How to pay for medical care? This question, which periodically has been the subject of vigorous debate in the United States for more than half a century, has moved to the forefront of public attention in the wake of rapid increases in the cost of care and heightened concern about inequality of access. More than a dozen different proposals for some type of national health insurance have been submitted in Congress, and major interest groups—private insurance companies, hospitals, organized medicine, and organized labor—have staked out their positions in great detail. Before considering the pros and cons of national health insurance and the implications of alternative proposals, a few general remarks about medical care finance and the present U.S. system are in order….
The increasing volume of research by the medical community are also leading numbers of contradictory findings and conclusions. The main reason of this contradiction is sampling variability and sample size. The differences observed between the groups may represent true difference, but significance level of the same difference is varying from one study to another study due to variation in sample size. Sample size not only affects the level of significance but also affect the power of the study and margin of error. Sample size has no direct relationship with effect size although increasing sample size increases reliability of the effect size detected between the groups. An appropriate sample size, allows the researcher to control the error (Type I & II error). At the time of planning of the study, the researcher must establish a justifiable level of statistical significance, with corresponding power of the study, targeted difference (ie, effect size), and the variability of the data (for continuous data). The proper planning of sample size can boost the study importance. The aim of this study is to discuss the efffect of sample size on level of significance, power of the study and the reliability of the research findings. Biography: Prabhaker Mishra (DOB: January 1979), presently working as Associate Professor in SGPGI Lucknow-India. He had completed his PhD in Statistics on the topic “Statistical Study of Human vulnerability and Risk. Assessment of Natural Hazards in Orissa” as Senior research fellowship (ICMR) in 2010. He had worked as Assistant Professor (Biostatistics) in the Department of Community Medicine, in medical colleges during 2011 to 2014. He had co-supervised 12 MD students; and presently other 31 MD /2PhD and 1PhD students are pursuing under his co-supervision /supervision. He had published 82 research papers in various national / international journals. His expertise area is applied and medical statistics. Speaker Publications: 1. Gogate N. Principles of sample size calculation. Indian J Ophthalmol. 2010;58:517–8. 2. Whitley E, Ball J. Statistics review 4: Sample size calculations. Crit Care. 2002;6:335–41. 3. Fosgate GT. Practical sample size calculations for surveillance and diagnostic investigations. J Vet Diagn Invest. 2009;21:3–14. 4. Bacchetti P. Current sample size conventions: Flaws, harms, and alternatives. BMC Med. 2010;8:17. 5. Malhotra RK, Indrayan A. Simple nomogram for estimating sample size for sensitivity and specificity of medical tests. Indian J Ophthalmol. 2010;58:519–22. 5th World Congress on Public Health and Nutrition; London, UK- February 24-25, 2020. Abstract Citation: Prabhaker Mishra, The importance of sample size in research studies, Public Health 2020, 5th World Congress on Public Health and Nutrition; London, UK- February 24-25, 2020 (https://publichealth.healthconferences.org/abstract/2020/the-importance-of-sample-size-in-research-studies)
Cholera is an acute enteric bacterial disease characterized by copious watery diarrhea with or without vomiting, severe dehydration and death if left untreated. The disease is caused Vibrio cholerae (V. cholerae) serogroups, O1 and O139 strains. The transmission of the infection exclusively occurs via ingestion of fecally contaminated water or food. To date, the world has hosted seven distinct cholera pandemics. In the developing world, particularly in low-income countries, cholera continues to be a significant cause of morbidity and mortality. The disease is endemic in Asia, Africa, South America and the Caribbean. Detection of the presence of V. cholerae in environmental or clinical samples early and accurately is pivotal for appropriate treatment, control and prevention of the disease. Here, we give a brief account of detection techniques of V. cholerae in a variety of specimen types. Detection methods of different types such as the conventional microbiological method, molecular techniques, enzyme-linked immunesorbent assay, dipstick tests, agglutination test, conglutination test and immunofluorescence assay are available. Commercially, several immunechromatographic format rapid diagnostic tests are available for the detection of V. cholerae in a variety of specimen types. It is more likely that the developing world will host series of cholera outbreaks in the years to come. Therefore, endemic countries should improve surveillance of V. cholerae, educate the public about the disease, provide clean drinking water and equip local health centers with diagnostic techniques of lower cost, less timeconsuming, easy to use and interpret.
The paper presents the findings of a qualitative assessment which was conducted with the aim of exploring the practices, knowledge & attitude of married young women about oral contraceptive pills. The study also aimed to understand the factors which influence the uptake of OCP among married females. A quantitative study was conducted among females belonging to age group of 19-29 years. The data was collected through on ground activations conducted at beauty parlors located at urban areas by asking pre structured questions with females. The findings reveal that females had many myths & misconceptions related to use of OCP as a method of contraception. These myths & misconceptions were major reasons for low uptake of OCP as a chosen method of contraception. Reasons of not using OCP included problems of abnormal weight gain, failure to further conception, and deposition of pills in the stomach, lethargy & general illness due to consumption. The study concluded that there is a need to do innovative & focused IEC/BCC about oral contraceptive pills. There is also a need to address issues specific to myths on OCP, ensuring its ready availability & to popularize the positive impact that the OCP can have on females to increase the uptake of OCP as a preferred method of contraception so that females can fulfill their child bearing & reproductive health goals.
Despite being one of the most basic needs for any human being, not all countries provide free medical coverage to all their residents, in a matter of fact there are only 32 countries that follow such system which Kuwait is one of them. The universal government-funded health system, also known as single-payer healthcare, is a healthcare system where government funds all healthcare services to all citizens and non-citizens residence regardless of their income or employment status. Some countries may require non-citizens to buy private insurance that is partially subsidized by the government. The aim of this study is to evaluate the factors that mostly affects healthcare expenditure (HE) per capita and based on it estimate HE per capita and compare it to the actual HE per capita to find which countries overspend or underspend on their HE. Using OLS regression that is based on a panel data of 29 countries that follows single-payer healthcare system in 2019 where HE per capita is set as a dependent variable. Results revealed that HE as percentage of GDP, GDP per capita, number of physicians per 1000 persons, and number of hospital beds per 1000 persons all showed statistically significant direct relation with HE per capita while oddly percentage of people aged 65 and above showed a statistically significant inverse relation with HE per capita. Results also showed that corruption and life expectancy did not have any statistically significant relation with HE per capita. Running the estimation model revealed that 6 countries were in the acceptable range, ±5% from forecasted HE, while 12 countries showed overspending and 11 countries were underspending. Cuba showed that it was the most overspending country by +22.26% and Georgia was the most underspending country by -30.80% while Kuwait overspend by +9.90%.
American free enterprise drives the healthcare market. Private practice medical offices work in conjunction with health insurance companies to create negotiated terms on pricing for diagnostic studies, laboratory tests, and procedures in providing optimum patient care. These annual negotiations create a potential for uncertainty, and either party may decide to forego future coverage of patients if certain conditions are not met. Insurance companies typically are concerned about physicians they identify as expensive utilizers for underserved patients, while physicians are disconcerted about poor reimbursement rates or denials for patient services. The physician is markedly aware of this delicate equilibrium and proceeds with caution before establishing a diverse portfolio of contractual agreements.
Introduction: SARS-CoV-2 its infectious diseases was named coronavirus disease 2019 (COVID-19) by the World Health Organization (WHO) pandemic. The first report on prevalence of SARS-Cov2 at Nicaragua, showed the first cases March 2020 and during the months of June and July began exponential growth period. The telemedicine can provide rapid access, efficient and immediately available person. This approach has been explored most fully in the context of Covid 19 stroke. The estimates of intervention costs are really challenge, particularly for lowand middle-income countries. Create a health strategy during a health emergency with the lowest cost investment but great population health impact is the primary objective. The gold of this study decided the economic impact, through of the cost benefit of medical advice through mobile phone during the COVID-19 pandemia, as health strategy at Nicaragua.
The current world pandemic of COVID-19 necessitates a public health strategy with a lot of stress on medicine, particularly with regards to understanding the causes further as distinctive applicable population-based behavioural and academic program.
A growing body of evidence maintains that obesity may be strongly related to\r\ngreater adverse outcomes from infection with the new SARS-CoV-2 (COVID-19). It\r\nis known that obesity is a low-grade chronic inflammatory condition, which leaves\r\nits sufferers susceptible to numerous diseases, including cardiovascular diseases,\r\nwhich are particularly related to inflammation and hypercoagulability, mainly. In\r\nthis literature review work, emerging knowledge about the pathophysiology and\r\npathological mechanisms of COVID-19 was combined with the pathophysiology of\r\nobesity, and some hypotheses about the deleterious effects and impact of Obesity\r\nin the course of COVID-19 will be evidenced. These hypotheses are testable and\r\ncan guide future therapeutic and preventive interventions.
The influx of ambulatory care sensitive conditions (ACSC) to the emergency department (ED) in pediatrics may be avoidable if direct primary care access is available 24 hours per day. According to the Overview of Pediatric Emergency Department Visits, greater than 17% of children (ages 0-18y) in the United States visited the pediatric ED for care in a given year. The goal of our retrospective study is to review the number of pediatric ED visits in the United States compared to the number of visits from pediatric patients having access to direct primary care (DPC). Within a retrospective review spanning 1 year of our DPC study population, we found that 1 in 9 children had visited the ED. This strong correlation shows that direct primary care access may decrease the likelihood of ACSC reaching the ED. Patients with this 24/7 access are able to receive preventative care and have a treatment plan established prior to utilizing the ED for an ACSC. 5
We explore the effects of adapted physical exercise programs in nursing homes, in which some residents suffer from dementia and/or physical limitations and others do not. We use data from 452 participants followed over 12 months in 32 retirement homes in four European countries. Using a difference-in-difference with individual random effects model, we show that the program had a significant impact on the number of falls and the self-declared health and health-related quality of life of residents (EQ-5D). The wide scope of this study, in terms of sites, countries, and measured outcomes, brings generality to previously existing evidence. A simple computation, in the case of France, suggests that such programs are highly cost-efficient.
Acromegaly is associated with enhanced cardiovascular mortality. This implies that its treatment must be complete and effective. The consensus for the management of acromegaly has a well-codified protocol. The normalization of IGF-1 and a low GH value are essential for healing. The management of acromegaly is cumbersome. Many African countries do not have the proper technical platform to manage this condition. Radiotherapy centres are non-existent in some regions and somatostatin analogues, when available, are inaccessible because of their high cost. Thus, the prognosis of acromegaly seems reserved in underprivileged areas. In this series of 6 patients followed for acromegaly, total hypophysectomy appeared to bring a better prognosis compared to standard treatment. This would suggest that in the absence of an optimal technical platform, total hypophysectomy should be considered in the treatment of acromegaly in less developed countries.
In the steel industries, workers are exposed to heat and ambient thermal stresses on a daily basis, leading to discomfort and limited performance. In this study, the main purpose is to investigate the effect of climate heat stress on the rate of accidents in the workplace for workers for 5 consecutive years. The data of this study were received without any sampling through the HSE Center for Steel Industry and meteorological data from 2015 to 2019 from Isfahan Meteorological station. The daily number of casualties among workers in the steel industry during 2015-2019 by adjusting seasonal patterns, months, effects of the day of the week and other meteorological factors on the average daily temperature using the studied model has a decreasing effect. Eviews software (version 8) was used to model and investigate the relationship between events and meteorological variables. The mean temperature was at least 40.2-2 and at most 70.34 ° C, respectively. In the time-series study for the main model, the number of accidents shows a direct relationship with the average temperature and wind speed. Climatic indices of humidity and rainfall have the least impact on accidents compared to temperature and wind speed. A strong correlation was shown between the increase in average ambient temperature and the rate of accidents over the past 5 years. Given the fundamental differences in studies of environmental exposure and wind speed over heat stress, further analysis in workers should be considered.
Context: America experienced dramatic changes in the healthcare workforce over the past two centuries. Understanding how the workforce changed in density and skill mix over time yields lessons for predicting future workforce dynamics. Objective: To quantify the changes in the American healthcare workforce from 1850 to 2017. The secondary objective is to quantify the changes in physicians and nurses from 1850 to 2017. Design: Using data from the work of Kendix, the Census Bureau and the Bureau of Labor Statistics, we performed descriptive analysis on trends in the healthcare workforce from 1850 to 2017. Setting: America from 1850 to 2017. Participants: American healthcare workers from the Current Population Survey. Main outcome measures: The study will measure the number of healthcare workers, physicians and nurses. This number will be tracked in relation to the total American population and the total American workforce. Results: The number of physicians per 100,000 Americans increased from 177 in 1850 to 331 in 2017; most of the gain occurred after 1950 following nearly a century of nearly flat trends. The number of nurses increased to 970 per 100,000 Americans. The healthcare workforce per 100,000 Americans as a whole increased from 198 to 392. Conclusion: The American healthcare workforce has expanded dramatically over the past two centuries. After a period of flat supply (1850-1960), the healthcare workforce has grown faster than GDP, becoming one the largest sectors of U.S. labor. Understanding the trajectory of the health workforce may guide planning by countries undergoing similar economic transitions.
The increased competitiveness in the healthcare leads to higher financial and operational pressures. Continuous process improvements are an essential part of current healthcare environment. According to the Institute of Healthcare Improvement (IHI), the sustainability of process improvement efforts depends on how successful the healthcare organization has been in creating a culture of accountability and transparency with engagement among all members of the clinical team [1]. Thus, the leadership team of the department of pediatrics employed lean methodology to develop a consistent culture of accountability and engagement for each division and team member in the department. Previous isolated lean transformation projects conducted within the departments failed to effectively engage all providers towards consistently embracing value centered mindset. We will discuss how lean methodology facilitated engaging physicians and all other frontline team members towards a value-centered culture.
