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1.
Artigo em Inglês | MEDLINE | ID: mdl-32872616

RESUMO

This study used the Korean National Health Insurance (NHI) claims database from 2011 to 2017 to estimate the incidence and the incidence-based cost of cervical cancer and carcinoma in situ of cervix uteri (CIS) in Korea. The primary outcome was the direct medical cost per patient not diagnosed with cervical cancer (C53) or CIS (D06) 2 years prior to the index date in the first year after diagnosis. A regression analysis was conducted to adjust for relevant covariates. The incidence of cervical cancer tended to decrease from 2013 to 2016, while that of CIS increased. In particular, the incidence rate of CIS in women in their 20 s and 30 s increased by 56.8% and 28.4%, respectively, from 2013 to 2016. The incidence-based cost of cervical cancer and CIS was USD 13,058 and USD 2695 in 2016, respectively, which increased from 2013. Multivariate regression analysis suggested that age was the most influential variable of the cost in both patient groups, and the cost was highest in those aged over 60, i.e., the medical cost was significantly lower in younger women than their older counterparts. These findings suggest that targeting younger women in cervical cancer prevention is a reasonable option from both economic and public health perspectives.


Assuntos
Custos de Cuidados de Saúde/estatística & dados numéricos , Neoplasias do Colo do Útero , Adulto , Fatores Etários , Carcinoma in Situ/economia , Carcinoma in Situ/epidemiologia , Efeitos Psicossociais da Doença , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Humanos , Incidência , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Lesões Pré-Cancerosas/economia , Lesões Pré-Cancerosas/epidemiologia , República da Coreia/epidemiologia , Projetos de Pesquisa , Neoplasias do Colo do Útero/economia , Neoplasias do Colo do Útero/epidemiologia , Adulto Jovem
2.
Am J Public Health ; 110(9): 1418-1420, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32673116

RESUMO

Objectives. To measure trends in infertility treatment use between 2008 and 2017 in France using data from the national health insurance system.Methods. Between 2008 and 2017, we observed a representative national sample of nearly 1% of all women aged 20 to 49 years who were affiliated with the main health insurance scheme in France (more than 100 000 women observed each year). We exhaustively recorded all health care reimbursed to these women.Results. Among women aged 20 to 49 years, 1.25% were treated for infertility each year. Logistic regression analysis showed a significant interaction between age and year of treatment use (P < .001). Over the decade, infertility treatment use increased by 23.9% among women aged 34 years or older, whereas among women younger than 34 years there was a nonsignificant variation.Conclusions. Women aged 34 years or older were increasingly treated for infertility between 2008 and 2017.Public Health Implications. Treatment efficiency decreases strongly with a woman's age, presenting a challenge for medical infertility care.


Assuntos
Fatores Etários , Infertilidade Feminina/epidemiologia , Infertilidade Feminina/terapia , Técnicas de Reprodução Assistida/tendências , Adulto , Feminino , França/epidemiologia , Humanos , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos
3.
Infect Dis Poverty ; 9(1): 83, 2020 Jul 06.
Artigo em Inglês | MEDLINE | ID: mdl-32631426

RESUMO

BACKGROUND: The coronavirus disease 2019 (COVID-19) outbreak has seriously endangered the health and lives of Chinese people. In this study, we predicted the COVID-19 epidemic trend and estimated the efficacy of several intervention strategies in the mainland of China. METHODS: According to the COVID-19 epidemic status, we constructed a compartmental model. Based on reported data from the National Health Commission of People's Republic of China during January 10-February 17, 2020, we estimated the model parameters. We then predicted the epidemic trend and transmission risk of COVID-19. Using a sensitivity analysis method, we estimated the efficacy of several intervention strategies. RESULTS: The cumulative number of confirmed cases in the mainland of China will be 86 763 (95% CI: 86 067-87 460) on May 2, 2020. Up until March 15, 2020, the case fatality rate increased to 6.42% (95% CI: 6.16-6.68%). On February 23, 2020, the existing confirmed cases reached its peak, with 60 890 cases (95% CI: 60 350-61 431). On January 23, 2020, the effective reproduction number was 2.620 (95% CI: 2.567-2.676) and had dropped below 1.0 since February 5, 2020. Due to governmental intervention, the total number of confirmed cases was reduced by 99.85% on May 2, 2020. Had the isolation been relaxed from February 24, 2020, there might have been a second peak of infection. However, relaxing the isolation after March 16, 2020 greatly reduced the number of existing confirmed cases and deaths. The total number of confirmed cases and deaths would increase by 8.72 and 9.44%, respectively, due to a 1-day delayed diagnosis in non-isolated infected patients. Moreover, if the coverage of close contact tracing was increased to 100%, the cumulative number of confirmed cases would be decreased by 88.26% on May 2, 2020. CONCLUSIONS: The quarantine measures adopted by the Chinese government since January 23, 2020 were necessary and effective. Postponing the relaxation of isolation, early diagnosis, patient isolation, broad close-contact tracing, and strict monitoring of infected persons could effectively control the COVID-19 epidemic. April 1, 2020 would be a reasonable date to lift quarantine in Hubei and Wuhan.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Betacoronavirus , China/epidemiologia , Controle de Doenças Transmissíveis/legislação & jurisprudência , Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/legislação & jurisprudência , Transmissão de Doença Infecciosa/prevenção & controle , Transmissão de Doença Infecciosa/estatística & dados numéricos , Previsões , Humanos , Modelos Estatísticos , Programas Nacionais de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia
4.
Yonsei Med J ; 61(7): 640-643, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32608209

RESUMO

The purpose of this study was to examine the degree to which the magnitude of income inequality in life expectancy according to different categorization across beneficiary types under the National Health Insurance Service (NHIS) in Korea. We used population and death data in 2017 from the National Health Information Database of the NHIS. Income quintile groups were classified in four ways according to beneficiary type (employee insured, self-employed insured, and Medical Aid beneficiaries). Standard life table procedures were used to calculate life expectancy. The life expectancy gap between the lowest and highest income quintiles was the largest when the entire population was divided into quintiles without distinguishing among types of beneficiaries. In conclusion, we suggest that income quintile indicators in NHIS data, measured without distinguishing among types of beneficiaries, may best represent the magnitude of health inequalities in Korean society. This indicator could be used for future research on health inequalities, as well as for monitoring health inequalities in Korea.


Assuntos
Política de Saúde , Disparidades nos Níveis de Saúde , Expectativa de Vida , Programas Nacionais de Saúde/estatística & dados numéricos , Bases de Dados Factuais , Feminino , Humanos , Renda , Masculino , República da Coreia/epidemiologia , Fatores Socioeconômicos
5.
PLoS One ; 15(7): e0234135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32614848

RESUMO

BACKGROUND: Educational inequalities in health and mortality in European countries have often been studied in the context of welfare regimes or political systems. We argue that the healthcare system is the national level feature most directly linkable to mortality amenable to healthcare. In this article, we ask to what extent the strength of educational differences in mortality amenable to healthcare vary among European countries and between European healthcare system types. METHODS: This study uses data on mortality amenable to healthcare for 21 European populations, covering ages 35-79 and spanning from 1998 to 2006. ISCED education categories are used to calculate relative (RII) and absolute inequalities (SII) between the highest and lowest educated. The healthcare system typology is based on the latest available classification. Meta-analysis and ANOVA tests are used to see if and how they can explain between-country differences in inequalities and whether any healthcare system types have higher inequalities. RESULTS: All countries and healthcare system types exhibited relative and absolute educational inequalities in mortality amenable to healthcare. The low-supply and low performance mixed healthcare system type had the highest inequality point estimate for the male (RII = 3.57; SII = 414) and female (RII = 3.18; SII = 209) population, while the regulation-oriented public healthcare systems had the overall lowest (male RII = 1.78; male SII = 123; female RII = 1.86; female SII = 78.5). Due to data limitations, results were not robust enough to make substantial claims about typology differences. CONCLUSIONS: This article aims at discussing possible mechanisms connecting healthcare systems, social position, and health. Results indicate that factors located within the healthcare system are relevant for health inequalities, as inequalities in mortality amenable to medical care are present in all healthcare systems. Future research should aim at examining the role of specific characteristics of healthcare systems in more detail.


Assuntos
Escolaridade , Disparidades em Assistência à Saúde , Mortalidade , Programas Nacionais de Saúde/estatística & dados numéricos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Europa (Continente)/epidemiologia , Feminino , Gastos em Saúde/estatística & dados numéricos , Humanos , Seguro Saúde , Masculino , Pessoa de Meia-Idade , Prevenção Primária , Seguridade Social , Medicina Estatal/estatística & dados numéricos , Uso de Tabaco/epidemiologia
6.
Health Syst Reform ; 6(1): 1-11, 2020 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-32568597

RESUMO

Mexico's health system is undergoing major restructuring by the administration of President Andrés Manuel López Obrador (known as AMLO) starting in December 2018. The government has eliminated the 2003 health reform (Seguro Popular) from national laws and government agencies and is returning Mexico to a centralized health system with integrated public financing and delivery and reduced private participation. This article looks at the political drivers of Mexico's restructuring reform. Three main ethical principles are identified as the foundation for the government's health system vision: universality, free services, and anti-corruption. The article then compares what existed under Seguro Popular with the new system under the Instituto de Salud para el Bienestar (INSABI), which began on 1 January 2020. The analysis uses the five policy levers that shape health system performance: financing, payment, organization, regulation, and persuasion. The article concludes with five lessons about the reform process in Mexico. First, undoing past reforms is much easier than implementing a new system. Second, the AMLO government's restructuring emerged more from broad ethical principles than detailed technical analyses, with limited plans for evaluation. Third, the overarching values of the AMLO government reflect a pro-statist and anti-market bias, swimming against the global flow of health policy trends to include the private sector in reforming health systems. Fourth, the experiences in Mexico show that path dependence does not always work as expected in policy reform. Finally, the debate of Seguro Popular versus INSABI shows the influence of personality politics and polarization.


Assuntos
Reforma dos Serviços de Saúde/métodos , Reforma dos Serviços de Saúde/normas , Reforma dos Serviços de Saúde/tendências , Humanos , México , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Política
7.
Medicine (Baltimore) ; 99(26): e20800, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590763

RESUMO

Medication adherence plays an important role in disease management, especially for diabetes. The aim of this study was to examine the impacts of demographic characteristics on medication nonadherence and the impacts of nonadherence on both health status and medical expenses for diabetic patients in Taiwan.A total of 1 million diabetes mellitus patients were randomly selected from the National Health Insurance Research Database between January 1, 2000 and December 31, 2004. All records with missing values and those for participants under 18 years of age were then deleted. Because many patients had multiple clinical visit records, all records within the same calendar year were summarized into 1 single record for each person. This pre-processing resulted in 14,602 total patients with a combined 73,010 records over the course of 5 years. Generalized estimating equation models were then constructed to investigate the effects of demographic characteristics on medication nonadherence and the effects of nonadherence on patient health status and medical expenses. The demographic characteristics examined for each patient include gender, age, residential area, and socioeconomic status.Our analysis of how demographic variables impacted nonadherence revealed that elderly patients exhibited better overall medication adherence, but that male patients exhibited poorer medication adherence than female patients. Next, our analysis of how nonadherence impacted health status revealed that patients who exhibited medication nonadherence had poorer health status than patients with proper medication adherence. Finally, our analysis of how nonadherence impacted medical expenses revealed that patients who exhibited medication nonadherence incurred more medical expenses than those who exhibited proper medication adherence.This study's empirical results corroborate the general relationships expressed in the current literature regarding medication nonadherence. However, this study's results were statistically more reliable and revealed the precise impact on health status in terms of the Charlson comorbidity index and increased annual medical expenses. This indicates the need to improve patient attitudes toward medication adherence, which can have substantial effects both medically and economically.


Assuntos
Diabetes Mellitus Tipo 2 , Disparidades nos Níveis de Saúde , Hipoglicemiantes/uso terapêutico , Adesão à Medicação/estatística & dados numéricos , Diabetes Mellitus Tipo 2/tratamento farmacológico , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Gastos em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde , Taiwan/epidemiologia
8.
Environ Health Prev Med ; 25(1): 17, 2020 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-32517677

RESUMO

BACKGROUND: Health policies in the Philippines have evolved in response to increasing health demands of older adults. However, there is a lack of research on equity among the ageing population in low-middle income countries. The objective of this study was to identify the trends in National Health Insurance Program (NHIP) coverage and healthcare utilization among older adults in the Philippines for the period from 2003 to 2017, during which NHIP expansion policies were implemented, focusing on reductions in socio-economic inequalities. METHODS: A literature search of policies for older adults and an analysis of four Philippine National Demographic and Health Surveys (2003, 2008, 2013, and 2017) with data from 25,217 older adults who were 60 years or older were performed. The major outcome variables were NHIP coverage, self-reported illness, outpatient healthcare utilization, and inpatient healthcare utilization. Inequalities in NHIP coverage and healthcare utilization according to wealth were evaluated by calculating the concentration index for individual years, followed by a regression-based decomposition analysis. RESULTS: NHIP coverage among older adults increased from 9.4 (2003) to 87.6% (2017). Although inequalities according to wealth quintile were observed in all four surveys (all P < 0.001), the concentration index declined from 0.3000 (2003) to 0.0247 (2017), showing reduced inequalities in NHIP coverage over time as observed for self-reported illness and healthcare utilization. NHIP coverage expansion for older adults in 2014 enabled equal opportunity for access to healthcare. CONCLUSION: The passage of mandatory NHIP coverage for older Filipino adults in 2014 was followed by a reduction in inequality in NHIP coverage and healthcare utilization according to wealth.


Assuntos
Disparidades em Assistência à Saúde/tendências , Cobertura do Seguro/tendências , Programas Nacionais de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/legislação & jurisprudência , Filipinas , Fatores Socioeconômicos
9.
BMC Public Health ; 20(1): 846, 2020 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-32493256

RESUMO

BACKGROUND: Germany has a statutory health insurance (SHI) that covers nearly the entire population and most of the health services provided. Newly arrived refugees whose asylum claim is still being processed are initially excluded from the SHI. Instead, their entitlements are restricted and parallel access models have been implemented. We assessed differences in realized access of healthcare services between these access models. METHODS: In Germany's largest federal state, North Rhine-Westphalia, two different access models have been implemented in the 396 municipalities: the healthcare voucher (HcV) model and the electronic health card (eHC) model. As refugees are quasi-randomly assigned to municipalities, we were able to realize a natural quasi-experiment including all newly assigned refugees from six municipalities (three for each model) in 2016 and 2017. Using claims data, we compared the standardized incidence rates (SIR) of specialist services use, emergency services use, and hospitalization due to ambulatory care sensitive conditions (ACSC) between both models. We indirectly standardized utilization patterns first for age and then for the sex. RESULTS: SIRs of emergency use were higher in municipalities with HcV (ranging from 1.41 to 2.63) compared to emergency rates in municipalities with eHC (ranging from 1.40 to 1.71) and differed significantly from the expected rates derived from official health reporting. SIRs of emergency and specialist use in municipalities with eHC converged with the expected rates over time. There were no significant differences in standardized hospitalization rates for ACSC. CONCLUSION: The results suggest that the eHC model is slightly better able to provide refugees with SHI-like access to specialist services and goes along with lower utilization of emergency services compared to the HcV model. No difference between the models was found for hospitalizations due to ACSC. Results might be slightly biased due to incompletely documented service use and due to (self-) selection on the level of municipalities with municipalities interested in facilitating access showing more interest in joining the project.


Assuntos
Utilização de Instalações e Serviços/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adulto , Idoso , Assistência Ambulatorial/estatística & dados numéricos , Cidades , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/legislação & jurisprudência , Feminino , Alemanha/epidemiologia , Acesso aos Serviços de Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde/etnologia , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/legislação & jurisprudência , Programas Nacionais de Saúde/estatística & dados numéricos , Ensaios Clínicos Controlados não Aleatórios como Assunto
10.
Obesity (Silver Spring) ; 28(7): 1205-1214, 2020 07.
Artigo em Inglês | MEDLINE | ID: mdl-32478469

RESUMO

OBJECTIVE: Administrative data are increasingly used in research and evaluation yet lack standardized guidelines for constructing measures using these data. Body weight measures from administrative data serve critical functions of monitoring patient health, evaluating interventions, and informing research. This study aimed to describe the algorithms used by researchers to construct and use weight measures. METHODS: A structured, systematic literature review of studies that constructed body weight measures from the Veterans Health Administration was conducted. Key information regarding time frames and time windows of data collection, measure calculations, data cleaning, treatment of missing and outlier weight values, and validation processes was collected. RESULTS: We identified 39 studies out of 492 nonduplicated records for inclusion. Studies parameterized weight outcomes as change in weight from baseline to follow-up (62%), weight trajectory over time (21%), proportion of participants meeting weight threshold (46%), or multiple methods (28%). Most (90%) reported total time in follow-up and number of time points. Fewer reported time windows (54%), outlier values (51%), missing values (34%), or validation strategies (15%). CONCLUSIONS: A high variability in the operationalization of weight measures was found. Improving methods to construct clinical measures will support transparency and replicability in approaches, guide interpretation of findings, and facilitate comparisons across studies.


Assuntos
Peso Corporal , Pesos e Medidas Corporais/estatística & dados numéricos , Bases de Dados Factuais/provisão & distribução , Programas Nacionais de Saúde/organização & administração , Pesos e Medidas Corporais/métodos , Bases de Dados Factuais/normas , Humanos , Programas Nacionais de Saúde/normas , Programas Nacionais de Saúde/estatística & dados numéricos , Sistema de Registros , Projetos de Pesquisa , Estados Unidos/epidemiologia , Veteranos/estatística & dados numéricos , Serviços de Saúde para Veteranos Militares/organização & administração , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos
11.
Clin Orthop Surg ; 12(2): 200-208, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32489542

RESUMO

Backgroud: To compare the risk of low back pain (LBP) and related spinal diseases between smokers (exposure group) and nonsmokers (non-exposure group). No large registry study has so far investigated the association between smoking and LBP-related spinal diseases such as intervertebral disc disease, spinal stenosis, spinal instability, and spondylolisthesis. Methods: A random sample was taken from the Korean National Health Insurance Research Database. In total, 204,066 men (160,105 smokers, 43,961 nonsmokers) who were followed up between 2002 and 2013 were included in the analysis. Patients with previous back pain or spinal disease in 2003 and 2004, patients with inappropriate data, and women (due to the lower percentage of smokers) were excluded. The Cox proportional hazard model was used to investigate the risk of LBP and related spinal diseases associated with smoking, while adjusting for demographic, clinical, and socioeconomic factors. Results: The overall median follow-up period was 5.6 years (interquartile range, 3.48-8.43 years). Compared to the nonsmoker group, the smoker group had a higher incidence of LBP (p = 0.01), intervertebral disc disease (p < 0.001), spinal stenosis (p = 0.004), spinal instability (p < 0.001), and spondylolisthesis (p = 0.023). Compared to the nonsmoker group, the smoker group had a higher adjusted hazard ratio (HR) per year of LBP (HR, 1.18; 95% confidence interval [CI], 1.15 to 1.21), intervertebral disc disease (HR, 1.25; 95% CI, 1.21 to 1.30), spinal stenosis (HR, 1.52; 95% CI, 1.41 to 1.64), spinal instability (HR, 1.33; 95% CI, 1.24 to 1.44), and spondylolisthesis (HR, 1.49; 95% CI, 1.23 to 1.80). Conclusions: Smokers in male samples were at higher risk for LBP and related spinal diseases than nonsmokers.


Assuntos
Dor Lombar/epidemiologia , Programas Nacionais de Saúde/estatística & dados numéricos , Fumar/efeitos adversos , Doenças da Coluna Vertebral/epidemiologia , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , República da Coreia/epidemiologia
12.
Curationis ; 43(1): e1-e11, 2020 Apr 30.
Artigo em Inglês | MEDLINE | ID: mdl-32370534

RESUMO

BACKGROUND: The use of the performance management (PM) system is highly contested by public servants in South Africa, although its value as essential to the appraisal and management of staff is undeniable. OBJECTIVES: The aim of this study was to explore nurses' perceptions and experiences of the PM system at primary healthcare (PHC) facilities in relation to the current health system's reforms. METHOD: An exploratory, descriptive and qualitative design was utilised. Participants were selected through purposive sampling. A semi-structured interview tool was used to collect data from 18 nurses in four sub-districts of Dr. Kenneth Kaunda district in the North West province. Data were analysed through thematic analysis. RESULTS: The findings of this study confirmed that PM is implemented to some extent. However, various loopholes in its implementation threaten the accuracy and transparency of the system and leave it vulnerable to perceived organisational injustice and unfairness, with the objectivity of the system questioned. The limitations of the current PM system revealed by this study include (1) the lack of alignment with current health system reforms towards comprehensive and integrated care that demands person-centred care; (2) the system's usefulness for career progression, performance improvement and rewarding exceptional performance. CONCLUSION: Performance management is inadequately applied in PHC facilities at district level and needs to be realigned to include the appraisal of key attributes required for the current health system's reforms towards comprehensive and integrated care, including the provision of person-centred care, which is central for responding adequately to South Africa's changing disease profile towards multi-morbidity.


Assuntos
Avaliação de Desempenho Profissional/normas , Enfermeiras e Enfermeiros/psicologia , Atenção Primária à Saúde/normas , Avaliação de Desempenho Profissional/métodos , Avaliação de Desempenho Profissional/estatística & dados numéricos , Reforma dos Serviços de Saúde/métodos , Humanos , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , Enfermeiras e Enfermeiros/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/estatística & dados numéricos , África do Sul
13.
Rev Bras Epidemiol ; 23: e200042, 2020.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32428191

RESUMO

INTRODUCTION: The acquisition of medicines accounts for a significant proportion of private health expenditures. The objective of this study was to analyse the private spending with the purchase of medicines and the commitment of the family income, by the elderly. METHODS: Population survey conducted in Praia Grande, São Paulo, Brazil. The monthly expenditure and the per capita family income commitment with the purchase of medicines were calculated from the information obtained in the interviews. The variables were described in absolute and relative frequencies and the hypothesis test was Pearson's χ2, Student's t and Anova, with a significance level of 5%. RESULTS: The prevalence of drug use was 61.2%. The average monthly expenditure per capita was R$ 34.59, with significantly higher income impairment for individuals with higher levels of education, without chronic diseases and health plan beneficiaries. CONCLUSION: The prevalence of drug use was low. The cost generated by the purchase of medicines is one of the ways in which inequality can manifest in society. The expansion of free drug provision would be necessary to expand access and avoid spending, especially those who have private health plans but cannot afford drug treatment.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Renda/estatística & dados numéricos , Preparações Farmacêuticas/economia , Idoso , Idoso de 80 Anos ou mais , Brasil , Cidades , Custos de Medicamentos/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Preparações Farmacêuticas/provisão & distribução , Fatores Socioeconômicos , Estatísticas não Paramétricas
14.
Rev Lat Am Enfermagem ; 28: e3266, 2020.
Artigo em Português, Espanhol, Inglês | MEDLINE | ID: mdl-32401903

RESUMO

OBJECTIVE: To verify factors associated with early newborn access to biological neonatal screening. METHOD: A cross-sectional quantitative study was carried out with all newborns who underwent tests in healthcare units, hospitals, and laboratories of a city in the state of São Paulo, Brazil, with programs linking healthcare information. The following variables were investigated: child's age at collection (dependent); place of collection; date of collection; and type of user (independent). Descriptive and inferential statistics were applied. RESULTS: Records of 15,652 screenings were found in the two years analyzed. In the first year analyzed, 7,955 births and 7,640 (96.0%) tests were recorded, of which 5,586 (73.1%) were undertaken with newborns between three and five days old. In the next year analyzed, 8,316 births and 8,012 (96.3%) screenings were recorded, of which 7,025 (87.6%) were undertaken with newborns in the same age group. A statistically significant association was found between the variables "child's age" and "type of user" in one year, and between the variables "child's age" and "place of collection" in both years. CONCLUSION: Early access to these tests enables the screening of diseases and referral for treatment. The present study contributes to the management of child care programs by presenting strategies linking data and actions to improve access to biological neonatal screening.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Triagem Neonatal , Brasil , Serviços de Saúde da Criança/estatística & dados numéricos , Estudos Transversais , Diagnóstico Precoce , Humanos , Recém-Nascido , Programas Nacionais de Saúde/organização & administração , Programas Nacionais de Saúde/estatística & dados numéricos , Triagem Neonatal/enfermagem , Triagem Neonatal/organização & administração , Fatores de Tempo
16.
Artigo em Inglês | MEDLINE | ID: mdl-32340141

RESUMO

Background: Children with cerebral palsy (CP) place a considerable burden on medical costs and add to an increased number of inpatient days in Taiwan. Continuity of care (COC) has not been investigated in this population thus far. Materials and Methods: We designed a retrospective population-based cohort study using Taiwan's National Health Insurance Research Database. Patients aged 0 to 18 years with CP catastrophic illness certificates were enrolled. We investigated the association of COC index (COCI) with medical costs and inpatient days. We also investigated the possible clinical characteristics affecting the outcome. Results: Over five years, children with CP with low COCI levels had higher medical costs and more inpatient days than did those with high COCI levels. Younger age at CP diagnosis, more inpatient visits one year before obtaining a catastrophic illness certificate, pneumonia, and nasogastric tube use increased medical expenses and length of hospital stay. Conclusions: Improving COC reduces medical costs and the number of inpatient days in children with CP. Certain characteristics also influence these outcomes.


Assuntos
Paralisia Cerebral/economia , Continuidade da Assistência ao Paciente/economia , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Pacientes Internados , Adolescente , Paralisia Cerebral/terapia , Criança , Pré-Escolar , Estudos de Coortes , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Feminino , Hospitalização , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros , Masculino , Programas Nacionais de Saúde/economia , Programas Nacionais de Saúde/estatística & dados numéricos , Estudos Retrospectivos , Taiwan/epidemiologia
17.
Rev Bras Epidemiol ; 23: e200006, 2020.
Artigo em Português, Inglês | MEDLINE | ID: mdl-32130395

RESUMO

INTRODUCTION: Systemic arterial hypertension (SAH) has a high prevalence in Brazil and impacts on the use of health services. OBJECTIVE: This study verified the influence of the Family Health Strategy (FHS) on the use of health services by adults ≥ 18 years old who reported SAH in the National Health Survey (Pesquisa Nacional de Saúde - PNS) 2013. METHODS: The Propensity Score (PS) method was used to correct the lack of homogeneity between the groups with SAH under exposed or not to the FHS. PS was estimated using binary logistic regression, which reflected the conditional probability of receiving the household register in the FHS according to socioeconomic, demographic and health covariates of adults and their families. After estimating the PS, the stratification was used to group hypertensive adults into five mutually exclusive strata (pairing them). Prevalence and confidence intervals at 95% were estimated of medical consultations and hospitalizations. The effects of the complex NHS sampling were incorporated into all phases of the analysis. RESULTS: It was verified that hypertensive adults enrolled in FHS had worse socioeconomic, health and health conditions, but similar prevalence of medical consultations and hospitalizations to adults without a FHS registry and with better living and health conditions. The FHS has attenuated individual and contextual inequalities that impact the health of Brazilians by favoring the use of health services. CONCLUSION: The FHS can favor the care and control of SAH in Brazil. Thus, it must receive investments that guarantee its effectiveness.


Assuntos
Saúde da Família , Serviços de Saúde/estatística & dados numéricos , Hipertensão/epidemiologia , Hipertensão/prevenção & controle , Programas Nacionais de Saúde/estatística & dados numéricos , Idoso , Brasil/epidemiologia , Características da Família , Feminino , Pesquisas sobre Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pontuação de Propensão , Fatores Socioeconômicos
18.
Am J Ophthalmol ; 214: 86-96, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32209346

RESUMO

PURPOSE: Few studies have measured the incidence and risk factors of intraocular lens (IOL) dislocation in the total population. We investigate the risk factors for IOL dislocation in a nationwide Korean cohort. DESIGN: Retrospective cohort study. METHODS: National data on 2,162,191 subjects who underwent cataract surgery were collected from the Health Insurance Review and Assessment service database of health claims from 2009 to 2016. The Health Insurance Review and Assessment database was used to identify potential risk factors for IOL dislocation, including age, sex, and various pre- and postoperative ophthalmic conditions. The hazard ratios (HRs) and confidence intervals (CIs) of these risk factors were assessed with a multivariable-adjusted Cox regression model. RESULTS: IOL dislocation occurred in 15,170 patients (0.7%) in the cataract surgery cohort (2,162,191 patients). The incidence rate of IOL dislocation peaked at 40-50 years of age, although the mean age of IOL dislocation was 65.25 ± 10.81 years. The average male:female ratio was 1.8. The adjusted HR for IOL dislocation in patients with partial vitrectomy was 11.93 (95% CI 10.95-12.99; P < .0001). Posterior capsulotomy performed within 1 year after the cataract surgery significantly decreased IOL dislocation, with an adjusted HR of 0.48 (95% CI 0.44-0.51; P < .0001). CONCLUSIONS: IOL dislocation tended to occur in young males. Anterior vitrectomy was a significant risk factor for IOL dislocation, while posterior capsulotomy after surgery was associated with a decreased risk of IOL dislocation.


Assuntos
Migração do Implante de Lente Intraocular/epidemiologia , Lentes Intraoculares , Facoemulsificação/efeitos adversos , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Facoemulsificação/estatística & dados numéricos , Modelos de Riscos Proporcionais , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Vitrectomia
19.
PLoS One ; 15(3): e0229666, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32130241

RESUMO

BACKGROUND: Despite increasing political will to achieve Universal Health Coverage (UHC), there is a paucity of empiric data describing what health system indicators are useful surrogates of country-level progress towards UHC. We sought to determine what public health interventions were useful tracers of country-level UHC progress. METHODS: Across 183 countries we evaluated the extent to which 16 service delivery indicators explained variability in the UHC Service Coverage Index, (UHC SCI) a WHO-validated indicator of country-level health coverage. Dominance analyses, stratifying countries by World Bank income criteria, were used to determine which indicators were most important in in predicting UHC SCI scores. FINDINGS: Health workforce density ranked first overall, provision of basic sanitation and access to clean water ranked second, and provision of basic antenatal services ranked third. In analysis stratified by World Bank income criteria, health workforce density ranked first in Lower Middle Income-Countries (LMICs) (n = 45) and third in Upper Middle Income-Countries (UMICs) (n = 51). CONCLUSIONS: While each country will have a different approach to achieving UHC, strengthening the health workforce will need to be a key priority if they are to be successful in achieving UHC.


Assuntos
Mão de Obra em Saúde , Cobertura Universal do Seguro de Saúde , Feminino , Serviços de Saúde/estatística & dados numéricos , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Masculino , Programas Nacionais de Saúde/estatística & dados numéricos , Gravidez , Desenvolvimento Sustentável , Cobertura Universal do Seguro de Saúde/estatística & dados numéricos , Organização Mundial da Saúde
20.
World J Gastroenterol ; 26(4): 404-415, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-32063689

RESUMO

BACKGROUND: The incidence of inflammatory bowel disease (IBD) is increasing in Asia. Numerous risk factors associated with IBD development have been investigated. AIM: To investigate trends and environmental risk factors of Crohn's disease (CD) diagnosed in persons aged ≥ 40 years in South Korea. METHODS: Using the National Health Insurance Service database, a total of 14060821 persons aged > 40 years who underwent national health screening in 2009 were followed up until December 2017. Patients with newly diagnosed CD were enrolled and compared with non-CD cohort. CD was identified according to the International Classification of Diseases 10th revision and the rare/intractable disease registration program codes from the National Health Insurance Service database. The mean follow-up periods was 7.39 years. Age, sex, diabetes, hypertension, smoking, alcohol consumption, regular exercise, body mass index, anemia, chronic kidney disease (CKD) and dyslipidemia were adjusted for in the multivariate analysis model. RESULTS: During the follow-up, 1337 (1.33/100000) patients developed CD. Men in the middle-aged group (40-64 years) had a higher risk than women [adjusted hazard ratio (aHR) 1.46, 95% confidence interval (CI): 1.29-1.66]; however, this difference tended to disappear as the age of onset increases. In the middle-aged group, patients with a history of smoking [aHR 1.46, 95%CI: 1.19-1.79) and anemia (aHR 1.85, 95%CI: 1.55-2.20) had a significantly higher CD risk. In the elderly group (age, ≥ 65 years), ex-smoking and anemia also increased the CD risk (aHR 1.68, 95%CI: 1.22-2.30) and 1.84 (95%CI: 1.47-2.30, respectively). Especially in the middle-aged group, those with CKD had a statistically elevated CD risk (aHR 1.37, 95%CI: 1.05-1.79). Alcohol consumption and higher body mass index showed negative association trend with CD incidence in both of the age groups. [Middle-aged: aHR 0.77 (95%CI: 0.66-0.89) and aHR 0.73 (95%CI: 0.63-0.84), respectively] [Elderly-group: aHR 0.57 (95%CI: 0.42-0.78) and aHR 0.84 (95%CI 0.67-1.04), respectively]. For regular physical activity and dyslipidemia, negative correlation between CD incidences was proved only in the middle-aged group [aHR 0.88 (95%CI: 0.77-0.89) and aHR 0.81 (95%CI: 0.68-0.96), respectively]. CONCLUSION: History of cigarette smoking, anemia, underweight and CKD are possible risk factors for CD in Asians aged > 40 years.


Assuntos
Fatores Etários , Doença de Crohn/epidemiologia , Adulto , Idade de Início , Idoso , Anemia/complicações , Anemia/epidemiologia , Fumar Cigarros/efeitos adversos , Fumar Cigarros/epidemiologia , Doença de Crohn/etiologia , Bases de Dados Factuais , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde/estatística & dados numéricos , Modelos de Riscos Proporcionais , Insuficiência Renal Crônica/complicações , Insuficiência Renal Crônica/epidemiologia , República da Coreia/epidemiologia , Estudos Retrospectivos , Fatores de Risco , Magreza/complicações , Magreza/epidemiologia
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