Race in the Structure of Access to Treatment

Introdução: A pobreza influencia na evolução dos pacientes com doenças crônicas, porque contribui para o seu agravamento e dificulta o acesso à assistência médica. O objetivo deste trabalho foi avaliar os aspectos relacionados à desigualdade social de pacientes em hemodiálise. Métodos: Estudo transversal com 123 pacientes em hemodiálise no Hospital Samuel Libânio – Pouso Alegre, MG, divididos, de acordo com a classe econômica, em 3 grupos: AB (n=23), C (n=60) e DE (n=40),. Foram coletados dados sociodemográficos e econômicos, antecedentes clínicos e informações sobre o acesso a serviços de saúde. Para a análise dos resultados, foi utilizada estatística analítica e descritiva. Adotou-se p £ 0,05. Resultados: O grupo AB apresentou um menor número de pacientes jovens (4,3% em AB vs 40% em C e 25% em DE, p < 0,05), um maior número de indivíduos com mais anos de escolaridade (65,3% em AB vs 18,3% em C e 2,5% em DE; p < 0,05), predomínio de pacientes com menos de um ano em tratamento de hemodiálise (65,2% em AB vs 10% em C e 5% em DE, p < 0,05), menor número de usuários do SUS (40% em C e 25% em DE vs 4,3% em AB; p < 0,05) e maior acesso ao tratamento com nefrologista (73,9% em AB vs 46,7% em C e 52,5 em DE; p < 0,05). Conclusão: Classes economicamente desfavorecidas agregam indivíduos mais jovens, com menor escolaridade, usuários do SUS, com maior tempo em hemodiálise e pior acesso ao tratamento com nefrologista.Introduction: The poverty influence on the evolution of patients with chronic diseases because it contributes to your aggravation and hinders access to health care. Our goal was to evaluate the aspects related to social inequality on hemodialysis patients. Methods: cross-sectional study with 123 patients on hemodialysis in Samuel Libânio Hospital – Pouso Alegre, MG, divided according to the economic class, into 3 groups: AB (n = 23), C (n = 60) and DE (n = 40). Were collected socio-demographic and economic data, clinical background and information about access to health services. For analysis of the results has been used statistical analytical and descriptive. We take p £ 0,05. Results: The AB group has fewer young patients (4,3% in AB vs 40% in C and 25% in DE, p< 0,05), a greater number of individuals with more years of schooling (65,3% in AB vs 18,3% in C and 2,5% in DE; p< 0,05), predominance of patients with less than a year on haemodialysis treatment (65,2% in AB vs 10% in C and 5% in DE, p< 0,05), smaller number of users of SUS (40% in C and 25% in DE vs 4,3% in AB; p< 0,05), greater access to treatment with nephrologist (73,9% in AB vs 46,7% in C and 52,5% in DE; p< 0,05). Conclusion: Economically disadvantaged classes bring younger patients, with less schooling, users of SUS, patients with greater time on hemodialysis and worse access to treatment with nephrologist.

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Drug policy and control at the international level

10.1093/oso/9780198818014.003.0013 ◽

2018 ◽

Author(s):

Thomas F. Babor ◽

Jonathan Caulkins ◽

Benedikt Fischer ◽

David Foxcroft ◽

Keith Humphreys ◽

...

Keyword(s):

Low Income ◽

Low Income Countries ◽

Drug Control ◽

Prescription Medications ◽

Access To Treatment ◽

Illicit Markets ◽

Pain Medications ◽

Almost All ◽

And Control ◽

Illicit Trafficking

International drug control efforts are designed to coordinate domestic laws with international activities that regulate or limit the supply of psychoactive substances. These efforts are organized around three main drug control treaties that almost all countries have ratified in order to prevent illicit trafficking and other drug-related crime, while at the same time allowing access to prescription medications. The effects of the system have been evaluated mostly in terms of the ability to eliminate illicit markets and supply. The gross imbalance in world consumption of legal opiates is a pointer to the limited availability of effective pain medications in many low-income countries, with 80% of the world’s population having either no or inadequate access to treatment for moderate or severe pain.

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Hidden Tales of Ebola: Airing the Forgotten Voices of Ugandan “Ebola Nurses”

Journal of Transcultural Nursing ◽

10.1177/10436596211017968 ◽

2021 ◽

pp. 104365962110179

Author(s):

Isaac Okello Wonyima ◽

Susan Fowler-Kerry ◽

Grace Nambozi ◽

Charlotte Barry ◽

Jeanie Wills ◽

...

Keyword(s):

Health Care ◽

Health Care Professionals ◽

Access To Treatment ◽

Care Workers ◽

Free Health Care ◽

Control And Prevention ◽

Holistic Practice ◽

Phenomenological Design ◽

Depth Interviews ◽

Current Reality

Introduction According to the Centers for Disease Control and Prevention, Ebola has affected the lives of thousands, including health care workers. With few studies describing the experience of nurses who survived Ebola, the study aimed to describe Ugandan nurses’ experiences. Method Using a phenomenological design, in-depth interviews were conducted among five Ugandan nurses who contracted Ebola and survived. Result Thematic analysis revealed themes of expectations of dying, hopelessness, loneliness, and betrayal by family, community, and the health system. Discussion Results support the need for policies targeting holistic practice protocols to protect all health care professionals during future outbreaks. Last, nursing survivors should have access to government-guaranteed support programs, including free health care and financial stipends. These results and recommendations transcend to the current reality of living with COVID-19 (coronavirus disease 2019). Efficient practice protocols could protect all rights and privileges and contribute to access to treatment and stigma removal.

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The European Association for the Study of Obesity (EASO) Endorses the Milan Charter on Urban Obesity

Obesity Facts ◽

10.1159/000514218 ◽

2021 ◽

pp. 1-6

Author(s):

Michele O. Carruba ◽

Luca Busetto ◽

Sheree Bryant ◽

Antonio Caretto ◽

Nathalie J. Farpour-Lambert ◽

...

Keyword(s):

Public Health ◽

Social Stigma ◽

National Level ◽

Well Being ◽

Communicable Diseases ◽

Urban Environments ◽

Shared Responsibility ◽

Access To Treatment ◽

Non Communicable Diseases ◽

Health Goals

The Milan Charter on Urban Obesity highlights the challenges of urban environments as a battleground for human health, as cities are often organized to subvert public health goals, and promote rather than prevent the development of obesity and consequent non-communicable diseases. The Charter articulates ten principles which detail actions and strategies through which general practitioners, diverse medical specialists, related healthcare professionals, administrators and healthcare practice managers, policy actors – within health systems and at a national level – along with experts across disciplines, and citizens, can work in cooperation to meet this challenge and improve public health. The Charter urges the adoption of decisions that deliver the following: (i) policies which enable our cities to become healthier and less obesogenic, more supportive of well-being and less health-disruptive in general, and (ii) policies that fully support primary prevention strategies, that address social stigma, and that ensure fair access to treatment for people living with obesity. The Milan Charter on Urban Obesity aims to raise awareness of our shared responsibility for the health of all citizens, and focuses on addressing the health of people living with obesity – not only as a challenge in its own right, but a gateway to other major non-communicable diseases, including cardiovascular diseases, type 2 diabetes, and some cancers.

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“I’m truly free from my eating disorder”: Emerging adults’ experiences of FREED, an early intervention service model and care pathway for eating disorders

Journal of Eating Disorders ◽

10.1186/s40337-020-00354-9 ◽

2021 ◽

Vol 9 (1) ◽

Author(s):

Rachel Potterton ◽

Amelia Austin ◽

Michaela Flynn ◽

Karina Allen ◽

Vanessa Lawrence ◽

...

Keyword(s):

Eating Disorders ◽

Eating Disorder ◽

Early Intervention ◽

Emerging Adults ◽

Care Pathway ◽

Support Network ◽

First Episode ◽

Service Model ◽

Access To Treatment ◽

Rapid Access

Abstract Background Eating disorders (EDs) typically start during adolescence or emerging adulthood, periods of intense biopsychosocial development. FREED (First Episode Rapid Early Intervention for EDs) is a service model and care pathway providing rapid access to developmentally-informed care for emerging adults with EDs. FREED is associated with reduced duration of untreated eating disorder and improved clinical outcomes, but patients’ experiences of treatment have yet to be assessed. Objective This study aimed to assess emerging adults’ experiences of receiving treatment through FREED. Method This study triangulated qualitative data on participants’ experiences of FREED treatment from questionnaires and semi-structured interviews. Participants were 106 emerging adults (aged 16–25; illness duration < 3 yrs) (questionnaire only = 92; interview only = 6; both = 8). Data were analysed thematically. Results Most participants reported psychological and behavioural changes over the course of treatment (e.g. reduction in symptoms; increased acceptance and understanding of difficulties). Participants identified five beneficial characteristics of FREED treatment: i) rapid access to treatment; ii) knowledgeable and concerned clinicians; iii) focusing on life beyond the eating disorder; iv) building a support network; v) becoming your own therapist. Conclusion This study provides further supports for the implementation of early intervention and developmentally-informed care for EDs. Future service model development should include efforts to increase early help-seeking.

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741 Manipulation and Reduction of Paediatric Forearm Fractures in The Emergency Department Using Intranasal Diamorphine and Entonox

British Journal of Surgery ◽

10.1093/bjs/znab134.481 ◽

2021 ◽

Vol 108 (Supplement_2) ◽

Author(s):

S Kapoor ◽

A Valand ◽

J Dartnell

Keyword(s):

Emergency Department ◽

Patient Discharge ◽

General Anaesthetic ◽

Forearm Fractures ◽

Distal Radial Fractures ◽

Access To Treatment ◽

Early Access ◽

The Mean ◽

Salter Harris

Abstract Background Paediatric forearm fractures are commonly encountered in Trauma and Orthopaedics. Currently most forearm fractures are manipulated in theatre the following day, increasing resource burden and delays in management. The aim of this project was to introduce guidelines to reduce fractures in the Emergency Department (ED) using intranasal Diamorphine and Entonox. Method 197 cases were identified over a 6-month period in 2018 and 2019. 74 distal radial fractures and 123 mid shaft forearm fractures were analysed. Fractures with an intact periosteal hinge or a Salter Harris type 2 were reduced in ED. The pre manipulation and post manipulation radiographs were compared with particular attention to the post reduction angles. Results 67% of fractures were reduced in the correct setting. A number of fractures reduced in ED required re-manipulation or internal fixation. Overall, there was a 56% reduction in patients undergoing general anaesthetic. There was a reduction in the mean length of stay from 36 hours to 3.5 hours. Conclusions Intranasal Diamorphine and Entonox offer a safe method for managing paediatric forearm fractures in ED. Implementation of this method facilitates early access to treatment and early patient discharge. Manipulation in ED offers significant financial savings and reduces demands on the Trauma Theatres.

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Rural Emergency Medical Service Providers Perceptions on the Causes of and Solutions to the Opioid Crisis: A Qualitative Assessment

Journal of Primary Care & Community Health ◽

10.1177/2150132720987715 ◽

2021 ◽

Vol 12 ◽

pp. 215013272098771

Author(s):

Heather Blue ◽

Ashley Dahly ◽

Susan Chhen ◽

Julie Lee ◽

Adam Shadiow ◽

...

Keyword(s):

Pain Management ◽

Rural Communities ◽

Social Determinants Of Health ◽

Emergency Medical Service ◽

Social Determinants ◽

Medical Service ◽

Critical Role ◽

Access To Treatment ◽

Opioid Crisis

Introduction: The continuing opioid crisis poses unique challenges to remote and often under-resourced rural communities. Emergency medical service (EMS) providers serve a critical role in responding to opioid overdose for individuals living in rural or remote areas who experience opioid overdoses. They are often first at the scene of an overdose and are sometimes the only health care provider in contact with an overdose patient who either did not survive or refused additional care. As such, EMS providers have valuable perspectives to share on the causes and consequences of the opioid crisis in rural communities. Methods: EMS providers attending a statewide EMS conference serving those from greater Minnesota and surrounding states were invited to take a 2-question survey asking them to reflect upon what they believed to be the causes of the opioid crisis and what they saw as the solutions to the opioid crisis. Results were coded and categorized using a Consensual Qualitative Research approach. Results: EMS providers’ perceptions on causes of the opioid crisis were categorized into 5 main domains: overprescribing, ease of access, socioeconomic vulnerability, mental health concerns, and lack of resources and education. Responses focused on solutions to address the opioid crisis were categorized into 5 main domains: need for increased education, enhanced opioid oversight, increased access to treatment programs, alternative therapies for pain management, and addressing socioeconomic vulnerabilities. Conclusion: Along with the recognition that the opioid crisis was at least partially caused by overprescribing, rural EMS providers who participated in this study recognized the critical role of social determinants of health in perpetuating opioid-related harm. Participants in this study reported that education and increased access to treatment facilities and appropriate pain management, along with recognition of the role of social determinants of health in opioid dependency, were necessary steps to address the opioid crisis.

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The use of clozapine in a rural and remote region of Australia

Australasian Psychiatry ◽

10.1177/1039856220975277 ◽

2020 ◽

pp. 103985622097527

Author(s):

Bridson Tahnee ◽

Abeysundera Hesitha ◽

Arunachalam Arulmathy ◽

Lam Anthea ◽

Mora Linda ◽

...

Keyword(s):

Standard Deviation ◽

Torres Strait Islander ◽

Psychotic Disorders ◽

Clinical Information ◽

Antipsychotic Treatment ◽

Rural And Remote ◽

Access To Treatment ◽

Regional Area ◽

The Mean ◽

Torres Strait

Objective: Clozapine is the most effective antipsychotic available for treatment-resistant schizophrenia. Unfortunately, it is often underutilised or administered late in the treatment course, if at all. This issue is further augmented in rural and remote regions where access to treatment is sparse. This study is the first of its kind to investigate the use of clozapine in a remote and regional area of Australia with a high proportion of Aboriginal and/or Torres Strait Islander individuals. Methods: This study includes all individuals who were commenced on clozapine between June 2013 and June 2018. Relevant clinical information was sourced from electronic medical records and descriptive statistical analysis performed. Results: A total of 3850 patients with psychotic disorders were reviewed over 5 years, of whom 63 were commenced on clozapine. The majority were male ( n = 50, 79.4%) with a mean age of 33.9 years (standard deviation 11.0). A total of 34.9% ( n = 22) identified as Aboriginal and/or Torres Strait Islander. The mean length of time between diagnosis and commencement of clozapine was 7.2 years (standard deviation ±4.6 years), while the mean number of antipsychotic medications tried prior to clozapine was 4.2 (standard deviation ±1.6 antipsychotics). Clozapine was discontinued in 57.1% of the individuals in this study (41% within the first 12 months). The most common cause for cessation was poor compliance ( n = 19, 30.2%). Conclusion: While clozapine remains the most effective antipsychotic treatment, it is often commenced late in the treatment or ceased prematurely. Further work is required, particularly in remote and regional populations, to ensure treatment adherence for optimal patient outcomes.

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