Association between medical resources and the proportion of oldest-old in the Chinese population.

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.

Spatial analysis of Brazil's COVID-19 response capacity: a proposal for a Healthcare Infrastructure Index. / Análise espacial das condições de enfrentamento à COVID-19: uma proposta de Índice da Infraestrutura da Saúde do Brasil.

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.

Análise espacial das condições de enfrentamento à COVID-19: uma proposta de Índice da Infraestrutura da Saúde do Brasil / Spatial analysis of Brazil's COVID-19 response capacity: a proposal for a Healthcare Infrastructure Index

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.

An Organ for My Child: Public Appeals for Limited Resources.

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.

Nurses' psychological trauma: "They leave me lying awake at night".

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.

Allocation of Scarce Resources in a Pandemic: A Systematic Review of US State Crisis Standards of Care Documents.

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.

African Conceptions of Age-Based Moral Standing: Anchoring Values to Regional Realities.

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.

Facilitators and barriers to the self-management of COPD: a qualitative study from rural Nepal.

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.

Supply Chains in Healthcare Organizations: Lessons Learned from Recent Shortages.

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.

Resource availability for the management of maternal sepsis in Malawi, other low-income countries, and lower-middle-income countries.

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.

Continuous free access to HAART could be one of the potential factors impacting on loss to follow-up in HAART-eligible patients living in a resource-limited setting: N'djamena, Chad.

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.

Critical care management of major disasters: a practical guide to disaster preparation in the intensive care unit.

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.

Analysis of the environmental impact of insulin infusion sets based on loss of resources with waste.

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.

Introduction to section III: resources for CFTR research.

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.

Child and adolescent mental health policy: promise to provision.

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).

[A survey of neurological medical care resources in grade II suburban and urban hospitals in Beijing].

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.