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1.
BMJ Case Rep ; 13(8)2020 Aug 25.
Artículo en Inglés | MEDLINE | ID: mdl-32843473

RESUMEN

The current COVID-19 crisis has significantly impacted healthcare systems worldwide. There has been a palpable increase in public avoidance of hospitals, which has interfered in timely care of critical cardiovascular conditions. Complications from late presentation of myocardial infarction, which had become a rarity, resurfaced during the pandemic. We present two such encounters that occurred due to delay in seeking medical care following myocardial infarction due to the fear of contracting COVID-19 in the hospital. Moreover, a comprehensive review of literature is performed to illustrate the potential factors delaying and decreasing timely presentations and interventions for time-dependent medical emergencies like ST-segment elevation myocardial infarction (STEMI). We emphasise that clinicians should remain vigilant of encountering rare and catastrophic complications of STEMI during this current era of COVID-19 pandemic.


Asunto(s)
Infecciones por Coronavirus/epidemiología , Servicio de Urgencia en Hospital , Miedo , Aceptación de la Atención de Salud/psicología , Neumonía Viral/epidemiología , Infarto del Miocardio con Elevación del ST/diagnóstico , Tiempo de Tratamiento , Anciano de 80 o más Años , Betacoronavirus , Femenino , Humanos , Persona de Mediana Edad , Pandemias , Infarto del Miocardio con Elevación del ST/complicaciones , Infarto del Miocardio con Elevación del ST/terapia
2.
PLoS One ; 15(7): e0234876, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32645017

RESUMEN

BACKGROUND: Access to neurology specialty care can influence outcomes in individuals with multiple sclerosis (MS), but may vary based on patient sociodemographic characteristics, including immigration status. OBJECTIVE: To compare health services utilization in the year of MS diagnosis, one year before diagnosis and two years after diagnosis in immigrants versus long-term residents in Ontario, Canada. METHODS: We identified incident cases of MS among adults aged 20-65 years by applying a validated algorithm to health administrative data in Ontario, Canada, a region with universal health insurance and comprehensive coverage. We separately assessed hospitalizations, emergency department (ED) visits, outpatient neurology visits, other outpatient specialty visits, and primary care visits. We compared rates of health service use in immigrants versus long-term residents using negative binomial regression models with generalized estimating equations adjusted for age, sex, socioeconomic status, urban/rural residence, MS diagnosis calendar year, and comorbidity burden. RESULTS: From 2003 to 2014, there were 13,028 incident MS cases in Ontario, of whom 1,070 (8.2%) were immigrants. As compared to long-term residents, rates of hospitalization were similar (Adjusted rate ratio (ARR) 0.86; 95% CI: 0.73-1.01) in immigrants the year before MS diagnosis, but outpatient neurology visits (ARR 0.93; 95% CI: 0.87-0.99) were slightly less frequent. However, immigrants had higher rates of hospitalization during the diagnosis year (ARR 1.20, 95% CI: 1.04-1.39), and had greater use of outpatient neurology (ARR 1.17, 95% CI: 1.12-1.23) but fewer ED visits (ARR 0.86; 95% CI: 0.78-0.96). In the first post-diagnosis year, immigrants continued to have greater numbers of outpatient neurology visits (ARR 1.16; 95% CI: 1.10-1.23), but had fewer hospitalizations (ARR 0.79; 95% CI: 0.67-0.94). CONCLUSIONS: Overall, our findings were reassuring concerning health services access for immigrants with MS in Ontario, a publicly funded health care system. However, immigrants were more likely to be hospitalized despite greater use of outpatient neurology care in the year of MS diagnosis. Reasons for this may include more severe disease presentation or lack of social support among immigrants and warrant further investigation.


Asunto(s)
Emigrantes e Inmigrantes/psicología , Aceptación de la Atención de Salud/etnología , Aceptación de la Atención de Salud/psicología , Adulto , Atención Ambulatoria/tendencias , Canadá/etnología , Estudios de Cohortes , Servicio de Urgencia en Hospital/tendencias , Femenino , Hospitalización/tendencias , Humanos , Masculino , Trastornos Mentales/terapia , Servicios de Salud Mental/tendencias , Persona de Mediana Edad , Esclerosis Múltiple/psicología , Ontario/etnología , Atención Primaria de Salud/tendencias , Estudios Retrospectivos , Clase Social
3.
PLoS One ; 15(7): e0234827, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32645112

RESUMEN

BACKGROUND: The most important factor influencing maternal vaccination uptake is healthcare professional (HCP) recommendation. However, where data are available, one-third of pregnant women remain unvaccinated despite receiving a recommendation. Therefore, it is essential to understand the significance of other factors and distinguish between vaccines administered routinely and during outbreaks. This is the first systematic review and meta-analysis (PROSPERO: CRD 42019118299) to examine the strength of the relationships between identified factors and maternal vaccination uptake. METHODS: We searched MEDLINE, Embase Classic & Embase, PsycINFO, CINAHL Plus, Web of Science, IBSS, LILACS, AfricaWideInfo, IMEMR, and Global Health databases for studies reporting factors that influence maternal vaccination. We used random-effects models to calculate pooled odds ratios (OR) of being vaccinated by vaccine type. FINDINGS: We screened 17,236 articles and identified 120 studies from 30 countries for inclusion. Of these, 49 studies were eligible for meta-analysis. The odds of receiving a pertussis or influenza vaccination were ten to twelve-times higher among pregnant women who received a recommendation from HCPs. During the 2009 influenza pandemic an HCP recommendation increased the odds of antenatal H1N1 vaccine uptake six times (OR 6.76, 95% CI 3.12-14.64, I2 = 92.00%). Believing there was potential for vaccine-induced harm had a negative influence on seasonal (OR 0.22, 95% CI 0.11-0.44 I2 = 84.00%) and pandemic influenza vaccine uptake (OR 0.16, 95% CI 0.09-0.29, I2 = 89.48%), reducing the odds of being vaccinated five-fold. Combined with our qualitative analysis the relationship between the belief in substantial disease risk and maternal seasonal and pandemic influenza vaccination uptake was limited. CONCLUSIONS: The effect of an HCP recommendation during an outbreak, whilst still powerful, may be muted by other factors. This requires further research, particularly when vaccines are novel. Public health campaigns which centre on the protectiveness and safety of a maternal vaccine rather than disease threat alone may prove beneficial.


Asunto(s)
Aceptación de la Atención de Salud/psicología , Mujeres Embarazadas/psicología , Vacunación/psicología , Adulto , Toma de Decisiones , Femenino , Personal de Salud/psicología , Humanos , Subtipo H1N1 del Virus de la Influenza A/inmunología , Vacunas contra la Influenza/inmunología , Gripe Humana/prevención & control , Oportunidad Relativa , Embarazo , Encuestas y Cuestionarios
5.
Med Care ; 58(8): 703-709, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32692136

RESUMEN

BACKGROUND: Provisions of the Affordable Care Act (ACA) provided nonelderly individuals, including Veterans, with additional health care coverage options. This may impact enrollment for health care through the Veterans Health Administration (VHA). National enrollment data was used to: (1) compare characteristics of enrollees at 3 time points in relation to the implementation of ACA insurance provisions (2012); and (2) examine enrollment trends. METHODS: The study population included a 10% sample of Veterans under age 65 who were VHA enrollees between January 2012 and September 2015. Demographic and baseline characteristics were compared between 3 enrollment groups: pre-2012, pre-ACA (2012-2013), and post-ACA (2014-2015). Using an interrupted time series approach, we employed pooled logistic regression to assess trends in new VHA enrollment, overall, and by select enrollee characteristics. RESULTS: A total of 429,833 enrollees were identified. Compared with pre-ACA enrollees, post-ACA enrollees were more likely to be older, have a service-connected disability, live further away from a VHA medical center, but less likely to use primary care within 6 months. The post-ACA quarterly trend in the odds of being a new enrollee was 3% lower (95% confidence interval: 0.96, 0.98) as compared with the pre-ACA trend. This decline was consistent across sex, geography, (all but 1) priority group, and state Medicaid-expansion subgroups. CONCLUSIONS: The ACA appears to have contributed to a decline in new VHA enrollment. In addition, the profile of newer enrollees differs from that of pre-ACA enrollees. The VHA must continue to monitor trends in demand in order to continue delivering high-quality, efficient care.


Asunto(s)
Aceptación de la Atención de Salud/estadística & datos numéricos , Patient Protection and Affordable Care Act/estadística & datos numéricos , United States Department of Veterans Affairs/estadística & datos numéricos , Veteranos/estadística & datos numéricos , Adolescente , Adulto , Femenino , Humanos , Modelos Logísticos , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Patient Protection and Affordable Care Act/normas , Estados Unidos , United States Department of Veterans Affairs/normas , Veteranos/psicología
6.
Psychiatry Res ; 290: 113118, 2020 08.
Artículo en Inglés | MEDLINE | ID: mdl-32593807

RESUMEN

This article has the purpose of examining the problem of getting help for the medical-psychiatric-substance use group of "homeless" people on the streets of our cities, who refuse treatment. The problem has gradually worsened since closure of state hospitals and subsequent lack of community resources. It has been stalemated, in part, by advocates, who argue for personal autonomy and freedom rather than involuntary diagnosis and treatment over the life of these people. It has reached a crisis situation secondary to such potential patients being imprisoned and/or sick with COVID-19 being potential health and legal threats. We review A) the nature of the problem, B) the current social-legal availability of treatment and long-term management (or lack of one) in the context of societal rejection of these potential patients, and C) suggest what might be done, locally and nationally. Mandating scientifically-based medical orders to citizens regardless of personal freedom - are now being implemented to manage the COVID-19 pandemic. We argue for creating a similar med-psych short- and long-term system as a new approach to help this group. They are now mostly being ignored "to die on the streets."


Asunto(s)
Accesibilidad a los Servicios de Salud/ética , Personas sin Hogar/psicología , Trastornos Mentales/terapia , Pandemias/ética , Aceptación de la Atención de Salud/psicología , Betacoronavirus , Infecciones por Coronavirus/psicología , Infecciones por Coronavirus/terapia , Humanos , Trastornos Mentales/epidemiología , Trastornos Mentales/virología , Autonomía Personal , Neumonía Viral/psicología , Neumonía Viral/terapia
7.
Arthritis Care Res (Hoboken) ; 72(9): 1189-1195, 2020 09.
Artículo en Inglés | MEDLINE | ID: mdl-32526068

RESUMEN

OBJECTIVE: To determine health perceptions of patients with rheumatic diseases in the early phase of the coronavirus disease 2019 (COVID-19) pandemic. METHODS: Rheumatology patients at a single center received via text message the Australian Rheumatology Association COVID-19 information sheet and an invitation to participate in a deidentified survey. Patient concerns regarding risks conferred by their rheumatologic disease or medications, impact of receiving the information sheet on the likelihood of staying on medication, and acceptance of telehealth were ascertained. RESULTS: A total of 2,630 patients received the text message, and the survey response rate was 21% (n = 550). The mean ± SD age of the participants was 52 ± 15.2 years, and 75.3% were female. Participants' highest ranked concern was that their medications would increase the severity of their COVID-19 symptoms (76.1%). The highest levels of concern were seen in patients taking combination conventional synthetic disease-modifying antirheumatic drugs (DMARDs) and/or a biologic/targeted synthetic DMARD. There was no association between prednisolone dose and concern. While 63% of patients planned to continue their antirheumatic medications, a further 30% were more likely to continue taking their medications because of receiving the information. Telehealth was acceptable to 98.4% of patients, but 28.1% felt this was only appropriate while infection control measures were in place. CONCLUSION: Concerns regarding the risk of COVID-19 among patients taking antirheumatic drugs are common. Proactive dissemination of information is needed to address misconceptions related to medication risk, improve medication adherence, and minimize the risk of flares. Telehealth is acceptable to most patients during the COVID-19 pandemic.


Asunto(s)
Antirreumáticos/efectos adversos , Betacoronavirus , Infecciones por Coronavirus/psicología , Aceptación de la Atención de Salud/psicología , Neumonía Viral/psicología , Enfermedades Reumáticas/psicología , Actitud Frente a la Salud , Infecciones por Coronavirus/prevención & control , Femenino , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Pandemias/prevención & control , Neumonía Viral/prevención & control , Enfermedades Reumáticas/tratamiento farmacológico , Enfermedades Reumáticas/virología , Índice de Severidad de la Enfermedad , Encuestas y Cuestionarios
9.
Public Health Rep ; 135(4): 452-460, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32511940

RESUMEN

OBJECTIVE: Multidrug-resistant organisms (MDROs) are continually emerging and threatening health care systems. Little attention has been paid to the effect of patient transfers on MDRO dissemination among health care entities in health care systems. In this study, the Florida Department of Health in Orange County (DOH-Orange) developed a baseline social network analysis of patient movement across health care entities in Orange County, Florida, and regionally, within 6 surrounding counties in Central Florida. MATERIALS AND METHODS: DOH-Orange constructed 2 directed network sociograms-graphic visualizations that show the direction of relationships (ie, county and regional)-by using 2016 health insurance data from the Centers for Medicare & Medicaid Services, which include metrics that could be useful for local public health interventions, such as MDRO outbreaks. RESULTS: We found that both our county and regional networks were sparse and centralized. The county-level network showed that acute-care hospitals had the highest influence on controlling the flow of patients between health care entities that would otherwise not be connected. The regional-level network showed that post-acute-care hospitals and other facilities (behavioral hospitals and mental health/substance abuse facilities) served as the primary controls for flow of patients between health care entities. The most prominent health care entities in both networks were the same 2 acute-care hospitals. PRACTICE IMPLICATIONS: Social network analysis can help local public health officials respond to MDRO outbreak investigations by determining which health care facilities are the main contributors of dissemination of MDROs or are at high risk of receiving patients with MDROs. This information can help epidemiologists prioritize prevention efforts and develop county- or regional-specific interventions to control and halt MDRO transmission across a health care network.


Asunto(s)
Aceptación de la Atención de Salud/psicología , Aceptación de la Atención de Salud/estadística & datos numéricos , Alta del Paciente/estadística & datos numéricos , Satisfacción del Paciente/estadística & datos numéricos , Transferencia de Pacientes/estadística & datos numéricos , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Florida , Humanos , Masculino , Persona de Mediana Edad , Estados Unidos
10.
Public Health Rep ; 135(4): 483-491, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32516053

RESUMEN

OBJECTIVES: Cervical cancer is the second-most common type of cancer among women aged 15-44, and racial, ethnic, and economic disparities exist in survival rates despite widely available screening tests and early treatment options. The objective of this study was to describe the association among knowledge, sociodemographic characteristics, and cervical cancer screening, with the goal of developing interventions to prevent cervical cancer in populations at risk of the disease. METHODS: In 2017, we conducted a nationwide survey of women in the United States aged ≥18 who had ever received a Papanicolaou (Pap) test (N = 630). We conducted t tests and one-way analysis of variance to determine sociodemographic differences (age, education, race, ethnicity, income, type of health insurance) in knowledge about cervical cancer screening (Pap test and human papillomavirus [HPV] test). We used logistic regressions to define significant determinants of cervical cancer screening behaviors in the previous 5 years. RESULTS: Of 629 respondents, 407 (64.7%) had an annual household income <$30 000, and 322 of 536 (60.1%) respondents had government-provided health insurance. Of 630 women who had ever had a Pap test, 425 (67.5%) had an HPV test. Hispanic and non-Hispanic white women were more likely than Hispanic and non-Hispanic black women (odds ratio [OR] = 2.49; 95% CI, 1.12-4.54; P = .02) and women with government-provided health insurance (OR = 1.91; 95% CI, 1.08-3.37; P = .03) were more likely than women with private health insurance to have received a Pap test in the previous 5 years. Knowledge of HPV was a significant predictor of having received an HPV test in the previous 5 years (OR = 1.37; 95% CI, 1.22-1.54; P < .001). CONCLUSION: Disparities in cervical cancer screening among sociodemographic groups of women suggest the need for targeted interventions to improve knowledge about Pap and HPV tests.


Asunto(s)
Detección Precoz del Cáncer/psicología , Tamizaje Masivo/psicología , Prueba de Papanicolaou/psicología , Infecciones por Papillomavirus/prevención & control , Infecciones por Papillomavirus/psicología , Aceptación de la Atención de Salud/psicología , Neoplasias del Cuello Uterino/prevención & control , Neoplasias del Cuello Uterino/psicología , Adulto , Detección Precoz del Cáncer/estadística & datos numéricos , Femenino , Conocimientos, Actitudes y Práctica en Salud , Disparidades en Atención de Salud , Humanos , Tamizaje Masivo/estadística & datos numéricos , Persona de Mediana Edad , Prueba de Papanicolaou/estadística & datos numéricos , Aceptación de la Atención de Salud/estadística & datos numéricos , Factores Socioeconómicos , Encuestas y Cuestionarios , Estados Unidos
11.
PLoS One ; 15(6): e0233234, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32544161

RESUMEN

BACKGROUND: Voluntary medical male circumcision (MC) is safe and effective. Nevertheless, MC programs require multiple post-operative visits. In Zimbabwe, a randomized control trial (RCT) found that post-operative two-way texting (2wT) between clients and MC providers instead of in-person reviews reduced provider workload and safeguarded patient safety. A critical component of the RCT assessed usability and acceptability of 2wT among providers and clients. These findings inform scale-up of the 2wT approach to post-operative follow-up. METHODS: The RCT assigned 362 adult MC clients with cell phones into 2wT; these men responded to 13 automated daily texts supported by interactive texting or in-person follow-up, when needed. A subset of 100 texting clients filled a self-administered usability survey on day 14. 2wT acceptability was ascertained via 2wT response rates. Among 2wT providers, eight key informant interviews focused on 2wT acceptability and usability. Influences of wage and age on response rates and client-reported potential AEs were explored using linear and logistic regression models, respectively. RESULTS: Clients felt confident, comfortable, satisfied, and well-supported with 2wT-based follow-up; few noted texting challenges or concerns about healing. Clients felt 2wT saved them time and money. Response rates (92%) suggested 2wT acceptability. Both clients and providers felt 2wT was highly usable. Providers noted 2wT saved them time, empowered clients to engage in their healing, and closed gaps in MC service quality. For scale, providers reinforced good post-operative counseling on AEs and texting instructions. Wage and age did not influence text response rates or potential AE texts. CONCLUSION: Results strongly suggest that 2wT is highly usable and acceptable for providers and patients. Men with concerns solicited provider guidance and reassurance offered via text. Providers noted that men engaged proactively in their healing. 2wT between providers and patients should be expanded for MC and considered for other short-term care contexts. The trial is registered on ClinicalTrials.gov, trial NCT03119337, and was activated on April 18, 2017. https://clinicaltrials.gov/ct2/show/NCT03119337.


Asunto(s)
Circuncisión Masculina/métodos , Cuidados Posoperatorios/métodos , Envío de Mensajes de Texto/tendencias , Adulto , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Seguridad del Paciente , Periodo Posoperatorio , Carga de Trabajo , Zimbabwe/epidemiología
12.
PLoS Negl Trop Dis ; 14(5): e0008327, 2020 05.
Artículo en Inglés | MEDLINE | ID: mdl-32407312

RESUMEN

BACKGROUND: Against the background of the international public health emergency related to the Ebola outbreak in the Democratic Republic of Congo, in addition to other recent large Ebola epidemics, the issue of transmission due to viral persistence from survivors' body fluids is becoming increasingly urgent. Clinical research in which body fluids play a role is critical and semen testing programs are part of the suggested response to the outbreak. Broad acceptance and understanding of testing programs and research, often in resource poor settings, is essential for the success and sustainability of clinical studies and an accurate epidemic response. Study participants' perceptions on the collection of body fluids are therefore relevant for the programmatic planning and implementation of clinical studies. STUDY AIM AND METHODS: In this qualitative study we aimed to explore the perceptions on bio-sampling in the Sierra Leone Ebola Virus Persistence Study (SLEVP study). We were interested to understand how norms on gender and sexuality related to perceptions and experiences of study participants and staff, specifically, in what way perceptions of the body, on intimacy and on body fluids related to the study process. We purposively sampled former study participants for in-depth interviews and focus-group discussions. We conducted 56 in-depth interviews and eight focus group discussions with 93 participants. In a participatory approach we included study participants in the analysis of data. RESULTS: Overall the SLEVP study was well perceived by study participants and study staff. Study participants conceived the testing of their body fluids positively and saw it as a useful means to know their status. However, some study participants were ambivalent and sometimes reluctant towards sampling of certain body fluids (especially semen, blood and vaginal fluid) due to religious or cultural reasons. Self-sampling was described by study participants as a highly unusual phenomenon. Several narratives were related to the loss of body fluids (especially semen) that would make men weak and powerless, or women dizzy and sick (especially blood). Some rumors indicated mistrust related to study aims that may have been expressions of broader societal challenges and historical circumstances. These reservations could eventually be overcome by guaranteeing confidentiality and privacy and by comprehensive professional counseling. CONCLUSION: In the course of the sampling exercise, study participants were often obliged to transgress cultural and intimate boundaries. It is therefore important to understand the potential importance some of these perceptions have on the recruitment of study participants and the acceptability of studies, on a symbolic as well as a structural level. In order to capture any reservations it is necessary to provide plenty of possibilities of information sharing and follow-up of continuous consent.


Asunto(s)
Investigación Biomédica/métodos , Líquidos Corporales/virología , Transmisión de Enfermedad Infecciosa/prevención & control , Ebolavirus/aislamiento & purificación , Fiebre Hemorrágica Ebola/transmisión , Aceptación de la Atención de Salud/psicología , Manejo de Especímenes/psicología , Adolescente , Adulto , Anciano , Femenino , Fiebre Hemorrágica Ebola/virología , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Sierra Leona , Adulto Joven
13.
BMC Infect Dis ; 20(1): 352, 2020 May 18.
Artículo en Inglés | MEDLINE | ID: mdl-32423422

RESUMEN

BACKGROUND: Loss of patients in the latent tuberculosis infection (LTBI) cascade of care is a major barrier to LTBI management. We evaluated the impact and acceptability of local solutions implemented to strengthen LTBI management of household contacts (HHCs) at an outpatient clinic in Ghana. METHODS: Local solutions to improve LTBI management were informed by a baseline evaluation of the LTBI cascade and questionnaires administered to index patients, HHCs, and health care workers at the study site in Offinso, Ghana. Solutions aimed to reduce patient costs and improve knowledge. We evaluated the impact and acceptability of the solutions. Specific objectives were to: 1) Compare the proportion of eligible HHCs completing each step in the LTBI cascade of care before and after solution implementation; 2) Compare knowledge, attitude, and practices (KAP) before and after solution implementation, based on responses of patients and health care workers (HCW) to structured questionnaires; 3) Evaluate patient and HCW acceptability of solutions using information obtained from these questionnaires. RESULTS: Pre and Post-Solution LTBI Cascades included 58 and 125 HHCs, respectively. Before implementation, 39% of expected < 5-year-old HHCs and 66% of ≥5-year-old HHCs were identified. None completed any further cascade steps. Post implementation, the proportion of eligible HHCs who completed identification, assessment, evaluation, and treatment initiation increased for HHCs < 5 to 94, 100, 82, 100%, respectively, and for HHCs ≥5 to 96, 69, 67, 100%, respectively. Pre and Post-Solutions questionnaires were completed by 80 and 95 respondents, respectively. Study participants most frequently mentioned financial support and education as the solutions that supported LTBI management. CONCLUSION: Implementation of locally selected solutions was associated with an increase in the proportion of HHCs completing all steps in the LTBI cascade. Tuberculosis programs should consider prioritizing financial support, such as payment for chest x-rays, to support LTBI cascade completion.


Asunto(s)
Evaluación del Impacto en la Salud/métodos , Tuberculosis Latente/epidemiología , Tuberculosis Latente/terapia , Adolescente , Adulto , Anciano , Anciano de 80 o más Años , Preescolar , Composición Familiar , Femenino , Ghana/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Personal de Salud/psicología , Humanos , Lactante , Conocimiento , Tuberculosis Latente/economía , Tuberculosis Latente/psicología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Ensayos Clínicos Controlados no Aleatorios como Asunto , Pacientes Ambulatorios/psicología , Aceptación de la Atención de Salud/psicología , Encuestas y Cuestionarios , Adulto Joven
14.
PLoS One ; 15(5): e0233348, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32433680

RESUMEN

BACKGROUND: Patient-delivered partner therapy (PDPT) is an evidence-based method of partner treatment, but further research was needed to understand theoretical underpinnings of potential PDPT use. PURPOSE: We sought to develop and test a theoretical framework to understand PDPT intentions. METHODS: A Midwestern sample of sexually transmitted infection clinic patients were recruited to participate in a three-phase study incorporating semi-structured interviews (n = 20, total), cognitive interviews (n = 5), and surveys (n = 197; Mage = 31.3, 61% male, 91% Black or African-American). Thematic analysis was conducted to identify major themes, which guided development and testing of a theoretical framework on PDPT intentions using structural equation modeling. RESULTS: We identified themes of information (knowledge); motivation (individual and partner protection beliefs, partner and provider motivation-to-comply); social support (sexual health and general); and behavioral skills (partner notification, medication delivery, and communication skills self-efficacy) in thematic analysis. The developed Interpersonal-Behavior model demonstrated good model fit in structural equation modeling [χ2(36) = 95.56, p<0.01; RMSEA = 0.09 (0.07-0.11, 90%C.I.); CFI = 0.94; SRMR = 0.05]. Information was associated with motivation (ß = 0.37, p<0.001) and social support (ß = 0.23, p = 0.002). Motivation was associated with social support (ß = 0.64, p<0.001) and behavioral skills (ß = 0.40, p<0.001), and social support was associated with behavioral skills (ß = 0.23, p = 0.025). Behavioral skills were associated with higher PDPT intentions (ß = 0.31, p<0.001), partially mediated the association of motivation with intentions (ßdirect = 0.53, p<0.001; ßindirect = 0.12, 95%CI: 0.03-0.30), and fully mediated the association of social support with intentions (ßindirect = 0.07, 95%CI: 0.00-0.21). CONCLUSIONS: The Interpersonal-Behavior model seems appropriate for PDPT intentions but should be tested longitudinally with PDPT outcomes and other interpersonal health behaviors.


Asunto(s)
Trazado de Contacto/métodos , Intención , Relaciones Interpersonales , Pacientes , Parejas Sexuales , Enfermedades Bacterianas de Transmisión Sexual/tratamiento farmacológico , Adulto , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Femenino , Humanos , Entrevistas como Asunto , Masculino , Modelos Psicológicos , Aceptación de la Atención de Salud/psicología , Enfermedades Bacterianas de Transmisión Sexual/psicología
15.
PLoS One ; 15(4): e0231459, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32352983

RESUMEN

BACKGROUND: The high incidence (32.9, age-standardized per 100,000) and mortality (23.0, age-standardized per 100,000) of cervical cancer (CC) in Ghana have been largely attributed to low screening uptake (0.8%). Although the low cost (Visual inspection with acetic acid) screening services available at various local health facilities screening uptake is meager. OBJECTIVE: The purpose of the study is to determine the barriers influencing CC screening among women in the Ashanti Region of Ghana using the health belief model. METHODS: A analytical cross-sectional study design was conducted between January and March 2019 at Kenyase, the Ashanti Region of Ghana. The study employed self-administered questionnaires were used to collect data from 200 women. Descriptive statistics were used to examine the differences in interest and non-interest in participating in CC screening on barriers affecting CC screening. Multivariable logistic regression was used to determine factors affecting CC screening at a significance level of p<0.05. RESULTS: Unemployed women were less likely to have an interest in CC screening than those who were employed (adjustes odds ratio (aOR) = 0.005, 95%CI:0.001-0.041, p = 0.005). Women who were highly educated were 122 times very likely to be interested in CC screening than those with no or low formal education (aOR = 121.915 95%CI: 14.096-1054.469, p<0.001) and those who were unmarried were less likely to be interested in CC screening than those with those who were married (aOR = 0.124, 95%CI: 0.024-0.647, p = 0.013). Also, perceived threat, perceived benefits, perceived barriers and cues for action showed significant differences with interest in participating in screening with a P-values <0.003. The association was different for long waiting time, prioritizing early morning and late evening screening which showed no significant difference (P-value > 0.003). CONCLUSIONS: Married women, unemployed and those with no formal education are less likely to participate in CC screening. The study details significant barriers to cervical cancer screening uptake in Ghana. It is recommended that the Ghana health services should develop appropriate, culturally tailored educational materials to inform individuals with no formal education through health campaigns in schools, churches and communities to enhance CC screening uptake.


Asunto(s)
Detección Precoz del Cáncer/psicología , Tamizaje Masivo/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Neoplasias del Cuello Uterino/diagnóstico , Neoplasias del Cuello Uterino/psicología , Adolescente , Adulto , Estudios Transversales , Femenino , Ghana , Instituciones de Salud/estadística & datos numéricos , Conocimientos, Actitudes y Práctica en Salud , Humanos , Persona de Mediana Edad , Oportunidad Relativa , Encuestas y Cuestionarios/estadística & datos numéricos , Adulto Joven
16.
PLoS One ; 15(5): e0232472, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32374754

RESUMEN

Access to the influenza vaccine pose little barriers in developed countries such as Singapore and vaccination against influenza is highly recommended for at-risk populations including older adults. However, vaccination rates are much lower than recommended despite the significant morbidity and mortality associated with the disease among this vulnerable population. Given timely goals to increase vaccine acceptance and uptake, we explored Singaporean older adults' misperceptions about influenza disease and vaccine. Qualitative semi-structured interviews were conducted among 76 Singaporean adults aged 65 and above with no focus on a specific area in Singapore. Data were analyzed with grounded theory methods to understand participants' attitudes, perceptions, and knowledge. We developed in vivo codes that reflect the verbiage used by participants and exhaustively catalogued themes through a constant comparison coding method. Focusing specifically on older adults' misperceptions, seven main themes about influenza disease or vaccine emerged from our data analysis: familiarity with influenza, misperceptions about influenza, personal susceptibility to influenza, familiarity with the influenza vaccine, misperceptions about the influenza vaccine, misperceptions about influenza vaccine usage, and opinions about and barriers to influenza vaccine uptake. Notably, there is a lack of adequate knowledge and motivation in vaccinating against influenza among older adults in Singapore. Health communication needs to be more tailored toward older adults' message processing systems and engage health professionals' involvement in addressing the influenza disease and vaccine misperceptions identified in this study.


Asunto(s)
Conocimientos, Actitudes y Práctica en Salud , Vacunas contra la Influenza/farmacología , Gripe Humana/prevención & control , Aceptación de la Atención de Salud/psicología , Vacunación/psicología , Anciano , Anciano de 80 o más Años , Susceptibilidad a Enfermedades/psicología , Femenino , Humanos , Gripe Humana/epidemiología , Gripe Humana/psicología , Masculino , Aceptación de la Atención de Salud/estadística & datos numéricos , Singapur/epidemiología , Vacunación/estadística & datos numéricos
17.
PLoS One ; 15(5): e0231615, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32469883

RESUMEN

Businesses in the smart home sector are actively promoting the benefits of smart home technologies for consumers, such as convenience, economy and home security. To better understand meanings of and trust in the smart home, we carried out a nationally representative survey of UK consumers designed to measure adoption and acceptability, focusing on awareness, ownership, experience, trust, satisfaction and intention to use. We analysed the results using theories of meanings and acceptability of technologies including semiotics, social construction of technology (SCOT) and sociotechnical affordance. Our findings suggest that the meaning and value proposition of the smart home have not yet achieved closure for consumers, but is already foregrounding risks to privacy and security amongst the other meaning-making possibilities it could afford. Anxiety about the likelihood of a security incident emerges as a prominent factor influencing adoption of smart home technology. This factor negatively impacts adoption. These findings underline how businesses and policymakers will need to work together to act on the sociotechnical affordances of smart home technology in order to increase consumers' trust. This intervention is necessary if barriers to adoption and acceptability of the smart home are to be addressed now and in the future.


Asunto(s)
Seguridad Computacional , Vivienda , Sistemas de Información/normas , Aceptación de la Atención de Salud/estadística & datos numéricos , Instituciones Residenciales/normas , Confianza , Adolescente , Adulto , Anciano , Confidencialidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/psicología , Medición de Riesgo , Encuestas y Cuestionarios , Telemedicina , Reino Unido , Adulto Joven
20.
PLoS One ; 15(4): e0231424, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-32298320

RESUMEN

BACKGROUND: People who inject drugs (PWID) are at an increased risk for HIV infection due to injection and sexual risk behaviors. This study aims to examine PrEP knowledge, awareness, and willingness to be linked to PrEP services at a syringe services program (SSP), and examine the relationship between substance use and interest in PrEP linkage. METHODS: Data were collected using a cross-sectional survey of IDEA SSP clients in Miami, FL (N = 157). Based on reported substance injected, participants were classified into opioid-only injection or polysubstance injection. Socio-demographics and HIV risk were examined using Pearson's Chi-Squared analysis. Bivariate and multivariable logistic regression models were used to test for significant correlates of interest in PrEP linkage. RESULTS: Only 28.3% of PWID surveyed had previously heard of PrEP. However, 57.2% were interested in receiving more information about PrEP. In the adjusted model, people with opioid-only use were significantly less likely to report interest in being linked to PrEP. CONCLUSION: Knowledge, awareness, and interest in being linked to PrEP were low among PWID surveyed. No participants of the study were successfully linked to PrEP services through direct referrals. Further research is needed to examine low threshold service delivery of PrEP to PWID at SSPs.


Asunto(s)
Consumidores de Drogas/psicología , Infecciones por VIH/prevención & control , Conocimientos, Actitudes y Práctica en Salud , Profilaxis Pre-Exposición/métodos , Abuso de Sustancias por Vía Intravenosa/psicología , Adulto , Consumidores de Drogas/estadística & datos numéricos , Utilización de Instalaciones y Servicios/estadística & datos numéricos , Femenino , Florida , Infecciones por VIH/etiología , Infecciones por VIH/psicología , Humanos , Masculino , Persona de Mediana Edad , Programas de Intercambio de Agujas/estadística & datos numéricos , Aceptación de la Atención de Salud/psicología , Abuso de Sustancias por Vía Intravenosa/complicaciones
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