The Continuum of Care in Cross-Border Health Travel

2021 ◽  
Vol 1 (1) ◽  
pp. 1-13
Author(s):  
David G. Vequist IV
Keyword(s):  
Statistical Analysis ◽  
Large Population ◽  
Continuum Of Care ◽  
Healthcare Outcomes ◽  
Moderate Amount ◽  
Cross Border ◽  
Before And After ◽  
International Boundary ◽  
The Impact ◽  
The Continuum

There are several studies showing that a breakdown in the continuum of care occurs when a person crosses an international boundary for healthcare, such as migrants and medical tourists. This study attempted to measure the impact of a lack of standard continuity on the healthcare outcomes by comparing self-reported perceptions of health among a large population of people that traveled across borders. These travelers, without a discernible continuum of care, were surveyed before and after travel. A statistical analysis of self-reported perception data about general health before and after cross-border travel shows a significant decrease in overall health after cross-border travel. Despite some limitations, a moderate amount of the decline can be attributed to the breakdown of the continuum of care between providers on both sides of the border. The development of standards for cross-border healthcare could potentially improve the healthcare received by migrants and medical travelers.

scholarly journals Impact of COVID-19 pandemic on HIV viremia: a single-center cohort study in northern Italy

2021 ◽  
Vol 18 (1) ◽  
Author(s):  
Ilaria Izzo ◽  
Canio Carriero ◽  
Giulia Gardini ◽  
Benedetta Fumarola ◽  
Erika Chiari ◽  
...  
Keyword(s):  
Time Window ◽  
Time Windows ◽  
Continuum Of Care ◽  
Northern Italy ◽  
Hiv Diagnosis ◽  
Hiv Patients ◽  
Before And After ◽  
Missed Visits ◽  
Hiv Continuum Of Care ◽  
The Impact

Abstract Background Brescia Province, northern Italy, was one of the worst epicenters of the COVID-19 pandemic. The division of infectious diseases of ASST (Azienda Socio Sanitaria Territoriale) Spedali Civili Hospital of Brescia had to face a great number of inpatients with severe COVID-19 infection and to ensure the continuum of care for almost 4000 outpatients with HIV infection actively followed by us. In a recent manuscript we described the impact of the pandemic on continuum of care in our HIV cohort expressed as number of missed visits, number of new HIV diagnosis, drop in ART (antiretroviral therapy) dispensation and number of hospitalized HIV patients due to SARS-CoV-2 infection. In this short communication, we completed the previous article with data of HIV plasmatic viremia of the same cohort before and during pandemic. Methods We considered all HIV-patients in stable ART for at least 6 months and with at least 1 available HIV viremia in the time window March 01–November 30, 2019, and another group of HIV patients with the same two requisites but in different time windows of the COVID-19 period (March 01–May 31, 2020, and June 01–November 30, 2020). For patients with positive viremia (PV) during COVID-19 period, we reported also the values of viral load (VL) just before and after PV. Results: the percentage of patients with PV during COVID-19 period was lower than the previous year (2.8% vs 7%). Only 1% of our outpatients surely suffered from pandemic in term of loss of previous viral suppression. Conclusions Our efforts to limit the impact of pandemic on our HIV outpatients were effective to ensure HIV continuum of care.

scholarly journals Cost-effectiveness of conditional cash transfers to retain women in the continuum of care during pregnancy, birth and the postnatal period: protocol for an economic evaluation of the Afya trial in Kenya

BMJ Open ◽  
2019 ◽  
Vol 9 (11) ◽  
pp. e032161
Author(s):  
Neha Batura ◽  
Jolene Skordis ◽  
Tom Palmer ◽  
Aloyce Odiambo ◽  
Andrew Copas ◽  
...  
Keyword(s):  
Economic Evaluation ◽  
Cost Effectiveness ◽  
Care Facility ◽  
Continuum Of Care ◽  
Postnatal Period ◽  
Cash Transfers ◽  
Conditional Cash Transfers ◽  
Sensitivity Analyses ◽  
The Impact ◽  
The Continuum

IntroductionA wealth of evidence from a range of country settings indicates that antenatal care, facility delivery and postnatal care can reduce maternal and child mortality and morbidity in high-burden settings. However, the utilisation of these services by pregnant women, particularly in low/middle-income country settings, is well below that recommended by the WHO. The Afya trial aims to assess the impact, cost-effectiveness and scalability of conditional cash transfers to promote increased utilisation of these services in rural Kenya and thus retain women in the continuum of care during pregnancy, birth and the postnatal period. This protocol describes the planned economic evaluation of the Afya trial.Methods and analysisThe economic evaluation will be conducted from the provider perspective as a within-trial analysis to evaluate the incremental costs and health outcomes of the cash transfer programme compared with the status quo. Incremental cost-effectiveness ratios will be presented along with a cost-consequence analysis where the incremental costs and all statistically significant outcomes will be listed separately. Sensitivity analyses will be undertaken to explore uncertainty and to ensure that results are robust. A fiscal space assessment will explore the affordability of the intervention. In addition, an analysis of equity impact of the intervention will be conducted.Ethics and disseminationThe study has received ethics approval from the Maseno University Ethics Review Committee, REF MSU/DRPI/MUERC/00294/16. The results of the economic evaluation will be disseminated in a peer-reviewed journal and presented at a relevant international conference.Trial registration numberNCT03021070

scholarly journals Seawater desalination and serum magnesium concentrations in Israel

2016 ◽  
Vol 15 (2) ◽  
pp. 296-299 ◽  
Author(s):  
Gideon Koren ◽  
Meital Shlezinger ◽  
Rachel Katz ◽  
Varda Shalev ◽  
Yona Amitai
Keyword(s):  
Serum Magnesium ◽  
Large Population ◽  
Population Based ◽  
Morbidity And Mortality ◽  
Population Based Study ◽  
Cardiac Morbidity ◽  
Before And After ◽  
The Mean ◽  
Magnesium Status ◽  
The Impact

With increasing shortage of fresh water globally, more countries are consuming desalinated seawater (DSW). In Israel >50% of drinking water is now derived from DSW. Desalination removes magnesium, and hypomagnesaemia has been associated with increased cardiac morbidity and mortality. Presently the impact of consuming DSW on body magnesium status has not been established. We quantified changes in serum magnesium in a large population based study (n = 66,764), before and after desalination in regions consuming DSW and in regions where DSW has not been used. In the communities that switched to DSW in 2013, the mean serum magnesium was 2.065 ± 0.19 mg/dl before desalination and fell to 2.057 ± 0.19 mg/dl thereafter (p < 0.0001). In these communities 1.62% of subjects exhibited serum magnesium concentrations ≤1.6 mg/dl between 2010 and 2013. This proportion increased by 24% between 2010–2013 and 2015–2016 to 2.01% (p = 0.0019). In contrast, no such changes were recorded in the communities that did not consume DSW. Due to the emerging evidence of increased cardiac morbidity and mortality associated with hypomagnesaemia, it is vital to consider re-introduction of magnesium to DSW.

scholarly journals Impact of the Kunming–Bangkok Highway on Land Use Changes along the Route between Laos and Thailand

Land ◽  
2021 ◽  
Vol 10 (9) ◽  
pp. 991
Author(s):  
Fangyu Zheng ◽  
Jiuming Huang ◽  
Zhiming Feng ◽  
Chiwei Xiao
Keyword(s):  
Land Use ◽  
Land Use Changes ◽  
Sustainable Use ◽  
Road Construction ◽  
Buffer Zone ◽  
Scientific Basis ◽  
The Road ◽  
Cross Border ◽  
Before And After ◽  
The Impact

Road construction fragments the landscape, reduces connectivity, and drives land use changes. To our knowledge, little is known about the scope and intensity of the effects of cross-border roads on changes in land use. Here, with the land use data products provided by the US Agency for International Development’s SERVIR Mekong project, using the GIS-based spatial analysis to quantitatively analyze and compare the effects of the cross-border road on land use changes within a 30 km buffer area along the Kunming–Bangkok Highway between Laos and Thailand. The results show the following: The greater the distance was from the highway, the smaller were the overall changes in land use within the buffer zone. A comparison of the situation before and after the road was opened in 2013 revealed significant differences in the most influential land use types of agricultural expansion, i.e., from 47.07% to 52.07% (the buffer zone was 1 km). In particular, 57.32% (1381.93 ha) and 40.08% (966.46 ha) of the land occupied by forests had been converted into land for plantation and agriculture, respectively, from 2013 to 2018. The scope of the impact of the operational route on the dynamics of land use was inconsistent. The largest impact before the road became operational was within 4 km of the buffer zone (0.26 to 0.24). Once the road had been opened, the range of its impact was beyond 10 km (0.63 to 0.57). The work here can provide a scientific basis for regional transportation planning and the sustainable use of land resources.

The impact of IPARD supports on structural and managerial featuresof dairy enterprises in Afyonkarahisar province

2017 ◽  
Author(s):  
Mehmet Yardimci ◽  
Hikmet Ari ◽  
Recep Aslan
Keyword(s):  
Statistical Analysis ◽  
Milk Yield ◽  
Production Quality ◽  
Years Of Experience ◽  
Before And After ◽  
Automatic Milking System ◽  
Automatic Milking ◽  
Daily Milk Yield ◽  
The Impact ◽  
Daily Milk

A survey was carried out to determine the impact of IPARD supports on dairy enterprises in Afyonkarahisar. IPADR beneficiary group found to have 3-5 years of experience, university graduate owners with no extra income where records are kept and statistical analysis is performed. Non-beneficiary group was more experienced with less educated owners, half had an extra income but did not keep records and not perform statistical analysis. In the first group, average daily milk yield was 25 liters, calves were weaned at 90 days, automatic milking system was used, hoof care was regularly performed, manure was removed by scrapers, teats were cleaned before and after milking while in the second group average daily milk yield is 10-30 liters, calves were weaned between 30-90 days, mobile milking machines were used, hoof care was slightly performed, manure was collected manually, teats were cleaned before milking. Consequently, IPARD grants were useful for improving the production quality, hygiene and amount in dairy enterprises.

scholarly journals Statistical Analysis of Graph-Theoretic Indices to Study EEG-TMS Connectivity in Patients With Depression

2021 ◽  
Vol 15 ◽  
Author(s):  
Elzbieta Olejarczyk ◽  
Adam Jozwik ◽  
Vladas Valiulis ◽  
Kastytis Dapsys ◽  
Giedrius Gerulskis ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
Brain Connectivity ◽  
Therapeutic Effects ◽  
Graph Theoretic ◽  
Repetitive Tms ◽  
Dorsolateral Prefrontal ◽  
Before And After ◽  
The Right ◽  
Leave One Out ◽  
The Impact

AimThe objective of this work was to demonstrate the usefulness of a novel statistical method to study the impact of transcranial magnetic stimulation (TMS) on brain connectivity in patients with depression using different stimulation protocols, i.e., 1 Hz repetitive TMS over the right dorsolateral prefrontal cortex (DLPFC) (protocol G1), 10 Hz repetitive TMS over the left DLPFC (G2), and intermittent theta burst stimulation (iTBS) consisting of three 50 Hz burst bundle repeated at 5 Hz frequency (G3).MethodsElectroencephalography (EEG) connectivity analysis was performed using Directed Transfer Function (DTF) and a set of 21 indices based on graph theory. The statistical analysis of graph-theoretic indices consisted of a combination of the k-NN rule, the leave-one-out method, and a statistical test using a 2 × 2 contingency table.ResultsOur new statistical approach allowed for selection of the best set of graph-based indices derived from DTF, and for differentiation between conditions (i.e., before and after TMS) and between TMS protocols. The effects of TMS was found to differ based on frequency band.ConclusionA set of four brain asymmetry measures were particularly useful to study protocol- and frequency-dependent effects of TMS on brain connectivity.SignificanceThe new approach would allow for better evaluation of the therapeutic effects of TMS and choice of the most appropriate stimulation protocol.

scholarly journals The impact of the construction of the new 400 kV transmission power lines between Slovakia and Hungary on the cross-border transmissions

2019 ◽  
Vol 70 (5) ◽  
pp. 418-428
Author(s):  
Marek Siranec ◽  
Alena Otcenasova ◽  
Peter Bracinik
Keyword(s):  
Simulation Model ◽  
Transmission Lines ◽  
Transmission System ◽  
Power Lines ◽  
Transmission Power ◽  
System Operation ◽  
Cross Border ◽  
Before And After ◽  
The Cross ◽  
The Impact

Abstract This article is focused on the analysis of impacts on the cross-border transmissions between Slovakia and Hungary and between Slovakia and Ukraine after the completion of the new 400 kV transmission lines on the cross-border profile Slovakia – Hungary. A simulation model of the Slovak transmission system in software ETAP was created, which is set for exploring the impacts of the new Slovak – Hungarian transmission lines 447, 480 and 481 on the cross-border and national transmissions. Correctness of the created simulation model was confirmed by the match of the measured values from winter nationwide measurement with the calculated values from the simulation model. Subsequently, several variants of the Slovak transmission system operation before and after completion of the new power lines to Hungary were evaluated.

scholarly journals Improving the continuum of care monitoring in Brazilian HIV healthcare services: An implementation science approach

PLoS ONE ◽  
2021 ◽  
Vol 16 (5) ◽  
pp. e0250060
Author(s):  
Ana Paula Loch ◽  
Simone Queiroz Rocha ◽  
Mylva Fonsi ◽  
Joselita Maria de Magalhães Caraciolo ◽  
Artur Olhovetchi Kalichman ◽  
...  
Keyword(s):  
Implementation Science ◽  
Virologic Failure ◽  
Healthcare Services ◽  
Continuum Of Care ◽  
Public Healthcare ◽  
Treatment Gap ◽  
Positive Effects ◽  
Number Of Patients ◽  
The Impact ◽  
The Continuum

Objective To evaluate the impact of an intervention improving the continuum of care monitoring (CCM) within HIV public healthcare services in São Paulo, Brazil, and implementing a clinical monitoring system. This system identified three patient groups prioritized for additional care engagement: (1) individuals diagnosed with HIV, but not receiving treatment (the treatment gap group); (2) individuals receiving treatment for >6 months with a detectable viral load (the virologic failure group); and (3) patients lost to follow-up (LTFU). Methods The implementation strategies included three training sessions, covering system logistics, case discussions, and development of maintenance goals. These strategies were conducted within 30 HIV public healthcare services (May 2019 to April 2020). After each training session, professionals shared their experiences with CCM at regional meetings. Before and after the intervention, providers were invited to answer 23 items from the normalization process theory questionnaire (online) to understand contextual factors. The mean item scores were compared using the Mann–Whitney U test. The RE-AIM implementation science framework (evaluating reach, effectiveness, adoption, implementation, and maintenance) was used to evaluate the integration of the CCM. Results In the study, 47 (19.3%) of 243 patients with a treatment gap initiated treatment, 456 (49.1%) of 928 patients with virologic failure achieved suppression, and 700 of 1552 (45.1%) LTFU patients restarted treatment. Strategies for the search and reengagement of patients were developed and shared. Providers recognized the positive effects of CCM on their work and how it modified existing activities (3.7 vs. 4.4, p<0.0001, and 3.9 vs. 4.1, p<0.05); 27 (90%) centers developed plans to sustain routine CCM. Conclusion Implementing CCM helped identify patients requiring more intensive attention. This intervention led to changes in providers’ perceptions of CCM and care and management processes, which increased the number of patients engaged across the care continuum and improved outcomes.

scholarly journals Effectiveness of conditional cash transfers (Afya credits incentive) to retain women in the continuum of care during pregnancy, birth and the postnatal period in Kenya: a cluster-randomised trial

BMJ Open ◽  
2022 ◽  
Vol 12 (1) ◽  
pp. e055921
Author(s):  
Fedra Vanhuyse ◽  
Oliver Stirrup ◽  
Aloyce Odhiambo ◽  
Tom Palmer ◽  
Sarah Dickin ◽  
...  
Keyword(s):  
Controlled Trial ◽  
Randomised Trial ◽  
Electronic System ◽  
Continuum Of Care ◽  
Cash Transfers ◽  
Conditional Cash Transfers ◽  
Cluster Randomised Trial ◽  
Cluster Randomised ◽  
The Impact ◽  
The Continuum

ObjectivesGiven high maternal and child mortality rates, we assessed the impact of conditional cash transfers (CCTs) to retain women in the continuum of care (antenatal care (ANC), delivery at facility, postnatal care (PNC) and child immunisation).DesignWe conducted an unblinded 1:1 cluster-randomised controlled trial.Setting48 health facilities in Siaya County, Kenya were randomised. The trial ran from May 2017 to December 2019.Participants2922 women were recruited to the control and 2522 to the intervention arm.InterventionsAn electronic system recorded attendance and triggered payments to the participant’s mobile for the intervention arm (US$4.5), and phone credit for the control arm (US$0.5). Eligibility criteria were resident in the catchment area and access to a mobile phone.Primary outcomesPrimary outcomes were any ANC, delivery, any PNC between 4 and 12 months after delivery, childhood immunisation and referral attendance to other facilities for ANC or PNC. Given problems with the electronic system, primary outcomes were obtained from maternal clinic books if participants brought them to data extraction meetings (1257 (50%) of intervention and 1053 (36%) control arm participants). Attendance at referrals to other facilities is not reported because of limited data.ResultsWe found a significantly higher proportion of appointments attended for ANC (67% vs 60%, adjusted OR (aOR) 1.90; 95% CI 1.36 to 2.66) and child immunisation (88% vs 85%; aOR 1.74; 95% CI 1.10 to 2.77) in intervention than control arm. No intervention effect was seen considering delivery at the facility (90% vs 92%; aOR 0.58; 95% CI 0.25 to 1.33) and any PNC attendance (82% vs 81%; aOR 1.25; 95% CI 0.74 to 2.10) separately. The pooled OR across all attendance types was 1.64 (1.28 to 2.10).ConclusionsDemand-side financing incentives, such as CCTs, can improve attendance for appointments. However, attention needs to be paid to the technology, the barriers that remain for delivery at facility and PNC visits and encouraging women to attend ANC visits within the recommended WHO timeframe.Trial registrationNCT03021070.

scholarly journals Analyzing the Impact of Large Dams on Seismicity Patterns around Their Locations

2021 ◽  
Vol 68 (1) ◽  
pp. 3-17
Author(s):  
Mina Parvizishad ◽  
Simin Naseri ◽  
Ramin Nabizadeh ◽  
Abdollah Sohrabi Bidar ◽  
Amir Hossein Mahvi ◽  
...  
Keyword(s):  
Statistical Analysis ◽  
T Test ◽  
Dam Construction ◽  
Seismicity Patterns ◽  
Regional Seismicity ◽  
Large Dams ◽  
Significant Difference ◽  
Before And After ◽  
The Mean ◽  
The Impact

Abstract Dam construction is one of the most popular solutions for managing water resources. In recent years, changes in patterns of regional seismicity associated with large impoundment dams have raised concerns among environmentalists. In this study, five large dams located in Iran were studied from this perspective. The Gutenberg-Richter, linear regression and T-test were used to examine the seismic changes in the radius of 100 km of each of the dams during a twenty-five-year period before and after the construction of the dams. The results revealed that the seismicity level and relative density of large and small earthquakes in three of these dams have increased after dam construction. A significant difference between the magnitude of earthquakes, as well as the number of earthquakes before and after the construction of dams in the region, was recognized. However, the results of the T-test statistical analysis indicated that the mean depth of the earthquakes and their distance from the dams before and after construction have not changed significantly. Overall, these results indicated that the construction of large impoundment dams has been associated with some changes in patterns of regional seismicity. The findings would guide researchers to further investigate the type of impacts that dam construction may have on seismicity patterns.

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