Health Care Avoidance Among Rural Populations: Results From a Nationally Representative Survey

BACKGROUND: Previous research suggests that certain populations, including rural residents, exhibit health care avoidant behaviors more frequently than other groups. Additionally, health care avoidance is related to sociodemographics, attitudes, social expectations, ability to pay for care, and prior experiences with providers. However, previous studies have been limited to specific geographic areas, particular health conditions, or by analytic methods. METHODS: The 2008 Health Information Trends Survey (HINTS) was used to estimate the magnitude of health care avoidance nationally and, while controlling for confounding factors, identify groups of people in the United States who are more likely to avoid health care. Chi-square procedures tested the statistical significance (P \u3c .05) of bivariate relationships. Multivariable analysis was conducted through a weighted multiple logistic regression with backward selection. RESULTS: For 6,714 respondents, bivariate analyses revealed differences (P \u3c .05) in health care avoidance for multiple factors. However, multiple regression reduced the set of significant factors (P \u3c .05) to rural residence (OR = 1.69), male sex (OR = 1.24), younger age (18-34 years OR = 2.34; 35-49 years OR = 2.10), lack of health insurance (OR = 1.43), lack of confidence in personal health care (OR = 2.24), lack of regular provider (OR = 1.49), little trust in physicians (OR = 1.34), and poor provider rapport (OR = 0.94). CONCLUSION: The results of this study will help public health practitioners develop programs and initiatives targeted and tailored to specific groups, particularly rural populations, which seek to address avoidant behavior, thereby reducing the likelihood of adverse health outcomes

Standard epidemiological methods to understand and improve Apis mellifera health

In this paper, we describe the use of epidemiological methods to understand and reduce honey bee morbidity and mortality. Essential terms are presented and defined and we also give examples for their use. Defining such terms as disease, population, sensitivity, and specificity, provides a framework for epidemiological comparisons. The term population, in particular, is quite complex for an organism like the honey bee because one can view “epidemiological unit” as individual bees, colonies, apiaries, or operations. The population of interest must, therefore, be clearly defined. Equations and explanations of how to calculate measures of disease rates in a population are provided. There are two types of study design; observational and experimental. The advantages and limitations of both are discussed. Approaches to calculate and interpret results are detailed. Methods for calculating epidemiological measures such as detection of rare events, associating exposure and disease (Odds Ratio and Relative Risk), and comparing prevalence and incidence are discussed. Naturally, for beekeepers, the adoption of any management system must have economic advantage. We present a means to determine the cost and benefit of the treatment in order determine its net benefit. Lastly, this paper presents a discussion of the use of Hill’s criteria for inferring causal relationships. This framework for judging cause-effect relationships supports a repeatable and quantitative evaluation process at the population or landscape level. Hill’s criteria disaggregate the different kinds of evidence, allowing the scientist to consider each type of evidence individually and objectively, using a quantitative scoring method for drawing conclusions. It is hoped that the epidemiological approach will be more broadly used to study and negate honey bee disease.The COST Action FA0803http://www.ibra.org.uk/am201

A national survey of managed honey bee 2010-11 winter colony losses in the USA: results from the Bee Informed Partnership

This study records the fifth consecutive year that winter losses of managed honey bee (Apis mellifera) colonies in the USA have been around 30%. In April 2011, a total of 5,441 US beekeepers (an estimated 11% of total US beekeepers) responded to a survey conducted by the Bee Informed Partnership. Survey respondents reported that they had lost an average of 38.4% of their colonies, for a total US colony loss of 29.9% over the winter of 2010-11. One-third of respondents (all classified as backyard beekeepers, i.e. keeping fewer than 50 colonies) reported no winter loss. There was considerable variation in both the average and total loss by state. On average, beekeepers consider acceptable losses to be 13.2%, but 68% of all responding beekeepers suffered actual losses in excess of what they considered acceptable. Of beekeepers who reported losing at least one colony, manageable conditions, such as starvation and a weak condition in the fall, were the leading self-identified causes of mortality. Respondents who indicated that varroa mites (Varroa destructor), small hive beetles (Aethina tumida), poor wintering conditions, and/or Colony Collapse Disorder (CCD) conditions were a leading cause of mortality in their operations suffered a higher average loss than beekeepers who did not list any of these as potential causes. In a separate question, beekeepers who reported the symptom "no dead bees in hive or apiary" had significantly higher losses than those who did not report this symptom. In addition, commercial beekeepers were significantly more likely to indicate that colonies died with this symptom than either backyard or sideliner beekeepers.Keywords: 2010-11, USA, Mortality, Honey bee, OverwinterKeywords: 2010-11, USA, Mortality, Honey bee, Overwinte

A national survey of managed honey bee 2011-12 winter colony losses in the United States: results from the Bee Informed Partnership

Estimates of winter loss for managed honey bee (Apis mellifera) colonies are an important measure of honey bee health and productivity. We used data from 5,500 US beekeepers (5,244 backyard, 189 sideline and 67 commercial beekeepers) who responded to the April 2012 Bee Informed Partnership Winter Colony Loss Survey and calculated loss as the difference in the number of colonies between October 1, 2011 and April 1, 2012, adjusting for increases and decreases over that period. In the US, the total colony loss was 22.5% for the 2011-12 winter; 45.1% (n = 2,482) of respondents reported no colony loss. Total loss during 2011-12 was substantially lower than loss during 2010-11 (29.9%). Of the 4,484 respondents who kept bees in 2010-11 and 2011-12, 72.0% reported that the loss during 2011-12 was smaller or similar to the loss during 2010-11. There was substantial variation in total loss by state (range 6.2% to 47.7%). The average loss per beekeeping operation was 25.4%, but the average loss was not significantly different by operation type (backyard, sideline, commercial). The average self-reported acceptable loss per respondent was 13.7%; 46.8% (n = 2,259) of respondents experienced winter colony losses in excess of the average acceptable loss. Of beekeepers who reported losing at least one colony during 2011-12, the leading self-identified causes of mortality were weak condition in the fall and queen failure. Respondents who indicated poor wintering conditions, CCD, or pesticides as a leading cause of mortality suffered a higher average loss when compared to beekeepers who did not list these as potential causes.Keywords: Mortality, Colony losses, USA, Honey bee, Overwinter, 2011-1

Academic detailing to increase colorectal cancer screening by primary care practices in Appalachian Pennsylvania

<p>Abstract</p> <p>Background</p> <p>In the United States, colorectal cancer (CRC) is the third most frequently diagnosed cancer and second leading cause of cancer death. Screening is a primary method to prevent CRC, yet screening remains low in the U.S. and particularly in Appalachian Pennsylvania, a largely rural area with high rates of poverty, limited health care access, and increased CRC incidence and mortality rates. Receiving a physician recommendation for CRC screening is a primary predictor for patient adherence with screening guidelines. One strategy to disseminate practice-oriented interventions is academic detailing (AD), a method that transfers knowledge or methods to physicians, nurses or office staff through the visit(s) of a trained educator. The objective of this study was to determine acceptability and feasibility of AD among primary care practices in rural Appalachian Pennsylvania to increase CRC screening.</p> <p>Methods</p> <p>A multi-site, practice-based, intervention study with pre- and 6-month post-intervention review of randomly selected medical records, pre- and post-intervention surveys, as well as a post-intervention key informant interview was conducted. The primary outcome was the proportion of patients current with CRC screening recommendations and having received a CRC screening within the past year. Four practices received three separate AD visits to review four different learning modules.</p> <p>Results</p> <p>We reviewed 323 records pre-intervention and 301 post-intervention. The prevalence of being current with screening recommendation was 56% in the pre-intervention, and 60% in the post-intervention (p = 0. 29), while the prevalence of having been screened in the past year increased from 17% to 35% (p < 0.001). Colonoscopies were the most frequently performed screening test. Provider knowledge was improved and AD was reported to be an acceptable intervention for CRC performance improvement by the practices.</p> <p>Conclusions</p> <p>AD appears to be acceptable and feasible for primary care providers in rural Appalachia. A ceiling effect for CRC screening may have been a factor in no change in overall screening rates. While the study was not designed to test the efficacy of AD on CRC screening rates, our evidence suggests that AD is acceptable and may be efficacious in increasing recent CRC screening rates in Appalachian practices which could be tested through a randomized controlled study.</p

A national survey of managed honey bee 2010-11 winter colony losses in the USA: results from the Bee Informed Partnership

This study records the fifth consecutive year that winter losses of managed honey bee (Apis mellifera) colonies in the USA have been around 30%. In April 2011, a total of 5,441 US beekeepers (an estimated 11% of total US beekeepers) responded to a survey conducted by the Bee Informed Partnership. Survey respondents reported that they had lost an average of 38.4% of their colonies, for a total US colony loss of 29.9% over the winter of 2010-11. One-third of respondents (all classified as backyard beekeepers, i.e. keeping fewer than 50 colonies) reported no winter loss. There was considerable variation in both the average and total loss by state. On average, beekeepers consider acceptable losses to be 13.2%, but 68% of all responding beekeepers suffered actual losses in excess of what they considered acceptable. Of beekeepers who reported losing at least one colony, manageable conditions, such as starvation and a weak condition in the fall, were the leading self-identified causes of mortality. Respondents who indicated that varroa mites (Varroa destructor), small hive beetles (Aethina tumida), poor wintering conditions, and / or Colony Collapse Disorder (CCD) conditions were a leading cause of mortality in their operations suffered a higher average loss than beekeepers who did not list any of these as potential causes. In a separate question, beekeepers who reported the symptom “no dead bees in hive or apiary” had significantly higher losses than those who did not report this symptom. In addition, commercial beekeepers were significantly more likely to indicate that colonies died with this symptom than either backyard or sideliner beekeepers. Este estudio registra por quinto año consecutivo que las pérdidas invernales de abejas manejadas (Apis mellifera) en Estados Unidos están en torno al 30%. En abril del 2011, un total de 5,441 apicultores de los EE.UU. (se estima que el 11% del total de apicultores de EE.UU.) respondieron a una encuesta realizada por la Bee Informed Partnership. Los encuestados indicaron que habían perdido un promedio de 38.4% de sus colonias, con una pérdida total de colonias en EE.UU. del 29.9% durante el invierno de 2010-11. Un tercio de los encuestados (todos ellos clasificados como apicultores aficionados, es decir, con menos de 50 colonias) indicaron que no tuvieron pérdidas de invierno. Hubo una variación considerable tanto en la media como en el total de pérdidas por Estado. Por término medio, los apicultores consideran aceptables pérdidas del 13.2%, sin embargo, el 68% de todos los apicultores encuestados sufrieron pérdidas reales superiores a lo que consideran aceptable. Entre los apicultores que informaron de la pérdida de al menos una colonia, las principales causas de mortalidad identificadas por ellos fueron condiciones de manejo, tales como el hambre o una condición débil de las abejas en el otoño. Los encuestados que indicaron como principales causas de mortalidad de sus colmenas a los ácaros de Varroa (Varroa destructor), los escarabajos de las colmenas (Aethina tumida), las malas condiciones de invernada y / o condiciones del Síndrome de Colapso de las Colmenas (SCC), sufrieron una pérdida media mayor que aquellos apicultores que no incluyeron ninguna de estas causas potenciales. En una cuestión aparte, los apicultores que indicaron el síntoma “sin abejas muertas en la colmena o apiario” tenían pérdidas muy superiores a aquellos que no registraron ese síntoma. Además, los apicultores comerciales fueron significativamente más propensos a indicar que las colonias morían con este síntoma que los apicultores aficionados o los apicultores semi-profesionales

Calculating and Reporting Managed Honey Bee Colony Losses

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