Barriers to healthcare access for children with congenital heart disease in eight Latin American countries

BACKGROUND

Mortality from congenital heart disease has decreased considerably in the last two decades due to improvements in overall health care. However, there are barriers to access to healthcare in Latin America for this population, which could be related to factors such as healthcare system, policies, resources, geographic, cultural, educational, and psychological factors. Understanding the barriers to access to care is of paramount importance for the design and implementation of policies and facilitate the provision of care.

AIM

The aim of the study was to investigate the perception of barriers to access to health care on parents/guardians of children with congenital heart disease in selected Latin American countries.

METHODS

A descriptive, cross-sectional study, in which parents/guardians or primary caregivers of children with congenital heart disease was recruited to participate and surveyed. Once the informed consent process had been completed, a set of paper-based scales was used to collect data, namely socioeconomic and demographic information, the Barriers to Care for Children with Special Health Care Needs Questionnaire, and the General Health Questionnaire.

RESULTS

In total, 286 participants completed the surveys, with an average age of 34.81 years and 73.4% being female. Mean score of overall barriers was 54.45 (minimum score 39, maximum score 195, higher scores show greater perception of barriers). In Mexico, the parents/guardians of children perceived fewer barriers to access (46.69), while Peru is the country where the most barriers were perceived (69.91). Nonpoor participants showed higher overall barrier perception scores (57.34) than poor participants (52.58). The regression analysis demonstrated the overall perception of barriers was positively associated with individual and social factors, such as educational level, contract status, household monthly income, and psychological well-being and with the country of the participants.

CONCLUSIONS

Multiple factors are associated with the perception of barriers to accessing health care for children with congenital heart disease, including socioeconomic status, expectations, psychological well-being, and structural factors.

Poverty, quality of life and psychological wellbeing in adults with congenital heart disease in Chile

The objective of this study was to assess the quality of life and psychological wellbeing of adults with congenital heart disease (CHD) in Chile, and to identify other associated factors. The study enrolled 68 patients aged between 18 and 72 (median 29), 35 being females. They completed a questionnaire, which included a quality of life assessment tool (the Medical Outcome Study 36-Item Short Form Health Survey), a number of psychological scales (the General Health Questionnaire, the Basic Psychological Needs Scales and the Beck Hopelessness Scale), a socioeconomic survey, and some clinical data. CHD patients reported worse scores in those scales assessing physical dimensions of quality of life (physical function (70.5), physical role functioning (64), vitality (65.3)), and general quality of life (58.6), than in emotional or social dimensions. Female gender was associated with lower scores in physical function (59.12 versus 82.66; p<0.01) and physical role functioning (53.68 versus 75; p<0.05); poverty was associated with worse results in physical function (61.92 versus 82.96; p<0.01), role physical (53.21 versus 79.63; p<0.01), vitality (60.89 versus 71.67; p<0.05), social role functioning (70.19 versus 82.87; p<0.05) and bodily pain (65.77 versus 81.2; p<0.05). Furthermore, we found that psychological scales had an association with quality of life, but clinical variables did not show significant correlations to any dimension. Poverty has an impact on the quality of life of CHD patients. This population only has a decrease in the quality of life physical dimensions, suggesting that quality of life depends on many different factors.

Attribution of net carbon change by disturbance type across forest lands of the conterminous United States

BACKGROUND

Locating terrestrial sources and sinks of carbon (C) will be critical to developing strategies that contribute to the climate change mitigation goals of the Paris Agreement. Here we present spatially resolved estimates of net C change across United States (US) forest lands between 2006 and 2010 and attribute them to natural and anthropogenic processes.

RESULTS

Forests in the conterminous US sequestered -460 ± 48 Tg C year^-1, while C losses from disturbance averaged 191 ± 10 Tg C year^-1. Combining estimates of net C losses and gains results in net carbon change of -269 ± 49 Tg C year^-1. New forests gained -8 ± 1 Tg C year^-1, while deforestation resulted in losses of 6 ± 1 Tg C year^-1. Forest land remaining forest land lost 185 ± 10 Tg C year^-1 to various disturbances; these losses were compensated by net carbon gains of -452 ± 48 Tg C year^-1. C loss in the southern US was highest (105 ± 6 Tg C year^-1) with the highest fractional contributions from harvest (92%) and wind (5%). C loss in the western US (44 ± 3 Tg C year^-1) was due predominantly to harvest (66%), fire (15%), and insect damage (13%). The northern US had the lowest C loss (41 ± 2 Tg C year^-1) with the most significant proportional contributions from harvest (86%), insect damage (9%), and conversion (3%). Taken together, these disturbances reduced the estimated potential C sink of US forests by 42%.

CONCLUSION

The framework presented here allows for the integration of ground and space observations to more fully inform US forest C policy and monitoring efforts.

Attribution of net carbon change by disturbance type across forest lands of the conterminous United States

BACKGROUND

Locating terrestrial sources and sinks of carbon (C) will be critical to developing strategies that contribute to the climate change mitigation goals of the Paris Agreement. Here we present spatially resolved estimates of net C change across United States (US) forest lands between 2006 and 2010 and attribute them to natural and anthropogenic processes.

RESULTS

Forests in the conterminous US sequestered -460 ± 48 Tg C year^-1, while C losses from disturbance averaged 191 ± 10 Tg C year^-1. Combining estimates of net C losses and gains results in net carbon change of -269 ± 49 Tg C year^-1. New forests gained -8 ± 1 Tg C year^-1, while deforestation resulted in losses of 6 ± 1 Tg C year^-1. Forest land remaining forest land lost 185 ± 10 Tg C year^-1 to various disturbances; these losses were compensated by net carbon gains of -452 ± 48 Tg C year^-1. C loss in the southern US was highest (105 ± 6 Tg C year^-1) with the highest fractional contributions from harvest (92%) and wind (5%). C loss in the western US (44 ± 3 Tg C year^-1) was due predominantly to harvest (66%), fire (15%), and insect damage (13%). The northern US had the lowest C loss (41 ± 2 Tg C year^-1) with the most significant proportional contributions from harvest (86%), insect damage (9%), and conversion (3%). Taken together, these disturbances reduced the estimated potential C sink of US forests by 42%.

CONCLUSION

The framework presented here allows for the integration of ground and space observations to more fully inform US forest C policy and monitoring efforts.