scholarly journals Gender disparities in access to care for time-sensitive conditions during COVID-19 pandemic in Chile

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Jorge Pacheco ◽  
Francisca Crispi ◽  
Tania Alfaro ◽  
María Soledad Martínez ◽  
Cristóbal Cuadrado
Keyword(s):  
Cardiovascular Diseases ◽  
Access To Care ◽  
National Level ◽  
Continuous Variable ◽  
Gender Disparities ◽  
Outcome Variable ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Level Effect ◽  
Sensitive Conditions

Abstract Background During the COVID-19 pandemic, reductions in healthcare utilization are reported in different contexts. Nevertheless, studies have not explored specifically gender disparities in access to healthcare in the context of COVID-19. Methods To evaluate gender disparities in access to medical in Chile we conducted an interrupted time series analysis using segmented regression. The outcome variable was the number of weekly confirmed cases of a set of oncologic and cardiovascular time-sensitive conditions at a national level. The series contained data from weeks 1 to 39 for 2017 to 2020. The intervention period started at week 12. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. We estimated the level effect using a dummy variable indicating the intervention period and slope effect using a continuous variable from weeks 12 to 39. To test heterogeneity by gender and age group, we conducted a stratified analysis. Results We observed a sizable reduction in access to care with a slowly recovery for oncologic (level effect 0.323; 95% CI 0.291–0.359; slope effect 1.022; 95% CI 1.016–1.028) and cardiovascular diseases (level effect 0.586; 95% CI 0.564–0.609; slope effect 1.009; 95% CI 1.007–1.011). Greater reduction occurred in women compared to men, particularly marked on myocardial infarction (level effect 0.595; 95% CI 0.566–0.627 versus 0.532; 95% CI 0.502–0.564) and colorectal cancer (level effect 0.295; 95% CI 0.248–0.35 versus 0.19; 95% CI 0.159–0.228). Compared to men, a greater absolute reduction was observed in women for oncologic diseases, excluding sex-specific cancer, (1352; 95% CI 743–1961) and cardiovascular diseases (1268; 95% CI 946–1590). Conclusion We confirmed a large drop in new diagnoses for time-sensitive conditions during the COVID-19 pandemic in Chile. This reduction was greater for women. Our findings should alert policy-makers about the urgent need to integrate a gender perspective into the pandemic response.

scholarly journals Gender disparities in access to care for time-sensitive conditions during COVID-19 pandemic in Chile

2021 ◽  
Author(s):  
Jorge Pacheco ◽  
Francisca Crispi ◽  
Tania Alfaro ◽  
Maria Soledad Martinez ◽  
Cristobal Cuadrado
Keyword(s):  
Cardiovascular Diseases ◽  
Access To Care ◽  
National Level ◽  
Healthcare Services ◽  
Continuous Variable ◽  
Gender Disparities ◽  
Outcome Variable ◽  
Intervention Period ◽  
Level Effect ◽  
Sensitive Conditions

Abstract Background: During the COVID-19 pandemic reduction on the utilization of healthcare services are reported in different contexts. Nevertheless, studies have not explored specifically gender disparities on access to healthcare in the context of covid-19. Methods: To evaluate gender disparities in access to medical in Chile we conducted an interrupted time series design using a segmented regression. The outcome variable was the number of weekly confirmed cases of a set of oncologic and cardiovascular time-sensitive conditions at a national level. The series contained data from week 1 to 39 for 2017 to 2020. Intervention period started at week 12. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. We estimated level effect using a dummy variable indicating the intervention period and slope effect using a continuous variable from week 12 to 39. To test heterogeneity by sex and age-group, we conducted stratified analysis. Results: We observed a sizable reduction in access to care with a slowly recovery for oncologic (level effect 0,323; 95% CI 0,291-0,359; slope effect 1,022; 95% CI 1,016-1,028) and cardiovascular diseases (level effect 0,586; 95% CI 0,564-0,609; slope effect 1,009; 95% CI 1,007-1,011). Greater reduction occurred in women compared to men, particularly marked on myocardial infarction (level effect 0,595; 95% CI 0,566-0,627 versus 0,532; 95% CI 0,502-0,564) and colorectal cancer (level effect 0,295; 95% CI 0,248-0,35 versus 0,19; 95% CI 0,159-0,228). Compared to men, a greater absolute reduction was observed in women for oncologic diseases, excluding sex-specific cancer, (1.352; 95% CI 743-1.961) and cardiovascular diseases (1.268; 95% CI 946-1.590). Conclusion: We confirmed a large drop in new diagnosis for time-sensitive conditions during the COVID-19 pandemic in Chile. This reduction was greater for women. Our findings should alert policy-makers about the urgent need to integrate a gender perspective into the pandemic response.

scholarly journals Gender disparities in access to care for time-sensitive conditions during COVID-19 pandemic in Chile

2020 ◽  
Author(s):  
Jorge Pacheco ◽  
Francisca Crispi ◽  
Tania Alfaro ◽  
Maria Soledad Martinez ◽  
Cristobal Cuadrado
Keyword(s):  
Cardiovascular Diseases ◽  
Access To Care ◽  
National Level ◽  
Healthcare Services ◽  
Gender Disparities ◽  
Difference In Difference ◽  
School Closures ◽  
Time Sensitivity ◽  
Quasi Experimental ◽  
Sensitive Conditions

Introduction: During the COVID-19 pandemic reduction on the utilisation of healthcare services are reported in different contexts. Nevertheless, studies have not explored specifically gender disparities on access to healthcare. Aim: To evaluate disparities in access to care in Chile during the COVID-19 pandemic from a gender-based perspective. Methods: We conducted a quasi-experimental design using a difference-in-difference approach. We compared the number of weekly confirmed cases of a set of oncologic and cardiovascular time-sensitive conditions at a national level. We defined weeks 12 to 26 as an intervention period and the actual year as a treatment group. We selected this period because preventive interventions, such as school closures or teleworking, were implemented at this point. To test heterogeneity by sex, we included an interaction term between difference-in-difference estimator and sex. Results: A sizable reduction in access to care for patients with time-sensitivity conditions was observed for oncologic (IRR 0.56; 95% CI 0.50-0.63) and cardiovascular diseases (IRR 0.64; 95% CI 0.62-0.66). Greater reduction occurred in women compared to men across diseases groups, particularly marked on myocardial infarction (0.89; 95% CI 0.85-0.93), stroke (IRR 0.88 IC95% 0.82-0.93), and colorectal cancer (IRR 0.79; 95% CI 0.69-0.91). Compared to men, a greater absolute reduction in women for oncologic diseases (782; 95% CI 704-859) than cardiovascular diseases (172; 95% CI 170-174) occurred over 14 weeks. Conclusion: We confirmed a large drop in new diagnosis for time-sensitive conditions during the COVID-19 pandemic in Chile. This reduction was greater for women. Our findings should alert policy-makers about the urgent need to integrate a gender perspective into the pandemic response and its aftermath.

scholarly journals Gender Disparities in Access to Care for Time-Sensitive Conditions During COVID-19 Pandemic in Chile

2020 ◽  
Author(s):  
Jorge Pacheco ◽  
Francisca Crispi ◽  
Tania Alfaro ◽  
Maria Soledad Martinez ◽  
Cristóbal Cuadrado Nahum
Keyword(s):  
Access To Care ◽  
Gender Disparities ◽  
Sensitive Conditions

scholarly journals An interrupted time series analysis of the lockdown policies in India: a national-level analysis of COVID-19 incidence

2021 ◽  
Author(s):  
Winter M Thayer ◽  
Md Zabir Hasan ◽  
Prithvi Sankhla ◽  
Shivam Gupta
Keyword(s):  
Time Series ◽  
Time Series Analysis ◽  
Incidence Rate ◽  
Case Reports ◽  
National Level ◽  
Model Development ◽  
Interrupted Time Series ◽  
Interrupted Time Series Analysis ◽  
Additional Time ◽  
Series Analysis

Abstract India implemented a national mandatory lockdown policy (Lockdown 1.0) on 24 March 2020 in response to Coronavirus Disease 2019 (COVID-19). The policy was revised in three subsequent stages (Lockdown 2.0–4.0 between 15 April to 18 May 2020), and restrictions were lifted (Unlockdown 1.0) on 1 June 2020. This study evaluated the effect of lockdown policy on the COVID-19 incidence rate at the national level to inform policy response for this and future pandemics. We conducted an interrupted time series analysis with a segmented regression model using publicly available data on daily reported new COVID-19 cases between 2 March 2020 and 1 September 2020. National-level data from Google Community Mobility Reports during this timeframe were also used in model development and robustness checks. Results showed an 8% [95% confidence interval (CI) = 6–9%] reduction in the change in incidence rate per day after Lockdown 1.0 compared to prior to the Lockdown order, with an additional reduction of 3% (95% CI = 2–3%) after Lockdown 4.0, suggesting an 11% (95% CI = 9–12%) reduction in the change in COVID-19 incidence after Lockdown 4.0 compared to the period before Lockdown 1.0. Uptake of the lockdown policy is indicated by decreased mobility and attenuation of the increasing incidence of COVID-19. The increasing rate of incident case reports in India was attenuated after the lockdown policy was implemented compared to before, and this reduction was maintained after the restrictions were eased, suggesting that the policy helped to ‘flatten the curve’ and buy additional time for pandemic preparedness, response and recovery.

Content of antenatal care and perception about services provided by primary hospitals in Nepal: a convergent mixed methods study

2021 ◽  
Vol 33 (2) ◽  
Author(s):  
Yubraj Acharya ◽  
Nigel James ◽  
Rita Thapa ◽  
Saman Naz ◽  
Rishav Shrestha ◽  
...  
Keyword(s):  
Quality Of Care ◽  
Mixed Methods ◽  
Antenatal Care ◽  
Quality Care ◽  
National Level ◽  
Poor Quality ◽  
Public Hospitals ◽  
World Health ◽  
Outcome Variable

Abstract Background Nepal has made significant strides in maternal and neonatal mortality over the last three decades. However, poor quality of care can threaten the gains, as maternal and newborn services are particularly sensitive to quality of care. Our study aimed to understand current gaps in the process and the outcome dimensions of the quality of antenatal care (ANC), particularly at the sub-national level. We assessed these dimensions of the quality of ANC in 17 primary, public hospitals across Nepal. We also assessed the variation in the ANC process across the patients’ socio-economic gradient. Methods We used a convergent mixed methods approach, whereby we triangulated qualitative and quantitative data. In the quantitative component, we observed interactions between providers (17 hospitals from all 7 provinces) and 198 women seeking ANC and recorded the tasks the providers performed, using the Service Provision Assessments protocol available from the Demographic and Health Survey program. The main outcome variable was the number of tasks performed by the provider during an ANC consultation. The tasks ranged from identifying potential signs of danger to providing counseling. We analyzed the resulting data descriptively and assessed the relationship between the number of tasks performed and users’ characteristics. In the qualitative component, we synthesized users’ and providers’ narratives on perceptions of the overall quality of care obtained through focus group discussions and in-depth interviews. Results Out of the 59 tasks recommended by the World Health Organization, providers performed only 22 tasks (37.3%) on average. The number of tasks performed varied significantly across provinces, with users in province 3 receiving significantly higher quality care than those in other provinces. Educated women were treated better than those with no education. Users and providers agreed that the overall quality of care was inadequate, although providers mentioned that the current quality was the best they could provide given the constraints they faced. Conclusion The quality of ANC in Nepal’s primary hospitals is poor and inequitable across education and geographic gradients. While current efforts, such as the provision of 24/7 birthing centers, can mitigate gaps in service availability, additional equipment, infrastructure and human resources will be needed to improve quality. Providers also need additional training focused on treating patients from different backgrounds equally. Our study also points to the need for additional research, both to document the quality of care more objectively and to establish key determinants of quality to inform policy.

Access to Care for Patients With Time-Sensitive Conditions in Pennsylvania

2014 ◽  
Vol 63 (5) ◽  
pp. 572-579 ◽  
Author(s):  
Rama A. Salhi ◽  
J. Matthew Edwards ◽  
David F. Gaieski ◽  
Roger A. Band ◽  
Benjamin S. Abella ◽  
...  
Keyword(s):  
Access To Care ◽  
Sensitive Conditions

scholarly journals Polypharmacy Is Associated with Lower Memory Function in African American Older Adults

2020 ◽  
Vol 10 (1) ◽  
pp. 49 ◽  
Author(s):  
Shervin Assari ◽  
Cheryl Wisseh ◽  
Mohammed Saqib ◽  
Mohsen Bazargan
Keyword(s):  
Older Adults ◽  
African American ◽  
Cognitive Function ◽  
Los Angeles ◽  
Living Arrangement ◽  
Memory Function ◽  
Continuous Variable ◽  
Financial Strain ◽  
Outcome Variable ◽  
Future Research

Although previous research has linked polypharmacy to lower cognitive function in the general population, we know little about this association among economically challenged African American (AA) older adults. This study explored the link between polypharmacy and memory function among AA older adults. This community-based study recruited 399 AA older adults who were 65+ years old and living in economically disadvantaged areas of South Los Angeles. Polypharmacy (taking 5+ medications) was the independent variable, memory function was the outcome variable (continuous variable), and gender, age, living arrangement, socioeconomic status (educational attainment and financial strain), health behaviors (current smoking and any binge drinking), and multimorbidity (number of chronic diseases) were the covariates. Linear regression was used for data analyses. Polypharmacy was associated with lower scores on memory function, above and beyond covariates. Among AA older adults, polypharmacy may be linked to worse cognitive function. Future research should test the mechanisms by which polypharmacy is associated with lower levels of cognitive decline. There is a need for screening for memory problems in AA older adults who are exposed to polypharmacy.

scholarly journals Access to Care and the Incidence of Endstage Renal Disease Due to Systemic Lupus Erythematosus

2010 ◽  
Vol 37 (6) ◽  
pp. 1158-1163 ◽  
Author(s):  
MICHAEL M. WARD
Keyword(s):  
Systemic Lupus Erythematosus ◽  
Access To Care ◽  
Ambulatory Care ◽  
Lupus Erythematosus ◽  
Ambulatory Care Sensitive Conditions ◽  
Systemic Lupus ◽  
Endstage Renal Disease ◽  
Zip Code ◽  
Ambulatory Care Sensitive ◽  
Sensitive Conditions

Objective.Persons with low socioeconomic status have an increased risk of endstage renal disease (ESRD) due to systemic lupus erythematosus (SLE), possibly because of limited access to care. We examined if the incidence of ESRD due to SLE was higher in geographic areas with poorer access to care.Methods.In this population-based ecological study, we tested associations between the incidence of ESRD due to SLE and the proportion of hospitalizations with no insurance, Medicaid or managed care insurance, residence in a primary care-provider shortage area or rural area, and rate of hospitalizations for ambulatory care-sensitive conditions, by ZIP code in California in 1999–2004.Results.The incidence of ESRD due to SLE was higher in ZIP codes with higher proportions of hospitalizations with no insurance (r = 0.22, p < 0.0001) or Medicaid (r = 0.21, p < 0.0001), and in ZIP codes with higher rates of hospitalizations for ambulatory care-sensitive conditions (r = 0.23, p < 0.0001). In multivariate analyses, incidences were higher in ZIP codes with higher proportions of hospitalizations with Medicaid (p < 0.0001) and higher rates of hospitalizations for ambulatory care-sensitive conditions (p = 0.06), independent of the socioeconomic status of the ZIP code residents.Conclusion.The incidence of ESRD due to SLE is higher in areas with higher proportions of residents who have public insurance and higher rates of avoidable hospitalizations, suggesting that limited access to care may contribute to this complication of SLE.

scholarly journals Evaluation of a complex intervention to improve primary care prescribing: a phase IV segmented regression interrupted time series analysis

2017 ◽  
Vol 67 (658) ◽  
pp. e352-e360 ◽  
Author(s):  
Sean MacBride-Stewart ◽  
Charis Marwick ◽  
Neil Houston ◽  
Iain Watt ◽  
Andrea Patton ◽  
...  
Keyword(s):  
Primary Care ◽  
Time Series ◽  
High Risk ◽  
Older People ◽  
Secondary Analysis ◽  
Interrupted Time Series ◽  
Segmented Regression ◽  
Intervention Period ◽  
Interrupted Time Series Analysis ◽  
Primary Analysis

BackgroundIt is uncertain whether improvements in primary care high-risk prescribing seen in research trials can be realised in the real-world setting.AimTo evaluate the impact of a 1-year system-wide phase IV prescribing safety improvement initiative, which included education, feedback, support to identify patients to review, and small financial incentives.Design and settingAn interrupted time series analysis of targeted high-risk prescribing in all 56 general practices in NHS Forth Valley, Scotland, was performed. In 2013–2014, this focused on high-risk non-steroidal anti-inflammatory drugs (NSAIDs) in older people and NSAIDs with oral anticoagulants; in 2014–2015, it focused on antipsychotics in older people.MethodThe primary analysis used segmented regression analysis to estimate impact at the end of the intervention, and 12 months later. The secondary analysis used difference-in-difference methods to compare Forth Valley changes with those in NHS Greater Glasgow and Clyde (GGC).ResultsIn the primary analysis, downward trends for all three NSAID measures that were existent before the intervention statistically significantly steepened following implementation of the intervention. At the end of the intervention period, 1221 fewer patients than expected were prescribed a high-risk NSAID. In contrast, antipsychotic prescribing in older people increased slowly over time, with no intervention-associated change. In the secondary analysis, reductions at the end of the intervention period in all three NSAID measures were statistically significantly greater in NHS Forth Valley than in NHS GGC, but only significantly greater for two of these measures 12 months after the intervention finished.ConclusionThere were substantial and sustained reductions in the high-risk prescribing of NSAIDs, although with some waning of effect 12 months after the intervention ceased. The same intervention had no effect on antipsychotic prescribing in older people.

scholarly journals Effects of a compensatory dry-land training program on shoulder posture and scapular position of competitive female swimmers

2019 ◽  
Vol 3 (6) ◽  
pp. 45-52
Author(s):  
João Paulo Sousa ◽  
João Malta ◽  
Ana Carrageta ◽  
Nuno Batalha
Keyword(s):  
Training Program ◽  
Intervention Program ◽  
Control Period ◽  
National Level ◽  
Intervention Period ◽  
Dry Land ◽  
Medial Border ◽  
Spinal Process ◽  
Thoracic Spinal ◽  
Competitive Swimmers

Background: Competitive swimmers place a significant demand on the shoulder adductors and internal rotator muscles due to the repetitive nature of swimming movements.Objectives: To evaluate the effect of a compensatory dry-land training program on the shoulder posture and scapular position of competitive female swimmersMethod: 25 National Level female competitive swimmers received an 8-week intervention program focused on strengthening of posterior shoulder girdle muscles and stretching of anterior shoulder muscles. The study sample was exposed to a control period of 2 weeks and an intervention period of 8 weeks.Results: Significant differences were found after the intervention period, on both dominant and non-dominant sides, with respect to shoulder protraction (distance between the anterior aspect of the acromion to the wall – p < .05) and scapular abduction (distance between a medial line marked over the thoracic spinal process and the medial border of spina scapulae – p < .05; and distance between a medial line marked over the thoracic spinal process and the medial border of the spina scapulae – p < .05).Conclusions: The results revealed that the incorporation of a compensatory dry-land training program alongside a normal in-water training significantly reduced the distance of shoulder posture in protraction and scapular position in abduction.Key words: shoulder protraction, scapular abduction, dry-land training, swimming, female.

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