necessary medical care. The purpose of article to evaluate the availability of endovascular care (EVC) for patients at regional level in Russia and to develop a system for its improvement. As a result the low availability of EVC for the population at the regional level in Russia with coronary heart disease, atherosclerosis of the brachiocephalic arteries and critical lower limb ischemia (CLLI) was funded. The main reasons for the difficulties in obtaining EVC in the regions of Russia are the low frequency of diagnosing a critical stage of cardiovascular disease (CVD) requiring surgical treatment, the absence of cardiovascular surgeons and cardiologists in the medical care organizations, the failure in information to patients attending a regular doctor´s appointment about effectiveness and safety of endovascular treatment technology. More old-school traditional methods remain in place like bypass or endarterectomy surgery. Further obstacles are prolonged waiting list at the regional level for the provision of high-tech care in cardiovascular surgery, choice of conservative treatment methods or amputation of lower limbs for patients with CLLI 3 and 4 st. (p<0.05). In Conclusion the Clinical and organizational assessment of the endovascular care accessibility in CVD for the population in regions of Russia elaborated. One way to improve the situation is the introduction of the cardiovascular care clinical management. A dual-circuit clinical and organizational system was developed and proposed to increase endovascular care accessibility in regions.

Services of the Bureau of Jail Management and Penology (BJMP): An Assessment

Corrections is one of the five pillars of the Criminal Justice System. The study aimed to assess the Bureau of Jail Management and Penology (BJMP) towards the inmates of the jails located in the Province of Agusan del Norte. The study used a descriptive method of research. The survey was given to the 317 inmates. The findings revealed that in the jails under the Bureau of Jail Management and Penology, the majority of the inmates’ responses were slightly dissatisfied. In addition, the food budget of the inmates in the province of Agusan del Norte is not sufficient to provide a complete set of utensils and diet that would provide better nourishment to the inmates. The regular doctor is also not available to provide the regular evaluation of the inmates’ physical and other conditions. The nurse personnel is available but can’t cater to all the inmates’ needs towards emergency cases. Moreover, the Alternative learning system is inaccessible because the budget for school supplies and reading materials is insufficient. It was recommended that the National Government was comprised of the Executive, Legislative, and Judiciary must provide the budget for the creation of additional courts, appointed judges, public prosecutor, public lawyers, and Jail officers. The Bureau of Jail Management and Penology administration should seek a plan and intervention programs that enhance the Bureau’s current services.

Factors Associated With HIV Testing in Teenage Men Who Have Sex With Men.

Adolescent men who have sex with men (AMSM) have a high rate of HIV diagnoses. An estimated 14.5% of HIV infections in the United States are undiagnosed; but among 13- to 24-year-olds, the rate is 51.4%. We describe HIV testing rates and identifies salient individual, family, school, and health care influences among AMSM. Data were collected as part of SMART, an ongoing pragmatic trial of an online HIV prevention intervention for AMSM (N = 699). Measures included lifetime HIV testing, demographics, sexual behaviors, condom use, HIV education from school and family, sexual health communication with doctors, HIV knowledge, and risk attitudes. Only 23.2% of participants had ever had an HIV test. Rates of testing increased with age (5.6% in 13- to 14-year-olds; 15.8% in 15- to 16-year-olds; 37.8% in 17- to 18-year-olds), and sexual experience was a strong predictor of testing (odds ratio: 6.54; 95% confidence interval: 3.95-11.49; P < .001). Most participants had a regular doctor (67.5%), but few had conversations about same-sex sexual behaviors (21.3%), HIV testing (19.2%), or sexual orientation (29.2%). Speaking to a doctor about HIV testing had a large effect (odds ratio: 25.29; confidence interval: 15.91-41.16; P < .001), with 75.4% who had such conversations having been tested, compared to only 10.8% of those who had not had such conversations. Despite higher risk, few participants reported ever having received an HIV test. Data indicate pediatricians are an important, but largely untapped, source of testing and could be integral to achieving testing rates needed to end the epidemic.

Prostate-specific antigen (PSA) screening rates and factors associated with screening in Eastern Canadian men: Findings from cross-sectional survey data.

The prostate-specific antigen (PSA) test is used in Canada to detect prostate cancer (PCa) despite mixed recommendations. Complications arising from false-positives are common, posing as a cancer-screening concern. This work estimates some Canadian rates of PSA screening and identifies men at increased odds for PSA screening. The Canadian Community Health Survey (CCHS) from 2009/10 (Atlantic Canada; ATL), 2011/2012 (Ontario; ON), and 2013/2014 (Quebec; QC) were used. Lifetime and recent PSA screening with confidence intervals were constructed to estimate PSA screening in ATL, ON, and QC. Two logistic regression models (for men <50 and ≥50 years of age) were used to determine associations between factors and lifetime PSA screening. PSA screening rates have increased in most age groups for ATL, ON, and QC since 2000/2001. Factors positively associated with lifetime PSA screening in men of all ages were: having a digital rectal exam, having a regular doctor, and having a colorectal exam. Fruit and vegetables consumption and non-smoking status were positively associated with lifetime PSA screening in men <50 years of age. High income and the presence of chronic health conditions were positively associated with lifetime PSA screening in men ≥50 years of age. PSA screening rates have generally increased since 2000/2001 in Canada. Physician-related factors play a role in men at all ages, while different factors are associated in men <50 years of age and men ≥50 years of age. Limitations include the generalizability to all of Canada and the potential for recall bias.

Breast Cancer Fear Among Mexican American Women in the United States.

Introduction:Fear has been described as potentially important in affecting breast cancer screening completion. Limited information is available on the prevalence and determinants of fear among Mexican American women. This study describes perceived breast cancer fear and its association with personal characteristics and screening behavior among Mexican American women.Methods:This is a secondary analysis of data collected during the implementation of the Breast Cancer Education, Screening and NavigaTion program among eligible uninsured women in two Texas border counties. Participants completed a 26-item survey to assess eligibility, risk status, prior screening, and breast cancer fear. Descriptive statistics and multivariable analyses were used to determine associations between the fear score, personal characteristics, and mammography screening.Results:In all, 1916 of 2012 eligible women completed the study. The mean age was 57.3 years, 99.2% were Hispanic, and 88% were born in Mexico; 15% had a family history of breast cancer and 14% had never had a mammogram. The mean breast cancer fear score was 25.5 (standard deviation: 10.52; range: 8-40); 54.0 % (95% confidence interval: 52.1%-56.7%) had a high fear level. In multivariable analyses, better health status (P < .001), older age (P = .039), birth in the United States (P = .020), and having a regular doctor (P = .056) were associated with lower fear scores. There was no association between breast cancer fear and mammography screening.Conclusion:Breast cancer fear is high and varies by personal characteristics and health status among uninsured Mexican American border-residing women due for screening, but is not associated with screening behavior. Further research is needed to clarify the effect of interventions designed to help reduce breast cancer fear among these women, including educational interventions to reduce breast cancer fear.

Fractional exhaled nitric oxide and forced expiratory volume in 1 second/forced vital capacity have predictive value of asthma exacerbation in Korean school children.

BackgroundThe incidence of asthma exacerbation (AE) and the predictive value of spirometry and fractional exhaled nitric oxide (FeNO) in school children have not been evaluated.ObjectiveWe sought to evaluate the efficacy of spirometry measurement and FeNO monitoring for predicting AE in school children in the Cheongju area in Korea.MethodsWith parental agreement, we studied 170 students aged 7–12 years. Children were evaluated by an asthma specialist using baseline spirometry, skin prick test, seasonal FeNO measurement, and asthma control test. The study participants underwent a physical examination and their medical history was also evaluated by the specialist. They were assessed for asthma control status during regular doctor visits for 1 year.ResultsIn total, 160 children (94.1%) completed follow-up and FeNO monitoring. Of which, 26 children (16.3%) had AE. AE was associated with male children and children with allergic rhinitis (p < 0.05). While, children with AE tended to have higher FeNO than those without AE, no significant difference was found. The maximum value of FeNO ≥35 ppb was associated with AE (p < 0.05). Children with AE had a significantly decreased baseline forced expiratory volume in 1 second/forced vital capacity (FEV1/FVC), %predicted, forced expiratory flow at 25%–75% of FVC (FEF25%–75%). FEV1/FVC < 80% was associated with AE in children regardless of inhalant allergen sensitization (all p < 0.05).ConclusionBaseline spirometry had a predictive value of AE in school children. Sensitive spirometric parameters such as FEV1/FVC and FEF25%–75% can be used as prognostic factors to predict future childhood AE. FeNO value ≥ 35 ppb during monitoring was associated with AE in school children.

Compulsory admissions and preferences in decision-making in patients with psychotic and bipolar disorders.

Participation in medical decisions and taking into account patients' values and preferences are especially important for psychiatric patients who may be treated against their will. The increasing rates of coercive measures and the underlying clinical, ethical, and legal issues highlight the need to examine their use in psychiatry. Although limited congruence in decision-making preferences may be on the basis of these coercive practices, this issue has not been adequately addressed. We explore the relationship between compulsory admissions and congruence in decision-making preferences in mental health settings. Cross-sectional study among 107 outpatients with DSM diagnoses of schizophrenia of bipolar disorder using the Control Preference Scale to assess congruence in decision-making experienced and preferred style. History of compulsory admissions was obtained through review of available records. Descriptive statistics and multivariate analyses were used. 70% of patients reported experiencing their preferred style of decision-making and 44% patients had history of compulsory admissions. These patients were more autonomous and preferred to take a more active role. The degree of congruence was lower in patients with previous compulsory admissions. The best predictors of compulsory admissions were not having a regular doctor and the unmatched participation preferences. Patients who experienced a different level of participation in decision-making than desired more frequently had compulsory admissions. We propose to assess participation preferences each time a relevant treatment decision is about to be made and tailor care accordingly. We identified several factors leading to compulsory admissions that can be modified to prevent further coercive measures.

Relationship between sun safety behaviours and modifiable lifestyle cancer risk factors and vitamin D levels.

Sun exposure is the most importantenvironmental risk factor for causing skin cancer. This study examines the relationship between sun protection behaviours and modifiable lifestyle risk factors for other cancers as well as vitamin D levels. Cross-sectional data were analysed from two large national health surveys (n=31, 445 and n=5604). Sun exposure and protection were characterized by the presence of sunburn, duration of sun exposure, frequency of seeking shade, frequency of wearing a hat and frequency of wearing sunscreen. Using Statistical Analysis System (SAS) software 9.3.1, multivariate logistic regression models were compiled. Unhealthy behaviour practices were associated with sunburns or infrequent sun protection behaviour, such as cigarette consumption (either current or former smokers), second-hand smoke exposure, not having a regular doctor, higher level of alcohol consumption, street drug usage and low levels of fruit/vegetable consumption. Approximately one-quarter of individuals had less than the recommended value of serum vitamin D levels (<50nmol/L), despite 39.2% of these individuals reporting ≥1hour of sun exposure. Modifiable lifestyle risk factors for other cancers are correlated with infrequently practicing sun protection behaviours for skin cancer prevention. Therefore, cancer prevention campaigns can aim to target all these risk factors associated with different cancers. Sun exposure is not a reliable source to obtain recommended vitamin D levels and that other sources (eg. fish, egg yolk, fortified drinks and supplements) are a safer and more reliable option.

Health Needs Assessment of Five Pennsylvania Plain Populations.

We performed a health needs assessment for five Plain communities in Pennsylvania from a random sample of households, comparing them to the general population of Pennsylvania adults. Plain respondents were more likely to drink well water, as likely to eat fruit and vegetables and much more likely to drink raw milk and be exposed to agricultural chemicals. Plain respondents were less likely to receive screening exams compared to the general population and there was variation from settlement to settlement in whether respondents had a regular doctor, whether they received preventive screenings or had their children vaccinated, with Mifflin County Amish generally lowest in these and Plain Mennonites highest. Plain respondents reported good physical and mental health compared to the general population but Groffdale Mennonite respondents had a high proportion of diagnoses of depression and were more likely to be receiving treatment for a mental health condition. Most Plain respondents would want a spouse tested for genetic disease with Mifflin County Amish least in favor of these tests. Despite their geographic and genetic isolation, the health of Plain communities in Pennsylvania is similar to that of other adults in the state.