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1.
N Z Med J ; 133(1513): 11-22, 2020 04 24.
Artigo em Inglês | MEDLINE | ID: mdl-32325464

RESUMO

AIM: To describe and consider the findings of a workforce survey of New Zealand Oral and Maxillofacial Surgeons (OMS) which was conducted in 2017-18, and to compare those to findings from a similar survey undertaken in 2001. METHODS: A questionnaire was used to obtain information on the qualifications, sociodemographic characteristics and and practising circumstances of all practising OMS in New Zealand. Data were analysed using SPSS (version 24). After the computation of descriptive statistics, cross-tabulations were used to identify differences in proportions (with those tested for statistical significance using Chi-squared tests), and analysis of variance was used to examine differences in means. RESULTS: All 39 OMS took part. There were 17 medically qualified surgeons who also held a surgical fellowship, comprising just under half of the workforce. Overall, one in eight surgeons worked solely in the public sector, while just under one-quarter worked solely in private; the remainder worked in both sectors. Dentoalveolar procedures were by far the most common undertaken (with considerably more done by older surgeons than younger ones), followed by implants, the treatment of facial trauma, skin lesions and surgery for malignancy. Orthognathic surgery and dentoalveolar trauma procedures were the least commonly reported. Only two-thirds of surgeons participated in public on-call work. While 95% of surgeons were indeed satisfied with their work, the lowest rate was observed among those working solely in the public sector, where it was 80%; among those working exclusively in private, it was 100%. Between 2001 and 2017-18, the proportion of medically qualified surgeons rose from just over one-quarter to more than two-thirds. The proportion of surgeons working solely in private practice rose from one in seven to almost one-quarter. There were marked increases in the mean number of malignancies dealt with and implants provided. CONCLUSION: The findings highlight a number of problems-some long-standing, others emerging-in New Zealand's OMS system. Fewer surgeons are participating in public sector provision and there is stress on those who remain. Workforce planners should be aware that more resources need to be put into training surgeons who will take up hospital appointments and provide essential after-hours emergency services.


Assuntos
Cirurgiões Bucomaxilofaciais , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Cirurgiões Bucomaxilofaciais/organização & administração , Cirurgiões Bucomaxilofaciais/estatística & dados numéricos , Prática Privada/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Inquéritos e Questionários , Recursos Humanos
2.
Int Braz J Urol ; 46(2): 224-233, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32022511

RESUMO

INTRODUCTION: Considering the lack of data on BC trends in Brazilian population, mainly as a result of the difficulty on gathering data, the present manuscript provides an overview of bladder cancer incidence, hospitalization, mortality patterns and trends using the Brazilian Data Center for The Public Health System (DATASUS). MATERIALS AND METHODS: All hospital admissions associated with BC diagnosis (ICD-10 C67) between 2008 and 2017 were analyzed. Distributions according to year, gender, age group, ethnicity, death, length of hospital stay, and costs were evaluated. Demographic data was obtained from the last Brazilian national census. RESULTS: From 2008 to 2017 there were 119,058 public hospital admissions related to BC. Patients were mostly white males aged 60 to 79 years-old. Mortality rates for patients who have undergone surgery was 6.75% on average, being 7.38% for women and 6.49% for men. Mortality rates were higher when open surgeries were performed compared to endoscopic procedures (4.98% vs 1.18%). Considering only endoscopic procedures, mortality rates were three times higher after urgent surgeries compared to elective ones (2.6% vs 0.6%). Over the years the cystectomy/transurethral bladder resection (C/T) ratio significantly decreased in all Brazilian Regions. In 2008, the C/T ratio was 0.19, while in 2017 it reduced to 0.08. CONCLUSIONS: Despite BC relatively low incidence, it still represents a significant social economic burden in Brazil, as it presents with recurrent episodes that might require multiple hospitalizations and surgical treatment. The set of data collected might suggest that population access to health care has improved between 2008-2017.


Assuntos
Neoplasias da Bexiga Urinária/mortalidade , Adulto , Idoso , Idoso de 80 Anos ou mais , Brasil/epidemiologia , Feminino , Humanos , Incidência , Masculino , Pessoa de Meia-Idade , Setor Público/estatística & dados numéricos , Fatores Socioeconômicos
3.
Braz Oral Res ; 33: e124, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31994597

RESUMO

This study aimed to assess the association of demographic conditions, socioeconomic status, clinical variables, and psychosocial factors with the number of filled teeth in adolescents from public schools. This cohort study comprised 1,134 12-year-old adolescents enrolled in public schools in Santa Maria, Brazil, in 2012. They were followed-up in 2014, where 743 individuals were reassessed (follow-up rate of 65.52%) for the number of filled teeth. Data were collected via dental examinations and structured interviews. Demographic and socioeconomic characteristics were collected from parents or legal guardians. The psychosocial factor comprised students' subjective measurement of happiness (Brazilian version of the Subjective Happiness Scale - SHS). Dental examinations were performed to assess the number of filled teeth through decay, missing, and filled teeth index (DMF-T). Unadjusted and adjusted Poisson regression analyses were performed to assess the association between baseline variables and filled teeth at follow-up. The number of filled teeth in 2012 and 2014 were 193 (17.02%) and 235 (31.63%), respectively. The incidence of filled teeth in 2014 was 42 (5.65%). Adolescents with untreated dental caries, those who visited the dentist in the last 6 months, those that exhibited being happier, and those who had filled teeth at baseline were associated with a higher number of filled teeth at follow-up. We conclude that the number of filled teeth in adolescents was influenced by clinical and psychosocial factors, emphasizing the need to focus on oral health policies in individuals with higher disease burden and those who feel psychologically inferior.


Assuntos
Inquéritos de Saúde Bucal/estatística & dados numéricos , Restauração Dentária Permanente/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Instituições Acadêmicas/estatística & dados numéricos , Estudantes/estatística & dados numéricos , Adolescente , Brasil/epidemiologia , Criança , Estudos de Coortes , Cárie Dentária/epidemiologia , Cárie Dentária/terapia , Serviços de Saúde Bucal/estatística & dados numéricos , Restauração Dentária Permanente/psicologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Análise de Regressão , Fatores Socioeconômicos , Estudantes/psicologia
4.
Pediatrics ; 145(2)2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31911477

RESUMO

BACKGROUND: Children frequently receive low-value services that do not improve health, but it is unknown whether the receipt of these services differs between publicly and privately insured children. METHODS: We analyzed 2013-2014 Medicaid Analytic eXtract and IBM MarketScan Commercial Claims and Encounters databases. Using 20 measures of low-value care (6 diagnostic testing measures, 5 imaging measures, and 9 prescription drug measures), we compared the proportion of publicly and privately insured children in 12 states who received low-value services at least once or twice in 2014; the proportion of publicly and privately insured children who received low-value diagnostic tests, imaging tests, and prescription drugs at least once; and the proportion of publicly and privately insured children eligible for each measure who received the service at least once. RESULTS: Among 6 951 556 publicly insured children and 1 647 946 privately insured children, respectively, 11.0% and 8.9% received low-value services at least once, 3.9% and 2.8% received low-value services at least twice, 3.2% and 3.8% received low-value diagnostic tests at least once, 0.4% and 0.4% received low-value imaging tests at least once, and 8.4% and 5.5% received low-value prescription drug services at least once. Differences in the proportion of eligible children receiving each service were typically small (median difference among 20 measures, public minus private: +0.3 percentage points). CONCLUSIONS: In 2014, 1 in 9 publicly insured and 1 in 11 privately insured children received low-value services. Differences between populations were modest overall, suggesting that wasteful care is not highly associated with payer type. Efforts to reduce this care should target all populations regardless of payer mix.


Assuntos
Children's Health Insurance Program/normas , Medicaid/normas , Setor Privado/normas , Setor Público/normas , Seguro de Saúde Baseado em Valor , Adolescente , Criança , Pré-Escolar , Children's Health Insurance Program/estatística & dados numéricos , Estudos Transversais , Testes Diagnósticos de Rotina/normas , Testes Diagnósticos de Rotina/estatística & dados numéricos , Feminino , Humanos , Lactente , Recém-Nascido , Revisão da Utilização de Seguros/estatística & dados numéricos , Masculino , Medicaid/estatística & dados numéricos , Medicamentos sob Prescrição/normas , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Estados Unidos , Seguro de Saúde Baseado em Valor/estatística & dados numéricos
5.
Ann Otol Rhinol Laryngol ; 129(4): 369-375, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31752501

RESUMO

OBJECTIVE: Delayed medical care may be costly and dangerous. Examining referral pathways may provide insight into ways to reduce delays in care. We sought to compare time between initial referral and first clinic visit and referral and surgical intervention for index otolaryngologic procedures between a public safety net hospital (PSNH) and tertiary-care academic center (TAC). METHODS: Retrospective cohort study of eligible adult patients undergoing one of several general otolaryngologic procedures at a PSNH (n = 216) and a TAC (n = 161) over a 2-year time period. RESULTS: PSNH patients were younger, less likely to have comorbidities and more likely to be female, Hispanic or Asian, and to lack insurance. Time between referral and first clinic visit was shorter at the PSNH than the TAC (Mean 35.8 ± 47.7 vs 48.3 ± 60.3 days; P = .03). Time between referral and surgical intervention did not differ between groups (129 ± 90 for PSNH vs 141 ± 130 days for TAC, P = .30). On multivariate analysis, the TAC had more patient-related delays in care than the PSNH (OR: 3.75, P < .001). Time from referral to surgery at a PSNH was associated with age, source of referral, type of surgery, diagnostic workup and comorbidities, and at a TAC was associated with gender and type of surgery and comorbidities. CONCLUSIONS: Sociodemographic differences between PSNH and TAC patients, as well as differences in referral pathways between the types of institutions, influence progression of surgical care in otolaryngology. These differences may be targets for interventions to streamline care. LEVEL OF EVIDENCE: 2c.


Assuntos
Centros Médicos Acadêmicos/estatística & dados numéricos , Otolaringologia , Otorrinolaringopatias , Procedimentos Cirúrgicos Otorrinolaringológicos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Encaminhamento e Consulta , Procedimentos Clínicos/organização & administração , Procedimentos Clínicos/normas , Feminino , Hospitais Públicos , Humanos , Masculino , Pessoa de Meia-Idade , Otolaringologia/métodos , Otolaringologia/normas , Otorrinolaringopatias/diagnóstico , Otorrinolaringopatias/epidemiologia , Otorrinolaringopatias/cirurgia , Procedimentos Cirúrgicos Otorrinolaringológicos/métodos , Procedimentos Cirúrgicos Otorrinolaringológicos/estatística & dados numéricos , Encaminhamento e Consulta/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Tempo para o Tratamento , Estados Unidos/epidemiologia
6.
Medicina (B Aires) ; 79(6): 461-467, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31829948

RESUMO

Treatment of acute coronary syndrome (ACS) may differ according to the health system coverage. The objective of this study was to evaluate demographic characteristics of patients with ACS assisted in public sector institutions compared to the non-public sector of Argentina, as well as the therapeutic and its relationship with the resources of each sector. We analyzed patients hospitalized in institutions of a national, voluntary, prospective and multicenter registry. Between March 2006 and May 2016, 11 072 ACSs were registered in 64 institutions, 39% public (44% have hemodynamic laboratory) and 61% non-public (82% with hemodynamic). Public centers presented less structure and assisted a higher proportion of ST elevation acute coronary syndrome (STE-ACS). (52.5% vs. 36.1%, p < 0.001). Public sector patients were younger, more frequently men, smokers, and less dyslipemics. The proportion of patients reperfused in the STE-ACS was similar in both sectors. The use of coronary angiography in non-ST elevation acute coronary syndrome (NSTE-ACS) was higher in the public sector, whose patients presented more frequently electrocardiographic changes and biomarker elevation. Considering all ACS, 80.2% of patients in public and 90.1% in non-public institutions were incorporated by haemodynamic centers. The availability of hemodynamics was the variable most associated with reperfusion in NSTE-ACS, and invasive treatment in NSTE-ACS. This research demonstrates the complexity of a comparative analysis of health sectors, due to the relevance acquired by the level of resources installed and the demographic differences of the inpatient population, above the simple difference of belonging to the public or non-public system.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Instalações de Saúde/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Síndrome Coronariana Aguda/diagnóstico por imagem , Distribuição por Idade , Idoso , Argentina/epidemiologia , Angiografia Coronária/métodos , Diabetes Mellitus/epidemiologia , Dislipidemias/epidemiologia , Feminino , Hemodinâmica , Humanos , Hipertensão/epidemiologia , Laboratórios/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Estudos Prospectivos , Distribuição por Sexo , Fumar/epidemiologia , Estatísticas não Paramétricas
7.
N Z Med J ; 132(1507): 70-76, 2019 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-31830019

RESUMO

AIM: To characterise the demographics, size and distribution of the New Zealand rheumatology workforce. METHOD: An online survey was sent to New Zealand rheumatologists in February 2018. RESULTS: The survey was completed by 63 of 64 practising New Zealand rheumatologists (response rate 98%). In public practice, the number of half-day clinics per FTE was five (R2 linear 0.87), so a half-day session in private practice was counted as 0.2 FTE. There were 28.71 FTE in the public sector, 14.97 in private and 43.68 total FTE. By district health board (DHB), public FTE per capita ranged from 0.20 FTE per 100,000 population in Nelson-Marlborough DHB to 0.96 in Whanganui DHB. None of the 20 DHBs met the Royal College of Physicians guideline of 1.16 FTE per 100,000 population in the public sector, and only four DHBs reached this level when private FTE were included. Rheumatologists under the age of 50 years were predominantly female (62% female), and older rheumatologists predominantly male (7.7% female, p<0.001). In the next five years 6.58 FTE public rheumatologists intended to retire, (94% male). 23/53 (43%) of public hospital rheumatologists offer appointments for non-inflammatory conditions, compared to 30/31 (97%) of private practice rheumatologists. Between 1999 and 2011, the FTE per 100,000 population increased by 35.4%, but the rate of improvement slowed in the interval between 2011 and 2018, increasing by 3.0%. CONCLUSION: The New Zealand rheumatologist workforce is becoming more gender-balanced but is below recommended FTE levels, is unevenly distributed, and previously documented improvements in overall FTE have now reached a plateau.


Assuntos
Necessidades e Demandas de Serviços de Saúde , Mão de Obra em Saúde/tendências , Reumatologistas/provisão & distribução , Reumatologia , Adulto , Distribuição por Idade , Idoso , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Setor Público/estatística & dados numéricos , Distribuição por Sexo , Inquéritos e Questionários
8.
Int J Equity Health ; 18(1): 187, 2019 12 02.
Artigo em Inglês | MEDLINE | ID: mdl-31791347

RESUMO

BACKGROUND: Horizontal equity in access to public general practitioner (GP) services by socioeconomic group has been addressed econometrically by testing the statement "equal probability of using public GP services for equal health care needs, regardless of socioeconomic status". Based on survey data, the conventional approach has been to estimate binomial econometric models in which when the respondent reports having visited a public GP, it counts as 1, otherwise it counts as 0. This is what we call a compartmentalised approach. Those respondents who did not visit a public GP but visited instead another doctor (specialist or private GP) would count as 0 (despite having used instead other modes of health care), thus conclusions of the compartmentalised approach might be biased. In such cases, a multinomial econometric model -that we called comprehensive approach- would be more appropriate to analyse horizontal equity in access to public GP services. The objective of this paper is to test for this potential bias by comparing a compartmentalised and a comprehensive approach, when analysing horizontal equity in access to public GP. METHODS: Using data from the 2016/17 Spanish National Health Survey, we estimate the probability of visiting a public GP as determined by socioeconomic status, health care need and demographic characteristics. We use binomial and multinomial logit and probit models in order to highlight the potential differences in the conclusions regarding socioeconomic inequities in access to public GP services. Socioeconomic status is proxied by education level, social class and employment situation. RESULTS: Our results show that conclusions are sensitive to the approach selected. Particularly, the horizontal inequity favouring individuals with lower education that resulted from the compartmentalised approach disappears under a comprehensive approach and only a social class effect remains. CONCLUSION: An analysis of horizontal equity in access to a particular health care service (like public GP services) undertaken following a compartmentalised approach should be compared with a comprehensive approach in order to test that there is no bias as a consequence of considering as zeros the utilisation of other types of health care.


Assuntos
Medicina Geral/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Classe Social , Adolescente , Adulto , Idoso , Viés , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Adulto Jovem
9.
S Afr Med J ; 109(12): 934-940, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31865955

RESUMO

BACKGROUND: In South Africa (SA), the National Department of Health has developed an Antimicrobial Resistance National Strategy Framework document to manage antimicrobial resistance (AMR). One of the strategic objectives is to optimise surveillance and early detection of AMR. At the National Institute for Communicable Diseases (NICD), an analysis of selected organisms and antimicrobial agents from both the public and the private sectors was conducted. OBJECTIVES: The relevance of surveillance for AMR is increasingly recognised in the light of global action plans to combat resistance. In this report, we present an overview of ESKAPE (Enterococcus faecium, Staphylococcus aureus, Klebsiella pneumoniae, Acinetobacter baumannii, Pseudomonas aeruginosa, Enterobacter spp.) organisms and Escherichia coli reported from public and private sector laboratories in SA for the period 2016 - 2017. METHODS: Antimicrobial susceptibility testing (AST) profiles on selected ESKAPE organisms and E. coli isolated from blood cultures from the public and private sectors in 2016 and 2017 were analysed. AST data were extracted from a web-based electronic platform created by the NICD. Drug-bug combinations following the World Health Organization's Global Antimicrobial Surveillance System guidelines were included in the analysis. RESULTS: A total of 28 920 ESKAPE organisms and E. coli were reported in 2016 and 32 293 in 2017 across the two health sectors. Proportions of some organisms differed between the two health sectors, such as E. coli (19% in the public sector and 36% in the private sector), A. baumannii (14% public and 4% private), P. aeruginosa (7% public and 11% private) and S. aureus (27% public and 17% private). Susceptibility data indicated changing patterns in both sectors towards an increase in non-susceptibility to carbapenems in K. pneumoniae (p<0.01). However, we demonstrated an increase in susceptibility to cloxacillin in S. aureus (p<0.01) in both sectors. CONCLUSIONS: The key clinically important finding is the rapidly decreasing carbapenem susceptibility among Enterobacteriaceae reported in SA, irrespective of sector. In addition, the analysis provides information that could be used to monitor the effectiveness of interventions implemented at a national level under the guidance and direction of the national AMR framework.


Assuntos
Antibacterianos/farmacologia , Bacteriemia/microbiologia , Farmacorresistência Bacteriana , Vigilância da População , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Acinetobacter baumannii/efeitos dos fármacos , Hemocultura , Enterobacter/efeitos dos fármacos , Enterococcus faecium/efeitos dos fármacos , Escherichia coli/efeitos dos fármacos , Humanos , Klebsiella pneumoniae/efeitos dos fármacos , Testes de Sensibilidade Microbiana , Pseudomonas aeruginosa/efeitos dos fármacos , África do Sul , Staphylococcus aureus/efeitos dos fármacos
10.
S Afr Med J ; 109(12): 957-962, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31865959

RESUMO

BACKGROUND: The International Diabetes Federation (IDF) recently reported that there are 1.8 million South Africans with diabetes, and estimates an additional undiagnosed population of 69% of the total number of diabetics. The African continent is expected to see the highest increase in diabetes globally by 2045. Healthcare measures to manage this surge in diabetes and its related complications should be tailored to Africa's unique challenges; however, the epidemiolocal data essential for policy development are lacking. Bridging the data gap will guide funding distribution and the creation of evidence-based initiatives for diabetes. OBJECTIVES: To investigate the frequency, age proportion and distribution of new patients diagnosed with diabetes in the public healthcare sector of Eastern Cape (EC) Province, South Africa (SA). METHODS: All data collected to date were obtained from the EC District Health Information System. According to the information collected from the Department of Health, diabetes-related data collection fields were implemented in 2013, which resulted in this 4-year study. Additional open-source data on population estimates, mortality and medical aid coverage were provided by Statistics SA. RESULTS: Of the eight districts in the province, O R Tambo was recorded as having the highest average proportion of new patients diagnosed with diabetes. A positive correlation was found between the calculated incidence of disease and the diabetes mortality rate. CONCLUSIONS: The study showed an annual growth in the incidence of diabetes in the EC since 2014, and highlights the issue of an increasing burden of diabetes in the rural population. This increase is consonant with predictions by authoritative bodies on the growing burden of diabetes in Africa. The pattern of distribution highlights the deprived district of O R Tambo contradicting the well-known link between diabetes and urbanisation.


Assuntos
Área Programática de Saúde/estatística & dados numéricos , Diabetes Mellitus/epidemiologia , Setor Público/estatística & dados numéricos , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Adolescente , Adulto , Distribuição por Idade , Diabetes Mellitus/mortalidade , Política de Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Incidência , Pessoa de Meia-Idade , Áreas de Pobreza , Prevalência , África do Sul/epidemiologia , Adulto Jovem
11.
BMC Health Serv Res ; 19(1): 973, 2019 Dec 18.
Artigo em Inglês | MEDLINE | ID: mdl-31852546

RESUMO

BACKGROUND: Cardiovascular diseases are the leading cause of death in Lebanon and Qatar. When lifestyle modifications prove insufficient, medication becomes a cornerstone in controlling such diseases and saving lives. Price, availability, and affordability hinder the equitable access to medicines. The study aimed to assess prices, availability, and affordability of essential cardiovascular disease medicines in relation to pricing strategies in Qatar and Lebanon. METHODS: A cross-sectional survey using a variant of the World Health Organization and Health Action International (WHO/HAI) methodology as outlined in "Measuring medicine prices, availability, affordability and price components" (2008), second edition, was adopted. Prices and availability of 27 cardiovascular medicines were collected from public and private dispensing outlets. For international comparison, prices were adjusted to purchasing power parity. Data was analyzed across multiple sectors, within and across countries. RESULTS: A total of 15 public and private outlets were surveyed in each country. Prices were more uniform in Qatar than in Lebanon. In the public sector, medicines were free-of-charge in Lebanon and priced lower than the international reference prices in Qatar. The ratio of medicine unit price to international reference price in the private sectors surveyed are significantly higher than the acceptable threshold of 4. This ratio of originator brands and lowest priced generics in Qatar were up to two and five times those in Lebanon, respectively, even after adjusting for purchasing power parity. However, prices of lowest priced generics in the private sector were at least 35% cheaper in Qatar and 65% cheaper in Lebanon than their comparative originator brands. Medicines were more available in the private sector in Lebanon than in Qatar, but only the originator brand availability in the public sector in Qatar exceeded the WHO target of more than 80%. While affordable in the public sector in Qatar, four out of thirteen medicines exceeded the threshold in all private sectors covered. Hence, only the public sector in Qatar had a satisfying level of availability and affordability. CONCLUSIONS: Except for the Qatari public sector, medicine prices, availability, and affordability are falling short from targets. Key policy decisions should be implemented to improve access to medicines.


Assuntos
Fármacos Cardiovasculares/economia , Fármacos Cardiovasculares/provisão & distribução , Doenças Cardiovasculares/tratamento farmacológico , Comércio/estatística & dados numéricos , Custos e Análise de Custo/estatística & dados numéricos , Estudos Transversais , Medicamentos Essenciais/economia , Medicamentos Essenciais/provisão & distribução , Medicamentos Genéricos/economia , Medicamentos Genéricos/provisão & distribução , Humanos , Líbano , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Catar , Inquéritos e Questionários
12.
Rev Bras Enferm ; 72(suppl 3): 204-211, 2019 Dec.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31851255

RESUMO

OBJECTIVE: to analyze the prenatal follow-up of high-risk pregnancy in the public service. METHOD: an analytical cross-sectional study carried out in a public maternity hospital in the South of Brazil, during the hospitalization of 319 postpartum women using a semi-structured tool for transcription of the prenatal card records and interview. The data were analyzed using the Chi-Square test (p≤0.05). RESULTS: the adequacy of prenatal care was high (74%); 22.6% intermediate; 3.4% inefficient. Prenatal care had high coverage (100%), early onset (81.5%) and six or more visits (92.4%), but (77.4%) did not receive information about gestational disease and examinations (69.3%). There was statistical significance between the quality of prenatal care and the place of prenatal care (p=0.005). CONCLUSION: the need to implement a specific protocol for high-risk gestation and continuous education to the teams was evidenced.


Assuntos
Assistência ao Convalescente/tendências , Gravidez de Alto Risco/psicologia , Cuidado Pré-Natal/tendências , Assistência ao Convalescente/métodos , Assistência ao Convalescente/psicologia , Brasil , Distribuição de Qui-Quadrado , Estudos Transversais , Feminino , Maternidades/organização & administração , Maternidades/estatística & dados numéricos , Humanos , Gravidez , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/psicologia , Setor Público/estatística & dados numéricos
13.
Acta Med Port ; 32(11): 697-705, 2019 Nov 04.
Artigo em Português | MEDLINE | ID: mdl-31703182

RESUMO

INTRODUCTION: The aim of this study is to characterize and assess work-family balance within the medical profession in Portugal. MATERIAL AND METHODS: This cross-sectional and exploratory study analyzed a sample of 181 doctors who are members of the Portuguese Catholic Doctors' Association. A qualitative survey with multiple-choice questions was applied in order to assess socioeconomic and working conditions as well as work-family balance. Descriptive and linear regression analyses were carried out. RESULTS: Nearly 40% of the surveyed doctors negatively assessed the work-family balance within the private sector. As for the Portuguese National Health System, 73% negatively assessed the work-family balance within the public sector. More than half of those surveyed (56%) worked more hours than what they considered as harmful for their work-family balance and the vast majority was working at the limit or overtime. Data collected enabled us to associate a heavier workload with working in the emergency room, age and men. Moreover, it was observed that working more hours was not linked to having children or being married. DISCUSSION: In our study, the three measures of work-family balance that the participants considered to be the most important were the possibility of flexible scheduling, part-time work and temporarily reducing working hours (e.g. for family assistance). These aspects may explain the differences found in the assessment of work-family balance between the public and private sector. CONCLUSION: Due to the demanding nature of the medical profession, doctors are placed into a particularly risky situation in order to achieve a suitable work-family balance. The results of our study indicate a general dissatisfaction regarding this balance - special in the public sector - which is mainly associated with excessive weekly working hours.


Assuntos
Médicos/estatística & dados numéricos , Equilíbrio Trabalho-Vida , Adulto , Fatores Etários , Idoso , Estudos Transversais , Feminino , Humanos , Satisfação no Emprego , Modelos Lineares , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Médicas/psicologia , Médicas/estatística & dados numéricos , Portugal , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Pesquisa Qualitativa , Fatores Sexuais , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Tolerância ao Trabalho Programado , Equilíbrio Trabalho-Vida/estatística & dados numéricos , Carga de Trabalho/psicologia , Carga de Trabalho/estatística & dados numéricos
14.
Pan Afr Med J ; 34: 16, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31762885

RESUMO

Introduction: Do health facilities (HF) have basic resources needed to manage malaria? The purpose of our study was to analyze the operational capacity (OC) of first-line health facilities in Ivory Coast in the management of malaria. Methods: SARA methodology was used to conduct a descriptive cross-sectional study from 10 to 30 July 2016. The operational capacity in the management showed an average availability of 9 identification tracers divided in 3 areas: (i) staff and guidelines; (ii) capacity of diagnosis; (iii) drugs and products. This operational capacity was assessed through the calculation of an index and then compared with the health facilities according to the management authority and the geographical area using Chi-square test with p-values α fixed at 0.05. Results: Out of 818 HFs, 651(79.6%) were in the public sector and 487(59.5%) were located in the rural area. The operational capacity of first line health facilities was 74.5%. This OC was higher in the public sector (81.3%) than in the private sector (48.8%) (p < 10-3) as well as in the rural area (82.7%) compared to the urban area (62.9%) (p < 10-3). Conclusion: In 2016, first line health facilities in Ivory Coast had basic resources needed to manage malaria. It is necessary to focus on the need to strengthen health facility services in addition to prevention.


Assuntos
Assistência à Saúde/organização & administração , Instalações de Saúde/estatística & dados numéricos , Malária/terapia , Antimaláricos/administração & dosagem , Costa do Marfim , Estudos Transversais , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos
15.
Pan Afr Med J ; 34: 60, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31762925

RESUMO

Introduction: Approximately two-thirds of the world's population has no access to diagnostic imaging. Basic radiological services should be integral to universal health coverage. The World Health Organization postulates that one basic X-ray and ultrasound unit for every 50000 people will meet 90% of global imaging needs. However, there are limited country-level data on radiological resources, and little appreciation of how such data reflect access and equity within a healthcare system. The aim of this study was a detailed analysis of licensed Zimbabwean radiological equipment resources. Methods: The equipment database of the Radiation Protection Authority of Zimbabwe was interrogated. Resources were quantified as units/million people and compared by imaging modality, geographical region and healthcare sector. Zimbabwean resources were compared with published South African and Tanzanian data. Results: Public-sector access to X-ray units (11/106 people) is approximately half the WHO recommendation (20/106 people), and there exists a 5-fold disparity between the least- and best-resourced regions. Private-sector exceeds public-sector access by 16-fold. More than half Zimbabwe's radiology equipment (215/380 units, 57%) is in two cities, serving one-fifth of the population. Almost two-thirds of all units (243/380, 64%) are in the private sector, routinely accessible by approximately 10% of the population. Southern African country-level public-sector imaging resources broadly reflect national per capita healthcare expenditure. Conclusion: There exists an overall shortfall in basic radiological equipment resources in Zimbabwe, and inequitable distribution of existing resources. The national radiology equipment register can reflect access and equity in a healthcare system, while providing medium-term radiological planning data.


Assuntos
Equipamentos e Provisões/provisão & distribução , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Radiografia/instrumentação , Humanos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Cobertura Universal do Seguro de Saúde , Zimbábue
16.
S Afr Med J ; 109(10): 761-764, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635574

RESUMO

BACKGROUND: The Bachelor of Clinical Medical Practice (BCMP) programme was introduced in South Africa as a strategy to fill human resource gaps in both the public sector and rural communities. A previous study explored the practice intentions of BCMP students from one university prior to graduation. OBJECTIVES: To determine whether the actual practice choices of these BCMP graduates reflect their practice intentions. METHODS: A cross-sectional analytical study invited all graduates from the four cohorts of BCMP graduates (N=250) who graduated during the period 2011 - 2014 to complete an online survey. Data were exported and analysed using Stata 13. Chi-square tests of independence were done to explore associations in the data. RESULTS: More than 80% of participants were currently employed in the public sector, with over 50% in rural settings. Factors such as where clinical associates spent most of their lives (i.e. where they were born and raised) and bursary obligations influenced their current practice choices. There was no association between gender and rural practice choice. Intention to emigrate was not associated with origin, gender or race. Almost 90% of participants indicated an interest in furthering their studies; 46% of these intended a change in career, with 65% interested in studying medicine. CONCLUSIONS: The practice choices of the first four cohorts of this degree were similar to their intended practice choices. Although the policy intentions of public sector employment and rural practice have been met, it is not clear what will happen once bursary obligations are fulfilled. The reasons for increased intentions to change career need further research, as a change of career would countermand gains achieved in implementing the policy.


Assuntos
Pessoal de Saúde/organização & administração , Setor Público/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Estudantes de Ciências da Saúde/estatística & dados numéricos , Adulto , Escolha da Profissão , Estudos Transversais , Feminino , Humanos , Intenção , Masculino , África do Sul , Inquéritos e Questionários , Adulto Jovem
17.
Psicothema ; 31(4): 351-362, 2019 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-31634079

RESUMO

Research Ranking of Spanish Public Universities (2019). BACKGROUND: The changes produced in the Spanish university system due to the Bologna process require periodically updated evaluation reports of research activity. The objective of this study is to update the last available ranking of Spanish public universities, based on data from 2013-2018. METHOD: The production and productivity of each university were assessed based on seven specific indicators and a global score: articles in journals indexed in the JCR (Journal Citation Reports), research periods, R+D projects, doctoral theses, FPU (training of university professors) grants, FPI (training of personal researchers) grants, and patents. RESULTS: Globally, the universities Complutense of Madrid, Barcelona, and Granada hold the first positions in terms of production, while the first positions in terms of productivity are held by the universities Pompeu Fabra, Autonomous of Madrid, and Autonomous of Barcelona. CONCLUSIONS: The universities that hold the top positions in this ranking remain relatively steady over time and are also the Spanish universities that stand out in international classifications.


Assuntos
Eficiência Organizacional/classificação , Setor Público/classificação , Pesquisa/classificação , Universidades/classificação , Indexação e Redação de Resumos/estatística & dados numéricos , Dissertações Acadêmicas como Assunto , Bibliometria , Eficiência Organizacional/estatística & dados numéricos , Docentes/educação , Organização do Financiamento/classificação , Organização do Financiamento/estatística & dados numéricos , Humanos , Patentes como Assunto/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Pesquisa/estatística & dados numéricos , Universidades/estatística & dados numéricos
18.
Salud Publica Mex ; 61(5): 637-647, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31661741

RESUMO

OBJECTIVE: This study aimed to compare the performance in the National Assessment for Applicants for Medical Resi- dency (ENARM in spanish) of private versus public medical schools, geographic regions and socioeconomic levels by using three different statistical methods (summary measurements, the rate of change and the area under the receiver operator characteristics [AUROC]). These methods have not been previously used for the ENARM; however, some variations of the summary measurements have been reported in some USA assessments of medical school graduates. MATERIALS AND METHODS: Cross-sectional study based on historical data (2001-2017). We use summary measures and colourfilled map. The statistical analysis included Mann-Whitney U, Kruskal-Wallis, Spearman correlation coefficient (Rs), and linear regression. RESULTS: A total of 113 medical schools were included in our analysis; 60 were public and 53 private. We found difference in the median of total scores for type of schools, MD= 54.07 vs. MD= 57.36, p= 0.011. There were also significant differences among geographic and socioeconomic regions (p<0.05). CONCLUSIONS: Differences exist in the total scores and percentage of selected test-takers between type of schools, geographic and socioeconomic regions. Higher scores are prevalent in the Northeast and Norwest regions. Additional research is required to identify factors that contribute to these differences. Unsuspected differences in examination scores can be unveiled using summary measures.


Assuntos
Avaliação Educacional/estatística & dados numéricos , Internato e Residência/estatística & dados numéricos , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Faculdades de Medicina/estatística & dados numéricos , Área Sob a Curva , Humanos , México , Curva ROC , Faculdades de Medicina/provisão & distribução , Fatores Socioeconômicos , Estatísticas não Paramétricas
19.
BMJ ; 367: l5766, 2019 10 23.
Artigo em Inglês | MEDLINE | ID: mdl-31645328

RESUMO

OBJECTIVE: To determine the extent to which late stage development of new drugs relies on support from public funding. DESIGN: Cohort study. SETTING: All new drugs containing one or more new molecular entities approved by the US Food and Drug Administration (FDA) between January 2008 and December 2017 via the new drug application pathway. MAIN OUTCOME MEASURES: Patents or drug development histories documenting late stage research contributions by a public sector research institution or a spin-off company, as well as each drug's regulatory approval pathway and first-in-class designation. RESULTS: Over the 10 year study period, the FDA approved 248 drugs containing one or more new molecular entities. Of these drugs, 48 (19%) had origins in publicly supported research and development and 14 (6%) originated in companies spun off from a publicly supported research program. Drugs in these groups were more likely to receive expedited FDA approval (68% v 47%, P=0.005) or be designated first in class (45% v 26%, P=0.007), indicating therapeutic importance. CONCLUSIONS: A review of the patents associated with new drugs approved over the past decade indicates that publicly supported research had a major role in the late stage development of at least one in four new drugs, either through direct funding of late stage research or through spin-off companies created from public sector research institutions. These findings could have implications for policy makers in determining fair prices and revenue flows for these products.


Assuntos
Ensaios Clínicos como Assunto/economia , Aprovação de Drogas/economia , Setor Público/economia , Pesquisa Médica Translacional/economia , Ensaios Clínicos como Assunto/estatística & dados numéricos , Estudos de Coortes , Aprovação de Drogas/legislação & jurisprudência , Aprovação de Drogas/estatística & dados numéricos , Humanos , Patentes como Assunto/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Pesquisa Médica Translacional/estatística & dados numéricos , Estados Unidos , United States Food and Drug Administration/legislação & jurisprudência , United States Food and Drug Administration/estatística & dados numéricos
20.
Int J Tuberc Lung Dis ; 23(10): 1090-1099, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31627774

RESUMO

BACKGROUND: India accounts for 27% of global childhood tuberculosis (TB) burden. Understanding barriers to early diagnosis and treatment in children may improve care and outcomes.METHODS: A cross-sectional study was performed among 89 children initiated on anti-TB treatment from a public hospital in Pune during 2016, using a structured questionnaire and hospital records. Health care providers (HCPs) were defined as medical personnel consulted about the child's TB symptoms. Time-to-treatment initiation (TTI) was defined as the number of days between onset of TB symptoms and anti-TB treatment initiation. Based on Revised National TB Control Programme recommendations, delayed TTI was defined as >28 days.RESULTS: Sixty-seven (75%) of 89 enrolled children had significant TTI delays (median 51 days, interquartile range [IQR] 27-86). Sixty-six (74%) children visited 1-8 HCPs in the private sector before approaching the public sector. The median HCP delay was 28 days (IQR 10-75). Bacille Calmette-Guérin vaccination (aOR 10.96, P = 0.04) and loss of appetite (aOR 4.44, P = 0.04) were associated with delayed TTI.CONCLUSION: The majority of the children had TTI delays due to delays by HCPs in the private sector. Strengthening HCP competency in TB symptom screening and encouraging early referrals are crucial for rapid scaling up of early treatment initiation in childhood TB.


Assuntos
Antituberculosos/administração & dosagem , Vacina BCG/administração & dosagem , Programas de Rastreamento/estatística & dados numéricos , Tuberculose/diagnóstico , Adolescente , Adulto , Criança , Pré-Escolar , Estudos Transversais , Diagnóstico Tardio , Feminino , Humanos , Índia , Lactente , Masculino , Setor Privado/estatística & dados numéricos , Setor Público/estatística & dados numéricos , Tempo para o Tratamento , Tuberculose/tratamento farmacológico , Adulto Jovem
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