Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 9.961
Filtrar
1.
JAMA Netw Open ; 4(5): e2111629, 2021 05 03.
Artículo en Inglés | MEDLINE | ID: mdl-34042990

RESUMEN

Importance: The impact of COVID-19 in the US has been far-reaching and devastating, especially in Black populations. Vaccination is a critical part of controlling community spread, but vaccine acceptance has varied, with some research reporting that Black individuals in the US are less willing to be vaccinated than other racial/ethnic groups. Medical mistrust informed by experiences of racism may be associated with this lower willingness. Objective: To examine the association between race/ethnicity and rejection of COVID-19 vaccine trial participation and vaccine uptake and to investigate whether racial/ethnic group-based medical mistrust is a potential mediator of this association. Design, Setting, and Participants: This cross-sectional survey study was conducted from June to December 2020 using a convenience sample of 1835 adults aged 18 years or older residing in Michigan. Participants were recruited through community-based organizations and hospital-academic networks. Main Outcomes and Measures: Separate items assessed whether respondents, if asked, would agree to participate in a research study to test a COVID-19 vaccine or to receive a COVID-19 vaccine. Participants also completed the suspicion subscale of the Group-Based Medical Mistrust Scale. Results: Of the 1835 participants, 1455 (79%) were women, 361 (20%) men, and 19 (1%) other gender. The mean (SD) age was 49.4 (17.9) years, and 394 participants (21%) identified as Black individuals. Overall, 1376 participants (75%) reported low willingness to participate in vaccine trials, and 945 (52%) reported low willingness to be vaccinated. Black participants reported the highest medical mistrust scores (mean [SD], 2.35 [0.96]) compared with other racial/ethnic groups (mean [SD] for the total sample, 1.83 [0.91]). Analysis of path models revealed significantly greater vaccine trial and vaccine uptake rejection among Black participants (vaccine trial: B [SE], 0.51 [0.08]; vaccine uptake: B [SE], 0.51 [0.08]; both P < .001) compared with the overall mean rejection. The association was partially mediated by medical mistrust among Black participants (vaccine trial: B [SE], 0.04 [0.01]; P = .003; vaccine uptake: B [SE], 0.07 [0.02]; P < .001) and White participants (vaccine trial: B [SE], -0.06 [0.02]; P = .001; vaccine uptake: B [SE], -0.10 [0.02]; P < .001). Conclusions and Relevance: In this survey study of US adults, racial/ethnic group-based medical mistrust partially mediated the association between individuals identifying as Black and low rates of acceptance of COVID-19 vaccine trial participation and actual vaccination. The findings suggest that partnerships between health care and other sectors to build trust and promote vaccination may benefit from socially and culturally responsive strategies that acknowledge and address racial/ethnic health care disparities and historical and contemporary experiences of racism.


Asunto(s)
/uso terapéutico , Ensayos Clínicos como Asunto/psicología , Grupos de Población Continentales/psicología , Confianza , Negativa a la Vacunación/etnología , Adolescente , Adulto , Afroamericanos/psicología , Afroamericanos/estadística & datos numéricos , Anciano , Americanos Asiáticos/psicología , Americanos Asiáticos/estadística & datos numéricos , Actitud Frente a la Salud/etnología , Grupos de Población Continentales/estadística & datos numéricos , Estudios Transversales , Grupo de Ascendencia Continental Europea/psicología , Grupo de Ascendencia Continental Europea/estadística & datos numéricos , Femenino , Hispanoamericanos/psicología , Hispanoamericanos/estadística & datos numéricos , Humanos , Masculino , Michigan , Persona de Mediana Edad , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Confianza/psicología , Negativa a la Vacunación/psicología , Negativa a la Vacunación/estadística & datos numéricos , Adulto Joven
3.
BMC Emerg Med ; 21(1): 56, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33932988

RESUMEN

BACKGROUND: Emergency department (ED) visits due to non-coronavirus disease 2019 (COVID-19) conditions have drastically decreased since the outbreak of the COVID-19 pandemic. This study aimed to identify the magnitude, characteristics and underlying motivations of ED visitors with delayed healthcare seeking behaviour during the first wave of the pandemic. METHODS: Between March 9 and July 92,020, adults visiting the ED of an academic hospital in the East of the Netherlands received an online questionnaire to collect self-reported data on delay in seeking emergency care and subsequent motivations for this delay. Telephone interviews were held with a subsample of respondents to better understand the motivations for delay as described in the questionnaire. Quantitative data were analysed using descriptive statistics. Qualitative data were thematically analysed. RESULTS: One thousand three hundred thirty-eight questionnaires were returned (34.0% response). One in five respondents reported a delay in seeking emergency care. Almost half of these respondents (n = 126; 45.4%) reported that the pandemic influenced the delay. Respondents reporting delay were mainly older adults (mean 61.6; ±13.1 years), referred to the ED by the general practitioner (GP; 35.1%) or a medical specialist (34.7%), visiting the ED with cardiac problems (39.7%). The estimated median time of delay in receiving ED care was 3 days (inter quartile range  8 days). Respectively 46 (16.5%) and 26 (9.4%) respondents reported that their complaints would be either less severe or preventable if they had sought for emergency care earlier. Delayed care seeking behaviour was frequently motivated by: fear of contamination, not wanting to burden professionals, perceiving own complaints less urgent relative to COVID-19 patients, limited access to services, and by stay home instructions from referring professionals. CONCLUSIONS: A relatively large proportion of ED visitors reported delay in seeking emergency care during the first wave. Delay was often driven by misperceptions of the accessibility of services and the legitimacy for seeking emergency care. Public messaging and close collaboration between the ED and referring professionals could help reduce delayed care for acute needs during future COVID-19 infection waves.


Asunto(s)
Actitud Frente a la Salud , Servicio de Urgencia en Hospital/estadística & datos numéricos , Conducta de Búsqueda de Ayuda , Aceptación de la Atención de Salud/estadística & datos numéricos , Factores de Edad , Anciano , Servicios Médicos de Urgencia , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Persona de Mediana Edad , Países Bajos , Aceptación de la Atención de Salud/psicología , Estudios Retrospectivos
4.
BMJ ; 373: n1022, 2021 05 18.
Artículo en Inglés | MEDLINE | ID: mdl-34006604

RESUMEN

OBJECTIVE: To evaluate whether opt out framing, messaging incorporating behavioral science concepts, or electronic communication increases the uptake of hepatitis C virus (HCV) screening in patients born between 1945 and 1965. DESIGN: Pragmatic randomized controlled trial. SETTING: 43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020. PARTICIPANTS: Patients born between 1945 and 1965 with no history of screening and at least two primary care visits in the two years before the enrollment period. INTERVENTIONS: This multilevel trial was divided into two studies. Substudy A included 1656 eligible patients of 17 primary care clinicians who were randomized in a 1:1 ratio to a mailed letter about HCV screening (letter only), or a similar letter with a laboratory order for HCV screening (letter+order). Substudy B included the remaining 19 837 eligible patients followed by 417 clinicians. Active electronic patient portal users were randomized 1:5 to receive a mailed letter about HCV screening (letter), or an electronic patient portal message with similar content (patient portal); inactive patient portal users were mailed a letter. In a factorial design, patients in substudy B were also randomized 1:1 to receive standard content (usual care), or content based on principles of social norming, anticipated regret, reciprocity, and commitment (behavioral content). MAIN OUTCOME MEASURES: Proportion of patients who completed HCV testing within four months. RESULTS: 21 303 patients were included in the intention-to-treat analysis. Among the 1642 patients in substudy A, 19.2% (95% confidence interval 16.5% to 21.9%) completed screening in the letter only arm and 43.1% (39.7% to 46.4%) in the letter+order arm (P<0.001). Among the 19 661 patients in substudy B, 14.6% (13.9% to 15.3%) completed screening with usual care content and 13.6% (13.0% to 14.3%) with behavioral science content (P=0.06). Among active patient portal users, 17.8% (16.0% to 19.5%) completed screening after receiving a letter and 13.8% (13.1% to 14.5%) after receiving a patient portal message (P<0.001). CONCLUSIONS: Opt out framing and effort reduction by including a signed laboratory order with outreach increased screening for HCV. Behavioral science messaging content did not increase uptake, and mailed letters achieved a greater response rate than patient portal messages. TRIAL REGISTRATION: ClinicalTrials.gov NCT03712553.


Asunto(s)
Control de la Conducta/métodos , Relaciones Comunidad-Institución , Hepatitis C/diagnóstico , Tamizaje Masivo/psicología , Aceptación de la Atención de Salud/psicología , Anciano , Método Doble Ciego , Femenino , Estudios de Seguimiento , Humanos , Masculino , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Motivación , Aceptación de la Atención de Salud/estadística & datos numéricos , Portales del Paciente , Pennsylvania , Servicios Postales , Atención Primaria de Salud/estadística & datos numéricos , Resultado del Tratamiento
5.
Nurse Pract ; 46(6): 37-42, 2021 06 01.
Artículo en Inglés | MEDLINE | ID: mdl-34004640

RESUMEN

ABSTRACT: The impact of COVID-19 on older adults may not be readily apparent. Personal protective and social distancing measures can reduce activity levels, increase feelings of isolation and loss, and result in lapsed medical care. NPs must recognize detrimental impacts on overall health and wellness and assist older adults in overcoming them.


Asunto(s)
/psicología , Transmisión de Enfermedad Infecciosa/prevención & control , Anciano Frágil/psicología , Anciano Frágil/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Adaptación Psicológica , Anciano , Anciano de 80 o más Años , Femenino , Humanos , Masculino , Estrés Psicológico , Estados Unidos/epidemiología
6.
Reprod Health ; 18(1): 100, 2021 May 21.
Artículo en Inglés | MEDLINE | ID: mdl-34020669

RESUMEN

BACKGROUND: Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for desired outcomes. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to assess the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. METHODS: A community-based cross-sectional study was conducted from February 1 to 30, 2020. A total of 600 mothers who have given birth in the last 12 months have been randomly selected. A two-stage sampling technique was employed. For data collection, a pre-tested, semi-structured questionnaire was used. The data was encoded and entered into Epi-Data version 3.1 and exported for analysis to SPSS version 23. Household wealth status was determined through the application of principal component analysis(PCA). The practice PCC was considered as a count variable and measured as a minimum score of 0 and a maximum of 10. A bivariable statistical analysis was performed through analysis of variance (ANOVA) and independent t-tests and variables with a p-value of < 0.05 were eligible for the generalized linear regression model. To see the weight of each explanatory variable on PCC utilization, generalized linear regression with a Poisson link was done. RESULTS: Of the sampled 600 participants, 591 took part in the study, which yielded a response rate of 98.8%.The mean (± SD) score of the practice of PCC was 3.94 (± 1.98) with minimum and maximum scores of 0 and 10 respectively. Only 6.4% (95%CI: 4.6, 8.6) of mothers received all selected items of PCC services. Thecommonest item received by 67.2% of mothers was Folic acid supplementation, while 16.1% of mothers received the least item of optimizing psychological health. Education status of mother[AOR 0.74, 95%CI 0.63, 0.97], time spent to access nearby health facilities [AOR 0.69, 95%CI 0.58, 0.83], availability of PCC unit [AOR 1.46; 95%CI 1.17, 1.67], mother's knowledge on PCC [AOR 1.34, 95%CI 1.13, 1.65], being a model household [AOR 1.31, 95%CI 1.18, 1.52] and women's autonomy in decision making [AOR 0.75, 95%CI 0.64, 0.96] were identified as significant predictors of practice of PCC. CONCLUSION: The uptake of WHO-recommended PCC service elements in the current study area was found to be unsatisfactory. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice. Plain language summary Preconception care (PCC) is a series of biomedical, mental, and psycho-social health services provided to women and a couple before pregnancy and throughout subsequent pregnancies for better endings. The main goal of the PCC is to improve maternal and child health outcomes, by-promoting wellness and providing preventive care. It can also be seen as an earlier chance for teenage girls, mothers, and children to live a better and longer-term healthy life. Pieces of PCC service packages suggested by the World Health Organization(WHO) are, micronutrient supplementation (Folate supplementation), infectious disease (STI/HIV) screening and testing, chronic disease screening and management, healthy diet therapy, vaccination, prevention of substance use (cessation of cigarette smoking and too much alcohol consumption), optimizing psychological health, counseling on the importance of exercise and reproductive health planning and implementation. Millions of women and new-borns have died in low-income countries due to impediments that arise before and exaggerate during pregnancies that are not deal with as part of pre-conception care. To the best of our knowledge, however, there is a lack of information about preconception care practice and its determinants in southern Ethiopia, including the study area. This study was therefore planned to evaluate the practice of preconception care and its determinants among mothers who recently gave birth in Wolkite town, southern Ethiopia, in 2020. Mothers who have given birth in the last 12 months have been randomly selected Household wealth status was determined through the application of principal component analysis(PCA). To see the weight of each explanatory variable on PCC, generalized linear regression with a Poisson type was done. Accordingly, the Education status of the mother, time spent to access nearby health facilities, availability of PCC unit, mother's knowledge on PCC, being a model household, and women's autonomy in decision making were identified as significant predictors of practice of PCC. Stakeholders must therefore increase their efforts to align PCC units with existing MNCH service delivery points, improve women's decision-making autonomy, and focus on behavioral change communication to strengthen PCC practice.


Asunto(s)
Atención a la Salud/organización & administración , Instituciones de Salud/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Aceptación de la Atención de Salud/psicología , Atención Preconceptiva/métodos , Atención Preconceptiva/estadística & datos numéricos , Salud Reproductiva , Adolescente , Adulto , Niño , Estudios Transversales , Etiopía , Femenino , Humanos , Masculino , Embarazo , Salud de la Mujer
7.
BMC Infect Dis ; 21(1): 472, 2021 May 25.
Artículo en Inglés | MEDLINE | ID: mdl-34030652

RESUMEN

BACKGROUND: HIV Pre-exposure prophylaxis (PrEP) is being considered for implementation among MSM nationwide in Vietnam. However, there may be concerns about potential obstacles for PrEP adherence among Vietnamese MSM. This study aims to assess the acceptability to use PrEP, potential barriers and facilitators, and the preferences for PrEP service accessibility and delivery among Vietnamese MSM. METHODS: Four focus group discussions (FGDs) were conducted with 30 HIV-negative MSM in January 2018 in Hanoi, Vietnam. FGDs explored MSM's awareness regarding PrEP, perceived benefits and barriers of PrEP use, and willingness to use PrEP. FGDs were audio-recorded and transcribed verbatim. Content analysis was used. RESULTS: The mean age of participants was 23.9 years old. Most participants realized the advantages of PrEP given its efficacy in HIV risk reduction and expressed high motivation and interest to use PrEP in the future. PrEP was considered as a supplement alongside condoms. Common concerns about PrEP included side-effects, forgetting to take the pill daily, stigmatization due to using PrEP, negative attitudes toward PrEP from other MSM and accessibility of PrEP. Participants would prefer an injectable PrEP regime if available as it was seen as easier to adhere to. Concerns were also raised that PrEP usage could be interpreted as an indication of engaging in sexual risk behavior for HIV, potentially causing suspicion in love relationships or by family and friends. Participants preferred to receive PrEP in civil business organizations and MSM-friendly clinics, and recommended that pharmacy stores would not be suitable for PrEP implementation due to lack of trust and fear of fake drugs. CONCLUSION: This study indicated a high level of willingness to use PrEP among MSM in Vietnam in combination with condom. Strategies to raise awareness of PrEP, reduce stigma towards PrEP, and improve the accessibility among MSM in Vietnam is needed. Existing MSM-friendly clinics were recommended to implement PrEP programs in Vietnam.


Asunto(s)
Atención a la Salud/métodos , Infecciones por VIH/prevención & control , Aceptación de la Atención de Salud/psicología , Profilaxis Pre-Exposición , Adulto , Atención a la Salud/organización & administración , Grupos Focales , Homosexualidad Masculina , Humanos , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Investigación Cualitativa , Minorías Sexuales y de Género , Estigma Social , Vietnam , Adulto Joven
8.
AIDS Educ Prev ; 33(3): 216-233, 2021 06.
Artículo en Inglés | MEDLINE | ID: mdl-34014108

RESUMEN

Women experiencing incarceration (WEI) in the United States are disproportionately impacted by HIV, yet HIV pre-exposure prophylaxis (PrEP) is underutilized by women in the United States. In order to inform an intervention to promote PrEP initiation during incarceration and facilitate linkage to PrEP care following release from incarceration, we conducted individual, semistructured qualitative interviews with WEI (N = 21) and key stakeholders (N = 14). While WEI had little or no previous knowledge about PrEP, they viewed it as something that would benefit women involved in the criminal justice system. Participants stated that HIV-related stigma and underestimation of HIV risk might serve as barriers to PrEP initiation during incarceration. Participants reported that competing priorities, difficulty scheduling an appointment, and lack of motivation could interfere with linkage to PrEP care in the community. Further, cost, substance use, and difficulty remembering to take the medication were cited most commonly as likely barriers to adherence.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Servicios de Salud Comunitaria/organización & administración , Infecciones por VIH/prevención & control , Cumplimiento de la Medicación/psicología , Aceptación de la Atención de Salud/psicología , Profilaxis Pre-Exposición/métodos , Prisioneros/estadística & datos numéricos , Estigma Social , Trastornos Relacionados con Sustancias/complicaciones , Adulto , Fármacos Anti-VIH/uso terapéutico , Femenino , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Motivación , Investigación Cualitativa , Asunción de Riesgos , Conducta Sexual , Trastornos Relacionados con Sustancias/psicología , Estados Unidos
9.
Integr Cancer Ther ; 20: 15347354211019111, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34036820

RESUMEN

BACKGROUND: The acceptability of videoconferencing delivery of yoga interventions in the advanced cancer setting is relatively unexplored. The current report summarizes the challenges and solutions of the transition from an in-person (ie, face-to-face) to a videoconference intervention delivery approach in response to the Coronavirus Disease pandemic. METHOD: Participants included patient-family caregiver dyads who were enrolled in ongoing yoga trials and 2 certified yoga therapists who delivered the yoga sessions. We summarized their experiences using recordings of the yoga sessions and interventionists' progress notes. RESULTS: Out of 7 dyads participating in the parent trial, 1 declined the videoconferenced sessions. Participants were between the ages of 55 and 76 and mostly non-Hispanic White (83%). Patients were mainly male (83%), all had stage III or IV cancer and were undergoing radiotherapy. Caregivers were all female. Despite challenges in the areas of technology, location, and setting, instruction and personal connection, the overall acceptability was high among patients, caregivers, and instructors. Through this transition process, solutions to these challenges were found, which are described here. CONCLUSION: Although in-person interventions are favored by both the study participants and the interventionists, videoconference sessions were deemed acceptable. All participants had the benefit of a previous in-person experience, which was helpful and perhaps necessary for older and advanced cancer patients requiring practice modifications. In a remote setting, the assistance of caregivers seems particularly beneficial to ensure practice safety. CLINICALTRIALS.GOV: NCT03948100; NCT02481349.


Asunto(s)
COVID-19/epidemiología , Cuidadores , Neoplasias/terapia , Comunicación por Videocoferencia , Yoga , Adulto , Anciano , Actitud del Personal de Salud , COVID-19/psicología , Cuidadores/psicología , Estudios de Factibilidad , Femenino , Humanos , Masculino , Meditación/métodos , Meditación/psicología , Persona de Mediana Edad , Neoplasias/psicología , Pandemias , Aceptación de la Atención de Salud/psicología , Percepción , Telemedicina/métodos , Telemedicina/organización & administración , Resultado del Tratamiento , Yoga/psicología
10.
Emergencias ; 33(3): 181-186, 2021 06.
Artículo en Inglés, Español | MEDLINE | ID: mdl-33978331

RESUMEN

BACKGROUND: The time lapse between onset of symptoms and a call to an emergency dispatch center (pain-to-call time) is a critical prognostic factor in patients with chest pain. It is therefore important to identify factors related to delays in calling for help. OBJECTIVES: To analyze whether age, gender, or time of day influence the pain-to-call delay in patients with acute STsegment elevation myocardial infarction (STEMI). MATERIAL AND METHODS: Data were extracted from a prospective registry of STEMI cases managed by 39 mobile intensive care ambulance teams before hospital arrival within 24 hours of onset in our region, the greater metropolitan area of Paris, France. We analyzed the relation between pain-to-call time and the following factors: age, gender, and the time of day when symptoms appeared. We also assessed the influence of pain-to-call time on the rate of prehospital decisions to implement reperfusion therapy. RESULTS: A total of 24 662 consecutive patients were included; 19 291 (78%) were men and 4371 (22%) were women. The median age was 61 (interquartile range, 52-73) years (men, 59 [51-69] years; women, 73 [59-83] years; P .0001). The median pain-to-call time was 60 (24-164) minutes (men, 55 [23-150] minutes; women, 79 [31-220] minutes; P .0001). The delay varied by time of day from a median of 40 (17-101) minutes in men between 5 pm and 6 pm to 149 (43-377) minutes in women between 2 am and 3 am. The delay was longer in women regardless of time of day and increased significantly with age in both men and women (P .001). A longer pain-to-call time was significantly associated with a lower rate of implementation of myocardial reperfusion (P .001). CONCLUSION: Pain-to-call delays were longer in women and older patients, especially at night. These age and gender differences identify groups that would benefit most from health education interventions.


Asunto(s)
Factores de Edad , Servicios Médicos de Urgencia , Conducta de Búsqueda de Ayuda , Aceptación de la Atención de Salud/estadística & datos numéricos , Infarto del Miocardio con Elevación del ST/epidemiología , Factores Sexuales , Factores de Tiempo , Tiempo de Tratamiento , Anciano , Anciano de 80 o más Años , Ambulancias/estadística & datos numéricos , Dolor en el Pecho/epidemiología , Dolor en el Pecho/etiología , Femenino , Educación en Salud , Humanos , Masculino , Persona de Mediana Edad , Reperfusión Miocárdica/estadística & datos numéricos , Paris/epidemiología , Aceptación de la Atención de Salud/psicología , Utilización de Procedimientos y Técnicas/estadística & datos numéricos , Pronóstico , Estudios Prospectivos , Sistema de Registros , Factores de Riesgo , Infarto del Miocardio con Elevación del ST/psicología , Infarto del Miocardio con Elevación del ST/terapia
11.
Epidemiol Infect ; 149: e123, 2021 05 11.
Artículo en Inglés | MEDLINE | ID: mdl-33972001

RESUMEN

We investigated likelihood to vaccinate and reasons for and against accepting a coronavirus disease 2019 (COVID-19) vaccine among adult residents of Finland. Vaccine acceptance declined from 70% in April to 64% in December 2020. Complacency and worry about side effects were main reasons against vaccination while concern about severe disease was a strong motive for vaccination. Convenience of vaccination and recommendations by healthcare workers were identified as enablers for vaccination among those aged under 50 years. Understanding barriers and enablers behind vaccine acceptance is decisive in ensuring a successful implementation of COVID-19 vaccination programmes, which will be key to ending the pandemic.


Asunto(s)
/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Negativa a la Vacunación , Vacunación , Adolescente , Adulto , Anciano , Femenino , Finlandia , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Encuestas y Cuestionarios , Vacunación/psicología , Vacunación/estadística & datos numéricos , Negativa a la Vacunación/psicología , Negativa a la Vacunación/estadística & datos numéricos , Adulto Joven
13.
BMC Health Serv Res ; 21(1): 317, 2021 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-33827570

RESUMEN

BACKGROUND: To identify the determinants of health care use among homeless individuals. METHODS: Data were taken from the Hamburg survey of homeless individuals (n = 100 individuals in the here used model, mean age 44.8 years, SD 12.5) focusing on homeless individuals in Hamburg, Germany. The number of physician visits in the past 3 months and hospitalization in the preceding 12 months were used as outcome measures. Drawing on the Andersen model of health care use as a conceptual framework, predisposing characteristics, enabling resources and need factors as well as psychosocial variables were included as correlates. RESULTS: Negative binomial regressions showed that increased physician visits were associated with being female (IRR: 4.02 [95% CI: 1.60-10.11]), absence of chronic alcohol consume (IRR: 0.26 [95% CI: 0.12-0.57]) and lower health-related quality of life (IRR: 0.97 [95% CI: 0.96-0.98]). Furthermore, logistic regressions showed that the likelihood of hospitalization was positively associated with lower age (OR: 0.93 [95% CI: 0.89-0.98]), having health insurance (OR: 8.11 [2.11-30.80]) and lower health-related quality of life (OR: 0.97 [95% CI: 0.94-0.99]). CONCLUSIONS: Our study showed that predisposing characteristics (both age and sex), enabling resources (i.e., health insurance) and need factors in terms of health-related quality of life are main drivers of health care use among homeless individuals. This knowledge may assist in managing health care use.


Asunto(s)
Accesibilidad a los Servicios de Salud , Personas sin Hogar , Aceptación de la Atención de Salud/psicología , Adulto , Atención a la Salud , Femenino , Alemania/epidemiología , Personas sin Hogar/psicología , Humanos , Masculino , Calidad de Vida , Encuestas y Cuestionarios
14.
Dan Med J ; 68(5)2021 03 31.
Artículo en Inglés | MEDLINE | ID: mdl-33870886

RESUMEN

INTRODUCTION Prompted by reports of thromboembolic events - some with fatal outcomes - among people who had received the ChAdOx1 nCoV-19 (AZD1222) vaccine from Oxford-AstraZeneca against COVID-19, a number of European countries paused vaccination with this vaccine in early and mid-March 2021. Prior studies have suggested that vaccine willingness is highly dependent on public trust in the safety of vaccines. We therefore investigated whether vaccine willingness dropped in the wake of the reported cases of thromboembolic events in relation to the Oxford-AstraZeneca COVID-19 vaccine. METHODS Using longitudinal survey data from Denmark, we compared vaccine willingness shortly before and after the reported cases of thromboembolic events, as well as the perceived safety of the two most widely used COVID-19 vaccines in Denmark - those from Pfizer-BioNTech and Oxford-AstraZeneca - in the wake of these events. RESULTS We found sustained vaccine willingness after the reported cases of thromboembolic events (89% both before and after). However, the safety of the Oxford-AstraZeneca COVID-19 vaccine was perceived to be significantly and substantially lower than the safety of the vaccine from Pfizer-BioNTech, and this difference was particularly pronounced among those who were vaccine-hesitant. CONCLUSIONS The vaccine willingness of Danes does not seem to have been affected by the reports of thromboembolic events in relation to the Oxford-AstraZeneca COVID-19 vaccine. FUNDING The study was funded by a grant from the Novo Nordisk Foundation (grant number: NNF20SA0062874). TRIAL REGISTRATION not relevant.


Asunto(s)
/efectos adversos , Aceptación de la Atención de Salud/psicología , Tromboembolia/inducido químicamente , Tromboembolia/epidemiología , Anciano , Dinamarca/epidemiología , Europa (Continente)/epidemiología , Femenino , Humanos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Pandemias , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Encuestas y Cuestionarios , Confianza
15.
Medicine (Baltimore) ; 100(15): e25286, 2021 Apr 16.
Artículo en Inglés | MEDLINE | ID: mdl-33847626

RESUMEN

ABSTRACT: To explore associations between self-reported ill-health as a primary motivator for HIV-testing and socio-demographic factors.Four local primary healthcare clinics in Johannesburg, South Africa.A total of 529 newly HIV diagnosed adults (≥18 years) enrolled from October 2017 to August 2018, participated in the survey on the same day of diagnosis.Testing out of own initiative or perceived HIV exposure was categorized as asymptomatic. Reporting ill-health as the main reason for testing was categorized as symptomatic. Modified Poisson regression was used to evaluate predictors of motivators for HIV testing.Overall, 327/520 (62.9%) participants reported symptoms as the main motivator for testing. Among the asymptomatic, 17.1% reported potential HIV exposure as a reason for testing, while 20.0% just wanted to know their HIV status. Baseline predictors of symptom-related motivators for HIV testing include disclosing intention to test (aPR 1.4 for family/friend/others vs partners/spouse, 95% CI: 1.1-1.8; aPR 1.4 for not disclosing vs partners/spouse, 95% CI: 1.1-1.7), and HIV testing history (aPR 1.2 for last HIV test >12-months ago vs last test 12-months prior, 95% CI: 1.0-1.5; aPR 1.3 for never tested for HIV before vs last test 12-months prior, 95%CI:1.0-1.6).Findings indicate that newly diagnosed HIV positive patients still enter care because of ill-health, not prevention purposes. Increasing early HIV testing remains essential to maximize the benefits of expanded ART access.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/psicología , Motivación , Aceptación de la Atención de Salud/psicología , Adolescente , Adulto , Factores de Edad , Revelación , Femenino , Accesibilidad a los Servicios de Salud , Estado de Salud , Humanos , Masculino , Atención Primaria de Salud , Estudios Prospectivos , Autoinforme , Índice de Severidad de la Enfermedad , Factores Sexuales , Factores Socioeconómicos , Sudáfrica , Adulto Joven
17.
MMWR Morb Mortal Wkly Rep ; 70(13): 473-477, 2021 Apr 02.
Artículo en Inglés | MEDLINE | ID: mdl-33793457

RESUMEN

Incarcerated and detained persons are at increased risk for acquiring COVID-19. However, little is known about their willingness to receive a COVID-19 vaccination. During September-December 2020, residents in three prisons and 13 jails in four states were surveyed regarding their willingness to receive a COVID-19 vaccination and their reasons for COVID-19 vaccination hesitancy or refusal. Among 5,110 participants, 2,294 (44.9%) said they would receive a COVID-19 vaccination, 498 (9.8%) said they would hesitate to receive it, and 2,318 (45.4%) said they would refuse to receive it. Willingness to receive a COVID-19 vaccination was lowest among Black/African American (Black) (36.7%; 510 of 1,390) persons, participants aged 18-29 years (38.5%; 583 of 1,516), and those who lived in jails versus prisons (43.7%; 1,850 of 4,232). Common reasons reported for COVID-19 vaccine hesitancy were waiting for more information (54.8%) and efficacy or safety concerns (31.0%). The most common reason for COVID-19 vaccination refusal was distrust of health care, correctional, or government personnel or institutions (20.1%). Public health interventions to improve vaccine confidence and trust are needed to increase vaccination acceptance by incarcerated or detained persons.


Asunto(s)
/administración & dosificación , Aceptación de la Atención de Salud/psicología , Prisioneros/psicología , Vacunación/psicología , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , /prevención & control , Brotes de Enfermedades/prevención & control , Femenino , Humanos , Masculino , Persona de Mediana Edad , Prisioneros/estadística & datos numéricos , Prisiones , Factores Socioeconómicos , Encuestas y Cuestionarios , Estados Unidos/epidemiología , Adulto Joven
18.
Acad Med ; 96(5): 635-640, 2021 05 01.
Artículo en Inglés | MEDLINE | ID: mdl-33885412

RESUMEN

After a medical student prompted medical faculty to tell their stories of depression and related mental health issues, the author wrote this article with the aim of decreasing the stigma of mental illness and encouraging treatment, as needed, in the medical profession. The professional culture of the house of medicine not only mimics society in attributing stigma to people with mental health issues but may also contribute to high rates of suicide in the ranks of health care professionals by leading to a delay in seeking treatment. Acculturation accelerates in the first year of medical school such that medical students experience an increase in burnout and depressive symptoms from prematriculation levels. It follows that faculty have a responsibility to improve the learning environment. Survey data from medical faculty at the author's institution showed that depression decreased respondents' willingness to seek mental health treatment because of the stigma and issues of access to help. Faculty attitudes toward mental health issues, including reluctance to admit having such issues, may be conveyed to medical students in the hidden curriculum that teaches them to keep depression hidden. Moreover, the fear of mental disorders is manifested in licensing and privileging applications under the guise of patient safety, contributing to a culture of shame and silence. As creators and guardians of this professional culture, medical faculty and other physicians must be the ones who change it. The same faculty who play a part in causing and perpetuating stigma related to mental health issues have the power to derive and enact some of the solutions. In addition to giving voice to a personal experience of mental health issues, this article offers suggestions for normalizing moderate to severe depression as a medical disorder, decreasing the stigma of mental health issues, and encouraging faculty to seek treatment.


Asunto(s)
Depresión/psicología , Aceptación de la Atención de Salud/psicología , Médicos/psicología , Estigma Social , Antidepresivos/uso terapéutico , Agotamiento Profesional/psicología , Depresión/tratamiento farmacológico , Humanos , Internado y Residencia , Psiquiatría/educación , Psicoterapia
19.
Nutrients ; 13(3)2021 Mar 04.
Artículo en Inglés | MEDLINE | ID: mdl-33806617

RESUMEN

Achieving the optimal transition to a family diet over the first two years of life has remained a challenge in Ethiopia. The use of amylase-rich flour (ARF) can improve complementary foods. However, utilisation requires an effective delivery strategy for upskilling the community to use ARF. The aim of this study was to explore facilitators and barriers of cascading ARF skills to improve complementary foods. The study was conducted in Gale Mirga kebele of Kersa district in Eastern Ethiopia in 2016. The study utilised exploratory qualitative research that used participatory action. Focus group discussions (FGDs) were conducted with the Health Development Army (HDA) leaders, religious leaders, and observation of participatory complementary food demonstrations. Cultural acceptability and the presence of HDA structure that supports skill development were identified as key facilitators to ARF use. On the other hand, the potential barriers to expanding ARF skill were lack of sustainability of external skill support for HDA leaders, perceived time constraints, unsuitable demonstration settings, cooking method, and large group size. The indigenous community's knowledge of germination has not been used to improve complementary foods. The universal use of ARF requires integration into the Health Extension Programme (HEP) with support and supervision for HDA leaders.


Asunto(s)
Amilasas/administración & dosificación , Dieta/psicología , Conducta Alimentaria/psicología , Alimentos Fortificados , Aceptación de la Atención de Salud/psicología , Cultura , Etiopía , Femenino , Harina/análisis , Grupos Focales , Humanos , Lactante , Fenómenos Fisiológicos Nutricionales del Lactante , Masculino , Investigación Cualitativa
20.
AIDS Educ Prev ; 33(2): 103-119, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33821679

RESUMEN

HIV pre-exposure prophylaxis (PrEP) reduces HIV acquisition among adolescent girls and young women (AGYW). Existing evidence suggests that uptake and adherence are low among AGYW and that relationship factors such as gender-based violence (GBV) are important barriers. Through a community-based participatory research (CBPR) process, a youth advisory board (YAB), service providers (SP), and a study team developed the Tu'Washindi na PrEP intervention to support AGYW PrEP use in the context of GBV. The YAB also guided the formative research and interpretation of results. The authors pretested the intervention with SP, AGYW and their partners, and community change agents, and then developed guides for AGYW support clubs, community-based male sensitization sessions, and couples-based events that included formulation of story lines for dramatized PrEP negotiation and information dissemination skills. Stakeholder engagement led to an intervention responsive to AGYW's needs for PrEP support in the context of their relationships, which was evaluated through a 6-month pilot community randomized controlled trial.


Asunto(s)
Fármacos Anti-VIH/administración & dosificación , Violencia de Género/psicología , Infecciones por VIH/prevención & control , Aceptación de la Atención de Salud/psicología , Profilaxis Pre-Exposición/métodos , Profilaxis Pre-Exposición/estadística & datos numéricos , Adolescente , Fármacos Anti-VIH/uso terapéutico , Investigación Participativa Basada en la Comunidad , Femenino , Infecciones por VIH/psicología , Humanos , Adulto Joven
SELECCIÓN DE REFERENCIAS
DETALLE DE LA BÚSQUEDA
...