scholarly journals Geography as a Determinant of Health: Health Services Utilization of Pediatric Respiratory Illness in a Canadian Province

2021 ◽  
Vol 18 (16) ◽  
pp. 8347
Author(s):  
Shehzad Kassam ◽  
Jesus Serrano-Lomelin ◽  
Anne Hicks ◽  
Susan Crawford ◽  
Jeffrey A. Bakal ◽  
...  
Keyword(s):  
Health Services ◽  
Healthcare Utilization ◽  
Respiratory Diseases ◽  
Social Inequalities ◽  
Social Deprivation ◽  
Respiratory Illness ◽  
Rural And Urban ◽  
The Difference ◽  
Tract Infections ◽  
The Impact

Respiratory diseases contribute to high healthcare utilization rates among children. Although social inequalities play a major role in these conditions, little is known about the impact of geography as a determinant of health, particularly with regard to the difference between rural and urban centers. A regional geographic analysis was conducted using health repository data on singleton births between 2005 and 2010 in Alberta, Canada. Data were aggregated according to regional health sub-zones in the province and standardized prevalence ratios (SPRs) were determined for eight respiratory diseases (asthma, influenza, bronchitis, bronchiolitis, croup, pneumonia, and other upper and other lower respiratory tract infections). The results indicate that there are higher rates of healthcare utilization in northern compared to southern regions and in rural and remote regions compared to urban ones, after accounting for both material and social deprivation. Geography plays a role in discrepancies of healthcare utilization for pediatric respiratory diseases, and this can be used to inform the provision of health services and resource allocation across various regions.

scholarly journals 216. Are Automatic Antimicrobial Stop Orders an Effective Stewardship Tool for Urinary Tract and Intra-Abdominal Infections?

2020 ◽  
Vol 7 (Supplement_1) ◽  
pp. S110-S110
Author(s):  
Christina Maguire ◽  
Dusten T Rose ◽  
Theresa Jaso
Keyword(s):  
Urinary Tract ◽  
Antimicrobial Therapy ◽  
Source Control ◽  
Clostridioides Difficile ◽  
Days Of Therapy ◽  
Before And After ◽  
The Difference ◽  
Tract Infections ◽  
Length Of Therapy ◽  
The Impact

Abstract Background Automatic antimicrobial stop orders (ASOs) are a stewardship initiative used to decrease days of therapy, prevent resistance, and reduce drug costs. Limited evidence outside of the perioperative setting exists on the effects of ASOs on broad spectrum antimicrobial use, discharge prescription duration, and effects of missed doses. This study aims to evaluate the impact of an ASO policy across a health system of adult academic and community hospitals for treatment of intra-abdominal (IAI) and urinary tract infections (UTI). ASO Outcome Definitions ASO Outcomes Methods This multicenter retrospective cohort study compared patients with IAI and UTI treated before and after implementation of an ASO. Patients over the age of 18 with a diagnosis of UTI or IAI and 48 hours of intravenous (IV) antimicrobial administration were included. Patients unable to achieve IAI source control within 48 hours or those with a concomitant infection were excluded. The primary outcome was the difference in sum length of antimicrobial therapy (LOT). Secondary endpoints include length and days of antimicrobial therapy (DOT) at multiple timepoints, all cause in hospital mortality and readmission, and adverse events such as rates of Clostridioides difficile infection. Outcomes were also evaluated by type of infection, hospital site, and presence of infectious diseases (ID) pharmacist on site. Results This study included 119 patients in the pre-ASO group and 121 patients in the post-ASO group. ASO shortened sum length of therapy (LOT) (12 days vs 11 days respectively; p=0.0364) and sum DOT (15 days vs 12 days respectively; p=0.022). This finding appears to be driven by a decrease in outpatient LOT (p=0.0017) and outpatient DOT (p=0.0034). Conversely, ASO extended empiric IV LOT (p=0.005). All other secondary outcomes were not significant. Ten patients missed doses of antimicrobials due to ASO. Subgroup analyses suggested that one hospital may have influenced outcomes and reduction in LOT was observed primarily in sites without an ID pharmacist on site (p=0.018). Conclusion While implementation of ASO decreases sum length of inpatient and outpatient therapy, it may not influence inpatient length of therapy alone. Moreover, ASOs prolong use of empiric intravenous therapy. Hospitals without an ID pharmacist may benefit most from ASO protocols. Disclosures All Authors: No reported disclosures

Impact of Medicaid Managed Care on Illinois's Acute Health Services Expenditures for Adults With Intellectual and Developmental Disabilities

2018 ◽  
Vol 56 (2) ◽  
pp. 133-146 ◽  
Author(s):  
Kiyoshi Yamaki ◽  
Coady Wing ◽  
Dale Mitchell ◽  
Randall Owen ◽  
Tamar Heller
Keyword(s):  
Developmental Disabilities ◽  
Managed Care ◽  
Health Services ◽  
Cost Savings ◽  
Intellectual And Developmental Disabilities ◽  
Fee For Service ◽  
Access To Health Services ◽  
Medicaid Managed Care ◽  
The Difference ◽  
The Impact

Abstract States have increasingly transitioned Medicaid enrollees with disabilities from fee-for-service (FFS) to Medicaid Managed Care (MMC), intending to reduce state Medicaid spending and to provide better access to health services. Yet, previous studies on the impact of MMC are limited and findings are inconsistent. We analyzed the impact of MMC on costs by tracking Illinois's Medicaid acute health services expenditures for adults with intellectual and developmental disabilities (IDD) living in the community (n = 1,216) before and after their transition to MMC. Results of the difference-in-differences (DID) regression analysis using an inverse propensity score weight (IPW) matched comparison group (n = 1,134) design suggest that there were no significant state Medicaid cost savings in transitioning people with IDD from FFS to MMC.

scholarly journals The Impact of Schools and Families in the Religions Perceptions of Children in Albania and Kosovo

2021 ◽  
Vol 8 (1) ◽  
pp. 110
Author(s):  
Loloçi Rita ◽  
Menada Petro
Keyword(s):  
Religious Education ◽  
Rural Areas ◽  
Urban Areas ◽  
Fundamental Rights ◽  
Age Group ◽  
Rural And Urban Areas ◽  
Rural And Urban ◽  
The Difference ◽  
The Impact

This study aimed to identify children`s perceptions regarding the role of religion in their education, their religious belonging, the parent's role in their religious education, and the attitude they have towards other religions. To gather quantitative data regarding the opinion the 10-14 age children have on religion and religious education, a survey was performed in several schools in Albania and Kosovo urban and rural areas (720 students from 8 schools of Durres, 4 in rural areas, and 473 students from 8 schools of Pristina and the surrounding area). A questionnaire was used to fulfill the purpose of the research regarding the knowledge, attitudes, and the perceptions of 10-14 age group on religious education in schools. At the same time, studies of national and international authors were consulted for a better analysis of the problems raised in the questionnaires such as the role and the importance of intercultural education in the coexistence and the harmony between people of different cultures, the education on The Fundamental Rights, the role of the curricula in schools, the difference between families in the rural and urban areas and the effect of the parents’ education on children. The results of the study showed that children of this age group receive the first knowledge about religion from the family. An irreplaceable role in religious education has the media. The school involvement in giving knowledge on religious beliefs in both studied regions will positively influence pupil’s formation, eliminating this way the violation of other people religion that often is present in our schools and not only. A correlation between the tolerance of parents and the tolerance of their children resulted as the consequence of the care that families show to respect different religions and often even sects.

scholarly journals 343. RURAL-COVID-19 Trial: Retrospective Analysis of COVID-19 Coinfections in Hospitalized Urban and Rural Adults

2021 ◽  
Vol 8 (Supplement_1) ◽  
pp. S275-S275
Author(s):  
Caroline Hamilton ◽  
Heather Frazier ◽  
Jose A Vazquez
Keyword(s):  
Staphylococcus Aureus ◽  
Retrospective Analysis ◽  
Patient Outcomes ◽  
Urban Residents ◽  
Urban Populations ◽  
Empiric Antibiotics ◽  
Rural And Urban ◽  
Significant Difference ◽  
Tract Infections ◽  
The Impact

Abstract Background The impact of COVID-19 in rural communities has been well described. However, little is known regarding differences in coinfections among COVID-19 patients in rural vs. urban settings. Our primary objective is to evaluate community acquired coinfection (CACo) rates (< 72 hrs from admission) and healthcare-associated infection (HAI) rates ( > 72 hrs from admission) in these populations. Secondary objectives include use of empiric antibiotics, pathogen prevalence, and patient outcomes. Methods Retrospective analysis of the first 255 adult patients admitted to a tertiary medical center with symptomatic COVID-19 and confirmed by PCR. Rural and urban categories were determined using patient address and county census data. Isolated pathogens were individually evaluated and considered coinfections if the patient met predetermined criteria. Predetermined Coinfection Criteria Results The rates of CACo for rural (n = 90) and urban (n = 165) residents were 11.1% and 13.3%, respectively. Non-respiratory coinfections, such as bloodstream and urinary tract infections, were more common in urban residents; however, empiric antibiotics were started in 75.1% of all subjects. Methicillin susceptible staphylococcus aureus and Escherichia coli were the most common pathogens isolated on admission in both populations. HAI rates were 13.3% in the rural residents vs 13.9% in the urban residents with Methicillin resistant staphylococcus aureus as the most common respiratory pathogen, although Pseudomonas aeruginosa was the most prevalent overall pathogen. There was no significant difference in hospital length of stay or 30-day all-cause mortality among both populations. Patient Outcomes Among Rural and Urban Populations Conclusion There was no significant difference in the rate of CACo or HAI among rural or urban populations. Despite the high rate of antibiotic use to empirically cover community acquired respiratory infections at the start of the pandemic, only 1.9% of the subjects had a possible or proven respiratory coinfection on admission. Despite prior research showing worse outcomes for rural populations with COVID-19, our data demonstrates that coinfection rates and patient outcomes were similar among these populations when receiving medical care at an academic hospital. Disclosures All Authors: No reported disclosures

scholarly journals The Impact of Indonesia’s School Operational Assistance Program on The Transition Rate from Primary to Junior Secondary School

2021 ◽  
Author(s):  
Байю Харизма ◽  
Сутястие Соэмитро Реми ◽  
Динда Аю Махарани
Keyword(s):  
Secondary School ◽  
Rural Areas ◽  
Urban Areas ◽  
Transition Rate ◽  
Assistance Program ◽  
Junior Secondary School ◽  
Rural And Urban ◽  
Junior Secondary ◽  
The Difference ◽  
The Impact

This study investigates the impact of Indonesia’s School Operational Assistance Program (BOS) on the transition rate from primary to junior secondary school using data from the Indonesian Family Life Survey (IFLS) and the Difference-in-Differences method. The results showed that the School Operational Assistance Program (BOS) significantly increases the transition rate from Primary to Junior Secondary School. Meanwhile, the School Operational Assistance Program (BOS) is more effective in increasing the transition rate in girls compared to boys. When comparing rural and urban settings, the program is more effective in rural than urban areas. Despite results showing that the School Operational Assistance Program (BOS) has successfully increased the transition rate from primary to junior secondary school, the program still has several problems, such as inadequate management of the funds and the lack of quality control related to its usage. The three models tested in the study conclude that the School Operational Assistance Program (BOS) significantly improved the overall transition rate from primary to junior secondary school in Indonesia, particularly for girls and rural areas. Acknowledgments. This research is supported by DRPMI Universitas Padjadjaran (UNPAD) for Lecture Competency Research (RKDU) scheme. We thank our colleagues from the Department of Economics, who provided insight and expertise that greatly assisted the research and we thank “anonymous” reviewers for their so-called insights.

scholarly journals Effects of Confounding Bias in COVID-19 and Influenza Vaccine Effectiveness Test-Negative Designs Due to Correlated Influenza and COVID-19 Vaccination Behaviors

2021 ◽  
Author(s):  
Margaret K. K Doll ◽  
Stacy M. Pettigrew ◽  
Julia Ma ◽  
Aman Verma
Keyword(s):  
Influenza Vaccine ◽  
Conditional Probability ◽  
Respiratory Illness ◽  
Vaccine Effectiveness ◽  
The Other ◽  
Acute Respiratory Illness ◽  
Potential Bias ◽  
Confounding Bias ◽  
The Difference ◽  
The Impact

Background: The test-negative design is commonly used to estimate influenza and COVID-19 vaccine effectiveness (VE). In these studies, correlated COVID-19 and influenza vaccine behaviors may introduce a confounding bias where controls are included with the other vaccine-preventable acute respiratory illness (ARI). We quantified the impact of this bias on VE estimates in studies where this bias is not addressed. Methods: We simulated study populations under varying vaccination probabilities, COVID-19 VE, influenza VE, and proportions of controls included with the other vaccine-preventable ARI. Mean bias was calculated as the difference between true and estimated VE. Absolute mean bias in VE estimates was classified as low (<10%), moderate (10% to <20%), and high (≥20%). Results: Where vaccination probabilities are positively correlated, COVID-19 and influenza VE test-negative studies with influenza and SARS-CoV-2 ARI controls, respectively, underestimate VE. For COVID-19 VE studies, mean bias was low for all scenarios where influenza represented ≤50% of controls. For influenza VE studies, mean bias was low for all scenarios where SARS-CoV-2 represented ≤10% of controls. Although bias was driven by the conditional probability of vaccination, low VE of the vaccine of interest and high VE of the confounding vaccine increase its magnitude. Conclusions: Where a low percentage of controls are included with the other vaccine-preventable ARI, bias in COVID-19 and influenza VE estimates is low. However, influenza VE estimates are likely more susceptible to bias. Researchers should consider potential bias and its implications in their respective study settings to make informed methodological decisions in test-negative VE studies.

Impact of influenza vaccination on respiratory illness rates in children attending private boarding schools in England, 2013–2014: a cohort study

2015 ◽  
Vol 143 (16) ◽  
pp. 3405-3415 ◽  
Author(s):  
N. BROUSSEAU ◽  
H. K. GREEN ◽  
N. ANDREWS ◽  
R. PRYSE ◽  
M. BAGUELIN ◽  
...  
Keyword(s):  
Secondary School ◽  
Influenza Vaccination ◽  
Negative Binomial ◽  
Disease Incidence ◽  
Respiratory Illness ◽  
Boarding Schools ◽  
Upper Respiratory Tract ◽  
Respiratory Illnesses ◽  
Tract Infections ◽  
The Impact

SUMMARYSeveral private boarding schools in England have established universal influenza vaccination programmes for their pupils. We evaluated the impact of these programmes on the burden of respiratory illnesses in boarders. Between November 2013 and May 2014, age-specific respiratory disease incidence rates in boarders were compared between schools offering and not offering influenza vaccine to healthy boarders. We adjusted for age, sex, school size and week using negative binomial regression. Forty-three schools comprising 14 776 boarders participated. Almost all boarders (99%) were aged 11–17 years. Nineteen (44%) schools vaccinated healthy boarders against influenza, with a mean uptake of 48·5% (range 14·2–88·5%). Over the study period, 1468 respiratory illnesses were reported in boarders (5·66/1000 boarder-weeks); of these, 33 were influenza-like illnesses (ILIs, 0·26/1000 boarder-weeks) in vaccinating schools and 95 were ILIs (0·74/1000 boarder-weeks) in non-vaccinating schools. The impact of vaccinating healthy boarders was a 54% reduction in ILI in all boarders [rate ratio (RR) 0·46, 95% confidence interval (CI) 0·28–0·76]. Disease rates were also reduced for upper respiratory tract infections (RR 0·72, 95% CI 0·61–0·85) and chest infections (RR 0·18, 95% CI 0·09–0·36). These findings demonstrate a significant impact of influenza vaccination on ILI and other clinical endpoints in secondary-school boarders. Additional research is needed to investigate the impact of influenza vaccination in non-boarding secondary-school settings.

Affecting Factors Related to Air Pollution on Elderly Respiratory Health during Heating Period

2014 ◽  
Vol 955-959 ◽  
pp. 919-923
Author(s):  
Chun Shan Zhao ◽  
Min Xu ◽  
Chun Guo Li
Keyword(s):  
Air Pollution ◽  
Respiratory Diseases ◽  
Respiratory Health ◽  
Multivariate Logistic Regression Analysis ◽  
The Elderly ◽  
Survey Method ◽  
Upper Respiratory Tract ◽  
Heating Period ◽  
Tract Infections ◽  
The Impact

The aim of this study is to investigate the status in elderly respiratory illness and the impact of air pollution on elderly respiratory health in Jilin during the heating period. A stratified random cluster sampling was used to select 536 elderly living in different districts with different degrees of atmospheric pollution in Jilin as the research objects. The survey on the respiratory diseases and symptoms was conducted with face-to-face retrospective questionnaire survey method, and the data were analyzed with multivariate logistic regression analysis. The results showed that in the heating season in 2012, the major respiratory diseases in elderly of the three districts in Jilin City were acute upper respiratory tract infections, bronchitis and asthma, and the major respiratory symptoms were cough, sputum, wheezing; the severe level order of respiratory diseases and symptoms was inturn Longtan District (an industrial area) > Changyi District (a living area) > Fengman District (a tourist area), and differences in them were statistically significant (P <0.05); residence, opening window for ventilation and smoking were the factors affecting respiratory diseases and symptoms in the elderly. The study indicates that air pollution during the heating period is directly correlated with the elderly respiratory health and the incidence of respiratory diseases should be reduced by changing the heating energy materials, giving up smoking, ventilation and other measures to improve air quality.

scholarly journals Respiratory Morbidities among Children in a Grass Root Level Hospital in Bangladesh

2019 ◽  
Vol 48 (1) ◽  
pp. 1-4
Author(s):  
Rahat Bin Habib ◽  
ARM Luthful Kabir ◽  
Md Abdur Rouf ◽  
Md Sk Shahid Ullah ◽  
Md Nazmul Hossain ◽  
...  
Keyword(s):  
Respiratory Tract ◽  
Urban Areas ◽  
Respiratory Tract Infections ◽  
Respiratory Illness ◽  
Rural Setting ◽  
Respiratory Morbidity ◽  
Upper Respiratory Tract ◽  
Multicentric Study ◽  
Tract Infections ◽  
The Impact

Children mostly suffer from respiratory illnesses around the world. Situation is not different in Bangladesh as suggested by many studies on childhood illness. But most of these studies have been done in tertiary level hospitals located in urban areas and very few were done in rural setting. This study was conducted to estimate the frequency and to determine the pattern of respiratory morbidity among children and also to assess the impact of passive  smoking on the magnitude of acute respiratory tract infections (ARI) among children. This was an observational study. It was carried out on 1002 children over a period of about 180 days, who attended the Tungipara Upazila Health Complex (UHC), Gopalganj, Bangladesh between January 2018 and June 2018. Data were collected through face to face interview, physical examination, relevant investigations and collected data in the questionnaire for respiratory illness and others then respiratory data were not collected. Out of 1002 children, more then half (54%) were male and the age range was new born to 168 months. Among them upper respiratory tract infections (URTI) were 98.5% as against only 1.5% of lower respiratory tract infections (LRTI). In this study, 38% fathers were smoker and no mother found as smoker. Families of 63% patients used smoke producing substances for cooking. Respiratory illness was more prevalent among the children whose fathers used to smoke tobacco χ2 (1) 380   P 0.01. As well as babies more vulnerable for respiratory morbidity where smoke producing fuel used for cooking χ2 (1) 170   P 0.01. Children suffered more from diseases affecting the respiratory system than diseases of other systems. Simple cough related illness was the most common URTI. Under 05 children suffered most. Respiratory illness was more common among those whose fathers smoked tobacco. Children were more vulnerable to respiratory morbidity, where smoke producing fuel used for cooking. There need multicentric study to observe the real picture of respiratory morbidity. Bangladesh Med J. 2019 Jan; 48 (1): 1-4

scholarly journals Effect of household relocation on child vaccination and health service utilisation in Dhaka, Bangladesh: a cross-sectional community survey

BMJ Open ◽  
2019 ◽  
Vol 9 (3) ◽  
pp. e026176
Author(s):  
Lily Horng ◽  
Nadira Sultana Kakoly ◽  
Jaynal Abedin ◽  
Stephen P Luby
Keyword(s):  
Health Services ◽  
Respiratory Illness ◽  
Community Survey ◽  
Service Utilisation ◽  
Medical Provider ◽  
Cross Sectional ◽  
Total N ◽  
Household Relocation ◽  
The Impact ◽  
Children Under 5

ObjectiveTo explore the relationship between household relocation and use of vaccination and health services for severe acute respiratory illness (ARI) among children in Dhaka, Bangladesh.DesignAnalysis of cross-sectional community survey data from a prior study examining the impact ofHaemophilus influenzaetype b vaccine introduction in 2009 on meningitis incidence in Bangladesh.SettingCommunities surrounding two large paediatric hospitals in Dhaka, Bangladesh.ParticipantsHouseholds with children under 5 years old who either recently relocated<12 months or who were residentially stable living>24 months in their current residence (total n=10 020) were selected for this study.Primary outcome measuresFull vaccination coverage among children aged 9-59 months and visits to a qualified medical provider for severe ARI among children under 5 years old.ResultsUsing vaccination cards with maternal recall, full vaccination was 80% among recently relocated children (n=3795) and 85% among residentially stable children (n=4713; χ2=37.2, p<0.001). Among children with ARI in the prior year, 69% of recently relocated children (n=695) had visited a qualified medical provider compared with 82% of residentially stable children (n=763; χ2=31.9, p<0.001). After adjusting for demographic and socioeconomic characteristics, recently relocated children were less likely to be fully vaccinated (prevalence ratio [PR] 0.97; 95% CI 0.95 to 0.99; p=0.016) and to have visited a qualified medical provider for ARI (PR 0.88; 95% CI 0.84 to 0.93; p<0.001).ConclusionsChildren in recently relocated households in Dhaka, Bangladesh, have decreased use of vaccination and qualified health services for severe ARI.

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