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1.
BMC Health Serv Res ; 21(1): 657, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225704

RESUMO

BACKGROUND: Community Health Navigators (CHNs) are members of a patient's care team that aim to reduce barriers in accessing healthcare. CHNs have been described in various healthcare settings, including chronic disease management. The ENhancing COMmunity health through Patient navigation, Advocacy, and Social Support (ENCOMPASS) program of research employs CHNs, who are trained to improve access to care and community resources for patients with multiple chronic diseases. With complex and demanding roles, it is essential that CHNs communicate with each other to maintain knowledge exchange and best practices. A Community of Practice (CoP) is a model of situated learning that promotes communication, dedication, and collaboration that can facilitate this communication. The objective of this study was to engage with CHNs to determine how a CoP could be implemented to promote consistency in practices and knowledge for CHNs across primary care sites. METHODS: A needs assessment for a CHN CoP was conducted using sequential steps of inquiry. A preliminary focused literature review (FLR) was done to examine the ways in which other healthcare CoPs have been implemented. Results from the FLR guided the creation of an exploratory survey and group interview with key informants to understand best approaches for CoP creation. Political, economic, social, and technological (PEST) and strengths, weaknesses, opportunities, and threats (SWOT) analyses synthesized results in a comprehensive manner for strategic recommendations. RESULTS: The FLR identified different approaches and components of healthcare CoPs and guided analyses of mitigatable risk factors and leverageable assets for the intervention. The survey and group interview revealed an informal and effective CoP amongst current CHNs, with preferred methods including coffee meetings, group trainings, and seminars. A well-maintained web platform with features such as an encrypted discussion forum, community resource listing, calendar of events, and semi-annual CHN conferences were suggested methods for creating an inter-regional, formal CoP. CONCLUSION: The study findings recognise the presence of an informal CoP within the studied CHN cohort. Implementation of a formal CoP should complement current CoP approaches and aid in facilitating expansion to other primary care centres utilizing digital communication methods, such as a comprehensive web platform and online forum.


Assuntos
Serviços de Saúde Comunitária , Saúde Pública , Atenção à Saúde , Humanos , Conhecimento , Determinação de Necessidades de Cuidados de Saúde
2.
Mymensingh Med J ; 30(3): 789-795, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34226469

RESUMO

Curriculum is the road map of any course and an instrument for developing the competencies of the human resources. The MBBS curriculum in our country was last updated in 2012 during the period of Millennium Development Goals (MDGs). Since then it has been under implementation in different government, non-government and Army medical colleges in association with different universities. "Health Professional for a New Century" now asks for a transformation of the education to strengthen the health systems for meeting the challenges of the 21st century. Curriculum reform is an important issue in transformative education and need assessment is the first and essential task to review and update any curriculum. The objective of the study was to assess the need to review and update the MBBS curriculum 2012 of Bangladesh. Review and updating of MBBS curriculum was organized by Centre for Medical Education (CME) and supported by World Health Organization (WHO). CME, DGHS, Dean offices, MOH&FW, BM&DC and all the government and non-government medical colleges were involved in this activity. Duration of study was 7 months from April 2019 to October 2019. Data were collected from academic councils of 102 medical colleges through structured questionnaire and through FGD with teachers and interns. Around 90(88.2%) academic councils agreed and 12(12%) disagreed about the appropriateness of existing four phases of MBBS curriculum. About 80(84.2%) academic councils agreed with 1.5 years duration of Phase I, 84(88.4%) agreed with one year duration of Phase II, 84(94.4%) agreed with one year duration of Phase III and 77(84.6%) agreed with 1.5 years duration of Phase IV. The study suggested the subjects for 2nd phase are, Pharmacology 74(84.1%), Pathology 53(60.3%), Forensic Medicine 46(52.3%), and for 3rd phase are Community Medicine 60(69.8%), Microbiology 54(62.8%). The study revealed that the subjects of overloaded contents are, Anatomy - 24(50%), Community Medicine - 35(72.9%) and Pathology - 19(39.6%). The study suggested incorporation of organized teaching-learning for behavioral science, communication skills, ethics and development of attitude by most of the academic councils. The study suggested that the increased duration of ambulatory care (outdoor/emergency) teaching. The study revealed around 84(83.2%) academic councils recommended that Single Best Answer (SBA) type of questions should be included in MCQ part for all subjects along with multiple true-false response and around 82(81.2%) academic councils recommended that Structured Essay Question (SEQ) should be included in written part along with Short Answer Question (SAQ). The study revealed that 58(58.6%) academic councils recommended that carry-on system should not be in Phase I and 53(53.5%) academic councils opined to introduce grading system in MBBS course. Most of the academic councils agreed about the appropriateness of existing four phases of MBBS curriculum. The subjects for 2nd phase are, Pharmacology - 84.1%, Pathology - 60.3%, Forensic Medicine - 52.3%, and for 3rd phase are Community Medicine - 69.8%, Microbiology - 62.8%. Most of the participants are in favour of the present curriculum components, grading system for assessment but not the carry-on system in Phase I. The study recommended for national level consultations involving the concerned persons for finalization of the MBBS curriculum.


Assuntos
Currículo , Educação Médica , Bangladesh , Humanos , Determinação de Necessidades de Cuidados de Saúde , Inquéritos e Questionários
3.
Braz J Med Biol Res ; 54(8): e11447, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34320123

RESUMO

Knowledge about the needs of psychiatric patients is essential for mental health care planning. However, research on met and unmet needs is still scarce, particularly in low- and middle-income countries. This study aimed to describe the patients' needs (met and unmet) at least four years after their first psychiatric hospitalization and to verify the role of demographic and clinical features as possible predictors of these needs. Patients who had their first psychiatric admission between January 1, 2006 and December 31, 2007 at an inpatient unit in the city of Ribeirão Preto, Brazil, were eligible to participate in the study. Patients were contacted and face-to-face interviews were conducted by psychologists using the Camberwell Assessment of Need. Data were analyzed using zero-inflated negative binomial regression model. Of 933 eligible patients, 333 were interviewed. The highest level of needs was related to welfare benefits (32.4%, unmet=25.5%), followed by household skills (30.3%, unmet=3.0%), psychotic symptoms (29.4%, unmet=9.0%), psychological distress (27.6%, unmet=8.4%), physical health (24.3%, unmet=5.4%), daytime activities (19.5%, unmet=16.5%), and money (16.8%, unmet=9.0%). Fewer years of schooling, living with relatives, and unemployment at the moment of the first admission were significantly associated with a higher number of both met and unmet needs in the follow-up. Unmet needs were also more often reported by patients living alone. In conclusion, socioeconomic indicators were the best predictors of needs. The unmet needs related to welfare benefits point to the need for specific social and health policies.


Assuntos
Hospitalização , Pacientes Internados , Brasil , Estudos de Coortes , Humanos , Determinação de Necessidades de Cuidados de Saúde
4.
Proc Natl Acad Sci U S A ; 118(29)2021 07 20.
Artigo em Inglês | MEDLINE | ID: mdl-34253617

RESUMO

We study US sick leave use and unaddressed sick leave needs in the midst of the global severe acute respiratory syndrome coronavirus type 2 (SARS COV 2) pandemic based on a representative survey. More than half of all US employees are unaware of the new emergency sick leave options provided by the federal Families First Coronavirus Response Act (FFCRA). Awareness and take-up rates are significantly higher among Asian Americans and lower among the foreign-born. About 8 million employees used emergency sick leave in the first 6 to 8 mo. Nevertheless, the share of employees who needed but could not take paid sick leave tripled in the pandemic; unaddressed sick leave needs total 15 million employees per month and are 69% higher among women. Our findings show that access to paid sick leave significantly reduces unaddressed sick leave needs. We conclude that given the fragmented US sick leave landscape, to address the strong increase in unaddressed sick leave needs during the pandemic, federal FFCRA response was not adequate.


Assuntos
COVID-19/psicologia , Determinação de Necessidades de Cuidados de Saúde , Presenteísmo/estatística & dados numéricos , Licença Médica/estatística & dados numéricos , Conscientização , COVID-19/epidemiologia , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços/estatística & dados numéricos , Humanos , Estados Unidos
5.
MMWR Morb Mortal Wkly Rep ; 70(26): 937-941, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34197364

RESUMO

Disasters can adversely affect population health, resulting in increased need for health services. Hurricane Irma made landfall in the Florida Keys (Monroe County) as a Category 4 hurricane on September 10, 2017. The hurricane caused substantial damage to 65% of homes and resulted in 40 persons injured and 17 deaths from hurricane-related causes.* During 2018, the county suicide rate increased to 34.9 per 100,000 population from the 5-year (2013-2017) average of 25.2 per 100,000 population (1). In May 2019, 20 months after the hurricane, the Florida Department of Health (FDOH) conducted a modified Community Assessment for Public Health Emergency Response (CASPER) to assess the community's mental, physical, and economic health and develop public health interventions to decrease the suicide rate. A consenting adult member from 231 households was interviewed, and a weighted cluster analysis was conducted to estimate the number and percentage of households throughout the Florida Keys with a particular response, as well as the number and percentage of persons at risk for suicide. During the 20 months since Hurricane Irma, 17% of households reported a need for a mental health care provider; 37.9% of these did not receive those services. A modified CASPER was used to calculate population estimates of suicide risk in an area of high landfall for hurricanes; estimated population suicide risk was 7.3%. Respondents reported worsening of respiratory conditions (17.7%), anxiety (17.0%), and depression (11.3%). Emergency preparedness plans should consider strengthening mental health service delivery after a hurricane, particularly during the long-term recovery phase.


Assuntos
Tempestades Ciclônicas , Desastres , Determinação de Necessidades de Cuidados de Saúde , Saúde Pública , Adulto , Idoso , Ansiedade/epidemiologia , Serviços Comunitários de Saúde Mental , Depressão/epidemiologia , Florida/epidemiologia , Humanos , Pessoa de Meia-Idade , Medição de Risco , Suicídio
6.
J Emerg Manag ; 19(3): 293-305, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34195982

RESUMO

INTRODUCTION: Community assessments to measure emergency preparedness can inform policies, planning, and communication to the public to improve readiness and response if an emergency was to occur. Public health and emergency management officials need an effective assessment tool to measure community preparedness for a radiological emergency. METHODS: The authors created a survey instrument to collect data on household radiological emergency preparedness that could be implemented using the Community Assessment for Public Health Emergency Response (CASPER) methodology, developed by the U.S. Centers for Disease Control and Prevention. To inform the development of the tool, the authors examined existing CASPER surveys, focusing on identifying best practices for creating a survey instrument, as well as analyzing the results of a survey of radiation preparedness experts and state/local health and emergency management officials. RESULTS: The developed survey tool includes 32 questions covering four domains: communication in an emergency, preparedness planning, physical/behavioral health, and demographics. The instrument captures information related to identified barriers in communicating in a radiological emergency as well as self-reported behaviors that could potentially be influenced through awareness and education. DISCUSSION: Using the proposed survey instrument and following the existing rapid assessment methodology provided by CASPER, public health and emergency management agencies can collect valuable information on the radiation preparedness needs of their communities, which can then be used to improve household readiness for an emergency.


Assuntos
Defesa Civil , Planejamento em Desastres , Emergências , Características da Família , Humanos , Determinação de Necessidades de Cuidados de Saúde , Saúde Pública
7.
Isr Med Assoc J ; 23(7): 401-407, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34251120

RESUMO

BACKGROUND: The coronavirus disease-2019 (COVID-19) pandemic forced drastic changes in all layers of life. Social distancing and lockdown drove the educational system to uncharted territories at an accelerated pace, leaving educators little time to adjust. OBJECTIVES: To describe changes in teaching during the first phase of the COVID-19 pandemic. METHODS: We described the steps implemented at the Technion-Israel Institute of Technology Faculty of Medicine during the initial 4 months of the COVID-19 pandemic to preserve teaching and the academic ecosystem. RESULTS: Several established methodologies, such as the flipped classroom and active learning, demonstrated effectiveness. In addition, we used creative methods to teach clinical medicine during the ban on bedside teaching and modified community engagement activities to meet COVID-19 induced community needs. CONCLUSIONS: The challenges and the lessons learned from teaching during the COVID-19 pandemic prompted us to adjust our teaching methods and curriculum using multiple online teaching methods and promoting self-learning. It also provided invaluable insights on our pedagogy and the teaching of medicine in the future with emphasis on students and faculty being part of the changes and adjustments in curriculum and teaching methods. However, personal interactions are essential to medical school education, as are laboratories, group simulations, and bedside teaching.


Assuntos
COVID-19 , Educação à Distância , Educação Médica , Distanciamento Físico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Controle de Doenças Transmissíveis/métodos , Educação à Distância/métodos , Educação à Distância/organização & administração , Educação Médica/organização & administração , Educação Médica/tendências , Humanos , Determinação de Necessidades de Cuidados de Saúde , Inovação Organizacional , Avaliação de Resultados em Cuidados de Saúde , SARS-CoV-2 , Faculdades de Medicina , Ensino/tendências
8.
Rev Esp Salud Publica ; 952021 Jul 30.
Artigo em Espanhol | MEDLINE | ID: mdl-34267177

RESUMO

OBJECTIVE: Due to the agricultural labor supply in the province of Huelva, the immigrant population has been growing, establishing a situation of irregularity that favors precarious work and hinders access to decent housing. Therefore, our objective was to identify the socio-sanitary needs of the immigrant population facing the living conditions with which they live in the irregular settlements of the province of Huelva. METHODS: Cross-sectional descriptive study of mixed method on an estimated population of 2500 residents in 23 settlements. A quantitative study of socio-sanitary variables was carried out using a survey and observation guide, and a water, air and soil quality study. Semi-structured interviews were conducted with 13 inhabitants of the settlements until the saturation of the speeches. RESULTS: The settlements were located far away from the towns. Surrounded by garbage, without running water, electricity, sewer, toilets or showers. Its residents were stocked up on purchased food and water from fields, wells and public fountains, which they stored in jugs of plant protection products. They were mostly in an irregular situation. 49% had a health card and 48% ever went to a health center, declared mostly a good perception of health. They stood out as expressed needs: access to water (main demand), protection from the risk of fire, improvement of the irregular situation and the working conditions, and the need to help and to protect their family of origin. CONCLUSIONS: These living conditions belong to an underdeveloped environment within an advanced society, with access to water being the main problem. Legal irregularity is key for them, preventing them regularized employment contracts and the perception of being able to access to a better future. Their self-perception of health is good and they do not make a greater use of health services, despite the conditions in which they live.


Assuntos
Autoavaliação Diagnóstica , Emigrantes e Imigrantes/estatística & dados numéricos , Condições Sociais/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde , Pesquisa Qualitativa , Espanha
9.
Recenti Prog Med ; 112(7): 499-503, 2021.
Artigo em Italiano | MEDLINE | ID: mdl-34263876

RESUMO

Access to vaccines against covid-19 is a very topical issue. On the one hand, we are suffering from supply problems and inadequate availability of doses both nationally and internationally. On the other hand, public health needs do not coincide with those of the market economy: the need to vaccinate the entire world population to overcome the pandemic cannot be satisfied due to market rules and limits in production processes. The result is a radical inequality in access to vaccines. We are aware of the delicate balance between health and economy: the latter cannot ignore the former. Also for this reason, the demand for greater equity in access to vaccines is growing: the race for innovation may not be hindered by a targeted relaxation of the rules on intellectual property during a pandemic health emergency.


Assuntos
Vacinas contra COVID-19/provisão & distribuição , COVID-19/prevenção & controle , Desenvolvimento de Medicamentos , Propriedade Intelectual , Pesquisa Biomédica/economia , Vacinas contra COVID-19/economia , Difusão de Inovações , Saúde Global , Disparidades em Assistência à Saúde , Humanos , Itália , Determinação de Necessidades de Cuidados de Saúde , Patentes como Assunto , Saúde Pública , Apoio à Pesquisa como Assunto/economia , Cobertura Vacinal
11.
Artigo em Inglês | MEDLINE | ID: mdl-34206384

RESUMO

In 2020, the COVID-19 pandemic severely impacted the global public health system and led to many deaths worldwide. COVID-19 is highly contagious and can be spread by symptomatic or asymptomatic individuals. As such, determining the risk of infection within a community is difficult. To mitigate the risk of the spread of COVID-19, the government of Malaysia implemented seven phases of the movement control order (MCO) from 18 March to 31 December 2020. However, the socioeconomic cost was substantial despite the effectiveness of the MCO in bringing down cases of infection. As noted by the Prime Minister of Malaysia, the final criterion that should be met is community empowerment. In other words, community-based mitigation measures through which communities unite to contain the pandemic are essential before the completion of the vaccination program. As a measure for controlling the pandemic, mitigation strategies in the new normal should be feasible, practical, and acceptable to communities. In this paper, we present a deliberation of a set of community-based monitoring criteria to ensure health and well-being in communities, such as efficacy, technicality, feedback, and sustainability. The proposed criteria will be instrumental in developing community-based monitoring initiatives to achieve the desired goals in coping with the pandemic as well as in empowering communities to be part of the governance process.


Assuntos
COVID-19 , Pandemias , Humanos , Malásia/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Pandemias/prevenção & controle , SARS-CoV-2
12.
Prev Chronic Dis ; 18: E65, 2021 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-34197284

RESUMO

INTRODUCTION: Telehealth plays a role in the continuum of care, especially for older adults during the COVID-19 pandemic. Our objective was to examine factors associated with the accessibility of telehealth services during the COVID-19 pandemic among older adults. METHODS: We analyzed the nationally representative Medicare Current Beneficiary Survey COVID-19 Rapid Response Supplement Questionnaire of beneficiaries aged 65 years or older. Two weighted multivariable logistic regression models were used to examine associations between usual providers who offered telehealth 1) during the COVID-19 pandemic and 2) to replace a regularly scheduled appointment. We examined factors including sociodemographic characteristics, comorbidities, and digital access and literacy. RESULTS: Of the beneficiaries (n = 6,172, weighted n = 32.4 million), 81.2% reported that their usual providers offered telehealth during the COVID-19 pandemic. Among those offered telehealth services, 56.8% reported that their usual providers offered telehealth to replace a regularly scheduled appointment. Disparities in accessibility of telehealth services by sex, residing area (metropolitan vs nonmetropolitan), income level, and US Census region were observed. Beneficiaries who reported having internet access (vs no access) (OR, 1.75, P < .001) and who reported ever having participated in video, voice, or conference calls over the internet before (vs not) (OR, 2.18, P < .001) were more likely to report having access to telehealth. Non-Hispanic Black beneficiaries (versus White) (OR, 1.57, P = .007) and beneficiaries with comorbidities (vs none) (eg, 2 or 3 comorbidities, OR, 1.25, 95% P = .044) were more likely to have their usual provider offer telehealth to replace a regularly scheduled appointment. CONCLUSION: Although accessibility of telehealth has increased, inequities raise concern. Educational outreach and training, such as installing and launching an online web conferencing platform, should be considered for improving accessibility of telehealth to vulnerable populations beyond the COVID-19 pandemic.


Assuntos
COVID-19 , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Controle de Infecções/métodos , Medicare/estatística & dados numéricos , Telemedicina , Idoso , COVID-19/epidemiologia , COVID-19/prevenção & controle , Comorbidade , Estudos Transversais , Demografia , Feminino , Acesso aos Serviços de Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/organização & administração , Humanos , Acesso à Internet/estatística & dados numéricos , Masculino , Determinação de Necessidades de Cuidados de Saúde , SARS-CoV-2 , Fatores Socioeconômicos , Telemedicina/métodos , Telemedicina/organização & administração , Telemedicina/estatística & dados numéricos , Estados Unidos/epidemiologia
13.
Medicine (Baltimore) ; 100(26): e26509, 2021 Jul 02.
Artigo em Inglês | MEDLINE | ID: mdl-34190181

RESUMO

ABSTRACT: Medical diagnosis and therapy often rely on laboratory testing. We observed mistaken testing in evaluations for hemophagocytic lymphohistiocytosis (HLH) that led to delays and adverse outcomes. Physicians were mistakenly ordering interleukin-2 and quantitative natural killer cell flow cytometry, rather than soluble interleukin 2 receptor (sIL2R) or qualitative natural killer functional tests in the evaluation of patients suspected to have HLH.We initiated a prospective quality improvement project to reduce mistaken testing, reduce delays in correct testing due to mistaken ordering, and improve HLH evaluations. This consisted of provider education, developing an evaluation algorithm, and ultimately required systems interventions such as pop-ups and removal of the mistaken tests from the electronic ordering catalog.Active education reduced mistaken testing significantly in HLH evaluations from baseline (73.3% vs 33.3%, P = .003, relative risk reduction (RRR) 54.5%), but failed to meet the pre-specified RRR cutoff for success (70%). Education alone did not significantly reduce the proportion of HLH evaluations with delays in sIL2R testing (23.3% vs 7.4%, P = .096). Mistaken testing increased after the active intervention ended (33.3% vs 43.5%, P = .390, with RRR 40.7% from baseline. Mistaken test removal was successful: mistaken testing dropped to 0% (P < .001, RRR 100%), saved $14,235 yearly, eliminated delays in sIL2R testing from mistaken testing (23.3% vs 0%, P = .008), and expedited sIL2R testing after admission for HLH symptoms (14.6 days vs 3.8 days, P = .0012). These data show systems controls are highly effective in quality improvement while education has moderate efficacy.


Assuntos
Serviços de Laboratório Clínico/normas , Erros de Diagnóstico , Linfo-Histiocitose Hemofagocítica/diagnóstico , Melhoria de Qualidade/organização & administração , Erros de Diagnóstico/prevenção & controle , Erros de Diagnóstico/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Avaliação de Resultados em Cuidados de Saúde , Risco Ajustado/métodos , Risco Ajustado/organização & administração , Desenvolvimento de Pessoal/métodos , Desenvolvimento de Pessoal/organização & administração , Tempo para o Tratamento/estatística & dados numéricos
14.
J Health Care Poor Underserved ; 32(2): 598-606, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34120960

RESUMO

In response to the COVID-19 pandemic, the Herbert Wertheim College of Medicine's Neighborhood Health Education Learning Program (NeighborhoodHELP) initiated a longitudinal assessment and mitigation of social and health care challenges for a population of approximately 850 underserved households. Here, we describe the needs assessment, ensuing interventions, and lessons learned during this pandemic.


Assuntos
COVID-19/epidemiologia , Determinação de Necessidades de Cuidados de Saúde , Populações Vulneráveis , Adolescente , Adulto , Idoso , Criança , Serviços de Saúde Comunitária , Informação de Saúde ao Consumidor , Feminino , Florida/epidemiologia , Assistência Alimentar , Necessidades e Demandas de Serviços de Saúde , Humanos , Masculino , Área Carente de Assistência Médica , Pessoa de Meia-Idade , Pandemias , Determinantes Sociais da Saúde , Adulto Jovem
15.
BMJ Open ; 11(6): e043960, 2021 06 16.
Artigo em Inglês | MEDLINE | ID: mdl-34135086

RESUMO

OBJECTIVES: The main study objective was to identify challenges and barriers experienced by dermatologists and rheumatologists when engaging women of reproductive age in shared decision-making (SDM) related to treatment and management of chronic inflammatory disease (CID) before, during and after pregnancy. DESIGN: A mixed-methods study was conducted, employing (1) semistructured interviews, (2) an online survey and (3) triangulation of findings. PARTICIPANTS: 524 dermatologists and rheumatologists entered the study; 495 completed it; 388 met inclusion criteria for analysis. Participants were included if actively practising in Germany (GER), the UK or the USA; had a minimum 5% caseload of female patients of reproductive age with either axial spondyloarthritis, psoriasis, psoriatic arthritis or rheumatoid arthritis; and had experience prescribing biologics. RESULTS: 48 interviews and 340 surveys were analysed. Interviews underscored dermatologists and rheumatologists' suboptimal integration of SDM in clinical practice. In the survey, 90% (n=305) did not know about SDM models. A perceived lack of competency counselling patients on pregnancy and family planning was also identified during interviews. Among the survey sample, 44% (n=150) of specialists agreed they preferred leaving pregnancy-related discussions to obstetricians and/or gynaecologists and 57% (n=189) reported having suboptimal skills discussing contraceptive methods with patients. Another finding that emerged from interviews was the perception that all biologics are strictly contraindicated during pregnancy. Suboptimal knowledge was noted among 57% (n=95) of dermatologists and 48% (n=83) of rheumatologists surveyed in that regard, with a statistically significant difference by country among dermatologists (GER: 42% vs UK: 71% vs USA: 57%, p=0.015). CONCLUSIONS: This study identified low levels of knowledge, skill and confidence, as well as attitudinal issues, that explain why SDM is not fully integrated in dermatology and rheumatology clinical practice. Blended-learning interventions are recommended to assist CID specialists in developing effective communication and patient engagement competencies.


Assuntos
Artrite Psoriásica , Reumatologia , Dermatologistas , Feminino , Alemanha , Humanos , Determinação de Necessidades de Cuidados de Saúde , Reumatologistas
16.
Artigo em Inglês | MEDLINE | ID: mdl-34070723

RESUMO

While the benefits of physical activity (PA) during and after pregnancy have been established, many women do not reach the recommended PA levels during this time. A major barrier found in the literature is a lack of counselling by healthcare providers (HCPs), which is partly caused by the limited knowledge on the topic. The aim of this study was to develop an intervention to improve the promotion of PA by HCPs. We used Intervention Mapping (IM), a theory-based framework to develop an intervention, called "Baby steps", in a high-income (Austria) and a low-to-middle-income country (South Africa). We applied the following IM steps: (1) A needs assessment to determine the barriers and enablers of PA promotion by HCPs, including a scoping literature review and community needs assessments (qualitative interviews, questionnaires, and focus groups with midwives, obstetricians, and community health workers) to determine the desired outcomes of the intervention. (2) Performance and change objectives were formulated, describing the behaviors that need to change for the intervention to succeed. (3) Based on these objectives, theory-based behavior change techniques were selected, and practical applications were developed. (4) The applications were combined into two evidence-based interventions tailored to each country's needs. Step (5) and (6) consist of an implementation and evaluation plan, respectively. The intervention is aimed at HCPs, such as midwives and community health workers, consisting of a two-day training course, including practical resources. Combining didactic and interactive education, it addresses both PA knowledge and the skills needed to transfer knowledge and facilitate behavior change. In the future, the intervention's effect on women's activity levels during and after pregnancy needs to be studied.


Assuntos
Exercício Físico , Parto , Áustria , Feminino , Humanos , Determinação de Necessidades de Cuidados de Saúde , Gravidez , África do Sul
17.
Public Health ; 195: 145-151, 2021 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-34116382

RESUMO

OBJECTIVES: A collaborative study was undertaken by palliative care and public health on behalf of Chorley & South Ribble and Greater Preston Clinical Commissioning Groups. Going beyond a traditional needs assessment by providing projections of local palliative and end-of-life care needs in all conditions over 20 years, the study will support locality commissioning and development of appropriate health care services. STUDY DESIGN: Population-based needs assessment involving secondary analysis of routinely available regional mortality and population data for Central Lancashire (2017). Palliative care need was estimated using three different recognised methods. METHODS: These estimates were combined with routinely available population and mortality projections and observed trends in palliative care need to provide projections up to 2040. RESULTS: Palliative care need in 2017 in Chorley & South Ribble and Greater Preston is estimated to be between 75% (1292) and 97% (1670), and 74.9% (1337) and 95.7% (1710) of all deaths, respectively. By 2040, the annual need is projected to increase compared with 2017 figures, by 24.2-55.9% (314-729 more deaths) in Chorley & South Ribble and by 13.4-41.4% (180-554 more deaths) in Greater Preston. The numbers of deaths from dementia are forecast to increase by three-fold in both localities. CONCLUSION: This study demonstrates practical application of public health data to support the development of locally responsive palliative care services. Dissemination of findings from this needs assessment on rising palliative care need, including numbers of deaths in different disease groups, provides direction to plan appropriate, equitable and sustainable services. Rapidly growing dementia deaths deserve particular attention in the planning of care. Collaborative work between public health and palliative care in other settings is encouraged, and will likely increase in significance as the full impact of COVID-19 is felt.


Assuntos
Previsões , Cuidados Paliativos na Terminalidade da Vida/tendências , Cuidados Paliativos/tendências , Assistência Terminal/tendências , COVID-19 , Humanos , Determinação de Necessidades de Cuidados de Saúde , Saúde Pública , SARS-CoV-2
18.
Indian J Tuberc ; 68(3): 401-404, 2021 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-34099209

RESUMO

BACKGROUD: Coronavirus disease (COVID-19) is a new respiratory infectious disease, and there is no vaccine currently. Previous studies have found that BCG vaccination can provide extensive protection against respiratory infectious diseases. METHODS: Herein, we obtained the latest data from the World Health Organization (WHO) as of August 12, 2020, and determined the relationship between three parameters (including the BCG vaccination coverage, human development index (HDI), and transmission classifications) and the incidence rate and mortality of COVID-19. RESULTS: The results showed that the morbidity and mortality of COVID-19 in countries with BCG vaccination recommendation were significantly lower than these in countries without BCG vaccination recommendation, and countries with lower HDI have lower morbidity and mortality. In addition, we also found that the mode of virus transmission is also related to the morbidity and mortality of COVID-19. CONCLUSIONS: Although our data supports the hypothesis that BCG vaccination is beneficial in reducing the morbidity and mortality of COVID-19, the data supporting this result may be inaccurate due to many confounders such as PCR testing rate, population characteristics, and protection strategies, the reliability of this result still needs to be verified by clinical trials.


Assuntos
Vacina BCG , COVID-19 , Saúde Global/estatística & dados numéricos , Programas de Imunização , Adjuvantes Imunológicos/uso terapêutico , Vacina BCG/imunologia , Vacina BCG/uso terapêutico , COVID-19/epidemiologia , COVID-19/prevenção & controle , Países em Desenvolvimento/estatística & dados numéricos , Eficiência Organizacional , Regulamentação Governamental , Humanos , Programas de Imunização/legislação & jurisprudência , Programas de Imunização/métodos , Mortalidade , Determinação de Necessidades de Cuidados de Saúde , SARS-CoV-2
19.
BMC Med Educ ; 21(1): 325, 2021 Jun 07.
Artigo em Inglês | MEDLINE | ID: mdl-34092216

RESUMO

BACKGROUND: Effective communication between pharmacists and patients is essential and improves health outcomes. Simulated patients (SPs) are trained to reproduce real-life situations and can help pharmacy students to develop and adapt their communication skills in a safe, learner-centred environment. The aim of this research was to explore how SP and pharmacy student role-play supports communication training. METHODS: A mixed methods realist evaluation approach was adopted to test an initial theory relating to SP role-play for pharmacy students. The intervention tested involved complex communication cases in a men's and women's health module in year three of a new MPharm programme. This SP session was the first such session, of the programme which exclusively focused on complex communication skills for the students. Data collected comprised video-recordings of both training and mock OSCE sessions, and from student focus groups. Communication videos were scored using the Explanation and Planning Scale (EPSCALE) tool. Scores from SP and mock OSCE sessions were compared using the Wilcoxon-signed rank test. Focus groups were conducted with students about their experience of the training and analysed thematically, through a realist lens. Data was analysed for Context-Mechanism-Outcome configurations to produce modified programme theories. RESULTS: Forty-six students (n = 46/59, 78 %) consented to their video-recorded interactions to be used. Students identified contextual factors relating to the timing within the course and the setting of the intervention, the debrief and student individual contexts. Mechanisms included authenticity, feedback, reflection, self-awareness and confidence. Negative responses included embarrassment and nervousness. They distinguished outcomes including increased awareness of communication style, more structured communication and increased comfort. However quantitative data showed a decrease (p < 0.001) in communication scores in the mock OSCE compared with scores from training sessions. Modified programme theories relating to SP training for pharmacy students were generated. CONCLUSIONS: SP role-play is a valuable communication skills training approach. Emphasis should be placed on multiple stakeholder feedback and promotion of reflection. Time limits need to be considered in this context and adjusted to meet student needs, especially for students with lower levels of communication comfort and those communicating in languages different to their first language.


Assuntos
Farmacêuticos , Estudantes de Farmácia , Comunicação , Retroalimentação , Feminino , Humanos , Masculino , Determinação de Necessidades de Cuidados de Saúde
20.
Medwave ; 21(4): e8186, 2021 May 24.
Artigo em Espanhol, Inglês | MEDLINE | ID: mdl-34086666

RESUMO

Introduction: On March 19, 2020, preventive and mandatory social isolation was decreed in Argentina in response to the pandemic caused by the SARS-CoV-2 virus and the disease it causes (COVID-19). This measure aimed to reduce the transmission of the virus and the resulting severe respira-tory condition that frequently besets older adults. However, this measure can also affect the support networks of these isolated people. Objectives: To explore the emerging needs related to the mental health of isolated older adults in this period and to identify the main support networks they have and the emerging coping strategies in the face of the situation. Methodology: We carried out an exploratory qualitative study, summoning participants over 60 years of age. Using snowball sampling, a group of researchers contacted them by phone to collect data. The analysis of the findings was triangulated among researchers with different academic backgrounds (medicine, psychology, and sociology). The concepts emerging from the interviews were linked in conceptual networks using an inductive methodology and were mapped into conceptual frameworks available to researchers. Atlas.ti 8 software was used for coding. Results: Thirty-nine participants belonging to the Buenos Aires Metropolitan Area were interviewed between April and July 2020. For greater clarity, the main themes were described in five cross-sectional axes: network configurations, resources and coping strategies, affective states and emo-tions, perceptions and reflections on the future, and actions emerging from the participatory approach. Participants reported distress, anxiety, anger, uncertainty, exhaustion, and expressed fear of contagion from themselves and their loved ones. We identify greater vulnerability in people living alone, in small and closed environments, with weak linkages and networks, or limited access to technologies. We also found vari-ous coping strategies and technology was a fundamental factor in maintaining the bonds. Conclusions: The findings of this research have implications for decision-making at the individual level, health systems, professional care, and policy devel-opment. Future research may elucidate the regional, temporal, and socioeconomic variations of the phenomena explored in our research.


Assuntos
COVID-19/psicologia , Determinação de Necessidades de Cuidados de Saúde , Distanciamento Físico , Isolamento Social/psicologia , Atividades Cotidianas , Adaptação Psicológica , Idoso , Argentina/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Emoções , Relações Familiares , Medo , Feminino , Regulamentação Governamental , Humanos , Relações Interpessoais , Masculino , Saúde Mental , Pessoa de Meia-Idade , Redes Sociais Online , Grupo Associado , Pesquisa Qualitativa , Quarentena/psicologia , Rede Social , Participação Social , Apoio Social
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