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4.
Malar J ; 19(1): 411, 2020 Nov 16.
Artículo en Inglés | MEDLINE | ID: mdl-33198747

RESUMEN

The global COVID-19 pandemic has been affecting the maintenance of various disease control programmes, including malaria. In some malaria-endemic countries, funding and personnel reallocations were executed from malaria control programmes to support COVID-19 response efforts, resulting mainly in interruptions of disease control activities and reduced capabilities of health system. While it is principal to drive national budget rearrangements during the pandemic, the long-standing malaria control programmes should not be left behind in order to sustain the achievements from the previous years. With different levels of intensity, many countries have been struggling to improve the health system resilience and to mitigate the unavoidable stagnation of malaria control programmes. Current opinion emphasized the impacts of budget reprioritization on malaria-related resources during COVID-19 pandemic in malaria endemic countries in Africa and Southeast Asia, and feasible attempts that can be taken to lessen these impacts.


Asunto(s)
Presupuestos/tendencias , Infecciones por Coronavirus/economía , Enfermedades Endémicas/economía , Recursos en Salud/economía , Malaria/economía , Pandemias/economía , Neumonía Viral/economía , África , Asia Sudoriental , Presupuestos/estadística & datos numéricos , Infecciones por Coronavirus/prevención & control , Enfermedades Endémicas/prevención & control , Recursos en Salud/tendencias , Humanos , Malaria/prevención & control , Control de Mosquitos/economía , Control de Mosquitos/tendencias , Pandemias/prevención & control , Neumonía Viral/prevención & control
7.
Pediatrics ; 146(3)2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32817437

RESUMEN

BACKGROUND: Multiple factors constrain the trajectories of child cognitive development, but the drivers that differentiate the trajectories are unknown. We examine how multiple early life experiences differentiate patterns of cognitive development over the first 5 years of life in low-and middle-income settings. METHODS: Cognitive development of 835 children from the Etiology, Risk Factors, and Interactions of Enteric Infections and Malnutrition and the Consequences for Child Health and Development (MAL-ED) multisite observational cohort study was assessed at 6, 15, 24 (Bayley Scales of Infant and Toddler Development), and 60 months (Wechsler Preschool and Primary Scale of Intelligence). Markers of socioeconomic status, infection, illness, dietary intake and status, anthropometry, and maternal factors were also assessed. Trajectories of development were determined by latent class-mixed models, and factors associated with class membership were examined by discriminant analysis. RESULTS: Five trajectory groups of cognitive development are described. The variables that best discriminated between trajectories included presence of stimulating and learning resources in the home, emotional or verbal responsivity of caregiver and the safety of the home environment (especially at 24 and 60 months), proportion of days (0-24 months) for which the child had diarrhea, acute lower respiratory infection, fever or vomiting, maternal reasoning ability, mean nutrient densities of zinc and phytate, and total energy from complementary foods (9-24 months). CONCLUSIONS: A supporting and nurturing environment was the variable most strongly differentiating the most and least preferable trajectories of cognitive development. In addition, a higher quality diet promoted cognitive development while prolonged illness was indicative of less favorable patterns of development.


Asunto(s)
Desarrollo Infantil/fisiología , Cognición/fisiología , Recursos en Salud/tendencias , Acontecimientos que Cambian la Vida , Preescolar , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Recursos en Salud/economía , Humanos , Recién Nacido , Masculino , Estudios Prospectivos
8.
PLoS One ; 15(7): e0234845, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32609766

RESUMEN

Epidemiological evidence from prospective cohort studies on risk factors of Parkinson's disease (PD) is limited as case ascertainment is challenging due to a lack of registries and the disease course of PD. The objective of this study was to create a case ascertainment method for PD within two prospective Dutch cohorts based on multiple sources of PD information. This method was validated using clinical records from the general practitioners (GPs). Face validity of the case ascertainment was tested for three etiological factors (smoking, sex and family history of PD). In total 54825 participants were included from the cohorts AMIGO and EPIC-NL. Sources of PD information included self-reported PD, self-reported PD medication, a 9 item screening questionnaire (Tanner), electronical medical records, hospital discharge data and mortality records. Based on these sources we developed a likelihood score with 4 categories (no PD, unlikely PD, possible PD, likely PD). For the different sources of PD information and for the likelihood score we present the agreement with GP-validated cases. Risk of PD for established factors was studied by logistic regression as exact diagnose dates were not always available. Based on the algorithm, we assigned 346 participants to the likely PD category. GP validation confirmed 67% of these participants in EPIC-NL, but only 12% in AMIGO. PD was confirmed in only 3% of the participants with a possible PD classification. PD case ascertainment by mortality records (91%), EMR ICPC (82%) and self-reported information (62-69%) had the highest confirmation rates. The Tanner PD screening questionnaire had a lower agreement (18%). Risk estimates for smoking, family history and sex using all likely PD cases were comparable to the literature for EPIC-NL, but not for smoking in AMIGO. Using multiple sources of PD evidence in cohorts remains important but challenging as performance of sources varied in validity.


Asunto(s)
Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/epidemiología , Anciano , Estudios de Cohortes , Registros Electrónicos de Salud/tendencias , Femenino , Recursos en Salud/tendencias , Humanos , Modelos Logísticos , Masculino , Persona de Mediana Edad , Países Bajos , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Autoinforme
9.
Pediatrics ; 146(1)2020 07.
Artículo en Inglés | MEDLINE | ID: mdl-32487592

RESUMEN

OBJECTIVES: Management decisions for patients with gastroenteritis affect resource use within pediatric emergency departments (EDs), and algorithmic care using evidence-based guidelines (EBGs) has become widespread. We aimed to determine if the implementation of a dehydration EBG in a pediatric ED resulted in a reduction in intravenous (IV) fluid administration and the cost of care. METHODS: In a single-center quality improvement initiative between 2010 and 2016, investigators aimed to decrease the percentage of patients with gastroenteritis who were rehydrated with IV fluids. The EBG assigned the patient a dehydration score with subsequent rehydration strategy on the basis of presenting signs and symptoms. The primary outcome was proportion of patients receiving IV fluid, which was analyzed using statistical process control methods. The secondary outcome was cost of the episode of care. Balancing measures included ED length of stay, admission rate, and return visit rate within 72 hours. RESULTS: A total of 7145 patients met inclusion criteria with a median age of 17 months. Use of IV fluid decreased from a mean of 15% to 9% postimplementation. Average episode of care-related health care costs decreased from $599 to $410. For our balancing measures, there were improvements in ED length of stay, rate of admission, and rate of return visits. CONCLUSIONS: Implementation of an EBG for patients with gastroenteritis led to a decrease in frequency of IV administration, shorter lengths of stay, and lower health care costs.


Asunto(s)
Deshidratación/economía , Servicio de Urgencia en Hospital/economía , Fluidoterapia/economía , Gastroenteritis/economía , Recursos en Salud/tendencias , Costos de Hospital/estadística & datos numéricos , Mejoramiento de la Calidad , Algoritmos , Niño , Preescolar , Deshidratación/etiología , Deshidratación/terapia , Femenino , Fluidoterapia/métodos , Gastroenteritis/complicaciones , Gastroenteritis/terapia , Humanos , Lactante , Masculino , Estudios Retrospectivos
10.
Arch Cardiovasc Dis ; 113(6-7): 401-419, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32473996

RESUMEN

BACKGROUND: Guidelines have been published concerning patient management after hospitalization for heart failure. The French national healthcare database (Systèmenationaldesdonnéesdesanté; SNDS) can be used to compare these guidelines with real-life practice. AIMS: To study healthcare utilization 30 days before and after hospitalization for heart failure, and the variations induced by the exclusion of institutionalized patients, who are less exposed to outpatient healthcare utilization. METHODS: We identified the first hospitalization for heart failure in 2015 of adult beneficiaries of the health insurance schemes covering 88% of the French population, who were alive 30 days after hospitalization. Outpatient healthcare utilization rates during the 30 days after hospitalization and the median times to outpatient care, together with their interquartile ranges, were described for all patients, and for a subgroup excluding institutionalized patients. RESULTS: Among the 104,984 patients included (mean age 79 years; 52% women), 74% were non-institutionalized (mean age 78 years; 47% women). The frequencies of at least one consultation after hospitalization and the median times to consultation were 69% (total sample) vs. 78% (subgroup excluding institutionalized patients) and 8 days (interquartile range 3; 16) vs. 7 days (3; 15) for general practitioners, 20% vs. 21% and 14 days (7; 23) vs. 16 days (9; 24) for cardiologists and 58% vs. 69% and 3 days (1; 9) vs. 2 days (1; 7) for nurses, with reimbursement of diuretics in 77% vs. 86%, angiotensin-converting enzyme inhibitors or angiotensin II receptor blockers in 48% vs. 55% and beta-blockers in 55% vs. 63%. Departmental variations, excluding institutionalized patients, were large: general practice consultations (interquartile range 74%; 83%), cardiology consultations (11%; 23%) and nursing care (68%; 77%). CONCLUSIONS: Low outpatient healthcare utilization rates, long intervals to first healthcare utilization and departmental variations indicate a mismatch between guidelines and real-life practice, which is accentuated when including institutionalized patients.


Asunto(s)
Atención Ambulatoria/tendencias , Recursos en Salud/tendencias , Disparidades en Atención de Salud/tendencias , Insuficiencia Cardíaca/terapia , Programas Nacionales de Salud , Admisión del Paciente , Alta del Paciente , Pautas de la Práctica en Medicina/tendencias , Anciano , Anciano de 80 o más Años , Cardiólogos/tendencias , Bases de Datos Factuales , Utilización de Medicamentos/tendencias , Femenino , Francia , Medicina General/tendencias , Adhesión a Directriz/tendencias , Insuficiencia Cardíaca/diagnóstico , Insuficiencia Cardíaca/fisiopatología , Humanos , Masculino , Servicios de Enfermería/tendencias , Guías de Práctica Clínica como Asunto , Derivación y Consulta/tendencias , Factores de Tiempo
11.
Nutr Metab Cardiovasc Dis ; 30(6): 1014-1022, 2020 06 09.
Artículo en Inglés | MEDLINE | ID: mdl-32423665

RESUMEN

BACKGROUND AND AIMS: Nonalcoholic steatohepatitis (NASH) may progress to advanced liver disease (AdvLD). This study characterized comorbidities, healthcare resource utilization (HCRU) and associated costs among hospitalized patients with AdvLD due to NASH in Italy. METHODS AND RESULTS: Adult nonalcoholic fatty liver disease (NAFLD)/NASH patients from 2011 to 2017 were identified from administrative databases of Italian local health units using ICD-9-CM codes. Development of compensated cirrhosis (CC), decompensated cirrhosis (DCC), hepatocellular carcinoma (HCC), or liver transplant (LT) was identified using first diagnosis date for each severity cohort (index-date). Patients progressing to multiple disease stages were included in >1 cohort. Patients were followed from index-date until the earliest of disease progression, end of coverage, death, or end of study. Within each cohort, per member per month values were annualized to calculate all-cause HCRU or costs(€) in 2017. Of the 9,729 hospitalized NAFLD/NASH patients identified, 97% were without AdvLD, 1.3% had CC, 3.1% DCC, 0.8% HCC, 0.1% LT. Comorbidity burden was high across all cohorts. Mean annual number of inpatient services was greater in patients with AdvLD than without AdvLD. Similar trends were observed in outpatient visits and pharmacy fills. Mean total annual costs increased with disease severity, driven primarily by inpatient services costs. CONCLUSION: NAFLD/NASH patients in Italy have high comorbidity burden. AdvLD patients had significantly higher costs. The higher prevalence of DCC compared to CC in this population may suggest challenges of effectively screening and identifying NAFLD/NASH patients. Early identification and effective management are needed to reduce risk of disease progression and subsequent HCRU and costs.


Asunto(s)
Recursos en Salud/economía , Costos de Hospital , Enfermedad del Hígado Graso no Alcohólico/economía , Enfermedad del Hígado Graso no Alcohólico/terapia , Reclamos Administrativos en el Cuidado de la Salud , Adolescente , Adulto , Anciano , Atención Ambulatoria/economía , Carcinoma Hepatocelular/economía , Carcinoma Hepatocelular/epidemiología , Carcinoma Hepatocelular/terapia , Comorbilidad , Bases de Datos Factuales , Progresión de la Enfermedad , Costos de los Medicamentos , Femenino , Recursos en Salud/tendencias , Costos de Hospital/tendencias , Humanos , Italia/epidemiología , Cirrosis Hepática/economía , Cirrosis Hepática/epidemiología , Cirrosis Hepática/terapia , Neoplasias Hepáticas/economía , Neoplasias Hepáticas/epidemiología , Neoplasias Hepáticas/terapia , Trasplante de Hígado/economía , Masculino , Persona de Mediana Edad , Enfermedad del Hígado Graso no Alcohólico/diagnóstico , Enfermedad del Hígado Graso no Alcohólico/epidemiología , Admisión del Paciente/economía , Prevalencia , Pronóstico , Estudios Retrospectivos , Factores de Riesgo , Factores de Tiempo , Adulto Joven
12.
Pediatrics ; 145(6)2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32376726

RESUMEN

OBJECTIVES: Unplanned extubations (UEs) in adult and pediatric populations are associated with poor clinical outcomes and increased costs. In-hospital outcomes and costs of UE in the NICU are not reported. Our objective was to determine the association of UE with clinical outcomes and costs in very-low-birth-weight infants. METHODS: We performed a retrospective matched cohort study in our level 4 NICU from 2014 to 2016. Very-low-birth-weight infants without congenital anomalies admitted by 72 hours of age, who received mechanical ventilation (MV), were included. Cases (+UE) were matched 1:1 with controls (-UE) on the basis of having an equivalent MV duration at the time of UE in the case, gestational age, and Clinical Risk Index for Babies score. We compared MV days after UE in cases or the equivalent date in controls (postmatching MV), in-hospital morbidities, and hospital costs between the matched pairs using raw and adjusted analyses. RESULTS: Of 345 infants who met inclusion criteria, 58 had ≥1 UE, and 56 out of 58 (97%) were matched with appropriate controls. Postmatching MV was longer in cases than controls (median: 12.5 days; interquartile range [IQR]: 7 to 25.8 vs median 6 days; IQR: 2 to 12.3; adjusted odds ratio: 4.3; 95% confidence interval: 1.9-9.5). Inflation-adjusted total hospital costs were higher in cases (median difference: $49 587; IQR: -15 063 to 119 826; adjusted odds ratio: 3.8; 95% confidence interval: 1.6-8.9). CONCLUSIONS: UEs in preterm infants are associated with worse outcomes and increased hospital costs. Improvements in UE rates in NICUs may improve clinical outcomes and lower hospital costs.


Asunto(s)
Extubación Traqueal/economía , Recursos en Salud/economía , Costos de Hospital , Recien Nacido Prematuro/fisiología , Recién Nacido de muy Bajo Peso/fisiología , Extubación Traqueal/tendencias , Estudios de Cohortes , Femenino , Recursos en Salud/tendencias , Costos de Hospital/tendencias , Humanos , Recién Nacido , Masculino , Estudios Prospectivos , Estudios Retrospectivos , Resultado del Tratamiento
13.
J Hepatol ; 73(4): 873-881, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-32454041

RESUMEN

BACKGROUND & AIMS: The outbreak of COVID-19 has vastly increased the operational burden on healthcare systems worldwide. For patients with end-stage liver failure, liver transplantation is the only option. However, the strain on intensive care facilities caused by the pandemic is a major concern. There is an urgent need for ethical frameworks to balance the need for liver transplantation against the availability of national resources. METHODS: We performed an international multicenter study of transplant centers to understand the evolution of policies for transplant prioritization in response to the pandemic in March 2020. To describe the ethical tension arising in this setting, we propose a novel ethical framework, the quadripartite equipoise (QE) score, that is applicable to liver transplantation in the context of limited national resources. RESULTS: Seventeen large- and medium-sized liver transplant centers from 12 countries across 4 continents participated. Ten centers opted to limit transplant activity in response to the pandemic, favoring a "sickest-first" approach. Conversely, some larger centers opted to continue routine transplant activity in order to balance waiting list mortality. To model these and other ethical tensions, we computed a QE score using 4 factors - recipient outcome, donor/graft safety, waiting list mortality and healthcare resources - for 7 countries. The fluctuation of the QE score over time accurately reflects the dynamic changes in the ethical tensions surrounding transplant activity in a pandemic. CONCLUSIONS: This four-dimensional model of quadripartite equipoise addresses the ethical tensions in the current pandemic. It serves as a universally applicable framework to guide regulation of transplant activity in response to the increasing burden on healthcare systems. LAY SUMMARY: There is an urgent need for ethical frameworks to balance the need for liver transplantation against the availability of national resources during the COVID-19 pandemic. We describe a four-dimensional model of quadripartite equipoise that models these ethical tensions and can guide the regulation of transplant activity in response to the increasing burden on healthcare systems.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Enfermedad Hepática en Estado Terminal , Recursos en Salud/tendencias , Trasplante de Hígado , Pandemias , Neumonía Viral/epidemiología , Obtención de Tejidos y Órganos , Betacoronavirus , Enfermedad Hepática en Estado Terminal/mortalidad , Enfermedad Hepática en Estado Terminal/cirugía , Humanos , Cooperación Internacional , Trasplante de Hígado/ética , Trasplante de Hígado/métodos , Innovación Organizacional , Pandemias/ética , Pandemias/prevención & control , Selección de Paciente/ética , Encuestas y Cuestionarios , Obtención de Tejidos y Órganos/ética , Obtención de Tejidos y Órganos/organización & administración , Obtención de Tejidos y Órganos/tendencias , Listas de Espera/mortalidad
14.
Am J Nurs ; 120(6): 48-55, 2020 06.
Artículo en Inglés | MEDLINE | ID: mdl-32443125

RESUMEN

Nurses have the capacity and opportunity to alter their organization's environmental footprint. This article addresses how they can strengthen efficiency and environmental sustainability initiatives in their facilities by engaging in, monitoring, and supporting environmentally friendly clinical practices and programs at the point of care. Included are practical tips and examples of projects in which nurses identified sources of waste-the relaundering of unused linens; disposal of unused products; and improper sorting of pharmaceutical waste, recycling, and regulated medical waste-and realized significant cost savings as well as improved efficiency and environmental sustainability.


Asunto(s)
Administración de Residuos/métodos , Ropa de Cama y Ropa Blanca/efectos adversos , Ropa de Cama y Ropa Blanca/normas , Restauración y Remediación Ambiental/métodos , Restauración y Remediación Ambiental/tendencias , Recursos en Salud/tendencias , Humanos , Reciclaje/métodos , Reciclaje/tendencias
16.
PLoS Med ; 17(3): e1003061, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32182239

RESUMEN

BACKGROUND: Migrant women, especially from Indian and African ethnicity, have a higher risk of stillbirth than native-born populations in high-income countries. Differential access or timing of ANC and the uptake of other services may play a role. We investigated the pattern of healthcare utilisation among migrant women and its relationship with the risk of stillbirth (SB)-antepartum stillbirth (AnteSB) and intrapartum stillbirth (IntraSB)-in Western Australia (WA). METHODS AND FINDINGS: A retrospective cohort study using de-identified linked data from perinatal, birth, death, hospital, and birth defects registrations through the WA Data Linkage System was undertaken. All (N = 260,997) non-Indigenous births (2005-2013) were included. Logistic regression analysis was used to estimate odds ratios and 95% CI for AnteSB and IntraSB comparing migrant women from white, Asian, Indian, African, Maori, and 'other' ethnicities with Australian-born women controlling for risk factors and potential healthcare-related covariates. Of all the births, 66.1% were to Australian-born and 33.9% to migrant women. The mean age (years) was 29.5 among the Australian-born and 30.5 among the migrant mothers. For parity, 42.3% of Australian-born women, 58.2% of Indian women, and 29.3% of African women were nulliparous. Only 5.3% of Maori and 9.2% of African migrants had private health insurance in contrast to 43.1% of Australian-born women. Among Australian-born women, 14% had smoked in pregnancy whereas only 0.7% and 1.9% of migrants from Indian and African backgrounds, respectively, had smoked in pregnancy. The odds of AnteSB was elevated in African (odds ratio [OR] 2.22, 95% CI 1.48-2.13, P < 0.001), Indian (OR 1.64, 95% CI 1.13-2.44, P = 0.013), and other women (OR 1.46, 95% CI 1.07-1.97, P = 0.016) whereas IntraSB was higher in African (OR 5.24, 95% CI 3.22-8.54, P < 0.001) and 'other' women (OR 2.18, 95% CI 1.35-3.54, P = 0.002) compared with Australian-born women. When migrants were stratified by timing of first antenatal visit, the odds of AnteSB was exclusively increased in those who commenced ANC later than 14 weeks gestation in women from Indian (OR 2.16, 95% CI 1.18-3.95, P = 0.013), Maori (OR 3.03, 95% CI 1.43-6.45, P = 0.004), and 'other' (OR 2.19, 95% CI 1.34-3.58, P = 0.002) ethnicities. With midwife-only intrapartum care, the odds of IntraSB for viable births in African and 'other' migrants (combined) were more than 3 times that of Australian-born women (OR 3.43, 95% CI 1.28-9.19, P = 0.014); however, with multidisciplinary intrapartum care, the odds were similar to that of Australian-born group (OR 1.34, 95% CI 0.30-5.98, P = 0.695). Compared with Australian-born women, migrant women who utilised interpreter services had a lower risk of SB (OR 0.51, 95% CI 0.27-0.96, P = 0.035); those who did not utilise interpreters had a higher risk of SB (OR 1.20, 95% CI 1.07-1.35, P < 0.001). Covariates partially available in the data set comprised the main limitation of the study. CONCLUSION: Late commencement of ANC, underutilisation of interpreter services, and midwife-only intrapartum care are associated with increased risk of SB in migrant women. Education to improve early engagement with ANC, better uptake of interpreter services, and the provision of multidisciplinary-team intrapartum care to women specifically from African and 'other' backgrounds may reduce the risk of SB in migrants.


Asunto(s)
Emigrantes e Inmigrantes , Emigración e Inmigración , Conocimientos, Actitudes y Práctica en Salud/etnología , Recursos en Salud , Disparidades en Atención de Salud/etnología , Servicios de Salud Materna , Aceptación de la Atención de Salud/etnología , Mortinato/etnología , Adulto , Grupo de Ascendencia Continental Africana , Grupo de Ascendencia Continental Asiática , Recursos en Salud/tendencias , Disparidades en Atención de Salud/tendencias , Humanos , Servicios de Salud Materna/tendencias , Persona de Mediana Edad , Grupo de Ascendencia Oceánica , Educación del Paciente como Asunto/tendencias , Factores Raciales , Estudios Retrospectivos , Medición de Riesgo , Factores de Riesgo , Australia Occidental/epidemiología , Adulto Joven
17.
PLoS Med ; 17(3): e1003043, 2020 03.
Artículo en Inglés | MEDLINE | ID: mdl-32126079

RESUMEN

BACKGROUND: Globally, international migration is increasing. Population growth, along with other demographic changes, may be expected to put new pressures on healthcare systems. Some studies across Europe suggest that emergency departments (EDs) are used more, and differently, by migrants compared to non-migrant populations, which may be a result of unfamiliarity with the healthcare systems and difficulties accessing primary healthcare. However, little evidence exists to understand how migrant parents, who are typically young and of childbearing age, utilise EDs for their children. This study aimed to examine the association between paediatric ED utilisation in the first 5 years of life and maternal migration status in the Born in Bradford (BiB) cohort study. METHODS AND FINDINGS: We analysed linked data from the BiB study-an ongoing, multi-ethnic prospective birth cohort study in Bradford. Bradford is a large, ethnically diverse city in the north of England. In 2017, more than a third of births in Bradford were to mothers who were born outside the UK. Between March 2007 and December 2010, pregnant women were recruited to BiB during routine antenatal care, and the children born to these mothers have been, and continue to be, followed over time to assess how social, genetic, environmental, and behavioural factors impact on health from childhood to adulthood. Data analysed in this study included baseline questionnaire data from BiB mothers, and Bradford Royal Infirmary ED episode data for their children. Main outcomes were likelihood of paediatric ED use (no visits versus at least 1 ED visit in the first 5 years of life) and ED utilisation rates (number and frequency of ED visits) for children who have accessed the ED. The main explanatory variable was mother's migrant status (foreign-born versus UK/Irish-born). Multivariable analyses (logistic and zero-truncated negative binomial regression) were conducted adjusting for socio-demographic and socio-economic factors. The final dataset included 10,168 children born between April 2007 and June 2011, of whom 35.6% were born to migrant mothers. Foreign-born mothers originated from South Asia (28.6%), Europe/Central Asia (3.2%), Africa (2.1%), East Asia/Pacific (1.1%), and the Middle East (0.6%). At recruitment the mothers ranged in age from 15 to 49 years old. Overall, 3,104 (30.5%) children had at least 1 ED visit in the first 5 years of life, with the highest proportion of visits being in the first year of life (36.7%). The proportion of children who visited the ED at least once was lower for children of migrant mothers as compared to children of non-migrant mothers (29.4% versus 31.2%). Children of migrant mothers were found to be less likely to visit the ED (odds ratio 0.88 [95% CI 0.80 to 0.97], p = 0.012). However, among children who visited the ED, the utilisation rate was significantly higher for children of migrant mothers (incidence rate ratio [IRR] 1.19 [95% CI 1.01 to 1.40], p = 0.040). Utilisation rates were higher for children born to mothers from Europe (IRR 1.71 [95% CI 1.07 to 2.71], p = 0.024) and established migrants (≥5 years living in UK) (IRR 1.24 [95% CI 1.02 to 1.51], p = 0.032) compared to UK/Irish-born mothers. Important limitations include being unable to measure children's underlying health status and the urgency of ED attendance, as well as the analysis being limited by missing data. CONCLUSIONS: In this study we observed that there is no higher likelihood of first paediatric ED attendance in the first 5 years of life for children in the BiB cohort for migrant mothers. However, among ED users, children of migrant mothers attend the service more frequently than children of UK/Irish-born mothers. Our findings show that patterns of ED utilisation differ by mother's region of origin and time since arrival in the UK.


Asunto(s)
Servicio de Urgencia en Hospital/tendencias , Emigrantes e Inmigrantes , Emigración e Inmigración/tendencias , Recursos en Salud/tendencias , Madres , Aceptación de la Atención de Salud , Pediatría/tendencias , Adolescente , Adulto , Preescolar , Estudios Transversales , Grupos Étnicos , Femenino , Humanos , Lactante , Recién Nacido , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Estudios Prospectivos , Factores Raciales , Factores Socioeconómicos , Adulto Joven
18.
Rev Bras Enferm ; 73(1): e20170864, 2020.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-32049217

RESUMEN

OBJECTIVE: to analyze a Psychosocial Care Network structure, based on the compromise of its resources and meeting objectives and guidelines recommended in Ordinance 3,088/2011. METHOD: an empirical, quantitative study with 123 primary care professionals, psychosocial and emergency care, who work at Western Network of the city of São Paulo. Questionnaires and statistical analysis were applied through the Exact Fisher's test with 5% significance considering p= <0.05. RESULTS: there is compromise of physical resources in the absence of mental health beds in a general hospital (p=0.047); of technological resources in the lack of discussion forums (p=0.036); of human resources in number of teams (p=0.258); and of financial resources (p=0.159). Psychosocial care is the one that most meets the objectives and guidelines. CONCLUSION: there are insufficient physical, technological, human, and financial resources for the work articulated in the three care modalities that are heterogeneous in terms of meeting the objectives and guidelines.


Asunto(s)
Redes Comunitarias/tendencias , Recursos en Salud/tendencias , Sistemas de Apoyo Psicosocial , Brasil , Hospitales Psiquiátricos/organización & administración , Hospitales Psiquiátricos/estadística & datos numéricos , Humanos , Encuestas y Cuestionarios
19.
Trends Parasitol ; 36(4): 321-324, 2020 04.
Artículo en Inglés | MEDLINE | ID: mdl-32035817

RESUMEN

BEI Resources has contributed to the advancement of parasitic diseases research for over 16 years. The accessibility of our reference strains and reagents is relevant to the development of new therapeutics and vaccines. Here we provide a resource update with emphasis on the new assets for toxoplasmosis and vector research.


Asunto(s)
Vectores Artrópodos , Recursos en Salud/tendencias , Parásitos , Parasitología/métodos , Parasitología/tendencias , Animales
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