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1.
Malar J ; 20(1): 20, 2021 Jan 06.
Artigo em Inglês | MEDLINE | ID: mdl-33407471

RESUMO

The COVID-19 pandemic has resulted in massive global disruptions with considerable impact on the delivery of health services and national health programmes. Since the detection of the first COVID-19 case on 5th March 2020, the Royal Government of Bhutan implemented a number of containment measures including border closure and national lockdowns. Against the backdrop of this global COVID-19 pandemic response, there was a sudden surge of locally-transmitted malaria cases between June to August 2020. There were 20 indigenous cases (zero Plasmodium falciparum and 20 Plasmodium vivax) from a total of 49 cases (seven P. falciparum and 42 P. vivax) in 2020 compared to just two from a total of 42 in 2019. Over 80% of the cases were clustered in malaria endemic district of Sarpang. This spike of malaria cases was attributed to the delay in the delivery of routine malaria preventive interventions due to the COVID-19 pandemic. As a result, Bhutan is unlikely to achieve the national goal of malaria elimination by 2020.


Assuntos
/epidemiologia , Malária/prevenção & controle , Butão/epidemiologia , Objetivos , Humanos , Serviços Preventivos de Saúde , Saúde Pública , /isolamento & purificação
4.
Womens Health Issues ; 31(1): 9-16, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-33023807

RESUMO

BACKGROUND: The Affordable Care Act (ACA) increased health insurance coverage throughout the United States and improved care delivery for some services. We assess whether ACA implementation and Medicaid expansion were followed by greater receipt of recommended preventive services among women and girls in a large network of community health centers. METHODS: Using electronic health record data from 354 community health centers in 14 states (10 expansion, 4 nonexpansion), we used generalized estimating equations and difference-in-difference methods to compare receipt of six recommended preventive services (cervical cancer screening, human papilloma virus vaccination, chlamydia screening, influenza vaccination, human immunodeficiency virus screening, and blood pressure screening) among active female patients ages 11 to 65 (N = 711,121) before and after ACA implementation and between states that expanded versus did not expand Medicaid. RESULTS: Except for blood pressure screening, receipt of all examined preventive services increased after ACA implementation in both Medicaid expansion and nonexpansion states. Influenza vaccination and blood pressure screening increased more in expansion states (adjusted absolute prevalence difference-in-difference, 1.55; 95% confidence interval, 0.51-2.60; and 1.98; 95% confidence interval, 0.91-3.05, respectively). Chlamydia screening increased more in nonexpansion states (adjusted absolute prevalence difference-in-difference: -4.21; 95% confidence interval, -6.98 to -1.45). Increases in cervical cancer screening, human immunodeficiency virus screening, and human papilloma virus vaccination did not differ significantly between expansion and nonexpansion states. CONCLUSIONS: Among female patients at community health centers, receipt of recommended preventive care improved after ACA implementation in both Medicaid expansion and nonexpansion states, although the overall rates remained low. Continued support is needed to overcome barriers to preventive care in this population.


Assuntos
Patient Protection and Affordable Care Act , Neoplasias do Colo do Útero , Adolescente , Adulto , Idoso , Criança , Centros Comunitários de Saúde , Detecção Precoce de Câncer , Feminino , Acesso aos Serviços de Saúde , Humanos , Cobertura do Seguro , Medicaid , Pessoa de Meia-Idade , Serviços Preventivos de Saúde , Estados Unidos , Neoplasias do Colo do Útero/prevenção & controle , Adulto Jovem
5.
Health Educ Behav ; 48(1): 29-33, 2021 02.
Artigo em Inglês | MEDLINE | ID: mdl-33322924

RESUMO

Decreased engagement in preventive services, including vaccination, during the COVID-19 pandemic represents a grave threat to global health. We use the case of the Bom Retiro Public Health Clinic in São Paulo, Brazil, to underscore how continuity of care is not only feasible, but a crucial part of health as a human right. The long-standing relationship between the clinic and neighborhood residents has facilitated ongoing management of physical and mental health conditions. Furthermore, we demonstrate how the clinic's history of confronting infectious diseases has equipped it to adapt preventive services to meet patients' needs during the pandemic. Our academic-community partnership used a multidisciplinary approach, relying on analysis of historical data, ethnographic data, and direct clinical experience. We identify specific prevention strategies alongside areas for improvement. We conclude that the clinic serves as a model for continuity of care in urban settings during a pandemic.


Assuntos
/epidemiologia , Serviços Preventivos de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Serviços Urbanos de Saúde/organização & administração , Brasil/epidemiologia , Relações Comunidade-Instituição , Humanos , Pandemias , Fatores Socioeconômicos , Universidades/organização & administração
6.
Prev Sci ; 22(1): 94-99, 2021 01.
Artigo em Inglês | MEDLINE | ID: mdl-33215309

RESUMO

Never before has the value of prevention science become so apparent to the populace, particularly in simultaneous fashion across all nations. A general understanding of what prevention represents in true form has lagged well behind the science and, in fact, few outside of the field recognize that there is actually a significant body of research that undergirds preventative practices, programs and policies. The current pandemic and the uneven impacts on underserved and marginalized populations has highlighted the need for proactive approaches to prevent underlying conditions that increase risk for infection, worsen the wide ranging harms from the virus, and significantly exacerbate disparities that characterize many nations. To ensure uptake of the science by end-users (e.g., community stakeholders, practitioners, policymakers), who operate the levers that determine whether resources and services are distributed equitably across societies' sectors, prevention scientists have a unique and powerful role to play. This commentary on the special issue, focused on the "culture of prevention," considers the broader issues covered in the set of original articles in light of the ongoing COVID-19 pandemic. Toward that end, I also outline two interrelated "calls to action" for prevention scientists. The first call is to concertedly apply a race equity lens to all aspects of our research, a need that is particularly critical given that our field is inherently actionable and, as such, evidence amassed has potential to equalize the playing field for disadvantaged and marginalized groups. The second acknowledges the need for prevention scientists to learn how to effectively communicate scientific knowledge to the public and policymakers to compellingly advocate for reforms guided by the science. A powerful, research-backed collective advocacy can effectively sway action of governing bodies in addressing disparities and inequities for constituents who have no voice.


Assuntos
/prevenção & controle , Serviços Preventivos de Saúde/organização & administração , Marginalização Social , Sindemia , /virologia , Humanos , Fatores de Risco
9.
BMJ Open ; 10(12): e042930, 2020 12 18.
Artigo em Inglês | MEDLINE | ID: mdl-33371046

RESUMO

OBJECTIVE: Our study aims to understand the psychological impact of the COVID-19 pandemic among healthcare workers (HCWs) at acute hospital settings in the South-East of Ireland, as a crucial step in guiding policies and interventions to maintain their psychological well-being. DESIGN: Observational cohort study. PARTICIPANTS AND SETTING: 472 HCWs participated from two distinct acute hospital settings, A and B, in the South-East of Ireland. PRIMARY AND SECONDARY OUTCOME MEASURES: Measures of psychological distress-depression, anxiety, acute and post-traumatic stress disorder (PTSD)-as dictated by the Depression, Anxiety and Stress Scale (DASS-21) and Impact of Event Scale-Revised (IES-R). An independent sample t-test and a Mann-Whitney U test was used to determine significance of difference in continuous variables between groups. Categorical variables were assessed for significance with a χ2 test for independence. RESULTS: The DASS-21 provided independent measures of depression (mean 4.57, IQR 2-7), anxiety (mean 3.87, IQR 1-6) and stress (mean 7.41, IQR 4-10). Positive scores were reflected in 201 workers (42.6%) for depression and 213 (45.1%) for both anxiety and stress. The IES-R measured subjective distress on three subscales: intrusion (mean 1.085, IQR 0.375-1.72), avoidance (mean 1.008, IQR 0.375-1.5) and hyperarousal (mean 1.084, IQR 0.5-1.667). Overall, 195 cases (41.3%) were concerning for PTSD. Site B scored significantly higher across all parameters of depression (5.24 vs 4.08, p<0.01), anxiety (4.66 vs 3.3, p<0.01), stress (8.91 vs 6.33, p<0.01) and PTSD (0.058 vs 0.043, p<0.01). Worse outcomes were also noted in HCWs with underlying medical ailments. CONCLUSION: Psychological distress is prevalent among HCWs during the COVID-19 pandemic; screening for adverse mental and emotional outcomes and developing timely tailored preventative measures with effective feedback are vital to protect their psychological well-being, both in the immediate and long-term.


Assuntos
Ansiedade , Pessoal de Saúde , Hospitais/estatística & dados numéricos , Estresse Ocupacional , Transtornos de Estresse Pós-Traumáticos , Adulto , Ansiedade/diagnóstico , Ansiedade/epidemiologia , Ansiedade/etiologia , /psicologia , Feminino , Pessoal de Saúde/psicologia , Pessoal de Saúde/estatística & dados numéricos , Política de Saúde , Humanos , Irlanda/epidemiologia , Masculino , Saúde Mental/tendências , Determinação de Necessidades de Cuidados de Saúde , Estresse Ocupacional/diagnóstico , Estresse Ocupacional/epidemiologia , Estresse Ocupacional/etiologia , Estresse Ocupacional/psicologia , Serviços Preventivos de Saúde , Escalas de Graduação Psiquiátrica , Angústia Psicológica , Transtornos de Estresse Pós-Traumáticos/diagnóstico , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia
10.
BMJ Open ; 10(12): e044197, 2020 12 29.
Artigo em Inglês | MEDLINE | ID: mdl-33376182

RESUMO

AIM: To explore indigenous communities' responses to the COVID-19 pandemic and its consequences for maternal and neonatal health (MNH) care in the Peruvian Amazon. METHODS: Mamás del Río is a community-based, MNH programme with comprehensive supervision covering monthly meetings with community health workers (CHW), community leaders and health facilities. With the onset of the lockdown, supervisors made telephone calls to discuss measures against COVID-19, governmental support, CHW activities in communities and provision of MNH care and COVID-19 preparedness at facilities. As part of the programme's ongoing mixed methods evaluation, we analysed written summaries of supervisor calls collected during the first 2 months of Peru's lockdown. RESULTS: Between March and May 2020, supervisors held two rounds of calls with CHWs and leaders of 68 communities and staff from 17 facilities. Most communities banned entry of foreigners, but about half tolerated residents travelling to regional towns for trade and social support. While social events were forbidden, strict home isolation was only practised in a third of communities as conflicting with daily routine. By the end of April, first clusters of suspected cases were reported in communities. COVID-19 test kits, training and medical face masks were not available in most rural facilities. Six out of seven facilities suspended routine antenatal and postnatal consultations while two-thirds of CHWs resumed home visits to pregnant women and newborns. CONCLUSIONS: Home isolation was hardly feasible in the rural Amazon context and community isolation was undermined by lack of external supplies and social support. With sustained community transmission, promotion of basic hygiene and mask use becomes essential. To avoid devastating effects on MNH, routine services at facilities need to be urgently re-established alongside COVID-19 preparedness plans. Community-based MNH programmes could offset detrimental indirect effects of the pandemic and provide an opportunity for local COVID-19 prevention and containment.


Assuntos
Controle de Doenças Transmissíveis , Serviços de Saúde Comunitária , Saúde do Lactente , Saúde Materna , Adulto , /prevenção & controle , Controle de Doenças Transmissíveis/organização & administração , Controle de Doenças Transmissíveis/normas , Serviços de Saúde Comunitária/métodos , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/normas , Transmissão de Doença Infecciosa/prevenção & controle , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Necessidades e Demandas de Serviços de Saúde , Serviços de Saúde do Indígena/tendências , Humanos , Saúde do Lactente/estatística & dados numéricos , Saúde do Lactente/tendências , Recém-Nascido , Masculino , Saúde Materna/estatística & dados numéricos , Saúde Materna/tendências , Peru/epidemiologia , Gravidez , Serviços Preventivos de Saúde/métodos
11.
Ned Tijdschr Geneeskd ; 1652020 12 15.
Artigo em Holandês | MEDLINE | ID: mdl-33332034

RESUMO

The Dutch test capacity to detect the SARS-CoV-2 virus has increased enormously since the start of the COVID-19 pandemic. As a consequence of ongoing spreading of the virus, tests are also increasingly being carried out among people without COVID-19 related symptoms. Preventive testing for SARS-CoV-2 is especially performed in sectors in which early detection of the virus is essential, for instance in the professional sports sector. The guideline of the RIVM states that people who have tested positive for SARS-CoV-2 but without COVID-19 related symptoms are advised to stay in isolation for five days from time of the test. However, this guideline is not suitable for people who are diagnosed in a very early stage of the infection as a result of preventive testing. They are likely to leave isolation during the most contagious phase of the infection. In this paper, we argue that people who are positive for SARS-CoV-2, but without COVID-19 related symptoms, after a preventive test should be advised to isolate longer than five days.


Assuntos
/métodos , Controle de Doenças Transmissíveis/métodos , /isolamento & purificação , /diagnóstico , Diagnóstico Precoce , Humanos , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Fatores de Tempo
14.
J Natl Med Assoc ; 112(6): 681-687, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33276969

RESUMO

Influenza is a contagious respiratory virus that causes a significant annual health burden in the United States (US). In spite of effective yearly vaccinations to protect individuals against influenza-related health complications, especially with certain chronic co-morbid illnesses, persistent racial/ethnic disparities exist in influenza immunization. African Americans continue to experience low vaccination uptake, stemming, at least in part, from years of bias in and mistrust of orthodox medicine, safety concerns, and environmental barriers to vaccine access. The novel respiratory coronavirus, SARS-CoV2, causes COVID-19, leading to a pandemic that in the U.S. has exerted severe physical, psychological, and economic tolls on the African Americans and other disadvantaged communities. These two respiratory-borne virus' cause disparate effects in the black community, unmasking persistent disparities in healthcare. Unfortunately, suboptimal influenza immunization acceptance exacerbates flu-related adverse health outcomes, similar to difficulties from the effects of the COVID-19 pandemic. In consideration of the impending influenza-COVID-19 "twindemic", robust educational campaigns, policy initiatives, and novel approaches to influenza immunization must be considered for the African American community to build trust in the health benefits of the influenza vaccination and, ultimately, to trust in the health benefits of potential SARS-CoV2 vaccines, when available for the general public.


Assuntos
Afro-Americanos , Vacinas contra Influenza/uso terapêutico , Influenza Humana , Serviços Preventivos de Saúde , Melhoria de Qualidade/organização & administração , /epidemiologia , Disparidades em Assistência à Saúde , Humanos , Influenza Humana/epidemiologia , Influenza Humana/prevenção & controle , Pandemias/prevenção & controle , Aceitação pelo Paciente de Cuidados de Saúde/etnologia , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/normas , Estados Unidos/epidemiologia , Vacinação
15.
J Vasc Nurs ; 38(4): 176-179, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33279106

RESUMO

Coronavirus disease of 2019 poses significant risks for patients with vascular disease. Telemedicine can help clinicians provide care for patients with vascular disease while adhering to social-distancing guidelines. In this article, we review the components of telemedicine used in the vascular medicine practice at the Vanderbilt University Medical Center. In addition, we describe inpatient and outpatient diagnosis-based algorithms to help select patients for telemedicine versus in-person evaluation.


Assuntos
/prevenção & controle , Cardiologia/normas , Assistência à Saúde/normas , Pandemias/prevenção & controle , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde/normas , Telemedicina/normas , Cardiologia/métodos , Assistência à Saúde/métodos , Humanos , Serviços Preventivos de Saúde/métodos , Telemedicina/métodos , Tennessee
16.
J Appl Psychol ; 105(12): 1397-1407, 2020 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-33271028

RESUMO

In order to combat the spread of the novel coronavirus, the Centers for Disease Control and Prevention (CDC) has developed a list of recommended preventative health behaviors for Americans to enact, including social distancing, frequent handwashing, and limiting nonessential trips from home. Drawing upon scarcity theory, the purpose of this study was to examine whether the economic stressors of perceived job insecurity and perceived financial insecurity are related to employee self-reports of enacting such behaviors. Moreover, we tested propositions regarding the impact of two state-level contextual variables that may moderate those relationships: the generosity of unemployment insurance benefits and extensiveness of statewide COVID-19-related restrictions. Using a multilevel data set of N = 745 currently employed U.S. workers nested within 43 states, we found that both job insecurity and financial insecurity were negatively related to the enactment of the CDC-recommended guidelines. However, the state-level variables acted as cross-level moderators, such that the negative relationship between job insecurity and compliance with the CDC guidelines was attenuated within states that have a more robust unemployment system. However, working in a state with more extensive COVID-19 restrictions seemed to primarily benefit more financially secure workers. When statewide policies were more restrictive, employees reporting more financial security were more likely to enact the CDC-recommended guidelines compared to their financially insecure counterparts. We discuss these findings in light of the continuing need to develop policies to address the public health crisis while also protecting employees facing economic stressors. (PsycInfo Database Record (c) 2020 APA, all rights reserved).


Assuntos
/economia , Centers for Disease Control and Prevention, U.S./legislação & jurisprudência , Serviços Preventivos de Saúde/legislação & jurisprudência , Governo Estadual , Adulto , Centers for Disease Control and Prevention, U.S./economia , Feminino , Humanos , Masculino , Pandemias , Serviços Preventivos de Saúde/economia , Serviços Preventivos de Saúde/métodos , Desemprego/psicologia , Desemprego/estatística & dados numéricos , Estados Unidos
18.
JAMA ; 324(18): 1884-1895, 2020 11 10.
Artigo em Inglês | MEDLINE | ID: mdl-33170247

RESUMO

Importance: Childhood hypertension can result in adverse outcomes during adulthood; identifying and treating primary and secondary childhood hypertension may reduce such risks. Objective: To update the evidence on screening and treatment of hypertension in childhood and adolescence for the US Preventive Services Task Force. Data Sources: PubMed, Cochrane Library, International Pharmaceutical Abstracts, EMBASE, and trial registries through September 3, 2019; bibliographies from retrieved articles, experts, and surveillance of the literature through October 6, 2020. Study Selection: Fair- or good-quality English-language studies evaluating diagnostic accuracy of blood pressure screening; cohort studies assessing the association of hypertension in childhood and adolescence with blood pressure or other intermediate outcomes in adulthood; randomized clinical trials (RCTs) or meta-analyses of pharmacological and lifestyle interventions. Data Extraction and Synthesis: Two reviewers independently assessed titles/abstracts and full-text articles, extracted data, and assessed study quality; the evidence was synthesized qualitatively. Main Outcomes and Measures: Sensitivity, specificity, and measures of association between childhood and adulthood blood pressure; reduction of childhood blood pressure; adverse effects of treatments. Results: Forty-two studies from 43 publications were included (N>12 400). No studies evaluated the benefits or harms of screening and the effect of treating childhood hypertension on outcomes in adulthood. One study reported a sensitivity of 0.82 and a specificity of 0.70 for 2 office-based blood pressure measurements. Twenty observational studies suggested a significant association between childhood hypertension and abnormal blood pressure in adulthood (odds ratios, 1.1-4.5; risk ratios, 1.45-3.60; hazard ratios, 2.8-3.2). Thirteen placebo-controlled RCTs and 1 meta-analysis assessed reductions in systolic (SBP) and diastolic blood pressure from pharmacological treatments. Pooled reductions of SBP were -4.38 mm Hg (95% CI, -7.27 to -2.16) for angiotensin-converting enzyme inhibitors and -3.07 mm Hg (95% CI, -4.99 to -1.44) for angiotensin receptor blockers. Candesartan reduced SBP by -6.56 mm Hg (P < .001; n = 240). ß-Blockers, calcium channel blockers, and mineralocorticoid receptor antagonists did not achieve significant reductions over 2 to 4 weeks. SBP was significantly reduced by exercise over 8 months (-4.9 mm Hg, P ≤ .05; n = 69), by dietary approaches to stop hypertension over 3 months (-2.2 mm Hg, P < .01; n = 57), and by a combination of drug treatment and lifestyle interventions over 6 months (-7.6 mm Hg; P < .001; n = 95). Low-salt diet did not achieve reductions of blood pressure. Conclusions and Relevance: Observational studies indicate an association between hypertension in childhood and hypertension in adulthood. However, the evidence is inconclusive whether the diagnostic accuracy of blood pressure measurements is adequate for screening asymptomatic children and adolescents in primary care.


Assuntos
Hipertensão/diagnóstico , Programas de Rastreamento , Adolescente , Adulto , Anti-Hipertensivos/efeitos adversos , Anti-Hipertensivos/uso terapêutico , Determinação da Pressão Arterial/instrumentação , Doenças Cardiovasculares/prevenção & controle , Criança , Pré-Escolar , Terapia Combinada , Dieta Saudável , Exercício Físico , Feminino , Humanos , Hipertensão/terapia , Masculino , Programas de Rastreamento/efeitos adversos , Programas de Rastreamento/psicologia , Estudos Observacionais como Assunto , Guias de Prática Clínica como Assunto , Serviços Preventivos de Saúde , Sensibilidade e Especificidade
19.
JAMA ; 324(18): 1878-1883, 2020 Nov 10.
Artigo em Inglês | MEDLINE | ID: mdl-33170248

RESUMO

Importance: Prevalence of hypertension (both primary and secondary) in children and adolescents in the US ranges from 3% to 4%. Primary hypertension in children and adolescents occurs primarily in children older than 13 years and has no known cause but is associated with several risk factors, including family history and higher body mass index. Secondary hypertension occurs primarily in younger children and is most commonly caused by genetic disorders, renal disease, endocrine disorders, or cardiovascular abnormalities. Objective: To update its 2013 recommendation, the USPSTF commissioned a review of the evidence on the benefits and harms of screening, test accuracy, the effectiveness and harms of treatment, and the association between hypertension and markers of cardiovascular disease in childhood and adulthood. Population: This recommendation statement applies to children and adolescents aged 3 to 18 years not known to have hypertension or who are asymptomatic. Evidence Assessment: The USPSTF concludes that the evidence to support screening for high blood pressure in children and adolescents is insufficient and that the balance of benefits and harms cannot be determined. Recommendation: The USPSTF concludes that the current evidence is insufficient to assess the balance of benefits and harms of screening for high blood pressure in children and adolescents. (I statement).


Assuntos
Hipertensão/diagnóstico , Programas de Rastreamento , Adolescente , Determinação da Pressão Arterial/instrumentação , Doenças Cardiovasculares/prevenção & controle , Criança , Pré-Escolar , Reações Falso-Positivas , Feminino , Humanos , Hipertensão/terapia , Masculino , Programas de Rastreamento/efeitos adversos , Serviços Preventivos de Saúde , Valores de Referência
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