Measurement of stigma and associated characteristics in people with tuberculosis in Medellín, Colombia: a cross-sectional study.

BACKGROUND: Stigma towards tuberculosis (TB) delays diagnosis and compromises adherence to treatment. We measured the degree of stigma and identified the sociodemographic and clinical characteristics that were associated with a higher degree of stigma in patients with pulmonary and extrapulmonary TB in Colombia. METHODS: We conducted a cross-sectional study with 232 participants included in the TB control program in 2017. Sociodemographic and clinical variables were measured. The stigma component was measured through a validated scale and a multiple linear regression was used. RESULTS: The study analysed 232 patients, of which 52.2% were men, 53.5% were between 27 and 59 y of age and 66.8% had a basic-medium education level. Two characteristics were significantly related to a higher stigma score: the basic-medium education level and homeless status. Homeless status increased the stigma score by 0.27. In contrast, the adjusted stigma score decreased by 0.07 if the patient's health status was perceived as 'healthy'. CONCLUSION: Stigma is maximized in homeless patients and patients with a low education level. It is minimized in patients who perceive their state of health as 'healthy'.

Perception and Knowledge of Mercury by Occupationally Exposed Health Care Personnel.

Thermometers and baumanometers frequently contain mercury, a toxic heavy metal. Inadequate management of this substance can constitute an occupational hazard by exposing health care professionals to health risks including memory loss, psychosomatic symptoms, fatigue, and other signs of cognitive dysfunction as reported in several studies. PURPOSE: To assess Mexico's health care professionals' health and mercury-related knowledge and risk perception and to explore the measurement properties of a questionnaire assessing that level of knowledge. MATERIALS AND METHODS: Mixed methodology. A quantitative, cross-sectional study was conducted to measure health care professionals' knowledge of mercury and to validate an instrument using a Rasch analysis in 160 professionals. A qualitative study involving in-depth interviews was conducted to identify participants' risk perception for mercury exposure. RESULTS: The total knowledge of mercury was 19.0 ± 2.0 on a scale of 0 to 28 points. The scores for medical specialists were significantly (P < .001) higher, ranging between 20.0 ± 2.05 and 23.0 ± 1.63. In general, the level of risk perception for mercury exposure was low. The questionnaire presented a reasonable fit to the Rasch model (good item fit with a Bonferroni-adjusted P = .000714). The response categories of three items were collapsed, and two pairs of items were bundled into two super items. CONCLUSION: The levels of the knowledge of the health and safety risks and risk perception for mercury exposure in the Mexican health care professionals evaluated were low. Health care professionals should receive comprehensive training in the safe use and health risks of mercury.

Components of the transitional care model (TCM) to reduce readmission in geriatric patients: a systematic review.

BACKGROUND: Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components' role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). METHODS: Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. RESULTS: Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). CONCLUSIONS: Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.