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5.
Braz J Med Biol Res ; 53(3): e9614, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32159613

RESUMEN

The global burden of chronic kidney disease (CKD) is rapidly increasing with a projection of becoming the 5th most common cause of years of life lost globally by 2040. CKD is a major cause of catastrophic health expenditure. The costs of dialysis and transplantation consume up to 3% of the annual healthcare budget in high-income countries. However, the onset and progression of CKD is often preventable. In 2020, the World Kidney Day campaign highlights the importance of preventive interventions - be it primary, secondary, or tertiary. This article focuses on outlining and analyzing measures that can be implemented in every country to promote and advance CKD prevention. Primary prevention of kidney disease should focus on the modification of risk factors and addressing structural abnormalities of the kidney and urinary tracts, as well as exposure to environmental risk factors and nephrotoxins. In persons with pre-existing kidney disease, secondary prevention, including blood pressure optimization and glycemic control, should be the main goal of education and clinical interventions. In patients with advanced CKD, management of co-morbidities such as uremia and cardiovascular disease is a highly recommended preventative intervention to avoid or delay dialysis or kidney transplantation. Political efforts are needed to proliferate the preventive approach. While national policies and strategies for non-communicable diseases might be present in a country, specific policies directed toward education and awareness about CKD screening, management, and treatment are often lacking. Hence, there is an urgent need to increase the awareness of preventive measures throughout populations, professionals, and policy makers.


Asunto(s)
Carga Global de Enfermedades , Equidad en Salud , Accesibilidad a los Servicios de Salud , Insuficiencia Renal Crónica/epidemiología , Diagnóstico Precoz , Política de Salud , Promoción de la Salud , Humanos , Tamizaje Masivo/economía , Servicios Preventivos de Salud/métodos , Insuficiencia Renal Crónica/diagnóstico , Insuficiencia Renal Crónica/prevención & control , Factores de Riesgo
6.
Rev Bras Epidemiol ; 23: e200020, 2020.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-32159630

RESUMEN

INTRODUCTION: Linkage is a critical step in the ongoing care of human immunodeficiency virus (HIV/aids) infection and is essential for providing access to antiretroviral therapy, as well as comprehensive care. METHODOLOGY: Cross-sectional study on people living with HIV (PLHIV), aged ≥ 18 years old, linked between January and December 2015, in a referral service for outpatient and hospital care specialized in HIV/AIDS in Belo Horizonte, Minas Gerais. Linkage time was defined as the time from diagnosis to service linkage. Timely care linkage was considered when this time was ≤ 90 days. Data were collected through clinical records. A logistic regression analysis with a confidence interval of 95% (95%CI) was performed. RESULTS: Among 208 patients, most of them were males (77.8%) with a mean age of 39 years. About 45% presented AIDS-defining conditions at the moment of linkage. Linkage time presented a mean of 138 ± 397 days. And timely linkage occurred for 76.9% of the patients. The variables associated with timely care linkage were: age ≥ 48 years (odds ratio - OR = 8.50; 95%CI 1.53 - 47.28), currently working (OR = 3.69; 95%CI 1.33 - 10.25) at the time of linkage, and present CD4+ T lymphocyte count (CD4+ T) ≤ 200 cells/mm3 at the time of HIV diagnosis (OR = 4.84; 95%CI 1.54 - 15.18). There was an important proportion of timely care linkage among PLHIV, but with late diagnosis. CONCLUSION: Interventions should be targeted at younger people with higher CD4+ T lymphocyte counts, in order to better provide continuous HIV care.


Asunto(s)
Fármacos Anti-VIH/uso terapéutico , Continuidad de la Atención al Paciente/estadística & datos numéricos , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Tiempo de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Terapia Antirretroviral Altamente Activa , Brasil/epidemiología , Recuento de Linfocito CD4 , Estudios Transversales , Diagnóstico Tardío , Femenino , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Humanos , Masculino , Persona de Mediana Edad , Factores de Tiempo , Adulto Joven
8.
Isr Med Assoc J ; 22(3): 148-153, 2020 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-32147978

RESUMEN

BACKGROUND: Opposition to neonatal Hepatitis B vaccination is a growing trend in Israel. OBJECTIVES: To assess the sociodemographic factors and attitudes associated with non-vaccination of term singleton newborns. METHODS: This prospective, pair-matched, controlled trial was conducted in a tertiary university-affiliated hospital. Data on maternal sociodemographic parameters, delivery, and infant care practices were gathered. Knowledge and references of Hepatitis B virus (HBV) vaccination, vaccination schedule, and health government policies were assessed. A follow-up telephone survey was completed at the age of 7 weeks postpartum regarding vaccine catch-up rate. RESULTS: Mothers in the study group were mostly Jewish white middle class married multiparous women with some higher education. Hepatitis B serology was not tested in most. Higher rates of rooming-in and exclusive breastfeeding were observed. Knowledge about HBV was stated, multiple sources of information were significantly associated with newborn non-vaccination. Many objected to the timing of the vaccine and its necessity. Multiple medical encounters are viewed as missed opportunities. CONCLUSIONS: Multiple sources of vaccine information are associated with non-vaccination. Medical encounters prior and post-delivery should be used for vaccination education and may improve vaccination coverage.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Vacunas contra Hepatitis B/uso terapéutico , Cuidado del Lactante/métodos , Educación del Paciente como Asunto/métodos , Vacunación/estadística & datos numéricos , Adulto , Femenino , Humanos , Cuidado del Lactante/estadística & datos numéricos , Recién Nacido , Israel , Masculino , Embarazo , Estudios Prospectivos
9.
Stomatologiia (Mosk) ; 99(1): 82-85, 2020.
Artículo en Ruso | MEDLINE | ID: mdl-32125308

RESUMEN

AIM: Based on the comprehensive socio-economic study the analysis of the amount of dental and preventive care provided in terms of Compulsory Medical Insurance program has been made. MATERIAL AND METHODS: The study was based in six dental clinics of the Central Federal District of Russia, treating children and adults with the total amount of attached and insured patients equaled 170.000 in each. RESULTS: Visits for the purpose of prophylaxis make up 24.87±0.27% in the structure of all methods. Dental care specialists have conducted 25 413.0 prophylaxis admissions of their patients. 35 563.29 conventional units of labor input are elaborated on the total cost of 4 614 812.16 rubles. In the purpose of diseases prevention it is planned to spend the average of 0.21 conventional units of labor input on each insured citizen or 2.1 minute on the cost of 27.31 rubles. It was spent 0.51 conventional units of labor input or 5.1 minutes that costs 66,06 rubles for each patient. These data indicate the lack of funding and time to conduct quality preventive care. CONCLUSION: Dental diseases prophylaxis is at the low rate which is proved by the study results - only 0.19 visits with preventive purposes per one insured person. The total share of preventive services in the structure of all services, not including specialists, is 17.51±0.06%.


Asunto(s)
Accesibilidad a los Servicios de Salud , Calidad de la Atención de Salud , Adulto , Niño , Atención Odontológica , Hospitalización , Humanos , Federación de Rusia
14.
MMWR Morb Mortal Wkly Rep ; 69(6): 155-160, 2020 Feb 14.
Artículo en Inglés | MEDLINE | ID: mdl-32053583

RESUMEN

The prevalence of current cigarette smoking is approximately twice as high among adults enrolled in Medicaid (23.9%) as among privately insured adults (10.5%), placing Medicaid enrollees at increased risk for smoking-related disease and death (1). Medicaid spends approximately $39 billion annually on treating smoking-related diseases (2). Individual, group, and telephone counseling and seven Food and Drug Administration (FDA)-approved medications* are effective in helping tobacco users quit (3). Comprehensive, barrier-free, widely promoted coverage of these treatments increases use of cessation treatments and quit rates and is cost-effective (3). To monitor changes in state Medicaid cessation coverage for traditional Medicaid enrollees† over the past decade, the American Lung Association collected data on coverage of nine cessation treatments by state Medicaid programs during December 31, 2008-December 31, 2018: individual counseling, group counseling, and the seven FDA-approved cessation medications§; states that cover all nine of these treatments are considered to have comprehensive coverage. The American Lung Association also collected data on seven barriers to accessing covered treatments.¶ As of December 31, 2018, 15 states covered all nine cessation treatments for all enrollees, up from six states as of December 31, 2008. Of these 15 states, Kentucky and Missouri were the only ones to have removed all seven barriers to accessing these cessation treatments. State Medicaid programs that cover all evidence-based cessation treatments, remove barriers to accessing these treatments, and promote covered treatments to Medicaid enrollees and health care providers could reduce smoking, smoking-related disease, and smoking-attributable federal and state health care expenditures (3-7).


Asunto(s)
Accesibilidad a los Servicios de Salud , Cobertura del Seguro/estadística & datos numéricos , Medicaid/economía , Cese del Uso de Tabaco , Adulto , Humanos , Fumar/epidemiología , Prevención del Hábito de Fumar , Estados Unidos/epidemiología
16.
BMJ ; 368: m40, 2020 Feb 05.
Artículo en Inglés | MEDLINE | ID: mdl-32024637

RESUMEN

OBJECTIVE: To examine the association between expansion of the Medicaid program under the Affordable Care Act and changes in healthcare spending among low income adults during the first four years of the policy implementation (2014-17). DESIGN: Quasi-experimental difference-in-difference analysis to examine out-of-pocket spending and financial burden among low income adults after Medicaid expansions. SETTING: United States. PARTICIPANTS: A nationally representative sample of individuals aged 19-64 years, with family incomes below 138% of the federal poverty level, from the 2010-17 Medical Expenditure Panel Survey. MAIN OUTCOMES AND MEASURES: Four annual healthcare spending outcomes: out-of-pocket spending; premium contributions; out-of-pocket plus premium spending; and catastrophic financial burden (defined as out-of-pocket plus premium spending exceeding 40% of post-subsistence income). P values were adjusted for multiple comparisons. RESULTS: 37 819 adults were included in the study. Healthcare spending did not change in the first two years, but Medicaid expansions were associated with lower out-of-pocket spending (adjusted percentage change -28.0% (95% confidence interval -38.4% to -15.8%); adjusted absolute change -$122 (£93; €110); adjusted P<0.001), lower out-of-pocket plus premium spending (-29.0% (-40.5% to -15.3%); -$442; adjusted P<0.001), and lower probability of experiencing a catastrophic financial burden (adjusted percentage point change -4.7 (-7.9 to -1.4); adjusted P=0.01) in years three to four. No evidence was found to indicate that premium contributions changed after the Medicaid expansions. CONCLUSION: Medicaid expansions under the Affordable Care Act were associated with lower out-of-pocket spending and a lower likelihood of catastrophic financial burden for low income adults in the third and fourth years of the act's implementation. These findings suggest that the act has been successful nationally in improving financial risk protection against medical bills among low income adults.


Asunto(s)
Financiación Personal/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Renta/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Medicaid/legislación & jurisprudencia , Pobreza/economía , Pobreza/estadística & datos numéricos , Adulto , Costo de Enfermedad , Femenino , Financiación Personal/economía , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/economía , Encuestas Epidemiológicas , Humanos , Cobertura del Seguro/economía , Masculino , Medicaid/economía , Persona de Mediana Edad , Estados Unidos/epidemiología
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