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[PMID]:28462755
[Au] Autor:Hinkle KA; Wilkes J; McFadden M; Williams RV; Minich LL; Menon SC
[Ad] Endereço:1Division of Pediatric Cardiology,Department of Pediatrics,University of Utah,Salt Lake City,Utah,United States of America.
[Ti] Título:A multi-institutional study of factors affecting resource utilisation following the Fontan operation.
[So] Source:Cardiol Young;27(4):739-746, 2017 May.
[Is] ISSN:1467-1107
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:The few studies evaluating data on resource utilisation following the Fontan operation specifically are outdated. We sought to evaluate resource utilisation and factors associated with increased resource use after the Fontan operation in a contemporary, large, multi-institutional cohort. This retrospective cohort study of children who had the Fontan between January, 2004 and June, 2013 used the Pediatric Health Information Systems Database. Generalised linear regression analyses evaluated factors associated with resource use. Of 2187 Fontan patients included in the study, 62% were males. The median age at Fontan was 3.2 years (inter-quartile range (IQR): 2.6-3.8). The median length of stay following the Fontan was 9 days (IQR: 7-14). The median costs and charges in 2012 dollars for the Fontan operation were $93,900 (IQR: $67,800-$136,100) and $156,000 (IQR: $112,080-$225,607), respectively. Postoperative Fontan mortality (30 days) was 1% (n=21). Factors associated with increased resource utilisation included baseline and demographic factors such as region, race, and renal anomaly, factors at the bidirectional Glenn such as seizures, valvuloplasty, and surgical volume, number of admissions between the bidirectional Glenn and the Fontan, and factors at the Fontan such as surgical volume and age at Fontan. The most strongly associated factors for both increased Fontan length of stay and increased Fontan charges were number of bidirectional Glenn to Fontan admissions (p<0.001) and Fontan surgical volume per year (p<0.001). As patient characteristics and healthcare-related delivery variables accounted for most of the factors predicting increased resource utilisation, changes should target healthcare delivery factors to reduce costs in this resource-intensive population.
[Mh] Termos MeSH primário: Técnica de Fontan/economia
Técnica de Fontan/mortalidade
Custos Hospitalares
Síndrome do Coração Esquerdo Hipoplásico/cirurgia
Tempo de Internação
[Mh] Termos MeSH secundário: Criança
Pré-Escolar
Feminino
Recursos em Saúde/utilização
Ventrículos do Coração/anormalidades
Ventrículos do Coração/cirurgia
Seres Humanos
Lactente
Modelos Lineares
Masculino
Cuidados Paliativos
Complicações Pós-Operatórias
Estudos Retrospectivos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170503
[St] Status:MEDLINE
[do] DOI:10.1017/S1047951116001244


  2 / 10691 MEDLINE  
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[PMID]:28455174
[Au] Autor:Prins W; Butcher E; Hall LL; Puckrein G; Rosof B
[Ad] Endereço:National Quality Forum, 1030 15th Street NW, Suite 800, Washington DC 20005, United States. Electronic address: wprins@qualityforum.org.
[Ti] Título:Improving adult immunization equity: Where do the published research literature and existing resources lead?
[So] Source:Vaccine;35(23):3020-3025, 2017 05 25.
[Is] ISSN:1873-2518
[Cp] País de publicação:Netherlands
[La] Idioma:eng
[Ab] Resumo:Evidence suggests that disparities in adult immunization (AI) rates are growing. Providers need adequate patient resources and information about successful interventions to help them engage in effective practices to reduce AI disparities. The primary purposes of this paper were to review and summarize the evidence base regarding interventions to reduce AI disparities and to scan for relevant resources that could support providers in their AI efforts to specifically target disparities. First, building on a literature review conducted by the U.S. Centers for Disease Control and Prevention, we searched the peer-reviewed literature to identify articles that either discussed interventions to reduce AI disparities or provided reasons and associations for disparities. We scanned the articles and conducted an internet search to identify tools and resources to support efforts to improve AI rates. We limited both searches to resources that addressed influenza, pneumococcal, hepatitis B, Tdap, and/or herpes zoster vaccinations. We found that most articles characterized AI disparities, but several discussed strategies for reducing AI disparities, including practice-based changes, communication and health literacy approaches, and partnering with community-based organizations. The resources we identified were largely fact sheets and handouts for patients and journal articles for providers. Most resources pertain to influenza vaccination and Spanish was the most prevalent language after English. More evaluation is needed to assess the health literacy levels of the materials. We conclude that additional research is needed to identify effective ways to reduce AI disparities and more resources are needed to support providers in their efforts. We recommend identifying best practices of high performers, further reviewing the appropriateness and usefulness of available resources, and prioritizing which gaps should be addressed.
[Mh] Termos MeSH primário: Equidade em Saúde
Alfabetização em Saúde
Recursos em Saúde
Imunização/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adulto
Centers for Disease Control and Prevention (U.S.)/estatística & dados numéricos
Controle de Doenças Transmissíveis/estatística & dados numéricos
Competência Cultural
Seres Humanos
Vacinas contra Influenza/administração & dosagem
Editoração
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Influenza Vaccines)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170430
[St] Status:MEDLINE


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[PMID]:29220115
[Au] Autor:Anderson SJ; Ghys PD; Ombam R; Hallett TB
[Ad] Endereço:Department of Infectious Disease Epidemiology, Imperial College London, London, UK.
[Ti] Título:HIV prevention where it is needed most: comparison of strategies for the geographical allocation of interventions.
[So] Source:J Int AIDS Soc;20(4), 2017 Dec.
[Is] ISSN:1758-2652
[Cp] País de publicação:Switzerland
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: A strategic approach to the application of HIV prevention interventions is a core component of the UNAIDS Fast Track strategy to end the HIV epidemic by 2030. Central to these plans is a focus on high-prevalence geographies, in a bid to target resources to those in greatest need and maximize the reduction in new infections. Whilst this idea of geographical prioritization has the potential to improve efficiency, it is unclear how it should be implemented in practice. There are a range of prevention interventions which can be applied differentially across risk groups and locations, making allocation decisions complex. Here, we use mathematical modelling to compare the impact (infections averted) of a number of different approaches to the implementation of geographical prioritization of prevention interventions, similar to those emerging in policy and practice, across a range of prevention budgets. METHODS: We use geographically specific mathematical models of the epidemic and response in 48 counties and major cities of Kenya to project the impact of the different geographical prioritization approaches. We compare the geographical allocation strategies with a nationally uniform approach under which the same interventions must be applied across all modelled locations. RESULTS: We find that the most extreme geographical prioritization strategy, which focuses resources exclusively to high-prevalence locations, may substantially restrict impact (41% fewer infections averted) compared to a nationally uniform approach, as opportunities for highly effective interventions for high-risk populations in lower-prevalence areas are missed. Other geographical allocation approaches, which intensify efforts in higher-prevalence areas whilst maintaining a minimum package of cost-effective interventions everywhere, consistently improve impact at all budget levels. Such strategies balance the need for greater investment in locations with the largest epidemics whilst ensuring higher-risk groups in lower-priority locations are provided with cost-effective interventions. CONCLUSIONS: Our findings serve as a warning to not be too selective in the application of prevention strategies. Further research is needed to understand how decision-makers can find the right balance between the choice of interventions, focus on high-risk populations, and geographical targeting to ensure the greatest impact of HIV prevention.
[Mh] Termos MeSH primário: Infecções por HIV/prevenção & controle
Alocação de Recursos
[Mh] Termos MeSH secundário: Análise Custo-Benefício
Epidemias
Política de Saúde
Recursos em Saúde
Seres Humanos
Quênia
Modelos Biológicos
Prevalência
Fatores de Risco
[Pt] Tipo de publicação:COMPARATIVE STUDY; JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180307
[Lr] Data última revisão:
180307
[Sb] Subgrupo de revista:IM; X
[Da] Data de entrada para processamento:171209
[St] Status:MEDLINE
[do] DOI:10.1002/jia2.25020


  4 / 10691 MEDLINE  
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[PMID]:28459900
[Au] Autor:Gundareddy VP; Maruthur NM; Chibungu A; Bollampally P; Landis R; Eid SM
[Ad] Endereço:Department of Medicine, Johns Hopkins University School of Medicine, Baltimore, MD.
[Ti] Título:Association Between Radiologic Incidental Findings and Resource Utilization in Patients Admitted With Chest Pain in an Urban Medical Center.
[So] Source:J Hosp Med;12(5):323-328, 2017 May.
[Is] ISSN:1553-5606
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Increasing use of testing among hospitalized patients has resulted in an increase in radiologic incidental findings (IFs), which challenge the provision of high-value care in the hospital setting. OBJECTIVE: To understand impact of radiologic incidental findings on resource utilization in patients hospitalized with chest pain. DESIGN: Retrospective observational cross sectional study. SETTING: Academic medical center. PARTICIPANTS: Adult patients hospitalized with principal diagnosis of chest pain. MEASUREMENTS: Demographic, imaging, and length of stay (LOS) data were abstracted from the medical charts. We used multiple logistic regression to evaluate factors associated with radiologic IFs and negative binomial regression to evaluate the association between radiologic IFs and LOS. RESULTS: 1811 consecutive admissions with chest pain were analyzed retrospectively over a period of 24 months; 376 patients were included in the study after exclusion criteria were applied and readmissions removed. Of these, 197 patients (52%) had 364 new radiologic IFs on imaging; most IFs were of minor (50%) or moderate clinical significance (42%), with only 7% of major significance. Odds of finding radiologic IFs increased with age (adjusted odds ratio, 1.04; 95% confidence interval [CI], 1.01-1.06) and was associated with a 26% increase in LOS (adjusted incidence rate ratio, 1.26; 95% CI, 1.07-1.49). CONCLUSION: Radiologic IFs were very common among patients hospitalized with chest pain of suspected cardiac origin and independently associated with an increase in the LOS. Interventions to address radiologic IFs may reduce LOS and, thereby, support high-value care. Journal of Hospital Medicine 2017;12:323-328.
[Mh] Termos MeSH primário: Dor no Peito/diagnóstico por imagem
Recursos em Saúde/utilização
Hospitais Urbanos/utilização
Achados Incidentais
Admissão do Paciente
Serviço Hospitalar de Radiologia/utilização
[Mh] Termos MeSH secundário: Adulto
Dor no Peito/terapia
Estudos Transversais
Feminino
Recursos em Saúde/tendências
Hospitais Urbanos/tendências
Seres Humanos
Masculino
Meia-Idade
Admissão do Paciente/tendências
Serviço Hospitalar de Radiologia/tendências
Estudos Retrospectivos
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180308
[Lr] Data última revisão:
180308
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170502
[St] Status:MEDLINE
[do] DOI:10.12788/jhm.2722


  5 / 10691 MEDLINE  
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[PMID]:29181929
[Au] Autor:Miljeteig I; Onarheim KH; Defaye FB; Desalegn D; Norheim OF; Hevrøy O; Johansson KA
[Ti] Título:Ethics capacity building in low-income countries: Ethiopia as a case study..
[So] Source:Tidsskr Nor Laegeforen;137(22), 2017 11 28.
[Is] ISSN:0807-7096
[Cp] País de publicação:Norway
[La] Idioma:nor
[Mh] Termos MeSH primário: Tomada de Decisão Clínica/ética
Ética Médica/educação
[Mh] Termos MeSH secundário: Etiópia/epidemiologia
Saúde Global
Alocação de Recursos para a Atenção à Saúde/ética
Política de Saúde
Recursos em Saúde
Seres Humanos
Cooperação Internacional
Noruega
Pobreza
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171129
[St] Status:MEDLINE
[do] DOI:10.4045/tidsskr.17.0759


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[PMID]:29206951
[Au] Autor:Hong M; Harrington D
[Ad] Endereço:School of Social Work, Indiana University, 902 West New York Street, Education/SW Building ES 4109, Indianapolis, IN 46202-5156; School of Social Work, University of Maryland, Baltimore.
[Ti] Título:The Effects of Caregiving Resources on Perceived Health among Caregivers.
[So] Source:Health Soc Work;41(3):155-163, 2016 Aug 01.
[Is] ISSN:0360-7283
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:This study examined how various types of resources influence perceived health of caregivers. Guided by the conservation of resources theory, a caregiver health model was built and tested using structural equation modeling. The caregiver health model consisted of caregiving situations (functional limitations and cognitive impairments of older adults and caregiving time), resources (financial resources, mastery, social support, family harmony, and service utilization), caregiver burden, and perceived health of caregivers. The sample included 1,837 unpaid informal caregivers drawn from the 2004 National Long-Term Caregiver Survey. The model fit indices indicated that the first structural model did not fit well; however, the revised model yielded an excellent model fit. More stressful caregiving situations were associated with fewer resources and higher burden, whereas greater resources were associated with lower burden and better perceived health of caregivers. The results suggest explicit implications for social work research and practice on how to protect the health of caregivers.
[Mh] Termos MeSH primário: Cuidadores/psicologia
Transtornos Cognitivos/enfermagem
Pessoas com Deficiência
Relações Familiares
Recursos em Saúde
Autoeficácia
Apoio Social
[Mh] Termos MeSH secundário: Adulto
Idoso
Feminino
Seres Humanos
Masculino
Meia-Idade
Inquéritos e Questionários
Fatores de Tempo
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180227
[Lr] Data última revisão:
180227
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171206
[St] Status:MEDLINE
[do] DOI:10.1093/hsw/hlw025


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[PMID]:29351338
[Au] Autor:Gils T; Bossard C; Verdonck K; Owiti P; Casteels I; Mashako M; Van Cutsem G; Ellman T
[Ad] Endereço:Médecins sans Frontières, Southern Africa Medical Unit, Cape Town, South Africa.
[Ti] Título:Stockouts of HIV commodities in public health facilities in Kinshasa: Barriers to end HIV.
[So] Source:PLoS One;13(1):e0191294, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Stockouts of HIV commodities increase the risk of treatment interruption, antiretroviral resistance, treatment failure, morbidity and mortality. The study objective was to assess the magnitude and duration of stockouts of HIV medicines and diagnostic tests in public facilities in Kinshasa, Democratic Republic of the Congo. This was a cross-sectional survey involving visits to facilities and warehouses in April and May 2015. All zonal warehouses, all public facilities with more than 200 patients on antiretroviral treatment (ART) (high-burden facilities) and a purposive sample of facilities with 200 or fewer patients (low-burden facilities) in Kinshasa were selected. We focused on three adult ART formulations, cotrimoxazole tablets, and HIV diagnostic tests. Availability of items was determined by physical check, while stockout duration until the day of the survey visit was verified with stock cards. In case of ART stockouts, we asked the pharmacist in charge what the facility coping strategy was for patients needing those medicines. The study included 28 high-burden facilities and 64 low-burden facilities, together serving around 22000 ART patients. During the study period, a national shortage of the newly introduced first-line regimen Tenofovir-Lamivudine-Efavirenz resulted in stockouts of this regimen in 56% of high-burden and 43% of low-burden facilities, lasting a median of 36 (interquartile range 29-90) and 44 days (interquartile range 24-90) until the day of the survey visit, respectively. Each of the other investigated commodities were found out of stock in at least two low-burden and two high-burden facilities. In 30/41 (73%) of stockout cases, the commodity was absent at the facility but present at the upstream warehouse. In 30/57 (54%) of ART stockout cases, patients did not receive any medicines. In some cases, patients were switched to different ART formulations or regimens. Stockouts of HIV commodities were common in the visited facilities. Introduction of new ART regimens needs additional planning.
[Mh] Termos MeSH primário: Mercantilização
Infecções por HIV/terapia
Instalações de Saúde/economia
Recursos em Saúde/economia
Recursos em Saúde/provisão & distribuição
[Mh] Termos MeSH secundário: Estudos Transversais
República Democrática do Congo
Seres Humanos
Inquéritos e Questionários
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180226
[Lr] Data última revisão:
180226
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180120
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191294


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[PMID]:28742419
[Au] Autor:Gomez-de-León A; Gómez-Almaguer D; Ruiz-Delgado GJ; Ruiz-Arguelles GJ
[Ad] Endereço:a Universidad Autónoma de Nuevo León , Facultad de Medicina y Hospital Universitario "Dr.José Eleuterio González". Hematology Service, Monterrey , Nuevo León , México.
[Ti] Título:Insights into the management of chronic myeloid leukemia in resource-poor settings: a Mexican perspective.
[So] Source:Expert Rev Hematol;10(9):809-819, 2017 09.
[Is] ISSN:1747-4094
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: The arrival of targeted therapy for chronic myeloid leukemia (CML) was revolutionary. However, due to the high cost of tyrosine kinase inhibitors, access to this highly effective therapy with strict monitoring strategies is limited in low to middle-income countries. In this context, following standard recommendations proposed by experts in developed countries is difficult. Areas covered: This review aims to provide an insight into the management of patients with CML living in a resource-limited setting. It addresses several issues: diagnosis, initial treatment, disease monitoring, and additional treatment alternatives including allogeneic hematopoietic stem cell transplantation. Expert commentary: Imatinib is probably the most cost-effective TKI for initial treatment in developing and underdeveloped countries. Generic imatinib preparations should be evaluated before considering their widespread use. Adherence to treatment should be emphasized. Adequate monitoring can be performed through several methods successfully and is important for predicting outcomes, particularly early in the first year, and if treatment suspension is being considered. Access to further therapeutic alternatives should define our actions after failure or intolerance to imatinib, preferring additional TKIs if possible. Allogeneic transplantation in chronic phase is a viable option in this context.
[Mh] Termos MeSH primário: Recursos em Saúde
Leucemia Mielogênica Crônica BCR-ABL Positiva/diagnóstico
Leucemia Mielogênica Crônica BCR-ABL Positiva/terapia
[Mh] Termos MeSH secundário: Antineoplásicos/administração & dosagem
Antineoplásicos/efeitos adversos
Antineoplásicos/uso terapêutico
Protocolos de Quimioterapia Combinada Antineoplásica/efeitos adversos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico
Terapia Combinada
Gerenciamento Clínico
Resistência a Medicamentos Antineoplásicos
Medicamentos Genéricos/uso terapêutico
Transplante de Células-Tronco Hematopoéticas
Seres Humanos
Adesão à Medicação
México
Estadiamento de Neoplasias
Inibidores de Proteínas Quinases/administração & dosagem
Inibidores de Proteínas Quinases/efeitos adversos
Inibidores de Proteínas Quinases/uso terapêutico
Transplante Homólogo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Nm] Nome de substância:
0 (Antineoplastic Agents); 0 (Drugs, Generic); 0 (Protein Kinase Inhibitors)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:180225
[Lr] Data última revisão:
180225
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170726
[St] Status:MEDLINE
[do] DOI:10.1080/17474086.2017.1360180


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[PMID]:29293611
[Au] Autor:Revill P; Walker S; Cambiano V; Phillips A; Sculpher MJ
[Ad] Endereço:Centre for Health Economics, University of York, York, United Kingdom.
[Ti] Título:Reflecting the real value of health care resources in modelling and cost-effectiveness studies-The example of viral load informed differentiated care.
[So] Source:PLoS One;13(1):e0190283, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The WHO HIV Treatment Guidelines suggest routine viral-load monitoring can be used to differentiate antiretroviral therapy (ART) delivery and reduce the frequency of clinic visits for patients stable on ART. This recommendation was informed by economic analysis that showed the approach is very likely to be cost-effective, even in the most resource constrained of settings. The health benefits were shown to be modest but the costs of introducing and scaling up viral load monitoring can be offset by anticipated reductions in the costs of clinic visits, due to these being less frequent for many patients. KEY ISSUES FOR ECONOMIC EVALUATION: The cost-effectiveness of introducing viral-load informed differentiated care depends upon whether cost reductions are possible if the number of clinic visits is reduced and/or how freed clinic capacity is used for alternative priorities. Where freed resources, either physical or financial, generate large health gains (e.g. if committed to patients failing ART or to other high value health care interventions), the benefits of differentiated care are expected to be high; if however these freed physical resources are already under-utilized or financial resources are used less efficiently and would not be put to as beneficial an alternative use, the policy may not be cost-effective. The implication is that the use of conventional unit costs to value resources may not well reflect the latter's value in contributing to health improvement. Analyses intended to inform resource allocated decisions in a number of settings may therefore have to be interpreted with due consideration to local context. In this paper we present methods of how economic analyses can reflect the real value of health care resources rather than simply applying their unit costs. The analyses informing the WHO Guidelines are re-estimated by implementing scenarios using this framework, informing how differentiated care can be prioritized to generate greatest gains in population health. IMPLICATIONS: The findings have important implications for how economic analyses should be undertaken and reported in HIV and other disease areas. Results provide guidance on conditions under which viral load informed differentiated care will more likely prove to be cost effective when implemented.
[Mh] Termos MeSH primário: Infecções por HIV/virologia
Recursos em Saúde
Modelos Teóricos
Carga Viral
[Mh] Termos MeSH secundário: Adulto
África ao Sul do Saara
Fármacos Anti-HIV
Análise Custo-Benefício
Infecções por HIV/tratamento farmacológico
Infecções por HIV/economia
Seres Humanos
Monitorização Fisiológica
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180215
[Lr] Data última revisão:
180215
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180103
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0190283


  10 / 10691 MEDLINE  
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[PMID]:27776592
[Au] Autor:Izumi K; Kawatsu L; Ohkado A; Uchimura K; Kato S
[Ad] Endereço:Department of Epidemiology and Clinical Research, Research Institute of Tuberculosis (RIT), Japan Anti-Tuberculosis Association (JATA), Tokyo, Japan; Graduate School of Biomedical Sciences, Nagasaki University, Nagasaki, Japan.
[Ti] Título:Evaluating the impact of health resource reconstruction on improving spatial accessibility of tuberculosis care.
[So] Source:Int J Tuberc Lung Dis;20(11):1501-1508, 2016 Nov.
[Is] ISSN:1815-7920
[Cp] País de publicação:France
[La] Idioma:eng
[Ab] Resumo:SETTING: In Japan, a decline in tuberculosis (TB) notification rates and shortening of duration of hospitalisation have led to a drastic decrease in the number of hospital beds for TB patients (TB beds), causing severe undersupply in certain regions. OBJECTIVE: To assess the current status of spatial access to TB beds in Japan and evaluate the potential impact of health resource reconstruction in mitigating undersupply of TB beds. DESIGN: A cross-sectional study was conducted whereby a two-step floating catchment area (2SFCA) method was used to calculate an 'accessibility score' to evaluate spatial accessibility of TB beds in the regions classified by four levels of urbanisation. The impact of introducing 'potential TB beds' was assessed via the changes in the proportion of undersupplied regions and TB patients notified from undersupplied regions. RESULTS: Undersupplied regions were characterised by 'very low', 'low' and 'moderate' level of urbanisation. By introducing 'potential TB beds', the proportion of both undersupplied regions and TB patients could be significantly reduced, especially in less urbanised regions. CONCLUSION: Our results may be used to guide future decision-making over resource allocation of TB care in Japan. The 2SFCA method may be applied to other countries using appropriate demand and supply variables.
[Mh] Termos MeSH primário: Recursos em Saúde/normas
Acesso aos Serviços de Saúde/normas
Tuberculose/epidemiologia
Tuberculose/terapia
[Mh] Termos MeSH secundário: Estudos Transversais
Tomada de Decisões
Hospitalização
Seres Humanos
Japão/epidemiologia
Escarro/microbiologia
Teste Tuberculínico
Tuberculose/diagnóstico
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180214
[Lr] Data última revisão:
180214
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE



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BIREME/OPAS/OMS - Centro Latino-Americano e do Caribe de Informação em Ciências da Saúde