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1.
BMC Infect Dis ; 20(1): 299, 2020 Apr 22.
Artigo em Inglês | MEDLINE | ID: mdl-32321442

RESUMO

BACKGROUND: Sexualized drug use (SDU) refers to use of any psychoactive substance before/during sexual intercourse. Chemsex is a subset of SDU, which is defined as the use of some specific psychoactive substances (methamphetamine, mephedrone, γ-hydroxybutyrate, ketamine and cocaine) before/during sexual intercourse. SDU and chemsex are prevalent among gay, bisexual and other men who have sex with men (GBMSM). This study investigated uptake and willingness to use pre-exposure prophylaxis (PrEP) among a sample of GBMSM in Hong Kong with experience of SDU in the past year. METHODS: A total of 600 GBMSM were recruited by convenient sampling through outreaching in gay venues, online recruitment and peer referral. Participants completed a cross-sectional anonymous telephone interview. This study was based on a subsample of 580 GBMSM self-reported as HIV negative/unknown sero-status. RESULTS: Of the participants, 82 (14.1%) and 37 (6.4%) had experience of SDU and chemsex in the past year. The prevalence of PrEP uptake was 4.0% among all participants and 14.6% among those with experience of SDU in the past year. Among GBMSM with experience of SDU in the past year who were not on PrEP (n = 70), 67.1% were willing to use daily oral PrEP in the next 6 months. Multivariate logistic regression models showed that positive attitudes toward PrEP (AOR: 2.37, 95%CI: 1.47, 3.82), perceived support from significant others to use PrEP (AOR: 9.67, 95%CI: 2.95, 31.71), and perceived behavioral control of using PrEP (AOR: 19.68, 95%CI: 5.44, 71.26) were significantly associated with higher willingness to use PrEP. CONCLUSION: GBMSM with experience of recent SDU are potentially good candidates of PrEP implementation. This group of GBMSM reported high prevalence of uptake and willingness to use PrEP. Perceptions related to PrEP based on the Theory of Planned Behavior were significantly associated with willingness to use PrEP.


Assuntos
Homossexualidade Masculina/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Profilaxia Pré-Exposição/métodos , Psicotrópicos/uso terapêutico , Minorias Sexuais e de Gênero/estatística & dados numéricos , Doenças Sexualmente Transmissíveis/prevenção & controle , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Volição , Adolescente , Adulto , Atitude Frente a Saúde , Bissexualidade/psicologia , Bissexualidade/estatística & dados numéricos , China/epidemiologia , Estudos Transversais , Infecções por HIV/epidemiologia , Infecções por HIV/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Homossexualidade Masculina/psicologia , Hong Kong/epidemiologia , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Profilaxia Pré-Exposição/estatística & dados numéricos , Prevalência , Comportamento Sexual/fisiologia , Comportamento Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Doenças Sexualmente Transmissíveis/epidemiologia , Inquéritos e Questionários , Volição/fisiologia , Adulto Jovem
2.
Bull Cancer ; 107(3): 322-327, 2020 Mar.
Artigo em Francês | MEDLINE | ID: mdl-32061377

RESUMO

Cervical cancer screening is considered one of the most significant public health interventions that can reduce not only the incidence, but also the mortality of the disease. One of the most important factors for screening effectiveness is coverage defined as the number of women tested within a recommended interval. In the first years of the cervical screening, the participation rate in National Screening Program in Romania was 14.2% with slight difference in different region of the country. In the northeastern part of the country, in the first four years of the program, the rate was 16.9% with an alarmingly continuous decrease. Thus, increasing the rate of uptake of cervical screening is essential. The policy-makers should take new measures to increase women's participation in this screening program. The objective of this paper was to review situation of the screening program and to identify gaps and needs in the system and to bring or suggest solution.


Assuntos
Detecção Precoce de Câncer/métodos , Programas de Rastreamento/métodos , Participação do Paciente/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Neoplasias do Colo do Útero/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Detecção Precoce de Câncer/tendências , Feminino , Educação em Saúde/métodos , Humanos , Disseminação de Informação , Programas de Rastreamento/organização & administração , Programas de Rastreamento/estatística & dados numéricos , Programas de Rastreamento/tendências , Infecções por Papillomavirus/diagnóstico , Infecções por Papillomavirus/prevenção & controle , Vacinas contra Papillomavirus/administração & dosagem , Participação do Paciente/tendências , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Romênia/epidemiologia , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/mortalidade , Neoplasias do Colo do Útero/virologia
3.
PLoS One ; 15(2): e0229284, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32101580

RESUMO

BACKGROUND: Limited evidence exists on the treatment outcome and factors that are associated with the duration from the initiation of treatment to death or treatment failure in children with drug resistant tuberculosis (DR-TB). Thus, we aimed to determine the proportion of treatment enrollment, status of treatment outcome and determine factors that are associated with the duration from treatment initiation to death or treatment failure in children treated for DR-TB in Ethiopia. METHODS: We conducted a retrospective cohort study in children younger than 15 years old who were treated for DR-TB from February 2009 to February 2019 in Ethiopia. We collected data on socio-demographic and clinical characteristics from clinical charts, registration books and laboratory result reports on 155 children. Proportion of enrollment to the treatment was calculated by dividing the total number of children who were receiving the treatment by the total number of DR-TB patients treated during the specified years. We used Cox proportional hazard models to determine factors that were associated with the duration from the beginning of the treatment to death or treatment failure. Data was analyzed using STATA version 14. RESULTS: Of the 3,478 DR-TB patients enrolled into the treatment and fulfilling our inclusion criteria during the past ten years, 155 (4.5%) were children. Of the 155 children, 75 (48.4%) completed the treatment and 51 (32.9%) were cured. Furthermore, 18 (11.6%) children were died, seven (4.5%) lost to follow up and treatment of four (2.6%) children was failed. The overall treatment success was 126 (81.3%). Age younger than 5 years old [Adjusted Hazard Ratio (AHR) = 3.2, 95%CI (1.2-8.3)], HIV sero-reactivity [AHR = 5.3, 95%CI (1.8-14.9)] and being anemic [AHR = 4.3, 95%CI (1.8-10.3)] were significantly associated with the duration from the enrollment into the treatment to death or treatment failure. CONCLUSION: In this study, the proportion of children enrolled into DR-TB treatment was lower than the proportion of adults enrolled to the treatment (4.5% in children versus 95.5% in adults) in last ten years. Our findings also suggest that children with DR-TB can be successfully treated with standardized long term regimen. Further prospective cohort study is required to investigate factors contributing to death or treatment failure.


Assuntos
Antituberculosos/uso terapêutico , Mycobacterium tuberculosis/efeitos dos fármacos , Participação do Paciente/estatística & dados numéricos , Tuberculose Resistente a Múltiplos Medicamentos/tratamento farmacológico , Adolescente , Criança , Pré-Escolar , Feminino , Seguimentos , Humanos , Lactente , Masculino , Mycobacterium tuberculosis/isolamento & purificação , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento , Tuberculose Resistente a Múltiplos Medicamentos/epidemiologia , Tuberculose Resistente a Múltiplos Medicamentos/microbiologia
4.
South Med J ; 113(2): 81-86, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-32016438

RESUMO

OBJECTIVES: To examine the prevalence of self-reported aerobic leisure-time physical activity (LTPA) and muscle-strengthening activity (MSA) participation using a representative sample of US adults (18 years old and older) with a seizure disorder or epilepsy. METHODS: Data from the 2010, 2013, and 2015 National Health Interview Survey cycles were used to examine the prevalence and odds of meeting the 2018 PA guidelines with a nationally representative sample of US adults. Descriptive analyses and logistic regression were used in calculating estimates. RESULTS: Overall, the prevalence of adults with a seizure disorder or epilepsy reporting no (0 min), insufficient (<150 min), sufficient (150-300 min [meets recommendations]), or high volumes of LTPA (>300 min [meets recommendations]) were 45.1%, 20.0%, 10.8%, and 24.1% (P < 0.001), respectively, and had a 43% (odds ratio 0.57, 95% confidence interval 0.50-0.66) lower odds of meeting the 2018 federal guidelines for aerobic LTPA. In addition, 17.7% of adults with a seizure disorder reported meeting the MSA recommendation and were 32% (odds ratio 0.68, 95% confidence interval 0.57-0.80) less likely to preform MSA ≥2 days/week (P < 0.05). CONCLUSIONS: Adults reporting a seizure disorder or epilepsy also indicate their ability to participate in both LTPA and MSA; however, this population was found to have a significantly lower odds of meeting current federal aerobic LTPA and MSA recommendations.


Assuntos
Epilepsia/psicologia , Exercício Físico/psicologia , Participação do Paciente/estatística & dados numéricos , Treinamento de Resistência/estatística & dados numéricos , Adulto , Estudos Transversais , Epilepsia/terapia , Feminino , Inquéritos Epidemiológicos , Humanos , Atividades de Lazer , Modelos Logísticos , Masculino , Razão de Chances , Prevalência , Autorrelato
5.
BMC Health Serv Res ; 20(1): 61, 2020 Jan 28.
Artigo em Inglês | MEDLINE | ID: mdl-31992271

RESUMO

BACKGROUND: Patient-centred care is an essential component of quality of health care. We hypothesize that integration of a mental health care package into versatile first-line health care services can strengthen patient participation, an important dimension of patient-centred care. The objective of this study is to analyse whether consultations conducted by providers in facilities that integrated mental health care score higher in terms of patient participation. METHODS: This study was conducted in Guinea in 12 not-for-profit health centres, 4 of which had integrated a mental health care package (MH+) and 8 had not (MH-). The study involved 450 general curative consultations (175 in MH+ and 275 in MH- centres), conducted by 18 care providers (7 in MH+ and 11 in MH- centres). Patients were interviewed after the consultation on how they perceived their involvement in the consultation, using the Patient Participation Scale (PPS). The providers completed a self-administered questionnaire on their perception of patient's involvement in the consultation. We compared scores of the PPS between MH+ and MH- facilities and between patients and providers. RESULTS: The mean PPS score was 24.21 and 22.54 in MH+ and MH- health centres, respectively. Participation scores depended on both care providers and the health centres they work in. The patients consulting an MH+ centre were scoring higher on patient participation score than the ones of an MH- centre (adjusted odds ratio of 4.06 with a 95% CI of 1.17-14.10, p = 0.03). All care providers agreed they understood the patients' concerns, and patients shared this view. All patients agreed they wanted to be involved in the decision-making concerning their treatment; providers, however, were reluctant to do so. CONCLUSION: Integrating a mental health care package into versatile first-line health services can promote more patient-centred care.


Assuntos
Serviços de Saúde Mental/organização & administração , Organizações sem Fins Lucrativos/organização & administração , Participação do Paciente/estatística & dados numéricos , Setor Privado/organização & administração , Adolescente , Adulto , Criança , Pré-Escolar , Feminino , Guiné , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/organização & administração , Relações Médico-Paciente , Pesquisa Qualitativa , Encaminhamento e Consulta , Adulto Jovem
6.
PLoS One ; 15(1): e0226870, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31905209

RESUMO

BACKGROUND: PositiveLinks (PL) is a smartphone-based platform designed in partnership with people living with HIV (PLWH) to improve engagement in care. PL provides daily medication reminders, check-ins about mood and stress, educational resources, a community message board, and an ability to message providers. The objective of this study was to evaluate the impact of up to 24 months of PL use on HIV viral suppression and engagement in care and to examine whether greater PL use was associated with improved outcomes. SETTING: This study occurred between September 2013 and March 2017 at a university-based Ryan White HIV clinic. METHODS: We assessed engagement in care and viral suppression from study baseline to the 6-, 12-, 18- and 24-month follow-up time periods and compared trends among high vs. low PL users. We compared time to viral suppression, proportion of days virally suppressed, and time to engagement in care in patients with high vs. low PL use. RESULTS: 127 patients enrolled in PL. Engagement in care and viral suppression improved significantly after 6 months of PL use and remained significantly improved after 24 months. Patients with high PL use were 2.09 (95% CI 0.64-6.88) times more likely to achieve viral suppression and 1.52 (95% CI 0.89-2.57) times more likely to become engaged in care compared to those with low PL use. CONCLUSION: Mobile technology, such as PL, can improve engagement in care and clinical outcomes for PLWH. This study demonstrates long-term acceptability of PL over two years and provides evidence for long-term improvement in engagement in care and viral suppression associated with PL use.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Infecções por HIV/tratamento farmacológico , Educação de Pacientes como Assunto/métodos , Participação do Paciente/estatística & dados numéricos , Adulto , Instituições de Assistência Ambulatorial , Fármacos Anti-HIV/farmacologia , Feminino , Infecções por HIV/virologia , Humanos , Masculino , Pessoa de Meia-Idade , Unidades Móveis de Saúde , Smartphone , Carga Viral/efeitos dos fármacos
7.
Int J Cancer ; 146(5): 1316-1323, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31509608

RESUMO

Due to the increasing incidence and prevalence of neuroendocrine tumors (NETs), there is a need to assess any gaps in awareness and care. A survey was undertaken in 2017 to identify perceived unmet needs from the perspectives of patients/families, patient advocates and health care professionals (HCPs). The survey consisted of 33-37 questions (depending on type of respondent) across four areas: information, care, treatments and research. In total, 443 participants from 26 countries responded: 338 patients/families, 35 advocates and 70 HCPs. Perceived unmet needs regarding provision of information at diagnosis differed between groups. While 59% of HCPs believed they provided sufficient information, informational needs were mostly/fully met for only 30% of patients and 18% of advocates. Additionally, 91% of patients and 97% of advocates felt that patients had to search for information themselves. Availability of Gallium-68-Dotatate PET/CT scan was limited for the majority of patients (patients: 73%; advocates: 85%; HCP: 86%), as was access to treatments, particularly peptide receptor radionuclide therapy (patients: 42%; advocates: 95%; HCPs: 77%). All groups felt that standards of care, including psychological needs and diagnosis of mental health, were not fully met. Although about two-thirds of patients were managed by a multidisciplinary team, 14% of patients reportedly did not have enough contact. All groups supported more patient involvement in research; patients and advocates prioritized improvement in diagnosis and HCPs focused on clinical trials. This survey revealed significant unmet needs but differing perceptions regarding these among the groups. There is a need for investigation and collaboration to improve standards of care for NET patients.


Assuntos
Saúde Global , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Tumores Neuroendócrinos/terapia , Participação do Paciente/estatística & dados numéricos , Lacunas da Prática Profissional/estatística & dados numéricos , Adolescente , Adulto , Carga Global da Doença , Comunicação em Saúde , Pessoal de Saúde/estatística & dados numéricos , Humanos , Incidência , Comportamento de Busca de Informação , Oncologia/organização & administração , Oncologia/estatística & dados numéricos , Pessoa de Meia-Idade , Tumores Neuroendócrinos/diagnóstico , Tumores Neuroendócrinos/epidemiologia , Neuroendocrinologia/organização & administração , Neuroendocrinologia/estatística & dados numéricos , Defesa do Paciente/estatística & dados numéricos , Prevalência , Relações Profissional-Paciente , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
8.
Int J Cancer ; 146(5): 1230-1240, 2020 03 01.
Artigo em Inglês | MEDLINE | ID: mdl-31107987

RESUMO

Our study used a refined case-control cervical cancer Audit framework to investigate effectiveness of cervical screening, with measures of three screening failures: irregular-participation, cervical cancer developed after cytological abnormalities and after normal screening results. The register-based study included 4,254 cervical cancer cases diagnosed in Sweden during 2002-2011, and 30 population-based controls per case. We used conditional logistic regression models to examine relative risks of cervical cancer in relation to screening participation and screening results in the past two screening rounds from 6 months before cancer diagnosis. We found that women unscreened in past two screening rounds showed four times increased risk of cervical cancer compared to women screened in time (OR = 4.1, 95% CI = 3.8-4.5), and women unscreened in the previous round but screened in the most recent round also showed a statistically significantly elevated risk (OR = 1.6, 95% CI = 1.5-1.8). Women having abnormality in previous two rounds exhibited higher risk of cervical cancer compared to women screened with normal results, while having normal results in the subsequent round after the abnormality also yielded an increased risk (OR = 4.0, 95% CI = 3.2-5.1). Being screened with only normal results was associated with 89% risk reduction for squamous cell cancer, compared to women unscreened, but only 60% reduction for adenocarcinoma. Our findings emphasize the importance of routine participation in cervical screening and suggest that management of abnormalities, as well as sensitivity of the test, warrants improvement especially for preventing cervical adenocarcinoma. The Audit framework serves as routine evaluation model and the findings benchmark for future evaluation of changes in screening practice.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/organização & administração , Auditoria Médica/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Neoplasias do Colo do Útero/epidemiologia , Adulto , Idoso , Benchmarking/estatística & dados numéricos , Estudos de Casos e Controles , Colo do Útero/patologia , Feminino , Humanos , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Teste de Papanicolaou/estatística & dados numéricos , Gravidez , Avaliação de Programas e Projetos de Saúde , Sistema de Registros/estatística & dados numéricos , Medição de Risco , Suécia/epidemiologia , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/patologia , Adulto Jovem
9.
Br J Radiol ; 93(1105): 20190240, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31651188

RESUMO

OBJECTIVE: To compare the participation rate between CT colonography (CTC) and colonoscopy in screening population in randomized controlled trials (RCTs). METHODS: A search was performed using the PubMed, Web of Science, and Cochrane databases. RCTs that included screening populations and reported participation number were assessed. Cochrane risk of bias tool was used to assess the bias and quality. Risk ratio (RR) was used to present the results. The non-participation rate was analyzed to verify the results of participation rate. RESULTS: Five of 760 studies, with a total of 15,974 invitees, were included. The participation rate was higher at CTC (28.8%) than colonoscopy (20.8%), although the difference did not reach statistical significance (RR = 1.26; p = 0.070; I2 = 90.3%). The non-participation rate at CTC was significantly lower than colonoscopy (RR = 0.92; p = 0.012; I2 = 86.7%). Subgroup analysis suggested both the participation and non-participation rate were with significant difference between reduced/no cathartic preparation CTC and colonoscopy. Cumulative meta-analysis showed both the participation rate and non-participation rate exhibited a trend over time and sample size. CONCLUSION: The participation rate was higher at CTC than colonoscopy, although the difference did not reach statistical significance. But the non-participation rate was with statistical difference. Screening population seemed more likely to participate the reduced/no cathartic preparation CTC. Statistical evidence was provided for more large RCTs are needed in the future. ADVANCES IN KNOWLEDGE: The screening populations seem more likely to participate in the CTC, especially the reduced/no cathartic preparation CTC. The statistical evidence was provided for more large RCTs are needed in the future.


Assuntos
Colonografia Tomográfica Computadorizada/estatística & dados numéricos , Colonoscopia/estatística & dados numéricos , Neoplasias Colorretais/diagnóstico por imagem , Programas de Rastreamento/métodos , Participação do Paciente/estatística & dados numéricos , Detecção Precoce de Câncer , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
10.
Nursing ; 50(1): 1-3, 2020 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-31855997

RESUMO

This article discusses the potential drivers and barriers to clinical nurse research participation. Here, the author describes a research exemplar that highlights how understanding the link between research and practice can influence participation.


Assuntos
Pesquisa em Enfermagem Clínica/organização & administração , Participação do Paciente/estatística & dados numéricos , Humanos , Seleção de Pacientes
11.
BMC Public Health ; 19(1): 1701, 2019 Dec 19.
Artigo em Inglês | MEDLINE | ID: mdl-31856796

RESUMO

BACKGROUND: The Patient Activation Measure (PAM) is a recognized measure of how active patients are in their care, and has been translated into several languages and cultural contexts. Patient activity, self-care, and health literacy have become increasingly important aspects of health care, and thus reliable measures of these are needed. However, a Swedish translation of PAM is currently lacking. The aim of the study was to translate and assess the validity and reliability of the Swedish PAM-13. METHODS: A self-report questionnaire was handed out to 521 patients at ten medical, geriatric, and surgical wards, and one Virtual Health Room. The Rasch model was employed, using the partial credit model, to assess the functioning of the PAM scale, item fit, targeting, unidimensionality, local independence, differential item functioning (DIF), and person-separation index. Evidence of substantive, content, structural, and external validity was examined. RESULTS: Of the 521 patients who were consecutively handed a questionnaire, 248 consented to participate, yielding a response rate of 47.6%. The average measure for each category advanced monotonically. The difficulty of the PAM items ranged from - 1.55 to 1.26. The infit and outfit values for the individual items were acceptable. Items 1, 2, and 4 showed disordered thresholds. The mean person location was 1.48 (SD = 1.66). The person-item map revealed that there were no item representations at the top of the scale. The evidence for unidimensionality was ambiguous and response dependency was seen in some items. DIF was found for age. The person separation index was 0.85. CONCLUSION: The Swedish PAM-13 was reliable, but was not conclusively found to represent one underlying construct. It seems that the Swedish PAM-13 lacks strong evidence for substantive, content, and structural validity. Although valid and reliable measures of ability for activation in self-care among patients are highly warranted, we recommend further development of PAM-13 before application in everyday clinical care.


Assuntos
Alta do Paciente , Participação do Paciente/estatística & dados numéricos , Autocuidado/psicologia , Inquéritos e Questionários , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes , Suécia , Traduções , Adulto Jovem
12.
Presse Med ; 48(12): e361-e368, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31767250

RESUMO

BACKGROUND: Few studies of mental health or substance abuse have focused on rural life. This study aimed to evaluate the association between socio-demographic and clinical characteristics and the probability of rural alcoholic women seeking help on their own at a specialty treatment service. METHODS: This exploratory study used a cross-sectional design to collect data from alcoholic women upon admission to a French outpatient department. Multiple logistic regression models tested whether the socio-demographic and clinical characteristics of these women predicted the likelihood that they would seek treatment at a specialty service on their own. RESULTS: Among 50 rural alcoholic women, the probability of seeking help on their own at a specialty treatment service was 5.6 times greater (95% CI 1.2-25.7, P=0.03) for participants with a history of physical and/or sexual trauma and 5.1 times greater (95% CI 1.1-24, P=0.03) among women with no complementary health insurance. CONCLUSION: Increased knowledge of the specific characteristics of rural alcoholic women is needed to develop programs that will increase awareness of and access to specialty treatment services among these women.


Assuntos
Alcoolismo/epidemiologia , Aceitação pelo Paciente de Cuidados de Saúde , População Rural/estatística & dados numéricos , Adulto , Alcoolismo/psicologia , Alcoolismo/terapia , Estudos Transversais , Feminino , França/epidemiologia , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Humanos , Medicina/estatística & dados numéricos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Participação do Paciente/psicologia , Participação do Paciente/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , Adulto Jovem
13.
BMC Health Serv Res ; 19(1): 754, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655598

RESUMO

BACKGROUND: Cancer patients experience psychological and social distress due to their medical treatment and social issues. However, continuous and specialized social support is still lacking. In Germany, a group of company health insurance funds has developed an approach to support cancer patients with monthly structured interviews conducted by specially trained Social Care Nurses. The nurses will identify patient needs in order to provide help with medical, personal, and social matters. One aim of the scientific evaluation is to analyze the effect of the consultations on various patient-reported outcomes, especially quality of life. The evaluation concept will be described in this study protocol. METHODS/DESIGN: The evaluation is a non-randomized, controlled, multi-center intervention study with a mixed-method design. It consists of three research modules which include primary data from questionnaires, and claims data from the health insurance funds. In Module 1, cancer patients will be recruited to form an intervention group (OSCAR, n = 150) and a control group (n = 200) in four study centers for a period of 1 year. One baseline and three follow-up questionnaires will be conducted to survey the patient-reported outcomes. Relevant secondary outcomes are health literacy, participation, and physician-patient communication. In Module 2, claims data will be used to analyze cost effects and thereby assess effectivity and hospitalization. Module 3 will involve a qualitative analysis of project diaries kept by the Social Care Nurses. The diaries will record the nurses' practical experiences and the benefits of deploying OSCAR across the German healthcare system. DISCUSSION: OSCAR is an innovative way of providing cancer patients with continuous support to improve their quality of life. The evaluation concept aims to assess the effects of the monthly consultations by the Social Care Nurses on the patients, and will use a mixed-method design. The results are important for assessing the transferability of OSCAR to the healthcare system as a whole. TRIAL REGISTRATION: German Clinical Trials Register (DRKS-ID: DRKS00013640 ). Registered 29 December 2017.


Assuntos
Letramento em Saúde/estatística & dados numéricos , Neoplasias/terapia , Participação do Paciente/estatística & dados numéricos , Qualidade de Vida , Apoio Social , Alemanha , Pesquisa sobre Serviços de Saúde , Humanos , Neoplasias/psicologia , Relações Enfermeiro-Paciente , Encaminhamento e Consulta , Projetos de Pesquisa , Inquéritos e Questionários
14.
Health Serv Res ; 54(6): 1156-1165, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31642066

RESUMO

OBJECTIVE: To examine whether the Wellness Incentive and Navigation (WIN) intervention can improve health-related quality of life (HRQOL) among Medicaid enrollees with co-occurring physical and behavioral health conditions. DATA SOURCES: Annual telephone survey data from 2013 to 2016, linked with claims data. STUDY DESIGN: We recruited 1259 participants from the Texas STAR + PLUS managed care program and randomized them into an intervention group that received flexible wellness accounts and navigator services or a control group that received standard care. We conducted 4 waves of telephone surveys to collect data on HRQOL, patient activation, and other participant demographic and clinical characteristics. DATA COLLECTION/EXTRACTION METHODS: The 3M Clinical Risk Grouping Software was used to extract variables from claims data and group participants based on disease severity. PRINCIPAL FINDINGS: Our results showed that the WIN intervention was effective in increasing patient activation and HRQOL among Medicaid enrollees with co-occurring physical and behavioral health conditions. Furthermore, we found that this intervention effect on HRQOL was partially mediated by patient activation. CONCLUSIONS: Providing navigator support with wellness account is effective in improving HRQOL among Medicaid enrollees. The pragmatic nature of the trial maximizes the chance of successfully implementing it in state Medicaid programs.


Assuntos
Comportamentos Relacionados com a Saúde , Promoção da Saúde/métodos , Medicaid/estatística & dados numéricos , Motivação , Navegação de Pacientes/métodos , Participação do Paciente/psicologia , Qualidade de Vida/psicologia , Adulto , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Participação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Texas , Estados Unidos
15.
Z Gastroenterol ; 57(9): 1051-1058, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31525797

RESUMO

BACKGROUND AND AIM: Colorectal cancer (CRC) screening can effectively reduce cancer-associated mortality. In Germany, individuals over the age of 50 or 55 have access to CRC screening services. However, utilization rates are persistently low, particular in the male population. This observational study investigates the effect of standard versus gender-specific invitation letters on utilization of CRC screening services. METHODS: We analyzed utilization rates of individuals who were insured by a large health insurance fund in Bavaria, Germany. Persons who became eligible for CRC screening received a standard (2013-2014) or a gender-specific invitation letter (2015-2016). We compared utilization rates within 6 months after receipt of the invitation letter using billing codes of the health insurance fund. RESULTS: Invitation letters were sent to 49 535 individuals, of which 48.8 % were gender-specific. The overall utilization rate did not differ between recipients of the standard versus gender-specific invitation letter (11.6 % vs 11.1 %; RR: 0.97 [0.92-1.02], p = 0.19). However, uptake of screening colonoscopy was significantly higher among recipients of gender-specific invitations (2.9 % vs 3.5 %; RR: 1.21 [1.04-1.39], p = 0.01), whereas utilization of fecal occult blood tests declined (10.4 % vs 9.7 %; RR: 0.93 [0.88-0.99], p = 0.016). CONCLUSIONS: Gender-specific design of invitation letters can modify the patients' preference for specific CRC screening services and increase the acceptance of screening colonoscopy.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/métodos , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Participação do Paciente/estatística & dados numéricos , Colonoscopia , Neoplasias Colorretais/prevenção & controle , Feminino , Alemanha , Humanos , Masculino , Programas de Rastreamento/métodos , Pessoa de Meia-Idade , Sangue Oculto
16.
BMC Public Health ; 19(1): 1233, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492117

RESUMO

BACKGROUND: Follow-up studies of infants born prematurely are essential to understand the long-term consequences of preterm birth and the efficacy of interventions delivered in the neonatal period. Retention of participants for follow-up studies, however, is challenging, with attrition rates of up to 70%. Our aim was to examine retention rates in two follow-up studies of prematurely born children and identify participant or study characteristics that were associated with higher attrition, and to discuss retention strategies with regard to the literature. METHODS: Data from children recruited at birth to one of two studies of prematurely born infants were assessed. The two studies were the United Kingdom Oscillation Study (UKOS, a randomised study comparing two modes of neonatal ventilation in infants born less than 29 weeks of gestational age (GA)), and an observational study examining the impact of viral lower respiratory tract infections in infancy in those born less than 36 weeks of GA (virus study). The UKOS participants, but not those in the virus study, had regularly been contacted throughout the follow-up period. UKOS subjects were followed up at 11 to 14 years of age and subjects in the virus study at 5-7 years of age. At follow up in both studies, pulmonary function and respiratory morbidity were assessed. Retention rates to follow-up in the two studies and baseline characteristics of those who were and were not retained were assessed. RESULTS: Retention was significantly higher in UKOS than the virus study (61% versus 35%, p < 0.0001). Subjects lost to UKOS follow up had greater deprivation scores (p < 0.001), a greater likelihood of intrauterine tobacco exposure (p = 0.001) and were more likely to be of non-white ethnicity (p < 0.001). In the virus study, those lost to follow-up had higher birth weights (p = 0.036) and were less likely to be oxygen dependent at hospital discharge (p = 0.003) or be part of a multiple birth (p = 0.048). CONCLUSIONS: Higher retention was demonstrated when there was regular contact in the follow-up period. Both social factors and initial illness severity affected the retention into follow-up studies of prematurely born infants, though these factors were not consistent across the two studies.


Assuntos
Seguimentos , Recém-Nascido Prematuro , Participação do Paciente/estatística & dados numéricos , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Recém-Nascido , Perda de Seguimento , Masculino , Reino Unido
17.
Artigo em Inglês | MEDLINE | ID: mdl-31398821

RESUMO

The aim of this paper is to describe frail older persons' experiences of hospital care of information and participation when being an inpatient at a hospital. A qualitative method was used. Data were collected at the hospital from 20 interviews with frail older patients, together with observations in the environment at the hospital ward. A content analysis was performed. Patients experienced not receiving information about their care and rehabilitation, or receiving such information in noisy surroundings. They experienced situations of misunderstanding related to their medication, which indicates the need for appropriate discharge calls for frail older patients. They expressed feelings of distress concerning the future, caused by hasty admissions or relatives' problems to handle the situation. The results highlight the need to receive appropriate information and to participate in decision-making. The level of health literacy should be taken notice of when giving information, using peaceful and quiet environments when informing frail older persons. Person-centered care should be recognized to a greater extent in order for healthcare professionals to give information to frail older people in a health literacy-friendly way. This might make it easier for frail older persons to participate in a partnership in care.


Assuntos
Comunicação , Idoso Fragilizado/psicologia , Disseminação de Informação/métodos , Pacientes Internados/psicologia , Participação do Paciente/psicologia , Assistência Centrada no Paciente/métodos , Idoso , Idoso de 80 Anos ou mais , Tomada de Decisões , Feminino , Idoso Fragilizado/estatística & dados numéricos , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Participação do Paciente/estatística & dados numéricos
18.
J Ment Health ; 28(5): 527-535, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31364902

RESUMO

Background: Though patients' access to clinicians' visit notes may improve patient engagement and strengthen patient-clinician relationships, it is unknown whether these benefits extend to mental health settings. Aims: Examine patients' attitudes and experiences reading their psychotherapists' notes online. Methods: Using a mixed methods design, we conducted telephone interviews and an online survey of patients at an academic medical center who had opened ≥1 of their psychotherapy notes online. Eleven patients who had read ≥6 psychotherapy notes participated in semi-structured interviews, and 85 patients completed an online survey (response rate = 24%). Results: Nearly all survey respondents (94%) agreed that having open therapy notes is a good idea, and 87% wanted it to continue. More than half reported therapy notes were "very important" (≥7/10 on 0-10 scale) for feeling in control of their care, trusting their providers and taking care of themselves. Two respondents felt offended, and 7 (11%) felt judged by something they read in a note. Interview data supported survey findings. Conclusions: Our pilot findings indicate that most patients who read open therapy notes find them valuable for understanding and engaging in their mental health care, with minimal adverse effects. Larger studies with diverse patient populations are needed.


Assuntos
Transtornos Mentais/psicologia , Pessoas Mentalmente Doentes/psicologia , Participação do Paciente/estatística & dados numéricos , Psicoterapia , Adulto , Idoso , Idoso de 80 Anos ou mais , Atitude , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Relações Médico-Paciente , Adulto Jovem
19.
BMC Res Notes ; 12(1): 458, 2019 Jul 25.
Artigo em Inglês | MEDLINE | ID: mdl-31345257

RESUMO

INTRODUCTION: The Childbirth Experience Questionnaire (CEQ) is a Sweden origin, self-administered questionnaire to assess birth satisfaction of women in different aspects of their first labour and birth. It measures four main domains of the woman's childbirth experience. Those are own capacity, professional support, perceived safety and participation, comprising of 22 items. OBJECTIVES: To conduct a linguistic translation, to conduct a validation study and to assess the psychometric properties of the Sinhala version of the CEQ.


Assuntos
Parto Obstétrico/psicologia , Trabalho de Parto/psicologia , Parto/psicologia , Satisfação do Paciente/estatística & dados numéricos , Inquéritos e Questionários , Adolescente , Adulto , Feminino , Humanos , Idioma , Participação do Paciente/estatística & dados numéricos , Gravidez , Psicometria/estatística & dados numéricos , Sri Lanka , Suécia , Traduções
20.
Nat Rev Clin Oncol ; 16(12): 746-761, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31350467

RESUMO

An earlier diagnosis is a key strategy for improving the outcomes of patients with cancer. However, achieving this goal can be challenging, particularly for the growing number of people with one or more chronic conditions (comorbidity/multimorbidity) at the time of diagnosis. Pre-existing chronic diseases might affect patient participation in cancer screening, help-seeking for new and/or changing symptoms and clinicians' decision-making on the use of diagnostic investigations. Evidence suggests, for example, that pre-existing pulmonary, cardiovascular, neurological and psychiatric conditions are all associated with a more advanced stage of cancer at diagnosis. By contrast, hypertension and certain gastrointestinal and musculoskeletal conditions might be associated with a more timely diagnosis. In this Review, we propose a comprehensive framework that encompasses the effects of disease-specific, patient-related and health-care-related factors on the diagnosis of cancer in individuals with pre-existing chronic illnesses. Several previously postulated aetiological mechanisms (including alternative explanations, competing demands and surveillance effects) are integrated with newly identified mechanisms, such as false reassurances, or patient concerns about appearing to be a hypochondriac. By considering specific effects of chronic diseases on diagnostic processes and outcomes, tailored early diagnosis initiatives can be developed to improve the outcomes of the large proportion of patients with cancer who have pre-existing chronic conditions.


Assuntos
Doença Crônica/epidemiologia , Detecção Precoce de Câncer/métodos , Neoplasias/complicações , Neoplasias/diagnóstico , Neoplasias/epidemiologia , Comorbidade , Tomada de Decisões/fisiologia , Humanos , Participação do Paciente/estatística & dados numéricos , Fatores de Risco
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