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1.
Rev. enferm. UERJ ; 28: e33123, jan.-dez. 2020.
Artigo em Inglês, Português | LILACS, BDENF - Enfermagem | ID: biblio-1096012

RESUMO

Objetivo: analisar as repercussões do trabalho docente na saúde nos professores de enfermagem. Método: estudo qualitativo e descritivo realizado com 27 docentes de duas universidades públicas federais do Rio de Janeiro. A coleta de dados ocorreu por meio de entrevista semiestruturada e a técnica utilizada para o tratamento dos dados foi a análise temática de conteúdo. Resultados: devido às novas configurações do trabalho docente, que pressiona por alta demanda laboral e, por sua vez, oferece inadequadas condições de trabalho, esta atividade favorece ao adoecimento desses profissionais, que em contrapartida, relegam a segundo plano o cuidado com a própria saúde. Conclusão: compromissos exigidos no dia a dia e a falta de qualidade no trabalho tornam a vida do docente cada vez mais afastada do seu autocuidado e com elevado potencial para o adoecimento.


Objective: to analyze the repercussions of teaching work on the health of nursing professors. Method: qualitative and descriptive study with 27 teachers from two federal public universities in Rio de Janeiro. The data collection took place through a semi-structured interview and the technique used for the data treatment was the thematic content analysis. Results: due to the new configurations of the teaching work, which presses for high labor demand and, in turn, offers inadequate working conditions, this profession favors the teaching sickness, which, on the other hand, relegate health care to the background. Conclusion: commitments required on a daily basis and lack of quality in the work make the life of the teacher increasingly removed from their self-care and with high potential for illness. Descriptors: Faculty; occupational health; education, nursing; working conditions.


Objetivo: analizar las repercusiones del trabajo docente en la salud de los profesores de enfermería. Método: estudio cualitativo y descriptivo realizado con 27 maestros de dos universidades públicas federales de Río de Janeiro. La recolección de datos ocurrió por medio de entrevista semiestructurada y la técnica utilizada para el tratamiento de los datos fue el análisis temático de contenido. Resultados: debido a las nuevas configuraciones del trabajo docente, que presiona por alta demanda laboral y, a su vez, ofrece inadecuadas condiciones de trabajo, esta profesión favorece al enfermo docente, que en contrapartida, relegan a segundo plano el cuidado con la propia salud. Conclusión: compromisos exigidos en el día a día y la falta de calidad en el trabajo hacen la vida del docente cada vez más alejada de su autocuidado y con elevado potencial para la enfermedad.


Assuntos
Humanos , Masculino , Feminino , Universidades , Condições de Trabalho , Processo Saúde-Doença , Saúde do Trabalhador , Docentes de Enfermagem/psicologia , Brasil , Epidemiologia Descritiva , Setor Público , Pesquisa Qualitativa , Equilíbrio Trabalho-Vida
2.
JAMA Netw Open ; 3(10): e2026702, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-33112402

RESUMO

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


Assuntos
Infecções por Coronavirus , Instituições Privadas de Saúde , Investimentos em Saúde , Casas de Saúde , Propriedade , Pandemias , Pneumonia Viral , Qualidade da Assistência à Saúde , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/mortalidade , Infecções por Coronavirus/virologia , Estudos Transversais , Equipamentos e Provisões , Governo , Instituição de Longa Permanência para Idosos , Humanos , Enfermeiras e Enfermeiros , Equipamento de Proteção Individual , Administração de Recursos Humanos , Pneumonia Viral/epidemiologia , Pneumonia Viral/mortalidade , Pneumonia Viral/virologia , Setor Privado , Setor Público , Instituições de Cuidados Especializados de Enfermagem
4.
PLoS One ; 15(10): e0241017, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33104705

RESUMO

BACKGROUND: Economic recessions carry an impact on population health and access to care; less is known on how health systems adapt to the conditions brought by a downturn. This particularly matters now that the COVID-19 epidemic is putting health systems under stress. Brazil is one of the world's most affected countries, and its health system was already experiencing the aftermath of the 2015 recession. METHODS: Between 2018 and 2019 we conducted 46 semi-structured interviews with health practitioners, managers and policy-makers to explore the impact of the 2015 recession on public and private providers in prosperous (São Paulo) and impoverished (Maranhão) states in Brazil. Thematic analysis was employed to identify drivers and consequences of system adaptation and coping strategies. Nvivo software was used to aid data collection and analysis. We followed the Standards for Reporting Qualitative Research to provide an account of the findings. RESULTS: We found the concept of 'health sector crisis' to be politically charged among healthcare providers in São Paulo and Maranhão. Contrary to expectations, the public sector was reported to have found ways to compensate for diminishing federal funding, having outsourced services and adopted flexible-if insecure-working arrangements. Following a drop in employment and health plans, private health insurance companies have streamlined their offer, at times at the expenses of coverage. Low-cost walk-in clinics were hit hard by the recession, but were also credited for having moved to cater for higher-income customers in Maranhão. CONCLUSIONS: The 'plates' of a health system may shift and adjust in unexpected ways in response to recessions, and some of these changes might outlast the crisis. As low-income countries enter post-COVID economic recessions, it will be important to monitor the adjustments taking place in health systems, to ensure that past gains in access to care and job security are not eroded.


Assuntos
Pessoal Administrativo/psicologia , Betacoronavirus , Infecções por Coronavirus , Recessão Econômica , Setor de Assistência à Saúde/economia , Administradores de Instituições de Saúde/psicologia , Pessoal de Saúde/psicologia , Pandemias , Pneumonia Viral , Setor Privado/economia , Setor Público/economia , Instituições de Assistência Ambulatorial/economia , Atitude do Pessoal de Saúde , Brasil , Serviços de Saúde Comunitária/economia , Países em Desenvolvimento , Humanos , Reembolso de Seguro de Saúde , Entrevistas como Assunto , Médicos/psicologia , Pesquisa Qualitativa , Telemedicina , Desemprego
5.
Ann Glob Health ; 86(1): 100, 2020 08 13.
Artigo em Inglês | MEDLINE | ID: mdl-32864352

RESUMO

Background: Brazil faces some challenges in the battle against the COVID-19 pandemic, including: the risks for cross-infection (community infection) increase in densely populated areas; low access to health services in areas where the number of beds in intensive care units (ICUs) is scarce and poorly distributed, mainly in states with low population density. Objective: To describe and intercorrelate epidemiology and geographic data from Brazil about the number of intensive care unit (ICU) beds at the onset of COVID-19 pandemic. Methods: The epidemiology and geographic data were correlated with the distribution of ICU beds (public and private health systems) and the number of beneficiaries of private health insurance using Pearson's Correlation Coefficient. The same data were correlated using partial correlation controlled by gross domestic product (GDP) and number of beneficiaries of private health insurance. Findings: Brazil has a large geographical area and diverse demographic and economic aspects. This diversity is also present in the states and the Federal District regarding the number of COVID-19 cases, deaths and case fatality rate. The effective management of severe COVID-19 patients requires ICU services, and the scenario was also dissimilar as for ICU beds and ICU beds/10,000 inhabitants for the public (SUS) and private health systems mainly at the onset of COVID-19 pandemic. The distribution of ICUs was uneven between public and private services, and most patients rely on SUS, which had the lowest number of ICU beds. In only a few states, the number of ICU beds at SUS was above 1 to 3 by 10,000 inhabitants, which is the number recommended by the World Health Organization (WHO). Conclusions: Brazil needed to improve the number of ICU beds units to deal with COVID-19 pandemic, mainly for the SUS showing a late involvement of government and health authorities to deal with the COVID-19 pandemic.


Assuntos
Infecções por Coronavirus , Acesso aos Serviços de Saúde/organização & administração , Unidades de Terapia Intensiva/provisão & distribução , Pandemias , Administração dos Cuidados ao Paciente , Pneumonia Viral , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Ocupação de Leitos/estatística & dados numéricos , Betacoronavirus , Brasil/epidemiologia , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Necessidades e Demandas de Serviços de Saúde , Humanos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Inovação Organizacional , Pandemias/prevenção & controle , Administração dos Cuidados ao Paciente/organização & administração , Administração dos Cuidados ao Paciente/normas , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Índice de Gravidade de Doença
6.
S Afr Med J ; 110(8): 747-750, 2020 Jul 29.
Artigo em Inglês | MEDLINE | ID: mdl-32880299

RESUMO

Broader policy research and debate on the issues related to the planning of National Health Insurance (NHI) in South Africa (SA) need to be complemented by case studies to examine and understand the issues that will have to be dealt with at micro and macro levels. The objective of this article is to use caesarean section (CS) as a case study to examine the health systems challenges that NHI would need to address in order to ensure sustainability. The specific objectives are to: (i) provide an overview of the key clinical considerations related to CS; (ii) assess the CS rates in the SA public and private sectors; and (iii) use a health systems framework to examine the drivers of the differences between the public and private sectors and to identify the challenges that the proposed NHI would need to address on the road to implementation.


Assuntos
Cesárea/estatística & dados numéricos , Programas Nacionais de Saúde , Feminino , Planejamento em Saúde , Humanos , Gravidez , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , África do Sul
7.
J Ment Health Policy Econ ; 23(3): 81-91, 2020 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-32853157

RESUMO

BACKGROUND: Alternative payment models, including Accountable Care Organizations and fully capitated models, change incentives for treatment over fee-for-service models and are widely used in a variety of settings. The level of payment may affect the assignment to a payment category, but to date the upcoding literature has been motivated largely incorporating financial penalties for upcoding rather than by a theoretical model that incorporates the downstream effects of upcoding on service provision requirements. AIMS OF THE STUDY: In this paper, we contribute to the literature on upcoding by developing a new theoretical model that is applicable to capitated, case-rate and shared savings payment systems. This model incorporates the downstream effects of upcoding on service provision requirements rather than just the avoidance of penalties. This difference is important especially for shared-savings models with quality benchmarks. METHODS: We test implications of our theoretical model on changes in severity determination and service use associated with changes in case-rate payments in a publicly-funded mental health care system. We model provider-assigned severity categories as a function of risk-adjusted capitated payments using conditional logit regressions and counts of service days per month using negative binomial models. RESULTS: We find that severity determination is only weakly associated with the payment rate, with relatively small upcoding effects, but that level of use shows a greater degree of association. DISCUSSION: These results are consistent with our theoretical predictions where the marginal utility of savings or profit is small, as would be expected from public sector agencies. Upcoding did seem to occur, but at very small levels and may have been mitigated after the county and providers had some experience with the new system. The association between the payment levels and the number of service days in a month, however, was significant in the first period, and potentially at a clinically important level. Limitations include data from a single county/multiple provider system and potential unmeasured confounding during the post-implementation period. IMPLICATIONS FOR HEALTH CARE PROVISION AND USE: Providers in our data were not at risk for inpatient services but decreases in use of outpatient services associated with rate decreases may lead to further increases in inpatient use and therefore expenditures over time. IMPLICATIONS FOR HEALTH POLICIES: Health program directors and policy makers need to be acutely aware of the interplay between provider payments and patient care and eventual health and mental health outcomes. IMPLICATIONS FOR FURTHER RESEARCH: Further research could examine the implications of the theoretical model of upcoding in other payment systems, estimate the power of the tiered-risk systems, and examine their influence on clinical outcomes.


Assuntos
Organizações de Assistência Responsáveis , Capitação/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/economia , Motivação , Atenção Primária à Saúde/economia , Análise Custo-Benefício/estatística & dados numéricos , Planos de Pagamento por Serviço Prestado/estatística & dados numéricos , Gastos em Saúde , Humanos , Modelos Econômicos , Modelos Teóricos , Setor Público
8.
PLoS One ; 15(8): e0236411, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32745100

RESUMO

BACKGROUND: Access to affordable and good quality medicines is a key to meeting Sustainable Development Goal No. 3 by the year 2030. Prices, availability and affordability of essential medicines have been studied in many developing countries, but no such information has been published about Rwanda yet. This study aimed at providing data on prices, availability and affordability of medicines in different health facilities of Rwanda. METHODS: A survey was carried out on availability, prices and affordability of 18 medicines in Kigali City and five districts of Rwanda. 44 health facilities were surveyed, including public and faith-based hospitals, public and faith-based health centers and private pharmacies. The standardized methodology developed by WHO and Health Action International (HAI) was used to collect and analyze the data. FINDINGS: Prices for generic medicines in public and faith-based health facilities were remarkably low, with median price ratios (MPRs) of 1.0 in comparison to the international procurement prices published by Management Sciences for Health. In private pharmacies, prices were twice as high (MPR = 1.99 for generics). Availability of medicines fell short of the of 80% target set by WHO, but was better than reported from many other developing countries. Availability of medicines was highest in the private sector (71.3%) and slightly lower in the faith-based (62.8%) and public (59.6%) sectors. The government procurement agency was found to work efficiently, achieving prices 30% below the international procurement price given in the International Medical Product Price Guide. Affordability of medicines was better in the public and faith-based sectors than in the private sector. CONCLUSION: In Rwanda, medicines are affordable but poorly available in both the public and the faith-based sectors. Further improvements of the availability of medicines in the public and the faith-based health facilities represent the most important key to increase accessibility and affordability of medicines in Rwanda.


Assuntos
Medicamentos Essenciais/economia , Saúde Global , Instalações de Saúde/economia , Acesso aos Serviços de Saúde/economia , Custos e Análise de Custo , Medicamentos Essenciais/uso terapêutico , Medicamentos Genéricos/economia , Humanos , Farmácias/economia , Setor Privado , Setor Público/tendências , Ruanda/epidemiologia , Inquéritos e Questionários
10.
Diabetes Res Clin Pract ; 167: 108336, 2020 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-32755762

RESUMO

OBJECTIVE: In 2007, the Ministry of Health (MoH) in Mexico implemented a multidisciplinary health-care model (MHC) for patients with type-2 diabetes (T2D), which has proven more effective in controlling this condition than the conventional health-care model (CHC). RESEARCH DESIGN AND METHODS: We compared the cost-effectiveness of the MHC vs. the CHC for patients with T2D using a quasi-experimental, retrospective design. Epidemiologic and cost data were obtained from a randomly selected sample of health-care units, using medical records as well as patient- and facility-level data. We modelled the cost-effectiveness of the MHC at one, 10 and 20 years using a simulation model. RESULTS: The average cumulative costs per patient at 20 years were US$4,225 for the MHC and US$4,399 for the CHC. With a willingness to pay one gross domestic product (GDP) per capita per quality-adjusted life year (QALY) (US$8,910), the incremental net benefits per patient were US$1,450 and US$3,737 at 10 and 20 years, respectively. The MHC was cost-effective from the third year onward; however, increasing coverage to 500 patients per year rendered it cost-effective at year one. CONCLUSIONS: The MHC is cost-effective at 10 and 20 years. Cost-effectiveness can be achieved in the short term by increasing MHC coverage.


Assuntos
Assistência à Saúde/economia , Diabetes Mellitus Tipo 2/epidemiologia , Setor Público , Adulto , Idoso , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/economia , Feminino , Humanos , Masculino , México , Pessoa de Meia-Idade , Modelos Teóricos , Anos de Vida Ajustados por Qualidade de Vida , Estudos Retrospectivos
11.
PLoS One ; 15(8): e0236984, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32790677

RESUMO

BACKGROUND: Understanding of the facilitators and challenges to female condom (FC) uptake has been limited due to lack of evaluation of national FC programmes. SETTING: The FC has been an integral component of South Africa's (SA) HIV prevention programme for 20 years and is the largest government-funded FC programme worldwide. METHODS: The national FC evaluation used a mixed-methods approach and consisted of key informant interviews and a telephone survey in a national sample of public and non-public sites. A sub-sample of sites participated in client and provider interviews, and a self-administered client survey. A review of distribution statistics from South Africa's District Health Information System was also conducted. RESULTS: All 256 public-sector and 28 non-public-sector facilities reported having ever distributed FCs. Less than 5% of these facilities reported stock-outs and less than 3% reported they had a supply of expired female condoms. Systems for male condom (MC) and FC distribution were complementary, with similar ordering, delivery and reporting processes. FC promotion by providers (n = 278) varied with regard to FC training, whether attitudes about FCs influenced providers offer of FCs, and how they counselled clients about FCs. Of the 4442 self-administered client surveys in 133 facilities, similar proportions of women (15.4%) and men (15.2%) had ever used FCs. Although FCs were available at almost all sites surveyed, only two-thirds of clients were aware of their availability. CONCLUSION: Data highlight the role of providers as gatekeepers to FC access in public and non-public sectors and provide support for further FC programme expansion in SA and globally.


Assuntos
Preservativos Femininos , Adolescente , Adulto , Preservativos/estatística & dados numéricos , Preservativos/provisão & distribução , Preservativos Femininos/estatística & dados numéricos , Preservativos Femininos/provisão & distribução , Feminino , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Política de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Programas Nacionais de Saúde , Setor Privado , Setor Público , África do Sul , Inquéritos e Questionários , Adulto Jovem
12.
Asia Pac J Ophthalmol (Phila) ; 9(4): 285-290, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32657805

RESUMO

Coronavirus disease 19 (COVID-19) was first reported in Wuhan, China, in December 2019, and has since become a global pandemic. Singapore was one of the first countries outside of China to be affected and reported its first case in January 2020. Strategies that were deployed successfully during the 2003 outbreak of severe acute respiratory syndrome have had to evolve to contain this novel coronavirus. Like the rest of the health care services in Singapore, the practice of ophthalmology has also had to adapt to this rapidly changing crisis. This article discusses the measures put in place by the 3 largest ophthalmology centers in Singapore's public sector in response to COVID-19, and the challenges of providing eye care in the face of stringent infection control directives, staff redeployments and "social distancing." The recently imposed "circuit breaker," effectively a partial lockdown of the country, has further limited our work to only the most essential of services. Our staff are also increasingly part of frontline efforts in the screening and care of patients with COVID-19. However, this crisis has also been an opportunity to push ahead with innovative practices and given momentum to the use of teleophthalmology and other digital technologies. Amidst this uncertainty, our centers are already planning for how ophthalmology in Singapore will be practiced in this next stage of the COVID-19 pandemic, and beyond.


Assuntos
Infecções por Coronavirus/epidemiologia , Transmissão de Doença Infecciosa/prevenção & controle , Oftalmologia/métodos , Pneumonia Viral/epidemiologia , Setor Público , Telemedicina/métodos , Betacoronavirus , Infecções por Coronavirus/transmissão , Humanos , Pandemias , Pneumonia Viral/transmissão , Singapura/epidemiologia
13.
Artigo em Inglês | MEDLINE | ID: mdl-32708838

RESUMO

OBJECTIVES: The COVID-19 (SARS-CoV-2) pandemic is an ongoing public health challenge, also for the dentistry community. The main objective of this paper was to determine the economic and health-care impact of COVID-19 on dentists in the Autonomous Region of Galicia (Spain). METHODS: This was a descriptive observational study in which the data was collected by means of a self-administered survey (from 1 April 2020 to 30 April 2020). RESULTS: A total of 400 dentists from Galicia responded to the survey. Only 12.3% of the participants could obtain personal protective equipment (PPE) including FFP2 masks. Of the male respondents, 33.1% suffered losses >€15,000 compared to 19.4% of female respondents (OR = 3.121, p < 0.001). Economic losses seem to have contributed to the applications for economic help as 29.5% of the respondents who applied for this measure recorded losses in excess of €15,000 (p = 0.03). Patients complained more about the fact that only emergency care was available during the State of Alarm, in dental surgeries that do not work with insurance companies or franchises. Only 4 professionals tested positive, 50% of whom worked exclusively in private practice and the other 50% who practised in both private and public surgeries. Dentists who practise in the public sector saw more urgent patients per week than those practising in private surgeries (p = 0.013). CONCLUSIONS: The COVID-19 pandemic has had economic repercussions in dentistry as only urgent treatment was available during the State of Alarm. These repercussions seem to be higher in male participants, as the majority of the participants have revealed higher economic losses than females. The level of assistance has also been affected, reducing the number of treated patients, although this quantity has been different in private and public surgeries. By presenting these findings we look to highlight the role that dentists play in society in treating dental emergencies in our surgeries, and this must be recognised and addressed by the relevant authorities, who must provide PPEs as a priority to this group as well as providing special economic aid in accordance with the losses incurred by the sector.


Assuntos
Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/prevenção & controle , Serviços de Saúde Bucal/economia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Setor Privado , Setor Público , Procedimentos Cirúrgicos Operatórios/economia , Infecções por Coronavirus/virologia , Feminino , Humanos , Masculino , Equipamento de Proteção Individual , Projetos Piloto , Pneumonia Viral/virologia , Espanha , Inquéritos e Questionários , Fatores de Tempo
14.
Proc Natl Acad Sci U S A ; 117(29): 16898-16907, 2020 07 21.
Artigo em Inglês | MEDLINE | ID: mdl-32631989

RESUMO

Although the Flint, Michigan, water crisis renewed concerns about lead (Pb) in city drinking water, little attention has been paid to Pb in private wells, which provide drinking water for 13% of the US population. This study evaluates the risk of Pb exposure in children in households relying on private wells. It is based on a curated dataset of blood Pb records from 59,483 North Carolina children matched with household water source information. We analyze the dataset for statistical associations between children's blood Pb and household drinking water source. The analysis shows that children in homes relying on private wells have 25% increased odds (95% CI 6.2 to 48%, P < 0.01) of elevated blood Pb, compared with children in houses served by a community water system that is regulated under the Safe Drinking Water Act. This increased Pb exposure is likely a result of corrosion of household plumbing and well components, because homes relying on private wells rarely treat their water to prevent corrosion. In contrast, corrosion control is required in regulated community water systems. These findings highlight the need for targeted outreach to prevent Pb exposure for the 42.5 million Americans depending on private wells for their drinking water.


Assuntos
Água Potável/normas , Intoxicação do Sistema Nervoso por Chumbo na Infância/epidemiologia , Chumbo/sangue , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Poços de Água , Pré-Escolar , Feminino , Humanos , Lactente , Masculino , North Carolina , Purificação da Água/economia , Purificação da Água/estatística & dados numéricos
15.
J Coll Physicians Surg Pak ; 30(6): 3-8, 2020 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-32723441

RESUMO

The national response of Pakistan's health system to COVID-19 was assessed by applying a framework of three distinct tiers. The first tier assessed politico-economic ecosystems: lockdown procedures, contact-screening, monetary/organisational arrangements for economically deprived groups, and travel restrictions. The second tier assessed intervention measures according to six building blocks of WHO: strategic vision highlighted by National Action Plan COVID-19, inadequacy and urban bias of healthcare professionals, expanded bed capacity, enhanced laboratory diagnostic capacity and financial assistance. The third tier of community participation revealed that the majority of the population was abiding by restrictions, but sporadic instances of orthodox religious gatherings were facilitating community spread. We recommend private health sector coordination with public facilities and call for deployment of non-practising health professionals. The neighborhood-warden-system should be introduced at the union council level with the help of community level volunteers to facilitate enforcement of quarantines and responding to emerging community needs. Key Words: COVID-19, Coronavirus disease 2019, Pakistan healthcare delivery.


Assuntos
Infecções por Coronavirus , Coronavirus , Assistência à Saúde , Planos de Sistemas de Saúde , Pneumonia Viral , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Humanos , Paquistão/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Setor Privado , Setor Público , Quarentena
16.
PLoS One ; 15(7): e0236636, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730357

RESUMO

This study assesses the degree of internationalization of Chinese firms along the Belt and Road initiative countries. Most of the extant studies of the Belt and Road initiative have been qualitative, and where there have been quantitative studies, they have usually been at the aggregate level, and only a handful have used firm-level data to study initiative. Using a composite measure of the degree of internationalization, DOIBRI, that composed of variables capturing the performance, structural and attitudinal dimensions of internationalization, comparative analysis of State-owned enterprises and privately owned enterprises turned up counter-intuitive results. Firstly, given that state ownership could be positively associated with the degree of internationalization of firms and because of the significance of the Belt and Road initiative, we expected the State-owned enterprises to dominate the DOIBRIrankings. We assessed the firms, and contrary to expectations, privately owned firms had a higher average degree of internationalization. Furthermore, we expected both state-owned enterprises and privately-owned enterprises to have similar levels of psychic dispersion. However, state-owned enterprises were more psychically dispersed. Suggesting that along the belt and road countries, the advantages of state ownership of Chinese multinationals may be attenuated.


Assuntos
Internacionalidade , China , Setor Privado , Setor Público
17.
S Afr Med J ; 110(4): 274-283, 2020 Mar 30.
Artigo em Inglês | MEDLINE | ID: mdl-32657738

RESUMO

BACKGROUND: Over the past 18 years, the South African (SA) Ministry of Health has committed to allocate 2% of the national health budget to research, while the National Health Research Policy (2001) proposed that the health research budget should be 2% of total public sector health expenditure. A review was conducted by the National Health Research Committee (NHRC) in 2014 to determine whether these goals had been met, using available data up to 2009/10. It revealed that public sector health research funding remained below 2% of the national health budget, supporting the perception of reduced public sector health research funding. OBJECTIVES: To provide an update on the previous review to investigate changes in the health research landscape since 2009/10 and whether goals have been met. METHODS: Various publicly available sources of information on public and private expenditure on health research in SA were used to investigate health research funding and expenditure. In addition, questionnaires were sent to 35 major national and international funders of health research in SA to obtain data on the level of funding provided and the fields of research funded. RESULTS: Total health research expenditure in SA was ZAR6.9 billion in 2016/17, or 19.2% of gross expenditure on research and development, with 1.7% of the ZAR38.6 billion National Department of Health budget from National Treasury being spent on health research through the South African Medical Research Council (ZAR658 million), corresponding to 0.4% of the consolidated government expenditure on health. However, although the total government plus science council spend on health research in 2016/17 was ZAR1.45 billion, this represents just 0.033% of the gross domestic product (GDP), thus remaining well below the aspirational target of 0.15% of the GDP set by the NHRC in 2014. Based on feedback from the funders, the estimated baseline health research funding in 2016/17 was in excess of ZAR4.1 billion, which is considerably higher than many researchers may realise. Three-quarters of this funding originated from foreign sources, suggesting both strengths and opportunities for health research in SA, but also highlighting increasing dependence on foreign funding. Notably, the majority of funders approached were not able to readily break down expenditure according to disease area. CONCLUSIONS: Health research funding has changed significantly since our previous review, although the government's own commitments to it remain unmet. Improved mechanisms to track health research expenditure are urgently required for better alignment of funding priorities and increased co-ordination between science councils in health research funding.


Assuntos
Pesquisa Biomédica/economia , Governo , Gastos em Saúde/tendências , Apoio à Pesquisa como Assunto/economia , Pesquisa Biomédica/tendências , Orçamentos , Educação/economia , Humanos , Organizações/economia , Organizações sem Fins Lucrativos/economia , Setor Privado/economia , Setor Público/economia , Apoio à Pesquisa como Assunto/tendências , África do Sul
18.
PLoS One ; 15(7): e0235250, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32730256

RESUMO

OBJECTIVES: To elicit citizen preferences for national budget resource allocation in Uganda, examine respondents' preferences for health vis-à-vis other sectors, and compare these preferences with actual government budget allocations. METHODS: We surveyed 432 households in urban and rural areas of Mukono district in central Uganda.We elicited citizens' preferences for resource allocation across all sectors using a best-worst scaling (BWS) survey. The BWS survey consisted of 16 sectors corresponding to the Uganda national budget line items. Respondents chose, from a subset of four sectors across 16 choice tasks, which sectors they thought were most and least important to allocate resources to. We utilized the relative best-minus-worst score method and a conditional logistic regression to obtain ranked preferences for resource allocation across sectors. We then compared the respondents' preferences with actual government budget allocations. RESULTS: The health sector was the top ranked sector where 82% of respondents selected health as the most important sector for the government to fund, but it was ranked sixth in national budget allocation, encompassing 6.4% of the total budget. Beyond health, water and environment, agriculture, and social development sectors were largely underfunded compared to respondents' preferences. Works and transport, education, security, and justice, law and order received a larger share of the national budget compared to respondents' preferences. CONCLUSIONS: Among respondents from Mukono district in Uganda, we found that citizens' preferences for resource allocation across sectors, including for the health sector, were fundamentally misaligned with current government budget allocations. Evidence of respondents' strong preferences for allocating resources to the health sector could help stakeholders make the case for increased health sector allocations. Greater investment in health is not only essential to satisfy citizens' needs and preferences, but also to meet the government's health goals to improve health, strengthen health systems, and achieve universal health coverage.


Assuntos
Orçamentos/estatística & dados numéricos , Comportamento do Consumidor/estatística & dados numéricos , Alocação de Recursos para a Atenção à Saúde/estatística & dados numéricos , Governo Local , Alocação de Recursos/estatística & dados numéricos , Adulto , Orçamentos/organização & administração , Estudos Transversais , Feminino , Alocação de Recursos para a Atenção à Saúde/organização & administração , Habitação/economia , Habitação/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Setor Público/economia , Setor Público/organização & administração , Alocação de Recursos/organização & administração , Participação dos Interessados , Transportes/economia , Uganda , Assistência de Saúde Universal , Reforma Urbana/economia , Reforma Urbana/organização & administração , Adulto Jovem
19.
Artigo em Inglês | MEDLINE | ID: mdl-32635534

RESUMO

Talent management (TM) is a fundamental issue for both private and public sector companies. This study analyzes the impact of TM on service performance (SP) and the mediating role of affective organizational commitment (AOC). We analyze a sample of 104 local government employees with three measures of TM, AOC and SP. The mediation hypothesis of AOC was also raised in the study using Baron and Kenny's methodology and Hayes PROCESS. The results reveal how AOC is a total mediating variable in the causal relationship TM → SP. This study is cross-sectional. Common-method bias is controlled in the study. The results involves a concern for improving services through the professionals who provide them, which in turn entails managing people in a way that is different, more flexible, less bureaucratic, and more client- or citizen-oriented. Given the scant research exploring the role of talent management in public services, this article offers valuable insights for scientific literature and practitioners in the public administration.


Assuntos
Aptidão , Governo Local , Lealdade ao Trabalho , Administração de Recursos Humanos , Setor Público , Estudos Transversais , Feminino , Humanos , Masculino
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