scholarly journals Effect of specificity of health expenditure questions in the measurement of out-of-pocket health expenditure: evidence from field experimental study in Ghana

BMJ Open ◽  
2021 ◽  
Vol 11 (5) ◽  
pp. e042562
Author(s):  
Isaiah Awintuen Agorinya ◽  
Amanda Ross ◽  
Gabriela Flores ◽  
Tessa TanTorres Edejer ◽  
Maxwell Ayindenaba Dalaba ◽  
...  
Keyword(s):  
Health Expenditure ◽  
Inpatient Care ◽  
Rural Setting ◽  
Living Standard ◽  
Cross Sectional ◽  
Household Expenditures ◽  
The Mean ◽  
Nationally Representative ◽  
Using Data ◽  
The Individual

BackgroundThe effect of number of health items on out-of-pockets (OOPs) has been identified as a source of bias in measuring OOPs. Evidence comes mostly from cross-sectional comparison of different survey instruments to collect data on OOPs. Very few studies have attempted to validate these questionnaires, or distinguish bias arising from the comprehensiveness of the OOPs list versus specificity of OOPs questions.ObjectivesThis study aims to estimate biases arising from the specificity of OOPs questions by comparing provider and household’s information.MethodsA generic questionnaire to collect data on household’s OOPs was developed following the nomenclature proposed in division 6 of the classification of household final consumption 2018. The four categories within such division are used to set the comprehensiveness of the OOPs list, the specificity within each category was tailored to the design of the nationally representative living standard survey in Ghana where a field experiment was conducted to test the validity of different versions. Households were randomised to 11, 44 or 56 health items. Using data from provider records as the gold standard, we compared the mean positive OOPs, and estimated the mean ratio and variability in the ratio of household expenditures to provider data for the individual households using the Bland-Altman method of assessing agreement.FindingsWe found evidence of a difference in the overall mean ratio in the specificity for OOPs in inpatient care and medications. Within each of these two categories, a more detailed disaggregation yielded lower OOPs estimates than less detailed ones. The level of agreement between household and provider OOPs also decreased with increasing specificity of health items.ConclusionOur findings suggest that, for inpatient care and medications, systematically decomposing OOPs categories into finer subclasses tend to produce lower OOPs estimates. Less detailed items produced more accurate and reliable OOPs estimates in the context of a rural setting.

scholarly journals Cognitive Performance and Its Associations with Dental Caries: Results from the Dental, Oral, Medical Epidemiological (DOME) Records-Based Nationwide Study

Biology ◽  
2021 ◽  
Vol 10 (3) ◽  
pp. 178
Author(s):  
Itzhak Abramovitz ◽  
Avraham Zini ◽  
Matan Atzmoni ◽  
Ron Kedem ◽  
Dorit Zur ◽  
...  
Keyword(s):  
Dental Caries ◽  
Cognitive Performance ◽  
Odds Ratio ◽  
Allocation Of Resources ◽  
Cross Sectional ◽  
Intelligence Score ◽  
Health Related ◽  
The Mean ◽  
Nationally Representative ◽  
Age Range

Relatively few studies have analyzed the association between cognitive performance and dental status. This study aimed to analyze the association between cognitive performance and dental caries. Included were data from the dental, oral, medical epidemiological (DOME) study; cross-sectional records-based research, which integrated large socio-demographic, medical, and dental databases of a nationally representative sample of young to middle-aged military personnel (N = 131,927, mean age: 21.8 ± 5.9 years, age range: 18–50). The cognitive function of draftees is routinely measured at age 17 years using a battery of psychometric tests termed general intelligence score (GIS). The mean number of decayed teeth exhibited a gradient trend from the lowest (3.14 ± 3.58) to the highest GIS category (1.45 ± 2.19) (odds ratio (OR) lowest versus highest = 5.36 (5.06–5.68), p < 0.001). A similar trend was noted for the other dental parameters. The associations between GIS and decayed teeth persisted even after adjusting for socio-demographic parameters and health-related habits. The adjustments attenuated the OR but did not eliminate it (OR lowest versus highest = 3.75 (3.38–4.16)). The study demonstrates an association between cognitive performance and caries, independent of the socio-demographic and health-related habits that were analyzed. Better allocation of resources is recommended, focusing on populations with impaired cognitive performance in need of dental care.

scholarly journals Ultra-processed food consumption in Barbados: evidence from a nationally representative, cross-sectional study

2021 ◽  
Vol 10 ◽  
Author(s):  
Rachel M. Harris ◽  
Angela M. C. Rose ◽  
Suzanne Soares-Wynter ◽  
Nigel Unwin
Keyword(s):  
Communicable Disease ◽  
Population Based ◽  
Cross Sectional Study ◽  
Sectional Study ◽  
Cross Sectional ◽  
Targeted Interventions ◽  
Sweetened Beverages ◽  
Group 4 ◽  
The Mean ◽  
Nationally Representative

Abstract Our objective was to describe, for the first time in an English-speaking Caribbean country, the contribution of ultra-processed foods (UPFs) to nutrients linked to non-communicable disease. Using a cross-sectional study design, dietary data were collected from two non-consecutive 24-h dietary recalls. Recorded food items were then classified according to their degree of processing by the NOVA system. The present study took place in Barbados (2012–13). A representative population-based sample of 364 adult Barbadians (161 males and 203 females) aged 25–64 years participated in the study. UPFs represented 40⋅5 % (838 kcal/d; 95 % CI 791, 885) of mean energy intake. Sugar-sweetened beverages made the largest contribution to energy within the UPF category. Younger persons (25–44 years) consumed a significantly higher proportion of calories from UPF (NOVA group 4) compared with older persons (45–64 years). The mean energy shares of UPF ranged from 22⋅0 to 58⋅9 % for those in the lowest tertile to highest tertile. Within each tertile, the energy contribution was significantly higher in the younger age group (25–44 years) compared with the older (45–64 years). One-quarter of persons consume ≥50 % of their daily calories from UPF, this being significantly higher in younger persons. The ultra-processed diet fraction contained about six times the mean of free sugars and about 0⋅8 times the dietary fibre of the non-ultra-processed fraction (NOVA groups 1–3). Targeted interventions to decrease the consumption of UPF especially in younger persons is thus of high priority to improve the diet quality of Barbadians.

scholarly journals Psychological factors underpinning vaccine willingness in Israel, Japan and Hungary

2021 ◽  
Author(s):  
Robin Goodwin ◽  
Menachem Ben-Ezra ◽  
Masahito Takahashi ◽  
Lan Anh Nguyen Luu ◽  
Krisztina Borsfay ◽  
...  
Keyword(s):  
Latent Class ◽  
Systems Approach ◽  
Vaccine Hesitancy ◽  
Effective Vaccine ◽  
Anticipated Regret ◽  
Nationally Representative ◽  
The Government ◽  
Using Data ◽  
The Individual ◽  
Representative Samples

The rapid international spread of the SARS-CoV-2 virus 19 led to unprecedented attempts to develop and administer an effective vaccine. However, there is evidence of considerable vaccine hesitancy in some countries and sub-populations. We investigated willingness to vaccinate in three nations with historically different levels of vaccine willingness and attitudes to the COVID-19 vaccine rollout: Israel, Japan and Hungary. Employing an ecological-systems approach we analysed associations between demographic factors and health status, individual cognitions, normative pressures, trust in government, belief in COVID-19 myths and willingness to be vaccinated, using data from three nationally representative samples (Israel, N=1011 (Jan 2021); Japan, N= 997 (Feb 2021); Hungary, N=1131 (Apr 2021)). In Israel 74% indicated a willingness to vaccinate, but only 51% in Japan and 31% in Hungary. Results from multigroup regression analyses indicated greater vaccine willingness amongst those who perceived benefits to vaccination, anticipated regret if not vaccinated and trusted the government. Multi-group latent class analysis of ten COVID-19 (mis)beliefs identified three classes of myths, with concerns about the alteration of DNA (Israel), allergies (Hungary) and catching COVID-19 from the vaccine (Japan) specific to vaccine willingness for each culture. Rather than focusing primarily on disease threats, intervention campaigns should focus on increasing trust and addressing culturally specific myths while emphasising the individual and social group benefits of vaccination.

scholarly journals Genetic homozygosity as a marker of smoking dependency

Genetika ◽  
2020 ◽  
Vol 52 (3) ◽  
pp. 1009-1019
Author(s):  
Slavko Brankovic ◽  
Dejan Nikolic ◽  
Dragoslav Marinkovic ◽  
Suzana Cvjeticanin
Keyword(s):  
Cross Sectional Study ◽  
Male Gender ◽  
Sectional Study ◽  
Cross Sectional ◽  
Male And Female ◽  
Mean Values ◽  
Individual Variations ◽  
Significant Difference ◽  
The Mean ◽  
The Individual

The aim of our study was to evaluate the morphogenetic variability as a marker of smoking dependency in adult smokers versus controls and to investigate the presence and the degree of morphogenetic variability difference between male and female smokers versus same gender controls. The cross-sectional study evaluated 241 smokers and 185 nonsmoker individuals as controls. We analyzed 17 homozygous recessive characteristics (HRC). There was a significant difference in the individual variations of 17 HRCs between the controls and smokers (??2=61.400, p<0.001; for females ??2=79.440, p<0.001; for males ??2=84.972, p<0.001). The mean values of HRCs significantly differed between smokers and controls (MV?SEM(Controls) -4.79?0.13, MV?SEM(Smokers) -5.70?0.12; p<0.001). For males, presence of 6/17 (35.29% genetic homozygosity) HRCs (OR=6.12) was to the certain degree predictor for smoking dependency. Higher degree of genetic homozygosity, changed variability and male gender, might be some among potential numerous factors that could have impact on smoking development and dependence.

Lead screening in children presenting to three hospitals in Lebanon

2021 ◽  
pp. archdischild-2021-322012
Author(s):  
Tharwat El Zahran ◽  
Hala Mostafa ◽  
Hani Hamade ◽  
Moustafa Al Hariri ◽  
Aed Saab ◽  
...  
Keyword(s):  
Blood Lead ◽  
Cross Sectional Study ◽  
Construction Sites ◽  
Cross Sectional ◽  
Leaded Gasoline ◽  
Traditional Remedies ◽  
Lead Levels ◽  
Risk Of Exposure ◽  
The Mean ◽  
Nationally Representative

BackgroundLead damages most body organs and its effects are most profound in children. In a study in Beirut in 2003, before banning the leaded gasoline, 79% of the participants showed blood lead levels (BLLs) higher than 5 µg/dL. The prevalence of lead exposure in Lebanon after the ban on leaded gasoline has not been studied. This study assessed the BLL in Lebanese children aged 1–6 years.MethodsThis cross-sectional study was conducted in three hospitals in Beirut. The children’s BLLs were tested, and their caregiver completed a questionnaire to identify subgroups at risk of exposure. Participants were provided with a WHO brochure highlighting the risks of lead.ResultsNinety children with a mean age of 3.5±1.5 years were enrolled in the study and had a mean BLL of 1.1±0.7 µg/dL, with all values being below 5.0 µg/dL, showing a marked decrease in BLL compared with the mean BLL before the ban on leaded gasoline in 2002. Having a father or a mother with a college degree (p=0.01 and p=0.035, respectively) and having a monthly household income greater than $1000 (p=0.021) were associated with significantly lower BLL. Having more rooms at home and residing close to construction sites were associated with a significantly lower BLL (p=0.001 and p=0.026, respectively). Residing in a house aged >40 years and receiving traditional remedies were associated with a significantly higher BLL (p=0.009 and p<0.0001, respectively).ConclusionBLLs have declined among Lebanese children and this could be attributed to multiple factors including the ban of leaded gasoline. It would be beneficial to conduct a larger study with a nationally representative sample to better characterise the BLL.

Crowding-Out Effect of Out-of-Pocket Health Expenditures on Consumption Among Households in Mongolia

2021 ◽  
Author(s):  
Ochirbat Batbold ◽  
Tuvshin Banzragch ◽  
Davaatseren Davaajargal ◽  
Christy Pu
Keyword(s):  
Social Health Insurance ◽  
Health Expenditures ◽  
Household Consumption ◽  
Cross Sectional Study ◽  
Absolute Amount ◽  
Crowding Out ◽  
Cross Sectional ◽  
Household Expenditures ◽  
Engel Curves ◽  
Nationally Representative

Background: High out-of-pocket (OOP) health expenditures are a common problem in developing countries. Studies rarely investigate the crowding-out effect of OOP health expenditures on other areas of household consumption. OOP health costs are a colossal burden on families and can lead to adjustments in other areas of consumption to cope with these costs. Methods: This cross-sectional study used self-reported household consumption data from the nationally representative Household Socioeconomic Survey (HSES), collected in 2018 by the National Statistical Office of Mongolia. We estimated a quadratic conditional Engel curves system to determine intrahousehold resource allocation among 12 consumption variables. The 3-stage least squared method was used to deal with heteroscedasticity and endogeneity problems to estimate the causal crowding-out effect of OOP. Results: The mean monthly OOP health expenditure per household was ₮64 673 (standard deviation [SD]=259 604), representing approximately 6.9% of total household expenditures. OOP health expenditures were associated with crowding out durables, communication, transportation, and rent, and with crowding in education and heating for all households. The crowding-out effect of ₮10 000 in OOP health expenditures was the largest for food (₮5149, 95% CI=−8582; −1695) and crowding-in effect was largest in heating (₮2691, 95% CI=737; 4649) in the lowest-income households. The effect of heating was more than 10 times greater than that in highest-income households (₮261, 95% CI=66; 454); in the highest-income households, food had a crowding-in effect (₮179, 95% CI=-445; 802) in absolute amounts. In terms of absolute amount, the crowding-out effect for food was up to 5 times greater in households without social health insurance (SHI) than in those with SHI. Conclusion: Our findings suggest that Mongolia’s OOP health expenses are associated with reduced essential expenditure on items such as durables, communication, transportation, rent, and food. The effect varies by household income level and SHI status, and the lowest-income families were most vulnerable. SHI in Mongolia may not protect households from large OOP health expenditures.

scholarly journals Polypharmacy Increases Risk of Dyspnea Among Adults With Serious, Life-Limiting Diseases

2019 ◽  
Vol 37 (4) ◽  
pp. 278-285 ◽  
Author(s):  
Kathleen M. Akgün ◽  
Supriya Krishnan ◽  
Shelli L. Feder ◽  
Janet Tate ◽  
Jean S. Kutner ◽  
...  
Keyword(s):  
Symptom Assessment ◽  
Assessment System ◽  
Advanced Illness ◽  
Cross Sectional ◽  
Chronic Medication ◽  
Parallel Group ◽  
Increased Risk ◽  
Dyspnea Score ◽  
The Mean ◽  
Using Data

Background: Polypharmacy is associated with dyspnea in cross-sectional studies, but associations have not been determined in longitudinal analyses. Statins are commonly prescribed but their contribution to dyspnea is unknown. We determined whether polypharmacy was associated with dyspnea trajectory over time in adults with advanced illness enrolled in a statin discontinuation trial, overall, and in models stratified by statin discontinuation. Methods: Using data from a parallel-group unblinded pragmatic clinical trial (patients on statins ≥3 months with life expectancy of 1 month to 1 year, enrolled in the parent study between June 3, 2011, and May 2, 2013, n = 308/381 [81%]), we restricted analyses to patients with available baseline medication count and ≥1 dyspnea score. Polypharmacy was assessed by self-reported chronic medication count. Dyspnea trajectory group, our primary outcome, was determined over 24 weeks using the Edmonton Symptom Assessment System. Results: The mean age of the patients was 73.8 years (standard deviation [SD]: ±11.0) and the mean medication count was 11.6 (SD: ±5.0). We identified 3 dyspnea trajectory groups: none (n = 108), mild (n = 130), and moderate–severe (n = 70). Statins were discontinued in 51.8%, 48.5%, and 42.9% of patients, respectively. In multivariable models adjusting for age, sex, diagnosis, and statin discontinuation, each additional medication was associated with 8% (odds ratio [OR] = 1.08 [1.01-1.14]) and 16% (OR = 1.16 [1.08-1.25]) increased risk for mild and moderate–severe dyspnea, respectively. In stratified models, polypharmacy was associated with dyspnea in the statin continuation group only (mild OR = 1.12 [1.01-1.24], moderate–severe OR = 1.24 [1.11-1.39]) versus statin discontinuation (mild OR = 1.03 [0.95-1.12], and moderate–severe OR = 1.09 [0.98-1.22]). Conclusion: Polypharmacy was strongly associated with dyspnea. Prospective interventions to decrease polypharmacy may impact dyspnea symptoms, especially for statins.

scholarly journals Functional Hearing Loss and Social Engagement Among Medicare Beneficiaries

2019 ◽  
Vol 76 (1) ◽  
pp. 195-200 ◽  
Author(s):  
Aishwarya Shukla ◽  
Thomas K M Cudjoe ◽  
Frank R Lin ◽  
Nicholas S Reed
Keyword(s):  
Older Adults ◽  
Hearing Loss ◽  
Social Engagement ◽  
Social Activity ◽  
Medicare Beneficiaries ◽  
Cross Sectional ◽  
The Past ◽  
Hearing Ability ◽  
Nationally Representative ◽  
Using Data

Abstract Objectives Hearing loss is common in older adults and limits communication. We investigated the independent association between functional hearing loss and social engagement in a nationally representative sample of older adults. Methods Using data from the 2015 Medicare Current Beneficiaries Survey, we modeled the cross-sectional association between self-reported hearing ability and limitation in social activity over the past month using multivariable logistic regression. Results The majority of the study population was female (54.8%) and non-Hispanic white (74.3%). Participants (40.4%) reported “a little trouble” hearing and 7.4% reported “a lot of trouble” hearing. Those who reported any trouble hearing had higher odds of limited social engagement in the past month. After adjustment for demographic, clinical, and functional covariates, those who reported “a lot of trouble” hearing had 37% higher odds of limited social activity in the past month compared to those with normal hearing. Discussion These results suggest that hearing loss may be an important risk factor for limited social engagement and downstream negative health consequences, independent of other disability and health conditions.

scholarly journals Influence of Different Intellectual Disability Levels on Caries and Periodontal Disease

2016 ◽  
Vol 27 (1) ◽  
pp. 52-55 ◽  
Author(s):  
Antônio Augusto Iponema Costa ◽  
Álvaro Della Bona ◽  
Micheline Sandini Trentin
Keyword(s):  
Intellectual Disability ◽  
Periodontal Disease ◽  
Retention Factor ◽  
Severe Disabilities ◽  
Exceptional Children ◽  
Cross Sectional ◽  
The Mean ◽  
The Individual ◽  
Disability Level ◽  
Oral Condition

Abstract Oral health care is fundamental to preserve the individual integrity and consequently influences the general health. This observational, cross-sectional and analytical study evaluated the oral condition of 129 intellectually disabled individuals from the Association of Parents and Friends of Exceptional Children (APAE) in three southern Brazilian cities. Dental caries (DMFT and dmft indices) and periodontal disease (PSR index) were evaluated considering the intellectual disability level. A questionnaire on socioeconomic status (income and education level) and the last visit to a dentist was answered by the subjects' parents/guardians. The data were statistically evaluated using analysis of variance (ANOVA) and Tukey test (α=0.05). The mean DMFT values were 2.27, 3.76 and 0.58 (p<0.05), and the mean dmft values were 1.48, 1.55 and 2.75, respectively for subjects with mild, moderate and severe disabilities. Regarding the PSR index, 43% of the subjects presented gingivitis without retention factor (no calculus or defective margins) with no significant differences among the three disability levels. Considering the population and the limitations of this study, the subjects presenting severe disabilities showed significantly lower mean DMFT values compared to other disability levels, probably because the caretakers are responsible for the oral hygiene of such subjects.

Twin and Sibling Attachment in a Nationally Representative Sample

2012 ◽  
Vol 38 (3) ◽  
pp. 308-316 ◽  
Author(s):  
R. Chris Fraley ◽  
Caroline M. Tancredy
Keyword(s):  
Older People ◽  
Representative Sample ◽  
Inclusive Fitness ◽  
Identical Twins ◽  
Cross Sectional ◽  
Attachment Figure ◽  
Nationally Representative ◽  
Using Data

The objective of this research was to evaluate the hypothesis that twin relationships are attachments, using data from a nationally representative sample. The results indicated that twin siblings were more likely than nontwin siblings to be attached to their siblings. Moreover, analyses indicated that both attachment theoretical and inclusive fitness perspectives are necessary for explaining these findings. Namely, twins were more likely to be attached than nontwin siblings, as expected from an attachment perspective. But identical twins were more likely than fraternal twins to be attached to one another, as might be expected from an inclusive fitness perspective. Cross-sectional analyses indicated that older people are less likely than younger people to use their sibling as an attachment figure compared to younger people and that married adults are less likely to use their sibling as an attachment figure than nonmarried people.

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