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2.
BMC Health Serv Res ; 19(1): 685, 2019 Oct 07.
Artigo em Inglês | MEDLINE | ID: mdl-31590663

RESUMO

BACKGROUND: Schistosomiasis is endemic in the uMkhanyakude district of KwaZulu-Natal, South Africa. The South Africa Department of Health (DoH) has decided to implement a schistosomiasis preventive mass drug administration program in all affected parts of the country. Quality management is part of the strategic objectives of the treatment program. We conducted a risk assessment and developed guidelines for the quality management of a schistosomiasis preventive treatment program for children aged 5 years and below in the uMkhanyakude District of KwaZulu-Natal. METHODS: We conducted a scenario planning exercise by interviewing 10 child health experts from the uMkhanyakude Health District to establish potential risks associated with a planned schistosomiasis preventive control treatment program for children aged 5 years old and below. The risks were analyzed using a modified Failure Mode and Effect Analysis (FMEA). An FMEA table was produced to guide the quality management of the planned schistosomiasis preventive control treatment program for children aged 5 years and below in the uMkhanyakude Health District. RESULTS: We identified potential risks, failure modes and possible failure corrective/preventive measures in the following activities that would be part of the mass treatment of children aged 5 years and below infected with schistosomiasis in the uMkhanyakude District. These included enrolment of children into the treatment program; general health checks; weight and height measurements; administration of drugs; reporting of side effects and monitoring and evaluation. CONCLUSION: We were able to use FMEA guide quality management and identify potential risks associated with the planned schistosomiasis preventive treatment program for children aged 5 years old and below in the uMkhanyakude District of KwaZulu-Natal. The FMEA for this program will be useful to the quality management of schistosomiasis preventive treatment programs for this age group in other similar settings.


Assuntos
Administração Massiva de Medicamentos/métodos , Esquistossomose/prevenção & controle , Pré-Escolar , Feminino , Humanos , Lactente , Recém-Nascido , Masculino , Administração Massiva de Medicamentos/estatística & dados numéricos , Serviços Preventivos de Saúde/organização & administração , Estudos Prospectivos , Medição de Risco , África do Sul/epidemiologia
4.
Heart Fail Clin ; 15(4): 435-445, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31472879

RESUMO

Elevated blood pressure (BP) has a strong and continuous association with Stage B and C heart failure (HF) and carries the highest attributable risk for HF. Intensive treatment of hypertension is crucial, as progression from hypertension (Stage A HF) to left ventricular hypertrophy (LVH) or other structural damage (Stage B HF) is common despite therapy. Echo cardiography is the modality of choice to detect Stage B HF. Ideally, Stage B HF should be prevented. However, regression of established LVH and other structural damage is feasible and improves prognosis. Despite differences among antihypertensive agents, control of BP remains the most important goal.


Assuntos
Anti-Hipertensivos , Insuficiência Cardíaca , Hipertensão , Hipertrofia Ventricular Esquerda , Serviços Preventivos de Saúde , Anti-Hipertensivos/classificação , Anti-Hipertensivos/uso terapêutico , Progressão da Doença , Insuficiência Cardíaca/diagnóstico , Insuficiência Cardíaca/epidemiologia , Insuficiência Cardíaca/etiologia , Insuficiência Cardíaca/prevenção & controle , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Fatores de Risco
6.
Eur J Gen Pract ; 25(3): 101-108, 2019 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-31411091

RESUMO

Background: Selective prevention of cardiometabolic diseases (CMD)-that is, preventive measures specifically targeting the high-risk population-may represent the most effective approach for mitigating rising CMD rates. Objectives: To develop a universal concept of selective CMD prevention that can guide implementation within European primary care. Methods: Initially, 32 statements covering different aspects of selective CMD prevention programmes were identified based on a synthesis of evidence from two systematic literature reviews and surveys conducted within the SPIMEU project. The Rand/UCLA appropriateness method (RAM) was used to find consensus on these statements among an international panel consisting of 14 experts. Before the consensus meeting, statements were rated by the experts in a first round. In the next step, during a face-to-face meeting, experts were provided with the results of the first rating and were then invited to discuss and rescore the statements in a second round. Results: In the outcome of the RAM procedure, 28 of 31 statements were considered appropriate and three were rated uncertain. The panel deleted one statement. Selective CMD prevention was considered an effective approach for preventing CMD and a proactive approach was regarded as more effective compared to case-finding alone. The most efficient method to implement selective CMD prevention systematically in primary care relies on a stepwise approach: initial risk assessment followed by interventions if indicated. Conclusion: The final set of statements represents the key characteristics of selective CMD prevention and can serve as a guide for implementing selective prevention actions in European primary care.


Assuntos
Doenças Cardiovasculares/prevenção & controle , Doenças Metabólicas/prevenção & controle , Serviços Preventivos de Saúde/organização & administração , Atenção Primária à Saúde/organização & administração , Consenso , Assistência à Saúde/organização & administração , Europa (Continente) , Humanos , Medição de Risco/métodos , Fatores de Risco
7.
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
8.
BMC Oral Health ; 19(1): 162, 2019 07 24.
Artigo em Inglês | MEDLINE | ID: mdl-31340799

RESUMO

BACKGROUND: There is a paucity of research concerning paediatric dental consultations in primary care. This is potentially due to the difficulty of measuring the communication behaviours in the complex triadic consultations. The present study aims to describe the development and refinement of a coding scheme to record the triadic communication between dental professionals, child patients and parents. METHODS: The PaeD-TrICS was developed from video observation of triadic communications and refined through an iterative process. Its practical applicability was assessed via implementation of the scheme on specialised behavioural coding software. Reliability was calculated using Cohen's Kappa. RESULTS: The PaeD-TrICS contains 45 codes. Forty-four dental professional-child-parent communications were successfully coded through administering the scheme on The Observer XT 10.5 system. Cohen's Kappa was 0.83 (inter-coder) and 0.90 (intra-coder). "Parental verbal facilitation" (mean = 1.68/min) was the most frequent behaviour. Dental professionals' "dentally engaging talk" (mean = 1.24/min), "praise" (mean = 1.10/min) and "instruction" (mean = 0.62/min) were frequently seen. Children's common behaviours included "speech other" (mean = 0.66/min) and non-verbal behaviour i.e. "non-verbal agreement" and verbal behaviour "speech yes" (mean = 0.26/min). CONCLUSIONS: The PaeD-TrICS is developed to capture the communication behaviour of the triadic consultations in a preventive dental setting. It demonstrates satisfactory intra- and inter-coder reliability and has been successfully used in paediatric dental consultations.


Assuntos
Codificação Clínica , Comunicação , Relações Dentista-Paciente , Odontólogos/psicologia , Pais/psicologia , Encaminhamento e Consulta , Criança , Comportamento Infantil , Pré-Escolar , Codificação Clínica/métodos , Humanos , Pacientes , Serviços Preventivos de Saúde/organização & administração , Psicometria , Reprodutibilidade dos Testes , Gravação em Vídeo
10.
BMC Health Serv Res ; 19(1): 347, 2019 May 31.
Artigo em Inglês | MEDLINE | ID: mdl-31151451

RESUMO

BACKGROUND: In life time, nearly each person succumbs to some sort of chronic disease and many develop complicated chronic diseases. It is critical to focus on preventive services with a relatively high health impact and favorable cost effectiveness. During routine health facility visits, it is advisable to evaluate both symptomatic and asymptomatic patients for their needs of health promotion and disease prevention services. This necessitates the development of an integrated health service (IHS) approach that incorporates health promotion, disease prevention and curative services. METHODS: There were two phases for the study. The first phase explored the degree of promotive and preventive health care delivery at the health centers and hospitals. Phase two, utilizing the Delphi strategy, centered on looking for agreement on the finding from phase 1 and on IHS approach. Delphi questions were created based on the results of phase 1, and the reply choices were tied to a five point Likert scale. Consensus was considered come to when 75% of the experts concurred on an issue. From that point, advance clarification and agreement was looked for by implies of a second-round assessment for scores between 50 and 75%. Agreement on proposed IHS model, application of case finding and Periodic Health Examination (PHE) approaches were also sought. This study focuses on finding from phase 2. RESULT: Of the twenty experts, 90% (n = 18) agreed that the IHS framework shows the causal relationship of diseases and included plausible intervention approaches. Experts reached consensus (90%;n = 18) that case finding testing,screening patients for conditions other than the medical care they sought at a particular time, can be performed at health facilities. All experts (100%; n = 20) recommended conducting periodic health examinations in selected diseases for patients who are apparently not sick. CONCLUSION: The Integrated Health Service (IHS) framework was agreed by experts to be a plausible method in describing the causal relationship of chronic non-communicable, communicable, and nutrition-related diseases. The framework can play a vital role by preventing the acquiring, progression, suffering or dying from diseases through restraining the vicious cycle of chronic diseases.


Assuntos
Prestação Integrada de Cuidados de Saúde/organização & administração , Doenças não Transmissíveis/prevenção & controle , Adulto , Consenso , Análise Custo-Benefício , Etiópia , Feminino , Promoção da Saúde/organização & administração , Humanos , Masculino , Pessoa de Meia-Idade , Serviços Preventivos de Saúde/organização & administração
12.
Rev Infirm ; 68(251): 25-27, 2019 May.
Artigo em Francês | MEDLINE | ID: mdl-31208562

RESUMO

COMPLEXITY OF PREVENTION AND SCREENING PROGRAMMES AMONG MIGRANTS: The healthcare and advice clinic in Nice offers a prevention and screening consultation for migrants, with insecure rights and precarious living conditions, recently arrived in France and wishing to stay. Time, availability and the chance to open up to others help to establish the connection needed to carry out screenings and pass on prevention messages to men and women for whom this is not a priority. A volunteer nurse shares her experience of designing and setting up such a consultation, in partnership with a pulmonologist.


Assuntos
Programas de Rastreamento/organização & administração , Serviços Preventivos de Saúde/organização & administração , Migrantes , Feminino , França , Humanos , Masculino , Enfermeiras e Enfermeiros/psicologia , Encaminhamento e Consulta/organização & administração , Voluntários/psicologia
13.
Arch. prev. riesgos labor. (Ed. impr.) ; 22(2): 76-80, abr.-jun. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-181179

RESUMO

El objetivo de este estudio es evaluar la relación entre los distintos sistemas de integración de la salud y seguridad laboral (SSL) y la participación los agentes sociales. Utilizando la Encuesta Nacional de Gestión de Riesgos Laborales en las Empresas de 2014 (n=3.162) se comparan los niveles de participación (pasiva, activa y prospectiva) según el sistema de integración de la SSL (medios propios, ajenos o combinados), estimando las odds ratio (OR) y los intervalos de confianza del 95% (IC95%) mediante regresiones logísticas crudas y ajustadas. Los resultados obtenidos muestran como la gestión con medios propios y combinados presenta mayor prevalencia de participación activa tanto en los debates de personal (ORa=1,78; 1,08-2,94 y 2,07; 1,21-3,53, respectivamente) como en las reuniones de SSL (2,09; 1,19-3,68 y 1,85; 1,03-3,22). Sin embargo, España es el segundo país de la Unión Europea con mayor índice de externalización, suponiendo una barrera para la activación de la cultura preventiva


We evaluated the relationship between different occupational health and safety (OHS) integration systems and the participation of social agents. Using the 2014 National Survey on Labor Risk Management in Companies (n=3.162), we compared levels of participation (passive, active and prospective) by type of OHS integration system (in-house, third-party or a combination of the two), estimating the odds ratio and the 95% confidence intervals (95% CI) using crude (OR) and adjusted (aOR) logistic regression. Results showed that inhouse and combined OHS resources were associated with a greater prevalence of active participation both in employee discussions(aOR = 1.78, 95% CI = 1.08-2.94 and aOR = 2.07, 95% CI = 1.21-3.53, respectively) and in OHS meetings (aOR = 2.09, 95% CI = 1.19-3.68 and aOR = 1.85, 95% C( = 1.03-3.22). Nevertheless, Spain is the second country in the European Union with the highest outsourcing index, which constitutes a barrier to the promotion of a preventive culture


Assuntos
Saúde do Trabalhador/estatística & dados numéricos , Serviços Preventivos de Saúde/organização & administração , Avaliação de Resultado de Ações Preventivas/métodos , Planejamento Participativo , Engajamento no Trabalho , Inquéritos e Questionários , Medição de Risco , Programa de Prevenção de Riscos no Ambiente de Trabalho , Estudos Transversais
14.
Public Health Rep ; 134(4): 371-378, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31112071

RESUMO

OBJECTIVES: Studies of sexually transmitted disease (STD) clinics have been limited by the lack of a national list for representative sampling. We sought to establish the number, type, and distribution of STD clinics and describe selected community characteristics associated with them. METHODS: We conducted a 2-phased, multilevel, online search from September 2014 through March 2015 and from May through October 2017 to identify STD clinics in all 50 US states and the District of Columbia. We obtained data on clinic name, address, contact information, and 340B funding status (which requires manufacturers to provide outpatient drugs at reduced prices). We classified clinics by type. We also obtained secondary county-level data to compare rates of chlamydia and HIV, teen births, uninsurance and unemployment, and high school graduation; ratios of primary care physician to population; health care costs; median household income; and percentage of population living in rural areas vs nonrural areas. We used t tests to examine mean differences in characteristics between counties with and without STD clinics. RESULTS: We found 4079 STD clinics and classified them into 10 types; 2530 (62.0%) clinics were affiliated with a local health department. Of 3129 counties, 1098 (35.1%) did not have an STD clinic. Twelve states had an STD clinic in every county, and 34 states had ≥1 clinic per 100 000 population. Most STD clinics were located in areas of high chlamydia morbidity and where other surrogate needs were greatest; rural areas were underserved by STD clinics. CONCLUSIONS: This list may aid in more comprehensive national studies of clinic services, STD clinic adaptation to external policy changes (eg, in public financing or patient access policy), and long-term clinic survival, with special attention to clinic coverage in rural areas.


Assuntos
Instituições de Assistência Ambulatorial/organização & administração , Instituições de Assistência Ambulatorial/estatística & dados numéricos , Geografia , Serviços Preventivos de Saúde/organização & administração , Doenças Sexualmente Transmissíveis/epidemiologia , Doenças Sexualmente Transmissíveis/terapia , Adulto , District of Columbia , Feminino , Humanos , Masculino , Serviços Preventivos de Saúde/estatística & dados numéricos , Estados Unidos
15.
Acta Oncol ; 58(6): 822-823, 2019 Jun.
Artigo em Inglês | MEDLINE | ID: mdl-30939973

RESUMO

Colorectal cancer (CRC) screening programs are far from perfect. Many crucial questions remain, yet expensive CRC screening services are implemented throughout the world without a plan on how to evaluate and improve the service. The time is ripe for improving the design of CRC screening programs.


Assuntos
Neoplasias Colorretais/diagnóstico , Neoplasias Colorretais/prevenção & controle , Detecção Precoce de Câncer/métodos , Serviços Preventivos de Saúde/organização & administração , Humanos
18.
J Foot Ankle Res ; 12: 17, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30923577

RESUMO

Background: Aboriginal and Torres Islander Australians experience considerably higher rates of diabetes and diabetes related foot complications and amputations than non-Indigenous Australians. Therefore there is a need to identify aspects of Aboriginal and Torres Islander focussed foot health programs that have had successful outcomes in reducing diabetes related foot complications. Wider knowledge and implementation of these programs may help reduce the high burden of diabetes related foot disease experienced by Aboriginal and Torres Islander Australians. Methods: PubMeD, Informit Indigenous collection, CINAHL, SCOPUS, the Cochrane Library and grey literature sources were searched to 28th August 2018. We included any published reports or studies of stand-alone diabetes related foot care interventions, programs, services, educational resources or assessment of these interventions, designed for Aboriginal and Torres Strait Islander Australians. Results: Thirteen studies detailing interventions in the Northern Territory, New South Wales, Queensland and Western Australia met the inclusion criteria. Five reports described delivery of podiatry services while the other eight investigated educational and training programs. Half of the reports related to aspects of the Indigenous Diabetic Foot program which provides culturally appropriate foot education and training workshops for health care providers. One article reported quantitative data related to clinical patient outcome measures. Conclusions: No state- or nation-wide foot health programs for prevention of diabetes related foot complications in Aboriginal and Torres Strait Islander Australians were identified. One program achieved high adherence to the national guidelines regarding timing of podiatry review treatments through use of an evidence based foot risk classification tool and provision of services in a culturally appropriate centre.


Assuntos
Pé Diabético/etnologia , Pé Diabético/prevenção & controle , Acesso aos Serviços de Saúde/estatística & dados numéricos , Grupo com Ancestrais Oceânicos/estatística & dados numéricos , Podiatria/organização & administração , Austrália/epidemiologia , Assistência à Saúde/organização & administração , Humanos , Grupo com Ancestrais Oceânicos/educação , Educação de Pacientes como Assunto/organização & administração , Serviços Preventivos de Saúde/organização & administração
19.
Medicine (Baltimore) ; 98(8): e14664, 2019 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-30813211

RESUMO

South Africa recently implemented the 'test and treat' strategy for all HIV-infected individuals receiving diagnosis at the health facility level. However, the impact of this programme in terms of the prevention of HIV transmission, morbidity and mortality associated with HIV can only be maximized if patients are diagnosed early. This study determines the prevalence of late presentation among newly diagnosed HIV-infected individuals and also examines the socio-demographic and clinical determinants for late presentation in health facilities in the Eastern Cape Province, South Africa.In this cross-sectional study, a total of 335 newly diagnosed patients were recruited consecutively between August 2016 and July 2017. Late presenter for HIV care was defined in accordance with the European Late Presenter Consensus working group as a patient who reports for care when the CD4 count is below 350 cells/µL and/or when there is an established AIDS-defining clinical condition, irrespective of CD4 count. Adjusted and unadjusted logistic regression analysis was used to examine the determinants of late HIV diagnosis.Participants' mean age was 33.6 (SD: 10.6). Almost 96% of the participants believed their route of HIV infection was heterosexual sex. Most newly diagnosed HIV-infected patients (60%) were late presenters (CD4+ count ≤350 cells/µL and/or having an AIDS-defining illness in World Health Organisation (WHO)-defined stage III/IV), with 35% presenting with Acquired Immune Deficiency Syndrome (AIDS)-related complications. In the adjusted model, only male sex (AOR: 2.81; CI: 1.51-5.23), no formal education (AOR: 5.63; CI: 1.68-18.85), and overweight body mass category (AOR: 2.45; CI: 1.04-5.75) were independently associated with late HIV diagnosis.The majority of newly diagnosed HIV-infected individuals were late presenters. To maximize the impact of the 'test and treat' policy aimed at reducing new HIV transmissions and preventing the morbidity and mortality associated with HIV, there is a need for programmes to improve early detection of HIV in the study settings. This programme should target males and individuals with no formal education for maximum impact.


Assuntos
Controle de Doenças Transmissíveis , Diagnóstico Tardio , Diagnóstico Precoce , Infecções por HIV , Serviços Preventivos de Saúde , Adolescente , Adulto , Controle de Doenças Transmissíveis/métodos , Controle de Doenças Transmissíveis/organização & administração , Estudos Transversais , Diagnóstico Tardio/prevenção & controle , Diagnóstico Tardio/estatística & dados numéricos , Demografia , Feminino , Infecções por HIV/diagnóstico , Infecções por HIV/epidemiologia , Infecções por HIV/transmissão , Humanos , Masculino , Pessoa de Meia-Idade , Determinação de Necessidades de Cuidados de Saúde , Prevalência , Serviços Preventivos de Saúde/métodos , Serviços Preventivos de Saúde/organização & administração , Serviços Preventivos de Saúde/normas , Fatores de Risco , Fatores Socioeconômicos , África do Sul/epidemiologia
20.
Acta Odontol Scand ; 77(6): 439-451, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-30905244

RESUMO

Objective: To explore barriers and facilitators to oral disease prevention in Danish dental care from a multi-stakeholder perspective. Methods: Eleven semi-structured focus groups and interviews about Danish oral healthcare were conducted with 27 stakeholders (general public, dental teams, dental policy makers) in Copenhagen. Transcripts were analyzed using deductive thematic analysis independently by KR and HL, supervised by JC and KVC. Results: Seven broad themes were identified, including both barriers and facilitators: Knowledge and attitudes, Education and training, Regulation, Incentivization, Multidisciplinary approach, Access to care and the Dental professional-patient relationship. Whilst all themes were relevant to each group of stakeholders, the salient driver within each theme was different for each group. Conclusions: Stakeholder perspectives on the Danish Oral health care system suggest the following are important features for a preventively focused system: (a) Involving all stakeholders in oral healthcare planning. (b) Securing sufficient and ongoing briefing regarding disease prevention for all stakeholders. (c) Regulatory support and creation of incentives to promote and facilitate implementation of disease prevention. (d) Appropriate prevention for disadvantaged groups within society which may be possible to a higher degree by means of multidisciplinary collaboration. (e) Personal relations between the patient and the professional based on mutual trust.


Assuntos
Assistência à Saúde/organização & administração , Assistência Odontológica/organização & administração , Cárie Dentária/prevenção & controle , Serviços Preventivos de Saúde/organização & administração , Relações Profissional-Paciente , Adulto , Idoso , Dinamarca , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Acesso aos Serviços de Saúde , Humanos , Masculino , Inquéritos e Questionários
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