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1.
Infectio ; 25(4): 256-261, oct.-dic. 2021. tab, graf
Artículo en Español | LILACS, COLNAL | ID: biblio-1286719

RESUMEN

Resumen Objetivo: Determinar los factores de riesgo en adultos con COVID-19 en población rural andina durante 2020. Métodos: En este estudio de cohorte retrospectivo multicéntrico, incluimos a 184 pacientes adultos (≥18 años) con pruebas serológicas y moleculares para CO VID-19 de tres hospitales de la sierra peruana (Ancash y Apurímac) incluidos con sospecha clínica entre abril y junio. Se utilizó análisis descriptivos y regresión logística univariable para explorar los factores de riesgo asociados a los pacientes con COVID-19. Resultados: Del total de pacientes, 14 (7.6%) tuvieron SARS-CoV-2. En los pacientes infectados 12 (85.7%) fueron varones con promedio de edad de 47.3±21 años. Las comorbilidades estuvieron presentes en cerca de la tercera parte de pacientes, siendo la hipertensión y diabetes las más frecuentes (ambas 14.3%), y la sinto matología más frecuentes fueron fiebre y cefalea (57.2%). La regresión univariable mostró mayores probabilidades de infección con SARS-CoV-2 en la población rural andina asociada con la edad avanzada (OR: 1.1 IC95% 0.7-1.8; p=0,019), comorbilidades previas (OR: 1.7, IC95% 0.32-9.39; p=0,006), y sintomatología previa (OR: 49.8, IC95% 5.6-436.9; p=0,0011). Conclusiones: Los posibles factores de riesgo como la edad avanzada, las comorbilidades y sintomatología previas están relacionados con el desarrollo de CO VID-19 en población rural andina de Perú.


Abstract Objective: To determine the risk factors in adults with COVID-19 in the rural Andean population during 2020. Methods: This multicenter retrospective cohort study included 184 adult patients (≥18 years) with COVID-19's serological and molecular tests from three Hospitals in the Peruvian mountains (Ancash and Apurímac) included with clinical suspicion between April and June. Descriptive analysis and univariate logistic regression were used to explore the risk factors associated with patients with COVID-19. Results: Of total of patients, 14 (7.6%) had a SARS-CoV-2. In infected patients 12 (85.7%) were men with an average age of 47.3±21 years. Comorbidities were present in about a third of patients, with hypertension and diabetes being the most frequent (both 14.3%), and the most frequent symptoms were fever and hea dache (57.2%). Univariate regression showed higher probabilities of infection with SARS-CoV-2 in the rural Andean population associated with advanced age (OR: 1.1 95% CI 0.7 - 1.8; p = 0.019), previous comorbidities (OR: 1.7, 95%CI 0.32 - 9.39; p = 0.006), and previous symptoms (OR: 49.8, 95%CI 5.6 - 436.9; p = 0.0011). Conclusions: Possible risk factors such as advanced age, comorbidities and previous symptoms are related to the development of COVID-19 in the rural Andean population of Peru.


Asunto(s)
Humanos , Masculino , Femenino , Niño , Adolescente , Adulto , Persona de Mediana Edad , Anciano , COVID-19 , Perú , Población Rural , Factores de Riesgo , Estudios de Cohortes , SARS-CoV-2 , Cefalea , Hospitales , Hipertensión , Infecciones
2.
BMJ Glob Health ; 6(9)2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34593512

RESUMEN

BACKGROUND: In 2019, there are more than 290 million people who have ever migrated from rural to urban areas in China. These rural-to-urban internal migrants account for more than one-fifth of China's population and is the largest internal migrant group globally. We present the first systematic review that examines whether internal migrants are more likely to exhibit non-communicable diseases (NCDs) risk factors and have worse NCD management outcomes than non-migrant counterparts in China. METHODS: A systematic review was conducted via medical, public health, and economic databases including Scopus, MEDLINE, JSTOR, WHO Library Database and World Bank e-Library from 2000 to 2020. Study quality was assessed using the National Institute of Health Quality Assessment tool. We conducted a narrative review and synthesised differences for all studies included, stratified by different types of outcomes. We also conducted random-effects meta-analysis where we had a minimum of two studies with 95% CIs reported. The study protocol has been registered with PROSPERO: CRD42019139407. RESULTS: For most NCD risk factors and care cascade management, comparisons between internal migrants and other populations were either statistically insignificant or inconclusive. While most studies found migrants have a higher prevalence of tobacco use than urban residents, these differences were not statistically significant in the meta-analysis. Although three out four studies suggested that migrants may have worse access to NCD treatment and both studies suggested migrants have lower blood pressure control rates than non-migrants, these findings were not statistically significant. CONCLUSION: Findings from this systematic review demonstrate that there is currently insufficient evidence on migrant and non-migrant differences in NCD risk factors and management in China. Further research is expected to investigate access to healthcare among internal and its effect on both their NCD outcomes and long-term healthcare costs in China.


Asunto(s)
Enfermedades no Transmisibles , Migrantes , China/epidemiología , Humanos , Enfermedades no Transmisibles/epidemiología , Enfermedades no Transmisibles/terapia , Factores de Riesgo , Población Rural
3.
BMC Health Serv Res ; 21(1): 1082, 2021 Oct 12.
Artículo en Inglés | MEDLINE | ID: mdl-34641871

RESUMEN

BACKGROUND: By testing children and adolescents of HIV positive caretakers, index-linked HIV testing, a targeted HIV testing strategy, has the ability to identify high risk children and adolescents earlier and more efficiently, compared to blanket testing. We evaluated the incremental cost of integrating index-linked HIV testing via three modalities into HIV services in Zimbabwe. METHODS: A mixture of bottom-up and top-down costing was employed to estimate the provider cost per test and per HIV diagnosis for 2-18 year olds, through standard of care testing, and the incremental cost of index-linked HIV testing via three modalities: facility-based testing, home-based testing by a healthcare worker, and testing at home by the caregiver using an oral mucosal transudate test. In addition to interviews, direct observation and study process data, facility registries were abstracted to extract outcome data and resource use. Costs were converted to 2019 constant US$. RESULTS: The average cost per standard of care test in urban facilities was US$5.91 and US$7.15 at the rural facility. Incremental cost of an index-linked HIV test was driven by the uptake and number of participants tested. The lowest cost approach in the urban setting was home-based testing (US$6.69) and facility-based testing at the rural clinic (US$5.36). Testing by caregivers was almost always the most expensive option (rural US$62.49, urban US$17.49). CONCLUSIONS: This is the first costing analysis of index-linked HIV testing strategies. Unit costs varied across sites and with uptake. When scaling up, alternative testing solutions that increase efficiency such as index-linked HIV testing of the entire household, as opposed to solely targeting children/adolescents, need to be explored.


Asunto(s)
Infecciones por VIH , Prueba de VIH , Adolescente , Niño , Costos y Análisis de Costo , Infecciones por VIH/diagnóstico , Humanos , Población Rural , Zimbabwe/epidemiología
4.
Sci Rep ; 11(1): 19623, 2021 10 04.
Artículo en Inglés | MEDLINE | ID: mdl-34608178

RESUMEN

One of the lessons from the COVID-19 pandemic is the importance of social distancing, even in challenging circumstances such as pre-hurricane evacuation. To explore the implications of integrating social distancing with evacuation operations, we describe this evacuation process as a Capacitated Vehicle Routing Problem (CVRP) and solve it using a DNN (Deep Neural Network)-based solution (Deep Reinforcement Learning) and a non-DNN solution (Sweep Algorithm). A central question is whether Deep Reinforcement Learning provides sufficient extra routing efficiency to accommodate increased social distancing in a time-constrained evacuation operation. We found that, in comparison to the Sweep Algorithm, Deep Reinforcement Learning can provide decision-makers with more efficient routing. However, the evacuation time saved by Deep Reinforcement Learning does not come close to compensating for the extra time required for social distancing, and its advantage disappears as the emergency vehicle capacity approaches the number of people per household.


Asunto(s)
Algoritmos , Distanciamiento Físico , COVID-19/patología , COVID-19/prevención & control , COVID-19/virología , Aprendizaje Profundo , Urgencias Médicas , Refugio de Emergencia , Humanos , Redes Neurales de la Computación , SARS-CoV-2/aislamiento & purificación , Transportes
5.
Mymensingh Med J ; 30(4): 1154-1162, 2021 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-34605490

RESUMEN

Determinants of pre-hospital delay after myocardial infarction, strictly among South-Asian rural community, till now is largely unknown. And Bangladesh is not an exception. It is a fact that though around two third of its population still live in villages, we do not know what factors are having influence on such delay. To find out these primers of time consumption before seeking medical help, this is a picture of a medical college hospital situated in a rural precinct. This cross-sectional analytical study was conducted among 98 patients came with Myocardial Infarction (MI) who had met inclusion and exclusion criteria from July 2019 and December 2019. Both STEMI & NSTEMI patients were selected as they have similar attributes. Data was collected in the coronary care unit using a preformed questionnaire. Among 98 MI patients, where 16 female and 82 male patients had average age 53±12 years. Average income rural community was around 100 USD. Almost 50% of sample were illiterate or below 5th grade. On average 6.6 hours (95% CI: 3.5-12.3) were required to reach CCU after symptom onset, whereas distance to first medical contact (FMC) was about 10.2 Km (95% CI: 6.4-16.2). Median distance to nearest PCI-capable hospital was 140 Km (IQR- 20 Km). Only 28% of patients could reach hospital within 2 hours, where 85% had onset of symptom while they were at home. Tertiary level medical college (74.5%) followed by Upazilla (Sub-urban) government health complex (22.4%) were frequent site of FMC. Principle mode of transport to hospital was CNG-three-wheeler (75% of cases). Logistic regression analysis showed only low literacy was as significant predictor about more than 2 hours pre-hospital delay (OR=2.58; p=0.043). Other factors such as low income (OR=2.51; p=0.126), diabetes mellitus (OR=2.99; p=0.059), female sex (OR=1.56; p=0.753), house wife (OR=1.88; p=0.547), previous MI (OR=1.52; p=1.000), symptom ignorance (OR=2.14; p=0.455) increases pre-hospital delay and distance to FMC <10 Km (OR=0.44; p=0.079) no significant prediction of pre-hospital delay after myocardial infarction. As rural community has less access to education low literacy has a significant impact on pre-hospital delay after myocardial infarction. So measures should be taken in rural areas through patient education and social awareness program regarding MI symptom and danger of delayed medical attention.


Asunto(s)
Infarto del Miocardio , Intervención Coronaria Percutánea , Adulto , Anciano , Bangladesh/epidemiología , Estudios Transversales , Femenino , Hospitales , Humanos , Masculino , Persona de Mediana Edad , Infarto del Miocardio/epidemiología , Infarto del Miocardio/terapia , Población Rural , Factores de Tiempo
6.
Medicine (Baltimore) ; 100(39): e27315, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34596131

RESUMEN

ABSTRACT: Participation in volunteer activity has positive effects on health among elderly. Few studies have investigated the association between volunteer activity and depression among Chinese elderly. This study aimed to examine the association between volunteer activity and depression among the elderly in China regarding rural-urban differences.Totally 8255 subjects from the 2015 China Health and Retirement Longitudinal Study were selected in this study. Depression was assessed by 10-item Center for Epidemiologic Studies Depression Scale. Types and frequency of volunteer activity were measured in the questionnaire. Multiple linear regression analysis was used to explore the relationship between volunteer activity and depression of elderly.In our study, the urban elderly had lower depressive scores than rural elderly (6.7 ±â€Š5.8 vs. 9.1 ±â€Š6.7). After adjustment for all covariates, our results revealed that almost daily participation in formal volunteer activities was negatively associated with depression among urban elderly (B = -2.69, SE = 1.05, P = .010); almost daily caring for a sick or disabled adult was positively associated with depression among both urban and rural elderly (urban:B = 3.13, SE = 1.54, P = .043; rural:B = 2.56, SE = 1.18, P = .031).These findings suggested that there was a negative association between formal volunteer activity and depression among urban elderly, while there was a positive association between caring for a sick or disabled adult and depression among both urban and rural elderly. The government should take effective measures to encourage the elderly to participate in formal volunteer activities to prevent them from depression.


Asunto(s)
Depresión/epidemiología , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Voluntarios/psicología , Factores de Edad , Anciano , Anciano de 80 o más Años , Envejecimiento/psicología , Cuidadores/psicología , China/epidemiología , Femenino , Conductas Relacionadas con la Salud , Humanos , Estilo de Vida , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Factores Sexuales , Factores Socioeconómicos
7.
Medicine (Baltimore) ; 100(39): e27350, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34596141

RESUMEN

ABSTRACT: A community-based cross-sectional study was undertaken by the Cardiology Society of India (Kerala Chapter) to determine the prevalence of coronary artery disease (CAD) and its risk factors. The periodontal health status of the rural and urban participants in the Thiruvananthapuram district of Kerala was evaluated to document any association between periodontal disease (PD) and CAD and to describe any shared risk factors.The participants were selected using a multistage cluster random sampling method. Socio-demographic data and personal histories were collected using a structured interview schedule and validated tools. Body mass index, blood pressure, electrocardiogram, and biochemical investigations were recorded and analyzed using standard protocols. A modification of the Ramfjord periodontal disease index was used to assess periodontal health.PD was more frequent among rural (61.4%) than in the urban population (35.5%). The frequencies of CAD associated with PD in the rural and urban populations were 82.6% and 40.5%, respectively. PD was not found to be a significant risk factor for CAD in the univariate regression analysis of urban populations. In the rural population, the odds of PD as a risk factor for CAD were found to be 3.08 (95% CI [1.38-8.38]) and significant (P = .043) in univariate regression analysis and 1.54 (95% CI: 0.44-5.4) and non-significant (P = .503) in the multivariate regression analysis.In rural areas, male sex and dyslipidemia demonstrated borderline significance as risk factors for CAD. PD was not found to be an independent risk factor after adjusting for age, sex, tobacco use, hypertension, sedentary lifestyle, and dyslipidemia. Male sex and dyslipidemia were identified as shared risk factors between PD and CAD, which could have confounded the significant association between the latter. In urban areas, age, male sex, and dyslipidemia demonstrated an independent association with CAD. This study could not establish an independent association between PD and CAD in either community. Future epidemiological studies should identify and recruit novel environmental factors to understand the interrelationships between PD and CAD and focus on the role of effect modifiers that may have a protective role against PD colluding with CAD.


Asunto(s)
Enfermedad de la Arteria Coronaria/epidemiología , Enfermedades Periodontales/epidemiología , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto , Anciano , Presión Sanguínea , Índice de Masa Corporal , Comorbilidad , Estudios Transversales , Dislipidemias/epidemiología , Electrocardiografía , Femenino , Humanos , India/epidemiología , Masculino , Persona de Mediana Edad , Prevalencia , Factores de Riesgo , Factores Sexuales , Factores Socioeconómicos , Adulto Joven
8.
BMC Health Serv Res ; 21(1): 1052, 2021 Oct 05.
Artículo en Inglés | MEDLINE | ID: mdl-34610827

RESUMEN

BACKGROUND: Recruiting and retaining medical, nursing, and allied health professionals in rural and remote areas is a worldwide challenge, compromising continuity of care and population health outcomes in these locations. Specifically, pharmacists play an essential and accessible frontline healthcare role, and are often the first point of contact for health concerns. Despite several incentives, there remains a maldistribution and undersupply of pharmacists in rural and remote areas across many parts of the world. Although current systematic reviews have focussed on factors affecting pharmacists' retention generally, literature specifically focused on rural pharmacist workforce in a global context remains limited. The aim of this systematic review is to identify factors associated with recruitment and retention of the pharmacist workforce in rural and remote settings. Better understanding of these contributors will inform more effective interventional strategies to resolve pharmacist workforce shortages. METHODS: A systematic search of primary studies was conducted in online databases, including Medline, Embase, CINAHL, Scopus, Web of Science and PsycINFO, and by hand-searching of reference lists. Eligible studies were identified based on predefined inclusion/exclusion criteria and methodological quality criteria, utilising the Critical Appraisal Skills Programme (CASP) and Good Reporting of A Mixed Methods Study (GRAMMS) checklists. RESULTS: The final review included 13 studies, with quantitative, qualitative, or mixed methods research design. Study-specific factors associated with recruitment and retention of pharmacists in rural practice were identified and grouped into five main themes: geographic and family-related, economic and resources, scope of practice or skills development, the practice environment, and community and practice support factors. CONCLUSIONS: The results provide critical insights into the complexities of rural recruitment and retention of pharmacists and confirms the need for flexible yet multifaceted responses to overcoming rural pharmacist workforce challenges. Overall, the results provide an opportunity for rural communities and health services to better identify key strengths and challenges unique to the rural and remote pharmacist workforce that may be augmented to guide more focussed recruitment and retention endeavours.


Asunto(s)
Farmacéuticos , Servicios de Salud Rural , Humanos , Motivación , Población Rural , Recursos Humanos
10.
Pan Afr Med J ; 39: 195, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34603576

RESUMEN

Introduction: active ageing is the process of optimizing opportunities for health in order to enhance quality of life and wellbeing. It is influenced by physical activity, social participation and social network, cognitive and continuous learning and socio-economic factors. It involves disease prevention and promotion of healthy behaviours that can reduce the risk and occurrence of non-communicable diseases in middle age and also at old age. The study aimed to determine and compare the active ageing process and its determinants among middle-aged men in rural and urban areas in Nigeria. Methods: this was a comparative cross-sectional study among middle-aged men 40-60 years using mixed methods. A multi-stage sampling technique was used to select 720 respondents. A structured interviewer administered questionnaire and Key informant interviews were used to collect data. Results: respondents in the rural area were a little older compared to the respondents in the urban area with a mean age of 49.6 ± 6.3 years and 48.6 ± 6.2 years respectively. A higher proportion of the respondents in the rural area (83.2%) than the respondents in the urban area (73.8%) practice good active ageing processes in their lives. There was a significant association between education of respondent and the practice of active ageing among respondents in the urban and rural areas. Multivariate logistic regression showed that physical activity (aOR 7.62, 95% CI: 243-23.94, P = 0.001), life-long learning (aOR 51.73, 95% CI: 12.14-220.49, P = 0.000) and community participation (aOR 3.46, 95% CI: 2.51-4.77, P=0.000) are predictors of active ageing. Conclusion: the study showed that respondents in the rural area practice good active ageing compared to the respondents in the urban area and hence engaged more in sufficient active life in their daily activities, reducing the risk of non-communicable diseases.


Asunto(s)
Envejecimiento Saludable/fisiología , Calidad de Vida , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adulto , Envejecimiento/fisiología , Estudios Transversales , Conductas Relacionadas con la Salud , Promoción de la Salud , Humanos , Masculino , Persona de Mediana Edad , Nigeria , Factores Socioeconómicos , Encuestas y Cuestionarios
11.
Reprod Health ; 18(1): 199, 2021 Oct 07.
Artículo en Inglés | MEDLINE | ID: mdl-34620186

RESUMEN

BACKGROUND: The World Health Organization recommends research to evaluate the effects of a single third trimester Doppler ultrasound examination on preventable deaths in unselected-risk pregnancies, particularly in low- and middle-income countries (LMICs) where the evidence base is scarce. While evaluating such technologies, researchers often ignore women and health care provider perspectives. This study explored the views and experiences of women and healthcare providers regarding the use of advanced ultrasound technology to optimize the health of mothers and their babies in a rural community in mid-western Uganda. METHODS: We enrolled 53 mothers and 10 healthcare providers, and captured data on their perceptions, barriers, and facilitators to the use of Doppler ultrasound technology using focus group discussions, semi-structured interviews and observations. Using qualitative content analysis, we inductively coded the transcripts in ATLAS.ti 8.0, detecting emerging themes. RESULTS: Women were afraid that ultrasound would harm them or their fetuses and many of them had never seen an ultrasound scan. The majority of the women found their partners supportive to attend antenatal care and use ultrasound services. Healthcare providers in Kagadi Hospital were unfamiliar with Doppler technology and using it to guide clinical decisions. Other barriers to the implementation of Doppler ultrasound included shortage of trained local staff, insufficient equipment, long distance to and from the hospital, and frequent power cuts. CONCLUSIONS: We found limited exposure to Doppler ultrasound technology among women and healthcare providers in mid-western Uganda. Engaging male partners may potentially influence the likelihood of accepting and using it to improve the health of women and their fetuses while wide spread myths and misconceptions about it may be changed by community engagement. Healthcare workers experienced difficulties in offering follow-up care to mothers detected with complications and Doppler ultrasound required a high level of training. While introducing advanced ultrasound machines to weak health systems, it is important to adequately train healthcare providers to avoid inappropriate interventions based on misinterpretation of the findings, consider where it is likely to be most beneficial, and embed it with realistic clinical practice guidelines.


Asunto(s)
Personal de Salud , Población Rural , África del Sur del Sahara , Femenino , Humanos , Lactante , Masculino , Embarazo , Investigación Cualitativa , Ultrasonografía Doppler
12.
J Appl Oral Sci ; 29: e20200939, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34495104

RESUMEN

BACKGROUND: Arsenic contamination in the environment and groundwater is a major global public health problem. Several researchers suggest that the toxicity of arsenic could be related to oral cancer development, usually resulting from potentially malignant lesions. During pathological processes, salivary proteins suffer modifications, which could lead to the discovery of new biomarkers. OBJECTIVE: To analyze the protein profile in human saliva samples from a rural population exposed to high levels of arsenic in drinking water and its association with potentially malignant lesions. METHODOLOGY: This observational, analytic and cross-sectional design included 121 patients from the state of Graneros (Tucumán, Argentina). Arsenic concentration in drinking water was determined and, according to the values obtained, individuals were divided into 2 groups: exposed group and non-exposed group. Saliva samples were obtained, and total protein concentration was measured by Bradford method. Finally, Laemmli SDS-polyacrylamide gel electrophoresis was conducted to obtain the protein profile. RESULTS: Total protein concentration in saliva was lower in the exposed group than in the non-exposed group. Average areas of 20 and 42 KDa bands were significantly lower in exposed group than non-exposed group. CONCLUSION: Chronic intake of high arsenic concentrations in drinking water produces changes in the salivary protein profile, which is associated with the presence of potentially malignant lesions.


Asunto(s)
Arsénico , Agua Potable , Contaminantes Químicos del Agua , Argentina , Arsénico/análisis , Arsénico/toxicidad , Estudios Transversales , Agua Potable/análisis , Monitoreo del Ambiente , Humanos , Proyectos Piloto , Población Rural , Proteínas y Péptidos Salivales , Contaminantes Químicos del Agua/análisis , Contaminantes Químicos del Agua/toxicidad
13.
An Acad Bras Cienc ; 93(4): e20191178, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34495197

RESUMEN

To better understand the dispersion strategies of Triatoma infestans (Klug) (Hemiptera: Reduviidae, Triatominae), we evaluated the spatial effect of infested peridomicile and density vegetation cover in a historically endemic area for Chagas disease. The study was conducted in rural houses of the northwest of Córdoba province, Argentine, during 2012-2013. Active search of triatomines were made in domicile and peridomicile habitats. To characterize vegetation coverage, a thematic map was obtained considering five types of vegetation cover (closed/open forest, closed/open shrubland and cultural land). From each house we extracted the area of vegetation coverage, housing density and infested peridomiciles density. We used generalized linear models to evaluate the effect of these variables on the occurrence of infested peridomicile. According to our results, the probability of a peridomicile to be infested increases by 1.34 (95%CI [0.98; 1.90]) times more when peridomicile structures are in environments with higher housing density and by 1.25 (95%CI [0.84; 1.88]) more times when houses are surrounded by open shrublands. Among the multiple ecological determinants of peridomestic infestation, the influence of vegetation cover has been poorly studied. In this study we discussed the effect of the vegetation as a potential modulator of the dispersion strategies of T. infestans.


Asunto(s)
Enfermedad de Chagas , Triatoma , Animales , Argentina , Vivienda , Humanos , Insectos Vectores , Población Rural
14.
Pan Afr Med J ; 39: 83, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34466185

RESUMEN

Introduction: quality of life and life expectancy of people are improved when preventive health care services are utilized because these identify treatable health problems and puts life-threatening diseases in check. Morbidity and mortality associated with age-related chronic disease among the older adults is on the increase, therefore, this study aims at determining preventive health care services utilization among older adults in rural communities in Anambra State. Methods: a cross sectional design adopted for this study was carried out on older adults from the ages of 65 years and above in rural communities in Anambra State from October 2019 to January 2020. Data were collected through researcher-administered structured questionnaire. Data were analysed using univariable and multivariable regression analysis. Results: a total of 1944 older adults participated with an overall cluster percentage of 40.6% older adults utilizing investigated preventive health care services. The results of the multivariable analysis indicates that the following factors were associated with utilization of preventive healthcare services: male gender (aOR: 0.443, 95%CI: 0.281 - 5.472, p=0.47), level of education; primary (aOR: 1.536, 95%CI: 1.201 - 5.261, p=0.00), secondary (aOR: 4.516, 95%CI: 3.192 - 6.242, p=0.00), and tertiary (aOR: 3.407, 95%CI: 3.199 - 5.666, p=0.00)], income of N50,000-N100,000 (aOR: 2.754, 95%CI: 1.066 - 10.766, p=0.01), and N100,000 and above (aOR: 4.233, 95%CI: 1.846 - 12.811, p=0.00)], and health insurance [aOR: 0.691, 95%CI: 0.422 - 1.945, p=0.03]. Conclusion: preventive health care services were under-utilized. Creating awareness on the importance of utilizing preventive health care services is highly recommended since most age-related chronic diseases once established may last a lifetime and affect quality of life and wellbeing.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Servicios Preventivos de Salud/estadística & datos numéricos , Calidad de Vida , Población Rural/estadística & datos numéricos , Anciano , Estudios Transversales , Femenino , Humanos , Masculino , Nigeria , Encuestas y Cuestionarios
15.
BMC Health Serv Res ; 21(1): 914, 2021 Sep 04.
Artículo en Inglés | MEDLINE | ID: mdl-34479540

RESUMEN

BACKGROUND: In 2018, 875 000 under-five children died in India with children from poor families and rural communities disproportionately affected. Community health centres are positioned to improve access to quality child health services but capacity is often low and the systems for improvements are weak. METHODS: Secondary analysis of child health program data from the Uttar Pradesh Technical Support Unit was used to delineate how program activities were temporally related to public facility readiness to provide child health services including inpatient admissions. Fifteen community health centres were mapped regarding capacity to provide child health services in July 2015. Mapped domains included human resources and training, infrastructure, equipment, drugs/supplies and child health services. Results were disseminated to district health managers. Six months following dissemination, Clinical Support Officers began regular supportive supervision and gaps were discussed monthly with health managers. Senior pediatric residents mentored medical officers over a three-month period. Improvements were assessed using a composite score of facility readiness for child health services in July 2016. Usage of outpatient and inpatient services by under-five children was also assessed. RESULTS: The median essential composition score increased from 0.59 to 0.78 between July 2015 and July 2016 (maximum score of 1) and the median desirable composite increased from 0.44 to 0.58. The components contributing most to the change were equipment, drugs and supplies and service provision. Scores for trained human resources and infrastructure did not change between assessments. The number of facilities providing some admission services for sick children increased from 1 in July 2015 to 9 in October 2016. CONCLUSIONS: Facility readiness for the provision of child health services in Uttar Pradesh was improved with relatively low inputs and targeted assessment. However, these improvements were only translated into admissions for sick children when clinical mentoring was included in the support provided to facilities.


Asunto(s)
Servicios de Salud del Niño , Población Rural , Niño , Centros Comunitarios de Salud , Personal de Salud , Humanos , India
16.
BMC Health Serv Res ; 21(1): 925, 2021 Sep 06.
Artículo en Inglés | MEDLINE | ID: mdl-34488746

RESUMEN

BACKGROUND: Telemedical care of nursing home residents in Germany, especially in rural areas, is limited to a few pilot projects and is rarely implemented as part of standard care. The possible merits of implementing video consultations in longer-term nursing care currently lack supporting evidence. In particular, there is little documentation of experiences and knowledge about the effects and potential benefits of the implementation in presently existing structures. The goal was to assess the effect of implementing medical video consultations into nursing home care addressing the following research questions: How is medical care currently provided to nursing home residents, and where do problems in its implementation arise? How can video consultations be used to reduce difficulties arising in everyday care? How does implementation of video consultations impact day-to-day nursing home care delivery? METHODS: Twenty-one guided interviews (pre-implementation n = 13; post-implementation n = 8) were conducted with a total of 13 participants (physicians, nurses and medical technical assistants). Narratives were analysed using qualitative content analysis. The results were contrasted in a pre-post analysis. RESULTS: Challenges described by the participants before implementation included a requirement for additional organisational and administrative efforts, interruptions in the daily care routine or delayed treatments, and risk for loss of patient-relevant information due to process diversity. After implementation, communication was facilitated upon introduction of assigned time slots for video consultations. Clinical information was less likely to be lost, additional work was spared, and medication and therapeutic and assistive devices were provided more quickly. CONCLUSIONS: Telehealth cannot replace physical, in-person visits, but does offer an alternative form of service delivery when properly integrated into existing structures. Our results suggest that the use of video consultations in nursing homes can reduce the burden and additional workload, and increase the efficiency of care provision for nursing home residents. Video consultations can complement in-person visits to nursing homes, especially to address the shortage of medical specialists in rural areas in Germany. To promote implementation and acceptance of video consultation in nursing homes, we need to increase awareness of its benefits and undertake further evaluation of video consultations in nursing home care.


Asunto(s)
Telemedicina , Alemania , Humanos , Casas de Salud , Derivación y Consulta , Población Rural
17.
Cien Saude Colet ; 26(suppl 2): 3805-3813, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34468674

RESUMEN

This paper aimed to identify food consumption differences as per healthy and unhealthy diet markers among adults living in Brazilian urban and rural areas. A cross-sectional study was performed with data from the National Health Survey (2013). Diet was assessed by using healthy and unhealthy diet markers. Prevalence (%) was estimated, and sequential logistic regression models were adjusted to estimate odds ratios (OR) and confidence intervals (95%CI). Urban areas evidenced a higher consumption of fruits and vegetables, fish, soft drinks, and meal replacement by snacks, while rural areas showed higher consumption of meat with excess fat and beans. Adjusted analyses showed higher regular consumption of beans and meat with excess fat; and lower consumption of soft drinks, fruits and vegetables and meal replacement by snacks in rural areas compared to urban areas. Similar trends were observed in the macro-regions of the country. Food consumption differences among Brazilians living in rural and urban areas denote the importance of fostering food policies that respect and value food traditions and culture.


Asunto(s)
Conducta Alimentaria , Verduras , Adulto , Estudios Transversales , Dieta , Encuestas Epidemiológicas , Humanos , Población Urbana
18.
J Glob Health ; 11: 13002, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34484709

RESUMEN

Background: Early marriage and maternity prevalence rates among adolescent girls remain alarmingly high in West and Central Africa (WCA). This study aims to explore the associations between socio-economic factors and the prevalence of early marriage and maternity, thus contributing to the identification of girls at risk of early pregnancy or marriage. Methods: We pooled data from national representative surveys (1986 - 2017) for 23 countries in WCA to examine associations between wealth, educational attainment, religious affiliation, and place of residence with adolescent marriage and maternity. We decomposed the wealth and education gradients for individual countries, while controlling for common characteristics of the local environment via the use of primary sampling unit fixed-effects. The pooled sample provides information on 262 721 girls (age 15-19 years). Survey weights and population share weights were used in the estimations. Results: The prevalence of adolescent maternity and marriage exhibited a wealth and education gradient. Prevalence of marriage in the poorest wealth quintile was 41.1% (95% confidence interval (CI) = 38.8%-43.5%) and 10.5% (95% CI = 9.5%-11.6%) in the richest. For maternity it was 38.3% (95% CI = 36.4%-40.3%) in the poorest quintile and 12.7% (95% CI = 11.5%-13.9%) in the richest. Marriage/maternity is three/two times more likely to occur among girls with incomplete primary or no formal education than in those with at least primary. Maternity and marriage among adolescents exhibit a geographical pattern and differences between religious groups. Adolescent marriage prevalence was 34.4% (95% CI = 32.9%-35.8%) in rural areas compared to 13.3% (95% CI = 12.3%-14.2%) in urban areas. Adolescent maternity prevalence was 32.8% (95% CI = 31.7%-33.9%) in rural compared to 16.3% (95% CI = 15.3%-17.3%) in urban areas. Finally, the prevalence of adolescent marriage was substantially higher among Muslims compared to all other religious groups. Conclusions: Our results highlight the disparities in the prevalence of adolescent marriage and maternity and confirm the existence of wealth and education gradients. These findings can help to improve targeting of vulnerable adolescents and to identify areas for policy implementation.


Asunto(s)
Matrimonio , Población Rural , Adolescente , Adulto , África Central , Escolaridad , Femenino , Humanos , Embarazo , Prevalencia , Factores Socioeconómicos , Adulto Joven
19.
BMC Pediatr ; 21(1): 390, 2021 09 07.
Artículo en Inglés | MEDLINE | ID: mdl-34493225

RESUMEN

BACKGROUND: Neonatal mortality remains unacceptably high. Many studies successful at reducing neonatal mortality have failed to realise similar gains at scale. Effective implementation and scale-up of interventions designed to tackle neonatal mortality is a global health priority. Multifaceted programmes targeting the continuum of neonatal care, with sustainability and scalability built into the design, can provide practical insights to solve this challenge. Cambodia has amongst the highest neonatal mortality rates in South-East Asia, with rural areas particularly affected. The primary objective of this study is the design, implementation, and assessment of the Saving Babies' Lives programme, a package of interventions designed to reduce neonatal mortality in rural Cambodia. METHODS: This study is a five-year stepped-wedge cluster-randomised trial conducted in a rural Cambodian province with an estimated annual delivery rate of 6615. The study is designed to implement and evaluate the Saving Babies' Lives programme, which is the intervention. The Saving Babies' Lives programme is an iterative package of neonatal interventions spanning the continuum of care and integrating into the existing health system. The Saving Babies' Lives programme comprises two major components: participatory learning and action with community health workers, and capacity building of primary care facilities involving facility-based mentorship. Standard government service continues in control arms. Data collection covering the whole study area includes surveillance of all pregnancies, verbal and social autopsies, and quality of care surveys. Mixed methods data collection supports iteration of the complex intervention, and facilitates impact, outcome, process and economic evaluation. DISCUSSION: Our study uses a robust study design to evaluate and develop a holistic, innovative, contextually relevant and sustainable programme that can be scaled-up to reduce neonatal mortality. TRIAL REGISTRATION: ClinicalTrials.gov: NCT04663620 . Registered on 11th December 2020, retrospectively registered.


Asunto(s)
Mortalidad Infantil , Población Rural , Cambodia , Agentes Comunitarios de Salud , Atención a la Salud , Femenino , Humanos , Lactante , Recién Nacido , Embarazo , Ensayos Clínicos Controlados Aleatorios como Asunto
20.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 33(4): 406-410, 2021 Aug 23.
Artículo en Chino | MEDLINE | ID: mdl-34505449

RESUMEN

OBJECTIVE: To investigate the prevalence and influencing factors of Enterobius vermicularis infections among children in Fanxian County, Henan Province in 2019, so as to provide insights into the management of enterobiasis. METHODS: Five kindergartens were selected in urban and rural areas of Fanxian County, Henan Province using the stratified sampling method in 2019, and a census of E. vermicularis infections was performed among all children in the kindergartens. E. vermicularis eggs were detected using adhesive and scotch cellophane-tape anal swab methods, and the basic characteristics of children and their families, health habits and the kindergartens' information were investigated with questionnaires. Logistic regression analysis was used to investigate the risk factors and protective factors of pinworm infection in children. RESULTS: A total of 671 children were tested, and the mean prevalence of E. vermicularis infections was 15.50% (104/671). The prevalence of E. vermicularis infections was higher among children in rural kindergartens (28.13%, 72/256) than in urban kindergartens (7.71%, 32/415) (χ2 = 50.380, P < 0.01), and greater in private kindergartens (32.26%, 60/186) than in public kindergartens (9.07%, 44/485) (χ2 = 55.183, P < 0.01). There was no gender-specific prevalence of E. vermicularis infections among children (χ2 = 1.442, P > 0.05), and the prevalence of E. vermicularis infections presented a tendency towards a rise with age (χ2trend = 8.373, P < 0.05) and school grade (χ2trend = 30.274, P < 0.05). Logistic regression analysis identified rural kindergartens and high grades as risk factors, and separate washing of children's and adults' cloths, frequent bathing and frequent dinnerware disinfection in kindergartens as protective factors for E. vermicularis infections among children. In addition, there was no significant difference in the detection of E. vermicularis infections among children by using adhesive (73.08%, 76/104) and scotch cellophane-tape anal swab methods (56.73%, 59/104) (χ2 = 3.959, P > 0.05). CONCLUSIONS: The prevalence of E. vermicularis infection is high among children in Fanxian Country, Henan Province. Health education and surveillance of enterobiasis are required to be intensified among children in rural kindergartens and senior grades and their parents and teachers.


Asunto(s)
Enterobiasis , Animales , Niño , Enterobiasis/epidemiología , Enterobius , Humanos , Prevalencia , Factores de Riesgo , Población Rural
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