scholarly journals Spatial Access Matters: An Analysis of Policy Change and Its Effects on Avoidable Infant Mortality in Portugal

2021 ◽  
Vol 18 (3) ◽  
pp. 1242
Author(s):  
Morgan Weiland ◽  
Paula Santana ◽  
Claudia Costa ◽  
Julia Doetsch ◽  
Eva Pilot
Keyword(s):  
Infant Mortality ◽  
Access To Care ◽  
Qualitative Data ◽  
Policy Reform ◽  
Freedom Of Choice ◽  
Spatial Access ◽  
Spatial Inequalities ◽  
Organization Of Care ◽  
Maternal And Neonatal Health ◽  
Quantitative Spatial Analysis

In 2006, a policy reform restructured the maternal and perinatal healthcare system, including closing smaller maternity units, to further improve care in Portugal. This study aimed to investigate the effects of the 2006 National Program of Maternal and Neonatal Health policy on spatial inequalities in access to care and consequently avoidable infant mortality. A thematic analysis of qualitative data including interviews and surveys and a quantitative spatial analysis using Geographic Information Systems was applied. Spatial inequalities were found which may lead to avoidable infant mortality. Inequalities exist in freedom of choice and autonomy in care, within a medicalized system. Changes in approach to and organization of care would further enhance equitable spatial access to care in maternal health and reduce avoidable infant mortality.

scholarly journals Geovisualization and Spatial Analysis of Infant Mortality and Preterm Birth in Ohio, 2008-2015: Opportunities to Enhance Spatial Thinking

2020 ◽  
Vol 135 (4) ◽  
pp. 472-482
Author(s):  
Elisabeth Dowling Root ◽  
Emelie D. Bailey ◽  
Tyler Gorham ◽  
Christopher Browning ◽  
Chi Song ◽  
...  
Keyword(s):  
Public Health ◽  
Preterm Birth ◽  
Spatial Analysis ◽  
Infant Mortality ◽  
Spatial Patterns ◽  
Urban Areas ◽  
Vital Statistics ◽  
Infant Mortality Rate ◽  
Spatial Inequalities ◽  
Geographic Clustering

Objectives Geovisualization and spatial analysis are valuable tools for exploring and evaluating the complex social, economic, and environmental interactions that lead to spatial inequalities in health. The objective of this study was to describe spatial patterns of infant mortality and preterm birth in Ohio by using interactive mapping and spatial analysis. Methods We conducted a retrospective cohort study using Ohio vital statistics records from 2008-2015. We geocoded live births and infant deaths by using residential address at birth. We used multivariable logistic regression to adjust spatial and space–time cluster analyses that examined the geographic clustering of infant mortality and preterm birth and changes in spatial distribution over time. Results The overall infant mortality rate in Ohio during the study period was 6.55 per 1000 births; of 1 097 507 births, 10.3% (n = 112 552) were preterm. We found significant geographic clustering of both infant mortality and preterm birth centered on large urban areas. However, when known demographic risk factors were taken into account, urban clusters disappeared and, for preterm birth, new rural clusters appeared. Conclusions Although many public health agencies have the capacity to create maps of health outcomes, complex spatial analysis and geovisualization techniques are still challenging for public health practitioners to use and understand. We found that actively engaging policymakers in reviewing results of the cluster analysis improved understanding of the processes driving spatial patterns of birth outcomes in the state.

scholarly journals Small-Area Estimation of Spatial Access to Care and Its Implications for Policy

2015 ◽  
Vol 92 (5) ◽  
pp. 864-909 ◽  
Author(s):  
Monica Gentili ◽  
Kim Isett ◽  
Nicoleta Serban ◽  
Julie Swann
Keyword(s):  
Access To Care ◽  
Small Area ◽  
Small Area Estimation ◽  
Spatial Access ◽  
Area Estimation

scholarly journals Residential Racial Composition, Spatial Access to Care, and Breast Cancer Mortality among Women in Georgia

2011 ◽  
Vol 88 (6) ◽  
pp. 1117-1129 ◽  
Author(s):  
Emily Russell ◽  
Michael R. Kramer ◽  
Hannah L. F. Cooper ◽  
Winifred Wilkins Thompson ◽  
Kimberly R. Jacob Arriola
Keyword(s):  
Breast Cancer ◽  
Access To Care ◽  
Cancer Mortality ◽  
Breast Cancer Mortality ◽  
Racial Composition ◽  
Spatial Access

scholarly journals Facility Attractiveness and Social Vulnerability Impacts on Spatial Accessibility to Opioid Treatment Programs in South Carolina

2021 ◽  
Vol 18 (8) ◽  
pp. 4246
Author(s):  
Parisa Bozorgi ◽  
Jan M. Eberth ◽  
Jeannie P. Eidson ◽  
Dwayne E. Porter
Keyword(s):  
South Carolina ◽  
Access To Care ◽  
Social Vulnerability ◽  
Catchment Area ◽  
The United States ◽  
Spatial Accessibility ◽  
Treatment Programs ◽  
Spatial Access ◽  
Opioid Treatment ◽  
Related Mortality

Opioid dependence and opioid-related mortality have been increasing in recent years in the United States. Available and accessible treatments may result in a reduction of opioid-related mortality. This work describes the geographic variation of spatial accessibility to opioid treatment programs (OTPs) and identifies areas with poor access to care in South Carolina. The study develops a new index of access that builds on the two-step floating catchment area (2SFCA) method, and has three dimensions: a facility attractiveness index, defined by services rendered incorporated into the Huff Model; a facility catchment area, defined as a function of facility attractiveness to account for variable catchment size; and a Social Vulnerability Index (SVI) to account for nonspatial factors that mitigate or compound the impacts of spatial access to care. Results of the study indicate a significant variation in access to OTPs statewide. Spatial access to OTPs is low across the entire state except for in a limited number of metropolitan areas. The majority of the population with low access (85%) live in areas with a moderate-to-high levels of social vulnerability. This research provides more realistic estimates of access to care and aims to assist policymakers in better targeting disadvantaged areas for OTP program expansion and resource allocation.

scholarly journals Baseline clinical features of COVID-19 patients, delay of hospital admission and clinical outcome: A complex relationship

PLoS ONE ◽  
2022 ◽  
Vol 17 (1) ◽  
pp. e0261428
Author(s):  
Cédric Dananché ◽  
Christelle Elias ◽  
Laetitia Hénaff ◽  
Sélilah Amour ◽  
Elisabetta Kuczewski ◽  
...  
Keyword(s):  
Hospital Admission ◽  
Access To Care ◽  
Symptom Onset ◽  
Multiple Testing ◽  
Multiple Logistic Regression Analysis ◽  
Individual Characteristics ◽  
Short Delay ◽  
Clinical Prognosis ◽  
Reactive Protein ◽  
Organization Of Care

Introduction Delay between symptom onset and access to care is essential to prevent clinical worsening for different infectious diseases. For COVID-19, this delay might be associated with the clinical prognosis, but also with the different characteristics of patients. The objective was to describe characteristics and symptoms of community-acquired (CA) COVID-19 patients at hospital admission according to the delay between symptom onset and hospital admission, and to identify determinants associated with delay of admission. Methods The present work was based on prospective NOSO-COR cohort data, and restricted to patients with laboratory confirmed CA SARS-CoV-2 infection admitted to Lyon hospitals between February 8 and June 30, 2020. Long delay of hospital admission was defined as ≥6 days between symptom onset and hospital admission. Determinants of the delay between symptom onset and hospital admission were identified by univariate and multiple logistic regression analysis. Results Data from 827 patients were analysed. Patients with a long delay between symptom onset and hospital admission were younger (p<0.01), had higher body mass index (p<0.01), and were more frequently admitted to intensive care unit (p<0.01). Their plasma levels of C-reactive protein were also significantly higher (p<0.01). The crude in-hospital fatality rate was lower in this group (13.3% versus 27.6%), p<0.01. Multiple analysis with correction for multiple testing showed that age ≥75 years was associated with a short delay between symptom onset and hospital admission (≤5 days) (aOR: 0.47 95% CI (0.34–0.66)) and CRP>100 mg/L at admission was associated with a long delay (aOR: 1.84 95% CI (1.32–2.55)). Discussion Delay between symptom onset and hospital admission is a major issue regarding prognosis of COVID-19 but can be related to multiple factors such as individual characteristics, organization of care and severe pathogenic processes. Age seems to play a key role in the delay of access to care and the disease prognosis.

scholarly journals Access to care among children with disabilities enrolled in the MassHealth CommonHealth Buy-In program

2018 ◽  
Vol 23 (1) ◽  
pp. 6-19 ◽  
Author(s):  
Melissa Hirschi ◽  
Angela Wangari Walter ◽  
Kasey Wilson ◽  
Kate Jankovsky ◽  
Beth Dworetzky ◽  
...  
Keyword(s):  
Access To Care ◽  
Health Care Services ◽  
Qualitative Data ◽  
Children With Disabilities ◽  
Family Income ◽  
Care Services ◽  
Medicaid Eligibility ◽  
The Impact ◽  
Out Of Pocket Costs ◽  
Parents And Caregivers

Children with disabilities utilize more health-care services and incur higher costs than other children do. Medicaid Buy-In programs for children with disabilities have the potential to increase access to benefits while reducing out-of-pocket costs for families whose income exceeds Medicaid eligibility. This study sought to understand how parents and caregivers of Massachusetts children with disabilities perceive access to care under CommonHealth, Massachusetts’s Medicaid Buy-In program. Parents and caregivers ( n = 615) whose children were enrolled in CommonHealth participated in a survey assessing the impact of the program. Qualitative data were coded across five access domains—availability, accessibility, accommodation, affordability, and acceptability. Data suggest that CommonHealth improves access to care for children with disabilities by providing the benefits that were limited in scope or unavailable through other insurance before enrollment and by making available services more affordable. Policy and administrative changes could improve the program and further increase access to care for children with complex, costly conditions. Adopting a Medicaid Buy-In program may be an effective way for states to create a pathway to Medicaid for children with disabilities whose family income is too high for Medicaid and who have unmet needs and/or whose families incur high out-of-pocket costs for their care.

scholarly journals Public Policy Reform and Police Prevention Practice: A Journey Upstream?

2021 ◽  
Author(s):  
Nick Bland ◽  
Amy Calder ◽  
Nicholas R Fyfe ◽  
Simon Anderson ◽  
James Mitchell ◽  
...  
Keyword(s):  
Public Health ◽  
Public Policy ◽  
Qualitative Data ◽  
Policy Reform ◽  
Trust Building ◽  
Policy And Practice ◽  
Collaborative Advantage ◽  
Police Practice ◽  
Growing Body ◽  
First Time

Abstract This article contributes to a growing body of research on the police reforms in Scotland. It examines the particular place given to prevention in public policy and its impact on police practice. We show how public policy reconfigured the place and purpose of prevention for the police, with a focus on safety, wellbeing, and the prevention of harm. The research draws on qualitative data collected in four areas as part of a 4-year evaluation of the police reforms. We refine a public health typology of prevention and operationalize it empirically for the first time to analyse cases of innovative practice. We distinguish a pattern of prevention practice heavily weighted towards secondary prevention, focused predominantly on issues of crime and disorder. In fewer cases, the police applied primary and tertiary prevention, with a focus on vulnerability and harm. Looking in detail at two cases, we illustrate the importance of collaboration for the police, which created opportunities and brought additional resources and expertise to support new prevention approaches which had a significant impact on effectiveness. The police realized collaborative advantage through common aims, trust-building, and leadership. We do not suggest this demonstrates a transformation in police prevention; it illustrates successful police innovation, and identifies the potential to go further. The implications for policy and practice are to recognize the value to the police of investing in new partnerships. They create opportunities for the police to collaborate, innovate, and focus more sharply on the prevention of harm.

Contributions of Community Involvement to Organizational-Level Empowerment: The Federal Healthy Start Experience

2001 ◽  
Vol 28 (6) ◽  
pp. 783-807 ◽  
Author(s):  
Meredith Minkler ◽  
Mildred Thompson ◽  
Judith Bell ◽  
Kalima Rose
Keyword(s):  
Infant Mortality ◽  
Community Involvement ◽  
Qualitative Data ◽  
Healthy Start ◽  
Organizational Level ◽  
Empowerment Theory ◽  
Community Based ◽  
Health Initiatives ◽  
Healthy Start Program

This article presents findings of a multisite case study of the experience of nine federal Healthy Start Program sites in using consortia and other community involvement strategies in the fight against infant mortality. Using empowerment theory as a conceptual framework, qualitative data are employed to examine howcommunity involvement in the program through community-based consortia and other means contributed to empowerment at the organizational level. The article concludes with implications of the study findings for practice both within Healthy Start and in the context of other community-based health initiatives.

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