Public Health Care Planning Research Articles

Accuracy in clinical diagnosis of benign peri-ocular mass lesions

To analyze accuracy in clinical diagnosis of peri-ocular benign lesions. A prospective, interventional study of 279 clinically diagnosed and or histo-pathologically confirmed eyelid mass lesions. At presentation, detailed demographic data, symptoms, duration since the mass noted, it’s location, size & physical appearance, progression/regression/recurrence of the lid mass if any and associated systemic ailments were noted. Then, a pre-treatment clinical diagnosis (PTCD) was made. The treatment given, its outcome and histo-pathological examination (HPE) report were noted. Results then analysed in terms of how many cases needed HPE and in how many did PTCD match with HPE reports. Commonest lesions were of infective type (64.5%) followed by cysts and neoplastic which together contributed for 26.9% cases and others like congenital, traumatic, depositive etc., contributed for 8.6%. Totally, 25.8% sent for HPE; 94.4% did match with PTCD. Accuracy in clinical diagnosis is good with a thorough understanding of physical characteristics of lid mass lesions. Studies on a large scale would be extremely beneficial for the practicing ophthalmologists and the training residents and also for public health-care planning.

Abstract TMP96: Area Deprivation Index (ADI) And NIHSS Predicts The Infarct Growth Rate (IGR)

Introduction: Socioeconomic status has been shown to affect the clinical outcome of cardiovascular disease and stroke. Early clinical severity and infarct growth rate (IGR) are highly variable across patients with anterior circulation large vessel occlusion (ACLVO) stroke but remain poorly understood. We aimed to measure the social determinants of early NIHSS and IGR in ACLVO stroke using the Area Deprivation Index (ADI), which incorporates housing, education, income, and employment status at the neighborhood level. Methods: Single-center retrospective study of all patients with acute intracranial ICA or proximal MCA occlusion and baseline CTP or MRI within 24 hours of stroke onset from 2014-2017. IGR (ischemic core volume / stroke onset to core imaging time, ml / hours) was calculated. Demographics, co-morbidities, admission NIHSS, ADI, and median income data were collected. Multivariable linear regression models tested the independent association between ADI and NIHSS (model 1) or IGR (model 2, including NIHSS). Results: A total of 165 patients were included in the analysis, with mean age 71 (SD, 15), 40 % male sex and median NIHSS 17(IQR, 12--21). In model 1, ADI (coefficient 0.07, 95% CI 0.025-0.13, P=0.004) and age (coefficient 0.11, 95% CI 0.4—0.19, P=0.003) were the only independent predictors of NIHSS. In model 2, ADI (coefficient 0.11, 95% CI 0.004-0.21, P=0.04) and NIHSS (coefficient 0.46, 95% CI 0.16-0.76, P=0.003) were the only independent predictors of IGR. Median income, sex, diabetes or hypertension status were not independently associated with NIHSS or IGR in these models. Conclusions: ADI is independently associated with worse stroke severity and faster infarct progression of ACLVO stroke. These findings have possibly important implications for public health care planning of stroke systems of care and enrollment in clinical trials of reperfusion therapies.

Quality of Life of Elementary School Students with Type 1 Diabetes in a Developing Country during the COVID Pandemic.

Type 1 diabetes (T1D) is a condition that affects all aspects of life, and thus is closely related to the quality of life itself. Dealing with it during the COVID-19 pandemic is a big challenge. A case-control study conducted in Montenegro at the end of 2021 included 87 elementary school students with T1D and 248 of their peers as controls matched by gender. Standardized questionnaires were distributed to participants (Peds-QL Generic core 4.0 questionnaire for all participants and Peds-QL Diabetes Module 3.2 only for cases). Based on them, the results of obtained scores were measured and compared using non-parametric statistical methods in relation to gender, region and type of household. Children with T1D reported lower quality of life comparing to matching controls with lower scores in almost all domains. Differences in the same domains among patients and their classmates were also observed in the different gender subgroups, environment type subgroups and in the central region. Results of the study provide insights to prioritizing actions for children with diabetes care as well as for public healthcare planning.

Strategies to Prevent Elderly Suicide: A Delphi Consensus Study

In the next decades, many countries will become 'ageing societies'. This combined with the current high rates of suicide in later life suggests that many older adults may die by suicide before clinical trials can be conducted to demonstrate the best approaches to prevent late-life suicide. A New Zealand (NZ) 'expert panel' has reviewed key considerations for suicide prevention interventions in older adults based on existing evidence, where available, and expert opinion. The key considerations were extracted from the current literature. The Delphi survey method was used to reach consensus for identifying interventions to be recommended as part of a national strategy for older adults' suicide prevention. A set of 20 key recommended considerations are presented. The major addition to existing recommendations is the need for 'A suicide prevention strategy for the elderly…' to enhance the national all-ages suicide prevention strategy. The recommended statements are offered for consideration by stakeholder groups preparing new interventions, large-scale public healthcare planning and governmental policy.

Awareness about Gynecological Cancers amongst Tribal Females

Background: Gender differences are engrained in our culture and are evident when perceiving women’s health and ill health. Health issues of women are of great importance in a society as it directly impacts the fabric of family and society. With limited access to education or employment, high illiteracy rates and increasing poverty levels health improvements for women are quite difficult in developing countries including India. There is a significant lack of official data on gynecological cancers further for women from tribal population which is important for advocacy and public health care planning. Aim: Study aimed at assessing awareness of gynecological cancers amongst tribal females in Borivali Taluka of Mumbai, Maharashtra. Methodology: The research is a descriptive study with a cross-sectional research design. 100 tribal female comprised the total sample. Result: Significant lack of awareness about the Gynecological cancers was seen in the tribal respondents of Aarey circle of Borivalli Taluka, Mumbai regarding the symptoms, treatment, and preventive measures of gynecological cancers. Conclusion: It is evident from previous as well as current study several factors are responsible for poor awareness about gynecological cancers among marginalized tribal respondents.
 

Comparison of the usage habits of healthcare systems of the imigrants and local residents

Turkey is one of the most popular immigration countries because of the wars that are ongoing in its southern border and its location on access routes to Europe. Migrations continue because of wars and political turmoil. The increasing number of migrants requires revising the public healthcare planning. In our study, we compared the behaviors of immigrants and local people. We examined to which extent immigrants used the clinics of our hospital. We interpreted the adequacy of the current healthcare system for migrants. We analyzed the hospital admissions of migrants and local residents who applied to our hospital between January 2014 and December 2018 in retrospective fashion. We determined the rates of referral to clinics. We determined that the highest referral rates of the migrants were made to emergency services, gynecology and obstetrics. We observed that the birth rates increased in migrants in the following period. However, despite the traumas, immigrants did not use psychiatric units. The existing healthcare and social policies must be revised by considering especially the needs of immigrants and their use of healthcare systems. We believe that primary healthcare services must be delivered equally to all individuals to reduce the intensity of emergency services, gynecology and obstetrics departments, and pediatric services. We also believe that the trauma that iscaused by immigration must not be underestimated.

Integration of Facility Location and Equipment Allocation in Health Care Management

Goal: This study aims at solving a location problem of Medical Specialties Centers (MSCs) and medical care equipment allocation. Addressing both problems simultaneously is an opportunity to improve public health service quality in the long-term since the literature traditionally treats these problems separately.
 Design / Methodology / Approach: The challenge consists in maximizing demand satisfaction with the minimum resource allocation in the public health care reality, where there is limited resource availability and high demand for medical services. For that, it was developed an integrated mathematical model, throughout mixed linear programming. The problem is a case study applied to the secondary public health care level in a Brazilian state. The method is generic and suitable to set the location and allocate resources in health care if the decision maker’s intention is to maximize the use of specialists’ assistance and medical exams.
 Results: The results reveal possible improvements in accessibility. Among the insights, the state government should hire 4% more specialists and acquire 1.5% more equipment to assist 99% of population demand for health care service on the secondary level. 
 Limitation of the investigation: Usually, one appointment can result in more than one medical exam referral. However, this study considers that each specialist meeting refers to only one exam per consultation. 
 Practical implications: This study contributes to healthcare planning, suggesting a better distribution and allocation of facilities, equipment, and professionals. Moreover, the study proposes accessibility improvements to health unit centers.
 Originality / Value: The main contribution of this work is the new integrated approach to public health care planning. The system proposes the reduction of access inequality and the improvement of the quality of health care services.

Neuropathologic, genetic, and longitudinal cognitive profiles in primary age-related tauopathy (PART) and Alzheimer's disease

IntroductionPrimary age-related tauopathy (PART) is a recently described entity that can cause cognitive impairment in the absence of Alzheimer's disease (AD). Here, we compared neuropathological features, tau haplotypes, apolipoprotein E (APOE) genotypes, and cognitive profiles in age-matched subjects with PART and AD pathology. MethodsBrain autopsies (n = 183) were conducted on participants 85 years and older from the Baltimore Longitudinal Study of Aging and Johns Hopkins Alzheimer's Disease Research Center. Participants, normal at enrollment, were followed with periodic cognitive evaluations until death. ResultsCompared with AD, PART subjects showed significantly slower rates of decline on measures of memory, language, and visuospatial performance. They also showed lower APOE ε4 allele frequency (4.1% vs. 17.6%, P = .0046). DiscussionOur observations suggest that PART is separate from AD and its distinction will be important for the clinical management of patients with cognitive impairment and for public health care planning.

Spatial association of public sports facilities with body mass index in Korea.

Governments and also local councils create and enforce their own regional public health care plans for the problem of overweight and obesity in the population. Public sports facilities can help these plans. In this paper, we investigated the contribution of public sports facilities to the reduction of the obesity of local residents. We used the data obtained from the Fifth Korea National Health and Nutrition Examination Surveys; and measured the degree of obesity using body mass index (BMI). We conducted various spatial regression analyses including the global Moran's I test and local indicators of spatial autocorrelation analysis finding that there exists spatial dependence in the error term of spatial regression model for BMI. However, we also observed that the number of local public sports facilities is not significantly related to local BMI. This result can be caused by the low utilization ratio and an unbalanced spatial distribution of local public sports facilities. Based on our findings, we suggest that local councils need to improve the quality of public sports facilities encouraging the establishment of preferred types of pubic sports facilities.

Population-Wide Genetic Risk Prediction of Complex Diseases: A Pilot Feasibility Study in Macau Population for Precision Public Healthcare Planning

The genetic bases of many common diseases have been identified through genome-wide association studies in the past decade. However, the application of this approach on public healthcare planning has not been well established. Using Macau with population of around 650,000 as a basis, we conducted a pilot study to evaluate the feasibility of population genomic research and its potential on public health decisions. By performing genome-wide SNP genotyping of over a thousand Macau individuals, we evaluated the population genetic risk profiles of 47 non-communicable diseases and traits, as well as two traits associated with influenza infection. We found that for most of the diseases, the genetic risks of Macau population were different from those of Caucasian, but with similar profile with mainland Chinese. We also identified a panel of diseases that Macau population may have a high or elevated genetic risks. This pilot study showed that (1) population genomic study is feasible in Asian regions like Macau; (2) Macau may have different profile of population-based genetic risks than Caucasians, (3) the different prevalence of genetic risk profile indicates the importance of Asian-specific studies for Asian populations; and (4) the results generated may have an impact for going forward healthcare planning.

Blindness and cataract surgical services in Atsinanana region, Madagascar.

Purpose:To assess the prevalence and causes of avoidable blindness in Atsinanana Region, Madagascar, with the Rapid Assessment of Avoidable Blindness (RAAB) survey. We analyzed the hospital records to supplement the findings for public health care planning.Materials and Methods:Only villages within a two-hour walk from a road, about half of the population of Atsinanana was included. Seventy-two villages were selected by population-proportional-to-size sampling. In each village, compact segment sampling was used to select 50 people over age 50 for eye examination using standard RAAB methods. Records at the two hospitals providing cataract surgery in the region were analyzed for information on patients who underwent cataract surgery in 2010. Cataract incidence rate and target cataract surgery rate (CSR) was modeled from age-specific prevalence of cataract.Results:The participation rate was 87% and the sample prevalence of blindness was 1.96%. Cataract was responsible for 64% and 85.7% of blindness and severe visual impairment, respectively. Visual impairment was due to cataract (69.4%) and refractive error (14.1%). There was a strong positive correlation between cataract surgical rate by district and the proportion of people living within 2 hours of a road. There were marked differences in the profiles of the cataract patients at the two facilities. The estimated incidence of cataract at the 6/18 level was 2.4 eyes per 100 people over age 50 per year.Conclusions:Although the survey included only people with reasonable access, the main cause of visual impairment was still cataract. The incidence of cataract is such that it ought to be possible to eliminate it as a cause of visual impairment, but changes in service delivery at hospitals and strategies to improve access will be necessary for this change.

De la dignité en Ehpad

It is by taking vulnerable people into account that a civilisation can prove itself worthy of this name, as elderly people can testify. These vulnerable people are thereby placed at the centre of public healthcare plans. What is the situation in nursing homes and what needs to be done to give them as much dignity as possible in all circumstances?

Spinal Trauma in Mainland China From 2001 to 2007

Descriptive epidemiological study. To determine the epidemiological characteristics of spinal trauma in Mainland China. To date, a large-scale epidemiological analysis of spinal trauma in Mainland China has not been undertaken. Data were acquired from Chinese Database of Traumas. Patients with International Classification of Diseases, Ninth Revision, Clinical Modification (ICD-9-CM) coding of 805.x and 806.x (spinal column fracture with and without spinal cord injury) from 2001 to 2007 were identified. Variables assessed included patient demographics, etiology, segmental distribution, and outcomes. A total of 82,720 patients with spinal trauma were identified, accounting for 4.58% of all trauma patients in the study period. Spinal cord injuries (SCIs) and fracture-dislocations accounted for 16.87% and 7.17% of spinal trauma and 0.74% and 0.32% of all traumas in the same period, respectively. The male-to-female ratio was 2.33:1. About 79.32% of spinal trauma occurred in patients between 20 and 60 years of age. There was an annual increase in incidence during the study period. A total of 64,630 patients (78.13%) had a definitive cause, with motor vehicle accidents identified as the leading etiological factor (33.61%), followed by high falls (31.25%) and trivial falls (23.23%). Lumbar spine was most frequently involved (56.09%), followed by thoracic spine (23.77%), cervical spine (17.75%), and sacrococcygeal vertebrae (2.39%). Fracture-dislocation occurred most frequently in the cervical and lumbar spines, whereas spinal cord injury occurred most frequently in the cervical and thoracic spines. Children younger than 10 years of age were prone to cervical spine injury, whereas adults older than 60 years were more prone to osteoporotic thoracic and lumbar fractures. Overall rate of conservative treatment (55.88%) was higher than that of operative treatment (44.12%). Overall combined cure and improvement rates exceeded 90%. The male mortality rate was twice that of the female population. Lumbar spine injury was the most curable, whereas cervical spine injury was associated with the worst prognosis and the highest medical costs. This is the first large-scale epidemiological study of spinal injury in Mainland China. The results obtained have important implications for future public health care planning, public safety, and resource allocation.

Key Considerations for Preventing Suicide in Older Adults

The number of older adults is growing rapidly. This fact, combined with the high rates of suicide in later life, indicates that many more older adults will die by their own hands before rigorous trials can be conducted to fully understand the best approaches to prevent late life suicide. To disseminate key considerations for interventions addressing senior suicidal behavior. An international expert panel has reviewed and discussed key considerations for interventions against suicide in older adults based on existing evidence, where available, and expert opinion. A set of new key considerations is divided into: universal, selective, and indicated prevention as well as a section on general considerations. The suggestions span a wide range and are offered for consideration by local groups preparing new interventions, as well as large scale public health care planning.

Venous Thromboembolism: Regional Differences in the Nationwide Inpatient Sample, 1993 to 2000

Venous thromboembolism (VTE) is a costly complication of hospitalization. The sequelae make it a concern for public health planners. The Nationwide Inpatient Sample (NIS) contains data for hospital discharges in the United States. These data were reviewed to determine their suitability for health policy planning. International Classification of Diseases, Ninth Revision, Clinical Modification codes for VTE were applied to the NIS data. The sample was queried for demographic information, mortality, length of hospital stay, diagnosis, and treatment. The rates were standardized for geographic region and disease acuity. Statistical analysis included descriptive reporting of means and event rates; analysis of variance and logistic regression were used for regional effects and modeling of mortality. Between 1993 and 2000, 636,814 discharges involved VTE (1.2%). This rate was consistent over time and within regions. Regional differences existed in the acceptance of new technology and hospital charges. Mortality varied from 6.3% (Midwest) to 7.9% (Northeast) and was associated with admission type, comorbidities, pulmonary embolism, and discharge from the Northeast region. White race, chronic venous insufficiency, and female gender were protective variables. The NIS data report a consistent mortality rate despite improved therapy. Regional diagnostic, treatment, and economic differences exist. The data are useful for the purposes of public health care planning and stimulating clinical trial questions.

Cutting Oneself on Too Sharp an Administrative Knife: Problems of Implementation in Finnish Health Care Planning

Finnish public health care planning is a multi‐level five year planning system which is heavily bureaucratized. The planning process is formalized and is supposed to work according to fixed time‐tables. Here the system is seen to display a conflict between technical planning assumptions and the political and pluralistic setting of the system. This conflict is seen to generate bureaucratic inertia. Empirical evidence indicates that the system does not work according to the a priori set schedules and it is doubtful whether it will keep up to schedule even after the reforms that have been made.

Nosocomial infections in U.S. hospitals, 1975–1976: Estimated frequency by selected characteristics of patients

To obtain estimates of the frequency of nosocomial infections nationwide, those occurring at the four major sites—urinary tract, surgical wound, lower respiratory tract and bloodstream—were diagnosed in a stratified random sample of 169,526 adult, general medical and surgical patients selected from 338 hospitals representative of the “mainstream” of U.S. hospitals. We estimate that in the mid-1970s one or more infections developed in 5.23 percent (± 0.16) of the patients and that 6.62 (± 0.24) infections occurred among every 100 admissions. Risks were significantly related to age, sex, service, duration of total and of preoperative hospitalization, presence of previous nosocomial or community-acquired infection, types of underlying illnesses and operations, duration of surgery, and treatment with urinary catheters, continuous ventilatory support or immunosuppressive medications. Seventy-one percent of the nosocomial infections occurred in the 42 percent of patients undergoing surgery and 56 percent in the 38 percent financed by Medicare, Medicaid or other public health care plans.