scholarly journals Variation in referrals from primary care to scheduled paediatric services in North and East Scotland -a cross-sectional study

2021 ◽  
Vol 21 (1) ◽  
Author(s):  
Smita Dick ◽  
Ryen Crabb ◽  
Claire McFaul ◽  
Clare MacRae ◽  
Philip Wilson ◽  
...  
Keyword(s):  
Cross Sectional Study ◽  
Annual Number ◽  
Area Deprivation ◽  
Sectional Study ◽  
Cross Sectional ◽  
Practice Level ◽  
Number Of Children ◽  
Practice Characteristics ◽  
Paediatric Outpatient ◽  
Deprived Areas

Abstract Background Factors contributing to decisions to refer children for scheduled appointments at medical paediatric outpatient clinics are not well understood. Our aim was to describe practice-level characteristics associated with referrals to general paediatric clinics. Methods In this cross-sectional study the setting was general practices in three health boards in Scotland, NHS Grampian, NHS Highland and NHS Tayside The outcome was average annual number of referrals per 1000 children between 2011 and 2017. Univariate and multivariate analyses related the outcome to practice characteristics. For each practice the following characteristics were determined: distance from hospital; area deprivation; number of children registered; presence of ≥ 1 general practitioner with a child health interest and practice ownership. Results There were 62 practices in NHS Grampian, 63 in NHS Highland, and 65 in NHS Tayside; representative annual number of referrals to paediatric clinics per capita were 22, 34, and 35/1000 respectively. In the multivariate model, the number of referrals was inversely related to number of children in the practice (0.8 % fall per 1000 children [95 % confidence interval, CI, 0.5, 1.1]) and was higher from practices in the more deprived areas by a mean 55 % [95 % CI 9, 121] compared to less deprived areas. The number of referrals from a practice rose by 0.91 % [95 % CI 0.86, 0.97] for each additional partner in the practice. Conclusion Some practice-level characteristics were related to the standardised number of referrals, and associations differed between regions.

scholarly journals Patient and practice characteristics predicting attendance and completion at a specialist weight management service in the UK: a cross-sectional study

BMJ Open ◽  
2017 ◽  
Vol 7 (11) ◽  
pp. e018286 ◽  
Author(s):  
David N Blane ◽  
Philip McLoone ◽  
David Morrison ◽  
Sara Macdonald ◽  
Catherine A O’Donnell
Keyword(s):  
Weight Management ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Management Service ◽  
Sectional Study ◽  
Cross Sectional ◽  
Practice Level ◽  
Practice Characteristics ◽  
Weight Management Service ◽  
Deprived Areas

ObjectiveTo determine the association between patient and referring practice characteristics and attendance and completion at a specialist health service weight management service (WMS).DesignCross-sectional study.SettingRegional specialist WMS located in the West of Scotland.Participants9677 adults with obesity referred between 2012 and 2014; 3250 attending service and 2252 completing.Primary and secondary outcome measuresPrimary outcome measure was attendance at the WMS; secondary outcome was completion, defined as attending four or more sessions.AnalysisMultilevel binary logistic regression models constructed to determine the association between patient and practice characteristics and attendance and completion.ResultsApproximately one-third of the 9677 obese adults referred attended at least one session (n=3250, 33.6%); only 2252 (23%) completed by attending four or more sessions. Practice referrals ranged from 1 to 257. Patient-level characteristics were strongest predictors of attendance; odds of attendance increased with age (OR 4.14, 95% CI 3.27 to 5.26 for adults aged 65+ compared with those aged 18–24), body mass index (BMI) category (OR 1.83, 95% CI 1.56 to 2.15 for BMI 45+ compared with BMI 30–35) and increasing affluence (OR 1.96, 95% CI 1.17 to 3.28). Practice-level characteristics most strongly associated with attendance were being a non-training practice, having a larger list size and not being located in the most deprived areas.ConclusionsThere was wide variation in referral rates across general practice, suggesting that there is still much to do to improve engagement with weight management by primary care practitioners. The high attrition rate from referral to attendance and from attendance to completion suggests ongoing barriers for patients, particularly those from the most socioeconomically deprived areas. Patient and practice-level characteristics can help us understand the observed variation in attendance at specialist WMS following general practitioner (GP) referral and the underlying explanations for these differences merit further investigation.

scholarly journals Tooth Loss and Its Association With Frequency of Pregnancy: A Cross-Sectional Study Among Yemeni Women

2021 ◽  
Author(s):  
Anas Shamala ◽  
Ebtesam Al-Maimooni ◽  
Salsbeel Al-Matari ◽  
Ryhana Hiyat ◽  
Mohammed Al-wesabi ◽  
...  
Keyword(s):  
Oral Hygiene ◽  
Tooth Loss ◽  
Cross Sectional Study ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Khat Chewing ◽  
Number Of Children ◽  
Hygiene Practices ◽  
The Mean

Abstract Backgrounds: The present study sought to assess tooth loss and oral hygiene practices among a sample of Yemeni women in association with giving births (parity).Subjects and Methods: This cross-sectional study included a sample of 644 Yemeni women. They were interviewed to gather socio-demographic (age, education, number of children) and behavioral data (oral hygiene practices, khat chewing and smoking). Additionally, they were examined clinically to assess number of tooth loss. Data were analyzed using SPSS with a P-value < 0.05 was considered statistically significant. Results: The participating women aged between 16 and 51 years. Only one fifth of the sample reported brushing their teeth regularly (i.e, at least once a day), and around 36.8% reported using dental aids occasionally. Additionally, 52% and 21% of the sample reported they were khat chewers and smokers, respectively. The mean number of tooth loss was 4.7. The mean number of children was 4.15, with approximately 54% of the participating women had more than 3 children. The results of the logistic regression revealed a significant association between number of children and tooth loss. Conclusion: Yemeni women had poor oral hygiene practices and high prevalence of tooth loss increased proportionally with the increased number of children. This emphasizes the importance of an effective oral hygiene motivation and health education among female patients during pregnancy periods.

scholarly journals Epidemiology of High Fertility Status among Women of Reproductive Age in Wonago District, Gedeo Zone, Southern Ethiopia: A Community-Based Cross-Sectional Study

2020 ◽  
Vol 2020 ◽  
pp. 1-8
Author(s):  
Medhin Girmay Reda ◽  
Girma Tenkolu Bune ◽  
Mohammed Feyisso Shaka
Keyword(s):  
Cross Sectional Study ◽  
Fertility Rate ◽  
Reproductive Age ◽  
High Fertility ◽  
Age At First Birth ◽  
Sectional Study ◽  
Community Based ◽  
Cross Sectional ◽  
Number Of Children ◽  
Fertility Status

Background. High fertility remains one of the most important public health issues hampering the health and welfare of mothers and the survival of their children in developing nations. In Ethiopia, the high fertility rate has been seen for a long historical period with some pocket areas of high fertility still showing poor improvement. Hence, this study was aimed at determining the magnitude of high fertility status (number of children ever born alive≥5) and associated factors among women of the reproductive age group in Wonago district. Methods. A community-based cross-sectional study was conducted on randomly selected 512 women in Wonago district. Data were collected using a pretested structured interviewer administered questionnaire. Data was entered into EpiData version 3.1 and then analyzed by SPSS version 25. Logistic regression was used to analyze the data, and the adjusted odds ratio with the 95% confidence interval was computed, and a significant association was declared at p value ≤ 0.05. Result. This study revealed that 354 (69.1%) of the respondents have high fertility. High fertility is independently associated with residing in rural area [AOR=4.88, 95% CI: 3.21, 7.86], desire for children [AOR=6.97, 95% CI: 3.24, 11.40], history of under-five child mortality [AOR =5.32, 95% CI: 2.59, 8.43], poor knowledge of contraception [AOR=2.67, 95% CI: 1.66, 4.04], and low wealth tertile [AOR=2.21, 95% CI: 1.51, 3.58]. On the other hand, women with age at first birth above 18 years [AOR=0.34, 95% CI: 0.17, 0.68] and those with birth interval≥24 months [AOR=0, 26, 95% CI: 0.14, 0.49] were less likely to have high fertility. Conclusion and Recommendation. The substantial number of women in the study area has high fertility status far away from the country’s costed implementation plan of reducing the total fertility rate to 3.0. Considering these, much is needed to be done among poor, rural residents, who have not yet attained their desired number of children, and on enhancing the knowledge of mothers towards contraceptive methods.

scholarly journals A cross-sectional study on determinants of immunization coverage in urban area Chidambaram, Tamil Nadu

2021 ◽  
Vol 8 (5) ◽  
pp. 2309
Author(s):  
D. P. Lakshmi Priya ◽  
P. Kalyani ◽  
B. Sindhu Bala
Keyword(s):  
Tamil Nadu ◽  
Immunization Coverage ◽  
Cost Effective ◽  
Healthcare Facility ◽  
Cross Sectional Study ◽  
Child Health Services ◽  
P Value ◽  
Sectional Study ◽  
Cross Sectional ◽  
Number Of Children

Background: Immunization is one of the cost effective measures preventing approximately 2 to 3 million deaths in young children every year. Inspite of the progress in vaccination coverage challenges still remain for underserved and inaccessible children. It is therefore essential to evaluate the immunization coverage at periodic intervals and improve coverage in vulnerable areas.Methods: A cross-sectional study was conducted among 152 children aged 12 to 42 months in urban Chidambaram from September to October 2018. We collected details regarding immunization from vaccination card or mother’s recall. A pretested semi-structured proforma was used to collect sociodemographic variables. Data were collected, compiled and tabulated using microsoft excel and analyzed using SPSS 20.0 version.Results: Complete immunization coverage was 80.3% and 19.7% were partially immunized. Lack of awareness is the major reason for failure of full immunization (63.3%). Immunization coverage was higher when parents studied up to higher secondary or graduates (mother 91.3%, father 87.5%, p value 0.01), father do skilled jobs (91.9%, p value 0.02), among first birth ordered children (88.3%, p value 0.01), children born in healthcare facility and among mothers who received antenatal care during pregnancy (80.8% each, p value 0.04).Conclusions: Lack of awareness, parents’ literacy and occupation, place of birth, antenatal services and number of children in the family are important determinants of immunisation coverage. Apart from strengthening of infrastructure for better delivery of mother and child health services other issues also need to be addressed for better immunization practices.

scholarly journals Determinants of inter-practice variation in childhood asthma and respiratory infections: cross-sectional study of a national sentinel network

BMJ Open ◽  
2019 ◽  
Vol 9 (1) ◽  
pp. e024372
Author(s):  
Uy Hoang ◽  
Harshana Liyanage ◽  
Rachel Coyle ◽  
Charles Godden ◽  
Simon Jones ◽  
...  
Keyword(s):  
Childhood Asthma ◽  
Respiratory Infections ◽  
Cross Sectional Study ◽  
Secondary Outcome ◽  
Sectional Study ◽  
Cross Sectional ◽  
Practice Level ◽  
Children With Asthma ◽  
The Mean ◽  
Tract Infections

ObjectivesRespiratory infections are associated with acute exacerbations of asthma and accompanying morbidity and mortality. In this study we explore inter-practice variations in respiratory infections in children with asthma and study the effect of practice-level factors on these variations.DesignCross-sectional study.SettingWe analysed data from 164 general practices in the Royal College of General PractitionersResearch and Surveillance Centresentinel network in England.ParticipantsChildren 5–12 years.InterventionsNone. In this observational study, we used regression analysis to explore the impact of practice-level determinants on the number of respiratory infections in children with asthma.Primary and secondary outcome measuresWe describe the distribution of childhood asthma and the determinants of upper/lower respiratory tract infections in these children.Results83.5% (137/164) practices were in urban locations; the mean number of general practitioners per practice was 7; and the mean duration since qualification 19.7 years. We found almost 10-fold difference in the rate of asthma (1.5–11.8 per 100 children) and 50-fold variation in respiratory infection rates between practices. Larger practices with larger lists of asthmatic children had greater rates of respiratory infections among these children.ConclusionWe showed that structural/environmental variables are consistent predictors of a range of respiratory infections among children with asthma. However, contradictory results between measures of practice clinical care show that a purely structural explanation for variability in respiratory infections is limited. Further research is needed to understand how the practice factors influence individual risk behaviours relevant to respiratory infections.

scholarly journals The Phenomena of Naturopathic Practitioner: Predictors of a High Patient Throughput

2017 ◽  
Vol 2017 ◽  
pp. 1-6 ◽  
Author(s):  
Katja Goetz ◽  
Stefanie Kattge ◽  
Jost Steinhäuser
Keyword(s):  
Response Rate ◽  
Cross Sectional Study ◽  
Federal State ◽  
Sectional Study ◽  
Patient Throughput ◽  
Cross Sectional ◽  
Practice Characteristics ◽  
Sociodemographic Data ◽  
Binary Regression Analysis ◽  
German Federal State

Objective. The aim of the current study was to evaluate which factors predicted a high patient throughput to add more evidence to the phenomena of naturopathic practitioners. Methods. The cross-sectional study was based on a questionnaire with a sample of 1,096 naturopathic practitioners in the German Federal State of Schleswig-Holstein. Besides, sociodemographic data and practice characteristics topics like job satisfaction and feeling for the job were evaluated. This was supplemented with an evaluation of patient traits which were perceived as challenging. Descriptive statistics and binary regression analysis were computed to identify potential predictors to a high patient throughput. Results. A response rate of 29.4% (322/1096 participants) was observed for the study. In general, our sample of the naturopathic practitioners was very satisfied with their job (mean = 6.38). Naturopathic practitioners described that 40% of their patients are challenging. The highest rate was for “aggressive patients.” A high patient throughput was predicted with a higher satisfaction rate with the “opportunity to use abilities” and more direct contact with the patient. Conclusions. Therapeutic freedom and time with patients are important factors which are accountable for a high patient throughput. Moreover, our study provides evidence for the understanding of the phenomena of naturopathic practitioners.

scholarly journals Trends in socioeconomic inequalities in underweight and obesity in 5-year-old children, 2011–2018: a population-based, repeated cross-sectional study

BMJ Open ◽  
2021 ◽  
Vol 11 (3) ◽  
pp. e042023
Author(s):  
Ryan Stewart ◽  
John J Reilly ◽  
Adrienne Hughes ◽  
Louise A Kelly ◽  
David I Conway ◽  
...  
Keyword(s):  
Risk Ratio ◽  
Primary Schools ◽  
Population Based ◽  
Cross Sectional Study ◽  
Socioeconomic Inequalities ◽  
Sectional Study ◽  
Cross Sectional ◽  
School Year ◽  
The Uk ◽  
Deprived Areas

ObjectiveTo explore trends in prevalence and socioeconomic inequalities in underweight and obesity in 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.DesignA population-based, repeated cross-sectional study.SettingLocal authority primary schools in Scotland.Participants373 189 5-year-old schoolchildren in Scotland between 2011/2012 and 2017/2018.MethodologyTrends in prevalence and inequalities in underweight and obesity were examined across seven school years (2011/2012–2017/2018) for 373 189 5-year-old schoolchildren in Scotland. Body mass index SD scores were calculated, and epidemiological cut-offs relative to the UK 1990 references categorised underweight and obesity. Slope/relative indices of inequality (SII/RII) were calculated for underweight and obesity by school year using the area-based Scottish Index of Multiple Deprivation.ResultsThe prevalence of obesity rose slightly overall during the study period (9.8% in 2011/2012; 10.1% in 2017/2018). However, this masked a widening of inequalities, with children from the most deprived areas experiencing a greater risk of obesity in 2017/2018 than in 2011/2012 (risk ratio=1.14, 95% CI 1.04 to 1.25) compared with an unchanged risk in children from the least deprived areas (risk ratio=0.95, 95% CI 0.82 to 1.11). SII and RII indicate widening inequalities for obesity, with RII rising from 1.95 (95% CI 1.71 to 2.22) in 2011/2012 to 2.22 (95% CI 1.93 to 2.56) in 2017/2018. The prevalence of underweight was consistently low (compared with the UK 1990 references) and remained unchanged over the study period (1.2% in 2011/2012; 1.1% in 2017/2018), with no consistent evidence of social patterning over time.ConclusionsInequalities in obesity in schoolchildren in Scotland are large and have widened from 2011, despite only a slight rise in overall prevalence. In contrast there has been little change in underweight prevalence or inequalities during the study period. Extra resources for policy implementation and measures which do not widen inequalities and focus on reaching the most deprived children are required to tackle the high prevalence and growing inequalities in childhood obesity in Scotland.

Need for pharmacological analgesia after cast immobilisation in children with bone fractures: an observational cross-sectional study

2021 ◽  
pp. emermed-2020-210989
Author(s):  
Giorgio Cozzi ◽  
Luisa Cortellazzo Wiel ◽  
Anna Bassi ◽  
Manuela Giangreco ◽  
Daniela Dibello ◽  
...  
Keyword(s):  
Bone Fractures ◽  
Cross Sectional Study ◽  
Fracture Site ◽  
Sectional Study ◽  
Cross Sectional ◽  
Analgesic Treatment ◽  
Number Of Children ◽  
Cast Immobilisation ◽  
Secondary Outcomes

BackgroundBone fractures are a common reason for children and adolescents to seek evaluation in the ED. Little is known about the pain experienced after cast immobilisation and discharge from the ED and its optimal management. We aimed to investigate the administration of pharmacological analgesia in the first days after cast immobilisation and to identify possible influencing variables.MethodsA prospective observational cross-sectional study was conducted at the ED of the children’s hospital, Institute for Maternal and Child Health of Trieste, Italy, from October 2019 to June 2020. Patients aged 0–17 years with bone fractures were included. The primary outcome was the administration of analgesia during the 10 days following discharge, while secondary outcomes were the associated variables, including age, gender, fracture type and location, the mean limitation in usual activities and the frequency of re-evaluation at the ED for pain. Data were recorded through a questionnaire, completed by caregivers and collected by the researchers mainly through a telephone interview. The primary endpoint was evaluated as the ratio between the number of children who took at least one analgesic dose and the total enrolled children, while Χ2 or Fisher’s exact tests were used to assess secondary outcomes.ResultsDuring the study period, 213 patients, mean age 10 years (IQR: 8–13), were enrolled. Among them, 137 (64.3%) did not take any analgesic during follow-up. Among children who were administered analgesia, 22 (28.9%) received it only on the first day, and 47 (61.8%) for less than 5 days. One hundred and sixty one patients (75.6%) did not report any limitation in usual activities because of pain. The administration of analgesia was not related to the child’s age, gender or fracture site. Displaced fractures were associated with significantly more frequent analgesia being taken (OR 5.5, 95% CI 1.4 to 21.0).ConclusionAlthough some studies recommend scheduled analgesic treatment after discharge for bone fractures, this study would suggest analgesia on demand in children with non-displaced fractures, limiting scheduled analgesia to children with displaced fractures.

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