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1.
Artículo en Inglés | MEDLINE | ID: mdl-33435462

RESUMEN

The consequences of the COVID-19 pandemic on behavioral health, including tobacco use, are not fully known. The current study sought to measure the perceived impact of COVID-19 and the resulting stay-at-home orders in Philadelphia, Pennsylvania and Buffalo, New York on smokers enrolled in four smoking cessation trials between March 2020 and July 2020. The survey collected quantitative data regarding life changes due to COVID-19, health/exposure status, and the impact on their cessation attempt (e.g., motivation to quit, change in triggers). The questionnaire collected qualitative data to better understand how such changes could explain changes in smoking behavior. Of the 42 participants surveyed, approximately half indicated that COVID-19 changed their motivation and ability to quit or remain quit. Among those who reported that it was easier to quit following the stay-at-home orders (n = 24), most attributed this to concerns regarding the severity of COVID-19 among smokers. Among those who reported more difficulty quitting (n = 15), most attributed this to their increased stress due to the pandemic and the inability to access activities, places, or people that could help them manage triggers. Given public health warnings of continued surges in COVID-19, these data provide insight into who may benefit from further smoking cessation support should existing restrictions or new stay-at-home orders be enacted.


Asunto(s)
Motivación , Aceptación de la Atención de Salud/estadística & datos numéricos , Fumadores , Cese del Hábito de Fumar/estadística & datos numéricos , Humanos , New York/epidemiología , Pandemias , Philadelphia/epidemiología , Encuestas y Cuestionarios
2.
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
3.
Vaccine ; 39(3): 473-479, 2021 01 15.
Artículo en Inglés | MEDLINE | ID: mdl-33358265

RESUMEN

In absence of a COVID-19 vaccine, testing, contact tracing and social restrictions are among the most powerful strategies adopted around the world to slow down the spread of the pandemic. Citizens of most countries are suffering major physical, psychological and economic distress. At this stage, a safe and effective COVID-19 vaccine is the most sustainable option to manage the current pandemic. However, vaccine hesitancy by even a small subset of the population can undermine the success of this strategy. The objective of this research is to investigate the vaccine characteristics that matter the most to Australian citizens and to explore the potential uptake of a COVID-19 vaccine in Australia. Through a stated preference experiment, preferences towards a COVID-19 vaccine of 2136 residents of the Australian states and territories were collected and analysed via a latent class model. Results show that preferences for mild adverse cases, mode of administration, location of administration, price and effectiveness are heterogeneous. Conversely, preferences for immediacy and severe reactions are homogeneous, with respondents preferring a shorter period until vaccine is available and lower instances of severe side effects. The expected uptake of the vaccine is estimated under three different scenarios, with the value of 86% obtained for an average scenario. By calculating individual preferences, the willingness to pay is estimated for immediacy, effectiveness, mild and severe side effects.


Asunto(s)
/administración & dosificación , Aceptación de la Atención de Salud/psicología , Prioridad del Paciente/psicología , Vacunación/psicología , Adulto , Anciano , Australia , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias/prevención & control , Aceptación de la Atención de Salud/estadística & datos numéricos , Prioridad del Paciente/estadística & datos numéricos , Encuestas y Cuestionarios
9.
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
10.
JMIR Mhealth Uhealth ; 8(12): e20642, 2020 12 30.
Artículo en Inglés | MEDLINE | ID: mdl-33315579

RESUMEN

BACKGROUND: The COVID-19 pandemic has become a global public health event, which has raised concerns regarding individuals' health. Individuals need to cope with the COVID-19 pandemic with guidelines on symptom recognition, home isolation, and maintain mental health. Besides routine use of mobile health (mHealth) such as accessing information to keep healthy, individuals can use mHealth services in situations requiring urgent medical care, which is defined as mHealth emergency use. It is not known whether individuals have increased their daily mHealth services emergency use as a result of disruptions caused by the COVID-19 pandemic. OBJECTIVE: The purpose of this diary analysis study is to assess the influences of daily disruptions related to the COVID-19 pandemic on individuals' mHealth emergency use. The secondary purpose of this study is to explore the mediating role of COVID-19-induced strain and the moderating role of promotion regulatory focus in the relationship between daily disruptions of COVID-19 and mHealth emergency use. Drawing from the cognitive activation theory of stress, we investigated the underlying mechanism and boundary condition of the influence of COVID-19-related disruptions on daily mHealth emergency use. METHODS: To test the proposed model, this study adopts the experience sampling method to collect daily data. The experience sampling method helps researchers to capture participants' fluctuations in emotions, mental engagement in an activity, and experienced stress. This study collected 550 cases nested in 110 samples in mainland China to test the conceptual model. In addition, we employed hierarchical linear modeling analysis to test the effect of COVID-19-related disruptions on mHealth emergency use. RESULTS: We found that COVID-19-related disruptions increased COVID-19-induced strain (γ=0.24, P<.001) and mHealth emergency use on a daily basis (γ=0.28, P<.001). COVID-19-induced daily strain mediated this relationship (effect=0.09, 95% CI 0.05-0.14). Promotion regulatory focus moderated the relationship between COVID-19-induced strain and mHealth emergency use (γ=0.35, P=.02). In addition, the indirect relationship between disruptions and mHealth emergency use intentions through COVID-19-induced strain is contingent upon promotion regulatory focus: this relationship was stronger in those with high promotion regulatory focus (effect=0.12, 95% CI 0.06-0.19) than in those with low promotion regulatory focus (effect=0.06, 95% CI 0.02-0.11). CONCLUSIONS: Event disruption of the COVID-19 pandemic induced mHealth emergency use intention through increased psychological strain. Furthermore, individuals' promotion regulatory focus amplified this indirect relationship. Our findings extend our understanding of the factors underlying mHealth emergency use intention and illustrate the potential contingent role of promotion regulatory focus in the cognitive activation theory of stress. This study also opens avenues for future research on mHealth emergency use intention in other countries and cultural settings.


Asunto(s)
/psicología , Intención , Aceptación de la Atención de Salud/estadística & datos numéricos , Telemedicina/estadística & datos numéricos , Adolescente , Adulto , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Masculino , Evaluación de Necesidades
11.
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
12.
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
13.
PLoS Negl Trop Dis ; 14(12): e0008961, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33332359

RESUMEN

BACKGROUND: This study attempts to understand coronavirus disease 2019 (COVID-19) vaccine demand and hesitancy by assessing the public's vaccination intention and willingness-to-pay (WTP). Confidence in COVID-19 vaccines produced in China and preference for domestically-made or foreign-made vaccines was also investigated. METHODS: A nationwide cross-sectional, self-administered online survey was conducted on 1-19 May 2020. The health belief model (HBM) was used as a theoretical framework for understanding COVID-19 vaccination intent and WTP. RESULTS: A total of 3,541 complete responses were received. The majority reported a probably yes intent (54.6%), followed by a definite yes intent (28.7%). The perception that vaccination decreases the chances of getting COVID-19 under the perceived benefit construct (OR = 3.14, 95% CI 2.05-4.83) and not being concerned about the efficacy of new COVID-19 vaccines under the perceived barriers construct (OR = 1.65, 95% CI 1.31-2.09) were found to have the highest significant odds of a definite intention to take the COVID-19 vaccine. The median (interquartile range [IQR]) of WTP for COVID-19 vaccine was CNY¥200/US$28 (IQR CNY¥100-500/USD$14-72). The highest marginal WTP for the vaccine was influenced by socio-economic factors. The majority were confident (48.7%) and completely confident (46.1%) in domestically-made COVID-19 vaccine. 64.2% reported a preference for a domestically-made over foreign-made COVID-19 vaccine. CONCLUSIONS: The findings demonstrate the utility of HBM constructs in understanding COVID-19 vaccination intent and WTP. It is important to improve health promotion and reduce the barriers to COVID-19 vaccination.


Asunto(s)
/administración & dosificación , Aceptación de la Atención de Salud/estadística & datos numéricos , Vacunación/psicología , Adolescente , Adulto , Anciano , China/epidemiología , Estudios Transversales , Femenino , Humanos , Intención , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Encuestas y Cuestionarios , Vacunación/economía , Adulto Joven
14.
J Prim Care Community Health ; 11: 2150132720969557, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33174495

RESUMEN

OBJECTIVE: In this brief report, we characterize pediatric primary care service utilization in metropolitan Chicago over the first 24 weeks of the COVID-19 pandemic response in relation to the comparable time period in 2019. METHODS: We examined retrospective visit and billing data, regardless of payer, from 16 independent pediatric practices that utilize a common electronic medical record platform within an Accountable Care Organization of 252 pediatricians in 71 offices throughout metropolitan Chicago. We categorized visits as Well-Child and Immunization-Only (WC-IO) or Other types and identified visits with a telemedicine billing modifier. Diagnoses for Other visits were tallied and categorized using the Agency for Healthcare Research and Quality Clinical Classification System. We summarized counts of visits and the proportion of visits with a telemedicine billing modifier in one-week epochs for 2020 compared with 2019. RESULTS: There were 102 942 total visits (72 030 WC-IO; 30 912 Other) in 2020 and 144 672 visits (80 578 WC-IO; 64 094 Other) in 2019. WC-IO visits in 2020 were half of 2019 visits at the start of the Illinois Stay-at-Home Order and returned greater than 90% of 2019 visits in 8 weeks. Other visit types have remained below 70% of 2019 visits. A telemedicine billing modifier peaked in mid-April (21% of all visits) and declined to <10% of all visits in June (Phase 2 reopening). The top 10 most common diagnoses differed between years. CONCLUSIONS: Recovery of well child and immunization visits suggests that practice-level efforts and policy change can ensure children receive recommended care as the pandemic evolves.


Asunto(s)
Atención Ambulatoria , Salud del Niño , Infecciones por Coronavirus , Pandemias , Aceptación de la Atención de Salud/estadística & datos numéricos , Pediatría/estadística & datos numéricos , Neumonía Viral , Atención Primaria de Salud/estadística & datos numéricos , Adolescente , Betacoronavirus , Chicago/epidemiología , Niño , Preescolar , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Registros Electrónicos de Salud , Humanos , Inmunización , Lactante , Visita a Consultorio Médico/estadística & datos numéricos , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Estudios Retrospectivos , Aislamiento Social , Telemedicina
15.
BMJ Glob Health ; 5(11)2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33184065

RESUMEN

INTRODUCTION: The COVID-19 pandemic caused a healthcare crisis in China and continues to wreak havoc across the world. This paper evaluated COVID-19's impact on national and regional healthcare service utilisation and expenditure in China. METHODS: Using a big data approach, we collected data from 300 million bank card transactions to measure individual healthcare expenditure and utilisation in mainland China. Since the outbreak coincided with the 2020 Chinese Spring Festival holiday, a difference-in-difference (DID) method was employed to compare changes in healthcare utilisation before, during and after the Spring Festival in 2020 and 2019. We also tracked healthcare utilisation before, during and after the outbreak. RESULTS: Healthcare utilisation declined overall, especially during the post-festival period in 2020. Total healthcare expenditure and utilisation declined by 37.8% and 40.8%, respectively, while per capita expenditure increased by 3.3%. In a subgroup analysis, we found that the outbreak had a greater impact on healthcare utilisation in cities at higher risk of COVID-19, with stricter lockdown measures and those located in the western region. The DID results suggest that, compared with low-risk cities, the pandemic induced a 14.8%, 26.4% and 27.5% reduction in total healthcare expenditure in medium-risk and high-risk cities, and in cities located in Hubei province during the post-festival period in 2020 relative to 2019, an 8.6%, 15.9% and 24.4% reduction in utilisation services; and a 7.3% and 18.4% reduction in per capita expenditure in medium-risk and high-risk cities, respectively. By the last week of April 2020, as the outbreak came under control, healthcare utilisation gradually recovered, but only to 79.9%-89.3% of its pre-outbreak levels. CONCLUSION: The COVID-19 pandemic had a significantly negative effect on healthcare utilisation in China, evident by a dramatic decline in healthcare expenditure. While the utilisation level has gradually increased post-outbreak, it has yet to return to normal levels.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Gastos en Salud/estadística & datos numéricos , Accesibilidad a los Servicios de Salud , Aceptación de la Atención de Salud/estadística & datos numéricos , Neumonía Viral/epidemiología , Betacoronavirus , China/epidemiología , Humanos , Pandemias
16.
JAMA ; 324(15): 1532-1542, 2020 10 20.
Artículo en Inglés | MEDLINE | ID: mdl-33079153

RESUMEN

Importance: The World Health Organization is developing a global strategy to eliminate cervical cancer, with goals for screening prevalence among women aged 30 through 49 years. However, evidence on prevalence levels of cervical cancer screening in low- and middle-income countries (LMICs) is sparse. Objective: To determine lifetime cervical cancer screening prevalence in LMICs and its variation across and within world regions and countries. Design, Setting, and Participants: Analysis of cross-sectional nationally representative household surveys carried out in 55 LMICs from 2005 through 2018. The median response rate across surveys was 93.8% (range, 64.0%-99.3%). The population-based sample consisted of 1 136 289 women aged 15 years or older, of whom 6885 (0.6%) had missing information for the survey question on cervical cancer screening. Exposures: World region, country; countries' economic, social, and health system characteristics; and individuals' sociodemographic characteristics. Main Outcomes and Measures: Self-report of having ever had a screening test for cervical cancer. Results: Of the 1 129 404 women included in the analysis, 542 475 were aged 30 through 49 years. A country-level median of 43.6% (interquartile range [IQR], 13.9%-77.3%; range, 0.3%-97.4%) of women aged 30 through 49 years self-reported to have ever been screened, with countries in Latin America and the Caribbean having the highest prevalence (country-level median, 84.6%; IQR, 65.7%-91.1%; range, 11.7%-97.4%) and those in sub-Saharan Africa the lowest prevalence (country-level median, 16.9%; IQR, 3.7%-31.0%; range, 0.9%-50.8%). There was large variation in the self-reported lifetime prevalence of cervical cancer screening among countries within regions and among countries with similar levels of per capita gross domestic product and total health expenditure. Within countries, women who lived in rural areas, had low educational attainment, or had low household wealth were generally least likely to self-report ever having been screened. Conclusions and Relevance: In this cross-sectional study of data collected in 55 low- and middle-income countries from 2005 through 2018, there was wide variation between countries in the self-reported lifetime prevalence of cervical cancer screening. However, the median prevalence was only 44%, supporting the need to increase the rate of screening.


Asunto(s)
Detección Precoz del Cáncer/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Neoplasias del Cuello Uterino/diagnóstico , Adulto , Estudios Transversales , Países en Desarrollo , Femenino , Salud Global , Encuestas de Atención de la Salud , Humanos , Persona de Mediana Edad , Autoinforme
18.
J Psychiatr Res ; 131: 244-254, 2020 12.
Artículo en Inglés | MEDLINE | ID: mdl-33035957

RESUMEN

BACKGROUND: COVID-19 has affected social interaction and healthcare worldwide. METHODS: We examined changes in presentations and referrals to the primary provider of mental health and community health services in Cambridgeshire and Peterborough, UK (population ~0·86 million), plus service activity and deaths. We conducted interrupted time series analyses with respect to the time of UK "lockdown", which was shortly before the peak of COVID-19 infections in this area. We examined changes in standardized mortality ratio for those with and without severe mental illness (SMI). RESULTS: Referrals and presentations to nearly all mental and physical health services dropped at lockdown, with evidence for changes in both supply (service provision) and demand (help-seeking). This was followed by an increase in demand for some services. This pattern was seen for all major forms of presentation to liaison psychiatry services, except for eating disorders, for which there was no evidence of change. Inpatient numbers fell, but new detentions under the Mental Health Act were unchanged. Many services shifted from face-to-face to remote contacts. Excess mortality was primarily in the over-70s. There was a much greater increase in mortality for patients with SMI, which was not explained by ethnicity. CONCLUSIONS: COVID-19 has been associated with a system-wide drop in the use of mental health services, with some subsequent return in activity. "Supply" changes may have reduced access to mental health services for some. "Demand" changes may reflect a genuine reduction of need or a lack of help-seeking with pent-up demand. There has been a disproportionate increase in death among those with SMI during the pandemic.


Asunto(s)
Servicios de Salud Comunitaria/estadística & datos numéricos , Infecciones por Coronavirus , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Trastornos Mentales/mortalidad , Pandemias , Aceptación de la Atención de Salud/estadística & datos numéricos , Neumonía Viral , Derivación y Consulta/estadística & datos numéricos , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Servicios Comunitarios de Salud Mental/estadística & datos numéricos , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Control de Infecciones/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Mortalidad , Pandemias/prevención & control , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Reino Unido/epidemiología , Adulto Joven
19.
Obstet Gynecol ; 136(5): 1006-1015, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33030866

RESUMEN

OBJECTIVE: To evaluate the result of an inpatient postpartum human papillomavirus (HPV) immunization pilot program in a diverse, low-income patient population from an urban, hospital-based obstetrics and gynecology clinic. METHODS: In this cohort study, we present results from the first 2 years of the inpatient postpartum HPV immunization program, in which vaccine-eligible postpartum women were identified and immunized during their hospital stays. The program was implemented after educational outreach with prenatal and postpartum clinicians and nurses. Associations between receipt of the HPV vaccine as an inpatient and the characteristics of patients, and the likelihood of and missed opportunities for receiving a subsequent dose of the HPV vaccine as an outpatient were determined using logistic regression, time-to-event analyses, chi-squared tests and t-tests. RESULTS: From April 11, 2017, to April 10, 2019, 394 (59.2%) of 666 postpartum women were eligible for the inpatient postpartum HPV immunization program. The majority (265/394, 67.3%) received the immunization pilot program HPV dose; 36 of those 265 (13.6%) completed the series with that dose. Among women due for additional doses after hospital discharge, those who received the inpatient dose were more likely to receive a subsequent outpatient dose (138/229) than were those who did not receive an inpatient dose (39/129; hazard ratio 2.51, 95% CI 1.76-3.58). On average, there were 30.7 fewer (95% CI 5.8-55.6, P<.02) missed opportunities for subsequent outpatient doses for every 100 eligible visits among women who received the inpatient dose, compared with women who did not. By the end of the study, the proportion of women who had completed the vaccine series was higher among women who received the inpatient dose (95/265, 35.8%) than in those who did not (12 out 129, 9.3%; odds ratio 5.45, 95% CI 2.86-10.38). CONCLUSION: The inpatient postpartum HPV immunization program was associated with increased rates of immunization and addressed a previously missed opportunity. Inpatient immunization programs can serve as a critical way to address gaps in vaccine uptake.


Asunto(s)
Programas de Inmunización/estadística & datos numéricos , Pacientes Internos/estadística & datos numéricos , Infecciones por Papillomavirus/prevención & control , Vacunas contra Papillomavirus/administración & dosificación , Atención Posnatal/estadística & datos numéricos , Adulto , Distribución de Chi-Cuadrado , Femenino , Hospitales Urbanos , Humanos , Programas de Inmunización/métodos , Programas de Inmunización/normas , Modelos Logísticos , Aceptación de la Atención de Salud/estadística & datos numéricos , Atención Posnatal/métodos , Atención Posnatal/normas , Pobreza/estadística & datos numéricos , Embarazo , Evaluación de Programas y Proyectos de Salud , Mejoramiento de la Calidad , Adulto Joven
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