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Journal of the National Medical... Jul 1995The compliance with a program of breast-conservation treatment for early-stage breast cancer and the results of that treatment among women treated between January 1983...
The compliance with a program of breast-conservation treatment for early-stage breast cancer and the results of that treatment among women treated between January 1983 and January 1992 was investigated in a large inner-city public hospital serving a primarily black population. Medical records and charts were reviewed for 25 consecutive patients with stage I and II breast cancer seen in consultation in the radiation oncology department. Of those 25 patients, 20 underwent lumpectomy and radiation therapy. Survival, disease-free survival, and local recurrence-free survival were computed using the Kaplan-Meier method. Compliance was evaluated based on time to complete the prescribed course of radiotherapy after a lumpectomy. Five-year local recurrence-free survival for stage I and II patients was 95% (confidence interval [CI]: 71% to 99%). Five-year overall survival for stage II patients was 71% (CI: 31% to 92%), and disease-free survival was 74% (CI: 36% to 91%). This study demonstrates that a program of breast-conservation treatment for early-stage breast cancer can be implemented with good results, excellent treatment compliance, and 100% follow-up in a population of medically indigent women.
Topics: Adult; Aged; Aged, 80 and over; Black People; Breast Neoplasms; Chemotherapy, Adjuvant; Combined Modality Therapy; Disease-Free Survival; Female; Follow-Up Studies; Humans; Mastectomy, Segmental; Medical Indigency; Middle Aged; Neoplasm Recurrence, Local; Neoplasm Staging; Patient Compliance; Retrospective Studies; Survival Rate; Urban Health
PubMed: 7636896
DOI: No ID Found -
Tropical Medicine & International... Jan 2012To analyse the costs and evaluate the equity, efficiency and feasibility of four strategies to identify poor households for premium exemptions in Ghana's National Health...
OBJECTIVES
To analyse the costs and evaluate the equity, efficiency and feasibility of four strategies to identify poor households for premium exemptions in Ghana's National Health Insurance Scheme (NHIS): means testing (MT), proxy means testing (PMT), participatory wealth ranking (PWR) and geographic targeting (GT) in urban, rural and semi-urban settings in Ghana.
METHODS
We conducted the study in 145-147 households per setting with MT as our gold standard strategy. We estimated total costs that included costs of household surveys and cost of premiums paid to the poor, efficiency (cost per poor person identified), equity (number of true poor excluded) and the administrative feasibility of implementation.
RESULTS
The cost of exempting one poor individual ranged from US$15.87 to US$95.44; exclusion of the poor ranged between 0% and 73%. MT was most efficient and equitable in rural and urban settings with low-poverty incidence; GT was efficient and equitable in the semi-urban setting with high-poverty incidence. PMT and PWR were less equitable and inefficient although feasible in some settings.
CONCLUSION
We recommend MT as optimal strategy in low-poverty urban and rural settings and GT as optimal strategy in high-poverty semi-urban setting. The study is relevant to other social and developmental programmes that require identification and exemptions of the poor in low-income countries.
Topics: Costs and Cost Analysis; Data Collection; Delivery of Health Care; Efficiency; Eligibility Determination; Family Characteristics; Ghana; Health Services Accessibility; Humans; Medical Indigency; National Health Programs; Poverty; Public Health Administration; Social Welfare; Universal Health Insurance
PubMed: 21951306
DOI: 10.1111/j.1365-3156.2011.02886.x -
Health Services Research 1966An analysis has been made of the patient population attending North Carolina Memorial Hospital (NCMH), primarily a referral center, in a nine-week period, with...
An analysis has been made of the patient population attending North Carolina Memorial Hospital (NCMH), primarily a referral center, in a nine-week period, with particular attention paid to county of residence of patients and to the type of care being obtained (consultative or continuing). Patients' use of NCMH, in relation to the population of their county of residence, showed a variability that could not be explained completely by distance from NCMH. Evidence is presented suggesting that the extent of other medical care personnel and facilities in the home county had little influence on utilization rates for this referral center. One significant determinant of increased utilization of NCMH appeared to be lack of county welfare funds for payment for medical care of its indigent population. In a review of the medical records of a five percent random sample of the total patient population, it was found that approximately 16 percent of the patients were probably receiving primary, continuing care at NCMH, i.e., care usually provided by family or personal physicians. Among Orange county residents approximately 35 percent were in the primary care group. Such patients had an average 6.3 visits per year to NCMH clinics and emergency room, compared to 2.3 visits per year for patients receiving consultative care. It is suggested that continuing tabulation of hospital utilization data, in addition to the usual statistics on visits and admissions, would be of value in recognizing changing patterns of utilization and in determining the type of service best suited to each individual patient.
Topics: Community Health Services; Emergency Service, Hospital; Hospitalization; Humans; Medical Indigency; Medical Records; North Carolina; Outpatient Clinics, Hospital; Statistics as Topic
PubMed: 5971544
DOI: No ID Found -
Health Services Research Aug 1986Health care for the indigent is a major problem in the United States. This review of the literature on health care for the indigent was undertaken to determine which... (Review)
Review
Health care for the indigent is a major problem in the United States. This review of the literature on health care for the indigent was undertaken to determine which major questions remain unresolved. Overall, this article finds that a very large pool of individuals under age 65 are at risk of being medically indigent. A myriad of health programs for some economically disadvantaged individuals do exist, but their level of funding has fluctuated over time--and many poor individuals must rely entirely on the generosity of a relatively small number of hospitals and other providers for their care. Economic pressures on these providers as well as structural changes in the health care sector can only adversely affect the amount of charity care that they offer. It is clear that a well-planned solution to indigent care in the United States, rather than a piecemeal approach, is needed.
Topics: Financing, Government; Health Services Accessibility; Hospitals; Humans; Insurance, Health; Medicaid; Medical Indigency; Physicians; Population; Poverty; Reimbursement Mechanisms; Unemployment; United States
PubMed: 3531094
DOI: No ID Found -
Public Health Reports (Washington, D.C.... 1986Tuberculosis patients who are homeless, indigent, and alcoholic infrequently complete a course of chemotherapy, risking treatment failure, recurrence, and continued...
Tuberculosis patients who are homeless, indigent, and alcoholic infrequently complete a course of chemotherapy, risking treatment failure, recurrence, and continued spread of infection in the community. Obstacles to successful treatment include an erratic schedule, mistrust of authority, and uncooperative or aggressive behavior. Successful management of this problem requires the use of proven case holding techniques, a correct choice of drug regimen, and a prompt and appropriate response to the patient who is lost or refuses treatment. Nine- and six-month drug regimens with proven success are now available; however, the direct observation of medication-taking should be maximized. Patient default may be further minimized by encouraging prompt notification of the health department. Occasionally, the threat or use of existing public health laws on confinement for purposes of treatment are required for noncompliant patients.
Topics: Antitubercular Agents; Community Health Services; Health; Ill-Housed Persons; Humans; Medical Indigency; Patient Compliance; Public Health Administration; Tuberculosis, Pulmonary; United States; Urban Health
PubMed: 3094077
DOI: No ID Found -
The Western Journal of Medicine Oct 1989Because patterns of disease and health care system usage by the homeless constitute a neglected area of research in the medical literature, we undertook a retrospective...
Because patterns of disease and health care system usage by the homeless constitute a neglected area of research in the medical literature, we undertook a retrospective analysis of inpatient records on medically indigent adults, controlling for housing status, to add to the growing body of research in the area of homeless health care. Data on all 4,243 indigent patients admitted over 2 fiscal years (1985 and 1986) under the county medical services program of San Diego County, California, revealed 5.3% (226) to be homeless. The commonest major diagnostic category among the homeless discharges was "diseases and disorders of the skin, subcutaneous tissue, and breast," constituting 21.2% as compared with only 8.7% of the discharge diagnoses for housed indigent persons. Within this major diagnostic category, the predominant diagnosis-related group was cellulitis, accounting for 12.8% of diagnoses in the homeless and only 4.0% of discharge diagnoses in other medically indigent persons. A homeless housing status was also correlated with a higher percentage of discharges with the major diagnostic category of "substance use and substance-induced organic mental disorders" but was negatively correlated with that of "diseases and disorders of the circulatory system."
Topics: Delivery of Health Care; Epidemiology; Ill-Housed Persons; Hospitalization; Humans; Medical Indigency; Retrospective Studies; United States
PubMed: 2588589
DOI: No ID Found -
Journal of Community Health Feb 2000A bilingual survey was developed to collect information regarding socio-demographics, access to medical and dental care, health insurance coverage, perceived health...
A bilingual survey was developed to collect information regarding socio-demographics, access to medical and dental care, health insurance coverage, perceived health status, and use of folk medicine providers from 70 adults presenting to a health fair in South Los Angeles County. Ninety-seven percent of respondents were foreign-born. Seventy-nine percent reported having no health insurance during the year prior to survey. Of the uninsured, 61 percent lacked a doctor visit and 76 percent lacked a dental visit during the previous year. The high cost of care was the most frequently cited barrier to seeking medical (58 percent) and dental (67 percent) care even when respondents felt it was necessary. Respondents who felt they needed medical attention but did not seek it had a lower perceived health status (7.0 +/- 2.2) than those who did (8.0 +/-2.0). Among respondents perceiving themselves in poor health, only 17 percent were insured. Relatively few respondents (7.2 percent) reported seeing a folk healer during the past year. Our results support the argument that the medically indigent in some localities face serious financial, as well as less salient, barriers to access. These local conditions reflect inadequate enforcement by local governments in correcting the difficult problems indigent populations face in accessing medical and dental care.
Topics: Adolescent; Adult; Emigration and Immigration; Female; Health Care Surveys; Health Fairs; Health Services; Health Services Accessibility; Health Status; Hispanic or Latino; Humans; Los Angeles; Male; Medical Indigency; Medically Uninsured; Medicine, Traditional; Middle Aged; Patient Acceptance of Health Care; Socioeconomic Factors; Surveys and Questionnaires
PubMed: 10706208
DOI: 10.1023/a:1005188801228 -
CMAJ : Canadian Medical Association... Jan 2015
Topics: Aid to Families with Dependent Children; Canada; Capital Financing; Child; Efficiency, Organizational; Female; Humans; Maternal-Child Health Centers; Medical Indigency; Models, Organizational; Privatization; United States
PubMed: 25452316
DOI: 10.1503/cmaj.109-4951 -
PLoS Medicine Oct 2007The authors explain how the international framework of human rights can be better used to help reduce child poverty and improve child survival rates. (Review)
Review
The authors explain how the international framework of human rights can be better used to help reduce child poverty and improve child survival rates.
Topics: Child; Child Advocacy; Child Mortality; Child Welfare; Developing Countries; Female; Global Health; Goals; Health Priorities; Health Promotion; Health Services Needs and Demand; Healthcare Disparities; Humans; International Cooperation; Male; Medical Indigency; Poverty; Social Problems; United Nations
PubMed: 17958466
DOI: 10.1371/journal.pmed.0040307 -
PloS One 2013In an earlier study, we detected an association between human T-cell lymphotropic virus (HTLV) infection and cervical human papillomavirus (HPV) in indigenous Amazonian...
BACKGROUND
In an earlier study, we detected an association between human T-cell lymphotropic virus (HTLV) infection and cervical human papillomavirus (HPV) in indigenous Amazonian Peruvian women of the Shipibo-Konibo ethnic group. As both HTLV and HPV can be transmitted sexually, we now report a population-based study examining the prevalence and risk factors for HTLV-1 and HTLV-2 infection in this population.
METHODS
Between July and December 2010, we conducted a comprehensive screening for HTLV among Shipibo-Konibo women 15 to 39 years of age living in two communities located in Lima and in 17 communities located within four hours by car or boat from the Amazonian city of Pucallpa in Peru.
RESULTS
We screened 1,253 Shipibo-Konibo women for HTLV infection 74 (5.9%) tested positive for HTLV-1, 47 (3.8%) for HTLV-2 infection, and 4 (0.3%) had indeterminate results. In the multivariate analysis, factors associated with HTLV-1 infection included: older age (Prevalence Ratio (PR): 1.04, 95% CI 1.00-1.08), primary education or less (PR: 2.01, 95% CI: 1.25-3.24), younger or same age most recent sex partner (PR: 1.66, 95% CI: 1.00-2.74), and having a most recent sex partner who worked at a logging camp (PR: 1.73, 95% CI: 1.09-2.75). The only factor associated with HTLV-2 infection was older age (PR: 1.08, 95% CI: 1.03-1.12).
CONCLUSION
HTLV infection is endemic among Shipibo-Konibo women. Two characteristics of the sexual partner (younger age and labor history) were associated with infection in women. These results suggest the need for implementation of both HTLV screening during the antenatal healthcare visits of Shipibo-Konibo women, and counseling about the risk of HTLV transmission through prolonged breastfeeding in infected women. We also recommend the implementation of prevention programs to reduce sexual transmission of these viruses.
Topics: Adult; Female; Geography, Medical; HTLV-I Infections; HTLV-II Infections; Human T-lymphotropic virus 1; Human T-lymphotropic virus 2; Humans; Medical Indigency; Peru; Prevalence; Public Health Surveillance; Risk Factors; Sex Factors; Sexual Behavior; Sexual Partners; Young Adult
PubMed: 24040133
DOI: 10.1371/journal.pone.0073978