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2.
Epidemiol Health ; 41: e2019031, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31319656

RESUMO

OBJECTIVES: Vaccinations for infectious diseases are opposed despite their achievement, and this opposition has recently been revealed in Korea. However, research in Korea has not been vigorous. The authors studied why some Korean parents hesitate to vaccinate their children by applying the health belief model. METHODS: Parents who hesitate to vaccinate and parents who do not were surveyed in alternative education preschools and elementary schools. They were classified into four types of hesitancy and statistically compared. RESULTS: Among the 129 subjects, 43 vaccinated without hesitancy, 20 vaccinated on time with hesitancy, 32 vaccinated with a deliberate delay of one month or longer, and 34 did not vaccinate. Vaccination increased with an increase in the awareness that severe outcomes can occur when unvaccinated. Concerns about adverse reactions from vaccinations or direct/indirect experiences affected refusal. Furthermore, perceptions of the lack of meaningfulness of vaccinations, distrust of policy and safety management, influence of leaders or activists in joined organizations, and experts of Korean traditional or alternative medicine affected refusal. Explanations by doctors, text messages and mails from institutions, and concerns about disadvantages caused by not complying with government policies increased vaccination. CONCLUSIONS: The reasons for vaccine hesitancy and acceptance were similar to the results of international research. Health authorities and professionals should communicate sufficiently and appropriately with hesitant parents and find ways to rationally resolve social conflicts. However, this sample was small and there is little Korean research, so more in-depth and diverse researchs are needed.


Assuntos
Pais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Vacinação/psicologia , Adulto , Criança , Feminino , Pesquisas sobre Serviços de Saúde , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Modelos Psicológicos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , República da Coreia , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Vacinação/estatística & dados numéricos
3.
Artigo em Russo | MEDLINE | ID: mdl-31251863

RESUMO

The problem of refusal of immunodiagnostic of tuberculosis has a significant public resonance in Russia, but it is not widely covered by research. The purpose of study is to determine causes of refusal of legitimate representatives of children to carry out measures for mass immunodiagnostic of tuberculosis and to suggest possible ways of adjusting this negative phenomenon. In a cross-sectional study, the results of a questionnaire survey of 269 respondents - legal representatives of children who systematically refused to carry out immunodiagnostic of tuberculosis, are being studied. Results. The main reasons for the refusal included distrust of quality of the test (31.6%), insufficient semantic motivation (23.0%), fear of adverse reactions, complications (17.8%), negative information received from Internet (13.4%) or mass media (12.3%). Denial of the problem of tuberculosis or its displacement into a remote social environment was demonstrated by 60.6% of respondents (95% CI 54.7-66.3). Respondents are characterized by a high percentage of people (46.8%, 95% CI 40.9-52.8) who have not undergone chest X-ray examinations for more than two years, as well as individuals whose children are not vaccinated with BCG (11.9%, 95% CI 8.3-16.0). Replacement of the regulated method of detection of latent tuberculosis infection by the method chosen by the respondent will allow to examine children about half (52.4%) of the respondents. However, that will require a change in regulatory framework of the Russian Federation. The greatest part of refusals from immunodiagnostic of tuberculosis is associated with defects in sanitary education, resulting in distrust of the quality of tests and insufficient semantic motivation for implementing tests. The respondents are characterized by denial of the problem of tuberculosis. The significant percentage of respondents demonstrate risky behavior regarding the transmission of tuberculosis behavior. They have not been tested for a long time on tuberculosis, and their children are not vaccinated with BCG. The acuteness of the problem can be reduced through greater flexibility in choosing the survey technique and activation of sanitary education of population.


Assuntos
Recusa do Paciente ao Tratamento , Tuberculose , Criança , Estudos Transversais , Humanos , Motivação , Federação Russa , Inquéritos e Questionários , Tuberculose/diagnóstico
4.
Prax Kinderpsychol Kinderpsychiatr ; 68(4): 253-270, 2019 May.
Artigo em Alemão | MEDLINE | ID: mdl-31044679

RESUMO

"I Would Never have done it Without Coercion …" - Experiences with Coercion and Compulsion in a Family Psychiatric and Psychotherapeutic Day Clinic Coercion and compulsion have negative connotations, especially in psychiatric therapy. But in families, children are always also affected if parents do not want or are not able to make use of therapy. The avoidance of therapy can be a symptom of illness, e. g. separation anxiety. Perceived or real external coercion, e. g. from the youth welfare office or school, can be used to initially open up access to therapy and to allow parents to become capable of acting again. Coercion can initially reduce the ambivalence of the parents. The Family Therapeutic Centre (FaTZ) is a psychiatric and psychotherapeutic day clinic for parents and children. Family constellations are described in which initial coercion was a door-opener to therapy. During courses of treatment therapeutic alliances could be established, hope for positive change emerged, and the outcome was favourable. School avoidance of the child (e. g. due to separation anxiety) in combination with mentally ill parents is an exemplary constellation in which initial coercion can pave the way to therapy for families that otherwise wouldn't get access. Afterwards, voluntary cooperation should be intended, as the overriding objective is to reduce coercive measures to a minimum.


Assuntos
Coerção , Centros Comunitários de Saúde Mental , Terapia Familiar/métodos , Tratamento Psiquiátrico Involuntário/métodos , Transtornos Mentais/terapia , Pais/psicologia , Psicoterapia/métodos , Recusa do Paciente ao Tratamento/psicologia , Adolescente , Ansiedade de Separação , Criança , Filho de Pais Incapacitados/psicologia , Terapia Familiar/ética , Humanos , Tratamento Psiquiátrico Involuntário/ética , Transtornos Mentais/psicologia , Cooperação do Paciente/psicologia , Psicoterapia/ética
6.
Fortschr Neurol Psychiatr ; 87(7): 361-366, 2019 Jul.
Artigo em Alemão | MEDLINE | ID: mdl-30887491

RESUMO

Alcohol intoxication is the most common psychiatric cause of admission to German emergency rooms. Many of these patients refuse inpatient observation or treatment. Therefore, the physician in charge will have to decide on how to proceed. The capacity to consent has to be clarified, especially if the patient insists on being discharged. In this context, the risks of injuries, complicated alcohol withdrawal, and aggressive or suicidal behaviour have to be evaluated. In this article, the juridical aspects and the necessary mental and physical assessments, especially in case of discharge of the patient against medical advice, are presented. Essential aspects are summarized in checklists.


Assuntos
Intoxicação Alcoólica/psicologia , Intoxicação Alcoólica/terapia , Medicina de Emergência/métodos , Psiquiatria/métodos , Intoxicação Alcoólica/complicações , Intoxicação Alcoólica/epidemiologia , Alemanha/epidemiologia , Hospitalização/estatística & dados numéricos , Humanos , Alta do Paciente/estatística & dados numéricos , Síndrome de Abstinência a Substâncias/complicações , Recusa do Paciente ao Tratamento/psicologia , Recusa do Paciente ao Tratamento/estatística & dados numéricos
7.
Rev Soc Bras Med Trop ; 52: e20180366, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30892550

RESUMO

INTRODUCTION: Immunization is the primary method of preventing influenza. The objective of this study was to describe reasons and determine causes of acceptance or refusal of the influenza vaccine by elderly people. METHODS: This cross-sectional and descriptive study included elderly patients (aged >60 years) from the City of Jundiai, São Paulo, Brazil. RESULTS: The sample comprised 185 people; 71.9% reported receiving the vaccine and 21% claimed to have experienced complications. CONCLUSIONS: The vaccination coverage was below the national goal; the reasons for not being vaccinated was "did not want to receive the vaccine", in addition to "forgot".


Assuntos
Vacinas contra Influenza/administração & dosagem , Influenza Humana/prevenção & controle , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Brasil , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Vacinação
8.
Rev. enferm. UFPE on line ; 13(3): 664-673, mar. 2019.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1015568

RESUMO

Objetivo: conhecer os motivos que levam os pacientes com doença renal crônica a recusarem o transplante renal. Método: trata-se de estudo qualitativo, descritivo e exploratório realizado com 22 pacientes submetidos à hemodiálise em um Centro de Tratamento de Doenças Renais. Utilizou-se uma entrevista semiestruturada transcrita e submetida à Análise de Conteúdo na modalidade Análise Temática. Resultados: percebe-se que após a análise de conteúdo para a organização dos dados, emergiram as categorias "Sentimento de culpa por desejar a morte de alguém e preocupação com a vida do doador vivo"; "Implicações financeiras e demora na realização do transplante" e "Adaptação ao tratamento hemodialítico e as incertezas quanto ao transplante". Conclusão: constatou-se que vários motivos influenciam a recusa para o transplante renal, como questões financeiras e burocráticas, o medo da cirurgia e do seu prognóstico influenciado pelo conhecimento de experiências negativas de pacientes transplantados, o medo justificado pela adaptação ao tratamento dialítico e a algumas comorbidades, bem como a culpa por desejar um órgão. Os profissionais de saúde têm papel fundamental no esclarecimento sobre o transplante para que esses pacientes tomem uma decisão consciente acerca do tratamento.(AU)


Objective: to learn the reasons that lead patients with chronic kidney disease to refuse kidney transplantation. Method: this is a qualitative, descriptive and exploratory study of 22 patients submitted to hemodialysis at a Center for the Treatment of Renal Diseases. A semi-structured interview was used, transcribed and submitted to Content Analysis in the Thematic Analysis modality. Results: it is noticed that after the content analysis for the organization of the data, the categories "Feeling guilty for wanting someone's death and concern for the life of the living donor" emerged; "Financial implications and delay in carrying out the transplant" and "Adaptation to hemodialysis treatment and uncertainties regarding transplantation". Conclusion: it was observed that several reasons influence the refusal for renal transplantation, such as financial and bureaucratic issues, fear of surgery and its prognosis influenced by the knowledge of negative experiences of transplanted patients, fear justified by adaptation to dialysis treatment and some comorbidities, as well as the guilt for wanting an organ. Health professionals play a key role in clarifying the transplant so that these patients make a conscious decision about the treatment.(AU)


Objetivo: conocer los motivos que llevan a los pacientes con enfermedad renal crónica a rechazar el trasplante renal. Método: se trata de un estudio cualitativo, descriptivo y exploratorio realizado con 22 pacientes sometidos a la hemodiálisis en un Centro de Tratamiento de Enfermedades Renales. Se utilizó una entrevista semiestructurada transcrita y sometida al Análisis de Contenido en la modalidad Análisis Temático. Resultados: se percibe que después del análisis de contenido para la organización de los datos, emergieron las categorías "Sentimiento de culpa por desear la muerte de alguien y preocupación por la vida del donante vivo"; "Implicaciones financieras y demora en la realización del trasplante" y "Adaptación al tratamiento hemodialítico y las incertidumbres en cuanto al trasplante". Conclusión: se constató que varios motivos influencian la negativa para el trasplante renal, como cuestiones financieras y burocráticas, el miedo a la cirugía y su pronóstico influenciado por el conocimiento de experiencias negativas de pacientes trasplantados, el miedo justificado por la adaptación al tratamiento dialítico y a algunas comorbilidades, así como la culpa por desear un órgano. Los profesionales de la salud desempeñan un papel fundamental en la aclaración del trasplante para que estos pacientes tomen una decisión consciente sobre el tratamiento.(AU)


Assuntos
Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Idoso , Pacientes , Percepção , Listas de Espera , Recusa do Paciente ao Tratamento , Transplante de Rim , Incerteza , Insuficiência Renal Crônica , Medo , Falência Renal Crônica , Motivação , Epidemiologia Descritiva , Pesquisa Qualitativa
9.
BMC Health Serv Res ; 19(1): 99, 2019 Feb 06.
Artigo em Inglês | MEDLINE | ID: mdl-30728033

RESUMO

BACKGROUND: In French Guiana, health inequalities are patent for a broad range of pathologies for all age groups. The objective of the present study was to quantify the proportion of the population that had renounced care in the past year, to study predictive factors, and to compare results with other French territories. METHODS: A two-stage random sample of 2015 individuals aged 15 to 75 years was surveyed by telephone. A descriptive analysis of variables relative to renouncing care, use of health care, screening, and vaccination was initially performed. Multivariate analysis was then used to determine variables associated with renouncing care for financial reasons and renouncing for reasons linked to time were directly estimated using a Poisson model on weighted data. Variables with a significance level < 0.2 in the bivariate analysis were included in the full multivariate model. RESULTS: In French Guiana, during the past 12 months, 30.9% of surveyed persons renounced care whatever the type for financial reasons. Results of the multivariate analysis showed that gender, perceived financial situation, perceived health and complementary insurance status were independent predictive factors of care renouncement for financial reasons. Overall, 24% of the surveyed population declared having renounced to care for time-related motives. The independent predictors for time-related renouncing were different than those for renouncing care for financial reasons: a higher education level and a poor perceived health were independently associated with time-related renouncement; retired persons and students were found to renounce care less frequently than persons with a job. CONCLUSIONS: Renouncing for financial reasons, a major target of the 2016 health law, represented a public health problem in French Guiana. Renouncing for lack of time was an important motive for renouncing, which is aggravated by the insufficient number of health professionals, but may benefit from organizational solutions. There are avenues for improvement of health for the most vulnerable: promote health, act on risk factors, and facilitate the readability and accessibility of the health system. Recent reforms to stabilize health insurance may however have some adverse consequences for migrants.


Assuntos
Disparidades em Assistência à Saúde/estatística & dados numéricos , Cobertura do Seguro/estatística & dados numéricos , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Adolescente , Adulto , Idoso , Feminino , Guiana Francesa , Pesquisas sobre Serviços de Saúde , Gastos em Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Humanos , Seguro Saúde/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Fatores Socioeconômicos , Inquéritos e Questionários , Fatores de Tempo , Migrantes/estatística & dados numéricos , Adulto Jovem
10.
Med Leg J ; 87(1): 23-26, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30706758

RESUMO

This article considers situations where treatment is refused and whether this is reasonable taking into account statutory duties, efficacy of treatment, the role and advice of NICE, local and general resources. What should be the priorities for treatment? Eligibility for treatment, the economic case for an early intervention and/or preventative medicine, caesarean sections, human rights, examples from the cases.


Assuntos
Medicina Estatal/economia , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Custos de Cuidados de Saúde/normas , Direitos Humanos , Humanos , Jurisprudência , Direitos do Paciente , Medicina Estatal/organização & administração , Recusa do Paciente ao Tratamento/ética , Recusa do Paciente ao Tratamento/tendências , Reino Unido
11.
BMC Gastroenterol ; 19(1): 30, 2019 Feb 13.
Artigo em Inglês | MEDLINE | ID: mdl-30760205

RESUMO

BACKGROUND: Inflammatory Bowel Disease (IBD) with its high incidence and prevalence rates in Canada generates a heavy burden of tests and procedures. The purpose of this study is to gain a better understanding of the transfer of information from physician to patient, as well as the patient understanding and perceptions about the tests and procedures that are ordered to them in the context of IBD diagnosis and monitoring. METHODS: An online questionnaire was completed by 210 IBD patients in Canada. Information on the five most-often used tests or procedures in IBD diagnosis/monitoring was collected. These include: general blood test, colonoscopy, colon biopsy, medical imaging and stool testing. RESULTS: The general blood test is both the most ordered and most refused tool. It is also the one with which patients are the least comfortable, the one that generates the least concern and the one about which physicians provide the least information. The stool test is the test/procedure with which patients are the most comfortable. Procedures raise more concerns among patients and physicians provide more information about why they are needed, their impact and the risks they present. Very little information is provided to patients about the risks of having false positives or negative tests. CONCLUSIONS: This study provides an initial understanding of patient perceptions, the transfer of information from a physician to a patient and a patient's understanding of the tests and procedures that will be required to treat IBD throughout what is a lifelong disease. The present study takes a first step in better understanding the acceptance of the test or procedure by IBD patients, which is essential for them to adhere to the monitoring process.


Assuntos
Doenças Inflamatórias Intestinais/diagnóstico , Doenças Inflamatórias Intestinais/psicologia , Aceitação pelo Paciente de Cuidados de Saúde , Educação de Pacientes como Assunto , Percepção , Adolescente , Adulto , Canadá/epidemiologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Incidência , Doenças Inflamatórias Intestinais/epidemiologia , Doenças Inflamatórias Intestinais/terapia , Masculino , Pessoa de Meia-Idade , Monitorização Fisiológica , Prevalência , Qualidade de Vida , Inquéritos e Questionários , Recusa do Paciente ao Tratamento , Adulto Jovem
12.
BMC Surg ; 19(1): 17, 2019 Feb 04.
Artigo em Inglês | MEDLINE | ID: mdl-30717721

RESUMO

BACKGROUND: Hepatic portal vein gas (HPVG) is a rare acute abdomen, which is not an independent disease. Meanwhile, HPVG combined with appendicitis has been rarely reported. We found only a similar report by looking for literature, but no intestinal necrosis occurred. We report a patient with HPVG, appendicitis and intestinal necrosis was reported in the current study. The patient was given frequent monitoring and had been conducted operation in time. CASE PRESENTATION: An 86-year-old female with appendicitis complicated by HPVG was reported in the present study. Abdominal examination revealed rebound tenderness at the McBurney's point. Moreover, abdominal computed tomography (CT) revealed gas in portal and mesenteric veins in addition to appendicitis. An emergency operation was planned on the appendix. However, the patient refused surgical treatment. Therefore, conservative treatment of antibiotics and frequent imaging observation was conducted for this patient. Although imaging results suggested disappeared gas in intra- and extra-hepatic portal veins, the small intestine was dilated, after conservative treatment of antibiotics. In addition, signs of diffused peritonitis could also be observed and an exploratory laparotomy was performed. Intra-operative findings had confirmed suppurated appendix, mesenteric ischemia and small intestinal necrosis. CONCLUSIONS: Frequent monitoring benefits us in observing the progress of intestinal diseases. When there exist other possible causes of HPVG such as infection, it is not easy for us to ignore the possibility of intestinal necrosis.


Assuntos
Apendicite/cirurgia , Enfisema/diagnóstico por imagem , Intestino Delgado/patologia , Isquemia Mesentérica/diagnóstico por imagem , Veias Mesentéricas/diagnóstico por imagem , Veia Porta/diagnóstico por imagem , Idoso de 80 Anos ou mais , Apendicite/diagnóstico por imagem , Apêndice/diagnóstico por imagem , Apêndice/cirurgia , Tratamento Conservador , Enfisema/cirurgia , Feminino , Humanos , Intestino Delgado/diagnóstico por imagem , Intestino Delgado/cirurgia , Laparotomia , Isquemia Mesentérica/cirurgia , Monitorização Fisiológica , Necrose , Peritonite/diagnóstico , Peritonite/cirurgia , Pneumatose Cistoide Intestinal/diagnóstico por imagem , Pneumatose Cistoide Intestinal/patologia , Pneumatose Cistoide Intestinal/cirurgia , Tomografia Computadorizada por Raios X , Falha de Tratamento , Recusa do Paciente ao Tratamento
13.
Rev. ADM ; 76(1): 44-48, ene.-feb. 2019. ilus, tab
Artigo em Espanhol | LILACS | ID: biblio-996080

RESUMO

Introducción: El término kissing molars se traduce como «dientes besándose¼; superfi cies oclusales de dos molares retenidos están en contacto una con otra en espacio folicular único y raíces en dirección contraria. Literatura científi ca ha reportado 44 casos. Cuartos molares o distomolares, supernumerarios que se forman distalmente a terceros molares; tamaño y forma variable, generalmente retenidos. Caso clínico: Femenino de 32 años con molestias en zona retromolar inferior izquierda, limitación de apertura, trismus, disfagia. En ortopantomografía, se observa cuarto molar retenido junto con tercer molar, superfi cies oclusales de ambos órganos dentarios retenidos en íntimo contacto dentro de un mismo saco folicular, raíces en dirección opuesta. Discusión: Existe controversia acerca de diferencia entre molares retenidos y KM, algunos autores sugieren que la ausencia de contacto entre dos molares retenidos no permite incluirlos en esta condición. Etiología aún incierta, algunos lo consideran como un evento aislado. Existe una teoría en relación con la formación de quiste dentígero; resorción ósea causada por presencia y expansión de éste, resulta en pérdida de hueso en zona mesial de molares retenidos facilitando movilización, inclinación y contacto uno con otro (AU)


Introduction: The term kissing molars is used when the occlusal surfaces of two retained molars are in intimate contact inside the same follicular sack and roots in opposite direction. Literature has reported 44 cases. Fourth molars, also known as distomolars, are a supernumerary tooth that grows distally to third molars; size and shape are variable, generally retained. Case report: Female 32 years old, pain in the left inferior retromolar zone, trismus, dysphagia. Fourth and third retained molars, with occlusal surfaces in contact, inside the same follicular sack, roots in opposite direction are observed in orthopantomography. Discussion: There is controversy about the diff erence between retained molars and KM, some authors suggest that the absence of contact between two retained molars, does not allow to include them in this condition. Etiology still unknown. Dentigerous cyst formation theory is proposed due to the bone resorption in the mesial zone of retained molars in this entity, which facilitates mobilization and contact between molars (AU)


Assuntos
Humanos , Feminino , Adulto , Erupção Ectópica de Dente , Dente Impactado , Dente Supranumerário , Dente Molar/anormalidades , Diagnóstico por Imagem , Radiografia Panorâmica , Recusa do Paciente ao Tratamento
16.
Anaesthesia ; 74(1): 74-82, 2019 Jan.
Artigo em Inglês | MEDLINE | ID: mdl-30270470

RESUMO

There are approximately 8.5 million Jehovah's Witnesses and around 150,000 live in Great Britain and Ireland. Based on their beliefs and core values, Jehovah's Witnesses refuse blood component transfusion (including red cells, plasma and platelets). They regard non-consensual transfusion as a physical violation. Consent to treatment is at the heart of this guideline. Refusal of treatment by an adult with capacity is lawful. The reasons why a patient might refuse transfusion and the implications are examined. The processes and products that are deemed acceptable or unacceptable to Jehovah's Witnesses are described. When a team is faced with a patient who refuses transfusion, a thorough review of the clinical situation is advocated and all options for treatment should be explored. After discussion, a plan should then be made that is acceptable to the patient and appropriate consent obtained. When agreement cannot be reached between the doctor and the patient, referral for a second opinion should be considered. When the patient is a child, the same strategy should be used but on occasion the clinical team may have to obtain legal help.


Assuntos
Anestesia/métodos , Transfusão de Sangue/métodos , Testemunhas de Jeová , Recusa do Paciente ao Tratamento , Humanos , Consentimento Livre e Esclarecido , Irlanda , Reino Unido
17.
Rev Med Chil ; 146(7): 914-917, 2018 Jul.
Artigo em Espanhol | MEDLINE | ID: mdl-30534892

RESUMO

The law N° 20.584 established the informed consent. This could suggest that patients have a right to refuse a blood transfusion. However, the dominant jurisprudence in protection claims filed against Jehovah Witnesses who rejected a blood transfusion, reveals that they do not have such a right. There were two exceptions in 2008, where courts acknowledged the patient's autonomy and denied the petition to authorize a blood transfusion. Most cases precede law N° 20.584. However, those cases which were upheld by the courts after the promulgation of the law, although few, follow exactly the same doctrine as before the appearance of this act.


Assuntos
Transfusão de Sangue/legislação & jurisprudência , Consentimento Livre e Esclarecido/legislação & jurisprudência , Testemunhas de Jeová , Religião e Medicina , Recusa do Paciente ao Tratamento/legislação & jurisprudência , Transfusão de Sangue/ética , Chile , Humanos
19.
BMJ Case Rep ; 11(1)2018 Dec 07.
Artigo em Inglês | MEDLINE | ID: mdl-30567199

RESUMO

We present a 21-year-old woman diagnosed with Philadelphia (Ph) chromosome-like CD20 positive B-cell acute lymphoblastic leukaemia (ALL). She was a Jehovah's Witness (JW) and declined all blood product transfusion support. She was initiated on the CALGB 10403 chemotherapy protocol for her ALL. She received darbepoetin alfa and romiplostim as supportive therapies for her disease/chemotherapy-associated anaemia and thrombocytopaenia. A complete remission was achieved with negative minimal residual disease and she remains in remission 18 months after diagnosis. This case report describes the successful treatment of an adult JW with Ph-like CD20 +B cell ALL, in the absence of blood product transfusions, using growth factor support.


Assuntos
Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Darbepoetina alfa/uso terapêutico , Hematínicos/uso terapêutico , Quimioterapia de Indução/métodos , Testemunhas de Jeová , Leucemia-Linfoma Linfoblástico de Células Precursoras/tratamento farmacológico , Receptores Fc/uso terapêutico , Receptores de Trombopoetina/agonistas , Proteínas Recombinantes de Fusão/uso terapêutico , Trombopoetina/uso terapêutico , Feminino , Humanos , Indução de Remissão , Recusa do Paciente ao Tratamento , Adulto Jovem
20.
Transplant Proc ; 50(10): 3165-3171, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30577183

RESUMO

Brunei Darussalam has a live related kidney transplant program since 2013. Uptake of transplant remains poor in the country despite full government subsidy for health care. This study aims to assess barriers and factors affecting patients' preference toward dialysis over transplant as their choice of renal replacement therapy. It is hoped that the study can provide a better insight into the poor uptake of transplant in the country. METHODS: The target population was all patients with end-stage renal disease undergoing dialysis in Brunei Darussalam who are fit enough to undergo kidney transplant. The shortlisted patients were approached during their hemodialysis sessions or while waiting for clinical reviews in peritoneal dialysis clinics and were given self-administered structured questionnaires. RESULTS: Out of 348 eligible patients in the country, 226 (64.9%) agreed to participate in the study. The majority of patients (71.2%), especially the unmarried patients (81.5%), cited "lack of donor" as their main reason for not choosing transplant. "Happy with dialysis" (31.9%), "inadequate information" (21.2%), "unwilling to take risk" (26.5%), and "financial problems" (18.1%) were the other common factors identified. A total of 51.8% of the respondents had considered transplant, and 42.5 % of patients had considered the option of commercialization through foreign black market channels. Younger patients (<40 years) on dialysis for less than 5 years with higher education were more likely to consider transplant (P < .05). Likewise, patients who were younger, highly educated, and employed were more likely to choose commercialization (P < .05). CONCLUSION: Lack of donor and poor knowledge were the main barriers to patients receiving kidney transplant in the country. Religio-cultural barriers, lack of reimbursement, poor knowledge, and stringent donor criteria contributed to the limited donor pool. Despite universal health coverage for the population, financial and social security factors were still important determinants that influenced recipients' and donors' decisions to reject transplant.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Transplante de Rim/psicologia , Recusa do Paciente ao Tratamento/psicologia , Adulto , Brunei , Comportamento de Escolha , Feminino , Humanos , Falência Renal Crônica/terapia , Transplante de Rim/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Terapia de Substituição Renal/métodos , Terapia de Substituição Renal/estatística & dados numéricos , Inquéritos e Questionários
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