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1.
Int J Equity Health ; 20(1): 77, 2021 03 15.
Artigo em Inglês | MEDLINE | ID: mdl-33722225

RESUMO

Global response to COVID-19 pandemic has inadvertently undermined the achievement of existing public health priorities and laregely overlooked local context. Recent evidence suggests that this will cause additional maternal and childhood mortality and morbidity especially in low- and middle-income countries (LMICs). Here we have explored the contextual factors influencing maternal, neonatal and children health (MNCH) care in Bangladesh, Nigeria and South Africa amidst the pandemic. Our findings suggest that between March and May 2020, there was a reduction in utilisation of basic essential MNCH services such as antenatal care, family planning and immunization due to: a) the implementation of lockdown which triggered fear of contracting the COVID-19 and deterred people from accessing basic MNCH care, and b) a shift of focus towards pandemic, causing the detriment to other health services, and c) resource constraints. Taken together these issues have resulted in compromised provision of basic general healthcare. Given the likelihood of recurrent waves of the pandemic globally, COVID-19 mitigation plans therefore should be integrated with standard care provision to enhance system resilience to cope with all health needs. This commentary suggests a four-point contextualised mitigation plan to safeguard MNCH care during the pandemic using the observed countries as exemplars for LMIC health system adaptations to maintain the trajectory of progress regarding sustainable development goals (SDGs).


Assuntos
/prevenção & controle , Serviços de Saúde da Criança , Controle de Doenças Transmissíveis/métodos , Utilização de Instalações e Serviços/tendências , Serviços de Saúde Materna , Adulto , Bangladesh , Criança , Países em Desenvolvimento , Feminino , Humanos , Nigéria , Gravidez , Saúde Pública/legislação & jurisprudência , Quarentena/legislação & jurisprudência , África do Sul , Populações Vulneráveis
2.
Ann Acad Med Singap ; 50(2): 126-134, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33733255

RESUMO

INTRODUCTION: We evaluated the impact of public health measures on paediatric emergency department attendances during the COVID-19 and severe acute respiratory syndrome (SARS) outbreaks in Singapore. METHODS: Between 1 January 2020 and 31 July 2020, we retrospectively reviewed paediatric emergency department attendances and admissions in a tertiary paediatric hospital in Singapore before and after a national lockdown to combat the spread of COVID-19 in Singapore. Hospital attendances and admissions were compared with data from a corresponding period in 2019 (1 January 2019 to 31 July 2019), as well as during and after the SARS outbreak (1 January 2003 to 31 December 2004). RESULTS: Compared with a corresponding non-outbreak period, emergency department attendances decreased in line with nationwide public health measures during the COVID-19 and SARS outbreaks (2020 and 2003 respectively), before increasing gradually following lifting of restrictions, albeit not to recorded levels before these outbreaks. During the COVID-19 outbreak, mean daily attendances decreased by 40%, from 458 per day in January-July 2019, to 274 per day in January-July 2020. The absolute number of hospital inpatient admissions decreased by 37% from January-July 2019 (19,629) to January-July 2020 (12,304). The proportion of emergency department attendances requiring admission remained similar: 20% in January-July 2019 and 21% in January-July 2020. CONCLUSION: Nationwide public health measures in Singapore have had an impact on paediatric emergency department attendances and hospital inpatient admissions. Data from this study could inform planning and resource allocation for emergency departments in Singapore and internationally.


Assuntos
Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Síndrome Respiratória Aguda Grave , Adolescente , /prevenção & controle , Criança , Pré-Escolar , Surtos de Doenças , Feminino , Política de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Admissão do Paciente/tendências , Pediatria , Estudos Retrospectivos , Síndrome Respiratória Aguda Grave/epidemiologia , Singapura/epidemiologia
4.
Australas Psychiatry ; 29(2): 194-199, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33626304

RESUMO

OBJECTIVE: The Australian federal government introduced new COVID-19 psychiatrist Medicare Benefits Schedule (MBS) telehealth items to assist with providing private specialist care. We investigate private psychiatrists' uptake of video and telephone telehealth, as well as total (telehealth and face-to-face) consultations for Quarter 3 (July-September), 2020. We compare these to the same quarter in 2019. METHOD: MBS-item service data were extracted for COVID-19-psychiatrist video and telephone telehealth item numbers and compared with Quarter 3 (July-September), 2019, of face-to-face consultations for the whole of Australia. RESULTS: The number of psychiatry consultations (telehealth and face-to-face) rose during the first wave of the pandemic in Quarter 3, 2020, by 14% compared to Quarter 3, 2019, with telehealth 43% of this total. Face-to-face consultations in Quarter 3, 2020 were only 64% of the comparative number of Quarter 3, 2019 consultations. Most telehealth involved short telephone consultations of ⩽15-30 min. Video consultations comprised 42% of total telehealth provision: these were for new patient assessments and longer consultations. These figures represent increased face-to-face consultation compared to Quarter 2, 2020, with substantial maintenance of telehealth consultations. CONCLUSIONS: Private psychiatrists continued using the new COVID-19 MBS telehealth items for Quarter 3, 2020 to increase the number of patient care contacts in the context of decreased face-to-face consultations compared to 2019, but increased face-to-face consultations compared to Quarter 2, 2020.


Assuntos
/prevenção & controle , Transtornos Mentais/terapia , Serviços de Saúde Mental/tendências , Padrões de Prática Médica/tendências , Prática Privada/tendências , Psiquiatria/tendências , Telemedicina/tendências , Assistência Ambulatorial/métodos , Assistência Ambulatorial/organização & administração , Assistência Ambulatorial/tendências , Austrália , Utilização de Instalações e Serviços/tendências , Acesso aos Serviços de Saúde/organização & administração , Acesso aos Serviços de Saúde/tendências , Humanos , Serviços de Saúde Mental/organização & administração , Programas Nacionais de Saúde , Pandemias , Padrões de Prática Médica/organização & administração , Prática Privada/organização & administração , Psiquiatria/organização & administração , Telemedicina/métodos , Telemedicina/organização & administração , Telefone/tendências , Comunicação por Videoconferência/tendências
6.
Med Care ; 59(1): 58-61, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33136711

RESUMO

BACKGROUND: During the COVID-19 pandemic, there is concern that social distancing, fear of contagion, quarantining of providers, cancellation of elective procedures, media coverage about the pandemic, and other factors drastically reduced physician visits, putting severe financial strain on outpatient providers, and having unknown ramifications for health outcomes. OBJECTIVES: We estimate the effect of the pandemic on utilization of outpatient services. RESEARCH DESIGN: Using 2010-2020 data from a national dataset, the Outpatient Influenza-like Illness Surveillance Network, we estimate the difference in outpatient care utilization during the time period of the COVID-19 pandemic versus the same weeks in prior years. RESULTS: Our findings indicate that the pandemic started to reduce visits during the week of March 15-21. The effect on visits grew until reaching a peak during the week of April 5-11, 2020, when the pandemic reduced the total number of outpatient visits per provider by 70% relative to the same week in prior years. We find negative effects of the pandemic on visits for non-flu symptoms as well as on visits for flu symptoms, but the magnitudes of these latter effects tended to be larger in magnitude. The pandemic's impact declined over time, and by the week of June 28 to July 4, 2020, there was no longer any difference in total visits per provider relative to the same week in prior years. Despite the resurgence of COVID-19 in June and July, we still find no effects on total visits when our data end in July 26 to August 1, 2020. CONCLUSIONS: Our findings show that one by-product of the COVID-19 pandemic in the United States is a large decline in the use of outpatient care which peaked around the week of April 5-11. Total outpatient visits rebounded completely and remain stable as of July 26 to August 1, 2020.


Assuntos
Assistência Ambulatorial/tendências , Utilização de Instalações e Serviços/tendências , Padrões de Prática Médica/tendências , Humanos , Estados Unidos
7.
Mayo Clin Proc ; 95(11): 2395-2407, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-33153630

RESUMO

OBJECTIVE: To quantify the impact of the severe acute respiratory syndrome coronavirus 2 pandemic on emergency department volumes and patient presentations and evaluate changes in community mortality for the purpose of characterizing new patterns of emergency care use. PATIENTS AND METHODS: This is an observational cross-sectional study using electronic health records for emergency department visits in an integrated multihospital system with academic and community practices across 4 states for visits between March 17 and April 21, 2019, and February 9 and April 21, 2020. We compared numbers and proportions of common and critical chief symptoms and diagnoses, triage assessments, throughput, disposition, and selected hospital lengths of stay and out-of-hospital deaths. RESULTS: In the period of interest, emergency department visits decreased by nearly 50% (35037 to 18646). Total numbers of patients with myocardial infarctions, stroke, appendicitis, and cholecystitis diagnosed decreased. The percentage of visits for mental health symptoms increased. There was an increase in deaths, driven by out-of-hospital mortality. CONCLUSION: Fewer patients presenting with acute and time-sensitive diagnoses suggests that patients are deferring care. This may be further supported by an increase in out-of-hospital mortality. Understanding which patients are deferring care and why will allow us to develop outreach strategies and ensure that those in need of rapid assessment and treatment will do so, preventing downstream morbidity and mortality.


Assuntos
Infecções por Coronavirus , Prestação Integrada de Cuidados de Saúde/tendências , Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Pandemias , Pneumonia Viral , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mortalidade/tendências , Estados Unidos , Adulto Jovem
8.
BMC Pediatr ; 20(1): 427, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894080

RESUMO

BACKGROUND: The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. Little is known on the effect of the pandemic on pediatric and adolescent medicine. We examined the impact of the pandemic on pediatric emergency healthcare utilization. METHODS: We conducted a monocentric, retrospective analysis of n = 5,424 pediatric emergency department visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization during the pandemic in 2020 to the same period in 2019. RESULTS: In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ± SEM 1.5 in 2019 vs. 9.7 ± SEM 1 in 2020, p < 0.005). This drop in cases occurred for both communicable and non-communicable diseases. A larger proportion of patients under one year old (daily mean of 16.6% ±SEM 1.4 in 2019 vs. 23.1% ±SEM 1.7 in 2020, p < 0.01) and of cases requiring hospitalisation (mean of 13.9% ±SEM 1.6 in 2019 vs. 26.6% ±SEM 3.3 in 2020, p < 0.001) occurred during the pandemic. During the analysed time periods, few intensive care admissions and no fatalities occurred. CONCLUSIONS: Our data illustrate a significant decrease in pediatric emergency department visits during the COVID-19 pandemic. Public outreach is needed to encourage parents and guardians to seek medical attention for pediatric emergencies in spite of the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Acesso aos Serviços de Saúde/tendências , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral , Adolescente , Criança , Pré-Escolar , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Feminino , Alemanha , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Estudos Retrospectivos
9.
PLoS One ; 15(9): e0239722, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32976544

RESUMO

BACKGROUND: Pakistan and other developing countries need to address disparities in maternal health care and factors associated with it. This justifies tracking the progress on two important indicators 'spousal violence' and 'maternal health care utilization' to improve maternal health and achieve Sustainable Development Goals (SDGs) for these nations. OBJECTIVE: The objective of this study is to compare the data from the latest two Demographic Health Surveys of Pakistan to identify trends in prevalence of various forms of spousal violence and maternal healthcare utilization and to determine the predictive role of spousal violence in poor maternal health. METHODS: We conducted a retrospective analysis of nationally representative data from the 2012-13 and 2017-18 PDHS. The data used in this analysis is from the domestic violence module and core women's questionnaire. Spousal violence and sociodemographic background were predictor variables. Terminated pregnancy, number of pregnancy losses, number of antenatal visits for last birth and institutional delivery for last birth were taken as indicators of maternal health. Logistic regression analysis was conducted to test for association between maternal health indicators and various forms of spousal violence after controlling for sociodemographic variables. RESULTS: Almost one quarter of women experienced physical and emotional violence as revealed by both surveys. Binary analysis revealed that all forms of spousal violence significantly associate with maternal health variables in both surveys. The comparison of results on logistic regression analysis showed that odd ratios were relatively higher for 2012-13 as compared to 2017-18 PDHS. Logistic regression analysis from 2017-18 data showed that experience of less severe physical violence (OR = 1.26; 95% CI, 1.08-1.47), severe physical violence (OR = 1.41; 95% CI, 1.09-1.83), sexual violence (OR = 1.39; 95% CI, 1.02-1.89), physical violence during pregnancy (OR = 1.37; 95% CI, 1.07-1.76) augment the risk of terminated pregnancy. Emotional violence decreases the likelihood for institutional delivery (OR = 0.64; 95% CI, 0.45-0.93) and above than four antenatal visits (OR = 0.54; 95% CI, 0.37-0.79). CONCLUSIONS: Strategies to prevent spousal violence should be at the core of maternal health programs because health sector provides a platform to challenge social norms and promote attitudes that disapprove spousal violence which are essential for promoting gender equality, women empowerment (SDG 3) and improve maternal health (SDG 5).


Assuntos
Utilização de Instalações e Serviços/tendências , Serviços de Saúde Materna/estatística & dados numéricos , Maus-Tratos Conjugais/estatística & dados numéricos , Adolescente , Adulto , Demografia/estatística & dados numéricos , Feminino , Humanos , Pessoa de Meia-Idade , Paquistão , Fatores Socioeconômicos
10.
Emerg Infect Dis ; 26(11): 2709-2712, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32917293

RESUMO

Coronavirus disease has disrupted tuberculosis services globally. Data from 33 centers in 16 countries on 5 continents showed that attendance at tuberculosis centers was lower during the first 4 months of the pandemic in 2020 than for the same period in 2019. Resources are needed to ensure tuberculosis care continuity during the pandemic.


Assuntos
Continuidade da Assistência ao Paciente/tendências , Infecções por Coronavirus/epidemiologia , Utilização de Instalações e Serviços/tendências , Saúde Global/tendências , Pneumonia Viral/epidemiologia , Tuberculose/terapia , Betacoronavirus , Humanos , Pandemias , Tuberculose/epidemiologia
12.
An Pediatr (Barc) ; 93(5): 313-322, 2020 Nov.
Artigo em Espanhol | MEDLINE | ID: mdl-32800720

RESUMO

INTRODUCTION: SARS-CoV-2, coronavirus that causes coronavirus disease 2019 (COVID-19), was first detected in Spain on 31 January 2020. On 14 March 2020, a state of emergency was declared in Spain in a bid to control the spread of the COVID-19 pandemic in the country. The aim of our study is to analyse the impact on emergency medicine attendance after the national lockdown, as well as the clinical presentation and the management of patients with suspected COVID-19 in the Paediatric Emergency Department. PATIENTS AND METHODS: This retrospective observational study included children and adolescents under the age of 18, attended in our Paediatric Emergency Department during the period March 14 to April 17, 2020. RESULTS: A total of 1,666 patients were attended during the study period, 65.4% less than in the same period of 2019. Just over half (51.2%) were males, and mean age was 5.4 years. In triage, 39.9% were high priority levels, 6.5% more than 2019. Most frequent reasons for consultation at the Paediatric Emergency Department were fever (26.5%), respiratory symptoms (16.1%), and trauma (15.2%). A total of 218 patients (13%) received a diagnosis of possible COVID-19, with SARS-CoV-2 infection confirmed in 18.4%, and 23.8% (52/218) were hospitalised. At discharge, 44% (96/218) were diagnosed with lower, and 33.9% (74/218) with upper respiratory infection. CONCLUSIONS: During the SARS-CoV-2 outbreak, the demand for urgent paediatric care decreased, with the proportion of cases with high priority triage levels increasing. Most of the patients with suspected or microbiological confirmation of COVID-19 had mild respiratory symptoms.


Assuntos
Infecções por Coronavirus , Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Hospitais Pediátricos/tendências , Pandemias , Pneumonia Viral , Adolescente , Betacoronavirus , Criança , Pré-Escolar , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/terapia , Feminino , Alocação de Recursos para a Atenção à Saúde , Política de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/terapia , Estudos Retrospectivos , Espanha/epidemiologia , Triagem
13.
Mayo Clin Proc ; 95(8): 1704-1708, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32753143

RESUMO

On March 11, 2020, the World Health Organization declared the coronavirus disease 2019 (COVID-19) a pandemic, and in the weeks following, public health organizations, medical associations, and governing bodies throughout the world recommended limiting contact with others to "flatten the curve" of COVID-19. Although both ischemic and hemorrhagic strokes have been reported with COVID-19, there has been anecdotal suggestion of an overall decrease in stroke admissions. To date, the effects of any pandemic on telestroke service lines have not been described. The purpose of this cross-sectional analysis of telestroke activations in the 30 days before and after the declaration of the COVID-19 pandemic is to describe the difference in case volumes of telestroke activations, the characteristics of patients, and treatment recommendations between the 2 time frames. We found a 50.0% reduction in total telestroke activations between the predeclaration group (142 patients) and the postdeclaration group (71 patients). There were no statistically significant differences in age (P=.95), sex (P=.10), diagnosis (P=.26), or regional variations (P=.08) in activation volumes. The percentage of patients for whom we recommended urgent stroke treatment with intravenous alteplase, mechanical thrombectomy, or both decreased from 44.4% (28 of 63) to 33.3% (11 of 33). The reasons for the sunstantial decrease in telestroke activations and urgent stroke treatment recommendations are likely multifactorial but nevertheless underscore the importance of continued public health measures to encourage patients and families to seek emergency medical care at the time of symptom onset.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Utilização de Instalações e Serviços/tendências , Pandemias , Pneumonia Viral , Padrões de Prática Médica/tendências , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Telemedicina/tendências , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Acidente Vascular Cerebral/epidemiologia , Estados Unidos/epidemiologia
14.
MMWR Morb Mortal Wkly Rep ; 69(25): 795-800, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32584802

RESUMO

On March 13, 2020, the United States declared a national emergency in response to the coronavirus disease 2019 (COVID-19) pandemic. Subsequently, states enacted stay-at-home orders to slow the spread of SARS-CoV-2, the virus that causes COVID-19, and reduce the burden on the U.S. health care system. CDC* and the Centers for Medicare & Medicaid Services (CMS)† recommended that health care systems prioritize urgent visits and delay elective care to mitigate the spread of COVID-19 in health care settings. By May 2020, national syndromic surveillance data found that emergency department (ED) visits had declined 42% during the early months of the pandemic (1). This report describes trends in ED visits for three acute life-threatening health conditions (myocardial infarction [MI, also known as heart attack], stroke, and hyperglycemic crisis), immediately before and after declaration of the COVID-19 pandemic as a national emergency. These conditions represent acute events that always necessitate immediate emergency care, even during a public health emergency such as the COVID-19 pandemic. In the 10 weeks following the emergency declaration (March 15-May 23, 2020), ED visits declined 23% for MI, 20% for stroke, and 10% for hyperglycemic crisis, compared with the preceding 10-week period (January 5-March 14, 2020). EDs play a critical role in diagnosing and treating life-threatening conditions that might result in serious disability or death. Persons experiencing signs or symptoms of serious illness, such as severe chest pain, sudden or partial loss of motor function, altered mental state, signs of extreme hyperglycemia, or other life-threatening issues, should seek immediate emergency care, regardless of the pandemic. Clear, frequent, highly visible communication from public health and health care professionals is needed to reinforce the importance of timely care for medical emergencies and to assure the public that EDs are implementing infection prevention and control guidelines that help ensure the safety of their patients and health care personnel.


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/tendências , Hiperglicemia/terapia , Infarto do Miocárdio/terapia , Pandemias , Pneumonia Viral/epidemiologia , Acidente Vascular Cerebral/terapia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos/epidemiologia , Adulto Jovem
15.
Ann Plast Surg ; 85(2S Suppl 2): S161-S165, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32501839

RESUMO

BACKGROUND: The COVID-19 crisis has brought many unique challenges to the health care system. Across the United States, social distancing measures have been put in place, including stay-at-home (SAH) orders, to combat the spread of this infection. This has impacted the type and volume of traumatic injuries sustained during this time. Meanwhile, steps have been taken in our health care system to assure that adequate resources are available to maintain a high standard of patient care while recognizing the importance of protecting health care providers. Using comparative data, we aim to describe the trends in traumatic injuries managed by our plastic surgery service and detail the changes in consultation policies made to minimize provider exposure. METHODS: A retrospective chart review was performed of all plastic surgery emergencies at our institution during the 3 weeks preceding the issuance of SAH orders in Chicago and the 3 weeks after. The electronic medical record was queried for patient age, type and mechanism of injury, location where injury was sustained, presence of domestic violence, length of inpatient hospital stays, and treatment rendered. The two 3-week periods were then comparatively analyzed to determine differences and trends in these variables and treatment rendered. The 2 periods were then comparatively analyzed to determine differences and trends in these variables. RESULTS: There was a significant decrease in trauma consults since the issuance of SAH (88 pre-SAH vs 62 post-SAH) with a marked decrease in trauma-related hand injuries. There was an increase in the percentage of assault-related injuries including those associated with domestic violence, whereas there was an overall decrease in motor vehicle collisions. There was no notable change in the location where injuries were sustained. Significantly fewer patients were seen by house staff in the emergency room, whereas those requiring surgical intervention were able to receive care without delay. CONCLUSIONS: Stay-at-home orders in Chicago have impacted traumatic injury patterns seen by the Section of Plastic and Reconstructive Surgery at a level I Trauma Center. Safe and timely care can continue to be provided with thorough communication, vigilance, and guidance from our colleagues.


Assuntos
Betacoronavirus , Infecções por Coronavirus/prevenção & controle , Utilização de Instalações e Serviços/tendências , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Procedimentos Cirúrgicos Reconstrutivos/tendências , Centros de Traumatologia/tendências , Ferimentos e Lesões/cirurgia , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Chicago/epidemiologia , Criança , Pré-Escolar , Protocolos Clínicos , Emergências , Feminino , Política de Saúde , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Centro Cirúrgico Hospitalar , Estados Unidos , Ferimentos e Lesões/diagnóstico , Ferimentos e Lesões/epidemiologia , Ferimentos e Lesões/etiologia , Adulto Jovem
16.
Eur Heart J Acute Cardiovasc Care ; 9(3): 222-228, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-32375487

RESUMO

Hospitals play a critical role in providing communities with essential medical care during all types of disaster. Depending on their scope and nature, disasters can lead to a rapidly increasing service demand that can overwhelm the functional capacity and safety of hospitals and the healthcare system at large. Planning during the community outbreak of coronavirus disease 2019 (Covid-19) is critical for maintaining healthcare services during our response. This paper describes, besides general measures in times of a pandemic, also the necessary changes in the invasive diagnosis and treatment of patients presenting with different entities of acute coronary syndromes including structural adaptations (networks, spokes and hub centres) and therapeutic adjustments.


Assuntos
Síndrome Coronariana Aguda/epidemiologia , Betacoronavirus/isolamento & purificação , Infecções por Coronavirus/complicações , Serviço Hospitalar de Emergência/organização & administração , Pneumonia Viral/complicações , Síndrome Coronariana Aguda/diagnóstico , Síndrome Coronariana Aguda/terapia , Defesa Civil/organização & administração , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Assistência à Saúde/organização & administração , Assistência à Saúde/estatística & dados numéricos , Desastres , Surtos de Doenças/estatística & dados numéricos , Emergências/epidemiologia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Utilização de Instalações e Serviços/tendências , Hospitais , Humanos , Pandemias , Segurança , Capacidade de Resposta ante Emergências/estatística & dados numéricos
17.
BMC Health Serv Res ; 20(1): 274, 2020 Apr 01.
Artigo em Inglês | MEDLINE | ID: mdl-32238160

RESUMO

BACKGROUND: The "practice makes perfect" concept considers the more frequent a hospital performs a procedure, the better the outcome of the procedure. We aimed to study this concept by investigating whether patient outcomes improve in hospitals with a significantly increased volume of high-risk surgery over time and whether a learning effect existed at the individual hospital level. METHODS: We included all patients who underwent one of 10 digestive, cardiovascular and orthopaedic procedures between 2010 and 2014 from the French nationwide hospitals database. For each procedure, we identified three groups of hospitals according to volume trend (increased, decreased, or no change). In-hospital mortality, reoperation, and unplanned hospital readmission within 30 days were compared between groups using Cox regressions, taking into account clustering of patients within hospitals and potential confounders. Individual hospital learning effect was investigated by considering the interaction between hospital groups and procedure year. RESULTS: Over 5 years, 759,928 patients from 694 hospitals were analysed. Patients' mortality in hospitals with procedure volume increase or decrease over time did not clearly differ from those in hospitals with unchanged volume across the studied procedures (e.g., Hazard Ratios [95%] of 1.04 [0.93-1.17] and 1.08 [0.97-1.21] respectively for colectomy). Furthermore, patient outcomes did not improve or deteriorate in hospitals with increased or decreased volume of procedures over time (e.g., 1.01 [0.95-1.08] and 0.99 [0.92-1.05] respectively for colectomy). CONCLUSIONS: Trend in hospital volume over time did not appear to influence patient outcomes based on real-world data. TRIAL REGISTRATION: NCT02788331, June 2, 2016.


Assuntos
Utilização de Instalações e Serviços/tendências , Hospitais/estatística & dados numéricos , Avaliação de Resultados da Assistência ao Paciente , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Bases de Dados Factuais , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Medição de Risco
18.
Gac. sanit. (Barc., Ed. impr.) ; 33(6): 579-583, nov.-dic. 2019.
Artigo em Inglês | IBECS | ID: ibc-189854

RESUMO

A proper understanding of health is a social and political challenge, the modern social medicine approach to public health and health approaches more generally tend to minimise this, making the isolated individual the primary unit of health. Ivan Illich, social critic and philosopher, was at the forefront of arguing for a collective health approach and challenging medical hegemony. His theories of institutional counter-productivity, proportionality and his critique of the medical model which he argued was entrenched within an economics of scarcity are as relevant today as they were at their height of popularity, in the 1970s. Applying his analysis to current trends in health approaches I conclude, as did he, that beyond a certain institutional scale or intensity more medicine is making us sicker. Therefore public health requires a dramatic shift away from a focus on individual deficits, lifestyle diseases, behaviour change and health promotion approaches towards genuine community building and significant political investment in the health creation of local communities. Moreover, there is need for more resolute regulation of the marketplace to prevent the health-harming behaviours of industrial and other institutional interests, including public sector and third sector organisations engaged in institutional overreach


La sanidad, propiamente entendida, es un reto social y político. La medicina social moderna apunta a la salud pública y, por lo general, los enfoques sanitarios tienden a minimizar este hecho, convirtiendo a la persona aislada en la unidad primaria de la salud. Ivan Illich, crítico social y filósofo, encabezó el debate a favor de un enfoque basado en la sanidad colectiva y la lucha contra la hegemonía médica. Sus teorías sobre contraproductividad y proporcionalidad institucional, y su crítica sobre el modelo médico, del que argumentó que estaba arraigado en una economía de escasez, son relevantes hoy en día, al igual que lo eran en la cima de su popularidad, en los años 1970. Aplicando su análisis a las tendencias actuales, yo concluyo, como hizo él, que más allá de una cierta escala o intensidad institucional, el uso de más medicina nos vuelve más enfermos. Por ello, la sanidad pública requiere un cambio drástico, alejando su objetivo de los déficits individuales, las enfermedades relacionadas con el estilo de vida, los cambios de comportamiento y la promoción de la salud, centrándose en cambio en el desarrollo comunitario genuino y la inversión política en la creación de salud en las comunidades locales. Además, existe una necesidad de regular firmemente el mercado para evitar los comportamientos nocivos para la salud provenientes de los intereses industriales y demás instituciones, incluyendo el sector público y las organizaciones del tercer sector, implicadas en las extralimitaciones institucionales


Assuntos
Humanos , Eficiência Organizacional/tendências , Doença Iatrogênica/epidemiologia , Determinantes Sociais da Saúde/tendências , Erros Médicos/tendências , Filosofia Médica , Relações Interinstitucionais , Políticas Públicas de Saúde , Qualidade de Vida , Acesso aos Serviços de Saúde/tendências , Utilização de Instalações e Serviços/tendências , Isolamento Social/psicologia
19.
BMJ Open ; 9(11): e030844, 2019 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727653

RESUMO

OBJECTIVES: This paper aims to provide an estimate of the prevalence rate of autism spectrum disorder (ASD) in 8-year-olds in 2017 based on administrative databases and to investigate the change in healthcare service use during the healthcare transition age of 18. DESIGN: This research is based on a longitudinal retrospective cohort study. SETTING: The data is drawn from the Italian Administrative Healthcare Database (2010-2017). PARTICIPANTS: We identified 5607 ASD patients; 331 ASD patients from 2012 to 2015 in the calendar year of their 18th birthday were selected and their health service utilisation during a 5-year period-ranging from 2 years preceding and succeeding their 18th year-were investigated. INTERVENTIONS: None. PRIMARY AND SECONDARY OUTCOME MEASURES: Prevalence, incidence and proportion of ASD patients receiving specific healthcare services were included in the outcome measures. RESULTS: Prevalence of ASD at age 8 was 5.4/1000. Global access to health and social services was lower both before and after age 18 (46.5% at 16; 68.0% at 18; 54.1% at 20). The percentage of patients receiving a neuropsychiatric consultation decreased after age 18 (30.8% at 18; 5.4% at 20). Community mental health services (CMHS) utilisation rate increased above 18 years of age. Regarding psychiatric visits, for both outpatient and CMHS, an increase was observed from 17.8% at age 18 to 25.4% at age 20. The utilisation of rehabilitation services decreased with age, dropping from 17.8% at age 16 to 1.8% at age 20. Psychiatric outpatient services remained stable across ages at about 14%. CONCLUSION: Our findings suggest that ASD patients changed clinical reference services with age from neuropsychiatric and rehabilitative services towards psychiatric and community-based services as they transitioned from paediatric to adult healthcare services.


Assuntos
Transtorno do Espectro Autista/terapia , Utilização de Instalações e Serviços/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transição para Assistência do Adulto/tendências , Adolescente , Transtorno do Espectro Autista/epidemiologia , Transtorno do Espectro Autista/psicologia , Criança , Serviços de Saúde Comunitária/tendências , Bases de Dados Factuais , Feminino , Humanos , Itália/epidemiologia , Estudos Longitudinais , Masculino , Serviços de Saúde Mental/tendências , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Estudos Retrospectivos
20.
Psychiatry Res ; 282: 112622, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31733419

RESUMO

The aim of the study reported here was to assess whether the prevalence of mental health problems (MHP) among Dutch 19-24 year old adults increased in the past decade and/or whether the distribution of latent profiles of mental health problems changed over the years. For this purpose, data was extracted from the LISS panel, based on a representative national sample of the Dutch population. We focused on three exclusive groups who were 19-24 years old in 2007 (n = 383), 2012 (n = 351) or 2017 (n = 362). Multivariate logistic regression analyses showed that the 2012 and 2017 group did not have more MHP according to seven mental health-related indicators including mental health services utilization. Latent profile analysis identified 4 classes of MHP profiles, labeled "healthy" (82.2%), "at risk" (9.6%), "clinical" (4.2%) and "treatment" (3.9%). The 2007, 2012 and 2017 cohorts were equally distributed across these four classes. However, females had systematically more health problems than males and more often belonged to the "at risk", "clinical" and "treatment" class. In sum, our findings do not support concerns about an increase in MHP or that problems have become more complex among Dutch young adults over the past decade.


Assuntos
Utilização de Instalações e Serviços/tendências , Transtornos Mentais/epidemiologia , Serviços de Saúde Mental/estatística & dados numéricos , Saúde Mental/tendências , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Feminino , Nível de Saúde , Humanos , Modelos Logísticos , Masculino , Países Baixos/epidemiologia , Prevalência , Adulto Jovem
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