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1.
Salud Colect ; 16: e2897, 2020 10 17.
Artículo en Español | MEDLINE | ID: mdl-33147400

RESUMEN

Taking into account the latent threat of future pandemics, the objective of this study is to analyze - particularly with respect to medications - the sustainability of the health system, healthcare coverage, budgetary efficiency, and connections with the pharmaceutical patent system. In this context, the pharmaceutical patent system acts as a determining factor, given that promoting its existence stimulates the production of research, but in turn its existence stands in the way of rapid advancements, primarily due to the development of protective legislation concerning patents, which has largely accommodated the industry. Given that the pharmaceutical industry has managed to extend the duration of patents and avoid the incorporation of generics, our analysis focuses on the influence of pharmaceutical patents; this influence has led to reflection on the possibility of combining efforts by forging alliances between numerous companies and the public sector in order to face the challenges posed by new diseases caused by viruses that give rise to epidemics and pandemics.


Asunto(s)
Antivirales , Costos de los Medicamentos , Industria Farmacéutica/organización & administración , Política de Salud , Accesibilidad a los Servicios de Salud/organización & administración , Patentes como Asunto , Virosis/tratamiento farmacológico , Antivirales/economía , Antivirales/uso terapéutico , Medicamentos Genéricos , Salud Global , Humanos , Pandemias , Evaluación de Programas y Proyectos de Salud , Virosis/economía , Virosis/epidemiología , Virosis/prevención & control
2.
Trials ; 21(1): 941, 2020 Nov 23.
Artículo en Inglés | MEDLINE | ID: mdl-33225995

RESUMEN

OBJECTIVES: 1. To compare the effectiveness of four different surveillance strategies in detecting COVID-19 within the homeless shelter population. 2. To assess the participant adherence over time for each surveillance method. TRIAL DESIGN: This is a prospective cluster-randomized study to compare the effectiveness of four different surveillance regimens across eight homeless shelters in the city of Hamilton. PARTICIPANTS: Participants will include both residents of, and the staff working within, the homeless shelters. All participants aged 18 or older who consent to the study and are able to collect a swab sample (where relevant) are eligible for the study. The study will take place across eight homeless shelters (four men-only and four women-only) in the City of Hamilton in Ontario, Canada. INTERVENTION AND COMPARATOR GROUPS: The comparator group will receive active daily surveillance of symptoms and testing will only be completed in symptomatic participants (i.e. those who fail screening or who seek care for potential COVID-19 related symptoms). The three intervention arms will all receive active daily surveillance of symptoms and testing of symptomatic participants (as in the comparator group) in addition to one of the following: 1. Once weekly self-collected oral swabs (OS) regardless of symptoms using written and visual instructions. 2. Once weekly self-collected oral-nares swab (O-NS) regardless of symptoms using written and visual instructions. 3. Once weekly nurse collected nasopharyngeal swab (NPS) regardless of symptoms. Participants will follow verbal and written instructions for the collection of OS and O-NS specimens. For OS collection, participants are instructed to first moisten the swab on their tongue, insert the swab between the cheek and the lower gums and rotate the swab three times. This is repeated on the other side. For O-NS collection, after oral collection, the swab is inserted comfortably (about 2-3 cm) into one nostril, parallel to the floor and turned three times, then repeated in the other nostril. NPS specimens were collected by the nurse following standard of care procedure. All swabs were placed into a viral inactivation medium and transported to the laboratory for COVID-19 testing. Briefly, total nucleic acid was extracted from specimens and then amplified by RT-PCR for the UTR and Envelope genes of SARS-CoV-2 and the human RNase P gene, which is used as a sample adequacy marker. MAIN OUTCOMES: 1. PRIMARY OUTCOME: COVID-19 detection rate, i.e. the number of new positive cases over the study period of 8 weeks in each arm of the study. 2. SECONDARY OUTCOMES: Qualitative assessment of study enrollment over 8 weeks. Percentage of participants who performed 50% or more of the weekly swabs in the intervention arms in the 8 week study period. RANDOMIZATION: We will use a computer-generated random assignment list to randomize the shelters to one of four interventions. Shelters were stratified by gender, and the simple randomization scheme was applied within each stratum. The randomization scheme was created using WinPEPI. BLINDING: This is an open-label study in which neither participants nor assessors are blinded. NUMBERS TO BE RANDOMIZED (SAMPLE SIZE): Since we are including our total sample frame, a sample size estimation at the cluster level is not required. However, if we succeed to enroll 50 participants per shelter from 8 shelters (n=400), and the detection rate is 3 times higher in the intervention groups (0.15) than in the comparator groups (0.05), we will have 90% power to detect a statistically significant and clinically important difference at a type I error rate of alpha=0.05 (one tailed), assuming an intraclass correlation of ~0.008. These computations were done using WinPEPI, and informed by conservative estimates from other studies on respiratory illness in the homeless (see Full protocol). TRIAL STATUS: The protocol version number is 3.0. Recruitment began on April 17, 2020 and is ongoing. Due to low numbers of COVID cases in the community and shelter system during the initial study period, the trial was extended. The estimated date for the end of the extended recruitment period is Feb 1, 2021. TRIAL REGISTRATION: The trial was registered with ClinicalTrials.gov on June 18, 2020 with the identifier NCT04438070 . FULL PROTOCOL: The full protocol is attached as an additional file, accessible from the Trials website (Additional file 1). In the interest in expediting dissemination of this material, the familiar formatting has been eliminated; this Letter serves as a summary of the key elements of the full protocol.


Asunto(s)
Infecciones por Coronavirus/diagnóstico , Infecciones por Coronavirus/prevención & control , Personas sin Hogar/estadística & datos numéricos , Tamizaje Masivo/métodos , Pandemias/prevención & control , Neumonía Viral/diagnóstico , Neumonía Viral/prevención & control , Adulto , Betacoronavirus/genética , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/virología , Diagnóstico Precoz , Femenino , Humanos , Masculino , Ontario/epidemiología , Cooperación del Paciente , Neumonía Viral/epidemiología , Neumonía Viral/virología , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Manejo de Especímenes/métodos , Factores de Tiempo
3.
Rev Saude Publica ; 54: 103, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33146324

RESUMEN

OBJECTIVE: To evaluate the effect of implementation intentions as an intervention strategy to promote walking in adults with type 2 diabetes mellitus (T2DM). METHODS: We conducted a controlled and randomized trial, with 12 months of follow-up, involving 65 people with T2DM recruited from primary health care units and allocated them in the control group (CG, n = 32) and intervention group (IG, n = 33). The IG received the implementation intention strategy to promote walking and the CG remained in follow-up for conventional treatment in primary health care. The researchers were blinded by anthropometric measurements and the filling of the instruments. RESULTS: After twelve months of follow up, the IG presented a statistically significant increase in the leisure time physical activity when compared with the CG (p = 0.0413) and showed a significant decrease in waist circumference (p = 0.0061). No significant difference was observed regarding body mass index and glycated hemoglobin among groups. CONCLUSIONS: Implementation intention was effective in promoting walking and improving clinical indicators in adults with T2DM.


Asunto(s)
Diabetes Mellitus Tipo 2 , Promoción de la Salud , Intención , Caminata , Anciano , Diabetes Mellitus Tipo 2/terapia , Femenino , Hemoglobina A Glucada/análisis , Promoción de la Salud/métodos , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Caminata/psicología
4.
Epilepsy Behav ; 112: 107493, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33181913

RESUMEN

OBJECTIVE: The purpose of this study was to assess parent satisfaction with the management of ketogenic diet therapies (KDTs) through telemedicine using WhatsApp as the main tool. METHODS: Parent satisfaction was longitudinally evaluated through questionnaires. The survey was developed with Google Questionnaire forms and sent via WhatsApp. The questionnaire consisted of 13 items concerning the management of KDTs using telemedicine in the context of the coronavirus disease 2019 (COVID-19) pandemic. Our population of patients has limited financial resources and low levels of education. Given that many families did not have either computers or WIFI, or any other access to information or communication technology, WhatsApp was chosen as a tool as it was available on the cell phones of all families and the professionals. RESULTS: Our survey showed that 96.3% of the parents were satisfied with the management of KDTs through telemedicine. The main benefits observed were the possibility of continuing treatment during the COVID-19 pandemic and the ease of accessing the professional team from the comfort of their home. Overall, 72.2% of the families would recommend using telemedicine for KDTs in any situation regardless of the pandemic. None of the families reported that they would recommend against treatment by telemedicine. The availability of a social support network (parents WhatsApp group) coordinated by professionals from the KDT team was considered to be useful by most respondents (90%). CONCLUSIONS: Our study suggests that management of children with DRE on KDTs through telemedicine is feasible, well accepted by the families, and probably as safe as conventional medicine. WhatsApp may be an interesting telemedicine tool to start and maintain KDTs.


Asunto(s)
Dieta Cetogénica/métodos , Epilepsia Refractaria/dietoterapia , Padres/psicología , Telemedicina , Adolescente , Adulto , Argentina , Betacoronavirus , Niño , Preescolar , Coronavirus , Infecciones por Coronavirus/epidemiología , Infecciones por Coronavirus/prevención & control , Prestación de Atención de Salud , Epilepsia Refractaria/epidemiología , Femenino , Humanos , Lactante , Masculino , Pandemias , Satisfacción Personal , Neumonía Viral/epidemiología , Neumonía Viral/prevención & control , Evaluación de Programas y Proyectos de Salud , Medios de Comunicación Sociales , Encuestas y Cuestionarios
5.
J Stroke Cerebrovasc Dis ; 29(11): 105220, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33066906

RESUMEN

BACKGROUND: Acute stroke outcomes depend on timely reperfusion. In 3/2017, local EMS agencies implemented a prehospital triage algorithm with hospital bypass and field activation of the neurointerventional team using the Field Assessment Stroke Triage for Emergency Destination (FAST-ED). A score ≥4 bypasses to a comprehensive stroke center (CSC) and a score ≥6 also has the interventional team field activated off-hours. AIM: We analyzed effects of this initiative on volume, acute stroke transfers, treatment times, and outcomes and determined the tool's ability to predict large vessel occlusion. METHODS: Stroke cases brought to our center by EMS during 3/2016-2/2018 were analyzed, which included one year before and after FAST-ED implementation. Treatment times were compared on- vs. off-hours and to those with field activation. RESULTS: Of 1153 patients, 761 (67%) were coded as stroke and 235 (20%) underwent reperfusion. Age, sex, race/ethnicity, stroke severity, length of stay, door-to-needle, and 90-d mRS were comparable between periods. Scale compliance was 85%. Concordance rate of ±1 between EMS and calculated score was 53%. Compared to the previous year, door-to-puncture (DTP) improved by 17 min (p < 0.01) overall, 25 min (p < 0.001) off-hours, and 33 min (p < 0.05) with field activation. A cutoff of 4 vs. 6 would have led to 140% increase in field activations but only 36% increase in procedures. CONCLUSIONS: This prehospital initiative led to faster DTP by up to 33 min. The highest impact was off-hours with field activation. Only 1/3 of activations led to endovascular treatment. FAST-ED≥6 appears to be appropriate for field activation.


Asunto(s)
Servicios Médicos de Urgencia , Procedimientos Endovasculares , Accidente Cerebrovascular/terapia , Terapia Trombolítica , Tiempo de Tratamiento , Triaje , Atención Posterior , Anciano , Anciano de 80 o más Años , Femenino , Florida , Humanos , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Estudios Prospectivos , Estudios Retrospectivos , Accidente Cerebrovascular/diagnóstico , Accidente Cerebrovascular/fisiopatología , Factores de Tiempo , Resultado del Tratamiento
6.
PLoS One ; 15(10): e0239336, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33052905

RESUMEN

All across the globe politically initiated research evaluations are based on "informed peer review" procedures. Scholars are appointed as evaluators and can apply self-defined quality standards in order to overcome shortcomings of standardized measures. Even though there are no binding criteria in these procedures and the quality standards of the scholars' disciplines vary, studies suggest that scholars, in their role as government-appointed research evaluators, assess research uniformly.By drawing on a small-N investigation, this study compares the quality standards scholars apply as government-appointed research evaluators with quality standards they follow as researchers. The study points to a paradox: Criteria scholars refer to while describing the excellence of their own research and criteria they use as evaluators differ and contradict each other. The results are discussed from different angles.


Asunto(s)
Evaluación de Programas y Proyectos de Salud/normas , Investigadores/psicología , Humanos , Entrevistas como Asunto , Desarrollo de Programa , Proyectos de Investigación
7.
Niger J Clin Pract ; 23(10): 1449-1455, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33047705

RESUMEN

Objectives: To evaluate the knowledge level of individuals who attended a first aid training update program, and to determine the factors affecting their approaches in such cases. Methods: This is a descriptive cross-sectional study. The sample of the research consists of 747 individuals (laypersons) who applied to the first aid training update organized in an institution in Istanbul providing health education between 01.02.2018 and 01.08.2018, and who agreed to participate in the research. These first aid trainings are provided by healthcare professionals who have first aid certificate of authority within the scope of first aid regulation. Data were collected using the "Participant Information Form" and the "Basic First Aid Knowledge Level Evaluation Form". Results: The participants administered first aid within the three years of time following their basic first aid training course (24.6%). They administered first aid primarily in emergency cases of fainting (29.6%) and the majority of them (95.7%) did not perform cardiopulmonary resuscitation during their basic first aid effort. Of the participants, 73.9% answered incorrectly the question: "The letter 'A' in the abbreviation ABC of basic life support administration stands for airway". In our study, it was also found that there was a significant relationship between the total knowledge score and the number of trainings update and first aid intervention in the last three years (P < 0.05, P < 0.001, respectively). Conclusions: It was determined that individuals had a high level of knowledge about basic first aid and one-quarter of the participants had administered first aid in the last three years. In order for individuals not to lose their knowledge and skills gained through first aid training; updating training and providing first aid training programs to individuals in society can be a guide for bystanders who provide faster and sufficient first aid in cases of emergency.


Asunto(s)
Reanimación Cardiopulmonar/educación , Primeros Auxilios/métodos , Educación en Salud/métodos , Conocimientos, Actitudes y Práctica en Salud , Adulto , Estudios Transversales , Evaluación Educacional , Femenino , Personal de Salud , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud , Turquia
8.
J Nurs Adm ; 50(11): 562-564, 2020 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-33105332

RESUMEN

Professional practice model (PPM) is one of the initial steps toward nursing excellence and the main requirement to earn Magnet Recognition. This article will describe the process of development, implementation, and evaluation of a PPM for nursing in a specialized cancer center in Jordan.


Asunto(s)
Instituciones Oncológicas/organización & administración , Modelos de Enfermería , Personal de Enfermería en Hospital , Instituciones Oncológicas/normas , Humanos , Jordania , Desarrollo de Programa , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud
9.
Can J Surg ; 63(5): E468-E474, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33107816

RESUMEN

BACKGROUND: The implementation of quality-of-care indicators aiming to improve colorectal cancer (CRC) outcomes has been previously described by Cancer Care Ontario. The aim of this study was to assess the quality-of-care indicators in CRC at a referral centre in a developing country and to determine whether improvement occurred over time. METHODS: We performed a retrospective study of our prospectively collected database of patients after CRC surgery from 2001 to 2016. We excluded patients who underwent local transanal excision, pelvic exenteration or palliative procedures. We evaluated trends over time using the Cochran-Armitage test for trend. RESULTS: A total of 343 patients underwent surgical resection of CRC over the study period. There was improvement of the following indicators over time: the proportion of patients detected by screening (p = 0.03), the proportion of patients with preoperative liver imaging (p = 0.001), the proportion of patients with stage II or III rectal cancer who received neoadjuvant chemotherapy (p = 0.03), the proportion of patients with pathology reports that indicated the number of lymph nodes examined and the number of positive nodes (p = 0.001), and the proportion of patients with pathology reports describing the details on margin status (p = 0.001). CONCLUSION: This study showed the feasibility of applying the Cancer Care Ontario indicators for evaluating outcomes in CRC treatment at a single centre in a developing country. Although there was an improvement of some of the quality-of-care indicators over time, policies and interventions must be implemented to improve the fulfillment of all indicators.


Asunto(s)
Neoplasias Colorrectales/cirugía , Países en Desarrollo , Recurrencia Local de Neoplasia/epidemiología , Evaluación de Resultado en la Atención de Salud/métodos , Indicadores de Calidad de la Atención de Salud/organización & administración , Adulto , Anciano , Anciano de 80 o más Años , Neoplasias Colorrectales/mortalidad , Estudios de Factibilidad , Femenino , Estudios de Seguimiento , Implementación de Plan de Salud/organización & administración , Implementación de Plan de Salud/estadística & datos numéricos , Humanos , Estimación de Kaplan-Meier , Masculino , México , Persona de Mediana Edad , Recurrencia Local de Neoplasia/prevención & control , Evaluación de Programas y Proyectos de Salud , Indicadores de Calidad de la Atención de Salud/estadística & datos numéricos , Estudios Retrospectivos , Centros de Atención Terciaria/organización & administración , Centros de Atención Terciaria/estadística & datos numéricos , Adulto Joven
10.
Arch Cardiovasc Dis ; 113(10): 590-598, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33011157

RESUMEN

BACKGROUND: Cardiovascular diseases are a leading cause of mortality, but a substantial proportion are preventable. AIMS: The Mutuelle générale de l'éducation nationale (MGEN), a provider of private health insurance in France, has developed the VIVOPTIM programme, a novel digital approach to healthcare based on individualized, multiprofessional, ranked management of cardiovascular risk factors. METHODS: Between November 2015 and June 2016, eligible individuals (age 30-70 years) from two regions of France were invited to participate. Volunteers completed a questionnaire based on the Framingham Heart Study Risk Score and were assigned to one of three cardiovascular risk levels. VIVOPTIM comprises four components: cardiovascular risk assessment, instruction on cardiovascular diseases and associated risk factors, personalized coaching (telephone sessions with a specially trained healthcare professional to provide information on risk factors and disease management, set individual health targets, monitor progress and motivate participants), and e-Health monitoring. RESULTS: Data from 2240 participants were analysed. Significant benefits were observed on mean systolic blood pressure (-3.4mmHg), weight (-1.5kg), smoking (-2.2 cigarettes/day) and daily steps (+1726 steps/day (all P<0.0001)), though not on weekly duration of exercise (-0.2hours/week, P=0.619). CONCLUSION: As a result of the positive mid-to-long-term results of the pilot programme on weight, smoking, blood pressure, and uptake of physical activity, the VIVOPTIM programme was extend to the whole of France in 2018 and has the potential to have a genuine impact on patient care and organization of the healthcare system in France.


Asunto(s)
Enfermedades Cardiovasculares/prevención & control , Estilo de Vida Saludable , Educación del Paciente como Asunto , Prevención Primaria , Telemedicina , Adulto , Anciano , Presión Sanguínea , Enfermedades Cardiovasculares/diagnóstico , Enfermedades Cardiovasculares/etiología , Dieta Saludable , Ejercicio Físico , Femenino , Francia , Conocimientos, Actitudes y Práctica en Salud , Estado de Salud , Humanos , Masculino , Cumplimiento de la Medicación , Persona de Mediana Edad , Proyectos Piloto , Evaluación de Programas y Proyectos de Salud , Medición de Riesgo , Factores de Riesgo , Cese del Hábito de Fumar , Pérdida de Peso
11.
Glob Health Sci Pract ; 8(3): 396-412, 2020 10 01.
Artículo en Inglés | MEDLINE | ID: mdl-33008854

RESUMEN

This article assesses the CORE Group Polio Project (CGPP) experience over a 20-year period in 5 countries. It examines how a program designed to provide social mobilization to eradicate one disease, and which did so effectively, functioned within the general framework of community health workers (CHWs). Vertical health programs often have limited impact on broader community health. CGPP has a 20-year history of social mobilization and effective program interventions. This history provided an opportunity to assess how CGPP community mobilizers (CMs) functioned in polio and maternal and child health. The Updated Program Functionality Matrix for Optimizing Community Health Programs tool of the CHW Assessment and Improvement Matrix (AIM) was used to examine CGPP CM roles across different contexts. The analysis determined that CGPP CMs met the basic level of functioning (level 3) for 6 of the 10 components of the AIM tool. This cross-country descriptive analysis of the CGPP demonstrates the importance of embracing the full range of CHW AIM components, even in a vertical program. Use of data, community involvement, local adaptation, and linkage with the health system are especially critical for success. This general lesson could be applied to other community mobilization and disease/epidemic control initiatives, especially as we face the issues of the COVID-19 pandemic.


Asunto(s)
Agentes Comunitarios de Salud , Erradicación de la Enfermedad/métodos , Poliomielitis/prevención & control , Evaluación de Programas y Proyectos de Salud/métodos , Servicios de Salud Rural , África , Asia , Humanos , Población Rural
12.
J Dent Educ ; 84(10): 1091-1098, 2020 Oct.
Artículo en Inglés | MEDLINE | ID: mdl-33063364

RESUMEN

INTRODUCTION: A grant-funded faculty development program, From Practice to Preceptor (FP2P), sought to recruit and train diverse general and pediatric dentists to become dental faculty from 2012-2018. This study is an evaluation of this completed initiative and offers an initial review of long-term outcomes of the program. METHODS: Over 5 entering cohorts, 133 practitioners applied to the program and 45 were accepted. A 2-year training program used classroom and hands-on training to prepare practitioners for the occupational demands of academia. Program participants were offered pre- and post-surveys to evaluate their perceived preparedness in faculty competencies identified by the program. Participants were also sent an alumni survey, and employment was tracked by the host institution. RESULTS: Most (43 of 45) participants completed the program. Pre- and post-survey results were received from 24 of 30 (80%) participants in Cohorts 2, 3, and 5, and used for this analysis. The results suggest the program participants' perception of their ability to work effectively as faculty members in administrative, teaching, and clinical arenas increased. Over half of the program completers obtained employment as dental faculty. A majority of (19/26, 73%) program completers who responded to the alumni survey indicated the skills and knowledge gained in the program were useful to their current employment. CONCLUSION: The FP2P program evaluation results indicate a long-term faculty training program may be a useful methodology for recruiting and training current dentists to work in academic dentistry.


Asunto(s)
Docentes de Odontología , Desarrollo de Personal , Niño , Estudios de Cohortes , Curriculum , Humanos , Evaluación de Programas y Proyectos de Salud
13.
Lancet Glob Health ; 8(11): e1418-e1426, 2020 11.
Artículo en Inglés | MEDLINE | ID: mdl-33069302

RESUMEN

BACKGROUND: Few studies have been done of patterns of treatment during mass drug administration (MDA) to control neglected tropical diseases. We used routinely collected individual-level treatment records that had been collated for the Tuangamize Minyoo Kenya Imarisha Afya (Swahili for Eradicate Worms in Kenya for Better Health [TUMIKIA]) trial, done in coastal Kenya from 2015 to 2017. In this analysis we estimate the extent of and factors associated with the same individuals not being treated over multiple rounds of MDA, which we term systematic non-treatment. METHODS: We linked the baseline population of the TUMIKIA trial randomly assigned to receive biannual community-wide MDA for soil-transmitted helminthiasis to longitudinal records on receipt of treatment in any of the four treatment rounds of the study. We fitted logistic regression models to estimate the association of non-treatment in a given round with non-treatment in the previous round, controlling for identified predictors of non-treatment. We also used multinomial logistic regression to identify factors associated with part or no treatment versus complete treatment. FINDINGS: 36 327 participants were included in our analysis: 16 236 children aged 2-14 years and 20 091 adults aged 15 years or older. The odds of having no treatment recorded was higher if a participant was not treated during the previous round of MDA (adjusted odds ratio [OR] 3·60, 95% CI 3·08-4·20 for children and 5·58, 5·01-6·21 for adults). For children, school attendance and rural residence reduced the odds of receiving part or no treatment, whereas odds were increased by least poor socioeconomic status and living in an urban or periurban household. Women had higher odds than men of receiving part or no treatment. However, when those with pregnancy or childbirth in the previous 2 weeks were excluded, women became more likely to receive complete treatment. Adults aged 20-25 years were the age group with the highest odds of receiving part (OR 1·41, 95% CI 1·22-1·63) or no treatment (OR 1·81, 95% CI 1·53-2·14). INTERPRETATION: Non-treatment was associated with specific sociodemographic groups and characteristics and did not occcur at random. This finding has important implications for MDA programme effectiveness, the relevance of which will intensify as disease prevalence decreases and infections become increasingly clustered. FUNDING: Bill & Melinda Gates Foundation, Joint Global Health Trials Scheme of the Medical Research Council, UK Department for International Development, Wellcome Trust, Children's Investment Fund Foundation, and London Centre for Neglected Tropical Diseases.


Asunto(s)
Helmintiasis/prevención & control , Administración Masiva de Medicamentos/estadística & datos numéricos , Suelo/parasitología , Privación de Tratamiento/estadística & datos numéricos , Adolescente , Adulto , Anciano , Niño , Preescolar , Femenino , Helmintiasis/epidemiología , Helmintiasis/transmisión , Humanos , Kenia/epidemiología , Estudios Longitudinales , Masculino , Persona de Mediana Edad , Evaluación de Programas y Proyectos de Salud , Factores Socioeconómicos , Adulto Joven
14.
PLoS One ; 15(10): e0240087, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33057353

RESUMEN

BACKGROUND: Childhood Human Immunodeficiency Virus (HIV) infection occurs almost exclusively via mother to child transmission (MTCT) during pregnancy, birth, or through breastfeeding. Recent studies have shown that male involvement (MI) in antenatal care (ANC) and HIV testing, including couples voluntary counselling and testing (CVCT), increases the likelihood that women will adhere to prevention advice and comply with HIV treatment if required during their pregnancy; hence reducing the rates of MTCT of HIV. This realist review investigates how, why, when, and for whom MI in ANC works best to provide contextual advice on how MI in ANC can be best used for prevention of mother to child transmission (PMTCT) of HIV. METHODS: A realist review of existing evidence was conducted. Realist review seeks to explain how and why an intervention works, or does not work, in a given context. This was completed through the five stages of realist synthesis; Eliciting the program theory, search strategy, study selection criteria, data extraction, and data analysis and synthesis. Findings are presented as context-mechanism-outcome (CMO) configurations outlining the mechanisms that work in given contexts to give an outcome. RESULTS: Three CMO configurations were developed. These describe that 1) Couples in monogamous relationships have higher levels of trust, commitment and security leading to increased uptake of PMTCT programs together; 2) ANC spaces that make 'male friendly' adaptions promote normalisation of MI in PMTCT and are more welcoming, leading to increased willingness of male partners to participate in ANC; and 3) couples and communities with higher health literacy encourage increased informed decision making, ownership, and responsibility and thus increased participation in PMTCT of HIV. CONCLUSIONS: The CMOs developed in this review give contextual advice on how one might improve ANC services to increase MI and help reduce MTCT of HIV. We propose that MI in ANC works best where couples are monogamous and trusting, where ANC spaces actively promote being a 'male friendly space' and where there are high levels of community education programs around MTCT.


Asunto(s)
Infecciones por VIH/patología , Transmisión Vertical de Enfermedad Infecciosa/prevención & control , Atención Prenatal , Bases de Datos Factuales , Países en Desarrollo , Femenino , Infecciones por VIH/transmisión , Alfabetización en Salud , Humanos , Masculino , Evaluación de Programas y Proyectos de Salud
15.
Acad Med ; 95(10): 1479-1482, 2020 10.
Artículo en Inglés | MEDLINE | ID: mdl-33006867

RESUMEN

The Hedwig van Ameringen Executive Leadership in Academic Medicine (ELAM) Program for Women is designed to promote the careers of senior female leaders in academic health care in a way that ultimately seeks to transform culture and promote gender equity far beyond the careers of its participants. In an era of increased awareness of gender inequity within academic medicine, the longevity of the ELAM program raises several important questions. First, why is such a program still needed? Second, what exactly does it do, and what has been its influence on its participants and beyond? And third, what lessons can ELAM's example provide to help guide the medical profession as it strives to promote gender equity in the field? In this Invited Commentary, the authors seek to answer these questions from the perspective of a recent program participant and the current program director. The authors review the evidence that identifies how women, even today, face accumulating disadvantage over the course of their academic careers, stemming from repeated encounters with powerful unconscious biases and stereotypes, societal expectations for a gendered division of domestic labor, and still-present overt discrimination and sexual harassment. They describe ELAM's approach, which builds the knowledge and skills of the women who participate in the program, while also intentionally raising their visibility within their home institutions so that they have opportunities to share with institutional leaders what they have learned in ways that not only promote their own careers but also support gender equity in the broader environment. The authors conclude by offering thoughts on how ELAM's model may be leveraged in the future, ideally in partnership with the numerous professional societies, funding agencies, and other organizations that are committed to accelerating the rate of progress toward gender equity at all levels of academic medicine.


Asunto(s)
Docentes Médicos/educación , Predicción , Liderazgo , Ejecutivos Médicos/educación , Médicos Mujeres/organización & administración , Centros Médicos Académicos/organización & administración , Docentes Médicos/organización & administración , Femenino , Identidad de Género , Humanos , Ejecutivos Médicos/organización & administración , Evaluación de Programas y Proyectos de Salud
18.
PLoS One ; 15(10): e0233948, 2020.
Artículo en Inglés | MEDLINE | ID: mdl-33104731

RESUMEN

The US budget for global health funding, which was by far the largest of similar funding in the world, increased from US $1.3 billion in 2001 to more than US $10 billion in recent years. More than 54% of this funding was allocated to the Global Fund to Fight HIV/AIDS through the US President's Emergency Plan for AIDS Relief (PEPFAR) in Africa. However, recent studies indicate contradictory results regarding the effectiveness of PEPFAR. One by Bendavid, Holmes, Bhattacharya, and Miller shows positive effects of PEPFAR in reducing adult mortality in Africa, while another by Duber, Coates, Szekeras, Kaji, and Lewis finds that there are no significant differences in reducing adult mortality in countries that received PEPFAR funding vs countries that did not. Due to their potential impact on policy decisions regarding critical global health funding, we wanted to assess why the results are discrepant. To do this, we replicated the Bendavid study. The replication provides verification that the study replicable and that the analytic choices of the authors are robust to different assumptions or restrictions. This allows us to assess the different choices and data available to the two research groups and draw some conclusions about why the results may be different. Then, focusing on two of the prominently discrepant studies, i.e., the Bendavid study (1998-2008) and the Duber study (2000-2006), we establish why the two studies are in disagreement. We apply appropriate individual-level and country-level analytical methodology as used by Bendavid over the analytical time period used for the Duber study (2000-2006), which originally focused on nationally aggregated data and differed in some key focus countries. For our first objective, we replicated the original Bendavid study findings and our findings support their conclusion that between 1998-2008 all-cause mortality decreased significantly more (OR = 0.84, CI, 0.72-0.99) in countries that implemented PEPFAR. For our second objective (Bendavid's data and methodology applied to Duber's study period), we found reduction in all cause adult mortality to be borderline insignificant (OR = 0.87 CI, 0.75-1.01, p = 0.06), most possibly reflecting the abbreviated fewer number of events and sample size over a shorter period. Therefore, our overall analyses are consistent with the conclusion of positive impact of the PEPFAR program in reducing adult mortality. We believe that the discrepancy observed in the original studies mainly a reflection of shortcomings in the analytical approach necessitated by the Duber study's nationally aggregated dataset or "may reflect a lack of data quality" in the Duber study (Duber, et al. 2010).


Asunto(s)
Salud Global/legislación & jurisprudencia , Infecciones por VIH/mortalidad , Evaluación de Programas y Proyectos de Salud/métodos , Adulto , África del Sur del Sahara/epidemiología , Países en Desarrollo , Femenino , Salud Global/economía , Infecciones por VIH/economía , Promoción de la Salud/economía , Promoción de la Salud/legislación & jurisprudencia , Humanos , Cooperación Internacional/legislación & jurisprudencia , Evaluación del Resultado de la Atención al Paciente , Estados Unidos
19.
Medicine (Baltimore) ; 99(44): e22961, 2020 Oct 30.
Artículo en Inglés | MEDLINE | ID: mdl-33126366

RESUMEN

BACKGROUND: Internet-based rehabilitation can ease the progression of chronic diseases. There had been studies on internet-based rehabilitation of knee osteoarthritis (OA), but them were conducted at home and ignored the potential benefits in the community setting. This study will explore the feasibility and effectiveness of internet-based rehabilitation accompanies wearable devices in the community setting for the patients with knee OA. METHODS: An assessor-blinded randomized controlled feasibility trial will be performed to study the feasibility and effectiveness of internet-based rehabilitation program for the patients with knee OA in the community setting. Forty participants with knee OA will be recruited and randomly allocated into internet-based rehabilitation group (IRG) or control group (CG). The interventions of IRG will be performed in the community setting via web-based platform and wearable devices. The outcome measures will be conducted at baseline, and post-intervention 6 weeks, 12 weeks during the study. The feasibility will be tested by the proportion of participants who will complete the internet-based rehabilitation program within 12 weeks in IRG as well as the compliance and satisfaction. Additionally, the effectiveness of internet-based rehabilitation will be assessed by the Western Ontario and McMaster Universities Osteoarthritis Index, 11-point Numerical Rating Scale and Short Form-36 quality-of-life questionnaire. CONCLUSION: The internet-based rehabilitation program and community-based interventions is feasible and efficacy to ameliorate the osteoarthritic pain and promote the physical function and quality of life for the patients with knee OA in the community setting. TRIAL REGISTRATION NUMBER: The study was registered in the clinical trial registry ChiCTR2000033397.


Asunto(s)
Intervención basada en la Internet , Osteoartritis de la Rodilla/rehabilitación , Telerrehabilitación/métodos , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Cooperación del Paciente , Evaluación de Programas y Proyectos de Salud , Ensayos Clínicos Controlados Aleatorios como Asunto
20.
Artículo en Inglés | MEDLINE | ID: mdl-33126634

RESUMEN

Older adults are less familiar with communication technology, which became essential to maintain social contacts during the COVID-19 lockdown. The present study aimed at exploring how older adults, previously trained for Social Networking Sites (SNSs) use, experienced the lockdown period. In the first two weeks of May 2020, telephone surveys were conducted with individuals aged 81-85 years and resident in Abbiategrasso (Milan), who previously participated in a study aimed at evaluating the impact of SNSs use on loneliness in old age (ClinicalTrials.gov, NCT04242628). We collected information on SNSs use, self-perceived loneliness, and social engagement with family and friends. Interviewed participants were stratified as trained (N = 60) and untrained (N = 70) for SNSs use, based on their attendance to group courses held the previous year as part of the main experimental study. The groups were comparable for sociodemographics and clinical features. Participants trained for SNSs use reported significantly higher usage of SNSs and reduced feeling of being left out. Compared to pre-lockdown levels, individuals trained for SNSs use showed a lighter reduction in social contacts. These findings support the utility of training older adults for SNSs use in order to improve their social inclusion, even in extreme conditions of self-isolation and perceived vulnerability.


Asunto(s)
Envejecimiento/psicología , Infecciones por Coronavirus/psicología , Soledad/psicología , Neumonía Viral/psicología , Calidad de Vida , Red Social , Participación Social/psicología , Anciano , Anciano de 80 o más Años , Betacoronavirus , Infecciones por Coronavirus/epidemiología , Humanos , Salud Mental , Pandemias , Neumonía Viral/epidemiología , Evaluación de Programas y Proyectos de Salud , Apoyo Social , Encuestas y Cuestionarios
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