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1.
Value Health ; 24(5): 632-640, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33933231

RESUMO

OBJECTIVE: To estimate the overall quality-adjusted life-years (QALYs) gained by averting 1 coronavirus disease 2019 (COVID-19) infection over the duration of the pandemic. METHODS: A cohort-based probabilistic simulation model, informed by the latest epidemiological estimates on COVID-19 in the United States provided by the Centers for Disease Control and Prevention and literature review. Heterogeneity of parameter values across age group was accounted for. The main outcome studied was QALYs for the infected patient, patient's family members, and the contagion effect of the infected patient over the duration of the pandemic. RESULTS: Averting a COVID-19 infection in a representative US resident will generate an additional 0.061 (0.016-0.129) QALYs (for the patient: 0.055, 95% confidence interval [CI] 0.014-0.115; for the patient's family members: 0.006, 95% CI 0.002-0.015). Accounting for the contagion effect of this infection, and assuming that an effective vaccine will be available in 3 months, the total QALYs gains from averting 1 single infection is 1.51 (95% CI 0.28-4.37) accrued to patients and their family members affected by the index infection and its sequelae. These results were robust to most parameter values and were most influenced by effective reproduction number, probability of death outside the hospital, the time-varying hazard rates of hospitalization, and death in critical care. CONCLUSION: Our findings suggest that the health benefits of averting 1 COVID-19 infection in the United States are substantial. Efforts to curb infections must weigh the costs against these benefits.


Assuntos
/prevenção & controle , Custos de Cuidados de Saúde/estatística & dados numéricos , Medicina Preventiva/normas , Anos de Vida Ajustados por Qualidade de Vida , /epidemiologia , Análise Custo-Benefício , Custos de Cuidados de Saúde/tendências , Humanos , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Medicina Preventiva/economia , Medicina Preventiva/métodos , Estados Unidos
2.
Mayo Clin Proc ; 96(4): 1033-1040, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33814072

RESUMO

Breast cancer remains the most common cancer in women in the United States. For certain women at high risk for breast cancer, endocrine therapy (ET) can greatly decrease the risk. Tools such as the Breast Cancer Risk Assessment Tool (or Gail Model) and the International Breast Cancer Intervention Study risk calculator are available to help identify women at increased risk for breast cancer. Physician awareness of family history, reproductive and lifestyle factors, dense breast tissue, and history of benign proliferative breast disease are important when identifying high-risk women. The updated US Preventive Services Task Force and American Society of Clinical Oncology guidelines encourage primary care providers to identify at-risk women and offer risk-reducing medications. Among the various ETs, which include tamoxifen, raloxifene, anastrozole, and exemestane, tamoxifen is the only one available for premenopausal women aged 35 years and older. A shared decision-making process should be used to increase the usage of ET and must be individualized. This individualized approach must account for each woman's medical history and weigh the benefits and risks of ET in combination with the personal values of the patient.


Assuntos
Anastrozol/administração & dosagem , Neoplasias da Mama/prevenção & controle , Antagonistas de Estrogênios/administração & dosagem , Pessoal de Saúde/educação , Medicina Preventiva/educação , Cloridrato de Raloxifeno/administração & dosagem , Moduladores Seletivos de Receptor Estrogênico/administração & dosagem , Tamoxifeno/administração & dosagem , Adulto , Idoso , Idoso de 80 Anos ou mais , Neoplasias da Mama/epidemiologia , Currículo , Tomada de Decisão Compartilhada , Educação Médica Continuada , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Medicina Preventiva/métodos , Medição de Risco , Fatores de Risco , Estados Unidos/epidemiologia
3.
OMICS ; 25(4): 234-241, 2021 04.
Artigo em Inglês | MEDLINE | ID: mdl-33794117

RESUMO

A key lesson emerging from COVID-19 is that pandemic proofing planetary health against future ecological crises calls for systems science and preventive medicine innovations. With greater proximity of the human and animal natural habitats in the 21st century, it is also noteworthy that zoonotic infections such as COVID-19 that jump from animals to humans are increasingly plausible in the coming decades. In this context, glycomics technologies and the third alphabet of life, the sugar code, offer veritable prospects to move omics systems science from discovery to diverse applications of relevance to global public health and preventive medicine. In this expert review, we discuss the science of glycomics, its importance in vaccine development, and the recent progress toward discoveries on the sugar code that can help prevent future infectious outbreaks that are looming on the horizon in the 21st century. Glycomics offers veritable prospects to boost planetary health, not to mention the global scientific capacity for vaccine innovation against novel and existing infectious agents.


Assuntos
/administração & dosagem , Glicômica/organização & administração , Pandemias/prevenção & controle , Zoonoses/epidemiologia , Animais , /prevenção & controle , /biossíntese , Ecossistema , Saúde Global/economia , Saúde Global/tendências , Humanos , Cooperação Internacional , Vacinação em Massa/métodos , Medicina Preventiva/métodos , Glicoproteína da Espícula de Coronavírus/química , Glicoproteína da Espícula de Coronavírus/imunologia , Vacinas Sintéticas/administração & dosagem , Vacinas Sintéticas/biossíntese , Zoonoses/imunologia , Zoonoses/prevenção & controle , Zoonoses/transmissão
4.
Am J Nurs ; 121(4): 25, 2021 04 01.
Artigo em Inglês | MEDLINE | ID: mdl-33755622

RESUMO

Editor's note: The mission of Cochrane Nursing is to provide an international evidence base for nurses involved in delivering, leading, or researching nursing care. Cochrane Corner provides summaries of recent systematic reviews from the Cochrane Library. For more information, see https://nursing.cochrane.org.


Assuntos
Neoplasias/prevenção & controle , Medicina Preventiva/métodos , Chá , Chás Medicinais , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade
5.
Reprod Health ; 18(1): 51, 2021 Feb 28.
Artigo em Inglês | MEDLINE | ID: mdl-33639963

RESUMO

BACKGROUND: FGM/C is a cultural practice associated with adverse health outcomes that involves the partial or complete removal of the external female genitalia or injury to the genitalia. FGM/C is a form of violence against women and girls. There are no laws that specifically outlaw FGM/C in Sri Lanka and no national prevalence data. There is a lack of evidence about this practice to inform prevention efforts required to achieve the Sustainable Development Goal (SDG) target 5.3.2, which focuses on the elimination of all harmful practices, including FGM/C. METHODS: We undertook a qualitative interpretative study to explore the knowledge and perceptions of community members, religious leaders and professionals from the health, legal and community work sectors in five districts across Sri Lanka. We aimed to identify strategies to end this practice. RESULTS: Two-hundred-and twenty-one people participated in focus group discussions and key informant interviews. A template analysis identified five top-level themes: Providers, procedures and associated rituals; demand and decision-making; the role of religion; perceived benefits and adverse outcomes; ways forward for prevention. CONCLUSIONS: This study delivered detailed knowledge of FGM/C related beliefs, perceptions and practitioners and provided opportunities to develop an integrated programming strategy that incorporates interventions across three levels of prevention.


Assuntos
Circuncisão Feminina , Genitália Feminina/lesões , Medicina Preventiva , Adolescente , Adulto , Circuncisão Feminina/efeitos adversos , Circuncisão Feminina/psicologia , Circuncisão Feminina/estatística & dados numéricos , Feminino , Grupos Focais , Genitália Feminina/patologia , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde , Humanos , Entrevistas como Assunto , Masculino , Motivação , Prevalência , Medicina Preventiva/métodos , Medicina Preventiva/normas , Pesquisa Qualitativa , Religião , Sri Lanka/epidemiologia , Adulto Jovem
6.
J Prev Med Public Health ; 54(1): 22-30, 2021 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-33618496

RESUMO

OBJECTIVES: The coronavirus disease 2019 (COVID-19) pandemic is a public health emergency posing unprecedented challenges for health authorities. Social media may serve as an effective platform to disseminate health-related information. This study aimed to assess the extent of social media use, its impact on preventive behavior, and negative health effects such as cyberchondria and information overload. METHODS: A cross-sectional observational study was conducted between June 10, 2020 and August 9, 2020 among people visiting the outpatient department of the authors' institution, and participants were also recruited during field visits for an awareness drive. Questions were developed on preventive behavior, and the Short Cyberchondria Scale and instruments dealing with information overload and perceived vulnerability were used. RESULTS: The study recruited 767 participants with a mean age of about 45 years. Most of the participants (>90%) engaged in preventive behaviors, which were influenced by the extent of information received through social media platforms (ß=3.297; p<0.001) and awareness of infection when a family member tested positive (ß=29.082; p<0.001) or a neighbor tested positive (ß=27.964; p<0.001). The majority (63.0%) of individuals often searched for COVID-19 related news on social media platforms. The mean±standard deviation scores for cyberchondria and information overload were 9.09±4.05 and 8.69±2.56, respectively. Significant and moderately strong correlations were found between cyberchondria, information overload, and perceived vulnerability to COVID-19. CONCLUSIONS: This study provides evidence that the use of social media as an information- seeking platform altered preventive behavior. However, excessive and misleading information resulted in cyberchondria and information overload.


Assuntos
Processamento Eletrônico de Dados/instrumentação , Medicina Preventiva/métodos , Mídias Sociais/instrumentação , Adolescente , Adulto , /prevenção & controle , Estudos Transversais , Processamento Eletrônico de Dados/métodos , Feminino , Humanos , Índia/epidemiologia , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Medicina Preventiva/normas , Medicina Preventiva/estatística & dados numéricos , Saúde Pública , Mídias Sociais/tendências , Inquéritos e Questionários
7.
Nat Commun ; 12(1): 1148, 2021 02 19.
Artigo em Inglês | MEDLINE | ID: mdl-33608511

RESUMO

The overuse of antibiotics is exacerbating the antibiotic resistance crisis. Since this problem is a classic common-goods dilemma, it naturally lends itself to a game-theoretic analysis. Hence, we designed a model wherein physicians weigh whether antibiotics should be prescribed, given that antibiotic usage depletes its future effectiveness. The physicians' decisions rely on the probability of a bacterial infection before definitive laboratory results are available. We show that the physicians' equilibrium decision rule of antibiotic prescription is not socially optimal. However, we prove that discretizing the information provided to physicians can mitigate the gap between their equilibrium decisions and the social optimum of antibiotic prescription. Despite this problem's complexity, the effectiveness of the discretization solely depends on the type of information available to the physician to determine the nature of infection. This is demonstrated on theoretic distributions and a clinical dataset. Our results provide a game-theory based guide for optimal output of current and future decision support systems of antibiotic prescription.


Assuntos
Antibacterianos , Resistência Microbiana a Medicamentos , Teoria do Jogo , Antibacterianos/uso terapêutico , Infecções Bacterianas/tratamento farmacológico , Biologia Computacional , Farmacorresistência Bacteriana , Farmacorresistência Viral , Humanos , Medicina Preventiva/métodos , Viroses
8.
Work ; 68(1): 33-43, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33459678

RESUMO

BACKGROUND: Musculoskeletal and psychosocial problems have tended to increase during the COVID-19 pandemic. OBJECTIVE: To evaluate the changes in musculoskeletal problems and psychosocial status of teachers during the COVID-19 pandemic due to online education and to investigate the effects of preventive telerehabilitation applications for musculoskeletal problems. METHODS: Forty teachers who conducted online education during the pandemic volunteered to participate in the study. All assessments were performed via online methods. The Cornell Musculoskeletal Discomfort Questionnaire (CMDQ), ProFitMap-Neck questionnaire, Oswestry Disability Index (ODI), and Upper Extremity Functional Index (UEFI) were used to evaluate musculoskeletal problems; the Beck Anxiety Inventory (BAI) and the Beck Depression Inventory (BDI) were used to evaluate anxiety and depression, respectively; and the Work-Life Balance Scale (WLBS) was used to evaluate how well individuals achieve this balance. Information about before online education, during online education, and after training was obtained with the assessments. After the first assessment, telerehabilitation, which involved presentations and brochures, was applied to 18 participants willing to participate in the training. RESULTS: The ProFitMap, UEFI, and WLBS scores during the online education decreased significantly, while the scores of the CMDQ, ODI, BDI, and BAI during the online education increased significantly compared to the pre-online education scores (p < 0.05). In addition, the total CMDQ, ProFitMap, and ODI scores improved significantly after the training (p < 0.05). CONCLUSION: Musculoskeletal and psychosocial problems increased in teachers during online education. Preventive telerehabilitation methods will be beneficial for individuals who do not have access to face-to-face physiotherapy.


Assuntos
Educação a Distância/métodos , Doenças Musculoesqueléticas/etiologia , Psicologia , Telerreabilitação/normas , Adulto , /prevenção & controle , Educação a Distância/normas , Ergonomia/métodos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Pandemias/prevenção & controle , Pandemias/estatística & dados numéricos , Medicina Preventiva/instrumentação , Medicina Preventiva/métodos , Escalas de Graduação Psiquiátrica , Inquéritos e Questionários , Telerreabilitação/instrumentação , Telerreabilitação/métodos , Turquia
10.
Crit Care Nurs Q ; 44(1): 128-137, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33234866

RESUMO

The COVID-19 pandemic caused by severe acute respiratory syndrome coronavirus (SARS-CoV-2) remains a serious issue for global health, given widespread infectivity and a high contagion rate. A tremendous amount of data has been generated since it was first identified in December 2019. It is vital to keep up with these data from across the world at a time of uncertainty and continuously evolving guidelines and clinical practice. This review provides an update on recent developments concerning epidemiology, clinical presentation, treatment options, and scientific advancements to combat the COVID-19 pandemic.


Assuntos
/epidemiologia , /terapia , Busca de Comunicante/métodos , Saúde Global/estatística & dados numéricos , Pandemias/prevenção & controle , Medicina Preventiva/métodos , Humanos , Estados Unidos/epidemiologia
11.
Obstet Gynecol ; 136(5): 1074, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-33093424

RESUMO

Travel is an increasingly common aspect of modern life, and the practicing obstetrician-gynecologist needs a good understanding of the health- and safety-related issues it presents for patients. This monograph examines the environmental data that support individual risk assessment and provides guidance on how to eliminate or mitigate those risks, including recommendations for immunization and chemoprophylaxis for women traveling to areas with endemic infectious disease. Management approaches for travel-related diseases, such as traveler's diarrhea, altitude sickness, and location-specific diseases, are reviewed as are special considerations for pregnant and breastfeeding women and women who are attempting pregnancy. Evaluation and management of the returned traveler also is addressed. The recommendations in this document cite resources available from the United States federal government; therefore, they are applicable to women seeking care in the United States.


Assuntos
Medicina Preventiva/métodos , Atenção Primária à Saúde/métodos , Medicina de Viagem/métodos , Doença Relacionada a Viagens , Saúde da Mulher , Adulto , Feminino , Ginecologia/métodos , Humanos , Obstetrícia/métodos , Gravidez , Viagem , Estados Unidos
12.
Pediatr Clin North Am ; 67(5): 923-944, 2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32888690

RESUMO

Although progress had been made in reducing cardiovascular disease (CVD) mortality, the positive trend has reversed in recent years, and CVD remains the most common cause of mortality in US women and men. Youth represent the future of CVD prevention; emerging evidence suggests exposure to risk factors in children contributes to atherosclerosis and results in vascular changes and increased CVD events. The contributors to CVD include those commonly seen in adults. This article reviews hypercholesterolemia, hypertension, obesity, diabetes, and smoking. It discusses the prevalence of each disease, diagnosis, treatment, and cardiovascular complications.


Assuntos
Cardiologia/métodos , Doenças Cardiovasculares/prevenção & controle , Gerenciamento Clínico , Medicina Preventiva/métodos , Criança , Humanos
15.
Front Med ; 14(5): 681-688, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-32651936

RESUMO

Traditional Chinese medicine (TCM), an ancient system of alternative medicine, played an active role in the prevention and control of COVID-19 in China. It improved the clinical symptoms of patients, reduced the mortality rate, improved the recovery rate, and effectively relieved the operating pressure on the national medical system during critical conditions. In light of the current global pandemic, TCM-related measures might open up a new channel in the control of COVID-19 in other countries and regions. Here, we summarize the TCM-related measures that were widely used in China, including TCM guidelines, the Wuchang pattern, mobile cabin hospitals, integrated treatment of TCM and modern medicine for critical patients, and non-medicine therapy for convalescent patients, and describe how TCM effectively treated patients afflicted with the COVID-19. Effective TCM therapies could, therefore, be recommended and practiced based on the existing medical evidence from increased scientific studies.


Assuntos
Betacoronavirus/fisiologia , Controle de Doenças Transmissíveis/métodos , Infecções por Coronavirus , Medicamentos de Ervas Chinesas , Medicina Tradicional Chinesa/métodos , Pandemias , Pneumonia Viral , Medicina Preventiva/métodos , Assistência ao Convalescente/métodos , Assistência ao Convalescente/organização & administração , China/epidemiologia , Infecções por Coronavirus/diagnóstico , Infecções por Coronavirus/tratamento farmacológico , Infecções por Coronavirus/epidemiologia , Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/terapia , Medicamentos de Ervas Chinesas/classificação , Medicamentos de Ervas Chinesas/farmacologia , Humanos , Unidades Móveis de Saúde/organização & administração , Pandemias/prevenção & controle , Assistência ao Paciente/métodos , Pneumonia Viral/diagnóstico , Pneumonia Viral/epidemiologia , Pneumonia Viral/prevenção & controle , Pneumonia Viral/terapia
16.
Artigo em Alemão | MEDLINE | ID: mdl-32355991

RESUMO

Digital technologies increasingly affect our daily lives and interact with our living environment. A high potential for prevention and health promotion is referred to digital interventions. So far, however, there is a lack of well-founded evidence on the effectiveness of such measures. This paper will address the challenges of evidence-based digital interventions in prevention and health promotion. The results are summarised in the form of a narrative review.So far, evidence-based medicine methods have not been sufficiently used in the evaluation of benefits and harms in the field of prevention and health promotion. The reasons for this are found in the complexity of the corresponding measures. This complexity is further increased by digital interventions. Nevertheless, it is urgently recommended to place a stronger focus on evidence-based interventions in order to enable meaningful and comprehensible evaluation procedures with regard to the effectiveness of digital interventions in prevention and health promotion.Digitalisation leads to new demands on prevention and health promotion. A critical perspective on the actual impact of digital interventions and their social implications is needed. The development of a solid knowledge base is necessary in order to promote acceptance of the technologies and to achieve sustainable implementation.


Assuntos
Medicina Baseada em Evidências , Promoção da Saúde/métodos , Medicina Preventiva/métodos , Telemedicina , Alemanha , Educação em Saúde/métodos , Tecnologia
17.
PLoS One ; 15(5): e0231388, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32374729

RESUMO

BACKGROUND: Women with HIV have an elevated risk of HPV infection, and eventually, cervical cancer. Tanzania has a high burden of both HIV and cervical cancer, with an HIV prevalence of 5.5% in women in 2018, and a cervical cancer incidence rate among the highest globally, at 59.1 per 100,000 per year, and an estimated 9,772 cervical cancers diagnosed in 2018. We aimed to quantify the impact that interventions intended to control HIV have had and will have on cervical cancer in Tanzania over a period from 1995 to 2070. METHODS: A deterministic transmission-dynamic compartment model of HIV and HPV infection and natural history was used to simulate the impact of voluntary medical male circumcision (VMMC), anti-retroviral therapy (ART), and targeted pre-exposure prophylaxis (PrEP) on cervical cancer incidence and mortality from 1995-2070. FINDINGS: We estimate that VMMC has prevented 2,843 cervical cancer cases and 1,039 cervical cancer deaths from 1995-2020; by 2070 we predict that VMMC will have lowered cervical cancer incidence and mortality rates by 28% (55.11 cases per 100,000 women in 2070 without VMMC, compared to 39.93 with VMMC only) and 26% (37.31 deaths per 100,000 women in 2070 without VMMC compared to 27.72 with VMMC), respectively. We predict that ART will temporarily increase cervical cancer diagnoses and deaths, due to the removal of HIV death as a competing risk, but will ultimately further lower cervical cancer incidence and mortality rates by 7% (to 37.31 cases per 100,000 women in 2070) and 5% (to 26.44 deaths per 100,000 women in 2070), respectively, relative to a scenario with VMMC but no ART. A combination of ART and targeted PrEP use is anticipated to lower cervical cancer incidence and mortality rates to 35.82 and 25.35 cases and deaths, respectively, per 100,000 women in 2070. CONCLUSIONS: HIV treatment and control measures in Tanzania will result in long-term reductions in cervical cancer incidence and mortality. Although, in the near term, the life-extending capability of ART will result in a temporary increase in cervical cancer rates, continued efforts towards HIV prevention will reduce cervical cancer incidence and mortality over the longer term. These findings are critical background to understanding the longer-term impact of achieving cervical cancer elimination targets in Tanzania.


Assuntos
Infecções por HIV/prevenção & controle , Controle de Infecções , Infecções por Papillomavirus/epidemiologia , Medicina Preventiva , Neoplasias do Colo do Útero/epidemiologia , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Feminino , HIV , Infecções por HIV/epidemiologia , História do Século XX , História do Século XXI , Humanos , Incidência , Controle de Infecções/história , Controle de Infecções/métodos , Controle de Infecções/tendências , Masculino , Pessoa de Meia-Idade , Modelos Teóricos , Mortalidade , Infecções por Papillomavirus/prevenção & controle , Profilaxia Pré-Exposição/métodos , Profilaxia Pré-Exposição/tendências , Medicina Preventiva/história , Medicina Preventiva/métodos , Medicina Preventiva/tendências , Avaliação de Programas e Projetos de Saúde/tendências , Tanzânia/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem
18.
Cochrane Database Syst Rev ; 4: CD012566, 2020 04 09.
Artigo em Inglês | MEDLINE | ID: mdl-32270476

RESUMO

BACKGROUND: Illness-related absenteeism is an important problem among preschool and school children for low-, middle- and high- income countries. Appropriate hand hygiene is one commonly investigated and implemented strategy to reduce the spread of illness and subsequently the number of days spent absent. Most hand hygiene strategies involve washing hands with soap and water, however this is associated with a number of factors that act as a barrier to its use, such as requiring running water, and the need to dry hands after cleaning. An alternative method involves washing hands using rinse-free hand wash. This technique has a number of benefits over traditional hand hygiene strategies and may prove to be beneficial in reducing illness-related absenteeism in preschool and school children. OBJECTIVES: 1. To assess the effectiveness of rinse-free hand washing for reducing absenteeism due to illness in preschool and school children compared to no hand washing, conventional hand washing with soap and water or other hand hygiene strategies. 2. To determine which rinse-free hand washing products are the most effective (if head-to-head comparisons exist), and what effect additional strategies in combination with rinse-free hand washing have on the outcomes of interest. SEARCH METHODS: In February 2020 we searched CENTRAL, MEDLINE, Embase, CINAHL, 12 other databases and three clinical trial registries. We also reviewed the reference lists of included studies and made direct contact with lead authors of studies to collect additional information as required. No date or language restrictions were applied. SELECTION CRITERIA: Randomized controlled trials (RCTs), irrespective of publication status, comparing rinse-free hand wash in any form (hand rub, hand sanitizer, gel, foam etc.) with conventional hand washing using soap and water, other hand hygiene programs (such as education alone), or no intervention. The population of interest was children aged between two and 18 years attending preschool (childcare, day care, kindergarten, etc.) or school (primary, secondary, elementary, etc.). Primary outcomes included child or student absenteeism for any reason, absenteeism due to any illness and adverse skin reactions. DATA COLLECTION AND ANALYSIS: Following standard Cochrane methods, two review authors (out of ZM, CT, CL, CS, TB), independently selected studies for inclusion, assessed risk of bias and extracted relevant data. Absences were extracted as the number of student days absent out of total days. This was sometimes reported with the raw numbers and other times as an incidence rate ratio (IRR), which we also extracted. For adverse event data, we calculated effect sizes as risk ratios (RRs) and present these with 95% confidence intervals (CIs). We used standard methodological procedures expected by Cochrane for data analysis and followed the GRADE approach to establish certainty in the findings. MAIN RESULTS: This review includes 19 studies with 30,747 participants. Most studies were conducted in the USA (eight studies), two were conducted in Spain, and one each in China, Colombia, Finland, France, Kenya, Bangladesh, New Zealand, Sweden, and Thailand. Six studies were conducted in preschools or day-care centres (children aged from birth to < five years), with the remaining 13 conducted in elementary or primary schools (children aged five to 14 years). The included studies were judged to be at high risk of bias in several domains, most-notably across the domains of performance and detection bias due to the difficulty to blind those delivering the intervention or those assessing the outcome. Additionally, every outcome of interest was graded as low or very low certainty of evidence, primarily due to high risk of bias, as well as imprecision of the effect estimates and inconsistency between pooled data. For the outcome of absenteeism for any reason, the pooled estimate for rinse-free hand washing was an IRR of 0.91 (95% CI 0.82 to 1.01; 2 studies; very low-certainty evidence), which indicates there may be little to no difference between groups. For absenteeism for any illness, the pooled IRR was 0.82 (95% CI 0.69 to 0.97; 6 studies; very low-certainty evidence), which indicates that rinse-free hand washing may reduce absenteeism (13 days absent per 1000) compared to those in the 'no rinse-free' group (16 days absent per 1000). For the outcome of absenteeism for acute respiratory illness, the pooled IRR was 0.79 (95% CI 0.68 to 0.92; 6 studies; very low-certainty evidence), which indicates that rinse-free hand washing may reduce absenteeism (33 days absent per 1000) compared to those in the 'no rinse-free' group (42 days absent per 1000). When evaluating absenteeism for acute gastrointestinal illness, the pooled estimate found an IRR of 0.79 (95% CI 0.73 to 0.85; 4 studies; low-certainty evidence), which indicates rinse-free hand washing may reduce absenteeism (six days absent per 1000) compared to those in the 'no rinse-free' group (eight days absent per 1000). There may be little to no difference between rinse-free hand washing and 'no rinse-free' group regarding adverse skin reactions with a RR of 1.03 (95% CI 0.8 to 1.32; 3 studies, 4365 participants; very low-certainty evidence). Broadly, compliance with the intervention appeared to range from moderate to high compliance (9 studies, 10,749 participants; very-low certainty evidence); narrativley, no authors reported substantial issues with compliance. Overall, most studies that included data on perception reported that teachers and students perceived rinse-free hand wash positively and were willing to continue its use (3 studies, 1229 participants; very-low certainty evidence). AUTHORS' CONCLUSIONS: The findings of this review may have identified a small yet potentially beneficial effect of rinse-free hand washing regimes on illness-related absenteeism. However, the certainty of the evidence that contributed to this conclusion was low or very low according to the GRADE approach and is therefore uncertain. Further research is required at all levels of schooling to evaluate rinse-free hand washing regimens in order to provide more conclusive, higher-certainty evidence regarding its impact. When considering the use of a rinse-free hand washing program in a local setting, there needs to be consideration of the current rates of illness-related absenteeism and whether the small beneficial effects seen here will translate into a meaningful reduction across their settings.


Assuntos
Absenteísmo , Higiene das Mãos/métodos , Adolescente , Criança , Pré-Escolar , Gastroenteropatias/epidemiologia , Gastroenteropatias/prevenção & controle , Humanos , Medicina Preventiva/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Doenças Respiratórias/epidemiologia , Doenças Respiratórias/prevenção & controle , Instituições Acadêmicas/estatística & dados numéricos
19.
BMC Cancer ; 20(1): 16, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906955

RESUMO

BACKGROUND: Improved, multimodal treatment strategies have been shown to increase cure rates in cancer patients. Those who survive cancer as a child, adolescent or young adult (CAYA), are at a higher risk for therapy-, or disease-related, late or long-term effects. The CARE for CAYA-Program has been developed to comprehensively assess any potential future problems, to offer need-based preventative interventions and thus to improve long-term outcomes in this particularly vulnerable population. METHODS: The trial is designed as an adaptive trial with an annual comprehensive assessment followed by needs stratified, modular interventions, currently including physical activity, nutrition and psycho-oncology, all aimed at improving the lifestyle and/or the psychosocial situation of the patients. Patients, aged 15-39 years old, with a prior cancer diagnosis, who have completed tumour therapy and are in follow-up care, and who are tumour free, will be included. At baseline (and subsequently on an annual basis) the current medical and psychosocial situation and lifestyle of the participants will be assessed using a survey compiled of various validated questionnaires (e.g. EORTC QLQ C30, NCCN distress thermometer, PHQ-4, BSA, nutrition protocol) and objective parameters (e.g. BMI, WHR, co-morbidities like hyperlipidaemia, hypertension, diabetes), followed by basic care (psychological and lifestyle consultation). Depending on their needs, CAYAs will be allocated to preventative interventions in the above-mentioned modules over a 12-month period. After 1 year, the assessment will be repeated, and further interventions may be applied as needed. During the initial trial phase, the efficacy of this approach will be compared to standard care (waiting list with intervention in the following year) in a randomized study. During this phase, 530 CAYAs will be included and 320 eligible CAYAs who are willing to participate in the interventions will be randomly allocated to an intervention. Overall, 1500 CAYAs will be included and assessed. The programme is financed by the innovation fund of the German Federal Joint Committee and will be conducted at 14 German sites. Recruitment began in January 2018. DISCUSSION: CAYAs are at high risk for long-term sequelae. Providing structured interventions to improve lifestyle and psychological situation may counteract against these risk factors. The programme serves to establish uniform regular comprehensive assessments and need-based interventions to improve long-term outcome in CAYA survivors. TRIAL REGISTRATION: Registered at the German Clinical Trial Register (ID: DRKS00012504, registration date: 19th January 2018).


Assuntos
Assistência ao Convalescente/métodos , Sobreviventes de Câncer/psicologia , Adolescente , Adulto , Assistência ao Convalescente/organização & administração , Criança , Depressão/psicologia , Depressão/terapia , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/complicações , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/prevenção & controle , Exercício Físico/fisiologia , Feminino , Humanos , Estilo de Vida , Masculino , Neoplasias/complicações , Neoplasias/psicologia , Avaliação Nutricional , Medicina Preventiva/métodos , Medicina Preventiva/organização & administração , Fatores de Risco , Inquéritos e Questionários , Fatores de Tempo , Adulto Jovem
20.
Diabetes Care ; 43(3): 563-571, 2020 03.
Artigo em Inglês | MEDLINE | ID: mdl-31882408

RESUMO

OBJECTIVE: Previous randomized trials found that treating periodontitis improved glycemic control in patients with type 2 diabetes (T2D), thus lowering the risks of developing T2D-related microvascular diseases and cardiovascular disease (CVD). Some payers in the U.S. have started covering nonsurgical periodontal treatment for those with chronic conditions, such as diabetes. We sought to identify the cost-effectiveness of expanding periodontal treatment coverage among patients with T2D. RESEARCH DESIGN AND METHODS: A cost-effectiveness analysis was conducted to estimate lifetime costs and health gains using a stochastic microsimulation model of oral health conditions, T2D, T2D-related microvascular diseases, and CVD of the U.S. POPULATION: Model parameters were obtained from the nationally representative National Health and Nutrition Examination Survey (NHANES) (2009-2014) and randomized trials of periodontal treatment among patients with T2D. RESULTS: Expanding periodontal treatment coverage among patients with T2D and periodontitis would be expected to avert tooth loss by 34.1% (95% CI -39.9, -26.5) and microvascular diseases by 20.5% (95% CI -31.2, -9.1), 17.7% (95% CI -32.7, -4.7), and 18.4% (95% CI -34.5, -3.5) for nephropathy, neuropathy, and retinopathy, respectively. Providing periodontal treatment to the target population would be cost saving from a health care perspective at a total net savings of $5,904 (95% CI -6,039, -5,769) with an estimated gain of 0.6 quality-adjusted life years per capita (95% CI 0.5, 0.6). CONCLUSIONS: Providing nonsurgical periodontal treatment to patients with T2D and periodontitis would be expected to significantly reduce tooth loss and T2D-related microvascular diseases via improved glycemic control. Encouraging patients with T2D and poor oral health conditions to receive periodontal treatment would improve health outcomes and still be cost saving or cost-effective.


Assuntos
Diabetes Mellitus Tipo 2/terapia , Angiopatias Diabéticas/prevenção & controle , Modelos Econômicos , Periodontite/terapia , Doenças Vasculares/prevenção & controle , Adulto , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/economia , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Simulação por Computador , Análise Custo-Benefício , Diabetes Mellitus Tipo 2/complicações , Diabetes Mellitus Tipo 2/economia , Diabetes Mellitus Tipo 2/epidemiologia , Angiopatias Diabéticas/epidemiologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/estatística & dados numéricos , Periodontite/complicações , Periodontite/economia , Periodontite/epidemiologia , Medicina Preventiva/economia , Medicina Preventiva/métodos , Medicina Preventiva/estatística & dados numéricos , Anos de Vida Ajustados por Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto/economia , Ensaios Clínicos Controlados Aleatórios como Assunto/estatística & dados numéricos , Estados Unidos/epidemiologia , Doenças Vasculares/economia , Doenças Vasculares/epidemiologia
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