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1.
Einstein (Sao Paulo) ; 18: eGS4442, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31576910

RESUMO

OBJECTIVE: To analyze the legal demands of tiotropium bromide to treat chronic obstructive pulmonary disease. METHODS: We included secondary data from the pharmaceutical care management systems made available by the Paraná State Drug Center. RESULTS: Public interest civil action and ordinary procedures, among others, were the most common used by the patients to obtain the medicine. Two Health Centers in Paraná (Londrina and Umuarama) concentrated more than 50% of the actions. The most common specialty of physicians who prescribed (33.8%) was pulmonology. There is a small financial impact of tiotropium bromide on general costs with medicines of the Paraná State Drug Center. However, a significant individual financial impact was observed because one unit of the medicine represents 38% of the Brazilian minimum wage. CONCLUSION: Our study highlights the need of incorporating this medicine in the class of long-acting anticholinergic bronchodilator in the Brazilian public health system.


Assuntos
Broncodilatadores/economia , Medicamentos Essenciais/provisão & distribução , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Função Jurisdicional , Doença Pulmonar Obstrutiva Crônica/economia , Brometo de Tiotrópio/economia , Brasil , Medicamentos Essenciais/economia , Acesso aos Serviços de Saúde/economia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Programas Nacionais de Saúde , Doença Pulmonar Obstrutiva Crônica/tratamento farmacológico , Estudos Retrospectivos , Estatísticas não Paramétricas , Fatores de Tempo
2.
PLoS One ; 14(1): e0210350, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30615663

RESUMO

INTRODUCTION: Chronic respiratory diseases in Tanzania are prevalent and a silent burden to the affected population, and healthcare system. We aimed to explore the availability of services and level of health facilities readiness to provide management of chronic respiratory diseases and its associated factors. METHODS: The current study is a secondary analysis of the 2014-2015 Tanzania Service Provision Assessment Survey data. Facilities were considered to have a high readiness to provide management of chronic respiratory diseases if they scored at least half (≥50%) of the indicators listed in each of the three domains (staff training and guideline, equipment, and basic medicines) as identified by World Health Organization-Service Availability and Readiness Assessment manual. Descriptive, unadjusted and adjusted logistic regression analyses were performed. A P value < 0.05 was taken to indicate statistical significance. RESULTS: Out of 723 facilities included in this analysis, approximately one-tenth had a high readiness to provide management of chronic respiratory diseases. Less than 10% of the facilities had at least one staff who received training for management of chronic respiratory diseases. In an adjusted model, privately owned facilities [AOR = 3.3; 95% CI, 1.5-7.5], hospitals [AOR = 11.6; 95% CI, 5.0-27.2], health centres [AOR = 5.0; 95% CI, 2.4-10.7], and performance of routine management meeting [AOR = 3.3; 95% CI, 1.4-7.8] were significantly associated with high readiness to provide management for chronic respiratory diseases. CONCLUSION: Majority of Tanzanian health facilities have low readiness to provide management for chronic respiratory diseases. There is a need for the Tanzanian government to increase the availability of diagnostic equipment, medication, and to provide refresher training specifically in the lower-level and public health facilities for better management of chronic respiratory diseases and other non-communicable diseases.


Assuntos
Assistência à Saúde/organização & administração , Instalações de Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Transtornos Respiratórios/epidemiologia , Transtornos Respiratórios/prevenção & controle , Feminino , Pesquisas sobre Serviços de Saúde , Instalações de Saúde/normas , Instalações de Saúde/provisão & distribução , Humanos , Masculino , Inquéritos e Questionários , Tanzânia/epidemiologia
3.
Rev. bioét. derecho ; (44): 73-88, nov. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-176790

RESUMO

La escasez de órganos es un problema global constante, aun cuando se presentan diversas alternativas para superar ese problema que genera miles de muertes cada año. El presente artículo analiza los problemas éticos y jurídicos del mercado regulado de órganos, partiendo del modelo de donación recompensada de riñones en vida entre no parientes, implantado en Irán en 1988. Para ello, se realizarán algunos apuntes históricos, pasando por la presentación de los procedimientos y características de dicho modelo, concluyendo con sus principales resultados, aciertos y errores. Al final, adoptando una base empírica como punto de partida, se pretende contribuir con el debate teórico que existe en torno a esa polémica alternativa


Organ shortage is a constant, global problem, even though various alternatives are presented to overcome a problem that generates thousands of deaths every year. This article analyses the ethical and legal issues of the regulated organ market, based on the model of rewarded donation of living kidneys among non-relatives, introduced in Iran in 1988. To this purpose, some historical notes will be made, including a presentation of the procedures and characteristics of the Iranian model, concluding with its main results, successes and errors. In the end, adopting an empirical basis as a starting point, the aim is to contribute to the theoretical debate that exists around this controversial alternative


L'escassetat d'òrgans és un problema global constant, tot i que es presenten diverses alternatives per superar aquest problema que genera milers de morts cada any. El present article analitza els problemes ètics i jurídics del mercat regulat d'òrgans, partint del model de donació recompensada de ronyons en vida entre no parents implantat a Iran en 1988. A tal fi, es realitzaran algunes anotacions històriques, passant per la presentació dels procediments i característiques d'aquest model i concloent amb els seus principals resultats, encerts i errors. Adoptant una base empírica com a punt de partida, el que es pretén és intervenir en el debat teòric que existeix a l’entorn d'aquesta polèmica alternativa


Assuntos
Humanos , Obtenção de Tecidos e Órgãos/ética , Obtenção de Tecidos e Órgãos/legislação & jurisprudência , Coleta de Tecidos e Órgãos/ética , Doação Dirigida de Tecido/ética , Doação Dirigida de Tecido/legislação & jurisprudência , Irã (Geográfico) , Necessidades e Demandas de Serviços de Saúde/ética , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Diálise Renal/ética , Transplante de Rim/ética
5.
Wiad Lek ; 71(3 pt 2): 772-776, 2018.
Artigo em Ucraniano | MEDLINE | ID: mdl-29783265

RESUMO

OBJECTIVE: Introduction: The development of international legal cooperation in the field of health has largely been driven by the trade interests of states. The aim: The article analyzes the legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization. PATIENTS AND METHODS: Materials and methods: Using the historical legal method has allowed to analyze the genesis of legal regulation of the circulation of medicines through the prism of the law of the World Trade Organization. The dialectical method is widely used, in particular, when it comes to the issue of the ratio of market regulation of medicines circulation and public health protection, the formal logic method, in particular, in formulating the general principles, principles and methods of legal regulation in the field of medicines, as well as the systemic method, in particular, in defining the institutional component of legal regulation in the field of medicines. RESULTS: Review: The activities of the WTO include several areas related to health protection: international control over infectious diseases, international legal regulation of food safety (food security), tobacco control, environmental protection, international legal aspects of access and treatment of medicinal and pharmaceutical products, international legal regulation of medical services provision. CONCLUSION: Conclusions: It is proved that the right to health is a right to access to medicines. However, for many developing countries, it is problematic to obtain patents for the production of necessary medicines or to pay a license fee, which creates a barrier to the realization of the right to health.


Assuntos
Acesso aos Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Direitos Humanos/legislação & jurisprudência , Países Desenvolvidos , Países em Desenvolvimento , Indústria Farmacêutica/legislação & jurisprudência , Saúde Global , Acesso aos Serviços de Saúde/estatística & dados numéricos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Direitos Humanos/estatística & dados numéricos , Humanos , Cooperação Internacional
7.
Lancet ; 391(10133): 1953-1964, 2018 05 12.
Artigo em Inglês | MEDLINE | ID: mdl-29550030

RESUMO

Modern, affordable pathology and laboratory medicine (PALM) systems are essential to achieve the 2030 Sustainable Development Goals for health in low-income and middle-income countries (LMICs). In this last in a Series of three papers about PALM in LMICs, we discuss the policy environment and emphasise three crucial high-level actions that are needed to deliver universal health coverage. First, nations need national strategic laboratory plans; second, these plans require adequate financing for implementation; and last, pathologists themselves need to take on leadership roles to advocate for the centrality of PALM to achieve the Sustainable Development Goals for health. The national strategic laboratory plan should deliver a tiered, networked laboratory system as a central element. Appropriate financing should be provided, at a level of at least 4% of health expenditure. Financing of new technologies such as molecular diagnostics is challenging for LMICs, even though many of these tests are cost-effective. Point-of-care testing can substantially reduce test-reporting time, but this benefit must be balanced with higher costs. Our research analysis highlights a considerable deficiency in advocacy for PALM; pathologists have been invisible in national and international health discourse and leadership. Embedding PALM in LMICs can only be achieved if pathologists advocate for these services, and undertake leadership roles, both nationally and internationally. We articulate eight key recommendations to address the current barriers identified in this Series and issue a call to action for all stakeholders to come together in a global alliance to ensure the effective provision of PALM services in resource-limited settings.


Assuntos
Serviços de Laboratório Clínico/normas , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Sistemas Automatizados de Assistência Junto ao Leito/economia , Qualidade da Assistência à Saúde/normas , Serviços de Laboratório Clínico/legislação & jurisprudência , Países em Desenvolvimento , Educação em Saúde , Gastos em Saúde , Política de Saúde , Humanos , Patologistas , Pobreza , Saúde Pública , Qualidade da Assistência à Saúde/legislação & jurisprudência
8.
BMC Psychiatry ; 17(1): 376, 2017 11 24.
Artigo em Inglês | MEDLINE | ID: mdl-29178895

RESUMO

BACKGROUND: In the UK, crisis planning for mental health care should acknowledge the right to make an informed advance treatment refusal under the Mental Capacity Act 2005. Our aims were to estimate the demand for such treatment refusals within a sample of service users who had had a recent hospital admission for psychosis or bipolar disorder, and to examine the relationship between refusals, and service user characteristics. METHODS: To identify refusals we conducted content analysis of Joint Crisis Plans, which are plans formulated by service users and their clinical team with involvement from an external facilitator, and routine care plans in sub-samples from a multi-centre randomised controlled trial of Joint Crisis Plans (plus routine mental health care) versus routine care alone (CRIMSON) in England. Factors hypothesised to be associated with refusals were identified using the trial data collected through baseline interviews of service users and clinicians and collection of routine clinical data. RESULTS: Ninety-nine of 221 (45%) of the Joint Crisis Plans contained a treatment refusal compared to 10 of 424 (2.4%) baseline routine care plans. No Joint Crisis Plans recorded disagreement with refusals on the part of clinicians. Among those with completed Joint Crisis Plans, adjusted analyses indicated a significant association between treatment refusals and perceived coercion at baseline (odds ratio = 1.21, 95% CI 1.02-1.43), but not with baseline working alliance or a past history of involuntary admission. CONCLUSIONS: We demonstrated significant demand for written treatment refusals in line with the Mental Capacity Act 2005, which had not previously been elicited by the process of treatment planning. Future treatment/crisis plans should incorporate the opportunity for service users to record a treatment refusal during the drafting of such plans. TRIAL REGISTRATION: ISRCTN11501328 Registered 13th March 2008.


Assuntos
Intervenção na Crise/métodos , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Transtornos Mentais/terapia , Planejamento de Assistência ao Paciente/estatística & dados numéricos , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Adulto , Transtorno Bipolar/psicologia , Transtorno Bipolar/terapia , Coerção , Intervenção na Crise/legislação & jurisprudência , Inglaterra , Análise Fatorial , Feminino , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Hospitalização , Humanos , Consentimento Livre e Esclarecido/legislação & jurisprudência , Consentimento Livre e Esclarecido/psicologia , Masculino , Transtornos Mentais/psicologia , Planejamento de Assistência ao Paciente/legislação & jurisprudência , Transtornos Psicóticos/psicologia , Transtornos Psicóticos/terapia , Ensaios Clínicos Controlados Aleatórios como Assunto , Recusa do Paciente ao Tratamento/psicologia
9.
Psychiatr Pol ; 51(4): 599-608, 2017 Aug 29.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-28987051

RESUMO

Stay in a psychiatric hospital of persons who committed the gravest criminal acts while in a state of insanity aims to ensure their effective treatment (therapeutic function), but above all to prevent the repetition of prohibited acts of significant harm to the community (preventive function). Forensic patients are provided with suitable medical, psychiatric, rehabilitation and resocialization care. The court imposes an indefinite detention. In view of the dual purpose of the stay in a psychiatric hospital, both therapeutic and preventive, the treatment costs generated by forensic wards are higher than those of general psychiatric wards. This prompts person from outside psychiatry, who do not understand the nature of preventive measures, to call for continuing reductions in the expenditure on forensic psychiatric care. It is, therefore, worth analyzing the possible meaning and results of the attempts to economizeforensic psychiatry, to find savings and to manipulate financing system under the pretence of economic incentive to improve treatment quality. In this paper, the authors address and discuss the above and other issues.


Assuntos
Internação Compulsória de Doente Mental/legislação & jurisprudência , Serviços Comunitários de Saúde Mental/legislação & jurisprudência , Reforma dos Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Segurança/legislação & jurisprudência , Hospitais Psiquiátricos/legislação & jurisprudência , Humanos , Alta do Paciente/legislação & jurisprudência , Competência Profissional/legislação & jurisprudência , Saúde Pública/legislação & jurisprudência
10.
Nervenarzt ; 88(11): 1292-1297, 2017 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-29063263

RESUMO

Complex trends in occupancy determined by many influencing factors, clear state-specific differences in imprisonment practices as well as recently implemented statutory alterations to the appropriate paragraphs in criminal law, underline the necessity for qualitative high-grade concomitant research of German forensic commitment; however, neither the structural prerequisites nor an adequate data situation are currently present in order to do justification to this aim. Not even the total number of patients currently accommodated in forensic commitment can be elucidated from the publicized (partial) statistics. This consensus paper, which was formulated by three research institutes active at the state level, describes the limited possibilities for current forensic healthcare research and raises the demand for a nationwide uniform data situation on patients in forensic commitment. Furthermore, how the appropriate elicitation instrument should be organizationally and structurally achieved, is sketched from a scientific perspective. This article aims at initiating a discussion on a sustainable improvement in the prerequisites for healthcare research in German forensic commitment and targets a sensitization of decision makers in politics and administration for this topic.


Assuntos
Internação Compulsória de Doente Mental/tendências , Coleta de Dados/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Pesquisa sobre Serviços de Saúde/tendências , Internação Compulsória de Doente Mental/legislação & jurisprudência , Coleta de Dados/legislação & jurisprudência , Previsões , Alemanha , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Pesquisa sobre Serviços de Saúde/legislação & jurisprudência , Humanos , Inquéritos e Questionários
11.
Tech Vasc Interv Radiol ; 20(2): 109-115, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28673647

RESUMO

Physician-inventors are in a unique position to identify unserved patient needs, and innovate solutions to clinical problems. These solutions may also have associated commercial opportunities. The logistics of developing these medical products, however, can seem a daunting task. One of the primary barriers in the United States is the regulatory process of the Food and Drug Administration (FDA). In this article, we will explore the risk-based approach used by the FDA which forms a framework to consider the regulatory pathway and the process to gain regulatory clearance or approval for medical devices. Inherent device properties and the procedural risk of the devices will determine the rigor with which they are scrutinized by FDA, and the evidentiary requirements to legally market them. Data and evidentiary development will vary depending on risk and regulatory precedent and may or may not require clinical data This regulatory paradigm will determine into which risk-based device class they fit, and whether they are regulated under the 510(k) or premarket approval application pathways. The FDA, although gatekeeper of the US market and tasked with determining which products are safe and effective, can be a powerful ally for product development. They have significant scientific and medical expertise, and mechanisms to both provide guidance, and also to consider novel approaches to product development and evidence development. Early interaction for routine and novel products alike can result in expedited and efficient development. This collaborative approach can be best practice to most expeditiously develop the next generation of products, getting them into the hands of US doctors and into the treatment of US patients.


Assuntos
Aprovação de Equipamentos/legislação & jurisprudência , Equipamentos e Provisões , Setor de Assistência à Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Determinação de Necessidades de Cuidados de Saúde/legislação & jurisprudência , Avaliação da Tecnologia Biomédica/legislação & jurisprudência , United States Food and Drug Administration/legislação & jurisprudência , Difusão de Inovações , Desenho de Equipamento , Equipamentos e Provisões/efeitos adversos , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Segurança do Paciente , Medição de Risco , Fatores de Risco , Avaliação da Tecnologia Biomédica/organização & administração , Estados Unidos
12.
Tech Vasc Interv Radiol ; 20(2): 116-120, 2017 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-28673648

RESUMO

Intellectual property (IP) is a term that describes a number of distinct types of intangible assets. IP protection allows a rightsholder to exclude others from interfering with or using the property right in specified ways. The main forms of IP are patents, copyrights, trademarks, and trade secrets. Each type of IP protection is different, varying in the subject matter that can be covered, timeframe of protection, and total expense. Although some inventions may be covered by multiple types of IP protection, it is important to consider a number of business and legal factors before selecting the best protection strategy. Some technologies require strong IP protection to commercialize, but unnecessary costs can derail bringing a product to market. IP departments of organizations weigh these various considerations and perform essential IP protection functions. This primer introduces researchers to the main forms of IP and its legal aspects.


Assuntos
Setor de Assistência à Saúde , Necessidades e Demandas de Serviços de Saúde , Propriedade Intelectual , Determinação de Necessidades de Cuidados de Saúde , Avaliação da Tecnologia Biomédica , Direitos Autorais , Difusão de Inovações , Desenho de Equipamento , Setor de Assistência à Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/organização & administração , Humanos , Determinação de Necessidades de Cuidados de Saúde/legislação & jurisprudência , Determinação de Necessidades de Cuidados de Saúde/organização & administração , Patentes como Assunto , Avaliação da Tecnologia Biomédica/legislação & jurisprudência , Avaliação da Tecnologia Biomédica/organização & administração
13.
Policy Polit Nurs Pract ; 18(2): 72-83, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28735567

RESUMO

Providing affordable, high-quality care for the 10 million persons who are dual-eligible beneficiaries of Medicare and Medicaid is an ongoing health-care policy challenge in the United States. However, the workforce and the care provided to dual-eligible beneficiaries are understudied. The purpose of this article is to provide a narrative of the challenges and lessons learned from an exploratory study in the use of clinical and administrative data to compare the workforce of two care models that deliver home- and community-based services to dual-eligible beneficiaries. The research challenges that the study team encountered were as follows: (a) comparing different care models, (b) standardizing data across care models, and (c) comparing patterns of health-care utilization. The methods used to meet these challenges included expert opinion to classify data and summative content analysis to compare and count data. Using descriptive statistics, a summary comparison of the two care models suggested that the coordinated care model workforce provided significantly greater hours of care per recipient than the integrated care model workforce. This likely represented the coordinated care model's focus on providing in-home services for one recipient, whereas the integrated care model focused on providing services in a day center with group activities. The lesson learned from this exploratory study is the need for standardized quality measures across home- and community-based services agencies to determine the workforce that best meets the needs of dual-eligible beneficiaries.


Assuntos
Definição da Elegibilidade/legislação & jurisprudência , Política de Saúde , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Cobertura do Seguro/legislação & jurisprudência , Medicaid/legislação & jurisprudência , Medicare/legislação & jurisprudência , Gastos em Saúde/legislação & jurisprudência , Acesso aos Serviços de Saúde/legislação & jurisprudência , Humanos , Estados Unidos
15.
Australas J Ageing ; 36(4): E43-E49, 2017 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-28547921

RESUMO

OBJECTIVE: To develop projections of the size of the Australian population aged 65 years and over eligible for disability support through the National Disability Insurance Scheme (NDIS) for the decade following its introduction, to support planning and costing of the scheme. METHODS: We estimate disability and mortality transition probabilities and develop projections of the NDIS-eligible, ageing population from 2017 to 2026. RESULTS: An estimated 8000 men and 10 200 women aged 65 years and over will be eligible for support through the NDIS in 2017 (the scheme's first full year), increasing to 48 800 men and 56 900 women in 2026. CONCLUSIONS: Growth in the NDIS-eligible, ageing population has implications for relative budget allocations between the NDIS and the aged-care system, and projections of the size of this population are useful for calculating the overall cost of the NDIS.


Assuntos
Envelhecimento , Avaliação da Deficiência , Pessoas com Deficiência/estatística & dados numéricos , Definição da Elegibilidade/tendências , Necessidades e Demandas de Serviços de Saúde/tendências , Seguro por Invalidez/tendências , Determinação de Necessidades de Cuidados de Saúde/tendências , Fatores Etários , Idoso , Austrália , Pessoas com Deficiência/legislação & jurisprudência , Definição da Elegibilidade/legislação & jurisprudência , Feminino , Previsões , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Seguro por Invalidez/legislação & jurisprudência , Masculino , Determinação de Necessidades de Cuidados de Saúde/legislação & jurisprudência , Formulação de Políticas , Dinâmica Populacional/tendências , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo
16.
Soins Psychiatr ; 38(310): 12-16, 2017 May - Jun.
Artigo em Francês | MEDLINE | ID: mdl-28476249

RESUMO

From confinement to the philosophy of care in the community, the history of psychiatry testifies to the evolution of practices in the matter of the restriction of freedom. The French National Health Authority still too often recommends practices based on restraint. Caregivers, in relation to the clinical aspect of the patients, need clearly identified therapeutic projects. While training can be vital for them, risk management policies can prove to be a hindrance to patients' freedom.


Assuntos
Transtornos Mentais/enfermagem , Transtornos Mentais/psicologia , Isolamento de Pacientes/psicologia , Isolamento de Pacientes/tendências , Restrição Física/psicologia , Gestão de Riscos/tendências , Previsões , França , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/tendências , Humanos , Relações Enfermeiro-Paciente , Isolamento de Pacientes/legislação & jurisprudência , Autonomia Pessoal , Filosofia em Enfermagem , Restrição Física/legislação & jurisprudência , Restrição Física/estatística & dados numéricos , Gestão de Riscos/legislação & jurisprudência
18.
Clin. transl. oncol. (Print) ; 19(2): 204-210, feb. 2017. tab
Artigo em Inglês | IBECS | ID: ibc-159453

RESUMO

Aim. Assessing the demand for radiotherapy in Spain based on existing evidence to estimate the human resources and equipment needed so that every person in Spain has access to high-quality radiotherapy when they need it. Material and methods. We used data from the European Cancer Observatory on the estimated incidence of cancer in Spain in 2012, along with the evidence-based indications for radiotherapy developed by the Australian CCORE project, to obtain an optimal radiotherapy utilisation proportion (OUP) for each tumour. Results. About 50.5 % of new cancers in Spain require radiotherapy at least once over the course of the disease. Additional demand for these services comes from reradiation therapy and non-melanoma skin cancer. Approximately, 25–30 % of cancer patients with an indication for radiotherapy do not receive it due to factors that include access, patient preference, familiarity with the treatment among physicians, and especially resource shortages, all of which contribute to its underutilisation. Conclusions. Radiotherapy is underused in Spain. The increasing incidence of cancer expected over the next decade and the greater frequency of reradiations necessitate the incorporation of radiotherapy demand into need-based calculations for cancer services planning (AU)


No disponible


Assuntos
Humanos , Masculino , Feminino , Radioterapia Assistida por Computador/instrumentação , Radioterapia Assistida por Computador/métodos , Radioterapia Assistida por Computador , Radioterapia Adjuvante/métodos , Neoplasias Cutâneas/epidemiologia , Estadiamento de Neoplasias/métodos , Estadiamento de Neoplasias , Espanha/epidemiologia , Benchmarking/organização & administração , Benchmarking/normas , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Necessidades e Demandas de Serviços de Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde/tendências
19.
Rehabil Psychol ; 62(1): 7-19, 2017 02.
Artigo em Inglês | MEDLINE | ID: mdl-28045280

RESUMO

PURPOSE: Existing research suggests that the decision to grant or deny workplace accommodations for people with disabilities is influenced by a range of legal and nonlegal factors. However, less is known about how these factors operate at the within-person level. Thus, we proposed and tested a multilevel model of the accommodation decision-making process, which we applied to better understand why people with psychological disabilities often experience greater challenges in obtaining accommodations. METHOD: A sample of 159 Australian adults, composed mostly of managers and HR professionals, read 12 vignettes involving requests for accommodations from existing employees. The requests differed in whether they were for psychological or physical disabilities. For each vignette, participants rated their empathy with the employee, the legitimacy of the employee's disability, the necessity for productivity, the perceived cost, and the reasonableness, and indicated whether they would grant the accommodation. RESULTS: Multilevel modeling indicated that greater empathy, legitimacy, and necessity, and lower perceived cost predicted perceptions of greater reasonableness and greater granting. Accommodation requests from employees with psychological disabilities were seen as less reasonable and were less likely to be granted; much of this effect seemed to be driven by perceptions that such accommodations were less necessary for productivity. Ratings on accommodations were influenced both by general between-person tendencies and within-person appraisals of particular scenarios. CONCLUSIONS: The study points to a need for organizations to more clearly establish guidelines for how decision-makers should fairly evaluate accommodation requests for employees with psychological disabilities and disability more broadly. (PsycINFO Database Record


Assuntos
Acessibilidade Arquitetônica/métodos , Tomada de Decisões , Pessoas com Deficiência/reabilitação , Análise Multinível , Reabilitação Vocacional/métodos , Local de Trabalho , Adulto , Acessibilidade Arquitetônica/legislação & jurisprudência , Austrália , Pessoas com Deficiência/legislação & jurisprudência , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Humanos , Masculino , Pessoas com Deficiência Mental/legislação & jurisprudência , Pessoas com Deficiência Mental/reabilitação , Pessoa de Meia-Idade , Preconceito , Estereotipagem
20.
J Int Assoc Provid AIDS Care ; 16(4): 383-395, 2017 Jul/Aug.
Artigo em Inglês | MEDLINE | ID: mdl-26139096

RESUMO

The Health Resources and Services Administration requires that jurisdictions receiving Ryan White (RW) funding justify need, set priorities, and provide allocations using evidence-based methods. Methods and results from the 2011 Los Angeles Coordinated HIV/AIDS Needs Assessment-Care (LACHNA-Care) study are presented. Individual-level weights were applied to expand the sample from 400 to 18 912 persons, consistent with the 19 915 clients in the system. Awareness, need, and utilization for medical outpatient care were high (>90%). Other services (eg, child care) had limited awareness (21%). Majority of participants reported at least 1 service gap (81%). Lack of insurance (risk ratio [RR] = 3.0, 95% confidence interval [CI]: 1.5-6.2), substance use (RR = 2.9, 95% CI: 1.3-6.4), and past lapses in medical care (RR = 2.8, 95% CI: 1.3-5.9) were associated with gaps. Within clusters, past incarceration was associated with gaps for housing (RR = 13.5, 95% CI: 3.5-52.1), transportation (RR = 3.2, 95% CI: 1.2-8.4), and case management (RR = 4.0, 95% CI: 1.3-12.2). Applied methods resulted in representative data instrumental to RW program planning efforts.


Assuntos
Assistência à Saúde/estatística & dados numéricos , Infecções por HIV/terapia , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Serviço Social/estatística & dados numéricos , Adolescente , Adulto , Assistência Ambulatorial/estatística & dados numéricos , Administração de Caso/estatística & dados numéricos , Assistência à Saúde/economia , Assistência à Saúde/legislação & jurisprudência , Serviços de Saúde Bucal/estatística & dados numéricos , Feminino , Infecções por HIV/complicações , Infecções por HIV/economia , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde/economia , Necessidades e Demandas de Serviços de Saúde/legislação & jurisprudência , Serviços de Assistência Domiciliar/estatística & dados numéricos , Cuidados Paliativos na Terminalidade da Vida/estatística & dados numéricos , Habitação/estatística & dados numéricos , Humanos , Los Angeles , Masculino , Pessoas sem Cobertura de Seguro de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Projetos de Pesquisa , Amostragem , Serviço Social/economia , Serviço Social/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias/complicações , Inquéritos e Questionários , Transportes/estatística & dados numéricos , Adulto Jovem
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