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3.
Medicine (Baltimore) ; 99(37): e22067, 2020 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-32925742

RESUMO

INTRODUCTION: Coastal areas in Malaysia can have important impacts on the livelihoods and health of local communities. Efforts by Malaysian government to develop and improve the landscape and ecosystem have been planned; however, the progress has been relatively slow because some of the coastal areas are remote and relatively inaccessible. Thus, these coastal communities face various challenges in health, healthcare and quality of life. This paper presents a study protocol to examine the health status, healthcare utilisation, and quality of life among the coastal communities. In addition, the relationship between the community and their coastal environment is examined. METHODOLOGY AND ANALYSIS: The population of interest is the coastal communities residing within the Tun Mustapha Park in Sabah, Malaysia. The data collection is planned for a duration of 6 months and the findings are expected by December 2020. A random cluster sampling will be conducted at three districts of Sabah. This study will collect 600 adult respondents (300 households are estimated to be collected) at age of 18 and above. The project is a cross sectional study via face-to-face interview with administered questionnaires, anthropometrics measurements and observation of the living condition performed by trained interviewers.


Assuntos
Utilização de Instalações e Serviços , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Vigilância em Saúde Pública , Qualidade de Vida , Saúde da População Rural , Estudos Transversais , Ecossistema , Programas Governamentais , Acesso aos Serviços de Saúde , Humanos , Malásia/epidemiologia
4.
Med Care ; 58(9): 757-762, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32732786

RESUMO

BACKGROUND: The Affordable Care Act's Medicaid expansions (ME) increased insurance coverage for low-income Americans, among whom unmet need for mental health care is high. Empirical evidence regarding the impact of expanding insurance coverage on use of mental health services among low income and minority populations is lacking. METHODS: Data on mental health service use collected between 2007 and 2015 by the Medical Expenditures Panel Survey from nationally representative cross-sectional samples of low income (income<138% of the federal poverty line) adults were analyzed. Use trends among people in states that expanded Medicaid (ME states; n=29,827) were compared with concurrent trends among people in states that did not (non-ME states; n=22,873), with statistical adjustment for demographic characteristics and psychological distress. RESULTS: Annual outpatient visits for mental health conditions increased by 0.513 (0.053-0.974) visits per person, from a baseline rate in ME states of 0.894 visits per person. However, no significant changes were observed in number of mental health related hospital stays, emergency department visits or prescription fills. The increase outpatient visits was limited to Hispanics and non-Hispanic Whites, with no increase in service use observed among non-Hispanic Blacks. There was no apparent increase in the number of users of outpatient mental health care (AOR=0.992, P=0.942) and a marginally significant (P=0.096) increase of 3.144 visits per user. DISCUSSION: ME had a limited but positive impact on use of mental health services by low income Americans, although it may also have increased racial/ethnic disparities.


Assuntos
Serviços de Saúde/estatística & dados numéricos , Medicaid/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Patient Protection and Affordable Care Act/legislação & jurisprudência , Pobreza/estatística & dados numéricos , Adulto , Grupos de Populações Continentais/estatística & dados numéricos , Estudos Transversais , Grupos Étnicos/estatística & dados numéricos , Feminino , Gastos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/etnologia , Fatores Socioeconômicos , Estresse Psicológico/epidemiologia , Estados Unidos
5.
Med Care ; 58(9): 770-777, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826742

RESUMO

OBJECTIVE: To estimate the average incremental health care expenditures associated with habitual long and short duration of sleep as compared with healthy/average sleep duration. DATA SOURCE: Medical Expenditure Panel Survey data (2012; N=6476) linked to the 2010-2011 National Health Interview Survey. STUDY DESIGN: Annual differences in health care expenditures are estimated for habitual long and short duration sleepers as compared with average duration sleepers using 2-part logit generalized linear regression models. PRINCIPAL FINDINGS: Habitual short duration sleepers reported an additional $1400 in total unadjusted health care expenditures compared to people with average sleep duration (P<0.01). After adjusting for demographics, socioeconomic factors, and health behavior factors, this difference remained significant with an additional $1278 in total health care expenditures over average duration sleepers (P<0.05). Long duration sleepers reported even higher, $2994 additional health care expenditures over average duration sleepers. This difference in health care expenditures remained significantly high ($1500, P<0.01) in the adjusted model. Expenditure differences are more pronounced for inpatient hospitalization, office expenses, prescription expenses, and home health care expenditures. CONCLUSIONS: Habitual short and long sleep duration is associated with higher health care expenditures, which is consistent with the association between unhealthy sleep duration and poorer health outcomes.


Assuntos
Gastos em Saúde/estatística & dados numéricos , Transtornos do Sono-Vigília/economia , Transtornos do Sono-Vigília/epidemiologia , Sono/fisiologia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Comportamentos Relacionados com a Saúde , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos , Adulto Jovem
6.
Med Care ; 58(9): 833-841, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32826748

RESUMO

BACKGROUND: Although one third of Medicare beneficiaries are enrolled in Medicare Advantage (MA) plans, there is limited information about the cost of treating Alzheimer disease and related dementias (ADRD) in these settings. OBJECTIVE: The objective of this study was to estimate direct health care costs attributable to ADRD among older adults within a large MA plan. RESEARCH DESIGN: A retrospective cohort design was used to estimate direct total, outpatient, inpatient, ambulatory pharmacy, and nursing home costs for 3 years before and after an incident ADRD diagnosis for 927 individuals diagnosed with ADRD relative to a sex-matched and birth year-matched set of 2945 controls. SUBJECT: Adults 65 years of age and older enrolled in the Kaiser Permanente Washington MA plan and the Adult Changes in Thought (ACT) Study, a prospective longitudinal cohort study of ADRD and brain aging. MEASURES: Data on monthly health service use obtained from health system electronic medical records for the period 1992-2012. RESULTS: Total monthly health care costs for individuals with ADRD are statistically greater (P<0.05) than controls beginning in the third month before diagnosis and remain significantly greater through the eighth month following diagnosis. Greater total health costs are driven by significantly (P<0.05) greater nursing home costs among individuals diagnosed with ADRD beginning in the third month prediagnosis. Although total costs were no longer significantly greater at 8 months following diagnosis, nursing home costs remained higher for the people with dementia through the 3 years postdiagnosis we analyzed. CONCLUSION: Greater total health care costs among individuals with ADRD are primarily driven by nursing home costs.


Assuntos
Demência/economia , Gastos em Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Medicare Part C/economia , Idoso , Idoso de 80 Anos ou mais , Doença de Alzheimer/economia , Feminino , Serviços de Saúde/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/economia , Humanos , Estudos Longitudinais , Masculino , Casas de Saúde/economia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Estudos Prospectivos , Estados Unidos
7.
Int J Equity Health ; 19(1): 140, 2020 08 15.
Artigo em Inglês | MEDLINE | ID: mdl-32799872

RESUMO

The emergence of the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) has alarmed the world with its high rate of transmission and the ability to cause severe and fatal disease. The impact of this pandemic may be even greater in populations where the absence of health services is a chronic aspect, as reported with populations living in the Brazilian Amazon. In this article, we address the perspective of possible impacts of the pandemic on these populations and the importance of conducting seroepidemiological surveillance studies.


Assuntos
Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Brasil/epidemiologia , Infecções por Coronavirus/epidemiologia , Serviços de Saúde/estatística & dados numéricos , Humanos , Pneumonia Viral/epidemiologia , Estudos Soroepidemiológicos
8.
Arch Phys Med Rehabil ; 101(10): 1720-1730, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32653582

RESUMO

OBJECTIVE: To compare Veterans Health Administration (VHA) diagnoses, health services utilization, and costs by mild traumatic brain injury (mTBI) group (blast-related [BR] mTBI vs non-blast-related [NBR] mTBI vs no mTBI) among Operation Enduring Freedom (OEF)/Operation Iraqi Freedom (OIF)/Operation New Dawn (OND) veterans in the Chronic Effects of Neurotrauma Consortium multicenter observational study. DESIGN: Prospective cohort study. SETTING: Four Veterans Affairs Medical Centers. PARTICIPANTS: OEF/OIF/OND veterans (N=472) who used Veterans Affairs Medical Centers services between 2002-2017. INTERVENTIONS: Not applicable. Lifetime mTBI history was assessed via semistructured interviews. MAIN OUTCOME MEASURES: VHA diagnoses, health services utilization, and costs. RESULTS: Relative to NBR mTBI and no mTBI, veterans with BR mTBI were more likely to be male, have greater combat, and have controlled and uncontrolled detonations exposures (median BR, 15.0 vs NBR, 3.0 vs no mTBI, 3.0). They also had higher prevalence of headache, posttraumatic stress disorder, and anxiety diagnoses. Veterans with BR had the highest site-adjusted mean annual VHA utilization (26.31 visits; 95% confidence interval [CI], 26.01-26.61) relative to NBR (20.43 visits; 95% CI, 20.15-20.71) and no mTBI (16.62 visits; 95% CI, 16.21-17.04) and highest site adjusted mean annual VHA outpatient costs ($6480; 95% CI, $5842-$7187) relative to NBR ($4901; 95% CI, $4392-$5468) and no mTBI ($4069; 95% CI, $3404-$4864). CONCLUSIONS: Veterans with BR mTBI had higher exposure to combat and detonation. BR was associated with greater prevalence of select diagnoses and higher health services utilization and costs relative to NBR and no mTBI. The role of health care needs from mTBI polytrauma, other deployment-related exposures, and VHA access warrants future research.


Assuntos
Concussão Encefálica/epidemiologia , Gastos em Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Veteranos/estatística & dados numéricos , Adolescente , Adulto , Concussão Encefálica/economia , Doença Crônica , Feminino , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Nível de Saúde , Humanos , Guerra do Iraque 2003-2011 , Masculino , Saúde Mental , Militares/psicologia , Militares/estatística & dados numéricos , Estudos Prospectivos , Fatores Sexuais , Fatores Socioeconômicos , Índices de Gravidade do Trauma , Estados Unidos , Veteranos/psicologia , Serviços de Saúde para Veteranos Militares/estatística & dados numéricos , Adulto Jovem
9.
J Am Acad Orthop Surg ; 28(14): 597-605, 2020 Jul 15.
Artigo em Inglês | MEDLINE | ID: mdl-32692097

RESUMO

INTRODUCTION: The purpose of this study is to assess the impact of Trauma Recovery Services (TRS), a program facilitating engagement and recovery on satisfaction after orthopaedic trauma. METHODS: Two hundred ninety-four patients with surgically managed extremity fractures were prospectively surveyed. Satisfaction was assessed after 12 months using a 13-question telephone survey, rated on a Likert scale from 1 to 5 (with five being excellent). TRS resource utilization during and after hospitalization was recorded. Eighty-eight patients (30%) used TRS. RESULTS: Overall satisfaction was high with a mean score of 4.32. Although no differences were observed between the control group and patients with TRS utilization in age, sex, race, insurance, smoking history, or employment status, TRS patients sustained more high-energy mechanisms (81% versus 56%) and had more associated psychiatric illness (33% versus 17%), both P < 0.01. Multivariable regression indicated general exposure to TRS to be an independent predictor of higher overall care ratings (B = 1.31; P = 0.03). DISCUSSION: Utilization of TRS was the greatest predictor of better overall care ratings. This study builds on existing evidence demonstrating the positive impact of Trauma Survivor Network programming. We conclude that a hospital-wide program supporting patient education and engagement can effectively increase patient satisfaction after traumatic injury. LEVEL OF EVIDENCE: Prognostic Level II.


Assuntos
Fraturas Ósseas/psicologia , Fraturas Ósseas/cirurgia , Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto/métodos , Educação de Pacientes como Assunto/estatística & dados numéricos , Satisfação do Paciente , Serviços Preventivos de Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Eficiência Organizacional , Feminino , Previsões , Fraturas Ósseas/fisiopatologia , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Recuperação de Função Fisiológica , Inquéritos e Questionários , Adulto Jovem
10.
Emerg Infect Dis ; 26(10): 2361-2369, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32692648

RESUMO

Social distancing orders have been enacted worldwide to slow the coronavirus disease (COVID-19) pandemic, reduce strain on healthcare systems, and prevent deaths. To estimate the impact of the timing and intensity of such measures, we built a mathematical model of COVID-19 transmission that incorporates age-stratified risks and contact patterns and projects numbers of hospitalizations, patients in intensive care units, ventilator needs, and deaths within US cities. Focusing on the Austin metropolitan area of Texas, we found that immediate and extensive social distancing measures were required to ensure that COVID-19 cases did not exceed local hospital capacity by early May 2020. School closures alone hardly changed the epidemic curve. A 2-week delay in implementation was projected to accelerate the timing of peak healthcare needs by 4 weeks and cause a bed shortage in intensive care units. This analysis informed the Stay Home-Work Safe order enacted by Austin on March 24, 2020.


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Política de Saúde , Serviços de Saúde/provisão & distribução , Serviços de Saúde/estatística & dados numéricos , Número de Leitos em Hospital , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Cidades/epidemiologia , Simulação por Computador , Infecções por Coronavirus/mortalidade , Previsões , Hospitalização/estatística & dados numéricos , Humanos , Lactente , Unidades de Terapia Intensiva/estatística & dados numéricos , Pessoa de Meia-Idade , Modelos Estatísticos , Pneumonia Viral/mortalidade , Instituições Acadêmicas , Texas/epidemiologia , Ventiladores Mecânicos/estatística & dados numéricos , Adulto Jovem
11.
Medicina (B Aires) ; 80 Suppl 3: 16-24, 2020.
Artigo em Espanhol | MEDLINE | ID: mdl-32658843

RESUMO

The COVID-19 pandemic affected the organization of health services and had consequences for health teams, according to the pre-existing safety and working conditions. During the first week of April 2020, a cross sectional study was carried out with a qualitative-quantitative approach. The aim was to explore the conditions determining the organizational climate: leadership, communication, institutional resources, cohesion/conflict management, and training; and how these were perceived by health personnel to deal with the pandemic. A total of 5670 healthcare workers participated in an online survey and 50 were interviewed, from all subsectors of the Argentinean health system (public, private and union-health insurance); 72.9% were women, 51.4% were physicians, and the predominant age group was under 40 years. In the qualitative sample (interviews), 52% were men, 62% were physicians, and the average age was 44.8 years. The dimensions of the organizational climate were stratified and five independent predictors of perception of conditions were identified: age, gender, tasks performed, health system subsector, and jurisdiction. The condition most frequently perceived as inadequate were the inaccessibility of institutional resources and the access to personal protective equipment was a major concern. Claims included the need of institutional strategies to support healthcare workers and of a clear and uniform communication. In conclusion, at the time of the study, the health personnel perceived serious deficits in their organizations regarding the conditions necessary to confront COVID-19, with differences among subsectors of the health system.


Assuntos
Infecções por Coronavirus , Pessoal de Saúde/psicologia , Serviços de Saúde/estatística & dados numéricos , Pandemias , Equipamento de Proteção Individual/provisão & distribução , Pneumonia Viral , Local de Trabalho/organização & administração , Adolescente , Adulto , Idoso , Betacoronavirus , Criança , Infecções por Coronavirus/epidemiologia , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Pesquisa Qualitativa , Inquéritos e Questionários
12.
West Afr J Med ; 37(3): 268-274, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32476121

RESUMO

BACKGROUND: An increased population growth has led to the proliferation of slums in urban areas. Urban slum dwellers are susceptible to ailments which may be worsened from reduced access to health facilities or weak institutional capacity. Understanding the pattern of morbidity and choice of care among slum dwellers can inform appropriate health interventions among this group. This study was conducted to investigate and document the morbidity patterns and choice of care within an urban slum community of South-western Nigeria. METHODS: The study was a descriptive cross-sectional survey involving 480 respondents selected through a random sampling technique in Idikan community of Southwestern Nigeria. The survey was conducted using a pre-tested semi-structured interviewer administered questionnaire on morbidity pattern and choice of care. Data were analyzed using SPSS Vs version 13 to generate frequencies and association between independent variables and choice of care using Chi-square at 5% level of significance. RESULTS: Among those that were ill, slightly over half of the respondents, 254 (52.9%) used self-medication while only 226 respondents (47.1%) sought medical care Majority of the respondents that sought care did so from Christian based health facilities (66.8%). A significantly higher proportion, (74.3%) of those in the higher occupational class compared with those of low occupational class (55.1%) (p = 0.001) sought care in a health facility. Also, a significantly higher proportion of those with tertiary education (69.0%) sought care in facilities compared to other cadres (p = 0.033). CONCLUSION: Disparities in morbidity patterns and access to care still persists in the surveyed community which requires urgent attention in the urban slums. This is evidently linked to educational and socio-economic status. Re-distribution of national funds to educational institutions and creation of jobs in the slums are advocated to improve the health seeking behaviours of slum dwellers in Ibadan and Nigeria at large.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde/estatística & dados numéricos , Hospitais Religiosos/estatística & dados numéricos , Morbidade/tendências , Áreas de Pobreza , Automedicação/estatística & dados numéricos , Adulto , Idoso , Estudos Transversais , Feminino , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Fatores Socioeconômicos , População Urbana
13.
Matern Child Health J ; 24(9): 1121-1129, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32557134

RESUMO

OBJECTIVES: Maternal health-seeking behaviors are critical to improving maternal and child health in low-income countries. This study investigates associations between maternal decision-making input and their health-seeking behaviors in the first 1000-day period between pregnancy and a child's second birthday in Nepal. METHODS: We used data from a cross-sectional survey conducted in 2018 in 16 districts of Nepal. Among the 3648 households surveyed, 1910 mothers of a child 0 to 24 months with complete data were included for analyses. Logistic regression was used to examine associations between decision-making input and the utilization of antenatal, delivery and postnatal care services, and attendance at health mothers' group (HMG) meetings. We also used negative binomial regression to assess the relationship between her decision-making input and participation in growth monitoring and promotion (GMP) in the 6 months prior to the survey. For each relationship examined, we adjusted for clustering, as well as potentially confounding factors at individual and household levels. RESULTS: After adjusting for confounders, maternal decision-making input had a small but positive and significant association with receiving at least 4 antenatal care visits (OR = 1.09, 95% CI 1.02, 1.17), attendance at GMP in the 6 months prior to the survey (IRR = 1.02, 95% CI 1.00, 1.04), and HMG attendance (OR = 1.10, 95% CI 1.03, 1.17), but not with receiving at least 3 postnatal care visits or delivering in a health institution. CONCLUSIONS FOR PRACTICE: Our findings indicated that empowering women and mothers in household decision-making might warrant greater attention when developing future policies and programs in Nepal.


Assuntos
Serviços de Saúde da Criança/estatística & dados numéricos , Tomada de Decisões , Comportamentos Relacionados com a Saúde , Serviços de Saúde/estatística & dados numéricos , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Criança , Estudos Transversais , Feminino , Humanos , Saúde Materna/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Mães/estatística & dados numéricos , Nepal , Gravidez , Fatores Socioeconômicos
14.
Artigo em Inglês | MEDLINE | ID: mdl-32585992

RESUMO

BACKGROUND: LGBTIQ asylum-seekers face multiple health risks. Yet, little is known about their healthcare needs. In 2016, Berlin opened the only major shelter for LGBTIQ asylum-seekers in Germany. This preliminary study describes health and healthcare utilization by asylum-seekers living in Berlin's LGBTIQ shelter. To identify particular healthcare needs, we compared our results to asylum-seekers from other shelters. METHODS: We surveyed residents of the LGBTIQ shelter and 21 randomly selected shelters in Berlin, using a validated questionnaire in nine languages (n = 309 respondents, including 32 respondents from the LGBTIQ shelter). Bivariate tests and generalized linear mixed models were applied to examine differences in health and healthcare utilization between the two groups. RESULTS: Residents of the LGBTIQ shelter show high rates of chronic and mental illness. They use ambulatory and mental health services more frequently than asylum-seekers from other shelters, including a significantly higher chance of obtaining psychotherapy/psychiatric care in case of need. Emergency room utilization is also higher in the LGBTIQ group. CONCLUSIONS: Asylum-seekers from the LGBTIQ shelter face high chronic and mental health burdens. Tailored services in the LGBTIQ shelter help obtain adequate healthcare; they should be scaled up to maximize their potential. Yet, unmet needs remain and warrant further research.


Assuntos
Doença Crônica/etnologia , Serviços de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Transtornos Mentais/etnologia , Qualidade de Vida , Refugiados/psicologia , Minorias Sexuais e de Gênero/psicologia , Adulto , Doença Crônica/psicologia , Feminino , Alemanha/epidemiologia , Acesso aos Serviços de Saúde , Inquéritos Epidemiológicos , Humanos , Masculino , Transtornos Mentais/psicologia , Refugiados/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários
15.
Washington; Organización Panamericana de la Salud; June 4, 2020. 8 p.
Não convencional em Inglês, Espanhol | LILACS | ID: biblio-1104286

RESUMO

This brief report presents a snapshot of the impact that the COVID-19 pandemic has had on NCD services in the Region of the Americas. It represents the views and perspectives of the national health authorities responsible for overseeing the governmental NCD programs during a period of 4 weeks in May 2020, at a time when the Region of the Americas was considered the epicenter of the global COVID-19 pandemic.


En este informe se presenta un panorama general del impacto que la pandemia de COVID-19 ha tenido en los servicios contra las enfermedades no transmisibles en la Región de las Américas, con datos obtenidos a lo largo de cuatro semanas en mayo del 2020, en un momento en el que se consideraba que la Región era el epicentro de la pandemia mundial de COVID-19.


Assuntos
Infecções por Coronavirus/epidemiologia , Pandemias/estatística & dados numéricos , Betacoronavirus , Doenças não Transmissíveis/prevenção & controle , Serviços de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , América/epidemiologia
16.
BMC Public Health ; 20(1): 619, 2020 May 05.
Artigo em Inglês | MEDLINE | ID: mdl-32370763

RESUMO

BACKGROUND: Numerous studies have reported the economic burden of childhood diarrhea in low- and middle-income countries (LMICs). Yet, empirical data on the cost of diarrheal illness is sparse, particularly in LMICs. In this study we review the existing literature on the cost of childhood diarrhea in LMICs and generate comparable estimates of cost of diarrhea across 137 LMICs. METHODS: The systematic literature review included all articles reporting cost estimates of diarrhea illness and treatment from LMICs published between January 2006 and July 2018. To generate country-specific costs, we used service delivery unit costs from the World Health Organization's Choosing Interventions that are Cost-Effective (WHO-CHOICE database). Non-medical costs were calculated using the ratio between direct medical and direct non-medical costs, derived from the literature review. Indirect costs (lost wages to caregivers) were calculated by multiplying the average GDP per capita per day by the average number of days lost to illness identified from the literature. All cost estimates are reported in 2015 USD. We also generated estimates using the IHME's service delivery unit costs to explore input sensitivity on modelled cost estimates. RESULTS: We identified 25 articles with 64 data points on either direct or indirect cost of diarrhoeal illness in children aged < 5 years in 20 LMICs. Of the 64 data points, 17 were on the cost of outpatient care, 28 were on the cost of inpatient care, and 19 were unspecified. The average cost of illness was US$36.56 (median $15.73; range $4.30 - $145.47) per outpatient episode and $159.90 (median $85.85; range $41.01 - $538.33) per inpatient episode. Direct medical costs accounted for 79% (83% for inpatient and 74% for outpatient) of the total direct costs. Our modelled estimates, across all 137 countries, averaged (weighted) $52.16 (median $47.56; range $8.81 - $201.91) per outpatient episode and $216.36 (median $177.20; range $23.77 -$1225.36) per inpatient episode. In the 12 countries with primary data, there was reasonable agreement between our modelled estimates and the reported data (Pearson's correlation coefficient = .75). CONCLUSION: Our modelled estimates generally correspond to estimates observed in the literature, with a few exceptions. These estimates can serve as useful inputs for planning and prioritizing appropriate health interventions for childhood diarrheal diseases in LMICs in the absence of empirical data.


Assuntos
Efeitos Psicossociais da Doença , Países em Desenvolvimento/estatística & dados numéricos , Diarreia/epidemiologia , Pobreza/estatística & dados numéricos , Cuidadores/economia , Pré-Escolar , Análise Custo-Benefício , Produto Interno Bruto , Gastos em Saúde/estatística & dados numéricos , Recursos em Saúde/economia , Recursos em Saúde/estatística & dados numéricos , Serviços de Saúde/economia , Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Modelos Econométricos
17.
PLoS One ; 15(5): e0232908, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32379820

RESUMO

BACKGROUND: Providing compassionate and respectful maternity services in order to bring satisfaction to service users is one of the health extension services packages in Ethiopia. Though the service utilization and its associated factors have been well documented so far, yet there is a dearth of information on client satisfaction; particularly among rural women who are mostly the target groups of health extension services within the Ethiopia. Thus, this study aimed to assess mothers' satisfaction with health extension services and the associated factors in the Gamo Goffa Zone, of Southern Ethiopia. METHODS: A community based cross sectional study was conducted among 478 women from February 1st to February 28th of 2018. A pre-tested and interviewer administered questionnaire was used to collect the data. The study participants were selected using a systematic random sampling technique by allocating a proportion to each rural kebeles. Both bivariate and multivariate logistic regression analysis were performed to identify associated factors. Odds ratio with its 95% confidence interval was used to determine the degree of association. Level of statistical significance was set at a p-value of less than 0.05. RESULT: The overall proportion of mothers who were satisfied with health extension services was 37.4% with 95% CI (33-44%). Mothers who had good family monthly income [AOR = 4.66 (95% CI: 1.1, 20.6)], whose husbands participated in the health extension program [AOR = 4.02 (95% CI: 2.0, 8.1)], who had recent participation in planning of health extension programs [AOR = 5.75 (95% CI: 2.0, 16.5)], who were recognized as a model family [AOR = 2.23 (95% CI: 1.1, 4.6)] had higher odds of satisfaction with health extension services. CONCLUSION: Satisfaction with the health extension services was low among women in the study area. A better household monthly income, women's and their husbands' participation in health extension services and being a member of a model family were positively associated with their satisfaction. Interventions to enhance women's satisfaction in the health extension service need to focus on household-based involvement of them and their husbands in planning and implementing the services. Likewise, expansion of experiences of model families in the community would raise satisfaction levels.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Estudos Transversais , Parto Obstétrico/estatística & dados numéricos , Etiópia , Feminino , Serviços de Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Mães/estatística & dados numéricos , Razão de Chances , Satisfação do Paciente , Satisfação Pessoal , Gravidez , População Rural , Inquéritos e Questionários
20.
Am J Gastroenterol ; 115(6): 832-840, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-32224703

RESUMO

Various lifestyle factors including physical activity and obesity, stress, sleep, and smoking may modify the risk of developing inflammatory bowel diseases (IBDs). In patients with established IBD, these lifestyle factors may significantly impact the natural history and clinical outcomes. Recreational exercise decreases the risk of flare and fatigue in patients with IBD. In contrast, obesity increases the risk of relapse and is associated with higher anxiety, depression, fatigue, and pain and higher health care utilization. Obesity also modifies pharmacokinetics of biologic agents unfavorably and is associated with a higher risk of treatment failure. Sleep disturbance is highly prevalent in patients with IBD, independent of disease activity, and increases the risk of relapse and chronic fatigue. Similarly, stress, particularly perceived stress rather than major life events, may trigger symptomatic flare in patients with IBD, although its impact on inflammation is unclear. Cigarette smoking is associated with unfavorable outcomes including the risk of corticosteroid dependence, surgery, and disease progression in patients with Crohn's disease; in contrast, smoking does not significantly impact outcomes in patients with ulcerative colitis, although some studies suggest that it may be associated with a lower risk of flare. The effect of alcohol and cannabis use in patients with IBD is inconsistent, with some studies suggesting that cannabis may decrease chronic pain in patients with IBD, without a significant effect of biological remission. Although these lifestyle factors are potentially modifiable, only a few interventional studies have been conducted. Trials of structured exercise and psychological therapy including mindfulness-based therapies such as meditation and yoga and gut-directed hypnotherapy have not consistently demonstrated benefit in clinical and/or endoscopic disease activity in IBD, although may improve overall quality of life.


Assuntos
Fumar Cigarros/epidemiologia , Colite Ulcerativa/fisiopatologia , Doença de Crohn/fisiopatologia , Exercício Físico , Fadiga/fisiopatologia , Obesidade/epidemiologia , Transtornos do Sono-Vigília/fisiopatologia , Consumo de Bebidas Alcoólicas/epidemiologia , Ansiedade/psicologia , Colite Ulcerativa/epidemiologia , Colite Ulcerativa/psicologia , Colite Ulcerativa/terapia , Doença de Crohn/epidemiologia , Doença de Crohn/psicologia , Doença de Crohn/terapia , Depressão/psicologia , Progressão da Doença , Serviços de Saúde/estatística & dados numéricos , Humanos , Hipnose , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/fisiopatologia , Doenças Inflamatórias Intestinais/psicologia , Doenças Inflamatórias Intestinais/terapia , Estilo de Vida , Uso da Maconha/epidemiologia , Meditação , Atenção Plena , Ioga
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