Relationships among epilepsy self-management, health outcomes, and socioeconomic status

The purpose of this study was to investigate the association between epilepsy self-management and disease control and socio-economic status. Study participants were adult patients at two epilepsy specialty clinics in Houston, Texas that serve demographically and socioeconomically diverse populations. Self-management behaviors- medication, information, safety, seizure, and lifestyle management were tested against emergency room visits, hospitalizations, and seizure occurrence. Overall self-management score was associated with a greater likelihood of hospitalizations over a prior twelve month time frame, but not for three months, and was not associated with seizure occurrence or emergency room visits, at all. Scores on specific self-management behaviors varied in their relationships to the different disease control indicators, over time. Contrary to expectations based on the findings of previous research, higher information management scores were associated with greater likelihood of emergency room visits and hospitalizations, over the study's twelve months. Higher lifestyle management scores were associated with lower likelihood of any emergency room visits, over the preceding twelve months and emergency room visits for the last three months. The positive associations between overall self-management scores and information management behaviors and disease control are contrary to published research. These findings may indicate that those with worse disease control in a prior period employ stronger self-management efforts to better control their epilepsy. Further research is needed to investigate this hypothesis.^

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. ^

Analysis of symptoms of rural workers exposed to pesticides

This cross-sectional study was conducted in southern Minas Gerais, in two counties: São Gonçalo do Sapucaí and Silvianópolis. Presented as objective to verify the important variables associated with the occurrence of symptoms of subacute intoxication related to pesticides exposure. A questionnaire was dedicated to a sample of 412 workers. An analysis of non-conditional logistic regression was applied gradually. The likelihood ratio method was used to define the significant variables in the final model. Of the analysed population, 59.2% reported symptoms typical of subacute intoxication. Of the respondents, 91.5% reported knowing the deleterious effects associated with exposure to pesticides. The adjusted model was found with the significant variables: being male that presented Prevalence Odds Ratio (POR) adjusted . PORof 0.54 (95% CI 0.36 to 0.81), already hospitalized for poisoning with pesticides, POR of 3.26 (95% CI 1.08 to 9.82), living in the rural area of residence., POR of 2.17 (95% CI 1.20 to 3.93) and type of employment relationship or temporary employment, POR of 2.32 (95% CI 1.08 to 4.95).

Impact of electrification on children's nutritional status in rural Bangladesh

We offer micro-econometric evidence for a positive impact of rural electrification on the nutritional status of children under five as measured by height-for-age Z-score (HAZ) in rural Bangladesh. In most estimates, access to electricity is found to improve HAZ by more than 0.15 points and this positive impact comes from increased wealth and reduced fertility, even though the evidence for the latter is weak. We also analyze the causal channels through the local health facility and exposure to television. We find no evidence for the presence of the former channel and mixed evidence for the latter.

BioMet®Phon: A system to monitor phonation quality in the clinics

BioMet®Phon is a software application developed for the characterization of voice in voice quality evaluation. Initially it was conceived as plain research code to estimate the glottal source from voice and obtain the biomechanical parameters of the vocal folds from the spectral density of the estimate. This code grew to what is now the Glottex®Engine package (G®E). Further demands from users in laryngology and speech therapy fields instantiated the development of a specific Graphic User Interface (GUI’s) to encapsulate user interaction with the G®E. This gave place to BioMet®Phon, an application which extracts the glottal source from voice and offers a complete parameterization of this signal, including distortion, cepstral, spectral, biomechanical, time domain, contact and tremor parameters. The semantic capabilities of biomechanical parameters are discussed. Study cases from its application to the field of laryngology and speech therapy are given and discussed. Validation results in voice pathology detection are also presented. Applications to laryngology, speech therapy, and monitoring neurological deterioration in the elder are proposed.

A gaze to rural education according to scientific discourses during the last decade

He largest proportion of illiteracy and lack of access to education in the world is concentrated in rural areas; therefore it is important to ensure there is access to quality education in these spots. This challenge is assumed by different branches of social research and it is reflected within the publication of articles in scientific journals. In the present document the scientific discourse surrounding the theme of rural education during the last decade was analyzed. To do this, the paper focuses on three aspects: the countries that set the agenda, the geographical areas that represent most of the attention and the prevalent themes within continents. It was observed that USA was the most productive country in terms of scientific writings with 30%; that Asia is really interested in health issues associated to rural education; that in Europe gender issues are on the table and that the African and Asian continents, as well as Latin America, are interested only on their own issues, as 100% of the times they only wrote about themselves.

Providing health information to the general public: a survey of current practices in academic health sciences libraries*

A questionnaire was mailed to 148 publicly and privately supported academic health sciences libraries affiliated with Association of American Medical Colleges (AAMC)–accredited medical schools in the United States and Canada to determine level of access and services provided to the general public. For purposes of this study, “general public” was defined as nonaffiliated students or health care professionals, attorneys and other nonhealth-related professionals, patients from affiliated or other hospitals or clinics, and general consumers. One hundred five (71%) libraries responded. Results showed 98% of publicly supported libraries and 88% of privately supported libraries provided access to some or all of the general public. Publicly supported libraries saw greater numbers of public patrons, often provided more services, and were more likely to circulate materials from their collections than were privately supported libraries. A significant number of academic health sciences libraries housed a collection of consumer-oriented materials and many provided some level of document delivery service, usually for a fee. Most allowed the public to use some or all library computers. Results of this study indicated that academic health sciences libraries played a significant role in serving the information-seeking public and suggested a need to develop written policies or guidelines covering the services that will be provided to minimize the impact of this service on primary clientele.

Outreach to public health professionals: lessons learned from a collaborative Iowa public health project*

In 1995, the National Library of Medicine (NLM) and the Public Health Service (PHS) recommended that special attention be given to the information needs of unaffiliated public health professionals. In response, the National Network of Libraries of Medicine (NN/LM) Greater Midwest Region initiated a collaborative outreach program for public health professionals working in rural east and central Iowa. Five public health agencies were provided equipment, training, and support for accessing the Internet. Key factors in the success of this project were: (1) the role of collaborating agencies in the implementation and ongoing success of information access outreach projects; (2) knowledge of the socio-cultural factors that influence the information-seeking habits of project participants (public health professionals); and (3) management of changing or varying technological infrastructures. Working with their funding, personnel from federal, state, and local governments enhanced the information-seeking skills of public health professionals in rural eastern and central Iowa communities.

The evolution of rural outreach from Package Library to Grateful Med: introduction to the symposium

Outreach is now a prevailing activity in health sciences libraries. As an introduction to a series of papers on current library outreach to rural communities, this paper traces the evolution of such activities by proponents in health sciences libraries from 1924 to 1992. Definitions of rural and outreach are followed by a consideration of the expanding audience groups. The evolution in approaches covers the package library and enhancements in extension service, library development, circuit librarianship, and self-service arrangements made possible by such programs as the Georgia Interactive Network (GaIN) and Grateful Med.

Library outreach: addressing Utah's “Digital Divide”

A “Digital Divide” in information and technological literacy exists in Utah between small hospitals and clinics in rural areas and the larger health care institutions in the major urban area of the state. The goals of the outreach program of the Spencer S. Eccles Health Sciences Library at the University of Utah address solutions to this disparity in partnership with the National Network of Libraries of Medicine—Midcontinental Region, the Utah Department of Health, and the Utah Area Health Education Centers. In a circuit-rider approach, an outreach librarian offers classes and demonstrations throughout the state that teach information-access skills to health professionals. Provision of traditional library services to unaffiliated health professionals is integrated into the library's daily workload as a component of the outreach program. The paper describes the history, methodology, administration, funding, impact, and results of the program.

DUI program as OEF/OIF Veterans Outreach: Descriptive Data from Two Community-Based Outpatient Clinics

Although initially conceived as providing simply the preventive portion of an extended continuum of care for veterans, the Driving Under the Influence (DUI) program has turned out to be an important outreach service for active duty or recently discharged OEF/OIF (Operation Enduring Freedom/Operation Iraqi Freedom) veterans. Veterans receive empirically-based, state-mandated education and therapy under the only Department of Veterans Affairs (VA) - sponsored DUI program in the State of Colorado, with the advantage of having providers who are sensitive to symptoms of Post-Traumatic Stress Disorder (PTSD) and other relevant diagnoses specific to this population, including Traumatic Brain Injury (TBI). In this paper, the rapid growth of this program is described, as well as summary data regarding the completion, discontinuation, and augmentation of services from the original referral concern. Key results indicated that for nearly one third (31.9%) of the OEF/OIF veterans who were enrolled in the DUI program, this was their initial contact with the VA health care system. Furthermore, following their enrollment in the DUI program, more than one fourth (27.6%) were later referred to and attended other VA programs including PTSD rehabilitation and group therapy, anger management, and intensive inpatient or outpatient dual diagnosis programs. These and other findings from this study suggest that the DUI program may be an effective additional pathway for providing treatment that is particularly salient to the distinctive OEF/OIF population; one that may also result in earlier intervention for problem drinking and other problems related to combat. Relevant conclusions discussed herein primarily aim to improve providers' understanding of effective outreach, and to enhance the appropriate linkages between OEF/OIF veterans and existing VA services.

Cardiovascular disease in Switzerland - health care, mortality and geographical pattern

SUMMARY Switzerland is facing an aging population and a growing amount of patients with chronic diseases. It is crucial to display health care processes and pathways, to identify inequalities and obstacles, and to point out possibilities for improvements of the Swiss health care system (e.g. increase efficiency). The introductory part of the thesis presents a brief description of the Swiss health care system, health services research and regional variation as well as an introduction of CVD and its epidemiological key figures, aetiology and treatments. This is followed by the description of the utilized methods and data, and the objectives of this thesis. The subsequent sections present the four articles included in this thesis. The first article focuses on a small area analysis on regional variation of avoidable hospitalisations in Switzerland including density of primary care physicians and specialists, rurality and hospital supply factors as explanatory variables in the analysis. Lower rates of avoidable hospitalisations were found in areas with very high supply of primary care physicians, increased avoidable hospitalisation rates in areas with more specialists and in areas with higher proportion of rural residents. The second article aims to examine whether emergency patients with acute ST-segment elevation myocardial infarction were adequately treated, i.e. according to the treatment guidelines, in Switzerland. Results show that older and female patients were less likely to receive revascularization which suggests that the treatment guidelines may not be uniformly applied in Switzerland. Similar to the first article, also in the third article a small area analysis was performed but this time investigating regional variation in costs at the end of life. Strongest associations of cost was found with cause of death, age and language region of the decedents. The strong spatial variation of costs could only partly be explained by the included covariates. Article four aims to examine the relationship of distance to different hospital types and mortality from AMI or stroke. We found that AMI mortality in the Swiss population 30 and older and stroke mortality in those 65 and above increased with distance to central and university hospitals, while adjusting for sociodemographic and economic characteristics of the population. The presentation of the four articles is followed by a discussion, which summarizes the main findings and the strengths and limitations of the presented articles. The thesis concludes with a discussion about the challenges for policy, practice and future research.

DVD-based distance-learning program for university entrance exams -- RCT experiments in rural Bangladesh

In contrast to the remarkable progress in developing countries in improving primary education, access to higher education in many countries remains limited, especially in rural areas where the quality of education is inadequate. We evaluate a DVD-based distance-learning program in rural Bangladesh, targeted at students aiming to take university entrance tests. We conducted two experiments: one to evaluate the effect of the distance-learning program and the second to determine the demand and price sensitivity. Our first experiment shows that the DVD-based distance-learning program has a considerable positive effect on the number of students passing entrance exams. This effect does not depend on cognitive scores, but does depend on non-cognitive attributes, indicating the importance of commitment, which is imposed through our program. In the second experiment, we offered a random subsidy to interested participants. The uptake decision is price-sensitive, although the price sensitivity is not correlated with students' past academic performance or their socio-economic status, suggesting that increasing the price should not disproportionately exclude poor students.

Urban and rural hospital costs : 1981-85 /

Mode of access: Internet.

The rural homeless.

Mode of access: Internet.