Effects of health care decentralization in Spain from a citizens’ perspective

The aim of this article is to analyze the impact of the decentralization of the public national health system in Spain on citizens’ satisfaction with different dimensions of primary and hospital care. Using micro-data from the Health Barometer 1996–2009 and taking advantage of the exogeneity of the different pace of decentralization across Spain using a difference-in-differences strategy, we find that, in general, decentralization has not improved citizens’ satisfaction with different features of the health services. In our base model, we find that there are even some small negative effects on a subset of variables. Sensitivity analysis confirms that there is no empirical evidence for supporting that decentralization has had a positive impact on citizens’ satisfaction with health care. We outline several possible reasons for this.     

Routine childhood vaccination programme coverage,El Salvador, 2011—In search of timeliness

While assessing immunization programmes, not only vaccination coverage is important, but also timely receipt of vaccines. We estimated both vaccination coverage and timeliness, as well as reasons for non-vaccination, and identified predictors of delayed or missed vaccination, for vaccines of the first two years of age, in El Salvador.     

Postoperative apnea, respiratory strategies, and pathogenesis mechanisms: a review

Recovery from anesthesia is ideally routine and uneventful. After extubation, the recovering postoperative patient ought to breathe without supportive care or additional oxygenation. It has been demonstrated in previous studies that postoperative pulmonary complications are clinically relevant in terms of mortality, morbidity, and length of hospital stay. Compromised postoperative ventilation can be described as the condition in which the postoperative patient does not have satisfactory spontaneous ventilation support and adequate oxygenation. Causes of impaired ventilation, oxygenation, and airway maintenance can be mechanical, hemodynamic, and pharmacologic. This review describes prevalence and differential diagnosis, including co-morbidities of postoperative apnea. The physiological mechanisms of breathing and prolonged postoperative apnea are also reviewed; these mechanisms include influences from the brainstem, the cerebral cortex, and chemoreceptors in the carotid and aortic body. Causes of prolonged postoperative apnea and management are also discussed.     

Emergency department visits involving opioids in Connecticut, 2011–2015

Background: Opioid abuse has demonstrated an unwavering elevation in the past decade. This study examined emergency department (ED) utilization for this growing public health problem in the state of Connecticut.

Methods: We evaluated the ED discharges involving opioids in individuals treated in Connecticut EDs from 2011 to 2015. International Classification of Disease, 9th Revision, Clinical Modification and external cause of injury codes were used to identify cases.

Results: There were 38,003 ED visits involving opioids during the study period. Visits were most prevalent in males (63.4%) and in those aged 18–44 years (71.8%). The rate of visits (per 10,000 ED visits) in whites (72.7) was more than three times that of blacks (24.7) and nearly double that of individuals of Hispanic ethnicity (37.7). The rate of visits for females under the age of 18 was slightly greater than that for males in the same age groups (2.7 vs. 2.4/10,000 ED visits, respectively).

Conclusion: Manual labor work and racial stereotyping are possible causal factors for higher rates of opioid-related ED visits among white males between the ages of 18 and 44, while higher levels of emotional distress may be contributing to similar rates among females under the age of 18 and over the age of 65.