scholarly journals An ecological study of publicly funded elective hip arthroplasties in Brazil and Scotland: do access inequalities reinforce the inverse care law?

JRSM Open ◽  
2020 ◽  
Vol 11 (5) ◽  
pp. 205427042092077
Author(s):  
Jonathan Filippon ◽  
Stephen Bremner ◽  
Ligia Giovanella ◽  
Allyson Pollock
Keyword(s):  
Public Sector ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Ecological Study ◽  
Publicly Funded ◽  
The Public ◽  
Unified Health System ◽  
Inverse Care Law ◽  
And Gender ◽  
Hip Arthroplasties

Objectives To compare elective hip arthroplasty rates funded by the public sector in Brazil and Scotland. Design Ecological study, 2009–13, of crude and directly standardised rates of elective primary hip arthroplasty rates (per 100,000) funded by the public sector at national and regional level for age (30 + years) and gender in Brazil and Scotland. Setting National Health Service Scotland and Unified Health System in Brazil. Participants Over 30 s who had undergone an elective hip arthroplasty funded by the public sector. Main outcome measures Publicly funded standardised elective hip arthroplasty rates in Brazil and Scotland. Results Between 2009 and 2013, there was a seven-fold difference in treatment rates between Brazil and Scotland, and an eight-fold regional difference in Brazil; Brazil (7.8–8.3/100,000, increase of 0.5 per 100,000, 95% confidence interval (CI) (0.3, 0.7) from 2009/10 to 2012/13) and Scotland (from 61.1 to 57.7/100,000, decrease of 3.4 per 100,000, 95% confidence interval (1.4, 5.8) per 100,000); a two-fold difference in number of public beds per head of population (Brazil 158.3/100,000 vs. Scotland 305.1/100,000) and general medical workforce (Brazil 198.8/100,000 vs. Scotland 327.4/100,000); numbers of orthopaedic surgeons per head of population in the two countries were similar in 2013 (Brazil 5.2/100,000 vs. Scotland 4.3/100,000). Conclusion Although the ‘inverse care law’ is seen in both countries, access to publicly funded hip arthroplasties in Brazil is worse than in Scotland; the distribution of specialists and higher treatment rates in Brazil is highly skewed towards wealthier areas, perpetuating historical regional inequalities.

Should National Standards for Reporting Surgical Site Infections Distinguish between Primary and Revision Orthopedic Surgeries?

2010 ◽  
Vol 31 (05) ◽  
pp. 503-508 ◽  
Author(s):  
Surbhi Leekha ◽  
Priya Sampathkumar ◽  
Daniel J. Berry ◽  
Rodney L. Thompson
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Odds Ratio ◽  
Risk Index ◽  
National Standards ◽  
Revision Total Hip Arthroplasty ◽  
Total Hip ◽  
Hip Arthroplasties ◽  
Primary Total Hip Arthroplasty

Objective. To compare the surgical site infection (SSI) rate after primary total hip arthroplasty with the SSI rate after revision total hip arthroplasty. Design. Retrospective cohort study. Setting. Mayo Clinic in Rochester, Minnesota, a referral orthopedic center. Patients. All patients undergoing primary total hip arthroplasty or revision total hip arthroplasty during the period from January 1, 2002, through December 31, 2006. Methods. We obtained data on total hip arthroplasties from a prospectively maintained institutional surgical database. We reviewed data on SSIs collected prospectively as part of routine infection control surveillance, using the criteria of the Centers for Disease Control and Prevention for the definition of an SSI. We used logistic regression analyses to evaluate differences between the SSI rate after primary total hip arthroplasty and the SSI rate after revision total hip arthroplasty. Results. A total of 5,696 total hip arthroplasties (with type 1 wound classification) were analyzed, of which 1,381 (24%) were revisions. A total of 61 SSIs occurred, resulting in an overall SSI rate of 1.1% for all total hip arthroplasties. When stratified by the National Nosocomial Infection Surveillance (NNIS) risk index, SSI rates were 0.5%, 1.2%, and 1.6% in risk categories 0, 1, and 2, respectively. After controlling for the NNIS risk index, the risk of SSI after revision total hip arthroplasty was twice as high as that after primary total hip arthroplasty (odds ratio, 2.2 [95% confidence interval, 1.3-3.7]). In the analysis restricted to the development of deep incisional or organ space infections, the risk of SSI after revision total hip arthroplasty was nearly 4 times that after primary total hip arthroplasty (odds ratio, 3.9 [95% confidence interval, 2.0-7.6]). Conclusion. Including revision surgeries in the calculation of SSI rates can result in higher infection rates for institutions that perform a larger number of revisions. Taking NNIS risk indices into account does not eliminate this effect. Differences between primary and revision surgeries should be considered in national standards for the reporting of SSIs.

scholarly journals Violence against the Brazilian elderlies: an analysis of hospitalizations

2018 ◽  
Vol 71 (suppl 2) ◽  
pp. 777-785 ◽  
Author(s):  
Vivian Carla de Castro ◽  
Leidyani Karina Rissardo ◽  
Lígia Carreira
Keyword(s):  
Public Sector ◽  
The Elderly ◽  
Cross Sectional Study ◽  
Demographic Variables ◽  
Chi Square ◽  
Cross Sectional ◽  
The Public ◽  
Unified Health System ◽  
Quantitative Descriptive ◽  
Old Men

ABSTRACT Objective: to identify the prevalence of physical aggression and neglect and abandonment in the hospitalizations of Brazilian elderly people for violence and assault from 2008 to 2013 and the association of these causes with socio-demographic variables related to hospitalization. Method: quantitative, descriptive, cross-sectional study with elderlies hospitalized for assault. Inclusion criteria: to be 60 years old or over, to have been hospitalized in the Unified Health System (SUS) for assault or neglect and abandonment, between 2008 and 2013. The data were collected in February 2016, in Datasus database and descriptive and inferentially, using the Chi-square distribution, in the Epi Info 3.5.4 program. Results: the prevalence of hospitalizations due to assaults and violence prevailed among 60 and 69 years old men in the public sector. For abandonment and neglect, there was a higher prevalence in women, over 80 years old, in the public sector. Conclusion: nurses must be able to identify and prevent violence against the elderly.

The Government and Pharmaceutical Innovation: Looking Back and Looking Ahead

2021 ◽  
Vol 49 (1) ◽  
pp. 10-18 ◽  
Author(s):  
Bhaven N. Sampat
Keyword(s):  
Public Sector ◽  
Research Funding ◽  
Pharmaceutical Innovation ◽  
Public Research ◽  
Publicly Funded ◽  
Public And Private ◽  
The Public ◽  
Funded Research ◽  
The Government ◽  
Looking Back

AbstractCurrent debates about the roles of the public and private sectors in pharmaceutical innovation have a long history. The extent to which, and ways in which, the public sector supports drug innovation has implications for assessments of the returns to public research funding, taxpayer rights in drugs, the argument the high prices are needed to support drug innovation, and the desirability of patenting publicly funded research.

Leadership in universities

2011 ◽  
Vol 7 (3) ◽  
pp. 229-234 ◽  
Author(s):  
Peter Scott
Keyword(s):  
Higher Education ◽  
Public Sector ◽  
New Public Management ◽  
Central Government ◽  
Publicly Funded ◽  
Apparent Paradox ◽  
Mass System ◽  
Content Type ◽  
The Public ◽  
The Impact

PurposeThe purpose of this paper is to consider whether recent changes in higher education – notably a tripling of student fees and the withdrawal of most direct public funding for teaching – pose fundamental challenges for the pattern of governance, leadership and management in colleges in universities. It considers the impact not only of these visible, politically‐driven changes but also of less visible and longer‐terms shifts in curriculum, teaching delivery, learning cultures and research organisation.Design/methodology/approachHigher education has changed more than most other publicly funded services. Within the space of two generations it has moved from being a collection of institutions catering for an academically (and socially) selected elite, to become a mass system enrolling almost half of young adults – and an increasing proportion of adult students. Yet its governance and management have been marked by continuity. This paper considers the challenges that this greatly extended role for higher education poses for leadership – but in the context of stable arrangements for governance and management. Higher education leadership is also compared, and contrasted with, leadership in other parts of the public sector.FindingsAlthough higher education has been influenced by the New Public Management, it has changed less than other publicly funded services. Although Vice‐chancellors have taken on many of the trappings of executive leaders, most continue to be drawn from traditional academic backgrounds. Few professional managers have broken through into top leadership roles. Governance arrangements, in particular, have changed little – posing issues of strategic oversight and management accountability. Nevertheless, universities have demonstrated remarkable resilience and adaptability, experiencing few of the crises (financial and otherwise) common in other parts of the public sector. This apparent paradox may indicate how effective university leadership may be in the context of managing more open and distributed “knowledge” organisations.Originality/valueConventional wisdom, within central government and elsewhere, suggests that higher education may be experiencing a “deficit” in relation to modern leadership cultures. This paper challenges that assumption, suggesting that other parts of the public sector, especially, those employing a large number of expert and autonomous professionals, could learn from the experience of universities.

scholarly journals Online appendix 2:An evaluation of the public sector optometric service provided within the health districts in KwaZulu-Natal, South Africa

2018 ◽  
Vol 77 (1) ◽  
Author(s):  
Moraka E. Maake ◽  
Vanessa R. Moodley
Keyword(s):  
South Africa ◽  
Public Sector ◽  
Rural Communities ◽  
Health Sector ◽  
Systematic Sampling ◽  
Cross Sectional ◽  
The Public ◽  
Online Appendix ◽  
And Gender ◽  
Study Sites

Background: In South Africa, optometry has been traditionally positioned within the private sector. The situation has gradually changed over the past two decades, with optometry being introduced into the public sector in many parts of the country. Despite the growing numbers, optometrists are still new within the public health sector, motivating this study to evaluate the eye care services they provide.Methods: A cross-sectional, retrospective, descriptive study was undertaken. Stratified random selection was applied to select the study sites, and systematic sampling was used to select patients’ files. A saturated sample of public sector optometrists employed in the selected districts completed study questionnaires. Data were analysed using the Statistical Package for Social Sciences, Version 21.Results: A total of 2968 records were reviewed, and gender distribution was 67.6% female and 32.4% male. Refraction (86.73%) was the most frequently conducted test, followed by ophthalmoscopy (74.73%), colour vision (0.07%) and gonioscopy (0.03%). The response rate for the questionnaires was 64.7%. Optometric outreach services were conducted by 54.5% of optometrists, and the majority (83.3%) reported that the farthest outreach facility was more than 50 km from their base hospital. The availability of equipment at outreach facilities was less as compared to base hospitals, while some reported not having the necessary equipment even at base hospitals. None of the optometrists did contact lens fitting at outreach facilities. A lack of equipment was cited as one of the reasons for not providing this service by 100% of optometrists. Most optometrists (63.6%) believed that more than 30% of their referrals might have been avoided if they had prescribed therapeutic agents to manage ocular conditions.Conclusion: Introducing optometrists within the public sector improves access to services for rural communities. However, the minimum standard of optometric care is not practised, allegedly because of a lack of equipment. Therefore, resources should be made available to enable optometrists to provide comprehensive optometric services. In addition, the study highlighted the need for more optometry posts in rural communities and for the implementation of career growth paths to attract and retain optometrists within the public sector.

scholarly journals Between survival and relevance: remaking 30 years of the Ministry of Women’s Affairs

2015 ◽  
Vol 11 (1) ◽  
Author(s):  
Rachel Simon-Kumar
Keyword(s):  
Public Sector ◽  
Public Management ◽  
New Public Management ◽  
The Other ◽  
The Public ◽  
New Public ◽  
The World ◽  
And Gender ◽  
The One ◽  
Women's Policy Agencies

Since its establishment in 1984 the Ministry of Women’s Affairs has had a controversial profile.1 What began as a feminist policy agency in the public sector discernibly transitioned, in the course of a decade, into a mainstream policy agency whose function is to focus on issues of relevance to women (Curtin and Teghtsoonian, 2010). The ministry’s distinctive location at the crossroads of policy and gender places it in a maelstrom of contradictory expectations; like other women’s policy agencies elsewhere in the world, the Ministry of Women’s Affairs has historically been caught between expectations from community to be its advocate, on the one hand, and requirements from the public sector to conform to the standards of new public management on the other.

scholarly journals Posterior approach, fracture diagnosis, and American Society of Anesthesiology class III–IV are associated with increased risk of revision for dislocation after total hip arthroplasty: An analysis of 33,337 operations from the Finnish Arthroplasty Register

2020 ◽  
pp. 145749692093061
Author(s):  
V. J. Panula ◽  
E. M. Ekman ◽  
M. S. Venäläinen ◽  
I. Laaksonen ◽  
R. Klén ◽  
...  
Keyword(s):  
Total Hip Arthroplasty ◽  
Confidence Interval ◽  
Hip Arthroplasty ◽  
Head Size ◽  
Anterolateral Approach ◽  
Class Iii ◽  
Arthroplasty Register ◽  
Total Hip ◽  
American Society ◽  
Hip Arthroplasties

Background and Aims: Dislocation is one of the most common reasons for revision surgery after primary total hip arthroplasty. Both patient related and surgical factors may influence the risk of dislocation. In this study, we evaluated risk factors for dislocation revision after total hip arthroplasty based on revised data contents of the Finnish Arthroplasty Register. Materials and Methods: We analyzed 33,337 primary total hip arthroplasties performed between May 2014 and January 2018 in Finland. Cox proportional hazards regression was used to estimate hazard ratios with 95% confidence intervals for first dislocation revision using 18 potential risk factors as covariates, such as age, sex, diagnosis, hospital volume, surgical approach, head size, body mass index, American Society of Anesthesiology class, and fixation method. Results: During the study period, there were 264 first-time revisions for dislocation after primary total hip arthroplasty. The hazard ratio for dislocation revision was 3.1 (confidence interval 1.7–5.5) for posterior compared to anterolateral approach, 3.0 (confidence interval 1.9–4.7) for total hip arthroplasties performed for femoral neck fracture compared to total hip arthroplasties performed for osteoarthritis, 2.0 (confidence interval 1.0–3.9) for American Society of Anesthesiology class III–IV compared to American Society of Anesthesiology class I, and 0.5 (0.4–0.7) for 36-mm femoral head size compared to 32-mm head size. Conclusion: Special attention should be paid to patients with fracture diagnoses and American Society of Anesthesiology class III–IV. Anterolateral approach and 36-mm femoral heads decrease dislocation revision risk and should be considered for high-risk patients.

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