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1.
Health Policy Plan ; 2021 Apr 05.
Artículo en Inglés | MEDLINE | ID: mdl-33822943

RESUMEN

The use of quality antenatal care (ANC) improves maternal and newborn health outcomes. Ensuring equity in access to quality maternal health services is a priority agenda in low- and middle-income countries. This study aimed to assess inequalities in the use of quality ANC in nine East African countries using the most recent Demographic and Health Surveys. We used two outcome variables to examine ANC service adequacy: four or more ANC contacts and quality ANC. We defined quality ANC as having six of the recommended ANC components during follow-up: blood pressure measurement, urine sample test, blood sample test, provision of iron supplements, drug for intestinal parasite and tetanus toxoid injections. We used the concentration index (CCI) to examine inequalities within and across countries. We fitted a multilevel regression model to assess the predictors of inequalities in the contact and content of ANC. This study included 87 068 women; among those 54.4% (n = 47 387) had four or more ANC contacts, but only 21% (n = 15 759) reported receiving all six services. The coverage of four or more ANC and receipt of all six services was pro-rich within and across all countries. The highest inequality in four or more ANC contacts was in Ethiopia with a CCI of 0.209, while women in Burundi had the highest inequality in coverage of all six services (CCI: 0.318). Higher education levels and media exposure were predictors of service uptake, while women who had unintended pregnancies were less likely to make four or more ANC contacts and receive six services. Interventions to improve access to quality ANC require rethinking the service delivery mechanisms in all countries. Moreover, ensuring equity in access to quality ANC requires tailoring service delivery modalities to address the social determinants of service uptake.

2.
Pediatr Rheumatol Online J ; 19(1): 52, 2021 Apr 07.
Artículo en Inglés | MEDLINE | ID: mdl-33827608

RESUMEN

BACKGROUND: Involving the end-users of scientific research (patients, carers and clinicians) in setting research priorities is important to formulate research questions that truly make a difference and are in tune with the needs of patients. We therefore aimed to generate a national research agenda for Juvenile Idiopathic Arthritis (JIA) together with patients, their caregivers and healthcare professionals through conducting a nationwide survey among these stakeholders. METHODS: The James Lind Alliance method was used, tailored with additional focus groups held to involve younger patients. First, research questions were gathered through an online and hardcopy survey. The received questions that were in scope were summarised and a literature search was performed to verify that questions were unanswered. Questions were ranked in the interim survey, and the final top 10 was chosen during a prioritisation workshop. RESULTS: Two hundred and seventy-eight respondents submitted 604 questions, of which 519 were in scope. Of these 604 questions, 81 were generated in the focus groups with younger children. The questions were summarised into 53 summary questions. An evidence checking process verified that all questions were unanswered. A total of 303 respondents prioritised the questions in the interim survey. Focus groups with children generated a top 5 of their most important questions. Combining this top 5 with the top 10s of patients, carers, and clinicians led to a top 21. Out of these, the top 10 research priorities were chosen during a final workshop. Research into pain and fatigue, personalised treatment strategies and aetiology were ranked high in the Top 10. CONCLUSIONS: Through this study, the top 10 research priorities for JIA of patients, their caregivers and clinicians were identified to inform researchers and research funders of the research topics that matter most to them. The top priority involves the treatment and mechanisms behind persisting pain and fatigue when the disease is in remission.

3.
Global Health ; 17(1): 33, 2021 Mar 29.
Artículo en Inglés | MEDLINE | ID: mdl-33781272

RESUMEN

BACKGROUND: The global health agenda is ill-defined as an analytical construct, complicating attempts by scholars and proponents to make claims about the agenda status of issues. We draw on Kingdon's definition of the agenda and Hilgartner and Bosk's public arenas model to conceptualize the global health agenda as those subjects or problems to which collectivities of actors operating nationally and globally are paying serious attention at any given time. We propose an arenas model for global health agenda setting and illustrate its potential utility by assessing priority indicators in five arenas, including international aid, pharmaceutical industry, scientific research, news media and civil society. We then apply the model to illustrate how the status of established (HIV/AIDS), emergent (diabetes) and rising (Alzheimer's disease) issues might be measured, compared and change in light of a pandemic shock (COVID-19). RESULTS: Coronavirus priority indicators rose precipitously in all five arenas in 2020, reflecting the kind of punctuation often caused by focusing events. The magnitude of change varied somewhat by arena, with the most pronounced shift in the global news media arena. Priority indicators for the other issues showed decreases of up to 21% and increases of up to 41% between 2019 and 2020, with increases suggesting that the agenda for global health issues expanded in some arenas in 2020- COVID-19 did not consistently displace priority for HIV/AIDS, diabetes or Alzheimer's disease, though it might have for other issues. CONCLUSIONS: We advance an arenas model as a novel means of addressing conceptual and measurement challenges that often undermine the validity of claims concerning the global health agenda status of problems and contributing causal factors. Our presentation of the model and illustrative analysis lays the groundwork for more systematic investigation of trends in global health agenda setting. Further specification of the model is needed to ensure accurate representation of vital national and transnational arenas and their interactions, applicability to a range of disease-specific, health systems, governance and policy issues, and sensitivity to subtler influences on global health agenda setting than pandemic shocks.

4.
AIDS Care ; : 1-9, 2021 Mar 22.
Artículo en Inglés | MEDLINE | ID: mdl-33745403

RESUMEN

Chronic pain is a common comorbidity in people with HIV (PWH), with prevalence estimates of 25-85%. Research in this area is growing, but significant gaps remain. A Global Task Force of HIV experts was organized to brainstorm a scientific agenda and identify measurement domains critical to advancing research in this field. Experts were identified through literature searches and snowball sampling. Two online questionnaires were developed by Task Force members. Questionnaire 1 asked participants to identify knowledge gaps in the field of HIV and chronic pain and identify measurement domains in studies of chronic pain in PWH. Responses were ranked in order of importance in Questionnaire 2, which was followed by a group discussion. 29 experts completed Questionnaire 1, 25 completed Questionnaire 2, and 21 participated in the group. Many important clinical and research priorities emerged, including the need to examine etiologies of chronic pain in PWH. Pain-related measurement domains were discussed, with a primary focus on domains that could be assessed in a standardized manner across various cohorts that include PWH in different countries. We collaboratively identified clinical and research priorities, as well as gaps in standardization of measurement domains, that can be used to move the field forward.

5.
Integr Cancer Ther ; 20: 1534735421999101, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-33655797

RESUMEN

BACKGROUND: The COVID-19 pandemic has catalyzed the use of mobile technologies to deliver health care. This new medical model has benefited integrative oncology (IO) consultations, where cancer patients are counseled about healthy lifestyle, non-pharmacological approaches for symptom management, and addressing questions around natural products and other integrative modalities. Here we report the feasibility of conducting IO physician consultations via telehealth in 2020 and compare patient characteristics to prior in-person consultations conducted in 2019. METHODS: An integrated EHR-telemedicine platform was used for IO physician consultations. As in the prior in-person visits, patients completed pre-visit patient-reported outcome (PRO) assessments about common cancer symptoms [modified Edmonton Symptom Assessment Scale, (ESAS)], Measure Yourself Concerns and Wellbeing (MYCaW), and the PROMIS-10 to assess quality of life (QOL). Patient demographics, clinical characteristics, and PROs for new telehealth consultation in 2020 were compared to new in-person consultations in 2019 using t-tests, chi-squared tests, and -Wilcoxon rank-sum test. RESULTS: We provided telehealth IO consultations to 509 new patients from April 21, 2020, to October 21, 2020, versus 842 new patients in-person during the same period in 2019. Most were female (77 % vs 73%); median age (56 vs 58), and the most frequent cancer type was breast (48% vs 39%). More patients were seeking counseling on herbs and supplements (12.9 vs 6.8%) and lifestyle (diet 22.7 vs 16.9% and exercise 5.2 vs 1.8%) in the 2020 cohort than 2019, respectively. The 2020 telehealth cohort had lower symptom management concerns compared to the 2019 in-person cohort (19.5 vs 33.1%). CONCLUSIONS: Delivering IO consultations using telehealth is feasible and meets patients' needs. Compared to patients seen in-person during 2019, patients having telehealth IO consultations in 2020 reported lower symptom burden and more concerns about lifestyle and herbs and supplements. Additional research is warranted to explore the satisfaction and challenges among patients receiving telehealth IO care.


Asunto(s)
/epidemiología , Oncología Integrativa/estadística & datos numéricos , Neoplasias/terapia , Relaciones Profesional-Paciente , Telemedicina/organización & administración , Actitud del Personal de Salud , Femenino , Humanos , Persona de Mediana Edad , Satisfacción Personal , Calidad de Vida , Consulta Remota/organización & administración , Encuestas y Cuestionarios , Comunicación por Videocoferencia
6.
J Occup Health ; 63(1): e12211, 2021 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-33683773

RESUMEN

OBJECTIVES: To address ongoing problems concerning population aging and labor shortages in Japan, employers have sought to improve work efficiency and labor productivity. However, it is unclear how presenteeism is affected by working styles in line with current corporate initiatives, such as reduced working hours, varied employment status, and flexible work arrangements. The purpose of this article was to investigate the association between work style and presenteeism. METHODS: This cross-sectional study extracted data from employee profiles, employee attendance records, and a questionnaire in a large service sector company. Multiple linear regression was conducted to estimate the contributions of work style variables to the Work Limitations Questionnaire (WLQ) index score. RESULTS: In total, 21 500 participants were eligible for analysis. The WLQ index was lower for those working < 35 h/week (adjusted regression coefficient [ARC]:-0.35%; 95% CI: -0.48 to - 0.21) and higher for those working 40-44 h/week or ≥ 45 h/week, compared with those working 35-39 h/week. The position of team manager was positively associated with the WLQ index, whereas senior manager (ARC: -1.44%; 95% CI: -1.71 to - 1.17) and part-time staff (ARC: -1.75%; 95% CI: -1.98 to - 1.52) positions were negatively associated with the WLQ index, compared with non-managers. Those who worked remotely had significantly lower WLQ index scores (ARC: -0.61%; 95% CI: -0.95 to - 0.27). CONCLUSIONS: Reduced working hours and flexible work arrangements were associated with lower work limitations, which imply presenteeism, although additional research is necessary to verify these results.


Asunto(s)
Empleo , Admisión y Programación de Personal , Presentismo , Personal Administrativo , Adulto , Estudios Transversales , Femenino , Humanos , Japón , Masculino , Persona de Mediana Edad , Encuestas y Cuestionarios , Factores de Tiempo , Adulto Joven
7.
Anal Chim Acta ; 1154: 338227, 2021 Apr 15.
Artículo en Inglés | MEDLINE | ID: mdl-33736818

RESUMEN

In all professional sports, performance pressure is high at the top level. Therefore, rules are defined and controlled to keep sports fair in accordance e.g. with the Agenda 21 of the International Olympic Committee. However, it's about money and honour and as a consequence it is obvious that the athletes will go to the limits at all levels or even beyond. This is not only true for performance-enhancing substances to improve the physical capacity but - when sports equipment is involved - also for their optimisation. Thus, rules and related controls are necessary with regard to fairness between competitors but also with regard to their health when chemicals are involved. In table tennis, such chemicals (so-called boosters) are used occasionally - but against the rules - to improve the performance of the rackets. In the present study, several boosters were analysed as well as numerous common racket coverings using ion mobility spectrometry coupled to gas-chromatographic pre-separation. After optimisation of sampling with regard to improving reproducibility, characteristic patterns of volatiles for booster compounds and for racket coverings with different characteristics were developed successfully. In particular, signals related to particular softening agents could be identified and detected even in the untreated coverings. The patterns of volatiles were found to be characteristic for the particular boosters investigated as well as for the particular coverings. Furthermore, those patterns enable a differentiation between booster and covering or - in other words - between rule-consistent racket coverings and rule violation by after treatment of the rubber with a booster. After adaptation of the entire procedure to realistic competition situations, the method could be used for proving an infringement against the prohibition of applying such compounds.

8.
BMJ Open ; 11(3): e044154, 2021 03 05.
Artículo en Inglés | MEDLINE | ID: mdl-33674374

RESUMEN

OBJECTIVE: Describe the disease course in a cohort of outpatients with COVID-19 and evaluate factors predicting duration of symptoms. DESIGN: Retrospective cohort study. SETTING: Telemedicine clinic at a large medical system in Atlanta, Georgia. PARTICIPANTS: 337 patients with acute COVID-19. Exclusion criteria included intake visit more than 10 days after symptom onset and hospitalisation prior to intake visit. MAIN OUTCOME MEASURES: Symptom duration in days. RESULTS: Common symptoms at intake visit are upper respiratory (73% cough, 55% loss of smell or taste, 57% sinus congestion, 32% sore throat) and systemic (66% headache, 64% body aches, 53% chills, 30% dizziness, 36% fever). Day of symptom onset was earliest for systemic and upper respiratory symptoms (median onset day 1 for both), followed by lower respiratory symptoms (day 3, 95% CI 2 to 4), with later onset of gastrointestinal symptoms (day 4, 95% CI 3 to 5), when present. Cough had the longest duration when present with median 17 days (95% CI 15 to 21), with 42% not resolved at final visit. Loss of smell or taste had the second longest duration with 14 days (95% CI 12 to 17), with 38% not resolved at final visit. Initial symptom severity is a significant predictor of symptom duration (p<0.01 for multiple symptoms). CONCLUSIONS: COVID-19 illness in outpatients follows a pattern of progression from systemic symptoms to lower respiratory symptoms and persistent symptoms are common across categories. Initial symptom severity is a significant predictor of disease duration for most considered symptoms.


Asunto(s)
/diagnóstico , Evaluación de Síntomas/métodos , Telemedicina , Adulto , Anciano , Femenino , Georgia , Humanos , Masculino , Persona de Mediana Edad , Embarazo , Estudios Retrospectivos
9.
JAMA Netw Open ; 4(3): e210667, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33662134

RESUMEN

Importance: Before the widespread implementation of robotic systems to provide patient care during the COVID-19 pandemic occurs, it is important to understand the acceptability of these systems among patients and the economic consequences associated with the adoption of robotics in health care settings. Objective: To assess the acceptability and feasibility of using a mobile robotic system to facilitate health care tasks. Design, Setting, and Participants: This study included 2 components: a national survey to examine the acceptability of using robotic systems to perform health care tasks in a hospital setting and a single-site cohort study of patient experiences and satisfaction with the use of a mobile robotic system to facilitate triage and telehealth tasks in the emergency department (ED). The national survey comprised individuals living in the US who participated in a sampling-based survey via an online analytic platform. Participants completed the national survey between August 18 and August 21, 2020. The single-site cohort study included patients living in the US who presented to the ED of a large urban academic hospital providing quaternary care in Boston, Massachusetts between April and August 2020. All data were analyzed from August to October 2020. Exposures: Participants in the national survey completed an online survey to measure the acceptability of using a mobile robotic system to perform health care tasks (facilitating telehealth interviews, acquiring vital signs, obtaining nasal or oral swabs, placing an intravenous catheter, performing phlebotomy, and turning a patient in bed) in a hospital setting in the contexts of general interaction and interaction during the COVID-19 pandemic. Patients in the cohort study were exposed to a mobile robotic system, which was controlled by an ED clinician and used to facilitate a triage interview. After exposure, patients completed an assessment to measure their satisfaction with the robotic system. Main Outcomes and Measures: Acceptability of the use of a mobile robotic system to facilitate health care tasks in a hospital setting (national survey) and feasibility and patient satisfaction regarding the use of a mobile robotic system in the ED (cohort study). Results: For the national survey, 1154 participants completed all acceptability questions, representing a participation rate of 35%. After sample matching, a nationally representative sample of 1000 participants (mean [SD] age, 48.7 [17.0] years; 535 women [53.5%]) was included in the analysis. With regard to the usefulness of a robotic system to perform specific health care tasks, the response of "somewhat useful" was selected by 373 participants (37.3%) for facilitating telehealth interviews, 350 participants (35.0%) for acquiring vital signs, 307 participants (30.7%) for obtaining nasal or oral swabs, 228 participants (22.8%) for placing an intravenous catheter, 249 participants (24.9%) for performing phlebotomy, and 371 participants (37.1%) for turning a patient in bed. The response of "extremely useful" was selected by 287 participants (28.7%) for facilitating telehealth interviews, 413 participants (41.3%) for acquiring vital signs, 192 participants (19.2%) for obtaining nasal or oral swabs, 159 participants (15.9%) for placing an intravenous catheter, 167 participants (16.7%) for performing phlebotomy, and 371 participants (37.1%) for turning a patient in bed. In the context of the COVID-19 pandemic, the median number of individuals who perceived the application of robotic systems to be acceptable for completing telehealth interviews, obtaining nasal and oral swabs, placing an intravenous catheter, and performing phlebotomy increased. For the ED cohort study, 51 individuals were invited to participate, and 41 participants (80.4%) enrolled. One participant was unable to complete the study procedures because of a signaling malfunction in the robotic system. Forty patients (mean [SD] age, 45.8 [2.7] years; 29 women [72.5%]) completed the mobile robotic system-facilitated triage interview, and 37 patients (92.5%) reported that the interaction was satisfactory. A total of 33 participants (82.5%) reported that their experience of receiving an interview facilitated by a mobile robotic system was as satisfactory as receiving an in-person interview from a clinician. Conclusions and Relevance: In this study, a mobile robotic system was perceived to be acceptable for use in a broad set of health care tasks among survey respondents across the US. The use of a mobile robotic system enabled the facilitation of contactless triage interviews of patients in the ED and was considered acceptable among participants. Most patients in the ED rated the quality of mobile robotic system-facilitated interaction to be equivalent to in-person interaction with a clinician.


Asunto(s)
Prestación de Atención de Salud/métodos , Servicio de Urgencia en Hospital , Hospitales , Atención al Paciente/métodos , Satisfacción del Paciente , Robótica/métodos , Triaje , Adulto , Anciano , Boston , Cateterismo , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , Flebotomía , Examen Físico , Encuestas y Cuestionarios , Telemedicina
10.
Sci Rep ; 11(1): 5958, 2021 03 16.
Artículo en Inglés | MEDLINE | ID: mdl-33727655

RESUMEN

There is concern that digital public health initiatives used in the management of COVID-19 may marginalise certain population groups. There is an overlap between the demographics of groups at risk of digital exclusion (older, lower social grade, low educational attainment and ethnic minorities) and those who are vulnerable to poorer health outcomes from SARS-CoV-2. In this national survey study (n = 2040), we assessed how the UK population; particularly these overlapping groups, reported their preparedness for digital health strategies. We report, with respect to using digital information to make health decisions, that those over 60 are less comfortable (net comfort: 57%) than those between 18 and 39 (net comfort: 78%) and lower social grades are less comfortable (net comfort: 63%) than higher social grades (net comfort: 75%). With respect to a preference for digital over non-digital sources in seeking COVID-19 health information, those over 60 (net preference: 21%) are less inclined than those between 18 and 39 (net preference: 60%) and those of low educational attainment (net preference: 30%) are less inclined than those of high educational attainment (net preference: 52%). Lastly, with respect to distinguishing reliable digital COVID-19 information, lower social grades (net confidence: 55%) are less confident than higher social grades (net confidence: 68%) and those of low educational attainment (net confidence: 51%) are less confident than those of high educational attainment (net confidence: 71%). All reported differences are statistically significant (p < 0.01) following multivariate regression modelling. This study suggests that digital public health approaches to COVID-19 have the potential to marginalise groups who are concurrently at risk of digital exclusion and poor health outcomes from SARS-CoV-2.


Asunto(s)
/patología , Encuestas Epidemiológicas , Telemedicina , Adolescente , Adulto , Anciano , Escolaridad , Grupos Étnicos , Femenino , Humanos , Masculino , Persona de Mediana Edad , Factores de Riesgo , Clase Social , Reino Unido , Adulto Joven
12.
Musculoskelet Sci Pract ; 52: 102340, 2021 04.
Artículo en Inglés | MEDLINE | ID: mdl-33571900

RESUMEN

BACKGROUND: Telehealth services have helped enable continuity of care during the coronavirus pandemic. We aimed to investigate use and views towards telehealth among allied health clinicians treating people with musculoskeletal conditions during the pandemic. METHODS: Cross-sectional international survey of allied health clinicians who used telehealth to manage musculoskeletal conditions during the coronavirus pandemic. Questions covered demographics, clinician-related factors (e.g. profession, clinical experience and setting), telehealth use (e.g. proportion of caseload, treatments used), attitudes towards telehealth (Likert scale), and perceived barriers and enablers (open questions). Data were presented descriptively, and an inductive thematic content analysis approach was used for qualitative data, based on the Capability-Opportunity-Motivation Behavioural Model. RESULTS: 827 clinicians participated, mostly physiotherapists (82%) working in Australia (70%). Most (71%, 587/827) reported reduced revenue (mean (SD) 62% (24.7%)) since the pandemic commenced. Median proportion of people seen via telehealth increased from 0% pre (IQR 0 to 1) to 60% during the pandemic (IQR 10 to 100). Most clinicians reported managing common musculoskeletal conditions via telehealth. Less than half (42%) of clinicians surveyed believed telehealth was as effective as face-to-face care. A quarter or less believed patients value telehealth to the same extent (25%), or that they have sufficient telehealth training (21%). Lack of physical contact when working through telehealth was perceived to hamper accurate and effective diagnosis and management. CONCLUSION: Although telehealth was adopted by allied health clinicians during the coronavirus pandemic, we identified barriers that may limit continued telehealth use among allied health clinicians beyond the current pandemic.


Asunto(s)
Técnicos Medios en Salud/estadística & datos numéricos , Actitud del Personal de Salud , Enfermedades Musculoesqueléticas/rehabilitación , Telemedicina/estadística & datos numéricos , Adulto , Técnicos Medios en Salud/psicología , Australia , Estudios Transversales , Femenino , Accesibilidad a los Servicios de Salud/estadística & datos numéricos , Humanos , Masculino , Persona de Mediana Edad , Aceptación de la Atención de Salud/estadística & datos numéricos , Pautas de la Práctica en Medicina/estadística & datos numéricos
13.
BMJ Glob Health ; 6(2)2021 Feb.
Artículo en Inglés | MEDLINE | ID: mdl-33602687

RESUMEN

BACKGROUND: Preterm birth is the leading cause of under-five-mortality worldwide, with the highest burden in low-income and middle-income countries (LMICs). The aim of this study was to synthesise evidence-based interventions for preterm and low birthweight (LBW) neonates in LMICs, their associated neonatal mortality rate (NMR), and barriers and facilitators to their implementation. This study updates all existing evidence on this topic and reviews evidence on interventions that have not been previously considered in current WHO recommendations. METHODS: Six electronic databases were searched until 3 March 2020 for randomised controlled trials reporting NMR of preterm and/or LBW newborns following any intervention in LMICs. Risk ratios for mortality outcomes were pooled where appropriate using a random effects model (PROSPERO registration number: CRD42019139267). RESULTS: 1236 studies were identified, of which 49 were narratively synthesised and 9 contributed to the meta-analysis. The studies included 39 interventions in 21 countries with 46 993 participants. High-quality evidence suggested significant reduction of NMR following antenatal corticosteroids (Pakistan risk ratio (RR) 0.89; 95% CI 0.80 to 0.99|Guatemala 0.74; 0.68 to 0.81), single cord (0.65; 0.50 to 0.86) and skin cleansing with chlorhexidine (0.72; 0.55 to 0.95), early BCG vaccine (0.64; 0.48 to 0.86; I2 0%), community kangaroo mother care (OR 0.73; 0.55 to 0.97; I2 0%) and home-based newborn care (preterm 0.25; 0.14 to 0.48|LBW 0.42; 0.27 to 0.65). No effects on perinatal (essential newborn care 1.02; 0.91 to 1.14|neonatal resuscitation 0.95; 0.84 to 1.07) or 7-day NMR (essential newborn care 1.03; 0.83 to 1.27|neonatal resuscitation 0.92; 0.77 to 1.09) were observed after training birth attendants. CONCLUSION: The findings of this study encourage the implementation of additional, evidence-based interventions in the current (WHO) guidelines and to be selective in usage of antenatal corticosteroids, to reduce mortality among preterm and LBW neonates in LMICs. Given the global commitment to end all preventable neonatal deaths by 2030, continuous evaluation and improvement of the current guidelines should be a priority on the agenda.

14.
J Gen Intern Med ; 2021 Feb 09.
Artículo en Inglés | MEDLINE | ID: mdl-33564945

RESUMEN

BACKGROUND: Diagnostic errors are a major source of preventable harm but the science of reducing them remains underdeveloped. OBJECTIVE: To identify and prioritize research questions to advance the field of diagnostic safety in the next 5 years. PARTICIPANTS: Ninety-seven researchers and 42 stakeholders were involved in the identification of the research priorities. DESIGN: We used systematic prioritization methods based on the Child Health and Nutrition Research Initiative (CHNRI) methodology. We first invited a large international group of expert researchers in various disciplines to submit research questions while considering five prioritization criteria: (1) usefulness, (2) answerability, (3) effectiveness, (4) potential for translation, and (5) maximal potential for effect on diagnostic safety. After consolidation, these questions were prioritized at an in-person expert meeting in April 2019. Top-ranked questions were subsequently reprioritized through scoring on the five prioritization criteria using an online questionnaire. We also invited non-research stakeholders to assign weights to the five criteria and then used these weights to adjust the final prioritization score for each question. KEY RESULTS: Of the 207 invited researchers, 97 researchers responded and 78 submitted 333 research questions which were then consolidated. Expert meeting participants (n = 21) discussed questions in different breakout sessions and prioritized 50, which were subsequently reduced to the top 20 using the online questionnaire. The top 20 questions addressed mostly system factors (e.g., implementation and evaluation of information technologies), teamwork factors (e.g., role of nurses and other health professionals in the diagnostic process), and strategies to engage patients in the diagnostic process. CONCLUSIONS: Top research priorities for advancing diagnostic safety in the short-term include strengthening systems and teams and engaging patients to support diagnosis. High-priority areas identified using these systematic methods can inform an actionable research agenda for reducing preventable diagnostic harm.

15.
Nature ; 589(7843): 567-571, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33505035

RESUMEN

Overfishing is the primary cause of marine defaunation, yet declines in and increasing extinction risks of individual species are difficult to measure, particularly for the largest predators found in the high seas1-3. Here we calculate two well-established indicators to track progress towards Aichi Biodiversity Targets and Sustainable Development Goals4,5: the Living Planet Index (a measure of changes in abundance aggregated from 57 abundance time-series datasets for 18 oceanic shark and ray species) and the Red List Index (a measure of change in extinction risk calculated for all 31 oceanic species of sharks and rays). We find that, since 1970, the global abundance of oceanic sharks and rays has declined by 71% owing to an 18-fold increase in relative fishing pressure. This depletion has increased the global extinction risk to the point at which three-quarters of the species comprising this functionally important assemblage are threatened with extinction. Strict prohibitions and precautionary science-based catch limits are urgently needed to avert population collapse6,7, avoid the disruption of ecological functions and promote species recovery8,9.


Asunto(s)
Organismos Acuáticos/aislamiento & purificación , Biodiversidad , Conservación de los Recursos Naturales , Especies en Peligro de Extinción/estadística & datos numéricos , Océanos y Mares , Tiburones , Rajidae , Animales , Conservación de los Recursos Naturales/legislación & jurisprudencia , Conservación de los Recursos Naturales/métodos , Extinción Biológica , Femenino , Peces , Cadena Alimentaria , Objetivos , Historia del Siglo XX , Historia del Siglo XXI , Dinámica Poblacional/estadística & datos numéricos , Conducta Predatoria , Medición de Riesgo , Desarrollo Sostenible
16.
Nature ; 589(7843): 554-561, 2021 01.
Artículo en Inglés | MEDLINE | ID: mdl-33505037

RESUMEN

Historically, human uses of land have transformed and fragmented ecosystems1,2, degraded biodiversity3,4, disrupted carbon and nitrogen cycles5,6 and added prodigious quantities of greenhouse gases (GHGs) to the atmosphere7,8. However, in contrast to fossil-fuel carbon dioxide (CO2) emissions, trends and drivers of GHG emissions from land management and land-use change (together referred to as 'land-use emissions') have not been as comprehensively and systematically assessed. Here we present country-, process-, GHG- and product-specific inventories of global land-use emissions from 1961 to 2017, we decompose key demographic, economic and technical drivers of emissions and we assess the uncertainties and the sensitivity of results to different accounting assumptions. Despite steady increases in population (+144 per cent) and agricultural production per capita (+58 per cent), as well as smaller increases in emissions per land area used (+8 per cent), decreases in land required per unit of agricultural production (-70 per cent) kept global annual land-use emissions relatively constant at about 11 gigatonnes CO2-equivalent until 2001. After 2001, driven by rising emissions per land area, emissions increased by 2.4 gigatonnes CO2-equivalent per decade to 14.6 gigatonnes CO2-equivalent in 2017 (about 25 per cent of total anthropogenic GHG emissions). Although emissions intensity decreased in all regions, large differences across regions persist over time. The three highest-emitting regions (Latin America, Southeast Asia and sub-Saharan Africa) dominate global emissions growth from 1961 to 2017, driven by rapid and extensive growth of agricultural production and related land-use change. In addition, disproportionate emissions are related to certain products: beef and a few other red meats supply only 1 per cent of calories worldwide, but account for 25 per cent of all land-use emissions. Even where land-use change emissions are negligible or negative, total per capita CO2-equivalent land-use emissions remain near 0.5 tonnes per capita, suggesting the current frontier of mitigation efforts. Our results are consistent with existing knowledge-for example, on the role of population and economic growth and dietary choice-but provide additional insight into regional and sectoral trends.


Asunto(s)
Agricultura/estadística & datos numéricos , Dióxido de Carbono/análisis , Combustibles Fósiles , Actividades Humanas , Internacionalidad , Metano/análisis , Óxido Nitroso/análisis , África del Sur del Sahara , Animales , Asia Sudoriental , Productos Agrícolas/provisión & distribución , Grano Comestible/provisión & distribución , Mapeo Geográfico , Historia del Siglo XX , Historia del Siglo XXI , América Latina , Estiércol , Oryza , Carne Roja/provisión & distribución , Suelo , Desarrollo Sostenible/tendencias , Madera
17.
Patient Educ Couns ; 104(3): 460-463, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33422368

RESUMEN

OBJECTIVE: To elucidate whether Amazon's virtual assistant, Alexa, provides evidence-based support as a supplement to provider-facilitated prenatal care, during the COVID-19 pandemic. METHODS: Using a conceptual content analysis approach, a query of 40 questions, relating to all phases of pregnancy, was collected from Alexa by two independent investigators, using two unique devices, over a one-week period between May 20, 2020 and May 27, 2020. Alexa's responses were matched to the evidence-based content from the American College of Obstetricians and Gynecologists (ACOG) and reviewed by a Certified Nurse Midwife for completeness and currency. RESULTS: Of the 40 questions asked of Alexa, it was unable to answer 14 questions (35%). A total of 21 out of the 40 responses (52%) were not evidence-based and three COVID-specific questions (about 1%) were answered incorrectly or insufficiently. Four questions (10%) were answered accurately. CONCLUSION: Alexa was largely unable to provide evidence-based answers to commonly asked pregnancy questions and, in many cases, supplied inaccurate, incomplete, or completely unrelated answers that could further confuse health consumers. PRACTICE IMPLICATIONS: Ensuring that mobile health (mhealth) tools, such as Amazon Alexa, are evidence-based and credible in answering common prenatal questions has important implications for this pandemic and future consumer needs.


Asunto(s)
Atención Prenatal/métodos , Telemedicina , Femenino , Promoción de la Salud , Humanos , Pandemias , Embarazo , Salud Reproductiva
18.
Am J Med Genet C Semin Med Genet ; 187(1): 70-82, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33385186

RESUMEN

The COVID-19 pandemic necessitated a rapid transition from in-person office visits to virtual visits in the Down syndrome specialty program at Massachusetts General Hospital (MGH DSP). We describe the clinic transition to virtual visits in April 2020 and reflect on our six-month experience in virtual visits. Clinic metrics were tracked. Electronic survey responses were collected from caregivers attending virtual visits. Input from the MGH DSP team was collected. From April to September 2020, we maintained patient volume (45 visits per month) and overall satisfaction score (6.7 out of 7) following a sudden, unanticipated transition to virtual visits. Survey of 17 caregivers attending virtual visits found that most were equipped with technology, had access to a private location, and most were able to access visit without any limitations. Caregivers appreciated the convenience of virtual visits but sometimes missed the personal connection of an in-person visit. Overall, though, virtual visits were frequently viewed as no different than office visits. Team members identified benefits and challenges of virtual visits, as well as lessons learned from this transition. We were able to maintain multidisciplinary, specialty care with optimal caregiver feedback and sustained number of patient visits.


Asunto(s)
Síndrome de Down/epidemiología , Pautas de la Práctica en Medicina/tendencias , Telemedicina/métodos , Telemedicina/estadística & datos numéricos , Adolescente , Adulto , Cuidadores , Niño , Preescolar , Síndrome de Down/diagnóstico , Síndrome de Down/terapia , Femenino , Humanos , Lactante , Comunicación Interdisciplinaria , Masculino , Grupo de Atención al Paciente , Interfaz Usuario-Computador , Adulto Joven
19.
JAMA Surg ; 156(3): 221-228, 2021 03 01.
Artículo en Inglés | MEDLINE | ID: mdl-33439221

RESUMEN

Importance: Postdischarge video-based virtual visits are a growing aspect of surgical care and have dramatically increased in the setting of the coronavirus disease 2019 (COVID-19) pandemic. Objective: To evaluate the outcomes of all-cause 30-day hospital encounter proportion among patients who have a postdischarge video-based virtual visit follow-up compared with in-person follow-up. Design, Setting, and Participants: Randomized, active, controlled noninferiority trial in an urban setting, including patients from a small community hospital and a large, tertiary care hospital. Patients who underwent minimally invasive appendectomy or cholecystectomy by a group of surgeons who cover emergency general surgery at these 2 hospitals were included. Patients undergoing elective and nonelective procedures were included. Interventions: Patients were randomized in a 2:1 fashion to video-based virtual visit or in-person visit. Main Outcomes and Measures: The primary outcome is the percentage of patients with 30-day hospital encounter, and we hypothesized that there would not be a significant increase in the 30-day hospital encounter proportion for patients who receive video-based virtual postdischarge care compared with patients who receive standard (in-person) care. Hospital encounter includes emergency department visit, observation, or inpatient admission. Results: A total of 1645 patients were screened; 289 patients were randomized to the virtual group and 143 to the in-person group. Fifty-three patients crossed over to the in-person follow-up group. The percentage of patients who had a hospital encounter was noninferior for virtual visits (12.8% vs 13.3% for in-person, Δ 0.5% with 1-sided 95% CI, -∞ to 5.2%). The amount of time patients spent with the clinician (mean of 8.4 minutes virtual vs 7.8 minutes in-person; P = .30) was not different, but the median overall postoperative visit time was 27.5 minutes shorter (95% CI, -33.5 to -24.0). Conclusions and Relevance: Postdischarge video-based virtual visits did not increase hospital encounter proportions and provided shorter overall time commitment but equal time with the surgical team member. This information will help surgeons and patients feel more confident in using video-based virtual visits. Trial Registration: ClinicalTrials.gov Identifier: NCT03258177.


Asunto(s)
Cuidados Posteriores , Apendicectomía , Colecistectomía , Telemedicina , Adulto , /prevención & control , Estudios Cruzados , Femenino , Humanos , Masculino , Persona de Mediana Edad , Procedimientos Quirúrgicos Mínimamente Invasivos , Alta del Paciente , Comunicación por Videocoferencia , Adulto Joven
20.
J Diabetes Sci Technol ; 15(2): 478-514, 2021 03.
Artículo en Inglés | MEDLINE | ID: mdl-33476193

RESUMEN

The coronavirus disease 2019 (COVID-19) pandemic caused by the severe acute respiratory syndrome coronavirus 2 (SARS-CoV-2) virus has rapidly involved the entire world and exposed the pressing need for collaboration between public health and other stakeholders from the clinical, scientific, regulatory, pharmaceutical, and medical device and technology communities. To discuss how to best protect people with diabetes from serious outcomes from COVID-19, Diabetes Technology Society, in collaboration with Sansum Diabetes Research Institute, hosted the "International COVID-19 and Diabetes Virtual Summit" on August 26-27, 2020. This unique, unprecedented real-time conference brought together physicians, scientists, government officials, regulatory experts, industry representatives, and people with diabetes from six continents to review and analyze relationships between COVID-19 and diabetes. Over 800 attendees logged in. The summit consisted of five sessions: (I) Keynotes, (II) Preparedness, (III) Response, (IV) Recovery, and (V) Surveillance; eight parts: (A) Background, (B) Resilience, (C) Outpatient Care, (D) Inpatient Care, (E) Resources, (F) High-Risk Groups, (G) Regulation, and (H) The Future; and 24 sections: (1) Historic Pandemics and Impact on Society, (2) Pathophysiology/Risk Factors for COVID-19, (3) Social Determinants of COVID-19, (4) Preparing for the Future, (5) Medications and Vaccines, (6) Psychology of Patients and Caregivers, (7) Outpatient Treatment of Diabetes Mellitus and Non-Pharmacologic Intervention, (8) Technology and Telehealth for Diabetes Outpatients, (9) Technology for Inpatients, (10) Management of Diabetes Inpatients with COVID-19, (11) Ethics, (12) Accuracy of Diagnostic Tests, (13) Children, (14) Pregnancy, (15) Economics of Care for COVID-19, (16) Role of Industry, (17) Protection of Healthcare Workers, (18) People with Diabetes, (19) International Responses to COVID-19, (20) Government Policy, (21) Regulation of Tests and Treatments, (22) Digital Health Technology, (23) Big Data Statistics, and 24) Patient Surveillance and Privacy. The two keynote speeches were entitled (1) COVID-19 and Diabetes-Meeting the Challenge and (2) Knowledge Gaps and Research Opportunities for Diabetes and COVID-19. While there was an emphasis on diabetes and its interactions with COVID-19, the panelists also discussed the COVID-19 pandemic in general. The meeting generated many novel ideas for collaboration between experts in medicine, science, government, and industry to develop new technologies and disease treatment paradigms to fight this global pandemic.


Asunto(s)
/epidemiología , Diabetes Mellitus/epidemiología , Diabetes Mellitus/terapia , /complicaciones , Complicaciones de la Diabetes/epidemiología , Complicaciones de la Diabetes/prevención & control , Geografía , Salud Global , Historia del Siglo XX , Humanos , Influenza Pandémica, 1918-1919/historia , Cooperación Internacional , Pandemias , Sociedades Médicas , Telemedicina/tendencias
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