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1.
J Fam Pract ; 70(4): 182-188, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34339361

RESUMO

Assess risk factors, then work to address modifiable ones, such as wearing the right running shoes and building up slowly. Don't let overweight or OA dampen enthusiasm.


Assuntos
Lesões Acidentais/prevenção & controle , Medicina de Família e Comunidade/normas , Guias de Prática Clínica como Assunto , Medicina Preventiva/normas , Corrida/lesões , Corrida/normas , Sapatos/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos
2.
J Fam Pract ; 70(4): 189-204, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-34339362

RESUMO

The Task Force has expanded the age range for screening for hepatitis C virus infection in adolescents and adults, and now endorses behavioral counseling for all adults with any CVD risk factors.


Assuntos
Terapia Comportamental/normas , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/terapia , Hepatite C/diagnóstico , Programas de Rastreamento/normas , Guias de Prática Clínica como Assunto , Medicina Preventiva/normas , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Estados Unidos , Adulto Jovem
3.
Med Arch ; 75(2): 149-153, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34219876

RESUMO

Background: In the early postoperative period after cardiac surgery the heart may be temporarily dysfunctional and prone to arrhythmias due to the phenomenon of myocardial stunning, vasoplegic syndrome, systemic inflammatory response syndrome (SIRS), electrolyte disturbances, operative trauma and myocardial edema. Most cases of cardiac arrest after cardiac surgery are reversible. Objective: To analyse the factors that may influence the outcome of cardiac arrest after adult and pediatric cardiac surgery. Methods: Retrospective analysis that included cardiac surgical procedures (886 adult and 749 pediatric patients) performed during the 18 month period of this study at Queen Alia Heart Institute/ Amman, Jordan. All cardiac arrest events were recorded and analysed. Data was collected on Utstein style templates designed for the purpose of this study. The outcome of cardiac arrest is examined as an early outcome (ROSC or lethal outcome) and late outcome (full recovery, recovery with complications, or in-hospital mortality). Factors that may influence the outcome of cardiac arrest were recorded and statistically analysed. Ethical committee approval obtained. Results: The overall mortality rate was 3.3%. Cardiac arrest occurred in 114 patients (6.97%). The age of patients ranged from 5 days to 82 years and constituted 66 pediatric and 48 adult patients. Most pediatric cardiac arrests manifested as non-shockable rhythms (77%). Most in-hospital cardiac arrests occurred in the intensive care unit (86.5%). The majority of patients were mechanically ventilated at the time of occurrence of arrest (62.5% and 54.5% in adult and pediatric patients, respectively). Average time of cardiopulmonary resuscitation was 32.24 minutes. Overall, CA survival was 20% higher in the paediatric sub-group (full recovery rate of 51.5%). Neurological injury was slightly lower in pediatric than adult cardiac arrest survivals. (2% vs. 3%). Conclusion: Shockable rhythms are more common in adult cardiac arrest, while non-shockable rhythms are more frequent in the pediatric sub-population. Hemodynamic monitoring, witnessed-type of cardiac arrest, non-interrupted cardiac massage, and early recognition of cardiac tamponade are the factors associated with higher rates of survival.


Assuntos
Procedimentos Cirúrgicos Cardíacos/efeitos adversos , Procedimentos Cirúrgicos Cardíacos/mortalidade , Parada Cardíaca/etiologia , Parada Cardíaca/mortalidade , Parada Cardíaca/prevenção & controle , Guias de Prática Clínica como Assunto , Medicina Preventiva/normas , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Período Pós-Operatório , Estudos Retrospectivos , Adulto Jovem
4.
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
COVID-19/prevenção & controle , Custos de Cuidados de Saúde/estatística & dados numéricos , Medicina Preventiva/normas , Anos de Vida Ajustados por Qualidade de Vida , COVID-19/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
5.
Sci Rep ; 11(1): 5304, 2021 03 05.
Artigo em Inglês | MEDLINE | ID: mdl-33674627

RESUMO

We propose a novel data-driven framework for assessing the a-priori epidemic risk of a geographical area and for identifying high-risk areas within a country. Our risk index is evaluated as a function of three different components: the hazard of the disease, the exposure of the area and the vulnerability of its inhabitants. As an application, we discuss the case of COVID-19 outbreak in Italy. We characterize each of the twenty Italian regions by using available historical data on air pollution, human mobility, winter temperature, housing concentration, health care density, population size and age. We find that the epidemic risk is higher in some of the Northern regions with respect to Central and Southern Italy. The corresponding risk index shows correlations with the available official data on the number of infected individuals, patients in intensive care and deceased patients, and can help explaining why regions such as Lombardia, Emilia-Romagna, Piemonte and Veneto have suffered much more than the rest of the country. Although the COVID-19 outbreak started in both North (Lombardia) and Central Italy (Lazio) almost at the same time, when the first cases were officially certified at the beginning of 2020, the disease has spread faster and with heavier consequences in regions with higher epidemic risk. Our framework can be extended and tested on other epidemic data, such as those on seasonal flu, and applied to other countries. We also present a policy model connected with our methodology, which might help policy-makers to take informed decisions.


Assuntos
COVID-19/epidemiologia , Ciência de Dados/métodos , Pandemias/prevenção & controle , COVID-19/prevenção & controle , COVID-19/transmissão , COVID-19/virologia , Geografia , Política de Saúde , Humanos , Itália/epidemiologia , Pandemias/estatística & dados numéricos , Formulação de Políticas , Medicina Preventiva/normas , Medição de Risco/métodos , Fatores de Risco , SARS-CoV-2/patogenicidade , Fatores de Tempo
6.
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
7.
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 , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/transmissão , 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
8.
Euro Surveill ; 26(3)2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33478622

RESUMO

When facing an emerging virus outbreak such as severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2), a quick reaction time is key to control the spread. It takes time to develop antivirals and vaccines, and implement vaccination campaigns. Therefore, preventive measures such as rapid isolation of cases and identification and early quarantine of cases' close contacts-as well as masks, physical distancing, hand hygiene, surface disinfection and air control-are crucial to reduce the risk of transmission. In this context, disinfectants and antiseptics with proven efficacy against the outbreak virus should be used. However, biocidal formulations are quite complex and may include auxiliary substances such as surfactants or emollients in addition to active substances. In order to evaluate disinfectants' efficacy objectively, meaningful efficacy data are needed. Therefore, the European Committee for Standardisation technical committee 216 'Chemical disinfectants and antiseptics' Working Group 1 (medical area) has developed standards for efficacy testing. The European tiered approach grades the virucidal efficacy in three levels, with corresponding marker test viruses. In the case of SARS-CoV-2, disinfectants with proven activity against vaccinia virus, the marker virus for the European claim 'active against enveloped viruses', should be used to ensure effective hygiene procedures to control the pandemic.


Assuntos
Anti-Infecciosos Locais/farmacologia , Anti-Infecciosos Locais/normas , COVID-19/prevenção & controle , Desinfetantes/farmacologia , Desinfetantes/normas , Medicina Preventiva/normas , Viroses/prevenção & controle , Guias como Assunto , Humanos , Pandemias/prevenção & controle , SARS-CoV-2
9.
Clin J Oncol Nurs ; 25(1): 48-55, 2021 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-33480874

RESUMO

BACKGROUND: The COVID-19 pandemic has required healthcare systems to transform the delivery of care. Although the core principles of care for patients with cancer have not changed, this pandemic has led to heightened awareness concerning the fragility of patients with cancer and how healthcare systems can protect them. OBJECTIVES: The aims were to identify and implement inpatient and ambulatory care clinical practice changes during the COVID-19 pandemic, based on defining moments and coping strategies from clinical oncology nurses, advanced practice RNs, nurse leaders, and researchers. METHODS: This article presents a Lean Six Sigma framework, accompanied by numerous rapid cycle tests of change. FINDINGS: The COVID-19 pandemic required clinical healthcare providers at the authors' institution to focus on seven priority areas. Nurses tested and implemented practice changes.


Assuntos
Adaptação Psicológica , Assistência Ambulatorial/normas , COVID-19/enfermagem , Pessoal de Saúde/psicologia , Neoplasias/enfermagem , Enfermagem Oncológica/normas , Medicina Preventiva/normas , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto , SARS-CoV-2 , Estresse Psicológico
10.
Front Public Health ; 8: 572042, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33330317

RESUMO

An outbreak of Severe Acute Respiratory Syndrome Coronavirus 2 started in China's Hubei province at the end of 2019 has rapidly become a pandemic. In Italy, a great number of patients was managed in primary care setting and the role of general practitioners and physicians working in the first-aid emergency medical service has become of utmost importance to coordinate the network between the territory and hospitals during the pandemic. Aim of this manuscript is to provide a guidance model for the management of suspected, probable, or confirmed cases of SARS-CoV-2 infection in the primary care setting, from diagnosis to treatment, applying also the recommendations of the Italian Society of General Medicine. Moreover, this multidisciplinary contribution would analyze and synthetize the preventive measures to limit the spread of SARS-CoV-2 infection in the general population as well as the perspective for vaccines.


Assuntos
COVID-19/prevenção & controle , Surtos de Doenças/prevenção & controle , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto , Medicina Preventiva/normas , Atenção Primária à Saúde/normas , Humanos , Itália
11.
Nurs Clin North Am ; 55(4): 543-556, 2020 12.
Artigo em Inglês | MEDLINE | ID: mdl-33131631

RESUMO

Evidence supports exercise as a first-line option for many chronic diseases. Although recommendations suggest 150 to 300 minutes a week of moderate-intensity or 75 to 150 minutes a week of vigorous-intensity aerobic activity, replacing sedentary behaviors with light-intensity activities reduces risks of all-cause mortality, and cardiovascular disease (CVD) mortality and incidence of CVD and type 2 diabetes mellitus. Exercise has positive effects on brain function, cognition, and depressive symptoms. Based on such evidence, health care providers should incorporate evaluation of physical activity into patient care. Patients should be evaluated for readiness and ability to exercise and encouraged to increase activity level.


Assuntos
Terapia por Exercício/enfermagem , Medicina Preventiva/normas , Terapia por Exercício/tendências , Humanos , Medicina Preventiva/métodos , Medicina Preventiva/tendências , Comportamento Sedentário
12.
South Med J ; 113(10): 475-481, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33005960

RESUMO

OBJECTIVE: To determine the association of utilization of health maintenance tables (HMTs) as a provider reminder tool within the electronic medical record with the completion of women's preventive health services. METHODS: Guidelines from the US Preventive Services Task Force and the Advisory Committee on Immunization Practices were used to create the HMT. The study sample consisted of female patients between 18 and 74 years of age who visited the University of Florida Internal Medicine Clinic at Medical Plaza between February 15, 2016 and June 24, 2016. We determined whether a reminder system was used for each visit and whether the following preventive health services were up to date: breast cancer screening, cervical cancer screening, and human papillomavirus vaccination. χ2 tests of independence were performed to compare the number of up-to-date preventive measures associated with each provider reminder type. RESULTS: We divided the visits into four groups based on the type of provider reminder used: the HMT, the computer-generated reminder .HM, simple annotation, and no reminder. Compared with .HM, no reminder, and all non-HMT, HMT utilization had a statistically significant positive association with the completion of breast and cervical cancer screening and human papillomavirus vaccination. The difference between the HMT and simple annotation groups did not achieve statistical difference, however. CONCLUSIONS: Despite well-established, evidence-based guidelines for screening tests and immunizations effective in reducing cancer-related morbidity and mortality, significant gaps in routine preventive care remain. The HMT may be a provider-friendly and cost-effective reminder tool to enhance the preventive health care of women.


Assuntos
Medicina Preventiva/métodos , Melhoria de Qualidade , Sistemas de Alerta , Saúde da Mulher , Adolescente , Adulto , Idoso , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/normas , Feminino , Humanos , Pessoa de Meia-Idade , Vacinas contra Papillomavirus/uso terapêutico , Medicina Preventiva/normas , Neoplasias do Colo do Útero/diagnóstico , Saúde da Mulher/normas , Adulto Jovem
14.
Pan Afr Med J ; 36: 146, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32874410

RESUMO

This was a cross-sectional study describing HIV testing uptake and ART initiation for pregnant women and HIV-exposed infants after one-off clinical mentorship training in 2013 for nurses in 56 peripheral health-facilities, Zimbabwe. Between 2014-2018, 92% of 106411 pregnant women were HIV tested and 98% of HIV-positive women initiated antiretroviral therapy (ART). There were 15846 HIV-exposed infants, of whom 96% had dried blood spots collected for virologic diagnosis and 51% of those diagnosed HIV-positive initiated ART. In conclusion, this one-off clinical mentorship training in 2013 was associated with consistently high HIV testing and ART initiation in pregnant women and their children.


Assuntos
Educação Continuada em Enfermagem/métodos , Transmissão Vertical de Doenças Infecciosas/prevenção & controle , Tutoria/métodos , Complicações Infecciosas na Gravidez/diagnóstico , Complicações Infecciosas na Gravidez/terapia , Adulto , Fármacos Anti-HIV/uso terapêutico , Estudos Transversais , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Infecções por HIV/transmissão , Instalações de Saúde/estatística & dados numéricos , Humanos , Ciência da Implementação , Recém-Nascido , Doenças do Recém-Nascido/diagnóstico , Doenças do Recém-Nascido/epidemiologia , Doenças do Recém-Nascido/prevenção & controle , Programas de Rastreamento/métodos , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Triagem Neonatal/métodos , Triagem Neonatal/normas , Papel do Profissional de Enfermagem , Participação do Paciente , Gravidez , Complicações Infecciosas na Gravidez/epidemiologia , Cuidado Pré-Natal/métodos , Cuidado Pré-Natal/organização & administração , Cuidado Pré-Natal/normas , Medicina Preventiva/métodos , Medicina Preventiva/organização & administração , Medicina Preventiva/normas , Avaliação de Programas e Projetos de Saúde , Zimbábue/epidemiologia
15.
Sanid. mil ; 76(3): 186-191, jul.-sept. 2020. ilus
Artigo em Espanhol | IBECS | ID: ibc-198584

RESUMO

El Instituto de Medicina Preventiva de la Defensa (IMPDEF) ha jugado un papel importante durante la Operación Balmis en materia de medicina preventiva y salud pública en el ámbito de las Fuerzas Armadas. La finalidad ha sido proporcionar una guía para la vigilancia de casos COVID-19 y adopción de medidas de protección sanitaria de la fuerza, mantener su operatividad y proporcionar información como parte de promoción de la salud. El presente artículo pretende dar a conocer la gestión del COVID-19 realizada desde el IMPDEF en el entorno extrahospitalario de territorio nacional y de las operaciones militares en el exterior, y su evolución durante la Operación Balmis


The Military Institute of Preventive Medicine for the Defence (IMPDEF) has played an important role during Balmis Operation in preventive medicine and public health in the field of the Armed Forces. The aim has been to provide guidance for case surveillance of COVID-19 and the adoption of measures related with force health protection, maintenance of force operativity and provide information as part of medical education. This article aims to present the role of the IMPDEF during the Balmis Operation providing recommendations for public health policy and interventions in the units in Spain and for the deployed forces


Assuntos
Humanos , Medicina Militar/organização & administração , Institutos Governamentais de Pesquisa , Medicina Preventiva/normas , Infecções por Coronavirus/prevenção & controle , Pneumonia Viral/prevenção & controle , Pandemias/prevenção & controle , Promoção da Saúde/organização & administração , Promoção da Saúde/normas , Comportamentos Relacionados com a Saúde , Espanha
17.
J Hosp Infect ; 106(3): 610-612, 2020 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-32781200

RESUMO

This article reports the observed rate of infection with severe acute respiratory syndrome coronavirus-2 in healthcare workers (HCWs) who worked on wards dedicated to care of patients with coronavirus disease 2019 (COVID-19) compared with HCWs who worked on non-COVID-19 wards. The infection rate was significantly higher among HCWs who worked on non-COVID-19 wards (odds ratio 2.3, P=0.005), illustrating the need to strengthen social distancing measures and training.


Assuntos
Infecções por Coronavirus/prevenção & controle , Infecções por Coronavirus/transmissão , Pessoal de Saúde/educação , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Pneumonia Viral/transmissão , Medicina Preventiva/educação , Medicina Preventiva/normas , Distância Psicológica , Adulto , Betacoronavirus , COVID-19 , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Exposição Ocupacional/prevenção & controle , Fatores de Risco , SARS-CoV-2
19.
Rev Epidemiol Sante Publique ; 68(4): 201-214, 2020 Aug.
Artigo em Francês | MEDLINE | ID: mdl-32631663

RESUMO

BACKGROUND: Early childhood caries represent a major public health problem. In addition to their individual impact, the massive social inequalities in oral health that are at the roots and result from the disease have largely underestimated consequences for the child, his family and the community. In response to the question of "how and where to act?", this scoping review identifies the individual characteristics associated with the disease on which it would be possible to act, using appropriate prevention strategies. METHODS: This scoping review is aimed at describing and analyzing available data in the literature on the different factors associated with early childhood caries. RESULTS: The predictors of early childhood caries are represented by mediating (knowledge, attitudes and parents' oral health practices) and moderating (psychosocial parameters, parental health literacy and alcohol consumption) factors. Twenty-eight articles fulfilled the selection criteria, twenty of which studied mediators related to early childhood caries, and fourteen of which dealt with moderators. The lower the parents' level of knowledge and literacy in oral health, the higher a child's dmft index. Additional studies are needed to assess the role of psychosocial parameters. CONCLUSION: Parents' knowledge and oral health literacy are the key predictors to be preferentially targeted in view of reducing social inequalities in health through actions undertaken on a local scale. The prevention of early childhood caries necessitates a combination of generic and targeted interventions.


Assuntos
Cárie Dentária/epidemiologia , Cárie Dentária/etiologia , Cárie Dentária/prevenção & controle , Saúde Bucal , Pais , Criança , Pré-Escolar , Cárie Dentária/diagnóstico , Família , Comportamentos Relacionados com a Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Saúde Bucal/normas , Saúde Bucal/estatística & dados numéricos , Pais/psicologia , Medicina Preventiva/métodos , Medicina Preventiva/normas , Prognóstico , Fatores de Risco , Fatores Socioeconômicos
20.
JAMA Netw Open ; 3(7): e2011677, 2020 07 01.
Artigo em Inglês | MEDLINE | ID: mdl-32716515

RESUMO

Importance: Primary care physicians have limited time to discuss preventive care, but it is unknown how they prioritize recommended services. Objective: To understand primary care physicians' prioritization of preventive services. Design, Setting, and Participants: This online survey was administered to primary care physicians in a large health care system from March 17 to May 12, 2017. Physicians were asked whether they prioritize preventive services and which factors contribute to their choice (5-point Likert scale). Results were analyzed from July 8, 2017, to September 19, 2019. Exposures: A 2 × 2 factorial design of 2 hypothetical patients: (1) a 50-year-old white woman with hypertension, type 2 diabetes, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of breast cancer; and (2) a 45-year-old black man with hypertension, hyperlipidemia, obesity, a 30-pack-year history of smoking, and a family history of colorectal cancer. Two visit lengths (40 minutes vs 20 minutes) were given. Each patient was eligible for at least 11 preventive services. Main Outcomes and Measures: Physicians rated their likelihood of discussing each service during the visit and reported their top 3 priorities for patients 1 and 2. Physician choices were compared with the preventive services most likely to improve life expectancy, using a previously published mathematical model. Results: Of 241 physicians, 137 responded (57%), of whom 74 (54%) were female and 85 (62%) were younger than 50 years. Physicians agreed they prioritized preventive services (mean score, 4.27 [95% CI, 4.12-4.42] of 5.00), mostly by ability to improve quality (4.56 [95% CI, 4.44-4.68] of 5.00) or length (4.53 [95% CI, 4.40-4.66] of 5.00) of life. Physicians reported more prioritization in the 20- vs 40-minute visit, indicating that they were likely to discuss fewer services during the shorter visit (median, 5 [interquartile range {IQR}, 3-8] vs 11 [IQR, 9-13] preventive services for patient 1, and 4 [IQR, 3-6] vs 9 [IQR, 8-11] for patient 2). Physicians reported similar top 3 priorities for both patients: smoking cessation, hypertension control, and glycemic control for patient 1 and smoking cessation, hypertension control, and colorectal cancer screening for patient 2. Physicians' top 3 priorities did not usually include diet and exercise or weight loss (ranked in their top 3 recommendations for either patient by only 48 physicians [35%]), although these were among the 3 preventive services most likely to improve life expectancy based on the mathematical model. Conclusions and Relevance: In this survey study, physicians prioritized preventive services under time constraints, but priorities did not vary across patients. Physicians did not prioritize lifestyle interventions despite large potential benefits. Future research should consider whether physicians and patients would benefit from guidance on preventive care priorities.


Assuntos
Prioridades em Saúde/normas , Médicos/normas , Medicina Preventiva/métodos , Adulto , Competência Clínica/normas , Comorbidade , Atenção à Saúde/métodos , Atenção à Saúde/normas , Atenção à Saúde/tendências , Feminino , Prioridades em Saúde/tendências , Humanos , Masculino , Pessoa de Meia-Idade , Médicos/psicologia , Médicos/estatística & dados numéricos , Médicos de Atenção Primária/normas , Médicos de Atenção Primária/tendências , Medicina Preventiva/normas , Medicina Preventiva/tendências , Fatores de Tempo
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