Disparity in the Hospitals Utilization among Regions in Indonesia

2020 ◽  
Author(s):  
Agung Dwi Laksono ◽  
Beben Benyamin ◽  
Trias Mahmudiono
Keyword(s):  
Health Care ◽  
Data Collection ◽  
Multinomial Logistic Regression ◽  
Continuous Variables ◽  
Chi Square ◽  
Chi Square Test ◽  
The Difference ◽  
Outpatient Utilization ◽  
Significant Regional Difference ◽  
Ethical Clearance

Abstract Background. The utilization of hospital services is a benchmark for the success of a health care referral system. Indonesia as the largest archipelago in the world encounters challenging conditions along with lack of infrastructure posed economic and health disparity among its regions. Disparities as a result of this development also have an impact on the accessibility of health care facilities.Methods. Chi Square test was used to test dichotomy variables and t-tests were performed for analyzing the difference among continuous variables. These tests were employed to assess the hypothesis that there was significant regional difference in the access of health care in Indonesia. Estimation using multinomial logistic regression test was used to study the disparity between regions in hospital utilization.Results. The results of this study indicate that there were disparities between regions in Indonesia. In the inpatient category all regions have better utilization than the Papua region, except the Sumatra region. The highest disparity occurs between the Nusa Tenggara region and the Papua region. Possibility of utilizing hospital vs. inpatient facilities not using the hospital 1,439 times in adults in the Nusa Tenggara region compared to the Papua region (OR = 1,439; 95% CI = 1,271 - 1,629). In the category of outpatient utilization as well as hospitalization in hospitals, the Papua region has better hospital utilization compared to other regions. The greatest disparity with the Sumatra region (OR = 0.484; 95% CI = 0.392 - 0.597).Conclusion. In conclusion, there were disparities between regions in Indonesia even though the odds ratio for mortality between regions decreased compared to the previous period.Ethical Clearance. The 2013 RISKESDAS survey had ethical clearance that was approved by the national ethical committee in the NIHRD (ethic number: 01.1206.207). Informed consent was used during data collection, which considered aspects of data collection procedure, voluntary, and confidentiality.

scholarly journals Disparity in the Hospitals Utilization among Regions in Indonesia

2021 ◽  
Vol 9 (E) ◽  
pp. 1461-1466
Author(s):  
Trias Mahmudiono ◽  
Agung Dwi Laksono
Keyword(s):  
Health Care ◽  
Multinomial Logistic Regression ◽  
Individual Characteristics ◽  
Health Care Facilities ◽  
Hospital Utilization ◽  
Continuous Variables ◽  
Chi Square ◽  
Care Facilities ◽  
Chi Square Test ◽  
The Difference

Abstract: The utilization of hospital services is a benchmark for the success of a health care referral system. Indonesia as the largest archipelago in the world encounters challenging conditions along with lack of infrastructure posed economic and health disparity among its regions. Disparities as a result of this development also have an impact on the accessibility of health care facilities. Regions with good economic movements tend to have good accessibility to health care facilities. For this reason, reducing disparity to achieve universal health services is the goal of health planners and policy makers. Chi Square test was used to test dichotomy variables and t-tests was performed for analysing the difference among continuous variables. These tests were employed to assess the hypothesis that there was significant regional difference in the access of health care in Indonesia. Estimation using multinomial logistic regression test was used to study the disparity between regions in hospital utilization. The results of this study showed that disparities between regions in Indonesia exist in term of hospital utilization. The disparities in hospital utilization among regions in Indonesia were associated with: marital status, socioeconomic status, education level, occupation and insurance ownership. However, the difference in odds ratio for mortality between regions decreased compared to the previous period. Conclusion. Disparities in the hospital utilization among region in Indonesia was associated with complex factors from individual characteristics through geographic barriers.

Universal screening for Lynch syndrome (LS) in colorectal cancer (CRC) and survival.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 415-415 ◽  
Author(s):  
Sigurdis Haraldsdottir ◽  
Christina Sing-Ying Wu ◽  
Heather Hampel ◽  
Wendy Frankel ◽  
Xueliang Jeff Pan ◽  
...  
Keyword(s):  
Universal Screening ◽  
Gene Sequencing ◽  
Rank Test ◽  
Continuous Variables ◽  
State University ◽  
Chi Square ◽  
Chi Square Test ◽  
The Difference ◽  
The Ohio State University ◽  
Or Gene

415 Background: It has been argued that universal screening for LS should be performed on all patients (pts) diagnosed with CRC because screening LS pts and their relatives can detect early cancers and improve outcomes. This approach is being adopted by many comprehensive cancer centers around the country. The Ohio State University (OSU) began screening for deficient mismatch repair (dMMR) proteins by immunohistochemistry (IHC) on all CRC cases in 2006. This retrospective study aims to assess whether universal screening with IHC followed by conclusive testing (BRAF mutation in setting of MLH1 deficiency, and/or gene sequencing) affects pts survival. Methods: All CRC pts diagnosed at OSU from 3/2006-6/2012 with dMMR testing per IHC were included, and their charts were reviewed. Chi-square test was used to for categorical parameters, t-test was used for continuous variables, and the log-rank test for overall survival (OS) to compare the difference between pts with full conclusive testing vs those without full testing. Patients who expired within 4 weeks of diagnosis were excluded (n=10) from the OS analysis. Results: One hundred and twenty-two tumors (15.7% of 777 tumors tested) had dMMR by IHC during the study period. Fifty-one pts went on to have conclusive testing done; thirteen patients (25.5%) were diagnosed with LS, 29 patients (56.9%) had MLH1-hypermethylated tumors, and 9 patients (17.6%) were not found to have MMR mutations on gene sequencing. In an OS analysis, patients undergoing conclusive testing had significantly longer survival as compared to those with abnormal IHC without further testing (median OS not reached vs. 38 months, p=0.04). The difference was similar and remained marginally significant (p= 0.04-0.09) after correcting for age, stage and testing date using different models. Conclusions: Patients who had conclusive testing after initial abnormal universal screening with IHC had significantly longer OS compared to pts who had abnormal IHC without follow-up testing. It is possible that ascertainment bias and pts compliance influenced survival so larger prospective studies that document stage and treatment are needed to determine if increased surveillance in the setting of a LS diagnosis leads to better OS.

scholarly journals Effect of different stages on match outcomes during high level judo competitions

2020 ◽  
Vol 15 (1) ◽  
pp. 14
Author(s):  
Bayram Ceylan ◽  
Furkan Öztürk ◽  
Sükrü Serdar Balci
Keyword(s):  
Efficiency Index ◽  
Descriptive Statistics ◽  
The Other ◽  
Continuous Variables ◽  
Chi Square ◽  
Men And Women ◽  
Chi Square Test ◽  
Judo Athletes ◽  
The Difference ◽  
High Level

<p>This study aimed to demonstrate the effect of successive stages of high-level judo competitions on match outcome and the factors effecting it. A total of 4550 official matches in both men and women were included in the analysis. Frequencies and percentages were used for descriptive statistics. Mean and standard deviations with 95% confidence intervals were also presented. The difference in the variables investigated for each stage of judo competitions was analysed with the Chi-square test. Continuous variables were analysed with the Kruskal-Wallis test. The way competitors won a match differed in elimination, final stages, and medal matches (<em>p</em>=.02). When the difficulty of the matches increased, the percentage of the matches ended with <em>ippon </em>decreased and the percentage of the matches resulted with <em>waza-ari</em> increased. The percentage of the matches without any <em>shido</em> decreased from the elimination to the finals while there was a significant increase in the percentage of the matches with s<em>hido </em>(<em>p</em>=.01). The match duration was found to increase from eliminations to the finals (<em>p</em>=.00). The efficiency index of the winner athletes during the first stage was higher than the other stages (<em>p</em>&lt;.05). In conclusion, high-level judo athletes won a match with different scores at different stages during high-level judo competitions. Moreover, athletes were awarded with penalties more during the finals compared to eliminations, and match duration incrementally increased from the eliminations to the finals.</p>

scholarly journals SORE THROAT

2018 ◽  
Vol 25 (09) ◽  
pp. 1421-1425
Author(s):  
Liaqat Ali ◽  
Sabir Khan ◽  
Haroon Israr ◽  
Aamir Furqan
Keyword(s):  
Sore Throat ◽  
Sampling Technique ◽  
P Value ◽  
Continuous Variables ◽  
Chi Square ◽  
Significant Difference ◽  
Chi Square Test ◽  
Spss Software ◽  
The Difference ◽  
Trial Setting

Objectives: To compare the effect of ketamine nebulization and ketamine gargleon post operative sore throat. Study Design: Randomized control trial. Setting: Department ofAnaesthesia Ibn e Sina Hospital. Multan and National, Lahore. Period: May 2016 to May 2017.Methodology: After provision form ethical committee and informed consent to be included instudy. Patients of age 20-60 years, ASA status I and II, elective surgeries under GA and both sexwere included in the study through consecutive sampling technique. SPSS software was used toanalyze all variables included in the study continuous variables were measured and presentedas mean and standard deviation, categorical measurement were measured in numbers andpercents. Chi square test was applied to check the difference among both groups. P value ≤0.05 was considered as significant. Results: Overall, 100% (n=160) patients were included, inthis study; divided into two equal groups, 50% (n=80) in each, gargled ketamine group (GKgroup) and nebulization group (NK group) respectively. The incidence of postoperative sorethroat at 0, 2, 4, and 24 hours, in GK group, was (n=8) 40%, (n=4) 20%, (n=3) 15% and (n=3)15%respectively. While, at corresponding time point in group NK it was (n=1) 5%, (n=7) 35%,(n=4) 20% and (n=2) 10%respectively. Conclusion: The observations of our study revealedthat ketamine nebulization and ketamine gargles having no significant difference in reductionof POST incidence.

scholarly journals 350. Neurocysticercosis – Gender Differences in Clinical Presentations

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S244-S244
Author(s):  
Bharath Pendyala ◽  
Prasanth Lingamaneni ◽  
Patricia DeMarais ◽  
Lakshmi Warrior ◽  
Gregory Huhn
Keyword(s):  
Gender Differences ◽  
Categorical Variables ◽  
Public Health Issue ◽  
Diagnostic Code ◽  
Continuous Variables ◽  
Chi Square ◽  
Generalized Seizures ◽  
Icd 10 ◽  
Chi Square Test ◽  
Reported Data

Abstract Background Neurocysticercosis is a Neglected Tropical Disease and an important public health issue. Our goal was to collect and analyze data regarding clinically significant gender differences among our Neurocysticercosis patients. Methods A retrospective chart search with ICD 9/ ICD 10 diagnostic code for Neurocysticercosis and neuroimaging suggestive of Neurocysticercosis was performed for clinical encounters in the hospital or affiliated clinics between years 2013–2018. After a careful chart review, patients who were clinically diagnosed with Neurocysticercosis were included in the study. T-test was used to compare means of continuous variables and chi-square test to compare proportions of categorical variables. Results Among 90 total patients included, male (49.4%) and female (50.6%) distribution were nearly identical. The mean age in females was found to be higher than males (52.5 vs 42.0, P &lt; 0.0001). Almost an equal number of males and females presented with either seizures (63.6% vs 57.8%, P= 0.85), headaches (25.0% vs 28.9%, p= 0.85), or other symptoms (11.4% vs 13.3%, p= 0.85). Males had more generalized seizures compared to females (60% vs 38%, P= 0.37), although this result was not statistically significant. Females were more likely to present with &gt; 1 lesion (82.2% vs 56.8%, P= 0.01). Males were more likely to have cystic lesions (64.7% vs 27.9%, P &lt; 0.001) compared to females who had more calcified lesions on presentation (65.1% vs 20.6%, P &lt; 0.001). Male patients were more likely to have contrast enhancement or edema surrounding the lesions (61.4% vs 33.3%, P= 0.01) and were more likely to require treatment with Albendazole/Praziquantel (75.8% vs 31.7%, P &lt; 0.001). Conclusion Although previously reported data is limited, there is a suggestion that there are gender differences in host immune response and that inflammation surrounding parenchymal lesions is more intense in females. This study suggests that men either present early in the disease phase or have different immune responses than women and require anti-parasitic therapy more frequently. More research in this aspect is needed. Disclosures All Authors: No reported disclosures

Performance of Abbreviated Protocols Versus Unenhanced MRI in Detecting Occult Breast Lesions of Mammography in Patients with Dense Breasts

2021 ◽  
Author(s):  
Suhong Zhao ◽  
Peipei Chen ◽  
Guangrui Shao ◽  
Baijie Li ◽  
Huikun Zhang ◽  
...  
Keyword(s):  
Reading Time ◽  
Area Under The Curve ◽  
Lesion Size ◽  
Lower Sensitivity ◽  
Chi Square ◽  
Dense Breast Tissue ◽  
Negative Findings ◽  
Chi Square Test ◽  
The Difference ◽  
Sensitivity Specificity

Abstract Objective: To assess the diagnostic ability of abbreviated protocols of MRI (AP-MRI) compared with unenhanced MRI (UE-MRI) in mammographically occult cancers in patients with dense breast tissue.Materials and Methods: The retrospective analysis consisted of 102 patients without positive findings on mammography who received preoperative MRI full diagnostic protocols (FDP) between January 2015 and December 2018. Two breast radiologists read the UE, AP, and FDP. The interpretation times were recorded. The comparisons of the sensitivity, specificity and area under the curve of each MRI protocol, and the sensitivity of these protocols in each subgroup of different size tumors used the Chi-square test. The paired sample t-test was used for evaluating the difference of reading time of the three protocols.Results: Among 102 women, there were 68 cancers and two benign lesions in 64 patients and 38 patients had benign or negative findings. Both readers found the sensitivity and specificity of AP and UE-MRI were similar (p>0.05), whereas compared with FDP, UE had lower sensitivity (Reader 1/Reader 2: p=0.023, 0.004). For different lesion size groups, one of the readers found that AP and FDP had higher sensitivities than UE-MRI for detecting the lesions ≤10 mm in diameter (p=0.041, p=0.023). Compared with FDP, the average reading time of UE-MRI and AP was remarkably reduced (p < 0.001).Conclusion: AP-MRI had more advantages than UE-MRI to detect mammographically occult cancers, especially for breast tumors ≤10 mm in diameter.

Abstract 14721: Impact of Covid-19 on Cardiology Consultation in Tertiary Care Hospital of a Developing Country

Circulation ◽  
2020 ◽  
Vol 142 (Suppl_3) ◽  
Author(s):  
ghufran adnan ◽  
Osman Faheem ◽  
Maria Khan ◽  
Pirbhat Shams ◽  
Jamshed Ali
Keyword(s):  
Emergency Department ◽  
Tertiary Care ◽  
Reduction Rate ◽  
Care Hospital ◽  
Chi Square ◽  
Coronary Syndrome ◽  
Significant Difference ◽  
Drastic Increase ◽  
Chi Square Test ◽  
The Difference

Introduction: COVID-19 pandemic has overwhelmed the healthcare system of Pakistan. There has been observation regarding changes in pattern of patient presentation to emergency department (ED) for all diseases particularly cardiovascular. The aim of the study is to investigate these changes in cardiology consultations and compare pre-COVID-19 and COVID-19 era. Hypothesis: There is a significant difference in cardiology consultations during COVID era as compared to non-COVID era. Method: We collected data retrospectively of consecutive patients who visited emergency department (ED) during March-April 2019 (non-COVID era) and March-April 2020 (COVID era). Comparison has been made to quantify the differences in clinical characteristics, locality, admission, type, number, and reason of Cardiology consults generated. Results: We calculated the difference of 1351 patients between COVID and non-COVID era in terms of cardiology consults generated from Emergency department, using Chi-square test. Out of which 880 (59%) are male with mean age of 61(SD=15). Analysis shows pronounced augmentation in number of comorbidities [Hypertension(6%), Chronic kidney disease (6%), Diabetes (5%)] but there was 36% drop in total cardiology consultations and 43% reduction rate in patient’s ED visit from other cities during COVID era. There was 60% decrease in acute coronary syndrome presentation in COVID era, but fortuitously drastic increase (30%) in type II myocardial injury has been noted. Conclusion: There is a remarkable decline observed in patients presenting with cardiac manifestations during COVID era. Lack in timely care could have a pernicious impact on outcomes, global health care organizations should issue directions to adopt telemedicine services in underprivileged areas to provide timely care to cardiac patients.

scholarly journals A single-center study on impact of psychological intervention to acclimatize medical staffs who are serving COVID-19 disease patients, to continue hospital activities without any disruption

2021 ◽  
Vol 8 (6) ◽  
pp. 3048
Author(s):  
Dhaval Dalal ◽  
Kamalpriya Thiyagarajan ◽  
Humeshwari Nipane ◽  
Vijaykumar Gawali
Keyword(s):  
Health Care ◽  
Anxiety Disorder ◽  
Generalized Anxiety Disorder ◽  
Health Care Workers ◽  
Psychological Intervention ◽  
P Value ◽  
Generalized Anxiety ◽  
Chi Square ◽  
Care Workers ◽  
Chi Square Test

Background: COVID-19 has brought psychological disorders that affect health care workers and the general public. Hence it is important to have necessary counselling to address the psychological, social aspects of the pandemic to ensure psychological well-being of especially Health-care Workers and preserve their innate and acquired immunity.Methods: The study was planned as single centre retrospective study and conducted between April and June 2020 at dedicated COVID-19 hospital in India. Front-line HCWs more than 18 years, of any gender working in COVID-19 hospital and willing to participate for the study were enrolled in the study. Study included two questionnaires, generalized anxiety disorder scale, and socio-demographics and COVID-19 related awareness questionnaire. Measurements were taken pre and post the psychological counselling intervention.Results: As per generalized anxiety disorder (GAD) scale people suffering from moderate anxiety disorder dropped from 19% (pre counselling) to 5% (post counselling) and severe cases dropped from 14% (pre counseling) to 2% (post counseling), there was statistically significant difference observed due to psychological intervention in GAD scale (Chi square test-10.794, p value=3.67E-27). Socio demographics and COVID-19 related awareness questionnaire results were statistically significant (Chi square test-11.945, p value=6.91E-33).Conclusions: Counselling interventions based on scientific data offered in groups by investigator with an accurate knowledge of the COVID-19 and its manifestation increased the confidence of health care workers (HCWs) and reduced anxiety level. This was translated into the full availability of HCWs on the clinical study site, although medical services were disrupted while other hospitals were starving due to lack of staff.

scholarly journals Efficacy of 4% chlorhexidine in preventing neonatal umbilical cord infection

2020 ◽  
Vol 14 (03) ◽  
pp. 136-139
Author(s):  
Fouzia Ishaq ◽  
Anila Jamil ◽  
Muhammad Sajjad ◽  
Maria Iftikhar ◽  
Muhammad Adnan Zafar ◽  
...  
Keyword(s):  
Umbilical Cord ◽  
Analytical Study ◽  
Bacterial Colonization ◽  
Neonatal Morbidity ◽  
Chi Square ◽  
Once Daily ◽  
Group 4 ◽  
Chi Square Test ◽  
The Difference ◽  
Random Method

Background: Umbilical cord stump is a budding point for bacterial colonization subsequently leading to sepsis that contributes to high neonatal morbidity and mortality, if not properly managed. Antiseptic care can significantly reduce omphalitis and ultimately improve newborn survival. Objective of this study was to see the efficacy of 4% chlorhexidine use to prevent umbilical cord infection in neonates.Subjects and methods: It was a comparative analytical study conducted in Neonatal unit, Sir Ganga Ram Hospital (SGRH) Lahore from July, 2016 till January, 2017. One hundred neonates were enrolled and randomized into two equal group by simple random method (50 each). In one group, nothing was applied to cord while in chlorhexidine group, 4% chlorhexidine gel was applied on umbilicus and around it, once daily for 7 days or till cord detached whichever came early. First application was done by a nurse followed by duly trained mother/caregiver. The signs of omphalitis (redness, pus or localized oedema) were observed and recorded for each neonate in both groups. Chi square test was used to see the difference in omphalitis in these groups with p˂ 0.05 considered as statistically significant result.Results: Out of 100 neonates, 29 (58%) and 23 (46%) males while 21 (42%) and 27 (54%) females neonates belonged to dry care and chlorhexidine group respectively. Nineteen (38%) neonates with dry cord had omphalitis compared to only 5 (10%) in chlorhexidine group (p 0.001). Neonates with chlorhexidine application showed prolonged mean cord separation time (7.9±1.5 days) compared to dry care (6.1±1.8 days). Conclusion: The use of 4% Chlorhexidine was effective to lower omphalitis compared to neonates with dry cord care.

scholarly journals Non-Prescription Antibiotic Use For People Aged 15 Years Or Older For Cough In China: A Community-Based Survey

2021 ◽  
Author(s):  
Yan Luo ◽  
Xuewen Tang ◽  
Lingling Ding ◽  
Zhujun Shao ◽  
Jianxing Yu ◽  
...  
Keyword(s):  
Antimicrobial Resistance ◽  
Univariate Analysis ◽  
Antibiotic Use ◽  
Categorical Variables ◽  
Continuous Variables ◽  
Chi Square ◽  
Main Driver ◽  
Antibiotics Use ◽  
Chi Square Test ◽  
Use Behavior

Abstract Background Non-prescription antibiotic use at community is a main driver of antimicrobial resistance. Cough is a common condition and prevalent in all communities, including China. This study aims to investigate the non-prescription antibiotic use for cough in China and explore to which extent antibiotic use knowledge was correctly instructed in communities.Methods A probability-proportionate-to-size (PPS) sampling method was adopted to survey from all 14 communities in Yiwu city, China. All participants were investigated by face-to-face interview on Portable Android Devices (PADs). The continuous variables were presented by mean and standard deviation (SD) or medium and inter-quartile range (IQR). The categorical variables were presented using percentage or constituent ratio. Chi-square test for univariate analysis and logistic regression for multivariate analysis were conducted to assess the odds ratios (ORs) and 95% confidence intervals (CIs), respectively.Results A total of 3034 respondents across the 14 communities and the 50 natural villages/streets completed all key items of the questionnaire. Of 2400 (79.10%) respondents stated that they experienced cough in the past 12 months with the medium age of 36.5 (IQR: 26-49) and 12.21% (293/2400) respondents had the non-prescription antibiotic use behavior. Among those 293 respondents, the proportion of non-prescription antibiotic use for cough peaked at around 16% among people aged 30-39 years old. The major sources of antibiotics were pharmacy (77.70%) and/or family storage (43.92%). As for antibiotic knowledge in 3034 participants, 61.8% participants had minimal knowledge on broad-spectrum antibiotic and 53.76% were not familiar about the effects of joint use.Conclusions Non-prescription antibiotics use for cough is prevalent in the community, especially among people in their thirties. Strengthened drug purchase regulation and well-trained professional pharmacists would be promising alternatives to ameliorate AMR. Moreover, penetrating antibiotics knowledge to common citizens and is an urgent task to alleviate antimicrobial resistance. Therefore, proactive policies and regulations should be made to improve current situations.

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