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1.
BMJ Open ; 10(10): e043763, 2020 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-33020109

RESUMEN

OBJECTIVES: We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). DESIGN: Observational cohort SETTING: Data were analysed from 11 primary healthcare clinics in northern KZN. PARTICIPANTS: A total of 46 523 individuals made 89 476 clinic visits during the observation period. EXPOSURE OF INTEREST: We conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods. OUTCOME MEASURES: Daily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories: child health, perinatal care and family planning, HIV services, non-communicable diseases and by age and sex strata. RESULTS: We found no change in total clinic visits/clinic/day at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI -16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (-7.1 visits/clinic/day, 95% CI -8.9 to 5.3), both for children aged <1 year and 1-5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8). CONCLUSIONS: In rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.


Asunto(s)
Atención Ambulatoria/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/tendencias , Neumonía Viral/epidemiología , Atención Primaria de Salud , Salud Pública , Adulto , Factores de Edad , Betacoronavirus , Servicios de Planificación Familiar/estadística & datos numéricos , Femenino , Infecciones por VIH/epidemiología , Humanos , Masculino , Pandemias , Pediatría/estadística & datos numéricos , Atención Primaria de Salud/métodos , Atención Primaria de Salud/estadística & datos numéricos , Salud Pública/métodos , Salud Pública/estadística & datos numéricos , Población Rural
3.
BMJ Open ; 10(10): e044566, 2020 10 05.
Artículo en Inglés | MEDLINE | ID: mdl-33020111

RESUMEN

OBJECTIVES: To analyse enrolment to interventional trials during the first wave of the COVID-19 pandemic in England and describe the barriers to successful recruitment in the circumstance of a further wave or future pandemics. DESIGN: We analysed registered interventional COVID-19 trial data and concurrently did a prospective observational study of hospitalised patients with COVID-19 who were being assessed for eligibility to one of the RECOVERY, C19-ACS or SIMPLE trials. SETTING: Interventional COVID-19 trial data were analysed from the clinicaltrials.gov and International Standard Randomized Controlled Trial Number databases on 12 July 2020. The patient cohort was taken from five centres in a respiratory National Institute for Health Research network. Population and modelling data were taken from published reports from the UK government and Medical Research Council Biostatistics Unit. PARTICIPANTS: 2082 consecutive admitted patients with laboratory-confirmed SARS-CoV-2 infection from 27 March 2020 were included. MAIN OUTCOME MEASURES: Proportions enrolled, and reasons for exclusion from the aforementioned trials. Comparisons of trial recruitment targets with estimated feasible recruitment numbers. RESULTS: Analysis of trial registration data for COVID-19 treatment studies enrolling in England showed that by 12 July 2020, 29 142 participants were needed. In the observational study, 430 (20.7%) proceeded to randomisation. 82 (3.9%) declined participation, 699 (33.6%) were excluded on clinical grounds, 363 (17.4%) were medically fit for discharge and 153 (7.3%) were receiving palliative care. With 111 037 people hospitalised with COVID-19 in England by 12 July 2020, we determine that 22 985 people were potentially suitable for trial enrolment. We estimate a UK hospitalisation rate of 2.38%, and that another 1.25 million infections would be required to meet recruitment targets of ongoing trials. CONCLUSIONS: Feasible recruitment rates, study design and proliferation of trials can limit the number, and size, that will successfully complete recruitment. We consider that fewer, more appropriately designed trials, prioritising cooperation between centres would maximise productivity in a further wave.


Asunto(s)
Investigación Biomédica , Infecciones por Coronavirus , Pandemias , Selección de Paciente , Neumonía Viral , Ensayos Clínicos Controlados Aleatorios como Asunto , Betacoronavirus/aislamiento & purificación , Investigación Biomédica/organización & administración , Investigación Biomédica/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/terapia , Determinación de la Elegibilidad , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Neumonía Viral/epidemiología , Neumonía Viral/terapia , Estudios Prospectivos , Ensayos Clínicos Controlados Aleatorios como Asunto/métodos , Ensayos Clínicos Controlados Aleatorios como Asunto/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Reino Unido
4.
Lancet Glob Health ; 8(11): e1435-e1443, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33069304

RESUMEN

BACKGROUND: In conflict settings, data to guide humanitarian and development responses are often scarce. Although geospatial analyses have been used to estimate health-care access in many countries, such techniques have not been widely applied to inform real-time operations in protracted health emergencies. Doing so could provide a more robust approach for identifying and prioritising populations in need, targeting assistance, and assessing impact. We aimed to use geospatial analyses to overcome such data gaps in Yemen, the site of one of the world's worst ongoing humanitarian crises. METHODS: We derived geospatial coordinates, functionality, and service availability data for Yemen health facilities from the Health Resources and Services Availability Monitoring System assessment done by WHO and the Yemen Ministry of Public Health and Population. We modelled population spatial distribution using high-resolution satellite imagery, UN population estimates, and census data. A road network grid was built from OpenStreetMap and satellite data and modified using UN Yemen Logistics Cluster data and other datasets to account for lines of conflict and road accessibility. Using this information, we created a geospatial network model to deduce the travel time of Yemeni people to their nearest health-care facilities. FINDINGS: In 2018, we estimated that nearly 8·8 million (30·6%) of the total estimated Yemeni population of 28·7 million people lived more than 30-min travel time from the nearest fully or partially functional public primary health-care facility, and more than 12·1 million (42·4%) Yemeni people lived more than 1 h from the nearest fully or partially functional public hospital, assuming access to motorised transport. We found that access varied widely by district and type of health service, with almost 40% of the population living more than 2 h from comprehensive emergency obstetric and surgical care. We identified and ranked districts according to the number of people living beyond acceptable travel times to facilities and services. We found substantial variability in access and that many front-line districts were among those with the poorest access. INTERPRETATION: These findings provide the most comprehensive estimates of geographical access to health care in Yemen since the outbreak of the current conflict, and they provide proof of concept for how geospatial techniques can be used to address data gaps and rigorously inform health programming. Such information is of crucial importance for humanitarian and development organisations seeking to improve effectiveness and accountability. FUNDING: Global Financing Facility for Women, Children, and Adolescents Trust Fund; Development and Data Science grant; and the Yemen Emergency Health and Nutrition Project, a partnership between the World Bank, UNICEF, and WHO.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Modelos Estadísticos , Sistemas de Socorro , Análisis Espacial , Yemen
5.
Turk Kardiyol Dern Ars ; 48(7): 640-645, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33034585

RESUMEN

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic caused by the emergence of severe acute respiratory syndrome coronavirus 2 has resulted in a health crisis and a significant number of deaths worldwide. The full effect on access to medical care and the treatment for patients with chronic diseases and acute conditions is still unknown. This is an investigation of access to primary percutaneous coronary intervention (PPCI) for patients diagnosed with ST-segment myocardial infarction (STEMI) during the pandemic. METHODS: Consecutive patients who were diagnosed with STEMI and underwent PPCI during the ongoing COVID-19 pandemic were included in the study. Clinical and angiographic characteristics of the patients were assessed. A control group of patients diagnosed with STEMI and who underwent PPCI during the same time interval a year prior to the outbreak of the disease was analyzed retrospectively for comparison. RESULTS: There was a significant reduction in the number of STEMI cases during the COVID-19 crisis period. Furthermore, these patients had a prolonged ischemic time; they were more likely to have a longer pain-to-balloon (Odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.1-10.2) and door-to-balloon time (OR: 5.4, 95% CI: 3.1-22.8). CONCLUSION: Patients diagnosed with STEMI during the pandemic experienced a significant delay between the onset of symptoms and PPCI.


Asunto(s)
Infecciones por Coronavirus , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Pandemias , Intervención Coronaria Percutánea/estadística & datos numéricos , Neumonía Viral , Infarto del Miocardio con Elevación del ST/epidemiología , Infarto del Miocardio con Elevación del ST/cirugía , Anciano , Betacoronavirus , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Retrospectivos
7.
Bull Cancer ; 107(11): 1129-1137, 2020 Nov.
Artículo en Francés | MEDLINE | ID: mdl-33036742

RESUMEN

PURPOSE: Human, material, and financial resources being limited, the organization of the care system must allow an efficient allocation of resources. The management of cancers leads to specific and repetitive care for which the reimbursement of transport costs represents a high cost. We carried out an analysis of the additional transport costs, linked to the care of patients in Île-de-France, in a center other than the radiotherapy center closest to their home. MATERIALS AND METHODS: Using data from the Île-de-France Regional Health Agency, we have created a model evaluating the additional cost linked to transport generated by the care of a radiotherapy patient far from his home. In order to take into account the uncertainties linked to the hypotheses made in the development of the model, we carried out deterministic and probabilistic sensitivity analyzes. RESULTS: In the base case, the additional annual cost related to transport was 841,176 euros in Île-de-France. The probabilistic sensitivity analysis reports a total annual additional cost of 2,817,481 euros. CONCLUSION: Our results are similar to a report from the General Inspectorate of Social Affairs published in July 2011, which then pointed to an additional cost of between 4 and 6 million euros annually. The long-term care of cancer patients from their homes contributes to a deterioration in the quality of life linked to travel times, a delay in the care of potential treatment complications, and the spread of infectious diseases, such as COVID-19, and bacteria resistant to antibiotics.


Asunto(s)
Ambulancias/economía , Instituciones Oncológicas/provisión & distribución , Accesibilidad a los Servicios de Salud/economía , Neoplasias/radioterapia , Transporte de Pacientes/economía , Ambulancias/estadística & datos numéricos , Costos y Análisis de Costo , Francia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Modelos Estadísticos , Neoplasias/economía , Paris , Calidad de Vida , Asignación de Recursos , Factores de Tiempo , Transporte de Pacientes/estadística & datos numéricos , Incertidumbre
10.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33000953

RESUMEN

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Asunto(s)
Toma de Decisiones Conjunta , Detección Precoz del Cáncer/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Disparidades en Atención de Salud/etnología , Neoplasias Pulmonares/diagnóstico , Fumar/etnología , Determinación de la Elegibilidad , Grupos Étnicos/estadística & datos numéricos , Costos de la Atención en Salud , Disparidades en Atención de Salud/estadística & datos numéricos , Humanos , Ciencia de la Implementación , Cobertura del Seguro , Comercialización de los Servicios de Salud/métodos , Medicaid , Pacientes no Asegurados/estadística & datos numéricos , Grupos Minoritarios/estadística & datos numéricos , Guías de Práctica Clínica como Asunto , Derivación y Consulta/estadística & datos numéricos , Factores Sexuales , Fumar/epidemiología , Fumar/terapia , Cese del Hábito de Fumar/estadística & datos numéricos , Clase Social , Estados Unidos
11.
N Z Med J ; 133(1524): 11-19, 2020 10 30.
Artículo en Inglés | MEDLINE | ID: mdl-33119566

RESUMEN

AIM: Recent changes in funding have reduced the cost of the highly effective levonorgestrel-releasing intrauterine system (LIUS) contraceptives (Mirena and Jaydess). This paper explores equity of access to intrauterine contraceptives for Maori and the general population by locating and surveying all potential providers within the Southern District Health Board catchment area. METHODS: Using online survey, e-mail or phone, we asked if intrauterine contraceptive insertion was provided, what device was provided, cost and number of appointments required. ArcGIS 10.6.1 software was used to estimate population distribution, and to create service areas showing distance to nearest current providers for Maori and the general population. RESULTS: All 88 potential providers agreed to participate; two thirds (66.3%) provided some intrauterine contraceptive insertion. Approximately three quarters of the Maori and general population live within 5km of a primary provider. Costs ranged from $0 to $270, in addition to the cost of the required consultations. Number of consultations required varied from one to three. CONCLUSIONS: Cost and travel time likely remain barriers to accessing intrauterine contraceptives for a significant population within this catchment. Increasing the capacity for all primary providers to offer insertion, funding the insertion process, minimising the number of appointments required and providing mobile services would improve access.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Dispositivos Intrauterinos Medicados , Instituciones de Atención Ambulatoria , Servicios de Planificación Familiar , Femenino , Humanos , Dispositivos Intrauterinos Medicados/economía , Dispositivos Intrauterinos Medicados/estadística & datos numéricos , Levonorgestrel , Anticoncepción Reversible de Larga Duración , Nueva Zelanda , Viaje
12.
N Z Med J ; 133(1524): 40-49, 2020 10 30.
Artículo en Inglés | MEDLINE | ID: mdl-33119569

RESUMEN

AIMS: To analyse the surgical intervention rate (SIR), best spectacle-corrected visual acuity (BSCVA) and disparities in access to public-funded cataract surgery in New Zealand. The New Zealand Ministry of Health uses the National Prioritisation Web Service (NPWS) to prioritise all patients for public-funded cataract surgery. BSCVA at prioritisation, ethnic, demographic and geographic disparities have not previously been assessed. METHODS: A retrospective cohort study. Between November 2014 and March 2019, 61,095 prioritisation events for 44,403 unique patients were identified. Cataract prioritisation events extracted from the NPWS were merged with date of birth and ethnicity extracted from the National Health Index database. All data were de-identified prior to statistical analysis. RESULTS: Mean age at prioritisation was 74.4 years, with female preponderance (56%). Overall ethnicity was 'European' in 69.8% and 'New Zealand Maori' in 9.6%. Mean Snellen BSCVA was 6/30-2 (prioritised eye), and 6/12-1 (binocular). Maori and Pasifika presented on average 10 years earlier than other ethnic groups with significantly worse BSCVA. Surgery was approved in 74.4% of prioritisation events with mean Snellen BSCVA of 6/38-2. Only 34.9% of New Zealand patients had Snellen BSCVA of 6/12 or better in the prioritised eye, compared to 58.4% in the European Union. Cataract SIR varied by region. CONCLUSIONS: New Zealand's cataract SIR is lower than most Organisation for Economic Co-operation and Development countries and patients have significantly worse BSCVA at prioritisation. Access to cataract surgery in New Zealand varies according to region. Maori and Pasifika present younger with worse BSCVA, suggesting potential barriers in accessing timely referral and prioritisation.


Asunto(s)
Extracción de Catarata/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Agudeza Visual , Anciano , Anciano de 80 o más Años , Catarata/etnología , Femenino , Financiación Gubernamental , Humanos , Masculino , Persona de Mediana Edad , Nueva Zelanda/epidemiología , Calidad de Vida , Estudios Retrospectivos
13.
PLoS One ; 15(10): e0239326, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33085682

RESUMEN

BACKGROUND: Long distances to facilities, topographical constraints, inadequate service capacity of institutions and insufficient/ rudimentary road & transportation network culminate into unprecedented barriers to access. These barriers gets exacerbated in presence of external factors like conflict and political disruptions. Thus, this study was conducted in rural, remote and fragile region in India measuring geographical accessibility and modelling spatial coverage of public healthcare network. METHODS: Vector and raster based approaches were used to discern accessibility for various packages of service delivery. Alternative scenarios derived from local experiences were modelled using health facility, population and ancillary data. Based on that, a raster surface of travel time between facilities and population was developed by incorporating terrain, physical barriers, topography and travelling modes and speeds through various land-cover classes. Concomitantly, spatial coverage was modelled to delineate catchment areas. Further, underserved population and zonal statistics were assessed in an interactive modelling approach to ascertain spatial relationship between population, travel time and zonal boundaries. Finally, raster surface of travel time was re-modelled for the conflict situation in villages vulnerable to obstruction of access due to disturbed security scenario. RESULTS: Euclidean buffers revealed 11% villages without ambulatory & immunization care within 2 km radius. Similarly, for 5 km radius, 11% and 12% villages were bereft of delivery and inpatient care. Travel time accessibility analysis divulged walking scenario exhibiting lowest level of accessibility. Enabling motorized travel improved accessibility measures, with highest degree of accessibility for privately owned vehicle (motorcycle and cars). Differential results were found between packages of services where ambulatory & immunization care was relatively accessible by walking; whereas, delivery and inpatient care had a staggering average of three hours walking time. Even with best scenario, around 2/3rd population remained unserved for all package of services. Moreover, 90% villages in conflict zone grapples with inaccessibility when the scenario of heightened border tensions was considered. CONCLUSIONS: Our study demonstrated the application of GIS technique to facilitate evidence backed planning at granular level. Regardless of the scenario, the analysis divulged inaccessibility to delivery and inpatient care to be most pronounced and majority of population to be unserved. It was suggested to have concerted efforts to bolster already existing facilities and adapt systems approach to exploit synergies of inter-sectoral development.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Salud Pública , Sistemas de Información Geográfica , Humanos , India , Modelos Teóricos , Población Rural , Transportes , Caminata
14.
Medicine (Baltimore) ; 99(35): e21767, 2020 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-32871897

RESUMEN

Risk factors such as smoking and sugar intake threaten the health of human being at an individual national level as well as at a global level. The globalization affect health indirectly through macro and micro-level factors. This study aimed to identify the global trend of dental caries according to countries national income level, and to examine the role of globalization, health services, obesity, and sugar consumption on dental caries. Data for 160 countries were collected for the time period of the 1990s to 2010s. The final sample included 46 countries with complete data (21 high income countries (HIC) and 25 middle and low income countries (MLIC)). The main dependent variable was the mean decayed, missing, and filled teeth (DMFT) index of 12-year-olds as an indicator of dental caries. Globalization was a main independent variable which was measured by economic growth, urbanization and economic freedom. Other independent variables were health services, obesity and sugar consumption. The data were analyzed first using repeated measures analysis of variance to compare dental caries trends in HIC and MLIC. Then, using multiple linear regression and partial least squares structural equation modeling (PLS-SEM), the relationships between globalization, health services, obesity, sugar consumption, and dental caries were examined. The results of PLS-SEM revealed that globalization was associated with lower DMFT in HIC. The global dental caries trend had a declined pattern, but this pattern has been attenuated in MLIC after the new millennium. There is a need for policy change and regulations on sugar trade especially in MLIC to diminish the adverse consequences of globalization, and to improve population dental health.


Asunto(s)
Índice CPO , Caries Dental/epidemiología , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/estadística & datos numéricos , Internacionalidad , Niño , Azúcares de la Dieta , Desarrollo Económico , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Análisis de Clases Latentes , Modelos Lineales , Obesidad/epidemiología , Urbanización
15.
MMWR Morb Mortal Wkly Rep ; 69(36): 1238-1243, 2020 Sep 11.
Artículo en Inglés | MEDLINE | ID: mdl-32914770

RESUMEN

Frequent mental distress, defined as 14 or more self-reported mentally unhealthy days in the past 30 days,* is associated with adverse health behaviors, increased use of health services, mental disorders (e.g., diagnosis of major depressive disorder), chronic diseases, and functional limitations (1). Adults with disabilities more often report depression and anxiety (2), reduced health care access (3), and health-related risk behaviors (4) than do adults without disabilities. CDC analyzed 2018 Behavioral Risk Factor Surveillance System (BRFSS) data to compare the prevalence of frequent mental distress among adults with disabilities with that among adults without disabilities and to identify factors associated with mental distress among those with disabilities. Nationwide, an estimated 17.4 million adults with disabilities reported frequent mental distress; the prevalence of reported mental distress among those with disabilities (32.9%) was 4.6 times that of those without disabilities (7.2%). Among adults with disabilities, those with both cognitive and mobility disabilities most frequently reported mental distress (55.6%). Adults with disabilities who reported adverse health-related characteristics (e.g., cigarette smoking, physical inactivity, insufficient sleep, obesity, or depressive disorders) or an unmet health care need because of cost also reported experiencing more mental distress than did those with disabilities who did not have these characteristics. Adults living below the federal poverty level reported mental distress 70% more often than did adults in higher income households. Among states, age-adjusted prevalence of mental distress among adults with disabilities ranged from 25.2% (Alaska) to 42.9% (New Hampshire). Understanding the prevalence of mental distress among adults with disabilities could help health care providers, public health professionals, and policy makers target interventions and inform programs and policies to ensure receipt of mental health screening, care, and support services to reduce mental distress among adults with disabilities.


Asunto(s)
Personas con Discapacidad/psicología , Personas con Discapacidad/estadística & datos numéricos , Distrés Psicológico , Adolescente , Adulto , Anciano , Sistema de Vigilancia de Factor de Riesgo Conductual , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Pobreza/estadística & datos numéricos , Prevalencia , Factores de Riesgo , Estados Unidos/epidemiología , Adulto Joven
17.
Sante Publique ; 32(2): 263-272, 2020.
Artículo en Francés | MEDLINE | ID: mdl-32985843

RESUMEN

INTRODUCTION: The Central East region of Burkina Faso has vaccine coverage which is among the lowest in the country with an epidemiological profile marked by the occurrence of measles or meningitis outbreaks. This study was conducted with the aim of carrying out an equity analysis of the organization of immunization services in this region in order to identify factors that cause potential inequities in vaccination offer. MATERIALS AND METHOD: This descriptive cross-sectional study covered the seven districts in the Central East region. Data collection was done in two weeks combined with observation method, individual interviews and document review. Part of the data was collected using a self-administered questionnaire. The data analysis was performed with the Epi info 7 software using a plan designed for this purpose. RESULTS: A total of 144 health centers in the region (93.0% coverage) were surveyed. The average distance between villages and health facilities was 5.2 km with 16.2% of villages that were located more than 10 km from a health facility. Health centers had an average of four health workers, however the urban health centers had more workers than those in rural areas. About 16% of the villages did not benefit from an on-site vaccination trip due to the unavailability of transport logistics. More than half of the health centers (53.9%) had experienced vaccine shortages in the last six months before the study. More than 5,000 safety boxes containing used syringes were stored in the districts of the region. CONCLUSION: This study identified factors potentially responsible for an inequity in providing vaccination services in the Central East region. These factors include, but are not limited to, the geographical distribution of the health centers, the availability of transport logistics, and the shortage in vaccines and deficiencies in the waste disposal system. Concerted actions should be developed, involving all stakeholders in the health system in order to address these issues.


Asunto(s)
Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Inmunización , Burkina Faso , Estudios Transversales , Encuestas de Atención de la Salud , Humanos
18.
BMC Public Health ; 20(1): 1467, 2020 Sep 29.
Artículo en Inglés | MEDLINE | ID: mdl-32993596

RESUMEN

BACKGROUND: Breast cancer is one of the leading public health problem globally, especially in low-resource countries (LRCs). Breast cancer screening (BCS) services are an effective strategy for early determining of breast cancer. Hence, it is imperative to understand the utilisation of BCS services and their correlated predictors in LRCs. This study aims to determine the distribution of predictors that significantly influence the utilisation of BCS services among women in LRCs. METHODS: The present study used data on 140,974 women aged 40 years or over from 14 LRCs. The data came from country Demographic and Health Surveys (DHS) between 2008 and 2016. Multivariate logistic regression analysis was employed to investigate the significant predictors that influence the use of BCS services. RESULTS: The utilisation of BCS services was 15.41%, varying from 81.10% (95% CI: 76.85-84.73%) in one European country, to 18.61% (95% CI: 18.16 to 19.06%) in Asian countries, 14.30% (95% CI: 13.67-14.96%) in American countries, and 14.29% (95% CI: 13.87-14.74%). Factors that were significantly associated to increase the use of BCS services include a higher level of education (OR = 2.48), advanced age at first birth (> 25 years) (OR = 1.65), female-headed households (OR = 1.65), access to mass media communication (OR = 1.84), health insurance coverage (OR = 1.09), urban residence (OR = 1.20) and highest socio-economic status (OR = 2.01). However, obese women shown a significantly 11% (OR = 0.89) lower use of BSC services compared to health weight women. CONCLUSION: The utilisation of BCS services is low in many LRCs. The findings of this study will assist policymakers in identifying the factors that influence the use of BCS services. To increase the national BCS rate, more attention should be essential to under-represented clusters; in particular women who have a poor socioeconomic clusters, live in a rural community, have limited access to mass media communication, and are have a low level educational background. These factors highlight the necessity for a new country-specific emphasis of promotional campaigns, health education, and policy targeting these underrepresented groups in LRCs.


Asunto(s)
Neoplasias de la Mama/diagnóstico , Detección Precoz del Cáncer/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Servicios de Salud para Mujeres/estadística & datos numéricos , Salud de la Mujer/estadística & datos numéricos , Adulto , Anciano , Asia , Neoplasias de la Mama/epidemiología , Europa (Continente) , Femenino , Educación en Salud/estadística & datos numéricos , Humanos , Persona de Mediana Edad , Estados Unidos
19.
JCO Glob Oncol ; 6: 1428-1438, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32986516

RESUMEN

PURPOSE: The COVID-19 pandemic affected health care systems globally and resulted in the interruption of usual care in many health care facilities, exposing vulnerable patients with cancer to significant risks. Our study aimed to evaluate the impact of this pandemic on cancer care worldwide. METHODS: We conducted a cross-sectional study using a validated web-based questionnaire of 51 items. The questionnaire obtained information on the capacity and services offered at these centers, magnitude of disruption of care, reasons for disruption, challenges faced, interventions implemented, and the estimation of patient harm during the pandemic. RESULTS: A total of 356 centers from 54 countries across six continents participated between April 21 and May 8, 2020. These centers serve 716,979 new patients with cancer a year. Most of them (88.2%) reported facing challenges in delivering care during the pandemic. Although 55.34% reduced services as part of a preemptive strategy, other common reasons included an overwhelmed system (19.94%), lack of personal protective equipment (19.10%), staff shortage (17.98%), and restricted access to medications (9.83%). Missing at least one cycle of therapy by > 10% of patients was reported in 46.31% of the centers. Participants reported patient exposure to harm from interruption of cancer-specific care (36.52%) and noncancer-related care (39.04%), with some centers estimating that up to 80% of their patients were exposed to harm. CONCLUSION: The detrimental impact of the COVID-19 pandemic on cancer care is widespread, with varying magnitude among centers worldwide. Additional research to assess this impact at the patient level is required.


Asunto(s)
Instituciones Oncológicas/estadística & datos numéricos , Infecciones por Coronavirus/prevención & control , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Oncología Médica/estadística & datos numéricos , Neoplasias/terapia , Pandemias/prevención & control , Neumonía Viral/prevención & control , Betacoronavirus/patogenicidad , Instituciones Oncológicas/normas , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/transmisión , Infecciones por Coronavirus/virología , Estudios Transversales , Carga Global de Enfermedades , Accesibilidad a los Servicios de Salud/normas , Humanos , Control de Infecciones/normas , Cooperación Internacional , Oncología Médica/normas , Neumonía Viral/epidemiología , Neumonía Viral/transmisión , Neumonía Viral/virología , Encuestas y Cuestionarios/estadística & datos numéricos
20.
J Adolesc Health ; 67(5): 649-652, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-32933836

RESUMEN

PURPOSE: This study aimed to determine the needs, emotions, and coping behaviors of U.S. youth during COVID-19. METHODS: Two open-ended questions were posed to 1,174 MyVoice youth, aged 14-24 years, on March 20, 2020, regarding their needs and coping strategies during COVID-19. Qualitative responses were coded using thematic analysis and data were summarized with descriptive statistics. RESULTS: The average age of the 950 respondents (RR = 80.9%) was 18.9 ± 2.8 years with 52.1% female and 63.8% white. While 32.6% of participants felt resources were readily available, 35.2% felt resources were difficult to access or unavailable. Participants also described both emotional responses (27.4%) and coping strategies (69.8%). Most emotional responses were negative, including symptoms of anxiety or depression. Commonly reported coping strategies included staying connected and maintaining positivity. CONCLUSIONS: A significant portion of U.S. youth are experiencing unmet needs and negative emotions due to COVID-19 suggesting additional youth outreach is necessary to ensure basic needs, including socialization, are met.


Asunto(s)
Adaptación Psicológica , Infecciones por Coronavirus/psicología , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Salud Mental , Neumonía Viral/psicología , Psicología del Adolescente , Adolescente , Femenino , Humanos , Masculino , Evaluación de Necesidades , Pandemias , Apoyo Social , Socialización , Encuestas y Cuestionarios , Estados Unidos , Adulto Joven
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