Socioeconomic position and prediagnostic health care contacts in children with cancer in Denmark: a nationwide register study

Abstract Background While underlying mechanisms and pathways of social inequalities in cancer survival have been extensively examined in adults, this is less so for children with cancer. Hypothesized mechanisms include prediagnostic utilization of and navigation through the health care system, which may differ by socioeconomic resources of the families. In this nationwide register-based study we investigated the association between measures of family socioeconomic position in relation to prediagnostic health care contacts and stage of disease at diagnosis in children with cancer in Denmark. Methods We identified all children diagnosed with a cancer at ages 0–15 years in 1998–2016 (N = 3043) from the Danish Childhood Cancer Registry. We obtained comprehensive information on measures of socioeconomic position, parental health and prediagnostic contacts to both general practitioners and hospitals 24 months prior to diagnosis from various national registries. We fitted multivariable conditional logistic regression models for the association of family socioeconomic and health-related variables with firstly, frequent health care contacts and secondly, advanced stage. Results We found higher odds ratios (OR) of frequent both overall and emergency health care contacts in the last 3 months before diagnosis in children from households with short parental education and mixed affiliation to work market, when compared to children with high family socioeconomic position. Further, children of parents with depression or of non-Western origin, respectively, had higher OR for frequent overall and emergency contacts. We found no association between socioeconomic position, parental health and stage of disease. Conclusion Families with socioeconomic disadvantage, non-Western origin or depression more frequently utilize prediagnostic health care services, both generally and in the acute setting, indicating that some disadvantaged families may struggle to navigate the health care system when their child is sick. Reassuringly, this was not reflected in disparities in stage at diagnosis. In order to improve the diagnostic process and potentially reduce health care contacts, attention and support should be given to families with a high number of health care contacts over a short period of time.

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Sociocultural Barriers to Early Diagnosis of Autism Spectrum Disorder

Life and Science ◽

10.37185/lns.1.1.106 ◽

2020 ◽

Vol 1 (4) ◽

pp. 6

Author(s):

Anum Farooq ◽

Shoaib Ahmed

Keyword(s):

Health Care ◽

Autism Spectrum Disorder ◽

Early Diagnosis ◽

Health Care System ◽

Autism Spectrum ◽

Spectrum Disorder ◽

Educational Outreach ◽

Diagnostic Process ◽

Pathway To Care ◽

Care System

Objective: To qualitatively explore community, family, and health care system barriers to early diagnosis of autism spectrum disorder (ASD) in children. Study Design: A phenomenological qualitative approach was used to explore mothers' experiences of receiving ASD diagnosis for their children. Place and Duration of Study: The study was conducted at Autism Resource Centre Islamabad, from March 2018 to August 2018. Materials and Methods: In-depth qualitative interviews of eight mothers of children diagnosed with ASD, who were above 36 months of age. Results: Using thematic analysis, three major themes were identified as barriers in reaching ASD diagnosis i.e. parent's lack of knowledge and misperceptions of ASD; health care system issues like undefined pathway to care, dissatisfaction with medical or associated professionals, delays due to structural and process barriers; and family factors such as stigma around mental health and disability, family denial and financial constraints. Conclusion: Additional educational outreach to families, de-stigmatization of ASD, streamlining the ASD diagnostic process, and providing additional support to parents of at-risk children may decrease delays in ASD diagnosis among children.

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POST-COVID-19HEALTHCARE:TRANSITIONTOANEW NORMAL

Journal of Gandhara Medical and Dental Science ◽

10.37762/jgmds.8-1.216 ◽

2021 ◽

Vol 8 (1) ◽

pp. 1

Author(s):

Safia Rehman

Keyword(s):

Primary Care ◽

Health Care ◽

Social Media ◽

Healthcare System ◽

Health Care System ◽

World Health ◽

Care Process ◽

Care Providers ◽

Short Period ◽

Care System

The COVID-19 pandemic has challenged the health care system to face extraordinary circumstances. These challenges bring forth a new era with a certain high point like the transition to the fusion of in person and digital health practice framework. Post COVID-19 there is a lot of sludge in health care, inthe form of administrative processes and requirements that slow down the core activities of providing care. COVID-19 crisis is used as an opportunity to reduce administrative burdens which most of the times made a primary care physician feel demoralized and burned out'. The focus of healthcare has shifted from hospitals to homes using telemedicine technologies which enabled virtual visits and remote care delivery. COVID-19 signified the telemedicine to be an essential component of healthcare delivery. It proved to an effective and safe way of treatment and avoiding nosocomial infections’. Previously, telemedicine was not considered to be a normal consultation method, nowadays it’s part of the normal lives of the patients as well as health care providers. The other big advantage of this great tool is that one can consult doctors even from very remote areas, which is impossible to consult physically. Different technological advancement like Artificial Intelligence-based diagnostics, cloud-based storage of medical records and integration of information in and outside hospitals were explored and adopted in the COVID-19 pandemic. Data is the key to advance research and refine health care process and outcomes for the COVID-19 patients. The digitalization of the health care system can provide significant benefit’. The phenomenon of digitalization of healthcare system is especially benefited for the developing world, because, in the resource-limited environment, a lot of cost and resources can be saved by opting paperless systems. When people were locked down, social media was pivotal in creating awareness and educating people in a short period*. There was a lot of stuff regarding COVID-19 pandemic on social media and most interestingly it was portrayedin a way that one could not be able to neglect the content. Consequently, intentionally or unintentionally many of the users opted some of the measures for prevention of the deadlyinfection. The pandemic has shown us that countries with the more robust public health system, primary care services and a healthier population perform well in the fight against the pandemic. Safeguard of voluntary and community organization is essential’. At the same time the countries with fewer resources and with limited measures for controlling massive disasters, in the form of this pandemic, got exposed. This is an alarming situation for global organizations like the World Health Organization and other health-related global leaders to work together for making sure that health resources be equally provided to all the countries across the globe. The COVID-19 pandemic educated the underdeveloped countries regarding infection control measures like Biosafety and Biosecurity. Health official shifted their resources in maintaining hygienic measures to patients, doctors and support staff. Overall, this led to great impact in revolutionizing patient care and improving quality standards. The deficiency of trained staff in Intensive Care Unit and Accident & Emergency is also highlighted in this pandemic. Hence the focus should be on enabling the existing resources to acquire skill in these specialties. The people started making the right food choice, adapting to healthy physical exercise and ensuring therapies to relieve stress and anxiety’. The pandemic brings changes to the healthcare system, whichis not entirely new, these were introduced by technologists earlier; the system is going back to normal that is stronger, smarter and healthier. Hospitals should ensure that their infrastructure is sufficiently ready to cope with the advent of digitalization.

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Assessment of Immunization Compliance Among Children in the Department of Defense Health Care System

PEDIATRICS ◽

10.1542/peds.97.3.308 ◽

1996 ◽

Vol 97 (3) ◽

pp. 308-311 ◽

Cited By ~ 1

Author(s):

J. O. Lopreiato ◽

M. C. Ottolini

Keyword(s):

Health Care ◽

Health Care System ◽

Department Of Defense ◽

Parental Education ◽

Haemophilus Influenzae Type ◽

Cross Sectional Survey ◽

Health Maintenance ◽

Immunization Status ◽

Immunization Rates ◽

Care System

Objective. To describe immunization rates among children enrolled in the Department of Defense health care system and to determine risk factors for delay. Design. Cross-sectional survey of immunization records and demographic characteristics among parents of children presenting for acute care at seven pediatric clinics operated by the Department of Defense. Participants. Subjects were 1977 children aged 2 months to 18 years. Outcome Measures. Immunization rates were measured for various age strata from infancy to adolescence. Results. The overall immunization rate was 84%. By age 2 years, 86% of patients had received four diphtheriatetanus -pertussis, three oral polio, Haemophilus influenzae type b, and measles-mumps-rubella (MMR) vaccines. At school entry, 87% of children were fully immunized for diphtheria-tetanus-pertussis and MMR. However, only 50% of adolescents were up-to-date, primarily because of failure to receive booster doses of MMR. Seventy-nine percent of parents whose children were delayed thought that they were up-to-date. Factors associated with immunization delay included incorrect parental perception of immunization status, failure to keep routine health maintenance visits, and non-white race. Socioeconomic status, parental education level, access to care, and family mobility had no effect on immnization status. Conclusions. Although immunization rates for preschoolers approached national goals, accessibility to care and free vaccines did not guarantee immunization compliance, especially among adolescents. Most patients with delayed vaccinations were older children and adolescents whose school and parental reports of immunization status were incorrect. Immunization delay in our study was primarily the result of a failure to track patients and notify parents of when immunizations were due.

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Impact of User Fees in Health Care System on Health Care Consumption

Review of Economic Perspectives ◽

10.2478/v10135-011-0001-3 ◽

2010 ◽

Vol 10 (4) ◽

pp. 113-132 ◽

Cited By ~ 6

Author(s):

Veronika Krůtilová

Keyword(s):

Health Care ◽

Health Care System ◽

Age Groups ◽

Resource Scarcity ◽

User Fees ◽

Regulatory Effect ◽

Health Care Consumption ◽

Czech Population ◽

Short Period ◽

Care System

Impact of User Fees in Health Care System on Health Care Consumption In comparison to other European countries, it is claimed that the Czech Republic belongs to the countries with higher health care consumption, even if health status does not positively correlate with health care use. Therefore, user fees as a form of patient cost sharing were introduced to regulate health care consumption and to confront the patient with resource scarcity in the health care system as a part of health care reform package in 2008. The goal of the paper is to determine the changes in health care consumption after user fees implementation and evaluate their regulatory effect in a short period of time. The analysis of the changes in health care consumption is made on the basis of data from the largest health insurance company - VZP ČR (60 % of the Czech population). The health care consumption is monitored according to particular types of health care services for particular age groups in years 2007, 2008 and 2009. This analysis identifies the major changes in the consumption after user fees implementation among the observed age groups of Czech population. Furthermore, it is possible to prove the regulatory effect of user fees in a short period of time (2 years).

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The second sputum sample complicates tuberculosis diagnosis for women: a qualitative study from Malawi

The International Journal of Tuberculosis and Lung Disease ◽

10.5588/ijtld.17.0146 ◽

2017 ◽

Vol 21 (12) ◽

pp. 1258-1263

Author(s):

M. Kumwenda ◽

B-T. Nyang'wa ◽

B. Chikuse ◽

T. Biseck ◽

S. Maosa ◽

...

Keyword(s):

Health Care ◽

Health Care System ◽

Health Care Access ◽

Sputum Sample ◽

Care Facility ◽

Health Care Facility ◽

Health Care Facilities ◽

System Level ◽

Diagnostic Process ◽

Care System

SETTING: District hospital and peripheral health care facilities in Balaka District, Malawi.OBJECTIVE: To identify barriers encountered by women in submitting a second sputum sample.DESIGN: Focus-group discussions and semi-structured interviews.RESULTS: Women encounter barriers at several levels: personal, cultural, socio-economic and health care system. Personal, cultural and socio-economic barriers include the fear of a tuberculosis (TB) diagnosis, the perception and condition of the patient, the distance and cost of travel to a health care facility, the subordinate position of women in household decision-making and the social support that women receive. Barriers at the health care system level include high patient numbers, staff shortages, the duration of the TB diagnostic process as well as the uncaring attitude and poor communication of health care workers. These barriers may apply not only to the submission of the second sample, but to health care access in general.CONCLUSION: Women face multiple barriers in submitting a second sputum sample. These do not operate in isolation but instead compound each other. Although potential solutions to overcome these barriers are recognised, some have yet to be adopted. To improve TB case finding, innovative and community approaches should be adopted more rapidly.

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Teletinnitus Program at the VA Gulf Coast Veterans Health Care System

Perspectives on Telepractice ◽

10.1044/teles4.1.23 ◽

2014 ◽

Vol 4 (1) ◽

pp. 23-29

Author(s):

Constance Hilory Tomberlin

Keyword(s):

Health Care ◽

Patient Satisfaction ◽

Patient Care ◽

Health Care System ◽

Gulf Coast ◽

New Technology ◽

Cost Effective ◽

Veterans Health ◽

Potential Benefits ◽

Care System

There are a multitude of reasons that a teletinnitus program can be beneficial, not only to the patients, but also within the hospital and audiology department. The ability to use technology for the purpose of tinnitus management allows for improved appointment access for all patients, especially those who live at a distance, has been shown to be more cost effective when the patients travel is otherwise monetarily compensated, and allows for multiple patient's to be seen in the same time slots, allowing for greater access to the clinic for the patients wishing to be seen in-house. There is also the patient's excitement in being part of a new technology-based program. The Gulf Coast Veterans Health Care System (GCVHCS) saw the potential benefits of incorporating a teletinnitus program and began implementation in 2013. There were a few hurdles to work through during the beginning organizational process and the initial execution of the program. Since the establishment of the Teletinnitus program, the GCVHCS has seen an enhancement in patient care, reduction in travel compensation, improvement in clinic utilization, clinic availability, the genuine excitement of the use of a new healthcare media amongst staff and patients, and overall patient satisfaction.

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