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2.
Psychiatr Prax ; 51(2): 70-78, 2024 Mar.
Artigo em Alemão | MEDLINE | ID: mdl-38167830

RESUMO

BACKGROUND: The treatment of addicted offenders detained under § 64 of the German Criminal Code can be terminated prematurely. There is an extensive literature on predictors of such premature termination concerned with factors established before treatment. OBJECTIVE: The aim of this paper is to present predictors of premature termination that become apparent during the course of therapy. METHODS: We conducted a systematic literature search and included 16 publications. RESULTS: Patients and therapists rated impulsivity/aggressiveness, substance use relapses and a lack of patient-therapist relationship as negative predictors. Both groups assessed as beneficial the presence of motivation and a positive social network. CONCLUSION: To prevent early treatment termination a positive patient-therapist relationship, motivation and working through incidents during therapy is essential.


Assuntos
Transtornos Relacionados ao Uso de Substâncias , Humanos , Alemanha , Transtornos Relacionados ao Uso de Substâncias/terapia , Prisioneiros , Recusa do Paciente ao Tratamento
3.
Gynecol Obstet Fertil Senol ; 52(2): 109-113, 2024 Feb.
Artigo em Francês | MEDLINE | ID: mdl-38190966

RESUMO

Our team was confronted with a situation of stubborn refusal of care, including the indication of a cesarean section for an adult patient able to express her wishes. This refusal was formulated during pregnancy follow-up, during the discussion of the birth plan and during delivery, the patient having accepted the indication of a possible emergency cesarean section under general anesthesia only in the occurrence of severe fetal heart rate abnormalities. The impasse forced caregivers to violate the rules of good clinical practice, which indicated the performance of a cesarean section, and to wait for a complication to arise in order to be able to act, taking the risk of intervening too late. This situation has led to direct risks to the health of the mother and the unborn child, without putting the life of either of them in imminent danger. Finally, the time devoted to this patient in a tense organization was to the detriment of the care of other patients.


Assuntos
Cesárea , Cuidado Pré-Natal , Adulto , Gravidez , Humanos , Feminino , Anestesia Geral , Recusa do Paciente ao Tratamento
6.
Int J Radiat Oncol Biol Phys ; 118(2): 427-435, 2024 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-37657506

RESUMO

PURPOSE: Radiation therapy (RT) refusal is known to have deleterious effects on survival for multiple cancer types. Factors associated with RT refusal by patients with gynecologic malignancies have not been well described. This study aimed to examine factors associated with and the survival impact of documented RT refusal among patients with gynecologic cancers. METHODS AND MATERIALS: This study analyzed data from the National Cancer Database (NCDB) of patients with gynecologic cancers diagnosed between 2004 and 2020. Patients were included if they had complete survival data and a documented RT recommendation by their treating physician in the NCDB. Patients coded as received RT were compared with those coded as refused RT in the NCDB using a multivariate log binomial regression with robust variance to yield incidence rate ratios (IRR). Overall survival was analyzed using a multivariate (MV) Cox proportional hazards model to yield hazard ratios. RESULTS: This study identified 209,976 patients. A total of 5.75% (n = 12,081) patients were coded as refusing RT. Multivariable IRR showed that documentation of RT refusal was positively associated with older age (MV IRR, 1.04; 95% CI, 1.041-1.045), Native Hawaiian Pacific Islander race (1.72 [1.27-2.32]), and increased morbidity (score = 1: 1.06 [1.02-1.11]; score = 2: 1.20 [1.12-1.29]; score ≥3: 1.26 [1.14-1.38]). Negative associations were seen with Hispanic ethnicity (0.74 [0.67-0.80]), having insurance (0.58 [0.53-0.63]), and annual income >$74,063 (0.85 [0.81-0.90]). During the 16-year period, a statistically significant test for trend (P = .001) for increasing RT refusal was noted. RT refusal was associated with a significantly higher risk of death (MV hazard ratio, 1.59 [1.55-1.63]). CONCLUSIONS: For patients with gynecologic malignancies diagnosed from 2004 to 2020, an increase in documented RT refusal is associated with decreased overall survival in all disease types. Targeted interventions aimed at mitigating potential sociodemographic barriers to receipt of RT are warranted.


Assuntos
Neoplasias dos Genitais Femininos , Humanos , Feminino , Neoplasias dos Genitais Femininos/radioterapia , Modelos de Riscos Proporcionais , Renda , Fatores de Risco , Documentação , Estudos Retrospectivos , Recusa do Paciente ao Tratamento
9.
Otol Neurotol ; 45(1): 24-28, 2024 Jan 01.
Artigo em Inglês | MEDLINE | ID: mdl-38013485

RESUMO

OBJECTIVE: Evaluate the rate at which cochlear implant (CI) candidates decline surgery and identify associated factors. STUDY DESIGN: Retrospective cohort study. SETTING: Tertiary referral center. PATIENTS: Four hundred ninety-three CI candidates from July 1989 to December 2020 with complete demographic and socioeconomic data. INTERVENTIONS: Diagnostic. MAIN OUTCOME MEASURES: Age, sex, race, marital and employment status, median household income percentile, distance-to-CI-center, and residence in a medically underserved county. RESULTS: Of the 493 CI candidates included, 80 patients (16.2%) declined surgery. Based on chart checking, the most common reason patients did not receive the implant was due to loss of follow-up (38%). African American patients were 73% less likely to undergo implantation compared with White patients (odds ratio [OR], 0.27 [0.11-0.68]; p = 0.005). Asian patients were 95% less likely to undergo implantation (OR, 0.05 [0.009-0.25]; p = 0.0003) compared with White patients. For every 1-year age increase, patients were 4% less likely to undergo implantation (OR, 0.96 [0.94-0.98]; p < 0.0001) and for every 10-year age increase, the patients were 33% less likely. Compared with their single counterparts, married patients were more likely to undergo implantation (OR, 1.87 [1.12-3.15]; p = 0.02). No differences were observed when comparing implanted and nonimplanted CI candidates in sex, employment status, distance-to-CI-center, or median family income percentile. A χ2 test of independence showed no association between receiving CIs and living in medically underserved counties ( χ2 = 2; N = 493; 0.3891; p = 0.53). CONCLUSIONS: Not infrequently, CI candidates decline surgery. Although demographic factors (race, age, and marital status) were associated with the cochlear implantation decision, socioeconomic factors (median family income and residence in a medically underserved community) were not. Perhaps cultural components of a patient's race have a larger impact on whether or not the patients get implanted.


Assuntos
Implante Coclear , Implantes Cocleares , Recusa do Paciente ao Tratamento , Humanos , Estudos Retrospectivos , Fatores Socioeconômicos , Recusa do Paciente ao Tratamento/estatística & dados numéricos
12.
BMJ Open ; 13(12): e074005, 2023 12 30.
Artigo em Inglês | MEDLINE | ID: mdl-38159951

RESUMO

OBJECTIVE: The prevention of HIV/AIDS is not making sufficient progress. The slow reduction of HIV/AIDS infections needs to prioritise hesitancy towards service utilisation, including treatment duration, social support and social stigma. This study investigates HIV-positive patients' avoidance of healthcare services and its correlates. DESIGN: A cross-sectional study. SETTING: The secondary data analysis used cross-sectional data from a randomised controlled intervention, examining the effectiveness of HIV-assisted smartphone applications in the treatment of HIV/AIDS patients in the Bach Mai and Ha Dong clinics in Hanoi. METHODS: Simple random sampling was used to identify 495 eligible patients. Two-tailed χ2, Mann-Whitney, multivariate logistic and ordered logistic regression models were performed. PRIMARY AND SECONDARY OUTCOME MEASURES: The main study outcome was the patients' healthcare avoidance and frequency of healthcare avoidance. The association of individual characteristics, social and behavioural determinants of HIV patients' usage of health services was also determined based on the collected data using structured questionnaires. RESULTS: Nearly half of the participants avoid health service use (47.3%), while 30.7% rarely avoid health service use. Duration of antiretroviral therapy and initial CD4 cell count were negatively associated with avoidance of health services and frequency of health service avoidance. Similarly, those with the middle and highest income were more likely to avoid health services compared with those with the lowest income. People having health problems avoided health service use more frequently (OR 1.47, 95% CI 1.35 to 1.61). CONCLUSIONS: Our study's findings identify characteristics of significance in relation to health service avoidance and utilisation among HIV-positive patients. The results highlighted the need to improve satisfaction, adherence and utilisation of treatment. Moreover, identifying ways to address or incorporate those social determinants in new policy may also help the treatment of HIV/AIDS and strategically allocate funding in the changing financial and political climate of Vietnam. TRIAL REGISTRATION NUMBER: Thai Clinical Trials Registry TCTR20220928003.


Assuntos
Síndrome de Imunodeficiência Adquirida , Infecções por HIV , Humanos , Infecções por HIV/prevenção & controle , Síndrome de Imunodeficiência Adquirida/tratamento farmacológico , Estudos Transversais , Vietnã , Inquéritos e Questionários , Serviços de Saúde , Recusa do Paciente ao Tratamento
13.
Niger J Clin Pract ; 26(12): 1927-1933, 2023 Dec 01.
Artigo em Inglês | MEDLINE | ID: mdl-38158363

RESUMO

BACKGROUND: Discharge against medical advice (DAMA) is when a patient decides to leave the hospital without the consent of the treating physician. It poses serious clinical, ethical, and legal challenges to the individual physician as well as the hospital. AIM: To determine the prevalence and reasons for DAMA in orthopedic departments of eight tertiary hospitals in Nigeria. MATERIALS AND METHODS: This was a prospective multi-center descriptive study undertaken in eight tertiary Nigerian hospitals. Consecutive patients who requested for DAMA within 1 year of the study and who consented to participate in the study had face-to-face interviews. Data obtained were documented in a questionnaire and analyzed with SPSS version 20. RESULTS: The total number of patients studied was 373 with a mean age 34.7 ± 17.5 years. About a quarter of them (25.5%) were between 31 and 40 years. A prevalence rate of 1.9% was found with financial constraint being the predominant reason for DAMA (40.8%). Other reasons include family preference for unorthodox treatment (18.8%) and treatment dissatisfaction (7.0%) among others. CONCLUSION: The study findings indicate a low DAMA rate when compared to previous studies in this region. It also indicates that financial constraints, family preference for unorthodox care, and low educational status are major drivers of DAMA. Deepened health insurance and other measures that can reduce the prevalence of DAMA should be prioritized to improve treatment outcomes.


Assuntos
Alta do Paciente , Recusa do Paciente ao Tratamento , Humanos , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Estudos Prospectivos , Centros de Atenção Terciária , Nigéria/epidemiologia
14.
BMC Womens Health ; 23(1): 562, 2023 11 01.
Artigo em Inglês | MEDLINE | ID: mdl-37915037

RESUMO

BACKGROUND: Radiotherapy improves survival for many cancer patients. However, some patients still refuse radiotherapy despite the recommendations of their physicians. We aimed to investigate the impact of refusing recommended radiotherapy on overall survival in patients with gynecological cancers (GC) and attempted to describe what characteristics are associated with the refusal of radiotherapy. METHODS: Data were extracted from the Surveillance, Epidemiology and End Result (SEER) database for patients who were diagnosed with GC and recommended for radiotherapy between 1988 and 2016. Kaplan-Meier and multivariate Cox regression analyses were utilized to analyze the impact of refusal of radiotherapy on overall survival. Univariate and multivariate logistic regression analyses were used to identify characteristics associated with refusal of radiotherapy. RESULTS: In total, 1,226 of 208,093 patients (0.6%) refused radiotherapy. Multivariate Cox regression analysis showed that refusal of radiotherapy was associated with poorer overall survival in GC patients with stage I/II [hazard ratio (HR) = 1.64; 95% confidence interval (CI), 1.50-1.79], but may not affect overall survival in patients with stage III/IV (HR = 1.03; 95%CI, 0.84-1.25). Multivariate logistic regression analysis demonstrated that factors such as older age (40-65 years, > 65 years), unmarried status (divorced, single, widowed), higher foreign-born rate (1.87-2.82%, 1.51-2.19), refusal of surgery (recommended but not performed), and higher grade (poorly differentiated, undifferentiated/anaplastic) may increase the likelihood of refusing radiotherapy (all P < 0.05). Factors that may reduce the likelihood of refusing radiotherapy include higher income (> 42,810$), lower grade (well-differentiated), primary site of ovarian cancer, and no/unknown chemotherapy (all P < 0.05). CONCLUSION: Refusal of radiotherapy is related to worse overall survival in GC patients with stage I/II, and many characteristics may affect a patient's choice of refusal of radiotherapy.


Assuntos
Neoplasias , Recusa do Paciente ao Tratamento , Humanos , Estudos Retrospectivos , Modelos de Riscos Proporcionais , Análise Multivariada
15.
Hosp Pract (1995) ; 51(5): 288-294, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-37994412

RESUMO

BACKGROUND: Discharges against medical advice (DAMA) increase the risk of death. METHODS: We retrieved DAMA from five hospitals within a large health system and reviewed 10% of DAMA from the academic site between 2016 and 2021. RESULTS: DAMA increased at the onset of the pandemic. Patients who discharged AMA multiple times accounted for a third of all DAMA. Detailed review was completed for 278 patients who discharged AMA from the academic site. In this sample, women comprised 52% of those who discharged AMA multiple times. Relative to the proportion of all discharges from the academic site during the study period, Black patients were overrepresented among DAMA (21% vs. 34%, p < .05). Patients with multiple AMA discharges were younger, more likely to be unmarried, or have substance use disorders (SUD) than those who discharged AMA once. The most common reason for requesting premature discharge noted in n = 77, 28% of instances was related to patient obligations outside the hospital. Hospital policies and procedures contributed in n = 29, 10% of instances. Reasons for requesting premature discharge and documentation of key safety processes were similar by gender and race however the sample may be underpowered to detect differences. Capacity was evaluated in 109 (39%). Among those who consumed alcohol (n = 81 (29%)) or had SUDs (n = 112 (40%)), information on the amount or timing of last use was missing in n = 39 (48%) and n = 74 (66%), respectively. Critical tools to manage illness were provided in 45 (16%) of DAMA reviewed. CONCLUSIONS: Drivers of AMA discharge may differ by AMA discharge frequency. Recognition of the common reasons for requesting premature discharge may help destigmatize AMA discharges and also identifies early assessments by social work colleagues as an important prevention strategy. Opportunities also exist in anticipating and preventing withdrawal symptoms and in revising hospital practices that contribute to DAMA.


Assuntos
Alta do Paciente , Recusa do Paciente ao Tratamento , Feminino , Humanos , Masculino , Hospitais , Estudos Retrospectivos
16.
J Clin Ethics ; 34(3): 273-277, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37831646

RESUMO

AbstractInjuries from failed suicide attempts account for a large number of patients cared for in the emergency and trauma setting. While a fundamental underpinning of clinical ethics is that patients have a right to refuse treatment, individuals presenting with life-threating injuries resulting from suicide attempts are almost universally treated in this acute care setting. Here we discuss the limitations on physician ability to determine capacity in this setting and the challenges these pose in carrying out patient wishes.


Assuntos
Tentativa de Suicídio , Recusa do Paciente ao Tratamento , Humanos , Recusa do Paciente ao Tratamento/ética
17.
Surgery ; 174(6): 1428-1435, 2023 12.
Artigo em Inglês | MEDLINE | ID: mdl-37821266

RESUMO

BACKGROUND: Surgical resection is the standard of care for early-stage non-small cell lung cancer. Black patients have higher surgical refusal rates than White patients. We evaluated factors associated with the refusal of resection and subsequent non-small cell lung cancer outcomes. METHODS: We identified patients with non-small cell lung cancer stages IA to IIIA eligible for surgical resection (lobectomy or pneumonectomy) listed between 2004 and 2017 in the National Cancer Database. We stratified hospitals by the proportion of Black patients served and lung cancer resection volume. We used multivariable regression models to identify factors associated with refusal of resection and assessed 5-year mortality using Kaplan-Meier analysis and Cox proportional hazard modeling. RESULTS: Of 221,396 patients identified, 7,753 (3.5%) refused surgery. Black race was associated with increased refusal (adjusted odds ratio 2.06, 95% confidence interval 1.90-2.22). Compared to White race, Black race was associated with increased refusal across the highest (adjusted odds ratio 2.29, 95% confidence interval 1.94-2.54), intermediate (adjusted odds ratio 2.05, 95% confidence interval 1.78-2.37), and lowest (adjusted odds ratio 1.77, 95% confidence interval 1.58-1.99) volume tertiles. Similarly, Black race was associated with increased refusal across the highest (adjusted odds ratio 1.97, 95% confidence interval 1.78-2.17), intermediate (adjusted odds ratio 2.08, 95% confidence interval 1.80-2.40), and lowest (adjusted odds ratio 1.53, 95% confidence interval 1.13-2.06) Black-serving tertiles. However, surgical resection yielded similar 5-year survival for Black and White patients. CONCLUSION: Racial disparities in non-small cell lung cancer surgery refusal persist regardless of hospital volume or proportion of Black patients served. These findings suggest that a better understanding of patient and patient-provider level interventions could facilitate a better understanding of treatment decision-making.


Assuntos
Carcinoma Pulmonar de Células não Pequenas , Disparidades em Assistência à Saúde , Neoplasias Pulmonares , Recusa do Paciente ao Tratamento , Humanos , Carcinoma Pulmonar de Células não Pequenas/cirurgia , Neoplasias Pulmonares/cirurgia , Grupos Raciais , Negro ou Afro-Americano , Brancos , Hospitais com Alto Volume de Atendimentos
18.
Acta Biomed ; 94(S3): e2023155, 2023 08 30.
Artigo em Inglês | MEDLINE | ID: mdl-37695195

RESUMO

BACKGROUND AND AIM: The number of People with Dementia (PwD) is rising worldwide and represents a complex figure because of the changes in the cognitive sphere, altering perceptions of the Built Environment (BE). Even though the role of the built environment in the health and well-being of people it's nowadays well known, few studies analyze and evaluate the impact of specific Architectural Features. To this end, this contribution provides a systematic review that will underline the impacts of BE on the Health and Well-being of PwD and set a matrix of the relationship with measurable outcomes. METHODS: A literature review has been conducted on scientific databases. 40 studies that relate health outcomes and aspects of the built environment have been identified and organized on a comparison matrix that clearly shows the relationships between Architectural Features of BE and Health and Wellbeing Outcome. This matrix allows to identify which are the aspects that can impact on PwD as well as possible lacks. RESULTS: Many aspects appear to be widely explored, such as BPSD or wandering. In addition, significant gaps in the relationship between recognized aspects of the built environment recognized as relevant to the well-being of people with dementia and the real impacts on health outcomes such as the location and personalization of spaces. CONCLUSIONS: This study collected the most recent studies to underline the relationship between BE and dementia, providing a set of outcomes and architectural features that can be analyzed to assess the quality of BE for PwD.


Assuntos
Ambiente Construído , Demência , Humanos , Bases de Dados Factuais , Recusa do Paciente ao Tratamento
19.
PLoS One ; 18(8): e0290322, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-37616320

RESUMO

When we engage in internally directed cognition, like doing mental arithmetic or mind wandering, fewer cognitive resources are assigned for other activities like reacting to perceptual input-an effect termed perceptual decoupling. However, the exact conditions under which perceptual decoupling occurs and its underlying cognitive mechanisms are still unclear. Hence, the present study systematically manipulated the task type (arithmetic, visuospatial) and workload (control, low, high) of the internal task in a within-subject design and tested its effects on voluntary saccades in a target-distractor saccade task. As expected, engagement in internal tasks delayed saccades to the target. This effect was moderated by time, task, and workload: The delay was largest right after internal task onset and then decreased, potentially reflecting the intensity of internal task demands. Saccades were also more delayed for the high compared to the low workload condition in the arithmetic task, whereas workload conditions had similarly high effects in the visuospatial task. Findings suggests that perceptual decoupling of eye behavior gradually increases with internal demands on general resources and that perceptual decoupling is specifically sensitive to internal demands on visuospatial resources. The latter may be mediated by interference due to eye behavior elicited by the internal task itself. Internal tasks did not affect the saccade latency-deviation trade-off, indicating that while the internal tasks delayed the execution of the saccade, the perception of the saccade stimuli and spatial planning of the saccade continued unaffected in parallel to the internal tasks. Together, these findings shed further light on the specific mechanisms underlying perceptual decoupling by suggesting that perceptual decoupling of eye behavior increases as internal demands on cognitive resources overlap more strongly with demands of the external task.


Assuntos
Movimentos Sacádicos , Carga de Trabalho , Cognição , Levanogestrel , Recusa do Paciente ao Tratamento
20.
Ann Behav Med ; 57(12): 1024-1031, 2023 11 16.
Artigo em Inglês | MEDLINE | ID: mdl-37616560

RESUMO

BACKGROUND: Intersex individuals experience poor health due, in part, to healthcare avoidance. Nonconsensual intersex surgery may contribute to medical mistrust and avoidance among intersex populations. PURPOSE: The purpose of this study was to explore the relationship between nonconsensual surgery and healthcare avoidance among intersex populations and to examine if medical mistrust mediates this relationship. METHODS: Data for this cross-sectional study were collected in 2018 and analyzed in 2022. Participants completed a survey collecting information on demographics, medical mistrust, history of nonconsensual surgery, and history of postponing healthcare. One hundred nine participants with valid responses to all regression model variables were included in the study. Multivariable logistic regression models controlling for age, race, and income, examined the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. Mediation analyses of cross-sectional data examined whether medical mistrust mediated the relationship between nonconsensual surgery and postponing preventive and emergency healthcare. RESULTS: Mean medical mistrust score was 2.8 (range = 1-4; standard deviation = 0.8), 49.7% of participants had nonconsensual surgery in their lifetime, 45.9% postponed emergency healthcare, and 61.5% postponed preventive healthcare in their lifetime. Nonconsensual surgery was associated with increased odds of delaying preventive (adjusted odds ratio [AOR] = 4.17; confidence interval [CI] = 1.76-9.88; p = .016) and emergency healthcare (AOR = 4.26; CI = 1.71-10.59; p = .002). Medical mistrust mediated the relationship between nonconsensual surgery and delaying preventive (indirect effect = 1.78; CI = 1.16-3.67) and emergency healthcare (indirect effect = 1.66; CI = 1.04-3.30). CONCLUSIONS: Nonconsensual surgery contributed to healthcare avoidance in this intersex population by increasing medical mistrust. To decrease healthcare avoidance, intersex health promotion interventions should restrict nonconsensual surgery and build trust through trauma-informed care.


Many intersex people experience nonconsensual surgery during childhood to alter their genitalia and other anatomy. Some intersex people who have experienced nonconsensual surgery develop subsequent mistrust in medical providers and avoidance of healthcare. The purpose of this study was to understand the relationship between nonconsensual surgery and delay in emergency and preventive healthcare among intersex adults. Additionally, this study aimed to understand whether mistrust in medical providers mediates the relationship between nonconsensual surgery and delaying emergency and preventive healthcare. This study found that ever having nonconsensual surgery was positively associated with delaying both emergency and preventive healthcare among intersex adults. Additionally, this study found that increased mistrust in medical providers mediated the relationship between nonconsensual surgery and delaying emergency and preventive healthcare. Interventions aimed at improving the healthcare engagement of intersex adults may focus on building trust between intersex patients and healthcare providers and restricting nonconsensual intersex surgeries.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Confiança , Adulto , Humanos , Estudos Transversais , Inquéritos e Questionários , Recusa do Paciente ao Tratamento
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