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1.
Isr Med Assoc J ; 22(3): 154-159, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32147979

RESUMO

BACKGROUND: Guidelines recommend initiation of parenteral biologic or oral target-specific disease-modifying anti-rheumatic drugs (bDMARDs/tsDMARDs) in rheumatoid arthritis (RA) patients who do not adequately respond to conventional DMARDs. OBJECTIVES: To compare the preferred route of administration of bDMARDs or tsDMARDs in RA patients who were previously treated with at least one type. METHODS: A cross-sectional survey was conducted of consecutive RA patients previously prescribed bDMARDs or tsDMARDs. We analyzed the factors associated with patients' preferred route of administration. RESULTS: The cohort included 95 patients, mostly female (72.6%), seropositive (81.05%), mean age 63.4 ± 11.9 years. The oral route was preferred by 39 patients (41%) and 56 (59%) preferred the parenteral route. Most patients (65.9%) preferred to continue with their current route (P < 0.001). Switching from a current route was less common with patients who were currently using the oral route (13.3% vs. 38.2%, P = 0.04). Many patients (53.8%) who preferred the oral route had never experienced it before, while this was rare (3.6%) regarding the parenteral route (P = 0.0001). Employment status was associated with preference of the subcutaneous route over the intravenous route of bDMARDs (P = 0.01). Of the 21 patients who had previously experienced both parenteral and oral treatment, 16 (76.2%) preferred the oral route. CONCLUSIONS: RA patients preferred to continue treatment with an administration route they have already experienced. However, when choosing an unexperienced route, significantly more patients preferred the oral route. Our results strengthen the understanding of patient preferences, which could improve drug adherence, compliance, and disease outcome.


Assuntos
Antirreumáticos/administração & dosagem , Artrite Reumatoide/tratamento farmacológico , Produtos Biológicos/administração & dosagem , Nutrição Parenteral/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Administração Oral , Adulto , Idoso , Idoso de 80 Anos ou mais , Antirreumáticos/uso terapêutico , Produtos Biológicos/uso terapêutico , Estudos de Coortes , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
2.
Urology ; 137: 138-145, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-31899227

RESUMO

OBJECTIVE: To evaluate treatment preferences of patients with lower urinary tract symptoms suggestive of benign prostatic hyperplasia (LUTS/BPH) before and after using a web-based decision aid (DA). PATIENTS AND METHODS: Between July 2016 and January 2017 patients were invited to use a web-based LUTS/BPH DA. Treatment preferences (for lifestyle advices, medication or surgery) before and after DA use and responses on values clarification exercises were extracted from the DA. RESULTS: In total, 126 patients were included in the analysis. Thirty-four percent (43/126) had not received any previous treatment and were eligible for (continuation of) lifestyle advices or to start medication, as initial treatment. The other 66% (83/126) did use medication and were eligible, either for continuing medication or to undergo surgery. Before being exposed to the DA, 67 patients (53%) were undecided and 59 patients (47%) indicated an initial treatment preference. Half of the patients who were initially undecided were able to indicate a preference after DA use (34/67, 51%). Of those with an initial preference, 80% (47/59) confirmed their initial preference after DA use. Five out of 7 values clarification exercises used in the DA were discriminative between final treatment preferences. In 79%, the treatment preferred after DA use matched the received treatment. Overall, healthcare providers were positive about DA feasibility. CONCLUSION: Our findings suggest that a LUTS/BPH DA may help patients to confirm their initial treatment preference and support them in forming a treatment preference if they did not have an initial preference.


Assuntos
Tomada de Decisões , Técnicas de Apoio para a Decisão , Sintomas do Trato Urinário Inferior , Preferência do Paciente/estatística & dados numéricos , Hiperplasia Prostática , Qualidade de Vida , Idoso , Tratamento Conservador/métodos , Tratamento Conservador/psicologia , Humanos , Estilo de Vida , Sintomas do Trato Urinário Inferior/etiologia , Sintomas do Trato Urinário Inferior/psicologia , Sintomas do Trato Urinário Inferior/terapia , Masculino , Pessoa de Meia-Idade , Países Baixos , Hiperplasia Prostática/patologia , Hiperplasia Prostática/fisiopatologia , Hiperplasia Prostática/psicologia , Hiperplasia Prostática/terapia , Procedimentos Cirúrgicos Operatórios/métodos , Procedimentos Cirúrgicos Operatórios/psicologia , Inquéritos e Questionários , Conduta Expectante
3.
BMC Public Health ; 20(1): 4, 2020 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-31906905

RESUMO

BACKGROUND: In China, addressing disparities in the HIV epidemic among men who have sex with men (MSM) requires targeted efforts to increase their engagement and retention in prevention. In an effort to advance MSM-friendly HIV services within China, and informed by community-based partnerships, we tested whether MSM who have ever versus never disclosed their same-sex behavior to healthcare providers (HCP) differ in sociodemographic and behavioral characteristics as well as the qualities of sexual health services each group would prefer to access. METHODS: We conducted a cross-sectional survey among HIV-negative MSM who went to MSM-focused voluntary counseling and testing clinics in four cities in China. The survey was anonymous and collected information on sociodemographic characteristics, testing behaviors, sexual-health related behavior, and sexual health service model preferences. RESULTS: Of 357 respondents, 68.1% participants had ever disclosed same-sex behavior to HCPs when seeking advice for sexual health. Younger age (aOR = 1.04; 95% CI: 1.01-1.08), and worry of HIV acquisition (aOR = 1.39; 95% CI: 1.05-1.84) were associated with higher odds of past disclosure. The availability of comprehensive sexual health services was one of the most valued characteristics of the ideal sexual health clinic. Those who ever disclosed and never disclosed differed significantly in their ranking of the importance of three out of ten dimensions: sexual health counseling services available (M = 3.99 vs. M = 3.65, p = .002), gay identity support available (M = 3.91 vs. M = 3.62, p = .016) and clinic collaborates with a gay CBO (M = 3.81 vs. M = 3.56, p = .036). CONCLUSIONS: Our hypothesis that MSM who had disclosed versus never disclosed same-sex behavior would differ in the value they placed on different dimensions of sexual health service was partially borne out. As health authorities in China decide on implementation models for pre-exposure prophylaxis (PrEP) delivery and specifically within which institutions to integrate PrEP services, the preferences of target populations should be considered to develop comprehensive, patient-centric and LGBT-friendly services.


Assuntos
Revelação/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Homossexualidade Masculina/psicologia , Preferência do Paciente/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Adulto , China , Cidades , Estudos Transversais , Pesquisas sobre Serviços de Saúde , Homossexualidade Masculina/estatística & dados numéricos , Humanos , Masculino , Assistência Centrada no Paciente/organização & administração , Relações Médico-Paciente , Minorias Sexuais e de Gênero/estatística & dados numéricos
4.
J Surg Res ; 246: 435-441, 2020 02.
Artigo em Inglês | MEDLINE | ID: mdl-31630881

RESUMO

BACKGROUND: Thyroidectomy is a definitive treatment for hyperthyroidism. The purpose of this study is to examine how often patients with hyperthyroidism are referred for thyroidectomy and what are the common reasons for referral. MATERIALS AND METHODS: We identified 864 patients with hyperthyroidism diagnosis. A total of 237 patients underwent thyroidectomy from January 2011 to December 2016. Patients were divided into six groups according to the year of thyroidectomy, group 1 to group 6, from 2011 to 2016, respectively. Primary and secondary outcomes: reasons why patient was referred for thyroidectomy, time from diagnosis, and/or start of antithyroid drugs (ATDs) to thyroidectomy as well as the trend and total number of thyroidectomies each surgeon did during the study period. RESULTS: The mean age was 44 ± 15 y, 73% were women, and 54% were African American. A significant increase in the rate of thyroidectomy over the study period was observed where 31 patients underwent thyroidectomy in 2011 compared with 61 patients in 2016. The most common reasons patients were referred for thyroidectomy were resistance or intolerance to ATDs followed by patient's preference, and presentation with obstructive symptoms with no statistically significant difference between groups. The median time from diagnosis to surgery was 8 mo (0 to 204 mo) and 7 mo from initiation of ATDs to thyroidectomy with no significant difference between groups. CONCLUSIONS: An increase of thyroidectomy rate was observed at our institution over the last 6 y. Patients were mostly referred due to resistance or intolerance to antithyroid medications, patients' preference of surgery, and presentation with obstructive symptoms.


Assuntos
Antitireóideos/farmacologia , Hipertireoidismo/terapia , Encaminhamento e Consulta/estatística & dados numéricos , Tireoidectomia/tendências , Adulto , Antitireóideos/uso terapêutico , Resistência a Medicamentos , Feminino , Humanos , Radioisótopos do Iodo , Masculino , Pessoa de Meia-Idade , Preferência do Paciente/estatística & dados numéricos , Estudos Retrospectivos , Tireoidectomia/estatística & dados numéricos , Tempo para o Tratamento/estatística & dados numéricos
5.
Med J Aust ; 211(11): 514-517, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31813173

RESUMO

OBJECTIVES: To determine whether gendered symbols on patient call bells are restricted to our hospital or are examples of an international practice that perpetuates gender stereotypes and occupational segregation. SETTING: Multicentre, international study of hospital equipment, 2018. MAIN OUTCOME MEASURE: Types of symbols on patient call bells. RESULTS: We received 56 responses from 43 hospitals in eight countries across five continents: 37 devices included female-specific images, nine included gender-neutral images, and ten did not use imagery (for example, button-only devices). No call bells included male-specific images. CONCLUSION: Female symbols on patient call bells are an international phenomenon. Only female or gender-neutral images are used, indicating bias in their design, manufacture, and selection. Female symbols may reinforce gender stereotypes and contribute to occupational segregation and reduced equity of opportunity. We suggest alternative symbols. Individual action with coloured marker pens may provide a pragmatic short term, albeit provocative, solution. While call bell design has only a minor impact on patients, everyday bias affects all staff and society in general.


Assuntos
Sistemas de Comunicação no Hospital/estatística & dados numéricos , Defesa do Paciente/estatística & dados numéricos , Sexismo , Viés , Feminino , Saúde Global , Humanos , Masculino , Preferência do Paciente/estatística & dados numéricos , Satisfação do Paciente
6.
BMC Health Serv Res ; 19(1): 1003, 2019 Dec 27.
Artigo em Inglês | MEDLINE | ID: mdl-31881959

RESUMO

BACKGROUND: Despite high HIV incidence rates among young people in Nigeria, less than 24% of this population have ever tested for HIV. These low HIV testing rates suggest that current testing services may not align with their testing preferences. To address this gap, the objective of this study was to assess preferences for HIV testing options among young people in Nigeria. METHODS: We conducted a cross-sectional study using survey to assess preferences for HIV testing options among 113 youth aged 14-24 years residing in Nigeria. The survey included a series of hypothetical HIV testing options, comprised of six characteristics centered around HIV testing service (i.e. location of testing, test administrator, mode of pre-test, mode of post-test counseling, type of HIV test, and cost of HIV test). For each characteristic, participants were asked to select one of the options that they prefer or indicate none of the above. A descriptive analysis of the preferences made by participants was conducted, summarizing proportions of participants who selected different options for HIV testing. RESULTS: The mean age of study participants was 19.5 years old (SD = 2.7). Most youth (73, 64.6%) had at least a secondary school degree. There was pronounced heterogeneity in HIV testing preferences among young people. Although most youth preferred free HIV testing, 14 (16.7%) reported preferring paying a small amount compared to free testing. More youth preferred blood-based HIV self-testing 39(48.8%) compared to facility-based HIV testing and oral HIV self-testing. CONCLUSIONS: Our finding suggest that young people have a range of HIV testing preferences in Nigeria. This suggests that a "one-size-fits-all" approach to delivering services to youth may be challenging in this context. HIV testing services can be optimized to reach young people if a variety options are provided to meet their unique preferences.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/psicologia , Preferência do Paciente/estatística & dados numéricos , Adolescente , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Humanos , Masculino , Programas de Rastreamento/métodos , Nigéria/epidemiologia , Inquéritos e Questionários , Adulto Jovem
7.
BMC Health Serv Res ; 19(1): 799, 2019 Nov 05.
Artigo em Inglês | MEDLINE | ID: mdl-31690299

RESUMO

INTRODUCTION: Female Sex workers (FSW) and their clients accounted for 18% of the new HIV infections in 2015/2016. Special community-based HIV testing service delivery models (static facilities, outreaches, and peer to peer mechanism) were designed in 2012 under the Most At Risk Populations Frame work and implemented to increase access and utilization of HIV care services for key populations like female sex workers. However, to date there is no study that has been done to access the preference and uptake of different community-based HIV testing service delivery models used to reach FSW. We assessed preference and uptake of the current community-based HIV testing services delivery models that are used to reach FSW and identified challenges faced during the implementation of the models. METHODS: We conducted a cross-sectional study design using quantitative (interview with the health workers in facilities providing services to female sex workers and interviews with FSWs) and qualitative (interviews with Ministry of Health staff, health workers, district health team members, program staff at different levels involved in delivery of HIV care services, FSWs and political leaders to assess for the enabling environment created to deliver the different community-based HIV testing services to FSWs along the Malaba-Kampala highway. Malaba - Kampala high way is one of the major high ways with many different hot spots where the actual buying and selling of sex takes place. We defined FSWs as any female, who undertakes sexual activity after consenting with a man for money or other items/benefits as an occupation or as a primary source of livelihood irrespective of site of operation within the past six months. We assessed the preference and uptake of different community based HIV testing services delivery model among FSWs based on two indicators, i.e., the proportion of FSWs who had an HIV Counseling and Testing (HCT) in the last 12 months and the proportion of FSWs who were positive and linked to care. RESULTS: Overall, 86% (390/456) of the FSWs had taken an HIV test in the last 12 months. Of the 390 FSWs, 72% (279/390) had used static facilities, 25% (98/390) had used outreaches, and 3.3% (13/390) used peer to peer mechanisms to have an HIV test. Overall, 35% (159/390) of the FSWs who had taken an HIV test were HIV positive. Of the 159, 83% (132/159) were successfully linked into care. Ninety one percent (120/132) reported to have been linked into care by static facilities. Challenges experienced included; lack of trust in the results given during outreaches, failure to offer other testing services including hepatitis B and syphilis during outreaches, inconsistent supply of testing kits, condoms, STI drugs, and unfriendly health services due to the infrastructure and non-trained health workers delivering KP HIV testing services. CONCLUSIONS: Most of the FSWs had HCT services and were linked to care through static facilities. Community-based HIV testing service delivery models are challenged with inconsistent supply of HIV testing commodities and unfriendly services.. We recommended strengthening of all HIV testing community-based HIV testing service deliverymodels by ensuring constant supply of HIV testing/AIDS care commoditiesoffering FSW friendly services, and provision of comprehensive HIV/AIDS health care package.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Profissionais do Sexo/psicologia , Adolescente , Adulto , Serviços de Saúde Comunitária/organização & administração , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Profissionais do Sexo/estatística & dados numéricos , Uganda , Adulto Jovem
8.
Afr J AIDS Res ; 18(4): 332-340, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31779576

RESUMO

HIV testing rates remain stubbornly low among men - a crucial target population for reaching the ambitious global and regional goals of the HIV programme. In an era of declining donor funding, identifying cost-effective strategies to increase testing rates amongst men remains paramount. Antenatal care is an effective entry-point for the delivery of HIV testing services for women, and partner testing presents an important opportunity to reach their male partners. We present the results of a discrete choice experiment in Uganda, examining preferences among 824 pregnant women and 896 male partners regarding service delivery characteristics of HIV testing. Both men and women preferred nurse administered testing to self-testing (OR = 0.835; p < 0.001), oral testing over a finger-prick test (OR = 1.176; p < 0.001) and testing with a partner over testing alone (OR = 1.230; p < 0.001). Men had a preference for testing at home compared to testing at a clinic (OR = 1.099; p = 0.024), but women were indifferent regarding the testing location. The cost of testing had the biggest effect on preferences. Free testing was preferred over a cost of US$2.90 (OR = 0.781; p < 0.001) or US$2.00 (OR = 0.670; p < 0.001). Offering an incentive of US$3.40 increased men's preferences compared to a free test (OR = 1.168; p < 0.001), although this did not affect women's preferences. Partner testing linked to antenatal care is a potential strategy to increase testing coverage among men, particularly given the preference for partner testing - provided costs to clients remain low. Future cost-effectiveness evaluations should investigate the economic impact of reaching men using these strategies.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/psicologia , Preferência do Paciente/estatística & dados numéricos , Gestantes/psicologia , Cuidado Pré-Natal/estatística & dados numéricos , Parceiros Sexuais/psicologia , Adulto , Instituições de Assistência Ambulatorial , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/psicologia , Humanos , Masculino , Gravidez , Cuidado Pré-Natal/psicologia , Uganda/epidemiologia
9.
BMC Health Serv Res ; 19(1): 810, 2019 Nov 07.
Artigo em Inglês | MEDLINE | ID: mdl-31699085

RESUMO

BACKGROUND: Even though maternal mortality during the time of delivery can be prevented with proper medical care in the health facilities with skilled healthcare professionals, unexpectedly death is still high and is a persistent challenge for low-income countries. Therefore identifying factors affecting the preference of institutional delivery after antenatal care service attendance is a key intervention to reduce maternal morbidity and mortality. METHOD: A community-based cross-sectional study was conducted using face to face using interviewer-administered questionnaire from a total of 528 women who gave their last birth within 12 months prior to the study period who attended antenatal care (ANC) services. Descriptive statistics, bivariable and multivariable logistic regressions analysis were performed. Statistical significance was considered at p < 0.05 and odds ratio with 95% CI were calculated to examine factors associated with institutional delivery. RESULTS: Of the 528 pregnant women attending ANC services, 250 (47.3%) gave birth in health facilities (95% CI: 43.2, 51.7%). Urban residence [AOR = 7.8, 95% CI: 4.1, 15.6], four or more ANC visits [AOR = 4.5, 95% CI: 1.6, 12.3], those who got health education on ANC [AOR = 2.9, 95% CI: 1.5, 5.6] and decision on place of delivery with her partner agreement [AOR = 3.3, 95% CI: 1.3, 8.7] were found to be contributing factors for the preference of institutional delivery. CONCLUSION: Institutional delivery was not adequate. Residence, number of antenatal care visits, health education, decisions making on a place of delivery and having awareness of the difference of place of delivery were contributing factors for the preference of institutional delivery.


Assuntos
Parto Obstétrico/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Cuidado Pré-Natal/estatística & dados numéricos , Adulto , Estudos Transversais , Tomada de Decisões , Etiópia , Feminino , Educação em Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Gravidez , Características de Residência/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
10.
Artigo em Inglês | MEDLINE | ID: mdl-31623324

RESUMO

Older adults often have limited health literacy and experience difficulties in communicating about their health. In view of the need for efficacious interventions, we compared a narrative photo story booklet regarding doctor-patient communication with a non-narrative but otherwise highly similar brochure. The photo story booklet included seven short picture-based stories about themes related to doctor-patient communication. The non-narrative brochure had comparable pictures and layout and dealt with the same themes, but it did not include any stories. We conducted two Randomized Controlled Trials (RCTs) among older adults with varying levels of health literacy: one RCT in Germany (N = 66) and one RCT in the Netherlands (N = 54); the latter one was followed by an in-depth interview study among a subset of the participants (81.5%; n = 44). In the RCTs, we did not find significant differences between the photo story booklet and the non-narrative brochure. In the interview study, a majority of the participants expressed a preference for the photo story booklet, which was perceived as recognizable, relevant, entertaining and engaging. We conclude that photo story booklets are a promising format but that there is room for improving their effectiveness.


Assuntos
Alfabetização em Saúde , Folhetos , Preferência do Paciente/estatística & dados numéricos , Fotografação , Idoso , Comunicação , Compreensão , Alfabetização em Saúde/estatística & dados numéricos , Humanos , Relações Médico-Paciente , Avaliação de Programas e Projetos de Saúde
11.
BMC Res Notes ; 12(1): 590, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533796

RESUMO

OBJECTIVE: Despite the access and availability of modern health care, Traditional Bone Setting (TBS) has a big place as alternative health care. Hence, this study was aimed to assess the preference of Traditional Bone Setting and associated factors among patients with a fracture. RESULTS: A total of 224 patients known to have fractured at Black Lion Hospital, Addis Ababa was included in the study. This study revealed that 29.9% of the study participants had a preference for the Traditional Bone Setting. Hospital admission (AOR = 8.158, 95% CI 1.179, 56.439), Traditional Bone Setting center as first port of call after injury (AOR = 0.004, 95% CI 0.001, 0.090), knowledge (AOR = 9.448, 95% CI 1.481, 60.251) and perception (AOR = 0.026, 95% CI 0.003, 0.215) were statistically significant. The preference for the Traditional Bone Setting is high. Hospital admission, Traditional Bone Setting center as a first port of call after injury, knowledge, and perception were significantly associated with the preference of Traditional Bone Setting. In addition to deployment of trained in trauma professionals, working more on awareness creation and training are recommended.


Assuntos
Fraturas Ósseas/terapia , Hospitais , Admissão do Paciente/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Ferimentos e Lesões/terapia , Adolescente , Adulto , Estudos Transversais , Etiópia , Feminino , Fraturas Ósseas/diagnóstico , Pessoal de Saúde/normas , Pessoal de Saúde/estatística & dados numéricos , Humanos , Masculino , Inquéritos e Questionários , Ferimentos e Lesões/diagnóstico , Adulto Jovem
12.
BMC Pregnancy Childbirth ; 19(1): 333, 2019 Sep 11.
Artigo em Inglês | MEDLINE | ID: mdl-31510943

RESUMO

BACKGROUND: The place of birth has been rapidly changing from home to health facility in Lao People's Democratic Republic (Lao PDR) following the strategy to improve the maternal and neonatal mortality. This change in the place of birth might affect the mother's satisfaction with childbirth. The objective of this study was to assess whether the place of birth is related to the mother's satisfaction with childbirth in a rural district of the Lao PDR. METHODS: A community-based survey was implemented in 21 randomly selected hamlets in Xepon district, Savannakhet province, between February and March, 2016. Questionnaire-based interviews were conducted with mothers who experienced a normal vaginal birth in the past 2 years. Satisfaction with childbirth was measured by the Satisfaction with Childbirth Experience Questionnaire. Using the median, the outcome variable was dichotomized into "high satisfaction group" and "low satisfaction group". Logistic regression was performed to assess the association between place of birth and satisfaction with childbirth. Three models were examined: In Model 1, only the predictor of interest (i.e., place of birth) was included. In Model 2, the predictor of interest and the obstetrical predictors were included. In Model 3, in addition to these predictors, socio-demographic and economic predictors were included. A mixed-effects model was used to account for the hierarchical structure. RESULTS: Among the 226 mothers who were included in data analysis, 60.2% gave birth at the health facility and the remaining 39.8% gave birth at home. Logistic regression analysis showed that the mothers who gave birth at the health facility were significantly more likely to have a higher level of satisfaction compared to the mothers who gave birth at home (crude odds ratio: 5.44, 95% confidence interval: 3.03 to 9.75). This association remained even after adjusting for other predictors (adjusted odds ratio: 6.05, 95% confidence interval: 2.81 to 13.03). CONCLUSION: Facility-based birth was significantly associated with a higher level of satisfaction with childbirth among the mothers in the study district where maternal and neonatal mortalities are relatively high. The findings of the present study support the promotion of facility-based birth in a rural district of the Lao PDR.


Assuntos
Entorno do Parto/estatística & dados numéricos , Centros de Assistência à Gravidez e ao Parto , Parto Domiciliar , Preferência do Paciente/estatística & dados numéricos , Gestantes/psicologia , Adulto , Centros de Assistência à Gravidez e ao Parto/normas , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Feminino , Parto Domiciliar/psicologia , Parto Domiciliar/estatística & dados numéricos , Humanos , Trabalho de Parto/psicologia , Laos/epidemiologia , Mães/estatística & dados numéricos , Satisfação Pessoal , Gravidez , Resultado da Gravidez/epidemiologia , Garantia da Qualidade dos Cuidados de Saúde/métodos , Serviços de Saúde Rural/normas , Inquéritos e Questionários
13.
J Drugs Dermatol ; 18(9): 858-866., 2019 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-31524341

RESUMO

BACKGROUND: The patient populations seeking facial aesthetic treatments is expanding in terms of racial, ethnic, and cultural diversity. While treatment of facial aging patterns among white women is well-documented, far less information describes the aesthetic needs of the African American patient. OBJECTIVE: An online study was conducted to survey facial aesthetic concerns and treatment priorities among US-based population of African American women. MATERIALS AND METHODS: A total of 401 female African American participants ages 30 to 65 years reported their attitudes toward facial aging, current facial conditions, most bothersome facial areas and areas most/least likely to be treated first, awareness of treatment options and their consideration rates, and motives and barriers factoring into consideration of injectable treatments. RESULTS: Uneven skin tone/color (57%) and dark circles under the eyes (48%) were the most frequently-reported facial concerns. Other common bothersome facial areas affected by signs of aging were the submental area, periorbital area, forehead lines, and chin. Similarly, areas given greater priority with respect to future treatment included the periorbital area, submental area, and forehead lines. With advancing age, priorities heightened for the mid and lower facial areas, which included the nasolabial folds, chin, and oral commissures. Although the majority of participants would consider injectables, cost, and safety/side effects were cited as frequent concerns. CONCLUSION: For African American women, concerns about facial aging may be less about fine lines and wrinkles caused by increasing skin laxity, and more about pigmentary concerns and shifts in underlying soft tissue volume. J Drugs Dermatol. 2019;18(9):858-866.


Assuntos
Afro-Americanos/psicologia , Técnicas Cosméticas , Preferência do Paciente/psicologia , Envelhecimento da Pele/etnologia , Pigmentação da Pele , Adulto , Idoso , Estética , Face , Feminino , Humanos , Pessoa de Meia-Idade , Preferência do Paciente/estatística & dados numéricos , Envelhecimento da Pele/fisiologia , Inquéritos e Questionários/estatística & dados numéricos
14.
Bull Hosp Jt Dis (2013) ; 77(3): 164-170, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31487480

RESUMO

BACKGROUND: Little is known about the factors that drive hospital-switching behavior of patients when they seek a second total joint arthroplasty (TJA) surgery. METHODS: We analyzed the population-based, all-payer California Healthcare Cost and Utilization Project (HCUP) data for a cohort undergoing sequential TJAs for osteoarthritis (N = 48,800) from 2006 to 2011, excluding TJA for fracture. We used multivariable logistic regression analysis to identify factors associated with returning to the same hospital for each surgery, including rural or urban, surgery sequence and timing, Deyo-Charlson comorbidity index, age, sex, race and ethnicity, and insurance. RESULTS: Overall, 15.1% of subjects (7,364/48,000) utilized a different hospital for their second surgery. Increasing years between TJAs was associated with decreasing odds of going to the same hospital for the second TJA (p < 0.05). Subjects switching from private insurance to Medicare between surgeries were much less likely to return to same hospital (OR: 0.53; 95% CI: 0.47-0.59), as were those with alternate-joint sequencing (e.g., hip-knee). Those with Medicaid were somewhat less likely to return for the second surgery (OR: 0.87; 95% CI: 0.75-1.01). Urban and rural residents were equally likely to return to the same hospital (p > 0.05). Increasing age was associated with increasing likelihood of returning to the same hospital [e.g., ages 75- 79, OR: 1.36 (95% CI: 1.19-1.56) and ages 80+, OR: 1.41 (95% CI: 1.22-1.63)]. CONCLUSION: Fifteen percent of patients switched hospitals for their second TJA within the 6-year study period. Those with Medicare or who had surgery on the alternate joint for second surgery were more likely to switch hospitals as were those who waited longer between surgeries and those living in a rural environment.


Assuntos
Artroplastia de Quadril , Artroplastia do Joelho , Hospitalização/estatística & dados numéricos , Osteoartrite do Quadril/cirurgia , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Readmissão do Paciente/estatística & dados numéricos , Fatores Etários , Idoso , Artroplastia de Quadril/métodos , Artroplastia de Quadril/estatística & dados numéricos , Artroplastia do Joelho/métodos , Artroplastia do Joelho/estatística & dados numéricos , Feminino , Humanos , Masculino , Medicare/estatística & dados numéricos , Pessoa de Meia-Idade , Osteoartrite do Joelho/cirurgia , Preferência do Paciente/estatística & dados numéricos , Características de Residência , Fatores Sexuais , Estados Unidos
15.
Braz Oral Res ; 33: e078, 2019 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-31432928

RESUMO

The aim of this study was to assess, correlate, and compare users' perceptions and preference related to maxillary removable retainers. Volunteers were recruited to use four retainer types: conventional wrap-around (CWA), wrap-around with an anterior opening (OWA), "U" wrap-around (UWA), and clear thermoplastic retainer (CT). The main outcomes were the volunteers' perceptions, evaluated with a 100-mm visual analogue scale, and their preferred retainer. The retainers were used for 21 days each (washout intervals of 7 days). Nineteen volunteers (27 ± 4.53 years) were randomly divided into four groups that used the four retainers, but with a different sequence. Perceptions were evaluated immediately after the use of each retainer and the preference at the end of the research. Repeated measures ANOVA and Friedman tests with post-hoc Tukey's test (intergroup comparisons), and Pearson and Spearman analyses (correlations between perceptions) were applied. The WA retainers did not significantly differ among themselves. The CT was rated significantly worse in speech (p ≤ 0.001), discomfort (p < 0.001), and occlusal interference (p < 0.001), and did not significantly differ from the others in esthetics. Users preferred significant more the WA retainers in comparison with the CT retainers. The occlusal interference caused by the CT was positively correlated to other perceptions, such as changes in speech and discomfort. WA retainers presented similar preference and perceptions, but were significantly better than the CT. The CT occlusal coverage appeared to be the primary cause of its rejection.


Assuntos
Desenho de Aparelho Ortodôntico/estatística & dados numéricos , Contenções Ortodônticas/normas , Preferência do Paciente/estatística & dados numéricos , Adulto , Análise de Variância , Estudos Cross-Over , Feminino , Humanos , Masculino , Maxila , Valores de Referência , Estatísticas não Paramétricas , Resultado do Tratamento , Escala Visual Analógica , Adulto Jovem
16.
J Emerg Nurs ; 45(5): 517-522.e6, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31445628

RESUMO

INTRODUCTION: Health literacy can create barriers for ED staff attempting to communicate important information to patients. Video discharge instructions may address some of these barriers by improving patients' comprehension of medical information and addressing health literacy challenges. METHODS: One hundred ninety-six patients diagnosed with either hypertension, asthma, congestive heart failure, or diabetes were randomly assigned to 1 of 2 interventions: watching video medical information followed by reviewing written discharge instructions or written instructions first, followed by video education. After the interventions, patients from both groups completed surveys assessing their preferences for receiving medical information. RESULTS: We found that 44% (n = 86/196) of ED patients preferred receiving medical information in video format, whereas 18% (n = 35/196) favored the written format, and 38% (n = 75/196) of the sample preferred receiving both formats. Fifty-five percent of men (n = 38/69) preferred the video format, whereas 42% (n = 51/122) of women indicated a preference for both video and written formats. Learning something new from the video was associated with patient preference for receiving medical instructions, (χ2 [1] = 9.39, P = 0.01) and the desire to watch medical videos or read information at home via the Internet (χ2 [1] = 18.46, P < 0.001). DISCUSSION: The majority of ED patients in this study preferred medical information in video or video plus written formats, compared with written-only format.


Assuntos
Enfermagem em Emergência/métodos , Serviço Hospitalar de Emergência , Comunicação em Saúde/métodos , Alfabetização em Saúde , Alta do Paciente/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Distribuição Aleatória , Inquéritos e Questionários , Adulto Jovem
17.
Geriatr Gerontol Int ; 19(8): 829-833, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31282019

RESUMO

AIM: Japan introduced dementia-friendly initiatives into its national policies to help people with dementia remain involved in society for as long as possible. However, some people might choose to live in a nursing home to avoid care burden on family members. Understanding middle-aged adults' preferences for place of care and identifying factors that influence their preferences would help policy decision-makers promote dementia-friendly initiatives. The present study aimed to investigate the care preferences of middle-aged adults if they acquired dementia in Japan and the USA. METHODS: We carried out a cross-sectional observational study using an internet-based questionnaire survey of Japanese residents with Japanese ethnicity, Japanese Americans, and non-Asian Americans aged 40-70 years. A total of 301 participants, including 104 Japanese residents, 93 Japanese Americans and 104 non-Asian Americans, completed the survey. Participants were asked to answer the items based on a hypothetical situation in which they had acquired dementia requiring regular care and supervision. RESULTS: Participants preferred nursing home care (29.9%), followed by professional home care (19.6%), family home care (17.6%) and hospital care (11.3%). Japanese residents had a significantly lower preference for professional home care than did Japanese or non-Asian Americans (adjusted odds ratio 0.28, 95% confidence interval 0.10-0.75). Between-ethnicity difference in care preferences was not observed. CONCLUSIONS: A low preference for professional home care among the middle-aged adults might be influenced by country-specific long-term and dementia care systems. Policy decision-makers should develop professional home care services that are more available for families of people living with dementia. Geriatr Gerontol Int 2019; 19: 829-833.


Assuntos
Demência , Serviços de Assistência Domiciliar , Preferência do Paciente , Instituições de Cuidados Especializados de Enfermagem , Idoso , Americanos Asiáticos/psicologia , Americanos Asiáticos/estatística & dados numéricos , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Comparação Transcultural , Estudos Transversais , Demência/etnologia , Demência/psicologia , Feminino , Humanos , Vida Independente/psicologia , Vida Independente/estatística & dados numéricos , Japão/epidemiologia , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Preferência do Paciente/etnologia , Preferência do Paciente/estatística & dados numéricos , Estados Unidos/epidemiologia
18.
PLoS One ; 14(7): e0218795, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31260480

RESUMO

BACKGROUND: Adolescents living in sub-Saharan Africa constitute a vulnerable population at significant risk of HIV infection. This study aims to evaluate the acceptability, feasibility, and accuracy of home-based, supervised HIV self-testing (HIVST) as well as their predictors among adolescents living in Kisangani, Democratic Republic of the Congo (DRC). METHODS: A cross-sectional, door-to-door survey using a blood-based HIV self-test and a peer-based supervised HIVST approach was conducted from July to August 2018 in Kisangani, DRC. The acceptability and feasibility of HIVST were assessed among adolescents' consenting to use and interpret HIV self-test. The accuracy of HIVST was estimated by the sensibility and specificity of adolescent-interpreted HIV self-test. Factors associated with acceptability and feasibility of HIVST were analyzed with logistic regression. RESULTS: A total of 628 adolescents (including 369 [58.8%] females) aged between 15 and 19 years were enrolled. Acceptability of HIVST was high (95.1%); 96.1% of participants correctly used the self-test, and 65.2% asked for verbal instructions. The majority of adolescents (93.5%) correctly interpreted their self-test results. The Cohen's κ coefficient between the results read by adolescents and by supervisors was 0.62. The correct interpretation decreased significantly when adolescents had no formal education or attended primary school as compared to those currently attending university (37.0% versus 100%; adjusted OR: 0.01 [95% CI: 0.004-0.03]). In the hands of adolescents at home, the sensitivity of the Exacto Test HIV Self-test was estimated at 100%, while its specificity was 96.0%. The majority of participants (68.0%) affirmed that post-test counseling was essential, and that face-to-face counseling (78.9%) was greatly preferred. CONCLUSIONS: Home-based, supervised HIVST using a blood-based self-test and peer-based approach can be used with a high degree of acceptability and feasibility by adolescents living in Kisangani, DRC. Misinterpretation of test results is challenging to obtaining good feasibility of HIVST among adolescents with poor educational level. Face-to-face post-test counseling seems to be preferred among Kisangani's adolescents.


Assuntos
Infecções por HIV/diagnóstico , HIV-1/imunologia , HIV-2/imunologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Preferência do Paciente/psicologia , Autogestão/psicologia , Sorodiagnóstico da AIDS/métodos , Adolescente , Aconselhamento/métodos , Estudos Transversais , República Democrática do Congo , Estudos de Viabilidade , Feminino , Antígenos HIV/sangue , Infecções por HIV/imunologia , Infecções por HIV/virologia , Humanos , Modelos Logísticos , Masculino , Programas de Rastreamento/métodos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Kit de Reagentes para Diagnóstico , Autogestão/educação , Autogestão/estatística & dados numéricos , Sensibilidade e Especificidade , Adulto Jovem
19.
Int J Health Plann Manage ; 34(3): 926-934, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31353750

RESUMO

In China, patients with chronic diseases have complete freedom to choose the medical institutions at which they are treated, which has resulted in wasted medical resources and increased medical expenses. The purpose of this study is to determine the effective mechanisms to incentivise patients with chronic diseases to obtain referrals from community health centres to tertiary hospitals and estimate the funds that could be saved using various mechanisms. Questionnaire research, expert consultations, and data simulation were applied. We surveyed 1824 outpatients at nine tertiary hospitals in Shanghai, and the results showed that the proportion of patients willing to obtain referrals was 48.4%. By increasing the registration fee, reducing the payment ratio of medical insurance, publicising, and rating the quality of community health centres, up to 51.3%, 50.6%, and 65.41% patients with chronic diseases indicated that they would obtain referrals, respectively. According to the 2015 Shanghai outpatient database, the funding that could be saved through these three mechanisms would be 361.67, 356.73, and 461.14 million yuan, respectively. We conclude that referral of patients with chronic diseases could reduce medical expenses and save medical insurance funds. Nevertheless, no single measure can effectively change patient habits. Comprehensive measures need to be applied to guide patient referral actively.


Assuntos
Doença Crônica/terapia , Preferência do Paciente/psicologia , Alocação de Recursos/métodos , China/epidemiologia , Doença Crônica/economia , Doença Crônica/epidemiologia , Redução de Custos/métodos , Humanos , Seguro Saúde/economia , Seguro Saúde/estatística & dados numéricos , Preferência do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Inquéritos e Questionários
20.
Midwifery ; 77: 78-85, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31271963

RESUMO

BACKGROUND: Alongside midwifery units (AMUs) are managed by midwives and proximate to obstetric units (OUs), offering a home-like birth environment for women with straightforward pregnancies. They support physiological birth, with fast access to medical care if needed. AMUs have good perinatal outcomes and lower rates of interventions than OUs. In England, uptake remains lower than potential use, despite recent changes in policy to support their use. This article reports on experiences of access from a broader study that investigated AMU organisation and care. METHODS: Organisational case studies in four National Health Service (NHS) Trusts in England, selected for variation geographically and in features of their midwifery units. Fieldwork (December 2011 to October 2012) included observations (>100 h); semi-structured interviews with staff, managers and stakeholders (n = 89) and with postnatal women and partners (n = 47), on which this paper reports. Data were analysed thematically using NVivo10 software. RESULTS: Women, partners and families felt welcome and valued in the AMU. They were drawn to the AMUs' environment, philosophy and approach to technology, including pain management. Access for some was hindered by inconsistent information about the existence, environment and safety of AMUs, and barriers to admission in early labour. CONCLUSIONS: Key barriers to AMUs arise through inequitable information and challenges with admission in early labour. Most women still give birth in obstetric units and despite increases in the numbers of women birthing on AMUs since 2010, addressing these barriers will be essential to future scale-up.


Assuntos
Acesso aos Serviços de Saúde/normas , Tocologia/normas , Adulto , Centros de Assistência à Gravidez e ao Parto/organização & administração , Centros de Assistência à Gravidez e ao Parto/normas , Centros de Assistência à Gravidez e ao Parto/estatística & dados numéricos , Inglaterra , Feminino , Acesso aos Serviços de Saúde/estatística & dados numéricos , Humanos , Tocologia/organização & administração , Unidade Hospitalar de Ginecologia e Obstetrícia , Preferência do Paciente/psicologia , Preferência do Paciente/estatística & dados numéricos , Pesquisa Qualitativa , Medicina Estatal/organização & administração
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