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1.
S Afr Med J ; 0(0): 13185, 2020 12 15.
Artigo em Inglês | MEDLINE | ID: mdl-33334393

RESUMO

BACKGROUND: Current evidence indicates that children are relatively spared from direct COVID-19-related morbidity and mortality, but that the indirect effects of the pandemic pose significant risks to their health and wellbeing. OBJECTIVES: To assess the impact of the local COVID-19 outbreak on routine child health services. METHODS: The District Health Information System data set for KwaZulu-Natal (KZN) provincial health services was accessed, and monthly child health-related data were extracted for the period January 2018 - June 2020. Chronological and geographical variations in sentinel indicators for service access, service delivery and the wellbeing of children were assessed. RESULTS: During April - June 2020, following the start of the COVID-19 outbreak in KZN, significant declines were seen for clinic attendance (36%; p=0.001) and hospital admissions (50%; p=0.005) of children aged <5 years, with a modest recovery in clinic attendance only. Among service delivery indicators, immunisation coverage recovered most rapidly, with vitamin A supplementation, deworming and food supplementation remaining low. Changes were less pronounced for in- and out-of-hospital births and uptake rates of infant polymerase chain reaction testing for HIV at birth, albeit with wide interdistrict variations, indicating inequalities in access to and provision of maternal and neonatal care. A temporary 47% increase in neonatal facility deaths was reported in May 2020 that could potentially be attributed to COVID-19-related disruption and diversion of health resources. CONCLUSIONS: Multiple indicators demonstrated disruption in service access, service delivery and child wellbeing. Further studies are needed to establish the intermediate- and long-term impact of the COVID-19 outbreak on child health, as well as strategies to mitigate these.


Assuntos
Serviços de Saúde da Criança , Acesso aos Serviços de Saúde , Controle de Infecções , Assistência Perinatal , /epidemiologia , Saúde da Criança/normas , Serviços de Saúde da Criança/organização & administração , Serviços de Saúde da Criança/estatística & dados numéricos , Pré-Escolar , Recursos em Saúde/normas , Acesso aos Serviços de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/tendências , Necessidades e Demandas de Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Controle de Infecções/métodos , Controle de Infecções/organização & administração , Assistência Perinatal/normas , Assistência Perinatal/estatística & dados numéricos , África do Sul/epidemiologia
2.
Curationis ; 43(1): e1-e8, 2020 Aug 05.
Artigo em Inglês | MEDLINE | ID: mdl-32787431

RESUMO

BACKGROUND: Professional nurses are responsible for the provision of care, treatment and rehabilitation of all mental healthcare users (MHCUs) in the institutions for mental healthcare. However, professional nurses find themselves in difficult circumstances under which they must provide quality healthcare services to MHCUs. OBJECTIVES: The study explored and described the challenges experienced by the professional nurses working in a mental healthcare institution in Limpopo province of South Africa. METHOD: A qualitative approach was used to explore and describe the challenges faced by professional nurses working in a mental healthcare institution. The study was conducted from July 2016 to December 2016. Purposive sampling was used to select participants. Data were obtained through individual in-depth interviews with professional nurses between the ages of 26 and 50 years. Data collection continued until data saturation, which occurred after interviewing 18 participants. Tech's open coding method was used to analyse data in this study. RESULTS: Four themes emerged from data analysis, namely: inadequate safety measures, inadequate resources, impact of high workload and shortage of staff. The themes were further sub-divided into sub-themes. CONCLUSION: The study revealed several challenges that professional nurses face in mental healthcare institutions which might be a barrier to the provision of quality healthcare. Conducive working environments should be established to enable professional health nurses to provide quality nursing care, thereby promoting the health of MHCUs.


Assuntos
Hospitais Psiquiátricos/normas , Satisfação no Emprego , Enfermeiras e Enfermeiros/psicologia , Local de Trabalho/normas , Adulto , Feminino , Recursos em Saúde/normas , Recursos em Saúde/provisão & distribução , Hospitais Psiquiátricos/organização & administração , Hospitais Psiquiátricos/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Enfermeiras e Enfermeiros/estatística & dados numéricos , Pesquisa Qualitativa , Qualidade da Assistência à Saúde , África do Sul , Carga de Trabalho/psicologia , Carga de Trabalho/normas , Local de Trabalho/psicologia , Local de Trabalho/estatística & dados numéricos
3.
Tohoku J Exp Med ; 251(1): 47-49, 2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32461502

RESUMO

The reported number of new cases underestimates the real spread of COVID-19 pandemic because of non-tested asymptomatic people and limited global access to reliable diagnostic tests. In this context, COVID-19 mortality with confirmed diagnosis becomes an attractive source of information to be included in the analysis of perspectives and proposals. Objective data are required to calculate the capacity of resources provided by health systems. New strategies are needed to stabilize or minimize the mortality surge. However, we will not afford this goal until more alternatives were available. We still need an effective treatment, an affordable vaccine, or a collective achievement of sufficient immunity (reaching up to 70% of the whole population). At any time, the arriving waves of the pandemic are testing the capacity of governments. The health services struggle to keep the plateau in a steady-state below 100 deaths per million inhabitants. Therefore, it is necessary to increase the alternatives and supplies based on the current and near-future expected demands imposed by the number of deaths by COVID-19. Estimating COVID-19 mortality in various scenarios with the gradual release of social constraints will help predict the magnitude of those arriving waves.


Assuntos
Betacoronavirus , Infecções por Coronavirus/mortalidade , Monitoramento Epidemiológico , Mortalidade , Pneumonia Viral/mortalidade , População , Betacoronavirus/patogenicidade , Betacoronavirus/fisiologia , Sistemas Computacionais , Infecções por Coronavirus/epidemiologia , Surtos de Doenças/estatística & dados numéricos , Sistemas de Informação Geográfica/organização & administração , Sistemas de Informação Geográfica/normas , Mapeamento Geográfico , Geografia , Recursos em Saúde/organização & administração , Recursos em Saúde/normas , Necessidades e Demandas de Serviços de Saúde , Humanos , Mortalidade/tendências , Pandemias , Pneumonia Viral/epidemiologia , Fatores de Tempo
4.
Am Soc Clin Oncol Educ Book ; 40: 1-10, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32223670

RESUMO

Low- and middle-income countries (LMICs) are shouldering most of the burden of the rapidly increasing cancer incidence and mortality worldwide, and this situation is projected to worsen in coming decades. Studies estimate that more than one million deaths could be prevented annually if all patients received high-quality care, but most LMICs lack the resources and infrastructure to adopt U.S. or European clinical oncology practice guidelines. Several organizations have developed resource-stratified guidelines (RSGs) to provide graduated and/or region-specific strategies for cancer diagnosis and treatment. The birth of these efforts traces to 2002, when the World Health Organization (WHO) called for tailoring cancer treatments to the level of available resources by country; the Breast Health Global Initiative (BHGI) formalized the first stratified guidelines for breast cancer shortly thereafter. Since then, multiple organizations including ASCO and the National Comprehensive Cancer Network (NCCN) have created guidelines customized for various cancer subtypes and regions. These RSGs offer roadmaps for policy makers, clinicians, and health care administrators in LMICs to design projects in implementation science that can gradually and strategically raise the quality of cancer care in their nation or region. Although the same resource limitations that complicate cancer care in these areas also pose barriers to data gathering and research, some countries have met the challenge and are improving cancer care using RSGs as a metric for success.


Assuntos
Assistência à Saúde/normas , Recursos em Saúde/normas , Neoplasias/terapia , Guias como Assunto , Humanos
5.
Pediatrics ; 145(5)2020 05.
Artigo em Inglês | MEDLINE | ID: mdl-32312909

RESUMO

Surgical procedures are performed in the United States in a wide variety of clinical settings and with variation in clinical outcomes. In May 2012, the Task Force for Children's Surgical Care, an ad hoc multidisciplinary group comprising physicians representing specialties relevant to pediatric perioperative care, was convened to generate recommendations to optimize the delivery of children's surgical care. This group generated a white paper detailing the consensus opinions of the involved experts. Following these initial recommendations, the American College of Surgeons (ACS), Children's Hospital Association, and Task Force for Children's Surgical Care, with input from all related perioperative specialties, developed and published specific and detailed resource and quality standards designed to improve children's surgical care (https://www.facs.org/quality-programs/childrens-surgery/childrens-surgery-verification). In 2015, with the endorsement of the American Academy of Pediatrics (https://pediatrics.aappublications.org/content/135/6/e1538), the ACS established a pilot verification program. In January 2017, after completion of the pilot program, the ACS Children's Surgery Verification Quality Improvement Program was officially launched. Verified sites are listed on the program Web site at https://www.facs.org/quality-programs/childrens-surgery/childrens-surgery-verification/centers, and more than 150 are interested in verification. This report provides an update on the ACS Children's Surgery Verification Quality Improvement Program as it continues to evolve.


Assuntos
Saúde da Criança/normas , Recursos em Saúde/normas , Melhoria de Qualidade/normas , Especialidades Cirúrgicas/normas , Cirurgiões/normas , Criança , Hospitais Pediátricos/normas , Humanos , Especialidades Cirúrgicas/métodos , Estados Unidos
6.
J Med Internet Res ; 22(3): e17921, 2020 03 17.
Artigo em Inglês | MEDLINE | ID: mdl-32181745

RESUMO

BACKGROUND: Survey-based studies are frequently used to describe the economic impact of multiple sclerosis (MS). However, there is no validated health resource survey available, preventing comparison of study results and meaningful conclusions regarding the efficiency of long-term treatments. OBJECTIVE: The aim of this study was to develop and validate a tablet- and paper-based MS health resource utilization survey. METHODS: We developed and validated the Multiple Sclerosis Health Resource Utilization Survey (MS-HRS), consisting of 24 cost items for paper and tablet users. Data for validation came from two large German observational studies. Survey practicability was assessed according to the response rate. Reliability was described using test-retest reliability as well as Guttman lambda. Construct validity was assessed as convergent and discriminant validity via correlations with associated patient-reported outcomes and known-group analyses. RESULTS: In total, 2207 out of 2388 (response rate: 92.4%) patients completed the survey and were included to determine psychometric properties. The test-retest reliability had an intraclass correlation coefficient of 0.828 over a course of 3 months. Convergent validity analyses showed that total costs correlated positively with increased disability (r=0.411, P<.001). For discriminant validity, correlations of total costs with the Treatment Satisfaction Questionnaire for Medication ranged from -0.006 (convenience) to -0.216 (effectiveness). The mean annual cost was €28,203 (SD €14,808) (US $39,203; SD US $20,583) with disease-modifying therapies. CONCLUSIONS: The MS-HRS is a multilingual, reliable, valid, electronically available, and easy-to-administer questionnaire providing a holistic cross-sectional and longitudinal assessment of resource utilization in patients with MS.


Assuntos
Recursos em Saúde/normas , Esclerose Múltipla/epidemiologia , Medidas de Resultados Relatados pelo Paciente , Psicometria/métodos , Adulto , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , Reprodutibilidade dos Testes
7.
PLoS One ; 15(3): e0229771, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32155180

RESUMO

INTRODUCTION: Enhancing the self-management activities of patients improves the quality of care and is an integrated element of current healthcare provision. However, self-management support (SMS) is not yet common in healthcare. The Primary Care Resources and Support for Self-Management (PCRS) is a tool for healthcare professionals to assess the quality of SMS. In this study, we assessed the validity and reliability of the Dutch version of the PCRS. METHOD: The validation of the PCRS was performed in Dutch healthcare centres. Correlations between the PCRS scores and the Assessment of Chronic Illness Care (ACIC) and Clinician Support for Patient Activation Measure (CS-PAM) scores were calculated to assess the convergent and discriminant validity. A confirmatory factor analysis (CFA) was performed to test the factor structure. Lastly, the internal consistency and face validity were assessed. RESULTS: The convergent and discriminant validity were good, with respective correlations of 0.730 (p < 0.001) and 0.030 (p > 0.050) between the PCRS and the ACIC SMS subscale and the PCRS and the CS-PAM. Although 49% of the variance of the PCRS was explained by one factor, the CFA could not confirm a fit between a one-factor model and the data. The reliability was excellent (Cronbach's α = 0.921). CONCLUSION: The PCRS showed good validity and excellent internal consistency. However, the evidence for its validity was inconclusive. We therefore suggest rephrasing specific items.


Assuntos
Atenção Primária à Saúde/normas , Garantia da Qualidade dos Cuidados de Saúde/métodos , Autogestão , Adulto , Atitude do Pessoal de Saúde , Feminino , Clínicos Gerais/psicologia , Clínicos Gerais/normas , Recursos em Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Países Baixos , Garantia da Qualidade dos Cuidados de Saúde/normas , Apoio Social , Inquéritos e Questionários
8.
Am Soc Clin Oncol Educ Book ; 40: 1-9, 2020 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-32213085

RESUMO

In its 2017 guideline, ASCO challenged members to integrate palliative care into their standard oncology practices for all patients, throughout their cancer trajectory. However, partnering with palliative care experts alone will not be enough to achieve that goal; there are too few experts now, and there will not be enough in the future to meet the needs of patients with cancer and their families. Other strategies are required. Oncologists can develop new communication skills that were not included in their fellowship curricula, skills that integrate into their visits the subjects that palliative care clinicians discuss routinely with patients referred to them. In this review, Dr. Back offers three questions matched to communication skills that can help oncologists explore key areas: (1) What is happening? (2) How do you (and I) feel? and (3) What is important? and discusses the "REMAP" strategy for making urgent medical decisions. Dr. Friedman reviews the impact of community-based palliative care resources and telehealth on care quality, patient centeredness, and reducing costs. Community-based palliative care services and telehealth are available to patients and families at home, during active treatment. Dr. Abrahm reviews how patient-reported outcomes (PROs) completed at home can enhance patients' symptom control, quality of life, and toleration of treatment and decrease unplanned emergency visits by alerting clinicians to patients' severe symptoms, making appropriate referrals, or suggesting patients contact their oncology team. She also provides an update on using PROs and natural language processing with clinical decision support to create sophisticated palliative care assessments and treatment options in the electronic health record during patients' office visits.


Assuntos
Recursos em Saúde/normas , Oncologia/métodos , Neoplasias/terapia , Cuidados Paliativos/métodos , Feminino , Humanos , Masculino
9.
J Cancer Surviv ; 14(3): 294-304, 2020 06.
Artigo em Inglês | MEDLINE | ID: mdl-31897877

RESUMO

PURPOSE: To identify patterns of healthcare utilization in allogeneic and autologous hematopoietic stem cell transplantation (HSCT) recipients and evaluate factors associated with high-need and high-cost post-transplantation care. METHODS: Latent class analysis of a retrospective cohort of long-term allogeneic (n = 436) and autologous (n = 888) HSCT survivors within the Truven MarketScan database (2009-2014). We assessed factors associated with the latent classes by comparing post-transplantation healthcare utilization including inpatient admissions and length of stay, emergency room visits, specialist visits, and primary care provider visits. RESULTS: Four utilization classes were identified in allogeneic and autologous HSCT recipients: (i) outpatient specialist care dominant (51.8% and 57.3%), (ii) outpatient primary care dominant (10.3% and 25.7%), (iii) outpatient/inpatient balanced (20.6% and 13.5%), and (iv) inpatient dominant (17.2% and 3.5%). Mean monthly healthcare expenditures in the inpatient dominant utilization class were $41,097 and $25,556 for allogeneic and autologous survivors, respectively, which were two to five times higher compared with other classes during the 2-year post-transplantation period. Factors associated with the high utilization class were transfusion (OR = 1.87, 95% CI 1.06-3.30) and 100-day post-transplant graft-versus-host-disease (OR = 1.76, 95% CI 1.05-2.94) in allogeneic HSCT; higher baseline Charlson comorbidity index (OR = 1.45, 95% CI 1.19-1.76) in autologous HSCT. CONCLUSION: Based on distinct patterns of healthcare utilization following HSCT, we identified factors associated with higher resource utilization and greater healthcare related expenditures. IMPLICATIONS FOR CANCER SURVIVORS: Earlier identification of high-cost and high-need HSCT long-term survivors could pave the way for clinicians to offer more continuous engagement in survivorship care delivery.


Assuntos
Recursos em Saúde/normas , Transplante de Células-Tronco Hematopoéticas/economia , Transplante de Células-Tronco Hematopoéticas/mortalidade , Condicionamento Pré-Transplante/economia , Condicionamento Pré-Transplante/mortalidade , Feminino , Humanos , Análise de Classes Latentes , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Análise de Sobrevida
10.
Artigo em Inglês | MEDLINE | ID: mdl-31389322

RESUMO

BACKGROUND: The knowledge of the pathophysiology of Lysosomal Storage Disorders has gradually increased, but information on their incidence is still scarce. The objective of this study was to evaluate the status and use of resources of these disorders in Spain from 1997 to 2015. METHODS: Records from 4,999 patients diagnosed with a Lysosomal Storage Disorder were extracted from a Spanish database containing data from public and private hospitals from 1997 to 2015. RESULTS: The database registered 2,441 patients with an LSD in Spain during the study period. Leukodystrophy, Krabbe disease, Pelizaeus-Merzbacher disease and sulfatide lipidosis represented, as a group, the most common combination of diseases in Spain, affecting 26% of total patients. The average age of diagnosis of these disorders was 16.7 years. A sex bias was observed in most of the groups, with a proportion of male/female of 60 to 40%. The direct medical cost of Lysosomal Storage Diseases was €5,686 per patient with an average cost per hospital admission of €4,923. Global costs displayed a growing tendency. CONCLUSION: Contrary to worldwide disease incidence estimations, the group with Krabbe disease registered the highest number of patients in the study period, which makes evident the need for accurate regional disease incidence and patient demographic studies. Altogether, data suggest the need to improve LSDs diagnostic protocols, and support the inclusion of these disorders in standard newborn screening programs.


Assuntos
Gerenciamento de Dados/métodos , Bases de Dados Factuais , Recursos em Saúde , Doenças por Armazenamento dos Lisossomos/diagnóstico , Doenças por Armazenamento dos Lisossomos/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Gerenciamento de Dados/normas , Bases de Dados Factuais/normas , Feminino , Recursos em Saúde/normas , Humanos , Lactente , Recém-Nascido , Masculino , Triagem Neonatal/métodos , Triagem Neonatal/normas , Espanha/epidemiologia , Adulto Jovem
11.
Midwifery ; 81: 102591, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31830675

RESUMO

OBJECTIVE: Pregnancy and the postnatal period offers an opportunity to optimise maternal health. A UK-based charity has developed parenting resources - Baby Buddy smartphone app, Baby Express magazine, and 'From Bump to Breastfeeding' DVD - designed to complement health service care to promote maternal wellbeing, breastfeeding and positive parenting. We evaluated the embedding of these resources into maternity and early years care pathways at three sites in the north of England. Here we present results relating to the impact of the resources on breastfeeding, women's parenting confidence, and mother-infant bonding. DESIGN AND SETTING: We conducted a mixed-methods study comprising qualitative interviews and women and care provider surveys at three sites. Women's questionnaires were issued to two cohorts of postnatal women pre and post embedding of the resources. This questionnaire included validated scales (Iowa Infant Feeding Attitude Scale, Breastfeeding Self-Efficacy, Parenting Sense of Competency, Mother to Baby Bonding Scale), and bespoke questions to elicit women's views of the resources and infant feeding data. A survey of professionals in the post-embedding phase explored how the resources were used in practice. Interviews with stakeholders explored views of the resources and embedding process. We conducted descriptive and inferential statistics of quantitative data, and thematic analysis of qualitative data. FINDINGS: There were 30 stakeholder interviews, 146 professionals completed a survey, and 161 and 192 women completed a survey before and after embedding, respectively. Receipt and use of the resources was relatively low, however, overall views of the resources were positive. There was no significant change in outcomes relating to infant feeding or parenting confidence, before and after embedding. After embedding, scores on the Mother to Baby Bonding Scale were significantly more positive when compared to pre-embedding scores. KEY CONCLUSIONS: While there were issues with the receipt and use of the resources, the resources were well received by women and professionals. While the resources did not appear to have influenced parents' confidence and self-efficacy, there may be a positive impact on mother-infant bonding. Further research is needed to understand whether more focussed integration of the resources into care pathways over a longer term can increase user engagement, and the impact of such on key parenting outcomes.


Assuntos
Aleitamento Materno , Pessoal de Saúde/psicologia , Promoção da Saúde/métodos , Recursos em Saúde/normas , Relações Mãe-Filho , Mães/psicologia , Poder Familiar/psicologia , Adulto , Inglaterra , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Gravidez , Pesquisa Qualitativa , Autoimagem , Autoeficácia , Inquéritos e Questionários
12.
BMJ Sex Reprod Health ; 46(2): 88-99, 2020 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-31678969

RESUMO

BACKGROUND: Contraceptive and sexual healthcare is increasingly delivered in an integrated setting in the UK and worldwide, requiring staff to be competent in differing styles of delivery, and to have a wide knowledge base. OBJECTIVES: We did a scoping review of the literature for evidence of the resources that exist for healthcare professionals to guide or structure the process of conducting an integrated sexual and reproductive health (SRH) consultation. ELIGIBILITY CRITERIA: Articles were included in the review if (1) their primary focus was a consultation resource related to one or more aspects of an SRH consultation and (2) they provided details of the resource and/or its application including evaluation of use. SOURCES OF EVIDENCE: Peer-reviewed articles published in English, published non-peer-reviewed guides, and web-based guidelines addressing the conduct of a contraception or sexual health consultation were included. Date range: 1998-December 2018. Searches were carried out in the databases AMED (Ovid), ASSIA (ProQuest), CINAHL Complete (EBSCO), Cochrane Library (Wiley), HMIC (NHS Evidence), Medline (EBSCO), PsycINFO (Proquest) and Scopus (Elsevier) on 10 February 2017, and incremental searching performed until December 2018. RESULTS: A total of 12 peer-reviewed journal articles, two web-published guidelines from the Faculty of Sexual & Reproductive Healthcare and three published, non-peer-reviewed resources were included. CONCLUSION: Many resources exist to guide either the contraceptive or sexual health consultations, but there is a lack of a comprehensive consultation resource to guide the conduct of an integrated consultation.


Assuntos
Recursos em Saúde/normas , Acesso aos Serviços de Saúde/normas , Encaminhamento e Consulta/normas , Serviços de Saúde Reprodutiva/tendências , Recursos em Saúde/tendências , Acesso aos Serviços de Saúde/tendências , Humanos , Encaminhamento e Consulta/tendências
14.
Afr J Prim Health Care Fam Med ; 11(1): e1-e8, 2019 Nov 12.
Artigo em Inglês | MEDLINE | ID: mdl-31714127

RESUMO

BACKGROUND: Sub-Saharan African countries have been the worst affected by the high incidence of maternal and child mortality rates and HIV/AIDS (human immunodeficiency virus/acquired immunodeficiency syndrome) pandemic. Preventive care is the area that requires serious attention as a lot of maternal and child morbidity and mortality can be averted through rendering comprehensive care to women of child-bearing age. Preconception care (PCC) is recognised as an important factor in improving pregnancy outcome; yet, most primary health care (PHC) nurses lack the necessary resources to render PCC. AIM: To describe the PHC nursing student's knowledge of and attitude towards the provision of PCC. SETTING: Higher Education Institution that offers PHC programme at six different sites to nurses working in the PHC clinics in the province. METHODS: A quantitative, non-experimental, descriptive study design was used. The total population from three sites selected, based on their geographical location were all invited to participate in the study. Questionnaire was used to collect data which was subsequently analysed using the Statistical Package for Social Sciences (SPSS) version 24. RESULTS: The response rate was approximately 85% (n = 138). The respondents have practised in the PHC clinic for more than 1 year. Study centre, age and area of employment were found to be predictors of knowledge, but no direct association was found between the demographic factor and attitude. Furthermore, a significant difference was found between knowledge and age, and between the area of employment and attitude. CONCLUSION: PHC nursing students were knowledgeable and had a favourable attitude towards PCC, but the absence of PCC resources in many practices has hindered them to a greater extent. It is recommended that for proper implementation of PCC to occur, health care workers should be provided with the necessary resources.


Assuntos
Atitude do Pessoal de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Cuidado Pré-Concepcional/normas , Atenção Primária à Saúde , Estudantes de Enfermagem/psicologia , Adulto , África ao Sul do Saara , Feminino , Recursos em Saúde/normas , Humanos , Masculino , Gravidez , Adulto Jovem
15.
BMC Geriatr ; 19(1): 311, 2019 11 14.
Artigo em Inglês | MEDLINE | ID: mdl-31727000

RESUMO

BACKGROUND: African American caregivers of community-residing persons with dementia are mostly unpaid and have high rates of unmet basic and health needs. The National Alzheimer's Project Act (NAPA) mandates improved coordination of care for persons with dementia and calls for special attention to racial populations at higher risk for Alzheimer's Disease or related dementias (ADRD) to decrease health disparities. The purpose of this study is to describe the perceptions of African American caregivers of people with dementia about community resources needed to support caregiving as well as their own self-care. METHODS: Using a qualitative study design, in-depth, semi-structured qualitative interviews were conducted with caregivers (N = 13) at an urban geriatric clinic to elicit community resource needs, barriers to and facilitators of resource use and how to optimize clinical referrals to community resources. Caregivers were shown a community resource referral list ("HealtheRx") developed for people with dementia and were queried to elicit relevance, gaps and insights to inform delivery of this information in the healthcare setting. Data were iteratively coded and analyzed using directed content analysis. Results represent key themes. RESULTS: Most caregivers were women (n = 10, 77%) and offspring (n = 8, 62%) of the person with dementia. Community resource needs of these caregivers included social, entertainment, personal self-care and hospice services. Main barriers to resource use were the inability to leave the person with dementia unsupervised and the care recipient's disinterest in participating in their own self-care. Facilitators of resource use included shared caregiving responsibility and learning about resources from trusted sources. To optimize clinical referrals to resources, caregivers wanted specific eligibility criteria and an indicator of dementia care capability. CONCLUSIONS: African American caregivers in this study identified ways in which community resource referrals by clinicians can be improved to meet their caregiving and self-care needs.


Assuntos
Afro-Americanos/psicologia , Cuidadores/psicologia , Demência/psicologia , Recursos em Saúde , Pesquisa Qualitativa , População Urbana , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/normas , Demência/terapia , Feminino , Recursos em Saúde/normas , Humanos , Masculino , Pessoa de Meia-Idade , Encaminhamento e Consulta/normas , Autocuidado
16.
Cell Syst ; 9(5): 417-421, 2019 11 27.
Artigo em Inglês | MEDLINE | ID: mdl-31677972

RESUMO

As more digital resources are produced by the research community, it is becoming increasingly important to harmonize and organize them for synergistic utilization. The findable, accessible, interoperable, and reusable (FAIR) guiding principles have prompted many stakeholders to consider strategies for tackling this challenge. The FAIRshake toolkit was developed to enable the establishment of community-driven FAIR metrics and rubrics paired with manual and automated FAIR assessments. FAIR assessments are visualized as an insignia that can be embedded within digital-resources-hosting websites. Using FAIRshake, a variety of biomedical digital resources were manually and automatically evaluated for their level of FAIRness.


Assuntos
Disseminação de Informação/métodos , Internet/tendências , Sistemas On-Line/normas , Recursos em Saúde/normas , Humanos
17.
BMC Geriatr ; 19(1): 282, 2019 10 22.
Artigo em Inglês | MEDLINE | ID: mdl-31640572

RESUMO

BACKGROUND: 'Screening tool of older people's prescriptions (STOPP) and screening tool to alert to right treatment (START)' criteria is a useful tool to assess the appropriateness of medicines among older adults. However, the original STOPP/START criteria developed in the West, may not be directly applicable to resource limited healthcare settings like Sri Lanka. Hence, we aimed to modify STOPP/START criteria (Version 2) to suit Sri Lanka. METHOD: Two investigators (a clinical pharmacologist and a pharmacist) reviewed and flagged criteria that were unfeasible to Sri Lanka based on their previous research experiences on using STOPP/START version 1. A Delphi consensus methodology was conducted among six experts, including geriatricians, clinical pharmacologists, physicians and a pharmacist, to review and assess each criterion (including the ones flagged by the researchers) for suitability to Sri Lanka. RESULTS: Two Delphi validation rounds were conducted. A final meeting was held with the participation of all experts to resolve disagreements and to establish 100% consensus. The expert panel agreed on a list of 105 criteria, including 70 STOPP and 35 START criteria, indicating an 8% reduction in criteria compared to the original version. Modifications included complete removal (n = 11), re-wording (n = 25), splitting (n = 1) of original criteria and adding a new criterion (n = 1). Main reasons for modifications were unavailability of some medicines in the country, unavailability or inaccessibility of specific clinical information required for assessment of criteria, and adherence to treatment guidelines commonly used in the country. CONCLUSION: A list of 'Modified STOPP/START criteria for Sri Lanka' was developed. These criteria are currently being validated through a multi-centre study.


Assuntos
Técnica Delfos , Prescrições de Medicamentos/normas , Recursos em Saúde/normas , Prescrição Inadequada/prevenção & controle , Lista de Medicamentos Potencialmente Inapropriados/normas , Pesquisa Médica Translacional/normas , Idoso , Idoso de 80 Anos ou mais , Consenso , Feminino , Humanos , Masculino , Farmacêuticos/normas , Padrões de Prática Médica/normas , Sri Lanka/epidemiologia , Pesquisa Médica Translacional/métodos
18.
Workplace Health Saf ; 67(11): 554-564, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31364508

RESUMO

Nurses provide the majority of health care in sub-Saharan Africa, which has high rates of Hepatitis B Virus (HBV) and human immunodeficiency virus (HIV). This systematic review used PRISMA methodology to synthesize the literature published between January 2008 and December 2018 examining the occupational health of nurses practicing in the Economic Community of West African States (ECOWAS). The United States' National Institute for Occupational Safety and Health's Hierarchy of Controls is used to frame the findings. This research was mostly conducted in Nigeria and Ghana and focused on administrative controls. Nurses practicing in ECOWAS are at high risk of acquiring a bloodborne illness due to inadequate engineering and administrative controls, as well as limited access to personal protective equipment (PPE). These findings indicate interventions to improve these controls would likely lower the occupational risks faced by nurses practicing in ECOWAS. Research in more countries in ECOWAS would likely find differences in occupational health practices in Nigeria and Ghana, which are relatively wealthy, and other countries in the region. This literature showed nurses practicing in ECOWAS did not have adequate protection from biological hazards. Regional health groups, such as the West African Health Organization, should commit to improving occupational health practice. Needle recapping and double gloving must be discontinued, and PPE must be made more widely available in ECOWAS. Occupational health professionals in the region should advocate for better distribution of PPE and consider offering trainings on these behaviors.


Assuntos
Enfermeiras e Enfermeiros/estatística & dados numéricos , Saúde do Trabalhador/normas , África Ocidental , Recursos em Saúde/normas , Recursos em Saúde/estatística & dados numéricos , Recursos em Saúde/provisão & distribução , Humanos , Saúde do Trabalhador/estatística & dados numéricos , Equipamento de Proteção Individual/normas , Equipamento de Proteção Individual/estatística & dados numéricos , Equipamento de Proteção Individual/provisão & distribução
19.
Cancer Epidemiol Biomarkers Prev ; 28(10): 1559-1562, 2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31462397

RESUMO

The NCI invests heavily in research resources to serve the research community, including datasets, biospecimen banks, and networks of institutions in which clinical trials and other human subjects research are conducted. These resources often begin as grant-funded infrastructure initiated by scientists based on their own scientific interests, with a subsequent recognition of additional scientific uses. Although converting existing project-specific research activities into research resources may appear efficient in terms of time and financial investment, challenges can arise that undermine this efficiency and jeopardize future use. Here, we describe three challenges in the conversion process: (i) project-based infrastructure versus a research resource for a broader research community; (ii) complexity versus ease of use; and (iii) individual professional goals versus research resource priorities. We use our experience with the NCI-funded Cancer Research Network, particularly the Virtual Data Warehouse, to illustrate each challenge, concluding with strategies to mitigate each one. As studies grow in size and complexity, an ever-increasing volume of data, biospecimens, and human subjects research networks will be available for conversion to resources for scientific questions beyond those originally proposed. Addressing likely challenges thoughtfully can result in a more efficient conversion process and ultimately greater scientific impact.


Assuntos
Pesquisa Biomédica/economia , Recursos em Saúde/economia , Revisão da Pesquisa por Pares/normas , Bancos de Tecidos/organização & administração , Pesquisa Biomédica/métodos , Regulamentação Governamental , Recursos em Saúde/normas , Humanos , Armazenamento e Recuperação da Informação , National Cancer Institute (U.S.) , Bancos de Tecidos/economia , Bancos de Tecidos/normas , Estados Unidos
20.
Pediatr Diabetes ; 20(7): 1016-1024, 2019 11.
Artigo em Inglês | MEDLINE | ID: mdl-31355957

RESUMO

BACKGROUND: The American Diabetes Association recommends a family-centered approach that addresses each family's specific type 1 diabetes self-management barriers. OBJECTIVE: To assess an intervention that tailored delivery of self-management resources to families' specific self-management barriers. SUBJECTS: At two sites, 214 children 8-16 years old with type 1 diabetes and their parent(s) were randomized to receive tailored self-management resources (intervention, n = 106) or usual care (n = 108). METHODS: Our intervention (1) identified families' self-management barriers with a validated survey, (2) tailored self-management resources to identified barriers, and (3) delivered the resources as four group sessions coordinated with diabetes visits. Mixed effects models with repeated measures were fit to A1c as well as parent and child QOL during the intervention and 1 year thereafter. RESULTS: Participants were 44% youth (8-12 years) and 56% teens (13-16 years). No intervention effect on A1c or QOL was shown, combining data from sites and age groups. Analyzing results by site and age group, post-intervention A1c for teens at one site declined by 0.06 more per month for intervention teens compared to usual care (P < 0.05). In this group, post-intervention A1c declined significantly when baseline A1c was >8.5 (-0.08, P < 0.05), with an even larger decline when baseline A1c was >10 (-0.19, P < 0.05). In addition, for these teens, the significant improvements in A1c resulted from addressing barriers related to motivation to self-manage. Also at this site, mean QOL increased by 0.61 points per month more during the intervention for parents of intervention youth than for usual care youth (P < 0.05). CONCLUSIONS: Tailored self-management resources may improve outcomes among specific populations, suggesting the need to consider families' self-management barriers and patient characteristics before implementing self-management resources.


Assuntos
Diabetes Mellitus Tipo 1/terapia , Família , Recursos em Saúde/organização & administração , Assistência Centrada no Paciente/organização & administração , Relações Profissional-Família , Autogestão/métodos , Adolescente , Criança , Barreiras de Comunicação , Diabetes Mellitus Tipo 1/psicologia , Família/psicologia , Feminino , Hemoglobina A Glicada/análise , Comportamentos Relacionados com a Saúde , Recursos em Saúde/normas , Humanos , Comunicação Interdisciplinar , Masculino , Equipe de Assistência ao Paciente/organização & administração , Equipe de Assistência ao Paciente/normas , Assistência Centrada no Paciente/normas , Qualidade de Vida , Autocuidado/métodos , Padrão de Cuidado
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