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1.
J Clin Med ; 10(15)2021 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-34362147

RESUMO

Hemolytic anemia (HA) renders erythropoietic stress on the bone marrow and has been linked to osteoporosis. In this nationwide retrospective cohort study, we examined this correlation by utilizing the Taiwan National Health Insurance Research Database (NHIRD). We identified two cohorts, matching population with and without HA in a 1:4 ratio. A total of 2242 HA patients and 8968 non-HA patients were enrolled. Patients with HA had a significantly higher cumulative incidence (log-rank test p = 0.0073), higher incidence density (5.11 vs. 3.76 per 1000 persons-years), and a 1.31-fold risk of developing osteoporosis than non-HA patients (aHR = 1.31, 95% C.I. 1.04-1.63, p = 0.01). After adjusting for age, sex, and comorbidities, patients with factors including female (aHR = 2.57, 95% C.I. 2.05-3.22, p < 0.001), age > 65 (aHR = 9.25, 95% C.I. 7.46-11.50, p < 0.001), diagnosis of cholelithiasis (aHR = 1.76, 95% C.I. 1.20-2.58, p = 0.003) and peptic ulcer disease (aHR = 1.87, 95% C.I. 1.52-2.29, p < 0.001) had significantly higher risk of osteoporosis. We propose that this correlation may be related to increased hematopoietic stress, increased consumption of nitric oxide (NO) by hemolysis, and the inhibitory effects of iron supplements on osteogenesis through the receptor activator of nuclear factor κB ligand (RANKL)/Osteoprotegerin pathway and the Runt-related transcription factor 2 (RUNX2) factor. Our findings suggest that patients with hemolytic anemia are at a higher risk of developing osteoporosis, and it would be in the patient's best interest for physicians to be aware of this potential complication and offer preventative measures.

2.
Int J Equity Health ; 20(1): 185, 2021 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-34404390

RESUMO

OBJECTIVE: The study analyzed the common points and discrepancies of COVID-19 control measures of the two countries in order to provide appropriate coping experiences for countries all over the world. METHOD: This study examined the associations between the epidemic prevention and control policies adopted in the first 70 days after the outbreak and the number of confirmed cases in China and Singapore using the generalized linear model. Policy comparisons and disparities between the two countries were also discussed. RESULTS: The regression models show that factors influencing the cumulative number of confirmed cases in China: Locking down epicenter; activating Level One public health emergency response in all localities; the central government set up a leading group; classified management of "four categories of personnel"; launching makeshift hospitals; digital management for a matrix of urban communities; counterpart assistance. The following four factors were the key influencing factors of the cumulative confirmed cases in Singapore: The National Centre for Infectious Diseases screening center opens; border control measures; surveillance measures; Public Health Preparedness Clinics launched. CONCLUSIONS: Through analyzing the key epidemic prevention and control policies of the two countries, we found that the following factors are critical to combat COVID-19: active case detection, early detection of patients, timely isolation, and treatment, and increasing of medical capabilities. Countries should choose appropriate response strategies with health equity in mind to ultimately control effectively the spread of COVID-19 worldwide.


Assuntos
COVID-19 , Políticas , COVID-19/epidemiologia , COVID-19/prevenção & controle , China/epidemiologia , Humanos , Singapura/epidemiologia
3.
Medicine (Baltimore) ; 100(31): e26718, 2021 Aug 06.
Artigo em Inglês | MEDLINE | ID: mdl-34397811

RESUMO

ABSTRACT: To provide references for global pandemic prevention and control, this study aimed to analyze the epidemiological characteristics and clinical manifestations of 103 new confirmed cases between June 12 and June 15, 2020, in Beijing. All confirmed cases in this study were tested with a positive SARS-CoV-2 reverse transcriptase-polymerase chain reaction and extracting data from the Beijing Municipal Health Commission (June 11 to July 6, 2020). We selected the 103 typical confirmed cases (excluding imported cases) between June 12 and June 15 for statistical analysis and explored differences among different clinical cases. A cluster of COVID-19 was reported in Beijing between June 12 and June 15, 2020, involving 103 confirmed cases. Patients aged 21 to 65 years old and the mean age was 42.38 ±â€Š11.507, the male-to-female sex ratio was 1.40:1. All confirmed cases had a direct or indirect exposure history in the Beijing Xinfadi Market (BXM), and the clinical manifestations of 97% confirmed cases was diagnosed as mild or moderate. Different clinical classification in age (P = .041), exposure history (P = .025), fever (P = .020), and cough (P = .000) were the statistically significant difference, but there was no statistically significant difference in gender (P = .501), the type of diagnosis (P = .478), expectoration (P = .979), fatigue (P = .906), dizziness or headache (P = .848), muscle pain (P = .825), sore throat or throat discomfort (P = .852), chills (P = .933), diarrhea (P = .431) and runny nose or nasal congestion (P = .898). This study shows that Beijing's epidemic scope was mainly concentrated in the Xinfadi Market. The initial cases were epidemiologically related to the BXM, the clinical classification of most cases was mild and moderate, and the differences in age, exposure history, fever, and cough among different clinical cases were statistically significant.


Assuntos
COVID-19/diagnóstico , Supermercados , Adulto , Pequim/epidemiologia , COVID-19/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
4.
Int J Equity Health ; 20(1): 198, 2021 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-34461910

RESUMO

BACKGROUND: The goal of this paper was to assess the quality of primary healthcare services at community health centres (CHCs) from the demand (patient) and supplier (healthcare service institution) angles. METHODS: This study was conducted at six CHCs in the Greater Bay Area of China. Between August and October 2019, 1,568 patients were recruited (55.8% women and 44.2% men). We evaluated the service quality of CHCs using the National Committee for Quality Assurance Patient-Centred Medical Home (NCQA-PCMH) recognition questionnaire. We assessed patients' experiences with medical and health services using the Primary Care Assessment Tools (PCAT). RESULTS: PCAT total and sub-domains scores were significantly difference at the six CHCs (P < 0.001). Among the six CHCs, Shayuan CHC had the highest PCAT total and sub-domain scores and the highest NCQA-PCMH total and sub-domain scores, as well. Older (> 60 years), female, lower education, and employee medical-insured individuals had better patient experiences. CONCLUSIONS: Our results indicate that CHCs could improve their service quality by improving both institutional health service quality based on NCQA-PCMH assessment and patient experiences based on PCAT scales. These findings can help inform patient-centred primary healthcare policy and management.


Assuntos
Centros Comunitários de Saúde , Satisfação do Paciente , Atenção Primária à Saúde , Qualidade da Assistência à Saúde , Adolescente , Adulto , China , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Satisfação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Adulto Jovem
5.
Soc Sci Med ; 283: 114210, 2021 08.
Artigo em Inglês | MEDLINE | ID: mdl-34274783

RESUMO

To reduce the heavy reliance of public hospitals on drug sales and use of advanced technologies and to contain the escalating medical expenditures, Beijing implemented two rounds of comprehensive public hospital reform in 2017 and 2019, respectively. The first round focused on separating drug sales from hospital revenue (reform1), and the second round extended to include zero markup on medical consumables and price adjustments for medical services (reform2). To estimate how these two rounds of reform have affected public hospitals' revenue structures, we used observational data of medical revenues from 2016 to 2019 covering 354 healthcare facilities. A Panel-interrupted time-series (PITS) model was used to analyze the effects. The results suggest that the reforms have changed the structure of public hospitals' revenues. The proportion of drug sales in hospital revenues fell from 43.96% in 2016 (pre-reform) to 34.08% in 2019 (post-reform); the proportions of medical consumables decreased by 0.73% after reform 2; and the proportion of medical consultation service fees increased from 15.16% in 2016 to 24.51% in 2019. PITS analysis showed that the proportion of drug sales dropped by 5.46% in the month of reform 1, and it dropped by 0.20% per month on average after reform 2(p < 0.001). The proportion of medical consumables decreased by 0.04% per month on average after reform 2 (p < 0.001). The proportion of medical consultation service increased by 7.13% in the month of reform 1, and it increased by 0.14% per month on average after reform 2(p < 0.001). Similar trends were seen in hospital revenue structures from both inpatient services and from outpatient and accident and emergency services. Thus, Beijing's reforms successfully contained rising medical expenditures and optimized hospitals' revenue structures. These reforms can provide a reference for further public hospital reforms in China and other countries with similar systems.


Assuntos
Custos de Medicamentos , Reforma dos Serviços de Saúde , Pequim , China , Gastos em Saúde , Hospitais Públicos , Humanos
6.
Front Public Health ; 9: 606188, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34169053

RESUMO

Objective: Primary care in China is facing mounting challenges with multimorbidity as the aging population grows. Knowing how patients experience primary care may highlight the deficiencies of the care system and guide health system reform. The purpose of this study was to compare the quality of primary care experienced by patients with and without multimorbidity at community health centers (CHCs) in Shanghai, China and to examine the factors influencing these experiences. Methods: A cross-sectional survey was conducted from August to December 2019 using the validated Chinese Primary Care Assessment Tool-Adult Edition (PCAT-AE). ANOVA was performed to compare the overall and domain-specific quality of primary care for patients with and without multimorbidity. Multivariate linear regressions were used to assess the factors associated with primary care quality while controlling for patients' sociodemographic and healthcare characteristics. Results: From 2,404 completed questionnaires, patients with multimorbidity reported higher PCAT scores in the domains of first contact-utilization (3.54 ± 0.55 vs. 3.48 ± 0.56, P < 0.01), accessibility (2.93 ± 0.49 vs. 2.86 ± 0.47, P < 0.001), and ongoing care (3.20 ± 0.39 vs. 3.14 ± 0.43, P < 0.001), while reporting lower scores in coordination (information system) (2.72 ± 0.41 vs. 2.79 ± 0.35, P < 0.001) and family-centeredness (3.23 ± 0.63 vs. 3.30 ± 0.64, P < 0.01). Multimorbidity (ß = 0.355, P < 0.01), education level (ß = 0.826, P < 0.01), district (suburb: ß = 1.475, P < 0.001), and self-perceived good health status (ß = 0.337, P < 0.05) were associated with better patient experiences in primary care. Patients between the age 61 and 70 (ß = -0.623, P < 0.001; >70 years: ß = -0.573, P < 0.01), with a monthly household income ≥6,000 RMB (ß = -1.385, P < 0.001) and with more than 20 outpatient visits the previous year (ß = -1.883, P < 0.001) reported lower total PCAT scores. Conclusion: The findings of our study suggest that CHCs in China have contributed to better primary care experiences for patients with multimorbidity in certain quality domains, including first contact-utilization, accessibility, and ongoing care. However, there is still room for improvement in care coordination and family-centeredness.


Assuntos
Centros Comunitários de Saúde , Multimorbidade , Adulto , Idoso , China/epidemiologia , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Avaliação de Resultados da Assistência ao Paciente , Atenção Primária à Saúde
7.
Biomed Res Int ; 2021: 6610045, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34159196

RESUMO

Background: This study is aimed at confirming the effectiveness of nonpharmaceutical interventions during the COVID-19 outbreak in Hubei, China. Methods: The data are all from the epidemic information released by the National Health Commission of the People's Republic of China and the Health Commission of Hubei Province. We used the multivariable linear regression by the SPSS 19.0 software: the cumulative number of confirmed cases, the cumulative number of cured cases, and the number of daily severe cases were taken as dependent variables, and the six policies, including the Joint Prevention and Control Mechanism of the State Council, lockdown Wuhan city, the first-level response to public health emergencies, the expansion of medical insurance coverage to suspected patients, mobile cabin hospitals, and counterpart assistance in Hubei province, were gradually entered into multiple linear regression models as independent variables. Results: The factors influencing the cumulative number of diagnosed cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. The factors influencing the cumulative number of cured cases ranged from large to small: counterpart support medical teams in Hubei province and mobile cabin hospitals. The factors influencing the number of daily severe cases ranged from large to small: mobile cabin hospitals and the expansion of medical insurance coverage to suspected patients. Conclusion: The mobile cabin hospital is a major reason for the successfully defeating COVID-19 in China. As COVID-19 pandemic spreads globally, the mobile cabin hospital is a successful experience in formulating policies to defeat COVID-19 for other countries in the outbreak phase.


Assuntos
Ambulâncias/estatística & dados numéricos , COVID-19/terapia , Controle de Doenças Transmissíveis/métodos , Pandemias/prevenção & controle , Saúde Pública/métodos , China/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Humanos , Seguro Médico Ampliado/normas , Modelos Lineares , Pacientes/estatística & dados numéricos , Políticas , Software , Telemedicina/métodos
9.
J Epidemiol Glob Health ; 11(2): 246-252, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-33876595

RESUMO

OBJECTIVES: This study analyzed the effects of COVID-19 non-pharmaceutical measures between China and South Korea to share experiences with other countries in the struggle against SARS-CoV-2. METHODS: We used the generalized linear model to examine the associations between non-pharmaceutical measures adopted by China and South Korea and the number of confirmed cases. Policy disparities were also discussed between these two countries. RESULTS: The results show that the following factors influence the number of confirmed cases in China: lockdown of Wuhan city (LWC); establishment of a Leading Group by the Central Government; raising the public health emergency response to the highest level in all localities; classifying management of "four categories of personnel"; makeshift hospitals in operation (MHIO); pairing assistance (PA); launching massive community screening (LMCS). In South Korea, these following factors were the key influencing factors of the cumulative confirmed cases: raising the public alert level to orange (three out of four levels); raising the public alert to the highest level; launching drive-through screening centers (LDSC); screening all members of Shincheonji religious group; launching Community Treatment Center (LCTC); distributing public face masks nationwide and quarantining all travelers from overseas countries for 14 days. CONCLUSION: Based on the analysis of the generalized linear model, we found that a series of non-pharmaceutical measures were associated with contain of the COVID-19 outbreak in China and South Korea. The following measures were crucial for both of them to fight against the COVID-19 epidemic: a strong national response system, expanding diagnostic tests, establishing makeshift hospitals, and quarantine or lockdown affected areas.


Assuntos
COVID-19/epidemiologia , Política de Saúde/legislação & jurisprudência , COVID-19/prevenção & controle , China/epidemiologia , Controle de Doenças Transmissíveis/legislação & jurisprudência , Humanos , República da Coreia/epidemiologia , SARS-CoV-2
10.
Int J Equity Health ; 20(1): 96, 2021 04 07.
Artigo em Inglês | MEDLINE | ID: mdl-33827600

RESUMO

OBJECTIVE: This study applied the vulnerability framework and examined the combined effect of race and income on health insurance coverage in the US. DATA SOURCE: The household component of the US Medical Expenditure Panel Survey (MEPS-HC) of 2017 was used for the study. STUDY DESIGN: Logistic regression models were used to estimate the associations between insurance coverage status and vulnerability measure, comparing insured with uninsured or insured for part of the year, insured for part of the year only, and uninsured only, respectively. DATA COLLECTION/EXTRACTION METHODS: We constructed a vulnerability measure that reflects the convergence of predisposing (race/ethnicity), enabling (income), and need (self-perceived health status) attributes of risk. PRINCIPAL FINDINGS: While income was a significant predictor of health insurance coverage (a difference of 6.1-7.2% between high- and low-income Americans), race/ethnicity was independently associated with lack of insurance. The combined effect of income and race on insurance coverage was devastating as low-income minorities with bad health had 68% less odds of being insured than high-income Whites with good health. CONCLUSION: Results of the study could assist policymakers in targeting limited resources on subpopulations likely most in need of assistance for insurance coverage. Policymakers should target insurance coverage for the most vulnerable subpopulation, i.e., those who have low income and poor health as well as are racial/ethnic minorities.


Assuntos
Renda , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/etnologia , Idoso , Criança , Feminino , Gastos em Saúde , Acesso aos Serviços de Saúde , Humanos , Masculino , Estados Unidos
11.
Sci Rep ; 11(1): 7520, 2021 04 06.
Artigo em Inglês | MEDLINE | ID: mdl-33824394

RESUMO

Chronic Fatigue Syndrome (CFS) has been defined as unexplained relapsing or persistent fatigue for at least 6 consecutive months. Immuno-inflammatory pathway, bacterial infection, and other causes play essential roles in CFS. Helicobacter pylori infection is one of the most common causes of foregut inflammation, leading to peptic ulcer disease (PUD). This study aimed to analyze the risk of CFS development between patients with and without PUD. Other related factors were also analyzed. We performed a retrospective, nationwide cohort study identifying patients with or without PUD respectively by analyzing the Longitudinal Health Insurance Database 2000 (LHID2000), Taiwan. The overall incidence of CFS was higher in the PUD cohort than in the non- PUD cohort (HR = 2.01, 95% CI = 1.75-2.30), with the same adjusted HR (aHR) when adjusting for age, sex, and comorbidities. The sex-specific PUD cohort to the non-PUD cohort relative risk of CFS was significant in both genders. The age-specific incidence of CFS showed incidence density increasing with age in both cohorts. There is an increased risk of developing CFS following PUD, especially in females and the aging population. Hopefully, these findings can prevent common infections from progressing to debilitating, chronic conditions such as CFS.

12.
J Health Care Poor Underserved ; 32(1): 373-385, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33678702

RESUMO

In order to describe the Chinese experience for the purposes of global epidemic control, the study analyzed the impact on the COVID-19 pandemic of policies adopted during the lockdown of Wuhan city. Descriptive analysis and stepwise regression analysis were performed using the official case data from January 10, 2020 to April 8, 2020. The results show that the prevention and control policies of Lockdown Wuhan City (LWC) has played a significant role in reducing new case numbers, improving COVID-19's cure rate and reducing mortality. Among the policies of LWC, stay at home, centralized isolation of convalescent patients, launching makeshift hospitals, and centralized isolation of "the four types of personnel" that play a decisive role. As the COVID-19 pandemic progresses, this study provides valuable experience for other countries.


Assuntos
COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Quarentena , COVID-19/epidemiologia , COVID-19/mortalidade , China/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Humanos , Pandemias/prevenção & controle , Análise de Regressão
13.
Int J Equity Health ; 20(1): 86, 2021 03 25.
Artigo em Inglês | MEDLINE | ID: mdl-33766049

RESUMO

OBJECTIVE: Our research summarized policy disparities in response to the first wave of COVID-19 between China and Germany. We look forward to providing policy experience for other countries still in severe epidemics. METHODS: We analyzed data provided by National Health Commission of the People's Republic of China and Johns Hopkins University Coronavirus Resource Center for the period 10 January 2020 to 25 May 252,020. We used generalized linear model to evaluate the associations between the main control policies and the number of confirmed cases and the policy disparities in response to the first wave of COVID-19 between China and Germany. RESULTS: The generalized linear models show that the following factors influence the cumulative number of confirmed cases in China: the Joint Prevention and Control Mechanism; locking down the worst-hit areas; the highest level response to public health emergencies; the expansion of medical insurance coverage to suspected patients; makeshift hospitals; residential closed management; counterpart assistance. The following factors influence the cumulative number of confirmed cases in Germany: the Novel Coronavirus Crisis Command; large gathering cancelled; real-time COVID-19 risk assessment; the medical emergency plan; schools closure; restrictions on the import of overseas epidemics; the no-contact protocol. CONCLUSIONS: There are two differences between China and Germany in non-pharmaceutical interventions: China adopted the blocking strategy, and Germany adopted the first mitigation and then blocking strategy; China's goal is to eliminate the virus, and Germany's goal is to protect high-risk groups to reduce losses. At the same time, the policies implemented by the two countries have similarities: strict blockade is a key measure to control the source of infection, and improving medical response capabilities is an important way to reduce mortality.


Assuntos
COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/legislação & jurisprudência , Política de Saúde/legislação & jurisprudência , Pandemias/legislação & jurisprudência , Pandemias/prevenção & controle , Saúde Pública/legislação & jurisprudência , Adulto , Idoso , Idoso de 80 Anos ou mais , China/epidemiologia , Feminino , Alemanha/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , SARS-CoV-2
14.
Medicine (Baltimore) ; 100(3): e24077, 2021 Jan 22.
Artigo em Inglês | MEDLINE | ID: mdl-33546011

RESUMO

ABSTRACT: This study aimed to systematically analyze the effect of Wuhan mobile cabin hospitals (WMCHs) on the novel coronavirus-caused pneumonia (COVID-19) prevention and control in China. Between February 5, 2020 and March 10, 2020, a total of 16 mobile cabin hospitals were constructed in 3 batches to offer over 13,000 beds and admitted more than 12,000 patients in Wuhan City. The strategy of implementing WMCHs in 3 batches played a key role in fighting against COVID-19 in China. (1) The first batch of WMCHs increased hospital admission capacity of COVID-19 patients in Wuhan, which showed initial effect on COVID-19 epidemic control. (2) The operation of the second batch of WMCHs greatly contributed to the rapid growth in discharged patients. (3) After launching the third batch of WMCHs, the COVID-19 epidemic situation in Wuhan improved considerably. The last batch of WMCHs made a substantial contribution to defeating the COVID-19 epidemic in Wuhan.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Política de Saúde , Unidades Móveis de Saúde/organização & administração , China/epidemiologia , Número de Leitos em Hospital , Hospitalização , Humanos
15.
Global Health ; 17(1): 22, 2021 02 22.
Artigo em Inglês | MEDLINE | ID: mdl-33618688

RESUMO

BACKGROUND: The study aimed to analyze the effectiveness of COVID-19 strategies adopted by China, Japan, Singapore, and South Korea. METHODS: We extracted publicly available data from various official websites, summarized the strategies implemented in these four countries, and assessed the effectiveness of the prevention and control measures adopted by these countries. RESULTS: As of October 28, 2020, the growth of daily new confirmed cases has stabilized in China, Singapore, and South Korea. In Japan, the daily new confirmed cases increased sharply since it lifted a state of emergency, but case-fatality maintains at a lower level. The growth of total cases is near stagnant in China and Singapore, with a case-fatality of 5.39 and 0.05% respectively. The case-fatality rate between Japan and South Korea is identical at 1.76%, however, Japan's growth rate of cases has increased more rapidly than South Korea. CONCLUSION: This study found that China, Japan, Singapore, and South Korea accessed the situation within their own borders and implemented different intervention strategies to curb the spread of COVID-19 and maintain lower rates of case-fatality. China, Singapore, and South Korea adopted the containment strategy, while Japan adopted the mitigation strategy. Although Japan's case-fatality maintained at a low level, daily new cases increased faster than the other three countries. This result indicated that a mitigation strategy could be inferior to a containment strategy.


Assuntos
COVID-19/prevenção & controle , Comparação Transcultural , Pandemias , COVID-19/epidemiologia , China/epidemiologia , Humanos , Japão/epidemiologia , República da Coreia/epidemiologia , Singapura/epidemiologia
16.
Int J Equity Health ; 20(1): 33, 2021 01 13.
Artigo em Inglês | MEDLINE | ID: mdl-33441144

RESUMO

OBJECTIVE: In order to provide experiences for international epidemic control, this study systematically summarized the Coronavirus disease 2019 (COVID-19) prevention and control policies in Japan, Italy, China and Singapore, and also analyzed the possible inequalities that exist in these response approaches to improve global infectious disease control. METHODS: We summarized the epidemic prevention and control policies in Japan, Italy, China, and Singapore, and analyzed the policy effects of these four countries by using the data published by Johns Hopkins Coronavirus Resource Center. RESULTS: As of May 27, 2020, the growing trend of new cases in Japan, Italy, China and Singapore has stabilized. However, the cumulative number of confirmed cases (231139) and case-fatality rate (14.3%) in Italy far exceeded those in the other three countries, and the effect of epidemic control was inferior. Singapore began to experience a domestic resurgence after April 5, with a cumulative number of confirmed cases reaching 32,876, but the case-fatality rate remained extremely low (0.1%). The growth of cumulative confirmed cases in China (84547) was almost stagnant, and the case-fatality rate was low (5.5%). The growth of cumulative confirmed cases in Japan (16661) increased slowly, and the case-fatality rate (4.8%) was slightly lower than that in China. CONCLUSION: This study divided the epidemic prevention and control policies of the four countries into two categories: the blocking measures adopted by China and Singapore, and the mitigation measures adopted by Japan and Italy. According to the Epidemic control results of these four countries, we can conclude that the blocking measures were generally effective. As the core strategy of blocking measures, admitting mild patients into hospital and cases tracing helped curb the spread of the outbreak in Singapore and China. Countries should choose appropriate response strategies on the premise of considering their own situation, increase investment in health resources to ensure global health equity, and eventually control the spread of infectious diseases in the world effectively.


Assuntos
COVID-19/epidemiologia , COVID-19/terapia , Controle de Doenças Transmissíveis/métodos , Política de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , COVID-19/prevenção & controle , China/epidemiologia , Surtos de Doenças , Humanos , Itália/epidemiologia , Japão/epidemiologia , SARS-CoV-2 , Singapura/epidemiologia
17.
BMJ Open ; 10(12): e040143, 2020 12 01.
Artigo em Inglês | MEDLINE | ID: mdl-33262190

RESUMO

OBJECTIVES: To assess the relationship between occupational health and safety (OH&S)-related behaviours of migrating workers in China and their knowledge regarding OH&S laws and regulations (L&Rs). MATERIALS AND METHODS: We sampled 1282 migrant workers from 12 labour-intensive manufacturers in Guangdong, China, with a response rate of 98.6%. Self-reported questionnaires were completed by the participants. Logistic regression models were used to examine the association between OH&S-related behaviours and knowledge among migrant workers adjusting for their demographic features and the survey sites. RESULTS: Migrant workers' behaviour of seeking occupational disease (OD) diagnosis and treatment was found to be statistically significantly correlated with their knowledge of all three OH&S L&Rs. A higher score of knowledge regarding these OH&S L&Rs is associated with a better chance to seek OD diagnosis and treatment. The ORs of the high-score group (subjects correctly answered more than one question) versus the low-score group (subjects correctly answered less than or equal to one question) are 2.02 (95% CI: 1.33 to 3.07) for Law of Occupational Disease Prevention and Treatment, 2.89 (95% CI: 1.65 to 5.09) for Regulations on Safe Management of Dangerous Chemicals and Regulations on Labor Protection for Using Toxic Substances in Workplace and 2.25 (95% CI: 1.34 to 3.77) for Work-Related Injury Insurance Regulations. However, knowledge about these L&Rs is not statistically significantly associated with OH&S-related protective behaviours such as wearing a mask or gloves at work. CONCLUSIONS: Knowledge of OH&S L&Rs helps migrant workers in China to seek OD diagnosis and treatment.


Assuntos
Saúde do Trabalhador , Migrantes , Adulto , China , Estudos Transversais , Feminino , Humanos , Masculino , Inquéritos e Questionários , Local de Trabalho , Adulto Jovem
18.
BMC Fam Pract ; 21(1): 178, 2020 08 27.
Artigo em Inglês | MEDLINE | ID: mdl-32854623

RESUMO

OBJECTIVE: Following World Health Organization's initiatives to advance primary care, China put forth forceful policies including the Personal Family Doctor Contract to ensure that every family sign up with a qualified doctor in a community health center (CHC) ever since its 2009 New Health Reform. We used the Johns Hopkins-designed Primary Care Assessment Tool (PCAT) to assess primary care quality experienced by the contracted residents and compare this across different socioeconomic regions. METHODS: Using a multistage sampling method, four CHCs each were randomly selected from urban, suburban and rural districts of Shanghai, a metropolitan with 24 million residents. ANOVA and Multivariate analyses were used to assess the association between location of CHC and the quality of primary care experience. FINDINGS: A total of 2404 CHC users completed our survey. Except for the domain of coordination (information systems), users from suburban CHCs reported best primary care experiences in all other domains, followed by users of rural CHCs. After controlling for covariates, suburban CHC users were more likely to report higher total PCAT scores (ß = 1.57, P <  0.001) compared with those from urban CHCs. CONCLUSION: That contracted residents from suburban CHCs reporting better primary care experience than those from urban CHCs demonstrates the unique value of CHCs in relatively medical-underserved areas. In particular, urban CHCs could further strengthen first contact (utilization), first contact (accessibility), coordination (referral system), comprehensiveness (available), and community orientation aspects of primary care performance. However, all CHCs could improve coordination (information system).

19.
Artigo em Inglês | MEDLINE | ID: mdl-32646063

RESUMO

BACKGROUND: A series of reforms were implemented to improve the quality of primary care services in China. This study aims to assess patients' perceived quality of primary healthcare between rural and urban community health centers in Guangdong. METHODS: A cross-sectional survey was conducted from July to December 2015 in Guangdong. We surveyed 1010 respondents who visited either community health centers/stations (CHCs/CHSs) in urban areas or township health centers/rural health stations (THCs/RHSs) in rural areas. A validated Chinese version of the Primary Care Assessment Tool-Adult Short Version (PCAT-AS), representing ten primary care domains, was used to collect information on patients' primary care experiences. A t-test was used for comparison on domain scores and total scores between patients from CHCs/CHSs and THCs/RHSs. An analysis of covariance was employed to compare the adjusted PCAT domain scores and total scores. Multilevel models were used to explore factors associated with PCAT total scores. RESULTS: Overall, patients reported a lower level of experience of community orientation and family centeredness compared to other primary care domains. Patients from THCs/RHSs settings in the rural area reported better primary care experience in four domains, including first contact, accessibility, ongoing care, and community orientation. Higher education background and those with a chronic disease were associated with better primary care experience, after controlling for confounding factors. Patients who preferred primary care institutions when getting sick or used health services more frequently reported better primary care experiences. CONCLUSION: Continued efforts are needed to strengthen primary care performances, particularly in a community orientation and family centeredness. Primary care delivery in CHCs/CHSs settings should be improved in four domains, including first contact, accessibility, ongoing care, and community orientation.


Assuntos
Centros Comunitários de Saúde/normas , Satisfação do Paciente , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Adulto , China , Estudos Transversais , Feminino , Humanos , Masculino , Garantia da Qualidade dos Cuidados de Saúde , População Rural , Inquéritos e Questionários , População Urbana
20.
Int J Equity Health ; 19(1): 104, 2020 06 26.
Artigo em Inglês | MEDLINE | ID: mdl-32586388

RESUMO

The COVID-19 is disproportionally affecting the poor, minorities and a broad range of vulnerable populations, due to its inequitable spread in areas of dense population and limited mitigation capacity due to high prevalence of chronic conditions or poor access to high quality public health and medical care. Moreover, the collateral effects of the pandemic due to the global economic downturn, and social isolation and movement restriction measures, are unequally affecting those in the lowest power strata of societies. To address the challenges to health equity and describe some of the approaches taken by governments and local organizations, we have compiled 13 country case studies from various regions around the world: China, Brazil, Thailand, Sub Saharan Africa, Nicaragua, Armenia, India, Guatemala, United States of America (USA), Israel, Australia, Colombia, and Belgium. This compilation is by no-means representative or all inclusive, and we encourage researchers to continue advancing global knowledge on COVID-19 health equity related issues, through rigorous research and generation of a strong evidence base of new empirical studies in this field.


Assuntos
Infecções por Coronavirus/epidemiologia , Saúde Global/estatística & dados numéricos , Equidade em Saúde , Disparidades nos Níveis de Saúde , Pandemias , Pneumonia Viral/epidemiologia , COVID-19 , Humanos , Fatores Socioeconômicos
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