scholarly journals The association between a conditional cash transfer programme and malaria incidence: a longitudinal ecological study in the Brazilian Amazon between 2004 and 2015

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Layana Costa Alves ◽  
Mauro Niskier Sanchez ◽  
Thomas Hone ◽  
Luiz Felipe Pinto ◽  
Joilda Silva Nery ◽  
...  
Keyword(s):  
Fixed Effects ◽  
Negative Binomial ◽  
Malaria Incidence ◽  
Panel Study ◽  
Negative Binomial Regression ◽  
Brazilian Amazon ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Percentage Point Increase ◽  
The Impact

Abstract Background Malaria causes 400 thousand deaths worldwide annually. In 2018, 25% (187,693) of the total malaria cases in the Americas were in Brazil, with nearly all (99%) Brazilian cases in the Amazon region. The Bolsa Família Programme (BFP) is a conditional cash transfer (CCT) programme launched in 2003 to reduce poverty and has led to improvements in health outcomes. CCT programmes may reduce the burden of malaria by alleviating poverty and by promoting access to healthcare, however this relationship is underexplored. This study investigated the association between BFP coverage and malaria incidence in Brazil. Methods A longitudinal panel study was conducted of 807 municipalities in the Brazilian Amazon between 2004 and 2015. Negative binomial regression models adjusted for demographic and socioeconomic covariates and time trends were employed with fixed effects specifications. Results A one percentage point increase in municipal BFP coverage was associated with a 0.3% decrease in the incidence of malaria (RR = 0.997; 95% CI = 0.994–0.998). The average municipal BFP coverage increased 24 percentage points over the period 2004–2015 corresponding to be a reduction of 7.2% in the malaria incidence. Conclusions Higher coverage of the BFP was associated with a reduction in the incidence of malaria. CCT programmes should be encouraged in endemic regions for malaria in order to mitigate the impact of disease and poverty itself in these settings.

scholarly journals Long-term impact of a conditional cash transfer programme on maternal mortality: a nationwide analysis of Brazilian longitudinal data

BMC Medicine ◽  
2021 ◽  
Vol 19 (1) ◽  
Author(s):  
Davide Rasella ◽  
Flávia Jôse Oliveira Alves ◽  
Poliana Rebouças ◽  
Gabriela Santos de Jesus ◽  
Maurício L. Barreto ◽  
...  
Keyword(s):  
Maternal Mortality ◽  
Fixed Effects ◽  
Access To Health Care ◽  
Negative Binomial ◽  
Longitudinal Design ◽  
Case Fatality ◽  
Conditional Cash Transfer ◽  
Cash Transfer ◽  
Childhood And Adolescence

Abstract Background Reducing poverty and improving access to health care are two of the most effective actions to decrease maternal mortality, and conditional cash transfer (CCT) programmes act on both. The aim of this study was to evaluate the effects of one of the world’s largest CCT (the Brazilian Bolsa Familia Programme (BFP)) on maternal mortality during a period of 11 years. Methods The study had an ecological longitudinal design and used all 2548 Brazilian municipalities with vital statistics of adequate quality during 2004–2014. BFP municipal coverage was classified into four levels, from low to consolidated, and its duration effects were measured using the average municipal coverage of previous years. We used negative binomial multivariable regression models with fixed-effects specifications, adjusted for all relevant demographic, socioeconomic, and healthcare variables. Results BFP was significantly associated with reductions of maternal mortality proportionally to its levels of coverage and years of implementation, with a rate ratio (RR) reaching 0.88 (95%CI 0.81–0.95), 0.84 (0.75–0.96) and 0.83 (0.71–0.99) for intermediate, high and consolidated BFP coverage over the previous 11 years. The BFP duration effect was stronger among young mothers (RR 0.77; 95%CI 0.67–0.96). BFP was also associated with reductions in the proportion of pregnant women with no prenatal visits (RR 0.73; 95%CI 0.69–0.77), reductions in hospital case-fatality rate for delivery (RR 0.78; 95%CI 0.66–0.94) and increases in the proportion of deliveries in hospital (RR 1.05; 95%CI 1.04–1.07). Conclusion Our findings show that a consolidated and durable CCT coverage could decrease maternal mortality, and these long-term effects are stronger among poor mothers exposed to CCT during their childhood and adolescence, suggesting a CCT inter-generational effect. Sustained CCT coverage could reduce health inequalities and contribute to the achievement of the Sustainable Development Goal 3.1, and should be preserved during the current global economic crisis due to the COVID-19 pandemic.

scholarly journals Association Between Federal Value-Based Incentive Program Implementation and Hospital-Onset C. difficile Infection Rates

2020 ◽  
Vol 41 (S1) ◽  
pp. s133-s133
Author(s):  
Mohammad Alrawashdeh ◽  
Chanu Rhee ◽  
Heather Hsu ◽  
Grace Lee
Keyword(s):  
Program Implementation ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Neutralization Assay ◽  
Nucleic Acid Amplification ◽  
Teaching Hospitals ◽  
Future Research ◽  
Testing Methods ◽  
Toxigenic Culture ◽  
The Impact

Background: The Hospital-Acquired Conditions Reduction Program (HACRP) and Hospital Value-Based Purchasing (HVBP) are federal value-based incentive programs that financially reward or penalize hospitals based on quality metrics. Hospital-onset C. difficile infection (HO-CDI) rates reported to the CDC NHSN became a target quality metric for both HACRP and HVBP in October 2016, but the impact of these programs on HO-CDI rates is unknown. Methods: We used an interrupted time-series design to examine the association between HACRP/HVBP implementation in October 2016 and quarterly rates of HO-CDI per 10,000 patient days among incentive-eligible acute-care hospitals conducting facility-wide HO-CDI NHSN surveillance between January 2013 and March 2019. Generalized estimating equations were used to fit negative binomial regression models to assess for immediate program impact (ie, level change) and changes in the slope of HO-CDI rates, controlling for each hospital’s predominant method for CDI testing (nucleic acid amplification including PCR (NAAT), enzyme immunoassay for toxin (EIA), or other testing method including cell cytotoxicity neutralization assay and toxigenic culture). Results: Of the 265 study hospitals studied, most were medium-sized (100–399 beds, 55%), not-for-profit (77%), teaching hospitals (70%), and were located in a metropolitan area (87%). Compared to EIA, rates of HO-CDI were higher when detected by NAAT (incidence rate ratio [IRR], 1.55; 95% CI, 1.41–1.70) or other testing methods (IRR, 1.47; 95% CI, 1.26–1.71). Controlling for CDI testing methods, HACRP/HVBP implementation was associated with an immediate 6% decline in HO-CDI rates (IRR, 0.94; 95% CI, 0.89–0.99) and a 4% decline in slope per year-quarter thereafter (IRR, 0.96; 95% CI, 0.95–0.97) (Fig. 1). Conclusions: HACRP/HVBP implementation was associated with both immediate and gradual improvements in HO-CDI rates, independent of CDI testing methods of differing sensitivity. Future research may evaluate the precise mechanisms underlying this improvement and if this impact is sustained in the long term.Funding: NoneDisclosures: None

scholarly journals The impact of teaching on the duration of common urological operations

2016 ◽  
Vol 10 (5-6) ◽  
pp. 172 ◽  
Author(s):  
Blayne Welk ◽  
Jennifer Winick-Ng ◽  
Andrew McClure ◽  
Chris Vinden ◽  
Sumit Dave ◽  
...  
Keyword(s):  
Radical Prostatectomy ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Potential Effect ◽  
Sensitivity Analyses ◽  
Teaching Hospitals ◽  
Operative Duration ◽  
Open Radical Prostatectomy ◽  
Academic Hospitals ◽  
The Impact

Introduction: The ability of academic (teaching) hospitals to offer the same level of efficiency as non-teaching hospitals in a publicly funded healthcare system is unknown. Our objective was to compare the operative duration of general urology procedures between teaching and non-teaching hospitals. Methods: We used administrative data from the province of Ontario to conduct a retrospective cohort study of all adults who underwent a specified elective urology procedure (2002–2013). Primary outcome was duration of surgical procedure. Primary exposure was hospital type (academic or non-teaching). Negative binomial regression was used to adjust relative time estimates for age, comorbidity, obesity, anesthetic, and surgeon and hospital case volume.Results: 114 225 procedures were included (circumcision n=12 280; hydrocelectomy n=7221; open radical prostatectomy n=22 951; transurethral prostatectomy n=56 066; or mid-urethral sling n=15 707). These procedures were performed in an academic hospital in 14.8%, 13.3%, 28.6%, 17.1%, and 21.3% of cases, respectively. The mean operative duration across all procedures was higher in academic centres; the additional operative time ranged from 8.3 minutes (circumcision) to 29.2 minutes (radical prostatectomy). In adjusted analysis, patients treated in academic hospitals were still found to have procedures that were significantly longer (by 10‒21%). These results were similar in sensitivity analyses that accounted for the potential effect of more complex patients being referred to tertiary academic centres.Conclusions: Five common general urology operations take significantly longer to perform in academic hospitals. The reason for this may be due to the combined effect of teaching students and residents or due to inherent systematic inefficiencies within large academic hospitals.

scholarly journals NATO between Exclusivity and Inclusivity: Measuring NATO’s Partnerships

2021 ◽  
pp. 1-32
Author(s):  
Branislav Mičko
Keyword(s):  
Human Rights ◽  
Fixed Effects ◽  
International Institutions ◽  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Original Dataset ◽  
Strategic Approach ◽  
Binomial Regression ◽  
The Given ◽  
The Relationship

Building on an original dataset, this article focuses on the interactions between NATO and its declared worldwide partners. It argues that the analysis of these interactions can reveal NATO’s strategic approach to partnerships, but it can also provide a tool for its classification as an organisation that is either exclusive – defined by the focus on defence of its members, or inclusive – emphasising the global protection of democracies and human rights. The relationship between types of interactions and NATO categorisation is estimated using an unconditional negative binomial regression with fixed effects as well as a within-between (hybrid) model. Furthermore, they are illustrated on two brief case studies of Sweden and Japan. The results of the study suggest that NATO engages primarily with countries that are powerful relative to their neighbourhood, even though they are not the most powerful among the partners. The given country’s level of democracy, integration into the international institutions, and stability, do not seem to play any overarching role here.

scholarly journals Design and evaluation of probabilistic record linkage methods supporting the Brazilian 100-million cohort initiative.

2017 ◽  
Vol 1 (1) ◽  
Author(s):  
Robespierre Pita ◽  
Clicia Pinto ◽  
Marcos Barreto ◽  
Samila Sena ◽  
Rosemeire Fiaccone ◽  
...  
Keyword(s):  
Hybrid Approach ◽  
Conditional Cash Transfer ◽  
Probabilistic Methods ◽  
Cash Transfer ◽  
Bloom Filters ◽  
Santa Catarina ◽  
Entire Cohort ◽  
Unified Health System ◽  
Linkage Methods ◽  
The Impact

ABSTRACTBackground and aimsA cooperation Brazil-UK was set in mid-2013 aiming at to build a huge cohort comprised by individuals registered in CadastroÚnico (CADU), a socioeconomic database used in social programmes of the Brazilian government. Epidemiologists and statisticians wish to assess the impact of Bolsa Família (PBF), a conditional cash transfer programme, on the incidence of several diseases (tuberculosis, leprosy, HIV etc). The cohort must contain all individuals who received at least one payment from PBF between 2007 and 2012, which results in a 100-million records according to our preliminary analysis. These individuals must be probabilistically linked with databases from the Unified Health System (SUS), such as hospitalization (SIH), notifiable diseases (SINAN), mortality (SIM), live births (SINASC), to produce data marts (domain-specific data) to the proposed studies. Within this cooperation, our first goal was to design and evaluate probabilistic methods to routine link the cohort, PBF, and SUS outcomes. ApproachWe implemented two probabilistic linkage methods: a full probabilistic, based on the Dice similarity (Sorensen index) of Bloom filters; and an hybrid approach, based on rules to deterministic and probabilistic matching. We performed linkages involving CADU (2011 extraction) and SUS outcomes (SIH, SINAN, and SIM) with samples from 3 states (Sergipe, Santa Catarina and Bahia) with an increasing size (from 1,447,512 to 12,036,010). ResultsUsing a Dice between 0.90 and 0.92, our methods retrieved more than 95% of true positive pairs amongst the linked pairs. For Sergipe, we obtained as <linked pairs,true positives>: <23,22>, <315,300>, <32,32>, respectively for SIH, SINAN, and SIM. For Bahia: <771,593>, <2677,2626>, <208,207>. Another linkage between CADU (1,447,512 records) and SINAN (624 records), for tuberculosis in Sergipe, returned 397 (full probabilistic) and 311 (hybrid) linked pairs, being 306 and 300 true positives. Another execution considering CADU (1,988,599 records) and SINAN (2,094 records), for tuberculosis in Santa Catarina, returned 791 (full probabilistic) and 500 (hybrid) linked pairs, with 667 and 472 true positives. Linking CADU (1.685,697 records) and SIM, for mortality of children under-4, returned 18 linked pairs, all of them true positives, for a Dice between 0.90 and 0.92 and with 100% of sensitivity, specificity, and positive predictive value. ConclusionDue to the absence of gold standards, we use samples with increasing sizes and manual review when adequate. Our results are quite accurate, although obtained with an unique extraction of CADU. We are starting to run linkages with the entire cohort.

scholarly journals Trends of limb amputation considering type, level, sex and age in Saskatchewan, Canada 2006–2019: an in-depth assessment

2022 ◽  
Vol 80 (1) ◽  
Author(s):  
Samuel Kwaku Essien ◽  
David Kopriva ◽  
A. Gary Linassi ◽  
Audrey Zucker-Levin
Keyword(s):  
Negative Binomial ◽  
Negative Binomial Regression ◽  
Limb Amputation ◽  
Annual Percent Change ◽  
Discharge Data ◽  
Resident Population ◽  
True Incidence ◽  
Depth Analysis ◽  
The Impact ◽  
Extremity Amputation

Abstract Background Most epidemiologic reports focus on lower extremity amputation (LEA) caused specifically by diabetes mellitus. However, narrowing scope disregards the impact of other causes and types of limb amputation (LA) diminishing the true incidence and societal burden. We explored the rates of LEA and upper extremity amputation (UEA) by level of amputation, sex and age over 14 years in Saskatchewan, Canada. Methods We calculated the differential impact of amputation type (LEA or UEA) and level (major or minor) of LA using retrospective linked hospital discharge data and demographic characteristics of all LA performed in Saskatchewan and resident population between 2006 and 2019. Rates were calculated from total yearly cases per yearly Saskatchewan resident population. Joinpoint regression was employed to quantify annual percentage change (APC) and average annual percent change (AAPC). Negative binomial regression was performed to determine if LA rates differed over time based on sex and age. Results Incidence of LEA (31.86 ± 2.85 per 100,000) predominated over UEA (5.84 ± 0.49 per 100,000) over the 14-year study period. The overall LEA rate did not change over the study period (AAPC -0.5 [95% CI − 3.8 to 3.0]) but fluctuations were identified. From 2008 to 2017 LEA rates increased (APC 3.15 [95% CI 1.1 to 5.2]) countered by two statistically insignificant periods of decline (2006–2008 and 2017–2019). From 2006 to 2019 the rate of minor LEA steadily increased (AAPC 3.9 [95% CI 2.4 to 5.4]) while major LEA decreased (AAPC -0.6 [95% CI − 2.1 to 5.4]). Fluctuations in the overall LEA rate nearly corresponded with fluctuations in major LEA with one period of rising rates from 2010 to 2017 (APC 4.2 [95% CI 0.9 to 7.6]) countered by two periods of decline 2006–2010 (APC -11.14 [95% CI − 16.4 to − 5.6]) and 2017–2019 (APC -19.49 [95% CI − 33.5 to − 2.5]). Overall UEA and minor UEA rates remained stable from 2006 to 2019 with too few major UEA performed for in-depth analysis. Males were twice as likely to undergo LA than females (RR = 2.2 [95% CI 1.99–2.51]) with no change in rate over the study period. Persons aged 50–74 years and 75+ years were respectively 5.9 (RR = 5.92 [95% Cl 5.39–6.51]) and 10.6 (RR = 10.58 [95% Cl 9.26–12.08]) times more likely to undergo LA than those aged 0–49 years. LA rate increased with increasing age over the study period. Conclusion The rise in the rate of minor LEA with simultaneous decline in the rate of major LEA concomitant with the rise in age of patients experiencing LA may reflect a paradigm shift in the management of diseases that lead to LEA. Further, this shift may alter demand for orthotic versus prosthetic intervention. A more granular look into the data is warranted to determine if performing minor LA diminishes the need for major LA.

scholarly journals Geographical factors in access: investigating the impact of distance on the use of primary care extended hours, an administrative data study.

2019 ◽  
Vol 4 (3) ◽  
Author(s):  
Jen Murphy ◽  
William Whittaker ◽  
Mark Elliot ◽  
Rathi Ravindrarajah
Keyword(s):  
Primary Care ◽  
Negative Binomial ◽  
Unmet Need ◽  
Negative Binomial Regression ◽  
City Region ◽  
Hub Location ◽  
Barriers To Access ◽  
Access To Primary Care ◽  
The Right ◽  
The Impact

IntroductionNHS national targets mandate extended opening hours of doctors’ surgeries as a mechanism for increasing access to primary care, based on the assumption that unmet need is caused by a lack of appointments at the right time. Research has shown that other factors impact access and it may not simply be availability that limits an individual’s ability to access healthcare. Aims and Objectives To determine whether distance, familiarity and deprivation impact on the uptake of extended hours GP services that use a hub practice model. MethodsWe linked an appointments dataset to publicly available population datasets. With that linked dataset, we used negative binomial regression to model count data relating to uses of the extended hours service in one care commissioning group in the Greater Manchester city region. The dataset included 32,693 appointments across 4 hubs serving 37 practices. ResultsFamiliarity and distance are important in predicting the number of uses of the extended hours service at a GP practice level. For a theoretical pair of practices collocated at the hub location, the model predicts a use rate of 101.2 for the non hub compared with 283.7 for the hub, a 180% uplift. For a pair of non-hub practices, one located the mean distance from the hub, the other located one mile further away, the model predicts 64.8 uses for the nearer practice, and 46.5 uses for the far practice, a 28% penalty. ConclusionThe results indicate geographical inequity in the extended hours service. There may be many patients with unmet need for whom the extension of hours via a hub model does not address barriers to access. Providers should consider whether or not this type of model actually works to facilitate access. This is particularly of importance in the context of closing health inequality gaps.

Sign in / Sign up

Export Citation Format

Share Document