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1.
Ital J Pediatr ; 49(1): 52, 2023 May 04.
Artículo en Inglés | MEDLINE | ID: mdl-37143161

RESUMEN

BACKGROUND: The quality of life in children undergoing tonsillectomy remains unclear. We aimed to analyze the current status and influencing factors of quality of life in children undergoing tonsillectomy, to provide useful insights to clinical postoperative care for children. METHODS: Children who underwent tonsillectomy in our hospital from June 1, 2021 to October 31, 2022 were selected. The characteristics of children were collected and Paediatric Quality of Life Inventory Version 4.0 (PedsQL™ 4.0) was used for evaluating the quality of life in children. Pearson correlation, univariate and logistic regression analyses were condcuted to evaluate the influencing factors of quality of life in children undergoing tonsillectomy. RESULTS: A total of 118 children undergoing tonsillectomy were included. The total score of PedsQL™ 4.0 in children undergoing tonsillectomy was (70.28 ± 13.15). Pearson correlation analyses indicated that age(r = 0.586), courses of tonsillitis(r = 0.595), parental education level(r = 0.612) and monthly family income(r = 0.608) were associated with the PedsQL™ 4.0 total score in children undergoing tonsillectomy (all P < 0.05). Logistic regression analyses indicated that age ≤ 5y (OR = 2.009,95%CI: 1.826 ~ 2.401), courses of tonsillitis ≥ 3years (OR = 2.167,95%CI: 1.688 ~ 2.547), high school of parental education level (OR = 1.807,95%CI: 1.224 ~ 2.181) and monthly family income ≤ 5000 RMB(OR = 2.624,95%CI:2.092 ~ 3.077) were the independent influencing factors of quality of life in children with undergoing tonsillectomy (all P < 0.05). CONCLUSIONS: The quality of life of children after tonsillectomy is not high, and the quality of life of children is affected by many factors. Medical staff should take early targeted nursing countermeasures tageted on those influencing factors to improve the quality of life of children.


Asunto(s)
Tonsilectomía , Tonsilitis , Niño , Humanos , Calidad de Vida , Estudios Transversales , Tonsilitis/cirugía , Renta
2.
BMC Health Serv Res ; 23(1): 509, 2023 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-37208673

RESUMEN

BACKGROUND: The Affordable Care Act (ACA) provisions, especially Medicaid expansion, are believed to have "spillover effects," such as boosting participation in the Supplemental Nutrition Assistance Program (SNAP) among eligible individuals in the United States (US). However, little empirical evidence exists about the impact of the ACA, with its focus on the dual eligible population, on SNAP participation. The current study investigates whether the ACA, under an explicit policy aim of enhancing the interface between Medicare and Medicaid, has improved participation in the SNAP among low-income older Medicare beneficiaries. METHODS: We extracted 2009 through 2018 data from the US Medical Expenditure Panel Survey (MEPS) for low-income (≤ %138 Federal Poverty Level [FPL]) older Medicare beneficiaries (n = 50,466; aged ≥ 65), and low-income (≤ %138 FPL) younger adults (aged 20 to < 65 years, n = 190,443). MEPS respondents of > %138 FPL incomes, younger Medicare and Medicaid beneficiaries, and older adults without Medicare were excluded from this study. Using a quasi-experimental comparative interrupted time-series design, we examined (1) whether ACA's support for the Medicare-Medicaid dual-eligible program, through facilitating the online Medicaid application process, was associated with an increase in SNAP uptake among low-income older Medicare beneficiaries, and (2) in the instance of an association, to assess the magnitude of SNAP uptake that can be explicitly attributed to the policy's implementation. The outcome, SNAP participation, was measured annually from 2009 through 2018. The year 2014 was set as the intervention point when the Medicare-Medicaid Coordination Office started facilitating Medicaid applications online for eligible Medicare beneficiaries. RESULTS: Overall, the change in the probability of SNAP enrollment from the pre- to post-intervention period was 17.4 percentage points higher among low-income older Medicare enrollees, compared to similarly low-income, SNAP-eligible, younger adults (ß = 0.174, P < .001). This boost in SNAP uptake was significant and more apparent among older White (ß = 0.137, P = .049), Asians (ß = 0.408, P = .047), and all non-Hispanic adults (ß = 0.030, P < .001). CONCLUSIONS: The ACA had a positive, measurable effect on SNAP participation among older Medicare beneficiaries. Policymakers should consider additional approaches that link enrollment to multiple programs to increase SNAP participation. Further, there may be a need for additional, targeted efforts to address structural barriers to uptake among African Americans and Hispanics.


Asunto(s)
Asistencia Alimentaria , Medicare , Humanos , Anciano , Estados Unidos , Patient Protection and Affordable Care Act , Pobreza , Renta , Medicaid
3.
BMC Geriatr ; 23(1): 285, 2023 05 11.
Artículo en Inglés | MEDLINE | ID: mdl-37170103

RESUMEN

BACKGROUND: Older adults with physical disability need long-term services and support, which incur enormous costs. However, supportive environments may reduce disability and promote aging in place. It is unclear how the physical and social environment affect different types of functional impairments and influence the performance of activities of daily living (ADL) in physically disabled older adults. OBJECTIVE: The purpose of this study was to examine the relationship between person, environmental factors, and ADL performance among physically disabled older adults living at home. METHODS: This was a cross-sectional study. Using long-term care insurance claims data from a pilot city in China, we used a structural equation model to assess the potential paths among person, environmental factors, and ADL performance. RESULTS: Education and income had different influences on the social environment and physical environment. The functional impairments had significant effects on ADL performance, either directly or through physical environment (with handrails) and social environment (family support). CONCLUSIONS: The present findings offer crucial evidence for understanding the interactions between a person and the environment, as well as their influence on physical ADLs, suggesting the importance of a supportive environment and a subpopulation-targeting strategy for disabled older adults.


Asunto(s)
Actividades Cotidianas , Personas con Discapacidad , Humanos , Anciano , Vida Independiente , Estudios Transversales , Renta
5.
JAMA ; 329(19): 1650-1661, 2023 05 16.
Artículo en Inglés | MEDLINE | ID: mdl-37191704

RESUMEN

Importance: Most epidemiological studies of heart failure (HF) have been conducted in high-income countries with limited comparable data from middle- or low-income countries. Objective: To examine differences in HF etiology, treatment, and outcomes between groups of countries at different levels of economic development. Design, Setting, and Participants: Multinational HF registry of 23 341 participants in 40 high-income, upper-middle-income, lower-middle-income, and low-income countries, followed up for a median period of 2.0 years. Main Outcomes and Measures: HF cause, HF medication use, hospitalization, and death. Results: Mean (SD) age of participants was 63.1 (14.9) years, and 9119 (39.1%) were female. The most common cause of HF was ischemic heart disease (38.1%) followed by hypertension (20.2%). The proportion of participants with HF with reduced ejection fraction taking the combination of a ß-blocker, renin-angiotensin system inhibitor, and mineralocorticoid receptor antagonist was highest in upper-middle-income (61.9%) and high-income countries (51.1%), and it was lowest in low-income (45.7%) and lower-middle-income countries (39.5%) (P < .001). The age- and sex- standardized mortality rate per 100 person-years was lowest in high-income countries (7.8 [95% CI, 7.5-8.2]), 9.3 (95% CI, 8.8-9.9) in upper-middle-income countries, 15.7 (95% CI, 15.0-16.4) in lower-middle-income countries, and it was highest in low-income countries (19.1 [95% CI, 17.6-20.7]). Hospitalization rates were more frequent than death rates in high-income countries (ratio = 3.8) and in upper-middle-income countries (ratio = 2.4), similar in lower-middle-income countries (ratio = 1.1), and less frequent in low-income countries (ratio = 0.6). The 30-day case-fatality rate after first hospital admission was lowest in high-income countries (6.7%), followed by upper-middle-income countries (9.7%), then lower-middle-income countries (21.1%), and highest in low-income countries (31.6%). The proportional risk of death within 30 days of a first hospital admission was 3- to 5-fold higher in lower-middle-income countries and low-income countries compared with high-income countries after adjusting for patient characteristics and use of long-term HF therapies. Conclusions and Relevance: This study of HF patients from 40 different countries and derived from 4 different economic levels demonstrated differences in HF etiologies, management, and outcomes. These data may be useful in planning approaches to improve HF prevention and treatment globally.


Asunto(s)
Países Desarrollados , Países en Desarrollo , Salud Global , Insuficiencia Cardíaca , Femenino , Humanos , Masculino , Persona de Mediana Edad , Causalidad , Insuficiencia Cardíaca/epidemiología , Insuficiencia Cardíaca/etiología , Insuficiencia Cardíaca/mortalidad , Insuficiencia Cardíaca/terapia , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Hipertensión/complicaciones , Hipertensión/epidemiología , Renta , Volumen Sistólico , Salud Global/estadística & datos numéricos , Sistema de Registros/estadística & datos numéricos , Países Desarrollados/economía , Países Desarrollados/estadística & datos numéricos , Países en Desarrollo/economía , Países en Desarrollo/estadística & datos numéricos , Anciano
6.
Int J Equity Health ; 22(1): 93, 2023 05 17.
Artículo en Inglés | MEDLINE | ID: mdl-37198638

RESUMEN

BACKGROUND: Rare diseases (RDs) are difficult to diagnose and expensive to treat. Thus, the South Korean government has implemented several policies to help RD patients, including the Medical Expense Support Project, supporting low- to middle-income RD patients. However, no study in Korea has yet addressed health inequity in RD patients. This study assessed inequity trends in the medical utilization and expenditures of RD patients. METHODS: This study measured the horizontal inequity index (HI) of RD patients and an age- and sex-matched control group using the National Health Insurance Service data from 2006 to 2018. Sex, age, number of chronic diseases, and disability variables were used to model expected medical needs and adjust the concentration index (CI) for medical utilization and expenditures. RESULTS: The HI index of healthcare utilization in RD patients and the control group ranged from -0.0129 to 0.0145, increasing until 2012 and fluctuating since then. This increasing trend was more apparent for inpatient utilization in the RD patient group than in the outpatient group. The same index in the control group ranged from -0.0112 to -0.0040 without a significant trend. The healthcare expenditure HI in RD patients rose from -0.0640 to -0.0038, showing pro-poor values but moving toward a pro-rich state. In the control group, the HI for healthcare expenditures remained between 0.0029 and 0.0085. CONCLUSIONS: The HI of inpatient utilization and inpatient expenditures increased in a pro-rich state. The study results showed that implementing a policy that supports inpatient service utilization could help achieve health equity for RD patients.


Asunto(s)
Disparidades en Atención de Salud , Enfermedades Raras , Humanos , Enfermedades Raras/epidemiología , Enfermedades Raras/terapia , Aceptación de la Atención de Salud , Renta , República de Corea , China , Factores Socioeconómicos
7.
PLoS One ; 18(5): e0285379, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37200271

RESUMEN

BACKGROUND: The personal economic impact of bariatric surgery is not well-described. OBJECTIVES: To examine earnings and work loss from 5 years before to 5 years after bariatric surgery compared with the general population. SETTING: Nationwide matched cohort study in the Swedish health care system. METHODS: Patients undergoing primary bariatric surgery (n = 15,828) and an equal number of comparators from the Swedish general population were identified and matched on age, sex, place of residence, and educational level. Annual taxable earnings (primary outcome) and annual work loss (secondary outcome combining months with sick leave and disability pension) were retrieved from Statistics Sweden. Participants were included in the analysis until the year of study end, emigration or death. RESULTS: From 5 years before to 5 years after bariatric surgery, earnings increased for patients overall and in subgroups defined by education level and sex, while work loss remained relatively constant. Bariatric patients and matched comparators from the general population increased their earnings in a near parallel fashion, from 5 years before (mean difference -$3,489 [95%CI -3,918 to -3,060]) to 5 years after surgery (-$4,164 [-4,709 to -3,619]). Work loss was relatively stable within both groups but with large absolute differences both at 5 years before (1.09 months, [95%CI 1.01 to 1.17]) and 5 years after surgery (1.25 months, [1.11 to 1.40]). CONCLUSIONS: Five years after treatment, bariatric surgery had not reduced the gap in earnings and work loss between surgery patients and matched comparators from the general population.


Asunto(s)
Cirugía Bariátrica , Renta , Humanos , Estudios de Cohortes , Pensiones , Ausencia por Enfermedad , Suecia/epidemiología
8.
PLoS One ; 18(5): e0286010, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37200341

RESUMEN

Multiple sclerosis (MS) is a chronic neurological disease that may cause several different symptoms, some which may entail the need for help in daily life. The aim of this study was to explore the association between sociodemographic background factors and the use of personal assistance and home help services (home help) among persons with MS in Sweden. The study was based on cross-sectional survey data merged with register data and included 3,863 persons with MS aged 20-51. Binary logistic regression analyses were performed to identify factors associated with the use of personal assistance and home help. The central finding of this study was that grade of impairment, as determined by the Expanded Disability Status Scale for Multiple Sclerosis (EDSS), was the most important variable associated with the use of both personal assistance (p < 0.001, OR 18.83) and home help (p < 0.001, OR 6.83). Living alone and receiving sickness benefit were also both associated with the use of personal assistance (p < 0.001, OR 3.32; p 0.001, OR 3.32) and home help (p 0.004, OR 2.56; p 0.011, OR 2.56). Stating a visible symptom of MS as being the most limiting factor of the disease (p 0.001, OR 2.73) and having a disposable income below the limit for poverty risk (p 0.02, OR 2.16) was associated with the use of personal assistance. Receiving informal, meaning unpaid, help (p 0.049, OR 1.89) was associated with the use of home help. Several background factors were controlled for but were not related to differences in the usage of formal help. The results indicated no significant differences in demographic characteristics that could be linked to unequal distribution. However, differences were found between those using personal assistance and home help. The latter were mainly affected by invisible symptoms, suggesting a plausible influencing factor in the chances of obtaining more comprehensive help in the form of personal assistance. Users of home help were also more likely to receive informal help than users of personal assistance, which may suggest that home help is not sufficient.


Asunto(s)
Personas con Discapacidad , Esclerosis Múltiple , Humanos , Actividades Cotidianas , Esclerosis Múltiple/epidemiología , Esclerosis Múltiple/terapia , Suecia/epidemiología , Estudios Transversales , Renta
9.
Stud Health Technol Inform ; 302: 217-221, 2023 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-37203650

RESUMEN

Social determinants of health (SDOH) impact 80% of health outcomes from acute to chronic disorders, and attempts are underway to provide these data elements to clinicians. It is, however, difficult to collect SDOH data through (1) surveys, which provide inconsistent and incomplete data, or (2) aggregates at the neighborhood level. Data from these sources is not sufficiently accurate, complete, and up-to-date. To demonstrate this, we have compared the Area Deprivation Index (ADI) to purchased commercial consumer data at the individual-household level. The ADI is composed of income, education, employment, and housing quality information. Although this index does a good job of representing populations, it is not adequate to describe individuals, especially in a healthcare context. Aggregate measures are, by definition, not sufficiently granular to describe each individual within the population they represent and may result in biased or imprecise data when simply assigned to the individual. Moreover, this problem is generalizable to any community-level element, not just ADI, in so far as they are an aggregate of the individual community members.


Asunto(s)
Exactitud de los Datos , Determinantes Sociales de la Salud , Humanos , Características de la Residencia , Empleo , Renta
10.
J Glob Health ; 13: 04053, 2023 May 19.
Artículo en Inglés | MEDLINE | ID: mdl-37204132

RESUMEN

Background: Physical functional disability is prevalent among middle-aged and older adults, with substantial health inequality. This study compared cross-country variation in the prevalence and inequality of physical functional disability and investigated the potential determinants of household income-related inequality. Methods: This cross-sectional study used data from 33 countries between 2017 and 2020, containing 141 016 participants aged 55 years and older. Physical functions were grouped into three domains: activities of daily living (ADLs), instrumental activities of daily living (IADLs), and mobility function. Physical functional disability of each domain was indicated by having some difficulty with the activity. We first estimated the prevalence of physical functional disability in each country. Second, the concentration index was used to quantify household income-related health inequality. Finally, recentred influence function (RIF) decomposition method was used to decompose the inequality into individual and country-level determinants. Results: Physical functional disability prevalence was higher in lower-middle-income countries than in high-income countries and more prevalent in the poor-income groups in all study countries. Besides, health inequality in different domains of disability was higher in high-income countries than in low-income countries. Regarding determinants of health inequality, we found that individual married, tertiary education, and country-level health infrastructure and resources were associated with reduced health inequality. In contrast, age, unhealthy lifestyles, and chronic diseases were associated with increased health inequality. Conclusions: Inequality in physical functional disability among middle-aged and older adults varies substantially across countries, with individual and macro determinants being contributing factors. Policies to achieve healthy ageing and reduce the inequality of physical function disability can focus on improving individual healthy lifestyles and country health care facilities.


Asunto(s)
Actividades Cotidianas , Disparidades en el Estado de Salud , Persona de Mediana Edad , Humanos , Anciano , Factores Socioeconómicos , Estudios Transversales , Renta
11.
PLoS One ; 18(5): e0284572, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37163564

RESUMEN

BACKGROUND: Youth orphaned by HIV in sub-Saharan Africa experience immense hardships including social disadvantage, adverse childhood events and limited economic prospects. These adversities disrupt the normative developmental milestones and can gravely compromise their health and emotional wellbeing. The Bridges to the Future study (2012-2018) prospectively followed 1,383 adolescents, between 10-16 years, to evaluate the efficacy and cost-effectiveness of a family-based economic empowerment intervention comprising of child development accounts, financial literacy training, family income generating activities and peer mentorship. Study findings show efficacy of this contextually-driven intervention significantly improving mental health, school retention and performance and sexual health. However, critical questions, such as those related to the longitudinal impact of economic empowerment on HIV prevention and engagement in care remain. This paper presents a protocol for the follow-up phase titled, Bridges Round 2. METHODS: The Original Bridges study participants will be tracked for an additional four years (2022-2026) to examine the longitudinal developmental and behavioral health outcomes and potential mechanisms of the effect of protective health behaviors of the Bridges cohort. The study will include a new qualitative component to examine participants' experiences with the intervention, the use of biomedical data to provide the most precise results of the highly relevant, but currently unknown sexual health outcomes among study participants, as well as a cost-benefit analysis to inform policy and scale-up. DISCUSSION: Study findings may contribute to the scientific knowledge for low-resource communities on the potential value of providing modest economic resources to vulnerable boys and girls during childhood and early adolescence and how these resources may offer long-term protection against known HIV risks, poor mental health functioning and improve treatment among the HIV treatment care continuum.


Asunto(s)
Síndrome de Inmunodeficiencia Adquirida , Masculino , Niño , Femenino , Humanos , Adolescente , Adulto Joven , Adulto , Renta , Empoderamiento , Conductas Relacionadas con la Salud , Continuidad de la Atención al Paciente
12.
JAMA Netw Open ; 6(5): e2310367, 2023 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-37145601

RESUMEN

Importance: The expansion of genetic and genomic testing in health care has led to recognition that these tests provide personal as well as clinical utility to patients and families. However, available systematic reviews on this topic have not reported the demographic backgrounds of participants in studies of personal utility, leaving generalizability unclear. Objective: To determine the demographic characteristics of participants in studies examining the personal utility of genetic and genomic testing in health care. Evidence Review: For this systematic review, we utilized and updated the results of a highly cited 2017 systematic review on the personal utility of genetics and genomics, which identified relevant articles published between January 1, 2003, and August 4, 2016. We also used the original methods to update this bibliography with literature published subsequently up to January 1, 2022. Studies were screened for eligibility by 2 independent reviewers. Eligible studies reported empirical data on the perspectives of patients, family members, and/or the general public in the US on the personal utility of any type of health-related genetic or genomic test. We utilized a standardized codebook to extract study and participant characteristics. We summarized demographic characteristics descriptively across all studies and by subgroup based on study and participant characteristics. Findings: We included 52 studies with 13 251 eligible participants. Sex or gender was the most frequently reported demographic characteristic (48 studies [92.3%]), followed by race and ethnicity (40 studies [76.9%]), education (38 studies [73.1%]), and income (26 studies [50.0%]). Across studies, participants disproportionately were women or female (mean [SD], 70.8% [20.5%]), were White (mean [SD], 76.1% [22.0%]), had a college degree or higher (mean [SD], 64.5% [19.9%]), and reported income above the US median (mean [SD], 67.4% [19.2%]). Examination of subgroups of results by study and participant characteristics evidenced only small shifts in demographic characteristics. Conclusions and Relevance: This systematic review examined the demographic characteristics of individual participants in studies of the personal utility of health-related genetic and genomic testing in the US. The results suggest that participants in these studies were disproportionately White, college-educated women with above-average income. Understanding the perspectives of more diverse individuals regarding the personal utility of genetic and genomic testing may inform barriers to research recruitment and uptake of clinical testing in currently underrepresented populations.


Asunto(s)
Etnicidad , Genómica , Humanos , Femenino , Masculino , Escolaridad , Renta , Familia
13.
Front Public Health ; 11: 1098005, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37151599

RESUMEN

Introduction: Older people spend a lot of time at home and in the area near where they live. Housing conditions ensure their ability to participate in social life, especially when they suffer from mobility restrictions. Barrier-free access to the residence and to rooms within the residence is a key condition for their everyday mobility. As a result, this is what we define as minimal criteria for barrier-reduced residences. This article examines the extent to which people aged 65 and over (including people with mobility issues) live in barrier-reduced housing and what factors influence the chance of living in such residences. Data and method: Cross-sectional data from the German Ageing Survey (DEAS) 2020/21 (persons aged 65 and over, n = 2,854) were used. The DEAS is a representative cross-sectional and longitudinal survey of the population aged 40 and over in Germany. In our analyses, we used logistic regression models to investigate the probability of living in a barrier-reduced residence. We defined housing as barrier-reduced when the apartment/house and the rooms inside it can be reached without steps or stairs. As explanatory variable, we considered mobility restrictions, defined as limited ability to climb a flight of stairs. In addition, the model includes other individual factors (age, gender, equivalized household income), regional factors (living in East vs. West Germany, in urban vs. rural region) and moving to the current residence after the age of 65. Results and discussion: Of all individuals aged 65 or older, 19.3 percent live in a barrier-reduced residence. Also, of mobility-restricted elders, only 21.4 percent have such residences. The logistic regression results show that mobility restrictions are associated with a higher probability of living in a barrier-reduced residence. Compared to the lowest income group, older people in the highest income group are more likely to live in barrier-reduced housing. East Germans and people in urban areas are less likely to live in a barrier-reduced home. The likelihood of barrier-reduced living is higher among seniors who moved into their current residence after age 65. No significant differences were found for age groups and gender. The findings show that not enough seniors have barrier-reduced access to their homes and rooms, even if they suffer from mobility restrictions. Preventing functional restrictions must therefore also include improvements in the residential environment, especially in disadvantaged residential areas.


Asunto(s)
Envejecimiento , Vivienda , Humanos , Adulto , Persona de Mediana Edad , Anciano , Estudios Transversales , Renta , Alemania/epidemiología
14.
BMC Health Serv Res ; 23(1): 454, 2023 May 08.
Artículo en Inglés | MEDLINE | ID: mdl-37158887

RESUMEN

INTRODUCTION: Time optimization is a common goal to most health information institutions. In several countries, chronic electronic renewal prescriptions were one of the main focuses when implementing information systems. In Portugal, Electronic Medical Prescription (PEM®) software is used for most electronic prescriptions. This study aims to quantify the time spent in chronic prescription renewal appointments (CPRA) in primary care and its impact in the Portuguese National Health System (SNS). METHODS: Eight general practitioners (GP) were included in the study during February 2022. The average duration of 100 CPRA was obtained. To determine the number of CPRA performed every year, a primary care BI-CSP® platform was used. Using Standard Cost Model and average medical doctor hourly rate in Portugal we estimated CPRA global costs. RESULTS: Each doctor spent on average 1:55 ± 01:07 min per CPRA. There were 8295 GP working in 2022. A total 635 561 CPRA were performed in 2020 and 774 346 in 2021. In 2020, CPRA costs ranged 303 088 ± 179 419€, and in 2021 that number increased to 369 272 ± 218 599€. CONCLUSION: This is the first study to quantify CPRA's real cost in Portugal. A PEM® software update would allow daily savings, ranging from 830€ (± 491€) in 2020 and 1011€ (± 598€) in 2021. That change could allow hiring 8 ± 5 GP in 2020 and 12 ± 7 in 2021.


Asunto(s)
Médicos Generales , Prescripciones , Humanos , Etnicidad , Renta , Atención Primaria de Salud
15.
PLoS One ; 18(5): e0285170, 2023.
Artículo en Inglés | MEDLINE | ID: mdl-37155660

RESUMEN

INTRODUCTION: Antibiotic resistance (ABR) has substantial global public health concerns. This systematic review aimed to synthesise recent evidence estimating the economic burden of ABR, characterised by study perspectives, healthcare settings, study design, and income of the countries. METHODS: This systematic review included peer-reviewed articles from PubMed, Medline, and Scopus databases, and grey literature on the topic of the economic burden of ABR, published between January 2016 and December 2021. The study was reported in line with 'Preferred Reporting Items for Systematic Review and Meta-Analysis' (PRISMA). Two reviewers independently screened papers for inclusion first by title, then abstract, and then the full text. Study quality was assessed using appropriate quality assessment tools. Narrative synthesis and meta-analyses of the included studies were conducted. RESULTS: A total of 29 studies were included in this review. Out of these studies, 69% (20/29) were conducted in high-income economies and the remainder were conducted in upper-and-middle income economies. Most of the studies were conducted from a healthcare or hospital perspective (89.6%, 26/29) and 44.8% (13/29) studies were conducted in tertiary care settings. The available evidence indicates that the attributable cost of resistant infection ranges from -US$2,371.4 to +US$29,289.1 (adjusted for 2020 price) per patient episode; the mean excess length of stay (LoS) is 7.4 days (95% CI: 3.4-11.4), the odds ratios of mortality for resistant infection is 1.844 (95% CI: 1.187-2.865) and readmission is 1.492 (95% CI: 1.231-1.807). CONCLUSION: Recent publications show that the burden of ABR is substantial. There is still a lack of studies on the economic burden of ABR from low-income economies, and lower-middle-income economies, from a societal perspective, and in relation to primary care. The findings of this review may be of value to researchers, policymakers, clinicians, and those who are working in the field of ABR and health promotion. SYSTEMATIC REVIEW REGISTRATION: CRD42020193886.


Asunto(s)
Estrés Financiero , Renta , Humanos , Pobreza , Atención a la Salud , Farmacorresistencia Microbiana
16.
Phys Ther ; 103(4)2023 04 04.
Artículo en Inglés | MEDLINE | ID: mdl-37128811

RESUMEN

OBJECTIVE: Rigorously trained physical therapy researchers are essential for the generation of knowledge that guides the profession. However, there is a current and projected dearth of physical therapy researchers capable of sustaining research programs in part due to perceived financial barriers associated with pursuit of a doctor of philosophy (PhD) degree, with and without postdoctoral training, following doctor of physical therapy (DPT) degree completion. This study aimed to evaluate the financial impact of PhD and postdoctoral training, including opportunity cost, years to break even, and long-term earnings. METHODS: Clinical and academic salaries were obtained via the 2016 APTA Median Income of Physical Therapist Summary Report and 2019 CAPTE Annual Accreditation Report. Salaries were adjusted to total compensation to account for benefits and compared over a 30-year period starting after DPT education. Total compensations were also adjusted to the present value, placing greater weight on early career earnings due to inflation and potential investments. RESULTS: Relative to work as a clinical physical therapist, 4 years of PhD training result in an earnings deficit of $264,854 rising to $357,065 after 2 years of additional postdoctoral training. These deficits do not persist as evidenced by a clinical physical therapist career earning $449,372 less than a nonmajority scholarship academic career (DPT to PhD to academia pathway) and $698,704 less than a majority scholarship academic career (DPT to PhD to postdoctoral training to academia pathway) over a 30-year period. Greater long-term earnings for PhD careers persist when adjusting to present value. CONCLUSIONS: Although there is an initial opportunity cost of PhD and postdoctoral training represented by a relative earnings deficit, advanced research training results in greater long-term earnings. IMPACT: The findings of this study allow physical therapists interested in pursuing PhD and postdoctoral training to be better informed about the associated financial ramifications.


Asunto(s)
Fisioterapeutas , Humanos , Selección de Profesión , Renta , Salarios y Beneficios , Becas
17.
BMJ Open ; 13(4): e065792, 2023 04 25.
Artículo en Inglés | MEDLINE | ID: mdl-37185202

RESUMEN

OBJECTIVE: To determine willingness to pay for a diabetic retinopathy screening, and its determinants, among people with diabetes mellitus in Qujiang District of Shaoguan City, rural Guangdong, southern China. DESIGN: This cross-sectional study was conducted through a large-scale screening programme in 2019. We randomly selected 575 (21.5%) among 2677 people over 18 years old with known diabetes who attended the screening. Participants elected to pay nothing or RMB10-RMB120 (US$1.6-US$18.8), in RMB10 intervals, displayed on printed cards. One trained interviewer collected all the data. SETTING: Ten primary health centres in Qujiang District of Shaoguan City, Guangdong. PARTICIPANTS: 545 from the 575 randomly selected people (94.8%) agreed to participate in the study. OUTCOME MEASURES: Proportion of participants willing to pay anything for screening, mean amount they were willing to pay and determinants of these figures. RESULTS: Among 545 participants (mean age 64.6 years (SD±10.4), 40.7% men), 327 (60.0%) were willing to pay something for screening, of whom 273 (83.5%) would pay RMB10-RMB30 (US$1.6-US$4.7). People living in rural areas and those from lower-income families were more likely to be willing to pay anything, while men, urban residents and those covered by employer-linked insurance were willing to pay larger sums (p<0.05 for all). CONCLUSION: Nearly two-thirds of participants were willing to pay for screening in this screening programme organised at the primary care level in rural China. This finding offers the potential that such activities can be sustained and scaled up through user fees.


Asunto(s)
Diabetes Mellitus , Retinopatía Diabética , Seguro , Masculino , Humanos , Persona de Mediana Edad , Adolescente , Femenino , Encuestas y Cuestionarios , Estudios Transversales , Retinopatía Diabética/diagnóstico , Renta , China
18.
Cad Saude Publica ; 39(4): e00100522, 2023.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-37194846

RESUMEN

This essay aims to discuss the flexibilization of work, which has been accentuated during the COVID-19 pandemic, leading to an expansion of precarious work. Additionally, the essay seeks to explore theoretical models and methodological challenges for the study of precarious work, its dimensions, and its effects on workers' health. The health and economic crisis has heightened the social vulnerability of workers, introduced by the global flexibilization and the Brazilian Labor Reform. The setbacks materialize in precarious work, a multidimensional construct that encompasses the characteristics of this flexibilization in its three dimensions: (1) unstable work relationships resulting from insecure hiring, temporary contracts, involuntary part-time work, and outsourcing; (2) inadequate and unstable income; and (3) insufficient rights and protection, with reduced collective representation of workers, resulting in low power to react to degrading working conditions, lack of social security, and setbacks in regulatory support for labor safety. Repercussions of precarious work on health - work accidents, musculoskeletal and mental disorders - are evidenced in epidemiological studies, highlighting the theoretical and methodological limitations that still exist. The conclusion is that if the current bases of social protection and work insertion for workers are maintained, the future will see an expansion of precarious work. Thus, highlighting the causal relationships between precarious work and health is a contemporary challenge of the research and public policy agenda that is imposed upon society, with a focus on workers' health services.


Este ensaio objetivou discutir a flexibilização do trabalho, acentuada no curso da pandemia de COVID-19, com ampliação do trabalho precário; e discutir modelos teóricos e desafios metodológicos para o estudo do trabalho precário, suas dimensões e os efeitos à saúde de trabalhadoras(es). A crise sanitária e econômica ampliou a vulnerabilidade social de trabalhadoras(es), já em curso em decorrência das mudanças trazidas pela flexibilização, globalmente, e pela Reforma Trabalhista brasileira. Os retrocessos se concretizam no trabalho precário, construto multidimensional que engloba as características dessa flexibilização, em suas três dimensões: (1) relações de trabalho instáveis, decorrentes de contratação insegura, contrato temporário, trabalho parcial involuntário, terceirização; (2) renda inadequada e instável; e (3) insuficiência de direitos e de proteção, com reduzida representação coletiva de trabalhadoras(es), que implica baixo poder de reação às condições aviltantes de trabalho, falta de seguridade social, e retrocessos no apoio regulatório em segurança laboral. Repercussões do trabalho precário na saúde - acidentes de trabalho, distúrbios musculoesqueléticos e transtornos mentais - são evidenciadas em estudos epidemiológicos, destacando-se as limitações teóricas e metodológicas ainda existentes. Conclui-se, que mantidas as bases atuais da inserção de trabalhadoras(es) sem proteção social e do trabalho, o futuro será de ampliação do trabalho precário. Destarte, evidenciar as relações causais entre trabalho precário e saúde é desafio contemporâneo da agenda de pesquisa e de políticas públicas que se impõe na sociedade, com destaque para serviços de saúde do trabalhador.


Este ensayo tuvo como objetivo discutir la flexibilización del trabajo, acentuada en el transcurso de la pandemia de la COVID-19, con la expansión del trabajo precario; y discutir modelos teóricos y desafíos metodológicos para el estudio del trabajo precario, sus dimensiones y los efectos sobre la salud de las trabajadoras(es). La crisis sanitaria y económica aumentó la vulnerabilidad social de los trabajadoras(es) ya en marcha, como resultado de los cambios provocados por la flexibilización, a nivel mundial, y por la Reforma Laboral brasileña. Los retrocesos se concretan en el trabajo precario, constructo multidimensional que engloba las características de esa flexibilización, en sus tres dimensiones: (1) relaciones laborales inestables, derivadas de contratación insegura, contrato temporal, trabajo parcial involuntario, tercerización; (2) ingresos inadecuados e inestables; y (3) insuficiencia de derechos y de protección, con reducida representación colectiva de trabajadoras(es), lo que implica un bajo poder de reacción ante condiciones de trabajo degradantes, falta de seguridad social y retrocesos en el apoyo normativo a la seguridad laboral. Las repercusiones del trabajo precario en la salud -accidentes de trabajo, trastornos musculoesqueléticos y trastornos mentales- se evidencian en estudios epidemiológicos, destacando las limitaciones teóricas y metodológicas que aún existen. Se concluye que de mantenerse las bases actuales para la inserción de trabajadoras(es) sin protección social y laboral, el futuro será de expansión del trabajo precario. Por lo tanto, evidenciar las relaciones causales entre trabajo precario y salud es desafío contemporáneo de la agenda de investigación y de políticas públicas que se impone en la sociedad, con destaque para servicios de salud del trabajador.


Asunto(s)
COVID-19 , Pandemias , Humanos , Pandemias/prevención & control , COVID-19/epidemiología , Brasil , Empleo , Renta
19.
Sci Adv ; 9(18): eade7979, 2023 05 05.
Artículo en Inglés | MEDLINE | ID: mdl-37146136

RESUMEN

Since 1983, more than 70 employment audit experiments, carried out in more than 26 countries across five continents, have randomized the gender of fictitious applicants to measure the extent of hiring discrimination on the basis of gender. The results are mixed: Some studies find discrimination against men, and others find discrimination against women. We reconcile these heterogeneous findings through a "meta-reanalysis" of the average effects of being described as a woman (versus a man), conditional on occupation. We find a strongly positive gender gradient. In (relatively better paying) occupations dominated by men, the effect of being a woman is negative, while in the (relatively lower paying) occupations dominated by women, the effect is positive. In this way, heterogeneous employment discrimination on the basis of gender preserves status quo gender distributions and earnings gaps. These patterns hold among both minority and majority status applicants.


Asunto(s)
Empleo , Sexismo , Humanos , Masculino , Femenino , Renta , Ocupaciones , Salarios y Beneficios
20.
Artículo en Inglés | MEDLINE | ID: mdl-37174154

RESUMEN

INTRODUCTION: Exposure to residential radon is a preventable cause of cancer. Prevention requires testing, but the percentage of homes that have been tested is small. One reason for the low testing rates may be that printed brochures fail to motivate people to obtain and return a radon test. METHODS: We developed a radon app for smartphones that contained the same information as printed brochures. We conducted a randomized, controlled trial that compared the app to brochures in a population comprised largely of homeowners. Cognitive endpoints included radon knowledge, attitudes toward testing, perceived severity and susceptibility to radon, and response and self-efficacy. Behavioral endpoints were participants' requests for a free radon test and the return of the test to the lab. Participants (N = 116) were residents of Grand Forks, North Dakota, a city with one of the nation's highest radon levels. Data were analyzed by general linear models and logistic regression. RESULTS: Participants in both conditions showed significant increases in radon knowledge (p < 0.001), perceived susceptibility (p < 0.001), and self-efficacy (p = 0.004). There was a significant interaction, with app users showing greater increases. After controlling for income, app users were three times more likely to request a free radon test. However, contrary to expectation, app users were 70% less likely to return it to the lab (p < 0.01). CONCLUSIONS: Our findings confirm the superiority of smartphones in stimulating radon test requests. We speculate that the advantage of brochures in promoting test returns may be due to their ability to serve as physical reminders.


Asunto(s)
Radón , Humanos , Radón/análisis , Actitud , Teléfono Inteligente , Renta , Comunicación
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