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1.
Biomed Res Int ; 2021: 6627430, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33748271

RESUMO

Introduction: Although the efforts at global and national levels have attempted to decrease the COVID-19 pandemic, the low level of preparedness among healthcare providers is a challenge mainly in developing countries. Hence, this study is aimed at assessing the level of preparedness for COVID-19 and its associated factors among frontline healthcare providers in South Gondar public hospitals, northwest Ethiopia. Methods and Materials: A hospital-based cross-sectional study was conducted among 207 selected healthcare providers who were working in South Gondar public hospital from July 08 to August 29, 2020. A pretested structured questionnaire was used to collect data. The healthcare providers were selected through simple random sampling techniques. Both bivariable and multivariable logistic regressions with a 95% confidence interval were fitted with 95% CI to establish the associated factors with a low level of preparedness. A p value < 0.05 was considered statistically significant. Results: The overall level of preparedness among healthcare providers for COVID-19 was found to be 41.3% (95% CI: 37.4, 44.7). Only 81 (40.1%) healthcare providers had prepared for telling their family and friends if they are infected with COVID-19. Besides, only 23.8% of healthcare providers obtained alcohol-based hand sanitizer in every patient room. Factors associated with a low level of preparedness include being male (AOR = 2.5, 95% CI: 1.22-4.94), unmarried (AOR = 3.4, 95% CI: 1.44-8.00), and working experience less than five years (AOR = 3.4, 95% CI: 1.29-9.09). Conclusion: The level of preparedness among frontline healthcare providers towards COVID-19 was found to be very low. In the future, more emphasis should be placed on healthcare providers who are male, unmarried, and had working experience of lower than five years to decrease the burden of the COVID-19 pandemic.


Assuntos
/prevenção & controle , Pessoal de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Adulto , Estudos Transversais , Etiópia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Modelos Logísticos , Masculino , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Inquéritos e Questionários
2.
Arch Ital Urol Androl ; 93(1): 111-114, 2021 Mar 22.
Artigo em Inglês | MEDLINE | ID: mdl-33754622

RESUMO

The SARS-CoV-2 (Severe acute respiratory syndrome coronavirus 2) was first reported in December 2019, then its rapid spread around the world caused a global pandemic in March 2020 recording a high death rate. The epicenter of the victims moved from Asia to Europe and then to the United States. In this Pandemic, the different governance mechanisms adopted by local health regional authorities made the difference in terms of contagiousness and mortality together with a community strong solidarity. This document analyzes the andrological urgencies management in public hospitals and in private practice observed in Italy and in particular in the most affected Italian Regions: Emilia-Romagna and Marche.


Assuntos
Andrologia/estatística & dados numéricos , Infertilidade Masculina/terapia , Pandemias , Gerenciamento Clínico , Hospitais Públicos/estatística & dados numéricos , Humanos , Itália , Masculino , Prática Privada/estatística & dados numéricos , Doenças Urológicas/terapia
3.
J. healthc. qual. res ; 36(1): 3-11, ene.-feb. 2021. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-196570

RESUMO

OBJETIVO: Describir el proceso de planificación y ejecución de un estudio masivo de seroprevalencia para SARS-CoV-2 en los profesionales del Hospital Universitario Fundación Alcorcón (HUFA) (España). MÉTODO: Se efectúa una descripción del plan diseñado y desarrollado en el HUFA para la realización de las extracciones de las muestras para serología en el total de los profesionales que prestan servicio en el hospital, entre el 14 y el 29 de abril del 2020. Se lleva a cabo un análisis descriptivo de la participación de los profesionales en el estudio. De igual manera, se planificaron zonas de extracción, personal sanitario y tiempos de ejecución. Se asignaron 2.326 extracciones a personal sanitario, el resto fueron a trabajadores de las empresas externas. RESULTADOS: Participaron en el estudio 2.641 trabajadores (90,5%) de 2.918 candidatos. La categoría profesional que más se analizó globalmente fue la de enfermería con un 28,3% (n = 590). El porcentaje de cumplimiento de la organización de los horarios fue del 28,6%. Se planificó hasta un máximo de 298 extracciones diarias. El día con más afluencia fue el cuarto con 399 extracciones. CONCLUSIONES: El hecho de organizar un dispositivo tan grande con un alcance al 100% de los trabajadores que prestan servicio en el hospital, y con una respuesta tan mayoritaria por parte de ellos, ha permitido que el estudio de seroprevalencia realizado obtenga unos resultados con alta fiabilidad. Aunque el porcentaje de participación fue muy alto, el grado de cumplimiento de la planificación fue reducido


OBJECTIVE: To describe the planning and execution process of a massive seroprevalence study for SARS-CoV-2 in professionals of the Hospital Universitario Fundación Alcorcón (HUFA) (Spain). METHODS: A description is presented of the plan designed and developed at the HUFA for the execution of the extraction of the samples for serology from all the professionals who worked in the hospital between 14 and 29 April 2020. A descriptive analysis of the participation of the professionals in the study is carried out. Extraction areas, health personnel, and execution times were planned. A total of 2326 extractions were assigned to health personnel, the remaining extractions were assigned to workers from external companies. RESULTS: A total of 2641 workers (90.5%) out of 2918 candidates participated in the study. The professional category most analysed was nursing with 28.3% (n = 590). The percentage of compliance with schedule planning was 28.6%. Up to a maximum of 298 daily extractions were planned. The busiest day was the 4th day of the study with 399 extractions. CONCLUSIONS: The organising of such a large study, with a 100% coverage of those who worked in the hospital, and with such a great response from the workers involved, has led to obtaining results of high reliability in the seroprevalence study carried out. Although the percentage of participation was very high, the level of compliance with the planning was low


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Infecções por Coronavirus/epidemiologia , Pneumonia Viral/epidemiologia , Pandemias , Recursos Humanos em Hospital/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Estudos Soroepidemiológicos , Espanha/epidemiologia
4.
BMC Infect Dis ; 21(1): 233, 2021 Feb 27.
Artigo em Inglês | MEDLINE | ID: mdl-33639871

RESUMO

BACKGROUND: The risk of hepatitis B virus infection among medical waste handlers who undergo collection, transportation, and disposal of medical wastes in the health institutions is higher due to frequent exposure to contaminated blood and other body fluids. There is limited evidence on the seroprevalence of hepatitis B among medical waste handlers in eastern Ethiopia. The study was aimed at studying the seroprevalence of Hepatitis B Virus and associated risk factors among medical waste collectors at health facilities of eastern Ethiopia. METHODS: A facility-based cross-sectional study was conducted among randomly selected medical waste collectors from public health facilities in eastern Ethiopia from March to June 2018. A pre-tested and well-structured questionnaire was used to collect data on socio-demographic characteristics and hepatitis B infection risk factors. A2.5ml venous blood was also collected, centrifuged and the serum was analyzed for hepatitis B surface antigen using the instant hepatitis B surface antigen kit. Descriptive summary measures were done. Chi-square and Fisher exact tests were used to assess the risk of association. Multivariate logistic regression was conducted with 95% CI and all value at P-value < 0.05 was declared statistically significant. RESULTS: From a total of 260 (97.38%) medical waste collectors participated, HBV was detected in 53 (20.4%) of the participants [95%CI; 15.8, 25.6]. No significant differences were observed in the detection rates of HBV with respect to socio-demographic characteristics. In both bivariate and multivariable logistic regression analysis, being unvaccinated (AOR = 6.35; 95%CI = [2.53-15.96], P = 0.001), history of blood transfusion (receiving) (AOR; 3.54; 95%CI; [1.02-12.24], P = 0.046), history of tattooing (AOR = 2.86; 95%CI = [1.12-7.27], p = 0.03), and history of multiple sexual partner (AOR = 10.28; 95%CI = [4.16-25.38], P = 0.001) remained statistically significantly associated with HBsAg positivity. CONCLUSION: This cross-sectional study identified that HBV infection is high among medical waste collectors in eastern Ethiopia. Immunization and on job health promotion and disease prevention measures should be considered in order to control the risk of HBV infection among medical waste collectors in eastern Ethiopia.


Assuntos
Hepatite B/epidemiologia , Serviço Hospitalar de Limpeza/estatística & dados numéricos , Eliminação de Resíduos de Serviços de Saúde/estatística & dados numéricos , Exposição Ocupacional/estatística & dados numéricos , Recursos Humanos em Hospital/estatística & dados numéricos , Adulto , Centros Comunitários de Saúde/estatística & dados numéricos , Infecção Hospitalar/sangue , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/etiologia , Estudos Transversais , Escolaridade , Etiópia/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hepatite B/sangue , Hepatite B/etiologia , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/isolamento & purificação , Vírus da Hepatite B/fisiologia , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Resíduos de Serviços de Saúde/efeitos adversos , Resíduos de Serviços de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Exposição Ocupacional/análise , Logradouros Públicos/estatística & dados numéricos , Fatores de Risco , Estudos Soroepidemiológicos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
5.
Phys Ther ; 101(4)2021 04 04.
Artigo em Inglês | MEDLINE | ID: mdl-33517462

RESUMO

OBJECTIVE: Knowledge of the experiences of health care professionals who have actively worked on the first line of the COVID-19 pandemic could help to identify specific professional duties focused on health assistance objectives. No qualitative study has yet been published, to our knowledge, describing the experience of physical therapists during the COVID-19 pandemic. The purpose of this study was to describe and explore the experiences and perspectives of physical therapists working in public hospitals in Madrid, Spain, during the COVID-19 pandemic. METHODS: A qualitative exploratory study was conducted based on an interpretive framework. Thirty physical therapists working at 11 national public hospitals during the COVID-19 outbreak were recruited by purposeful sampling and snowball techniques. In-depth interviews and researchers' field notes were used to collect data. Interviews were transcribed verbatim. Inductive thematic analysis was used to identify emerging themes. RESULTS: After identifying 3912 codes and 13 categories, 3 themes emerged. The first theme was "call of duty"; as COVID-19 infection dramatically spread, the hospitals were contaminated and overwhelmed, and all floors were converted into COVID-19 wards. The second theme was "working in war time." Every day, therapists were given "the war report," receiving their orders, meeting protective personal equipment requirements, and confronting fear. The third theme was "when I arrive at home." Working during the pandemic had an impact on the therapists' families and the information shared with them. CONCLUSIONS: Physical therapists described the COVID-19 outbreak as an apocalyptic and unexpected war. Comprehensive support is needed for all frontline health care professionals. The COVID-19 outbreak revealed that health care systems were not prepared for a pandemic. IMPACT: To our knowledge, this is the first qualitative study to be published describing the experience of physical therapists during the COVID-19 pandemic.


Assuntos
/epidemiologia , Hospitais Públicos/normas , Fisioterapeutas/psicologia , Adulto , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Entrevistas como Assunto , Masculino , Equipamento de Proteção Individual/provisão & distribução , Pesquisa Qualitativa , Espanha
6.
J Healthc Risk Manag ; 40(4): 46-57, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33496013

RESUMO

Health care organizations have had to respond to the Coronavirus disease 2019 (COVID-19) pandemic in unprecedented ways. In the United States, where health risk management is an established profession, health care risk managers (HRMs) contributed to the response by supporting organizations and frontline workers. HRMs advised administrative and clinical leadership on decisions and policies aimed at addressing the medico legal, ethical, and operational dilemmas raised by this public health emergency. This article describes these challenges from the perspective of a New York City (NYC) public hospital located in the "epicenter within the epicenter" of the pandemic and aims to provide practical guidance for HRMs on the front lines of this crisis.


Assuntos
/prevenção & controle , Política de Saúde , Hospitais Públicos/normas , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto , Política Pública , Gestão de Riscos/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cidade de Nova Iorque/epidemiologia , Gestão de Riscos/estatística & dados numéricos
7.
N Z Med J ; 133(1526): 55-66, 2020 12 04.
Artigo em Inglês | MEDLINE | ID: mdl-33332340

RESUMO

AIM: This retrospective review examined the influence of age and severity of comorbidities on goals-of-care in advance care plans (ACPlans) and concordance between these wishes and care received during hospital admission. METHODS: The medical records of 149 people with an ACPlan admitted to a public hospital were reviewed to evaluate concordance with treatment. The associations between age and comorbidities and goals-of-care were determined using contingency tables and logistic regression analyses. RESULTS: The majority of the review cohort were Caucasian and elderly, with people from minority ethnic groups under-represented compared to census data. Increasing age had a measurable influence on the choice of goal-of-care, whereas comorbidity severity had less influence on this decision. In 60 of the 411 hospital admissions the patient was classified as incompetent, with the goal-of-care adhered to in 59 of these cases and treatment preferences adhered to in six of seven cases. Fifty-five people had died since writing their ACPlan, with 63% dying at their preferred place or with no preference stated. CONCLUSIONS: Age and to a lesser extent the severity of comorbidities influence the choice of goal-of-care in an ACPlan. Our review also showed that end-of-life care appeared to adhere to the instructions in the plan.


Assuntos
Planejamento Antecipado de Cuidados/organização & administração , Hospitalização/tendências , Hospitais Públicos/estatística & dados numéricos , Registros Médicos/estatística & dados numéricos , Preferência do Paciente , Assistência Terminal/organização & administração , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Nova Zelândia , Estudos Retrospectivos
8.
J Pregnancy ; 2020: 8878037, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33194231

RESUMO

Introduction: Uterine rupture is a leading cause of maternal death in Ethiopia. Despite strengthening the health care system and providing basic and comprehensive emergency obstetric care closer to the communities, uterine rupture continues to produce devastating maternal and fetal outcomes. Although risk factors of uterine rupture are context specific, there is lack of clarity in our context towards the contributing factors and untoward outcomes of uterine rupture. This study was conducted to identify the risk factors of uterine rupture and its impacts in public hospitals of Tigrai. Objective: This study would identify determinant factors of uterine rupture and its management outcomes among mothers who gave birth in public hospitals in Tigrai region, North Ethiopia. Method: A retrospective hospital-based unmatched case control study design was implemented with 135 cases of women with uterine rupture and 270 controls of women without uterine rupture. Cases were enrolled consecutively from case notes of women who gave birth from 1/9/2015 to 30/6/2019, while charts (case note) of women without uterine rupture found following the cases were selected randomly and enrolled. Bivariate and multivariate logistic regression with 95% confidence interval was used to identify the determinants of uterine rupture. Result: Mothers referred from remote health institutions (AOR 7.29 (95% CI: 2.7, 19.68)), mothers who visited once for antenatal care (AOR 2.85 (95% CI: 1.02, 7.94)), those experiencing obstructed labor (AOR 13.33 (95% CI: 4.23, 42.05)), and birth weight of a newborn greater than four kilograms (AOR 5.68 (95% CI: 1.39, 23.2)) were significantly associated with uterine rupture. From 135 mothers who develop uterine rupture, 13 (9.6%) mothers died and 101 (74.8%) fetuses were stillborn. Obstetrical complications like abdominal hysterectomy in 75 (55.6%) of mothers and excessive blood loss in 84 (57.8%) were additional untoward outcomes of uterine rupture. Conclusion: Referrals from remote health institutions, once-visited antenatal care, obstructed labor, and birth weight of newborns greater than four kilograms were significant determinants of uterine rupture. Maternal death, stillbirth, hysterectomy, and hemorrhage were adverse outcomes. The findings of this study suggest early identification of factors that expose to uterine rupture during antenatal care, labor, and delivery must be attended to and further prospective studies are needed to explore predictors of untoward outcomes. Knowing the determinants of uterine rupture helps prevent the occurrence of a problem in pregnant women, which reduces maternal morbidity and mortality, and would have a tremendous help in identifying the best optional strategies in our current practices. This assertion was added to the abstract concluding session.


Assuntos
Parto Obstétrico , Hospitais Públicos/estatística & dados numéricos , Ruptura Uterina/etiologia , Adulto , Peso ao Nascer , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Acesso aos Serviços de Saúde , Humanos , Histerectomia , Gravidez , Cuidado Pré-Natal , Estudos Retrospectivos , Fatores de Risco , Natimorto , Resultado do Tratamento , Ruptura Uterina/epidemiologia , Ruptura Uterina/mortalidade , Ruptura Uterina/prevenção & controle , Adulto Jovem
9.
Emergencias ; 32(5): 320-331, 2020 09.
Artigo em Inglês, Espanhol | MEDLINE | ID: mdl-33006832

RESUMO

OBJECTIVES: To estimate the impact of the coronavirus disease 2019 (COVID-19) pandemic on the organization of Spanish hospital emergency departments (EDs). To explore differences between Spanish autonomous communities or according to hospital size and disease incidence in the area. MATERIAL AND METHODS: Survey of the heads of 283 EDs in hospitals belonging to or affiliated with Spain's public health service. Respondents evaluated the pandemic's impact on organization, resources, and staff absence from work in March and April 2020. Assessments were for 15-day periods. Results were analyzed overall and by autonomous community, hospital size, and local population incidence rates. RESULTS: A total of 246 (87%) responses were received. The majority of the EDs organized a triage system, first aid, and observation wards; areas specifically for patients suspected of having COVID-19 were newly set apart. The nursing staff was increased in 83% of the EDs (with no subgroup differences), and 59% increased the number of physicians (especially in large hospitals and locations where the COVID-19 incidence was high). Diagnostic tests for the severe acute respiratory syndrome coronavirus 2 were the resource the EDs missed most: 55% reported that tests were scarce often or very often. Other resources reported to be scarce were FPP2 and FPP3 masks (38% of the EDs), waterproof protective gowns (34%), and space (32%). More than 5% of the physicians, nurses, or other emergency staff were on sick leave 20%, 19%, and 16% of the time. These deficiencies were greatest during the last half of March, except for tests, which were most scarce in the first 15 days. Large hospital EDs less often reported that diagnostic tests were unavailable. In areas where the COVID-19 incidence was higher, the EDs reported higher rates of staff on sick leave. Resource scarcity differed markedly by autonomous community and was not always associated with the incidence of COVID-19 in the population. CONCLUSION: The COVID-19 pandemic led to organizational changes in EDs. Certain resources became scarce, and marked differences between autonomous communities were detected.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Absenteísmo , Adulto , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Surtos de Doenças , Serviço Hospitalar de Emergência/organização & administração , Recursos em Saúde/provisão & distribução , Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Hospitais Públicos/organização & administração , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Recursos Humanos em Hospital/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Alocação de Recursos , /etiologia , Espanha/epidemiologia , Triagem/organização & administração
10.
J Glob Health ; 10(2): 020509, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33110592

RESUMO

Background: The COVID-19 pandemic has overwhelmed hospitals in several areas in high-income countries. An effective response to this pandemic requires health care workers (HCWs) to be present at work, particularly in low- and middle-income countries (LMICs) where they are already in critically low supply. To inform whether and to what degree policymakers in Bangladesh, and LMICs more broadly, should expect a drop in HCW attendance as COVID-19 continues to spread, this study aims to determine how HCW attendance has changed during the early stages of the COVID-19 pandemic in Bangladesh. Methods: This study analyzed daily fingerprint-verified attendance data from all 527 public-sector secondary and tertiary care facilities in Bangladesh to describe HCW attendance from January 26, 2019 to March 22, 2020, by cadre, hospital type, and geographic division. We then regressed HCW attendance onto fixed effects for day-of-week, month, and hospital, as well as indicators for each of three pandemic periods: a China-focused period (January 11, 2020 (first confirmed COVID-19 death in China) until January 29, 2020), international-spread period (January 30, 2020 (World Health Organization's declaration of a global emergency) until March 6, 2020), and local-spread period (March 7, 2020 (first confirmed COVID-19 case in Bangladesh) until the end of the study period). Findings: On average between January 26, 2019 and March 22, 2020, 34.1% of doctors, 64.6% of nurses, and 70.6% of other health care staff were present for their scheduled shift. HCWs' attendance rate increased with time in 2019 among all cadres. Nurses' attendance level dropped by 2.5% points (95% confidence interval (CI) = -3.2% to -1.8%) and 3.5% points (95% CI = -4.5% to -2.5%) during the international-spread and the local-spread periods of the COVID-19 pandemic, relative to the China-focused period. Similarly, the attendance level of other health care staff declined by 0.3% points (95% CI = -0.8% to 0.2%) and 2.3% points (95% CI = -3.0% to -1.6%) during the international-spread and local-spread periods, respectively. Among doctors, however, the international-spread and local-spread periods were associated with a statistically significant increase in attendance by 3.7% points (95% CI = 2.5% to 4.8%) and 4.9% points (95% CI = 3.5% to 6.4%), respectively. The reduction in attendance levels across all HCWs during the local-spread period was much greater at large hospitals, where the majority of COVID-19 testing and treatment took place, than that at small hospitals. Conclusions: After a year of significant improvements, HCWs' attendance levels among nurses and other health care staff (who form the majority of Bangladesh's health care workforce) have declined during the early stages of the COVID-19 pandemic. This finding may portend an even greater decrease in attendance if COVID-19 continues to spread in Bangladesh. Policymakers in Bangladesh and similar LMICs should undertake major efforts to achieve high attendance levels among HCWs, particularly nurses, such as by providing sufficient personal protective equipment as well as monetary and non-monetary incentives.


Assuntos
Infecções por Coronavirus , Mão de Obra em Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Pandemias , Pneumonia Viral , Atenção Secundária à Saúde/estatística & dados numéricos , Atenção Terciária à Saúde/estatística & dados numéricos , Adulto , Bangladesh/epidemiologia , Betacoronavirus , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Atenção Secundária à Saúde/organização & administração , Atenção Terciária à Saúde/organização & administração
11.
Eur J Radiol ; 132: 109285, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32957001

RESUMO

PURPOSE: The COVID-19 pandemic has led to an urgent reorganisation of the healthcare system to prevent hospitals from overflowing and the virus from spreading. Our objective was to evaluate the socioeconomic and psychological impact of the COVID-19 outbreak on radiologists. MATERIAL AND METHODS: French radiologists were invited to answer an online survey during the pandemic through mailing lists. The questionnaire was accessible for nine days. It covered socio-demographic information, exposure to COVID-19 at work and impact on work organisation, and included the Insomnia Severity Index and Hospital Anxiety and Depression Scale. Outcomes were moderate to severe insomnia, definite symptoms of depression or anxiety. Risk and protective factors were identified through multivariate binary logistic regression. RESULTS: 1515 radiologists answered the survey. Overall, 674 (44.5 %) worked in a highCOVID-19 density area, 671 (44.3 %) were women, and 809 (53.4 %) worked in private practice. Among responders, 186 (12.3 %) expressed insomnia, 222 (14.6 %) anxiety, and 189 (12.5 %) depression symptoms. Lack of protective equipment, increased teleradiology activity and negative impact on education were risk factors for insomnia (respectively OR [95 %CI]:1.7[1.1-2.7], 1.5[1.1-2.2], and 2.5[1.8-3.6]). Female gender, respiratory history, working in COVID-19 high density area, increase of COVID-19 related activity, and impacted education were risk factors for anxiety (OR[95 %CI]:1.7[1.2-2.3], 2[1.1-3.4], 1.5[1.1-2], 1.2[1-1.4], and 2.1[1.5-3]). Conversely, working in a public hospital was a protective factor against insomnia, anxiety, and depression (OR[95 %CI]:0.4[0.2-0.7], 0.6[0.4-0.9], and 0.5[0.3-0.8]). CONCLUSIONS: During COVID-19 pandemic, many radiologists expressed depression, anxiety and insomnia symptoms. Working in a public hospital was a protective factor against every psychological symptom. Socio-economic impact was also major especially in private practice.


Assuntos
Infecções por Coronavirus/economia , Infecções por Coronavirus/psicologia , Hospitais Públicos/economia , Pandemias/economia , Pneumonia Viral/economia , Pneumonia Viral/psicologia , Prática Privada/economia , Radiologistas/economia , Radiologistas/psicologia , Fatores Socioeconômicos , Adulto , Betacoronavirus , Feminino , França , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Prática Privada/estatística & dados numéricos , Radiologistas/estatística & dados numéricos , Fatores de Risco , Inquéritos e Questionários , Adulto Jovem
12.
PLoS One ; 15(8): e0237083, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32780769

RESUMO

INTRODUCTION: Adequate control of hypertension is a global challenge and is the key to reduce cardiovascular disease risk factors. This study evaluates management of hypertensive patients in primary care clinics in Malaysia. METHODS: A cross-sectional analysis of 13 784 medical records from 20 selected public primary care clinics in Malaysia was performed for patients aged ≥30 years old who were diagnosed with hypertension and had at least one visit between 1st November 2016 and 30th June 2019. Multivariable logistic regression adjusted for complex survey design was used to determine the association between process of care and blood pressure (BP) control among the hypertensive patients. RESULTS: Approximately 50% of hypertensive patients were obese, 38.4% of age ≥65 years old, 71.2% had at least one comorbidity and approximately one-third were on antihypertensive monotherapy. Approximately two-third of the hypertensive patients with diabetic proteinuria were prescribed with the appropriate choice of antihypertensive agents. Approximately half of the patients received at least 70% of the target indicated care and 42.8% had adequately controlled BP. After adjusting for covariates, patients who received counseling on exercise were positively associated with adequate BP control. Conversely, patients who were prescribed with two or more antihypertensive agents were negatively associated with good BP control. CONCLUSIONS: These findings indicated that BP control was suboptimal and deficient in the process of care with consequent gaps in guidelines and actual clinical practices. This warrants a re-evaluation of the current strategies and approaches to improve the quality of hypertension management and ultimately to improve outcome.


Assuntos
Hospitais Públicos/normas , Hipertensão/terapia , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Hipertensão/epidemiologia , Malásia , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos
13.
PLoS One ; 15(8): e0235591, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790671

RESUMO

Adverse drug reactions (ADRs) are associated with morbidity and mortality worldwide. Although national systems for reporting ADRs exist there is a low reporting rate. The aim of the current study was to evaluate an intervention plan for improving ADRs reporting among medical professionals (physicians and nurses). A multicentre intervention study was conducted, in which one medical centre was randomly assigned to the intervention group and two medical centres to the control group. The study consisted of 3 phases: baseline data collection, intervention and follow-up of the reporting rate. The questionnaire that was filled in at base line and at the end of study, contained questions about personal/professional demographic variables, and statements regarding knowledge of and behaviour toward ADRs reporting. The intervention program consisted of posters, lectures, distant electronic learning and reminders. An increase in the number of ADRs reports was noted in the intervention group (74 times higher than in the control group) during the intervention period, which was gradually decreased with as the study progressed (adjusted O.R = 74.1, 95% CI = 21.11-260.1, p<0.001). The changes in the "knowledge related to behaviour" (p = 0.01) and in the "behaviour related to reporting" (p<0.001) score was significantly higher in the intervention group. Specialist physicians and nurses (p<0.001), fulfilling additional positions (p<0.001) and those working in other places (p = 0.05) demonstrated a high rate of report. Lectures were preferable as a method to encourage ADRs reporting. The most convenient reporting tools were telephone and online reporting. Thus, implementation and maintenance of a continuous intervention program, by a pharmacovigilance specialist staff member, will improve ADRs reporting rates.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Educação Profissional em Saúde Pública/métodos , Pessoal de Saúde/educação , Hospitais Públicos/estatística & dados numéricos , Humanos , Melhoria de Qualidade
14.
PLoS Med ; 17(7): e1003089, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32649668

RESUMO

INTRODUCTION: Inequalities in maternal and newborn health persist in many high-income countries, including for women of refugee background. The Bridging the Gap partnership programme in Victoria, Australia, was designed to find new ways to improve the responsiveness of universal maternity and early child health services for women and families of refugee background with the codesign and implementation of iterative quality improvement and demonstration initiatives. One goal of this 'whole-of-system' approach was to improve access to antenatal care. The objective of this paper is to report refugee women's access to hospital-based antenatal care over the period of health system reforms. METHODS AND FINDINGS: The study was designed using an interrupted time series analysis using routinely collected data from two hospital networks (four maternity hospitals) at 6-month intervals during reform activity (January 2014 to December 2016). The sample included women of refugee background and a comparison group of Australian-born women giving birth over the 3 years. We describe the proportions of women of refugee background (1) attending seven or more antenatal visits and (2) attending their first hospital visit at less than 16 weeks' gestation compared over time and to Australian-born women using logistic regression analyses. In total, 10% of births at participating hospitals were to women of refugee background. Refugee women were born in over 35 countries, and at one participating hospital, 40% required an interpreter. Compared with Australian-born women, women of refugee background were of similar age at the time of birth and were more likely to be having their second or subsequent baby and have four or more children. At baseline, 60% of refugee-background women and Australian-born women attended seven or more antenatal visits. Similar trends of improvement over the 6-month time intervals were observed for both populations, increasing to 80% of women at one hospital network having seven or more visits at the final data collection period and 73% at the other network. In contrast, there was a steady decrease in the proportion of women having their first hospital visit at less than 16 weeks' gestation, which was most marked for women of refugee background. Using an interrupted time series of observational data over the period of improvement is limited compared with using a randomisation design, which was not feasible in this setting. CONCLUSIONS: Accurate ascertainment of 'harder-to-reach' populations and ongoing monitoring of quality improvement initiatives are essential to understand the impact of system reforms. Our findings suggest that improvement in total antenatal visits may have been at the expense of recommended access to public hospital antenatal care within 16 weeks of gestation.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adolescente , Adulto , Feminino , Maternidades/estatística & dados numéricos , Humanos , Recém-Nascido , Análise de Séries Temporais Interrompida , Idade Materna , Gravidez , Segundo Trimestre da Gravidez , Melhoria de Qualidade , Fatores Socioeconômicos , Vitória/epidemiologia , Adulto Jovem
15.
Diabetes Res Clin Pract ; 166: 108288, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32615277

RESUMO

BACKGROUND: The prevalence and incidence of Type 2 Diabetes mellitus (T2DM) are significantly increasing in Nigeria. Effective management of the condition, in clinical settings, can be achieved with a minimal financial cost, but this is often overlooked. It is crucial to understand organisational factors influencing non-pharmacological management of T2DM in Nigerian public hospitals for effective management of patients diagnosed with the condition. AIM: To examine healthcare delivery services influencing patient management and seek approaches to heighten optimisation of patient health outcomes. METHODS: Adopting a qualitative case study design, we used the Constant Comparative Method and semi-structured questions to interview17 nurses in public hospitals across Lagos. Using the five stages of the Framework Analysis process, the transcribed interviews were thematically analysed. RESULTS: Nurses suggested that a complex, multifaceted system constituted organisational factors influencing T2DM management in public hospitals across Lagos, Nigeria. Specific factors identified were levels of available information and knowledge, relationship, policy and decision-making management. These factors were, in turn, linked to political, infrastructural, health professional and the environments within which patients were given health services. CONCLUSIONS: The study revealed a significant gap in the organisation of care for individuals diagnosed with T2DM in public hospitals across Lagos. Timely and affordable strategies have been highlighted to secure effective care delivery to patients.


Assuntos
Assistência à Saúde/organização & administração , Diabetes Mellitus Tipo 2/terapia , Serviços de Saúde/normas , Hospitais Públicos/organização & administração , Enfermeiras e Enfermeiros , Percepção , Adulto , Atitude do Pessoal de Saúde , Tomada de Decisões Gerenciais , Assistência à Saúde/normas , Diabetes Mellitus Tipo 2/epidemiologia , Diabetes Mellitus Tipo 2/enfermagem , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Enfermeiras e Enfermeiros/organização & administração , Enfermeiras e Enfermeiros/psicologia , Enfermeiras e Enfermeiros/normas , Enfermeiras e Enfermeiros/estatística & dados numéricos , Padrões de Prática em Enfermagem/organização & administração , Padrões de Prática em Enfermagem/normas , Padrões de Prática em Enfermagem/estatística & dados numéricos , Pesquisa Qualitativa , Fatores Socioeconômicos , Inquéritos e Questionários , Resultado do Tratamento
16.
J Pregnancy ; 2020: 6029160, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32695514

RESUMO

Background: Maternal near miss refers to a very ill pregnant or delivered woman who nearly died but survived a complication during pregnancy, childbirth, or within 42 days of termination of pregnancy. Maternal death; the most catastrophic end is frequently described as just "tip of the iceberg," whereas maternal near-miss as the "base." Therefore, this study aimed at assessing the factors associated with maternal near-miss among women admitted in public hospitals of West Arsi zone, Ethiopia. Methods: A facility-based unmatched case-control study was conducted from Mar 1 to Apr 30, 2019. Three hundred twenty-one (80 cases and 241 controls) study participants were involved in the study. Cases were recruited consecutively as they present, whereas controls were selected by systematic sampling method. Cases were women admitted to hospitals during pregnancy, delivery, or within 42 days of termination of pregnancy and fulfilled at least one of the maternal near-miss disease-specific criteria, while controls were women admitted and gave birth by normal vaginal delivery. The interviewer-administered structured questionnaire and data abstraction tool was used to collect data. Data were entered Epi data 3.1 and then transferred into SPSS 20 for analysis. Multivariable logistic regression was used, and the significance level was declared at p value ≤ 0.05. Results: The major maternal near-miss morbidities were severe obstetric hemorrhage (32.5%), pregnancy-induced hypertensive disorders (31.3%), and obstructed labor (26.3%), followed by 6.3% and 3.8% of severe anemia and pregnancy-induced sepsis, respectively. The odds of maternal near miss were statistically significantly associated with women's lack of formal education [AOR = 2.24, 95% CI: (1.17, 4.31)]. Not attending antenatal care [AOR = 3.71, 95% CI: (1.10, 12.76)], having prior history of cesarean section [AOR = 3.53, 95% CI: (1.49, 8.36)], any preexisting chronic medical disorder [AOR = 2.04, 95% CI: (1.11, 3.78)], and having experienced first delay [AOR = 5.74, 95% CI: (2.93, 11.2)]. Conclusions: Maternal education, antenatal care, chronic medical disorders, previous cesarean section, and first delay of obstetric care-seeking were identified as factors associated with maternal near-miss morbidity. Therefore, this finding implies the need to get better with those factors, to preclude severe maternal complications and subsequent maternal mortality.


Assuntos
Hospitais Públicos/estatística & dados numéricos , Near Miss/estatística & dados numéricos , Complicações na Gravidez/epidemiologia , Anemia/epidemiologia , Anemia/mortalidade , Estudos de Casos e Controles , Etiópia/epidemiologia , Feminino , Educação em Saúde , Humanos , Hipertensão Induzida pela Gravidez/epidemiologia , Hipertensão Induzida pela Gravidez/mortalidade , Modelos Logísticos , Complicações do Trabalho de Parto/epidemiologia , Complicações do Trabalho de Parto/mortalidade , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/mortalidade , Gravidez , Complicações na Gravidez/mortalidade , Cuidado Pré-Natal , Sepse/epidemiologia , Sepse/mortalidade , Inquéritos e Questionários
17.
PLoS One ; 15(6): e0234988, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32559256

RESUMO

BACKGROUND: Even though there are different tuberculosis (TB) prevention and control measures implemented globally including Ethiopia, TB is still major public health problem. This is partly due to compromised quality of care delivered for tuberculosis patients in health facilities (HFs) during diagnosis, treatment and follows-up. Thus this study is intended to determine the quality of care delivered for TB patients in all public HFs of Debre Tabor town, Northwest Ethiopia. METHODS: Cross sectional study was conducted from January to May 2018. Data were collected with face-to-face interview and TB registration book review using structured questionnaire and checklist respectively. Collected data was entered and processed using SPSS and P value <0.05 was considered statistically significant. The quality of care for each HF was graded as very good, good, moderate, poor and very poor if HFs achieve [90-100%], [80-90%), [70-80%), [60-70%) and <60% of performance indicators respectively using Donabedian structure, process and outcome model of health care quality. RESULTS: All HFs have sputum collection area, enough microscopic slide, at least one functional microscope and sufficient anti TB drug supply. But HFs lack backup laboratory stains. Overall structural aspects of quality of care in all HFs were very poor achieving 42.5-52.9% structural performance indicators out of 100%. Similarly the overall process aspects of quality of care was poor in all public HFs which achieved 60-68.9% of the scores out of 100%. In the study; 68.9%, 54.5% and 80.6% of Medical Laboratory, pharmacy and other healthcare workers (HWs) provided correct response respectively on TB causative agent, risk factor, transmission, treatment, prevention, case management and case finding strategies. HWs who knew at least two TB case finding strategies in DTH was significantly higher than those HWs working in Health Centers (P = 0.004). On the other hand, except Ginbot 20 HC, HFs was graded as good by scoring 86.6-89.3% of performance indicators on the outcome aspects of quality of care. In all HFs studied, all TB patients' unit TB registration number, sex, age, TB category, treatment initiation date and intensive phase treatment start year were properly registered. Moreover 110 (78%) and 147 (69%) contact person address in DTH and HCs was properly registered on TB unit register book respectively with no statistical difference in hospital and HCs (P = 0.063). There was proper TB patients' address registration in hospital than HCs studied (P< 0.001). CONCLUSIONS: The outcome aspects of quality of care for TB patients in all HFs were promising. But structural & process aspects of quality of care was compromised which necessitate different corrective actions to be taken by different stakeholders to enhance quality of care for TB patients in public HFs studied. Moreover based on the study findings, continuous supply of drugs, laboratory equipment and reagents, availing current guideline/s in HFs, providing up-to-date training for HWs on TB and proper documentation are important to improve quality of care provided for TB patients.


Assuntos
Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Tuberculose Pulmonar/terapia , Adulto , Etiópia , Feminino , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Qualidade da Assistência à Saúde/normas , Inquéritos e Questionários , Tuberculose Pulmonar/epidemiologia
18.
PLoS One ; 15(4): e0232178, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32353001

RESUMO

INTRODUCTION: Physician is a central figure in the client list of clinical laboratory. Monitoring physicians' satisfaction with laboratory service is an important indicator of the quality management system and required by international laboratory standards. However, there is no national data on physician satisfaction with laboratory services in Ethiopia. Therefore, the aim of this national survey was to assess satisfaction level of physicians with laboratory services at public hospitals in Ethiopia. METHODS: Institutional based cross-sectional study design was employed from November 1-30/2017. A total of 327 physicians were randomly selected from 60 public hospitals from all regions of Ethiopia. Data was collected using pre-tested self-administered questionnaire and analyzed with SPSS version 23 software. Logistic regression model was fitted to identify predictors of physician satisfaction with laboratory services. A p-value of less than 0.05 was taken as statistically significant. RESULTS: Overall, 55% of physicians were satisfied with the clinical laboratory services. More than half of the physicians were satisfied with the existing laboratory request form (69%), legibility and completeness of laboratory report (61%), notification of new test (78%) and test interruption (70%). On the other hand, many physicians were dissatisfied with the absence of laboratory hand book (87.5%), the existing test menu (68%), lab-physician interface (62%), availability of referral and/or back up service (62%), notification of Turn Around Time (TAT) (54%), timely notification of panic result (55%), long TAT (33.1%), provision of urgent service (67%), and timely advisory service (57%). Most of the physicians perceived that consistent quality of service was not delivered at all working shifts (71%). At 5% level of significance, we did not find enough evidence to conclude that sex, age, marital status, education level, and experience were statistically associated with physician satisfaction (p-values > 0.05). CONCLUSION: This national survey revealed nearly half of the physicians were unsatisfied with laboratory service at public hospitals in Ethiopia, which mainly related to lack of adequate test menu, laboratory hand book, on time notification of panic result, provision of urgent service, timely advisory service, delivery of quality services in all working shifts and weak lab-physician interface. Therefore, hospital management should address the gaps and improve the needs of physicians for better patient health care. In addition, laboratories should evaluate and monitor physician satisfaction level at regular interval.


Assuntos
Serviços de Laboratório Clínico/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Adulto , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Satisfação Pessoal , Médicos/estatística & dados numéricos , Encaminhamento e Consulta , Inquéritos e Questionários , Adulto Jovem
19.
Int J Equity Health ; 19(1): 57, 2020 04 29.
Artigo em Inglês | MEDLINE | ID: mdl-32349770

RESUMO

BACKGROUND: Multimorbidity in primary care is a challenge not only for developing countries but also for low and medium income countries (LMIC). Health services in LMIC countries are being provided by both public and private health care providers. However, a critical knowledge gap exists on understanding the true extent of multimorbidity in both types of primary care settings. METHODS: We undertook a study to identify multimorbidity prevalence and healthcare utilization among both public and private primary care attendees in Odisha state of India. A total of 1649 patients attending 40 primary care facilities were interviewed using a structured multimorbidity assessment questionnaire collecting information on 22 chronic diseases, medication use, number of hospitalization and number of outpatient visits. RESULT: The overall prevalence of multimorbidity was 28.3% and nearly one third of patients of public facilities and one fourth from private facilities had multimorbidity. Leading diseases among patients visiting public facilities included acid peptic diseases, arthritis and chronic back pain. No significant difference in reporting of hypertension and diabetes across the facilities was seen. Besides age, predictors of multimorbidity among patients attending public facilities were, females [AOR: 1.6; 95% CI 1.1-1.3] and non-aboriginal groups [AOR: 1.6; 95%CI 1.1-2.3] whereas, in private females [AOR: 1.6; 95%CI 1.1-2.4], better socioeconomic conditions [AOR 1.4; 95% CI 1.0-2.1] and higher educational status [primary school completed [AOR 2.6; 95%CI 1.6-4.2] and secondary schooling and above [AOR 2.0; 95%CI 1.1-3.6] with reference to no education were seen to be the determinants of multimorbidity. Increased number of hospital visits to public facilities were higher among lower educational status patients [IRR: 1.57; 95% CI 1.13-2.18] whereas, among private patients, the mean number of hospital visits was 1.70 times more in higher educational status [IRR: 1.70; 95%CI 1.01-3.69]. The mean number of medicines taken per day was higher among patients attending private hospitals. CONCLUSION: Our findings suggest that, multimorbidity is being more reported in public primary care facilities. The pattern and health care utilization in both types of settings are different. A comprehensive care approach must be designed for private care providers.


Assuntos
Doença Crônica/terapia , Hospitalização/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Multimorbidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
20.
Medicina (B Aires) ; 80(3): 203-210, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32442934

RESUMO

Social vulnerability has proved to be an independent risk factor for hypoglycemia in patients with diabetes. In some countries, patients who are in a vulnerable situation are assisted in the public health system which provides free medical care. This study compares the prevalence of hypoglycemia among patients with type 2 diabetes (T2D), in public versus private sector and its relationship with social vulnerability. This multicentric descriptive study included 600 patients with T2D from public and private care institutions of Argentina. Socioeconomic level (SEL) was evaluated through the Marketing Argentinean Association survey. Number of severe, documented symptomatic and asymptomatic hypoglycemias were registered. Among the patients included, 66% were assisted in the public sector. The 41% of patients (n = 246) registered at least 1 episode of any hypoglycemia event being more prevalent in the public sector compared to the private sector (50% vs. 22%). In the adjusted analysis it was observed a greater risk of hypoglycemia in public sector (OR 4, 95% CI 2.65-6.04) and in patients that did not have diabetological education (OR 2.28 95% CI 1.35-3.84). Similarly, unemployment (OR 5.04 95% CI 2.69-9.46), and marginal SEL (OR 60.79 95% CI 14.89-248.13) increased the risk of hypoglycemia. Several factors related to social vulnerability as unemployment, marginal SEL and poor sanitary education showed a significant increase in the hypoglycemia risk. Professionals working with people with diabetes must take into account these factors for a safe treatment of the disease.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hipoglicemia/epidemiologia , Idoso , Argentina/epidemiologia , Estudos Transversais , Complicações do Diabetes/epidemiologia , Diabetes Mellitus Tipo 2/fisiopatologia , Feminino , Humanos , Hipoglicemia/fisiopatologia , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Prevalência , Setor Privado , Setor Público , Fatores de Risco , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Populações Vulneráveis/estatística & dados numéricos
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