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Real-World Cost-Consequence Analysis of an Integrated Chronic Disease Management Program in Saskatchewan, Canada 加拿大萨斯喀彻温省慢性病综合管理计划的实际成本-后果分析
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-01 DOI: 10.1177/11786329231224621
J. P. Kuwornu, Fernando Maldonado, Gary Groot, E. Penz, Elizabeth J Cooper, Amy Reid, Darcy D Marciniuk
An integrated disease management program otherwise called a clinical pathway was recently implemented in Saskatchewan, Canada for patients living with chronic obstructive pulmonary disease (COPD). This study compared the real-world costs and consequences of the COPD clinical pathway program with 2 control treatment programs. The study comprised adult COPD patients in Regina (clinical pathway group, N = 759) matched on propensity scores to 2 independent control groups of similar adults in (1) Regina (historical controls, N = 759) and (2) Saskatoon (contemporaneous controls, N = 759). The study measures included patient-level healthcare costs and acute COPD exacerbation outcomes, both tracked in population-based administrative health data over a one-year follow-up period. Analyses included Cox proportional hazards models and differences in means between groups. The bias-corrected and accelerated bootstrap method was used to calculate 95% confidence intervals (CI). The COPD pathway patients had lower risks of moderate (hazard ratio [HR] =0.57, 95% CI [0.40-0.83]) and severe (HR = 0.43, 95% CI [0.28-0.66]) exacerbations compared to the historical control group, but similar risks compared with the contemporaneous control group. The COPD pathway patients experienced fewer episodes of exacerbations compared with the historical control group (mean difference = −0.30, 95% CI [−0.40, −0.20]) and the contemporaneous control group (mean difference = −0.12, 95% CI [−0.20, −0.03]). Average annual healthcare costs in Canadian dollars were marginally higher among patients in the COPD clinical pathway (mean = $10 549, standard deviation [SD] =$18 149) than those in the contemporaneous control group ($8841, SD = $17 120), but comparable to the historical control group ($10 677, SD = $21 201). The COPD pathway provides better outcomes at about the same costs when compared to the historical controls, but only slightly better outcomes and at a marginally higher cost when compared to the contemporaneous controls.
最近,加拿大萨斯喀彻温省为慢性阻塞性肺病(COPD)患者实施了一项被称为临床路径的综合疾病管理计划。这项研究比较了慢性阻塞性肺病临床路径项目与两个对照治疗项目的实际成本和后果。研究对象包括里贾纳的慢性阻塞性肺病(COPD)成年患者(临床路径组,N = 759),他们与里贾纳(历史对照组,N = 759)和萨斯卡通(当代对照组,N = 759)的两个类似成年患者独立对照组的倾向得分相匹配。研究指标包括患者的医疗费用和慢性阻塞性肺疾病急性加重的结果,这两项指标都在一年的随访期内通过基于人口的行政健康数据进行跟踪。分析包括 Cox 比例危险模型和组间均值差异。采用偏差校正和加速引导法计算95%置信区间(CI)。与历史对照组相比,慢性阻塞性肺病路径患者的中度(危险比 [HR] =0.57,95% CI [0.40-0.83])和重度(HR = 0.43,95% CI [0.28-0.66])病情加重风险较低,但与同期对照组相比风险相似。与历史对照组(平均差异=-0.30,95% CI [-0.40,-0.20])和同期对照组(平均差异=-0.12,95% CI [-0.20,-0.03])相比,慢性阻塞性肺病路径患者的病情加重次数更少。以加元计算,慢性阻塞性肺病临床路径患者的年均医疗费用(平均值=10 549加元,标准差=18 149加元)略高于同期对照组(8841加元,标准差=17 120加元),但与历史对照组(10 677加元,标准差=21 201加元)相当。与历史对照组相比,慢性阻塞性肺病路径提供了更好的治疗效果,费用基本相同,但与同期对照组相比,治疗效果略好,费用略高。
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引用次数: 0
Identifying a Cohort of People Who Are Transgender and Gender-Diverse Within Saskatchewan’s Administrative Health Databases 在萨斯喀彻温省行政健康数据库中识别变性人和性别多样化人群
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2024-01-01 DOI: 10.1177/11786329231222122
Gwen Rose, Seanna Goalen, Megan Clark, Stéphanie Madill
This was a retrospective cohort study. Algorithms were developed to identify a cohort of people who were trans and gender diverse (PTGD) among provincial-level administrative health databases (physician, hospital, emergency department, and pharmacy) from April 1, 2012 to September 30, 2020. Then, healthcare usage was compared between the identified cohort and the general population. There were 6466 unique individuals identified in the cohort, out of a total population of 1.2 million Saskatchewan residents (~0.5%). They had a mean age of 42.5 (SD 17.7) years. 1946 (30.1%) had a female sex marker and 4560 (69.9%) had a male sex marker, which may not indicate their lived gender. The cohort had increased healthcare usage 2 years prior to their index date, compared to the general population, which continued to rise to 1 year past their index date across physician, emergency department visits, and hospitalizations. The results for drugs were mixed. The percentage of PTGD identified in Saskatchewan was comparable to other studies. Healthcare utilization among the cohort was higher than the general population. Further research could use external data sources to validate and improve the cohort identification methods. The large majority of individuals with a male sex marker deserves further investigation.
这是一项回顾性队列研究。研究人员开发了一套算法,以便从省级卫生行政数据库(医生、医院、急诊科和药房)中识别出2012年4月1日至2020年9月30日期间的变性和性别多元化人群(PTGD)。然后,将识别出的人群与普通人群的医疗保健使用情况进行比较。在总计 120 万萨斯喀彻温省居民(约占 0.5%)中,有 6466 人被确定为该群组中的独特个体。他们的平均年龄为 42.5 岁(标准偏差为 17.7)。1946人(30.1%)的性别标记为女性,4560人(69.9%)的性别标记为男性,这可能并不表明他们的真实性别。与普通人群相比,该人群在索引日期前 2 年的医疗保健使用率有所上升,在索引日期后 1 年,医生、急诊科就诊和住院治疗的使用率继续上升。药物方面的结果喜忧参半。萨斯喀彻温省发现的 PTGD 比例与其他研究相当。队列中的医疗保健使用率高于普通人群。进一步的研究可以使用外部数据源来验证和改进队列识别方法。大部分人的性别标记为男性,这值得进一步研究。
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引用次数: 0
Comparative Effectiveness of Home- versus Center-Based Cardiac Rehabilitation Following Heart Transplantation. 心脏移植后家庭与中心心脏康复的效果比较。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-26 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231222377
Alireza Hosseinpour, Maryam Koushkie Jahromi
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引用次数: 0
Medical Doctors' Perceptions of the Media Coverage during the Covid-19 Pandemic: A Case Study in Stockholm. 医生对 Covid-19 大流行期间媒体报道的看法:斯德哥尔摩案例研究。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-12-25 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231222168
Clara Brune, Janne Agerholm, Ann Liljas

The strain on healthcare systems including emergency departments increased substantially during the Covid-19 pandemic,negatively affecting healthcare workers and their well-being. The emotional distress experienced by healthcare staff during the pandemic was worsened by confusion and conspiracy theories that circulated in the news and online media. Reports on the pandemic and general consumption of media intensified as the public's demand for information increased. There is limited research on how doctors perceived media coverage, and how they were affected in their work. This study aimed to explore how medical doctors in emergency departments perceived the media coverage during the Covid-19 pandemic. Twelve doctors at two different emergency departments in Stockholm, Sweden, participated. Interview questions on media were asked as part of a more extensive questionnaire. Informants' responses were analysed qualitatively. The results indicate that doctors to some extent used media as a source of information, due to limited access to knowledge about the virus. Results further suggest that media coverage triggered fear of infection, caused worry and job strain. The doctors percieved that the media coverage on Covid-19 affected patient-seeking behaviour as well as the doctor-patient relationship. The findings can be relevant in preparation for future pandemics and considered in development of policy for media and emergency departments.

在 Covid-19 大流行期间,包括急诊科在内的医疗保健系统的压力大幅增加,对医护人员及其福祉造成了负面影响。大流行期间,新闻和网络媒体上流传的混乱和阴谋论加剧了医护人员的情绪困扰。随着公众对信息需求的增加,有关大流行病的报道和媒体的普遍消费也随之增加。关于医生如何看待媒体报道以及他们在工作中受到何种影响的研究十分有限。本研究旨在探讨在 Covid-19 大流行期间,急诊科的医生是如何看待媒体报道的。瑞典斯德哥尔摩两个不同急诊科的 12 名医生参加了此次研究。有关媒体的访谈问题是更广泛的问卷调查的一部分。对受访者的回答进行了定性分析。结果表明,由于获取病毒知识的途径有限,医生在一定程度上将媒体作为信息来源。结果进一步表明,媒体报道引发了对感染的恐惧,造成了担忧和工作压力。医生们认为,媒体对 Covid-19 的报道影响了患者的就医行为以及医患关系。这些研究结果可用于为未来的大流行病做准备,并在制定媒体和急诊科政策时加以考虑。
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引用次数: 0
Covid-19 and Pre-Morbid Lifestyle-Related Risk Factors-A Review. Covid-19和发病前生活方式相关风险因素综述
IF 2.4 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-30 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231215049
Ifeoma N Monye, Moyosore Taiwo Makinde, Tijani Idris Ahmad Oseni, Abiodun Bamidele Adelowo, Samba Nyirenda

Since its outbreak in December 2019 in China, COVID-19 has spread like wild fire to affect many communities of the world. The high infectivity and case fatality rates of the disease among the general population and the severely ill patients respectively drew the attention of the global community. Our review showed that socio-demographic and lifestyle-related risk factors and underlying comorbid diseases were directly and indirectly associated with increased susceptibility and severity of COVID-19. These factors included older age (⩾60 years), male gender, and ethnic minority groups (especially blacks), smoking, low serum level of vitamin D, unhealthy diet, physical inactivity (with poor exposure to sunlight), overweight/obesity, high blood pressure/hypertension, high blood cholesterol, cardiovascular diseases (like stroke and coronary heart disease), diabetes mellitus, chronic obstructive pulmonary disease, chronic kidney disease, chronic liver disease, and some cancers (like leukemia, lymphoma, or myeloma). The literature further revealed that the clinical progression of the majority of these associated risk factors can be modified through effective and comprehensive risk reduction through healthy living and lifestyle modification. COVID-19 preventive and treatment guidelines that give adequate attention to risk reduction and healthy lifestyle among people-either in the pre-, peri-, or post-COVID-19 stage, should be developed by public health policymakers and clinicians. This will play a significant role in the global effort to combat the pandemic, and reduce its negative impact on the life expectancy and socio-economic development of the world particularly in low- and middle-income countries (LMICs).

自2019年12月在中国暴发以来,新冠肺炎疫情像野火一样蔓延,影响了世界许多社区。该病在普通人群和重症患者中的高传染性和病死率分别引起了国际社会的关注。我们的综述显示,社会人口统计学和生活方式相关的危险因素以及潜在的合并症与COVID-19易感性和严重程度的增加直接或间接相关。这些因素包括年龄较大(小于或等于60岁)、男性和少数民族群体(特别是黑人)、吸烟、血清维生素D水平低、不健康的饮食、缺乏身体活动(暴露在阳光下的时间较短)、超重/肥胖、高血压/高血压、高血胆固醇、心血管疾病(如中风和冠心病)、糖尿病、慢性阻塞性肺病、慢性肾脏疾病、慢性肝病和一些癌症(如白血病、淋巴瘤或骨髓瘤)。文献进一步揭示,通过健康的生活方式和生活方式的改变,有效而全面地降低风险,可以改变大多数相关危险因素的临床进展。公共卫生政策制定者和临床医生应制定COVID-19预防和治疗指南,充分关注人们在COVID-19前期、中期或后期的风险降低和健康生活方式。这将在全球防治这一流行病的努力中发挥重要作用,并减少其对世界特别是中低收入国家的预期寿命和社会经济发展的负面影响。
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引用次数: 0
Completion of the Maternal Health Care Continuum-Barriers and Facilitators Among Pregnant Women in Jimma Zone, Southwest Ethiopia: A Prospective Study. 完成孕产妇保健连续-障碍和促进孕妇在吉马地区,埃塞俄比亚西南部:一项前瞻性研究。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-30 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231214607
Sena Belina Kitila, Garumma Tolu Feyissa, Muluemebet Abera Wordofa
Background: Continuum of care (CoC) for Maternal Health Care (MHC) is a key strategy aimed at saving lives and promoting the well-being of women and newborns. To achieve the global targets for reducing maternal and newborn mortality, it is preferable to ensure the completion of key care stages (Antenatal, Institutional Delivery, and Postnatal) rather than fragmented care. Therefore, investigating the determinants of CoC completion for MHC is imperative for recommending schemes and designing strategies. Objective: To assess the determinants influencing completion of the maternal healthcare continuum among pregnant women in Jimma Zone, Southwest Ethiopia. Methods and Materials: A community-based prospective study was conducted from July 2020 to June 2021 among 1065 pregnant women from randomly selected woredas in Jimma Zone. The data were collected, entered using Epi-data and analyzed with SPSS software. Binary logistic regression was used to select candidate variables for multivariate analysis. Multivariate analysis was performed to identify associations between the dependent and independent factors. Principal Component Analysis (PCA) was used to determine the socioeconomic index. Results: The overall completion rate was 16.1% (CI, 13.8%–18.5%), with significant dropouts observed between the first and the fourth ANC. Factors associated with the completion of MHC included the women’s residence (AOR: 1.73 95% CI: 1.07, 2.81), educational status of their partners (AOR: 5.60 95% CI: 2.40, 13.08), women’s occupation (AOR: 2.57 95% CI: 1.28, 5.16), knowledge of ANC (AOR: 7.64 95% CI: 4.03, 14.48), knowledge of PNC (AOR: 4.88 95% CI: 3.21, 7.42), service provided during ANC contacts (AOR: 3.39 95% CI: 1.94, 5.93), parity (AOR: 1.86 95% CI: 1.11, 3.12), time of booking for ANC (AOR: 2.10 95% CI: 1.45, 3.03), and nature of care (AOR: 2.03 95% CI: 1.07, 3.82). Additionally, factors such as topography, distance, lack of transportation, facility closeness, and indirect costs were associated with the completion for MHC. Conclusion and Recommendations: The completion rate of CoC for MHC remains low. Factors influencing completion include women’s residence, partners’ educational status, women’s occupation, services provided during ANC, history of PNC use, parity, time of booking for ANC, knowledge of ANC and PNC, and nature of care. To address this, strategies should focus on empowering women economically, improving knowledge of ANC and PNC, enhancing the capacity of health facilities to provide comprehensive ANC services, and making the service delivery more supportive. Further research is recommended to explore the impact of CoC for MHC on birth outcomes.
背景:孕产妇保健连续护理(CoC)是一项关键战略,旨在挽救生命和促进妇女和新生儿的福祉。为了实现降低孕产妇和新生儿死亡率的全球目标,最好确保完成关键护理阶段(产前、机构分娩和产后),而不是分散的护理。因此,研究MHC CoC完成的决定因素对于推荐方案和设计策略至关重要。目的:评估影响埃塞俄比亚西南部吉马地区孕妇完成孕产妇保健连续体的决定因素。方法与材料:于2020年7月至2021年6月对吉马地区随机抽取的1065名孕妇进行社区前瞻性研究。数据采集,使用Epi-data录入,SPSS软件分析。采用二元逻辑回归选择候选变量进行多变量分析。进行多变量分析以确定依赖因素和独立因素之间的关联。采用主成分分析(PCA)确定社会经济指标。结果:总体完成率为16.1% (CI, 13.8%-18.5%),在第一次和第四次ANC之间观察到显着的辍学率。与MHC的完成相关的因素包括女性的住所(优势比:1.73 95%置信区间:1.07,2.81),教育地位的伙伴(优势比:5.60 95%置信区间:2.40 - 13.08),女性的职业(优势比:2.57 95%置信区间:1.28 - 5.16),非国大的知识(优势比:7.64 95%置信区间:4.03,14.48),PNC知识(优势比:4.88 95%置信区间:3.21 - 7.42),提供的服务在ANC联系人(优势比:3.39 95%置信区间:1.94,5.93),平价(优势比:1.86 95%置信区间:1.11 - 3.12),预订时间为非国大(优势比:2.10 95%置信区间:1.45, 3.03)和护理性质(AOR: 2.03 95% CI: 1.07, 3.82)。此外,地形、距离、缺乏交通、设施接近和间接成本等因素与MHC的完成有关。结论与建议:MHC CoC完成率仍然较低。影响完成度的因素包括妇女的住所、伴侣的教育状况、妇女的职业、ANC期间提供的服务、使用PNC的历史、平价、预约ANC的时间、ANC和PNC的知识以及护理的性质。为解决这一问题,战略应侧重于在经济上增强妇女权能,提高对非裔美国人和非裔美国人的认识,增强保健设施提供全面非裔美国人服务的能力,并使服务提供更具支持性。建议进一步研究CoC对MHC对出生结果的影响。
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引用次数: 0
Doing Trauma-Informed Work in a Trauma-Informed Way: Understanding Difficulties and Finding Solutions. 以了解创伤的方式进行了解创伤的工作:了解困难并找到解决办法。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-29 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231215037
Natalie Edelman

Trauma-informed practice (TIP) is expanding as a means of improving patient safety and engagement. Accordingly, professionals and other stakeholders increasingly come together in meetings and workshops to learn about, plan and evaluate TIP in health and social care settings. However, these kinds of trauma-informed work are sometimes carried out in a way that is not itself trauma-informed - missing an opportunity to 'model the model' and risking re-traumatisation and disengagement from further trauma-informed work for some attendees. Inaccurate use of language, the desire to destigmatise, and conflation of trauma-informed and trauma-enhanced practice may all be contributing factors. Careful attention to remit and content, accuracy of language and adequate provisions around the discussion of traumatising adversities can do much to reduce the risk of psychological harm and enable our trauma-informed work to be fully enriched by those who bring lived experience that is undisclosed as well as experiences that may be extant in their roles. Issues of relationality and context are not only central to traumatisation but offer a means to avoid it, both in our work as practitioners, managers, commissioners and researchers and in the ways that we come together to plan and reflect on that TIP.

创伤知情实践(TIP)作为提高患者安全和参与的一种手段正在扩大。因此,专业人员和其他利益攸关方越来越多地在会议和讲习班上聚集在一起,了解、规划和评价卫生和社会保健环境中的TIP。然而,这些类型的创伤信息工作有时是以一种本身没有创伤信息的方式进行的——失去了“为模型建模”的机会,并且对一些参与者来说,有可能再次受到创伤,并脱离进一步的创伤信息工作。不准确的语言使用,去污名化的愿望,以及创伤知情和创伤强化实践的合并都可能是促成因素。仔细关注内容和内容,语言的准确性以及关于创伤性逆境的讨论的充分规定可以大大减少心理伤害的风险,并使我们的创伤信息工作充分丰富那些带来未公开的生活经验以及可能存在于他们角色中的经验的人。无论是在我们作为从业者、管理者、专员和研究人员的工作中,还是在我们一起规划和反思TIP的方式中,关系和背景问题不仅是创伤的核心,而且提供了一种避免创伤的手段。
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引用次数: 0
The Impact of COVID-19 Lockdown on Service Utilization Among Chronic Disease Patients in South Africa. COVID-19封锁对南非慢性病患者服务利用的影响
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-29 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231215040
Micheal Kofi Boachie, Mariana Khoza, Susan Goldstein, Maggie Munsamy, Karen Hofman, Evelyn Thsehla

Introduction: Globally, the COVID-19 pandemic has brought many disruptions in health service delivery. Evidence show that the pandemic has negatively affected routine healthcare utilization such as maternal and child health services, but the literature on the effect on non-communicable diseases (NCDs) is scant in South Africa. These disruptions can have long-term health and economic implications for patients.

Objective: To estimate the impact of COVID-19 lockdown on service utilization among chronic disease patients in South Africa using administrative data.

Methods: Using monthly data from the Centralized Chronic Medication Dispensing and Distribution (CCMDD) program database covering November 2018 to October 2021, we examined the effects of COVID-19 lockdown on utilization among patients receiving antiretroviral therapy (ART) medication only (ART-only), patients receiving both ART and NCD medication (ART + NCD), and patients receiving NCD medications only (NCD-only). We employed segmented interrupted time series approach to examine the changes. We stratified the analysis by socioeconomic status.

Results: We found that, overall, the lockdown was associated with increased utilization of CCMDD services by 10.8% (95% CI: 3.3%-19%) for ART-only and 10.3% (95% CI: 3.3%-17.7%) for NCD-only patients. The increase in utilization was not different across socioeconomic groups. For patients receiving ART + NCD medications, utilization declined by 56.6% (95% CI: 47.6%-64.1%), and higher reductions occurred in low SES districts.

Conclusion: Patients should be educated about the need to continue with utilization of disease programs during a pandemic and beyond. More efforts are needed to improve service use among patients with multi-morbidities.

导言:在全球范围内,COVID-19大流行给卫生服务提供带来了许多中断。有证据表明,疫情对孕产妇和儿童保健服务等常规医疗保健服务的利用产生了负面影响,但在南非,关于疫情对非传染性疾病影响的文献很少。这些干扰可能对患者的健康和经济产生长期影响。目的:利用行政数据估计COVID-19封锁对南非慢性病患者服务利用的影响。方法:利用2018年11月至2021年10月CCMDD项目数据库的月度数据,研究了COVID-19封锁对仅接受抗逆转录病毒治疗(ART)药物治疗(ART-only)、同时接受ART和非传染性疾病药物治疗(ART + NCD)和仅接受非传染性疾病药物治疗(NCD-only)患者使用药物的影响。我们采用分段中断时间序列方法来研究这些变化。我们按社会经济地位对分析进行了分层。结果:我们发现,总体而言,封锁与仅art患者的CCMDD服务利用率增加10.8% (95% CI: 3.3%-19%)和仅ncd患者的CCMDD服务利用率增加10.3% (95% CI: 3.3%-17.7%)相关。在不同的社会经济群体中,利用率的增加并没有什么不同。对于接受ART +非传染性疾病药物治疗的患者,使用率下降了56.6% (95% CI: 47.6%-64.1%),低SES地区的使用率下降幅度更大。结论:应教育患者在大流行期间及以后继续使用疾病规划的必要性。需要作出更多努力来改善多重疾病患者的服务使用情况。
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引用次数: 0
An Exploration of Productivity Costs and Years of Potential Life Lost: Understanding the Impact of Premature Mortality From Injury in Mongolia. 生产力成本和潜在生命损失年的探索:了解蒙古伤害导致过早死亡的影响。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-23 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231212295
Purevgerel Altangerel, Otgonbayar Damdinbazar, Urjinbadam Borgilchuluun, Dorjmyagmar Batbayar, Batmanduul Erdenebat, Tseden Purevdorj, Gantugs Yundendorj

This study estimates the years of potential life lost (YPLL), years of potential productive life lost (YPPLL), and cost of productivity loss (CPL) owing to injury-related mortalities in Mongolia. By implementing a retrospective cohort study, the study used secondary mortality data for Mongolia from 2016 to 2020 from the Health Development Center. Our study incorporates information on 13 551 fatalities from injuries and external factors, with the aim of estimating YPLL, YPPLL, and CPL associated with the leading causes injury-induced deaths. These include exposure to toxic substances, road accidents, homicides, suicides, and falls. Our findings reveal majority of the losses occur because of exposure to poisonous chemicals, road accidents, suicides, falls, and homicides. Furthermore, 444 550 years of potential life are lost owing to injury-related mortalities, in which YPPLL accounts for 338 482 years. The CPL caused by these premature deaths during the study period accounts for $1.368 billion. Notably, YPLL, YPPLL, and CPL rates are significantly higher in males than in females. The YPLL from exposure to poisonous chemicals is higher than those caused by other factors. This study is the first to calculate the CPL owing to YPLL from injury in Mongolia.

本研究估算了蒙古国因工伤死亡造成的潜在生命损失年数(YPLL)、潜在生产寿命损失年数(YPPLL)和生产力损失成本(CPL)。通过实施一项回顾性队列研究,该研究使用了蒙古卫生发展中心2016年至2020年的继发性死亡率数据。我们的研究纳入了13551例因伤害和外部因素导致的死亡的信息,目的是估计与伤害导致死亡的主要原因相关的YPLL、YPPLL和CPL。这些包括接触有毒物质、道路交通事故、杀人、自杀和跌倒。我们的研究结果显示,大多数损失是由于接触有毒化学物质、交通事故、自杀、跌倒和他杀造成的。此外,与伤害有关的死亡造成444 550岁的潜在寿命损失,其中338 482岁的潜在寿命损失。在研究期间,这些过早死亡造成的CPL为13.68亿美元。值得注意的是,男性的YPLL、YPPLL和CPL发生率明显高于女性。接触有毒化学物质导致的YPLL高于其他因素。本研究首次计算了蒙古国因伤引起的YPLL的CPL。
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引用次数: 0
Implementation of the Revised National Malaria Control Guidelines: Compliance and Challenges in Public Health Facilities in a Southern Nigerian State. 《国家疟疾控制准则修订版》的执行情况:尼日利亚南部一个州公共卫生设施的遵守情况和挑战。
IF 2.8 Q2 HEALTH CARE SCIENCES & SERVICES Pub Date : 2023-11-20 eCollection Date: 2023-01-01 DOI: 10.1177/11786329231211779
Ubong Akpan, Ekpo Edet, Kazeem Arogundade, Chinyere Akpanika, Mabel Ekott, Saturday Etuk

Background: There has been a concerted effort to reduce malaria burden and bring malaria related mortality to zero. The objectives of this survey were to assess the level of adherence to the current revised malaria control guidelines in the public health facilities in Cross River State of Nigeria and to identify the challenges as well as suggest ways for improvement in treatment outcomes.

Methods: This was a mixed observational and qualitative survey conducted in 32 public health facilities from 21st to 25th June 2022. Treatment records on malaria were assessed for adherence to the National guidelines. In-depth interviews were conducted with 36 key informants and 4 purposefully selected stakeholders to identify the successes and challenges. Quantitative data were summarized and presented in simple proportions and percentages while qualitative information was recorded, the transcripts thematically coded, analyzed and presented using NVivo 11 software.

Results: The survey revealed that vector control program was poorly implemented across the state. For case management, presumptive treatment was frequently practiced especially at secondary health facilities for uncomplicated malaria. More than 60% of uncomplicated malaria were being treated with parenteral artemether instead of oral artemisinin combination therapy (ACTs) as recommended. Severe malaria were not treated with Intravenous (IV) Artesunate as first line drug in about 40% of the secondary health facilities. Key successes were noted in malaria management in pregnancy. Major challenges identified include: stock out of commodities, shortage of clinical man power, and low trust in parasitological diagnosis.

Conclusion: The survey showed that adherence to the key recommendations in various categories of malaria control among health care providers in the public health facilities was below expectation. Malaria preventive treatment in pregnancy with SP fared better perhaps because of its inclusion in ANC packages.

背景:为减少疟疾负担和将与疟疾有关的死亡率降至零作出了协调一致的努力。这项调查的目的是评估尼日利亚克罗斯河州公共卫生设施遵守目前修订的疟疾控制准则的程度,确定挑战,并提出改善治疗结果的方法。方法:采用观察性和定性调查相结合的方法,于2022年6月21日至25日在32家公共卫生机构开展调查。评估了疟疾治疗记录是否符合国家指导方针。深入访谈了36名关键线人和4名有目的地选择的利益相关者,以确定成功和挑战。定量数据汇总并以简单的比例和百分比呈现,定性信息记录,转录本主题编码,分析并使用NVivo 11软件呈现。结果:调查显示,整个州的病媒控制方案执行不力。在病例管理方面,特别是在二级卫生设施,经常对无并发症的疟疾采取假定治疗。60%以上的非并发症疟疾患者正在接受肠外青蒿醚治疗,而不是按照建议接受口服青蒿素联合疗法。在大约40%的二级卫生设施中,没有将静脉注射青蒿琥酯作为一线药物来治疗严重疟疾。在妊娠期疟疾管理方面取得了重大成功。确定的主要挑战包括:商品库存不足、临床人力短缺以及对寄生虫学诊断的信任度低。结论:调查显示,公共卫生机构的卫生保健提供者遵守各类疟疾控制关键建议的情况低于预期。怀孕期间使用SP的疟疾预防治疗效果更好,这可能是因为它被纳入了ANC一揽子计划。
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Health Services Insights
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