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A special issue of International Journal of Environmental Research and Public Health (ISSN 1660-4601). This special issue belongs to the section "Environmental Health".

Deadline for manuscript submissions: closed (31 December 2020) | Viewed by 42596

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Special Issue Editors

Prof. Domenica Matranga

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Guest Editor

Department of Sciences for Health Promotion and Mother and Child Care, University of Palermo, Palermo, Italy
Interests: statistical modeling; data envelopment analysis; congestion analysis; multilevel Modeling; Bayesian modelling; additive Bayesian networks; structural equation modeling; healthcare efficiency evaluation; socioeconomic health inequality; noncommunicable diseases; elderly; active aging
Special Issues, Collections and Topics in MDPI journals

Prof. Filippa Bono

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Guest Editor

Department of Economics, Business and Statistics (SEAS), University of Palermo, 90100 Palermo, Italy
Interests: multidimensional analysis; data envelopment analysis; multilevel models; efficiency analysis; health inequality; concentration index; European Commission; socioeconomic inequality
Special Issues, Collections and Topics in MDPI journals

Ms. Laura Maniscalco

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Guest Editor

Department of Biomedicine, Neuroscience and Advanced Diagnostics (BI.N.D.), University of Palermo, 90100 Palermo, Italy
Interests: statistical modeling; additive Bayesian networks; logistic regression with Firth’s penalty; structural equation modeling; socioeconomic health inequality; noncommunicable diseases; elderly; active aging; social network; appropriateness of drugs and diagnostics exam prescriptions; mental disorders
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Currently, the key role of statistical modeling in epidemiology and public health is unquestionable. The methods and tools of biostatistics are extensively used for understanding disease development, uncovering the etiology, and evaluating the development of new strategies of prevention and control of the disease. Through data analysis, epidemiology can steer decision-making processes, guiding health and healthcare policy and planning and assisting in the management and care of health and disease in individuals. The growing availability of large healthcare databases allows to draw new evidence in the use of healthcare interventions, drugs, devices, and in the knowledge of population health and health inequality. Digital technologies, the internet, and social media allow to gather information about the efficiency and quality of healthcare delivery process, in addition to patient satisfaction.

In recognition of the extent of statistical modeling in epidemiology and public health, the International Journal of Environmental Research and Public Health devotes this Special Issue to recent findings on “Statistical Advances in Epidemiology and Public Health”. A wide range of topics will be included in this issue. These are:

Healthcare efficiency evaluation;
Quality of care;
Persistence and adherence with chronic therapy;
Effectiveness of treatment;
Data envelopment analysis;
Congestion analysis;
Socioeconomic health inequality and inequity;
Using healthcare utilization databases;
Bayesian models in epidemiology;
Real World Data in healthcare and public health;
Big Data in epidemiology and public health.

You are invited to submit manuscripts for consideration in this Special Issue, which covers the aforementioned topics.

Prof. Dr. Domenica Matranga
Prof. Dr. Filippa Bono
Ms. Laura Maniscalco
Guest Editors

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. International Journal of Environmental Research and Public Health is an international peer-reviewed open access monthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2500 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

Efficiency
Appropriateness
Persistence
Treatment adherence
Safety
Patient satisfaction
Quality of care
Healthcare utilization databases
Social media
Facebook
YouTube
Internet
Data envelopment analysis
Congestion analysis
Health inequality
Bayesian modeling
Additive Bayesian network

Published Papers (13 papers)

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14 pages, 344 KiB

Open AccessArticle

The Impact of a Change in Employment on Three Work-Related Diseases: A Retrospective Longitudinal Study of 10,530 Belgian Employees

by Laura Maniscalco, Martijn Schouteden, Jan Boon, Domenica Matranga and Lode Godderis

Int. J. Environ. Res. Public Health 2020, 17(20), 7477; https://doi.org/10.3390/ijerph17207477 - 14 Oct 2020

Cited by 3 | Viewed by 2226

Abstract

Background: The literature that has investigated to what extent a change in employment contributes to good health is contradictory or shows inconsistent results. The aim of this study was to investigate whether an association exists between a change in employment and cardiovascular, musculoskeletal and neuropsychological diseases in a sample of 10,530 Belgian workers in a seven-year follow-up study period. Methods: The following factors were analysed: Demographic variables, a change in employment and the work-related risks. Individuals being on medication for cardiovascular, musculoskeletal, and neuropsychological diseases were used as proxies for the three health issues. Logistic regression models for autocorrelated data with repeated measures were used to examine each medication type. Results: A change in employment and psychosocial load can have an important effect on the health of cardiovascular employees. Demographic variables, such as BMI and age, are risk factors for all three medications. Repetitive, manual tasks, handling static, exposure to noise levels of 87 dB, mechanical and/or manual handling with loads, and shift work were found to be positively associated with medications taken for musculoskeletal diseases. Exposure to noise 80 dB(A), managing physical loads and night work were found to be associated with being on medication for neuropsychological diseases. Physical activity and skill levels were considered to be protective factors for being on medication for neuropsychological diseases. Conclusions: Change in employment and psychosocial load were found as two important risk factors for being on medication for cardiovascular (CVD). Dealing with loads, doing shift work and being daily exposed to the noise of 87 dB correlated with being on medication for musculoskeletal (MSD). Dealing with physical loads, doing night work and being exposed to the noise of 80 dB were risk factors for being on medication for neuropsychological (NPD). While doing physical activity and reporting higher skill levels were found to be protective factors for NPD. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

13 pages, 313 KiB

Open AccessArticle

Lifestyle Medicine and Psychological Well-Being toward Health Promotion: A Cross-Sectional Study on Palermo (Southern Italy) Undergraduates

by Domenica Matranga, Vincenzo Restivo, Laura Maniscalco, Filippa Bono, Giuseppe Pizzo, Giuseppe Lanza, Valerio Gaglio, Walter Mazzucco and Silvana Miceli

Int. J. Environ. Res. Public Health 2020, 17(15), 5444; https://doi.org/10.3390/ijerph17155444 - 28 Jul 2020

Cited by 18 | Viewed by 3075

Abstract

(1) Aim: To assess the attitude toward Lifestyle Medicine and healthy behaviours among students in the healthcare area and to demonstrate its association to psychological well-being; (2) Methods: A cross-sectional study is conducted among 508 undergraduates of the University of Palermo (140 (27.6%) in the healthcare area and 368 (72.4%) in the non-healthcare area), during the academic year 2018–2019. Psychological well-being is measured through two dimensions of eudaimonia and hedonia, using the 10-item Hedonic and Eudaimonic Motives for Activities-Revised (HEMA-R) scale, with answers coded on a 7-point scale. The association between demographic and modifiable behavioural risk factors for chronic diseases is assessed through crude and adjusted Odds ratios with 95% confidence intervals; (3) Results: Orientation to both hedonia and eudaimonia is significantly associated to the Mediterranean diet (ORAdj = 2.28; 95% CI = (1.42–3.70)) and drinking spirits less than once a week (ORAdj = 1.89; 95% CI = (1.10–3.27)) and once a week or more (ORAdj = 6.02; 95% CI = (1.05–34.52)), while these conditions occur together less frequently for current smokers (ORAdj = 0.38; 95% CI = (0.18–0.81)). Students inclined to well-being consider healthcare professionals as models for their patients and all people in general (OR = 1.96, 95% CI = (1.28–3.00)); (4) Conclusions: The positive relation found between a virtuous lifestyle and psychological well-being suggests the construction, development and cultivation of individual skills are a means to succeed in counteracting at risk behaviours for health. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

13 pages, 345 KiB

Open AccessArticle

Latent Tuberculosis Infection among Healthcare Students and Postgraduates in a Mediterranean Italian Area: What Correlation with Work Exposure?

by Maria Gabriella Verso, Nicola Serra, Antonina Ciccarello, Benedetta Romanin and Paola Di Carlo

Int. J. Environ. Res. Public Health 2020, 17(1), 137; https://doi.org/10.3390/ijerph17010137 - 24 Dec 2019

Cited by 11 | Viewed by 2912

Abstract

Background: Tuberculosis screening is part of the standard protocol for evaluating the risk of infection in healthcare workers. The aim of this study was to evaluate the prevalence of latent tuberculosis infection (LTBI) among students attending various healthcare profession degree courses and postgraduate medical courses at the School of Medicine of the University of Palermo, Italy, and assess the possible professional origin of infection. Methods: In total, 2946 students (2082 undergraduates and 864 postgraduates) took part in a screening program for LTBI between January 2014 to April 2019 using the tuberculin skin test (TST). Students with a positive TST result underwent a Quantiferon-TB test (QFT). Results: Among the 2082 undergraduates, 23 (1.1%) had a positive TST; the result was confirmed with QFT for 13 (0.62%) of them. Among the 864 postgraduate students, 24 (2.78%) had a positive TST and only 18 (2.08%) showed a positive QTF. Latent tuberculosis infections were significantly more frequent among postgraduates than undergraduates (2.08% > 0.62%, p < 0.0001). There was a higher number of subjects previously vaccinated for TB (18.87% > 0.24%, p < 0.0001), and of vaccinated subjects found positive for TST and QTF (66.67% > 7.69%, p = 0.001) in the postgraduate group. Conclusion: Latent TB is relatively low among medical school students in our geographic area. Nevertheless, this infectious disease must be regarded as a re-emerging biohazard for which preventive strategies are required to limit the risk of infection, especially among exposed workers. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

15 pages, 722 KiB

Open AccessArticle

Does Community-Level Social Capital Predict Decline in Instrumental Activities of Daily Living? A JAGES Prospective Cohort Study

by Satoko Fujihara, Taishi Tsuji, Yasuhiro Miyaguni, Jun Aida, Masashige Saito, Shihoko Koyama and Katsunori Kondo

Int. J. Environ. Res. Public Health 2019, 16(5), 828; https://doi.org/10.3390/ijerph16050828 - 07 Mar 2019

Cited by 28 | Viewed by 4515

Abstract

Instrumental activities of daily living (IADL) represent the most relevant action capacity in older people with regard to independent living. Previous studies have reported that there are geographical disparities in IADL decline. This study examined the associations between each element of community-level social capital (SC) and IADL disability. This prospective cohort study conducted between 2010 and 2013 by the Japan Gerontological Evaluation Study (JAGES) surveyed 30,587 people aged 65 years or older without long-term care requirements in 380 communities throughout Japan. Multilevel logistic-regression analyses were used to determine whether association exists between community-level SC (i.e., civic participation, social cohesion, and reciprocity) and IADL disability, with adjustment for individual-level SC and covariates such as demographic variables, socioeconomic status, health status, and behavior. At three-year follow-up, 2886 respondents (9.4%) had suffered IADL disability. Residents in a community with higher civic participation showed significantly lower IADL disability (odds ratio: 0.90 per 1 standard deviation increase in civic participation score, 95% confidence interval: 0.84–0.96) after adjustment for covariates. Two other community-level SC elements showed no significant associations with IADL disability. Our findings suggest that community-based interventions to promote community-level civic participation could help prevent or reduce IADL disability in older people. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

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15 pages, 1082 KiB

Open AccessArticle

Value-Based Healthcare in Ostomies

by Ana C. Montesinos Gálvez, Francisco Jódar Sánchez, Carmen Alcántara Moreno, Antonio J. Pérez Fernández, Rosario Benítez García, Mercedes Coca López, María Paz Bienvenido Ramírez, Monserrat Cabrera López, Luisa Vázquez Burrero, Pilar Jurado Berja, Raquel Sánchez García, Josefa Martín Cebrián, María Luz Hervas García, Remedios López Fernández, Claudia Pérez Jiménez, María Antonia Reyes Vico, Ana Belén Vargas Villegas, Nuria García-Agua Soler and Antonio J. García Ruiz

Int. J. Environ. Res. Public Health 2020, 17(16), 5879; https://doi.org/10.3390/ijerph17165879 - 13 Aug 2020

Cited by 7 | Viewed by 3708

Abstract

In order to achieve significant improvements in quality, cost, and accessibility (the health “iron triangle”), innovation in organizational and service delivery models is necessary to increase the value of healthcare. The aim of this study is to evaluate the efficiency of a model of organizational innovation based on advanced practice nurse in the care of people with ostomies (APN-O) versus usual care. An observational, exploratory, analytical, prospective study with a six-month follow-up was carried out at 12 hospitals that implemented this model in Andalusia. A total of 75 patients who had undergone a digestive elimination ostomy and/or a urinary ostomy were followed for six months. Clinical outcomes, healthcare resources, health-related quality of life, and willingness to pay (WTP) were analyzed. The economic evaluation was conducted from a societal perspective, including healthcare costs and indirect costs. The cost difference between the two models was €136.99 and the quality-adjusted life year (QALY) gained was 0.05965 (€2297 per QALY gained). At six months, the mean of WTP was €69 per APN-O consultation. This model contributes to increasing the value-based healthcare in ostomies. Results of this study suggested that APN-O is an effective patient management model for improving their health status and is highly efficient. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

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16 pages, 643 KiB

Open AccessArticle

Determinants and Differences of Township Hospital Efficiency among Chinese Provinces

by Bo Li, Muhammad Mohiuddin and Qian Liu

Int. J. Environ. Res. Public Health 2019, 16(9), 1601; https://doi.org/10.3390/ijerph16091601 - 07 May 2019

Cited by 19 | Viewed by 3141

Abstract

This study aimed to measure the efficiency and change in efficiency over time of township hospitals among Chinese provinces, to decompose the difference in efficiency between districts, and to study the correlations between the difference in efficiency and its determinants. Based on Chinese provincial panel data, the empirical analysis was established using data envelopment analysis (DEA), Malmquist index, Theil index decomposition method and Grey correlation analysis method. First, it was found that the township hospitals in most provinces were operating in an inefficient state, and the township hospitals in most provinces achieved gains in efficiency. Second, from 2003 to 2016 the shrinkage of the difference in provincial efficiency of township hospitals progressed slowly. Intra-regional difference is the main cause of the overall provincial efficiency difference of Chinese township hospitals, while inter-regional difference is the minor cause of the overall difference. Third, the correlation between the difference of overall provincial efficiency and the difference of economic development level is the highest among all the correlations, while other determinants rank second to seventh place in their degree of correlation with respect to the overall difference in provincial efficiency. Furthermore, the correlations between the intra-regional difference of provincial efficiency of Chinese township hospitals and its determinants vary tremendously across regions. Based on our findings, we can conclude, first, that efforts should be made to improve the overall provincial difference in efficiency of Chinese township hospitals, and enhance the utilization level of input resources, and to reduce resource waste. Second, in order to shrink the overall provincial efficiency of Chinese township hospitals, the most important measure that should be taken is to improve the economic development level in relatively backward provinces in order to lay a solid economic foundation for the improvement of efficiency and shrink the differences in efficiency between provinces. Third, more attention should be paid to the shrinkage of intra-regional efficiency differences in Chinese township hospitals, while the narrowing of inter-regional efficiency difference should not be ignored. For each region, it is necessary to recognize the difference in the relative importance of determinants, and to make development strategies according to local conditions so as to make full use of local characteristics and advantages. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

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19 pages, 2853 KiB

Open AccessArticle

Spatial-Temporal Modelling of Disease Risk Accounting for PM2.5 Exposure in the Province of Pavia: An Area of the Po Valley

by Leonardo Trivelli, Paola Borrelli, Ennio Cadum, Enrico Pisoni and Simona Villani

Int. J. Environ. Res. Public Health 2021, 18(2), 658; https://doi.org/10.3390/ijerph18020658 - 14 Jan 2021

Cited by 3 | Viewed by 2403

Abstract

Spatio-temporal Bayesian disease mapping is the branch of spatial epidemiology interested in providing valuable risk estimates in certain geographical regions using administrative areas as statistical units. The aim of the present paper is to describe spatio-temporal distribution of cardiovascular mortality in the Province of Pavia in 2010 through 2015 and assess its association with environmental pollution exposure. To produce reliable risk estimates, eight different models (hierarchical log-linear model) have been assessed: temporal parametric trend components were included together with some random effects that allowed the accounting of spatial structure of the region. The Bayesian approach allowed the borrowing information effect, including simpler model results in the more complex setting. To compare these models, Watanabe–Akaike Information Criteria (WAIC) and Leave One Out Information Criteria (LOOIC) were applied. In the modelling phase, the relationship between the disease risk and pollutants exposure (PM2.5) accounting for the urbanisation level of each geographical unit showed a strong significant effect of the pollutant exposure (OR = 1.075 and posterior probability, or PP, >0.999, equivalent to p < 0.001). A high-risk cluster of Cardiovascular mortality in the Lomellina subareas in the studied window was identified. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

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5 pages, 277 KiB

Open AccessEditorial

Statistical Advances in Epidemiology and Public Health

by Domenica Matranga, Filippa Bono and Laura Maniscalco

Int. J. Environ. Res. Public Health 2021, 18(7), 3549; https://doi.org/10.3390/ijerph18073549 - 29 Mar 2021

Cited by 2 | Viewed by 2937

Abstract

The key role of statistical modeling in epidemiology and public health is unquestionable [...] Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

12 pages, 1995 KiB

Open AccessArticle

Bring More Data!—A Good Advice? Removing Separation in Logistic Regression by Increasing Sample Size

by Hana Šinkovec, Angelika Geroldinger and Georg Heinze

Int. J. Environ. Res. Public Health 2019, 16(23), 4658; https://doi.org/10.3390/ijerph16234658 - 22 Nov 2019

Cited by 16 | Viewed by 3293

Abstract

The parameters of logistic regression models are usually obtained by the method of maximum likelihood (ML). However, in analyses of small data sets or data sets with unbalanced outcomes or exposures, ML parameter estimates may not exist. This situation has been termed ‘separation’ as the two outcome groups are separated by the values of a covariate or a linear combination of covariates. To overcome the problem of non-existing ML parameter estimates, applying Firth’s correction (FC) was proposed. In practice, however, a principal investigator might be advised to ‘bring more data’ in order to solve a separation issue. We illustrate the problem by means of examples from colorectal cancer screening and ornithology. It is unclear if such an increasing sample size (ISS) strategy that keeps sampling new observations until separation is removed improves estimation compared to applying FC to the original data set. We performed an extensive simulation study where the main focus was to estimate the cost-adjusted relative efficiency of ML combined with ISS compared to FC. FC yielded reasonably small root mean squared errors and proved to be the more efficient estimator. Given our findings, we propose not to adapt the sample size when separation is encountered but to use FC as the default method of analysis whenever the number of observations or outcome events is critically low. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

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12 pages, 566 KiB

Open AccessArticle

Availability of Real-World Data in Italy: A Tool to Navigate Regional Healthcare Utilization Databases

by Edlira Skrami, Flavia Carle, Simona Villani, Paola Borrelli, Antonella Zambon, Giovanni Corrao, Paolo Trerotoli, Vincenzo Guardabasso and Rosaria Gesuita

Int. J. Environ. Res. Public Health 2020, 17(1), 8; https://doi.org/10.3390/ijerph17010008 - 18 Dec 2019

Cited by 10 | Viewed by 3186

Abstract

The purpose of the study was to map and describe the healthcare utilization databases (HUDs) available in Italy’s 19 regions and two autonomous provinces and develop a tool to navigate through them. A census of the HUDs covering the population of a single region/province and recording local-level data was conducted between January 2014 and October 2016. The characteristics of each HUD regarding the start year, data type and completeness, data management system (DMS), data protection procedures, and data quality control adopted were collected through interviews with the database managers using a standard questionnaire or directly from the website of the regional body managing them. Overall, 352 HUDs met the study criteria. The DMSs, anonymization procedures of personal identification data, and frequency of data quality control were fairly homogeneous within regions, whereas the number of HUDs, data availability, type of identification code, and anonymization procedures were considerably heterogeneous across regions. The study provides an updated inventory of the available regional HUDs in Italy and highlights the need for greater homogeneity across regions to improve comparability of health data from secondary sources. It could represent a reference model for other countries to provide information on the available HUDs and their features, enhancing epidemiological studies across countries. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

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11 pages, 1265 KiB

Open AccessArticle

Warning of Immortal Time Bias When Studying Drug Safety in Pregnancy: Application to Late Use of Antibiotics and Preterm Delivery

by Giovanni Corrao, Federico Rea, Matteo Franchi, Benedetta Beccalli, Anna Locatelli and Anna Cantarutti

Int. J. Environ. Res. Public Health 2020, 17(18), 6465; https://doi.org/10.3390/ijerph17186465 - 05 Sep 2020

Cited by 9 | Viewed by 3289

Abstract

This study aimed to illustrate and account for immortal time bias in pregnancy observational investigations, using the relationship between late use of antibiotics and risk of preterm birth as an example. We conducted a population-based cohort study including 549,082 deliveries between 2007 and 2017 in Lombardy, Italy. We evaluated the risk of preterm births, low birth weight, small for gestational age, and low Apgar score associated with antibiotic dispensing during the third trimester of pregnancy. Cox proportional hazards models were used to estimate hazard ratios (HRs) and 95% confidence intervals (CI) of the outcomes, considering the use of antibiotics as time-fixed (with biased classification of exposure person-time) and time-varying (with proper classification of exposure person-time) exposure. There were 23,638 (4.3%) premature deliveries. There was no association between time-fixed exposure to antibiotics and preterm delivery (adjusted HR 0.96; 95% CI 0.92 to 1.01) but an increased risk of preterm birth when time-varying exposure to antibiotics was considered (1.27; 1.21 to 1.34). The same trend was found for low birth weight and low Apgar score. Immortal time bias is a common and sneaky trap in observational studies involving exposure in late pregnancy. This bias could be easily avoided with suitable design and analysis. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

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15 pages, 1265 KiB

Open AccessArticle

Self-Perceived Health, Objective Health, and Quality of Life among People Aged 50 and Over: Interrelationship among Health Indicators in Italy, Spain, and Greece

by Laura Maniscalco, Silvana Miceli, Filippa Bono and Domenica Matranga

Int. J. Environ. Res. Public Health 2020, 17(7), 2414; https://doi.org/10.3390/ijerph17072414 - 02 Apr 2020

Cited by 27 | Viewed by 3416

Abstract

It is well known that self-perceived health (SPH), even if it is a subjective health indicator, is significantly associated with objective health and quality of life (QoL) in the general population. Whether it can be considered an indicator of cognitive functioning and quality of life in the elderly is still an open issue. This study used a data-driven approach to investigate the interrelationship among SPH, non-communicable diseases (NCDs), QoL, and cognitive functioning to answer this question. The study sample included information about 12,831 people living in Italy, Spain, and Greece, extracted from the Survey on Health, Aging, and Retirement in Europe, in the year 2015. The additive Bayesian networks methodology was used to identify the best directed acyclic graphs (DAG) for SPH, QoL, and NCDs. Results were given as posterior estimates of generalized linear models (GLM) coefficients, with 95% credibility intervals. Good SPH was associated with a decreasing number of chronic diseases in Italy (coeff = −0.52, 95%CI: [−0.59, −0.44]), Spain (coeff = −0.53, 95%CI: [−0.60, −0.46]) and Greece (coeff = −0.57, 95%CI: [−0.64, −0.50]). Age and Body Mass Index were determinants of NCDs in all countries. QoL of elderly was associated with SPH in Italy (coeff = 0.12, 95%CI: [0.10, 0.14]), Spain (coeff = 0.16, 95%CI: [0.15, 0.18]), and Greece (coeff = 0.18, 95%CI: [0.16, 0.20]). The number of NCDs was higher for people who were not employed in Spain (coeff = 0.45, 95%CI: [0.37, 0.53]) and was decreasing for a unitary increase in years of education in Greece (coeff = −0.12, 95%CI: [−0.14, −0.09]). As a general rule, the framework of the interrelationship among NCDs, SPH, and QoL was similar for Italy, Spain, and Greece. The connections found among indicators could be proposed to identify strategies for health promotion and healthy aging among people aged 50 and above, which are viable in general and at a country level. Reinforcing strategies targeted at some health indicators could have relevant effects on other related indicators. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

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18 pages, 1540 KiB

Open AccessArticle

Combining Direct and Indirect Measurements to Assess Patients’ Satisfaction with the Quality of Public Health Services in Romania: Uncovering Structural Mechanisms and Their Implications

by Elena Druică, Viorel Mihăilă, Marin Burcea and Vasile Cepoi

Int. J. Environ. Res. Public Health 2020, 17(1), 152; https://doi.org/10.3390/ijerph17010152 - 24 Dec 2019

Cited by 14 | Viewed by 3468

Abstract

Introduction: Patients’ satisfaction was extensively researched over the last decades, given its role in building loyalty, compliance to treatment, prevention, and eventually higher levels of wellbeing and improved health status. Patients’ feedback on the perceived quality of health services can be incorporated into practice; therefore, understanding factors and mechanisms responsible for patients’ satisfaction allows providers to tailor targeted interventions. Method: A questionnaire assessing patients’ perception of the quality of health services was administered to a country-representative sample of 1500 Romanian patients. Using a partial least squares—path modeling approach (PLS-PM), with cross-sectional data, we developed a variance-based structural model, emphasizing the mediating role of trust and satisfaction with various categories of health services. Results: We confirmed the mediating role of trust in shaping the relationship between the procedural accuracy of health professionals, along with the perceived intensity of their interaction with patients, and patients’ experienced quality of the health services. We confirmed the mediating role of satisfaction by the categories of services in the relationship between waiting time on the premises, attention received, and the perceived reliability of the information received, as predictors, and the experienced quality of the health services. In addition, indirect assessment of patients’ satisfaction is a good predictor for direct assessment, thereby affirming the idea that the results of the two types of evaluations converge. Discussions: One of the most efficient solutions to increase both patients’ satisfaction and their compliance is to empower the communication dimension between patients and health practitioners. Given the non-linear relationships among variables, we advocate that, unless the nature of the relationships between satisfaction and its predictors is understood, practical interventions could fail. The most relevant variable for intervention is the degree of attention patients perceive they received. We suggest three methods to turn waiting time into attention given to patients. Full article

(This article belongs to the Special Issue Statistical Advances in Epidemiology and Public Health)

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