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2.
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
5.
Mil Med ; 184(5-6): e183-e191, 2019 05 01.
Artigo em Inglês | MEDLINE | ID: mdl-30793212

RESUMO

INTRODUCTION: The division psychiatrist has been a bedrock U.S. Army institution for nearly 100 years. The role of the position in combat is well established, but its role in garrison has historically been less well defined. Prevention of behavioral health casualties has long been a governing objective of the division psychiatrist and forms the cornerstone of the behavioral health (BH) readiness concept. Accordingly, the Army's increased emphasis on readiness mandates that the division psychiatrist maximize BH force readiness through applied prevention methods. This process begins in garrison, and the crucible of recent protracted conflict has yielded effective BH screening principles applied in that environment. Despite this achievement, an evolving operational environment threatens the blanket effectiveness of BH screening and prevention in garrison. This article examines the historical evolution of the division psychiatrist's role in garrison, elucidates division psychiatry BH readiness principles in garrison, and expands on previously documented division psychiatry led efforts to maximize BH readiness levels. MATERIALS AND METHODS: A historical review of the division psychiatrist was conducted in order to analyze the role of the position in BH prevention operations. Identified division psychiatry preventive lessons are leveraged against current BH readiness challenges resulting in proposed solutions from a division psychiatry perspective. RESULTS: The historical trajectory of the division psychiatrist's role in garrison prevention operations has advanced significantly in the last 17 years. With the advent of evidence-based BH readiness findings, the division psychiatrist's garrison readiness duties have expanded to include analysis of unit BH readiness levels. By applying pre-deployment screening principles in new ways to existing BH readiness platforms, the division psychiatrist can analyze BH readiness levels much earlier than immediately prior to deployment. The resultant BH readiness feedback allows for individualized readiness improvements for the BH systems that serve Army units. The division psychiatrist is the natural proponent of such readiness efforts, and will require staff officer, consultant, liaison, and trainer skill sets in order to be successful. CONCLUSIONS: The division psychiatrist's role must adapt to a changing operational environment in order to preserve and build on historical successes. The recommended end state would see the division psychiatrist maintaining a robust pre/post-deployment BH screening process and organizing the regular analysis of BH readiness levels to optimize existing BH clinical platforms. Systematically pursued, this would not only maximize BH readiness, but dramatically enhance safety and the provision of resources towards soldier health and welfare across the Army. The division psychiatrist should lead this effort.


Assuntos
Militares/psicologia , Medicina Preventiva/métodos , Psiquiatria/métodos , Humanos , Transtornos Mentais/diagnóstico , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Militares/estatística & dados numéricos , Medicina Preventiva/normas , Medicina Preventiva/tendências , Papel Profissional , Psiquiatria/normas , Psiquiatria/tendências
9.
Diabetes ; 67(7): 1211-1215, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29934364

RESUMO

Very recently one of the largest type 1 diabetes prevention trials using daily administration of oral insulin or placebo was completed. After 9 years of study enrollment and follow-up, the randomized controlled trial failed to delay the onset of clinical type 1 diabetes, which was the primary end point. The unfortunate outcome follows the previous large-scale trial, the Diabetes Prevention Trial-Type 1 (DPT-1), which again failed to delay diabetes onset with oral insulin or low-dose subcutaneous insulin injections in a randomized controlled trial with relatives at risk for type 1 diabetes. These sobering results raise the important question, "Where does the type 1 diabetes prevention field move next?" In this Perspective, we advocate for a paradigm shift in which smaller mechanistic trials are conducted to define immune mechanisms and potentially identify treatment responders. The stage is set for these interventions in individuals at risk for type 1 diabetes as Type 1 Diabetes TrialNet has identified thousands of relatives with islet autoantibodies and general population screening for type 1 diabetes risk is under way. Mechanistic trials will allow for better trial design and patient selection based upon molecular markers prior to large randomized controlled trials, moving toward a personalized medicine approach for the prevention of type 1 diabetes.


Assuntos
Diabetes Mellitus Tipo 1/tratamento farmacológico , Hipoglicemiantes/administração & dosagem , Insulina/administração & dosagem , Medicina Preventiva , Administração Oral , Ensaios Clínicos como Assunto/história , Ensaios Clínicos como Assunto/métodos , Diabetes Mellitus Tipo 1/sangue , História do Século XX , História do Século XXI , Humanos , Hipoglicemiantes/efeitos adversos , Insulina/efeitos adversos , Medicina Preventiva/história , Medicina Preventiva/métodos , Medicina Preventiva/tendências , Falha de Tratamento
10.
J Med Ethics ; 44(10): 685-689, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29907579

RESUMO

Mobile health (mHealth) is rapidly being implemented and changing our ways of doing, understanding and organising healthcare. mHealth includes wearable devices as well as apps that track fitness, offer wellness programmes or provide tools to manage chronic conditions. According to industry and policy makers, these systems offer efficient and cost-effective solutions for disease prevention and self-management. While this development raises many ethically relevant questions, so far mHealth has received only little attention in medical ethics. This paper provides an overview of bioethical issues raised by mHealth and aims to draw scholarly attention to the ethical significance of its promises and challenges. We show that the overly positive promises of mHealth need to be nuanced and their desirability critically assessed. Finally, we offer suggestions to bioethicists to engage with this emerging trend in healthcare to develop mHealth to its best potential in a morally sound way.


Assuntos
Assistência à Saúde/tendências , Medicina Preventiva/tendências , Autocuidado/ética , Telemedicina , Bioética , Análise Custo-Benefício , Assistência à Saúde/economia , Assistência à Saúde/ética , Humanos , Medicina Preventiva/economia , Medicina Preventiva/ética , Autocuidado/economia , Telemedicina/economia , Telemedicina/ética , Telemedicina/tendências
11.
Diabetes ; 67(7): 1216-1225, 2018 07.
Artigo em Inglês | MEDLINE | ID: mdl-29769238

RESUMO

The early to mid-1980s were an inflection point in the history of type 1 diabetes research. Two landmark events occurred: the initiation of immune-based interventions seeking to prevent type 1 diabetes and the presentation of an innovative model describing the disorder's natural history. Both formed the basis for hundreds of subsequent studies designed to achieve a dramatic therapeutic goal-a means to prevent and/or reverse type 1 diabetes. However, the need to screen large numbers of individuals and prospectively monitor them using immunologic and metabolic tests for extended periods of time suggested such efforts would require a large collaborative network. Hence, the National Institutes of Health formed the landmark Diabetes Prevention Trial-Type 1 (DPT-1) in the mid-1990s, an effort that led to Type 1 Diabetes TrialNet. TrialNet studies have helped identify novel biomarkers; delineate type 1 diabetes progression, resulting in identification of highly predictable stages defined by the accumulation of autoantibodies (stage 1), dysglycemia (stage 2), and disease meeting clinical criteria for diagnosis (stage 3); and oversee numerous clinical trials aimed at preventing disease progression. Such efforts pave the way for stage-specific intervention trials with improved hope that a means to effectively disrupt the disorder's development will be identified.


Assuntos
Pesquisa Biomédica/organização & administração , Ensaios Clínicos como Assunto , Diabetes Mellitus Tipo 1/terapia , Biomarcadores/análise , Pesquisa Biomédica/métodos , Ensaios Clínicos como Assunto/história , Ensaios Clínicos como Assunto/métodos , Diabetes Mellitus Tipo 1/diagnóstico , Diabetes Mellitus Tipo 1/patologia , Progressão da Doença , Descoberta de Drogas/história , Descoberta de Drogas/tendências , História do Século XX , História do Século XXI , Humanos , Planejamento de Assistência ao Paciente , Medicina de Precisão/métodos , Medicina de Precisão/tendências , Medicina Preventiva/história , Medicina Preventiva/métodos , Medicina Preventiva/tendências , Indução de Remissão , Terapias em Estudo/métodos , Terapias em Estudo/tendências , Resultado do Tratamento
16.
Tunis Med ; 96(10-11): 584-589, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30746650

RESUMO

The fight against tuberculosis remains a priority for world leaders: a re-emerging disease in developed countries, endemic elsewhere, it was declared in 1993, as a "world emergency" by the World Health Organization (WHO). The aim of programs is to prevent infection from spreading and perpetuating; the recommended strategies were the subject of common consent by expert committees convened by international agencies, primarily the WHO. As a result, programs of the Maghreb countries have great similarities. Though the regression in cases's number, especially primary and post-primary forms, as well as extensive, deleterious pulmonary tuberculosis in adults, the endemic persists. The proportion of extra-pulmonary tuberculosis (PET) is high. Control of "contacts" would be lacking or delayed in almost half of the cases. The cover by an effective treatment of these cases in Libya and in Mauritania stays below the required 85 %. Taken as a whole, the constituent countries of the Maghreb entity count approximately 78 000 tuberculosis patients for a population close to 100 million inhabitants, with an incidence rate of 76 for 100 000. Reducing the incidence of tuberculosis by 90 % and the mortality by 95%, to ensure that by the end of 2035 tuberculosis is no longer a public health problem is a goal within the reach of Maghreb countries. It can be postulated that by this deadline, the conditions for success will be met.


Assuntos
Erradicação de Doenças , Tuberculose/prevenção & controle , África do Norte/epidemiologia , Antituberculosos/uso terapêutico , Erradicação de Doenças/métodos , Erradicação de Doenças/organização & administração , Erradicação de Doenças/normas , Erradicação de Doenças/tendências , História do Século XX , História do Século XXI , Humanos , Incidência , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Controle de Infecções/normas , Controle de Infecções/tendências , Objetivos Organizacionais , Medicina Preventiva/organização & administração , Medicina Preventiva/normas , Medicina Preventiva/tendências , Tuberculose/epidemiologia , Tuberculose/história , Tuberculose/terapia , Vacinas contra a Tuberculose/uso terapêutico , Tuberculose Pulmonar/tratamento farmacológico , Organização Mundial da Saúde
18.
Aust J Gen Pract ; 47(12): 842-845, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-31212401

RESUMO

Background and objective: It is helpful for general practitioners (GPs) and their patients to understand the amount of health benefit expected from different preventive activities to enable a thoughtful choice of which to adopt first. The aim of this article is to illustrate how it might be possible to quantify the mortality benefit for cancer screening, quitting smoking, losing weight and treating lipids, which are preventive activities from The Royal Australian College of General Practitioners' (RACGP's) Guidelines for preventive activities in general practice (Red Book). Methods: A sample of common preventive activities was taken, with an outcome for each selected for fair comparison, and benefits and harms were estimated. Results: For a man aged 50 years, the benefit in terms of reduced risk of dying is greatest for quitting smoking (at 24 fewer deaths/1000/decade), which is approximately 10 times the benefit of lowering lipids in a man with metabolic syndrome and about 50 times greater than from participating in regular colorectal cancer screening. Benefits for women are generally lower, as their baseline risk is lower. Discussion: It is feasible to quantify the benefits of some preventive activities, although estimating them is not straightforward and requires several assumptions. Nevertheless, extending estimates such as these to the items in the RACGP's Red Book would assist GPs and their patients' preventive activity prioritisation.


Assuntos
Programas de Rastreamento/efeitos adversos , Medicina Preventiva/normas , Adulto , Idoso , Austrália/epidemiologia , Feminino , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Medicina Preventiva/métodos , Medicina Preventiva/tendências , Fumar/efeitos adversos , Fumar/epidemiologia
19.
Evid. actual. práct. ambul ; 21(1): 2-3, 2018. ilus.
Artigo em Espanhol | LILACS | ID: biblio-1021394

RESUMO

Se denomina apoyo social (AS) a la información y/o ayuda que recibe o percibe recibir una persona, con repercusión conductual y emocional. El AS estructural se refiere a los aspectos objetivos y/o cuantitativos de la red social, mientras que el funcional hace hincapié en los efectos que generan en un sujeto la conservación de su relaciones sociales. Se denomina AS objetivo a los recursos, las provisiones y las transacciones reales a los que las personas pueden recurrir. El AS percibido integra aspectos subjetivos de apoyo social y se centra en lo que percibe la persona en cuestión respecto de la ayuda con la que cree contar, existiendo creciente evidencia de su importancia pronóstica a través de caminos causales conductuales, psicológicos y fisiológicos. (AU)


Social support (AS) includes information and/or help received or perceived by a person, with behavioral and emotional conse-quences. Structural AS refers to objective and/or quantitative aspects of the social network, while functional AS emphasizes the effects generated by the preservation of social relations.Objective AS means resources, provisions and actual transactions to which people can turn. Perceived AS integrates subjective aspects of social support and focuses on what the person in question feels with respect to the help he or she believes they have; and there is growing evidence of its prognostic importance through behavioral psychological and physiological causal paths. (AU)


Assuntos
Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Isolamento Social/psicologia , Apoio Social , Envelhecimento Saudável/psicologia , Promoção da Saúde/tendências , Relações Interpessoais , Serviços Preventivos de Saúde , Qualidade de Vida , Autoimagem , Grupos de Autoajuda/tendências , Comportamentos Relacionados com a Saúde , Medicina Preventiva/tendências , Fatores de Risco , Grupo Social , Prevenção de Doenças , Envelhecimento Saudável/fisiologia , Comportamento de Ajuda
20.
Gesundheitswesen ; 79(11): 936-939, 2017 Nov.
Artigo em Alemão | MEDLINE | ID: mdl-29172223

RESUMO

There is a considerable need for action to systematically strengthen public health in Germany by increasing public responsibility for health. A Good Governance approach for health has not yet been developed. The main areas of action would be the establishment of a health impact assessment for proposed legislation, the expansion of public health services and a new role for structural interventions for disease prevention and health promotion. It is also necessary to focus government action on the provision of public health services and - related to that - on strengthening the municipal level as a relevant decision-making structure for health.


Assuntos
Governança Clínica/tendências , Comportamentos Relacionados com a Saúde , Programas Nacionais de Saúde/tendências , Saúde Pública/tendências , Responsabilidade Social , Berlim , Previsões , Alemanha , Necessidades e Demandas de Serviços de Saúde/tendências , Indicadores Básicos de Saúde , Humanos , Medicina Preventiva/tendências
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