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1.
Siglo cero (Madr.) ; 54(4): 49-64, oct.-dic. 2024. tab, graf
Artículo en Español | IBECS | ID: ibc-EMG-558

RESUMEN

El paradigma de apoyos y el de calidad de vida se han transformado en guías fundamentales para los avances en el ámbito de la discapacidad intelectual (DI). Con base en una muestra de 93 personas adultas con DI, se analiza, desde un enfoque cuantitativo no experimental, la relación entre la calidad de vida y las necesidades de apoyo, aplicando la escala INICO-FEAPS y la escala de Intensidad de Apoyos (SIS) para cada constructo. Los principales resultados evidencian que existe una relación fuerte e indirecta entre calidad de vida y necesidades de apoyos, y también la relevancia de analizar dichos resultados desde variables como grado de discapacidad, sexo o nivel socioeconómico. La discusión permite inferir la necesidad de discutir nuevas estrategias en torno a categorías como el grado de discapacidad, la autodeterminación e inclusión social, como elementos facilitadores de la calidad de vida y apoyos desde un enfoque integral que contribuya al desarrollo de estrategias de programas sociales para la población con DI. (AU)


The support paradigm and the quality of life paradigm have become fundamental guides for progress in the field of Intellectual Disability (ID). Based on a sample of 93 adults with ID, the relationship between Quality of Life and Support Needs is analyzed from a non-experimental quantitative approach, applying the INICO-FEAPS scale and the SIS Support Intensity scale for each construct. The main results show that there is a strong and indirect relationship between quality of life and support needs, and the relevance of analyzing these results from variables such as the degree of disability, sex or socioeconomic level. The discussion allows us to infer the need to discuss new strategies around categories such as the degree of disability, self-determination and social inclusion, as facilitating elements of quality of life and supporting a comprehensive approach that contributes to the development of social program strategies for the population with ID. (AU)


Asunto(s)
Humanos , Adulto Joven , Adulto , Discapacidad Intelectual , Calidad de Vida , Personas con Discapacidad , Chile , Muestreo
2.
BMC Public Health ; 24(1): 80, 2024 01 03.
Artículo en Inglés | MEDLINE | ID: mdl-38172756

RESUMEN

BACKGROUND: Primary healthcare centers (PHCs) serve as the cornerstone of accessible medical services in society, playing a crucial role in screening, detecting, and treating various health issues. This study aimed to investigate the prevalence of psychiatric disorders in middle-aged individuals who refer to PHCs and the potential of PHCs in diagnosing mental disorders. METHODS: This cross-sectional study was implemented at PHCs under the supervision of Mashhad University of Medical Sciences (MUMS) in northeast Iran in 2018. The enrolled subjects were middle-aged adults who had electronic medical records in SINA, an integrated health management system, and the electronic medical records of MUMS. The prevalence of psychiatric disorders by type and their relationship with demographic information was evaluated by a Chi-square test using SPSS 22. RESULTS: This study involved 218,341 middle-aged participants. Prevalence of psychiatric disorders was 8.59%, and depression (53.72%) and anxiety (42.02%) were the most common psychiatric disorders in both males and females. The prevalence of mental disorders was significantly higher in females than in males (88.18% vs. 18.81%; P < 0.0001). Indeed, a significant higher prevalence of depression, anxiety, somatoform, childhood psychiatric disorder, and bipolar disorders was observed in females compared to males (P < 0.05). In addition, individuals between the age of 45-60 years, and those from rural areas showed more prevalence of mental disorders than others, but these differences were not significant. CONCLUSIONS: Considering the previous studies in Iran, the prevalence of mental disorders among patients presenting to PHCs was noticeably lower than expected rates. It seems probable that this huge difference is due to poor screening and detection of mental illness in PHCs of MUMS. It is recommended that health policymakers pursue specific measures to make PHCs more helpful for people with mental health problems in the community.


Asunto(s)
Trastornos Mentales , Salud Mental , Adulto , Persona de Mediana Edad , Masculino , Femenino , Humanos , Niño , Estado de Salud , Irán/epidemiología , Estudios Transversales , Prevalencia , Predicción , Encuestas Epidemiológicas , Población Rural , Población Urbana , Distribución por Edad , Distribución por Sexo , Modelos Logísticos , Muestreo , Trastornos Mentales/epidemiología , Atención Primaria de Salud
3.
PLoS One ; 16(12): e0261015, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34919574

RESUMEN

BACKGROUND AND OBJECTIVES: Xinjiang is one of the areas in China with extremely severe iodine deficiency. The health of Xinjiang residents has been endangered for a long time. In order to provide reasonable suggestions for scientific iodine supplementation and improve the health and living standards of the people in Xinjiang, it is necessary to understand the spatial distribution of iodine content in drinking water and explore the influencing factors of spatial heterogeneity of water iodine content distribution. METHODS: The data of iodine in drinking water arrived from the annual water iodine survey in Xinjiang in 2017. The distribution of iodine content in drinking water in Xinjiang is described from three perspectives: sampling points, districts/counties, and townships/streets. ArcGIS was used for spatial auto-correlation analysis, mapping the distribution of iodine content in drinking water and visualizing the distribution of Geographically Weighted Regression (GWR) model parameter. Kriging method is used to predict the iodine content in water at non-sampling points. GWR software was used to build GWR model in order to find the factors affecting the distribution of iodine content in drinking water. RESULTS: There are 3293 sampling points in Xinjiang. The iodine content of drinking water ranges from 0 to 128 µg/L, the median is 4.15 µg/L. The iodine content in 78.6% of total sampling points are less than 10 µg/L, and only that in the 3.4% are more than 40 µg/L. Among 1054 towns' water samples in Xinjiang, 88.9% of the samples' water iodine content is less than 10 µg/L. Among the 94 studied areas, the median iodine content in drinking water in 87 areas was less than 10 µg/L, those values in 7 areas were between 10-40 µg/L, and the distribution of water iodine content in Xinjiang shows clustered. The GWR model established had found that the effects of soil type and precipitation on the distribution of iodine content in drinking water were statistically significant. CONCLUSIONS: The iodine content of drinking water in Xinjiang is generally low, but there are also some areas which their drinking water has high iodine content. Soil type and precipitation are the factors affecting the distribution of drinking water iodine content, and are statistically significant (P<0.05).


Asunto(s)
Agua Potable/química , Yodo/análisis , China , Monitoreo del Ambiente , Muestreo , Análisis Espacial
4.
Transfusion ; 61 Suppl 2: S11-S35, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34337759

RESUMEN

INTRODUCTION: Supplemental data from the 2019 National Blood Collection and Utilization Survey (NBCUS) are presented and include findings on donor characteristics, autologous and directed donations and transfusions, platelets (PLTs), plasma and granulocyte transfusions, pediatric transfusions, transfusion-associated adverse events, cost of blood units, hospital policies and practices, and implementation of blood safety measures, including pathogen reduction technology (PRT). METHODS: National estimates were produced using weighting and imputation methods for a number of donors, donations, donor deferrals, autologous and directed donations and transfusions, PLT and plasma collections and transfusions, a number of crossmatch procedures, a number of units irradiated and leukoreduced, pediatric transfusions, and transfusion-associated adverse events. RESULTS: Between 2017 and 2019, there was a slight decrease in successful donations by 1.1%. Donations by persons aged 16-18 decreased by 10.1% while donations among donors >65 years increased by 10.5%. From 2017 to 2019, the median price paid for blood components by hospitals for leukoreduced red blood cell units, leukoreduced apheresis PLT units, and for fresh frozen plasma units continued to decrease. The rate of life-threatening transfusion-related adverse reactions continued to decrease. Most whole blood/red blood cell units (97%) and PLT units (97%) were leukoreduced. CONCLUSION: Blood donations decreased between 2017 and 2019. Donations from younger donors continued to decline while donations among older donors have steadily increased. Prices paid for blood products by hospitals decreased. Implementation of PRT among blood centers and hospitals is slowly expanding.


Asunto(s)
Donantes de Sangre/estadística & datos numéricos , Encuestas de Atención de la Salud , Adolescente , Adulto , Distribución por Edad , Anciano , Bancos de Sangre/estadística & datos numéricos , Eliminación de Componentes Sanguíneos/estadística & datos numéricos , Transfusión de Componentes Sanguíneos/estadística & datos numéricos , Transfusión de Componentes Sanguíneos/tendencias , Donantes de Sangre/provisión & distribución , Antígenos de Grupos Sanguíneos/genética , Transfusión Sanguínea/estadística & datos numéricos , Transfusión Sanguínea/tendencias , Transfusión de Sangre Autóloga/estadística & datos numéricos , Transfusión de Sangre Autóloga/tendencias , Áreas de Influencia de Salud , Niño , Preescolar , Transmisión de Enfermedad Infecciosa/prevención & control , Selección de Donante/estadística & datos numéricos , Femenino , Costos de la Atención en Salud , Hospitales/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Procedimientos de Reducción del Leucocitos/economía , Procedimientos de Reducción del Leucocitos/métodos , Masculino , Persona de Mediana Edad , Política Organizacional , Asunción de Riesgos , Muestreo , Procedimientos Quirúrgicos Operativos/estadística & datos numéricos , Reacción a la Transfusión/epidemiología , Estados Unidos/epidemiología , Adulto Joven
5.
Psychosom Med ; 83(6): 624-630, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34213862

RESUMEN

OBJECTIVE: Because of fast-growing interest in the applications of mindfulness to promote well-being and mental health, there are field-wide efforts to better understand how mindfulness training works and thereby to optimize its delivery. Key to these efforts is the role of home practice in mindfulness-based intervention (MBI) outcomes. Despite its centrality in MBIs, recent reviews have documented limited and mixed effects of home practice on MBI outcomes. However, methodological issues regarding monitoring and quantifying home practice and focus on cumulative or additive effects may limit our understanding of it. Temporally proximate, more transient, and contextually circumscribed effects of mindfulness mediation practice have not been examined. METHODS: We applied intensive experience sampling to measure daily practice and levels of targeted proximal outcomes (state mindfulness, decentering, emotional valance, and arousal) of training over the course of a 21-day MBI among a community-based sample of 82 meditation-naive adults. RESULTS: Despite intensive experience sampling, we found no evidence of cumulative or additive effects of total mindfulness meditation practice on outcomes at postintervention for mindfulness, decentering, emotional valence, or emotional arousal. However, we found that that daily dose of mindfulness meditation home practice significantly predicted same-day levels of state mindfulness (B = 0.004, SE = 0.001, t = 3.17, p = .000, f2 = 0.24), decentering (B = 0.004, SE = 0.001, t = 2.757, p = .006, f2 = 0.05), and emotional valence (B = 0.006, SE = 0.003, t = 2.015, p = .044, f2 = 0.01) but not daily levels of emotional arousal. Daily dose-response practice effects did not carry over to next-day levels of monitored outcomes. CONCLUSIONS: Findings show that effects of daily home mindfulness meditation practice dose on state mindfulness, decentering, and positive emotion are reliable but transient and time-limited. Findings are discussed with respect to the proposed daily dose-response hypothesis of mindfulness meditation practice.


Asunto(s)
Meditación , Atención Plena , Adulto , Evaluación Ecológica Momentánea , Emociones , Humanos , Muestreo
6.
Med Care ; 59(7): 565-571, 2021 07 01.
Artículo en Inglés | MEDLINE | ID: mdl-33989247

RESUMEN

BACKGROUND: Integrated care that is continuous, coordinated and patient-centered is vital for Medicare beneficiaries, but its relationship to health care expenditures remains unclear. RESEARCH OBJECTIVE: This study explores-for the first time-the relationship between integrated care, as measured from the patient's perspective, and health care expenditures. METHODS: Subjects include a sample of continuously eligible fee-for-service Medicare beneficiaries (n=8807) in 2015. Analyses draw on 7 previously validated measures of patient-perceived integrated care from the 2015 Medicare Current Beneficiary Survey. These data are combined with 2015 administrative utilization data that measure health care expenditures. Relationships between patient-perceived integrated care and costs are assessed using generalized linear models with comprehensive control measures. RESULTS: Patients who perceive more integrated care have higher expenditures for many, but not all, cost categories examined. Aspects of integrated care pertaining to primary provider and specialist care are associated with higher costs in several areas (particularly inpatient costs associated with specialist knowledge of the patient). Office staff members' knowledge of the patient's medical history is associated with lower home health costs. CONCLUSIONS: Patients who experience their care as more integrated may have higher expenditures on average. Thoughtful policy choices, further research, and innovations that enable patients to perceive integrated care at lower or neutral cost are needed.


Asunto(s)
Prestación Integrada de Atención de Salud , Gastos en Salud , Medicare/economía , Calidad de la Atención de Salud , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Muestreo , Estados Unidos
7.
ScientificWorldJournal ; 2021: 8888845, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33833622

RESUMEN

BACKGROUND: Home visit is an integral component of Ghana's PHC delivery system. It is preventive and promotes health practice where health professionals render care to clients in their own environment and provide appropriate healthcare needs and social support services. This study describes the home visit practices in a rural district in the Volta Region of Ghana. Methodology. This descriptive cross-sectional study used 375 households and 11 community health nurses in the Adaklu district. Multistage sampling techniques were used to select 10 communities and study respondents using probability sampling methods. A pretested self-designed questionnaire and an interview guide for household members and community health nurses, respectively, were used for data collection. Quantitative data collected were coded, cleaned, and analysed using Statistical Package for Social Sciences into descriptive statistics, while qualitative data were analysed using the NVivo software. Thematic analysis was engaged that embraces three interrelated stages, namely, data reduction, data display, and data conclusion. RESULTS: Home visit is a routine responsibility of all CHNs. The factors that influence home visiting were community members' education and attitude, supervision challenges, lack of incentives and lack of basic logistics, uncooperative attitude, community inaccessibility, financial constraint, and limited number of staff. Household members (62.3%) indicated that health workers did not adequately attend to minor ailments as 78% benefited from the service and wished more activities could be added to the home visiting package (24.5%). CONCLUSION: There should be tailored training of CHNs on home visits skills so that they could expand the scope of services that can be provided. Also, community-based health workers such as community health volunteers, traditional birth attendants, and community clinic attendants can also be trained to identify and address health problems in the homes.


Asunto(s)
Enfermería en Salud Comunitaria , Visita Domiciliaria , Enfermeros de Salud Comunitaria , Atención Primaria de Salud/organización & administración , Enfermería Rural , Adolescente , Adulto , Anciano , Áreas de Influencia de Salud , Enfermería en Salud Comunitaria/organización & administración , Enfermería en Salud Comunitaria/estadística & datos numéricos , Estudios Transversales , Recolección de Datos , Presentación de Datos , Atención a la Salud/organización & administración , Atención a la Salud/estadística & datos numéricos , Demografía , Femenino , Ghana , Educación en Salud , Visita Domiciliaria/estadística & datos numéricos , Humanos , Renta , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Enfermeros de Salud Comunitaria/estadística & datos numéricos , Proyectos Piloto , Investigación Cualitativa , Enfermería Rural/organización & administración , Enfermería Rural/estadística & datos numéricos , Muestreo , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
8.
J Appl Psychol ; 106(8): 1250-1265, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-32914993

RESUMEN

Incivility at work poses a problem, both for individuals who are the targets of incivility and for organizations. However, relatively little is known about what drives or hinders individuals to engage in incivility, and how they respond to their own uncivil behavior. Adopting a self-regulation perspective, we link theories explaining enacted incivility as self-regulatory failure with research about the self-regulatory benefits of mindfulness. We develop and investigate a conceptual model on the role of trait mindfulness in antecedent- and consequent-based processes of enacted workplace incivility. Data from an experience-sampling study across 5 work days provided support for the majority of our hypotheses. Individuals high in trait mindfulness not only showed generally low levels of enacted incivility, but they also displayed less variability in enacted incivility over time. Specifically, while enacted incivility was entrained to the work week and systematically decreased from Monday to Friday for individuals low in mindfulness, enacted incivility remained stable over the course of the work week for individuals high in mindfulness. Furthermore, employees high in trait mindfulness reacted in a more morally mature manner and experienced guilt when having engaged in uncivil behavior compared to their low mindful counterparts. However, increases in guilt for high mindful individuals did not translate into lower levels of enacted incivility the following work day. (PsycInfo Database Record (c) 2021 APA, all rights reserved).


Asunto(s)
Incivilidad , Atención Plena , Evaluación Ecológica Momentánea , Humanos , Muestreo , Lugar de Trabajo
9.
Ther Adv Respir Dis ; 14: 1753466620951053, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32873175

RESUMEN

Infection with novel SARS-CoV-2 carries significant morbidity and mortality in patients with pulmonary compromise, such as lung cancer, autoimmune disease, and pneumonia. For early stages of mild to moderate disease, care is entirely supportive.Antiviral drugs such as remdesivir may be of some benefit but are reserved for severe cases given limited availability and potential toxicity. Repurposing of safer, established medications that may have antiviral activity is a possible approach for treatment of earlier-stage disease. Tetracycline and its derivatives (e.g. doxycycline and minocycline) are nontraditional antibiotics with a well-established safety profile, potential efficacy against viral pathogens such as dengue fever and chikungunya, and may regulate pathways important in initial infection, replication, and systemic response to SARS-CoV-2. We present a series of four high-risk, symptomatic, COVID-19+ patients, with known pulmonary disease, treated with doxycycline with subsequent rapid clinical improvement. No safety issues were noted with use of doxycycline.Doxycycline is an attractive candidate as a repurposed drug in the treatment of COVID-19 infection, with an established safety profile, strong preclinical rationale, and compelling initial clinical experience described here.The reviews of this paper are available via the supplemental material section.


Asunto(s)
Adenocarcinoma del Pulmón/complicaciones , Infecciones por Coronavirus/tratamiento farmacológico , Doxiciclina/administración & dosificación , Neumonía Viral/tratamiento farmacológico , Enfermedad Pulmonar Obstructiva Crónica/complicaciones , Sarcoidosis Pulmonar/complicaciones , Adenocarcinoma del Pulmón/diagnóstico , Adenocarcinoma del Pulmón/terapia , Adulto , Anciano , Anciano de 80 o más Años , COVID-19 , Comorbilidad , Infecciones por Coronavirus/complicaciones , Infecciones por Coronavirus/diagnóstico , Femenino , Estudios de Seguimiento , Humanos , Masculino , Persona de Mediana Edad , Multimorbilidad , Pandemias , Neumonía Viral/complicaciones , Neumonía Viral/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/diagnóstico , Enfermedad Pulmonar Obstructiva Crónica/terapia , Medición de Riesgo , Muestreo , Sarcoidosis Pulmonar/diagnóstico , Sarcoidosis Pulmonar/terapia , Resultado del Tratamiento
10.
J Pediatr ; 220: 80-85, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32067781

RESUMEN

OBJECTIVE: To characterize home phototherapy treatment for neonatal hyperbilirubinemia and assess the risk factors associated with the need for hospital admission during or after home phototherapy. STUDY DESIGN: This was a retrospective study of newborn infants born at ≥35 weeks of gestation who underwent comprehensive home phototherapy (that included daily in-home lactation support and blood draws) over an 18-month period. We excluded infants who lacked a recorded birth date or time, started treatment at age >14 days, or had a conjugated serum bilirubin level of ≥2 mg/dL (≥34.2 µmol/L). The primary study outcome was any hospital admission during or within 24 hours after completion of home phototherapy. Logistic regression was used to identify risk factors for hospitalization. RESULTS: Of the cohort of 1385 infants, 1324 met the inclusion criteria. At the time home phototherapy was initiated, 376 infants (28%) were at or above the American Academy of Pediatrics phototherapy threshold. Twenty-five infants required hospitalization (1.9%; 95% CI, 1.3%-2.8%). Hospital admission was associated with a younger age at phototherapy initiation (OR, 0.63 for each day older in age; 95% CI, 0.44-0.91) and a higher total serum bilirubin level relative to the treatment threshold at phototherapy initiation (OR, 1.71 for each 1 mg/dL above the treatment threshold; 95% CI, 1.40-2.08). CONCLUSIONS: Comprehensive home phototherapy successfully treated hyperbilirubinemia in the vast majority of the infants in this cohort.


Asunto(s)
Servicios de Atención a Domicilio Provisto por Hospital , Hiperbilirrubinemia Neonatal/terapia , Fototerapia , Factores de Edad , Bilirrubina/sangre , Femenino , Servicios de Atención a Domicilio Provisto por Hospital/economía , Humanos , Recién Nacido , Masculino , Admisión del Paciente/estadística & datos numéricos , Fototerapia/economía , Retratamiento , Estudios Retrospectivos , Muestreo
11.
J Biosoc Sci ; 52(3): 439-451, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-31496456

RESUMEN

Evidence on the impact of the quality of prenatal care on childhood mortality is limited in developing countries, including India. Therefore, using nationally representative data from the latest round of the National Family Health Survey (2015-16), this study examined the impact of the quality of prenatal care on neonatal and infant mortality in India using a multivariable binary logistic regression model. The effect of the essential components of prenatal care services on neonatal and infant mortality were also investigated. The results indicate that improvement in the quality of prenatal care is associated with a decrease in neonatal (OR: 0.93, 95% CI: 0.91-0.97) and infant (OR: 0.94, 95% CI: 0.92-0.96) mortality in India. Tetanus toxoid vaccination, consumption of iron-folic acid tablets during pregnancy and having been weighed during pregnancy were statistically associated with a lower risk of neonatal and infant mortality. Educating women on pregnancy complications was also associated with a lower risk of neonatal mortality. No effect of blood pressure examination, blood test and examination of the abdomen during pregnancy were found on either of the two indicators of childhood mortality. Although the coverage of prenatal care has increased dramatically in India, the quality of prenatal care is still an area of concern. There is therefore a need to ensure high-quality prenatal care in India.


Asunto(s)
Mortalidad Infantil , Complicaciones del Embarazo/prevención & control , Atención Prenatal/métodos , Calidad de la Atención de Salud , Adolescente , Adulto , Estudios Transversales , Suplementos Dietéticos , Femenino , Encuestas Epidemiológicas , Humanos , India , Lactante , Recién Nacido , Modelos Logísticos , Persona de Mediana Edad , Embarazo , Muestreo , Tétanos/mortalidad , Tétanos/prevención & control , Toxoide Tetánico/uso terapéutico , Vacunación , Adulto Joven
12.
Can Fam Physician ; 65(12): e515-e522, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31831500

RESUMEN

OBJECTIVE: To examine patients' perceptions of care outcomes following the introduction of collaborative teams into community family practices. DESIGN: Cross-sectional, longitudinal study comprising 4 patient telephone surveys between 2007 and 2016, using random sampling of telephone records based on postal codes. SETTING: Ten WestView Primary Care Network (WPCN) clinics in Alberta, serving a suburban-rural population of approximately 89 000 and an aggregate clinic panel of 61 611 (in 2016). PARTICIPANTS: Adults aged 18 and older with a visit to a family physician in a WPCN clinic at least once in the previous 18 months. INTERVENTIONS: In 2006, WPCN implemented a decentralized and distributed collaborative team model, integrating nonphysician health care professionals into member clinics. MAIN OUTCOME MEASURES: The Primary Care Assessment Tool (PCAT) was used to evaluate standardized primary care delivery domains. Between-year changes were compared using ANOVA (analysis of variance). Clinic-level subgroup analyses were performed. RESULTS: The number of completed surveys included 896 in 2007, 904 in 2010, 1000 in 2013, and 1800 in 2016, reaching 90% to 100% of the targeted sample size. In aggregate, the WPCN PCAT summary score and the scores of 4 core and 2 ancillary domains of primary care exceeded the quality threshold of 3.0: extent of affiliation, ongoing care, first-contact utilization, coordination of care, family-centredness, and cultural competence. The first-contact access domain significantly improved from 2007 to 2016 (P < .001). The domains extent of affiliation, first-contact utilization, and coordination of information systems were unchanged. Ongoing care, coordination of care, comprehensiveness, family-centredness, community orientation, and cultural competence decreased. Except for in 2010, the 2 highest scoring clinics were non-participating solo practices; the lowest-scoring clinic was the one with the largest number of physicians. Across survey years, the PCAT summary score increased statistically significantly for 1 solo practice, remained consistent at an above-quality threshold for another, but decreased for all multi-physician clinics. Unattached patients (ie, those without a family doctor) scored the lowest. CONCLUSION: This study found that WPCN provides high-quality primary care overall, but that patient-perceived outcomes do not indicate global improvement concurrent with team-based initiatives. Decreased standardization of the distributed model likely influenced study-observed variations in clinic performance. Future research should identify clinic and team characteristics that benefit most from team-based care and factors that explain solo practices outperforming models of team-based care.


Asunto(s)
Servicios de Salud Comunitaria/normas , Prestación Integrada de Atención de Salud/métodos , Medicina Familiar y Comunitaria/normas , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud/normas , Evaluación de Procesos, Atención de Salud/métodos , Adolescente , Adulto , Anciano , Alberta , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Población Rural , Muestreo , Población Suburbana , Encuestas y Cuestionarios , Adulto Joven
13.
Photobiomodul Photomed Laser Surg ; 37(10): 615-622, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31536464

RESUMEN

Background: Parkinson's disease is a well-known neurological disorder with distinct motor signs and non-motor symptoms. Objective: We report on six patients with Parkinson's disease that used in-house built photobiomodulation (PBM) helmets. Methods: We used "buckets" lined with light-emitting diodes (LEDs) of wavelengths across the red to near-infrared range (i.e., 670, 810, and 850 nm; n = 5) or an homemade intranasal LED device (660 nm; n = 1). Progress was assessed by the patients themselves, their spouse, or their attending medical practitioners. Results: We found that 55% of the initial signs and symptoms of the six patients showed overall improvement, whereas 43% stayed the same and only 2% got worse. We also found that PBM did not target a specific sign or symptom, with both motor and nonmotor ones being affected, depending on the patient. Conclusions: In summary, our early observations are the first to note the impact of PBM on patients' signs and symptoms over an extended period, up to 24 months, and lays the groundwork for further development to clinical trial.


Asunto(s)
Láseres de Semiconductores/uso terapéutico , Terapia por Luz de Baja Intensidad/instrumentación , Terapia por Luz de Baja Intensidad/métodos , Enfermedad de Parkinson/diagnóstico , Enfermedad de Parkinson/radioterapia , Anciano , Encéfalo/efectos de la radiación , Diseño de Equipo , Estudios de Seguimiento , Dispositivos de Protección de la Cabeza , Humanos , Rayos Infrarrojos/uso terapéutico , Masculino , Persona de Mediana Edad , Pruebas Neuropsicológicas/normas , Medición de Riesgo , Muestreo , Índice de Severidad de la Enfermedad , Factores de Tiempo , Resultado del Tratamiento
16.
Dermatol Ther ; 32(5): e13069, 2019 09.
Artículo en Inglés | MEDLINE | ID: mdl-31430015

RESUMEN

Traumatic tattoos can be treated with several methods, including mechanical and chemical devices. However, they are rarely used due to the high risk of permanent side effects such as scarring and depigmentation. Recently, laser devices, especially the Q-switched (QS) laser and the pulsed dye laser (PDL), applied in combination, have achieved complete clearance of the lesions without any risk of side effects. Herein, we reported three cases of traumatic facial tattoos successfully treated with combined PDL and QS Nd:YAG laser.


Asunto(s)
Traumatismos Faciales/complicaciones , Hiperpigmentación/radioterapia , Láseres de Colorantes/uso terapéutico , Láseres de Estado Sólido/uso terapéutico , Terapia por Luz de Baja Intensidad/métodos , Adulto , Niño , Terapia Combinada , Estética , Traumatismos Faciales/radioterapia , Estudios de Seguimiento , Humanos , Hiperpigmentación/etiología , Masculino , Satisfacción del Paciente/estadística & datos numéricos , Muestreo , Tatuaje , Resultado del Tratamiento
17.
Oncol Nurs Forum ; 46(5): 617-630, 2019 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-31424447

RESUMEN

PURPOSE: To explore caregivers' writings about their experiences caring for adult individuals with cancer on a social media health communication website. PARTICIPANTS & SETTING: Journal entries (N = 392) were analyzed for 37 adult caregivers who were posting on behalf of 20 individuals with cancer. CaringBridge is a website used by patients and informal caregivers to communicate about acute and chronic disease. METHODOLOGIC APPROACH: A retrospective descriptive study using qualitative content analysis of caregivers' journal entries from 2009 to 2015. FINDINGS: Major categories identified in caregivers' online journals included patient health information, cancer awareness/advocacy, social support, caregiver burden, daily living, emotions (positive and negative), and spirituality. IMPLICATIONS FOR NURSING: Nurses often recommend using social media as a communication strategy for patients with cancer and their caregivers. The findings from this study provide potential guidance nurses may wish to offer caregivers. For example, nurses may talk with caregivers about how and what to post regarding treatment decisions. In addition, nurses can provide support for caregivers struggling with when and how often to communicate on social media.


Asunto(s)
Cuidadores/psicología , Neoplasias/psicología , Narrativas Personales como Asunto , Medios de Comunicación Sociales , Actividades Cotidianas , Adulto , Confidencialidad , Diarios como Asunto , Emociones , Femenino , Humanos , Masculino , Defensa del Paciente , Investigación Cualitativa , Estudios Retrospectivos , Muestreo , Apoyo Social , Espiritualidad , Escritura
18.
J Manipulative Physiol Ther ; 42(5): 366-371, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31262581

RESUMEN

OBJECTIVE: The aim of this study was to relate forearm anthropometric measures to ultrasound pronator teres depth to determine the necessary needle length to prevent median nerve (MN) injury during pronator teres dry needling. METHODS: We conducted a study employing a diagnostic accuracy prediction model (NCT03308279) at a Spanish university center. The study recruited 65 participants to predict the depth of the MN (measured with ultrasound) in the pronator teres using a decision tree algorithm to reduce the risk of MN puncture using 2 needle lengths (13 mm or 25 mm). The decision tree was developed by automatically selecting a cutoff for body mass index, forearm length and circumference, and pronator teres thickness. RESULTS: For forearm circumferences ≤27.5 cm, the predictive value for the 13-mm needle was 92%. For forearm circumferences >27.5 cm and forearm lengths ≤26.75 cm, the predictive value for the 25-mm needle was 100%. CONCLUSION: Based upon the findings of this study, we suggest that needle length should be selected according to forearm anthropometric measures to prevent MN injury during pronator teres dry needling.


Asunto(s)
Punción Seca , Nervio Mediano/diagnóstico por imagen , Músculo Esquelético/diagnóstico por imagen , Adulto , Algoritmos , Árboles de Decisión , Femenino , Antebrazo/anatomía & histología , Humanos , Enfermedad Iatrogénica/prevención & control , Masculino , Traumatismos de los Nervios Periféricos/prevención & control , Muestreo , Ultrasonografía
19.
J Manipulative Physiol Ther ; 42(5): 343-352, 2019 06.
Artículo en Inglés | MEDLINE | ID: mdl-31255312

RESUMEN

OBJECTIVE: This study aimed to refine a magnetic resonance imaging (MRI)-ultrasound registration (ie, alignment) technique to make noninvasive, nonionizing, 3-dimensional measurement of the lumbar segmental motion in vivo. METHODS: Five healthy participants participated in this validation study. We scanned the lumbar region of each participant 5 times using an ultrasound probe while he or she kept a prone lying posture on a plinth. Participant-specific models of L1-L5 were constructed from magnetic resonance (MR) images and aligned with the 3-dimensional ultrasound dataset of each scan using 4 variants of MRI-ultrasound registration approach (simplified intensity-based registration [1] with and [2] without including the transverse processes and their surrounding soft tissues [denoted as TP complex]; and hierarchical intensity-based registration [3] with and [4] without including the TP complex). The robustness and precision of these registration approaches were compared. RESULTS: Although all registration approaches converged to a similar solution, excluding the TP complex improved the percentage of successful registration from 92% to 100%. There was no significant difference in the precision among the 4 MRI-ultrasound registration variants. For the simplified intensity-based registration without including the TP complex, average precision at each degree of freedom was 1.33° (flexion-extension), 2.48° (lateral bending), 1.32° (axial rotation), 2.15 mm (left/right), 1.08 mm (anterior-posterior), and 1.16 (superior-inferior), respectively. CONCLUSION: Given that using simplified intensity-based MRI-ultrasound registration can substantially streamline the registration process and excluding the TP complex would improve the robustness of the registration, we conclude that this combination is the method of choice for in vivo human applications.


Asunto(s)
Vértebras Lumbares/diagnóstico por imagen , Imagen por Resonancia Magnética , Ultrasonografía , Adulto , Algoritmos , Femenino , Voluntarios Sanos , Humanos , Imagenología Tridimensional , Masculino , Muestreo
20.
J Manipulative Physiol Ther ; 42(3): 187-194, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31078315

RESUMEN

OBJECTIVES: The purpose of this study was to determine the immediate effects of a manual therapy technique consisting of axial traction compared with side lying on increased spine height after sustained loading. METHODS: Twenty-one asymptomatic participants were included. Participants either received manual therapy technique consisting of manual axial traction force for 2 consecutive rounds of 3 minutes or sustained side lying for 10 minutes. Spine height was measured using a commercially available stadiometer. Spinal height change was determined from measurements taken after loaded walking and measurements taken after manual therapy. A paired t test was performed to determine if a manual therapy technique consisting of axial traction increased spinal height after a period of spinal loading. RESULTS: A significant increase in height was found after both manual therapy technique and sustained side lying (P < .0001). The mean height gain was 8.60 mm using 3-dimensional axial separation. CONCLUSION: This study is an initial attempt at evaluating the biomechanical effects of manual therapy technique consisting of axial traction. Both manual axial traction force and sustained side-lying position were equally effective for short-term change in spine height after a loaded walking protocol among healthy asymptomatic individuals. This study protocol may help to inform future studies that evaluate spine height after loading.


Asunto(s)
Disco Intervertebral/anatomía & histología , Vértebras Lumbares/anatomía & histología , Manipulaciones Musculoesqueléticas , Tracción , Adulto , Estudios Cruzados , Femenino , Humanos , Disco Intervertebral/fisiología , Vértebras Lumbares/fisiología , Masculino , Postura , Muestreo , Soporte de Peso
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