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1.
Health Policy Plan ; 34(7): 499-507, 2019 Sep 01.
Artículo en Inglés | MEDLINE | ID: mdl-31369667

RESUMEN

The Congenital Zika Syndrome (CZS) epidemic took place in Brazil between 2015 and 2017 and led to the emergence of at least 3194 children born with CZS. We explored access to healthcare services and activities in the Unified Health Service (Sistema Único de Saúde: SUS) from the perspective of mothers of children with CZS and professionals in the Public Healthcare Network. We carried out a qualitative, exploratory study, using semi-structured interviews, in two Brazilian states-Pernambuco, which was the epicentre of the epidemic in Brazil, and Rio de Janeiro, where the epidemic was less intense. The mothers and health professionals reported that healthcare provision was insufficient and fragmented and there were problems with follow-up care. There was a lack of co-ordination and an absence of communication between the various specialized services and between different levels of the health system. We also noted a public-private mixture in access to healthcare services, resulting from a segmented system and related to inequality of access. High reported household expenditure is an expression of the phenomenon of underfunding of the public system. The challenges that mothers and health professionals reported exposes contradictions in the health system which, although universal, does not guarantee equitable and comprehensive care. Other gaps were revealed through the outbreak. The epidemic provided visibility regarding difficulties of access for other children with disabilities determined by other causes. It also made explicit the gender inequalities that had an impact on the lives of mothers and other female caregivers, as well as an absence of the provision of care for these groups. In the face of an epidemic, the Brazilian State reproduced old fashioned forms of action-activities related to the transmitting mosquito and to prevention with an emphasis on the individual and no action related to social determinants.


Asunto(s)
Personal de Salud , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Madres , Infección por el Virus Zika/terapia , Adulto , Brasil , Preescolar , Anticoncepción , Femenino , Accesibilidad a los Servicios de Salud/economía , Humanos , Lactante , Recién Nacido , Masculino , Programas Nacionales de Salud/economía , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/normas , Embarazo , Atención Prenatal , Investigación Cualitativa , Factores Socioeconómicos , Infección por el Virus Zika/rehabilitación
3.
Indian J Tuberc ; 66(3): 394-401, 2019 Jul.
Artículo en Inglés | MEDLINE | ID: mdl-31439186

RESUMEN

BACKGROUND: Multi-drug-resistant TB (MDR-TB) has become a significant public health problem and an obstacle to effective TB control. Rapid diagnostic tests for anti tubercular drugs sensitivity have significantly reduced total time in initiation of treatment. Still there is a significant gap between MDR diagnosis and start of category IV treatment. Delay in establishing the diagnosis may cause disease progression, transmission, lost to follow up and death. This study was planned to assess the actual delay from day one of sputum examination to the day of initiation of category IV in operational settings. METHODOLOGY: MDR-TB suspected patients attending the Respiratory medicine department, JLNMC, Ajmer from June-15 to July-16 were followed from sputum examination to sample deposition for drug sensitivity testing (LPA/CBNAAT) to MDR detection to category IV initiation, for assessment of procedural delay at various steps. RESULTS: LPA group (371 patients): Sputum smear to LPA deposition mean duration was 8.02 days, LPA deposition to LPA result upload mean duration was 3.78 days, LPA deposition to patients received LPA reports mean duration was 21.73 days and reports received to PMDT site admission (if drug resistant) mean duration was 3.61 days. Total time duration in category IV initiation was 32.63 days. CBNAAT group (50 patients): Sputum smear to CBNAAT deposition mean duration was 6.70 days, CBNAAT deposition to CBNAAT result upload mean duration was 1.13 days, CBNAAT deposition to patients received CBNAAT reports mean duration was 6.53 days and reports received to PMDT site admission (if R-resistant) mean duration was 3.8 days. Total time duration in category IV initiation was 12.4 days. CONCLUSION: Major delay seen on part of receiving sensitivity reports indicates the need to stress upon field staff motivation, appropriate training, sensitisation and expert counselling.


Asunto(s)
Antituberculosos/uso terapéutico , Diagnóstico Tardío , Programas Nacionales de Salud/normas , Rifampin/uso terapéutico , Tuberculosis Resistente a Múltiples Medicamentos/diagnóstico , Tuberculosis Pulmonar/diagnóstico , Antituberculosos/administración & dosificación , Benchmarking , Esquema de Medicación , Humanos , India , Mycobacterium tuberculosis/aislamiento & purificación , Rifampin/administración & dosificación , Esputo/microbiología , Centros de Atención Terciaria , Tuberculosis Resistente a Múltiples Medicamentos/tratamiento farmacológico , Tuberculosis Resistente a Múltiples Medicamentos/prevención & control , Tuberculosis Pulmonar/tratamiento farmacológico , Tuberculosis Pulmonar/prevención & control
5.
Cien Saude Colet ; 24(6): 2193-2201, 2019 Jun 27.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-31269178

RESUMEN

This paper describes the experience of the School for the Improvement of the Unified Health System in the Federal District of Brazil (EAPSUS, acronym in Portuguese), which, together with the Superior School of Health Sciences and Technical School of Health of Brasília, is maintained by the Health Sciences Teaching and Research Foundation (FEPECS, acronym in Portuguese). This group of schools works jointly to provide health education in the Federal District. EAPSUS is responsible for the education of staff at the Department of Health of the Federal District of Brazil, using Pedagogy of Problematization as its theoretical frame of reference. It seeks to tailor teaching and learning to the needs of health services, building health professionals' capacity to examine practice reflectively and construct alternative actions. EAPSUS adopts a unique approach as a government school, developing contextualized educational actions. Education is a key component of an ambitious design that aligns concepts, guiding principles, and instruments with the strategic planning of the centers and the Federal District Health Plan. FEPECS conforms to the logic of a public health school, given that it provides higher education, professional education, and promotes the professional development of SUS staff and administrators in the Federal District.


Asunto(s)
Educación Continua/métodos , Personal de Salud/educación , Programas Nacionales de Salud/normas , Brasil , Creación de Capacidad , Personal de Salud/normas , Humanos , Instituciones Académicas , Desarrollo de Personal
6.
Br J Clin Psychol ; 58(4): 440-451, 2019 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-31183886

RESUMEN

OBJECTIVES: To evaluate whether demographic and clinical variables are related to disengagement rates in cognitive behavioural therapy (CBT) for psychosis in a clinical setting. METHODS: The medical records and symptom severity data (from Health of the Nation Outcome Scales) were analysed retrospectively for 103 referrals for CBT for psychosis in a National Health Service secondary care and Early Intervention in Psychosis team. RESULTS: Overall, 42.7% (n = 44) disengaged from CBT. There was no impact of gender or ethnicity, and no impact of clinical variables such as risk history and comorbid diagnosis. However, risk of disengagement was significantly higher for those who were younger, F = 6.89, partial η2  = .064, p = <.05; those with greater total HoNOS scores, F = 4.22, partial η2  = .04, p < .05; more severe symptoms on the HoNOS items of overactive, aggressive, disruptive, or agitated behaviour, χ2  = 6.13, p < .01; problem drinking or drug taking, χ2  = 7.65, p < .05; depressed mood, χ2  = 7.0, p < .01; and problems with occupation and activities: χ2  = 3.68, p < .05. There was a non-significant trend for shorter waiting times to be associated with greater levels of disengagement. CONCLUSIONS: These results indicate that it may not be psychosis per se that disrupts engagement in CBT, but linked behavioural and emotional factors. A more assertive approach to these factors - overactive, aggressive, disruptive, or agitated behaviour, problem drinking or drug taking, depressed mood, and problems with occupation and activities, particularly in younger people - may be valuable prior to or early on in therapy as a means of increasing engagement in CBT for psychosis. PRACTITIONER POINTS: Risk of disengagement from CBT for psychosis increases with overactive, aggressive, disruptive, or agitated behaviour (54.9% vs. 30.8%), problem drinking and drug taking (61.1% vs. 32.8%), depressed mood (56% vs. 30.2%), and problems with occupation and activities (53.3% vs. 34.5%), with a trend for younger age. An assertive and motivational approach to engagement and a focus on addressing low mood and problematic behaviours, prior to or early in therapy, may be warranted, particularly for younger people. This evaluation is limited by small sample size and being retrospective. These results speak to the question of whether psychosis itself renders people inappropriate for CBT for psychosis, or whether problems arise due to behavioural and emotional factors that might be addressed to increase access to CBT for psychosis.


Asunto(s)
Terapia Cognitivo-Conductual/métodos , Programas Nacionales de Salud/normas , Trastornos Psicóticos/psicología , Adulto , Femenino , Humanos , Masculino , Estudios Retrospectivos
8.
BMC Infect Dis ; 19(1): 496, 2019 Jun 06.
Artículo en Inglés | MEDLINE | ID: mdl-31170921

RESUMEN

BACKGROUND: HIV testing serves as a critical gateway for linkage and retention to care services, particularly in sub-Saharan African countries with high burden of HIV infections. However, the current progress towards addressing the first cascade of the 90-90-90 programme is largely contributed by women. This study aimed to map evidence on the intervention strategies to improve HIV uptake among men in sub-Saharan Africa. METHODS: We conducted a scoping review guided by Arksey and O'Malley's (2005) framework and Levac et al. (2010) recommendation for methodological enhancement for scoping review studies. We searched for eligible articles from electronic databases such as PubMed/MEDLINE; American Doctoral Dissertations via EBSCO host; Union Catalogue of Theses and Dissertations (UCTD); SA ePublications via SABINET Online; World Cat Dissertations; Theses via OCLC; and Google Scholar. We included studies from January 1990 to August 2018. We used the PRISMA extension for scoping reviews (PRISMA-ScR): checklist and explanation. The Mixed Method Appraisal Tool version 2018 was used to determine the methodological quality of the included studies. We further used NVivo version 11 to aid with content thematic analysis. RESULTS: This study revealed that teaching men about HIV; Community-Based HIV testing; Home-Based HIV testing; Antenatal Care HIV testing; HIV testing incentives and HIV Self-testing are important strategies to improving HIV testing among men in sub-Saharan Africa. The need for improving programmes aimed at giving more information to men about HIV that are specifically tailored for men, especially given their poor uptake of HIV testing services was also found. This study further revealed the need for implementing Universal Test and Treat among HIV positive men found through community-based testing strategies, while suggesting the importance of restructuring home-based HIV testing visits to address the gap posed by mobile populations. CONCLUSION: The community HIV testing, as well as, HIV self-testing strategies showed great potential to increase HIV uptake among men in sub-Saharan Africa. However, to address poor linkage to care, ART should be initiated soon after HIV diagnosis is concluded during community testing services. We also recommend more research aimed at addressing the quality of HIV self-testing kits, as well as, improving the monitoring systems of the distributed HIV self-testing kits.


Asunto(s)
Infecciones por VIH/diagnóstico , Infecciones por VIH/epidemiología , Tamizaje Masivo , Participación del Paciente/estadística & datos numéricos , Adulto , África del Sur del Sahara/epidemiología , Actitud Frente a la Salud , Demografía/estadística & datos numéricos , Práctica Clínica Basada en la Evidencia , Femenino , Geografía , VIH , Infecciones por VIH/transmisión , Humanos , Masculino , Tamizaje Masivo/métodos , Tamizaje Masivo/organización & administración , Tamizaje Masivo/estadística & datos numéricos , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/normas , Programas Nacionales de Salud/estadística & datos numéricos , Embarazo , Complicaciones Infecciosas del Embarazo/diagnóstico , Complicaciones Infecciosas del Embarazo/epidemiología , Complicaciones Infecciosas del Embarazo/prevención & control , Pruebas Serológicas
9.
Epidemiol Serv Saude ; 28(1): e2018128, 2019.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30970074

RESUMEN

OBJECTIVE: to analyze factors associated with the perception of quality of primary health care (PHC) services by older adults. METHODS: this was a cross-sectional survey with 893 older adults aged 60 years and over living in the Metropolitan Region of Belo Horizonte, MG, Brazil; the study's outcomes were the indicators of the essential attributes of PHC, while explanatory variables included sociodemographic conditions, use of health services and health conditions; Poisson regression with robust variance was used. RESULTS: older adults aged 80 years and over, women and those with higher education levels gave better evaluations for access and longitudinality, while evaluation was worst among those who reported greater use of health services and chronic health conditions, especially for the PHC attributes of coordination of care and family and community orientation. CONCLUSION: poorer health conditions and higher use of services are associated with a more negative perception of PHC attributes among the elderly.


Asunto(s)
Programas Nacionales de Salud/normas , Atención Primaria de Salud/normas , Indicadores de Calidad de la Atención de Salud , Calidad de la Atención de Salud , Factores de Edad , Anciano , Anciano de 80 o más Años , Brasil , Estudios Transversales , Escolaridad , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Distribución de Poisson , Atención Primaria de Salud/estadística & datos numéricos , Factores Sexuales , Encuestas y Cuestionarios
10.
Value Health ; 22(3): 362-369, 2019 Mar.
Artículo en Inglés | MEDLINE | ID: mdl-30832975

RESUMEN

BACKGROUND: Decision makers are facing growing challenges in prioritizing drugs for reimbursement because of soaring drug costs and increasing pressures on financial resources. In addition to cost and effectiveness, payers are using other values to dictate which drugs are prioritized for funding, yet there are limited data on the Canadian public's priorities. OBJECTIVES: To measure the relative societal importance of values considered most relevant in informing drug reimbursement decisions in a representative sample of Canadians. METHODS: An online survey of 2539 Canadians aged 19 years and older was performed in which 13 values used in drug funding prioritization were ranked and then weighted using an analytic hierarchy process. RESULTS: Canadians value safe and efficacious drugs that have certainty of evidence. The values ranked in the top 5 by most of our subjects were potential effect on quality of life (65.4%), severity of the disease (62.6%), ability of drug to work (61.1%), safety (60.5%), and potential to extend life (49.4%). Values related to patient or disease characteristics such as rarity, socioeconomic status, and health and lifestyle choices held the lowest rankings and weights. CONCLUSIONS: Canadians value, above all, treatment-related factors (eg, efficacy and safety) and disease-related factors (eg, severity and equity). Decision makers are currently using additional justifications to prioritize drugs for reimbursement, such as rarity and unmet need, which were not found to be highly valued by Canadians. Decision makers should integrate the public's values into a Canadian reimbursement framework for prioritization of drugs competing for limited funds.


Asunto(s)
Toma de Decisiones , Costos de los Medicamentos/tendencias , Cobertura del Seguro/tendencias , Programas Nacionales de Salud/tendencias , Encuestas y Cuestionarios , Adulto , Canadá/epidemiología , Toma de Decisiones/fisiología , Costos de los Medicamentos/normas , Femenino , Humanos , Cobertura del Seguro/normas , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/normas , Producción de Medicamentos sin Interés Comercial/métodos , Producción de Medicamentos sin Interés Comercial/normas , Encuestas y Cuestionarios/normas
11.
J Fr Ophtalmol ; 42(3): 288-294, 2019 Mar.
Artículo en Francés | MEDLINE | ID: mdl-30857804

RESUMEN

INTRODUCTION: Diabetic retinopathy (DR) is a leading cause of blindness worldwide. Non-mydriatic fundus photography (NMFP) has been adopted as a screening tool for this disease. We aim to determine the prevalence of DR through this method in Lebanese diabetic patients and to evaluate the impact of such screening in this population. MATERIALS AND METHODS: This study explores data from an awareness and screening campaign conducted in Lebanon. Diabetic patients from multiple regions were referred by their endocrinologists to undergo NMFP using the Optomed SmartScope® handheld fundus camera. Photographs were interpreted by a remote observer, and recommendations were given accordingly. The prevalence of DR was calculated, and statistical analyses were performed on the clinical characteristics, fundus findings and number of referrals to ophthalmologists. RESULTS: The campaign lasted 11 months, during which 2205 patients were examined in 37 screening locations. Out of the 97.41% of patients with type 2 diabetes mellitus, 12.56% had signs of DR, with no significant difference between the regions. 6.28% of the photos were uninterpretable. Positive results were associated with a longer duration of diabetes (P<0.01), treatment with insulin (P<0.01), as well as the presence and chronicity of systemic hypertension (P=0.01). 25% of patients with positive testing were retrospectively asked about their follow-up; only one third had an ophthalmologic examination as per the recommendation, among whom 68.18% underwent treatment for proliferative DR and/or diabetic macular edema. CONCLUSION: Tele-ophthalmology is useful in mass screening for DR. The importance of dilated fundus examinations still needs to be highlighted for diabetic patients, and better collaboration between endocrinologists and ophthalmologists is required to improve screening outcomes.


Asunto(s)
Retinopatía Diabética/diagnóstico , Técnicas de Diagnóstico Oftalmológico , Fondo de Ojo , Tamizaje Masivo/métodos , Fotograbar/métodos , Adulto , Anciano , Anciano de 80 o más Años , Diabetes Mellitus Tipo 2/complicaciones , Diabetes Mellitus Tipo 2/diagnóstico , Diabetes Mellitus Tipo 2/epidemiología , Diabetes Mellitus Tipo 2/patología , Retinopatía Diabética/epidemiología , Femenino , Humanos , Líbano/epidemiología , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/normas , Examen Físico , Prevalencia , Evaluación de Programas y Proyectos de Salud , Estudios Retrospectivos , Adulto Joven
12.
BMC Health Serv Res ; 19(1): 196, 2019 Mar 28.
Artículo en Inglés | MEDLINE | ID: mdl-30922298

RESUMEN

BACKGROUND: Ghana's National Health Insurance Scheme (NHIS) has witnessed an upsurge in enrollment since its inception in 2003, with over 40% of the Ghanaian population actively enrolled in the scheme. While the scheme strives to achieve universal health coverage, this quest is derailed by negative perceptions of the quality of services rendered to NHIS subscribers. This paper presents an analysis on perceptions of service quality provided to subscribers of Ghana's NHIS with emphasis on rural and urban scheme policy holders, using a nationally representative data. METHODS: The study used data from the 2014 Ghana Demographic and Health Survey. Ordered logistic regressions were estimated to identify the correlates of perceived quality of care of services rendered by the NHIS. Also, chi-square statistics were performed to test for significant differences in the proportions of subscribers in the two subsamples (rural and urban). RESULTS: Rural subscribers of the NHIS were found to identify more with better perception of quality of services provided by the NHIS than urban subscribers. Results from the chi-square statistics further indicated that rural subscribers are significantly different from urban subscribers in terms of the selected socioeconomic and demographic characteristics. In the full sample; age, out-of-pocket payment for healthcare and region of residence proved significant in explaining perceived quality of services rendered by the NHIS. Age, out-of-pocket payment for healthcare, region of residence, wealth status, and access to media were found to be significant predictors of perceived quality of services provided to both rural and urban subscribers of the NHIS. The significance of these variables varied among men and women in rural and urban areas. CONCLUSION: Different factors affect the perception of quality of services provided to rural and urban subscribers of Ghana's NHIS. Health financing policies geared toward improving the NHIS-related services in rural and urban areas should be varied.


Asunto(s)
Actitud Frente a la Salud , Programas Nacionales de Salud/normas , Adolescente , Adulto , Exactitud de los Datos , Prestación de Atención de Salud/economía , Prestación de Atención de Salud/normas , Demografía , Femenino , Ghana , Gastos en Salud/estadística & datos numéricos , Encuestas Epidemiológicas , Humanos , Seguro de Salud/economía , Modelos Logísticos , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/economía , Percepción , Opinión Pública , Calidad de la Atención de Salud , Salud Rural/economía , Salud Rural/normas , Cobertura Universal del Seguro de Salud/economía , Cobertura Universal del Seguro de Salud/normas , Salud Urbana/economía , Salud Urbana/normas , Adulto Joven
13.
J Bras Pneumol ; 45(1): e20170194, 2019 Feb 11.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30758425

RESUMEN

OBJECTIVE: To describe COPD pharmacological treatment patterns in the state of Bahia, Brazil, and to evaluate the extent to which these patterns conform to clinical guidelines for the management of COPD. METHODS: This was a cross-sectional study of 441 patients referred from the Public Health Care Network of the state of Bahia to a public referral outpatient clinic of a COPD management program of the Brazilian Unified Health Care System. Individuals with a spirometry-confirmed diagnosis of moderate to very severe COPD were included in the study. Patients were evaluated as to whether they had used any COPD medications in the last seven days. The appropriateness or inappropriateness (undertreatment or overtreatment) of the patient's pharmacological treatment was evaluated by comparing the patient's current treatment with that recommended by national and international guidelines. RESULTS: A total of 383 individuals were included in the analysis. Approximately half of the patients (49.1%) used long-acting bronchodilators. These patients were older and had had the disease longer. Of the sample as a whole, 63.7% and 83.0% did not receive pharmacological treatment in accordance with international and national recommendations, respectively. Inappropriateness due to undertreatment was indentified in more than half of the patients. CONCLUSIONS: Long-acting bronchodilators are frequently underused in individuals with moderate to very severe COPD within the Brazilian Unified Health Care System in the state of Bahia. Most patients in our sample were treated inappropriately, and undertreatment predominated. Strategies to improve access to long-acting bronchodilators and the quality of COPD pharmacological management are required.


Asunto(s)
Broncodilatadores/uso terapéutico , Manejo de la Enfermedad , Programas Nacionales de Salud/normas , Enfermedad Pulmonar Obstructiva Crónica/tratamiento farmacológico , Anciano , Brasil , Estudios Transversales , Femenino , Humanos , Masculino , Persona de Mediana Edad , Mal Uso de Medicamentos de Venta con Receta/estadística & datos numéricos , Índice de Severidad de la Enfermedad , Distribución por Sexo , Factores Socioeconómicos , Espirometría , Resultado del Tratamiento
14.
Diabetes Metab Res Rev ; 35(2): e3101, 2019 02.
Artículo en Inglés | MEDLINE | ID: mdl-30468566

RESUMEN

AIM: No studies have investigated if national guidelines to manage diabetic foot disease differ from international guidelines. This study aimed to compare guidelines of Western Pacific nations with the International Working Group on the Diabetic Foot (IWGDF) guidance documents. METHODS: The 77 recommendations in five chapters of the 2015 IWGDF guidance documents were used as the international gold standard reference. The IWGDF national representative(s) from 12 Western Pacific nations were invited to submit their nation's diabetic foot guideline(s). Four investigators rated information in the national guidelines as "similar," "partially similar," "not similar," or "different" when compared with IWGDF recommendations. National representative(s) reviewed findings. Disagreements in ratings were discussed until consensus agreement achieved. RESULTS: Eight of 12 nations (67%) responded: Australia, China, New Zealand, Taiwan, and Thailand provided national guidelines; Singapore provided the Association of Southeast Asian Nations guidelines; and Hong Kong and the Philippines advised no formal national diabetic foot guidelines existed. The six national guidelines included were 39% similar/partially similar, 58% not similar, and 2% different compared with the IWGDF recommendations. Within individual IWGDF chapters, the six national guidelines were similar/partially similar with 53% of recommendations for the IWGDF prevention chapter, 42% for wound healing, 40% for infection, 40% for peripheral artery disease, and 20% for offloading. CONCLUSIONS: National diabetic foot disease guidelines from a large and diverse region of the world showed limited similarity to recommendations made by international guidelines. Differences between recommendations may contribute to differences in national diabetic foot disease outcomes and burdens.


Asunto(s)
Pie Diabético/prevención & control , Medicina Basada en la Evidencia , Agencias Internacionales , Programas Nacionales de Salud/normas , Guías de Práctica Clínica como Asunto/normas , Adulto , Manejo de la Enfermedad , Femenino , Humanos , Masculino
15.
Encephale ; 45 Suppl 1: S35-S37, 2019 Jan.
Artículo en Francés | MEDLINE | ID: mdl-30477900

RESUMEN

ISSUE: Suicide is a major problem of public health around the world, and if suicidal mortality rates have declined in recent years, the elderly remain a category of the world's population at major risk of suicide. Seventeen percent of deaths by suicide across the world are individuals over the age of 65. The existence of suicidal ideas for an individual in this age group increases the risk of suicide attempt in the year by 34. In France, about a little less than a quarter of suicides belong to persons over 60-years-old. More risk factors found in the international literature are in the foreground of mental disorders and in particular the major depression episode, then secondarily addictions, neuro-degenerative disorders as well as pain and other diseases. Depression is found in 60% to 90% of suicides. We notice also that older people privileged the general practitioner as interlocutor to discuss their problems and worries much more than psychiatrists or psychologists. In fact, two-thirds of the elderly who committed suicide had consulted their general practioner in the month prior to suicide and half in the 10 last days. That raises the question of the identification of depression and the evaluation of suicidal risk. On the other side, there is an abundant literature about psychosocial risk factors especially on the influence of isolation and lack of social support as well as on conflicts and family losses. In France, more than 4 million of the elderly live alone. So, while the world population is increasing and life expectancy lengthens, it is important to already act for elderly suicide prevention. PERSPECTIVES: Suicide prevention actions whose efficacity have been demonstrated around the world are designed as part of multimodal strategies combining several levers of action. The consensual recommendations for prevention of elderly suicide recommend the association of actions on the reduction of depression and combating social isolation in connection with the training of front-line actors such as general practitioners. As a result of these experiments and recommendations, the first francophone multimodal strategy was developed to act both on depression and social isolation: the Coopération Québec France sur la dépression et l'isolement (CQFDi) program which will be implemented in France and Quebec in 2019. CONCLUSION: It has been proven that multimodal suicide prevention strategies allow a reduction in the number of suicides. The CQFDi program focuses on at risk of suicide population and aims to reduce the suicide rate of elderly people in France.


Asunto(s)
Depresión/psicología , Depresión/terapia , Psiquiatría Preventiva/métodos , Conducta Autodestructiva/terapia , Aislamiento Social/psicología , Suicidio/prevención & control , Factores de Edad , Anciano , Anciano de 80 o más Años , Terapia Combinada , Conducta Cooperativa , Depresión/diagnóstico , Depresión/epidemiología , Francia/epidemiología , Evaluación Geriátrica , Humanos , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/normas , Quebec/epidemiología , Factores de Riesgo , Conducta Autodestructiva/diagnóstico , Conducta Autodestructiva/epidemiología , Conducta Autodestructiva/psicología , Apoyo Social , Ideación Suicida , Suicidio/psicología , Suicidio/estadística & datos numéricos
17.
Encephale ; 45 Suppl 1: S38-S41, 2019 Jan.
Artículo en Francés | MEDLINE | ID: mdl-30424863

RESUMEN

INTRODUCTION: In terms of suicide prevention, population-based prevention devices often struggle to demonstrate an effect in terms of reducing suicidal acts of suicide, often focusing on the evolution of the number of suicide attempts, on time too short to statistically interpret changes in mortality. The consolidated figures for mortality in France are provided by the CepiDC with a delay of approximately three years. We therefore had to try to work with an approximation of the phenomenon, and we tested the proxy value of the enumeration of corpses, body examinations and medico-legal autopsies for suicide by the forensic doctors of the Nord-Pas-de-Calais region in France. In parallel, we conducted a comprehensive mortality study for 2016 in the VigilanS cohort. METHOD: By measuring the evolution of the number of body lifts for suicide by the Department of Forensic Medicine of the region, for the 3 years before VigilanS (2012-2014) compared to the 3 years since VigilanS (2015-2017). The deaths of patients of the VigilanS cohort were identified by calling the city halls of birth and domicile of all patients integrating the device in 2016. The cause of death was then characterized by contact of the attending physician. RESULTS: We observe an average decrease in suicide mortality of 9.9% (-12% for men, +0.3% for women). The exhaustive analysis of suicide mortality in the VigilanS cohort in 2016 found 19 deaths, of which 14 by suicide, or 0.4% of patients. This observed mortality rate in the VigilanS cohort in 2016 is significantly below the expected threshold in the literature (1 to 2% in the year following TS). CONCLUSION: It seems possible to reach the 2020 target for a 10% decrease in suicidal behavior in industrialized countries by 2020. The VigilanS device could therefore be protective in terms of suicide mortality.


Asunto(s)
Monitoreo Fisiológico , Mortalidad/tendencias , Programas Nacionales de Salud , Psiquiatría Preventiva , Suicidio/estadística & datos numéricos , Adulto , Causas de Muerte/tendencias , Estudios de Cohortes , Femenino , Francia/epidemiología , Humanos , Masculino , Monitoreo Fisiológico/métodos , Monitoreo Fisiológico/normas , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/normas , Vigilancia de la Población/métodos , Psiquiatría Preventiva/organización & administración , Psiquiatría Preventiva/normas , Evaluación de Programas y Proyectos de Salud , Intento de Suicidio/estadística & datos numéricos , Intento de Suicidio/tendencias
18.
Value Health Reg Issues ; 18: 8-13, 2019 May.
Artículo en Inglés | MEDLINE | ID: mdl-30412915

RESUMEN

BACKGROUND: Setting priorities for limited public resources has become a topic of heated discussion the world over. Assigning different weights for the health gains of different population groups allows for equity considerations in cost-effectiveness analysis. However, only a few empirical works have elicited the preferences of the general public. OBJECTIVE: To compare the equity preferemce assigned by Japanese and Koreans. METHODS: We conducted a Web-based survey in March 2013, including a discrete choice experiment, to elicit the equity preferences of the general public for the life expectancy gains of different population groups. We selected attributes and designed the experiment following Norman et al.'s study (Norman R, Hall J, Street D, Viney R. Efficiency and equity: a stated preference approach. Health Econ 2013;22:568-81). Accordingly, we analyzed preference for sex, smoking status, lifestyle, caring status, income, and age. RESULTS: The Japanese assigned a higher preference for males (P < 0.001), nonsmokers (P < 0.001), those with lower income (P < 0.001), and carers (P < 0 .001), and they assigned a lower preference for those with a life expectancy of 60 years (P = 0.002) and 75-year-olds (P < 0.001). Koreans have the same patterns of preference for lower income (P < 0.001), caring (P < 0.001), and smoking status (P = 0.026). However, they prefer both sexes (P = 0.331) and different age groups equally. In both countries, respondents tend to prefer groups with characteristics similar to their own. CONCLUSIONS: People from the two Asian developed countries, with universal health insurance, show different equity preferences. These may reflect the variations in cultural background and coverage of health care services.


Asunto(s)
Esperanza de Vida/etnología , Programas Nacionales de Salud/normas , Opinión Pública , Adulto , Grupo de Ascendencia Continental Asiática/etnología , Grupo de Ascendencia Continental Asiática/psicología , Grupo de Ascendencia Continental Asiática/estadística & datos numéricos , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/estadística & datos numéricos , Años de Vida Ajustados por Calidad de Vida , República de Corea , Encuestas y Cuestionarios
19.
Rev Esc Enferm USP ; 52: e03407, 2018 Dec 20.
Artículo en Inglés, Portugués | MEDLINE | ID: mdl-30569958

RESUMEN

OBJECTIVE: To assess the perception of professionals of Family Health Strategy Teams on the National Program for Access and Quality Improvement in Primary Care and the possible changes in the work processes resulting from its implementation. METHOD: Oral history methodology conducted with members of Basic Health Units' teams who participated in the first two cycles of the Program in São Paulo. RESULTS: Six team members participated in the research. The professionals described the use of information to support the planning, diverged on the changes in the organization of the service and identified contributions to the direction of the teams and the control of the activities. The implementation of the Program led to changes in professional practice and favored autonomy and teamwork. The Community Health Workers stood out in the information acquisition process, and the teams found difficulties to organize the information. The collection and retrieval of information contributed to broaden the professionals' view of the service, and the interviewees criticized the fragility of information dissemination in the Units. CONCLUSION: Despite its limitations, the Program led to direct improvements in the work of the teams in Primary Care.


Asunto(s)
Salud de la Familia , Grupo de Atención al Paciente/organización & administración , Atención Primaria de Salud/organización & administración , Mejoramiento de la Calidad , Femenino , Accesibilidad a los Servicios de Salud , Humanos , Entrevistas como Asunto , Masculino , Persona de Mediana Edad , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/normas , Grupo de Atención al Paciente/normas , Atención Primaria de Salud/normas
20.
An. sist. sanit. Navar ; 41(3): 309-320, sept.-dic. 2018. tab
Artículo en Español | IBECS | ID: ibc-179079

RESUMEN

Fundamento: Determinar qué indicadores clave del Servicio Nacional de Salud (SNS) español influyen en la satisfacción del paciente con el SNS, con el médico de familia y con el médico especialista. Métodos: Se relacionaron las medias de cada comunidad autónoma para cada indicador, publicadas por el Ministerio de Sanidad, Servicios Sociales e Igualdad correspondientes a los años 2005 a 2014, con la satisfacción del paciente con el SNS, con el médico de familia y con el especialista mediante regresión lineal múltiple. Resultados: La satisfacción del paciente con el SNS se explicó en un 57,32%, con el médico de familia en un 54,45% y con el especialista en un 55,11%. En los tres tipos de satisfacción influyó positiva y significativamente el número de médicos especialistas, el número de ingresos hospitalarios y la mortalidad intrahospitalaria, mientras que lo hizo negativamente el número de intervenciones quirúrgicas. El mayor uso de equipos de tomografía axial computarizada y la tasa de infección hospitalaria influyeron negativamente en la satisfacción con el SNS y con el médico especialista, mientras que el mayor porcentaje de cirugía ambulatoria lo hizo de forma positiva. La estancia media hospitalaria muestra una relación negativa con la satisfacción con los médicos de familia y especialistas. Conclusiones: Las políticas sanitarias deberían considerar el incremento en el número de médicos especialistas, favorecer la cirugía ambulatoria, facilitar el tratamiento hospitalario, vigilar la efectividad de las intervenciones quirúrgicas, controlar las infecciones hospitalarias y moderar la prescripción de fármacos mediante el uso de alternativas a in de incrementar la satisfacción del paciente


Background: Determine which key indicators of the Spanish National Health Service (NHS) influence patient satisfaction with the Spanish NHS and physicians (family doctors and specialists). Method: The mean for each indicator for each autonomous community, published by the Ministry of Health, Social Services and Equality, corresponding to the years 2005 to 2014, was related to patient satisfaction with NHS, family doctors and specialists by means of multiple linear regression. Results: Patient satisfaction with the NHS was ascertained at 57.32%, with general practitioners at 54.45% and specialist doctors at 55.11%. In the three types of satisfaction, the number of specialist doctors, hospital admissions and in-hospital mortality had a positive and significant influence, while the number of surgical interventions had a negative influence. The greater use of computerized tomography equipment and the hospital infection rate had a negative effect on satisfaction with the NHS and with specialist physicians, while the percentage of outpatient surgery had a positive effect. The average hospital stay shows a negative relationship with satisfaction with family doctors and specialists. Conclusions: Health policies should consider an increase in the number of medical specialists, favour ambulatory surgery, facilitate hospital treatment, monitor the effectiveness of surgical interventions, control hospital infections and moderate the prescription of drugs through the use of alternatives in order to increase patient satisfaction


Asunto(s)
Humanos , Programas Nacionales de Salud/organización & administración , Programas Nacionales de Salud/normas , Satisfacción del Paciente , Medicina Familiar y Comunitaria , Calidad de la Atención de Salud/organización & administración , Modelos Lineales , Política de Salud
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