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1.
Recenti Prog Med ; 112(3): 219-224, 2021 03.
Artigo em Italiano | MEDLINE | ID: mdl-33687361

RESUMO

The pandemic period has generated major problems in the pharmacies of hospitals and local health care companies regarding the distribution of drugs to patients undergoing treatment with chronic drugs. This is because the patient, during the lockdown, was forced to leave the house and go several miles away to reach the place where the drug was dispensed. Moreover, very often, the place was placed in covid-19 hospitals, like the one in Perugia, and was also a risk for the patient himself. The logistical organization allows, in addition to the advantages of traceability, efficiency and savings, with the arrival of the drug at home, a very high patient compliance that also translates into greater security in a pandemic period. To the Usl Umbria 1 of Perugia (Italy) has been centralized the activity of warehouse for all the South area that includes three hospitals and four sanitary districts. Such warehouse, through computerized procedure, guarantees the direct distribution with sending of the medicines directly to the district of belonging of the patient. In this way the patient was not forced to make long and risky trips to continue their chronic therapies. Moreover, this logistic warehouse has also allowed to cope with the correct management of many medicinal specialties that have been used against the SARS-CoV-2 virus avoiding their temporary deficiency for patients already on therapy according to the normal therapeutic indications (anti-inflammatory, antiretroviral and immunomodulatory). This paper aims to demonstrate how logistical organization is of vital importance for a National Health System that has to face increasing costs, ensure the traceability of all processes and, last but not least, survive a worldwide pandemic period.


Assuntos
Armazenamento de Medicamentos , Pandemias , Preparações Farmacêuticas/provisão & distribução , Anti-Infecciosos/provisão & distribução , Anti-Infecciosos/uso terapêutico , Anti-Inflamatórios/provisão & distribução , Anti-Inflamatórios/uso terapêutico , Anti-Hipertensivos/provisão & distribução , Anti-Hipertensivos/uso terapêutico , Antineoplásicos/provisão & distribução , Antineoplásicos/uso terapêutico , Antivirais/provisão & distribução , Antivirais/uso terapêutico , Área Programática de Saúde , Custos de Medicamentos/estatística & dados numéricos , Reposicionamento de Medicamentos , Armazenamento de Medicamentos/estatística & dados numéricos , Humanos , Fatores Imunológicos/provisão & distribução , Fatores Imunológicos/uso terapêutico , Itália , Organização e Administração , Preparações Farmacêuticas/economia , Serviço de Farmácia Hospitalar/organização & administração
2.
Artigo em Inglês | MEDLINE | ID: mdl-33525529

RESUMO

Equity in accessible healthcare is crucial for measuring health equity in community care policy. The most important objective of such a policy in Taiwan is empowering people and communities by improving health literacy and increasing access to healthcare resources. Using the nearest-neighbor two-step floating catchment area method, this study performed an accessibility assessment for community care resources before and after supply capacity optimization. For the target of maximum equity when allocating community care resources, taking maximum values, mean values and minimum values of the distances into consideration, three analytical allocation solutions for supply capability optimization were derived to further compare disparities in geographical accessibility. Three indicators, namely, the Gini coefficient, median minus mean and mean-squared error, were employed to assess the degree of optimization of geographical accessibility scores at the locations of the demand population and to determine the degree of geographic inequities in the allocation of community care resources. Our study proposed a method in which the minimum value of the distance is adopted as the approximate representation of distances between the service point and the locations of demand to determine the minimum value for supply capacity optimization. The study found that the method can effectively assess inequities in care resource allocation among urban and rural communities.


Assuntos
Equidade em Saúde , Acesso aos Serviços de Saúde , Área Programática de Saúde , Humanos , Alocação de Recursos , Taiwan
3.
Soc Sci Med ; 273: 113773, 2021 03.
Artigo em Inglês | MEDLINE | ID: mdl-33609968

RESUMO

The rapid spread of COVID-19 across the world has raised concerns about the responsiveness of cities and healthcare systems during pandemics. Recent studies try to model how the number of COVID-19 infections will likely grow and impact the demand for hospitalization services at national and regional levels. However, less attention has been paid to the geographic access to COVID-19 healthcare services and to hospitals' response capacity at the local level, particularly in urban areas in the Global South. This paper shows how transport accessibility analysis can provide actionable information to help improve healthcare coverage and responsiveness. It analyzes accessibility to COVID-19 healthcare at high spatial resolution in the 20 largest cities of Brazil. Using network-distance metrics, we estimate the vulnerable population living in areas with poor access to healthcare facilities that could either screen or hospitalize COVID-19 patients. We then use a new balanced floating catchment area (BFCA) indicator to estimate spatial, income, and racial inequalities in access to hospitals with intensive care unit (ICU) beds and mechanical ventilators while taking into account congestion effects. Based on this analysis, we identify substantial social and spatial inequalities in access to health services during the pandemic. The availability of ICU equipment varies considerably between cities, and it is substantially lower among black and poor communities. The study maps territorial inequalities in healthcare access and reflects on different policy lessons that can be learned for other countries based on the Brazilian case.


Assuntos
Área Programática de Saúde , Acesso aos Serviços de Saúde , Pandemias , Brasil , Humanos
4.
Artigo em Inglês | MEDLINE | ID: mdl-33375249

RESUMO

The contradiction between the supply and demand of public medical resources in China is serious. On the basis of the "graded diagnosis and treatment" model, the Chinese government divides the medical grade and adjusts the allocation of medical facilities so as to alleviate the adverse impact of these issues on residents' health. Although the government tries to guide residents' medical treatment according to the level of medical facilities, there are differences between residents' medical treatment mode and policy rules in reality. Therefore, it is of great significance to explore spatial differences in accessibility to medical services for residents on the basis of the actual medical behavior. This article takes Shaanxi province as the research area, and uses the improved node cost network analysis method with the space-time distance model and the two-step floating catchment area method, respectively, to analyze the spatial differences of accessibility to three-level medical services and evaluate the equity of accessibility in different areas and groups in Shaanxi. Results showed that the overall level of accessibility to primary medical services in the province is good, and spatial distribution is balanced; the polarization of accessibility to secondary and tertiary medical services is a serious issue, and within the research area, a band-shaped multicore spatial structure was formed with the built-up areas of various cities as high-level centers of accessibility. Provincial residents have poor equity to access three-level medical services, and the equity of accessibility to primary medical services is better than that to highly specialized medical services. There is no obvious gap between accessibility to three-level medical services for the aging and the nonaging populations in Shaanxi, but the unfair phenomenon between agricultural and the nonagricultural populations is prominent. In addition, this article found that the improvement in traffic conditions can produce space-time convergence and effectively weaken spatial deprivation. Therefore, developing public transportation is an effective approach to improve the equity of accessibility to medical services.


Assuntos
Instalações de Saúde , Acesso aos Serviços de Saúde , Área Programática de Saúde , China , Cidades , Análise Espacial
5.
Vínculo ; 17(2): 46-66, jul.-dez. 2020. ilus
Artigo em Português | LILACS, Index Psicologia - Periódicos técnico-científicos | ID: biblio-1157017

RESUMO

A psicossomática busca compreensão dos sintomas físicos de origem psíquica e a intervenção psicológica grupal surge como ferramenta possibilitando espaço para a reflexão em grupo acerca deste adoecimento. Este estudo objetiva levantar produções científicas que integram a psicologia grupal e a psicossomática. Utilizou-se como metodologia a revisão integrativa, no período de 2011 a 2016, por meio de base de dados eletrônicas, os periódicos da CAPES, Scielo, Pepsic e LILACS. Utilizados os descritores: grupos e psicossomática como filtros. Dentre os resultados notou-se a carência de produções científicas entre os descritores no tocante a serviços na área da saúde. Verificou-se também que pesquisas nesta área estão voltadas para orientação diagnóstica, sem efetivo interesse na promoção de saúde e no empoderamento do usuário.


The psychosomatic seeks understanding of physical symptoms of psychic origin and the group psychological intervention appears as a tool allowing space for group reflection about this illness. This study aims make a survey of the scientific productions that integrate group and psychosomatic psychology. Used the integrative review from 2011 to 2016 through the electronic database the CAPES, Scielo, Pepsic and LILACS scientific journals. Used the descriptors: groups and psychosomatic as research filters. Among the results it was observed the lack of scientific productions between the descriptors in relation to the health área. It was also verified that researchs in this area are geared towards diagnostic orientation without an effective interest in health promotion and in user empowerment.


La psicosomática busca la comprensión de los síntomas físicos de origen psíquico y la intervención psicológica grupal surge como herramienta posibilitando espacio para la reflexión en grupo acerca de este enfermo. Este estudio objetiva levantar producciones científicas que integran la psicología grupal y la psicosomática. Se utilizó como metodología la revisión integrativa, en el período de 2011 a 2016, por medio de base de datos electrónicos, los periódicos de CAPES, Scielo, Pepsic y LILACS.Utilizados los descriptores: grupos y psicosomática como filtros. Entre los resultados se notó la carencia de producciones científicas entre los descriptores en cuanto a servicios en el área de la salud.Se verificó también que investigaciones en esta área están orientadas hacia orientación diagnóstica, sin efectivo interés en la promoción de la salud y en el empoderamiento del usuario.


Assuntos
Medicina Psicossomática , Psicoterapia de Grupo , Sinais e Sintomas , Área Programática de Saúde , Compreensão , Prevenção de Doenças , Empoderamento , Promoção da Saúde
6.
PLoS One ; 15(12): e0244291, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33347485

RESUMO

Studies on fracture incidence have mostly been based on retrospectively registered data from local hospital databases. The Swedish Fracture Register (SFR) is a national quality register collecting data prospectively on fractures, at the time of care-seeking. In the present study the incidence of all different fractures, regardless of location, in adults' ≥ 16 years treated at the only care provider for patients with fractures within a catchment area of approximately 550,000 inhabitants, during 2015‒2018 are described. Age, gender, and fracture location (according to AO/OTA classification) was used for the analyses and presentation of fracture incidences. During the 4-year study period, 23,917 individuals sustained 27,169 fractures. The mean age at fracture was 57.9 years (range 16‒105 years) and 64.5% of the fractures occurred in women. The five most common fractures accounted for more than 50% of all fractures: distal radius, proximal femur, ankle, proximal humerus, and metacarpal fractures. Seven fracture incidence distribution groups were created based on age- and gender-specific incidence curves, providing visual and easily accessible information on fracture distribution. This paper reports on incidence of all fracture locations based on prospectively collected data in a quality register. The knowledge on fracture incidence related to age and gender may be of importance for the planning of orthopaedic care, involving both in- and out-patients as well as allocating surgical resources. Further, this might be useful for organizing preventive measures, especially in countries with similar socioeconomic structure and fracture burden.


Assuntos
Fatores Etários , Fraturas Ósseas/epidemiologia , Fatores Sexuais , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Área Programática de Saúde , Gerenciamento de Dados , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Sistema de Registros , Suécia/epidemiologia
7.
Int J Health Geogr ; 19(1): 36, 2020 09 14.
Artigo em Inglês | MEDLINE | ID: mdl-32928236

RESUMO

BACKGROUND: The severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), causing the coronavirus disease 2019 (COVID-19) pandemic, has infected millions of people and caused hundreds of thousands of deaths. While COVID-19 has overwhelmed healthcare resources (e.g., healthcare personnel, testing resources, hospital beds, and ventilators) in a number of countries, limited research has been conducted to understand spatial accessibility of such resources. This study fills this gap by rapidly measuring the spatial accessibility of COVID-19 healthcare resources with a particular focus on Illinois, USA. METHOD: The rapid measurement is achieved by resolving computational intensity of an enhanced two-step floating catchment area (E2SFCA) method through a parallel computing strategy based on cyberGIS (cyber geographic information science and systems). The E2SFCA has two major steps. First, it calculates a bed-to-population ratio for each hospital location. Second, it sums these ratios for residential locations where hospital locations overlap. RESULTS: The comparison of the spatial accessibility measures for COVID-19 patients to those of population at risk identifies which geographic areas need additional healthcare resources to improve access. The results also help delineate the areas that may face a COVID-19-induced shortage of healthcare resources. The Chicagoland, particularly the southern Chicago, shows an additional need for resources. This study also identified vulnerable population residing in the areas with low spatial accessibility in Chicago. CONCLUSION: Rapidly measuring spatial accessibility of healthcare resources provides an improved understanding of how well the healthcare infrastructure is equipped to save people's lives during the COVID-19 pandemic. The findings are relevant for policymakers and public health practitioners to allocate existing healthcare resources or distribute new resources for maximum access to health services.


Assuntos
Área Programática de Saúde/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Recursos em Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Betacoronavirus , Acesso aos Serviços de Saúde/organização & administração , Número de Leitos em Hospital/estatística & dados numéricos , Humanos , Illinois , Unidades de Terapia Intensiva/estatística & dados numéricos , Pandemias , Fatores Socioeconômicos , Análise Espacial , Ventiladores Mecânicos/provisão & distribução
8.
Health Place ; 65: 102406, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32877867

RESUMO

The increasing inequality in spatial accessibility to hospitals in developing countries has been attracting attention from researchers and politicians. The situation seems to be worse in growing megacities where more than 10 million people live and rapid urban sprawl has caused serious problems with the supply of health and public transport services. The recent global COVID-19 pandemic calls for particular attention to be afforded to the matter of equal access to basic medical facilities and services for people across different neighborhoods. Although some studies have already been undertaken into the subject of health-focused inequality in the cities of developing countries, the spatial inequity in hospital accessibility has rarely been discussed to date. In this paper, I aim to provide new evidence by considering Beijing as a case study. With the results of my analysis, I show that low-income neighborhoods have experienced lower levels of accessibility not only to high-tier hospitals (secondary and tertiary hospitals) but also to primary healthcare services (primary hospital and neighborhood clinics). The rate at which high-income neighborhoods access secondary and tertiary hospitals is approximately 4 times and 1.5 times as high as that of low-income neighborhoods. Low-income face nearly twice the travel time of those from high-income neighborhoods to reach the nearest primary hospital or neighborhood clinics. Suburban neighborhoods have less access to medical services than neighborhoods that are located in the central urban areas. It seems that the rapid urban sprawl has been worsening spatial inequality in the context of access to medical services in the growing megacity of Beijing. Equal access to healthcare services should be prioritized in future policy discussions, especially in relation to the urban growth management of megacities in developing countries in order to ensure that fair and inclusive urbanization processes are undertaken. Equal access to healthcare services would also be widely beneficial in the context of managing the COVID-19 pandemic.


Assuntos
Área Programática de Saúde/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde , Hospitais/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Fatores Socioeconômicos , Pequim , Betacoronavirus/isolamento & purificação , Cidades , Humanos , Características de Residência , Transportes
9.
PLoS One ; 15(7): e0235963, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32722700

RESUMO

The impacts of changes in climate are often most readily observed through the effects of extremes in local weather, effects that often propagate through multiple ecosystem levels. Precise effects of any extreme weather event depend not only on the type of event and its timing, but also on the ecosystem affected. Here the cascade of effects following the arrival of an atmospheric river (directed by record-breaking Storm Desmond) across terrestrial, freshwater and coastal zones is quantified, using the Burrishoole system on the Atlantic coast of Ireland as a natural observatory. We used a network of high-frequency in-situ sensors to capture in detail the effects of an unprecedented period of rainfall, high wind speeds and above-average winter air temperatures on catchment and estuarine dynamics. In the main freshwater lake, water clarity decreased and acidity increased during Storm Desmond. Surface heat input, due to a warm and moist above-lake air mass, was rapidly distributed throughout the water column. River discharge into the downstream coastal basin was estimated to be the highest on record (since 1976), increasing the buoyancy flux by an order of magnitude and doubling the water column stratification stability. Entrainment of salt into the outflowing freshwater plume exported resident salt from the inner estuarine basin, resulting in net salt loss. Here, the increased stratification markedly reinforced isolation of the bottom waters, promoting deoxygenation. Measurements of current between the inner estuarine basin and the adjacent coastal waters indicated a 20-fold increase in the volume of seaward flowing low-salinity water, as a result of storm rainfall over the watershed. Storm impacts spanned the full catchment-to-coast continuum and these results provide a glimpse into a potential future for hydrological systems where these severe hydroclimatic events are expected to occur more frequently.


Assuntos
Mudança Climática , Ecossistema , Monitoramento Ambiental/métodos , Modelos Teóricos , Estações do Ano , Tempo (Meteorologia) , Oceano Atlântico , Área Programática de Saúde , Humanos
10.
Semergen ; 46 Suppl 1: 35-39, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32646731

RESUMO

OBJECTIVE: To evaluate the prevalence of and factors associated with SARS-CoV-2 infection in general practitioners and nurses from primary care centers and nursing homes in the Healthcare Area of León (Spain). MATERIALS AND METHODS: Cross-sectional study in a convenience sample of professionals from 30 health centers and 30 nursing homes from the primary care management division of the Healthcare Area of Leon. The work center, type of profession, COVID-19 infection, level of exposure, compliance with preventive measures, isolation (if required) and diagnostic tests carried out were collected. The determination of infection was made by differentiated rapid diagnostic test (dRDT), using a finger-stick whole-blood sample. The association of variables with infection was assessed by multivariable non-conditional logistic regression. The true prevalence of SARS-CoV-2 infection was calculated according to two scenarios for RDT (Sensitivity=0.6 and Specificity=0.985; Sensitivity=0.8 and Specificity=1). RESULTS: The true prevalence of SARS-CoV-2 infection was between 4.9% and 11.0%. The observed prevalence was 5.9% and was higher in nursing homes than in primary care centers (9.5% vs. 5.5%). No statistically significant differences were observed by sex, type of professional, level of exposure or compliance with preventive measures. CONCLUSIONS: The prevalence of SARS-CoV-2 infection in this group is low. A high number of professionals remain susceptible to SARS-CoV-2 infection and therefore protective measures should be taken, especially for professionals working in nursing homes.


Assuntos
Infecções por Coronavirus/epidemiologia , Medicina Geral , Casas de Saúde , Enfermagem , Doenças Profissionais/epidemiologia , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde , Adulto , Área Programática de Saúde , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , Prevalência , Espanha/epidemiologia
11.
Artigo em Inglês | MEDLINE | ID: mdl-32674524

RESUMO

Due to the rapid increase in the number of elderly people in Chinese cities, the development and planning of aged care facilities, and particularly community care facilities, which will gradually become the mainstream choice for the elderly in China, is becoming an important topic for urban sustainability. Previous studies have shown that the number and scale of aged care facilities in many cities are far from meeting the needs of the elderly and the overall occupation rate is low. Some of these cities are still expanding and some are undergoing urban renovation. In this process, the scientific planning of community care facilities to promote efficient use of facility resources has become an urgent problem that needs to be solved. In this study, the two-step floating catchment area (2SFCA) method and a potential model based on the Geographic Information System (GIS) were used to carry out a scientific evaluation of the spatial accessibility of community care facilities in the Beilin district of Xi'an. The aims were to explore the best quantitative research methods for assessing the distribution of Xi'an community care facilities' spatial accessibility, provide ideas for similar studies in the future, and further the understanding of spatial allocation of urban community care facilities resources.


Assuntos
Área Programática de Saúde , Acesso aos Serviços de Saúde , Idoso , China , Cidades , Humanos , Crescimento Sustentável , Saúde da População Urbana
12.
J Stroke Cerebrovasc Dis ; 29(8): 104894, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32689599

RESUMO

INTRODUCTION: Mobile Stroke Units (MSUs) deliver acute stroke treatment on-scene in coordination with Emergency Medical Services (EMS). One criticism of the MSU approach is the limited range of a single MSU. The Houston MSU is evaluating MSU implementation, and we developed a rendezvous approach as an innovative solution to expand the range and number of patients treated. METHODS: In addition to direct 911 dispatch of our MSU to the scene within our 7-mile catchment area, we empowered more distant EMS units to activate the MSU. We also monitored EMS radio communications to identify possible patients. For these distant patients, the MSU met the EMS unit en route to the stroke center and treated the patient at that intermediate location. The distribution of the distance from MSU base station to site of stroke and time from 911 alert to tissue plasminogen activator (tPA) bolus were compared between patients treated on-scene and by rendezvous using Wilcoxon rank sum test. RESULTS: Over 4 years, 338 acute ischemic stroke patients were treated with tPA on our MSU. Of these, 169 (50%) were treated on-scene after MSU dispatch at a median of 6.4 miles (IQR 6.4 miles) from MSU base station. 169 (50%) were treated by 'rendezvous' pathway with assessment and treatment of stroke a median of 12.4 miles from base (IQR 5.5 miles) (p< 0.0001). Time (min) from MSU alert to tPA bolus did not differ: 36.0 ± 10.0 for on-scene vs 37.0 ± 10.0 with rendezvous (p=0.65). 13% of patients alerted via direct 911 dispatch were treated vs 44% of rendezvous patients. CONCLUSION: Adding a rendezvous approach to an MSU dispatch pathway doubles the range of operations and the number of patients treated by an MSU in an urban area, without incurring delay.


Assuntos
Área Programática de Saúde , Prestação Integrada de Cuidados de Saúde , Despacho de Emergência Médica , Fibrinolíticos/administração & dosagem , Unidades Móveis de Saúde , Acidente Vascular Cerebral/tratamento farmacológico , Terapia Trombolítica , Tempo para o Tratamento , Ativador de Plasminogênio Tecidual/administração & dosagem , Transporte de Pacientes , Idoso , Idoso de 80 Anos ou mais , Pesquisa Comparativa da Efetividade , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia , Texas , Fatores de Tempo , Resultado do Tratamento , Serviços Urbanos de Saúde
13.
Stroke ; 51(7): 2224-2227, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32516064

RESUMO

BACKGROUND AND PURPOSE: This study aims to assess the number of patients with acute ischemic cerebrovascular events seeking in-patient medical emergency care since the implementation of social distancing measures in the coronavirus disease 2019 (COVID-19) pandemic. METHODS: In this retrospective multicenter study, data on the number of hospital admissions due to acute ischemic stroke or transient ischemic attack and numbers of reperfusion therapies performed in weeks 1 to 15 of 2020 and 2019 were collected in 4 German academic stroke centers. Poisson regression was used to test for a change in admission rates before and after the implementation of extensive social distancing measures in week 12 of 2020. The analysis of anonymized regional mobility data allowed for correlations between changes in public mobility as measured by the number and length of trips taken and hospital admission for stroke/transient ischemic attack. RESULTS: Only little variation of admission rates was observed before and after week 11 in 2019 and between the weeks 1 and 11 of 2019 and 2020. However, reflecting the impact of the COVID-19 pandemic, a significant decrease in the number of admissions for transient ischemic attack was observed (-85%, -46%, -42%) in 3 of 4 centers, while in 2 of 4 centers, stroke admission rates decreased significantly by 40% and 46% after week 12 in 2020. A relevant effect on reperfusion therapies was found for 1 center only (thrombolysis, -60%; thrombectomy, -61%). Positive correlations between number of ischemic events and mobility measures in the corresponding cities were identified for 3 of 4 centers. CONCLUSIONS: These data demonstrate and quantify decreasing hospital admissions due to ischemic cerebrovascular events and suggest that this may be a consequence of social distancing measures, in particular because hospital resources for acute stroke care were not limited during this period. Hence, raising public awareness is necessary to avoid serious healthcare and economic consequences of undiagnosed and untreated strokes and transient ischemic attacks.


Assuntos
Betacoronavirus , Isquemia Encefálica/epidemiologia , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/epidemiologia , Doença Aguda , Idoso , Isquemia Encefálica/terapia , Área Programática de Saúde , Feminino , Alemanha/epidemiologia , Hospitais Especializados/estatística & dados numéricos , Humanos , Ataque Isquêmico Transitório/epidemiologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Utilização de Procedimentos e Técnicas , Reperfusão/estatística & dados numéricos , Estudos Retrospectivos , Acidente Vascular Cerebral/terapia
14.
JAMA Netw Open ; 3(6): e207559, 2020 06 01.
Artigo em Inglês | MEDLINE | ID: mdl-32525547

RESUMO

Importance: Social determinants of health, such as income, education, housing quality, and employment, are associated with disparities in Alzheimer disease and health generally, yet these determinants are rarely incorporated within neuropathology research. Objective: To establish the feasibility of linking neuropathology data to social determinants of health exposures using neighborhood disadvantage metrics (the validated Area Deprivation Index) and to evaluate the association between neighborhood disadvantage and Alzheimer disease-related neuropathology. Design, Setting, and Participants: This cross-sectional study consisted of decedents with a known home address who donated their brains to 1 of 2 Alzheimer disease research center brain banks in California and Wisconsin between January 1, 1990, and December 31, 2016. Neither site had preexisting social metrics available for their decedents. Neuropathologic features were obtained from each site for data collected using the standardized Neuropathology Data Set form and from autopsy reports. Data were analyzed from June 7 to October 10, 2019. Exposures: Geocoded decedent addresses linked to neighborhood disadvantage as measured by the Area Deprivation Index calculated for the year of death. Main Outcomes and Measures: Presence of Alzheimer disease neuropathology. The association between neighborhood disadvantage and Alzheimer disease neuropathology was evaluated via logistic regression, adjusting for age, sex, and year of death. Results: The sample consisted of 447 decedents (249 men [56%]; mean [SD] age, 80.3 [9.5] years; median year of death, 2011) spanning 24 years of donation. Fewer decedents (n = 24 [5.4%]) originated from the top 20% most disadvantaged neighborhood contexts. Increasing neighborhood disadvantage was associated with an 8.1% increase in the odds of Alzheimer disease neuropathology for every decile change on the Area Deprivation Index (adjusted odds ratio, 1.08; 95% CI, 1.07-1.09). As such, living in the most disadvantaged neighborhood decile was associated with a 2.18 increased odds of Alzheimer disease neuropathology (adjusted odds ratio, 2.18; 95% CI, 1.99-2.39). Conclusions and Relevance: The findings of this cross-sectional study suggest that social determinants of health data can be linked to preexisting autopsy samples as a means to study sociobiological mechanisms involved in neuropathology. This novel technique has the potential to be applied to any brain bank within the United States. To our knowledge, this is the first time Alzheimer disease neuropathology has been associated with neighborhood disadvantage.


Assuntos
Doença de Alzheimer , Área Programática de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/epidemiologia , Doença de Alzheimer/patologia , Doença de Alzheimer/terapia , Pesquisa Biomédica , Encéfalo/patologia , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Bancos de Tecidos
15.
J Glob Health ; 10(1): 010422, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32426122

RESUMO

Background: The primary cause of death in Burkina Faso is lower respiratory tract infections, accounting for 1 in 7 deaths. The Ministry of Health is building surveillance for severe acute respiratory infections (SARI) in four districts. This study sought to determine the catchment area of the Boussé district hospital and to describe disease burden of individuals hospitalized for SARI. Methods: Data were collected from hospital log books to identify individuals with a SARI diagnosis during 2015 and 2016. Residence of SARI patients was recorded to determine the catchment area of the hospital. Population data were used to estimate SARI incidence rates. Results: Investigators reviewed logs for 3034 hospital admissions; 885 SARI cases were identified. Five communes were identified as the hospital catchment area, with 770 SARI patients residing in these communes. The SARI incidence rate (IR) for all ages was 136 (95% confidence interval (CI) = 115, 161) and 266 (95% CI = 236, 300) cases per 100 000 population for 2015 and 2016, respectively. Children <1 (RI = 1111 cases per 100 000, 95% CI = 1047, 1178, and RI = 2425 cases per 100 000, 95% CI = 2330, 2524) and adults ≥65 years old (RI = 377 cases per 100 000, 95% CI = 341, 417, and RI = 816 cases per 100 000, 95% CI = 762, 874) had the highest burden of disease for 2015 and 2016, respectively. Conclusion: Our analysis found high rates of SARI, especially among children <1 year of age, and marked variation in incidence between the years studied. These baseline data and the method developed will be useful for the new SARI surveillance system.


Assuntos
Área Programática de Saúde , Hospitais de Distrito/estatística & dados numéricos , Vigilância da População , Infecções Respiratórias/epidemiologia , Infecções Respiratórias/terapia , Adolescente , Adulto , Idoso , Burkina Faso/epidemiologia , Criança , Pré-Escolar , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Incidência , Lactente , Masculino , Pessoa de Meia-Idade , Adulto Jovem
17.
PLoS One ; 15(5): e0232848, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32374771

RESUMO

BACKGROUND: Sub-Saharan Africa (SSA) has an increasing non-communicable disease burden. Tanzania has an incidence of more than 35,000 cancer cases per year with an 80% mortality rate. Hematological malignancies account for 10% of these cases. The numbers will double within the next 10 years due to demographic changes, better diagnostic capabilities and life style changes. Kilimanjaro Christian Medical Centre established a Cancer Care Centre (CCC) in December 2016 for a catchment area of 15 million people in Northern Tanzania. This article aims to display the hematological diagnosis and characteristics of the patients as well as to describe the advancements of hematologic services in a low resource setting. METHODS: A cross-sectional analysis of all hematological malignancies at CCC from December 2016 to May 2019 was performed and a narrative report provides information about diagnostic means, treatment and the use of synergies. RESULTS: A total of 209 cases have been documented, the most common malignancies were NHL and MM with 44% and 20%. 36% of NHL cases, 16% of MM cases and 63% of CML cases were seen in patients under the age of 45. When subcategorized, CLL/SLL cases had a median age was 56.5, 51 years for those with other entities of NHL. Sexes were almost equally balanced in all NHL groups while clear male predominance was found in HL and CML. DISCUSSION: Malignancies occur at a younger age and higher stages than in Western countries. It can be assumed that infections play a key role herein. Closing the gap of hematologic services in SSA can be achieved by adapting and reshaping existing infrastructure and partnering with international organizations.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Neoplasias Hematológicas/epidemiologia , Adolescente , Adulto , Distribuição por Idade , Idade de Início , Idoso , Institutos de Câncer/estatística & dados numéricos , Área Programática de Saúde , Criança , Pré-Escolar , Estudos Transversais , Diagnóstico Tardio , Feminino , Previsões , Neoplasias Hematológicas/diagnóstico , Neoplasias Hematológicas/patologia , Neoplasias Hematológicas/terapia , Humanos , Lactente , Recém-Nascido , Cooperação Internacional , Linfoma não Hodgkin/epidemiologia , Masculino , Pessoa de Meia-Idade , Morbidade/tendências , Mieloma Múltiplo/epidemiologia , Programas Nacionais de Saúde , Especificidade de Órgãos , Recursos Humanos em Hospital/estatística & dados numéricos , Sistema de Registros , Distribuição por Sexo , Tanzânia/epidemiologia , Adulto Jovem
18.
BMC Health Serv Res ; 20(1): 476, 2020 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-32460778

RESUMO

BACKGROUND: Day care is an important service for many people with dementia and their carers. In Ireland, day care services for people with dementia are delivered by a mix of dementia-specific day care centres as well as generic day care centres that cater for people with dementia to various degrees. In this paper we examine the geographic distribution of day care services for people with dementia relative to potential need. METHODS: Using a national survey of day care centres, we estimate the current availability of day care services for people with dementia in the country. We use geographic information systems (GIS) to map day care provision at regional and sub-regional levels and compare this to the estimated number of people with dementia in local areas. RESULTS: There is significant variation across the country in the existing capacity of day care centres to cater for people with dementia. The number of places per 100 persons with dementia in the community varies from 14.2 to 21.3 across Community Health Organisation areas. We also show that 18% of people with dementia do not live within 15kms of their nearest day care centre. CONCLUSION: Currently, day care centres, in many parts of the country, have limited capacity to provide a service for people with dementia who live in their catchment area. As the number of people with dementia increases, investment in day care centres should be targeted to areas where need is greatest. Our GIS approach provides valuable evidence that can help inform decisions on future resource allocation and service provision in relation to day care.


Assuntos
Hospital Dia , Demência , Acesso aos Serviços de Saúde , Área de Atuação Profissional , Área Programática de Saúde , Sistemas de Informação Geográfica , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Irlanda , Alocação de Recursos , Inquéritos e Questionários
20.
Artigo em Inglês | MEDLINE | ID: mdl-32316229

RESUMO

Spatial accessibility to general hospitals is an important indicator of the convenience and ability of residents to obtain medical services. Therefore, developing a model for measuring accessibility to general hospitals by multiple transportation modes is necessary. In this study, considering that the increase in travel time will reduce the attractiveness of general hospitals, we used the Two-Step Floating Catchment Area with the Gaussian attenuation function, in which the supply was presented by capacity of hospitals (i.e., number of beds), and the demand was presented by population in each grid derived with social media data mapping real-time locations of active users. The Gaussian Two-Step Floating Catchment Area (Ga2SFCA) simulates the attenuation tendency of the general hospital service capabilities over transit time. To obtain a highly precise understanding of accessibility to hospitals, transit time on Baidu Maps' navigation service was used as the impedance condition, and the study area was divided into 1 square kilometer grids as the basic unit of research. Taking Nanjing city as a case study, it is found that the accessibility distribution shape changes from a multi-centered circular pattern to a multi-peak distribution, as the time threshold increases. By comparing the accessibility among 11 districts varying from main urban area to suburbs, the accessibility to general hospitals in Nanjing is significantly regionally unbalanced in both travel modes. By calculating and mapping the Modal Accessibility Gap (MAG) of the two travel modes, different modes of transportation resulted in different general hospital accessibility distributions. Generally, private car is superior in access to general hospitals to public transit in most areas. In the central area, public traffic may not contribute to the access to medical services as much as we thought, rather it plays a role in areas far from hospitals along metro lines and bus routes.


Assuntos
Acesso aos Serviços de Saúde , Hospitais Gerais , Mídias Sociais , Área Programática de Saúde , Transportes
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