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Albayrak S, Aydın Z. Pediatric renal caregiver burden scale: Psychometric properties of the Turkish version. J Pediatr Nurs 2024; 77:e593-e601. [PMID: 38797645 DOI: 10.1016/j.pedn.2024.05.026] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 02/14/2024] [Revised: 05/19/2024] [Accepted: 05/19/2024] [Indexed: 05/29/2024]
Abstract
BACKGROUND AND PURPOSE As treatment increasingly shifts from hospital settings to home environments, the burden on caregivers of chronic kidney disease patients has the potential to increase further. It is essential to assess the experience and burdens of caregivers of children with chronic kidney disease to identify caregivers' needs and provide targeted interventions when necessary. Hence, this study aimed to assess the psychometric properties of the Turkish version of the Pediatric Renal Caregiver Burden Scale (PR-CBS). METHODS This methodological study involved 215 parents with children aged 5-18 and was conducted between December 5, 2021, and August 15, 2022. The Content Validity Index, Explanatory and Confirmatory Factor Analyses, Cronbach's alpha, Test-retest reliability, and item-total score correlation were used in the data analysis. The Turkish version of PR-CBS test-retest reliability analysis was performed with 30 parents after four weeks. RESULTS PR-CBS consists of 20 items and five sub-dimensions (illness worries, impact on self, impact on child, responsibility, institutional burden). The Turkish version of the PR-CBS and its five dimensions demonstrated satisfactory internal consistency and reliability. The construct validity of the Turkish version of the PR-CBS was confirmed by Explanatory Factor Analyses and was validated with Confirmatory Factor Analysis. CONCLUSIONS PR-CBS is a valid and reliable tool to assess the burden of caregivers of children with chronic kidney disease in Turkish society. IMPLICATIONS FOR PRACTICE By assessing the care burden of families, pediatric nurses can enhance the opportunity to provide quality care and support to caregivers and their patients.
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Affiliation(s)
- Selvinaz Albayrak
- Istinye University Faculty of Health Sciences, Nursing Department, Istanbul, Turkey.
| | - Zehra Aydın
- Atlas University Faculty of Health Sciences, Nursing Department, Istanbul, Turkey.
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Martínez-Pérez JE, Quesada-Torres JA, Martínez-Gabaldón E. Predicting healthcare expenditure based on Adjusted Morbidity Groups to implement a needs-based capitation financing system. HEALTH ECONOMICS REVIEW 2024; 14:33. [PMID: 38717699 PMCID: PMC11077809 DOI: 10.1186/s13561-024-00508-4] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 12/27/2023] [Accepted: 04/26/2024] [Indexed: 05/12/2024]
Abstract
BACKGROUND Due to population aging, healthcare expenditure is projected to increase substantially in developed countries like Spain. However, prior research indicates that health status, not merely age, is a key driver of healthcare costs. This study analyzed data from over 1.25 million residents of Spain's Murcia region to develop a capitation-based healthcare financing model incorporating health status via Adjusted Morbidity Groups (AMGs). The goal was to simulate an equitable area-based healthcare budget allocation reflecting population needs. METHODS Using 2017 data on residents' age, sex, AMG designation, and individual healthcare costs, generalized linear models were built to predict healthcare expenditure based on health status indicators. Multiple link functions and distribution families were tested, with model selection guided by information criteria, residual analysis, and goodness-of-fit statistics. The selected model was used to estimate adjusted populations and simulate capitated budgets for the 9 healthcare districts in Murcia. RESULTS The gamma distribution with logarithmic link function provided the best model fit. Comparisons of predicted and actual average costs revealed underfunded and overfunded areas within Murcia. If implemented, the capitation model would decrease funding for most districts (up to 15.5%) while increasing it for two high-need areas, emphasizing allocation based on health status and standardized utilization rather than historical spending alone. CONCLUSIONS AMG-based capitated budgeting could improve equity in healthcare financing across regions in Spain. By explicitly incorporating multimorbidity burden into allocation formulas, resources can be reallocated towards areas with poorer overall population health. Further policy analysis and adjustment is needed before full-scale implementation of such need-based global budgets.
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Affiliation(s)
| | - Juan-Antonio Quesada-Torres
- Department of Health of the Region of Murcia, 4 Pinares Street, Murcia, 30001, Spain
- International Doctorate School of the University of Murcia (EIDUM), PhD Program in Economics (DEcIDE), Murcia, Spain
| | - Eduardo Martínez-Gabaldón
- Department of Financial Economics and Accounting. University of Alicante, Carrer San Vicente de Raspeig, Alicante, 03690, Spain
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Antón J, Moreno Ruzafa E, Lopez Corbeto M, Bou R, Sánchez Manubens J, Carriquí Arenas S, Calzada Hernández J, Bittermann V, Estepa Guillén C, Mosquera Angarita J, Rodríguez Díez L, Iglesias E, Marti Masanet M, Lopez Montesinos B, González Fernández MI, de Lossada A, Peral C, Valderrama M, Llevat N, Montoro Álvarez M, Calvo Penadés I. Real-World Health Care Outcomes and Costs Among Patients With Juvenile Idiopathic Arthritis in Spain. JOURNAL OF HEALTH ECONOMICS AND OUTCOMES RESEARCH 2023; 10:141-149. [PMID: 38145114 PMCID: PMC10742379 DOI: 10.36469/001c.85088] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/28/2023] [Accepted: 08/07/2023] [Indexed: 12/26/2023]
Abstract
Background: Juvenile idiopathic arthritis (JIA) is the most frequent chronic rheumatic disease in children. If inflammation is not adequately treated, joint damage, long-term disability, and active disease during adulthood can occur. Identifying and implementing early and adequate therapy are critical for improving clinical outcomes. The burden of JIA on affected children, their families, and the healthcare system in Spain has not been adequately assessed. The greatest contribution to direct costs is medication, but other expenses contribute to the consumption of resources, negatively impacting healthcare cost and the economic conditions of affected families. Objective: To assess the direct healthcare, indirect resource utilization, and associated cost of moderate-to-severe JIA in children in routine clinical practice in Spain. Methods: Children were enrolled in this 24-month observational, multicentric, cross-sectional, retrospective study (N = 107) if they had been treated with biologic disease-modifying anti-rheumatic drugs (bDMARDs), had participated in a previous study (ITACA), and continued to be followed up at pediatric rheumatology units at 3 tertiary Spanish hospitals. Direct costs included medication, specialist and primary care visits, hospitalizations, emergency visits or consultations, surgeries, physiotherapy, and tests. Indirect costs included hospital travel expenses and loss of caregiver working hours. Unitary costs were obtained from official sources (€, 2020). Results: Overall, children had inactive disease/low disease activity according to JADAS-71 score and very low functional disability as measured by Childhood Health Assessment Questionnaire score. Up to 94.4% of children received treatment, mainly with bDMARDs as monotherapy (84.5%). Among anti-TNFα treatments, adalimumab (47.4%) and etanercept (40.2%) were used in similar proportions. Annual mean (SD) total JIA cost was €7516.40 (€5627.30). Average cost of pharmacological treatment was €3021.80 (€3956.20), mainly due to biologic therapy €2789.00 (€3399.80). Direct annual cost (excluding treatments) was €3654.60 (€3899.00). Indirect JIA cost per family was €747.20 (€1452.80). Conclusion: JIA causes significant costs to the Spanish healthcare system and affected families. Public costs are partly due to the high cost of biologic treatments, which nevertheless remain an effective long-term treatment, maintaining inactive disease/low disease activity state; a very low functional disability score; and a good quality of life.
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Affiliation(s)
- Jordi Antón
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
- Universitat Autònoma de Barcelona, Barcelona, Spain
| | | | - Mireia Lopez Corbeto
- Pediatric Rheumatology Section, Vall d'Hebron Barcelona Hospital Campus, Barcelona, Spain
| | - Rosa Bou
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | - Judith Sánchez Manubens
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
- Servei de Pediatria, Hospital Parc Taulí Sabadell
| | | | | | - Violetta Bittermann
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | | | | | | | - Estíbaliz Iglesias
- Pediatric Rheumatology Department Hospital San Joan de Déu, Barcelona, Spain
| | - Miguel Marti Masanet
- Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
| | - Berta Lopez Montesinos
- Pediatric Rheumatology Unit, Hospital Universitario y Politécnico La Fe, Valencia, Spain
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Bandeira-de Oliveira M, Aparicio-González T, Del Cura-González I, Suárez-Fernández C, Rodríguez-Barrientos R, Barrio-Cortes J. Adjusted morbidity groups and survival: a retrospective cohort study of primary care patients with chronic conditions. BMC PRIMARY CARE 2023; 24:103. [PMID: 37081395 PMCID: PMC10120109 DOI: 10.1186/s12875-023-02059-9] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 06/01/2022] [Accepted: 04/12/2023] [Indexed: 04/22/2023]
Abstract
BACKGROUND Chronic conditions are one of the main determinants of frailty, functional disability, loss of quality of life and the number one cause of death worldwide. This study aimed to describe the survival of patients with chronic conditions who were followed up in primary care according to the level of risk by adjusted morbidity groups and to analyse the effects of sex, age, clinician and care factors on survival. METHODS This was a longitudinal observational study of a retrospective cohort of patients with chronic conditions identified by the adjusted morbidity group stratifier of the electronic medical records in a primary health centre of the Region of Madrid, which has an assigned population of 18,107 inhabitants. The follow-up period was from June 2015 to June 2018. A description of survival according to the Kaplan-Meier method and Cox proportional hazards multivariate regression model was used to analyse the effects of sex, age, clinician and care factors. RESULTS A total of 9,866 patients with chronic conditions were identified; 77.4% (7,638) had a low risk, 18.1% (1,784) had a medium risk, and 4.5% (444) had a high risk according to the adjusted morbidity groups. A total of 477 patients with chronic conditions died (4.8%). The median survival was 36 months. The factors associated with lower survival were age over 65 years (hazard ratio [HR] = 1.3; 95% confidence interval [CI] = 1.1-1.6), receiving palliative care (HR = 3.4; 95% CI = 2.6-4.5), high versus low risk level (HR = 2.4; 95% CI = 1.60-3.7), five chronic conditions or more (HR = 1.5; 95% CI = 1.2-2), complexity index (HR = 1.01; 95% CI = 1.02-1.04) and polymedication (HR = 2.6; 95% CI = 2.0-3.3). CONCLUSIONS There was a gradual and significant decrease in the survival of patients with chronic conditions according to their level of risk as defined by adjusted morbidity groups. Other factors, such as older age, receiving palliative care, high number of chronic conditions, complexity, and polymedication, had a negative effect on survival. The adjusted morbidity groups are useful in explaining survival outcomes and may be valuable for clinical practice, resource planning and public health research.
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Affiliation(s)
| | | | - Isabel Del Cura-González
- Research Unit. Primary Care Management, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Department of Medical Specialties and Public Health, Rey Juan Carlos University, Madrid, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain
| | - Carmen Suárez-Fernández
- University Hospital of La Princesa, Madrid, Spain
- Department of Medicine, Autonomous University of Madrid, Madrid, Spain
| | - Ricardo Rodríguez-Barrientos
- Research Unit. Primary Care Management, Madrid, Spain
- Gregorio Marañón Health Research Institute, Madrid, Spain
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain
| | - Jaime Barrio-Cortes
- Research Unit. Primary Care Management, Madrid, Spain.
- Gregorio Marañón Health Research Institute, Madrid, Spain.
- Research Network on Chronicity, Primary Care and Prevention and Health Promotion, Carlos III Health Institute, Madrid, Spain.
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain.
- Faculty of Health, Camilo José Cela University, Madrid, Spain.
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Antoñón M, Pernía-Sánchez JV, Cancho-Soto T, Segovia-Molina I, Díez-Monge N, Cano A. Asthma control in children, socioeconomic inequality and health care. An Pediatr (Barc) 2023; 98:353-361. [PMID: 37055301 DOI: 10.1016/j.anpede.2022.12.005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2022] [Accepted: 12/29/2022] [Indexed: 04/15/2023] Open
Abstract
INTRODUCTION Socioeconomic inequality (SEI) can adversely affect asthma control. The aim of this study was to establish the association of SEI with asthma control in children and caregiver quality of life. METHODS We assessed socioeconomic status based on the area of residence, according to the at risk of poverty rate (ARPR). After stratifying the paediatric population of Castilla y León (Spain) in ARPR tertiles, we selected participants by stratified random sampling, and identified children with asthma aged 6-14 years from the health records of primary care centres. We collected data through questionnaires completed by parents. The primary outcomes were asthma control and caregiver quality of life. We assessed their association with SEI, health care quality measures and individual factors (such as parental educational attainment) by means of multivariate regression models. RESULT The ARPR tertile was not associated with asthma control, quality of life or health care quality. A medium or high maternal educational attainment was associated with a lower risk of making an unscheduled or urgent visit (OR = .50; 95% CI, .27-.95; P = .034) and paternal educational attainment was associated with a lower risk of uncontrolled asthma (OR = 0.51; 95% CI, .28-.94; P = .030). CONCLUSION In the sample under study, SEI assessed at the local level was not associated with asthma control in children. Other factors, such as parental educational attainment, may have a protective effect.
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Affiliation(s)
- Miguel Antoñón
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | | | - Teresa Cancho-Soto
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Inés Segovia-Molina
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain
| | - Nuria Díez-Monge
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain
| | - Alfredo Cano
- Servicio de Pediatría, Hospital Universitario Río Hortega, Valladolid, Spain; Facultad de Medicina, Universidad de Valladolid, Valladolid, Spain.
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Control del asma en niños, desigualdad socioeconómica y asistencia sanitaria. An Pediatr (Barc) 2023. [DOI: 10.1016/j.anpedi.2022.12.009] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/16/2023] Open
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Marangoz Y, Akin Sari B, Özçay F, Haberal M. Association of Liver Transplant and Attention-Deficit Hyperactivity Disorder: A Single-Center Experience. EXP CLIN TRANSPLANT 2023. [PMID: 36656110 DOI: 10.6002/ect.2022.0257] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/20/2023]
Abstract
OBJECTIVES This prospective cohort study aimed to determine the prevalence of attention-deficit hyperactivity disorder and to reveal how the diagnosis of attention-deficit/hyperactivity disorder can be made most accurately in children with liver transplant. MATERIALS AND METHODS We studied a group of 62 children from 6 and 18 years old who underwent liver transplant at least 1 year previous to our study and who were followed up in the Department of Pediatric Gastroenterology. A child and adolescent psychiatrist evaluated all liver transplant patients for attention- deficit hyperactivity disorder based on the criteria of the Diagnostic and Statistical Manual of Mental Disorders, Fifth Edition. The Kiddie Schedule for Affective Disorders and Schizophrenia (in Turkish) was applied to the children. The Kiddie Schedule and the Conners Parent Rating Scale were applied to the children's parents. The Conners Teacher Rating Scale was applied to the children's teachers. RESULTS The frequency of attention-deficit hyperactivity disorder in the sample was found to be 24.5% according to Kiddie Schedule, 45.9% according to the Conners Parent Rating Scale, and 24% according to the Conners Teacher Rating Scale. However, clinical examination showed that 9.67% of the children had attention-deficit hyperactivity disorder. CONCLUSIONS We concluded that detailed clinical examination is more important than neuropsychological tests and scales when diagnosing attention-deficit hyperactivity disorder in pediatric liver transplant recipients.
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Affiliation(s)
- Yildiz Marangoz
- From the Department of Pediatrics, Faculty of Medicine, Baskent University, Ankara, Turkey
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8
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Stotsky MV, Henning E. Commentary: Developing a Measure of Inpatient Rehabilitation Treatment Beliefs and Expectations for Youth With Chronic Illness. J Pediatr Psychol 2023; 48:14-16. [PMID: 35997553 DOI: 10.1093/jpepsy/jsac065] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/05/2022] [Revised: 07/11/2022] [Accepted: 07/12/2022] [Indexed: 01/17/2023] Open
Affiliation(s)
- Mimi V Stotsky
- Department of Behavioral Psychology, Kennedy Krieger Institute, USA.,Johns Hopkins University School of Medicine, USA
| | - Ellen Henning
- Department of Behavioral Psychology, Kennedy Krieger Institute, USA
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Díaz-García RS, Sánchez-Gómez A, López-Zambrano MA, Esteban-Vasallo MD, Cañellas Llabrés S, Gutiérrez Rodríguez MÁ, Lasheras Carbajo MD. Vaccination against influenza: Coverage and adherence in children under 15 years with high-risk medical conditions in the Community of Madrid. ANALES DE PEDIATRÍA (ENGLISH EDITION) 2023; 98:3-11. [PMID: 36496313 DOI: 10.1016/j.anpede.2022.07.006] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/29/2022] [Accepted: 07/18/2022] [Indexed: 12/12/2022] Open
Abstract
INTRODUCTION Vaccination against influenza is indicated in children at risk of complications or severe disease. The objective of this study was to describe the percentage of children aged less than 15 years with risk conditions vaccinated against influenza in the Community of Madrid, and to analyze the factors associated with adherence to vaccination throughout 3 vaccination campaigns. MATERIALS AND METHODS Population-based cross-sectional observational study of children aged 6 months to 14 years with conditions that indicated influenza vaccination at the beginning of the 2018-2019 campaign. Electronic population registers were used. We described the percentage of children vaccinated in 3 consecutive campaigns, and assessed the association of adherence to vaccination with demographic and socioeconomic variables and risk conditions using bivariate and multivariate analysis. RESULTS The vaccination coverage was 15.6% in the 2018-2019 campaign. The adherence to vaccination was 65.9%. The variables associated with greater adherence were age greater than 2 years, especially in the 6-10 years group (aOR = 1.63; 95% CI, 1.43-1.85) and presenting more than one risk condition, especially 3 or more diseases (aOR = 1.80; 95% CI, 1.00-3.26). Diabetes mellitus was the disease associated most strongly with adherence (aOR = 2.15; 95% CI, 1.74-2.65). Adherence was lower in the immigrant population (aOR = 0.43; 95% CI, 0.36-0.51). We found no association between vaccination adherence and sex or socioeconomic status. CONCLUSIONS Vaccination coverage and adherence were suboptimal. Adherence to vaccination against influenza is associated with demographic and clinical conditions. Strategies need to be established to increase vaccination in children, with greater involvement of professionals and education of parents.
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Affiliation(s)
- Rosa S Díaz-García
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain; Servicio de Medicina Preventiva y Gestión de Calidad, Hospital General Universitario Gregorio Marañón, Madrid, Spain.
| | - Amaya Sánchez-Gómez
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - María Alejandra López-Zambrano
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - María Dolores Esteban-Vasallo
- Servicio de Informes de Salud y Estudios, Subdirección General de Vigilancia en Salud Pública, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - Soledad Cañellas Llabrés
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - María Ángeles Gutiérrez Rodríguez
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
| | - María Dolores Lasheras Carbajo
- Servicio de Prevención de la Enfermedad, Subdirección General de Prevención y Promoción de la Salud, Dirección General de Salud Pública, Consejería de Sanidad, Comunidad de Madrid, Madrid, Spain
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10
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Díaz-García RS, Sánchez-Gómez A, López-Zambrano MA, Esteban-Vasallo MD, Cañellas Llabrés S, Gutiérrez Rodríguez MÁ, Lasheras Carbajo MD. Cobertura y adherencia a la vacunación frente a la gripe en menores de 15 años con condiciones de riesgo en la Comunidad de Madrid. An Pediatr (Barc) 2022. [DOI: 10.1016/j.anpedi.2022.07.006] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
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11
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Company-Sancho MC, González-Chordá VM, Orts-Cortés MI. Variability in Healthcare Expenditure According to the Stratification of Adjusted Morbidity Groups in the Canary Islands (Spain). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:ijerph19074219. [PMID: 35409900 PMCID: PMC8998451 DOI: 10.3390/ijerph19074219] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/05/2022] [Revised: 03/29/2022] [Accepted: 03/30/2022] [Indexed: 02/06/2023]
Abstract
Morbidity is the main item in the distribution of expenditure on healthcare services. The Adjusted Morbidity Group (AMG) measures comorbidity and complexity and classifies the patient into mutually exclusive clinical categories. The aim of this study is to analyse the variability of healthcare expenditure on users with similar scores classified by the AMG. Observational analytical and retrospective study. Population: 1,691,075 subjects, from Canary Islands (Spain), aged over 15 years with data from health cards, clinical history, Basic Minimum Specialised Healthcare Data Set, AMG, hospital agreements information system and Electronic Prescriptions. A descriptive, bivariant (ANOVA coefficient η2) and multivariant analysis was conducted. There is a correlation between the costs and the weight of AMG (rho = 0.678) and the prescribed active ingredients (rho = 0.689), which is smaller with age and does not exist with the other variables. As for the influence of the AMG morbidity group on the total costs of the patient, the coefficient η2 (0.09) obtains a median effect in terms of the variability of expenditure, hence there is intra- and inter-group variability in the cost. In a first model created with all the variables and the cost, an explanatory power of 36.43% (R2 = 0.3643) was obtained; a second model that uses solely active ingredients, AMG weight, being female and a pensioner obtained an explanatory power of 36.4%. There is room for improvement in terms of predicting the expenditure.
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Affiliation(s)
- Maria Consuelo Company-Sancho
- Health Promotion Service, Directorate General for Public Health, Canary Islands Health Service, 35003 Las Palmas de Gran Canaria, Spain
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, 28029 Madrid, Spain
- Correspondence:
| | | | - María Isabel Orts-Cortés
- Nursing and Healthcare Research Unit (Investén-isciii), Institute of Health Carlos III, 28029 Madrid, Spain
- Department of Nursing, University of Alicante (BALMIS), Alicante Institute for Health and Biomedical Research (ISABIAL), 03690 Alicante, Spain;
- CIBER of Frailty and Healthy Ageing, (CIBERFES) Institute of Health Carlos III, 28029 Madrid, Spain
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Armas Junco L, Fernández-Hawrylak M. Teachers and Parents' Perceptions of Care for Students with Type 1 Diabetes Mellitus and Their Needs in the School Setting. CHILDREN (BASEL, SWITZERLAND) 2022; 9:143. [PMID: 35204864 PMCID: PMC8870444 DOI: 10.3390/children9020143] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/13/2021] [Revised: 01/19/2022] [Accepted: 01/21/2022] [Indexed: 11/16/2022]
Abstract
The high incidence of Type 1 Diabetes Mellitus (DM1) increases the likelihood of teachers having students with this illness in their classrooms. The objective of this study is to investigate the needs of students with DM1 during the school day from the perspective of both teachers and parents. A mixed methods study was designed and a questionnaire was administered to practicing teachers in Pre-primary Education, Primary Education, Compulsory Secondary Education, and Further Education, as well as Vocational Education within both the province and the city of Burgos (Castile and Leon, Spain) who may have students with DM1. Semi-structured interviews were also conducted with mothers and fathers, members of the Burgos Diabetics Association (ASDIBUR). In the questionnaires administered to the teaching staff, 54.8% affirmed that they knew of students with DM1 at their centers. Of those questioned, 51.2% affirmed that they knew of the existence of action protocols on DM, and 45.2% declared that they had received specialized information on the illness; 92.8% believed that there was no discrimination at their center towards students with DM, and 82.8% thought that the educational center raised no objections to students with DM departing on trips during the school year. In their interviews, both family and teachers assessed the material and human resources as insufficient and called for the presence of school nurses at the educational centers. It is important to raise the awareness of the educational community about the needs of students with DM1 and to provide guidelines on emergency situations to teachers and staff at the centers.
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Affiliation(s)
- Laura Armas Junco
- Department of Educational Sciences, Universidad de Burgos, 09001 Burgos, Spain
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13
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Busto-Parada L, Solís-Sánchez G, Riaño-Galán I. [Perceived needs regarding school health care]. J Healthc Qual Res 2021; 37:3-11. [PMID: 34635467 DOI: 10.1016/j.jhqr.2021.08.003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/28/2021] [Revised: 08/08/2021] [Accepted: 08/24/2021] [Indexed: 10/20/2022]
Abstract
BACKGROUND AND OBJECTIVE Changes in infant morbidity require adaptations to preserve their proper development and academic performance. The objective of this study was to know the perceived needs of teachers, pediatricians and pediatric nurses regarding the training of schools to deal with emergences related to chronic pathology and accidents. METHOD Cross-sectional study using an ad hoc validated questionnaire on digital support (Google Forms) that included sociodemographic variables and a structured survey that collected information on chronic pathology, health care and safety in case of emergency in the school. RESULTS Data from 266 questionnaires (134 teachers, 132 pediatricians and pediatric nurses) were analyzed. 73.9% of the teachers stated that they have had students with chronic pathology during the last year and 45.5% confirmed the existence of protocols for their assistance, although 68.7% did not receive specific training for their care. 25% of pediatricians and nurses stated that the parents of children with chronic disease always notify the schools and 17.4% stated that they knew about the existence of specific protocols. 35.6% collaborated in training related to specific pathology or emergencies in schools, with a greater predominance of primary health care (P<.001). 50.7% of the pediatricians and 79.7% of the nurses stated as a medium-high priority the need to have a school nurse in the centers. CONCLUSIONS The health care of students with chronic diseases in schools can be improved for teachers, pediatricians and pediatric nurses, considering the figure of school nurse as the main improvement measure.
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Affiliation(s)
- L Busto-Parada
- Servicio de Pediatría, Hospital Universitario San Agustín, Avilés, Asturias, España.
| | - G Solís-Sánchez
- Área de Gestión Clínica de Pediatría, Servicio de Neonatología, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
| | - I Riaño-Galán
- Área de Gestión Clínica de Pediatría, Unidad de Endocrino, Hospital Universitario Central de Asturias, Oviedo, Asturias, España
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Barrio-Cortes J, Castaño-Reguillo A, Beca-Martínez MT, Bandeira-de Oliveira M, López-Rodríguez C, Jaime-Sisó MÁ. Chronic diseases in the geriatric population: morbidity and use of primary care services according to risk level. BMC Geriatr 2021; 21:278. [PMID: 33902470 PMCID: PMC8074273 DOI: 10.1186/s12877-021-02217-7] [Citation(s) in RCA: 16] [Impact Index Per Article: 5.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/01/2021] [Accepted: 04/13/2021] [Indexed: 11/23/2022] Open
Abstract
BACKGROUND Geriatric patients have significant morbidity and greater needs for care and assistance. The objective of this study was to describe the characteristics, morbidity, and use of services in primary care (PC) of patients with chronic diseases older than 65 years according to their risk level assigned by the adjusted morbidity groups (AMG) and to analyse the factors associated with the use of PC services. METHODS This was a cross-sectional descriptive observational study. Patients older than 65 years from a healthcare service area, classified as chronically ill by the AMG classification system of the PC electronic medical record of the Community of Madrid, were included. Sociodemographic, clinical-care, and PC service utilization variables were collected. Univariate, bivariate and multivariate analyses were done. RESULTS A total of 3292 chronic patients older than 65 years were identified, of whom 1628 (49.5%) were low risk, 1293 (39.3%) were medium risk and 371 (11.3%) were high risk. Their mean age was 78.1 (SD = 8.1) years and 2167 (65.8%) were women. Their mean number of chronic diseases was 3.8 (SD = 2), 89.4% had multimorbidity and 1550 (47.1%) were polymedicated. The mean number of contacts/year with PC was 19.5 (SD = 18.2) [men: 19.4 (SD = 19.8); women: 19.5 (SD = 17.4)]. The mean number of contacts/year in people over 85 years was 25.2 (SD = 19.6); in people 76-85 years old, it was 22.1 (SD = 20.3); and in people 66-75 years old, it was 14.5 (SD = 13.9). The factors associated with greater use of services were age (B coefficient [BC] = 0.3; 95%CI = 0.2-0.4), high risk level (BC = 1.9; 95%CI =0.4-3.2), weight of complexity (BC = 0.7; 95%CI = 0.5-0.8), and ≥ 4 chronic diseases (BC = 0.7; 95%CI = 0.3-1.1). CONCLUSIONS In the geriatric population, we found a high number of patients with chronic diseases and there were three levels of risk by AMG with differences in characteristics, morbidity, and use of PC services. The greatest use of services was by patients with older age, high risk level, greater weight of complexity and ≥ 4 chronic diseases. Further research is needed to develop an intervention model more adapted to the reality of the geriatric population based on risk levels by AMG.
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Affiliation(s)
- Jaime Barrio-Cortes
- Research Unit, Primary Health Care Management of Madrid, Madrid, Spain.
- Foundation for Biosanitary Research and Innovation in Primary Care, Madrid, Spain.
- Faculty of Health, Camilo José Cela University, Madrid, Spain.
| | | | | | | | - Carmen López-Rodríguez
- Healthcare Centre Ciudad Jardín, Primary Health Care Management of Madrid, Madrid, Spain
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15
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Social Support and Peer Group Integration of Adolescents with Diabetes. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2021; 18:ijerph18042064. [PMID: 33672506 PMCID: PMC7923757 DOI: 10.3390/ijerph18042064] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 01/21/2021] [Revised: 02/10/2021] [Accepted: 02/17/2021] [Indexed: 11/17/2022]
Abstract
The aim of this study was to examine, through the roles of peers with regards to diabetes, the relationship between the support perceived by adolescents with diabetes and their peer-group affiliation. This is a descriptive, phenomenological and retrospective study based on a qualitative methodology. In-depth interviews with 15 people aged 18-35 with type 1 diabetes mellitus diagnosed in their childhood or adolescence were carried out. Data was analyzed through the interpretation of general discourses. Peers have considerable influence on adolescents and provide them social support from different roles. The protective role basically offers emotional support and sends reminders of different aspects of the treatment, while the indifferent role does not meddle in any aspect related to the diabetes. Both roles can foster social integration of adolescents with diabetes into the peer group. The offender role creates social conflicts through discrimination and stigma of adolescents with diabetes. These roles appear during the process of socialization of adolescents with diabetes, where commensality and situations of self-monitoring or administering insulin, key aspect of diabetes treatment, are crucial. Peer groups, depending on the role adopted, may offer support or bring a specific conflict regarding diabetes to their adolescent peer. The combination of roles that friends and peer group play with regards to diabetes will determine the degree of socialization and integration of adolescents with diabetes.
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Praena Crespo M, Cortés Rico O. Patient-centered primary care pediatrics. Is a paradigm change needed? An Pediatr (Barc) 2020; 93:149-151. [PMID: 32868995 PMCID: PMC7450238 DOI: 10.1016/j.anpede.2020.08.002] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
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17
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Praena Crespo M, Cortés Rico O. [Patient-centered primary care pediatrics. Is a paradigm change needed?]. An Pediatr (Barc) 2020; 93:149-151. [PMID: 32591319 PMCID: PMC7311335 DOI: 10.1016/j.anpedi.2020.06.001] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/24/2020] [Revised: 05/29/2020] [Accepted: 06/04/2020] [Indexed: 11/23/2022] Open
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