This study aimed to examine the determinants of life satisfaction of older adults in Turkey. The sample consisted of 2,959 older adults over 65 years. The effects of psychological, daily life and ...instrumental activity, physical health and health status, and other important variables on life satisfaction were analyzed. The variables lessening life satisfaction for older adults included poverty, a lower self-reported health status, a decline in physical health, ability to chew, ability to do household activities, and an increase in feelings of depression and feeling social withdrawn. In contrast, being married, having a higher education level, and having an income-generating work increased life satisfaction among older adults. This study suggests the necessity of developing local and national policies that enable older adults to become more active in their communities. These policies should be coordinated under the framework of national aging policies that bridge health, social, and economic issues.
Objectives
Poor oral health has been shown to be associated with selected adverse health outcomes. This study assessed the association between untreated dental caries and mortality and examined ...whether having dental insurance mitigates the risk of mortality among working‐age US adults with dental caries.
Methods
Analysis used the publicly available linked mortality file for NHANES III, an observational study conducted in 1988‐1994, with follow‐up through December 2015. Propensity score matching was conducted to create similar populations of insured and uninsured adults, resulting in a sample of 4420 matched observations. The Cox proportional hazard model was used to investigate the effect of untreated dental caries and that of dental insurance on risk of all‐cause mortality. The descriptive and final outcome statistical analyses were adjusted for complex sampling technique using weights, strata and cluster variables.
Results
Adults with untreated dental caries had a higher risk of mortality (HR: 1.33; 95% CI: 1.06‐1.68) than those with no dental caries. Having dental insurance was associated with a lower risk of mortality (HR: 0.73; 95% CI: 0.59‐0.92). An interaction between caries treatment status and dental insurance was not statistically significant.
Conclusions
Adults with untreated dental caries have a higher risk of mortality, even in the presence of dental insurance. Untreated caries may be an indicator for multiple risk factors, including personal attitudes regarding health and healthcare‐seeking behaviour.
Coronavirus disease 2019 (COVID-19) is an infectious disease characterised by symptoms that are like the common cold. The current pandemic situation in anticipation of a vaccine has posed serious ...threats to the health and economic sectors of countries worldwide. To overcome the quick transmission of the virus, the government of Australia has also taken drastic measures to prevent its spread. These policies include an international and interstate travel ban, social distancing rules, lockdown, shutdown of educational institutes and work-from-home policies. Such rules have affected people on both behavioural and psychological levels. This study aims to analyse the effect of COVID-19 on Australian citizens, and therefore, the changed behaviour of citizens concerning their mobility patterns, transport preferences and shopping methods under the pandemic have been studied. A detailed literature search was adopted for gathering data related to the study theme, along with real-time evidence of changes in the behaviour of people following the pandemic. The socioeconomic impact of the pandemic on social inequality and thereby the effect on the vulnerable people of the population are also studied. Authentic surveys and statistical data are consulted to figure out how the new lifestyle choices of people will linger in the post-pandemic era. It was found that people in Australia have adopted the work-from-home regime, and new habits suiting the nationwide restrictions have become routine for many people.
The scale and scope of medical tourism have expanded rapidly over the last few decades. Turkey is becoming an important player in this market because of its relatively better service quality and ...large comparative cost advantage.
This paper compares cost, quality and effectiveness of in-vitro fertilization (IVF) in the USA and in Turkey. The data from Turkey were obtained from a hospital specializing in IVF services and the US data came from secondary sources. Package price offered by the dominant IVF-service provider to international patients in Turkey was used as a measure of cost for Turkey while IVF-specific service prices were used to estimate the cost for USA. To compare quality and effectiveness of IVF services, a number of general clinical quality indicators and IVF success rate were used.
Indicators of quality, cost and success rate in the Turkish hospital were found to be better than the corresponding indicators in US hospitals. The cost difference of IVF services between USA and Turkey is so significant that the overall cost of obtaining the service from Turkey remains lower even with additional expenses for travel and accommodation.
Cost-effectiveness ratio of IVF treatment per successful clinical pregnancy was much lower in Turkey than in the USA. It appears that cost and quality are the two most important factors affecting demand for health care services by international patients in Turkey. Like other important players in the medical tourism market, Turkey should be able to take advantage of its success in IVF, a highly specialized niche market, to transform its health system into an important exporter of general health services.
There exists a gap between existing security mechanisms and their ability to detect advancing threats. Antivirus and EDR (End Point Detection and Response) aim to detect and prevent threats; such ...security mechanisms are reactive. This approach did not prove to be effective in protecting against stealthy attacks. SCADA (Supervisory Control and Data Acquisition) security is crucial for any country. However, SCADA is always an easy target for adversaries due to a lack of security for heterogeneous devices. An attack on SCADA is mainly considered a national-level threat. Recent research on SCADA security has not considered "unknown threats," which has left a gap in security. The proactive approach, such as threat hunting, is the need of the hour. In this research, we investigated that threat hunting in conjunction with cyber deception and kill chain has countervailing effects on detecting SCADA threats and mitigating them. We have used the concept of "decoy farm" in the SCADA network, where all attacks are engaged. Moreover, we present a novel threat detection and prevention approach for SCADA, focusing on unknown threats. To test the effectiveness of approach, we emulated several SCADA, Linux and Windows based attacks on a simulated SCADA network. We have concluded that our approach detects and prevents the attacker before using the current reactive approach and security mechanism for SCADA with enhanced protection for heterogeneous devices. The results and experiments show that the proposed threat hunting approach has significantly improved the threat detection ability.
ObjectiveThis study aims to explore the rural–urban differentials in the influences of individual and geospatial preparedness on institutional childbirth in Bangladesh. A related aim of this paper is ...to derive estimates to measure geospatial preparedness for institutional births, through statistical modelling, when no data are available for measuring this areal indicator.Design, settings and participantsThe paper used data from a large-scale nationally representative Bangladesh Multiple Indicator Cluster Survey 2019. The analytical sample included 9203 currently married women of reproductive age who had a live birth in the 2 years preceding the survey.MethodsMixed effect logistic regression models were employed to explore the rural–urban differentials in influences of individual and geospatial preparedness on institutional childbirth. The district-level random effect estimation was done to measure geospatial preparedness. The conditional autoregressive model was used to examine the association of geospatial preparedness with areal variation in institutional births.ResultsIn rural settings, women who gave birth to a female newborn were 18% less likely to have facility births compared with women who gave birth to a male newborn. Also, women from households in the highest wealth quintile were twice as likely to have facility births compared with those from households in the poorest wealth quintile. In contrast, in urban areas, facility births did not vary by sex of the fetus or by households’ socioeconomic status. The geospatial preparedness explained 8% and 9% of the variability in institutional births in rural and urban areas, respectively. Geospatial mapping revealed low preparedness in the hill tracts. Findings identified geospatial preparedness as a potential source of areal variation in facility births.ConclusionFindings suggest improving district-level preparedness and developing differential programme strategies for urban and rural areas to increase the national prevalence and more equitable use of institutional childbirth in Bangladesh.
The Affordable Care Act (ACA) waived deductibles and eliminated coinsurance for colonoscopies for Medicare beneficiaries beginning in January 1, 2011. This study investigated the effect of the ACA's ...directive to remove the financial barriers on the receipt of colonoscopies among the elderly insured, who are predominantly covered by Medicare.
Data from the 2008-2016 Behavioral Risk Factor Surveillance System (BRFSS) were used to examine the receipt of colonoscopies in two years prior to the implementation of the ACA (2008 and 2010) and three years after the change (2012, 2014, and 2016). Multivariate logistic regressions were estimated to examine the change in colonoscopy use before and after the introduction of the ACA, adjusting for patient characteristics and availability of health care providers in the geographic region.
Of 349,899 eligible elderly insured in the age group 65 to 75 years, 236,275 (67.2%) had received a colonoscopy in the previous ten years. The receipt of colonoscopies increased from 63.5% in pre-ACA years to 69.2% in the post-ACA years (
< 0.001). Compared with the pre-ACA period, the odds ratio of colonoscopy uptake in post-ACA years was 1.15 (95% CI = 1.08-1.22).
A statistically significant increase in colonoscopy use was observed in the post-ACA years. However, achieving the target coverage rate of 80% will require additional interventions to encourage higher levels of screenings.
Abstract
Background
Papua New Guinea (PNG) has one of the highest burdens of HIV and syphilis in pregnancy in the Asia-Pacific region. Timely and effective diagnosis can alleviate the burden of HIV ...and syphilis and improve maternal and newborn health. Supply-side factors related to implementation and scale up remain problematic, yet few studies have considered their impact on antenatal testing and treatment for HIV and syphilis. This study explores health service availability and readiness for antenatal HIV and/or syphilis testing and treatment in PNG.
Methods
Using data from two sources, we demonstrate health service availability and readiness. Service availability is measured at a province level as the average of three indicators: infrastructure, workforce, and antenatal clinic utilization. The readiness score comprises 28 equally weighted indicators across four domains; and is estimated for 73 health facilities. Bivariate and multivariate robust linear regressions explore associations between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis.
Results
Most provinces had fewer than one health facility per 10 000 population. On average, health worker density was 11 health workers per 10 000 population per province, and approximately 22% of pregnant women attended four or more antenatal clinics. Most health facilities had a composite readiness score between 51% and 75%, with urban health facilities faring better than rural ones. The multivariate regression analysis, when controlling for managing authority, catchment population, the number of clinicians employed, health facility type and residence (urban/rural) indicated a weak positive relationship between health facility readiness and the proportion of antenatal clinic attendees tested and treated for HIV and/or syphilis.
Conclusion
This study adds to the limited evidence base for the Asia-Pacific region. There is a need to improve antenatal testing and treatment coverage for HIV and syphilis and reduce healthcare inequalities faced by rural and urban communities. Shortages of skilled health workers, tests, and medicines impede the provision of quality antenatal care. Improving service availability and health facility readiness are key to ensuring the effective provision of antenatal care interventions.
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