Effect of primary care availability and health insurance coverage on risk and cost of Preventable Hospitalizations in Harris County

Preventable Hospitalizations (PHs) are hospitalizations that can be avoided with appropriate and timely care in the ambulatory setting and hence are closely associated with primary care access in a community. Increased primary care availability and health insurance coverage may increase primary care access, and consequently may be significantly associated with risks and costs of PHs. Objective. To estimate the risk and cost of preventable hospitalizations (PHs); to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs, first alone and then simultaneously; and finally, to estimate the impact of expansions in primary care availability and health insurance coverage on the burden of PHs among non-elderly adult residents of Harris County. Methods. The study population was residents of Harris County, age 18 to 64, who had at least one hospital discharge in a Texas hospital in 2008. The primary independent variables were availability of primary care physicians, availability of primary care safety net clinics and health insurance coverage. The primary dependent variables were PHs and associated hospitalization costs. The Texas Health Care Information Collection (THCIC) Inpatient Discharge data was used to obtain information on the number and costs of PHs in the study population. Risk of PHs in the study population, as well as average and total costs of PHs were calculated. Multivariable logistic regression models and two-step Heckman regression models with log-transformed costs were used to determine the association of primary care availability and health insurance coverage with the risk and costs of PHs respectively, while controlling for individual predisposing, enabling and need characteristics. Predicted PH risk and cost were used to calculate the predicted burden of PHs in the study population and the impact of expansions in primary care availability and health insurance coverage on the predicted burden. Results. In 2008, hospitalized non-elderly adults in Harris County had 11,313 PHs and a corresponding PH risk of 8.02%. Congestive heart failure was the most common PH. PHs imposed a total economic burden of $84 billion at an average of $7,449 per PH. Higher primary care safety net availability was significantly associated with the lower risk of PHs in the final risk model, but only in the uninsured. A unit increase in safety net availability led to a 23% decline in PH odds in the uninsured, compared to only a 4% decline in the insured. Higher primary care physician availability was associated with increased PH costs in the final cost model (β=0.0020; p<0.05). Lack of health insurance coverage increased the risk of PH, with the uninsured having 30% higher odds of PHs (OR=1.299; p<0.05), but reduced the cost of a PH by 7% (β=-0.0668; p<0.05). Expansions in primary care availability and health insurance coverage were associated with a reduction of about $1.6 million in PH burden at the highest level of expansion. Conclusions. Availability of primary care resources and health insurance coverage in hospitalized non-elderly adults in Harris County are significantly associated with the risk and costs of PHs. Expansions in these primary care access factors can be expected to produce significant reductions in the burden of PHs in Harris County.^

Social integration, health behaviors and health status among Mexican-American women in the *southwestern United States

Using the Hispanic Health and Nutrition Examination Survey (HHANES), this research examined several health behaviors and the health status of Mexican American women. This study focused on determining the relative impact of social contextual factors: age, socioeconomic status, quality of life indicators, and urban/rural residence on (a) health behaviors (smoking, obesity and alcohol use) and (b) health status (physician's assessment of health status, subject's assessment of health status and blood pressure levels). In addition, social integration was analyzed. The social integration indicators relate to an individual's degree of integration within his/her social group: marital status, level of acculturation (a continuum of traditional Mexican ways to dominant U.S. cultural ways), status congruency, and employment status. Lastly, the social contextual factors and social integration indicators were examined to identify those factors that contribute most to understanding health behaviors and health status among Mexican American women.^ The study found that the social contextual factors and social integration indicators proved to be important concepts in understanding the health behaviors. Social integration, however, did not predict health status except in the case of the subject's assessment of health status. Age and obesity were the strongest predictors of blood pressure. The social contextual factors and obesity were significant predictors of the physician's assessment of health status while acculturation, education, alcohol use and obesity were significant predictors of the subject's assessment of health status. ^

The association between academic achievement and health status among eighth -grade Hispanic students in Houston

This cross-sectional study examines the association between health and academic achievement among Hispanic eighth-grade students in the Houston Independent School District. As part of the district's 3 year Safe Schools/Healthy Students Initiative to enhance comprehensive educational programs, a brief anonymous questionnaire was administered in the classroom to 359 students in two schools during a one-month period in the early part of the 2001 school year. ^ The primary study questions are: Among this sample of Hispanic adolescents, is there a significant association between academic achievement and health status? and in this same population, is there a significant association between health risk behavior and health status? The specific aims of this research are: (1) to describe the association between academic achievement and health status; (2) to describe the association between health risk behaviors and health status; and (3) to describe the relative contribution of health risk behaviors and academic achievement to adolescent health status among this sample of Hispanic adolescents. ^ The survey instrument was a 32-item questionnaire that incorporated: several academic achievement questions measuring usual grades, school-related performance, attendance, student and perceived parental satisfaction with academic achievement, and educational aspirations; two health and quality of life scales measuring adolescent self-reported health; and specific measures of health risk behavior, e.g., frequency of tobacco cigarette smoking, alcohol and other drug use, aggression, and suicidal ideation and behavior that were incorporated from the national Youth Risk Behavior Survey. Questions pertaining to sexual behavior and pregnancy were omitted to comply with school district guidelines. ^ Analysis revealed that strong associations between academic achievement and health status and between health risk behaviors and health status were observed after controlling for the covariates. Eight factors were found to be significantly associated with poor health status: usual grades (low), academic performance (low), academic achievement beliefs (low), classroom and homework performance satisfaction (low), ever drinking alcohol (6 or more times), suicidality (ever thought about, planned for, or sought medical help after attempting suicide), gender (female), and age (15 years and older). (Abstract shortened by UMI.) ^

Diversity and health traits of local landraces of runner bean (Phaseolus coccineus L.) from Spain

Diversity and health traits of local landraces of runner bean (Phaseolus coccineus L.) from Spain

Safety and health in forest harvesting operations. Diagnosis and preventive actions. A review

Aim of study: to review the present state of the art in relation to the main labour risks and the most relevant results of recent studies evaluating the safety and health conditions of the forest harvesting work and better ways to reduce accidents. Area of study: It focuses mainly on developed Countries, where the general concern about work risks prevention, together with the complex idiosyncrasy of forest work in forest harvesting operations, has led to a growing interest from the forest scientific and technical community. Material and Methods: The main bibliographic and Internet references have been identified using common reference analysis tools. Their conclusions and recommendations have been comprehensively summarized. Main results: Collection of the principal references and their most important conclusions relating to the main accident risk factors, their causes and consequences, the means used towards their prevention, both instrumental as well as in the aspects of training and business management, besides the influence of the growing mechanization of logging operations on those risks. Research highlights: Accident risk is higher in forest harvesting than in most other work sectors, and the main risk factors such as experience, age, seasonality, training, protective equipment, mechanization degree, etc. have been identified and studied. The paper summarizes some relevant results, one of the principal being that the proper entrepreneurial risk management is a key factor leading to the success in minimizing labour risks..

Feasibility of a wireless health monitoring system for prevention and health assessment of elderly people

The work presented in this paper comprises the methodology and results of a pilot study on the feasibility of a wireless health monitoring system designed under main EU challenges for the promotion of healthy and active ageing. The system is focused on health assessment, prevention and lifestyle promotion of elderly people. Over a hundred participants including elderly users and caregivers tested the system in four pilot sites across Europe. Tests covered several scenarios in senior centers and real home environments, including performance and usability assessment. Results indicated strong satisfactoriness on usability, usefulness and user friendliness, and the acceptable level of reliability obtained supports future investigation on the same direction for further improvement and transfer of conclusions to the real world in the healthcare delivery.

Vivienda y Revolución. El Concurso entre Camaradas de la OSA, la Sección de Tipificación del Stroykom y la Casa Experimental de Transición Narkomfin (1926-1930) = Housing and Revolution. OSA’s Comradely Competition, Typification Section of the Stroykom and Narkomfin Experimental Transitional House (1926-1930)

La cuestión del asentamiento socialista en la URSS durante la década de 1920 estuvo caracterizada por el objetivo de definir y establecer un estado socialista en términos políticos, sociales y económicos. En este contexto de inestabilidad y cambio, un grupo de arquitectos pertenecientes a la Asociación de Arquitectos Contemporáneos, OSA, y liderado por Moisey Ginzburg, abordó el tema de la vivienda obrera asumiendo la responsabilidad y el compromiso por alcanzar un nuevo orden social. Su misión no consistió únicamente en solucionar el problema del alojamiento para los trabajadores en las grandes ciudades soviéticas, sino en redefinirlo como el marco adecuado para una sociedad sometida a un cambio sin precedentes que, al mismo tiempo y en un proceso dialéctico, debía contribuir a la construcción de esa nueva sociedad. La respuesta dada por la OSA trascendió el diseño inmediato bajo los estándares modernos establecidos en Occidente y tomó forma en un proceso de investigación que habría de prolongarse durante cinco años. Este trabajo, que culminó con la construcción y puesta en crisis de la Casa Narkomfin, se desarrolló en tres aproximaciones sucesivas. La primera, de carácter conceptual, consideró la participación ciudadana, así como de especialistas independientes, formalizándose en el Concurso entre Camaradas convocado por la OSA en 1926. La segunda aproximación al problema de la vivienda obrera se articuló a través de la investigación llevada a cabo por la Sección de Tipificación del Stroykom, esta vez desde premisas científicas y metodológicas. Finalmente, las conclusiones alcanzadas fueron transferidas a la práctica arquitectónica por medio de la construcción de seis Casas Experimentales de Transición, entre las que destacó la Casa Narkomfin. Este último acercamiento, de carácter empírico, ha sido tradicionalmente examinado por los expertos como un hecho aislado. Sin embargo, su estudio debe trascender necesariamente el genio del autor-creador en favor del proceso de investigación al que pertenece. En esta tesis, la Casa Narkomfin no se presenta sólo como el paradigma de vivienda soviética de vanguardia al que estamos acostumbrados, sino como un prototipo que recoge los principios y conclusiones alcanzados en las aproximaciones conceptuales y científicas precedentes. Únicamente desde este punto de vista cobra sentido la consideración de Ginzburg sobre su propio edificio como un medio propositivo y no impositivo: un proyecto concebido como una herramienta de transición hacia una sociedad más avanzada. ABSTRACT The question of mass housing in the USSR during the Twenties was marked by the drive to define and establish a socialist state in political, social and economic terms. In this context of instability and change, a group of architects gathered together under the Association of Contemporary Architects, OSA, led by Moisey Ginzburg, to address the issue of mass housing, thus taking on the responsibility and being committed to creating a new social order. Their quest not only involved solving the problem of housing for workers in large Soviet cities, but also redefining this solution as an appropriate framework for a society undergoing dramatic changes which, at the same time and in a dialectical process, would contribute to the creation of this new society. The solution provided by OSA transcended Modern standards of immediate design set by the West and was the result of a research process that would last five years. This work culminated in the construction of Narkomfin House and its self-criticism, developed in three successive approaches. The first was conceptual, being formalized in the Comradely Competition held by the OSA in 1926 and taking into account the participation of citizens and independent experts. The second approach to the problem of mass housing involved research developed by the Typification Section of the Stroykom, this time under scientific and methodological premises. Finally, the conclusions reached were put in practice with the construction of six Experimental Transitional Houses of which the most notable is Narkomfin House. This third empirical approach has traditionally been examined by scholars in isolation. However, its study must necessarily transcend the genius of the author-creator and involve the research process of which it is part. In this thesis, Narkomfin House is presented not only as the paradigm in Soviet housing avant-garde we are used to, but also as a prototype reflecting the principles and conclusions reached in the preceding conceptual and scientific approaches. Only from this point of view does Ginzburg’s understanding of his own building as a proactive and non-imposed environment make sense: a project conceived as a transition tool towards a more advanced society.