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Introducción: el apoyo al automanejo, la participación y retroalimentación son centrales en la implementación de una atención centrada en el usuario en el marco del modelo de cuidados crónicos. Esto ha demostrado mejorar diversos resultados sanitarios. Objetivo: estimar el grado de participación de los pacientes hipertensos y diabéticos, en las decisiones sobre su plan de tratamiento en población adulta chilena. Métodos: análisis secundario de la Encuesta Nacional de Salud (ENS) 2016-2017, muestra aleatoria estratificada de hogares, multietápica por conglomerados, representativa de la población adulta chilena. Se incluyó población mayor de 15 años hipertensa o diabética bajo tratamiento. Se describen las prevalencias expandidas de la variable percepción de participación en la toma de decisio-nes sobre plan terapéutico en escala Likert de 5 niveles, según edad, sexo, zona urbana/rural y nivel educacional. Se utilizó regresión logística y OR ajustados. Resultados: el 72,3% de los diabéticos y el 71,9% de los hipertensos, refieren "nunca" haber sido consultados al preparar su plan de tratamiento. En la población hipertensa, existe una percepción de participación significativamente más baja en mujeres que en hombres (OR ajustado por edad = 0,5 (IC 95% de 0,3-0,8) no se observaron diferencias estadísticamente significativas según edad, ruralidad ni nivel educacional. Conclusiones: la población hipertensa y diabética percibe bajos niveles de participación en el diseño de su plan terapéutico y los resultados sugieren inequidad de género en hipertensos. Este estudio permitirá evaluar futuras políticas y modificaciones al modelo de cuidados crónicos en el sistema de salud chileno.
Introduction: Self-management support, activation, participation, and feedback are core elements in chronic care models. Patients' participation in decision-making has been shown to improve health outcomes. Objective: To estimate the degree of participation of hypertensive and diabetic patients in decisions about their treatment plan in the general Chilean adult population. Methods: Secon-dary analysis of the "Encuesta Nacional de Salud (National Health Survey) (ENS) 2016-2017" multistage random stratified sample of households representative of the Chilean adult population. Hypertensive or diabetic populations older than 15 years of age that were under treatment were included. The weighted prevalence of the variable "perception of participation in decision making about their treatment plan" was described on a Likert scale of 5 levels, according to age, sex, urban/rural area, and educational level. We used logistic regression and adjusted OR. Results 72.3.5% of diabetic and 71.9% of hypertensive patients say they have "never" been asked their opinion about their treatment plan. In the hypertensive population, women perceived less participation than men (OR adjust by age =0.5 [IC 95% de 0.3-0.8]), with no significant differences observed by age, rurality, or educational level. Conclusions: Hypertensive and diabetic populations perceive low levels of participation in the design of their therapeutic plan, results also suggest gender inequity. This study contributes essential insights for the reformulation of Chilean chronic care models and may stand as a baseline to evaluate the implementation of future health policy.
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A study of sources of finance which the household resorts to, in order to meet the hospitalization expense can be of use to policy makers who may want to work in the direction of providing financial security against hospitalization expenses to the masses. In this view, an attempt has been made to study the sources of finance for hospitalized treatment at an individual level based on criteria such as level of living, socio-economic background, level of care in India, as well as at state level through unit level data of the survey on “Social Consumption related to Health”, conducted by National Sample Survey (NSS) during January, 2014 to June, 2014. It has been found that the household's income or saving is not sufficient to meet the expenditure for hospitalized treatment and people have to borrow or arrange finance by other means for hospitalized treatment across the country. The results thereby suggest inputs to policy makers and re-establish the necessity of appropriate policy in order to provide financial security against escalating medical expenses.
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BACKGROUND AND PURPOSE: The rapid increases in the elderly population and urbanization in South Korea have influenced both demographics and the environment. This study investigated trends in the prevalence and incidence of Parkinson's disease (PD), and the associations of PD with the urban and rural environments in South Korea. METHODS: This study examined subjects aged 40 years or older in a cohort constructed using the National Sample Cohort data set in South Korea during 2002–2013. We estimated the age-standardized prevalence and incidence of PD based on the 2002 population, and estimated their trends. We analyzed regional differences in these rates by dividing South Korea into three regions based on geographic characteristics and two regions based on the degree of urbanization. RESULTS: The standardized prevalence rates of PD per 100,000 increased significantly from 75.8 in 2003 to 136.8 in 2012 (p 0.05). The standardized incidence of PD in younger subjects was lower in eastern Korea than in the other two regions, while in the older subjects it was lower in western Korea than in metropolitan Seoul over almost the entire analyzed period. The standardized incidence of PD did not differ significantly between metropolitan and nonmetropolitan areas. CONCLUSIONS: The standardized prevalence of PD increased steadily from 2003 to 2012 in South Korea, while its standardized incidence has remained constant. There were regional differences in the prevalence and incidence of PD based on the degree of urbanization and the area of agricultural land.
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Aged , Humans , Cohort Studies , Dataset , Demography , Incidence , Korea , Parkinson Disease , Prevalence , Seoul , UrbanizationABSTRACT
Las enfermedades crónicas no transmisibles del adulto son el principal desafío de los sistemas de salud en el mundo. Se requiere información local para planificación sanitaria. Objetivos: Estimar la magnitud y distribución de problemas de salud crónicos prioritarios y sus determinantes en una muestra nacional representativa de la población general chilena. Métodos: ENS 2016-2017 es un estudio transversal con muestra de hogares aleatoria, estratificada, multietápica y por conglomerados representativa del nivel nacional, regional, urbano rural de 6233 personas de 15 y más años. Personal capacitado (encuestadores y enfermeras) en sucesivas visitas al hogar, administraron cuestionarios, examen dental, presión arterial, antropometría, recolectaron muestras de sangre en ayunas y orina. Se estimó la magnitud de 72 problemas de salud. Resultados: Se observa un elevado nivel absoluto de morbilidad por enfermedades crónicas y sus factores de riesgo. Se estima una magnitud de al menos 11 millones de personas con multimorbilidad que requieren atención médica y control crónico anual de por vida. Algunos ejemplos de altas prevalencias son: hipertensión (27,6 por ciento), dislipidemia HDL (46 por ciento), obesidad (34,4 por ciento), caries cavitadas (55 por ciento), diabetes (12,3 por ciento), tabaquismo actual (33,4 por ciento), problemas asociados al consumo de alcohol (12 por ciento), síntomas depresivos (15,8 por ciento), consumo excesivo de sal (98 por ciento), bajo consumo de frutas y verduras (85 por ciento), sedentarismo de tiempo libre (87 por ciento). Las mayores diferencias entre hombres y mujeres se observan en el uso riesgoso de alcohol y los síntomas depresivos. Conclusiones: la magnitud de población que requiere atención médica y cuidados crónicos supera la capacidad de respuesta del sistema de salud. Urgen fuertes estrategias preventivas de tipo poblacional (medidas regulatorias masivas) complementadas con una priorización de las estrategias de alto riesgo individual más costo efectivas. ENS aporta a la evaluación y vigilancia de ambas estrategias.(AU)
Chronic non communicable diseases are the main challenge for health systems in the world. Local information is required for health planning and policy design. Objectives: To estimate the magnitude and distribution of major chronic health problems and their determinants in the general population. Methods: ENS 2016-2017 is a cross-sectional study using a stratified, multistage and clustered random sample of households at the national, regional, rural and urban level including 6233 people aged 15 and over. Trained interviewers and nurses apply health questionnaires, physical examinations, collect blood and urine samples in successive household visits. Results: there is a high level of morbidity due to chronic diseases and their risk factors in Chile. At least 11 million people would need chronic long life medical care. Some prevalence magnitudes are: hypertension (27.6 percent), low HDL cholesterol (46 percent), obesity (34.4 percent), dental cavities (55 percent), diabetes (12.3 percent), current smoking (33.4 percent), at risk for alcohol use disorders(12 percent), depressive symptoms (15.8 percent), excessive salt consumption (98 percent), low consumption of fruits and vegetables (85 percent), Leisure-time physical inactivity (87 percent). Higher gender differences are related withalcohol use and depressive symptoms. Conclusions: the absolute number of people in need of medical chronic care exceeds our Health System's capacity. Population-wide preventive strategies (regulatory policies) coupled with carefully prioritized cost effective individual health care interventions are needed. ENS data contributes to the assessment and planning of both strategies.(AU)
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Humans , Male , Female , Public Policy , Chile , Global Health , Chronic Disease , MorbidityABSTRACT
BACKGROUND AND PURPOSE: Falling with a femur fracture is a serious event that negatively affects the quality of life of elderly individuals as well as patients with parkinsonism. This study investigated the association between parkinsonism and femur fracture and compared the risk of femur fracture between subjects with and without parkinsonism. METHODS: This study examined a population-based matched cohort constructed using the National Sample Cohort data set, which comprises approximately one million subscribers to medical insurance and aid in South Korea. Subjects with parkinsonism during 2003–2013 were identified as the exposed group, and up to five individuals matched for age, sex, and index years were identified as the controls for each parkinsonism subject. The risk of femur fracture for parkinsonism was evaluated using Cox regression. RESULTS: The incidence of femur fracture according to age, sex, and body mass index varied significantly between subjects with parkinsonism and controls (p<0.001). The presence of parkinsonism was associated with a higher risk of femur fractures for males [hazard ratio (HR)=2.85, 95% confidence interval [CI]=1.87–4.34], subjects younger than 65 years (HR=2.89, 95% CI=1.64–5.11), and underweight subjects (HR=3.90, 95% CI=1.82–8.35). The adjusted HR for femur fracture with parkinsonism was highest within 2 years of the disease diagnosis (HR=3.10, 95% CI=2.12–4.53). CONCLUSIONS: Our study found that the presence of parkinsonism is more strongly related to femur fracture in males, and increases the influence of traditional risk factors on femur fracture. It is necessary to consider how factors associated with the amount of ambulatory activity–even in an early diagnosed state–can play an important role in femur fracture in subjects with parkinsonism.
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Aged , Humans , Male , Accidental Falls , Body Mass Index , Cohort Studies , Dataset , Diagnosis , Femur , Incidence , Insurance , Korea , Parkinsonian Disorders , Quality of Life , Risk Factors , ThinnessABSTRACT
PURPOSE: To assess the trends in pars plana vitrectomy surgery rates and factors affecting rate change between 2002 and 2013 in South Korea. METHODS: Data from National Health Insurance Service-National Sample Cohort 2002–2013, which represents 1,025,340 samples with a sampling rate of 2.2% from the total eligible Korean population, was analyzed. RESULTS: A total of 3,816 vitrectomy procedures were performed (male, 2,010; female, 1,806) from 2002 to 2013. Annual rates of vitrectomy increased from 15.1 (in 2002) to 49.4 (in 2013) per 100,000 individuals, and this trend was prominent in those aged 60 years or older. As for the anesthetic method, vitrectomy under local anesthesia increased more prominently than vitrectomy under general anesthesia. The most common diagnoses associated with vitrectomy were diabetic retinopathy, retinal detachment, epiretinal membrane, and macular hole. CONCLUSIONS: The average annual rate of vitrectomy surgery was 31.5 per 100,000 between 2002 and 2013, and the rate has steadily increased.
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Female , Humans , Anesthesia, General , Anesthesia, Local , Cohort Studies , Diabetic Retinopathy , Diagnosis , Epiretinal Membrane , Incidence , Korea , Methods , National Health Programs , Republic of Korea , Retinal Detachment , Retinal Perforations , VitrectomyABSTRACT
Objective To explore the unmet needs and service of rehabilitation for Chinese people with disabilities. Methods The unmet needs and services of rehabilitation data from the Second National Sample Survey of Disability and 2006-2016 Statistical Bulletin on the De-velopment of People with disabilities in China issued by China Disabled Persons Federation had been analyzed. Results The unmet needs of rehabilitation for people with disabilities in China were mainly included health care and support, assistive devices, rehabilitation therapy and services, poverty alleviation, accessible facilities, accessible information, and other rehabilitation needs. The highest rate of unmet needs of rehabilitation was in the fields of health care (34.84%) and poverty alleviation (33.25%). There were significant differences in unmet needs of rehabilitation among people with different types of disabilities (χ2=40322.1, P<0.01). For all the types of disabilities, 41.46%had not re-ceived any service and support, 30.45%received health care and support, and 0.55%received accessible information. The main approaches recommended by professionals for people with disabilities were institutional rehabilitation, and community and family based services. The main services recommended by professionals to people with psychiatric (68.18%) or visual disabilities (60.28%) were health care, to people with hearing disability (51.67%) were assistive device, and to people with intellectual (57.36%) and speech disability (47.06%) were rehabil-itation therapy and training. There were significant differences both in rehabilitation approaches and contents among people with different types of disabilities preferred by professionals (χ2=12489.9,χ2=52528.93, P<0.01). Conclusion The unmet needs of rehabilitation for people with different types of disabilities were mainly included health care and assistance, assistive devices, rehabilitation training and services, and poverty alleviation. There were significant differences among people with different types of disabilities. For service delivery, the highest rate was in health care and assistance. The gap between the service and unmet needs of poverty alleviation for people with disabilities in China was the highest. There were significant differences in rehabilitation approaches and contents recommended by professionals among people with different types of disabilities. It was recommended to construct the national and local system of policy support system and rehabilita-tion service governance, to provide precision rehabilitation services based on the unmet needs of rehabilitation, to develop the comprehen-sive rehabilitation service delivery to achieve the goal of rehabilitation for all, and to conduct scientific research on rehabilitation by using International Classification of Functioning, Disability and Health to provide evidence and support for the development of rehabilitation.
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No study has yet attempted to measure mean out-of-pocket expenditure on health care at household level, separately for government and private health facilities in India. Therefore, this study analyses the change in the out-of-pocket expenditure between 1995-96 and 2004 for fifteen major states of India, separately for rural/urban sector and inpatient/outpatient care. Using data from the 52nd and 60th rounds of the National Sample Survey, we present a disaggregated analysis of the trends and patterns of inflation adjusted household expenditure on health care. The analysis of average household expenditure on health care demonstrated that the mean outpatient care expenditure in government health sector decreased marginally at the aggregate level in both rural and urban sector, whereas it showed a significant increase in private facilities. A substantial rural-urban differential was also observed regarding households’ mean hospitalization expenditure in private hospitals while the same was not true for government hospitals. Almost all states observed a very high growth in households’ mean hospitalization expenditure in the private sector, while it was quite low in the government sector and even negative in rural areas of some states. The same pattern was observed in the growth pattern of households’ outpatient care expenditure. The analyses indicated a little improvement in the performance of government health sector in terms of out-of pocket expenditure. The improvement was more visible in developed and less developed states than in least developed states. Similarly, the improvement was more visible in rural areas than in urban areas.
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Health Expenditures , Delivery of Health Care , IndiaABSTRACT
@#Objective To investigate the needs of rehabilitations in persons with mental retardation in Beijing.Methods 738 persons with mental retardation surveyed in the Second China National Sample Survey on Disability were involved,their rehabilitation condition and requisition were evaluated.Results 63.69% of them needed rehabilitation in community and family,73.31% needed rehabilitation training,their needs on medical service were met,needs on rehabilitation training were above provided service,needs on assistance articles and utensils were low,and needs on employment were high.Conclusion The case management system for persons with mental retardation should be built to meet their rehabilitation requisitions on different age and grade with various approaches.
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Since the first survey done in 1983, this is the second national sample survey of medical students about their perception and evaluation on medical study, career plan, and medical care system. One out of every 10 students plus one in each class were systematically sampled from each grade year of 32 medical schools in Korea that had students from freshman to senior in November 1997. A questionnaire was developed by adding items related with recent changes in medical care environment and with viewpoint on medicine and physician as an occupation to the questionnaire used in 1983. The questionnaire was administered at each school under the supervision of designated collaborator of the same school in December 1997 through January 1998. A total of 1,386 students were sampled from a total of 11,987 medical students and 1,233 students(89.0%) filled out the questionnaire. Twelve students were excluded from the analysis because of incomplete response and the final analysis was done for 1,221 students. A few demographic characteristics of the sample were compared with those of the study population to check the representativeness of the sample and found no skew. The contents of the study were divided into three parts and the first part describes the study methods, demographic and other characteristics of the sample, students' viewpoint on medical education, and students' aptitude for medicine Male students accounted for 75.7% of the sample. The proportion of students who entered medical school right after graduating from a high school was 45.8% in Seoul and 53.4% in other than Seoul area. The students who classified their own political inclination conservative were 43.9% in Seoul and 33.0% in other than Seoul and the percentage of students with progressive inclination was higher in out of Seoul than Seoul area. The proportion of students who have a religion was 57.2%; Christian 31.0%, Catholic 15.2%, and Buddhist 9.5%. The educational level of fathers of students was far higher than the level of general population, e.g. 59.8% had college or higher education. Occupation of fathers was mainly white-collar worker; professional worker 21.2%, company employee 17.2%, government official 13.1%, manager 11.8%, and medical professional 8.7%. In the decision-making process to enter the medical school, 53.7% of the students were influenced by someone else and 62.1% of them were parents. Socio-economic factor was the most common reason for recommending medical school and it accounted 33.5% of the reasons. Medical students enjoy learning life phenomenon(47.2%) and human being(44.3%) in medical study but most disturbing factors are memory work(39.7%) and too much to study(34.1%). If students were given another chance to choose a college as a senior student in high school, 50.3% of them said that they would choose medical school. Only 6% of students have intention to change their major subject of study if they are allowed to change now. The proportion of students who consider their scholastic aptitude is compatible with medical study was 64.9% and such proportion increased with grade. The percentage of students who are going to recommend medical school to their own son in the future was 36.6% for male and 26.7% for female students and to their own daughter 33.6% and 27.7%, respectively.