scholarly journals Factors associated with the health system and disease in San Antonio (Catamarca, Argentina): an anthropological approach

2021 ◽  
Vol 32 (3) ◽  
pp. 411-418
Author(s):  
Bárbara Martínez
Keyword(s):  
Health System ◽  
San Antonio ◽  
Factors Associated ◽  
Anthropological Approach

Objetivo: Identificar los procesos de salud, enfermedad y cura entre los pobladores de El Cajón, Catamarca, Argentina, la vinculación de estas dinámicas con la biomedicina, y las articulaciones entre ambos sistemas. Materiales y métodos: La investigación es de corte cualitativo. Se privilegia el abordaje etnográfico en el que la observación participante, la co-residencia y las entrevistas abiertas de sesiones múltiples cumplen un rol primordial. La pesquisa se ha centrado en los pobladores locales que regularmente asisten a la posta sanitaria, los enfermeros, los agentes sanitarios y los miembros del equipo de salud itinerante. Resultados: Se ha constatado que los procesos de salud, enfermedad y cura no se limitan al cuerpo humano, sino que también en ellos intervienen el paisaje y los seres que lo pueblan. Se ha identificado que en la resolución de numerosas patologías resulta central la figura del especialista ritual. Se ha determinado la gente valora y utiliza la biomedicina, aunque la asistencia a la institución hospitalaria suele ser rehuida. Conclusión: Se ha identificado un uso combinado de ambos sistemas. En él influyen las valoraciones de las personas sobre la enfermedad de que se trate, pero también otros factores como la distancia hasta el centro asistencial y las relaciones interpersonales con los profesionales de la salud. Se resalta la relevancia del enfoque cualitativo para dar cuenta de las especificidades de las categorías locales, que resultan esquivas para un abordaje construido a partir de conceptos derivados del dualismo cartesiano.

scholarly journals Sociocultural and health system factors associated with mortality among febrile inpatients in Tanzania: a prospective social biopsy cohort study

2018 ◽  
Vol 3 (1) ◽  
pp. e000507 ◽  
Author(s):  
Michael E Snavely ◽  
Michael J Maze ◽  
Charles Muiruri ◽  
Lilian Ngowi ◽  
Flora Mboya ◽  
...  
Keyword(s):  
Health System ◽  
Community Education ◽  
Conditional Logistic Regression ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Care Seeking ◽  
Factors Associated ◽  
Northern Tanzania ◽  
System Factors ◽  
At Home

IntroductionCommunicable diseases are the leading causes of death in Tanzania despite the existence of effective treatment tools. We aimed to assess the sociocultural and health system factors associated with mortality from febrile illness in northern Tanzania.MethodsWe interviewed febrile inpatients to determine prevalence of barriers in seeking or receiving care and grouped these barriers using the Three Delays model (delays at home, in transport and at healthcare facilities). We assessed 6-week mortality and, after matching on age, gender and severity of illness, measured the association between delays and mortality using conditional logistic regression.ResultsWe enrolled 475 children, of whom 18 (3.8%) died, and 260 adults, of whom 34 (13.0%) died. For children, home delays were not associated with mortality. Among adults, a delay in care-seeking due to not recognising severe symptoms was associated with mortality (OR: 3.01; 95% CI 1.24 to 7.32). For transport delays, taking >1 hour to reach a facility increased odds of death in children (OR: 3.27; 95% CI 1.11 to 9.66) and adults (OR: 3.03; 95% CI 1.32 to 6.99). For health system delays, each additional facility visited was associated with mortality for children (OR: 1.59; 95% CI 1.06 to 2.38) and adults (OR: 2.00; 95% CI 1.17 to 3.41), as was spending >4 days between the first facility visit and reaching tertiary care (OR: 4.39; 95% CI 1.49 to 12.93).ConclusionOur findings suggest that delays at home, in transport and in accessing tertiary care are risk factors for mortality from febrile illness in northern Tanzania. Interventions that may reduce mortality include community education regarding severe symptoms, expanding transportation infrastructure and streamlining referrals to tertiary care for the sickest patients.

scholarly journals Prevalence and factors associated with Metabolic Syndrome in elderly users of the Unified Health System

2014 ◽  
Vol 17 (4) ◽  
pp. 805-817 ◽  
Author(s):  
Edna Cunha Vieira ◽  
Maria do Rosário Gondim Peixoto ◽  
Erika Aparecida da Silveira
Keyword(s):  
Metabolic Syndrome ◽  
Health System ◽  
Health Workers ◽  
The Elderly ◽  
World Health ◽  
Fat Percentage ◽  
Cross Sectional ◽  
Factors Associated ◽  
Unified Health System ◽  
The Metabolic Syndrome

OBJECTIVE: To evaluate the prevalence and factors associated with metabolic syndrome in the elderly. METHODS: Cross-sectional study, with 133 individuals randomly selected in the Unified Health System in Goiania, Goiás. The following variables were researched: anthropometric (BMI, waist circumference, fat percentage by Dual X-ray absorptiometry), sociodemographic (gender, age, color, income, marital status and years of schooling), lifestyle (physical activity, smoking and risk alcohol consumption) and food intake (risk and protective foods). The metabolic syndrome was assessed according to harmonized criteria proposed by the World Health Organization (WHO). The combinations were tested by Poisson regression for confounding factors. RESULTS: The prevalence of metabolic syndrome was 58.65% (95%CI 49.8 - 67.1), with 60.5% (95%CI 49.01 - 71.18) for females and 55.7% (95%CI 41.33 - 69.53) for males. Hypertension was the most prevalent component of the syndrome in both men, with 80.8% (95%CI 64.5 - 90.4), and women, with 85.2% (95%CI 75.5 - 92.1). After the multivariate analysis, only the excess of weight measured by body mass index (prevalence ratio = 1.66; p < 0.01) remained associated with the metabolic syndrome. CONCLUSIONS: The prevalence of metabolic syndrome in this sample was high, indicating the need for systematic actions by health workers in the control of risk factors through prevention strategies and comprehensive care to the elderly.

scholarly journals 547. Risk Factors Associated with 30-Day Mortality in a Large Cohort of Patients who Received Remdesivir and Corticosteroids for Severe COVID-19

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S375-S376
Author(s):  
Kartik Gupta ◽  
Lea Monday ◽  
Milan Kaushik ◽  
George J Alangaden ◽  
Indira Brar
Keyword(s):  
Risk Factors ◽  
Logistic Regression ◽  
Health System ◽  
Drug Administration ◽  
Food And Drug Administration ◽  
Antiviral Agent ◽  
Advanced Age ◽  
Event Analysis ◽  
Time To Event ◽  
Factors Associated

Abstract Background Remdesivir (RDV), an antiviral agent, is approved by Food and Drug Administration (FDA) for the treatment of patients (pts) admitted with SARS-COV-2 infection (COVID-19). Earlier RDV studies (such as ACCT-1) prior to widespread use of corticosteroids (CS), showed a 30-day mortality of 11%. Advanced age, obesity, and certain comorbidities are known risk factors for death in COVID-19, but whether these risks vary in pts treated with RDV and CS is unknown. As of March 20, 2020 CS were routinely used for the treatment of pts admitted with COVID19 in our health care system. The objective of this study was to identify risk factors associated with 30 -Day mortality in a cohort of pts admitted with COVID-19 and who received RDV and CS. Methods This retrospective cohort study evaluated pts admitted to a health system in South East Michigan with COVID-19 between March and November 2020 who received ≥1 dose RDV. Demographics, comorbidities, and characteristics including quick sequential organ failure assessment (qSOFA) score were collected and compared between patients who died versus survived. Primary outcome was 30 day mortality. Secondary outcomes were risk factors for death using logistic regression and time-to-event analysis. Results A total of 1,591 pts received RDV and were included in the study; median age 67 years, 56% male and 18% Black. RDV use increased after emergency use authorization and FDA approval (Fig 1). Death within 30 days occurred in 15.3%. Patients who died were older males with higher rates of hypertension, kidney disease, diabetes, and were more likely to have qSOFA ≥2 on arrival (Table 1). In a multivariable logistic model, advanced age, male gender, pulmonary disease, CKD, obesity, and qSOFA≥2 were independent predictors of death (Figure 2). Among these, age and qSOFA≥2 were the most important risk factors (Figure 2). Patients receiving remdesivir (red) were included in the study. Routine use of corticosteroids was adopted on all patients in our health system beginning March 20, 2020. System-wide use of remdesivir increased following Food and Drug Administration approval in fall 2020. On both logistic regression and time-to-event analysis, advanced age and qSOFA ≥ 2 had the highest predictive value for mortality. Others comorbidities were similar and comparable in importance. Conclusion The population in our Real-world study was older with more comorbidities as compared to ACCT-1, and the 30 day mortality was 15%. Despite the use of CS and RDV advanced age and qSOFA were the most important drivers of mortality. Future, therapeutic strategies need to focus on this group which is at the highest risk of dying from COVID-19 infection. Disclosures All Authors: No reported disclosures

Predictors of clinical trial enrollment and impact on outcome in children and adolescents with acute lymphoblastic leukemia: A population based study.

2021 ◽  
Vol 39 (15_suppl) ◽  
pp. 7031-7031
Author(s):  
Paul James Gibson ◽  
Uma H. Athale ◽  
Vicky Rowena Breakey ◽  
Nicole Mittmann ◽  
Mylene Bassal ◽  
...  
Keyword(s):  
Clinical Trial ◽  
Clinical Trials ◽  
Acute Lymphoblastic Leukemia ◽  
Health System ◽  
Children And Adolescents ◽  
Lymphoblastic Leukemia ◽  
Income Quintile ◽  
Factors Associated ◽  
Income Status ◽  
Single Payer

7031 Background: Outcomes in pediatric acute lymphoblastic leukemia (ALL) have shown remarkable improvements in large part due to sequential clinical trials. Concerns however persist around whether access to clinical trials is equitable. It is also unclear whether patient outcomes are improved simply by enrolling on a clinical trial. Our objective was to therefore determine which patient and disease-related factors are associated with enrollment, and whether enrollment was associated with clinical outcomes among children and adolescents with ALL in a single-payer health system in Ontario, Canada. Methods: We included all Ontario patients diagnosed with ALL between 0-18 years of age from 2002-2012 treated at a pediatric center, identified through a provincial pediatric cancer registry. Clinical trial availability was determined by whether each patient’s primary institution had an open frontline trial for which the patient was eligible at the time of their diagnosis, considering individual disease characteristics such as lineage, central nervous system (CNS) status and risk group. Demographic, disease, trial enrolment, and outcome data were obtained through chart abstraction. Logistic regression models determined factors associated with trial enrolment, while Cox proportional hazard models determined factors associated with event-free and overall survival (EFS, OS). Results: Of 858 patients, 693 (81%) were eligible for an open clinical trial at their time of diagnosis. 476 (69%) enrolled on a trial. In adjusted analyses, age > 15 years (odds ratio 0.4 vs. age 5-9, 95th confidence interval (95CI) 0.2-0.8; p = 0.01) and CNS3 disease (OR 0.38 vs. CNS1, 95CI 0.17-0.83; p = 0.01) were significantly associated with decreased likelihood of enrolment, while sex and neighborhood income quintile were not associated with enrolment. Adjusted for disease and demographic factors, clinical trial enrolment was not significantly associated with either EFS (hazard ratio (HR) 1.1, 95CI 0.7-1.7; p = 0.83) or OS (HR 1.3, 95CI 0.7-2.5; p = 0.44). Conclusions: The majority of patients with ALL eligible for available clinical trials at their time of diagnosis were enrolled. While no disparities in enrolment by income status were noted, adolescents were substantially less likely to participate in trials even within pediatric centers. Studies of mechanisms underlying this disparity are warranted in order to design and implement effective interventions targeting increased enrolment rates in this patient population. Our results however also suggest that clinical trial enrolment on its own is not associated with improved outcomes in the context of a single payer health system.

scholarly journals Health system responsiveness in maternity care at Hadiya zone public hospitals in Southern Ethiopia: Users’ perspectives

PLoS ONE ◽  
2021 ◽  
Vol 16 (10) ◽  
pp. e0258092
Author(s):  
Ritbano Ahmed Abdo ◽  
Hassen Mosa Halil ◽  
Biruk Assefa Kebede ◽  
Abebe Alemu Anshebo ◽  
Minychil Demelash Ayalew ◽  
...  
Keyword(s):  
Logistic Regression ◽  
Health System ◽  
Maternity Care ◽  
Public Hospitals ◽  
Southern Ethiopia ◽  
Factors Associated ◽  
Multivariable Logistic Regression ◽  
System Responsiveness ◽  
Health System Responsiveness ◽  
Hadiya Zone

Background Health system responsiveness refers to non-financial, non-clinical qualities of care that reflect respect for human dignity and interpersonal aspects of the care process. The non-clinical aspects of the health system are therefore essential to the provision of services to patients. Therefore, the main purpose of this study was to assess the responsiveness in maternity care, domain performance and factors associated with responsiveness in maternity care in the Hadiya Zone public Hospitals in Southern Ethiopia. Methods A hospital-based cross-sectional study was employed on 413 participants using a systematic sampling technique from 1 July to 1 August 2020. An exit interviewer–administered questionnaire was used to collect data. EpiData (version 3.1) and SPSS (version 24) software were used for data entry and analysis, respectively. Bivariate and multivariable logistic regression were computed to identify the associated factors of health system responsiveness in maternity care at 95% CI. Results The findings indicated that 53.0% of users gave high ratings for responsiveness in delivery care. In the multivariable logistic regression analysis, mothers aged ≥ 35 (AOR = 0.4; 95% CI = 0.1–0.9), urban resident (AOR = 2.5; 95% CI = 1.5–4.8), obstetrics complications during the current pregnancy (AOR = 2.1; 95% CI = 1.1–3.0), and caesarean delivery (AOR = 0.4; 95% CI = 0.2–0.7) were factors associated with poor ratings for responsiveness in maternity care. Conclusion In the hospitals under investigation, responsiveness in maternity care was found to be good. The findings of this study suggest that the ministry of health and regional health bureau needs to pay attention to health system responsiveness as an indicator of the quality of maternity care.

scholarly journals Factors associated with self-medication in users of drugstores and pharmacies in Peru: an analysis of the National Survey on User Satisfaction of Health Services, ENSUSALUD 2015

F1000Research ◽  
2019 ◽  
Vol 8 ◽  
pp. 23
Author(s):  
Diego Urrunaga-Pastor ◽  
Vicente A. Benites-Zapata ◽  
Edward Mezones-Holguín
Keyword(s):  
Health Insurance ◽  
Health Services ◽  
Health System ◽  
National Survey ◽  
User Satisfaction ◽  
Multinomial Logistic Regression ◽  
Secondary Data ◽  
Male Gender ◽  
Self Medication ◽  
Factors Associated

Background: Irresponsible self-medication is a problem for health systems in developing countries. We aimed to estimate the frequency of self-medication and associated factors in users of drugstores and pharmacies in Peru. Methods: We performed a secondary data analysis of the 2015 National Survey on User Satisfaction of Health Services (ENSUSALUD), a two-stage probabilistic sample of all regions of Peru. Non self-medication (NSM), responsible self-medication (RSM) and irresponsible self-medication (ISM) were defined as the outcome categories. Demographic, social, cultural and health system variables were included as covariates. We calculated relative prevalence ratios (RPR) with their 95% confidence intervals (95%CI) using crude and adjusted multinomial logistic regression models for complex samples with NSM as the referent category. Results: 2582 participants were included. The average age was 41.4 years and the frequencies of NSM, RSM and ISM were 25.2%, 23.8% and 51.0%; respectively. The factors associated with RSM were male gender (RPR: 1.35; 95%CI: 1.06-1.72), being between 40 and 59 years old (RPR: 0.53; 95%IC: 0.39-0.72), being 60 or older (RPR: 0.39; 95%IC: 0.25-0.59), not having health insurance (RPR: 1.89; 95%CI: 1.31-2.71) and living in the Highlands region (RPR: 2.27; 95%CI: 1.23-4.21). The factors associated with ISM were male gender (RPR: 1.41; 95%CI: 1.16-1.72), being between 40 and 59 years old (RPR: 0.68; 95%IC: 0.53-0.88), being 60 or older (RPR: 0.65; 95%IC: 0.48-0.88) and not having health insurance (RPR: 2.03; 95%CI: 1.46-2.83). Conclusion: Around half of the population practiced ISM, which was associated with demographic and health system factors. These outcomes are the preliminary evidence that could contribute to the development of health policies in Peru.

scholarly journals S19 Patient Factors Associated With Oral Feeding Within 1 Day of Admission for Acute Pancreatitis in a Large Multihospital Health System

2021 ◽  
Vol 116 (1) ◽  
pp. S9-S9
Author(s):  
Aaron M. Hein ◽  
Neesha Nama ◽  
Sandra Au ◽  
Jared N. Gloria ◽  
Courtney M. Richman ◽  
...  
Keyword(s):  
Acute Pancreatitis ◽  
Health System ◽  
Oral Feeding ◽  
Patient Factors ◽  
Factors Associated

scholarly journals Factors associated with conducting planning for secondary oral health care services in Brazil

2020 ◽  
Author(s):  
Edson Hilan Gomes de Lucena ◽  
Rênnis Oliveira da Silva ◽  
Carolina Dantas Rocha Xavier de Lucena ◽  
Amalia Issufo Mepatia ◽  
Yuri Wanderley Cavalcanti ◽  
...  
Keyword(s):  
Oral Health ◽  
Health System ◽  
Health Care Services ◽  
Service Management ◽  
Statistical Tests ◽  
Secondary Data ◽  
Chi Square ◽  
Factors Associated ◽  
Unified Health System ◽  
Service Production

Abstract Background: Planning in health services specifically aims to improve the health status of a given population, guaranteeing access with equity and justice, as well as streamlining the response of the health system to the needs perceived by the community. This research aims to identify the factors associated with planning Specialized Dental Clinics (SDCs).Methods: Secondary data were used from the external evaluation of the database of the first National Program for Access and Quality Improvement of SDCs (NPAQI–SDCs) and the informed Outpatient Information System of the Unified Health System (OIS/UHS), which contains data on the specialized dental procedures performed at SDCs. It consisted of a quantitative study in which Pearson chi-square statistical tests (p ˂ 0.05) and a multivariate logistic regression were applied with odds ratio (OR) estimate. Results: The results indicated that the realization of planning in SDCs was associated with lower coverage of the Oral Health Team of the Familiy Health Strategy in a municipality (OR = 1.4; 95% CI: 1.0-1.9, p = 0.049), additional training for managers (p = 0.038), the practice of self-assessment (OR = 8.2; 95% CI: 5.8-11.6; p = 0.000) and meeting service production targets (OR = 1.9; 95% CI: 1.2-3.2; p = 0.011). Conclusion: The results indicate that the work processes of the SDCs, especially with regard to service management, are essential to the proper functioning of the service and the practice of planning is linked to the technical capacity and commitment of service managers.

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