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1.
Medicine (Baltimore) ; 99(1): e18078, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31895765

RESUMEN

Sun protection early in life is an essential issue for primary prevention of skin cancers. The Il Sole per Amico was an educational campaign among 66 Italian primary schools. A total of 12,188 questionnaires were completed at baseline. Overall, 9.4% children reported >1 sunburn during the last year and 44.7% parents a use of sunlamps. Independent factors associated with sunburns were: age, lower level of parents' education, light eye and skin color, freckles, nevi on arms, intense sun exposure during the last year, sporadic use of sunscreens, and parental use of sunlamps. A total of 7280 (59.7%) questionnaires were completed at the end of the educational intervention. No significant difference was documented about behavior between the pre- and post-intervention periods. A significant reduction was instead found in both prevalence of recent sunburns and total number of sunburn episodes after comparison with the data obtained by identical questionnaire in the same geographic areas in the "Sole Si Sole No" project in 2001.


Asunto(s)
Quemadura Solar/epidemiología , Protectores Solares/administración & dosificación , Niño , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Italia , Masculino , Padres/psicología , Evaluación de Programas y Proyectos de Salud , Neoplasias Cutáneas/prevención & control , Estudiantes/estadística & datos numéricos , Quemadura Solar/prevención & control , Encuestas y Cuestionarios
2.
Hu Li Za Zhi ; 67(1): 33-43, 2020 Feb.
Artículo en Chino | MEDLINE | ID: mdl-31960395

RESUMEN

BACKGROUND: Surgery, the primary treatment for oral cancer, results in oral and facial structural defects that may cause difficulties in swallowing or mastication and thereby affect nutrition status and quality of life. PURPOSE: This study was designed to understand nutritional status and quality of life in oral cancer patients who had undergone surgery and to examine the effects of a dietary education program on nutritional status and quality of life in these patients. METHODS: A quasi-experimental design was conducted. Eligible patients were enrolled immediately after they could sip water after surgery. The participants were randomized into the experimental group (n = 42) and the control group (n = 42). Both groups were provided guidance for swallowing exercise and performed a pre-test (T0) and three post-tests (T1-T3) for a total of three months. The experimental group additionally received a diet assessment and dietary education program intervention. The outcome measures included the nursing nutritional risk screening tool (NNRST) and oral health impact profile (OHIP-14T). RESULTS: The level of malnutrition risk (T0 vs. T3) was 47.6% vs. 4.8% in the experimental group and 35.7% vs. 42.9 in the control group. Generalized estimating equation (GEE) statistics were used to assess the effects of the dietary education program on nutritional status. Quality of life was found to be significantly better in the experimental group than in the control group (p < .001). CONCLUSIONS / IMPLICATIONS FOR PRACTICE: A dietary education program may be used to effectively improve the nutritional status and quality of life of patients after oral cancer surgery. We suggest that specialized nutritional support be provided during cancer treatment in order to achieve good nutritional status and improve quality of life.


Asunto(s)
Dieta , Educación en Salud , Neoplasias de la Boca/cirugía , Humanos , Estado Nutricional , Evaluación de Programas y Proyectos de Salud , Calidad de Vida
3.
J Nurs Adm ; 50(2): 85-89, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31977945

RESUMEN

OBJECTIVE: The aim of this study was to examine program effectiveness in changing Caritas leadership, self-caring behaviors, and perceptions of coworkers of participants who completed the Caritas Coach Education Program (CCEP). BACKGROUND: The CCEP has been a highly successful education program for individuals who wish to intellectually and experientially learn to teach, live, and practice human caring theory. METHODS: A pretest-posttest descriptive design was used to evaluate changes in perceptions of self-caring, caritas leadership, and coworker behaviors after completion of CCEP. RESULTS: The mean scores of all measures improved significantly. CONCLUSIONS: After completion of CCEP, participants demonstrated statistically significant changes in 3 caritas measures: leadership, coworker, and self-rating. Caritas Coach participants exhibited the greatest change in their self-caring scores.


Asunto(s)
Actitud del Personal de Salud , Educación en Enfermería/organización & administración , Empatía , Personal de Enfermería en Hospital/educación , Personal de Enfermería en Hospital/psicología , Filosofía en Enfermería , Adulto , Arizona , Estudios de Cohortes , Femenino , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud
4.
Int J Radiat Oncol Biol Phys ; 106(3): 639-647, 2020 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-31983560

RESUMEN

PURPOSE: We sought to develop a quality surveillance program for approximately 15,000 US veterans treated at the 40 radiation oncology facilities at the Veterans Affairs (VA) hospitals each year. METHODS AND MATERIALS: State-of-the-art technologies were used with the goal to improve clinical outcomes while providing the best possible care to veterans. To measure quality of care and service rendered to veterans, the Veterans Health Administration established the VA Radiation Oncology Quality Surveillance program. The program carries forward the American College of Radiology Quality Research in Radiation Oncology project methodology of assessing the wide variation in practice pattern and quality of care in radiation therapy by developing clinical quality measures (QM) used as quality indices. These QM data provide feedback to physicians by identifying areas for improvement in the process of care and identifying the adoption of evidence-based recommendations for radiation therapy. RESULTS: Disease-site expert panels organized by the American Society for Radiation Oncology (ASTRO) defined quality measures and established scoring criteria for prostate cancer (intermediate and high risk), non-small cell lung cancer (IIIA/B stage), and small cell lung cancer (limited stage) case presentations. Data elements for 1567 patients from the 40 VA radiation oncology practices were abstracted from the electronic medical records and treatment management and planning systems. Overall, the 1567 assessed cases passed 82.4% of all QM. Pass rates for QM for the 773 lung and 794 prostate cases were 78.0% and 87.2%, respectively. Marked variations, however, were noted in the pass rates for QM when tumor site, clinical pathway, or performing centers were separately examined. CONCLUSIONS: The peer-review protected VA-Radiation Oncology Surveillance program based on clinical quality measures allows providers to compare their clinical practice to peers and to make meaningful adjustments in their personal patterns of care unobtrusively.


Asunto(s)
Instituciones Oncológicas/normas , Hospitales de Veteranos/normas , Desarrollo de Programa , Garantía de la Calidad de Atención de Salud/normas , Oncología por Radiación/normas , Carcinoma de Pulmón de Células no Pequeñas/radioterapia , Medicina Basada en la Evidencia/normas , Humanos , Neoplasias Pulmonares/radioterapia , Masculino , Revisión por Expertos , Evaluación de Programas y Proyectos de Salud/normas , Neoplasias de la Próstata/radioterapia , Garantía de la Calidad de Atención de Salud/métodos , Mejoramiento de la Calidad/normas , Indicadores de Calidad de la Atención de Salud/normas , Carcinoma Pulmonar de Células Pequeñas/radioterapia , Sociedades Médicas/normas , Estados Unidos , Veteranos
5.
N C Med J ; 81(1): 5-13, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31908325

RESUMEN

BACKGROUND In 2016, the North Carolina Division of Public Health (DPH) launched the Improving Community Outcomes for Maternal and Child Health (ICO4MCH) program to provide 5 local health departments (LHDs) with financial resources and technical assistance to address 3 aims: improve birth outcomes, reduce infant mortality, and improve health for children from birth to 5 years.METHOD: State legislation established an academic-practice partnership between NCDPH and the University of North Carolina at Chapel Hill (UNC) to provide program evaluation and implementation coaching to LHDs. ICO4MCH used a collective impact framework, principles of implementation science, and a health equity approach to implement evidence-based strategies to address the program's aims.RESULTS: A shared measurement system was developed by an evaluation stakeholders group led by the NCDPH and UNC in which LHDs reported data on a quarterly basis and the evaluators returned reports to drive improvements. Structured assessments and technical assistance provided by implementation coaches helped grantees address barriers to implementation including cultivating and sustaining a diverse community action team, addressing staff turnover, and using data to drive improvements.LIMITATIONS: It was challenging for grantees to balance community needs and build partnerships in the first year while integrating data from multiple assessments into action plans to meet the performance measures. It was necessary to streamline assessments and reduce indicators to make data more actionable.CONCLUSION: An academic-practice partnership was integral to successful implementation of the ICO4MCH program and may serve as a model for moving evidence-based maternal child health programs to practice in LHDs.


Asunto(s)
Salud del Niño , Promoción de la Salud/organización & administración , Relaciones Interinstitucionales , Salud Materna , Preescolar , Femenino , Humanos , Lactante , Recién Nacido , North Carolina , Embarazo , Evaluación de Programas y Proyectos de Salud
6.
CMAJ ; 192(4): E81-E91, 2020 Jan 27.
Artículo en Inglés | MEDLINE | ID: mdl-31988152

RESUMEN

BACKGROUND: Preterm birth is the leading cause of morbidity and mortality in children younger than 5 years. We report the changes in neonatal outcomes and care practices among very preterm infants in Canada over 14 years within a national, collaborative, continuous quality-improvement program. METHODS: We retrospectively studied infants born at 23-32 weeks' gestation who were admitted to tertiary neonatal intensive care units that participated in the Evidence-based Practice for Improving Quality program in the Canadian Neonatal Network from 2004 to 2017. The primary outcome was survival without major morbidity during the initial hospital admission. We quantified changes using process-control charts in 6-month intervals to identify special-cause variations, adjusted regression models for yearly changes, and interrupted time series analyses. RESULTS: The final study population included 50 831 infants. As a result of practice changes, survival without major morbidity increased significantly (56.6% [669/1183] to 70.9% [1424/2009]; adjusted odds ratio [OR] 1.08, 95% confidence interval [CI] 1.06-1.10, per year) across all gestational ages. Survival of infants born at 23-25 weeks' gestation increased (70.8% [97/137] to 74.5% [219/294]; adjusted OR 1.03, 95% CI 1.02-1.05, per year). Changes in care practices included increased use of antenatal steroids (83.6% [904/1081] to 88.1% [1747/1983]), increased rates of normothermia at admission (44.8% [520/1160] to 67.5% [1316/1951]) and reduced use of pulmonary surfactant (52.8% [625/1183] to 42.7% [857/2009]). INTERPRETATION: Network-wide quality-improvement activities that include better implementation of optimal care practices can yield sustained improvement in survival without morbidity in very preterm infants.


Asunto(s)
Cuidado Intensivo Neonatal/métodos , Cuidado Intensivo Neonatal/normas , Mejoramiento de la Calidad , Canadá , Femenino , Edad Gestacional , Humanos , Recién Nacido , Recien Nacido Prematuro , Masculino , Evaluación de Programas y Proyectos de Salud , Indicadores de Calidad de la Atención de Salud , Estudios Retrospectivos , Análisis de Supervivencia
7.
Gut ; 69(2): 311-316, 2020 02.
Artículo en Inglés | MEDLINE | ID: mdl-31040168

RESUMEN

OBJECTIVE: The impact of a screening programme on colorectal cancer (CRC) incidence in its target population depends on several variables, including coverage with invitations, participation rate, positivity rate of the screening test, compliance with an invitation to second-level assessment and endoscopists' sensitivity. We propose a synthetic indicator that may account for all the variables influencing the potential impact of a screening programme on CRC incidence. DESIGN: We defined the 'rate of advanced adenoma on the target population' (AA-TAP) as the rate of patients who received a diagnosis of advanced adenoma within a screening programme, divided by the programme target population. We computed the AA-TAP for the CRC Italian screening programmes (biennial faecal immunochemical test, target population 50-69 year olds) using the data of the Italian National Survey from 2003 to 2016, overall and by region, and assessed the association between AA-TAP and CRC incidence fitting a linear regression between the trend of regional CRC incidence rates in 50-74 year old subjects and the cumulative AA-TAP. RESULTS: In 2016, the AA-TAP at a national level was 105×100 000, whereas significant differences were observed between the northern and central regions (respectively 126 and 149×100 000) and the South and Islands (36×100 000). The cumulative AA-TAP from 2004 to 2012 was significantly correlated with the difference between CRC incidence rates in 2013-2014 and those in 2003-2004 (p=0.009). CONCLUSION: The AA-TAP summarises into a single indicator the potential impact of a screening programme in reducing CRC incidence rates.


Asunto(s)
Neoplasias Colorrectales/diagnóstico , Neoplasias Colorrectales/epidemiología , Adenoma/diagnóstico , Adenoma/epidemiología , Anciano , Colonoscopía , Detección Precóz del Cáncer/métodos , Femenino , Humanos , Incidencia , Italia/epidemiología , Masculino , Tamizaje Masivo/métodos , Persona de Mediana Edad , Sangre Oculta , Cooperación del Paciente/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/métodos
8.
Urology ; 135: 28-31, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31628969

RESUMEN

OBJECTIVE: To address information overload for trainees, a concise electronic case-based urology learning program (CBULP) was developed. Previous qualitative assessments suggested CBULP's potential efficacy/utility. Herein we assess CBULP more stringently by evaluating test performance before/after reviewing a CBULP curriculum covering core concepts in testicular cancer. METHODS: Eleven of 33 CBULP testicular cancer cases were strategically selected for this curriculum. A 26 question multiple-choice test was developed to assess fundamental knowledge about testis cancer tumor biology and evaluation/management. Pretest was administered to PGY4/PGY1 residents at 2 pilot urology-training programs, and medical students interested in Urology. Participants were given 4 weeks to review the curriculum and the test was then repeated. A control group (4 PGY1s) was administered the pretest and repeat test in an analogous manner without provision of the CBULP curriculum. RESULTS: Twenty individuals took the pretest (7 medical students, 8 PGY1s, and 5 PGY4s), and 17 (85%) took the post-test (5 medical students, 8 PGY1s, and 4 PGY4s,). As expected, PGY4s performed significantly better than the other 2 groups on the pre- and post-test. However, significant improvement in test performance was seen across all groups that utilized the CBULP curriculum (P <.02), with highest increase demonstrated by PGY1 residents (4.75 more questions correct, P = .002). The control arm did not demonstrate significant improvement (P = .20). CONCLUSION: Significant improvement in test performance was observed after completion of the CBULP testicular series. This study suggests that CBULP can be an efficacious and clinically useful educational resource for urologic residents and students interested in the field.


Asunto(s)
Curriculum , Educación de Pregrado en Medicina/métodos , Internado y Residencia/métodos , Neoplasias Testiculares/diagnóstico , Urología/educación , Adulto , Competencia Clínica , Instrucción por Computador/métodos , Educación de Pregrado en Medicina/estadística & datos numéricos , Evaluación Educacional/estadística & datos numéricos , Humanos , Internado y Residencia/estadística & datos numéricos , Masculino , Evaluación de Programas y Proyectos de Salud , Estudiantes de Medicina/estadística & datos numéricos , Neoplasias Testiculares/patología , Neoplasias Testiculares/terapia
9.
Br J Anaesth ; 124(2): 206-213, 2020 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-31839255

RESUMEN

BACKGROUND: Short educational programmes are important in building global anaesthesia workforce capacity. The Vital Anaesthesia Simulation Training (VAST) course is a 3-day immersive simulation-based programme concentrating on core clinical challenges and non-technical skills required by anaesthesia providers in low-resource settings. METHODS: This mixed methods study prospectively evaluated the impact of VAST in Rwanda. Anaesthetists' Non-Technical Skills (ANTS) scores were quantitatively assessed for 30 course participants at three time points (pre-, post-, and 4 months after VAST). Qualitative data were gathered during focus groups (4 months after VAST) to learn of participants' experiences implementing new knowledge into clinical practice. RESULTS: The ANTS total scores improved from pre- (11.0 [2.3]) (mean [standard deviation]) to post-test (14.0 [1.6]), and improvements were maintained at retention (14.2 [1.7]). A similar pattern was observed when data were analysed using the four ANTS categories (all P<0.001). The key theme that emerged during focus group discussions was that the use of cognitive aids and clinical algorithms, repeated and reinforced across simulated scenarios, encouraged a systematic approach to patient care. The participants attributed the systematic approach to improving their problem-solving skills and confidence, particularly during emergencies. They found value in well-functioning teams and shared decision-making. After VAST, the participants described empowerment to advocate for better patient care and system improvement. CONCLUSIONS: VAST offers a simulation-based training to anaesthesia providers working in low-resource settings. Skills retention and self-reported application of learning into the workplace reflect the scope of impact of this training.


Asunto(s)
Anestesiología/educación , Competencia Clínica/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud/métodos , Entrenamiento Simulado/métodos , Anestesistas , Países en Desarrollo , Estudios de Seguimiento , Humanos , Estudios Prospectivos , Rwanda
10.
Sports Health ; 12(1): 12-22, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-31390306

RESUMEN

BACKGROUND: Understanding how existing youth injury prevention programs affect specific modifiable injury risk factors will inform future program development for youth athletes. OBJECTIVE: To comprehensively evaluate the effects of injury prevention programs on the modifiable intrinsic risk factors associated with lower extremity performance in youth athletes. DATA SOURCES: This systematic review followed the PRISMA (Preferred Reporting Items for Systematic Reviews and Meta-Analyses) guidelines. A systematic search of the literature was performed using multiple databases (PubMed, EBSCOhost [including CINAHL, Medline, and SPORTDiscus], and PEDro). Secondary references were appraised for relevant articles. Article types included randomized or cluster randomized controlled trials and randomized cohort designs with youth athletes engaged in organized sports, along with outcomes that included at least 1 physical performance outcome measure. STUDY SELECTION: Eight studies met inclusion and exclusion criteria and were reviewed by 2 independent reviewers, with a third consulted in the case of disagreement, which was not needed. STUDY DESIGN: Systematic review. LEVEL OF EVIDENCE: Level 3. DATA EXTRACTION: Included studies underwent review of methodological quality using the Physiotherapy Evidence Database scale. RESULTS: Studies included mixed-sex samples of youth athletes who predominantly participated in soccer at different skill levels. The FIFA 11+ series was the most commonly used injury prevention program. Among studies, the mean percentage of improvement identified was 11.3% for force generation, 5.7% for coordination, 5.2% for posture, and 5.2% for balance. The lowest mean percentage improvement was in speed (2.2%). Endurance was not significantly affected by any of the programs. CONCLUSION: This systematic review shows that injury prevention programs improve several modifiable intrinsic risk factors of lower extremity performance among youth athletes, particularly force generation. However, several intrinsic risk factors were either not significantly affected or specifically addressed by existing programs.


Asunto(s)
Traumatismos en Atletas/prevención & control , Extremidad Inferior/lesiones , Deportes Juveniles/lesiones , Humanos , Evaluación de Programas y Proyectos de Salud , Factores de Riesgo
11.
J Surg Res ; 245: 107-114, 2020 01.
Artículo en Inglés | MEDLINE | ID: mdl-31415931

RESUMEN

BACKGROUND: To help control opioid overprescription, we conducted a large institutional, 3-site initiative to provide discharge prescribing guidelines for different procedures. Our aim is to refine institutional guidelines for parathyroidectomy. METHODS: Patients undergoing parathyroidectomy completed a 28-question survey about opioid consumption. Discharge opioid prescription amounts were converted into morphine milligram equivalents (MMEs) and reported as median and interquartile range (IQR). Consumption was dichotomized into top quartile MME users (Q4) versus standard users (Q1, Q3). Univariate analysis compared opioid consumption. RESULTS: A total of 91 patients were included; 90% were opioid-naive. While the median prescribed was 75 (IQR 75, 150) MME, the median consumed was 0 (IQR 0, 20). Top users reported higher pain scores [median (IQR): 2 (2, 4)] compared to standard users [1 (0, 3), P = 0.01]. However, there was no difference in opioid consumption between unilateral neck exploration, bilateral exploration, or thyroidectomy and parathyroidectomy, P = 0.11. There was no difference in opioid consumption by age, sex, or BMI (all P > 0.05). Of those receiving a prescription, 94.6% had left-over opioids at the time of survey, resulting in 82% of prescribed opioids being unused. CONCLUSIONS: Over half of patients undergoing parathyroidectomy did not consume any opioid, and very few needed more than 2 d of opioid. Moreover, most patients did not dispose the unused opioids, which put these pills at risk of diversion and misuse. Surgical approach did not change consumption, illustrating that these guidelines are applicable to thyroidectomy given the similarity between techniques. We recommend prescribing nonopioid analgesics for patients undergoing parathyroidectomy.


Asunto(s)
Analgésicos no Narcóticos/efectos adversos , Analgésicos Opioides/uso terapéutico , Dolor Postoperatorio/tratamiento farmacológico , Paratiroidectomía/efectos adversos , Pautas de la Práctica en Medicina/normas , Adulto , Anciano , Anciano de 80 o más Años , Prescripciones de Medicamentos/normas , Femenino , Humanos , Masculino , Persona de Mediana Edad , /prevención & control , Dimensión del Dolor , Dolor Postoperatorio/diagnóstico , Dolor Postoperatorio/etiología , Guías de Práctica Clínica como Asunto , Mal Uso de Medicamentos de Venta con Receta/prevención & control , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Estudios Retrospectivos , Tiroidectomía/efectos adversos
12.
J Nurs Adm ; 50(1): 28-33, 2020 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-31809454

RESUMEN

Nursing leaders have embraced newly licensed registered nurse (NLRN) transition-to-practice programs, which contribute to nursing confidence, competence, work satisfaction, and retention in a complex healthcare environment. We report on the evolution of a Midwest urban pediatric medical center's transition-to-practice program, guided for 2 decades by foundational and emerging theory, research, and evidence that has supported accreditation with distinction as a Practice Transition Accreditation Program (PTAP) by the American Nurses Credentialing Center's Commission in Accreditation. Nursing leaders should use emerging evidence to inform curricular revisions that accelerate NLRN role transition and practice integration, increase organizational commitment, improve patient safety and satisfaction, and achieve PTAP accreditation.


Asunto(s)
Acreditación , Movilidad Laboral , Modelos de Enfermería , Personal de Enfermería en Hospital/normas , Humanos , Illinois , Evaluación de Programas y Proyectos de Salud
13.
Rev Saude Publica ; 53: 110, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31826176

RESUMEN

OBJECTIVE: To evaluate the influence of the Mais Médicos (More Doctors) Program on the performance of primary health care by quantifying health services access and use in Northeast Brazil, based on the population size of the municipalities, on the financial investment in health, and on the number of physicians in the family health teams. METHOD: Evaluative research of quantitative nature. Access was evaluated by the population coverage ratio of the Family Health Strategy and use of health services, which were measured by medical appointments conducted between April 2013 and September 2015. We defined processes for database selection, adjustment, and validation, including explanatory variables for a sample of 896 municipalities. The analysis was based on the time periods before and after the implementation of the program. The Wilcoxon signed-rank test and non-parametric alternatives constituted statistical tests in the comparative analysis of the data. RESULTS: A 19.2% increase was observed in the number of medical appointments between the first six months and the final six months of the data series. In this period, the median appointments in municipalities with up to 5,000 inhabitants increased from 701.0 to 768.0; while in those with more than 100,000 inhabitants it decreased from 285.5 to 280.0 (p < 0.05). Between April 2013 and September 2015, the median coverage ratio of the family health teams increased from 89.2% to 95.3%, approaching 100% in the municipalities with up to 20,000 inhabitants. CONCLUSIONS: The study highlights the expansion of access and use of primary health care services in the northeast region after the implementation of the Mais Médicos (More Doctors) Program. Between April 2013 and September 2015, the coverage of family health teams and the production of medical appointments increased, constituting important achievements for SUS.


Asunto(s)
Prestación de Atención de Salud/estadística & datos numéricos , Programas de Gobierno , Médicos/provisión & distribución , Atención Primaria de Salud/estadística & datos numéricos , Derivación y Consulta/estadística & datos numéricos , Brasil , Prestación de Atención de Salud/economía , Salud de la Familia , Asignación de Recursos para la Atención de Salud , Humanos , Atención Primaria de Salud/economía , Evaluación de Programas y Proyectos de Salud , Recursos Humanos
14.
J Glob Health ; 9(2): 0204249, 2019 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-31788233

RESUMEN

Background: mHealth technology holds promise for improving the effectiveness of frontline health workers (FLWs), who provide most health-related primary care services, especially reproductive, maternal, newborn, child health and nutrition services (RMNCHN), in low-resource - especially hard-to-reach - settings. Data are lacking, however, from rigorous evaluations of mHealth interventions on delivery of health services or on health-related behaviors and outcomes. Methods: The Information Communication Technology-Continuum of Care Service (ICT-CCS) tool was designed for use by community-based FLWs to increase the coverage, quality and coordination of services they provide in Bihar, India. It consisted of numerous mobile phone-based job aids aimed to improve key RMNCHN-related behaviors and outcomes. ICT-CCS was implemented in Saharsa district, with cluster randomization at the health sub-center level. In total, evaluation surveys were conducted with approximately 1100 FLWs and 3000 beneficiaries who had delivered an infant in the previous year in the catchment areas of intervention and control health sub-centers, about half before implementation (mid-2012) and half two years afterward (mid-2014). Analyses included bivariate and difference-in-difference analyses across study groups. Results: The ICT-CCS intervention was associated with more frequent coordination of AWWs with ASHAs on home visits and greater job confidence among ASHAs. The intervention resulted in an 11 percentage point increase in FLW antenatal home visits during the third trimester (P = 0.04). In the post-implementation period, postnatal home visits during the first week were increased in the intervention (72%) vs the control (60%) group (P < 0.01). The intervention also resulted in 13, 12, and 21 percentage point increases in skin-to-skin care (P < 0.01), breastfeeding immediately after delivery (P < 0.01), and age-appropriate complementary feeding (P < 0.01). FLW supervision and other RMNCHN behaviors were not significantly impacted. Conclusions: Important improvements in FLW home visits and RMNCHN behaviors were achieved. The ICT-CCS tool shows promise for facilitating FLW effectiveness in improving RMNCHN behaviors.


Asunto(s)
Agentes Comunitarios de Salud , Promoción de la Salud/métodos , Telemedicina , Niño , Salud del Niño , Femenino , Humanos , India , Salud del Lactante , Recién Nacido , Salud Materna , Servicios de Salud Materno-Infantil/organización & administración , Estado Nutricional , Embarazo , Evaluación de Programas y Proyectos de Salud , Salud Reproductiva , Servicios de Salud Reproductiva/organización & administración
15.
Rev Saude Publica ; 53: 104, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-31800915

RESUMEN

OBJECTIVE: To verify if the Melhor em Casa program can actually reduce hospitalization costs. METHODS: We use as an empirical strategy a Regression Discontinuity Design, which reduces endogeneity problems of our model. We also performed tests of heterogeneous responses and robustness. Data on the dependent variable, namely hospitalization costs, were collected in the Department of Informatics of the Unified Health System (DATASUS), using the microdata set from the Hospital Admissions System of the Unified Health System (SUS) from 2010 to 2013, totaling 3,609,384 observations. The covariates or control variables used were age and costs with patients in the intensive care unit, also from DATASUS. RESULTS: The results point out that the Melhor em Casa program effectively reduced hospitalization costs by approximately 4.7% in 2011, 5.8% in 2012 and 10.2% in 2013. CONCLUSIONS: Based on the analyses, we observed that maintaining the program can effectively improve the management of public resources, since it reduced the hospitalization costs in the three years studied. The program reduced hospitalization costs of risk groups and also in situations that usually increase hospital costs such as lack of equipment and elective hospitalizations. Thus, it can be affirmed that the program can reduce hospitalization costs, especially in risk and more vulnerable groups, showing efficiency as a public policy.


Asunto(s)
Costos de la Atención en Salud/estadística & datos numéricos , Costos de Hospital/estadística & datos numéricos , Hospitalización/economía , Visita Domiciliaria/economía , Factores de Edad , Brasil , Ciudades/economía , Femenino , Humanos , Masculino , Programas Nacionales de Salud/economía , Evaluación de Programas y Proyectos de Salud , Valores de Referencia , Factores Sexuales , Factores de Tiempo
17.
Rev Chilena Infectol ; 36(5): 565-575, 2019 Oct.
Artículo en Español | MEDLINE | ID: mdl-31859797

RESUMEN

BACKGROUND: Antimicrobial resistance (AMR) is a global threat to public health. Antibiotic stewardship programs (AMSP) promote the proper use of antimicrobials, improve clinical and economic outcomes, and helps containing the AMR. AIM: To evaluate the diagnostic phase of the AMS programs and early implementation of AMS at three high complexity hospitals that belong to the social security system in Peru. METHODS: A quasi-experimental multicenter study was implemented. The construction of the AMSP, microbiological baselines, antimicrobial consumption and consensus on AMS activities were evaluated at the diagnosis and early implementation periods of the AMSP. RESULTS: Following implementation, hospitals doubled their score of resources and processes available for the AMS program from 6.75 to 13.75. The prevalence of extended spectrum beta-lactamase producing enterobacteria was 50-60% while Pseudomonas aeruginosa averaged 69% resistance to carbapenems. The defined daily dose (DDD) of ceftriaxone was 13.63, vancomycin 7.35 and meropenem 6.73 in average. Hospitals A and C decreased the use of antimicrobials (30-50%). DISCUSSION: The implementation of the AMSP in the three hospitals was achieved through diverse strategies designed by multidisciplinary teams, which in addition to its articulation, reduce the consumption of broad spectrum antimicrobials at an early stage.


Asunto(s)
Antiinfecciosos/administración & dosificación , Programas de Optimización del Uso de los Antimicrobianos/métodos , Evaluación de Programas y Proyectos de Salud/métodos , Farmacorresistencia Microbiana , Implementación de Plan de Salud , Hospitales/estadística & datos numéricos , Humanos , Ensayos Clínicos Controlados no Aleatorios como Asunto , Perú , Seguridad Social , Factores de Tiempo
18.
BMC Public Health ; 19(1): 1427, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666034

RESUMEN

BACKGROUND: Malnutrition among school children may contribute to adverse health consequences such as non-communicable diseases, poor cognitive performance, psychological distress and poor quality of life that may persist into adulthood. In order to prevent childhood malnutrition, an intervention programme that integrates nutrition education and healthy school food environment is needed to provide nutrition information and reinforce the skills on healthy eating behaviours in schools. This paper describes a study protocol of a school-based intervention programme that integrates nutrition education and healthy school food environment, namely School Nutrition Programme (SNP). The SNP is a primary prevention programme that promotes healthy lifestyle among primary school children in light of the high prevalence of malnutrition in Malaysian children. METHODS/DESIGN: This quasi-experimental study aimed to evaluate the effectiveness of the SNP between intervention and comparison groups before and after the SNP, and after a 3-month follow-up. The SNP consisted of two main components, whereby three nutrition education sessions were implemented by trained teachers using three standardised modules, and healthy school food environment was implemented by the canteen food handlers with the provision of healthy menu to children during school recess times. Children from intervention group participated in the SNP, in addition to the standard Physical and Health Curriculum. The comparison group attended only the standardised Physical and Health Curriculum and the school canteen food handlers were reminded to follow the standard canteen guidelines from the Ministry of Education Malaysia. The assessment parameters in evaluating the effectiveness of the programme were knowledge, attitude and practice on nutrition, eating behaviours, physical activity, body composition, psychological distress, cognitive performance and health-related quality of life. Assessments were conducted at three time points: pre-intervention, post-intervention and 3-month follow-up. DISCUSSION: It was hypothesised that the SNP would be effective in promoting healthy lifestyle among school children, and further contributes in preventing malnutrition problem, enhancing cognitive performance and improving health-related quality of life among school children. Findings of the present study can be expanded to other schools in future on ways to improve nutrition education and healthy school food environment. TRIAL REGISTRATION: UMIN Clinical Trial Registration UMIN000032914 (Date of registration: 7th June 2018, retrospectively registered). PROTOCOL VERSION: 16th September 2019 & Version 4.


Asunto(s)
Curriculum , Servicios de Alimentación , Educación en Salud , Promoción de la Salud/métodos , Evaluación de Programas y Proyectos de Salud , Instituciones Académicas , Composición Corporal , Niño , Cognición , Ejercicio , Conducta Alimentaria , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Malasia , Masculino , Estado Nutricional , Calidad de Vida , Proyectos de Investigación , Estudios Retrospectivos , Servicios de Salud Escolar
19.
BMC Public Health ; 19(1): 1417, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666043

RESUMEN

BACKGROUND: The DREAMS Partnership is an ambitious effort to deliver combinations of biomedical, behavioural and structural interventions to reduce HIV incidence among adolescent girls and young women (AGYW). To inform multi-sectoral programming at scale, across diverse settings in Kenya and South Africa, we identified who the programme is reaching, with which interventions and in what combinations. METHODS: Randomly-selected cohorts of 606 AGYW aged 10-14 years and 1081 aged 15-22 years in Nairobi and 2184 AGYW aged 13-22 years in uMkhanyakude, KwaZulu-Natal, were enrolled in 2017, after ~ 1 year of DREAMS implementation. In Gem, western Kenya, population-wide cross-sectional survey data were collected during roll-out in 2016 (n = 1365 AGYW 15-22 years). We summarised awareness and invitation to participate in DREAMS, uptake of interventions categorised by the DREAMS core package, and uptake of a subset of 'primary' interventions. We stratified by age-group and setting, and compared across AGYW characteristics. RESULTS: Awareness of DREAMS was higher among younger women (Nairobi: 89%v78%, aged 15-17v18-22 years; uMkhanyakude: 56%v31%, aged 13-17v18-22; and Gem: 28%v25%, aged 15-17v18-22, respectively). HIV testing was the most accessed intervention in Nairobi and Gem (77% and 85%, respectively), and school-based HIV prevention in uMkhanyakude (60%). Among those invited, participation in social asset building was > 50%; > 60% accessed ≥2 core package categories, but few accessed all primary interventions intended for their age-group. Parenting programmes and community mobilisation, including those intended for male partners, were accessed infrequently. In Nairobi and uMkhanyakude, AGYW were more likely to be invited to participate and accessed more categories if they were: aged < 18 years, in school and experienced socio-economic vulnerabilities. Those who had had sex, or a pregnancy, were less likely to be invited to participate but accessed more categories. CONCLUSIONS: In representative population-based samples, awareness and uptake of DREAMS were high after 1 year of implementation. Evidence of 'layering' (receiving multiple interventions from the DREAMS core package), particularly among more socio-economically vulnerable AGYW, indicate that intervention packages can be implemented at scale, for intended recipients, in real-world contexts. Challenges remain for higher coverage and greater 'layering', including among older, out-of-school AGYW, and community-based programmes for families and men.


Asunto(s)
Concienciación , Infecciones por VIH/prevención & control , Conductas Relacionadas con la Salud , Promoción de la Salud/métodos , Aceptación de la Atención de Salud , Prevención Primaria/métodos , Evaluación de Programas y Proyectos de Salud , Adolescente , Adulto , Niño , Estudios Transversales , Femenino , Conocimientos, Actitudes y Práctica en Salud , Humanos , Incidencia , Kenia , Masculino , Embarazo , Conducta Sexual , Parejas Sexuales , Sudáfrica , Encuestas y Cuestionarios , Adulto Joven
20.
BMC Health Serv Res ; 19(1): 776, 2019 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-31666066

RESUMEN

BACKGROUND: In 2002, a voluntary diagnosis-related groups (DRGs) payment system was introduced in South Korea for seven disease groups, and participation in the DRGs was mandated for all hospitals beginning in 2013. The primary aim of this study was to compare results reflective of patient care between voluntary participation hospitals (VPHs) and mandatory participation hospitals (MPHs) governed by either the DRGs or fee-for-service (FFS) payment system. METHODS: We collected DRGs and FFS inpatient records (n=3,038,006) from the Health Insurance Review and Assessment for the period of July 2011 to July 2014 and compared length-of-stay, total medical costs, shifting services to an outpatient setting, and readmission rates according to payment system, time of DRGs implementation, and hospital type. We analyzed the effects of mandatory introduction in DRGs payment system on results for patient care and used generalized estimating equations with difference-in-difference methodology. RESULTS: Most notably, patients at MPHs had significantly shorter LOS and lower readmission rates than VPH patients after mandatory introduction of the DRGs. Shifting services to an outpatient setting was similar between the groups. CONCLUSIONS: Our findings suggest that the DRGs payment policy in Korea has decreased LOS and readmission rates. These findings support the continued implementation and enlargement of the DRGs payment system for other diseases in South Korea, given its potential for curbing unnecessary resource usage encouraged by FFS. If the Korean government deliberates on expansion of the DRGs to include other diseases with higher rates of complications, policymakers need to monitor deterioration of health care quality caused by fixed pricing.


Asunto(s)
Grupos Diagnósticos Relacionados/economía , Hospitales , Programas Obligatorios , Calidad de la Atención de Salud/estadística & datos numéricos , Adulto , Anciano , Planes de Aranceles por Servicios/economía , Femenino , Humanos , Revisión de Utilización de Seguros , Tiempo de Internación/estadística & datos numéricos , Masculino , Persona de Mediana Edad , Readmisión del Paciente/estadística & datos numéricos , Evaluación de Programas y Proyectos de Salud , República de Corea , Adulto Joven
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