Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 295
Filtrar
1.
BMC Res Notes ; 12(1): 594, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533813

RESUMO

OBJECTIVE: The aim of this study was to assess the magnitude, patterns and predictive factors of unhealthy practice among mothers during pregnancy, childbirth, postnatal and newborn care in Southern Ethiopia. RESULTS: Among the total participants, 29.0% mothers performed at least one unhealthy practice during pregnancy, childbirth, postnatal period and newborn care. This study identified the following harmful practices such as food prohibition (53.2%), home delivery (41.5%), discarding colostrum (18.6%), application of substance on the cord stump (12.1%), delayed breast feeding (28.4%), prelacteal feeding (43.0%) and early bathing (49.3%). Being grand multiparous (AOR = 2.528, 95% CI 1.037-6.166), being illiterate (AOR = 7.611, 95% CI 2.375-24.396) and lack of awareness on the effect of unhealthy practice (OR = 4.673, 95% CI 1.163-18.774) were independent predictors of outcome variable.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde , Mães/psicologia , Parto/psicologia , Cuidado Pós-Natal/psicologia , Adolescente , Adulto , Aleitamento Materno/psicologia , Redes Comunitárias/estatística & dados numéricos , Estudos Transversais , Parto Obstétrico/psicologia , Etiópia , Feminino , Humanos , Recém-Nascido , Mães/estatística & dados numéricos , Gravidez , Adulto Jovem
2.
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
3.
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
4.
PLoS One ; 14(2): e0212396, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30789929

RESUMO

BACKGROUND: Stroke care and outcomes have improved significantly over the past decades. It is unclear if patients who had a stroke in hospital (in-hospital stroke, IHS) experienced similar improvements to those who were admitted with stroke (community-onset stroke, COS). METHODS: Data from the South London Stroke Register were analysed to estimate trends in processes of care and outcomes across three cohorts (1995-2001, 2002-2008, 2009-2015). Kaplan-Meier survival curves were calculated for each cohort. Associations between patient location at stroke onset, processes of care, and outcomes were investigated using multiple logistic regression and Cox proportional hazards models. RESULTS: Of 5,119 patients admitted to hospital and registered between 1995 and 2015, 552(10.8%) had IHS. Brain imaging rates increased from 92.4%(COS) and 78.3%(IHS) in 1995-2001 to 100% for COS and IHS in 2009-2015. Rates of stroke unit admission rose but remained lower for IHS (1995-2001: 32.2%(COS) vs. 12.4%(IHS), 2002-2008: 77.1%(COS) vs. 50.0%(IHS), 2009-2015: 86.3%(COS) vs. 65.4%(IHS)). After adjusting for patient characteristics and case-mix, IHS was independently associated with lower rates of stroke unit admission in each cohort (1995-2001: OR 0.49, 95%CI 0.29-0.82, 2002-2008: 0.29, 0.18-0.45, 2009-2015: 0.22, 0.11-0.43). In 2009-2015, thrombolysis rates were lower for ischaemic IHS (17.8%(COS) vs. 13.8%(IHS)). Despite a decline, in-hospital mortality remained significantly higher after IHS in 2009-2015 (13.7%(COS) vs. 26.7%(IHS)). Five-year mortality rates declined for COS from 58.9%(1995-2001) to 35.2%(2009-2015) and for IHS from 80.8%(1995-2001) to 51.1%(2009-2015). In multivariable analysis, IHS was associated with higher mortality over five years post-stroke in each cohort (1995-2001: HR 1.27, 95%CI 1.03-1.57, 2002-2008: 1.24, 0.99-1.55, 2009-2016: 1.39, 0.95-2.04). CONCLUSIONS: Despite significant improvements for IHS patients similar to those for COS patients, rates of stroke unit admission and thrombolysis remain lower, and short- and long-term outcomes poorer after IHS. Factors preventing IHS patients from entering evidence-based stroke-specific hospital pathways in a timely fashion need further investigation.


Assuntos
Redes Comunitárias/estatística & dados numéricos , Assistência à Saúde/tendências , Mortalidade Hospitalar/tendências , Hospitalização/tendências , Hospitais/estatística & dados numéricos , Acidente Vascular Cerebral/mortalidade , Acidente Vascular Cerebral/terapia , Idoso , Estudos de Coortes , Feminino , Humanos , Londres , Masculino , Sistema de Registros , Fatores de Risco , Taxa de Sobrevida , Terapia Trombolítica , Fatores de Tempo , Resultado do Tratamento
6.
Neurol Sci ; 40(3): 561-570, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30604336

RESUMO

BACKGROUND: GENetics of mOyaMoyA (GEN-O-MA) project is a multicenter observational study implemented in Italy aimed at creating a network of centers involved in moyamoya angiopathy (MA) care and research and at collecting a large series and bio-repository of MA patients, finally aimed at describing the disease phenotype and clinical course as well as at identifying biological or cellular markers for disease progression. The present paper resumes the most important study methodological issues and preliminary results. METHODS: Nineteen centers are participating to the study. Patients with both bilateral and unilateral radiologically defined MA are included in the study. For each patient, detailed demographic and clinical as well as neuroimaging data are being collected. When available, biological samples (blood, DNA, CSF, middle cerebral artery samples) are being also collected for biological and cellular studies. RESULTS: Ninety-eight patients (age of onset mean ± SD 35.5 ± 19.6 years; 68.4% females) have been collected so far. 65.3% of patients presented ischemic (50%) and haemorrhagic (15.3%) stroke. A higher female predominance concomitantly with a similar age of onset and clinical features to what was reported in previous studies on Western patients has been confirmed. CONCLUSION: An accurate and detailed clinical and neuroimaging classification represents the best strategy to provide the characterization of the disease phenotype and clinical course. The collection of a large number of biological samples will permit the identification of biological markers and genetic factors associated with the disease susceptibility in Italy.


Assuntos
Redes Comunitárias/estatística & dados numéricos , Doença de Moyamoya , Neuroimagem , Acidente Vascular Cerebral/complicações , Adolescente , Adulto , Idoso , Isquemia Encefálica/complicações , Criança , Pré-Escolar , Progressão da Doença , Feminino , Humanos , Lactente , Recém-Nascido , Itália , Masculino , Pessoa de Meia-Idade , Doença de Moyamoya/diagnóstico por imagem , Doença de Moyamoya/epidemiologia , Doença de Moyamoya/genética , Fenótipo , Estudos Retrospectivos , Adulto Jovem
7.
Cancer ; 125(3): 382-390, 2019 02 01.
Artigo em Inglês | MEDLINE | ID: mdl-30343497

RESUMO

BACKGROUND: Platinum and etoposide with thoracic radiation followed by prophylactic cranial irradiation constitute the standard treatment for limited-stage small cell lung cancer (LS-SCLC). Many patients with LS-SCLC are elderly with comorbidities. METHODS: Individual patient data were collected from 11 phase 2 or 3 trials for LS-SCLC conducted by the National Clinical Trials Network and activated from 1990 to 2010. The primary endpoint was overall survival (OS); the secondary endpoints were progression-free survival (PFS), the rate of severe adverse events, and off-treatment reasons. The outcomes were compared for patients 70 years old or older (elderly patients) and patients younger than 70 years (younger patients). RESULTS: Individual patient data from 1049 younger patients (81%) and 254 elderly patients (19%) were analyzed. In the multivariate model, elderly patients, in comparison with younger patients, had worse OS (hazard ratio [HR], 1.38; 95% confidence interval [CI], 1.18-1.63; median OS for elderly patients, 17.8 months; OS for younger patients, 23.5 months) and worse PFS (HR, 1.19; 95% CI, 1.03-1.39; median PFS for elderly patients, 10.6 months; median PFS for younger patients, 12.3 months). Elderly patients, in comparison with younger patients, experienced more grade 5 adverse events (8% vs 3%; P < .01) and more grade 3 or higher dyspnea (11% vs 7%; P = .03) but less grade 3 or higher esophagitis/dysphagia (14% vs 19%; P = .04) and less grade 3 or higher vomiting (11% vs 17%; P = .01). Elderly patients completed treatment less often, discontinued treatment because of adverse events and patient refusal more frequently, and died during treatment more frequently. CONCLUSIONS: Elderly patients with LS-SCLC have worse PFS and OS and more difficulty in tolerating therapy. Future trials should incorporate assessments of elderly patients, novel monitoring of adverse events, and more tolerable radiation and systemic therapies.


Assuntos
Quimiorradioterapia , Neoplasias Pulmonares/epidemiologia , Neoplasias Pulmonares/terapia , Carcinoma de Pequenas Células do Pulmão/epidemiologia , Carcinoma de Pequenas Células do Pulmão/terapia , Adulto , Fatores Etários , Idade de Início , Idoso , Idoso de 80 Anos ou mais , Protocolos de Quimioterapia Combinada Antineoplásica/uso terapêutico , Quimiorradioterapia/efeitos adversos , Quimiorradioterapia/estatística & dados numéricos , Ensaios Clínicos como Assunto/organização & administração , Ensaios Clínicos como Assunto/estatística & dados numéricos , Redes Comunitárias/organização & administração , Redes Comunitárias/estatística & dados numéricos , Irradiação Craniana/efeitos adversos , Irradiação Craniana/estatística & dados numéricos , Feminino , Humanos , Neoplasias Pulmonares/patologia , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Estudos Retrospectivos , Carcinoma de Pequenas Células do Pulmão/patologia
8.
BMJ Support Palliat Care ; 9(3): 263-266, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-29151044

RESUMO

OBJECTIVES: Intermediate care services have been introduced to help mitigate unnecessary hospital demand and premature placement in long-term residential care. Many patients are elderly and/or with complex comorbidities, but little consideration has been given to the palliative care needs of patients referred to intermediate care services. The objective of this study is to determine the proportion of patients referred to a community-based intermediate care team who died during care and up to 24 months after discharge and so to help inform the development of supportive and palliative care in this setting. METHODS: A retrospective cohort study of all 4770 adult patients referred to Northamptonshire Intermediate Care Team (ICT) between 11 April 2010 and 10 April 2011. RESULTS: Of 4770 patients referred, 60% were 75 years or older and 32% were 85 years of age or older. 4.0% of patients died during their ICT stay and 11% within 30 days of discharge. At the end of 12 months, 25% of the patients had died, increasing to 32% before the end of the second year. About 34% of all deaths occurred during the ICT stay or within 30 days of discharge, and a further 46% by the end of the first year. Male gender and higher age were associated with greater likelihood of death. CONCLUSIONS: It is important for ICT clinicians to consider immediate and longer-term palliative care needs among patients referred to ICTs. Care models involving ICTs and palliative care teams working together could enable more people with end-stage non-cancer illnesses to die at home.


Assuntos
Estado Terminal/mortalidade , Instituições para Cuidados Intermediários/estatística & dados numéricos , Cuidados Paliativos/estatística & dados numéricos , Alta do Paciente/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Adulto , Idoso , Idoso de 80 Anos ou mais , Redes Comunitárias/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos
9.
Rev. Asoc. Esp. Neuropsiquiatr ; 38(134): 401-417, jul.-dic. 2018. tab
Artigo em Espanhol | IBECS | ID: ibc-176427

RESUMO

El objetivo de este trabajo es valorar la efectividad del Plan de Servicios individualizado (PSI) tras sus primeros 10 años de funcionamiento. Se trata de un estudio retrospectivo sobre la efectividad del programa teniendo en cuenta variables clínicas, psicosociales y de utilización de servicios. Se realizan comparaciones de estas variables en el momento en que las personas entran y salen del programa. El PSI se muestra efectivo en las medidas de funcionamiento clínico y psicosocial, y se observa una disminución significativa de ingresos hospitalarios. La mayoría de personas atendidas mantuvo continuidad de su atención al alta. Además, se realiza una comparativa entre los primeros 5 años de funcionamiento del programa frente a los 5 siguientes en la que se observa únicamente una disminución de la intensidad de la intervención. Finalmente, se realiza un estudio de la relación entre variables consideradas importantes. En general, el PSI se muestra efectivo en la atención a las personas con trastorno mental grave de larga evolución y con dificultades de vinculación a los servicios


The objective of this work is to assess the effectiveness of the Individualized Service Plan (PSI) after 10 years of functioning. It is a retrospective study that takes into account clinical, psychosocial and variables related to use of services. Comparisons of these variables between the time people enter and leave the program are made. PSI is effective in measures of clinical and psychosocial functioning, and a significant decrease in hospitalization is observed. The majority of people received continuity of care after discharge. In addition, the comparison between the first 5 years of operation of the program and the following 5 years yielded only a decrease in the intensity of the intervention. Finally, a study of the relationship between variables considered important is carried out. Overall, the PSI is effective in the care of patients with long-term severe mental illness and with difficulties in maintaining contact with services


Assuntos
Humanos , Masculino , Feminino , Medicina de Precisão/tendências , Transtornos Mentais/epidemiologia , Centros Comunitários de Saúde Mental/estatística & dados numéricos , Estudos Retrospectivos , Avaliação de Processos e Resultados (Cuidados de Saúde)/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Esquizofrenia/epidemiologia , Redes Comunitárias/estatística & dados numéricos , Doenças Individuais/estatística & dados numéricos
10.
J Int Assoc Provid AIDS Care ; 17: 2325958218811640, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30444156

RESUMO

The purpose of this study is to examine the female sex workers' (FSWs) community organization (CO) membership, their financial and social protection security, and the relationship between these factors among FSWs in India. Data from 4098 FSWs collected under the Avahan-III baseline evaluation survey-2015 in 5 high HIV prevalence states (Maharashtra, Tamil Nadu, Karnataka, Telangana, and Andhra Pradesh) in India were used here. More than three-fifths (77%) were registered CO members, of whom 79% had been CO members for more than 1 year. The likelihood of having high financial security (19% versus 10%; adjusted odds ratio [AOR]: 1.7; 95% confidence interval [CI]: 1.3-2.1) and social protection security (13% versus 6%; AOR: 1.6; 95% CI: 1.2-2.0) was 2 times higher among FSWs who were CO members compared to those who were not. The study offers important insights into furthering CO membership to address financial and social vulnerability as a path to a sustainable reduction of HIV risk.


Assuntos
Redes Comunitárias/estatística & dados numéricos , Declarações Financeiras , Política Pública , Profissionais do Sexo/estatística & dados numéricos , Adulto , Preservativos , Estudos Transversais , Feminino , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Índia/epidemiologia , Razão de Chances , Prevalência , Sexo Seguro
11.
Asian Nurs Res (Korean Soc Nurs Sci) ; 12(4): 286-292, 2018 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-30448262

RESUMO

PURPOSE: This study aimed to evaluate the outcomes of a community-based palliative care project conducted in Busan city, Korea, from 2013 to 2015. METHODS: We selected four outcome indices based on the project's outcomes derived from a logic model and used a longitudinal and cross-sectional comparative design approach depending on the outcome index. RESULTS: The utilization rate of palliative care increased from 9.2% in 2012 to 41.9% in 2015. Regarding symptom changes in 65 patients receiving palliative care at 3 and 6 months (mean age = 72 years, standard deviation = 9.64, 55.4% women), pain, anxiety, and depression had improved. Quality of life was higher among palliative care patients compared with patients who did not receive palliative care (t = 2.09, p = .039). Regarding recognition of palliative care, civil servants at public health centers who participated in the pilot project (2013-2014) scored higher than those at public health centers who began participation in 2015 (t = 2.67, p = .008). CONCLUSION: This is the first study in Korea that systematically evaluated community-based palliative care. The Busan Community-based Palliative Care Project improved the quality of life of palliative care patients by providing services at an appropriate level and by raising the recognition of palliative care in the community. To increase the utilization ratio of palliative care and the quality of service, strategies should be developed to supplement medical support systems.


Assuntos
Redes Comunitárias/organização & administração , Redes Comunitárias/estatística & dados numéricos , Cuidados Paliativos/organização & administração , Cuidados Paliativos/estatística & dados numéricos , Qualidade da Assistência à Saúde/organização & administração , Qualidade da Assistência à Saúde/estatística & dados numéricos , Qualidade de Vida/psicologia , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Projetos Piloto , República da Coreia
12.
PLoS One ; 13(10): e0205284, 2018.
Artigo em Inglês | MEDLINE | ID: mdl-30372429

RESUMO

Community structures are ubiquitous in various complex networks, implying that the networks commonly be composed of groups of nodes with more internal links and less external links. As an important topic in network theory, community detection is of importance for understanding the structure and function of the networks. Optimizing statistical measures for community structures is one of most popular strategies for community detection in complex networks. In the paper, by using a type of self-loop rescaling strategy, we introduced a set of global modularity functions and a set of local modularity functions for community detection in networks, which are optimized by a kind of the self-consistent method. We carefully compared and analyzed the behaviors of the modularity-based methods in community detection, and confirmed the superiority of the local modularity for detecting community structures on large-size and heterogeneous networks. The local modularity can more quickly eliminate the first-type limit of modularity, and can eliminate or alleviate the second-type limit of modularity in networks, because of the use of the local information in networks. Moreover, we tested the methods in real networks. Finally, we expect the research can provide useful insight into the problem of community detection in complex networks.


Assuntos
Algoritmos , Redes Comunitárias/estatística & dados numéricos , Modelos Estatísticos , Animais , Simulação por Computador , Golfinhos/fisiologia , Golfinhos/psicologia , Humanos , Saccharomyces cerevisiae/fisiologia , Tamanho da Amostra
13.
Pediatr Diabetes ; 19(8): 1422-1428, 2018 12.
Artigo em Inglês | MEDLINE | ID: mdl-30209881

RESUMO

OBJECTIVE: To determine the incidence of and risk factors for development of celiac disease (CD) in individuals with type 1 diabetes. METHODS: Cohort study using The Health Improvement Network (THIN), a UK primary care database of >13 million people. Individuals with incident type 1 diabetes diagnosed at 1 to 35 years of age between 1995 and 2015 with no previous diagnosis of CD were included. Cox regression was used to identify risk factors for CD, including age at diabetes diagnosis and sex, while adjusting for year of diagnosis to control for potential rising incidence in CD over time. RESULTS: Subjects (n = 9180; 43% female) had a median observation time of 5.1 years (interquartile range 2.0-10.1). CD was diagnosed in 196 (2%) during follow up. Median time to diagnosis was 2.1 years, but 25% were diagnosed more than 5 years after diabetes diagnosis. Incidence (per 10 000 person-years) was greater in females (43.0 [95% confidence interval [CI] 35.2-52.0]) vs males (26.8 [95% CI 21.5-32.9]). In multivariable Cox regression stratified by childhood- vs young adult-onset diabetes, younger age at diabetes diagnosis within childhood (hazard ratio [HR] 0.91 [95% CI 0.88-0.94]) and female sex among the adult-onset diabetes group (HR 3.19 [95% CI 1.39-7.34]) were associated with greater risk of CD. CONCLUSIONS: As expected, incidence of CD was higher in individuals with childhood-onset diabetes vs those with adult-onset diabetes. However, individuals with diabetes are at risk of developing CD throughout childhood and adulthood, and prolonged screening after diagnosis may be warranted. Prospective studies are needed in order to guide risk-stratified approaches to screening.


Assuntos
Doença Celíaca/epidemiologia , Doença Celíaca/etiologia , Diabetes Mellitus Tipo 1/complicações , Diabetes Mellitus Tipo 1/epidemiologia , Adolescente , Adulto , Criança , Pré-Escolar , Estudos de Coortes , Redes Comunitárias/organização & administração , Redes Comunitárias/estatística & dados numéricos , Bases de Dados Factuais/estatística & dados numéricos , Feminino , Promoção da Saúde/métodos , Promoção da Saúde/organização & administração , Humanos , Incidência , Lactente , Masculino , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/estatística & dados numéricos , Fatores de Risco , Reino Unido/epidemiologia , Adulto Jovem
14.
Malar J ; 17(1): 289, 2018 Aug 10.
Artigo em Inglês | MEDLINE | ID: mdl-30097021

RESUMO

BACKGROUND: The extensive research on community members' willingness to support malaria interventions ignores the role of psychosocial determinants. This study assesses the impact of individuals' sense of community (perceptions of community cohesion, altruism, seeking help from neighbours and migrant status) on their willingness to participate in a mosquito control programme using data on 768 individuals from the 2013 RIPS Urban Health and Poverty Survey in poor coastal communities in Accra, Ghana. A contingent valuation experiment was employed to elicit individuals' willingness to support the programme by contributing nothing, labour time/money only or both. RESULTS: Findings show that different dimensions of sense of community related differently with willingness to support the programme. Perceived community cohesion was associated with lower odds while help-seeking from neighbours and being a migrant were associated with higher odds of supporting the programme. Altruism was the only dimension not linked to willingness to participate. CONCLUSIONS: Different dimensions of sense of community are associated with community members' willingness to provide labour, time or both to support the malaria eradication programme. The findings of this study have implications for targeting social relational aspects, in addition to geographical aspects, of communities with malaria-resilient policy and intervention. They also warrant further research on psychosocial factors that predict willingness to support health programmes in urban poor settings.


Assuntos
Controle de Doenças Transmissíveis , Redes Comunitárias/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Malária/prevenção & controle , População Urbana , Populações Vulneráveis/estatística & dados numéricos , Adolescente , Adulto , Feminino , Gana , Humanos , Masculino , Pessoa de Meia-Idade , Pobreza , Saúde da População Urbana , Adulto Jovem
15.
Artigo em Inglês | MEDLINE | ID: mdl-29966341

RESUMO

Social and spatial characteristics of a population often interact to influence health outcomes, suggesting a need to jointly analyze both to offer useful insights in community health. However, researchers have used either social or spatial analyses to examine community-based health issues and inform intervention programs. We propose a combined socio-spatial analytic approach to develop a social network with spatial weights and a spatial statistic with social weights, and apply them to an ongoing study of mental and physical well-being of rural Latino immigrants in North Florida, USA. We demonstrate how this approach can be used to calculate measures, such as social network centrality, support contact dyads, and spatial kernel density based on a health survey data. Findings reveal that the integrated approach accurately reflected interactions between social and spatial elements, and identified community members (who) and locations (where) that should be prioritized for community-based health interventions.


Assuntos
Planejamento em Saúde Comunitária/métodos , Redes Comunitárias/estatística & dados numéricos , Inquéritos Epidemiológicos/métodos , Análise Espacial , Emigrantes e Imigrantes/estatística & dados numéricos , Feminino , Florida , Hispano-Americanos/estatística & dados numéricos , Humanos , Masculino , Pesquisa Qualitativa , População Rural/estatística & dados numéricos
16.
Nat Commun ; 9(1): 2544, 2018 06 29.
Artigo em Inglês | MEDLINE | ID: mdl-29959323

RESUMO

Uncovering modular structure in networks is fundamental for systems in biology, physics, and engineering. Community detection identifies candidate modules as hypotheses, which then need to be validated through experiments, such as mutagenesis in a biological laboratory. Only a few communities can typically be validated, and it is thus important to prioritize which communities to select for downstream experimentation. Here we develop CRANK, a mathematically principled approach for prioritizing network communities. CRANK efficiently evaluates robustness and magnitude of structural features of each community and then combines these features into the community prioritization. CRANK can be used with any community detection method. It needs only information provided by the network structure and does not require any additional metadata or labels. However, when available, CRANK can incorporate domain-specific information to further boost performance. Experiments on many large networks show that CRANK effectively prioritizes communities, yielding a nearly 50-fold improvement in community prioritization.


Assuntos
Algoritmos , Redes Reguladoras de Genes , Redes e Vias Metabólicas , Mapas de Interação de Proteínas , Animais , Redes Comunitárias/estatística & dados numéricos , Humanos , Serviços de Informação/estatística & dados numéricos
17.
Therapie ; 73(6): 483-493, 2018 Dec.
Artigo em Francês | MEDLINE | ID: mdl-29921459

RESUMO

OBJECTIVE: General practitioners (GPs) report little adverse drug reactions (ADR), although it is mandatory in France. The objective was to evaluate the satisfaction of the GPs who participated to a pharmacovigilance ADR declaration support network via a clinical research assistant (CRA) moving to their GP office in the French South-West region of Midi-Pyrénées. STUDY DESIGN: A satisfaction questionnaire was sent to the 59 active GPs of this network in November 2016. RESULTS: A total number of 44 GPs responded to the survey (mean age 44±11years; 48% of women). The overall satisfaction grade was rated 9/10 (SD±1). The personalized help from a CRA was highly appreciated (n=39; 89%), reduced time-loss (n=35; 90%), and facilitated communication with the local pharmacovigilance department (n=33; 85%). Most GP (95%; n=35) stated that they would keep reporting ADRs, 83% (n=35) stated to declare ADRs via the CRA, the others stated to declare ADRs directly to the Regional Pharmacovigilance Center, mainly via numerical or online tools. For 59% (n=26) their participation to the network had a positive impact on their relationship with patients through the improvement of their vigilance to ADR. DISCUSSION: Most of the active GP answered. They were very satisfied of the pharmacovigilance CRA network helping ADR reports. It may corroborate the increase of ADRs reporting in Midi-Pyrénées since this network was set up.


Assuntos
Sistemas de Notificação de Reações Adversas a Medicamentos , Redes Comunitárias , Clínicos Gerais , Satisfação Pessoal , Farmacovigilância , Adulto , Sistemas de Notificação de Reações Adversas a Medicamentos/organização & administração , Sistemas de Notificação de Reações Adversas a Medicamentos/normas , Redes Comunitárias/organização & administração , Redes Comunitárias/normas , Redes Comunitárias/estatística & dados numéricos , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/diagnóstico , Efeitos Colaterais e Reações Adversas Relacionados a Medicamentos/epidemiologia , Feminino , França/epidemiologia , Medicina Geral/métodos , Medicina Geral/organização & administração , Medicina Geral/normas , Medicina Geral/estatística & dados numéricos , Clínicos Gerais/psicologia , Clínicos Gerais/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde/organização & administração , Atenção Primária à Saúde/normas , Atenção Primária à Saúde/estatística & dados numéricos , Inquéritos e Questionários
18.
CMAJ ; 190(10): E276-E284, 2018 03 12.
Artigo em Inglês | MEDLINE | ID: mdl-29530868

RESUMO

BACKGROUND: Primary care networks are designed to facilitate access to inter-professional, team-based care. We compared health outcomes associated with primary care networks versus conventional primary care. METHODS: We obtained data on all adult residents of Alberta who visited a primary care physician during fiscal years 2008 and 2009 and classified them as affiliated with a primary care network or not, based on the physician most involved in their care. The primary outcome was an emergency department visit or nonelective hospital admission for a Patient Medical Home indicator condition (asthma, chronic obstructive pulmonary disease, heart failure, coronary disease, hypertension and diabetes) within 12 months. RESULTS: Adults receiving care within a primary care network (n = 1 502 916) were older and had higher comorbidity burdens than those receiving conventional primary care (n = 1 109 941). Patients in a primary care network were less likely to visit the emergency department for an indicator condition (1.4% v. 1.7%, mean 0.031 v. 0.035 per patient, adjusted risk ratio [RR] 0.98, 95% confidence interval [CI] 0.96-0.99) or for any cause (25.5% v. 30.5%, mean 0.55 v. 0.72 per patient, adjusted RR 0.93, 95% CI 0.93-0.94), but were more likely to be admitted to hospital for an indicator condition (0.6% v. 0.6%, mean 0.018 v. 0.017 per patient, adjusted RR 1.07, 95% CI 1.03-1.11) or all-cause (9.3% v. 9.1%, mean 0.25 v. 0.23 per patient, adjusted RR 1.08, 95% CI 1.07-1.09). Patients in a primary care network had 169 fewer all-cause emergency department visits and 86 fewer days in hospital (owing to shorter lengths of stay) per 1000 patient-years. INTERPRETATION: Care within a primary care network was associated with fewer emergency department visits and fewer hospital days.


Assuntos
Redes Comunitárias/normas , Atenção Primária à Saúde/métodos , Adulto , Idoso , Idoso de 80 Anos ou mais , Alberta , Redes Comunitárias/estatística & dados numéricos , Aglomeração , Serviço Hospitalar de Emergência/organização & administração , Serviço Hospitalar de Emergência/estatística & dados numéricos , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Tempo de Internação/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Distribuição de Poisson , Atenção Primária à Saúde/estatística & dados numéricos
19.
Diabetes Care ; 41(6): 1149-1156, 2018 06.
Artigo em Inglês | MEDLINE | ID: mdl-29588293

RESUMO

OBJECTIVE: This study examined whether changes in depressive symptoms and social support prospectively predicted diabetes management among Hispanic patients with probable depression in patient-centered medical homes at safety-net clinics in East Los Angeles, CA. RESEARCH DESIGN AND METHODS: Data were collected from 251 patients enrolled in a randomized clinical trial testing the effectiveness of a self-management intervention assisted by a promotora (Hispanic community health worker). Cross-lagged analyses examined associations between changes in depression symptoms and social support between baseline and 6-month follow-up and self-efficacy and adherence to diabetes management at the 6- and 12-month follow-ups. RESULTS: Changes in depressive symptoms predicted self-efficacy and level of adherence at the 6- and 12-month follow-ups. Changes in total social support and emotional social support were correlated only with self-efficacy regarding diabetes management at 6-month follow-up. CONCLUSIONS: Decline in depressive symptoms is a reliable predictor of improvement in self-efficacy and adherence to diabetes management. Further studies are recommended to study psychosocial mechanisms related to social relationships other than social support that affect diabetes management.


Assuntos
Depressão/epidemiologia , Diabetes Mellitus/epidemiologia , Diabetes Mellitus/terapia , Hispano-Americanos/estatística & dados numéricos , Assistência Centrada no Paciente , Pobreza , Apoio Social , Idoso , Redes Comunitárias/economia , Redes Comunitárias/organização & administração , Redes Comunitárias/estatística & dados numéricos , Depressão/economia , Depressão/etnologia , Diabetes Mellitus/economia , Diabetes Mellitus/psicologia , Feminino , Hispano-Americanos/psicologia , Humanos , Los Angeles/epidemiologia , Masculino , Pessoa de Meia-Idade , Assistência Centrada no Paciente/economia , Assistência Centrada no Paciente/normas , Assistência Centrada no Paciente/estatística & dados numéricos , Pobreza/estatística & dados numéricos , Autocuidado/economia , Autocuidado/métodos , Autocuidado/psicologia , Autocuidado/estatística & dados numéricos , Autoeficácia
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA