Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 1.484
Filtrar
1.
BMC Infect Dis ; 21(1): 237, 2021 Mar 05.
Artigo em Inglês | MEDLINE | ID: mdl-33663410

RESUMO

BACKGROUND: Healthcare workers are usually the first responders during outbreaks and are instrumental in educating the populace about the prevention of different diseases and illnesses. The aim of this study was to assess the association between healthcare workers' characteristics and knowledge, attitudes and practices toward Zika virus. METHODS: This was a cross-sectional study that collected data from healthcare workers at 3 medical facilities using a validated self-administered questionnaire between July 2017 - September 2017. Logistic regression models were used to examine the association between sociodemographic and knowledge, attitudes, and practices. RESULTS: A total of 190 healthcare workers were analyzed. Of these, 60, 72.6 and 64.7% had good knowledge, positive attitudes, and good practices toward Zika virus, respectively. Healthcare workers without a formal degree were less likely to have good knowledge of Zika virus (adjusted odds ratio (AOR) = 0:49; 95% confidence interval (CI) = 0.24-0.99) compared to those with a formal degree. Reduced odds for positive attitude towards Zika virus were observed in healthcare workers with low income as compared to those with high income (AOR = 0.31; 95% CI =0.13-0.75). Being younger than 40 years old was associated with poor Zika virus practices (AOR = 0:34; 95% CI = 0.15-0.79). CONCLUSIONS: Significant association between healthcare workers' sociodemographic characteristics and Zika virus knowledge, attitudes and practices were observed. Public health interventions that seek to increase Zika virus awareness should aim to train healthcare workers who are younger, without formal degree and those earning low income.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/estatística & dados numéricos , Zika virus , Adulto , Estudos Transversais , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Razão de Chances , São Cristóvão e Névis/epidemiologia , Fatores Socioeconômicos , Inquéritos e Questionários , Infecção por Zika virus/epidemiologia
2.
BMC Public Health ; 21(1): 447, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33673813

RESUMO

BACKGROUND: Amidst the COVID-19 pandemic, governments, health experts, and ethicists have proposed guidelines about ICU triage and priority access to a vaccine. To increase political legitimacy and accountability, public support is important. This study examines what criteria beyond medical need are deemed important to be perceived of priority COVID-19 healthcare access. METHOD: Two conjoint experiments about priority over ICU treatment and early COVID-19 vaccination were implemented in a probability-based sample of 1461 respondents representative of the Netherlands. Respondents were asked who should receive treatment out of two fictitious healthcare claimants that differed in in age, weight, complying with corona policy measures, and occupation, all randomly assigned. Average marginal coefficient effects are estimated to assess the relative importance of the attributes; attributes were interacted with relevant respondent characteristics to find whether consensus exists in this relative ranking. RESULTS: The Dutch penalize those not complying with coronavirus policy measures, and the obese, but prioritize those employed in 'crucial' sectors. For these conditions, there is consensus among the population. For age, young people are prioritized for ICU treatment, while the middle-aged are given priority over a vaccine, with younger respondents favoring healthcare for elderly claimants, while older respondents favor support for young cohorts. CONCLUSION: People who have no control over their social risk and are able to reciprocate to society are considered as more deserving of priority of COVID-19 healthcare. Our findings provide fair support for the implemented ethical guidelines about ICU-treatment and COVID-19 vaccines.


Assuntos
/prevenção & controle , Cuidados Críticos/normas , Assistência à Saúde/normas , Instalações de Saúde/normas , Acesso aos Serviços de Saúde/normas , Vacinação/normas , Adulto , Idoso , Idoso de 80 Anos ou mais , Consenso , Cuidados Críticos/estatística & dados numéricos , Assistência à Saúde/estatística & dados numéricos , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Pandemias , Guias de Prática Clínica como Assunto , Vacinação/estatística & dados numéricos
3.
PLoS One ; 16(3): e0249214, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33770120

RESUMO

The novel coronavirus (COVID-19) is an infectious disease caused by a newly discovered coronavirus. Despite strong efforts that have been taking place to control the pandemic globally, the virus is on the rise in many countries. Hence, this study assessed the maternal health care services utilization amidst the COVID-19 pandemic in West Shoa zone, Central Ethiopia. A community-based cross-sectional study was conducted among 844 pregnant women or those who gave birth in the last 6 months before the study. A multi-stage sampling technique was used to select the study participants. The data were collected through face-to-face interviews using a semi-structured questionnaire. Logistic regressions were performed to identify the presence of significant associations, and an adjusted odds ratio with 95%CI was employed for the strength and directions of association between the independent and outcome variables. A P-value of <0.05 was used to declare statistical significance. The prevalence of maternal health service utilization during the COVID-19 pandemic was 64.8%. The odds of maternal health service utilization was higher among mothers who had primary (AOR = 2.16, 95%CI: 1.29-3.60), secondary (AOR = 1.97, 95%CI: 1.13-3.44), and college and above education (AOR = 2.89, 95%CI: 1.34-6.22) than those who could not read and write. Besides, mothers who did travel 30-60 minutes (AOR = 0.37, 95%CI: 0.23-0.59) and 60-90minutes (AOR = 0.10, 95%CI: 0.05-0.19) to reach the health facility had a lower odds of maternal health service utilization than those who did travel <30 minutes. Moreover, mothers who earn 1000-2000 (AOR = 3.10, 95%CI: 1.73-5.55) and > 2000 birrs (AOR = 2.66 95%CI: 1.52-4.64) had higher odds of maternal health service utilization than those who earn <500 birrs. Similarly, the odds of utilizing maternal health service were higher among mothers who did not fear COVID-19 infection (AOR = 2.79, 95%CI: 1.85-4.20), who had not had to request permission from husband to visit the health facility (AOR = 7.24, 95%CI: 2.65-19.75), who had practicedCOVID-19 prevention measure (AOR = 5.82, 95%CI: 3.87-8.75), and used face mask (AOR = 2.06, 95% CI: 1.28-3.31) than their counterpart. Empowering mothers and creating awareness on COVID-19 preventionis recommended to improve maternal health service utilization during the COVID-19 pandemic.


Assuntos
/patologia , Instalações de Saúde/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Adolescente , Adulto , /virologia , Estudos Transversais , Escolaridade , Etiópia/epidemiologia , Feminino , Humanos , Modelos Logísticos , Máscaras , Razão de Chances , Pandemias , Gravidez , Classe Social , Adulto Jovem
4.
Cochrane Database Syst Rev ; 2: CD012006, 2021 02 24.
Artigo em Inglês | MEDLINE | ID: mdl-33625741

RESUMO

BACKGROUND: Pressure ulcers (PUs) are injuries to the skin and underlying tissues that occur most commonly over bony prominences, such as the hips and heels as a result of pressure and shear forces. PUs cause pain, discomfort, longer hospital stays, and decreased quality of life. They are also very costly to treat and consume substantial parts of healthcare budgets. PUs are largely preventable, and education targeted at patients and their carers is considered important. OBJECTIVES: To assess the effects of patient and/or lay carer education on preventing pressure ulceration in at-risk people, in any care setting. SEARCH METHODS: In June 2019 we searched the Cochrane Wounds Specialised Register; the Cochrane Central Register of Controlled Trials (CENTRAL); Ovid MEDLINE (including In-Process & Other Non-Indexed Citations); Ovid Embase; Ovid PsycINFO and EBSCO CINAHL Plus. We also searched clinical trials registries for ongoing and unpublished studies.  There were no restrictions with respect to language, date of publication or study setting. SELECTION CRITERIA: We included randomised controlled trials (RCTs) that recruited people of any age at risk of pressure ulceration, and RCTs that recruited people who informally care for someone at risk of pressure ulceration. DATA COLLECTION AND ANALYSIS: Two review authors independently performed study selection, data extraction, 'Risk of bias' assessment, and GRADE assessment of the certainty of the evidence. MAIN RESULTS: We included 10 studies with 11 publications (2261 participants analysed). Seven targeted their intervention at people at risk of ulceration and measured outcomes on these at risk people; two targeted those at risk and their family carers and measured outcomes on the at risk people cared for by their families; and one targeted lay carers only and measured outcomes on the at risk people they cared for. There were two main types of interventions: the provision of information on prevention of pressure ulcers, and the use of different types of education programmes. Provision of information on the prevention of pressure ulcers Three studies (237 participants) reported data for this comparison: two provided information directly to those at risk and their carers, and the third provided information to lay carers. As data could not be pooled we present individual study data. The evidence for primary outcomes is of very low certainty (downgraded twice for study limitations and twice for imprecision). We are uncertain whether the combined use of a self-instruction manual and one-to-one patient training and counselling versus a self-instruction manual alone reduces the proportion of at risk people developing a new PU (risk ratio (RR) 0.40, 95% confidence interval (CI) 0.14 to 1.18), or whether carer self-instruction and one-to-one counselling versus self-instruction alone reduces the proportion of at risk people developing a new PU (RR 2.05, 95% CI 0.19 to 21.70). We are uncertain whether the use of home-based training, compared with routine ward-based training, reduces the proportion of at risk people developing a new PU (RR 0.53, 95% CI 0.27 to 1.02). One study explored the secondary outcome patient knowledge of pressure ulcer prevention; however, as usable data were not provided, we were unable to carry out further analysis, and no effect estimate could be calculated. Educational programmes on the prevention of pressure ulcers Seven studies (2024 participants analysed) provided data for this comparison. In all studies the intervention was aimed at people at risk of ulceration. Risk of pressure ulceration One secondary report of an included study reported the primary outcome as time to PU development or occurrence and three studies and one secondary report of an included study reported this as the proportion of at risk people developing a new PU. One study reported the secondary outcome grade of PU and five studies and one secondary report of an included study reported on patient knowledge. There is low certainty evidence of there being no clear difference in the proportion of participants developing a new PU between use of a pressure ulcer prevention care bundle (PUPCB) and standard care: HR 0.58, 95% CI 0.25 to 1.33 (downgraded twice for imprecision). One secondary report of an included study explored whether individualised PU education and monthly structured telephone follow-up reduces the mean time to PU occurrence. Not all participants in this study developed a pressure ulcer, therefore the mean time to pressure ulcer occurrence could not be calculated from the data. We are uncertain whether the following three interventions reduce the proportion of at risk people developing a new PU as we assessed the certainty of evidence as very low: individualised PU education and monthly structured telephone follow-up (RR 0.55, 95% CI 0.23 to 1.30), education delivery (RR 3.57, 95% CI 0.78 to 16.38), (downgraded twice for risk of bias and twice for imprecision); and computerised feedback and one-to-one consultations (no clear data provided), (downgraded twice for risk of bias and once for indirectness). Grade of pressure ulcer There is low certainty evidence that use of a PU prevention care bundle may make no difference to the severity of new PU development when compared with standard care. Patient knowledge We are uncertain whether the following interventions improve patient knowledge: enhanced educational intervention and structured follow-up (mean difference (MD) 9.86, 95% CI 1.55 to 18.17); multi component motivational interviewing/self-management with a multi component education intervention (no clear data provided); Spinal Cord Injury Navigator programme (no clear data provided); individualised PU education and monthly structured telephone follow-up (no clear data provided); computerised feedback (no clear data provided), structured, patient-centric PU prevention education event (MD 30.15, 95% CI 23.56 to 36.74). We assessed the certainty of the evidence for this outcome as low or very low (downgraded for risk of bias, imprecision, or indirectness). AUTHORS' CONCLUSIONS: We are uncertain whether educational interventions make any difference to the number of new PUs that develop, or to patient knowledge based on evidence from the 10 included studies, which we assessed as of low or very low certainty due to problems with risk of bias, serious imprecision and indirectness. The low certainty of evidence means that additional research is required to confirm these results.


Assuntos
Cuidadores/educação , Educação de Pacientes como Assunto/métodos , Lesão por Pressão/prevenção & controle , Intervalos de Confiança , Instalações de Saúde/estatística & dados numéricos , Humanos , Lesão por Pressão/epidemiologia , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Risco , Higiene da Pele , Traumatismos da Medula Espinal/complicações , Cicatrização
5.
MMWR Morb Mortal Wkly Rep ; 70(7): 240-244, 2021 Feb 19.
Artigo em Inglês | MEDLINE | ID: mdl-33600385

RESUMO

Telehealth can facilitate access to care, reduce risk for transmission of SARS-CoV-2 (the virus that causes coronavirus disease 2019 [COVID-19]), conserve scarce medical supplies, and reduce strain on health care capacity and facilities while supporting continuity of care. Health Resources and Services Administration (HRSA)-funded health centers* expanded telehealth† services during the COVID-19 pandemic (1). The Centers for Medicare & Medicaid Services eliminated geographic restrictions and enhanced reimbursement so that telehealth services-enabled health centers could expand telehealth services and continue providing care during the pandemic (2,3). CDC and HRSA analyzed data from 245 health centers that completed a voluntary weekly HRSA Health Center COVID-19 Survey§ for 20 consecutive weeks to describe trends in telehealth use. During the weeks ending June 26-November 6, 2020, the overall percentage of weekly health care visits conducted via telehealth (telehealth visits) decreased by 25%, from 35.8% during the week ending June 26 to 26.9% for the week ending November 6, averaging 30.2% over the study period. Weekly telehealth visits declined when COVID-19 cases were decreasing and plateaued as cases were increasing. Health centers in the South and in rural areas consistently reported the lowest average percentage of weekly telehealth visits over the 20 weeks, compared with health centers in other regions and urban areas. As the COVID-19 pandemic continues, maintaining and expanding telehealth services will be critical to ensuring access to care while limiting exposure to SARS-CoV-2.


Assuntos
/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Pandemias , Telemedicina/estatística & dados numéricos , Telemedicina/tendências , Pesquisas sobre Serviços de Saúde , Humanos , Estados Unidos/epidemiologia
6.
MMWR Morb Mortal Wkly Rep ; 70(4): 114-117, 2021 Jan 29.
Artigo em Inglês | MEDLINE | ID: mdl-33507887

RESUMO

During September 3-November 16, 2020, daily confirmed cases of coronavirus disease 2019 (COVID-19) reported to the Wisconsin Department of Health Services (WDHS) increased at a rate of 24% per week, from a 7-day average of 674 (August 28-September 3) to 6,426 (November 10-16) (1). The growth rate during this interval was the highest to date in Wisconsin and among the highest in the United States during that time (1). To characterize potential sources of this increase, the investigation examined reported outbreaks in Wisconsin that occurred during March 4-November 16, 2020, with respect to their setting and number of associated COVID-19 cases.


Assuntos
/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Vigilância em Saúde Pública , Instalações de Saúde/estatística & dados numéricos , Humanos , Incidência , Laboratórios , Assistência de Longa Duração , Prisões/estatística & dados numéricos , Universidades/estatística & dados numéricos , Wisconsin/epidemiologia
7.
Pan Afr Med J ; 37(Suppl 1): 18, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343797

RESUMO

Introduction: the increased demands of health facilities and workers due to coronavirus overwhelm the already burdened Tanzanian health systems. This study evaluates the current capacity of facilities and providers for HIV care and treatment services and their preparedness to adhere to the national and global precaution guidelines for HIV service providers and patients. Methods: data for this study come from the latest available, Tanzania Service Provision Assessment survey 2014-15. Frequencies and percentages described the readiness and availability of HIV services and providers. Chi-square test compared the distribution of services by facility location and availability and readiness of precaution commodities and HIV services by managing authorities. Results: availability of latex gloves was high (83% at OPD and 95.3% laboratory). Availability of medical masks, alcohol-based hand rub and disinfectants was low. Availability of medical mask at outpatient department (OPD) was 28.7% urban (23.5% public; 33.8% private, p=0.02) and 13.5% rural (10.1% public; 25.4% private, p=0.001) and lower at laboratories. Fewer facilities in rural area (68.4%) had running water in OPD than urban (86.3%). Higher proportions of providers at public than private facilities in urban (82.8% versus 73.1%) and rural (88.2% versus 81.6%) areas provided HIV test counseling and at least two other HIV services. Conclusion: availability of commodities such as medical masks, alcohol-based hand rub, and disinfectant was low while the readiness of providers to multitask HIV related services was high. Urgent distribution and re-assessment of these supplies are necessary, to protect HIV patients, their caregivers, and health providers from COVID-19.


Assuntos
/prevenção & controle , Assistência à Saúde/estatística & dados numéricos , Infecções por HIV/terapia , Instalações de Saúde/estatística & dados numéricos , Assistência à Saúde/normas , Desinfetantes/provisão & distribução , Fidelidade a Diretrizes/estatística & dados numéricos , Higienizadores de Mão/provisão & distribução , Pesquisas sobre Serviços de Saúde , Instalações de Saúde/normas , Humanos , Máscaras/provisão & distribução , Instalações Privadas/normas , Instalações Privadas/estatística & dados numéricos , Logradouros Públicos/normas , Logradouros Públicos/estatística & dados numéricos , Serviços de Saúde Rural/normas , Serviços de Saúde Rural/estatística & dados numéricos , Tanzânia , Serviços Urbanos de Saúde/normas , Serviços Urbanos de Saúde/estatística & dados numéricos
8.
J Environ Public Health ; 2020: 8973739, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33343669

RESUMO

Background: Local villages in the Vhembe district of South Africa have experienced high malaria infection rates and a high variability of malaria case mortality rates over the past 20 years. This research project sets out to determine if specific socioeconomic factors have influence on the varying malaria case mortality rates. Methods: The study used existing malaria records of all reported malaria cases in the Vhembe district between 1998 and 2017. The data set was sampled using maximum variation sampling combined with a stratified sampling approach to select the source locations with the highest reported variations in malaria case mortality. The number of medical facilities used, distances to the medical facilities, and proximity to significant water sources were subsequently spatially and statistically analysed for potential correlations between these factors and the malaria case fatality rates of the source locations. Results: Within the period of study, a total of 57,974 malaria infections were reported from 850 source locations across the villages and neighbourhoods. The result of the sampling methods gave 30 source locations with highest reported variations in malaria case mortality. The statistical analysis indicated a significant negative correlation between the case mortality rates and the number of medical facilities used, the number of infections reported, and the maximum and mean distances travelled to the medical facilities used. In addition, the analysis indicated a positive correlation between the minimum distances travelled to the medical facilities used and the case mortality rates. The spatial analysis supported the majority of the findings from the statistical analysis. Proximity to significant water bodies was not found to have any significant impact on case mortality rates. Conclusion: The results suggested that malaria patients from larger communities, those who had financial or other means to consult more advanced facilities, or those with a larger variety of services had a significantly lower risk of mortality. The findings of this study could assist societies and authorities in mitigating the negative effects of malaria infections on human life expectancies through improved socioeconomic development.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Malária/mortalidade , Adulto , Feminino , Humanos , Fatores Socioeconômicos , África do Sul/epidemiologia , Análise Espacial , Adulto Jovem
9.
PLoS One ; 15(12): e0244310, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33378372

RESUMO

Although strong evidence exists about the effectiveness of basic childbirth services in reducing maternal and newborn mortality, these services are not provided in every childbirth, even those at health facilities. The WHO Safe Childbirth Checklist (SCC) was developed as a job aide to remind health workers of evidenced-based practices to be provided at specific points in the childbirth process. The Zambian government requested context-specific evidence on the feasibility and outcomes associated with introducing the checklist and related mentorship. A study was conducted on use of the SCC in four facilities in Nchelenge District of Zambia. Observations of childbirth services were conducted just before and six months after the introduction of the intervention. Observers used a structured tool to record adherence to essential services indicated on the checklist. The primary outcome of interest was the change in the average proportion of essential childbirth practices completed. Feedback questionnaires were administered to health workers before and six months after the intervention. At baseline and endline, 108 and 148 pause points were observed, respectively. There was an increase from 57% to 76% of tasks performed (p = 0.04). Considering only these cases where necessary supplies were available, health workers completed 60% of associated tasks at baseline compared to 84% at endline (p<0.01). Some tasks, such as taking an infant's temperature and hand washing, were never or rarely performed at baseline. Feedback from the health workers indicated that nearly all health workers agreed or strongly agreed with positive statements about the intervention. The performance of health workers in Zambia in completing essential practices in childbirth was low at baseline but improvements were observed with the introduction of the SCC and mentorship. Our results suggest that such interventions could improve quality of care for facility-based childbirth. However, national-level commitment to ensuring availability of trained staff and supplies is essential for success. Trial registration Clinical Trials.gov (NCT03263182) Registered August 28, 2017 This study adheres to CONSORT guidelines.


Assuntos
Lista de Checagem/métodos , Fidelidade a Diretrizes/estatística & dados numéricos , Educação Pré-Natal/métodos , Adulto , Lista de Checagem/estatística & dados numéricos , Parto Obstétrico/normas , Parto Obstétrico/estatística & dados numéricos , Parto Obstétrico/tendências , Feminino , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde , Humanos , Masculino , Serviços de Saúde Materna/normas , Serviços de Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/tendências , Pessoa de Meia-Idade , Parto/psicologia , Gravidez , Melhoria de Qualidade , Inquéritos e Questionários , Organização Mundial da Saúde , Zâmbia/epidemiologia
10.
MMWR Morb Mortal Wkly Rep ; 69(50): 1902-1905, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332297

RESUMO

Early in the coronavirus disease 2019 (COVID-19) pandemic, in-person ambulatory health care visits declined by 60% across the United States, while telehealth* visits increased, accounting for up to 30% of total care provided in some locations (1,2). In March 2020, the Centers for Medicare & Medicaid Services (CMS) released updated regulations and guidance changing telehealth provisions during the COVID-19 Public Health Emergency, including the elimination of geographic barriers and enhanced reimbursement for telehealth services† (3-6). The Health Resources and Services Administration (HRSA) administers a voluntary weekly Health Center COVID-19 Survey§ to track health centers' COVID-19 testing capacity and the impact of COVID-19 on operations, patients, and staff. CDC and HRSA analyzed data from the weekly COVID-19 survey completed by 1,009 HRSA-funded health centers (health centers¶) for the week of July 11-17, 2020, to describe telehealth service use in the United States by U.S. Census region,** urbanicity,†† staffing capacity, change in visit volume, and personal protective equipment (PPE) supply. Among the 1,009 health center respondents, 963 (95.4%) reported providing telehealth services. Health centers in urban areas were more likely to provide >30% of health care visits virtually (i.e., via telehealth) than were health centers in rural areas. Telehealth is a promising approach to promoting access to care and can facilitate public health mitigation strategies and help prevent transmission of SARS-CoV-2 and other respiratory illnesses, while supporting continuity of care. Although CMS's change of its telehealth provisions enabled health centers to expand telehealth by aligning guidance and leveraging federal resources, sustaining expanded use of telehealth services might require additional policies and resources.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde , Acesso aos Serviços de Saúde , Humanos , Telemedicina/organização & administração , Estados Unidos/epidemiologia
11.
MMWR Morb Mortal Wkly Rep ; 69(50): 1895-1901, 2020 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-33332299

RESUMO

Long-standing social inequities and health disparities have resulted in increased risk for coronavirus disease 2019 (COVID-19) infection, severe illness, and death among racial and ethnic minority populations. The Health Resources and Services Administration (HRSA) Health Center Program supports nearly 1,400 health centers that provide comprehensive primary health care* to approximately 30 million patients in 13,000 service sites across the United States.† In 2019, 63% of HRSA health center patients who reported race and ethnicity identified as members of racial ethnic minority populations (1). Historically underserved communities and populations served by health centers have a need for access to important information and resources for preventing exposure to SARS-CoV-2, the virus that causes COVID-19, to testing for those at risk, and to follow-up services for those with positive test results.§ During the COVID-19 public health emergency, health centers¶ have provided and continue to provide testing and follow-up care to medically underserved populations**; these centers are capable of reaching areas disproportionately affected by the pandemic.†† HRSA administers a weekly, voluntary Health Center COVID-19 Survey§§ to track health center COVID-19 testing capacity and the impact of COVID-19 on operations, patients, and personnel. Potential respondents can include up to 1,382 HRSA-funded health centers.¶¶ To assess health centers' capacity to reach racial and ethnic minority groups at increased risk for COVID-19 and to provide access to testing, CDC and HRSA analyzed survey data for the weeks June 5-October 2, 2020*** to describe all patients tested (3,194,838) and those who received positive SARS-CoV-2 test results (308,780) by race/ethnicity and state of residence. Among persons with known race/ethnicity who received testing (2,506,935), 36% were Hispanic/Latino (Hispanic), 38% were non-Hispanic White (White), and 20% were non-Hispanic Black (Black); among those with known race/ethnicity with positive test results, 56% were Hispanic, 24% were White, and 15% were Black. Improving health centers' ability to reach groups at increased risk for COVID-19 might reduce transmission by identifying cases and supporting contact tracing and isolation. Efforts to improve coordination of COVID-19 response-related activities between state and local public health departments and HRSA-funded health centers can increase access to testing and follow-up care for populations at increased risk for COVID-19.


Assuntos
/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Grupos Minoritários/estatística & dados numéricos , /diagnóstico , Pesquisas sobre Serviços de Saúde , Disparidades nos Níveis de Saúde , Humanos , Medição de Risco , Fatores Socioeconômicos , Estados Unidos/epidemiologia
12.
PLoS One ; 15(12): e0244875, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33382825

RESUMO

INTRODUCTION: Maternal mortality is an issue of global public health concern with over 300,000 women dying globally each year. In sub-Saharan Africa (SSA), these deaths mainly occur around childbirth and the first 24hours after delivery. The place of delivery is, therefore, important in reducing maternal deaths and accelerating progress towards attaining the 2030 sustainable development goals (SDGs) related to maternal health. In this study, we examined the prevalence and determinants of the place of delivery among reproductive age women in SSA. MATERIALS AND METHODS: This was a cross-sectional study among women in their reproductive age using data from the most recent demographic and health surveys of 28 SSA countries. Frequency, percentage, chi-square, and logistic regression were used in analysing the data. All analyses were done using STATA. RESULTS: The overall prevalence of health facility delivery was 66%. This ranged from 23% in Chad to 94% in Gabon. More than half of the countries recorded a less than 70% prevalence of health facility delivery. The adjusted odds of health facility delivery were lowest in Chad. The probability of giving birth at a health facility also declined with increasing age but increased with the level of education and wealth status. Women from rural areas had a lower likelihood (AOR = 0.59, 95%CI = 0.57-0.61) of delivering at a health facility compared with urban women. CONCLUSIONS: Our findings point to the inability of many SSA countries to meet the SDG targets concerning reductions in maternal mortality and improving the health of reproductive age women. The findings thus justify the need for peer learning among SSA countries for the adaption and integration into local contexts, of interventions that have proven to be successful in improving health facility delivery among reproductive age women.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Parto , Adolescente , Adulto , África ao Sul do Saara , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Mortalidade Materna , Pessoa de Meia-Idade , Gravidez , Adulto Jovem
13.
Malar J ; 19(1): 410, 2020 Nov 16.
Artigo em Inglês | MEDLINE | ID: mdl-33198754

RESUMO

BACKGROUND: In the past decade substantial reduction in malaria morbidity and mortality has been observed through well-implemented case management and vector control strategies. India has also achieved a significant reduction in malaria burden in 2018 and has committed to eliminate malaria by 2030. The Mandla Malaria Elimination Demonstration Project (MEDP) was started in 2017 in 1233 villages of District Mandla to demonstrate malaria elimination in a tribal district with hard-to-reach areas was possible using active and passive surveillance, case management, vector control, and targeted information, education and communication campaigns. An operational plan was developed to strengthen the existing surveillance and malaria elimination systems, through fortnightly active case detection to ensure that all cases including those that are introduced into the communities are rapidly identified and treated promptly. The plan also focused on the reduction of human-mosquito contact through the use of Long-Lasting Insecticial Nets (LLINs) and Indoor Residual Spray (IRS). The operational plan was modified in view of the present COVID-19 pandemic by creating systems of assistance for the local administration for COVID-related work while ensuring the operational integrity of malaria elimination efforts. RESULTS: The use of MEDP study design and operational plan, with its built-in management control systems, has yielded significant (91%) reduction of indigenous cases of malaria during the period from June 2017 to May 2020. The malaria positivity rate was 0.33% in 2017-18, 0.13% in 2018-19, and 0.06% in 2019-20. Mass screening revealed 0.18% malaria positivity in September-October 2018, followed by 0.06% in June 2019, and 0.03% in December 2019, and these were mostly asymptomatic cases in the community. The project has been able to sustain the gains of the past three years during the ongoing COVID-19 pandemic. CONCLUSION: This paper provides the study design and the operational plan for malaria elimination in a high-burden district of Central India, which presented difficulties of hard to reach areas, forest malaria, and complex epidemiology of urban and rural malaria. The lessons learned could be used for malaria elimination efforts in rest of the country and other parts of South Asia with comparable demography and epidemiology.


Assuntos
Infecções por Coronavirus/prevenção & controle , Assistência à Saúde/métodos , Doenças Endêmicas/prevenção & controle , Malária/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Vigilância da População/métodos , Altitude , Animais , Infecções por Coronavirus/epidemiologia , Assistência à Saúde/organização & administração , Doenças Endêmicas/estatística & dados numéricos , Florestas , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Humanos , Índia/epidemiologia , Mosquiteiros Tratados com Inseticida , Malária/epidemiologia , Controle de Mosquitos , Pneumonia Viral/epidemiologia , Prevalência , Chuva , População Rural , População Urbana
14.
PLoS One ; 15(10): e0239767, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044968

RESUMO

INTRODUCTION: HIV status disclosure in children is one of acontroversial issue in current health. Over 44,000 children in Ethiopia were living with HIV in the year 2019 with a variable level of disclosure, which ranges from 16.3% to 49%. Therefore, this study aimed to assess HIV-positive status disclosure and associated factors among HIV-infected children. METHODS: A cross-sectional study was conducted in ten public health facilities providing pediatric antiretroviral therapy services. Systematic random sampling was used to select 221 caregivers of children aged 6-15 years. Face-to-face interviews were employed to generate the data. Binary logistic regression was used to analyze the association between HIV-positive status disclosure to children and independent variables with statistical significance set at p-value <0.05. RESULTS: Out of the total, 134 (60.6%) of HIV-infected children knew about their HIV status. The mean age at disclosure was 10.71 years. Children aged older than 10 years [AOR = 22, 95% CI: 5.3-79.2], female children [AOR = 3; 95% CI = 1.2-8.7], children lost their family member by HIV [AOR = 3.5, 95% CI: 1.2-10], caregiver's perception of child did not get stigmatized [AOR = 4, 95% CI: 1.6-11], and children's responsible for anti-retroviral therapy [AOR = 16, 95% CI: 5-50] were significantly associated with HIV positive status disclosure compared to their counterpart respectively. Children who stayed on anti-retroviral for 10-15 years were [AOR = 7; 95% CI: 2-27] more likely to know their HIV positive status compared to those staying on anti-retroviral therapy for <6 years. CONCLUSION: The proportion of disclosure of HIV-positive status among HIV-infected children was low. Factors associated were the age of the child, sex, existence of parent, stigma, ART duration, and responsibility of the child for his/her drugs. HIV care providers should consider these factors while supporting disclosure.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Revelação/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Cuidadores/estatística & dados numéricos , Criança , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pais , Estigma Social , Adulto Jovem
15.
Sci Rep ; 10(1): 18422, 2020 10 28.
Artigo em Inglês | MEDLINE | ID: mdl-33116179

RESUMO

We use an individual based model and national level epidemic simulations to estimate the medical costs of keeping the US economy open during COVID-19 pandemic under different counterfactual scenarios. We model an unmitigated scenario and 12 mitigation scenarios which differ in compliance behavior to social distancing strategies and in the duration of the stay-home order. Under each scenario we estimate the number of people who are likely to get infected and require medical attention, hospitalization, and ventilators. Given the per capita medical cost for each of these health states, we compute the total medical costs for each scenario and show the tradeoffs between deaths, costs, infections, compliance and the duration of stay-home order. We also consider the hospital bed capacity of each Hospital Referral Region (HRR) in the US to estimate the deficit in beds each HRR will likely encounter given the demand for hospital beds. We consider a case where HRRs share hospital beds among the neighboring HRRs during a surge in demand beyond the available beds and the impact it has in controlling additional deaths.


Assuntos
Infecções por Coronavirus/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Pandemias/economia , Pneumonia Viral/economia , Fortalecimento Institucional/economia , Fortalecimento Institucional/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Instalações de Saúde/economia , Instalações de Saúde/estatística & dados numéricos , Humanos , Controle de Infecções/economia , Controle de Infecções/estatística & dados numéricos , Modelos Estatísticos , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estados Unidos
16.
PLoS One ; 15(10): e0241030, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33108381

RESUMO

BACKGROUND/OBJECTIVES: To analyze mortality, costs, residents and personnel characteristics, in six long-term care facilities (LTCF) during the outbreak of COVID-19 in Spain. DESIGN: Epidemiological study. SETTING: Six open LTCFs in Albacete (Spain). PARTICIPANTS: 198 residents and 190 workers from LTCF A were included, between 2020 March 6 and April 5. Epidemiological data were also collected from six LTCFs of Albacete for the same period of time, including 1,084 residents. MEASUREMENTS: Baseline demographic, clinical, functional, cognitive and nutritional variables were collected. 1-month and 3-month mortality was determined, excess mortality was calculated, and costs associated with the pandemics were analyzed. RESULTS: The pooled mortality rate for the first month and first three months of the outbreak were 15.3% and 28.0%, and the pooled excess mortality for these periods were 564% and 315% respectively. In facility A, the percentage of probable COVID-19 infected residents were 33.6%. Probable infected patients were older, frail, and with a worse functional situation than those without COVID-19. The most common symptoms were fever, cough and dyspnea. 25 residents were transferred to the emergency department, 21 were hospitalized, and 54 were moved to the facility medical unit. Mortality was higher upon male older residents, with worse functionality, and higher comorbidity. During the first month of the outbreak, 65 (24.6%) workers leaved, mainly with COVID-19 symptoms, and 69 new workers were contracted. The mean number of days of leave was 19.2. Costs associated with the COVID-19 in facility A were estimated at € 276,281/month, mostly caused by resident hospitalizations, leaves of workers, staff replacement, and interventions of healthcare professionals. CONCLUSION: The COVID-19 pandemic posed residents at high mortality risk, mainly in those older, frail and with worse functional status. Personal and economic costs were high.


Assuntos
Betacoronavirus , Infecções por Coronavirus/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Assistência de Longa Duração , Pandemias , Pneumonia Viral/epidemiologia , Absenteísmo , Idoso , Idoso de 80 Anos ou mais , Comorbidade , Infecções por Coronavirus/economia , Efeitos Psicossociais da Doença , Infecção Hospitalar/economia , Infecção Hospitalar/epidemiologia , Idoso Fragilizado , Instalações de Saúde/economia , Pessoal de Saúde/estatística & dados numéricos , Mortalidade Hospitalar , Hospitalização/economia , Humanos , Assistência de Longa Duração/economia , Masculino , Mortalidade , Doenças Profissionais/epidemiologia , Pandemias/economia , Pneumonia Viral/economia , Espanha/epidemiologia
17.
PLoS One ; 15(10): e0239744, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33057417

RESUMO

BACKGROUND: Globally, health care-associated infections had become serious public health importance. Compliance with standard safety precaution is effective and inexpensive measure to improve quality of healthcare in reducing occurrence of healthcare associated infections. In developing countries, like Ethiopia adherence to recommended standard safety precaution is scanty. OBJECTIVE: To assess level of compliance with standard safety precaution and associated factors among healthcare workers in Hawassa comprehensive specialized hospital Southern Ethiopia. METHODS: An institutional based cross-sectional study was conducted at Hawassa comprehensive specialized hospital. Data were collected by using self-administered questionnaire. Study participants were allocated proportionally based on their profession by using stratified random sampling method. Data were entered and analyzed by using SPSS version 20.0. Bi-variable analysis and multi variable logistic regression model were used to check which variables were associated with dependent variable. P-values ≤ 0.05 were considered statistically significant. In this study the overall compliance with standard safety precaution among healthcare workers were only 56.5%. Being female healthcare worker AOR: 2.76(1.34, 5.54), married healthcare workers AOR: 4.2(2, 9.03), accessibility of safety box AOR: 3.4(1.6, 7.17), HCWs had perceived IP training AOR: 3.99(1.46, 10.9), availability of tape water AOR: 2.68(1.15, 6.2) and healthcare workers had internal infection prevention and control supportive supervision AOR: 5.8(2.54, 13.48) associated with compliance with standard safety precaution. CONCLUSION: According to findings of the current study, overall level of compliance with standard SP among HCWs considered to be very low. Factors such as healthcare workers being female, accessibility of safety box, availability of running tape water, training and supportive supervision were independent predictors of compliance with standard safety precaution. Thus ensuring availability and accessibility of safety precaution materials and regular observing and supervising healthcare workers' practices are highly recommended.


Assuntos
Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Hospitais Especializados/estatística & dados numéricos , Hospitais Universitários/estatística & dados numéricos , Gestão da Segurança/estatística & dados numéricos , Universidades/estatística & dados numéricos , Adulto , Infecção Hospitalar/prevenção & controle , Estudos Transversais , Etiópia , Feminino , Humanos , Controle de Infecções/estatística & dados numéricos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Adulto Jovem
18.
Environ Health Prev Med ; 25(1): 52, 2020 Sep 10.
Artigo em Inglês | MEDLINE | ID: mdl-32912144

RESUMO

OBJECTIVE: This study estimated the effects of weekend and off-hour childbirth and the size of perinatal medical care center on the incidence of cerebral palsy. METHODS: The cases were all children with severe cerebral palsy born in Japan from 2009 to 2012 whose data were stored at the Japan Obstetric Compensation System for Cerebral Palsy database, a nationally representative database. The inclusion criteria were the following: neonates born between January 2009 and December 2012 who had a birth weight of at least 2000 g and gestational age of at least 33 weeks and who had severe disability resulting from cerebral palsy independent of congenital causes or factors during the neonatal period or thereafter. Study participants were restricted to singletons and controls without report of death, scheduled cesarean section, or ambulance transportation. The controls were newborns, randomly selected by year and type of delivery (normal spontaneous delivery without cesarean section and emergency cesarean section) using a 1:10 case to control ratio sampled from the nationwide Japan Society of Obstetrics and Gynecology database. RESULTS: A total of 90 cerebral palsy cases and 900 controls having normal spontaneous delivery without cesarean section were selected, as were 92 cerebral palsy cases and 920 controls with emergent cesarean section. A significantly higher risk for cerebral palsy was found among cases that underwent emergent cesarean section on weekends (odds ratio [OR] 1.72, 95% confidence interval [CI] 1.06-2.81) and during the night shift (OR 2.29, 95% CI 1.30-4.02). No significant risk was found among normal spontaneous deliveries on weekends (OR 1.63, 95% CI 0.97-2.73) or during the quasi-night shift (OR 1.26, 95% CI 0.70-2.27). Regional perinatal care centers showed significantly higher risk for cerebral palsy in both emergent cesarean section (OR 2.35, 95% CI 1.47-3.77) and normal spontaneous delivery (OR 2.92, 95% CI 1.76-4.84). CONCLUSION: Labor on weekends, during the night shift, and at regional perinatal medical care centers was associated with significantly elevated risk for cerebral palsy in emergency cesarean section.


Assuntos
Paralisia Cerebral/epidemiologia , Parto Obstétrico/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Assistência Perinatal/estatística & dados numéricos , Estudos de Casos e Controles , Paralisia Cerebral/etiologia , Humanos , Incidência , Recém-Nascido , Japão/epidemiologia , Parto , Estudos Retrospectivos , Fatores de Tempo
19.
J Obstet Gynaecol Res ; 46(11): 2237-2241, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32909322

RESUMO

AIM: A nationwide questionnaire survey was performed to evaluate how Japanese Society of Obstetrics and Gynecology (JSOG) members dealt with the coronavirus disease (COVID-19) pandemic during the declared nationwide emergency. METHODS: We sent questionnaires to members of JSOG via official email. Participants answered anonymously using Google forms. RESULTS: Two (0.08%) JSOG members had contracted COVID-19. There was a clear decrease in the number of patients scheduled for operation, not only for malignant but also for benign diseases. A decrease in the number of outpatients for infertility treatment was also observed. Polymerase chain reaction testing for severe acute respiratory syndrome coronavirus 2 was available in 20.4% of the facilities. Inpatients and outpatients were requested to wear masks, limit the number of contacts and check body temperature when visiting hospitals/clinics. During parturition care, caregivers and physicians wore gloves, masks (other than N-95), face shields and gowns. About 66% and 80% of the facilities decided to transfer pregnant women if they had asymptomatic and symptomatic infection, respectively. Cesarean section was typically chosen as delivery mode in infected women. CONCLUSION: The COVID-19 pandemic provoked significant changes in obstetrics and gynecology practices in Japan. Apparently, nosocomial infections were largely prevented due to these changes, although some of them might not have been necessary.


Assuntos
Infecções por Coronavirus/prevenção & controle , Ginecologia/estatística & dados numéricos , Instalações de Saúde/estatística & dados numéricos , Obstetrícia/estatística & dados numéricos , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Padrões de Prática Médica/estatística & dados numéricos , Complicações Infecciosas na Gravidez/prevenção & controle , Betacoronavirus , Técnicas de Laboratório Clínico/estatística & dados numéricos , Infecções por Coronavirus/diagnóstico , Feminino , Ginecologia/métodos , Humanos , Japão , Obstetrícia/métodos , Pneumonia Viral/diagnóstico , Gravidez , Complicações Infecciosas na Gravidez/virologia
20.
MMWR Morb Mortal Wkly Rep ; 69(38): 1355-1359, 2020 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-32970660

RESUMO

Pregnant women might be at increased risk for severe coronavirus disease 2019 (COVID-19), possibly related to changes in their immune system and respiratory physiology* (1). Further, adverse birth outcomes, such as preterm delivery and stillbirth, might be more common among pregnant women infected with SARS-CoV-2, the virus that causes COVID-19 (2,3). Information about SARS-CoV-2 infection during pregnancy is rapidly growing; however, data on reasons for hospital admission, pregnancy-specific characteristics, and birth outcomes among pregnant women hospitalized with SARS-CoV-2 infections are limited. During March 1-May 30, 2020, as part of Vaccine Safety Datalink (VSD)† surveillance of COVID-19 hospitalizations, 105 hospitalized pregnant women with SARS-CoV-2 infection were identified, including 62 (59%) hospitalized for obstetric reasons (i.e., labor and delivery or another pregnancy-related indication) and 43 (41%) hospitalized for COVID-19 illness without an obstetric reason. Overall, 50 (81%) of 62 pregnant women with SARS-CoV-2 infection who were admitted for obstetric reasons were asymptomatic. Among 43 pregnant women hospitalized for COVID-19, 13 (30%) required intensive care unit (ICU) admission, six (14%) required mechanical ventilation, and one died from COVID-19. Prepregnancy obesity was more common (44%) among pregnant women hospitalized for COVID-19 than that among asymptomatic pregnant women hospitalized for obstetric reasons (31%). Likewise, the rate of gestational diabetes (26%) among pregnant women hospitalized for COVID-19 was higher than it was among women hospitalized for obstetric reasons (8%). Preterm delivery occurred in 15% of pregnancies among 93 women who delivered, and stillbirths (fetal death at ≥20 weeks' gestation) occurred in 3%. Antenatal counseling emphasizing preventive measures (e.g., use of masks, frequent hand washing, and social distancing) might help prevent COVID-19 among pregnant women,§ especially those with prepregnancy obesity and gestational diabetes, which might reduce adverse pregnancy outcomes.


Assuntos
Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/terapia , Hospitalização/estatística & dados numéricos , Pneumonia Viral/diagnóstico , Pneumonia Viral/terapia , Complicações Infecciosas na Gravidez/terapia , Complicações Infecciosas na Gravidez/virologia , Adolescente , Adulto , Infecções por Coronavirus/epidemiologia , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Pandemias , Pneumonia Viral/epidemiologia , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia , Adulto Jovem
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA
...