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1.
Rev Med Liege ; 75(2): 83-88, 2020 Feb.
Artigo em Francês | MEDLINE | ID: mdl-32030931

RESUMO

Facing the aging of primary care practitioners and their still increasing duties, we implemented a new and original solution to maintain the continuity of primary care in the area surrounding of our university hospital. Thereby, we created a new model of nurse telephone triage for the regulation of out-of-hours primary care calls, the SALOMON algorithm ("Système Algorithmique Liégeois d'Orientation pour la Médecine Omnipraticienne Nocturne"). Following the nurse telephone triage and the assessment of the illness severity, the patient is referred to four potential orientations : Emergency Medical Services (EMS), Emergency Department Referred Consultation (EDRC), Primary Care Physician Home visit (PCPH) and Primary Care Physician Delayed visit (PCPD). In this article, we aim to describe the SALOMON model and present a 12-month feasibility study in order to determine the safety of the tool. We can also notice nurse and general practitioner satisfaction about this approach with a positive impact on the global primary care out-of-hour organization. Currently, SALOMON seems to be full of promise. Further investigations on a larger cohort are needed to determine more precisely the reliability of the algorithm.


Assuntos
Serviço Hospitalar de Emergência , Atenção Secundária à Saúde , Triagem , Emergências , Humanos , Reprodutibilidade dos Testes , Telefone
2.
Emergencias (Sant Vicenç dels Horts) ; 32(1): 19-25, feb. 2020. graf, tab
Artigo em Espanhol | IBECS | ID: ibc-185849

RESUMO

Objetivo. La correcta identificación en el primer contacto médico de los pacientes con un síndrome coronario agudo (SCA) es esencial. No existe ninguna escala predictiva para el diagnóstico de SCA en los centros de coordinación de emergencias (CCE) que facilite la toma de decisiones al equipo médico. El objetivo primario es construir y validar una escala de estas características. Método. Estudio prospectivo, observacional, unicéntrico, realizado durante 1 año (2016). Se incluyeron los pacientes que consultaron telefónicamente por dolor torácico no traumático en un CCE. Los pacientes incluidos se repartieron en las muestras de derivación y validación de forma aleatoria. La escala predictiva –escala SCARE– se construyó mediante regresión logística, la discriminación y calibración del modelo se realizó con el cálculo del área bajo la curva (ABC) de la característica operativa del receptor y el test de Hosmer-Lemeshow. Resultado. La muestra de derivación incluyó 902 pacientes y 7 de las variables recogidas se relacionaron con un diagnóstico final de SCA: sexo masculino, edad, tabaquismo, dolor torácico de características típicas, primer episodio de dolor torácico, diaforesis y la intuición del médico que realizó la entrevista telefónica. La utilización de la escala desarrollada en los 465 pacientes de la muestra de validación obtuvo un ABC de 0,81 (intervalo de confianza al 95% 0,76-0,87) y el test de Hosmer-Lemeshow fue de 5,18 (p = 0,74). Conclusión. La escala SCARE mostró una correcta discriminación y calibración. Es necesaria una validación externa multicéntrica antes de implementar su uso en los CCE


Background and objective. Correctly identifying patients with acute coronary syndrome (ACS) on first contact is essential, yet emergency dispatchers currently lack a risk scale that can help predict an ACS diagnosis. Our main aim was to develop and validate such a risk scale. Methods. Prospective, observational single-center study in 2016 (January 1 to December 31). We included patients who called our emergency dispatch center to report nontraumatic chest pain. Included patients were randomly assigned to a development or a validation sample. The predictive SCARE scale was built with logistic regression analysis. Discrimination and calibration were analyzed by calculating the area under the receiver operating characteristic curve; calibration was assessed with the Hosmer-Lemeshow test. Results. The development sample included 902 patients. The regression model identified 7 variables associated with a final diagnosis of ACS: male sex, age, smoking, typical pain characteristics, first episode of chest pain, diaphoresis, and physician intuition (the teledispatcher’s suspicion). When we applied the scale in the validation sample of 465 patients the area under the curve was 0.81 (95% CI, 0.76-0.87). The Hosmer-Lemeshow statistic was 5.18 (P=.74). Conclusions. The SCARE scale had good discrimination and calibration properties. The scale should be further validated in an external sample from a multicenter study before it is implemented by emergency dispatch centers


Assuntos
Humanos , Masculino , Adulto , Pessoa de Meia-Idade , Síndrome Coronariana Aguda/diagnóstico , Serviços Médicos de Emergência/métodos , Técnicas de Apoio para a Decisão , Dor no Peito/diagnóstico , Estudos Prospectivos , Valor Preditivo dos Testes , Telefone/estatística & dados numéricos , Modelos Logísticos , Intuição , Inquéritos e Questionários
3.
JAMA ; 323(2): 140-148, 2020 01 14.
Artigo em Inglês | MEDLINE | ID: mdl-31935026

RESUMO

Importance: Guidelines endorsing vegetable-enriched diets to improve outcomes for prostate cancer survivors are based on expert opinion, preclinical studies, and observational data. Objective: To determine the effect of a behavioral intervention that increased vegetable intake on cancer progression in men with early-stage prostate cancer. Design, Setting, and Participants: The Men's Eating and Living (MEAL) Study (CALGB 70807 [Alliance]) was a randomized clinical trial conducted at 91 US urology and medical oncology clinics that enrolled 478 men aged 50 to 80 years with biopsy-proven prostate adenocarcinoma (International Society of Urological Pathology grade group = 1 in those <70 years and ≤2 in those ≥70 years), stage cT2a or less, and serum prostate-specific antigen (PSA) level less than 10 ng/mL. Enrollment occurred from January 2011 to August 2015; 24-month follow-up occurred from January 2013 to August 2017. Interventions: Patients were randomized to a counseling behavioral intervention by telephone promoting consumption of 7 or more daily vegetable servings (MEAL intervention; n = 237) or a control group, which received written information about diet and prostate cancer (n = 241). Main Outcomes and Measures: The primary outcome was time to progression; progression was defined as PSA level of 10 ng/mL or greater, PSA doubling time of less than 3 years, or upgrading (defined as increase in tumor volume or grade) on follow-up prostate biopsy. Results: Among 478 patients randomized (mean [SD] age, 64 [7] years; mean [SD] PSA level, 4.9 [2.1] ng/mL), 443 eligible patients (93%) were included in the primary analysis. There were 245 progression events (intervention: 124; control: 121). There were no significant differences in time to progression (unadjusted hazards ratio, 0.96 [95% CI, 0.75 to 1.24]; adjusted hazard ratio, 0.97 [95% CI, 0.76 to 1.25]). The 24-month Kaplan-Meier progression-free percentages were 43.5% [95% CI, 36.5% to 50.6%] and 41.4% [95% CI, 34.3% to 48.7%] for the intervention and control groups, respectively (difference, 2.1% [95% CI, -8.1% to 12.2%]). Conclusions and Relevance: Among men with early-stage prostate cancer managed with active surveillance, a behavioral intervention that increased vegetable consumption did not significantly reduce the risk of prostate cancer progression. The findings do not support use of this intervention to decrease prostate cancer progression in this population, although the study may have been underpowered to identify a clinically important difference. Trial Registration: ClinicalTrials.gov Identifier: NCT01238172.


Assuntos
Aconselhamento , Neoplasias da Próstata/dietoterapia , Verduras , Conduta Expectante , Idoso , Idoso de 80 Anos ou mais , Progressão da Doença , Humanos , Masculino , Pessoa de Meia-Idade , Estadiamento de Neoplasias , Antígeno Prostático Específico/sangue , Neoplasias da Próstata/patologia , Neoplasias da Próstata/terapia , Telefone
4.
Br J Nurs ; 28(19): 1234-1238, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31680571

RESUMO

INTRODUCTION: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.


Assuntos
Assistência ao Convalescente/organização & administração , Neoplasias Colorretais/cirurgia , Enfermeiras Especialistas , Telefone , Difusão de Inovações , Pesquisa sobre Serviços de Saúde , Humanos , Medicina Estatal/organização & administração , Reino Unido
5.
Health Serv Res ; 54 Suppl 2: 1409-1418, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31667831

RESUMO

OBJECTIVE: To examine experiences of racial/ethnic discrimination among Latinos in the United States, which broadly contribute to their poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 803 Latinos and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. METHODS: We calculated the percent of Latinos reporting discrimination in several domains, including health care. We used logistic regression to compare the Latino-white difference in odds of discrimination, and among Latinos only to examine variation by socioeconomic status and country of birth. PRINCIPAL FINDINGS: One in five Latinos (20 percent) reported experiencing discrimination in clinical encounters, while 17 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Latinos also reported experiencing discrimination with employment (33 percent applying for jobs; 32 percent obtaining equal pay/promotions), housing (31 percent), and police interactions (27 percent). In adjusted models, Latinos had significantly higher odds than whites for reporting discrimination in health care visits (OR: 3.18, 95% CI: 1.61, 6.26) and across several other domains. Latinos with college degrees had significantly higher odds of reporting discrimination in multiple domains than those without college degrees, with few differences between foreign-born and US-born Latinos. CONCLUSIONS: Latinos in the United States report experiencing widespread discrimination in health care and other areas of their lives, at significantly higher levels than whites. Being born in the United States and earning a college degree are not protective against discrimination, suggesting that further health and social policy efforts to eliminate discrimination are needed.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Hispano-Americanos/estatística & dados numéricos , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Fatores Socioeconômicos , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/psicologia , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos
6.
BMJ ; 367: l4962, 2019 11 04.
Artigo em Inglês | MEDLINE | ID: mdl-31685480

RESUMO

The studyEveritt H, Landau G, Little P. Therapist telephone-delivered CBT and web-based CBT compared with treatment as usual in refractory irritable bowel syndrome: the ACTIB three-arm RCT. Health Technol Assess 2019;23:1-154.This project was funded by the NIHR Health Technology Assessment Programme (project number 11/69/02).To read the full NIHR Signal, go to https://discover.dc.nihr.ac.uk/content/signal-000784/irritable-bowel-syndrome-helped-by-telephone-or-internet-cbt.


Assuntos
Síndrome do Intestino Irritável , Humanos , Internet , Fonoterapia , Avaliação da Tecnologia Biomédica , Telefone
7.
Medicine (Baltimore) ; 98(44): e17552, 2019 Nov.
Artigo em Inglês | MEDLINE | ID: mdl-31689758

RESUMO

This study aimed to investigate the effect of comprehensive education and care (CEC) program on anxiety, depression, quality of life, and survival in patients with hepatocellular carcinoma (HCC) who underwent surgical resection.Totally 136 patients with HCC who underwent hepatectomy were randomly assigned to CEC group and control group as 1:1 ratio. CEC group received health education, psychological nursing, caring activity, and telephone condolence, whereas control group received basic health education and rehabilitation for 12 months. Anxiety and depression were assessed by Hospital Anxiety and Depression Scale (HADS); quality of life was evaluated using European Organization for Research and Treatment of Cancer Quality of Life Questionnaire (QLQ-C30).HADS-Anxiety (HADS-A) score was decreased at 9 month (M9) and M12, and reduction in HADS-A score (M12-M0) was greater in CEC group compared with control group. At M12, percentage of anxiety patients was less, but anxiety severity was similar in CEC group compared with control group. HADS-Depression (HADS-D) score was decreased at M12, and reduction in HADS-D score (M12-M0) was greater in CEC group compared with control group. At M12, percentage of depression patients were less but depression severity was similar in CEC group compared with control group. In addition, QLQ-C30 global health status and functional score was increased at M12, and score improvement (M12-M0) was greater in CEC group compared with control group. In addition, overall survival was longer in CEC group compared with control group.CEC relieves anxiety and depression, improves quality of life, and prolongs survival in patients with HCC underwent surgical resection.


Assuntos
Ansiedade/terapia , Carcinoma Hepatocelular/psicologia , Aconselhamento/métodos , Depressão/terapia , Neoplasias Hepáticas/psicologia , Educação de Pacientes como Assunto/métodos , Adulto , Idoso , Carcinoma Hepatocelular/reabilitação , Carcinoma Hepatocelular/cirurgia , Feminino , Nível de Saúde , Humanos , Neoplasias Hepáticas/reabilitação , Neoplasias Hepáticas/cirurgia , Masculino , Pessoa de Meia-Idade , Psicoterapia de Grupo/métodos , Qualidade de Vida , Telefone
8.
Actas dermo-sifiliogr. (Ed. impr.) ; 110(9): 744-751, nov. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185566

RESUMO

Antecedentes y objetivos: Tanto el eccema como la urticaria son enfermedades inflamatorias de la piel. La prevalencia de ambas varía a lo largo de todo el mundo y se desconocen las razones de este hecho. Nuestro objetivo es investigar la prevalencia del eccema y la urticaria en la población portuguesa adulta (≥ 16 años). Materiales y métodos: Se realizó una encuesta telefónica en el último trimestre de 2017. Para calcular las prevalencias, los individuos debían haber sido diagnosticados previamente, por un profesional sanitario, de eccema/urticaria, ser mayores de 16 años y residir en Portugal. La muestra era aproximadamente representativa de la población, región, sexo y grupo de edad. La ratio de odds se empleó para medir las asociaciones con la prevalencia. Se utilizó el software SPSS Statistics, y aquellos datos con un valor p < 0,005 con un intervalo de confianza del 95% fueron considerados estadísticamente significativos. Resultados: Se analizaron 5.000 llamadas telefónicas. La prevalencia en Portugal del eccema y la urticaria es del 4,4% y 3,4%, respectivamente. El Algarve es la región en la que la prevalencia de ambas enfermedades es más alta. Ser mujer es el factor que más influyó en estas enfermedades, con una OR = 1,99 (p < 0,001; IC: 1,49-2,66) para el eccema y OR = 1,73 (p = 0,001; IC: 1,25-2,40) para la urticaria, siendo las prevalencias también más altas (5,7% y 4,2%, respectivamente). Conclusiones: Las prevalencias encontradas son más altas que las observadas en estudios anteriores en Portugal y comparables a los resultados procedentes de otros países. Las comparativas de la prevalencia en el eccema se ven afectadas por varios obstáculos. En cuanto a la urticaria, nuestros resultados parecen estar en consonancia con otros. Ser mujer con eccema y urticaria es más frecuente y representa un factor de riesgo más alto que el ser hombre. De acuerdo con Harrop et al., 2007, en Europa, el eccema atópico supone el 0,14-0,60% del eccema total. En este sentido, podemos estimar que la prevalencia del eccema atópico en Portugal ronda el 0,61-2,64%


Background and aims: Eczema and urticaria are both inflammatory skin diseases. The prevalence of both diseases varies worldwide and the reasons are unknown. We aimed to investigate the eczema and urticaria prevalence in the Portuguese adult (≥ 16 years-old) population. Materials and methods: A telephone interview survey was performed in the last quarter of 2017. To calculate the prevalences, subjects should have been previously diagnosed with eczema/urticaria by a health professional, be aged ≥ 16 years-old, and reside in Portugal. The sample had a proportion that was approximately representative by population, region, gender, and age group. Odds ratios were performed to measure associations with prevalences. SPSS statistics and values of p < 0.05 with 95% confidence intervals were considered statistically significant. Results: 5,000 phone calls were analysed. The prevalence of eczema and urticaria in Portugal is 4.4% and 3.4%, respectively. Algarve is the region with the highest prevalence for both diseases. Being a female is the factor that most influenced these diseases with an OR = 1.99 (p < 0.001; CI 1.49-2.66) for eczema and 1.73 (p = 0.001; CI 1.25 - 2.40) for urticaria, with also higher prevalences (5.7% and 4.2%, respectively). Conclusions: The prevalences found are higher than in previous studies in Portugal and comparable to results from other countries. Comparisons among prevalence of eczema are affected by several obstacles. Regarding urticaria, our results seem to be in the same line as others. Being female with eczema and urticaria is more common and represents a higher risk factor than male subjects. According to Harrop et al., 2007, in Europe, atopic eczema is 0.14-0.60% of general eczema. In this way, we can estimate that prevalence of atopic eczema in Portugal is around 0.61-2.64%


Assuntos
Humanos , Masculino , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Idoso , Idoso de 80 Anos ou mais , Eczema/epidemiologia , Urticária/epidemiologia , Portugal/epidemiologia , Telefone/estatística & dados numéricos , Intervalos de Confiança , Inquéritos e Questionários , Razão de Chances , Análise Multivariada , Fatores de Risco
9.
Health Serv Res ; 54 Suppl 2: 1467-1471, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31650534

RESUMO

OBJECTIVE: To summarize findings from this Special Issue, which examine reported experiences of discrimination among six underrepresented groups in public opinion research-blacks, Latinos, Native Americans, Asian Americans, lesbian, gay, bisexual, transgender, or queer (LGBTQ) adults, and women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 3453 US adults, conducted January-April 2017. METHODS: We calculated the percent of adults reporting discrimination in several domains, including health care. PRINCIPAL FINDINGS: In health care encounters, 32 percent of black adults reported discrimination, as did 23 percent of Native Americans, 20 percent of Latinos, 18 percent of women, 16 percent of LGBTQ adults, and 13 percent of Asian Americans. Significant shares also reported experiencing racial, gender, or LGBTQ identity-based violence against themselves or family members, including 51 percent of LGBTQ adults, 42 percent of blacks, 38 percent of Native Americans, and 21 percent of women. At least one in seven blacks (22 percent), LGBTQ adults (18 percent), Latinos (17 percent), and Native Americans (15 percent) reported avoiding health care for themselves or family members over concerns of anticipated discrimination or unfair treatment. CONCLUSIONS: Taken together, this polling effort illustrates the significant and widespread level of discrimination against many groups in America today, as well as the complex manifestation of these experiences across different groups and different areas of life. While it is beyond the scope of these results to make specific recommendations for how to end discrimination in each area of life we studied, this Special Issue provides important evidence that more research and practice on discrimination are sorely needed in health services research.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Racismo/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adulto , Afro-Americanos/estatística & dados numéricos , Americanos Asiáticos/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Índios Norte-Americanos/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Racismo/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos
10.
Health Serv Res ; 54 Suppl 2: 1389-1398, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31657001

RESUMO

OBJECTIVE: To describe survey methods used to examine reported experiences of discrimination against African Americans, Latinos, Asian Americans, Native Americans, women, and LGBTQ (lesbian, gay, bisexual, transgender, and queer) adults. DATA SOURCE AND STUDY DESIGN: Data came from a nationally representative, probability-based telephone survey of 3453 US adults, conducted January-April 2017. METHODS: We examined the survey instrument, sampling design, and weighting of the survey, and present selected survey findings. PRINCIPAL FINDINGS: Examining reported discrimination experienced by multiple groups in a telephone survey requires attention to details of sampling and weighting. In health care settings, 32 percent of African Americans reported discrimination, as did 23 percent of Native Americans, 20 percent of Latinos, 18 percent of women, 16 percent of LGBTQ adults, and 13 percent of Asian Americans. Also, 51 percent of LGBTQ adults, 42 percent of African Americans, and 38 percent of Native Americans reported identity-based violence against themselves or family members; 57 percent of African Americans and 41 percent of women reported discrimination in pay or promotions; 50 percent of African Americans, 29 percent of Native Americans, and 27 percent of Latinos reported being discriminated against in interactions with police. CONCLUSIONS: Even the small selection of results presented in this article as examples of survey measures show a pattern of substantial reported discrimination against all six groups studied.


Assuntos
Grupos Étnicos/estatística & dados numéricos , Pesquisa sobre Serviços de Saúde , Racismo/estatística & dados numéricos , Projetos de Pesquisa , Sexismo/estatística & dados numéricos , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adulto , Afro-Americanos , Idoso , Americanos Asiáticos , Feminino , Hispano-Americanos , Humanos , Índios Norte-Americanos , Masculino , Pessoa de Meia-Idade , Determinantes Sociais da Saúde/etnologia , Inquéritos e Questionários , Telefone , Estados Unidos
11.
Health Serv Res ; 54 Suppl 2: 1431-1441, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31657013

RESUMO

OBJECTIVE: To examine reported racial discrimination and harassment against Native Americans, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 342 Native American and 902 white US adults, conducted January-April 2017. METHODS: We calculated the percent of Native Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Native American-white difference in odds of discrimination and conducted exploratory analyses among Native Americans only to examine variation by socioeconomic and geographic/neighborhood characteristics. PRINCIPAL FINDINGS: More than one in five Native Americans (23 percent) reported experiencing discrimination in clinical encounters, while 15 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A notable share of Native Americans also reported they or family members have experienced violence (38 percent) or have been threatened or harassed (34 percent). In adjusted models, Native Americans had higher odds than whites of reporting discrimination across several domains, including health care and interactions with the police/courts. In exploratory analyses, the association between geographic/neighborhood characteristics and discrimination among Native Americans was mixed. CONCLUSIONS: Discrimination and harassment are widely reported by Native Americans across multiple domains of their lives, regardless of geographic or neighborhood context. Native Americans report major disparities compared to whites in fair treatment by institutions, particularly with health care and police/courts. Results suggest modern forms of discrimination and harassment against Native Americans are systemic and untreated problems.


Assuntos
Disparidades em Assistência à Saúde/etnologia , Índios Norte-Americanos/estatística & dados numéricos , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Idoso , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Índios Norte-Americanos/psicologia , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone , Estados Unidos
12.
Health Serv Res ; 54 Suppl 2: 1419-1430, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31657465

RESUMO

OBJECTIVE: To examine experiences of racial discrimination among Asian Americans, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey, including 500 Asian and a comparison group of 902 white US adults, conducted January to April 2017. METHODS: We calculated the percent of Asian Americans reporting discrimination in several domains, including health care. We used logistic regression to compare the Asian-white difference in odds of discrimination, and among Asians only to examine variation by geographic heritage group (South Asian versus East Asian) and gender. PRINCIPAL FINDINGS: 13 percent of Asians reported discrimination in healthcare encounters. At least one in four adults reported experiencing discrimination in employment (27 percent job applications, 25 percent equal pay/promotions); housing (25 percent); and interpersonal interactions (35 percent microaggressions, 32 percent racial slurs). In unadjusted models, East and South Asians were more likely than whites to report experiences of institutional discrimination, and South Asians were more likely than whites to report microaggressions. In adjusted models, Asians had higher odds than whites of reporting avoiding health care due to discrimination concerns and also when obtaining housing. CONCLUSIONS: Asians in the United States experience discrimination interpersonally and across many institutional settings, including housing and health care. South Asians may be especially vulnerable to forms of institutional discrimination and microaggressions. These results illustrate a need for greater investigation into the unique experiences of Asian subgroups and greater protections for groups at higher risk of discrimination, within health care and beyond.


Assuntos
Americanos Asiáticos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Americanos Asiáticos/psicologia , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Racismo/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone
13.
Health Serv Res ; 54 Suppl 2: 1454-1466, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31659745

RESUMO

OBJECTIVE: To examine reported experiences of discrimination against lesbian, gay, bisexual, transgender, and queer (LGBTQ) adults in the United States, which broadly contribute to poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data came from a national, probability-based telephone survey of US adults, including 489 LGBTQ adults (282 non-Hispanic whites and 201 racial/ethnic minorities), conducted January-April 2017. METHODS: We calculated the percentages of LGBTQ adults reporting experiences of discrimination in health care and several other domains related to their sexual orientation and, for transgender adults, gender identity. We report these results overall, by race/ethnicity, and among transgender adults only. We used multivariable models to estimate adjusted odds of discrimination between racial/ethnic minority and white LGBTQ respondents. PRINCIPAL FINDINGS: Experiences of interpersonal discrimination were common for LGBTQ adults, including slurs (57 percent), microaggressions (53 percent), sexual harassment (51 percent), violence (51 percent), and harassment regarding bathroom use (34 percent). More than one in six LGBTQ adults also reported avoiding health care due to anticipated discrimination (18 percent), including 22 percent of transgender adults, while 16 percent of LGBTQ adults reported discrimination in health care encounters. LGBTQ racial/ethnic minorities had statistically significantly higher odds than whites in reporting discrimination based on their LGBTQ identity when applying for jobs, when trying to vote or participate in politics, and interacting with the legal system CONCLUSIONS: Discrimination is widely experienced by LGBTQ adults across health care and other domains, especially among racial/ethnic minorities. Policy and programmatic efforts are needed to reduce these negative experiences and their health impact on sexual and/or gender minority adults, particularly those who experience compounded forms of discrimination.


Assuntos
Disparidades em Assistência à Saúde , Assédio Sexual , Minorias Sexuais e de Gênero/estatística & dados numéricos , Adolescente , Adulto , Feminino , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Habitação , Humanos , Masculino , Assédio Sexual/etnologia , Assédio Sexual/estatística & dados numéricos , Minorias Sexuais e de Gênero/psicologia , Inquéritos e Questionários , Telefone , Estados Unidos , Adulto Jovem
14.
Br J Nurs ; 28(19): 1134-1138, 2019 Oct 24.
Artigo em Inglês | MEDLINE | ID: mdl-31647733

RESUMO

INTRODUCTION: the NHS Long Term Plan has called for a reduction in the number of outpatient appointments to reduce pressure on hospital services and increase ease of access for patients. This article presents a service evaluation of an innovative, nurse-led telephone follow-up service for a group of elective bowel cancer patients following surgery. METHODS: the records of patients who underwent surgery over a 2-year period were accessed to determine the number of telephone follow-ups and other investigations. This was used to model the potential cost saving for commissioners against traditional clinic follow-up. Patient satisfaction was assessed by the European Organisation for Research and Treatment of Cancer questionnaire on Outpatient Satisfaction in 30 patients. RESULTS: feedback on the service was overwhelmingly positive, with patients praising the care received from the specialist nurses, but also commenting on increased continuity of care, ease of access and convenience. The service also potentially creates significant savings for commissioners as the agreed tariff for nurse telephone follow-up is significantly less than the outpatient tariff. DISCUSSION: this innovative follow-up system is well liked by patients and should provide savings for commissioners. The hospital also benefits from an increase in capacity to see new or more unwell patients, and a reduction in carbon emissions. Such a service, however, is dependent on people, and although it has functioned effectively in this department for approximately 20 years, it would only be generalisable to other units if staff had appropriate expertise.


Assuntos
Assistência ao Convalescente/organização & administração , Neoplasias Colorretais/cirurgia , Enfermeiras Especialistas , Telefone , Difusão de Inovações , Pesquisa sobre Serviços de Saúde , Humanos , Medicina Estatal/organização & administração , Reino Unido
15.
BMC Health Serv Res ; 19(1): 686, 2019 Oct 09.
Artigo em Inglês | MEDLINE | ID: mdl-31597555

RESUMO

BACKGROUND: Low-intensity treatments imply reduced therapist contact due to an emphasis on self-help and the use of technologies to deliver treatment. The role of the remoteness, the reduced therapist contact, and the interplay of these components has not been differentiated from a patients' perspective so far. This study's purpose is to capture patients' experiences with telephone-based self-help cognitive behavioural therapy (tel-CBT). METHODS: A subsample of mildly to moderately depressed patients (N = 13) who finished tel-CBT as part of a larger randomised controlled trial (RCT) in routine care were interviewed using a semi-structured questionnaire. Interviews were audiotaped, transcribed verbatim, and independently coded by two coders blind to treatment outcome. Using qualitative content analysis with deductive and inductive procedures, a two-level category system was established. RESULTS: The category system contains four category clusters regarding expectations, self-help related aspects, telephone-related aspects, and implications for patients' treatment pathway, and subsumes a total of 15 categories. Self-help related aspects circulate around the interplay between written materials and professional input, trust and support in the therapeutic relationship and its relation to the initial personal contact, as well as CBT principles. Telephone-related aspects entail perceived advantages and disadvantages of the telephone on an organisational and content level as well as a discourse around distance and closeness in the interaction. Although patients raised doubts regarding the long-term effect of the intervention on symptomatology, patients expressed satisfaction with the treatment and reported an immediate as well as a longer lasting personal impact of the treatment. These results indicate user acceptance with tel-CBT. CONCLUSIONS: This qualitative analysis captures patients' experiences with tel-CBT and the perceived helpfulness of the diverse treatment components. This can facilitate refining aspects of low-intensity treatments and might improve dissemination. TRIAL REGISTRATION: ClinicalTrials.gov NCT02667366. Registered on 3 December 2015.


Assuntos
Atitude Frente a Saúde , Terapia Cognitivo-Comportamental/métodos , Transtorno Depressivo/terapia , Adulto , Idoso , Transtorno Depressivo/psicologia , Feminino , Humanos , Internet , Masculino , Pessoa de Meia-Idade , Relações Profissional-Paciente , Pesquisa Qualitativa , Projetos de Pesquisa , Telemedicina/métodos , Telefone , Resultado do Tratamento
16.
Health Serv Res ; 54 Suppl 2: 1442-1453, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31663120

RESUMO

OBJECTIVE: To examine reported experiences of gender discrimination and harassment among US women. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey of 1596 women, conducted January-April 2017. METHODS: We calculated the percentages of women reporting gender discrimination and harassment in several domains, including health care. We used logistic regression to examine variation in experiences among women by race/ethnicity and sexual orientation/gender identity. PRINCIPAL FINDINGS: Sizable fractions of women experience discrimination and harassment, including discrimination in health care (18 percent), equal pay/promotions (41 percent), and higher education (20 percent). In adjusted models, Native American, black, and Latina women had higher odds than white women of reporting gender discrimination in several domains, including health care. Latinas' odds of health care avoidance versus whites was (OR [95% CI]) 3.69 (1.59, 8.58), while blacks' odds of discrimination in health care visits versus whites was 2.00 [1.06, 3.74]. Lesbian, gay, bisexual, transgender, and queer (LGBTQ) women had higher odds of reporting sexual harassment (2.16 [1.06, 4.40]) and violence (2.71 [1.43, 5.16]) against themselves or female family members than non-LGBTQ women. CONCLUSIONS: Results suggest that discrimination and harassment are widely experienced by women across multiple domains of their lives, particularly those who are a racial/ethnic minority or LGBTQ. Further policy and programmatic efforts beyond current legal protections for women are needed to meaningfully reduce these negative experiences, as they impact women's health care and their lives overall.


Assuntos
Disparidades em Assistência à Saúde , Sexismo , Assédio Sexual , Minorias Sexuais e de Gênero/estatística & dados numéricos , Saúde da Mulher , Adolescente , Adulto , Idoso , Emprego , Feminino , Disparidades em Assistência à Saúde/etnologia , Disparidades em Assistência à Saúde/estatística & dados numéricos , Humanos , Pessoa de Meia-Idade , Aceitação pelo Paciente de Cuidados de Saúde , Sexismo/etnologia , Sexismo/estatística & dados numéricos , Assédio Sexual/etnologia , Assédio Sexual/estatística & dados numéricos , Inquéritos e Questionários , Telefone , Estados Unidos
17.
Health Serv Res ; 54 Suppl 2: 1399-1408, 2019 12.
Artigo em Inglês | MEDLINE | ID: mdl-31663124

RESUMO

OBJECTIVE: To examine experiences of racial discrimination among black adults in the United States, which broadly contribute to their poor health outcomes. DATA SOURCE AND STUDY DESIGN: Data come from a nationally representative, probability-based telephone survey including 802 non-Hispanic black and a comparison group of 902 non-Hispanic white US adults, conducted January-April 2017. METHODS: We calculated the percent of blacks reporting discrimination in several domains, including health care. We used logistic regression to compare the black-white difference in odds of discrimination, and among blacks only to examine variation by socioeconomic status, gender, and neighborhood racial composition. PRINCIPAL FINDINGS: About one-third of blacks (32 percent) reported experiencing discrimination in clinical encounters, while 22 percent avoided seeking health care for themselves or family members due to anticipated discrimination. A majority of black adults reported experiencing discrimination in employment (57 percent in obtaining equal pay/promotions; 56 percent in applying for jobs), police interactions (60 percent reported being stopped/unfairly treated by police), and hearing microaggressions (52 percent) and racial slurs (51 percent). In adjusted models, blacks had significantly higher odds than whites of reporting discrimination in every domain. Among blacks, having a college degree was associated with higher odds of experiencing overall institutional discrimination. CONCLUSIONS: The extent of reported discrimination across several areas of life suggests a broad pattern of discrimination against blacks in America, beyond isolated experiences. Black-white disparities exist on nearly all dimensions of experiences with public and private institutions, including health care and the police. Evidence of systemic discrimination suggests a need for more active institutional interventions to address racism in policy and practice.


Assuntos
Afro-Americanos/estatística & dados numéricos , Disparidades em Assistência à Saúde/etnologia , Racismo/estatística & dados numéricos , Determinantes Sociais da Saúde/etnologia , Adolescente , Adulto , Afro-Americanos/psicologia , Idoso , Grupo com Ancestrais do Continente Europeu , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Racismo/psicologia , Fatores Socioeconômicos , Inquéritos e Questionários , Telefone , Estados Unidos
18.
Aten. prim. (Barc., Ed. impr.) ; 51(8): 479-485, oct. 2019. tab, graf
Artigo em Espanhol | IBECS | ID: ibc-185750

RESUMO

Objetivo: Estimar la prevalencia de uso de anticoncepción hormonal de solo gestágenos (AHSG) entre las mujeres demandantes de anticoncepción reversible en atención primaria (AP). Diseño: Estudio descriptivo transversal multicéntrico. Emplazamiento: AP de la Comunidad de Madrid. Participantes: Mujeres entre 16-50 años, usuarias de anticoncepción reversible, que hablen español y hubieran acudido en el último año a consulta de AP. Mediciones principales: Encuesta telefónica. Variable principal: método anticonceptivo utilizado: solo gestágenos (sí/no). Edad, paridad, país de origen, tipo de método anticonceptivo (MAC) utilizado, motivo de elección, duración, fuente de información, lugar de obtención, satisfacción con el método. Resultados: 417 mujeres. Edad: media 30,3 años (DE: 7,7). Españolas: 69%, estudios secundarios y universitarios: 82%, nulíparas: 57%. Tipo de MAC utilizado: AHSG 14%, hormonal combinado (AHC): 74%, DIU cobre: 2%, preservativo: 10%. La prevalencia de uso de AHSG fue del 13,9% (IC95%: 10,6-17,2). Entre los AHSG el método más utilizado fue el inyectable trimestral de acetato de medroxiprogesterona (4,6%), píldora oral de desogestrel (4,1%), DIU-LNG (3,9%), implante subdérmico de etonogestrel (1,9%). El médico de familia fue el prescriptor del MAC en el 71% de las mujeres. Satisfacción: alta (mediana 10 sobre 10). Utilizar AHSG se asoció con mayor edad, ser extranjera y motivos de prescripción: lactancia y tener contraindicación médica para AHC (p < 0,05). Conclusiones: La prevalencia de uso para la AHSG fue del 14%, la satisfacción fue muy alta para todos los MAC. El perfil de usuaria para la AHSG corresponde a mujer de mayor edad, extranjera y con condiciones como la lactancia o la contraindicación para otros MAC


Aim: To estimate the prevalence of use of progestin-only contraceptive among women who request reversible contraception in Primary Care (PC). Design: Multicentre cross-sectional study. Setting: Primary Care Health Care Centres (Madrid). Participants: Women aged 16-50 years old, users of reversible contraception, who speak Spanish, and had attended the Primary Care Centre in the last year. Main measurements: Primary outcome: contraceptive method used: Contraception with progestins-only (yes/no). Age, parity, country of origin, type of contraceptive method used, reason for choice, source of information, satisfaction with the contraceptive method. Telephone survey. Results: A total of 417 women were interviewed. The median age was 30.3 years (SD: 7.7). Spanish 69%, and 82% of participants had secondary or university studies. More than half (57%) were nulliparous. The type of contraceptive used included: progestins only: 14%, combined hormonal contraceptive: 74%, copper IUD: 2%, and condom 10%. The prevalence of use of "progestins-only" was 13.9% (95%CI: 10.6-17.2). Medroxyprogesterone acetate injection was the most progestin-only method used (4.6%), desogestrel oral pill (4.1%), IUD-levonorgestrel IUD (3.9%), and etonogestrel subdermal implant (1.9%). The family doctor was the prescriber in 71% of the women. Satisfaction: high (range 9-10). Using only progestogens was associated with older age, being non-Spanish, breastfeeding, and having a medical contraindication for combined contraception (P < 0.05). Conclusions: The prevalence of use for progestins was 14%, satisfaction was very high for all contraceptive methods. The user profile for the only progestins-only corresponds to older, and non-Spanish women with conditions such as breastfeeding or contraindications for other contraceptives


Assuntos
Humanos , Feminino , Adolescente , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Progestinas/uso terapêutico , Atenção Primária à Saúde/métodos , Anticoncepção , Satisfação do Paciente , Estudos Transversais , Epidemiologia Descritiva , Telefone , Contraindicações de Medicamentos
19.
Bull Cancer ; 106(10): 847-859, 2019 Oct.
Artigo em Francês | MEDLINE | ID: mdl-31521255

RESUMO

INTRODUCTION: The Cancer Observatory, from the OMEDITs (Observatory for Medicines and Medical Devices and Treatment Innovations) of Bretagne and Pays de la Loire areas has conducted a survey aiming to know and map the current practices of management of patients by Oral Anti-cancer Drug (OAD) in inter-region. METHODS: Forty eight cancer centers received by e-mail in July and October 2016 a questionnaire concerning the management of OADs : from prescription by the specialist of oncology, to the intervention of the pharmacist (analysis and pharmaceutical consulting), to follow-up by nurse, as well as the financing of this activity and the feelings of the actors about this organizational set up. RESULTS: Fifty-seven professionals from 31 centers, including the most important ones, responded to the survey. As a result, half of the establishments carry out a pharmaceutical analysis for some or all of the OAD prescriptions and only 30% carry out a pharmaceutical consulting. The nurse consultation is, on the other hand, more largely implanted (74% of the centers) as well as the telephone follow-up (6%). More than 90% of professionals believe that the organizational set up could be improved and more secure by, at least, the stronger involvement of pharmacists, the development of tools for nurse (for monitoring, therapeutic education…) and by improving the city-hospital link. CONCLUSION: This survey shows the variability in the management of patients under OAD because of the lack of resources to ensure the fairness and sustainability of the organizational set up. The hospital/city link could still be optimized to secure patient care.


Assuntos
Antineoplásicos/administração & dosagem , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Neoplasias/tratamento farmacológico , Administração Oral , Institutos de Câncer/estatística & dados numéricos , Continuidade da Assistência ao Paciente/estatística & dados numéricos , Prescrições de Medicamentos , França , Humanos , Papel do Profissional de Enfermagem , Objetivos Organizacionais , Satisfação do Paciente , Farmacêuticos , Padrões de Prática em Enfermagem/estatística & dados numéricos , Telefone
20.
Artigo em Inglês | MEDLINE | ID: mdl-31484338

RESUMO

Adequate ehealth literacy is one of the key instruments safeguarding people against unreliable health-related information obtained from the Internet. This paper presents an assessment of the reliability and the validity of a Polish version of the ehealth literacy scale (Pl-eHEALS). The assessment was carried out on the basis of two nationally representative samples of the Polish population. In the first survey of adults at least 50 years old, the technique of computer-assisted telephone interviewing (CATI) was applied. In the second survey of young adult women (18-35 years old), the technique of computer-assisted web interviewing (CAWI) was used. The reliability and the validity of the Pl-eHEALS was analyzed. There were no floor or ceiling effects revealed in either sample. The Cronbach's alpha coefficients were 0.90 and 0.88, and Guttman split-half coefficients were 0.89 and 0.81, respectively. Exploratory factors analysis revealed single factor models in both cases. The sum of squared loadings in the first survey was 6.090 and accounted for 58.72% of the variance. In the second survey, the sum was 5.927 and was responsible for 55.06% of the variance. Hypothesis testing showed that, for older adults, higher ehealth literacy was prevalent in the respondents who used the Internet more frequently. Among young adult women, higher readiness to use the Internet as a primary source of health-related information and to undertake specific internet health-related activities was associated with higher ehealth literacy. The analysis reported in this paper confirmed the reliability and the validity of the instrument. It should be stressed that, prior to this study, there was no validated Polish version of the eHEALS that could be used with Polish-speaking respondents.


Assuntos
Alfabetização em Saúde , Internet , Telemedicina , Telefone , Adolescente , Adulto , Idoso , Análise Fatorial , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Polônia , Reprodutibilidade dos Testes , Inquéritos e Questionários , Adulto Jovem
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