Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 13.054
Filtrar
1.
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
2.
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
3.
Pan Afr Med J ; 33: 213, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31692660

RESUMEN

Introduction: HIV self-testing could add a new approach to scaling up HIV testing with potential of being high impact, low cost, confidential, and empowering for users. Methods: Pregnant women attending antenatal clinics (ANC) and their male partners were recruited in 14 clinics in the eastern and central regions of Kenya and randomly allocated to intervention or control arms at a ratio of 1:1:1. Arm 1 received the standard of care, which involved invitation of the male partner to the clinic through word of mouth, arm 2 received an improved invitation letter, and arm 3 received the same improved letter and, two self-testing kits. Analysis was done using adjusted odds ratios (aOR) at 95% confidence intervals (CI) to calculate and determine effects of HIV self-testing in increasing uptake of male partner testing. Results: A total of 1410 women and 1033 men were recruited; 86% (1217) women and 79% (1107) couples were followed up. In arm 3, over 80% (327) of male partners took HIV test, compared to only 37% (133) in arm 2 and 28% (106) in arm one. There was a statistical significance between arm one and two (p-value=0.01) while arm three was statistically significant compared to arm two (p-value<0.001). Men in arm three were twelve times more likely to test compared to arm one (aOR 12.45 (95% CI 7.35, 21.08)). Conclusion: Giving ANC mothers test kits and improved male invitation letter increased the likelihood of male partner testing by twelve times. These results demonstrate that HIV self-test kits could complement routine HIV testing methods in the general population.


Asunto(s)
Infecciones por VIH/diagnóstico , Tamizaje Masivo/métodos , Atención Prenatal/métodos , Parejas Sexuales , Adolescente , Adulto , Pruebas Diagnósticas de Rutina , Femenino , Humanos , Kenia , Masculino , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Embarazo , Adulto Joven
4.
JAMA ; 322(14): 1371-1380, 2019 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-31593271

RESUMEN

Importance: Patients hospitalized for chronic obstructive pulmonary disease (COPD) exacerbations have high rehospitalization rates and reduced quality of life. Objective: To evaluate whether a hospital-initiated program that combined transition and long-term self-management support for patients hospitalized due to COPD and their family caregivers can improve outcomes. Design, Setting, and Participants: Single-site randomized clinical trial conducted in Baltimore, Maryland, with 240 participants. Participants were patients hospitalized due to COPD, randomized to intervention or usual care, and followed up for 6 months after hospital discharge. Enrollment occurred from March 2015 to May 2016; follow-up ended in December 2016. Interventions: The intervention (n = 120) involved a comprehensive 3-month program to help patients and their family caregivers with long-term self-management of COPD. It was delivered by nurses with special training on supporting patients with COPD using standardized tools. Usual care (n = 120) included transition support for 30 days after discharge to ensure adherence to discharge plan and connection to outpatient care. Main Outcomes and Measures: The primary outcome was number of COPD-related acute care events (hospitalizations and emergency department visits) per participant at 6 months. The co-primary outcome was change in participants' health-related quality of life measured by the St George's Respiratory Questionnaire (SGRQ) at 6 months after discharge (score, 0 [best] to 100 [worst]; 4-point difference is clinically meaningful). Results: Among 240 patients who were randomized (mean [SD] age, 64.9 [9.8] years; 61.7% women), 203 (85%) completed the study. The mean (SD) baseline SGRQ score was 62.3 (18.8) in the intervention group and 63.6 (17.4) in the usual care group. The mean number of COPD-related acute care events per participant at 6 months was 1.40 (95% CI, 1.01-1.79) in the intervention group vs 0.72 (95% CI, 0.45-0.97) in the usual care group (difference, 0.68 [95% CI, 0.22-1.15]; P = .004). The mean change in participants' SGRQ total score at 6 months was 2.81 in the intervention group and -2.69 in the usual care group (adjusted difference, 5.18 [95% CI, -2.15 to 12.51]; P = .11). During the study period, there were 15 deaths (intervention: 8; usual care: 7) and 339 hospitalizations (intervention: 202; usual care: 137). Conclusions and Relevance: In a single-site randomized clinical trial of patients hospitalized due to COPD, a 3-month program that combined transition and long-term self-management support resulted in significantly greater COPD-related hospitalizations and emergency department visits, without improvement in quality of life. Further research is needed to determine reasons for this unanticipated finding. Trial Registration: ClinicalTrials.gov Identifier: NCT02036294.


Asunto(s)
Hospitalización/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Enfermedad Pulmonar Obstructiva Crónica/terapia , Calidad de Vida , Automanejo , Cuidado de Transición , Anciano , Servicio de Urgencia en Hospital/estadística & datos numéricos , Femenino , Humanos , Estimación de Kaplan-Meier , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos
5.
Artículo en Chino | MEDLINE | ID: mdl-31594123

RESUMEN

Objective: To understand the situation and characteristics of out-patient utilization of urban and rural pneumoconiosis patients in Jiangsu province, and to provide a reference for the formulation of relevant policies. Methods: Using a questionnaire on patients with pneumoconiosis and their influencing factors, 120 patients with pneumoconiosis were randomly selected in Nanjing, Wuxi, Suzhou, Yancheng Vocational Defense Institute or CDC. The rate of outpatients with pneumoconiosis in urban and rural areas and the choice of out-patient hospitals were analyzed. Results: Of the 75 patients with severe pneumoconi-related symptoms such as chest tightness and dyspnea in the first two weeks of the survey, 36 (48.0%) lived in cities and 39 (52.0%) lived in rural areas. Patients with pneumoconiosis who live in urban and rural areas have different aggravating conditions within two weeks. Two weeks of aggravated symptoms in outpatient consultations accounted for36 (48.0%) . Of the 36 patients who used outpatient treatment, rural residents mainly chose 8 people from a hospital and a township health hospital, accounting for 34.8%, while 10 people from urban residents chose a nursing home or nursing home, accounting for 40.0%. The main reason why urban and rural pneumoconiosis patients did not go to the doctor is "conscious symptoms are lighter" and "feel that the doctor is useless." Conclusion: The rate of outpatients with pneumoconiosis in Jiangsu province within two weeks is lower than that of ordinary elderly residents. There may be differences in treatment behavior patterns of urban and rural pneumoconiosis patients.Economic factors have a certain influence on the outpatient treatment behavior of pneumoconiosis patients. The recognition of outpatient service is the main factor affecting the outpatient treatment of pneumoconiosis patients. It is very important to popularize the knowledge of pneumoconiosis and do a good job in propaganda of occupational diseases and health education for pneumoconiosis patients. Focusing on the outpatient treatment of pneumoconiosis patients and making targeted medical policies is very important to standardize and improve the rehabilitation of pneumoconiosis patients.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Neumoconiosis , China , Ciudades , Humanos , Pacientes Ambulatorios , Población Rural , Población Urbana
6.
Artículo en Chino | MEDLINE | ID: mdl-31594131

RESUMEN

Objective: To investigate the situation where pneumoconiosis patients who should be in hospital are not hospitalized, to analyze the main reasons and influencing factors for their restricted use of hospitalization medical services, and to provide a reference for relevant policy making. Methods: Subjects were sampled in nine provinces, including Zhejiang, Jiangsu, Shandong, and Hebei, using a method that combined stratified sampling and typical sampling, from March 2017 to January 2018. These subjects were patients occupationally diagnosed with pneumoconiosis and patients clinically diagnosed with pneumoconiosis. The questionnaire The health seeking behaviors of pneumoconiosis patients and their influencing factors was used as the survey tool to investigate their health seeking behaviors such as going to the outpatient clinic and being hospitalized. Andersen's Behavioral Model of Health Services Use was used as the analysis model; The χ2 test was used for univariate analysis, and the multivariate logistic regression model was used for multivariate analysis. Results: A total of 1 037 patients with pneumoconiosis were surveyed, with a mean age of 55.9±11.2 years and 67.5% (700/1 037) living in rural areas for a long time. Occupational injury insurance and medical insurance for urban and rural residents were the main insurances used, accounting for 40.9% (424/1 037) and 59.4% (616/1 037) of the cases, respectively. A total of 177 (17.1%) patients were once advised by the doctors to be hospitalized because of pneumoconiosis, while they did not. The proportion of patients who should be in hospital but did not do so among rural patients was significantly higher than that in urban patients (20.1% (141/700) vs 10.7% (36/337) , P<0.05) . Financial difficulties (12.0%, 124/1 037) and self-rated mild symptoms (3.2%, 33/1 037) were the main reasons for not being hospitalized. Model analysis showed that the propensity factor, ability factor, health needs, health seeking behaviors, and self-rated health factor in the Anderson model were all statistically significant (P<0.05) . The main features of high proportion of patients who should be in hospital but did not do so were as follows: personal monthly income below 1 000 RMB (odds ratio[OR]of no income=2.92, 95% confidence interval[CI]: 1.14-7.48; OR of less than 1 000 RMB=3.55, 95%CI: 1.35-9.35) , no occupational injury insurance (OR=2.05, 95%CI: 1.16-3.43) , and concurrent emphysema (OR= 1.98, 95%CI: 1.12-3.50) . Conclusion: Low income, no occupational injury insurance, and concurrent emphy-sema are the main constraining factors for hospitalization services use in pneumoconiosis patients.


Asunto(s)
Hospitalización/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Neumoconiosis , Adulto , Anciano , China , Enfisema/complicaciones , Humanos , Renta , Seguro de Salud , Modelos Logísticos , Persona de Mediana Edad , Población Rural , Encuestas y Cuestionarios , Población Urbana
7.
Pan Afr Med J ; 33: 159, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31565121

RESUMEN

Introduction: Hospital-based surveillance programs only capture people presenting to facilities and may underestimate disease burden. We conducted a healthcare utilisation survey to characterise healthcare-seeking behaviour among people with common infectious syndromes in the catchment areas of two sentinel surveillance hospitals in Johannesburg, South Africa. Methods: A cross-sectional survey was conducted within three regions of Johannesburg from August to November 2015. Premises were randomly selected from an enumerated list with data collected on household demographics and selected syndromes using a structured questionnaire. Fisher's exact or chi-square tests were used to determine association of characteristics among different regions. Results: Of 3650 selected coordinates, 3358 were eligible dwellings and 2930 (87%) households with 9850 individuals participated. Four percent of participants (431/9850) reported influenza-like illness (ILI) in the last 30 days; equal numbers of participants (0.2%, 20/9850) reported pneumonia or tuberculosis symptoms in the last year and <1% reported diarrhoea or meningitis symptoms. Sixty eight percent (295/431) of participants who reported ILI, 75% (6/8) of children with diarrhoea and all participants who reported pneumonia (20), tuberculosis (20) or meningitis (6) sought healthcare. For all syndromes most sought care at registered healthcare providers. Of these only 10% (24/237) attended sentinel hospitals, predominantly those that lived closer to the hospitals. In contrast, of patients with meningitis, 50% (3/6) sought care at sentinel hospitals. Conclusion: Patterns of seeking healthcare differed by syndrome and distance from facilities. Surveillance programs are still relevant in collecting information on infectious syndromes and reflect a proportion of the hospital's catchment area.


Asunto(s)
Enfermedades Transmisibles/epidemiología , Prestación de Atención de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Vigilancia de Guardia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Niño , Preescolar , Enfermedades Transmisibles/terapia , Estudios Transversales , Femenino , Humanos , Lactante , Masculino , Persona de Mediana Edad , Sudáfrica/epidemiología , Encuestas y Cuestionarios , Síndrome , Adulto Joven
8.
BMJ ; 367: l5515, 2019 Oct 02.
Artículo en Inglés | MEDLINE | ID: mdl-31578196

RESUMEN

CLINICAL QUESTION: Recent 15-year updates of sigmoidoscopy screening trials provide new evidence on the effectiveness of colorectal cancer screening. Prompted by the new evidence, we asked: "Does colorectal cancer screening make an important difference to health outcomes in individuals initiating screening at age 50 to 79? And which screening option is best?" CURRENT PRACTICE: Numerous guidelines recommend screening, but vary on recommended test, age and screening frequency. This guideline looks at the evidence and makes recommendations on screening for four screening options: faecal immunochemical test (FIT) every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy. RECOMMENDATIONS: These recommendations apply to adults aged 50-79 years with no prior screening, no symptoms of colorectal cancer, and a life expectancy of at least 15 years. For individuals with an estimated 15-year colorectal cancer risk below 3%, we suggest no screening (weak recommendation). For individuals with an estimated 15-year risk above 3%, we suggest screening with one of the four screening options: FIT every year, FIT every two years, a single sigmoidoscopy, or a single colonoscopy (weak recommendation). With our guidance we publish the linked research, a graphic of the absolute harms and benefits, a clear description of how we reached our value judgments, and linked decision aids. HOW THIS GUIDELINE WAS CREATED: A guideline panel including patients, clinicians, content experts and methodologists produced these recommendations using GRADE and in adherence with standards for trustworthy guidelines. A linked systematic review of colorectal cancer screening trials and microsimulation modelling were performed to inform the panel of 15-year screening benefits and harms. The panel also reviewed each screening option's practical issues and burdens. Based on their own experience, the panel estimated the magnitude of benefit typical members of the population would value to opt for screening and used the benefit thresholds to inform their recommendations. THE EVIDENCE: Overall there was substantial uncertainty (low certainty evidence) regarding the 15-year benefits, burdens and harms of screening. Best estimates suggested that all four screening options resulted in similar colorectal cancer mortality reductions. FIT every two years may have little or no effect on cancer incidence over 15 years, while FIT every year, sigmoidoscopy, and colonoscopy may reduce cancer incidence, although for FIT the incidence reduction is small compared with sigmoidoscopy and colonoscopy. Screening related serious gastrointestinal and cardiovascular adverse events are rare. The magnitude of the benefits is dependent on the individual risk, while harms and burdens are less strongly associated with cancer risk. UNDERSTANDING THE RECOMMENDATION: Based on benefits, harms, and burdens of screening, the panel inferred that most informed individuals with a 15-year risk of colorectal cancer of 3% or higher are likely to choose screening, and most individuals with a risk of below 3% are likely to decline screening. Given varying values and preferences, optimal care will require shared decision making.


Asunto(s)
Colonoscopía/estadística & datos numéricos , Neoplasias Colorrectales/diagnóstico , Detección Precóz del Cáncer/normas , Tamizaje Masivo/normas , Sangre Oculta , Sigmoidoscopía/estadística & datos numéricos , Anciano , Colonoscopía/normas , Neoplasias Colorrectales/epidemiología , Detección Precóz del Cáncer/métodos , Detección Precóz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Incidencia , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Sigmoidoscopía/normas , Factores de Tiempo
11.
Adv Clin Exp Med ; 28(10): 1377-1383, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31638746

RESUMEN

BACKGROUND: Poland is considered among the European countries with an average incidence of cervical cancer (CC; about 3,000-3,500/year) and at the same time with high mortality (5-year survival rate - 55.2%). For this reason, in 2006 Poland introduced a Population-Based Cervical Cancer Prevention and Early Detection Program addressed to women aged 25-59 years, in which a cytological test is carried out every 3 years. OBJECTIVES: The aim of the study was to assess the changes in the curability of CC patients brought by the introduction of the Screening Program in the Lower Silesian voivodeship and to identify the subpopulation of women for whom activities aimed at increasing adherence rates must be intensified. MATERIAL AND METHODS: The 5-year relative survival in 3,586 CC patients from 2000-2010 registered in the Lower Silesian Cancer Registry was analyzed. RESULTS: In the Lower Silesian voivodeship, a 55.1% 5-year survival rate was recorded in 2000-2004 and 70.5% in 2010. The highest increase in 5-year relative survival rates was found in rural communities (from 53.1% in 2000-2004 to 77.7% in 2010) and in Wroclaw (56.8% and 74.2%, respectively). In the study group, the number of patients with invasive CC (C53) detected in the local stage of the disease increased systematically from 61.5% in 2000-2004 to 74.3% in 2010. CONCLUSIONS: The introduction of the population-based screening program improved the curability rate in CC patients in the Lower Silesian voivodeship. In order to maintain the recent positive trends, further education should be continued, and activities aimed at increasing adherence to screening tests should be intensified, especially in urban-rural communities.


Asunto(s)
Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Cooperación del Paciente/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Detección Precóz del Cáncer , Femenino , Humanos , Incidencia , Masculino , Tamizaje Masivo/organización & administración , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Cooperación del Paciente/psicología , Polonia/epidemiología , Vigilancia de la Población , Evaluación de Programas y Proyectos de Salud , Tasa de Supervivencia/tendencias , Neoplasias del Cuello Uterino/mortalidad , Neoplasias del Cuello Uterino/patología
12.
Pan Afr Med J ; 33: 106, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31489084

RESUMEN

Introduction: Cervical cancer remains one of the leading health hazards affecting a majority women across the globe. The situation is even more, preoccupying particularly in areas where screening programmes and services are absent. The World Health Organization (WHO) says "cervical cancer is the fourth most frequent cancer in women, with an estimated 570,000 new cases diagnosed in 2018 which represents 6.6% of all female cancers. Approximately 90% of deaths from cervical cancer occurred in low- and middle-income countries". Despite the high mortality rate from cervical cancer globally, the trend could be reduced through a comprehensive approach that includes prevention, early diagnosis, effective screening and treatment programmes. In Cameroon, the prevalence of cervical cancer is 24% among women of reproductive age. An estimated 1,993 new cases are recorded annually in Cameroon with 1676 deaths. Despite this precarious situation, the uptake in cervical cancer screening service remains poor and stands at 19.6% in Cameroon. It is against this background that this paper evaluates the uptake of cervical cancer among women aged 25-65 years in the Kumbo West Health District (KWHD). Specifically, this study assesses the knowledge of women in this health district on cervical cancer and determines factors that affect the uptake of cervical cancer screening services. Methods: This study is a cross-sectional study in the KWHD involving 253 consented women between the ages 25 to 65 years. The principal research instrument was a three-part questionnaire designed to collect information on socio-demographic profile, cervical cancer knowledge and associated factors for uptake in cervical cancer screening. Data was entered in MS Excel and analysed using Excel. Results were presented in tables and figures. Results: Our study reveals that a majority of the participants (74.70%) had heard of cervical cancer and 43.48% had undergone cervical cancer screening. Again, 24.51% and 29.25% of the participants respectively could not identify any risk factor and symptom of cervical cancer. Conclusion: The study revealed that the uptake of cervical cancer screening in KWHD is higher than the national uptake. The level of awareness on the risk factors and symptoms of cervical cancer is low, posing a need to put more emphasis on educating and creating awareness of cervical cancer among communities on risk factors, prevention measures and signs and symptoms in all the health areas of the KWHD.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Anciano , Camerún , Estudios Transversales , Detección Precóz del Cáncer/estadística & datos numéricos , Femenino , Humanos , Persona de Mediana Edad , Factores de Riesgo , Encuestas y Cuestionarios
13.
Z Gastroenterol ; 57(9): 1051-1058, 2019 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-31525797

RESUMEN

BACKGROUND AND AIM: Colorectal cancer (CRC) screening can effectively reduce cancer-associated mortality. In Germany, individuals over the age of 50 or 55 have access to CRC screening services. However, utilization rates are persistently low, particular in the male population. This observational study investigates the effect of standard versus gender-specific invitation letters on utilization of CRC screening services. METHODS: We analyzed utilization rates of individuals who were insured by a large health insurance fund in Bavaria, Germany. Persons who became eligible for CRC screening received a standard (2013-2014) or a gender-specific invitation letter (2015-2016). We compared utilization rates within 6 months after receipt of the invitation letter using billing codes of the health insurance fund. RESULTS: Invitation letters were sent to 49 535 individuals, of which 48.8 % were gender-specific. The overall utilization rate did not differ between recipients of the standard versus gender-specific invitation letter (11.6 % vs 11.1 %; RR: 0.97 [0.92-1.02], p = 0.19). However, uptake of screening colonoscopy was significantly higher among recipients of gender-specific invitations (2.9 % vs 3.5 %; RR: 1.21 [1.04-1.39], p = 0.01), whereas utilization of fecal occult blood tests declined (10.4 % vs 9.7 %; RR: 0.93 [0.88-0.99], p = 0.016). CONCLUSIONS: Gender-specific design of invitation letters can modify the patients' preference for specific CRC screening services and increase the acceptance of screening colonoscopy.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Detección Precóz del Cáncer/métodos , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Participación del Paciente/estadística & datos numéricos , Colonoscopía , Neoplasias Colorrectales/prevención & control , Femenino , Alemania , Humanos , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Sangre Oculta
14.
BMC Health Serv Res ; 19(1): 549, 2019 Aug 05.
Artículo en Inglés | MEDLINE | ID: mdl-31382956

RESUMEN

BACKGROUND: The awareness of diabetes mellitus (DM) and its complications, especially diabetic retinopathy (DR), is the key to reducing their burden. This study aimed to assess both the awareness of diabetic outpatients and their action towards periodic eye exam, and to determine the causes of non-compliance amongst patients who were aware. Because the Syrian Crisis affected all aspects of Syrians' life, the study aimed to determine the crisis' effects on patients' care-seeking behavior. Our study was the first step in paving the way of prevention strategies. METHODS: This observational cross-section study was conducted on 260 patients with DM who were visiting the four main hospitals in the Syrian capital, Damascus between August and November 2017. RESULTS: The mean (±SD) age of participants was 54.3(±12.8) years. Females were more than half (56.2%). The majority were from areas outside Damascus (72.3%). The mean (±SD) DM duration was 10.6 (±7.1) years. Almost all patients (93.8%) thought that DM could affect the eye. 67.3% believed that it could cause blindness. 86.9% of the patients conceived that DM patients should visit an ophthalmologist regularly. 37% did not visit any ophthalmologists at all, while 63% reported they had visited their ophthalmologists. Only 21.5% had a regular eye exam. Gender, educational level, economic status, province, and family history of DM had statistically an insignificant relation with an ophthalmologist visit. The preponderance of the patients who haven't visited regularly did not appreciate the necessity of regular eye exam. Diabetic neuropathy was the most common complication of DM that patients were aware of (92%) and suffered from (56.5%). Meanwhile, regarding the effects of the Syrian Crisis: 41.2% of diabetic patients had stopped their medications for at least one month, mainly because the drugs were unavailable (74.7% of them), as some drug companies had been destroyed. Half of the patients had struggled to reach a medical care center. Half of the patients had been displaced, two-third of them were from outside Damascus. CONCLUSION: A screening program for DR should be initiated. Also, awareness about DM and its complications, especially DR, should be raised through doctors and media.


Asunto(s)
Retinopatía Diabética/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Adulto , Anciano , Atención Ambulatoria , Conflictos Armados , Concienciación , Ceguera/prevención & control , Estudios Transversales , Neuropatías Diabéticas/diagnóstico , Neuropatías Diabéticas/epidemiología , Neuropatías Diabéticas/psicología , Retinopatía Diabética/diagnóstico , Retinopatía Diabética/epidemiología , Diagnóstico Precoz , Femenino , Hospitales Públicos/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Pacientes Ambulatorios/psicología , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Cooperación del Paciente/psicología , Cooperación del Paciente/estadística & datos numéricos , Factores Socioeconómicos , Siria/epidemiología
15.
BMC Public Health ; 19(1): 1185, 2019 Aug 28.
Artículo en Inglés | MEDLINE | ID: mdl-31462254

RESUMEN

BACKGROUND: Even though there is a growing literature on barriers to formal healthcare use among older people, little is known from the perspective of vulnerable older people in Ghana. Involving poor older people under the Livelihood Empowerment Against Poverty (LEAP) programme, this study explores barriers to formal healthcare use in the Atwima Nwabiagya District of Ghana. METHODS: Interviews and focus group discussions were conducted with 30 poor older people, 15 caregivers and 15 formal healthcare providers in the Atwima Nwabiagya District of Ghana. Data were analysed using the thematic analytical framework, and presented based on an a posteriori inductive reduction approach. RESULTS: Four main barriers to formal healthcare use were identified: physical accessibility barriers (poor transport system and poor architecture of facilities), economic barriers (low income coupled with high charges, and non-comprehensive nature of the National Health Insurance Scheme [NHIS]), social barriers (communication/language difficulties and poor family support) and unfriendly nature of healthcare environment barriers (poor attitude of healthcare providers). CONCLUSIONS: Considering these barriers, removing them would require concerted efforts and substantial financial investment by stakeholders. We argue that improvement in rural transport services, implementation of free healthcare for poor older people, strengthening of family support systems, recruitment of language translators at the health facilities and establishment of attitudinal change programmes would lessen barriers to formal healthcare use among poor older people. This study has implications for health equity and health policy framework in Ghana.


Asunto(s)
Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Pobreza/estadística & datos numéricos , Anciano , Femenino , Grupos Focales , Ghana , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Investigación Cualitativa
16.
AIDS Behav ; 23(10): 2654-2673, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31463711

RESUMEN

Pre-exposure prophylaxis (PrEP) has demonstrated high efficacy to reduce HIV infections, however, racial/ethnic HIV disparities continue among black MSM. The purpose of this review was to assess available data to inform interventions to increase PrEP awareness, uptake, and adherence among black MSM. Of the 3024 studies retrieved, 36 met final inclusion criteria and were categorized into the PrEP care continuum: (1) awareness (n = 16), (2) uptake (n = 9), and (3) adherence (n = 12). Only 26 of the studies presented analytical findings by race/ethnicity. Key barrier themes included cost, HIV-related stigma, and fear of potential side effects. A key facilitator theme identified by black MSM included gaining PrEP awareness from social and sexual networks. There are significant gaps in research on black MSM and PrEP utilization, especially regarding PrEP uptake and adherence. These data are needed to inform interventions to address current inequities in PrEP services, to help improve care outcomes for black MSM.


Asunto(s)
Afroamericanos/psicología , Fármacos Anti-VIH/administración & dosificación , Continuidad de la Atención al Paciente , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Aceptación de la Atención de Salud/psicología , Profilaxis Pre-Exposición/estadística & datos numéricos , Adolescente , Adulto , Afroamericanos/estadística & datos numéricos , Fármacos Anti-VIH/uso terapéutico , Concienciación , Infecciones por VIH/tratamiento farmacológico , Homosexualidad Masculina/etnología , Homosexualidad Masculina/psicología , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Retención en el Cuidado , Conducta Sexual , Estigma Social
17.
BMC Public Health ; 19(1): 1136, 2019 Aug 19.
Artículo en Inglés | MEDLINE | ID: mdl-31426776

RESUMEN

BACKGROUND: Worldwide, HIV remains a major public health challenge, especially in Sub-Saharan Africa. Literature indicates that men's involvement in HIV testing, care, and treatment services is lower compared to women, therefore novel approaches are required to engage men in the cascade of HIV care. This study aimed to explore men's perception on the provision of HIV testing services in venues where English Premier League football games are televised. METHODS: An exploratory qualitative study was conducted between February and May 2018. Six focus group discussions were conducted with 50 conveniently selected men aged 18 years and older using a pre-tested discussion guide. All focus group discussions were audio recorded, transcribed verbatim, and analyzed thematically. RESULTS: Overall, HIV testing at venues telecasting English Premier League football games was acceptable to men. There was a very strong preference for health workers providing testing and counseling services be external or unknown in the local community. Possible motivators for testing services provided in these settings include subsidizing or eliminating entrance fee to venues telecasting games, integrating testing and counseling with health promotion or screening for other diseases, use of local football games as mobilization tools and use of expert clients as role models. CONCLUSIONS: This study suggests that HIV testing services at venues where EPL football games are televised is generally acceptable to men. In implementing such services, consideration should be given to preferences for external or unknown health workers and the motivating factors contributing to the use of these services. Given that HIV testing is currently not conducted in these settings, further research should be conducted to evaluate the feasibility of this approach as a means of enhancing HIV testing among Ugandan men.


Asunto(s)
Infecciones por VIH/prevención & control , Promoción de la Salud/métodos , Tamizaje Masivo/psicología , Hombres/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Fútbol , Adulto , Anciano , Grupos Focales , Humanos , Masculino , Persona de Mediana Edad , Motivación , Uganda , Adulto Joven
18.
AIDS Behav ; 23(Suppl 3): 304-312, 2019 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-31456198

RESUMEN

Client-level data from two Tennessee-based PrEP navigation demonstration projects reported to the Tennessee Department of Health from January to December 2017 were evaluated to determine the proportion of clients who accepted, were linked to, and were prescribed PrEP. Disparities by age, race, transmission risk, and geographic region as well as trends over time were examined via bivariate and multivariable modified Poisson regression models accounting for potential confounders. Among 1385 PrEP-eligible individuals, 50.5% accepted, 33.4% were linked, and 27.3% were prescribed PrEP. PrEP uptake varied by age, race, and HIV transmission risk, and most disparities persisted across Tennessee throughout evaluation period. Multivariable regression models revealed significant independent associations between age, race/ethnicity, transmission risk, and region and PrEP acceptance and linkage. While differences in PrEP acceptance by race narrowed over time, success among black MSM was limited, underscoring a significant need to improve upstream PrEP continuum outcomes for this important population.


Asunto(s)
Infecciones por VIH/etnología , Infecciones por VIH/prevención & control , Aceptación de la Atención de Salud/psicología , Profilaxis Pre-Exposición/estadística & datos numéricos , Adulto , Afroamericanos/psicología , Afroamericanos/estadística & datos numéricos , Distribución por Edad , Grupo de Ascendencia Continental Europea/psicología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Infecciones por VIH/transmisión , Conocimientos, Actitudes y Práctica en Salud , Homosexualidad Masculina/etnología , Homosexualidad Masculina/psicología , Homosexualidad Masculina/estadística & datos numéricos , Humanos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Profilaxis Pre-Exposición/métodos , Distribución por Sexo , Tennessee
19.
BMC Public Health ; 19(1): 1131, 2019 Aug 17.
Artículo en Inglés | MEDLINE | ID: mdl-31420028

RESUMEN

BACKGROUND: Intimate partner violence (IPV) has been shown to be associated with poor maternal healthcare utilisation and poor pregnancy outcomes. IPV can be seen both as the cause and result of low socioeconomic status and lack of maternal autonomy that can limit women's access to resources and motivation necessary for seeking healthcare during pregnancy. This paper aims to study the relationship between intimate partner violence (IPV) and the utilisation of facility delivery services in Nigeria. METHODS: We applied propensity score matching (PSM) approach to examine the relationship between intimate partner violence (IPV) and the utilisation of facility delivery services. PSM is a popular strategy for reducing sampling bias through balancing sample characteristics, a technique that mimics randomization on cross-sectional data. Data were collected from Nigeria DHS surveys conducted in 2008 and 2013. IPV was the main explanatory variable of interest for delivery at health facility which was defined as delivering at any health institution including health clinics. RESULTS: PSM generated 20,446 cases distributed into two equal groups i.e. those who delivered at health facility versus those who did not. The prevalence of facility delivery in 2013 was 56.8% (95%CI 55.0-58.6) indicating a moderate increase from its 2008 level of 43.2% (41.4-45.0%). Lifetime prevalence of emotional, physical and sexual abuse was respectively 21.5%(95%CI 20.6, 22.4), 14.9% (14.2, 15.7) and 5.0% (4.6-5.4). In the multivariable analysis after adjusting for potential confounders, ever experiencing emotional abuse was associated increased odds of not delivering at a health facility. (AOR = 1.228, 95%CI, 1.095-1.679). CONCLUSION: Women experiencing emotional violence are less likely to use institutional delivery services, and hence are susceptible to increased risk of reproductive complications. IPV is a complex issue that needs to be tackled by introducing evidence based strategies contextually relevant to local sociocultural environment. Further studies are required to understand the roots of IPV and the pathways through which it hindrances healthcare utilisation among women.


Asunto(s)
Utilización de Instalaciones y Servicios/estadística & datos numéricos , Violencia de Pareja/estadística & datos numéricos , Servicios de Salud Materna/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Adulto , Estudios Transversales , Femenino , Encuestas Epidemiológicas , Humanos , Nigeria/epidemiología , Embarazo , Prevalencia , Puntaje de Propensión , Delitos Sexuales/estadística & datos numéricos , Adulto Joven
20.
Niger Postgrad Med J ; 26(3): 182-188, 2019.
Artículo en Inglés | MEDLINE | ID: mdl-31441457

RESUMEN

Background: Despite women's adequate knowledge and the obvious unmet need for family planning (FP), contraceptive prevalence in Nigeria is low. A greater understanding of the barriers to FP that informs service utilisation and preferences is needed to improve service delivery. Aim: This study was aimed at assessing the use and preferences of FP services among women. Subjects and Methods: A community-based, descriptive, cross-sectional survey was carried out among 367 women (15-49 years of age) residing in Ikosi-Isheri, Kosofe local government area, who were selected by multistage sampling method. Data were collected using a pre-tested, semi-structured, interviewer-administered questionnaire and were analysed using SPSS software version 20. Frequency distributions and cross tabulations were generated. The Chi-square and Fisher's exact tests were used to determine associations, and the level of significance was set at P ≤ 0.05. Results: Although 64.0% were aware of FP, only 26.4% had ever used FP services. The contraceptive prevalence was 17.9%. Traditional or religious restrictions were given as the reasons for not using FP (40.9%). The preferred FP services were those offered at primary healthcare centres (45.2%) and teaching hospitals (33.9%) because of proximity (38.7%), privacy (14.5%) and health workers being female (22.6%). Age, level of education and marital status were associated with the utilisation of FP services (P < 0.001, P = 0.020 and P < 0.001, respectively). Conclusion: Although awareness was high, uptake was low. Government health facilities were preferred. Primary healthcare should be strengthened, and FP services should be scaled up to make FP more accessible. Services should be closer to where people live while providing the privacy they desire.


Asunto(s)
Conducta Anticonceptiva , Anticoncepción/psicología , Servicios de Planificación Familiar/estadística & datos numéricos , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Prioridad del Paciente , Adolescente , Adulto , Actitud del Personal de Salud , Conducta de Elección , Anticoncepción/estadística & datos numéricos , Estudios Transversales , Escolaridad , Femenino , Humanos , Gobierno Local , Estado Civil , Persona de Mediana Edad , Nigeria , Aceptación de la Atención de Salud/etnología , Encuestas y Cuestionarios , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA