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1.
PLoS One ; 16(8): e0255343, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34351971

RESUMO

BACKGROUND: Social and ecological differences in early SARS-CoV-2 pandemic screening and outcomes have been documented, but the means by which these differences have arisen are not well understood. OBJECTIVE: To characterize socioeconomic and chronic disease-related mechanisms underlying these differences. DESIGN: Observational cohort study. SETTING: Outpatient and emergency care. PATIENTS: 12900 Cleveland Clinic Health System patients referred for SARS-CoV-2 testing between March 17 and April 15, 2020. INTERVENTIONS: Nasopharyngeal PCR test for SARS-CoV-2 infection. MEASUREMENTS: Test location (emergency department, ED, vs. outpatient care), COVID-19 symptoms, test positivity and hospitalization among positive cases. RESULTS: We identified six classes of symptoms, ranging in test positivity from 3.4% to 23%. Non-Hispanic Black race/ethnicity was disproportionately represented in the group with highest positivity rates. Non-Hispanic Black patients ranged from 1.81 [95% confidence interval: 0.91-3.59] times (at age 20) to 2.37 [1.54-3.65] times (at age 80) more likely to test positive for the SARS-CoV-2 virus than non-Hispanic White patients, while test positivity was not significantly different across the neighborhood income spectrum. Testing in the emergency department (OR: 5.4 [3.9, 7.5]) and cardiovascular disease (OR: 2.5 [1.7, 3.8]) were related to increased risk of hospitalization among the 1247 patients who tested positive. LIMITATIONS: Constraints on availability of test kits forced providers to selectively test for SARS-Cov-2. CONCLUSION: Non-Hispanic Black patients and patients from low-income neighborhoods tended toward more severe and prolonged symptom profiles and increased comorbidity burden. These factors were associated with higher rates of testing in the ED. Non-Hispanic Black patients also had higher test positivity rates.


Assuntos
Teste para COVID-19/tendências , COVID-19/diagnóstico , Fatores Socioeconômicos , Adulto , Idoso , COVID-19/economia , COVID-19/psicologia , Teste para COVID-19/métodos , Estudos de Coortes , Comorbidade , Grupos de Populações Continentais/psicologia , Grupos Étnicos , Feminino , Hospitalização , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Ohio/epidemiologia , Pandemias , Fatores de Risco , SARS-CoV-2/patogenicidade
2.
Elife ; 102021 08 24.
Artigo em Inglês | MEDLINE | ID: mdl-34427182

RESUMO

Background: Women 50-65 years of age have the lowest cervical and colorectal cancer (CRC) screening rates among ages recommended for screening. The primary aim of this work is to determine how cancer risk perceptions and provider communication behaviors, in addition to known demographic factors, influence the uptake of both cervical and CRC screening or a single screen among women in southeast Michigan. Methods: Fourteen health services and communication behavior questions were adapted from the Health Information National Trends Survey (HINTS) and administered to a multiethnic sample of adults in southeast Michigan. The outcome variable was self-reported up-to-date cervical cancer and/or CRC screening as defined by the United States Preventive Services Task Force (USPSTF). Demographic and cancer risk/communication behavior responses of the four screening populations (both tests, one test, no tests) were analyzed with multinomial regression for all comparisons. Results: Of the 394 respondents, 54% were up to date for both cervical and CRC screening, 21% were up to date with only cervical cancer screening and 12% were up to date for only CRC screening. Of the 14 risk perception and communication behavior questions, only 'Did your primary care physician (PCP) involve you in the decisions about your health care as much as you wanted?' was significantly associated with women having both screens compared to only cervical cancer screening (aOR 1.67; 95% CI: 1.08, 2.57). The multivariate model showed age, and Middle East and North African (MENA) ethnicity and Black race, in addition to PCP-patient dyad decision-making to be associated with the cancer screenings women completed. Conclusions: Optimizing PCP-patient decision-making in health care may increase opportunities for both cervical cancer and CRC screening either in the office or by self-sampling. Understanding the effects of age and the different interventional strategies needed for MENA women compared to Black women will inform future intervention trials aimed to increase both cancer screenings. Funding: This work was supported by NIH through the Michigan Institute for Clinical and Health Research UL1TR002240 and by NCI through The University of Michigan Rogel Cancer Center P30CA046592-29-S4 grants.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer/psicologia , Programas de Rastreamento/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Médicos/psicologia , Neoplasias do Colo do Útero/diagnóstico , Estudos Transversais , Feminino , Comunicação em Saúde , Humanos , Michigan , Pessoa de Meia-Idade , Percepção , Fatores de Risco , Fatores Socioeconômicos
3.
Reprod Health ; 18(1): 138, 2021 Jun 30.
Artigo em Inglês | MEDLINE | ID: mdl-34193195

RESUMO

PURPOSES: This study aimed to understand the influence of health beliefs, demographic factors, and health characteristics on the intention to undergo Pap smear testing among women in rural areas of Indonesia. METHODS: A descriptive cross-sectional study was conducted and 687 married women participated in the study. A convenience sampling was applied to recruit the participants from community health centres in a rural region in Indonesia. Self-reported data using the Health Beliefs Model Scale for Cervical Cancer and Pap Smear Test was collected to assess the health beliefs. Independent t-tests, simple logistic regressions, and a hierarchical logistic regression with 3 steps were run. Statistical significance for analysis was set at p < 0.05. RESULTS: The mean age of the participants was 42 years (SD = 8.4). Among the participants, 81% of the women had never undergone a Pap smear test, and 61% (n = 422) of the women reported a high intention of receiving a Pap smear test. Income and education Health beliefs regarding Pap smear testing were different between women who had low and high intentions to undergo Pap smear testing. Health beliefs, such as perceived benefits, severity, barriers to Pap smear testing, and health motivation for a Pap smear test were associated with the intention to undergo Pap smear testing among rural Indonesian women. Overall, the hierarchical multiple regression with 3 steps containing demographic, health characteristics, and health belief variables accounted for 31% variance of the intention to undergo Pap smear test among the Indonesian rural women. CONCLUSIONS: Low screening rates of cervical cancer and high intentions to do the screening exist among rural Indonesian women. Health beliefs significantly affect the rural women's intention of Pap smear testing in Indonesia.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Intenção , Programas de Rastreamento/métodos , Teste de Papanicolaou/estatística & dados numéricos , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle , Adulto , Estudos Transversais , Detecção Precoce de Câncer , Feminino , Modelo de Crenças de Saúde , Humanos , Indonésia , Programas de Rastreamento/psicologia , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , População Rural , Inquéritos e Questionários , Esfregaço Vaginal/psicologia , Esfregaço Vaginal/estatística & dados numéricos
4.
PLoS One ; 16(7): e0251708, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34264940

RESUMO

BACKGROUND: COVID-19 is an emerging infectious disease which is a major public health problem worldwide. Given the serious threats imposed by COVID-19 and the absence of vaccines until August 2020, preventive measures play an essential role in reducing infection rates and controlling its spread. This shows the necessity of public adherence for preventive and control measures, which is affected by their knowledge, attitudes, and practices. OBJECTIVE: This study aimed to determine knowledge, attitude, and practice (KAP) towards COVID-19 and associated factors among outpatient service visitors, Debre Markos compressive specialized hospital, north-west,Ethiopia. METHOD: Institutional-based cross-sectional study design with a systematic random sampling technique was conducted from July to August 2020. Among a total of 404 participants, 398 were recruited. Data were collected using a structured questionnaire. The data was edited, coded, and entered into Epi data version 4.6 and exported to SPSS-25 for analysis. Bivariable and multivariable logistic regression models were employed to identify factors associated with KAP. A p-value of <0.05 was considered statistically significant. RESULT: The prevalence of poor knowledge, attitude and practice among the outpatient service visitors were 27.1%, 30.7% and 44%, respectively. The mean age of the participants was 33.4 ±10.9 years. Variables like; educational status, ''can't read and write" [AOR = 3.76, 95% CI (1.36-10.42), P = 0.01], read and write [AOR = 5.90, 95% CI (2.39-14.98), P = 0.01], rural residence [AOR = 3.04, 95% CI (1.43-6.46), P = 0.01] and having no television [AOR = 0.8, 95% CI (0.79-0.89), P = 0.03] were significantly associated with poor knowledge. While, educational status of "can't read and write", [AOR = 6.71, 95% CI (2.78-16.16), P = 0.01] and rural residence [AOR = 2.03, 95% CI (1.14-3.61), P = 0.02] were significantly associated with poor attitude. Additionally, poor knowledge, [AOR = 22.73, 95% CI (10.5-49.21), P = 0.01], rural residence [AOR = 2.08, 95% CI (1.08-4.88), P = 0.04] and having no television [AOR = 2.24, 95% CI (1.05-4.79), P = 0.01] were significantly associated with poor practice. CONCLUSION: In this study, knowledge, attitude, and practice among outpatient service visitors was poor which needs targeted health education and interventions from the health professional to enhance their knowledge, attitude, and practice towards COVID-19. In parallel with this, special attention should be given for the rural community and for those with an educational status of can't read and write.


Assuntos
COVID-19/psicologia , Conhecimentos, Atitudes e Prática em Saúde , Pacientes Ambulatoriais/psicologia , Adolescente , Adulto , COVID-19/epidemiologia , COVID-19/prevenção & controle , Escolaridade , Etiópia , Feminino , Humanos , Renda , Masculino , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Quarentena/psicologia , População Rural/estatística & dados numéricos
5.
J Prev Med Public Health ; 54(3): 190-198, 2021 May.
Artigo em Inglês | MEDLINE | ID: mdl-34092065

RESUMO

OBJECTIVES: Insufficient evidence exists regarding factors that affect screening adherence among people with a family history of diabetes, who comprise roughly half of all patients with diabetes. Therefore, we aimed to identify the determinants of diabetes screening adherence in adults with a family history of diabetes who had not yet been diagnosed with diabetes. METHODS: This cross-sectional study was conducted at selected urban primary healthcare facilities in Tehran, Iran. The study population was clinically non-diabetic adults above 20 years of age with a family history of diabetes in at least 1 first-degree relative. All eligible people identified on randomly-selected days of the month were invited to join the study. RESULTS: Among 408 participants, 128 (31.4%) had received a fasting blood glucose check during the last year. Using binary logistic regression, the independent predictors of screening adherence were knowledge of adverse effects of diabetes such as sexual disorders (odds ratio [OR], 3.05) and renal failure (OR, 2.73), the impact of family members' advice on receiving diabetes screening (OR, 2.03), recommendation from a healthcare provider to have a fasting blood glucose check (OR, 2.61), and intention to have a fasting blood glucose check within the next 6 months (OR, 2.85). Other variables that predicted screening adherence were age (OR, 1.05), job (being a housekeeper; OR, 3.39), and having a college degree (OR, 3.55). CONCLUSIONS: Knowledge of the adverse effects of diabetes, physicians' and healthcare providers' advice about the benefits of early disease detection, and family members' advice were independent predictors of screening adherence.


Assuntos
Diabetes Mellitus Tipo 2/diagnóstico , Programas de Rastreamento/psicologia , Cooperação e Adesão ao Tratamento/psicologia , Adulto , Estudos Transversais , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Irã (Geográfico) , Modelos Logísticos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/estatística & dados numéricos , Anamnese/estatística & dados numéricos , Pessoa de Meia-Idade , Cooperação e Adesão ao Tratamento/estatística & dados numéricos
6.
Nurs Res ; 70(5): 354-365, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34173380

RESUMO

BACKGROUND: Optimizing care continuum entry interventions is key to ending the HIV epidemic. Offering HIV screening to key populations in emergency departments (EDs) is a strategy that has been demonstrated to be effective. Analyzing patient and provider perceptions of such screening can help identify implementation facilitators and barriers. OBJECTIVES: The aim of this study was to investigate the acceptability of offering nurse-driven HIV screening to key populations based on data collected from patients, nurses, and other service providers. METHODS: This convergent mixed-methods study was a substudy of a cluster-randomized two-period crossover trial conducted in eight EDs to evaluate the effectiveness of the screening strategy. During the DICI-VIH (Dépistage Infirmier CIblé du VIH) trial, questionnaires were distributed to patients aged 18-64 years. Based on their responses, nurses offered screening to members of key populations.Over 5 days during the intervention period in four EDs, 218 patients were secondarily questioned about the acceptability of screening. Nurses completed 271 questionnaires pre- and posttrial regarding acceptability in all eight EDs. Descriptive analyses were conducted on these quantitative data. Convenience and purposeful sampling was used to recruit 53 providers to be interviewed posttrial. Two coders conducted a directed qualitative content analysis of the interview transcripts independently. RESULTS: The vast majority of patients (95%) were comfortable with questions asked to determine membership in key populations and agreed (89%) that screening should be offered to key populations in EDs. Nurses mostly agreed that offering screening to key populations was well accepted by patients (62.2% pretrial and 71.4% posttrial), was easy to implement, and fell within the nursing sphere of competence. Pretrial, 73% of the nurses felt that such screening could be implemented in EDs. Posttrial, the proportion was 41%. Three themes emerged from the interviews: preference for targeted screening and a written questionnaire to identify key populations, facilitators of long-term implementation, and implementation barriers. Nurses were favorable to such screening provided specific conditions were met regarding training, support, collective involvement, and flexibility of application to overcome organizational and individual barriers. DISCUSSION: Screening for key populations was perceived as acceptable and beneficial by patients and providers. Addressing the identified facilitators and barriers would help increase screening implementation in EDs.


Assuntos
Infecções por HIV/diagnóstico , Programas de Rastreamento/normas , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Adolescente , Adulto , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Infecções por HIV/psicologia , Humanos , Masculino , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Paris , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Pesquisa Qualitativa , Inquéritos e Questionários
7.
Nurs Womens Health ; 25(4): 272-277, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34146524

RESUMO

OBJECTIVE: To explore health care providers' perceived barriers to conducting standardized screening processes for substance use during pregnancy. DESIGN: Descriptive survey. SETTING/LOCAL PROBLEM: A health system in the northwestern United States where there was a lack of consistent substance use screening in prenatal clinics. PARTICIPANTS: A convenience sample of 12 women's health care providers from two hospitals in the health system, including obstetricians/gynecologists, women's health nurse practitioners, women's health physician assistants, and certified nurse-midwives. INTERVENTION/MEASUREMENTS: We created a 16-item questionnaire that identified potential barriers to screening, such as education/resources for providers, screening tools, referral processes, legal implications, patient relations, and infrastructure. RESULTS: A majority (n = 8, 66.7%) of participants indicated they had received adequate training regarding substance use during pregnancy and felt comfortable asking pregnant women about their substance use. All (n = 12, 100%) providers indicated that women would feel safe disclosing their substance use but might feel offended if their provider asked them about it. Although most reported screening women for substance use, they did not use a consistent screening tool or process. Participants identified lack of time, legal concerns, and lack of access to resources for referrals as other barriers to screening. CONCLUSION: Clinicians perceive barriers to screening for substance use during pregnancy, and they may be unaware of legal implications for patients related to perinatal substance use. Identifying barriers to universal screening may facilitate development of best practices related to counseling patients about substance use during pregnancy.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Programas de Rastreamento/métodos , Transtornos Relacionados ao Uso de Substâncias/diagnóstico , Adulto , Feminino , Acesso aos Serviços de Saúde , Humanos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Gravidez , Gestantes , Cuidado Pré-Natal , Encaminhamento e Consulta
8.
Nurs Res ; 70(5S Suppl 1): S73-S83, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34173374

RESUMO

BACKGROUND: Southeast Asian women have high rates of cervical cancer and yet are among the least likely to be screened. There is sparse literature on communication patterns among Southeast Asian women, specifically related to cervical cancer and Pap test uptake. Little is known about the influence of Southeast Asian mothers and daughters on each other's cervical cancer beliefs and screening behaviors. OBJECTIVES: We examined the perceptions of and barriers to cervical cancer screening among Cambodian and Lao mothers and daughters and explored how they converse about women's health issues, specifically cervical cancer and Pap testing. METHODS: We conducted in-depth interviews with Cambodian and Lao mother-daughter dyads, aged 18 years and older, living in a large Midwestern city between February and September of 2015. Descriptive statistics were calculated to summarize the sample demographic characteristics. Bivariate tests (contingency table analyses, independent t-tests, and Pearson correlations) were conducted to test for differences between the mothers and daughters in demographic characteristics and measures of health status and beliefs. Qualitative data were analyzed using content analysis. RESULTS: In-depth interviews were conducted with three Cambodian and eight Lao mother-daughter dyads. The daughters were significantly more acculturated to English, had greater education, and were mostly employed full time. The mothers and daughters evaluated their health status much the same, their medical mistrust equally, and all of the mothers and nine of the daughters were Buddhist. Themes in mother-daughter communication included what mothers and daughters do and do not talk about with regard to sexual health, refugee experiences, what hinders mother-daughter communication, and relationship dynamics. The mothers were embarrassed and uncomfortable discussing cervical cancer, Pap testing, and other women's health issues with their daughters. Although mothers did not influence women's health promotion or cervical cancer prevention with their daughters, daughters did influence their mothers' health and healthcare decisions. Daughters were critical in navigating healthcare systems, engaging with providers, and making medical decisions on behalf of their mothers. DISCUSSION: By leveraging the unique and dynamic intergenerational bond that mothers and daughters who identify as Southeast Asian have, we can develop strategies to influence the cultural dialogue related to cervical cancer and early detection.


Assuntos
Relações Mãe-Filho , Neoplasias do Colo do Útero/prevenção & controle , Adolescente , Adulto , Idoso , Ásia Sudeste/etnologia , Grupo com Ancestrais do Continente Asiático/etnologia , Grupo com Ancestrais do Continente Asiático/psicologia , Grupo com Ancestrais do Continente Asiático/estatística & dados numéricos , Detecção Precoce de Câncer/métodos , Detecção Precoce de Câncer/psicologia , Detecção Precoce de Câncer/normas , Feminino , Humanos , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Programas de Rastreamento/normas , Pessoa de Meia-Idade , Mães/psicologia , Mães/estatística & dados numéricos , Ohio , Pesquisa Qualitativa , Inquéritos e Questionários , Neoplasias do Colo do Útero/etnologia , Neoplasias do Colo do Útero/psicologia
9.
BMJ ; 373: n1022, 2021 05 18.
Artigo em Inglês | MEDLINE | ID: mdl-34006604

RESUMO

OBJECTIVE: To evaluate whether opt out framing, messaging incorporating behavioral science concepts, or electronic communication increases the uptake of hepatitis C virus (HCV) screening in patients born between 1945 and 1965. DESIGN: Pragmatic randomized controlled trial. SETTING: 43 primary care practices from one academic health system (Philadelphia, PA, USA) between April 2019 and May 2020. PARTICIPANTS: Patients born between 1945 and 1965 with no history of screening and at least two primary care visits in the two years before the enrollment period. INTERVENTIONS: This multilevel trial was divided into two studies. Substudy A included 1656 eligible patients of 17 primary care clinicians who were randomized in a 1:1 ratio to a mailed letter about HCV screening (letter only), or a similar letter with a laboratory order for HCV screening (letter+order). Substudy B included the remaining 19 837 eligible patients followed by 417 clinicians. Active electronic patient portal users were randomized 1:5 to receive a mailed letter about HCV screening (letter), or an electronic patient portal message with similar content (patient portal); inactive patient portal users were mailed a letter. In a factorial design, patients in substudy B were also randomized 1:1 to receive standard content (usual care), or content based on principles of social norming, anticipated regret, reciprocity, and commitment (behavioral content). MAIN OUTCOME MEASURES: Proportion of patients who completed HCV testing within four months. RESULTS: 21 303 patients were included in the intention-to-treat analysis. Among the 1642 patients in substudy A, 19.2% (95% confidence interval 16.5% to 21.9%) completed screening in the letter only arm and 43.1% (39.7% to 46.4%) in the letter+order arm (P<0.001). Among the 19 661 patients in substudy B, 14.6% (13.9% to 15.3%) completed screening with usual care content and 13.6% (13.0% to 14.3%) with behavioral science content (P=0.06). Among active patient portal users, 17.8% (16.0% to 19.5%) completed screening after receiving a letter and 13.8% (13.1% to 14.5%) after receiving a patient portal message (P<0.001). CONCLUSIONS: Opt out framing and effort reduction by including a signed laboratory order with outreach increased screening for HCV. Behavioral science messaging content did not increase uptake, and mailed letters achieved a greater response rate than patient portal messages. TRIAL REGISTRATION: ClinicalTrials.gov NCT03712553.


Assuntos
Controle Comportamental/métodos , Relações Comunidade-Instituição , Hepatite C/diagnóstico , Programas de Rastreamento/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Idoso , Método Duplo-Cego , Feminino , Seguimentos , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Motivação , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Portais do Paciente , Pennsylvania , Serviços Postais , Atenção Primária à Saúde/estatística & dados numéricos , Resultado do Tratamento
11.
PLoS One ; 16(5): e0252008, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34032802

RESUMO

INTRODUCTION: Breast cancer is the leading cause of death in Singaporean women, with advanced stage rendering a poorer prognosis. This study aims to explore the barriers to early presentation, information needs and sources in patients with locally advanced breast cancer (LABC). MATERIALS & METHODS: A convenience sample of patients who presented with locally advanced breast cancer to the Department of General Surgery in a teaching tertiary hospital were recruited for the study. We conducted semi-structured interviews face to face with the recruited patients. We recorded the interviews, transcribed them verbatim and analysed using thematic content analysis. RESULTS: Twenty-three participants were recruited of which 12 were Chinese and 11 were Malay women. Mean age was 60 years (± 13 SD). The most common knowledge barrier resulting in delay was the misconception that a breast lump must be painful to be malignant. Other knowledge barriers include the lack of knowledge and misinformation from the internet or other social media platforms. Some perceived barriers include fear of diagnosis, fear of treatment and fear of imposing financial burden on family members. A significant proportion of participants were also not aware of a national breast screening programme. CONCLUSIONS: Our study has found that barriers to early presentation of women with locally advanced breast cancer remain similar and have persisted over the years despite targeted efforts. There is a need for a rethink of existing strategies and to develop new innovative ways to reach out to this group of patients.


Assuntos
Neoplasias da Mama/diagnóstico , Detecção Precoce de Câncer/psicologia , Recidiva Local de Neoplasia/diagnóstico , Adulto , Neoplasias da Mama/epidemiologia , Neoplasias da Mama/patologia , Medo/psicologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , Recidiva Local de Neoplasia/epidemiologia , Recidiva Local de Neoplasia/patologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Singapura/epidemiologia
12.
Cancer Control ; 28: 10732748211010799, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33926235

RESUMO

BACKGROUND: Cervical Cancer is the second most common cancer among women in the world leading to 90% deaths in low and middle income countries. About 96,922 new Cervical Cancer cases are diagnosed annually in India. OBJECTIVE: To study the knowledge, attitude and practice on Cervical Cancer and screening among women in India. MATERIALS AND METHODS: Health sciences electronic databases PubMed and Google Scholar were searched for studies published between 2012 to March 2020. Keywords used for the search were ("Cervical Cancer screening"), ("knowledge"),("attitude"), ("practice") AND ("India"). 19 articles were included in the review based on the eligibility criteria. Statistical software SPSS-V.23 was used for the statistical application. RESULTS: 7688 women were included in the study. Age of study participants ranged from 12-65 years. Overall knowledge on Cervical Cancer among women was 40.22%. Knowledge of risk factors and signs and symptoms was fairly adequate among the women. 32.68% of women knew that early age of marriage was a risk factor for Cervical Cancer followed by 23.01% women who mentioned that early age of initiation of sexual activity was a common risk factor for Cervical Cancer. Inter menstrual bleeding and foul smelling discharge was the most common sign and symptom reported in 30.75% and 28.86% women respectively. Knowledge, attitude and practice regarding Cervical Cancer screening was seen in 20.31%, 43.64% and 13.22% of women respectively. CONCLUSION: Effective information, education and communication strategies are required to improve the level of awareness of women on Cervical Cancer.


Assuntos
Detecção Precoce de Câncer/estatística & dados numéricos , Programas de Rastreamento/estatística & dados numéricos , Neoplasias do Colo do Útero/prevenção & controle , Esfregaço Vaginal/estatística & dados numéricos , Adulto , Idoso , Serviços de Saúde Comunitária/organização & administração , Detecção Precoce de Câncer/psicologia , Feminino , Humanos , Índia , Programas de Rastreamento/psicologia , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , População Urbana/estatística & dados numéricos , Neoplasias do Colo do Útero/psicologia , Esfregaço Vaginal/psicologia
13.
J Psychosom Res ; 144: 110419, 2021 05.
Artigo em Inglês | MEDLINE | ID: mdl-33765518

RESUMO

OBJECTIVE: Recommendations on screening for depression in patients with coronary heart disease (CHD) are highly debated. While recent research has prioritized efficacy studies, little is known about what is potentially required for screening to be efficacious. Expanding our knowledge of how patients with CHD view screening is likely to pose a first step towards addressing this gap. We aimed to investigate patients ́ views on routine screening for depression in cardiac practice. METHODS: This exploratory, qualitative study was conducted among 12 patients with CHD, who completed semi-structured interviews. We used a purposive sampling strategy to include patients within a range of ages, gender and self-reported depression. Thematic analysis was carried out. RESULTS: We identified four main themes: Acceptance, utility, barriers and expectations. Patients in this sample appeared to be in favor of standardized routine screening for depression in cardiac practice, if the rationale was disclosed. Patients reported that standardized screening addresses holistic care demands, promotes validation of individual symptom burden and legitimizes the display of psychological distress in cardiac practice. Yet, skepticism towards the validity of screening instruments and perceived stigmatization could pose a main barrier to screening efficacy. Patients expected to receive feedback on results and consecutive recommendations. CONCLUSION: We found that depression screening is endorsed by patients with CHD in this study sample. Standardized routine screening procedures could serve as a useful tool to combat stigmatization, and encourage patients to display symptoms of depression towards cardiologists. The efficacy of depression screening could potentially be enhanced by tailoring the screening process towards patients´ needs.


Assuntos
Atitude Frente a Saúde , Doença das Coronárias/psicologia , Depressão/diagnóstico , Programas de Rastreamento/psicologia , Pacientes/psicologia , Idoso , Idoso de 80 Anos ou mais , Doença das Coronárias/terapia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Pacientes/estatística & dados numéricos , Pesquisa Qualitativa
14.
PLoS One ; 16(3): e0247568, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33705422

RESUMO

BACKGROUND: Active case-finding (ACF), also referred to as community-based tuberculosis screening, is a component of the World Health Organization's End TB Strategy. ACF has potential benefits but also harms, which need to be carefully assessed when developing and implementing ACF policies. While empirical evidence on the benefits of ACF is still weak, evidence on the harms is even weaker. This study aimed to explore experts' views on the benefits and harms of ACF for people with presumptive TB and communities. METHODS: This was an exploratory study. Semi-structured interviews were conducted with a purposive sample of 39 experts from international, non-governmental/non-profit organizations, funders, government institutions, international societies, think tanks, universities and research institutions worldwide. Framework analysis was applied. RESULTS: Findings elaborated perceived benefits of ACF, including reaching vulnerable populations, reducing patient costs, helping raise awareness for tuberculosis among individuals and engaging communities, and reducing tuberculosis transmission. Perceived harms included increasing stigma and discrimination, causing false-positive diagnoses, as well as triggering other unintended consequences related to screening for tuberculosis patients, such as deportation of migrants once confirmed to have tuberculosis. Most of the perceived benefits of ACF could be linked to its objective of finding and treating persons with tuberculosis early (theme 1), while ACF was also perceived as a "double-edged sword" and could cause harms, if inappropriately designed and implemented (theme 2). The analysis underlined the importance of considering the benefits and harms of ACF throughout the screening pathway. The study provides new insights into the perceived benefits and harms of ACF from the perspectives of experts in the field. CONCLUSION: This study highlights gaps in the evidence base surrounding ACF and can stimulate further research, debate and analysis regarding the benefits and harms of ACF to inform contextual optimization of design and implementation of ACF strategies.


Assuntos
Pesquisa Participativa Baseada na Comunidade , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Tuberculose/diagnóstico , Conscientização , Efeitos Psicossociais da Doença , Deportação , Diagnóstico Precoce , Feminino , Humanos , Masculino , Programas de Rastreamento/economia , Pesquisa Qualitativa , Discriminação Social , Estigma Social , Migrantes , Tuberculose/economia , Populações Vulneráveis
15.
Aust N Z J Public Health ; 45(2): 150-157, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-33683744

RESUMO

OBJECTIVE: To investigate perspectives of primary health care providers (HCPs) on providing cervical screening for Aboriginal and Torres Strait Islander women, who experience a higher burden of cervical cancer than other Australian women. METHODS: Semi-structured interviews with 13 HCPs from four Australian Indigenous primary health care centres (PHCCs). Transcripts were thematically analysed. RESULTS: HCPs discussed the need to approach cervical screening with sensitivity to women's emotional and cultural needs and sustaining relationships built on trust and respect. HCPs reported challenges in promoting screening to Aboriginal and Torres Strait Islander women due to cumbersome systems, competing clinical priorities, workforce capacity limitations and specific challenges associated with implementing the renewed National Cervical Screening Program. CONCLUSIONS: In practice, HCPs experience several challenges to delivering cervical screening. Understanding HCPs' perspectives on their approach to cervical screening delivery, and the systems in which this occurs, can help to ensure that they receive adequate support and resources to deliver cervical screening to Aboriginal and Torres Strait Islander women. Implications for public health: It is important that HCPs adopt a multi-faceted, person-centred approach to cervical screening that is responsive to women's needs and that works synchronously with supportive PHCC services and systems and the National Cancer Screening Register.


Assuntos
Competência Cultural , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Programas de Rastreamento , Atenção Primária à Saúde/organização & administração , Neoplasias do Colo do Útero , Adulto , Austrália , Detecção Precoce de Câncer , Feminino , Serviços de Saúde do Indígena , Humanos , Entrevistas como Assunto , Programas de Rastreamento/métodos , Programas de Rastreamento/psicologia , Grupo com Ancestrais Oceânicos/psicologia , Relações Profissional-Paciente , Pesquisa Qualitativa , Neoplasias do Colo do Útero/diagnóstico , Neoplasias do Colo do Útero/prevenção & controle
16.
Aval. psicol ; 20(1): 71-79, jan.-mar. 2021. ilus, tab
Artigo em Português | LILACS, Index Psicologia - Periódicos | ID: biblio-1249046

RESUMO

Este estudo é uma revisão de literatura desenvolvida para investigar o uso de instrumentos de vigilância e rastreio para atraso do desenvolvimento infantil por meio de tecnologia móvel. Além disso, objetivou-se caracterizar as metodologias utilizadas, amostras de participantes, se clínicas ou não, contexto de pesquisa, bem como a finalidade do uso instrumento. Foi realizada a busca de artigos, por três juízes, nas bases de dados indexadas na BVS, PUBMED/MEDLINE e APA PsyNET. Utilizaram-se as recomendações do PRISMA para essa revisão. A partir de critérios de inclusão/exclusão, foram recuperados e analisados cinco artigos. As duas modalidades de instrumentos: vigilância e rastreio, apresentaram-se em três categorias de estudo: 1) descritivo 2) viabilidade/usabilidade 3) validade. Conclui-se que mais estudos sejam necessários, especialmente para avaliar o impacto e eficácia do uso de instrumentos de vigilância e rastreio para atraso no desenvolvimento infantil em formato de tecnologia móvel. (AU)


This study is a literature review designed to investigate the use of monitoring and screening instruments for child developmental delay using mobile technology. In addition, the aim was to characterize the methodologies used, samples of participants, whether clinical or not, the research context and the purpose of the instrument use. Articles were searched by three judges in the databases indexed in the BVS, PUBMED/MEDLINE and APA PsyNET. The PRISMA recommendations were used for this review. After applying the inclusion/exclusion criteria, five articles were retrieved and analyzed. The two types of instruments: monitoring and screening, were presented in three study categories: 1) descriptive 2) viability/usability 3) validity. Further studies are needed to assess the impact and effectiveness of the use of mobile format instruments for the monitoring and screening for childhood developmental delays. (AU)


Este estudio es una revisión de la literatura desarrollada para investigar el uso de instrumentos de vigilancia y rastreo del retraso del desarrollo infantil a través de la tecnología móvil. Asimismo, el objetivo fue caracterizar las metodologías utilizadas, muestras de participantes, ya sean clínicas o no; además del contexto de investigación y la finalidad del uso del instrumento. Tres jueces realizaron una búsqueda de artículos en las bases de datos indexadas en la BVS, PUBMED/MEDLINE y APA PsyNET. Las recomendaciones de PRISMA se utilizaron para esta revisión. Según los criterios de inclusión/exclusión, cinco artículos fueron recuperados y analizados. Los dos tipos de instrumentos fueron: vigilancia y detección, se presentaron en tres categorías de estudio: 1) descriptivo 2) viabilidad/usabilidad 3) validez. Se concluyó que son necesarios más estudios, especialmente para evaluar el impacto y la efectividad del uso de instrumentos de vigilancia y rastreo del retraso en el desarrollo infantil en formato de tecnología móvil. (AU)


Assuntos
Desenvolvimento Infantil , Deficiências do Desenvolvimento/psicologia , Programas de Rastreamento/psicologia , Aplicativos Móveis , Bases de Dados Bibliográficas
17.
PLoS One ; 16(2): e0246991, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33592037

RESUMO

BACKGROUND: There is considerable heterogeneity in individuals' risk of disease and thus the absolute benefits and harms of population-wide screening programmes. Using colorectal cancer (CRC) screening as an exemplar, we explored how people make decisions about screening when presented with information about absolute benefits and harms, and how those preferences vary with baseline risk, between screening tests and between individuals. METHOD: We conducted two linked studies with members of the public: a think-aloud study exploring decision making in-depth and an online randomised experiment quantifying preferences. In both, participants completed a web-based survey including information about three screening tests (colonoscopy, sigmoidoscopy, and faecal immunochemical testing) and then up to nine scenarios comparing screening to no screening for three levels of baseline risk (1%, 3% and 5% over 15 years) and the three screening tests. Participants reported, after each scenario, whether they would opt for screening (yes/no). RESULTS: Of the 20 participants in the think-aloud study 13 did not consider absolute benefits or harms when making decisions concerning CRC screening. In the online experiment (n = 978), 60% expressed intention to attend at 1% risk of CRC, 70% at 3% and 77% at 5%, with no differences between screening tests. At an individual level, 535 (54.7%) would attend at all three risk levels and 178 (18.2%) at none. The 27% whose intention varied by baseline risk were more likely to be younger, without a family history of CRC, and without a prior history of screening. CONCLUSIONS: Most people in our population were not influenced by the range of absolute benefits and harms associated with CRC screening presented. For an appreciable minority, however, magnitude of benefit was important.


Assuntos
Neoplasias Colorretais/diagnóstico , Análise Custo-Benefício , Tomada de Decisões , Intenção , Internet , Programas de Rastreamento/psicologia , Feminino , Humanos , Masculino , Programas de Rastreamento/estatística & dados numéricos , Pessoa de Meia-Idade , Inquéritos e Questionários
18.
PLoS One ; 16(1): e0245542, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33481878

RESUMO

Human Immunodeficiency Virus (HIV) prevalence among South African youth is high, yet HIV testing remains suboptimal. We explored how perceptions of HIV risk and behaviours informed decisions to test for HIV. This study was conducted from April 2018 to March 2019 in Ekurhuleni district, Gauteng Province with males and females aged between 15-24 years. Twenty-five youth with unknown HIV status participated in in-depth interviews (IDIs); while four focus group discussions (FGDs) were conducted with those that previously tested for HIV. Probes used in the guides included types of incentives that youth would value when testing for HIV or receiving treatment; barriers and motivators to HIV testing; enablers and challenges to using cellphone technology and preferences on type of social media that could be used to create awareness about HIV testing services. IDIs and FGDs were audio-recorded, transcribed, and translated. QSR NVIVO 10 was used for the analysis. The majority of the youth perceived that their risk of HIV infection was low due to factors such as being young, lacking physical signs of HIV, being sexually inactive and parents not being HIV positive. However, youth identified high risk behaviours such as unprotected sex, multiple sexual partners, excessive drinking of alcohol, being victims of sexual abuse, road accidents and violent behaviour as increasing their vulnerability to HIV. Most youth highlighted cues to action that would motivate them to test for HIV such as support of parents, receiving incentives, improved confidentiality during HIV testing and receiving information about HIV via social media (Facebook, Twitter and Whatsapp). Despite perceptions of low risk to HIV, youth remain vulnerable to HIV. Disseminating HIV information via digital platforms; giving youth options to choose between testing locations that they consider to be private; providing incentives and equipping parents/guardians to encourage youth to test could optimise HIV testing.


Assuntos
Tomada de Decisões , Infecções por HIV/diagnóstico , Infecções por HIV/psicologia , Programas de Rastreamento/psicologia , Motivação , Percepção , Assunção de Riscos , Adolescente , Feminino , Grupos Focais , Humanos , Masculino , África do Sul , Adulto Jovem
19.
Lancet Child Adolesc Health ; 5(2): 122-132, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33417838

RESUMO

BACKGROUND: The prevalence of sexually transmitted infections (STIs) among youth is high in sub-Saharan Africa. We investigated the uptake of testing for and prevalence of Chlamydia trachomatis (chlamydia) and Neisseria gonorrhoeae (gonorrhoea) infections among youth in community-based settings in Zimbabwe, and explored the facilitators and barriers to testing. METHODS: This study was nested within a cluster randomised trial of community-based delivery of integrated HIV and sexual and reproductive health services for youth aged 16-24 years. Chlamydia and gonorrhoea testing via urine samples using the Xpert CT/NG test was offered in the four intervention clusters in Harare, Zimbabwe. Factors associated with testing uptake were investigated in a subset of participants (n=257) using hierarchical multivariate logistic regression. In-depth interviews with a separate purposively selected sample (n=26) explored facilitators and barriers to STI testing and partner notification and were analysed using thematic analysis. FINDINGS: Between June 1, 2019, and Jan 31, 2020, there were 6200 attendances by 4440 participants (78·2% women, 21·8% men) median age 20·3 (IQR 17·9-22·8) years. 1478 participants had 1501 tests done, and 248 tests were positive and 1253 tests were negative for chlamydia or gonorrhoea, or both. STI test uptake was 33·3% (95% CI 31·9-34·7), increasing from 11·7% in June, 2019, to 37·1% in January, 2020. The prevalence of chlamydia or gonorrhoea, or both, was 16·5% (95% CI 14·7-18·5; 248 of 1501), with only seven participants (3%) showing symptoms. The overall yield of testing was 4·0% (95% CI 3·5-4·5; 248 of 6200). Uptake was associated with having symptoms (adjusted odds ratio [OR] 14·8, 95% CI 1·66-132·07) and negatively associated with being single (adjusted OR 0·33, 95% CI 0·13-0·84) or having a boyfriend or girlfriend (adjusted OR 0·19, 95% CI 0·087-0·43) compared with being married, and being a student compared with being employed (adjusted OR 0·26, 95% CI 0·10-0·68). Perceived risk and symptoms of STIs were motivators for testing whereas misinformation, anticipated stigma, and concern about confidentiality were barriers. INTERPRETATION: The prevalence of chlamydia or gonorrhoea, or both, was high among youth but only a minority were symptomatic. Therefore most infections would remain untreated without access to STI testing. Provision of education, counselling, and confidentiality are essential to improve uptake and acceptability of STI testing. FUNDING: Wellcome Trust.


Assuntos
Infecções por Chlamydia/epidemiologia , Gonorreia/epidemiologia , Programas de Rastreamento/estatística & dados numéricos , Adolescente , Adulto , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Programas de Rastreamento/psicologia , Prevalência , Doenças Sexualmente Transmissíveis , Adulto Jovem , Zimbábue/epidemiologia
20.
BMC Psychol ; 9(1): 7, 2021 Jan 07.
Artigo em Inglês | MEDLINE | ID: mdl-33413695

RESUMO

BACKGROUND: Harms of colorectal cancer (CRC) screening include psychosocial consequences. We have not identified studies using a participant-relevant questionnaire with adequate measurement properties to investigate these harms. However, Brodersen et al. have previously developed a core questionnaire consequences of screening (COS) for use in screening for life-threatening diseases. Therefore, the objectives were: (1) To investigate content validity of COS in a CRC screening setting and in case of gaps in content coverage (2) generate new items and themes and (3) test the possibly extended version of COS for dimensionality and differential item functioning (DIF) using Rasch Models. METHODS: We performed two-part-focus-groups with CRC screenees. Screenees were recruited by strategic sampling. In the first part 16 screenees with false-positive results (n = 7) and low-risk polyps (n = 9) were interviewed about their CRC screening experiences and in the second part COS was examined for content validity. When new information was developed in the focus groups, new items covering this topic were generated. Subsequently, new items were, together with COS, tested in the subsequent interviews. A random subsample (n = 410) from a longitudinal questionnaire study, not yet published, was used to form the data for this paper. We analysed multidimensionality and uniform DIF with Andersen's conditional likelihood ratio test. We assessed individual item fit to the model. We also analysed Local Dependence (LD) and DIF by partial gamma coefficients using Rasch Models. RESULTS: COS was found relevant in a CRC screening setting. However, new information was discovered in the focus groups, covered by 18 new CRC screening-specific items. The Rasch analyses only revealed minor problems in the COS-scales. The 18 new items were distributed on four new CRC screening-specific dimensions and one single item. CONCLUSION: An extended version of COS specifically for use in a CRC screening setting has been developed. The extended part encompasses four new scales and one new single item. The original COS with the CRC-screening specific extension is called consequences of screening in colorectal cancer (COS-CRC). COS-CRC possessed reliability, unidimensionality and invariant measurement.


Assuntos
Neoplasias Colorretais/diagnóstico , Detecção Precoce de Câncer , Programas de Rastreamento , Neoplasias Colorretais/psicologia , Detecção Precoce de Câncer/psicologia , Grupos Focais , Humanos , Programas de Rastreamento/psicologia , Medidas de Resultados Relatados pelo Paciente , Psicometria , Pesquisa Qualitativa , Reprodutibilidade dos Testes , Inquéritos e Questionários
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