Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 6.761
Filtrar
Mais filtros

Intervalo de ano de publicação
1.
Br J Nurs ; 30(17): 1032-1038, 2021 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-34605255

RESUMO

During the COVID-19 pandemic, virtual pre-assessment was introduced for all elective and semi-urgent surgeries to maintain surgical clinical services in the authors' Trust. This mainly involved telephone pre-assessments, although occasionally video technology was used. This had to be managed and maintained at a distance with little or no training or established method. This article includes experiences of staff involved in a single tertiary centre, an assessment of the pros and cons of virtual pre-assessment and concludes with a set of recommendations to enhance the utility of the service for the future.


Assuntos
COVID-19 , Pandemias , Procedimentos Cirúrgicos Eletivos , Humanos , SARS-CoV-2 , Telefone
2.
Front Public Health ; 9: 741525, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34604164

RESUMO

The outbreak of COVID-19 pandemic has caused profound consequences on world economy. In order to explore the long-term impact of the pandemic on economic growth and the effects of different policy responses, this paper combines economic theory with epidemiological model to construct an interdisciplinary model, in which labor supply is dynamically constrained by pandemic conditions. Analysis of model equilibrium suggests that outbreaks of infectious disease reduce labor supply and negatively affect economic output. The accumulation of health capital can suppress the spread of disease and improve the recovery rate of infected individuals, which will alleviate the labor supply constraint caused by the pandemic and lead to an increase in output and consumption. The model is then calibrated to Chinese economy. The simulation results imply that government's public health policy can enhance the role of health capital in promoting economic growth. But the marginal effect of certain policies is diminishing. Therefore, the government needs to balance pandemic prevention and control costs and marginal benefits when formulating public health policies. When the pandemic is under control, the resumption of production is feasible and the economic stimulus package could lead to economic recovery.


Assuntos
COVID-19 , Pandemias , Desenvolvimento Econômico , Governo , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
3.
Health Res Policy Syst ; 19(Suppl 3): 103, 2021 Oct 12.
Artigo em Inglês | MEDLINE | ID: mdl-34641912

RESUMO

BACKGROUND: Community health workers (CHWs) play a critical role in grassroots healthcare and are essential for achieving the health-related Sustainable Development Goals. While there is a critical shortage of essential health workers in low- and middle-income countries, WHO and international partners have reached a consensus on the need to expand and strengthen CHW programmes as a key element in achieving Universal Health Coverage (UHC). The COVID-19 pandemic has further revealed that emerging health challenges require quick local responses such as those utilizing CHWs. This is the second paper of our 11-paper supplement, "Community health workers at the dawn of a new era". Our objective here is to highlight questions, challenges, and strategies for stakeholders to consider while planning the introduction, expansion, or strengthening of a large-scale CHW programme and the complex array of coordination and partnerships that need to be considered. METHODS: The authors draw on the outcomes of discussions during key consultations with various government leaders and experts from across policy, implementation, research, and development organizations in which the authors have engaged in the past decade. These include global consultations on CHWs and global forums on human resources for health (HRH) conferences between 2010 and 2014 (Montreux, Bangkok, Recife, Washington DC). They also build on the authors' direct involvement with the Global Health Workforce Alliance. RESULTS: Weak health systems, poor planning, lack of coordination, and failed partnerships have produced lacklustre CHW programmes in countries. This paper highlights the three issues that are generally agreed as being critical to the long-term effectiveness of national CHW programmes-planning, coordination, and partnerships. Mechanisms are available in many countries such as the UHC2030 (formerly International Health Partnership), country coordinating mechanisms (CCMs), and those focusing on the health workforce such as the national Human Resources for Health Observatory and the Country Coordination and Facilitation (CCF) initiatives introduced by the Global Health Workforce Alliance. CONCLUSION: It is imperative to integrate CHW initiatives into formal health systems. Multidimensional interventions and multisectoral partnerships are required to holistically address the challenges at national and local levels, thereby ensuring synergy among the actions of partners and stakeholders. In order to establish robust and institutionalized processes, coordination is required to provide a workable platform and conducive environment, engaging all partners and stakeholders to yield tangible results.


Assuntos
COVID-19 , Agentes Comunitários de Saúde , Humanos , Pandemias , SARS-CoV-2 , Tailândia
4.
PLoS One ; 16(10): e0257162, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34618829

RESUMO

BACKGROUND: Successful implementation of medical technologies applied in life-threatening conditions, including extracorporeal membrane oxygenation (ECMO) requires appropriate preparation and training of medical personnel. The pandemic has accelerated the creation of new ECMO centers and has highlighted continuous training in adapting to new pandemic standards. To reach high standards of patients' care, we created the first of its kind, National Education Centre for Artificial Life Support (NEC-ALS) in 40 million inhabitants' country in the Central and Eastern Europe (CEE). The role of the Center is to test and promote the novel or commonly used procedures as well as to develop staff skills on management of patients needing ECMO. METHOD: In 2020, nine approved and endorsed by ELSO courses of "Artificial Life Support with ECMO" were organized. Physicians participated in the three-day high-fidelity simulation-based training that was adapted to abide by the social distancing norms of the COVID-19 pandemic. Knowledge as well as crucial cognitive, behavioral and technical aspects (on a 5-point Likert scale) of management on ECMO were assessed before and after course completion. Moreover, the results of training in mechanical chest compression were also evaluated. RESULTS: There were 115 participants (60% men) predominantly in the age of 30-40 years. Majority of them (63%) were anesthesiologists or intensivists with more than 5-year clinical experience, but 54% had no previous ECMO experience. There was significant improvement after the course in all cognitive, behavioral, and technical self-assessments. Among aspects of management with ECMO that all increased significantly following the course, the most pronounced was related to the technical one (from approximately 1.0 to more 4.0 points). Knowledge scores significantly increased post-course from 11.4 ± SD to 13 ± SD (out of 15 points). The quality of manual chest compression relatively poor before course improved significantly after training. CONCLUSIONS: Our course confirmed that simulation as an educational approach is invaluable not only in training and testing of novel or commonly used procedures, skills upgrading, but also in practicing very rare cases. The implementation of the education program during COVID-19 pandemic may be helpful in founding specialized Advanced Life Support centers and teams including mobile ones. The dedicated R&D Innovation Ecosystem established in the "ECMO for Greater Poland" program, with developed National Education Center can play a crucial role in the knowledge and know-how transfer but future research is needed.


Assuntos
COVID-19 , Educação à Distância , Educação Médica Continuada , Pandemias , SARS-CoV-2 , Treinamento por Simulação , Adulto , COVID-19/epidemiologia , COVID-19/terapia , Feminino , Humanos , Masculino
5.
Artigo em Inglês | MEDLINE | ID: mdl-34639373

RESUMO

(1) Background: With the rapid global spread of the coronavirus disease 2019 (COVID-19) and the relatively high daily cases recorded in a short time compared to other types of seasonal flu, the world remains under continuous threat unless we identify the key factors that contribute to these unexpected records. This identification is important for developing effective criteria and plans to reduce the spread of the COVID-19 pandemic and can guide national authorities to tighten or reduce mitigation measures, in addition to spreading awareness of the important factors that contribute to the propagation of the disease. (2) Methods: The data represents the daily infections (210 days) in four different countries (China, Italy, Iran, and Lebanon) taken approximately in the same duration, between January and March 2020. Path analysis was implemented on the data to detect the significant factors that affect the daily COVID-19 infections. (3) Results: The path coefficients show that quarantine commitment (ß = -0.823) and full lockdown measures (ß = -0.775) have the largest direct effect on COVID-19 daily infections. The results also show that more experience (ß = -0.35), density in society (ß = -0.288), medical resources (ß = 0.136), and economic resources (ß = 0.142) have indirect effects on daily COVID-19 infections. (4) Conclusions: The COVID-19 daily infections directly decrease with complete lockdown measures, quarantine commitment, wearing masks, and social distancing. COVID-19 daily cases are indirectly associated with population density, special events, previous experience, technology used, economic resources, and medical resources.


Assuntos
COVID-19 , Pandemias , Controle de Doenças Transmissíveis , Humanos , Quarentena , SARS-CoV-2 , Fatores Socioeconômicos
6.
Artigo em Inglês | MEDLINE | ID: mdl-34639570

RESUMO

There has long been a gender bias in medicine. This qualitative study aims to identify the experience of sexism among frontline female nurses and further explore their expectations and possible strategies to get rid of gender bias. This is a descriptive phenomenological study of 23 female nurses with 11 ± 3.98 years of experience who spent 36 ± 6.50 days at the frontline during the initial COVID-19 outbreak. We employed Colaizzi's phenomenological analysis method to understand the subjective experiences, revealing the following themes: (a) materialization of gender identity; (b) incoordinate relationships; (c) future voice of female nurses. The gender bias experienced by female frontline nurses further challenges their emotional identity and self-identity. Therefore, it is important to require extensive consciousness-raising and policy support to defend female nurses' rights.


Assuntos
COVID-19 , Recursos Humanos de Enfermagem no Hospital , China , Feminino , Identidade de Gênero , Humanos , Masculino , Pandemias , Pesquisa Qualitativa , SARS-CoV-2 , Sexismo
7.
Artigo em Inglês | MEDLINE | ID: mdl-34639612

RESUMO

At the end of 2019, the COVID-19 pandemic began to emerge on a global scale, including China, and left deep traces on all societies. The spread of this virus shows remarkable temporal and spatial characteristics. Therefore, analyzing and visualizing the characteristics of the COVID-19 pandemic are relevant to the current pressing need and have realistic significance. In this article, we constructed a new model based on time-geography to analyze the movement pattern of COVID-19 in Hebei Province. The results show that as time changed COVID-19 presented an obvious dynamic distribution in space. It gradually migrated from the southwest region of Hebei Province to the northeast region. The factors affecting the moving patterns may be the migration and flow of population between and within the province, the economic development level and the development of road traffic of each city. It can be divided into three stages in terms of time. The first stage is the gradual spread of the epidemic, the second is the full spread of the epidemic, and the third is the time and again of the epidemic. Finally, we can verify the accuracy of the model through the standard deviation ellipse and location entropy.


Assuntos
COVID-19 , Pandemias , China/epidemiologia , Cidades , Geografia , Humanos , SARS-CoV-2
8.
Artigo em Inglês | MEDLINE | ID: mdl-34639829

RESUMO

The spatial and temporal behavior of the occurrence of forest fires in Chile was evaluated in the presence of COVID-19 and mobility restrictions. The fire period from 2015-2016 to 2020-2021 was considered and statistics on mobility restrictions were granted by the Government of Chile. The analysis was developed at different scales of geographic perception. At the national and regional levels, the global behavior of the occurrence was determined, and later at the communal level, the political territorial unit, to determine internal variations attributable to the mobility dynamics in the quarantine period. In the process, the meteorological background of the fire activity was also considered. The results indicate that it is possible to rule out a meteorological effect, based on the variation of the moisture content of fine fuel. There was also no statistical association between the humidity of the fuel and the variation in the occurrence of fires. It is concluded that the communes that presented the greatest mobility of people before the pandemic were those that obtained the greatest reduction in fires. The variation in mobility, the product of restriction measures, is a statistical predictor of the increase or decrease in fires.


Assuntos
COVID-19 , Incêndios , Incêndios Florestais , Chile/epidemiologia , Florestas , Humanos , Pandemias , SARS-CoV-2
10.
J Manag Care Spec Pharm ; 27(10): 1489-1493, 2021 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-34595946

RESUMO

SUMMARY The 1-month drug-dispensing limit is a common drug utilization tool used by state Medicaid agencies to control spending. Since the beginning of the COVID-19 pandemic, many states relaxed the 1-month dispensing limit restriction in order to align with social distancing recommendations. Yet, some states have not relaxed this limit and have differed substantially regarding the policies that have been implemented. Among states that relaxed the 1-month supply limit, determining which chronic disease drugs qualified for this extension can be challenging for patients and clinicians. As more commercial and Medicare insurance beneficiaries are offered 90-day drug supplies, the 30-day drug supply limit with Medicaid has become a health equity issue, since many individuals insured by Medicaid have already experienced a disproportionate impact from and remain at high risk for severe COVID-19 disease. Thus, we propose policy solutions to ensure that Medicaid beneficiaries have safe and uninterrupted access to chronic disease medications during and beyond the COVID-19 pandemic. DISCLOSURES: No funding was received for this work. Alpern has received funding from Arnold Ventures for research related to the use and spending of off-patent drugs, unrelated to this work, and is a member of the Pharmacy and Therapeutics Committee at Regions Hospital, St. Paul, MN. DeSilva has received CDC support for work on Vaccine Safety Datalink, VISION network, and Center of Excellence for Newcomer Health, unrelated to this work. Chomilo is Medicaid Medical Director for the State of Minnesota's Department of Human Services.


Assuntos
COVID-19/epidemiologia , Medicaid/normas , Distanciamento Físico , Doença Crônica , Humanos , Reembolso de Seguro de Saúde/economia , Reembolso de Seguro de Saúde/normas , Medicaid/economia , Pandemias , Políticas , SARS-CoV-2 , Estados Unidos/epidemiologia
11.
Int J Public Health ; 66: 1604004, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34630005

RESUMO

Objectives: To quantify the Black/Hispanic disparity in COVID-19 mortality in the United States (US). Methods: COVID-19 deaths in all US counties nationwide were analyzed to estimate COVID-19 mortality rate ratios by county-level proportions of Black/Hispanic residents, using mixed-effects Poisson regression. Excess COVID-19 mortality counts, relative to predicted under a counterfactual scenario of no racial/ethnic disparity gradient, were estimated. Results: County-level COVID-19 mortality rates increased monotonically with county-level proportions of Black and Hispanic residents, up to 5.4-fold (≥43% Black) and 11.6-fold (≥55% Hispanic) higher compared to counties with <5% Black and <15% Hispanic residents, respectively, controlling for county-level poverty, age, and urbanization level. Had this disparity gradient not existed, the US COVID-19 death count would have been 92.1% lower (177,672 fewer deaths), making the rate comparable to other high-income countries with substantially lower COVID-19 death counts. Conclusion: During the first 8 months of the SARS-CoV-2 pandemic, the US experienced the highest number of COVID-19 deaths. This COVID-19 mortality burden is strongly associated with county-level racial/ethnic diversity, explaining most US COVID-19 deaths.


Assuntos
Afro-Americanos , COVID-19 , Disparidades nos Níveis de Saúde , Hispano-Americanos , Pandemias , Adolescente , Adulto , Afro-Americanos/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , COVID-19/etnologia , COVID-19/mortalidade , Criança , Pré-Escolar , Hispano-Americanos/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Fatores Socioeconômicos , Estados Unidos/epidemiologia , Adulto Jovem
12.
Washington, D.C.; OPS; 2021-10-06.
em Espanhol | PAHOIRIS | ID: phr-54953

RESUMO

En el Informe anual del Director de la Oficina Sanitaria Panamericana correspondiente al 2021 sobre la labor de la Oficina Sanitaria Panamericana, Oficina Regional de la Organización Mundial de la Salud para las Américas, se pone de relieve la cooperación técnica que prestó la Oficina en el período comprendido entre julio del 2020 y junio del 2021, en el marco del Plan Estratégico de la Organización Panamericana de la Salud 2020-2025. Este informe, cuyo tema central es "Seguir trabajando para superar la pandemia de COVID-19", abarca el período más difícil que la Organización Panamericana de la Salud (OPS) haya tenido que enfrentar jamás. La pandemia, y sus devastadoras consecuencias en los ámbitos de la economía y la salud, ha tenido un impacto profundo en la vida y los medios de subsistencia de las personas, y ha causado graves trastornos en los países, la sociedad, la economía y el desarrollo. Esto ha ocurrido a la par de los desafíos inevitables en el camino hacia un desarrollo equitativo y sostenible, y hacia el logro de los Objetivos de Desarrollo Sostenible fijados para el 2030 y los objetivos de la Agenda de Salud Sostenible para las Américas 2018-2030.


Assuntos
COVID-19 , Coronavirus , Infecções por Coronavirus , Vacinas contra COVID-19 , Pandemias , Epidemias , Controle de Infecções , Desenvolvimento Sustentável , Desenvolvimento Sustentável , Estratégias de Saúde Globais , Estratégias de Saúde Globais
13.
Torture ; 31(1): 37-52, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34606476

RESUMO

INTRODUCTION: Due to the COVID-19 pandemic, Freedom from Torture developed remote telephone assessments to provide interim medico-legal reports, ensuring people could obtain medical evidence to support their asylum claim. METHOD: To audit this new way of working, feedback was collected from the doctors, interpreters, individuals being assessed, and senior medical and legal staff who reviewed the reports. This paper presents findings from the first 20 assessments. RESULTS: Individuals assessed reported that the doctor developed good rapport, but in 35% of assessments reported that there were some experiences they felt unable to disclose. In 70% of assessments, doctors felt that rapport was not as good compared to face-to-face. In the majority of assessments, doctors were unable to gain a full account of the torture or its impact. They reported feeling cautious about pressing for more information on the telephone, mindful of individuals' vulnerability and the difficulty of providing support remotely. Nevertheless, in 85% of assessments doctors felt able to assess the consistency of the account of torture with the psychological findings, in accordance with the Istanbul Protocol (United Nations, 2004). Factors that hindered the assessment included the inability to observe body language, the person's ill health, and confidentiality concerns. CONCLUSION: This research indicates that psychological medico-legal reports can safely be produced by telephone assessment, but are more likely to be incomplete in terms of both full disclosure of torture experiences and psychological assessment. The limitations underline the need for a follow-up face-to-face assessment to expand the psychological assessment as well as undertake a physical assessment.


Assuntos
COVID-19/epidemiologia , Relações Médico-Paciente/ética , Refugiados/psicologia , Consulta Remota/ética , Telefone , Tortura , Humanos , Anamnese , Pandemias , Exame Físico , SARS-CoV-2 , Reino Unido/epidemiologia
14.
Int J Med Inform ; 155: 104602, 2021 11.
Artigo em Inglês | MEDLINE | ID: mdl-34601238

RESUMO

OBJECTIVE: During the COVID-19 pandemic, social distancing and self-isolation called for innovative, readily implementable, and effective short-term health solutions. The objective of this study was to assess the feasibility of self-assessment of vital signs and symptoms with electronic transmission of results, by self-isolating individuals with positive SARS-CoV-2 polymerase chain reaction (PCR) test. The secondary objective was to describe the association between the presence of abnormal vital signs and severe symptoms as well as their evolution over time. METHOD: Participants with positive SARS-CoV-2 PCR test were asked to perform twice daily standardized vital signs measurements and self-assessment of symptoms for 14 consecutive days. All data were transmitted electronically through a mobile application and a web-based platform. Participants were provided with decision support tools based on the severity of their condition and a weekly nurse practitioner telephone follow-up. Abnormal values for vital signs and severe symptoms were determined. Per participant and per days, proportions of abnormal vital signs and severe symptoms were calculated. RESULTS: Data from 46 participants (mean age 54.1 ± 6.9 years, 54% male) were available for analysis. On average, participants performed the standardized self-assessment for 12.3 ± 3.4 days (89% performed at least 7 measurement days and 61% completed all 14 days). The highest proportions abnormal values for vital signs were for oximetry (20.1%) and respiratory rate (12.1%). The highest proportions of severe symptoms were for fatigue (16.9%) and myalgia. (10.2%). The combined proportion of abnormal vital signs and severe symptoms was maximal on day 1 with 20.3% of total measurements, with a linear decrease to 3.5% on day 14. CONCLUSION: Remote initiation of home measurements of vital signs and symptoms, self-management of these measures, accompanied by a decision support tool and supported by preplanned nurse follow-up are feasible. This could allow to opening up new insight for the care of sick individuals.


Assuntos
COVID-19 , Telemedicina , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias , SARS-CoV-2 , Autoavaliação (Psicologia) , Sinais Vitais
15.
BMJ Open ; 11(10): e049134, 2021 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-34607860

RESUMO

OBJECTIVE: Early in the COVID-19 pandemic, US Veterans Health Administration (VHA) employee occupational health (EOH) providers were tasked with assuming a central role in coordinating employee COVID-19 screening and clearance for duty, representing entirely novel EOH responsibilities. In a rapid qualitative needs assessment, we aimed to identify learnings from the field to support the vastly expanding role of EOH providers in a national healthcare system. METHODS: We employed rapid qualitative analysis of key informant interviews in a maximal variation sample on the parameters of job type, rural versus urban and provider gender. We interviewed 21 VHA EOH providers between July and December 2020. This sample represents 15 facilities from diverse regions of the USA (large, medium and small facilities in the Mid-Atlantic; medium sites in the South; large facilities in the West and Pacific Northwest). RESULTS: Five interdependent needs included: (1) infrastructure to support employee population management, including tools that facilitate infection control measures such as contact tracing (eg, employee-facing electronic health records and coordinated databases); (2) mechanisms for information sharing across settings (eg, VHA listserv), especially for changing policy and protocols; (3) sufficiently resourced staffing using detailing to align EOH needs with human resource capital; (4) connected and resourced local and national leaders; and (5) strategies to support healthcare worker mental health.Our identified facilitators for EOH assuming new challenging and dynamically changing roles during COVID-19 included: (A) training or access to expertise; (B) existing mechanisms for information sharing; (C) flexible and responsive staffing; and (D) leveraging other institutional expertise not previously affiliated with EOH (eg, chaplains to support bereavement). CONCLUSIONS: Our needs assessment highlights local and system level barriers and facilitators of EOH assuming expanded roles during COVID-19. Integrating changes both within and across systems and with alignment of human capital will enable EOH preparedness for future challenges.


Assuntos
COVID-19 , Saúde do Trabalhador , Pessoal de Saúde , Humanos , Determinação de Necessidades de Cuidados de Saúde , Pandemias , SARS-CoV-2 , Saúde dos Veteranos , Recursos Humanos
16.
BMJ Open ; 11(10): e052482, 2021 10 04.
Artigo em Inglês | MEDLINE | ID: mdl-34607870

RESUMO

OBJECTIVES: This study explores the hospital journey of patients with intellectual disabilities (IDs) compared with the general population after admission for COVID-19 during the first wave of the pandemic (when demand on inpatient resources was high) to identify disparities in treatment and outcomes. DESIGN: Matched cohort study; an ID cohort of 506 patients were matched based on age, sex and ethnicity with a control group using a 1:3 ratio to compare outcomes from the International Severe Acute Respiratory and emerging Infections Consortium WHO Clinical Characterisation Protocol UK. SETTING: Admissions for COVID-19 from UK hospitals; data on symptoms, severity, access to interventions, complications, mortality and length of stay were extracted. INTERVENTIONS: Non-invasive respiratory support, intubation, tracheostomy, ventilation and admission to intensive care units (ICU). RESULTS: Subjective presenting symptoms such as loss of taste/smell were less frequently reported in ID patients, whereas indicators of more severe disease such as altered consciousness and seizures were more common. Controls had higher rates of cardiovascular risk factors, asthma, rheumatological disorder and smoking. ID patients were admitted with higher respiratory rates (median=22, range=10-48) and were more likely to require oxygen therapy (35.1% vs 28.9%). Despite this, ID patients were 37% (95% CI 13% to 57%) less likely to receive non-invasive respiratory support, 40% (95% CI 7% to 63%) less likely to receive intubation and 50% (95% CI 30% to 66%) less likely to be admitted to the ICU while in hospital. They had a 56% (95% CI 17% to 102%) increased risk of dying from COVID-19 after they were hospitalised and were dying 1.44 times faster (95% CI 1.13 to 1.84) compared with controls. CONCLUSIONS: There have been significant disparities in healthcare between people with ID and the general population during the COVID-19 pandemic, which may have contributed to excess mortality in this group.


Assuntos
COVID-19 , Deficiência Intelectual , Estudos de Coortes , Hospitais , Humanos , Deficiência Intelectual/epidemiologia , Deficiência Intelectual/terapia , Pandemias , SARS-CoV-2 , Reino Unido/epidemiologia
17.
Front Public Health ; 9: 653923, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34631639

RESUMO

Over the last few decades, the perception of disease has changed significantly. In the concept of the sick person's role it should be the aim of every person to keep health at a good level for as long as possible. Several examples can be found where, however, a disease can be caused or worsened by a person. Examples include unhealthy diet, alcohol consumption leading to atherosclerosis and diabetes, or smoking, leading to lung cancer and COPD. There are also other appropriate examples where there is a potential for conflict between the autonomy of the individual and health. Improving public health should be the main objective of any health system. However, the more the impact is on personal freedom (and there is no extraneous danger), the more an attempt should be made to achieve this through the motivation of each individual to support the desire for a healthy lifestyle, rather than through legal prohibitions or penalties. The situation is even more complex in the case of the Covid-19 pandemic. In this context too, personal freedom is restricted in many areas and some people feel, for example, that compulsory masks or the prohibition of large crowds are serious encroachment on their autonomy. However, even in this case, the risk of possible external threats from the spread of the virus outweighs the right to personal choice and freedom. To sum up, it is necessary to balance the two principles - autonomy and interference in them in the interests of public health.


Assuntos
COVID-19 , Pandemias , Custos de Cuidados de Saúde , Instalações de Saúde , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
18.
BMJ Open ; 11(10): e049472, 2021 10 07.
Artigo em Inglês | MEDLINE | ID: mdl-34620659

RESUMO

OBJECTIVES: Post-traumatic stress disorder (PTSD) is commonly experienced in the aftermath of major incidents such as terrorism and pandemics. Well-established principles of response include effective and scalable treatment for individuals affected by PTSD. In England, such responses have combined proactive outreach, screening and evidence-based interventions (a 'screen-and-treat' approach), but little is known about its cost-effectiveness. The objective of this paper is to report the first systematic attempt to assess the cost-effectiveness of this approach. METHODS: A decision modelling analysis was undertaken to estimate the costs per quality-adjusted life-year (QALY) gained from a screen-and-treat approach compared with treatment-as-usual, the latter involving identification of PTSD by general practitioners and referral to psychological therapy services. Model input variables were drawn from relevant empirical studies in the context of terrorism and the unit costs of health and social care in England. The model was run over a 5-year time horizon for a hypothetical cohort of 1000 exposed adults from the perspective of the National Health Service and Personal Social Services in England. RESULTS: The incremental cost per QALY gained was £7931. This would be considered cost-effective 88% of the time at a willingness-to-pay threshold of £20 000 per QALY gained, the threshold associated with the National Institute for Health and Care Excellence in England. Sensitivity analysis confirmed this result was robust. CONCLUSIONS: A screen-and-treat approach for identifying and treating PTSD in adults following terrorist attacks appears cost-effective in England compared with treatment-as-usual through conventional primary care routes. Although this finding was in the context of terrorism, the implications might be translatable into other major incident-related scenarios including the current COVID-19 pandemic.


Assuntos
COVID-19 , Transtornos de Estresse Pós-Traumáticos , Adulto , Análise Custo-Benefício , Humanos , Pandemias , Anos de Vida Ajustados por Qualidade de Vida , SARS-CoV-2 , Medicina Estatal , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/terapia
19.
Curr Cardiol Rep ; 23(11): 153, 2021 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-34599461

RESUMO

PURPOSE OF REVIEW: Behavioral economics represents a promising set of principles to inform the design of health-promoting interventions. Techniques from the field have the potential to increase quality of cardiovascular care given suboptimal rates of guideline-directed care delivery and patient adherence to optimal health behaviors across the spectrum of cardiovascular care delivery. RECENT FINDINGS: Cardiovascular health-promoting interventions have demonstrated success in using a wide array of principles from behavioral economics, including loss framing, social norms, and gamification. Such approaches are becoming increasingly sophisticated and focused on clinical cardiovascular outcomes in addition to health behaviors as a primary endpoint. Many approaches can be used to improve patient decisions remotely, which is particularly useful given the shift to virtual care in the context of the COVID-19 pandemic. Numerous applications for behavioral economics exist in the cardiovascular care delivery space, though more work is needed before we will have a full understanding of ways to best leverage such applications in each clinical context.


Assuntos
COVID-19 , Economia Comportamental , Comportamentos Relacionados com a Saúde , Humanos , Pandemias , SARS-CoV-2
20.
Adv Ther ; 38(10): 5302-5316, 2021 10.
Artigo em Inglês | MEDLINE | ID: mdl-34515976

RESUMO

INTRODUCTION: The impact of the COVID-19 pandemic on routine medical care may result in altered healthcare resource use in patients with immune-mediated conditions. The aim of this study was to determine the impact of treatment interruptions in patients with and without COVID-19 infections who were treated with targeted immunomodulators (TIMs) in the USA. METHODS: Data from the IBM® MarketScan® Research Databases were analyzed in patients with immune-mediated conditions from January 1, 2018, through December 31, 2020. Healthcare resource use (HCRU) including hospitalizations, emergency department (ED) visits, in-person outpatient visits, and respiratory outcomes was assessed in a cohort of patients without COVID-19 who had uninterrupted versus interrupted TIM use. The impact of treatment interruption on HCRU and respiratory outcomes was also evaluated in a cohort of patients with COVID-19. Results from adjusted logistic regression were reported as adjusted odds ratios (aORs) with 95% confidence intervals. RESULTS: Approximately 25% of patients in both the COVID-19 (N = 787) and non-COVID-19 cohorts (N = 77,178) experienced interruptions in TIM therapy. In the non-COVID-19 cohort, the likelihood of being hospitalized was 20% less in patients with uninterrupted versus interrupted TIM use (aOR = 0.80, 95% CI 0.71-0.90). Patients with uninterrupted TIM use had a similar likelihood of an ED visit (aOR = 0.99, 95% CI 0.91-1.08) and respiratory outcome (aOR = 0.97, 95% CI 0.71-1.31) versus patients with interrupted TIM use. The likelihood of having an in-person outpatient visit was 87% greater in patients with uninterrupted versus interrupted TIM use (aOR = 1.87, 95% CI 1.81-1.94). Similar findings were observed in the COVID-19 cohort. CONCLUSION: This analysis of real-world claims data showed that uninterrupted TIM use was not associated with an increased likelihood of hospitalizations, ED visits, or negative respiratory outcomes compared to interrupted TIM use among patients with immune-mediated conditions, regardless of COVID-19 diagnosis.


Assuntos
COVID-19 , Pandemias , Teste para COVID-19 , Atenção à Saúde , Humanos , Fatores Imunológicos/uso terapêutico , Revisão da Utilização de Seguros , Estudos Retrospectivos , SARS-CoV-2
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA