scholarly journals Effect of a brief emergency medicine education course on emergency department work intensity of family physicians

CJEM ◽  
2013 ◽  
Vol 15 (01) ◽  
pp. 34-41
Author(s):  
Samuel Vaillancourt ◽  
Susan E. Schultz ◽  
Chad Leaver ◽  
Thérèse Stukel ◽  
Michael J. Schull
Keyword(s):  
Emergency Medicine ◽  
Rural Areas ◽  
Urban Areas ◽  
Cohort Analysis ◽  
Family Physicians ◽  
High Volume ◽  
Work Intensity ◽  
Term Care ◽  
Physician Staffing ◽  
Before And After

ABSTRACT Background: Recently, many Canadian emergency departments (EDs) have struggled with physician staffing shortages. In 2006, the Ontario Ministry of Health and Long-Term Care funded a brief “emergency medicine primer” (EMP) course for family physicians to upgrade or refresh skills, with the goal of increasing their ED work intensity. We sought to determine the effect of the EMP on the ED work intensity of family physicians. Methods: A retrospective longitudinal study was conducted of the ED work of 239 family physicians in the 2 years before and after a minimum of 6 months and up to 2 years from completing an EMP course in 2006 to 2008 compared to non-EMP physicians. ED work intensity was defined as the number of ED shifts per month and the number of ED patients seen per month. We conducted two analyses: a before and after comparison of all EMP physicians and a matched cohort analysis matching each EMP physician to four non-EMP physicians on sex, year of medical school graduation, rurality, and pre-EMP ED work intensity. Results: Postcourse, EMP physicians worked 0.5 more ED shifts per month (13% increase, p = 0.027). Compared to their matched controls, EMP physicians worked 0.7 more shifts per month (13% increase, p = 0.0032) and saw 15 more patients per month (17% increase, p = 0.0008) compared to matched non-EMP physicians. The greatest increases were among EMP physicians who were younger, were urban, had previous ED experience, or worked in a high-volume ED. The effect of the EMP course was negligible for physicians with no previous ED experience or working in rural areas. Conclusion: The EMP course is associated with modest increases in ED work intensity among some family physicians, in particular younger physicians in urban areas. No increase was seen among physicians without previous ED experience or working in rural areas.

Impact of adenotonsillectomy on the quality of life of patients operated on at the Hospital de Clínicas, Paraguay

2021 ◽  
pp. 1-7
Author(s):  
Carlos Mena Canata ◽  
Rebeca Noemí Ruiz Vallejos
Keyword(s):  
Quality Of Life ◽  
Obstructive Sleep Apnea ◽  
Sleep Apnea ◽  
Rural Areas ◽  
Urban Areas ◽  
Obstructive Sleep ◽  
Significant Difference ◽  
Before And After ◽  
The Impact

The objective of this study is to determine the impact of adenotonsillectomy on the quality of life of postoperative patients.The study is observational, cross-sectional, and retrospective. The files of all postoperative adenotonsillectomy patients in Otorhinolaryngology Service, Hospital de Clínicas, San Lorenzo Paraguay. The Obstructive sleep apnea – 18 questionnaire (OSA 18) was applied, asking patients about symptoms before and after surgery. An effective sample of 143 postoperative patients was obtained. The average age was 6.05 ± 2.08 years, 55.10% (81) were male and 44.89% (66) were female, 65.30% (96) were from urban areas and 34.69% (51) from the rural areas. The t test was performed for means of two paired samples, comparing the results of the Obstructive sleep apnea – 18 questionnaire surveys before and after surgery which presented a significant difference (p <0.05) with a tendency to improve the quality of life after surgery. It has been shown that there is a significant difference, a considerable improvement in the quality of life of patients after adenotonsillectomy.

scholarly journals Can interactive parental education impact health care utilization in pediatric asthma: A study in rural Texas

2018 ◽  
Vol 46 (8) ◽  
pp. 3172-3182 ◽  
Author(s):  
Vijay Agusala ◽  
Priyanka Vij ◽  
Veena Agusala ◽  
Vivekanand Dasari ◽  
Bhargavi Kola
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Parental Education ◽  
Pediatric Patients ◽  
Hospital Admissions ◽  
Care Utilization ◽  
Asthma Education ◽  
Before And After ◽  
Ed Visits ◽  
The Impact

Objective It is well known that parent/patient education helps to reduce the burden of asthma in urban areas, but data are scarce for rural areas. This study explored the impact of asthma education in Ector County, a rural part of Health Services Region 9 in Texas, which has one of the highest prevalence rates of asthma in the state. Methods This prospective study investigated an interactive asthma education intervention in pediatric patients aged 2–18 years and their caregivers. Change in parental/caregiver knowledge about their child’s asthma along with frequency of missed school days, emergency department (ED) visits and hospital admissions was obtained via telephone surveys before and after the educational intervention was delivered. Results The study enrolled 102 pediatric patients and their parents/caregivers. Asthma education was associated with significantly fewer school absences, ED visits and hospitalizations. Parents/caregivers reported feeling better educated, knowing what triggers an asthma exacerbation, identifying the signs of a severe asthma attack in their child, feeling confident about managing asthma and feeling that the asthma was under control. Conclusion Asthma education of caregivers and children was associated with better symptom management and fewer acute exacerbations, pointing to the relevance and importance of asthma education among pediatric patients in rural areas.

scholarly journals Do adult health outcomes in urban population reflect local health risk? A matched cohort analysis of migration effects in Ouagadougou, Burkina Faso

BMJ Open ◽  
2019 ◽  
Vol 9 (7) ◽  
pp. e029059
Author(s):  
Philippe Bocquier ◽  
Abdramane Bassiahi Soura ◽  
Souleymane Sanogo ◽  
Sara Randall
Keyword(s):  
Health Status ◽  
Health Services ◽  
Health Outcomes ◽  
Health Risks ◽  
Rural Areas ◽  
Urban Areas ◽  
Cohort Analysis ◽  
Local Health ◽  
Access To Health Services ◽  
Access To Health

BackgroundSelective migration may affect health indicators in both urban and rural areas. Sub-Saharan African urban areas show evidence of both negative and positive selection on health status at outmigration. Health outcomes as measured in urban populations may not reflect local health risks and access to health services.MethodsUsing the Ouagadougou Health and Demographic Surveillance System and a migrant follow-up survey, we measured differences in health between matched non-migrants and outmigrants. We applied Cox and competing risks models on migration and death.ResultsControlling for premigration health status, migrants who moved out of Ouagadougou have higher mortality (HR 3.24, 95% CI 1.23 to 8.58) than non-migrants and migrants moving to other Ouagadougou areas. However, these effects vanish in the matched sample controlling for all interactions between death determinants. These and other results show little evidence that migration led to higher mortality or worse health.ConclusionsHealth outcomes as measured in Ouagadougou population do reflect local health risks and access to health services despite high migration intensity. However, neither the hypothesis of effect of health on migration nor the hypothesis of negative effect of migration on health or survival was confirmed.

scholarly journals Utilisation willingness for institutional care by the elderly: a comparative study of empty nesters and non-empty nesters in Shandong, China

BMJ Open ◽  
2018 ◽  
Vol 8 (8) ◽  
pp. e022324 ◽  
Author(s):  
Yangyang Qian ◽  
Wen Qin ◽  
Chengchao Zhou ◽  
Dandan Ge ◽  
Li Zhang ◽  
...  
Keyword(s):  
Rural Areas ◽  
Living Arrangements ◽  
Urban Areas ◽  
Institutional Care ◽  
Binary Logistic Regression ◽  
The Elderly ◽  
Empty Nest ◽  
Care Needs ◽  
Term Care ◽  
The Government

IntroductionInstitutional care has been strongly promoted in China to meet seniors’ long-term care needs. Empty-nest elderly, in comparison with their counterparts, have less social support and fewer caring networks. This study aimed to compare the utilisation willingness for institutional care and its predictors between empty-nest and non-empty-nest seniors.MethodsA total of 3923 seniors were included in the analysis. Binary logistic regression models were used to understand the association between the living arrangements of the elderly households and willingness for institutional care and to identify the predictors of the utilisation willingness for institutional care among empty nesters and non-empty nesters.ResultsOur study found that approximately 8.5% of the seniors had a willingness for institutional care in Shandong, China. Empty-nest singles (OR 5.301; 95% CI 2.838 to 9.904) and empty-nest couples (OR 1.547; 95% CI 1.135 to 2.107) were found to be more willing to receive institutional care. Our results also showed that residence was a key determinant for institutionalisation willingness in empty-nest and non-empty-nest elderly. Among empty-nest singles, psychological stress was a positive determinant for institutional care. Factors, including education attainment, relationship with adult children, household income and per capita living space, were determinants for empty-nest couple willingness for institutionalisation. Age, number of children and self-reported health status were found to be associated factors for willingness among non-empty nesters.ConclusionsThe government should pay more attention to institutional care in rural areas where there is still a gap in elder care compared with that in urban areas. Targeted policies should be made for different types of seniors to offer appropriate institutional care.

scholarly journals Prediction of the Number of and Care Costs for Disabled Elderly from 2020 to 2050: A Comparison between Urban and Rural Areas in China

2020 ◽  
Vol 12 (7) ◽  
pp. 2598 ◽  
Author(s):  
Liangwen Zhang ◽  
Sijia Fu ◽  
Ya Fang
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
The Elderly ◽  
Severe Disabilities ◽  
Term Care ◽  
The Sustainable Development ◽  
Global Challenge ◽  
Disabled Elderly ◽  
Urban And Rural Areas ◽  
Care Costs

An aging population and an increase in the proportion of elderly people who are disabled have created an unprecedented global challenge, especially in China. This study aimed to predict the number of, and the care costs for, disabled elderly from 2020 to 2050 in China. A comparison was made between urban and rural areas, and we analyzed what must be done to maintain the sustainable development of China’s long-term care insurance (LTCI) system. An overall simulation model and a Monte Carlo simulation were used to estimate the number of disabled elderly and their related care costs, in both urban and rural areas. According to the forecast, the total disabled population will increase rapidly, rising from 43.75 million in 2020 to 91.4 million in 2050. Of that total, 69.7% are expected to be urban elderly. Starting in 2020, the growth rates of the elderly with mild, moderate, and severe disabilities will be 108%, 104%, and 120%, respectively, by 2050. Accordingly, the total care costs will increase from 538.0 billion yuan in 2020 to 8530.8 billion yuan in 2050, of which 80.2% will be required in urban areas. In addition, the per capita costs of care in urban and rural areas in 2050 will be 6 times and 11 times higher than in 2020, respectively. The predicted results show that the number of disabled elderly and the related care costs will increase sharply from 2020 to 2050, especially the growth rate of the number of severely disabled elderly. This study provides strong evidence of the need for the establishment of a unified national LTCI system in China.

scholarly journals Prediction the Contribution Rate of Long-Term Care Insurance for the Aged in China Based on the Balance of Supply and Demand

2020 ◽  
Vol 12 (8) ◽  
pp. 3144 ◽  
Author(s):  
Liangwen Zhang ◽  
Sijia Fu ◽  
Ya Fang
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Long Term Care ◽  
Population Census ◽  
Contribution Rate ◽  
Term Care ◽  
Disabled Elderly ◽  
Long Term Care Insurance ◽  
Per Capita

There are a large number of disabled elderly people in China, which results in huge care and financial burdens to their families and society. However, China has not yet launched a unified long-term care insurance (LTCI) system. This study aims to predict the contribution rate of LTCI in China from 2020 to 2050 based on the long-term care (LTC) cost of the disabled elderly, aged 65 and over, in order to provide strong evidence for the establishment of a unified and sustainable national LTCI system in China. The simulations are based on data from the population census data, the Chinese statistical yearbook, and the Chinese Longitudinal Healthy Longevity Survey (CLHLS) database. Based on the International Labor Organization (ILO) financing model from the perspective of fund balance, an overall simulation model and a Monte Carlo simulation are used to estimate the contribution rate of LTCI for disabled elderly from 2020 to 2050 in China. The total financial demands will increase sharply from 538.0 billion yuan in 2020 to 8530.8 billion yuan in 2050. Of that total, 80.2% will be required in urban areas. In addition, the per capita financial demands of care in urban and rural areas in 2050 will be approximately six times and 11 times higher than in 2020, respectively. The predicted results show that the overall contribution rate of LTCI in China will increase sharply from 1.46% in 2020 to 5.14% in 2050, an increase of about 3.5 times. By comparison, the contribution rate in 2020 will be close to 1.33% in Japan in 2015 and 1.40% in Germany in 2010. According to the 1:1 payment proportion between employer and employee, each side bears 0.68% of the insurance premium. From 2020 to 2050, the financial demands of long-term care for disabled elderly in China will increase, especially in urban areas, and the burden of per capita financial demands in rural areas will increase significantly. The overall contribution rate of LTCI will increase linearly and the payment burden of policyholders will increase year by year. This study provides evidence of the need for the establishment of a sustainable financing mechanism for multiple financial supplies.

scholarly journals Trends and Patterns of Educational Homogamy in India: A Marriage Cohort Analysis

2016 ◽  
Vol 2016 ◽  
pp. 1-8
Author(s):  
Kakoli Borkotoky ◽  
Ashish Kumar Gupta
Keyword(s):  
Rural Areas ◽  
Urban Areas ◽  
Cohort Analysis ◽  
Family Health ◽  
Married Couples ◽  
Socioeconomic Background ◽  
Educational Homogamy ◽  
National Family ◽  
Economic Background ◽  
Female Literacy

Research in assortative mating in developing countries focused mainly on the cultural similarities of individuals till the most recent times. Educational homogamy was not considered a significant factor. This study examined the changes in educational homogamy of 39,257 ever-married couples in India for the three marriage cohorts 1964–1984, 1985–1995, and 1996–2006 by place of residence, religion, and economic background. The study also examined the regional pattern of educational homogamy based on female literacy and the probability of educational homogamy after adjusting for socioeconomic background of the respondent. Data from the National Family Health Survey (NFHS-3) was used for the study. The study observed significant increase in educational homogamy for the successive marriage cohorts. Homogamy is concentrated at the extremes of the educational attainment. In urban areas, homogamy is concentrated among the higher educated individuals whereas, in rural areas, homogamy is high among uneducated individuals. The results also depict regions with higher female literacy having the highest educational homogamy and vice versa. The study also found an increase in the probability of homogamy and a decline in hypogamy for literate women, after accounting for socioeconomic confounders.

scholarly journals New Health Care Reform and Impoverishment among Chronic Households in China: A Random-Intercept Approach

2019 ◽  
Vol 16 (6) ◽  
pp. 1074
Author(s):  
Yongjian Xu ◽  
Anupam Garrib ◽  
Zhongliang Zhou ◽  
Duolao Wang ◽  
Jianmin Gao ◽  
...  
Keyword(s):  
Health Care ◽  
Health Care Reform ◽  
Chronic Diseases ◽  
Rural Areas ◽  
Urban Areas ◽  
Shaanxi Province ◽  
World Health ◽  
Before And After ◽  
Using Data ◽  
Health Organization

High out-of-pocket (OOP) payments for chronic disease care often contribute directly to household poverty. Although previous studies have explored the determinants of impoverishment in China, few published studies have compared levels of impoverishment before and after the New Health Care Reform (NHCR) in households with members with chronic diseases (hereafter referred to as chronic households). Our study explored this using data from the fourth and fifth National Health Service Surveys conducted in Shaanxi Province. In total, 1938 households in 2008 and 7700 households in 2013 were included in the analysis. Rates of impoverishment were measured using a method proposed by the World Health Organization. Multilevel logistic modeling was used to explore the influence of the NHCR on household impoverishment. Our study found that the influence of NHCR on impoverishment varied by residential location. After the reform, in rural areas, there was a significant decline in impoverishment, although the impoverishment rate remained high. There was little change in urban areas. In addition, impoverishment in the poorest households did not decline after the NHCR. Our findings are important for policy makers in particular for evaluating reform effectiveness, informing directions for health policy improvement, and highlighting achievements in the efforts to alleviate the economic burden of households that have members with chronic diseases.

scholarly journals Estimating Long-Term Care Costs among Thai Elderly: A Phichit Province Case Study

2018 ◽  
Vol 2018 ◽  
pp. 1-11 ◽  
Author(s):  
Pattaraporn Khongboon ◽  
Sathirakorn Pongpanich
Keyword(s):  
Informal Care ◽  
Rural Areas ◽  
Urban Areas ◽  
Socioeconomic Development ◽  
Long Term Care ◽  
The Elderly ◽  
Term Care ◽  
Rural And Urban Areas ◽  
Rural And Urban

Background. Rural-urban inequality in long-term care (LTC) services has been increasing alongside rapid socioeconomic development. This study estimates the average spending on LTC services and identifies the factors that influence the use and cost of LTC for the elderly living in urban and rural areas of Thailand. Methods. The sample comprised 837 elderly aged 60 years drawn from rural and urban areas in Phichit Province. Costs were assessed over a 1-month period. Direct costs of caregiving and indirect costs (opportunity cost method) were analyzed. Binary logistic regression was performed to determine which factors affected LTC costs. Results. The total annual LTC spending for rural and urban residents was on average USD 7,285 and USD 7,280.6, respectively. Formal care and informal care comprise the largest share of payments. There was a significant association between rural residents and costs for informal care, day/night care, and home renovation. Conclusions. Even though total LTC expenditures do not seem to vary significantly across rural and urban areas, the fundamental differences between areas need to be recognized. Reorganizing country delivery systems and finding a balance between formal and informal care are alternative solutions.

scholarly journals Age-Friendly Online Training Programs for Long-Term Services and Supports Staff to Improve Care for Older Adults

2020 ◽  
Vol 4 (Supplement_1) ◽  
pp. 532-532
Author(s):  
Linda Edelman ◽  
Kara Dassel
Keyword(s):  
Older Adults ◽  
Rural Communities ◽  
Rural Areas ◽  
Urban Areas ◽  
Online Training ◽  
Team Leadership ◽  
Educational Opportunities ◽  
Opioid Use ◽  
Term Care

Abstract The purpose of our Geriatric Workforce Enhancement Program is to provide geriatric and primary care education and training to long-term care (LTC) providers and staff, health professions students and community members. Our LTC partners and the communities we serve are often very rural and travel to urban areas for training can be difficult. Therefore, we have developed four online training that are offered free to our partners and rural communities statewide. These programs are designed to integrate the aims of the Age-Friendly 4M’s model (i.e., What Matters, Mobility, Medication, Mentation). The LTC nurse residency program provides gerontological nursing and inter-professional leadership training (all 4M’s), in a synchronous online environment. The asynchronous Alzheimer’s Disease and Related Dementias training modules educate LTC staff and family caregivers about types, diagnosis and care of older adults with dementia (Mentation and Medication). The asynchronous Opioid Use in LTC modules were developed with partners to deliver live at LTC staff trainings about opioid stewardship (Medication). The LTC Learning Communities are monthly tele-health sessions for inter-professional LTC teams to discuss current issues and propose solutions (all 4M’s). We have successfully leveraged different synchronous and asynchronous online modalities to increase educational opportunities for formal and informal caregivers, including those in rural areas whose educational opportunities are geographically limited. To date our programs have reached over 500 individuals across our state, increasing knowledge about geriatric concepts, communication and team leadership. Moving forward, we will continue to develop and refine educational programs that promote the Age-Friendly geriatric-focused health care.

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