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1.
BMC Public Health ; 19(1): 1462, 2019 Nov 06.
Artigo em Inglês | MEDLINE | ID: mdl-31694586

RESUMO

BACKGROUND: The number of interventions to support parents is growing. The level of evidence regarding these intervention varies. In this paper we describe a study that aims to assess the effectiveness of specific 'elements' within such parenting interventions for families with children up to 7 years. A naturalistic effect evaluation will be applied. Study questions are: 1. What is the exposure of parents to (elements of) parenting interventions in the daily practice of preventive youth health care? 2. What are the associations between the exposure to (elements of) parenting interventions and outcomes in parents/children related to parenting and child development? METHODS/DESIGN: Thousand parents/caregivers are recruited by preventive youth health care providers in the Netherlands. Measurements will be performed after inclusion and after 12-months follow up. Data regarding child/parent/caregiver characteristics, use of (parenting) interventions and care, and outcomes with regard to parenting skills, family functioning and child development will be collected. Outcomes will be compared between parents/children exposed and non-exposed to the (elements of) parenting interventions (adjusting for confounders). DISCUSSION: We hypothesize that parents/caregivers with exposure to (elements of) parenting interventions show (relatively more) improvements in parenting outcomes. Results will support intervention selection/development, and support communities/professionals to select appropriate intervention-elements. TRIAL REGISTRATION: Netherlands National Trial Register number NL7342 . Date of registration: 05-November-2018, retrospectively registered.


Assuntos
Poder Familiar , Medicina Preventiva/métodos , Apoio Social , Adolescente , Criança , Desenvolvimento Infantil , Educação Infantil , Pré-Escolar , Educação não Profissionalizante , Feminino , Humanos , Masculino , Países Baixos , Relações Pais-Filho , Pais/psicologia , Ensaios Clínicos Pragmáticos como Assunto , Projetos de Pesquisa
2.
Aten. prim. (Barc., Ed. impr.) ; 51(9): 562-570, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185932

RESUMO

Objetivo: Conocer la oferta de actividades preventivas propuestas por médicos residentes de medicina familiar en la consulta a demanda de Atención Primaria y su relación con las habilidades comunicacionales. Diseño: Estudio descriptivo multicéntrico mediante videograbación de la consulta médica. Emplazamiento: Ocho centros de salud de Jaén (Andalucía). Participantes: Setenta y tres médicos residentes de cuarto año. Mediciones principales: Se valora la oferta de actividades preventivas (según el Programa español de actividades preventivas y promoción de la salud -PAPPS-) y las características del médico, el paciente y la consulta. Valoración por pares de la comunicación médico-paciente mediante la escala CICAA. Análisis descriptivo, bivariable y de regresión logística. Resultados: Se valoran 260 entrevistas (duración 8,5 ± 4,0 min) de 73 residentes (50,7% mujeres, edad media 32,9 ± 7,7 años, 79% medio urbano). El paciente es más frecuentemente mujer (60%), que acude sola (72%) por procesos agudos (80%) y con 2,1 ± 1,0 motivos de consulta. Se ofertan actividades preventivas en un 47% (duración inferior al minuto) de tipo primario (70%) y secundario (59%) mediante consejo (72%) o cribado (52%), centradas en el área cardiovascular (52%) y estilos de vida (53%). Un 80% se relaciona con el motivo de consulta. Habilidades en comunicación: 41% mejorables, 26% adecuadas, 23% excelentes. La oferta de actividades preventivas se relaciona con la duración de la consulta (OR = 1,1; IC 95% 1,01; 1,16) y la puntuación del CICAA (OR = 1,03; IC 95% 1,01; 1,10). Conclusiones: Se realizan actividades preventivas en casi la mitad de las consultas, aunque centradas en consejo y cribado y ligadas a la demanda del paciente. El tiempo de consulta y las habilidades de comunicación favorecen una mayor oferta preventiva


Objective: To determine the offer of preventive activities by resident physicians of family medicine in the Primary Care consultations and the relation with their communication habilities. Design: A descriptive multicentre study assessing medical consultations video recording. Location: Eight Primary Healthcare centres in Jaen (Andalucia). Participants: Seventy-three resident physicians (4th year) filmed and observed with patients. Principal measurements: Offer of preventive activities (according to the Spanish Program of Preventive Activities and Health Promotion -PAPPS-). Doctor, patient and consultation characteristics. Peer-review of the communication between physicians and patients, using a CICAA scale. A descriptive, bivariate, logistic regression analysis was performed. Results: Two hundred and sixty interviews were evaluated (duration 8.5 ± 4.0 min) of 73 residents (50.7% women, mean age 32.9 ± 7.7 years, 79% urban environment). The patient is more frequently a woman (60%) who comes alone (72%) due to acute processes (80%) and with 2.1 ± 1.0 demands. Preventive activities are offered in 47% (duration less than one minute) of primary (70%) and secondary (59%) prevention, offered through advice (72%) or screening (52%) and focused on the cardiovascular area (52%) and lifestyles (53%). Eighty percent related to the patient's reason for consultation. Communication skills 41% improvable, 26% adequate, 23% excellent. The offer of preventive activities is related to the duration of the consultation (OR = 1.1, 95% CI 1.01; 1.16) and communication skills (OR = 1.03, 95% CI 1.01; 1.10). Conclusions: Preventive activities are carried out in almost half of the consultations, although focused on advice and screening and linked to the patient's demand. Consultation time and communication skills favor a greater preventive offer


Assuntos
Humanos , Masculino , Feminino , Adulto , Internato e Residência , Serviços Preventivos de Saúde , Medicina Preventiva , Atenção Primária à Saúde , Comunicação , Gravação em Vídeo , Avaliação de Resultado de Ações Preventivas , Relações Médico-Paciente , Promoção da Saúde , Análise de Variância
3.
BMC Health Serv Res ; 19(1): 658, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31511019

RESUMO

BACKGROUNDS: In 2009, the prevention service "Familieambulatoriet" (FA) was established in three pilot hospital areas offering psychosocial support and health monitoring to parents in high risk regarding mental health and substance use, for the purpose of preventing child mental health and developmental problems through preschool years. This study selected new-born health as a preliminary endpoint for evaluation of population effects in three pilot areas, utilizing national statistics for birth cohorts from 2005 to 2013. The aim of the study is to evaluate changes in population new born health incidences associated with the establishment of new supportive and preventive FA-services at three pilot sites from 2009 in contrast to previous years and the remaining country. This quasi-experimental design evaluated changes in populations with new services available not those receiving the services, and controlled for national historical changes, variation between hospital districts, and random variation across the years before or years after the pilot services were introduced. Our hypothesis was to expect reduced frequencies of preterm births, SGA births, low APGAR scores, pediatric transfer, and new born abstinence symptoms in the pilot areas. METHODS: The baseline was established through 4 years preceding 2009, contrasting changes at pilot sites the following 4 years 2009-2013 using the remaining hospital area populations in Norway 2005-2008 and 2009-2013 as contrasts. RESULTS: Related to the introduction of FA services, we found three significant improvements in new born health using mixed effects logistic regression. 1) In the population rate of babies born prematurely with small for gestational age (SGA), using the 10th percentile criteria as the definition; odds ratio (OR) = 0.73 (95% Cl: 0.60 to 0.88). 2) A similar reduction using the 2.5th percentile criteria, although with wider confidence limits; OR = 0.73 (95% Cl: 0.54 to 0.99). 3) A decrease in the frequency of low APGAR scores (0-6) 5 min. after birth; OR = 0.80 (95% Cl: 0.68 to 0.95). Thus, the FA-areas remained significantly lowered on SGA rates or Low APGAR rates across the years after FA establishment, despite considerable variation, in contrast to the baseline years and to the remaining country. No significant effect was found for the outcomes frequency of premature births (unrelated to SGA), SGA among full-term babies, child abstinence symptoms or pediatric transfer of the baby. False negative findings may result from low-rate outcomes or studying the population rather than users. CONCLUSIONS: Population rates suggest that introducing FA services offering support and monitoring in high-risk families may contribute to improving aspects of new born infant health. Intervention components and strategies should be studied more closely using individual data.


Assuntos
Desenvolvimento Infantil/fisiologia , Medicina Preventiva , Humanos , Recém-Nascido , Recém-Nascido Pequeno para a Idade Gestacional , Projetos Piloto , Nascimento Prematuro/epidemiologia , Medicina Preventiva/tendências , Fatores de Risco
4.
Gerontologist ; 59(Suppl 1): S1-S6, 2019 06.
Artigo em Inglês | MEDLINE | ID: mdl-31511747

RESUMO

Over two-thirds of all new cancers are diagnosed among adults aged ≥60 years. As the number of adults living to older ages continues to increase, so too will the number of new cancer cases. Can we do more as a society to reduce cancer risk and preserve health as adults enter their 60s, 70s, and beyond? Cancer development is a multi-step process involving a combination of factors. Each cancer risk factor represents a component of cancer causation, and opportunities to prevent cancer may exist at any time up to the final component, even years after the first. The characteristics of the community in which one lives often shape cancer risk-related behaviors and exposures over time, making communities an ideal setting for efforts to reduce cancer risk at a population level. A comprehensive approach to cancer prevention at older ages would lower exposures to known causes of cancer, promote healthy social and physical environments, expand the appropriate use of clinical preventive services, and engage older adults in these efforts. The collection of articles in this supplement provide innovative insights for exciting new directions in research and practice to expand cancer prevention efforts for older adults. This brief commentary sets the stage for the papers that follow.


Assuntos
Promoção da Saúde/métodos , Neoplasias/prevenção & controle , Medicina Preventiva/métodos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-Idade , Fatores de Risco
5.
Cochrane Database Syst Rev ; 8: CD012595, 2019 08 08.
Artigo em Inglês | MEDLINE | ID: mdl-31425627

RESUMO

BACKGROUND: School dental screening refers to visual inspection of children's oral cavity in a school setting followed by making parents aware of their child's current oral health status and treatment needs. Screening at school intends to identify children at an earlier stage than symptomatic disease presentation, hence prompting preventive and therapeutic oral health care for the children. This review evaluates the effectiveness of school dental screening in improving oral health status. It is an update of the original review, which was first published in December 2017. OBJECTIVES: To assess the effectiveness of school dental screening programmes on overall oral health status and use of dental services. SEARCH METHODS: Cochrane Oral Health's Information Specialist searched the following databases: Cochrane Oral Health's Trials Register (to 4 March 2019), the Cochrane Central Register of Controlled Trials (CENTRAL, the Cochrane Register of Studies, to 4 March 2019), MEDLINE Ovid (1946 to 4 March 2019), and Embase Ovid (15 September 2016 to 4 March 2019). The US National Institutes of Health Trials Registry (ClinicalTrials.gov) and the World Health Organization International Clinical Trials Registry Platform were searched for ongoing trials. No restrictions were placed on language or publication status when searching the electronic databases; however, the search of Embase was restricted to the last six months due to the Cochrane Centralised Search Project to identify all clinical trials and add them to CENTRAL. SELECTION CRITERIA: We included randomised controlled trials (RCTs) (cluster or parallel) that evaluated school dental screening compared with no intervention or with one type of screening compared with another. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. MAIN RESULTS: We included seven trials (five were cluster-RCTs) with 20,192 children who were 4 to 15 years of age. Trials assessed follow-up periods of three to eight months. Four trials were conducted in the UK, two were based in India and one in the USA. We assessed two trials to be at low risk of bias, two trials to be at high risk of bias and three trials to be at unclear risk of bias.None of the trials had long-term follow-up to ascertain the lasting effects of school dental screening.None of the trials reported the proportion of children with untreated caries or other oral diseases, cost effectiveness or adverse events.Four trials evaluated traditional screening versus no screening. We performed a meta-analysis for the outcome 'dental attendance' and found an inconclusive result with high heterogeneity. The heterogeneity was found to be, in part, due to study design (three cluster-RCTs and one individual-level RCT). Due to the inconsistency, we downgraded the evidence to 'very low certainty' and are unable to draw conclusions about this comparison.Two cluster-RCTs (both four-arm trials) evaluated criteria-based screening versus no screening and showed a pooled effect estimate of RR 1.07 (95% CI 0.99 to 1.16), suggesting a possible benefit for screening (low-certainty evidence). There was no evidence of a difference when criteria-based screening was compared to traditional screening (RR 1.01, 95% CI 0.94 to 1.08) (very low-certainty evidence).In one trial, a specific (personalised) referral letter was compared to a non-specific one. Results favoured the specific referral letter with an effect estimate of RR 1.39 (95% CI 1.09 to 1.77) for attendance at general dentist services and effect estimate of RR 1.90 (95% CI 1.18 to 3.06) for attendance at specialist orthodontist services (low-certainty evidence).One trial compared screening supplemented with motivation to screening alone. Dental attendance was more likely after screening supplemented with motivation, with an effect estimate of RR 3.08 (95% CI 2.57 to 3.71) (low-certainty evidence).Only one trial reported the proportion of children with treated dental caries. This trial evaluated a post screening referral letter based on the common-sense model of self-regulation (a theoretical framework that explains how people understand and respond to threats to their health), with or without a dental information guide, compared to a standard referral letter. The findings were inconclusive. Due to high risk of bias, indirectness and imprecision, we assessed the evidence as very low certainty. AUTHORS' CONCLUSIONS: The trials included in this review evaluated short-term effects of screening. We found very low-certainty evidence that is insufficient to allow us to draw conclusions about whether there is a role for traditional school dental screening in improving dental attendance. For criteria-based screening, we found low-certainty evidence that it may improve dental attendance when compared to no screening. However, when compared to traditional screening, there is no evidence of a difference in dental attendance (very low-certainty evidence).We found low-certainty evidence to conclude that personalised or specific referral letters may improve dental attendance when compared to non-specific counterparts. We also found low-certainty evidence that screening supplemented with motivation (oral health education and offer of free treatment) may improve dental attendance in comparison to screening alone. For children requiring treatment, we found very-low certainty evidence that was inconclusive regarding whether or not a referral letter based on the 'common-sense model of self-regulation' was better than a standard referral letter.We did not find any trials addressing possible adverse effects of school dental screening or evaluating its effectiveness for improving oral health.


Assuntos
Cárie Dentária/prevenção & controle , Saúde Bucal , Odontopediatria , Serviços de Odontologia Escolar/métodos , Instituições Acadêmicas , Odontopatias/diagnóstico , Adolescente , Criança , Pré-Escolar , Humanos , Medicina Preventiva , Ensaios Clínicos Controlados Aleatórios como Assunto , Serviços de Odontologia Escolar/estatística & dados numéricos
6.
Neonatal Netw ; 38(2): 80-87, 2019 Mar 01.
Artigo em Inglês | MEDLINE | ID: mdl-31470370

RESUMO

PURPOSE: This evidence-based practice project evaluated the efficacy of a respiratory algorithm administered by specially trained transition nurses on the reduction of preventable NICU admissions for infants experiencing mild respiratory distress during transition. DESIGN: A retrospective chart review compared a cohort of newborn admission rates for seven months before and seven months after initiation of a respiratory algorithm. SAMPLE: Records of infants were included if they were born >35 weeks' gestation, had documented mild respiratory distress after birth, required <48 hours of noninvasive respiratory support, and had a length of stay less than four days. RESULTS: Ninety-six infants (before n = 34, after n = 62) were included. Before implementation of the respiratory algorithm, infants requiring noninvasive respiratory support were admitted to the NICU. Following implementation of the algorithm, NICU admissions for mild respiratory distress significantly decreased (86 percent), despite a concurrent increase in maternal acuity.


Assuntos
Manuseio das Vias Aéreas/enfermagem , Enfermagem Neonatal/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido , Terapia Respiratória/métodos , Algoritmos , Feminino , Idade Gestacional , Humanos , Recém-Nascido , Unidades de Terapia Intensiva Neonatal , Tempo de Internação , Masculino , Gravidade do Paciente , Medicina Preventiva/métodos , Síndrome do Desconforto Respiratório do Recém-Nascido/diagnóstico , Síndrome do Desconforto Respiratório do Recém-Nascido/terapia , Estudos Retrospectivos
8.
Presse Med ; 48(7-8 Pt 1): 756-766, 2019.
Artigo em Francês | MEDLINE | ID: mdl-31307878

RESUMO

Human oncogenic papillomaviruses (HPV) have an increasingly prominent role in the genesis of many cancers. The oncogenic mechanisms associated with HPV are now better known and make it possible to explain the etiopathogenesis of the association. HPV status is now sought for certain cancers and conditions both prognosis and management of patients. Preventive antiviral vaccination has become a real public health issue and aims to effectively reduce the prevalence of cervical, anal and oropharynx cancer, HPV-associated. However, vaccination against HPV still lags behind. The purpose of this review is to redefine the involvement of HPV in several cancers as well as current therapeutic challenges of HPV-related cancers, notably in term of prevention.


Assuntos
Transformação Celular Viral/fisiologia , Papillomaviridae/fisiologia , Infecções por Papillomavirus/prevenção & controle , Medicina Preventiva/métodos , Vacinação , Neoplasias do Ânus/prevenção & controle , Neoplasias do Ânus/virologia , Carcinogênese , Feminino , Humanos , Masculino , Neoplasias Orofaríngeas/prevenção & controle , Neoplasias Orofaríngeas/virologia , Infecções por Papillomavirus/virologia , Vacinas contra Papillomavirus/uso terapêutico , Neoplasias do Colo do Útero/prevenção & controle , Neoplasias do Colo do Útero/virologia , Vacinação/métodos , Vacinação/psicologia , Vacinação/tendências
9.
BMC Cancer ; 19(1): 659, 2019 Jul 04.
Artigo em Inglês | MEDLINE | ID: mdl-31272420

RESUMO

BACKGROUND: In order to maximize later health, there are established components and guidelines for quality follow-up care of breast cancer survivors. However, adherence to quality follow-up in Canada may not be optimal, and may vary by province. We determined and compared the proportion of patients in each province who received adherent and non-adherent surveillance for recurrence, new cancers and late effects, recommended preventive care, and recommended physician visits for comorbidities. METHODS: Cohorts consisted of all adult women diagnosed with incident invasive breast cancer between 2007 and 2010/2012 in four Canadian provinces (British Columbia (BC) N = 9338; Manitoba N = 2688; Ontario N = 23,700; Nova Scotia (NS) N = 2735), identified from provincial cancer registries, alive and cancer-free at 30 months post-diagnosis. Their healthcare utilization was determined from one to 5 years post-treatment, using linked administrative databases. Adherence, underuse, and overuse of recommended services were evaluated yearly and compared using descriptive statistics. RESULTS: In all provinces and follow-up years, the majority of survivors had more than the recommended number of visits to either an oncologist or primary care physician (range 53.8% NS Year 3; 85.8% Ontario Year 4). The proportion of patients with the guideline-recommended number of oncologist visits varied by province (range 29.8% BC Year 5; 74.8% Ontario Year 5), and the proportion of patients with less than the recommended number of specified breast cancer-related visits with either an oncologist or primary care physician ranged from 32.6% (Ontario Year 2) to 84.4% (NS Year 3). Underuse of surveillance breast imaging was identified in NS and BC. The proportion of patients receiving imaging for metastatic disease (not recommended in the guidelines) in BC, Manitoba, and Ontario (not reported in NS) ranged from 20.3% (BC Year 5) to 53.3% (Ontario Year 2). Compliance with recommended physician visits for patients with several chronic conditions was high in Ontario and NS. Preventive care was less than optimal in all provinces with available data. CONCLUSIONS: Quality of breast cancer survivor follow-up care varies among provinces. Results point to exploration of factors affecting differences, province-specific opportunities for care improvement, and the value of administrative datasets for health system assessment.


Assuntos
Neoplasias da Mama/epidemiologia , Neoplasias da Mama/terapia , Doença Crônica/epidemiologia , Fidelidade a Diretrizes , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/terapia , Sobrevivência , Assistência ao Convalescente , Idoso , Canadá/epidemiologia , Sobreviventes de Câncer , Doença Crônica/prevenção & controle , Comorbidade , Assistência à Saúde , Feminino , Humanos , Pessoa de Meia-Idade , Oncologistas , Médicos de Atenção Primária , Guias de Prática Clínica como Assunto , Medicina Preventiva , Estudos Retrospectivos , Cooperação e Adesão ao Tratamento
10.
Cells ; 8(7)2019 07 03.
Artigo em Inglês | MEDLINE | ID: mdl-31277291

RESUMO

Autophagy (self-eating) is a conserved cellular degradation process that plays important roles in maintaining homeostasis and preventing nutritional, metabolic, and infection-mediated stresses. Autophagy dysfunction can have various pathological consequences, including tumor progression, pathogen hyper-virulence, and neurodegeneration. This review describes the mechanisms of autophagy and its associations with other cell death mechanisms, including apoptosis, necrosis, necroptosis, and autosis. Autophagy has both positive and negative roles in infection, cancer, neural development, metabolism, cardiovascular health, immunity, and iron homeostasis. Genetic defects in autophagy can have pathological consequences, such as static childhood encephalopathy with neurodegeneration in adulthood, Crohn's disease, hereditary spastic paraparesis, Danon disease, X-linked myopathy with excessive autophagy, and sporadic inclusion body myositis. Further studies on the process of autophagy in different microbial infections could help to design and develop novel therapeutic strategies against important pathogenic microbes. This review on the progress and prospects of autophagy research describes various activators and suppressors, which could be used to design novel intervention strategies against numerous diseases and develop therapeutic drugs to protect human and animal health.


Assuntos
Autofagia , Doença , Desenho de Drogas , Tratamento Farmacológico/métodos , Humanos , Medicina Preventiva/métodos
12.
Zhonghua Liu Xing Bing Xue Za Zhi ; 40(7): 849-853, 2019 Jul 10.
Artigo em Chinês | MEDLINE | ID: mdl-31357810

RESUMO

Objective: To understand the internship of students majoring in preventive medicine in 6 colleges and universities in China, and provide reference suggestions for the improvement of internship arrangement. Methods: By using the method of combined clustering and convenient sampling, the fifth grades students majoring in preventive medicine in six universities in the eastern, central and western China were surveyed by using questionnaires to collect the information of their attitudes (to) and suggestions for clinical and public health internships. Results: A total of 596 students were surveyed. In terms of the benefits of clinical internship and public health internship, students who thought that the internship was fruitful accounted for >88%, and more students thought that reform is needed in clinical internship compared with public health internship. In clinical internship, the students through that the time arrangement was not appropriate enough (95, 39.58%), the content should be more detailed and in-depth (73, 30.42%) and the content did not conform to the professional direction (54, 22.50%). In public health internship, the students thought that the time arrangement was not appropriate (77, 45.56%), the content should be more detailed and standardized (65, 38.46%) and the types of internship bases should be more diversified (20, 11.83%). Conclusions: The undergraduates majoring in preventive medicine felt to be benefited from clinical practice and public health internships and thought they are of necessity. At the same time, there are still many problems which needs to be improved in the two types of internships. It is necessary to make joint efforts from students, teachers, colleges and practice bases to promote the continuous improvement of undergraduate internship.


Assuntos
Atitude , Internato e Residência , Medicina Preventiva/educação , Estudantes de Ciências da Saúde/psicologia , China , Humanos , Inquéritos e Questionários , Universidades
13.
Cad. Ibero Am. Direito Sanit. (Impr.) ; 8(2): 116-122, abr.-jun.2019.
Artigo em Português | LILACS | ID: biblio-1016305

RESUMO

The anti-vaccination movement has gained worldwide strength despite the undeniable advances in vaccines in drastically reducing the incidence of contagious diseases. The causes for this breakthrough are still issues of discussion and research, but ignorance, ease of dissemination of false information, and the rise of populist policies have been implicated. The major challenge for the future will be the dichotomy between the interest of public health and individual freedoms. (AU).


El movimiento contra la vacunación ha ganado fuerza en todo el mundo a pesar de los innegables avances en las vacunas para reducir drásticamente la incidencia de enfermedades contagiosas. Las causas de este avance aún son temas de discusión e investigación, pero la ignorancia, la facilidad de difusión de información falsa y el auge de las políticas populistas han sido implicados. El principal desafío para el futuro será la dicotomía entre el interés de la salud pública y las libertades individuales. (AU).


O movimento anti-vacinação tem ganhado força no mundo inteiro, apesar dos inquestionáveis avanços obtidos com as vacinas na redução drástica da incidência das doenças contagiosas. As causas para este avanço ainda são temas de discussão e pesquisa, mas a ignorância, a facilidade da disseminação de informações falsas e a ascensão de políticas populistas têm sido implicadas. O grande desafio para o futuro será a dicotomia entre o interesse da saúde pública e as liberdades individuais. (AU).


Assuntos
Medicina Preventiva , Recusa de Vacinação , Movimento contra Vacinação
14.
Bull World Health Organ ; 97(6): 415-422, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31210679

RESUMO

Thailand's policy on universal health coverage (UHC) has made good progress since its inception in 2002. Every Thai citizen is now entitled to essential preventive, curative and palliative health services at all life stages. Like its counterparts elsewhere, however, the policy faces challenges. A predominantly tax-financed system in a nation with a high proportion of people living in poverty will always strive to contain rising costs. Disparities exist among the different health insurance schemes that provide coverage for Thai citizens. National health expenditure is heavily borne by the government, primarily to reduce financial barriers to access for the poor. The population is ageing and the disease profiles of the population are changing alongside the modernization of Thai people's lifestyles. Thailand is now aiming to enhance and sustain its UHC policy. We examine the merits of different policy options and aim to identify the most promising and feasible way to enhance and sustain UHC. We argue that developing the existing primary care system in Thailand has the greatest potential to provide more self-sustaining, efficient, equitable and effective UHC. Primary care needs to move from its traditional role of providing basic disease-based care, to being the first point of contact in an integrated, coordinated, community-oriented and person-focused care system, for which the national health budget should be prioritized.


Assuntos
Acesso aos Serviços de Saúde/economia , Financiamento da Assistência à Saúde , Atenção Primária à Saúde , Cobertura Universal do Seguro de Saúde/economia , Política de Saúde , Humanos , Medicina Preventiva/economia , Medicina Preventiva/métodos , Atenção Primária à Saúde/economia , Impostos , Tailândia
16.
BMC Health Serv Res ; 19(1): 353, 2019 Jun 04.
Artigo em Inglês | MEDLINE | ID: mdl-31164125

RESUMO

BACKGROUND: The Republic of Moldova is faced with a high prevalence of non-communicable diseases (NCDs) related to lifestyle and health behavioural factors. Within the frame of the decentralisation reform, the primary health care system has been tasked to play an important role in the provision of preventative and curative NCD health services. There is however limited evidence available on the actual coverage and quality of care provided. Our paper aims to provide an updated overview of the coverage and quality of service provision in rural and urban regions of Moldova. METHODS: We designed a facility-based survey to measure aspects of coverage and quality of care of NCD services across 20 districts of the Republic of Moldova. This study presents descriptive data on the structural, procedural and clinical aspects of primary healthcare delivery at health centre and family doctor office level. Adjacent private pharmacies were also assessed for the availability of essential NCD medicine. RESULTS: Organised under the WHO Health Systems Framework, our findings highlight that service provision and information were generally the strongest among the six health systems building blocks, with more weaknesses found in the area of the health workforce, medical products, financing, and leadership/governance. Urban facilities generally fared better across all indicators. CONCLUSIONS: The gaps in service provision identified by this study require broad health system improvements to ensure NCD related policies and strategies are embedded in primary health care service provision. This likely calls for stronger coordination and collaboration between the public and private sectors and the different levels of government working towards ensuring universal health coverage in Moldova.


Assuntos
Acesso aos Serviços de Saúde/estatística & dados numéricos , Doenças não Transmissíveis/prevenção & controle , Medicina Preventiva/normas , Atenção Primária à Saúde/normas , Qualidade da Assistência à Saúde/normas , Feminino , Seguimentos , Pesquisa sobre Serviços de Saúde , Humanos , Moldávia , Medicina Preventiva/organização & administração , Atenção Primária à Saúde/organização & administração
17.
BMC Health Serv Res ; 19(1): 358, 2019 Jun 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170990

RESUMO

BACKGROUND: Little is known about the participation of surgeons in preventative health activities in the non-admitted hospital care setting. The aim of this study was to identify which preventive health activities surgeons practice and to explore their attitudes towards preventive health. METHODS: A mixed methods study was conducted using a sequential explanatory design. Quantitative results were obtained from a self-reported clinician survey (n = 16) and a Generalized Estimating Equation was used to assess the relationship between dependent (preventive health practice) and independent (confidence and knowledge in preventive health practice, years of practice, and attitudinal factors) variables. Using a building approach to integration, results from the quantitative analyses informed design of the interview guide. Surgeons' beliefs and attitudes were explored using in-depth, semi structured interviews with a purposeful sample of surgeons (n = 14). Responses were collected, independently coded and analysed using a qualitative descriptive approach. RESULTS: In accordance with a contiguous narrative approach to integration, the quantitative and qualitative findings are reported separately. The clinician survey found that the surgeons carried out preventive health activities at low levels. Preventive health advice was predominantly verbal in nature, and few surgeons provided written material or referred patients to additional services. The GEE analyses indicated that the following factors best predicted the tendency to undertake preventive health activities: years of clinical practice (p = 0.041), and the perceived work priority placed on preventive health (p = 0.008). Interviews generated four themes that influenced the tendency of surgeons to undertake preventive health activities: perceptions of their role in preventive health, perceived motivation of patients, hospital structure, and facilitating factors. In regards to enabling factors that are likely to increase preventive health practice, surgeons unanimously advocated for referral pathways into specialist behaviour change programs that they could facilitate within their relatively brief consulting time. CONCLUSIONS: The findings suggests that the majority of public hospital surgeons engage in routine preventive health advice at a low level. The high volume of non-admitted surgical consultations undertaken annually, coupled with medium to high self-reported knowledge and confidence in addressing behavioural risk factors, support an increased involvement of surgeons in preventive health practice.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Promoção da Saúde/métodos , Padrões de Prática Médica , Medicina Preventiva , Cirurgiões , Estudos de Avaliação como Assunto , Hospitais Públicos , Humanos , Liderança , Medicina Preventiva/métodos
18.
Isr J Health Policy Res ; 8(1): 50, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31171033

RESUMO

BACKGROUND: Preventive medicine and health education are among the strategies used in coping with chronic diseases. However, it is yet to be determined what effect do personal and organizational aspects have on its' implementation in primary care. METHODS: A cross-sectional survey was conducted in order to assess and compare preventive medicine and health education activities in three types of primary care models: solo working independent physicians, nurse-physician collaborations and teamwork (nurses, dietitians and social workers working alongside a physician). Questionnaires were emailed to 1203 health professionals between September and November 2015, working at Maccabi Healthcare Services, the second largest Israeli healthcare organization. Self-reported rates of health education groups conducted, proactive appointments scheduling and self-empowerment techniques use during routine appointments, were compared among the three models. Independent variables included clinic size as well as health professionals' occupation, health behaviors and training. A series of multivariate linear regressions were performed in order to identify predictors of preventive medicine and health education implementation. Computerized health records (CHR) validated our self-report data through data regarding patients' health behaviours and outcomes, including health education group registration, adherence to occult blood tests and influenza vaccinations as well as blood lipid levels. RESULTS: Responders included physicians, nurses, dietitians and social workers working at 921 clinics (n = 516, response rate = 31%). Higher rates of proactive appointments scheduling and health education groups were found in the Teamwork and Collaboration models, compared to the Independent Physician Model. Occupation (nurses and dietitians), group facilitation training and personal screening adherence were identified as preventive medicine and health education implementation predictors. Group registration, occult blood tests, healthy population's well-controlled blood lipids as well as influenza vaccinations among chronically ill patients were all significantly higher in the Teamwork and Collaboration models, compared to the Independent Physician Model. CONCLUSIONS: The Teamwork and Collaboration models presented higher rates of preventive medicine and health education implementation as well as higher rates of patients' positive health behaviours documented in these models. This suggests multidisciplinary primary care models may contribute to population's health by enhancing preventive medicine and health education implementation alongside health professionals' characteristics.


Assuntos
Educação em Saúde/normas , Pessoal de Saúde/educação , Comunicação Interdisciplinar , Medicina Preventiva/normas , Idoso , Estudos Transversais , Feminino , Educação em Saúde/estatística & dados numéricos , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Preventiva/estatística & dados numéricos , Atenção Primária à Saúde/métodos , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos
19.
Plant Foods Hum Nutr ; 74(3): 266-276, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31243622

RESUMO

Herbal teas are used as therapeutic vehicles in many forms of traditional medicine and are a popular global beverage. The purpose of this scoping review was to examine the evidence relating to the clinical efficacy and safety of herbal teas, and to identify the main research themes and gaps in knowledge to inform further work. A scoping review methodology was followed that set out the research question and described the sourcing, selection and analysis of studies. Overall, a total of 145 research publications were retrieved from global bibliographic databases, and after applying exclusion criteria, 21 remained. These studies looked at herbal tea use in female health, diabetes, heart disease and weight loss, with plant species including lavender, chamomile, fenugreek, stinging nettle, spearmint, hibiscus, yerba maté, echinacea and combinations of herbs. Observational studies explored associations between herbal tea consumption and cancer risk, liver health, and the risks linked to the consumption of environmental contaminants in the plant material. Despite plant materials being the basis for drug discovery, and the popularity of herbal teas, the number of articles exploring clinical efficacy and safety is small. In this review we discuss how herbal teas may be beneficial in some areas of clinical and preventative health, and what further research is required to understand whether regular consumption can contribute to healthy living more generally.


Assuntos
Medicina Tradicional , Compostos Fitoquímicos/análise , Plantas Medicinais , Chás de Ervas/análise , Biodiversidade , Humanos , Medicina Preventiva
20.
Zhonghua Yu Fang Yi Xue Za Zhi ; 53(6): 625-627, 2019 Jun 06.
Artigo em Chinês | MEDLINE | ID: mdl-31177762

RESUMO

To investigate the current status of postgraduates training in public health and preventive medicine in China. In this study, a questionnaire survey was conducted among directors of enrollment and teaching in 22 universities with postgraduate admission qualifications in corresponding disciplines nationwide. In 2016, full-time postgraduates were mainly academic masters. In addition to the graduate entrance examination, the common enrollment mode in colleges was to enroll a high qualified student with recommendations from relevant experts or institutions and an exemption from entrance examination (20/22). The emphasis on training contents between academic and public health master was different. Currently, the scale of public health postgraduate enrollment in public health and preventive medicine in China is stable, and the training program is reasonable, but there is an issue of monotonous model and uneven distribution of enrollment.


Assuntos
Currículo , Medicina Preventiva , Saúde Pública , China , Humanos , Medicina Preventiva/educação , Saúde Pública/educação , Inquéritos e Questionários , Universidades
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