ABSTRACT
Abstract Access to health care is a sensitive issue in low population density territories, as these areas tend to have a lower level of service provision. One dimension of access is accessibility. This paper focuses on measuring the accessibility to urgent and emergency care services in the Portuguese region of Baixo Alentejo, a territory characterized by low population density. Data for the calculation of accessibility is the road network, and the methodology considers the application of a two-level network analyst method: time-distance by own mean (car or taxi) to the urgent care services and the time distance to emergency services as a way to get assistance and to go to urgent care services. While urgent care accessibility meets the requirements stipulated in the Integrated Medical Emergency System's current legislative framework, the simulation of different scenarios of potential accessibility shows intra-regional disparities. Some territories have a low level of accessibility. Older adults, the poorly educated, and low-income population, also have the lowest levels of accessibility, which translates into dually disadvantageous situation since the potential users of emergency services are most likely to belong to this group of citizens.
Resumo Em territórios de baixa densidade populacional, o acesso aos cuidados de saúde é uma questão delicada, pois essas áreas tendem a ter um nível mais baixo de prestação de serviços. Uma dimensão do acesso é a medição da acessibilidade. Este artigo tem como propósito medir a acessibilidade aos serviços de urgência e aos meios de emergência médica na região portuguesa do Baixo Alentejo, território caracterizado por uma baixa densidade populacional. A metodologia considera o método network analyst aplicado à rede viária, em dois níveis: o cálculo da distância-tempo aos serviços de urgência usando modo próprio (carro ou táxi); e o cálculo da distância-tempo recorrendo aos meios de socorro e emergência como forma de aceder aos serviços de urgência. Embora se considere que a acessibilidade às urgências atende ao atual quadro legislativo do Sistema Integrado de Emergência Médica, a simulação de diferentes cenários no Baixo Alentejo mostra a existência de disparidades intra-regionais no que se refere à acessibilidade aos serviços de urgência. Verifica-se que é a população idosa, de baixa instrução e residente em zonas com baixa densidade populacional quem apresenta menores índices de acessibilidade, o que traduz uma situação duplamente desvantajosa, uma vez que estes são os maiores utilizadores destes serviços.
Subject(s)
Humans , Aged , Emergency Medical Services , Health Services Accessibility , Portugal , Emergency Service, Hospital , Emergency TreatmentABSTRACT
Japan has been speculated to have more than 10,000 bathing accidents per year, and the number increases annually. In particular, the number of bathing accidents in the elderly is increasing. I investigated the bathing accidents that occurred in Noboribetsu City between April of 2014 and March of 2015 with the full cooperation of the Noboribetsu ambulance service. There were 52 accidents in total; 25 occurred in women with an average age of 64.4±20.5 years, and 27 occurred in men with an average age of 70.7±18.2 years. In 11 cases, patients were transported via ambulance because of cardiopulmonary arrest (CPA). Eight of these patients were men, and three were women; 10 of the 11 CPA patients were brought to the hospital during the winter. Although I was unable to clearly determine whether alcohol consumption influenced the increase in the number and seriousness of bathing accidents, I do not recommend heavy alcohol consumption because of the additional risk of consciousness disturbance and drowning. The number of bathing accidents at the patient’s own home in Noboribetsu City increased significantly (P<0.05) in the winter, and I found no correlation between the season of the year and the number of accidents in public baths in Noboribetsu City and the number of accidents in hotels and inns in Noboribetsu hot springs.
ABSTRACT
Japan has been speculated to have more than 10,000 bathing accidents per year, and the number increases annually. In particular, the number of bathing accidents in the elderly is increasing.<BR> I investigated the bathing accidents that occurred in Noboribetsu City between April of 2014 and March of 2015 with the full cooperation of the Noboribetsu ambulance service. There were 52 accidents in total; 25 occurred in women with an average age of 64.4±20.5 years, and 27 occurred in men with an average age of 70.7±18.2 years.<BR> In 11 cases, patients were transported via ambulance because of cardiopulmonary arrest (CPA). Eight of these patients were men, and three were women; 10 of the 11 CPA patients were brought to the hospital during the winter.<BR> Although I was unable to clearly determine whether alcohol consumption influenced the increase in the number and seriousness of bathing accidents, I do not recommend heavy alcohol consumption because of the additional risk of consciousness disturbance and drowning.<BR> The number of bathing accidents at the patient’s own home in Noboribetsu City increased significantly (P<0.05) in the winter, and I found no correlation between the season of the year and the number of accidents in public baths in Noboribetsu City and the number of accidents in hotels and inns in Noboribetsu hot springs.
ABSTRACT
Objective To investigate into hand hygiene facilities and worker's practice of hand hygiene during 120 ambulance services in a capital city.Methods With the standard Observation Form publicized by the World Health Organization,field observation was carried out to monitor hand hygiene facilities and the practice of hand hygiene in workers during ambulance services provided by four service centers.Results A total of seven ambulances and 80 times of services were observed across a span of 21 days.The provision and position of hand hygiene facilities were found very limited in these ambulances.Of 656 times of presence of indictors for hand hygiene,the overall compliance rate was 3.04％ reflecting the practice of hand hygiene in ambulance workers.The compliance rate was found to be 0 (0/291),1.96％ (1/51),13.64％ (3/22),5.21％ (16/307) and 0(0/2) before touching patients,after body fluids exposure risk,before clean/aseptic procedures and after touching patients' surroundings respectively.Conclusions Poor practice of hand hygiene which was revealed in 120 ambulance services suggests the great need for education and training to improve patient safety and occupational health.