A DEA-Based Complexity of Needs Approach for Hospital Beds Evacuation during the COVID-19 Outbreak.

Data envelopment analysis (DEA) is a powerful nonparametric engineering tool for estimating technical efficiency and production capacity of service units. Assuming an equally proportional change in the output/input ratio, we can estimate how many additional medical resource health service units would be required if the number of hospitalizations was expected to increase during an epidemic outbreak. This assessment proposes a two-step methodology for hospital beds vacancy and reallocation during the COVID-19 pandemic. The framework determines the production capacity of hospitals through data envelopment analysis and incorporates the complexity of needs in two categories for the reallocation of beds throughout the medical specialties. As a result, we have a set of inefficient healthcare units presenting less complex bed slacks to be reduced, that is, to be allocated for patients presenting with more severe conditions. The first results in this work, in collaboration with state and municipal administrations in Brazil, report 3772 beds feasible to be evacuated by 64% of the analyzed health units, of which more than 82% are moderate complexity evacuations. The proposed assessment and methodology can provide a direction for governments and policymakers to develop strategies based on a robust quantitative production capacity measure.

Ethnic differences in prevalence and determinants of mother-child bed-sharing in early childhood.

BACKGROUND: To date few studies have examined how multiple layers of influences shape the emergence of bed-sharing practices in the first 2 years postpartum. In our report, we examined bed-sharing in a large multiethnic sample, exploring the influences of three broad classes of influence on bed-sharing at single time points and across time: (1) sociodemographic and (2) contextual factors such as breastfeeding, maternal mental health and stress, and (3) child temperament and sleep habits. METHODS: Frequencies of bed-sharing were assessed at two time points, 2 and 24 months, in a population-based multiethnic (Dutch, Turkish or Moroccan, and Caribbean) sample of 6309 children born in the Netherlands. RESULTS: In Dutch mothers, the majority of mothers did not share their beds with their child, and bed-sharing rates decreased from 2 to 24 months. Other ethnic groups showed higher bed-sharing rates, typified by both increases in bed-sharing (the Turkish and Moroccan group) and persistence of bed-sharing over time (the Caribbean group). There were few family and child characteristics associated with bed-sharing in the non-Dutch ethnic groups. In contrast, bed-sharing in Dutch mothers was associated with child temperament and sleeping problems, maternal depression, and sociodemographic variables like crowding and maternal education. CONCLUSIONS: Our results suggest that mothers with a Turkish and Moroccan or Caribbean background were more influenced by cultural values, whereas bed-sharing practices were more reactive in the Dutch group.

[Bed-sharing in the first semester of life: prevalence and associated factors]. / Coleito no primeiro semestre de vida: prevalência e fatores associados.

The aim of this study was to verify the prevalence of bed-sharing and factors associated with this sleeping environment in an urban population in Southern Brazil. This was a cross-sectional nested cohort study with 233 mother-infant pairs selected at the maternity ward of the University Hospital in Porto Alegre. When the infant was 3 and 6 months old, home visits were performed to collect data on bed-sharing and associated variables. The main outcome was the place shared by the mother and infant for sleeping. Variables with p < 0.2 were included in a Poisson regression model. At 3 and 6 months, 31.2% and 28.5% of infants slept with their mothers at night. At 3 months, prevalence was higher for single mothers (PR: 1.56; CI: 1.01-2.39) and mothers sharing the home with the infant's maternal grandmother (PR: 1.70; CI: 1.09-2.65). Prevalence of bed-sharing at 3 months was high and associated with single mothers and sharing the home with the infant's maternal grandmother.

Infant sleep location: associated maternal and infant characteristics with sudden infant death syndrome prevention recommendations.

OBJECTIVE: To identify factors associated with infant sleep location. STUDY DESIGN: Demographic information and infant care practices were assessed for 708 mothers of infants ages 0 to 8 months at Women, Infants and Children centers. Generalized linear latent mixed models were constructed for the outcome, sleeping arrangement last night (room-sharing without bed-sharing versus bed-sharing, and room-sharing without bed-sharing versus sleeping in separate rooms). RESULTS: Two-thirds of the mothers were African-American. A total of 48.6% mothers room-shared without bed-sharing, 32.5% bed-shared, and 18.9% slept in separate rooms. Compared with infants who slept in separate rooms, infants who room-shared without bed-sharing were more likely to be Hispanic (odds ratio [OR], 2.58, 95% CI 1.11-5.98) and younger (3.66- and 1.74-times more likely for infants 0-1 month old and 2-3 months old, respectively, as compared with older infants). Compared with infants who bed-shared, infants who room-shared without bed-sharing were more likely to be 0 to 1 month old (OR, 1.57; 95% CI, 1.05-2.35) and less likely to be African-American (OR, 0.43; 95% CI, 0.26-0.70) or have a teenage mother (OR, 0.37; 95% CI, 0.23-0.58). CONCLUSIONS: Approximately one-third of mothers and infants bed-share, despite increased risk of sudden infant death syndrome (SIDS). The factors associated with bed-sharing are also associated with SIDS, likely rendering infants with these characteristics at high risk for SIDS.

Rendimientos hospitalarios de establecimientos asistenciales. Subsector oficial. Provincia de Buenos Aires Año 1998

Contiene: los rendimientos de establecimientos con y sin internación de dependencia provincial, municipal y nacional

[Low adherence and high cost as factors in the failure of the use of insecticide-impregnated mosquito bed nets in the control of malaria in the Brazilian Amazon]. / Baixa aderência e alto custo como fatores de insucesso do uso de mosquiteiros impregnados com inseticida no controle da malária na Amazônia Brasileira.

In 1992 during a trial with deltamethrin-impregnated bed nets conducted in Porto Murtinho, municipality of Costa Marques, Rondônia, in the Brazilian Amazon, we investigated community compliance and the economic aspects capable of reducing the impact of this intervention on malaria morbidity. Impregnated bed nets were well accepted by the local population. However, compliance was found to be very low among adults over 15 years of age and mainly during the dry season. The cost of impregnated bed nets was US$18.83 for double-bed nets and US$13.82 for single bed nets. Despite the economic advantages of using impregnated bed nets subsidized by the government, the low compliance and local epidemiological factors do not allow to indicate the use of impregnated bed nets for mass malaria control in the Amazon region.

Sleep characteristics in children in the isolated rural African-Brazilian descendant community of Furnas do Dionísio, State of Mato Grosso do Sul, Brazil.

Developmental and cultural factors affect sleep habits in childhood. The objective of this research was to determine sleep habits of children in the isolated rural African-Brazilian community of Furnas do Dionísio. Mato Grosso do Sul, Brazil. The members of this community are closely related descendants of the ex-slave Dionísio, and remained in relative geographical isolation for about a century. Sleep characteristics of 55 children (35 M; 20 F), 2 to 10 year olds, were evaluated in interviews with their mothers. The results showed that cosleeping, in the same bed with family members, was present in 80.0% of the 2-3 year olds; decreasing to 25.0% of the 8-10 year olds. Only 5.4% of the children slept alone in their own bedroom. Mean number of persons per bedroom was 2.8. Only 7.0% of the bedrooms had TV; 98.1% slept in silence. The data obtained support the need to weigh cultural factors influence on sleep.