Your browser doesn't support javascript.
loading
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 7.218
Filtrar
4.
S Afr Med J ; 110(7): 594-598, 2020 Jul 07.
Artigo em Inglês | MEDLINE | ID: mdl-32880327

RESUMO

Chronic rhinitis is a troublesome condition for sufferers. It is tempting to label all patients with chronic nasal symptoms as having allergic rhinitis (AR), but many such patients have other causes of chronic rhinitis that need a specific diagnosis and management strategy. Even when the patient fully fits the definition of AR, their condition will be best served by combining medication with ongoing patient education.


Assuntos
Doença Crônica , Rinite/diagnóstico , Doença Crônica/terapia , Transtornos da Motilidade Ciliar/diagnóstico , Fibrose Cística/diagnóstico , Diagnóstico Diferencial , Humanos , Educação de Pacientes como Assunto , Doenças da Imunodeficiência Primária/diagnóstico , Rinite/etiologia , Rinite/terapia , África do Sul
5.
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
6.
PLoS One ; 15(9): e0236861, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32960886

RESUMO

OBJECTIVE: Telephone based health coaching (TBHC) seems to be a promising approach to foster self-management in patients with chronic conditions. The aim of this study was to evaluate the effectiveness of a TBHC on patient-reported outcomes and health behavior for people living with chronic conditions in Germany. METHODS: Patients insured at a statutory health insurance were randomized to an intervention group (IG; TBHC) and a control group (CG; usual care), using a stratified random allocation before giving informed consent (Zelen's single-consent design). The TBHC was based on motivational interviewing, goal setting, and shared decision-making and carried out by trained nurses. All outcomes were assessed yearly for three years. We used mixed effects models utilizing all available data in a modified intention-to-treat sample for the main analysis. Participants and study centers were included as random effects. All models were adjusted for age, education and campaign affiliation. RESULTS: Of the 10,815 invited patients, 4,283 returned their questionnaires at baseline. The mean age was 67.23 years (SD = 9.3); 55.5% were female. According to the model, TBHC was statistically significant superior to CG regarding 6 of 19 outcomes: physical activity in hours per week (p = .030) and in metabolic rate per week (p = .048), BMI (p = .009) (although mainly at baseline), measuring blood pressure (p< .001), patient activation (p< .001), and health literacy (p< .001). Regarding stages of change (p = .005), the IG group also showed statistically different results than the CG group, however the conclusion remains inconclusive. Within-group contrasts indicating changes from baseline to follow-ups and significant between-group comparisons regarding these changes supported the findings. Standardized effect sizes were small. TBHC did not show any effect on mental QoL, health status, alcohol, smoking, adherence, measuring blood sugar, foot monitoring, anxiety, depression and distress. Campaign-specific subgroup effects were detected for 'foot monitoring by a physician' and 'blood sugar measurement'. CONCLUSION: TBHC interventions might have small effects on some patient reported and behavioral outcomes. PRACTICE IMPLICATIONS: Future research should focus on analyzing which intervention components are effective and who profits most from TBHC interventions. REGISTRATION: German Clinical Trials Register (Deutsches Register Klinischer Studien; DRKS): DRKS00000584.


Assuntos
Doença Crônica/terapia , Aconselhamento à Distância/métodos , Comportamentos Relacionados com a Saúde , Medidas de Resultados Relatados pelo Paciente , Telemedicina , Idoso , Ansiedade/psicologia , Glicemia/análise , Exercício Físico , Feminino , Alemanha , Letramento em Saúde , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Entrevista Motivacional , Participação do Paciente , Autocuidado
7.
PLoS One ; 15(9): e0238356, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32991624

RESUMO

BACKGROUND: A lack of patient-centered communication (PCC) with health providers plays an important role in perpetuating disparities in health care outcomes and experiences for minority men. This study aimed to identify factors associated with any racial differences in the experience of PCC among Black and Latino men in a nationally representative sample. METHODS: We employed a cross-sectional analysis of four indicators of PCC representative of interactions with doctors and nurses from (N = 3082) non-Latino White, Latino, and Black males from the 2010 Health and Retirement Study (HRS) Core and the linked HRS Health Care Mail in Survey (HCMS). Men's mean age was 66.76 years. The primary independent variable was Race/Ethnicity (i.e. Black and Hispanic/Latino compared to white males) and covariates included age, education, marital status, insurance status, place of care, and self-rated health. RESULTS: Bivariate manova analyses revealed racial differences across each of the four facets of PCC experience such that non-Hispanic white men reported PC experiences most frequently followed by black then Hispanic/Latino men. Multivariate linear regressions predictive of PCC by race/ethnicity revealed that for Black men, fewer PCC experiences were predicted by discriminatory experiences, reporting fewer chronic conditions and a lack of insurance coverage. For Hispanic/Latino men, access to a provider proved key where not having a place of usual care solely predicted lower PCC frequency. IMPLICATIONS: Researchers and health practitioners should continue to explore the impact of inadequate health care coverage, time-limited medical visits and implicit racial bias on medical encounters for underrepresented patients, and to advocate for accessible, inclusive and responsive communication between minority male patients and their health providers.


Assuntos
Afro-Americanos/estatística & dados numéricos , Doença Crônica/terapia , Comunicação , Disparidades em Assistência à Saúde , Hispano-Americanos/estatística & dados numéricos , Assistência Centrada no Paciente/normas , Relações Médico-Paciente , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Seguimentos , Humanos , Cobertura do Seguro , Masculino , Pessoa de Meia-Idade , Educação de Pacientes como Assunto , Prognóstico , Racismo/estatística & dados numéricos
9.
J Med Internet Res ; 22(9): e20874, 2020 09 21.
Artigo em Inglês | MEDLINE | ID: mdl-32896833

RESUMO

BACKGROUND: The COVID-19 outbreak has overwhelmed and altered health care systems worldwide, with a substantial impact on patients with chronic diseases. The response strategy has involved implementing measures like social distancing, and care delivery modalities like telemedicine have been promoted to reduce the risk of transmission. OBJECTIVE: The aim of this study was to analyze the benefits of using telemedicine services for patients with chronic liver disease (CLD) at a tertiary care center in Italy during the COVID-19-mandated lockdown. METHODS: From March 9 to May 3, 2020, a prospective observational study was conducted in the Liver Unit of the University Hospital of Naples Federico II to evaluate the impact of (1) a fully implemented telemedicine program, partially restructured in response to COVID-19 to include video consultations; (2) extended hours of operation for helpline services; and (3) smart-working from home to facilitate follow-up visits for patients with CLD while adhering to social distancing regulations. RESULTS: During the lockdown in Italy, almost 400 visits were conducted using telemedicine; only patients requiring urgent care were admitted to a non-COVID-19 ward of our hospital. Telemedicine services were implemented not only for follow-up visits but also to screen patients prior to hospital admission and to provide urgent evaluations during complications. Of the nearly 1700 patients with CLD who attended a follow-up visit at our Liver Unit, none contracted COVID-19, and there was no need to alter treatment schedules. CONCLUSIONS: Telemedicine was a useful tool for following up patients with CLD and for reducing the impact of the COVID-19 pandemic. This system of health care delivery was appreciated by patients since it gave them the opportunity to be in contact with physicians while respecting social distancing rules.


Assuntos
Infecções por Coronavirus/epidemiologia , Hepatopatias/epidemiologia , Hepatopatias/terapia , Pandemias , Pneumonia Viral/epidemiologia , Telemedicina/estatística & dados numéricos , Assistência Ambulatorial , Betacoronavirus , Doença Crônica/terapia , Assistência à Saúde , Surtos de Doenças , Feminino , Hospitalização , Humanos , Itália/epidemiologia , Masculino , Estudos Prospectivos , Encaminhamento e Consulta
10.
Nature ; 585(7824): 193-202, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32908264

RESUMO

Advances in machine learning and contactless sensors have given rise to ambient intelligence-physical spaces that are sensitive and responsive to the presence of humans. Here we review how this technology could improve our understanding of the metaphorically dark, unobserved spaces of healthcare. In hospital spaces, early applications could soon enable more efficient clinical workflows and improved patient safety in intensive care units and operating rooms. In daily living spaces, ambient intelligence could prolong the independence of older individuals and improve the management of individuals with a chronic disease by understanding everyday behaviour. Similar to other technologies, transformation into clinical applications at scale must overcome challenges such as rigorous clinical validation, appropriate data privacy and model transparency. Thoughtful use of this technology would enable us to understand the complex interplay between the physical environment and health-critical human behaviours.


Assuntos
Inteligência Ambiental , Assistência à Saúde/métodos , Monitoramento Ambiental/métodos , Algoritmos , Doença Crônica/terapia , Assistência à Saúde/normas , Unidades Hospitalares , Humanos , Saúde Mental , Segurança do Paciente , Privacidade
11.
Rev Med Suisse ; 16(708): 1818-1821, 2020 Sep 30.
Artigo em Francês | MEDLINE | ID: mdl-32997453

RESUMO

This study focuses on the management of chronic depression at the general practitioner's office and the collaboration between general practitioner (GP)-psychiatrist. Our study's highlights two different situations: patients able to verbalize their psychological suffering and who can be directly referred to the psychiatrist and patients expressing their psychological suffering mainly by physical symptoms. GPs consider they first have to work with their patient to help them connect their somatic symptoms and their psychological suffering, which will allow them to refer their patient to the psychiatrist. If this work does not succeed, the GP remains at the forefront of medical care. Long-term support continues, where the GP sometimes ends up giving up on curing and focusing on the doctor/patient relationship.


Assuntos
Depressão/terapia , Medicina de Família e Comunidade , Clínicos Gerais , Psiquiatria , Doença Crônica/psicologia , Doença Crônica/terapia , Depressão/psicologia , Humanos , Relações Médico-Paciente , Estresse Psicológico
12.
Health Qual Life Outcomes ; 18(1): 279, 2020 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-32795317

RESUMO

PURPOSE: The aim of this work was to develop a mapping algorithm for estimating EuroQoL 5 Dimension (EQ-5D) utilities from responses to the Long-Term Conditions Questionnaire (LTCQ), thus increasing LTCQ's potential as a comprehensive outcome measure for evaluating integrated care initiatives. METHODS: We combined data from three studies to give a total sample of 1334 responses. In each of the three datasets, we randomly selected 75% of the sample and combined the selected random samples to generate the estimation dataset, which consisted of 1001 patients. The unselected 25% observations from each dataset were combined to generate an internal validation dataset of 333 patients. We used direct mapping models by regressing responses to the LTCQ-8 directly onto EQ-5D-5L and EQ-5D-3L utilities as well as response (or indirect) mapping to predict the response level that patients selected for each of the five EQ-5D-5L domains. Several models were proposed and compared on mean squared error and mean absolute error. RESULTS: A two-part model with OLS was the best performing based on the mean squared error (0.038) and mean absolute error (0.147) when estimating the EQ-5D-5L utilities. A multinomial response mapping model using LTCQ-8 responses was used to predict EQ-5D-5L responses levels. CONCLUSIONS: This study provides a mapping algorithm for estimating EQ-5D utilities from LTCQ responses. The results from this study can help broaden the applicability of the LTCQ by producing utility values for use in economic analyses.


Assuntos
Qualidade de Vida , Inquéritos e Questionários/normas , Adulto , Doença Crônica/psicologia , Doença Crônica/terapia , Conjuntos de Dados como Assunto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
13.
Am J Emerg Med ; 38(9): 1884-1889, 2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32745921

RESUMO

OBJECTIVE: Adults presenting to pediatric emergency departments (PEDs) include those with complex chronic conditions (CCCs) often still followed by pediatric providers, and those without CCCs (non-CCCs). This paper describes recent trends in adults seen within PEDs, both by age subgroups and CCC status. METHODS: Data were retrospectively reviewed from the Pediatric Health Information System for PED visits between Jan 1, 2013 and Dec 31, 2017. Yearly visit rates were trended for all adult visits, age subgroups (18-21, 22-25, 26-40, and 41-95 years), and by CCC status. The most frequent diagnoses were reviewed for each adult age group and CCC category. RESULTS: Rates of adult PED visits significantly increased from 3.7% in 2013 to 4.2% in 2017 (P < 0.0001). While the overall majority (88% overall and >70% for each age group) of adult PED patients were non-CCC, the rate of CCC patients increased overall (P < 0.0001), especially among older patients (41-95 years) from 8.7% in 2013 to 29% in 2017 (P < 0.0001). The most frequent CCC diagnoses were sickle cell disease (18-21 and 22-25 years), cardiac pathology (26-40 years), and hyperlipidemia (41-95 years). The most frequent non-CCC diagnoses were abdominal pain (18-21 years), pregnancy-related (22-25 and 26-40 years), and chest pain (41-95 years). CONCLUSION: Visits to PEDs by adult patients have increased over time, with the majority of the population being represented by non-CCC adults. The results of this study can be used to guide specifics in adult medicine training during Pediatric Emergency Medicine fellowship and assist in continuing education efforts.


Assuntos
Serviço Hospitalar de Emergência/estatística & dados numéricos , Hospitais Pediátricos/estatística & dados numéricos , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doença Crônica/terapia , Humanos , Pessoa de Meia-Idade , Estudos Retrospectivos , Estados Unidos , Adulto Jovem
14.
Health Qual Life Outcomes ; 18(1): 288, 2020 Aug 24.
Artigo em Inglês | MEDLINE | ID: mdl-32831086

RESUMO

PURPOSE: Evidence suggests that Patient-centred Medical Home (PCMH) model facilitates person-centred care and improves health-related quality of life for patients with chronic illness. This study aims to evaluate changes in health-related quality of life (HRQoL), before and after enrolment into a 12-month integrated care program called 'WellNet'. METHODS: This study includes 616 eligible consented patients aged 40 years and above with one or more chronic conditions from six general practices across Sydney, Australia. The WellNet program included a team of general practitioners (GPs) and clinical coordinators (CCs) providing patient-tailored care plans configured to individual risk and complexity. HRQoL was recorded using the validated EuroQol five dimensions five levels (EQ-5D-5L) instrument at baseline and 12 months. Additionally, patients diagnosed with osteoarthritis also reported HRQoL using short versions of Knee and/or Hip disability and osteoarthritis outcome scores (KOOSjr and HOOSjr). A case-series study design with repeated measures analysis of covariance (ANCOVA) was used to assess changes in mean differences of EQ-5D index scores after controlling for baseline covariates. Additionally, backward stepwise multivariable linear regression models were conducted to determine significant predictors of EQ-5D index scores at follow-up. RESULTS: Out of 616 patients, 417 (68%) reported EQ-5D scores at follow-up. Almost half (48%) of the WellNet patients reported improved EQ-5D index scores at follow-up. After controlling for baseline covariates, the adjusted mean difference was statistically significant whilst also meeting the bare minimal clinically important difference (MCID) with a change of 0.03 (95% CI 0.01, 0.05). The multivariable regression models determined that baseline EQ-5D scores and positive diagnosis of a respiratory illness were significant predictors of HRQoL at follow-up. There were significant improvements across both KOOS and HOOS assessments, specifically, the pain and symptom scores in both scales met statistical significance in addition to meeting the MCID. CONCLUSION: Patient-tailored chronic disease management (CDM) plans designed by team of GPs and CDM clinical coordinators could lead to better HRQoL among primary care patients.


Assuntos
Assistência Centrada no Paciente/normas , Qualidade de Vida , Idoso , Austrália , Doença Crônica/psicologia , Doença Crônica/terapia , Estudos Controlados Antes e Depois , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Diferença Mínima Clinicamente Importante , Reprodutibilidade dos Testes , Inquéritos e Questionários
15.
Medicine (Baltimore) ; 99(30): e21080, 2020 Jul 24.
Artigo em Inglês | MEDLINE | ID: mdl-32791680

RESUMO

BACKGROUND: Chronic conditions are placing a serious burden on individuals as well as the health care system. Health coaching (HC) has emerged as a promising approach that can support effective lifestyle interventions for chronic conditions. However, until now there is no particularly comprehensive systematic review of HC impact on a chronic condition from the angle of patient improvement and detail coaching characteristics reported. OBJECTIVE: To synthesize available studies on the efficacy and current status of HC interventions on the health of chronically ill adult patients. METHODS: The literature search will be conducted for trials published in English within the past four years. Electronic databases CINAHL, Cochrane Library, Embase, MEDLINE, and Scopus will be searched with keywords describing HC for chronic diseases. Randomized controlled trials that compare HC interventions to conventional care or other alternative therapies will be included. Data extraction will be conducted by two reviewers independently, and enrolled trials will be evaluated for quality and bias assessment. If appropriate, meta-analysis will be conducted on the last stage of the review; otherwise, the study findings will be described narratively. The software Review Manager (Revman version 5.3.5.) provided by the Cochrane Collaboration will be applied for the meta-analysis. RESULTS: This is the first study to comprehensively explore the effectiveness and current status of HC intervention for patients with chronic conditions. DISCUSSION: Study findings from this review will advance the appropriate utilization of coaching practice by determining whether HC is effective and feasible among patients with chronic disease. If proven effective, this approach may be applied more broadly through public health interventions. The current status findings will also provide evidence to inform decisions for integrating HC interventions into the current management pathway for individuals with chronic conditions. SYSTEMATIC REVIEW REGISTRATION: PROSPERO CRD42020153280.


Assuntos
Doença Crônica/terapia , Tutoria , Terapia Comportamental , Humanos , Estilo de Vida , Metanálise como Assunto , Projetos de Pesquisa , Autogestão , Revisões Sistemáticas como Assunto
16.
Pflege ; 33(4): 219-227, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32811324

RESUMO

Background: COVID-19 has led to a change in care for patients with chronic conditions, involving a transfer of drug administration from an outpatient to a community setting. AIM: To investigate patient preferences for treatment settings in the light of the current pandemic. METHODS: Patients, who prior to the pandemic had attended two different outpatient clinics in a university hospital for their infusions or injections, were interviewed by telephone. The semi-structured interviews were analyzed using qualitative and quantitative methods. RESULTS: Out of 49 patients with either anti-inflammatory or immunoglobulin treatments (response rate: 83 %), 24 (49.0 %) switched from subcutaneous (sc) injections in the hospital to the community setting, 18 (36.7 %) from intravenous infusions (iv) in the hospital to sc administration at home and 7 (14.3 %) moved to iv at home. During the pandemic 38 (80.9 %) wanted to continue their treatment at home, but after the pandemic 22 (46.8 %) would opt to go back to the hospital. Satisfaction was high with both settings, slightly favoring drug administration in hospital. Qualitative data shows that patients while emphasizing the importance of the relationship with the healthcare team, had increased concerns about safety as a result of COVID-19. CONCLUSIONS: The experience during the COVID-19 pandemic has increased self-management-skills in some patients, but long-term follow-up is needed. It has repercussions for future shared decision making for patients and their healthcare teams.


Assuntos
Assistência Ambulatorial/organização & administração , Doença Crônica/terapia , Serviços de Saúde Comunitária/organização & administração , Infecções por Coronavirus/epidemiologia , Pandemias , Pneumonia Viral/epidemiologia , Humanos , Preferência do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Medição de Risco
17.
Am J Manag Care ; 26(8): 329-330, 2020 08.
Artigo em Inglês | MEDLINE | ID: mdl-32835459

RESUMO

In the coronavirus disease 2019 (COVID-19) era, clinical registries and innovative virtual care delivery tools should be leveraged to engage populations in effective chronic disease management.


Assuntos
Doença Crônica/terapia , Infecções por Coronavirus/epidemiologia , Administração dos Cuidados ao Paciente/tendências , Pneumonia Viral/epidemiologia , Telemedicina/tendências , Betacoronavirus , Humanos , Pandemias , Padrões de Prática Médica/tendências , Realidade Virtual
18.
PLoS One ; 15(8): e0237746, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32810144

RESUMO

In recent years, several studies suggested that the ability of hyperbaric oxygen therapy (HBOT) to promote healing in patients with diabetic ulcers and chronic wounds is due to the reduction of inflammatory cytokines and to a significant decrease in neutrophils recruitment to the damaged area. α4 and ß2 integrins are receptors mediating the neutrophil adhesion to the endothelium and the comprehension of the effects of hyperbaric oxygenation on their expression and functions in neutrophils could be of great importance for the design of novel therapeutic protocols focused on anti-inflammatory agents. In this study, the α4 and ß2 integrins' expression and functions have been evaluated in human primary neutrophils obtained from patients with chronic non-healing wounds and undergoing a prolonged HBOT (150 kPa per 90 minutes). The effect of a peptidomimetic α4ß1 integrin antagonist has been also analyzed under these conditions. A statistically significant decrease (68%) in ß2 integrin expression on neutrophils was observed during the treatment with HBO and maintained one month after the last treatment, while α4 integrin levels remained unchanged. However, cell adhesion function of both neutrophilic integrins α4ß1 and ß2 was significantly reduced 70 and 67%, respectively), but α4ß1 integrin was still sensitive to antagonist inhibition in the presence of fibronectin, suggesting that a combined therapy between HBOT and integrin antagonists could have greater antinflammatory efficacy.


Assuntos
Oxigenação Hiperbárica , Integrina alfa4beta1/antagonistas & inibidores , Neutrófilos/imunologia , Peptidomiméticos/uso terapêutico , Úlcera Cutânea/terapia , Idoso , Idoso de 80 Anos ou mais , Antígenos CD18/análise , Antígenos CD18/metabolismo , Adesão Celular/imunologia , Doença Crônica/terapia , Terapia Combinada/métodos , Feminino , Seguimentos , Humanos , Integrina alfa4beta1/análise , Integrina alfa4beta1/metabolismo , Masculino , Pessoa de Meia-Idade , Infiltração de Neutrófilos , Neutrófilos/metabolismo , Peptidomiméticos/farmacologia , Cultura Primária de Células , Úlcera Cutânea/sangue , Úlcera Cutânea/imunologia , Úlcera Cutânea/patologia , Resultado do Tratamento , Cicatrização/efeitos dos fármacos , Cicatrização/imunologia
19.
PLoS One ; 15(8): e0234733, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32822350

RESUMO

PURPOSE: To investigate the knowledge and practices regarding diabetic retinopathy (DR) among diabetic patients included in a community-based primary health system (CBPHS) in China. METHODS: Diabetic patients aged 18 years and above registered in the CBPHS in Yueqing city, Zhejiang province were recruited. Information obtained by questionnaire included: demographic and socioeconomic status, knowledge about DR, and ocular and medical history. The primary outcome was whether the participant knew that DM can affect the eyes, defined according to the question: "Do you know diabetes mellitus (DM) can affect eyes? (yes or no)". A knowledge score was calculated based on the responses to seven questions, with 1 point awarded for a correct response and 0 points for an incorrect or uncertain answer. RESULTS: A total of 1972 diabetic patients were included in the study with an average age of 65.2±10.8 years, 45.7% were male. One thousand two hundred and nineteen patients (61.8%) knew that DM can affect the eyes. Significant differences in age, education, income status, insurance covering eye care, fasting blood glucose, duration of DM, history of hypertension existed between subjects who knew and those who did not know that DM can affect the eyes (P<0.05 for all). The proportion of correct answers to the DR knowledge questions ranged from 33.3% to 61.8%, with an average score of 3.65±2.47. In the multiple regression analysis, the knowledge score was significantly associated with age, education, income, history of hypertension, duration of DM, being told that regular examinations should be performed and concern about vision loss (P <0.01 for all). CONCLUSIONS: The knowledge toward DR among DM patients were still low within the chronic disease management system in eastern China. Routine ophthalmic screening, health care promotions, and educational programs should be emphasized and implemented for better DR prevention and management.


Assuntos
Retinopatia Diabética/epidemiologia , Idoso , China/epidemiologia , Doença Crônica/epidemiologia , Doença Crônica/prevenção & controle , Doença Crônica/terapia , Retinopatia Diabética/prevenção & controle , Retinopatia Diabética/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Política Pública , Sistema de Registros/estatística & dados numéricos , População Rural/estatística & dados numéricos , Inquéritos e Questionários
20.
Health Qual Life Outcomes ; 18(1): 261, 2020 Aug 03.
Artigo em Inglês | MEDLINE | ID: mdl-32746921

RESUMO

INTRODUCTION: Caring for patients with chronic disorders can lead to different problems for caregivers in physical, psychological, social, family, and financial domains. High levels of burden of care can make caregivers vulnerable to physical and psychological conditions and influence their quality of life. Therefore, the goal of the present study was to estimate the overall percentage of burden of care in caregivers of Iranian patients with chronic disorders. METHODS: A total of 25 articles published from inception to February 2019 were reviewed. Search for articles was conducted in international (Scopus, Web of Science, and PubMed) and domestic (Scientific Information Database (SID) and MagIran) databases, using the following keywords: "Caregiver," "Burden," and "Iran," and their possible combinations. The data were analyzed using the meta-analysis method and the random effects model. All the analyses were performed using STATA, version 14. RESULTS: The overall percentage of burden of care in caregivers of Iranian patients with chronic disorders was 53.28% (95% CI: 46.13-60.43). The highest percentage of burden of care was related to dialysis (62.75; 95% CI: 56.11-69.38), mental disorders (58.69; 95% CI: 49.70-67.69), and Alzheimer's disease (57.07; 95% CI: 46.23-67.92), respectively; and the lowest percentage of burden of care was related to diabetes (34.92; 95% CI: 18.01-51.82). CONCLUSIONS: Caregivers of Iranian patients with chronic disorders experience high levels of burden of care, especially those caring for patients undergoing dialysis, patients with mental disorders, and patients with Alzheimer's disease. Therefore, necessary measures need to be taken by Iranian health care officials to reduce burden of care in caregivers.


Assuntos
Cuidadores/psicologia , Qualidade de Vida/psicologia , Doença Crônica/terapia , Humanos , Irã (Geográfico)
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA