Your browser doesn't support javascript.
Mostrar: 20 | 50 | 100
Resultados 1 - 20 de 12.720
Filtrar
2.
N C Med J ; 81(1): 14-22, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-31908326

RESUMO

BACKGROUND The Zika virus (ZIKV) epidemic that began in 2015 presented a risk for ZIKV infection among persons who traveled to ZIKV-affected countries. Latinas in North Carolina and their sexual partners may be exposed to ZIKV when traveling to these regions.METHODS We administered a cross-sectional survey, measuring ZIKV risk and knowledge, to a convenience sample of 262 reproductive-age Latinas attending a Federally Qualified Health Center in rural North Carolina. We described ZIKV risk and knowledge in the sample, and compared responses between those who were pregnant or recently pregnant, and those who were not pregnant. We further identified factors associated with 1) awareness of ZIKV and 2) high knowledge of ZIKV sequelae and prevention among those who were aware of ZIKV, using log-binomial regression.RESULTS Two-thirds of participants had ever heard of ZIKV, which was positively associated with educational attainment. Most participants aware of ZIKV had moderate/high knowledge of ZIKV transmission (92.5%) and symptoms (73.2%), but knowledge of preventing sexual and congenital transmission was limited. Travel was infrequent among pregnant or recently pregnant participants (5.4%) and their partners (7.1%). Despite low risk for ZIKV infection, participants were willing to practice ZIKV prevention.LIMITATIONS Our study is limited by a lack of generalizability to Latinas in other regions of the country, self-reporting bias, and lack of survey validation as an indicator of English language proficiency.CONCLUSIONS Providers should identify patients likely to become pregnant and travel to high-risk areas, inquire about partner travel history, and offer culturally appropriate ZIKV risk counseling.


Assuntos
Conhecimentos, Atitudes e Prática em Saúde/etnologia , Hispano-Americanos/psicologia , Doença Relacionada a Viagens , Infecção por Zika virus/etnologia , Estudos Transversais , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , North Carolina , Gravidez , Fatores de Risco , Serviços de Saúde Rural
3.
Medicine (Baltimore) ; 98(45): e17709, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31702622

RESUMO

BACKGROUND: The rising maternal and child healthcare costs and the lack of training and educational resources for healthcare workers have reduced service quality in primary health centers of China. We sought to compare strategies promoting healthcare service utilization in rural western China. METHOD: A randomized community trial was carried out in Zhen'an country between 2007 and 2009. Two cross-sectional surveys were conducted to compare the outcomes of financial subsidy for pregnant women seeking antenatal care and clinical training provided to healthcare workers by difference-in-difference estimation. RESULTS: In all, 1113 women completed the questionnaires. The proportion of postnatal visits increased three times in the training group, reaching 35.7%. The number of women who received advice from their doctors regarding nutrition and warning signs necessitating immediate medical attention also improved significantly (5.8% and 8.2%, respectively). Furthermore, the percentage of women who underwent blood tests increased significantly to 19.5% in the training group. Compared to the financial group, the training group had more women who breastfed for longer than 4 months (15.8%) and provided timely complementary feeding (8.9%). CONCLUSION: The training intervention appeared to have improved prenatal care utilization. Essential obstetric training helped enhance knowledge and self-efficacy among healthcare workers.


Assuntos
Pessoal de Saúde/educação , Serviços de Saúde Materna/economia , Serviços de Saúde Rural/economia , Estudos Transversais , Feminino , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Gravidez , Autoeficácia , Inquéritos e Questionários
4.
BMC Public Health ; 19(1): 1415, 2019 Oct 29.
Artigo em Inglês | MEDLINE | ID: mdl-31664981

RESUMO

BACKGROUND: Appropriate contraceptive use remains a major health challenge in rural Jordan. The Japan International Cooperation Agency implemented a project aimed at enhancing the capacity of village health centers (VHCs) to improve the quality and quantity of family planning (FP) services in rural Jordan in 2016-2018. Facility- and community-based approaches were integrated into the interventions. We evaluated the project's impacts on contraceptive behaviors and the effectiveness of the two approaches. METHODS: We used a difference-in-differences analysis based on the project baseline and endline surveys, and logistic regression analysis to assess associations between eight primary outcomes and three secondary outcomes (impacts). The unit of intervention was five target VHCs; the unit of analysis was currently married women of reproductive age (15-49 years) in five intervention and five control villages. RESULTS: Overall, 2061 married women participated; 83.8% were in need of FP. Compared with the control villages, significant effects, ranging from + 0.4% points (pp) to + 11.5 pp., were observed in the intervention villages for six primary outcomes in these categories: increasing the use of FP services at VHCs, participation in health promotion activities, and changing the sources of reproductive health information. There was a trend toward improved secondary outcomes in the intervention villages, but no significant differences were observed between the intervention and control villages regarding modern contraceptive use (mCU; + 4.3 pp), traditional contraceptive use (tCU; - 0.5 pp), and spousal agreement on contraception (+ 5.1 pp). mCU was positively associated with five primary outcomes: obtaining contraceptives at VHCs [adjusted odds ratio (AOR) 3.44, 95% confidence interval (CI) 1.26-9.40], education sessions at VHC (AOR 7.41, 95% CI 1.60-34.39), health activities in communities (AOR 7.41, 95% CI 3.28-16.78), counseling by private doctor/clinic (AOR 0.62, 95% CI 0.40-0.97), and information gained through TV (AOR 0.50, 95% CI 0.32-0.76). Spousal agreement on contraception showed similar positive trends. tCU was associated only with TV. CONCLUSIONS: The project had impacts on increased mCU and husbands' perception of contraception in rural Jordan. The integration of facility- and community-based approaches may be effective in shifting from tCU to mCU in other rural areas.


Assuntos
Comportamento Contraceptivo/estatística & dados numéricos , Serviços de Planejamento Familiar/organização & administração , Serviços de Saúde Rural/organização & administração , População Rural , Adolescente , Adulto , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Jordânia , Estado Civil/estatística & dados numéricos , Pessoa de Meia-Idade , População Rural/estatística & dados numéricos , Adulto Jovem
5.
BMC Health Serv Res ; 19(1): 709, 2019 Oct 17.
Artigo em Inglês | MEDLINE | ID: mdl-31623609

RESUMO

BACKGROUND: With rural population aging there are growing numbers of people with dementia in rural and remote settings. The role of primary health care (PHC) is critical in rural locations, yet there is a lack of rural-specific PHC models for dementia, and little is known about factors influencing the development, implementation, and sustainability of rural PHC interventions. Using a community-based participatory research approach, researchers collaborated with a rural PHC team to co-design and implement an evidence-based interdisciplinary rural PHC memory clinic in the Canadian province of Saskatchewan. This paper reports barriers and facilitators to developing, implementing, and sustaining the intervention. METHODS: A qualitative longitudinal process evaluation was conducted over two and half years, from pre- to post-implementation. Data collection and analyses were guided by the Consolidated Framework for Implementation Research (CFIR) which consists of 38 constructs within five domains: innovation characteristics, outer setting, inner setting, individual characteristics, and process. Data were collected via focus groups with the PHC team and stakeholders, smaller team workgroup meetings, and team member interviews. Analysis was conducted using a deductive approach to apply CFIR codes to the data and an inductive analysis to identify barriers and facilitators. RESULTS: Across all domains, 14 constructs influenced development and implementation. Three domains (innovation characteristics, inner setting, process) were most important. Facilitators were the relative advantage of the intervention, ability to trial on a small scale, tension for change, leadership engagement, availability of resources, education and support from researchers, increased self-efficacy, and engagement of champions. Barriers included the complexity of multiple intervention components, required practice changes, lack of formal incentive programs, time intensiveness of modifying the EMR during iterative development, lack of EMR access by all team members, lack of co-location of team members, workload and busy clinical schedules, inability to justify a designated dementia care manager role, and turnover of PHC team members. CONCLUSIONS: The study identified key factors that supported and hindered the development and implementation of a rural-specific strategy for dementia assessment and management in PHC. Despite challenges related to the rural context, the researcher-academic partnership was successful in developing and implementing the intervention.


Assuntos
Demência/terapia , Acesso aos Serviços de Saúde , Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Feminino , Grupos Focais , Humanos , Estudos Longitudinais , Masculino , Pesquisa Qualitativa , Saskatchewan
6.
Rev Infirm ; 68(254): 33-35, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31587850

RESUMO

Many rural areas, far from hospitals, are seeing a decline in the number of general practitioners, making it more difficult for patients in these regions to access care. However, there are relevant solutions, as illustrated by the Dousopal network in Normandy, which, teaming up with home care providers, contributes to organising palliative care support for all, in optimal conditions.


Assuntos
Cuidados Paliativos/organização & administração , Serviços de Saúde Rural/organização & administração , França , Clínicos Gerais/provisão & distribução , Acesso aos Serviços de Saúde , Serviços de Assistência Domiciliar/organização & administração , Humanos
7.
BMC Health Serv Res ; 19(1): 758, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655576

RESUMO

BACKGROUND: Despite a national focus on closing the gap between Aboriginal and non-Aboriginal child health outcomes in Australia, there remain significant challenges, including provision of health services in very remote communities. We aimed to identify and map child health services in the very remote Fitzroy Valley, West Kimberley, and document barriers to effective service delivery. METHODS: Identification and review of all regional child health services and staffing in 2013. Verification of data by interview with senior managers and staff of key providers in the Western Australian Country Health Service, Kimberley Population Health Unit, Nindilingarri Cultural Health Services and non-government providers. RESULTS: We identified no document providing a comprehensive overview of child health services in the Fitzroy Valley. There were inadequate numbers of health professionals, facilities and accommodation; high staff turnover; and limited capacity and experience of local health professionals. Funding and administrative arrangements were complex and services poorly coordinated and sometimes duplicated. The large geographic area, distances, extreme climate and lack of public and private transport challenge service delivery. The need to attend to acute illness acts to deprioritise crucial primary and preventative health care and capacity for dealing with chronic, complex disorders. Some services lack cultural safety and there is a critical shortage of Aboriginal Health Workers (AHW). CONCLUSIONS: Services are fragmented and variable and would benefit from a coordinated approach between government, community-controlled agencies, health and education sectors. A unifying model of care with emphasis on capacity-building in Aboriginal community members and training and support for AHW and other health professionals is required but must be developed in consultation with communities. Innovative diagnostic and care models are needed to address these challenges, which are applicable to many remote Australian settings outside the Fitzroy Valley, as well as other countries globally. Our results will inform future health service planning and strategies to attract and retain health professionals to work in these demanding settings. A prospective audit of child health services is now needed to inform improved planning of child health services with a focus on identifying service gaps and training needs and better coordinating existing services to improve efficiency and potentially also efficacy.


Assuntos
Serviços de Saúde da Criança/organização & administração , Serviços de Saúde do Indígena/organização & administração , Serviços de Saúde Rural/organização & administração , Criança , Pesquisa sobre Serviços de Saúde , Humanos , Austrália Ocidental
8.
BMC Health Serv Res ; 19(1): 756, 2019 Oct 26.
Artigo em Inglês | MEDLINE | ID: mdl-31655588

RESUMO

BACKGROUND: Village Health and Nutrition Days (VHNDs) are a cornerstone of the Government of India's strategy to provide first-contact primary health care to rural areas. Recent government programmes such as the Janani Suraksha Yojana (JSY) and Mission Indradhanush (MI) have catalysed important changes impacting VHNDs. To learn how VHNDs are currently being delivered, we assessed the fidelity of services provided as compared to government norms in a priority district of Uttar Pradesh. METHODS: We fielded a cross-sectional study of VHNDs to provide a snapshot of health services functioning. Process evaluation data were collected via administrative sources, non-participant observation using a standardised form, and structured questionnaires. Questionnaires were designed using a framework to assess implementation fidelity. Key respondents were VHND participants, front-line workers involved in VHND delivery, and VHND non-participants (pregnant women due for antenatal care or children due for vaccination as per administrative records). Results were summarised as counts, frequencies, and proportions. RESULTS: In the 30 villages randomly selected for inclusion, 36 VHNDs were scheduled but four (11.1%) were cancelled and one VHND was not surveyed. Vaccination and antenatal care were offered at 96.8% (30/31) and child weighing at 83.9% (26/31) of VHNDs. Other normed services were infrequently provided or completely absent. Health education and promotion were particularly weak; institutional delivery was the only topic discussed in a majority of VHNDs. The true proportion of any serious problem impeding vaccine delivery was 47.2% (17/36), comprising 4 VHND cancellations and 13 VHNDs experiencing vaccine shortages. Of the 13 incidents of vaccine shortage, 11 related to an unexpected global shortage of injectable polio vaccine (IPV). Over the 31 VHNDs, 37.8% (171 of the 452 scheduled beneficiaries) did not participate. Analysis of missed opportunities for vaccination highlighted inaccuracies in beneficiary identification and tracking and demand side-factors. CONCLUSIONS: The transformative potential of VHNDs to improve population health is only partially being met. A core subset of high-priority services for antenatal care, institutional delivery, and vaccination associated with high-priority government programmes (JSY, MI) is now being provided quite successfully. Other basic health promotion and prevention services are largely not provided, constituting a critical missed opportunity.


Assuntos
Transtornos da Nutrição Infantil/prevenção & controle , Serviços de Saúde Materno-Infantil/organização & administração , Serviços de Saúde Rural/organização & administração , Saúde da População Rural/estatística & dados numéricos , Adulto , Criança , Transtornos da Nutrição Infantil/epidemiologia , Estudos Transversais , Feminino , Pesquisa sobre Serviços de Saúde , Humanos , Índia/epidemiologia , Masculino , Gravidez , Cuidado Pré-Natal/organização & administração , Inquéritos e Questionários , Vacinação
10.
MMW Fortschr Med ; 161(Suppl 6): 9-14, 2019 Oct.
Artigo em Alemão | MEDLINE | ID: mdl-31587169

RESUMO

BACKGROUND: Shortage of general practitioners (GPs), especially in rural areas, is an increasing problem for the German healthcare system. Different approaches are pursued to counteract this development. The study HaMEdSi (Hausärzte (GPs) for Medical Education in Siegen-Wittgenstein) among other things examines the occupational perspectives of the GPs depending on their surgeries' characteristics and draws a realistic picture of how primary care in the region of Siegen-Wittgenstein, representative for many rural regions, will develop over the next few years. METHOD: A survey was conducted among GPs in the region of Siegen-Wittgenstein. This area is a representative rural region in Germany. GPs were amongst other assessed regarding their demographic characteristics and working perspectives. RESULTS: A representative number of GPs took part in the study (n = 85, 54%). For instance, 50.6% of the study participants will no longer be working in practice in 10 years from now and 25% of them assume that their practices be closed after the age-related retirement due to a lack of successor. CONCLUSIONS: The situation in rural areas in reality looks worse than previously estimated in the assessments of the Statutory Health Insurance. Something must be done here to mitigate the impending GPs' shortage. Measures such as promotion of training, employment or settlement in undersupplied regions as well as cross-border promotion, could on the long term compensate for the shortage that threatens many rural regions in Germany.


Assuntos
Educação Médica , Clínicos Gerais , Serviços de Saúde Rural , Clínicos Gerais/provisão & distribução , Clínicos Gerais/tendências , Alemanha , Humanos , Atenção Primária à Saúde , Aposentadoria
11.
J Stroke Cerebrovasc Dis ; 28(11): 104358, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31519456

RESUMO

BACKGROUND: The majority of studies on multimorbidity have been in aging populations and there is a paucity of data on individuals following stroke. OBJECTIVE: In order to better understand the overall complexity of the stroke population in rural Kentucky, we examined the prevalence of multimorbidity that impact the overall long-term health and health care for these individuals. METHODS: A secondary analysis examined whether there are gender or age differences in this stroke population related to the prevalence of multimorbidity. A total of 5325 individuals, 18 years of age and older, seen at an academic medical center for the primary diagnosis of acute ischemic stroke or transient ischemic attack between the years of 2010-2017 were identified using the Kentucky Appalachian Stroke Registry. Descriptive analysis was used to report the prevalence of each comorbidity in the rural population by age group, gender, and level of multimorbidity by looking at concurrent frequencies. RESULTS: Overall, hypertension, dyslipidemia, tobacco use, diabetes, and obesity were the comorbidities with the highest prevalence in our population irrespective of gender. Over 78% (n = 4153) of the individuals had 3 or more comorbidities while 61% (n = 3285) had at least 3 out of the top 5 comorbidities (hypertension, hyperlipidemia, tobacco, obesity, diabetes). With respect to age, 15% (n = 795) of the sample was under the age of 50, while 32% (n = 1704) were between the age of 50 and 64 and 53% (n = 2826) of the sample were 65 years or older. CONCLUSIONS: The results of this study indicate the majority of individuals affected by stroke in rural Appalachia Kentucky have multimorbidity. In addition, almost half of these individuals are having their strokes at a younger age, which will require a shift in the focus for therapeutic interventions (eg, reintegration into the workforce versus just community reintegration).


Assuntos
Ataque Isquêmico Transitório/epidemiologia , Multimorbidade , Saúde da População Rural , Acidente Vascular Cerebral/epidemiologia , Idade de Início , Idoso , Região dos Apalaches/epidemiologia , Feminino , Nível de Saúde , Humanos , Ataque Isquêmico Transitório/diagnóstico , Ataque Isquêmico Transitório/terapia , Masculino , Pessoa de Meia-Idade , Prevalência , Sistema de Registros , Medição de Risco , Fatores de Risco , Serviços de Saúde Rural , Fatores Sexuais , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/terapia , Reabilitação do Acidente Vascular Cerebral
12.
Fam Med ; 51(8): 649-656, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31509216

RESUMO

BACKGROUND AND OBJECTIVES: Family medicine rural training track (RTT) residency programs produce a higher proportion of graduates who choose rural practice than other programs, yet RTTs face continuing threats to their existence. This study sought to understand threats to RTT sustainability and resilience factors that enable RTTs to thrive. METHODS: In 2014 and 2015, the authors conducted semistructured interviews of 21 RTT leaders representing two closed programs and 22 functioning programs. Interview topics included program strengths providing resilience and sustainability, risk factors for closure or vulnerabilities threatening sustainability, and advice for other RTTs. The authors performed a content analysis, coding pertinent themes in all interview data. RESULTS: From the top three assets, risks, and advice that respondents offered, the following nine themes emerged, in order from most to least mentioned: leadership, faculty and teaching resources, program support, finances, resident recruitment, program attributes, program mission, political and environmental context, and patient-related clinical experiences. Interviewees frequently reported multifactorial causes for RTT sustainability or closure. CONCLUSIONS: Numerous factors identified, such as distance, can operate as positive or negative influences for program resilience, depending on place and context. Resilience depends on multiple forms of social capital, including robust networks among individuals and various communities: the local population and patients, local health care providers, residency faculty, and RTTs in general. The small size and remoteness of RTTs make them vulnerable to multiple challenges in finances, regulations, and accreditation, requiring program adaptability and suggesting the need for flexibility in the policies that govern them.


Assuntos
Medicina de Família e Comunidade/educação , Internato e Residência , Área de Atuação Profissional/tendências , Educação de Pós-Graduação em Medicina , Medicina de Família e Comunidade/tendências , Humanos , Entrevistas como Assunto , Liderança , Fatores de Risco , Serviços de Saúde Rural/tendências
13.
Artigo em Inglês | MEDLINE | ID: mdl-31547407

RESUMO

Global concerns persist regarding the shortage and misdistribution of health workers in rural and remote areas. Medical education is an important input channel of human resources for health. This study aimed to identify the association between medical graduates' job choices for rural practice and their initial intentions when they began to look for a job in China. Data were extracted from a cross-sectional survey among medical students in ten western provinces in China in 2013. Only medical students who were in the last year of study (i.e., medical graduates) and had found a job were included in this study. Of the 482 participants, 61.04% (293) presented an initial intention of rural practice when they began to look for a job, and 68.88% (332) made a final job choice for rural practice. However, of the 332 graduates with a final job choice of rural practice, only 213 (64.55%) had an initial intention. A univariate association was identified in which medical graduates who were more likely to make final job choices for rural practice were those having initial intentions (OR: 1.59; 95% CI: 1.08-2.36); however, after adjusting for controlled variables, it became insignificant and was reduced to a 1.31-fold increase (95% CI: 0.82-2.07). The initial intentions of medical graduates are not assurance of ultimate job outcomes, and it cannot be deduced that all medical graduates who made a final job choice for rural practice had authentic desires for rural practice. Twenty years of age or below, low-income families, majoring in non-clinical medicine, and studying in a junior medical college or below were associated with medical graduates' final job choices for rural practice. More studies are required on how to translate medical student's intention of rural medical practice into reality and how to retain these graduates via a job choice in rural practice in the future.


Assuntos
Escolha da Profissão , Intenção , Serviços de Saúde Rural/estatística & dados numéricos , Estudantes de Medicina/psicologia , China , Estudos Transversais , Feminino , Humanos , Masculino , Estudantes de Medicina/estatística & dados numéricos , Adulto Jovem
14.
BMC Health Serv Res ; 19(1): 675, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533696

RESUMO

BACKGROUND: The Ghana Community-based Health Planning and Services (CHPS) initiative is a national strategy for improving access to primary health care services for underserved communities. Following a successful trial in the North Eastern part of the country, CHPS was adopted as Ghana's flagship programme for achieving the Universal Health Coverage. Recent empirical evidence suggests, however, that scale-up of CHPS has not necessarily replicated the successes of the pilot study. This study examines the community's perspective of the performance of CHPS and how the scale up could potentially align with the original experimental study. METHOD: Applying a qualitative research methodology, this study analysed transcripts from 20 focus group discussions (FGDs) in four functional CHPS zones in separate districts of the Northern and Volta Regions of Ghana to understand the community's assessment of CHPS. The study employed the thematic analysis to explore the content of the CHPS service provision, delivery and how community members feel about the service. In addition, ordinary least regression model was applied in interpreting 126 scores consigned to CHPS by the study respondents. RESULTS: Two broad areas of consensus were observed: general favourable and general unfavourable thematic areas. Favourable themes were informed by approval, appreciation, hard work and recognition of excellent services. The unfavourable thematic area was informed by rudeness, extortion, inappropriate and unprofessional behaviour, lack of basic equipment and disappointments. The findings show that mothers of children under the age of five, adolescent girls without children, and community leaders generally expressed favourable perceptions of CHPS while fathers of children under the age of five and adolescent boys without children had unfavourable expressions about the CHPS program. A narrow focus on maternal and child health explains the demographic divide on the perception of CHPS. The study revealed wide disparities in actual CHPS deliverables and community expectations. CONCLUSIONS: A communication gap between health care providers and community members explains the high and unrealistic expectations of CHPS. Efforts to improve program acceptability and impact should address the need for more general outreach to social networks and men rather than a sole focus on facility-based maternal and child health care.


Assuntos
Atenção Primária à Saúde/organização & administração , Serviços de Saúde Rural/organização & administração , Adolescente , Adulto , Criança , Pai/estatística & dados numéricos , Feminino , Gana , Pessoal de Saúde , Humanos , Masculino , Mães/estatística & dados numéricos , Projetos Piloto , Cobertura Universal do Seguro de Saúde/organização & administração
15.
Artigo em Inglês | MEDLINE | ID: mdl-31540046

RESUMO

The proportion of migrating females has increased, and more often, old females are left in rural regions. Resources are needed to provide suitable hospitalization service to females in underdeveloped rural regions. Using multi-stage hierarchical cluster random sampling method, nine towns from three counties were enrolled in five-time points between 2006 and 2014 in this study. The research subjects of this study were females age 15 and up. Data regarding the utilization of inpatient services were collected and analyzed. Complex sampling logistic regression was conducted to analyze influencing factors. This study reveals that for both permanent females and migrant females, the older their age, the higher their hospitalization rate. The utilization of hospitalization service for permanent females was associated with the occurrence of chronic diseases (adjusted Odds Ratio (aOR) = 5.402). In addition, permanent females suffering from chronic diseases were more likely to avoid hospitalization despite their doctor's advice (aOR = 34.657) or leave the hospital early against medical advice (AMA) (aOR = 10.009). Interventions to combat chronic diseases and adjust compensation schemes for permanent females need to be provided.


Assuntos
Utilização de Instalações e Serviços , Hospitalização/estatística & dados numéricos , Serviços de Saúde Rural/estatística & dados numéricos , População Rural/estatística & dados numéricos , Migrantes/estatística & dados numéricos , Adolescente , Adulto , Doença Crônica , Feminino , Humanos , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Inquéritos e Questionários , Adulto Jovem
17.
Am J Health Syst Pharm ; 76(6): 387-397, 2019 02 21.
Artigo em Inglês | MEDLINE | ID: mdl-31415684

RESUMO

PURPOSE: As a preliminary evaluation of the outcomes of implementing pharmacogenetic testing within a large rural healthcare system, patients who received pre-emptive pharmacogenetic testing and warfarin dosing were monitored until June 2017. SUMMARY: Over a 20-month period, 749 patients were genotyped for VKORC1 and CYP2C9 as part of the electronic Medical Records and Genomics Pharmacogenetics (eMERGE PGx) study. Of these, 27 were prescribed warfarin and received an alert for pharmacogenetic testing pertinent to warfarin; 20 patients achieved their target international normalized ratio (INR) of 2.0-3.0, and 65% of these patients achieved target dosing within the recommended pharmacogenetic alert dose (± 0.5 mg/day). Of these, 10 patients had never been on warfarin prior to the alert and were further evaluated with regard to time to first stable target INR, bleeds and thromboembolic events, hospitalizations, and mortality. There was a general trend of faster time to first stable target INR when the patient was initiated at a warfarin dose within the alert recommendation versus a dose outside of the alert recommendation with a mean (± SD) of 34 (± 28) days versus 129 (± 117) days, respectively. No trends regarding bleeds, thromboembolic events, hospitalization, or mortality were identified with respect to the pharmacogenetic alert. The pharmacogenetic alert provided pharmacogenetic dosing information to prescribing clinicians and appeared to deploy appropriately with the correct recommendation based upon patient genotype. CONCLUSION: Implementing pharmacogenetic testing as a standard of care service in anticoagulation monitoring programs may improve dosage regimens for patients on anticoagulation therapy.


Assuntos
Anticoagulantes/administração & dosagem , Monitoramento de Medicamentos/métodos , Testes Farmacogenômicos , Serviços de Saúde Rural/organização & administração , Varfarina/administração & dosagem , Idoso , Anticoagulantes/efeitos adversos , Fibrilação Atrial/tratamento farmacológico , Coagulação Sanguínea/efeitos dos fármacos , Relação Dose-Resposta a Droga , Feminino , Genótipo , Implementação de Plano de Saúde , Hemorragia/sangue , Hemorragia/induzido quimicamente , Humanos , Coeficiente Internacional Normatizado , Masculino , Pessoa de Meia-Idade , Variantes Farmacogenômicos , Avaliação de Programas e Projetos de Saúde , Estudos Retrospectivos , Padrão de Cuidado , Tromboembolia/sangue , Tromboembolia/prevenção & controle , Varfarina/efeitos adversos
18.
Stud Health Technol Inform ; 266: 174-182, 2019 Aug 08.
Artigo em Inglês | MEDLINE | ID: mdl-31397320

RESUMO

Telehealth using high quality satellite internet has been shown to improve health service delivery in three very remote Aboriginal communities, however, further expansion of telehealth in this and other areas of the Northern Territory (NT) is limited by the lack of adequate internet. Despite the growing evidence of the benefits of telehealth there remains limited uptake in the NT in the primary health care sector. A national survey through Broadband for the Bush Alliance (B4BA) and its member organisations into consumers' experiences of telecommunications and telehealth services was done. The survey was supported by detailed case studies based on semi-structured interviews. It was found there were a number of barriers to telehealth uptake at the national level: Lack of adequate internet; consumers not being aware of, or knowing how, to access telehealth; lack of access to clinicians providing telehealth services; lack of Medicare item numbers for telehealth and the lack of resourcing at the patient end. The research indicated there needs to be investment into telecommunications infrastructure, public education about telehealth, an increase in Medicare telehealth item numbers and resourcing for primary health care services to support telehealth expansion particularly in rural, regional and remote areas.


Assuntos
Serviços de Saúde Rural , Telecomunicações , Telemedicina , Austrália , Humanos , Atenção Primária à Saúde , População Rural
19.
BMC Womens Health ; 19(1): 108, 2019 08 09.
Artigo em Inglês | MEDLINE | ID: mdl-31399092

RESUMO

BACKGROUND: Uganda has one of the highest age-standardized incidence rates of cervical cancer in the world. The proportion of Ugandan women screened for cervical cancer is low. To evaluate barriers and facilitators to accessing cervical cancer screening, we performed a systematic review of reported views of Ugandan women and healthcare workers. The aim of this review is to inform development of cervical cancer screening promotional and educational programs to increase screening uptake and improve timely diagnosis for women with symptoms of cervical cancer. METHODS: Fourteen studies that included the views of 4386 women and 350 healthcare workers published between 2006 and 2019 were included. Data were abstracted by two reviewers and findings collated by study characteristics, study quality, and barriers and facilitators. RESULTS: Nineteen barriers and twenty-one facilitators were identified. Study settings included all districts of Uganda, and the quality of included studies was variable. The most frequently reported barriers were embarrassment, fear of the screening procedure or outcome, residing in a remote or rural area, and limited resources / health infrastructure. The most frequent facilitator was having a recommendation to attend screening. CONCLUSION: Understanding the barriers and facilitators to cervical cancer screening encountered by Ugandan women can guide efforts to increase screening rates in this population. Additional studies with improved validity and reliability are needed to produce reliable data so that efforts to remove barriers and enhance facilitators are well informed.


Assuntos
Detecção Precoce de Câncer , Promoção da Saúde , Neoplasias do Colo do Útero/diagnóstico , Constrangimento , Medo , Feminino , Recursos em Saúde/provisão & distribução , Humanos , Pesquisa Qualitativa , Reprodutibilidade dos Testes , Serviços de Saúde Rural/provisão & distribução , Uganda
20.
Medicine (Baltimore) ; 98(32): e16693, 2019 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-31393371

RESUMO

To strengthen rural health services, the Chinese government has launched a series of policies to promote health workforce development. This study aims to understand the current status of village doctors and to explore the factors associated with village doctors' job satisfaction in western China. It also attempts to provide references for further building capacities of village doctors and promoting the development of rural health service policy.A multistage stratified sampling method was used to obtain data from a cross-sectional survey on village doctors across 2 provinces of western China during 2012 to 2013. Quantitative data were collected from village doctors face-to-face, through a self-administered questionnaire.Among the 370 respondents, 225 (60.8%) aged 25 to 44 years, and 268 (72.4%) were covered by health insurance. Their income and working time calculated by workloads were higher than their self-report results. Being healthy, working fewer years, and having government funding and facilities were the positive factors toward their job satisfaction. Village doctors working with government-funded village clinics or facilities were more likely to feel satisfied.Problems identified previously such as low income and lack of insurance, heavy workload and aging were not detected in our study. Instead, village doctors were better-paid and better-covered by social insurance than other local rural residents, with increased job satisfaction. Government policies should pay more attention to improving the quality of rural health services and the income and security system of village doctors, to maintain and increase their job satisfaction and work enthusiasm. Further experimental study could evaluate effects of government input to improve rural health human resources and system development.


Assuntos
Satisfação no Emprego , Médicos/psicologia , Serviços de Saúde Rural/organização & administração , Adulto , Atitude do Pessoal de Saúde , Fortalecimento Institucional , China , Estudos Transversais , Humanos , Serviços de Saúde Rural/legislação & jurisprudência , Autorrelato
SELEÇÃO DE REFERÊNCIAS
DETALHE DA PESQUISA