Gender differences in barriers to alcohol and other drug treatment in Cape Town, South Africa

Objective: The study aimed to identify gender differences in barriers to alcohol and other drug (AOD) treatment use among disadvantaged communities in Cape Town, South Africa. The Behavioral Model of Health Services Utilization was used as an analytic framework. Method: A case-control design was used to compare 434 individuals with AOD problems from disadvantaged communities who had accessed treatment with 555 controls who had not accessed treatment on a range of variables. Logistic regression procedures were employed to examine the unique profile of variables associated with treatment utilization for male and female participants. Results: Few gender differences emerged in terms of the pattern of variables associated with AOD treatment use. Greater awareness of treatment options and fewer geographic access and affordability barriers were strongly associated with an increased likelihood of AOD treatment use for both men and women from disadvantaged communities. However, while similar types of barriers to treatment were reported by men and women, these barriers had a greater impact on treatment utilization for women compared to men. Conclusion: Compared to men, women from disadvantaged communities in South Africa do not have equal access to AOD treatment. Recommendations on how to reduce these barriers and ways to improve AOD treatment use among women from disadvantaged communities in South Africa are provided.Keywords: Health care quality; Access and evaluation; Gender; Substance abuse treatment centres; South Afric

Hepatitis C Treatment for Substance Users in North Dakota

In the 1960’s, the hepatitis C virus (HCV) epidemic began mainly through the transmission of blood transfusions. By the time screening was implemented, millions had already become infected worldwide. After a decade of declining infection rates, a second wave started in the midst of the opioid epidemic in 2010. Prior to 2014 and the application of curative direct-acting antivirals, treatment was expensive, had low efficacy, many side effects, and long treatment durations. Advances in medicine have allowed for HCV elimination with shorter treatment durations, less side effects, and higher treatment rates. Unfortunately, treatment is not offered to all HCV patients due to current Medicaid restrictions and drug and alcohol abstinent requirements. This literature review aimed to investigate the effectiveness of treating HCV in active substance users. A comprehensive literature review was performed using electronic search databases PubMed, Embase, and CINHAL. Keywords used, along with MeSH words, included: hepatitis C, drugs, alcohol, economics, prevention and control, psychology, health care disparities, statistics and numerical data, health care quality, access and evaluation, and public health. The search results were limited to the last 10 years which yielded 30,397 articles. Exclusion criteria consisted of research on other variables with lacking data on substance use and HCV therapy completion. Studies with specific populations such as African Americans, pregnant patients and those with HCV/HIV co-infection were excluded. Research that was not completed in the United States (US) was also excluded. Current literature provides strong evidence in successful treatment regardless of substance use. Given the prevalence of those not receiving treatment and continual increase of HCV in the US, applying this research to clinical application could move us one step closer to HCV eradication

Effectiveness of Various Health Insurances in Tackling Health Problems of the 21st Century: A Systematic Review

  Objective: To investigate the relationship between health insurance and health quality using systematic method. Background: Health insurance can be said has strong relation in achieving Goal 3 of Sustainable Development Goals (SDGs), “Ensure healthy lives and promote well-being for all at all ages”. One of the key factor in reaching ‘healthy lives’ is the access to medical care. Health insurance has been implemented across many countries in order to facilitate access for good quality medical care. Some studies indicated that health insurance have positive effect to improve health quality of patient. Another study indicated there is inverted effect between ownership of health insurance and health quality. The link between health insurance and its ability to tackle health problems therefore should be thoroughly investigated. Methods: Systematic review was conducted using keywords “Insurance, Health”[Mesh] AND “Health Care Quality, Access, and Evaluation”[Mesh] on Pubmed. Afterwards, titles are screened for relevancy and duplication. Contents then were then screened for inclusion criteria, which include studies with publication age less than five years, observational studies, and studies which look upon effects of health insurance on its users’ health, and exclusion criteria, which include inaccessible articles, articles written in foreign languages, and irrelevant articles. A total of 6 suitable studies were included in the final review and were subjected to STROBE analysis. Key Findings: Increased usage of proper health insurance is related to an increase in overall health outcomes of various diseases, including type 1 Diabetes Mellitus (7% decrease of hyperglycemia on patients with more expensive insurance), acuity of thoracic aortic operations (underinsured patients were at greatest risk of getting acute nonelective operation; OR: 2.67), gastritis (insurance coverage reduce prevalence of H. pylori), cardiac arrest (102/100.000 to 85/100.000 incidence after insurance expansion), albuminuria (higher mortality for individuals without private insurance), and peritonitis (better prognosis for individuals with better insurance). These conditions could be explained by increase in health awareness and accessibility of medication by patients with quality health insurance. This finding could become a basis for governments to highly consider quality insurances as means to improve the health of the nation

ACCCN Workforce Standards for Intensive Care Nursing: Systematic and evidence review, development, and appraisal

Background: The intensive care nursing workforce plays an essential role in the achievement of positive healthcare outcomes. A growing body of evidence indicates that inadequate nurse staffing and poor skill mix are associated with negative outcomes for patients, and potentially compromises nurses’ ability to maintain the safety of those in their care. In Australia, the Australian College of Critical Care Nurses (ACCCN) has previously published a position statement on intensive care staffing. There was a need for a stronger more evidence based document to support the intensive nursing workforce. Objectives: To undertake a systematic and evidence review of the evidence related to intensive care nurse staffing and quality of care, and determine evidence-based professional standards for the intensive care nursing workforce in Australia. Methods: The National Health and Medical Research Council standard for clinical practice guidelines methodology was employed. The English language literature, for the years 2000-2015 was searched. Draft standards were developed and then peer- and consumer-reviewed. Results: A total of 553 articles was retrieved from the initial searches. Following evaluation, 231 articles met the inclusion criteria and were assessed for quality using established criteria. This evidence was used as the basis for the development of ten workforce standards, and to establish the overall level of evidence in support of each standard. All draft standards and their subsections were supported multi-professionally (median score >6) and by consumers (85–100% agreement). Following minor revisions, independent appraisal using the AGREE II tool indicated that the standards were developed with a high degree of rigour. Conclusion: The ACCCN intensive care nursing nurse workforce standards are the first to be developed using a robust, evidence-based process. The standards represent the optimal nurse workforce to achieve the best patient outcomes and to maintain a sustainable intensive care nursing workforce for Australia

Biomedical Convergence Facilitated by the Emergence of Technological and Informatic Capabilities

We analyzed Medical Subject Headings (MeSH) from 21.6 million research articles indexed by PubMed to map this vast space of entities and their relations, providing insights into the origins and future of biomedical convergence. Detailed analysis of MeSH co-occurrence networks identifies three robust knowledge clusters: the vast universe of microscopic biological entities and structures; systems, disease and diagnostics; and emergent biological and social phenomena underlying the complex problems driving the health, behavioral and brain science frontiers. These domains integrated from the 1990s onward by way of technological and informatic capabilities that introduced highly controllable, scalable and permutable research processes and invaluable imaging techniques for illuminating fundamental structure-function-behavior questions. Article-level analysis confirms a positive relationship between team size and topical diversity, and shows convergence to be increasing in prominence but with recent saturation. Together, our results invite additional policy support for cross-disciplinary team assembly to harness transdisciplinary convergence.Comment: 12 pages, 4 figures; 8 pages of Supplementary Informatio

Prev Chronic Dis

IntroductionHigh-quality epidemiologic research is essential in reducing chronic diseases. We analyzed the quality of systematic reviews of observational nontherapeutic studies.MethodsWe searched several databases for systematic reviews of observational nontherapeutic studies that examined the prevalence of or risk factors for chronic diseases and were published in core clinical journals from 1966 through June 2008. We analyzed the quality of such reviews by using prespecified criteria and internal quality evaluation of the included studies.ResultsOf the 145 systematic reviews we found, fewer than half met each quality criterion; 49% reported study flow, 27% assessed gray literature, 2% abstracted sponsorship of individual studies, and none abstracted the disclosure of conflict of interest by the authors of individual studies. Planned, formal internal quality evaluation of included studies was reported in 37% of systematic reviews. The journal of publication, topic of review, sponsorship, and conflict of interest were not associated with better quality. Odds of formal internal quality evaluation (odds ratio [OR], 1.10 per year; 95% confidence interval [CI], 1.02-1.19) and either planned, formal internal quality evaluation or abstraction of quality criteria of included studies (OR, 1.17 per year; 95% CI, 1.08-1.26) increased over time, without positive trends in other quality criteria from 1990 through June 2008. Systematic reviews with internal quality evaluation did not meet other quality criteria more often than those that ignored the quality of included studies.ConclusionCollaborative efforts from investigators and journal editors are needed to improve the quality of systematic reviews

Empirical probabilities of (non)optimal healthcare choice conditional on socio-economic status and time consumption

Background: Patients need healthcare information for making decisions in choosing health service provider, but data sufficiency and quality are major obstacles. Non-optimal decisions are common. The problem persists even with the growing power of the Internet and ICT-based facilities. Asymmetric information exacerbates the economic inequality, worsening community health. Aims & Objectives: The study reports results on existence of empirical relations between such factor as socioeconomic status, consumption of time and outcome of healthcare provider choice by Vietnamese patients. Material & Methods: Cross-section data from a patient community survey spanning >30 hospitals in Hanoi, during 2015 Q4-2016 Q1. Study sample contains 1459 observations. Main method used is baseline category logits regression. Results: Empirical relations among the above factors are confirmed. The rich possess advantages over the poor, with a >63% probability of making an optimal choice. But two groups are not different with respect to wrong choice, with probabilities of making wrong choice for high- and low-SES patients, spending significant time for seeking information, being 13.6% and 15.1% respectively. Conclusion: a) Even for the rich with significant information the chance of choosing right healthcare provider is relatively low, 51%; b) Quality of information or information processing by healthcare consumers shows some problem

A Survey of Patients' Satisfaction in Emergency Department of Rasht Poursina Hospital

Introduction: Patients' satisfaction (PS) is one of the important indicators of emergency care quality and outcomes of health care services. Some researchers believe that improve the work processes and hospital quality are not possible without caring to comments, requirements, expectations, and satisfaction of patients. The percent study was aimed to assess the emergency department (ED) PS of Poursina hospital, Rasht, Iran. Methods: In this descriptive cross sectional study, the samples was selected from 378 patients admitted to ED of Poursina Hospital, Rasht, Iran, 2013. For each patient a check list and a questionnaire, including 37 questions about PS, were filled that had categories like physical comfort and residential aspects, physicians care, nurse care, behavioral aspect, and waiting time for service presentation. Data were analyzed by SPSS version 16. Results: Entirely, 378 patients were entered to the study with mean age of 38.44±17.8 (60.8% male). The mean score of total satisfaction of ED patients was 106.94±13.62 (range: 72-144). The mean score of physical comfort was 33.25±4.76 out of the highest obtainable score of 55, nurse care 25.33±5.13 out of 40, physician care 24.34±3.38 out of 40, waiting time for services 13.42±5.48 out of 30, and behavioral aspects 10.58±2.66 out of 20. There were significant relation among PS, sex (P=0.0001), and the shift of admission (P=0.023). Conclusion: The findings of percent study showed that giving services to emergency clients in various fields such as physical comfort and residential aspects, physicians care, nurse care, and the total ED satisfaction is relatively agreeable. The periodic and continuous assessment as well as comparison of satisfaction and dissatisfaction parameters during the time, before and after performing the changes, could be effectual