Socioeconomic differences in access to care in Australia for women fearful of birth

2019 ◽  
Vol 43 (6) ◽  
pp. 639 ◽  
Author(s):  
Jocelyn Toohill ◽  
Emily Callander ◽  
Haylee Fox ◽  
Daniel Lindsay ◽  
Jenny Gamble ◽  
...  
Keyword(s):  
Health Policy ◽  
Low Income ◽  
Univariate Analysis ◽  
Perinatal Period ◽  
Positive Outcomes ◽  
Midwifery Care ◽  
Policy Makers ◽  
Caseload Midwifery ◽  
Significant Difference ◽  
Equity In Access

Objective Fear of childbirth is known to increase a woman’s likelihood of having a Caesarean section. Continuity of midwifery care is known to reduce this risk, but less than 8% of women have access to this relationship-based, primary care model. The aims of this study were to determine whether healthcare use and access to continuity models are equal across different indicators of socioeconomic status for women who are fearful of birth. Methods A secondary analysis was conducted of data obtained during a randomised controlled trial of a psychoeducation intervention by trained midwives to minimise childbirth fear (the Birth Emotions and Looking to Improve Expectant Fear (BELIEF) study). In all, 1410 women were screened, with 339 women reporting high levels of fear (Wijma-Delivery Expectancy/Experience Questionnaire ≥66). Demographic, obstetric information, birth preference and psychosocial measures were collected at recruitment and at 36 weeks gestation for the 339 fearful women, with the birth method and health service use returned by 183 women at 6 weeks after the birth. Results Univariate analysis revealed no significant difference in the number of general practitioner and midwife visits between women of high and low income and high and low education. However, women with higher levels of education had 2.51-fold greater odds of seeing the same midwife throughout their pregnancy than women with lower education (95% confidence interval 1.25–5.04), after adjusting for age, parity and hospital site. Conclusions Given the known positive outcomes of continuity of midwifery care for women fearful of birth, health policy makers need to provide equity in access to evidence-based models of midwifery care. What is known about this topic? Caseload midwifery care is considered the gold standard care due to the known positive outcomes it has for the mother and baby during the perinatal period. Pregnant women who receive caseload midwifery care are more likely to experience a normal vaginal birth. What does this paper add? There is unequal access to midwifery caseload care for women fearful of birth across socioeconomic boundaries. Midwifery caseload care is not used for all fearful mothers during the perinatal period. What are the implications for practitioners? Health policy makers seeking to provide equity in access to maternity care should be aware of these inequalities in use to target delivery of care at this specific cohort of mothers.

scholarly journals The Value of Anthropology in Child Health Policy

2018 ◽  
Vol 25 (1) ◽  
pp. 29-40 ◽  
Author(s):  
Julie Spray
Keyword(s):  
Health Policy ◽  
Child Health ◽  
Social Relations ◽  
Low Income ◽  
Active Role ◽  
Policy Makers ◽  
Child Health Policy ◽  
Streptococcus A ◽  
Government Initiative

AbstractWorking at the nexus of medical anthropology and the anthropology of childhood, this article challenges three assumptions often embedded in child health policy: (1) children are the passive recipients of healthcare; (2) children’s knowledge of illness and their body can be assumed based on adult understandings; and (3) children’s healthcare can be isolated from their social relations. I explore these themes through the case study of a 2011 New Zealand government initiative to reduce the rates of rheumatic fever affecting low-income Māori and Pasifika children. Drawing on fieldwork with around 80 children at an Auckland primary school, I show how the ‘sore throat’ programme does not merely treat streptococcus A infections, but plays an active role in constituting children’s experiences and understandings of their bodies and illness, and in shaping healthcare practices in ways unintended by policy-makers.

Factors affecting time to treatment in hepatocellular cancer.

2020 ◽  
Vol 38 (15_suppl) ◽  
pp. e19088-e19088 ◽  
Author(s):  
Karan Seegobin ◽  
Umair Majeed ◽  
Ashton Ritter ◽  
Natasha Wylie ◽  
Jason Scott Starr ◽  
...  
Keyword(s):  
Socioeconomic Factors ◽  
Low Income ◽  
Treatment Initiation ◽  
Univariate Analysis ◽  
Published Data ◽  
Time To Treatment ◽  
Risk Of Death ◽  
Increased Risk ◽  
Significant Difference ◽  
Time To Treatment Initiation

e19088 Background: Significant disparities in the stage at diagnosis and survival outcomes exist between various groups diagnosed with hepatocellular carcinoma (HCC) based on sex, race, insurance coverage, and marital status. Previously published data shows disparities more in patients who are African-American, Asian and low income. Little data has been published on factors that influence timeliness to treatment initiation in patients diagnosed with HCC. Methods: Retrospective analysis was performed on 96,586 patients diagnosed with HCC from 2004-2014 using data in the National Cancer Database (NCDB). Time to treatment was divided into two categories: ≤40 days (early, n = 66322) and > 40 days (late, n = 30264). We carried out univariate and multivariate analyses to compare demographic, clinical, treatment, and facility-related factors influencing the timeliness of treatment initiation in HCC. Results: Univariate analysis revealed a significant difference in time to treatment initiation based on age, race, income, insurance status, type of area, geographic region, type of facility, and cancer stage (P < 0.001). Multivariate analysis showed that household income < $30,000/year, Pacific region, urban area of residence, black race, age 70-79 years old or ≥80 years old, academic centers, stage II disease and medicaid insurance were all factors with longer time to treatment initiation. Discussion: HCC is the sixth most common cancer and the second leading cause of cancer mortality worldwide. The 5-year relative survival for localized, regional, and distant stages are 32.6%, 10.8% and 2.4% respectively. In our results we noted significant disparities in time to treatment with respect to various socioeconomic factors. These results are comparable to that reported in other cancer types. Further subgroup analysis of our data shows 2581 patients who received their first treatment after 200 days. In a similar study done in Taiwan, those treated more than 181 days and 61–180 days after diagnosis had a 1.68 and a 1.39 increased risk of death respectively, which were statistically significant. Many factors contribute to delayed treatment, some of which are difficult to circumvent, however where possible efforts should be made to overcome these. Conclusions: Various socioeconomic factors were found to affect the time to treatment initiation in HCC patients. The next step would be to strategically implement policies and practices to address these factors.

A Revolutionary Look at Health Policy Analysis in Developing Countries

2016 ◽  
pp. 137-157
Author(s):  
Rahmatollah Gholipour ◽  
Khadijeh Rouzbehani ◽  
Goltan Fakhteh Yavari
Keyword(s):  
Health Policy ◽  
Policy Analysis ◽  
Low Income ◽  
Research Process ◽  
Low Income Countries ◽  
Policy Makers ◽  
Health Policy Analysis ◽  
Health Practitioners ◽  
Research Designs ◽  
Policy Researcher

Health policy analysis has been the focus of attention of a number of scholars, health practitioners and policy makers. However, there has been much less attention given to how to do policy analysis, what research designs, theories or methods best inform policy analysis. This study begins by looking at the health policy environment, and some of the challenges to researching this highly complex phenomenon. It focuses on research in middle and low income countries. Attention is drawn to the roles of the policy researcher and the importance of reflexivity and researcher's position in the research process and finally ways of advancing the field of health policy analysis is discussed.

Factors Related to the High Prevalence of Diabetic Kidney Disease in Ecuador-Update for Health Policy Makers

Diabetes ◽  
2018 ◽  
Vol 67 (Supplement 1) ◽  
pp. 526-P
Author(s):  
MARIANA E. GUADALUPE ◽  
GRACIELA B. ALVAREZ CONDO ◽  
FANNY E. VERA LORENTI ◽  
BETTY J. PAZMIÑO GOMEZ ◽  
EDGAR I. RODAS NEIRA ◽  
...  
Keyword(s):  
Health Policy ◽  
Kidney Disease ◽  
Diabetic Kidney Disease ◽  
Policy Makers ◽  
Diabetic Kidney ◽  
High Prevalence

Households Discrimination in School Enrolment in Pakistan: Does gender matter?

2018 ◽  
Vol 2 (1) ◽  
pp. 29-36
Author(s):  
Ali Muhammad ◽  
Zahoor Ul Haq ◽  
Imad Khan
Keyword(s):  
Low Income ◽  
Gender Discrimination ◽  
Rural Areas ◽  
Gender Disparity ◽  
School Enrollment ◽  
Female Education ◽  
Public And Private ◽  
Significant Difference ◽  
Different Types ◽  
Socio Economic Factors

This study uses Pakistan Social and Living Measurement Survey 2016 to study gender discrimination in school enrollment across the four provinces of Pakistan using bi-variate analysis. Results show that there is highly significant difference between male and female education in rural areas (x^2=4940.50 and p<0.05). Analysis indicate that gender disparity in enrollment is significantly higher in low income households (x^2=115.468 and P<0.05). The study also showed that as compared to male, fewer female are enrolled in both public and private sectors. Hence, socio-economic factors play important role in making decision about children enrollment in different types of school. The study recommends that government to take appropriate steps to reduce gender discrimination in school enrollment by offering subsidy on female education in the country.

scholarly journals Cohort study of the overall survival of patients with pancreatic cancer in a hospital of specialties of Quito-Ecuador in the period 2007–2017

2021 ◽  
Vol 0 (0) ◽  
Author(s):  
Andrés Moreno Roca ◽  
Luciana Armijos Acurio ◽  
Ruth Jimbo Sotomayor ◽  
Carlos Céspedes Rivadeneira ◽  
Carlos Rosero Reyes ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Cohort Study ◽  
Survival Time ◽  
Univariate Analysis ◽  
Rank Test ◽  
Kaplan Meier ◽  
Significant Difference ◽  
Icd 10 ◽  
The Difference ◽  
Clinical Records

Abstract Objectives Pancreatic cancers in most patients in Ecuador are diagnosed at an advanced stage of the disease, which is associated with lower survival. To determine the characteristics and global survival of pancreatic cancer patients in a social security hospital in Ecuador between 2007 and 2017. Methods A retrospective cohort study and a survival analysis were performed using all the available data in the electronic clinical records of patients with a diagnosis of pancreatic cancer in a Hospital of Specialties of Quito-Ecuador between 2007 and 2017. The included patients were those coded according to the ICD 10 between C25.0 and C25.9. Our univariate analysis calculated frequencies, measures of central tendency and dispersion. Through the Kaplan-Meier method we estimated the median time of survival and analyzed the difference in survival time among the different categories of our included variables. These differences were shown through the log rank test. Results A total of 357 patients diagnosed with pancreatic cancer between 2007 and 2017 were included in the study. More than two-thirds (69.9%) of the patients were diagnosed in late stages of the disease. The median survival time for all patients was of 4 months (P25: 2, P75: 8). Conclusions The statistically significant difference of survival time between types of treatment is the most relevant finding in this study, when comparing to all other types of treatments.

scholarly journals 387. Markers for Mortality in COVID-19 Patients with Atrial Fibrillation or Flutter

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S262-S262
Author(s):  
Kok Hoe Chan ◽  
Bhavik Patel ◽  
Iyad Farouji ◽  
Addi Suleiman ◽  
Jihad Slim
Keyword(s):  
Atrial Fibrillation ◽  
Logistic Regression ◽  
Cohort Study ◽  
Retrospective Cohort Study ◽  
Retrospective Cohort ◽  
Prognostic Markers ◽  
Univariate Analysis ◽  
Laboratory Data ◽  
Significant Difference ◽  
New Onset

Abstract Background Severe Acute Respiratory Syndrome Coronavirus 2 (SARS-CoV-2) infection can lead to many different cardiovascular complications, we were interested in studying prognostic markers in patients with atrial fibrillation/flutter (A. Fib/Flutter). Methods A retrospective cohort study of patients with confirmed COVID-19 and either with existing or new onset A. Fib/Flutter who were admitted to our hospital between March 15 and May 20, 2020. Demographic, outcome and laboratory data were extracted from the electronic medical record and compared between survivors and non-survivors. Univariate and multivariate logistic regression were employed to identify the prognostic markers associated with mortality in patients with A. Fib/Flutter Results The total number of confirmed COVID-19 patients during the study period was 350; 37 of them had existing or new onset A. Fib/Flutter. Twenty one (57%) expired, and 16 (43%) were discharged alive. The median age was 72 years old, ranged from 19 to 100 years old. Comorbidities were present in 33 (89%) patients, with hypertension (82%) being the most common, followed by diabetes (46%) and coronary artery disease (30%). New onset of atrial fibrillation was identified in 23 patients (70%), of whom 13 (57%) expired; 29 patients (78%) presented with atrial fibrillation with rapid ventricular response, and 2 patients (5%) with atrial flutter. Mechanical ventilation was required for 8 patients, of whom 6 expired. In univariate analysis, we found a significant difference in baseline ferritin (p=0.04), LDH (p=0.02), neutrophil-lymphocyte ratio (NLR) (p=0.05), neutrophil-monocyte ratio (NMR) (p=0.03) and platelet (p=0.015) between survivors and non-survivors. With multivariable logistic regression analysis, the only value that had an odds of survival was a low NLR (odds ratio 0.74; 95% confidence interval 0.53–0.93). Conclusion This retrospective cohort study of hospitalized patients with COVID-19 demonstrated an association of increase NLR as risk factors for death in COVID-19 patients with A. Fib/Flutter. A high NLR has been associated with increased incidence, severity and risk for stroke in atrial fibrillation patients but to our knowledge, we are first to demonstrate the utilization in mortality predictions in COVID-19 patients with A. Fib/Flutter. Disclosures Jihad Slim, MD, Abbvie (Speaker’s Bureau)Gilead (Speaker’s Bureau)Jansen (Speaker’s Bureau)Merck (Speaker’s Bureau)ViiV (Speaker’s Bureau)

scholarly journals AB0132 THE STUDY OF SUBCLINICAL SYNOVITIS DETECTED BY ULTRASONOGRAPHY AND MRI IN RA PATIENTS AFTER REACHING CLINICAL REMISSION ON PATIENT’S SUBJECTIVE SYMPTOMS

2021 ◽  
Vol 80 (Suppl 1) ◽  
pp. 1094.2-1094
Author(s):  
M. Nawata ◽  
K. Someya ◽  
T. Aritomi ◽  
M. Funada ◽  
K. Nakamura ◽  
...  
Keyword(s):  
Clinical Remission ◽  
Research Funding ◽  
Morning Stiffness ◽  
Univariate Analysis ◽  
P Value ◽  
Research Support ◽  
Residual Symptoms ◽  
Logistic Analysis ◽  
Significant Difference ◽  
Multivariate Logistic Analysis

Background:The goal of treatment in rheumatoid arthritis (RA) is to achieve remission. There is the patient with residual symptoms in the Japanese RA patient who achieved clinical remission. There are not many studies to examine the relation between everyday life, social activity and evaluation of disease activities using high-sensitivity image examinations (musculoskeletal ultrasound (MSKUS) and MRI).Objectives:To examine the relationship between subjective residual symptoms and imaging examinations in RA patients who have achieved clinical remission.Methods:30 RA patients who achieved SDAI remission during RA treatment. Age, sex, disease duration, physical findings, serological markers, disease activity, HAQ, EQ-5D-5L, FACIT-F, Patient Reported Outcomes (PROs), EGA and medications were evaluated. 44 joints were assessed by MSKUS with gray scale (GS) and power doppler (PD) and contrast-enhanced bilateral joint MRI scoring with OMERACT-RAMRIS scoring.Results:1. The mean SDAI of the 30 RA patients was 1.3. 2.In the analysis of the presence or absence of subjective residual symptoms that led to remission of SDAI (Table 1).Table 1.Subjective residual symptoms/presence (N=17)Subjective residual symptoms/absence (N=13)Univariate analysisp valueMultivariate logistic analysisp valueTJC0.0±0.00.3±0.50.0173HAQ0.4±0.40.05±0.10.00950.00181EQ5D-5L0.8±0.10.9±0.00.0001FACIT-F14.5±9.84.6±4.30.0233Morning stiffness (min)256.5±564.80.0±0.00.0210Pain (VAS) (mm)9.2±9.50.9±1.50.00440.0455PGA (mm)7.7±9.00.5±1.10.0013(1). In the univariate analysis, the number of tender joints, HAQ, EQ-5D-5L, FACIT-F, morning stiffness, and pain VAS were extracted with significant differences.(2). In multivariate logistic analysis, HAQ and pain VAS were extracted as independent factors with significant differences. 3.In univariate analysis of the association between HAQ and pain VAS extracted in multivariate logistic analysis and imaging examinations (MSKUS/MRI), MRI-synovitis was extracted with a significant difference in HAQ.Conclusion:1. It was suggested that Pain VAS and HAQ due to RA could be identified in patients reaching SDAI remission. 2. In patients reaching SDAI remission, Pain VAS ≤10 or HAQ ≤0.5 suggested that subjective residual symptoms may be eliminated. 3. HAQ ≤ 0.5 suggests that synovitis is less likely to be detected on MRI. 4. In patients who have reached SDAI remission, little residual inflammation was observed on US, suggesting that induction of remission is important not only to prevent joint destruction, but also to improve and maintain long-term QoL.Disclosure of Interests:MASAO NAWATA Grant/research support from: I have received research funding from Eli Lilly Japan K.K., Kazuki Someya: None declared, Takafumi Aritomi: None declared, Masashi funada: None declared, Katsumi Nakamura: None declared, SAITO KAZUYOSHI Grant/research support from: I have received research funding from Eli Lilly Japan K.K., Yoshiya Tanaka Speakers bureau: I have received speaking fees from Abbvie, Daiichi-Sankyo, Chugai, Takeda, Mitsubishi-Tanabe, Bristol-Myers, Astellas, Eisai, Janssen, Pfizer, Asahi-kasei, Eli Lilly, GlaxoSmithKline, UCB, Teijin, MSD, and Santen, Consultant of: I have received consulting fees from Abbvie, Daiichi-Sankyo, Chugai, Takeda, Mitsubishi-Tanabe, Bristol-Myers, Astellas, Eisai, Janssen, Pfizer, Asahi-kasei, Eli Lilly, GlaxoSmithKline, UCB, Teijin, MSD, and Santen, Grant/research support from: I have received research grants from Mitsubishi-Tanabe, Takeda, Chugai, Astellas, Eisai, Taisho-Toyama, Kyowa-Kirin, Abbvie, and Bristol-Myers

scholarly journals The Dimension of Sustainability: A Comparative Analysis of Broadness of Information in Italian Companies

2021 ◽  
Vol 13 (3) ◽  
pp. 1457 ◽  
Author(s):  
Sabrina Spallini ◽  
Virginia Milone ◽  
Antonio Nisio ◽  
Patrizia Romanazzi
Keyword(s):  
Business Performance ◽  
Univariate Analysis ◽  
Multivariate Regression Analysis ◽  
Global Reporting Initiative ◽  
Policy Makers ◽  
Mean Values ◽  
Regulatory Interventions ◽  
Development Goals ◽  
Key Dimensions ◽  
Positive Correlations

In recent years, sustainability has become one of the key dimensions of business performance. The results obtained in terms of sustainability must be adequately communicated in suitable reports, the quality of which is determined by several factors. One of these, the breadth of information provided, plays a significant role. The aim of this paper is to measure the broadness of non-financial information in sustainability reports and correlate this to some selected variables that refer to corporate governance, i.e., the presence of an internal sustainability committee and of female directors; the characteristics of the report e.g., Sustainable Development Goals (SDG) citation; company features, number of employees, revenues, and Return On Assets ROA. For this purpose, 134 Italian companies were studied and a score based on the conformity of the NFD (non-financial disclosure) with the GRI (Global Reporting Initiative) standards was created. To test the research hypotheses, univariate analysis and multivariate regression analysis were performed. The results showed different behaviors by the companies in terms of sustainability policies. The GRISC (Global Reporting Initiative Score) has a greater concentration on mean values. Positive correlations were found between GRISC and the presence of an internal sustainability committee, SDG citation in the NFD and company size. This study offers support for policy makers and practitioners as it provides a measure of the breadth of sustainability information and relates this to the variables analyzed. The latter depend on regulatory interventions or company policies which are implemented, or could be implemented, to improve the extent of the NFD.

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