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1.
PLoS One ; 15(8): e0235411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822368

RESUMO

BACKGROUND: Delayed treatment initiation of Tuberculosis patients results in increased infectivity, poor treatment outcome, and increased mortality. However, there is a paucity of evidence on the delay in new adult pulmonary Tuberculosis patients to initiate treatment in Tigray, Northern Ethiopia. OBJECTIVE: To assess the factors associated with treatment initiation delay among new adult pulmonary tuberculosis patients in Tigray, Northern Ethiopia. METHODS: The study design was cross-sectional. A total of 875 new adult pulmonary tuberculosis patients were recruited from 21 health facilities from October 2018 to October 2019. Health facilities were selected by simple random sampling technique and tuberculosis cases from the health facilities were consecutively enrolled. Data were collected using structured questionnaire within the first 2 weeks of treatment initiation. Delay was categorized as patient, health system and total delays. Data were analyzed using SPSS version 21 and logistic regression was used to identify factors associated with the odds of delays to initiate treatment. A p-value of less than 0.05 was reported as statistically significant. RESULTS: The median patient, health system and total delays were 30, 18 and 62 days, respectively. Rural residence, being poor, visiting non-formal medication sources, being primary health care and the private clinic had higher odds of patient delay whereas being HIV positive had lower odds of patient delay. Illiteracy, first visit to primary health care and private clinic had higher odds of health system delay whereas a visit to health facility one time and have no patient delay had lower odds of health system delay. CONCLUSION: The median patient delay was higher than the median health system delay before initiating treatment. Hence, improved awareness of the community and involving the informal medication sources in the tuberculosis pathways would reduce patient delay. Similarly, improved cough screening and diagnostic efficiency of the lower health facilities would shorten health system delay.


Assuntos
Tempo para o Tratamento/estatística & dados numéricos , Tuberculose Pulmonar/tratamento farmacológico , Adolescente , Adulto , Antituberculosos/administração & dosagem , Antituberculosos/uso terapêutico , Comorbidade , Etiópia , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/estatística & dados numéricos , Tuberculose Pulmonar/epidemiologia
5.
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
6.
PLoS One ; 15(4): e0231631, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32299089

RESUMO

OBJECTIVE: The study aimed to assess and compare the prevalence of caesarean birth and associated factors among women gave birth at public and private health facilities in Bahir Dar city, Amhara region, Ethiopia. METHODS: An institution-based comparative cross-sectional study design was conducted from March1-April 15, 2019 at health facility provide emergency obstetrics service in Bahir Dar city. Study participants 724(362 for each public and private facility) were recruited using a systematic random sampling technique. Structured interview administered questionnaires and chart review checklist were used to collect data. The data were entered into Epi info version 7.2 and analyzed using SPSS version 23.0 software. A binary logistic regression model was fitted and an adjusted odds ration with 95% CI was used to determine the presence and strength of association between independent variables and cesarean birth. RESULTS: The response rate was 98.3% and 97.2% for public and private health facilities respectively. The prevalence of caesarean birth in private health facilities was 198 (56.3%) (95%CI: 50.9, 61.4) and in public health facilities was 98 (27.5%) (95%CI: 22.8, 32.2). Overall prevalence of caesarean birth was 296 (41.8%) (95%CI: 38.4, 45.5). Breech presentation (AOR = 3.64; 95%CI:1.49, 8.89), urban residence (AOR = 6.54; 95%CI:2.59, 16.48) and being referred (AOR = 2.44; 95%CI:1.46, 4.08) were variables significantly associated with caesarean birth among public facilities whereas age between 15-24 (AOR = 0.20, 95% CI; 0.07, 0.52), government employe (AOR = 2.28; 95%CI: 1.39,3.75), self-employed (AOR = 3.73; 95%CI:1.15,8.59), para one (AOR = 6.79; 95%CI:2.02, 22.79), para two (AOR = 3.88; 95% CI:1.15,13.08), and wealth index being highest level of wealth asset AOR = 5.39; 95%CI:1.08, 26.8) in private health facility associated with caesarean birth. CONCLUSIONS: We concluded that there is high prevalence of caesarean birth both in private and public facility. There is a statistically significant difference in the prevalence of caesarean birth in public and private health facilities.


Assuntos
Cesárea/estatística & dados numéricos , Adolescente , Adulto , Cidades , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde/estatística & dados numéricos , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Gravidez , Prevalência , Fatores Socioeconômicos , Adulto Jovem
7.
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
8.
Rev Paul Pediatr ; 38: e2018178, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31778412

RESUMO

OBJECTIVE: To describe the perception of physiotherapists in neonatal units regarding pain, the use of measurement scales and strategies that minimize pain. METHODS: Interviews were conducted with physiotherapists in hospitals with neonatal units between 2013 and 2015 in Rio de Janeiro. The questions concerned the knowledge of the feeling of pain, from its recognition to its care or treatment. The description of the results was done by comparing public and private hospitals (Fisher''s Exact exact Testtest), considering p<0.05 as significant. RESULTS: 27 hospitals were visited. All the professionals interviewed (n=27) stated that the newborns feel pain, with facial expression being the most cited and known sign for pain. 26% of physiotherapists believe that newborns experience pain at the same magnitude as adults. Among the scales, the Neonatal Infant Pain Scale (NIPS) was the most well known, but only 37% of the units had routine pain assessment protocols. IV cannulation and blood collection were the most mentioned procedures as a cause of pain and there was no difference between public and private hospitals. CONCLUSIONS: There is a gap in the knowledge about neonatal pain and how to evaluate it among the participating physiotherapists, with no systematization of care routines involving this assessment.


Assuntos
Medição da Dor/métodos , Dor/diagnóstico , Percepção/fisiologia , Fisioterapeutas/psicologia , Brasil/epidemiologia , Expressão Facial , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Recém-Nascido , Recém-Nascido Prematuro/psicologia , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Entrevistas como Assunto/métodos , Conhecimento , Dor/epidemiologia , Dor/etiologia
9.
Arch Dis Child Fetal Neonatal Ed ; 105(2): 209-214, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31201255

RESUMO

OBJECTIVE: There is a high incidence of preterm birth in low-income and middle-income countries where healthcare resources are often limited and may influence decision making. We aimed to explore the interplay between resource limitations and resuscitation practices for extremely preterm infants (EPIs) in neonatal intensive care units (NICUs) across the Philippines. METHODS: We conducted a national survey of NICUs in the Philippines. Institutions were classified according to sector (private/public), region and level. Respondents were asked about unit capacity, availability of ventilators and surfactant, resuscitation practices and estimated survival rates for EPIs of different gestational ages. RESULTS: Respondents from 103/228 hospitals completed the survey (response rate 45%). Public hospitals reported more commonly experiencing shortages of ventilators than private hospitals (85%vs23%, p<0.001). Surfactant was more likely to be available in city hospitals than regional/district hospitals (p<0.05) and in hospitals classified as Level III/IV than I/II (p<0.05). The financial capacity of parents was a major factor influencing treatment options. Survival rates for EPIs were estimated to be higher in private than public institutions. Resuscitation practice varied; active treatment was generally considered optional for EPIs from 25 weeks' gestation and usually provided after 27-28 weeks' gestation. CONCLUSION: Our survey revealed considerable disparities in NICU resource availability between different types of hospitals in the Philippines. Variation was observed between hospitals as to when resuscitation would be provided for EPIs. National guidelines may generate greater consistency of care yet would need to reflect the variable context for decisions in the Philippines.


Assuntos
Países em Desenvolvimento , Lactente Extremamente Prematuro , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Unidades de Terapia Intensiva Neonatal/normas , Ressuscitação/estatística & dados numéricos , Idade Gestacional , Alocação de Recursos para a Atenção à Saúde/normas , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Gastos em Saúde , Hospitais Privados/normas , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/normas , Hospitais Públicos/estatística & dados numéricos , Humanos , Recém-Nascido , Recém-Nascido de muito Baixo Peso , Filipinas , Padrões de Prática Médica , Surfactantes Pulmonares/administração & dosagem , Respiração Artificial/normas , Respiração Artificial/estatística & dados numéricos , Ressuscitação/normas , Fatores Socioeconômicos , Análise de Sobrevida
10.
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
11.
J Surg Res ; 245: 354-359, 2020 01.
Artigo em Inglês | MEDLINE | ID: mdl-31425875

RESUMO

BACKGROUND: Enhanced recovery pathways (ERPs) can decrease length of stay (LOS) and improve colorectal surgery outcomes in private health care; however, their efficacy in the public realm, comprised largely of underserved and uninsured patients, remains uncertain. MATERIALS AND METHODS: An ERP without social interventions was implemented at a private hospital (PH) and a safety-net hospital (SNH) within a large academic medical center in 2014. Process and outcome metrics from 100 patients in the 18 mo before ERP implementation at each institution were retrospectively compared with a similar group after ERP implementation. Primary outcomes were LOS, 30-d readmission, and reoperation. RESULTS: Post-ERP groups were older than pre-ERP (P = 0.047, 0.034), with no difference in sex or body mass index. Rate of open versus minimally invasive was similar at the SNH (P = 0.067), whereas more post-ERP patients at PH underwent open surgery (P = 0.002). Ninety six percentage of PH patients were funded through private insurance or Medicare, verses 6% at the SNH. LOS at PH decreased from 8.1 to 5.9 d (P = 0.028) and at SNH from 7.0 to 5.1 d (P = 0.004). There was no change in 30-d all-cause readmission (PH P = 0.634; SNH P = 1) or reoperation (PH P = 0.610; SNH P = 0.066). CONCLUSIONS: ERP reduced LOS in both private and safety-net settings without addressing social determinants of health. Readmission and reoperation rates were unchanged. As health care moves toward a bundled payment model, ERP can help optimize outcomes and control costs in the public arena.


Assuntos
Cirurgia Colorretal , Procedimentos Clínicos , Recuperação Pós-Cirúrgica Melhorada , Hospitais Privados/estatística & dados numéricos , Provedores de Redes de Segurança/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Avaliação de Processos e Resultados em Cuidados de Saúde , Estudos Retrospectivos
12.
Rev. Paul. Pediatr. (Ed. Port., Online) ; 38: e2018178, 2020. tab, graf
Artigo em Inglês | LILACS | ID: biblio-1057220

RESUMO

ABSTRACT Objective: To describe the perception of physiotherapists in neonatal units regarding pain, the use of measurement scales and strategies that minimize pain. Methods: Interviews were conducted with physiotherapists in hospitals with neonatal units between 2013 and 2015 in Rio de Janeiro. The questions concerned the knowledge of the feeling of pain, from its recognition to its care or treatment. The description of the results was done by comparing public and private hospitals (Fisher''s Exact exact Testtest), considering p<0.05 as significant. Results: 27 hospitals were visited. All the professionals interviewed (n=27) stated that the newborns feel pain, with facial expression being the most cited and known sign for pain. 26% of physiotherapists believe that newborns experience pain at the same magnitude as adults. Among the scales, the Neonatal Infant Pain Scale (NIPS) was the most well known, but only 37% of the units had routine pain assessment protocols. IV cannulation and blood collection were the most mentioned procedures as a cause of pain and there was no difference between public and private hospitals. Conclusions: There is a gap in the knowledge about neonatal pain and how to evaluate it among the participating physiotherapists, with no systematization of care routines involving this assessment.


RESUMO Objetivo: Descrever a percepção dos fisioterapeutas de unidades neonatais sobre a dor, a utilização de escalas de mensuração e estratégias que a minimizem. Métodos: Entrevistas foram realizadas com chefes ou rotinas de fisioterapia em hospitais com unidades neonatais entre 2013 e 2015, no Rio de Janeiro. As perguntas versaram sobre o conhecimento da sensação dolorosa, desde seu reconhecimento até seu cuidado ou tratamento. Foi realizada a descrição dos resultados, comparando-se os dados dos hospitais públicos com os privados (teste exato de Fisher), considerando-se p<0,05 como significante. Resultados: Vinte e sete hospitais foram visitados. Todos os profissionais entrevistados (n=27) afirmaram que os recém-nascidos sentem dor, sendo a expressão facial o sinal de dor mais conhecido. Do total de fisioterapeutas entrevistados, 26% acreditam que os neonatos sentem dor na mesma magnitude que o adulto. Entre as escalas, a Neonatal Infant Pain Scale (NIPS) era a mais conhecida, e apenas 37% das unidades possuíam protocolos de avaliação da dor na rotina. As coletas e as punções foram os procedimentos mais mencionados como causa de dor, e não houve diferença entre os hospitais públicos e privados. Conclusões: Constatou-se uma lacuna no conhecimento sobre dor neonatal e como avaliá-la entre os fisioterapeutas participantes, com ausência de sistematização de rotinas assistenciais que envolvam essa aferição.


Assuntos
Humanos , Recém-Nascido , Dor/diagnóstico , Percepção/fisiologia , Medição da Dor/métodos , Fisioterapeutas/psicologia , Dor/etiologia , Dor/epidemiologia , Brasil/epidemiologia , Recém-Nascido Prematuro/psicologia , Unidades de Terapia Intensiva Neonatal/organização & administração , Unidades de Terapia Intensiva Neonatal/estatística & dados numéricos , Entrevistas como Assunto/métodos , Hospitais Privados/estatística & dados numéricos , Conhecimento , Expressão Facial , Hospitais Públicos/estatística & dados numéricos
13.
Salud Publica Mex ; 62(1): 96-104, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31869566

RESUMO

OBJECTIVE: To briefly describe the process of establishment and preliminary results of the Mérida Population-based Cancer Registry (Mérida-PBCR). MATERIALS AND METHODS: Mérida-PBCR started in 2016 as a research project in the IMSS, with a gradual increase in its information sources. It covers a population of 908 536 inhabitants. Data collection is active and passive, international standards are used; CanReg5 software enables data entry, storage and analysis. RESULTS: Current data include 71.5% of sources. For the period 2015- 2016, a total of 2 623 new cancer cases were registered, the majority of these (60.1%) among females. 81.5% of the cases had morphological verification. Prostate (17.4%), colorectal (8.5%) and stomach (8.1%) cancers were the most common among males, and breast (31.6%), cervix (12%) and corpus uteri (7.6%) cancers, the most common among females. Ageadjusted cancer incidence rates (per 100 000) for all sites combined were 114.9 among males and 145.1 among females. CONCLUSIONS: The implementation of the Mérida-PBCR has followed particular parameters, with important efforts to include new information sources. Although the data are still preliminary and must be interpreted with great caution, the main cancers follow a similar pattern to that of the national and regional estimates.


Assuntos
Neoplasias/epidemiologia , Sistema de Registros/estatística & dados numéricos , Distribuição por Idade , Fatores Etários , Cidades/epidemiologia , Coleta de Dados/métodos , Coleta de Dados/normas , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Incidência , Masculino , México/epidemiologia , Distribuição por Sexo , Software
14.
BMC Health Serv Res ; 19(1): 1004, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31882004

RESUMO

BACKGROUND: Many LMICs have implemented Publicly Funded Health Insurance (PFHI) programmes to improve access and financial protection. The national PFHI scheme implemented in India for a decade has been recently modified and expanded to cover free hospital care for 500 million persons. Since increase in annual cover amount is one of the main design modifications in the new programme, the relevant policy question is whether such design change can improve financial protection for hospital care. An evaluation of state-specific PFHI programmes with vertical cover larger than RSBY can help answer this question. Three states in Southern India - Andhra Pradesh, Karnataka and Tamil Nadu have been pioneers in implementing PFHI with a large insurance cover. METHODS: The current study was meant to evaluate the PFHI in above three states in improving utilisation of hospital services and financial protection against expenses of hospitalization. Two cross-sections from National Sample Survey's health rounds, the 60th round done in 2004 and the 71st round done in 2014 were analysed. Instrumental Variable method was applied to address endogeneity or the selection problem in insurance. RESULTS: Enrollment under PFHI was not associated with increase in utilisation of hospital care in the three states. Private hospitals dominated the empanelment of facilities under PFHI as well as utilisation. Out of Pocket Expenditure and incidence of Catastrophic Health Expenditure did not decrease with enrollment under PFHI in the three states. The size of Out of Pocket Expenditure was significantly greater for utilisation in private sector, irrespective of insurance enrollment. CONCLUSION: PFHI in the three states used substantially larger vertical cover than national scheme in 2014. The three states are known for their good governance. Yet, the PFHI programmes in all three states failed in fulfilling their fundamental purpose. Increasing vertical cover of PFHI and using either 'Trusts' or Insurance-companies as purchasers may not give desired results in absence of adequate regulation. The study raises doubts regarding effectiveness of contracting under PFHIs to influence provider-behavior in the Indian context. Further research is required to find solutions for addressing gaps that contribute to poor financial outcomes for patients under PFHI.


Assuntos
Hospitalização/economia , Hospitalização/estatística & dados numéricos , Programas Nacionais de Saúde/economia , Doença Catastrófica/economia , Gastos em Saúde/estatística & dados numéricos , Hospitais Privados/economia , Hospitais Privados/estatística & dados numéricos , Humanos , Índia
15.
Einstein (Sao Paulo) ; 18: eAO4752, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31664323

RESUMO

OBJECTIVE: To evaluate the epidemiological profile of patients seen at a dementia outpatient clinic. METHODS: A retrospective study conducted by medical record review searching data on sex, race, age, schooling level, and diagnosis of patients seen from 2008 to 2015. RESULTS: A total of 760 patients were studied, with a predominance of female (61.3%; p<0.0001). The mean age was 71.2±14.43 years for women and 66.1±16.61 years for men. The most affected age group was 71 to 80 years, accounting for 29.4% of cases. In relation to race, 96.3% of patients were white. Dementia was diagnosed in 68.8% of patients, and Alzheimer's disease confirmed in 48.9%, vascular dementia in 11.3%, and mixed dementia in 7.8% of cases. The prevalence of dementia was 3% at 70 years and 25% at 85 years. Dementia appeared significantly earlier in males (mean age 68.5±15.63 years). As to sex distribution, it was more frequent in women (59.6%) than in men (40.4%; p<0.0001; OR=2.15). People with higher schooling level (more than 9 years) had a significantly younger age at onset of dementia as compared to those with lower schooling level (1 to 4 years; p=0.0007). CONCLUSION: Most patients seen in the period presented dementia, and Alzheimer was the most prevalent disease. Women were more affected, and men presented young onset of the disease. Individuals with higher schooling level were diagnosed earlier than those with lower level.


Assuntos
Disfunção Cognitiva/epidemiologia , Demência/epidemiologia , Pacientes Ambulatoriais/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/diagnóstico , Doença de Alzheimer/epidemiologia , Brasil/epidemiologia , Disfunção Cognitiva/diagnóstico , Demência/diagnóstico , Escolaridade , Feminino , Hospitais Privados/estatística & dados numéricos , Humanos , Masculino , Registros Médicos , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Distribuição por Sexo , Adulto Jovem
16.
PLoS One ; 14(8): e0220693, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31393926

RESUMO

BACKGROUND: Globally, Caesarean section (CS) rates are mounting and currently exceed the safe upper limit of 15%. Monitoring CS rates using clinical indications and obstetric sub-group analysis could confirm that women in need have been served. In Bangladesh, the reported CS rate was 31% in 2016, and almost twice that rate in urban settings. Delivering in the private healthcare sector was a strong determinant. This study uses Robson Ten Group Classification System (TGCS) to report CS rates in urban Bangladesh. The clinical causes and determining factors for CS births have also been examined. METHODS: This record linkage cross-sectional survey was undertaken in 34 urban for-profit private hospitals having CS facilities during the period June to August 2015. Data were supplied by inpatient case records and operation theatre registers. Descriptive analyses were performed to calculate the relative size of each group; the group-specific CS rate, and group contribution to total CS and overall CS rate. CS indications were grouped into eleven categories using ICD 10 codes. Binary logistic regression was performed to explore the determinants of CS. RESULTS: Out of 1307 births, delivery by CS occurred in 1077 (82%). Three obstetric groups contributed the most to overall CS rate: previous CS (24%), preterm (23%) and term elective groups (22%). The major clinical indications for CS were previous CS (35%), prolonged and obstructed labor (15%), fetal distress (11%) and amniotic fluid disorder (11%). Multiple gestation, non-cephalic presentation, previous bad obstetric history were positive predictors while oxytocin used for labour induction and increased parity were negative predictors of CS. CONCLUSIONS: As the first ever study in urban private for-profit health facilities in Bangladesh, this study usefully identifies the burden of CS and where to intervene. Engagement of multiple stakeholders including the private sector is crucial in planning effective strategies for safe reduction of CS.


Assuntos
Cesárea/estatística & dados numéricos , Hospitais Privados , Adulto , Líquido Amniótico , Bangladesh , Cesárea/tendências , Estudos Transversais , Parto Obstétrico/métodos , Feminino , Sofrimento Fetal , Hospitais Privados/estatística & dados numéricos , Hospitais Privados/tendências , Humanos , Trabalho de Parto Induzido , Gravidez , Complicações na Gravidez , População Urbana , Adulto Jovem
17.
Br J Surg ; 106(11): 1549-1557, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31386174

RESUMO

BACKGROUND: Many multivariable models to calculate mortality risk after surgery are limited by insufficient sample size at development or by application to cohorts distinct from derivation populations. The aims of this study were to validate the Surgical Outcome Risk Tool (SORT) for a New Zealand population and to develop an extended NZRISK model to calculate 1-month, 1-year and 2-year mortality after non-cardiac surgery. METHODS: Data from the New Zealand National Minimum Data Set for patients having surgery between January 2013 and December 2014 were used to validate SORT. A random 75 per cent split of the data was used to develop the NZRISK model, which was validated in the other 25 per cent of the data set. RESULTS: External validation of SORT in the 360 140 patients who underwent surgery in the study period showed good discrimination (area under the receiver operating characteristic curve (AUROC) value of 0·906) but poor calibration (McFadden's pseudo-R2 0·137, calibration slope 5·32), indicating it was invalid in this national surgical population. Internal validation of the NZRISK model, which incorporates sex and ethnicity in addition to the variables used in SORT for 1-month, 1-year and 2-year outcomes, demonstrated excellent discrimination with AUROC values of 0·921, 0·904 and 0·895 respectively, and excellent calibration (McFadden's pseudo-R2 0·275, 0·308 and 0·312 respectively). Calibration slopes were 1·12, 1·02 and 1·02 respectively. CONCLUSION: The SORT performed poorly in this national population. However, inclusion of sex and ethnicity in the NZRISK model improved performance. Calculation of mortality risk beyond 30 days after surgery adds to the utility of this tool for shared decision-making.


Assuntos
Procedimentos Cirúrgicos Operatórios/mortalidade , Adolescente , Adulto , Idoso , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Sistema de Registros , Medição de Risco/métodos , Fatores de Risco , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto Jovem
18.
Cancer Radiother ; 23(5): 395-400, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31331842

RESUMO

PURPOSE: Lung and some digestive tumours move during a respiratory cycle. Four-dimensional scanography (4D-CT) is commonly used in treatment planning to account for respiratory motion. Although many French radiotherapy centres are now equipped, there are no guidelines on this subject to date. We wanted to draw up a description of the use of the 4D-CT for the treatment planning in France. METHODS AND MATERIAL: We conducted a survey in all French radiotherapy centres between March and April 2017. RESULTS: One hundred and seventy-two were contacted. The participation rate was 88.37%. The use of the 4D-CT seems to be common and concerned planning for 15.28% of kidney and adrenal cancers, 19.72% of pancreatic cancers, 27.78% of oesophageal cancers and 73.24% of lung cancers in case of normofractionated treatments. The use of the 4D-CT was also widespread in the case of stereotactic body radiation therapy: with 61.11% in the case of pulmonary irradiation and 34.72% in the case of hepatic irradiation. Many centres declared they carried out several 4D-CT for treatment planning (29, 55% in case of stereotactic body radiation therapy for lung tumours and 20% for liver tumours). Private centres tend to repeat 4D-CT more. CONCLUSION: Although the use of the 4D-CT appears to be developing, it remains very heterogeneous. To date, the repetition of the 4D-CT has been very poorly studied and could be the subject of clinical studies, allowing to define in which indications and for which populations there is a real benefit.


Assuntos
Tomografia Computadorizada Quadridimensional , Planejamento da Radioterapia Assistida por Computador/métodos , Artefatos , Institutos de Câncer/estatística & dados numéricos , França , Pesquisas sobre Serviços de Saúde , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Humanos , Imageamento Tridimensional/estatística & dados numéricos , Movimento (Física) , Neoplasias/diagnóstico por imagem , Neoplasias/radioterapia , Utilização de Procedimentos e Técnicas , Serviço Hospitalar de Radiologia/estatística & dados numéricos , Radiocirurgia/métodos , Planejamento da Radioterapia Assistida por Computador/estatística & dados numéricos , Planejamento da Radioterapia Assistida por Computador/tendências , Respiração
19.
Arq Bras Cardiol ; 113(2): 260-269, 2019 07 18.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31340237

RESUMO

BACKGROUND: Having appropriate dietary habits is part of the recommendations after ST-Elevation Myocardial Infarction (STEMI), however, the quality of intra-hospital nutritional counselling in the different health services has been minimally explored. OBJECTIVE: To evaluate the quality of intra-hospital nutritional counselling among patients with STEMI in the public and private health systems in Sergipe. METHODS: A cross-sectional, with data from the Via Crucis for the Treatment of Myocardial Infarction (VICTIM) Register, conducted from April to November of 2017, with individuals aged ≥ 18 years diagnosed with STEMI, in one public health service hospital and three private hospitals. The occurrence and quality of nutritional counselling were analyzed based on current guidelines and the administration of questionnaires. A significance level of 0.05 was adopted. RESULTS: A total of 188 patients were analyzed; 80.3% were from the public health service facility. Among the interviewees, 57.6% of the public health service, and 70.3% of the private hospital patients received intra-hospital nutritional counselling (p = 0.191). The documentation of this practice, in medical records, was lower in the public service (2.6% vs. 37.8%, p < 0.001). A predominance of restrictive orientations was found in the public and private sectors, mainly regarding salt and fat, 52.3% and 70.3% respectively (p = 0.064). Patients from the private service were more counselling to introduce of cardioprotective foods, mainly fruit, vegetable/legume consumption (48.6% vs. 13.2%, p < 0.001). Among those who received counselling, nutritional knowledge was higher in the private sector (68.2% vs. 26.3%, p < 0.001). CONCLUSION: The intra-hospital nutritional counselling provided to patients with STEMI, in Sergipe, still presents poor quality in both services, especially in the public health system.


Assuntos
Aconselhamento/normas , Dieta Saudável/normas , Educação em Saúde/normas , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Infarto do Miocárdio com Supradesnível do Segmento ST/dietoterapia , Idoso , Brasil , Aconselhamento/métodos , Estudos Transversais , Dieta Saudável/métodos , Feminino , Educação em Saúde/métodos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais , Garantia da Qualidade dos Cuidados de Saúde , Fatores de Risco , Autorrelato , Fatores Socioeconômicos , Estatísticas não Paramétricas
20.
BMC Infect Dis ; 19(1): 654, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31331280

RESUMO

BACKGROUND: Retaining patients on antiretroviral treatment in care is critical to sustaining the 90:90:90 vision. Nigeria has made some progress in placing HIV-positive patients on treatment. In an effort to increase access to treatment, ART decentralization has been implemented in the country. This is aimed at strengthening lower level health facilities to provide comprehensive antiretroviral treatment. We determined the level of retention and adherence to treatment as well as the associated factors among private and public secondary level hospitals in Anambra State. METHOD: We conducted a cross-sectional study among patients who had taken antiretroviral treatment for at least one complete year. A structured questionnaire and patient record review were used to extract information on patient adherence to treatment, and retention in care. Adherence to treatment was ascertained by patient self-report of missed pills in the 30 days prior to date of interview. Retention in care was ascertained using the 3-month visit constancy method reviewing the period spanning 12 months prior to the study. RESULT: We found a comparable level of retention in care (private 81.1%; public 80.3%; p = 0.722). However, treatment adherence was significantly higher amongst participants in the private hospitals compared to those in the public hospitals (private: 95.3%; public: 90.7%; p = 0.001). Determinants of good retention in the private hospitals included disclosure of one's HIV status (AOR: 1.94, 95% CI: 1.09-3.46), being on first-line regimen (AOR: 3.07, 95% CI: 1.27-7.41), whereas being on once-daily regimen (AOR: 0.58, 95% CI: 0.36-0.92), and being currently married (AOR: 0.54 95% CI: 0.32-0.91) determined poor retention. In the public hospitals, only disclosure (AOR: 3.12 95% CI: 1.81-5.56) determined good retention, whereas, spending less than N1000 on transport (AOR: 0.230 95% CI: 0.07-0.78) and residing in a rural area (AOR: 0.64 95% CI: 0.41-0.99) determined poor retention. None of the factors determined adherence. CONCLUSION: Retention in care was high and comparable among the different hospital types and HIV disclosure status was an important factor relating to retention in care. The other factors that determined retention were however different at public and private hospitals. The HIV program manager should consider these variations in designing programs to improve patient retention in care and adherence to treatment.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Retenção nos Cuidados/estatística & dados numéricos , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Adulto , Estudos Transversais , Feminino , Hospitais Privados/estatística & dados numéricos , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Adesão à Medicação/estatística & dados numéricos , Nigéria , Cooperação do Paciente/estatística & dados numéricos , Inquéritos e Questionários
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