scholarly journals Sociocultural and health system factors associated with mortality among febrile inpatients in Tanzania: a prospective social biopsy cohort study

2018 ◽  
Vol 3 (1) ◽  
pp. e000507 ◽  
Author(s):  
Michael E Snavely ◽  
Michael J Maze ◽  
Charles Muiruri ◽  
Lilian Ngowi ◽  
Flora Mboya ◽  
...  
Keyword(s):  
Health System ◽  
Community Education ◽  
Conditional Logistic Regression ◽  
Tertiary Care ◽  
Febrile Illness ◽  
Care Seeking ◽  
Factors Associated ◽  
Northern Tanzania ◽  
System Factors ◽  
At Home

IntroductionCommunicable diseases are the leading causes of death in Tanzania despite the existence of effective treatment tools. We aimed to assess the sociocultural and health system factors associated with mortality from febrile illness in northern Tanzania.MethodsWe interviewed febrile inpatients to determine prevalence of barriers in seeking or receiving care and grouped these barriers using the Three Delays model (delays at home, in transport and at healthcare facilities). We assessed 6-week mortality and, after matching on age, gender and severity of illness, measured the association between delays and mortality using conditional logistic regression.ResultsWe enrolled 475 children, of whom 18 (3.8%) died, and 260 adults, of whom 34 (13.0%) died. For children, home delays were not associated with mortality. Among adults, a delay in care-seeking due to not recognising severe symptoms was associated with mortality (OR: 3.01; 95% CI 1.24 to 7.32). For transport delays, taking >1 hour to reach a facility increased odds of death in children (OR: 3.27; 95% CI 1.11 to 9.66) and adults (OR: 3.03; 95% CI 1.32 to 6.99). For health system delays, each additional facility visited was associated with mortality for children (OR: 1.59; 95% CI 1.06 to 2.38) and adults (OR: 2.00; 95% CI 1.17 to 3.41), as was spending >4 days between the first facility visit and reaching tertiary care (OR: 4.39; 95% CI 1.49 to 12.93).ConclusionOur findings suggest that delays at home, in transport and in accessing tertiary care are risk factors for mortality from febrile illness in northern Tanzania. Interventions that may reduce mortality include community education regarding severe symptoms, expanding transportation infrastructure and streamlining referrals to tertiary care for the sickest patients.

Patient and health system factors associated with hospital readmission in older adults without cognitive impairment

2018 ◽  
Vol 53 ◽  
pp. 44-51
Author(s):  
Helen-Maria Vasiliadis ◽  
Raymond Milan ◽  
Samantha Gontijo Guerra ◽  
Marie-Josée Fleury
Keyword(s):  
Older Adults ◽  
Cognitive Impairment ◽  
Health System ◽  
Hospital Readmission ◽  
Factors Associated ◽  
System Factors

scholarly journals Factors associated with non-participation in and dropout from cardiac rehabilitation programmes: a systematic review of prospective cohort studies

2018 ◽  
Vol 18 (1) ◽  
pp. 38-47 ◽  
Author(s):  
Davinia Maria Resurrección ◽  
Patricia Moreno-Peral ◽  
Marta Gómez-Herranz ◽  
Maria Rubio-Valera ◽  
Luis Pastor ◽  
...  
Keyword(s):  
Cohort Studies ◽  
Cardiac Rehabilitation ◽  
Health System ◽  
Prospective Cohort ◽  
Data Extraction ◽  
Clinical Factors ◽  
Cardiac Rehabilitation Programme ◽  
Factors Associated ◽  
Prospective Cohort Studies ◽  
System Factors

Background: Although evidence exists for the efficacy of cardiac rehabilitation programmes to reduce morbidity and mortality among patients with cardiovascular disease, cardiac rehabilitation programmes are underused. We aimed systematically to review the evidence from prospective cohort studies on factors associated with non-participation in and/or dropping out from cardiac rehabilitation programmes. Methods: MedLine, Embase, Scopus, Open Grey and Cochrane Database were searched for relevant publications from inception to February 2018. Search terms included (a) coronary heart disease and other cardiac conditions; (b) cardiac rehabilitation and secondary prevention; and (c) non-participation in and/or dropout. Databases were searched following the PRISMA statement. Study selection, data extraction and the assessment of study quality were performed in duplicate. Results: We selected 43 studies with a total of 63,425 patients from 10 different countries that met the inclusion criteria. Factors associated with non-participation in and dropout from cardiac rehabilitation were grouped into six broad categories: intrapersonal factors, clinical factors, interpersonal factors, logistical factors, cardiac rehabilitation programme factors and health system factors. We found that clinical factors, logistical factors and health system factors were the main factors assessed for non-participation in cardiac rehabilitation. We also found differences between the factors associated with non-participation and dropout. Conclusions: Several factors were determinant for non-participation in and dropout from cardiac rehabilitation. These findings could be useful to clinicians and policymakers for developing interventions aimed at improving participation and completion of cardiac rehabilitation, such as E-health or home-based delivery programmes. Trial Registration: International Prospective Register of Systematic Reviews (PROSPERO) identifier: CRD42016032973.

scholarly journals Health system factors associated with rehospitalizations after traumatic spinal cord injury: a population-based study

Spinal Cord ◽  
2009 ◽  
Vol 47 (8) ◽  
pp. 604-609 ◽  
Author(s):  
S B Jaglal ◽  
S E P Munce ◽  
S J Guilcher ◽  
C M Couris ◽  
K Fung ◽  
...  
Keyword(s):  
Spinal Cord ◽  
Spinal Cord Injury ◽  
Health System ◽  
Population Based ◽  
Traumatic Spinal Cord Injury ◽  
Population Based Study ◽  
Factors Associated ◽  
Cord Injury ◽  
System Factors

scholarly journals Health system factors associated with choice of place of delivery among postnatal women in Marsabit County, Kenya

2021 ◽  
Vol 05 (12) ◽  
pp. 207-215
Author(s):  
Christine Bokayo Arero ◽  
Keraka Nyanchoka Margaret ◽  
Shadrack Yonge Ayieko ◽  
Matoke Omwenga Vincent ◽  
Okari Maseme Geoffrey
Keyword(s):  
Health System ◽  
Place Of Delivery ◽  
Factors Associated ◽  
Postnatal Women ◽  
System Factors

scholarly journals Patient-Associated Risk Factors for Acquisition of Methicillin-Resistant Staphylococcus aureus in a Tertiary Care Hospital

2010 ◽  
Vol 31 (11) ◽  
pp. 1139-1147 ◽  
Author(s):  
Jo-anne M. Salangsang ◽  
Lee H. Harrison ◽  
Maria M. Brooks ◽  
Kathleen A. Shutt ◽  
Melissa I. Saul ◽  
...  
Keyword(s):  
Risk Factors ◽  
Staphylococcus Aureus ◽  
Logistic Regression ◽  
Tertiary Care Hospital ◽  
Conditional Logistic Regression ◽  
Tertiary Care ◽  
Care Hospital ◽  
Factors Associated ◽  
Target Unit ◽  
Associated Risk Factors

Background.Determining risk factors for acquisition of methicillin-resistant Staphylococcus aureus (MRSA) in hospitals is important for defining infection-control measures that may lead to fewer hospital-acquired infections.Objective.To determine patient-associated risk factors for acquisition of MRSA in a tertiary care hospital with the goal of identifying modifiable risk factors.Methods.A retrospective matched case-control study was performed. Case patients who acquired MRSA during hospitalization and 2 matched control patients were selected among inpatients admitted to target units during the period from 2001 through 2008. The odds of exposure to potential risk factors were compared between case patients and control patients, using matched univariate conditional logistic regression. A single multivariate conditional logistic regression model identifying independent patient-specific risk factors was generated.Results.A total of 451 case patients and 866 control patients were analyzed. Factors positively associated with MRSA acquisition were as follows: target unit stay before index culture; primary diagnosis of respiratory disease, digestive tract disease, injury or trauma, or other diagnosis compared with cardiocirculatory disease; peripheral vascular disease; mechanical ventilation with pneumonia; ventricular shunting or ventriculostomy; and ciprofloxacin use. Factors associated with decreased risk were receipt of a solid-organ transplant and use of penicillins, cephalosporins, rifamycins, daptomycin or linezolid, and proton pump inhibitors.Conclusion.Among the factors associated with increased risk, few are modifiable. Patients with at-risk conditions could be targeted for intensive surveillance to detect acquisition sooner. The association of MRSA acquisition with target unit exposure argues for rigorous application of hand hygiene, appropriate barriers, environmental control, and strict aseptic technique for all procedures performed on such Patients. Our findings support focusing efforts to prevent MRSA transmission and restriction of ciprofloxacin use.

Variation in the use of adjuvant chemotherapy following neoadjuvant radiotherapy and surgery for rectal cancer in a publicly-insured health care system.

2018 ◽  
Vol 36 (4_suppl) ◽  
pp. 854-854
Author(s):  
Lev Bubis ◽  
Alyson L. Mahar ◽  
Vaibhav Gupta ◽  
Yunni Jeong ◽  
Laura Davis ◽  
...  
Keyword(s):  
Rectal Cancer ◽  
Adjuvant Chemotherapy ◽  
Health System ◽  
Preoperative Radiotherapy ◽  
Care Practice ◽  
Patient Centered ◽  
Neoadjuvant Radiotherapy ◽  
Factors Associated ◽  
Chemotherapy Administration ◽  
System Factors

854 Background: The efficacy of routine administration of adjuvant chemotherapy following sequential neoadjuvant chemoradiotherapy and surgery for rectal cancer is uncertain. This uncertainty may lead to practice pattern variations, with significant downstream discrepancies in oncological outcomes, patient-centered outcomes, and healthcare costs. The objective of this study, therefore, was to evaluate patient, disease, and health system factors associated with receipt of adjuvant chemotherapy following neoadjuvant radiotherapy and proctectomy. Methods: A retrospective cohort study of patients diagnosed with rectal cancer undergoing preoperative radiotherapy prior to proctectomy from January 1, 2010 to December 31, 2014 was performed using linked administrative healthcare databases. We compared the rate of chemotherapy administration (≥ 1 billing record) within 180 days of index rectal resection by healthcare administrative region in Ontario, Canada (2014 population: 13.4 million). Multivariable logistic regression models were constructed to assess patient, disease, and health system factors associated with differences in receipt of adjuvant chemotherapy. Results: We studied 1668 patients treated with preoperative radiotherapy and proctectomy, of whom 67% received chemotherapy within 180 days after surgery. The rate of adjuvant chemotherapy administration varied among health regions from 54% to 93%. On multivariable analysis, health region of residence, younger patient age, lower baseline comorbidity burden, and pathological nodal involvement were significant predictors of receipt of adjuvant chemotherapy. Conclusions: There is significant variation in receipt of adjuvant chemotherapy for patients receiving preoperative radiotherapy followed by proctectomy in Ontario. This variability is associated with patient, disease, and health system-related factors. Identifying the drivers of variability in cancer care practice may help to provide a basis for understanding and addressing discrepancies in clinical, patient-centered, and economic outcomes in healthcare systems.

scholarly journals Factors Associated with the Regularity of Physical Exercises as a Means of Improving the Public Health System in Vietnam

2018 ◽  
Vol 10 (11) ◽  
pp. 3828 ◽  
Author(s):  
Quan-Hoang Vuong ◽  
Anh-Duc Hoang ◽  
Thu-Trang Vuong ◽  
Viet-Phuong La ◽  
Hong Nguyen ◽  
...  
Keyword(s):  
Public Health ◽  
Health Communication ◽  
Health System ◽  
Communication Systems ◽  
Public Health System ◽  
University Education ◽  
Average Height ◽  
Factors Associated ◽  
Physical Exercises ◽  
At Home

Being ranked among the most sedentary countries, Vietnam’s social public health is challenged by the rising number of overweight people. This study aims to evaluate factors associated with the regularity of exercise and sports (EAS) among Vietnamese people living in the capital city of Hanoi, using data collected from a randomized survey involving 2068 individuals conducted in 2016. Physical exercises and daily sports are considered a major means for improving the Vietnamese social public health system by the government, families, and individuals. Applying the baseline-category logit model, the study analyzed two groups of factors associated with EAS regularity: (i) physiological factors (sex, body mass index (BMI)) and (ii) external factors (education, health communication, medical practice at home). Females with a university education or higher usually exercise less than those with lower education, while the opposite is true for males. The study also shows that those with a higher BMI tend to report higher activity levels. Additionally, improved health communication systems and regular health check-ups at home are also associated with more frequent EAS activities. These results, albeit limited to only one location in Vietnam, provide a basis for making targeted policies that promote a more active lifestyle. This, in turn, could help the country realize the goal of improving the average height of the population and reducing the incidents of non-communicable diseases.

scholarly journals Community and health system factors associated with antiretroviral therapy initiation among men and women in Malawi: a mixed methods study exploring gender-specific barriers to care

2020 ◽  
Author(s):  
Khumbo Phiri ◽  
Kaitlyn McBride ◽  
Corrina Moucheraud ◽  
Misheck Mphande ◽  
Kelvin Balakasi ◽  
...  
Keyword(s):  
Social Support ◽  
Antiretroviral Therapy ◽  
Health System ◽  
Qualitative Data ◽  
Waiting Times ◽  
System Level ◽  
Men And Women ◽  
Factors Associated ◽  
Art Initiation ◽  
System Factors

Abstract Background Although community and health system factors are known to be critical to timely antiretroviral therapy (ART) initiation, little is known about how they affect men and women. Methods We examined community- and health system-level factors associated with ART initiation in Malawi and whether associations differ by gender; 312 ART initiates and 108 non-initiates completed a survey; a subset of 30 individuals completed an indepth interview. Quantitative data were analyzed using univariate and multivariate logistic regressions, with separate models by gender. Qualitative data were analyzed through constant comparison methods. Results Among women, no community-level characteristics were associated with ART initiation in multivariable models; among men, receiving social support for HIV services (adjusted OR [AOR]=4.61; p<0.05) was associated with ART initiation. Two health system factors were associated with ART initiation among men and one for women: trust that accessing ART services would not lead to unwanted disclosure (women: AOR=4.51, p<0.01; men: AOR=1.71, p<0.01) and trust that clients were not turned away from ART services (men: 12.36, p=0.001). Conclusions Qualitative data indicate that men were concerned about unwanted disclosure due to engaging in ART services and long waiting times for services. Interventions to remove health system barriers to ART services should be explored to promote social support among men.

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