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1.
Lancet Glob Health ; 9(9): e1262-e1272, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34363766

RESUMO

BACKGROUND: Quality of care is consistently shown to be inadequate in health-care settings in many low-income and middle-income countries, including in private facilities, which are rapidly growing in number but often do not have effective quality stewardship mechanisms. The SafeCare programme aims to address this gap in quality of care, using a standards-based approach adapted to low-resource settings, involving assessments, mentoring, training, and access to loans, to improve clinical quality and facility business performance. We assessed the effect of the SafeCare programme on quality of patient care in faith-based and private for-profit facilities in Tanzania. METHODS: In this cluster-randomised controlled trial, health facilities were eligible if they were dispensaries, health centres, or hospitals in the faith-based or private for-profit sectors in Tanzania. We randomly assigned facilities (1:1) using computer-generated stratified randomisation to receive the full SafeCare package (intervention) or an assessment only (control). Implementing staff and participants were masked to outcome measurement and the primary outcomes were measured by fieldworkers who had no knowledge of the study group allocation. The primary outcomes were health worker compliance with infection prevention and control (IPC) practices as measured by observation of provider-patient interactions, and correct case management of undercover standardised patients at endline (after a minimum of 18 months). Analyses were by modified intention to treat. The trial is registered with ISRCTN, ISRCTN93644888. FINDINGS: Between March 7 and Nov 30, 2016, we enrolled and randomly assigned 237 health facilities to the intervention (n=118) or control (n=119). Nine facilities (seven intervention facilities and two control facilities) closed during the trial and were not included in the analysis. We observed 29 608 IPC indications in 5425 provider-patient interactions between Feb 7 and April 5, 2018. Health facilities received visits from 909 standardised patients between May 3 and June 12, 2018. Intervention facilities had a 4·4 percentage point (95% CI 0·9-7·7; p=0.015) higher mean SafeCare standards assessment score at endline than control facilities. However, there was no evidence of a difference in clinical quality between intervention and control groups at endline. Compliance with IPC practices was observed in 8181 (56·9%) of 14 366 indications in intervention facilities and 8336 (54·7%) of 15 242 indications in control facilities (absolute difference 2·2 percentage points, 95% CI -0·2 to -4·7; p=0·071). Correct management occurred in 120 (27·0%) of 444 standardised patients in the intervention group and in 136 (29·2%) of 465 in the control group (absolute difference -2·8 percentage points, 95% CI -8·6 to -3·1; p=0·36). INTERPRETATION: SafeCare did not improve clinical quality as assessed by compliance with IPC practices and correct case management. The absence of effect on clinical quality could reflect a combination of insufficient intervention intensity, insufficient links between structural quality and care processes, scarcity of resources for quality improvement, and inadequate financial and regulatory incentives for improvement. FUNDING: UK Health Systems Research Initiative (Medical Research Council, Economic and Social Research Council, UK Department for International Development, Global Challenges Research Fund, and Wellcome Trust).


Assuntos
Certificação , Instalações de Saúde/normas , Controle de Infecções/normas , Melhoria de Qualidade/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Organizações Religiosas , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Guias de Prática Clínica como Assunto , Setor Privado , Avaliação de Programas e Projetos de Saúde , Tanzânia
2.
Medicine (Baltimore) ; 100(30): e26809, 2021 Jul 30.
Artigo em Inglês | MEDLINE | ID: mdl-34397739

RESUMO

ABSTRACT: Sacubitril/valsartan (sac/val) was launched in China in 2018; however, the adoption of sac/val in real-world clinical practice has yet to be described.This study aimed to analyze real-world treatment patterns of sac/val using data from 3 tertiary hospitals in China.A non-interventional, retrospective cohort study of patients with Heart failure (HF) prescribed sac/val from 3 tertiary hospitals in China between January 1, 2018 and June 30, 2020 was conducted. The analysis included sac/val dose titration patterns and persistence during 6 months post-index.A total of 267 patients were included, with a mean age of 63.9 ±â€Š13.1 years. At index, 27% of patients were prescribed sac/val 12/13 mg b.i.d., 63.7% were prescribed 24/26 mg b.i.d., 4.5% were prescribed the target dose of 49/51 mg b.i.d., and 4.8% were not prescribed according to the recommended dose. During the 6 months post-index, 8.3% of patients had only 1 dose titration record. Good therapeutic persistence was observed across sac/val doses, and only 15.7% of patients discontinued sac/val during the 6 months post-index.In China, the majority of patients prescribed sac/val are not initiated on the recommended dose nor up-titrated according to drug instruction. Notably, good persistence with sac/val is observed in the real-world cohort study.


Assuntos
Aminobutiratos/uso terapêutico , Antagonistas de Receptores de Angiotensina/uso terapêutico , Compostos de Bifenilo/uso terapêutico , Fidelidade a Diretrizes/estatística & dados numéricos , Insuficiência Cardíaca/tratamento farmacológico , Valsartana/uso terapêutico , Idoso , Combinação de Medicamentos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
3.
Nutrients ; 13(8)2021 Aug 09.
Artigo em Inglês | MEDLINE | ID: mdl-34444892

RESUMO

A nutrient profiling model (NPM) was developed in 2005 in the UK to regulate the marketing of foods to children. It was revised in 2018, but the new version has not been finalised. The Eatwell Guide (EWG) is the UK's official food-based dietary guidelines. The aim of this study was to evaluate the agreement between the 2005 and 2018 versions of the NPM and the EWG. Using recent National Diet and Nutrition Surveys, we estimated the healthiness of individual diets based on an EWG dietary score and a NPM dietary index. We then compared the percentage of agreement and Cohen's kappa for each combination of the EWG score and NPM index across the range of observed values for the 2005 and 2018 versions. A total of 3028 individual diets were assessed. Individuals with a higher (i.e., healthier) EWG score consumed a diet with, on average, a lower (i.e., healthier) NPM index both for the 2005 and 2018 versions. Overall, there was good agreement between the EWG score and the NPM dietary index at assessing the healthiness of representative diets of the UK population, when a low cut-off for the NPM dietary index was used, irrespective of the version. This suggests that dietary advice to the public is broadly aligned with NPM-based food policies and vice-versa.


Assuntos
Dieta Saudável/estatística & dados numéricos , Indústria Alimentícia/legislação & jurisprudência , Fidelidade a Diretrizes/estatística & dados numéricos , Marketing/legislação & jurisprudência , Política Nutricional/legislação & jurisprudência , Criança , Dieta Saudável/normas , Feminino , Humanos , Masculino , Inquéritos Nutricionais , Reino Unido
4.
Nutrients ; 13(8)2021 Aug 01.
Artigo em Inglês | MEDLINE | ID: mdl-34444841

RESUMO

High sodium and low potassium intakes are associated with increased levels of blood pressure and risk of cardiovascular diseases. Assessment of habitual dietary habits are helpful to evaluate their intake and adherence to healthy dietary recommendations. In this study, we determined sodium and potassium food-specific content and intake in a Northern Italy community, focusing on the role and contribution of adherence to Mediterranean diet patterns. We collected a total of 908 food samples and measured sodium and potassium content using inductively coupled plasma mass spectrometry. Using a validated semi-quantitative food frequency questionnaire, we assessed habitual dietary intake of 719 adult individuals of the Emilia-Romagna region. We then estimated sodium and potassium daily intake for each food based on their relative contribution to the overall diet, and their link to Mediterranean diet patterns. The estimated mean sodium intake was 2.15 g/day, while potassium mean intake was 3.37 g/day. The foods contributing most to sodium intake were cereals (33.2%), meat products (24.5%, especially processed meat), and dairy products (13.6%), and for potassium they were meat (17.1%, especially red and white meat), fresh fruits (15.7%), and vegetables (15.1%). Adherence to a Mediterranean diet had little influence on sodium intake, whereas potassium intake was greatly increased in subjects with higher scores, resulting in a lower sodium/potassium ratio. Although we may have underestimated dietary sodium intake by not including discretionary salt use and there may be some degree of exposure misclassification as a result of changes in food sodium content and dietary habits over time, our study provides an overview of the contribution of a wide range of foods to the sodium and potassium intake in a Northern Italy community and of the impact of a Mediterranean diet on intake. The mean sodium intake was above the dietary recommendations for adults of 1.5-2 g/day, whilst potassium intake was only slightly lower than the recommended 3.5 g/day. Our findings suggest that higher adherence to Mediterranean diet patterns has limited effect on restricting sodium intake, but may facilitate a higher potassium intake, thereby aiding the achievement of healthy dietary recommendations.


Assuntos
Dieta Saudável/estatística & dados numéricos , Dieta Mediterrânea , Fidelidade a Diretrizes/estatística & dados numéricos , Potássio na Dieta/análise , Sódio na Dieta/análise , Adulto , Idoso , Inquéritos sobre Dietas , Dieta Saudável/normas , Ingestão de Alimentos/fisiologia , Comportamento Alimentar/fisiologia , Feminino , Fatores de Risco de Doenças Cardíacas , Humanos , Itália , Masculino , Espectrometria de Massas , Pessoa de Meia-Idade , Política Nutricional , Estado Nutricional/fisiologia , Potássio na Dieta/sangue , Sódio na Dieta/sangue
5.
Nutrients ; 13(7)2021 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-34371882

RESUMO

There are numerous dietary recommendations during pregnancy. However, there are limited recommendations during the lactation period, a nutritionally vulnerable period for women. The Mediterranean Diet and adherence to the Healthy Food Pyramid (HFP) is considered as the standard for healthy eating. In this study, we investigated the differences in adherence to the HFP in pregnant, lactating, and non-pregnant/non-lactating (NPNL) women concerning sociodemographic factors. A sociodemographic and nutritional and lifestyle questionnaire (AP-Q) were used to assess adherence to the HFP, including lifestyle. The AP-Q score ranges from 0 to 10 meaning the higher the score, the greater the adherence to the HFP. Lactating women had the lowest AP-Q score (6.13 [5.31; 6.82]) compared to the pregnant (6.39 [5.56; 7.05]) and NPNL women (6.27 [5.43; 6.88]), while pregnant women had the highest scores. Maternal age was positively correlated with AP-Q score in pregnant (rho = 0.22; p-Value < 0.001) and lactating women (rho = 0.18; p-Value < 0.001), but not in NPNL women. Educational level and monthly income had a positive influence on the degree of adherence to the HFP. In conclusion, breastfeeding mothers of young age and low socioeconomic and educational level would be the target population to carry out nutritional interventions that improve their adherence to the HFP. The knowledge gained from this study can help to design recommendation guidelines and nutritional educational interventions for a given population.


Assuntos
Dieta Saudável/psicologia , Comportamento Alimentar/psicologia , Fidelidade a Diretrizes/estatística & dados numéricos , Lactação/psicologia , Gestantes/psicologia , Adolescente , Adulto , Aleitamento Materno/psicologia , Inquéritos sobre Dietas , Dieta Saudável/normas , Dieta Mediterrânea/psicologia , Feminino , Humanos , Renda , Estilo de Vida , Idade Materna , Política Nutricional , Estado Nutricional , Gravidez , Inquéritos e Questionários , Adulto Jovem
6.
N Z Med J ; 134(1538): 120-127, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239151

RESUMO

AIM: In response to the COVID-19 pandemic, the New Zealand government enforced a nationwide 'alert level 4' lockdown from 26 March to 27 April 2020. We assessed the impact of this lockdown on New Zealand's public ophthalmology service. METHOD: An anonymous online survey was sent to all New Zealand-based fellows of the Royal Australian and New Zealand College of Ophthalmologists (RANZCO) after lockdown. Respondents provided retrospective assessment of practice patterns and their personal health during the COVID-19 lockdown. This was supported by national-level administrative data, allowing survey findings to be contextualised. RESULTS: Fifty-seven respondents (response rate 49%) working in the public health system participated. A large majority of respondents reduced elective clinic and surgical volumes by at least 75% (82% and 98%, respectively). National-level information confirmed clinic reduced to 38.2% of normal and elective operating volumes to 11.5%, with virtual visits increasing 17.9-fold. Elective clinic and elective operating volumes promptly recovered to usual volumes on the second month post lockdown. Most respondents (58%) followed the RANZCO triaging guideline, and 28% triaged emergencies only. At a personal level, respondents reported a significant physical health benefit (p<0.001) associated with the lockdown experience, but no change in mental health or social wellbeing. CONCLUSIONS: Publicly employed ophthalmologists experienced dramatic reductions to elective clinic and operating volumes during the COVID-19 lockdown. The prompt recovery of service delivery volumes back to pre-lockdown levels supports the value of a COVID-19 elimination strategy in New Zealand. Virtual visits for selected patients allowed ongoing management without risking virus transmission.


Assuntos
COVID-19/prevenção & controle , Atenção à Saúde/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Procedimentos Cirúrgicos Oftalmológicos/estatística & dados numéricos , Oftalmologia/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Procedimentos Cirúrgicos Eletivos/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Nova Zelândia , Oftalmologistas/psicologia , Estudos Retrospectivos , SARS-CoV-2 , Inquéritos e Questionários , Telemedicina/estatística & dados numéricos , Triagem/normas
7.
Eur J Vasc Endovasc Surg ; 62(3): 432-438, 2021 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-34217598

RESUMO

OBJECTIVE: Patients with intermittent claudication (IC) are initially treated with supervised exercise therapy (SET), as advised by national and international guidelines. Dutch health insurance companies and the Dutch National Health Care Institute suggested an 87% compliance rate with these guidelines in the Netherlands in 2017 and judged this to be undesirably low. The aim of this study was to evaluate compliance with IC guidelines and to elaborate on the reasons for deviating from them (practice variation) in a large teaching hospital. METHODS: A retrospective single centre cohort study was conducted at a large teaching hospital in the Netherlands. In total, 420 patients with newly diagnosed IC between 1 January 2017 and 31 December 2018 were analysed. Data included risk profiles and prescribed therapies. RESULTS: For all 420 included patients, the compliance rate with the guidelines for SET was 80.5%. The rate of adequately motivated and defensible practice variation was 15.7%; the rate of unjustified practice variation was 3.8%. Meaningful care was seen in 96.2% of cases. CONCLUSION: Deviation from IC guidelines was found in 19.5% of patients. Almost three quarters of this deviation can be explained by the decision to provide personalised, meaningful care.


Assuntos
Terapia por Exercício/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Claudicação Intermitente/terapia , Padrões de Prática Médica/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Terapia por Exercício/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Guias de Prática Clínica como Assunto , Estudos Retrospectivos
8.
Ann Glob Health ; 87(1): 56, 2021 06 25.
Artigo em Inglês | MEDLINE | ID: mdl-34221909

RESUMO

Background: The adherence of medical laboratory technicians (MLT) to infection control guidelines is essential for reducing the risk of exposure to infectious agents. This study explored the adherence of MLT towards infection control practices during the COVID-19 pandemic. Method: The study population consisted of MLT (n = 444) who worked in private and government health sectors in Jordan. A self-reported survey was used to collect data from participants. Findings: More than 87% of the participants reported adherence to hand-washing guidelines and using personal protective equipment (PPE) when interacting with patients (74.5%), and handling clinical samples (70.0%). Besides, 88.1%, 48.2%, and 7.7% reported wearing of lab coats, face masks, and goggles, at all times, respectively. The majority reported increased adherence to infection control practices during the COVID-19 pandemic. This includes increased PPE use at the workplace (94.2%), increased frequency of disinfection of laboratory surfaces (92.4%) and laboratory equipment (86.7%), and increased frequency of handwashing/use of antiseptics (94.6%). Having a graduate degree was significantly associated with increased adherence of participants to the daily use of goggles/eye protection (p = 0.002), and the use of PPE while handling clinical samples (p = 0.011). Having work experience of >10 years was associated with increased adherence to the use of PPE while handling clinical samples (p = 0.001). Conclusion: MLT reported very good adherence with most assessed infection control practices. In addition, they reported increased conformity with infection control guidelines during the COVID-19 pandemic.


Assuntos
COVID-19 , Fidelidade a Diretrizes , Controle de Infecções , Laboratórios , Pessoal de Laboratório Médico , Equipamento de Proteção Individual , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Feminino , Fidelidade a Diretrizes/normas , Fidelidade a Diretrizes/estatística & dados numéricos , Desinfecção das Mãos/métodos , Desinfecção das Mãos/normas , Pesquisas sobre Serviços de Saúde , Humanos , Controle de Infecções/instrumentação , Controle de Infecções/métodos , Controle de Infecções/normas , Jordânia/epidemiologia , Laboratórios/organização & administração , Laboratórios/normas , Masculino , Pessoal de Laboratório Médico/normas , Pessoal de Laboratório Médico/estatística & dados numéricos , Equipamento de Proteção Individual/estatística & dados numéricos , Equipamento de Proteção Individual/provisão & distribuição , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Autorrelato
9.
Isr J Health Policy Res ; 10(1): 41, 2021 07 19.
Artigo em Inglês | MEDLINE | ID: mdl-34281594

RESUMO

OBJECTIVES: Coronavirus Disease 2019 (COVID-19) is a highly infectious viral pandemic that has claimed the lives of millions. Personal protective equipment (PPE) may reduce the risk of transmission for health care workers (HCWs), especially in the emergency setting. This study aimed to compare the adherence to PPE donning and doffing protocols in the Emergency Department (ED) vs designated COVID-19 wards and score adherence according to the steps in our protocol. DESIGN: Prior to managing COVID-19 patients, mandatory PPE training was undertaken for all HCWs. HCWs were observed donning or doffing COVID-19 restricted areas. SETTING: Donning and doffing was observed in COVID-19 designated Emergency department and compared to COVID-19 positive wards. PARTICIPANTS: All HCWs working in the aforementioned wards during the time of observation. RESULTS: We observed 107 donning and doffing procedures (30 were observed in the ED). 50% HCWs observed donned PPE correctly and 37% doffed correctly. The ED had a significantly lower mean donning score (ED: 78%, Internal: 95% ICU: 96%, p < 0.001); and a significantly lower mean doffing score (ED: 72%, Internal: 85% ICU: 91%, p = 0.02). CONCLUSIONS: As hypothesized, HCWs assigned to the designated ED wing made more protocol deviations compared with HCWs positive COVID-19 wards. Time management, acuity, lack of personnel, stress and known COVID-19 status may explain the lesser adherence to donning and doffing protocols. Further studies to assess the correlation between protocol deviations in use of PPE and morbidity as well as improvement implementations are required. Resources should be invested to ensure PPE is properly used.


Assuntos
COVID-19/prevenção & controle , Serviço Hospitalar de Emergência/normas , Pessoal de Saúde/estatística & dados numéricos , Transmissão de Doença Infecciosa do Paciente para o Profissional/prevenção & controle , Equipamento de Proteção Individual/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Controle de Infecções/métodos , Controle de Infecções/normas , Israel , Equipamento de Proteção Individual/normas , Recursos Humanos em Hospital/normas , Recursos Humanos em Hospital/estatística & dados numéricos
10.
Nutrients ; 13(6)2021 Jun 05.
Artigo em Inglês | MEDLINE | ID: mdl-34198781

RESUMO

BACKGROUND: The small-for-gestational-age (SGA) in infants is related to an increased risk of developing Non-Communicable Diseases later in life. The Mediterranean diet (MD) is related to lower odds of being SGA. The study explored retrospectively the association between SGA, maternal MD adherence, lifestyle habits and other SGA risk factors during pregnancy. METHODS: One hundred women (16-44 years) with a pregnancy at term were enrolled. Demographic data, parity, pre-gestational BMI, gestational weight gain, pregnancy-related diseases, and type of delivery were collected. The MD adherence (MEDI-LITE score ≥ 9), physical activity level, and smoking/alcohol consumption were registered. SGA neonates were diagnosed according to the neonatal growth curves. RESULTS: Women were divided into "SGA group" vs. "non-SGA group". The MD was adopted by 71% of women and its adherence was higher in the "non-SGA group" (p = 0.02). The prevalence of pregnancy-related diseases (gestational diabetes/pregnancy-induced hypertension) was higher in the "SGA group" (p = 0.01). The logistic regression showed that pregnancy-related diseases were the only independent risk factor for SGA. CONCLUSIONS: MD may indirectly reduce the risk of SGA since it prevents and exerts a positive effect on pregnancy-related diseases (e.g., gestational diabetes and hypertension). The small sample size of women in the SGA group of the study imposes a major limitation to the results and conclusions of this research, suggesting however that it is worthy of further investigation.


Assuntos
Dieta Mediterrânea/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Recém-Nascido Pequeno para a Idade Gestacional , Estilo de Vida , Complicações na Gravidez/epidemiologia , Adolescente , Adulto , Feminino , Idade Gestacional , Ganho de Peso na Gestação , Humanos , Recém-Nascido , Itália/epidemiologia , Modelos Logísticos , Fenômenos Fisiológicos da Nutrição Materna , Política Nutricional , Gravidez , Prevalência , Estudos Retrospectivos , Fatores de Risco , Adulto Jovem
11.
Nutrients ; 13(6)2021 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-34204023

RESUMO

The purpose of this cross-sectional study was to examine the relationship between diet and anthropometric measures in postmenopausal women. Data collected from 937 women enrolled in the Minnesota Green Tea Trial (NTC00917735) were used for this analysis. Dietary intake and health-related data were collected via questionnaires. Body weight, height, and waist circumference (WC) were measured by the study staff. The mean age of participants was 59.8 years and mean WC was 83 cm. Approximately 30% of the participants had WC greater than 88 cm. Healthy Eating Index-2015 score was 72.6 and the Dietary Inflammatory Index score was 0. Intakes of whole grains, dairy, protein, sodium, and saturated fat did not meet the dietary guidelines. Only 12.5% consumed the recommended daily amount of calcium (mean intake = 765 mg/day). When calcium supplements were considered, only 35.2% of the participants had adequate intakes, even though 68.9% reported taking a calcium supplement. We found that age and number of medications taken were significantly associated with waist circumference (p = 0.005). Women who reported taking two or more medications had greater WC (85 cm) compared to women who reported not taking any medications (82.2 cm), p = 0.002. Our findings suggest that achieving adequate calcium and vitamin D intake may be challenging to postmenopausal women.


Assuntos
Antropometria , Dieta Saudável/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Pós-Menopausa , Idoso , Cálcio na Dieta/análise , Estudos Transversais , Método Duplo-Cego , Feminino , Humanos , Pessoa de Meia-Idade , Política Nutricional , Ensaios Clínicos Controlados Aleatórios como Assunto , Vitamina D/análise , Circunferência da Cintura
12.
Nutrients ; 13(6)2021 Jun 09.
Artigo em Inglês | MEDLINE | ID: mdl-34207909

RESUMO

The Mediterranean Diet (MedDiet) is a healthy eating pattern associated with a better quality of life among older adults and reduced risk of non-communicable diseases. Little is known about the MedDiet in immigrant communities from countries in which the MedDiet is a settled cultural heritage. Thus, we examined MedDiet adherence and perceived knowledge, benefits, and barriers to the MedDiet in a Portuguese immigrant community in Turlock, California. A cross-sectional study was conducted with 208 participants in Turlock and Livermore, California, which was used as a reference population. Univariate, multivariable, and logistic regression models were used for data analysis. Compared to the Livermore group, the Turlock group was younger and less educated, but had a higher average MedDiet score and active adherence to a MedDiet (p < 0.001 for both). In the Turlock group, convenience, sensory appeal, and health were observed to be significant barriers to the MedDiet (p < 0.05), while health, weight loss, natural content, familiarity, price, sensory appeal, and mood were significant benefit factors (p < 0.05). In conclusion, participants in Turlock had greater MedDiet adherence despite lower education attainment. Furthermore, the perceived benefits of the MedDiet were key factors in MedDiet perception and adherence in a Portuguese immigrant community.


Assuntos
Dieta Saudável/estatística & dados numéricos , Dieta Mediterrânea/etnologia , Emigrantes e Imigrantes/estatística & dados numéricos , Fidelidade a Diretrizes/estatística & dados numéricos , Política Nutricional , Idoso , California , Estudos Transversais , Inquéritos sobre Dietas , Dieta Saudável/etnologia , Escolaridade , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Portugal/etnologia
13.
BMJ Open ; 11(6): e048042, 2021 06 23.
Artigo em Inglês | MEDLINE | ID: mdl-34162651

RESUMO

INTRODUCTION: The coronavirus (COVID-19) pandemic has caused significant global mortality and impacted lives around the world. Virus Watch aims to provide evidence on which public health approaches are most likely to be effective in reducing transmission and impact of the virus, and will investigate community incidence, symptom profiles and transmission of COVID-19 in relation to population movement and behaviours. METHODS AND ANALYSIS: Virus Watch is a household community cohort study of acute respiratory infections in England and Wales and will run from June 2020 to August 2021. The study aims to recruit 50 000 people, including 12 500 from minority ethnic backgrounds, for an online survey cohort and monthly antibody testing using home fingerprick test kits. Nested within this larger study will be a subcohort of 10 000 individuals, including 3000 people from minority ethnic backgrounds. This cohort of 10 000 people will have full blood serology taken between October 2020 and January 2021 and repeat serology between May 2021 and August 2021. Participants will also post self-administered nasal swabs for PCR assays of SARS-CoV-2 and will follow one of three different PCR testing schedules based on symptoms. ETHICS AND DISSEMINATION: This study has been approved by the Hampstead National Health Service (NHS) Health Research Authority Ethics Committee (ethics approval number 20/HRA/2320). We are monitoring participant queries and using these to refine methodology where necessary, and are providing summaries and policy briefings of our preliminary findings to inform public health action by working through our partnerships with our study advisory group, Public Health England, NHS and government scientific advisory panels.


Assuntos
COVID-19 , Fidelidade a Diretrizes/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde Pública , COVID-19/epidemiologia , Inglaterra/epidemiologia , Humanos , Estudos Prospectivos , Fatores de Risco , Medicina Estatal , País de Gales/epidemiologia
14.
Pan Afr Med J ; 38: 293, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34178212

RESUMO

Introduction: following the global COVID-19 outbreak, the government of Benin implemented preventive measures to stall viral transmission. We sought to evaluate adherence of the Beninese people to these preventive measures, in order to identify predictors of poor adherence and adapt the national response to COVID-19. Methods: two consecutive online surveys were conducted between May and August 2020. Four hundred and sixty two and 507 adult participants aged 18 years and above responded to the first and second survey respectively, with >70% being males. Results: more than 98% of respondents reported wearing face masks. A five-point adherence score was constituted by scoring observance to key preventive measures (mask use, physical distancing, hand hygiene, coughing hygiene and avoiding to touch one´s face). We observed that the mean adherence scores were fairly stable over time, respectively 4.08 and 4.03 during the first and second survey (p=0.439). Increasing age (aOR=1.043, 95% CI: 1.026 - 1.061; p<0.001) and obtaining COVID-19 information from official sources (aOR=1.628, 95% CI: 1.275 - 2.081; p<0.001) were significantly associated with higher adherence scores in a multivariable model. Conclusion: these findings suggest that a wide dissemination of adequate information about COVID-19 would increase adherence, and that targeted efforts should be directed towards increasing the compliance to preventive measures among the younger age groups.


Assuntos
COVID-19/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Comportamentos Relacionados com a Saúde , Saúde Pública , Adulto , Fatores Etários , Benin/epidemiologia , COVID-19/epidemiologia , Estudos Transversais , Surtos de Doenças , Feminino , Humanos , Higiene/normas , Disseminação de Informação , Masculino , Inquéritos e Questionários , Adulto Jovem
15.
PLoS Comput Biol ; 17(6): e1009058, 2021 06.
Artigo em Inglês | MEDLINE | ID: mdl-34133427

RESUMO

As part of a concerted pandemic response to protect public health, businesses can enact non-pharmaceutical controls to minimise exposure to pathogens in workplaces and premises open to the public. Amendments to working practices can lead to the amount, duration and/or proximity of interactions being changed, ultimately altering the dynamics of disease spread. These modifications could be specific to the type of business being operated. We use a data-driven approach to parameterise an individual-based network model for transmission of SARS-CoV-2 amongst the working population, stratified into work sectors. The network is comprised of layered contacts to consider the risk of spread in multiple encounter settings (workplaces, households, social and other). We analyse several interventions targeted towards working practices: mandating a fraction of the population to work from home; using temporally asynchronous work patterns; and introducing measures to create 'COVID-secure' workplaces. We also assess the general role of adherence to (or effectiveness of) isolation and test and trace measures and demonstrate the impact of all these interventions across a variety of relevant metrics. The progress of the epidemic can be significantly hindered by instructing a significant proportion of the workforce to work from home. Furthermore, if required to be present at the workplace, asynchronous work patterns can help to reduce infections when compared with scenarios where all workers work on the same days, particularly for longer working weeks. When assessing COVID-secure workplace measures, we found that smaller work teams and a greater reduction in transmission risk reduced the probability of large, prolonged outbreaks. Finally, following isolation guidance and engaging with contact tracing without other measures is an effective tool to curb transmission, but is highly sensitive to adherence levels. In the absence of sufficient adherence to non-pharmaceutical interventions, our results indicate a high likelihood of SARS-CoV-2 spreading widely throughout a worker population. Given the heterogeneity of demographic attributes across worker roles, in addition to the individual nature of controls such as contact tracing, we demonstrate the utility of a network model approach to investigate workplace-targeted intervention strategies and the role of test, trace and isolation in tackling disease spread.


Assuntos
COVID-19/prevenção & controle , Busca de Comunicante , Modelos Biológicos , Local de Trabalho , COVID-19/epidemiologia , COVID-19/transmissão , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Pandemias , Saúde Pública , SARS-CoV-2 , Trabalho/estatística & dados numéricos
16.
Ann Rheum Dis ; 80(9): 1175-1182, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34162597

RESUMO

BACKGROUND: Quality of care is receiving increased attention in systemic lupus erythematosus (SLE). We developed quality indicators (QIs) for SLE based on the 2019 update of European League Against Rheumatism recommendations. METHODS: A total of 44 candidate QIs corresponding to diagnosis, monitoring and treatment, were independently rated for validity and feasibility by 12 experts and analysed by a modified Research and Development Corporation/University of California Los Angeles model. Adherence to the final set of QIs and correlation with disease outcomes (flares, hospitalisations and organ damage) was tested in a cohort of 220 SLE patients with a median monitoring of 2 years (IQR 2-4). RESULTS: The panel selected a total of 18 QIs as valid and feasible. On average, SLE patients received 54% (95% CI 52.3% to 56.2%) of recommended care, with adherence ranging from 44.7% (95% CI 40.8% to 48.6%) for diagnosis-related QIs to 84.3% (95% CI 80.6% to 87.5%) for treatment-related QIs. Sustained remission or low disease activity were achieved in 26.8% (95% CI 21.1% to 33.2%). Tapering of prednisone dose to less than 7.5 mg/day was achieved in 93.6% (95% CI 88.2% to 97.0%) while 73.5% (95% CI 66.6% to 79.6%) received the recommended hydroxychloroquine dose. Higher adherence to monitoring-related QIs was associated with reduced risk for a composite adverse outcome (flare, hospitalisation or damage accrual) during the last year of observation (OR 0.97 per 1% adherence rate, 95% CI 0.96 to 0.99). CONCLUSION: We developed QIs for assessing and improving the care of SLE patients. Initial real-life data suggest face validity, but a variable degree of adherence and a need for further improvement.


Assuntos
Lúpus Eritematoso Sistêmico/terapia , Indicadores de Qualidade em Assistência à Saúde , Inibidores da Enzima Conversora de Angiotensina/uso terapêutico , Antirreumáticos/administração & dosagem , Aspirina/uso terapêutico , Redução da Medicação , Europa (Continente) , Feminino , Glucocorticoides/administração & dosagem , Fidelidade a Diretrizes/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Humanos , Hidroxicloroquina/administração & dosagem , Imunossupressores/uso terapêutico , Rim/patologia , Lúpus Eritematoso Sistêmico/diagnóstico , Nefrite Lúpica/diagnóstico , Nefrite Lúpica/terapia , Masculino , Programas de Rastreamento , Osteoporose/diagnóstico , Inibidores da Agregação Plaquetária/uso terapêutico , Guias de Prática Clínica como Assunto , Pré-Eclâmpsia/prevenção & controle , Prednisona/administração & dosagem , Gravidez , Indução de Remissão , Reprodutibilidade dos Testes , Medição de Risco , Sociedades Médicas , Exacerbação dos Sintomas
17.
Am J Infect Control ; 49(9): 1118-1122, 2021 09.
Artigo em Inglês | MEDLINE | ID: mdl-34182068

RESUMO

BACKGROUND: Information about the long-term effects of hand hygiene (HH) interventions is needed. We aimed to investigate the change in HH compliance (HHC) of healthcare workers (HCWs) once a data-driven feedback intervention was stopped, and to assess if the COVID-19 pandemic influenced the HH behavior. METHODS: We conducted an observational, extension trial in a surgical department between January 2019-December 2020. Doctors (n = 19) and nurses (n = 53) were included and their HHC was measured using an electronic HH monitoring system (EHHMS). We compared the changes in HHC during 3 phases: (1) Intervention (data presentation meetings), (2) Prepandemic follow-up and (3) Follow-up during COVID-19. RESULTS: The HHC during phase 1 (intervention), phase 2 (prepandemic follow-up) and phase 3 (follow-up during COVID-19) was 58%, 46%, and 34%, respectively. Comparison analyses revealed that the HHC was significantly lower in the prepandemic follow-up period (46% vs 58%, P < .0001) and in the follow-up period during COVID-19 (34% vs 58%, P < .0001) compared with the intervention period (phase 1). CONCLUSIONS: Despite the COVID-19 pandemic, the HHC of the HCWs significantly decreased over time once the data presentation meetings from management stopped. This study demonstrates that HCWs fall back into old HH routines once improvement initiatives are stopped.


Assuntos
COVID-19 , Infecção Hospitalar , Fidelidade a Diretrizes/estatística & dados numéricos , Higiene das Mãos , Pessoal de Saúde , Infecção Hospitalar/epidemiologia , Infecção Hospitalar/prevenção & controle , Seguimentos , Humanos , Controle de Infecções , Pandemias
18.
Rev Esp Salud Publica ; 952021 Jun 29.
Artigo em Espanhol | MEDLINE | ID: mdl-34184666

RESUMO

OBJECTIVE: News about suicide may have either a contagion effect or a protective effect. For this reason, interventions aimed to the media are a priority. However, the effectiveness of the interventions has not yet been elucidated. The objective of the study was to evaluate comparatively the characteristics and adequacy of suicide news articles between geographical areas in which interventions aimed at media either exist or not. METHODS: We evaluated suicide news articles in the four main digital media of Spain (without interventions) and Victoria, Australia (with interventions), according to Alexa (a website traffic statistics). We assessed adherence to World Health Organization (WHO) recommendations, avoidability, frequency, and typology of suicide news articles. The evaluation period was 6 months. Bivariate analysis was performed comparing the samples using t-test, Chi-Squared test and Fisher's exact test according to the type of variable. RESULTS: We identified 378 suicide news articles: 141 in Spain and 237 in Victoria. Suicide news articles in Spain showed a lower degree of adherence to the WHO recommendations than those from Victoria (2.97 vs. 11.8; p<0.001). Mean daily number of suicide news articles was lower in Spain (0.78 vs. 1.31; p<0.001). Typology according to contents was different between both regions (p=0.045), with greater prevalence of "suicide after murder" in Spain. However, there were no differences either in avoidability, or in typology according to behaviour. CONCLUSIONS: Suicide news articles are more adequate in the geographic area in which interventions aimed at media are performed. These better characteristics imply lower risk of contagion effect, greater likelihood of protective effect and, therefore, a potential beneficial effect on the suicidal behaviour in the reference population.


Assuntos
Meios de Comunicação de Massa/estatística & dados numéricos , Meios de Comunicação de Massa/normas , Suicídio , Fidelidade a Diretrizes/estatística & dados numéricos , Humanos , Espanha , Vitória , Organização Mundial da Saúde
19.
Nutrients ; 13(5)2021 May 01.
Artigo em Inglês | MEDLINE | ID: mdl-34062850

RESUMO

Improving dietary habits at a young age could prevent adverse health outcomes. The aim was to gain insight into the adequacy of the dietary intake of Dutch toddlers, which may provide valuable information for preventive measures. Data obtained from the Dutch National Food Consumption Survey 2012-2016 were used, which included 672 children aged one to three years. Habitual intakes of nutrients were evaluated according to recommendations set by the Dutch Health Council. Specific food groups were evaluated according to the Dutch food-based dietary guidelines. For most nutrients, intakes were estimated to be adequate. High intakes were found for saturated fatty acids, retinol, iodine, copper, zinc, and sodium. No statement could be provided on the adequacy of intakes of alpha-linoleic acids, N-3 fish fatty acids, fiber, and iron. 74% of the toddlers used dietary supplements, and 59% used vitamin D supplements specifically. Total median intakes of vegetables, bread, and milk products were sufficient. Consumption of bread, potatoes and cereals, milk products, fats, and drinks consisted largely of unhealthy products. Consumption of unfavorable products may have been the cause of the observed high and low intakes of several nutrients. Shifting towards a healthier diet that is more in line with the guidelines may positively affect the dietary intake of Dutch toddlers and prevent negative health impacts, also later in life.


Assuntos
Dieta Saudável/estatística & dados numéricos , Ingestão de Alimentos , Fidelidade a Diretrizes/estatística & dados numéricos , Política Nutricional , Pré-Escolar , Estudos Transversais , Dieta Saudável/normas , Comportamento Alimentar , Feminino , Humanos , Lactente , Masculino , Micronutrientes/análise , Países Baixos , Nutrientes/análise , Inquéritos Nutricionais
20.
Pan Afr Med J ; 38: 199, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33995805

RESUMO

Introduction: the current pandemic of coronavirus disease (COVID-19) caused by a novel strain (SARS-CoV-2) is enormous and continues to pose a threat to the lives of people. In Nigeria, as of 21st April 2020, 668 confirmed cases, 22 deaths and 188 recoveries have been reported. Police officers are at the forefront of enforcing advisories to ensure public compliance. However, there is a paucity of data on knowledge, risk perception, and adherence to COVID-19 advisories issued by the Health authorities particularly among the police officers. We, therefore, assessed the knowledge, risk perceptions and adherence to NCDC recommended advisory on COVID-19. Methods: we conducted a two-stage sampling cross-sectional study among different cadres of police officers in Benue State, Nigeria using a pretested, semi-structured, interviewer-administered questionnaire. The results of the study were presented in frequencies and proportions. Chi-square test was used for an association between variables at p-value < 0.05. Results: the mean age of the 305 participants was 39.1 ± 8.4 years and most, 124 (40.7%) of the participants were within age-group 30-39 years, 19 (64.3%.8) were male, 250 (82.0%) were married and 160 (52.5%) had secondary education as the highest qualification. Majority of the participants, 301 (98.7%) have heard about COVID-19 and the commonest source of information was via television/radio, 230 (76.4%). Most participants demonstrate a good knowledge of COVID-19 infection, 302 (99.0%) and positive risk perception of COVID-19, 303 (99.3%) but few demonstrated good adherences on COVID-19 prevention practices, 133 (43.6%). Participants' academic qualification (X2 = 10.98, p = 0.001) and cadre (X2 = 112.5, p = 0.001) were found to be associated with good adherence. Conclusion: while most participants had a good knowledge of COVID-19 transmission dynamics, and positive risk perception about COVID-19, good adherence to public health advisories were low. We recommended periodic training, provision of adequate PPE and personal hand-sanitizers as a strategy to improve adherence.


Assuntos
COVID-19/prevenção & controle , Fidelidade a Diretrizes/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Polícia/estatística & dados numéricos , Adulto , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Nigéria , Percepção , Saúde Pública , Inquéritos e Questionários , Adulto Jovem
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