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2.
JAMA Netw Open ; 3(6): e206445, 2020 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-32478849

RESUMEN

Importance: While many organizations endorse screening for social risk factors in clinical settings, few studies have examined the health and utilization effects of interventions to address social needs. Objective: To compare the acute care utilization effects of a written resources handout vs an in-person navigation service intervention to address social needs. Design, Settings, and Participants: In this secondary analysis of a randomized clinical trial, 1809 adult caregivers of pediatric patients seen in primary and urgent care clinics of 2 safety-net hospitals in northern California were recruited between October 13, 2013, and August 27, 2015. Each participating family was randomly assigned to an in-person navigator intervention vs active control to address the family's social needs. Analyses were conducted between February 28, 2018, and September 25, 2019. Interventions: Caregivers either received written information about relevant local resources related to social needs (active control) or met with a patient navigator focused on helping them resolve social needs (navigator intervention). After an initial in-person visit, navigation services included telephone, email, and/or in-person follow-up for up to 3 months. Main Outcome and Measures: Child emergency department visit or hospitalization within 12 months of study enrollment. Results: Among the 1300 caregivers enrolled in the study without missing follow-up data, most spoke English (878 [67.5%]) and were women (1127 [86.7%]), with a mean (SD) age of 33.0 (9.33) years. Most children were aged 0 to 5 years (779 of 1300 [59.9%]), 723 children (55.6%) had Hispanic ethnicity, and 462 children (35.5%) were in excellent health; 840 families (64.6%) were recruited from urgent care. In total, 637 families (49.0%) were randomized to the in-person navigator group and 663 (51.0%) to the active control group. There was no difference in risk of an emergency department visit between the 2 groups. Children enrolled in the in-person navigator group had a decreased risk of hospitalization within 12 months (hazard ratio, 0.59; 05% CI, 0.38-0.94; P = .03), making them 69% less likely to be hospitalized. Conclusions and Relevance: In this randomized clinical trial evaluating heath care utilization effects of programs designed to address social needs among families, children enrolled in the navigation group were significantly less likely to be hospitalized after the intervention but equally likely to have an emergency department visit. These findings strengthen our understanding of the effects of addressing social needs in clinical settings as part of a comprehensive strategy to improve health and reduce health care utilization. Trial Registration: ClinicalTrials.gov Identifier: NCT01939704.


Asunto(s)
Cuidadores/psicología , Servicios de Salud del Niño/tendencias , Aceptación de la Atención de Salud/estadística & datos numéricos , Navegación de Pacientes/métodos , Adulto , Atención Ambulatoria/estadística & datos numéricos , California/epidemiología , Cuidadores/estadística & datos numéricos , Preescolar , Servicio de Urgencia en Hospital/estadística & datos numéricos , Familia , Femenino , Estudios de Seguimiento , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Masculino , Tamizaje Masivo , Navegación de Pacientes/tendencias , Atención Primaria de Salud/estadística & datos numéricos , Factores de Riesgo , Proveedores de Redes de Seguridad
5.
Int J Equity Health ; 19(1): 65, 2020 05 12.
Artículo en Inglés | MEDLINE | ID: mdl-32398089

RESUMEN

BACKGROUND: Although World Health Organization works to make vaccination service available to everyone everywhere by 2030, majority of the world's children have been unvaccinated and unprotected from vaccine-preventable diseases. In fact, evidences on factors contributing to changes in vaccination coverage across residential areas, wealth categories and over time have not been adequate. Therefore, this study aimed at investigating inequalities in vaccination status of children aged 12-23 months owing to variations in wealth status, residential areas and over time. METHODS: Maternal and child health service data were extracted from the 2011 and 2016 Ethiopian Demographic and Health Survey datasets. Then, multivariate decomposition analysis was done to identify the major factors contributing to differences in the rate of vaccination utilization across residences and time variations. Similarly, a concentration index and curve were also done to identify the concentration of child vaccination status across wealth categories. RESULTS: Among children aged 12-23 months, the prevalence of complete childhood vaccination status increased from 20.7% in rural to 49.2% in urban in 2011 and from 31.7% in rural to 66.8% in urban residences in 2016. The decomposition analyses indicated that 72% in 2011 and 70.5% in 2016 of the overall difference in vaccination status was due to differences in respondent characteristics. Of the changes due to the composition of respondent characteristics, such as antenatal care and place of delivery were the major contributors to the increase in complete childhood vaccination in 2011, while respondent characteristics such as wealth index, place of delivery and media exposure were the major contributors to the increase in 2016. Of the changes due to differences in coefficients, those of low wealth status in 2016 across residences significantly contributed to the differences in complete childhood vaccination. On top of that, from 2011 to 2016, there was a significant increment in complete childhood vaccination status and a 59.8% of the overall increment between the surveys was explained by the difference in composition of respondents. With regard to the change in composition, the differences in composition of ANC visit, wealth status, place of delivery, residence, maternal education and media exposure across the surveys were significant predictors for the increase in complete child vaccination over time. On the other hand, the wealth-related inequalities in the utilization of childhood vaccination status were the pro-rich distribution of health services with a concentration index of CI = 0.2479 (P-value < 0.0001) in 2011 and [CI = 0.1987; P-value < 0.0001] in 2016. CONCLUSION: A significant rural-urban differentials was observed in the probability of a child receiving the required childhood vaccines. Children in urban households were specifically more likely to have completed the required number of vaccines compared to the rural areas in both surveys. The effect of household wealth status on the probability of a child receiving the required number of vaccines are similar in the 2011 and 2016 surveys, and the vaccination status was high in households with high wealth status. The health policies aimed at reducing wealth related inequalities in childhood vaccination in Ethiopia need to adjust focus and increasingly target vulnerable children in rural areas. It is of great value to policy-makers to understand and design a compensation mechanism for the costs incurred by poor households. Special attention should also be given to rural communities through improving their access to the media. The findings highlight the importance of women empowerment, for example, through education to enhance childhood vaccination services in Ethiopia.


Asunto(s)
Servicios de Salud del Niño/estadística & datos numéricos , Servicios de Salud del Niño/tendencias , Disparidades en el Estado de Salud , Cobertura de Vacunación/estadística & datos numéricos , Cobertura de Vacunación/tendencias , Adolescente , Adulto , Etiopía/epidemiología , Composición Familiar , Femenino , Encuestas Epidemiológicas , Humanos , Lactante , Masculino , Análisis Multivariante , Atención Prenatal/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Factores Socioeconómicos , Población Urbana/estadística & datos numéricos , Adulto Joven
8.
Indian J Tuberc ; 66(4): 549-554, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31813447

RESUMEN

The targets of the WHO's End TB Strategy and the United Nations' (UN) Sustainable Development Goals (SDGs) have been expanded to"Find. Treat. All #EndTB" with universal access to TB diagnosis, treatment and care by 2022 in an effort to end the global TB epidemic. Trends to achieve the above targets in children have led to greater emphasis on the newer diagnostics paving way to microbiological confirmation and universal drug sensitivity in children.


Asunto(s)
Servicios de Salud del Niño/tendencias , Prueba de Tuberculina , Tuberculosis Pulmonar/prevención & control , Antituberculosos/farmacología , Antituberculosos/uso terapéutico , Niño , Salud Global , Humanos , Pruebas de Sensibilidad Microbiana , Mycobacterium tuberculosis/efectos de los fármacos , Mycobacterium tuberculosis/aislamiento & purificación , Tuberculosis Pulmonar/diagnóstico , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/microbiología
9.
Psychiatr Serv ; 70(11): 1034-1039, 2019 11 01.
Artículo en Inglés | MEDLINE | ID: mdl-31378192

RESUMEN

OBJECTIVE: This study investigated equity in enrollment in a Medicaid waiver program for early intensive behavioral intervention for children with autism spectrum disorder (ASD). METHODS: State administrative, Medicaid, and U.S. Census data for children enrolled in the waiver program between 2007 and 2015 (N=2,111) were integrated. Multivariate and bivariate analyses were used to compare enrollees' neighborhood demographic characteristics with those of the state's general population, with controls for enrollees' age, sex, and race-ethnicity. RESULTS: Findings indicate that in general, enrollment was equitable. During the years in which there were inequities, children who lived in neighborhoods of privilege were favored. These neighborhoods had higher median incomes, lower poverty levels, and fewer female-headed households and were located in urban areas. CONCLUSIONS: As states work to provide equitable treatment to children with ASD and their families, it is important to track potential inequities between children who do and do not enroll in services and to use this information to inform outreach efforts. States may turn to South Carolina for insight on how to ensure equity.


Asunto(s)
Trastorno del Espectro Autista/economía , Trastorno del Espectro Autista/terapia , Servicios de Salud del Niño/tendencias , Disparidades en Atención de Salud/estadística & datos numéricos , Medicaid/tendencias , Características de la Residencia , Planes Estatales de Salud/tendencias , Niño , Preescolar , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Masculino , Análisis Multivariante , Análisis de Regresión , Factores Socioeconómicos , South Carolina , Estados Unidos
10.
Midwifery ; 78: 104-113, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31419781

RESUMEN

BACKGROUND: Good quality midwifery care has the potential to reduce both maternal and newborn mortality and morbidity in high, low, and lower-middle income countries (LMIC) and needs to be underpinned by effective education. There is considerable variation in the quality of midwifery education provided globally. OBJECTIVE: To determine what are the most efficient and effective ways for LMICs to conduct pre-service and in-service education and training in order to adequately equip care providers to provide quality maternal and newborn care. DESIGN: Rapid Systematic Evidence Review METHODS: A systematic search of the following databases was conducted: Medline, CINAHL, LILACs, PsycInfo, ERIC, and MIDIRs. Studies that evaluated the effects of pre-service and in-service education that were specifically designed to train, educate or upskill care providers in order to provide quality maternal and newborn care were included. Data was extracted and presented narratively. FINDINGS: Nineteen studies were included in the review. Of these seven were evaluations of pre-service education programmes and 12 were evaluations of in-service education programmes. Whilst studies demonstrated positive effects on knowledge and skills, there was a lack of information on whether this translated into behaviour change and positive effects for women and babies. Moreover, the level of the evidence was low and studies often lacked an educational framework and theoretical basis. Mapping the skills taught in each of the programmes to the Quality Maternal and Newborn Care framework (Renfrew et al., 2014) identified that interventions focused on very specific or individual clinical skills and not on the broader scope of midwifery. KEY CONCLUSIONS: There is a very limited quantity and quality of peer reviewed published studies of the effectiveness of pre service and in service midwifery education in LMICs; this is at odds with the importance of the topic to survival, health and well-being. There is a preponderance of studies which focus on training for specific emergencies during labour and birth. None of the in-service programmes considered the education of midwives to international standards with the full scope of competencies needed. There is an urgent need for the development of theoretically informed pre-service and in-service midwifery education programmes, and well-conducted evaluations of such programmes. Upscaling quality midwifery care for all women and newborn infants is of critical importance to accelerate progress towards Sustainable Development Goal 3. Quality midwifery education is an essential pre-requisite for quality care. To deliver SDG 3, the startling underinvestment in midwifery education identified in this review must be reversed.


Asunto(s)
Servicios de Salud del Niño/tendencias , Educación/métodos , Personal de Salud/educación , Servicios de Salud Materna/tendencias , Adulto , Prestación de Atención de Salud , Países en Desarrollo , Educación/tendencias , Femenino , Personal de Salud/tendencias , Humanos , Recién Nacido , Masculino , Calidad de la Atención de Salud
11.
Pediatrics ; 143(6)2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31142579

RESUMEN

For 25 years, the American Academy of Pediatrics (AAP) Community Access to Child Health (CATCH) program has supported pediatricians in collaborating within their communities to advance the health of all children. CATCH grants support pediatric residents and pediatricians in planning or implementing community-based child health initiatives. The CATCH program has provided almost 10 million dollars through 842 planning, 585 resident, and 305 implementation grants to >1700 pediatricians. Urban, rural, suburban, and tribal communities in every state as well as the District of Columbia and Puerto Rico have benefited from CATCH-funded projects. Collaborations with community partners such as schools, homeless shelters, and mental health centers have led to programs serving children and families, especially those living in poverty and in minority groups. The most recent program data reveal that 87.5% of the projects are operating 2 years after funding. Many CATCH projects have not only sustained themselves but have grown into larger programs with funding from other sources. CATCH has influenced pediatricians' careers by providing important skills, networking opportunities, career legitimacy, mentoring opportunities, and increased engagement with the AAP. More than 350 pediatricians have served the AAP as CATCH facilitators, the network of physicians that provides technical assistance to applicants and reviews grant applications. Responding to changing trends, CATCH leaders have looked at other funding models and recently launched the CATCH-On initiative. CATCH-On creates and provides templates from successful CATCH projects to busy pediatricians who can then implement the project in their communities with minimal funding.


Asunto(s)
Academias e Institutos/economía , Servicios de Salud del Niño/economía , Servicios de Salud Comunitaria/economía , Accesibilidad a los Servicios de Salud/economía , Pediatría/economía , Academias e Institutos/tendencias , Servicios de Salud del Niño/tendencias , Preescolar , Servicios de Salud Comunitaria/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Humanos , Pediatría/tendencias , Factores de Tiempo , Estados Unidos/epidemiología
13.
Emerg Med J ; 36(1): 39-46, 2019 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-30389792

RESUMEN

BACKGROUND: The number of EDs visit is on the increase, and the pressure on EDs is of significant concern worldwide. The usage of EDs by parents of children with minor illness is an important and still unresolved problem causing a burden to healthcare services. The aim of this study was to review the literature to summarise parental reasons for visiting ED for children with minor illness. METHOD: Seven electronic databases (Medline, Embase, PsycINFO, CINAHL, PubMed, Web of Science and Scopus) were comprehensively searched during a 2-week period in August 2016 and updated between 11 and 20 June 2018. The study selection process was undertaken independently by two authors. Qualitative and quantitative studies that focused on the reasons for parents of children with minor illness to attend an ED were included. Studies were assessed for quality and data were analysed by means of narrative synthesis. RESULTS: Twenty-four studies were included. Eleven studies employed quantitative methods, eleven studies used qualitative methods and two studies used mixed methods. Parental reasons for using ED included perceived urgency, ED advantages (eg, faster service, superior ED resources and efficiency), difficulties with getting a general practitioner appointment, lack of facilities in primary healthcare services, lack of health insurance, reassurance, convenience and access. CONCLUSION: This review identified some of the reasons why parents bring their children to the ED for minor illnesses highlighting the multifaceted nature of this problem. Understanding parental reasons behind their choice to use the ED may help us better design targeted interventions to reduce unnecessary ED visits and alleviate the burden on overstretched healthcare services. This review may help inform emergency care policy makers, researchers and healthcare staff to understand parents' reasons for visiting the ED, to better meet their healthcare needs.


Asunto(s)
Servicios de Salud del Niño/tendencias , Conducta de Enfermedad , Padres/psicología , Aceptación de la Atención de Salud , Niño , Preescolar , Conducta de Elección , Servicio de Urgencia en Hospital/organización & administración , Servicio de Urgencia en Hospital/tendencias , Humanos , Lactante
14.
Rev Bras Enferm ; 71(suppl 6): 2612-2619, 2018.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30540035

RESUMEN

OBJECTIVE: To analyze the care coordination for the child and adolescent in chronic condition and users planning in the Health Care Network. METHOD: Qualitative study, conducted with 26 health professionals and managers through Focus Groups. Thematic content analysis was used. RESULTS: Care coordination is fragile, with lack of support from the management, and presence of high turnover of managers and professionals. The limits in the network planning are due to frequent changes in the careflow. Communication between levels of care and lack of counter-referral makes network care unfeasible. FINAL CONSIDERATIONS: There is a need for planning in the Health Care Network and establishment of careflow, as well as the construction of communication channels and tools of referral and counter-referral between professionals and services, for the constitution and integration of the network from the perspective of user-centered care.


Asunto(s)
Servicios de Salud del Niño/normas , Enfermedad Crónica/terapia , Continuidad de la Atención al Paciente/normas , Personal de Salud/psicología , Adolescente , Adulto , Anciano , Niño , Servicios de Salud del Niño/tendencias , Enfermedad Crónica/rehabilitación , Femenino , Grupos Focales , Accesibilidad a los Servicios de Salud/normas , Humanos , Masculino , Persona de Mediana Edad , Investigación Cualitativa , Derivación y Consulta/normas
15.
Artículo en Ruso | MEDLINE | ID: mdl-30412149

RESUMEN

BACKGROUND: The Moscow Health Department organized an efficient and comprehensive three-level system of medical rehabilitation for the children. Health resort-based treatment is normatively a component of the third stage of rehabilitation. AIM: The objective of the present study was to substantiate the necessity and validity of the health resort-based treatment as an integral part of the third stage of medical rehabilitation. MATERIAL AND METHODS: We have carried out the analysis of activities of 16 health resorts facilities during the period from 2016 to 2017 that included the evaluation in volume terms of the medical assistance, availability of the health resort-based treatment, and its clinical outcomes. The data thus obtained were systematized and processed with the use of the MS Office software package. RESULTS: The analysis of dynamics of the extent of the provided medical assistance expressed in terms of volume has demonstrated the increase in the overall number of people who had received health resort-based treatment in 2017 in comparison with that in 2016. The analysis of the structure of the pathological conditions in the patients admitted for the treatment in the health resort settings revealed correlation with the profiles of specialization of these facilities and with the structure of newly registered diseases. The analysis of the services rendered within the framework of the health resort-based treatment programs confirmed the effectiveness of medical assistance organized with the use of such approach. The study revealed challenges still facing the services responsible for the provision of the health resort-based treatment of the children in Moscow and the lines of activities in this field to be carried out in the near future. CONCLUSION: The experience gained by the Moscow public healthcare organizations gives evidence that the health resort facilities located directly in the region are necessary for rendering the comprehensive three-level medical rehabilitation as a very important component of its third (final).


Asunto(s)
Servicios de Salud del Niño/organización & administración , Colonias de Salud , Rehabilitación/organización & administración , Niño , Servicios de Salud del Niño/tendencias , Predicción , Humanos , Moscú , Rehabilitación/tendencias
16.
Orv Hetil ; 159(46): 1948-1956, 2018 11.
Artículo en Húngaro | MEDLINE | ID: mdl-30450931

RESUMEN

Paediatric organ transplantation today is considered and accepted and widely available therapy in children with end-stage organ failure. It is important to know that in childhood, diseases leading to end-stage organ failure differ from those in adults. Beside this, in children there are different surgical and paediatric challenges before and after transplantation (size differences of the patient and donor organ, special and paediatric infections, different pharmacokinetics and pharmacodynamics of immunosuppressive drugs, noncompliance). However, paediatric organ transplantation in the last decades became a success story of the Hungarian health care owing to several working groups in Hungary and outside the country. Orv Hetil. 2018; 159(46): 1948-1956.


Asunto(s)
Servicios de Salud del Niño/tendencias , Bienestar del Niño/tendencias , Trasplante de Órganos/tendencias , Obtención de Tejidos y Órganos/organización & administración , Niño , Supervivencia de Injerto , Humanos , Hungría , Inmunosupresores/uso terapéutico
17.
Buenos Aires; s.n; nov. 2018. 78 p. graf..
No convencional en Español | LILACS | ID: biblio-1009891

RESUMEN

Ateneo de la Residencia de Psicopedagogía del CESAC Nº 15, del Área Programática del Hospital General de Agudos Cosme Argerich, de la Ciudad de Buenos Aires. A partir del Dispositivo de Crecimiento y Desarrollo, que funciona en el Centro de Salud desde hace más de veinte años, y trabaja con bebés de 0 a 18 meses, y sus madres, padres, o adultos referentes; se plantean distintas preguntas sobre el contexto de la infancia, y sobre estrategias de Atención Primaria en Salud. Se detalla la normativa y programas vigentes, para Nación y CABA; así como el tipo de intervención que se propone desde el Centro de Salud. En el último apartado se abordan diferentes aspectos constitutivos de la infancia, como el vínculo, el juego y el aprendizaje


Asunto(s)
Atención Primaria de Salud , Servicios de Salud del Niño/legislación & jurisprudencia , Servicios de Salud del Niño/provisión & distribución , Servicios de Salud del Niño/tendencias , Salud del Niño , Centros Comunitarios de Salud , Atención Integrada a las Enfermedades Prevalentes de la Infancia , Internado no Médico
20.
Pediatr. aten. prim ; 20(79): e89-e104, jul.-sept. 2018. tab, mapas, graf
Artículo en Español | IBECS | ID: ibc-180959

RESUMEN

Introducción: la Asociación Española de Pediatría de Atención Primaria (AEPap) ha querido conocer el porcentaje de plazas de Pediatría de Atención Primaria (PAP) del sector público ocupadas por médicos no especialistas en Pediatría y sus Áreas Específicas (PAE), las condiciones laborales de las mismas y el número de profesionales que se encuentran próximos a la jubilación. Para ello, se ha realizado una encuesta entre los vocales de las asociaciones autonómicas que componen la asociación. Resultados: se han obtenido datos del 90% de las plazas de PAP. El porcentaje de plazas a nivel nacional no ocupadas por especialistas en PAE es del 25,1% (IC 95: 24,1-26,4%), habiendo mucha variabilidad entre comunidades autónomas y provincias, que va del 48,97% en las Islas Baleares al 0% en La Rioja. En relación con la edad de los profesionales, con datos obtenidos del 47,0% de las plazas, la cuarta parte tiene más de 60 años y un 40% supera los 55. En cuanto a los horarios de atención, con datos recogidos del 72,1% de las plazas, un 42,2% de los pediatras de AP trabajan exclusivamente de mañanas, un 29,9% cuatro mañanas y una tarde semanal y un 27,8% un mayor porcentaje de tardes o tardes exclusivas. Conclusiones: existe un déficit de pediatras de AP y una previsión de que este déficit aumente. Las autoridades sanitarias tienen que hacer un esfuerzo en la formación MIR y tienen que conseguir que las plazas de PAP sean más atractivas para los nuevos especialistas, favoreciendo la formación, investigación y disminuyendo el 30% de horarios de tarde exclusivas o predominantes


Introduction: the Spanish Association of Primary Care Pediatrics (AEPap) wants to know the percentage of primary care paediatrics (PAP) places in public health services occupied by non-specialists in Pediatrics and their Specific Areas (PSA), the working conditions of the same and the number of professionals who are next to retirement. For this, a survey has been carried out among the members of the autonomous associations that make up the association. Results: data of 90% of the PAP places have been obtained. The percentage of places at the national level not occupied by specialists in PSA is 25.1% (IC 95: 24,1 a 26,4%), there is a lot of variability among regions and provinces, ranging from 48.97% in the Balearic Islands to 0% in La Rioja. With data on the age obtained from 47% of the places, a quarter of the pediatricians are over 60 years old and 40% are more than 55. Regarding the hours of care, with data collected from 72,1% of the places, a 42,2% of the PAP works in the mornings, 29,9% in the morning and one evening per week and 27,8% in a higher percentage of evenings. Conclusions: there is a deficit of PAP and a forecast that this deficit will increase. The health authorities have to make an effort in the MIR training and they have to make PAP seats more attractive for new specialists, favoring training, research and decreasing 30% of exclusive or predominant evening schedules


Asunto(s)
Humanos , Atención Primaria de Salud/tendencias , Personal de Salud/tendencias , Servicios de Salud del Niño/tendencias , Enfermeras Pediátricas/estadística & datos numéricos , España , Especialización/tendencias , Cobertura Efectiva de Servicios de Salud/estadística & datos numéricos
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