Suchergebnisse

To investigate the psychopathology of immigrants' children and psychiatric service utilization by the immigrant families, data were collected from the files of all 35 immigrant children seen over a 3-year period at the Community Mental Health Centre of the Athens University Psychiatric Department. Immigrant children were matched by age, gender and intake date with 70 Greek children. Data concerned information about the child's place of birth, current living conditions, parents' country of origin, social and economic situation, occupations and educational status, social insurance, psychiatric history, referral source, diagnostic and therapeutic services rendered, number of sessions and outcome. Utilization of services was assessed 6 months after intake. No significant differences were found regarding family's structure and parents' psychopathology. However, immigrant families had significantly worse economic situations, lower status jobs, worse housing and were usually uninsured. No significant differences were observed regarding service utilization parameters, except concerning 'cooperation with other services'. No differences were found regarding frequency or type of psychiatric diagnosis. However, 91% of the immigrant group received a psychosocial diagnosis as opposed to 49% of the Greek group. Immigrant children did not present more serious or diverse psycho-pathology than did Greek children. Immigrant families had equal levels of service utilization as Greek families. However, it was apparent that immigrant families did not apply for help as readily as their Greek counterparts.

This study examines the health services utilization of older adults in China with depressive symptoms and chronic health conditions. In older adults with chronic conditions, depression has shown to be associated with greater severity of medical illness, poorer health status and quality of life, and increased mortality. Studies in western industrialized societies have shown that individuals with depression use a higher number of physical health services. However, there have been no studies identified to date that have looked at this question for China, including for Chinese older adults in particular. The healthcare utilization patterns of Chinese residents with depression may show differential patterns from those of individuals living in western industrialized countries due to differences in culture, available forms of help, existing service systems, and policy contexts, including the rapid expansion of healthcare coverage in China in recent years due to healthcare reform. This study employs logistic regression to analyze the relationships between depression, chronic health conditions, and health services utilization among Chinese older adults. It uses nationally representative survey data from the 2011-2012 China Health and Retirement and Longitudinal Study (CHARLS) (n=17,708). The study also presents a profile of service users based on a cluster analysis of health conditions and health services used. After controlling for sociodemographic and health characteristics, depression was found to be positively associated with outpatient service utilization but not significantly associated with inpatient service utilization for the general sample of older adults in China. Among the sample of older adults with chronic conditions, also having depression was significantly associated with greater outpatient service use. Those with both chronic conditions and depression were 1.53 times more likely to use outpatient services than those who only had chronic conditions with no depression. There was no significant relationship between chronic conditions and depression with inpatient service use. Results of a cluster analysis indicate that depression levels and levels of ADLs and IADLs appear to be positively associated with both outpatient and inpatient service utilization. High utilizers of outpatient services tend to be less uninsured and to have the most Urban Employee and New Cooperative insurance, and the least Urban Resident and Government insurance relative to moderate and low users of outpatient services. High users of outpatient services are more likely to be female and rural residents. High users of inpatient services tend to be more rural and to have lower levels of social support than both moderate and low users. Findings on the healthcare usage patterns of this population have implications for improving health policy and interventions related to the treatment and prevention of depression among this population of vulnerable older adults.

The objective of this paper could be phrased as follows: What
are the health consequences of changes in public fiscal and income
policies? This is an important question, especially in times where
programmes of macroeconomic structural adjustments are being implemented
in many developing countries. The health consequences of these policies
continue to be debated. Some argue that the main victims are mainly the
poor and the vulnerable [cf. Cornia et al. (1987) and (1988)]. Others
maintain that the longer term benefits will more than compensate for
short-term losses and that the real test is to compare with the
consequences of not making the adjustments. The conceptual and empirical
foundation of the debate seems to be less than satisfactory, however. It
is our view that to understand the health consequences of such policies
a careful examination of three issues are required: (a) the existing
pattern of disease; (b) the initial distributional structure (equity
pattern) of public policies; and (c) the behavioural response of
households in allocating resources towards health-promoting activities
given (a) and (b). Our approach is necessarily context specific. It is
in line with Streeten's (1988) conclusion that ..... the most important
general lesson that emerged was that there are no general lessons, and
that each case has to be treated separately and on its merits". Our
purpose is to provide an overall general framework that serves as a
guide to examine specific cases. For more detailed theoretical analysis,
see Diop (1990), and for an empirical application, see Diop and
Sirageldin (1990).

IntroductionOf the 15-18% of children and youth in Canada with a mental health disorder, some receive specialized mental health (MH) services and need additional treatment as young adults. Lack of a shared database across child and adult sectors has prevented examining predictors of future MH health service use.
Objectives and ApproachWe examined predictors of mental health service utilization in adulthood, and compared a sample of youth who received specialized MH treatment and age-, sex-, and region- matched controls. Patient-level administrative data from five MH agencies funded by the Ministry of Children and Youth Services (MCYS) in Ontario, with population health sector datasets held at the Institute for Clinical Evaluative Sciences (ICES). We expanded previous definitions of coding a MH visit by including codes specific to long-lasting childhood MH diagnoses (e.g., Attention Deficit-Hyperactivity Disorder).
ResultsOur match rate for linking the MCYS treated youth with their population health data was 77%. Youth who received MH treatment (N= 2957) were twice as likely as matched controls (N= 8891) to have a MH visit in the medical system in adulthood (i.e., after age 18). The most common diagnostic codes for the first visit were anxiety, depressive disorders, and ADHD. The median survival time (when 50% had a visit) from age 18 to first MH visit was 3.3 years. In adjusted Cox regressions, significant predictors of having an adult MH visit included service use history in both medical and MH systems during childhood and adolescence (e.g., ongoing pattern of children's MH service use).
Conclusion/ImplicationsThis study represents the first longitudinal, case-control cohort study in Canada to examine MH service utilization in the medical sector by youth treated for MH problems. The linkage of information from multiple datasets allowed for a broader understanding of MH service utilization across sectors of care, specific to children and youth.

Hong Kong's health services have shown signs of development in recent decades. The provision of public low-cost universal health services acts as a safety net, but its quality and quantity is sometimes questionable. Citizens' health service needs often must be met by the supplementary private health services, especially the primary health services. Nevertheless, criticisms have been expressed regarding access to, and utilization of, these health services. This paper examines the utilization, in terms of accessibility, affordability, and primary health services for Hong Kong residents. Based on a survey data collected in 2009, findings revealed that the respondents were, on the whole, satisfied with the primary health services and that this attitude is positively correlated with their satisfaction in their own health status. Nevertheless, the findings also show that health services utilization varies according to social class which deserves attention.

Objectives: In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing. The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran. Methods: A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis. Results: We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge. Conclusions: Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS. Copyright © 2018 The Korean Society for Preventive Medicine.

Objectives: In most countries around the world, sex work is an illegal activity. Female sex workers (FSWs) in Iran hide their identities, and they are known to be a hard-to-reach population. Despite free access to HIV testing, fewer than half of FSWs receive HIV testing. The purpose of this study was to characterize the reasons for which FSWs do not seek testing at drop-in centers (DICs) and voluntary counseling and testing (VCT) centers in Iran. Methods: A qualitative study was conducted in 2016. The participants were 24 FSWs who received services at VCT centers and DICs for vulnerable females in the north of Iran and 9 males who were the clients of FSWs. In this study, we made use of purposive sampling and carried out a thematic analysis. Results: We found 4 major and 6 minor themes. The major themes were: fear of being infected (with HIV), stigma, indifference, and knowledge. Conclusions: Despite the significant efforts made by the government of Iran to establish and expand DICs for vulnerable females, the number of FSWs receiving services at these centers has not been very considerable. Consequently, by introducing and implementing training programs for peer groups, it may be possible to take steps toward establishing strategic programs for the control and prevention of HIV/AIDS. Copyright © 2018 The Korean Society for Preventive Medicine.

There are a number of reasons for anticipating that contact by women in developing country settings with modern maternal–child health (MCH) services will lead to increased use of family planning services. Indeed, the expectation of such a relationship underlies the integrated service delivery strategy that has been adopted on a more or less global basis. However, the available empirical evidence in support of this proposition is inconclusive. This study re-examines this issue in Morocco. Household survey data and data on the supply environment for health and family planning services gathered in 1992 are analysed in the study. A full-information maximum likelihood estimator is used to control for the possible endogeneity of health care and contraceptive choices. The findings indicate a substantial and apparently causal relationship between the intensity of MCH service use and subsequent contraceptive use. Policy simulations indicate that sizeable increases in contraceptive prevalence might be realized by increasing the coverage and intensity of use of MCH services.

Infertility is a discretionary health condition; although it carries with it important life course implications, treatment is rarely necessary for health reasons. Sociological theories of medical help‐seeking emphasize demographic factors, perceived need, and enabling conditions in health services utilization, but we find that social cues are also strongly associated with health services utilization for infertility. Adjusted for conventional predictors of medical help‐seeking, several social cue indicators have significant associations with utilization, including having friends and family with children, perceiving infertility stigma, and having a partner and/or family member who encourages treatment. Perceived need accounts for the largest portion of the variation in utilization. Enabling conditions explain less of the variance than social cues. Social cues should be especially important for discretionary health services utilization. Studies of service utilization for discretionary health conditions should explicitly incorporate a range of measures of social cues into their models.