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1.
Medicine (Baltimore) ; 98(39): e17376, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31574887

RESUMO

This study aimed to compare the catastrophic health expenditure (CHE) and impoverishment of type 2 diabetes mellitus (T2DM) patients between 2 ethnic groups and explore the contribution of associated factors to ethnic differences in CHE and impoverishment in Ningxia Hui Autonomous Region, China.A cross-sectional study was conducted in 2 public hospitals from October 2016 to June 2017. Data were collected by interviewing eligible Hui and Han T2DM inpatients and reviewing the hospital electronic records. Both CHE and impoverishment were measured by headcount and gap. The contributions of associated factors to ethnic differences were analyzed by the Blinder-Oaxaca decomposition technique.Both the CHE and impoverishment of Hui patients before and after reimbursement were significantly higher than those of Han patients. The ethnic differences in CHE and impoverishment headcount after reimbursement were 11.9% and 9.8%, respectively. The different distributions of associated factors between Hui and Han patients contributed to 60.5% and 35.7% of ethnic differences in CHE and impoverishment, respectively. Household income, occupation, and region were significant contributing factors.Hui T2DM patients suffered greater CHE and impoverishment than Han patients regardless of reimbursements from health insurance. Differences in socioeconomic status between Hui and Han patients were the main factors behind the ethnic differences.


Assuntos
Doença Catastrófica/economia , Diabetes Mellitus Tipo 2/economia , Gastos em Saúde/estatística & dados numéricos , Seguro Saúde/economia , Pobreza/economia , Idoso , China , Estudos Transversais , Diabetes Mellitus Tipo 2/etnologia , Grupos Étnicos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos
2.
BMC Health Serv Res ; 19(1): 580, 2019 Aug 19.
Artigo em Inglês | MEDLINE | ID: mdl-31426781

RESUMO

BACKGROUND: Care-seeking behavior is widely acknowledged to have strong influences on health outcomes among individuals with chronic conditions including diabetes. Despite its dynamic nature, care seeking behavior are often considered as time invariant in most studies. The likelihood of patients changing their regularity and source of chronic care over time is often neglected. This study aimed to determine the long-term trajectories of care-seeking patterns of both care-seeking regularity and health provider choices; and their associated factors among patients with type 2 diabetes under the National Health Insurance (NHI) program in Taiwan. METHODS: We utilized population-based data from the National Health Insurance Research Database (NHIRD) in Taiwan. Three thousand, nine hundred and eighty-seven adult patients with newly diagnosed type 2 diabetes in 1999 were enrolled in the cohort. We assessed their trajectories of regular care visits and sources of diabetes care from 2000 to 2010. A group-based trajectory model was applied. RESULTS: Seven distinct groups of long-term care-seeking patterns were identified. Only 51.44% of patients with newly diagnosed diabetes had regularly visited their providers over time. Among them, 56.41 and 16.09% had persistently sought care from generalized and specialized providers, respectively. 27.50% had sought care from different levels of providers. Patients who were male, elderly, low-income, and had a higher baseline diabetes severity were significantly more likely to either continue with their irregular care-seeking behavior or fail to maintain their regular care seeking behavior over time. Those who were younger, had a higher socioeconomic status, and lived in an urban area were significantly more likely to persistently seek care from specialized care settings. CONCLUSIONS: This study is the first population-based assessment of long-term care-seeking behaviors of type 2 diabetes patients under a single-payer system with a comprehensive benefit coverage. The most alarming finding was that, despite the existence of the comprehensive universal health insurance coverage in Taiwan, almost 50% of patients did not seek or maintain regular visits to providers over time as recommended. Understanding variations in the long-term trajectories of care adherence and sources of care may help to identify gaps in diabetes care management.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sistema de Fonte Pagadora Única/estatística & dados numéricos , Adulto , Idoso , Doença Crônica , Diabetes Mellitus Tipo 2/economia , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Pobreza/economia , Pobreza/estatística & dados numéricos , Estudos Retrospectivos , Taiwan , Cobertura Universal do Seguro de Saúde/economia , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Adulto Jovem
3.
BMC Public Health ; 19(1): 1132, 2019 Aug 17.
Artigo em Inglês | MEDLINE | ID: mdl-31420035

RESUMO

BACKGROUND: The mortality rate in children under 5 years old (U5MR) has decreased considerably in Ecuador in the last decade; however, thousands of children continue to die from causes related to poverty. A social program known as Bono de Desarrollo Humano (BDH) was created to guarantee a minimum level of consumption for families and to reduce chronic malnutrition and preventable childhood diseases. We sought to evaluate the effect of the BDH program on mortality of children younger than 5 years, particularly from malnutrition, diarrheal diseases, and lower respiratory tract infections. METHODS: Mortality rates and BDH coverage from 2009 to 2014 were evaluated from the 144 (of 222) Ecuadorian counties with intermediate and high quality of vital information. A multivariable regression analyses for panel data was conducted by using a negative binomial regression model with fixed effects, adjusted for all relevant demographic and socioeconomic covariates. RESULTS: Our research shows that for each 1% increase in BDH county coverage there would be a decrease in U5MR from malnutrition of 3% (RR 0.971, 95% CI 0.953-0.989). An effect of BDH county coverage on mortality resulting from respiratory infections was also observed (RR 0.992, 95% CI 0.984-0.999). The BDH also reduced hospitalization rates in children younger than 5 years, overall and for diarrhea. CONCLUSIONS: A conditional cash transfer program such as BDH could contribute to the reduction of mortality due to causes related to poverty, such as malnutrition and respiratory infections. The coverage should be maintained -or increased in a period of economic crisis- and its implementation strengthened.


Assuntos
Saúde da Criança/economia , Mortalidade da Criança/tendências , Pobreza/economia , Assistência Pública/economia , Transtornos da Nutrição Infantil/economia , Transtornos da Nutrição Infantil/mortalidade , Pré-Escolar , Diarreia/economia , Diarreia/mortalidade , Equador/epidemiologia , Feminino , Hospitalização/tendências , Humanos , Lactente , Recém-Nascido , Masculino , Análise de Regressão , Infecções Respiratórias/economia , Infecções Respiratórias/mortalidade
4.
Pediatrics ; 144(2)2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31292218

RESUMO

BACKGROUND AND OBJECTIVE: Children with special health care needs (SHCNs) have significant medical and educational expenses affecting household finances. Housing instability can be detrimental to family well-being. Our objective was to evaluate housing instability in households of children with and without SHCNs. METHODS: Cross-sectional surveys (2013-2017) in English and Spanish of caregivers with children <4 years old were conducted at 5 hospitals. The children with SHCN screener and caregiver report of child Supplemental Security Income (SSI) receipt were used to categorize children into the following groups: (1) no SHCNs, (2) SHCNs and no SSI, or (3) SHCNs and receiving SSI. Housing instability was determined by positive endorsement of ≥1 adverse circumstance: behind on rent or mortgage, or moving twice or more in the past year, or homelessness in the child's lifetime. Analyses used multivariable logistic regression models, adjusting for demographics and housing subsidies. RESULTS: Of 14 188 children, 80% had no SHCNs, 16% had SHCNs and no SSI, and 4% had SHCNs and received SSI. Compared with the no-SHCNs group, the SHCNs-no-SSI group but not the SHCN-receiving-SSI group experienced significantly greater adjusted odds of being behind on rent or mortgage (adjusted odds ratio [aOR] 1.28 [95% confidence interval (CI) 1.14-1.44]; P < .001), multiple moves (aOR 1.29 [95% CI 1.05-1.59]; P = .01), and homelessness (aOR 1.44 [95% CI 1.20-1.72]; P < .001). CONCLUSIONS: Families of children with SHCNs are at risk for housing instability. Child SSI receipt decreased the risk of housing instability among families of children with SHCNs. Protecting families of young children with SHCNs from housing instability is an important investment.


Assuntos
Necessidades e Demandas de Serviços de Saúde/tendências , Serviços de Saúde para Pessoas com Deficiência/tendências , Habitação , Pobreza/tendências , Pré-Escolar , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde/economia , Serviços de Saúde para Pessoas com Deficiência/economia , Habitação/economia , Humanos , Renda/tendências , Lactente , Masculino , Pobreza/economia
5.
World Neurosurg ; 130: e822-e830, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31295603

RESUMO

OBJECTIVE: In 2015, the Lancet Commission on Global Surgery highlighted the disparities in surgical care worldwide. The aim of the present study was to investigate the research productivity of low-income countries (LICs) and low- to middle-income countries (LMICs) in selected journals representing the worldwide neurosurgical data and their ability to report and communicate globally the existing differences between high-income countries (HICs) and LMICs. METHODS: We performed a retrospective bibliometric analysis using PubMed and Scopus databases to record all the reports from 2015 to 2017 by investigators affiliated with neurosurgical departments in LICs and LMICs. RESULTS: A total of 8459 reports by investigators self-identified as members of neurosurgery departments worldwide were identified. Of these, 6708 reports were included in accordance with our method in the final analysis. The systematic search resulted in 459 studies reported by LICs and LMICs. Of these, 334 reports were included for the full text evaluation. Of the 6708 reports, 303 (4.52%) had been reported with an LMIC affiliation and only 31 (0.46%) with an LIC. The leading countries were India with 182 (54.5% among LMICs and LICs; 2.71% overall), followed by Egypt at 66 (19.76% among the LMICs and LICs; 0.98% overall), with a large difference compared with other countries such as Uganda at 9 (2.69% among the LMICs and LICs) and Tunisia and Pakistan at 8 each (2.4% among the LMICs and LICs). A few reports studies had been generated by collaboration with HIC neurosurgeons. CONCLUSIONS: Our results have shown that research studies from LMICs are underrepresented. Understanding and discussing the reasons for this underrepresentation are necessary to start addressing the disparities in neurosurgical research and care capacity. Future engagements from international journals, more partnership collaboration from HICs, and tailored funding to support investigators, collaborations, and networks could be of help.


Assuntos
Bibliometria , Análise de Dados , Países em Desenvolvimento/economia , Procedimentos Neurocirúrgicos/economia , Pobreza/economia , Relatório de Pesquisa , Humanos , Procedimentos Neurocirúrgicos/tendências , Pobreza/tendências , Relatório de Pesquisa/tendências , Estudos Retrospectivos
6.
BMC Pregnancy Childbirth ; 19(1): 193, 2019 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-31159753

RESUMO

BACKGROUND: The effects of conditional cash transfer (CCT) programs on maternal and child health (MCH) service use in conflicted affected countries such as Afghanistan are not known. METHODS: We conducted a non-randomised population based intervention study in six Afghanistan districts from December 2016 to December 2017. Six control districts were purposively matched. Women were eligible to be included in the baseline and endline evaluation surveys if they had given birth to one or more children in the last 12 months. The intervention was a CCT program including information, education, communication (IEC) program about CCT to community members and financial incentives to community health workers (CHWs) and families if mothers delivered their child at a health facility. Control districts received standard care. The primary objective was to assess the effect of CCT on use of health facilities for delivery. Secondary objectives were to assess the effect of CCT on antenatal care (ANC), postnatal care (PNC) and CHW motivation to perform home visits. Outcomes were analysed at 12 months using multivariable difference-in-difference linear regression models adjusted for clustering and socio demographic variables. RESULTS: Overall, facility delivery increased in intervention villages by 14.3% and control villages by 8.4% (adjusted mean difference [AMD] 3.3%; 95% confidence interval [- 0.14 to 0.21], p value 0.685). There was no effect in the poorest quintile (AMD 0.8% [- 0.30 to 0.32], p value 0.953). ANC (AMD 45.0% [0.18 to 0.72] p value 0.004) and PNC (AMD 31.8% [- 0.05 to 0.68] p value 0.080) increased in the intervention compared to the control group. CHW home visiting changed little in intervention villages (- 3.0%) but decreased by - 23.9% in control villages (AMD 12.2% [- 0.27 to 0.51], p value 0.508). CCT exposure was 27.3% (342/1254) overall and 10.2% (17/166) in the poorest quintile. CONCLUSIONS: Our study demonstrated that a CCT program provided to women aged 16-49 years can be implemented in a highly conservative conflict affected population. CCT should be scaled up for the poorest women in Afghanistan.


Assuntos
Utilização de Instalações e Serviços/economia , Instalações de Saúde/estatística & dados numéricos , Serviços de Saúde Materno-Infantil/economia , Assistência Médica , Cuidado Pré-Natal/economia , Adulto , Afeganistão , Conflitos Armados , Agentes Comunitários de Saúde/economia , Feminino , Humanos , Recém-Nascido , Mães/estatística & dados numéricos , Pobreza/economia , Gravidez , Estudos Prospectivos , Adulto Jovem
7.
PLoS One ; 14(5): e0217617, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31150458

RESUMO

BACKGROUND: Health care provider (HCP) performance in low- and middle-income countries (LMICs) is often inadequate. The Health Care Provider Performance Review (HCPPR) is a comprehensive systematic review of the effectiveness and cost of strategies to improve HCP performance in LMICs. We present the HCPPR's methods, describe methodological and contextual attributes of included studies, and examine time trends of study attributes. METHODS: The HCPPR includes studies from LMICs that quantitatively evaluated any strategy to improve HCP performance for any health condition, with no language restrictions. Eligible study designs were controlled trials and interrupted time series. In 2006, we searched 15 databases for published studies; in 2008 and 2010, we completed searches of 30 document inventories for unpublished studies. Data from eligible reports were double-abstracted and entered into a database, which is publicly available. The primary outcome measure was the strategy's effect size. We assessed time trends with logistic, Poisson, and negative binomial regression modeling. We were unable to register with PROSPERO (International Prospective Register of Systematic Reviews) because the protocol was developed prior to the PROSPERO launch. RESULTS: We screened 105,299 citations and included 824 reports from 499 studies of 161 intervention strategies. Most strategies had multiple components and were tested by only one study each. Studies were from 79 countries and had diverse methodologies, geographic settings, HCP types, work environments, and health conditions. Training, supervision, and patient and community supports were the most commonly evaluated strategy components. Only 33.6% of studies had a low or moderate risk of bias. From 1958-2003, the number of studies per year and study quality increased significantly over time, as did the proportion of studies from low-income countries. Only 36.3% of studies reported information on strategy cost or cost-effectiveness. CONCLUSIONS: Studies have reported on the efficacy of many strategies to improve HCP performance in LMICs. However, most studies have important methodological limitations. The HCPPR is a publicly accessible resource for decision-makers, researchers, and others interested in improving HCP performance.


Assuntos
Pessoal de Saúde/tendências , Programas Nacionais de Saúde , Pobreza/economia , Assistência à Saúde/economia , Assistência à Saúde/tendências , Países em Desenvolvimento/economia , Pessoal de Saúde/economia , Humanos , Revisão da Pesquisa por Pares
8.
BMC Public Health ; 19(1): 732, 2019 Jun 11.
Artigo em Inglês | MEDLINE | ID: mdl-31185954

RESUMO

BACKGROUND: Women in India are often asked to make informal payments for maternal health care services that the government has mandated to be free. This paper is a descriptive case study of a social accountability project undertaken by SAHAYOG, a nongovernmental organization in Uttar Pradesh, India. SAHAYOG worked with community-based organizations and a grassroots forum comprised of low caste, Muslim, and tribal women to decrease the prevalence of health provider demands that women and their families make informal payments. METHODS: The study entailed document review; interviews and focus group discussions with program implementers, governmental stakeholders, and community activists; and participant observation in health facilities. RESULTS: The study found that SAHAYOG adapted their strategy over time to engender greater empowerment and satisfaction among program participants, as well as greater impact on the health system. Participants gained knowledge resources and agency; they learned about their entitlements, had access to mechanisms for complaints, and, despite risk of retaliation, many felt capable of demanding their rights in a variety of fora. However, only program participants seemed successfully able to avoid making informal payments to the health sector; health providers still demanded that other women make payments. Several features of the micro and macro context shaped the trajectory of SAHAYOG's efforts, including deeply rooted caste dynamics, low provider commitment to ending informal payments, the embeddedness of informal payments, human resources scarcity, and the overlapping private interests of pharmaceutical companies and providers. CONCLUSION: Though changes were manifest in certain fora, providers have not necessarily embraced the notion of low caste, tribal, or Muslim women as citizens with entitlements, especially in the context of free government services for childbirth. Grassroots advocates, CBOs, and SAHAYOG assumed a supremely difficult task. Project strategy changes may have made the task somewhat less difficult, but given the population making the rights claims and the rights they were claiming, widespread changes in demands for informal payments may require a much larger and stronger coalition.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde Materna/economia , Parto/psicologia , Pobreza/psicologia , Marginalização Social/psicologia , Adulto , Medo , Feminino , Grupos Focais , Gastos em Saúde/legislação & jurisprudência , Humanos , Índia , Islamismo/psicologia , Organizações , Grupos Populacionais/psicologia , Pobreza/economia , Gravidez , Classe Social , Responsabilidade Social
9.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31088893

RESUMO

BACKGROUND AND OBJECTIVES: Pregnancy, infancy, and toddlerhood are sensitive times in which families are particularly vulnerable to household food insecurity and when disparities in child obesity emerge. Understanding obesity-promoting infant-feeding beliefs, styles, and practices in the context of food insecurity could better inform both food insecurity and child obesity prevention interventions and policy guidelines. METHODS: We performed purposive sampling of low-income Hispanic mothers (n = 100) with infants in the first 2 years of life, all of whom were participants in a randomized controlled trial of an early child obesity prevention intervention called the Starting Early Program. Bilingual English-Spanish interviewers conducted semistructured qualitative interviews, which were audio recorded, transcribed, and translated. By using the constant comparative method, transcripts were coded through an iterative process of textual analysis until thematic saturation was reached. RESULTS: Three key themes emerged: (1) contributors to financial strain included difficulty meeting basic needs, job instability, and high vulnerability specific to pregnancy, infancy, and immigration status; (2) effects on infant feeding included decreased breastfeeding due to perceived poor maternal diet, high stress, and limiting of healthy foods; and (3) coping strategies included both home- and community-level strategies. CONCLUSIONS: Stakeholders in programs and policies to prevent poverty-related disparities in child obesity should consider and address the broader context by which food insecurity is associated with contributing beliefs, styles, and practices. Potential strategies include addressing misconceptions about maternal diet and breast milk adequacy, stress management, building social support networks, and connecting to supplemental nutrition assistance programs.


Assuntos
Aleitamento Materno/economia , Abastecimento de Alimentos/economia , Hispano-Americanos , Mães , Obesidade Pediátrica/economia , Pobreza/economia , Adulto , Aleitamento Materno/tendências , Pré-Escolar , Feminino , Hospitais Públicos/economia , Hospitais Públicos/tendências , Humanos , Lactente , Masculino , Obesidade Pediátrica/epidemiologia , Obesidade Pediátrica/prevenção & controle , Pobreza/tendências , Gravidez
10.
Pediatrics ; 143(6)2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31126971

RESUMO

BACKGROUND: Our primary aim was to evaluate the effects of 2 family-based obesity management interventions compared with a control group on BMI in low-income adolescents with overweight or obesity. METHODS: In this randomized clinical trial, 360 urban-residing youth and a parent were randomly assigned to 1 of 2 behaviorally distinct family interventions or an education-only control group. Eligible children were entering the sixth grade with a BMI ≥85th percentile. Interventions were 3 years in length; data were collected annually for 3 years. Effects of the interventions on BMI slope (primary outcome) over 3 years and a set of secondary outcomes were assessed. RESULTS: Participants were primarily African American (77%), had a family income of <25 000 per year, and obese at enrollment (68%). BMI increased over time in all study groups, with group increases ranging from 0.95 to 1.08. In an intent-to-treat analysis, no significant differences were found in adjusted BMI slopes between either of the family-based interventions and the control group (P = .35). No differences were found between the experimental and control groups on secondary outcomes of diet, physical activity, sleep, perceived stress, or cardiometabolic factors. No evidence of effect modification of the study arms by sex, race and/or ethnicity, household income, baseline levels of child and parent obesity, or exposure to a school fitness program were found. CONCLUSIONS: In this low-income, adolescent population, neither of the family-based interventions improved BMI or health-related secondary outcomes. Future interventions should more fully address poverty and other social issues contributing to childhood obesity.


Assuntos
Terapia Comportamental/métodos , Índice de Massa Corporal , Terapia Familiar/métodos , Obesidade Pediátrica/economia , Pobreza/economia , População Urbana , Adolescente , Adulto , Criança , Exercício/fisiologia , Exercício/psicologia , Feminino , Humanos , Masculino , Obesidade Pediátrica/psicologia , Obesidade Pediátrica/terapia , Pobreza/psicologia
11.
Infant Behav Dev ; 55: 112-122, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-31009861

RESUMO

Infants from low-income households typically spend less time exploring objects and use less mature strategies when they do explore compared to their higher-income peers (e.g., Clearfield et al., 2014). The current study tested a novel intervention designed to boost early object exploration in infants from low-income households. The intervention, called Play for Success, was administered through the Early Head Start home visiting program, and asked all infants to explore a toy with a caregiver for 10 min a day every day for two weeks. Forty-two 6- to 10-month-old infants were randomly assigned to one of three intervention groups: Social (unstructured direction), Teach Two (simple structured direction), or Teach Many (complex structured direction). Infants' exploratory behaviors were tested three times: before the intervention, immediately following, and again four weeks later. The results demonstrated that only infants in Teach 2 maintained their level of exploration at both the post-test and 4 weeks later while infants in the other groups showed significant decreases in exploration over time. These results suggest that Play for Success is a promising new intervention, but only in the condition that included repeated simple structured direction.


Assuntos
/métodos , Comportamento Exploratório/fisiologia , Comportamento do Lactente/fisiologia , Comportamento do Lactente/psicologia , Jogos e Brinquedos/psicologia , Pobreza/psicologia , /economia , Feminino , Humanos , Lactente , Masculino , Pobreza/economia , Distribuição Aleatória
12.
PLoS One ; 14(4): e0212257, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30943194

RESUMO

Mandatory fortification of edible oil (soybean and palm) with vitamin A was decreed in Bangladesh in 2013. Yet, there is a dearth of data on the availability and consumption of vitamin A fortifiable oil at household level across population sub-groups. To fill this gap, our study used a nationally representative survey in Bangladesh to assess the purchase of fortifiable edible oil among households and project potential vitamin A intake across population sub-groups. Data is presented by strata, age range and poverty-the factors that potentially influence oil coverage. Across 1,512 households, purchase of commercially produced fortifiable edible oil was high (87.5%). Urban households were more likely to purchase fortifiable oil (94.0%) than households in rural low performing (79.7%) and rural other strata (88.1%) (p value: 0.01). Households in poverty were less likely to purchase fortifiable oil (82.1%) than households not in poverty (91.4%) (p <0.001). Projected estimates suggested that vitamin A fortified edible oil would at least partially meet daily vitamin A estimated average requirement (EAR) for the majority of the population. However, certain population sub-groups may still have vitamin A intake below the EAR and alternative strategies may be applied to address the vitamin A needs of these vulnerable sub-groups. This study concludes that a high percentage of Bangladeshi population across different sub-groups have access to fortifiable edible oil and further provides evidence to support mandatory edible oil fortification with vitamin A in Bangladesh.


Assuntos
Alimentos Fortificados/estatística & dados numéricos , Política Nutricional , Recomendações Nutricionais , Deficiência de Vitamina A/prevenção & controle , Vitamina A/administração & dosagem , Adolescente , Adulto , Bangladesh , Criança , Pré-Escolar , Estudos Transversais , Inquéritos sobre Dietas/economia , Inquéritos sobre Dietas/estatística & dados numéricos , Características da Família , Feminino , Alimentos Fortificados/economia , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Óleo de Palmeira/administração & dosagem , Óleo de Palmeira/economia , Pobreza/economia , Pobreza/estatística & dados numéricos , População Rural/estatística & dados numéricos , Óleo de Soja/administração & dosagem , Óleo de Soja/economia , População Urbana/estatística & dados numéricos , Adulto Jovem
13.
Infect Dis Poverty ; 8(1): 21, 2019 Mar 24.
Artigo em Inglês | MEDLINE | ID: mdl-30904025

RESUMO

BACKGROUND: In response to the high financial burden of health services facing tuberculosis (TB) patients in China, the China-Gates TB project, Phase II, has implemented a new financing and payment model as an important component of the overall project in three cities in eastern, central and western China. The model focuses on increasing the reimbursement rate for TB patients and reforming provider payment methods by replacing fee-for-service with a case-based payment approach. This study investigated changes in out-of-pocket (OOP) health expenditure and the financial burden on TB patients before and after the interventions, with a focus on potential differential impacts on patients from different income groups. METHODS: Three sample counties in each of the three prefectures: Zhenjiang, Yichang and Hanzhong were chosen as study sites. TB patients who started and completed treatment before, and during the intervention period, were randomly sampled and surveyed at the baseline in 2013 and final evaluation in 2015 respectively. OOP health expenditure and percentage of patients incurring catastrophic health expenditure (CHE) were calculated for different income groups. OLS regression and logit regression were conducted to explore the intervention's impacts on patient OOP health expenditure and financial burden after adjusting for other covariates. Key-informant interviews and focus group discussions were conducted to understand the reasons for any observed changes. RESULTS: Data from 738 (baseline) and 735 (evaluation) patients were available for analysis. Patient mean OOP health expenditure increased from RMB 3576 to RMB 5791, and the percentage of patients incurring CHE also increased after intervention. The percentage increase in OOP health expenditure and the likelihood of incurring CHE were significantly lower for patients from the highest income group as compared to the lowest. Qualitative findings indicated that increased use of health services not covered by the standard package of the model was likely to have caused the increase in financial burden. CONCLUSIONS: The implementation of the new financing and payment model did not protect patients, especially those from the lowest income group, from financial difficulty, due partly to their increased use of health service. More financial resources should be mobilized to increase financial protection, particularly for poor patients, while cost containment strategies need to be developed and effectively implemented to improve the effective coverage of essential healthcare in China.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Gastos em Saúde/estatística & dados numéricos , Pobreza/economia , Pobreza/estatística & dados numéricos , Tuberculose/economia , Adulto , Idoso , China , Comorbidade , Custos e Análise de Custo , Feminino , Humanos , Seguro Saúde , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Análise de Regressão , Fatores Socioeconômicos
14.
PLoS Med ; 16(3): e1002751, 2019 03.
Artigo em Inglês | MEDLINE | ID: mdl-30822339

RESUMO

BACKGROUND: The prevalence of diabetes is increasing rapidly in low- and middle-income countries (LMICs), urgently requiring detailed evidence to guide the response of health systems to this epidemic. In an effort to understand at what step in the diabetes care continuum individuals are lost to care, and how this varies between countries and population groups, this study examined health system performance for diabetes among adults in 28 LMICs using a cascade of care approach. METHODS AND FINDINGS: We pooled individual participant data from nationally representative surveys done between 2008 and 2016 in 28 LMICs. Diabetes was defined as fasting plasma glucose ≥ 7.0 mmol/l (126 mg/dl), random plasma glucose ≥ 11.1 mmol/l (200 mg/dl), HbA1c ≥ 6.5%, or reporting to be taking medication for diabetes. Stages of the care cascade were as follows: tested, diagnosed, lifestyle advice and/or medication given ("treated"), and controlled (HbA1c < 8.0% or equivalent). We stratified cascades of care by country, geographic region, World Bank income group, and individual-level characteristics (age, sex, educational attainment, household wealth quintile, and body mass index [BMI]). We then used logistic regression models with country-level fixed effects to evaluate predictors of (1) testing, (2) treatment, and (3) control. The final sample included 847,413 adults in 28 LMICs (8 low income, 9 lower-middle income, 11 upper-middle income). Survey sample size ranged from 824 in Guyana to 750,451 in India. The prevalence of diabetes was 8.8% (95% CI: 8.2%-9.5%), and the prevalence of undiagnosed diabetes was 4.8% (95% CI: 4.5%-5.2%). Health system performance for management of diabetes showed large losses to care at the stage of being tested, and low rates of diabetes control. Total unmet need for diabetes care (defined as the sum of those not tested, tested but undiagnosed, diagnosed but untreated, and treated but with diabetes not controlled) was 77.0% (95% CI: 74.9%-78.9%). Performance along the care cascade was significantly better in upper-middle income countries, but across all World Bank income groups, only half of participants with diabetes who were tested achieved diabetes control. Greater age, educational attainment, and BMI were associated with higher odds of being tested, being treated, and achieving control. The limitations of this study included the use of a single glucose measurement to assess diabetes, differences in the approach to wealth measurement across surveys, and variation in the date of the surveys. CONCLUSIONS: The study uncovered poor management of diabetes along the care cascade, indicating large unmet need for diabetes care across 28 LMICs. Performance across the care cascade varied by World Bank income group and individual-level characteristics, particularly age, educational attainment, and BMI. This policy-relevant analysis can inform country-specific interventions and offers a baseline by which future progress can be measured.


Assuntos
Assistência à Saúde/economia , Diabetes Mellitus/economia , Diabetes Mellitus/epidemiologia , Necessidades e Demandas de Serviços de Saúde/economia , Inquéritos Epidemiológicos/economia , Pobreza/economia , Adolescente , Adulto , Estudos Transversais , Assistência à Saúde/tendências , Diabetes Mellitus/terapia , Feminino , Necessidades e Demandas de Serviços de Saúde/tendências , Inquéritos Epidemiológicos/tendências , Humanos , Renda/tendências , Masculino , Pessoa de Meia-Idade , Pobreza/tendências , Adulto Jovem
15.
Proc Natl Acad Sci U S A ; 116(14): 6737-6742, 2019 04 02.
Artigo em Inglês | MEDLINE | ID: mdl-30877257

RESUMO

A new generation of poverty programs around the globe provides cash payments to poor and vulnerable households. Studies show that these social cash transfer programs create income and welfare benefits for poor households and the local economies where they live. However, this may come at the cost of damaging local environments if cash payments stimulate food production that conflicts with natural resource conservation. Evaluations of the economic impacts of poverty programs do not account for the welfare consequences of environmental impacts, which are potentially large for poor communities closely tied to natural resources. We use an ex-ante policy simulation tool, a bioeconomic local computable general equilibrium model parameterized with microsurvey data, to analyze the expected welfare consequences of environmental degradation caused by a cash transfer program. For a Philippine fishing community that is a net importer of fish, we show that a government cash transfer program initially increases real incomes for all households. However, increased demand for fish leads to a decline in the local fish stock that reduces program benefits. Household groups experience declines in real income benefits of 2-63%, with fishing households suffering the largest declines. Impacts on local fish stocks depend on the extent to which markets link fishing communities to outside regions through trade. Greater market integration can mitigate the fish stock decline, but this reduces the local income benefits of cash transfers.


Assuntos
Conservação dos Recursos Naturais/economia , Meio Ambiente , Pesqueiros/economia , Abastecimento de Alimentos/economia , Modelos Econômicos , Pobreza , Filipinas , Pobreza/economia , Pobreza/prevenção & controle
16.
J Couns Psychol ; 66(3): 317-327, 2019 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-30920273

RESUMO

People from lower social classes experience significant difficulties in many life domains including work, yet their work lives continue to be understudied in psychology. This study examined the applicability of the Psychology of Working Theory (PWT), which emphasizes the role of socioeconomic constraints in shaping work and well-being outcomes, in a non-Western, collectivist cultural framework. Specifically, we tested the associations of social class with work volition and career adaptability in predicting decent work and job and life satisfaction with a sample of 401 low-income Turkish employees. Results of structural equation modeling analyses supported all hypothesized paths of the proposed model. Social class predicted decent work directly and indirectly through work volition and career adaptability, and decent work predicted job satisfaction and life satisfaction. In addition to extending the research on the international utility of the PWT, these results support the notion that social class has a crucial role in low-income working adults' access to decent and fulfilling work along with their attainment of well-being. The results of this study also underline the importance of promoting decent work among low-income individuals to improve their personal and work lives. Implications for practice with low-income Turkish employees and directions for future research are discussed. (PsycINFO Database Record (c) 2019 APA, all rights reserved).


Assuntos
Emprego/economia , Emprego/psicologia , Satisfação no Emprego , Ocupações/economia , Ocupações/estatística & dados numéricos , Satisfação Pessoal , Teoria Psicológica , Adolescente , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza/economia , Pobreza/estatística & dados numéricos , Classe Social , Fatores Socioeconômicos , Turquia , Adulto Jovem
17.
PLoS One ; 14(3): e0213403, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30917142

RESUMO

OBJECTIVES: To test the heterogeneity of the effect of a change in pharmaceutical cost-sharing by therapeutic groups in a Spanish region. METHODS: Data: random sample (provided by the Canary Islands Health Service) of 40,471 people covered by the Spanish National Health System (SNHS) in the Canary Islands. The database includes individualised monthly-dispensed medications (prescribed by the SNHS) from one year before (August 2011) to one year after (June 2013) the Royal Decree Law 16/2012 (RDL 16/2012). Sample: two intervention groups (low-income pensioners and middle-income working population) and one control group (low-income working population). Empirical model: quasi-experimental difference-in-differences design to study the change in consumption (measured in number of monthly Defined Daily Dose (DDDs) per individual) among 13 therapeutic groups. The policy break indicator (three-level categorical variable) tested the existence of stockpiling between the reform's announcement and its implementation. We ran 16 linear regression models (general, by therapeutic groups and by comorbidities) that considered whether the exclusion of some drugs from public provision impacted on consumption more than the co-payment increase. RESULTS: General: Reduction (-13.04) in consumption after the reform's implementation, which was fully compensated by a previous increase (16.60 i.e., stockpiling) among low-income pensioners. The middle-income working population maintained its trend of increasing consumption. Therapeutic groups: Reductions in consumption after the reform's implementation among low-income pensioners in 7 of the 13 groups, which were fully compensated for by a previous increase (i.e., stockpiling) in 4 groups and partially compensated for in the remaining 3. The analysis without the excluded medicines provided fewer negative coefficients. Comorbidities: Reduction in consumption that was only slightly compensated for by a previous increase (i.e., stockpiling). CONCLUSIONS: The negative impact of cost-sharing produced, among low-income pensioners, a risk of loss of adherence to treatments, which could deteriorate the health status of individuals, especially among pensioners within the most inelastic therapeutic groups (associated with chronic diseases) and patients with comorbidities (also, associated with chronic diseases). Notwithstanding the above, this risk was more related to the exclusion of some drugs from provision than to the cost-sharing increase.


Assuntos
Dedutíveis e Cosseguros , Custos de Medicamentos , Medicamentos sob Prescrição/economia , Dedutíveis e Cosseguros/legislação & jurisprudência , Dedutíveis e Cosseguros/estatística & dados numéricos , Dedutíveis e Cosseguros/tendências , Custos de Medicamentos/legislação & jurisprudência , Custos de Medicamentos/estatística & dados numéricos , Custos de Medicamentos/tendências , Feminino , Humanos , Modelos Lineares , Masculino , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/estatística & dados numéricos , Cooperação do Paciente/estatística & dados numéricos , Pobreza/economia , Pobreza/estatística & dados numéricos , Medicamentos sob Prescrição/provisão & distribução , Espanha
18.
PLoS One ; 14(3): e0214113, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30917187

RESUMO

Robust evidence underpinning the role of beekeeping in poverty alleviation is currently lacking. This study estimated the production potential for beekeepers in Northern Uganda by quantifying current production assets (equipment and knowledge) and impact on rural income streams range of proposed interventions. Intervention scenarios evaluated the economic benefits to be derived from different hive types combined with year-round provision of a nectar source (Calliandra calothyrsus) planted at varying density. Findings show that the type and number of beehive combinations used influenced the amount of revenue streams generated by the beekeepers. Addition of 20 log hives increased incomes 10 times, 20 KTBs increased revenues 16 times and Langstroth 18 times. Adding Calliandra trees as a forage source to the baseline scenario yielded revenues up to 17.6 times higher than the baseline. Implying that good management plus the introduction of a reliable nectar source, to off-set dry season challenges (absconding), could improve beekeeping productivity in Northern Uganda. Further research is required to validate in situ the impact of modelled scenarios on both honey yield and other ecosystem service benefits.


Assuntos
Criação de Abelhas/economia , Abelhas , Características da Família , Pobreza/economia , Pobreza/prevenção & controle , Animais , Humanos , Uganda
20.
Trials ; 20(1): 152, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-30823886

RESUMO

BACKGROUND: Antenatal care (ANC), facility delivery and postnatal care (PNC) are proven to reduce maternal and child mortality and morbidity in high-burden settings. However, few pregnant rural women use these services sufficiently. This study aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased contact between pregnant women or women who have recently given birth and the formal healthcare system in Kenya. METHODS: The intervention tested is a conditional cash transfer to women for ANC health visits, a facility birth and PNC visits until their newborn baby reaches 1 year of age. The study is a cluster randomized controlled trial in Siaya County, Kenya. The trial clusters are 48 randomly selected public primary health facilities, 24 of which are in the intervention arm of the study and 24 in the control arm. The unit of randomization is the health facility. A target sample of 7200 study participants comprises pregnant women identified and recruited at their first ANC visit over a 12-month recruitment period and their subsequent newborns. All pregnant women attending one of the selected trial facilities for their first ANC visit during the recruitment period are eligible for the trial and invited to participate. Enrolled mothers are followed up at all health visits during their pregnancy, at facility delivery and for a number of visits after delivery. They are also contacted at three additional time points after enrolling in the study: 5-10days after enrolment, 6 months after the expected delivery date and 12 27 months after birth. If they have not delivered in a facility, there is an additional follow-up 2 wees after the expected due date. The impact of the conditional cash transfers on maternal healthcare services and utilization will be measured by the trial's primary outcomes: the proportion of all eligible ANC visits made during pregnancy, delivery at a health facility, the proportion of all eligible PNC visits attended, the proportion of referrals attended during the pregnancy and the postnatal period, and the proportion of eligible child immunization appointments attended. Secondary outcomes include; health screening and infection control, live birth, maternal and child survival 48 h after delivery, exclusive breastfeeding, post-partum contraceptive use and maternal and newborn morbidity. Data sources for the measurement of outcomes include routine health records, an electronic card-reader system and telephone surveys and focus group discussions. A full economic evaluation will be conducted to assess the cost of delivery and cost effectiveness of the intervention and the benefit incidence and equity impact of trial activities and outcomes. DISCUSSION: This trial will contribute to evidence on the effectiveness and cost-effectiveness of conditional cash transfers in facilitating health visits and promoting maternal and child health in rural Kenya and in other comparable contexts. TRIAL REGISTRATION: ClinicalTrials.gov, NCT03021070 . Registered on 13 January 2017.


Assuntos
Continuidade da Assistência ao Paciente/economia , Apoio Financeiro , Financiamento Pessoal/economia , Custos de Cuidados de Saúde , Cooperação do Paciente , Assistência Perinatal/economia , Serviços de Saúde Rural/economia , Análise Custo-Benefício , Feminino , Humanos , Lactente , Recém-Nascido , Quênia , Motivação , Assistência Perinatal/métodos , Pobreza/economia , Gravidez , Ensaios Clínicos Controlados Aleatórios como Assunto , Fatores de Tempo
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