No abstract available.
Income ; Urease

Aging is associated with increased risk of frailty and malnutrition. However, food insecurity has rarely been highlighted in the elderly population, especially among the low income group. Thus, a cross-sectional study was conducted to determine the association between nutritional status, food insecurity and frailty among elderly in low income residences in Klang Valley. A total of 72 elderly individuals aged 60 years and above was selected (mean age 66 ± 6 years) through convenient sampling. Participants were interviewed to obtain information on socio-demographic, health status, food insecurity and cognitive status. Anthropometrics parameters and frailty assessments was measured using standard criteria. Results showed that 75.0% of the participants had abdominal obesity. Nearly half of the participants were overweight (41.7%), followed by normal (43.0%) and underweight (15.3%). With respect to food insecurity, most of them reported that they had enough food (93.1%). There were significant correlation (p < 0.05) between food insecurity with height (r = -0.263, p = 0.026). Most of the participants were pre-frail (58.3%), frail (27.8%) and followed by non-frail (13.9%). Calcium intake is inversely associated with frailty (t = -2.62, p = 0.011). In conclusion, food insecurity was not a problem, however, half of the subjects were overweight and pre-frail. Three out four subjects had abdominal obesity. There is a need to investigate further the pathogenesis of fat frail in this low income elderly population and formulate effective intervention strategies.
Aged ; Income

ASEAN Neurology Association (ASNA) consists of 9 member countries, Brunei, Indonesia, Lao, Malaysia, Myanmar, Philippines, Singapore, Thailand and Vietnam. Among them 2 countries are considered lower middle income, 4 as upper middle income, and 3 as high income by World Bank criteria. The life expectancy is above 75 years in Brunei and Singapore, below 60 years in Lao and Myanmar. There are a total of 1,871 neurologists in ASNA member countries which has a total of 540 million populations. This constitutes 2.2% of the world neurologists, although ASNA member countries accounts for 8.3% of the world population. Myanmar and Lao in particular, has lowest ratio of neurologist, with one neurologist serving 5 million populations in Myanmar, and 2 million populations in Lao.
Myanmar ; member ; Neurology ; Income ; Neurologist

BACKGROUND: Worldwide trends in health risks, lifestyle behaviors, health perceptions, and health-seeking patterns suggest alarming disparities among individuals from low- and middle-income countries. Such international comparisons are particularly troubling for older individuals (≥60 years). OBJECTIVES: This study aims to compare health risks, lifestyle behaviors, health perceptions, and health-seeking patterns between younger (<60) and older (≥60) Filipinos from rural communities in the Philippines. METHODS: A comparative cross-sectional study was employed with 863 younger and 427 older Filipinos. Data were analyzed using frequencies, chi-squares, and T-tests. RESULTS: Older participants were more likely to be single/widowed, ≤ high school education and had higher rates of hypertension, high cholesterol, diabetes, and depression. They reported poorer health status and went to the village health center when sick. Furthermore, they were less likely to drink alcohol and see a physician. CONCLUSION There were significant differences in modifiable health risks and lifestyle behaviors and differences in health perceptions between younger and older cohorts of Filipinos living in rural areas in the Philippines. Our findings suggest the need to design separate health promotion interventions that target older and younger Filipinos' unique needs from rural communities.
Low-Middle-Income Countries ; Aging ; Cross-sectional ; Population Health ; Philippines

PURPOSE: In a sequential objective structured clinical examination (OSCE), all students initially take a short screening OSCE. Examinees who pass are excused from further testing, but an additional OSCE is administered to the remaining examinees. Previous investigations of sequential OSCE were based on classical test theory. We aimed to design and evaluate screening OSCEs based on item response theory (IRT). METHODS: We carried out a retrospective observational study. At each station of a 10-station OSCE, the students' performance was graded on a Likert-type scale. Since the data were polytomous, the difficulty parameters, discrimination parameters, and students' ability were calculated using a graded response model. To design several screening OSCEs, we identified the 5 most difficult stations and the 5 most discriminative ones. For each test, 5, 4, or 3 stations were selected. Normal and stringent cut-scores were defined for each test. We compared the results of each of the 12 screening OSCEs to the main OSCE and calculated the positive and negative predictive values (PPV and NPV), as well as the exam cost. RESULTS: A total of 253 students (95.1%) passed the main OSCE, while 72.6% to 94.4% of examinees passed the screening tests. The PPV values ranged from 0.98 to 1.00, and the NPV values ranged from 0.18 to 0.59. Two tests effectively predicted the results of the main exam, resulting in financial savings of 34% to 40%. CONCLUSION: If stations with the highest IRT-based discrimination values and stringent cut-scores are utilized in the screening test, sequential OSCE can be an efficient and convenient way to conduct an OSCE.
Discrimination (Psychology) ; Humans ; Income ; Iran* ; Mass Screening ; Observational Study ; Retrospective Studies

OBJECTIVES: This study discussed dental care utilization efficiency and equity from the perspective of private health insurance policy using the 2011 Korea Health Panel dataset. METHODS: A total of 10,577 subjects, aged 20 years or older, were selected from a larger sample (N=18,256). The study conducted a two-part model analysis to determine the impact of private health insurance on utilization and amount of dental care. RESULTS: Average monthly payment of private health insurance is 76,727 KRW. Analysis of average monthly fees and income distribution by quartile showed that higher income groups pay proportionally more for private health insurance. The highest income group was 3.82 times more likely to have private health insurance than the lowest income group. Those with private health insurance coverage had a higher probability of using dental care but were not more likely to use a greater number of dental services. CONCLUSIONS: Based on these empirical findings, a guarantee of health care system and policy equity and efficiency should be established for changes in private health insurance.
Dataset ; Delivery of Health Care ; Dental Care* ; Fees and Charges ; Income ; Insurance, Health* ; Korea

OBJECTIVETo date, there has been little information published on the death of rural road accident deaths. This study uses burden of injury method to explore a more accurate estimate of years of life lost due to road traffic crashes occurring over a four-year period in Guilan province, northern Iran.

METHODSRural road accident deaths from 2009 to 2013 were extracted from Iran's Forensic Medicine System, Death Registry System and Road Trauma Research center database.

RESULTSDuring the study period, the average years of life lost due to motor vehicle crashes was 13.8 per 1 000 persons, ranging from 11.9 during March 2011-2012 to 15.8 per 1 000 persons during March 2012-2013.

CONCLUSIONRoad accident deaths in 2013 remained at the same high level as in 2009. The information obtained from this study provides a new perspective on fatal road traffic crash victims in rural settings and show us that more attention is needed in this area.

BACKGROUNDNational Breast and Cervical Cancer Early Detection Program (NBCCEDP) has provided free or low-cost mammograms to low-income or no health insurance women in all of the states of the United States (US) since 1997. The objective of this study was to understand whether health insurance and annual household income impacted the mammography utilization since the implementation of NBCCEDP, in order to evaluate how the implementation of NBCCEDP impacted mammography utilization among American women.

METHODSData were from the database of Behavioral Risk Factor Surveillance System (BRFSS) of the CDC in US. Mammography utilization was measured by whether the American woman aged 40 to 64 years had the mammography within the last two years. The chi square test and multivariate Logistic regression were used to evaluate the associations between mammography utilization and health insurance, annual household income, and other factors for any given year.

RESULTSFrom 2000 to 2008, the rate of mammography utilization among participants had a steady decrease on the whole from 86.7% to 83.8%. The results showed that the mammography utilization correlated significantly with health insurance and annual household income for any given year. The results also showed that compared with participants who were uninsured, those who were insured had a greater times higher rate of mammography in 2008 than any other year from 2000 to 2008, and compared with participants whose annual household income was below $15 000, those whose annual household income was above $50 000 had a greater times higher rate of mammography in 2008 than in 2004 and 2006.

CONCLUSIONSHealth insurance and annual household income impacted the mammography utilization for any given year from 2000 to 2008, and the implementation of NBCCEDP has not achieved its original goal on breast cancer screening.

BACKGROUND: The authors have developed a Digital image chart(DIC) and digital Radiotherapy Record System (DRRS). We have evaluated the DIC and DRRS for reliability, usefulness, ease of use, and efficiency. METHOD AND MATERIALS: The basic design o f the DIC and DRRS was to build an digital image database of radiation therapy patient records for a more efficient and timely flow of critical image in formation throughout the department. This system is a subunit of comprehensive radiation oncology managemert system (C-ROMS) and composed of a picture archiving and communication system (PACS), radiotherapy information database, and a radiotherapy imaging database. The DIC and DRRS were programmed using Delphi under a Windows 95 environment and is capable of displaying the digital images of patients identification photos, simulation films, radiotherapy setup, diagnostic radiology image... Gross lesion photos, and radiotherapy planning isodose charts with beam arrangements. Twenty-three clients in the department are connected by Ethernet (10 Mbps) to the central image server (Sun Ultra-sparc 1 workstation). RESULTS: From the introduction of this system in February 1998 through December 1999, we have accumulated a total of 15,732 individual images for 2,556 patients. We can organize radiation therapy in; paperless environment in 120 patients with breast cancer. Using this system, we have succeeded in the prompt, accurate, and simultaneous access to patient care information from multiple locations throughout the department. This coordination has resulted in improved operational efficiency within the department. CONCLUSION: The authors believe that the DIC and DRRS has contributed to the improvement of radiation oncology department efficacy as well as to time and resource savings by providing necessary visual information throughout the department conveniently and simultaneously. As a result, we can also achieve the paperless and filmless practice of radiation oncology with this system.
Breast Neoplasms ; Dacarbazine ; Hospital Information Systems ; Humans ; Income ; Patient Care ; Radiation Oncology* ; Radiotherapy*

Vietnam has pursued universal health insurance coverage for two decades but has yet to fully achieve this goal. This paper investigates the barriers to achieve universal coverage and examines the validity of facilitating factors to shorten the transitional period in Vietnam. A comparative study of facilitating factors toward universal coverage of Vietnam and Korea reveals significant internal forces for Vietnam to further develop the National Health Insurance Program. Korea in 1977 and Vietnam in 2009 have common characteristics to be favorable of achieving universal coverage with similarities of level of income, highly qualified administrative ability, tradition of solidarity, and strong political leadership although there are differences in distribution of population and structure of the economy. From a comparative perspective, Vietnam can consider the experience of Korea in implementing the mandatory enrollment approach, household unit of eligibility, design of contribution and benefit scheme, and resource allocation to health insurance for sustainable government subsidy to achieve and sustain the universal coverage of health insurance.
Eligibility Determination ; Humans ; Income ; National Health Programs/*economics ; Republic of Korea ; Socioeconomic Factors ; Universal Coverage/*economics ; Vietnam