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2.
J Subst Abuse Treat ; 120: 108158, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33298298

RESUMEN

Coronavirus disease 2019 (COVID-19) will have a lasting impact on public health. In addition to the direct effects of COVID-19 infection, physical distancing and quarantine interventions have indirect effects on health. While necessary, physical distancing interventions to control the spread of COVID-19 could have multiple impacts on people living with opioid use disorder, including impacts on mental health that lead to greater substance use, the availability of drug supply, the ways that people use drugs, treatment-seeking behaviors, and retention in care. The degree to which COVID-19 will impact the opioid epidemic and through which of the possible mechanisms that we discuss is important to monitor. We employed simulation modeling to demonstrate the potential impact of physical distancing on overdose mortality.


Asunto(s)
/epidemiología , Trastornos Relacionados con Opioides/epidemiología , /prevención & control , Simulación por Computador , Humanos , Salud Mental , Trastornos Relacionados con Opioides/psicología , Trastornos Relacionados con Opioides/rehabilitación , Aceptación de la Atención de Salud , Salud Pública , Cuarentena
3.
Support Care Cancer ; 29(1): 117-125, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-32318871

RESUMEN

PURPOSE: In REVEL, patients with advanced non-small-cell lung cancer (aNSCLC) and patients with increased tumor aggressiveness (rapid disease progression (RDP), platinum-refractory disease (PRD), and high symptom burden (HSB)) benefited from second-line treatment with ramucirumab plus docetaxel over placebo plus docetaxel. This post hoc analysis describes healthcare resource utilization (HCRU) associated with the treatment. METHODS: aNSCLC patients who had progressed during or after first-line platinum-based chemotherapy were randomized to receive docetaxel and either ramucirumab or placebo until disease progression, unacceptable toxicity, withdrawal, or death. HCRU included hospitalizations, transfusions, and concomitant medications. Categorical variables (counts and percentages) were compared using Fisher's exact test. Continuous variables (mean, standard deviation (SD), median, minimum, and maximum) were compared using the Wilcoxon rank sum test. RESULTS: Patient characteristics were largely similar between treatment arms. Within the intent-to-treat (ITT) population (n = 1253), the mean treatment duration was 19.7 and 16.9 weeks in the ramucirumab and control arms, respectively; 51.0% versus 54.9% of patients received subsequent anticancer therapy, respectively. Hospitalization rates were 41.9% versus 42.6% (p = 0.863), mean length of hospital stay was 14.5 days versus 11.3 days (p = 0.066), transfusion rates were 9.9% versus 12.3% (p = 0.206), and use of granulocyte colony-stimulating factors was 41.8% versus 36.6% (p = 0.063), respectively. No significant difference was observed in HCRU between treatment arms in both ITT population and in aggressive disease subgroups including RDP (n = 209), PRD (n = 360), and HSB (n = 497). CONCLUSION: In REVEL, the addition of ramucirumab to docetaxel did not increase HCRU among patients with aggressive aNSCLC disease. These results may help inform economic evaluation of treatment for patients with aNSCLC.


Asunto(s)
Anticuerpos Monoclonales Humanizados/uso terapéutico , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapéutico , Carcinoma de Pulmón de Células no Pequeñas/tratamiento farmacológico , Docetaxel/uso terapéutico , Neoplasias Pulmonares/tratamiento farmacológico , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Protocolos de Quimioterapia Combinada Antineoplásica/efectos adversos , Carcinoma de Pulmón de Células no Pequeñas/patología , Ensayos Clínicos Fase III como Asunto , Progresión de la Enfermedad , Femenino , Factor Estimulante de Colonias de Granulocitos/uso terapéutico , Humanos , Neoplasias Pulmonares/patología , Masculino , Persona de Mediana Edad , Estadificación de Neoplasias , Platino (Metal)/uso terapéutico , Taxoides/uso terapéutico
4.
J Nerv Ment Dis ; 209(1): 49-53, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33003053

RESUMEN

The novel coronavirus pandemic and the resulting expanded use of telemedicine have temporarily transformed community-based care for individuals with serious mental illness (SMI), challenging traditional treatment paradigms. We review the rapid regulatory and practice shifts that facilitated broad use of telemedicine, the literature on the use of telehealth and telemedicine for individuals with SMI supporting the feasibility/acceptability of mobile interventions, and the more limited evidence-based telemedicine practices for this population. We provide anecdotal reflections on the opportunities and challenges for telemedicine drawn from our daily experiences providing services and overseeing systems for this population during the pandemic. We conclude by proposing that a continued, more prominent role for telemedicine in the care of individuals with SMI be sustained in the post-coronavirus landscape, offering future directions for policy, technical assistance, training, and research to bring about this change.


Asunto(s)
Actitud del Personal de Salud , Servicios de Salud Comunitaria , Accesibilidad a los Servicios de Salud , Trastornos Mentales/terapia , Servicios de Salud Mental , Aceptación de la Atención de Salud , Telemedicina , Servicios de Salud Comunitaria/economía , Servicios de Salud Comunitaria/organización & administración , Servicios de Salud Comunitaria/normas , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/normas , Humanos , Servicios de Salud Mental/economía , Servicios de Salud Mental/organización & administración , Servicios de Salud Mental/normas , Telemedicina/economía , Telemedicina/organización & administración , Telemedicina/normas
5.
J Surg Res ; 257: 616-624, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-32949994

RESUMEN

BACKGROUND: Armenia has a high incidence of and mortality from colorectal cancer (CRC). No organized screening programs for CRC exist in Armenia. This study seeks to evaluate knowledge of and attitudes toward CRC and screening programs in Armenia. METHODS: Adults aged 40-64 y were administered a survey using convenience sampling throughout polyclinics in Yerevan city. Survey questions were based on the Health Belief Model and were translated and modified for local relevance. RESULTS: A total of 368 surveys were completed. Eighty-four percent had knowledge of CRC, 91% believed that early detection leads to improved outcomes, but only 22% had knowledge of screening. Women were more likely to have knowledge of CRC (odds ratio 2.19, P < 0.05). Although 19% have personally worried about having CRC, only 7% admitted to discussing their worries with a provider and 76% were willing to undergo screening if recommended by their doctor. Seventy-eight percent of respondents would only undergo screening if free or less than ~$20 USD. CONCLUSIONS: Self-reported knowledge of CRC is high, whereas knowledge of screening remains low in Armenia. There is a willingness to undergo screening if recommended by a health care professional; however, this willingness is cost-sensitive. Interventions aimed at (1) increasing awareness of the disease and screening tests, (2) improving physician counseling, and (3) reducing financial barriers to screening should be considered along with the implementation of a national screening program in Armenia.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Conocimientos, Actitudes y Práctica en Salud , Tamizaje Masivo/psicología , Aceptación de la Atención de Salud , Armenia , Femenino , Humanos , Masculino , Tamizaje Masivo/economía , Persona de Mediana Edad , Encuestas y Cuestionarios
6.
Am Heart J ; 231: 157-159, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33010246

RESUMEN

During the COVID-19 pandemic there has been a reduction in hospital admissions for acute myocardial infarction. This manuscript presents the analysis of Google Trends meta-data and shows a marked spike in search volume for chest pain that is strongly correlated with COVID-19 case numbers in the United States. This raises a concern that fear of contracting COVID-19 may be leading patients to self-triage using internet searches.


Asunto(s)
Dolor en el Pecho , Control de Enfermedades Transmisibles/estadística & datos numéricos , Autoevaluación Diagnóstica , Infarto del Miocardio/epidemiología , /epidemiología , Dolor en el Pecho/diagnóstico , Dolor en el Pecho/epidemiología , Dolor en el Pecho/psicología , Correlación de Datos , Miedo , Humanos , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Aislamiento Social , Estados Unidos/epidemiología
7.
J Ambul Care Manage ; 44(1): 71-75, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33165121

RESUMEN

A significant portion of the U.S. population may experience vaccine hesitancy of a new COVID-19 vaccine, which poses dangers to both the individual and their community, since exposure to a contagious disease places the person at risk, and individuals are far more likely to spread the disease to others if they do not get vaccinated. Many individuals are doubtful, and without the healthcare community, speaking with one voice has led to distrust. Experience from the influenza vaccines have shown vaccine acceptance has not been optimal, and this new vaccine, even though it is not approved, is already showing layperson skepticism compounded by political influences.


Asunto(s)
/administración & dosificación , Aceptación de la Atención de Salud/psicología , Centers for Disease Control and Prevention, U.S. , Información de Salud al Consumidor , Industria Farmacéutica , Humanos , Pandemias/prevención & control , Estados Unidos
8.
Estima (Online) ; 18(1): e2020, jan.-dez. 2020.
Artículo en Portugués | BDENF - Enfermería | ID: biblio-1141114

RESUMEN

Objetivo:descrever o itinerário terapêutico de pessoas com estomia em busca de cuidados especializados. Método: estudo exploratório, descritivo, com abordagem qualitativa, com dez pessoas com estomia atendidas no Serviço de Atenção à Saúde da Pessoa Ostomizada, de agosto a novembro de 2017. A reconstituição se deu por meio de entrevistas semiestruturadas, registro em diário de campo e consulta aos prontuários dos serviços de saúde especializados, e processadas pelo software Interface de R pour les Analyses Multidimensionnelles de Texte et de Questionnaires. Resultados: o itinerário terapêutico tem início com a descoberta dos sinais e sintomas, quando há acesso aos serviços de saúde mais próximos e a posteriori em busca de serviço especializado. Marcado por conexões formais e sustentados por subsistemas inter-relacionados. As trajetórias de busca, produção, transporte sanitário e gerenciamento do cuidado para saúde, empreendidos por pessoas, famílias e grupos informais expressam percursos e movimentos distintos na fase que antecede ao atendimento especializado. Conclusão: o conhecimento apreendido pelos discursos possibilita a identificação de necessidades básicas apresentadas por essa clientela, facilidades e barreiras encontradas no percurso empreendido para obter um plano terapêutico adequado.


Asunto(s)
Estomía , Aceptación de la Atención de Salud , Atención a la Salud , Accesibilidad a los Servicios de Salud
9.
JMIR Public Health Surveill ; 6(4): e25546, 2020 12 31.
Artículo en Inglés | MEDLINE | ID: mdl-33315584

RESUMEN

BACKGROUND: Ascertaining preferences for SARS-CoV-2 testing and incorporating findings into the design and implementation of strategies for delivering testing services may enhance testing uptake and engagement, a prerequisite to reducing onward transmission. OBJECTIVE: This study aims to determine important drivers of decisions to obtain a SARS-CoV-2 test in the context of increasing community transmission. METHODS: We used a discrete choice experiment to assess preferences for SARS-CoV-2 test type, specimen type, testing venue, and results turnaround time. Participants (n=4793) from the US national longitudinal Communities, Households and SARS-CoV-2 Epidemiology (CHASING) COVID Cohort Study completed our online survey from July 30 to September 8, 2020. We estimated the relative importance of testing method attributes and part-worth utilities of attribute levels, and simulated the uptake of an optimized testing scenario relative to the current typical testing scenario of polymerase chain reaction (PCR) via nasopharyngeal swab in a provider's office or urgent care clinic with results in >5 days. RESULTS: Test result turnaround time had the highest relative importance (30.4%), followed by test type (28.3%), specimen type (26.2%), and venue (15.0%). In simulations, immediate or same-day test results, both PCR and serology, or oral specimens substantially increased testing uptake over the current typical testing option. Simulated uptake of a hypothetical testing scenario of PCR and serology via a saliva sample at a pharmacy with same-day results was 97.7%, compared to 0.6% for the current typical testing scenario, with 1.8% opting for no test. CONCLUSIONS: Testing strategies that offer both PCR and serology with noninvasive methods and rapid turnaround time would likely have the most uptake and engagement among residents in communities with increasing community transmission of SARS-CoV-2.


Asunto(s)
/métodos , Comportamiento del Consumidor/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Adulto , Conducta de Elección , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Estados Unidos/epidemiología
10.
J Prev Med Public Health ; 53(6): 387-396, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33296578

RESUMEN

OBJECTIVES: The lack of advance planning in a public health emergency can lead to wasted resources and inadvertent loss of lives. This study is aimed at forecasting the needs for healthcare resources following the expansion of the coronavirus disease 2019 (COVID-19) outbreak in the Republic of Kazakhstan, focusing on hospital beds, equipment, and the professional workforce in light of the developing epidemiological situation and the data on resources currently available. METHODS: We constructed a forecast model of the epidemiological scenario via the classic susceptible-exposed-infected-removed (SEIR) approach. The World Health Organization's COVID-19 Essential Supplies Forecasting Tool was used to evaluate the healthcare resources needed for the next 12 weeks. RESULTS: Over the forecast period, there will be 104 713.7 hospital admissions due to severe disease and 34 904.5 hospital admissions due to critical disease. This will require 47 247.7 beds for severe disease and 1929.9 beds for critical disease at the peak of the COVID-19 outbreak. There will also be high needs for all categories of healthcare workers and for both diagnostic and treatment equipment. Thus, Republic of Kazakhstan faces the need for a rapid increase in available healthcare resources and/or for finding ways to redistribute resources effectively. CONCLUSIONS: Republic of Kazakhstan will be able to reduce the rates of infections and deaths among its population by developing and following a consistent strategy targeting COVID-19 in a number of inter-related directions.


Asunto(s)
/epidemiología , Control de Enfermedades Transmisibles/tendencias , Brotes de Enfermedades/prevención & control , Personal de Salud/tendencias , Pandemias/prevención & control , /terapia , Capacidad de Camas en Hospitales/estadística & datos numéricos , Humanos , Unidades de Cuidados Intensivos/tendencias , Kazajstán/epidemiología , Aceptación de la Atención de Salud
16.
Artículo en Inglés | MEDLINE | ID: mdl-33322095

RESUMEN

Public safety personnel (PSP) experience unique occupational stressors and suffer from high rates of mental health problems. The COVID-19 pandemic has impacted virtually all aspects of human life around the world and has introduced additional occupational stressors for PSP. The objective of this study was to explore how PSP, especially those seeking digital mental health services, have been affected by the pandemic. Our research unit, PSPNET, provides internet-delivered cognitive behavioral therapy to PSP in the Canadian province of Saskatchewan. When the pandemic spread to Saskatchewan, PSPNET began inquiring about the impact of the pandemic on prospective clients during the eligibility screening process. We used content analysis to analyze data from telephone screening interviews (n = 56) and descriptive statistics to analyze data from a questionnaire concerning the impacts of COVID-19 (n = 41). The results showed that most PSP reported facing several novel emotional challenges (e.g., social isolation, boredom, anger, and fear) and logistical challenges (e.g., related to childcare, finances, work, and access to mental healthcare). Most participants indicated they felt at least somewhat afraid of contracting COVID-19 but felt more afraid of their families contracting the virus than themselves. However, few participants reported severe challenges of any kind, and many (40%) indicated that they had not been significantly negatively impacted by the pandemic. Overall, the results suggest that PSP are not expressing significant concern at this time in meeting the novel challenges posed by COVID-19. Continued research will be required to monitor how diverse PSP populations and treatment outcomes are affected by the pandemic as the situation evolves.


Asunto(s)
/psicología , Socorristas/psicología , Servicios de Salud Mental/estadística & datos numéricos , Pandemias , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Femenino , Humanos , Masculino , Persona de Mediana Edad , Estudios Prospectivos , Saskatchewan
17.
Artículo en Inglés | MEDLINE | ID: mdl-33322332

RESUMEN

A decrease in attendance at emergency departments among paediatric populations has been reported during the Coronavirus Disease 2019 (COVID-19) pandemic. The present study sought to understand parents' hesitancy and concerns around accessing healthcare during the pandemic using a cross-sectional survey of parents of children under the age of 16 (N = 1044) in Ireland. Multinomial and logistic regression analyses were used to determine the factors that influenced avoidance and hesitancy. In total, 34% of participants stated that their child required healthcare during the pandemic, of whom 22% decided against seeking healthcare. Parents who reported being much more hesitant about accessing healthcare were more likely to report mild-moderate (Relative Risk Ratio (RRR) = 2.31, CI: 1.54-3.47) and severe-extremely severe stress (RRR: 3.37, CI: 1.81-6.27). Parents who understood government advice to mean avoiding health services were more likely to be hesitant to attend (RRR: 1.71, CI; 1.10-2.67). These effects held when restrictions were beginning to be lifted. Higher levels of stress were associated with a parent believing that the government advice meant that they should not attend health services (OR: 1.66, CI: 1.14-2.41). Public health messaging must ensure parents are reassured on the accessibility and safety of paediatric healthcare services as this public health emergency continues.


Asunto(s)
Pandemias , Padres/psicología , Aceptación de la Atención de Salud/psicología , Pediatría , Adolescente , Adulto , Ansiedad , Niño , Preescolar , Estudios Transversales , Femenino , Humanos , Irlanda , Masculino , Persona de Mediana Edad , Medición de Riesgo
18.
Front Public Health ; 8: 608852, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33344407

RESUMEN

This study was conducted to evaluate the impact of public perceptions of vaccine safety and efficacy on intent to seek COVID-19 vaccination using hypothetical vaccine acceptance scenarios. The behavioral economic methodology could be used to inform future public health vaccination campaigns designed to influence public perceptions and improve public acceptance of the vaccine. In June 2020, 534 respondents completed online validated behavioral economic procedures adapted to evaluate COVID-19 vaccine demand in relation to a hypothetical development process and efficacy. An exponential demand function was used to describe the proportion of participants accepting the vaccine at each efficacy. Linear mixed effect models evaluated development process and individual characteristic effects on minimum required vaccine efficacy required for vaccine acceptance. The rapid development process scenario increased the rate of decline in acceptance with reductions in efficacy. At 50% efficacy, 68.8% of respondents would seek the standard vaccine, and 58.8% would seek the rapid developed vaccine. Rapid vaccine development increased the minimum required efficacy for vaccine acceptance by over 9 percentage points, γ = 9.36, p < 0.001. Past-3-year flu vaccination, γ = -23.00, p < 0.001, and male respondents, γ = -4.98, p = 0.037, accepted lower efficacy. Respondents reporting greater conspiracy beliefs, γ = 0.39, p < 0.001, and political conservatism, γ = 0.32, p < 0.001, required higher efficacy. Male, γ = -4.43, p = 0.013, and more conservative, γ = -0.09, p = 0.039, respondents showed smaller changes in minimum required efficacy by development process. Information on the vaccine development process, vaccine efficacy, and individual differences impact the proportion of respondents reporting COVID-19 vaccination intentions. Behavioral economics provides an empirical method to estimate vaccine demand to target subpopulations resistant to vaccination.


Asunto(s)
/economía , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Percepción , Vacunación/economía , Vacunación/psicología , Adulto , Anciano , Anciano de 80 o más Años , Estudios Transversales , Economía del Comportamiento/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Vacunación/estadística & datos numéricos
20.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(10): 1655-1661, 2020 Oct 10.
Artículo en Chino | MEDLINE | ID: mdl-33297622

RESUMEN

Objective: To compare the rates of acceptance of colonoscopy, fecal immunochemical test (FIT), or a novel risk-adapted screening approach in the colorectal cancer (CRC) screening program. Related risk factors were also studied. Methods: The study has been based on an ongoing randomized controlled trial on colorectal cancer screening programs in six centers of research since May 2018. The involved participants were those who presented at the baseline screening phase. All the participants were randomly allocated into one of the following three intervention arms in a 1∶2∶2 ratio: colonoscopy group, FIT group, and a novel risk-adapted screening group. All the participants underwent risk assessment on CRC by an established risk score system. The subjects with high-risk were recommended to undertake the colonoscopy while the low-risk ones were receiving the FIT. Detailed epidemiological data was collected through questionnaires and clinical examinations. Rates of participation and compliance in all three groups were calculated. Multivariate logistic regression models were used to explore the potential associated factors related to the acceptance of screening. Results: There were 19 546 eligible participants involved in the study, including 3 916 in the colonoscopy group, 7 854 in the FIT group, and 7 776 in the novel risk-adapted screening group, respectively. Among the 19 546 participants, the mean age was 60.5 years (SD=6.5), and 8 154 (41.7%) were males. The rates of participation in the colonoscopy, FIT and the novel risk-adapted screening groups were 42.5%, 94.0% and 85.2%, respectively. In the novel risk-adapted screening group, the participation rate was 49.2% for the high-risk participants who need to undertake colonoscopy and was 94.0% for the low-risk ones who need to undertake FIT. Results from the multivariate logistic regression models demonstrated that there were several factors associated with the rates of participation in CRC screening, including age, background of education, history of smoking cigarettes, previous history of bowel examination, chronic inflammatory bowel disease and family history of CRC among the 1(st)-degree relatives. Conclusions: FIT and the novel risk-adapted screening approach showed superior participation rates to the colonoscopy. Further efforts including health promotion campaign for specific target population are needed to improve the engagement which ensures the effectiveness of CRC screening programs.


Asunto(s)
Colonoscopía , Neoplasias Colorrectales , Detección Precoz del Cáncer , Sangre Oculta , Aceptación de la Atención de Salud , Anciano , Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/prevención & control , Detección Precoz del Cáncer/métodos , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , Medición de Riesgo
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