Perspectives on access to in vitro fertilization in Portugal

OBJECTIVE: To analyze users' reasons for choosing in vitro fertilization treatment in public or private services and to identify their suggestions for improving fertility treatment. METHODS: A qualitative study using an interpretative approach was conducted. Fifteen semi-structured interviews were conducted with patients undergoing in vitro fertilization treatment (nine women, one man and five couples) at home or at their workplace in the districts of Viana do Castelo, Braga, Porto and Lisbon, Portugal, between July 2005 and February 2006. RESULTS: Users evaluated access to in vitro fertilization treatment in public and private services based mainly on their individual experiences and called for more access to less costly, faster and friendlier care with suitable facilities, appropriate time management and caring medical providers. These perceptions were also associated with views on the need for fighting stigmatization of infertility, protecting children's rights and guaranteeing sustainability of health care system. Interviewees sought to balance reduced waiting time and more attentive care with costs involved. The choice of services depended on the users' purchase power and place of residence and availability of attentive care. CONCLUSIONS: Current national policies on in vitro fertilization treatment meet user's demands of promoting access to, and quality, availability and affordability of in vitro fertilization treatment. However, their focus on legal regulation and technical-scientific aspects contrasts with the users' emphasis on reimbursement, insurance coverage and focus on emotional aspects of the treatment. The study showed these policies should ensure insurance coverage, participation of user representatives in the National Council for Assisted Reproductive Technology, promotion of infertility research and certification of fertility laboratories.

Access to medicines for acute illness in middle income countries in Central America

OBJECTIVE : To analyze the main predictors of access to medicines for persons who experienced acute health conditions. METHODS : This was a cross-sectional analytic study, based on data from household surveys. We examined the predictors of: (1) seeking care for acute illness in the formal health care system and (2) obtaining all medicines sought for the acute condition. RESULTS : The significant predictors of seeking health care for acute illnesses were urban geographic location, head of household with secondary school education or above, age under 15, severity of illness perceived by the respondent, and having health insurance. The most important predictor of obtaining full access to medicines was seeking care in the formal health care system. People who sought care in the formal system were three times more likely to receive all the medicines sought (OR 3.0, 95%CI 2.3;4.0). For those who sought care in the formal health system, the strongest predictors of full access to medicines were seeking care in the private sector, having secondary school education or above, and positive perceptions of quality of health care and medicines in public sector health facilities. For patients who did not seek care in the formal health system, full access to medicines was more likely in Honduras or Nicaragua than in Guatemala. Urban geographic location, higher economic status, and male gender were also significant predictors. CONCLUSIONS : A substantial part of the population in these three countries sought and obtained medicines outside of the formal health care system, which may compromise quality of care and pose a risk to patients. Determinants of full access to medicines inside and outside the formal health care system differ, and thus may require different strategies to improve access to medicines. 

Deported Mexican migrants: health status and access to care

OBJECTIVE To describe the health status and access to care of forced-return Mexican migrants deported through the Mexico-United States border and to compare it with the situation of voluntary-return migrants. METHODS Secondary data analysis from the Survey on Migration in Mexico’s Northern Border from 2012. This is a continuous survey, designed to describe migration flows between Mexico and the United States, with a mobile-population sampling design. We analyzed indicators of health and access to care among deported migrants, and compare them with voluntary-return migrants. Our analysis sample included 2,680 voluntary-return migrants, and 6,862 deportees. We employ an ordinal multiple logistic regression model, to compare the adjusted odds of having worst self-reported health between the studied groups. RESULTS As compared to voluntary-return migrants, deportees were less likely to have medical insurance in the United States (OR = 0.05; 95%CI 0.04;0.06). In the regression model a poorer self-perceived health was found to be associated with having been deported (OR = 1.71, 95%CI 1.52;1.92), as well as age (OR = 1.03, 95%CI 1.02;1.03) and years of education (OR = 0.94 95%CI 0.93;0.95). CONCLUSIONS According to our results, deportees had less access to care while in the United States, as compared with voluntary-return migrants. Our results also showed an independent and statistically significant association between deportation and having poorer self-perceived health. To promote the health and access to care of deported Mexican migrants coming back from the United States, new health and social policies are required.

Socioeconomic inequalities in the access to and quality of health care services

OBJECTIVE To assess the inequalities in access, utilization, and quality of health care services according to the socioeconomic status. METHODS This population-based cross-sectional study evaluated 2,927 individuals aged ≥ 20 years living in Pelotas, RS, Southern Brazil, in 2012. The associations between socioeconomic indicators and the following outcomes were evaluated: lack of access to health services, utilization of services, waiting period (in days) for assistance, and waiting time (in hours) in lines. We used Poisson regression for the crude and adjusted analyses. RESULTS The lack of access to health services was reported by 6.5% of the individuals who sought health care. The prevalence of use of health care services in the 30 days prior to the interview was 29.3%. Of these, 26.4% waited five days or more to receive care and 32.1% waited at least an hour in lines. Approximately 50.0% of the health care services were funded through the Unified Health System. The use of health care services was similar across socioeconomic groups. The lack of access to health care services and waiting time in lines were higher among individuals of lower economic status, even after adjusting for health care needs. The waiting period to receive care was higher among those with higher socioeconomic status. CONCLUSIONS Although no differences were observed in the use of health care services across socioeconomic groups, inequalities were evident in the access to and quality of these services.

Access to continued-use medication among older adults, Brazil

OBJECTIVE To determine the prevalence and associated access factors for all continued-use prescription drugs and the ways in which they can be obtained.METHODS Data was obtained from the 2008 Household National Survey. The sample comprised 27,333 individuals above 60 years who reported that they used continued-use prescription drugs. A descriptive analysis and binary and multiple multinomial logistic regressions were performed.RESULTS 86.0% of the older adults had access to all the medication they needed, and among them, 50.7% purchased said medication. Those who obtained medication from the public health system were younger (60-64 years), did not have health insurance plans, and belonged to the lower income groups. It is remarkable that 14.0% of the subjects still had no access to any continued-use medication, and for those with more than four chronic diseases, this amount reached 22.0%. Those with a greater number of chronic diseases ran a higher risk of not having access to all the medication they needed.CONCLUSIONS There are some groups of older adults with an increased risk of not obtaining all the medication they need and of purchasing it. The results of this study are expected to contribute to guide programs and plans for access to medication in Brazil.

Access to childbirth care by adolescents and young people in the Northeastern region of Brazil

ABSTRACT OBJECTIVE To identify the factors that interfere with the access of adolescents and young people to childbirth care for in the Northeast region of Brazil. METHODS Cross-sectional study with 3,014 adolescents and young people admitted to the selected maternity wards to give birth in the Northeast region of Brazil. The sample design was probabilistic, in two stages: the first corresponded to the health establishments and the second to women who had recently given birth and their babies. The data was collected by means of interviews and consulting the hospital records, from pre-tested electronic form. Descriptive statistics were used for the univariate analysis, Pearson’s Chi-square test for the bivariate analysis and multiple logistic regressions for the multivariate analysis. Sociodemographic variables, obstetrical history, and birth care were analyzed. RESULTS Half of the adolescents and young people interviewed had not been given guidance on the location that they should go to when in labor, and among those who had, 23.5% did not give birth in the indicated health service. Furthermore, one third (33.3%) had to travel in search of assisted birth, and the majority (66.7%) of the postpartum women came to maternity by their own means. In the bivariate analysis, the variables marital status, paid work, health insurance, number of previous pregnancies, parity, city location, and type of health establishment showed a significant association (p < 0.20) with inadequate access to childbirth care. The multivariate analysis showed that married adolescents and young people (p < 0.015), with no health insurance (p < 0.002) and from the countryside (p < 0.001) were more likely to have inadequate access to childbirth care. CONCLUSIONS Adolescents and young women, married, without health insurance, and from the countryside are more likely to have inadequate access to birth care. The articulation between outpatient care and birth care can improve this access and, consequently, minimize the maternal and fetal risks that arise from a lack of systematic hospitalization planning.

Extending access to remote labs from mobile devices in educational contexts

This paper describes how to extend the access to remote experiments from mobile devices, aiming to better engage digital native students who expect a more interactive and ubiquitous access mode. The extension is based on features of HTML5 and the jQuery Mobile framework, which allow accessing the experiments from different operating systems via the browser or native applications. As a result, users have a richer interaction mode with the experiments, which includes access from simple hand-held devices such as smartphones and PDAs. Extending the access to remote experiments, from simple devices, enables its use in other educational stages, such as high schools, where teachers struggle to engage students in STEM learning. By enabling students to use their everyday "technological companions", e.g. cellular phones, to access remote experiments, we seek to increase the educational value of this technology-enhanced learning resource.

Topics regarding access to european information institutions: European Union so close and yet so far

From the 1990s, the Parliament, the Council and the European Commission adopted a new approach to disclosure of their working papers. Legal instruments to regulate and allow a fairly broad access to internal working documents of these institutions were created. European institutions also exploited the potential of Information and Communication Technologies, developing new instruments to register the documents produced and make them accessible to the public. The commitment to transparency sought to shows a more credible European government, and reduces the democratic deficit. However, the data analysis regarding access to EU institutions documents shows that general public is still far from direct contact with European bodies.

European institutions at your fingertips: EUROPA gateway tools for dissemination and access to information

This paper intends to present the legal background that support dissemination and access to documents from European institutions, namely the Parliament, the Council and the European Commission. Currently, this legal framework is accomplished with a set of Internet tools that are analyzed regarding official documents types and options searches available. Some statistical data on access to European information published in annual reports from the institutions are also evaluated. The relationship between shadow and light in transparency to access administrative documents and marketing issues of a political communication are underlined. Neo-institutional approach, reputational concept in public organizations and systemic perspective are used as theoretical background.

Access to essential medicines in Timor-leste: availability, prices and affordability

O acesso a medicamentos essenciais a preços acessíveis de forma sustentável é um dos indicadores do cumprimento dos Objectivos de Desenvolvimento do Milénio e pode ser considerado como parte do direito universal à saúde. Tal como acontece com outros bens essenciais, o acesso aos medicamentos depende de múltiplos factores, como a sua disponibilidade, preços e capacidade de aquisição por parte da população. Na última década, foram efectuados mais de 50 estudos para avaliar esses factores, em países de baixos e médios rendimentos, utilizando uma metodologia desenvolvida pela Organização Mundial de Saúde e a organização Health Action International, numa tentativa de compreender as possíveis causas para o baixo acesso aos medicamentos. Os resultados destes estudos revelam uma baixa disponibilidade de medicamentos essenciais de um modo geral, sobretudo no sector público, e preços elevados, sobretudo no sector privado. O objectivo deste estudo foi descrever a disponibilidade, os preços e a capacidade de aquisição de medicamentos essenciais em Timor-Leste, com recurso à metodologia da OMS/HAI. Foram recolhidos dados sobre a disponibilidade e os preços de uma lista de medicamentos em hospitais, centros de saúde e farmácias comunitárias. Embora os resultados pareçam apontar para uma disponibilidade global razoável de medicamentos genéricos no sector público (59,2%), algumas substâncias activas e classes terapêuticas encontravam-se sistematicamente esgotadas em vários pontos do país. Nas unidades situadas em locais mais remotos, a disponibilidade de medicamentos chegava a descer para valores na ordem dos 47,5%. Verificou-se que a disponibilidade de medicamentos nas farmácias privadas era ainda mais baixa do que nos serviços públicos (38,0%). Os medicamentos são dispensados gratuitamente nos hospitais e centros de saúde, mas nas farmácias privadas chegam a ultrapassar 40 vezes os seus preços de referência internacionais, mesmo como genéricos. Consequentemente, estima-se por exemplo, que um funcionário público que utilize diclofenac para o tratamento crónico da artrose, tenha de trabalhar durante mais de 2 dias para pagar o seu tratamento mensal com o medicamento genérico, ou 12,5 dias, se for prescrito o medicamento de marca. Durante o estudo, foram detectados vários outros problemas que podem comprometer a qualidade e segurança dos medicamentos. Apesar das limitações inerentes a uma investigação deste tipo, foi possível concluir através do presente estudo que, ao contrário da tendência geral observada em países similares, o sector público de cuidados de saúde em Timor-Leste parece ter um melhor desempenho do que o privado. No entanto, as condições limitadas da maioria das unidades de saúde públicas pode forçar alguns doentes a recorrer ao sector privado, onde os preços pagos pelos tratamentos são inaceitavelmente elevados. A ausência de regulamentação do sector farmacêutico (e fiscalização insuficiente da existente) parece estar a contribuir para a estagnação do sector privado e a encorajar indirectamente a falta de transparência nas práticas farmacêuticas. Dada a escassez de estudos sobre este assunto em Timor-Leste, espera-se que o presente trabalho forneça evidências importantes que possam ser utilizadas em estudos subsequentes e como base a uma intervenção por parte das autoridades com o objectivo de melhorar a disponibilidade de medicamentos no sistema público e de encorajar o desenvolvimento do sector privado como alternativa viável, segura e de custo aceitável.

Equity in access to MRI equipment: the Portuguese case

Magnetic resonance imaging (MRI) is a method of image diagnose proven to be of undeniable importance when it comes to neuro and cardio related diseases. In fact, these diseases (such as: ischemic heart disease, stroke and acute myocardial infection) have high incidence in Portugal. For these reasons, the allocation of this medical technology should not be considered with light thoughts. In fact, making decision of resource allocation in health care can be a very complex and contested matter. The impacts of new technology allocation, such MRI, can be assessed in a variety of ways. However, a fundamental component should always be present: the use of evidence-based decision-making methods. One of these methods is Technology Assessment (TA). This paper aims to characterize the equity on access of the Portuguese population in general, to a specific medical device such as MRI, under the TA point of view. It is hoped to promote a bridge of scientific knowledge between the gap on research and policy-making through TA that can emerge as a tool to aid decision-makers in the organization of health systems. There are gaps in providing healthcare, due to geographical imbalances, with some areas unable to provide certain specialized services, as hospitals in the countryside do not provide all medical specialties. Portugal has also a large independent private sector that provides diagnostic and therapeutic services to NHS users under contracts called conventions. These medical contracts cover ambulatory health facilities for laboratory tests and examinations such as diagnostic tests and Radiology. However, there is no convention from the NHS when concerning the MRI exam. Therefore, this reality can be considered a limitation in the access of the general population to this kind of clinical exam. TA can play an useful and important role in helping the decision-makers to explore potential gains that might be achieved by introducing a more rational decision making into health care management, namely into the Radiology area, regarding the allocation of MRI equipment.

Grafting of adipic anhydride to carbon nanotubes through a Diels-Alder cycloaddition/oxidation cascade reaction

Accepted Manuscript

Car ownership and access to jobs in Spain

This study analyses the impact that job accessibility in public transport has on car ownership. An ordered probit explaining the number of cars per household is estimated as a function of head of household characteristics, household characteristics and job accessibility. The data used in the analysis come from the Microcensus of year 2001 of the Spanish Institute of Statistics for the areas of Barcelona and Madrid. Our results show a significant effect of accessibility on car ownership. Additionally, we carried out simulation exercises in which the expected number of vehicles decreases as accessibility improves. For instance, in the case of households living outside the central city, an improvement of accessibility up to the average level of the central city would offset the effect of the number of working adults on the expected number of vehicles.

Engorgement des centres d'urgences: une raison légitime de refuser l'accès aux patients non urgents [Emergency department overcrowding: a legitimate reason to refuse access to urgent care for non-urgent patients?].

Non-urgent cases represent 30-40% of all ED consults; they contribute to overcrowding of emergency departments (ED), which could be reduced if they were denied emergency care. However, no triage instrument has demonstrated a high enough degree of accuracy to safely rule out serious medical conditions: patients suffering from life-threatening emergencies have been inappropriately denied care. Insurance companies have instituted financial penalties to discourage the use of ED as a source of non-urgent care, but this practice mainly restricts access for the underprivileged. More recent data suggest that in fact most patients consult for appropriate urgent reasons, or have no alternate access to urgent care. The safe reduction of overcrowding requires a reform of the healthcare system based on patients' needs rather than access barriers.