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1.
J Environ Sci (China) ; 110: 129-139, 2021 Dec.
Artículo en Inglés | MEDLINE | ID: mdl-34593184

RESUMEN

The Environmental Kuznets Curve (EKC) model was applied to investigate the relationship between economic growth and water environment quality based on panel data of Taicang during 2010-2017. The typical inversed-U shaped relationship has been obtained between GDP (gross domestic product) and indicators of ammonia, total nitrogen (TN) and total phosphorus (TP), respectively. The EKC turning point appeared when the GDP per capita was around US$2270, which was much lower than those in some developed countries (US$11,200). However, the decoupling between chemical oxygen demand (COD) and GDP per capita occurred even before this period, which should be attributed to the strict COD emission regulation being implemented since 2010. Further, analysis based on the Tapio decoupling coefficient elasticity model analyzed the ammonia nitrogen and economic development of each industry. We found that the agriculture no-point was strong decoupling in 2011-2014, then came to Recessive decoupling. The domestic wastewater had been in a strong decoupling state; Both urban non-point and industry experienced expansive negative decoupling, due to strict policy that prioritizes the environment over development and the investment in improvement of environment and techniques, both of them gradually came to strong decoupling. The result demonstrated that the EKC turning point could be appear in earlier economic stage and the decoupling coefficient elasticity could be improved through taking strong regulation measures.


Asunto(s)
Desarrollo Económico , Desarrollo Sostenible , Análisis de la Demanda Biológica de Oxígeno , Dióxido de Carbono/análisis , China , Producto Interno Bruto , Agua
2.
Int J Med Inform ; 155: 104602, 2021 11.
Artículo en Inglés | MEDLINE | ID: mdl-34601238

RESUMEN

OBJECTIVE: During the COVID-19 pandemic, social distancing and self-isolation called for innovative, readily implementable, and effective short-term health solutions. The objective of this study was to assess the feasibility of self-assessment of vital signs and symptoms with electronic transmission of results, by self-isolating individuals with positive SARS-CoV-2 polymerase chain reaction (PCR) test. The secondary objective was to describe the association between the presence of abnormal vital signs and severe symptoms as well as their evolution over time. METHOD: Participants with positive SARS-CoV-2 PCR test were asked to perform twice daily standardized vital signs measurements and self-assessment of symptoms for 14 consecutive days. All data were transmitted electronically through a mobile application and a web-based platform. Participants were provided with decision support tools based on the severity of their condition and a weekly nurse practitioner telephone follow-up. Abnormal values for vital signs and severe symptoms were determined. Per participant and per days, proportions of abnormal vital signs and severe symptoms were calculated. RESULTS: Data from 46 participants (mean age 54.1 ± 6.9 years, 54% male) were available for analysis. On average, participants performed the standardized self-assessment for 12.3 ± 3.4 days (89% performed at least 7 measurement days and 61% completed all 14 days). The highest proportions abnormal values for vital signs were for oximetry (20.1%) and respiratory rate (12.1%). The highest proportions of severe symptoms were for fatigue (16.9%) and myalgia. (10.2%). The combined proportion of abnormal vital signs and severe symptoms was maximal on day 1 with 20.3% of total measurements, with a linear decrease to 3.5% on day 14. CONCLUSION: Remote initiation of home measurements of vital signs and symptoms, self-management of these measures, accompanied by a decision support tool and supported by preplanned nurse follow-up are feasible. This could allow to opening up new insight for the care of sick individuals.


Asunto(s)
COVID-19 , Telemedicina , Estudios de Factibilidad , Femenino , Humanos , Masculino , Persona de Mediana Edad , Pandemias , SARS-CoV-2 , Autoevaluación (Psicología) , Signos Vitales
3.
Mayo Clin Proc ; 96(9): 2332-2341, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34481597

RESUMEN

OBJECTIVES: To assess the impact of the COVID-19 pandemic on clinical research and the use of electronic approaches to mitigate this impact. METHODS: We compared the utilization of electronic consenting, remote visits, and remote monitoring by study monitors in all research studies conducted at Mayo Clinic sites (Arizona, Florida, and Minnesota) before and during the COVID-19 pandemic (ie, between May 1, 2019 and December 31, 2020). Participants are consented through a participant-tracking system linked to the electronic health record. RESULTS: Between May 2019, and December 2020, there were 130,800 new consents across every modality (electronic and paper) to participate in a non-trial (107,176 [82%]) or a clinical trial (23,624 [18%]). New consents declined from 5741 in February 2020 to 913 in April 2020 but increased to 11,864 in November 2020. The mean (standard deviation [SD]) proportion of electronic consent increased from 22 (2%) before to 45 (20%) during the pandemic (P=.001). Mean (SD) remote electronic consenting increased from 0.3 (0.5%) to 29 (21%) (P<.001). The mean (SD) number of patients with virtual visits increased from 3.5 (2.4%) to 172 (135%) (P=.003) per month between pre-COVID (July 2019 to February 2020) and post-COVID (March to December 2020) periods. Virtual visits used telemedicine (68%) or video (32%). Requests for remote monitor access to complete visits increased from 44 (17%) per month between May 2019 and February 2020 to 111 (74%) per month between March and December 2020 (P=.10). CONCLUSION: After a sharp early decline, the enrollment of new participants and ongoing study visits recovered during the COVID-19 pandemic. This recovery was accompanied by the increased use of electronic tools.


Asunto(s)
Atención Ambulatoria/tendencias , COVID-19/epidemiología , Registros Electrónicos de Salud/tendencias , SARS-CoV-2 , Telemedicina/tendencias , Humanos , Pandemias , Estudios Retrospectivos , Estados Unidos/epidemiología
4.
Health Res Policy Syst ; 19(1): 124, 2021 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-34503537

RESUMEN

BACKGROUND: The Sustainable Development Goals (SDGs) and universal design (UD) principles call for inclusive planning. Within the transportation field, this includes the development or improvement of facilities that accommodate people with disabilities. Between 10% and 20% of the African population is affected by disabilities. A lack of understanding of the needs of people with disabilities leads to isolation. Within the transportation field, isolation manifests itself as a reduction in trip-making. METHODS: This paper investigates the availability of transport policies and guidelines in 29 different African countries, focusing on the inclusion of persons with disabilities. A desktop study was conducted creating heat maps for 29 African countries, followed by the analysis of secondary data in the case study area, South Africa, demonstrating that the lack of adequate policies, guidelines, and appropriate implementation leads to a lack of accessibility, opportunities, and social isolation, measured through trip frequencies. RESULTS: The data analysed revealed that many African countries omit, or only superficially include, people with disabilities in their transport policy framework. Ghana has the most inclusive People with Disabilities Act, while South Africa is most inclusive regarding their planning and design of transport facilities and services. In South Africa, 4.5% of the population did not travel at all in the 7 days before the interview, as disability or age prevented them from doing so, or due to a lack of appropriate travel services. When comparing the trip rates per week, people with disabilities travel significantly less, between 27.2% and 65.8%, than their abled counterparts. CONCLUSIONS: The study reveals that people with disability live less integrated, more isolated lives due to the lack of acknowledgement in the transport policy framework and accommodation in infrastructure and services. The results underpin the need for disability-inclusive planning in the African context and provide recommendations for actions that mitigate the isolation challenges faced by people with disabilities. Municipalities play a crucial role in improving the quality of life for people with disabilities.


Asunto(s)
Personas con Discapacidad , Calidad de Vida , Ghana , Humanos , Sudáfrica , Desarrollo Sostenible
5.
BMC Public Health ; 21(1): 1608, 2021 09 02.
Artículo en Inglés | MEDLINE | ID: mdl-34470632

RESUMEN

BACKGROUND AND AIM: According to the United Nations' Sustainable Development Goal (SDG) target 3.4, premature mortality from four non-communicable diseases (cardiovascular diseases, cancer, chronic respiratory diseases, and diabetes mellitus, collectively referred to as NCD4) should achieve a minimum decline of 33% in 2030 relative to 2015. This remains a challenge for China. This study aimed to evaluate the current status and progress towards this target in Liaoning Province, one of the three provinces in northeast China. METHODS: We calculated the premature mortality rates (PMRs) per year and average annual percentage changes (AAPCs) from NCD4 using mortality data between 2004 and 2017. The trend was analyzed in the whole population, as well as in subpopulations of gender (male/female) and inhabiting area (urban/rural). PMRs from NCD4 for 2030 were projected by fitting a linear regression based on the current trend, which was identified by a Joinpoint model. FINDINGS: In the whole population, only chronic respiratory diseases showed a significant decline (AAPC: - 6.5%, p < 0.05), while only cancer showed a significant increase (AAPC: + 1.3%, p < 0.05); taken together, NCD4 showed a significant increase (AAPC: + 0.6%, p < 0.05). In the subpopulations, while males showed a significant increase in NCD4 (AAPC: + 1.5%, p < 0.05), cardiovascular diseases (AAPC: + 1.7%, p < 0.05), cancer (AAPC: + 1.8%, p < 0.05), and diabetes mellitus (AAPC: + 4.2%, p < 0.05), females showed a significant decline in NCD4 (AAPC: - 1.2%, p < 0.05), cardiovascular diseases (AAPC: - 1.8%, p < 0.05), diabetes mellitus (AAPC: - 2.1%, p < 0.05), but showed a mild increase in cancer (AAPC: + 0.5%, p > 0.05). A comparative analysis of the projected PMRs for 2030 with the 2015 levels revealed that only chronic respiratory diseases are expected to achieve the SDG target 3.4, apart from in the urban male subpopulation. CONCLUSION: Except for chronic respiratory diseases, NCD4 cannot be expected to achieve the SDG target 3.4 in the whole population of Liaoning Province. Under these circumstances, special attention should be paid to reducing the risks of cancer and providing preventative interventions for men.


Asunto(s)
Enfermedades no Transmisibles , Desarrollo Sostenible , China/epidemiología , Femenino , Objetivos , Humanos , Masculino , Mortalidad Prematura , Enfermedades no Transmisibles/epidemiología
6.
Lancet Oncol ; 22(9): e391-e399, 2021 09.
Artículo en Inglés | MEDLINE | ID: mdl-34478675

RESUMEN

The number of patients with cancer in Africa has been predicted to increase from 844 279 in 2012 to more than 1·5 million in 2030. However, many countries in Africa still lack access to radiotherapy as a part of comprehensive cancer care. The objective of this analysis is to present an updated overview of radiotherapy resources in Africa and to analyse the gaps and needs of the continent for 2030 in the context of the UN Sustainable Development Goals. Data from 54 African countries on teletherapy megavoltage units and brachytherapy afterloaders were extracted from the Directory for Radiotherapy Centres, an electronic, centralised, and continuously updated database of radiotherapy centres. Cancer incidence and future predictions were taken from the GLOBOCAN 2018 database of the International Agency for Research on Cancer. Radiotherapy need was estimated using a 64% radiotherapy utilisation rate, while assuming a machine throughput of 500 patients per year. As of March, 2020, 28 (52%) of 54 countries had access to external beam radiotherapy, 21 (39%) had brachytherapy capacity, and no country had a capacity that matched the estimated treatment need. Median income was an important predictor of the availability of megavoltage machines: US$1883 (IQR 914-3269) in countries without any machines versus $4485 (3079-12480) in countries with at least one megavoltage machine (p=0·0003). If radiotherapy expansion continues at the rate observed over the past 7 years, it is unlikely that the continent will meet its radiotherapy needs. This access gap might impact the ability to achieve the Sustainable Development Goals, particularly the target to reduce preventable, premature mortality by a third, and meet the target of the cervical cancer elimination strategy of 90% with access to treatment. Urgent, novel initiatives in financing and human capacity building are needed to change the trajectory and provide comprehensive cancer care to patients in Africa in the next decade.


Asunto(s)
Recursos en Salud/tendencias , Necesidades y Demandas de Servicios de Salud/tendencias , Radioterapia/tendencias , África/epidemiología , Predicción , Recursos en Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Humanos , Agencias Internacionales , Neoplasias/epidemiología , Neoplasias/radioterapia , Radioterapia/estadística & datos numéricos , Desarrollo Sostenible
7.
Stud Health Technol Inform ; 283: 202-208, 2021 Sep 21.
Artículo en Inglés | MEDLINE | ID: mdl-34545837

RESUMEN

Health-related Quality of Life (HRQoL) assessment has proven as a good means for assessing treatment options or impact of applications supporting the patient in adherence, monitoring and better understanding of health issues. While most of the HRQoL instruments were designed several years ago, their capability to assess the impact of ehealth application is in question. The objective of this paper is to assess HRQoL instruments including a focus on the ehealth domain. Methods: Generic and specific instruments are selected based on their widespread use. Published criteria for assessing HRQoL instruments are used for a baseline, which are amended by criteria covering both the ehealth domain and the conditions of use of instruments and structured in groups. Results: Seven instruments have been selected and assessed using the established criteria. The instruments scored differently regarding the ehealth domain, however overall rather low. Applying weighting per group allows highlighting specific aspects. Based on the assessment, further research should consider the development of a ehealth domain module as part of the specific instruments.


Asunto(s)
Calidad de Vida , Telemedicina , Humanos , Encuestas y Cuestionarios
8.
Prosthet Orthot Int ; 45(5): 373-377, 2021 Oct 01.
Artículo en Inglés | MEDLINE | ID: mdl-34483330

RESUMEN

BACKGROUND: COVID-19 has had a significant impact on the National Health Service in the United Kingdom (UK). OBJECTIVE: This study aimed to determine the impact of COVID-19 on orthotic services in the United Kingdom. STUDY DESIGN: Cross sectional survey. METHODS: An online survey was distributed to UK orthotists approximately 6 months after the first peak of COVID-19. Descriptive statistics of results related to appointment waiting times, disruption of services, introduction of telehealth appointments, and clinicians' opinions on the impact of COVID-19 was completed. RESULTS: Seventy-seven orthotists completed the survey, with many reporting that their service was closed or open only to inpatients/urgent patients at some point during the pandemic. There were substantial variation in appointment waiting times, time allocated per appointment, and increases in lead times for orthotic products across services. Over 90% reported using telehealth appointments. Results were comparable with previous research showing long appointment waiting times and indicated that the pandemic has added to this issue. CONCLUSIONS: The pandemic has had a significant impact on orthotic services with face-to-face appointments largely reserved for urgent patients and inpatients, and services going through stages of closing and reopening, alongside the introduction of telehealth to ensure less urgent patients could continue to access orthotic care. Future service evaluation studies are required to further assess how orthotic services have been affected by the pandemic and the effectiveness of recovery plans.


Asunto(s)
COVID-19/epidemiología , Conocimientos, Actitudes y Práctica en Salud , Accesibilidad a los Servicios de Salud , Aparatos Ortopédicos , Telemedicina , Tiempo de Tratamiento , Estudios Transversales , Humanos , Pandemias , SARS-CoV-2 , Encuestas y Cuestionarios , Reino Unido/epidemiología
9.
J Card Surg ; 36(11): 4226-4234, 2021 Nov.
Artículo en Inglés | MEDLINE | ID: mdl-34478205

RESUMEN

OBJECTIVE: We examined cardiac surgery patients who underwent monitoring of postoperative vital parameters using medical monitoring devices which transferred data to a mobile application and a web-based software. METHODS: From November 2017 to November 2020, a total of 2340 patients were enrolled in the remote patient monitoring system after undergoing cardiac surgery. The medical devices recorded vital parameters, such as blood pressure, pulse rate, saturation, body temperature, blood glucose, and electrocardiography were measured via the Health Monitor DakikApp and Holter ECG DakikApp devices which reported data to web-based software and a mobile application (DakikApp Mobile Systems, Remscheid, Germany). During the follow-up period, patients were contacted daily through text and voice messages, and video conferences. Remote Medical Evaluations (RMEs) concerning patients' medical states were performed. Medication reminders, daily treatment were communicated to the patients with the DakikApp Mobile Systems Software. RESULTS: During a mean follow-up period of 78.9 ± 107.1 (10-395) days, a total of 135,786 patient contacts were recorded (782 video conferences, 2805 voice messaging, and 132,199 text correspondence). The number of RMEs handled by the Telemedicine Team was 79,560. A total of 105,335 vital parameter measurements were performed and 5024 hospital application requests (6.3% per RME) were addressed successfully and hospitalization was avoided. A total of 144 (6.1%) potentially life-threatening complications were found to have been diagnosed early using the Telemedicine System. CONCLUSION: Remote Patient Monitoring Systems combined with professional medical devices are feasible, effective, and safe for the purpose of improving postoperative outcomes.


Asunto(s)
Procedimientos Quirúrgicos Cardíacos , Telemedicina , Electrocardiografía , Electrocardiografía Ambulatoria , Humanos , Programas Informáticos
10.
Lancet Glob Health ; 9(10): e1372-e1379, 2021 10.
Artículo en Inglés | MEDLINE | ID: mdl-34487685

RESUMEN

BACKGROUND: The tuberculosis targets for the UN Sustainable Development Goals (SDGs) call for a 90% reduction in tuberculosis deaths by 2030, compared with 2015, but meeting this target now seems highly improbable. To assess the economic impact of not meeting the target until 2045, we estimated full-income losses in 120 countries, including those due to excess deaths resulting from COVID-19-related disruptions to tuberculosis services, for the period 2020-50. METHODS: Annual mortality risk changes at each age in each year from 2020 to 2050 were estimated for 120 countries. This risk change was then converted to full-income risk by calculating a population-level mortality risk change and multiplying it by the value of a statistical life-year in each country and year. As a comparator, we assumed that current rates of tuberculosis continue to decline through the period of analysis. We calculated the full-income losses, and mean life expectancy losses per person, at birth and at age 35 years, under scenarios in which the SDG targets are met in 2030 and in 2045. We defined the cost of inaction as the difference in full-income losses and tuberculosis mortality between these two scenarios. FINDINGS: From 2020 to 2050, based on the current annual decrease in tuberculosis deaths of 2%, 31·8 million tuberculosis deaths (95% uncertainty interval 25·2 million-39·5 million) are estimated to occur, corresponding to an economic loss of US$17·5 trillion (14·9 trillion-20·4 trillion). If the SDG tuberculosis mortality target is met in 2030, 23·8 million tuberculosis deaths (18·9 million-29·5 million) and $13·1 trillion (11·2 trillion-15·3 trillion) in economic losses can be avoided. If the target is met in 2045, 18·1 million tuberculosis deaths (14·3 million-22·4 million) and $10·2 trillion (8·7 trillion-11·8 trillion) can be avoided. The cost of inaction of not meeting the SDG tuberculosis mortality target until 2045 (vs 2030) is, therefore, 5·7 million tuberculosis deaths (5·1 million-8·1 million) and $3·0 trillion (2·5 trillion-3·5 trillion) in economic losses. COVID-19-related disruptions add $290·3 billion (260·2 billion-570·1 billion) to this cost. INTERPRETATION: Failure to achieve the SDG tuberculosis mortality target by 2030 will lead to profound economic and health losses. The effects of delay will be greatest in sub-Saharan Africa. Affected countries, donor nations, and the private sector should redouble efforts to finance tuberculosis programmes and research because the economic dividend of such strategies is likely to be substantial. FUNDING: None.


Asunto(s)
Esperanza de Vida , Tuberculosis/economía , Tuberculosis/mortalidad , COVID-19 , Carga Global de Enfermedades/economía , Infecciones por VIH/complicaciones , Humanos , Desarrollo Sostenible , Tuberculosis/prevención & control
11.
BMC Cancer ; 21(1): 1009, 2021 Sep 09.
Artículo en Inglés | MEDLINE | ID: mdl-34496775

RESUMEN

BACKGROUND: This study aimed to investigate the incidence and long-term survival outcomes of occult lung cancer between 2004 and 2015. METHODS: A total of 2958 patients were diagnosed with occult lung cancer in the 305,054 patients with lung cancer. The entire cohort was used to calculate the crude incidence rate. Eligible 52,472 patients (T1-xN0M0, including 2353 occult lung cancers) were selected from the entire cohort to perform survival analyses after translating T classification according to the 8th TNM staging system. Cancer-specific survival curves for different T classifications were presented. RESULTS: The crude incidence rate of occult lung cancer was 1.00 per 100 patients, and it was reduced between 2004 and 2015 [1.4 per 100 persons in 2004; 0.6 per 100 persons in 2015; adjusted risk ratio = 0.437, 95% confidence interval (CI) 0.363-0.527]. In the survival analysis, there were 2206 death events in the 2353 occult lung cancers. The results of the multivariable analysis revealed that the prognoses with occult lung cancer were similar to patients with stage T3N0M0 (adjusted hazard ratio = 1.054, 95% CI 0.986-1.127, p = 0.121). Adjusted survival curves presented the same results. In addition, adjusted for other confounders, female, age ≤ 72 years, surgical treatment, radiotherapy, adenocarcinoma, and non-squamous and non-adenocarcinoma non-small cell carcinoma were independent protective prognostic factors (all p < 0.05). CONCLUSIONS: Occult lung cancer was uncommon. However, the cancer-specific survival of occult lung cancer was poor, therefore, we should put the assessment of its prognoses on the agenda. Timely surgical treatment and radiotherapy could improve survival outcomes for those patients. Besides, we still need more research to confirm those findings.

12.
JMIR Mhealth Uhealth ; 9(8): e26845, 2021 Aug 30.
Artículo en Inglés | MEDLINE | ID: mdl-34459745

RESUMEN

BACKGROUND: Considering the increasing demand for health services by older people and the ongoing COVID-19 pandemic, digital health is commonly viewed to offer a pathway to provide safe and affordable health services for older adults, thus enabling self-management of their health while health care systems are struggling. However, several factors cause older people to be particularly reluctant to adopt digital health technologies such as mobile health (mHealth) tools. In addition to previously studied technology acceptance factors, those related to perceived risks of mHealth use (eg, leakage of sensitive information or receiving incorrect health recommendations) may further diminish mHealth adoption by older adults. OBJECTIVE: The aim of this study was to explore the relationship between perceived risks of using mHealth applications and the intention to use these applications among older adults. METHODS: We designed a cross-sectional study wherein a questionnaire was used to collect data from participants aged 65 years and older in the Netherlands. Perceived risk was divided into four constructs: privacy risk, performance risk, legal concern, and trust. Linear regression analyses were performed to determine the associations between these perceived risk constructs and the intention to use mHealth applications. RESULTS: Linear regression per perceived risk factor showed that each of the four constructs is significantly associated with the intention to use mobile medical applications among older adults (adjusted for age, sex, education, and health status). Performance risk (ß=-.266; P=<.001), legal concern (ß=-.125; P=.007), and privacy risk (ß=-.100; P=.03) were found to be negatively correlated to intention to use mHealth applications, whereas trust (ß=.352; P=<.001) was found to be positively correlated to the intention to use mHealth applications. CONCLUSIONS: Performance risk, legal concern, and privacy risk as perceived by older adults may substantially and significantly decrease their intention to use mHealth applications. Trust may significantly and positively affect this intention. Health care professionals, designers of mHealth applications, and policy makers can use these findings to diminish performance risks, and tailor campaigns and applications to address legal and privacy concerns and promote mHealth uptake and health care access for older adults, especially during the COVID-19 pandemic.


Asunto(s)
COVID-19 , Telemedicina , Anciano , Estudios Transversales , Humanos , Intención , Países Bajos , Pandemias , SARS-CoV-2
13.
JMIR Mhealth Uhealth ; 9(8): e27926, 2021 08 31.
Artículo en Inglés | MEDLINE | ID: mdl-34463637

RESUMEN

BACKGROUND: In the United States, nearly 80% of family caregivers of people with dementia have at least one chronic condition. Dementia caregivers experience high stress and burden that adversely affect their health and self-management. mHealth apps can improve health and self-management among dementia caregivers with a chronic condition. However, mHealth app adoption by dementia caregivers is low, and reasons for this are not well understood. OBJECTIVE: The purpose of this study is to explore factors associated with dementia caregivers' intention to adopt mHealth apps for chronic disease self-management. METHODS: We conducted a cross-sectional, correlational study and recruited a convenience sample of dementia caregivers. We created a survey using validated instruments and collected data through computer-assisted telephone interviews and web-based surveys. Before the COVID-19 pandemic, we recruited dementia caregivers through community-based strategies, such as attending community events. After nationwide closures due to the pandemic, the team focused on web-based recruitment. Multiple logistic regression analyses were used to test the relationships between the independent and dependent variables. RESULTS: Our sample of 117 caregivers had an average age of 53 (SD 17.4) years, 16 (SD 3.3) years of education, and 4 (SD 2.5) chronic conditions. The caregivers were predominantly women (92/117, 78.6%) and minorities (63/117, 53.8%), experienced some to extreme income difficulties (64/117, 54.7%), and were the child or child-in-law (53/117, 45.3%) of the person with dementia. In logistic regression models adjusting for the control variables, caregiver burden (odds ratio [OR] 1.3, 95% CI 0.57-2.8; P=.57), time spent caregiving per week (OR 1.7, 95% CI 0.77-3.9; P=.18), and burden of chronic disease and treatment (OR 2.3, 95% CI 0.91-5.7; P=.08) were not significantly associated with the intention to adopt mHealth apps. In the final multiple logistic regression model, only perceived usefulness (OR 23, 95% CI 5.6-97; P<.001) and the interaction term for caregivers' education and burden of chronic disease and treatment (OR 31, 95% CI 2.2-430; P=.01) were significantly associated with their intention to adopt mHealth apps. Perceived ease of use (OR 2.4, 95% CI 0.67-8.7; P=.18) and social influence (OR 1.8, 95% CI 0.58-5.7; P=.31) were not significantly associated with the intention to adopt mHealth apps. CONCLUSIONS: When designing mHealth app interventions for dementia caregivers with a chronic condition, it is important to consider caregivers' perceptions about how well mHealth apps can help their self-management and which app features would be most useful for self-management. Caregiving factors may not be relevant to caregivers' intention to adopt mHealth apps. This is promising because mHealth strategies may overcome barriers to caregivers' self-management. Future research should investigate reasons why caregivers with a low education level and low burden of chronic disease and treatment have significantly lower intention to adopt mHealth apps for self-management.


Asunto(s)
COVID-19 , Demencia , Aplicaciones Móviles , Telemedicina , Cuidadores , Estudios Transversales , Demencia/terapia , Femenino , Humanos , Intención , Persona de Mediana Edad , Pandemias , SARS-CoV-2
14.
J Med Internet Res ; 23(9): e29959, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34351865

RESUMEN

BACKGROUND: Dramatic decreases in outpatient visits and sudden increases in telehealth visits were observed during the COVID-19 pandemic, but it was unclear whether these changes differed by patient demographics and socioeconomic status. OBJECTIVE: This study aimed to assess the impact of the pandemic on in-person outpatient and telehealth visits (telephone and video) by demographic characteristics and household income in a diverse population. METHODS: We calculated weekly rates of outpatient and telehealth visits by age, sex, race/ethnicity, and neighborhood-level median household income among members of Kaiser Permanente Southern California (KPSC) from January 5, 2020, to October 31, 2020, and the corresponding period in 2019. We estimated the percentage change in visit rates during the early pandemic period (March 22 to April 25, 2020) and the late pandemic period (October 4 to October 31, 2020) from the prepandemic period (January 5 to March 7, 2020) in Poisson regression models for each subgroup while adjusting for seasonality using 2019 data. We examined if the changes in visit rates differed by subgroups statistically by comparing their 95% CIs. RESULTS: Among 4.56 million KPSC members enrolled in January 2020, 15.0% (n=682,947) were ≥65 years old, 51.5% (n=2,345,020) were female, 39.4% (n=1,795,994) were Hispanic, and 7.7% (n=350,721) lived in an area of median household income

Asunto(s)
COVID-19 , Telemedicina , Anciano , Atención a la Salud , Femenino , Humanos , Pacientes Ambulatorios , Pandemias , Estudios Retrospectivos , SARS-CoV-2
15.
East Mediterr Health J ; 27(7): 643-645, 2021 Jul 29.
Artículo en Inglés | MEDLINE | ID: mdl-34369576

RESUMEN

Forty years after signing with the World Health Organization (WHO) the Basic Agreement for cooperation, the WHO Eastern Mediterranean Regional Office (WHO/ EMRO) is developing three new country offices: the first in Kuwait, which was inaugurated on 15 June 2021, the second in Bahrain with a planned inauguration on 25 July 2021, while the third is planned to follow soon in Qatar. The expansion of WHO/EMRO's presence in these countries follows from the commitments made in the EMR Vision 2023 by the Regional Director, Dr Ahmed Al-Mandhari, to "bring WHO closer to its Member States", exploit regional opportunities to cooperate and engage with regional resources. It is in full line with the 13th WHO Global Programme of Work (GPW13) objectives and strategic shifts proposed by the Director General of WHO transformative agenda on expanding partnerships, focusing on countries and working with a differentiated approach to engagement as per the country context (3) and needs, moving towards the achievement of the Sustainable Development Goals and Agenda 2030.


Asunto(s)
Organización Mundial de la Salud , Bahrein , Humanos , Kuwait , Región Mediterránea , Qatar
16.
Intern Med J ; 51(8): 1344-1347, 2021 Aug.
Artículo en Inglés | MEDLINE | ID: mdl-34423535

RESUMEN

Prisons remain a priority population in the treatment of hepatitis C (HCV) in Australia. To improve treatment uptake, we created a novel telehealth-based model of care for prisoners with HCV that is both cost-effective and requires minimal infrastructure. Over a period of 30 months, a total of 332 patients was initiated on treatment, achieving a per protocol sustained virological response (SVR12) rate of 91%. A large number (29%) of patients was lost to follow up after release from prison - highlighting the vital opportunity for HCV treatment during incarceration. We propose that similar models of care can be used to improve HCV treatment access for other priority populations in Australia.


Asunto(s)
Hepatitis C Crónica , Hepatitis C , Prisioneros , Telemedicina , Antivirales/uso terapéutico , Hepatitis C/diagnóstico , Hepatitis C/tratamiento farmacológico , Hepatitis C/epidemiología , Hepatitis C Crónica/diagnóstico , Hepatitis C Crónica/tratamiento farmacológico , Hepatitis C Crónica/epidemiología , Humanos , Prisiones
17.
Lancet ; 398(10303): 870-905, 2021 09 04.
Artículo en Inglés | MEDLINE | ID: mdl-34416195

RESUMEN

BACKGROUND: Sustainable Development Goal 3.2 has targeted elimination of preventable child mortality, reduction of neonatal death to less than 12 per 1000 livebirths, and reduction of death of children younger than 5 years to less than 25 per 1000 livebirths, for each country by 2030. To understand current rates, recent trends, and potential trajectories of child mortality for the next decade, we present the Global Burden of Diseases, Injuries, and Risk Factors Study (GBD) 2019 findings for all-cause mortality and cause-specific mortality in children younger than 5 years of age, with multiple scenarios for child mortality in 2030 that include the consideration of potential effects of COVID-19, and a novel framework for quantifying optimal child survival. METHODS: We completed all-cause mortality and cause-specific mortality analyses from 204 countries and territories for detailed age groups separately, with aggregated mortality probabilities per 1000 livebirths computed for neonatal mortality rate (NMR) and under-5 mortality rate (U5MR). Scenarios for 2030 represent different potential trajectories, notably including potential effects of the COVID-19 pandemic and the potential impact of improvements preferentially targeting neonatal survival. Optimal child survival metrics were developed by age, sex, and cause of death across all GBD location-years. The first metric is a global optimum and is based on the lowest observed mortality, and the second is a survival potential frontier that is based on stochastic frontier analysis of observed mortality and Healthcare Access and Quality Index. FINDINGS: Global U5MR decreased from 71·2 deaths per 1000 livebirths (95% uncertainty interval [UI] 68·3-74·0) in 2000 to 37·1 (33·2-41·7) in 2019 while global NMR correspondingly declined more slowly from 28·0 deaths per 1000 live births (26·8-29·5) in 2000 to 17·9 (16·3-19·8) in 2019. In 2019, 136 (67%) of 204 countries had a U5MR at or below the SDG 3.2 threshold and 133 (65%) had an NMR at or below the SDG 3.2 threshold, and the reference scenario suggests that by 2030, 154 (75%) of all countries could meet the U5MR targets, and 139 (68%) could meet the NMR targets. Deaths of children younger than 5 years totalled 9·65 million (95% UI 9·05-10·30) in 2000 and 5·05 million (4·27-6·02) in 2019, with the neonatal fraction of these deaths increasing from 39% (3·76 million [95% UI 3·53-4·02]) in 2000 to 48% (2·42 million; 2·06-2·86) in 2019. NMR and U5MR were generally higher in males than in females, although there was no statistically significant difference at the global level. Neonatal disorders remained the leading cause of death in children younger than 5 years in 2019, followed by lower respiratory infections, diarrhoeal diseases, congenital birth defects, and malaria. The global optimum analysis suggests NMR could be reduced to as low as 0·80 (95% UI 0·71-0·86) deaths per 1000 livebirths and U5MR to 1·44 (95% UI 1·27-1·58) deaths per 1000 livebirths, and in 2019, there were as many as 1·87 million (95% UI 1·35-2·58; 37% [95% UI 32-43]) of 5·05 million more deaths of children younger than 5 years than the survival potential frontier. INTERPRETATION: Global child mortality declined by almost half between 2000 and 2019, but progress remains slower in neonates and 65 (32%) of 204 countries, mostly in sub-Saharan Africa and south Asia, are not on track to meet either SDG 3.2 target by 2030. Focused improvements in perinatal and newborn care, continued and expanded delivery of essential interventions such as vaccination and infection prevention, an enhanced focus on equity, continued focus on poverty reduction and education, and investment in strengthening health systems across the development spectrum have the potential to substantially improve U5MR. Given the widespread effects of COVID-19, considerable effort will be required to maintain and accelerate progress. FUNDING: Bill & Melinda Gates Foundation.


Asunto(s)
Mortalidad del Niño/tendencias , Salud Global/tendencias , Mortalidad Infantil/tendencias , Desarrollo Sostenible , COVID-19/epidemiología , Causas de Muerte/tendencias , Niño , Preescolar , Femenino , Salud Global/estadística & datos numéricos , Humanos , Lactante , Recién Nacido , Tablas de Vida , Masculino , SARS-CoV-2
18.
Turk J Med Sci ; 2021 Aug 09.
Artículo en Inglés | MEDLINE | ID: mdl-34365779

RESUMEN

Due to the COVID-19 infection, which was recognized as a global pandemic by the World Health Organization (WHO) on March 11, 2020, the number of cases and disease-related deaths increases day by day globally. For this reason, antiviral agents used in treatment and vaccines, the most effective weapon in prevention, continue to be the most popular topic of the agenda. Several situations are expected to affect the course of the pandemic. The loss of the ability of the virus to mutate and cause disease, the fact that those who become immunized by having the disease in the society reach a critical rate and create social immunity (herd immunity), and the provision of social immunity with effective vaccination can be counted as some of these situations. Vaccination trials, which started due to the seriousness and urgency of our situation that we are in, continue exceptionally quickly and effectively. As per the WHO's data on April 9, 2021, there have been 273 vaccine trials, 87 of which are in the clinical phase, and 12 (14%) of the vaccine candidates in the clinical phase are RNA-based vaccines. Also, the number of RNA-based vaccines with ongoing preclinical trials is 24. This review aimed to examine COVID-19 vaccine candidates using RNA technology and compile its current data.

19.
Am J Nurs ; 121(9): 57, 2021 09 01.
Artículo en Inglés | MEDLINE | ID: mdl-34438432

RESUMEN

According to this study: Minimum nurse-to-patient staffing ratios not only improve nurse staffing and patient outcomes but also yield a good return on investment.Staffing improvements of one fewer patient per nurse led to improvements in mortality, readmissions, and length of stay.


Asunto(s)
Enfermeras y Enfermeros , Personal de Enfermería en Hospital , Humanos , Relaciones Enfermero-Paciente , Admisión y Programación de Personal , Recursos Humanos
20.
Artículo en Inglés | MEDLINE | ID: mdl-34444037

RESUMEN

Health services provided through the telecommunications system aim to improve the population's health and well-being. This research aims to explore what digital, economic, and health factors are associated with the provision of telehealth services, especially in ageing communities. Applying Organization for Economic Cooperation and Development (OECD) countries' experiences, this research tries to construct a logistic regression model between adopting a telehealth system or not, a binary outcome variable, and a group of potentially explanatory variables. Estimation results showed that there were thresholds for telehealth provision: The demand for telehealth service usually began when the provision of telecommunication accessibility reached 50%, the proportion of elders exceeded 10%, or the proportion of health spending occupied more than 3-5% of the gross domestic product (GDP); the slope of each variable seemed to correspond with an increase in demand for such a provision. A growing number of individuals in OECD countries are now readily served by telehealth systems under the COVID-19 pandemic. These findings could be regarded as a model for other countries for implementing the necessary infrastructure early on when any of these parameters reaches its threshold. Moreover, telehealth applied in developing countries could be elevated for wider populations to access basic health services and for the remote delivery of health care. A rational decision could be made to appropriately use additional resources in telehealth provision. With accessible e-health services, the population's health could be improved, which in turn would possibly increase productivity and social welfare.


Asunto(s)
COVID-19 , Telemedicina , Anciano , Humanos , Organización para la Cooperación y el Desarrollo Económico , Pandemias , SARS-CoV-2
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