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1.
Artigo em Inglês | MEDLINE | ID: mdl-31546719

RESUMO

(1) Background: Studies indicate that lesbian, gay, bisexual, transgender and intersex (LGBTI) people constantly face challenges and disadvantages in the health care system that prevent them from getting the best possible patient-centered care. However, the present study is the first to focus on LGBTI-related health in a major German metropolis. It aimed to investigate health care structures, prevention measures and diagnostic as well as treatment procedures that LGBTI individuals need in order to receive appropriate patient-centered health care and health promotion. (2) Methods: Following a participatory approach, five expert interviews with LGBTI people with multiplier function, i.e., people who have a key role in a certain social milieu which makes them able to acquire and spread information in and about this milieu, and three focus groups with LGBTI people and/or health professionals were conducted. Qualitative data were analyzed according to the principles of content analysis. (3) Results: The specific needs of LGBTI individuals must be recognized as a matter of course in terms of depathologization, sensitization, inclusion, and awareness. Such an attitude requires both basic knowledge about LGBTI-related health issues, and specific expertise about sufficient health care services for each of the minorities in the context of sex, sexual orientation and gender identity. (4) Conclusions: For an appropriate approach to LGBTI-centered health care and health promotion, health professionals will need to adopt a better understanding of specific soft and hard skills.


Assuntos
Protocolos Clínicos , Assistência à Saúde/estatística & dados numéricos , Serviços de Diagnóstico/estatística & dados numéricos , Serviços de Saúde/estatística & dados numéricos , Prevenção Primária/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto , Cidades , Assistência à Saúde/organização & administração , Feminino , Grupos Focais , Identidade de Gênero , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Primária/instrumentação , Pessoas Transgênero/estatística & dados numéricos
2.
JAMA Netw Open ; 2(6): e195877, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31199453

RESUMO

Importance: It is unclear whether effective population-wide interventions that reduce risk factors and improve health result in sustained benefits to a community's health. If benefits do persist after a program is ended, interventions could be brief rather than maintained long term. Objective: To measure mortality and smoking rates in a rural community over decades before, during, and after prevention program reductions. Design, Setting, and Participants: This cross-sectional study compared smoking and mortality rates in a rural Maine county with other Maine counties over time by 5-year intervals. Multiple changes occurred between 2001 and 2015 in the physiological and behavioral risk factor reduction programs offered in the county. They included reductions in leadership, staff, institutional resources, data monitoring, and the programs themselves. Data were analyzed from May 2018 to March 2019. Intervention: Previous multifaceted interventions and outcome monitoring were withdrawn or diminished in the past decade. Main Outcomes and Measures: Smoking and age-adjusted mortality rates vs household income. Results: Reduced mortality rates in Franklin County in 1986 to 2005 reverted to those predicted by household incomes, relative to other Maine counties, by 2006 to 2015 (1986-1990 T score = -2.86 [P = .01] and 2001-2005 T score = -3.00 [P = .01] to 2006 to 2010 T score = -0.43 [P = .67] and 2011-2015 T score = -0.72 [P = .48]). Analysis of County Health Rankings data from 2010 to 2018 also showed that Franklin County's outcomes have reverted to no better than predicted by socioeconomic status. The county's T scores increased from -3.62 (P = .003) in 2010 to -0.41 (P = .69) in 2015 to 0.13 (P = .90) in 2018. Statewide association of income with mortality by analyses of variance showed that the R2 values have increased from the decades preceding 2000 (1976-1980, R2 = 0.21; P = .08; 1986-1990, R2 = 0.32; P = .02) to 2006 to 2010 (R2 = 0.73; P < .001) and 2011 to 2015 (R2 = 0.70; P < .001). Conclusions and Relevance: This study suggests that gains associated with population health interventions may be lost when the interventions are reduced. Adjusting outcome measures for socioeconomic status may allow quicker and more sensitive monitoring of intervention adequacy and success. The increasing trend of age-adjusted mortality in Maine and nationally to correlate inversely with incomes may warrant further community interventions, especially for poorer populations.


Assuntos
Doenças Cardiovasculares/epidemiologia , Serviços de Saúde Comunitária/estatística & dados numéricos , Promoção da Saúde , Prevenção Primária/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologia , Serviços de Saúde Comunitária/economia , Estudos Transversais , Promoção da Saúde/economia , Humanos , Maine/epidemiologia , Prevenção Primária/economia , População Rural , Abandono do Hábito de Fumar , Fatores Socioeconômicos , Fumar Tabaco/prevenção & controle , Fumar Tabaco/psicologia
3.
Cancer Control ; 26(1): 1073274819848432, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31094222

RESUMO

Breast cancer (BC) and cervical cancer (CC) are the first and fifth common cancers in Iranian women. Although age-standardized incidence rate of BC and CC in Iran is low, the mortality to incidence ratio is high due to late diagnosis. Except an old and a quite comprehensive cancer registry, women's cancer care encounter many challenges in Iran. Lack of a customized national and inclusive protocol to control cancer care along with the fragmented health system is the first and foremost cancer care challenge. Many high-risk women miss the opportunity of early diagnosis and treatment because of poor knowledge, low accessibility, or affordability to health care, stigma, and spouse negligence. Although the most effective BC screening method is mammography, it is not equally available for all Iranian women. Furthermore, the cost of BC is very high and screening is accompanied by stigmatized sociocultural beliefs. Unfortunately, while Iran has a good primary care system, low coverage of clinical breast examination and poor knowledge of women indicate that this system has not operated effective. Also due to the limited resources, the Pap smear test has not been applied to the majority of Iranian women. Despite the high basic health insurance coverage in Iran, it does not cover diagnostic test and full treatment of cancers which intensified underutilization of cancer care. In conclusion, developing a national policy and guideline for full coverage of early diagnosis of BC or CC should be prioritized. In this regard, health insurance companies should be committed to including BC and CC screening and care for their basic service packages. The second strategy could be training skillful, responsible, and motivated health-care providers. They are able to decrease the stigmatized view of doing mammography. Survivorship care including follow-up care, posttreatment issues, and psychosocial support should also be considered.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Prevenção Primária/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias da Mama/tratamento farmacológico , Neoplasias da Mama/mortalidade , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Irã (Geográfico) , Mamografia/estatística & dados numéricos , Neoplasias do Colo do Útero/tratamento farmacológico , Neoplasias do Colo do Útero/mortalidade , Esfregaço Vaginal/estatística & dados numéricos
4.
Basic Clin Pharmacol Toxicol ; 125(2): 108-116, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30924261

RESUMO

The aim of this cohort study was to compare the effectiveness of statin regimens for primary prevention among seniors aged ≥ 75 years. Seniors aged 75-100 years for whom statin therapies for primary prevention were newly initiated between 1 January 2009 and 31 December 2011, and who continued the same statin regimen during the first year after the index date were identified using the claims data from the South Korean National Health Insurance Database. A propensity score matching and multivariable Cox proportional hazards model were developed to evaluate adjusted ischaemic cardiovascular-cerebrovascular event (CCE) risk and all-cause mortality risk for all patients, as well as for subgroups. A total of 5629 older patients aged 75-100 years were included in the study population. Compared to moderate-intensity statin therapy, low-intensity statin therapy was significantly associated with increased risk of ischaemic CCEs, while high-intensity statin therapy was associated with reduced risk of ischaemic CCEs; however, compared to moderate-intensity statin therapy, both low-intensity and high-intensity statin therapies were associated with increased risk of all-cause mortality. For the 4689 older patients who regularly received moderate-intensity statin therapy including 10 mg atorvastatin, 20 mg atorvastatin, 10 mg rosuvastatin or 20 mg simvastatin for primary prevention, multivariable regression adjusting for potential covariates revealed no significant difference in ischaemic CCEs or all-cause mortality between the moderate-intensity statin users and 10 mg atorvastatin users both before and after propensity scoring matching. No significant heterogeneity was detected in the patient subgroups. The results of this study based on real-world data can supply evidence-based reasons for choice of statin regimen for the primary prevention of CCEs in older people aged ≥ 75 years.


Assuntos
Doenças Cardiovasculares/epidemiologia , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Prevenção Primária/métodos , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Doenças Cardiovasculares/prevenção & controle , Bases de Dados Factuais/estatística & dados numéricos , Relação Dose-Resposta a Droga , Esquema de Medicação , Feminino , Humanos , Masculino , Programas Nacionais de Saúde/estatística & dados numéricos , Prevenção Primária/estatística & dados numéricos , Pontuação de Propensão , República da Coreia/epidemiologia , Estudos Retrospectivos , Resultado do Tratamento
5.
Evid Based Ment Health ; 22(2): 84-90, 2019 05.
Artigo em Inglês | MEDLINE | ID: mdl-30918000

RESUMO

QUESTION: A growing body of work suggests that medical students may be particularly at risk of mental ill health, suicidal ideation and behaviour, resulting in recent calls to develop interventions to prevent these outcomes. However, few reviews have synthesised the current evidence base regarding the effectiveness of these interventions and provided guidance to improve future intervention efforts. STUDY SELECTION AND ANALYSIS: The authors conducted a systematic review to identify studies of any design reporting the effectiveness of any universal intervention to address these outcomes in medical students. Embase, MEDLINE and PsycINFO databases were searched from their respective start dates until 1 December 2017. FINDINGS: Data from 39 studies were included. Most investigated the effectiveness of relatively brief interventions designed to reduce stress; most commonly using mindfulness-based or guided meditation approaches. Only one implemented an intervention specifically designed to address suicidal ideation; none investigated the effectiveness of an intervention specifically designed to address suicidal behaviour. Five investigated the effects of curriculum-level changes. Overall, there was limited evidence of an effect for these programmes at both the postintervention and longest follow-up assessment on depression, anxiety and stress. CONCLUSIONS: Relatively brief, individually focused, mindfulness-based interventions may be effective in reducing levels of anxiety, depression and stress in medical students in the short term. Effects on suicidal ideation and behaviour, however, remain to be determined. There has been a significant lack of attention on organisational-level stressors associated with medical education and training.


Assuntos
Transtornos Mentais/prevenção & controle , Prevenção Primária , Avaliação de Programas e Projetos de Saúde , Estudantes de Medicina , Ideação Suicida , Suicídio/prevenção & controle , Adolescente , Adulto , Feminino , Humanos , Masculino , /estatística & dados numéricos , Prevenção Primária/normas , Prevenção Primária/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde/normas , Avaliação de Programas e Projetos de Saúde/estatística & dados numéricos , Estudantes de Medicina/psicologia , Estudantes de Medicina/estatística & dados numéricos , Adulto Jovem
6.
G Ital Cardiol (Rome) ; 20(3): 136-148, 2019 Mar.
Artigo em Italiano | MEDLINE | ID: mdl-30821295

RESUMO

BACKGROUND: The pacemaker (PM) and implantable cardioverter-defibrillator (ICD) Registry of the Italian Association of Arrhythmology and Cardiac Pacing (AIAC) monitors the main epidemiological data in real-world practice. The survey for the 2017 activity collects information about demographics, clinical characteristics, main indications for PM/ICD therapy and device types from the Italian collaborating centers. METHODS: The Registry collects prospectively national PM and ICD implantation activity on the basis of European cards. RESULTS: PM Registry: data about 23 457 PM implantations were collected (19 378 first implant and 4079 replacements). The number of collaborating centers was 185. Median age of treated patients was 81 years (75 quartile I; 86 quartile III). ECG indications included atrioventricular conduction disorders in 37.1% of first PM implants, sick sinus syndrome in 19.5%, atrial fibrillation plus bradycardia in 13.2%, other in 30.2%. Among atrioventricular conduction defects, third-degree atrioventricular block was the most common type (21.0% of first implants). Use of single-chamber PMs was reported in 25.6% of first implants, of dual-chamber PMs in 66.7%, of PMs with cardiac resynchronization therapy (CRT) in 1.4%, and of single lead atrial-synchronized ventricular stimulation (VDD/R PMs) in 6.3%. ICD Registry: data about 19 023 ICD implantations were collected (13 898 first implants and 5125 replacements). The number of collaborating centers was 437. Median age of treated patients was 71 years (63 quartile I; 78 quartile III). Primary prevention indication was reported in 81.8% of first implants, secondary prevention in 18.2% (cardiac arrest in 6.4%). A single-chamber ICD was used in 27.0% of first implants, dual-chamber in 33.6% and biventricular in 39.3%. CONCLUSIONS: The PM and ICD Registry appears fundamental for monitoring PM and ICD utilization on a large national scale with rigorous examination of demographics and clinical indications. The PM Registry showed stable electrocardiographic and symptom indications, with an important prevalence of dual-chamber pacing. The use of CRT-PM regards a very limited number of patients. The ICD Registry documented a large use of prophylactic and biventricular ICD, reflecting a favorable adherence to trials and guidelines in clinical practice. In order to increase and optimize the cooperation of Italian implanting centers, online data entry (http://www.aiac.it/riprid) should be adopted at large scale.


Assuntos
Arritmias Cardíacas/terapia , Terapia de Ressincronização Cardíaca/estatística & dados numéricos , Desfibriladores Implantáveis/estatística & dados numéricos , Marca-Passo Artificial/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Arritmias Cardíacas/epidemiologia , Arritmias Cardíacas/fisiopatologia , Eletrocardiografia , Feminino , Humanos , Itália , Masculino , Pessoa de Meia-Idade , Prevenção Primária/estatística & dados numéricos , Sistema de Registros , Prevenção Secundária/estatística & dados numéricos , Inquéritos e Questionários
7.
Malar J ; 18(1): 32, 2019 Feb 01.
Artigo em Inglês | MEDLINE | ID: mdl-30709399

RESUMO

BACKGROUND: Despite decreases in incidence and related mortality, malaria remains a major public health challenge in the Greater Mekong Sub-region (GMS). The emergence of artemisinin resistance threatens these gains and has prompted efforts to accelerate elimination in the region. In the GMS, transmission now clusters in hotspots along international borders and among high-risk populations, including forest-goers. To eliminate malaria in the region, interventions must target such hard-to-reach populations. This review provides a comprehensive overview of the qualitative research on behaviours and perceptions that influence uptake of and adherence to malaria interventions among forest-goers in the GMS. METHODS: A systematic search strategy was used to identify relevant sources, including database (OVID SP, PubMed, ISI Web of Knowledge) and bibliographic searches. Relevant findings from qualitative research methods were extracted and thematic analysis undertaken. RESULTS: Of 268 sources retrieved in searches twenty-two were reviewed. Most reported studies were conducted in Cambodia (n = 10), and were published after 2014 (n = 16). Four major themes emerged that are particularly relevant to the design of intervention packages targeted at forest-goers: (1) understanding of malaria and perceived risk; (2) preventive measures used when visiting the forest; (3) behaviours that put forest-goers at risk of infection; and, (4) malaria-related treatment seeking. There were notable differences across the reviewed articles that suggest the need for a locally tailored approach. CONCLUSION: A more detailed characterization of forest activities is needed but research on this topic raises methodological challenges. Current vector control measures have limitations, with use of insecticidal-treated nets, hammocks and repellents influenced by the type of forest activities and the characteristics of these measures. In contrast, anti-malarial drugs, for example, as chemoprophylaxis, hold promise but require further evaluation.


Assuntos
Malária/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Prevenção Primária/estatística & dados numéricos , Assunção de Riscos , Cooperação e Adesão ao Tratamento/estatística & dados numéricos , Antimaláricos/uso terapêutico , Ásia Sudeste , Camboja , Florestas , Humanos
8.
Eur J Pediatr ; 178(2): 139-146, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30353222

RESUMO

Many programs aim to prevent abusive head trauma throughout the USA, Europe, and in many other regions of the world. Most of these programs inform mothers shortly after delivery about the dangers of abusive head trauma. Effectiveness of these programs usually is measured by the increase of knowledge on abusive head trauma. Recent research showed, however that for effective primary prevention, a much broader approach might be necessary. But so far, there is no data that reports the knowledge on key messages on abusive head trauma in the general public as a baseline. We conducted a representative population-based survey on abusive head trauma knowledge in Germany. Whereas the dangers are generally well known, a majority might be ambivalent towards the recommendation to leave a crying infant alone for a few minutes when the caregiver becomes too stressed or frustrated. Furthermore, a majority prefers being informed on abusive head trauma before birth.Conclusion: Future preventive programs should focus on educating adolescents (potential baby sitters) and young adults when they do not yet have children of their own. What is known: • Most programs for primary prevention of abusive head trauma (AHT) focus on mothers shortly after delivery • There are no analyses so far of the quality of education programs in the general public, as educating mothers might not be sufficient to reduce incidence rates What is new: • Our study is the first population-based survey to measure the knowledge on AHT in a representative population sample and to provide the data base for targeted prevention programs. • The introduction of broader prevention programs might be necessary.


Assuntos
Cuidadores/estatística & dados numéricos , Maus-Tratos Infantis/prevenção & controle , Educação em Saúde/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Síndrome do Bebê Sacudido/prevenção & controle , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/educação , Maus-Tratos Infantis/estatística & dados numéricos , Feminino , Alemanha , Educação em Saúde/métodos , Humanos , Lactente , Recém-Nascido , Masculino , Pessoa de Meia-Idade , Mães , Prevenção Primária/métodos , Prevenção Primária/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
9.
AIDS Behav ; 23(5): 1178-1194, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-30415429

RESUMO

Despite the large interest in economic interventions to reduce HIV risk, little research has been done to show whether there are economic gains of these interventions for younger women and what intermediary role economic resources play in changing participants' sexual behavior. This paper contributes to this gap by examining the impacts of a conditional cash transfer (CCT) for young women in South Africa on young women's economic resources and the extent to which they play a role in young women's health and behavior. We used data from HIV Prevention Trials Network 068 study, which provided transfers to young women (in addition to their parents) conditional on the young woman attending at least 80% of school days in the previous month. We found that the CCT increased young women's economic wellbeing in terms of having savings, spending money, being unindebted, and food secure. We also investigated heterogeneous effects of the program by household economic status at baseline because the program was not specifically poverty targeted and found that the results were driven by young women from the poorest families. From these results, we examined heterogeneity by baseline poverty for other outcomes related to HIV risk including sexual behavior and psychosocial well-being. We found psychosocial well-being benefits in young women from the poorest families and that economic wellbeing gains explained much these impacts.


Assuntos
Financiamento Governamental/estatística & dados numéricos , Infecções por HIV/prevenção & controle , Promoção da Saúde/economia , Promoção da Saúde/estatística & dados numéricos , Prevenção Primária/economia , Prevenção Primária/estatística & dados numéricos , Comportamento Sexual/psicologia , Adolescente , Adulto , Feminino , Infecções por HIV/economia , Humanos , Pobreza , Comportamento Sexual/estatística & dados numéricos , Adulto Jovem
10.
Zhongguo Xue Xi Chong Bing Fang Zhi Za Zhi ; 30(5): 518-522, 2018 Oct 26.
Artigo em Chinês | MEDLINE | ID: mdl-30567022

RESUMO

OBJECTIVE: To understand the professional theory, prevention and control practice, experimental diagnosis and other technical skills of parasitic diseases among technicians of all levels of disease control and prevention institutions, so as to provide the evidence for strengthening the capacity building of Chinese professional personnel. METHODS: According to the method of recommendation at all levels, the subjects from disease control and prevention institutions at province, prefecture or county levels were chosen to assess the theory of parasitic diseases and test operation skills by using the method of answering the questions together with on-site operations in China. A database was built consisting of subjects' basic information and assessment scores. By using the method of hierarchical classification, the scores by gender, age, professional title, institutions and places of participants were analyzed. RESULTS: A total of 124 professions in prevention and treatment of parasitic diseases in 31 provinces (cities and regions) were evaluated in China. The average total score of all the subjects was 125.0 ± 35.2, with a passing rate of 54.8%. The average scores of male subjects and female subjects were 120.8 ± 34.2 and 126.6 ± 35.4 respectively; the average scores of the subjects aged under 30 years, between 30 and 40 years, and above 40 years were 125.6 ± 33.6, 124.9 ± 35.8, and 119.3 ± 45.9 respectively; the average scores of persons with junior, intermediate and senior professional titles were 119.8 ± 35.8, 136.0 ± 32.5 and 127.1 ± 40.9 respectively. The average theoretical assessment score of all the subjects was 67.4 ± 15.6, with a passing rate of 68.5%. The average practical skill assessment score of all the subjects was 57.6 ± 21.8, with a passing rate of 46.0%. The average detection rates of Plasmodium falciparum, P. vivax, P. ovale and P. malariae in endemic and non-endemic areas were 64.1%, 72.8%, 57.0%, 58.3% and 35.9%, 46.9%, 33.3%, 43.8%, respectively. The detection ability of professionals in endemic areas was significantly higher than that in non-endemic areas (χ2 = 767.10, 462.12, 134.97 and 360.80, respectively, all P < 0.01). The total detection rate of schistosome eggs was 48.7%, and the detection rates of schistosome eggs were 67.4% and 36.8% in endemic and non-endemic areas, respectively. The detection ability of professionals in endemic areas was significantly higher than that in non-endemic areas (χ2 = 817.74, P < 0.01). The detection rates of Ascaris lumbricoides, Trichuris trichiura, and Enterobius vermicularis were 85.7%, 78.6%, 91.7%, and 61.8%, 23.5% and 74.4% in the technicians in southern region and northern region of China, showing significant differences (χ2 = 622.58, 301.70 and 588.71, respectively, all P < 0.01). CONCLUSIONS: The overall results of the subjects are good, but the technical operation capability of them is relatively low. Therefore, the specific training based on daily work needs should be enhanced. In addition, we should attach importance to talent cultivation and technical reserve, and strengthen the construction of the team, so as to meet the needs of the prevention and control of parasitic diseases.


Assuntos
Serviços de Diagnóstico , Profissionais Controladores de Infecções/estatística & dados numéricos , Doenças Parasitárias , Adulto , Animais , China , Bases de Dados Factuais , Serviços de Diagnóstico/normas , Serviços de Diagnóstico/estatística & dados numéricos , Feminino , Humanos , Profissionais Controladores de Infecções/educação , Masculino , Doenças Parasitárias/prevenção & controle , Prevenção Primária/estatística & dados numéricos , Fatores de Tempo
12.
J Am Geriatr Soc ; 66(10): 1987-1991, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-30251369

RESUMO

OBJECTIVES: To use restricted mean survival time, which summarizes treatment effects in terms of event-free time over a fixed time period, to evaluate the benefit of pravastatin therapy for primary prevention of cardiovascular disease in older adults. DESIGN: Secondary analysis of the Antihypertensive and Lipid-Lowering Treatment to Prevent Heart Attack Trial-Lipid-Lowering Trial (ALLHAT-LLT). SETTING: Ambulatory setting. PARTICIPANTS: Individuals aged 65 and older (mean aged 71, 49% female) free of cardiovascular disease (N=2,867). INTERVENTION: Pravastatin 40 mg/d (n=1,467) versus usual care (n=1,400). MEASUREMENTS: We estimated the difference in RMST for total and coronary heart disease (CHD)-free survival between the pravastatin and usual care groups over the 6-year trial period and used parametric survival models to estimate RMST differences projected over 10 years. RESULTS: Over 6 years, individuals treated with pravastatin lived (RMST 2,008.1 days), on average, 33.7 fewer days than those receiving usual care (RMST 2,041.8 days) (difference -33.7 days, 95% confidence interval (CI)=-67.0 to -0.5 days, p=.047). Pravastatin-treated individuals lived RMST 2,088.1 days), on average, 18.7 more days free of CHD over 6 years than those receiving usual care (RMST 2,069.4 days), but this difference was not statistically significant (difference 18.7 days, 95% CI=-10.4-47.8 days, p=.21). The 10-year projection showed that pravastatin-treated individuals would live 108.1 fewer days (95% CI=-204.5 to -14.1, p=.03) than those receiving usual care, although treated individuals would gain 77.9 days (95% CI=3.8-159.6, p=.046) of CHD-free survival. CONCLUSION: RMST provides an intuitive and explicit way to express the effect of pravastatin therapy on CHD-free and overall survival in older adults free of cardiovascular disease. This measure allows a more personalized interpretation than hazard ratios of the benefits and risks of a medical intervention for decision-making.


Assuntos
Anticolesterolemiantes/administração & dosagem , Doença das Coronárias/mortalidade , Doença das Coronárias/prevenção & controle , Pravastatina/administração & dosagem , Prevenção Primária/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Prevenção Primária/métodos , Modelos de Riscos Proporcionais , Taxa de Sobrevida , Fatores de Tempo , Resultado do Tratamento
13.
Dtsch Arztebl Int ; 115(27-28): 469-476, 2018 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-30064627

RESUMO

BACKGROUND: Cardiovascular diseases are among the most common causes of death in industrialized countries. The goal of the DECADE study ("decision aid, action planning, and follow-up support for patients to reduce the 10-year risk of cardiovascular diseases") is to improve patient activation and health-related behavior by means of structured cardiovascular risk counseling and DECADE brochures. In this pilot study, the applicability of DECADE and the potential effects of the intervention on patients with cardiovascular risk factors were investigated. METHODS: 87 patients were included in the two-arm, randomized, controlled pilot study. All of them participated in four structured counseling sessions. The A+D group received DECADE brochures (intervention group), while the A group did not (control group). The change in patient activation four months later (PAM13-D) was the primary endpoint. Secondary endpoints included, among others, changes in health status and health-related behavior, goal achievement, and patient satisfaction. These changes were studied in an intention-to-treat analysis. RESULTS: Endpoint data were available for 78 patients (38 in the A+D group and 40 in the A group) at four months. The use of DECADE brochures had a significant beneficial effect on PAM13-D scores (an increase of 3.30 points, p = 0.023), corresponding to a moderate effect size of 0.54. Positive trends were seen in most of the other endpoints. The improved patient activation was associated with an overall reduction of risk factors. CONCLUSION: This pilot study shows that DECADE can support patient activation. The effects can be expected to be stronger in a larger study and in comparison to usual care. If this can be confirmed, DECADE should be embedded in routine patient care.


Assuntos
Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Autogestão/educação , Idoso , Doenças Cardiovasculares/mortalidade , Feminino , Seguimentos , Alemanha/epidemiologia , Nível de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Motivação , Satisfação do Paciente/estatística & dados numéricos , Guias de Prática Clínica como Assunto/normas , Prevenção Primária/métodos , Prevenção Primária/estatística & dados numéricos , Fatores de Risco , Prevenção Secundária/métodos , Prevenção Secundária/estatística & dados numéricos , Autogestão/métodos
14.
Wiad Lek ; 71(4): 897-906, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30099432

RESUMO

OBJECTIVE: Introduction: Today, Ukraine is among the five largest European countries in terms of population, ranking fifth after Germany, Great Britain, France and Italy. Over the past decades, the number of people in Ukraine has been decreasing, mainly due to the excess of deaths over births. The high mortality rate in Ukraine is burdened by the fact that it concerns people of working age - the standardized mortality rate of the working-age population is 2.4 times higher than that of the EU countries and 1.5 times the average in Europe. The aim of this article was to determine the rationale for the economic effectiveness of the prevention of chronic non-communicable diseases and criteria for calculating the economic forecast. PATIENTS AND METHODS: Materials and methods: The research was conducted with the help of theoretical and statistical methods, by studying scientific sources and systematic analysis and generalization of the experience of finding economic efficiency of preventive measures of chronic diseases. CONCLUSION: Review and conclusions: The analysis of the considered methods of economic evaluation of the prevention and treatment of chronic non-infectious diseases made it possible to draw the following conclusions that the effectiveness of the health care system and individual health care facilities should be considered in a complex manner from the point of view of medical, social and economic efficiency. Economic efficiency, as a rule, is the result of medical and social efficiency. When calculating the cost-effectiveness of treatment and prevention measures, the whole complex of losses and costs associated with illnesses should be taken into account, in particular: direct costs directly related to preventionand treatment; Indirect losses associated with the illness, due to the unprocessed part of the gross domestic product, paid by sick leave. The task of the economic substantiation of medical and preventive measures is to calculate the necessary volume of material and technical and financial resources, as well as their effective use.


Assuntos
Efeitos Psicossociais da Doença , Programas de Rastreamento/economia , Doenças não Transmissíveis/economia , Doenças não Transmissíveis/prevenção & controle , Prevenção Primária/economia , Doença Crônica/economia , Doença Crônica/prevenção & controle , Feminino , Educação em Saúde/economia , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Prevenção Primária/estatística & dados numéricos , Ucrânia
15.
J Safety Res ; 66: 89-93, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30121114

RESUMO

INTRODUCTION: Every year, 4500 children die in motor-vehicle crashes in the United States, with estimated costs of more than $40,000 and $240 billion in productivity losses. The majority of deaths and injuries are associated with improper use of restraint devices, alcohol, high speeds, and built environments. METHODOLOGY: This is a retrospective study using U.S. panel data from 1997 through 2005. Data sources included the Fatality Analysis Reporting System, the Insurance Institute for Highway Safety, the U.S. Census Bureau, the Atlas of Presidential Elections, and the U.S. Bureau of Labor Statistics. This study used conditional fixed effects negative binomial regression to analyze the effect of the covariates on mortality by state and year. RESULTS: A total of 32,893 children died in motor-vehicle crashes (MVCs). States that allowed fines greater than $50 for lack of restraint use experienced significant reductions in mortality as well as states with laws allowing the use of red light cameras. Graduate licensing programs requiring a minimum age of 16 for the intermediate-level experienced mortality reductions as much as 90% compared with a minimum age of 14. Higher posted speeds were associated with higher mortality rates, particularly on local roads. CONCLUSION: This research focuses on the effects injury prevention laws have on mortality, but not on how effectively these laws are implemented and/or enforced. Results may be useful to policy-makers and public health practitioners involved in injury prevention and public health. Practical applications: Design appropriate education and training programs in road safety, implement effective road safety interventions and improve traffic safety legislation.


Assuntos
Acidentes de Trânsito/estatística & dados numéricos , Prevenção Primária/estatística & dados numéricos , Política Pública/legislação & jurisprudência , Adolescente , Criança , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Prevenção Primária/legislação & jurisprudência , Estudos Retrospectivos , Estados Unidos
16.
BMJ Open ; 8(7): e017937, 2018 07 11.
Artigo em Inglês | MEDLINE | ID: mdl-29997134

RESUMO

OBJECTIVES: Although both the prevalence and treatment rate of diabetes have increased, the degree of adherence to healthy behaviours by patients with diabetes has not yet been comprehensively evaluated. This study examines the differences in health management and mental health status according to diabetes status and awareness of that diagnosis. METHODS: This was a cross-sectional study of 14 655 people using data from the Korean National Health and Nutrition Examination Study 2010-2012, which used sampling weights. Multiple logistic regression analyses were used to compare health-risk behaviours, preventive healthcare utilisation and mental health status according to diabetes diagnosis and awareness of the disease. RESULTS: Compared with people without diabetes, people with diabetes had comparably worse smoking status (adjusted OR (aOR) 1.09, 95% CI 0.92 to 1.30), insufficient physical activity (aOR 1.09, 95% CI 0.95 to 1.24) and were less likely to receive cancer screenings and regular health check-ups (aOR 0.75, 95% CI 0.66 to 0.85). Furthermore, compared with people unaware of their diabetes, people aware of their diabetes had lower odds of physical inactivity (aOR 0.66, 95% CI 0.45 to 0.99) and greater odds of receiving colon cancer screening (aOR 1.55, 95% CI 1.17 to 2.05) and influenza vaccination (aOR 1.56, 95% CI 1.15 to 2.11). CONCLUSIONS: People with diabetes were no better in terms of health behaviours and preventive healthcare utilisation than those who were without diabetes. Further efforts and political attention to ensure the delivery of quality care for people with diabetes are needed.


Assuntos
Diabetes Mellitus Tipo 2/epidemiologia , Comportamentos de Risco à Saúde , Prevenção Primária/estatística & dados numéricos , Adulto , Idoso , Consumo de Bebidas Alcoólicas/epidemiologia , Estudos de Casos e Controles , Estudos Transversais , Diabetes Mellitus Tipo 2/psicologia , Feminino , Inquéritos Epidemiológicos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , República da Coreia/epidemiologia , Comportamento Sedentário , Fumar/epidemiologia
17.
Adv Respir Med ; 86(3)2018.
Artigo em Inglês | MEDLINE | ID: mdl-29960282

RESUMO

Since the second half of the 20th century the incidence of tuberculosis has been declining in Poland. Despite this, current epidemiological data still support the need for the continued mass BCG vaccination in Poland in the near future. Apart from the protection against severe hematogenous forms of tuberculosis, vaccination lowers the risk of infection with Mycobacterium tuberculosis. Primary and acquired immunodeficiency, including immunity disorders associated with an ongoing treatment, are contraindications to BCG vaccination. The most common adverse effects following BCG vaccination are reactions at the site of injection and in regional lymph nodes, which usually does not require treatment. Methods of tuberculosis prevention, particularly recommended in low-incidence countries, include: diagnostic investigations of patients who had contacts with pulmonary tuberculosis as well as an active detection and treatment of latent Mycobacterium tuberculosis infection. Latent tuberculosis infection can be identified on the basis of positive results of the tuberculin skin test or interferon-gamma release assays after the active disease has been ruled out. This condition does require prophylactic treatment.


Assuntos
Vacina BCG/uso terapêutico , Prevenção Primária/estatística & dados numéricos , Tuberculose/prevenção & controle , Vacinação/normas , Criança , Feminino , Humanos , Tuberculose Latente/prevenção & controle , Masculino , Polônia , Teste Tuberculínico/estatística & dados numéricos
18.
Health Policy ; 122(9): 1035-1042, 2018 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-30055899

RESUMO

In April 2013, the public health function was transferred from the NHS to local government, making local authorities (LAs) responsible for commissioning the NHS Health Check programme. The programme aims to reduce preventable mortality and morbidity in people aged 40-74. The national five-year ambition is to invite all eligible individuals and to achieve an uptake of 75%. This study evaluates the effects of LA expenditure on the programme's invitation rates (the proportion of the eligible population invited to a health check), coverage rates (the proportion of the eligible population who received a health check) and uptake rates (attendance by those who received a formal invitation letter) in the first three years of the reforms. We ran negative binomial panel models and controlled for a range of confounders. Over 2013/14-2015/16, the invitation rate, coverage rate and uptake rate averaged 57% 28% and 49% respectively. Higher per capita spend on the programme was associated with increases in both the invitation rate and coverage rate, but had no effect on the uptake rate. When we controlled for the LA invitation rate, the association between spend and coverage rate was smaller but remained statistically significant. This suggests that alternatives to formal invitation, such as opportunistic approaches in work places or sports centres, may be effective in influencing attendance.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Serviços Preventivos de Saúde/estatística & dados numéricos , Adulto , Idoso , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/economia , Atenção Primária à Saúde/economia , Atenção Primária à Saúde/estatística & dados numéricos , Prevenção Primária/economia , Prevenção Primária/estatística & dados numéricos , Medicina Estatal
19.
PLoS Biol ; 16(6): e2005761, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29912869

RESUMO

Reporting bias in the literature occurs when there is selective revealing or suppression of results, influenced by the direction of findings. We assessed the risk of reporting bias in the epidemiological literature on health-related behavior (tobacco, alcohol, diet, physical activity, and sedentary behavior) and cardiovascular disease mortality and all-cause mortality and provided a comparative assessment of reporting bias between health-related behavior and statin (in primary prevention) meta-analyses. We searched Medline, Embase, Cochrane Methodology Register Database, and Web of Science for systematic reviews synthesizing the associations of health-related behavior and statins with cardiovascular disease mortality and all-cause mortality published between 2010 and 2016. Risk of bias in systematic reviews was assessed using the ROBIS tool. Reporting bias in the literature was evaluated via small-study effect and excess significance tests. We included 49 systematic reviews in our study. The majority of these reviews exhibited a high overall risk of bias, with a higher extent in health-related behavior reviews, relative to statins. We reperformed 111 meta-analyses conducted across these reviews, of which 65% had statistically significant results (P < 0.05). Around 22% of health-related behavior meta-analyses showed small-study effect, as compared to none of statin meta-analyses. Physical activity and the smoking research areas had more than 40% of meta-analyses with small-study effect. We found evidence of excess significance in 26% of health-related behavior meta-analyses, as compared to none of statin meta-analyses. Half of the meta-analyses from physical activity, 26% from diet, 18% from sedentary behavior, 14% for smoking, and 12% from alcohol showed evidence of excess significance bias. These biases may be distorting the body of evidence available by providing inaccurate estimates of preventive effects on cardiovascular and all-cause mortality.


Assuntos
Doenças Cardiovasculares/mortalidade , Doenças Cardiovasculares/prevenção & controle , Comportamentos Relacionados com a Saúde , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prevenção Primária , Viés de Publicação , Comportamentos de Risco à Saúde , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/efeitos adversos , Prevenção Primária/estatística & dados numéricos , Viés de Publicação/estatística & dados numéricos , Fatores de Risco , Revisões Sistemáticas como Assunto
20.
Am J Med ; 131(10): 1234-1237, 2018 10.
Artigo em Inglês | MEDLINE | ID: mdl-29928863

RESUMO

BACKGROUND: The 2016 U.S. Preventive Services Task Force (USPSTF) guidelines for primary prevention statin therapy are more restrictive than the 2013 American College of Cardiology/American Heart Association (ACC/AHA) guidelines. There are important differences in how application of the risk thresholds from these guidelines would impact particular segments of the U.S. METHODS: Data from the National Health and Nutrition Examination Survey (2005-14) were used to determine statin eligibility across age, gender, and racial or ethnic group using criteria from the 2013 ACC/AHA and 2016 USPSTF guidelines. Proportions of the study population eligible for statins under the ACC/AHA 5% and 7.5% risk thresholds were compared with those eligible under the 2016 USPSTF 10% guidelines. RESULTS: Of the 5388 study participants, 34% were eligible for statin therapy under the USPSTF guideline compared with 43% under the Class I (7.5%) ACC/AHA treatment threshold and 53% under the Class IIa (5%) ACC/AHA treatment threshold. Moving from the USPSTF 10% threshold to the ACC/AHA 5% threshold increased statin eligibility for males ages 40-59 from 26%-48% (whites), from 19%-43% (Hispanics), and from 33%-74% (blacks). A similar disproportionate but less pronounced effect was seen when different risk thresholds were used for statin eligibility among women ages 40-59 across differing races and ethnicities. CONCLUSIONS: In this sample of U.S. adults from the National Health and Nutrition Examination Survey database, full implementation of the higher USPSTF statin treatment threshold could lead to less overall statin use and disproportionately lower statin use among non-Hispanic blacks.


Assuntos
Doenças Cardiovasculares , Inibidores de Hidroximetilglutaril-CoA Redutases/uso terapêutico , Prevenção Primária , Adulto , Fatores Etários , American Heart Association , Doenças Cardiovasculares/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Definição da Elegibilidade/estatística & dados numéricos , Grupos Étnicos , Feminino , Humanos , Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem , Masculino , Pessoa de Meia-Idade , Inquéritos Nutricionais/estatística & dados numéricos , Guias de Prática Clínica como Assunto , Prevenção Primária/métodos , Prevenção Primária/estatística & dados numéricos , Fatores de Risco , Fatores Sexuais , Estados Unidos/epidemiologia
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