RESUMEN
The mental health of college students is a growing concern, and gauging the mental health needs of college students is difficult to assess in real-time and in scale. To address this gap, researchers and practitioners have encouraged the use of passive technologies. Social media is one such "passive sensor" that has shown potential as a viable "passive sensor" of mental health. However, the construct validity and in-practice reliability of computational assessments of mental health constructs with social media data remain largely unexplored. Towards this goal, we study how assessing the mental health of college students using social media data correspond with ground-truth data of on-campus mental health consultations. For a large U.S. public university, we obtained ground-truth data of on-campus mental health consultations between 2011-2016, and collected 66,000 posts from the university's Reddit community. We adopted machine learning and natural language methodologies to measure symptomatic mental health expressions of depression, anxiety, stress, suicidal ideation, and psychosis on the social media data. Seasonal auto-regressive integrated moving average (SARIMA) models of forecasting on-campus mental health consultations showed that incorporating social media data led to predictions with r = 0.86 and SMAPE = 13.30, outperforming models without social media data by 41%. Our language analyses revealed that social media discussions during high mental health consultations months consisted of discussions on academics and career, whereas months of low mental health consultations saliently show expressions of positive affect, collective identity, and socialization. This study reveals that social media data can improve our understanding of college students' mental health, particularly their mental health treatment needs.
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Servicios de Salud Mental/tendencias , Salud Mental , Derivación y Consulta/tendencias , Medios de Comunicación Sociales/tendencias , Servicios de Salud para Estudiantes/tendencias , Estudiantes/psicología , Universidades , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Aprendizaje Automático , Procesamiento de Lenguaje Natural , Evaluación de Necesidades/tendencias , Factores de TiempoAsunto(s)
Prestación Integrada de Atención de Salud/organización & administración , Medicina General/organización & administración , Disparidades en Atención de Salud/estadística & datos numéricos , Evaluación de Necesidades/tendencias , Salud Pública/métodos , COVID-19/diagnóstico , COVID-19/epidemiología , COVID-19/prevención & control , COVID-19/virología , Conducta Cooperativa , Empoderamiento , Fuerza Laboral en Salud/estadística & datos numéricos , Disparidades en Atención de Salud/tendencias , Humanos , Colaboración Intersectorial , Pandemias/prevención & control , SARS-CoV-2/genética , Reino Unido/epidemiologíaRESUMEN
OBJECTIVE: We aimed to determine the interest and changing trends over time in the diagnosis and treatment of bladder cancer and its awareness campaign by examining the Google Trends application as an indicator of people's interest globally. METHODS: Using the Google Trends application, we determined the yearly and country-based relative search volumes of the term "bladder tumor" and of the methods used in the diagnosis and treatment of bladder cancer in the period from January 2004 to December 2019. We compared the median relative search volumes found in the period 2004-2011 (Period 1) with those found in the period 2012-2019 (Period 2). RESULTS: We found that the median relative search volume for bladder cancer decreased in period 2 and this was parallel to the decrease in the incidence rates in North America and Australia (p<0.001). We found that the bladder cancer awareness month did not cause an increase in the online interest (p>0.05). We found that the median relative search volumes of diagnostic cystoscopy and cytology were higher than those of molecular markers and imaging methods in line with guidelines (p<0.001). Also, TURBT was the most sought-term among treatment methods with increasing popularity in the second period (p<0.001). CONCLUSION: People use the internet intensively to search for information about bladder cancer. We think that several types of web-based applications such as "Google Trends" can help determine the behavioural patterns and tendencies of bladder cancer patients and affect the clinical decision-making processes, as well as readily determining the impact of cancer awareness campaigns to bring about an increased awareness in the society for the recognition of the importance of an early diagnosis.
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Salud Global/estadística & datos numéricos , Promoción de la Salud/estadística & datos numéricos , Evaluación de Necesidades/estadística & datos numéricos , Motor de Búsqueda/estadística & datos numéricos , Neoplasias de la Vejiga Urinaria/diagnóstico , Neoplasias de la Vejiga Urinaria/terapia , Australia , Biomarcadores de Tumor , Canadá , Estudios Transversales , Cistoscopía/estadística & datos numéricos , Cistoscopía/tendencias , Diagnóstico por Imagen/estadística & datos numéricos , Diagnóstico por Imagen/tendencias , Salud Global/tendencias , Promoción de la Salud/tendencias , Humanos , Incidencia , Irlanda , Evaluación de Necesidades/tendencias , Nueva Zelanda , Factores de Tiempo , Reino Unido , Estados Unidos , Neoplasias de la Vejiga Urinaria/epidemiología , Neoplasias de la Vejiga Urinaria/patologíaRESUMEN
INTRODUCTION: Health care for children with complex chronic conditions (CCC) constitutes an evolving and a challenging part of practices in pediatrics. These children need end-of-life services such as palliative care. The aim of this study was to identify the frequency of patients with CCC among all hospitalized children at our general pediatrics services and to describe the demographics, diagnosis, clinical spectrum, long-term care needs, and mortality data of patients with CCC. PATIENTS AND METHODS: All hospitalizations in 2018 at the general pediatric services were screened retrospectively. Patients' hospitalization diagnoses, gender, age, comorbid conditions, number of emergency admissions in 2018, intensive care unit needs, mortality rates, and the number of hospitalizations in 2018 were investigated. RESULTS: A total of 1591 patients were hospitalized for 2083 times in 2018. Overall, 145 of 1591 patients (9%) had CCC. Patients with CCC were hospitalized for 472 times (23% of all hospitalizations). The number of emergency admissions, the number of hospitalizations in 2018 and the need for intensive care, and the mortality rate during hospitalization for patients with CCC were significantly higher than those for patients without CCC. The median length of hospitalization in patients with CCC was significantly longer. CONCLUSION: Patients with CCC were hospitalized frequently and longer, had increased emergency and PICU admissions, and special long-term care needs. Pediatricians who pioneer care for children with CCC need education, training, and coordinated support to ensure qualified long-term care for these patients.
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Enfermedad Crónica/terapia , Evaluación de Necesidades/tendencias , Distribución de Chi-Cuadrado , Preescolar , Enfermedad Crónica/psicología , Femenino , Humanos , Lactante , Tiempo de Internación/estadística & datos numéricos , Masculino , Estudios Retrospectivos , Estadísticas no Paramétricas , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/estadística & datos numéricosRESUMEN
The breadth of childhood sleep problems is broad and can be associated with biologic, psychiatric, behavioral, social, and environmental processes. Unrecognized childhood sleep problems may threaten daytime behaviors and negatively impact school and psychosocial functioning. Left unattended, overall child biopsychosocial development may be impaired. Thus, identifying and addressing sleep problems has potential to optimize childhood health, development, and overall well-being. Nurses need to be cognizant of detrimental impacts of child sleep deprivation and advocate for appropriate sleep assessments while offering sleep education to parents and children.
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Trastornos del Sueño-Vigilia/etiología , Sueño/fisiología , Humanos , Evaluación de Necesidades/tendencias , Pediatría/métodos , Examen Físico/métodos , Polisomnografía/métodosAsunto(s)
Atención a la Salud/normas , Personal de Salud/estadística & datos numéricos , Evaluación de Necesidades/estadística & datos numéricos , Crecimiento Demográfico , África/epidemiología , Asia/epidemiología , Niño , Salud Infantil/tendencias , Atención a la Salud/tendencias , Salud Global , Humanos , Evaluación de Necesidades/tendencias , UrbanizaciónRESUMEN
BACKGROUND: Due to low care utilization, a complex intervention was done for two years to optimize the Ethiopian Health Extension Program. Improved quality of the integrated community case management services was an intermediate outcome of this intervention through community education and mobilization, capacity building of health workers, and strengthening of district ownership and accountability of sick child services. We evaluated the association between the intervention and the health extension workers' ability to correctly classify common childhood illnesses in four regions of Ethiopia. METHODS: Baseline and endline assessments were done in 2016 and 2018 in intervention and comparison areas in four regions of Ethiopia. Ill children aged 2 to 59 months were mobilized to visit health posts for an assessment that was followed by re-examination. We analyzed sensitivity, specificity, and difference-in-difference of correct classification with multilevel mixed logistic regression in intervention and comparison areas at baseline and endline. RESULTS: Health extensions workers' consultations with ill children were observed in intervention (n = 710) and comparison areas (n = 615). At baseline, re-examination of the children showed that in intervention areas, health extension workers' sensitivity for fever or malaria was 54%, 68% for respiratory infections, 90% for diarrheal diseases, and 34% for malnutrition. At endline, it was 40% for fever or malaria, 49% for respiratory infections, 85% for diarrheal diseases, and 48% for malnutrition. Specificity was higher (89-100%) for all childhood illnesses. Difference-in-differences was 6% for correct classification of fever or malaria [aOR = 1.45 95% CI: 0.81-2.60], 4% for respiratory tract infection [aOR = 1.49 95% CI: 0.81-2.74], and 5% for diarrheal diseases [aOR = 1.74 95% CI: 0.77-3.92]. CONCLUSION: This study revealed that the Optimization of Health Extension Program intervention, which included training, supportive supervision, and performance reviews of health extension workers, was not associated with an improved classification of childhood illnesses by these Ethiopian primary health care workers. TRIAL REGISTRATION: ISRCTN12040912, http://www.isrctn.com/ISRCTN12040912.
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Enfermedad/clasificación , Promoción de la Salud/métodos , Evaluación de Necesidades/tendencias , Manejo de Caso/tendencias , Servicios de Salud del Niño/tendencias , Preescolar , Agentes Comunitarios de Salud/tendencias , Participación de la Comunidad/métodos , Etiopía/epidemiología , Femenino , Fuerza Laboral en Salud/tendencias , Humanos , Lactante , Masculino , Atención Primaria de Salud/tendenciasRESUMEN
OBJECTIVE: The coronavirus disease 2019 (COVID-19) pandemic has resulted in an increase in hospital resource utilization and the need to defer nonurgent cardiac surgery procedures. The present study aims to report the regional variations of North American adult cardiac surgical case volume and case mix through the first wave of the COVID-19 pandemic. METHODS: A survey was sent to recruit participating adult cardiac surgery centers in North America. Data in regard to changes in institutional and regional cardiac surgical case volume and mix were analyzed. RESULTS: Our study comprises 67 adult cardiac surgery institutions with diverse geographic distribution across North America, representing annualized case volumes of 60,452 in 2019. Nonurgent surgery was stopped during the month of March 2020 in the majority of centers (96%), resulting in a decline to 45% of baseline with significant regional variation. Hospitals with a high burden of hospitalized patients with COVID-19 demonstrated similar trends of decline in total volume as centers in low burden areas. As a proportion of total surgical volume, there was a relative increase of coronary artery bypass grafting surgery (high +7.2% vs low +4.2%, P = .550), extracorporeal membrane oxygenation (high +2.5% vs low 0.4%, P = .328), and heart transplantation (high +2.7% vs low 0.4%, P = .090), and decline in valvular cases (high -7.6% vs low -2.6%, P = .195). CONCLUSIONS: The present study demonstrates the impact of COVID-19 on North American cardiac surgery institutions as well as helps associate region and COVID-19 burden with the impact on cardiac surgery volumes and case mix.
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COVID-19 , Procedimientos Quirúrgicos Cardíacos/tendencias , Disparidades en Atención de Salud/tendencias , Pautas de la Práctica en Medicina/tendencias , Regionalización/tendencias , Cirujanos/tendencias , Procedimientos Quirúrgicos Electivos/tendencias , Encuestas de Atención de la Salud , Necesidades y Demandas de Servicios de Salud/tendencias , Humanos , Evaluación de Necesidades/tendencias , América del Norte , Factores de TiempoRESUMEN
BACKGROUND: During a pandemic, it is paramount to understand volume changes in Level I trauma so that with appropriate planning and reallocation of resources, these facilities can maintain and even improve life-saving capabilities. Evaluating nonaccidental and accidental trauma can highlight potential areas of improvement in societal behavior and hospital preparedness. These critical questions were proposed to better understand how healthcare leaders might adjust surgeon and team coverage of trauma services as well as prepare from a system standpoint what resources will be needed during a pandemic or similar crisis to maintain services. QUESTIONS/PURPOSES: (1) How did the total observed number of trauma activations, defined as patients who meet mechanism of injury requirements which trigger the notification and aggregation of the trauma team upon entering the emergency department, change during a pandemic and stay-at-home order? (2) How did the proportion of major mechanisms of traumatic injury change during this time period? (3) How did the proportion and absolute numbers of accidental versus nonaccidental traumatic injury in children and adults change during this time period? METHODS: This was a retrospective study of trauma activations at a Level I trauma center in New Orleans, LA, USA, using trauma registry data of all patients presenting to the trauma center from 2017 to 2020. The number of trauma activations during a government mandated coronavirus 2019 (COVID-19) stay-at-home order (from March 20, 2020 to May 14, 2020) was compared with the expected number of activations for the same time period from 2017 to 2019, called "predicted period". The expected number (predicted period) was assumed based on the linear trend of trauma activations seen in the prior 3 years (2017 to 2019) for the same date range (March 20, 2020 to May 14, 2020). To define the total number of traumatic injuries, account for proportion changes, and evaluate fluctuation in accidental verses nonaccidental trauma, variables including type of traumatic injury (blunt, penetrating, and thermal), and mechanism of injury (gunshot wound, fall, knife wound, motor vehicle collision, assault, burns) were collected for each patient. RESULTS: There were fewer total trauma activations during the stay-at-home period than during the predicted period (372 versus 532 [95% CI 77 to 122]; p = 0.016). The proportion of penetrating trauma among total activations was greater during the stay-at-home period than during the predicted period (35% [129 of 372] versus 26% [141 of 532]; p = 0.01), while the proportion of blunt trauma was lower during the stay-at-home period than during the predicted period (63 % [236 of 372] versus 71% [376 of 532]; p = 0.02). The proportion of gunshot wounds in relation to total activations was greater during the stay-at-home period than expected (26% [97 of 372] versus 18% [96 of 532]; p = 0.004). There were fewer motor vehicle collisions in relation to total activations during the stay-at-home period than expected (42% [156 of 372] versus 49% [263 of 532]; p = 0.03). Among total trauma activations, the stay-at-home period had a lower proportion of accidental injuries than the predicted period (55% [203 of 372] versus 61% [326 of 532]; p = 0.05), and there was a greater proportion of nonaccidental injuries than the predicted period (37% [137 of 372] versus 27% [143 of 532]; p < 0.001). In adults, the stay-at-home period had a greater proportion of nonaccidental injuries than the predicted period (38% [123 of 328] versus 26% [123 of 466]; p < 0.001). There was no difference between the stay-at-home period and predicted period in nonaccidental and accidental injuries among children. CONCLUSION: Data from the trauma registry at our region's only Level I trauma center indicate that a stay-at-home order during the COVID-19 pandemic was associated with a 70% reduction in the number of traumatic injuries, and the types of injuries shifted from more accidental blunt trauma to more nonaccidental penetrating trauma. Non-accidental trauma, including gunshot wounds, increased during this period, which suggest community awareness, crisis de-escalation strategies, and programs need to be created to address violence in the community. Understanding these changes allows for adjustments in staffing schedules. Surgeons and trauma teams could allow for longer shifts between changeover, decreasing viral exposure because the volume of work would be lower. Understanding the shift in injury could also lead to a change in specialists covering call. With the often limited availability of orthopaedic trauma-trained surgeons who can perform life-saving pelvis and acetabular surgery, this data may be used to mitigate exposure of these surgeons during pandemic situations. LEVEL OF EVIDENCE: Level III, therapeutic study.
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COVID-19/prevención & control , Servicio de Urgencia en Hospital/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Control de Infecciones/tendencias , Evaluación de Necesidades/tendencias , Centros Traumatológicos/tendencias , Heridas y Lesiones/epidemiología , Adolescente , Adulto , Anciano , COVID-19/epidemiología , COVID-19/transmisión , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Lactante , Recién Nacido , Masculino , Persona de Mediana Edad , Nueva Orleans/epidemiología , Sistema de Registros , Estudios Retrospectivos , Factores de Tiempo , Heridas y Lesiones/diagnóstico , Heridas y Lesiones/terapia , Adulto JovenRESUMEN
Objective: Physical activity is a key component of maintaining and promoting the health of older people. New technologies from the fields of augmented reality (AR) and virtual reality (VR) could help to increase the motivation of older people and positively influence their health behavior. To be able to respond specifically to the needs and expectations when developing an exergame for seniors with hypertension, the aim of this study was to determine the requirements for movement training within an intelligent AR system. Materials and Methods: Eleven seniors aged 65 years or older with essential hypertension and five experts from the cardiological field were interviewed using a semistructured interview and were examined with a task-based approach. In the task-based application, both VR and AR demos were used. Results: The results presented in this article refer to requirements for the development of a movement training within an exergame for older adults with hypertension. We found that on the one hand, group effects and, on the other, natural environments have a high motivational character. Furthermore, communication and interaction represent a decisive criterion for participation during exercises. Regarding the training concept the experts, in particular, recommended endurance-related activities. In addition, vital data and performance monitoring should be used to evaluate success, to signal warnings and to provide additional motivation. Conclusions: This requirement analysis enabled 45 requirements to be obtained, which will be taken into account in the training application of an AR system and in the development of an interactive multiuser AR exergame.
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Realidad Aumentada , Hipertensión Esencial/terapia , Evaluación de Necesidades/tendencias , Anciano , Anciano de 80 o más Años , Hipertensión Esencial/psicología , Femenino , Humanos , Masculino , Investigación Cualitativa , Interfaz Usuario-Computador , Juegos de Video/psicología , Juegos de Video/normasRESUMEN
BACKGROUND: Pediatric accountable health communities (AHCs) are emerging collaborative models that integrate care across health and social service sectors. We aimed to identify needed capabilities and potential solutions for implementing pediatric AHCs. METHODS: We conducted a directed content analysis of responses to a Request for Information (RFI) from the Center for Medicare & Medicaid Innovation on the Integrated Care for Kids Model (n = 1550 pages from 202 respondents). We then interviewed pediatric health policy stakeholders (n = 18) to further investigate responses from the RFI. All responses were coded using a consensual qualitative research approach in 2019. RESULTS: To facilitate service integration, respondents emphasized the need for cross-sector organizational alignment and data sharing. Recommended solutions included designating "Bridge Organizations" to operationalize service integration across sectors and developing integrated data sharing systems. Respondents called for improved validation and collection methods for data relating to school performance, social drivers of health, family well-being, and patient experience. Recommended solutions included aligning health and education data privacy regulations and utilizing metrics with cross-sector relevance. Respondents identified that mechanisms are needed to blend health and social service funding in alternative payment models (APMs). Recommended solutions included guidance on cross-sector care coordination payments, shared savings arrangements, and capitation to maximize spending flexibility. CONCLUSIONS: Pediatric AHCs could provide more integrated, high-value care for children. Respondents highlighted the need for shared infrastructure and cross-sector alignment of measures and financing. IMPLICATIONS: Insights and solutions from this study can inform policymakers planning or implementing innovative, child-centered AHC models. LEVEL OF EVIDENCE: Level V.
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Organizaciones Responsables por la Atención/métodos , Evaluación de Necesidades/tendencias , Pediatría/métodos , Organizaciones Responsables por la Atención/tendencias , Atención a la Salud/tendencias , Humanos , Pediatría/tendencias , Salud PúblicaRESUMEN
OBJECTIVE: To monitor hospital activity for presentation, diagnosis and treatment of cardiovascular diseases during the COVID-19) pandemic to inform on indirect effects. METHODS: Retrospective serial cross-sectional study in nine UK hospitals using hospital activity data from 28 October 2019 (pre-COVID-19) to 10 May 2020 (pre-easing of lockdown) and for the same weeks during 2018-2019. We analysed aggregate data for selected cardiovascular diseases before and during the epidemic. We produced an online visualisation tool to enable near real-time monitoring of trends. RESULTS: Across nine hospitals, total admissions and emergency department (ED) attendances decreased after lockdown (23 March 2020) by 57.9% (57.1%-58.6%) and 52.9% (52.2%-53.5%), respectively, compared with the previous year. Activity for cardiac, cerebrovascular and other vascular conditions started to decline 1-2 weeks before lockdown and fell by 31%-88% after lockdown, with the greatest reductions observed for coronary artery bypass grafts, carotid endarterectomy, aortic aneurysm repair and peripheral arterial disease procedures. Compared with before the first UK COVID-19 (31 January 2020), activity declined across diseases and specialties between the first case and lockdown (total ED attendances relative reduction (RR) 0.94, 0.93-0.95; total hospital admissions RR 0.96, 0.95-0.97) and after lockdown (attendances RR 0.63, 0.62-0.64; admissions RR 0.59, 0.57-0.60). There was limited recovery towards usual levels of some activities from mid-April 2020. CONCLUSIONS: Substantial reductions in total and cardiovascular activities are likely to contribute to a major burden of indirect effects of the pandemic, suggesting they should be monitored and mitigated urgently.
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COVID-19 , Servicio de Cardiología en Hospital/tendencias , Enfermedades Cardiovasculares/terapia , Prestación Integrada de Atención de Salud/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Evaluación de Necesidades/tendencias , Enfermedades Cardiovasculares/diagnóstico , Estudios Transversales , Servicio de Urgencia en Hospital/tendencias , Humanos , Admisión del Paciente/tendencias , Estudios Retrospectivos , Factores de Tiempo , Reino UnidoRESUMEN
OBJECTIVE: To explore what first time mothers in England expect from postnatal care while they are pregnant, what they would ideally like, where they get their information on postnatal care, and their views on the sufficiency of this information. DESIGN: A qualitative descriptive interview-based study. SETTING: England PARTICIPANTS: A maximum variation sample of 40 women who were currently in the third trimester of pregnancy; aged 16 or over; planning to give birth in England and had not given birth previously. METHODS: Semi structured interviews were carried out between October 2017 and March 2018, by telephone (n = 32) and face to face (n = 8). Interviews were analysed using thematic analysis. RESULTS: There were six themes and twelve subthemes. The themes were: (1) 'Piecing together snippets of information' containing subthemes 'Incomplete official sources' and 'Other mothers' stories'; (2) 'Planning ahead or going with the flow' containing subthemes 'Wanting more information' and 'Postnatal care not a priority'; (3) 'Judgement or reassurance' containing subthemes 'Real: Being judged', 'Ideal: Reassurance and non-judgmental advice'; (4) 'Focus of care' containing subthemes 'Real: A focus on checks and feeding', 'Ideal: More focus on mother's wellbeing'; (5) 'A system under pressure' containing subthemes 'Real: Busy midwives, reactive care', 'Ideal: Reliable, proactive information'; (6) 'Deciding about discharge', containing subthemes 'Real: Confusion about decision-making', 'Ideal: More control over length of hospital stay'. KEY CONCLUSIONS: First time mothers' experience of the transition to parenthood could be improved by antenatal access to comprehensive information about the timing, location, content and purpose of postnatal care. Information should take a woman-centred perspective and cover all settings (hospitals, birth centres, home, community), including the roles and responsibilities of all the professionals who may be involved. IMPLICATIONS FOR PRACTICE: Clear and comprehensive information about postnatal care should be provided to all women in ways that are accessible at any stage of pregnancy or the postnatal period. As women pregnant for the first time worry about being judged if they seek professional advice and reassurance postnatally, information about postnatal care should aim to address this.
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Conducta en la Búsqueda de Información , Madres/psicología , Atención Posnatal/normas , Adulto , Inglaterra , Femenino , Humanos , Motivación , Evaluación de Necesidades/normas , Evaluación de Necesidades/tendencias , Atención Posnatal/psicología , Embarazo , Investigación Cualitativa , Apoyo SocialRESUMEN
Background. The Ottawa Decision Support Framework (ODSF) has been used for 20 years to assess and address people's decisional needs. The evidence regarding ODSF decisional needs has not been synthesized. Objectives. To synthesize evidence from ODSF-based decisional needs studies, identify new decisional needs, and validate current ODSF decisional needs. Methods. A mixed-studies systematic review. Nine electronic databases were searched. Inclusion criteria: studies of people's decisional needs when making health or social decisions for themselves, a child, or a mentally incapable person, as reported by themselves, families, or practitioners. Two independent authors screened eligibility, extracted data, and quality appraised studies using the Mixed Methods Appraisal Tool. Data were analyzed using narrative synthesis. Results. Of 4532 citations, 45 studies from 7 countries were eligible. People's needs for 101 unique decisions (85 health, 16 social) were reported by 2857 patient decision makers (n = 36 studies), 92 parent decision makers (n = 6), 81 family members (n = 5), and 523 practitioners (n = 21). Current ODSF decisional needs were reported in 2 to 40 studies. For 6 decisional needs, there were 11 new (manifestations): 1) information (overload, inadequacy regarding others' experiences with options), 2) difficult decisional roles (practitioner, family involvement, or deliberations), 3) unrealistic expectations (difficulty believing outcome probabilities apply to them), 4) personal needs (religion/spirituality), 5) difficult decision timing (unpredictable), and 6) unreceptive decisional stage (difficulty accepting condition/need for treatment, powerful emotions limiting information processing, lacking motivation to consider delayed/unpredictable decisions). Limitations. Possible publication bias (only peer-reviewed journals included). Possible missed needs (non-ODSF studies, patient decision aid development studies, 3 ODSF needs added in 2006). Conclusion. We validated current decisional needs, identified 11 new manifestations of 6 decisional needs, and recommended ODSF revisions.
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Técnicas de Apoyo para la Decisión , Conductas Relacionadas con la Salud , Conducta Social , Aniversarios y Eventos Especiales , Humanos , Evaluación de Necesidades/normas , Evaluación de Necesidades/tendenciasRESUMEN
Although in Canada, hearing screening and early intervention are presented as a health need, we question whether young deaf and hard of hearing children's access to language is adequately supported by public health and children's services. The Ontario Infant Hearing Program has the stated mandate of supporting the language development of deaf and hard of hearing infants and young children. However, this program presents parents with early intervention service options involving either spoken or signed language, but not both together. This policy effectively restricts access to sign language learning for a majority of Ontario's deaf children. Consequently, some deaf children suffer language deprivation and its deleterious effects on cognition and emotional development. In support of our arguments, we refer to Article 25 of the United Nations Convention on the Rights of Persons with Disabilities (CRPD), which Canada has signed and ratified. The CRPD supports recognition of deaf children's right to sign language as a health need because language deprivation occurs in many children who are not offered sign language, and this is a permanent impairment imposed on top of hearing loss. We conclude that in Canada, health services for deaf children do not align with accessibility and human rights legislation, thus creating a policy gap that leaves deaf children vulnerable to additional impairment.
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Política de Salud/legislación & jurisprudencia , Internacionalidad , Desarrollo del Lenguaje , Evaluación de Necesidades/legislación & jurisprudencia , Lengua de Signos , Canadá , Niño , Preescolar , Personas con Discapacidad/legislación & jurisprudencia , Política de Salud/tendencias , Humanos , Lactante , Evaluación de Necesidades/tendenciasRESUMEN
BACKGROUND: The COVID-19 pandemic's impact on stroke care is two-fold direct impact of the infection and indirect impact on non-COVID-19 diseases. Anecdotal evidence and clinical observation suggest that there is a decrease in the number of patients presenting with stroke during the pandemic. We aim to understand the impact of the COVID-19 pandemic on the utilization of stroke emergency services on a single comprehensive stroke center (CSC). METHODS: We performed a retrospective analysis of a prospectively maintained database and compared all emergency department (ED) encounters, acute stroke admissions (including TIA), and thrombectomy cases admitted in March 2017-2019 to patients admitted in March 2020 at a comprehensive stroke center. RESULTS: Number of total ED encounters (22%, p=0.005), acute ischemic strokes (40%, p=0.001), and TIAs (60%, p=0.163) decreased between March of 2017-2019 compared to March of 2020. The number of patients undergoing EVT in March 2020 was comparable to March 2017-2019 (p=0.430). CONCLUSION: A pandemic-related stay-at-home policy reduces the utilization of stroke emergency services at a CSC. This effect appears to be more prominent for ED encounters, all stroke admissions and TIAs, and less impactful for severe strokes. Given the relatively low prevalence of COVID-19 cases in our region, this decrement is likely related to healthcare seeking behavior rather than capacity saturation.
Asunto(s)
Infecciones por Coronavirus/terapia , Servicios Médicos de Urgencia/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Evaluación de Necesidades/tendencias , Neurología/tendencias , Neumonía Viral/terapia , Accidente Cerebrovascular/terapia , Betacoronavirus/patogenicidad , COVID-19 , Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Bases de Datos Factuales , Interacciones Microbiota-Huesped , Humanos , Pandemias , Pennsylvania/epidemiología , Neumonía Viral/diagnóstico , Neumonía Viral/epidemiología , Neumonía Viral/virología , Estudios Retrospectivos , SARS-CoV-2 , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/epidemiología , Factores de TiempoRESUMEN
BACKGROUND: There are increasing numbers of people living with dementia (PLWD) and most reside in community settings. Characterizing the number of individuals affected with dementia and their transitions are important to understand in order to plan for their healthcare needs. Using administrative health data in Ontario, Canada, we examined recent trends in the prevalence and incidence of dementia among the community-dwelling population, described their characteristics, and investigated admissions to long-term care (LTC) and overall survival. METHODS: Using a validated case ascertainment algorithm, we performed a population-based retrospective cohort study of community-dwelling PLWD aged 40-105 years old between 2010 and 2015. We assessed crude and age- and sex-adjusted prevalence and incidence, cohort characteristics, and time to LTC admission and survival. RESULTS: Between 2010 and 2015, the adjusted community prevalence increased by 9.5% (p < 0.001), while the incidence decreased by 15.8% (p < 0.001). Demographic and socioeconomic characteristics remained similar over time, while the prevalence of comorbidities increased significantly from 2010 to 2015. There was no difference in the time to LTC admission for individuals diagnosed in 2014 when compared to 2010 (p = 0.06). A lower risk of 2-year mortality was observed for individuals diagnosed in 2015 compared to 2010 (HR 0.93, 95% CI 0.90-0.97, p < 0.001). CONCLUSION: There was an increase in the prevalence of dementia despite decreasing incidence among community-dwelling PLWD. Lower rates of mortality indicate that PLWD are surviving longer following diagnosis. Adequate resources and planning are required to support this growing population, considering the changing population size and characteristics.
Asunto(s)
Demencia , Vida Independiente , Cuidados a Largo Plazo , Anciano , Estudios de Cohortes , Demencia/epidemiología , Demencia/terapia , Femenino , Hospitalización/estadística & datos numéricos , Humanos , Incidencia , Vida Independiente/psicología , Vida Independiente/estadística & datos numéricos , Cuidados a Largo Plazo/métodos , Cuidados a Largo Plazo/estadística & datos numéricos , Masculino , Evaluación de Necesidades/organización & administración , Evaluación de Necesidades/tendencias , Ontario/epidemiología , Prevalencia , Sistemas de Apoyo Psicosocial , Estudios Retrospectivos , Análisis de SupervivenciaRESUMEN
AIMS: The coronavirus SARS-CoV-2 outbreak led to the most recent pandemic of the twenty-first century. To contain spread of the virus, many nations introduced a public lockdown. How the pandemic itself and measures of social restriction affect hospital admissions due to acute cardiac events has rarely been evaluated yet. METHODS AND RESULTS: German public authorities announced measures of social restriction between March 21st and April 20th, 2020. During this period, all patients suffering from an acute cardiac event admitted to our hospital (N = 94) were assessed and incidence rate ratios (IRR) of admissions for acute cardiac events estimated, and compared with those during the same period in the previous three years (2017-2019, N = 361). Admissions due to cardiac events were reduced by 22% as compared to the previous years (n = 94 vs. an average of n = 120 per year for 2017-2019). Whereas IRR for STEMI 1.20 (95% CI 0.67-2.14) and out-of-hospital cardiac arrest IRR 0.82 (95% CI 0.33-2.02) remained similar, overall admissions with an IRR of 0.78 (95% CI 0.62-0.98) and IRR for NSTEMI with 0.46 (95% CI 0.27-0.78) were significantly lower. In STEMI patients, plasma concentrations of high-sensitivity troponin T at admission were significantly higher (644 ng/l, IQR 372-2388) compared to 2017-2019 (195 ng/l, IQR 84-1134; p = 0.02). CONCLUSION: The SARS-CoV-2 pandemic and concomitant social restrictions are associated with reduced cardiac events admissions to our tertiary care center. From a public health perspective, strategies have to be developed to assure patients are seeking and getting medical care and treatment in time during SARS-CoV-2 pandemic.