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1.
Lancet ; 395(10219): 226-239, 2020 01 18.
Artigo em Inglês | MEDLINE | ID: mdl-31791690

RESUMO

This final report of the Lancet Commission into liver disease in the UK stresses the continuing increase in burden of liver disease from excess alcohol consumption and obesity, with high levels of hospital admissions which are worsening in deprived areas. Only with comprehensive food and alcohol strategies based on fiscal and regulatory measures (including a minimum unit price for alcohol, the alcohol duty escalator, and an extension of the sugar levy on food content) can the disease burden be curtailed. Following introduction of minimum unit pricing in Scotland, alcohol sales fell by 3%, with the greatest effect on heavy drinkers of low-cost alcohol products. We also discuss the major contribution of obesity and alcohol to the ten most common cancers as well as measures outlined by the departing Chief Medical Officer to combat rising levels of obesity-the highest of any country in the west. Mortality of severely ill patients with liver disease in district general hospitals is unacceptably high, indicating the need to develop a masterplan for improving hospital care. We propose a plan based around specialist hospital centres that are linked to district general hospitals by operational delivery networks. This plan has received strong backing from the British Association for Study of the Liver and British Society of Gastroenterology, but is held up at NHS England. The value of so-called day-case care bundles to reduce high hospital readmission rates with greater care in the community is described, along with examples of locally derived schemes for the early detection of disease and, in particular, schemes to allow general practitioners to refer patients directly for elastography assessment. New funding arrangements for general practitioners will be required if these proposals are to be taken up more widely around the country. Understanding of the harm to health from lifestyle causes among the general population is low, with a poor knowledge of alcohol consumption and dietary guidelines. The Lancet Commission has serious doubts about whether the initiatives described in the Prevention Green Paper, with the onus placed on the individual based on the use of information technology and the latest in behavioural science, will be effective. We call for greater coordination between official and non-official bodies that have highlighted the unacceptable disease burden from liver disease in England in order to present a single, strong voice to the higher echelons of government.


Assuntos
Alcoolismo/epidemiologia , Hepatopatias/epidemiologia , Hepatopatias/prevenção & controle , Obesidade/epidemiologia , Bebidas Alcoólicas/economia , Alcoolismo/complicações , Alcoolismo/terapia , Comércio , Redes Comunitárias/organização & administração , Comorbidade , Efeitos Psicossociais da Doença , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Legislação sobre Alimentos , Hepatopatias/diagnóstico , Hepatopatias/etiologia , Transplante de Fígado/estatística & dados numéricos , Obesidade/complicações , Pacotes de Assistência ao Paciente , Escócia , Reino Unido/epidemiologia
2.
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
3.
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
4.
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
5.
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
6.
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
7.
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
8.
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
9.
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
10.
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
11.
Br J Nurs ; 28(12): 782-786, 2019 Jun 27.
Artigo em Inglês | MEDLINE | ID: mdl-31242108

RESUMO

Working as a children's community nurse (CCN), especially in remote and rural locations, can evoke feelings of professional isolation. Humans are by nature 'social animals' and the consequences of feeling isolated, and coping with distances, adverse weather and risky situations, could mean that nurses choose to work instead in more familiar and comfortable environments. This can affect retention issues and increase the risk of CCNs experiencing stress, burnout and illness-related absenteeism. The children they care for often have complex needs and parents want their CCN to be 'on the ball'; they will feel concerned and frustrated if the CCN team lets them down. Two academics were approached by CCNs in Wales seeking ways of overcoming isolation. It was decided that the best course of action was to develop a community of practice clinical network for band 5 and 6 CCNs working in Wales, with the aim of supporting staff, sharing best practice, and promoting safe and quality-driven care. Alternating the networks among health boards, whereby the nurses decided the agenda, booked the venue, invited guest speakers, led the meeting and wrote up the minutes, was an excellent way to achieve the designated aim: reducing professional isolation. A range of clinically focused topics were discussed and debated, and the first six meetings were so effective in meeting the aim of the network that each health board is starting the cycle of hosting the network again.


Assuntos
Redes Comunitárias/organização & administração , Enfermagem Pediátrica/organização & administração , Criança , Humanos , País de Gales
12.
Am J Health Syst Pharm ; 76(15): 1150-1157, 2019 Jul 18.
Artigo em Inglês | MEDLINE | ID: mdl-31201774

RESUMO

PURPOSE: The development and dissemination of a specialty pharmacy service to optimize fingolimod therapy management are described. SUMMARY: Fingolimod was the first oral therapy developed to counter relapsing-remitting multiple sclerosis. Pharmacovigilance measures and individualized support are strongly recommended due to associated safety concerns. The Fingolimod Patient Support Program (F-PSP) was developed and disseminated within a community pharmacy network. The F-PSP aims to ensure responsible use of fingolimod and patient empowerment by promoting medication adherence and patient safety through a person-centered and integrated care approach. It complements basic pharmacy services through 2 interventions: medication adherence support and pharmacovigilance tailored to fingolimod. The adherence intervention combines motivational interviewing with longitudinal electronic medication adherence monitoring. The pharmacovigilance component consists of informing patients of fingolimod recommendations, reminding patients of recommended medical tests, and tracking and monitoring symptoms, especially those of potential serious adverse fingolimod reactions. A secure Web platform guides the pharmacist in conducting interviews and enables collection of patient-reported outcome data. A transition care pharmacist proposes program participation to all patients initiated on fingolimod, performs enrollment, and coordinates transfers to patient-designated community pharmacies for ongoing care. CONCLUSION: The F-PSP enables support of individual patients, and also provides real-world data, helping to bridge the gap between practice and research. The F-PSP is intended to be a generic model of a specialty pharmacy service that is transferable to any other healthcare context, specialty drug or disease.


Assuntos
Serviços Comunitários de Farmácia/organização & administração , Cloridrato de Fingolimode/uso terapêutico , Conduta do Tratamento Medicamentoso/organização & administração , Esclerose Múltipla Recidivante-Remitente/tratamento farmacológico , Transferência de Pacientes/organização & administração , Administração Oral , Redes Comunitárias/organização & administração , Prestação Integrada de Cuidados de Saúde/organização & administração , Feminino , Humanos , Adesão à Medicação/psicologia , Entrevista Motivacional , Educação de Pacientes como Assunto , Segurança do Paciente , Farmacêuticos/organização & administração , Farmacovigilância , Desenvolvimento de Programas , Suíça
13.
Int J Older People Nurs ; 14(3): e12248, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31173482

RESUMO

AIMS AND OBJECTIVES: This study sought to assess the effect of a community-based intervention influencing adherence status at baseline, 1, 3 and 6 months, and to evaluate the impact that a community-based intervention and socio-economic factors have on adherence. BACKGROUND: Although high-quality treatment and modern hypertension clinical practice guidelines have been developed worldwide, the outcomes of patients with hypertension in Thailand are not optimal. Implementing a person-centred and integrated health services model to improve hypertension management, such as a community-based intervention, is challenging for healthcare providers in Thailand. DESIGN: An observational study of a community-based intervention. METHODS: The study comprised residents in 17 villages in one province of Thailand. A sample of 156 participants was allocated into the intervention and the control groups. Inclusion criteria were people aged 60 years or older diagnosed with hypertension. Exclusion criteria included the latest record of extreme hypertension and having a documented history of cognitive impairment. The intervention group received the 4-week community-based intervention programme. Multiple linear regression was applied to predict the adherence status at each phase. Multiple logistic regression was then implemented to predict influencing factors between the groups. RESULTS: Patients who received the intervention had significantly lower adherence scores (reflecting a higher level of adherence) at 3 and 6 months after intervention by 1.66 and 1.45 times, respectively, when adjusting for other variables. After 6 months, the intervention was associated with a significant improvement in adherence when adjusting for other variables. CONCLUSION: This study provides evidence to support the use of community-based interventions as an effective adjunct to hospital-based care of hypertension patients in Thailand. IMPLICATIONS FOR PRACTICE: Understanding factors between health outcomes and social determinants of health is crucial for informing the development of culturally appropriate interventions.


Assuntos
Redes Comunitárias/organização & administração , Hipertensão/enfermagem , Cooperação do Paciente , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Determinantes Sociais da Saúde , Fatores Socioeconômicos , Tailândia
14.
Nutr. hosp ; 36(3): 640-646, mayo-jun. 2019. tab
Artigo em Inglês | IBECS | ID: ibc-184563

RESUMO

Introduction: in several countries, there is an increasing trend of consumers and distributors of organic food. Objective: to identify consumer motivation, a socioeconomic profile and possible sociopolitical actions for the development of public policy by the consumers of organic products supplied by 12 alternative food distribution networks in Medellín and Eastern Antioquia. Methods: qualitative study with semi-structured interviews and participant and non-participant observation. Results: the main reason for organic food consumption is personal wellbeing, specifically health, followed by care for the environment and social welfare because such consumption contributes to improving the quality of life of poor producers (farmers and indigenous people). The consumption of these foods is also in some cases a form of resistance against the food industry, agroindustry and supermarkets; however, this social awareness does not imply that consumers commit themselves to sociopolitical actions transcending to the collective sphere. Conclusion: action by local governments is required to develop strategies that consolidate the transformative potential of consumer practices regarding organic products from alternative food networks


Introducción: el incremento de consumidores y distribuidores de alimentos y productos orgánicos constituye una tendencia en varios países. Objetivo: establecer las motivaciones para el consumo, el perfil socioeconómico y las posibles acciones de carácter sociopolítico para la construcción de políticas públicas realizadas por los consumidores de productos orgánicos de las 12 redes de distribución alternativa de alimentos que existen en Medellín y el oriente antioqueño. Métodos: estudio cualitativo con entrevistas semiestructuradas y observación participante y no participante. Resultados: se halló que la principal razón de consumo es el bienestar individual, específicamente la salud, seguido del cuidado del medio ambiente y el bienestar social porque se contribuye a mejorar la calidad de vida de los productores pobres (campesinos e indígenas). Se encontró, además, que el consumo de estos alimentos, se hace en algunos casos como forma de resistencia frente a la industria de alimentos, la agroindustria y los supermercados. Sin embargo, esta conciencia social no implica que los consumidores se comprometan con acciones sociopolíticas para trascender a la esfera colectiva. Conclusión: se requiere una acción de los gobiernos locales para desarrollar estrategias que consoliden el potencial transformador de las prácticas de los consumidores de productos orgánicos de las redes alternativas de alimentos


Assuntos
Humanos , Alimentos Orgânicos , Alimentos, Dieta e Nutrição , Política Pública/tendências , Redes Comunitárias/normas , Colômbia/epidemiologia , Análise Qualitativa , Comportamento Alimentar , Redes Comunitárias/legislação & jurisprudência , Redes Comunitárias/organização & administração , Classe Social
15.
Am J Public Health ; 109(7): 1025-1027, 2019 07.
Artigo em Inglês | MEDLINE | ID: mdl-31095408

RESUMO

The CHAMPIONS NETWork summer program trains high school students to become health advocates in underserved Chicago, Illinois, communities. It provides a more innovative approach to traditional pipeline programs through the added responsibility of active health promotion. To determine whether student empowerment changed during the program, participants completed pre- and postassessments on health knowledge and self-efficacy. We found significant increases in student empowerment after the program compared with before, especially regarding the students' abilities and experiences.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Redes Comunitárias/organização & administração , Grupos Minoritários/estatística & dados numéricos , Autoeficácia , Adolescente , Comportamento do Adolescente/psicologia , Chicago , Serviços de Saúde Comunitária/organização & administração , Promoção da Saúde/organização & administração , Humanos , Illinois , Masculino
17.
BMC Womens Health ; 19(1): 53, 2019 04 03.
Artigo em Inglês | MEDLINE | ID: mdl-30943958

RESUMO

BACKGROUND: Indigenous Maya women in Guatemala show some of the worst maternal health indicators worldwide. Our objective was to test acceptability, feasibility and impact of a co-designed group psychosocial intervention (Women's Circles) in a population with significant need but no access to mental health services. METHODS: A parallel group pilot randomised study was undertaken in five rural Mam and three periurban K'iche' communities. Participants included 84 women (12 per community, in seven of the communities) randomly allocated to intervention and 71 to control groups; all were pregnant and/or within 2 years postpartum. The intervention consisted of 10 sessions co-designed with and facilitated by 16 circle leaders. Main outcome measures were: maternal psychosocial distress (HSCL-25), wellbeing (MHC-SF), self-efficacy and engagement in early infant stimulation activities. In-depth interviews also assessed acceptability and feasibility. RESULTS: The intervention proved feasible and well accepted by circle leaders and participating women. 1-month post-intervention, wellbeing scores (p-value 0.008) and self-care self-efficacy (0.049) scores were higher among intervention compared to control women. Those women who attended more sessions had higher wellbeing (0.007), self-care and infant-care self-efficacy (0.014 and 0.043, respectively), and early infant stimulation (0.019) scores. CONCLUSIONS: The pilot demonstrated acceptability, feasibility and potential efficacy to justify a future definitive randomised controlled trial. Co-designed women's groups provide a safe space where indigenous women can collectively improve their functioning and wellbeing. TRIAL REGISTRATION: ISRCTN13964819 . Registered 26 June 2018, retrospectively registered.


Assuntos
Redes Comunitárias/organização & administração , Serviços de Saúde do Indígena/organização & administração , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , População Rural/estatística & dados numéricos , Adulto , Feminino , Guatemala , Humanos , Lactente , Serviços de Saúde Materna/organização & administração , Projetos Piloto , Período Pós-Parto , Gravidez , Estudos Retrospectivos , Adulto Jovem
18.
Transfusion ; 59(S2): 1429-1438, 2019 04.
Artigo em Inglês | MEDLINE | ID: mdl-30980748

RESUMO

BACKGROUND: Despite countless advancements in trauma care a survivability gap still exists in the prehospital setting. Military studies clearly identify hemorrhage as the leading cause of potentially survivable prehospital death. Shifting resuscitation from the hospital to the point of injury has shown great promise in decreasing mortality among the severely injured. MATERIALS AND METHODS: Our regional trauma network (Southwest Texas Regional Advisory Council) developed and implemented a multiphased approach toward facilitating remote damage control resuscitation. This approach required placing low-titer O+ whole blood (LTO+ WB) at helicopter emergency medical service bases, transitioning hospital-based trauma resuscitation from component therapy to the use of whole blood, modifying select ground-based units to carry and administer whole blood at the scene of an accident, and altering the practices of our blood bank to support our new initiative. In addition, we had to provide information and training to an entire large urban emergency medical system regarding changes in policy. RESULTS: Through a thorough, structured program we were able to successfully implement point-of-injury resuscitation with LTO+ WB. Preliminary evaluation of our first 25 patients has shown a marked decrease in mortality compared to our historic rate using component therapy or crystalloid solutions. Additionally, we have had zero transfusion reactions or seroconversions. CONCLUSION: Transfusion at the scene within minutes of injury has the potential to save lives. As our utilization expands to our outlying network we expect to see a continued decrease in mortality among significantly injured trauma patients.


Assuntos
Bancos de Sangue , Preservação de Sangue/normas , Transfusão de Sangue/normas , Redes Comunitárias , Serviços Médicos de Emergência , Hemorragia/terapia , Ressuscitação , Centros de Traumatologia , Sistema do Grupo Sanguíneo ABO , Bancos de Sangue/organização & administração , Bancos de Sangue/normas , Redes Comunitárias/organização & administração , Redes Comunitárias/normas , Soluções Cristaloides/administração & dosagem , Serviços Médicos de Emergência/organização & administração , Serviços Médicos de Emergência/normas , Feminino , Hemorragia/mortalidade , Humanos , Masculino , Texas , Centros de Traumatologia/organização & administração , Centros de Traumatologia/normas
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