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1.
Cochrane Database Syst Rev ; 10: CD012575, 2020 10 15.
Artigo em Inglês | MEDLINE | ID: mdl-33058172

RESUMO

BACKGROUND: Rehabilitation based upon research evidence gives stroke survivors the best chance of recovery. There is substantial research to guide practice in stroke rehabilitation, yet uptake of evidence by healthcare professionals is typically slow and patients often do not receive evidence-based care. Implementation interventions are an important means to translate knowledge from research to practice and thus optimise the care and outcomes for stroke survivors. A synthesis of research evidence is required to guide the selection and use of implementation interventions in stroke rehabilitation. OBJECTIVES: To assess the effects of implementation interventions to promote the uptake of evidence-based practices (including clinical assessments and treatments recommended in evidence-based guidelines) in stroke rehabilitation and to assess the effects of implementation interventions tailored to address identified barriers to change compared to non-tailored interventions in stroke rehabilitation. SEARCH METHODS: We searched CENTRAL, MEDLINE, Embase, and eight other databases to 17 October 2019. We searched OpenGrey, performed citation tracking and reference checking for included studies and contacted authors of included studies to obtain further information and identify potentially relevant studies. SELECTION CRITERIA: We included individual and cluster randomised trials, non-randomised trials, interrupted time series studies and controlled before-after studies comparing an implementation intervention to no intervention or to another implementation approach in stroke rehabilitation. Participants were qualified healthcare professionals working in stroke rehabilitation and the patients they cared for. Studies were considered for inclusion regardless of date, language or publication status. Main outcomes were healthcare professional adherence to recommended treatment, patient adherence to recommended treatment, patient health status and well-being, healthcare professional intention and satisfaction, resource use outcomes and adverse effects. DATA COLLECTION AND ANALYSIS: Two review authors independently selected studies for inclusion, extracted data, and assessed risk of bias and certainty of evidence using GRADE. The primary comparison was any implementation intervention compared to no intervention. MAIN RESULTS: Nine cluster randomised trials (12,428 patient participants) and three ongoing trials met our selection criteria. Five trials (8865 participants) compared an implementation intervention to no intervention, three trials (3150 participants) compared one implementation intervention to another implementation intervention, and one three-arm trial (413 participants) compared two different implementation interventions to no intervention. Eight trials investigated multifaceted interventions; educational meetings and educational materials were the most common components. Six trials described tailoring the intervention content to identified barriers to change. Two trials focused on evidence-based stroke rehabilitation in the acute setting, four focused on the subacute inpatient setting and three trials focused on stroke rehabilitation in the community setting. We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence was very low (risk ratio (RR) 1.19, 95% confidence interval (CI) 0.53 to 2.64; 2 trials, 39 clusters, 1455 patient participants; I2 = 0%). Low-certainty evidence indicates implementation interventions in stroke rehabilitation may lead to little or no difference in patient adherence to recommended treatment (number of recommended performed outdoor journeys adjusted mean difference (MD) 0.5, 95% CI -1.8 to 2.8; 1 trial, 21 clusters, 100 participants) and patient psychological well-being (standardised mean difference (SMD) -0.02, 95% CI -0.54 to 0.50; 2 trials, 65 clusters, 1273 participants; I2 = 0%) compared with no intervention. Moderate-certainty evidence indicates implementation interventions in stroke rehabilitation probably lead to little or no difference in patient health-related quality of life (MD 0.01, 95% CI -0.02 to 0.05; 2 trials, 65 clusters, 1242 participants; I2 = 0%) and activities of daily living (MD 0.29, 95% CI -0.16 to 0.73; 2 trials, 65 clusters, 1272 participants; I2 = 0%) compared with no intervention. No studies reported the effects of implementation interventions in stroke rehabilitation on healthcare professional intention to change behaviour or satisfaction. Five studies reported economic outcomes, with one study reporting cost-effectiveness of the implementation intervention. However, this was assessed at high risk of bias. The other four studies did not demonstrate the cost-effectiveness of interventions. Tailoring interventions to identified barriers did not alter results. We are uncertain of the effect of one implementation intervention versus another given the limited very low-certainty evidence. AUTHORS' CONCLUSIONS: We are uncertain if implementation interventions improve healthcare professional adherence to evidence-based practice in stroke rehabilitation compared with no intervention as the certainty of the evidence is very low.


Assuntos
Medicina Baseada em Evidências/métodos , Pessoal de Saúde/estatística & dados numéricos , Reabilitação do Acidente Vascular Cerebral/métodos , Medicina Baseada em Evidências/educação , Medicina Baseada em Evidências/estatística & dados numéricos , Pessoal de Saúde/educação , Nível de Saúde , Humanos , Cooperação do Paciente/estatística & dados numéricos , Ensaios Clínicos Controlados Aleatórios como Assunto , Reabilitação do Acidente Vascular Cerebral/psicologia
2.
Gynecol Obstet Fertil Senol ; 48(11): 777-783, 2020 11.
Artigo em Francês | MEDLINE | ID: mdl-33010487

RESUMO

OBJECTIVE: The exceptional health situation related to the SARS-Cov2 coronavirus pandemic (COVID-19) required a deep and very quickly adaptation of management practices in gynecological cancer. The main objective is to estimate the proportion of patients with treatment modifications. METHOD: This is a multicenter prospective study conducted in 3 university gynecological cancer departments (HCLyon, France) during the period of confinement (March 16 to May 11, 2020). All patients with non-metastatic breast cancer or gynecological cancer were included. The planned treatment, postponement, delay and organizational modifications (RCP, teleconsultations) were studied. RESULTS: Two hundred and five consecutive patients were included, average age 60.5±1.0. 7 patients (3.4%) had SARS-Cov-2 infection, 2 patients died. One hundred and twenty-two patients (59.5%) had a treatment maintained, 72 patients (35.1%) postponed, 11 patients (5.4%) cancelled. Of the 115 (56.1%) planned surgeries, 40 (34.8%) postponed, 7 cancelled (6.1%). 9 patients (7.8%) had a surgical modification. Of the 59 (28.8%) radiotherapy treatments scheduled, 24 (40.7%) postponed and 2 (3.4%) cancelled. Of the 56 (27.3%) chemotherapy treatment planned, 8 (14.3%) postponed and 2 (3.6%) cancelled. One hundred and forty-five patients (70.7%) have been discussed in multidisciplinary meeting. One hundred and fifty-eight patients (77%) had a teleconsultation system. CONCLUSION: Our study assessed the impact of the COVID-19 pandemic on therapeutic management of patients with gynecological cancer during the period of confinement. This will probably improve our management of an eventual epidemic rebound or future health crisis.


Assuntos
Betacoronavirus , Neoplasias da Mama/terapia , Infecções por Coronavirus/epidemiologia , Neoplasias dos Genitais Femininos/terapia , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Antineoplásicos , Neoplasias da Mama/epidemiologia , Feminino , França/epidemiologia , Neoplasias dos Genitais Femininos/epidemiologia , Procedimentos Cirúrgicos em Ginecologia/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Pandemias , Estudos Prospectivos , Radioterapia/estatística & dados numéricos , Consulta Remota/estatística & dados numéricos , Suspensão de Tratamento/estatística & dados numéricos
3.
Artigo em Inglês | MEDLINE | ID: mdl-33020395

RESUMO

In the wake of the sudden spread of COVID-19, a large amount of the Italian population practiced incongruous behaviors with the protective health measures. The present study aimed at examining psychological and psychosocial variables that could predict behavioral compliance. An online survey was administered from 18-22 March 2020 to 2766 participants. Paired sample t-tests were run to compare efficacy perception with behavioral compliance. Mediation and moderated mediation models were constructed to explore the association between perceived efficacy and compliance, mediated by self-efficacy and moderated by risk perception and civic attitudes. Machine learning algorithms were trained to predict which individuals would be more likely to comply with protective measures. Results indicated significantly lower scores in behavioral compliance than efficacy perception. Risk perception and civic attitudes as moderators rendered the mediating effect of self-efficacy insignificant. Perceived efficacy on the adoption of recommended behaviors varied in accordance with risk perception and civic engagement. The 14 collected variables, entered as predictors in machine learning models, produced an ROC area in the range of 0.82-0.91 classifying individuals as high versus low compliance. Overall, these findings could be helpful in guiding age-tailored information/advertising campaigns in countries affected by COVID-19 and directing further research on behavioral compliance.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus/prevenção & controle , Aprendizado de Máquina , Pandemias/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Algoritmos , Betacoronavirus , Humanos , Itália
4.
Semin Arthritis Rheum ; 50(5): 1150-1157, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32927376

RESUMO

BACKGROUND: Systemic lupus erythematosus (SLE) is a chronic disease characterised by autoimmunity and increased susceptibility to infections. COVID-19 is a systemic viral disease currently spreading as a pandemic. Little is known about the impact of COVID-19 in patients with SLE. OBJECTIVE: to acquire information on the impact of COVID-19 in SLE. METHODS: A 26-item anonymous questionnaire investigating demographics, SLE clinical features, COVID-19 diagnoses and changes in treatments and daily habits was administered to patients with SLE from three referral centres through www.surveymonkey.com over 10 days. Data from the survey were compared to those from published estimates about the general population. RESULTS: Four-hundred-seventeen patients responded to the survey. More than 60% of subjects complained of symptoms that are also associated to COVID-19. Fourteen COVID-19 diagnoses (five confirmed by polymerase chain reaction) were reported, in contrast to a 0.73% prevalence of confirmed cases in Lombardy. One hospitalisation was reported. Fever, anosmia, dry cough, a self-reported history of neuropsychiatric SLE and a recent contact with confirmed COVID-19 cases were more strongly associated with COVID-19, as were symptoms and lower compliance to behavioural preventive measures in patients' contacts. No protective effect was seen in subjects on hydroxychloroquine. CONCLUSION: COVID-19 morbidity might only moderately be increased in most patients with SLE, although limited information can be inferred on more severe cases. Hydroxychloroquine apparently seems not to confer protection to infection per se, although other beneficial roles cannot be excluded. Containment policies and behavioural preventive measures could have a major role in limiting the impact of COVID-19 in patients with SLE.


Assuntos
Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus , Hidroxicloroquina/uso terapêutico , Lúpus Eritematoso Sistêmico , Pandemias , Pneumonia Viral , Isolamento Social/psicologia , Avaliação de Sintomas , Adulto , Antirreumáticos/uso terapêutico , Betacoronavirus , Técnicas de Laboratório Clínico/métodos , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Feminino , Humanos , Itália/epidemiologia , Lúpus Eritematoso Sistêmico/epidemiologia , Lúpus Eritematoso Sistêmico/terapia , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Prevalência , Pesquisa Qualitativa , Avaliação de Sintomas/métodos , Avaliação de Sintomas/estatística & dados numéricos
5.
Sante Publique ; 32(2): 161-170, 2020 09 15.
Artigo em Francês | MEDLINE | ID: mdl-32989945

RESUMO

INTRODUCTION: For over 20 years, there have been many recommendations for iron, folic acid, and vitamin D supplements during pregnancy and periconceptional periods. Despite the recommendations, the deficiency rate remains high. METHOD: A quantitative, prospective, descriptive, multicentric survey was conducted with new mothers (n=200) hospitalized in the postpartum department in three different levels of maternity hospitals. A questionnaire based on current medical literature on the topic was used to question pregnant women about their pregnancy and their periconceptional period. The purpose of this study was to record the compliance and the reasons of non-compliance of pregnant women concerning their intake of supplementary iron, vitamin D and acid folic during their pregnancy. RESULTS: Less than one out of two women reported having received a prescription for folic acid or vitamin D; and two thirds of pregnant women reported having received iron supplementation during their pregnancy. More than one in three women who had received a supplementation prescription reported not knowing the aim. The multiparity (p=0.03) and social assistance affiliation (p=0.05) are significant parameters influencing a poor compliance of supplementations. CONCLUSIONS: The supplementations during pregnancy and periconceptional period are still insufficient in regards to recommendations. Public health measures could be applied at a younger age through the establishment of nutrition courses.


Assuntos
Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Ferro/administração & dosagem , Cooperação do Paciente/estatística & dados numéricos , Vitamina D/administração & dosagem , Feminino , Humanos , Gravidez , Estudos Prospectivos
6.
J Pediatr Psychol ; 45(9): 977-982, 2020 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-32929482

RESUMO

The COVID-19 pandemic has presented unique circumstances that have the potential to both positively and negatively affect pediatric adherence and self-management in youth with chronic medical conditions. The following paper discusses how these circumstances (e.g., stay-at-home orders, school closures, changes in pediatric healthcare delivery) impact disease management at the individual, family, community, and healthcare system levels. We also discuss how barriers to pediatric adherence and self-management exacerbated by the pandemic may disproportionately affect underserved and vulnerable populations, potentially resulting in greater health disparities. Given the potential for widespread challenges to pediatric disease management during the pandemic, ongoing monitoring and promotion of adherence and self-management is critical. Technology offers several opportunities for this via telemedicine, electronic monitoring, and mobile apps. Moreover, pediatric psychologists are uniquely equipped to develop and implement adherence-promotion efforts to support youth and their families in achieving and sustaining optimal disease management as the current public health situation continues to evolve. Research efforts addressing the short- and long-term impact of the pandemic on pediatric adherence and self-management are needed to identify both risk and resilience factors affecting disease management and subsequent health outcomes during this unprecedented time.


Assuntos
Betacoronavirus , Doença Crônica/terapia , Infecções por Coronavirus/prevenção & controle , Pandemias/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Autogestão/estatística & dados numéricos , Telemedicina/métodos , Adolescente , Criança , Doença Crônica/psicologia , Infecções por Coronavirus/psicologia , Humanos , Aplicativos Móveis , Pneumonia Viral/psicologia , Autogestão/métodos
7.
N Z Med J ; 133(1522): 30-41, 2020 09 25.
Artigo em Inglês | MEDLINE | ID: mdl-32994614

RESUMO

AIM: Chronic respiratory diseases, such as chronic obstructive pulmonary disease, are a worldwide public health problem. Pulmonary rehabilitation is a gold-standard intervention for these diseases, yet attendance and completion rates are poor. Counties Manukau Health, in Auckland, New Zealand, has a high prevalence of chronic respiratory disease and a culturally diverse population, comprising large numbers of Maori and Pacific Island people, who are known to be disproportionately affected by chronic respiratory disease. The aim of this study was to investigate patient characteristics affecting engagement with the Counties Manukau Health pulmonary rehabilitation programme and identify factors predicting completion of the programme. METHODS: Investigators performed a retrospective analysis using routinely collected data of 2,756 patients invited to attend the pulmonary rehabilitation programme at Counties Manukau Health. Data were analysed to compare demographic and clinical outcomes of patients who completed, did not complete or did not attend the programme, and identified factors predicting completion. RESULTS: Significant differences were found between groups in demographic and clinical characteristics. Increasing age, higher six-minute walk test distance at programme commencement and European ethnicity were significant predictors of completion of the PR programme. CONCLUSIONS: Compared to European people, Maori were 52% less likely and Pacific Island people were 40% less likely to complete the programme. These findings are significant for the Counties Manukau Health population. Further work needs to focus on determining how to make programmes more engaging to different cultures and how we can aim to reduce health inequities in these populations.


Assuntos
Cooperação do Paciente/estatística & dados numéricos , Doença Pulmonar Obstrutiva Crônica/epidemiologia , Doença Pulmonar Obstrutiva Crônica/terapia , Terapia Respiratória/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nova Zelândia/epidemiologia , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Estudos Retrospectivos , Adulto Jovem
8.
Sante Publique ; 32(2): 161-170, 2020.
Artigo em Francês | MEDLINE | ID: mdl-32985832

RESUMO

INTRODUCTION: For over 20 years, there have been many recommendations for iron, folic acid, and vitamin D supplements during pregnancy and periconceptional periods. Despite the recommendations, the deficiency rate remains high. METHOD: A quantitative, prospective, descriptive, multicentric survey was conducted with new mothers (n=200) hospitalized in the postpartum department in three different levels of maternity hospitals. A questionnaire based on current medical literature on the topic was used to question pregnant women about their pregnancy and their periconceptional period. The purpose of this study was to record the compliance and the reasons of non-compliance of pregnant women concerning their intake of supplementary iron, vitamin D and acid folic during their pregnancy. RESULTS: Less than one out of two women reported having received a prescription for folic acid or vitamin D; and two thirds of pregnant women reported having received iron supplementation during their pregnancy. More than one in three women who had received a supplementation prescription reported not knowing the aim. The multiparity (p=0.03) and social assistance affiliation (p=0.05) are significant parameters influencing a poor compliance of supplementations. CONCLUSIONS: The supplementations during pregnancy and periconceptional period are still insufficient in regards to recommendations. Public health measures could be applied at a younger age through the establishment of nutrition courses.


Assuntos
Suplementos Nutricionais , Ácido Fólico/administração & dosagem , Ferro/administração & dosagem , Cooperação do Paciente/estatística & dados numéricos , Vitamina D/administração & dosagem , Feminino , Humanos , Gravidez , Estudos Prospectivos , Inquéritos e Questionários
9.
Medicine (Baltimore) ; 99(36): e20976, 2020 Sep 04.
Artigo em Inglês | MEDLINE | ID: mdl-32898990

RESUMO

BACKGROUND: Adequate bowel preparation is essential for the detection of pathological lesions during colonoscopy. However, it has been found to be inadequate in approximately 20% to 30% of colonoscopy examinations. Educational interventions focused on health staff, such as physicians and nurses, may improve the patients' understanding of the bowel preparation instructions, and consequently, increase the quality of bowel preparation. OBJECTIVES: To investigate whether enhanced education of ward nurses could improve the bowel preparation quality in inpatients undergoing colonoscopy. DESIGN: This was a single-center randomized controlled study. METHODS: A total of 190 consecutive inpatients scheduled to undergo colonoscopy from March 2019 to March 2020 were randomized to the educated (nurses with enhanced education) or control group (nurses without enhanced education). We assessed the bowel preparation quality using the Boston bowel preparation scale. RESULTS: There were 89 patients in the educated group and 101 patients in the control group. The proportion of colonoscopies with adequate bowel preparation was 83.1% in the educated group and 69.3% in the control group. Patients' compliance with bowel preparation in the educated group was superior to that in the control group. Furthermore, significantly better sleep quality was found in the educated group. The multivariate logistic regression analysis identified the ward nurses-focused enhanced educational intervention as a risk factor for bowel preparation quality. CONCLUSIONS: The ward nurses-focused educational intervention improved the bowel preparation quality and reduced the adverse event rates in inpatients undergoing colonoscopy. TRIAL REGISTRATION: This study was registered in the Chinese Clinical Trial Registry under number ChiCTR2000030366.


Assuntos
Catárticos/uso terapêutico , Colonoscopia/normas , Recursos Humanos de Enfermagem no Hospital/educação , Cooperação do Paciente/estatística & dados numéricos , Idoso , Método Duplo-Cego , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Período Pré-Operatório
10.
Artigo em Inglês | MEDLINE | ID: mdl-32937929

RESUMO

The success of public health measures for controlling the coronavirus disease 2019 (COVID-19) pandemic relies on population compliance. We analyzed compliance with social distancing and its associations with mental health. The Hong Kong COVID-19 Health Information Survey was conducted from 9-23 April 2020 on 1501 adults randomly sampled for landline telephone interviews (n = 500) and online surveys (n = 1001). Compliance with social distancing and staying-at-home, stress (Perceived Stress Scale-4), anxiety (General Anxiety Disorders-2), and depressive symptoms (Patient Health Questionnaire-2) were collected. The associations between mental health symptoms and compliance were examined by multivariable regression models. Of the 1501 respondents (52.5% female, 72.3% aged 18-59 years), 74.2%, 72.7%, and 59.7% reported avoiding going out, going to crowded places, and attending social gatherings of more than four people, respectively. Most respondents had stayed-at-home for at least four of the past seven days (58.4%; mean 4.12, Standard Deviation 2.05). Adoption, perceived effectiveness, and perceived compliance with social distancing were associated with lower stress levels and less anxiety and depressive symptoms (all p < 0.01). However, more days stayed-at-home were associated with more depressive symptoms (adjusted Odds Ratio 1.09; 95%Confidence Interval 1.00, 1.18). The long-term psychological impact in relation to social distancing and staying-at-home requires further investigation.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/psicologia , Saúde Mental , Pandemias/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Pneumonia Viral/prevenção & controle , Pneumonia Viral/psicologia , Isolamento Social/psicologia , Adolescente , Adulto , Betacoronavirus , Feminino , Hong Kong , Humanos , Masculino , Pessoa de Meia-Idade , Adulto Jovem
12.
Vaccine ; 38(42): 6500-6507, 2020 09 29.
Artigo em Inglês | MEDLINE | ID: mdl-32863069

RESUMO

BACKGROUND: Coronavirus disease 2019 (COVID-19) was declared a pandemic in March 2020. Several prophylactic vaccines against COVID-19 are currently in development, yet little is known about people's acceptability of a COVID-19 vaccine. METHODS: We conducted an online survey of adults ages 18 and older in the United States (n = 2,006) in May 2020. Multivariable relative risk regression identified correlates of participants' willingness to get a COVID-19 vaccine (i.e., vaccine acceptability). RESULTS: Overall, 69% of participants were willing to get a COVID-19 vaccine. Participants were more likely to be willing to get vaccinated if they thought their healthcare provider would recommend vaccination (RR = 1.73, 95% CI: 1.49-2.02) or if they were moderate (RR = 1.09, 95% CI: 1.02-1.16) or liberal (RR = 1.14, 95% CI: 1.07-1.22) in their political leaning. Participants were also more likely to be willing to get vaccinated if they reported higher levels of perceived likelihood getting a COVID-19 infection in the future (RR = 1.05, 95% CI: 1.01-1.09), perceived severity of COVID-19 infection (RR = 1.08, 95% CI: 1.04-1.11), or perceived effectiveness of a COVID-19 vaccine (RR = 1.46, 95% CI: 1.40-1.52). Participants were less likely to be willing to get vaccinated if they were non-Latinx black (RR = 0.81, 95% CI: 0.74-0.90) or reported a higher level of perceived potential vaccine harms (RR = 0.95, 95% CI: 0.92-0.98). CONCLUSIONS: Many adults are willing to get a COVID-19 vaccine, though acceptability should be monitored as vaccine development continues. Our findings can help guide future efforts to increase COVID-19 vaccine acceptability (and uptake if a vaccine becomes available).


Assuntos
Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Pandemias/prevenção & controle , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Vacinação/psicologia , Adolescente , Adulto , Betacoronavirus/efeitos dos fármacos , Betacoronavirus/imunologia , Betacoronavirus/patogenicidade , Infecções por Coronavirus/imunologia , Infecções por Coronavirus/psicologia , Infecções por Coronavirus/virologia , Estudos Transversais , Humanos , Imunogenicidade da Vacina , Masculino , Pessoa de Meia-Idade , Cooperação do Paciente/psicologia , Cooperação do Paciente/estatística & dados numéricos , Segurança do Paciente , Pneumonia Viral/imunologia , Pneumonia Viral/virologia , Medição de Risco/tendências , Recusa do Paciente ao Tratamento/psicologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Estados Unidos/epidemiologia , Vacinas Virais/administração & dosagem
13.
Am J Trop Med Hyg ; 103(5): 1997-2004, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32975179

RESUMO

Within a short period of time, COVID-19 has spread globally, wreaking havoc in various facets of life. This study sought to measure the level of COVID-19 knowledge, attitudes, and practices of the Nigerian public. This was a cross-sectional online survey of the general population of educated Nigerians who had Internet access. Sociodemographic data and participants' knowledge, attitudes, and practices relating to COVID-19 were collected. Scores assessing knowledge, attitudes, and practices were allocated and graded based on specific stratified demarcations. Student's t-test, analysis of variance, and logistic regression analysis were used where appropriate. Of the total 1,015 respondents, most of them exhibited good knowledge of COVID-19, with a mean knowledge grade of 78%; this significantly affected their attitude and practice grades (66% and 60.4%, respectively). Most respondents expressed positive attitudes toward foreigners and other stigma-prone groups, while also practicing appropriate preventive measures. Those aged 21-30 years and those with medical-related occupations had significantly higher knowledge scores (P < 0.001); and having a medical-related occupation increased the likelihood of having good knowledge compared with being unemployed (odds ratio [95% CI]: 6.6 [2.5-17.3]). Male participants aged 21-30 years and those with medical-related occupations had significantly higher attitude scores (P < 0.05). Engaging literate Nigerians on various media platforms, particularly social media, will result in wider reach for the purpose of COVID-19 education. Further studies on other sociodemographic groups within the country (e.g., the less educated) would give a clearer picture of the Nigerian situation as regards COVID-19 knowledge, attitudes, and practices (coronavirus, COVID-19, Public health, Nigeria, Africa).


Assuntos
Infecções por Coronavirus/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Pneumonia Viral/epidemiologia , Adolescente , Adulto , Idoso , Betacoronavirus , Estudos Transversais , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Nigéria/epidemiologia , Pandemias , Cooperação do Paciente/estatística & dados numéricos , Mídias Sociais , Inquéritos e Questionários , Adulto Jovem
14.
Zhonghua Liu Xing Bing Xue Za Zhi ; 41(7): 1076-1080, 2020 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-32741174

RESUMO

Objective: To evaluate the compliance of low-dose computed tomography (LDCT) screening for high-risk groups of lung cancer and influencing factors in urban area of Henan province during 2013-2017. Methods: Cluster sampling method was used to select the residents of 40-74 years old in Henan for cancer risk factor investigation and lung cancer risk assessment. Subjects with high risk of lung cancer received LDCT screening. The differences of LDCT receiving rates between groups were compared with χ(2) tests, and the time trend of rates were tested with the Cochran- Armitage trend test. The potential factors correlating to the compliance of LDCT screening were identified with multivariate logistic regression models. Results: Overall, 35 672 participants who met the inclusion criteria were included in this analysis, and 13 383 of them received LDCT screening, the receiving rate was 37.52%. The receiving rate varied greatly across cities, ranging from 38.47% to 26.73% (P<0.05). Moreover, the receiving rate varied greatly across periods, ranging from 29.22% during 2013-2014 to 43.30% during 2014-2015, and the receiving rate increases gradually as the screening year increases (P<0.001). The multivariate logistic regression analyses showed that: being female, age 45-69 years, with education level of junior high school/high school, previous smoking, drinking or previous drinking, infrequent physical exercise, history of tuberculosis, history of chronic bronchitis, history of emphysema, history of asthma bronchiectasis and family history of lung cancer were positive factors for receiving LDCT screening (All P<0.05). Conclusions: The overall compliance of LDCT screening in high-risk population of lung cancer was still not high in urban area of Henan. Implementation of effective interventions targeting the specific high-risk populations might improve the overall compliance of LDCT screening in the future.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Neoplasias Pulmonares/prevenção & controle , Cooperação do Paciente/estatística & dados numéricos , Tomografia Computadorizada por Raios X/métodos , População Urbana , Adulto , Idoso , China/epidemiologia , Feminino , Humanos , Neoplasias Pulmonares/epidemiologia , Masculino , Pessoa de Meia-Idade , Medição de Risco , Fatores Socioeconômicos , População Urbana/estatística & dados numéricos
15.
Plast Reconstr Surg ; 146(2): 177e-186e, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32740586

RESUMO

BACKGROUND: Evidence-based practices in medicine are linked with a higher quality of care and lower health care cost. For trigger finger, identifying patient factors associated with nonadherence to evidence-based practices will aid physicians in treatment decisions. The objectives were to (1) determine patient factors associated with treatment nonadherence, (2) examine the success rates of steroid injections, and (3) evaluate the economic consequences of nonadherence to treatment recommendations. METHODS: The authors used data from the Clinformatics DataMart database from 2010 to 2017 to conduct a population-based analysis of patients with single-digit trigger finger. The authors calculated rates of steroid injection success and examined associations between injection success and patient factors using chi-square tests. In addition, the authors analyzed differences in the cost to the insurer, the cost to the patient, and total cost. RESULTS: A total of 29,722 patients were included in this analysis. Injection success rates were similar for diabetic (72 percent) and nondiabetic patients (73 percent), women (73 percent), and men (73 percent). Nonetheless, diabetics (OR, 1.4; 95 percent CI, 1.4 to 1.5; p < 0.001) and women (OR, 1.2; 95 percent CI, 1.1 to 1.2; p < 0.001) were significantly more likely to receive nonadherent treatment. In total, $23 million (U.S. dollars) were spent on nonadherent trigger finger care. CONCLUSIONS: Diabetics and women have increased odds of having surgery without a prior steroid injection, despite similar success rates of steroid injections compared to nondiabetics and men. Because performing surgical release before any steroid injections may represent a higher cost treatment option, providers should provide steroid injections before surgery for all patients regardless of diabetes status or sex to minimize overtreatment. CLINICAL QUESTION/LEVEL OF EVIDENCE: Risk, III.


Assuntos
Diabetes Mellitus/epidemiologia , Glucocorticoides/administração & dosagem , Procedimentos Ortopédicos/economia , Cooperação do Paciente/estatística & dados numéricos , Dedo em Gatilho/terapia , Idoso , Custos e Análise de Custo/estatística & dados numéricos , Medicina Baseada em Evidências/economia , Medicina Baseada em Evidências/métodos , Medicina Baseada em Evidências/estatística & dados numéricos , Feminino , Seguimentos , Glucocorticoides/economia , Custos de Cuidados de Saúde/estatística & dados numéricos , Humanos , Injeções Intralesionais/economia , Injeções Intralesionais/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Procedimentos Ortopédicos/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Resultado do Tratamento , Dedo em Gatilho/economia
16.
J Psychiatr Res ; 130: 19-21, 2020 11.
Artigo em Inglês | MEDLINE | ID: mdl-32768709

RESUMO

AIMS: The aim of this study was to examine the development of drug purchases during the corona crisis. METHODS: The evaluations in this retrospective cross-sectional study are based on the IMS RPM® (Regional Pharmaceutical Market) Weekly database, which shows the weekly purchases of public pharmacies from fully-stocked wholesalers at the time the pharmacy purchase is made in Germany. The outcome of this investigation was the development in psychotropic, neurological, and cardiovascular drug purchases by packing unit between Calendar Weeks 6 and 16. RESULTS: In analyses, performed for psychotropic and neurological drugs, compared to Week 11, the largest increases in Week 12 were for anti-Parkinson drugs and tranquilizers (both 24%), followed by antiepileptics (23%). Purchases of antidementive drugs increased by 16% between Week 11 and Week 12. The increase was 43% for vitamin k antagonists, 39% for ACE inhibitors, and 37% for betablockers. CONCLUSION: The results of this retrospective cross-sectional study suggest that the Covid-19 lockdown in Germany was associated with a significant surge in purchasing behavior in pharmacies for different markets including psychotropic, neurological, and cardiovascular drugs. Further studies are needed to investigate the sell-out data and to estimate the differences in panic buying by age and sex.


Assuntos
Betacoronavirus , Comportamento do Consumidor/estatística & dados numéricos , Infecções por Coronavirus/psicologia , Cooperação do Paciente/estatística & dados numéricos , Farmácias/estatística & dados numéricos , Pneumonia Viral/psicologia , Medicamentos sob Prescrição , Estudos Transversais , Bases de Dados Factuais , Alemanha , Humanos , Pandemias , Pânico , Cooperação do Paciente/psicologia , Estudos Retrospectivos
17.
PLoS One ; 15(8): e0237383, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32776967

RESUMO

With obesity having doubled in the last decade, hypertension is on the rise. In one-third of hypertensive patients the metabolic syndrome is present. This might be one factor for the increasing number of prescriptions for angiotensin receptor blockers and calcium-channel blockers besides a more favorable risk-to-benefit ratio. The aim of the present study was to evaluate a therapeutic drug monitoring (TDM) method for assessment of adherence based on cut-offs in inpatients and to compare it to an established urine drug screening in outpatients. A method for quantification of calcium-channel blockers and angiotensin receptor blockers using high-performance liquid chromatography-tandem mass spectrometric analysis (LC-MS/MS) was developed and validated. The method was applied to serum samples of 32 patients under supervised medication to establish cut-off values for adherence assessment based on dose-related concentrations (DRC, calculated from pharmacokinetic data). Furthermore, corresponding urine and blood samples of 42 outpatients without supervised medication were analysed and the results compared with regard to adherence assessment. All serum concentrations measured for amlodipine (n = 40), lercanidipine (n = 14), candesartan (n = 10), telmisartan (n = 4) and valsartan (n = 10) in inpatients were above the patient specific lower DRC confirming adherence. Of 42 outpatients the identification of analytes in urine as well as the quantification in serum exhibited differing results. According to urinalysis, adherence was demonstrated in only 87.0% of prescriptions, compared to 91.3% for serum analyses. Differences were observed for amlodipine, lercanidipine and candesartan which can be explained by a higher specificity of the serum analysis approach due to pharmacokinetics. The present study confirms that assessing adherence based on serum drug concentrations with individually calculated lower DRCs is more accurate than using qualitative urine analysis. In particular, drugs with low bioavailability, low renal excretion or high metabolism rate such as lercanidipine and candesartan may lead to underestimation of adherence via urine analysis.


Assuntos
Anti-Hipertensivos/sangue , Anti-Hipertensivos/urina , Monitoramento de Medicamentos/métodos , Cooperação do Paciente/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Feminino , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Pacientes Ambulatoriais/estatística & dados numéricos
18.
PLoS One ; 15(8): e0236965, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810140

RESUMO

BACKGROUND: Despite decades of implementation of maternal health care programs, the uptake of antenatal care services based on the recommended gestational age continues to be below the national and regional targets. Thus, this study aimed to assess the prevalence and factors related to the completion of four antenatal care visits among mothers who gave birth 6 months preceding the study. METHOD: We conducted a community-based cross-sectional study using both quantitative and qualitative approaches. The quantitative component included administering a pre-tested structured questionnaire to 466 mothers who gave birth 6 months preceding the study using a simple random sampling technique from respective Tabias. The quantitative result was analyzed using SPSS version 22. Bivariate and multivariate analysis was done to determine the association between independent and dependent variables. Variables were declared as statistically significant at P ≤ 0.05 in multivariable logistic regression model. The qualitative interview data were collected from eight mothers and four key informants recruited through purposive sampling method. RESULTS: The overall prevalence of completion of four ANC visits based on the recommended time schedule was 9.9% (95% CI, 7.1-12.4). However, 63.9% of the participants attended four visits or more regardless of the recommended time schedule. Being member of community health insurance (AOR 2.140, 95% CI, 1.032-4.436), walking on foot less than or equal one hour to reach the health facility (AOR 3.921, 95% CI, 1.915-8.031), having workload at home (AOR 0.369, 95% CI, 0.182-0.751), and husband supported during antenatal care (AOR 2.561, 95% CI, 1.252-5.240) were independently associated with the completion of four ANC visits based on the recommended time schedule in multivariable analysis. CONCLUSION: The completion of four ANC contacts based on the recommended time schedule remains low in rural areas of Northern Ethiopia. Being a member of community health insurance, distance to the health facility, workload, and male involvement were associated with the completion of four ANC visits based on the recommended time schedule. The existing health system should consider improving the recommended ANC visits by integrating Community based interventions.


Assuntos
Cuidado Pré-Natal/métodos , Adolescente , Adulto , Serviços de Saúde Comunitária/estatística & dados numéricos , Estudos Transversais , Etiópia , Feminino , Humanos , Serviços de Saúde Materna/estatística & dados numéricos , Pessoa de Meia-Idade , Análise Multivariada , Cooperação do Paciente/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , Fatores de Tempo , Adulto Jovem
20.
BMC Public Health ; 20(1): 1227, 2020 Aug 12.
Artigo em Inglês | MEDLINE | ID: mdl-32787809

RESUMO

BACKGROUND: Patients with coexisting type 2 diabetes and hypertension generally exhibit poor adherence to self-management, which adversely affects their disease control. Therefore, identification of the factors related to patient adherence is warranted. In this study, we aimed to examine (i) the socio-demographic correlates of patient adherence to a set of self-management behaviors relevant to type 2 diabetes and hypertension, namely, medication therapy, diet therapy, exercise, tobacco and alcohol avoidance, stress reduction, and self-monitoring/self-care, and (ii) whether health attitudes and self-efficacy in performing self-management mediated the associations between socio-demographic characteristics and adherence. METHODS: We performed a secondary analysis of data collected in a randomized controlled trial. The sample comprised 148 patients with coexisting type 2 diabetes mellitus and hypertension. Data were collected by a questionnaire and analyzed using logistic regression. RESULTS: Female patients were found to be less likely to exercise regularly (odds ratio [OR] = 0.49, P = 0.03) and more likely to avoid tobacco and alcohol (OR = 9.87, P < 0.001) than male patients. Older patients were found to be more likely to adhere to diet therapy (OR = 2.21, P = 0.01) and self-monitoring/self-care (OR = 2.17, P = 0.02). Patients living with family or others (e.g., caregivers) were found to be more likely to exercise regularly (OR = 3.44, P = 0.02) and less likely to avoid tobacco and alcohol (OR = 0.10, P = 0.04) than those living alone. Patients with better perceived health status were found to be more likely to adhere to medication therapy (OR = 2.02, P = 0.03). Patients with longer diabetes duration (OR = 2.33, P = 0.01) were found to be more likely to adhere to self-monitoring/self-care. Self-efficacy was found to mediate the association between older age and better adherence to diet therapy, while no significant mediating effects were found for health attitudes. CONCLUSIONS: Adherence to self-management was found to be associated with socio-demographic characteristics (sex, age, living status, perceived health status, and diabetes duration). Self-efficacy was an important mediator in some of these associations, suggesting that patient adherence may be improved by increasing patients' self-management efficacy, such as by patient empowerment, collaborative care, or enhanced patient-physician interactions.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Conhecimentos, Atitudes e Prática em Saúde , Hipertensão/terapia , Cooperação do Paciente/estatística & dados numéricos , Autogestão/psicologia , Idoso , Diabetes Mellitus Tipo 2/epidemiologia , Feminino , Humanos , Hipertensão/epidemiologia , Masculino , Pessoa de Meia-Idade , Autoeficácia , Fatores Socioeconômicos , Inquéritos e Questionários
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