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1.
Stud Health Technol Inform ; 282: 348-357, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34085980

RESUMO

This paper is presenting a research and development project related to areas with decreasing and ageing population. The focus of the study is on housing and the inclusion of older people in rural communities. The case study method was implemented in three shrinking municipalities in remote areas. The population loss in small ageing municipalities is affecting the number of local services as well as access to public transport. Most people 75 years old and older live in owner occupied single-family houses. The accessibility renovations of these houses for low-income older residents are challenging. Strategic long-term concepts are needed to improve the housing for older people and the urban quality of small municipal centers. Initiatives focusing on wellbeing and social cohesion are needed to enable people to remain living in rural areas in the future. Actions related to planning and services for the older population should contribute to social cohesion within the community. A dense and walkable municipal center with accessible apartments may help municipalities provide for their older populations. Future developments need to be based on resource efficiency and an intergenerational approach to keep these municipalities good places to live.


Assuntos
Envelhecimento , População Rural , Idoso , Serviços de Saúde , Acesso aos Serviços de Saúde , Habitação , Humanos
2.
Rev Med Chil ; 149(1): 62-75, 2021 Jan.
Artigo em Espanhol | MEDLINE | ID: mdl-34106137

RESUMO

BACKGROUND: A health system is successful when it maintains a healthy population and provides health services that are effective, equitable and safe. AIM: To design a system based on specific indicators to monitor equity in health care access in Chile. MATERIAL AND METHODS: Primary information about five dimensions of access to health was collected, namely health policies, characteristics of the health system, characteristics of the population at risk, utilization of health services and consumer satisfaction. Subsequently, inequalities in access between different social groups were identified. Finally, after collecting and filtering access indicators used in other systems and existing literature, the most relevant ones were selected to monitor each identified barrier. RESULTS: A system composed of 26 indicators, classified in the five dimensions of the framework was devised. It allows us to monitor those barriers with a greater impact on the population. For some specific indicators, population groups were disaggregated to carry out specific surveillances. CONCLUSIONS: The design of a multidimensional monitoring system for health access allows us to complement measures usually focused on a specific concept of access (such as utilization, coverage, etc.) with other dimensions. It includes those barriers that are relevant for the Chilean population. It also allows comparisons with other health systems and the generation of evidence to improve public policies.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde , Chile , Política de Saúde , Disparidades em Assistência à Saúde , Humanos , Política Pública
3.
BMC Health Serv Res ; 21(1): 568, 2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34107950

RESUMO

BACKGROUND: The epidemiology and cost of surgical care delivery in low-and middle-income countries (LMICs) is poorly understood. This study characterizes the cost of surgical care, rate of catastrophic medical expenditure and medical impoverishment, and impact of surgical hospitalization on patients' households at Soroti Regional Referral Hospital (SRRH), Uganda. METHODS: We prospectively collected demographic, clinical, and cost data from all surgical inpatients and caregivers at SRRH between February 2018 and January 2019. We conducted and thematically analyzed qualitative interviews to discern the impact of hospitalization on patients' households. We employed the chi-square, t-test, ANOVA, and Bonferroni tests and built regression models to identify predictors of societal cost of surgical care. Out of pocket spending (OOPS) and catastrophic expenses were determined. RESULTS: We encountered 546 patients, mostly male (62%) peasant farmers (42%), at a median age of 22 years; and 615 caregivers, typically married (87%), female (69%), at a median age of 35 years. Femur fractures (20.4%), soft tissue infections (12.3%), and non-femur fractures (11.9%) were commonest. The total societal cost of surgical care was USD 147,378 with femur fractures (USD 47,879), intestinal obstruction (USD 18,737) and non-femur fractures (USD 10,212) as the leading contributors. Procedures (40%) and supplies (12%) were the largest components of societal cost. About 29% of patients suffered catastrophic expenses and 31% were medically impoverished. CONCLUSION: Despite free care, surgical conditions cause catastrophic expenses and impoverishment in Uganda. Femur fracture is the most expensive surgical condition due to prolonged hospitalization associated with traction immobilization and lack of treatment modalities with shorter hospitalization.


Assuntos
Características da Família , Gastos em Saúde , Adulto , Feminino , Serviços de Saúde , Humanos , Masculino , Pobreza , Uganda/epidemiologia , Adulto Jovem
4.
Cien Saude Colet ; 26(suppl 1): 2459-2470, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34133626

RESUMO

Vulnerability processes and effects, albeit of great importance to cohesion and territorial policies, are nonetheless still underexplored and narrowly operationalized in scientific research. In particular, most assessments rely on economic indicators and a limited territorial scale, which do not have the same analytic potential of a broader view at a national level with regional/municipal similarities, specificities, and inter-connections. This gap also applies to health-related vulnerabilities, which, stemming from a lack of socioeconomic and environmental resources, has increased during and after the economic crisis of the past decade. This paper aims to analyze the health vulnerability phenomena in Portugal from a spatial perspective. Following a Multiple Correspondence Analysis, different territorial profiles of social vulnerability associated with the population health condition and access to and use of "health services" are identified. We conclude by outlining the importance of adding the spatial context to health policies addressing vulnerabilities and suggest avenues for future research.


Assuntos
Política de Saúde , Serviços de Saúde , Humanos , Portugal
5.
Cien Saude Colet ; 26(suppl 1): 2515-2528, 2021.
Artigo em Português, Inglês | MEDLINE | ID: mdl-34133631

RESUMO

This study aimed to investigate changes in the health service use pattern based on information from the 2013 and 2019 National Health Surveys (PNS). The two outcomes, "Seeking health-related care in the past two weeks" and "Medical visit in the last twelve months", were analyzed according to socioeconomic, geographic and health conditions characteristics. Multivariate Poisson regression models were used to investigate the factors associated with seeking care due to a health problem or prevention. The prevalence of chronic diseases increased from 15.0% to 22.5% between 2013 and 2019. The proportion of seeking care increased from 15.3 to 18.6%, and medical visits from 71.2% to 76.2%, ranging from 61.4 to 75.8% and 68.0 to 80.6% between the North and Southeast regions. There was no significant association of seeking care due to a health problem with per capita income, after controlling for the other covariates. We conclude by saying that, despite the expanded coverage of health service use, the persistent regional inequalities indicate unmet health needs among residents of the less developed regions. Health care models focused on prevention and health promotion are required.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde , Brasil/epidemiologia , Necessidades e Demandas de Serviços de Saúde , Humanos , Renda , Fatores Socioeconômicos
9.
Rev Bras Enferm ; 74(5): e20200524, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105598

RESUMO

OBJECTIVE: to analyze the Health Care Network (dis)articulation of late and moderate premature infants in the first year of life. METHOD: a qualitative study with semi-structured interview, which addressed the care network constitution in a municipality in southern Brazil. Fifteen mothers of infants participated. Thematic content analysis and flowchart were used to describe networks and services. RESULTS: first contact in Primary Health Care is a decisive factor for the recognition and articulation of neonates/infants in the network and enables resolution, especially in childcare demands. Secondary and hospital care services support isolated acute events or chronic conditions, without articulation between levels of care and in a uniprofessional way. FINAL CONSIDERATIONS: attention to health conditions is organized and structured in a uniprofessional, fragmented and disjointed way, which makes it impossible to form a Health Care Network premature infants' perspective.


Assuntos
Serviços de Saúde , Recém-Nascido Prematuro , Enfermagem Pediátrica , Brasil , Atenção à Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Mães , Pesquisa Qualitativa
10.
Front Public Health ; 9: 655999, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34109147

RESUMO

Background: Despite increasing calls for further spread of evidence-based collaborative care interventions (EBIs) in community-based settings, practitioner-driven efforts are often stymied by a lack of experience in addressing barriers to community-based implementation, especially for those not familiar with implementation science. The Michigan Mental Health Integration Partnership (MIP) is a statewide initiative that funds projects that support implementation and uptake of EBIs in community-based settings. MIP also provides an in situ implementation laboratory for understanding barriers to the uptake of EBIs across a variety of settings. We report findings from a statewide qualitative study of practitioners involved in MIP projects to garner their perspectives of best practices in the implementation of EBIs. Methods: Twenty-eight semi-structured interviews of practitioners and researchers from six MIP Projects were conducted with individuals implementing various MIP EBI projects across Michigan, including stakeholders from project teams, implementation sites, and the State of Michigan, to identify common barriers, challenges, and implementation strategies deployed by the project teams, with the purpose of informing a set of implementation steps and milestones. Results: Stakeholders identified a number of barriers to and strategies for success, including the need for tailoring program deployment and implementation to specific site needs, development of web-based tools for facilitating program implementation, and the importance of upper-level administration buy-in. Findings informed our resultant community-based Implementation Roadmap, which identifies critical steps across three implementation phases-pre-implementation, implementation, and sustainability-for implementation practitioners to use in their EBI implementation efforts. Conclusion: Implementation practitioners interested in community-based EBI implementation often lack access to operationalized implementation "steps" or "best practices" that can facilitate successful uptake and evaluation. Our community-informed MIP Implementation Roadmap, offering generalized steps for reaching successful implementation, uses experiences from a diverse set of MIP teams to guide practitioners through the practices necessary for scaling up EBIs in community-based settings over pre-implementation, implementation and sustainability phases.


Assuntos
Ciência da Implementação , Saúde Mental , Serviços de Saúde , Humanos , Michigan , Pesquisa Qualitativa
11.
Washington, D.C.; PAHO; 2021-06-14.
em Inglês | PAHO-IRIS | ID: phr-54285

RESUMO

The Pan American Health Organization, in recognition of the fundamental role of nursing and midwifery professionals in health systems, has published these reports to highlight the initiatives and contributions of these professionals with a focus on women's health. This publication helps to highlight the important work they do at different levels of care and professional settings, as well as the reality of women's health in the countries of the Region of the Americas. The related activities, stories, and cases illustrate the role of nursing and midwifery professionals in promoting universal access to health and universal health coverage, as well as their important contribution to health systems, universities, and schools in the countries of the Region.


Assuntos
Enfermagem , Tocologia , Gravidez , Saúde da Mulher , Serviços de Saúde da Mulher , Ginecologia , Serviços de Saúde , Pessoal de Saúde , Recursos Humanos de Enfermagem , Sistemas de Saúde , Saúde Pública , Cobertura Universal de Saúde , América , Região do Caribe
12.
Washington, D.C.; PAHO; 2021-06-10. (PAHO/EIH/IS/21-0004).
em Inglês | PAHO-IRIS | ID: phr-54256

RESUMO

The digitization of health services implies important cultural changes for both health personnel and the population in general. This guide presents eight guiding principles aimed at guiding the countries of the Region of the Americas in the processes of digital health transformation. Its purpose is to support them in making informed decisions, formulating short and long-term goals, and developing solid and sustainable public policies, leaving no one behind.


Assuntos
Serviços de Saúde , Sistemas de Saúde , Pessoal de Saúde , Política Pública , Setor de Assistência à Saúde , América
13.
Brasília, D.F.; OPAS; 2021-06-17. (OPAS-W/BRA/PHE/COVID-19/21-0029).
Não convencional em Português | PAHO-IRIS | ID: phr2-54317

RESUMO

A OMS lançou recentemente o guia Maintaining essential health services: operational guidance for the COVID-19 context [Manutenção de serviços essenciais de saúde: orientação operacional no contexto da COVID-19], que fornece uma estrutura integrada para orientar os países em seus esforços para reorganizar, adaptar e manter a prestação segura de serviços essenciais de saúde de alta prioridade no contexto da pandemia (1). Uma das estratégias operacionais recomendadas para a manutenção de serviços essenciais de saúde é fortalecer o monitoramento, por meio de rastreamento, análise e notificação regulares sobre a utilização e prestação de serviços essenciais de saúde durante o provável aumento e diminuição do surto. Na orientação mencionada, um conjunto de ações de alto nível e indicadores de amostra foram fornecidos para monitorar serviços essenciais de saúde que devem ser avaliados e divulgados regularmente.


Assuntos
COVID-19 , Infecções por Coronavirus , Coronavirus , Betacoronavirus , Funções Essenciais da Saúde Pública , Serviços de Saúde , Epidemias , Pandemias , Vacinas , Vacinação
14.
Barbarói ; (58): 172-194, jan.-jun. 2021.
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1150841

RESUMO

O presente artigo apresenta resultados de pesquisa que buscou investigar como os serviços de saúde podem (in) visibilizar atendimento ao público LGBTQIA+. O tema torna-se relevante à medida que discute a necessidade de acolhimento qualificado, bem como sua implicação na vida de lésbicas, gays, bissexuais, travestis, transexuais e transgêneros que buscam acessar serviços de saúde e que de alguma forma podem acabar sofrendo algum tipo de violência ­ nem sempre intencional - profissional ou institucional. Realizou-se pesquisa qualitativa via amostra intencional, onde foram realizadas entrevistas com onze integrantes da comunidade LGBTQIA+. Os dados foram analisados via análise conteúdo à luz do método dialético crítico. A partir dos dados coletados e reflexões geradas, fica evidente que cotidianamente ocorrem ações caracterizadas como LGBTQIAfobia. Não raro, no acolhimento perdura questões preconceituosas e de desrespeito a dignidade humana. Fica evidente, a necessidade de capacitações, diálogos e respeito à legislações que aparam o atendimento em saúde de forma ampliada.(AU)


This article presents results of research that sought to investigate how health services can (in) make the service to the LGBTQIA + public visible. The theme becomes relevant as it discusses the need for qualified reception as well as its implication in the lives of lesbians, gays, bisexuals, transvestites, transsexuals and transgender people who seek access to health services and who in some way may end up suffering some type of violence - not always intentional - professional or institutional. Qualitative research was carried out via an intentional sample, where interviews were conducted with eleven members of the LGBTQIA + community. The data were analyzed via content analysis in the light of the critical dialectical method. From the data collected and reflections generated, it is evident that actions characterized as LGBTQIAphobia occur daily. Not infrequently, prejudiced questions persist and disrespect for human dignity. It is evident, the need for training, dialogues and respect for legislation that reduce health care in an expanded way.(AU)


Assuntos
Humanos , Atenção à Saúde , Acolhimento , Pessoas Transgênero , Minorias Sexuais e de Gênero , Serviços de Saúde , Violência , Saúde Pública
15.
BMC Health Serv Res ; 21(1): 438, 2021 May 08.
Artigo em Inglês | MEDLINE | ID: mdl-33964906

RESUMO

BACKGROUND: Based on the "China Migrants Dynamic Survey-Special investigation on Floating Elderly in 8 megacities in 2015", the health status and the utilization of medical and health services in floating elderly were described and analyzed. OBJECTIVE: Scientific basis and critical suggestions are provided for improving the utilization level of medical and health services in the floating elderly and designing targeted health policies to improve their well-being. METHODS: The rank-sum test and Pearson χ2 test were used to compare the health status of floating elderly with different characteristics. Thereafter based on Andersen model, floating characteristics were added and binary logistic regression was used to explore the influencing factors of medical and health service utilization in the floating elderly. RESULTS: About 94.7% of the floating elderly were self-assessed as healthy/basically healthy. About 24.2% had hypertension or diabetes as diagnosed by the qualified doctors. About 7% suffered from diseases that required hospitalization. Only 28.6% of the floating elderly with hypertension or diabetes had visited a doctor for follow-up. In the case of minor ailments, only 48.7% decided to visit the clinics. Approximately 70.7% of the floating elderly had used in-patient services when they suffered from diseases requiring hospitalization. CONCLUSION: The floating elderly were observed to be generally in good health but a high prevalence of hypertension or diabetes was observed among them. The cultivation of health awareness was found to be of great significance contributing to the improvement of the overall health level among the floating elderly. The basic medical insurance coverage was low, and the medical and health services were found to be severely underutilized. Adequate social support can promote the health of the floating elderly and improve their utilization of medical and health services. The floating reasons, scope and years of the elderly significantly affected their health status and the utilization rate of the basic public health services.


Assuntos
Serviços de Saúde , Migrantes , Idoso , China/epidemiologia , Nível de Saúde , Hospitalização , Humanos
16.
Glob Health Action ; 14(1): 1896659, 2021 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-33975531

RESUMO

BACKGROUND: Immigrant populations experience diverse barriers to access healthcare services in the host countries. Among them, undocumented immigrants have more restricted legal access conditions and higher risk of having poorer health. Likewise, women are more likely to seek healthcare and face gender-based factors that hinder their access. OBJECTIVE: This thesis analysed the access of undocumented immigrants and immigrant women to public healthcare services in the Basque Country (Spain). METHODS: The thesis contained three sub-studies, carried out with qualitative and quantitative methods. For the quantitative approach, the trend in the number of consultations in a free clinic for undocumented immigrants was analysed before and after the launch of a new law, using a negative binomial regression analysis (n = 9,272). For the qualitative approach, qualitative content analysis was applied to 25 in-depth interviews with 14 immigrant women and 11 free clinic healthcare professionals. RESULTS: No clear relationship was found between the application of more restrictive legal conditions for immigrants to access public healthcare services and the trend of attendance of undocumented immigrants to a free clinic. Access of undocumented immigrants and immigrant women to healthcare services was subject to barriers dependent on their characteristics, health system functioning, legal requirements and a stereotyped and poor social consideration of immigrants, shared by professionals at the health centres. Meanwhile, provision of legal information and support by individual professionals, social organizations and personal networks represented main facilitators for accessing. CONCLUSIONS: For the access of undocumented immigrants and immigrant women, structural and individual barriers based on their social vulnerability were found. Among others, gender-based violence reduced women's possibility to access healthcare services and being undocumented led to restricted access entitlement and to fear rejection at health centres. Therefore, besides ensuring immigrants' legal entitlement, there is need of promoting rights-based attention to get more inclusive health systems.


Assuntos
Emigrantes e Imigrantes , Imigrantes Indocumentados , Feminino , Serviços de Saúde , Acesso aos Serviços de Saúde , Humanos , Espanha
17.
BMC Health Serv Res ; 21(1): 507, 2021 May 26.
Artigo em Inglês | MEDLINE | ID: mdl-34039324

RESUMO

BACKGROUND: Feedback on satisfaction regarding healthcare services is vital for continuous improvement of the service delivery process and outcome. AIMS AND METHODS: The objective of this study was to assess the satisfaction of refugees with the medical and dental services in Zaatari camp, under 3 domains with 20 key indicators (human and physical health resources, interaction and reactivity, and administration) using a self-administered questionnaire. RESULTS: Of the 500 participants, the satisfaction rate was 72.5%. Young participants and participants with a shorter stay in the camp showed higher overall satisfaction rates (P ≤ 0.01). Within the domains, 'interaction and reactivity' achieved the highest satisfaction score, whereas 'administration efficiency' was ranked the lowest. As for elements within the domains, the most acceptable were the sufficient number of staff and the working hours, availability of radiological services and proper care for children, reasonable waiting time and asking for medical history in every visit. Whereas difficulty to access healthcare services, difficulty to be referred to hospitals, lack of follow up and lack of dental services were the least acceptable. CONCLUSION: In conclusion, whereas refugees were generally satisfied with the provided services, this study indicates that there are areas for further service improvement. This study highlights a significant gaps in healthcare services which if not addressed have the potential to amplify oral/medical health problems.


Assuntos
Refugiados , Criança , Atenção à Saúde , Serviços de Saúde , Humanos , Jordânia , Satisfação Pessoal
18.
Stud Health Technol Inform ; 281: 1046-1050, 2021 May 27.
Artigo em Inglês | MEDLINE | ID: mdl-34042838

RESUMO

Multiple challenges await third-party digital health services when trying to enter the health market. Prominent examples of such services are clinical decision support systems provided as external software. Uncertainty about their challenges, technical as well as legal, pose serious hurdles for many innovations to be adopted early on. There are many options and trade-offs to provide digital healthcare solutions as a third-party service. This paper discusses them by referring to a pharmacogenetic decision support service. By providing best-practices, scenario descriptions and templates designed for third-party services with respect to legal and technical issues, obstacles and uncertainties can be reduced, which will have an impact on better diagnoses and treatments in the healthcare system.


Assuntos
Atenção à Saúde , Serviços de Saúde , Software
20.
BMJ Open ; 11(5): e042872, 2021 05 03.
Artigo em Inglês | MEDLINE | ID: mdl-33941625

RESUMO

INTRODUCTION: The importance of integrated, people-centred health systems has been recognised as a central component of Universal Health Coverage. Integration has also been highlighted as a critical element for building resilient health systems that can withstand the shock of health emergencies. However, there is a dearth of research and systematic synthesis of evidence on the synergistic relationship between integrated health services and pandemic preparedness, response, and recovery in low-income and lower-middle-income countries (LMICs). Thus, the authors are organising a scoping review aiming to explore the application of integrated health service delivery approaches during the emerging COVID-19 pandemic in LMICs. METHODS AND ANALYSIS: This scoping review adheres to the six steps for scoping reviews from Arksey and O'Malley. Peer-reviewed scientific literature will be systematically assembled using a standardised and replicable search strategy from seven electronic databases, including PubMed, Embase, Scopus, Web of Science, CINAHL Plus, the WHO's Global Research Database on COVID-19 and LitCovid. Initially, the title and abstract of the collected literature, published in English from December 2019 to June 2020, will be screened for inclusion which will be followed by a full-text review by two independent reviewers. Data will be charted using a data extraction form and reported in narrative format with accompanying data matrix. ETHICS AND DISSEMINATION: No ethical approval is required for the review. The study will be conducted from June 2020 to May 2021. Results from this scoping review will provide a snapshot of the evidence currently being generated related to integrated health service delivery in response to the COVID-19 pandemic in LMICs. The findings will be developed into reports and a peer-reviewed article and will assist policy-makers in making pragmatic and evidence-based decisions for current and future pandemic responses.


Assuntos
COVID-19 , Países em Desenvolvimento , Serviços de Saúde , Humanos , Pandemias , Projetos de Pesquisa , Literatura de Revisão como Assunto , SARS-CoV-2
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