Health Service utilization

Background: The Mapuche are the largest indigenous group in Chile; yet almost all data on the mental health of indigenous populations are from North America. Aim: The study examines the differential DSM-III-R prevalence rates of psychiatric disorders and service utilization among indigenous and non-indigenous community residence. Methods: The Composite International Diagnostic Interview (CIDI) was administered to a stratified random sample of 75 Mapuche and 434 non-Mapuche residents of the province of Cautín. Lifetime prevalence and 12-month prevalence rates were estimated. Results: Approximately 28.4% of the Mapuche population had a lifetime, and 15.7% a 12-month, prevalent psychiatric disorder compared to 38.0% and 25.7%, respectively, of the non-Mapuche. Few significant differences were noted between the two groups; however, generalized anxiety disorder, simple phobia, and drug dependence were less prevalent among the Mapuche. Service utilization among the Mapuche with mental illness was low. Conclusions: This is a preliminary study based on a small sample size. Further research on the mental health of indigenous populations of South America is needed.

Objective. Although prior populationbased studies have found that children in foster care use more mental health services than their Medicaid peers, less is known about how different experiences in foster care impact the likelihood of mental health service use. The primary aim of this study is to test the hypothesis that instability of foster care placements is associated with higher costs for mental health care services. The secondary aim is to test the hypothesis that foster care children are also more likely to generate high costs for mental health services if they generate higher costs for non-mental health claims.

The purpose of this study was to examine the health service utilization patterns of Ethiopian immigrants and refugees in a random sample of 342 adults residing in Toronto. The results suggested that 85% of the study participants used one or more type of health services, most often from a family physician. However, only 12.5% of them with a mental disorder received services from formal healthcare providers, mainly family physicians. While the presence of somatic symptoms was significantly associated with increased use of healthcare (p p 

The Prevention of Maternal Mortality Program is a collaborative effort of Columbia University's Center for Population and Family Health and multidisciplinary teams of researchers from Ghana, Nigeria and Sierra Leone. Program goals include dissemination of information to those concerned with preventing maternal deaths. This review, which presents findings from a broad body of research, is part of that activity.

The purpose of this paper is to ask the questiondoes mass customization really hold the key to customer value? It is argued that while mass customization can, and often does, increase the value of an offering, it is not always the case. In other words, mass customization does not represent the best strategy for all firms in all cases. It is critical that manufacturing firms understand whether their customers (existing and potential) really do value customization. The paper introduces the responsive agility tool that may provide the basis for an informed decision. The tool differentiates a number of value criteria and a method of selecting between them. Further, the tool identifies four levels of customization distinguished by secondary value criteria. We provide a case study demonstrating how the tool may operate in practice. The case study suggests that the tool may effectively differentiate customer types according to their value criteria. Finally the paper proposes that a value judgement is dependent on the negotiated process between a manufacturer and customer.

While numerous studies have documented the prevalence, correlates, and consequences of intimate partner violence (IPV); most of this research has used a criminal justice framework that has focused on acts of physical violence. However, critics argue that this narrow conceptualization of IPV belies the heterogeneity in this experience with respect to the nature of coercive control in the relationship. Moreover, they contend that the different types of abusive and controlling relationships not only have a different etiology, health consequences, and help-seeking characteristics, they also have a different relationship by gender. This study examined the extent to which different patterns of violence, abuse, and control were differentially associated with formal and informal help-seeking in a national Canadian sample. Data from the 2004 General Social Survey were analyzed, which included 696 women and 471 men who reported physical or sexual violence by a current or ex-spouse or common-law partner. The most commonly reported formal sources for women and men were health professionals (i.e., doctors, nurses, counselors, psychologists) and the police. For women, informal sources (i.e., family, friends, neighbors) were commonly reported across all IPV subgroups. However, the importance of almost all of the formal sources (e.g., health professionals, police, lawyers, shelters, crisis centers) increased as the severity of the violence and control increased. Shelters and crisis centers were also reported by a notable proportion of women who experienced the most severe pattern of violence and control. For men, both formal and informal sources were more commonly reported by those who experienced moderate violence and control compared with those who experienced relatively less severe acts of physical aggression. The results suggest that research that more sensitively examines people's experiences of violence and control can help identify their health, social, and safety needs; and ultimately better inform the development of programs and services aimed at addressing these needs.

salud pública de méxico / vol.41, no.2, marzo-abril de 1999 De la Cuesta-Benjumea C D iversos estudios muestran que no existe una relación directa entre sentirse enfermo e ir al médico, ya que este fenómeno está mediado por un proceso social en el que interviene la percepción individual y la forma en que el paciente interpreta los síntomas. 1 La antropología médica en particular, resalta el papel fundamental que las interpretaciones culturales representan en la experiencia y en la conducta ante la enfermedad. Así, en las décadas de los años setenta y Las mujeres y el manejo de un síntoma:

The Internet's influence in creating e-services has been revolutionary for providers and their customers. Unfortunately, there has been a wide gap between inspiring applications of the Internet that help increase service customization while maintaining or even improving delivery efficiency, and downright flops in which companies that have made bold promises have failed to deliver on even a portion of their pledges. This paper provides an examination of e-services utilizing three approaches in order to provide guidance on how to fly rather than flop. First, we develop a model of the e-service customer retention. Second, we offer a case study of Sothebys.com to illustrate how a well-known, but not typically technologically adventurous, company can utilize e-services to expand its offerings and streamline its services. Finally, we offer a profiling technique for analyzing the benefits and challenges of e-services for particular industries. "comprised of all interactive services that are delivered on the Internet using advanced telecommunications, information, and multimedia technologies." Clearly, the Internet's influence in creating e-services has been revolutionary for providers and their customers. This paper examines e-services utilizing three approaches. First, we employ a model of e-service customer retention. Second, we offer a case study of Sothebys.com to illustrate how a well-known, but not typically technologically adventurous, company can utilize e-services to expand its offerings and streamline its services. Finally, we offer a basic methodology for analyzing the benefits and challenges of e-services for particular industries. This profiling method borrows from the product profiling method developed by Terry Hill for use in operations strategy .

We sought to further explore the validity of the distinction between objective bulimic episodes (OBEs) and subjective bulimic episodes (SBEs) in the study of bulimic-type eating disorders. Drawing on data obtained at the second, interview phase of a large-scale epidemiological study, we identified mutually exclusive subgroups of women with bulimic-type eating disorders who engaged in regular OBEs but not SBEs (n ¼ 37) or regular SBEs but not OBEs (n ¼ 52). These subgroups were compared on a wide range of outcomes, including socio-demographic characteristics, current levels of eating disorder psychopathology, general psychological distress and impairment in role functioning, current and lifetime impairment in quality of life specifically associated with an eating problem, (self)-recognition of an eating problem, health service utilization and use of psychotropic medication. The only difference between groups was that participants who reported regular OBEs were heavier than those who reported regular SBEs. The findings converge with those of previous research in suggesting that bulimic-type eating disorders characterized by regular SBEs, but not OBEs, do not differ in any clinically meaningful way from those characterized by regular OBEs, but not SBEs. Inclusion of bulimic-type eating disorders characterized by regular SBEs as a provisional category requiring further research in DSM-V appears warranted.

The measurement of parenting behaviors is important to the field of psychology and the goal of remediating problematic parenting as a means of reducing child problem behaviors. The Parenting Young Children (PARYC) is a self-report measure designed to address parenting behaviors relevant for the caregivers of young children, and was assessed in sample of 579 high risk families. The measure assesses the frequency of several parenting behaviors, the perception of the parenting behaviors as problematic, and the degree to which the caregiver would like to make changes in specific parenting skills. An examination of the validity of the parenting behavior items revealed three parenting scales: (1) Supporting Positive Behavior (2) Setting Limits, and (3) Proactive Parenting. Confirmatory factor analysis results corroborate the findings of the exploratory factor analysis, supporting the measurement structure of these parenting scales. Tests of convergent validity indicate the PARYC scale is a suitable measure of parenting behaviors. In addition, the self-perception of parenting behaviors as problematic predicted concurrent levels of service utilization while controlling for simultaneous child behavior problems.

The Internet's influence in creating e-services has been revolutionary for providers and their customers. Unfortunately, there has been a wide gap between inspiring applications of the Internet that help increase service customization while maintaining or even improving delivery efficiency, and downright flops in which companies that have made bold promises have failed to deliver on even a portion of their pledges. This paper provides an examination of e-services utilizing three approaches in order to provide guidance on how to fly rather than flop. First, we develop a model of the e-service customer retention. Second, we offer a case study of Sothebys.com to illustrate how a well-known, but not typically technologically adventurous, company can utilize e-services to expand its offerings and streamline its services. Finally, we offer a profiling technique for analyzing the benefits and challenges of e-services for particular industries. "comprised of all interactive services that are delivered on the Internet using advanced telecommunications, information, and multimedia technologies." Clearly, the Internet's influence in creating e-services has been revolutionary for providers and their customers. This paper examines e-services utilizing three approaches. First, we employ a model of e-service customer retention. Second, we offer a case study of Sothebys.com to illustrate how a well-known, but not typically technologically adventurous, company can utilize e-services to expand its offerings and streamline its services. Finally, we offer a basic methodology for analyzing the benefits and challenges of e-services for particular industries. This profiling method borrows from the product profiling method developed by Terry Hill for use in operations strategy .

Grid computing has emerged from category of distributed and parallel computing where the heterogeneous resources from different network are used simultaneously to solve a particular problem that need huge amount of resources. Potential of Grid computing depends on my issues such as security of resources, heterogeneity of resources, fault tolerance & resource discovery and job scheduling. Scheduling is one of the core steps to efficiently exploit the capabilities of heterogeneous distributed computing resources and is an NP-complete problem. To achieve the promising potential of grid computing, an effective and efficient job scheduling algorithm is proposed, which will optimized two important criteria to improve the performance of resources i.e. makespan time & resource utilization. With this, we have classified various tasks scheduling heuristic in grid on the basis of their characteristics.

In order t o satisfy the client needs, his Utility should be increased by covering his Demand. The service Utility should be maximized through effective deployment of ATMs. Genetic Algorithm is one of widely used techniques to solve complex optimization problems, such as Banking ATM's Location Problem. This paper proposes a novel Rank Based Genetic Algorithm using convolution for solving the Banking ATM's Location Problem (RGAC). The proposed RGAC maximizes demand Coverage Percentage with less number of ATM machines. The novel RGAC speeds up the convergence using Rank Concept, with limited number of iterations to obtain a high quality feasible solution in resonable time.

This first, extensive, facility-based study of health services utilization in central, southern and western Ethiopia reveals steep distance decay gradients and underutilization of rural health services, the result of numerous geographical, socioeconomic, cultural and facility-based barriers. Out-patient statistics of 280,656 first-visit polyclinic patients in 8 hospitals, 8 health centres and 9 health stations in 7 administrative regions and of 10,885 sick children, 7767 antenatal attendants, 902 family planning acceptors, 275 vaccinated children and mothers and 1066 free patients, as well as in-patient statistics of 11,221 patients in 5 hospitals were analysed to determine catchment areas and utilization rates. On the average, 46% of the polyclinic patients were residents of the same town or village, 39% of the same awraja (district) and 5% of other administrative regions. Sick children, family planning attendants, free patients and in-patients lived relatively nearer to health facilities than polyclinic out-patients. Interviews with polyclinic out-patients showed that type and cost of transportation, type of illness, patient preferences, socioeconomic status of patients and referral patterns were important factors in utilization. Aggregation of all available health services data indicates that whereas some towns approach the targeted 2.5 per capita patient visits per year, coverage of the rural population is relatively low. Suggestions are made on how to overcome the problem of underutilization of rural health stations and to improve the health services information system.

OBJECTIVES: To describe the prevalence and determinants of dependence in older Nigerians and associations with informal care and health service utilization. DESIGN: A single-phase cross-sectional catchment area survey. SETTING: Dunukofia, a rural community in southeastern Nigeria. PARTICIPANTS: One thousand two hundred thirty-eight adults aged 65 and older, for whom full data were available on 914. MEASUREMENTS: The full 10/66 Dementia Research Group survey protocol was applied, including ascertainment of depression, cognitive impairment, physical impairments, and self-reported diagnoses. The interviewer rated dependence as not needing care, needing some care, or needing much care. The prevalence of dependence and the independent contribution of underlying health conditions were estimated. Sources of income, care arrangements, caregiver strain, and health service use are described according to level of dependence. RESULTS: The prevalence of dependence was 24.3% (95% confidence interval 5 22.1-26.5%), with a concentration in participants aged 80 and older. Only 1% of participants received a pension, and fewer than 7% had paid work. Those who were dependent were less likely than others to receive income from their family. Cognitive impairment, physical impairments, stroke, and depression were each independently associated with dependence. Depression made the largest contribution. Dependence was strongly associated with health service use (particularly private doctor and traditional healer services) and with high levels of out-of-pocket expenditure. CONCLUSION: In Nigeria, dependence is an important outcome given rapid demographic aging and increases in chronic disease prevalence in all developing regions. Enhancing the social protection of dependent older adults should be a policy priority. Cognitive and mental disorders are important contributors to disability and dependence; more attention should be given to their prevention, detection, and treatment.

Chronic obstructive pulmonary disease (COPD) is a common condition associated with considerable morbidity, mortality and hospital admissions. However, published COPD management guidelines have major limitations and lack practical summaries. We aimed to optimally develop, implement, and evaluate a multidisciplinary COPD inpatient management 'ACCORD' guideline, including prompts for comprehensive day one assessments through to a discharge criteria checklist. Two intervention and two control public teaching hospitals in Adelaide, South Australia, took part, with pre-intervention (721 COPD admissions over 7 months) and intervention phases (509 COPD admissions over 7 months). During the intervention stage the ACCORD guideline was placed in the case notes on the day of admission or soon after. Readmissions were categorized as either emergency or elective and compared between the study arms, as were mortality and potential confounders (age, gender, number of comorbidities), with Po...

The Advanced Cognitive Training for Independent and Vital Elderly (ACTIVE) trial is a randomized, controlled, single-masked trial designed to determine whether cognitive training interventions (memory, reasoning, and speed of information processing), which have previously been found to be successful at improving mental abilities under laboratory or small-scale field conditions, can affect cognitively based measures of daily functioning. Enrollment began during 1998; 2-year follow-up will be completed by January 2002. Primary outcomes focus on measures of cognitively demanding everyday functioning, including financial management, food preparation, medication use, and driving. Secondary outcomes include health-related quality of life, mobility, and health-service utilization. Trial participants (n = 2832) are aged 65 and over, and at entry into the trial, did not have significant cognitive, physical, or functional decline. Because of its size and the carefully developed rigor, ACTIVE may serve as a guide for future behavioral medicine trials of this nature.

Background: Utilization of maternal health services is associated with improved maternal and neonatal health outcomes. Considering global and national interests in the Millennium Development Goal and Nigeria's high level of maternal mortality, understanding the factors affecting maternal health use is crucial. Studies on the use of maternal care services have largely overlooked community and other contextual factors. This study examined the determinants of maternal services utilization in Nigeria, with a focus on individual, household, community and state-level factors.

Incarcerated women have high rates of substance abuse problems and trauma. A variety of variables may influence whether these women seek help or are referred for substance abuse problems. This study reports an exploratory project on service utilization among incarcerated substance-dependent women (N = 40) in southeastern Idaho. Using self-report and interview tools, most participants reported some substance abuse treatment history, although extent and types of treatment varied. Most of the women also reported some type of childhood abuse. Age, income, and consequences of alcohol and other drug use related positively to substance abuse treatment. However, severity of childhood sexual abuse and current trauma symptoms were negatively correlated with substance abuse treatment episodes. These women may use substances to cope with childhood trauma or may not perceive the substance abuse system as responsive to their co-occurring trauma symptoms.

Previous research has suggested that lesbian, gay, bisexual, and transgender (LGBT) individuals enter treatment for substance abuse with more severe problems than heterosexual individuals. However, methodological difficulties, particularly the difficulty of obtaining a representative sample, have limited the ability to draw conclusions about LGBT individuals who receive services for substance abuse. This study took advantage of a unique opportunity to examine a representative sample of openly LGBT clients receiving publicly funded substance abuse treatment by using data gathered by treatment providers in Washington State. Baseline differences between openly LGBT and heterosexual clients were compared in a variety of domains. Results demonstrated that openly LGBT clients enter treatment with more severe substance abuse problems, greater psychopathology, and greater medical service utilization when compared with heterosexual clients. When the analyses were stratified based on sex, different patterns of substance use and associated psychosocial characteristics emerged for the LGBT clients. Implications for provision of appropriate services and recommendations to treatment agencies are discussed in this article. D

The framework presented in this article extends the Andersen behavioral model of health services utilization research to examine the effects of contextual determinants of access. A conceptual framework is suggested for selecting and constructing contextual (or community-level) variables representing the social, economic, structural, and public policy environment that influence low-income people's use of medical care. Contextual variables capture the characteristics of the population that disproportionately relies on the health care safety net, the public policy support for low-income and safety-net populations, and the structure of the health care market and safety-net services within that market. Until recently, the literature in this area has been largely qualitative and descriptive and few multivariate studies comprehensively investigated the contextual determinants of access. The comprehensive and systematic approach suggested by the framework will enable researchers to strengthen the external validity of results by accounting for the influence of a consistent set of contextual factors across locations and populations. A subsequent article in this issue of Inquiry applies the framework to examine access to ambulatory care for low-income adults, both insured and uninsured.

Several clothes washing alternatives are investigated with a specific emphasis on characterizing the benefit, if any, associated with servicizing a washing machine product. The pay for use alternative will consider a laundromat, in which people wash their clothes and pay a fee for that service. Another alternative is selling washing machines for home use. The alternatives are evaluated in terms of their economic costs and environmental impacts to provide a quantitative comparison of the alternatives. The environmental evaluation is obtained using SimaPro 7.0. Specific measures of performance that are considered include costs, energy, and water usage.

This study reports psychosocial characteristics of a sample of 111 children (K to 2nd grade) and their mothers who were living in urban supportive housings. The aim of this study was to document the various types and degree of risk endemic to this population. First, we describe the psychosocial characteristics of this homeless sample. Second, we compared this homeless sample with a grade-matched, high-risk, school-based sample of children (n = 146) who were identified as showing early symptoms of disruptive behaviors. Third, we compared the parents in both samples on mental health, parenting practices, and service utilization. Results showed that children living in supportive housing were in the at-risk range and had comparable levels of externalizing problems, internalizing problems, school problems and emotional strengths with the school-based risk sample receiving prevention services at a family support community agency. Mothers in supportive housing reported significantly higher psychological distress, less optimal parenting practices and greater service utilization. These findings are among the first to provide empirical support for the need to deliver prevention interventions in community sectors of care.

Healthcare utilization has particular relevance as a public health and development issue. Unlike material and human capital, there is little empirical evidence on the utility of social resources in overcoming barriers to healthcare utilization in a developing country context. We sought to assess the relevance of social resources in overcoming barriers to healthcare utilization.

We have observed how each consumer judges his likes and dislikes on objects viewing them. We have modeled each consumer's evaluation process by relationships among physical features of objects, each consumer's subjective interpretations and preferences. Thus, based on the models, our system can estimate users' subjective evaluations and preferences from physical features of objects to perform a suitable recommendation.

Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2-year follow-up study Cougnard A, Parrot M, Grolleau S, Kalmi E, Desage A, Misdrahi D, Brun-Rousseau H, Verdoux H. Pattern of health service utilization and predictors of readmission after a first admission for psychosis: a 2-year follow-up study.

Clinical biomedical research, the traditional research orientatlon of quality of We (QOL) researchers, is chiefly concerned with disease processes and assessing the impact of therapeutic interventions on improving health status and QOL outcomes. This paper suggests, however, that the biomedical paradigm limits utility of QOL research findings In terms of its ability to shape health policy and improve healthrelated QOL In populations at risk. This paper proposes that health services research (HSR) and other health research paradigms can be used to assess QOL from multiple perspectives. HSR and QOL research can be mutually beneficial. The models for understanding health services utilized in HSR may asslst in defining major determinants of QOL and the interaction of QOL with its environment. Conversely, QOL measures may be used to establish the relevance of HSR to people's well-being. The paper first defines the domain of HSR and the domain of quality of life. In order to understand their relationship, we consider what a model or paradigm for each might be, and how they would overlap. Finally, a merging of conceptual frameworks is proposed, llnking QOL research to HSR and other health research. Ultimately, expanding the QOL paradigm beyond the biomedical model will promote two objectives. First, it will permit research findings to contribute more fully to shaping national health policy by considering the broader community and the delivery system factors which influence QOL. Second, researchers will be more aware of a broader range of factors affecting patients and will incorporate this in their research.

Do you have a multicultural practice? Do you understand the attitudes and expectations African Americans hold about mental health services? The attitudes and beliefs of 201 African Americans regarding psychotherapists, psychotherapy, and barriers to treatment were explored by means of focus groups. Key barriers to service utilization included stigma, lack of knowledge, lack of affordability, lack of trust, impersonal service, and lack of cultural understanding. Participants reported that race should not matter in therapy, but they often believed that psychologists were insensitive to the African American experience. The implications of participants' reports for meeting African American mental health and therapy needs are considered. Although psychologists are aware of the differential pattern of use and response to mental health services among ethnic clients, the in-depth understanding that would permit development of appropriate responses and programs is limited. Psychologists often struggle with whether, when, and how efforts to address issues of race, ethnicity, and culture will affect mental health attitudes and therapeutic response. The focus group is a qualitative research strategy that uses a semistructured discussion format to elicit a more in-depth understanding of the attitudes, values, and beliefs that affect behavior (Stewart & Shamdasani, 1990). Although this strategy sacrifices the rigor and precision of quantitative studies, it is a useful preliminary strategy that allows members of communities to share their insights on relevant issues and their opinions about how needs and concerns might be addressed. The current study represents a preliminary effort to understand what values and concerns may affect African American mental health attitudes and service use, as well as what efforts by the psychological community may prove beneficial in promoting an image of multicultural sensitivity and competence. African Americans have been identified as a group that uses mental health services inconsistently (Kessler et al., 1994; D. W. Sue & Sue, 1990). Research has documented the overuse of inpatient services and the over-and underuse of outpatient services depending on the setting and problem (Atkinson, Morten, & Sue, 1998). More recently, Snowden (1999) noted a mixed pattern of usage when sociodemographic differences and diagnoses were not controlled. However, controlled analyses indicated that African Americans in a community sample were consistently less likely than White Americans to seek mental health services. The National Survey of Black Mental Health (Jackson, Neighbors, & Gurin, 1986) indicated that African Americans sought services as a result of referrals by physicians, family members, or friends and tended to contact physicians, ministers, and hospitals; only 9% of those surveyed used the services of psychologists, psychiatrists, or community mental health facilities. African Americans have been found to average fewer sessions and to terminate from outpatient mental health services earlier than White Americans (D. W. Sue & Sue, 1990). Diala et al. (2000) noted that African Americans were more likely than White Americans to report positive attitudes toward seeking professional help and to feel comfortable discussing personal problems with a professional, and they were less embarrassed about friends knowing that they were seeking therapy prior to service use. African Americans were also more likely to reference negative attitudes and less likely to use mental health services after professional contact. These findings suggest the importance of examining barriers to African Americans' treatment seeking. A number of variables have been suggested to explain the inconsistent use of mental health services noted among African Americans. Economic issues may be relevant in this regard. Lack of access to health insurance would require African Americans interested in mental health services to use public programs (Muntaner & Parsons, 1996). Mutchler and Burr (1991) noted wealth as a factor in racial differences in the use of mental health services.

Even the most socially aware countries in the World have noticed the gap increase between the poorest and the richest population groups. The purpose of this study was to investigate the presence of inequity and to identify main barriers for equitable health care utilization by economic status, region and area of living, controlled for health needs in the Croatian adult population. The data from the Croatian Adult Health Survey 2003 were used in this study. The results show that among the respondents with higher health needs, those with economic status above average had higher proportion of reg- ular annual general practitioner and medical specialist visits. In contrast, highly frequent visits to physician were more common in respondents who were below average economic status. Economically worse-off women, regardless on their health care needs reported gynecologist visits less regularly than the better-off women. Long waiting and the large dis- tance from the health care facilities w...

Background: While there is a growing literature on various aspects of depression in women, there is little research about the economic cost of depression in women. This analysis focuses on the direct and indirect cost to employers of female compared to male employees treated for depression, and their service utilization patterns. Methods: We used a claims database from a national, Fortune 100 company to analyze the direct (medical and prescription drug) and indirect (disability and illness-related work absence) costs to an employer for female and male beneficiaries with depression. Results: In 1998, the average female employee with depression cost this company $9265 compared to $8502 for male employees with depression. These women had significantly greater work absence costs which led to higher total costs than men, even though their medical costs were lower than those of comparable men. Limitations: Our analysis of the indirect costs associated with depressed female and male employees is limited to the costs of disability and sporadic illness-related work absences. The data available from this one employer did not allow accounting for the cost of reduced productivity while at work. Conclusions: We recommend that employers consider programs to improve the management of individuals with depression, in particular women. Also, further research is necessary to encourage the medical community to be more sensitive to the symptoms of depression in women. 

2 0 0 6 ) Journal of Advanced Nursing 54(4), 511-517 Factors influencing use of home care and nursing homes Aim. This paper reports a study comparing the characteristics of patients who use home care services and those who are cared for in nursing homes, and identifying the factors that influence the use of these care settings.

Background: Pregnancy and childbirth are special events in women's lives and their families. Care of women during pregnancy is the most effective health interventions for safer and healthier outcome. Accessibility, quality of care, personal attitudes and socioeconomic characteristics affect on antenatal care (ANC) service use. This study was carried out to explore ANC service utilization pattern and contributing factors in a rural area of Belgaum in relation to generate Community based data of India for addressing the contributing factors. Methods: Cross-sectional study was carried out from August 2012 to January 2013 in rural Belgaum Karnataka, India. All together 630 mothers with under one year child were interviewed by using pretested structure questionnaire after taking written consent. Analysis was done in computer based software; SPSS-20 version applying appropriate statistics. Results: Out of 630 participants; 54.6% were 20-24 years of age, 61.6% were having secondary education, 89.8% were house wives and 91.6% were Hindus. About 69.7% were from joint family with low economic status. Almost 94.8% were registered for ANC service, 85.7% visited ≥3 times, 66.0% visited during first trimester and 42.3% visited in primary healthcare Centre. Three-fifth of the participants resided ≤6 Km. far from health service facilities. Education, family income, knowledge on ANC, distance of health facility from residence and transportation cost were significant contributors (p<0.05) of ANC service utilization.

Few studies have examined whether rural residence is associated with increased or decreased risk for postpartum depression (PPD). To address this research gap, this pilot study examined rates of depressive symptoms and perceived social support among women living in rural (population <10,000), semi-rural (population 10,000-20,000), and urban (downtown Toronto, population approximately 2.5 million) areas. Women were consecutively recruited at 25-35 weeks gestation from midwifery clinics and hospital-based prenatal care practices in two catchment areas and asked to complete a demographic questionnaire including postal code. On the basis of their responses, rural, semi-rural, and urban mothers were contacted by telephone at 36 weeks gestation (baseline) and 6-8 weeks postpartum (primary outcome). During each assessment, participants completed standardized measures of social connectedness, mental health, and health service utilization, including the Edinburgh Postnatal Depression Scale (EPDS) and the Medical Outcome Study Social Support Scale. A total of 87 participants [N=23 rural (R), N=23 semi-rural (SR), N=41 urban (U)] were recruited into the study. There were no statistically significant differences between groups in mean EPDS scores during pregnancy (U=7.1, SR=5.3, R=5.3, p=0.15) or at 6 weeks postpartum (U=5.3, SR=4.4, R=4.2, p=0.43). The proportion of women with EPDS scores >12 similarly did not differ between groups. There were few statistically significant differences between groups on indicators of social connectedness; however, urban women reported significantly lower scores on measures of social network diversity and social capital than either the semi-rural or rural groups. This pilot study is limited by its small sample size; however, our data do not support the hypothesis that there are clinically important differences in risk for PPD associated with rural residence. Further studies examining potential relationships between indicators of social connectedness and perinatal mental health may be warranted.