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1.
Epidemiol Psychiatr Sci ; 29: e92, 2020 Jan 13.
Artículo en Inglés | MEDLINE | ID: mdl-31928567

RESUMEN

AIMS: Research from high-income countries has implicated travel distance to mental health services as an important factor influencing treatment-seeking for mental disorders. This study aimed to test the extent to which travel distance to the nearest depression treatment provider is associated with treatment-seeking for depression in rural India. METHODS: We used data from a population-based survey of adults with probable depression (n = 568), and calculated travel distance from households to the nearest public depression treatment provider with network analysis using Geographic Information Systems (GIS). We tested the association between travel distance to the nearest public depression treatment provider and 12 month self-reported use of services for depression. RESULTS: We found no association between travel distance and the probability of seeking treatment for depression (OR 1.00, 95% CI 0.98-1.02, p = 0.78). Those living in the immediate vicinity of public depression treatment providers were just as unlikely to seek treatment as those living 20 km or more away by road. There was evidence of interaction effects by caste, employment status and perceived need for health care, but these effect sizes were generally small. CONCLUSIONS: Geographic accessibility - as measured by travel distance - is not the primary barrier to seeking treatment for depression in rural India. Reducing travel distance to public mental health services will not of itself reduce the depression treatment gap for depression, at least in this setting, and decisions about the best platform to deliver mental health services should not be made on this basis.


Asunto(s)
Depresión/terapia , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Conducta de Búsqueda de Ayuda , Servicios de Salud Mental/estadística & datos numéricos , Aceptación de la Atención de Salud , Población Rural/estadística & datos numéricos , Viaje/estadística & datos numéricos , Adulto , Estudios Transversales , Depresión/diagnóstico , Depresión/psicología , Femenino , Sistemas de Información Geográfica , Encuestas de Atención de la Salud , Investigación sobre Servicios de Salud , Humanos , India , Masculino , Vigilancia de la Población , Factores de Tiempo
2.
Isr Med Assoc J ; 22(1): 8-12, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31927798

RESUMEN

BACKGROUND: Heart failure centers with specialized nurse-supervised management programs have been proposed to improve prognosis. The Heart Failure Center in Beit Shemesh, Israel, is located within a large primary care facility. The specialist team supervised the managememt of patients both within the frame of the center and while they were hospitalized. OBJECTIVES: To evaluate the health services utilization by heart failure patients treated at a heart failure center and their clinical outcome. METHODS: In this retrospective study, we compared the clinical outcome of patients treated at a heart failure center to patients who received the standard care in 2013-2014. The clinical outcome included primary care visits, emergency room visits, hospitalizations, and death. RESULTS: The study comprised 430 heart failure patients; 82 were treated at the heart failure center and 348 under standard care. At baseline, no significant differences were seen in clinical parameters between the groups. Healthcare utilization was higher among the study group. No significant changes in healthcare utilization were found. During follow-up, patients treated in a heart failure center were more likely to get recommended heart failure medications. Mortality was significantly lower in patients treated in the heart failure center compared with those receiving standard care 3.6% vs. 24%, respectively (P = 0.001), hazard ratio 0.19, 95% confidence interval 0.06-0.62, P = 0.005. CONCLUSIONS: Joint management of heart failure by primary clinics and a specialized community heart failure center reduced mortality. There was no decrease in healthcare utilizations among heart failure center patients, despite the reduction in mortality.


Asunto(s)
Centros Comunitarios de Salud/estadística & datos numéricos , Insuficiencia Cardíaca/terapia , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Insuficiencia Cardíaca/mortalidad , Hospitalización/estadística & datos numéricos , Humanos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Primaria de Salud/estadística & datos numéricos , Estudios Retrospectivos
3.
Psychiatr Prax ; 47(1): 22-28, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31910457

RESUMEN

INTRODUCTION: Over the last decade, methamphetamine use has spread rapidly in Europe, leading to a significant medical shortfall in many regions. To date, there are no standardized German-language therapy programs for qualified detoxification and motivation treatment. We have developed a therapy manual ("CrystalClean") over 15 therapy modules, which was evaluated in the present pilot study with regard to feasibility and acceptability. METHODS: Observational study with systematic interviews over 3 months on 31 patients with methamphetamine dependence. RESULTS: Acceptability of most modules was rated as high by both patients and therapists. In addition, the manual was considered to be well feasible in inpatient daily routine. However, contact terminations frequently occurred when switching to outpatient treatment. CONCLUSION: Results from our study point to a high acceptance of the manual for the accompaniment of qualified detoxification and motivation treatment in patients with methamphetamine dependence. Feasibility in the clinical setting can be improved by reducing the number of modules to the 12 best evaluated and by increasing the frequency of therapies.


Asunto(s)
Lenguaje , Metanfetamina , Trastornos Relacionados con Opioides/rehabilitación , Trastornos Relacionados con Sustancias/rehabilitación , Europa (Continente) , Estudios de Factibilidad , Alemania , Humanos , Motivación , Aceptación de la Atención de Salud , Proyectos Piloto , Traducción
4.
Lancet ; 395(10220): 273-284, 2020 01 25.
Artículo en Inglés | MEDLINE | ID: mdl-31928765

RESUMEN

BACKGROUND: Hong Kong has been embroiled in increasingly violent social unrest since June, 2019. We examined the associated population mental health burden, risk factors, and health-care needs. METHODS: In a population-based prospective cohort, adult participants aged 18 years or older were assessed at nine timepoints from 2009. Probable depression was measured using the Patient Health Questionnaire-9 (score ≥10) and suspected post-traumatic stress disorder (PTSD) by the PTSD Checklist-Civilian Version (score ≥14), plus direct exposure to traumatic events related to the ongoing social unrest. We used multivariable logistic regression to identify factors associated with both outcomes, adjusting for doctor-diagnosed depression or anxiety disorders before the unrest. On the basis of routine service statistics and respondents' intention to seek professional care, we projected the number of additional ambulatory specialist psychiatric visits required. FINDINGS: After the two baseline surveys, we followed up random subsets of 1213-1736 adults at each timepoint. Probable depression was reported by 11·2% (95% CI 9·8-12·7) of participants in 2019, compared with 1·9% (1·6-2·1) during 2009-14 and 6·5% (5·3-7·6) in 2017 after the Occupy Central Movement and before the current unrest. Prevalence of suspected PTSD in 2019 was estimated to be 12·8% (11·2-14·4). Age, sex, educational attainment, or household income were not associated with either outcome, whereas heavy social media use (≥2 h per day) was associated with both. Political attitude or protest participation was not associated with probable depression, but neutrality towards the extradition bill approximately halved the risk of suspected PTSD. Family support mitigated against probable depression. We estimated that the mental health burden identified would translate into roughly an excess 12% service requirement to the public sector queue or equivalent. INTERPRETATION: We have identified a major mental health burden during the social unrest in Hong Kong, which will require substantial increases in service surge capacity. Health-care and social care professionals should be vigilant in recognising possible mental health sequelae. In a world of increasing unrest, our findings might have implications for service planning to better protect population mental health globally. FUNDING: Research Grants Council, University Grants Committee of Hong Kong, Hong Kong Jockey Club Charities Trust.


Asunto(s)
Depresión/epidemiología , Exposición a la Violencia/psicología , Trastornos por Estrés Postraumático/epidemiología , Adolescente , Adulto , Desórdenes Civiles/psicología , Femenino , Hong Kong , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Estudios Prospectivos , Índice de Severidad de la Enfermedad , Medios de Comunicación Sociales/estadística & datos numéricos , Encuestas y Cuestionarios , Adulto Joven
5.
Br J Nurs ; 29(2): S27-S34, 2020 Jan 23.
Artículo en Inglés | MEDLINE | ID: mdl-31972102

RESUMEN

BACKGROUND: Difficult venous access (DVA) is common in liver patients requiring blood collection using traditional peripheral approaches. This study aimed to understand the experience of DVA for liver patients and the acceptability of peripheral venepuncture versus external jugular venepuncture (EJV). A secondary aim was to explore the impact of EJV on local resource utilization. METHODS: Semistructured interviews with liver outpatients with DVA (n = 10) requiring venepuncture were firstly themed inductively. We then deductively applied the acceptability framework of Sekhon et al. as a further analytic lens. Audit data from DVA encounters (n = 24) allowed analysis of issues from multiple perspectives. The Consolidated Criteria for Reporting Qualitative Research reporting checklist guides this report. RESULTS: Peripheral venepuncture had poor prospective, concurrent, and retrospective acceptability, requiring significant mental and physical preparation. Fear, stigma, pain and distress, poor continuity of care, and poor effectiveness led to service disengagement. While EJV caused initial trepidation, it had high concurrent and retrospective acceptability. The significant improvement in patient experience was corroborated by audit data for both procedure duration (5 versus 15 minutes) and first attempt success (100 versus 28.5%) for EJV versus peripheral venepuncture, respectively. While EJV required a recumbent position, it required less staff. CONCLUSIONS: EJV is highly acceptable to patients, using less time and staff resources. EJV protocols and staff training should be considered where DVA presentations are common. Individualized care plans and careful care coordination could divert DVA patients needing venepuncture to services that use EJV preferentially. HIGHLIGHTS Peripheral venepuncture results in fear, stigma, pain, & distress for those with DVA. This poor acceptability of traditional venepuncture leads to service disengagement. External jugular venepuncture is highly acceptable & improves resource utilization.


Asunto(s)
Venas Yugulares , Hepatopatías/epidemiología , Aceptación de la Atención de Salud , Flebotomía/métodos , Adulto , Anciano , Femenino , Humanos , Masculino , Persona de Mediana Edad
7.
Medicine (Baltimore) ; 99(2): e18625, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31914043

RESUMEN

BACKGROUND: Inequality in health and health care remains a rather challenging issue in China, existing both in rural and urban area, and between rural and urban. This study used nationally representative data to assess inequality in both rural and urban China separately and to identify socioeconomic factors that may contribute to this inequality. METHODS: This study used 2008 National Health Services Survey data. Demographic characteristics, income, health status, medical service utilization, and medical expenses were collected. Horizontal inequality analysis was performed using nonlinear regression method. RESULTS: Positive inequity in outpatient services and inpatient service was evident in both rural and urban area of China. Greater inequity of outpatient service use in urban than that in rural areas was evident (horizontal inequity index [HI] = 0.085 vs 0.029). In contrast, rural areas had greater inequity of inpatient service use compared to urban areas (HI = 0.21 vs 0.16). The decomposition analysis found that the household income made the greatest pro-rich contribution in both rural and urban China. However, chronic diseases and aging were also important contributors to the inequality in rural area. CONCLUSION: The inequality in health service in both rural and urban China was mainly attributed to the household income. In addition, chronic disease and aging were associated with inequality in rural population. Those findings provide evidences for policymaker to develop a sustainable social welfare system in China.


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Disparidades en Atención de Salud/economía , Aceptación de la Atención de Salud/estadística & datos numéricos , Población Rural/estadística & datos numéricos , Población Urbana/estadística & datos numéricos , Adolescente , Adulto , Factores de Edad , Anciano , China , Femenino , Gastos en Salud/estadística & datos numéricos , Estado de Salud , Humanos , Renta/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Factores Socioeconómicos , Adulto Joven
8.
Artículo en Inglés | MEDLINE | ID: mdl-31802154

RESUMEN

Vaccination saves millions of lives, and the World Health Organization (WHO) European Region celebrated record high coverage in 2018. Still, national or sub-national coverage is insufficient to stop the spread of vaccine-preventable diseases. Health authorities are increasingly aware of the need to prioritize the "demand" side of vaccination. Achieving high and equitable vaccination uptake in all population groups is not a quick-fix; it requires long-term investment in multifaceted interventions, informed by research with the target groups. The WHO focuses on both individual and context determinants of vaccination behaviours. Individual determinants include risk perceptions, (dis)trust and perceived constraints; insights from psychology help us understand these. Context determinants include social norms, socioeconomic status and education level, and the way health systems are designed, operate and are financed. The WHO recommends using a proven theoretical model to understand vaccination behaviours and has adapted the "COM­B model" for their Tailoring Immunization Programmes (TIP) approach. This adapted model is described in the article. Informed by insights into the factors affecting vaccination behaviours, interventions and policies can be planned to increase vaccination uptake. Some evidence exists on proven methods to do this. At the individual level, some interventions have been seen to increase vaccination uptake, and experimental studies have assessed how certain messages or actions affect vaccination perceptions. At the context level, there is more documentation for effective strategies, including those that focus on making vaccination the easy, convenient and default behaviour and that focus on the interaction between caregivers and health workers.


Asunto(s)
Vacunas , Cuidadores , Alemania , Personal de Salud , Humanos , Aceptación de la Atención de Salud , Vacunación
9.
Urologe A ; 59(1): 87-98, 2020 Jan.
Artículo en Alemán | MEDLINE | ID: mdl-31728563

RESUMEN

The juridification of medicine affects all disciplines, including urology. Therefore, in this discipline it can well happen that patients not only feel wrongly treated or complain that a treatment was not performed lege artis but also demand compensation or even bring criminal charges. From the patient point of view, the doctor is often more likely to blame for a complication that has arisen or for a hoped for but failed treatment success, than that it is accepted that a complication is typical for the intervention, which, despite the greatest medical care, unfortunately can become reality and is a fateful course. Insurance against claims for damages can be taken out. Not to be underestimated, however, is the personal burden of the accusations with which doctors are confronted by patients, relatives, expert witnesses and courts and against which one must defend oneself. This can mean additional work in addition to the normal medical workload. Therefore, the legal pitfalls in urology should be known.


Asunto(s)
Mala Praxis/legislación & jurisprudencia , Urología/legislación & jurisprudencia , Compensación y Reparación/legislación & jurisprudencia , Testimonio de Experto/legislación & jurisprudencia , Humanos , Seguro de Responsabilidad Civil/economía , Seguro de Responsabilidad Civil/legislación & jurisprudencia , Responsabilidad Legal/economía , Mala Praxis/economía , Aceptación de la Atención de Salud , Relaciones Médico-Paciente , Relaciones Profesional-Familia , Urología/economía
10.
Ann R Coll Surg Engl ; 102(1): 18-24, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31233336

RESUMEN

INTRODUCTION: Patient flow is the process by which movement of patients and clinical productivity is achieved. The objectives of this study were to implement and evaluate the NHS Improvement SAFER patient flow bundle, evaluate the impact of the Red2Green initiative, and assess the impact of frailty on patient flow. MATERIALS AND METHODS: All patients admitted to a neurosurgery unit from 1 September to 30 November 2017 were included. Using guidance set out by NHS, data were prospectively collected from daily ward lists and patient notes, including demographics, admission and discharge details, length of stay, anticipated discharge date, red days with reasons and frailty (Rockwood Clinical Frailty Scale). NHS reference costs were used for cost analyses. RESULTS: A total of 420 patients (55% elective) were included, totalling 3909 bed days. All patients received daily senior reviews before midday, and anticipated discharge dates were set at daily multidisciplinary team meetings. Ten per cent of patients were discharged before midday. There were 21% (837) red days, significantly more (76%) for emergency patients (639 vs 198 elective; P < 0.001); 63% red days were attributed to awaiting a bed in a local hospital; 25% (106) patients were classed as frail (50 elective), which was associated with a significantly longer length of stay (17.3 vs 6; P < 0.01), and more red days (615 vs 222; p<0.01). Considering excess bed charges and lost revenue (with penalties), red days cost over £1 million per year. CONCLUSIONS: SAFER has identified areas for improvement in patient flow, with obvious cost implications. It has created a platform for discussion within the referral network and identified a role for a geriatric liaison service.


Asunto(s)
Departamentos de Hospitales/estadística & datos numéricos , Procedimientos Neuroquirúrgicos/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Anciano , Ocupación de Camas/estadística & datos numéricos , Procedimientos Quirúrgicos Electivos/estadística & datos numéricos , Utilización de Instalaciones y Servicios , Femenino , Fragilidad/terapia , Humanos , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Grupo de Atención al Paciente/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Seguridad del Paciente , Estudios Prospectivos , Estudios Retrospectivos , Triaje/métodos , Triaje/estadística & datos numéricos
11.
J Oral Rehabil ; 47(1): 87-100, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31398261

RESUMEN

Distress, suffering and care-seeking behaviour are characteristics of pain-related disease and illness. Pain that transitions from an acute to a chronic phase carries with it the potential of further effects: these include a worsening of the disease or illness; high-impact chronic pain; and substantial personal, societal and economic burden. The biopsychosocial model directly addresses these multiple processes, yet clinical frameworks supporting this model are not universally implemented. This paper explores barriers to clinical implementation of a full biopsychosocial framework for temporomandibular disorders (TMD) and other oro-facial pain (OFP) conditions. In June 2016, INfORM invited OFP researchers to a workshop designed to optimise the DC/TMD Axis-II. Workshop groups identified five sources of implementation barriers: (1) cultures and societies, (2) levels-of-care settings, (3) health services, (4) cross-cultural validity of self-report instruments and (5) provider and patient health literacy. Three core problems emerged: (A) mental health aspects are seldom fully considered, thus impairing the recognition of illness, (B) training in use of validated multi-axial assessment protocols is under-rated and insufficiently used, and (C) clinical assessment often fails to recognise that sensory and emotional dimensions are fundamental aspects of pain. To improve patient care, these barriers and problems require action. Most importantly, TMD/OFP educators and researchers need to coordinate globally and (i) be educated in the biopsychosocial model, (ii) implement evidence-based biopsychosocial guidelines for assessment and management of OFP conditions at their institutions, (iii) incorporate this model in undergraduate and postgraduate dental curricula and (iv) be responsive to stakeholders, including regulatory authorities and practitioners.


Asunto(s)
Dolor Crónico , Trastornos de la Articulación Temporomandibular , Dolor Facial , Humanos , Aceptación de la Atención de Salud , Autoinforme
13.
Presse Med ; 48(12): e369-e381, 2019 Dec.
Artículo en Francés | MEDLINE | ID: mdl-31785940

RESUMEN

BACKGROUND: In 2015, the vaccine against human Papillomavirus (hPV) was recommended in France for children from 11 to 14 years-old. This study assessed the knowledge of parents from Normandy about this vaccine and measured the impact of an information campaign on their intent to have their children vaccinated. METHODS: Parents from Normandy with children in sixth-grade class, aged 10 to 11, during the 2015-2016 school year were included. The secondary schools were selected in collaboration with academic institutions. The intent to have their child vaccinated was measured with a questionnaire distributed to children in April 2016 and collected from May to June 2016 by school nurses. RESULTS: Among the 16 selected secondary schools, 1428 questionnaires were distributed and 864 (60.5 %) were collected regardless of the gender of the child. Among the 439 girls, 85.9 % were not vaccinated against hPV. The intent to vaccinate was higher when the parent who responded was the mother (P<0.001). Among the parents who took note of the information booklet, 73.7 % found this information useful. There was a significant association between the knowledge about the vaccine against hPV and the intent to vaccinate (P<0.001). The percentage of vaccinated girls was significantly higher when their parents were informed (10.9 % versus 3.2 %). We noticed a significant rise of the intent to vaccinate children when information booklets were distributed (P<0.001). CONCLUSION: The vaccination rate after specific information about vaccination against hPV was significantly higher. The information campaign has thus a significant positive impact.


Asunto(s)
Intención , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/uso terapéutico , Padres , Vacunación/estadística & datos numéricos , Adolescente , Adulto , Niño , Femenino , Francia/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Historia del Siglo XXI , Humanos , Masculino , Persona de Mediana Edad , Relaciones Padres-Hijo , Padres/educación , Padres/psicología , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Servicios de Salud Escolar/historia , Instituciones Académicas/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Vacunación/psicología
14.
Adv Gerontol ; 32(4): 565-571, 2019.
Artículo en Ruso | MEDLINE | ID: mdl-31800185

RESUMEN

The paper presents the results of the study of the long-term post-infarction period in elderly patients with 5 years survival after myocardial infarction. The factors and features of the ambulatory rehabilitation stage that have a significant impact on the long-term post-infarction period have been established. It is shown that a regular follow up at the ambulatory rehabilitation stage along with such risk factors as the volume of coronary lesions, burdened history, complicated during the acute period of myocardial infarction have a significant impact on the post-infarction period. It was found that more than half of patients with recurrent cardiovascular events, irregularly visit or do not visit the clinic after a coronary accident. At the same time, doctor visits at the outpatient stage at less once a year increase the chances of an unfavorable course of the post-infarction period in 5,5 times (p<0,001).


Asunto(s)
Infarto del Miocardio , Anciano , Estudios de Seguimiento , Humanos , Infarto del Miocardio/diagnóstico , Infarto del Miocardio/rehabilitación , Aceptación de la Atención de Salud/estadística & datos numéricos , Pronóstico , Factores de Riesgo
15.
N Z Med J ; 132(1488): 38-48, 2019 01 18.
Artículo en Inglés | MEDLINE | ID: mdl-31851660

RESUMEN

AIM: In New Zealand, there are sexually active adolescents who are using poor or no methods of contraception, and who do not intend to become pregnant. The most effective methods of contraception suitable to this population are long acting reversible contraceptive (LARC) methods. A proactive LARC provision (PLP) programme has been proposed, and this study investigates whether such a model would be acceptable to adolescents. This study aims to determine how adolescents feel about a PLP programme. METHODS: We conducted four focus groups (FGs) of female adolescents at three high schools and one university residential college, with 32 participants in total. The data from these were analysed for themes using a general inductive thematic analysis approach. RESULTS: When asked how they felt about a PLP programme, the adolescents found the concept acceptable. This study identified misconceptions and myths around contraception in the adolescent population. The five identified themes were reproductive health fear, sex and body shame, adolescents' requirements for sexual health provision, barriers to contraception and sexual health knowledge. CONCLUSIONS: Adolescents consider a PLP programme to be acceptable. More research is needed about the acceptability of an adolescent PLP programme in other groups, and the feasibility of such a programme.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Anticoncepción Reversible de Larga Duración/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adolescente , Femenino , Grupos Focales , Humanos , Nueva Zelanda , Estudiantes/psicología , Estudiantes/estadística & datos numéricos
16.
BMC Infect Dis ; 19(1): 1076, 2019 Dec 21.
Artículo en Inglés | MEDLINE | ID: mdl-31864297

RESUMEN

BACKGROUND: HIV voluntary counseling and testing (VCT) is a crucial gateway to all strategies related to care, prevention and treatment of human immunodeficiency virus (HIV) infection. Nevertheless, utilization of voluntary counselling and testing (VCT) service among adults is very low in Ethiopia. The objective of this study is to identify determinants associated with VCT utilization among adult women aged 15-49 in Ethiopia. METHODS: A cross-sectional study was conducted based on data taken from the Ethiopian Demographic Health Survey (EDHS) 2016. Using cluster sampling, 14,369 women aged 15-49 years were selected from all the nine administrative regions and two city administrations. Logistic regression was used to analyze factors associated with HIV VCT utilization. RESULTS: Overall prevalence of ever tested for HIV was 53% (95% CI, 52, 54). Aged 20-44, ever married, being at higher socio economic position (SEP) and having risky sexual behavior were factors which are positively associated with VCT utilization. Being Muslims in urban and protestants in rural were factors significantly and negatively associated with VCT utilization. Those who had stigmatizing attitude both in urban and rural and who had comprehensive knowledge in rural were less likely to utilize VCT service. CONCLUSION: VCT utilization among women in Ethiopia is demonstrating better improvement in recent years. However, stigmatizing attitude continued to be among the major factors, which are negatively affecting VCT uptake among women in Ethiopia. Concerted efforts should be made by all stakeholders to mitigate stigma, improve socio economic inequities and increase awareness on the benefit of VCT in controlling HIV in the society. In this aspect, the role of religious leader, schools, health extension workers and community leaders should not be undermined.


Asunto(s)
Consejo/estadística & datos numéricos , Infecciones por VIH/diagnóstico , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Adolescente , Adulto , Estudios Transversales , Etiopía/epidemiología , Femenino , Infecciones por VIH/epidemiología , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Encuestas Epidemiológicas , Humanos , Tamizaje Masivo/psicología , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Estigma Social , Factores Socioeconómicos , Adulto Joven
18.
BMJ ; 367: l6326, 2019 Nov 27.
Artículo en Inglés | MEDLINE | ID: mdl-31776110

RESUMEN

OBJECTIVE: To determine how the UK National Health Service (NHS) is performing relative to health systems of other high income countries, given that it is facing sustained financial pressure, increasing levels of demand, and cuts to social care. DESIGN: Observational study using secondary data from key international organisations such as Eurostat and the Organization for Economic Cooperation and Development. SETTING: Healthcare systems of the UK and nine high income comparator countries: Australia, Canada, Denmark, France, Germany, the Netherlands, Sweden, Switzerland, and the US. MAIN OUTCOME MEASURES: 79 indicators across seven domains: population and healthcare coverage, healthcare and social spending, structural capacity, utilisation, access to care, quality of care, and population health. RESULTS: The UK spent the least per capita on healthcare in 2017 compared with all other countries studied (UK $3825 (£2972; €3392); mean $5700), and spending was growing at slightly lower levels (0.02% of gross domestic product in the previous four years, compared with a mean of 0.07%). The UK had the lowest rates of unmet need and among the lowest numbers of doctors and nurses per capita, despite having average levels of utilisation (number of hospital admissions). The UK had slightly below average life expectancy (81.3 years compared with a mean of 81.7) and cancer survival, including breast, cervical, colon, and rectal cancer. Although several health service outcomes were poor, such as postoperative sepsis after abdominal surgery (UK 2454 per 100 000 discharges; mean 2058 per 100 000 discharges), 30 day mortality for acute myocardial infarction (UK 7.1%; mean 5.5%), and ischaemic stroke (UK 9.6%; mean 6.6%), the UK achieved lower than average rates of postoperative deep venous thrombosis after joint surgery and fewer healthcare associated infections. CONCLUSIONS: The NHS showed pockets of good performance, including in health service outcomes, but spending, patient safety, and population health were all below average to average at best. Taken together, these results suggest that if the NHS wants to achieve comparable health outcomes at a time of growing demographic pressure, it may need to spend more to increase the supply of labour and long term care and reduce the declining trend in social spending to match levels of comparator countries.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Países Desarrollados/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Salud Poblacional/estadística & datos numéricos , Medicina Estatal/estadística & datos numéricos , Producto Interno Bruto , Gastos en Salud/estadística & datos numéricos , Humanos , Renta , Reino Unido
19.
Presse Med ; 48(12): e361-e368, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31767250

RESUMEN

BACKGROUND: Few studies of mental health or substance abuse have focused on rural life. This study aimed to evaluate the association between socio-demographic and clinical characteristics and the probability of rural alcoholic women seeking help on their own at a specialty treatment service. METHODS: This exploratory study used a cross-sectional design to collect data from alcoholic women upon admission to a French outpatient department. Multiple logistic regression models tested whether the socio-demographic and clinical characteristics of these women predicted the likelihood that they would seek treatment at a specialty service on their own. RESULTS: Among 50 rural alcoholic women, the probability of seeking help on their own at a specialty treatment service was 5.6 times greater (95% CI 1.2-25.7, P=0.03) for participants with a history of physical and/or sexual trauma and 5.1 times greater (95% CI 1.1-24, P=0.03) among women with no complementary health insurance. CONCLUSION: Increased knowledge of the specific characteristics of rural alcoholic women is needed to develop programs that will increase awareness of and access to specialty treatment services among these women.


Asunto(s)
Alcoholismo/epidemiología , Aceptación de la Atención de Salud , Población Rural/estadística & datos numéricos , Adulto , Alcoholismo/psicología , Alcoholismo/terapia , Estudios Transversales , Femenino , Francia/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Medicina/estadística & datos numéricos , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Participación del Paciente/psicología , Participación del Paciente/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Adulto Joven
20.
Orv Hetil ; 160(48): 1904-1914, 2019 Dec.
Artículo en Húngaro | MEDLINE | ID: mdl-31760778

RESUMEN

Introduction: The attitude to immunization and the issue of vaccine hesitancy in health care workers (HCWs) have been studied in a former survey performed by ECDC (European Centre for Disease Prevention and Control). Aim: Our aim was to study the immunization attitude of primary care paediatricians, general practitioners and primary care nurses in Hungary. Method: We studied vaccine hesitancy in HCWs by way of a questionnaire, developed on the basis of a recent similar survey by ECDC in four countries. The online survey has been performed between May and July 2017. Altogether 765 questionnaires have been returned: 189 primary care paediatricians, 375 general practitioners working in adult or mixed practices, and 201 primary care nurses. The sample has been weighted to the country-specific features - e.g., location of the practice, residence and age of the HCWs - within each of the three groups, so from this aspect it can be considered representative. Results: Our results did not differ substantially from the international ECDC data. Approximately 2/3 of the primary care doctors and about 50% of the primary care nurses were convinced of the benefit and value of vaccines. Data on vaccine hesitancy were consolingly low, though the data on recommended vaccines were somewhat higher compared to the age related/NIP (National Immunization Plan) vaccines. The well-known vaccine scares - e.g., autism-MMR, etc., known also from the literature - could hardly been detected, and it can be explained by the voluntary participation in the study. The least supported vaccine is BCG, while the highest hesitancy rates are related to MMR in Hungary. Conclusion: The need to improve immunization-related communication among primary HCWs could clearly been detected - both in gradual and in post-gradual training programs. Orv Hetil. 2019; 160(48): 1904-1914.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Aceptación de la Atención de Salud , Vacunación/psicología , Vacunas , Adulto , Humanos , Hungría , Atención Primaria de Salud , Seguridad , Confianza
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