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1.
Zhonghua Yu Fang Yi Xue Za Zhi ; 54(1): 84-91, 2020 Jan 06.
Artigo em Chinês | MEDLINE | ID: mdl-31914574

RESUMO

Objective: To investigate the demand and access to the cancer prevention and treatment knowledge and related factors among urban residents in China from 2015 to 2017. Methods: A cross-sectional survey was conducted in 16 provinces covered by the Cancer Screening Program in Urban China from 2015 to 2017. A total of 32 257 local residents aged ≥18 years old who could understand the investigation procedure were included in the study by using the cluster sampling method and convenient sampling method. All local residents were categorized into four groups, which contained 15 524 community residents, 8 016 cancer risk assessment/screening population, 2 289 cancer patients and 6 428 occupational population, respectively. The self-designed questionnaire was used to collect the information of general demographic characteristics, the demand and access to cancer prevention and treatment knowledge, and the influencing factors of the attitude. The Chi-square test was used to analyze the difference of the demand of the cancer prevention knowledge among different groups and the corresponding factors of the cancer prevention and treatment knowledge were analyzed by using the logistic regression model. Results: The proportion of residents who need the cancer prevention and treatment knowledge was 79.5%. The demand rate of the inducement, symptom and diagnosis methods of cancer in the occupational population was highest, about 66.8%, 71.0% and 20.8%, respectively. The demand rate of treatment methods and cost in current cancer patients was the highest, about the 45.9% and 21.9%, respectively. The top three sources to acquire the cancer prevention and treatment knowledge were "broadcast or television" (69.5%), "books, newspapers, posters or brochures" (44.7%) and "family and friends" (33.8%). The multivariate analysis showed that compared with public institution personnel/civil servants, unmarried/cohabiting/divorced/widowed and others, annual household income less than 20 000 CNY, from the eastern region, people without cancer diagnosis and people with self-assessment of cancer risk, the demand rate of cancer prevention and treatment knowledge was higher in enterprise personnel/workers, married, annual household income between 60 000 CNY and 150 000 CNY, from the central region, people with cancer and people with unclear cancer risk (all P values <0.05). Conclusion: There was a high demand for the cancer prevention and treatment knowledge among urban residents in China from 2015 to 2017. The main access to the knowledge is from the radio or television. The occupation, marital status, annual household income, residential region, health status and risk of disease were the main factors of the demand of the cancer prevention and treatment knowledge.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Neoplasias/prevenção & controle , População Urbana , Adolescente , Adulto , China , Estudos Transversais , Humanos , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana/estatística & dados numéricos
2.
Presse Med ; 48(11 Pt 1): e293-e306, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31734050

RESUMO

BACKGROUND: Little is known regarding healthcare for cancer patients treated mainly at home during the month before they die. The aim of this study was to provide information on how they were treated and what were their causes of death. METHODS: This population-based observational study analysing information obtained from the French national healthcare data system (SNDS) included adult health insurance beneficiaries treated for cancer who died in 2015 after having spent at least 25 of their last 30 days at home. RESULTS: Among the cancer patients who died in 2015, 25,463 (20%) were included [mean age (±SD) 74±13.2 years, men 62%]; 54% of them died at home. They were slightly older (75 vs. 73 years) than those who died in hospital, had less frequently received hospital palliative care during the year preceding their deaths (19% vs. 41%) and had less often used medical transport (41% vs. 73%) to an emergency department (8% vs. 62%), to hospital-based (11% vs. 17%) or community-based (16% vs. 12%) chemotherapy, to a general practitioner (73% vs. 78%) or to a community-based nursing service (63% vs. 73%). However, when they consulted a general practitioner (median 3 visits vs. 2) or a nurse (median 22 nursing procedures vs. 10) during their last month of life, visits were more frequent. The leading cause of death was tumour, which represented 69% of deaths at home vs. 74% of deaths in hospital. CONCLUSIONS: In France, home management during the last month of life is uncommon and even when it is occurs, in one out of two cases patients pass away in a hospital setting. This study is an interrogation on medical choices, given the wish of many of the French to die at home and placing their choices in an international perspective.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Assistência Domiciliar , Neoplasias/mortalidade , Neoplasias/terapia , Assistência Terminal , Distribuição por Idade , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Causas de Morte , Comorbidade , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , França , Medicina Geral/estatística & dados numéricos , Assistência Domiciliar/estatística & dados numéricos , Mortalidade Hospitalar , Humanos , Masculino , Pessoa de Meia-Idade , Serviços de Enfermagem/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Estudos Retrospectivos , Distribuição por Sexo , Fatores de Tempo , Transporte de Pacientes/estatística & dados numéricos
3.
Int J Equity Health ; 18(1): 156, 2019 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615530

RESUMO

BACKGROUND: With the adoption of the Sustainable Development Goals (SDGs), there is a renewed commitment of tackling the varied challenges of undernutrition, particularly stunting (SDG 2.2). Health equity is also a priority in the SDG agenda and there is an urgent need for disaggregated analyses to identify disadvantaged subgroups. We compared time trends in socioeconomic inequalities obtained through stratification by wealth quintiles and deciles for stunting prevalence. METHODS: We used 37 representative Demographic and Health Surveys and Multiple Indicator Cluster surveys from nine Latin American and Caribbean (LAC) countries conducted between 1996 and 2016. Stunting in children under-5 years was assessed according to the 2006 WHO Child Growth Standards and stratified by wealth quintiles and deciles. Within-country socioeconomic inequalities were measured through concentration index (CIX) and slope index of inequality (SII). We used variance-weighted least squares regression to estimate annual changes. RESULTS: Eight out of nine countries showed a statistical evidence of reduction in stunting prevalence over time. Differences between extreme deciles were larger than between quintiles in most of countries and at every point in time. However, when using summary measures of inequality, there were no differences in the estimates of SII with the use of deciles and quintiles. In absolute terms, there was a reduction in socioeconomic inequalities in Peru, Honduras, Dominican Republic, Belize, Suriname and Colombia. In relative terms, there was an increase in socioeconomic inequalities in Peru, Bolivia, Haiti, Honduras and Guatemala. CONCLUSIONS: LAC countries have made substantial progress in terms of reducing stunting,. Nevertheless, renewed actions are needed to improve equity. Particularly in those countries were absolute and relative inequalities did not change over time such Bolivia and Guatemala. Finer breakdowns in wealth distribution are expected to elucidate more differences between subgroups; however, this approach is relevant to cast light on those subgroups that are still lagging behind within populations and inform equity-oriented health programs and practices.


Assuntos
Transtornos do Crescimento/epidemiologia , Equidade em Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Fatores Socioeconômicos , Criança , Pré-Escolar , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , América Latina/epidemiologia , Prevalência , América do Sul
4.
Am Surg ; 85(10): 1198-1203, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31657324

RESUMO

Overdose of opioids is the number one cause of accidental death in the United States, and surgeons are overprescribing these medications. The aim of this study was to assess the feasibility of implementing postoperative opioid prescribing guidelines for general surgery procedures at a public hospital, where patients have lower socioeconomic status, public insurance, and limited access to care. We implemented a quality improvement project, which included in-service training for surgical staff and distribution of standardized guidelines. An infographic for patients was created to facilitate education on postoperative pain management. Pre- and postintervention opioid prescriptions and emergency room visits were compared for patients undergoing common general surgery procedures (inguinal hernia repair, appendectomy, and laparoscopic cholecystectomy). The median number of narcotic pills prescribed significantly decreased from 30 (n = 64) to 15 (n = 63) after the intervention (P < 0.0001). Morphine milligram equivalents decreased from a median [range] of 150 [20,600] to 90 [5,300] (P < 0.0001). The percentage of patients with postoperative pain-related emergency department visits remained low (1.6%). Standardization of postoperative opioid prescription practices was successfully implemented at a public hospital without an increase in the number of emergency room visits for pain.


Assuntos
Analgésicos Opioides/uso terapêutico , Manejo da Dor/normas , Dor Pós-Operatória/tratamento farmacológico , Melhoria de Qualidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Apendicectomia/efeitos adversos , Colecistectomia Laparoscópica/efeitos adversos , Prescrições de Medicamentos/normas , Serviço Hospitalar de Emergência/estatística & dados numéricos , Estudos de Viabilidade , Feminino , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Herniorrafia/efeitos adversos , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Guias de Prática Clínica como Assunto , Adulto Jovem
5.
BMC Med ; 17(1): 180, 2019 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-31551070

RESUMO

BACKGROUND: Vaccination has reduced the global incidence of measles to the lowest rates in history. However, local interruption of measles virus transmission requires sustained high levels of population immunity that can be challenging to achieve and maintain. The herd immunity threshold for measles is typically stipulated at 90-95%. This figure does not easily translate into age-specific immunity levels required to interrupt transmission. Previous estimates of such levels were based on speculative contact patterns based on historical data from high-income countries. The aim of this study was to determine age-specific immunity levels that would ensure elimination of measles when taking into account empirically observed contact patterns. METHODS: We combined estimated immunity levels from serological data in 17 countries with studies of age-specific mixing patterns to derive contact-adjusted immunity levels. We then compared these to case data from the 10 years following the seroprevalence studies to establish a contact-adjusted immunity threshold for elimination. We lastly combined a range of hypothetical immunity profiles with contact data from a wide range of socioeconomic and demographic settings to determine whether they would be sufficient for elimination. RESULTS: We found that contact-adjusted immunity levels were able to predict whether countries would experience outbreaks in the decade following the serological studies in about 70% of countries. The corresponding threshold level of contact-adjusted immunity was found to be 93%, corresponding to an average basic reproduction number of approximately 14. Testing different scenarios of immunity with this threshold level using contact studies from around the world, we found that 95% immunity would have to be achieved by the age of five and maintained across older age groups to guarantee elimination. This reflects a greater level of immunity required in 5-9-year-olds than established previously. CONCLUSIONS: The immunity levels we found necessary for measles elimination are higher than previous guidance. The importance of achieving high immunity levels in 5-9-year-olds presents both a challenge and an opportunity. While such high levels can be difficult to achieve, school entry provides an opportunity to ensure sufficient vaccination coverage. Combined with observations of contact patterns, further national and sub-national serological studies could serve to highlight key gaps in immunity that need to be filled in order to achieve national and regional measles elimination.


Assuntos
Busca de Comunicante/estatística & dados numéricos , Erradicação de Doenças/métodos , Imunidade Coletiva , Vírus do Sarampo/imunologia , Sarampo/epidemiologia , Sarampo/imunologia , Sarampo/prevenção & controle , Adolescente , Adulto , Criança , Pré-Escolar , Erradicação de Doenças/organização & administração , Surtos de Doenças/prevenção & controle , Surtos de Doenças/estatística & dados numéricos , Feminino , Geografia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Imunidade Coletiva/fisiologia , Incidência , Lactente , Recém-Nascido , Masculino , Sarampo/transmissão , Vacina contra Sarampo/uso terapêutico , Modelos Estatísticos , Estudos Soroepidemiológicos , Vacinação/estatística & dados numéricos , Adulto Jovem
6.
BMC Public Health ; 19(1): 1226, 2019 Sep 05.
Artigo em Inglês | MEDLINE | ID: mdl-31488094

RESUMO

BACKGROUND: Family planning is considered as an effective tool to control population and to bring improvement in maternal and child health. The Government of Pakistan has been continuously struggling to improve the availability of family planning services. However, like many other developing countries of the world, unmet need for family planning still exists in the country. According to Pakistan Demographic and Health Survey 2012-13, the prevalence of unmet need for family planning is 21% in the country. The objective of this study is to investigate the determinants of unmet need for family planning among married women in Pakistan. METHODS: Secondary data of Pakistan Demographic and Health Survey 2012-13 has been used to analyze the determinants of unmet need for family planning through Binary and Multinomial Logistic regressions. RESULTS: Outcomes of the study show that the likelihood of unmet need for family planning among married women in Pakistan goes on to decrease with an increase in their age and education. The likelihood of unmet need for family planning decreases with the increase in wealth status of women's household, number of living children and husband's education. Similarly, the women residing in rural areas are more likely to have unmet need for family planning as compared with women living in urban areas. The women who lack mass media exposure, who are not employed and who have fear of side effects for using contraceptives are more likely to have unmet need for family planning. CONCLUSIONS: Fear of side effects for using contraceptives has been identified as the major cause of unmet need for family planning in Pakistan. The Government of Pakistan has been putting a lot of efforts to convince people about the usefulness of population control programs. A huge media campaign has been launched to persuade people about the benefits of birth control. But the efforts of the government do not seem to be very much effective to clear the perception of people about side effects of contraceptive use. Hence, fear of side effects still remains one of the most important reason behind unmet need for family planning.


Assuntos
Serviços de Planejamento Familiar , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Casamento , Adolescente , Adulto , Comportamento Contraceptivo/psicologia , Anticoncepcionais/efeitos adversos , Demografia , Medo , Feminino , Governo , Humanos , Meios de Comunicação de Massa/estatística & dados numéricos , Pessoa de Meia-Idade , Paquistão , Fatores Socioeconômicos , Adulto Jovem
7.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31501238

RESUMO

BACKGROUND AND OBJECTIVES: Fifteen percent of US children live in households with inadequate food. Children who are food insecure often experience worse physical, emotional, and developmental health outcomes. Authors of previous studies have not examined the quality and cost implications of food insecurity in children. METHODS: This is a retrospective study of 7959 nationally representative US children (aged 1-17 years) in the 2016 Medical Expenditure Panel Survey. Households with food insecurity were identified by ≥3 positive responses to the 30-day, 10-item US Food Security Survey. Main outcomes were annual health expenditures and quality of care indicators: emergency department (ED) and inpatient use, primary care and specialist visits, routine medical and dental care, patient experience measures, and school absenteeism. Logistic and 2-part regression models were constructed to estimate outcomes conditional on sociodemographic and medical covariates. RESULTS: Children in households with food insecurity were more often publicly insured and had special needs compared with all other children. In multivariable logistic regression, household food insecurity was associated with significantly higher adjusted odds of an ED (adjusted odds ratio [aOR] = 1.37) or primary care treatment visit (aOR = 1.24) during the year. Household food insecurity was associated with significantly higher school absenteeism (aOR = 1.74) and lower access to care for routine (aOR = 0.55) or illness (aOR = 0.57) care. There were no differences in annual health expenditures, hospitalizations, or receipt of routine medical or dental care. CONCLUSIONS: Household food insecurity is associated with higher ED use and school absenteeism and lower access to care; however, it was not associated with higher annual health expenditures in children.


Assuntos
Abastecimento de Alimentos/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Absenteísmo , Adolescente , Criança , Pré-Escolar , Assistência Odontológica para Crianças/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Abastecimento de Alimentos/economia , Gastos em Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Modelos Logísticos , Masculino , Razão de Chances , Atenção Primária à Saúde/economia , Indicadores de Qualidade em Assistência à Saúde , Estudos Retrospectivos , Instituições Acadêmicas/estatística & dados numéricos , Estados Unidos
8.
Int J Equity Health ; 18(1): 122, 2019 08 05.
Artigo em Inglês | MEDLINE | ID: mdl-31382979

RESUMO

BACKGROUND: Unmet need for mental health services remains high in the United States and is disproportionately concentrated in some groups. The scale and nature of these disparities have not been fully elucidated and bear further scrutiny. As such, in this study, we examine the demographic, socioeconomic, and health correlates of unmet need for mental health treatment as well as the reasons for unmet need. METHODS: We draw upon the National Survey for Drug Use and Health (NSDUH) from 2002 to 16 for adults aged 18 and over in the United States (n = 579,017). Using multivariable logistic regression, we simultaneously model the demographic, socioeconomic, and health correlates of unmet need for mental health treatment from 2002 to 16. We also analyse the reasons for unmet need expressed by these populations, reasons which include cost, perceived stigma, minimisation of symptoms, low perceived effectiveness of treatment, and structural barriers. RESULTS: Major characteristics associated with increased odds of unmet need include past year substance abuse or dependence (other than hallucinogens and sedatives), fair, poor, or very poor health, being female, and an educational attainment of college or higher. With respect to reasons for unmet need, cost was most often cited, followed by perceived stigma, structural barriers, and minimisation. Characteristics associated with increased odds of indicating cost as a reason for unmet need include: being uninsured or aged 26-35. Minimisation and low perceived effectiveness are mentioned by high-income persons as reasons for unmet need. College-educated persons and women had higher odds of citing structural barriers as a reason for unmet need. CONCLUSIONS: The correlates and causes of unmet need highlight the intersectionality of individual health needs with implications on addressing inequities in mental health policy and practice.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Adulto , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoas sem Cobertura de Seguro de Saúde/psicologia , Saúde Mental , Pessoa de Meia-Idade , Fatores Socioeconômicos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Transtornos Relacionados ao Uso de Substâncias/psicologia , Estados Unidos , Adulto Jovem
9.
BMC Health Serv Res ; 19(1): 587, 2019 Aug 20.
Artigo em Inglês | MEDLINE | ID: mdl-31429734

RESUMO

BACKGROUND: Despite a growing number of adolescents and adults diagnosed with autism spectrum disorder (ASD), little is known about service needs and barriers to services in this population. Existing research shows that youth with ASD are more underserved as they approach final years of their high school education and that adequate services for individuals with ASD after transition to adulthood are even scarcer. However, few studies have directly compared differences in service availability between adolescents and adults with ASD, and even fewer studies are published on service use outside Anglo-Saxon countries. The purpose of the present study was to examine service access, perceived barriers, and unmet needs, as reported by parents of adolescents and young adults with ASD in Poland. METHODS: The study used a subsample of parents of young people with ASD (aged 12-38 years; N = 311) from the Polish Autism Survey - a survey covering different areas of functioning of people with ASD in Poland, based on a convenience sample. Responding parents were recruited via different service providers, social media, and press, and completed a survey using a web platform or a paper-and-pencil questionnaire. RESULTS: As expected, adults used services less often than adolescents, with 80.1% of adolescents and 61.1% of adults with ASD using services in the previous 12 months. Mental health services were among the most used and the most needed services, followed by educational services, while needs for sensory/motor services remained largely unmet. Young people with a coexisting intellectual disability used more services than those without it. Non-governmental organizations, private clinics, and schools were the most common service providers. Parents indicated that most of young people with ASD had unmet service needs for services (93.5%) and faced barriers to access them (82.7%). Low-income families and those living outside large cities were at the highest risk of facing barriers to service access. CONCLUSIONS: The results confirm still a thin body of evidence from different countries suggesting that adolescents and adults with ASD were both largely underserved populations. Policy-makers should address economic, regional, and age-related inequities in access to services for individuals with ASD.


Assuntos
Transtorno do Espectro Autista/terapia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde Mental/normas , Adolescente , Adulto , Criança , Assistência à Saúde/normas , Assistência à Saúde/estatística & dados numéricos , Feminino , Humanos , Deficiência Intelectual/terapia , Masculino , Área Carente de Assistência Médica , Serviços de Saúde Mental/provisão & distribução , Pais/psicologia , Polônia , Pobreza/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
10.
Rev Bras Epidemiol ; 22: e190042, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31432986

RESUMO

INTRODUCTION: The epidemiological profile of dental caries for Indigenous Peoples is complex and heterogeneous. The oral health of the Kaingang people, third largest Indigenous population from Brazil, has not been investigated so far. OBJECTIVE: The purpose of this study was to assess the prevalence and severity of dental caries, in addition to the associated factors of the need of dental extraction among Kaingang adult Indigenous. METHODS: A cross-sectional oral health survey was conducted among Kaingang adults aged from 35 to 44 years old living in the Guarita Indigenous Land, Rio Grande do Sul. Clinical exams were performed to analyze the conditions of dental crown and treatment needs. RESULTS: A total of 107 Indigenous adults were examined. Mean DMFT score was 14.45 (± 5.80). Two-thirds of the DMFT score accounted for missing teeth. Anterior lower dentition presented the highest rates of sound teeth, whereas the lower first molars had the lowest. Need for dental extraction was observed in 34.58% and was associated with village location, time of last dental visit, and higher number of decayed teeth. CONCLUSION: The high frequencies of caries and missing teeth observed in this population indicate a lack of adequate assistance. It is essential to discuss health care models in order to combat avoidable social and health injustices.


Assuntos
Cárie Dentária/epidemiologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Índios Sul-Americanos/estatística & dados numéricos , Extração Dentária/estatística & dados numéricos , Adulto , Distribuição por Idade , Brasil/epidemiologia , Estudos Transversais , Índice CPO , Feminino , Humanos , Masculino , Prevalência , Índice de Gravidade de Doença , Distribuição por Sexo , Fatores Sociológicos , Estatísticas não Paramétricas
11.
Int J Equity Health ; 18(1): 119, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362732

RESUMO

OBJECTIVES: Considerable evidence has advanced the role of citizen-led coalitions (CLC) in supporting the health and social needs of rural citizens. There has been little research focusing on the experiences and strategies of coalitions, with their limited resources and status, in targeting health inequities in their rural communities. The aim of this study was to understand the entrepreneurial strategies and experiences of rural coalitions to effect change in the delivery of health services for their older adult populations. METHOD: A qualitative descriptive study method was used to generate understanding of the entrepreneurial experiences and strategies of CLCs in advancing health services to meet the health and social needs of their citizens. Seven diverse CLCs (n = 40) from different rural communities participated in focus groups and in individual and coalition-level surveys. Thematic analysis was used to construct themes from the data. RESULTS: Two over-riding themes emerged: entrepreneurial strategies and societal recognition. CLCs engaged in numerous entrepreneurial strategies that enabled actions and outcomes in meeting their health care needs. These strategies included: securing quick wins, leveraging existing resources, and joining forces with stakeholder groups/individuals. However, despite these strategies and successes, coalitions expressed frustration with not being seen and not being heard by decision-makers. This pointed to a key structural barrier to coalition successes -- a broader societal and institutional problem of failing to recognize not only the health needs of rural citizens, but also the legitimacy of the community coalitions to represent and act on those needs. CONCLUSIONS: Despite the potential for coalitions to mobilize and effect change in addressing the inequities of rural health service access for older adults, broader barriers to their recognition, may undermine their entrepreneurial strategies and success.


Assuntos
Redes Comunitárias/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/organização & administração , População Rural/estatística & dados numéricos , Idoso , Feminino , Grupos Focais , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Saúde das Minorias , Inquéritos e Questionários
12.
Rev Assoc Med Bras (1992) ; 65(6): 796-800, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340307

RESUMO

OBJECTIVE: To estimate the human resources and services needed to meet the demand of the Brazilian population who would benefit from palliative care, based on the population growth projection for 2040. METHODS: Population and mortality estimates and projections were obtained from the Brazilian Institute of Geography and Statistics. Service needs were estimated based on literature data. RESULTS: The expected increase in the Brazilian population for 2000-2040 is 31.5%. The minimum estimate of patients with palliative care needs was 662,065 in 2000 and 1,166,279 in 2040. The staff required for each hundred thousand inhabitants would increase from 1,734 to 2,282, the number of doctors needed would increase from 4,470 to 6,274, and the number of nurses from 8,586 to 11,294, for the same period. CONCLUSION: The definition of a national strategy predicting the increasing palliative care needs of the population is necessary. The expansion of the support network for chronic and non-transmissible diseases is necessary, but the training of existing human resources at all levels of attention to perform palliative actions can be a feasible alternative to minimize the suffering of the population.


Assuntos
Necessidades e Demandas de Serviços de Saúde/tendências , Mão de Obra em Saúde/tendências , Cuidados Paliativos/tendências , Brasil , Feminino , Previsões , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Masculino , Cuidados Paliativos/estatística & dados numéricos , Fatores de Tempo
13.
Pan Afr Med J ; 32: 188, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31312300

RESUMO

Introduction: This study explored the differences on the level of medical care required by camp and non-camp resident patients during utilisation of the health services in Mae La refugee camp, Tak province, Thailand during the years 2006 and 2007. Methods: Data were extracted from camp registers and the Health Information System used during the years 2006 and 2007 and statistical analysis was performed. Results: The analysis showed that during 2006 and 2007 non-camp resident patients, coming from Thailand as well as Myanmar, who sought care in the outpatient department (OPD) of the camp required at a significantly higher proportion admission to the inpatient department (IPD) or referral to the district hospital compared to camp resident patients. Although there was a statistically significant increased mortality of the non-camp resident patients admitted in the IPD compared to camp resident patients, there was no significant difference in mortality among these two groups when the referrals to the district hospital were analysed. Conclusion: Non-camp resident patients tended to need a more advanced level of medical care compared to camp resident patients. Provided that this it is further validated, the above observed pattern might be potentially useful as an indirect indicator of unaddressed health needs of populations surrounding a refugee camp.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Campos de Refugiados/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Tailândia
14.
Artigo em Inglês | MEDLINE | ID: mdl-31284469

RESUMO

Unmet medical needs refer to the state where a patient's medical care or service is insufficient, inadequate, or lacking. Numerous factors influence unmet medical needs. We used a multi-pronged approach to explore the factors influencing unmet medical needs in the Korean health care system according to Anderson's Behavioral Model of Health Services Use. To this end, we used data from 11,378 adults over 19 years old in the 2016 Korea Health Panel Survey and performed multiple logistic regression analyses. The odds of experiencing unmet medical needs were significantly greater among older participants (odds ratio (OR) = 2.51, 95% confidence interval (CI) = 1.78-3.56); low-income participants (OR = 1.41, 95% CI = 1.14-1.75); non-workers (OR = 1.24, 95% CI = 1.06-1.46); those who had received non-covered treatment (OR = 1.24, 95% CI = 1.08-1.42); those who did not regularly exercise (OR = 1.23, 95% CI = 1.02-1.48); and those experiencing pain (OR = 2.29, 95% CI = 1.97-2.66), worse self-rated health status (OR = 2.29, 95% CI = 1.89-2.79), and severe depression (OR = 2.46, 95% CI = 1.39-4.35). About one in ten Korean citizens (11.60%) have unmet medical service needs. Policies that strengthen coverage for physically and economically vulnerable groups are needed.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Humanos , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , República da Coreia , Adulto Jovem
15.
Afr Health Sci ; 19(1): 1778-1788, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31149008

RESUMO

Background: Uganda's ageing population (age 50 years and older) will nearly double from 2015 to 2050. HIV/AIDS, diabetes, stroke among other disease processes have been studied in the elderly population. However, the burden of disease from surgically-treatable conditions is unknown. Objectives: To determine the proportion of adults above 50 years with unmet surgical need and deaths attributable to probable surgically-treatable conditions. Methods: A cluster randomized sample representing the national population of Uganda was enumerated. The previously validated Surgeons Overseas assessment of surgical need instrument, a head-to-toe verbal interview, was used to determine any surgically-treatable conditions in two randomly-selected living household members. Deaths were detailed by heads of households. Weighted metrics are calculated taking sampling design into consideration and Taylor series linearization was used for sampling error estimation. Results: The study enumerated 425 individuals above age 50 years. The prevalence proportion of unmet surgical need was 27.8% (95%CI, 22.1-34.3). This extrapolates to 694,722 (95%CI, 552,279-857,157) individuals living with one or more surgically treatable conditions. The North sub-region was observed to have the highest prevalence proportion. Nearly two out of five household deaths (37.9%) were attributed to probable surgically treatable causes. Conclusion: There is disproportionately high need for surgical care among the ageing population of Uganda with approximately 700,000 consultations needed.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Adulto , Idoso , Envelhecimento , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , População Rural , Inquéritos e Questionários , Uganda , População Urbana
16.
J Headache Pain ; 20(1): 74, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31248360

RESUMO

BACKGROUND: Although migraine is a disabling neurological condition that causes important disability, it remains an area of underdiagnosis and undertreatment worldwide. The aim of this study was to depict the burden of the unmet medical needs in migraine treated with triptans in a large Italian population. METHODS: A 2-year longitudinal analysis of migraineurs with unmet medical needs on treatment with triptans was performed. The studied cohort consisted of subjects with ≥4 triptan dose units per month, selected from the general population These patients were stratified into: possible Low-Frequency Episodic Migraine (pLF-EM: 4-9 triptan dose units per month), possible High-Frequency Episodic Migraine (pHF-EM: 10-14 triptan dose units per month) and possible Chronic Migraine (pCM:> 14 triptan dose units per month). The first follow-up year was analysed to describe the use of preventive therapies, the second year to describe the ≥50% reduction in triptan use. RESULTS: Of 10,270,683 adults, 8.0 per 1000 were triptan users and, of these, 38.2% were migraineurs with unmet medical needs, corresponding to 3.1 per 1000 adults. By stratifying for the number of triptan dose units per month, 72.3% were affected by pLF-EM, 17.4% by pHF-EM, and 10.3% by pCM. In this cohort, 19.1% of individuals used oral preventive drugs and 0.1% botulinum toxin. Triptan use reduction was found in 22.3% individuals of the cohort, decreasing with the intensification of need levels (25.8% pLF-EM, 13.6% pHF-EM, 12.0% pCM). CONCLUSIONS: This real-life analysis underlined that the unmet medical needs concern a large part of patients treated with triptans and there is an undertreatment with preventive therapies whose benefit is insufficient, which may be due to the lack of effective preventive strategies, probably still reserved to severe patients. This study allows forecasting the actual impact of newest therapeutic strategies aimed to fill this gap.


Assuntos
Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Transtornos de Enxaqueca/tratamento farmacológico , Triptaminas/administração & dosagem , Adulto , Estudos de Coortes , Pessoas com Deficiência , Feminino , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Transtornos de Enxaqueca/epidemiologia , Transtornos de Enxaqueca/prevenção & controle , Prevalência
17.
Asia Pac J Clin Oncol ; 15(5): e68-e78, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31215167

RESUMO

Understanding the unmet needs of cancer survivors is crucial to inform health service planning and optimize survivorship care. This systematic review sought to identify the most prevalent unmet needs of cancer survivors in Australia, and to determine personal, disease, and treatment-related variables correlated with unmet needs. Seventeen studies were included in the review. Substantial heterogeneity across the included studies precluded statistical pooling of the data; narrative synthesis and vote counting were used to synthesize results. Unmet needs were ranked by the number of endorsements (n) each item received. The most frequently reported unmet needs of Australian cancer survivors are for help with psychosocial issues, including fear of cancer recurrence (n = 14; 14-42%), uncertainty about the future (n = 9; 12-26%), worry about partners, friends, and families (n = 8; 12-26%), help to reduce stress (n = 8; 12-34%), and sexual changes (n = 7; 11-29%). Survivors also needed more help with physical issues, including fatigue (n = 7; 10-27%) and usual activities (n = 6; 13-27%), and expressed supportive care unmet needs, including for affordable hospital car parking (n = 7; 12-26%), information about available services (n = 7; 11-33%), and peer support (n = 6; 13-26%). Anxiety, depression, and lower overall and physical quality of life were significantly correlated with greater unmet needs, as were younger age and more advanced disease.


Assuntos
Sobreviventes de Câncer/psicologia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Neoplasias/psicologia , Qualidade de Vida , Austrália , Humanos
18.
Artigo em Inglês | MEDLINE | ID: mdl-31052591

RESUMO

There is a lack of population-based longitudinal studies which investigates the factors leading to frequent attendance of outpatient physicians. Thus, the purpose of this study was to analyze the determinants of frequent attendance using a longitudinal approach. The used dataset comprises seven waves (2002 to 2014; n = 28,574 observations; ranging from 17 to 102 years) from the nationally representative German Socio-Economic Panel (GSOEP). The number of outpatient physician visits in the last three months was used to construct the dependent variable "frequent attendance". Different cut-offs were used (top 25%; top 10%; top 5%). Variable selection was based on the "behavioral model of health care use" by Andersen. Accordingly, variables were grouped into predisposing, enabling, and need characteristics as well as health behavior, which are possible determinants of frequent attendance. Conditional fixed effects logistic regressions were used. As for predisposing characteristics, regressions showed that getting married and losing one's job increased the likelihood of frequent attendance. Furthermore, age was negatively associated with the outcome measure. Enabling characteristics were not significantly associated with the outcome measure, except for the onset of the "practice fee". Decreases in mental and physical health were associated with an increased likelihood of frequent attendance. Findings were robust across different subpopulations. The findings of this study showed that need characteristics are particularly important for the onset of frequent attendance. This might indicate that people begin to use health services frequently when medically indicated.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Serviços de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Feminino , Alemanha , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais , Aceitação pelo Paciente de Cuidados de Saúde , Fatores Socioeconômicos , Adulto Jovem
19.
J Manag Care Spec Pharm ; 25(5): 544-554, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31039062

RESUMO

BACKGROUND: Statins are effective in helping prevent cardiovascular disease (CVD). However, studies suggest that only 20%-64% of patients taking statins achieve reasonable low-density lipoprotein cholesterol (LDL-C) thresholds. On-treatment levels of LDL-C remain a key predictor of residual CVD event risk. OBJECTIVES: To (a) determine how many patients on statins achieved the therapeutic threshold of LDL-C < 100 mg per dL (general cohort) and < 70 mg per dL (secondary prevention cohort, or subcohort, with preexisting CVD); (b) estimate the number of potentially avoidable CVD events if the threshold were reached; and (c) forecast potential cost savings. METHODS: A retrospective, longitudinal cohort study using electronic health record data from the Indiana Network for Patient Care (INPC) was conducted. The INPC provides comprehensive information about patients in Indiana across health care organizations and care settings. Patients were aged > 45 years and seen between January 1, 2012, and October 31, 2016 (ensuring study of contemporary practice), were statin-naive for 12 months before the index date of initiating statin therapy, and had an LDL-C value recorded 6-18 months after the index date. Subsequent to descriptive cohort analysis, the theoretical CVD risk reduction achievable by reaching the threshold was calculated using Framingham Risk Score and Cholesterol Treatment Trialists' Collaboration formulas. Estimated potential cost savings used published first-year costs of CVD events, adjusted for inflation and discounted to the present day. RESULTS: Of the 89,267 patients initiating statins, 30,083 (33.7%) did not achieve the LDL-C threshold (subcohort: 58.1%). In both groups, not achieving the threshold was associated with patients who were female, black, and those who had reduced medication adherence. Higher levels of preventive aspirin use and antihypertensive treatment were associated with threshold achievement. In both cohorts, approximately 64% of patients above the threshold were within 30 mg per dL of the respective threshold. Adherence to statin therapy regimen, judged by a medication possession ratio of ≥ 80%, was 57.4% in the general cohort and 56.7% in the subcohort. Of the patients who adhered to therapy, 23.7% of the general cohort and 50.5% of the subcohort had LDL-C levels that did not meet the threshold. 10-year CVD event risk in the at-or-above threshold group was 22.78% (SD = 17.24%) in the general cohort and 29.56% (SD = 18.19%) in the subcohort. By reducing LDL-C to the threshold, a potential relative risk reduction of 14.8% in the general cohort could avoid 1,173 CVD events over 10 years (subcohort: 15.7% and 454 events). Given first-year inpatient and follow-up costs of $37,300 per CVD event, this risk reduction could save about $1,455 per patient treated to reach the threshold (subcohort: $1,902; 2017 U.S. dollars) over a 10-year period. CONCLUSIONS: Across multiple health care systems in Indiana, between 34% (general cohort) and 58% (secondary prevention cohort) of patients treated with statins did not achieve therapeutic LDL-C thresholds. Based on current CVD event risk and cost projections, such patients seem to be at increased risk and may represent an important and potentially preventable burden on health care costs. DISCLOSURES: Funding support for this study was provided by Merck (Kenilworth, NJ). Chase and Boggs are employed by Merck. Simpson is a consultant to Merck and Pfizer. The other authors have nothing to disclose.


Assuntos
Doenças Cardiovasculares/prevenção & controle , LDL-Colesterol/sangue , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Hiperlipidemias/tratamento farmacológico , Idoso , Doenças Cardiovasculares/sangue , Doenças Cardiovasculares/economia , LDL-Colesterol/efeitos dos fármacos , Redução de Custos/estatística & dados numéricos , Efeitos Psicossociais da Doença , Análise Custo-Benefício , Relação Dose-Resposta a Droga , Feminino , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/economia , Hiperlipidemias/sangue , Hiperlipidemias/economia , Indiana , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Resultado do Tratamento
20.
Health Serv Res ; 54(4): 739-751, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31070263

RESUMO

OBJECTIVE: To estimate the effects of the health insurance exchange and Medicaid coverage expansions on hospital inpatient and emergency department (ED) utilization rates, cost, and patient illness severity, and also to test the association between changes in outcomes and the size of the uninsured population eligible for coverage in states. DATA SOURCES: Healthcare Cost and Utilization Project State Inpatient and Emergency Department Databases, 2011-2015, Nielsen Demographic Data, and the American Community Survey. STUDY DESIGN: Retrospective study using fixed-effects regression to estimate the effects in expansion and nonexpansion states by age/sex demographic groups. FINDINGS: In Medicaid expansion states, rates of uninsured inpatient discharges and ED visits fell sharply in many demographic groups. For example, uninsured inpatient discharge rates across groups, except young females, decreased by ≥39 percent per capita on average in expansion states. In nonexpansion states, uninsured utilization rates remained unchanged or increased slightly (0-9.2 percent). Changes in all-payer and private insurance rates were more muted. Changes in inpatient costs per discharge were negative, and all-payer inpatient costs per discharge declined <6 percent in most age/sex groups. The size of the uninsured population eligible for coverage was strongly associated with changes in outcomes. For example, among males aged 35-54 years in expansion states, there was a 0.793 percent decrease in the uninsured discharge rate per unit increase in the coverage expansion ratio (the ratio of the size of the population eligible for coverage to the size of the previously covered population within an age/sex/payer/geographic group). CONCLUSIONS: Significant shifts in cost per discharge and patient severity were consistent with selective take-up of insurance. The "treatment intensity" of expansions may be useful for anticipating future effects.


Assuntos
Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Custos Hospitalares/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Adulto , Fatores Etários , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Cobertura do Seguro/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Sexuais , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
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