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1.
J Med Internet Res ; 23(4): e27275, 2021 04 13.
Artículo en Inglés | MEDLINE | ID: mdl-33847586

RESUMEN

BACKGROUND: Although the potential of big data analytics for health care is well recognized, evidence is lacking on its effects on public health. OBJECTIVE: The aim of this study was to assess the impact of the use of big data analytics on people's health based on the health indicators and core priorities in the World Health Organization (WHO) General Programme of Work 2019/2023 and the European Programme of Work (EPW), approved and adopted by its Member States, in addition to SARS-CoV-2-related studies. Furthermore, we sought to identify the most relevant challenges and opportunities of these tools with respect to people's health. METHODS: Six databases (MEDLINE, Embase, Cochrane Database of Systematic Reviews via Cochrane Library, Web of Science, Scopus, and Epistemonikos) were searched from the inception date to September 21, 2020. Systematic reviews assessing the effects of big data analytics on health indicators were included. Two authors independently performed screening, selection, data extraction, and quality assessment using the AMSTAR-2 (A Measurement Tool to Assess Systematic Reviews 2) checklist. RESULTS: The literature search initially yielded 185 records, 35 of which met the inclusion criteria, involving more than 5,000,000 patients. Most of the included studies used patient data collected from electronic health records, hospital information systems, private patient databases, and imaging datasets, and involved the use of big data analytics for noncommunicable diseases. "Probability of dying from any of cardiovascular, cancer, diabetes or chronic renal disease" and "suicide mortality rate" were the most commonly assessed health indicators and core priorities within the WHO General Programme of Work 2019/2023 and the EPW 2020/2025. Big data analytics have shown moderate to high accuracy for the diagnosis and prediction of complications of diabetes mellitus as well as for the diagnosis and classification of mental disorders; prediction of suicide attempts and behaviors; and the diagnosis, treatment, and prediction of important clinical outcomes of several chronic diseases. Confidence in the results was rated as "critically low" for 25 reviews, as "low" for 7 reviews, and as "moderate" for 3 reviews. The most frequently identified challenges were establishment of a well-designed and structured data source, and a secure, transparent, and standardized database for patient data. CONCLUSIONS: Although the overall quality of included studies was limited, big data analytics has shown moderate to high accuracy for the diagnosis of certain diseases, improvement in managing chronic diseases, and support for prompt and real-time analyses of large sets of varied input data to diagnose and predict disease outcomes. TRIAL REGISTRATION: International Prospective Register of Systematic Reviews (PROSPERO) CRD42020214048; https://www.crd.york.ac.uk/prospero/display_record.php?RecordID=214048.


Asunto(s)
Macrodatos , Enfermedades Cardiovasculares , Ciencia de los Datos , Prestación de Atención de Salud/estadística & datos numéricos , Diabetes Mellitus , Trastornos Mentales , Neoplasias , Adolescente , Adulto , Anciano , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/terapia , Diabetes Mellitus/diagnóstico , Diabetes Mellitus/terapia , Femenino , Humanos , Masculino , Trastornos Mentales/diagnóstico , Trastornos Mentales/terapia , Persona de Mediana Edad , Neoplasias/diagnóstico , Neoplasias/terapia , Pronóstico , Revisiones Sistemáticas como Asunto , Adulto Joven
2.
PLoS One ; 16(4): e0249133, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33793611

RESUMEN

BACKGROUND: Several research efforts have evaluated the impact of various factors including a) socio-demographics, (b) health indicators, (c) mobility trends, and (d) health care infrastructure attributes on COVID-19 transmission and mortality rate. However, earlier research focused only on a subset of variable groups (predominantly one or two) that can contribute to the COVID-19 transmission/mortality rate. The current study effort is designed to remedy this by analyzing COVID-19 transmission/mortality rates considering a comprehensive set of factors in a unified framework. METHODS AND FINDINGS: We study two per capita dependent variables: (1) daily COVID-19 transmission rates and (2) total COVID-19 mortality rates. The first variable is modeled using a linear mixed model while the later dimension is analyzed using a linear regression approach. The model results are augmented with a sensitivity analysis to predict the impact of mobility restrictions at a county level. Several county level factors including proportion of African-Americans, income inequality, health indicators associated with Asthma, Cancer, HIV and heart disease, percentage of stay at home individuals, testing infrastructure and Intensive Care Unit capacity impact transmission and/or mortality rates. From the policy analysis, we find that enforcing a stay at home order that can ensure a 50% stay at home rate can result in a potential reduction of about 33% in daily cases. CONCLUSIONS: The model framework developed can be employed by government agencies to evaluate the influence of reduced mobility on transmission rates at a county level while accommodating for various county specific factors. Based on our policy analysis, the study findings support a county level stay at home order for regions currently experiencing a surge in transmission. The model framework can also be employed to identify vulnerable counties that need to be prioritized based on health indicators for current support and/or preferential vaccination plans (when available).


Asunto(s)
Prestación de Atención de Salud , Demografía/estadística & datos numéricos , Pandemias/estadística & datos numéricos , Factores Socioeconómicos , /mortalidad , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/estadística & datos numéricos , Instituciones de Salud/estadística & datos numéricos , Política de Salud , Humanos , Factores de Riesgo , Estados Unidos
3.
Psychopharmacol Bull ; 51(1): 59-68, 2021 01 12.
Artículo en Inglés | MEDLINE | ID: mdl-33897063

RESUMEN

Background: The novel coronavirus pandemic (COVID-19) led healthcare providers, including mental health providers, across the U.S. to swiftly shift to telemedicine. Objectives: This shift gave our Department of Psychiatry a chance to better understand key challenges and opportunities vis-à-vis virtual mental healthcare. We aimed to obtain provider feedback on the use of telepsychiatry and to learn from the provider perspective about patient experiences with video visits. This information will be used to inform the telemedicine strategy at a systems level within our psychiatry department, our academic health system, as well as the field of telemedicine as a whole. Design and Sample: A 22-item online questionnaire comprising 16 quantitative and six qualitative items was distributed to providers currently using video visits to provide care. Results: A total of 89 mental health providers completed the questionnaire. Outcomes demonstrated that while providers perceive challenges associated with virtual care (e.g., fatigue, technology-related issues, and age-related concerns), they also recognize a number of benefits to themselves and their patients (e.g., convenience and increased access). Overall, provider satisfaction, comfort, and willingness to use telepsychiatry was high. Conclusions: The vast majority of providers adapted quickly to the use of virtual platforms; many endorse advantages that suggest virtual care will continue to be a modality they provide in the future, post-COVID-19. It will be important to continue to evaluate aspects of virtual care that may limit clinical assessments and to optimize use to improve access, convenience, and cost-efficiency of mental healthcare delivery.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Personal de Salud/estadística & datos numéricos , Trastornos Mentales/terapia , Telemedicina/estadística & datos numéricos , Prestación de Atención de Salud/métodos , Encuestas de Atención de la Salud , Humanos , Psiquiatría/métodos , Psiquiatría/estadística & datos numéricos
4.
BMC Health Serv Res ; 21(1): 288, 2021 Mar 31.
Artículo en Inglés | MEDLINE | ID: mdl-33789627

RESUMEN

BACKGROUND: Since the onset of the coronavirus disease 2019 (COVID-19) pandemic, the stroke care systems have been seriously affected because of social restrictions and other reasons. As the pandemic continues to spread globally, it is of great significance to understand how COVID-19 affects the stroke care systems in mainland China. METHODS: We retrospectively studied the real-world data of one comprehensive stroke center in mainland China from January to February 2020 and compared it with the data collected during the same period in 2019. We analyzed DTN time, onset-to-door time, severity, effects after treatment, the hospital length of stays, costs of hospitalization, etc., and the correlation between medical burden and prognosis of acute ischemic stroke (AIS) patients. RESULTS: The COVID-19 pandemic was most severe in mainland China in January and February 2020. During the pandemic, there were no differences in pre-hospital or in-hospital workflow metrics (all p>0.05), while the degree of neurological deficit on admission and at discharge, the effects after treatment, and the long-term prognosis were all worse (all p<0.05). The severity and prognosis of AIS patients were positively correlated with the hospital length of stays and total costs of hospitalization (all p<0.05). CONCLUSIONS: COVID-19 pandemic is threatening the stroke care systems. Measures must be taken to minimize the collateral damage caused by COVID-19.


Asunto(s)
Isquemia Encefálica , Prestación de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/estadística & datos numéricos , Accidente Cerebrovascular , Tiempo de Tratamiento , Isquemia Encefálica/diagnóstico , Isquemia Encefálica/epidemiología , Isquemia Encefálica/terapia , China/epidemiología , Servicios Médicos de Urgencia , Humanos , Pandemias , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Accidente Cerebrovascular/terapia
5.
PLoS One ; 16(3): e0248488, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33760851

RESUMEN

INTRODUCTION: The global COVID-19 pandemic has radically changed the way health care is delivered in many countries around the world. Evidence on the experience of those receiving or providing maternity care is important to guide practice through this challenging time. METHODS: A cross-sectional study was conducted in Australia. Five key stakeholder cohorts were included to explore and compare the experiences of those receiving or providing care during the COVID-19 pandemic. Women, their partners, midwives, medical practitioners and midwifery students who had received or provided maternity care from March 2020 onwards in Australia were recruited via social media and invited to participate in an online survey released between 13th May and 24th June 2020; a total of 3701 completed responses were received. FINDINGS: While anxiety related to COVID-19 was high among all five cohorts, there were statistically significant differences between the responses from each cohort for most survey items. Women were more likely to indicate concern about their own and family's health and safety in relation to COVID-19 whereas midwives, doctors and midwifery students were more likely to be concerned about occupational exposure to COVID-19 through working in a health setting than those receiving care through attending these environments. Midwifery students and women's partners were more likely to respond that they felt isolated because of the changes to the way care was provided. Despite concerns about care received or provided not meeting expectations, most respondents were satisfied with the quality of care provided, although midwives and midwifery students were less likely to agree. CONCLUSION: This paper provides a unique exploration and comparison of experiences of receiving and providing maternity care during the COVID-19 pandemic in Australia. Findings are useful to support further service changes and future service redesign. New evidence provided offers unique insight into key stakeholders' experiences of the rapid changes to health services.


Asunto(s)
/epidemiología , Prestación de Atención de Salud/tendencias , Servicios de Salud Materna/estadística & datos numéricos , Adulto , Actitud Frente a la Salud , Australia/epidemiología , Estudios de Cohortes , Estudios Transversales , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Personal de Salud/educación , Humanos , Persona de Mediana Edad , Partería/educación , Pandemias , Embarazo , /patogenicidad , Encuestas y Cuestionarios
6.
J Hosp Med ; 16(4): 223-226, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33734985

RESUMEN

Children's hospitals responded to COVID-19 by limiting nonurgent healthcare encounters, conserving personal protective equipment, and restructuring care processes to mitigate viral spread. We assessed year-over-year trends in healthcare encounters and hospital charges across US children's hospitals before and during the COVID-19 pandemic. We performed a retrospective analysis, comparing healthcare encounters and inflation-adjusted charges from 26 tertiary children's hospitals reporting to the PROSPECT database from February 1 to June 30 in 2019 (before the COVID-19 pandemic) and 2020 (during the COVID-19 pandemic). All children's hospitals experienced similar trends in healthcare encounters and charges during the study period. Inpatient bed-days, emergency department visits, and surgeries were lower by a median 36%, 65%, and 77%, respectively, per hospital by the week of April 15 (the nadir) in 2020 compared with 2019. Across the study period in 2020, children's hospitals experienced a median decrease of $276 million in charges.


Asunto(s)
/economía , Prestación de Atención de Salud , Costos de la Atención en Salud , Hospitales Pediátricos/economía , Pacientes Internos/estadística & datos numéricos , Niño , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/estadística & datos numéricos , Servicio de Urgencia en Hospital/economía , Servicio de Urgencia en Hospital/estadística & datos numéricos , Humanos , Estudios Retrospectivos
8.
BMC Public Health ; 21(1): 605, 2021 03 29.
Artículo en Inglés | MEDLINE | ID: mdl-33781225

RESUMEN

BACKGROUND: The COVID-19 pandemic is complex and is developing in different ways according to the country involved. METHODS: To identify the key parameters or processes that have the greatest effects on the pandemic and reveal the different progressions of epidemics in different countries, we quantified enhanced control measures and the dynamics of the production and provision of medical resources. We then nested these within a COVID-19 epidemic transmission model, which is parameterized by multi-source data. We obtained rate functions related to the intensity of mitigation measures, the effective reproduction numbers and the timings and durations of runs on medical resources, given differing control measures implemented in various countries. RESULTS: Increased detection rates may induce runs on medical resources and prolong their durations, depending on resource availability. Nevertheless, improving the detection rate can effectively and rapidly reduce the mortality rate, even after runs on medical resources. Combinations of multiple prevention and control strategies and timely improvement of abilities to supplement medical resources are key to effective control of the COVID-19 epidemic. A 50% reduction in comprehensive control measures would have led to the cumulative numbers of confirmed cases and deaths exceeding 590,000 and 60,000, respectively, by 27 March 2020 in mainland China. CONCLUSIONS: Multiple data sources and cross validation of a COVID-19 epidemic model, coupled with a medical resource logistic model, revealed the key factors that affect epidemic progressions and their outbreak patterns in different countries. These key factors are the type of emergency medical response to avoid runs on medical resources, especially improved detection rates, the ability to promote public health measures, and the synergistic effects of combinations of multiple prevention and control strategies. The proposed model can assist health authorities to predict when they will be most in need of hospital beds and equipment such as ventilators, personal protection equipment, drugs, and staff.


Asunto(s)
/terapia , Prestación de Atención de Salud/organización & administración , Brotes de Enfermedades/prevención & control , Recursos en Salud/estadística & datos numéricos , Pandemias , China/epidemiología , Prestación de Atención de Salud/estadística & datos numéricos , Humanos , Modelos Teóricos , Factores de Tiempo
10.
BMC Public Health ; 21(1): 447, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33673813

RESUMEN

BACKGROUND: Amidst the COVID-19 pandemic, governments, health experts, and ethicists have proposed guidelines about ICU triage and priority access to a vaccine. To increase political legitimacy and accountability, public support is important. This study examines what criteria beyond medical need are deemed important to be perceived of priority COVID-19 healthcare access. METHOD: Two conjoint experiments about priority over ICU treatment and early COVID-19 vaccination were implemented in a probability-based sample of 1461 respondents representative of the Netherlands. Respondents were asked who should receive treatment out of two fictitious healthcare claimants that differed in in age, weight, complying with corona policy measures, and occupation, all randomly assigned. Average marginal coefficient effects are estimated to assess the relative importance of the attributes; attributes were interacted with relevant respondent characteristics to find whether consensus exists in this relative ranking. RESULTS: The Dutch penalize those not complying with coronavirus policy measures, and the obese, but prioritize those employed in 'crucial' sectors. For these conditions, there is consensus among the population. For age, young people are prioritized for ICU treatment, while the middle-aged are given priority over a vaccine, with younger respondents favoring healthcare for elderly claimants, while older respondents favor support for young cohorts. CONCLUSION: People who have no control over their social risk and are able to reciprocate to society are considered as more deserving of priority of COVID-19 healthcare. Our findings provide fair support for the implemented ethical guidelines about ICU-treatment and COVID-19 vaccines.


Asunto(s)
/prevención & control , Cuidados Críticos/normas , Prestación de Atención de Salud/normas , Instituciones de Salud/normas , Accesibilidad a los Servicios de Salud/normas , Vacunación/normas , Adulto , Anciano , Anciano de 80 o más Años , Consenso , Cuidados Críticos/estadística & datos numéricos , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Instituciones de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Pandemias , Guías de Práctica Clínica como Asunto , Vacunación/estadística & datos numéricos
11.
Epidemiol Infect ; 149: e75, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33722335

RESUMEN

We investigated whether countries with higher coverage of childhood live vaccines [BCG or measles-containing-vaccine (MCV)] have reduced risk of coronavirus disease 2019 (COVID-19)-related mortality, while accounting for known systems differences between countries. In this ecological study of 140 countries using publicly available national-level data, higher vaccine coverage, representing estimated proportion of people vaccinated during the last 14 years, was associated with lower COVID-19 deaths. The associations attenuated for both vaccine variables, and MCV coverage became no longer significant once adjusted for published estimates of the Healthcare access and quality index (HAQI), a validated summary score of healthcare quality indicators. The magnitude of association between BCG coverage and COVID-19 death rate varied according to HAQI, and MCV coverage had little effect on the association between BCG and COVID-19 deaths. While there are associations between live vaccine coverage and COVID-19 outcomes, the vaccine coverage variables themselves were strongly correlated with COVID-19 testing rate, HAQI and life expectancy. This suggests that the population-level associations may be further confounded by differences in structural health systems and policies. Cluster randomised studies of booster vaccines would be ideal to evaluate the efficacy of trained immunity in preventing COVID-19 infections and mortality in vaccinated populations and on community transmission.


Asunto(s)
/inmunología , Inmunidad Innata/inmunología , Cobertura de Vacunación/estadística & datos numéricos , Vacuna BCG/administración & dosificación , Vacuna BCG/inmunología , Prestación de Atención de Salud/normas , Prestación de Atención de Salud/estadística & datos numéricos , Humanos , Inmunización Secundaria/normas , Inmunización Secundaria/estadística & datos numéricos , Modelos Lineales , Vacuna Antisarampión/administración & dosificación , Vacuna Antisarampión/inmunología , Calidad de la Atención de Salud/normas , Calidad de la Atención de Salud/estadística & datos numéricos
12.
J Coll Physicians Surg Pak ; 30(1): S11-S15, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33650416

RESUMEN

The SARS-CoV-2 outbreak began in China in December 2019 and rapidly spread globally. Up to July 2020, the number of cases of coronavirus disease 2019 (COVID-19) had been increasing in the USA, Italy, England, Spain and numerous other countries. Patients with this disease in different countries present with different clinical manifestations and different prognosis. The present study aimed to analyse the clinical characteristics of patients infected with SARS-CoV-2 in different regions of the world and provide special advices for the different regions to prevent the spread and a second outbreak of COVID-19. Key Words: COVID-19, SARS-CoV-2, Characteristics, Worldwide.


Asunto(s)
/epidemiología , Prestación de Atención de Salud/estadística & datos numéricos , Pandemias , Salud Global , Humanos
13.
Health Qual Life Outcomes ; 19(1): 63, 2021 Feb 25.
Artículo en Inglés | MEDLINE | ID: mdl-33632270

RESUMEN

BACKGROUND: Health-related quality of life (HRQoL) serves as a direct measure of individuals' health, life expectancy and the impact that the utilization of health care has on quality of life. The purpose of this study is to assess the HRQoL of people living with HIV (PLHIV), and to ascertain its association with the social inequalities and clinical determinants among people living with HIV in Benishangul Gumuz Regional State, Ethiopia. METHODS: A cross-sectional study was conducted between December 2016 and February 2017; 390 people at two referral hospitals and three health centers participated in the study. The Patient-Reported Outcomes Measurement Information System Global Health Scale (PROMIS Global 10) was used to measure key HRQoL domains. Global Physical Health (GPH) and Global Mental Health (GPH) summary scores were employed. GPH and GMH summary scores below 50 (the standardized mean score) were determined as poor HRQoL. Bivariate and multivariate logistic regression analyses were used to identify factors associated with GPH and GMH summary scores. RESULTS: This study included 259 (66.4%) females and 131 (33.6%) males. The GPH summary scores ranged from 16.2 to 67.7 with a mean of 48.8 (SD = 8.9). Almost 44.6% of the study population has a GPH summary score of below 50; the GMH summary scores ranged from 28.4 to 67.6 with a mean of 50.8 (SD = 8.1). About 41.8% of the study population has a GMH summary score of below 50. Unemployment, household food insecurity and comorbidities with HIV were associated with both poor GPH and poor GMH summary scores. Age below 25 years and being a member of Christian fellowship were inversely associated with poor GPH. The least wealth index score and CD4 count below 350 cells/mL were also associated with poor GMH. CONCLUSION: Overall, socioeconomic inequalities and HIV-related clinical factors play an important role in improving the HRQoL of PLHIV. Many of these determinants are alterable risk factors. Appropriate strategies can improve the holistic management of chronic HIV care and maximize PLHIVs' HRQoL. Such strategies require the adoption of comprehensive interventions, including policies and programmes that would improve the health, wellbeing and livelihood of PLHIV.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Infecciones por VIH/psicología , Calidad de Vida/psicología , Factores Socioeconómicos , Adulto , Fármacos Anti-VIH/uso terapéutico , Comorbilidad , Estudios Transversales , Etiopía , Femenino , Infecciones por VIH/tratamiento farmacológico , Humanos , Esperanza de Vida , Masculino , Salud Mental , Persona de Mediana Edad , Factores de Riesgo
14.
Medicine (Baltimore) ; 100(7): e24838, 2021 Feb 19.
Artículo en Inglés | MEDLINE | ID: mdl-33607853

RESUMEN

ABSTRACT: More than 70% of tuberculosis (TB) cases diagnosed in the United States (US) occur in non-US-born persons, and this population has experienced less than half the recent incidence rate declines of US-born persons (1.5% vs 4.2%, respectively). The great majority of TB cases in non-US-born persons are attributable to reactivation of latent tuberculosis infection (LTBI). Strategies to expand LTBI-focused TB prevention may depend on LTBI positive non-US-born persons' access to, and ability to pay for, health care.To examine patterns of health insurance coverage and usual sources of health care among non-US-born persons with LTBI, and to estimate LTBI prevalence by insurance status and usual sources of health care.Self-reported health insurance and usual sources of care for non-US-born persons were analyzed in combination with markers for LTBI using 2011-2012 National Health and Nutrition Examination Survey (NHANES) data for 1793 sampled persons. A positive result on an interferon gamma release assay (IGRA), a blood test which measures immunological reactivity to Mycobacterium tuberculosis infection, was used as a proxy for LTBI. We calculated demographic category percentages by IGRA status, IGRA percentages by demographic category, and 95% confidence intervals for each percentage.Overall, 15.9% [95% confidence interval (CI) = 13.5, 18.7] of non-US-born persons were IGRA-positive. Of IGRA-positive non-US-born persons, 63.0% (95% CI = 55.4, 69.9) had insurance and 74.1% (95% CI = 69.2, 78.5) had a usual source of care. IGRA positivity was highest in persons with Medicare (29.1%; 95% CI: 20.9, 38.9).Our results suggest that targeted LTBI testing and treatment within the US private healthcare sector could reach a large majority of non-US-born individuals with LTBI. With non-US-born Medicare beneficiaries' high prevalence of LTBI and the high proportion of LTBI-positive non-US-born persons with private insurance, future TB prevention initiatives focused on these payer types are warranted.


Asunto(s)
Prestación de Atención de Salud/economía , Emigrantes e Inmigrantes/estadística & datos numéricos , Cobertura del Seguro/estadística & datos numéricos , Tuberculosis Latente/epidemiología , Adolescente , Adulto , Anciano , Niño , Estudios Transversales , Prestación de Atención de Salud/estadística & datos numéricos , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Incidencia , Cobertura del Seguro/tendencias , Ensayos de Liberación de Interferón gamma/métodos , Tuberculosis Latente/diagnóstico , Tuberculosis Latente/prevención & control , Masculino , Medicare/estadística & datos numéricos , Persona de Mediana Edad , Mycobacterium tuberculosis/inmunología , Encuestas Nutricionales/métodos , Prevalencia , Estados Unidos/epidemiología , Adulto Joven
15.
Aust N Z J Public Health ; 45(2): 101-107, 2021 Apr.
Artículo en Inglés | MEDLINE | ID: mdl-33617131

RESUMEN

OBJECTIVE: This study explored whether all-cause healthcare attendance rate post-vaccination could detect the two historical influenza safety episodes occurring in 2010 and 2015 using a large de-identified general practitioner (GP) consultations dataset. METHODS: A retrospective observational cohort study was conducted using GP consultation data routinely collected from 2008 to 2017 in Victoria, Australia. Post-vaccination GP consultation rates were monitored, over a 22-week surveillance period each year that aligned with each year's influenza vaccination season, using the Observed minus Expected (O-E) and the Log-Likelihood Ratio (LLR) CUSUM charts. Days 1-7 post-vaccination were considered as the risk period. The LLR CUSUM was designed to detect both a 50% and two-fold rise in the odds of the baseline post-vaccination GP consultation rates. RESULTS: Over the 10-year study period, more than 1.5 million seasonal influenza vaccines doses were administered to 295,091 persons. Overall, 1.29% had a GP consultation within one week of vaccination, but 98.53% of the consultations occurred in days 1-3 post-vaccination. The LLR CUSUM chart detected significant increases in the weekly rates of post-vaccination GP consultation in 2010 in children aged under ten years and in 2015 in adults aged 19-64 years. These increases were aligned by week, but one week earlier and by age category, with the historical adverse events following immunisation (AEFI) signals occurring in 2010 and 2015. However, in the absence of historical AEFI signals, increased rates of post-vaccination GP consultations were identified in three of the eight influenza vaccination years. CONCLUSION: The crude post-vaccination healthcare attendance rate has the potential to offer a sensitive proxy to monitor vaccine safety signal. Implications for public health: Vaccine safety monitoring using syndromic indicator has the potential to augment the existing surveillance systems as part of an integrated vaccine safety monitoring approach.


Asunto(s)
Sistemas de Registro de Reacción Adversa a Medicamentos/estadística & datos numéricos , Prestación de Atención de Salud/estadística & datos numéricos , Medicina General/estadística & datos numéricos , Vacunas contra la Influenza/administración & dosificación , Vacunas contra la Influenza/efectos adversos , Gripe Humana/prevención & control , Vigilancia de la Población/métodos , Vacunación/efectos adversos , Adolescente , Adulto , Anciano , Niño , Preescolar , Estudios de Cohortes , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Estudios Retrospectivos , Estaciones del Año , Convulsiones Febriles/inducido químicamente , Victoria/epidemiología
16.
JCO Glob Oncol ; 7: 311-323, 2021 02.
Artículo en Inglés | MEDLINE | ID: mdl-33617304

RESUMEN

PURPOSE: There has been noteworthy concern about the impact of COVID-19 pandemic on health services including the management of cancer. In addition to being considered at higher risk for worse outcomes from COVID-19, people with cancer may also experience disruptions or delays in health services. This systematic review aimed to identify the delays and disruptions to cancer services globally. METHODS: This is a systematic review with a comprehensive search including specific and general databases. We considered any observational longitudinal and cross-sectional study design. The selection, data extraction, and methodological assessment were performed by two independent reviewers. The methodological quality of the studies was assessed by specific tools. The delays and disruptions identified were categorized, and their frequency was presented. RESULTS: Among the 62 studies identified, none exhibited high methodological quality. The most frequent determinants for disruptions were provider- or system-related, mainly because of the reduction in service availability. The studies identified 38 different categories of delays and disruptions with impact on treatment, diagnosis, or general health service. Delays or disruptions most investigated included reduction in routine activity of cancer services and number of cancer surgeries; delay in radiotherapy; and delay, reschedule, or cancellation of outpatient visits. Interruptions and disruptions largely affected facilities (up to 77.5%), supply chain (up to 79%), and personnel availability (up to 60%). CONCLUSION: The remarkable frequency of delays and disruptions in health care mostly related to the reduction of the COVID-19 burden unintentionally posed a major risk on cancer care worldwide. Strategies can be proposed not only to mitigate the main delays and disruptions but also to standardize their measurement and reporting. As a high number of publications continuously are being published, it is critical to harmonize the upcoming reports and constantly update this review.


Asunto(s)
Prestación de Atención de Salud/métodos , Neoplasias/terapia , Atención Ambulatoria , Estudios Transversales , Prestación de Atención de Salud/organización & administración , Prestación de Atención de Salud/estadística & datos numéricos , Humanos , Neoplasias/radioterapia , Neoplasias/cirugía
18.
Sex Transm Infect ; 97(2): 134-140, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33397802

RESUMEN

OBJECTIVES: In 2017, to reduce the proportion of men who have sex with men (MSM) in the undiagnosed HIV population in France (38%), HIV screening is advised each 3 months and STI screening is advised each year in multipartner MSM. Despite the range of testing solutions, over 40% of MSM were not tested for HIV and over 50% for STIs in the past year. Based on international experiments that offer screening solutions via online advertising, the French National Health Agency launched a programme (MemoDepistages) to provide a free self-sampling kit (SSK) for HIV and STIs. This article analyses the sociodemographic and behavioural characteristics of MSM in terms of kit acceptance and sample return. METHODS: Participants were registered for the programme online after ordering an SSK. The study included men aged over 18 years, living in one of the four selected French regions, and willing to disclose their postal and email address; they had health insurance, acknowledged more than one male partner in the past year, indicated a seronegative or unknown HIV status and were not taking medically prescribed pre-exposure prophylaxis drugs. Samples were collected by users and posted directly to the laboratory. Characteristics associated with kit acceptance and sample return were analysed using logistic regression. RESULTS: Overall, 7158 eligible MSM were offered to participate in the programme, with 3428 ordering the kit (47.9%) and 1948 returning their sample, leading to a return rate of 56.8% and an overall participation rate of 27.2%. Acceptance and return rates were strongly associated with sociodemographic characteristics, mainly education level but not with behavioural characteristics. Non-college graduates had lower acceptance (44.2%) and return rates (47.7%). CONCLUSION: The programme rapidly recruited a large number of MSM. It removed geographical inequalities related to screening access.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Intervención basada en la Internet/estadística & datos numéricos , Tamizaje Masivo/estadística & datos numéricos , Enfermedades de Transmisión Sexual/diagnóstico , Adulto , Francia/epidemiología , Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Homosexualidad Masculina , Humanos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Juego de Reactivos para Diagnóstico , Parejas Sexuales , Minorías Sexuales y de Género , Enfermedades de Transmisión Sexual/epidemiología , Enfermedades de Transmisión Sexual/prevención & control , Manejo de Especímenes
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