RESUMO
OBJECTIVE: To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. METHODS: A stratified two-stage randomized cross-sectional health survey was conducted in 2009 - 2010 among 1 002 Mexican American households. RESULTS: Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 - 2.76). CONCLUSIONS: Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management.
Assuntos
Diabetes Mellitus/etnologia , Turismo Médico/estatística & dados numéricos , Americanos Mexicanos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Adulto , Idoso , Barreiras de Comunicação , Comorbidade , Estudos Transversais , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Emigração e Imigração/estatística & dados numéricos , Feminino , Acessibilidade aos Serviços de Saúde/economia , Inquéritos Epidemiológicos , Humanos , Renda/estatística & dados numéricos , Cobertura do Seguro , Idioma , Masculino , Indigência Médica/estatística & dados numéricos , Turismo Médico/economia , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , México/epidemiologia , México/etnologia , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estudos de Amostragem , Texas/epidemiologia , Meios de Transporte/economia , Adulto JovemRESUMO
OBJECTIVE: To assess whether U.S.-Mexico border residents with diabetes 1) experience greater barriers to medical care in the United States of America versus Mexico and 2) are more likely to seek care and medication in Mexico compared to border residents without diabetes. METHODS: A stratified two-stage randomized cross-sectional health survey was conducted in 2009 - 2010 among 1 002 Mexican American households. RESULTS: Diabetes rates were high (15.4%). Of those that had diabetes, most (86%) reported comorbidities. Compared to participants without diabetes, participants with diabetes had slightly greater difficulty paying US$ 25 (P = 0.002) or US$ 100 (P = 0.016) for medical care, and experienced greater transportation and language barriers (P = 0.011 and 0.014 respectively) to care in the United States, but were more likely to have a person/place to go for medical care and receive screenings. About one quarter of participants sought care or medications in Mexico. Younger age and having lived in Mexico were associated with seeking care in Mexico, but having diabetes was not. Multiple financial barriers were independently associated with approximately threefold-increased odds of going to Mexico for medical care or medication. Language barriers were associated with seeking care in Mexico. Being confused about arrangements for medical care and the perception of not always being treated with respect by medical care providers in the United States were both associated with seeking care and medication in Mexico (odds ratios ranging from 1.70 - 2.76). CONCLUSIONS: Reporting modifiable barriers to medical care was common among all participants and slightly more common among 1) those with diabetes and 2) those who sought care in Mexico. However, these are statistically independent phenomena; persons with diabetes were not more likely to use services in Mexico. Each set of issues (barriers facing those with diabetes, barriers related to use of services in Mexico) may occur side by side, and both present opportunities for improving access to care and disease management.
OBJETIVO: Evaluar si las personas con diabetes que residen en la frontera mexicano-estadounidense 1) encuentran mayores barreras para obtener atención médica en los Estados Unidos de América que en México; y 2) acuden a México en busca de atención y medicación con mayor probabilidad que las personas no diabéticas que residen en la frontera. MÉTODOS: Durante el 2009 y el 2010, en una muestra de 1 002 hogares mexicano-estadounidenses, se llevó a cabo una encuesta transversal de salud en dos etapas, estratificada y aleatorizada. RESULTADOS: Las tasas de diabetes eran elevadas (15,4%). La mayor parte de las personas con diabetes (86%) notificaron comorbilidades. En comparación con los participantes no diabéticos, los afectados de diabetes experimentaban dificultades algo mayores para pagar US$ 25 (P = 0,002) o US$ 100 (P = 0,016) por recibir atención médica, y encontraban mayores barreras en materia de transporte e idioma (P = 0,011 y 0,014, respectivamente) para ser atendidos en los Estados Unidos, aunque era más probable que contaran con una persona o lugar adonde acudir en busca de atención médica y para ser sometidos a tamizaje. Una cuarta parte de los participantes acudían a México en busca de atención o medicamentos. Una edad menor y el haber vivido en México se asociaban con la búsqueda de atención en México, pero no el padecer diabetes. La presencia de múltiples barreras financieras se asociaba independientemente con una probabilidad aproximadamente tres veces mayor de acudir a México en busca de atención médica o medicación. Las barreras idiomáticas se asociaban con la búsqueda de atención en México. La confusión acerca de los trámites para recibir atención médica y la percepción de no recibir siempre un trato respetuoso por parte de los proveedores de atención médica en los Estados Unidos se asociaban con la búsqueda de atención y medicación en México (odds ratio, 1,70 - 2,76). CONCLUSIONES: La notificación de barreras modificables a la atención médica fue frecuente entre los participantes y algo más frecuente entre 1) las personas con diabetes; y 2) los que buscaban se atendidos en México. Sin embargo, estos fenómenos son estadísticamente independientes; no era más probable que las personas con diabetes utilizaran servicios en México. Ambos conjuntos de problemas (las barreras que deben afrontar las personas con diabetes, las barreras relacionadas con el uso de servicios en México) pueden coexistir, y proporcionan oportunidades para mejorar el acceso a la atención y el tratamiento de las enfermedades.
Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Adulto Jovem , Diabetes Mellitus/etnologia , Turismo Médico/estatística & dados numéricos , Americanos Mexicanos , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Barreiras de Comunicação , Comorbidade , Estudos Transversais , Diabetes Mellitus/economia , Diabetes Mellitus/terapia , Emigração e Imigração/estatística & dados numéricos , Acessibilidade aos Serviços de Saúde/economia , Inquéritos Epidemiológicos , Renda/estatística & dados numéricos , Cobertura do Seguro , Idioma , Indigência Médica/estatística & dados numéricos , Turismo Médico/economia , Americanos Mexicanos/psicologia , Americanos Mexicanos/estatística & dados numéricos , México/epidemiologia , México/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Estudos de Amostragem , Texas/epidemiologia , Meios de Transporte/economiaRESUMO
Healthcare models which recognize the equity principle have had to confront the challenge of providing healthcare for the poor and dispossessed. Healthcare premised on "human rights" strives to remove/ reduce barriers to access by a complete waiver of all fees in the public sector or various other subsidies to make healthcare more affordable. Social welfare programmes are held hostage to the vagaries of the economy and resource scarcity. The Alma-Ata's primary healthcare is inherently a health development strategy which embraces a wholistic approach to health and wellness. This strategy, by refocussing on the Millennium Development Goals, can therefore accommodate the innovations required to overcome the challenges posed by technological, financial, cultural and geographical factors to provide a better quality of life for all, but moreso for the poor and dispossessed.
Assuntos
Atenção à Saúde/organização & administração , Promoção da Saúde/organização & administração , Pobreza , Acessibilidade aos Serviços de Saúde/organização & administração , Humanos , Jamaica , Indigência Médica/estatística & dados numéricos , Objetivos Organizacionais , Qualidade de Vida , Classe Social , Seguridade SocialRESUMO
Healthcare models which recognize the equity principle have had to confront the challenge of providing healthcare for the poor and dispossessed. Healthcare premised on "human rights" strives to remove/reduce barriers to access by a complete waiver of all fees in the public sector or various other subsidies to make healthcare more affordable. Social welfare programmes are held hostage to the vagaries of the economy and resource scarcity. The Alma-Ata's primary healthcare is inherently a health development strategy which embraces a wholistic approach to health and wellness. This strategy, by refocussing on the Millennium Development Goals, can therefore accommodate the innovations required to overcome the challenges posed by technological, financial, cultural and geographical factors to provide a better quality of life for all, but moreso for the poor and dispossessed.
Los modelos de atención a la salud que reconocen el principio de la equidad han tenido que hacer frente al reto de brindar atención a la salud de los pobres y los desposeídos. La atención a la salud estipulada en los "derechos humanos" lucha por eliminar o reducir las barreras de acceso, a través de la completa exoneración de todos los pagos en el sector público y varios otros subsidios encaminados a poner los servicios de salud al alcance de todos. Los programas de bienestar social son rehenes de los caprichos de la economía y la escasez de recursos. La atención primaria a la salud en conformidad con Alma-Ata es en esencia una estrategia de desarrollo que se adhiere a un enfoque holístico de la salud y el bienestar. Esta estrategia, que reenfoca el Objectivos Desarrollo del Milenio, puede por tanto dar espacio a las innovaciones requeridas para superar los desafíos que los factores tecnológicos, financieros, culturales y geográficos presentan a la posibilidad de ofrecer una mejor calidad de vida a todos, pero sobre todo a los pobres y los desposeídos.
Assuntos
Humanos , Atenção à Saúde/organização & administração , Promoção da Saúde/organização & administração , Pobreza , Acessibilidade aos Serviços de Saúde/organização & administração , Jamaica , Indigência Médica/estatística & dados numéricos , Objetivos Organizacionais , Qualidade de Vida , Classe Social , Seguridade SocialRESUMO
PURPOSE: The worldwide prevalence of epilepsy is variable, estimated at 10//1,000 people, and access to treatment is also variable. Many people go untreated, particularly in resource-poor countries. OBJECTIVE: To estimate the prevalence of epilepsy and the proportion of people not receiving adequate treatment in different socioeconomic classes in Brazil, a resource-poor country. METHODS: A door-to-door survey was conducted to assess the prevalence and treatment gap of epilepsy in three areas of two towns in Southeast Brazil with a total population of 96,300 people. A validated screening questionnaire for epilepsy (sensitivity 95.8%, specificity 97.8%) was used. A neurologist further ascertained positive cases. A validated instrument for socioeconomic classification was used. RESULTS: Lifetime prevalence was 9.2/1,000 people [95% CI 8.4-10.0] and the prevalence of active epilepsy was 5.4/1,000 people. This was higher in the more deprived social classes (7.5/1,000 compared with 1.6/1,000 in the less deprived). Prevalence was also higher in elderly people (8.5/1,000). Thirty-eight percent of patients with active epilepsy had inadequate treatment (19% on no medication); the figures were similar in the different socioeconomic groups. CONCLUSION: The prevalence of epilepsy in Brazil is similar to other resource-poor countries, and the treatment gap is high. Epilepsy is more prevalent among less wealthy people and in elderly people. There is an urgent need for education in Brazil to inform people that epilepsy is a treatable, as well as preventable, condition.
Assuntos
Epilepsia/tratamento farmacológico , Epilepsia/epidemiologia , Acessibilidade aos Serviços de Saúde , Classe Social , Adolescente , Adulto , Fatores Etários , Anticonvulsivantes/uso terapêutico , Brasil/epidemiologia , Criança , Pré-Escolar , Quimioterapia Combinada , Feminino , Pesquisas sobre Atenção à Saúde , Educação em Saúde , Acessibilidade aos Serviços de Saúde/normas , Humanos , Masculino , Indigência Médica/estatística & dados numéricos , Pessoa de Meia-Idade , Pobreza/estatística & dados numéricos , Prevalência , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The incidence of skin cancer in Chile has increased in recent years. OBJECTIVE: To associate variables with skin cancer in Chile through indices generated using multivariate descriptive statistical techniques. MATERIAL AND METHOD: During May 2004, information was gathered from demographic, meteorological and clinical data from Chile corresponding to fiscal year 2001, the latest complete, official information available for the country's Health Services as a whole. The variables developed by the following were studied: the National Statistics Institute (INE), the Ministry of Health (MINSAL), the Ministry of Planning and Cooperation (MIDEPLAN), the National Health Fund (FONASA), the Chilean Meteorological Directorate, Federico Santa María Technical University and the Directorate-General for Water. A Principal Component Analysis (PCA) was then performed on the data obtained. RESULTS: The first three principal components were selected, with a cumulative explained variance percentage of 54.48 %. The first principal component explains 24.92 % of the variance, and is related to climatic and geographic variables. The second principal component explains 15.77 % of the variance, and is mainly related to FONASA's beneficiary population and the poverty rate. The mortality rate from skin cancer runs significantly against this component. The third principal component explains 13.79 % of the variance, and is related to population characteristics, such as total catchment population, female population and urban population. CONCLUSION: Performing PCA is useful in studying the factors associated with skin cancer.
Assuntos
Neoplasias Cutâneas/epidemiologia , Adulto , Idoso , Área Programática de Saúde , Chile/epidemiologia , Dermatologia , Feminino , Geografia , Hospitais/estatística & dados numéricos , Humanos , Masculino , Indigência Médica/estatística & dados numéricos , Conceitos Meteorológicos , Pessoa de Meia-Idade , Neoplasias Induzidas por Radiação/epidemiologia , Pobreza/estatística & dados numéricos , Análise de Componente Principal , Fatores de Risco , População Rural/estatística & dados numéricos , Luz Solar/efeitos adversos , População Urbana/estatística & dados numéricos , Recursos HumanosAssuntos
Humanos , Conservação dos Recursos Naturais , Indicadores Econômicos , Indicadores Sociais , Economia/estatística & dados numéricos , Produto Interno Bruto , Indigência Médica/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Salários e Benefícios/estatística & dados numéricos , Justiça Social/estatística & dados numéricosRESUMO
The aim of this study is to examine whether there is socioeconomic equity in health care utilization in Curaçao, Netherlands Antilles. We explore how educational level is related to utilization of GPs, specialists, hospitals; dentists and physiotherapists, taking into account the effects of sex, age and inequalities in health. The study also examines whether these relationships vary according to the unit of analysis: probability (or incidence) of services use versus overall volume of contacts. The data were derived from the Curaçao Health Study, a health interview survey among a random sample (N = 2248) of the non-institutionalized population aged 18 and over. The results indicate that there is socioeconomic inequity in the probability of health care utilization in Curaçao. People with a higher educational level are more likely to consult a specialist, dentist or physiotherapist, and are also more likely to be hospitalized. This is not only the case when the mediating effects of socioeconomic inequalities in health (need) are taken into account, but also before adjustment for health inequalities. In other words: there appears to be both vertical inequity (i.e. greater needs for services are not met by greater use) and horizontal inequity (i.e. similar needs for care are not met by similar levels of services use). The observed inequalities in use of specialists and hospitals contrast with findings from international research. The volume of health services use (i.e. the numbers of consultations) appears to be hardly connected with a person's position in the SES hierarchy; only dental services are used more extensively by higher educated individuals.
Assuntos
Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Indigência Médica/estatística & dados numéricos , Equipe de Assistência ao Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Escolaridade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Antilhas Holandesas , Revisão da Utilização de Recursos de SaúdeRESUMO
This investigation examines data on 13,000 Mexican Americans, Puerto Ricans, and Cuban Americans between 6 months and 74 years of age who were interviewed from 1982 through 1984 in the Hispanic Health and Nutrition Examination Survey. In addition, data from the 1989 Current Population Survey (N = 145,000) conducted by the US Bureau of the Census are presented for the white and black non-Hispanic populations as well as the three Hispanic national origin groups. The study revealed that over one third of the Mexican-American population, one fifth of the Puerto Rican population, and one fourth of the Cuban-American population is uninsured for medical expenditures compared with one fifth of the black, non-Hispanic population and one tenth of the white, non-Hispanic population. Furthermore, compared with Hispanics with private health insurance, uninsured Hispanics are less likely to have a regular source of health care, less likely to have visited a physician in the past year, less likely to have had a routine physical examination, and less likely to rate their health status as excellent or very good.
Assuntos
Hispânico ou Latino/estatística & dados numéricos , Seguro Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Estudos Transversais , Cuba/etnologia , Coleta de Dados , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Inquéritos Epidemiológicos , Humanos , Lactente , Indigência Médica/estatística & dados numéricos , México/etnologia , Pessoa de Meia-Idade , Inquéritos Nutricionais , Porto Rico/etnologia , Estados Unidos/epidemiologiaRESUMO
Fifty-four years after the first pacemaker implant was carried out on humans, the first successful implantation of a permanent pacing system was performed in Barbados in 1986, through the collaborative efforts of the Pacemaker Industry, Rotary International and Rotary Barbados, The Watson Clinic Foundation of Florida and The Queen Elizabeth Hospital, Barbados. In a programme in which pacemakers are supplied and implanted, free of cost to indigent individuals, 26 pacemaker systems have been implanted in 16 males and 10 females, average age 64 years, and age range 27-86 years. There were 17 Barbadians, 4 Antiguans, 2 St. Lucians and one each from Dominica, St. Vincent and Montserrat. The major indication for implantation was symptomatic third degree atrio-ventricular block, which occured in 11 (42.3 percent) of patients. Recurrent dizziness and/or loss of consciousness was the most common symptom - in 21 (80 percent) of patients, and the most common underlying cardiac conditions were myocardial ischaemia in 10 patients, and fibrosis in 7 patients. Cephalic vein cut down and subclavian vein puncture were performed on fourteen (14) and twelve (12) patients respectively. All pacemakers implanted were of the "ventricular pacing and sensing type (VVI)", of which 13 were programmable. Seventeen of the systems were provided by The Intermedics Pacemaker Company and nine by American Pacemakers. Twenty-three (88.5 percent) patients had an entirely successful outcome post implantation with complete resolution of symptoms. One patient died 5 weeks after implantation as a direct result of the procedure, another died within hours of emergengy implantation which had been carried out following several episodes of cardiac arrest, the pacing system was functioning normally at the time of death. A third suffered a cerebro-vascular accident with a progressively poorly functioning left ventricle some months after implantation, again the pacing system was functioning normally. Finally, one patient with previously diagnosed ischaemic heart disease suffered an acute myocardial infarction two months post implant from which he made an uneventful recovery with the pacing system intact. Two patients contracted insignificant wound infections. Pacemaker follow-up programmes aim by continued long-term follow-up to reduce the incidence of sudden and unpredicted pacemaker system failure and detect sub-standard performance of some models. Such a computer-assisted follow-up programme was started at the Queen Elizabeth Hospital, Barbados, on April 3, 1985, with more recently an associated programme at Holberton Hospital, Antigua. Sixty-five patients are registered in the clinic, 33 of whom are males and 32 females, average age 60 years, range 6-88 years. Forty (61.5 percent) patients in the pacemaker follow-up clinic have pacemaker systems in situ with 18 systems being from Intermedics Company, 9 American, 6 Medtronic, 4 Teletronics and one each from Vitatron and Cordis. During the follow-up period two patients had premonitory symptoms and electro-stimulogram derived data to suggest impending system failure, which duly occurred in both patients, one of whom had the successful implantation of a new pacing system while the other had a change of the battery system. Of the 25 patients registered and considered potential candidates for pacemaker implantation, one with asymptomatic complete atrio-ventricular block died. The successful implementation of a permanent pacemaker implantation and follow-up programme for Barbados and the Eastern Caribbean has been established. The major indication for implantation has been symptomatic acquired complete atrio-ventricular block. The main challenge of the computer-assisted pacemaker follow-up programme has been the need to monitor, be familiar with, and have programming equipment appropriate for pacemakers manufactured by several companies. The clinic has been particularly successful in the early detection of pacemaker system failure and the meticulous development of statistical patient data (AU)