Browsing by Author "Lein, Adriana"
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Item Open Access A cross-sectional exploratory study of knowledge, attitudes, and practices of emergency health care providers in the assessment of child maltreatment in Maputo, Mozambique.(BMC emergency medicine, 2018-05-09) Pinto, Liliana; Lein, Adriana; Mahoque, Raquel; Wright, David W; Sasser, Scott M; Staton, Catherine ABACKGROUND:In Mozambique, and other low-income countries (LICs), there is little information on the burden of child maltreatment (CM). Emergency care services (ECS) play an important role in recognizing, treating, and intervening in situations of CM. We aim to identify knowledge, attitudes, and practices regarding CM among health care providers in ECS at Mavalane General Hospital in Maputo, Mozambique. METHODS:This exploratory cross-sectional study evaluates the knowledge, attitudes, and practices of health care providers to diagnose and treat cases of CM. A 25 min, pilot-tested verbal interview questionnaire was administered to 49 physicians and nurses working in ECS at Mavalane General Hospital. Interviews were completed between October-November 2010. Data were managed and analyzed in SPSS 14.0 and descriptive statistics were generated. RESULTS:Of 49 health care providers, 83.6% reporting receiving no, or very little CM education or training. Only 61.2% had knowledge of physical abuse as a main form of child maltreatment and 38.8% were able to identify corresponding symptoms of physical abuse. Sexual abuse as a main form of CM was mentioned by 26.5 and 2% cited its symptoms. While 87.7% of health care providers strongly agreed or agreed that they hold an important role in preventing CM, 51.1% also strongly disagreed or disagreed that they feel confident diagnosing and treating CM cases. In regards to follow-up, 14.3% strongly disagreed or disagreed that they know where to refer victims for further follow-up and an additional 14.3% did not know whether they agreed or disagreed. CONCLUSION:This study revealed knowledge gaps in emergency health care provider knowledge of the main forms of CM and their symptoms. The fact that a majority of health care providers in our sample did not receive information specific to CM in their medical education and training could explain this gap, as well as their unawareness of where to refer victims. Given that health care providers believe they play an important role in identifying and treating CM, future research should focus on raising physician awareness of CM and developing education and training materials grounded in cultural contexts to build response capacity in Mozambique and other LICs.Item Open Access An Ecological Analysis of Predictors of Hospitalizations for Primary Care Sensitive Conditions under Brazil’s Family Health Strategy(2017) Lein, AdrianaBackground: Primary care sensitive conditions (PCSC), a classification of illnesses that includes noncommunicable diseases (NCDs) and maternal health complications, are considered preventable through appropriate care management and interventions at the primary care (PC) level. Consistent with trends in global disease burden, PCSC are a significant contributor to avoidable hospitalizations in low and middle income countries (LMIC), which carries profound social and economic consequences. Rates of hospitalizations for primary care sensitive conditions (HPCSC) have been found to be associated with the level of infrastructure of health services delivery, health system, and socioeconomic context. This study concentrates on the Brazilian state of Minas Gerais to evaluate the current profile of HPCSC and their predictors under the universal PC program, the Family Health Strategy (FHS).
Methods: This is an ecological study based on: 1) data of PC infrastructure from 560 municipalities, collected from 2012-2013 through the Programa Nacional de Melhoria do Acesso e da Qualidade da Atenção Básica (PMAQ-AB), 2) data on rates of HPCSC available in the Hospital Information System of the Unified Health System, and 3) data on health system and socioeconomic indicators from the Brazilian Ministry of Health and the Brazilian Institute for Geography and Statistics, respectively. For the analysis, 7 groups of PCSC specifically targeted under the FHS were considered. 24 structure and process indicators were selected from the PMAQ-AB database and a principal component analysis with factor interpretability was performed, utilizing the theoretical rationale of the Starfield Model of Primary Care, to reduce and describe data dimensionality. Principal component scores were averaged by municipality, and assessed as predictors of HPCSC across municipalities in multiple regression models both individually and progressively adjusting for health system and socioeconomic variables as groups.
Results: From January-December 2012, municipalities in our sample experienced 12,078 HPCSC due to the 7 conditions chosen, with an aggregate age-adjusted rate of 112.15 per 10,000 inhabitants. The NCDs of congestive heart failure, cerebrovascular diseases, and diabetes mellitus collectively accounted for 87.56% of all hospitalizations. The best-fitting principal component model of infrastructure data consisted of 3 components that corresponded to the level of adequacy of care comprehensiveness, continuity, and coordination. In the fully-adjusted models, the strongest predictors of HPCSC per 10,000 were continuity (β= 12.44) for heart failure, comprehensiveness (β= -3.09) for cerebrovascular diseases, continuity (β= 1.45) for diabetes, continuity (β= .92) for skin and subcutaneous tissue infections, comprehensives e (β=.99) for female pelvic inflammatory diseases, and continuity (β=.74) for prenatal and postpartum conditions.
Conclusions: NCDs heavily influence incidences of avoidable hospitalizations in Minas Gerais, Brazil. Yet, our findings suggest that the community-based care models of the FHS may have the potential to mitigate the role of social vulnerability in influencing health outcomes. This project offers a model for quantifying the quality of PC infrastructure and more research is needed to validate its use in LMIC, as well as to further understand the strength and directionality of the relationship between health center, health system, and socioeconomic predictors of HPCSC.
Item Open Access Characteristics of primary care and rates of pediatric hospitalizations in Brazil.(Revista de saude publica, 2020-01) Lisboa, Lívia Anniele Sousa; Queiroz, Rejane Christine de Sousa; Thomaz, Erika Bárbara Abreu Fonseca; Silva, Núbia Cristina da; Rocha, Thiago Augusto Hernandes; Vissoci, João Ricardo Nickenig; Staton, Catherine Ann; Lein, Adriana; Simões, Vanda Maria Ferreira; Thumé, Elaine; Facchini, Luiz AugustoObjective
To evaluate the association among characteristics of primary health care center (PHCC) with hospitalizations for primary care sensitive conditions (PCSC) in Brazil.Method
In this study, a cross-sectional ecological study was performed. This study analyzed the 27 capitals of Brazil's federative units. Data were aggregated from the following open access databases: National Program for Access and Quality Improvement in Primary Care, the Hospital Information System of Brazilian Unified Health System and Annual Population Census conducted by the Brazilian Institute of Geography and Statistics. Associations were estimated among characteristics of primary care with the number of three PCSC as the leading causes of hospitalization in children under-5 population in Brazil: asthma, diarrhea, and pneumonia.Results
In general, PHCC showed limited structural adequacy (37.3%) for pediatric care in Brazil. The capitals in South and Southeast regions had the best structure whereas the North and Northeast had the worst. Fewer PCSC hospitalizations were significantly associated with PHCC which presented appropriate equipment (RR: 0.98; 95%CI: 0.97-0.99), structural conditions (RR: 0.98; 95%CI: 0.97-0.99), and signage/identification of professionals and facilities (RR: 0.98; 95%CI: 0.97-0.99). Higher PCSC hospitalizations were significantly associated with PHCC with more physicians (RR: 1.23, 95%CI: 1.02-1.48), it forms (RR: 1.01, 95%CI: 1.01-1.02), and more medications (RR: 1.02, 95%CI: 1.01-1.03).Conclusion
Infrastructural adequacy of PHCC was associated with less PCSC hospitalizations, while availability medical professional and medications were associated with higher PCSC hospitalizations.