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5.
Medicine (Baltimore) ; 99(2): e18723, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914087

RESUMO

Effectiveness, efficacy and safety of biosimilar infliximab (CT-P13) in inflammatory bowel disease (IBD) patients has been shown in previous studies. Limited data exist on health-related quality of life (HRQoL) of switching originator to biosimilar infliximab (IFX) in IBD patients. The objective of this study was to evaluate impact of switching originator to biosimilar IFX on HRQoL, disease activity, and health care costs in IBD maintenance treatment.In this single-center prospective observational study, all IBD patients receiving maintenance IFX therapy were switched to biosimilar IFX. HRQoL was measured using the generic 15D health-related quality of life instrument (15D) utility measurement and the disease-specific Inflammatory Bowel Disease Questionnaire (IBDQ). Crohn Disease Activity Index (CDAI) or Partial Mayo Score (pMayo), and fecal calprotectin (FC) served for evaluation of disease activity. Data were collected at time of switching and 3 and 12 months after switching. Patients' characteristics, clinical background information and costs were collected from patient records and the hospital's electronic database.Fifty-four patients were included in the analysis. No statistically significant changes were observed in 15D, CDAI, pMayo, and FC during 1-year follow-up. IBDQ scores were higher (P = .018) in Crohn disease 3 months after switching than at time of switching. Costs of biosimilar IFX were one-third of costs of originator one. Total costs related to secondary health care (excluding costs of IFX), were similar before and after the onset of biosimilar IFX.HRQoL and disease activity were after switching from originator to biosimilar IFX comparable, but the costs of biosimilar IFX were only one-third of those of the originator one.


Assuntos
Anticorpos Monoclonais/uso terapêutico , Medicamentos Biossimilares/uso terapêutico , Fármacos Gastrointestinais/uso terapêutico , Doenças Inflamatórias Intestinais/tratamento farmacológico , Infliximab/uso terapêutico , Qualidade de Vida , Adulto , Anticorpos Monoclonais/economia , Medicamentos Biossimilares/economia , Substituição de Medicamentos/economia , Feminino , Fármacos Gastrointestinais/economia , Recursos em Saúde/economia , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Infliximab/economia , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Indução de Remissão
6.
Ann Otol Rhinol Laryngol ; 129(2): 181-190, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31631687

RESUMO

OBJECTIVES: Tracheostomy care in leading pediatric hospitals is both multidisciplinary and comprehensive, including generalized care protocols and thorough family training programs. This level of care is more difficult in resource-limited settings lacking developed healthcare infrastructure and tracheostomy education among nursing and resident staff. The objective of this study was to improve pediatric tracheostomy care in resource-limited settings. METHODS: In collaboration with a team of otolaryngologists, respiratory therapists, tracheostomy nurses, medical illustrators, and global health educators, image-based tracheostomy education materials and low-cost tracheostomy care kits were developed for use in resource-limited settings. In addition, a pilot study was conducted, implementing the image-based tracheostomy pamphlet, manual suctioning device and low-cost ambulatory supply kit ("Go-Bags"), within a low-fidelity simulated training course for nurses and residents in Kigali, Rwanda. RESULTS: An image-based language and literacy-independent tracheostomy care manual was created and published on OPENPediatrics, an open-access online database of clinician-reviewed learning content. Participants of the training program pilot study reported the course to be of high educational and practical value, and described improved confidence in their ability to perform tracheostomy care procedures. CONCLUSIONS: Outpatient tracheostomy care may be improved upon by implementing image-based tracheostomy care manuals, locally-sourced tracheostomy care kits, and tailored educational material into a low-fidelity simulated tracheostomy care course. These materials were effective in improving technical skills and confidence among nurses and residents. These tools are expected to improve knowledge and skills with outpatient tracheostomy care, and ultimately, to reduce tracheostomy-related complications.


Assuntos
Cuidados Pós-Operatórios/normas , Melhoria de Qualidade , Traqueostomia , Assistência Ambulatorial , Criança , Feminino , Recursos em Saúde , Humanos , Masculino , Projetos Piloto , Ruanda , Traqueostomia/educação , Traqueostomia/instrumentação
8.
Tidsskr Nor Laegeforen ; 139(18)2019 Dec 10.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31823588

RESUMO

BACKGROUND: Increasing the utilisation of unused capacity in hospitals is a health policy goal, but there is concern that little unused capacity remains. The objective of the study was to examine how healthcare personnel experience and deal with pressure on capacity in the somatic specialist health services. MATERIAL AND METHOD: In this qualitative study, we conducted semi-structured interviews with unit heads and doctors and nurses involved in discharging patients in two Norwegian hospital trusts. Nine interviews (both individual and group) with altogether 19 informants were carried out in the period October 2017-February 2018. The interviews were analysed using systematic text condensation. RESULTS: Pressure on hospital capacity was described as continual pressure to treat more patients. The informants used the term 'undercapacity': a situation in which increased demands without sufficient resources were detrimental to something or someone. Elderly patients who had completed their treatment and were waiting for the provision of municipal services were regarded as particularly vulnerable, since they were often overrepresented among the patients moved between departments and wards in order to free up capacity when beds were urgently needed. The hospital staff felt they had little influence on the type of municipal services the patients were offered following discharge. INTERPRETATION: The informants stated that their daily work was negatively affected by undercapacity. Health professionals' perceptions of pressure on hospital capacity constitute vital knowledge in policy formation in the field.


Assuntos
Atitude do Pessoal de Saúde , Pessoal de Saúde , Medicina , Carga de Trabalho , Idoso , Recursos em Saúde , Humanos , Noruega , Recursos Humanos em Hospital/psicologia , Pesquisa Qualitativa
9.
Lakartidningen ; 1162019 Nov 28.
Artigo em Sueco | MEDLINE | ID: mdl-31794047

RESUMO

The platform for priority-setting contains key ideas about the mission, goals and values of health care in Sweden. The basic idea is that health care resources should be distributed primarily according to need and effect, and secondarily according to cost-effectiveness. Nobody should be discriminated against on the basis of their gender, age, religion, ethnic origin or political views. We also need to distinguish between the health-related needs that we, as a society, have agreed should be met by publicly funded health care and needs for which there is no such agreement. The mission of health care can, and ought to, remain unchanged, even if, or as, this classification changes. The platform should not be abandoned, since it helps to maintain trust in our publicly financed health care system.


Assuntos
Alocação de Recursos para a Atenção à Saúde/organização & administração , Prioridades em Saúde/organização & administração , Necessidades e Demandas de Serviços de Saúde , Recursos em Saúde , Humanos , Alocação de Recursos , Medicina Estatal , Suécia
10.
Zhonghua Er Ke Za Zhi ; 57(12): 913-916, 2019 Dec 02.
Artigo em Chinês | MEDLINE | ID: mdl-31795556

RESUMO

Objective: To investigate general condition of children's rheumatic disease associated medical resources in Fujian Province. Methods: This questionnaire-based survey was conducted in 19 hospitals in Fujian province from December 2, 2018 to May 1, 2019. The questionnaire was designed to survey the general condition of the medical resources and the hospitalization of patients with rheumatic diseases from January 1, 2014 to December 1, 2018. Results: In the 19 hospitals, there were 15 general hospitals and 4 children's hospitals, and only 5 hospitals had children's rheumatic specialist clinic. There were only 53-62 beds for rheumatic disease patients in the 19 hospitals, accounting for 1.7%-2.0% of the total inpatient beds (3 137). There are 29 pediatric rheumatologists in total, accounting for 2.6% (29/1 120) of the total pediatricians. In the past five years, 613 patients with rheumatic diseases, accounting for 0.1% (613/625 214) of total hospitalized patients, were treated in these hospitals. Among them, 201 had juvenile idiopathic arthritis, 295 had systemic lupus erythematosus, 39 had dermatomyositis, 7 had scleroderma, and 57 had inflammatory bowel disease, 9 had Sjogren's syndrome, 5 had Behcet's disease, and none had overlap syndrome or mixed connective tissue disease. Conclusion: The medical resources of children rheumatic diseases in Fujian province are insufficient which need to be developed.


Assuntos
Recursos em Saúde/provisão & distribução , Recursos em Saúde/estatística & dados numéricos , Doenças Reumáticas/terapia , Criança , China , Hospitais , Humanos , Inquéritos e Questionários
11.
Afr J Reprod Health ; 23(3): 57-67, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31782632

RESUMO

The health system in many parts of Nigeria has been dysfunctional in several domains including financing, human resources, infrastructure, health management information system and hospital services. In an attempt to scale up Maternal and Child Health (MCH) services and ensure efficiency, Ebonyi State Government in Southeast Nigeria provided funding to mission hospitals across the State as a grant. This study used nonparametric method to assess the effect of this public financing on the efficiency of the mission hospitals. Operational cost and number of hospital beds were used as the input variables, while antenatal registrations, number of immunization doses and hospital deliveries were the output variables. The hospitals were disaggregated into 15 hospital-years. The mean overall technical efficiency of the mission hospitals was 84.05 22.45%. The mean pure technical efficiency was 95.56±6.9% and the scale efficiency was 88.05±22.20%. About 46.67% of all the hospital-years were technically and scale efficient. Although, 55.33% were generally inefficient, only 33.33% of hospital-years exhibited pure technical inefficiency. Low immunization coverage was the major cause of inefficiency. The study showed increased maternal health service output as result of public funding or intervention; however, the mission hospitals could have saved 16% of input resources if they had performed efficiently. It also shows that data envelopment analysis can be used in setting targets/benchmarks for relatively inefficient health facilities, and in monitoring impact of interventions on efficiency of hospitals over-time.


Assuntos
Serviços de Saúde da Criança/organização & administração , Assistência à Saúde/organização & administração , Eficiência Organizacional , Recursos em Saúde/estatística & dados numéricos , Hospitais Religiosos/organização & administração , Serviços de Saúde Materna/organização & administração , Criança , Serviços de Saúde da Criança/estatística & dados numéricos , Custos e Análise de Custo , Estudos Transversais , Assistência à Saúde/estatística & dados numéricos , Feminino , Financiamento Governamental , Hospitais Religiosos/estatística & dados numéricos , Humanos , Masculino , Serviços de Saúde Materna/estatística & dados numéricos , Nigéria , Gravidez , Estudos Retrospectivos
12.
BMC Public Health ; 19(1): 1509, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31718603

RESUMO

BACKGROUND: Health resources are limited, which means spending should be focused on the people, places and programs that matter most. Choosing the mix of programs to maximize a health outcome is termed allocative efficiency. Here, we extend the methodology of allocative efficiency to answer the question of how resources should be distributed among different geographic regions. METHODS: We describe a novel geographical optimization algorithm, which has been implemented as an extension to the Optima HIV model. This algorithm identifies an optimal funding of services and programs across regions, such as multiple countries or multiple districts within a country. The algorithm consists of three steps: (1) calibrating the model to each region, (2) determining the optimal allocation for each region across a range of different budget levels, and (3) finding the budget level in each region that minimizes the outcome (such as reducing new HIV infections and/or HIV-related deaths), subject to the constraint of fixed total budget across all regions. As a case study, we applied this method to determine an illustrative allocation of HIV program funding across three representative oblasts (regions) in Ukraine (Mykolayiv, Poltava, and Zhytomyr) to minimize the number of new HIV infections. RESULTS: Geographical optimization was found to identify solutions with better outcomes than would be possible by considering region-specific allocations alone. In the case of Ukraine, prior to optimization (i.e. with status quo spending), a total of 244,000 HIV-related disability-adjusted life years (DALYs) were estimated to occur from 2016 to 2030 across the three oblasts. With optimization within (but not between) oblasts, this was estimated to be reduced to 181,000. With geographical optimization (i.e., allowing reallocation of funds between oblasts), this was estimated to be further reduced to 173,000. CONCLUSIONS: With the increasing availability of region- and even facility-level data, geographical optimization is likely to play an increasingly important role in health economic decision making. Although the largest gains are typically due to reallocating resources to the most effective interventions, especially treatment, further gains can be achieved by optimally reallocating resources between regions. Finally, the methods described here are not restricted to geographical optimization, and can be applied to other problems where competing resources need to be allocated with constraints, such as between diseases.


Assuntos
Algoritmos , Assistência à Saúde/economia , Organização do Financiamento/métodos , Infecções por HIV/economia , Custos de Cuidados de Saúde , Recursos em Saúde , Alocação de Recursos , Tomada de Decisões , Infecções por HIV/terapia , Humanos , Anos de Vida Ajustados por Qualidade de Vida , Análise Espacial , Ucrânia
13.
Z Evid Fortbild Qual Gesundhwes ; 147-148: 34-44, 2019 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-31732386

RESUMO

BACKGROUND: Evidence-based and formally consensus-based clinical practice guidelines (S3-CPGs) are a valuable source for the development of quality indicators (QIs) in Germany. While deriving QIs from guideline recommendations is a mandatory part of the development of S3-CPGs within the National Program for Disease Management Guidelines (DMGP) and the German Guideline Program in Oncology (GGPO), there is no such obligation in the guideline program of the Association of the Scientific Medical Societies in Germany (AWMF) (MS program). Despite that, several S3-CPGs in the MS program have been published with QIs in the last years while some DMGP and one GGPO S3 guidelines have failed to meet this requirement. From the perspective of the guideline authors of all three mentioned programs, the present qualitative study examined why S3-CPGs do or do not contain QIs and explored the factors perceived by authors as either facilitating or hampering in the QI development process. METHODS: Semi-structured interviews were conducted with authors of 22 S3-CPGs, 11 of which represented guidelines containing QIs and 11 of which represented guidelines without QIs. Authors of guidelines containing QIs (n=11) were asked about the perceived decisive reasons for formulating QIs and about facilitators and barriers during the QI development process. Authors of guidelines without QIs (n=11) gave reasons for not formulating QIs. Interviews were analyzed using structuring qualitative content analysis. RESULTS: Within the MS program, not formulating QIs was mainly attributed to the lack of a mandatory requirement and to insufficient funding of guideline projects. Amongst DMGP authors, a low priority of QI development prevailed, which was, for example, due to already existing QIs or to their lacking implementation. In the GGPO guideline examined, not formulating QIs was due to the guideline topic (prevention) - for this topic, there was a lack of suitable evidence and data sources. If QIs were developed, the most important facilitating factor in the development process, across all programs, was the methodological support provided by the guideline program. Important hampering factors included the additional time required for QI development and concerns regarding the implementation of many potential QIs, especially due to a lack of data availability. DISCUSSION: For regular development of QIs within S3-CPG projects, the incorporation of such a requirement in the guideline program is a necessary, but not a sufficient, condition. Other pivotal factors include systematic methodological support, adequate financial and staff resources and the perceived meaningfulness and relevance of guideline-based QI development, measured in terms of the actual implementation of already existing QIs. CONCLUSION: The study reveals starting points for measures to strengthen the consideration of QI development in German S3-CPG projects, especially within the MS program. Without substantial structural changes, especially of the resources of guideline groups, and without an overall concept covering the entire process from QI development to QI implementation, guideline-based QI development will remain heavily dependent on the (self-)motivation of guideline groups.


Assuntos
Recursos em Saúde , Guias de Prática Clínica como Assunto/normas , Indicadores de Qualidade em Assistência à Saúde/normas , Sociedades Médicas , Protocolos Clínicos/normas , Assistência à Saúde/normas , Alemanha , Humanos , Oncologia , Pesquisa Qualitativa
15.
Adv Exp Med Biol ; 1168: 103-115, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31713167

RESUMO

The past two decades have seen unprecedented advances in the field of oncogenomics. The ongoing characterization of neoplastic tissues through genomic techniques has transformed many aspects of cancer research, diagnosis, and treatment. However, identifying sequence variants with biological and clinical significance is a challenging endeavor. In order to accomplish this task, variants must be annotated and interpreted using various online resources. Data on protein structure, functional prediction, variant frequency in relevant populations, and multiple other factors have been compiled in useful databases for this purpose. Thus, understanding the available online resources for the annotation and interpretation of sequence variants is critical to aid molecular pathologists and researchers working in this space.


Assuntos
Bases de Dados Genéticas , Privacidade Genética , Neoplasias , Farmacogenética , Privacidade Genética/tendências , Variação Genética , Recursos em Saúde , Humanos , Internet , Neoplasias/fisiopatologia , Neoplasias/terapia , Análise de Sequência de DNA/normas , Análise de Sequência de DNA/tendências
17.
Res Nurs Health ; 42(6): 446-457, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31599010

RESUMO

The purpose of this paper is to describe the approaches and recruitment strategies of a study focused on the impact of coal fly ash on neurobehavioral performance among children living in proximity to coal-burning power plants. Challenges encountered with each recruitment approach are highlighted as well as solutions used to overcome those challenges and ultimately enroll children and one of their parents or guardians. To ensure participants were distributed throughout the study area, geographical information systems were used to guide recruitment and achieve the target sample size (N = 300). Several approaches were employed to recruit the number of needed participants, including "shoe leather" or door-to-door recruitment, placement of flyers and brochures in public spaces, mailings to targeted addresses, media announcements, and local government outreach. Since September 2015, 265 participants have been enrolled in the study using a combination of the described recruitment approaches. Even with a well-designed plan, it is important to re-examine strategies at every step to maximize recruitment efforts. Researcher flexibility in adapting to new strategies is vital in facilitating recruitment efforts, and the recruitment of participants in the study remains a dynamic and evolving process.


Assuntos
Saúde da Criança , Cinza de Carvão/efeitos adversos , Seleção de Pacientes , Projetos de Pesquisa , Criança , Carvão Mineral , Sistemas de Informação Geográfica , Recursos em Saúde/economia , Humanos , Centrais Elétricas
18.
BMC Health Serv Res ; 19(1): 706, 2019 Oct 16.
Artigo em Inglês | MEDLINE | ID: mdl-31619234

RESUMO

BACKGROUND: Despite the increasing burden of diabetes in Uganda, little is known about the quality of type 2 diabetes mellitus (T2DM) care especially in rural areas. Poor quality of care is a serious limitation to the control of diabetes and its complications. This study assessed the quality of care and barriers to service delivery in two rural districts in Eastern Uganda. METHODS: This was a mixed methods cross-sectional study, conducted in six facilities. A randomly selected sample of 377 people with diabetes was interviewed using a pre-tested interviewer administered questionnaire. Key informant interviews were also conducted with diabetes care providers. Data was collected on health outcomes, processes of care and foundations for high quality health systems. The study included three health outcomes, six elements of competent care under processes and 16 elements of tools/resources and workforce under foundations. Descriptive statistics were computed to determine performance under each domain, and thematic content analysis was used for qualitative data. RESULTS: The mean age of participants was 49 years (±11.7 years) with a median duration of diabetes of 4 years (inter-quartile range = 2.7 years). The overall facility readiness score was 73.9%. Inadequacies were found in health worker training in standard diabetes care, availability of medicines, and management systems for services. These were also the key barriers to provision and access to care in addition to lack of affordability. Screening of clients for blood cholesterol and microvascular complications was very low. Regarding outcomes; 56.8% of participants had controlled blood glucose, 49.3% had controlled blood pressure; and 84.0% reported having at least one complication. CONCLUSION: The quality of T2DM care provided in these rural facilities is sub-optimal, especially the process of care. The consequences include sub-optimal blood glucose and blood pressure control. Improving availability of essential medicines and basic technologies and competence of health workers can improve the care process leading to better outcomes.


Assuntos
Assistência à Saúde/normas , Diabetes Mellitus Tipo 2/terapia , Adulto , Assistência Ambulatorial/normas , Assistência Ambulatorial/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Diagnóstico Tardio , Diabetes Mellitus Tipo 2/diagnóstico , Medicamentos Essenciais , Feminino , Instalações de Saúde/normas , Instalações de Saúde/estatística & dados numéricos , Pessoal de Saúde/educação , Recursos em Saúde , Mão de Obra em Saúde/estatística & dados numéricos , Humanos , Hipoglicemiantes/uso terapêutico , Masculino , Pacientes Ambulatoriais/estatística & dados numéricos , Qualidade da Assistência à Saúde , Saúde da População Rural , Uganda
19.
West Afr J Med ; 36(3): 267-273, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31622490

RESUMO

BACKGROUND: Asthma is known to constitute a huge economic burden to its sufferers and their carers. There is a dearth of studies documenting this burden among asthmatics in Nigeria. OBJECTIVE: This study assessed the relationship between economic cost and psychiatric morbidity among stable Nigerian patients with asthma. METHODS: 85 patients with asthma completed a socio-demographic and illness-related questionnaire, the modified Economic Cost Questionnaire and General Health Questionnaire 12 (GHQ 12). Associations between socio-demographic characteristics, illness related variables, psychiatric morbidity and the direct, indirect and total costs in relation to asthma were assessed. RESULTS: The average annual total, direct and indirect cost were $309, $190.65 and $118.34 respectively per patient for subjects with asthma. Direct cost constituted 62.7% while the indirect cost was 38.3% of the total cost for asthma. Drugs and hospitalisation were leading contributors to direct costs for asthma. Psychiatric morbidity was found to be present in 35% of subjects with asthma, those with psychiatric morbidity had a higher economic burden. CONCLUSION: The economic cost of asthma is high, psychiatric morbidity increases this cost. The cost is largely due to drugs and hospitalisations for exacerbation. There is an urgent need to optimize means of helping to minimize this cost and increase measures for detecting and treating psychiatric morbidity.


Assuntos
Antiasmáticos/economia , Asma/economia , Gastos em Saúde , Hospitalização/economia , Transtornos Mentais/epidemiologia , Antiasmáticos/administração & dosagem , Antiasmáticos/uso terapêutico , Asma/tratamento farmacológico , Asma/epidemiologia , Efeitos Psicossociais da Doença , Custos e Análise de Custo , Custos Diretos de Serviços/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Humanos , Morbidade , Nigéria/epidemiologia , Qualidade de Vida
20.
Pan Afr Med J ; 33: 186, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31565146

RESUMO

Introduction: Acute gastroenteritis (AGE) is a leading cause of mortality in children in developing countries. Management of AGE consumes medical resources, including antibiotics and intra-venous fluids, but factors affecting resource utilization in the management of AGE are under-studied. We hope to identify clinical predictors of resource utilization in AGE. Methods: We performed a retrospective chart review of patients 1-60 months of age admitted to a tertiary hospital in Northern Ghana between January 2013 and December 2014 with an admitting diagnosis of AGE. We collected data on patient demographics, presenting symptoms, and subsequent management. Our primary outcome was prolonged hospital length of stay, defined as >4 days. Secondary outcomes included other measures of resource utilization, such as use of antibiotics, antimalarials and intravenous fluids. Demographic and clinical characteristics were compared between groups with Pearson chi square test for categorical variables and ANOVA for continuous variables. Multivariable logistic regression modeling for each outcome included all variables found to be significant in the bivariate analysis. Results: We reviewed charts for 473 patients admitted for AGE during this timeframe. 264 (56%) were male, median age was 12 months. 448 (95%) received antibiotics, 396 (84%) received antimalarials and 365 (77.2%) received intravenous fluids. 167 (35.3%) had prolonged LOS >4 days. Following multiple logistic regression analysis, clinical features associated with prolonged LOS included fever duration (OR 2.87, 95% CI 2.28-3.61 per 1-day increase), mild (OR 2.39, 95% CI 1.12-5.08) or moderate (OR 3.13, 95% CI 1.57-6.21) dehydration (compared to none) and symptom duration (OR 1.13, 95% CI 1.01-1.27 per 1-day increase). Conclusion: Dehydration and duration of symptoms prior to presentation predict prolonged hospital LOS in young children with AGE in Northern Ghana.


Assuntos
Desidratação/terapia , Gastroenterite/terapia , Hospitalização/estatística & dados numéricos , Doença Aguda , Antibacterianos/administração & dosagem , Antimaláricos/administração & dosagem , Pré-Escolar , Desidratação/epidemiologia , Feminino , Febre/epidemiologia , Hidratação/estatística & dados numéricos , Gana , Recursos em Saúde/estatística & dados numéricos , Humanos , Lactente , Tempo de Internação/estatística & dados numéricos , Modelos Logísticos , Masculino , Estudos Retrospectivos , Centros de Atenção Terciária
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