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Published on 05.10.17 in Vol 19, No 10 (2017): October
Comparison of Health Information Technology Use Between American Adults With and Without Chronic Health Conditions: Findings From The National Health Interview Survey 2012
Yan Zhang1,2, PhD ;
Romy Lauche2, PhD ;
David Sibbritt2, PhD ;
Bolanle Olaniran3, PhD ;
Ronald Cook4, DO ;
Jon Adams2, PhD
1Division of Integrative Medicine, Department of Family and Community Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
2Australian Research Centre in Complementary and Integrative Medicine, Faculty of Health, University of Technology Sydney, Sydney, Australia
3Department of Communication Studies, College of Media and Communication, Texas Tech University, Lubbock, TX, United States
4Department of Family and Community Medicine, School of Medicine, Texas Tech University Health Sciences Center, Lubbock, TX, United States
Yan Zhang, PhD
Division of Integrative Medicine
Department of Family and Community Medicine, School of Medicine
3601 4th Street MS8143
Lubbock, TX, 79430
Phone: 1 8067436056
Email: yan.zhang@ttuhsc.edu
Background: Health information technology (HIT) is utilized by people with different chronic conditions such as diabetes and hypertension. However, there has been no comparison of HIT use between persons without a chronic condition, with one chronic condition, and multiple (≥2) chronic conditions (MCCs).
Objective: The aim of the study was to assess the difference in HIT use between persons without a chronic condition, with one chronic condition, and with MCCs, to describe the characteristics of HIT use among those with chronic conditions and to identify the predictors of HIT use of the persons with one chronic condition and MCCs.
Methods: A secondary data analysis was conducted in spring 2017 using the National Health Interview Survey (NHIS) 2012 Family Core and Sample Adult Core datasets that yielded 34,525 respondents aged 18 years and older. Measures included overall HIT use (ie, any use of the following five HIT on the Internet: seeking health information, ordering prescription, making appointment, emailing health provider, and using health chat groups), as well as sociodemographic and health-related characteristics. Sociodemographic and health characteristics were compared between HIT users and nonusers among those who reported having at least one chronic condition using chi-square tests. Independent predictors of HIT use were identified using multiple logistic regression analyses for those with one chronic condition, with MCCs, and without a chronic condition. Analyses were weighted and performed at significance level of .005.
Results: In 2012, adults with one health chronic condition (raw count 4147/8551, weighted percentage 48.54%) was significantly higher than among those with MCCs (3816/9637, 39.55%) and those with none of chronic condition (7254/16,337, 44.40%, P<.001). Seeking health information was the most prevalent HIT use. Chi-square tests revealed that among adults with chronic conditions, those who used HIT were significantly different from their counterpart peers who did not use HIT in terms of sociodemographic and health characteristics (P<.001). Overall, the significant factors related to HIT use were similar among the adults with one chronic condition, with MCCs, or without a chronic condition: younger age, female sex, non-Hispanic white, higher education level, and higher income level were shown to be positively related to the HIT use.
Conclusions: This study provides a snapshot of HIT use among those with chronic conditions and potential factors related to such use. Clinical care and public health communication efforts attempting to leverage more HIT use should acknowledge differential HIT usage as identified in this study to better address communication inequalities and persistent disparities in socioeconomic status.
J Med Internet Res 2017;19(10):e335
health information technology;
According to the 2012 update of National Health Interview Survey (NHIS) data [1], among the noninstitutionalized, civilian US adult population, approximately half (117 million) of US adults have at least one of 10 chronic conditions (eg, hypertension, coronary heart disease, stroke, diabetes, and cancer). More specifically, 24.3% report 1 chronic condition, 13.8% report 2 chronic conditions, and 11.7% report 3 or more chronic conditions, which indicates that around 1 in 4 American adults have multiple (≥2) chronic conditions (MCCs).
The use of health information technology (HIT) can include a wide range of activities, from searching general health information to using individual computerized modules or Web portals. HIT has been utilized by people with different specific chronic conditions such as diabetes [2,3] and hypertension [4]. Five HIT uses measured in NHIS include seeking Web-based health information, ordering a Web-based prescription, scheduling a Web-based appointment, communicating with a health care provider over email, or using Web-based chat groups to learn about health topics. On the basis of NHIS 2009 and 2011 data, of all the five HIT uses, seeking health information was 7 to 14 times more likely to occur than the other HIT activities among American adults [5]. Other national surveys reported increasing trend of those other HIT activities when compared with their use in the past two decades [6-8]. Literature revealed that the general HIT users tend to be young, women, white, with a relatively higher education level, and a higher income level [9-11]. However, there has been no comparison of HIT use between persons without a chronic condition, with one chronic condition, and with MCCs.
To address this research gap, we analyzed NHIS 2012 data to (1) assess whether patterns of HIT use differ for persons without a chronic condition, with one chronic condition, and with MCCs; (2) describe the characteristics of HIT use among those with chronic conditions; and (3) identify predictors of HIT use among individuals with one chronic condition and MCCs. The aim of this study was to provide health professionals with a better understanding of HIT use among patients with one or more chronic conditions to facilitate better clinical care and patient education.
This paper reports a secondary analysis of data from the NHIS, a cross-sectional household interview survey targeting the noninstitutionalized civilian population of the United States conducted by the Centers for Disease Control and Prevention's (CDC) National Center for Health Statistics (NCHS) periodically. This study utilized the 2012 NHIS Family Core and Sample Adult Core. The NHIS Family Core questionnaire contained information on the participant's sociodemographic characteristics and health status. Data on chronic conditions and computer use were collected via the Sample Adult Core questionnaire. Details of the NHIS sampling are reported elsewhere [12]. In brief, the interviewed sample consisted of 42,366 eligible households, which yielded 34,525 respondents aged 18 years and older with a final response rate of 79.7%. We retrieved the dataset and performed the analyses in spring 2017.
Use of Health Information Technology (HIT)
Participants were asked whether they have ever used computers in the past 12 months for any of the following tasks: (1) to look up health information on the Internet (referred as seeking Web-based health information in the text below), (2) to fill a prescription (referred as ordering a Web-based prescription in the text below), (3) to schedule a Web-based appointment with a health care provider, (4) to communicate with a health care provider by email, or (5) to use online chat groups to learn about health topics (referred as using Web-based chat group in the text below). If an individual indicated use for any of these five purposes, they were considered to have used HIT in the past 12 months.
The chronic conditions included in this study were 10 most frequently reported physical health conditions from a list of 20 conditions identified by the US Department of Health and Human Services (DHHS) to foster a more consistent and standardized approach to measuring the occurrence of chronic conditions in the United States [13]. Participants were identified as having 1 of the 10 conditions if they have ever been told by a doctor or health care provider that they had hypertension, coronary heart disease, stroke, diabetes, cancer, arthritis, hepatitis, experienced weak or failing kidneys during the past 12 months, asthma, or chronic obstructive pulmonary disease (COPD). COPD was assessed by using responses from 2 survey questions asking adults whether they had ever had emphysema or chronic bronchitis in the past 12 months; adults answering yes to either question were identified as having COPD. Adults who reported having 2 or more chronic conditions were defined as having MCCs.
Sociodemographic Characteristics
HIT use has been found to vary by age [12,14], sex [6,15], race or ethnicity [10,16], education level [6,16], employment, marital relationship, and income level [11]. To account for the variations, we included the following sociodemographic data in the analysis: sex (male or female), age (18-29, 30-39, 40-49, 50-64, 65-74, and 75+ years), race or ethnicity (Hispanic, non-Hispanic white, non-Hispanic black, non-Hispanic Asian, and non-Hispanic other), educational attainment (less than high school, high school graduate or some college, Bachelor's degree, Master's degree or higher), employment status (not employed in the past 12 months or employed in the past 12 months), annual household income (less than US $15,000, US $15,000-34,999, US $35,000-54,999, US $55,000-74,999, and US $75,000 or more), and marital status (not in relationship or in relationship).
Health-Related Characteristics
Previous research suggests that after controlling for sociodemographic characteristics, self-rated health status may not be significantly associated with HIT use [17]. To examine whether this is also true in the population with chronic conditions, we included factors such as general health status (poor or fair, good, and very good or excellent) and body mass index (BMI; <18.5, 18.5-24.9, 25-29.9, or 30 or above) in our analysis.
Statistical Analyses
Analyses were performed using the Statistical Package for Social Sciences (SPSS) software (IBM SPSS Statistics for Windows, release 24.0. Armonk, NY: IBM Corp). Because NHIS is a complex survey using a multistage probability complex sampling design that incorporates stratification, clustering, and oversampling of some subpopulations (eg, black, Hispanic, and Asian), sampling weights must be used to produce representative estimates and standard errors. We utilized SPSS Complex Samples to compute statistics and standard errors from complex sample designs by incorporating sample designs into survey analysis. HIT use by respondents with and without chronic conditions as well as characteristics of HIT users and nonusers were compared among those who reported having at least one chronic condition, using chi-square tests. Independent predictors of HIT use were identified using multiple logistic regression analyses for those with one chronic condition, with MCCs, and without a chronic condition. All variables were included in the logistic regression analyses without forward or backward procedures. Due to the large sample size, a statistical significance level of .005 was chosen, and the 99.5% CI were calculated.
Prevalence of Health Information Technology Use and Chronic Condition Status
In 2012, an estimated 98.5 million US adults (42%) sought Web-based health information, 15.8 million (6.7%) ordered a Web-based prescription, 10.8 million (4.6%) made Web-based appointments with their health care provider, 13.5 million (5.7%) emailed their health care provider, and 6.8 million (2.9%) used Web-based health chat groups. Approximately half (116.7 million, 49.7%) of US adults reported having at least one chronic condition, and 57.3 million (24.4%), 32.7 million (13.9%), and 26.9 million (11.4%) reported having one, two, and three or more chronic conditions, respectively. The prevalence of each condition varies from the most frequently reported hypertension (50.5 million, 21.5%) to the least reported weak or failing kidneys (3.9 million, 1.7%).
Chronic Conditions and HIT Use
A comparison of HIT use by respondents with and without chronic conditions is shown in Table 1. Prevalence of HIT use among adults with one chronic condition (raw count 4147/8551, weighted percentage 48.54%) was significantly higher than among those with MCCs (3816/9637, 39.55%) and those with none of chronic condition (7254/16,337, 44.40%). Adults with one chronic condition were significantly more likely than those in the other two groups to use HIT to look up health information, make an appointment, and use health chat group, whereas adults with MCCs reported highest prevalence of HIT use for ordering prescription and emailing health providers. The HIT use among adults varied by health conditions, ranging from 24.8% of respondents with stroke to 48.7% with asthma (data not provided in this paper).
Health information technology use variables All, % (Nb=34,525) No chronic condition, % (Nb=16,337) One condition, % (Nb=8551) MCCsa, % (Nb=9637) Chi-square P value
Any health information technology use 44.2 44.4 48.5 39.6 141.3 <.001
Looked up health information 42.0 42.4 45.9 37.2 133.5 <.001
Ordered prescription 6.7 4.7 8.4 9.0 218.8 <.001
Made appointment 4.6 4.4 5.4 4.3 15.5 .02
Emailed health provider 5.7 5.3 6.3 6.4 15.0 .02
Used health chat groups 2.9 3.0 3.2 2.5 8.5 .07
aMCCs: multiple chronic conditions.
bN: raw count.
Table 1. Weighted percentage of persons who had used health information technology by chronic condition groups.
Sociodemographic and health characteristics All, %
(N=34,525) Did not use health information technology, % (99.5% CI)
(N=20,178) Used health information technology, % (99.5% CI)
(N=14,347)
Age (in years)
18 to 29 8.6 7.4 (6.6-8.2) 10.2 (9.2-11.3)
30 to 39 9.9 7.4 (6.8-8.2) 13.1 (12.2-14.0)
40 to 49 16.0 13.6 (12.8-14.5) 19.1 (18.0-20.2)
75+ 13.7 20.2 (19.2-21.3) 5.4 (4.8-6.0)
Male 46.2 49.0 (47.8-50.2) 42.6 (41.1-44.1)
Female 53.8 51.0 (59.8-52.2) 57.4 (55.9-58.9)
Hispanic 10.5 13.1 (12.3-14.0) 7.1 (6.3-7.9)
Non-Hispanic white 72.2 66.6 (65.3-67.9) 79.3 (78.1-80.5)
Non-Hispanic black 12.6 15.4 (14.5-16.4) 9.1 (8.3-10.0)
Non-Hispanic Asian 3.8 3.9 (3.4-4.4) 3.7 (3.2-4.3)
Non-Hispanic all other race 0.9 1.0 (0.7-1.4) 0.8 (0.6-1.1)
Less than high school 15.2 23.7 (22.6-24.8) 4.4 (3.8-5.0)
High school graduate and some college 59.4 61.8 (60.6-63.0) 56.4 (54.8-57.9)
Bachelor's degree 15.6 9.3 (8.5-10.1) 23.6 (22.4-24.9)
Master's degree or higher 9.8 5.2 (4.6-5.8) 15.7 (14.6-16.8)
Not employed 44.9 54.5 (53.1-55.8) 31.5 (30.1-33.0)
Employed 55.1 45.5 (44.2-46.9) 68.5 (67.0-69.9)
Income (in US$)
Up to 14,999 22.8 26.8 (24.8-28.9) 19.7 (18.3-21.1)
15,000 to 34,999 24.2 32.3 (30.4-34.3) 24.2 (22.6-25.8)
55,000 to 74,999 14.0 9.3 (8.2-10.6) 14.0 (12.8-15.3)
75,000 and higher 20.4 10.1 (8.7-11.7) 20.4 (18.7-22.1)
Not in relationship 38.3 43.0 (41.7-44.4) 32.3 (31.0-33.7)
In relationship 61.7 57.0 (55.6-58.3) 67.7 (66.3-69.0)
Up to 18.49 1.2 1.6 (1.3-2.0) 0.7 (0.5-1.0)
18.5 to 24.9 25.6 25.0 (23.9-26.1) 26.3 (25.0-27.7)
25-29.9 34.4 33.7 (32.5-34.9) 35.3 (34.0-36.6)
30 and more 38.8 39.6 (38.5-40.8) 37.7 (36.3-39.0)
Very good to excellent 44.8 38.2 (37.1-39.3) 53.2 (51.7-54.7)
good 33.4 34.6 (33.4-35.8) 31.8 (30.5-33.2)
poor to fair 21.8 27.2 (26.1-28.4) 15.0 (14.0-16.1)
Table 2. Comparison of characteristic between health information technology (HIT) users and nonusers among those who had at least one chronic condition in the past 12 months: weighted percentage and 99.5% CI.
Characteristics Associated With HIT Use Among Adults With Chronic Conditions
The characteristics related to HIT use among adults with at least one chronic condition are presented in Table 2. We found that HIT users significantly differed from nonusers with regard to sociodemographic and health characteristics. Compared with HIT nonusers, HIT users were significantly more likely to be under the age of 65 years, female, non-Hispanic white, with education level of bachelor's degree or higher, having annual income of US $55,000 or higher, currently employed, and in a relationship. HIT users were significantly less likely than nonusers to report higher BMI level (≥30) and poorer self-rated health status (≤good).
Potential Predictors of HIT Use
When adding the chronic condition status as an independent variable in the logistic regression model, the finding shows that higher prevalent HIT use is more likely to be reported by adults with one chronic condition (odds ratio, OR 1.55, 99.5% CI 1.44-1.68, P<.001) or with MCCs (OR 1.81, 99.5% CI 1.64-2.01, P<.001) than those with none of the 10 chronic condition. Table 3 presents results of the logistic regression analyses examining factors associated with HIT use by persons with none of the chronic conditions, one chronic condition, and MCCs. Overall, the significant predictors of HIT use were similar across all the three chronic condition groups. Specifically, after adjusting for all of the sociodemographic and health factors, those who were relatively younger, female, non-Hispanic white, with comparatively higher education level, and higher income level were significantly more likely to be HIT users. The OR differences varied in ±1 range for most of the predictors between those with chronic conditions and MCCs.
Independent variable With one chronic condition, adjusted ORb (99.5% CI)
N=8551 With MCCsa,
adjusted OR (99.5% CI)
N=9637 With no chronic conditions,
N=16,337
18 to 29 1.00 1.00 1.00
30 to 39 0.95 (0.61-1.49) 0.61 (0.27-1.34) 0.77 (0.62-0.95)
75+ 0.12 (0.03-0.45) 0.11 (0.04-0.32) 0.19 (0.04-0.91)
Male 1.00 1.00 1.00
Female 1.92 (1.49-2.46) 2.21 (1.63-3.00) 2.25 (1.62-2.63)
Hispanic 1.00 1.00 1.00
Non-Hispanic white 1.93 (1.36-2.73) 1.95 (1.24-3.06) 1.58 (1.28-1.96)
Non-Hispanic black 1.18 (0.76-1.83) 1.09 (0.62-1.91) 0.90 (0.68-1.20)
Non-Hispanic Asian 0.93 (0.52-1.66) 1.04 (0.47-2.30) 1.20 (0.84-1.71)
Non-Hispanic all other 1.39 (0.37-5.18) 2.00 (0.57-6.98) 1.01 (0.44-2.33)
Less than high school 1.00 1.00 1.00
High school graduate and some college 3.02 (1.71-5.35) 4.28 (2.38-7.68) 2.79 (2.07-3.787)
Bachelor's degree 6.88 (3.73-12.72) 12.66 (6.56-24.44) 5.89 (4.21-8.25)
Master's degree or higher 9.89 (5.00-19.57)
13.18 (6.55-26.51) 7.57 (5.11-11.20)
Not employed 1.00 1.00 1.00
Employed 0.88 (0.47-1.64) 1.00 (0.56-1.78) 1.02 (0.65-1.61)
Up to 14,999 1.00 1.00 1.00
15,000 to 34,999 1.05 (0.73-1.50) 0.88 (0.59-1.31) 1.05 (0.85-1.29)
75,000 and higher 2.13 (1.34-3.37) 1.86 (1.09-3.18) 1.89 (1.39-2.56)
Not in relationship 1.00 1.00 1.00
In relationship 1.21 (0.94-1.55) 1.28 (0.95-1.73) 1.07 (0.91-1.25)
Up to 18.49 0.90 (0.29-2.79) 0.34 (0.07-1.74) 0.87 (0.45-1.70)
18.5 to 24.9 1.00 1.00 1.00
25-29.9 1.10 (0.80-1.52) 1.12 (0.73-1.73) 0.87 (0.73-1.03)
30 and more 1.01 (0.76-1.35) 0.94 (0.62-1.41) 0.90 (0.74-1.11)
Very good to excellent 1.00 1.00 1.00
Good 0.95 (0.72-1.25) 0.99 (0.72-1.36) 1.06 (0.86-1.31)
Poor to fair 1.11 (0.73-1.70) 0.93 (0.61-1.4) 1.31 (0.87-1.98)
bOR: odds ratio.
Table 3. Factors associated to health information technology (HIT) use among respondents with none, one chronic condition, and multiple chronic conditions (MCCs): weighted logistic regression model results.
Our findings show that HIT use is relatively common among people with chronic conditions, ranging from about 40% of those with MCCs, to 49% of those with one chronic condition. The number of HIT users is expected be even higher nowadays with the increasing adoption of electronic health record (EHR) systems since the passage of the Health Information Technology for Economic and Clinical Health (HITECH) provisions of the American Recovery and Reinvestment Act (ARRA) of 2009 [18-20]. Of the five types of HIT use that were assessed, seeking Web-based health information was the most frequently reported use among all adults. This finding resonates with other reports that show health consumers are increasingly relying on the Internet for health information [9,10]. Among adults with one or more chronic condition, ordering Web-based prescriptions is the second most prevalent type of HIT use, with nearly 1 in 10 adults using the Internet to order prescriptions via a patient portal or pharmacy website. Recent research suggests that Web-based patient portal use may arguably be associated with better medication adherence, improved health care quality, and favorable patient outcomes [21,22]. Given that medication adherence is critical for chronic disease management, interventions including Internet-based approach that promote medication adherence are worth exploring [23]. Use of HIT to make appointments, email health care providers, and participate in chat groups for health topics was less prevalent. Although there has been little research to explain why the use of HIT for those other purposes is much lower, usability, availability, and accessibility of HIT functions, as well as health literacy could be some reasons [24,25]. Additionally, some adults with chronic conditions may face different difficulties accessing health care services, resulting in lower use of different kinds of HIT [26]. How the nature of a disease, severity and prevalence of the chronic conditions, and health care access affect HIT use warrants further examination.
We found that overall HIT use significantly differed among adults with or without chronic conditions, those with one chronic condition being the most active HIT users, those with MCCs the least, and those with none of the 10 chronic conditions falling in between. Our findings based on the multivariate regression models suggest that socioeconomic factors may have more influence on HIT use than health-related characteristics because the same sociodemographic factors were predictive of HIT use across all three of our study groups (adults with no chronic conditions, one chronic condition, and with MCCs). Specifically, consistent with the findings of previous studies on digital divide [8,27-29], we found that that across all three groups, HIT users were more likely than nonusers to be younger, female, non-Hispanic white, with comparatively higher education level, and with higher income level.
The lower use of HIT among adults with MCCs than those with one or no chronic condition may be explained by differences in the sociodemographic profile of each group. Whereas prevalence of MCCs varies by age, gender, and race or ethnicity, older age might be the key factor related to the lower use of HIT by adults with MCCs. First of all, for both genders, adults with MCCs are more likely to be older (aged ≥65 years) than those with only one or no chronic conditions [30,31]. Considering the rates of HIT use reportedly being significantly lower among the age groups 65 or older compared with the younger age groups [32], it is not surprising to find less prevalent HIT use among our MCCs respondents. The variation of gender and race or ethnicity might be outweighed by the impact of older age among those with MCCs [33]. This may further explain why HIT use is less among people with MCCs. In addition, adults with chronic conditions are reported more likely to have lower educational attainment and income [34,35]. Education and income factors are also related to health literacy [36], which in turn can have an impact on HIT use [24]. Aforementioned observations suggest that adults with MCCs are more likely than those with one or no conditions to be racial minorities, older, less educated, and with lower income; it is reasonable to expect lower HIT use in the MCCs group based on previous research. Regardless of which socioeconomic factors have more influence on HIT use, the above finding implies that educational materials or interventions to promote HIT use among those with chronic conditions must take into account socioeconomic factors that influence use. For instance, efforts should be made to help older adults and ethnic or racial minorities improve their abilities to navigate and utilize the Internet and recognize dependable Web-based sources so that they may increase their trust in its use, thereby increasing satisfaction with their own ability to seek and use sources of health information [37].
This study has a number of strengths, including using a dataset with a good response rate and a large sample drawn from a representative nationwide survey. Nonetheless, this study was subject to a few limitations. First, NHIS information was collected via self-report and the questions relating to health conditions and HIT use examined the participant's experience in the previous 12 months; hence, the study findings are potentially subject to recall bias and social desirability bias. Second, because of the nature of the cross-sectional study design, it is not possible to draw conclusions about probable causal pathways between the two explored variables (eg, chronic conditions and computer use), and therefore, the study findings should be interpreted with caution. These limitations should be balanced against the strengths of the study, including the large sample size and representativeness of the US population.
Our study provides a snapshot of HIT use among those with chronic conditions and potential factors related to such use. Our study suggests that HIT may serve as an alternative to more traditional methods of obtaining health information or communicating directly with health care providers, which in turn may help those with chronic conditions to better manage their illness over the long term. However, clinical care and public health communication efforts attempting to leverage more HIT use should acknowledge differential HIT usage as identified in this study to better address communication inequalities and persistent disparities in socioeconomic status.
Conception of the work was done by YZ, DS, and JA. Data analysis was done by RL, YZ, and DS. Introduction was written by YZ, BO, and JA. Methods and Results were written by RL, YZ, and DS. Discussion was written by YZ, BO, RC, and JA.
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Patel V, Jamoom E, Hsiao CJ, Furukawa MF, Buntin M. Variation in electronic health record adoption and readiness for meaningful use: 2008-2011. J Gen Intern Med 2013 Jul;28(7):957-964 [FREE Full text] [CrossRef] [Medline]
Lyles CR, Sarkar U, Schillinger D, Ralston JD, Allen JY, Nguyen R, et al. Refilling medications through an online patient portal: consistent improvements in adherence across racial/ethnic groups. J Am Med Inform Assoc 2016 Apr;23(e1):e28-e33 [FREE Full text] [CrossRef] [Medline]
Sarkar U, Lyles CR, Parker MM, Allen J, Nguyen R, Moffet HH, et al. Use of the refill function through an online patient portal is associated with improved adherence to statins in an integrated health system. Med Care 2014 Mar;52(3):194-201 [FREE Full text] [CrossRef] [Medline]
Dixon BE, Jabour AM, Phillips EO, Marrero DG. Improving medication adherence for chronic disease using integrated e-technologies. Stud Health Technol Inform 2013;192:929. [Medline]
Mackert M, Mabry-Flynn A, Champlin S, Donovan EE, Pounders K. Health literacy and health information technology adoption: the potential for a new digital divide. J Med Internet Res 2016 Oct 04;18(10):e264 [FREE Full text] [CrossRef] [Medline]
Agha Z, Weir CR, Chen Y. Usability of telehealth technologies. Int J Telemed Appl 2013;2013:834514 [FREE Full text] [CrossRef] [Medline]
Amante DJ, Hogan TP, Pagoto SL, English TM, Lapane KL. Access to care and use of the internet to search for health information: results from the US national health interview survey. J Med Internet Res 2015 Apr 29;17(4):e106 [FREE Full text] [CrossRef] [Medline]
Choi NG, Dinitto DM. Internet use among older adults: association with health needs, psychological capital, and social capital. J Med Internet Res 2013 May 16;15(5):e97 [FREE Full text] [CrossRef] [Medline]
Lyles CR, Harris LT, Jordan L, Grothaus L, Wehnes L, Reid RJ, et al. Patient race/ethnicity and shared medical record use among diabetes patients. Med Care 2012 May;50(5):434-440. [CrossRef] [Medline]
Gordon NP, Hornbrook MC. Differences in access to and preferences for using patient portals and other eHealth technologies based on race, ethnicity, and age: a database and survey study of seniors in a large health plan. J Med Internet Res 2016 Mar 04;18(3):e50 [FREE Full text] [CrossRef] [Medline]
Gerteis J, Izrael D, Deitz D, LeRoy L, Ricciardi R, Miller T, et al. AHRQ.: AHRQ Publications; 2014 Apr. Multiple chronic conditions chartbook URL: https://www.ahrq.gov/sites/default/files/wysiwyg/professionals/prevention-chronic-care/decision/mcc/mccchartbook.pdf [accessed 2017-07-27] [WebCite Cache]
Choi N. Relationship between health service use and health information technology use among older adults: analysis of the US National Health Interview Survey. J Med Internet Res 2011 Apr 20;13(2):e33 [FREE Full text] [CrossRef] [Medline]
Fabbri E, Zoli M, Gonzalez-Freire M, Salive ME, Studenski SA, Ferrucci L. Aging and multimorbidity: new tasks, priorities, and frontiers for integrated gerontological and clinical research. J Am Med Dir Assoc 2015 Aug 01;16(8):640-647. [CrossRef] [Medline]
Choi AI, Weekley CC, Chen SC, Li S, Tamura MK, Norris KC, et al. Association of educational attainment with chronic disease and mortality: the kidney early evaluation program (KEEP). Am J Kidney Dis 2011 Aug;58(2):228-234 [FREE Full text] [CrossRef] [Medline]
CDC. Hyattsville, MD: National Center for Health Statistics; 2012. Health, United States, 2011: with special feature on socioeconomic status and health URL: https://www.cdc.gov/nchs/data/hus/hus11.pdf [accessed 2017-07-27] [WebCite Cache]
Protheroe J, Whittle R, Bartlam B, Estacio EV, Clark L, Kurth J. Health literacy, associated lifestyle and demographic factors in adult population of an English city: a cross-sectional survey. Health Expect 2017 Feb;20(1):112-119 [FREE Full text] [CrossRef] [Medline]
Chaudhuri S, Le T, White C, Thompson H, Demiris G. Examining health information-seeking behaviors of older adults. Comput Inform Nurs 2013 Nov;31(11):547-553 [FREE Full text] [CrossRef] [Medline]
BMI: body mass index
CDC: Centers for Disease Control and Prevention
COPD: chronic obstructive pulmonary disease
DHHS: Department of Health and Human Services
EHR: electronic health record
HIT: health information technology
HITECH: health information technology for economic and clinical health
MCCs: multiple chronic conditions
NHIS: National Health Interview Survey
NCHS: National Center for Health Statistics
SPSS: Statistical Package for Social Sciences
Edited by G Eysenbach; submitted 14.11.16; peer-reviewed by J Marquard, T English, N Gordon; comments to author 03.02.17; revised version received 03.04.17; accepted 10.07.17; published 05.10.17
©Yan Zhang, Romy Lauche, David Sibbritt, Bolanle Olaniran, Ronald Cook, Jon Adams. Originally published in the Journal of Medical Internet Research (http://www.jmir.org), 05.10.2017.
This is an open-access article distributed under the terms of the Creative Commons Attribution License (https://creativecommons.org/licenses/by/4.0/), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work, first published in the Journal of Medical Internet Research, is properly cited. The complete bibliographic information, a link to the original publication on http://www.jmir.org/, as well as this copyright and license information must be included.


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Home>Puerto Natales & Torres del Paine>Torres del Paine Full Day
Torres del Paine Full Day
First class tour from Puerto Natales, visiting the Cueva del Milodón and the main attractions of the Torres del Paine National Park.
Price per person:
CLP$ 42.000 per person.
11 hours.
pickup at your accommodation (urban area), shared transport and bilingual guide (Spanish and English).
warm clothing, waterproof clothing, comfortable shoes, warm hat, sunglasses and sunscreen.
In case of suspension for weather conditions, we will refund 100% of your payment.
subject to weather conditions.
lunch, entrance fee to Cueva del Milodón Natural Monument (see details in FAQs) and entrance fee to Torres del Paine National Park (see details in FAQs).
Cancellation and rescheduling policy:
If you cancel your booking until 24 hours before the beginning of the activity, we will refund 100% of the advance you paid for the booking.
If you aren't in Puerto Natales, you can check the tour's availability and price from Punta Arenas.
Adult: $ 42.000 per person.
Child (age 3 to 8): $ 31.000 per person.
Infant (age 0 to 2): for free.
We will leave Puerto Natales to the north, and after a half an hour trip we will arrive at our first stop: the Cueva del Milodón Natural Monument. We will visit the main cave of a group of three caves, where more than 100 years ago were found the remains of this prehistoric animal.
The travel continues towards the Torres del Paine National Park, enjoying the view of the Sofía Lagoon, Porteño Lake, Prat Mountain Range, Mesa Hill, Toro Range and Ballena Range. After a 2 hours trip, we will arrive in the Lago del Toro viewpoint, located in the lake's south coast. From there, we will have a spectacular view of the lake and the Paine Range (also known as Paine Massif). Then, we will make a small walk of around 20 minutes to get to the border of the Grey Lake, from where we will have another perspective of the Paine Massif and the Cuernos del Paine, if the weather conditions allow it. In total, to go there and back, and walk through the beach, you will walk around 3 km through an easy path. Regardless of it, this waling is optional for those who don't want or don't feel in conditions to do it.
After lunch in a coffee shop inside the park , we will go to the Salto Grande area, place where is located the Pehoé Lake viewpoint, where the glaciers of the Paine River unload its fast-flowing waters. At the end of the tour, we will visit the Amarga Lagoon and the Sarmiento Lake viewpoint, to then go back to Puerto Natales.
*The places that will be visited are subject to change the same day of the tour because of adverse weather conditions.
*The ending time of this activity might be modified due to weather conditions, reason why our recommendation is not to buy tickets for leaving Puerto Natales until three hours after the returning time, or travel the next day after the end of the tour.
*For December 25 and January 1, the tour schedule will be from 8:30 am to 6:30 pm approximately.
*This activity includes pickup and drop off only in accommodations located inside the urban area of Puerto Natales. It does not include pickup nor drop off in accommodations located outside the urban area of Puerto natales, which are Cabañas Joshen Aonken, Cabañas Kauken, Hotel Lago Grey, Hotel Las Torres, Hotel Llanuras de Diana, Hotel Río Serrano, Hostería Lago del Toro, Hostería Pehoé, Hotel del Paine, Hotel Garden Domes and Hostal El Puestero.
In what period of the year the tour is made?
The tour is made during the whole year, always subject to weather conditions.
How far can I see the Torres del Paine?
In this tour, the mountain range formed by the Torres del Paine and the Cuernos del Paine is seen in a panoramic way from the viewpoints of Amarga Lagoon and Sarmiento Lake, to an approximate distance of 20 kilometers. The view of the mountain range is always subject to the cloud conditions. It is important to say that this tour does not visit the Base of the Torres del Paine, which is possible making the Base of Torres del Paine Hike or the W Circuit.
Which are the lunch options in the tour?
Lunch is not included in the tour. You will have time for lunch in a coffe shop inside the national park. You will have the possibility to buy a quick lunch or having your own, in case you bring it with you.
How much do I have to walk during the tour?
This is a panoramic tour, in which the vehicle makes stops to have a better look of some tourist interest points. The distances walked are very short, just to get closer to a lookout and have a better perspective, so it is not physically demanding at all.
Is it possible to re-enter the park with the same ticket on different days?
The entrance fee is valid for 3 consecutive days, so you can re-enter without paying again, as long as you pass for one of the entrances so valid your ticket.
What is the difference between the Torres del Paine Full Day and Base of Torres del Paine Hike?
The Torres del Paine Full Day is a panoramic tour (suitable for all audiences), with which you can visit the Cueva del Milodon and the main lookout points of the Torres del Paine National Park, while the Base of Torres del Paine Hike is an 8-hours round trip walk (suitable only for people with trek experience) that reaches the base of the Torres del Paine. Both are completely different and complementary activities.
What's the price of Cueva del Milodón's entrance fee?
Residents in Chile:
Adult: CLP$ 4.500 per person.
Teenager from 12 to 17 years old: CLP$ 2.500 per person.
Child from 0 to 11 years old and adult over the age of 60: don't pay (despite that, it will be asked for the corresponding ticket).
Non-residents in Chile:
Adult: US$ 11 per person.
Teenager from 12 to 17 years old: US$ 6 per person.
Child from 0 to 11 years old: don't pay (despite that, it will be asked for the corresponding ticket).
What's the price of Torres del Paine National Park entrance fee?
Teenager from 12 to 17: CLP$ 4.500 per person.
Teenagers from 12 to 17 years old: US$ 18 per person.
When should I buy the Cueva del Milodón and Torres del Paine Park entrance fees?
Once your booking is confirmed, the entrance fees for Torres del Paine National Park and Cueva del Milodón must necessarily be bought not later than the day before the excursion, in https://www.aspticket.cl/. At the moment of the pickup, the guide will ask for the entrance fees to all passengers, including children and adults over the age of 60. If one of them does not have the tickets, he or she will not be able to make the tour and there will be no refund.
Loading availability...
CLP$ 42.000

redpajama_set_name: RedPajamaCommonCrawl


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After years of broad and deep support at home, bolstering her as she grew to become the Continent's most powerful leader, [Angela Merkel] is heading toward national elections next year more politically vulnerable than at any time since her early days in office, with implications that extend far beyond Germany's borders. – New York Times
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September 2018-The Long Fight to honor Woodrow Wilson Keeble
Woodrow "Woody" Wilson Keeble was a warrior who wore a U.S. Army uniform.
Almost six decades after gallant actions in the Korean War and 26 years after his death, the U.S. Army master sergeant received the Congressional Medal of Honor. Keeble was a member of the Sisseton Wahpeton Oyate and the first Dakota to receive the Medal of Honor, the highest military honor in the United States for valor in combat.
Keeble was born in Waubay on May 16, 1917. He attended what is now Circle of Nations boarding school at Wahpeton, N.D., and joined the North Dakota Army National Guard. His Guard unit was activated during World War II and he served in I Company of the North Dakota 164th Infantry Regiment. The 164th Infantry fought in the Pacific, most notably at Guadalcanal. Keeble developed a reputation for bravery and skill.
After the war, Keeble returned to Wahpeton, married and worked at the school he attended while growing up.
In 1951, Keeble returned to active duty when the 164th Infantry Regiment was reactivated for the Korean War. For his actions on Oct. 20, 1951, Keeble became a legend.
According to the U.S. Department of Defense, Keeble's platoon met up with two platoons pinned down by enemy fire coming from three bunkers or pillboxes in a V-formation on a hill. The officers or platoon leaders were wounded or killed in action, so Keeble assumed command of the company. Keeble's plan was to lead one platoon at a time up the hill to try to destroy the enemy. After the third failed attempt, Keeble decided to go up the hill alone.
But first, he had to eliminate soldiers in trenches in front of the bunkers. He did this and then took out a bunker with a grenade. He moved to the second bunker and destroyed it with another grenade.
The final bunker was at the top of the hill. Keeble lobbed a grenade through the back entrance. The enemy was eliminated.
Allied forces then advanced and secured the hill.
Keeble's assault on the enemy took two to four hours under heavy fire. He was wounded multiple times with injuries to his chest, both arms and both legs.
After the war, Keeble returned to North Dakota. One lung was removed because of tuberculosis. This triggered a series of strokes that left him partially paralyzed and unable to speak. His wife died but he later remarried.
Keeble received many awards for his military service in World War II and Korea, including the Army's second highest award, the Distinguished Service Cross.
Over the years, friends and family tried unsuccessfully to have Keeble awarded the Medal of Honor. Recommendations that Keeble receive the Medal of Honor were submitted twice, but each time, the paperwork was lost.
Keeble died in Sisseton on Jan. 28, 1982, at age 64.
The fight to have him receive the Medal of Honor lived on.
When it was determined that the recommendations had never arrived at headquarters, family and friends gathered recommendations from those who had fought with Keeble. U.S. Sens. John Thune and Tim Johnson of South Dakota and Byron Dorgan and Kent Conrad of North Dakota urged that Keeble be posthumously awarded the Medal of Honor.
In 2007, the Department of Defense notified the four senators that a statute of limitations would prevent the Medal of Honor from being granted -- there was a three-year-window from when the action took place to when the medal could be awarded.
The senators drafted legislation that would grant a waiver of the statute of limitations. This language was included in the funding bill for Iraq that was passed by Congress.
President George W. Bush awarded the medal on March 3, 2008. He said while the tribute came too late for Keeble to see the honor bestowed, his story can still be told and his memory honored.
On March 17, 2008, Gov. Mike Rounds officially proclaimed the date to be forever commemorated as Woodrow Wilson Keeble Day in South Dakota.
A Hall of Honor display honoring Keeble and eight other Medal of Honor recipients from South Dakota is located on the first floor of the west wing of the South Dakota Capitol, near the north entrance. Numerous regional sites also pay homage to Keeble's memory.
This moment in South Dakota history is provided by the South Dakota Historical Society Foundation, the nonprofit fundraising partner of the South Dakota State Historical Society at the Cultural Heritage Center in Pierre. Find us on the web at www.sdhsf.org. Contact us at info@sdhsf.org to submit a story idea.


text:
Guide to the 12th General Hospital Collection
Identifier: ghsl-3
Abstract The 12th General Hospital Collection is comprised of the papers of Michael L. Mason and James A. Conner, who served as part of Northwestern University's 12th General Hospital Unit stationed in North Africa and Italy during World War II.
Found in: Galter Health Sciences Library & Learning Center
Michael Mason Papers
Identifier: 55/27
Abstract Michael Mason, a surgeon, received four degrees from Northwestern University. Following his education he taught at Northwestern and revived U.S. Base Hospital No. 12, which operated essentially as a Northwestern military medical unit. Mason's papers fill four folders and contain biographical information, correspondence, and programs and brief histories of the Surgeons Club.
Names: Mason, Michael L., 1895-1963 X
Northwestern University Archives 1
Galter Health Sciences Library & Learning Center 1
Hospitals, Military 1
Medicine, Military 1
Pediatrics 1
Surgeons 1
Surgery, Military 1
Surgery--Study and teaching 1
Multiple languages 1
Conner, James A. (James Augustus), 1903-2001 1
Northwestern University (Evanston, Ill.). Department of Medicine 1
United States. Army. Mediterranean Theater of Operations 1


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The Giant Rider-Waite Tarot is just that -- huge. The 78 cards have the same images as the regular Rider-Waite Tarot, but are 3.75 by 6.5 inches in size. A bit too big for use in a reading, the cards are ideal for teaching, classes, meditation and close symbolic study.


Originally founded in 1986, Great Divide Insurance Company is a property and casualty company providing a limited number of products to businesses in Arizona, Alaska, and Hawaii. They were acquired in 1991 by Nautilus Insurance Group as a complement to what was then known as Nautilus Insurance Company. Today, the two combined companies and their subsidiaries write standard and surplus policies in 49 states.
If you're looking for health insurance rates from companies in your area why not begin searching by entering your zip code now?
Unfortunately, despite the fact that Great Divide and its sister company offer a long list of different insurance products, health insurance is not among them. Any health insurance coverage a customer might possibly have access to would come by way of an umbrella policy. Even so, coverage under an umbrella policy would only be effective after all other health insurance benefits had been exhausted. If you're looking for health insurance in a state covered by Great Divide, you will have to explore other options.
Like many other property and casualty companies, Great Divide sells and services policies through local agents in the states where they do business. Local agents are representatives not only of Great Divide, but also of other companies offering the same lines of insurance. Being a representative of multiple companies allows an agent to compare policies from all of them in order to offer clients the best coverage at the best price. The agent model is common in the insurance business.
You can locate a local Nautilus or Great Divide agent by using the agent locator tool found on the Nautilus website. Unfortunately, the tool is limited in its capability because you cannot simply enter your zip code and go. You must enter an agency name and the state in order for the tool to find it.
A better bet for finding a local agent would be to contact the Scottsdale office and inquire directly. You might also consider sending them an e-mail you prefer not to make the phone call.
A.M. Best gives Nautilus Insurance Group and "A+" rating for their current of financial strength. In terms of future outlook, they are considered to be stable. The combination of these two ratings means that A.M. Best has every confidence in the company's ability to meet financial obligations in both the short and long terms. They also have sufficient financial resources to pay claims they anticipate for the current fiscal year.
As for Great Divide specifically, financial filings indicate they enjoy good financial health. According to 2010 filings, the company reported more than $149 million in assets, nearly $63 million in policy surplus, and roughly $6 million of working capital. While these numbers have been attributed directly to Great Divide it is possible that they apply to the entire Nautilus group.
Great Divide and Nautilus offer customer service through telephone, e-mail, and online platform. Their website provides a list of toll-free telephone numbers and e-mail addresses for customers who wish to contact them using one of those two methods.
For those who prefer to conduct their business online, the company provides several features to make this possible. Their claims service is accessible 24/7 by telephone, or by filling out an online claim form. Using the online platform allows customers to track the progress of their claim after it's been filed.
Customers may also use the online platform to pay their premiums. They can utilize a single, onetime payment option or sign up for auto pay. With auto pay, a customer submits his banking information, which is then used by the company to bill insurance premiums on a predetermined schedule. Agents also have the same payment options available to them through the online platform.
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July 12th, 2019 | 2:02PM | By Solomon Friedman
Watch Kurt Vile join Purling Hiss onstage at PhillaMOCA for "Walkin' With Jesus"
Purling Hiss and Kurt Vile | still from video
On Tuesday of this week, Philly's own Purling Hiss released their latest EP, titled Interstellar Blue. Last night, they played PhilaMOCA to celebrate its release. During their set, the band surprised the crowd by inviting Kurt Vile up on stage with them to perform a cover of Spacemen 3's "Walkin' With Jesus". Purling Hiss released a studio version of their cover back in 2018 as a b-side to "Out Tonight" and have been performing it with Vile since at least 2016.
Kurt Vile covers The Rolling Stones for Spotify Singles session
Kurt Vile | photo by Samantha Bloom | courtesy of the artist
Hometown hero Kurt Vile recently stopped by Spotify HQ recently to record a pair of singles, including a cover of The Rolling Stones' "No Expectations." The track, from the Stones' 1968 album Beggars Banquet, is reimagined in Vile's signature style and stripped down for the session, with drawn out vocals and harmonica. The B side is an acoustic version of "Loading Zones," off Vile's recent album Bottle It In. Listen to the singles below via Spotify. Continue reading →
February 15th, 2019 | 12:54PM | By John Vettese
Kurt Vile performs "Yeah Bones" on Late Night With Seth Meyers
Kurt Vile on Seth Meyers | photo by Lloyd Bishop | via Matador Records
Philly's Kurt Vile returned to late-night television this week for a performance on Late Night with Seth Meyers. The band rocked a speedy and skittish version of "Yeah Bones," a song from last year's Bottle It In that is instrumentally complex (the closest Vile has gotten to math rock, perhaps) but is melodically incredibly poppy. Which is trademark KV: mixing the weird with the widely accessible. Continue reading →
February 10th, 2019 | 4:13PM | By John Vettese
The Essential Love Songs of Philadelphia: "Baby's Arms" by Kurt Vile
Kurt Vile | photo courtesy of the artist
Every day leading up to Valentine's Day this year, The Key is recapping 14 songs that scream "love" just as strongly as they scream "Philly." The Essential Love Songs of Philadelphia continues with "Baby's Arms" from Kurt Vile's 2010 album Smoke Ring For My Halo.
It's hard to imagine Kurt Vile as anything but a goof. He's the person with a smarmy half-smirk looking at you from out of the album cover of Bottle It In. He pays compliments to the fashion choices of his own reflection in "Pretty Pimpin'." He wrote an entire song, "Loading Zones," about how to find free parking in Philadelphia. And the wordplay; Vile is big into wordplay, and at the opening of his 2013 album Wakin' On A Pretty Daze, he combines his prankster and poet leanings for a lyric that is possibly peak KV: "Risin' at the crack of dawn / And I gotta think about what wisecracks I'm going to drop along the way."
Acclaimed guitarist, spectacular vibe-caster, noted smartass — that's our Kurt. Except for those moments when he's being unexpectedly, unabashedly, heart-warmingly sincere. The song that opens his pop breakthrough LP, 2011's Smoke Ring For My Halo, is one such moment. Continue reading →
February 6th, 2019 | 1:12PM | By Sarah Hojsak
Kurt Vile is characteristically laid back in his first solo Tiny Desk Concert
Kurt Vile | photo by Cameron Pollack for NPR
Kurt Vile's familiar chilled-out tunes sound great in any setting, but his laid back vibe makes him an outlier at NPR's Tiny Desk, where most artists experience some degree of nervousness. Vile recently visited NPR headquarters to record his first solo Tiny Desk Concert; he previously appeared behind the desk with Courtney Barnett while promoting their 2017 Lotta Sea Lice collaboration. Continue reading →
December 30th, 2018 | 4:05PM | By John Vettese
Kurt Vile brings mesmeric oddities and memorable hits to the majestic Met Philly
Kurt Vile | photo by John Vettese for WXPN
There was something decidedly cosmic about seeing Kurt Vile headline the immense space of The Met Philly last night. Cosmic not only in the interweaving, meditative instrumental passages of his songs like "Bassackwards" from this year's Bottle It In, but in that a set comprised largely of this far-out fare was able to mostly pack the 3500 capacity room, with only a couple sections of open seats in the upper-upper tiers.
To be fair, Kurt is more complex than just a rock and roll mumblecore meanderer; he's a loud and proud devotee of Petty and Prine with legit pop songs, like the set-opening "Loading Zones" and the encore "Pretty Pimpin'", hooky and fun nuggets boasting widespread appeal. When he branded himself "Philly's constant hitmaker" a decade or so ago, the handle might have been steeped in aughties irony, but the dude has legit hits: the jaunty "Jesus Fever" and the beautiful ballad "Baby's Arms" from 2011's Smoke Ring for My Halo are two others that made appearances last night. Continue reading →
October 12th, 2018 | 4:12PM | By Sam Kesler
Happy record release day to Kurt Vile's Bottle It In! Listen to him on WTF with Marc Maron
Philly's Kurt Vile released his album Bottle It In today on Matador, one year after his and Courtney Barnett's collaboration on Lotta Sea Lice. And if that hour and 18 minute LP isn't enough Kurt Vile for you, you can also check out his 74-minute episode of WTF with Marc Maron, released yesterday. Continue reading →
October 11th, 2018 | 3:22PM | By John Vettese
Watch Kurt Vile cover Tom Petty's "Learning To Fly" in a Sirius XMU session
Kurt Vile | photo by Jo McCaughey | courtesy of the artist
Whether you can hear it or not (and it definitely took me a minute), Kurt Vile has always been a huge Tom Petty fan, and takes any opportunity he gets to sing his praises. And sometimes, actually sing his songs. In a new acoustic session recorded for SiriusXMU, Vile puts his spacey drum machine stamp on "Learning to Fly" from Petty's 1991 album Into the Great Wide Open. Give it a watch below, and catch Kurt Vile at The Met Philly on December 29th; tickets and more information on the show can be found here. Continue reading →
October 4th, 2018 | 10:52AM | By John Vettese
Kurt Vile gets sentimental on his new song "One Trick Ponies"
Philly's Kurt Vile releases his latest record, Bottle It In, next Friday via Matador, and it's shaping up to be an expansive and eclectic set in the vein of his 2013 double LP Wakin On A Pretty Daze. While the previously released central tune "Bassackwards" wandered in weird alleyways for nine-plus minutes, his new "One Trick Ponies" is a pop gem with left-of-center quirks. Continue reading →
October 2nd, 2018 | 3:55PM | By Mariah Hall
Snail Mail will open for Kurt Vile at the Met; Kurt workshops Bottle It In via Pitchfork Live
Snail Mail | photo by Cameron Pollack for WXPN
Lindsey Jordan of Snail Mail has gone from casually releasing lo fi tracks on Bandcamp to playing sold out shows, releasing her acclaimed album Lush and touring internationally. To wrap the year, Jordan will trek to Philly to open for Kurt Vile and The Feelies on their December 29 appearance at The Met Philly. Tickets for the gig are on sale now, more information can be found at the XPN Concert Calendar. Continue reading →


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Home » » NEWSPAPER COVERAGE OF DIABETES IN NIGERIA: A CONTENT ANALYSIS OF SELECTED NATIONAL DAILIES
NEWSPAPER COVERAGE OF DIABETES IN NIGERIA: A CONTENT ANALYSIS OF SELECTED NATIONAL DAILIES
This study investigates newspaper coverage of diabetes in Nigeria with specific emphasis on frequency, interpretative of text, Volume and prominence coverage. Four newspapers- The Punch, Leadership, Daily Sun and Daily Trust were selected for the study, with views to represent the northern and Southern divide of the country. The study duration was two years (January 1st 2012 – December 31st 2014) while Holsti's Inter Coder reliability was applied to determine the reliability for the study and this yielded 0.84 which was considered high. Content analysis was adopted for the study, while result showed among others, that out of the 416 editions that were sampled, 201 (48%) editions had stories on diabetes while the remaining 215 (52%) had no stories on the diabetes disease whatsoever. Findings further revealed that 51.7% of the stories on diabetes were non interpretative/non educative. With regards to volume of coverage, it was found that most of the stories on diabetes were in small volume as 51.7% were on quarter page. Finally, the result indicates that less prominence was given to diabetes issues. This is because, 50. 7% of the stories were found on the inside page while only 14.4% were on the front page. Based on the result of this study, the researcher concludes that the two newspapers failed to properly set agenda on diabetes, thus, failing short of their social responsibility to the Nigerian society. The researcher recommends among others that Nigerian newspapers should improve in their coverage of diabetes considering its deadly nature.
1.7 Definition of Terms
2.2 Conceptual Review
2.2.1 Diabetes: Historic Overview
2.2.2 Causes, Symptoms and Control of Diabetes
2.2.3 Diabetes in Nigeria
2.2.4 Nigerian Newspapers and the Imperative for Health Coverage
2.3 Review of Empirical Studies
2.3.1 Clinical studies on Diabetes
2.3.2 Studies on Awareness and Control of Diabetes
2.3.3 Studies on Newspaper Coverage of Health Issues
1.4.1 Social Responsibility
CHAPTER THREE: METHODOLOGY
3.1 Research Design
3.2 Population of the Study
3.3: Sample Size
3.4 Sampling Technique
3.4.1 Unit of Measurement/Analysis
3.6 Instrument of data Collection
3.7 Validity
3.8 Reliability of Instrument
3.9 Coding Method (Method of Data Collection)
CHAPTER FOUR: DATA ANALYSIS AND INTERPRETATION
41. Discussion of Findings
CHAPTER FIVE: SUMMARY, CONCLUSION AND RECOMMENDATION
Diabetes is one of the commonest and dangerous diseases that have posed challenge to medical experts globally. Diabetes often refers to by doctors as diabetes mellitus, describes a group of metabolic diseases in which the person has high blood glucose (blood sugar), either because insulin production is inadequate, or because the body cells do not respond properly to insulin, or both (WHO, 2015). Patients with high blood sugar will typically experience polyuria (frequent urination), they will become increasingly thirsty (polydipsia) and hungry (polyphagia). Recent estimates indicate there were 171 million people in the world with diabetes in the year 2000 and this is projected to increase to 366 million by 2030 (Chinenye & Young 2011). The World Health Organization (2015) reports that only in 2014, the global prevalence of diabetes was estimated to be 9% among adults aged 18+ years. According to the world health body, in 2012, an estimated 1.5 million deaths were directly caused by diabetes and that more than 80% of diabetes deaths occur in low- and middle- income countries. WHO projects that diabetes will be the 7th leading cause of death in 2030. Consequently, WHO avers that healthy diet, regular physical activity, maintaining a normal body weight and avoiding tobacco use, can prevent or delay the onset of type 2 diabetes.
This increase in prevalence, according to WHO, is expected to be more in the Middle Eastern crescent, Sub-Saharan Africa and India. In Africa, the estimated prevalence of diabetes is 1% in rural areas, up to 7% in urban sub- Sahara Africa, and between 8-13% in more developed areas such as South Africa and in population of India origin. The prevalence in Nigeria varies from 0.65% in rural Mangu (North) to 11% in urban Lagos (Chinenye & Young 2011). The Diabetes Association of Nigeria (2015) lists the types of Diabetes in Nigeria to include: Type 2 diabetes (Non-insulin dependent type and constitutes the
majority). Type 1diabetes (Insulin dependent type) and Gestational (Pregnancy induced/pregnancy related).
Type 1 diabetes previously known as insulin-dependent, juvenile or childhood-onset) is characterized by deficient insulin production and requires daily administration of insulin. (Tucker, LeCheminant, & Bailey, 2015, Olamoyegun Ogunmola, Oladosu, Kolawole 2013). The cause of type 1 diabetes is not known and it is not preventable with current knowledge. Symptom includes excessive excretion of urine (polyuria), thirst (polydipsia), constant hunger, weight loss, vision changes and fatigue. These symptoms may occur suddenly. Type 2 diabetes (formerly called non-insulin-dependent or adult-onset) results from the body's ineffective use of insulin. Type 2 diabetes comprises 90% of people with diabetes around the world and is largely the result of excess body weight and physical inactivity. (WHO 2015). Gestational diabetes is hyperglycaemia with blood glucose values above normal but below those diagnostic of diabetes, occurring during pregnancy. Women with gestational diabetes are at an increased risk of complications during pregnancy and at delivery. They are also at increased risk of type 2 diabetes in the future. Gestational diabetes is diagnosed through prenatal screening, rather than reported symptoms (WHO 2015). Nigeria is one of the 32 countries of International Diabetes Federation in African region. According to the federation, there were 3.747 million cases of diabetes in Nigeria in 2014. The result of the Federation further revealed that the prevalence of diabetes in adults (20-79) is 4.6%. The number of cases of adult that are undiagnosed was put at 1.723.4. Cost per person diabetes was put at $178.4, while the number of deaths in adults due to diabetes was put at 105,091. These figures give an insight into the prevalence and danger posed by diabetes in Nigeria.
Diabetes is fast assuming a more dangerous dimension and this calls for awareness creation through newspaper coverage. Commenting on the importance of awareness creation, Chinenye and Ogbara (2013) write:
Awareness is the key to diabetes health, and the platform for creating awareness in our community include masquerades ("nwutam" from Ndoki and Opobo), festivals, and the traditional weekly markets (eke, orie, afor, nkwo) where all and sundry attend, providing a mass forum for communication. The use and interpretation of Diabetes Conversation Maps (a socio-educational tool) during community awareness is highly recommended; splitting the 'Ohanaeze' (communal assembly) into small groups of 3-10 persons.
The assertion above stresses the place of awareness creation as a means of combating diabetes. The only difference is that the researchers lay more emphasis on traditional communication, than on modern means of communication like newspaper, magazine, radio and television. Newspaper coverage of diabetes can go a long way in creating awareness on the disease and also educates people on its causes, symptoms, prevention and treatment. By the coverage of diabetes, newspapers would have set agenda on it. The agenda setting function of the media to give attention to issues of more importance for the attention of the general public (Asemah, 2011, Gever 2014 and McQuail 2005). Folarin (1998) cited in Gever (2014) averts that the media do these factors like frequency of reporting, prominence given to the reports through headline displays, pictures and layout in newspapers, magazines, films, graphics or timing on radio and television. Also, the degree of conflict generated in the reports and cumulative media specific effects over time. Newspapers are powerful medium of communication, through newspapers, important information are disseminated to the general public. The media as an institution, has a role to play in health communication....


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Rivard Report (https://therivardreport.com/city-considers-fast-tracking-housing-displacement-prevention-policy/)
City Considers Fast-Tracking Housing Displacement Prevention Policy
By Iris Dimmick | March 19, 2019
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Owner-occupied rehabilitation of homes is one element of the Mayor's Housing Policy Task Force recommendations.
This story has been updated.
After hearing concerns from affordable housing advocates that it's moving too slowly on developing policies to prevent housing displacement, the City of San Antonio is considering accelerating that process, officials said Tuesday.
The three-year plan to implement the recommendations of the Mayor's Housing Policy Task Force had called for spending 2020 on in-depth analysis and policy formation aimed at preventing housing displacement. Now, that so-called "root-cause assessment" could start this year – if City Council approves.
"Certainly it's a good step, and it should have been done yesterday," Maria Tijerina, a leader with of COPS/Metro Alliance and Our Lady of Guadalupe Catholic Church, told the Rivard Report. "Displacement is happening now."
COPS/Metro Alliance members pressed Mayor Ron Nirenberg and the City in February to tackle gentrification and displacement more urgently. Councilwoman Shirley Gonzales (D5), who chairs a Council subcommittee, has asked her colleagues to fast-track consideration of a shorter timeline for the study.
Related: COPS Metro Urges Mayor to Ramp Up Implementation of Affordable Housing Policy
But to accelerate the root-cause displacement study, something has to give, Deputy City Manager Peter Zanoni told reporters Tuesday. City staff in the Neighborhood and Housing Services Department would have to either "reshuffle our business plan" and delay work on one of three other projects, or the City would have to find an estimated $300,000 to hire a consultant to perform the displacement policy study and develop recommendations, Zanoni said. That number includes other costs associated with the study, including public engagement meetings.
"[The latter option] is one that [City Council] may like because it won't cause us to have to stop doing something today," he said.
After this article was originally published, Zanoni informed the Rivard Report that City staff, after a meeting between City Manager Erik Walsh and Mayor Ron Nirenberg, has decided to recommend using savings from other housing programs to fund a consultant that would perform the work that could take a year to 18 months to complete.
That recommendation will be presented to the Council's Comprehensive Plan Committee on Wednesday. That committee can make the final decision on how to proceed, or not to proceed, with the study now. City Council would have to approve a contract with the consultant at a later date.
Update: On Wednesday morning, the committee voted in favor of the plan to hire a consultant and start the study and policy formation this year.
On Thursday, City Council will vote on the $1 million Risk Mitigation Fund aimed at assisting people who have been or are about to be displaced because of rising rent, property taxes, or trouble paying mortgages. Eligibility for housing or relocation assistance through the fund would based on income and demonstrated financial burden. Anyone making the local average median income or below could qualify, but benefits are scaled to increase for those who make 80 percent AMI or less.
The fund is intended to help an estimated 200 families, Zanoni said.
"Some people are worried that the money will run out, which it might," he said.
The City, through its general fund and federal grants, already provides relocation assistance similar to the risk mitigation fund, said Veronica Soto, director of the Neighborhood and Housing Services Department (NHSD). But the roughly $500,000 that comes from existing sources comes with tighter eligibility restrictions.
Related: City Ramping Up Efforts in Affordable Housing Plan
Meanwhile, the City is working on other initiatives that should help ease housing vulnerability, Soto said. It's working with State Rep. Diego Bernal (D-San Antonio) on proposed legislation that would provide some school district tax relief for homes that have been occupied by the owner for at least 15 years, develop a coordinated housing system to connect homeowners in need with housing resources, carry out $10 million in housing rehabilitation programs, and work on establishing Neighborhood Empowerment Zones that would freeze taxes for homeowners who invest in improving their homes in certain neighborhoods.
"When we fix up a home, we keep a family that lives there in that home," Soto said. The mitigation fund is "a deliverable that we can address this year."
Previous local work commissioned by the Housing Task Force and Housing Commission provided a baseline of housing conditions in San Antonio, Zanoni said, but much more in-depth study is needed to formulate policy on how to stop or manage displacement.
"Austin, as an example, spent a year developing what were the root causes [of housing displacement], but they have not done anything to improve them," he said. "So it's a two-step process."
While the City of Austin has implemented numerous ways to mitigate displacement, none of the recommendations from its anti-displacement task force have been implemented, Zanoni added.
A 2018 report that identified potentially vulnerable neighborhoods provided "a foundation for the areas we need to focus on," Soto said, "but we need to update that information and see if the numbers [in subsequent years hold true]." The report used data from 2000-2016.
Related: Two Initiatives Aimed at Local Property Taxes Head to City Council
Soto said City housing officials are coordinating with the Bexar Appraisal District on the City's pending study of the property appraisal process.
Councilwoman Gonzales said she will file a council consideration request soon that would bump up the timeline for the root-cause study.
"I think that if we can find additional funding for a consultant that would be the best option [instead of delaying other work]," Gonzales told the Rivard Report. "We want to keep everything on track."
Nirenberg established the Housing Policy Task Force in 2017. Its report and recommendations, which were adopted by City Council last year, include estimates for a 10-year funding plan that approaches $3.9 billion in public and private money. Click here to download the 56-page report.
In an emailed statement, the mayor said he supports the accelerated timeline.
"One of the reasons that I created the Mayor's Housing Policy Task Force was to ensure that families can live in decent, stable and affordable housing regardless of their income," Nirenberg said. "The task force report established the framework for the current discussion, and I am encouraged by Council and staff's participation in moving the task force agenda forward."
The City's fiscal year 2019 budget includes $25 million for housing – the first budget to emphasize housing needs – and NHSD developed a three-year plan to implement the policy.
"[The City] couldn't do everything at the same time," Soto said, so the three-year plan was based on community feedback collected through the task force's process.
Several members of COPS Metro and other affordable housing advocates said they will appear at the "Citizens to be Heard" portion of City Council's weekly meeting at 6 p.m. Wednesday. They have invited Archbishop Gustavo García-Siller to speak in favor of the City addressing displacement.
Correction: This article has been updated to accurately reflect the estimated cost of the study $300,000 and that the Comprehensive Plan Committee can authorize staff to accelerate the study timeline. It does not require a full City Council vote.
About Iris Dimmick
Senior reporter Iris Dimmick covers City Hall, politics, development, and more. Contact her at iris@rivardreport.com
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COPS Metro Alliance
mayor's housing policy task force
14 thoughts on "City Considers Fast-Tracking Housing Displacement Prevention Policy"
Rogelio Jimenez on March 19, 2019 at 8:49 PM said:
This is the craziest thing I've ever seen. Don't we all know what causes displacement, why do we need a study tell us that people don't have the financial means to pay high taxes or the inability to make code complaince home repairs?? Is this a stalling tactic?
Ray on March 20, 2019 at 2:00 PM said:
No, it's about setting policies that are based on real data and not on anecdotes. That data takes time and manpower to find and analyze.
Well what was the Mayors Housing Policy Task Force doing from 2017 when they began their research, up to the time the city Council adopted their findings in 2018?! According to this article, "The task force report established the framework for the current discussion," It takes ONE YEAR to "establish," that displacement is occurring and now it's gonna take another year to gather data and analysis?!
Last year I attended one of these open comments meeting held at the Main Library and left feeling frustrated from the lack of audience participation and interaction. There was one gentle lady that evening whom I recall stated that the funding which the City was planning to set aside for displaced families was only a drop in the proverbial bucket. However no one, including myself followed up on her statement.
It's great that our downtown is finally becoming a bustling and thriving destination for all age groups and income levels, and I applaud the City for placing the issue of displacement front and center. But it mystifies me how long and expensive the process takes to find answers to this issue? The city maintains records on individuals that are late on their taxes as well as homes that are not within code compliance. They also maintain records of homes sales, right? Why would this take a year and $300,000.00 to get that answer. The city could also make this project into a data gathering/public event for local volunteers, high school or college students wishing to learn survey skills. Sign me up.
It's great that The Rivard Report allows for public discussion. Perhaps this platform can organize and engage fellow citizens into action. The results of which could increase the speed at which policy becomes law/ordinance.
Andrew Velis on March 19, 2019 at 10:18 PM said:
I would argue that you can follow other cities that have addressed similar housing problems and implement those policies almost word for word. I think there really doesn't need to be a study involved here.
Not Impressed on March 19, 2019 at 10:35 PM said:
This is ridiculous. If the city wants to prevent displacement and create affordable housing, it needs to quit providing corporate welfare to downtown developers in the form of massive tax break. This funding is depriving struggling neighborhoods throughout the city of millions of dollars. City policy is directly creating homelessness and poverty. How about dispersing funds to poor neighborhoods at the same level that downtown condo projects are receiving.
"Funding a consultant." Give me a break!
Pancho Valdez on March 20, 2019 at 7:35 AM said:
The City of San Antonio isn't serious. There's NO need to hire a $300,000 consultant. The above comments say it all.
What is needed is a City ordinance prohibiting the mayor and council members receiving bribes disguised as campaign donations from developers or building contractors.
Furthermore taxpayers shouldn't fund displacement costs. This should be paid for by the developers causing the displacement.
Fernando Centeno on March 20, 2019 at 7:54 AM said:
Root causes? How about critically examining the impacts & outcomes from the city's urban planning model, where "success" is measured in business terms, rather than in socioeconomic terms. This old, narrow, limited SA Tomorrow "vision" favors growth at any cost, leading directly & indirectly to scarcity, gentrification, displacement, rising property values/taxes, greatly & irreversibly affecting low-moderate income families. The city is not serious, courageous, or wise by pursuing their "economic growth", metroplex agenda. Changing the paradigm will not be easy, but is necessary when things go from bad to worse.
Robert on March 20, 2019 at 7:57 AM said:
Considering that the voters decided that a little more than $300,000 was to much to a CM who actually did something, spending that amount on a consultant that will do nothing seems nuts. One way to prevent most displacement is to stop all new construction, and put a halt to tax increases.
Actually, displacement is a myth. Say a developer puts four units where there was a single family dwelling. Four people move in to the new complex, after vacating former residences. Those residences are now available, presumably at lower cost or rent. And so in. Down the line.
All this concern is about the old liberal boogeyman, the worry that someone may make a profit.
Not Impressed on March 20, 2019 at 8:21 AM said:
The city needs to look no further than it's own pro-gentrification and development policies to get to the 'root cause.' It's that simple.
Why does the Mayor and city council act like they don't have a clue why displacement occurs when their votes on the dais are the major reasons for displacement?
JimTx on March 20, 2019 at 8:31 AM said:
I'll save you the trouble of a "root-cause analysis." The root cause is that Bexar County tax appraisals are getting jacked up by 20-30% every year for neighborhoods near downtown. Even with the 10% homestead cap, a 10% increase year after year adds up pretty quickly. I already had to move out of Tobin Hill because of it. My current house payment has gone up $300/month in 3 years just due to increased tax appraisal. I was hoping to retire next year, but can't afford my current house if I do. So, I'll need to sell to some incoming gentrifiers and move to a more affordable location. That's sad because I really love my neighborhood.
Fernando Centeno on March 20, 2019 at 12:03 PM said:
Your jacked-up tax appraisals & unaffordability problem is the consequence & is symptomatic of the actual "root cause" — the city's adopted, longstanding "vision" to facilitate & subsidize its economic growth, metroplex agenda. No one looks at its adopted long-range plan. Get it?
badback on March 20, 2019 at 10:03 AM said:
Displacement is cause by the the city and county and their neverending assault on their citizens.The county can lower the tax rate,they just do not want to.How do they expect us to budget for these increases?
SATX on March 20, 2019 at 12:52 PM said:
Neighborhood and Housing Servives Department has been working on issue for the last seven years or more with all the resources needed. Only meetings are held without any results, enough studies already and more results. When do we hold staff accountable? Management is too top heavy !
Todd on March 22, 2019 at 9:00 AM said:
This is not that difficult of a problem to solve. The people/City need to pass building codes/laws that require new multi-unit developers to mix-in a variety of sizes and affordability for every new development. And also raise corporate/business taxes to help subsidize if necessary – businesses need all kinds of people and people need affordable places to live.


Several years ago, I was contemplating a venture that involved the formation of a brand-new management team—people I didn't know well but who came to me with good recommendations and references. One of these folks was poised to become the head of an important area of the company. My partner and I explained how we planned to allocate a fixed amount of shares to each major area of the business, which would then be disseminated among the members of the individual teams. We hit a stumbling block when the candidate insisted on a stake that amounted to between 80% and 90 % of the entire team's allocated value. Not only were we never going to agree to something like that, but we also became concerned about the kind of character we were thinking of inviting into our venture. Optics matter—and what this fellow failed to realize was that at some point he'd be found out, to the detriment of his and our credibility.
Entrepreneurs prod their employees to take an ownership interest in the company. But the truth is, it's hard for employees at every level to really feel as if they have a stake that's worth protecting. I've tried to express this concept a little differently by putting it in terms of personal dollars and cents. For example, my management team once had a lengthy debate about outfitting our new offices. My chief financial officer and I wanted middle-of-the-road, utilitarian furniture for the space—including our own offices. Others petitioned for something more elegant or, as they described it, "commensurate with the successful company we've become." So, I presented the options to my team in the following terms: Would you rather sit on your money or have it in your pocket? Guess what we ended up doing.
There are no shortcuts to sustainability. I've seen companies reach for bigger and bigger sales only to find themselves with untenable concentrations of customer risk—where their businesses became dependent upon fewer and fewer customers who wield greater and greater influence as a result. I've also seen companies that were so eager to grow that they failed to adequately prepare to manage that growth. I'm not advocating an "If we build it, they will come" approach to infrastructure investments, but I am suggesting the importance of planning ahead for different growth scenarios. Otherwise, you'll find yourself playing an expensive game of catch-up.
Mitchell D. Weiss is an experienced financial services industry executive and entrepreneur. He is an Executive-in-Residence at the University of Hartford, co-founder of the university's Center for Personal Financial Responsibility and adjunct faculty at Rutgers University as well. His books include Life Happens: A Practical Course on Personal Finance from College to Career, Business Happens: A Practical Guide to Entrepreneurial Finance for Small Businesses and Professional Practices and Practical Finance: A Straightforward Guide to Personal and Entrepreneurial Finance, all of which are undergraduate courses that he teaches at the aforementioned schools and elsewhere.


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But it is exactly this type of fat that lends a uniform, stabilising structure to an indulgent ice cream experience. Reduce the level of saturated fat and the fat component of the product becomes softer. And this makes it more challenging to produce ice cream with a good structure and the desired eating quality, without making adjustments to the rest of the ingredients, such as the emulsifier and stabilizer systems used.
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We achieved 27 pieces of coverage on Thornton's 50th anniversary and significantly increased the company's public profile across.


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With several different types of mills of varying sizes, BI is able to deliver a broad range of particle sizes to suit any product form.
With both high shear and low shear capabilities and over 400 ingredients, BI is well-equipped to provide any combination to your specifications. Our in-house formulation experts guarantee homogenous dispersion, shelf life, and potency protection.
We offer all types of extracts, from ratio to standardized and oil to water soluble. Our extraction experts can help custom develop unique extracts for your specific needs. They are able to accentuate flavor driving compounds or minimize them, while maintaining efficacious marker compounds.
With major granulation capabilities – roller compaction, wet granulation – and the only organic certified granulation facility, BI is able to enhance the physical properties of a wide variety of ingredients. Our granulations adjust density and particle size to enhance flow, solubility, compressibility, and content uniformity.
Whether it is capacity or capability that is hindering your production, BI is here to get it going. In addition to contract milling, blending, and steam sterilization in SQF, Organic, Gluten-Free, Kosher, Halal certified facilities, we offer solutions to your problems. With 40 years of experience, BI can assist in the development and improvement of your product.
More information about BI's manufacturing capabilities is just a click away.