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4.
PLoS One ; 16(9): e0256136, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34469453

RESUMEN

BACKGROUND: Political ideologies drove public actions and health behaviors in the first year of the global pandemic. Different ideas about contagion, health behaviors, and the actions of governing bodies impacted the spread of the virus and health and life. Researchers used an immediate, mixed methods design to explore sociocultural responses to the virus and identified differences and similarities in anxiety, fear, blame, and perceptions of nation across political divides. METHODS: Researchers conducted 60 in-depth, semi-structured interviews and administered over 1,000 questionnaires with people living in the United States. The team analyzed data through an exploratory and confirmatory sequential mixed methods design. RESULTS: In the first months of the pandemic interviewees cited economic inequality, untrustworthy corporations and other entities, and the federal government as threats to life and pandemic control. Participants invoked ideas about others to determine blame. Findings reveal heavy associations between lack of safety during a public health crisis and blame of "culture" and government power across the political spectrum. CONCLUSION: Data indicate anxiety across political differences related to ideas of contagion and the maleficence of a powerful elite. Findings on how people understand the nation, politics, and pandemic management contribute to understanding dimensions of health behaviors and underlying connections between anxiety and the uptake of conspiracy theories in public health. The article ends with recommendations drawn from project findings for future pandemic response.


Asunto(s)
Ansiedad , COVID-19 , Miedo/psicología , Conductas Relacionadas con la Salud , Pandemias , SARS-CoV-2 , Encuestas y Cuestionarios , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Ansiedad/epidemiología , Ansiedad/psicología , COVID-19/epidemiología , COVID-19/psicología , Gobierno Federal , Femenino , Humanos , Masculino , Persona de Mediana Edad , Salud Pública , Estados Unidos/epidemiología
5.
Bone Joint J ; 103-B(10): 1555-1560, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34587804

RESUMEN

AIMS: Knee arthroplasty surgery is a highly effective treatment for arthritis and disorders of the knee. There are a wide variety of implant brands and types of knee arthroplasty available to surgeons. As a result of a number of highly publicized failures, arthroplasty surgery is highly regulated in the UK and many other countries through national registries, introduced to monitor implant performance, surgeons, and hospitals. With time, the options available within many brand portfolios have grown, with alternative tibial or femoral components, tibial insert materials, or shapes and patella resurfacings. In this study we have investigated the effect of the expansion of implant brand portfolios and where there may be a lack of transparency around a brand name. We also aimed to establish the potential numbers of compatible implant construct combinations. METHODS: Hypothetical implant brand portfolios were proposed, and the number of compatible implant construct combinations was calculated. RESULTS: A simple knee portfolio with cemented cruciate-retaining (CR) and posterior-stabilized (PS) components, with and without a patella, has four combinations. If there are two options available for each component, the numbers double for each option, resulting in 32 combinations. The effect of adding a third option multiplies the number by 1.3. Introducing compatible uncemented options, with the effect of hybrids, multiplies the number by 4. An implant portfolio with two femoral components (both in CR and PS), with two insert options and a patella, all in cemented and uncemented versions leads to 192 possible compatible implant construct combinations. There are implant brands available to surgeons with many more than two options. CONCLUSION: This study demonstrates that the addition of multiple variants within a knee brand portfolio leads to a large number (many hundreds) of compatible implant construct combinations. Revision rates of implant combinations are not currently reviewed at this level of granularity, leading to the risk of camouflage of true outcomes. Cite this article: Bone Joint J 2021;103-B(10):1555-1560.


Asunto(s)
Artroplastia de Reemplazo de Rodilla/instrumentación , Benchmarking/métodos , Toma de Decisiones Clínicas , Recolección de Datos/métodos , Prótesis de la Rodilla , Evaluación de Resultado en la Atención de Salud/métodos , Diseño de Prótesis , Artroplastia de Reemplazo de Rodilla/métodos , Benchmarking/normas , Recolección de Datos/normas , Gobierno Federal , Regulación Gubernamental , Humanos , Evaluación de Resultado en la Atención de Salud/normas , Guías de Práctica Clínica como Asunto , Pautas de la Práctica en Medicina/normas , Pautas de la Práctica en Medicina/estadística & datos numéricos , Sistema de Registros , Reoperación/estadística & datos numéricos , Reino Unido
6.
JAMA Netw Open ; 4(9): e2122885, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34499136

RESUMEN

Importance: Federal data underestimate the impact of COVID-19 on US nursing homes because federal reporting guidelines did not require facilities to report case and death data until the week ending May 24, 2020. Objective: To assess the magnitude of unreported cases and deaths in the National Healthcare Safety Network (NHSN) and provide national estimates of cases and deaths adjusted for nonreporting. Design, Setting, and Participants: This is a cross-sectional study comparing COVID-19 cases and deaths reported by US nursing homes to the NHSN with those reported to state departments of health in late May 2020. The sample includes nursing homes from 20 states, with 4598 facilities in 12 states that required facilities to report cases and 7401 facilities in 19 states that required facilities to report deaths. Estimates of nonreporting were extrapolated to infer the national (15 397 facilities) unreported cases and deaths in both May and December 2020. Data were analyzed from December 2020 to May 2021. Exposures: Nursing home ownership (for-profit or not-for-profit), chain affiliation, size, Centers for Medicare & Medicaid Services star rating, and state. Main Outcomes and Measures: The main outcome was the difference between the COVID-19 cases and deaths reported by each facility to their state department of health vs those reported to the NHSN. Results: Among 15 415 US nursing homes, including 4599 with state case data and 7405 with state death data, a mean (SE) of 43.7% (1.4%) of COVID-19 cases and 40.0% (1.1%) of COVID-19 deaths prior to May 24 were not reported in the first NHSN submission in sample states, suggesting that 68 613 cases and 16 623 deaths were omitted nationwide, representing 11.6% of COVID-19 cases and 14.0% of COVID-19 deaths among nursing home residents in 2020. Conclusions and Relevance: These findings suggest that federal NHSN data understated total cases and deaths in nursing homes. Failure to account for this issue may lead to misleading conclusions about the role of different facility characteristics and state or federal policies in explaining COVID outbreaks.


Asunto(s)
COVID-19/epidemiología , Casas de Salud/estadística & datos numéricos , Sesgo , COVID-19/mortalidad , Estudios Transversales , Bases de Datos Factuales , Gobierno Federal , Humanos , Encuestas y Cuestionarios , Estados Unidos/epidemiología
10.
J Public Health Policy ; 42(3): 439-451, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34453095

RESUMEN

In this manuscript, we point out that the federal government headed by President Bolsonaro has pursued a political agenda that contributed to the spread of COVID-19, transforming the country into a major repository for SARS-CoV-2 and its variants, thus representing a risk for worldwide containment efforts. Furthermore his actions are also weakening democratic institutions, which could counter his political agenda, effectively facilitating the spread of COVID-19. Thus, the perpetuation of the COVID-19 pandemic in Brazil is due to human behaviour factors, especially high-level public decision makers.


Asunto(s)
COVID-19 , Gobierno Federal , Salud Global , Pandemias , Política , Brasil/epidemiología , COVID-19/epidemiología , Salud Global/estadística & datos numéricos , Humanos , SARS-CoV-2
11.
Int J Surg ; 92: 106052, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34375769

RESUMEN

Fiji is facing the second wave of COVID-19 and has been recording increased number of COVID-19 cases. The response of Fijian Government is mainly directed towards obtaining international assistance in terms of expertise and vaccinations. While international support is necessary for the country, the Fijian Government also needs to consider the basic needs of the affected Fijians. In response, this article will provide an overview of the current COVID-19 crisis in Fiji to justify the need for reshaping the current approach of the Fijian Government.


Asunto(s)
COVID-19 , COVID-19/epidemiología , Gobierno Federal , Fiji/epidemiología , Humanos
17.
BMC Health Serv Res ; 21(1): 738, 2021 Jul 26.
Artículo en Inglés | MEDLINE | ID: mdl-34304743

RESUMEN

BACKGROUND: Evidence-informed clinical practice guidelines (CPGs) are useful tools to inform transparent healthcare decision-making. Consideration of health economic evidence (HEE) during CPG development in a structured manner remains a challenge globally and locally. This study explored the views, current practice, training needs and challenges faced by CPG developers in the production and use of HEE for CPGs in South Africa. METHODS: This mixed-methods study comprised an online survey and a focus group discussion. The survey was piloted and subsequently sent to CPG role players - evidence reviewers, CPG panellists, academics involved with training in relevant disciplines like health economics and public health, implementers and funders. The focus group participants hold strategic roles in CPG development and health economic activities nationally. The survey evaluated mean values, measures of variability, and percentages for Likert scales, while narrative components were thematically analysed. Focus group data were manually coded, thematically analysed and verified. RESULTS: The survey (n = 55 respondents to 245 surveys distributed) and one focus group (n = 5 participants from 10 people invited) occurred between October 2018 and February 2019. We found the most consistent reason why HEE should inform CPG decisions was 'making more efficient use of limited financial resources'. This was explained by numerous context and methodological barriers. Focus groups participants noted that consideration of complex HEE are not achievable without bolstering skills in applying evidence-based medicine principles. Further concerns include lack of clarity of standard methods; inequitable and opaque topic selection across private and public sectors; inadequate skills of CPG panel members to use HEE; and the ability of health economists to communicate results in accessible ways. Overall, in the absence of clarity about process and methods, politics and interests may drive CPG decisions about which interventions to implement. CONCLUSIONS: HEE should ideally be considered in CPG decisions in South Africa. However, this will remain hampered until the CPG community agree on methods and processes for using HEE in CPGs. Focused investment by national government to address the challenges identified by the study is imperative for a better return on investment as National Health Insurance moves forward.


Asunto(s)
Economía Médica , Medicina Basada en la Evidencia , Gobierno Federal , Humanos , Programas Nacionales de Salud , Sudáfrica
18.
Environ Sci Technol ; 55(16): 10923-10927, 2021 08 17.
Artículo en Inglés | MEDLINE | ID: mdl-34310109

RESUMEN

In the United States (U.S.), chemical evaluations and assessments are conducted by seven federal agencies responding to distinct statutory requirements and focusing on different exposure scenarios. While risk assessment is a fundamental concept in public health practice and policy, there is no clear, central, and concise summary of these processes. The novel infographic presented here depicts more than 30 different evaluation and assessment processes conducted by federal agencies for chemicals found in the environment, workplace, consumer products, hazardous waste sites, food, and/or cosmetics. The majority of these assessments are statutorily required. Most serve as sources of authoritative information to provide public health guidance or recommendations. Less than half directly result in risk management actions or regulations. Understanding these roles and processes can facilitate engagement from the broader community, including by highlighting priority areas for research to inform public health policy. This infographic also illustrates the opportunity and need for further intra- and interagency collaboration and coordination - including a particular focus on aggregate risk assessment, given that the population regularly experiences exposures from multiple sources crossing agency domains.


Asunto(s)
Salud Pública , Gestión de Riesgos , Salud Ambiental , Gobierno Federal , Medición de Riesgo , Estados Unidos , Lugar de Trabajo
19.
Cad Saude Publica ; 37(7): e00182119, 2021.
Artículo en Portugués | MEDLINE | ID: mdl-34287586

RESUMEN

The study aimed to identify and analyze the nationwide Health Information Systems (SIS) operating in Brazil from 2010 to 2018 and to understand the management and support structure for Information Technology (IT) in these systems in the Ministry of Health. This was a descriptive study based on document analysis, seeking to consolidate the data on nationwide SIS based on selection criteria referenced on the concept of SIS. The documents yielded incomplete and mutually disparate data, evidencing different interpretations of the concepts of systems and health information systems in the Ministry of Health. The survey found 54 nationwide Health Information Systems functioning from 2010 to 2018 and collected information on seven decentralized IT centers in Ministry of Health departments, which work autonomously from the Brazilian Health Informatics Department (DATASUS). The analysis of the logics of their functioning identified four groups of SIS pertaining to the following: monitoring relevant events for public health, greater control and monitoring of health programs in the Ministry of Health, registration of physical and legal persons, and a "new generation" of SIS that are developed and maintained by the Federal Government but differ from its verticalized programmatic logic, focused on administrative rationalization and improving the quality of services provided by the SUS at the local and regional levels.


Asunto(s)
Sistemas de Información en Salud , Informática Médica , Brasil , Gobierno Federal , Humanos , Salud Pública
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