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Adewole JA, Tumbo JM, Okonta HI. Emergency care visits at a South African hospital: Implications for healthcare services and policy. S Afr Fam Pract (2004) 2024; 66:e1-e6. [PMID: 38572872 PMCID: PMC11019032 DOI: 10.4102/safp.v66i1.5816] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/17/2023] [Revised: 10/23/2023] [Accepted: 11/25/2023] [Indexed: 04/05/2024] Open
Abstract
BACKGROUND A robust knowledge on the pattern of use of emergency care resources not only serves as an indicator of universal access to care but also provides a basis for quality improvement within the health system. This study was undertaken to describe the pattern of emergency room visits at Brits District Hospital (BDH) in North West province, South Africa. The objectives of this study were to determine the sociodemographic characteristics of emergency department (ED) users and other patterns of ED use. METHODS This was a cross-sectional descriptive study that was conducted at a district hospital. All patients who reported for emergency care in the ED in 2016 were eligible for the study. Data were extracted and analysed from a systematic sample of 355 clinical notes and hospital administrative records. RESULTS The age group that visited the ED most frequently (25.3%) was 25-34 years old. A high proportion of the ED users (60%) were self-referred, and only 38% were transported by the emergency medical response services (EMRS). Few (5.6%) presentations were of a non-urgent nature. Trauma-related conditions accounted for the most frequent presentation at the ED (36.5%). CONCLUSION Although most ED users were self-referred, their clinical presentations were appropriate and underscore the need for policy strategies to reduce the burden of trauma in the catchment populationContribution: The study findings may have an impact on future health policies by providing decision-makers with baseline information on the pattern of use of ED resources, ensuring better resource deployment and greater access to care.
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Affiliation(s)
- Jacob A Adewole
- Department of Family Medicine and Primary Health Care, Faculty of Medicine, Sefako Makgatho Health Sciences University, Pretoria, South Africa; and, Brits District Hospital, Bojanala District, Rustenburg.
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Taber DJ, Ward RC, Buchanan CH, Axon RN, Milfred-LaForest S, Rife K, Felkner R, Cooney D, Super N, McClelland S, McKenna D, Santa E, Gebregziabher M. Results of a multicenter cluster-randomized controlled clinical trial testing the effectiveness of a bioinformatics-enabled pharmacist intervention in transplant recipients. Am J Transplant 2023; 23:1939-1948. [PMID: 37562577 DOI: 10.1016/j.ajt.2023.08.004] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/05/2023] [Revised: 07/05/2023] [Accepted: 08/03/2023] [Indexed: 08/12/2023]
Abstract
An ambulatory medication safety dashboard was developed to identify missing labs, concerning labs, drug interactions, nonadherence, and transitions in care. This system was tested in a 2-year, prospective, cluster-randomized, controlled multicenter study. Pharmacists at 5 intervention sites used the dashboard to address medication safety issues, compared with usual care provided at 5 control sites. A total of 2196 transplant events were included (1300 intervention vs 896 control). During the 2-year study, the intervention arm had a 11.3% (95% confidence interval, 7.1%-15.5%) absolute risk reduction of having ≥1 emergency department (ED) visit (44.2% vs 55.5%, respectively; P < .001, respectively) and a 12.3% (95% confidence interval, 8.2%-16.4%) absolute risk reduction of having ≥1 hospitalization (30.1% vs 42.4%, respectively; P < .001). In those with ≥1 event, the median ED visit rate (2 [interquartile range (IQR) 1, 5] vs 2 [IQR 1, 4]; P = .510) and hospitalization rate (2 [IQR 1, 3] vs 2 [IQR 1, 3]; P = .380) were similar. Treatment effect varied by comorbidity burden, previous ED visits or hospitalizations, and heart or lung recipients. A bioinformatics dashboard-enabled, pharmacist-led intervention reduced the risk of having at least one ED visit or hospitalization, predominantly demonstrated in lower risk patients.
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Affiliation(s)
- David J Taber
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Division of Transplant Surgery, Department of Surgery, Medical University of South Carolina, Charleston, South Carolina, USA.
| | - Ralph C Ward
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
| | - Casey H Buchanan
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA
| | - Robert Neal Axon
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA
| | - Sherry Milfred-LaForest
- Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Kelsey Rife
- Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Rebecca Felkner
- Department of Pharmacy Services, William S. Middleton Veterans Affairs Medical Center, Madison, Wisconsin, USA
| | - Danielle Cooney
- Department of Pharmacy Service, Louis Stokes Veterans Affairs Medical Center, Cleveland, Ohio, USA
| | - Nicholas Super
- Department of Pharmacy Services, Jesse Brown Veterans Affairs Medical Center, Chicago, Illinois, USA
| | - Samantha McClelland
- Department of Pharmacy Services, Veterans Affairs Great Lakes Health Care System (VISN 12), Westchester, Illinois, USA
| | - Domenica McKenna
- Department of Pharmacy Services, Portland Veterans Affairs Health Care System, Portland, Oregon, USA
| | - Elizabeth Santa
- Department of Pharmacy Services, Atlanta Veterans Affairs Health Care System, Atlanta, Georgia, USA
| | - Mulugeta Gebregziabher
- Department of Pharmacy Services, Ralph H Johnson Veterans Affairs Medical Center, Health Equity and Rural Outreach Innovation Center, Charleston, South Carolina, USA; Department of Public Health Sciences, College of Medicine, Medical University of South Carolina, Charleston, South Carolina, USA
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Dreiher J, Einav S, Codish S, Frenkel A. Emergency Department Admission Rates, Waiting Times, and Mortality: An Observational Study in the Tertiary Center Most Proximal to Gaza During a Military Conflict. Disaster Med Public Health Prep 2023; 17:e463. [PMID: 37608756 DOI: 10.1017/dmp.2023.45] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 08/24/2023]
Abstract
OBJECTIVES Military conflicts may be ongoing and encompass multiple medical facilities. This study investigated the impact of a military conflict ("Protective Edge" PE) on emergency department (ED) function in a tertiary medical center. METHODS Visits to the ED during PE (July-August 2014) were compared with ED visits during July-August 2013 and 2015 with regard to admission rates, waiting times and 30-d mortality. Odds ratios (ORs) adjusted for confounders were used for the multivariable regression models. RESULTS There were 32,343 visits during PE and 74,279 visits during the comparison periods. A 13% decrease in the daily number of visits was noted. During PE, longer waiting times were found, on average 0.25 h longer, controlling for confounders. The difference in waiting times was greater in medicine and surgery. Admission rates were on average 10% higher during PE military conflict, controlling for confounders. This difference decreased to 7% controlling for the daily number of visits. Thirty-day mortality was significantly increased during PE (OR = 1.42; 95% CI: 1.18-1.70). ORs for mortality during PE were significantly higher in medicine (OR = 1.45; 95% CI: 1.15-1.81) and pediatrics (OR = 4.40; 95% CI: 1.33-14.5). CONCLUSIONS During an ongoing military conflict, waiting times, admission rates, and mortality were statistically significantly increased.
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Affiliation(s)
- Jacob Dreiher
- Hospital Administration, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Sharon Einav
- General Intensive Care Unit, Shaare Zedek Medical Center, and Anesthesia and Intensive Care Medicine, Hebrew University-Hadassah Faculty of Medicine, Jerusalem, Israel
| | - Shlomi Codish
- Hospital Administration, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
| | - Amit Frenkel
- General Intensive Care Unit, Soroka University Medical Center, and The Faculty of Health Sciences, Ben-Gurion University of the Negev, Beer-Sheva, Israel
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4
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Silva E, Pereira MF, Vieira JT, Ferreira-Coimbra J, Henriques M, Rodrigues NF. Predicting hospital emergency department visits accurately: A systematic review. Int J Health Plann Manage 2023. [PMID: 36898975 DOI: 10.1002/hpm.3629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/04/2021] [Revised: 09/28/2022] [Accepted: 02/04/2023] [Indexed: 03/12/2023] Open
Abstract
OBJECTIVES The emergency department (ED) is a very important healthcare entrance point, known for its challenging organisation and management due to demand unpredictability. An accurate forecast system of ED visits is crucial to the implementation of better management strategies that optimise resources utilization, reduce costs and improve public confidence. The aim of this review is to investigate the different factors that affect the ED visits forecasting outcomes, in particular the predictive variables and type of models applied. METHODS A systematic search was conducted in PubMed, Web of Science and Scopus. The review methodology followed the PRISMA statement guidelines. RESULTS Seven studies were selected, all exploring predictive models to forecast ED daily visits for general care. MAPE and RMAE were used to measure models' accuracy. All models displayed good accuracy, with errors below 10%. CONCLUSIONS Model selection and accuracy was found to be particularly sensitive to the ED dimension. While ARIMA-based and other linear models have good performance for short-time forecast, some machine learning methods proved to be more stable when forecasting multiple horizons. The inclusion of exogenous variables was found to be advantageous only in bigger EDs.
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Affiliation(s)
| | | | | | | | - Mariana Henriques
- Centre of Biological Engineering, University of Minho, Braga, Portugal
| | - Nuno F Rodrigues
- INESC TEC, Porto, Portugal.,Algoritmi Research Center, University of Minho, Braga, Portugal.,2Ai - School of Technology, IPCA, Barcelos, Portugal
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Day A, Newton D, Tamatea A. A Scoping Review of Family Focussed Interventions to Prevent Prison Violence. Int J Offender Ther Comp Criminol 2023; 67:151-163. [PMID: 34114483 DOI: 10.1177/0306624x211023917] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 06/12/2023]
Abstract
Violence is an ongoing concern for many people who live and work in correctional settings and yet relatively little is known about the effects of institutional violence prevention efforts. This paper reports the findings of a scoping review of recent research relevant to understanding the influence of one factor, contact with family, that potentially influences institutional violence in countries such as Aotearoa New Zealand where Indigenous peoples are over-represented in prison settings. A total of 15 different studies were identified that provided consistent evidence of an association between family contact and prison violence. The implications of this work for the development of evidence-based prison violence prevention strategies are discussed.
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Affiliation(s)
| | | | - Armon Tamatea
- University of Melbourne, VIC, Australia
- University of Waikato, Hamilton, New Zealand
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Woo YR, Ju HJ, Bae JM, Cho M, Cho SH, Kim HS. Patient Visits and Prescribing Patterns Associated with Rosacea in Korea: A Real-World Retrospective Study Based on Electronic Medical Records. J Clin Med 2022; 11:jcm11061671. [PMID: 35329996 PMCID: PMC8951589 DOI: 10.3390/jcm11061671] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2022] [Revised: 02/25/2022] [Accepted: 03/14/2022] [Indexed: 02/01/2023] Open
Abstract
Rosacea is a common and chronic inflammatory skin disorder. The visiting trends and prescribing patterns involving Korean patients with rosacea have not been thoroughly examined. To examine the visiting trends of patients with rosacea, and to analyze the prescription patterns of Korean dermatologists managing such patients, a retrospective cross-sectional study on dermatology outpatients who visited the seven affiliated hospitals of The Catholic University of Korea between 2007 and 2018 was performed. A total of 56,651 visits were made by rosacea patients. The mean annual number of hospital visits made by rosacea patients over a 6-year period increased from 2456 in 2007–2012 to 6985 in 2013–2018. Hospital visits were most prevalent in female patients aged 40 to 59 years. There was no statistically significant difference in patient visitation between the seasons. As for prescriptions, systemic antibiotics were most commonly prescribed, followed by antihistamines, non-steroidal anti-inflammatory drugs, and retinoids. Among the topical agents, metronidazole was the most prescribed agent during 2007–2012, whereas calcineurin inhibitors were favored most during 2013–2018. Dermatology outpatient visits by individuals with rosacea have increased in Korea over time. The real-world prescription trend presented here may help dermatologists facilitate better treatment strategies and provide appropriate guidance to patients with rosacea.
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Affiliation(s)
- Yu Ri Woo
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (M.C.); (S.H.C.)
| | - Hyun Jeong Ju
- Department of Dermatology, St. Vincent’s Hospital, The Catholic University of Korea, Seoul 06591, Korea;
| | - Jung Min Bae
- Heal House Skin Clinic, Mesanro 24, Paldal-gu, Suwon 16461, Korea;
| | - Minah Cho
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (M.C.); (S.H.C.)
| | - Sang Hyun Cho
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (M.C.); (S.H.C.)
| | - Hei Sung Kim
- Department of Dermatology, Incheon St. Mary’s Hospital, The Catholic University of Korea, Seoul 06591, Korea; (Y.R.W.); (M.C.); (S.H.C.)
- Correspondence:
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Abstract
Mental illness occurs more frequently in incarcerated individuals than in the general population. This study examined whether social support during incarceration is associated with improved mental health outcomes. Data were used from the 2004 Survey of Inmates in State Correctional Facilities; the analytic sample was 3,451 incarcerated individuals. Linear regression models predicted current mental health functioning from frequency of visits and phone calls while incarcerated. Controlling for demographic characteristics, incarcerated individuals with more frequent contact from family and friends had improved mental health. Mental health functioning was particularly enhanced for individuals who received more calls and visits. Future research should explore opportunities to increase visits and phone calls during incarceration along with additional social support mechanisms that may enhance mental health.
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Affiliation(s)
- Lindsay Chassay
- Department of Psychological Sciences, Kansas State University, Manhattan, Kansas, USA
| | - Kristen P Kremer
- Department of Sociology, Anthropology, and Social Work, Kansas State University, Manhattan, Kansas, USA
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Ugwu N, Cheraghlou S, Antaya RJ, Feng H, Cohen JM. Trends in office visits and treatment for urticaria in children in the United States, 1998-2016. Pediatr Dermatol 2021; 38:1162-1168. [PMID: 34339077 DOI: 10.1111/pde.14726] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/29/2022]
Abstract
BACKGROUND/OBJECTIVES Urticaria is a common condition with an estimated prevalence of up to 23% in the pediatric population. Studies characterizing visits and treatments for urticaria in the pediatric population are unavailable. Understanding visit and treatment trends for urticaria in the pediatric population may help inform care for patients with urticaria. METHODS A total of 108 278 outpatient records from the National Ambulatory Medical Care Survey representing 3.4 billion visits by patients of age 18 and younger were analyzed. This study included the calendar years 1998 through 2016. RESULTS Pediatricians saw the largest proportion of all visits (52.7%). Male and female patients accounted for approximately equal proportions of all visits for urticaria. There was a slight male predominance in visits to pediatricians (53.7%), whereas dermatologists saw female patients more frequently (63.3%). Most visits for urticaria were by non-Hispanic (78.1%) and White (78.2%) patients. H1 antihistamines were the most commonly prescribed treatment (70.3%), whereas topical corticosteroids were prescribed least frequently (4.9%). Topical corticosteroids were most frequently prescribed by dermatologists (7.7%). Non-H1 antihistamine and non-corticosteroid therapy were prescribed in 9.7% of all visits and in 4.5% of visits to pediatricians. Most visits for urticaria were to physicians in metropolitan areas (88.8%). Pediatricians saw the highest number of non-metropolitan area visits (56.3%). CONCLUSIONS H1 antihistamines were the most commonly used therapy (70%), consistent with established treatment guidelines. Male and female pediatric patients present equally often for urticaria, but sex differences were seen with visit frequencies to certain specialties.
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Affiliation(s)
- Nelson Ugwu
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Shayan Cheraghlou
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
| | - Richard J Antaya
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA.,Department of Pediatrics, Yale School of Medicine, New Haven, CT, USA
| | - Hao Feng
- Department of Dermatology, University of Connecticut Health Center, Farmington, CT, USA
| | - Jeffrey M Cohen
- Department of Dermatology, Yale School of Medicine, New Haven, CT, USA
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Abstract
Patient Portal represents a connecting service for the Slovenian eHealth solutions and enables patients with effective and secure access to their medical documentation. Ever since its national roll-out in 2017 the number of visits of the Patient Portal has been constantly growing, however, during the time of Covid-19, the number of visits has increased dramatically to reach almost 1.9 million visits in 2020. This article initially presents the functionalities of the Patient Portal and the dynamics of the visits to the Patient Portal in the time of Covid-19. In the second part, the article outlines the most significant benefits to healthcare stakeholders provided by the Patient Portal in the period of Covid-19. The study applies a focus group methodology. Structured focus group discussions were carried out with prominent experts, who are in charge of the Patient Portal and other national eHealth solutions in Slovenia. Research results indicate that the Patient Portal has attracted enormous interest and has become one of the essential public health tools empowering patients and supporting the enactment of public health policies and measures during the Covid-19 crisis.
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Henry TW, Townsend CB, Beredjiklian PK. Workers' Compensation Status Confers a Greater Number of Postoperative Visits After Common Upper Extremity Surgeries. Cureus 2021; 13:e14629. [PMID: 34055505 PMCID: PMC8144074 DOI: 10.7759/cureus.14629] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
Abstract
Background The impact of Workers’ Compensation (WC) status on postoperative healthcare utilization in hand and wrist surgery clinical practice is presently unclear. The purpose of this study was to compare the number of postoperative visits in WC to non-WC patients after common upper extremity surgical procedures. Methodology All patients who underwent one of four common surgical procedures (carpal tunnel release, De Quervain’s release, cubital tunnel release, and trigger finger release) between 2016 and 2019 were identified. A total of 64 surgeries billed under WC were randomly selected and matched 1:1 to surgeries billed outside of WC based on the primary CPT code. Results The most common procedure was carpal tunnel release (42 patients), followed by trigger finger release (30 patients), cubital tunnel release (28 patients), and De Quervain’s release (16 patients). The average number of postoperative visits was 2.3 (median = 2, range: 1-9) and was significantly higher in the WC group (mean/median = 3.0/3 versus 1.5/1, p < 0.001). Within the 90-day global postoperative billing period, the mean number of visits was 2.2 (median = 2, range: 1-4) in the WC group and 1.4 (median = 1, range: 1-3) in the non-WC group (p < 0.001). The average time to clinical discharge in the WC group was 101 days (range: 10-446 days), and in the non-WC group was 40 days (range: 7-474 days) (p < 0.001). Five patients (7.8%) in the WC group and four patients (6.3%) in the non-WC group were seen for unplanned visits after clinical discharge. Conclusions WC status conferred more postoperative visits after common upper extremity surgical procedures, both within and beyond the global billing period. Further investigation and targeted strategies are required to address the observed increase in healthcare utilization.
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Affiliation(s)
- Tyler W Henry
- Orthopaedic Surgery, Sidney Kimmel Medical College, Thomas Jefferson University, Philadelphia, USA
| | - Clay B Townsend
- Division of Hand Surgery, Rothman Orthopaedic Institute, Philadelphia, USA
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Rajwa P, Przydacz M, Krajewski W, Kuffel B, Zapala P, Krzywon A, Cortez AJ, Dybowski B, Stamirowski R, Jarzemski M, Drobot RB, Stelmach P, Mlynarek K, Marcinek M, Przudzik M, Krawczyk W, Ryszawy J, Choragwicki D, Zapala L, Lipa M, Pozniak M, Janczak D, Słomian S, Łaszkiewicz J, Nowak M, Miszczyk M, Roslan M, Tkocz M, Zdrojowy R, Potyka A, Szydełko T, Drewa T, Jarzemski P, Radziszewski P, Slojewski M, Antoniewicz A, Paradysz A, Chlosta PL. Changing patterns of urologic emergency visits and admissions during the COVID-19 pandemic: a retrospective, multicenter, nationwide study. Arch Med Sci 2021; 17:1262-1276. [PMID: 34522255 PMCID: PMC8425232 DOI: 10.5114/aoms.2020.98364] [Citation(s) in RCA: 7] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 07/28/2020] [Indexed: 11/17/2022] Open
Abstract
INTRODUCTION We aimed to examine the change in the number and severity of visits to the emergency departments (EDs) and subsequent admissions for urgent urologic conditions in the early stage of the coronavirus disease 2019 (COVID-19) pandemic in Poland. MATERIAL AND METHODS We evaluated data from 13 urologic centers in Poland and compared the number of visits to the EDs and subsequent admissions before and after the advent of COVID-19 in 2020, and before and after the escalating national restrictions. Furthermore, data on types of urologic complaints, crucial laboratory parameters, and post-admission procedures were analyzed. RESULTS In total 1,696 and 2,187 urologic visits (22.45% decrease) and 387 and 439 urologic urgent admissions (11.85% decrease) were reported in given periods in 2020 and 2019, respectively. The year-over-year difference in daily mean visits was clear (36.1 vs. 46.5; p < 0.001). Declines were seen in all complaints but device malfunction. In 2020 daily mean visits and admissions decreased from 40.9 and 9.6 before lockdowns to 30.9 (p < 0.001) and 6.9 (p = 0.001) after severe restrictions, respectively. There was a trend towards more negative laboratory parameter profiles in 2020, with patients who visited the EDs after severe restrictions having twice as high median levels of C-reactive protein (15.39 vs. 7.84, p = 0.03). CONCLUSIONS The observed declines in ED visits and admissions were apparent with the significant effect of national lockdowns. Our results indicate that some of the patients requiring urgent medical help did not appear at the ED or came later than they would have done before the pandemic, presenting with more severe complaints.
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Affiliation(s)
- Pawel Rajwa
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Mikolaj Przydacz
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Wojciech Krajewski
- Department of Urology and Urological Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Blazej Kuffel
- Department of General and Oncological Urology, 1 University Hospital, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Zapala
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Aleksandra Krzywon
- Department of Biostatistics and Bioinformatics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Alexander J. Cortez
- Department of Biostatistics and Bioinformatics, Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Bartosz Dybowski
- Department of Urology, Roefler Memorial Hospital, Pruszkow, Poland
| | - Remigiusz Stamirowski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Marcin Jarzemski
- Department of Urology, Jan Biziel University Hospital in Bydgoszcz, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Poland
| | - Rafal B. Drobot
- Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Miedzylesie, Warsaw, Poland
| | - Pawel Stelmach
- Clinical Department of Urology, 4 Clinical Military Hospital, Wroclaw, Poland
- Division of Oncology and Palliative Care, Faculty of Health Sciences, Wroclaw Medical University, Poland
| | - Krystyna Mlynarek
- Urological Ward, Independent Public Health Care Unit, Voivodeship Specialised Hospital No. 3, Rybnik, Poland
| | - Mateusz Marcinek
- Department of Urology, FMS in Katowice, Medical University of Silesia, Katowice, Poland
| | - Maciej Przudzik
- University of Warmia and Mazury, Faculty of Medicine, Department of Urology, Olsztyn, Poland
| | - Wiktor Krawczyk
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Jakub Ryszawy
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Dominik Choragwicki
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
| | - Lukasz Zapala
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Lipa
- Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Miedzylesie, Warsaw, Poland
| | - Michal Pozniak
- Department of General and Oncological Urology, 1 University Hospital, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Dawid Janczak
- Clinical Department of Urology, 4 Clinical Military Hospital, Wroclaw, Poland
- Division of Oncology and Palliative Care, Faculty of Health Sciences, Wroclaw Medical University, Poland
| | - Szymon Słomian
- Urological Ward, Independent Public Health Care Unit, Voivodeship Specialised Hospital No. 3, Rybnik, Poland
| | - Jan Łaszkiewicz
- Department of Urology and Urological Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Marcel Nowak
- Department of Urology, FMS in Katowice, Medical University of Silesia, Katowice, Poland
| | - Marcin Miszczyk
- Maria Skłodowska-Curie National Research Institute of Oncology, Gliwice Branch, Gliwice, Poland
| | - Marek Roslan
- University of Warmia and Mazury, Faculty of Medicine, Department of Urology, Olsztyn, Poland
| | - Michał Tkocz
- Department of Urology, FMS in Katowice, Medical University of Silesia, Katowice, Poland
| | - Romuald Zdrojowy
- Department of Urology and Urological Oncology, Wroclaw Medical University, Wroclaw, Poland
| | - Andrzej Potyka
- Urological Ward, Independent Public Health Care Unit, Voivodeship Specialised Hospital No. 3, Rybnik, Poland
| | - Tomasz Szydełko
- Department of Urology, Medical University of Silesia, Zabrze, Poland
- Division of Oncology and Palliative Care, Faculty of Health Sciences, Wroclaw Medical University, Poland
| | - Tomasz Drewa
- Department of General and Oncological Urology, 1 University Hospital, Nicolaus Copernicus University, Bydgoszcz, Poland
| | - Piotr Jarzemski
- Department of Urology, Jan Biziel University Hospital in Bydgoszcz, Nicolaus Copernicus University in Torun, Collegium Medicum in Bydgoszcz, Poland
| | - Piotr Radziszewski
- Department of General, Oncological and Functional Oncology, Medical University of Warsaw, Warsaw, Poland
| | - Marcin Slojewski
- Department of Urology and Urological Oncology, Pomeranian Medical University, Szczecin, Poland
| | - Artur Antoniewicz
- Department of Urology and Urological Oncology, Multidisciplinary Hospital in Warsaw-Miedzylesie, Warsaw, Poland
| | - Andrzej Paradysz
- Department of Urology, Medical University of Silesia, Zabrze, Poland
| | - Piotr L. Chlosta
- Department of Urology, Jagiellonian University Medical College, Krakow, Poland
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Liu Z, Man L. Impacts of the COVID-19 outbreak on visits and treatments for patients with ureteral stones in a general hospital emergency department. Urologia 2020; 88:232-236. [PMID: 33375917 DOI: 10.1177/0391560320985659] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
BACKGROUND The COVID-19 is a challenge for both patients and physicians in emergency department (ED). This study was aimed to report the impacts of the COVID-19 outbreak on visits and treatments for patients with ureteral stones in a general hospital ED. METHODS The patients with ureteral stones were collected from 24 January to 24 March 2020 during the COVID-19 outbreak in Beijing. Two periods were divided for study: 24 January to 24 February (Period 1) and 25 February to 24 March (Period 2). Data on patients' characteristics, attendance, visual analog scale (VAS) scores, stone features, and final treatment choices were retrieved from the computer and compared with the data in the same periods in 2019. RESULTS The study included 376 patients with ureteral stones during the COVID-19 outbreak periods in 2020 and 343 patients during the same periods in 2019. Compared with the same periods in 2019, the number of patients with ureteral stones was less in Period 1 (137 vs 163) but had a rebound phenomenon in Period 2 (239 vs 180). The visit frequency was significantly reduced (2.6 ± 0.4 vs 3.6 ± 0.8, p < 0.01) and the VAS scores and the onset time increased (7.7 ± 1.3 vs 5.5 ± 1.6, p < 0.01; 7.4 ± 1.8 vs 8.2 ± 1.5, p < 0.01, respectively) in Period 1. More patients chose oral analgesics medication to release from renal colic in the COVID-19 outbreak period instead of ESWL and intravenous analgesics medication (Period 1, 54.0% vs 20.2%, p < 0.01; Period 2, 20.9% vs 13.3%, p = 0.044; respectively). However, the percentage of patients underwent endoscopy surgery in outbreak period showed no significant difference compared with that in 2019. CONCLUSION These results showed that the COVID-19 outbreak can directly affect the visits and final treatment choices for patients with ureteral stones.
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Affiliation(s)
- Zhenhua Liu
- Department of Urology, Beijing Jishuitan Hospital, The 4th Medical College of Peking University, Beijing, China
| | - Libo Man
- Department of Urology, Beijing Jishuitan Hospital, The 4th Medical College of Peking University, Beijing, China
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Zhang L, Ding D, Neubeck L, Gallagher R. Health literacy as a predictor of emergency department visits and self-rated health among Chinese immigrants: findings from an Australian survey. Patient Educ Couns 2020; 103:2353-2360. [PMID: 32456982 DOI: 10.1016/j.pec.2020.04.017] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Subscribe] [Scholar Register] [Received: 07/03/2019] [Revised: 04/09/2020] [Accepted: 04/16/2020] [Indexed: 06/11/2023]
Abstract
OBJECTIVES Our objectives were to examine health literacy among first-generation Chinese immigrants living in Australia, identifying health literacy domains associated with emergency department (ED) visits and self-rated health (SRH). METHODS Chinese immigrants (n = 362, mean age = 59) were recruited from communities across New South Wales and surveyed for health literacy, ED visits in the past 12 months, and SRH using the Health Literacy Questionnaire (simplified Chinese version). RESULTS More than 70% of participants experienced health literacy difficulties. Health literacy was significantly lower among the following participants: older, migration at older age, recent immigrants, and those without university level education or proficient English. ED visits were independently associated with the health literacy domains lacking 'social support for health' (OR: 1.80; p = .031) and 'ability to appraise health information' (OR: 2.22; p = .005). Poor SRH was associated with the health literacy domains 'insufficient health information' (OR: 1.81; p = .025), 'inactively managing health' (OR: 1.72; p = .048), and 'lacking ability to appraise health information' (OR: 1.70; p = .048). CONCLUSIONS Inadequate health literacy was identified in the majority of first-generation Chinese immigrants and it had significantly association with higher prevalence of ED use and poorer SRH. PRACTICE IMPLICATIONS Early screening and support for health literacy is critical in Chinese immigrants.
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Affiliation(s)
- Ling Zhang
- Susan Wakil School of Nursing and Midwifery / Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; The Charles Perkins Centre, The University of Sydney, Camperdown, Australia.
| | - Ding Ding
- The Charles Perkins Centre, The University of Sydney, Camperdown, Australia; Sydney School of Public Health, The University of Sydney, Camperdown, Australia
| | - Lis Neubeck
- Susan Wakil School of Nursing and Midwifery / Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; The Charles Perkins Centre, The University of Sydney, Camperdown, Australia; School of Health and Social Care, Edinburgh Napier University, Edinburgh, UK
| | - Robyn Gallagher
- Susan Wakil School of Nursing and Midwifery / Sydney Nursing School, Faculty of Medicine and Health, The University of Sydney, Camperdown, Australia; The Charles Perkins Centre, The University of Sydney, Camperdown, Australia
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Seirafianpour F, Sodagar S, Pour Mohammad A, Panahi P, Mozafarpoor S, Almasi S, Goodarzi A. Cutaneous manifestations and considerations in COVID-19 pandemic: A systematic review. Dermatol Ther 2020; 33:e13986. [PMID: 32639077 PMCID: PMC7362033 DOI: 10.1111/dth.13986] [Citation(s) in RCA: 72] [Impact Index Per Article: 18.0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/14/2020] [Revised: 07/01/2020] [Accepted: 07/06/2020] [Indexed: 01/07/2023]
Abstract
COVID-19 had a great impact on medical approaches among dermatologist. This systematic review focuses on all skin problems related to COVID-19, including primary and secondary COVID-related cutaneous presentations and the experts recommendations about dermatological managements especially immunomodulators usage issues. Search was performed on PubMed, Scopus, Embase and ScienceDirect. Other additional resources were searched included Cochrane, WHO, Medscape and coronavirus dermatology resource of Nottingham university. The search completed on May 3, 2020. Three hundred seventy-seven articles assigned to the inclusion and exclusion groups. Eighty-nine articles entered the review. Primary mucocutaneous and appendageal presentations could be the initial or evolving signs of COVID-19. It could be manifest most commonly as a maculopapular exanthamatous or morbiliform eruption, generalized urticaria or pseudo chilblains recognized as "COVID toes" (pernio-like acral lesions or vasculopathic rashes). During pandemic, Non-infected non-at risk patients with immune-medicated dermatologic disorders under treatment with immunosuppressive immunomodulators do not need to alter their regimen or discontinue their therapies. At-risk o suspected patients may need dose reduction, interval increase or temporary drug discontinuation (at least 2 weeks). Patients with an active COVID-19 infection should hold the biologic or non-biologic immunosuppressives until the complete recovery occur (at least 4 weeks).
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Affiliation(s)
- Farnoosh Seirafianpour
- Student Research Committee, school of medicineIran University of Medical SciencesTehranIran
| | - Sogand Sodagar
- Student Research Committee, school of medicineIran University of Medical SciencesTehranIran
| | - Arash Pour Mohammad
- Student Research Committee, school of medicineIran University of Medical SciencesTehranIran
| | - Parsa Panahi
- Student Research Committee, school of medicineIran University of Medical SciencesTehranIran
| | - Samaneh Mozafarpoor
- Department of Dermatology, Skin Disease and Leishmaniasis Research CenterIsfahan University of Medical SciencesIsfahanIran
| | - Simin Almasi
- Department of Rheumatology, Rheumatology Research CenterFiroozgar Hospital, Iran University of Medical Sciences (IUMS)TehranIran
| | - Azadeh Goodarzi
- Department of DermatologyRasoul Akram Hospital, Iran University of Medical Sciences (IUMS)TehranIran
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Beeby E, Alsop B. Choosing among multiple alternatives: Relative and overall reinforcer rates. J Exp Anal Behav 2017; 108:204-222. [PMID: 28758210 DOI: 10.1002/jeab.269] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/12/2016] [Accepted: 07/08/2017] [Indexed: 11/09/2022]
Abstract
Choice behavior among two alternatives has been widely researched, but fewer studies have examined the effect of multiple (more than two) alternatives on choice. Two experiments investigated whether changing the overall reinforcer rate affected preference among three and four concurrently scheduled alternatives. Experiment 1 trained six pigeons on concurrent schedules with three alternatives available simultaneously. These alternatives arranged reinforcers in a ratio of 9:3:1 with the configuration counterbalanced across pigeons. The overall rate of reinforcement was varied across conditions. Preference between the pair of keys arranging the 9:3 reinforcer ratio was less extreme than the pair arranging the 3:1 reinforcer ratio regardless of overall reinforcer rate. This difference was attributable to the richer alternative receiving fewer responses per reinforcer than the other alternatives. Experiment 2 trained pigeons on concurrent schedules with four alternatives available simultaneously. These alternatives arranged reinforcers in a ratio of 8:4:2:1, and the overall reinforcer rate was varied. Next, two of the alternatives were put into extinction and the random interval duration was changed from 60 s to 5 s. The ratio of absolute response rates was independent of interval length across all conditions. In both experiments, an analysis of sequences of visits following each reinforcer showed that the pigeons typically made their first response to the richer alternative irrespective of which alternative was just reinforced. Performance on these three- and four-alternative concurrent schedules is not easily extrapolated from corresponding research using two-alternative concurrent schedules.
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Abstract
The present study examined young children's attachment behaviors during paternal incarceration and reported on initial validity of a new measure used to rate children's attachment-related behaviors and emotions during visits in a corrections setting. Seventy-seven children, age 2 to 6 years, and their jailed fathers and current caregivers participated in the home visit portion of the study, whereas 28 of these children participated in the jail visit. The results indicated that 27% of children witnessed the father's crime and 22% of children witnessed the father's arrest, with most children who witnessed these events exhibiting extreme distress; children who witnessed these events were more likely to have insecure attachments to their caregivers. Consistent with attachment theory and research, caregivers who exhibited more sensitivity and responsivity during interactions with children and those who provided more stimulating, responsive, learning-oriented home environments had children who were more likely to have secure attachments (measured with the Attachment Q-Sort). We also found preliminary evidence for the validity of our new measure, the Jail Prison Observation Checklist, in that children's attachment-related behaviors and emotions during the jail visit correlated with their attachment security observed in the home. Our observations indicate that, in certain contexts, noncontact visits with incarcerated parents can be stressful for children and that children's caregivers may play a significant role during these visits.
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Dunn EJ, Markert R, Hayes K, McCollom J, Bains L, Kahlon D, Kumar G. The Influence of Palliative Care Consultation on Health-Care Resource Utilization During the Last 2 Months of Life: Report From an Integrated Palliative Care Program and Review of the Literature. Am J Hosp Palliat Care 2016; 35:117-122. [PMID: 28273754 DOI: 10.1177/1049909116683719] [Citation(s) in RCA: 5] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022] Open
Abstract
BACKGROUND We reviewed 104 consecutive deaths of veterans receiving care in the Dayton VA Medical Center from October 10, 2015 to April 11, 2016. The purpose of our study was to test our hypothesis that palliative care consultation would be associated with reduced health care resource utilization for individuals approaching end of life. METHODS Medical records were reviewed and data entry recorded on a spreadsheet. Non-parametric statistical methods were used to compare four outcome variables from veterans with palliative care consultation (PCC) vs. those without PCC. These variables included the number of ED visits, hospitalizations, hospital days, and ICU days all during the last two months of life. Predictor variables included PCC vs. no PCC and PCC before vs. PCC during the last two months of life. The study sample was comprised of 102 patients after excluding two outlier cases with ethical challenges in surrogate decision-making. RESULTS Of the 102 consecutive veteran deaths, palliative care consultation was associated with a lower number of ICU days during the last two months of life. For 96 veterans with PCC, the frequency of ED visits and acute care hospitalizations, as well as the number of ICU and hospital days, were all significantly less after PCC compared to before PCC during the last two months of life. The timing of PCC had no effect on the outcomes of interest. CONCLUSION Palliative care consultation has a notable effect on health care resource utilization during the last two months of life.
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Affiliation(s)
- Edward J Dunn
- 1 Dayton VA Medical Center, Dayton, OH, USA.,2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Ronald Markert
- 1 Dayton VA Medical Center, Dayton, OH, USA.,2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Kathleen Hayes
- 1 Dayton VA Medical Center, Dayton, OH, USA.,2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Joseph McCollom
- 1 Dayton VA Medical Center, Dayton, OH, USA.,2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Loveleen Bains
- 1 Dayton VA Medical Center, Dayton, OH, USA.,2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Damanjeet Kahlon
- 1 Dayton VA Medical Center, Dayton, OH, USA.,2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
| | - Geetika Kumar
- 1 Dayton VA Medical Center, Dayton, OH, USA.,2 Boonshoft School of Medicine, Wright State University, Dayton, OH, USA
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Abstract
BACKGROUND Good oral health is essential for good general health and quality of life. In Portugal, there are few studies on oral-health habits and the population's perceptions of this behaviour. OBJECTIVE The main purpose of this study was to characterise the Portuguese population's self-reported oral-health status, habits and perceptions, as well as their demands regarding national oral health-care services. METHODS A randomised group of 1,395 individuals, > 15 years of age, was selected as a representative sample of the Portuguese population. Face-to-face interviews were conducted, based on a structured questionnaire with closed and semi-closed questions. The data were submitted for statistical analysis using SPSS. RESULTS AND DISCUSSION A sample of 1,102 individuals answered the questionnaire. The great majority of the sample (97.6%) brushed their teeth daily, 70.3% had lost permanent teeth and 6.4% were edentulous. The loss of permanent teeth was statistically associated with poor oral-hygiene habits (P < 0.01). Moreover, 50.1% of the participants had experienced difficulty eating and/or drinking, 18% had felt ashamed of the appearance of their teeth and 69.3% had experienced toothache or gingival pain. A reduction in visits to a dentist in the previous 12 months was identified mainly for people from a lower social class (31.2%) and older people (29.4%). CONCLUSION Evidence suggests that oral diseases might be more prevalent in Portuguese adults than the European average. Efforts should be made to promote good oral-hygiene habits among older people and people from lower social classes.
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Affiliation(s)
- Paulo Melo
- Portuguese Dental Association, Porto, Portugal.,Department of Conservative Dentistry, Faculty of Dental Medicine of the University of Porto, Porto, Portugal.,Department of Oral Public Health, Institute of Public Health of the University of Porto, Porto, Portugal
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Muyunda B, Makasa M, Jacobs C, Musonda P, Michelo C. Higher Educational Attainment Associated with Optimal Antenatal Care Visits among Childbearing Women in Zambia. Front Public Health 2016; 4:127. [PMID: 27379228 PMCID: PMC4909780 DOI: 10.3389/fpubh.2016.00127] [Citation(s) in RCA: 14] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/25/2016] [Accepted: 06/02/2016] [Indexed: 11/13/2022] Open
Abstract
OBJECTIVE Attendance of at least four antenatal care (ANC) visits over the period of pregnancy has been accepted by World Health Organization to comprise the optimal and adequate standard of ANC because of its positive association with good maternal and neonatal outcomes during the prenatal period. Despite free ANC being provided, many pregnant women have been found not to meet this minimum number of ANC visits in Zambia. We investigated if educational attainment is associated with optimal ANC visits among childbearing women in Zambia. METHODS Data stem from the 2007 Zambia Demographic and Health Survey for women, aged 15-49 years, who reported ever having been pregnant in the 5 years preceding the survey. The linked data comprised sociodemographic and other obstetrical data, which were cleaned, recoded, and analyzed using STATA version 12 (Stata Corporation, College Station, TX, USA). Multivariate logistic regression was used to examine the association of educational attainment and other background variables. RESULTS Women who had higher education level were more likely to attend at least four ANC visits compared to those with no education (AOR 2.8, 95% CI 1.51-5.15; p = 0.001); this was especially true in the urban areas. In addition, women with partners with higher education level were also more likely to have optimal ANC attendance (OR 2.0, 95% CI 1.3-3.1; p = 0.002). CONCLUSION Educational attainment-associated differentials found to be linked with optimal ANC attendance in this population suggests that access to health care is still driven by inequity-related dynamics and imbalances. Given that inequity stresses are heaviest in the uneducated and probably rural and poor groups, interventions should aim to reach this group. SIGNIFICANCE The study results will help program managers to increase access to ANC services and direct interventional efforts towards the affected subpopulations, such as the young, uneducated, and rural women. Furthermore, results will help promote maternal health education and advise policy makers and program implementers.
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Affiliation(s)
- Brian Muyunda
- Ministry of Health, University Teaching Hospital, Lusaka, Zambia
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Mpundu Makasa
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Choolwe Jacobs
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Patrick Musonda
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
| | - Charles Michelo
- Department of Public Health, School of Medicine, University of Zambia, Lusaka, Zambia
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Nelson KA, Garbutt JM, Wallendorf MJ, Trinkaus KM, Strunk RC. Primary care visits for asthma monitoring over time and association with acute asthma visits for urban Medicaid-insured children. J Asthma 2014; 51:907-12. [PMID: 24894745 DOI: 10.3109/02770903.2014.927483] [Citation(s) in RCA: 6] [Impact Index Per Article: 0.6] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022]
Abstract
OBJECTIVES To examine the association between numbers of primary care provider (PCP) visits for asthma monitoring (AM) over time and acute asthma visits in the emergency department (ED) and at the PCP for Medicaid-insured children. METHODS We prospectively enrolled 2-10 years old children during ED asthma visits. We audited hospital and PCP records for each subject for three consecutive years. We excluded subjects also receiving care from asthma subspecialists. PCP AM visits were those with documentation that suggested discussion of asthma management but no acute asthma symptoms or findings. PCP "Acute Asthma" visits were those with documentation of acute asthma symptoms or findings, regardless of treatment. ED asthma visits were those with documented asthma treatment. Generalized liner models were used to analyze the association between numbers of AM visits and acute asthma visits to the ED and PCP. RESULTS One hundred three subjects were analyzed. Over the 3 years, the mean number of AM visits/child was 2.5 ± 2.3 (standard deviation), range 0-10. Only 50% of subjects had at least 1 PCP visit with an asthma controller medication documented. The mean number of ED asthma visits/child was 3.2 ± 2.8; range 1-18. The mean number of PCP Acute Asthma visits/child was 0.7 ± 1.6; range 0-11. Increasing AM visits was associated with more ED visits (estimate 0.088; 95% CI 0.001, 0.174), and more PCP Acute Asthma visits (estimate 0.297; 95% CI 0.166, 0.429). Increasing PCP visits for any diagnosis was not associated with ED visits (estimate 0.021; 95% CI -0.018, 0.06). CONCLUSIONS Asthma monitoring visits and documented controller medication for these urban Medicaid-insured children occurred infrequently over 3 years, and having more asthma monitoring visits was not associated with fewer ED or PCP acute asthma visits.
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Affiliation(s)
- Kyle A Nelson
- Department of Emergency Medicine, Boston Children's Hospital , Boston , USA
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