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1.
Medicine (Baltimore) ; 99(2): e18679, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31914062

RESUMO

This study aimed to correlate hypoglycemic risk exposures (HREs) with low blood glucose value (BGV) in ambulatory patients to inform selection of a glucose critical action value (CAV).This was a retrospective study of ambulatory patients with at least 1 serum glucose ≤70 mg/dL obtained at 2 laboratories within the Johns Hopkins Health System over 3.8 years. Multivariable logistic regression was used to evaluate association of BGV cut-offs of <60, <54, <50, and <45 mg/dL with HREs. HREs were classified as "high hypoglycemic risk" (HHR), "moderate hypoglycemic risk" (MHR), "low hypoglycemic risk" (LHR), and "no hypoglycemic risk" (NHR).A total of 5404 patient samples of BG ≤70 mg/dL were analyzed, of which 30.3%, 23.2%, 28.5%, 18.0% occurred in NHR, LHR, MHR, and HHR groups, respectively. An inverse relationship was noted between BGV cut-offs and HHR, but no association was observed for LHR or MHR. After adjusting for age, sex, and race, there was an inverse association between BG thresholds and the odds of HHR. For classification of HHR, BGV cut-offs of <60, <54, <50, and <45 mg/dL correctly classified 71.2%, 69.8%, 68.8%, and 67.2% of BG samples, achieved false-positive rates of 13.6%, 4.7%, 1.7%, and 0.5% and positive likelihood ratios of 3.3, 6.0, 11.2, and 23.4, respectively.Nearly 70% of low BGVs occurred in patients with at least 1 HRE, but only ∼20% occurred in HHR patients. Given their high positive likelihood ratios, BGVs <54 or <50 mg/dL are reasonable candidates for CAVs that would allow sufficient clinician response time while minimizing false-positive alerts.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Glicemia/análise , Hipoglicemia/epidemiologia , Adulto , Idoso , Comorbidade , Diabetes Mellitus Tipo 1/sangue , Diabetes Mellitus Tipo 1/epidemiologia , Reações Falso-Positivas , Feminino , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Valores de Referência , Estudos Retrospectivos , Fatores de Risco
2.
Support Care Cancer ; 28(1): 295-301, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31044305

RESUMO

BACKGROUND: An international panel achieved consensus on 9 need-based and 2 time-based major referral criteria to identify patients appropriate for outpatient palliative care referral. To better understand the operational characteristics of these criteria, we examined the proportion and timing of patients who met these referral criteria at our Supportive Care Clinic. METHODS: We retrieved data on consecutive patients with advanced cancer who were referred to our Supportive Care Clinic between January 1, 2016, and February 18, 2016. We examined the proportion of patients who met each major criteria and its timing. RESULTS: Among 200 patients (mean age 60, 53% female), the median overall survival from outpatient palliative care referral was 14 (95% confidence interval 9.2, 17.5) months. A majority (n = 170, 85%) of patients met at least 1 major criteria; specifically, 28%, 30%, 20%, and 8% met 1, 2, 3, and ≥ 4 criteria, respectively. The most commonly met need-based criteria were severe physical symptoms (n = 140, 70%), emotional symptoms (n = 36, 18%), decision-making needs (n = 26, 13%), and brain/leptomeningeal metastases (n = 25, 13%). For time-based criteria, 54 (27%) were referred within 3 months of diagnosis of advanced cancer and 63 (32%) after progression from ≥ 2 lines of palliative systemic therapy. The median duration from patient first meeting any criterion to palliative care referral was 2.4 (interquartile range 0.1, 8.6) months. CONCLUSIONS: Patients were referred early to our palliative care clinic and a vast majority (85%) of them met at least one major criteria. Standardized referral based on these criteria may facilitate even earlier referral.


Assuntos
Assistência Ambulatorial/organização & administração , Neoplasias/terapia , Cuidados Paliativos/organização & administração , Seleção de Pacientes , Encaminhamento e Consulta/organização & administração , Adulto , Idoso , Assistência Ambulatorial/métodos , Assistência Ambulatorial/estatística & dados numéricos , Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Pré-Escolar , Consenso , Progressão da Doença , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Neoplasias/epidemiologia , Neoplasias/patologia , Pacientes Ambulatoriais , Cuidados Paliativos/métodos , Cuidados Paliativos/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos
3.
Medicine (Baltimore) ; 98(49): e18085, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31804318

RESUMO

This was a prospective cohort study with a short-term follow-up. To explore whether age is a factor in the prognosis following high ligation and stripping (HLS) performed in an ambulatory care center. This study included 170 patients who underwent their first HLS for varicose veins in an ambulatory center from November 2016 to October 2017 at West China Hospital. The patients were categorized as two groups: the ≤60 years old group and the >60 years old group. We collected the two age groups data included Clinical, Etiology, Anatomy, and Pathophysiology (CEAP) classification, Venous Clinical Severity Score (VCSS), Visual Analogue Score (VAS), Aberdeen Varicose Veins Questionnaire (AVVQ), Quality of Recovery (QoR-15), and postoperative complications at predetermined time points. The clinical correlation between age and prognosis following HLS in an ambulatory care center was prospectively studied after adjusting for potential confounders. The distribution of age and prognosis were also compared in the AVVQ improvement and VCSS improvement of patients at 6 weeks and 6 months after surgery. Our research comprised a total of 170 patients (236 limbs), of which 86 (50.6%) patients were female and 66 (38.8%) patients received bilateral procedures. After multivariable risk adjustment for potential confounding factors, we observed that age was not associated with the improvement of AVVQ (OR 0.3, 95%CI (1.3, 0.7), P = .54) and VCSS (OR 0.2, 95%CI (0.2, 0.6) P = .38) at 6 months after HLS, as well as AVVQ (OR 0.5,95%CI (1.2, 2.2), P = .57) at 6 weeks after HLS. However, at 6 weeks after HLS, age was related to the improvement of VCSS (OR -0.6, 95%CI (1.2, 0.1), P = .03), with the >60 years old group having a lower VCSS improvement compared to the 60 years old group. In postoperative complications, there were no significant differences in terms of complications between the two age groups (all P value >.05). Therefore, in our opinion, age is not a barrier for good outcomes following HLS in an ambulatory care center.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Ligadura/métodos , Qualidade de Vida , Varizes/cirurgia , Adulto , Fatores Etários , Idoso , China , Feminino , Humanos , Ligadura/efeitos adversos , Masculino , Pessoa de Meia-Idade , Complicações Pós-Operatórias/epidemiologia , Estudos Prospectivos , Índice de Gravidade de Doença
4.
Medicina (B Aires) ; 79(5): 345-348, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31671383

RESUMO

Hypovitaminosis D is frequent worldwide. In Argentina, according to studies conducted between 1987 and 2015, prevalence was > 40% in the general population. In people living with HIV it may vary between 20 and 90%, but the prevalence in our environment is not known. Our objective was to determine the prevalence of hypovitaminosis D in a cohort of adults with HIV infection in the city of Buenos Aires. We analyzed retrospectively medical records of 814 HIV positive subjects older than 18 years with at least one determination of vitamin D. The median age was 44 years (interquartile range 21-80), 746 (91.6%) were men, and 813 (99.9%) were on antiretroviral treatment. Univariate and multivariate analyses were performed to determine the association of hypovitaminosis D with CD4 values, viral load for HIV, and antiretroviral therapy. The present study shows that, in our environment, hypovitaminosis D is very common in people with HIV infection. Although it does not reveal evidence of a relationship with viral load for HIV, immune status, or antiretroviral treatment, the systematic search for hypovitaminosis D is mandatory in this population, taking into account its high frequency and the increased risk of osteopenia, osteoporosis and fractures, as described in people with HIV.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Infecções por HIV/epidemiologia , Deficiência de Vitamina D/epidemiologia , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Argentina/epidemiologia , Benzoxazinas/uso terapêutico , Contagem de Linfócito CD4 , Feminino , Infecções por HIV/tratamento farmacológico , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estudos Retrospectivos , Inibidores da Transcriptase Reversa/uso terapêutico , Fatores de Risco , Carga Viral , Deficiência de Vitamina D/etiologia , Adulto Jovem
5.
BMC Infect Dis ; 19(1): 991, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752720

RESUMO

BACKGROUND: Male urethritis is primary sexually transmitted. Northern Territory (NT) has the highest rates of gonococcal infection in Australia and local guidelines recommend empiric treatment with azithromycin and ceftriaxone for all men presenting with urethritis. As gonococcal drug resistance is a growing concern, this study aims to improve empiric use of ceftriaxone through examining local patterns of male urethritis, comparing cases of gonococcal urethritis (GU) to controls with non-gonococcal urethritis (NGU). METHODS: A retrospective study was undertaken of all men with symptomatic urethritis presenting to Darwin sexual health clinic from July 2015 to July 2016 and aetiology of urethritis in this population was described. Demographic, risk profile, and clinical features of GU cases were compared to NGU controls. RESULTS: Among n = 145 men, the most common organisms identified were Chlamydia trachomatis (23.4%, SE 3.5%) and Neisseria gonorrhoeae (17.2%, SE 3.1%). The main predictors of GU were any abnormalities on genital examination (aOR 10.4, 95% CI 2.1 to 50.8) and a history of urethral discharge (aOR 5.7, 95% CI 1.4 to 22.6). Aboriginal patients (aOR 3.0, 95% CI 0.9 to 9.6) and those over 30 years of age (aOR 1.4, 95% CI 0.3 to 7.0) were more likely to have GU in the unadjusted analysis, but not in the adjusted model. CONCLUSION: This is the first study looking at patterns of male urethritis in urban NT and the results support a move towards adopting national guidelines to use ceftriaxone for empiric management of syndromic urethritis only in high-risk patients. In addition to traditional demographic risk factors, clinical features remain an important component of risk stratification.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Uretrite/epidemiologia , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Azitromicina/uso terapêutico , Estudos de Casos e Controles , Ceftriaxona/uso terapêutico , Infecções por Chlamydia/tratamento farmacológico , Infecções por Chlamydia/microbiologia , Chlamydia trachomatis/efeitos dos fármacos , Chlamydia trachomatis/genética , Chlamydia trachomatis/isolamento & purificação , Gonorreia/tratamento farmacológico , Gonorreia/microbiologia , Humanos , Masculino , Neisseria gonorrhoeae/efeitos dos fármacos , Neisseria gonorrhoeae/genética , Neisseria gonorrhoeae/isolamento & purificação , Northern Territory/epidemiologia , Estudos Retrospectivos , Uretrite/diagnóstico , Uretrite/tratamento farmacológico , Uretrite/microbiologia
6.
BMC Health Serv Res ; 19(1): 847, 2019 Nov 19.
Artigo em Inglês | MEDLINE | ID: mdl-31744548

RESUMO

BACKGROUND: In Ethiopia, cervical cancer is a public health concern, as it is the second most cause of cancer deaths among reproductive age women and it affects the country's most vulnerable groups like; rural, poor, and HIV-positive women. Despite the strong evidence that cervical cancer screening results in decreased mortality from this disease, its utilization remains low. METHODS: An institution-based cross-sectional study was conducted from March 2 to April 1/2019 to assess the level and factors affecting utilization of cervical cancer screening among HIV positive women in Hawassa town. Quantitative data collection methods were used. Data were gathered using a structured and pretested questionnaire. Epi-Info version 7 and SPSS version 23 were used for data entry and analysis respectively. Statistically significant association of variables was determined based on Adjusted Odds ratio with its 95% confidence interval and p-value of ≤0.05. RESULTS: Of the 342 women interviewed, 40.1% (95% CI: 35.00, 45.33%) of them were screened. Having a post primary education (AOR = 5.1, 95% CI: 1.8, 14.5), less than 500 cell/mm3 CD4 count (AOR = 2.7, 95% CI: 1.2, 5.9); duration since HIV diagnosis (AOR = 4.2, 95% CI: 2.1, 8.5), partner support (AOR = 4.7, 95% CI: 2.3, 9.4), having knowledge about risk factors (AOR = 2.9 (95% CI: 1.2, 6.9) and having favorable attitude towards cervical cancer and its screening (AOR = 3.7 (95% CI: 1.8, 7.5) were associated with cervical cancer screening utilization. CONCLUSIONS: The study revealed utilization of cervical cancer screening service was low among HIV positive women. Educational status, duration of HIV diagnosis, partner support, knowledge status about risk factor, CD4 count and attitude towards cervical cancer and its screening were associated with cervical cancer screening utilization. Health care workers need to provide intensive counseling services for all ART care attendants to increase utilization.


Assuntos
Soropositividade para HIV/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Contagem de Linfócito CD4 , Aconselhamento , Estudos Transversais , Detecção Precoce de Câncer/estatística & dados numéricos , Etiópia/epidemiologia , Utilização de Instalações e Serviços , Feminino , Humanos , Pessoa de Meia-Idade , Razão de Chances , Inquéritos e Questionários , Neoplasias do Colo do Útero/epidemiologia , Adulto Jovem
7.
G Ital Nefrol ; 36(5)2019 09 24.
Artigo em Italiano | MEDLINE | ID: mdl-31580549

RESUMO

In 2017 the Italian Society of Nephrology operating in the Triveneto area investigated through a questionnaire, distributed to the various nephrological centers in the regions of Friuli Venezia Giulia, Trentino Alto Adige and Veneto, the differences concerning organizational models, choice of dialysis, creation and management of vascular access. The results emerging from the analysis of the collected data are presented.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Diálise Renal/estatística & dados numéricos , Insuficiência Renal Crônica/epidemiologia , Dispositivos de Acesso Vascular/estatística & dados numéricos , Instituições de Assistência Ambulatorial/provisão & distribução , Análise de Dados , Pesquisas sobre Serviços de Saúde , Humanos , Itália/epidemiologia , Corpo Clínico/estatística & dados numéricos , Modelos Organizacionais , Nefrologia , Diálise Peritoneal/estatística & dados numéricos , Densidade Demográfica , Prevalência , Encaminhamento e Consulta , Insuficiência Renal Crônica/terapia , Sociedades Médicas
8.
Rev Saude Publica ; 53: 95, 2019.
Artigo em Inglês, Português | MEDLINE | ID: mdl-31644773

RESUMO

OBJECTIVE: To analyze factors associated with outpatient follow-up of children with congenital syphilis. METHODS: A non-concurrent cohort study performed in primary care units and three reference maternity hospitals in Fortaleza (Ceará State). Data were collected from September 2013 to September 2016 in the notification forms and in the medical records of hospitalization and outpatient follow-up, and they were presented considering an adequate and inadequate follow-up. Children who attended the primary care unit or referral outpatient clinic during the period recommended by the Ministry of Health were considered adequately followed up and performed the recommended examinations. Pearson's chi-square and Fisher's exact tests were used in the comparative analysis. The estimated risk of adequate non-follow-up was verified by simple and multiple logistic regression. RESULTS: The total of 460 children with congenital syphilis were notified, of which 332 (72.2%) returned for at least one appointment and were part of the study. Exactly 287 (86.4%) children attended the primary health unit; however, there was no reference to congenital syphilis in 236 (71.1%) medical records and no information on the venereal disease research laboratory (VDRL) test was found in 264 (79.5%) children. There was nonadherence to subsequent appointments by 272 (81.9%) individuals. The following variables had a statistically significant association with the non-adequate follow-up of the children: marital status of the mothers, number of prenatal appointments, number of pregnancies, blood count, and radiography of long bones. CONCLUSIONS: Most children with congenital syphilis attended primary care for follow-up, but the services do not meet the recommendations of the Brazilian Ministry of Health for adequate follow-up.


Assuntos
Assistência ao Convalescente/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Mães/estatística & dados numéricos , Pacientes Ambulatoriais/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Sífilis Congênita/terapia , Adolescente , Adulto , Brasil/epidemiologia , Estudos de Coortes , Feminino , Seguimentos , Idade Gestacional , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Complicações Infecciosas na Gravidez/terapia , Fatores de Risco , Fatores Socioeconômicos , Sífilis Congênita/epidemiologia , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Resultado do Tratamento , Adulto Jovem
9.
BMC Health Serv Res ; 19(1): 668, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533716

RESUMO

BACKGROUND: In England, people of Black Caribbean (BC) ethnicity are disproportionately affected by sexually transmitted infections (STI). We examined whether differences in sexual healthcare behaviours contribute to these inequalities. METHODS: We purposively selected 16 sexual health clinics across England with high proportions of attendees of BC ethnicity. During May-September 2016, attendees at these clinics (of all ethnicities) completed an online survey that collected data on health service use and sexual behaviour. We individually linked these data to routinely-collected surveillance data. We then used multivariable logistic regression to compare reported behaviours among BC and White British/Irish (WBI) attendees (n = 627, n = 1411 respectively) separately for women and men, and to make comparisons by gender within these ethnic groups. RESULTS: BC women's sexual health clinic attendances were more commonly related to recent bacterial STI diagnoses, compared to WBI women's attendances (adjusted odds ratio, AOR 3.54, 95% CI 1.45-8.64, p = 0.009; no gender difference among BC attendees), while BC men were more likely than WBI men (and BC women) to report attending because of a partner's symptoms or diagnosis (AOR 1.82, 95% CI 1.14-2.90; AOR BC men compared with BC women: 4.36, 95% CI 1.42-13.34, p = 0.014). Among symptomatic attendees, BC women were less likely than WBI women to report care-seeking elsewhere before attending the sexual health clinic (AOR 0.60, 95% CI 0.38-0.97, p = 0.039). No ethnic differences, or gender differences among BC attendees, were observed in symptom duration, or reporting sex whilst symptomatic. Among those reporting previous diagnoses with or treatment for bacterial STI, no differences were observed in partner notification. CONCLUSIONS: Differences in STI diagnosis rates observed between BC and WBI ethnic groups were not explained by the few ethnic differences which we identified in sexual healthcare-seeking and use. As changes take place in service delivery, prompt clinic access must be maintained - and indeed facilitated - for those at greatest risk of STI, regardless of ethnicity.


Assuntos
Assistência Ambulatorial/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Saúde Sexual , Adolescente , Adulto , Grupo com Ancestrais do Continente Africano/etnologia , Idoso , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Região do Caribe/etnologia , Estudos Transversais , Inglaterra/epidemiologia , Grupos Étnicos/estatística & dados numéricos , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Utilização de Instalações e Serviços , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Assunção de Riscos , Fatores Sexuais , Comportamento Sexual/etnologia , Parceiros Sexuais , Doenças Sexualmente Transmissíveis/diagnóstico , Doenças Sexualmente Transmissíveis/etnologia , Inquéritos e Questionários , Adulto Jovem
10.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31527173

RESUMO

BACKGROUND: Off-label drug use in children is common and potentially harmful. In most previous off-label use research, authors studied hospitalized children, specific drug classes, or non-US settings. We characterized frequencies, trends, and reasons for off-label systemic drug orders for children in ambulatory US settings. METHODS: Using nationally representative surveys of office-based physicians (National Ambulatory Medical Care Surveys, 2006-2015), we studied off-label orders of systemic drugs for children age <18 based on US Food and Drug Administration-approved labeling for age, weight, and indication. We characterized the top classes and diagnoses with off-label orders and analyzed factors and trends of off-label orders using logistic regression. RESULTS: Physicians ordered ≥1 off-label systemic drug at 18.5% (95% confidence interval: 17.7%-19.3%) of visits, usually (74.6%) because of unapproved conditions. Off-label ordering was most common proportionally in neonates (83%) and in absolute terms among adolescents (322 orders out of 1000 visits). Off-label ordering was associated with female sex, subspecialists, polypharmacy, and chronic conditions. Rates and reasons for off-label orders varied considerably by age. Relative and absolute rates of off-label orders rose over time. Among common classes, off-label orders for antihistamines and several psychotropics increased over time, whereas off-label orders for several classes of antibiotics were stable or declined. CONCLUSIONS: US office-based physicians have ordered systemic drugs off label for children at increasing rates, most often for unapproved conditions, despite recent efforts to increase evidence and drug approvals for children. These findings can help inform education, research, and policies around effective, safe use of medications in children.


Assuntos
Instituições de Assistência Ambulatorial/tendências , Uso Off-Label/estatística & dados numéricos , Adolescente , Distribuição por Idade , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Intervalos de Confiança , Estudos Transversais , Feminino , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Lactente , Recém-Nascido , Modelos Logísticos , Masculino , Psicotrópicos/uso terapêutico , Estudos Retrospectivos , Estados Unidos
11.
Afr J Prim Health Care Fam Med ; 11(1): e1-e7, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31478740

RESUMO

BACKGROUND: Physical activity plays a significant role in the managing of type 2 diabetes and is essential in reducing morbidity and mortality associated with diabetes mellitus. A number of factors influence non-adherence to physical activity: social, personal, environmental and economic factors. Diabetes research conducted in Botswana has focused on behavioural change, treatment adherence and nutrition. The physical activity levels of type 2 diabetes patients and associated factors are not known. AIM: The aim of this study was to assess the physical activity levels (PALs) and factors associated with physical activity in type 2 diabetes mellitusSetting: The study was conducted at a public clinic in Gaborone, Botswana, in 2017. METHODS: An observational cross-sectional study was conducted at a public clinic in Gaborone, Botswana. An interview-administered questionnaire was used to assess the PALs and factors associated with physical activity in type 2 diabetes mellitus patients. Data were captured on Excel and exported to SPSS software version 25 for analysis. Chi-square test, Fischer's exact test and Pearson's moment correlation examined the relationship between participants' characteristics and their engagement in regular exercise. RESULTS: The majority of the study participants had low PALs (54.7%). The results showed a non-significant negative correlation between age and PAL (r = -0.085) and between sitting time (sedentary time) and PAL (-0.098). CONCLUSION: Most type 2 diabetes mellitus patients had low PALs. Health-promoting activities are needed to promote physical activity and thus prevent complications associated with physical inactivity.


Assuntos
Complicações do Diabetes/prevenção & controle , Diabetes Mellitus Tipo 2/terapia , Terapia por Exercício/estatística & dados numéricos , Exercício , Cooperação do Paciente/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Botsuana , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco
12.
Acta Med Port ; 32(9): 576-579, 2019 Sep 02.
Artigo em Inglês | MEDLINE | ID: mdl-31493360

RESUMO

INTRODUCTION: Outpatient antimicrobial therapy programs have been in place for more than four decades. They provide safe and effective treatment for a selected group of patients while reducing costs. In Europe in general, and in Portugal in particular, these programs are still a relatively new phenomenon. The aim of this study is to describe our center's two years' experience with such a program (Antibiotic Clinic). MATERIAL AND METHODS: The cohort of treatments administered by the Antibiotic Clinic in its first two years of existence (September 12th 2016 to September 11th 2018) was analyzed and data pertaining to patients, infections, infectious agents, antimicrobials and outcomes (infection resolution, adverse events and death) were characterized. RESULTS: The Antibiotic Clinic treated 231 patients in 250 episodes, providing a total of 2357 days of antibiotic treatment. The urinary tract was the most common site (39.2%) and Enterobacteriaceae the most common agents (63.7% of isolates). Infections were resolved in 90.8% of treatments (95.6% of patients), adverse events were few (1.2%) and direct mortality was not found. The dropout rate was 1.6%. DISCUSSION: Infection resolution and adverse event rates were comparable to other centers. High treatment and low dropout rates point to high physician and patient acceptance. CONCLUSION: Our experience with this program suggests it is a safe and effective alternative to inpatient admission. This is in line with current literature which suggests efforts should be made to expand this treatment modality.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Adulto , Idoso , Antibacterianos/efeitos adversos , Infecções Bacterianas/epidemiologia , Infecções Bacterianas/microbiologia , Farmacorresistência Bacteriana , Estudos de Viabilidade , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Portugal/epidemiologia , Avaliação de Programas e Projetos de Saúde , Fatores de Tempo , Resultado do Tratamento , Infecções Urinárias/tratamento farmacológico , Infecções Urinárias/epidemiologia , Infecções Urinárias/microbiologia
13.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(9): 951-954, 2019 Sep 06.
Artigo em Chinês | MEDLINE | ID: mdl-31474081

RESUMO

Construction and application of immunization information system is an important part of health information, which is very useful to improve the quality, efficiency and safety of vaccination. The background, system architecture, functions and applications, working conditions and characteristics of Shandong province Immunization Information System (IIS) are introduced in this article. It is expected to provide experiences for the development of immunization information system of other provinces.


Assuntos
Imunização , Sistemas de Informação , Vacinação , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Criança , China , Humanos , Imunização/estatística & dados numéricos , Sistemas de Informação/tendências
14.
J Glob Health ; 9(2): 020404, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31489187

RESUMO

Background: Displacement after a war or an armed conflict always leads to unexpected health problems, both among migrating people and in places to which new people have migrated. This study aimed to determine the health care needs and trends of Syrian patients. Methods: This retrospective study was conducted in a secondary care hospital in the city of Nevsehir, in central Turkey, between January 2013 and December 2017. All Syrian patients who visited the outpatient clinics and emergency department (ED) were enrolled in the study. Results: Over a span of five years, 41 723 Syrian patients visited the hospital's outpatient clinics and ED. The patients' median age was 23 (inter-quartile range (IQR) = 7-34), and 57.7% of them were female. In 2017, one-third of the Syrian patients visited the ED, a rate that was higher than that found among local patients (30.3% vs 25.0%, P < 0.001, respectively). The rate of pediatric clinic admissions among Syrian patients was about four times greater than the rate of local patients (20.1% vs 5.2%, P < 0.001, respectively), and Syrians' rate of admission to the obstetrics and gynecology clinic was about three times greater than the rate of local patients' admissions (12.3% vs 4.3%, P < 0.001, respectively). Conclusions: This study showed that Syrian patients' visits to the hospital, and especially the ED, are increasing. Further, the needs and expectations of these patients in terms of health care are different from local demands. New approaches should be applied to provide an appropriate use of health care facilities.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Serviço Hospitalar de Emergência/estatística & dados numéricos , Refugiados/estatística & dados numéricos , Adolescente , Adulto , Criança , Feminino , Humanos , Masculino , Estudos Retrospectivos , Síria/etnologia , Turquia , Adulto Jovem
15.
Int J Soc Psychiatry ; 65(7-8): 566-569, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31379243

RESUMO

BACKGROUND: Health anxiety may be an increasing problem because of the focus on monitoring health and increasing use of the Internet for self-diagnosis (cyberchondria). There is very little information about changes in the prevalence of health anxiety. AIM: We compared the prevalence of health anxiety in four medical clinics in one hospital over a 4-year period using the Health Anxiety Inventory (HAI) as a diagnostic marker. METHOD: Patients attending cardiology, endocrine, gastroenterology and respiratory medicine clinics at King's Mill Hospital, North Nottinghamshire, completed the HAI while waiting for their appointments. There were eight research assistants involved in collecting data, two in the 2006-2008 period and six in the 2008-2010 period. As a consequence, more data were collected on the second occasion. RESULTS: There was an increase in the prevalence of health anxiety from 14.9% in 2006-2008 (54 positive of 362 assessed) to 19.9% (1,132 positive out of 5,704 assessed) in 2008-2010. This increase was primarily noted in gastroenterology clinics (increase of 10%) and not shown in endocrine ones. CONCLUSION: The prevalence of health anxiety is increasing in those who attend medical out-patient clinics. Reasons are given that this may be a possible result of cyberchondria, as the excessive use of the Internet to interpret troubling symptoms is growing. Further studies are needed in other populations, but there is reason to be concerned at this trend as it is likely to increase the number of medical consultations unnecessarily.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Ansiedade/epidemiologia , Atitude Frente a Saúde , Hipocondríase/epidemiologia , Internet , Autoavaliação Diagnóstica , Hospitais Gerais , Humanos , Prevalência , Inquéritos e Questionários , Reino Unido
16.
BMC Pregnancy Childbirth ; 19(1): 297, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416427

RESUMO

BACKGROUND: Screening for hypertensive disorders in pregnancy (HDP) is clinically important for identifying women at high risk, and planning early preventative interventions to improve pregnancy outcomes. Several studies in developing countries show that pregnant women are seldom screened for HDP. We conducted a study in Kinshasa, DR Congo, in order to assess the proportion of pregnant women screened for HDP, and to identify factors associated with the screening. METHODS: We conducted a facility-based cross-sectional study in a random sample of 580 pregnant women attending the first antenatal visit. Data collection consisted of a review of antenatal records, observations at the antenatal care services, and interviews. A pregnant woman was considered as screened for HDP if she had received the tree following services: blood pressure measurement, urine testing for proteinuria, and HDP risk assessment. Multivariable logistic regression, with generalized estimating equations, was used to identify factors associated with the screening for HDP. RESULTS: Of the 580 pregnant women, 155 (26.7%) were screened for HDP, 555 (95.7%) had their blood pressure checked, 347(59.8%) were assessed for risk factors of HDP, and 156 (26.9%) were tested for proteinuria. After multivariable analysis, screening for HDP was significantly higher in parous women (AOR = 2.09; 95% CI, 1.11-3.99; P = 0.023), in women with a gestational age of at least 20 weeks (AOR = 5.50; 95% CI, 2.86-10.89; P = 0.002), in women attending in a private clinic (AOR = 3.49; 95% CI, 1.07-11.34; P = 0.038), or in a hospital (AOR = 3.24; 95% CI, 1.24-8.47; P = 0.017), and when no additional payment was required for proteinuria testing at the clinic (AOR = 2.39; 95% CI, 1.14-5.02; P = 0.021). CONCLUSION: Our results show that screening for HDP during the first antenatal visit in Kinshasa is not universal. The factors associated with screening included maternal as well as clinics' characteristics. More effort should be made both at maternal and clinic levels to improve the screening for HDP in Kinshasa.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Hipertensão Induzida pela Gravidez/diagnóstico , Cuidado Pré-Natal/estatística & dados numéricos , Diagnóstico Pré-Natal/estatística & dados numéricos , Adulto , Estudos Transversais , República Democrática do Congo , Feminino , Idade Gestacional , Humanos , Gravidez , Fatores de Risco
17.
BMC Res Notes ; 12(1): 509, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31416477

RESUMO

OBJECTIVE: This study aimed to determine the magnitude of serum HBsAg and the risk factors for hepatitis B virus infection among pregnant women in Bahir Dar. An institution based cross sectional study was implemented from February 1 to May 1, 2018 among 338 pregnant women attending antenatal care clinic at Felegehiwot referral hospital, Bahir Dar, 2018. Systematic random sampling technique was implemented. Blood sample was taken from 338 study participants and serum was tested for hepatitis B surface antigen (HBsAg) using Enzyme Linked ImmunoSorbent Assay. RESULTS: The overall prevalence of hepatitis B virus infection among pregnant women were 16 (4.7%) (95% CI 2.7, 7.7). Having a history of blood transfusion (AOR = 5.2; 95% CI 1.2-22.3), having a history of multiple sexual partners (AOR = 4.6; 95% CI 1.1-19.6) and having a history tonsillectomy (traditional surgical procedure) (AOR = 3.4; 95% CI 1.1-10.1) were the significant risk factors for hepatitis B virus infection.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Hepatite B/epidemiologia , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/estatística & dados numéricos , Encaminhamento e Consulta , Adulto , Estudos Transversais , Etiópia/epidemiologia , Feminino , Hepatite B/sangue , Hepatite B/virologia , Antígenos de Superfície da Hepatite B/sangue , Vírus da Hepatite B/fisiologia , Humanos , Gravidez , Complicações Infecciosas na Gravidez/sangue , Complicações Infecciosas na Gravidez/virologia , Cuidado Pré-Natal/métodos , Prevalência , Fatores de Risco
18.
Int J Med Inform ; 130: 103936, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31437617

RESUMO

BACKGROUND: While the access to information through digital resources is widely available for physicians, concerns are posed about the use of digital devices for information retrieval at the point of care. This use of digital devices among practicing physicians in the community setting is not well studied, particularly from the patient's perspective. AIM: The aim of this study is to assess the prevalence of use of digital devices by physicians in the community setting and attitude of patients towards the usage of digital devices by the physician to retrieve information at the point of care during the clinical encounter. DESIGN AND SETTINGS: This is a cross-sectional study among 385 patients who visited pharmacies to dispense a recent (2 weeks) prescription by their physician. MATERIAL AND METHODS: Patients who presented at a random set of pharmacies to buy medications prescribed in a recent clinical visit were approached to fill a paper-based questionnaire. Survey items included patient demographics and patients' attitude towards their physician's usage of digital devices using a Likert scale rating. RESULTS: This study shows that around one quarter of physicians use digital devices at the point of care. About 40% of patients are bothered by a physician who uses digital devices to retrieve information during the clinical encounter. Trusting the competence of physicians using digital devices at the point of care for retrieving information is positively correlated with being less bothered. Almost half (50.6%) are interested in knowing the reason behind their physician's use of the digital device. Patients tend to be less bothered when they are informed about the reason of the digital device use, as only 12.5% of those informed are bothered compared to 35.8% of those who are not (P value = 0.01). CONCLUSION: Physicians should be aware of their patients' preferences when using digital devices during the clinical encounter. Physicians' use of digital devices during the encounter may endanger the patient-doctor relationship due to the perception of the patient of the competence of the physician.


Assuntos
Instituições de Assistência Ambulatorial/estatística & dados numéricos , Registros Eletrônicos de Saúde/estatística & dados numéricos , Armazenamento e Recuperação da Informação/normas , Satisfação do Paciente/estatística & dados numéricos , Médicos/normas , Sistemas Automatizados de Assistência Junto ao Leito/estatística & dados numéricos , Padrões de Prática Médica/normas , Adolescente , Adulto , Competência Clínica , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Inquéritos e Questionários , Adulto Jovem
19.
Medicine (Baltimore) ; 98(33): e16818, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31415398

RESUMO

There is an increasing demand for medical provision systems that are friendly for working mothers with sick children in Japan. The aim of this cross-sectional, observational study was to analyze the demographic characteristics of pediatric patients presenting to a convenient care clinic, which was located in a large railway station and offered primary care with after-hours accessibility in a metropolitan area of Tokyo.We analyzed anonymous data for patients who had visited the pediatric department at a clinic between August 2013 and June 2016. Data regarding patients' sex, age, time of visit, waiting time, presence or absence of an appointment, diagnosis, and addresses were collected from electronic health and billing records.Overall, 8091 patients visited the department 45,388 times. The numbers of visits by patients who resided within 2, 5, and 10 miles of the clinic were 37,160 (84.6%), 42,336 (96.4%), and 43,399 (98.8%), respectively. No seasonal variation in the number of visits was observed. Male patients visited the clinic 23,742 times (52.3%) and the patients' median age was 3 years (interquartile range, 1-6). Most visits occurred on Mondays, and 5643 (15.2%) and 4790 (12.9%) patients visited the clinic when consultations began at 10 AM and 3 PM, respectively. Approximately 20% of weekday visits occurred after 6 PM, when other pediatricians' offices were typically closed. Children older than 7 years of age visited the clinic more frequently after 6 PM. The overall median waiting time was 650 seconds (interquartile range, 429-1020). The 3 most common diagnoses were upper respiratory tract infection (27,173), asthmatic bronchitis (23,744), and allergic rhinitis (10,556). The number of individuals who were referred to other medical institutions was 284 (0.6%).The majority of patients were children aged 1 to 4 years living near the clinic and 80% of visits were during the daytime. However, children older than 7 years of age visited the clinic more frequently after 6 PM. The convenience of the clinic contributed to the fulfillment of the medical needs of children with mild illnesses whose mothers were in full-time employment.


Assuntos
Plantão Médico/estatística & dados numéricos , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Assistência Ambulatorial/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Plantão Médico/métodos , Criança , Pré-Escolar , Estudos Transversais , Demografia , Feminino , Geografia , Humanos , Lactente , Masculino , Atenção Primária à Saúde/métodos , Fatores de Tempo , Tóquio
20.
Health Policy Plan ; 34(8): 574-581, 2019 Oct 01.
Artigo em Inglês | MEDLINE | ID: mdl-31419287

RESUMO

In India, most women now delivery in hospitals or other facilities, however, maternal and neonatal mortality remains stubbornly high. Studies have shown that mistreatment causes delays in care-seeking, early discharge and poor adherence to post-delivery guidance. This study seeks to understand the variation of women's experiences in different levels of government facilities. This information can help to guide improvement planning. We surveyed 2018 women who gave birth in a representative set of 40 government facilities from across Uttar Pradesh (UP) state in northern India. Women were asked about their experiences of care, using an established scale for person-centred care. We asked questions specific to treatment and clinical care, including whether tests such as blood pressure, contraction timing, newborn heartbeat or vaginal exams were conducted, and whether medical assessments for mothers or newborns were done prior to discharge. Women delivering in hospitals reported less attentive care than women in lower-level facilities, and were less trusting of their providers. After controlling for a range of demographic attributes, we found that better access, higher clinical quality, and lower facility-level, were all significantly predictive of patient-centred care. In UP, lower-level facilities are more accessible, women have greater trust for the providers and women report being better treated than in hospitals. For the vast majority of women who will have a safe and uncomplicated delivery, our findings suggest that the best option would be to invest in improvements mid-level facilities, with access to effective and efficient emergency referral and transportation systems should they be needed.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Serviços de Saúde Materna/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , Qualidade da Assistência à Saúde/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Parto Obstétrico/métodos , Parto Obstétrico/psicologia , Feminino , Hospitais Públicos/estatística & dados numéricos , Humanos , Índia , Cuidado do Lactente/estatística & dados numéricos , Recém-Nascido , Assistência Centrada no Paciente/estatística & dados numéricos , Inquéritos e Questionários
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