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3.
J Homosex ; 67(1): 104-126, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-30307803

RESUMO

Malay-Muslim men who have sex with men (MSM) are marginalized and hidden in Malaysia, a predominantly Muslim country in southeast Asia. We explored the policy, network, community, and individual factors related to HIV infection among Malay-Muslim MSM through 26 in-depth interviews and one focus group discussion (n = 5) conducted in Kuala Lumpur and Kota Bharu between October 2013 and January 2014. As religion plays an important role in their lives, participants viewed homosexuality as a sin. Low risk perception and misconceptions about HIV/AIDS were common, and most participants expressed reluctance to consult a doctor unless they had symptoms. Additionally, buying condoms was embarrassing and anxiety-producing. Fear of discrimination by health care providers and community hindered participants from disclosing sexual behaviors and accessing health services. Homophobic comments and policies by the government and religious leaders were concerns of participants. A safe and enabling environment is needed to reduce HIV risks among Malay-Muslim MSM.


Assuntos
Revelação , Infecções por HIV/psicologia , Homofobia , Homossexualidade Masculina , Islamismo , Religião e Sexo , Minorias Sexuais e de Gênero/psicologia , Adulto , Redes Comunitárias , Preservativos , Grupos Focais , Pessoal de Saúde , Acesso aos Serviços de Saúde , Humanos , Malásia , Masculino , Fatores de Risco
4.
RECIIS (Online) ; 13(4): 817-830, out.-dez. 2019. ilus
Artigo em Português | LILACS | ID: biblio-1047572

RESUMO

Este artigo mapeia as estratégias de atuação do Ministério da Saúde na rede social Instagram. Realizou-se um estudo de caso no período de agosto de 2017 a agosto de 2018 para verificar como o tema da amamentação foi abordado na rede oficial do governo brasileiro para saúde. O corpus tem 65 posts sobre a questão, que foram analisados considerando as métricas de monitoramento das redes sociais: alcance; volume; atividade; engajamento dos usuários e influência do conteúdo junto aos seguidores. Analisando as estratégias de atuação do marketing social e digital identificou-se a falta de interação e resposta aos usuários e a baixa diversidade de representação das mulheres. O levantamento aponta a necessidade de problematizar as práticas do Ministério nesta rede e propor melhorias para ampliar o diálogo com a sociedade.


This article maps out the strategies of performance of the Brazilian Ministry of Health in Instagram's social network. A case study was carried out in the period from August 2017 to August 2018 to verify how the topic of breast-feeding was approached in the official network of the Brazilian government for health. The corpus has 65 posts about that issue which were analised considering the measures to monitor social networks: scope, volume, activity, user engagement and influence of the content on the followers. Analyzing the strategies of social and digital marketing used by the Brazilian government for health, it was identified the lack of interaction with users and of response to them and the low diversity of women represented on its Instagram profile. The research points out that we need to problematize Ministry practices in this network and to propose improvements to broaden the dialogue with the society.


El artículo mapea las estrategias de actuación del Ministerio de Salud de Brasil en la red social Instagram. Se realizó un estudio de caso en el período de agosto de 2017 hasta agosto de 2018 para escudriñar como se abordó el tema de la lactancia en la red oficial del gobierno brasileño para salud. El corpus tiene 65 posts a respecto del asunto y fueron estudiados considerando las medidas para monitorizar redes sociales: alcance; volumen; actividad; interacción de los usuarios e la influencia del contenido en los seguidores. Analizando las estrategias de actuación del marketing social y digital se identificó falta de interactividad, usuarios sin respuesta y la baja diversidad de representación de las mujeres en lo perfil del gobierno brasileño en Instagram. La investigación apunta la necesidad de problematizar las prácticas del Ministerio en esta red y de proponer mejorías para ampliar el diálogo con la sociedad.


Assuntos
Humanos , Aleitamento Materno , Relatos de Casos , Marketing Social , Rede Social , Promoção da Saúde , Sistema Único de Saúde , Comunicação , Redes Comunitárias , Internet , Nutrição do Lactente , Política de Saúde , Relações Interpessoais
5.
BMC Health Serv Res ; 19(1): 752, 2019 Oct 25.
Artigo em Inglês | MEDLINE | ID: mdl-31653231

RESUMO

BACKGROUND: People living with and beyond cancer (PLC) receive various forms of specialty care at different locations and many interventions concurrently or over time. They are affected by the operation of professional and organizational silos. This results in undue delays in access, unmet needs, sub-optimal care experiences and clinical outcomes, and human and financial costs for PLCs and healthcare systems. National cancer control programs advocate organizing in a network to coordinate actions, solve fragmentation problems, and thus improve clinical outcomes and care experiences for every dollar invested. The variable outcomes of such networks and factors explaining them have been documented. Governance is the "missing link" for understanding outcomes. Governance refers to the coordination of collective action by a body in a position of authority in pursuit of a common goal. The Quebec Cancer Network (QCN) offers the opportunity to study in a natural environment how, why, by whom, for whom, and under what conditions collaborative governance contributes to practices that produce value-added outcomes for PLCs, healthcare providers, and the healthcare system. METHODS/DESIGN: The study design consists of a longitudinal case study, with multiple nested cases (4 local networks nested in the QCN), mobilizing qualitative and quantitative data and mixed data from various sources and collected using different methods, using the realist evaluation approach. Qualitative data will be used for a thematic analysis of collaborative governance. Quantitative data from validated questionnaires will be analyzed to measure relational coordination and teamwork, care experience, clinical outcomes, and health-related health-related quality of life, as well as a cost analysis of service utilization. Associations between context, governance mechanisms, and outcomes will be sought. Robust data will be produced to support decision-makers to guide network governance towards optimized clinical outcomes and the reduction of the economic toxicity of cancer for PLCs and health systems.


Assuntos
Redes Comunitárias/organização & administração , Neoplasias/terapia , Redes Comunitárias/economia , Custos de Cuidados de Saúde , Pesquisa sobre Serviços de Saúde , Humanos , Institucionalização , Estudos Longitudinais , Estudos de Casos Organizacionais , Quebeque , Projetos de Pesquisa
6.
Glob Health Action ; 12(1): 1662682, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31507254

RESUMO

Background: There is an increasing recognition that community resilience plays a significant role in addressing health shocks like the Ebola virus disease (EVD) epidemic. However, the factors that constitute community resilience, and how these operate dynamically with other health system factors are less understood. Objective: This paper seeks to understand key factors that constitute community resilience and their role in responding to the EVD outbreak in Liberia. Methods: Key informant interviews were conducted between November 2017 and April 2018 with community representatives in Bomi, Margibi and Montserrado counties, and other national stakeholders involved in the EVD response in Liberia from 2014 to 2016. A national stakeholder meeting was conducted to verify and interpret information emerging from the interviews. Results: Factors that were critical for addressing the EVD epidemic in Liberia were identified as: strong leadership, tight bonds and sense of kinship at the community level; trusted communication channels; and trust among various health system stakeholders. These factors facilitated collective actions within communities and helped to direct response initiatives from other levels of the health system to the community. Foreign assistance was seen as crucial for recovery and revitalization of affected communities. However, such aid is often not targeted at addressing critical challenges in a sustainable way, especially when the assistance is highly restricted to specific activities, and those activities are determined without consultation with local actors and community groups. Conclusion: Efforts to systematically build responsible leadership and social capital at community level, including those that strengthen bonds in communities and trust across key actors in the health system, are needed to address health shocks like EVD outbreaks. Without building such capabilities in community resilience, it will be difficult to reap the expected gains from investments focusing on building physical capital and technical capabilities in health services and emergency preparedness.


Assuntos
Redes Comunitárias/organização & administração , Surtos de Doenças , Doença pelo Vírus Ebola/epidemiologia , Assistência à Saúde/organização & administração , Epidemias , Humanos , Cooperação Internacional , Entrevistas como Assunto , Liderança , Libéria/epidemiologia , Pesquisa Qualitativa , Capital Social
7.
Artigo em Inglês | MEDLINE | ID: mdl-31546902

RESUMO

Social farming represents a hybrid governance model in which public bodies, local communities, and economic actors act together to promote health and social inclusion in rural areas. Although relational variables are crucial to foster social farm performance, the relational system in which farms are embedded has still not been fully described. Using social network analysis, here we map the nature of the links of a selected sample of social farms operating in Northern Italy. We also explore possible network variations following specific actions taken to potentiate local social farming initiatives. The results show a certain degree of variability in terms of the extension and features of the examined networks. Overall, the actions taken appear to be significant to enlarge and diversify farms' networks. Social farming has the potential to provide important benefits to society and the environment and to contrast vulnerability in rural areas. Being able to create social and economic networks of local communities, social farming may also represent an innovative way to respond to the cultural shift from institutional psychiatry to community-based mental health care. This study emphasizes the critical role played by network facilitation in diversifying actors, promoting heterogeneous relationships, and, in turn, system complexity.


Assuntos
Agricultura , Redes Comunitárias , Fazendas , Serviços de Saúde Mental , Serviços de Saúde , Humanos , Itália , Masculino , Saúde Mental , Natureza , Rede Social
8.
BMC Infect Dis ; 19(1): 814, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533646

RESUMO

BACKGROUND: Prevention of new HIV infections is a critical public health issue. The highest HIV testing gaps are in men, adolescents 15-19 years old, and adults 40 years and older. Community-based HIV testing services (HTS) can contribute to increased testing coverage and early HIV diagnosis, with HIV self-testing (HIVST) strategies showing promise. Community-based strategies, however, are resource intensive, costly and not widely implemented. A community-led approach to health interventions involves supporting communities to plan and implement solutions to improve their health. This trial aims to determine if community-led delivery of HIVST can improve HIV testing uptake, ART initiation, and broader social outcomes in rural Malawi. METHODS: The trial uses a parallel arm, cluster-randomised design with group village heads (GVH) and their defined catchment areas randomised (1:1) to community-led HIVST or continue with the standard of the care (SOC). As part of the intervention, informal community health cadres are supported to plan and implement a seven-day HIVST campaign linked to HIV treatment and prevention. Approximately 12 months after the initial campaign, intervention GVHs are randomised to lead a repeat HIVST campaign. The primary outcome includes the proportion of adolescents 15-19 years old who have tested for HIV in their lifetime. Secondary outcomes include recent testing in adults 40 years and older and men; ART initiation; knowledge of HIV prevention; and HIV testing stigma. Outcomes will be measured through cross-sectional surveys and clinic registers. Economic evaluation will determine the cost per person tested, cost per person diagnosed, and incremental cost effectiveness ratio. DISCUSSION: To the best of our knowledge, this is the first trial to assess the effectiveness of community-led HTS, which has only recently been enabled by the introduction of HIVST. Community-led delivery of HIVST is a promising new strategy for providing periodic HIV testing to support HIV prevention in rural communities. Further, introduction of HIVST through a community-led framework seems particularly apt, with control over healthcare concurrently devolved to individuals and communities. TRIAL REGISTRATION: Clinicaltrials.gov registry ( NCT03541382 ) registered 30 May 2018.


Assuntos
Infecções por HIV/diagnóstico , Testes Sorológicos/métodos , Adolescente , Adulto , Antirretrovirais/uso terapêutico , Redes Comunitárias , Análise Custo-Benefício , Estudos Transversais , Feminino , Infecções por HIV/tratamento farmacológico , Promoção da Saúde , Humanos , Malaui , Masculino , Programas de Rastreamento/economia , Programas de Rastreamento/métodos , Ensaios Clínicos Controlados Aleatórios como Assunto , Sistema de Registros , Testes Sorológicos/economia , Adulto Jovem
9.
Adv Parasitol ; 105: 95-110, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31530397

RESUMO

In 2005, the network decided to increase its number of target diseases to include other helminthic zoonoses such as fascioliasis, clonorchiasis, opisthorchiasis, paragonimiasis and cysticercosis and in the process expanding membership to include South Korea, Vietnam, Thailand and Japan. NTDs were eventually included as awareness is heightened on these diseases affecting poor and developing countries. Researches on clonorchiasis and opisthorchiasis unravel the mechanism by which these diseases eventually predispose to cholangiocarcinoma. The liver cancer associated with these liver fluke infections necessitate the need to clarify the global burden of disease of these infections. The magnitude of these liver fluke diseases in endemic countries like China, Vietnam, Laos, Cambodia and Thailand is described. Success in elimination of lymphatic filariasis in PR China and Cambodia is highlighted to show how intensified multisectoral collaboration and strong political become strong ingredients in elimination of parasitic diseases like LF. New advances are presented that clarify species and strain differences in Fasciola spp., Paragonimus spp., Taenia spp. and Echinococcocus spp. Conventional diagnostic techniques are compared with new serologic techniques that are being developed. New control strategies such as the Lawa model are presented.


Assuntos
Erradicação de Doenças , Helmintíase/prevenção & controle , Comunicação Interdisciplinar , Animais , Ásia , Redes Comunitárias/tendências , Humanos
10.
BMC Med ; 17(1): 149, 2019 07 31.
Artigo em Inglês | MEDLINE | ID: mdl-31362721

RESUMO

BACKGROUND: Persons with human immunodeficiency virus (HIV) have higher risks for myocardial infarction (MI) than the general population. This is driven in part by higher type 2 MI (T2MI, due to coronary supply-demand mismatch) rates among persons with HIV (PWH). In the general population, T2MI has higher mortality than type 1 MI (T1MI, spontaneous and generally due to plaque rupture and thrombosis). PWH have a greater burden of comorbidities and may therefore have an even greater excess risk for complication and death in the setting of T2MI. However, mortality patterns after T1MI and T2MI in HIV are unknown. METHODS: We analyzed mortality after MI among PWH enrolled in the multicenter, US-based Centers for AIDS Research Network of Integrated Clinical Systems (CNICS) cohort (N = 28,186). Incident MIs occurring between January 1, 1996, and December 31, 2014, were centrally adjudicated and classified as T1MI or T2MI. We first compared mortality following T1MI vs. T2MI among PWH. Cox survival analyses and Bayesian model averaging were then used to evaluate pre-MI covariates associated with mortality following T1MI and T2MI. RESULTS: Among the 596 out of 28,186 PWH who experienced MI (2.1%; 293 T1MI and 303 T2MI), mortality rates were significantly greater after T2MI (22.2/100 person-years; 1-, 3-, and 5-year mortality 39%, 52%, and 62%) than T1MI (8.2/100 person-years; 1-, 3-, and 5-year mortality 15%, 22%, and 30%). Significant mortality predictors after T1MI were higher HIV viral load, renal dysfunction, and older age. Significant predictors of mortality after T2MI were low body-mass index (BMI) and detectable HIV viral load. CONCLUSIONS: Mortality is high following MI for PWH and substantially greater after T2MI than T1MI. Predictors of death after MI differed by type of MI, reinforcing the different clinical scenarios associated with each MI type and the importance of considering MI types separately.


Assuntos
Infecções por HIV/mortalidade , Infarto do Miocárdio/mortalidade , Síndrome de Imunodeficiência Adquirida/complicações , Síndrome de Imunodeficiência Adquirida/epidemiologia , Síndrome de Imunodeficiência Adquirida/mortalidade , Adulto , Idoso , Estudos de Coortes , Redes Comunitárias , Comorbidade , Feminino , Infecções por HIV/complicações , Infecções por HIV/epidemiologia , Humanos , Masculino , Pessoa de Meia-Idade , Mortalidade , Infarto do Miocárdio/complicações , Infarto do Miocárdio/epidemiologia , Placa Aterosclerótica/complicações , Placa Aterosclerótica/epidemiologia , Placa Aterosclerótica/mortalidade , Estados Unidos/epidemiologia
11.
Int J Equity Health ; 18(1): 119, 2019 07 30.
Artigo em Inglês | MEDLINE | ID: mdl-31362732

RESUMO

OBJECTIVES: Considerable evidence has advanced the role of citizen-led coalitions (CLC) in supporting the health and social needs of rural citizens. There has been little research focusing on the experiences and strategies of coalitions, with their limited resources and status, in targeting health inequities in their rural communities. The aim of this study was to understand the entrepreneurial strategies and experiences of rural coalitions to effect change in the delivery of health services for their older adult populations. METHOD: A qualitative descriptive study method was used to generate understanding of the entrepreneurial experiences and strategies of CLCs in advancing health services to meet the health and social needs of their citizens. Seven diverse CLCs (n = 40) from different rural communities participated in focus groups and in individual and coalition-level surveys. Thematic analysis was used to construct themes from the data. RESULTS: Two over-riding themes emerged: entrepreneurial strategies and societal recognition. CLCs engaged in numerous entrepreneurial strategies that enabled actions and outcomes in meeting their health care needs. These strategies included: securing quick wins, leveraging existing resources, and joining forces with stakeholder groups/individuals. However, despite these strategies and successes, coalitions expressed frustration with not being seen and not being heard by decision-makers. This pointed to a key structural barrier to coalition successes -- a broader societal and institutional problem of failing to recognize not only the health needs of rural citizens, but also the legitimacy of the community coalitions to represent and act on those needs. CONCLUSIONS: Despite the potential for coalitions to mobilize and effect change in addressing the inequities of rural health service access for older adults, broader barriers to their recognition, may undermine their entrepreneurial strategies and success.


Assuntos
Redes Comunitárias/organização & administração , Acesso aos Serviços de Saúde/organização & administração , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde/estatística & dados numéricos , Serviços de Saúde Rural/organização & administração , População Rural/estatística & dados numéricos , Idoso , Feminino , Grupos Focais , Necessidades e Demandas de Serviços de Saúde/estatística & dados numéricos , Humanos , Masculino , Saúde das Minorias , Inquéritos e Questionários
12.
BMC Public Health ; 19(1): 979, 2019 Jul 23.
Artigo em Inglês | MEDLINE | ID: mdl-31337365

RESUMO

BACKGROUND: Children with overweight often do not receive appropriate integrated care. An innovative integrated network approach of preventive care for overweight children aged 4-12 years old has been developed and implemented in four neighbourhoods of 's-Hertogenbosch, The Netherlands. This new approach focusses on self-management of the family and is based on the principles of stepped and matched care. Youth health care (YHC) nurses support the families in their new role as central care providers. The aim of this study is to evaluate the implementation and effectiveness of this network approach. METHODS: The implementation of the new approach (reach, functioning of the central care provider, network functioning and patient satisfaction) is assessed by interviews and checklists with professionals and parents of 4-12 year old overweight or obese children. To evaluate effectiveness, we aim to compare 120 overweight or obese children in 's-Hertogenbosch with 60 overweight or obese children outside 's-Hertogenbosch during one year of YHC involvement. Quality of life, psychosocial problems of the child and parental empowerment are the main outcomes of the effectiveness study. Outcomes are measured with digital questionnaires at inclusion, at three months and one year after inclusion. BMI measurements and referrals are distracted from medical files. DISCUSSION: Integrated care for overweight and obese children is high on the agenda of many municipalities in The Netherlands. The new approach is expected to have beneficial effects for overweight children, their parents and professionals. With the results of this study, we can optimize the support for overweight and obese children and their parents. The first results are expected to be available in 2019. TRIAL REGISTRATION: This study is registered in the Dutch Trial Register on 10 November 2017 (NTR number NTR6813). https://www.trialregister.nl/trial/6596 Word count: 281 (max 350).


Assuntos
Redes Comunitárias/organização & administração , Obesidade Pediátrica/prevenção & controle , Serviços Preventivos de Saúde/organização & administração , Criança , Pré-Escolar , Feminino , Humanos , Masculino , Países Baixos , Avaliação de Programas e Projetos de Saúde
13.
BMC Med Educ ; 19(1): 258, 2019 Jul 11.
Artigo em Inglês | MEDLINE | ID: mdl-31296217

RESUMO

BACKGROUND: Community-based education (CBE) is strategically important to provide contextual learning for medical students. CBE is a priority for countries striving for better primary health care. However, the CBE literature provides little curriculum guidance to enhance undergraduate medical education with the primary health care context. We aim to develop a CBE framework for undergraduate medical education (from macro, meso, and micro curriculum levels) to engage students and teachers with better, more meaningful learning, within primary health care settings. METHODS: We used a grounded theory methodology by interviewing eight medical educationalists and ten CBE teachers, followed with the coding process by sensitizing the concepts of 'medical education' and 'primary care', to explore any new concepts. The primary data originated from a developing country where the paradigm of high-quality primary health care is mostly unfamiliar. Three senior researchers from international associations of general practices from different countries provided validation to the results. RESULTS: We identified a new framework for a community-based educational program. The micro-curriculum should offer opportunities for small group activities, ranging from simple to complex learning, emphasizing clinical skills, leadership, and teamwork to improve self-directed and collaborative practice. Sufficient role models and constructive feedback within primary care contexts are robust facilitators. For the meso-curriculum, comprehensive coordination on teacher-training and CBE program is needed. To ensure the sustainability of the program, faculty leaders and managers should include the macro-curriculum with a national postgraduate general practice curriculum and provide strong commitment. CONCLUSIONS: We designed a 'CBE-tree' model for the undergraduate medical curriculum. By using the CBE framework developed in this study, students and teachers may better comprehend the essential of primary health care.


Assuntos
Redes Comunitárias/organização & administração , Currículo , Educação de Graduação em Medicina/organização & administração , Medicina de Família e Comunidade/educação , Feminino , Teoria Fundamentada , Humanos , Masculino , Modelos Educacionais , Atenção Primária à Saúde , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa , Estudantes de Medicina/estatística & dados numéricos , Reino Unido
15.
BMC Health Serv Res ; 19(1): 479, 2019 Jul 12.
Artigo em Inglês | MEDLINE | ID: mdl-31299953

RESUMO

BACKGROUND: Intimate partner violence (IPV) is associated with adverse health effects and increased healthcare utilization. Systems-level interventions have been shown to be effective in identifying and referring survivors but little is known about how these strategies impact future utilization. The objective of this study is to examine the impact of a systems-level response on healthcare utilization among patients screening positive for IPV from November 2016 to February 2019 in a large multi-specialty outpatient health system in the Midwest. METHODS: Using electronic health record (EHR) data, we identified patients who screened positive for IPV (N = 756) and categorized their response as accepted printed material (N = 116), accepted direct referrals (N = 85), declined both (N = 271), or missing (N = 255). We used negative binomial models to model post-period utilization as a function of decision group, pre-period utilization, and clinical and demographic factors. RESULTS: After controlling for demographic characteristics and baseline utilization, the printed materials and direct referral groups had higher utilization rates than those who declined printed materials and direct referral during the post-period for every type of service. However, these differences were only statistically significant for outpatient, behavioral health, and social work services. Specifically, the visit rate for patients receiving printed materials was two times higher (rate ratio: 2.18; 95% CI: 1.21, 3.94) for behavioral health services and three times higher (rate ratio: 3.33; 95% CI: 1.3, 8.52) for social work services compared to those who refused printed material and direct referral. For those opting for a direct referral, the visit rate was two times higher for outpatient services (rate ratio: 1.97; 95% CI: 1.13, 3.42) compared to those who refused. CONCLUSIONS: Patients receiving printed materials or direct referrals had more social work and behavioral health visits, highlighting an important outcome of the protocol. However, higher utilization rates among outpatient services and a trend toward higher utilization of other services, including the emergency department, suggest greater health service utilization is not diminished by the systems level response-at least not within a two-year time frame.


Assuntos
Redes Comunitárias/organização & administração , Violência por Parceiro Íntimo , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Sobreviventes/psicologia , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Masculino , Meios de Comunicação de Massa/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Serviço Social/estatística & dados numéricos , Sobreviventes/estatística & dados numéricos
16.
Med Care ; 57(9): 680-687, 2019 09.
Artigo em Inglês | MEDLINE | ID: mdl-31295166

RESUMO

BACKGROUND: Properties of social networks and shared patient networks of physicians are associated with important outcomes, including costs, quality, information exchange, and organizational effectiveness. OBJECTIVES: To determine whether practice consolidation affects size, strength, and stability of US practice-based physician shared patient networks. RESEARCH DESIGN: We used a dynamic difference-in-differences (event study) design to determine how 2 types of vertical consolidation (hospital and health system practice acquisition) and 2 types of horizontal consolidation (medical group membership and practice-practice mergers) affect individual shared patient network characteristics, controlling for physician fixed effects and geographic market (metropolitan statistical area). SUBJECTS: Practice-based US physicians whose practices consolidated 2009-2014 are identified via health system, hospital, and medical group affiliation information and appearance/disappearance of listed practice affiliations in the SK&A Physician Database. MEASURES: Outcomes measured were network size (number of individual physicians with whom a physician shares patients within 30 d), strength (average number of shared patients within those relationships), and stability (percent of shared patient relationships that persist in the current and prior year), all generated from Medicare Shared Patient Patterns (30-d) data. RESULTS: Shared patient network stability increases significantly after acquisition of practices by horizontal practice-practice mergers [ßt=1=0.041 (P<0.001), ßt=2=0.047 (P<0.001), ßt=3=0.041 (P<0.001), ßt=4=0.031 (P<0.05), where t is the number of years after the consolidation event]. These effects were robust to sensitivity analyses. Shared patient network size and strength are not observably associated with practice consolidation events. CONCLUSIONS: Practice consolidation can increase the stability of physician networks, which may have positive implications for organizational effectiveness.


Assuntos
Redes Comunitárias/estatística & dados numéricos , Assistência ao Paciente/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Prática Profissional/organização & administração , Redes Comunitárias/organização & administração , Humanos , Médicos/organização & administração , Padrões de Prática Médica/organização & administração , Atenção Primária à Saúde/organização & administração , Estados Unidos
17.
Trop Doct ; 49(4): 298-300, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31333059

RESUMO

Community mobilisation is an essential part of cervical cancer screening programmes to increase demand for screening services. While there are different methods of community mobilisation, in Ethiopia community conversations during traditional coffee ceremonies appear to be a context appropriate and effective method. Linkage of community mobilisation with existing community networks can increase uptake of cervical cancer screening and improve continuous support and care among community members.


Assuntos
Café , Serviços de Saúde Comunitária/métodos , Redes Comunitárias/organização & administração , Detecção Precoce de Câncer/métodos , Neoplasias do Colo do Útero/diagnóstico , Adulto , Serviços de Saúde Comunitária/organização & administração , Etiópia/epidemiologia , Feminino , Humanos , Pessoa de Meia-Idade , Neoplasias do Colo do Útero/epidemiologia , Neoplasias do Colo do Útero/prevenção & controle
18.
BMC Med ; 17(1): 135, 2019 07 17.
Artigo em Inglês | MEDLINE | ID: mdl-31311600

RESUMO

BACKGROUND: Non-alcoholic fatty liver disease (NAFLD) is a common chronic liver illness with a genetically heterogeneous background that can be accompanied by considerable morbidity and attendant health care costs. The pathogenesis and progression of NAFLD is complex with many unanswered questions. We conducted genome-wide association studies (GWASs) using both adult and pediatric participants from the Electronic Medical Records and Genomics (eMERGE) Network to identify novel genetic contributors to this condition. METHODS: First, a natural language processing (NLP) algorithm was developed, tested, and deployed at each site to identify 1106 NAFLD cases and 8571 controls and histological data from liver tissue in 235 available participants. These include 1242 pediatric participants (396 cases, 846 controls). The algorithm included billing codes, text queries, laboratory values, and medication records. Next, GWASs were performed on NAFLD cases and controls and case-only analyses using histologic scores and liver function tests adjusting for age, sex, site, ancestry, PC, and body mass index (BMI). RESULTS: Consistent with previous results, a robust association was detected for the PNPLA3 gene cluster in participants with European ancestry. At the PNPLA3-SAMM50 region, three SNPs, rs738409, rs738408, and rs3747207, showed strongest association (best SNP rs738409 p = 1.70 × 10- 20). This effect was consistent in both pediatric (p = 9.92 × 10- 6) and adult (p = 9.73 × 10- 15) cohorts. Additionally, this variant was also associated with disease severity and NAFLD Activity Score (NAS) (p = 3.94 × 10- 8, beta = 0.85). PheWAS analysis link this locus to a spectrum of liver diseases beyond NAFLD with a novel negative correlation with gout (p = 1.09 × 10- 4). We also identified novel loci for NAFLD disease severity, including one novel locus for NAS score near IL17RA (rs5748926, p = 3.80 × 10- 8), and another near ZFP90-CDH1 for fibrosis (rs698718, p = 2.74 × 10- 11). Post-GWAS and gene-based analyses identified more than 300 genes that were used for functional and pathway enrichment analyses. CONCLUSIONS: In summary, this study demonstrates clear confirmation of a previously described NAFLD risk locus and several novel associations. Further collaborative studies including an ethnically diverse population with well-characterized liver histologic features of NAFLD are needed to further validate the novel findings.


Assuntos
Hepatopatia Gordurosa não Alcoólica/genética , Adulto , Idoso , Índice de Massa Corporal , Estudos de Casos e Controles , Redes Comunitárias/organização & administração , Redes Comunitárias/estatística & dados numéricos , Progressão da Doença , Registros Eletrônicos de Saúde/organização & administração , Registros Eletrônicos de Saúde/estatística & dados numéricos , Feminino , Predisposição Genética para Doença , Estudo de Associação Genômica Ampla , Genômica/organização & administração , Genômica/estatística & dados numéricos , Humanos , Lipase/genética , Masculino , Proteínas de Membrana/genética , Pessoa de Meia-Idade , Morbidade , Hepatopatia Gordurosa não Alcoólica/epidemiologia , Fenótipo , Polimorfismo de Nucleotídeo Único , Transdução de Sinais/genética
19.
J Allied Health ; 48(2): 114-118, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31167013

RESUMO

On-campus clinics have been a pillar of graduate education in allied health programs for decades. However, traditional clinical education is under scrutiny due to budget cuts, reimbursement rates, and supervision requirements. Some universities opening new programs have opted out of building on-campus clinics. The purpose of this multisite qualitative case study was to examine an alternative model of clinical education. Four graduate programs were selected that did not have an on-campus clinic and were not affiliated with a medical school. Four main themes emerged: authentic experiences, professional networking, collaborative partnerships, and responsiveness. The findings suggested on-campus clinics are not necessary for providing clinical education. The participants suggested more programs should consider this alternative model of clinical education to expose students to authentic and diverse clinical experiences throughout their graduate education.


Assuntos
Ocupações Relacionadas com Saúde/educação , Educação de Pós-Graduação/organização & administração , Serviços de Saúde para Estudantes/organização & administração , Redes Comunitárias , Comportamento Cooperativo , Humanos , Aprendizagem Baseada em Problemas
20.
Int J Equity Health ; 18(1): 82, 2019 06 06.
Artigo em Inglês | MEDLINE | ID: mdl-31170993

RESUMO

BACKGROUND: In the context of public expenditure reduction and cuts, in 2012, the Spanish government approved the RDL 16/2012, which significantly affected the core values of the national health system. The measure particularly affected undocumented immigrants over 18 years of age, excluding them from accessing the full range of healthcare services in Spain, except for emergency care. In 2014, Red de Denuncia y Resistencia al RDL 16/2012 (REDER) was created as a public awareness and resistance network to defend universal access to healthcare and to stop its infringement. This study aims to analyse the social impact of REDER as a solidarity movement in response to the exclusion of undocumented immigrants from their universal right to health. METHODS: Qualitative research methodologies were used for the research. Data were collected between November 2017 and December 2017, using eight semi-structured interviews with key informants from the main REDER stakeholders. Additionally, key publications, documents, and presentations of researchers and experts in the field were analysed. For data analysis, a framework extracted from the literature on exclusionary and transformative dimensions of solidarity was used to identify barriers and drivers in REDER's intervention. RESULTS: From its creation to the present, REDER has been able to achieve many of its objectives to defend the right to medical care of groups in irregular situations, contributing to the identification of 4,755 cases of discrimination in healthcare access and helping solve over 90% of these cases by delivering either healthcare assistance or administrative support. REDER has also played an important role in: stimulating social activation and empowering citizens to claim their fundamental rights, organising actions against restrictions on accessibility and creating synergies to restore universal healthcare coverage. CONCLUSIONS: REDER has been shown to be effective in leading the defence of universal healthcare rights, and some achievements in the years following 2012 could be directly attributed to the work done by the network, such as the elimination of legal requirements to obtain health cards or the reduction of the minimum time required to access healthcare. Despite context particularities, the initiatives and main actions of this network may be implemented in other settings that are facing similar limitations to healthcare access, in order to address injustices and promote solidarity.


Assuntos
Redes Comunitárias , Regulamentação Governamental , Acesso aos Serviços de Saúde , Ativismo Político , Discriminação Social , Justiça Social , Imigrantes Indocumentados , Adulto , Idoso , Conscientização , Feminino , Serviços de Saúde , Acesso aos Serviços de Saúde/legislação & jurisprudência , Disparidades em Assistência à Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Espanha , Medicina Estatal , Cobertura Universal do Seguro de Saúde , Adulto Jovem
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