scholarly journals A painful journey to antivenom: The therapeutic itinerary of snakebite patients in the Brazilian Amazon (The QUALISnake Study)

2021 ◽  
Vol 15 (3) ◽  
pp. e0009245
Author(s):  
Joseir Saturnino Cristino ◽  
Guilherme Maciel Salazar ◽  
Vinícius Azevedo Machado ◽  
Eduardo Honorato ◽  
Altair Seabra Farias ◽  
...  
Keyword(s):  
Rural Areas ◽  
Clinical Signs ◽  
Brazilian Amazon ◽  
Access To Healthcare ◽  
Community Healthcare ◽  
Effective Strategies ◽  
Poor Access ◽  
Timely Access ◽  
Acceptability Of Healthcare ◽  
The Moment

Access to antivenoms is not guarranteed for vulnerable populations that inhabit remote areas in the Amazon. The study of therapeutic itineraries (TI) for treatment of snakebites would support strategies to provide timely access to users. A TI is the set of processes by which individuals adhere to certain forms of treatment, and includes the path traveled in the search for healthcare, and practices to solve their health problems. This study aims to describe TIs of snakebite patients in the Brazilian Amazon. This study was carried out at the Fundação de Medicina Tropical Doutor Heitor Vieira Dourado, in Manaus, state of Amazonas, Brazil. The itinerary from the moment of the bite to the patient’s admission to the reference unit was analyzed. Sample size was defined by saturation. After an exploratory survey to collect epidemiological variables, in-depth interviews were conducted following a semi-structured guide. Patients originated from rural areas of 11 different municipalities, including ones located >500 kilometers from Manaus. A great fragmentation was observed in the itineraries, marked by several changes of means of transport along the route. Four themes emerged from the analysis: exposure to snakebite during day-to-day activities, use of traditional therapeutic practices, and personal perception of the severity, as well as the route taken and its contingencies. Access to healthcare requires considerable effort on the part of snakebite patients. Major barriers were identified, such as the low number of hospitals that offer antivenom treatment, poor access to healthcare due to long distances and geographic barriers, low acceptability of healthcare offered in countryside, lack of use of personal protective equipment, common use of ineffective or deleterious self-care practices, late recognition of serious clinical signs and resistance to seeking medical assistance. Health education, promotion of immediate transport to health centers and decentralization of antivenom from reference hospitals to community healthcare centers in the Brazilian Amazon are more effective strategies that would to maximize access to antivenom treatment.

Challenges Facing Healthcare Delivery Systems in Low-, Middle-, and High-Income Countries

2018 ◽  
pp. 1-69
Keyword(s):  
Rural Areas ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Services Delivery ◽  
The Poor ◽  
Poor Access ◽  
The World ◽  
Healthcare Insurance

In the USA, there exist inequities in health delivery depending on whether you have healthcare insurance or not. People living in rural areas also are facing limited access to healthcare. The other high-income countries present, however, another picture. Healthcare insurance is mandatory and thus enables access to healthcare services. Nevertheless, these countries also face challenges such as the poor access to the healthcare services delivery in rural areas because of lack of general physicians. The cost burden is an important point that impacts the access to healthcare and care delivery to a certain group of individuals such as elderly people. The healthcare systems also are facing off-label-use challenges (see Chapter 5) that can also negatively impact the care delivery. In the low- and middle-income countries, the developing world, the poor access to healthcare services delivery is due to infrastructural, structural issues, and poor funding. Information exchanges and communication remain a challenge facing all public healthcare systems around the world, though at diverse level. This chapter aims at investigating the challenges facing the healthcare delivery systems around the world and proposing information and communication-technology-based solutions to tackle some challenges. The chapter further focuses on two case studies and generalizes the results and solution approaches to the other countries. For these purposes, the Republic of Benin, representing the developing world, and the Federal Republic of Germany, representing the developed world, are selected as study cases.

Challenges Facing Healthcare Delivery Systems in Low-, Middle-, and High-Income Countries

2021 ◽  
pp. 299-352
Author(s):  
Thierry Oscar Edoh
Keyword(s):  
Rural Areas ◽  
Care Delivery ◽  
Healthcare Delivery ◽  
Healthcare Services ◽  
Access To Healthcare ◽  
Services Delivery ◽  
The Poor ◽  
Poor Access ◽  
The World ◽  
Healthcare Insurance

In the USA, there exist inequities in health delivery depending on whether you have healthcare insurance or not. People living in rural areas also are facing limited access to healthcare. The other high-income countries present, however, another picture. Healthcare insurance is mandatory and thus enables access to healthcare services. Nevertheless, these countries also face challenges such as the poor access to the healthcare services delivery in rural areas because of lack of general physicians. The cost burden is an important point that impacts the access to healthcare and care delivery to a certain group of individuals such as elderly people. The healthcare systems also are facing off-label-use challenges (see Chapter 5) that can also negatively impact the care delivery. In the low- and middle-income countries, the developing world, the poor access to healthcare services delivery is due to infrastructural, structural issues, and poor funding. Information exchanges and communication remain a challenge facing all public healthcare systems around the world, though at diverse level. This chapter aims at investigating the challenges facing the healthcare delivery systems around the world and proposing information and communication-technology-based solutions to tackle some challenges. The chapter further focuses on two case studies and generalizes the results and solution approaches to the other countries. For these purposes, the Republic of Benin, representing the developing world, and the Federal Republic of Germany, representing the developed world, are selected as study cases.

scholarly journals Socio-spatial disparities in access to emergency health care—A Scandinavian case study

PLoS ONE ◽  
2021 ◽  
Vol 16 (12) ◽  
pp. e0261319
Author(s):  
Jacob Hassler ◽  
Vania Ceccato
Keyword(s):  
Health Care ◽  
Rural Areas ◽  
Geographical Information ◽  
Demographic Groups ◽  
Emergency Health Care ◽  
Spatial Disparities ◽  
Poor Access ◽  
Timely Access ◽  
Urban And Rural Areas

Having timely access to emergency health care (EHC) depends largely on where you live. In this Scandinavian case study, we investigate how accessibility to EHC varies spatially in order to reveal potential socio-spatial disparities in access. Distinct measures of EHC accessibility were calculated for southern Sweden in a network analysis using a Geographical Information System (GIS) based on data from 2018. An ANOVA test was carried out to investigate how accessibility vary for different measures between urban and rural areas, and negative binominal regression modelling was then carried out to assess potential disparities in accessibility between socioeconomic and demographic groups. Areas with high shares of older adults show poor access to EHC, especially those in the most remote, rural areas. However, rurality alone does not preclude poor access to EHC. Education, income and proximity to ambulance stations were also associated with EHC accessibility, but not always in expected ways. Despite indications of a well-functioning EHC, with most areas served within one hour, socio-spatial disparities in access to EHC were detected both between places and population groups.

Avascular Necrosis of the Femoral Head in Dogs - Retrospective Study

2018 ◽  
Vol 46 (1) ◽  
Author(s):  
Catarina Borges Cardoso ◽  
Sheila Canevese Rahal ◽  
Maria Jaqueline Mamprim ◽  
Hugo Salvador Oliveira ◽  
Alessandra Melchert ◽  
...  
Keyword(s):  
Femoral Head ◽  
Avascular Necrosis ◽  
Body Mass ◽  
Hind Limb ◽  
Clinical Signs ◽  
Radiographic Appearance ◽  
Hind Limbs ◽  
Grade 5 ◽  
Patient Consultation ◽  
The Moment

Background: The avascular necrosis of the femoral head is a development disease caused by ischemic necrosis, which is mainly observed in young dogs. The etiology of the disease remains controversial. The diagnosis requires imaging exams such as MRI and radiographs. Thus, the aim of the current study was to retrospectively assess a population of dogs with avascular necrosis of the femoral head in order to feature the disease, as well as to analyze the radiographic appearance of the lesion at the moment of patient consultation.Materials, Methods & Results: The signalment factors of dogs (breed, gender, age and body mass), the affected hind limb, the radiographic appearance of the lesion, the clinical signs at the moment of patient consultation, the time of occurrence and the type of treatment were evaluated. The disease was radiographically classified according to the previously described items. Forty-three cases of avascular necrosis of the femoral head were identified, 97.67% presented lameness and pain during palpation of the hip joint; and 54.34%, were 1 week to 4 months old. Females represented 58.13% of the sample, and 65.11% of them weighed from 2.6 to 4.9 kg. Based on the radiographic classification, 4.34% were Grade 1; 32.60%, Grade 2; 8.69%, Grade 3; 19.56%, Grade 4; and 34.78%, Grade 5. The femoral head and neck ostectomy was performed in 42 hind limbs (91.30%); 42.85% of the dogs reached total functional recovery and 26.19% required physiotherapy and rehabilitation.Discussion: The present sample was composed of 25 dogs, which were 6-to-11-month old at the moment of patient consultation, but 17 dogs were 12-to-36-month old at this time; only one dog was older than 36 months. It may be associated with the non-recognition of clinical signs by the owners, rather than with the late-onset form of the disease. With respect to the breed, pinscher, Yorkshire, poodle, Lhasa apso, pug were most frequently observed. However, 7 dogs were crossbreed. Such group differed from that of a review involving 188 cases encompassing West Highland white terrier, Cairn terrier and poodle as the most commonly affected breeds. No sex predilection was found in a study comprising 188 cases, but in another study comprising 14 dogs, female predilection was observed. Likewise, the females represented 58.13% of cases in the present study; and 41.86% of the participants were male. The mean body mass of the dogs in the current study was 4.33 kg, which matches the small breed dogs, which are most affected by the disease. Clinical signs of non-weightbearing lameness or an intermittent subtle lameness are common in the avascular necrosis of the femoral head. Lameness of the affected hind limb was observed in 69.76% of the cases in the present study, but 2.32% showed no lameness. Occasionally, the avascular necrosis of the femoral head is bilaterally found in 12% to 16.5% of the cases. Only 3 out of the 43 cases assessed in the present study were bilateral. Since the lesions were more frequent in Grades 2 and 5, there is less chance of success through the conservative treatment. Thus, the femoral head and neck ostectomy was the surgical procedure performed in 42 hind limbs. The procedure is used to provide pain relief and to reduce the signs of lameness. In conclusion, the population assessed in the present study was composed of small size dogs, mean body mass 4.33 kg, no sex predilection, mostly presenting unilateral lesions and higher Grade 2 and Grade 5 radiographic lesion frequency.Keywords: radiographic, joint, canine, hip.

scholarly journals Development of unmanned aerial vehicle (UAV) networks delivering early defibrillation for out-of-hospital cardiac arrests (OHCA) in areas lacking timely access to emergency medical services (EMS) in Germany: a comparative economic study

BMJ Open ◽  
2021 ◽  
Vol 11 (1) ◽  
pp. e043791
Author(s):  
Jan Bauer ◽  
Dieter Moormann ◽  
Reinhard Strametz ◽  
David A Groneberg
Keyword(s):  
Cost Effectiveness ◽  
Emergency Medical Services ◽  
Rural Areas ◽  
Medical Services ◽  
Secondary Outcome ◽  
Annual Average ◽  
Emergency Medical ◽  
Life Years ◽  
Timely Access ◽  
The Cost

ObjectivesThis study wants to assess the cost-effectiveness of unmanned aerial vehicles (UAV) equipped with automated external defibrillators (AED) in out-of-hospital cardiac arrests (OHCA). Especially in rural areas with longer response times of emergency medical services (EMS) early lay defibrillation could lead to a significant higher survival in OHCA.Participants3296 emergency medical stations in Germany.SettingRural areas in Germany.Primary and secondary outcome measuresThree UAV networks providing 80%, 90% or 100% coverage for rural areas lacking timely access to EMS (ie, time-to-defibrillation: >10 min) were developed using a location allocation analysis. For each UAV network, primary outcome was the cost-effectiveness using the incremental cost-effectiveness ratio (ICER) calculated by the ratio of financial costs to additional life years gained compared with current EMS.ResultsCurrent EMS with 3926 emergency stations was able to gain 1224 life years on annual average in the study area. The UAV network providing 100% coverage consisted of 1933 UAV with average annual costs of €43.5 million and 1845 additional life years gained on annual average (ICER: €23 568). The UAV network providing 90% coverage consisted of 1074 UAV with average annual costs of €24.2 million and 1661 additional life years gained on annual average (ICER: €14 548). The UAV network providing 80% coverage consisted of 798 UAV with average annual costs of €18.0 million and 1477 additional life years gained on annual average (ICER: €12 158).ConclusionThese results reveal the relevant life-saving potential of all modelled UAV networks. Furthermore, all analysed UAV networks could be deemed cost-effective. However, real-life applications are needed to validate the findings.

PROGRESSIVE ATHEROSCLEROTIC CORONARY ARTERIES IN PATIENTS WITH SEVERAL ISCHEMIC EVENTS IN ANAMNESIS

2021 ◽  
pp. 113-119
Author(s):  
Parkhomenko O.M. ◽  
Lozhkina N.G.
Keyword(s):  
Myocardial Infarction ◽  
Coronary Arteries ◽  
Clinical Signs ◽  
Risk Groups ◽  
Adverse Outcomes ◽  
Syntax Score ◽  
One Year ◽  
The Moment ◽  
Microsoft Office ◽  
Ischemic Events

Вackground. Progressive atherosclerosis is accompanied by unfavorable clinical outcomes; study and understanding of this process is necessary to identify the appropriate risk groups. Purpose of the study to study the dynamics of atherosclerotic lesions of the coronary arteries in patients with several ischemic events in history. Patient Characterization and Research Methods. The present subanalysis included 51 patients with recurrent nonfatal myocardial infarction (MI) out of the initially included 100 patients with index MI. All 100 patients had a history of two or more ischemic coronary or cerebral events, which corresponds to the clinical signs of progressive atherosclerosis. The dynamics of the degree of coronary stenosis from the moment of index MI to repeated MI was assessed according to the data of selective coronary angiography. The statistical program Microsoft Office Excel 2019 was used. Results. All patients with recurrent myocardial infarction (51 people) had signs of progression of coronary artery stenosis: "mild" progression - 82.3%, "moderate" and "severe" - 15.6% and 2.1%, respectively. SYNTAX Score> 22.5 points was a predictor of one-year adverse outcomes: OR 6.349, CI (2.548-15.823). The results obtained make it possible to distinguish a group of patients with accelerated atherosclerosis syndrome in order to stratify the risk and optimally manage this complex category of patients.

“Professional Movements” and the Expansion of Access to Healthcare in the Industrializing World

2017 ◽  
Vol 3 (3) ◽  
pp. 252-272 ◽  
Author(s):  
Joseph Harris
Keyword(s):  
Political Parties ◽  
Labor Unions ◽  
Rural Areas ◽  
Access To Healthcare ◽  
Knowledge Networks ◽  
Mass Movements ◽  
Left Wing ◽  
Universal Healthcare ◽  
Health Policymaking ◽  
The Welfare State

Explanations for the expansion of the welfare state have frequently centered on the importance of left-wing political parties and labor unions. Scholars have even pointed to the rare but growing significance of social democracy in the industrializing world. Yet, in the field of healthcare, labor unions frequently oppose sweeping universalistic reforms that threaten to erode members’ existing benefits, and those most in need of healthcare in rural areas and the informal sector are often the least organized politically. In the absence of mass demands, who then is responsible for universal healthcare programs in the industrializing world, and by what means do they successfully advocate for far-reaching reforms? This article explores the role that “professional movements” played in expanding access to healthcare in an industrializing nation that was engaged in processes of democratization. Mass movements are typically composed of lay people; by contrast, professional movements are made up of elites from esteemed professions who command knowledge, networks, and access to state resources that set them apart from ordinary citizens. The account illustrates how and why professional movements are able to play such a powerful role in health policymaking in the industrializing world, points to the need for more research on professional movements in other cases and policy domains, and discusses their relevance to social change in the industrializing world.

scholarly journals Pathogenicity and non-opportunistic character of Blastocystis spp.: a hospital-based survey in Central Cameroon

2018 ◽  
Vol 12 (05) ◽  
pp. 373-379 ◽  
Author(s):  
Stéphanie Jupsa-Mbiandou ◽  
Samuel Fosso ◽  
Edimo Billé ◽  
Tito T Mélachio-Tanekou ◽  
Gideon Ajeagah-Aghaindum ◽  
...  
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Age Groups ◽  
Clinical Signs ◽  
Hiv Positive ◽  
Cross Sectional ◽  
Significant Difference ◽  
Blastocystis Spp ◽  
Stool Samples ◽  
Hiv Negative

Introduction: Blastocystis spp. is a protist found in humans. Although usually the most frequent protozoa found in stool samples of both symptomatic and healthy subjects, its pathogenic or rather opportunistic role is yet to be clearly elucidated. To attempt to fill this gap, a cross-sectional study was conducted to compare the frequency of Blastocystis spp. in HIV positive (HIV+) versus HIV negative (HIV-) individuals in four health facilities of the Center Region of Cameroon. Methodology: Stool samples were collected from 283 HIV positive and 245 HIV negative subjects and analyzed using direct diagnostic tests. Results: A total of 46 (8.7%) individuals were found infected with Blastocystis spp., including 6.7% HIV positive and 11.0% HIV negative. This species was more frequent in urban and semi-urban areas than in rural areas, but evenly distributed among genders and age groups as well as among all sectors of activity. The prevalence of Blastocystis spp. (11.3%) was higher in HIV+ patients with a CD4 count ≥ 500 cells / mm3, but no significant difference was found among HIV clinical stages. Likewise prevalence, the mean number of cysts per gram of stool was similar between HIV positive and HIV negative individuals. People infected with Blastocystis spp. showed diverse clinical signs, but only flatulence was significantly more prevalent. The frequencies of these clinical signs were not related to HIV status. Conclusion: No clear relationship links the infection with Blastocystis spp. to HIV, although its presence was associated with digestive disorder, suggesting that this parasite might not be opportunist.

scholarly journals DISRUPCIÓN RURAL: UN PRIMER PASO PARA LA CONSTRUCCIÓN DE DESTINOS TURÍSTICO CON ENFOQUE TERRITORIAL. UNA VISIÓN INTEGRADA DESDE LA “GROUNDED THEORY” / / / \ \ \ RURAL DISRUPTION: A FIRST STEP TOWARDS BUILDING TOURIST DESTINATIONS WITH TERRITORIAL APPROACH. AN INTEGRATED VISION FROM THE GROUNDED THEORY

2020 ◽  
pp. 115
Author(s):  
María del Carmen Solano Báez ◽  
Prudencio José Riquelme Perea ◽  
César García Pina
Keyword(s):  
Grounded Theory ◽  
Rural Areas ◽  
Territorial Development ◽  
Tourist Destinations ◽  
Analysis Methodology ◽  
Inductive Research ◽  
Palabras Clave ◽  
Territorial Approach ◽  
Investigación Cualitativa ◽  
The Moment

Resumen. Esta investigación se enmarca en el estudio del proceso de configuración de destinos turísticos rurales, en el cual se investiga la transición de territorio a destino. El objetivo de este trabajo es analizar el proceso de distanciamiento en el medio rural, identificado gracias a las potencialidades derivadas del uso de la triple codificación que caracteriza la Grounded Theory. El distanciamiento es definido como una desterritorialización multidimensional y caracterizado por cuatro rupturas: socioproductiva, sociocultural, socioambiental y política. Este proceso se identifica como el momento en el cual un territorio oscila entre el declive y la reconstrucción para el impulso del desarrollo territorial basado en las especificidades del territorio. Es una investigación cualitativa inductiva, realizada a partir de la perspectiva glaseriana de la Grounded Theory como metodología de investigación y análisis. Aborda la desterritorialización desde una perspectiva filosófica y económica para explicar el proceso de distanciamiento. Una fase de conceptualización del territorio previa a la construcción de destinos turísticos en el medio rural.   Palabras clave: Grounded Theory, distanciamiento, desterritorialización.   Abstract. This research is part of the study of the process of configuration of rural tourist destinations, in which the transition from territory to destination is researched. The aim of this paper is to analyze the process of distancing in the rural environment, identified thanks to the potentialities derived from the use of the triple coding that characterizes the Grounded Theory. Distancing is defined as a multidimensional deterritorialization, characterized by four ruptures: socio-productive, socio-cultural, socio-environmental and political. This process is identified as the moment in which a territory oscillates between decline and reconstruction in order to promote territorial development based on the specificities of the territory. It is a qualitative inductive research, carried out from the glaserian perspective of the Grounded Theory as a research and analysis methodology. It approaches deterritorialization from a philosophical and economic perspective to explain the process of distancing. A phase of conceptualization of the territory prior to the construction of tourist destinations in the rural areas.   Key words: Grounded Theory, distancing, deterritorialization.

scholarly journals Durable Rural Development Through the 2014 - 2020 National Rural Development Program

2018 ◽  
Vol 13 (2) ◽  
pp. 147-152 ◽  
Author(s):  
Paul Lucian
Keyword(s):  
Rural Development ◽  
Rural Areas ◽  
Rural Economy ◽  
Development Program ◽  
Development Programs ◽  
Local Identity ◽  
Rural Development Program ◽  
Implied Contracts ◽  
The Moment ◽  
The Village

AbstractRural Development Policy is a priority for the E.U., as half of the Union’s population lives in rural areas. This policy is focused on society’s durable development, under all its aspects: economic, social, cultural, and so on. The challenges which rural areas of member states face must be addressed, while at the same time applying European norms and standards for rural development. After Romania became a part of the E.U., rural areas here were supported through several national rural development programs, so as to create a durable and sustainable rural economy. Major changes are required to achieve this kind of development, such as replacing old agricultural structures, modernizing the village, while at the same time maintaining cultural and local identity. Rural areas in Romania are often affected by natural disasters. During the last 17 years, national rural development programs implied contracts worth billions of Euros. For instance, through the 2020 NRDP, a budget of 9.5 billion Euros was allocated, 8.1 billion Euros coming from E.U. funding and 1.34 billion Euros as national cofinancing. At the moment, Romania’s absorption degree for the 2020 NRDP is of 20% and is expected to surpass 50% by 2020. Another regional program includes the concept of Spatial Development - Romania - 2025. Spatial planning supports the avoidance of rural dispersion. The betterment of infrastructure is supported, such as access roads, expanding base utilities, consolidated works to prevent flooding or landslides, and so on.

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