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Visit Rates (visit + rate)
Selected AbstractsPresence of a Community Health Center and Uninsured Emergency Department Visit Rates in Rural CountiesTHE JOURNAL OF RURAL HEALTH, Issue 1 2009FAAFP, FACPM, George Rust MD ABSTRACT:,Context: Community health centers (CHCs) provide essential access to a primary care medical home for the uninsured, especially in rural communities with no other primary care safety net. CHCs could potentially reduce uninsured emergency department (ED) visits in rural communities. Purpose: We compared uninsured ED visit rates between rural counties in Georgia that have a CHC clinic site and counties without a CHC presence. Methods: We analyzed data from 100% of ED visits occurring in 117 rural (non-metropolitan statistical area [MSA]) counties in Georgia from 2003 to 2005. The counties were classified as having a CHC presence if a federally funded (Section 330) CHC had a primary care delivery site in that county throughout the study period. The main outcome measure was uninsured ED visit rates among the uninsured (all-cause ED visits and visits for ambulatory care sensitive conditions). Poisson regression models were used to examine the relationship between ED rates and the presence of a CHC. To ensure that the effects were unique to the uninsured population, we ran similar analyses on insured ED visits. Findings: Counties without a CHC primary care clinic site had 33% higher rates of uninsured all-cause ED visits per 10,000 uninsured population compared with non-CHC counties (rate ratio [RR] 1.33, 95% confidence interval [CI] 1.11-1.59). Higher ED visit rates remained significant (RR 1.21, 95% CI 1.02-1.42) after adjustment for percentage of population below poverty level, percentage of black population, and number of hospitals. Uninsured ED visit rates were also higher for various categories of diagnoses, but remained statistically significant on multivariate analysis only for ambulatory care sensitive conditions (adjusted RR = 1.22, 95% CI 1.01-1.47). No such relationship was found for ED visit rates of insured patients (RR 1.06, 95% CI 0.92-1.22). Conclusions: The absence of a CHC is associated with a substantial excess in uninsured ED visits in rural counties, an excess not seen for ED visit rates among the insured. [source] Age-period-cohort analysis of dentist use in Spain from 1987 to 1997.EUROPEAN JOURNAL OF ORAL SCIENCES, Issue 3 2001An analysis based on the Spanish National Health Interview Surveys The aim was to determine whether the effects of age, period (from 1987 to 1997), or cohort (birth-cohort) are the most plausible explanations for the variation in dentist utilisation over time in Spain. On the basis of three sequential Spanish National Health Surveys, the trend in the percentage of people visiting the dentist within the previous 3 months was analysed by means of a standard cohort table and by the Clayton & Schifflers method. The percent of people visiting the dentist grew from 13.6% in 1987, to 17.2% in 1997. Visual examination of the cohort table, together with the fit of the age-cohort model, indicates that cohort succession may be the best explanation for the increase. The younger the cohort, the higher the dental visit rate; this relationship was strongest for people born after 1977. The model also indicates that the rates of dental visiting tend to increase up to middle age, and then tend to decrease with age. [source] The influence of greenhouse chrysanthemum on the interaction between the beet armyworm, Spodoptera exigua, and the baculovirus SeMNPV: parameter quantification for a process-based simulation modelJOURNAL OF APPLIED ENTOMOLOGY, Issue 9-10 2001F. J. J. A. Bianchi During the building of a process-based simulation model for the epidemiology of the multicapsid nucleopolyhedrovirus of S. exigua (SeMNPV) in populations of Spodoptera exigua (Hübner) in greenhouse chrysanthemum, it was found that the effect of host plants had been under-rated. ,Missing links' included (i) the ,natural' background mortality of larvae of S. exigua in practical cropping conditions; (ii) the developmental rate of larvae of S. exigua on plant substrate in a glasshouse as compared to artificial medium in the laboratory; (iii) the validity of the results of dose-mortality and time-mortality bioassays conducted on artificial medium as compared to natural plant substrate; (iv) the distribution of inoculum released from deceased caterpillars over chrysanthemum leaves; and (v) the leaf visit rate of healthy caterpillars (as it affects horizontal transmission). Experiments were carried out to quantify these processes. Developmental rates of S. exigua larvae on greenhouse chrysanthemum were 36% lower than on an artificial diet. The fraction survival during the first, second, third and fourth instar S. exigua larvae in greenhouse chrysanthemum was 0.60, 0.80, 0.88 and 0.95, respectively. Forty percent of the first instar larvae reached the fifth larval stage. Second instar S. exigua larvae reared on chrysanthemum were significantly more susceptible to SeMNPV than larvae reared on an artificial diet. The food source had no effect on the time to kill S. exigua larvae. Cadavers of second, third and fourth instar S. exigua larvae contaminated on average 1.4, 2.5 and 3.3 chrysanthemum leaves. Second to fourth instar S. exigua larvae visited 2,3 leaves per day and spent 15,55% of the time on the underside of leaves. The above information is of critical importance for a trustworthy simulation of the epidemiology of SeMNPV in chrysanthemum. [source] How different provisioning strategies result in equal rates of food delivery: an experimental study of blue tits Parus caeruleusJOURNAL OF AVIAN BIOLOGY, Issue 4 2002Fabrizio Grieco Food provisioning in birds requires a considerable amount of time and usually has to be traded-off against other parental and non-parental activities. I investigated experimentally the rate at which blue tit Parus caeruleus parents deliver food to their brood after a change in food availability. The main argument behind this study is that parents enjoying an additional food source may use less time for self-feeding and therefore use more time for food provisioning. This could increase the rate at which food is brought to the nest. However, a prey choice model that takes the energetic needs of the parent into account allows for the possibility that the food-supplemented parents would deliver the same amount of food by increasing prey size (through an increase in prey selectivity) and reducing visit rate. The field data indicate that the parents changed provisioning strategy when food-supplemented: they fed the chicks natural food less frequently, but brought larger larvae. On the whole, delivery rate of natural food was the same or lower than in controls. The results suggest that food-supplemented parents used the time saved to increase their degree of food selectivity. When the gains from an increased delivery rate are not worth the increased costs (mainly resulting from an increased visiting rate), the parent with low energetic need may increase selectivity to provide the same amount of food to the brood as the unmanipulated parent, but at a lower cost. [source] Horizontal equity in utilisation of care and fairness of health financing: a comparison of micro-health insurance and user fees in RwandaHEALTH ECONOMICS, Issue 1 2006Pia Schneider Abstract This paper uses two methods to compare the impact of health care payments under insurance and user fees. Concentration indices for insured and uninsured groups are computed following the indirect standardisation method to evaluate horizontal inequity in utilisation of basic health care services. The minimum standard approach analyses the extent to which out-of-pocket health spending contributed to increased poverty. The analysis uses cross-sectional household survey data collected in Rwanda in 2000 in the context of the introduction of community-based health insurance. Results indicate that health spending had a small impact on the socio-economic situation of uninsured and insured households; however, this is at the expense of horizontal inequity in utilisation of care for user-fee paying individuals who reported significantly lower visit rates than the insured. Copyright © 2005 John Wiley & Sons, Ltd. [source] Targeted health insurance in a low income country and its impact on access and equity in access: Egypt's school health insuranceHEALTH ECONOMICS, Issue 3 2001Winnie Yip Abstract Governments are constantly faced with competing demands for public funds, thereby necessitating careful use of scarce resources. In Egypt, the School Health Insurance Programme (SHIP) is a government subsidized health insurance system that targets school children. The primary goals of the SHIP include improving access and equity in access to health care for children while, at the same time, ensuring programme sustainability. Using the Egyptian Household Health Utilization and Expenditure Survey (1995), this paper empirically assesses the extent to which the SHIP achieves its stated goals. Our findings show that the SHIP significantly improved access by increasing visit rates and reducing financial burden of use (out-of-pocket expenditures). With regard to the success of targeting the poor, conditional upon being covered, the SHIP reduced the differentials in visit rates between the highest and lowest income children. However, only the middle-income children benefitted from reduced financial burden (within group equity). Moreover, by targeting the children through school enrollment, the SHIP increased the differentials in the average level of access between school-going children and those not attending school (overall equity). Children not attending school tend to be poor and living in rural areas. Our results also indicate that original calculations may underestimate the SHIP financial outlays, thereby threatening the long run financial sustainability of the programme. Copyright © 2001 John Wiley & Sons, Ltd. [source] Dental Service Utilization among Urban and Rural Older Adults in China , A Brief CommunicationJOURNAL OF PUBLIC HEALTH DENTISTRY, Issue 3 2007Bei Wu PhD Abstract Objectives: China's health care system is bifurcated in nature between rural and urban areas. In addition, there is a huge gap in socioeconomic status between rural and urban residents. The purpose of the study was to examine the factors related to dental visits among elders in rural and urban areas of Shanghai, China. Methods: Using a stratified random sampling method, a cross-sectional, face-to-face survey was conducted among elders aged 60 years and above in Shanghai during 2003-04. A total of 1,044 older respondents were included in the sample. Results: There was a significant urban and rural difference in dental visit rates over the 12-month period of the study. Results from the logistic regression analysis suggested that residing in urban areas was a significant positive factor related to dental visits. In addition, being younger, being able to pay out-of-pocket medical expenses, having had regular medical checkups, having a higher number of limitations because of chronic conditions, and being more concerned about eating a healthy diet were associated with increased odds of dental visits. Conclusions: Results suggest that urban,rural differences, as reflected in the socioeconomic status gap, disparity in medical insurance coverage, and access to dental care, have a significant impact on the use of dental services by Chinese elders. Individual sociodemographic characteristics, health status, and health attitude are important explanatory variables. [source] National Study of Emergency Department Visits for Acute Exacerbation of Chronic Obstructive Pulmonary Disease, 1993,2005ACADEMIC EMERGENCY MEDICINE, Issue 12 2008Chu-Lin Tsai MD Abstract Objectives:, Little is known about recent trends in U.S. emergency department (ED) visits for acute exacerbation of chronic obstructive pulmonary disease (AECOPD) or about ED management of AECOPD. This study aimed to describe the epidemiology of ED visits for AECOPD and to evaluate concordance with guideline-recommended care. Methods:, Data were obtained from National Hospital Ambulatory Medical Care Survey (NHAMCS). ED visits for AECOPD, during 1993 to 2005, were identified using the International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) codes. Concordance with guideline recommendations was evaluated using process measures. Results:, Over the 13-year study period, there was an average annual 0.6 million ED visits for AECOPD, and the visit rates for AECOPD were consistently high (3.2 per 1,000 U.S. population; Ptrend = 0.13). The trends in the use of chest radiograph, pulse oximetry, or bronchodilator remained stable (all Ptrend > 0.5). By contrast, the use of systemic corticosteroids increased from 29% in 1993,1994 to 60% in 2005, antibiotics increased from 14% to 42%, and methylxanthines decreased from 15% to <1% (all Ptrend < 0.001). Multivariable analysis showed patients in the South (vs. the Northeast) were less likely to receive systemic corticosteroids (odds ratio [OR] = 0.6; 95% confidence interval [CI] = 0.4 to 0.9). Conclusions:, The high burden of ED visits for AECOPD persisted. Overall concordance with guideline-recommended care for AECOPD was moderate, and some emergency treatments had improved over time. [source] Changes in Sexual Expression as Result of Defoliation and Environment in a Monoecious Shrub in Mexico: Implications for PollinationBIOTROPICA, Issue 4 2009Gerardo Arceo-Gómez ABSTRACT Folivory may indirectly impact plant reproduction through changes in sexual expression (i.e., number or proportion of male and female flowers produced), which influence plant,pollinator interactions via changes in pollinator preference or efficiency. This study is an experimental evaluation of the effect that defoliation has on sex expression in the monoecious shrub Cnidoscolus aconitifolius, how such effect varies across sites, as well as how such changes indirectly affect pollinator visitation rates. The present study used three populations of C. aconitifolius, each one located in a different site in Yucatán (México): pasture, deciduous forest and subdeciduous medium height forest and three levels of defoliation: 50 percent, 100 percent, and a control (no damage). Results showed that defoliation reduced significantly the total number of male flowers produced in two of the sites. Defoliation did not impact female flower production or the proportion of female flowers produced. Finally, floral visit rates were not affected by defoliation via changes in sexual expression and neither by site or by the interaction site × defoliation. Findings showed that defoliation had an effect on sex expression in C. aconitifolius, although apparently this change did not affect the plant,pollinator interactions. [source] | |||||||||||||