| 1. |
- Barber, R. M., et al.
(författare)
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Healthcare access and quality index based on mortality from causes amenable to personal health care in 195 countries and territories, 1990-2015 : A novel analysis from the global burden of disease study 2015
- 2017
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Ingår i: The Lancet. - : Lancet Publishing Group. - 0140-6736 .- 1474-547X. ; 390:10091, s. 231-266
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Tidskriftsartikel (refereegranskat)abstract
- Background National levels of personal health-care access and quality can be approximated by measuring mortality rates from causes that should not be fatal in the presence of effective medical care (ie, amenable mortality). Previous analyses of mortality amenable to health care only focused on high-income countries and faced several methodological challenges. In the present analysis, we use the highly standardised cause of death and risk factor estimates generated through the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) to improve and expand the quantification of personal health-care access and quality for 195 countries and territories from 1990 to 2015. Methods We mapped the most widely used list of causes amenable to personal health care developed by Nolte and McKee to 32 GBD causes. We accounted for variations in cause of death certification and misclassifications through the extensive data standardisation processes and redistribution algorithms developed for GBD. To isolate the effects of personal health-care access and quality, we risk-standardised cause-specific mortality rates for each geography-year by removing the joint effects of local environmental and behavioural risks, and adding back the global levels of risk exposure as estimated for GBD 2015. We employed principal component analysis to create a single, interpretable summary measure-the Healthcare Quality and Access (HAQ) Index-on a scale of 0 to 100. The HAQ Index showed strong convergence validity as compared with other health-system indicators, including health expenditure per capita (r=0·88), an index of 11 universal health coverage interventions (r=0·83), and human resources for health per 1000 (r=0·77). We used free disposal hull analysis with bootstrapping to produce a frontier based on the relationship between the HAQ Index and the Socio-demographic Index (SDI), a measure of overall development consisting of income per capita, average years of education, and total fertility rates. This frontier allowed us to better quantify the maximum levels of personal health-care access and quality achieved across the development spectrum, and pinpoint geographies where gaps between observed and potential levels have narrowed or widened over time. Findings Between 1990 and 2015, nearly all countries and territories saw their HAQ Index values improve; nonetheless, the difference between the highest and lowest observed HAQ Index was larger in 2015 than in 1990, ranging from 28·6 to 94·6. Of 195 geographies, 167 had statistically significant increases in HAQ Index levels since 1990, with South Korea, Turkey, Peru, China, and the Maldives recording among the largest gains by 2015. Performance on the HAQ Index and individual causes showed distinct patterns by region and level of development, yet substantial heterogeneities emerged for several causes, including cancers in highest-SDI countries; chronic kidney disease, diabetes, diarrhoeal diseases, and lower respiratory infections among middle-SDI countries; and measles and tetanus among lowest-SDI countries. While the global HAQ Index average rose from 40·7 (95% uncertainty interval, 39·0-42·8) in 1990 to 53·7 (52·2-55·4) in 2015, far less progress occurred in narrowing the gap between observed HAQ Index values and maximum levels achieved; at the global level, the difference between the observed and frontier HAQ Index only decreased from 21·2 in 1990 to 20·1 in 2015. If every country and territory had achieved the highest observed HAQ Index by their corresponding level of SDI, the global average would have been 73·8 in 2015. Several countries, particularly in eastern and western sub-Saharan Africa, reached HAQ Index values similar to or beyond their development levels, whereas others, namely in southern sub-Saharan Africa, the Middle East, and south Asia, lagged behind what geographies of similar development attained between 1990 and 2015. Interpretation This novel extension of the GBD Study shows the untapped potential for personal health-care access and quality improvement across the development spectrum. Amid substantive advances in personal health care at the national level, heterogeneous patterns for individual causes in given countries or territories suggest that few places have consistently achieved optimal health-care access and quality across health-system functions and therapeutic areas. This is especially evident in middle-SDI countries, many of which have recently undergone or are currently experiencing epidemiological transitions. The HAQ Index, if paired with other measures of health-system characteristics such as intervention coverage, could provide a robust avenue for tracking progress on universal health coverage and identifying local priorities for strengthening personal health-care quality and access throughout the world. Copyright © The Author(s). Published by Elsevier Ltd.
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| 2. |
- Shor-Posner, G., et al.
(författare)
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Quality of life measures in the Miami HIV-1 infected drug abusers cohort : Relationship to gender and disease status
- 2000
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Ingår i: Journal of Substance Abuse. - : Elsevier. - 0899-3289 .- 1873-6491. ; 11:4, s. 395-404
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: This study examined activity, daily living, health, support, and outlook in HIV+ drug users. Methods: Using the physician-administered Spitzer Index, the study assessed 75 HIV-1 seropositive men (n = 51) and women (n = 24) enrolled in the Miami HIV-1 Infected Drug Abusers Study (MIDAS). Results: Total composite scores were significantly lower in the HIV-1 infected women than the men (p = .03). Significant gender differences were observed in activity assessment, independent of disease status, with women six times as likely to have lower activity scores (p = .0038). Most women (45%) in this category were homeless or marginally housed, compared to II percent of the men. Additionally, women with low activity scores had less social support than women with high activity scares. Cocaine use was significantly related to reports of normal activity, and varied across genders; more men used cocaine than women (p = .03). Conylared to non-AIDS participants, AIDS patients were more likely to have lower scores in health (p = .009) and poorer outlook (p = .03). Implications: These findings reveal specific deficits in areas of psychosocial capacity particularly in HIV-1 infected women who abuse drugs, that may need to be strengthened in order to enhance function and adherence to treatment, as well as well-being.
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| 3. |
- Ardila-Ardila, A., et al.
(författare)
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HUMANS: una batería neuropsicologica para la evaluación de pacientes infectados con VIH-1 : [Humans: a neuropsychological battery for evaluating HIV-1 infected patients]
- 2003
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Ingår i: Revista de Neurocirugía. - 1514-3716. ; 36:8, s. 756-762
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Forskningsöversikt (refereegranskat)abstract
- Objective. To develop a neuropsychological test battery in Spanish for the cognitive evaluation of HIV-1 infected patients. Development. Departing from the suggestions presented by the work group of the National Institute of Mental Health (USA), a neuropsychological assessment battery was developed. It was named HUMANS (HIV/University of Miami Annotated Neuropsychological test battery in Spanish). This battery includes the following domains: 1) attention and speed of processing information, 2) memory, 3) executive function, 4) language, 5) visuospacial/visuoconstructive abilities, and 6) motor abilities. Administration takes about 3-4 hours. The English parallel version of this battery has been successfully used in English for over a decade with HIV-1 infected patients. In the paper the development and adaptation to Spanish language of the HUMANS neuropsychology section is presented Conclusions. HUMANS neuropsychological test battery fulfill the recommendations presented by the workgroup of the National Institute of Mental Health for evaluating HIV-1 infected patients. Studies regarding validity and reliability are still required.
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| 4. |
- Burbano, X., et al.
(författare)
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Impact of a selenium chemoprevention clinical trial on hospital admissions of HIV-infected participants
- 2002
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Ingår i: HIV Clinical Trials. - 1528-4336 .- 1945-5771. ; 3:6, s. 483-491
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Tidskriftsartikel (refereegranskat)abstract
- Purpose: To evaluate the impact of selenium chemoprevention (200 μg/day) on hospitalizations in HIV-positive individuals. Method: Data were obtained from 186 HIV+ men and women participating in a randomized, double-blind, placebo-controlled selenium clinical trial (1998-2000). Supplements were dispensed monthly, and clinical evaluations were conducted every 6 months. Inpatient hospitalizations, hospitalization costs, and rates of hospitalization were determined 2 years before and during the trial. Results: At enrollment, no significant differences in CD4 cell counts or viral burden were observed between the two study arms. Fewer placebo-treated participants were using antiretrovirals (p < .05). The total number of hospitalizations declined from 157 before the trial to 103 during the 2-year study. A marked decrease in total admission rates (RR = 0.38; p =.002) and percent of hospitalizations due to infection/100 patients for those receiving selenium was observed (p = .01). As a result, the cost for hospitalization decreased 58% in the selenium group, compared to a 30% decrease in the placebo group (p = .001). In the final analyses, selenium therapy continued to be a significant independent factor associated with lower risk of hospitalization (p = .001). Conclusion: Selenium supplementation appears to be a beneficial adjuvant treatment to decrease hospitalizations as well as the cost of caring for HIV-1-infected patients.
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| 5. |
- Burbano, X., et al.
(författare)
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Thrombocytopenia in HIV-infected drug users in the HAART era
- 2001
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Ingår i: Platelets. - : Informa UK Limited. - 0953-7104 .- 1369-1635. ; 12:8, s. 456-461
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Tidskriftsartikel (refereegranskat)abstract
- The present case-control study compared 26 HIV+ drug users having persistent thrombocytopenia (TCP< 150 000/mm(3)) with 54 available age, gender and HIV CDC classification matched controls with normal platelet counts. Participants were followed longitudinally over a 2-year period (1998-2000), and hematological alterations evaluated in relationship to antiretroviral treatment, drug use and nutritional (selenium) status. Demographic information and medical history, including antiretroviral treatment were obtained. Blood was drawn for complete cell blood count, T lymphocytes and viral load. Sixty-nine percent of the individuals with persistent TCP and 49% of the controls were receiving antiretrovirals. At baseline, no significant differences in CD4 existed between the two groups. Over time, CD4 cell count declined in the cases (P = 0.05) and a significantly higher proportion of the cases (38%) developed AIDS (CD4< 200 cell/mm(3)), as compared to the controls (18%, P = 0.004). A high risk for development of thrombocytopenia was observed with specific drug use (heroin 2.96 times, P = 0.0007), selenium levels below 145 mug/l (6 times, P = 0.008), and abnormal liver enzyme (SGOT) levels (2 times, P = 0.002). Together, these results indicate a number of factors that may be sensitive predictors of thrombocytopenia, which, despite antiretroviral treatment, appears to be related to more rapid disease progression in drug users.
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