RESUMEN
The potential association between medical resources and the proportion of oldest-old (90 years of age and above) in the Chinese population was examined, and we found that the higher proportion of oldest-old was associated with the higher number of beds in hospitals and health centers.
Asunto(s)
Geriatría/métodos , Recursos en Salud/normas , Asignación de Recursos/provisión & distribución , Anciano de 80 o más Años , China/epidemiología , Geriatría/normas , Geriatría/estadística & datos numéricos , Recursos en Salud/estadística & datos numéricos , Humanos , Factores de RiesgoRESUMEN
One of the concerns linked to the COVID-19 pandemic is the capacity of health systems to respond to the demand for care for people with the disease. The objective of this study was to create a COVID-19 response Healthcare Infrastructure Index (HII), calculate the index for each state in Brazil, and determine its spatial distribution within and across regions. The HII was constructed using principal component factor analysis. The adequacy of the statistical model was tested using the Kaiser-Meyer-Olkin test and Bartlett's test of sphericity. The spatial distribution of the HII was analyzed using exploratory spatial data analysis. The data were obtained from DATASUS, the Federal Nursing Council, Ministry of Health, Government Procurement Portal, and the Transparency Portal. The nine states in the country's North and Northeast regions showed the lowest indices, while the five states from the Southeast and South regions showed the highest indices. Low-low clusters were observed in Amazonas and Pará and high-high clusters were found in Minas Gerais, Rio de Janeiro, São Paulo, and Paraná.
Uma das preocupações ligadas à pandemia da COVID-19 se refere à capacidade da estrutura do sistema de saúde suportar a demanda por atendimento e tratamento de pessoas acometidas por esta doença. Diante disso, o objetivo deste estudo consiste em criar e mapear o Índice de Infraestrutura de Saúde (IIS) das Unidades da Federação (UFs) brasileiras, bem como verificar a sua distribuição espacial. Para isso, foi aplicada a metodologia de Análise Fatorial por Componentes Principais. Aplicou-se os testes de Bartlett e Kaiser-Meyer-Olkin para verificação da sua adequabilidade. Em seguida procedeu-se a Análise Exploratória de Dados Espaciais. Os dados foram coletados no DATASUS, COFEN, Ministério da Saúde, Portal de Compras do Governo e Portal da Transparência. Quanto aos resultados, o índice revelou que nove estados do Norte e Nordeste registraram os menores índices e cinco estados do Sudeste e Sul apresentaram os maiores índices. Foi registrado um cluster baixo-baixo nos estados do Amazonas e Pará e um Cluster alto-alto em Minas Gerais, Rio de Janeiro, São Paulo e Paraná.
Asunto(s)
COVID-19/terapia , Instituciones de Salud/provisión & distribución , Accesibilidad a los Servicios de Salud , SARS-CoV-2 , Análisis Espacial , Brasil/epidemiología , COVID-19/epidemiología , Análisis Factorial , Fuerza Laboral en Salud/estadística & datos numéricos , Humanos , Análisis Multivariante , Pandemias , Asignación de Recursos/provisión & distribuciónRESUMEN
Resumo Uma das preocupações ligadas à pandemia da COVID-19 se refere à capacidade da estrutura do sistema de saúde suportar a demanda por atendimento e tratamento de pessoas acometidas por esta doença. Diante disso, o objetivo deste estudo consiste em criar e mapear o Índice de Infraestrutura de Saúde (IIS) das Unidades da Federação (UFs) brasileiras, bem como verificar a sua distribuição espacial. Para isso, foi aplicada a metodologia de Análise Fatorial por Componentes Principais. Aplicou-se os testes de Bartlett e Kaiser-Meyer-Olkin para verificação da sua adequabilidade. Em seguida procedeu-se a Análise Exploratória de Dados Espaciais. Os dados foram coletados no DATASUS, COFEN, Ministério da Saúde, Portal de Compras do Governo e Portal da Transparência. Quanto aos resultados, o índice revelou que nove estados do Norte e Nordeste registraram os menores índices e cinco estados do Sudeste e Sul apresentaram os maiores índices. Foi registrado um cluster baixo-baixo nos estados do Amazonas e Pará e um Cluster alto-alto em Minas Gerais, Rio de Janeiro, São Paulo e Paraná.
Abstract One of the concerns linked to the COVID-19 pandemic is the capacity of health systems to respond to the demand for care for people with the disease. The objective of this study was to create a COVID-19 response Healthcare Infrastructure Index (HII), calculate the index for each state in Brazil, and determine its spatial distribution within and across regions. The HII was constructed using principal component factor analysis. The adequacy of the statistical model was tested using the Kaiser-Meyer-Olkin test and Bartlett's test of sphericity. The spatial distribution of the HII was analyzed using exploratory spatial data analysis. The data were obtained from DATASUS, the Federal Nursing Council, Ministry of Health, Government Procurement Portal, and the Transparency Portal. The nine states in the country's North and Northeast regions showed the lowest indices, while the five states from the Southeast and South regions showed the highest indices. Low-low clusters were observed in Amazonas and Pará and high-high clusters were found in Minas Gerais, Rio de Janeiro, São Paulo, and Paraná.
Asunto(s)
Humanos , Infecciones por Coronavirus/terapia , Análisis Espacial , Betacoronavirus , Instituciones de Salud/provisión & distribución , Accesibilidad a los Servicios de Salud , Brasil/epidemiología , Análisis Multivariante , Análisis Factorial , Infecciones por Coronavirus/epidemiología , Asignación de Recursos/provisión & distribución , Pandemias , Fuerza Laboral en Salud/estadística & datos numéricosRESUMEN
The case of Jamie Fiske and subsequent public appeals for particular children by President Ronald Reagan represent classic cases in pediatric bioethics in which parents or others publicly appealed for a donor organ for a particular child. These raise questions about the appropriate boundaries for public appeals for a limited resource for a particular child and how the press and medical community should respond to such appeals. Public appeals by parents to advocate for their child to receive a limited resource above others promote rationing by morally irrelevant factors and shift the public focus from the national shortage of organs for transplant to the needs of a particular child. Yet these appeals are understandable and will likely continue. Recognizing this, we consider appropriate responses by the media, transplant community, hospitals, and individual clinicians.
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Discusiones Bioéticas , Donación Directa de Tejido/ética , Asignación de Recursos para la Atención de Salud/ética , Defensa del Paciente/ética , Asignación de Recursos/ética , Donación Directa de Tejido/tendencias , Selección de Donante/ética , Historia del Siglo XX , Hospitales , Humanos , Lactante , Medios de Comunicación de Masas/ética , Padres/psicología , Defensa del Paciente/tendencias , Rol del Médico , Política , Opinión Pública , Asignación de Recursos/métodos , Asignación de Recursos/provisión & distribución , Obtención de Tejidos y Órganos/métodosAsunto(s)
Ageísmo/ética , COVID-19/terapia , Cuidados Críticos , Enfermedad Crítica/terapia , Recursos en Salud , Esperanza de Vida , Triaje/ética , Factores de Edad , COVID-19/epidemiología , Cuidados Críticos/ética , Cuidados Críticos/métodos , Enfermedad Crítica/epidemiología , Asignación de Recursos para la Atención de Salud/ética , Recursos en Salud/ética , Recursos en Salud/provisión & distribución , Humanos , Asignación de Recursos/ética , Asignación de Recursos/provisión & distribución , Medición de Riesgo , SARS-CoV-2 , Ventiladores Mecánicos/provisión & distribuciónRESUMEN
OBJECTIVE: To describe nurses' personal and professional psychological trauma. METHODS: A content analysis of 372 responses surrounding personal and professional trauma was performed. RESULTS: Five themes emerged. A new type of trauma was uncovered, heretofore undescribed in the literature: insufficient resource trauma caused by a lack of resources and staff needed to render quality, safe care. CONCLUSION: Nurses' reports were vivid, frequently indicating they were still recovering from traumatic experiences. Professional sources of trauma were categorized as inherent in the role of the nurse and those that could be mitigated through organizational policy, adequate resources, and oversight.
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Actitud del Personal de Salud , Personal de Enfermería en Hospital/psicología , Trauma Psicológico/psicología , Asignación de Recursos/provisión & distribución , Adulto , Humanos , Persona de Mediana EdadRESUMEN
The aim of this systematic review was to locate and analyze United States state crisis standards of care (CSC) documents to determine their prevalence and quality. Following PRISMA guidelines, Google search for "allocation of scarce resources" and "crisis standards of care (CSC)" for each state. We analyzed the plans based on the 2009 Institute of Medicine (IOM) report, which provided guidance for establishing CSC for use in disaster situations, as well as the 2014 CHEST consensus statement's 11 core topic areas. The search yielded 42 state documents, and we excluded 11 that were not CSC plans. Of the 31 included plans, 13 plans were written for an "all hazards" approach, while 18 were pandemic influenza specific. Eighteen had strong ethical grounding. Twenty-one plans had integrated and ongoing community and provider engagement, education, and communication. Twenty-two had assurances regarding legal authority and environment. Sixteen plans had clear indicators, triggers, and lines of responsibility. Finally, 28 had evidence-based clinical processes and operations. Five plans contained all 5 IOM elements: Arizona, Colorado, Minnesota, Nevada, and Vermont. Colorado and Minnesota have all hazards documents and processes for both adult and pediatric populations and could be considered exemplars for other states.
Asunto(s)
Pandemias/prevención & control , Asignación de Recursos/métodos , Gobierno Estatal , Planificación en Desastres/métodos , Humanos , Asignación de Recursos/provisión & distribución , Asignación de Recursos/tendencias , Nivel de Atención/ética , Nivel de Atención/normas , Estados UnidosRESUMEN
Is age discrimination ethically objectionable? One puzzle is that we sometimes assume that the target of both age discrimination and ageism must be older people, yet in poorer nations, older people are generally shown more respect. This article explores the ethical question. It looks first at ethical arguments favoring age discrimination toward younger people in low-income, less industrialized countries of the global South, using sub-Saharan Africa as an illustration. It contrasts these with arguments favoring age discrimination toward older people in high-income, more industrialized countries of the global North, particularly the United States and United Kingdom. Finally, it considers what role, if any, differences in life expectancy, infant and child mortality, and prospects for healthy lives should play in the moral embrace of a particular view by a community. It argues that there can be reasons to favor different types of discrimination in different parts of the world.
Asunto(s)
Ageísmo/ética , Principios Morales , África , Atención a la Salud/ética , Humanos , Asignación de Recursos/ética , Asignación de Recursos/provisión & distribuciónRESUMEN
OBJECTIVE: To understand the facilitators and barriers to the self-management of chronic obstructive pulmonary disease (COPD) in rural Nepal. SETTINGS: Community and primary care centres in rural Nepal. PARTICIPANTS: A total of 14 participants (10 people with COPD and 4 health care providers) were interviewed. PRIMARY AND SECONDARY OUTCOME MEASURES: People with COPD and healthcare provider's experience of COPD self-management in rural Nepal. RESULTS: Facilitators and barriers affecting COPD self-management in Nepal operated at the patient-family, community and service provider levels. People with COPD were found to have a limited understanding of COPD and medications. Some participants reported receiving inadequate family support and described poor emotional health. At the community level, widespread use of complementary and alternative treatment was found to be driven by social networks and was used instead of western medicine. There were limited quality controls in place to monitor the safe use of alternative treatment. While a number of service level factors were identified by all participants, the pertinent concerns were the levels of trust and respect between doctors and their patients. Service level factors included patients' demands for doctor time and attention, limited confidence of people with COPD in communicating confidently and openly with their doctor, limited skills and expertise of the doctors in promoting behavioural change, frustration with doctors prescribing too many medicines and the length of time to diagnose the disease. These service level factors were underpinned by resource constraints operating in rural areas. These included inadequate infrastructure and resources, limited skills of primary level providers and lack of educational materials for COPD. CONCLUSIONS: The study findings suggest the need for a more integrated model of care with multiple strategies targeting all three levels in order to improve the self-management practices among people with COPD.
Asunto(s)
Personal de Salud/psicología , Atención Primaria de Salud/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Automanejo/métodos , Anciano , Anciano de 80 o más Años , Competencia Clínica/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Nepal/epidemiología , Atención Primaria de Salud/tendencias , Enfermedad Pulmonar Obstructiva Crónica/epidemiología , Enfermedad Pulmonar Obstructiva Crónica/psicología , Investigación Cualitativa , Calidad de Vida , Asignación de Recursos/provisión & distribución , Asignación de Recursos/tendencias , Población Rural , Automanejo/estadística & datos numéricos , Red SocialRESUMEN
This paper examines the need for better management of supply chains in healthcare facilities. Recent shortages have highlighted the need for better supply chain systems. The reasons for the shortages are false scarcity, natural disasters, medical lawsuits, production process problems, and group purchasing organizations (GPO). These problems have occurred with increasing frequency. There are three possible solutions available to handle the shortages. First, better use of supply chain management, including multiple suppliers and safety stock. Second, there needs to be better cooperation between suppliers, consumers, and government entities. Finally, healthcare facilities should develop teams of individuals responsible for monitoring critical areas and developing contingency plans.
Asunto(s)
Equipos y Suministros de Hospitales/normas , Asignación de Recursos/provisión & distribución , Utilización de Equipos y Suministros/normas , Utilización de Equipos y Suministros/estadística & datos numéricos , Equipos y Suministros de Hospitales/tendencias , Humanos , Asignación de Recursos/métodosRESUMEN
OBJECTIVE: To assess the availability of key resources for the management of maternal sepsis and evaluate the feasibility of implementing the Surviving Sepsis Campaign (SSC) recommendations in Malawi and other low-resource settings. METHODS: A cross-sectional study was conducted at health facilities in Malawi, other low-income countries, and lower-middle-income countries during January-March 2016. English-speaking healthcare professionals (e.g. doctors, nurses, midwives, and administrators) completed a questionnaire/online survey to assess the availability of resources for the management of maternal sepsis. RESULTS: Healthcare centers (n=23) and hospitals (n=13) in Malawi showed shortages in the resources for basic monitoring (always available in 5 [21.7%] and 10 [76.9%] facilities, respectively) and basic infrastructure (2 [8.7%] and 7 [53.8%], respectively). The availability of antibiotics varied between Malawian healthcare centers (9 [39.1%]), Malawian hospitals (8 [61.5%]), hospitals in other low-income countries (10/17 [58.8%]), and hospitals in lower-middle-income countries (39/41 [95.1%]). The percentage of SSC recommendations that could be implemented was 33.3% at hospitals in Malawi, 30.3% at hospitals in other low-income countries, and 68.2% at hospitals in lower-middle-income countries. CONCLUSION: The implementation of existing SSC recommendations is unrealistic in low-income countries because of resource limitations. New maternal sepsis care bundles must be developed that are applicable to low-resource settings.
Asunto(s)
Países en Desarrollo , Adhesión a Directriz/economía , Paquetes de Atención al Paciente/economía , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/terapia , Asignación de Recursos/provisión & distribución , Sepsis/economía , Sepsis/terapia , Estudios Transversales , Femenino , Encuestas de Atención de la Salud , Recursos en Salud/provisión & distribución , Humanos , Malaui , Pobreza/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/economía , Autoinforme , Sepsis/diagnósticoRESUMEN
BACKGROUND: Retention of HAART-eligible HIV-infected patients in clinical follow-up systems are now becoming an important issue in sub-Saharan African countries. METHODS: In this retrospective study (April 2008 to November 2011), we assessed the attrition rate variations in a cohort of 509 HAART-eligible patients in Chad. RESULTS: Decrease in levels of loss to follow-up were observed during the implementation of continuous free access to HAART (72.5 vs 10%; p<0.001) and was independent of gender, age, WHO clinical stage and CD4+ T cell count at inclusion and of the time delay to initiate HAART (p>0.48). CONCLUSIONS: These data suggest that the implementation of free access to HAART without any interruption of supply, from autumn 2009, could be the factor that potentially changed the HIV patient attrition rate in this resource-limited setting.
Asunto(s)
Terapia Antirretroviral Altamente Activa/economía , Infecciones por VIH/tratamiento farmacológico , Accesibilidad a los Servicios de Salud/economía , Perdida de Seguimiento , Adolescente , Adulto , África/epidemiología , Anciano , Recuento de Linfocito CD4 , Chad/epidemiología , Estudios de Cohortes , Femenino , Estudios de Seguimiento , Infecciones por VIH/epidemiología , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Asignación de Recursos/provisión & distribución , Estudios Retrospectivos , Carga Viral , Adulto JovenRESUMEN
Recent events and regulatory mandates have underlined the importance of medical planning and preparedness for catastrophic events. The purpose of this review is to provide a brief summary of current commonly identified threats, an overview of mass critical care management, and a discussion of resource allocation to provide the intensive care unit (ICU) director with a practical guide to help prepare and coordinate the activities of the multidisciplinary critical care team in the event of a disaster.
Asunto(s)
Cuidados Críticos/normas , Planificación en Desastres/organización & administración , Servicios Médicos de Urgencia/organización & administración , Unidades de Cuidados Intensivos , Incidentes con Víctimas en Masa , Guías de Práctica Clínica como Asunto , Lista de Verificación , Conducta Cooperativa , Cuidados Críticos/organización & administración , Desastres/prevención & control , Sistemas de Comunicación entre Servicios de Urgencia , Servicios Médicos de Urgencia/métodos , Equipos y Suministros , Humanos , Unidades de Cuidados Intensivos/organización & administración , Incidentes con Víctimas en Masa/prevención & control , Grupo de Atención al Paciente/organización & administración , Asignación de Recursos/provisión & distribución , Mantenimiento del Espacio en Ortodoncia , Triaje/métodos , Triaje/organización & administración , Estados Unidos , Ventiladores Mecánicos/provisión & distribución , Recursos HumanosRESUMEN
Insulin pump therapy [continuous subcutaneous insulin infusion (CSII)] requires regular change of infusion sets every 2-3 days in order to minimize the risk of skin irritations or other adverse events. This has been discussed to be a potential burden to the environment. The purpose of this analysis was to perform an environmental assessment of insulin pump infusion sets based on loss of resources occurring during incineration of the discarded products and by means of a lifecycle concept used to weight a material in relation to its rareness on earth and its consumption. In addition to five infusion sets (Inset30, InsetII, Comfort, Quick-set, and Cleo), a patch pump (Omnipod) was also included in this analysis. The annual loss in waste of the so called "person reserve" of 3 days of catheter use was compared with daily consumption of a cup of coffee in a disposable paper cup and to a soft drink in an aluminum can. The weight-based loss in resources through waste for the infusion sets (except for Cleo) corresponded to 70-200% of the loss of resources for a coffee cup (Cleo, 320%; Omnipod, 1,821,600%) and to 1-3% of the loss from an aluminum soft drink can (Cleo, 5%; Omnipod, 31,200%). The loss or resources by use of infusion sets used in insulin pump therapy appears to be low and is similar to the burden induced by the uptake of one cup of coffee per day. The loss or resources with regular CSII is considerably lower than the loss or resources induced by patch pumps.
Asunto(s)
Conservación de los Recursos Naturales , Ambiente , Sistemas de Infusión de Insulina/efectos adversos , Sistemas de Infusión de Insulina/provisión & distribución , Insulina/administración & dosificación , Residuos Sanitarios/efectos adversos , Bebidas/efectos adversos , Conservación de los Recursos Naturales/estadística & datos numéricos , Equipos Desechables/provisión & distribución , Contaminación Ambiental/efectos adversos , Contaminación Ambiental/estadística & datos numéricos , Humanos , Hipoglucemiantes/administración & dosificación , Hipoglucemiantes/efectos adversos , Incineración/estadística & datos numéricos , Insulina/efectos adversos , Estudios Longitudinales , Eliminación de Residuos Sanitarios/estadística & datos numéricos , Modelos Teóricos , Asignación de Recursos/organización & administración , Asignación de Recursos/normas , Asignación de Recursos/provisión & distribuciónRESUMEN
This section of Cystic Fibrosis Protocols and Diagnosis focuses on resources available to facilitate the activities of the research community in the field of cystic fibrosis (CF). An overview of the protocols and resources described in subsequent chapters of this book section is provided, as well as how they can accelerate research in this area.
Asunto(s)
Regulador de Conductancia de Transmembrana de Fibrosis Quística/análisis , Fibrosis Quística/fisiopatología , Asignación de Recursos/provisión & distribución , Animales , Fibrosis Quística/economía , Fibrosis Quística/genética , Fibrosis Quística/metabolismo , Regulador de Conductancia de Transmembrana de Fibrosis Quística/economía , Regulador de Conductancia de Transmembrana de Fibrosis Quística/genética , Regulador de Conductancia de Transmembrana de Fibrosis Quística/metabolismo , Bases de Datos Genéticas/economía , Bases de Datos Genéticas/provisión & distribución , Modelos Animales de Enfermedad , Humanos , Mutación , Asignación de Recursos/economíaRESUMEN
Mental health policy enables the translation of the knowledge base of 'how' to help children and families into the actual 'provision' of help. Amid competing pressures to leave the allocation of services to the market, policy is required to define needs, select priorities, match resources with need, and to measure what has been accomplished. Crafting policy requires balancing contrasting goals and approaches, here spelled out. Public mental health policy can be compared to other forms of continuous quality improvement (CQI).
Asunto(s)
Servicios de Salud del Adolescente/provisión & distribución , Servicios de Salud del Niño/provisión & distribución , Política de Salud/tendencias , Recursos en Salud/provisión & distribución , Trastornos Mentales/terapia , Servicios de Salud Mental/provisión & distribución , Adolescente , Servicios de Salud del Adolescente/organización & administración , Niño , Servicios de Salud del Niño/organización & administración , Preescolar , Predicción , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Trastornos Mentales/diagnóstico , Trastornos Mentales/epidemiología , Servicios de Salud Mental/organización & administración , Asignación de Recursos/provisión & distribución , Asignación de Recursos/tendenciasRESUMEN
OBJECTIVE: To survey the current availability of expertise in diagnosis and treatment of neurological diseases in grade II hospitals (primary hospitals) in Beijing. METHODS: Observation, personal in-depth interview and structured questionnaire methods were conducted to survey the status of neurology health care system. RESULTS: From June to August 2005, 66 grade II suburban and urban hospitals in Beijing of China were investigated. There were 66 grade II hospitals in Beijing (suburban 34; urban 32). Cerebrovascular disease was the most common disease. Accounting for 84% of the hospitalized cases in inpatients neurology departments. In urban areas, the proportion of grade II and grade III hospitals (referral hospitals) was 58:60, but in suburban and rural areas, the proportion was 48:6. In suburban and rural areas. Only 64.7% of the hospitals could provide urokinase treatment, 26.5% could provide recombinant tissue plasminogen activator (rt-PA) treatment and 58.8% had standardized operation protocol. CONCLUSIONS: The grade II hospitals in suburban areas have heavy grave responsibility to deal with cerebrovascular disease, but these hospitals are in lack of specialists, diagnostic equipment and stroke treatment protocols and could not satisfy the medical demand. It is suggested that in the grade II hospitals in suburban areas of Beijing, strengthening personnel training, establishing primary stroke center and setting up telestroke emergency care systems are urgently needed.