RESUMEN
BACKGROUND: Adopting high-value, cost-conscious care (HVCCC) principles into medical education is growing in importance due to soaring global healthcare costs and the recognition that efficient care can enhance patient outcomes and control costs. Understanding the current opportunities and challenges doctors face concerning HVCCC in healthcare systems is crucial to tailor education to doctors' needs. Hence, this study aimed to explore medical students, junior doctors, and senior doctors' experiences with HVCCC, and to seek senior doctors' viewpoints on how education can foster HVCCC in clinical environments. METHODS: Using a mixed-methods design, our study involved a cross-sectional survey using the Maastricht HVCCC-Attitude Questionnaire (MHAQ), with a subset of consultants engaging in semi-structured interviews. Descriptive analysis provided insights into both categorical and non-categorical variables, with differences examined across roles (students, interns, junior doctors, senior doctors) via Kruskal-Wallis tests, supplemented by two-group analyses using Mann-Whitney U testing. We correlated experience with MHAQ scores using Spearman's rho, tested MHAQ's internal consistency with Cronbach's alpha, and employed thematic analysis for the qualitative data. RESULTS: We received 416 responses to the survey, and 12 senior doctors participated in the semi-structured interviews. Overall, all groups demonstrated moderately positive attitudes towards HVCCC, with more experienced doctors exhibiting more favourable views, especially about integrating costs into daily practice. In the interviews, participants agreed on the importance of instilling HVCCC values during undergraduate teaching and supplementing it with a formal curriculum in postgraduate training. This, coupled with practical knowledge gained on-the-job, was seen as a beneficial strategy for training doctors. CONCLUSIONS: This sample of medical students and hospital-based doctors display generally positive attitudes towards HVCCC, high-value care provision, and the integration of healthcare costs, suggesting receptiveness to future HVCCC training among students and doctors. Experience is a key factor in HVCCC, so early exposure to these concepts can potentially enhance practice within existing healthcare budgets.
Asunto(s)
Actitud del Personal de Salud , Humanos , Estudios Transversales , Irlanda , Estudiantes de Medicina/psicología , Masculino , Encuestas y Cuestionarios , Femenino , Educación Médica , Adulto , Costos de la Atención en Salud , Médicos/psicología , Control de Costos , Cuerpo Médico de Hospitales/psicología , Cuerpo Médico de Hospitales/educaciónRESUMEN
BACKGROUND: A women's chances of getting pregnant decreases in cases of infertility, which may have several clinical etiologies. The prevalence of infertility is estimated as 10-15% worldwide. One of the causes of infertility is endometriosis, defined as the presence of an endometrial gland and/or stroma outside the uterus, inducing a chronic inflammatory reaction. Thus, infertility and endometriosis are diagnoses that significantly affect women's mental health. This study accessed and compared the levels of depression, anxiety, and quality of life in infertile women with and without endometriosis. METHODS: was an observational and cross-sectional study which included 201 infertile women, 81 of whom were also diagnosed with endometriosis. The STROBE Guidelines was used. The data were collected using validated scales: Hamilton D Questionnaire, Beck Depression Inventory, and Fertility Quality of Life Questionnaire; The data were collected at the Ideia Fertil Institute (Santo Andre, Brazil), between February 28 and June 8, 2019. RESULTS: the infertile women with endometriosis reported higher presence of depressive symptoms and a lower quality of life compared to women with infertility only. Similar presence of anxiety symptoms was observed regardless of being diagnosed with endometriosis. Women with infertility and endometriosis presented lower levels in quality-of-life domains when compared to women with infertility only - Mind and Body (58.33 × 79.17, p < 0.001), Relational (75 × 81.25, p = 0.009), Social (66.67 × 77.08, p = 0.001), Emotional (50.62 × 67.43, p < 0.001). CONCLUSION: the findings indicate the need for increased psychosocial support care for women suffering from infertility and endometriosis to assist them in maintaining and managing their own mental health and achieving their reproductive goals.
Asunto(s)
Ansiedad , Depresión , Endometriosis , Infertilidad Femenina , Calidad de Vida , Humanos , Femenino , Calidad de Vida/psicología , Endometriosis/psicología , Endometriosis/complicaciones , Infertilidad Femenina/psicología , Infertilidad Femenina/etiología , Adulto , Estudios Transversales , Depresión/psicología , Depresión/epidemiología , Ansiedad/psicología , Ansiedad/epidemiología , Encuestas y Cuestionarios , Brasil/epidemiologíaRESUMEN
ABSTRACT Objective: To determine the prevalence and types of violence suffered by women and to identify the gender attitudes related to the situation. Methods: This was a descritive, cross-sectional study incluiding 343 women who were assisted at the Brazilian Public Health System in countryside city in northeastern of Brazil. All participants were volunteers and they invited to participate during consultation at a Basic Health Unit. As participants, they filled out the World Health Organization Violence Against Women Questionnaire and responded to a sociodemographic questionnaire. Results: The victims were, on average, 20.3 years old, and 53.2% of them were married. There was a prevalence of 52.9% of psychological violence, 30.5% of physical violence, and 12.3% of sexual violence. Participants reported alcoholism (67%) and jealousy (60.8%) as triggers to violence. The main psychological abuses were insults and humiliation. In terms of physical violence, the major ones were pushes and slaps. The sexual violence most reportedwere sexual intercourse against the will of the woman and sexual intercourse because of fear of the partner. A portion of the participants justified violence due to women's infidelity, refusal to have sex, and disobedience to her husband. Conclusion: Education in gender equality as a measure of opposition to the culture of female subjugation can reflect on the resignification of the violence suffered by them, and not on blaming the victim of violence by an intimate partner.
RESUMO Objetivo: Verificar a prevalência dos tipos de violência sofridos por mulheres e identificar as atitudes de gênero em relação a eles. Métodos: Estudo descritivo, observacional com a participação de 343 mulheres atendidas no Sistema Único de Saúde em uma cidade no nordeste brasileiro. Todas as participantes eram voluntárias e estavam presentes em uma Unidade Básica de Saúde para realizar algum atendimento médico. As participantes preencheram o questionário World Health Organization Violence Against Women e responderam a um questionário sociodemográfico. Resultados: As vítimas tinham, em média, 20,3 anos de idade, e 53,2% eram casadas. Houve prevalência de 52,9% de violência psicológica, 30,5% de violência física e 12,3% de violência sexual. As participantes indicaram como disparadores de violência a bebida (67%) e o ciúme (60,8%). Os principais abusos psicológicos foram insultos e humilhação; os físicos foram empurrões e tapas, e os sexuais foram relação sexual contra a vontade da mulher e por medo do parceiro. Uma parcela das participantes justificou a violência sofrida com a infidelidade da própria mulher, a recusa em manter relações sexuais e a desobediência ao marido. Conclusão: A educação em igualdade de gênero como medida de contraposição à cultura de subjugo feminino pode refletir na ressignificação da violência sofrida e na não culpabilização da própria vítima de violência pelo parceiro íntimo.
Asunto(s)
Humanos , Femenino , Adulto , Adulto Joven , Salud Pública , Violencia de Pareja , Brasil/epidemiología , Estudios Transversales , Factores de RiesgoRESUMEN
ABSTRACT Objective: Economic evaluation of a scientific advisory program with the Public Defenders Office to mitigate the impacts of the judicialization on health in the municipality, as well as the implementation of an active follow-up program to monitor health outcomes arising from court demands. Methods: A two-step study, the first documental, retrospective, with data collection of lawsuits in the region of Barbalha (CE), Brazil, from 2013 to 2018, and the second stage, prospective and intervention, through mediation between the citizen and the Public Defenders Office, aiming to reduce the occurrence of the judicialization, and the monitoring of the health outcomes of the processes. The study adopted the Consolidated Health Economic Evaluation Reporting Standards protocol for economic health assessments. The data obtained from the processes were grouped and treated for characterization of the scenario. A comparison of the profile of the lawsuits in the period of 12 months before and after the installation of the program to delimit a complete fiscal cycle was carried out. Results: The advisory service promoted a decrease of 40% (p=0.01) in lawsuits. There was a 31% reduction in court costs (p=0.003), with medicines accounting for 33% of this amount. There was a decrease in inputs outside the Sistema Único de Saúde lists (27%; p=0.003), however there was no statistical difference among several demanding groups, suggesting an equanimous approach. Conclusion: Data from the initial survey were comparable to those reported in Brazil regarding the profile of judicial demands. In view of the scenario, the proposal proved feasible as a means to mitigate the costs of the judicialization through mediation. Finally, the initiative can serve as a model for adoption by municipalities that have characteristics similar to those presented in this study.
RESUMO Objetivo: Avaliação econômica de um programa de aconselhamento científico junto à defensoria pública para minimizar o impacto da judicialização da saúde no município, bem como da implementação de um programa de pesquisa ativa para monitorar os desfechos em saúde provenientes de demandas judiciais. Métodos: Estudo conduzido em duas etapas. A primeira foi documental, retrospectiva, e composta por dados coletados de processos judiciais de 2013 a 2018 da região de Barbalha, no estado do Ceará. A segunda etapa foi prospectiva e de intervenção, conduzida por meio da mediação entre o cidadão e a defensoria pública, com o objetivo de reduzir a ocorrência da judicialização e monitorar os resultados dos processos de saúde. O estudo adotou o protocolo para avaliações econômicas em saúde Roteiro para Relato de Estudos de Avaliação Econômica. Os dados obtidos foram agrupados e tratados para caracterização do cenário. Comparou-se o perfil dos processos no período de 12 meses antes e após a instalação do programa para delimitar ciclo fiscal completo. Resultados: O serviço de consultoria promoveu redução de 40% (p=0,01) nas ações judiciais. Além disso, observou-se redução de 31% nos custos judiciais (p=0,003) com a medicação sendo responsável por 33% desse valor. Observou-se redução no uso de insumos não constantes nas listas do Sistema Único de Saúde (27%; p=0,003), contudo, sem diferença estatística entre os grupos. Conclusão: Os dados desta pesquisa foram comparáveis aos já relatados em pesquisas brasileiras quanto ao perfil de demandas. A proposta mostrou-se viável como meio de mitigar os custos da judicialização por meio da mediação. Essa iniciativa pode servir como modelo para os municípios que possuem características similares às apresentadas em nosso estudo.