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1.
Mem Inst Oswaldo Cruz ; 114: e190253, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31664313

RESUMO

BACKGROUND: Timely diagnosis is recommended by the Brazilian Visceral Leishmaniasis (VL) Surveillance and Control Program to reduce case fatality. Attempts at assessing this topic in Brazil are scarce. OBJECTIVE: This study aimed to describe where, when, and how the diagnosis of VL has been performed in a Brazilian endemic setting. METHODS: Data of all autochthonous cases confirmed between 2011 and 2016 (N = 81) were recorded. The care-seeking itinerary until the confirmation of VL diagnosis was assessed among 57 patients. FINDINGS: The majority of VL cases (79.1%) were reported by referral hospitals. The patients mainly sought primary health care centres at the onset of symptoms. However, they had to visit seven health services on average to achieve a confirmed diagnosis. The time from the onset of symptoms to the diagnosis of VL (TD) ranged from 1-212 (median, 25) days. The TD was longer among adult patients. There was a direct correlation between the patient's age and TD (r = 0.22; p = 0.047) and a higher occurrence of deaths due to the disease among older patients (p = 0.002). Almost all the patients (98.9%) underwent laboratory investigation, and the VL diagnosis was mainly confirmed based on clinical-laboratory criteria (92.6%). Positive results for the indirect fluorescence antibody test (22.7%) and parasitological examination plus rk39-based immunochromatographic tests (21.3%) were commonly employed. MAIN CONCLUSIONS: VL diagnosis was predominantly conducted in hospitals with a long TD and wide application of serology. These findings may support measures focused on early diagnosis, including a greater involvement of the primary health care system.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Leishmaniose Visceral/diagnóstico , Adolescente , Adulto , Brasil/epidemiologia , Criança , Pré-Escolar , Cromatografia de Afinidade , Assistência à Saúde/classificação , Feminino , Técnica Indireta de Fluorescência para Anticorpo , Humanos , Lactente , Recém-Nascido , Leishmaniose Visceral/epidemiologia , Masculino , Estudos Retrospectivos
2.
Pan Afr Med J ; 33: 159, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565121

RESUMO

Introduction: Hospital-based surveillance programs only capture people presenting to facilities and may underestimate disease burden. We conducted a healthcare utilisation survey to characterise healthcare-seeking behaviour among people with common infectious syndromes in the catchment areas of two sentinel surveillance hospitals in Johannesburg, South Africa. Methods: A cross-sectional survey was conducted within three regions of Johannesburg from August to November 2015. Premises were randomly selected from an enumerated list with data collected on household demographics and selected syndromes using a structured questionnaire. Fisher's exact or chi-square tests were used to determine association of characteristics among different regions. Results: Of 3650 selected coordinates, 3358 were eligible dwellings and 2930 (87%) households with 9850 individuals participated. Four percent of participants (431/9850) reported influenza-like illness (ILI) in the last 30 days; equal numbers of participants (0.2%, 20/9850) reported pneumonia or tuberculosis symptoms in the last year and <1% reported diarrhoea or meningitis symptoms. Sixty eight percent (295/431) of participants who reported ILI, 75% (6/8) of children with diarrhoea and all participants who reported pneumonia (20), tuberculosis (20) or meningitis (6) sought healthcare. For all syndromes most sought care at registered healthcare providers. Of these only 10% (24/237) attended sentinel hospitals, predominantly those that lived closer to the hospitals. In contrast, of patients with meningitis, 50% (3/6) sought care at sentinel hospitals. Conclusion: Patterns of seeking healthcare differed by syndrome and distance from facilities. Surveillance programs are still relevant in collecting information on infectious syndromes and reflect a proportion of the hospital's catchment area.


Assuntos
Doenças Transmissíveis/epidemiologia , Assistência à Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Vigilância de Evento Sentinela , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Doenças Transmissíveis/terapia , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , África do Sul/epidemiologia , Inquéritos e Questionários , Síndrome , Adulto Jovem
3.
Middle East Afr J Ophthalmol ; 26(2): 101-106, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31543668

RESUMO

BACKGROUND: This study was undertaken to ascertain the current magnitude and causes of blindness and visual impairment in persons aged 50 years and over and to assess the impact of a 10-year eye care program in Sokoto State, Nigeria. METHODS: A rapid assessment of avoidable blindness (RAAB) survey (in persons 50 years and over) was conducted in 2016. Participants were selected in Wurno health zone using a two-stage cluster randomized sampling with probability proportional to size. Operational definitions were based on RAAB and World Health Organization eye examination record definitions. Eye care program documents were reviewed and data from a baseline survey undertaken in 2005 were reanalyzed. RESULTS: A response of 89.1% (2405 of 2700 participants) was obtained in the 2016 survey. With available correction, the unadjusted prevalence of blindness was 7.7% (95% confidence interval [CI]: 6.4, 8.9). The odds of blindness were 1.8 times higher in females than males (95% CI: 1.3, 2.4; P < 0.001). Major causes of blindness were cataract (48.9%) corneal disease (20.1%), glaucoma (10.3%), and uncorrected refractive error/aphakia (8.7%). The age- and sex-adjusted prevalence of blindness has declined from 11.6% (95% CI: 7.4, 17.0) in 2005 to 6.8% (95% CI: 5.6, 8.0%) in 2016. CONCLUSION: The blindness prevalence is high, and the major causes are avoidable in the health zone. The findings suggest that investments in the program over the last 10 years might have led to almost a halving in the prevalence of blindness in th e population. However, the small sample size of persons 50+ years from Wurno zone in the 2005 survey necessitate caution when comparing the 2005 and the 2016 surveys.


Assuntos
Cegueira/epidemiologia , Assistência à Saúde/estatística & dados numéricos , Baixa Visão/epidemiologia , Pessoas com Deficiência Visual/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Cegueira/etiologia , Catarata/complicações , Doenças da Córnea/complicações , Assistência à Saúde/organização & administração , Feminino , Glaucoma/complicações , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Exame Físico , Prevalência , Erros de Refração/complicações , Baixa Visão/etiologia
4.
Stud Health Technol Inform ; 264: 88-92, 2019 Aug 21.
Artigo em Inglês | MEDLINE | ID: mdl-31437891

RESUMO

Metadata matching is an important step towards integrating heterogeneous healthcare data and facilitating secondary use. MDRCupid supports this step by providing a configurable metadata matching toolbox incorporating lexical and statistical matching approaches. The matching configuration can be adapted to different purposes by manually selecting algorithms and their weights or by using the optimization module with corresponding training data. The toolbox can be accessed as a web service via programming or user interface. For every selected metadata element, the metadata elements with the highest similarity scores are presented to the user and can be manually confirmed via the user interface, while the programming interface uses a similarity threshold to select corresponding elements. An HL7 FHIR ConceptMap is used to save the matches. Manually confirmed matches may be used as new training data for the optimizer to improve the matching parameters further.


Assuntos
Algoritmos , Metadados , Assistência à Saúde/estatística & dados numéricos
5.
Infect Dis Poverty ; 8(1): 58, 2019 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-31262365

RESUMO

There was no global guidance or agreement regarding when a country has an adequate system to report on the service packages among human immunodeficiency virus (HIV) key populations. This article describes an approach to categorizing the system in a country for reporting the service package among HIV key populations. The approach consists of four dimensions, namely the epidemiological significance, comprehensiveness of the service packages, geographic coverage of services, and adequacy of the monitoring system. The proposed categorization approach utilizes available information and can inform the improvement of the service delivery and monitoring systems among HIV key populations.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Infecções por HIV/virologia , Vigilância da População , Infecções por HIV/tratamento farmacológico , Humanos
6.
Malar J ; 18(1): 229, 2019 Jul 09.
Artigo em Inglês | MEDLINE | ID: mdl-31288835

RESUMO

BACKGROUND: Intermittent preventive treatment during pregnancy (IPTp) is a highly-recommended intervention to prevent maternal and neonatal complications associated with malaria infection. Despite fairly high antenatal care (ANC) coverage in Tanzania, low IPTp uptake rates represent a gap in efforts to decrease complications attributed to malaria in pregnancy. The objective of this study was to examine if availability, readiness and managing authority are associated with uptake of IPTp during ANC. METHODS: Data for this analysis come from a cross-sectional survey, the Tanzania Service Provision Assessment conducted between 2014 and 2015. Principal component analysis was used to create scores for availability of malaria services and readiness for the provision of services. Generalized estimating equation models with logit link and the binomial distribution assessed factors that impact the uptake of IPTp by pregnant women attending ANC. RESULTS: Higher fraction of women in their third trimester than second (68% versus 49%, OR = 2.6; 95% CI (2.1-3.3)), had received at least one dose of IPTp. There was a wide variation in the availability and readiness of malaria services provision and diagnostic tools by managing authorities. Public facilities were more likely than private to offer malaria rapid diagnostic test, and more providers at public facilities than private diagnosed and/or treated malaria. Women who attended facilities where direct observation therapy was practiced were more likely to have received at least one dose of IPTp (64% versus 46% who received none; p < 0.001). Women who attended ANC at a facility with a high readiness score were more likely to take IPTp than those attending facilities with low readiness scores (OR = 2.1; 95% CI (1.4-3.3)). Reported stock out on the day of interview was negatively associated with IPTp uptake (OR 0.09; 95% CI 0.07-0.1). CONCLUSION: Readiness of health facilities to provide malaria related services, the number of ANC visits and gestational age were associated with uptake of IPTp among women attending ANC. There are disparities in malaria service availability and readiness across geographical location and managing authorities. These findings could be used to assist the malaria programme and policymakers to appropriately decide when planning for malaria service deliveries and interventions.


Assuntos
Antimaláricos/uso terapêutico , Assistência à Saúde/estatística & dados numéricos , Malária/prevenção & controle , Complicações Parasitárias na Gravidez/prevenção & controle , Cuidado Pré-Natal/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Malária/parasitologia , Pessoa de Meia-Idade , Gravidez , Complicações Parasitárias na Gravidez/parasitologia , Tanzânia , Adulto Jovem
7.
BMC Med ; 17(1): 133, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-31311528

RESUMO

BACKGROUND: There is great interest in and excitement about the concept of personalized or precision medicine and, in particular, advancing this vision via various 'big data' efforts. While these methods are necessary, they are insufficient to achieve the full personalized medicine promise. A rigorous, complementary 'small data' paradigm that can function both autonomously from and in collaboration with big data is also needed. By 'small data' we build on Estrin's formulation and refer to the rigorous use of data by and for a specific N-of-1 unit (i.e., a single person, clinic, hospital, healthcare system, community, city, etc.) to facilitate improved individual-level description, prediction and, ultimately, control for that specific unit. MAIN BODY: The purpose of this piece is to articulate why a small data paradigm is needed and is valuable in itself, and to provide initial directions for future work that can advance study designs and data analytic techniques for a small data approach to precision health. Scientifically, the central value of a small data approach is that it can uniquely manage complex, dynamic, multi-causal, idiosyncratically manifesting phenomena, such as chronic diseases, in comparison to big data. Beyond this, a small data approach better aligns the goals of science and practice, which can result in more rapid agile learning with less data. There is also, feasibly, a unique pathway towards transportable knowledge from a small data approach, which is complementary to a big data approach. Future work should (1) further refine appropriate methods for a small data approach; (2) advance strategies for better integrating a small data approach into real-world practices; and (3) advance ways of actively integrating the strengths and limitations from both small and big data approaches into a unified scientific knowledge base that is linked via a robust science of causality. CONCLUSION: Small data is valuable in its own right. That said, small and big data paradigms can and should be combined via a foundational science of causality. With these approaches combined, the vision of precision health can be achieved.


Assuntos
Interpretação Estatística de Dados , Conjuntos de Dados como Assunto/provisão & distribução , Medicina de Precisão , Comportamento Cooperativo , Ciência de Dados/métodos , Ciência de Dados/tendências , Conjuntos de Dados como Assunto/normas , Conjuntos de Dados como Assunto/estatística & dados numéricos , Assistência à Saúde/métodos , Assistência à Saúde/estatística & dados numéricos , Ensaios de Triagem em Larga Escala/métodos , Ensaios de Triagem em Larga Escala/estatística & dados numéricos , Humanos , Aprendizagem , Medicina de Precisão/métodos , Medicina de Precisão/estatística & dados numéricos , Análise de Pequenas Áreas
8.
Int J Equity Health ; 18(1): 101, 2019 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-31262310

RESUMO

BACKGROUND: People experiencing homelessness are often marginalized and are known to face barriers to accessing acceptable and respectful healthcare services. This study examines the experience of accessing hospital-based services of persons experiencing homelessness or vulnerable housing in southeastern Ontario and considers the potential of Equity-Oriented Health Care (EOHC) as an approach to improving care. METHODS: Focus groups and in-depth interviews with people with lived experience of homelessness (n=31), as well as in-depth interviews of health and social service provider key informants (n=10) were combined with qualitative data from a survey of health and social service providers (n=136). Interview transcripts and written survey responses were analyzed using directed content analysis to examine experiences of people with lived experience of homelessness within the healthcare system. RESULTS: Healthcare services were experienced as stigmatizing and shaming particularly for patients with concurrent substance use. These negative experiences could lead to avoidance or abandonment of care. Despite supposed universality, participants felt that the healthcare system was not accountable to them or to other equity-seeking populations. Participants identified a system that was inflexible, designed for a perceived middle-class population, and that failed to take into account the needs and realities of equity-seeking groups. Finally, participants did identify positive healthcare interactions, highlighting the importance of care delivered with dignity, trust, and compassion. CONCLUSIONS: The experiences of healthcare services among the homeless and vulnerably housed do not meet the standards of universally accessible patient-centered care. EOHC could provide a framework for changes to the healthcare system, creating a system that is more trauma-informed, equity-enhancing, and accessible to people experiencing homelessness, thus limiting identified barriers and negative experiences of care.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Equidade em Saúde/estatística & dados numéricos , Pessoas em Situação de Rua/estatística & dados numéricos , Problemas Sociais/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Populações Vulneráveis/estatística & dados numéricos , Grupos Focais , Humanos , Ontário , Inquéritos e Questionários
9.
Int J Equity Health ; 18(1): 97, 2019 06 21.
Artigo em Inglês | MEDLINE | ID: mdl-31227001

RESUMO

BACKGROUND: Many organizations have prioritized health equity and the social determinants of health (SDoH). These organizations need information to inform their planning, but, relatively few quantifiable measures exist. This study was conducted as an environmental scan to inform the American Academy of Family Physician's (AAFP's) health equity strategy. The objectives of the study were to identify and prioritize a comprehensive list of strategies in four focus areas: health equity leadership, policy, research, and diversity. METHODS: A Delphi study was used to identify and prioritize the most important strategies for reducing health inequities among the four aforementioned focus areas. Health equity experts were purposefully sampled. Data were collected in three rounds for each focus area separately. A comprehensive list of strategy statements was identified for each focus area in round one. The strategy statements were prioritized in round two and reprioritized in a final third round. Quantitative and qualitative data were integrated for the final analysis. RESULTS: Fifty strategies were identified across the four focus areas. Commitment to health equity, knowledge of health inequities, and knowledge of effective strategies to address the drivers of health inequities were ranked the highest for leadership. Universal access to health care and health in all policies were ranked highest for policy. Multi-level interventions, the effect of policy, governance, and politics, and translating and disseminating health equity interventions into practice were ranked the highest for research. Providing financial support to students from minority or low-socioeconomic backgrounds, commitment from undergraduate and medical school leadership for educational equity, providing opportunities for students from minority or low-socioeconomic backgrounds to prepare for standardized tests, and equitable primary and secondary school funding were ranked highest for diversity. CONCLUSIONS: The AAFP and other medical specialty societies have an important opportunity to advance health equity. They should develop a health equity policy agenda, equip physicians and other stakeholders, use their connections with practice-based research networks to identify and translate practical solutions to address the SDoH, and advocate for a more diverse medical workforce. TRIAL REGISTRATION: Not applicable.


Assuntos
Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Equidade em Saúde/organização & administração , Equidade em Saúde/estatística & dados numéricos , Planejamento em Saúde/métodos , Política de Saúde , Grupos Minoritários/estatística & dados numéricos , Adulto , Técnica Delfos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Médicos de Família , Determinantes Sociais da Saúde , Estados Unidos
10.
Int J Equity Health ; 18(1): 99, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238928

RESUMO

BACKGROUND: Despite large investment in central and state sponsored schemes for maternal care, out-of-pocket expenditure (OOPE) and catastrophic health spending (CHS) on institutional delivery remain high over time, across states and across socio-economic groups. Though many studies have examined the OOPE and CHS, few studies have examined the nature and extent of distress financing on institutional delivery in India. DATA: Data from the fourth round of National Family Health Survey (NFHS 4), 2015-16 was used for the analysis. Distress financing was defined as borrowing money or selling assets to meet the OOPE on delivery care. Composite variables, descriptive analyses, concentration index (CI), concentration curve (CC) and predicted probability were used to estimate the extent of distress financing for institutional delivery in India. RESULTS: The OOPE on institutional delivery has strong economic and educational gradient. One in four mothers resorted to borrowing or selling to meet the OOPE on institutional delivery. The extent of distress financing on institutional delivery was high in poorer state of Bihar and Odisha and in the state of Telangana that had highest prevalence of caesarean delivery. Savings was more prevalent among mothers compared to those who met the OOPE by borrowing/selling of assets. Finding are robust across the states of India. The predicted probability of incurring distress financing was 0.31 among mothers belonging to the poorest wealth quintile compared to 0.09 in the richest quintile, and 0.40 for those who incurred OOPE of more than INR 20,000. The probability of incurring distress financing was higher for mothers who had caesarean birth, delivered in private health centers and incurred high OOPE on institutional delivery. CONCLUSION: Distress financing on institutional delivery was higher among the less educated, poor and in private health centers. Increasing use of public health centers, reducing caesarean births, improving the availability of medicine and diagnostic services can reduce the extent of distress financing in India.


Assuntos
Assistência à Saúde/economia , Assistência à Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Instalações de Saúde/economia , Instalações de Saúde/estatística & dados numéricos , Saúde Pública/economia , Saúde Pública/estatística & dados numéricos , Feminino , Humanos , Índia , Fatores Socioeconômicos
11.
Int J Equity Health ; 18(1): 100, 2019 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-31238946

RESUMO

BACKGROUND: Health inequalities have been consistently reported across and within European countries and continue to pose major challenges to policy-making. The development of scenarios regarding what could affect population health (PH) inequalities across Europe in the future is considered critical. Scenarios can help policy-makers prepare and better cope with fast evolving challenges. OBJECTIVE: This paper describes the three 2030 time-horizon scenarios developed under the EURO-HEALTHY project, depicting the key factors that may affect the evolution of PH inequalities across European regions. METHODS: A three-stage socio-technical approach was applied: i) identification of drivers (key factors expected to affect the evolution of PH inequalities across European regions until 2030) - this stage engaged in a Web-Delphi process a multidisciplinary panel of 51 experts and other stakeholders representing the different perspectives regarding PH inequalities; ii) generation of scenario structures - different drivers' configurations (i.e. their hypotheses for evolution) were organized into coherent scenario structures using the Extreme-World Method; and iii) validation of scenario structures and generation of scenario narratives. Stages ii) and iii) were conducted in two workshops with a strategic group of 13 experts with a wide view about PH inequalities. The scenario narratives were elaborated with the participants' insights from both the Web-Delphi process and the two workshops, together with the use of evidence (both current and future-oriented) on the different areas within the PH domain. RESULTS: Three scenarios were developed for the evolution of PH inequalities in Europe until 2030: 'Failing Europe' (worst-case but plausible picture of the future), 'Sustainable Prosperity' (best-case but plausible picture of the future), and an interim scenario 'Being Stuck' depicting a 'to the best of our knowledge' evolution. These scenarios show the extent to which a combination of Political, Economic, Social, Technological, Legal and Environmental drivers shape future health inequalities, providing information for European policy-makers to reflect upon whether and how to design robust policy solutions to tackle PH inequalities. CONCLUSIONS: The EURO-HEALTHY scenarios were designed to inform both policy design and appraisal. They broaden the scope, create awareness and generate insights regarding the evolution of PH inequalities across European regions.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Assistência à Saúde/tendências , Previsões , Disparidades nos Níveis de Saúde , Formulação de Políticas , Saúde da População/estatística & dados numéricos , Fatores Socioeconômicos , Europa (Continente) , Humanos
12.
Technol Cult ; 60(2): 409-437, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31204337

RESUMO

During the Second Sino-Japanese War, the technological project of mass immunization united state health administrations and international aid organizations seeking to prevent epidemics in unoccupied China's wartime hinterland. This article examines a joint wartime effort between the Chinese government's National Epidemic Prevention Bureau and the League of Nations Health Organization to manufacture and distribute vaccines against smallpox, cholera, and other diseases in northwest China. The hardships of war presented challenges to the development of large-scale immunization, but also led to the establishment of international aid programs that helped Chinese microbiologists acquire standard cultures, animals, and equipment. Vaccination provided a means for the beleaguered Nationalist government to quell epidemics and resist the Japanese; subsequent state involvement in the process of managing transport of vaccines, organizing and training vaccinators, and mandating the shots suggests the significance of mass immunization, as well as its reliance on technological systems in which vaccines embodied emerging biomedical standards that the state sought to institutionalize.


Assuntos
Assistência à Saúde/história , Política de Saúde/história , Tecnologia/história , II Guerra Mundial , China , Assistência à Saúde/estatística & dados numéricos , História do Século XX , Microbiologia/história , Vacinação/história
13.
BMC Health Serv Res ; 19(1): 345, 2019 May 30.
Artigo em Inglês | MEDLINE | ID: mdl-31146744

RESUMO

BACKGROUND: Whether patients receive low-value hospital care (care that is not expected to provide a net benefit) may be influenced by unmeasured factors at the hospital they attend or the hospital's Local Health District (LHD), or the patients' areas of residence. Multilevel modelling presents a method to examine the effects of these different levels simultaneously and assess their relative importance to the outcome. Knowing which of these levels has the greatest contextual effects can help target further investigation or initiatives to reduce low-value care. METHODS: We conducted multilevel logistic regression modelling for nine low-value hospital procedures. We fit a series of six models for each procedure. The baseline model included only episode-level variables with no multilevel structure. We then added each level (hospital, LHD, Statistical Local Area [SLA] of residence) separately and used the change in the c statistic from the baseline model as a measure of the contribution of the level to the outcome. We then examined the variance partition coefficients (VPCs) and median odds ratios for a model including all three levels. Finally, we added level-specific covariates to examine if they were associated with the outcome. RESULTS: Analysis of the c statistics showed that hospital was more important than LHD or SLA in explaining whether patients receive low-value care. The greatest increases were 0.16 for endoscopy for dyspepsia, 0.13 for colonoscopy for constipation, and 0.14 for sentinel lymph node biopsy for early melanoma. SLA gave a small increase in c compared with the baseline model, but no increase over the model with hospital. The VPCs indicated that hospital accounted for most of the variation not explained by the episode-level variables, reaching 36.8% (95% CI, 31.9-39.0) for knee arthroscopy. ERCP (8.5%; 95% CI, 3.9-14.7) and EVAR (7.8%; 95% CI, 2.9-15.8) had the lowest residual variation at the hospital level. The variables at the hospital, LHD and SLA levels that were available for this study generally showed no significant effect. CONCLUSIONS: Investigations into the causes of low-value care and initiatives to reduce low-value care might best be targeted at the hospital level, as the high variation at this level suggests the greatest potential to reduce low-value care.


Assuntos
Assistência à Saúde/normas , Hospitalização , Hospitais/normas , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Colonoscopia/estatística & dados numéricos , Transtornos de Deglutição/etiologia , Assistência à Saúde/estatística & dados numéricos , Detecção Precoce de Câncer/estatística & dados numéricos , Endoscopia do Sistema Digestório/estatística & dados numéricos , Métodos Epidemiológicos , Feminino , Hospitais/estatística & dados numéricos , Humanos , Masculino , Melanoma/diagnóstico , Pessoa de Meia-Idade , New South Wales , Biópsia de Linfonodo Sentinela/estatística & dados numéricos , Neoplasias Cutâneas/diagnóstico , Adulto Jovem
14.
Cien Saude Colet ; 24(5): 1627-1636, 2019 May 30.
Artigo em Português | MEDLINE | ID: mdl-31166498

RESUMO

Adolescents underutilize health services, especially for monitoring purposes, which represents a concern for professionals. Since adolescence is a crucial phase in acquiring healthy behaviors and attitudes that facilitate access to these services, finding ways to respond to the specific needs of adolescents through their participation is an important investment in the well-being of future generations. This is an exploratory, descriptive and qualitative study with two phases, seeking to identify and analyze adolescents' ideas and preferences about healthcare. Eight group interviews were conducted with 64 adolescents aged 13 to 18 years: four focus groups (phase 1) and four nominal groups (phase 2). The data was submitted to content analysis. The adolescents revealed both favorable and unfavorable opinions, highlighting a set of preferences regarding service conditions, such as short waiting periods, more comfortable and less crowded settings. Concerning the professionals' attitudes, they emphasized their technical competencies, such as knowledge and experience, although combined with interpersonal skills. These findings support the need for changes in organizational practices, and particularly in the attitudes of the professionals.


Assuntos
Comportamento do Adolescente , Serviços de Saúde do Adolescente/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Adolescente , Atitude Frente a Saúde , Feminino , Grupos Focais , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Relações Profissional-Paciente
15.
Medicine (Baltimore) ; 98(20): e15425, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31096439

RESUMO

INTRODUCTION: The administration of opioids has been used for centuries as a viable option for pain management. When administered at appropriate doses, opioids prove effective not only at eliminating pain but further preventing its recurrence in long-term recovery scenarios. Physicians have complied with the appropriate management of acute and chronic pain; however, this short or long-term opioid exposure provides opportunities for long-term opioid misuse and abuse, leading to addiction of patients who receive an opioid prescription and/or diversion of this pain medication to other people without prescription. Several reviews attempted to summarize the epidemiology and management of opioid misuse, this integrative review seeks to summarize the current literature related with responsible parties of this opioid abuse crisis and discuss potential associations between demographics (ethnicity, culture, gender, religion) and opioid accessibility, abuse and overdose. METHODS: We performed an extensive literature search in Google Scholar and Pub Med databases that were published between December 7, 1999 and January 9, 2018 in accordance with the Preferred Reporting Items for Systematic Reviews and meta-Analysis (PRISMA) guidelines. Searches were referenced using medical subject headings (MeSH) that included "opioids", "over-prescription", "opioid consumption", or "opioid epidemic". The final review of all data bases was conducted on July 24, 2018. RESULTS: A total of 7160 articles were originally identified. After 3340 duplicate articles were removed, 3820 manuscripts were removed after title and abstract screening. Following this, 120 manuscripts underwent eligibility selection with only 70 publications being selected as reliable full-texts addressing related factors surrounding the opioid crisis. CONCLUSION: With approximately 100 million people suffering from both chronic and acute pain in the United States (US) in 2016, opiates will continue to remain a prominent class of medication in healthcare facilities and homes across the US. Over 66% of total overdose episodes in 2016 were opioid-related, a figure that attests to the severity and wide-spread nature of this issue. A three-point approach accentuating the prevention, treatment, and rehabilitation of both those currently affected and at-risk in the future may be the comprehensive solution.


Assuntos
Analgésicos Opioides/efeitos adversos , Assistência à Saúde/normas , Overdose de Drogas/epidemiologia , Transtornos Relacionados ao Uso de Opioides/epidemiologia , Dor Aguda/tratamento farmacológico , Adolescente , Adulto , Analgésicos Opioides/administração & dosagem , Analgésicos Opioides/uso terapêutico , Comportamento Aditivo/induzido quimicamente , Dor Crônica/tratamento farmacológico , Assistência à Saúde/estatística & dados numéricos , Epidemias , Feminino , Humanos , Prescrição Inadequada/efeitos adversos , Prescrição Inadequada/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Manejo da Dor/efeitos adversos , Manejo da Dor/métodos , Estados Unidos/epidemiologia , Adulto Jovem
16.
S Afr Med J ; 109(5): 333-339, 2019 Apr 29.
Artigo em Inglês | MEDLINE | ID: mdl-31131801

RESUMO

BACKGROUND: Public health facilities are used by the majority of South Africans, and healthcare utilisation surveys have been a useful tool to estimate the burden of disease in a given area. OBJECTIVES: To describe care-seeking behaviour in a periurban site with a high prevalence of HIV infection, as well as barriers to seeking appropriate healthcare. METHODS: We conducted a cross-sectional household survey in 22 wards of the Msunduzi municipality in KwaZulu-Natal Province, South Africa, from October to December 2013 using a simple random sample of households selected from a 2011 census enumeration. A primary caregiver/adult decision-maker was interviewed regarding demographic data as well as health status and recent self-reported episodes of selected illnesses and healthcare utilisation. RESULTS: Of the 2 238 eligible premises visited, 1 936 households (87%) with a total of 9 733 members were enrolled in the study. Of these, 635 (7%) reported one or more episodes of infectious illness during the study period. Public health clinics were most frequently consulted for all illnesses (361/635, 57%). Private healthcare (general practitioner, private clinic, private hospital) was sought by 90/635 of individuals (14%), only 13/635 (2%) reported seeking care from traditional healers, religious leaders or volunteers, and 71/635 (11%) did not seek any medical care for acute illnesses. Individuals in the lowest income group were more likely to seek care at public health facilities than those in the highest income group (70% v. 32%). CONCLUSIONS: Public health facility-based surveillance may be representative of disease patterns in this community, although surveillance at household level shows that high-income individuals may be excluded because they were more likely to use private healthcare, and the proportion of individuals who died at home would have been missed by facility-based surveillance. Data obtained in such surveys may be useful for public health planning.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Gastroenteropatias/epidemiologia , Meningite/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Doenças Respiratórias/epidemiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , África do Sul/epidemiologia , Síndrome , Adulto Jovem
17.
Cien Saude Colet ; 24(4): 1495-1505, 2019 Apr.
Artigo em Português | MEDLINE | ID: mdl-31066851

RESUMO

The scope of this study was to establish the influence of the Family Healthcare Strategy (FHS) in the use of health services for Brazilian children under 5 years of age interviewed in the 2013 National Health Survey (NHS). The Propensity Score Matching (PSM) method was used to correct the lack of comparability between the groups of children under scrutiny. The PSM was estimated by logistic regression and reflects the conditional probability of receiving registration in the FHS given a set of covariates that depict the socioeconomic, demographic, sanitary and health aspects of children and families who comprise same. The prevalence of medical visits and hospitalizations were estimated and incorporate the effects of the complex sample of NHS on all phases of analysis. It was found that children living in households with FHS coverage have worse socioeconomic, sanitary and health conditions, although they had options of medical appointments and hospitalizations close to the children without this healthcare link. The data suggest that the FHS can correct individual and contextual inequalities that impact the health of Brazilians by promoting the use of health services for children even when they have worse living and health conditions.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Saúde da Família , Programas Nacionais de Saúde/estatística & dados numéricos , Brasil , Serviços de Saúde da Criança/organização & administração , Pré-Escolar , Estudos Transversais , Assistência à Saúde/organização & administração , Feminino , Inquéritos Epidemiológicos , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Programas Nacionais de Saúde/organização & administração , Pontuação de Propensão , Fatores Socioeconômicos
18.
Cien Saude Colet ; 24(4): 1507-1516, 2019 Apr.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31066852

RESUMO

Rio de Janeiro maintains a recurrent history of dengue epidemics. There is scarce evidence about the route of the population to get health care. The study aimed to describe the pattern of suspected dengue patients flow in search of health care services in Rio de Janeiro. The following data were analyzed: dengue reports from 2011 to 2013; the neighborhoods of patient's residence; the neighborhoods of health services. Neighborhoods of the city were used as unit of analysis focusing on access to health facilities of municipal Planning Area (AP) 3.3. Flow maps were elaborated to describe the routes between the neighborhood of residence and the heath service. Between 2011 and 2013 48,576 suspected dengue cases living in program area 3.3 were reported, 72% got health care in the AP 3.3, 37% of which in primary care. A total of 12,545 suspected cases attended health facilities outside the AP 3.3. A great geographical variation was observed in the search for Primary Care within the AP 3.3, as well as a relevant movement to the center and south zone of the city on access to care, comprising 2,647 different flows. The findings indicate a large flow within the municipality.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Dengue/epidemiologia , Acesso aos Serviços de Saúde , Atenção Primária à Saúde/estatística & dados numéricos , Brasil/epidemiologia , Dengue/terapia , Instalações de Saúde/estatística & dados numéricos , Humanos , Características de Residência/estatística & dados numéricos
19.
Am Soc Clin Oncol Educ Book ; 39: 302-308, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31099647

RESUMO

The global cancer burden is estimated to have risen to 18.1 million new cases and 9.6 million deaths in 2018. By 2030, the number of cancer cases is projected to increase to 24.6 million and the number of cancer deaths, to 13 million. Global data mask the social and health disparities that influence cancer incidence and survival. Inequality in exposure to carcinogens, education, access to quality diagnostic services, and affordable treatments all affect the probability of survival. Worryingly, despite the fact that many cancers could be prevented by stronger public health actions and many others could be largely cured by better access to diagnostics and affordable treatments, the international community has yet to make a substantial move to tackle this challenge. In prostate cancer, studies show that there are geographic and racial/ethnic distribution differences as well as a number of other variables, including environmental factors, limited access to standard cancer treatments, reduced probability to be included in trials, and the financial burden of cancer treatments. Financial burden for the patients can result in poor adherence, increased debt, and poor long-term outcomes. The following article will discuss some of the important causes for disparity in prostate cancer and prostate cancer care, focused on the current situation in the United States, as well as possible remedies to address these causes.


Assuntos
Disparidades em Assistência à Saúde , Neoplasias da Próstata/epidemiologia , Grupos de Populações Continentais , Assistência à Saúde/estatística & dados numéricos , Grupos Étnicos , Saúde Global , Gastos em Saúde , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Incidência , Masculino , Neoplasias da Próstata/diagnóstico , Neoplasias da Próstata/terapia , Fatores de Risco , Fatores Socioeconômicos
20.
BMC Res Notes ; 12(1): 289, 2019 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-31133060

RESUMO

OBJECTIVE: Response rates in surveys continue to fall, and electronic online versions are increasingly replacing paper questionnaires in order to save costs and time. This can influence the composition of the respondent group in surveys. Using data from a national survey of patient experiences with maternity care, we aimed to (1) classify all of the women invited to participate in the study according to their different probabilities of responding, based on registry data, and (2) classify all of the respondents according to different probabilities of choosing a paper questionnaire when an online alternative was available, based on registry and self-reported data. RESULTS: We found that the likelihood of responding to surveys is strongly influenced by background variables, with the age, number of previous births and geographic origin predicting the response probability (range 0.25-0.73). Education level predicted the likelihood of choosing a paper questionnaire. Women with less education would more likely (probability 0.50) than women with more education (probability 0.38) choose a paper questionnaire rather than answering online.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Sistema de Registros , Autorrelato/estatística & dados numéricos , Adulto , Fatores Etários , Grupo com Ancestrais do Continente Asiático , Escolaridade , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Internet , Noruega , Paridade/fisiologia , Participação do Paciente/psicologia , Gravidez , Probabilidade
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