In Reply: Evaluating Effectiveness of Care: Some Questions

PEDIATRICS ◽  
1972 ◽  
Vol 49 (5) ◽  
pp. 782-782
Author(s):  
Leon Gordis ◽  
Milton Markowitz
Keyword(s):  
Health Services ◽  
Population Size ◽  
Target Population ◽  
Health Needs ◽  
Unmet Health Needs ◽  
Effectiveness Of Care ◽  
Measures Of Effectiveness

In our paper we specifically discussed the points raised by Drs. Sommers and Sussman regarding the problems of population size, duration of follow-up, and measures of effectiveness used. In regard to measures of effectiveness, we proceeded on the assumption that when a new program for delivering health services is developed to meet unmet health needs it should be possible to demonstrate measurable changes in the health of the target population if the program is indeed effective.

Understanding the Health of Refugee Women in Host Countries: Lessons from the Kosovar Re-Settlement in Canada

2008 ◽  
Vol 23 (4) ◽  
pp. 322-327 ◽  
Author(s):  
Lynda Redwood-Campbell ◽  
Harpreet Thind ◽  
Michelle Howard ◽  
Jennifer Koteles ◽  
Nancy Fowler ◽  
...  
Keyword(s):  
Health Care ◽  
Health Services ◽  
Focus Groups ◽  
Women’S Health ◽  
Women's Health ◽  
Cultural Influences ◽  
Women Refugees ◽  
Health Needs ◽  
Host Countries ◽  
Unmet Health Needs

AbstractIntroduction:Refugees from Kosovo arrived in several Canadian cities after humanitarian evacuations in 1999. Approximately 500 arrived in Hamilton, Canada. Volunteer sponsors from community organizations assisted the families with settlement, which included providing them access to healthcare services.Hypothesis/Problem: It was anticipated that women, in particular, would have unmet health needs relating to trauma and a lack of healthcare access after experiencing forced migration.Methods:This study describes the results of a self-administered survey regarding women's health issues and experiences with health services after the arrival of refugees. It also describes the sponsor group's experience related to women's health care. The survey was administered to a random sample of 85 women refugees, and focus groups with 14 sponsors.Women self-completed questionnaires about their health, which included the Harvard Trauma Questionnaire for post-traumatic stress disorder (PTSD) and use of preventive health services. Sponsor groups participated in a focus group discussing healthcare needs and experiences of their assigned refugee families. Themes pertaining to women's issues were identified from the focus groups.Results:Preventive screening rates were low, only 1/19 (5.3%) women ≥50- years-old had ever received a mammogram; 34.1% (28/82) had ever received a Pap test); and PTSD was prevalent (25.9%, 22/85). Sponsor groups identified challenges relating to prenatal care needs, finding family physicians, language barriers to health care services, cultural influences of women's healthcare decision-making, mental health concerns, and difficulties accessing dental care, eye care, and prescriptions.Conclusions:Many women refugees from Kosovo had unmet health needs. Culturally appropriate population level screening campaigns and integration of language and interpretation services into the healthcare sector on a permanent basis are important policy actions to be adequately prepared for newcomers and women in displaced situations. These needs should be anticipated during the evacuation period by host countries to aid in planning the provision of health resources more efficiently for refugees and displaced people going to host countries.

scholarly journals A comparison of zero-inflated and hurdle models for modeling zero-inflated count data

2021 ◽  
Vol 8 (1) ◽  
Author(s):  
Cindy Xin Feng
Keyword(s):  
Health Services ◽  
Count Data ◽  
Goodness Of Fit ◽  
Negative Binomial ◽  
Simulation Studies ◽  
Final Choice ◽  
Hurdle Models ◽  
Count Distribution ◽  
Careful Assessment

AbstractCounts data with excessive zeros are frequently encountered in practice. For example, the number of health services visits often includes many zeros representing the patients with no utilization during a follow-up time. A common feature of this type of data is that the count measure tends to have excessive zero beyond a common count distribution can accommodate, such as Poisson or negative binomial. Zero-inflated or hurdle models are often used to fit such data. Despite the increasing popularity of ZI and hurdle models, there is still a lack of investigation of the fundamental differences between these two types of models. In this article, we reviewed the zero-inflated and hurdle models and highlighted their differences in terms of their data generating processes. We also conducted simulation studies to evaluate the performances of both types of models. The final choice of regression model should be made after a careful assessment of goodness of fit and should be tailored to a particular data in question.

Transdiagnostic versus Diagnosis-Specific Group Cognitive Behavioral Therapy for Anxiety Disorders and Depression: A Randomized Controlled Trial

2021 ◽  
pp. 1-14
Author(s):  
Nina Reinholt ◽  
Morten Hvenegaard ◽  
Anne Bryde Christensen ◽  
Anita Eskildsen ◽  
Carsten Hjorthøj ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Behavioral Therapy ◽  
Controlled Trial ◽  
Well Being ◽  
Major Depressive ◽  
Outpatient Mental Health ◽  
End Of Treatment

<b><i>Introduction:</i></b> The Unified Protocol for Transdiagnostic Treatment of Emotional Disorders (UP) delivered in a group format could facilitate the implementation of evidence-based psychological treatments. <b><i>Objective:</i></b> This study compared the efficacy of group UP and diagnosis-specific cognitive behavioral therapy (dCBT) for anxiety and depression in outpatient mental health services. <b><i>Methods:</i></b> In this pragmatic, multi-center, single-blinded, non-inferiority, randomized controlled trial (RCT), we assigned 291 patients with major depressive disorder, social anxiety disorder, panic disorder, or agoraphobia to 14 weekly sessions in mixed-diagnosis UP or single-diagnosis dCBT groups. The primary test was non-inferiority, using a priori criteria, on the World Health Organisation 5 Well-Being Index (WHO-5) at the end of the treatment. Secondary outcomes were functioning and symptoms. We assessed outcomes at baseline, end-of-treatment, and at a 6-month follow-up. A modified per-protocol analysis was performed. <b><i>Results:</i></b> At end-of-treatment, WHO-5 mean scores for patients in UP (<i>n</i> = 148) were non-inferior to those of patients in dCBT (<i>n</i> = 143; mean difference –2.94; 95% CI –8.10 to 2.21). Results were inconclusive for the WHO-5 at the 6-month follow-up. Results for secondary outcomes were non-inferior at end-of-treatment and the 6-month follow-up. Client satisfaction and rates of attrition, response, remission, and deterioration were similar across conditions. <b><i>Conclusions:</i></b> This RCT demonstrated non-inferior acute-phase outcomes of group-delivered UP compared with dCBT for major depressive disorder, social anxiety disorder, panic disorder, and agoraphobia in outpatient mental health services. The long-term effects of UP on well-being need further investigation. If study findings are replicated, UP should be considered a viable alternative to dCBT for common anxiety disorders and depression in outpatient mental health services.

Health needs of indigenous Mayan older adults in Mexico and health services available

2020 ◽  
Vol 28 (5) ◽  
pp. 1688-1697
Author(s):  
Blanca Estela Pelcastre‐Villafuerte ◽  
Elizabeth Cuecuecha Rugerio ◽  
Sandra G. Treviño Siller ◽  
Celina M. Rueda Neria ◽  
María Guadalupe Ruelas‐González
Keyword(s):  
Older Adults ◽  
Health Services ◽  
Health Needs

scholarly journals Current delivery of infant mental health services: are infant mental health needs being met?

2005 ◽  
Vol 13 (4) ◽  
pp. 393-398 ◽  
Author(s):  
Elspeth Macdonald ◽  
Heather Mohay ◽  
Debra Sorensen ◽  
Neil Alcorn ◽  
Brett McDermott ◽  
...  
Keyword(s):  
Mental Health ◽  
Mental Health Services ◽  
Health Services ◽  
Health Needs ◽  
Infant Mental Health ◽  
Mental Health Needs
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