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1.
BMC Public Health ; 19(1): 1542, 2019 Nov 21.
Artigo em Inglês | MEDLINE | ID: mdl-31752801

RESUMO

BACKGROUND: Hypertension (HTN) and diabetes mellitus (DM) are highly prevalent in low- and middle-income countries (LMIC) and a leading cause of morbidity and mortality. Recent evidence on effectiveness of primary care interventions has attracted renewed calls for their implementation. This review aims to synthesize evidence pertaining to primary care interventions on these two diseases, evaluated and tested in LMICs. METHODS: Two reviewers conducted an electronic search of three databases (Pubmed, EMBASE and Web of Science) and screened for eligible articles. Interventions covering health promotion, prevention, treatment, or rehabilitation activities at the PHC or community level were included. Studies published in English, French, Portuguese and Spanish, from January 2007 to January 2017, were included. Key extraction variables included the 12 criteria identified by the Template for Intervention Description and Replication (TIDieR) checklist and guide. The Innovative Care for Chronic Conditions Framework (ICCCF) was used to guide analysis and reporting of results. RESULTS: 198 articles were analyzed. The strategies focused on healthcare service organization (76.5%), community level (9.7 %), creating a positive policy environment (3.6%) and strategies covering multiple domains (10.2%). Studies included related to the following topics: description or testing of interventions (n=81; 41.3%), implementation or evaluation projects (n=42; 21.4%), quality improvement initiatives (n=15; 7.7%), screening and prevention efforts (n=26; 13.2%), management of HTN or DM (n=13; 6.6%), integrated health services (n=10; 5.1%), knowledge and attitude surveys (n=5; 2.5%), cost-effective lab tests (n=2; 1%) and policy making efforts (n=2; 1%). Most studies reported interventions by non-specialists (n=86; 43.4%) and multidisciplinary teams (n=49; 25.5%). CONCLUSION: Only 198 articles were found over a 10 year period which demonstrates the limited published research on highly prevalent diseases in LMIC. This review shows the variety and complexity of approaches that have been tested to address HTN and DM in LMICs and highlights the elements of interventions needed to be addressed in order to strengthen delivery of care. Most studies reported little information regarding implementation processes to allow replication. Given the need for multi-component complex interventions, study designs and evaluation techniques will need to be adapted by including process evaluations versus simply effectiveness or outcome evaluations.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Países em Desenvolvimento/estatística & dados numéricos , Diabetes Mellitus/prevenção & controle , Hipertensão/prevenção & controle , Atenção Primária à Saúde/estatística & dados numéricos , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
2.
BMC Health Serv Res ; 19(1): 765, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660966

RESUMO

BACKGROUND: Direct Acting Antiviral (DAAs) drugs have a much lower burden of treatment and monitoring requirements than regimens containing interferon and ribavirin, and a much higher efficacy in treating hepatitis C (HCV). These characteristics mean that initiating treatment and obtaining a virological cure (Sustained Viral response, SVR) on completion of treatment, in non-specialist environments should be feasible. We investigated the English-language literature evaluating community and primary care-based pathways using DAAs to treat HCV infection. METHODS: Databases (Cinahl; Embase; Medline; PsycINFO; PubMed) were searched for studies of treatment with DAAs in non-specialist settings to achieve SVR. Relevant studies were identified including those containing a comparison between a community and specialist services where available. A narrative synthesis and linked meta-analysis were performed on suitable studies with a strength of evidence assessment (GRADE). RESULTS: Seventeen studies fulfilled the inclusion criteria: five from Australia; two from Canada; two from UK and eight from USA. Seven studies demonstrated use of DAAs in primary care environments; four studies evaluated integrated systems linking specialists with primary care providers; three studies evaluated services in locations providing care to people who inject drugs; two studies evaluated delivery in pharmacies; and one evaluated delivery through telemedicine. Sixteen studies recorded treatment uptake. Patient numbers varied from around 60 participants with pathway studies to several thousand in two large database studies. Most studies recruited less than 500 patients. Five studies reported reduced SVR rates from an intention-to-treat analysis perspective because of loss to follow-up before the final confirmatory SVR test. GRADE assessments were made for uptake of HCV treatment (medium); completion of HCV treatment (low) and achievement of SVR at 12 weeks (medium). CONCLUSION: Services sited in community settings are feasible and can deliver increased uptake of treatment. Such clinics are able to demonstrate similar SVR rates to published studies and real-world clinics in secondary care. Stronger study designs are needed to confirm the precision of effect size seen in current studies. Prospero: CRD42017069873.


Assuntos
Antivirais/uso terapêutico , Serviços de Saúde Comunitária/estatística & dados numéricos , Hepatite C/diagnóstico , Hepatite C/tratamento farmacológico , Programas de Rastreamento/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Humanos , Ensaios Clínicos Controlados Aleatórios como Assunto
3.
Artigo em Inglês | MEDLINE | ID: mdl-31627474

RESUMO

Rural medical services play an important role in protecting and promoting the health of the rural population; however, patient satisfaction with rural medical services has been understudied in China. A better understanding of the actual situation and the determinants involved will provide evidence for health-related policy makers and hospital managers to further improve rural medical services. A total of 9811 patients (5208 outpatients and 4603 inpatients) were included in this study from a cross-sectional survey conducted in rural hospitals from 11 western provinces in China. Three in five patients (including outpatients and inpatients) were satisfied with rural medical services. The mean overall satisfaction scores were 3.61 ± 0.857 and 3.80 ± 0.829 (out of a maximum of 5) for rural outpatients and inpatients, respectively. The most satisfying domains for outpatients and inpatients were medical service attitude and illness explanation, and waiting time and medical expenses were the domains that outpatients and inpatients were least satisfied with. Satisfaction with medical technology (OR: 1.73; 95% CI: 1.57-1.92) and satisfaction with trust in physicians (OR: 2.05; 95% CI: 1.85-2.28) were identified as the strongest predictors of outpatients' and inpatients' overall satisfaction with rural medical services, respectively. This study might shed light on rural medical services management in China.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Serviços de Saúde Comunitária/normas , Pacientes Ambulatoriais/estatística & dados numéricos , Satisfação do Paciente/estatística & dados numéricos , População Rural , Adulto , China , Estudos Transversais , Feminino , Humanos , Pacientes Internados , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
5.
Artigo em Inglês | MEDLINE | ID: mdl-31408983

RESUMO

We aimed to quantitatively estimate the amount of pressure that was placed on basic public health care services (BPHS) due to the universal two-child policy issued in 2015 by comparing the workload change in maternal and child health management and the immunization of children. BPHS performance surveillance data from 2014 to 2018 in Zhejiang Province, China were analyzed to calculate the workload of the above three services using the equivalent method of BPHS cost estimation of community health services. From 2014 to 2018, the numbers of births from the Statistical Yearbook in Zhejiang Province were 578,000, 581,000, 624,000, 670,000, and 628,000, respectively, and those from the surveillance data were 416,941, 41,490, 434,163, 546,816, and 45,964, respectively. The number of births reached a peak in 2017, with the yearbook and surveillance data showing increases of 15.92% and 31.15%, respectively, over 2014. The workload of maternal and child health management and children's immunization also peaked in 2017, increasing by 30.37%, 12.70%, and 4.33% over 2014, respectively. In 2018, the workload of maternal and child health management and children's immunization dropped to 107.34%, 107.73%, and 98.81% over 2014, respectively. The indicators of maternal and child health management and children's immunization services remained stable, and the related services did not decline, even in 2017. The maternal health management workload was more affected by the universal two-child policy than child health management and children's immunization.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Política Pública , Carga de Trabalho/estatística & dados numéricos , China , Serviços de Saúde Comunitária/economia , Custos e Análise de Custo , Humanos , Imunização , Estados Unidos
6.
BMC Health Serv Res ; 19(1): 570, 2019 Aug 14.
Artigo em Inglês | MEDLINE | ID: mdl-31412849

RESUMO

BACKGROUND: The focus of the community anti-retroviral therapy Group model is on drug refill, adherence and support groups. However, laboratory services are completely neglected in this model, and stable patient still have to go to the clinic for blood draws after drugs refills from the community. Due to the introduction of new ART drugs, the guidelines now recommend the use of viral loads to guide decision in switching all patients from NNRTI to dolutegravir based first line ART regimens. But the national viral load testing coverage stands at 37% and and falls short of meeting the global UNAIDS and phlebotomy delivery system is congested. The purpose of this study was to identify the perceptions in decentralizing phlebotomy services into the community anti-retroviral therapy Group model. METHOD: A qualitative case study design was used. Data were collected through ten Focused group discussions among community anti-retroviral therapy Group members, community and health care workers at anti-retroviral therapy clinics and in-depth interviews with five key informants. Data were managed with the help of Nvivo version 10 and analyzed using thematic method. RESULTS: Positive perceptions were identified as those which contributed to decongesting phlebotomy rooms, reduced missing phlebotomy appointments, work Load, and lost results. Improved quality of phlebotomy service delivery and testing coverage, innovative access to laboratory services and encouraged patient's accountability. The negative perceptions were compromised sample integrity, inability to perform prevention control and patients less contact with clinicians. CONCLUSION: The study has demonstrated that decentralizing phlebotomy services within the CAG model has greater potential to improve the quality of services delivery for patients. In addition, it has perceived threats on the quality of specimen collected, patient's safety, and health care.


Assuntos
Antirretrovirais/uso terapêutico , Serviços de Saúde Comunitária , Infecções por HIV/sangue , Flebotomia , Serviços de Saúde Comunitária/estatística & dados numéricos , Estudos de Viabilidade , Grupos Focais , Infecções por HIV/tratamento farmacológico , Humanos , Flebotomia/estatística & dados numéricos , Pesquisa Qualitativa , Zâmbia
7.
Salud Publica Mex ; 61(4): 461-469, 2019.
Artigo em Espanhol | MEDLINE | ID: mdl-31314209

RESUMO

OBJECTIVE: Monitor drug use through wastewater metabolite measurement. MATERIALS AND METHODS: Wastewater samples were obtained from 31 wastewater treatment plants and 95 sites with specific populations (38 schools, 42 units of addiction treatment and 15 penitentiaries). Using ultra high liquid chromatography, we measured nine metabolites from six drugs. RESULTS: Eight out of nine drug metabolites were identified in the samples. Marijuana (THC-COOH), cocaine (benzoylecgonine) and methamphetamine were identified in schools, centers of addiction treatment and penitentiaries. Nuevo Laredo, Culiacan and Torreon had the highest consumption of cocaine, marijuana, amphetamine and methamphetamine. CONCLUSIONS: Monitoring drug use through wastewater is feasible in Mexico and could constitute a surveillance system to identify changes in the time.


Assuntos
/análise , Detecção do Abuso de Substâncias/métodos , Transtornos Relacionados ao Uso de Substâncias/epidemiologia , Águas Residuárias/química , Cannabis/química , Cromatografia Líquida de Alta Pressão , Cidades/epidemiologia , Cocaína/análogos & derivados , Cocaína/análise , Serviços de Saúde Comunitária/estatística & dados numéricos , Dronabinol/análogos & derivados , Dronabinol/análise , Estudos de Viabilidade , Heroína/análise , Humanos , Metanfetamina/análise , México/epidemiologia , Morfina/análise , N-Metil-3,4-Metilenodioxianfetamina/análise , Projetos Piloto , Instituições Acadêmicas/estatística & dados numéricos , Centros de Tratamento de Abuso de Substâncias/estatística & dados numéricos , Fatores de Tempo , Purificação da Água
8.
Int J Equity Health ; 18(1): 95, 2019 06 20.
Artigo em Inglês | MEDLINE | ID: mdl-31221156

RESUMO

BACKGROUND: Health social enterprises in Africa working with community health workers (CHWs) are growing rapidly but understudied. In particular, gender equality issues related to their work has important public health and equity implications. METHODS: Particularly suited for generating timely findings from reviews at the intersection of overlapping disciplines, we utilized the rapid evidence assessment (REA) methodology to identify key unanswered research questions at the intersection of the fields of gender equality, social enterprises and community health workers. The REA used a series of structured Google Scholar searches, expert interviews and bibliography reviews to identify 57 articles in the academic and grey literatures that met the study inclusion criteria. Articles were thematically coded to identify answers to "What are the most important research questions about the influence of gender on CHWs working with health social enterprises in Africa?" RESULTS: The analysis identified six key unanswered research questions relating to 1) equitable systems and structures; 2) training; 3) leadership development and career enhancement; 4) payment and incentives; 5) partner, household and community support; and 6) performance. CONCLUSION: This is the first study of its kind to identify the key unanswered research questions relevant to gender equality in health social enterprises in Africa using community health workers. As such, it sets out a research agenda for this newly emerging but rapidly developing area of research and practice with important public health implications.


Assuntos
Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Agentes Comunitários de Saúde/organização & administração , Agentes Comunitários de Saúde/estatística & dados numéricos , Direitos Humanos/estatística & dados numéricos , Admissão e Escalonamento de Pessoal/estatística & dados numéricos , Adulto , África , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores Sexuais
9.
Nihon Koshu Eisei Zasshi ; 66(6): 287-294, 2019.
Artigo em Japonês | MEDLINE | ID: mdl-31231098

RESUMO

Objective The aim of this nationwide study was to estimate the duration of formal long-term care, provided by Japanese long-term care insurance (LTCI) services, among frail Japanese elderly people living in the community.Methods The study subjects were 2,188,397 (men: 579,422, women: 1,124,022, age≥65 years) beneficiaries who used LTCI services for community living in June 2013. The duration of LTCI services for community living per diem per capita was estimated by converting the benefit amount to duration of care using the code for service in claims bills according to gender and care levels, which are a nationally certified classification of individual needs for long-term care (care level 1: lowest need, care level 5: highest need). Subsequently, LTCI services for community living were categorized into respite services and community services. Community services were further subcategorized into home visiting services and daycare services.Results The overall average duration of formal care per diem per capita for men and women were 97.4 and 112.7 minutes for care level 1, 118.3 and 149.1 for care level 2, 186.9 and 246.4 for care level 3, 215.2 and 273.2 for care level 4, and 213.1 and 261.4 for care level 5, respectively. Length of respite services increased gradually with care level, whereas duration of community services peaked at care level 3 and decreased at care levels 4 and 5. With regard to the community service subcategories, duration of home visiting services increased with care level, but duration of daycare services peaked at care level 3.Conclusion Although the care levels in the LCTI system are designed to assess the need for formal care in terms of duration of care, our results suggest that the use of formal LTCI services for community living is not vertically equitable. Services that efficiently increase duration of formal care for those with higher needs for care may improve the equity and sustainability of formal long-term care services for community living.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Idoso Fragilizado/estatística & dados numéricos , Revisão da Utilização de Seguros/estatística & dados numéricos , Seguro de Assistência de Longo Prazo/economia , Seguro de Assistência de Longo Prazo/estatística & dados numéricos , Assistência de Longa Duração/estatística & dados numéricos , Tempo , Idoso , Idoso de 80 Anos ou mais , Serviços de Saúde Comunitária/economia , Feminino , Serviços de Assistência Domiciliar/economia , Serviços de Assistência Domiciliar/estatística & dados numéricos , Humanos , Revisão da Utilização de Seguros/economia , Japão/epidemiologia , Assistência de Longa Duração/economia , Masculino
10.
JAMA Netw Open ; 2(6): e195877, 2019 06 05.
Artigo em Inglês | MEDLINE | ID: mdl-31199453

RESUMO

Importance: It is unclear whether effective population-wide interventions that reduce risk factors and improve health result in sustained benefits to a community's health. If benefits do persist after a program is ended, interventions could be brief rather than maintained long term. Objective: To measure mortality and smoking rates in a rural community over decades before, during, and after prevention program reductions. Design, Setting, and Participants: This cross-sectional study compared smoking and mortality rates in a rural Maine county with other Maine counties over time by 5-year intervals. Multiple changes occurred between 2001 and 2015 in the physiological and behavioral risk factor reduction programs offered in the county. They included reductions in leadership, staff, institutional resources, data monitoring, and the programs themselves. Data were analyzed from May 2018 to March 2019. Intervention: Previous multifaceted interventions and outcome monitoring were withdrawn or diminished in the past decade. Main Outcomes and Measures: Smoking and age-adjusted mortality rates vs household income. Results: Reduced mortality rates in Franklin County in 1986 to 2005 reverted to those predicted by household incomes, relative to other Maine counties, by 2006 to 2015 (1986-1990 T score = -2.86 [P = .01] and 2001-2005 T score = -3.00 [P = .01] to 2006 to 2010 T score = -0.43 [P = .67] and 2011-2015 T score = -0.72 [P = .48]). Analysis of County Health Rankings data from 2010 to 2018 also showed that Franklin County's outcomes have reverted to no better than predicted by socioeconomic status. The county's T scores increased from -3.62 (P = .003) in 2010 to -0.41 (P = .69) in 2015 to 0.13 (P = .90) in 2018. Statewide association of income with mortality by analyses of variance showed that the R2 values have increased from the decades preceding 2000 (1976-1980, R2 = 0.21; P = .08; 1986-1990, R2 = 0.32; P = .02) to 2006 to 2010 (R2 = 0.73; P < .001) and 2011 to 2015 (R2 = 0.70; P < .001). Conclusions and Relevance: This study suggests that gains associated with population health interventions may be lost when the interventions are reduced. Adjusting outcome measures for socioeconomic status may allow quicker and more sensitive monitoring of intervention adequacy and success. The increasing trend of age-adjusted mortality in Maine and nationally to correlate inversely with incomes may warrant further community interventions, especially for poorer populations.


Assuntos
Doenças Cardiovasculares/epidemiologia , Serviços de Saúde Comunitária/estatística & dados numéricos , Promoção da Saúde , Prevenção Primária/estatística & dados numéricos , Fumar Tabaco/epidemiologia , Doenças Cardiovasculares/prevenção & controle , Doenças Cardiovasculares/psicologia , Serviços de Saúde Comunitária/economia , Estudos Transversais , Promoção da Saúde/economia , Humanos , Maine/epidemiologia , Prevenção Primária/economia , População Rural , Abandono do Hábito de Fumar , Fatores Socioeconômicos , Fumar Tabaco/prevenção & controle , Fumar Tabaco/psicologia
11.
Infez Med ; 27(2): 134-140, 2019 Jun 01.
Artigo em Inglês | MEDLINE | ID: mdl-31205035

RESUMO

Increasing bacterial resistance is strictly correlated to the increasing use of antibiotics, currently constituting a public health problem. The aim of this study was to describe the consumption of antibiotics in Asturias, an autonomous community in northwestern Spain, and compare the results obtained with data from elsewhere in Spain and other European countries. A descriptive study was carried out on the use of antibacterial drugs for systemic use, ATC code J01 in Asturias in 2011-2015. Data were obtained from the prescription-billing information system charged to the Health Service of Asturias. The consumption data are expressed in daily doses per 1,000 inhabitants and day (DHD), and number of packages per thousand inhabitants per day. The average weighted consumption of antibiotics for systemic use in the Asturian community was 26.23 daily doses per 1000 inhabitants per day (DHD) in 2015. This figure was higher than that of the EU/EEA population, which was 22.4 DHD, and that of the whole of Spain at 22.2 DHD. There is a wide variability in consumption among the different areas of the Asturian region. This variability is common to the rest of the country and Europe. It can be explained by the influence of the data used in the indicators and by the variability in medical practice. Priority should be given to homologating consumer-monitoring information systems and implementing national strategies aimed at providing more information to medical practitioners, encouraging the appropriate use of antibiotics so as to reduce variability, consumption and resistance.


Assuntos
Antibacterianos/uso terapêutico , Antibacterianos/administração & dosagem , Serviços de Saúde Comunitária/estatística & dados numéricos , Prescrições de Medicamentos/estatística & dados numéricos , Farmacorresistência Bacteriana , Revisão de Uso de Medicamentos/estatística & dados numéricos , Europa (Continente) , Humanos , Densidade Demográfica , Padrões de Prática Médica/estatística & dados numéricos , Estudos Retrospectivos , Espanha
12.
Health Serv Res ; 54(4): 912-919, 2019 08.
Artigo em Inglês | MEDLINE | ID: mdl-31132161

RESUMO

OBJECTIVE: To examine the effects of Medicaid Home and Community-based Services (HCBS) waivers on reducing racial/ethnic disparities in unmet need for services among families of children with autism spectrum disorder (ASD). DATA SOURCES: Data from the 2003, 2007, and 2011 waves of the National Survey of Children's Health and the 2005 and 2010 waves of the National Survey of Children with Special Health Care Needs were used. Data on waiver characteristics were collected from source materials that were submitted in support of each state's waiver application. Waiver characteristics were combined to create a single waiver generosity variable. STUDY DESIGN: Quasi-difference-in-difference-in-difference models were used to determine the effect of waiver generosity on racial/ethnic disparities in unmet need among children with ASD. PRINCIPAL FINDINGS: Increased waiver generosity was associated with significantly reduced odds of having unmet need for black children with ASD compared with white children with ASD. Unmet needs among black children with ASD were roughly cut in half, a 13 percentage point decrease, with the implementation of an average generosity waiver. No significant differences were seen for Hispanic ethnicity. CONCLUSION: These findings suggest that Medicaid HCBS waivers have the potential to ameliorate disparities in unmet need among children with ASD. Future policy development should focus on replicating the most effective characteristics of these waivers.


Assuntos
Transtorno do Espectro Autista/terapia , Serviços de Saúde Comunitária/estatística & dados numéricos , Grupos de Populações Continentais/estatística & dados numéricos , Grupos Étnicos/estatística & dados numéricos , Serviços de Assistência Domiciliar/estatística & dados numéricos , Medicaid/organização & administração , Afro-Americanos , Transtorno do Espectro Autista/diagnóstico , Estudos Transversais , Grupo com Ancestrais do Continente Europeu , Feminino , Acesso aos Serviços de Saúde , Hispano-Americanos , Humanos , Renda , Masculino , Fatores Socioeconômicos , Estados Unidos
13.
Medicine (Baltimore) ; 98(22): e15849, 2019 May.
Artigo em Inglês | MEDLINE | ID: mdl-31145334

RESUMO

The objective of this study was to examine the association between patient satisfaction with community health service (CHS) and self-management behaviors in patients with type 2 diabetes mellitus (T2DM).In all, 1691 patients with T2DM from 8 community health centers in 5 provinces in China participated in the present study. The dependent variables included 4 measures of self-management behaviors: regular self-monitoring of blood glucose (SMBG), prescribed medication adherence, recommended dietary changes, and regular exercise. The independent variable was patient satisfaction with CHS. Multivariable logistic regression models were performed to examine the association between patient satisfaction with CHS and self-management behaviors.The mean satisfaction score in the participants was 3.14 (out of a maximum of 5). After adjusting for covariates including demographic factors, health status, health knowledge, and socioeconomic status (SES), diabetic patients with high CHS satisfaction had better medication adherence (odds ratio [OR] 1.25, 95% confidence interval [CI] 1.02-1.55), increased exercise management (OR 1.19, 95% CI 1.06-1.35), and more SMBG (OR 1.16, 95% CI 1.03-1.32); all these associations varied across SES groups. The association between satisfaction and medication adherence was significant among participants younger than 65 years with lower education (OR 2.15, 95% CI 1.37-3.37), income (OR 1.62, 95% CI 1.13-2.32), and lower-status occupations (OR 1.69, 95% CI 1.16-2.47). Among participants younger than 65 years and had lower education attainment, the association between satisfaction and diet management was observed. There were positive associations between satisfaction and regular exercise among subgroups of participants younger than 65 years, except for lower education group. A significant association between satisfaction and SMBG among participants ≥65 years old, who also had lower SES and higher-status occupations, was also observed.The study findings suggested that T2DM patient satisfaction with CHS was moderate. High satisfaction with CHS indicated better medication adherence, exercise management, and SMBG, and these associations varied by SES.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Diabetes Mellitus Tipo 2/epidemiologia , Satisfação do Paciente/estatística & dados numéricos , Autogestão/estatística & dados numéricos , Classe Social , Idoso , Glicemia/análise , Automonitorização da Glicemia/psicologia , Automonitorização da Glicemia/estatística & dados numéricos , China/epidemiologia , Centros Comunitários de Saúde , Estudos Transversais , Diabetes Mellitus Tipo 2/sangue , Diabetes Mellitus Tipo 2/psicologia , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Autogestão/psicologia , Inquéritos e Questionários
14.
Trials ; 20(1): 238, 2019 Apr 25.
Artigo em Inglês | MEDLINE | ID: mdl-31023347

RESUMO

BACKGROUND: People who sustain spinal cord injuries in low- and middle-income countries are vulnerable to life-threatening complications after discharge. The aim of this trial is to determine the effect on all-cause mortality of a sustainable model of community-based care provided over the first 2 years after discharge. METHODS AND ANALYSIS: The CIVIC trial is a single centre, parallel group trial with concealed and stratified randomisation. The protocol has been previously published (BMJ Open 2016;6:e010350). This paper provides the accompanying detailed statistical plan. In total, 410 people with recent spinal cord injury who are wheelchair dependent and about to be discharged from the Centre for the Rehabilitation of the Paralysed in Bangladesh are randomised to intervention or control groups. Participants assigned to the intervention group receive a model of community-based care in which a case manager provides ongoing telephone-based support and visits participants in their homes over a 2-year period. Participants assigned to the control group receive usual care which may involve a follow-up phone call or a home visit. The primary outcome is all-cause mortality at 2 years as determined by a blinded assessor (Bangladesh does not have a death registry). The primary effectiveness analysis will compare Kaplan-Meier survival curves (time from allocation to death) in the intervention and control groups using the log-rank test (two-tailed α = 0.05). Participants will be censored at the time they were last known to be alive or at the time of the follow-up assessment. Recruitment finished in March 2018 and the last assessment will be conducted in March 2020. DISCUSSION: The CIVIC trial will provide unbiased and precise estimates of the effectiveness of a model of community-based care for people with spinal cord injuries in Bangladesh. The results will have implications for provision of health services for people with spinal cord injuries and other conditions that cause serious disability in low-income and middle-income countries. TRIAL REGISTRATION: ANZCTR, ACTRN12615000630516, U1111-1171-1876. Registered on 17 June 2015.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Traumatismos da Medula Espinal/reabilitação , Bangladesh , Interpretação Estatística de Dados , Humanos , Alta do Paciente , Ensaios Clínicos Pragmáticos como Assunto , Fatores de Risco , Traumatismos da Medula Espinal/complicações , Traumatismos da Medula Espinal/diagnóstico , Traumatismos da Medula Espinal/mortalidade , Fatores de Tempo , Resultado do Tratamento
15.
MMWR Morb Mortal Wkly Rep ; 68(14): 321-325, 2019 Apr 12.
Artigo em Inglês | MEDLINE | ID: mdl-30973847

RESUMO

Sexually transmitted diseases (STDs) disproportionately affect gay, bisexual, and other men who have sex with men (MSM) in the United States (1). Because chlamydia and gonorrhea at extragenital (rectal and pharyngeal) anatomic sites are often asymptomatic, these anatomic sites serve as a reservoir of infection, which might contribute to gonococcal antimicrobial resistance (2) and increased risk for human immunodeficiency virus (HIV) transmission and acquisition (3). To ascertain prevalence of extragenital STDs, MSM attending community venues were recruited in five U.S. cities to provide self-collected swabs for chlamydia and gonorrhea screening as part of National HIV Behavioral Surveillance (NHBS). Overall, 2,075 MSM provided specimens with valid results, and 13.3% of participants were infected with at least one of the two pathogens in at least one of these two extragenital anatomic sites. Approximately one third of participating MSM had not been screened for STDs in the previous 12 months. MSM attending community venues had a high prevalence of asymptomatic extragenital STDs. The findings underscore the importance of sexually active MSM following current recommendations for STD screening at all exposed anatomic sites at least annually (4).


Assuntos
Infecções por Chlamydia/epidemiologia , Serviços de Saúde Comunitária/estatística & dados numéricos , Gonorreia/epidemiologia , Homossexualidade Masculina/estatística & dados numéricos , Adolescente , Adulto , Cidades , Humanos , Masculino , Pessoa de Meia-Idade , Prevalência , Estados Unidos/epidemiologia , Adulto Jovem
16.
Perm J ; 232019.
Artigo em Inglês | MEDLINE | ID: mdl-30939269

RESUMO

INTRODUCTION: Clinics increasingly screen patients for food insecurity, but little is known about the efficacy of referring food-insecure patients to community-based food resources. OBJECTIVE: To evaluate the implementation of a tailored community food resource referral program in a safety-net diabetes clinic. METHODS: We conducted semistructured phone interviews with food-insecure patients participating in a screening and referral program in a diabetes clinic affiliated with a safety-net hospital. In this qualitative study, we describe barriers to and facilitators of successful food resource referrals from the patient's perspective. RESULTS: The prevalence of food insecurity was high (60%). Provision of written and verbal information alone about community food resources resulted in low linkage rates (0%-4%), even with individually tailored referrals. Misperceptions about eligibility, fears around government program registration, inaccessibility, lack of information retention, competing priorities, an inability to cook, stigma, and a perceived sense of stability with existing food support were major barriers to use. Personnel-guided, in-clinic enrollment to a food resource facilitated a higher connection rate (31%). DISCUSSION: Results of this study suggest that screening for food insecurity followed by a list of food resources for those screening positive may not adequately address patient barriers to using community-based food resources. For food insecurity screening programs in the clinical setting to be effective, systems must not only distribute food resource information but also assist patients in enrollment processes.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Diabetes Mellitus , Abastecimento de Alimentos/estatística & dados numéricos , Recursos em Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Encaminhamento e Consulta/estatística & dados numéricos , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Pesquisa Qualitativa , Fatores de Risco , São Francisco
17.
Aten. prim. (Barc., Ed. impr.) ; 51(4): 236-244, abr. 2019. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-180864

RESUMO

Objetivo: Evaluar la efectividad de un Programa de actividad física (AF) supervisado, con actividades socioculturales y de 9 meses de duración, sobre la autoestima y su asociación sobre el control de las enfermedades crónicas en adultos usuarios de atención primaria. Diseño: Ensayo de intervención comunitaria, aleatorizado, controlado y multicéntrico. Emplazamiento: Cuatro centros de atención primaria de Reus-Tarragona, España. Participantes: Un total de 364 sujetos, aleatorizados al grupo control (GC = 104) y grupo intervención (GI = 260). Intervención: Programa supervisado de caminatas de 120 min/semana con actividades socioculturales mensuales. Mediciones principales: En los momentos basal y postintervención se valoró: AF (IPAQ-S), autoestima (escala de Rosenberg) e indicadores cardiovasculares: tabaquismo, presión arterial sistólica (PAS) y diastólica (PAD), colesterol LDL y HDL séricos, y glucosa sérica. Se registran características sociodemográficas y diagnósticos de enfermedades crónicas. Resultados: El Programa incrementó la AF en el GI (p = 0,001), mientras que disminuyó en el GC (p = 0,002), y también la autoestima en el conjunto de participantes (1,28 puntos; p = 0,006) y en los grupos con diagnósticos de hipertensión (1,60 puntos; p = 0,005), dislipidemia (1,62 puntos; p = 0,012), exceso de peso (1,24 puntos; p = 0,011) o ansiedad/depresión (1,53 puntos; p = 0,045), valorados mediante modelos estadísticos multivariantes. El incremento de la autoestima durante la intervención disminuyó la PAS -0,5 mmHg (p = 0,030) en el grupo de hipertensos, independientemente de la PAS basal y del efecto de la intervención. Conclusión: El Programa de AF realizado incrementó la AF y la autoestima en adultos usuarios de atención primaria. El incremento de la autoestima mejoró el control de la PAS en hipertensos


Aim: To evaluate the effectiveness of a 9 months of supervised Physical Activity (PA) Program with sociocultural activities, on self-esteem and its association on the control of chronic diseases in adult primary care users. Design: Multicenter, randomized, controlled community intervention. Location: 4 Primary care centers in Reus-Tarragona, Spain. Participants: 364 subjects, randomized to the Control Group (CG = 104) and Intervention Group (IG = 260). Intervention: Supervised walking program of 120min/week with sociocultural activities once a month. Main measurements: At baseline and at post-intervention we assessed: PA (IPAQ-S), self-esteem (Rosenberg scale) and cardiovascular indicators: smoking, systolic (SBP) and diastolic (DBP) blood pressure, serum LDL and HDL cholesterol, and serum glucose. Sociodemographic characteristics and diagnostic of chronic diseases are recorded. Results: The Program increased the PA in the IG (P = .001), while it decreased in the CG (P = .002), and also the self-esteem in the group of participants (1.28 points, P = .006) and in the groups with diagnoses of hypertension (1.60 points, P = .005), dyslipidemia (1.62 points, P = .012), excess weight (1.24 points, P = .011) or anxiety/depression (1.53 points, P = .045), assessed by multivariate statistical models. The increase in self-esteem during the intervention decreased SBP -0.5 mmHg (P = .030) in the hypertension group, regardless of baseline SBP and the effect of the intervention. Conclusion: The PA program increased the PA and self-esteem in adult primary care users. The increase of self-esteem improved the control of SBP in hypertensive patients


Assuntos
Humanos , Masculino , Feminino , Adulto , Idoso , Pessoa de Meia-Idade , Terapia por Exercício/psicologia , Múltiplas Afecções Crônicas/psicologia , Autoimagem , Avaliação de Eficácia-Efetividade de Intervenções , Programas Gente Saudável/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos
18.
BMC Health Serv Res ; 19(1): 168, 2019 Mar 14.
Artigo em Inglês | MEDLINE | ID: mdl-30871529

RESUMO

BACKGROUND: Demand for Physiotherapy is on the rise due to increasing ageing population and consequent disability and morbidity. However, the costs of healthcare in developing countries are rising, and healthcare resources are limited making the supply of Physiotherapy services challenging in rural communities. Availability of Physiotherapy may help to reduce the burden of disability and enhance efficiency of healthcare systems. This study investigated the characteristics and associations of utilization and supply of community Physiotherapy in Nigeria. METHODS: Cross-sectional survey of 336 consenting community dwelling individuals from three selected communities in Nigeria was carried out. A three-section validated self-developed questionnaire which sought information on socio-demographics, utilization and supply of community Physiotherapy, as well as how to improve community Physiotherapy services was used. A household was used as the primary sampling unit in the study. Inferential and Descriptive statistics were used to assess the data. RESULTS: Lifetime, 12-month and point utilization of physiotherapy was 21.7, 7.4 and 2.7% respectively. Physiotherapy utilization was significantly associated with level of education (p = 0.007), belief on pain as "spiritual" (p = 0.020) and religious belief (p = 0.001). The respondents with primary, secondary and tertiary education were 14.3, 13.9 and 26 times more likely to utilize physiotherapy services, respectively. Those who 'agree' or were 'not sure' that their religious belief was against physiotherapy were 92 and 83% less likely to utilize physiotherapy services, respectively compared with those who 'disagree'. Availability and supply of Physiotherapy services were mostly at the township teaching hospital (47.9%) and private hospitals (20.5%). The supply of Physiotherapy services within the communities was mostly on temporary basis (24.7%) and through visiting Physiotherapists (21.4%). Physiotherapy services utilized was mainly exercise (46.6%) and soft tissue mobilization (41.1%). Travel costs (32.6%), time constraints (27.9%) and work commitments (24.8%) were the constraints for Physiotherapy utilization while positive beliefs and higher education improved Physiotherapy utilization. CONCLUSIONS: Utilization and supply of Physiotherapy services in Nigerian rural community was low. Low utilization of Physiotherapy services in Nigerian rural communities were most significantly influenced by low educational status and beliefs about pain.


Assuntos
Serviços de Saúde Comunitária/estatística & dados numéricos , Acesso aos Serviços de Saúde/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Países em Desenvolvimento , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Morbidade , Nigéria , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Fisioterapeutas/provisão & distribução , Utilização de Procedimentos e Técnicas , Saúde da População Rural/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
19.
PLoS One ; 14(2): e0212847, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-30817784

RESUMO

BACKGROUND: Although achieved development goals on maternal and child health, in the era of Sustainable Development Goals (SDGs), Bangladesh still needs to promote skilled attendance at birth as well as a continuum of care for mothers and babies. How to implement effective interventions by strengthening the community health system also remains as a crucial policy issue. The objective of the proposed study is to evaluate the impact of a community-based intervention as part of a bilateral development aid project on utilization of maternal and neonatal care provided by skilled providers and qualified facilities. METHODS: A cluster randomized trial was conducted in Kalaroa Upazila of Satkhira District. Community Clinics (CCs) in the study setting were randomly allocated to either intervention or control. We recruited all eligible women covered by CC catchment areas who gave a birth during the past 12 months of data collection at the baseline and end-line surveys. In the intervention areas, three Community Support Groups (CSGs) were developed in each of the CC areas. The members of CSG were trained to identify pregnant women, educate community people on pregnancy related danger signs, and encourage them for utilization of skilled services in the community and health facilities. The primary outcomes were the utilization of services for antenatal care, delivery, postnatal care and sick newborns. Difference-in-Difference (DID) analysis was performed to identify the changes by the intervention with adjustment of cluster effects by generalized mixed effects regression models. RESULT: The major indicators of the utilization of maternal and neonatal care among pregnant women with different wealth status showed significant improvement after the intervention. The impacts of the intervention were in particular significant among the women of 2nd and 3rd quintiles of household wealth status. The use of CCs increased after the intervention and private hospitals / clinics served as the major health providers. The study also identified increased practices of cesarean section. CONCLUSION: The success of the intervention suggests a potential of the government efforts to strengthen the community support system for promotion of safe motherhood. The intervention helps to identify and remove existing and emerging barriers that lie between women and healthcare providers for safe motherhood and continuum of care. TRIAL REGISTRATION: UMIN Clinical Trial Registry UMIN000031789.


Assuntos
Participação da Comunidade , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Assistência Perinatal/organização & administração , Cuidado Pré-Natal/organização & administração , Grupos de Autoajuda/organização & administração , Adolescente , Adulto , Bangladesh/epidemiologia , Serviços de Saúde Comunitária/organização & administração , Serviços de Saúde Comunitária/estatística & dados numéricos , Feminino , Seguimentos , Implementação de Plano de Saúde , Humanos , Lactente , Saúde do Lactente , Mortalidade Infantil , Recém-Nascido , Saúde Materna , Mortalidade Materna , Assistência Perinatal/estatística & dados numéricos , Gravidez , Cuidado Pré-Natal/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde , Serviços de Saúde Rural/organização & administração , Serviços de Saúde Rural/estatística & dados numéricos , Adulto Jovem
20.
Value Health ; 22(3): 355-361, 2019 Mar.
Artigo em Inglês | MEDLINE | ID: mdl-30832974

RESUMO

BACKGROUND: The distribution of EQ-5D-3L values (health state profiles, weighted by value sets) often shows two distinct groups, arising from both the distribution of profiles and the characteristics of value sets. To date, there is little evidence about the distribution of EQ-5D-5L values. OBJECTIVES: To explore the distribution of EQ-5D-5L profiles; to compare the distributions of EQ-5D-5L values arising from the English value set (EVS) and a 'mapped' value set (MVS); and to develop further the methods used to investigate clustering within EQ-5D data. METHODS: We obtained data from Cambridgeshire Community Services NHS Trust containing EQ-5D-5L profiles before treatment for three patient groups: community rehabilitation (N=6919); musculoskeletal physiotherapy (N=19999); and specialist nursing services (N=3366). Values were calculated using the EVS and MVS. Clusters were examined using the k-means method and Calinski-Harabasz pseudo-F index stopping rule. RESULTS: We found no evidence for clustering of EQ-5D-5L values arising from the classification system and no strong or consistent evidence of clustering arising from the EVS. There was clearer evidence of clustering using the MVS, with two being the optimal number of clusters. The clusters that were found for the EVS were very different from the MVS clusters. CONCLUSIONS: Unlike the EQ-5D-3L, clustering of EQ-5D-5L values does not seem to be driven by clustering of its profile. This suggests the EQ-5D-5L is superior in that it is less likely to generate artefactual clusters - however, clusters may still result from using value sets such as MVS that have the tendency to generate them.


Assuntos
Serviços de Saúde Comunitária/normas , Doenças Musculoesqueléticas/reabilitação , Enfermeiras Clínicas/normas , Modalidades de Fisioterapia/normas , Inquéritos e Questionários/normas , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Análise por Conglomerados , Serviços de Saúde Comunitária/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Musculoesqueléticas/epidemiologia , Enfermeiras Clínicas/estatística & dados numéricos , Modalidades de Fisioterapia/estatística & dados numéricos , Inquéritos e Questionários/estatística & dados numéricos , Adulto Jovem
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