Estimate the effects of non-pharmacological interventions used to prevent the spread of COVID-19 on the quality of life, measured by Quality Adjusted Life Years (QALYs).
A survey on 1,506 heads of ...households from Chile in May of 2022. Respondents were asked basic socioeconomic questions and a version of the EQ-5D-5L questionnaire that was used to calculate the evolution of HRQoLs. Comparisons of means in HRQoLs measures before the pandemic, at the peak of restrictions, and at the moment of the survey were performed.
The average HRQoL of the population before the pandemic was similar to other countries in the region (0.96). At the peak of restrictions (June 2020-August 2021), the average HRQoL decreased to 0.87 (-9%). At the time of survey (May 2022), the average HQRoL was 0.91 (4%). Assuming the recovery trend continued, pre-pandemic HRQoLs would be reached by January 2024. Altogether, the pandemic would have reduced QALYs by 0.2 in average. The effect is larger and the recovery slower among women. Our estimates imply that the restrictions to manage the pandemic came at a cost of 2.4 months of life years for the average (surviving) person, 1.8 months for men and 3.4 for women.
Our results suggest that COVID-19 had worse effects on life quality than previously thought. These effects are more significant among women than among men. Efforts to improve life quality and speed up its recovery could have large positive consequences for the population.
Celotno besedilo
Dostopno za:
DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
In 2011, Chile added 12 mandatory extra weeks of maternity leave (ML). In January 2015, a pay-for-performance (P4P) strategy was included in the primary healthcare system, incorporating exclusive ...breastfeeding (EBF) promotion actions. The COVID-19 pandemic led to healthcare access difficulties and augmented household workloads. Our aim was to evaluate the effect of a 24-week ML, the P4P strategy, and COVID-19 on EBF prevalence, at 3 and 6 months in Chile. Aggregated EBF prevalence data from public healthcare users nationwide (80% of the Chilean population) was collected by month. Interrupted time series analyses were used to quantify changes in EBF trends from 2009 to 2020. The heterogeneity of EBF changes was assessed by urban/setting and across geographic settings. We found no effect of ML on EBF; the P4P strategy increased EBF at 3 months by 3.1% and 5.7% at 6 months. COVID-19 reduced EBF at 3 months by - 4.5%. Geographical heterogeneity in the impact of the two policies and COVID-19 on EBF was identified. The null effect of ML on EBF in the public healthcare system could be explained by low access from public healthcare users to ML (20% had access to ML) and by an insufficient ML duration (five and a half months). The negative impact of COVID-19 on EBF should alert policy makers about the crisis's effect on health promotion activities.
Disruptions in essential health services during the COVID-19 pandemic have been reported in several countries. Yet, patterns in health service disruption according to country responses remain ...unclear. In this paper, we investigate associations between the stringency of COVID-19 containment policies and disruptions in 31 health services in 10 low- middle- and high-income countries in 2020.
Using routine health information systems and administrative data from 10 countries (Chile, Ethiopia, Ghana, Haiti, Lao People's Democratic Republic, Mexico, Nepal, South Africa, South Korea, and Thailand) we estimated health service disruptions for the period of April to December 2020 by dividing monthly service provision at national levels by the average service provision in the 15 months pre-COVID (January 2019-March 2020). We used the Oxford COVID-19 Government Response Tracker (OxCGRT) index and multi-level linear regression analyses to assess associations between the stringency of restrictions and health service disruptions over nine months. We extended the analysis by examining associations between 11 individual containment or closure policies and health service disruptions. Models were adjusted for COVID caseload, health service category and country GDP and included robust standard errors.
Chronic disease care was among the most affected services. Regression analyses revealed that a 10% increase in the mean stringency index was associated with a 3.3 percentage-point (95% CI -3.9, -2.7) reduction in relative service volumes. Among individual policies, curfews, and the presence of a state of emergency, had the largest coefficients and were associated with 14.1 (95% CI -19.6, 8.7) and 10.7 (95% CI -12.7, -8.7) percentage-point lower relative service volumes, respectively. In contrast, number of COVID-19 cases in 2020 was not associated with health service disruptions in any model.
Although containment policies were crucial in reducing COVID-19 mortality in many contexts, it is important to consider the indirect effects of these restrictions. Strategies to improve the resilience of health systems should be designed to ensure that populations can continue accessing essential health care despite the presence of containment policies during future infectious disease outbreaks.
Celotno besedilo
Dostopno za:
CEKLJ, DOBA, IZUM, KILJ, NUK, PILJ, PNG, SAZU, SIK, UILJ, UKNU, UL, UM, UPUK
4.
Health assessment and the capability approach López Barreda, Rodrigo; Robertson-Preidler, Joelle; Bedregal García, Paula
Global bioethics,
01/2019, Letnik:
30, Številka:
1
Journal Article
Recenzirano
Odprti dostop
Health has an important role in the achievement of a good quality of life. Many public policies intended to enhance individual and population health. Amartya Sen's Capability Approach (CA) offers a ...framework to assess well-being, as well as interventions seeking to increase it. There are, however, important practical challenges that must be faced before applying CA to concrete situations, such as health. One of these challenges is defining whether it is functioning or a capability that is the feature to be assessed. Moreover, some aspects of freedom that are relevant for CA are frequently neglected, such as agency. These aspects must be considered when performing a health assessment using the CA as a framework. A health assessment using the CA as a framework should include indicators based on the achieved dimension (health functioning), resources and conversion factors (health capability), and freedom to achieve (agency).
DEPPAS ("Dispositivo Electrónico Personal y Portable en Salud" or Personal, Portable Electronic Health Device in English) is a portable device in form of a bracelet that allows storing electronic ...health records of older adults experiencing chronic illnesses. The device seeks to support the vital sustainability of older adults by storing critical health information when electronic or paper records have been lost as a consequence of a disaster. Older adults are particularly vulnerable to experience negative consequences in this context. The present study explores the end-user acceptability of DEPPAS in order to inform the next design stages of the device.
Twenty home-dwelling urban male and female older adults enrolled in a chronic health management program were invited to participate in two focus groups. A prototype of DEPPAS was presented and reactions to health service disruption scenarios were explored. Focus groups were transcribed. Content analysis based on the Technology Acceptance Model was conducted.
Older adults are acutely aware of their vulnerable health status. Participants report overall positive reactions to DEPPAS. The device was associated with feelings of relief and an increased sense of control over their health management. DEPPAS is perceived as useful, usable, and safe. Even though concerns regarding confidentiality were raised, benefits are perceived as more relevant than potential risks. Participants agree that its usefulness could be extended beyond disaster situations to everyday health care management. Implications for future development and limitations are discussed.
The conceptual design DEPPAS shows a high level of acceptability by this end user and a high potential to be integrated with other complementary technologies (e.g. GPS, medication reminders) that could significantly contribute to improving health management in disaster situations.
Introducción: La violencia es un problema de salud mental que se ha abordado poco en escolares respecto a sus diferencias por sexo. En particular, la percepción de violencia por escolares es de ...importancia para el diseño de intervenciones comunitarias en salud mental. Objetivo: Analizar las diferencias en la magnitud de la percepción de violencia según contexto y tipo de exposición por sexo y la asociación con actitudes parentales percibidas por estudiantes de básica de colegios municipales chilenos. Método: Se realizó un diseño transversal en 6879 escolares (45,5% hombres) de 4-6° básico de escuelas municipales de seis comunas de Chile. Se aplicó un cuestionario que incluyó variables sociodemográficas, la percepción de violencia en el hogar, barrio y colegio (observada y personalmente vivenciada); y actitudes parentales. Se analizaron puntajes y asociación de variables, y además, se realizó análisis de regresión. Resultados: El lugar de mayor percepción de violencia por escolares de ambos sexos es en el colegio. En todos los contextos y tipos de exposición los hombres perciben más violencia que las mujeres (p<0,001). Las mujeres perciben mejores actitudes parentales que los hombres (p<0,05). Se encontraron correlaciones negativas significativas entre percepción de violencia y algunas actitudes parentales como: apoyo emocional otorgado, preocupación por la escuela y por otros aspectos de la vida. Conclusión: La alta frecuencia de percepción de violencia en diversos contextos y las diferencias por sexo encontradas nos abre a una reflexión en perspectiva de género, fundamental para la política pública.
Resumen: Introducción: los residentes de especialidad médica están expuestos a un alto nivel de burnout lo cual impacta negativamente en el profesionalismo. Esto ha promovido que los programas de ...residencias instalen curricularmente actividades de bienestar y autocuidado. Este estudio busca identificar la presencia de actividades de autocuidado/bienestar en residencias de psiquiatría de Chile y conocer la opinión docente respecto del tema. Materiales y métodos: se realizó un estudio descriptivo transversal invitando vía correo electrónico a 80 docentes de 3 departamentos de psiquiatría a contestar un cuestionario sobre el tema de bienestar/autocuidado de sus residentes en sus programas de formación. Se realizó un análisis cuantitativo de los datos. Resultados: un 69,4% de los encuestados señaló que su residencia no cuenta con contenidos curriculares formales o un programa de autocuidado/bienestar para sus residentes. Las actividades existentes para las residentes relacionadas al autocuidado/bienestar y mencionadas por los docentes son: supervisión, resolución de conflictos, habilidades de comunicación y apoyo o trabajo grupal guiado. Las principales barreras son la limitación de tiempo, la falta de conocimiento y el financiamiento. Discusión: el bienestar de los residentes ha ganado relevancia en los últimos años. El Consejo de Acreditación de Educación Médica para Graduados (ACGME) lo promueve activamente. En Chile, según los programas encuestados, hay poca presencia sistemática de actividades estandarizadas o programas dirigidos al autocuidado y bienestar de este grupo. Parece necesario incluir este aspecto considerando el impacto del burnout en el personal de salud especialmente en un contexto de pandemia o crisis sanitaria.
Aim
To determine the association between duration of untreated psychosis (DUP) and symptoms remission in a hospitalized first‐episode psychosis cohort.
Methods
Inpatients with a first‐episode ...non‐affective psychosis were recruited. Subjects were divided into two groups of long and short DUP using a 3‐month cut‐off point, and this was related to remission at 10 weeks of treatment. Multivariate analyses were performed.
Results
Fifty‐five inpatients were included. There were no differences in remission rates of positive symptoms. Up to 76.5% of the patients with a short DUP (<3 months) achieved remission of negative symptoms versus 31.6% in the DUP ≥ 3 months group (P = 0.003). After controlling for relevant factors, patients with a shorter DUP were still three times more likely to achieve negative symptoms remission (HR: 3.04, 95% CI 1.2–7.5).
Conclusions
DUP is a prognostic factor that should be considered at an early stage to identify a ‘high risk’ subgroup of persistent negative symptoms.
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