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1.
JAMA Netw Open ; 3(1): e1920010, 2020 Jan 03.
Artigo em Inglês | MEDLINE | ID: mdl-31995215

RESUMO

Importance: Racial and ethnic disparities in access to health care may result from discrimination. Objectives: To identify differences in the rates at which patients belonging to racial/ethnic minority groups are offered primary care appointments and the number of days they wait for their primary care appointment and to understand the mechanisms by which discrimination occurs. Design, Setting, and Participants: This cross-sectional study used 7 simulated black, Hispanic, and white patient callers to request appointments from 804 randomized primary care offices in 2 urban centers in Texas from November 2017 to February 2018. Data analysis was conducted between February and December 2018. Exposures: Research assistants called randomly assigned offices to schedule an appointment, supplying the same basic information. Race and ethnicity were signaled through callers' names and voices. Main Outcomes and Measures: Appointment offer rates, days to appointment, and questions asked during the call. Results: Of the 7 callers (age range, 18-29 years), 2 (28.6%) self-identified as non-Hispanic black, 3 (42.9%) self-identified as non-Hispanic white, and 2 (28.6%) self-identified as Hispanic. Of the 804 calls they made, 299 (37.2%) were from simulated white callers, 215 (26.7%) were from simulated black callers, and 290 (36.1%) were from simulated Hispanic callers. Overall, 582 callers (72.4%) were offered appointments. In unadjusted models, black and Hispanic callers were more likely to be offered an appointment than white callers (black callers, 32.2 [95% CI, 25.1-39.3] percentage points more likely; P < .001; Hispanic callers, 21.1 [95% CI, 13.7-28.5] percentage points more likely; P < .001). However, after adjusting for whether insurance status was revealed, this statistical significance was lost. In adjusted models, black callers were 44.0 (95% CI, 36.2-51.8) percentage points more likely to be asked about their insurance status than white callers (P < .001), and Hispanic callers were 25.3 (95% CI, 17.1-33.5) percentage points more likely to be asked about their insurance status (P < .001) than white callers. Black and Hispanic callers received appointments further in the future than white callers (black callers: marginal effect estimate, 3.650; 95% CI, 0.579 to 6.721; P = .08; Hispanic callers: marginal effect estimate, 2.644; 95% CI, -0.496 to 5.784; P = .02). Conclusions and Relevance: In this study, black and Hispanic patients were more likely to be offered an appointment, but they were asked more frequently about their insurance status than white callers. Black and Hispanic callers experienced longer wait times than white patients, indicating a barrier to timely access to primary care.


Assuntos
Grupo com Ancestrais do Continente Africano/estatística & dados numéricos , Agendamento de Consultas , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Hispano-Americanos/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Adulto , Feminino , Humanos , Masculino , Cooperação do Paciente/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Estudos Prospectivos , Estados Unidos
2.
Arthritis Care Res (Hoboken) ; 72(2): 184-192, 2020 Feb.
Artigo em Inglês | MEDLINE | ID: mdl-31595710

RESUMO

OBJECTIVE: To describe and compare triennial rates of physicians' recommendations for physical therapy (PT), lifestyle counseling, and pain medication for knee osteoarthritis (OA) and to identify patient, physician, and practice factors associated with each treatment recommendation. METHODS: We conducted a cross-sectional analysis examining data between 2007 and 2015 from the National Ambulatory Medical Care Survey. Visits to orthopedists and primary care physicians for knee OA were identified and assessed for the following: PT referral, lifestyle counseling, nonsteroidal antiinflammatory drug (NSAID) prescriptions, and narcotics prescriptions. Triennial rates for each treatment were calculated. We examined associations between patient (e.g., race, insurance), physician, and practice factors (e.g., ownership, location) and treatments prescribed using multivariate logistic regression that accounted for complex sampling design. RESULTS: A total of 2,297 physician visits related to knee OA (~67 [±4] million weighted visits) were identified. For visits to orthopedists, PT and lifestyle recommendation rates declined (158 to 88 of 1,000 visits and 184 to 86 of 1,000 visits, respectively), while NSAID and narcotics prescriptions increased (132 to 278 of 1,000 visits and 77 to 236 of 1,000 visits, respectively) over time (P < 0.05). For visits to primary care physicians, there were no significant changes in rates of PT, lifestyle counseling, and narcotics prescriptions over time, while NSAIDs prescriptions increased (221 to 498 of 1,000 visits; P < 0.05). Treatment recommendations were associated with nonclinical factors, including practice type, location, and type of provider. CONCLUSION: In patients with knee OA, PT and lifestyle counseling seem underutilized, while pain medication prescriptions increased during the investigated timeframe. Variation in treatment choices were associated with nonclinical factors. Future research is necessary to examine ways to improve PT and lifestyle utilization and reduce variation in care for knee OA.


Assuntos
Analgésicos/administração & dosagem , Aconselhamento/tendências , Osteoartrite do Joelho/terapia , Manejo da Dor/tendências , Modalidades de Fisioterapia/tendências , Comportamento de Redução do Risco , Idoso , Instituições de Assistência Ambulatorial , Estudos de Coortes , Aconselhamento/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/tendências , Osteoartrite do Joelho/diagnóstico , Manejo da Dor/métodos , Inquéritos e Questionários
3.
BMC Public Health ; 19(1): 1570, 2019 Nov 27.
Artigo em Inglês | MEDLINE | ID: mdl-31775684

RESUMO

BACKGROUND: The current study aims to compare correlations between a range of measures of physical performance and physical activity assessing the same underlying construct in different settings, that is, in a home versus a highly standardized setting of the research center or accelerometer recording. We also evaluated the selective attrition of participants related to these different settings and how selective attrition affects the associations between variables and indicators of health, functioning and overall activity. METHODS: Cross-sectional analyses comprising population-based samples of people aged 75, 80, and 85 years living independently in Jyväskylä, Finland. The AGNES study protocol involved the following phases: 1) phone interview (n = 1886), 2) face-to-face at-home interview (n = 1018), 3) assessments in the research center (n = 910), and 4) accelerometry (n = 496). Phase 2 and 3 included walking and handgrip strength tests, and phase 4 a chest-worn and thigh-worn accelerometer estimating physical activity and assessing posture, respectively, for 3-10 days in free-living conditions. RESULTS: Older people with poorer health and functioning more likely refrained from subsequent study phases, each requiring more effort or commitment from participants. Paired measures of walking speed (R = 0.69), handgrip strength (R = 0.85), time in physical activity of at least moderate intensity (R = 0.42), and time in upright posture (R = 0.30) assessed in different settings correlated with each other, and they correlated with indicators of health, functioning and overall activity. Associations were robust regardless of limitations in health and functioning, and low overall activity. CONCLUSIONS: Correlational analyses did not clearly reveal one superior setting for assessing physical performance or physical activity. Inclusion of older people with early declines in health, functioning and overall activity in studies on physical performance and physical activity is feasible in terms of study outcomes, but challenging for recruitment.


Assuntos
Envelhecimento/fisiologia , Exercício , Avaliação Geriátrica/métodos , Desempenho Físico Funcional , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Finlândia , Visita Domiciliar , Humanos , Masculino , Visita a Consultório Médico , Projetos de Pesquisa
5.
High Blood Press Cardiovasc Prev ; 26(6): 483-491, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31705461

RESUMO

INTRODUCTION: The use of unattended automated office blood pressure (uAutoOBP) versus attended automated (aAutoOBP) and manual auscultatory office blood pressure (AuscOBP) measurements is a topic of current controversy. AIM: To evaluate the differences between OBP measurements methods in the general practice (GP) setting. METHODS: We first compared aAutoOBP and uAutoOBP in 42 consecutive patients with hypertension (group 1). Secondly, we compared AuscOBP to uAutoOBP measurements in 133 consecutive patients with hypertension (group 2). In addition, we analyzed the achieved OBP targets as recommended in the 2018 European Society of Cardiology (ESC) and the European Society of Hypertension (ESH) guidelines in group 2. RESULTS: The mean age of patients in group 1 was 71 years (range 34-89 years, 54.8% females). The aAutoOBP and uAutoOBP systolic (131.7 and 131.6 mmHg) and diastolic (83.4 and 82.4 mmHg) mean values were not significantly different. The patient characteristics in group 2 were similar to group 1. We observed a significant difference between AuscOBP and uAutoOBP measurement for both systolic (149.4 versus 129.5 mm Hg) and diastolic (85.4 versus 81.6 mm Hg, p < 0.0001, respectively). Accordingly, 20.3% and 45.9% of patients reached the overall 2018 ESC/ESH systolic and diastolic OBP targets of < 140/80 mmHg according to AuscOBP and uAutoOBP (p < 0.0001). CONCLUSION: The attended versus unattended status of automated OBP measurements had no impact on OBP values in GP. However, significantly higher OBP values and lower rates of achieved target OBP were observed by using AuscOBP measurements by physicians in comparison to automated OBP recordings.


Assuntos
Determinação da Pressão Arterial/métodos , Pressão Sanguínea , Medicina Geral , Hipertensão/diagnóstico , Visita a Consultório Médico , Adulto , Idoso , Idoso de 80 Anos ou mais , Anti-Hipertensivos/uso terapêutico , Pressão Sanguínea/efeitos dos fármacos , Feminino , Humanos , Hipertensão/tratamento farmacológico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Valor Preditivo dos Testes , Reprodutibilidade dos Testes , Hipertensão do Jaleco Branco/diagnóstico , Hipertensão do Jaleco Branco/fisiopatologia
6.
S Afr Med J ; 109(10): 733-735, 2019 Sep 30.
Artigo em Inglês | MEDLINE | ID: mdl-31635567

RESUMO

Every day patients make appointments with doctors in order for both to be able to schedule their time accordingly. All is well unless one of the parties cancels the appointment. In the case of a cancellation that is within 2 hours of a general practitioner visit or 24 hours of a specialist visit, the patient is usually charged for either the full consultation or part thereof. Doctors may also have reasons to cancel and rearrange their appointments with patients, yet there is no penalty placed on the doctor for such behaviour. There appears to be a mismatch between the disincentives for the patient not to cancel v. those of the doctor not to cancel. In this article, the legal and ethical aspects of charging for a missed appointment will be dealt with in order to determine the current situation in South Africa. Furthermore, research into missed appointments will be discussed to ascertain the major causes and provide recommendations to prevent missed appointments from occurring.


Assuntos
Agendamento de Consultas , Pacientes não Comparecentes/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Médicos/estatística & dados numéricos , Humanos , Pacientes não Comparecentes/economia , Visita a Consultório Médico/economia , Médicos/economia , África do Sul
7.
Lakartidningen ; 1162019 Oct 18.
Artigo em Sueco | MEDLINE | ID: mdl-31638708

RESUMO

Since 2016, a number of companies offering primary care services via chats or video calls have entered the Swedish primary care market. This is the first study to investigate whether these services replace other primary care services or if they induce more care and potentially even increase the workload of traditional caregivers. Using administrative care register data from a Swedish region, we find that the use of telemedicine services is associated with higher use of other primary care services (visits and telephone/mail contacts). Further, telemedicine users visit the emergency room at least as often as other residents. We obtain similar results when using various strategies to account for differences between telemedicine users and non-users. However, we cannot completely rule out that an association between transitory health problems and telemedicine use explains the results.


Assuntos
Centros Comunitários de Saúde/estatística & dados numéricos , Serviços Médicos de Emergência/estatística & dados numéricos , Utilização de Instalações e Serviços , Visita a Consultório Médico/estatística & dados numéricos , Atenção Primária à Saúde/estatística & dados numéricos , Telemedicina/estatística & dados numéricos , Adolescente , Adulto , Idoso , Criança , Pré-Escolar , Grupos Étnicos , Feminino , Humanos , Renda , Lactente , Masculino , Pessoa de Meia-Idade , Suécia , Adulto Jovem
8.
Curr Med Sci ; 39(5): 741-747, 2019 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-31612391

RESUMO

Visit-to-visit variability in systolic blood pressure (SBP) may have an important additional role in increasing the risk of vascular complications, including stroke. We conducted a meta-analysis to assess the relationship between visit-to-visit SBP variability (SBPV) and stroke risk. PubMed, EMBASE, and the Cochrane library databases were searched for cohort studies with data on visit-to-visit SBPV and stroke risk. Studies that reported adjusted relative risks (RRs) with 95% CIs of stroke associated with SBPV were included. Fourteen cohort studies met the inclusion criteria and were included in our meta-analysis. After adjustment for age, sex, and existing vascular risk factors, the analysis showed that the risk of stroke in patients with SBPV was significantly increased compared with patients with a small baseline SBPV [SD (RR=1.20, 95% CI=(1.07-1.35), P=0.0005), CV (RR=1.12, 95% CI=(1.00-1.26), P=0.008)]. In addition, follow-up variations of more than 5 years were associated with a higher risk of stroke than those of less than 5 years [RR=1.08, 95% CI=(1.04-1.11)]. Visit-to-visit SBPV was associated with an increased risk of stroke, especially in terms of the time of variation. Taken together, SBPV data may be useful as a preventative diagnostic method in the management of stroke.


Assuntos
Pressão Sanguínea , Hipertensão/complicações , Acidente Vascular Cerebral/complicações , Adulto , Idoso , Idoso de 80 Anos ou mais , Estudos de Coortes , Feminino , Humanos , Hipertensão/diagnóstico , Hipertensão/fisiopatologia , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico , Fatores de Risco , Acidente Vascular Cerebral/diagnóstico , Acidente Vascular Cerebral/fisiopatologia
9.
Tidsskr Nor Laegeforen ; 139(15)2019 Oct 22.
Artigo em Norueguês, Inglês | MEDLINE | ID: mdl-31642635

RESUMO

BACKGROUND: The quality of the general practitioners' setting of diagnoses using codes from the International Classification for Primary Care (ICPC) is important, because these codes are used for purposes of quality development, research and public health statistics. It is uncertain, however, to what extent these diagnoses present a correct picture of the content of and reasons for the consultations and the prevalence of illness in the population. The objective of this study was to identify the extent to which the general practitioners' use of diagnostic codes correlates with the content of the patient record notes. MATERIAL AND METHOD: A total of 23 general practitioners from five different medical centres in Agder county participated in the study. The patient record notes from all patient contacts over two working days in 2013 were reviewed by two experienced general practitioners who assessed the degree of correspondence between the content of the patient record notes and the concomitant ICPC diagnostic codes. RESULTS: A total of 1 819 patient contact were assessed, and for 1 591 of these (87.5 %) it was possible to assess the correspondence between the patient record notes and the diagnosis. We found good correspondence for 693 (85.3 %) consultations and 321 (69.9 %) simple contacts with issuance of a prescription. For simple contacts with no issuance of a prescription there was good correspondence for 213 (83.9 %), although 144 of a total of 398 (36.2 %) could not be assessed because the patient record notes were absent, too brief or imprecise. INTERPRETATION: The diagnoses made during consultations corresponded well with the patient record notes examined in this study. The results may indicate that caution should be exercised in including simple contacts in the data on diagnoses in public statistics. The findings should be followed up in larger-scale and more representative national studies.


Assuntos
Clínicos Gerais/normas , Classificação Internacional de Doenças , Registros Médicos/normas , Padrões de Prática Médica/normas , Atenção Primária à Saúde/classificação , Humanos , Noruega , Visita a Consultório Médico , Encaminhamento e Consulta/classificação
10.
BMC Health Serv Res ; 19(1): 697, 2019 Oct 15.
Artigo em Inglês | MEDLINE | ID: mdl-31615523

RESUMO

BACKGROUND: The reason for doctor visits associated with bad working conditions (and workplace bullying) remains unknown. Therefore, the aim of this study was to examine the association between perceived working conditions as well as workplace bullying and the number of doctor visits as well as the reason for seeing a doctor. METHODS: Data were derived from the German General Social Survey, a representative cross-section of the population in the year 2014. Self-reported doctor visits in the last 3 months were used as outcome measure. Self-rated working conditions (noise, bad air; time/performance pressure; bad working atmosphere; overtime; shifts/night work; hard physical labour) and workplace bullying were assessed. The reason for seeing a doctor was also recorded (acute illness; chronic illness; feeling unwell; requesting advice; visit to the doctor's office without consulting the doctor (e.g., need to get a prescription); preventive medical check-up/vaccination). Regression analysis stratified by sex was conducted. RESULTS: Adjusting for various potential confounders, Poisson regressions showed that workplace bullying was associated with increased doctor visits in men, but not in women. Contrarily, time/performance pressure at work was only associated with increased doctor visits in women, but not in men. Furthermore, the probability of visiting the doctor for reasons of acute illness or feeling unwell increased with workplace bullying in men. The probability of visiting the doctor because of feeling unwell increased with time/performance pressure in women. CONCLUSIONS: Our findings stress the association between adverse working conditions (workplace bullying as well as time/performance pressure at work) and doctor visits, with remarkable gender differences. Longitudinal studies are required to confirm the present findings and to obtain further insights into this relationship.


Assuntos
Bullying/psicologia , Aceitação pelo Paciente de Cuidados de Saúde/psicologia , Doença Aguda , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Bullying/estatística & dados numéricos , Doença Crônica , Estudos Transversais , Feminino , Alemanha , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Percepção , Distribuição por Sexo , Inquéritos e Questionários , Local de Trabalho/psicologia , Local de Trabalho/estatística & dados numéricos , Adulto Jovem
11.
High Blood Press Cardiovasc Prev ; 26(6): 493-499, 2019 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-31625119

RESUMO

Accurate measurement of blood pressure (BP) has a pivotal role in the management of patients with arterial hypertension. Recently, introduction of unattended office BP measurement has been proposed as a method allowing more accurate management of hypertensive patients and prediction of hypertension-mediated target organ damage (HMOD). This approach to BP measurement has been in particular proposed to avoid the white coat effect (WCE), which can be easily assessed once both attended and unattended BP measurements are obtained. In spite of its interest, the role of WCE in predicting HMOD remains largely unexplored. To fill this gap the Young Investigator Group of the Italian Hypertension Society (SIIA) conceived the study "Evaluation of unattended automated office, conventional office and ambulatory blood pressure measurements and their correlation with target organ damage in an outpatient population of hypertensives". This is a no-profit multicenter observational study aiming to correlate attended and unattended BP measurements for quantification of WCE and to correlate WCE with markers of HMOD, such us left ventricular hypertrophy, left atrial dilatation, and peripheral atherosclerosis. The Ethical committee of the Federico II University hospital has approved the study.


Assuntos
Assistência Ambulatorial , Determinação da Pressão Arterial/métodos , Monitorização Ambulatorial da Pressão Arterial , Pressão Sanguínea , Hipertensão/diagnóstico , Visita a Consultório Médico , Estudos Transversais , Humanos , Hipertensão/complicações , Hipertensão/fisiopatologia , Hipertrofia Ventricular Esquerda/diagnóstico , Hipertrofia Ventricular Esquerda/etiologia , Hipertrofia Ventricular Esquerda/fisiopatologia , Itália , Doença Arterial Periférica/diagnóstico , Doença Arterial Periférica/etiologia , Doença Arterial Periférica/fisiopatologia , Valor Preditivo dos Testes , Prognóstico , Reprodutibilidade dos Testes , Projetos de Pesquisa , Fatores de Risco , Hipertensão do Jaleco Branco/complicações , Hipertensão do Jaleco Branco/diagnóstico por imagem , Hipertensão do Jaleco Branco/fisiopatologia
12.
J Pediatr Orthop ; 39(10): 505-509, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31599859

RESUMO

BACKGROUND: Variation exists in the Pavlik harness (PH) treatment regimen for infantile developmental dysplasia of the hip (DDH). The purpose of this study was to determine if the daily PH wear duration (23 vs. 24 h) and frequency of follow-up visits affect the clinical and radiographic outcomes of infants with dislocated but reducible (Ortolani+) hips. METHODS: This study reviewed prospectively enrolled patients with DDH in a single center who presented at age <6 months with Ortolani+ hips and were treated with PH. Recommended daily PH wear duration (23 vs. 24 h) and the frequency of clinic visits in first 4 weeks after the initiation of PH treatment were analyzed. The clinical success (stable hip that did not require closed or open reduction or the use of an abduction orthosis) and radiographic success based on the acetabular index at 2-year follow-up were compared between different PH regimen groups. RESULTS: Sixty-two patients (74 hips, 53 females) with Ortolani+ hips had a mean age of presentation of 23±28 days (range, 4 to 128 d) and mean follow-up of 33.2±18.4 months (range, 8 to 85 mo). Overall clinical success rate of PH for Ortolani+ hips was 93% (69/74 hips) and radiographic success rate at 2 years was 84% (48/57 hips). There was no difference in clinical or radiographic success rate between the 23- and 24-hour wear groups (P>0.99, 0.73) or between hips assessed almost weekly compared with once or twice during the first 4 weeks of PH treatment (P>0.99 for both). CONCLUSIONS: The 23- versus 24-hour PH regimen and frequency of clinic visits in the first 4 weeks of PH treatment did not affect the clinical or radiographic success rate of Ortolani+ hips in infantile DDH. A strict weekly clinic visit and 24-hour PH regimen may not be necessary to obtain stable reduced hips in infants presenting <6 months of age with Ortolani+ hips. LEVEL OF EVIDENCE: Level III-therapeutic.


Assuntos
Braquetes , Luxação Congênita de Quadril/terapia , Visita a Consultório Médico , Criança , Pré-Escolar , Protocolos Clínicos , Feminino , Seguimentos , Luxação Congênita de Quadril/diagnóstico por imagem , Humanos , Lactente , Recém-Nascido , Masculino , Radiologia , Estudos Retrospectivos , Fatores de Tempo , Resultado do Tratamento
13.
J Drugs Dermatol ; 18(10): 987-990, 2019 10 01.
Artigo em Inglês | MEDLINE | ID: mdl-31584776

RESUMO

Introduction: Introduction: Although future atopic dermatitis (AD) clinical research is intended to improve standard-of-care treatment, how patients are currently treated is not well characterized. The purpose of this study was to determine the most frequent medications prescribed in all ages of AD. Methods: The National Ambulatory Medical Care Survey (NAMCS) is a nationally representative survey of United States office-based ambulatory visits and records demographics, diagnoses, and treatments. This is a cross-sectional study using the NAMCS of all AD outpatient office visits from 2006 to 2015. Patient visits with an ICD-9-CM code for AD (691.8) were collected and analyzed. Frequency tables were created for age, race, providers managing AD, and treatment. Results: Patient demographics of AD visits included 51% male (95% Confidence Interval [CI]: 44-58%), 71% white (65-77%), 19% African American (14-25%), and 10% Asian (6-14%). About 31% (24-37%) of visits were to pediatricians and 27% (22-33%) to dermatologists whereas per physician, dermatologists managed more AD visits than pediatricians. Topical corticosteroids (59%; 52-66%) were the most common class of medications prescribed followed by antibiotics (11%; 6-16%) and second generation antihistamines (6%; 3-10%). The most common topical corticosteroid prescribed in AD was triamcinolone (25% of office visits; 18-31%). Hydrocortisone was the most common topical corticosteroid prescribed to children <1 year of age and children aged 8 to 18, whereas triamcinolone was more common in children 2 to 7 years and adults >18 years. Discussion: Topical corticosteroids were the most frequent prescriptions provided at office-based ambulatory visits whereas antibiotics and second-generation antihistamines were the second and third most common prescribed medications, respectively. Although pediatricians manage more AD visits than dermatologists in total visits, dermatologists manage more AD visits than pediatricians per physician. Characterizing how AD patients are currently treated may build a reference for future clinical research investigating novel standard-of-care treatment in AD. J Drugs Dermatol. 2019;18(10):987-990.


Assuntos
Dermatite Atópica/tratamento farmacológico , Fármacos Dermatológicos/uso terapêutico , Prescrições de Medicamentos/estatística & dados numéricos , Padrões de Prática Médica/estatística & dados numéricos , Padrão de Cuidado/estatística & dados numéricos , Administração Cutânea , Adolescente , Adulto , Antibacterianos/uso terapêutico , Criança , Pré-Escolar , Estudos Transversais , Dermatologistas/estatística & dados numéricos , Feminino , Glucocorticoides/uso terapêutico , Pesquisas sobre Serviços de Saúde/estatística & dados numéricos , Antagonistas dos Receptores Histamínicos/uso terapêutico , Humanos , Lactente , Recém-Nascido , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Estados Unidos , Adulto Jovem
15.
BMC Health Serv Res ; 19(1): 678, 2019 Sep 18.
Artigo em Inglês | MEDLINE | ID: mdl-31533819

RESUMO

BACKGROUND: This study aimed to investigate the relationship between complementary health insurance and frequency of dental visits. METHODS: The present study was performed using the Urban Health Equity Assessment and Response Tool (Urban HEART). A cross-sectional study was conducted in Tehran (Iran) to assess inequalities in health status among different socioeconomic and ethnic groups, genders, geographical areas, and social determinants of health. Out of 20,320 records retrieved from the original study with dental information, 17,252 had both dental insurance and dental visit information. Complementary health insurance as the main independent variable had three categories (i.e., basic insurance, with complementary medical coverage, and with dental coverage). The frequency of dental visits during the last year as a dependent variable had also three categories (i.e., no visit, one, and two, or more dental visits in the last year). In this study, in addition to investigating the relationship between complementary health insurance and frequency of dental visits, potential covariates that may affect the mentioned relationship were evaluated in the regression model. Statistical analyses included simple and multiple multinomial logistic regression considering the sampling method and sampling weights. RESULTS: The meanage of 17,252 participants (Tehran citizens) was 39.36 years; 49.4%were women, 86.0%hadonly basicinsurance, 7.2% had complementary medical insurance, and 6.8% had complementary dental insurance. Of all subjects, 43.8% reported no dental visit, 26.1% reported one, and 30.1% reportedtwoor more dental visits during the lastyear. The frequency of dental visits was lower in people who had basic insurance than others such that that odds ratio (OR) was 0.73 (p-value < 0.001) for one visit and 0.68 (p-value< 0.001) for two or more visits in the last year. The frequency of dental visits was also positively associated with dental brushing, toothpaste use, high educational level, being married, having more than 20 teeth, and having dental pain. CONCLUSION: Having dental insurance increases the frequency of dental visits but the association between dental insurance and dental visits was independently influenced by other predictors.


Assuntos
Serviços de Saúde Bucal/estatística & dados numéricos , Seguro Odontológico/estatística & dados numéricos , Visita a Consultório Médico/estatística & dados numéricos , Adolescente , Adulto , Idoso , Estudos Transversais , Análise de Dados , Utilização de Instalações e Serviços , Feminino , Nível de Saúde , Humanos , Irã (Geográfico) , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Fatores Socioeconômicos , Saúde da População Urbana/estatística & dados numéricos , Adulto Jovem
16.
BMC Health Serv Res ; 19(1): 646, 2019 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-31492128

RESUMO

BACKGROUND: Health care systems are continually being reformed, however care improvement and intervention effectiveness are often assumed, not measured. This paper aimed to review findings from published studies about the appropriateness of eye care delivery, using existing published evidence and/or experts' practice and to describe the methods used to measure appropriateness of eye care. METHODS: A systematic search was conducted using Medline, Embase and CINAHL (2006 to September 2016). Studies reporting the processes of eye care delivery against existing published evidence and/or experts' practice were selected. Data was extracted from published reports and the methodological quality using a modified critical appraisal tool. The primary outcomes were percentage of appropriateness of eye care delivery. This study was registered with PROSPERO, reference CRD42016049974. RESULTS: Fifty-seven studies were included. Most studies assessed glaucoma and diabetic retinopathy and the overall methodological quality for most studies was moderate. The ranges of appropriateness of care delivery were 2-100% for glaucoma, 0-100% for diabetic retinopathy and 0-100% for other miscellaneous conditions. Published studies assessed a single ocular condition, a sample from a single centre or a single domain of care, but no study has attempted to measure the overall appropriateness of eye care delivery. CONCLUSIONS: These findings indicated a wide range of appropriateness of eye care delivery, for glaucoma and diabetic eye care. Future research would benefit from a comprehensive approach where appropriateness of eye care is measured across multiple conditions with a single methodology, to guide priorities within eye care delivery and monitor quality improvement initiatives.


Assuntos
Assistência à Saúde/normas , Oftalmopatias/terapia , Qualidade da Assistência à Saúde , Assistência à Saúde/estatística & dados numéricos , Feminino , Humanos , Masculino , Visita a Consultório Médico/estatística & dados numéricos , Avaliação de Programas e Projetos de Saúde
17.
Anatol J Cardiol ; 22(3): 112-116, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475948

RESUMO

OBJECTIVE: Our study aims to compare the effects of blood pressure variability (BPV) during ambulatory blood pressure measurement (ABPM) and visit-to-visit measurements to predict future cardiovascular complications among hypertensive patients. METHODS: This is a retrospective case-control study of patients with hypertension over 10 years. All adult patients with at least one recorded ABPM, and at least three recorded visit measurements were included. Patients with incomplete ABPM readings, a history of a tested outcome, or the occurrence of any of the tested outcomes within the measurement period were excluded. The outcome was the development of any of the following: acute coronary syndrome (ACS), chronic ischemic heart disease (IHD), heart failure (HF), or stroke. RESULTS: Of the 305 cases reviewed, 152 were included. The mean follow-up was 6.6±2.3 years. The mean age was 53.5±14.3 years. Eighty-two (53.9%) patients were male, while 70 (46.1%) were female. Risk factors included diabetes mellitus (53.9%), dyslipidemia (39.5%), obesity (16.4%), and smoking (8.6%). Comorbidities included stroke (2%), ACS (8.6%), IHD (20.4%), HF (2.6%), and renal failure (1.3%). One or more complications were seen in 22.4 % of the included patients. The variation of the daytime systolic ABP had been found to predict the future risk of developing IHD (OR=1.94; 95% CI=1.09-3.45; p=0.025). Moreover, IHD was associated with night-time systolic standard deviation (SD) in ABPM (OR=1.23; 95% CI=1.00-1.51; p=0.048). On the other side, ACS was found to be associated with systolic SD in visit-to-visit measurement (OR=1.10; 95% CI=1.01-1.21; p=0.04). CONCLUSION: Hypertensive patients with high variability of daytime and night-time SD in ABPM are more likely to have IHD. Whereas, having high variability in systolic SD in visit-to-visit measurements is associated with developing ACS.


Assuntos
Pressão Sanguínea , Doenças Cardiovasculares/mortalidade , Hipertensão , Monitorização Ambulatorial da Pressão Arterial , Doenças Cardiovasculares/fisiopatologia , Estudos de Casos e Controles , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Visita a Consultório Médico , Prognóstico , Estudos Retrospectivos , Fatores de Risco , Turquia/epidemiologia
18.
Anatol J Cardiol ; 22(3): 117-124, 2019 Sep.
Artigo em Inglês | MEDLINE | ID: mdl-31475951

RESUMO

OBJECTIVE: A higher visit-to-visit variability in low-density lipoprotein cholesterol (LDL-C) is associated with an increased frequency of cardiovascular events. We investigated the association between the visit-to-visit LDL-C variability and all-cause mortality, myocardial infarction (MI), and coronary revascularization in a population with non-obstructive coronary artery disease (CAD). METHODS: From this retrospective cohort of individuals who underwent coronary angiography from 2006 to 2010, a total of 2.012 consecutive patients with non-obstructive CAD, who underwent three or more LDL-C determinations during the first 2 years, were identified and followed up for 5 years. The variability in the visit-to-visit LDL-C was measured by standard deviation (SD) and coefficient of variation (CV). The risk of all-cause mortality and composite endpoints, MI, and coronary revascularization were evaluated by a multivariable Cox regression analysis. RESULTS: During a 5-year follow-up, a total of 99 (4.92%) mortality cases and 154 (7.65%) cases of composite endpoints were observed. The percentage of subjects who experienced mortality or composite endpoints was higher in those with a higher LDL-C-SD or LDL-C-CV level. The association between the LDL-C variability and clinical endpoints was regardless of possible confounding factors. CONCLUSION: Among the patients with non-obstructive CAD, a higher visit-to-visit LDL-C variability is associated with increasing all-cause mortality or composite endpoints during the long-term follow-up.


Assuntos
LDL-Colesterol/sangue , Doença da Artéria Coronariana/sangue , Infarto do Miocárdio/mortalidade , Idoso , Estudos de Coortes , Técnicas de Apoio para a Decisão , Feminino , Humanos , Masculino , Infarto do Miocárdio/sangue , Visita a Consultório Médico , Estudos Retrospectivos , Fatores de Risco , Análise de Sobrevida , Turquia/epidemiologia
19.
BMC Res Notes ; 12(1): 610, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547855

RESUMO

OBJECTIVE: This study was aimed to identify factors affecting neonatal mortality in Ethiopia. RESULTS: According to the multilevel multivariable logistic regression analysis, the odds of neonatal mortality was significantly associated with husbands with no education (AOR = 2.30, 95% CI 1.10, 4.83), female birth (AOR = 0.57, 95% CI 0.39, 0.83), twin birth (AOR = 13.62, 95% CI 7.14, 25.99), pre-term birth (AOR = 15.07, 95% CI 7.80, 29.12) and mothers with no antenatal care (ANC) visit during pregnancy (AOR = 1.90 95% CI 1.11, 3.25).


Assuntos
Mortalidade Infantil/tendências , Visita a Consultório Médico/estatística & dados numéricos , Nascimento Prematuro/epidemiologia , Adolescente , Adulto , Estudos Transversais , Escolaridade , Etiópia/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Lactente , Modelos Logísticos , Pessoa de Meia-Idade , Razão de Chances , Gravidez , Gravidez de Gêmeos/estatística & dados numéricos , Nascimento Prematuro/etiologia , Fatores de Risco , População Rural , Fatores Sexuais , População Urbana
20.
BMC Res Notes ; 12(1): 618, 2019 Sep 23.
Artigo em Inglês | MEDLINE | ID: mdl-31547856

RESUMO

OBJECTIVE: Since data related to postpartum hemorrhage in Ethiopia is scarce, this study was aimed to assess the magnitude and associated factors of postpartum hemorrhage among mothers who delivered in Debre Tabor general hospital. RESULTS: In this study, one hundred forty-four mothers' charts were reviewed which made the response rate 100%. This study revealed that the magnitude of postpartum hemorrhage was 7.6% (CI 6.2, 9.8). Chi-square test revealed that there was an association between postpartum hemorrhage and gravidity, parity, having antenatal care visit, and the previous history postpartum hemorrhage. This finding confirmed that uterine atony, retained placenta, and genital tract trauma were the most common leading cause of postpartum hemorrhage.


Assuntos
Hospitais Gerais , Placenta Retida/fisiopatologia , Hemorragia Pós-Parto/diagnóstico , Inércia Uterina/fisiopatologia , Adolescente , Adulto , Estudos Transversais , Parto Obstétrico , Etiópia/epidemiologia , Feminino , Genitália Feminina/lesões , Número de Gestações/fisiologia , Humanos , Visita a Consultório Médico/estatística & dados numéricos , Paridade/fisiologia , Hemorragia Pós-Parto/epidemiologia , Hemorragia Pós-Parto/etiologia , Hemorragia Pós-Parto/fisiopatologia , Gravidez , Fatores de Risco
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