Analysis of the differences between the prescribed and the administered diet to preterm infants using an electronic too / Análise das diferenças entre a dieta prescrita e a dieta administrada aos recém-nascidos pré-termo usando um instrumento eletrônico

ABSTRACT Objective: To create an electronic instrument in order to analyze the adequacy of the preterm infants' nutritional therapy, checking the difference between the prescribed and the administered diet. Methods: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. Results: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. Conclusions: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers' decisions about the nutritional approach, which can contribute to patients' safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.

RESUMO Objetivo: Elaborar um instrumento eletrônico para análise da adequação da terapia nutricional dos recém-nascidos pré-termo, verificando a diferença entre a dieta prescrita e a administrada. Métodos: Estudo observacional prospectivo em recém-nascidos com peso de nascimento ≤1.500 g e/ou idade gestacional ≤32 semanas, sem malformações congênitas. O instrumento eletrônico foi desenvolvido com base em planilhas do Microsoft Excel 2010 para calcular automaticamente ganho de peso corporal, calorias e macronutrientes diariamente recebidos pelos pacientes por meio de dietas parenteral e enteral. Para comparar a dieta prescrita e a administrada, foram utilizados os resultados das médias semanais. Resultados: Para avaliar o instrumento, foram incluídos 60 recém-nascidos com peso de nascimento de 1.289±305 g e idade gestacional de 30±2 semanas. Destes, 9,6% apresentavam restrição de crescimento no nascimento e 55% no momento da alta. A média de internação foi de 45±17 dias. Foram verificadas diferenças significativas entre a dieta prescrita e a administrada para todos os macronutrientes e calorias totais nas três primeiras semanas. O lipídeo foi o macronutriente com o maior erro percentual na primeira semana. Conclusões: O emprego de uma rotina computacional foi importante para verificar discrepâncias entre a dieta prescrita e a administrada. Essa análise é necessária para minimizar erros de cálculo e agilizar as decisões da equipe de saúde acerca da abordagem nutricional, podendo contribuir para a segurança do paciente e para a boa prática nutricional. Os recém-nascidos de muito baixo peso são extremamente vulneráveis às deficiências nutricionais e qualquer redução nos macronutrientes recebidos pode ser deletéria para o crescimento satisfatório.

Measuring Health Vulnerability: An Interdisciplinary Indicator Applied to Mainland Portugal.

Health promotion and inequality reduction are specific goals of the United Nations 2030 Agenda, which are interconnected with several dimensions of life. This work proposes a composite index SEHVI-socioeconomic health vulnerability index-to address Portuguese population socioeconomic determinants that affect health outcomes. Variables composing SEHVI are aligned with the sustainable development goals considering data and times series availability to enable progress monitoring, and variables adequacy to translate populations' life conditions affecting health outcomes. Data for 35 variables and three periods were collected from official national databases. All variables are part of one of the groups: Health determinants (social, economic, cultural, and environmental factors) and health outcomes (mortality indicators). Variables were standardized and normalized by "Distance to a reference" method and then aggregated into the SEHVI formula. Several statistical procedures for validation of SEHVI revealed the internal consistency of the index. For all municipalities, SEHVI was calculated and cartographically represented. Results were analyzed by statistical tests and compared for three years and territory typologies. SEHVI differences were found as a function of population density, suggesting inequalities of communities' life conditions and in vulnerability to health.

Engagement of Urban, Pregnant Puerto Rican Women in Health Disparities Research.

Persistent challenges surround the recruitment of minority women from marginalized communities in health disparities research. These challenges include lack of the following: interest in research participation, trust, positive relationships between researchers and participants/community, and principal investigators from minority groups. The purpose of this article is to describe successful recruitment strategies used in health disparities research with pregnant Puerto Rican women and to suggest ways to ensure the future success of studies on health disparities. Suggested strategies include creating trust, facilitating active participation of stakeholders, and strengthening the research pipeline with undergraduate and graduate nursing students.

Income inequalities in oral health and access to dental services in the Brazilian population: National Health Survey, 2013.

INTRODUCTION: Despite the improvement in oral health conditions observed in the Brazilian population, there are still high social inequalities that must be monitored. OBJECTIVE: To evaluate income inequality in oral hygiene practices, oral health status and the use of dental services in the adult and senior Brazilian population. METHODS: Data from the National Health Survey conducted in 2013 (Pesquisa Nacional de Saúde - PNS 2013) were used for the population aged 18 years old or older. RESULTS: Inequalities were found among the income strata in most of the oral health indicators evaluated. The greatest inequalities were observed in the use of dental floss, in hygiene practices (PR = 2.85 in adults and PR = 2.45 in seniors), and in total tooth loss (PR = 6.74 in adults and PR = 2.24 in seniors) and difficulty in chewing (PR = 4.49 in adults and PR = 2.67 in seniors) among oral condition indicators. The magnitude of inequalities was high in both groups in most oral condition indicators. Income was a factor that persisted in limiting access to dental services, and even the lower income segments had high percentages that paid for dental consultations. CONCLUSION: Based on data from the first PNS, the findings of this study enabled the identification of oral health and dental care aspects more compromised by income differentials, thus, contributing to the planning of dental care in Brazil and to stimulate the monitoring of these disparities with data from future surveys.

Estrategias para la atención comunitaria orientada a grupos vulnerables en Ecuador / Strategies for community care aimed at vulnerable groups in Ecuador

RESUMEN Las propuestas de modelos de atención comunitaria se sustentan fundamentalmente en la necesidad de estandarizar el lenguaje y la acción de los profesionales en cuanto a la articulación de las diferentes organizaciones y grupos de individuos presentes en la comunidad, en aras del resguardo de su salud. El estudio pretende comentar las estrategias orientadas al abordaje comunitario de carácter inclusivo para la atención de grupos vulnerables. Para ello se hace revisión de los temas desigualdad y vulnerabilidad, claves en la Agenda 2030. En escenarios como las comunidades rurales del Ecuador, la estrategia de atención comunitaria potencia acciones sobre problemas y necesidades de salud detectados como prevalentes, a través de actividades locales dirigidas a promover la salud e incrementar la calidad de vida de los pobladores.

ABSTRACT The proposals of community care models are fundamentally based on the need to standardize the language and action of professionals regarding the articulation of different organizations and groups of individuals present in the community, in order to protect their health. The objective of this study is to comment on strategies aimed at an inclusive community approach for the attention of vulnerable groups. To do this, we review the issues of inequality and vulnerability, key in the 2030 Agenda. In scenarios such as rural communities in Ecuador, the community care strategy promotes actions on health problems and needs detected as prevalent, through local activities targeted at promoting health and increasing the quality of life of the inhabitants.

Pathways to, and use of, sexual healthcare among Black Caribbean sexual health clinic attendees in England: evidence from cross-sectional bio-behavioural surveys.

BACKGROUND: In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. METHODS: We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May-September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. RESULTS: BC women's sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women's attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45-8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner's symptoms or diagnosis (AOR 1.82, 95% CI 1.14-2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42-13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38-0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification. CONCLUSIONS: Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained - and indeed facilitated - for those at greatest risk of STI, regardless of ethnicity.

[Ethnic and racial inequalities in hospital admissions due to avoidable causes in under-five Brazilian children, 2009-2014]. / Iniquidades étnico-raciais nas hospitalizações por causas evitáveis em menores de cinco anos no Brasil, 2009-2014.

There has been a global increase in hospital admissions for primary care-sensitive conditions (PCSCs) as an indicator of effectiveness in primary health care. This article analyzes ethnic and racial inequalities in cause-related hospitalizations in under-five children in Brazil as a whole and the country's five major geographic regions, with an emphasis on PCSCs and acute respiratory infections (ARIs). Using data from the Hospital Information Systems of the Brazilian Unified National Health System (SIH/SUS), 2009-2014, the authors calculated proportions, rates, and rate ratios for PCSCs, adjusted by sex and age after multiple imputation of missing data on color/race. The principal causes of hospitalization were respiratory tract infections (37.4%) and infectious and parasitic diseases (19.3%), and indigenous children were proportionally the most affected. Crude PCSC rates (per 1,000) were highest in indigenous children (97.3; 95%CI: 95.3-99.2), followed by brown or mixed-raced children (40.0; 95%CI: 39.8-40.1), while the lowest rates were in Asiandescendant children (14.8; 95%CI: 14.1-15.5). The highest adjusted rate ratios for PCSCs were seen among indigenous children compared to white children - 5.7 (95%CI: 3.9-8.4) for Brazil as a whole, reaching 5.9 (95%CI: 5.0-7.1) and 18.5 (95%CI: 16.5-20.7) in the North and Central, respectively, compared to white children. ARIs remained as important causes of pediatric hospitalizations in Brazil. Alarming ethnic and racial inequalities were observed in PCSCs, with indigenous children at a disadvantage. Improvements are needed in living conditions, sanitation, and subsistence, as well as guaranteed timely access to high-quality primary health care in the more vulnerable population groups, especially the indigenous peoples of the North and Central, in order to mitigate the health inequalities and meet the guidelines of the SUS and the Brazilian Constitution.

Internacionalmente, observa-se um incremento no uso das internações por condições sensíveis à atenção primária (ICSAP) como indicador de efetividade da atenção primária à saúde. Este artigo analisa as iniquidades étnico-raciais nas internações por causas em menores de cinco anos no Brasil e regiões, com ênfase nas ICSAP e nas infecções respiratórias agudas (IRA). Com dados do Sistema de Informações Hospitalares do Sistema Único de Saúde (SIH/SUS), 2009-2014, calcularam-se proporções por causas, taxas e razões de taxas de ICSAP ajustadas por sexo e idade após a imputação múltipla de dados faltantes de cor/raça. As principais causas de internação foram doenças do aparelho respiratório (37,4%) e infecciosas e parasitárias (19,3%), sendo as crianças indígenas as mais acometidas. As taxas brutas de ICSAP (por 1.000) foram mais elevadas em indígenas (97,3; IC95%: 95,3-99,2), seguidas das pardas (40,0; IC95%: 39,8-40,1), e as menores foram nas amarelas (14,8; IC95%: 14,1-15,5). As maiores razões de taxas ajustadas de ICSAP foram registradas entre crianças de cor/raça indígena e branca - 5,7 (IC95%: 3,9-8,4) no país, atingindo 5,9 (IC95%: 5,0-7,1) e 18,5 (IC95%: 16,5-20,7) no Norte e Centro-oeste, respectivamente. As IRA permanecem como importantes causas de hospitalização em crianças no Brasil. Foram observadas alarmantes iniquidades étnico-raciais nas taxas de ICSAP, com situação de desvantagem para indígenas. São necessárias melhorias nas condições de vida, saneamento e subsistência, bem como garantia de acesso oportuno e qualificado à atenção primária à saúde das populações mais vulneráveis, com destaque para os indígenas no Norte e no Centro-oeste, a fim de minimizar iniquidades em saúde e fazer cumprir as diretrizes do SUS e da Constituição do Brasil.

Internacionalmente, se observa un incremento en las hospitalizaciones por condiciones sensibles a la atención primaria (ICSAP), como un indicador de efectividad de la atención primaria a la salud. Este artículo analiza las inequidades étnico-raciales en las hospitalizaciones por causas evitables em menores de cinco años en Brasil y sus regiones, con énfasis en las ICSAP y en las infecciones respiratorias agudas (IRA). Con datos del Sistema de Informaciones Hospitalarias del Sistema Único de Salud (SIH/SUS), 2009-2014, se calcularon porcentajes por causas, tasas y razones de tasas de ICSAP ajustadas por sexo y edad, tras la imputación múltiple de datos faltantes de color/raza. Las principales causas de hospitalización fueron enfermedades del aparato respiratório (37,4%) e infecciosas y parasitarias (19,3%), siendo los niños indígenas los más afectados. Las tasas brutas de ICSAP (por 1.000) fueron más elevadas en indígenas (97,3; IC95%: 95,3-99,2), seguidas de las mulatos/mestizos (40,0; IC95%: 39,8-40,1), mientras que las menores fueron en las de origen asiática (14,8; IC95%: 14,1-15,5). Las mayores razones de tasas ajustadas de ICSAP fueron en los niños indígenas comparados a los niños de color/raza blanca - 5,7 (IC95%: 3,9-8,4) en el país, alcanzando 5,9 (IC95%: 5,0-7,1) y 18,5 (IC95%: 16,5-20,7) en el Norte y Centro-oeste, respectivamente, en comparación con El color/raza blanca. Las IRA permanecen como importantes causas de hospitalización en niños em Brasil. Se observaron alarmantes inequidades étnico-raciales en las tasas de ICSAP, con situación de desventaja para los indígenas. Se necesitan mejoras en las condiciones de vida, saneamiento y subsistencia, así como la garantía de un acceso oportuno y cualificado a la atención primaria a La salud de las poblaciones más vulnerables, destacando los indígenas en el Norte y Centro-oeste, a fin de minimizar inequidades en salud y hacer cumplir las directrices del SUS y de la Constitución de Brasil.

ANALYSIS OF THE DIFFERENCES BETWEEN THE PRESCRIBED AND THE ADMINISTERED DIET TO PRETERM INFANTS USING AN ELECTRONIC TOO.

OBJECTIVE: To create an electronic instrument in order to analyze the adequacy of the preterm infants' nutritional therapy, checking the difference between the prescribed and the administered diet. METHODS: A prospective and observational study on newborns with birthweight ≤1,500g and/or gestational age ≤32 weeks, without congenital malformations. The electronic instrument was developed based on Microsoft Excel 2010 spreadsheets and aimed at automatically calculating body weight gain, calories and macronutrients received daily by each patient from parenteral nutrition, intravenous hydration and enteral feedings. The weekly means of each nutrient were used to compare the prescribed and administered diets. RESULTS: To evaluate the instrument, 60 newborns with a birth weight of 1,289±305 g and a gestational age of 30±2 weeks were included. Of them, 9.6% had restricted growth at birth and 55% at discharge. The median length of stay was 45±17 days. There were significant differences between prescribed and administered diet for all of the macronutrients and for total calories in the first three weeks. The lipid was the macronutrient with the greatest percentage error in the first week of life. CONCLUSIONS: The use of a computational routine was important to verify differences between the prescribed and the administered diet. This analysis is necessary to minimize calculation errors and to speed up health providers' decisions about the nutritional approach, which can contribute to patients' safety and to good nutritional practice. Very low birth weight infants are extremely vulnerable to nutritional deficiencies and any reduction in macronutrients they receive may be harmful to achieve satisfactory growth.

Differences between coverage of yellow fever vaccine and the first dose of measles-containing vaccine: A desk review of global data sources.

INTRODUCTION: The strategy to Eliminate Yellow Fever Epidemics (EYE) is a global initiative that includes all countries with risk of yellow fever (YF) virus transmission. Of these, 40 countries (27 in Africa and 13 in the Americas) are considered high-risk and targeted for interventions to increase coverage of YF vaccine. Even though the World Health Organization (WHO) recommends that YF vaccine be given concurrently with the first dose of measles-containing vaccine (MCV1) in YF-endemic settings, estimated coverage for MCV1 and YF vaccine have varied widely. The objective of this study was to review global data sources to assess discrepancies in YF vaccine and MCV1 coverage and identify plausible reasons for these discrepancies. METHODS: We conducted a desk review of data from 34 countries (22 in Africa, 12 in Latin America), from 2006 to 2016, with national introduction of YF vaccine and listed as high-risk by the EYE strategy. Data reviewed included procured and administered doses, immunization schedules, routine coverage estimates and reported vaccine stock-outs. In the 30 countries included in the comparitive analysis, differences greater than 3 percentage points between YF vaccine and MCV1 coverage were considered meaningful. RESULTS: In America, there were meaningful differences (7-45%) in coverage of the two vaccines in 6 (67%) of the 9 countries. In Africa, there were meaningful differences (4-27%) in coverage of the two vaccines in 9 (43%) of the 21 countries. Nine countries (26%) reported MVC1 stock-outs while sixteen countries (47%) reported YF vaccine stock-outs for three or more years during 2006-2016. CONCLUSION: In countries reporting significant differences in coverage of the two vaccines, differences may be driven by different target populations and vaccine availability. However,these were not sufficient to completely explain observed differences. Further follow-up is needed to identify possible reasons for differences in coverage rates in several countries where these could not fully be explained.

HIV Testing Among Middle-Aged and Older Men Who Have Sex With Men (MSM): A Blind Spot?

Middle-aged and older men who have sex with men (MSM) are one of the most underestimated populations with regard to HIV/AIDS infection, despite the worldwide trend of increasing prevalence in recent years. This population also has low rates of testing, although rare studies are done exclusively with middle-aged and older MSM assessing the factors associated with this prevalence. Thus, based on data from an exclusive online survey with middle-aged and older MSM who use geolocation-based dating applications, the purpose of the study was to analyze factors associated with not taking the HIV test among middle-aged (50 years old) and older MSM in Brazil. Using a modification of time-location sampling adapted to virtual reality, 412 volunteers were approached in Grindr®, Hornet®, SCRUFF®, and Daddyhunt®. The multivariate logistic regression model was adopted to produce adjusted odds ratios (ORa), considering a significance level at .05. There were factors associated with not taking the test: being in a relationship (ORa: 0.24; 95% CI [0.10, 0.53]); knowing partner through the applications (ORa: 1.84; 95% CI [1.07, 3.15]); not knowing the serological status (ORa: 5.07; 95% CI [1.88, 13.67]); ejaculating outside of anal cavity (ORa: 1.79; 95% CI [1.04, 3.05]); practicing sex without penetration (ORa: 2.30; 95% CI [1.17, 4.50]); not taking the test as a form of prevention (ORa: 2.83; 95% CI [1.05, 7.68]); and rarely using Viagra in sexual intercourse (ORa: 1.91; 95% CI [1.20, 3.65]). There is a blind spot in the prevalence of HIV testing in older MSM because this population is not being covered by services, which compromises the overall response to HIV, the goals set for universal health coverage.

Obstacles and opportunities for monitoring ethnicity-based inequalities in maternal health care: Lessons from Mexico.

BACKGROUND: Monitoring and reducing inequalities in health care has become more relevant since the adoption of the Sustainable Development Goals (SDGs). The SDGs bring an opportunity to put the assessment of inequalities by ethnicity on the agenda of decision-makers. The objective of this qualitative study is to know how current monitoring is carried out and to identify what factors influence the process in order to incorporate indicators that allow the evaluation of inequalities by ethnicity. METHODS: We conducted 17 semi-structured interviews with key informants from the health ministry, monitoring observatories, research centers, and international organizations, involved in maternal health care monitoring in Mexico. Our analysis was interpretative-phenomenological and focused on examining experiences about monitoring maternal health care in order to achieve a full picture of the current context in which it takes place and the factors that influence it. RESULTS: The obstacles and opportunities pointed out from the participants emerge from the limitations or advantages associated with the accuracy of evaluation, availability of information and resources, and effective management and decision-making. Technicians, coordinators, researchers or decision-makers are not only aware of the inequalities but also of its importance. However, this does not lead to political decisions permitting an indicator to be developed for monitoring it. As for opportunities, the role of international organizations and their links with the countries is crucial to carry out monitoring, due to political and technical support. CONCLUSIONS: The success of a monitoring system to help decision-makers reduce inequalities in health care depends not only on accurate evaluations but also on the context in which it is implemented. Understanding the operation, obstacles and opportunities for monitoring could be a key issue if the countries want to advance towards assessing inequalities and reducing health inequities with the aid of concrete policies and initiatives.

Gender disparity in ICU staffing in Argentina.

PURPOSE: Gender disparities in healthcare are striking, notwithstanding an increase in female students and physicians. Underrepresentation of women in leadership positions is well-documented; however, information from low and middle-income countries (LMICs) is still sparse. The Argentinian Society of Intensive Care Medicine (SATI) aimed to characterize the gender composition in Argentine ICUs. METHODS AND RESULTS: Between 8/1/2018 and 1/1/2019, 131 questionnaires were submitted to ICU Department Chairs of SATI research networks. Gender distribution of the different staffing levels, board certification and hospital characteristics were recorded. One-hundred and four were completed, including 2186 physicians; 44% were female. Female participation decreased with highest responsibility: only 23% of Department Chairs were female (P = .002 vs. the rest of the staffing categories, adjusted for multiple comparisons). Residents exhibited the highest proportion of female physicians (47%). Board certification was similar for both sexes (62.3% vs. 62.2%, P = .97). Female/male distribution in public and private hospitals was 47%/53% and 40/60% (P < .01), respectively. CONCLUSION: Our data provide evidence of an important gender gap in ICU management in a LMIC. Women were poorly represented in the leadership positions, although qualifications were similar to men. Moreover, female physicians worked more frequently in the public health subsector, usually underfinanced in LMICs-a surrogate of a gender pay gap.

Socioeconomic inequalities in oral health-related quality of life in adolescents: a cohort study.

PURPOSE: Socioeconomic inequalities are recognized as a major problem with people in low socioeconomic groups having worse subjective oral health outcomes, including oral health-related quality of life (OHRQoL). However, only a few longitudinal studies assessed the impact of contextual and individual socioeconomic determinants in adolescents' OHRQoL. We estimate the impact of socioeconomic inequalities on adolescents' OHRQoL over a 2-year period. METHODS: This study followed up a random sample of 1134 12-year-old schoolchildren for 2 years in Brazil. OHRQoL was assessed by the Brazilian version of the Child Perceptions Questionnaire for 11- to 14-year-old Children (CPQ11-14) at baseline and follow-up. Participants were clinically examined for dental caries, gingival bleeding, and malocclusion. The schoolchildren's parents answered a questionnaire regarding socioeconomic status, social capital, and adolescents' use of dental service. Socioeconomic contextual variables were collected from official city publications. Multilevel linear regression models fitted the associations between socioeconomic factors and overall CPQ11-14 scores over time. RESULTS: A total of 747, 14-year-old adolescents were reassessed for OHRQoL (follow-up rate of 66%). Adolescents with lower mean income school's neighborhood (P < 0.05), household income (P < 0.05), and maternal schooling (P < 0.05) had higher overall CPQ11-14 scores. Female sex, attending a dentist by toothache, dental caries, and malocclusion were also associated with higher overall CPQ11-14 scores. CONCLUSIONS: Adolescents from low socioeconomic background reported worse OHRQoL at 2-year follow-up compared to those from high socioeconomic background. Actions toward health inequalities need to address socioeconomic factors in adolescence.

Differences in hospitalizations, emergency room admissions, and outpatient visits among Mexican-American Medicare beneficiaries.

BACKGROUND: Few studies have investigated the healthcare utilization of Mexican-American Medicare beneficiaries. We used survey data that has been linked with Medicare claims records to describe the healthcare utilization of Mexican-American Medicare beneficiaries, determine common reasons for hospitalizations, and identify characteristics associated with healthcare utilization. METHODS: Data came from wave five (2004/05) of the Hispanic Established Populations for the Epidemiological Study of the Elderly. The final sample included 1187 participants aged ≥75 who were followed for two-years (eight-quarters). Generalized estimating equations were used to estimate the probability of ≥1 hospitalization, emergency room (ER) admissions, and outpatient visits. RESULTS: The percentage of beneficiaries who had ≥1 hospitalizations, ER admissions, and outpatient visits for each quarter ranged from 10.12-12.59%, 14.15-19.03%, and 76.61-80.68%, respectively. Twenty-three percent of hospital discharges were for circulatory conditions and 17% were for respiratory conditions. Hospitalizations for heart failure and simple pneumonia were most common. Older age was associated with significantly higher odds for ER admissions (OR = 1.49, 95% CI = 1.21-1.84) but lower odds for outpatient visits (OR = 0.74, 95% CI = 0.57-0.96). Spanish language and female gender were associated with significantly higher odds for hospitalizations (OR = 1.53, 95% CI = 1.14-2.06) and outpatient visits (OR = 1.82, 95% CI = 1.43-2.33), respectively. Having a middle-school or higher level of education was associated with significantly lower odds for ER admissions (OR = 0.71, 95% CI = 0.56-0.91). Participants who were deceased within two-years had significantly higher odds for hospitalizations (OR = 6.15, 95% CI = 4.79-7.89) and ER admissions (OR = 3.63, 95% CI = 2.88-4.57) than participants who survived at least three-years. CONCLUSION: We observed high healthcare utilization among Mexican-American Medicare beneficiaries. Forty percent of all hospitalizations were for circulatory and respiratory conditions with hospitalizations for heart failure and pneumonia being the most common. Older age, gender, education, language, and mortality were all associated with healthcare utilization. Continued research is needed to identify patterns and clusters of social determinants and health characteristics associated with healthcare utilization and outcomes in older Mexican-Americans.

Commitment and Human Tone: the Difference between Traditional Service and Nursing Care.

OBJECTIVES: To describe the transformation of decisive moments that arise within the nurse-patient and family caregiver interaction to turn them into moments of care capable of favoring adaptation. METHODS: In a high complexity hospital in the city of Bogotá (Colombia), a "nursing methodological research"-type study was conducted. It was developed in five stages: 1) identification of the institutional route of patients and their caregivers and, within it, the moments of encounter with nursing; 2) typical day of the nurse; 3) analysis of the nurse-patient and family caregiver encounters; 4) literature review on how to strengthen the nurse-patient and family caregiver relationship; and 5) proposal to transform decisive moments into moments of care. RESULTS: Patients and their family caregivers usually experience six moments of encounter with nursing that include admission, assessment, satisfaction of basic needs, administration of medication, shift change, and discharge; all of them cross-cut by education and communication. Recognition of experiences during moments of encounter allowed transforming them into moments of nursing care. CONCLUSIONS: The transformation of decisive moments into moments of nursing care to favor adaptation of patients and their family caregivers is consequence of the nursing commitment and human nature expressed in every encounter of the care process.