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1.
Crim Behav Ment Health ; 30(1): 38-49, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-32173951

RESUMO

BACKGROUND: In England, forensic psychiatric hospital services are provided at three security levels: high, medium and low. All are publicly funded and similarly regulated, but medium and low secure services are provided in the private and charitable (PCS) sector as well as the National Health Service (NHS). Originally, medium secure hospital services were conceived as for up to 2 years' inpatient stay, but numbers of longer stay patients have been rising. Little is known about their characteristics or whether they differ between NHS and PCS settings. AIMS: To describe and compare characteristics of long-stay patients in NHS and in PCS medium security hospital units. METHODS: Data were extracted from clinical records in 14 NHS and 9 PCS hospital units for all patients fulfilling criteria for long stay: having been in high security for more than 10 years or medium security for more than 5 years or in a mix of both for more than 15 years in total. RESULTS: 178 NHS and 107 PCS patients were eligible for inclusion, respectively, 16 and 22% of the total patient populations in these settings. The mean length of stay in a medium or high secure setting was similar: 163 and 164 months. Characteristics of the patients, however, differed between unit type. NHS services admitted more patients from prison and PCS services more from other hospitals. NHS services included a lower proportion of patients with personality disorder or intellectual disability. 'Challenging behaviour' was more prevalent in PCS; a history of absconding was found more often among NHS patients. CONCLUSIONS: The two systems of service appear to be used differently. More research is needed to explain why patients apparently without behavioural disturbances remain in specialist secure facilities for such a long time and whether their needs are truly being met in the least restrictive environment possible.


Assuntos
Hospitais Privados/estatística & dados numéricos , Hospitais Psiquiátricos/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Admissão do Paciente/estatística & dados numéricos , Adulto , Inglaterra , Feminino , Humanos , Tempo de Internação , Masculino , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Pessoa de Meia-Idade , Prisões , Instalações Privadas , Setor Privado , Logradouros Públicos , Setor Público , Medidas de Segurança , Fatores Socioeconômicos , Medicina Estatal/organização & administração
2.
Medicina (B Aires) ; 80(1): 1-9, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32044735

RESUMO

The Argentine Penal Code in its article 86 specifies the grounds for the legal interruption of pregnancy. In the Programmatic Area of the Piñero Hospital, city of Buenos Aires, a protocol to perform them was established. Since the implementation it had not been evaluated. The objective was to describe the characteristics of these interventions in 2017. A descriptive study was conducted, as a source of information a form completed by the teams after care for the women was used. There were 503 cases, the average gestational age at the first consultation was 8.5 weeks; 93.8% were resolved in the first level, 94.5% of them in the first trimester of pregnancy. The causal integral health was the main one addressed in the health centers, while in the hospital it was rape. The resolution period for the interruptions was 5.7 days in the health centers and 1.3 days in the hospital. The resolution was with medications in 80.9% of the cases in the health centers. The complication rate was 8 per 1000 interruptions. The subsequent contraceptive method coverage was 16.7 per 100 interruptions. In compliance with the sentence F.A.L. (Supreme Court of Justice), access to legal interruptions of pregnancy and women's care implies an increase in effective access to sexual and reproductive rights and a decrease in the number of those who will be exposed to unsafe practices that increase the risk of morbidity and mortality.


Assuntos
Aborto Legal/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Argentina , Criança , Feminino , Idade Gestacional , Humanos , Pessoa de Meia-Idade , Gravidez , Estudos Retrospectivos , Fatores de Tempo , Adulto Jovem
3.
Am J Public Health ; 110(4): 492-498, 2020 04.
Artigo em Inglês | MEDLINE | ID: mdl-32078357

RESUMO

Objectives. To examine content of financial assistance polices (FAPs) among US tax-exempt hospitals and determine whether restrictive policies were associated with reduced charity care spending.Methods. Using hospital tax filings with the Internal Revenue Service in 2016 and FAPs obtained from hospital Web sites, we examined characteristics of FAPs and associated expenditures for charity care in a representative sample of 170 tax-exempt hospitals. We identified common eligibility requirements and used them to define restrictiveness of FAPs.Results. FAPs were characterized by various ways to exclude patients, a patchwork of coverage for typical health care services, and wide-ranging discounts. FAP expenditures were lowest among restrictive hospitals in states that expanded Medicaid as part of the Affordable Care Act and highest among nonrestrictive hospitals in nonexpansion states. FAP expenses did not differ by hospital restrictiveness alone.Conclusions. Standardizing common eligibility requirements among FAPs carries potential benefits with regard to optimizing charity care for community benefit and achieving at least some level of equity; however, further policy efforts must account for additional restrictions, charges, and exclusions to be effective.


Assuntos
Hospitais Públicos/economia , Hospitais Filantrópicos/economia , Cuidados de Saúde não Remunerados/economia , Hospitais Públicos/estatística & dados numéricos , Hospitais Filantrópicos/estatística & dados numéricos , Humanos , Medicaid , Patient Protection and Affordable Care Act , Políticas , Pobreza/economia , Isenção Fiscal , Cuidados de Saúde não Remunerados/estatística & dados numéricos , Estados Unidos
4.
Nat Hum Behav ; 4(3): 255-264, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31959926

RESUMO

Health and social scientists have documented the hospital revolving-door problem, the concentration of crime, and long-term welfare dependence. Have these distinct fields identified the same citizens? Using administrative databases linked to 1.7 million New Zealanders, we quantified and monetized inequality in distributions of health and social problems and tested whether they aggregate within individuals. Marked inequality was observed: Gini coefficients equalled 0.96 for criminal convictions, 0.91 for public-hospital nights, 0.86 for welfare benefits, 0.74 for prescription-drug fills and 0.54 for injury-insurance claims. Marked aggregation was uncovered: a small population segment accounted for a disproportionate share of use-events and costs across multiple sectors. These findings were replicated in 2.3 million Danes. We then integrated the New Zealand databases with the four-decade-long Dunedin Study. The high-need/high-cost population segment experienced early-life factors that reduce workforce readiness, including low education and poor mental health. In midlife they reported low life satisfaction. Investing in young people's education and training potential could reduce health and social inequalities and enhance population wellbeing.


Assuntos
Crime/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Seguridade Social/estatística & dados numéricos , Fatores Socioeconômicos , Ferimentos e Lesões/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Análise por Conglomerados , Crime/economia , Bases de Dados Factuais , Dinamarca/epidemiologia , Prescrições de Medicamentos/economia , Escolaridade , Feminino , Hospitalização/economia , Hospitais Públicos/economia , Humanos , Lactente , Seguro Saúde/economia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Satisfação Pessoal , Seguridade Social/economia , Ferimentos e Lesões/economia , Adulto Jovem
5.
Medicine (Baltimore) ; 99(1): e18494, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31895783

RESUMO

INTRODUCTION: Peripherally inserted central catheters (PICC-line) are devices inserted through peripheral venous access. In our institution, this technology has been rapidly adopted by physicians in their routine practice. Bacteremia on catheters remains an important public health issue in France. However, the mortality attributable to bacteremia on PICC-line remains poorly evaluated in France and in the literature in general. We report in our study an exhaustive inventory of bacteremia on PICC-line and their 30 days mortality, over a 7 years period. MATERIAL AND METHODS: From January 2010 to December 2016, we retrospectively matched PICC-line registers of the radiology department, blood culture records of the microbiology laboratory and medical records from the Hospital Information Systems. RESULTS: The 11,334 hospital stays during which a PICC-line was inserted were included over a period of 7 years. Among them, 258 episodes of PICC-line-associated bacteremia were recorded, resulting in a prevalence of 2.27%. Hematology units: 20/324 (6.17%), oncology units: 55/1375 (4%) and hepato-gastro-enterology units: 42/1142 (3.66%) had the highest prevalence of PICC-line related bacteremia. The correlation analysis, when adjusted by exposure and year, shows that the unit profile explains 72% of the variability in the rate of bacteremia with a P = .023. Early bacteremia, occurring within 21 days of insertion, represented 75% of cases. The crude death ratio at 30 days, among patients PICC-line associated bacteremia was 57/11 334 (0.50%). The overall 30-day mortality of patients with PICC-line with and without bacteremia was 1369/11334 (12.07%). On day 30, mortality of patients with bacteremia associated PICC-line was 57/258 or 22.09% of cases, compared to a mortality rate of 1311/11076, or 11.83% in the control group (P < .05, RR 2.066 [1.54-2.75]). Kaplan-Meier survival analysis revealed a statistically significant excess mortality between patients with PICC-line associated bacteremia and PICC-line carriers without bacteremia (P < .0007, hazard ratio 1.89 [1307-2709]). CONCLUSION: Patients with PICC-line associated bacteremia have a significant excess mortality. The implementation of a PICC-line should remain the last resort after a careful assessment of the benefit/risk ratio by a senior doctor.


Assuntos
Infecções Relacionadas a Cateter/mortalidade , Cateterismo Venoso Central/efeitos adversos , Cateterismo Periférico/efeitos adversos , Cateteres de Demora/efeitos adversos , Idoso , Bacteriemia/microbiologia , Bacteriemia/mortalidade , Estudos de Casos e Controles , França/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Estimativa de Kaplan-Meier , Tempo de Internação/estatística & dados numéricos , Pessoa de Meia-Idade , Estudos Retrospectivos
6.
Lancet Psychiatry ; 7(2): 135-147, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31974072

RESUMO

BACKGROUND: Psychiatric disorders are established risk factors for self-harm. However, variation in the risk of self-harm by specific psychiatric disorder and stratified by gender and age is rarely examined in population-representative samples. This study aimed to investigate the risk of self-harm following diagnosis of different psychiatric disorders in an Asian population, through a review of inpatient records retrieved from the Hong Kong Clinical Data Analysis and Reporting System (CDARS). METHODS: For this nested case-control study, the inpatient data of people admitted for any reason to Hong Kong public hospitals, between Jan 1, 2000, and Dec 31, 2010, were extracted from CDARS. Cases were people aged 10 years or older who had been admitted to inpatient care with a first-listed record of psychiatric disorder during the study period. The seven psychiatric disorders of interest were: depression, alcohol misuse or dependence, personality disorders, bipolar disorders, anxiety disorders, schizophrenia, and substance misuse or dependence. Two control patients were matched per case from a subsample of all individuals with the same gender, age, and admission time (ie, same calendar year and month), who did not have any record of the psychiatric disorders of interest. Any patients with a history of self-harm diagnosis before, or at the same time as, the first diagnosis of psychiatric disorder (cases) or admission (controls), were excluded. For each diagnostic category, a Cox proportional hazard regression model was fitted to estimate the adjusted hazard ratio (HR; plus 95% CIs) of associated self-harm, adjusting for gender, age, control-matched admission time, 20 districts of residence, physical comorbidities established as risk factors for self-harm (diabetes, asthma, migraine, epilepsy, HIV, and cancer), and presence of the six other psychiatric disorders. We repeated this analysis in subgroups stratified by gender (male and female) and by age (adolescent, 10-24 years; young adult, 25-44 years; middle-aged, 45-64 years; and older people, ≥65 years). FINDINGS: Between 2000 and 2010, we followed up a cohort of 86 353 people with a first-recorded diagnosis of a psychiatric disorder of interest, and 134 857 matched controls. The highest risk of self-harm was observed in patients with substance misuse or dependence (adjusted HR vs matched controls, 9·6 [95% CI 8·4-11·0]), followed by those with personality disorders (3·7 [2·8-4·9]) and alcohol misuse or dependence (3·2 [2·9-3·7]). When stratified by gender and age, the highest risk of self-harm behaviour was found in the substance misuse or dependence group for both genders (for female patients: adjusted HR vs matched controls, 7·7 [6·0-9·8]; and for male patients, 10·5 [8·9-12·4]), and for all age groups (adolescent: 9·6 [7·2-12·7]; young adults: 10·2 [8·4-12·3]; middle-aged: 11·2 [8·0-15·6], and older people: 3·2 [1·7-6·1]). INTERPRETATION: First-recorded diagnoses of psychiatric disorders were significantly associated with an elevated risk of subsequent self-harm. The associations varied considerably by diagnostic categories across gender and age subgroups. Our findings highlight the need to develop more efficient and targeted preventive measures in psychiatric care management, with specific attention to demographic characteristics linked to increased risk within the same diagnostic category. FUNDING: None.


Assuntos
Transtornos de Ansiedade/epidemiologia , Transtorno Bipolar/epidemiologia , Transtorno Depressivo/epidemiologia , Transtornos da Personalidade/epidemiologia , Esquizofrenia/epidemiologia , Comportamento Autodestrutivo/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adolescente , Adulto , Fatores Etários , Idoso , Estudos de Casos e Controles , Criança , Feminino , Seguimentos , Hong Kong/epidemiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Sistemas Computadorizados de Registros Médicos/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos de Riscos Proporcionais , Risco , Fatores Sexuais , Adulto Jovem
7.
PLoS One ; 15(1): e0227712, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31961883

RESUMO

INTRODUCTION: Adverse drug reactions (ADRs) are global public health problems. In its severe form it may cause hospital admission, morbidity and mortality. Early reporting of suspected ADRs to regulatory authorities is known to be appropriate measure toinsure health and safety of public form such adverse drug reaction of drugs. In Addis Ababa, there is limited information on ADR reporting practices among medical doctors. Hence, this study aimed to assess ADR reporting practices and associated factors among doctors in government hospitals in Addis Ababa. METHODS: An institution based cross-sectional mixed-methods study design was used. Data werecollected from 407 doctors using self-administered questionnaire and five key informants using semi-structured questionnaire from October 01 to December 31, 2017. Binary logistic regression and thematic analysis methods for quantitative and qualitative data analysis were used respectively. RESULTS: Only 94(27.4%) of doctors had ever reported ADRs to national pharmacovigilance center. The study showed that sex (AOR = 3.51, 95% CI: 1.76-7.03), level ofeducation (AOR = 5.01, 95% CI: 2.23-11.28), work experience (AOR = 4.59, 95% CI: 1.21-17.40), existence of ADR reporting form (AOR = 3.96, 95% CI: 1.07-14.61) and reporting to respective marketing authorization holders (AOR = 21.41, 95% CI: 5.89-77.88) were significantly associated with ADR reporting practices. Poor awareness and training on risk of under-reporting, feeling that reporting is minor, absence of appropriate reporting tools, delay and/or absence of feedback on reported ADRs, overly burdened doctors, negligence, fear of legal liabilityand communication gap were cited by key informants as barriers for reporting practice. CONCLUSIONS: Adverse drug reaction reporting practice among doctors wasfound to be low. Sex, level of education, work experience, existence of reporting form and reporting to marketing authorization holderswere significantly associated with ADR reporting practice. In addition, there are gaps in availabilities of guidelines, reporting systems and structure, pre-service and in-service training, and awareness of doctors on impact of reporting. Hence, improving access to ADR reporting form, decentralize safety monitoring system, and conducting awareness training on ADR reporting are essential to improve the ADR reporting practice.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/estatística & dados numéricos , Atitude do Pessoal de Saúde , Farmacovigilância , Médicos/psicologia , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Competência Clínica/estatística & dados numéricos , Estudos Transversais , Escolaridade , Etiópia , Feminino , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Médicos/normas , Médicos/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Padrões de Prática Médica/normas , Fatores Sexuais , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
8.
PLoS One ; 15(1): e0227090, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31910215

RESUMO

BACKGROUND: Iron-folic acid supplementation during pregnancy is among the very effective interventions to prevent iron deficiency anemia, low birth weight, and prematurity. There is a need of having recent studies on adherence to the supplement that consider the very recent interventions targeted to scale up the use of iron-folic acid (IFA) supplement. Therefore we sought to assess adherence to IFA supplement and its associated factors among antenatal care attending pregnant mothers in governmental health institutions of Adwa town. METHODS: Institution-based cross-sectional study was conducted among 629 antenatal care attending pregnant mothers. Systematic random sampling method was used to select the study subjects. Data were collected through face-to-face interview and chart-review. Bivariable and multivariable binary logistic regression was computed. Variables with P-value <0.05 were considered statistically significant at 95% confidence interval (CI). RESULT: Only 40.9% (95%CI: 37.0%- 44.7%) of participants were adherent (took four or more tablets per week). Women in the age group of 25-29 years [AOR: 2.22(1.21-4.07)] had increased odds of adherence as compared to those in the age group ≥ 35 years. Women who received nutrition counseling [AOR: 4.12(2.12-8.03)] and partner support [AOR: 2.23 (1.42-3.49)] had increased odds of adherence as compared to those who didn't receive nutrition counseling and partner support respectively. Similarly, women who had satisfactory knowledge on IFA supplement (AOR: 2.16(1.37-3.40)) had increased odds of adherence as compared to those who didn't have satisfactory knowledge on IFA supplement. CONCLUSION: Adherence to the supplement was low. Efforts shall be done to improve awareness of pregnant mothers about IFA supplement through targeted nutrition counseling that includes the engagement of a partner.


Assuntos
Ácido Fólico/administração & dosagem , Ferro/administração & dosagem , Adesão à Medicação/estatística & dados numéricos , Cuidado Pré-Natal/normas , Oligoelementos/administração & dosagem , Vitaminas/administração & dosagem , Adulto , Anemia/prevenção & controle , Uso de Medicamentos/estatística & dados numéricos , Etiópia , Feminino , Ácido Fólico/uso terapêutico , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Públicos/estatística & dados numéricos , Humanos , Ferro/uso terapêutico , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Oligoelementos/uso terapêutico , Vitaminas/uso terapêutico
9.
Int J Radiat Oncol Biol Phys ; 106(1): 61-66, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-31505246

RESUMO

PURPOSE: To evaluate the use of single-fraction palliative radiation therapy (SFRT) for the management of bone metastases (BM) in Victoria, Australia. METHODS AND MATERIALS: This is a population-based cohort of patients with cancer who received radiation therapy for BM between 2012 and 2017 as captured in the Victorian Radiotherapy Minimum Data Set. The primary outcome was proportion of SFRT use. The Cochrane-Armitage test for trend was used to evaluate changes in practice over time. Multivariable logistic regression was used to assess factors associated with SFRT use. RESULTS: Of the 18,158 courses of radiation therapy for BM delivered to a total of 10,956 patients, 17% were SFRT. There was no significant change in SFRT use over time, from 18% in 2012 to 19% in 2017 (P = .07). SFRT was less commonly given to the skull (4%) and spine (14%), compared with the shoulder (37%) and ribs (53%). Patients with lung cancer (21%) were most likely to receive SFRT, followed by those with prostate cancers (18%) and gastrointestinal cancers (16%). Patients from regional/remote areas were more likely to have SFRT compared with those in major cities (22% vs 16%, P < .001). Patients treated in public institutions were more likely to have SFRT compared with those treated in private institutions (22% vs 10%, P < .001). In multivariable analyses, increasing age, lung cancer, higher socioeconomic status, residence in regional/ remote areas, and being treated in public institutions were factors independently associated with increased likelihood of receiving SFRT. CONCLUSIONS: SFRT appears underused for BM in Australia over time, with variation in practice by patient, tumor, sociodemographic, geographical, and institutional provider factors.


Assuntos
Neoplasias Ósseas/radioterapia , Neoplasias Ósseas/secundário , Cuidados Paliativos/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Austrália , Fracionamento da Dose de Radiação , Feminino , Neoplasias Gastrointestinais , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Neoplasias Pulmonares , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Neoplasias da Próstata , Radioterapia/métodos , Radioterapia/estatística & dados numéricos , Dosagem Radioterapêutica , População Rural/estatística & dados numéricos , Fatores Socioeconômicos , Fatores de Tempo , População Urbana/estatística & dados numéricos
10.
Rev Bras Epidemiol ; 22Suppl 3(Suppl 3): e19006.supl.3, 2019.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31800858

RESUMO

INTRODUCTION: The term "garbage code" (GC) is used to designate an underlying cause of death that is not very useful for the health policy, since it does not adequately identify actions to prevent and control diseases and health problems. OBJECTIVE: To evaluate the results of GC investigation on changing causes of death in 17 municipalities in the Brazilian Northern region in 2017. METHODS: This is a cross-sectional study on the results of the investigation of deaths with GC in selected hospitals in 17 cities in the seven states of the Northern region, as part of the Data for Health Initiative of the Ministry of Health (MH). In these hospitals, the underlying causes of deaths occurring in 2017 were reviewed, and the GC investigation protocol was applied to deaths with GC. RESULTS: In 2017, 37,082 deaths occurred in the 17 municipalities studied, of which 29.3% (n = 10,878) were GC and 83.2% were priority GC. Among the priority GCs, 25.9% were investigated, of which 79.1% had a change in the underlying cause. DISCUSSION: There is great variation among the 17 municipalities in relation to the proportion of GC. In 13 of the municipalities studied, the underlying cause of death was reclassified in at least 70% of the cases investigated for the priority GC. CONCLUSION: Despite the improvement in reducing the proportion of underlying causes of death with GC in this study, there is still a need for greater investment in training professionals and increasing services to carry out death investigations, in order to ensure the sustainability of the project in the region.


Assuntos
Causas de Morte , Sistemas de Informação/normas , Brasil/epidemiologia , Cidades/epidemiologia , Estudos Transversais , Confiabilidade dos Dados , Atestado de Óbito , Feminino , Geografia , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Características de Residência
11.
Medicine (Baltimore) ; 98(48): e18032, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31770218

RESUMO

BACKGROUND: The medical management of chronic respiratory diseases becomes more difficult with the increase in the rate of the elderly population. Monitoring and treating chronic respiratory diseases at home are more comfortable for both the patient and their relatives. Therefore, countries need to develop policies regarding home health services (HHS) according to the state of their social, cultural, and financial infrastructure. OBJECTIVE: The objective of this study is to show the role and contribution of hospital-based HHS regarding respiratory disorders, and to evaluate the model and its efficiency. STUDY DESIGN: The design of this study was cross-sectional. Data were obtained from the Ministry of Health of Turkey with official permission. Data were collected for HHS concerning respiratory diseases between 2011 and 2017. Age and sex distribution, the number of recorded patients, the number of visits for pulmonary diseases, the distribution of institutional visits, and the quantitative alterations within the years were investigated. STUDY POPULATION: The study population was based on patients with respiratory disorders who were given HHS as directed by the Ministry of Health of Turkey. RESULTS: Between 2011 and 2017, the majority of patients with pulmonary diseases, mostly those with chronic obstructive pulmonary disease, asthma, and lung cancer, visited government hospitals (78%). The number of house visits concerning pulmonary disorders increased nearly ten times, but hospitalization due to respiratory diseases decreased (13.5% in 2011 to 12.9% in 2017). CONCLUSION: Hospital-based HHS in pulmonary diseases can be considered as an appropriate model for implementation for countries like Turkey, those that have inadequate hospice-type health service infrastructure.


Assuntos
Serviços Hospitalares de Assistência Domiciliar/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Doenças Respiratórias/terapia , Idoso , Asma/terapia , Doença Crônica , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Visita Domiciliar/estatística & dados numéricos , Humanos , Neoplasias Pulmonares/terapia , Masculino , Pessoa de Meia-Idade , Doença Pulmonar Obstrutiva Crônica/terapia , Turquia
12.
Bull Cancer ; 106(12): 1094-1103, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31759512

RESUMO

Care, teaching, and research are all priorities of the French public teaching hospitals. In 2004, the remuneration method evolved from a global endowment to a fee-for-services system, based on the use of bibliometric tools. These were used in the present study to describe the research patterns of public teaching hospitals in regards to care and teaching activities. The present study was based on data from the 32 French public teaching hospitals, between 2004 and 2014. Records concerning the publications number, hospital stays, full-time equivalent (FTE) practitioners, and residents per FTE physician were accessed. Statistical analyses were performed using means, Pearson correlation coefficients, and regression lines. The mean number of publications per FTE physician was 0.73, the mean number of hospital stays per FTE physician was 235.8 and the mean number of residents per FTE physician was 0.63. There was a moderate positive correlation between the number of publications per FTE physician and the number of residents per FTE physician (R=0.53) and a negligible correlation between the number of residents per FTE physician and the number of hospital stays per FTE physician (R=0.12). There was a low negative correlation between publication numbers per FTE physician and the number of stays per FTE physician (R=-0.41). All public teaching hospitals presented different patterns in terms of care, teaching, and research activities. None of the 32 hospitals performed well in all three activities. Only nine performed well in at least two out of the three missions.


Assuntos
Bibliometria , Hospitais Públicos/estatística & dados numéricos , Hospitais de Ensino/estatística & dados numéricos , Corpo Clínico Hospitalar/estatística & dados numéricos , França , Humanos , Internato e Residência/estatística & dados numéricos , Tempo de Internação/estatística & dados numéricos , Pesquisa/estatística & dados numéricos , Ensino/estatística & dados numéricos
13.
BMC Health Serv Res ; 19(1): 796, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690313

RESUMO

BACKGROUND: Hepatitis B virus (HBV) infection is a global public health problem. The burden of the disease is high in low and middle income countries like Ethiopia. However, for highly vulnerable groups such as health professionals, vaccination coverage is a major issue in the developing countries where health professionals are expected to pay for vaccination. Therefore, the objective of this study was to assess health professionals' acceptance and willingness to pay (WTP) and associated factors for vaccination against HBV. METHODS: Cross-sectional study was conducted from March to April, 2017 in Gondar city administration governmental health institutions among 423 health professionals. Simple random sampling method was employed to select the study participants. Data were collected using self- administered questionnaire. Tobit model was used to analyze the determinants of WTP and the maximum amount of money the individuals might pay for HBV vaccination. P-value < 0.05 was considered statistically significant. RESULT: A total of 423 health professionals (physicians, nurses, midwives, laboratory technicians/technologists, and others) participated in the study with a response rate of 100, and 62.4% of them were willing to pay for HBV vaccination. The mean amount of money the participants might pay for HBV vaccination was 325.83 ± 283.46 ETB (US$ 14.39 ± 12.52). The study indicated that the WTP for HBV vaccination of health professionals from health centers was 179.41 ETB less compared to health professionals from hospital. The WTP for HBV vaccination of the participants who had no experience of seeing previous patients with HBV was 157.87 ETB less compared to participants who had experience of seeing previous patients with HBV. As monthly income of the study participants increased by one ETB, the WTP was increased by 0.027 ETB. CONCLUSION: The study revealed that the mean amount of money the participants might pay for HBV vaccination was much less than the market price for HBV vaccination. Type of workplace and experience of seeing/observing patients with HBV, and income were the predictors of WTP for HBV vaccination. Availing the vaccine with affordable cost in governmental health institutions may increase WTP of health professionals for HBV vaccination.


Assuntos
Pessoal de Saúde/psicologia , Vacinas contra Hepatite B/administração & dosagem , Vacinas contra Hepatite B/economia , Adulto , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Hepatite B/prevenção & controle , Hospitais Públicos/estatística & dados numéricos , Humanos , Governo Local , Masculino , Inquéritos e Questionários
14.
Artigo em Inglês | MEDLINE | ID: mdl-31581643

RESUMO

Patient satisfaction is a core tool for measuring the performance of the hospitals as well as the service provider and the services that they are providing to the patients. The aim of this research is to evaluate how information received, medical equipment, distance from the hospital, and physical infrastructure influenced patient satisfaction at public hospitals in Southern Punjab, Pakistan. An exploratory research technique was used. We distributed 700 questionnaires through a random method, and 579 provided proper responses. A confirmatory factor analysis (CFA) and a regression analysis were used for the data analysis. The study results illustrated that medical equipment, information received, distance from the hospital, and physical infrastructure had significantly positive impacts (p = 0.001) on patient satisfaction. To promote higher level of satisfaction, there is a need to take appropriate steps for improvement.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Paquistão , Inquéritos e Questionários , Adulto Jovem
15.
J Prev Med Public Health ; 52(5): 316-322, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31588701

RESUMO

OBJECTIVES: This study was conducted to assess the applicability of the Appropriateness Evaluation Protocol (AEP) for public hospitals in Korea. METHODS: In May 2016, 1500 admission claims were collected from Korean public district hospitals using stratified random sampling. Of these claims, 560 admissions to 37 hospitals were retrieved for analysis. Medical records administrators determined the appropriateness of admission using the criteria detailed in the AEP, and a physician separately assessed the appropriateness of admission based on her clinical judgment. To examine the applicability of the AEP, the concordance of the decisions made between a pair of AEP reviewers and between an AEP reviewer and a physician reviewer was compared. RESULTS: The results showed an almost perfect inter-rater agreement between the AEP reviewers and a moderate agreement between the AEP reviewers and the physician. The sensitivity and specificity of the AEP were calculated as 0.86 and 0.56, respectively. CONCLUSIONS: Our findings suggest that the AEP could potentially be applied to Korean public hospitals as a reliable and valid instrument for assessing the appropriateness of admissions.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Corpo Clínico Hospitalar , Admissão do Paciente/estatística & dados numéricos , Hospitalização , Humanos , Registros Médicos , Reprodutibilidade dos Testes , República da Coreia
16.
Afr Health Sci ; 19(2): 1930-1937, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-31656476

RESUMO

Background: Stillbirth is a death before the complete expulsion or extraction from the mother. The burden is severe and high in developing countries. Risk factors for stillbirth are not yet studied in Ethiopia. Objective: To identify risk factors of stillbirth among mothers delivered in public hospitals of Central Zone Tigray, Ethiopia. Methods: A case-control study design was used. Data collection period was from January to April 2018. Study subjects 63 cases and 252 controls were selected using systematic random sampling technique from respective hospitals. The interviewer-administered questionnaire, observational, and chart analysis were used to collect the data. A binary logistic regression model was employed. Results were presented at significance level P-value <0.05. Results: Maternal hypertension [AOR=12.83; 95% CI 3.38, 48.83], low birth weight [AOR=5.6; 95% CI 2.39, 13.38], pre-term [AOR=2.6;95%CI 1.12,6.16], alcohol intake [AOR=7.56; 95% CI 1.68, 34.04], polyhydramnios [AOR=13.43; 95% CI 3.63, 49.67], and meconium stained amniotic fluid [AOR=7.88; 95% CI 1.73, 8.18] were risk factors of stillbirth. Conclusion: The risk of stillbirth is increased with increasing maternal complication like maternal hypertension, alcohol consumption, polyhydramnios, and meconium-stained amniotic fluid. The occurrence of preterm and low birth weight of the fetus had an effect on the risk of stillbirth.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Natimorto/epidemiologia , Adulto , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Recém-Nascido de Baixo Peso , Recém-Nascido , Masculino , Mães , Poli-Hidrâmnios/epidemiologia , Pré-Eclâmpsia/epidemiologia , Gravidez , Complicações na Gravidez/etiologia , Complicações Infecciosas na Gravidez/epidemiologia , Nascimento Prematuro , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários
17.
BMC Health Serv Res ; 19(1): 748, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31651309

RESUMO

BACKGROUND: Despite the growing evidence base supporting intensive lifestyle and medical treatments for severe obesity, patient engagement in specialist obesity services is difficult to achieve and poorly understood. To address this knowledge gap, we aimed to develop a model for predicting non-completion of a specialist multidisciplinary service for clinically severe obesity, termed the Metabolic Rehabilitation Programme (MRP). METHOD: Using a case-control study design in a public hospital setting, we extracted data from medical records for all eligible patients with a body mass index (BMI) of ≥35 kg/m2 with either type 2 diabetes or fatty liver disease referred to the MRP from 2010 through 2015. Non-completion status (case definition) was coded for patients whom started but dropped-out of the MRP within 12 months. Using multivariable logistic regression, we tested the following baseline predictors hypothesised in previous research: age, gender, BMI, waist circumference, residential distance from the clinic, blood pressure, obstructive sleep apnoea (OSA), current continuous positive airway pressure (CPAP) therapy, current depression/anxiety, diabetes status, and medications. We used receiver operating characteristics and area under the curve to test the performance of models. RESULTS: Out of the 219 eligible patient records, 78 (35.6%) non-completion cases were identified. Significant differences between non-completers versus completers were: age (47.1 versus 54.5 years, p < 0.001); residential distance from the clinic (21.8 versus 17.1 km, p = 0.018); obstructive sleep apnoea (OSA) (42.9% versus 56.7%, p = 0.050) and CPAP therapy (11.7% versus 28.4%, p = 0.005). The probability of non-completion could be independently associated with age, residential distance, and either OSA or CPAP. There was no statistically significant difference in performance between the alternate models (69.5% versus 66.4%, p = 0.57). CONCLUSIONS: Non-completion of intensive specialist obesity management services is most common among younger patients, with fewer complex care needs, and those living further away from the clinic. Clinicians should be aware of these potential risk factors for dropping out early when managing outpatients with severe obesity, whereas policy makers might consider strategies for increasing access to specialist obesity management services.


Assuntos
Manejo da Obesidade/estatística & dados numéricos , Obesidade Mórbida/terapia , Cooperação do Paciente/estatística & dados numéricos , Ansiedade/etiologia , Pressão Sanguínea/fisiologia , Índice de Massa Corporal , Estudos de Casos e Controles , Pressão Positiva Contínua nas Vias Aéreas , Depressão/etiologia , Diabetes Mellitus Tipo 2/complicações , Feminino , Hospitalização/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Obesidade Mórbida/complicações , Obesidade Mórbida/psicologia , Fatores de Risco , Apneia Obstrutiva do Sono/complicações
18.
BMC Res Notes ; 12(1): 585, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533861

RESUMO

OBJECTIVES: This study was aimed to assess the magnitude of maternal near misses and the role of delays including other risk factors. A Hospital based cross sectional study was conducted at three referral hospitals of Amhara region on 572 mothers who came to obtain obstetrics care services from February 01 to July 30, 2018. RESULTS: The magnitude of maternal near miss was 26.6% (95% CI 23, 30). With regards to delays, 83 (14.5%), 226 (39.5%), and 154 (26.9%) of women delayed in the decision to seek care, in reaching care, and in receiving care respectively. Women who had no antenatal care [AOR = 3.16; CI (1.96, 5.10)], who stayed in hospital 7 days or more [AOR = 2.20; CI (1.33, 3.63)] and those who had delay in reaching health facility [AOR = 1.99; CI (1.10, 3.61)] were more likely to be near miss. While, women whose husband was able to read and write [AOR = 0.29; CI (0.09, 0.96)] and those with monthly household income between 2001 and 3000 ETB [AOR = 0.35; CI (0.18, 0.70)] were 71% and 65% less likely to be near misses respectively. Promoting antenatal care and increasing maternal health care access could have significant impact in reducing maternal near misses.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Encaminhamento e Consulta , Adulto , Estudos Transversais , Etiópia , Feminino , Acesso aos Serviços de Saúde/normas , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Obstetrícia/métodos , Gravidez , Fatores de Risco , Adulto Jovem
19.
J Clin Nurs ; 28(23-24): 4582-4594, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31494996

RESUMO

AIMS AND OBJECTIVES: To examine the influence of workplace incivility on the quality of nursing care. BACKGROUND: Recent evidence describes workplace incivility as a serious concern in the healthcare setting worldwide. Exposure to workplace incivility can alter a nurse's behaviour, thought process and perspective towards the nursing profession. However, there is insufficient evidence to determine whether workplace incivility might be associated with the quality of nursing care in Saudi Arabia. DESIGN: A quantitative and cross-sectional study. METHOD: A survey was carried out amongst 378 nurses in two government hospitals in Saudi Arabia from February 2018-May 2018 using the Nurse Incivility and quality of nursing care scales. Multivariate multiple regression was performed to investigate the influence of the uncivil experiences of nurses from different sources on the different aspects of quality of nursing care. The study adhered to STROBE guideline (see Appendix S1). RESULTS: The overall mean of the quality of nursing care scale was 3.14 (SD = 0.66) from a scale of 1-5, with patient satisfaction receiving the highest mean dimension (mean = 3.27, SD = 0.72) and health promotion the lowest mean dimension (mean = 3.08, SD = 0.74). Experience in the present hospital and the hospital were associated with the overall quality of nursing care. General and nurse incivility exerted a multivariate effect on overall quality of nursing care and its different dimensions. CONCLUSION: General incivility and nurse incivility were found to negatively impact quality of nursing care and its different dimensions. RELEVANCE TO CLINICAL PRACTICE: Stronger policies geared towards eliminating workplace incivility should be implemented as uncivil acts can lead to poor quality of nursing care. Nurse administrators and nurses should be pro-active in recognising, preventing, approaching, reporting and intervening with uncivil acts in the hospital to protect these workers from these types of behaviours and avoid their negative impacts on patient care.


Assuntos
Incivilidade , Recursos Humanos de Enfermagem no Hospital/psicologia , Cultura Organizacional , Local de Trabalho/psicologia , Adulto , Estudos Transversais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde , Arábia Saudita , Inquéritos e Questionários
20.
Artigo em Inglês | MEDLINE | ID: mdl-31505840

RESUMO

Patient satisfaction is a measure of the extent to which a patient is content with the health care they received from their health care provider. Patient satisfaction is one of the most important factors to determine the success of a health care facility. The purpose of this study was to determine patient satisfaction with healthcare services and encompass the physician's behavior as moderation between patient satisfaction and healthcare services. The study seeks to measure the health care services, like a laboratory and diagnostic care, preventive healthcare and prenatal care, to patient satisfaction in the public health sectors of Pakistan. A descriptive survey research design was used for this study. The target population was patients from the out-patient department (OPD) of three public hospitals from Pakistan. By using the convenient sampling technique, 290 sample participants were selected from the target population. The reliability scales were tallied by using Cronbach's Alpha. The findings of the study are gleaned by using regression to explore patient satisfaction with the health care services, and whether or not the physician's behavior moderates the link of patient satisfaction and healthcare services. SPSS Hayes process was used for the moderation effect of the physician's behavior. The main results of the regression analysis validate that health care services, such as laboratory and diagnostic care, preventive healthcare, and prenatal care, have a significant and positive effect on patient satisfaction. Specifically, the study suggests that the physician's behavior significantly moderates the effect of health care services on the satisfaction of patients. The overall opinions about the satisfaction level of patients for the availability of health services in the hospitals were good. The degree of satisfaction was satisfactory with respect to laboratory and diagnostic care, preventive healthcare, and prenatal care services. Based on the outcomes, the study confirms that the proposed hypotheses are statistically significant. Furthermore, the directions for future research of the study are offered.


Assuntos
Serviços de Saúde , Pacientes Ambulatoriais/psicologia , Satisfação do Paciente/estatística & dados numéricos , Médicos/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos , Paquistão , Médicos/psicologia , Adulto Jovem
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