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1.
Med Sci (Paris) ; 36(11): 1034-1037, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33151866

RESUMO

Coronavirus disease (COVID)-19 is an emerging pandemic infection whose significant ability to spread in a naïve population is well established. The first response of states to the COVID-19 outbreak was to impose lock-down and social barrier measures, such as wearing a surgical mask or social distancing. One of the consequences of this pandemic in terms of public health was the suspension or slowdown of infant vaccination campaigns, in almost all countries. The indirect effects of COVID-19 may therefore weigh on mortality from measles and polio in developing countries. In this pandemic chaos, the only hope lies in the rapid development of an effective vaccine against severe acute respiratory syndrome-coronavirus-2 (SARS-CoV-2). However, acceptance of this vaccine has not yet been won, as beyond the many unknowns that will inevitably weigh around such rapid development, skepticism among vaccine hesitants is growing.


Assuntos
Infecções por Coronavirus/epidemiologia , Programas de Imunização/estatística & dados numéricos , Pandemias , Pneumonia Viral/epidemiologia , Saúde Pública/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Betacoronavirus/fisiologia , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/prevenção & controle , Surtos de Doenças/prevenção & controle , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Programas de Imunização/organização & administração , Programas de Imunização/normas , Programas de Imunização/tendências , Sarampo/epidemiologia , Sarampo/prevenção & controle , Pandemias/prevenção & controle , Participação do Paciente/estatística & dados numéricos , Participação do Paciente/tendências , Pneumonia Viral/imunologia , Pneumonia Viral/prevenção & controle , Poliomielite/epidemiologia , Poliomielite/prevenção & controle , Saúde Pública/normas , Saúde Pública/tendências , Cobertura Vacinal/organização & administração , Cobertura Vacinal/estatística & dados numéricos , Vacinas Virais/uso terapêutico
4.
N Z Med J ; 133(1524): 11-19, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-33119566

RESUMO

AIM: Recent changes in funding have reduced the cost of the highly effective levonorgestrel-releasing intrauterine system (LIUS) contraceptives (Mirena and Jaydess). This paper explores equity of access to intrauterine contraceptives for Maori and the general population by locating and surveying all potential providers within the Southern District Health Board catchment area. METHODS: Using online survey, e-mail or phone, we asked if intrauterine contraceptive insertion was provided, what device was provided, cost and number of appointments required. ArcGIS 10.6.1 software was used to estimate population distribution, and to create service areas showing distance to nearest current providers for Maori and the general population. RESULTS: All 88 potential providers agreed to participate; two thirds (66.3%) provided some intrauterine contraceptive insertion. Approximately three quarters of the Maori and general population live within 5km of a primary provider. Costs ranged from $0 to $270, in addition to the cost of the required consultations. Number of consultations required varied from one to three. CONCLUSIONS: Cost and travel time likely remain barriers to accessing intrauterine contraceptives for a significant population within this catchment. Increasing the capacity for all primary providers to offer insertion, funding the insertion process, minimising the number of appointments required and providing mobile services would improve access.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Dispositivos Intrauterinos Medicados , Instituições de Assistência Ambulatorial , Serviços de Planejamento Familiar , Feminino , Humanos , Dispositivos Intrauterinos Medicados/economia , Dispositivos Intrauterinos Medicados/estatística & dados numéricos , Levanogestrel , Contracepção Reversível de Longo Prazo , Nova Zelândia , Viagem
5.
N Z Med J ; 133(1524): 40-49, 2020 10 30.
Artigo em Inglês | MEDLINE | ID: mdl-33119569

RESUMO

AIMS: To analyse the surgical intervention rate (SIR), best spectacle-corrected visual acuity (BSCVA) and disparities in access to public-funded cataract surgery in New Zealand. The New Zealand Ministry of Health uses the National Prioritisation Web Service (NPWS) to prioritise all patients for public-funded cataract surgery. BSCVA at prioritisation, ethnic, demographic and geographic disparities have not previously been assessed. METHODS: A retrospective cohort study. Between November 2014 and March 2019, 61,095 prioritisation events for 44,403 unique patients were identified. Cataract prioritisation events extracted from the NPWS were merged with date of birth and ethnicity extracted from the National Health Index database. All data were de-identified prior to statistical analysis. RESULTS: Mean age at prioritisation was 74.4 years, with female preponderance (56%). Overall ethnicity was 'European' in 69.8% and 'New Zealand Maori' in 9.6%. Mean Snellen BSCVA was 6/30-2 (prioritised eye), and 6/12-1 (binocular). Maori and Pasifika presented on average 10 years earlier than other ethnic groups with significantly worse BSCVA. Surgery was approved in 74.4% of prioritisation events with mean Snellen BSCVA of 6/38-2. Only 34.9% of New Zealand patients had Snellen BSCVA of 6/12 or better in the prioritised eye, compared to 58.4% in the European Union. Cataract SIR varied by region. CONCLUSIONS: New Zealand's cataract SIR is lower than most Organisation for Economic Co-operation and Development countries and patients have significantly worse BSCVA at prioritisation. Access to cataract surgery in New Zealand varies according to region. Maori and Pasifika present younger with worse BSCVA, suggesting potential barriers in accessing timely referral and prioritisation.


Assuntos
Extração de Catarata/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acuidade Visual , Idoso , Idoso de 80 Anos ou mais , Catarata/etnologia , Feminino , Financiamento Governamental , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Qualidade de Vida , Estudos Retrospectivos
7.
PLoS One ; 15(10): e0239326, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33085682

RESUMO

BACKGROUND: Long distances to facilities, topographical constraints, inadequate service capacity of institutions and insufficient/ rudimentary road & transportation network culminate into unprecedented barriers to access. These barriers gets exacerbated in presence of external factors like conflict and political disruptions. Thus, this study was conducted in rural, remote and fragile region in India measuring geographical accessibility and modelling spatial coverage of public healthcare network. METHODS: Vector and raster based approaches were used to discern accessibility for various packages of service delivery. Alternative scenarios derived from local experiences were modelled using health facility, population and ancillary data. Based on that, a raster surface of travel time between facilities and population was developed by incorporating terrain, physical barriers, topography and travelling modes and speeds through various land-cover classes. Concomitantly, spatial coverage was modelled to delineate catchment areas. Further, underserved population and zonal statistics were assessed in an interactive modelling approach to ascertain spatial relationship between population, travel time and zonal boundaries. Finally, raster surface of travel time was re-modelled for the conflict situation in villages vulnerable to obstruction of access due to disturbed security scenario. RESULTS: Euclidean buffers revealed 11% villages without ambulatory & immunization care within 2 km radius. Similarly, for 5 km radius, 11% and 12% villages were bereft of delivery and inpatient care. Travel time accessibility analysis divulged walking scenario exhibiting lowest level of accessibility. Enabling motorized travel improved accessibility measures, with highest degree of accessibility for privately owned vehicle (motorcycle and cars). Differential results were found between packages of services where ambulatory & immunization care was relatively accessible by walking; whereas, delivery and inpatient care had a staggering average of three hours walking time. Even with best scenario, around 2/3rd population remained unserved for all package of services. Moreover, 90% villages in conflict zone grapples with inaccessibility when the scenario of heightened border tensions was considered. CONCLUSIONS: Our study demonstrated the application of GIS technique to facilitate evidence backed planning at granular level. Regardless of the scenario, the analysis divulged inaccessibility to delivery and inpatient care to be most pronounced and majority of population to be unserved. It was suggested to have concerted efforts to bolster already existing facilities and adapt systems approach to exploit synergies of inter-sectoral development.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Saúde Pública , Sistemas de Informação Geográfica , Humanos , Índia , Modelos Teóricos , População Rural , Transportes , Caminhada
8.
Bull Cancer ; 107(11): 1129-1137, 2020 Nov.
Artigo em Francês | MEDLINE | ID: mdl-33036742

RESUMO

PURPOSE: Human, material, and financial resources being limited, the organization of the care system must allow an efficient allocation of resources. The management of cancers leads to specific and repetitive care for which the reimbursement of transport costs represents a high cost. We carried out an analysis of the additional transport costs, linked to the care of patients in Île-de-France, in a center other than the radiotherapy center closest to their home. MATERIALS AND METHODS: Using data from the Île-de-France Regional Health Agency, we have created a model evaluating the additional cost linked to transport generated by the care of a radiotherapy patient far from his home. In order to take into account the uncertainties linked to the hypotheses made in the development of the model, we carried out deterministic and probabilistic sensitivity analyzes. RESULTS: In the base case, the additional annual cost related to transport was 841,176 euros in Île-de-France. The probabilistic sensitivity analysis reports a total annual additional cost of 2,817,481 euros. CONCLUSION: Our results are similar to a report from the General Inspectorate of Social Affairs published in July 2011, which then pointed to an additional cost of between 4 and 6 million euros annually. The long-term care of cancer patients from their homes contributes to a deterioration in the quality of life linked to travel times, a delay in the care of potential treatment complications, and the spread of infectious diseases, such as COVID-19, and bacteria resistant to antibiotics.


Assuntos
Ambulâncias/economia , Institutos de Câncer/provisão & distribução , Acesso aos Serviços de Saúde/economia , Neoplasias/radioterapia , Transporte de Pacientes/economia , Ambulâncias/estatística & dados numéricos , Custos e Análise de Custo , França , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Estatísticos , Neoplasias/economia , Paris , Qualidade de Vida , Alocação de Recursos , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos , Incerteza
9.
Am J Respir Crit Care Med ; 202(7): e95-e112, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33000953

RESUMO

Background: There are well-documented disparities in lung cancer outcomes across populations. Lung cancer screening (LCS) has the potential to reduce lung cancer mortality, but for this benefit to be realized by all high-risk groups, there must be careful attention to ensuring equitable access to this lifesaving preventive health measure.Objectives: To outline current knowledge on disparities in eligibility criteria for, access to, and implementation of LCS, and to develop an official American Thoracic Society statement to propose strategies to optimize current screening guidelines and resource allocation for equitable LCS implementation and dissemination.Methods: A multidisciplinary panel with expertise in LCS, implementation science, primary care, pulmonology, health behavior, smoking cessation, epidemiology, and disparities research was convened. Participants reviewed available literature on historical disparities in cancer screening and emerging evidence of disparities in LCS.Results: Existing LCS guidelines do not consider racial, ethnic, socioeconomic, and sex-based differences in smoking behaviors or lung cancer risk. Multiple barriers, including access to screening and cost, further contribute to the inequities in implementation and dissemination of LCS.Conclusions: This statement identifies the impact of LCS eligibility criteria on vulnerable populations who are at increased risk of lung cancer but do not meet eligibility criteria for screening, as well as multiple barriers that contribute to disparities in LCS implementation. Strategies to improve the selection and dissemination of LCS in vulnerable groups are described.


Assuntos
Tomada de Decisão Compartilhada , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Neoplasias Pulmonares/diagnóstico , Fumar/etnologia , Definição da Elegibilidade , Grupos Étnicos/estatística & dados numéricos , Custos de Cuidados de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Ciência da Implementação , Cobertura do Seguro , Marketing de Serviços de Saúde/métodos , Medicaid , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Encaminhamento e Consulta/estatística & dados numéricos , Fatores Sexuais , Fumar/epidemiologia , Fumar/terapia , Abandono do Hábito de Fumar/estatística & dados numéricos , Classe Social , Estados Unidos
10.
Lancet Glob Health ; 8(11): e1435-e1443, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33069304

RESUMO

BACKGROUND: In conflict settings, data to guide humanitarian and development responses are often scarce. Although geospatial analyses have been used to estimate health-care access in many countries, such techniques have not been widely applied to inform real-time operations in protracted health emergencies. Doing so could provide a more robust approach for identifying and prioritising populations in need, targeting assistance, and assessing impact. We aimed to use geospatial analyses to overcome such data gaps in Yemen, the site of one of the world's worst ongoing humanitarian crises. METHODS: We derived geospatial coordinates, functionality, and service availability data for Yemen health facilities from the Health Resources and Services Availability Monitoring System assessment done by WHO and the Yemen Ministry of Public Health and Population. We modelled population spatial distribution using high-resolution satellite imagery, UN population estimates, and census data. A road network grid was built from OpenStreetMap and satellite data and modified using UN Yemen Logistics Cluster data and other datasets to account for lines of conflict and road accessibility. Using this information, we created a geospatial network model to deduce the travel time of Yemeni people to their nearest health-care facilities. FINDINGS: In 2018, we estimated that nearly 8·8 million (30·6%) of the total estimated Yemeni population of 28·7 million people lived more than 30-min travel time from the nearest fully or partially functional public primary health-care facility, and more than 12·1 million (42·4%) Yemeni people lived more than 1 h from the nearest fully or partially functional public hospital, assuming access to motorised transport. We found that access varied widely by district and type of health service, with almost 40% of the population living more than 2 h from comprehensive emergency obstetric and surgical care. We identified and ranked districts according to the number of people living beyond acceptable travel times to facilities and services. We found substantial variability in access and that many front-line districts were among those with the poorest access. INTERPRETATION: These findings provide the most comprehensive estimates of geographical access to health care in Yemen since the outbreak of the current conflict, and they provide proof of concept for how geospatial techniques can be used to address data gaps and rigorously inform health programming. Such information is of crucial importance for humanitarian and development organisations seeking to improve effectiveness and accountability. FUNDING: Global Financing Facility for Women, Children, and Adolescents Trust Fund; Development and Data Science grant; and the Yemen Emergency Health and Nutrition Project, a partnership between the World Bank, UNICEF, and WHO.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Modelos Estatísticos , Socorro em Desastres , Análise Espacial , Iêmen
11.
Turk Kardiyol Dern Ars ; 48(7): 640-645, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-33034585

RESUMO

OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic caused by the emergence of severe acute respiratory syndrome coronavirus 2 has resulted in a health crisis and a significant number of deaths worldwide. The full effect on access to medical care and the treatment for patients with chronic diseases and acute conditions is still unknown. This is an investigation of access to primary percutaneous coronary intervention (PPCI) for patients diagnosed with ST-segment myocardial infarction (STEMI) during the pandemic. METHODS: Consecutive patients who were diagnosed with STEMI and underwent PPCI during the ongoing COVID-19 pandemic were included in the study. Clinical and angiographic characteristics of the patients were assessed. A control group of patients diagnosed with STEMI and who underwent PPCI during the same time interval a year prior to the outbreak of the disease was analyzed retrospectively for comparison. RESULTS: There was a significant reduction in the number of STEMI cases during the COVID-19 crisis period. Furthermore, these patients had a prolonged ischemic time; they were more likely to have a longer pain-to-balloon (Odds ratio [OR]: 2.0, 95% confidence interval [CI]: 1.1-10.2) and door-to-balloon time (OR: 5.4, 95% CI: 3.1-22.8). CONCLUSION: Patients diagnosed with STEMI during the pandemic experienced a significant delay between the onset of symptoms and PPCI.


Assuntos
Infecções por Coronavirus , Acesso aos Serviços de Saúde/estatística & dados numéricos , Pandemias , Intervenção Coronária Percutânea/estatística & dados numéricos , Pneumonia Viral , Infarto do Miocárdio com Supradesnível do Segmento ST/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/cirurgia , Idoso , Betacoronavirus , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
13.
BMJ Open ; 10(10): e043763, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020109

RESUMO

OBJECTIVES: We evaluated whether implementation of lockdown orders in South Africa affected ambulatory clinic visitation in rural Kwa-Zulu Natal (KZN). DESIGN: Observational cohort SETTING: Data were analysed from 11 primary healthcare clinics in northern KZN. PARTICIPANTS: A total of 46 523 individuals made 89 476 clinic visits during the observation period. EXPOSURE OF INTEREST: We conducted an interrupted time series analysis to estimate changes in clinic visitation with a focus on transitions from the prelockdown to the level 5, 4 and 3 lockdown periods. OUTCOME MEASURES: Daily clinic visitation at ambulatory clinics. In stratified analyses, we assessed visitation for the following subcategories: child health, perinatal care and family planning, HIV services, non-communicable diseases and by age and sex strata. RESULTS: We found no change in total clinic visits/clinic/day at the time of implementation of the level 5 lockdown (change from 90.3 to 84.6 mean visits/clinic/day, 95% CI -16.5 to 3.1), or at the transitions to less stringent level 4 and 3 lockdown levels. We did detect a >50% reduction in child healthcare visits at the start of the level 5 lockdown from 11.9 to 4.7 visits/day (-7.1 visits/clinic/day, 95% CI -8.9 to 5.3), both for children aged <1 year and 1-5 years, with a gradual return to prelockdown within 3 months after the first lockdown measure. In contrast, we found no drop in clinic visitation in adults at the start of the level 5 lockdown, or related to HIV care (from 37.5 to 45.6, 8.0 visits/clinic/day, 95% CI 2.1 to 13.8). CONCLUSIONS: In rural KZN, we identified a significant, although temporary, reduction in child healthcare visitation but general resilience of adult ambulatory care provision during the first 4 months of the lockdown. Future work should explore the impacts of the circulating epidemic on primary care provision and long-term impacts of reduced child visitation on outcomes in the region.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Pneumonia Viral/epidemiologia , Atenção Primária à Saúde , Saúde Pública , Adulto , Fatores Etários , Betacoronavirus , Serviços de Planejamento Familiar/estatística & dados numéricos , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Pandemias , Pediatria/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , Saúde Pública/métodos , Saúde Pública/estatística & dados numéricos , População Rural
14.
BMJ Open ; 10(10): e044566, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-33020111

RESUMO

OBJECTIVES: To analyse enrolment to interventional trials during the first wave of the COVID-19 pandemic in England and describe the barriers to successful recruitment in the circumstance of a further wave or future pandemics. DESIGN: We analysed registered interventional COVID-19 trial data and concurrently did a prospective observational study of hospitalised patients with COVID-19 who were being assessed for eligibility to one of the RECOVERY, C19-ACS or SIMPLE trials. SETTING: Interventional COVID-19 trial data were analysed from the clinicaltrials.gov and International Standard Randomized Controlled Trial Number databases on 12 July 2020. The patient cohort was taken from five centres in a respiratory National Institute for Health Research network. Population and modelling data were taken from published reports from the UK government and Medical Research Council Biostatistics Unit. PARTICIPANTS: 2082 consecutive admitted patients with laboratory-confirmed SARS-CoV-2 infection from 27 March 2020 were included. MAIN OUTCOME MEASURES: Proportions enrolled, and reasons for exclusion from the aforementioned trials. Comparisons of trial recruitment targets with estimated feasible recruitment numbers. RESULTS: Analysis of trial registration data for COVID-19 treatment studies enrolling in England showed that by 12 July 2020, 29 142 participants were needed. In the observational study, 430 (20.7%) proceeded to randomisation. 82 (3.9%) declined participation, 699 (33.6%) were excluded on clinical grounds, 363 (17.4%) were medically fit for discharge and 153 (7.3%) were receiving palliative care. With 111 037 people hospitalised with COVID-19 in England by 12 July 2020, we determine that 22 985 people were potentially suitable for trial enrolment. We estimate a UK hospitalisation rate of 2.38%, and that another 1.25 million infections would be required to meet recruitment targets of ongoing trials. CONCLUSIONS: Feasible recruitment rates, study design and proliferation of trials can limit the number, and size, that will successfully complete recruitment. We consider that fewer, more appropriately designed trials, prioritising cooperation between centres would maximise productivity in a further wave.


Assuntos
Pesquisa Biomédica , Infecções por Coronavirus , Pandemias , Seleção de Pacientes , Pneumonia Viral , Ensaios Clínicos Controlados Aleatórios como Assunto , Betacoronavirus/isolamento & purificação , Pesquisa Biomédica/organização & administração , Pesquisa Biomédica/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Definição da Elegibilidade , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estudos Prospectivos , Ensaios Clínicos Controlados Aleatórios como Assunto/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Sistema de Registros/estatística & dados numéricos , Reino Unido
15.
PLoS One ; 15(9): e0238059, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32911511

RESUMO

In spite of reliable and skilled healthcare resources, the prevalence rate of obstetric fistula in Uganda is high. The risk factors for obstetric fistula cut across due to high poverty rates and cultural barriers. The main objective of this study was to assess the impact of inability to access skilled healthcare at delivery and implications to the economy. The specific objective was to determine the best way of investment in getting women access to skilled healthcare before, during and after child birth. The question to be answered was whether it was more economical to invest in getting women access to skilled healthcare, or in expanding healthcare. The study was conducted using data from the Uganda Demographic Health Survey 2016. The data was from 18,506 women in the age group of 15-49 in 15 regions around the country. Results show that the highest investment in providing access to skilled healthcare is required when there are few skilled healthcare centres. On the other hand, if there is little investment in providing access to skilled healthcare during child birth, many skilled healthcare centres are required. Results show further that the minimum time taken to reduce fistula prevalence is attained when there are many women accessing skilled healthcare in the few equipped health centres. However, if there are many skilled healthcare centres but a few women treated for obstetric fistula, then it will take longer to reduce fistula prevalence. Fitting the model to data suggested that Uganda has a big backlog of women to treat for obstetric fistula as in all skilled healthcare centres, there were less women treated than expected. Although still under the expected figure, the benefit of these treatments for obstetric fistula is that for every one woman treated, 8 more would seek treatment for the condition. This would however cost the country a great deal in that the treatment funds would perhaps give more returns if diverted to outreach activities aimed to get women seek skilled healthcare during child birth.


Assuntos
Modelos Estatísticos , Alocação de Recursos/estatística & dados numéricos , Fístula Vesicovaginal/prevenção & controle , Adolescente , Adulto , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Pessoa de Meia-Idade , Uganda , Adulto Jovem
16.
PLoS One ; 15(9): e0239482, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32970711

RESUMO

BACKGROUND: I investigate the association of perceived discrimination based both on race and other attributes such as age, gender, and insurance status on self-reported health access and health outcomes in a diverse and densely populated metropolitan area. METHODS: Restricted data from the 2016 round of the New York City Community Health Survey was used to create prevalence estimates for both racial and non-racial discrimination. Logistic regression models were used to estimate the association of these discrimination measures with health access and health outcome variables. RESULTS: Among residents who perceived discrimination receiving health care during the previous year, 15% reported the reason behind such discrimination to race, while the rest chose other reasons. Among the non-race based categories, 34% reported the reason behind such discrimination to be insurance status, followed by other reasons (26.83%) and income (11.76%). Non-racial discrimination was significantly associated with the adjusted odds of not receiving care when needed (AOR = 6.96; CI: [5.00 9.70]), and seeking informal care (AOR = 2.24; CI: [1.13 4.48] respectively, after adjusting for insurance status, age, gender, marital status, race/ethnicity, nativity, and poverty. It was also associated with higher adjusted odds of reporting poor health (AOR = 2.49; CI: [1.65 3.75]) and being diagnosed with hypertension (AOR = 1.75; CI: [1.21 2.52]), and diabetes (AOR = 1.84; CI: [1.22 2.77]) respectively. CONCLUSIONS: Perceived discrimination in health care exists in multiple forms. Non-racial discrimination was strongly associated with worse health access and outcomes, and such experiences may contribute to health disparities between different socioeconomic groups.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Preconceito/estatística & dados numéricos , Assistência à Saúde/tendências , Grupos Étnicos/estatística & dados numéricos , Feminino , Inquéritos Epidemiológicos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Masculino , Cidade de Nova Iorque/epidemiologia , Racismo/estatística & dados numéricos , Autorrelato , Fatores Socioeconômicos
18.
Medicine (Baltimore) ; 99(35): e21767, 2020 Aug 28.
Artigo em Inglês | MEDLINE | ID: mdl-32871897

RESUMO

Risk factors such as smoking and sugar intake threaten the health of human being at an individual national level as well as at a global level. The globalization affect health indirectly through macro and micro-level factors. This study aimed to identify the global trend of dental caries according to countries national income level, and to examine the role of globalization, health services, obesity, and sugar consumption on dental caries. Data for 160 countries were collected for the time period of the 1990s to 2010s. The final sample included 46 countries with complete data (21 high income countries (HIC) and 25 middle and low income countries (MLIC)). The main dependent variable was the mean decayed, missing, and filled teeth (DMFT) index of 12-year-olds as an indicator of dental caries. Globalization was a main independent variable which was measured by economic growth, urbanization and economic freedom. Other independent variables were health services, obesity and sugar consumption. The data were analyzed first using repeated measures analysis of variance to compare dental caries trends in HIC and MLIC. Then, using multiple linear regression and partial least squares structural equation modeling (PLS-SEM), the relationships between globalization, health services, obesity, sugar consumption, and dental caries were examined. The results of PLS-SEM revealed that globalization was associated with lower DMFT in HIC. The global dental caries trend had a declined pattern, but this pattern has been attenuated in MLIC after the new millennium. There is a need for policy change and regulations on sugar trade especially in MLIC to diminish the adverse consequences of globalization, and to improve population dental health.


Assuntos
Índice CPO , Cárie Dentária/epidemiologia , Países Desenvolvidos/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Internacionalidade , Criança , Açúcares da Dieta , Desenvolvimento Econômico , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Análise de Classes Latentes , Modelos Lineares , Obesidade/epidemiologia , Urbanização
20.
J Rural Health ; 36(4): 602-608, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32894612

RESUMO

PURPOSE: This study compared the average daily increase in COVID-19 mortality rates by county racial/ethnic composition (percent non-Hispanic Black and percent Hispanic) among US rural counties. METHODS: COVID-19 daily death counts for 1,976 US nonmetropolitan counties for the period March 2-July 26, 2020, were extracted from USAFacts and merged with county-level American Community Survey and Area Health Resource File data. Covariates included county percent poverty, age composition, adjacency to a metropolitan county, health care supply, and state fixed effects. Mixed-effects negative binomial regression with random intercepts to account for repeated observations within counties were used to predict differences in the average daily increase in the COVID-19 mortality rate across quartiles of percent Black and percent Hispanic. FINDINGS: Since early March, the average daily increase in the COVID-19 mortality rate has been significantly higher in rural counties with the highest percent Black and percent Hispanic populations. Compared to counties in the bottom quartile, counties in the top quartile of percent Black have an average daily increase that is 70% higher (IRR = 1.70, CI: 1.48-1.95, P < .001), and counties in the top quartile of percent Hispanic have an average daily increase that is 50% higher (IRR = 1.50, CI: 1.33-1.69, P < .001), net of covariates. CONCLUSION: COVID-19 mortality risk is not distributed equally across the rural United States, and the COVID-19 race penalty is not restricted to cities. Among rural counties, the average daily increase in COVID-19 mortality rates has been significantly higher in counties with the largest shares of Black and Hispanic residents.


Assuntos
Afro-Americanos/estatística & dados numéricos , Betacoronavirus , Infecções por Coronavirus/mortalidade , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Pneumonia Viral/mortalidade , Infecções por Coronavirus/terapia , Feminino , Disparidades nos Níveis de Saúde , Humanos , Pandemias , Pneumonia Viral/terapia , Pobreza/estatística & dados numéricos , Fatores de Risco , População Rural/estatística & dados numéricos , Estados Unidos
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