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1.
JAMA Netw Open ; 3(10): e2026702, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33112402

RESUMO

Importance: It is not known whether nursing homes with private equity (PE) ownership have performed better or worse than other nursing homes during the coronavirus disease 2019 (COVID-19) pandemic. Objective: To evaluate the comparative performance of PE-owned nursing homes on COVID-19 outcomes. Design, Setting, and Participants: This cross-sectional study of 11 470 US nursing homes used the Nursing Home COVID-19 Public File from May 17, 2020, to July 2, 2020, to compare outcomes of PE-owned nursing homes with for-profit, nonprofit, and government-owned homes, adjusting for facility characteristics. Exposure: Nursing home ownership status. Main Outcomes and Measures: Self-reported number of COVID-19 cases and deaths and deaths by any cause per 1000 residents; possessing 1-week supplies of personal protective equipment (PPE); staffing shortages. Results: Of 11 470 nursing homes, 7793 (67.9%) were for-profit; 2523 (22.0%), nonprofit; 511 (5.3%), government-owned; and 543 (4.7%), PE-owned; with mean (SD) COVID-19 cases per 1000 residents of 88.3 [2.1], 67.0 [3.8], 39.8 [7.6] and 110.8 [8.1], respectively. Mean (SD) COVID-19 deaths per 1000 residents were 61.9 [1.6], 66.4 [3.0], 56.2 [7.3], and 78.9 [5.9], respectively; mean deaths by any cause per 1000 residents were 78.1 [1.3], 91.5 [2.2], 67.6 [4.5], and 87.9 [4.8], respectively. In adjusted analyses, government-owned homes had 35.5 (95% CI, -69.2 to -1.8; P = .03) fewer COVID-19 cases per 1000 residents than PE-owned nursing homes. Cases in PE-owned nursing homes were not statistically different compared with for-profit and nonprofit facilities; nor were there statistically significant differences in COVID-19 deaths or deaths by any cause between PE-owned nursing homes and for-profit, nonprofit, and government-owned facilities. For-profit, nonprofit, and government-owned nursing homes were 10.5% (9.1 percentage points; 95% CI, 1.8 to 16.3 percentage points; P = .006), 15.0% (13.0 percentage points; 95% CI, 5.5 to 20.6 percentage points; P < .001), and 17.0% (14.8 percentage points; 95% CI, 6.5 to 23.0 percentage points; P < .001), respectively, more likely to have at least a 1-week supply of N95 masks than PE-owned nursing homes. They were 24.3% (21.3 percentage points; 95% CI, 11.8 to 30.8 percentage points; P < .001), 30.7% (27.0 percentage points; 95% CI, 17.7 to 36.2 percentage points; P < .001), and 29.2% (25.7 percentage points; 95% CI, 16.1 to 35.3 percentage points; P < .001) more likely to have a 1-week supply of medical gowns than PE-owned nursing homes. Government nursing homes were more likely to have a shortage of nurses (6.9 percentage points; 95% CI, 0.0 to 13.9 percentage points; P = .049) than PE-owned nursing homes. Conclusions and Relevance: In this cross-sectional study, PE-owned nursing homes performed comparably on staffing levels, resident cases, and deaths with nursing homes with other types of ownership, although their shortages of PPE may warrant monitoring.


Assuntos
Infecções por Coronavirus , Instituições Privadas de Saúde , Investimentos em Saúde , Casas de Saúde , Propriedade , Pandemias , Pneumonia Viral , Qualidade da Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estudos Transversais , Equipamentos e Provisões , Governo , Instituição de Longa Permanência para Idosos , Humanos , Enfermeiras e Enfermeiros , Equipamento de Proteção Individual , Administração de Recursos Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Setor Privado , Setor Público , Instituições de Cuidados Especializados de Enfermagem
3.
J Environ Public Health ; 2020: 2123652, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32879630

RESUMO

Background: Open defecation was largely a rural phenomenon most widely attributed to poor latrine ownership at community level. We aimed at examining latrine ownership and its determinants in rural villages of the Tigray region, Northern Ethiopia. Methods: Community-based cross-sectional study was conducted from June to July 2018. A total of 756 randomly selected households were involved in the study. The multistage cluster sampling technique was used to select study households. Data were checked, coded, and entered into Epi-Info version 7. Besides, it was exported to SPSS version 20 for data analysis. Multivariable logistic regression analysis was involved to estimate the net effect size of factors associated with latrine ownership. Results: The proportion of households owning latrine was 35.7%. The majority (84.4%) of constructed latrines were utilized by household families. Households advocated latrine IEC by Health Extension Workers (HEWs) (AOR = 1.902, 95% CI: 1.269-2.852), living in their private house (AOR = 3.13, 95% CI: 1.528-6.401), and the occupation status of government employees (AOR = 3.54, 95% CI: 0.586-21.397) are more likely to lead to the construction of latrines. The availability of latrine made on slab floor (AOR = 1.790, 95% CI: 0.297-3.102), having a latrine constructed inside the household compound (AOR = 4.463, 95% CI: 1.021-19.516), and delivery of latrine IEC by Women Development Armies (WDAs) (AOR = 2.425, 95% CI: 0.728-8.083) may lead to better latrine utilization at the household level. Conclusion: Households owning latrine at the community level were low. The desired level of latrine ownership will be realized if all sanitation and hygiene components are kept on eye side by side in line with identified predictor factors.


Assuntos
Propriedade/estatística & dados numéricos , População Rural/estatística & dados numéricos , Toaletes/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Emprego , Etiópia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Adulto Jovem
4.
Med Care ; 58(10): 889-894, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32925415

RESUMO

BACKGROUND: Patients in inpatient psychiatry settings are uniquely vulnerable to harm. As sources of harm, research and policy efforts have specifically focused on minimizing and eliminating restraint and seclusion. The Centers for Medicare and Medicaid's Inpatient Psychiatric Facility Quality Reporting (IPFQR) program attempts to systematically measure and reduce restraint and seclusion. We evaluated facilities' response to the IPFQR program and differences by ownership, hypothesizing that facilities reporting these measures for the first time will show a greater reduction and that ownership will moderate this effect. METHODS: Using a difference-in-differences design and exploiting variation among facilities that previously reported on these measures to The Joint Commission, we examined the effect of the IPFQR public reporting program on the use and duration of restraint and seclusion from the end of 2012 through 2017. RESULTS: There were a total of 9705 observations of facilities among 1841 unique facilities. Results suggest the IPFQR program reduced duration of restraint by 48.96% [95% confidence interval (95% CI), 16.69%-68.73%] and seclusion by 53.54% (95% CI, 19.71%-73.12%). There was no change in odds of zero restraint and, among for-profits only, a decrease of 36.89% (95% CI, 9.32%-56.07%) in the odds of zero seclusion. CONCLUSIONS: This is the first examination of the effect of the IPFQR program on restraint and seclusion, suggesting the program was successful in reducing their use. We did not find support for ownership moderating this effect. Additional research is needed to understand mechanisms of response and the impact of the program on nontargeted aspects of quality.


Assuntos
Centers for Medicare and Medicaid Services, U.S./normas , Transtornos Mentais , Isolamento de Pacientes/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/estatística & dados numéricos , Restrição Física/estatística & dados numéricos , Humanos , Pacientes Internados , Propriedade , Registros Públicos de Dados de Cuidados de Saúde , Fatores de Tempo , Estados Unidos
6.
Artigo em Inglês | MEDLINE | ID: mdl-32823922

RESUMO

Objective: To evaluate the relationship between the ownership structure of hospitals and the possibility of their being positioned on the frontier of technical efficiency in the economic crisis period 2010-2012, adjusting for hospital variables and regional characteristics in the areas where the Spanish National Health System (SNHS) hospitals are located. Methods: 230 National Health System hospitals were studied over the two-year period 2010-2012 according to their ownership structure-public hospitals, private hospitals and public-private partnership (PPP)-data envelopment analysis orientated to inputs was used to measure the overall technical efficiency, pure efficiency and efficiency of scale. A generalised linear mixed model (GLMM) with binomial distribution and logit link function was used to analyse the hospital and regional variables associated with positioning on the frontier. Results: There are substantial differences between the average pure technical efficiency of public, private and PPP hospitals, as well as a greater number of PPP models being positioned on the efficiency frontier (91.67% in 2012). The odds of being positioned on the frontier are 41.7 times higher in PPP models than in public hospitals. The average annual household income per region is related to the greater odds of hospitals being positioned on the frontier of efficiency. Conclusions: During the most acute period of recession in the Spanish economy, PPP formulas favoured hospital efficiency, by increasing the odds of being positioned on the frontier of efficiency when compared to private and public hospitals. The position on the frontier of efficiency of a hospital is related to the wealth of its region.


Assuntos
Eficiência Organizacional , Hospitais Privados/organização & administração , Hospitais Públicos/organização & administração , Análise Multinível , Propriedade , Humanos , Parcerias Público-Privadas , Espanha
7.
Med Care ; 58(9): 793-799, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826744

RESUMO

OBJECTIVES: The Emergency Medical Treatment and Labor Act (EMTALA) is a federal law enacted in 1986 prohibiting patient dumping (refusing or transferring patients with emergency medical conditions without appropriate stabilization), and discrimination based upon ability to pay. We evaluate hospital-level features associated with citation for EMTALA violation. MATERIALS AND METHODS: A retrospective analysis of observational data on EMTALA enforcement (2005-2013). Regression analysis evaluates the association between facility-level features and odds of EMTALA citation by hospital-year. RESULTS: Among 4916 EMTALA-obligated hospitals there were 1925 EMTALA citation events at 1413 facilities between 2005 and 2013, with 4.3% of hospitals cited per year. In adjusted analyses, increased odds of EMTALA citations were found at hospitals that were: for-profit [odds ratio (OR): 1.61; 95% confidence interval (CI): 1.32-1.96], in metropolitan areas (OR: 1.32; 95% CI: 1.11-1.57); that admitted a higher proportion of Medicaid patients (OR: 1.01; 95% CI: 1.0-1.01); and were in the top quartiles of hospital size (OR: 1.48; 95% CI: 1.10-1.99) and emergency department (ED) volume (OR: 1.56; 95% CI: 1.14-2.12). Predicted probability of repeat EMTALA citation in the year following initial citation was 17% among for-profit and 11% among other hospital types. Among citation events for patients presenting to the same hospital's ED, there were 1.30 EMTALA citation events per million ED visits, with 1.04 at private not-for-profit, 1.47 at government-owned, and 2.46 at for-profit hospitals. CONCLUSIONS: For-profit ownership is associated with increased odds of EMTALA citations after adjusting for other characteristics. Efforts to improve EMTALA might be considered to protect access to emergency care for vulnerable populations, particularly at large, urban, for-profit hospitals admitting high proportions of Medicaid patients.


Assuntos
Serviço Hospitalar de Emergência/legislação & jurisprudência , Serviço Hospitalar de Emergência/estatística & dados numéricos , Transferência de Pacientes/legislação & jurisprudência , Transferência de Pacientes/estatística & dados numéricos , Número de Leitos em Hospital/estatística & dados numéricos , Hospitais com Alto Volume de Atendimentos/estatística & dados numéricos , Humanos , Medicaid/estatística & dados numéricos , Propriedade/estatística & dados numéricos , Características de Residência/estatística & dados numéricos , Estudos Retrospectivos , Estados Unidos
8.
Public Health ; 186: 83-86, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32791341

RESUMO

OBJECTIVES: The purpose of this study was to investigate the association between ownership of a potted street garden (PSG) and depression levels in a densely populated, disadvantaged Moroccan neighbourhood. STUDY DESIGN: The study design used was a cross-sectional study. METHODS: Data were collected through a face-to-face survey conducted in January 2019. In total, there were 388 participants, in three densely populated neighbourhoods of the Beni-Makada district of Tangier, Morocco. We measured depression levels using the Patient Health Questionnaire-9 and data were analysed using weighted moderated ordinary least squared regression analysis. RESULTS: PSG ownership was associated with a .74-point increase in depression score (b = .74, 95% confidence interval [CI] = .38, 1.10, ß = .22, Variance Inflation Factor (VIF) = 1.15; P < .001). PSG ownership also moderated the negative association between depression levels and neighbourhood life satisfaction (F [3,336] = 5.058, P < .001, R2 change = .039). A one-level increase in PSG being perceived as a public amenity by their owners was associated with a .36-point decrease in depression score (b = -.36, 95% CI = -.71, -.01, ß = -.14, VIF = 1.08; P < .05), whereas a 1-min increase in PSG daily care duration was associated with .04-point increase in depression score (b = .04, 95% CI = .01, .06, ß = .24, VIF = 1.68; P < .01). CONCLUSIONS: Our findings suggest that PSG ownership might have a negative impact on mental health in densely populated, disadvantaged neighbourhoods. This negative association might be due to the fact of PSGs being deemed as private property present in an unsafe and uncontrolled environment.


Assuntos
Depressão/epidemiologia , Jardins/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Estudos Transversais , Planejamento Ambiental , Feminino , Humanos , Masculino , Saúde Mental , Marrocos/epidemiologia , Propriedade , Saúde Pública , Qualidade de Vida , Características de Residência/estatística & dados numéricos , Inquéritos e Questionários , Populações Vulneráveis , Adulto Jovem
9.
Proc Natl Acad Sci U S A ; 117(34): 20495-20502, 2020 08 25.
Artigo em Inglês | MEDLINE | ID: mdl-32788369

RESUMO

In this paper, we draw on common-pool resource theory to argue that indigenous territories, when granted full property rights, will be effective at curbing deforestation. Using satellite data, we test the effect of property rights on deforestation between 1982 and 2016. In order to identify causal effects, we combine a regression discontinuity design with the orthogonal timing of homologation. We find that observations inside territories with full property rights show a significant decrease in deforestation, while the effect does not exist in territories without full property rights. While these are local average treatment effects, our results suggest that not only do indigenous territories serve a human-rights role, but they are a cost-effective way for governments to preserve their forested areas. First, obtaining full property rights is crucial to recognize indigenous peoples' original right to land and protect their territories from illegal deforestation. Second, when implemented, indigenous property rights reduce deforestation inside indigenous territories in the Amazon rainforest, and could provide an important positive externality for Brazil and the rest of the world in terms of climate change mitigation.


Assuntos
Conservação dos Recursos Naturais , Povos Indígenas , Propriedade , Floresta Úmida , Brasil , Direitos Humanos , Humanos
10.
PLoS One ; 15(8): e0238371, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853287

RESUMO

BACKGROUND: Vaccination is the most important preventive measure for protection against infectious diseases in humans and companion animals. Nevertheless, scepticism about the safety and importance of vaccines is increasing in human and in veterinary medicine. Although owner attitudes towards vaccination have been investigated in cats, there are no similar studies in dogs. The goals of this study were therefore to investigate the vaccination status of dogs in Germany, to determine owner compliance with vaccination and to identify factors that play a role in owners' decisions to have their dogs vaccinated. METHODS: Data were collected from August 2018 to February 2019 using an online survey targeting dog owners in Germany. A total of 3,881 questionnaires were evaluated, and factors associated with the vaccination status of dogs were determined by a linear logistic regression model using Akaike information criterion. Cohen's kappa statistic was used to evaluate agreement between questionnaire and 340 vaccination passports submitted voluntarily by owners. RESULTS: A total of 46.8% (n = 1,818/3,881) of dogs were vaccinated with core vaccines according to current guidelines with the lowest vaccination rate for leptospirosis (50.1%; n = 1,941/3,874). Dog's age (16 weeks to 15 months) (odds ratio (OR): 3.08; 95% CI: 2.05-4.68), type (working dog) (OR: 2.06; 95% CI: 1.22-3.53) and travelling abroad within previous 36 months (OR: 1.82; 95% CI: 1.12-2.96) had the strongest 'positive' association with the vaccination status. Recommendation from a veterinarian not to vaccinate against leptospirosis had the strongest 'negative' association (OR: 0.08; 95% CI: 0.04-0.18). CONCLUSION: The study revealed a need for improvement in vaccination compliance because of inadequate vaccination coverage, especially for leptospirosis, in dogs. Factors influencing owner compliance were numerous. Vaccination recommendations made by the veterinarian had a strong association with the vaccination status and should be used to increase canine vaccination rates.


Assuntos
Doenças do Cão/imunologia , Doenças do Cão/prevenção & controle , Propriedade/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Animais , Atitude , Cães , Alemanha , Humanos , Leptospirose/imunologia , Leptospirose/prevenção & controle , Inquéritos e Questionários , Cobertura Vacinal/estatística & dados numéricos , Médicos Veterinários/estatística & dados numéricos
11.
PLoS One ; 15(8): e0237822, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32845923

RESUMO

Although popular culture describes them as mortal enemies, more and more often, dogs and cats live under the same roof. Does this make them best friends? Can sharing the same social and physical environment make them similar? This study compares the approaches of dogs and cats living in the same household have towards humans and other pets as perceived by the owner. Questionnaires collected from 1270 people owning both dog(s) and cat(s) were analysed. Most dogs and cats living together are playful with familiar humans (76.2%) but dogs have a more sociable approach towards strangers and conspecifics than cats (P<0.001). Moreover, the percentage of dogs that have a playful relationship with the owner (84.0%) was higher than cats (49.2%; P<0.001). Dogs and cats living together eat in different places and show different mutual interactions: more dogs lick the cat (42.8%) and more cats ignore the dog (41.8%) than vice versa (P<0.001). However, most dogs and cats sleep at least occasionally (68.5%) and play together (62.4%; P<0.001). Although some body postures, such as the tail's position, are interpreted differently by the two species, the greater proportions of dogs and cats show a relaxed response to several kinds of approaches of their roommate. Our questionnaire confirms the common beliefs about the sociability of the dog and the privacy of the cat, but this does not result in continuous internal struggles. Most cohabitations are peaceful. Moreover, it is true that they speak different languages, but they seem to understand each other well and interpret each other's approaches in the right way. Thus, aspiring owners should not blindly believe popular assumptions, but both knowledge and respect for species-specific pet behaviours are essential to establish a balance in the household.


Assuntos
Características da Família , Propriedade , Animais de Estimação/psicologia , Adolescente , Adulto , Idoso , Animais , Gatos , Cães , Comportamento Alimentar , Feminino , Amigos , Hábitos , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
PLoS One ; 15(8): e0237862, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853210

RESUMO

As passive investment through index funds and Exchange Traded Funds (ETFs) has become pervasive, the structure of corporate control in the global capital market is more complex than before. We propose a new model and calculation algorithm to measure a shareholder's power to control corporations in the global economy. Our method takes into account how fragmented voting rights attached to dispersed ownership may be consolidated to generate corporate control. Analyzing the ownership holdings in 49 million companies worldwide by 69 million shareholders in 2016, we find that the landscape of global corporate control appears differently if we adequately evaluate indirect influence via dispersed ownership. In particular, a larger portion of corporate control appears to be concentrated in the hands of sovereign governments than has been recognized before. Yet, such governmental capacities are "hidden" if we use the conventional method. Moreover, financial institutions appear to not be as powerful as emphasized before. These results point to important financial and political risks both for scholars and policymakers.


Assuntos
Organizações/economia , Propriedade/economia , Algoritmos , Análise Numérica Assistida por Computador
13.
Vet Rec ; 187(4): 159, 2020 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-32826380

RESUMO

This month, David Anderson discusses the Facebook group he set up to provide support for pet owners.


Assuntos
Vínculo Homem-Animal de Estimação , Empatia , Mídias Sociais , Apoio Social , Animais , Humanos , Propriedade , Relações Profissional-Paciente , Reino Unido , Medicina Veterinária
14.
PLoS One ; 15(7): e0236166, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32706798

RESUMO

Recently, concerns have been raised over the potential impacts of commercial relationships on editorial practices in biomedical publishing. Specifically, it has been suggested that certain commercial relationships may make editors more open to publishing articles with author conflicts of interest (aCOI). Using a data set of 128,781 articles published in 159 journals, we evaluated the relationships among commercial publishing practices and reported author conflicts of interest. The 159 journals were grouped according to commercial biases (reprint services, advertising revenue, and ownership by a large commercial publishing firm). 30.6% (39,440) of articles were published in journals showing no evidence of evaluated commercial publishing relationships. 33.9% (43,630) were published in journals accepting advertising and reprint fees; 31.7% (40,887) in journals owned by large publishing firms; 1.2% (1,589) in journals accepting reprint fees only; and 2.5% (3,235) in journals accepting only advertising fees. Journals with commercial relationships were more likely to publish articles with aCOI (9.2% (92/1000) vs. 6.4% (64/1000), p = 0.024). In the multivariate analysis, only a journal's acceptance of reprint fees served as a significant predictor (OR = 2.81 at 95% CI, 1.5 to 8.6). Shared control estimation was used to evaluate the relationships between commercial publishing practices and aCOI frequency in total and by type. BCa-corrected mean difference effect sizes ranged from -1.0 to 6.1, and confirm findings indicating that accepting reprint fees may constitute the most significant commercial bias. The findings indicate that concerns over the influence of industry advertising in medical journals may be overstated, and that accepting fees for reprints may constitute the largest risk of bias for editorial decision-making.


Assuntos
Pesquisa Biomédica , Conflito de Interesses , Políticas Editoriais , Propriedade , Viés de Publicação , Publicidade , Humanos
15.
CMAJ ; 192(33): E946-E955, 2020 08 17.
Artigo em Inglês | MEDLINE | ID: mdl-32699006

RESUMO

BACKGROUND: Long-term care (LTC) homes have been the epicentre of the coronavirus disease 2019 (COVID-19) pandemic in Canada to date. Previous research shows that for-profit LTC homes deliver inferior care across a variety of outcome and process measures, raising the question of whether for-profit homes have had worse COVID-19 outcomes than nonprofit homes. METHODS: We conducted a retrospective cohort study of all LTC homes in Ontario, Canada, from Mar. 29 to May 20, 2020, using a COVID-19 outbreak database maintained by the Ontario Ministry of Long-Term Care. We used hierarchical logistic and count-based methods to model the associations between profit status of LTC homes (for-profit, nonprofit or municipal) and COVID-19 outbreaks in LTC homes, the extent of COVID-19 outbreaks (number of residents infected), and deaths of residents from COVID-19. RESULTS: The analysis included all 623 Ontario LTC homes, comprising 75 676 residents; 360 LTC homes (57.7%) were for profit, 162 (26.0%) were nonprofit, and 101 (16.2%) were municipal homes. There were 190 (30.5%) outbreaks of COVID-19 in LTC homes, involving 5218 residents and resulting in 1452 deaths, with an overall case fatality rate of 27.8%. The odds of a COVID-19 outbreak were associated with the incidence of COVID-19 in the public health unit region surrounding an LTC home (adjusted odds ratio [OR] 1.91, 95% confidence interval [CI] 1.19-3.05), the number of residents (adjusted OR 1.38, 95% CI 1.18-1.61), and older design standards of the home (adjusted OR 1.55, 95% CI 1.01-2.38), but not profit status. For-profit status was associated with both the extent of an outbreak in an LTC home (adjusted risk ratio [RR] 1.96, 95% CI 1.26-3.05) and the number of resident deaths (adjusted RR 1.78, 95% CI 1.03-3.07), compared with nonprofit homes. These associations were mediated by a higher prevalence of older design standards in for-profit LTC homes and chain ownership. INTERPRETATION: For-profit status is associated with the extent of an outbreak of COVID-19 in LTC homes and the number of resident deaths, but not the likelihood of outbreaks. Differences between for-profit and nonprofit homes are largely explained by older design standards and chain ownership, which should be a focus of infection control efforts and future policy.


Assuntos
Infecções por Coronavirus , Coronavirus , Assistência de Longa Duração , Pandemias , Pneumonia Viral , Betacoronavirus , Surtos de Doenças , Humanos , Casas de Saúde , Ontário , Propriedade , Estudos Retrospectivos
16.
PLoS One ; 15(7): e0236078, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32687527

RESUMO

BACKGROUND: The disruptive potential of mobile phones in catalyzing development is increasingly being recognized. However, numerous gaps remain in access to phones and their influence on health care utilization. In this cross-sectional study from India, we assess the gaps in women's access to phones, their influencing factors, and their influence on health care utilization. METHODS: Data drawn from the 2015 National Family Health Survey (NFHS) in India included a national sample of 45,231 women with data on phone access. Survey design weighted estimates of household phone ownership and women's access among different population sub-groups are presented. Multilevel logistic models explored the association of phone access with a wide range of maternal and child health indicators. Blinder-Oaxaca (BO) decomposition is used to decompose the gaps between women with and without phone access in health care utilization into components explained by background characteristics influencing phone access (endowments) and unexplained components (coefficients), potentially attributable to phone access itself. FINDINGS: Phone ownership at the household level was 92·8% (95% CI: 92·6-93·0%), with rural ownership at 91·1% (90·8-91·4%) and urban at 97.1% (96·7-97·3%). Women's access to phones was 47·8% (46·7-48·8%); 41·6% in rural areas (40·5-42·6%) and 62·7% (60·4-64·8%) in urban. Phone access in urban areas was positively associated with skilled birth attendance, postnatal care and use of modern contraceptives and negatively associated with early antenatal care. Phone access was not associated with improvements in utilization indicators in rural settings. Phone access (coefficient components) explained large gaps in the use of modern contraceptives, moderate gaps in postnatal care and early antenatal care, and smaller differences in the use of skilled birth attendance and immunization. For full antenatal car, phone access was associated with reducing gaps in utilization. INTERPRETATION: Women of reproductive age have significantly lower phone access use than the households they belong to and marginalized women have the least phone access. Existing phone access for rural women did not improve their health care utilization but was associated with greater utilization for urban women. Without addressing these biases, digital health programs may be at risk of worsening existing health inequities.


Assuntos
Telefone Celular/estatística & dados numéricos , Nível de Saúde , Inquéritos Epidemiológicos , Adulto , Feminino , Habitação/estatística & dados numéricos , Humanos , Índia , Serviços de Saúde Materna/estatística & dados numéricos , Análise Multivariada , Propriedade/estatística & dados numéricos
17.
Am J Public Health ; 110(9): 1315-1317, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32673119

RESUMO

Objectives. To describe characteristics of rural hospitals in the United States by whether they provide labor and delivery (obstetric) care for pregnant patients.Methods. We used the 2017 American Hospital Association Annual Survey to identify rural hospitals and describe their characteristics based on the lack or provision of obstetric services.Results. Among the 2019 rural hospitals in the United States, 51% (n = 1032) of rural hospitals did not provide obstetric care. These hospitals were more often located in rural noncore counties (counties with no town of more than 10 000 residents). Rural hospitals without obstetrics also had lower average daily censuses, were more likely to be government owned or for profit compared with nonprofit ownership, and were more likely to not have an emergency department compared with hospitals providing obstetric care (P for all comparisons < .001).Conclusions. Rural US hospitals that do not provide obstetric care are located in more sparsely populated rural locations and are smaller than hospitals providing obstetric care.Public Health Implications. Understanding the characteristics of rural hospitals by lack or provision of obstetric services is important to clinical and policy efforts to ensure safe maternity care for rural residents.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Obstetrícia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitais Rurais/classificação , Humanos , Propriedade , Gravidez , Estados Unidos
20.
N Engl J Med ; 382(23): 2220-2229, 2020 06 04.
Artigo em Inglês | MEDLINE | ID: mdl-32492303

RESUMO

BACKGROUND: Research has consistently identified firearm availability as a risk factor for suicide. However, existing studies are relatively small in scale, estimates vary widely, and no study appears to have tracked risks from commencement of firearm ownership. METHODS: We identified handgun acquisitions and deaths in a cohort of 26.3 million male and female residents of California, 21 years old or older, who had not previously acquired handguns. Cohort members were followed for up to 12 years 2 months (from October 18, 2004, to December 31, 2016). We used survival analysis to estimate the relationship between handgun ownership and both all-cause mortality and suicide (by firearm and by other methods) among men and women. The analysis allowed the baseline hazard to vary according to neighborhood and was adjusted for age, race and ethnic group, and ownership of long guns (i.e., rifles or shotguns). RESULTS: A total of 676,425 cohort members acquired one or more handguns, and 1,457,981 died; 17,894 died by suicide, of which 6691 were suicides by firearm. Rates of suicide by any method were higher among handgun owners, with an adjusted hazard ratio of 3.34 for all male owners as compared with male nonowners (95% confidence interval [CI], 3.13 to 3.56) and 7.16 for female owners as compared with female nonowners (95% CI, 6.22 to 8.24). These rates were driven by much higher rates of suicide by firearm among both male and female handgun owners, with a hazard ratio of 7.82 for men (95% CI, 7.26 to 8.43) and 35.15 for women (95% CI, 29.56 to 41.79). Handgun owners did not have higher rates of suicide by other methods or higher all-cause mortality. The risk of suicide by firearm among handgun owners peaked immediately after the first acquisition, but 52% of all suicides by firearm among handgun owners occurred more than 1 year after acquisition. CONCLUSIONS: Handgun ownership is associated with a greatly elevated and enduring risk of suicide by firearm. (Funded by the Fund for a Safer Future and others.).


Assuntos
Armas de Fogo , Violência com Arma de Fogo/estatística & dados numéricos , Suicídio/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , California/epidemiologia , Causas de Morte , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Propriedade , Fatores de Risco , Suicídio/prevenção & controle , Análise de Sobrevida , Adulto Jovem
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