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1.
Am J Epidemiol ; 2025 Feb 03.
Artigo em Inglês | MEDLINE | ID: mdl-39898987

RESUMO

The coronavirus disease 2019 (COVID-19) pandemic has disproportionately impacted Black nursing home (NH) residents. Alzheimer's Disease and Related Dementias (ADRD) may exacerbate disparities, however little empirical evidence exists on the degree to which race and ADRD intersect to impact COVID-19-related outcomes. We conducted a cohort study (April-December 2020) leveraging electronic health records from 12 United States NH corporations. We used parametric g-formula to obtain standardized estimates of incident COVID-19 infection and 30-day COVID-19-associated hospitalization or death by race, both overall and within strata of ADRD status. The cohort comprised 127,913 resident-episodes, including 15,379 incident COVID-19 infections, 1,522 deaths, and 2,548 hospitalizations. Black residents were more likely than White residents to experience incident COVID-19 and subsequent hospitalization, but not more likely to subsequently die. Disparities in hospitalization and a combined endpoint of hospitalization or death were more pronounced among residents with ADRD compared to residents without ADRD. These results suggest the presence of disparities in COVID-19 outcomes by race and provide evidence that ADRD status may exacerbate racial disparities in COVID-19 outcomes among nursing home residents. Our findings offer valuable insights for current and future preparedness efforts in NHs in the United States and countries with similarly under-resourced long-term care settings.

2.
BMC Med ; 23(1): 35, 2025 Jan 21.
Artigo em Inglês | MEDLINE | ID: mdl-39838402

RESUMO

BACKGROUND: Cervical cancer is a significant health issue, especially in low- and middle-income countries like India, where it ranks fourth among women. The Human papillomavirus (HPV) vaccination, a vital preventive measure, has suboptimal uptake among nursing students. We aimed to assess the level of knowledge, attitudes, willingness, and reasons for non-uptake of HPV vaccination among nursing students. METHODS: A descriptive cross-sectional study was conducted from April to June 2023, using a total enumeration method. Data were collected from 313 nursing students using a validated questionnaire covering sociodemographic information, knowledge, attitudes, and reasons for non-uptake of HPV vaccination. Statistical analysis was performed using SPSS version 26.0. Descriptive statistics summarized the data, while binary and multivariable logistic regression analyses identified factors associated with knowledge, attitude, and willingness for HPV vaccination. RESULTS: The mean age of the students was 20.98 ± 2.38 years, with the majority being females (81.2%) and unmarried (93.0%). About half of the participants demonstrated moderate knowledge (52.4%) and negative attitudes (50.1%) towards HPV vaccination, with none having received the vaccine. Female students had 4.24 times the odds of having good knowledge (AOR = 4.24, 95% CI = 1.66-10.80), while those pursuing a bachelor's degree exhibited 2.70 times the odds of good knowledge (AOR = 2.70, 95% CI = 1.40-5.21). In contrast, first-year students had 0.30 times the odds of having good knowledge (AOR = 0.30, 95% CI = 0.11-0.79) but displayed 4.69 times the odds of having a positive attitude (AOR = 4.69, 95% CI = 1.92-11.41). Additionally, Hindu students had 2.44 times the odds of being willing to receive the vaccine (AOR = 2.44, 95% CI = 1.15-5.20). Most participants expressed willingness to receive the vaccine (62.0%), citing reasons such as not being sexually active (35.8%) and needing more information (18.2%) for non-uptake of the vaccine. CONCLUSIONS: The study highlights gaps in knowledge and negative attitudes towards HPV vaccination among nursing students. Targeted educational interventions and policy initiatives are essential to improve awareness, promote positive attitudes, and increase HPV vaccination uptake among nursing students.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Infecções por Papillomavirus , Vacinas contra Papillomavirus , Estudantes de Enfermagem , Humanos , Feminino , Estudos Transversais , Estudantes de Enfermagem/psicologia , Vacinas contra Papillomavirus/administração & dosagem , Masculino , Adulto Jovem , Infecções por Papillomavirus/prevenção & controle , Vacinação/psicologia , Vacinação/estatística & dados numéricos , Adulto , Inquéritos e Questionários , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Índia , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Adolescente , Papillomavirus Humano
3.
J Gen Intern Med ; 2025 Jan 14.
Artigo em Inglês | MEDLINE | ID: mdl-39809962

RESUMO

On April 22, 2024, the Centers for Medicare & Medicaid Services (CMS) announced new staffing mandates for long-term care (LTC) facilities in an effort to improve care quality in nursing homes (NHs). The guidelines require a minimum of 3.48 h of daily care per resident, including 0.55 h provided by registered nurses (RNs), 2.45 h by nurse aides (NAs), and an additional 0.48 h by other care staff. These requirements, including a 24/7 RN presence, aim to address chronic understaffing that has been linked to poor outcomes such as increased emergency visits and lower compliance with quality standards. However, concerns from for-profit NHs and the American Healthcare Association (AHCA) suggest that many facilities are ill-prepared to meet these standards, citing financial and staffing challenges, particularly in rural areas. In addition, a lawsuit from Texas Attorney General Warren Paxton argues that CMS overstepped its regulatory authority. Despite these challenges, workforce shortages may be alleviated by the CMS initiatives, which include a $75 million national campaign to grow the NH workforce. This commentary discusses the implications of the CMS staffing rule, the legal challenges it faces, and the potential to improve RN work conditions and resident care. The paper concludes with recommendations for expanding workforce capacity and enhancing compliance through financial investment and policy reform.

4.
J Sex Med ; 2025 Jan 13.
Artigo em Inglês | MEDLINE | ID: mdl-39805641

RESUMO

BACKGROUND: Sexual dysfunction (SD) is a complication of poorly managed diabetes mellitus (DM). To prevent SD, patients should develop sexual health literacy (SHL). OBJECTIVE: This study investigated the relationship between SHL and SD in women with DM. METHODS: This cross-sectional study was performed between 1 October 2023 and 1 June 2024. The sample comprised 400 participants. The inclusion criteria were (1) being 18-65 years of age, (2) having been diagnosed with DM, and (3) having a sex partner. Data were collected using a personal information form, the Female Sexual Function Index (FSFI), and the Sexual Health Literacy Scale (SHLS). OUTCOMES: The data were analyzed using the Mann-Whitney test, Kruskal-Wallis H test, Spearman correlation coefficients, and binary logistic regression. RESULTS: Over half of the participants experienced SD (68,2%). Participants with higher education, those whose partners had higher education, those who did not have any chronic disease other than DM, and those who did not take hormone replacement therapy had a lower rate of SD (P < 0.05). Participants with higher income, those who used family planning, those with DM I, and non-menopausal participants had lower SD and higher SHL (P < 0.05). Insulin-only participants had higher SD and lower SHL than those who were on other types of medications (P < 0.05). There was a significant negative correlation between scale scores (FSFI and SHLS) and age (r = -0.388; P < 0.001 r = -0.326; P < 0.001, respectively), age of partner (r = -0.383; P < 0.001, r = -0.274; P < 0.001, respectively), duration of romantic relationship (r = -0.326; P < 0.001, r = -0.328; P < 0.001, respectively), number of children (r = -0.109; P < 0.001, r = -0.290; P < 0.001, respectively), and duration of DM (r = -0.254; P < 0.001, r = -0.125; P < 0.013, respectively). There was a significant positive correlation between scale scores (FSFI and SHLS) and number of sexual intercourse (r = 0,493; P < 0.001, r = 0.127; P < 0.011, respectively). A one-unit increase in DM duration resulted in a 3.7% increase in SD rate (OR = 1.037). A one-unit increase in the number of sexual intercourses reduced the SD rate by 35.5% (OR = 0.645). CLINICAL IMPLICATION: The data show that the prevalence of SD in diabetic women is directly affected by the number of sexual intercourses per week, menopausal status, and duration of DM. STRENGTHS AND LIMITATIONS: This is the first study to examine the relationship between SHL and SD in women with DM. Second, the results are sample-specific and cannot be generalized to all women with DM. CONCLUSION: Healthcare professionals should ensure that women with DM have high levels of SHL to prevent SD and improve their quality of sexual life.

5.
Br J Clin Pharmacol ; 2025 Jan 31.
Artigo em Inglês | MEDLINE | ID: mdl-39888093

RESUMO

AIMS: Antidepressant use increases around long-term care facility (LTCF) entry, and initiation during hospitalizations may contribute to this. This study characterized the care setting (i.e., community-based, hospital or LTCF) where antidepressants were initiated and determined associated resident characteristics. METHODS: A cross-sectional study including non-Indigenous individuals aged 65-105 years who entered LTCFs in two Australian states during 2015-2019, and were dispensed an antidepressant within 2 months, was conducted. Care settings (community-based, hospital or LTCF) were determined from linked LTCF records, and hospitalizations ≤30 days before LTCF entry. Pharmaceutical claims before and after LTCF entry were screened to determine antidepressant initiation. Multivariate multinomial logistic regression estimated adjusted odds ratios (aORs) and 95% confidence intervals (95% CIs) for resident characteristics associated with care settings of antidepressant initiation. RESULTS: This study included 34 525 residents from 1046 LTCFs. Overall, 27 160 (78.7%) commenced antidepressants prior to entry, 2552 (7.4%) in hospital and 4813 (13.9%) in LTCFs. Mirtazapine constituted 44.8% (n = 1143) of antidepressants initiated in hospitals and 39.5% (n = 1902) in LTCFs. Residents who were aged ≥90 years were more likely to start an antidepressant in the LTCF compared to community-based settings (aOR = 1.97, 95% CI 1.74-2.23). Residents recently using a psychotropic were more likely to start an antidepressant in community-based settings before LTCF entry, compared to a hospital or LTCF. CONCLUSIONS: Individuals receiving antidepressants during transition to LTCFs are often already taking antidepressants prior to entry. Future interventions to optimize antidepressant use in LTCFs should consider setting, recency and indication for antidepressant initiation, and ongoing monitoring for safety.

6.
Epilepsy Behav ; 164: 110275, 2025 Jan 27.
Artigo em Inglês | MEDLINE | ID: mdl-39874673

RESUMO

OBJECTIVE: This study was conducted to investigate the relationship between caregiver burden and life satisfaction among caregivers of individuals with epilepsy. METHODS: This descriptive and cross-sectional study was conducted with 210 caregivers at a university hospital located in Van, a province in eastern Türkiye. A personal information form prepared by the researcher based on literature, along with The Caregiver Burden Scale and Life Satisfaction Scale, was used to collect data. Descriptive statistics including frequency, percentage, mean, and standard deviation were utilized. Kurtosis and Skewness coefficients were used to analyze the normal distribution of the data. The relationships between the dimensions determining the levels of the scales for caregivers were examined using Pearson correlation and linear regression analyses. Additionally, t-tests, one-way analysis of variance (ANOVA), and post hoc analyses (Tukey, LSD) were employed. A significance level of p < 0.05 was accepted. RESULTS: The mean total score for caregiver burden among the participants was found to be 35.433 ± 11.480. The mean total score for life satisfaction was determined to be 11.386 ± 2.972. A significant relationship was found between the caregiver burden and life satisfaction scores of the caregivers of individuals with epilepsy participating in the study (r = -0.333; p = 0.000 < 0.05). It was determined that the level of caregiver burden decreases the level of life satisfaction (ß=-0.333). CONCLUSION: It was determined that relatives of patients with epilepsy experience high levels of caregiver burden. It was also determined that caregiver burden is related to sociodemographic factors such as the caregiver being 41 years of age or older, literate, married, low-income, and the patient's spouse. In the same study, it was also determined that as the total caregiver burden score increased, the total life satisfaction score decreased.

7.
Pediatr Transplant ; 29(1): e70028, 2025 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-39837770

RESUMO

BACKGROUND: When a family decides to donate the organs or tissues of their child with brain death, it is necessary to consider which organs or tissues will be donated. This phenomenon presents an ethical dilemma that is underexplored in the scientific literature, making it essential to examine this context to understand how refusals occur within donations. OBJECTIVE: To analyze the rates and trends of specific refusals for each organ and tissue from pediatric donors with brain death occurring between 2001 and 2020 in an Organ Procurement Organization in the State of São Paulo, Brazil. METHODS: This was a cross-sectional, exploratory, retrospective, quantitative study. Data were derived from a database consisting of copies of organ and tissue donation authorization forms, organized, and subjected to descriptive and inferential analyses. This study adhered to international ethical guidelines. RESULTS: Data from 109 real donors were analyzed. The bones, skin, and blood vessels had the highest refusal rates among tissues, as well as the pancreas and lungs for solid organs. Most organs and tissues showed a decreasing refusal trend except for the corneas, liver, and kidneys, which exhibited a stationary trend. CONCLUSIONS: This study illustrates the refusals within real donations, with high refusal rates for tissues compared to solid organs.


Assuntos
Morte Encefálica , Família , Obtenção de Tecidos e Órgãos , Humanos , Estudos Transversais , Obtenção de Tecidos e Órgãos/ética , Estudos Retrospectivos , Brasil , Criança , Masculino , Feminino , Pré-Escolar , Adolescente , Lactente , Doadores de Tecidos
8.
Pacing Clin Electrophysiol ; 48(1): 95-105, 2025 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-39549250

RESUMO

AIMS: This study aimed to determine the relationship between sleep problems, shock pain, and shock anxiety in patients with implantable cardioverter defibrillator (ICD) and the affecting factors. METHODS AND RESULTS: The population of this descriptive cross-sectional study consisted of all patients who underwent ICD implantation in university hospital (N = 200), and the sample consisted of patients who met the inclusion criteria of the study (n = 132). Data were obtained using a "General Information Form", the "Florida Shock Anxiety Scale (FSAS)", the "Epworth Sleepiness Scale (ESS)", the "Pittsburgh Sleep Quality Index (PSQI)", and the "Visual Pain Scale (VPS)". The mean age of the patients was 66.13 years. The VPS was 6.40 ± 3.36; the mean FSAS score was 29.98 ± 8.46; the mean PSQI score was 8.02 ± 3.81; the mean ESS score was 7.59 ± 4.10. PSQI had a statistically significant correlation with the total FSAS score (p < 0.001) and a statistically insignificant correlation with ESS (p > 0.001). Age, sex, marital status, smoking status, cohabitants, previous ICD shocks, the status of lying on ICD, and fear of dislocation of ICD affected the total FSAS score; sex, employment status, history of heart attack, defined sleep disorder, awakening from sleep due to nightmares, and cessation of breathing during sleep affected the total PSQI score; history of previously defined sleep disorder, history of heart attack, use of medication for a sleep disorder, the pain felt when lying on ICD, and pain experienced during ICD shocks affected the total ESS score. The mean shock VPS scores differed between patients who received an ICD shock during sleep and those who were awakened by nightmares. CONCLUSIONS: It was found that the shock anxiety and shock pain scores of ICD patients were above average, that they had poor sleep quality, and that their sleepiness was at the level of "normal but increased daytime sleepiness".


Assuntos
Ansiedade , Desfibriladores Implantáveis , Transtornos do Sono-Vigília , Humanos , Feminino , Masculino , Estudos Transversais , Idoso , Dor/psicologia , Pessoa de Meia-Idade , Medição da Dor , Fatores de Risco , Inquéritos e Questionários
9.
Support Care Cancer ; 33(2): 118, 2025 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-39849285

RESUMO

PURPOSE: Our study aim was to understand the (human and organizational) factors influencing fall risk among people with hematological malignancies using the Reason model as a framework, providing insights that can inform the development of safe and effective fall management strategies. METHODS: Purposive sampling was employed to conduct semi-structured interviews with 13 people with hematological malignancies and 12 nurses from the hematology department of a tertiary grade A hospital in Guangzhou from December 2023 to February 2024. The topic analysis method was utilized to analyze the interview data. RESULTS: Factors influencing fall risk among people with hematological malignancies were categorized into four themes: (1) precondition of unsafe arts (lack of work experience in junior nurses, poor patient compliance, adverse drug reactions, inadequate ward facilities); (2) unsafe supervision (inadequate inspection management, inadequate accompanying capacity); (3) unsafe arts (variability in subjective assessment, lack of bidirectional education); and (4) organizational influences (limited nursing human resources, lack of organizational process management models). CONCLUSION: The specific fall risk factors among people with hematological malignancies, as summarized based on the Reason model framework, provide a theoretical basis and direction for the construction of specialized fall risk assessment tools, aiming to improve the quality of fall management for inpatients and reduce the incidence of falls.


Assuntos
Acidentes por Quedas , Neoplasias Hematológicas , Pesquisa Qualitativa , Humanos , Neoplasias Hematológicas/terapia , Masculino , Feminino , Fatores de Risco , Pessoa de Meia-Idade , Adulto , Acidentes por Quedas/prevenção & controle , Medição de Risco/métodos , China , Idoso , Entrevistas como Assunto
10.
Support Care Cancer ; 33(2): 109, 2025 Jan 16.
Artigo em Inglês | MEDLINE | ID: mdl-39820755

RESUMO

OBJECTIVE: This study is to develop and validate a robust risk prediction model for mild cognitive impairment (MCI) in patients with malignant haematological diseases after haematopoietic stem cell transplantation (HSCT). METHODS: In this study, we analysed the clinical data of the included patients. Logistic regression analysis was used to identify independent risk factors for cognitive impairment after HSCT in patients with malignant haematological diseases, and a risk prediction model was constructed. Multiple cohorts of patients with haematological malignancies after HSCT (282 cases) from the Affiliated Hospital of Xuzhou Medical University and the First People's Hospital of Yancheng City between April 2019 and February 2022, and patients from the Affiliated Huaian No.1 People's Hospital of Nanjing Medical University between March 2022 and July 2023 were used for external validation. Logistic regression analysis was performed to develop the predictive model. The predictive value and consistency of the model were evaluated using the area under the curve (AUC) and calibration method, respectively. Decision curve analysis (DCA) was performed to access the utility of the model. RESULTS: Approximately half (52.26%) of the patients in the study developed mild cognitive impairment (MCI). Older age, allogeneic HSCT, anxiety, graft-versus-host disease, and longer hospital stay were associated with a higher risk of developing MCI. ROC curve analysis confirmed the sound performance of the predictive model and external validation, with AUC of 0.897 and 0.789 respectively. The direction of the calibration curves of the training and validation sets is closer to the diagonal (ideal curve), indicating good model consistency; the DCA curves also show that the model has good predictive ability and stability. CONCLUSIONS: We conclude that it is possible to predict mild cognitive impairment with readily available, mostly pretransplant predictors. The accuracy of the risk prediction models can be improved for use in clinical practice, possibly by adding pretransplant patient-reported functioning and comorbidities.


Assuntos
Disfunção Cognitiva , Neoplasias Hematológicas , Transplante de Células-Tronco Hematopoéticas , Humanos , Disfunção Cognitiva/etiologia , Disfunção Cognitiva/epidemiologia , Transplante de Células-Tronco Hematopoéticas/efeitos adversos , Masculino , Feminino , Pessoa de Meia-Idade , Adulto , Fatores de Risco , Neoplasias Hematológicas/terapia , Modelos Logísticos , Medição de Risco/métodos , Idoso , Estudos Retrospectivos
11.
Support Care Cancer ; 33(3): 155, 2025 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-39912935

RESUMO

PURPOSE: This study aimed to identify challenges and facilitators in accessing cancer care in South Australia, from the perspectives of cancer survivors and caregivers, to inform responsive cancer navigation approaches. METHODS: A qualitative descriptive study was conducted using an online qualitative survey (n = 75) and video, phone, and in-person semi-structured interviews (n = 22) with cancer survivors and caregivers (herein cancer consumers). Data analysis was performed in two phases: content analysis categorised consumer challenges and facilitators, while a subjective-inductive approach guided by the supportive care framework was used to develop a statewide navigation approach. RESULTS: Key challenges reported by consumers included perceived invalidation of medical concerns, delayed diagnoses, poor communication, inadequate information provision, fragmented care, and limited logistical, cultural, and psychological support. Inductive analysis identified four key themes: 1) cancer consumers have dynamic care needs that can evolve throughout a patient's cancer experience, 2) cancer consumers require a foundational level of information to support navigation, 3) some cancer consumers express a preference for community-based navigation services to help them manage their care, and 4) individuals with more complex care needs may require more intensive professional navigation services. A conceptual needs-based navigation approach (the Flinders Needs-Based Approach to Cancer Navigation) was developed based on these insights. This approach consists of three levels of navigation interventions: level 1 involves providing information-based navigation to all individuals affected by cancer, level 2 involves community-based navigation support offered to those requiring or wanting additional supported assistance, and level 3 offers professional navigation for individuals with complex needs. CONCLUSION: Our study highlights the importance of tailoring cancer navigation services to meet the evolving needs of patients, emphasising the role of both community and professional support, particularly for individuals with complex care requirements. Findings will inform further co-design discussions involving consumers, health professionals, and policymakers to implement cancer navigation services across South Australia.


Assuntos
Sobreviventes de Câncer , Neoplasias , Navegação de Pacientes , Pesquisa Qualitativa , Humanos , Navegação de Pacientes/organização & administração , Feminino , Masculino , Neoplasias/psicologia , Neoplasias/terapia , Pessoa de Meia-Idade , Sobreviventes de Câncer/psicologia , Adulto , Austrália do Sul , Idoso , Acessibilidade aos Serviços de Saúde , Cuidadores/psicologia , Inquéritos e Questionários , Austrália
12.
Age Ageing ; 54(1)2025 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-39775726

RESUMO

BACKGROUND: The global trend of emergency department (ED) crowding can be mitigated with outreach care. The Mobile Hospital is an outreach acute care service in Espoo, Finland. This study describes the results of the Mobile Hospital intervention to nursing homes in a pre-post study setting with benchmarking validation data. METHODS: We compared Emergency Medical Services (EMS) missions, ED visits, hospitalisations and their estimated costs from two 6-month periods in 2018-2019 (1325 nursing home beds). Benchmarking control data for ED visits were obtained from health records of the 10 largest Finnish cities. RESULTS: The number of EMS missions to nursing homes decreased by 16% (720 vs 604), ED visits decreased by 22% (801 vs 622), there was no significant difference in specialised inpatient episodes (178 vs 162) and primary hospital inpatient episodes were fewer (285 vs 178, decreased 38%). Annual estimated savings per resident were 686 euros (decreased 14%). Annual estimated total savings were 934 908 euros. In the benchmarking analysis, the number of ED visits and acute hospitalisations amongst the older population decreased in Espoo, while in the other cities it increased. CONCLUSIONS: The Mobile Hospital seems to reduce nursing home residents' ED visits, hospitalisations and overall costs. Advance care planning and on-call physician telephone consultations may be useful components of the service.Implications to practice: This study adds to the growing evidence that outreach care to nursing homes is cost-effective in suburban areas with universal healthcare funding, at least as part of other developments in the acute care pathway.


Assuntos
Benchmarking , Análise Custo-Benefício , Serviço Hospitalar de Emergência , Instituição de Longa Permanência para Idosos , Casas de Saúde , Humanos , Casas de Saúde/economia , Finlândia , Serviço Hospitalar de Emergência/economia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Idoso , Masculino , Feminino , Instituição de Longa Permanência para Idosos/economia , Unidades Móveis de Saúde/economia , Idoso de 80 Anos ou mais , Hospitalização/economia , Custos Hospitalares , Serviços Médicos de Emergência/economia , Redução de Custos
13.
Age Ageing ; 54(2)2025 Feb 02.
Artigo em Inglês | MEDLINE | ID: mdl-39902847

RESUMO

BACKGROUND: The Netherlands introduced abrupt, large-scale, long-term care (LTC) reforms in 2015 that promoted ageing-in-place. However, there has been no comprehensive population-level study evaluating how these reforms have impacted nursing home (NH) utilisation. This study examines the association between the 2015 reforms with national monthly rates of NH admissions and survival time amongst newly admitted older adults. METHODS: We analysed population data from Statistics Netherlands (2011-2019), conducting an interrupted time-series analysis to compare monthly NH admission rates before and after the 2015 reforms amongst adults aged 65 and older (N = 402 350). A Cox proportional hazards model was used to assess the reform's impact on mortality risk amongst newly admitted residents. RESULTS: The adjusted NH admission rate before the reform was 88.80 per 100 000 older adults (95% CI (confidence interval): 82.36-95.83), compared to 69.82 per 100 000 after the reform (95% CI: 65.91-73.78), indicating a significant reduction (incident rate ratio: 0.80, 95% CI: 0.74-0.86). Over a 3-year follow-up, the average survival time for those admitted after the reform was 608 days (95% CI: 608.72-610.74), compared to 622.52 days (95% CI: 620.59-624.45) for those admitted before the reform. The reform was associated with a slightly increased mortality risk (hazard ratio: 1.05, 95% CI: 1.02-1.07). CONCLUSIONS: The 2015 Dutch LTC reform is associated with a reduction in national NH admissions and a decrease in average survival time of 2 weeks.


Assuntos
Reforma dos Serviços de Saúde , Análise de Séries Temporais Interrompida , Casas de Saúde , Humanos , Países Baixos , Casas de Saúde/estatística & dados numéricos , Casas de Saúde/tendências , Idoso , Masculino , Feminino , Idoso de 80 Anos ou mais , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/tendências , Assistência de Longa Duração/estatística & dados numéricos , Assistência de Longa Duração/tendências , Admissão do Paciente/estatística & dados numéricos , Admissão do Paciente/tendências , Modelos de Riscos Proporcionais , Fatores de Tempo
14.
Age Ageing ; 54(1)2025 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-39864066

RESUMO

OBJECTIVE: We aimed to investigate the association of sociodemographic, clinical and functional characteristics with the volume of transitions and specific trajectories across living and care settings. METHODS: Using data from the Swedish National Study on Aging and Care in Kungsholmen study, we identified transitions across home (with or without social care), nursing homes, hospitals and postacute care facilities among 3021 adults aged 60+. Poisson and multistate models were used to investigate the association between sociodemographic, clinical and functional characteristics and both the overall volume and hazard ratios (HRs) of specific transitions. RESULTS: Over 15 years, 720 (23.8%) participants experienced between 5 and 10 transitions, and 816 (26.7%) experienced >10 transitions across living and care settings. A higher number of transitions was observed in older participants with multimorbidity and slower walking speed. In contrast, cognitive impairment and disability were associated with a lower number of transitions. After hospital and postacute discharge, each additional year of age (HR range 1.06-1.08) and being a woman compared with being a man (HR range 1.35-4.38) increased the likelihood of discharge to home care. Multimorbidity (HR range 1.14-1.23) and slow gait speed (HR range 1.11-1.50) increased the risk of hospitalisation and home care after hospital discharge. Cognitive impairment raised the hazard of nursing home placement (HR range 1.99-2.15). Disability was associated with a higher hazard of nursing home placement after hospital discharge (HR range 2.57-3.07). CONCLUSIONS: Accounting for older adults' whole journey across living and care settings, we identified transition-specific predictors and potential triggers that could be timely leveraged to better tailor care to older adults' needs.


Assuntos
Casas de Saúde , Alta do Paciente , Humanos , Feminino , Suécia/epidemiologia , Masculino , Idoso , Idoso de 80 Anos ou mais , Alta do Paciente/estatística & dados numéricos , Casas de Saúde/estatística & dados numéricos , Pessoa de Meia-Idade , Serviços de Assistência Domiciliar/estatística & dados numéricos , Fatores Etários , Fatores de Risco , Cuidados Semi-Intensivos/estatística & dados numéricos , Fatores de Tempo , Estado Funcional , Multimorbidade , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Envelhecimento , Avaliação Geriátrica/métodos
15.
BMC Pregnancy Childbirth ; 25(1): 70, 2025 Jan 25.
Artigo em Inglês | MEDLINE | ID: mdl-39863863

RESUMO

BACKGROUND: Gestational diabetes mellitus is hyperglycemia in special populations (pregnant women), however gestational diabetes mellitus (GDM) not only affects maternal health, but also has profound effects on offspring health. The prevalence of gestational diabetes in my country is gradually increasing. OBJECTIVE: To study the application effect of self-transcendence nursing model in GDM patients. METHODS: One hundred fourteen GDM patients undergoing prenatal examination in Hai'an People's Hospital from January 2019 to November 2021 were selected and divided into two groups of 57 cases respectively according to the principle of random single blind. The patients in the control group should receive pregnancy health care under the routine nursing mode, while those in the observation group should receive pregnancy health care under the self-transcendence nursing mode. Then, we would compare the insulin utilization rate, admission before delivery, gestational weeks, delivery outcome and neonatal conditions between the two groups, examine the changes of blood glucose related indexes in the two groups and evaluate the differences between the two groups' Diabetes Distress Scale (DDS) scores and Chinese Versions of Diabetes Management Self-efficacy Scale (C-DMSES) scores. RESULTS: The number of hospital admissions (1.12 ± 0.31) and the hospital stay (7.54 ± 1.45) days in the observation group were less than those in the control group (1.56 ± 0.42) and (10.23 ± 2.32) days. There was no difference between the two groups after statistical analysis of gestational weeks and insulin utilization rate (P > 0.05). After the intervention, the total DDS score and emotional burden, doctor/life law/interpersonal relationship related distress score of GDM in the two groups were lower than those before the intervention, while the scores of healthy diet, regular exercise, regular monitoring of blood glucose and medication compliance in C-DMSES were higher than those before the intervention. In addition, the improvements of overall DDS scores and C-DMSES scores of GDM in the observation group were significantly better than those in the control group, so there was statistical significance (P < 0.05). In terms of the pregnancy outcomes and neonatal conditions, the rates of premature delivery and neonatal delivery in the observation group were higher than those in the control group, and there was no difference (P > 0.05) in other aspects of pregnancy outcomes and neonatal conditions. CONCLUSION: Self-transcendence nursing mode intervention can improve blood sugar, reduce psychological distress, and improve self-efficacy in GDM patients, thereby reducing the rate of pregnancy-induced hypertension and premature birth.


Assuntos
Diabetes Gestacional , Humanos , Diabetes Gestacional/psicologia , Gravidez , Feminino , Adulto , Modelos de Enfermagem , Insulina/uso terapêutico , Cuidado Pré-Natal/métodos , Glicemia/análise , Autoeficácia , Método Simples-Cego , China/epidemiologia , Resultado da Gravidez/epidemiologia
16.
BMC Womens Health ; 25(1): 21, 2025 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-39825322

RESUMO

BACKGROUND: Women are disproportionately affected by disasters due to their vulnerability and limited access to resources. The purpose of this study is to investigate the health concerns and experiences of women who relocated to a different city following the February 2023 earthquake in Turkey. METHODS: Data was collected using a constructivist qualitative research design. Between May 1 and July 1 2023, interviews were conducted with female participants who relocated to a different city after the February 2023 earthquake in Turkey. The collected data underwent qualitative content analysis, adhering to the Standards for Qualitative Research Reporting (SRQR). The study utilized Graneheim and Lundman's content analysis method to analyze the interview data. Interviews were transcribed. The transcripts were analyzed in the qualitative research software package ATLAS.ti 9. RESULTS: In the study, 32 women aged 19-43 years were interviewed. The results revealed four distinct categories and 10 sub-categories derived from the interviewees' narratives. These four categories were physiological needs, safety concerns, need for love and belonging, and self-realization. CONCLUSIONS: It was concluded that individuals who experience disasters face multiple hardships, especially related to these categories. Therefore, it is crucial to focus on the issues and requirements of survivors, particularly women belonging to vulnerable groups. One should not overlook the fundamental needs of women in service delivery.


Assuntos
Terremotos , Pesquisa Qualitativa , Humanos , Feminino , Turquia , Adulto , Adulto Jovem , Desastres , Sobreviventes/psicologia
17.
BMC Womens Health ; 25(1): 25, 2025 Jan 15.
Artigo em Inglês | MEDLINE | ID: mdl-39815217

RESUMO

PURPOSE: Women with breast cancer face a high degree of uncertainty. Trust between health providers and patients has been shown to improve patient quality of life and may enhance clinical outcomes. This study aimed to explore the meaning of trust along the treatment pathway. METHODS: The study followed a convergent mixed-methods design. We collected qualitative data longitudinally from diagnosis to follow-up using unstructured digital diaries and 45 semi-structured interviews with twelve women with breast cancer. To measure symptom burden and trust, we collected quantitative data by means of 57 questionnaires. Data analysis was based on phenomenology according to van Manen and on descriptive statistics. Data synthesis resulted in a conceptual model of trust. RESULTS: The women experienced trust as a dynamic phenomenon within the biomedical cancer care "machinery". Their trust was strongly influenced by contextual factors, professionals' expertise, and person-centeredness. The relevance of trust differed according to treatment phases. CONCLUSIONS: Due to a high degree of uncertainty, trust was particularly important. Professionals positively influenced the women's trust to a certain extent through a patient-centered approach and by demonstrating expertise within the biomedical cancer care "machinery". The conceptual model of trust should receive attention to bring care closer to the women's lived experience so that their care experience can be improved.


Assuntos
Neoplasias da Mama , Sobreviventes de Câncer , Pesquisa Qualitativa , Confiança , Humanos , Feminino , Neoplasias da Mama/psicologia , Neoplasias da Mama/terapia , Confiança/psicologia , Pessoa de Meia-Idade , Sobreviventes de Câncer/psicologia , Adulto , Idoso , Inquéritos e Questionários , Qualidade de Vida/psicologia , Assistência Centrada no Paciente , Relações Médico-Paciente
18.
Arch Phys Med Rehabil ; 106(1): 61-73, 2025 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-39341442

RESUMO

OBJECTIVE: To assess rehabilitation clinicians' viewpoints regarding a multicomponent implementation program aimed at promoting high-intensity resistance rehabilitation (HIR), as well as practical implications for its use in skilled nursing facility (SNF) rehabilitation. DESIGN: Prospective convergent mixed-method design. SETTING: Eight rural SNFs within the Department of Veterans Affairs. PARTICIPANTS: Physical rehabilitation clinicians (physical and occupational therapists, physical and occupational therapy assistants, recreational therapists, and kinesiotherapists) who engaged with the implementation program (n=38). INTERVENTIONS: Clinicians engaged with the multicomponent implementation program to promote the use of HIR in clinical practice. The program components included clinician training (i.e., virtual didactic modules with synchronous case discussions), provision of resources (e.g., equipment, job aids), and facilitated implementation (e.g., external implementation facilitator support, distributed tips and tricks). MAIN OUTCOME MEASURES: Acceptability of Intervention Measure, Training Acceptability Rating Scale, study-specific questionnaires, and qualitative focus groups exploring perceived acceptability, feasibility, and effect on work experience. RESULTS: Questionnaires revealed high levels of implementation program acceptability and perceived effect, alongside moderate levels of feasibility. Focus group themes supported these findings, explaining high acceptability and effect through differentiation from other trainings and prolonged engagement. Feasibility results were explained qualitatively by facilitatory factors (i.e., team participation, reduced caseloads, training characteristics) and inhibitory factors (i.e., training timing, self-paced scheduling logistics, lack of protected time and space). There was no reported negative effect on clinician work experience. CONCLUSIONS: According to SNF clinician perspectives, a positive HIR implementation experience may be enhanced through implementation programs that provide prolonged engagement and a self-paced structure with built-in accountability. Leadership and organizational support appear important to protect time and space for clinicians who experience competing priorities to successfully facilitate evidence uptake. Future work can evaluate the applicability across various contexts beyond rural VA SNFs.


Assuntos
Atitude do Pessoal de Saúde , Implementação de Plano de Saúde , Terapia Ocupacional , Terapia Recreacional , Treinamento Resistido , Instituições de Cuidados Especializados de Enfermagem , Instituições de Cuidados Especializados de Enfermagem/organização & administração , Treinamento Resistido/organização & administração , Grupos Focais , Pesquisa Qualitativa , Inquéritos e Questionários , Terapeutas Ocupacionais/psicologia , Fisioterapeutas/psicologia , Assistentes de Fisioterapeutas/psicologia , Terapia Recreacional/métodos , Terapia Recreacional/organização & administração , Terapia Ocupacional/métodos , Terapia Ocupacional/organização & administração , United States Department of Veterans Affairs , Estados Unidos , Serviços de Saúde Rural/organização & administração , Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade
19.
BMC Geriatr ; 25(1): 42, 2025 Jan 20.
Artigo em Inglês | MEDLINE | ID: mdl-39833685

RESUMO

BACKGROUND: Innovative technologies such as virtual reality may improve physical and cognitive functions in older people. While there are some experimental studies on virtual reality, qualitative studies related to the virtual reality experiences of older people are limited in the literature. This study aims to describe older people's perceptions about their experiences regarding virtual reality. METHODS: The study has qualitative descriptive design. The data were collected through semi-structured individual interviews with older people (n = 37). The interviews were conducted during a two-months period, from February to March 2022. Thematic and descriptive analysis was used to analyse data. The Consolidated Criteria for Reporting Qualitative Research (COREQ) checklist was used to report the study. RESULTS: Four themes and 15 sub-themes were identified from the interviews. The themes were (a) time travel through virtual reality, (b) comparing the past and present through virtual reality, (c) benefits of virtual reality, and (d) the meaning of virtual reality. CONCLUSIONS: This study provides in-depth information about the views of older people regarding the virtual reality experience. The study revealed that older people had positive experiences with virtual reality and showed that it has the potential to be useful in elderly care. In the study, virtual reality also enabled older people to have a time-traveling experience. It is recommended that virtual reality should be integrated into the care of older people by nurses and healthcare professionals.


Assuntos
Pesquisa Qualitativa , Realidade Virtual , Humanos , Idoso , Feminino , Masculino , Idoso de 80 Anos ou mais
20.
BMC Geriatr ; 25(1): 67, 2025 Jan 30.
Artigo em Inglês | MEDLINE | ID: mdl-39885429

RESUMO

BACKGROUND: During the COVID-19 pandemic, nursing home (NH) residents faced the highest risk of severe COVID-19 disease and mortality. Due to their frailty status, comorbidity burden can serve as a useful predictive indicator of vulnerability in this frail population. However, the prognostic value of these cumulative comorbidity scores like the Charlson comorbidity index (CCI) remained unclear in this population. We evaluated the incremental predictive value of the CCI for predicting 28-day mortality in NH residents with COVID-19, compared to prediction using age and sex only. METHODS: We included older individuals of ≥ 70 years of age in a large retrospective observational cohort across NHs in the Netherlands. Individuals with PCR-confirmed COVID-19 diagnosis from 1 March 2020 to 31 December 2021 were included. The CCI score was computed by searching for the comorbidities recorded in the electronic patient records. All-cause mortality within 28 days was predicted using logistic regression based on age and sex only (base model) and by adding the CCI to the base model (CCI model). The predictive performance of the base model and the CCI model were compared visually by the distribution of predicted risks and area under the receiver operator characteristic curve (AUROC), scaled Brier score, and calibration slope. RESULTS: A total of 4318 older NH residents were included in this study with a median age of 88 years [IQR: 83-93] and a median CCI score of 6 [IQR: 5-7]. 1357 (31%) residents died within 28 days after COVID-19 diagnosis. The base model, with age and sex as predictors, had an AUROC of 0.61 (CI: 0.60 to 0.63), a scaled brier score of 0.03 (CI: 0.02 to 0.04), and a calibration slope of 0.97 (CI: 0.83 to 1.13). The addition of CCI did not improve these predictive performance measures. CONCLUSION: The addition of the CCI as a vulnerability indicator did not improve short-term mortality prediction in NH residents. Similar (high) age and number of comorbidities in the NH population could reduce the effectiveness of these predictors, emphasizing the need for other population-specific predictors that can be utilized in the frail NH residents.


Assuntos
COVID-19 , Comorbidade , Casas de Saúde , Humanos , COVID-19/mortalidade , COVID-19/epidemiologia , COVID-19/diagnóstico , Masculino , Feminino , Idoso , Idoso de 80 Anos ou mais , Estudos Retrospectivos , Medição de Risco/métodos , Países Baixos/epidemiologia , Instituição de Longa Permanência para Idosos/tendências , Prognóstico , SARS-CoV-2 , Idoso Fragilizado
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