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1.
BMC Pediatr ; 20(1): 427, 2020 09 07.
Artigo em Inglês | MEDLINE | ID: mdl-32894080

RESUMO

BACKGROUND: The COVID-19 pandemic has disrupted healthcare systems worldwide. In addition to the direct impact of the virus on patient morbidity and mortality, the effect of lockdown strategies on health and healthcare utilization have become apparent. Little is known on the effect of the pandemic on pediatric and adolescent medicine. We examined the impact of the pandemic on pediatric emergency healthcare utilization. METHODS: We conducted a monocentric, retrospective analysis of n = 5,424 pediatric emergency department visits between January 1st and April 19th of 2019 and 2020, and compared healthcare utilization during the pandemic in 2020 to the same period in 2019. RESULTS: In the four weeks after lockdown in Germany began, we observed a massive drop of 63.8% in pediatric emergency healthcare utilization (mean daily visits 26.8 ± SEM 1.5 in 2019 vs. 9.7 ± SEM 1 in 2020, p < 0.005). This drop in cases occurred for both communicable and non-communicable diseases. A larger proportion of patients under one year old (daily mean of 16.6% ±SEM 1.4 in 2019 vs. 23.1% ±SEM 1.7 in 2020, p < 0.01) and of cases requiring hospitalisation (mean of 13.9% ±SEM 1.6 in 2019 vs. 26.6% ±SEM 3.3 in 2020, p < 0.001) occurred during the pandemic. During the analysed time periods, few intensive care admissions and no fatalities occurred. CONCLUSIONS: Our data illustrate a significant decrease in pediatric emergency department visits during the COVID-19 pandemic. Public outreach is needed to encourage parents and guardians to seek medical attention for pediatric emergencies in spite of the pandemic.


Assuntos
Betacoronavirus , Infecções por Coronavirus , Serviço Hospitalar de Emergência/tendências , Utilização de Instalações e Serviços/tendências , Acesso aos Serviços de Saúde/tendências , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral , Adolescente , Criança , Pré-Escolar , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Feminino , Alemanha , Humanos , Lactente , Recém-Nascido , Masculino , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Estudos Retrospectivos
2.
PLoS One ; 15(9): e0238354, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32936812

RESUMO

BACKGROUND: African-American men have the lowest 5-year survival rate in the U.S. for colorectal cancer (CRC) of any racial group, which may partly stem from low screening adherence. It is imperative to synthesize the literature evaluating the effectiveness of interventions on CRC screening uptake in this population. MATERIALS AND METHODS: In this systematic review and meta-analysis, Medline, CINAHL, Embase, and Cochrane CENTRAL were searched for U.S.-based interventions that: were published after 1998-January 2020; included African-American men; and evaluated CRC screening uptake explicitly. Checklist by Cochrane Collaboration and Joanna Brigg were utilized to assess risk of bias, and meta-regression and sensitivity analyses were employed to identify the most effective interventions. RESULTS: Our final sample comprised 41 studies with 2 focused exclusively on African-American men. The most frequently adopted interventions were educational materials (39%), stool-based screening kits (14%), and patient navigation (11%). Most randomized controlled trials failed to provide details about the blinding of the participant recruitment method, allocation concealment method, and/or the outcome assessment. Due to high heterogeneity, meta-analysis was conducted among 17 eligible studies. Interventions utilizing stool-based kits or patient navigation were most effective at increasing CRC screening completion, with odds ratios of 9.60 (95% CI 2.89-31.82, p = 0.0002) and 2.84 (95% CI 1.23-6.49, p = 0.01). No evidence of publication bias was present for this study registered with the International Prospective Registry of Systematic Reviews (PROSPERO 2019 CRD42019119510). CONCLUSIONS: Additional research is warranted to uncover effective, affordable interventions focused on increasing CRC screening completion among African-American men. When designing and implementing future multicomponent interventions, employing 4 or fewer interventions types may reduce bias risk. Since only 5% of the interventions solely focused on African-American men, future theory-driven interventions should consider recruiting samples comprised solely of this population.


Assuntos
Afro-Americanos/psicologia , Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Educação de Pacientes como Assunto/métodos , Afro-Americanos/estatística & dados numéricos , Neoplasias Colorretais/prevenção & controle , Neoplasias Colorretais/psicologia , Detecção Precoce de Câncer/estatística & dados numéricos , Humanos , Masculino , Prognóstico
3.
Vaccine ; 38(45): 7049-7056, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-32980199

RESUMO

BACKGROUND: Maintaining health of healthcare workers with vaccination is a major component of pandemic preparedness and acceptance of vaccinations is essential to its success. This study aimed to examine impact of the coronavirus disease 2019 (COVID-19) pandemic on change of influenza vaccination acceptance and identify factors associated with acceptance of potential COVID-19 vaccination. METHOD: A cross-sectional self-administered anonymous questionnaire survey was conducted among nurses in Hong Kong, China during 26 February and 31 March 2020. Their previous acceptance of influenza vaccination and intentions to accept influenza and COVID-19 vaccination were collected. Their relationship with work-related and other factors were examined using multiple multinomial logistic regressions. RESULTS: Responses from 806 participants were retrieved. More nurses changed from vaccination refusal to hesitancy or acceptance than those changed from acceptance to vaccination hesitancy or refusal (15.5% vs 6.8% among all participants, P < 0.001). 40.0% participants intended to accept COVID-19 vaccination, and those in private sector (OR: 1.67, 95%CI: 1.11-2.51), with chronic conditions (OR: 1.83, 95%CI: 1.22-2.77), encountering with suspected or confirmed COVID-19 patients (OR: 1.63, 95%CI: 1.14-2.33), accepted influenza vaccination in 2019 (OR: 2.03, 95%CI: 1.47-2.81) had higher intentions to accept it. Reasons for refusal and hesitation for COVID-19 vaccination included "suspicion on efficacy, effectiveness and safety", "believing it unnecessary", and "no time to take it". CONCLUSION: With a low level of COVID-19 acceptance intentions and high proportion of hesitation in both influenza and COVID-19 vaccination, evidence-based planning are needed to improve the uptake of both vaccinations in advance of their implementation. Future studies are needed to explore reasons of change of influenza vaccination acceptance, look for actual behaviour patterns of COVID-19 vaccination acceptance and examine effectiveness of promotion strategies.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Influenza Humana/psicologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Vacinação/psicologia , Adolescente , Adulto , Fatores Etários , Betacoronavirus/patogenicidade , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Estudos Transversais , Feminino , Pessoal de Saúde , Hong Kong/epidemiologia , Humanos , Vacinas contra Influenza/administração & dosagem , Influenza Humana/epidemiologia , Influenza Humana/imunologia , Intenção , Masculino , Pessoa de Meia-Idade , Orthomyxoviridae/patogenicidade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Segurança do Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Fatores Sexuais , Inquéritos e Questionários , Vacinas Virais/administração & dosagem , Vacinas Virais/imunologia
4.
PLoS Med ; 17(9): e1003284, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32925912

RESUMO

BACKGROUND: Psychiatric comorbidity is known to impact upon use of nonpsychiatric health services. The aim of this systematic review and meta-analysis was to assess the specific impact of severe mental illness (SMI) on the use of inpatient, emergency, and primary care services for nonpsychiatric medical disorders. METHODS AND FINDINGS: PubMed, Web of Science, PsychINFO, EMBASE, and The Cochrane Library were searched for relevant studies up to October 2018. An updated search was carried out up to the end of February 2020. Studies were included if they assessed the impact of SMI on nonpsychiatric inpatient, emergency, and primary care service use in adults. Study designs eligible for review included observational cohort and case-control studies and randomised controlled trials. Random-effects meta-analyses of the effect of SMI on inpatient admissions, length of hospital stay, 30-day hospital readmission rates, and emergency department use were performed. This review protocol is registered in PROSPERO (CRD42019119516). Seventy-four studies were eligible for review. All were observational cohort or case-control studies carried out in high-income countries. Sample sizes ranged from 27 to 10,777,210. Study quality was assessed using the Newcastle-Ottawa Scale for observational studies. The majority of studies (n = 45) were deemed to be of good quality. Narrative analysis showed that SMI led to increases in use of inpatient, emergency, and primary care services. Meta-analyses revealed that patients with SMI were more likely to be admitted as nonpsychiatric inpatients (pooled odds ratio [OR] = 1.84, 95% confidence interval [CI] 1.21-2.80, p = 0.005, I2 = 100%), had hospital stays that were increased by 0.59 days (pooled standardised mean difference = 0.59 days, 95% CI 0.36-0.83, p < 0.001, I2 = 100%), were more likely to be readmitted to hospital within 30 days (pooled OR = 1.37, 95% CI 1.28-1.47, p < 0.001, I2 = 83%), and were more likely to attend the emergency department (pooled OR = 1.97, 95% CI 1.41-2.76, p < 0.001, I2 = 99%) compared to patients without SMI. Study limitations include considerable heterogeneity across studies, meaning that results of meta-analyses should be interpreted with caution, and the fact that it was not always possible to determine whether service use outcomes definitively excluded mental health treatment. CONCLUSIONS: In this study, we found that SMI impacts significantly upon the use of nonpsychiatric health services. Illustrating and quantifying this helps to build a case for and guide the delivery of system-wide integration of mental and physical health services.


Assuntos
Comorbidade/tendências , Transtornos Mentais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Idoso , Feminino , Hospitalização/estatística & dados numéricos , Hospitalização/tendências , Humanos , Tempo de Internação , Masculino , Saúde Mental/tendências , Pessoa de Meia-Idade , Readmissão do Paciente
5.
Vaccine ; 38(44): 6922-6929, 2020 10 14.
Artigo em Inglês | MEDLINE | ID: mdl-32893036

RESUMO

INTRODUCTION: Despite historical exclusion, there has been recent recognition of the need to address the health of pregnant women in research on vaccines against emerging pathogens. However, pregnant women's views and decision-making processes about vaccine research participation during infectious disease outbreaks remain underexplored. This study aims to examine women's decision-making processes around vaccine research participation during infectious disease outbreaks. METHODS: We conducted qualitative semi-structured in-depth interviews with pregnant and recently pregnant women (n = 13), eliciting their views on four hypothetical Zika Virus vaccine research scenarios and probing their decision-making processes around participation. After recorded interviews were transcribed, thematic analysis was conducted based on a priori and emergent themes. RESULTS: Most women interviewed were accepting of vaccine research scenarios. Three broad themes-evidence, risk, and trust-characterized women's decision-making processes. Women varied in how different types and levels of evidence impacted their considerations, which risks were most salient to their decision-making processes, and from whom they trusted recommendations about vaccine research participation. Exemplary quotes from each theme are presented, and lessons for vaccine development during the current COVID-19 pandemic and future outbreaks are discussed. CONCLUSION: Some pregnant women are accepting of participation in vaccine research during infectious disease outbreaks. Incorporating their priorities into trial design may facilitate their participation and generation of evidence for this important population.


Assuntos
Ensaios Clínicos como Assunto , Tomada de Decisões , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gestantes/psicologia , Infecção por Zika virus/prevenção & controle , Adulto , Feminino , Humanos , Entrevistas como Assunto , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Medição de Risco , Vacinação , Vacinas , Vacinas Virais
7.
Vaccine ; 38(45): 7002-7006, 2020 10 21.
Artigo em Inglês | MEDLINE | ID: mdl-32988688

RESUMO

INTRODUCTION: The world is facing the COVID-19 pandemic. The development of a vaccine is challenging. We aimed to determine the proportion of people who intend to get vaccinated against COVID-19 in France or to participate in a vaccine clinical trial. METHODS: We conducted an anonymous on-line survey from the 26th of March to the 20th of April 2020. Primary endpoints were the intention to get vaccinated against COVID-19 if a vaccine was available or participate in a vaccine clinical trial. RESULTS: Three thousand two hundred and fifty nine individuals answered the survey; women accounted for 67.4% of the respondents. According to their statements, 2.512 participants (77.6%, 95% CI 76.2-79%) will certainly or probably agree to get vaccinated against COVID-19. Older age, male gender, fear about COVID-19, being a healthcare worker and individual perceived risk were associated with COVID-19 vaccine acceptance. Vaccine hesitancy was associated with a decrease in COVID-19 vaccine acceptance. One thousand and five hundred and fifty respondents (47.6% 95% CI 45.9-49.3%) will certainly or probably agree to participate in a COVID-19 vaccine clinical trial. Older age, male gender, being a healthcare worker and individual perceived risk were associated with potential acceptance to participate in a COVID-19 vaccine clinical trial. Vaccine hesitancy was associated with refusal for participation in a COVID-19 vaccine clinical trial. CONCLUSIONS: Nearly 75% and 48% of the survey respondents were respectively likely to accept vaccination or participation in a clinical trial against COVID-19. Vaccine hesitancy will be the major barrier to COVID-19 vaccine uptake.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Vacinação/psicologia , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Betacoronavirus/patogenicidade , Ensaios Clínicos como Assunto , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/imunologia , Feminino , França/epidemiologia , Pessoal de Saúde , Humanos , Intenção , Masculino , Pessoa de Meia-Idade , Segurança do Paciente , Pneumonia Viral/epidemiologia , Pneumonia Viral/imunologia , Fatores Sexuais , Inquéritos e Questionários , Vacinas Virais/administração & dosagem , Vacinas Virais/imunologia
8.
Ann Emerg Med ; 76(3S): S56-S63, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32928463

RESUMO

STUDY OBJECTIVE: Individuals living with sickle cell disease (SCD) often require urgent care; however, some patients hesitate to present to the emergency department (ED), which may increase the risk of serious clinical complications. Our study aims to examine psychosocial, clinical, and demographic factors associated with delaying ED care. METHODS: This was a cross-sectional study of 267 adults with SCD from the national INSIGHTS Study. The binary outcome variable asked whether, in the past 12 months, participants had delayed going to an ED when they thought they needed care. Logistic regression was performed with clinical, demographic, and psychosocial measures. RESULTS: Approximately 67% of the participants reported delaying ED care. Individuals who delayed care were more likely to have reported higher stigma experiences (odds ratio [OR]=1.09; 95% confidence interval [CI] 1.03 to 1.16), more frequent pain episodes (OR=1.15; 95% CI 1.01 to 1.32), lower health care satisfaction (OR= 0.74; 95% CI 0.59 to 0.94), and more frequent ED visits (OR=6.07; 95% CI 1.18 to 31.19). Disease severity and demographics, including sex, age, and health insurance status, were not significantly associated with delay in care. CONCLUSION: Psychosocial factors, including disease stigma and previous negative health care experiences, are associated with delay of ED care in this SCD cohort. There is a need to further investigate the influence of psychosocial factors on the health care-seeking behaviors of SCD patients, as well as the downstream consequences of these behaviors on morbidity and mortality. The resulting knowledge can contribute to efforts to improve health care experiences and patient-provider relationships in the SCD community.


Assuntos
Anemia Falciforme/terapia , Serviço Hospitalar de Emergência/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Adulto , Idoso , Anemia Falciforme/psicologia , Estudos Transversais , Diagnóstico Tardio/psicologia , Diagnóstico Tardio/estatística & dados numéricos , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Satisfação do Paciente/estatística & dados numéricos , Psicologia , Estigma Social , Adulto Jovem
9.
Br J Gen Pract ; 70(700): e817-e824, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32988955

RESUMO

BACKGROUND: The COVID-19 pandemic has impacted the psychological health and health service utilisation of older adults with multimorbidity, who are particularly vulnerable. AIM: To describe changes in loneliness, mental health problems, and attendance to scheduled medical care before and after the onset of the COVID-19 pandemic. DESIGN AND SETTING: Telephone survey on a pre-existing cohort of older adults with multimorbidity in primary care. METHOD: Mental health and health service utilisation outcomes were compared with the outcomes before the onset of the COVID-19 outbreak in Hong Kong using paired t-tests, Wilcoxon's signed-rank test, and McNemar's test. Loneliness was measured by the De Jong Gierveld Loneliness Scale. The secondary outcomes (anxiety, depression, and insomnia) were measured by the 9-item Patient Health Questionnaire, the 7-item Generalized Anxiety Disorder tool, and the Insomnia Severity Index. Appointments attendance data were extracted from a computerised medical record system. Sociodemographic factors associated with outcome changes were examined by linear regression and generalised estimating equations. RESULTS: Data were collected from 583 older (≥60 years) adults. There were significant increases in loneliness, anxiety, and insomnia, after the onset of the COVID-19 outbreak. Missed medical appointments over a 3-month period increased from 16.5% 1 year ago to 22.0% after the onset of the outbreak. In adjusted analysis, being female, living alone, and having >4 chronic conditions were independently associated with increased loneliness. Females were more likely to have increased anxiety and insomnia. CONCLUSION: Psychosocial health of older patients with multimorbidity markedly deteriorated and missed medical appointments substantially increased after the COVID-19 outbreak.


Assuntos
Infecções por Coronavirus , Solidão/psicologia , Saúde Mental/tendências , Doenças não Transmissíveis , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , Pneumonia Viral , Atenção Primária à Saúde , Isolamento Social/psicologia , Idoso , Ansiedade/epidemiologia , Betacoronavirus , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Feminino , Comportamento de Busca de Ajuda , Hong Kong/epidemiologia , Humanos , Masculino , Multimorbidade , Doenças não Transmissíveis/epidemiologia , Doenças não Transmissíveis/psicologia , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Atenção Primária à Saúde/estatística & dados numéricos , Atenção Primária à Saúde/tendências , Carência Psicossocial , Fatores Sexuais , Distúrbios do Início e da Manutenção do Sono/epidemiologia
10.
BMJ Case Rep ; 13(8)2020 Aug 25.
Artigo em Inglês | MEDLINE | ID: mdl-32843473

RESUMO

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


Assuntos
Infecções por Coronavirus/epidemiologia , Serviço Hospitalar de Emergência , Medo , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pneumonia Viral/epidemiologia , Infarto do Miocárdio com Supradesnível do Segmento ST/diagnóstico , Tempo para o Tratamento , Idoso de 80 Anos ou mais , Betacoronavirus , Feminino , Humanos , Pessoa de Meia-Idade , Pandemias , Infarto do Miocárdio com Supradesnível do Segmento ST/complicações , Infarto do Miocárdio com Supradesnível do Segmento ST/terapia
11.
Eur J Epidemiol ; 35(8): 785-788, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32808095

RESUMO

Researchers have been working quickly and collaboratively for the development of vaccines against the COVID-19 virus. The effort of the scientific community in searching a vaccine for COVID-19 may be hampered by a diffused vaccine hesitancy. Two waves of data collection on representative samples of the Italian population (during the "first" and "second" phase of the Italian Covid-19 mitigation strategy) were conducted to understand citizens' perceptions and behaviors about preventive behaviors willingness to vaccine for COVID-19. Our study shows that willingness to COVID-19 vaccine is correlated to trust in research and in vaccines, which decreased between phase 1 and phase 2 of the Italian pandemic. According to the results of our study, the proportion of citizens that seem to be intentioned to get the Covid-19 vaccine is probably too small to effectively stop the spreading of the disease. This requires to foster a climate of respectful mutual trust between science and society, where scientific knowledge is not only preached but also cultivated and sustained thanks to the emphatic understanding of citizens worries, needs of reassurance and health expectations.


Assuntos
Pesquisa Biomédica , Comunicação , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Pneumonia Viral/prevenção & controle , Confiança , Vacinação/psicologia , Betacoronavirus , Infecções por Coronavirus/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Itália , Vacinas Virais/administração & dosagem , Vacinas Virais/efeitos adversos
12.
PLoS One ; 15(8): e0237393, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32797048

RESUMO

BACKGROUND: Research on HIV testing in Thailand has largely focused on at-risk population groups, with limited information about the prevalence of correlates of HIV testing among the Thai general population. This study addresses this gap in research by using a population-based probability sample to examine correlates of HIV testing experience and intention to test. METHODS: We conducted a cross-sectional survey in Nonthaburi, Thailand during October-December 2012 using tablet computers to collect self-administered questionnaires from 2138 men and women (aged 15-59 years) identified through three-stage stratified cluster sampling. FINDINGS: Almost half of the respondents, 962 (45%), reported having been tested for HIV while an almost equal proportion, 1032 (48.3%), indicated their intention to test for HIV. Being sexually experienced, having a history of sexually transmitted infection, personally knowing someone infected with HIV, and youth were associated with both history of HIV testing and intention to test for HIV. High perceived risk of HIV, knowledge of an HIV testing location, and having been married were associated with having been tested for HIV. Having been tested for HIV and HIV/AIDS education were associated with intention to test for HIV. The most common reasons for testing were routine medical checkup and antenatal care. The major reasons for not testing were perception of having no or low risk. CONCLUSION: A substantially low proportion of the respondents reported a history of HIV testing and intention to test for HIV. Culturally appropriate programs that address HIV risk perception and provide accurate information related to HIV infection and HIV testing may be beneficial in increasing uptake of HIV testing among the general population in Thailand.


Assuntos
Infecções por HIV/diagnóstico , Intenção , Programas de Rastreamento/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Tailândia , Adulto Jovem
13.
PLoS One ; 15(8): e0238232, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853233

RESUMO

INTRODUCTION: Despite the broad success of Prevention of Mother-to-Child Transmission of HIV (PMTCT) programs, HIV care engagement during the pregnancy and postpartum periods is suboptimal. This study explored the perspectives of women who experienced challenges engaging in PMTCT care, in order to better understand factors that contribute to poor retention and to identify opportunities to improve PMTCT services. METHODS: We conducted in-depth interviews with 12 postpartum women to discuss their experiences with PMTCT care. We used data from a larger longitudinal cohort study conducted in five PMTCT clinics in Moshi, Tanzania to identify women with indicators of poor care engagement (i.e., medication non-adherence, inconsistent clinic attendance, or high viral load). Women who met one of these criteria were contacted by telephone and invited to complete an interview. Data were analyzed using applied thematic analysis. RESULTS: We observed a common pathway that fear of stigma contributed to a lack of HIV disclosure and reduced social support for seeking HIV care. Women commonly distrusted the results of their initial HIV test and reported medication side effects after care initiation. Women also reported barriers in the health system, including difficult-to-navigate clinic transfer policies and a lack of privacy and confidentiality in service provision. When asked how care might be improved, women felt that improved counseling and follow-up, affirming patient-provider interactions, and peer treatment supporters would have a positive effect on care engagement. CONCLUSION: In order to improve the impact of PMTCT programs, there is a need to implement active tracking and follow-up of patients, targeting individuals with evidence of poor care engagement. Tailored supportive intervention approaches may help patients to cope with both the perceived and actual impacts of HIV stigma, including navigating disclosures to loved ones and accessing social support. Fostering HIV acceptance is likely to facilitate commitment to long-term treatment.


Assuntos
Infecções por HIV/prevenção & controle , Infecções por HIV/psicologia , Transmissão Vertical de Doença Infecciosa/prevenção & controle , Adulto , Estudos de Coortes , Aconselhamento/métodos , Revelação , Feminino , Humanos , Estudos Longitudinais , Mães/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Período Pós-Parto/fisiologia , Período Pós-Parto/psicologia , Gravidez , Complicações Infecciosas na Gravidez/prevenção & controle , Complicações Infecciosas na Gravidez/psicologia , Pesquisa Qualitativa , Estigma Social , Apoio Social , Tanzânia , Carga Viral/fisiologia , Adulto Jovem
14.
PLoS One ; 15(8): e0238096, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32853258

RESUMO

The benefits of involving patients as partners in research across diverse medical and psychiatric settings are well established in the literature. However, researchers continue to struggle to access, engage and retain participants from hard-to-reach populations. The main objective of this study was to co-create pet therapy activities with patients admitted for serious and complex mental illness to a large urban mental health and addiction hospital. Informed by the principles of participatory action research methodology, we conducted focus group discussions with 38 inpatients in seven different clinical units. An experienced volunteer handler and a certified therapy dog helped facilitate our discussions. Participating researchers, recreational therapists, volunteer handlers and our participants all reported that the presence of a certified therapy dog at each of our discussions was integral to their success. Certified therapy dogs increased the motivation to participate in our study, helped to build rapport with participants and created connections in our discussions that enriched our data. To our knowledge our study is the first to demonstrate the value of using a therapy dog as a participatory research tool in a healthcare setting. The authors believe that therapy dogs are a low-tech intervention that could be used effectively to engage hard-to-reach populations in research about their treatment and care in a diverse range of medical settings. These findings support the creation of a pilot study to test the value of including therapy dogs in patient-centered research with vulnerable and hard-to-reach populations.


Assuntos
Terapia Assistida com Animais/estatística & dados numéricos , Cidades/estatística & dados numéricos , Hospitais/estatística & dados numéricos , Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transtornos Relacionados ao Uso de Substâncias/terapia , Animais , Cães , Feminino , Masculino , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Projetos Piloto , Pesquisa Qualitativa
15.
PLoS One ; 15(8): e0237171, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32760162

RESUMO

BACKGROUND: There is a need for reliable and validated tools to identify, classify, and quantify vaccine-hesitancy in low and middle-income countries, such as Sudan. We evaluated the psychometric properties of an adapted version of the measles vaccine hesitancy scale by assessing its reliability, convergent validity, and criterion validity in Sudan. The vaccine hesitancy scale (VHS) was originally developed by the WHO/SAGE Working Group of Vaccine Hesitancy. METHODS: A community-based survey among parents was conducted in February 2019 in Khartoum state. We conducted exploratory and confirmatory factor analysis to examine the structure of the adapted measles VHS (aMVHS). We computed Cronbach's alphas, correlations with other vaccine hesitancy measurements including the Parental Attitude towards Childhood Vaccination (PACV) and the Vaccine Confidence Index (VCI), and performed a Mann-Whitney U test for assessing the reliability and the convergent and criterion validity, respectively. Moreover, to examine whether the aMVHS can predict the child's vaccination status, the area under the curve (AUC) was estimated using receiver operator characteristic (ROC) curves. RESULTS: The questionnaire was completed by 500 parents. Most were women (87.2%) between the ages of 20 and 47 (M = 31.15, SD = 5.74). The factor analyses indicated that the aMVHS comprises of two factors (sub-scales): 'confidence' and 'complacency'. The aMVHS sub-scales correlated weakly to moderately with the PACV and VCI scales. The area under the curve was 0.499 at most (P >0.05) and the aMVHS score did hardly differ between actually vaccinated and non-vaccinated children. CONCLUSION: Our findings underscore that the aMVHS and its confidence and complacency sub-scales are reliable and have a moderately good convergent validity. However, the aMVHS has a limitation in predicting the concurrent child's vaccination status. More work is needed to revise and amend this aMVHS, particularly by additionally including the 'convenience' construct and by further evaluating its validity in other contexts.


Assuntos
Vacina contra Sarampo/uso terapêutico , Sarampo/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Inquéritos e Questionários/normas , Vacinação/psicologia , Adulto , Pré-Escolar , Feminino , Humanos , Masculino , Sarampo/psicologia , Pessoa de Meia-Idade , Pais/psicologia , Psicometria/normas , Sudão
16.
PLoS One ; 15(8): e0237081, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32764783

RESUMO

BACKGROUND: Approximately 18,000 Syrian refugees have resettled to the United States. Half of these refugees are children, whose age and refugee status jeopardize their abilities to attain quality healthcare. Information on Syrian refugees' health in the U.S. is limited. This qualitative study sought to explore Syrian refugee parents' beliefs, perspectives, and practices regarding their children's health through in-depth interviews. METHODS: Eighteen Syrian refugee parents residing in Cincinnati, Ohio were interviewed in Arabic by bilingual researchers using semi-structured in-depth interviews. The interviews were recorded, transcribed, and translated. Three members of the research team independently coded each interview using an inductive thematic analysis approach. RESULTS: Analysis identified four salient themes: stressors preclude health seeking behaviors, parents perceive health barriers, parents are dissatisfied with the healthcare system, and parents use resilience behaviors to overcome barriers. Stressors included poor housing and neighborhoods, reliving traumatic experiences, depression and anxiety, and social isolation. Dissatisfaction included emergency room wait times, lack of testing and prescriptions. Health barriers included missed appointments and inadequate transportation, translation services, health literacy and care coordination. Parents reported resilience through faith, by seeking knowledge, use of natural remedies, and utilizing community resources. CONCLUSION: This qualitative study provides information on the beliefs, practices, and behaviors of Syrian refugee parents related to health care utilization of pediatric refugees in the United States. Psychosocial and environmental stressors as well as perceived systemic health barriers, hinder health seeking behaviors in Syrian refugee parents. Culturally relevant care targeting perceived barriers and incorporating resilience behaviors may improve parental satisfaction and parental health seeking behaviors. Further study is needed to implement and evaluate interventions that target identified barriers.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Letramento em Saúde/estatística & dados numéricos , Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Refugiados/psicologia , Adolescente , Adulto , Criança , Pré-Escolar , Características da Família/etnologia , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Ohio , Poder Familiar/etnologia , Poder Familiar/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Refugiados/estatística & dados numéricos , Síria , Adulto Jovem
17.
Med Care ; 58(8): 703-709, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32692136

RESUMO

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


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Patient Protection and Affordable Care Act/estatística & dados numéricos , United States Department of Veterans Affairs/estatística & dados numéricos , Veteranos/estatística & dados numéricos , Adolescente , Adulto , Feminino , Humanos , Modelos Logísticos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Patient Protection and Affordable Care Act/normas , Estados Unidos , United States Department of Veterans Affairs/normas , Veteranos/psicologia
18.
PLoS One ; 15(7): e0234876, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645017

RESUMO

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


Assuntos
Emigrantes e Imigrantes/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adulto , Assistência Ambulatorial/tendências , Canadá/etnologia , Estudos de Coortes , Serviço Hospitalar de Emergência/tendências , Feminino , Hospitalização/tendências , Humanos , Masculino , Transtornos Mentais/terapia , Serviços de Saúde Mental/tendências , Pessoa de Meia-Idade , Esclerose Múltipla/psicologia , Ontário/etnologia , Atenção Primária à Saúde/tendências , Estudos Retrospectivos , Classe Social
19.
PLoS One ; 15(7): e0234827, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32645112

RESUMO

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


Assuntos
Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Gestantes/psicologia , Vacinação/psicologia , Adulto , Tomada de Decisões , Feminino , Pessoal de Saúde/psicologia , Humanos , Vírus da Influenza A Subtipo H1N1/imunologia , Vacinas contra Influenza/imunologia , Influenza Humana/prevenção & controle , Razão de Chances , Gravidez , Inquéritos e Questionários
20.
PLoS One ; 15(7): e0234821, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32628674

RESUMO

This mixed-methods study examined awareness of and willingness to use pre-exposure prophylaxis (PrEP) among sexually active Black and Latinx adolescents (13-17 years) residing in five cities in the United States with some of the highest burden of HIV. Data are from adolescents who participated in a cross-sectional survey (n = 208) and one-on-one interviews and focus groups (n = 26) conducted from September 2017-August 2019. Approximately 50% of the sample were recruited through community efforts, and the other half through a panel. Logistic regression with covariates including sexual orientation, relationship status, socioeconomic status, and race/ethnicity were used to assess factors associated with PrEP awareness and willingness. For the qualitative data, thematic analysis was used to develop a codebook of a-priori and inductive codes while analytic memos were written to identify key themes. PrEP awareness was reported by 38% of the sample and was associated with Black race (AOR = 0.49; 95% CI = 0.27, 0.90) and prior HIV testing (AOR = 3.89, 95% CI = 1.25, 12.08). PrEP willingness (defined as "definitely would use PrEP") was reported by 22% of the sample and was associated with higher age, more education, having had condomless sex in the past 6 months (AOR = 0.23; 95% CI = 0.10, 0.56), perceived likelihood of acquiring HIV (AOR = 3.59; 95% CI = 1.06, 12.21), and PrEP awareness (AOR = 0.41; 95% CI = 0.19, 0.89). Qualitative data showed that misconceptions about PrEP persist and PrEP stigma, fear of being punished, provider attitudes and recommendations, and empowerment were related to adolescents' willingness to use PrEP. Study findings reveal important strategies for improving PrEP delivery and scale-up to Black and Latinx adolescents. These strategies include using sociodemographic and health behavior data to target adolescents who may be more or less willing to use PrEP, improving provider communication about PrEP, and creating culturally and developmentally appropriate PrEP education materials that address common misconceptions held by adolescents.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Profilaxia Pré-Exposição/tendências , Adolescente , Afro-Americanos/psicologia , Conscientização , Estudos Transversais/métodos , Feminino , Infecções por HIV/epidemiologia , Hispano-Americanos/psicologia , Humanos , Masculino , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Profilaxia Pré-Exposição/métodos , Prevalência , Comportamento Sexual , Parceiros Sexuais , Inquéritos e Questionários , Estados Unidos
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