scholarly journals Epidemiological overview of epilepsy by Brazilian macro-regions

2021 ◽  
Author(s):  
Natália Guerreiro Costa Neeser ◽  
Caio Lopes Pereira Santos ◽  
Gabriela Malta Coutinho ◽  
Rebeca Menezes de Oliveira Lima ◽  
Tauá Vieira Bahia
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Average Length ◽  
Secondary Data ◽  
Public System ◽  
The Public ◽  
Average Length Of Stay ◽  
The North ◽  
Epidemiological Profile ◽  
Absolute Population

Introdution: Studying the epidemiology of epilepsy is important for the knowledge of this disease in the national territory, and also to improve the Public System. Objectives: Describe the epidemiological profile of epilepsy in Brazilian regions between 2010 and 2019. Methods: Refers to an ecological study with secondary data from the Ministry of Health, through DATASUS. The period investigated was from January 2010 to December 2019, in Brazilian regions. The variables explored were region, sex, number of hospitalizations, average length of stay and mortality rate. Results: 507,443 hospitalizations were identified, with the highest numbers of cases being in the Southeast (44.34%) and the lowest in the North (5.43%). There was a predominance of hospitalizations in males (58%).The mortality rate varied between 2.97 (Northeast) and 1.44 (South). Southeast had the longest stay (6.8 days) and the shortest was in the South (4.4 days). Conclusions: After analyzing this study, males have the highest rate of hospitalization and the Southeast has the highest number of hospitalizations and average length of stay for epilepsy, which may be associated with the fact that this region has the largest absolute population. Although, the Northeast had the highest mortality rate, a situation possibly related to a lower integration of the health system compared to the other regions.

scholarly journals Epidemiological profile of neurological diseases in Brazil from 2011 to 2020

2021 ◽  
Author(s):  
Rebeca Menezes de Oliveira Lima ◽  
Caio Lopes Pereira Santos ◽  
Gabriela Malta Coutinho ◽  
Natalia Guerreiro Costa Neeser ◽  
Tauá Vieira Bahia
Keyword(s):  
Mortality Rate ◽  
Old Age ◽  
Ecological Study ◽  
Neurological Diseases ◽  
Age Group ◽  
The South ◽  
Public System ◽  
The Public ◽  
The North ◽  
Epidemiological Profile

Background: Studying the epidemiology of neurological diseases is important to improve the Public System. Objectives: To describe the epidemiological profile of neurological diseases in Brazil between 2011 and 2020. Design and setting: Ecological study in Brazil. Methods: Data was collected from the Ministry of Health, through DATASUS. The period analyzed was between 2011 and 2020. The data collected were region, age, deaths, mortality rate, and average stay due to neurological diseases. Results: 1,833,363 hospitalizations were recorded, with 89,046 deaths. The age group from 50 to 54 years old was the most hospitalized (147,832 cases) and the 80 years and over had the highest mortality rate (14.9). The average stay averages were 13.1 days and the average lethality rates were 4.9. Furthermore, the highest average prevalence of cases per 100,000 inhabitants occurred in the South (142), while the lowest was in the North (49). However, there was a higher mortality rate in the North (6.2) than in the South (4.2). Conclusions: The highest mortality rate in the age of 80 years and over may be associated whit the effects of old age. Moreover, the lowest prevalence of cases and the highest mortality rate in North is possibly related to a deficiency in the diagnosis and treatment of this diseases in that location.

scholarly journals Internações, óbitos e custos hospitalares pelas intercorrências dialíticas

2019 ◽  
Vol 13 ◽  
Author(s):  
Edison Vitório de Souza Júnior ◽  
Sarah Rodrigues Silva ◽  
Poliana Souza Lapa ◽  
Mariana Alves Soledade de Jesus ◽  
Michele Silva dos Santos ◽  
...  
Keyword(s):  
Length Of Stay ◽  
Kidney Diseases ◽  
Average Length ◽  
Hospital Costs ◽  
Renal Dialysis ◽  
The Public ◽  
Average Value ◽  
Average Length Of Stay ◽  
Quantitative Descriptive ◽  
Dialysis Complications

Objetivo: descrever as internações, óbitos e custos hospitalares pelas intercorrências dialíticas em pacientes renais crônicos no Nordeste. Método: trata-se de um estudo quantitativo, descritivo e ecológico, voltado para a análise de dados do Sistema de Informações Hospitalares, organizados em frequências absolutas e relativas, a partir de tabelas construídas no software Excel. Resultados: notificaram-se 14.052 internações e 987 óbitos no Nordeste. Gerou-se, como consequência, um custo superior a R$ 19,6 milhões aos cofres públicos, com um valor médio de internação de R$ 1.543,09 e uma média de permanência de 9,1 dias. Destacaram-se os Estados de Alagoas, com a prevalência das internações (38,2%), e Bahia, em relação aos óbitos (40%), custos hospitalares (61,4%), média de permanência (14,4 dias) e valor médio de internação (R$ 2.794,42). Conclusão: aponta-se que as internações e óbitos pelas intercorrências dialíticas constituem um importante problema na Nefrologia, causando prejuízos diretos aos recursos financeiros públicos, especialmente, nos Estados da Bahia e Alagoas, por evidenciarem a maioria dos casos. Descritores: Saúde Pública; Nefrologia; Nefropatias; Diálise Peritoneal; Diálise Renal; Custos de Cuidados de Saúde.Abstract Objective: to describe hospitalizations, deaths and hospital costs due to dialysis complications in chronic renal patients in the Northeast. Method: this is a quantitative, descriptive and ecological study, focused on the analysis of data from the Hospital Information System, organized in absolute and relative frequencies, using tables built using Excel software. Results: 14,052 hospitalizations and 987 deaths were reported in the Northeast. As a result, the public coffers cost over R $ 19.6 million, with an average hospitalization value of R $ 1,543.09 and an average length of stay of 9.1 days. The states of Alagoas stood out, with the prevalence of hospitalizations (38.2%), and Bahia, in relation to deaths (40%), hospital costs (61.4%), average length of stay (14.4 days) and average value of hospitalization (R $ 2,794.42). Conclusion: it is pointed out that hospitalizations and deaths due to dialysis complications are an important problem in Nephrology, causing direct damage to public financial resources, especially in the states of Bahia and Alagoas, as they show the majority of cases. Descriptors:  Public Health; Nephrology; Kidney Diseases; Peritoneal Dialysis; Renal Dialysis; Health Care Costs. Resumen Objetivo: describir las hospitalizaciones, muertes y costos hospitalarios por las intercurrencias dialíticas en pacientes renales crónicos en el noreste. Método: se trata de un estudio cuantitativo, descriptivo y ecológico, destinado a analizar los datos del Sistema de Informaciones del Hospital, organizado en frecuencias absolutas y relativas, a partir de tablas construidas en el software Excel. Resultados: se reportaron 14.052 hospitalizaciones y 987 muertes en el noreste. Se generó como resultado de eso, un costo en exceso de R $ 19,6 millones para el gobierno, una hospitalización con costo promedio de R$1,543.09 y una estadía promedio de 9.1 días. Entre los estados, Alagoas tuvo una mayor prevalencia de hospitalizaciones (38,2%) y Bahía en las muertes (40%), costos hospitalarios (61,4%), duración media de la estancia (14,4 días) y media hospitalización (R $ 2.794,42). Conclusión: se observa que las hospitalizaciones y muertes debidas a las intercurrencias dialíticas se constituyen un problema importante en la nefrología, lo que implica directamente en los cofres públicos, especialmente en los Estados de Bahía y Alagoas, como evidencia de una mayor prevalencia de casos. Descriptores: Salud Pública; Nefrología; Enfermedades Renales; Diálisis Peritoneal; Diálisis Renal; Costos de la Atención en Salud. Descriptores: Salud Pública; Nefrología; Enfermedades Renales; Diálisis Peritoneal; Diálisis Renal; Costos de la Atención en Salud.  

scholarly journals Determinant Analysis of Restraint History and Length of Stay (LOS) of Patients with Schizophrenia in Aceh Mental Hospital 2018

2020 ◽  
Vol 3 (3) ◽  
pp. 1635-1640
Author(s):  
Humaira Humaira ◽  
Irwan Saputra ◽  
Nurjannah Nurjannah ◽  
Said Usman
Keyword(s):  
Length Of Stay ◽  
Mental Hospital ◽  
Clinical Symptoms ◽  
Average Length ◽  
Secondary Data ◽  
Average Length Of Stay ◽  
Aceh Province ◽  
Schizophrenic Patients ◽  
History Of ◽  
Study Population

Schizophrenia is classified as serious mental illness (SMI) due to its chronicity. Rumah Sakit Jiwa (RSJ) Aceh is the only referral mental hospital in Aceh Province. The number of inpatient visits in 2018 with a diagnosis of schizophrenia is 2,083 (96.12%). The average length of stay is 59.76 days. The purpose of this study was to determine the relationship between history of restraint and the length of stay (LOS) of schizophrenic patients in the Aceh Mental Hospital in 2018. This study uses quantitative method. Secondary data is collected from the medical records of patients returning home in 2018. The study population was all schizophrenic patients who returned in 2018, thus using the total sampling method. The study reveals that history of restraint influences the length of stay (LOS) of schizophrenic patients in Aceh Mental Hospital in 2018. The patients with restraint history was treated longer that the patients without restraint. Restraint exacerbates the clinical symptoms of Schizophrenia and causes physical abnormalities such as wasting in the extremities so that more time is needed in treatment. To avoid the severity of clinical symptoms, extremities deformation and the length of stay, stakeholders need to take strategic steps to eradicate restraint as a method in the handling of people with mental disorders at the community level.

516 Mortality from Inhalation Injury in Oxygen Dependent Patients Exceeds Prediction from Prognostic Models

2020 ◽  
Vol 41 (Supplement_1) ◽  
pp. S95-S96
Author(s):  
Kathleen Singer ◽  
Jalen Harvey ◽  
Elizabeth Dale
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Average Length ◽  
Small Sample Size ◽  
Small Sample ◽  
Chi Square ◽  
Average Length Of Stay ◽  
Risk Of Mortality ◽  
Secondary Outcomes ◽  
Chi Square Analysis

Abstract Introduction The Boston Criteria and the Abbreviated Burn Severity Index (ABSI) are two widely accepted models for predicting mortality in burn patients. We aimed to elucidate whether these models are able to accurately predict risk of mortality in patients who sustain burns while smoking on home oxygen given their overall clinical fragility. Methods We conducted a retrospective chart review of 48 patients admitted to our burn center from November 2013 to September 2017 who sustained a burn while smoking on home oxygen. Yearlong mortality was the primary outcome of the investigation; secondary outcomes included discharge to facility, length of stay, and need for tracheostomy. We then calculated the expected mortality rate for each patient based on Boston Criteria and ABSI, respectively, and compared the mortality rate observed in our cohort. Results Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p < 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy. Patients in our cohort suffered a 54% mortality rate within a year of injury, compared to a 23.5% mortality predicted by Boston Criteria, which was found to be statistically significant by chi-square analysis (p < 0.05). ABSI predicted mortality was 19.7%. While the absolute value of difference in mortality was greater, this was not found to be significant on chi-square analysis due to the small sample size. Our secondary outcomes revealed 42% discharge to facility, average length of stay of 6.2 days, and 6.25% required tracheostomy. Conclusions Patients whose burns are attributable to smoking on home oxygen may have an increased risk of mortality than prognostication models, such as the Boston Criteria and ABSI, may suggest. This bears significant clinical impact, particularly regarding family and provider decision-making in pursuing aggressive management. Applicability of Research to Practice This data indicates that these injuries are direr than expected, which may have significant impact on family and provider decision-making.

scholarly journals Internações, óbitos e custos hospitalares por diabetes mellitus

2019 ◽  
Vol 13 ◽  
Author(s):  
Edison Vitório de Souza Júnior ◽  
Mariana Alves Soledade de Jesus ◽  
Poliana Souza Lapa ◽  
Jamille Sales da Cruz ◽  
Tayná Freitas Maia ◽  
...  
Keyword(s):  
Diabetes Mellitus ◽  
Length Of Stay ◽  
Public Hospital ◽  
Average Length ◽  
Hospital Costs ◽  
Northeastern Brazil ◽  
Slight Reduction ◽  
The Public ◽  
Average Length Of Stay ◽  
Public Health Epidemiology

Objetivo: descrever as internações, óbitos e custos públicos hospitalares por Diabetes Mellitus no Nordeste brasileiro entre 2013 e 2017. Método: trata-se de estudo quantitativo, descritivo e ecológico com levantamento de dados secundários do Sistema de Informações Hospitalares. Coletaram-se os dados referentes às internações, óbitos, custos hospitalares, valor médio de internação e média de permanência. Analisaram-se os dados mediante estatística descritiva simples, apresentando-os por meio de tabelas elaboradas no software Excel. Resultados: registraram-se 136.504 internações e 7.424 óbitos por Diabetes Mellitus no Nordeste brasileiro. Destacaram-se, além disso, os custos públicos hospitalares superiores a R$ 65 milhões, com valor médio de internação de R$ 545,08 e média de permanência de 5,4 dias. Conclusão: conclui-se que as internações, óbitos e os custos públicos hospitalares por Diabetes Mellitus apresentaram discreta redução e, mesmo assim, implicaram, de maneira expressiva, o orçamento público, além das repercussões pessoais e familiares impostas pela doença. Descritores: Saúde Pública; Epidemiologia; Endocrinologia; Custos de Cuidados de Saúde; Doenças do Sistema Endócrino; Indicadores Básicos de Saúde.Abstract Objective: to describe hospitalizations, deaths and public hospital costs for Diabetes Mellitus in Northeastern Brazil between 2013 and 2017. Method: this is a quantitative, descriptive and ecological study with secondary data collection from the Hospital Information System. Data was collected regarding hospitalizations, deaths, hospital costs, average hospitalization value and average length of stay. Data was analyzed using simple descriptive statistics, presenting them using tables prepared using Excel software. Results: 136,504 hospitalizations and 7,424 deaths from diabetes mellitus were recorded in the Brazilian Northeast. Also noteworthy were the public hospital costs over R$ 65 million, with an average hospitalization value of R$ 545.08 and an average length of stay of 5.4 days. Conclusion: it can be concluded that hospitalizations, deaths and public hospital costs for Diabetes Mellitus showed a slight reduction and, even so, they significantly implied the public budget, in addition to the personal and family repercussions imposed by the disease. Descriptors: Public Health; Epidemiology; Endocrinology; Health Care Costs;ResumenObjetivo: describir las hospitalizaciones, muertes y costos hospitalarios por diabetes mellitus en el noreste de Brasil, entre 2013 y 2017. Método: se trata de un estudio cuantitativo, descriptivo y ecológico, con la recopilación de datos secundarios del Sistema de Informaciones Hospitalarias. Se recopilaron los datos de hospitalizaciones, muertes, costos hospitalarios, valor promedio y tiempo de permanencia de la hospitalización. Los datos se analizaron mediante estadísticas descriptivas simples y se presentaron a través de tablas elaboradas en el software Excel. Resultados: se registraron 136,504 hospitalizaciones y 7,424 muertes por diabetes mellitus en el noreste de Brasil. Además, se destacaron los costos hospitalarios públicos superiores a R $ 65 millones, con un valor promedio de hospitalización de R$ 545.08 y una permanencia con promedio de 5,4 días. Conclusión: se concluye que las hospitalizaciones, las muertes y los costos hospitalarios debidos a la diabetes mellitus presentaron una ligera reducción, y aun así, estaban significativamente implicados en el presupuesto público, además de las repercusiones personales y familiares impuestas por la enfermedad. Descriptores: Salud Pública; Epidemiología; Endocrinología; Costos de la Atención en Salud; Enfermedades del Sistema Endocrino; Indicadores de Salud.

scholarly journals 55 A Review of Stroke Demographics and Outcomes at a Regional Hospital without a Stroke Unit

2019 ◽  
Vol 48 (Supplement_3) ◽  
pp. iii17-iii65
Author(s):  
Lushen Pillay ◽  
Kushan Galav ◽  
Deeptish Tulsi ◽  
Joanna McGlynn ◽  
John Doherty ◽  
...  
Keyword(s):  
Mortality Rate ◽  
Length Of Stay ◽  
Stroke Unit ◽  
Average Length ◽  
Length Of Hospital Stay ◽  
Local Analysis ◽  
Stroke Patients ◽  
Stroke Units ◽  
Average Length Of Stay ◽  
Stroke Register

Abstract Background According to the 2017 National Stroke Register Report; 75% of strokes occur in patients aged 65 years and older. Within the audit 19 stroke units reported that 70.6% of stroke patients were admitted to a stroke unit and their median length of stay of 9 days. Numerous studies have shown better outcomes in patients admitted to a stroke unit versus a medical unit leading to national stroke networks and bypass protocols for patients. However, stroke patients can still be found in non-stroke unit hospitals such as our own. Methods Demographics from HIPE data was collected on all stroke patients admitted to our hospital between January 1st and December 31st 2017. Basic statistical methods were used to analyse the data. Results We analyzed 103 patient records. The average age at presentation was 73 years (range: 35-97) and 60.1% were males. The average length of hospital stay was 16.1 days (range 1- 130 days). Ischemic (77%) events were more common than haemorrhagic events (23%). The three most common co-morbidities were hypertension (45%), hyperlipidemia (30%) and atrial fibrillation (19%). Discharge destination was home (66%), nursing home (14%), national rehabilitation (2%) and an 18% mortality rate within 3 months. The mortality rate was higher in the hemorrhagic (42%) compared to ischemic (11%). Conclusion The average length of stay was 16.1 days, considerably higher than the national stroke unit average of 9. The overall mortality rate was 5% higher than the national of 13%. Limited rehabilitation services and time awaiting national rehabilitation beds contributed to the long LOS. There is a definite need for a dedicated stroke service at our hospital, local analysis suggests that 6 beds would meet the needs of our catchment area; and this would lead to better outcomes for stroke patients. A further locally dedicated stroke audit is needed.

scholarly journals Epidemiological profile of TBI in children under 10 years old before and after the implementation of the child seat law in Brazil

2021 ◽  
Author(s):  
Rebeca Menezes de Oliveira Lima ◽  
Brenda Luiza de Sousa Sanches ◽  
Guilherme Ribeiro Soare ◽  
Tauá Vieira Bahia
Keyword(s):  
Traumatic Brain Injury ◽  
Mortality Rate ◽  
Traffic Accidents ◽  
Ecological Study ◽  
Average Length ◽  
Car Seat ◽  
Average Length Of Stay ◽  
Before And After ◽  
The Law ◽  
Epidemiological Profile

Background: The Car Seat Law (2008) aims to minimize the impacts of traffic accidents on children under 10 years old, including the Traumatic Brain Injury (TBI). Objectives: To compare the epidemiological profile of TBI in children under 10 years old before and after the implementation of the Child Seat Law in Brazil. Design and setting: Ecological study in Brazil. Methods: Data was collected from the Ministry of Health, through DATASUS. The decade prior (1998- 2007) and subsequent (2009-2018) to the implementation of the Law were analyzed. The data collected included children of 10 years or less, average length of stay, hospitalizations, deaths, and mortality. Results: The average mortality between 1998-2007 was 2.31, while between 2009-2018 was 1.59, reducing 30.8%. There was also a reduction of 11% in the average stay averages, which went from 3.6 to 3.2 days. There was a 30.7% decrease in the lethality rate, from 2.3 to 1.6. The median of hospitalizations before the Law was 14,230, while afterwards it was 12,851. Conclusion: There was a significant decrease in the average mortality rate, lethality rate and average stay averages since the Law. This may suggest the Law’s effectiveness in protecting children under 10 years of age.

Impact of orthogeriatric management on the average length of stay of patients aged over seventy five years admitted to hospital after hip fractures

2021 ◽  
Author(s):  
Pierre-Sylvain Marcheix ◽  
Camille Collin ◽  
Jérémy Hardy ◽  
Christian Mabit ◽  
Achille Tchalla ◽  
...  
Keyword(s):  
Surgical Treatment ◽  
Hip Fracture ◽  
Mortality Rate ◽  
Length Of Stay ◽  
Average Length ◽  
Discharge Rate ◽  
Length Of Hospital Stay ◽  
Median Length ◽  
Average Length Of Stay ◽  
Significant Difference

Abstract Introduction Hip fracture is a frequent and serious condition in the elderly. We conducted a retrospective cohort study to answer the following questions: (1) Could treatment in an orthogeriatric unit help to reduce the average length of stay for patients aged over 75 years admitted to hospital for the treatment of a hip fracture?; and (2) Could such treatment influence the post-operative outcomes of patients with hip fracture? Methods and materials Our study included 534 patients admitted to hospital between January 2017 and December 2018 for surgical treatment of a hip fracture. We compared 246 patients who received traditional orthopaedic care with 288 patients treated in an orthogeriatric unit. Results Our cohort included 410 women (77%). The average age was 87.5 ± six years, and 366 patients (68%) were living at home prior to the fracture. A statistically significant difference in median length of stay (from 10 to 9 days) was observed between patients who did and did not receive orthogeriatric unit treatment (groups 1 and 2; 95% CI: 0.64; 2.59; p = 0.001). There was no difference in pre-operative delay, intra-hospital mortality rate, place of recovery, rate of institutionalisation after six months, or the number of new fractures at 6 months between the groups. The mortality rate after six months was 23.6% and 21.3% in groups 1 and 2, respectively; the difference was not significant. Discussion Orthogeriatric unit treatment reduced the median length of stay by one day, in line with most previous studies. According to Pablos-Hernandez et al., multifaceted orthogeriatric treatment is most effective. In our study, only 38% of the patients received surgical treatment within 48 hours, where early surgery is key for reducing the length of hospital stay. The intrahospital mortality rate was 2.6%, which is comparable to literature data. The discharge rate did not differ by orthogeriatric treatment status, which is also consistent with previous findings (e.g. Gregersen et al.). Lastly, the mortality rate after six months was slightly reduced by orthogeriatric care. In line with this, Boddaert et al. reported a difference in mortality rate after six months between groups who did and did not receive orthogeriatric treatment (15% vs. 24%).

Does migration make financial sense? The case of domestic workers from Vietnam to Taiwan

2015 ◽  
Vol 35 (11/12) ◽  
pp. 722-737 ◽  
Author(s):  
Nguyen Quynh Phuong ◽  
Sundar Venkatesh
Keyword(s):  
Length Of Stay ◽  
Financial Literacy ◽  
Average Length ◽  
Domestic Workers ◽  
Risk Allocation ◽  
Costs And Benefits ◽  
Content Type ◽  
Average Length Of Stay ◽  
The North ◽  
Migrant Domestic Workers

Purpose – Adopting a view that migration is an investment, the purpose of this paper is to investigate the risk-adjusted returns that migrant domestic workers from Vietnam to Taiwan can expect to earn. Design/methodology/approach – The study analyses data obtained through interviews of a sample of migrant domestic workers, all from Phu Tho in the north of Vietnam, who had migrated to Taiwan. Findings – The study found that migrants were driven strongly by financial motivations. Analysis of the typical costs of migrating, wages in the host country, average length of stay and especially, uncertainties affecting the length of stay, found that the investment in migration is a highly risky one for migrants. In most cases, migration does not pay. Research limitations/implications – Estimates of costs and benefits can be improved with larger samples of respondents and data sources that can help validate the interviews. Practical implications – There is a need to improve financial literacy among migrants to help them better assess their investment in migration. Social implications – This paper highlights the inequity in risk allocation in the context of migration. Originality/value – To the knowledge, there is no research of the financial costs and benefits of migration as domestic workers, especially from Vietnam to Taiwan.

scholarly journals Length of stay comparisons for private and public hospitals

2000 ◽  
Vol 23 (3) ◽  
pp. 162 ◽  
Author(s):  
Jennifer Badham ◽  
Jason Brandrup
Keyword(s):  
Length Of Stay ◽  
Public Hospital ◽  
Average Length ◽  
Public Hospitals ◽  
Private Hospitals ◽  
The Public ◽  
Average Length Of Stay ◽  
Private And Public

This analysis uses average length of stay as a proxy for efficiency, to compare the Australian private and public hospitalsectors. We conclude that private hospitals are more efficient than public hospitals in providing the range of care providedby private hospitals. However, public hospitals are more efficient in handling the casemix of the public hospital sector.The picture is more complicated when particular types of care (such as obstetric and psychiatric) are excluded.

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