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1.
Medicine (Baltimore) ; 100(22): e26252, 2021 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-34087914

RESUMO

ABSTRACT: Suicide is an increasingly serious public health care concern worldwide. The impact of decreased in-house psychiatric resources on emergency care for suicidal patients has not been thoroughly examined. We evaluated the effects of closing an in-hospital psychiatric ward on the prehospital and emergency ward length of stay (LOS) and disposition location in patients who attempted suicide.This was a retrospective before-and-after study at a community emergency department (ED) in Japan. On March 31, 2014, the hospital closed its 50 psychiatric ward beds and outpatient consultation days were decreased from 5 to 2 days per week. Electronic health record data of suicidal patients who were brought to the ED were collected for 5 years before the decrease in in-hospital psychiatric services (April 1, 2009-March 31, 2014) and 5 years after the decrease (April 1, 2014-March 31, 2019). One-to-one propensity score matching was performed to compare prehospital and emergency ward LOS, and discharge location between the 2 groups.Of the 1083 eligible patients, 449 (41.5%) were brought to the ED after the closure of the psychiatric ward. Patients with older age, burns, and higher comorbidity index values, and those requiring endotracheal intubation, surgery, and emergency ward admission, were more likely to receive ED care after the psychiatric ward closure. In the propensity matched analysis with 418 pairs, the after-closure group showed a significant increase in median prehospital LOS (44.0 minutes vs 51.0 minutes, P < .001) and emergency ward LOS (3.0 days vs 4.0 days, P = .014) compared with the before-closure group. The rate of direct home return was significantly lower in the after-closure group compared with the before-closure group (87.1% vs 81.6%, odds ratio: 0.66; 95% confidence interval: 0.45-0.96).The prehospital and emergency ward LOS for patients who attempted suicide in the study site increased significantly after a decrease in hospital-based mental health services. Conversely, there was significant reduction in direct home discharge after the decrease in in-house psychiatric care. These results have important implications for future policy to address the increasing care needs of patients who attempt suicide.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Fechamento de Instituições de Saúde/estatística & dados numéricos , Hospitais Comunitários/estatística & dados numéricos , Tentativa de Suicídio/psicologia , Adulto , Estudos de Casos e Controles , Estudos de Coortes , Desinstitucionalização/estatística & dados numéricos , Serviços Médicos de Emergência/normas , Serviços Médicos de Emergência/estatística & dados numéricos , Feminino , Fechamento de Instituições de Saúde/legislação & jurisprudência , Hospitalização/estatística & dados numéricos , Humanos , Japão/epidemiologia , Tempo de Internação/estatística & dados numéricos , Masculino , Serviços de Saúde Mental/economia , Serviços de Saúde Mental/legislação & jurisprudência , Serviços de Saúde Mental/estatística & dados numéricos , Pessoa de Meia-Idade , Alta do Paciente/estatística & dados numéricos , Unidade Hospitalar de Psiquiatria/economia , Unidade Hospitalar de Psiquiatria/organização & administração , Encaminhamento e Consulta/estatística & dados numéricos , Estudos Retrospectivos , Tentativa de Suicídio/estatística & dados numéricos
3.
Acad Med ; 96(9): 1263-1267, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-33735126

RESUMO

The announcement of the closure of Philadelphia's Hahnemann University Hospital in June 2019 sent shock waves through the academic community. The closure had a devastating impact on the residents and fellows who trained there, the patients who had long received their care there, and faculty and staff who had provided care there for decades. Since its beginnings, the hospital, established as part of Hahnemann Medical College in 1885, was a major site for medical student education. The authors share the planning before and actions during the crisis that protected the educational experiences of third- and fourth-year medical students at Drexel University College of Medicine assigned to Hahnemann University Hospital. The lessons they learned can be helpful to leadership in academic health systems in the United States facing a diminishing number of clinical training sites for medical and other health professions students, a situation that is likely to worsen as the COVID-19 pandemic continues to weaken the health care ecosystem.


Assuntos
Educação de Graduação em Medicina/organização & administração , Fechamento de Instituições de Saúde/métodos , Hospitais Universitários/organização & administração , Educação de Graduação em Medicina/métodos , Docentes de Medicina/organização & administração , Docentes de Medicina/psicologia , Humanos , Relações Interprofissionais , Philadelphia , Estudantes de Medicina/psicologia
4.
Am J Emerg Med ; 47: 35-41, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-33756131

RESUMO

BACKGROUND: During the early phase of the coronavirus disease 2019 (COVID-19) outbreak, many emergency departments (EDs) were exposed to COVID-19 and were temporarily closed according to national protocol of Korea. We aimed to evaluate the effect of concurrent and recurrent temporary closures of EDs on the clinical outcomes of patients who visited EDs during the COVID-19 outbreak. METHODS: This cross-sectional study used a nationwide emergency patient database. Patients who visited one of the 46 EDs in Daegu and Gyeongbuk between January 21 and April 14, 2020 were included. The main exposure variable was the first medical contact (ED visit or 119 call to emergency medical services (EMS)) during closure of at least one ED. There were 25 temporary closures of six Level-1 and Level-2 EDs between February 18 and March 17, 2020. We constructed a dataset by performing bidirectional crossover matching and conducted a conditional logistic regression analysis where the primary outcome was in-hospital mortality. RESULTS: Of the 94,360 eligible study participants, 36,327 were classified into the non-EMS-use group and 10,116 were classified into the EMS-use group. In-hospital mortality rates were 2.0% and 1.6% for the temporary-closure and no-closure groups in the non-EMS-use group (p-value, 0.03) and 8.7% and 7.4% in the EMS-use group (p-value, 0.02), respectively. In the conditional logistic analysis for in-hospital mortality, the odds ratios (95% confidence intervals) of the temporary-closure group compared the no-closure group were 1.22 (1.03-1.44) among the non-EMS-use group and 1.23 (1.04-1.46) among the EMS-use group. CONCLUSION: The temporary closures of EDs due to the unpredicted COVID-19 exposure resulted in an increase in emergency patients' in-hospital mortality rates irrespective of whether they used EMS. Preparing regional EMS systems to cope with new outbreaks is essential to protect the safety of all citizens.


Assuntos
COVID-19/epidemiologia , Serviço Hospitalar de Emergência , Fechamento de Instituições de Saúde , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , COVID-19/diagnóstico , COVID-19/terapia , Criança , Pré-Escolar , Estudos Transversais , Bases de Dados Factuais , Surtos de Doenças/prevenção & controle , Feminino , Mortalidade Hospitalar , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , SARS-CoV-2 , Adulto Jovem
6.
J Healthc Manag ; 66(1): 48-61, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33411486

RESUMO

EXECUTIVE SUMMARY: Financial distress is a persistent problem in U.S. hospitals, leading them to close at an alarming rate over the past two decades. Given the potential adverse effects of hospital closures on healthcare access and public health, interest is growing in understanding more about the financial health of U.S. hospitals. In this study, we set out to explore the extent to which relevant organizational and environmental factors potentially buffer financially distressed hospitals from closure, and even at the brink of closure, enable some to merge with other hospitals. We tested our hypotheses by first examining how factors such as slack resources, environmental munificence, and environmental complexity affect the likelihood of survival versus closing or merging with other organizations. We then tested how the same factors affect the likelihood of merging relative to closing for financially distressed hospitals that undergo one of these two events. We found that different types of slack resources and environmental forces impact different outcomes. In this article, we discuss the implications of our findings for hospital stakeholders.


Assuntos
Fechamento de Instituições de Saúde , Hospitais , American Hospital Association , Estados Unidos
7.
Minerva Obstet Gynecol ; 73(2): 261-267, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33435661

RESUMO

BACKGROUND: Since COVID-19 was declared a pandemic, governments have taken actions to limit the transmission of the virus such as lockdown measures and reorganization of the local Health System. Quarantine measures have influenced pregnant women's daily lives. The aim of this study was to understand the impact of the changes imposed by COVID-19 emergency on the well-being of pregnant women and how the transformation of Schiavonia Hospital into a dedicated COVID hospital affected their pregnancy experience. METHODS: A cross-sectional survey was conducted. Pregnant women who gave birth in Schiavonia Hospital during the period May-September 2020 have been included. The assessment examined clinical characteristics, attitudes in relation to the pandemic and how it affected birth plans, perception of information received, and attitudes regards giving birth in a COVID hospital. RESULTS: One hundred four women responded to the survey, with an enrolment rate of 58%. About the influence of COVID-19 pandemic, 51% of respondents reported changing some aspect of their lifestyle. The identification of Schiavonia Hospital as COVID hospital did not modify the trust in the facility and in the obstetrics ward for the 90% of women, in fact for the 85.6% it was the planned Birth Center since the beginning of pregnancy. The communication was complete and exhaustive for 82.7% of the respondents. CONCLUSIONS: Despite the COVID hospital transformation, the women who came to give birth at Schiavonia Birth Center rated the healthcare assistance received at high level, evidencing high affection for the structure and the healthcare workers.


Assuntos
Atitude Frente a Saúde , COVID-19/epidemiologia , Salas de Parto/organização & administração , Parto Obstétrico , Gestantes/psicologia , Adulto , Estudos Transversais , Feminino , Fechamento de Instituições de Saúde , Hospitais de Isolamento/organização & administração , Humanos , Itália/epidemiologia , Estilo de Vida , Pandemias , Paridade , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Mulheres Trabalhadoras/estatística & dados numéricos , Adulto Jovem
8.
BMJ Open ; 11(1): e045889, 2021 01 17.
Artigo em Inglês | MEDLINE | ID: mdl-33455941

RESUMO

BACKGROUND: The COVID-19 pandemic has had a major impact on delivery of social support services. This might be expected to particularly affect older adults and people living with dementia (PLWD), and to reduce their well-being. AIMS: To explore how social support service use by older adults, carers and PLWD, and their mental well-being changed over the first 3 months since the pandemic outbreak. METHODS: Unpaid dementia carers, PLWD and older adults took part in a longitudinal online or telephone survey collected between April and May 2020, and at two subsequent timepoints 6 and 12 weeks after baseline. Participants were asked about their social support service usage in a typical week prior to the pandemic (at baseline), and in the past week at each of the three timepoints. They also completed measures of levels of depression, anxiety and mental well-being. RESULTS: 377 participants had complete data at all three timepoints. Social support service usage dropped shortly after lockdown measures were imposed at timepoint 1 (T1), to then increase again by T3. The access to paid care was least affected by COVID-19. Cases of anxiety dropped significantly across the study period, while cases of depression rose. Well-being increased significantly for older adults and PLWD from T1 to T3. CONCLUSIONS: Access to social support services has been significantly affected by the pandemic, which is starting to recover slowly. With mental well-being differently affected across groups, support needs to be put in place to maintain better well-being across those vulnerable groups during the ongoing pandemic.


Assuntos
COVID-19/psicologia , Cuidadores/psicologia , Demência/psicologia , Fechamento de Instituições de Saúde , Serviço Social , Adulto , Idoso , Idoso de 80 Anos ou mais , Ansiedade/epidemiologia , COVID-19/prevenção & controle , Depressão/epidemiologia , Feminino , Humanos , Estudos Longitudinais , Masculino , Saúde Mental , Pessoa de Meia-Idade , Apoio Social , Reino Unido/epidemiologia , Adulto Jovem
9.
J Surg Res ; 258: 170-178, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33011448

RESUMO

BACKGROUND: Access to health care is an important issue, particularly in remote areas. Since 2010, 106 rural hospital have closed in the United States, potentially limiting geographic access to health care. The aim of this study was to evaluate the impact of these hospital closures on the proportion of the population who can reach a secondary care facility, by road, within 15, 30, 45, or 60 min. METHODS: Geographical information system analysis, using population data obtained from the 2010 U.S. Census Bureau and hospital data between 2010 and 2019 from the Center for Medicare and Medicaid Services, created 15-, 30-, 45-, and 60-min drive time isochrones (areas from which a central location can be reached within a set time). RESULTS: Rural hospital closures resulted in 0%-0.97% of the population no longer being able to access a hospital within 15 min. The most marked changes were in the East South Central (0.97%, 178,478 residents) and West South Central (0.54%, 197,660 residents) divisions. Lesser degrees of change were noted for longer drive times. The changes were more marked when the rural population was analyzed exclusively. CONCLUSIONS: Recent closures of rural hospitals in the United States have impacted population access to hospital care, although the extent varies. There are regions, such as the Southern and Southeastern United States, which demonstrate greater and potentially more concerning losses in population coverage, probably because of the greater number of closures. Future work should evaluate clinical implications of hospital closures and loss of population coverage.


Assuntos
Fechamento de Instituições de Saúde/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Acesso aos Serviços de Saúde , Humanos , População Rural/estatística & dados numéricos , Análise Espacial , Estados Unidos
10.
Riv Psichiatr ; 55(6): 15-19, 2020.
Artigo em Italiano | MEDLINE | ID: mdl-33349718

RESUMO

INTRODUCTION: Residential Services for the Execution of Security Measures (REMS) are specialist psychiatric units for forensic patients created in 2015 after OPG (Italian Security Psychiatric Forensic Hospitals) have been closed. AIMS: to describe the clinical, diagnostic and forensic features of patients and evaluate the relevance of 3 elements: use of alcohol and substance, antisociality, cognitive disability. A further aim is the evaluation of the level of pre and post admission diagnostic concordance. METHODS: A specific database has been set for the purpose of the study, which collects data of patients admitted in 5 years of activity of the unit. Data have been analysed through a descriptive approach. RESULTS: 4 main clusters have been identified: Psychosis, Use of Alcohol/Substance Disorder, Personality Disorder, Cognitive Disability. Alcohol/substance use, antisociality, cognitive disability elements are relevant in the sample. Diagnostic concordance level pre- and post- admission is overall good, sometimes partial. CONCLUSIONS: alcohol/substance use, antisociality and cognitive disability, often in comorbidity mode, represent core features in part of the sample. This finding emphasizes a complexity level which is linked to social and judicial aspects, in addition to the health component.


Assuntos
Transtorno da Personalidade Antissocial/epidemiologia , Transtornos Cognitivos/epidemiologia , Transtornos Psicóticos/epidemiologia , Instituições Residenciais , Medidas de Segurança/legislação & jurisprudência , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Transtornos Relacionados ao Uso de Álcool/epidemiologia , Bases de Dados Factuais , Diagnóstico Duplo (Psiquiatria)/estatística & dados numéricos , Feminino , Psiquiatria Legal/legislação & jurisprudência , Fechamento de Instituições de Saúde , Hospitais Psiquiátricos , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Admissão do Paciente/estatística & dados numéricos , Instituições Residenciais/legislação & jurisprudência , Instituições Residenciais/organização & administração , Estudos Retrospectivos , Esquizofrenia/epidemiologia , Fatores de Tempo , Adulto Jovem
11.
JAMA Netw Open ; 3(11): e2025815, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33196808

RESUMO

Importance: State decisions not to expand Medicaid under the Patient Protection and Affordable Care Act could reduce emergency access to acute care hospitals. Objective: To determine the relationship between state Medicaid expansion and emergency access to acute care hospitals in the United States. Design, Setting, and Participants: This cross-sectional study linked hospital-level data from the Centers for Medicare & Medicaid Services from 2007 to 2017 to US Census data for all 50 US states and the District of Columbia. Geospatial analyses and difference-in-differences regression models were used to compare temporal changes in the size of the population without 30-minute access to acute care hospitals between 32 states that expanded Medicaid with the population without access in 19 that did not, before and after expansion. Analyses focused on the total population and those with low incomes; secondary analyses examined emergency access to safety-net hospitals. Exposures: State-level Medicaid expansion. Main Outcomes and Measures: Population without emergency access to an acute care hospital, defined as living outside a 30-minute drive of any hospital. Results: States that did not expand Medicaid experienced an increase in the population without access to hospitals overall (without expansion: 6.76% to 6.79% [0.03%]; vs with expansion: 5.65% to 5.35% [-0.30%]; difference-in-differences, 0.33%; 95% CI, 0.33%-0.34%; P < .001) and for low-income persons (without expansion: 7.43% to 7.39% [-0.04%]; vs with expansion: 6.25% to 6.15% [-0.10%]; difference-in-differences, 0.06%; 95% CI, 0.05%-0.07%; P < .001). If access changes in nonexpansion states were the same as expansion states, an estimated 421 000 more persons overall and 48 000 more low-income persons would have retained access. States that did not expand Medicaid experienced an increase in the population without access to safety-net hospitals overall (46.91% to 47.70% [0.79%] vs 33.94% to 33.07% [-0.87%]; difference-in-differences, 1.66%; 95% CI, 1.64%-1.66%; P < .001) and for low-income persons (45.28% to 46.14% [0.86%] vs 33.00% to 32.23% [-0.77%]; difference-in-differences, 1.63%; 95% CI, 1.63%-1.67%; P < .001). If access changes in nonexpansion states were the same as expansion states, an estimated 2 242 000 more persons overall and 364 000 more low-income persons would have retained access. Conclusions and Relevance: States that did not expand Medicaid under the Patient Protection and Affordable Care Act were associated with worse emergency access to acute care hospitals compared with states that expanded Medicaid.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Medicaid , Patient Protection and Affordable Care Act , Tempo para o Tratamento , Centers for Medicare and Medicaid Services, U.S. , Estudos Transversais , Economia Hospitalar , Emergências , Fechamento de Instituições de Saúde , Humanos , Pobreza , Provedores de Redes de Segurança/estatística & dados numéricos , Análise Espacial , Viagem , Estados Unidos
12.
Pan Afr Med J ; 35(Suppl 2): 135, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33193950

RESUMO

Tuberculous neuroretinis, a relatively rare manifestation of extra-pulmonary tuberculosis, is characterized by optic disc edema, peripapillary and macula swelling, with hard exudates forming a partial or complete 'macular star' While the disease may present a diagnostic challenge for Ophthalmologists, prognosis is usually good, with proper management. The Coronavirus Disease 2019 (COVID-19) pandemic has presented a healthcare delivery dilemma in many parts of the world, with poor accessibility to, and under-utilization of, important healthcare services by non-COVID-19-related cases. Herein is a report of a case of tuberculous neuroretinitis in Lagos, Nigeria, whose care was negatively impacted by the ongoing pandemic through the combined factors of the interruption of clinical services during the lockdown, patient avoidance of healthcare facilities and the absence of robust telehealth services. These all culminated in the delayed institution of therapy which may be responsible for the poor visual outcome of no-light-perception.


Assuntos
Continuidade da Assistência ao Paciente , Infecções por Coronavirus/epidemiologia , Acesso aos Serviços de Saúde , Pandemias , Pneumonia Viral/epidemiologia , Retinite/tratamento farmacológico , Tuberculose Ocular/tratamento farmacológico , Antituberculosos/uso terapêutico , COVID-19 , Telefone Celular , Diagnóstico Tardio , Técnicas de Diagnóstico Oftalmológico , Quimioterapia Combinada , Feminino , Fechamento de Instituições de Saúde , Humanos , Macula Lutea/patologia , Nigéria/epidemiologia , Fotografação , Quarentena , Retinite/diagnóstico , Telemedicina , Tomografia de Coerência Óptica , Resultado do Tratamento , Recusa do Paciente ao Tratamento , Tuberculose Ocular/diagnóstico , Adulto Jovem
15.
J Med Imaging Radiat Sci ; 51(4): 574-578, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33121887

RESUMO

INTRODUCTION: As a result of the COVID-19 pandemic, outpatient diagnostic imaging (DI) facilities experienced decreased operations and even unprecedented closures. The purpose of this study was to examine the impact of COVID-19 on the practices of DI clinics, and investigate the reasons for the change in their operations during the initial period of the pandemic starting in mid-March 2020. MATERIALS AND METHODS: A questionnaire was created and distributed to the managers of eighteen outpatient DI clinics in London, Hamilton, and Halton, Ontario, Canada. The managers indicated whether their clinics had closed or decreased operations, the reasons for closure, and the types of imaging examinations conducted in the initial period of the COVID-19 pandemic. RESULTS: Fifty percent of the DI clinics surveyed (9/18) closed as a result of COVID-19, and those that remained open had decreased hours of operation. The clinics that closed indicated decreased referrals as the primary reason for closure, followed by staff shortage, concerns for safety, and suspension of elective imaging. Chest radiography and obstetric ultrasound were the most commonly conducted examinations. Clinics that were in close geographical proximity were able to redistribute imaging examinations amongst themselves. All DI clinics had suspended BMD examinations and elective breast screening, and some transitioned to booked appointments only. CONCLUSION: Many DI clinics needed to close or decrease operations as a result of COVID-19, a phenomenon that is unprecedented in radiological practice. The results of this study can assist outpatient DI clinics in preparing for subsequent waves of COVID-19, future pandemics, and other periods of crisis.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , COVID-19/prevenção & controle , Diagnóstico por Imagem/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Fechamento de Instituições de Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Pesquisas sobre Serviços de Saúde/métodos , Humanos , Ontário , Pandemias , Telemedicina/métodos
16.
Ann Ist Super Sanita ; 56(3): 365-372, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32959803

RESUMO

INTRODUCTION: On 21 February 2020, Schiavonia Hospital (SH) detected the first 2 cases of COVID-19 in Veneto Region. As a result of the underlying concomitant spread of infection, SH had to rearrange the clinical services in terms of structural changes to the building, management of spaces, human resources and supplies, in order to continue providing optimal care to the patients and staff safety. The aim of this article is to describe how SH was able to adjust its services coping with the epidemiological stages of the pandemic. MATERIAL AND METHODS: Three periods can be identified; in each one the most important organizational modifications are analyzed (hospital activities, logistical changes, communication, surveillance on HCW). RESULTS: The first period, after initial cases' identification, was characterized by the hospital isolation. In the second period the hospital reopened and it was divided into two completely separated areas, named COVID-19 and COVID-free, to prevent intra-hospital contamination. The last period was characterized by the re-organization of the facility as the largest COVID Hospital in Veneto, catching exclusively COVID-19 patients from the surrounding areas. CONCLUSIONS: SH changed its organization three times in less than two months. From the point of view of the Medical Direction of the Hospital the challenges had been many but it allowed to consolidate an organizational model which could answer to health needs during the emergency situation.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Hospitais Estaduais/organização & administração , Pandemias , Pneumonia Viral , Conversão de Leitos , Betacoronavirus/isolamento & purificação , COVID-19 , Teste para COVID-19 , Técnicas de Laboratório Clínico , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Infecção Hospitalar/prevenção & controle , Infecção Hospitalar/transmissão , Fechamento de Instituições de Saúde , Sistemas de Comunicação no Hospital , Departamentos Hospitalares , Hospitais Estaduais/estatística & dados numéricos , Humanos , Controle de Infecções , Unidades de Terapia Intensiva , Itália/epidemiologia , Nasofaringe/virologia , Doenças Profissionais/prevenção & controle , Política Organizacional , Ambulatório Hospitalar/organização & administração , Pandemias/prevenção & controle , Isolamento de Pacientes , Equipamento de Proteção Individual , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia , Gestão de Riscos , SARS-CoV-2 , Recursos Humanos
17.
Surg Clin North Am ; 100(5): 835-847, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882166

RESUMO

Nearly 60 million people live in a rural area across the United States. Since 2005, 162 rural hospitals have closed, and the rate of rural hospital closures seems to be accelerating. Major drivers of rural hospital closures are poor financial health, aging facilities, and low occupancy rates. Rural hospitals are particularly vulnerable to policy and market changes, and even small changes can have a disproportionate effect on rural hospital financial viability. Surgery can be safely performed in rural hospitals; however, hospital closures may be putting the rural population at increased risk of morbidity and mortality from surgical disease.


Assuntos
Fechamento de Instituições de Saúde/economia , Fechamento de Instituições de Saúde/estatística & dados numéricos , Hospitais Rurais/economia , Hospitais Rurais/estatística & dados numéricos , Serviços de Saúde Rural/economia , Serviços de Saúde Rural/normas , Procedimentos Cirúrgicos Operatórios/estatística & dados numéricos , Previsões , Hospitais Rurais/tendências , Humanos , População Rural , Procedimentos Cirúrgicos Operatórios/tendências , Estados Unidos , Local de Trabalho
18.
Surg Clin North Am ; 100(5): 869-877, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32882169

RESUMO

Rural hospitals are closing at an increasing rate. From 2010 to 2014, 47 rural hospitals closed, affecting 1.5 million people. The presence of surgeons is critical to keeping these hospitals open; to provide initial trauma care, cancer screening, and care to populations that cannot easily travel; and to provide solid general surgery procedures to almost 60 million Americans. Actions to provide surgeons trained for rural practice include exposure of surgery to students in high school (and earlier), recruitment of rural students into medical school, rural rotations in medical school, rural tracts within surgical residencies, and programs to support and retain rural surgeons.


Assuntos
Cirurgia Geral/estatística & dados numéricos , Fechamento de Instituições de Saúde/estatística & dados numéricos , Hospitais Rurais/estatística & dados numéricos , Serviços de Saúde Rural , Recursos Humanos , Currículo , Cirurgia Geral/educação , Estados Unidos
19.
Hum Reprod ; 35(11): 2556-2566, 2020 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-32761248

RESUMO

STUDY QUESTION: What are appraisals, coping strategies and emotional reactions of patients to coronavirus disease 2019 (COVID-19) fertility clinic closures? SUMMARY ANSWER: Clinic closure was appraised as stressful due to uncertainty and threat to the attainability of the parenthood goal but patients were able to cope using strategies that fit the uncertainty of the situation. WHAT IS KNOWN ALREADY: Psychological research on COVID-19 suggests that people are more anxious than historical norms and moderately to extremely upset about fertility treatment cancellation owing to COVID-19. STUDY DESIGN, SIZE, DURATION: The study was of cross-sectional design, comprising a mixed-methods, English language, anonymous, online survey posted from April 9 to 21 to social media. Eligibility criteria were being affected by COVID-19 fertility clinic closure, 18 years of age or older and able to complete the survey in English. In total, 946 people clicked on the survey link, 76 did not consent, 420 started but did not complete the survey and 450 completed (48% completion, 446 women, four men). PARTICIPANTS/MATERIALS, SETTING, METHODS: Overall 74.7% (n = 336) of respondents were residents in the UK with an average age of 33.6 years (SD = 4.4) and average years trying to conceive, 3.5 years (SD = 2.22). The survey comprised quantitative questions about the intensity of cognitive appraisals and emotions about clinic closure, and ability to cope with clinic closure. Open-text questions covered their understanding of COVID-19 and its effect on reproductive health and fertility plans, concerns and perceived benefits of clinic closure, and knowledge about closure. Sociodemographic information was collected. Descriptive and inferential statistics were used on quantitative data. Thematic qualitative analysis (inductive coding) was performed on the textual data from each question. Deductive coding grouped themes from each question into meta-themes related to cognitive stress and coping theory. MAIN RESULTS AND THE ROLE OF CHANCE: Most patients (81.6%, n = 367) had tests or treatments postponed, with these being self (41.3%, n = 186) or publicly (46.4%, n = 209) funded. Patients appraised fertility clinic closure as having potential for a more negative than positive impact on their lives, and to be very or extremely uncontrollable and stressful (P ≤ 0.001). Most reported a slight to moderate ability to cope with closure. Data saturation was achieved with all open-text questions, with 33 broad themes identified and four meta-themes linked to components of the cognitive stress and coping theory. First, participants understood clinic closure was precautionary due to unknown effects of COVID-19 but some felt clinic closure was unfair relative to advice about getting pregnant given to the public. Second, closure was appraised as a threat to attainability of the parenthood goal largely due to uncertainty of the situation (e.g. re-opening, effect of delay) and intensification of pre-existing hardships of fertility problems (e.g. long time waiting for treatment, history of failed treatment). Third, closure taxed personal coping resources but most were able to cope using thought-management (e.g. distraction, focusing on positives), getting mentally and physically fit for next treatments, strengthening their social network, and keeping up-to-date. Finally, participants reported more negative than positive emotions (P ≤ 0.001) and, almost all participants reported stress, worry and frustration at the situation, while some expressed anger and resentment at the unfairness of the situation. Overall, 11.8% were not at all able to cope, with reports of intense feelings of hopelessness and deteriorating well-being and mental health. LIMITATIONS, REASONS FOR CAUTION: The survey captures patient reactions at a specific point in time, during lockdown and before clinics announced re-opening. Participants were self-selected (e.g. UK residents, women, 48% starting but not completing the survey), which may affect generalisability. WIDER IMPLICATIONS OF THE FINDINGS: Fertility stakeholders (e.g. clinics, patient support groups, regulators, professional societies) need to work together to address the great uncertainty from COVID-19. This goal can be met proactively by setting up transparent processes for COVID-19 eventualities and signposting to information and coping resources. Future psychological research priorities should be on identifying patients at risk of distress with standardised measures and developing digital technologies appropriate for the realities of fertility care under COVID-19. STUDY FUNDING/COMPETING INTEREST(S): University funded research. Outside of the submitted work, Prof. J.B. reports personal fees from Merck KGaA, Merck AB, Theramex, Ferring Pharmaceuticals A/S; grants from Merck Serono Ltd; and that she is co-developer of the Fertility Quality of Life (FertiQoL) and MediEmo apps. Outside of the submitted work, Dr R.M. reports personal or consultancy fees from Manchester Fertility, Gedeon Richter, Ferring and Merck. Outside of the submitted work, Dr S.G. reports consultancy fees from Ferring Pharmaceuticals A/S, Access Fertility and SONA-Pharm LLC, and grants from Merck Serono Ltd. The other authors declare no conflicts of interest. TRIAL REGISTRATION NUMBER: N/A.


Assuntos
Infecções por Coronavirus/psicologia , Clínicas de Fertilização , Fechamento de Instituições de Saúde , Pneumonia Viral/psicologia , Adaptação Psicológica , Adulto , COVID-19 , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pandemias , Estresse Psicológico
20.
Trans R Soc Trop Med Hyg ; 114(10): 730-732, 2020 10 05.
Artigo em Inglês | MEDLINE | ID: mdl-32853370

RESUMO

Countries around the world are facing an enormous challenge due to the COVID-19 pandemic. The pressure that the pandemic inflicts on health systems could certainly impact on the care, control, and elimination of neglected tropical diseases (NTDs). From mid-January 2020, Ethiopia started to prepare for the prevention and treatment of COVID-19. The Federal Ministry of Health pledged to continue essential healthcare, including NTD care, during this pandemic. However, some hospitals have been closed for other healthcare services and have been turned into isolation and treatment centers for COVID-19. In addition to the healthcare facility measures, all community-based health promotion and disease prevention services have been stopped. The current shift in attention towards COVID-19 is expected to have a negative impact on NTD prevention and care.


Assuntos
Controle de Doenças Transmissíveis/organização & administração , Infecções por Coronavirus/epidemiologia , Doenças Negligenciadas/terapia , Pneumonia Viral/epidemiologia , Animais , Betacoronavirus , COVID-19 , Erradicação de Doenças , Etiópia/epidemiologia , Programas Governamentais , Fechamento de Instituições de Saúde , Humanos , Doenças Negligenciadas/epidemiologia , Pandemias , SARS-CoV-2 , Medicina Tropical
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