2001
|
Bartoli F, Cavaleri D, Moretti F, Bachi B, Calabrese A, Callovini T, Cioni RM, Riboldi I, Nacinovich R, Crocamo C, Carrà G. Pre-Discharge Predictors of 1-Year Rehospitalization in Adolescents and Young Adults with Severe Mental Disorders: A Retrospective Cohort Study. MEDICINA-LITHUANIA 2020; 56:medicina56110613. [PMID: 33203127 PMCID: PMC7696058 DOI: 10.3390/medicina56110613] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/25/2020] [Revised: 11/09/2020] [Accepted: 11/12/2020] [Indexed: 11/24/2022]
Abstract
Background and objectives: Readmissions of youths hospitalized for a severe mental disorder are common events and bear a remarkable human, social, and economic burden. The current study aimed at evaluating predictors of 1-year rehospitalization in a sample of adolescents and young adults with severe mental disorders. Materials and Methods: Data for ≤25-year-old inpatients with a severe mental disorder and consecutively admitted between 1 January 2016 and 30 June 2019 were collected. Subjects were retrospectively assessed over a follow-up period of one year after the index discharge to track readmissions—i.e., the primary outcome variable. Standard descriptive statistics were used. The association between variables and 1-year rehospitalization was estimated using the univariate Cox proportional hazards regression model. We then carried out a multivariable Cox regression model, also estimating the covariate-adjusted survivor function. Hazard ratios (HRs) with related 95% confidence intervals (95% CIs) were provided. Results: The final sample included 125 individuals. The multivariable Cox regression model estimated that co-occurring substance use disorders (HR = 2.14; 95% CI: 1.08 to 4.26; p = 0.029) and being admitted for a suicide attempt (HR = 2.49; 95% CI: 1.13 to 5.49; p = 0.024) were both significant predictors of 1-year rehospitalization. Conclusions: Our study showed that comorbid substance use disorders and being admitted for a suicide attempt were predictors of early readmission in youths with severe mental disorders. Although their generalizability is limited, our findings could contribute to improve the quality of young patients’ mental health care by identifying vulnerable subjects who may benefit from tailored interventions to prevent rehospitalizations.
Collapse
Affiliation(s)
- Francesco Bartoli
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
- Correspondence: ; Tel.: +39-02-5799-8353
| | - Daniele Cavaleri
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Federico Moretti
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Bianca Bachi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Angela Calabrese
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Tommaso Callovini
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Riccardo M. Cioni
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Ilaria Riboldi
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Renata Nacinovich
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Cristina Crocamo
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
| | - Giuseppe Carrà
- Department of Medicine and Surgery, University of Milano Bicocca, via Cadore 48, 20900 Monza, Italy; (D.C.); (F.M.); (B.B.); (A.C.); (T.C.); (R.M.C.); (I.R.); (R.N.); (C.C.); (G.C.)
- Division of Psychiatry, University College London, Maple House 149, London W1T 7BN, UK
| |
Collapse
|
2002
|
The Pivotal Role of Adipocyte-Na K peptide in Reversing Systemic Inflammation in Obesity and COVID-19 in the Development of Heart Failure. Antioxidants (Basel) 2020; 9:antiox9111129. [PMID: 33202598 PMCID: PMC7697697 DOI: 10.3390/antiox9111129] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/19/2020] [Revised: 11/11/2020] [Accepted: 11/11/2020] [Indexed: 01/10/2023] Open
Abstract
This review summarizes data from several laboratories that have demonstrated a role of the Na/K-ATPase, specifically its α1 subunit, in the generation of reactive oxygen species (ROS) via the negative regulator of Src. Together with Src and other signaling proteins, the Na/K-ATPase forms an oxidant amplification loop (NKAL), amplifies ROS, and participates in cytokines storm in obesity. The development of a peptide fragment of the α1 subunit, NaKtide, has been shown to negatively regulate Src. Several groups showed that the systemic administration of the cell permeable modification of NaKtide (pNaKtide) or its selective delivery to fat tissue—adipocyte specific expression of NaKtide—ameliorate the systemic elevation of inflammatory cytokines seen in chronic obesity. Severe acute respiratory syndrome – coronavirus 2 (SARS-CoV-2), the RNA Coronavirus responsible for the COVID-19 global pandemic, invades cells via the angiotensin converting enzyme 2 (ACE-2) receptor (ACE2R) that is appended in inflamed fat tissue and exacerbates the formation of the cytokines storm. Both obesity and heart and renal failure are well known risks for adverse outcomes in patients infected with COVID-19. White adipocytes express ACE-2 receptors in high concentration, especially in obese patients. Once the virus invades the white adipocyte cell, it creates a COVID19–porphyrin complex which degrades and produces free porphyrin and iron and increases ROS. The increased formation of ROS and activation of the NKAL results in a further potentiated formation of ROS production, and ultimately, adipocyte generation of more inflammatory mediators, leading to systemic cytokines storm and heart failure. Moreover, chronic obesity also results in the reduction of antioxidant genes such as heme oxygenase-1 (HO-1), increasing adipocyte susceptibility to ROS and cytokines. It is the systemic inflammation and cytokine storm which is responsible for many of the adverse outcomes seen with COVID-19 infections in obese subjects, leading to heart failure and death. This review will also describe the potential antioxidant drugs and role of NaKtide and their demonstrated antioxidant effect used as a major strategy for improving obesity and epicardial fat mediated heart failure in the context of the COVID pandemic.
Collapse
|
2003
|
Lv Y, Fu Q, Shen X, Jia E, Li X, Peng Y, Yan J, Jiang M, Xiong J. Treatment Preferences of Residents Assumed to Have Severe Chronic Diseases in China: A Discrete Choice Experiment. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17228420. [PMID: 33203010 PMCID: PMC7697856 DOI: 10.3390/ijerph17228420] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 10/23/2020] [Accepted: 11/12/2020] [Indexed: 12/17/2022]
Abstract
Objectives: This study aims to elicit the relative importance of treatment attributes that influence residents’ choice, assuming they are suffering severe non-communicable diseases (NCDs), to explore how they make trade-offs between these attributes and to estimate the monetary value placed on different attributes and attribute levels. Methods: A discrete choice experiment (DCE) was conducted with adults over 18 years old in China. Preferences were evaluated based on four treatment attributes: care provider, mode of service, distance to practice and cost. A mixed logit model was used to analyze the relative importance of the four attributes and to calculate the willingness to pay (WTP) for a changed attribute level. Results: A total of 93.47% (2019 of 2160) respondents completed valid questionnaires. The WTP results suggested that participants would be willing to pay CNY 822.51 (USD 124.86), CNY 470.54 (USD 71.41) and CNY 68.20 (USD 10.35) for services provided by experts, with integrated traditional Chinese medicine (TCM) and Western medicine (WM) and with a service distance <=30 min, respectively. Conclusions: The results suggested that mode of service, care provider, distance to practice and cost should be considered in priority-setting decisions. The government should strengthen the curative service capability in primary health facilities and give full play to the role of TCM in the prevention and treatment of severe chronic diseases.
Collapse
Affiliation(s)
- Yinghao Lv
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Qiang Fu
- Department of Epidemiology and Biostatistics, College for Public Health and Social Justice, Saint Louis University, St Louis, MO 63103, USA;
| | - Xiao Shen
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Erping Jia
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Xianglin Li
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Yingying Peng
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Jinghong Yan
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Mingzhu Jiang
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
| | - Juyang Xiong
- Department of Health Administration, School of Medicine and Health Management, Tongji Medical College, Huazhong University of Science and Technology, Wuhan 430030, China; (Y.L.); (X.S.); (E.J.); (X.L.); (Y.P.); (J.Y.); (M.J.)
- Correspondence:
| |
Collapse
|
2004
|
Misconceptions and Unmet Need for Modern Contraception among Cambodian Females: A Mix Methods Study. SEXES 2020. [DOI: 10.3390/sexes1010005] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
(1) Background: Women using unreliable traditional contraception need to be included in the proportion of women having an ‘unmet need for modern contraception’ instead of the current classification which presumes they have a ‘met need’. (2) Methods: Mix methods research design comprising initial quantitative analyses utilizing data from the nationally representative 2014 Cambodian Demographic and Health Survey (CDHS) for 4823 Cambodian, sexually active females aged 15–29 years. Then a qualitative phase explored knowledge about the menstrual cycle and misconceptions about modern contraception with 30 females aged 15–29 years in urban Cambodia using semi-structured interviews, transcribed verbatim with quality checks. Purposive and snowball sampling strategies were used until data saturation was reached. Inductive thematic data analysis was conducted; (3) Results: Unmet need for modern contraception increased to 25.4% when traditional contraception users were included. The qualitative themes show women have a lack of information about the menstrual cycle and misconceptions about modern contraception which contributed to increased use of traditional contraception; (4) Conclusion: Major drivers of increased unmet need for modern contraception include lack of literacy, misconceptions and low autonomy to choose modern contraception. Cambodia needs to endorse a policy shift to implement targeted, countrywide sexual and reproductive health literacy and family planning services.
Collapse
|
2005
|
Naito T, Chin J, Kim TU, Veera S, Jeannette M, Lomiguen CM. Further Reduction in Help-Seeking Behaviors Amidst Additional Barriers to Mental Health Treatment in Asian Populations: A Contemporary Review. Cureus 2020; 12:e11455. [PMID: 33329953 PMCID: PMC7733772 DOI: 10.7759/cureus.11455] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/10/2020] [Accepted: 11/12/2020] [Indexed: 12/19/2022] Open
Abstract
Under diagnosis and treatment of mental health illnesses lead to chronic presentations and consequences. Multiple factors contribute to gaps in treatment, including the role culture plays in the development or suppression of help-seeking behaviors (HSBs). In the Asian community, conversation and recognition of mental health and its disorders are considered shameful. This review presents an analysis of literature to identify barriers to mental health treatment pronounced in Asian populations and discusses how culture influences these barriers and treatment-seeking behaviors, particularly in the context of the Asian-origin Coronavirus disease 2019 (COVID-19) global pandemic. It is the purpose of this review to discuss Asian American underutilization of mental health services and understand the factors the contribute to psychiatric care resistance in Asian communities.
Collapse
Affiliation(s)
| | - Justin Chin
- Medical Education, Lake Erie College of Osteopathic Medicine, Erie, USA
- Family Medicine, LifeLong Medical Care, Richmond, USA
| | - Tae Un Kim
- Primary Care, Touro College of Osteopathic Medicine, New York, USA
| | - Simrat Veera
- Pediatrics, Goryeb Children's Hospital - Atlantic Health System, Morristown, USA
| | | | | |
Collapse
|
2006
|
Prevalence of work related musculoskeletal disorders in Italian workers: is there an underestimation of the related occupational risk factors? BMC Musculoskelet Disord 2020; 21:738. [PMID: 33183245 PMCID: PMC7659235 DOI: 10.1186/s12891-020-03742-z] [Citation(s) in RCA: 11] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 06/06/2020] [Accepted: 10/26/2020] [Indexed: 12/25/2022] Open
Abstract
Background Work-related musculoskeletal disorders (WMSDs) represent an important socio-economic burden. The current risk assessment and management involved in the ethiopathogenesis of WMSDs is based on observational tools and checklists, which have some limitations in terms of accuracy and reliability. The aim of this study was to assess WMSD prevalence and identify possible correlations with several socio-demographic and work-related variables in a large cohort representative of Italian workers in order to improve our understanding of the WMSD phenomenon. Methods This study includes data from INSuLa, a cross-sectional nationally representative survey of health and safety at work, developed by the Italian Workers’ Compensation Authority. A total of 8000 Italian workers were included. Multivariate logistic regression analyses were performed to evaluate the association of independent variables, such as workers’ perceptions of exposure to biomechanical/ergonomic and video display unit (VDU) risks (Risk Perceived) and the actual risk exposure (Risk Detected) on Back, Lower and Upper limb pain. Socio-demographic, occupational and other health-related variables were included to investigate possible association with musculoskeletal disorders. Results Workers perceiving a significant exposure to biomechanical/ergonomic and VDU risks but not included in a health surveillance program for them (Risk Perceived/No Risk Detected) have had significantly higher odds of reporting musculoskeletal disorders. Regarding the biomechanical/ergonomic risk these workers are in the 19–24 age range (39.9%), transportation, warehousing/information and communication sectors (38.9%) and are employed in companies with more than 250 workers (35.8%). Regarding VDU risk, workers are in the 45–54 age range (24.5%), professional, financial and business services (38.0%) and come from companies with more than 250 employees (25.6%). Conclusions Within the occupational safety and health management systems an appropriate assessment of occupational risk factors correlated to musculoskeletal disorders (mainly biomechanical/ergonomic and VDU) and the correct definition of their exposure levels is essential to adequately prevent the onset of WMSDs. In this regard, our findings provide useful information to design novel approaches, aimed at improving our understanding of emerging risks, identifying gaps in current risk assessment strategies and enhancing workplace interventions are mandatory to improve the occupational risk assessment and management process and therefore implement the subsequent health surveillance systems.
Collapse
|
2007
|
Malagon-Rojas JN, Pinzón-Silva DC, Parra EL, Lagos M LF, Toloza-Perez YG, Hernández Florez LJ, Morales Betancourt R, Romero SA, Ríos Cabra AP, Sarmiento OL. Assessment of personal exposure to particulate air pollution in different microenvironments and traveling by several modes of transportation in Bogotá, Colombia: protocol for a mixed-methods study. (Preprint). JMIR Res Protoc 2020; 11:e25690. [PMID: 35099404 PMCID: PMC8845014 DOI: 10.2196/25690] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Track Full Text] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 11/11/2020] [Revised: 04/12/2021] [Accepted: 05/04/2021] [Indexed: 12/27/2022] Open
Abstract
Background Air pollution in most countries exceeds the levels recommended by the World Health Organization, causing up to one-third of deaths due to noncommunicable diseases. Fine particulate matter (PM2.5) and black carbon (BC) from mobile sources are the main contaminants. Objective The aim of this study is to assess the relationship of exposure to air pollutants (PM2.5 and BC) in microenvironments according to respiratory health and physical activity in users traveling by different types of transportation in Bogotá, Colombia. Methods A mixed methods study based on a convergent parallel design will be performed with workers and students. The sample will include 350 healthy transport users traveling by different urban transportation modes in three main routes in Bogotá. The study is broken down into two components: (1) a descriptive qualitative component focused on assessing the individual perception of air pollution using semistructured interviews; and (2) a cross-sectional study measuring the individual exposure to PM2.5 and BC using portable instruments (DustTrak and microAeth, respectively), pulmonary function by spirometry, and physical activity with accelerometry. The analysis will include concurrent triangulation and logistic regression. Results The findings will be useful for the conception, design, and decision-making process in the sectors of health and mobility from public, academy, and private perspectives. This study includes personal measurements of PM2.5 and BC during typical trips in the city to assess the exposure to these contaminants in the major roadways in real time. The study further compares the performance of two different lung tests to identify possible short-term respiratory effects. As a limitation, the protocol will include participants from different institutions in the city, which are not necessarily representative of all healthy populations in Bogotá. In this sense, it is not possible to draw causation conclusions. Moreover, a convergent parallel design could be especially problematic concerning integration because such a design often lacks a clear plan for making a connection between the two sets of results, which may not be well connected. Nevertheless, this study adopts a procedure for how to integrate qualitative and quantitative data in the interpretation of the results and a multilevel regression. The time that participants must live in the city will be considered; this will be controlled in the stratified analysis. Another limitation is the wide age range and working status of the participants. Regional pollution levels and episodes (PM2.5) will be handled as confounding variables. The study is currently in the enrollment phase of the participants. Measurements have been made on 300 participants. Pandemic conditions affected the study schedule; however, the results are likely to be obtained by late 2022. Conclusions This study investigates the exposure to air pollutants in microenvironments in Bogotá, Colombia. To our knowledge, this is the first mixed methods study focusing on PM2.5, BC, and respiratory health effects in a city over 2 meters above sea level. This study will provide an integration of air pollution exposure variables and respiratory health effects in different microenvironments. International Registered Report Identifier (IRRID) PRR1-10.2196/25690
Collapse
Affiliation(s)
- Jeadran N Malagon-Rojas
- Grupo de Salud Ambiental y Laboral, Instituto Nacional de Salud, Bogotá, Colombia
- Facultad de Medicina, Universidad El Bosque, Bogotá, Colombia
| | | | - Eliana L Parra
- Grupo de Salud Ambiental y Laboral, Instituto Nacional de Salud, Bogotá, Colombia
| | - Luisa F Lagos M
- Grupo de Salud Ambiental y Laboral, Instituto Nacional de Salud, Bogotá, Colombia
| | - Yesith Guillermo Toloza-Perez
- Grupo de Salud Ambiental y Laboral, Instituto Nacional de Salud, Bogotá, Colombia
- Maestría en Epidemiologia, Facultad de Medicina, Universidad El Bosque, Bogotá, Colombia
| | - Luis Jorge Hernández Florez
- Grupo de Investigación Salud Pública, Educación y Profesionalismo, Universidad de los Andes, Bogotá, Colombia
| | | | - Sol Angie Romero
- Grupo de Cuidado Cardiorrespiratorio, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Ana Paola Ríos Cabra
- Grupo de Cuidado Cardiorrespiratorio, Universidad Manuela Beltrán, Bogotá, Colombia
| | - Olga L Sarmiento
- Grupo de Epidemiología EPIANDES, Universidad de los Andes, Bogotá, Colombia
| |
Collapse
|
2008
|
A comparison of inflammation markers for predicting oncological outcomes after surgical resection of non-small-cell lung cancer: a validated analysis of 2,066 patients. Sci Rep 2020; 10:19523. [PMID: 33177603 PMCID: PMC7658207 DOI: 10.1038/s41598-020-76644-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/26/2020] [Accepted: 08/11/2020] [Indexed: 02/06/2023] Open
Abstract
Clinical and pathological predictors have proved to be insufficient in identifying high-risk patients who develop cancer recurrence after tumour resection. We aimed to compare the prognostic ability of various inflammation markers in patients undergoing surgical resection of lung cancer. We consecutively included 2,066 patients with stage I-III non-small-cell lung cancer undergoing surgical resection at the center between 2005 and 2015. We evaluated prognostic nutritional index, neutrophil-to-lymphocyte ratio, and platelet-to-lymphocyte ratio along with their perioperative changes. We conducted stepwise backward variable elimination and internal validation to compare the selected markers' predictive performance for postoperative recurrence-free survival and overall survival. Preoperative neutrophil-to-lymphocyte ratio independently predicts recurrence-free survival (HR: 1.267, 95% CI 1.064-1.509, p = 0.0079, on base-2 logarithmic scale) and overall survival (HR: 1.357, 95% CI 1.070-1.721, p = 0.0117, on base-2 logarithmic scale). The cut-off value is 2.3 for predicting both recurrence (sensitivity: 46.1% and specificity: 66.7%) and mortality (sensitivity: 84.2% and specificity: 40.4%). Advanced cancer stage, poor tumour differentiation, and presence of perineural infiltration were significantly correlated with higher preoperative neutrophil-to-lymphocyte ratio. We concluded that preoperative neutrophil-to-lymphocyte ratio is superior to prognostic nutritional index and platelet-to-lymphocyte ratio in predicting postoperative recurrence and mortality of patients undergoing surgical resection of non-small-cell lung cancer.
Collapse
|
2009
|
Townsend L, Dyer AH, Jones K, Dunne J, Mooney A, Gaffney F, O'Connor L, Leavy D, O'Brien K, Dowds J, Sugrue JA, Hopkins D, Martin-Loeches I, Ni Cheallaigh C, Nadarajan P, McLaughlin AM, Bourke NM, Bergin C, O'Farrelly C, Bannan C, Conlon N. Persistent fatigue following SARS-CoV-2 infection is common and independent of severity of initial infection. PLoS One 2020; 15:e0240784. [PMID: 33166287 PMCID: PMC7652254 DOI: 10.1371/journal.pone.0240784] [Citation(s) in RCA: 516] [Impact Index Per Article: 129.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/22/2020] [Accepted: 10/02/2020] [Indexed: 12/12/2022] Open
Abstract
Fatigue is a common symptom in those presenting with symptomatic COVID-19 infection. However, it is unknown if COVID-19 results in persistent fatigue in those recovered from acute infection. We examined the prevalence of fatigue in individuals recovered from the acute phase of COVID-19 illness using the Chalder Fatigue Score (CFQ-11). We further examined potential predictors of fatigue following COVID-19 infection, evaluating indicators of COVID-19 severity, markers of peripheral immune activation and circulating pro-inflammatory cytokines. Of 128 participants (49.5 ± 15 years; 54% female), more than half reported persistent fatigue (67/128; 52.3%) at median of 10 weeks after initial COVID-19 symptoms. There was no association between COVID-19 severity (need for inpatient admission, supplemental oxygen or critical care) and fatigue following COVID-19. Additionally, there was no association between routine laboratory markers of inflammation and cell turnover (leukocyte, neutrophil or lymphocyte counts, neutrophil-to-lymphocyte ratio, lactate dehydrogenase, C-reactive protein) or pro-inflammatory molecules (IL-6 or sCD25) and fatigue post COVID-19. Female gender and those with a pre-existing diagnosis of depression/anxiety were over-represented in those with fatigue. Our findings demonstrate a significant burden of post-viral fatigue in individuals with previous SARS-CoV-2 infection after the acute phase of COVID-19 illness. This study highlights the importance of assessing those recovering from COVID-19 for symptoms of severe fatigue, irrespective of severity of initial illness, and may identify a group worthy of further study and early intervention.
Collapse
Affiliation(s)
- Liam Townsend
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Adam H. Dyer
- Department of Immunology, St James’s Hospital, Dublin, Ireland
- Department of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Karen Jones
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Jean Dunne
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Aoife Mooney
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Fiona Gaffney
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Laura O'Connor
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Deirdre Leavy
- Department of Immunology, St James’s Hospital, Dublin, Ireland
| | - Kate O'Brien
- Department of Physiotherapy, St James’s Hospital, Dublin, Ireland
| | - Joanne Dowds
- Department of Physiotherapy, St James’s Hospital, Dublin, Ireland
| | - Jamie A. Sugrue
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
| | - David Hopkins
- School of Medicine, Trinity College Dublin, Dublin, Ireland
| | | | - Cliona Ni Cheallaigh
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | | | | | - Nollaig M. Bourke
- Department of Medical Gerontology, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Colm Bergin
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Cliona O'Farrelly
- School of Biochemistry and Immunology, Trinity Biomedical Sciences Institute, Trinity College Dublin, Dublin, Ireland
- Department of Comparative Immunology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| | - Ciaran Bannan
- Department of Infectious Diseases, St James’s Hospital, Dublin, Ireland
- Department of Clinical Medicine, School of Medicine, Trinity Translational Medicine Institute, Trinity College Dublin, Dublin, Ireland
| | - Niall Conlon
- Department of Immunology, St James’s Hospital, Dublin, Ireland
- Department of Immunology, School of Medicine, Trinity College Dublin, Dublin, Ireland
| |
Collapse
|
2010
|
Shao H, Fonseca V, Furman R, Meneghini L, Shi L. Impact of Quality Improvement (QI) Program on 5-Year Risk of Diabetes-Related Complications: A Simulation Study. Diabetes Care 2020; 43:2847-2852. [PMID: 32887705 PMCID: PMC9162144 DOI: 10.2337/dc20-0465] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 03/07/2020] [Accepted: 08/16/2020] [Indexed: 02/03/2023]
Abstract
OBJECTIVE We successfully implemented the American Diabetes Association's (ADA) Diabetes INSIDE (INspiring System Improvement with Data-Driven Excellence) quality improvement (QI) program at a university hospital and safety-net health system (Tulane and Parkland), focused on system-wide improvement in poorly controlled type 2 diabetes (HbA1c >8.0% [64 mmol/mol]). In this study, we estimated the 5-year risk reduction in complications and mortality associated with the QI program. RESEARCH DESIGN AND METHODS The QI implementation period was 1 year, followed by the postintervention period of 6 months to evaluate the impact of QI on clinical measures. We measured the differences between the baseline and postintervention clinical outcomes in 2,429 individuals with HbA1c >8% (64 mmol/mol) at baseline and used the Building, Relating, Assessing, and Validating Outcomes (BRAVO) diabetes model to project the 5-year risk reduction of diabetes-related complications under the assumption that intervention benefits persist over time. An alternative assumption that intervention benefits diminish by 30% every year was also tested. RESULTS The QI program was associated with reductions in HbA1c (-0.84%) and LDL cholesterol (LDL-C) (-5.94 mg/dL) among individuals with HbA1c level >8.0% (64 mmol/mol), with greater reduction in HbA1c (-1.67%) and LDL-C (-6.81 mg/dL) among those with HbA1c level >9.5% at baseline (all P < 0.05). The implementation of the Diabetes INSIDE QI program was associated with 5-year risk reductions in major adverse cardiovascular events (MACE) (relative risk [RR] 0.78 [95% CI 0.75-0.81]) and all-cause mortality (RR 0.83 [95% CI 0.82-0.85]) among individuals with baseline HbA1c level >8.0% (64 mmol/mol), and MACE (RR 0.60 [95% CI 0.56-0.65]) and all-cause mortality (RR 0.61 [95% CI 0.59-0.64]) among individuals with baseline HbA1c level >9.5% (80 mmol/mol). Sensitivity analysis also identified a substantially lower risk of diabetes-related complications and mortality associated with the QI program. CONCLUSIONS Our modeling results suggest that the ADA's Diabetes INSIDE QI program would benefit the patients and population by substantially reducing the 5-year risk of complications and mortality in individuals with diabetes.
Collapse
Affiliation(s)
- Hui Shao
- Department of Pharmaceutical Outcomes and Policy, College of Pharmacy, University of Florida, Gainesville, FL
| | - Vivian Fonseca
- Department of Medicine and Pharmacology, School of Medicine, Tulane University, New Orleans, LA
| | - Roy Furman
- Quality Improvement Services, American Diabetes Association, Bala Cynwyd, PA
| | - Luigi Meneghini
- The University of Texas Southwestern Medical Center and Parkland Health & Hospital System, Dallas, TX
| | - Lizheng Shi
- Department of Health Policy and Management, School of Public Health and Tropical Medicine, Tulane University, New Orleans, LA
| |
Collapse
|
2011
|
|
2012
|
Primary Care Practitioners' Barriers to and Experience of COVID-19 Epidemic Control in China: a Qualitative Study. J Gen Intern Med 2020; 35:3278-3284. [PMID: 32869200 PMCID: PMC7458355 DOI: 10.1007/s11606-020-06107-3] [Citation(s) in RCA: 35] [Impact Index Per Article: 8.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/17/2020] [Accepted: 08/03/2020] [Indexed: 01/10/2023]
Abstract
BACKGROUND The coronavirus disease 2019 (COVID-19) emerged in December 2019 and posed numerous challenges to China's health system. Almost 4 million primary care practitioners (PCPs) participated in controlling the outbreak. However, PCPs' barriers to and experience of the epidemic control remain unknown and are essential for improving countermeasures. OBJECTIVE To better understand the barriers PCPs faced in COVID-19 epidemic control and their psychological and occupational impacts, and explore potential solutions. DESIGN This qualitative study was conducted through semi-structured, in-depth interviews from February 12, to March 10, 2020. PARTICIPANTS A purposive sample of frontline PCPs affiliated with either community health centers or township health centers in four provinces of China were recruited. APPROACH Interviews were conducted by telephone, and then recorded, transcribed, and content analyzed. Themes surrounding PCPs' barriers to COVID-19 epidemic control, their experience, and potential solutions were iteratively identified using the constant comparative method. KEY RESULTS Of the 21 PCPs interviewed, 10 (48%) were women and 5 (24%) worked in rural areas. Barriers to epidemic control in primary care included inappropriate PCP scheduling and role ambiguity, difficult tasks and inadequate capacities, and inexperienced community workers and insufficient cooperation. Some PCPs perceived respect and a sense of accomplishment and were preoccupied with the outbreak, while others were frustrated by fatigue and psychological distress. PCPs reported potential solutions for improving countermeasures, such as improving management, optimizing workflows, providing additional support, facilitating cooperation, and strengthening the primary care system. CONCLUSIONS Due to their roles in controlling the COVID-19 epidemic, PCPs in China faced a series of barriers that affected them physically and mentally. Support for PCPs should help them to overcome these barriers and work efficiently. The current findings provide insight into the challenges and potential solutions for strengthening the preparedness and response of China's primary care system in future disease outbreaks.
Collapse
|
2013
|
Coughlan B, Duschinsky R, O'Connor ME, Woolgar M. Identifying and managing care for children with autism spectrum disorders in general practice: A systematic review and narrative synthesis. HEALTH & SOCIAL CARE IN THE COMMUNITY 2020; 28:1928-1941. [PMID: 32667097 DOI: 10.1111/hsc.13098] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Received: 04/03/2020] [Revised: 06/17/2020] [Accepted: 06/19/2020] [Indexed: 06/11/2023]
Abstract
Many healthcare systems are organised such that General Practitioners (GPs) often have a key role in identifying autism spectrum disorders (hereafter collectively referred to as autism) in children. In this review, we explored what GPs know about autism and the factors that influence their ability to identify and manage care for their patients with autism in practice. We conducted a systematic narrative review using eight electronic databases. These included Embase and MEDLINE via Ovid, Web of Knowledge, PsycINFO via Ebscohost, PubMed, Scopus, ProQuest Dissertations and Thesis, and Applied Social Sciences Index and Abstracts (ASSIA) via ProQuest. Our search yielded 2,743 citations. Primary research studies were included, and we did not impose any geographical, language or date restrictions. We identified 17 studies that met our inclusion criteria. Studies included in the review were conducted between 2003 and 2019. We thematically synthesised the material and identified the following themes: the prototypical image of a child with autism; experience, sources of information, and managing care; barriers to identification; strategies to aid in identification; and characteristics that facilitate expertise. Together, the findings from this review present a mixed picture of GP knowledge and experiences in identifying autism and managing care for children with the condition. At one end of the continuum, there were GPs who had not heard of autism or endorsed outmoded aetiological theories. Others, however, demonstrated a sound knowledge of the conditions but had limited confidence in their ability to identify the condition. Many GPs and researchers alike called for more training and this might be effective. However, framing the problem as one of a lack of training risks silences the array of organisational factors that impact on a GP's ability to provide care for these patients.
Collapse
Affiliation(s)
- Barry Coughlan
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | - Robbie Duschinsky
- Department of Public Health and Primary Care, University of Cambridge, Cambridge, UK
| | | | - Matt Woolgar
- Institute of Psychiatry, Psychology and Neuroscience, King's College London, London, UK
| |
Collapse
|
2014
|
Wishnia J, Goudge J. Impact of financial management centralisation in a health system under austerity: a qualitative study from South Africa. BMJ Glob Health 2020; 5:bmjgh-2020-003524. [PMID: 33122297 PMCID: PMC7597483 DOI: 10.1136/bmjgh-2020-003524] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/23/2020] [Revised: 09/06/2020] [Accepted: 09/18/2020] [Indexed: 11/03/2022] Open
Abstract
INTRODUCTION International calls for universal health coverage (UHC) have led many countries to implement health sector reforms, however, since the 2008 global recession, economic growth has slowed in many lower-income and middle-income countries. In a renewed interest in public financial management (PFM), international organisations have emphasised the importance of giving spending control to those responsible for healthcare. However, centralisation is a common response when there is a need to cut expenditure due to a reduced budget; yet failure to decentralise often hampers the achievement of important goals. This paper examines the effect of centralising financial decision-making on the functioning of the South African health system. METHODS We used a case study design with an ethnographic approach. Primary data collection was conducted through participant-observation and semistructured interviews, over 1 year. Member checking was conducted. RESULTS New management implemented centralisation due to a reduced budget, a history of financial mismanagement, the punitive regulatory environment financial managers face, and their fear of poor audit outcomes. The reform, together with an authoritarian management style to ensure compliance, created a large power distance between financial and clinical managers. District managers felt that there was poor communication about the reform and that decision-making was opaque. This lowered commitment to the reform, even for those who thought it was necessary. It also reduced communal action, creating an individualistic environment. The authoritarian management style, and the impact of centralisation on service delivery, negatively affected planning and decision making, impairing organisational functioning. CONCLUSION As public health systems become even more financially constrained, recognising how PFM reforms can influence organisational culture, and how the negative effects can be mitigated, is of international importance. We highlight the importance of a participatory culture that encourages shared decision making and coproduction, particularly as countries grapple with how to achieve UHC with limited funds.
Collapse
Affiliation(s)
- Jodi Wishnia
- Centre for Health Policy, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| | - Jane Goudge
- Centre for Health Policy, Faculty of Health Sciences, School of Public Health, University of the Witwatersrand, Johannesburg, South Africa
| |
Collapse
|
2015
|
Lim PS, Lang AC, Davies WH. Parent Ethical Concerns About Patient Feedback Measures to Improve Pediatric Clinical Care. J Empir Res Hum Res Ethics 2020; 16:46-53. [PMID: 33118456 DOI: 10.1177/1556264620969327] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/16/2022]
Abstract
There are limited studies evaluating parental willingness to complete patient feedback measures to improve pediatric clinical care. Parents were randomly assigned to read a vignette that varied by parent satisfaction and type of feedback measure. Parents were generally willing to participate in the hypothetical research study aimed to improve their child's clinical care. Parents in the dissatisfied condition invited to participate in a potentially identifiable interview, compared to an anonymous survey, reported they would be less likely to respond honestly and more likely to feel obligated to participate. Researchers aiming to improve pediatric clinical care should be encouraged to use patient feedback measures that collect potentially identifiable information; however, researchers must consider the potential impact of parent satisfaction on feedback.
Collapse
Affiliation(s)
- Paulina S Lim
- 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | - Amy C Lang
- 14751University of Wisconsin-Milwaukee, Milwaukee, WI, USA
| | | |
Collapse
|
2016
|
Vrillon A, Hourregue C, Azuar J, Grosset L, Boutelier A, Tan S, Roger M, Mourman V, Mouly S, Sène D, François V, Dumurgier J, Paquet C. COVID-19 in Older Adults: A Series of 76 Patients Aged 85 Years and Older with COVID-19. J Am Geriatr Soc 2020; 68:2735-2743. [PMID: 33045106 PMCID: PMC7675559 DOI: 10.1111/jgs.16894] [Citation(s) in RCA: 34] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2020] [Revised: 10/04/2020] [Accepted: 10/05/2020] [Indexed: 02/06/2023]
Abstract
BACKGROUND Clinical presentation and risk factors of death in COVID‐19 in oldest adults have not been well characterized. OBJECTIVES To describe clinical features and outcome of COVID‐19 in patients older than 85 years and study risk factors for mortality. DESIGN Prospective cohort. PARTICIPANTS AND SETTING Patients aged 85 years and older, admitted in noncritical care units at the University Hospital Lariboisière Fernand‐Widal (Paris, France) for confirmed severe acute respiratory syndrome coronavirus 2 infection were included and followed up for 21 days. MEASUREMENTS Clinical and laboratory findings were collected. Cox survival analysis was performed to explore factors associated with death. RESULTS From March 14 to April 11, 2020, 76 patients (median age = 90 (86–92) years; women = 55.3%) were admitted for confirmed COVID‐19. Of the patients, 64.5% presented with three or more comorbidities. Most common symptoms were asthenia (76.3%), fever (75.0%) and confusion and delirium (71.1%). An initial fall was reported in 25.0% of cases, and digestive symptoms were reported in 22.4% of cases. COVID‐19 was severe in 51.3% of cases, moderate in 32.9%, and mild in 15.8%. Complications included acute respiratory syndrome (28.9%), cardiac decompensation (14.5%), and hypotensive shock (9.0%). Fatality at 21 days was 28.9%, after a median course of disease of 13 (8–17) days. Males were overrepresented in nonsurvivors (68.2%). In survivors, median length of stay was 12 (9–19.5) days. Independent predictive factors of death were C‐reactive protein level at admission and lymphocyte count at nadir. CONCLUSION Specific clinical features, multiorgan injury, and high case fatality rate are observed in older adults with COVID‐19. However, rapid diagnosis, appropriate care, and monitoring seem to improve prognosis.
Collapse
Affiliation(s)
- Agathe Vrillon
- Université de Paris, INSERM U1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France.,Centre de Neurologie Cognitive, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France.,COVID Unit Féréol, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France
| | - Claire Hourregue
- Centre de Neurologie Cognitive, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France.,COVID Unit Féréol, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France
| | - Julien Azuar
- Université de Paris, INSERM U1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France.,COVID Unit Féréol, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Hôpital Fernand Widal, Paris, France
| | - Lina Grosset
- Centre de Neurologie Cognitive, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France.,COVID Unit Féréol, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France
| | - Ada Boutelier
- COVID Unit Féréol, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France
| | - Sophie Tan
- COVID Unit Féréol, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France.,Département de Psychiatrie et de Médecine Addictologique, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Hôpital Fernand Widal, Paris, France
| | - Michael Roger
- COVID Unit Féréol, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France
| | - Vianney Mourman
- Médecine de la Douleur et Médecine Palliative, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Hôpital Fernand Widal, Paris, France
| | - Stéphane Mouly
- Département de Médecine Interne, AP-HP, Groupe Hospitalier Lariboisière Fernand-Widal, Hôpital Lariboisière, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Damien Sène
- Département de Médecine Interne, AP-HP, Groupe Hospitalier Lariboisière Fernand-Widal, Hôpital Lariboisière, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | - Véronique François
- Gériatrie, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Hôpital Fernand Widal, Paris, France
| | - Julien Dumurgier
- Centre de Neurologie Cognitive, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France.,COVID Unit Féréol, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France.,Université de Paris, INSERM U1153 Epidemiology of Ageing and Neurodegenerative Diseases, Paris, France
| | - Claire Paquet
- Université de Paris, INSERM U1144 Optimisation Thérapeutique en Neuropsychopharmacologie, Paris, France.,Centre de Neurologie Cognitive, AP-HP, Groupe Hospitalier Saint-Louis Lariboisière Fernand-Widal, Paris, France.,Université de Paris, Faculté de Médecine, Paris, France
| | | |
Collapse
|
2017
|
Feng Z, Glinskaya E, Chen H, Gong S, Qiu Y, Xu J, Yip W. Long-term care system for older adults in China: policy landscape, challenges, and future prospects. Lancet 2020; 396:1362-1372. [PMID: 34338215 DOI: 10.1016/s0140-6736(20)32136-x] [Citation(s) in RCA: 163] [Impact Index Per Article: 40.8] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 08/09/2019] [Revised: 07/12/2020] [Accepted: 07/14/2020] [Indexed: 11/29/2022]
Abstract
In China, the population is rapidly ageing and the capacity of the system that cares for older people is increasingly a concern. In this Review, we provide a profile of the long-term care system and policy landscape in China. The long-term care system is characterised by rapid growth of the residential care sector, slow development of home and community-based services, and increasing involvement of the private sector. The long-term care workforce shortage and weak quality assurance are concerning. Public long-term care financing is minimal and largely limited to supporting welfare recipients and subsidising the construction of residential care beds and operating costs. China is piloting social insurance long-term care financing models and, concurrently, programmes for integrating health care and long-term care services in selected settings across the country; the effectiveness and sustainability of these pilots remain to be seen. Informed by international long-term care experiences, we offer policy recommendations to strengthen the evolving care system for older people in China.
Collapse
Affiliation(s)
| | | | - Hongtu Chen
- Department of Global Health and Social Medicine and Department of Psychiatry, Harvard University, Boston, MA, USA
| | - Sen Gong
- Center for International Knowledge on Development, Beijing, China
| | - Yue Qiu
- China Development Research Foundation, Development Research Center of the State Council, Beijing, China
| | - Jianming Xu
- School of Nursing, Fudan University, Shanghai, China
| | - Winnie Yip
- Department of Global Health and Population, Harvard University, Boston, MA, USA.
| |
Collapse
|
2018
|
Toma G, Essuman A, Fetters MD. Family medicine residency training in Ghana after 20 years: resident attitudes about their education. Fam Med Community Health 2020; 8:fmch-2020-000394. [PMID: 33093166 PMCID: PMC7583799 DOI: 10.1136/fmch-2020-000394] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/23/2022] Open
Abstract
Objective In addition to assessing educational needs of family medicine trainees in Ghana, we sought to assess whether those entering the training programme aimed to pursue an academic career. Design A case study using an anonymous cross-sectional survey through collaboration between faculty members from the family medicine departments of Ghana and the University of Michigan. Setting The family medicine postgraduate trainees and the most recent graduates in the three training sites, Accra, Kumasi and Mampong, as well as modular residents in Ghana served as the targeted participants during data collection between October and November of 2018. Participants Second and third year family medicine residents, fellows (known as senior residents in Ghana) and recent graduates were invited to participate in this study. Thirty-five of 77 eligible subjects provided responses (46% response rate), but five records were eliminated due to incomplete data to yield a survey completion rate of 39% (30/77). Result Participants were mostly men (n=19), and the average age of respondents was 37 years old. The participants indicated the residency programmes needed more faculty 97% (n=29), supervision during outpatient care 87% (n=26) and lectures 83% (n=25). The main reason provided by respondents for entering residency programme in family medicine, which is currently not required for practising primary care in Ghana, was to obtain more education 93% (n=28). Participants who had completed the residency programme were much more likely to be interested in becoming faculty compared with those still in residency (p <0.001). Conclusion The research confirms the need for more faculty and the importance of investing in faculty development resources for ensuring a robust programme. These findings provide constructive feedback that could improve residency curricula of the local and regional family medicine training programmes and supports investing in trainees and new graduates as future faculty candidates.
Collapse
Affiliation(s)
- Ghazwan Toma
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA
| | - Akye Essuman
- Family Medicine Unit, Department of Community Health, University of Ghana, Accra, Ghana
| | - Michael D Fetters
- Department of Family Medicine, University of Michigan, Ann Arbor, Michigan, USA.,Mixed Methods Program, University of Michigan, Ann Arbor, Michigan, USA
| |
Collapse
|
2019
|
Neurological manifestations of COVID-19: a systematic review and meta-analysis of proportions. Neurol Sci 2020; 41:3437-3470. [PMID: 33089477 PMCID: PMC7577367 DOI: 10.1007/s10072-020-04801-y] [Citation(s) in RCA: 124] [Impact Index Per Article: 31.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Accepted: 10/05/2020] [Indexed: 01/08/2023]
Abstract
BACKGROUND Coronaviruses mainly affect the respiratory system; however, there are reports of SARS-CoV and MERS-CoV causing neurological manifestations. We aimed at discussing the various neurological manifestations of SARS-CoV-2 infection and to estimate the prevalence of each of them. METHODS We searched the following electronic databases; PubMed, MEDLINE, Scopus, EMBASE, Google Scholar, EBSCO, Web of Science, Cochrane Library, WHO database, and ClinicalTrials.gov . Relevant MeSH terms for COVID-19 and neurological manifestations were used. Randomized controlled trials, non-randomized controlled trials, case-control studies, cohort studies, cross-sectional studies, case series, and case reports were included in the study. To estimate the overall proportion of each neurological manifestations, the study employed meta-analysis of proportions using a random-effects model. RESULTS Pooled prevalence of each neurological manifestations are, smell disturbances (35.8%; 95% CI 21.4-50.2), taste disturbances (38.5%; 95%CI 24.0-53.0), myalgia (19.3%; 95% CI 15.1-23.6), headache (14.7%; 95% CI 10.4-18.9), dizziness (6.1%; 95% CI 3.1-9.2), and syncope (1.8%; 95% CI 0.9-4.6). Pooled prevalence of acute cerebrovascular disease was (2.3%; 95%CI 1.0-3.6), of which majority were ischaemic stroke (2.1%; 95% CI 0.9-3.3), followed by haemorrhagic stroke (0.4%; 95% CI 0.2-0.6), and cerebral venous thrombosis (0.3%; 95% CI 0.1-0.6). CONCLUSIONS Neurological symptoms are common in SARS-CoV-2 infection, and from the large number of cases reported from all over the world daily, the prevalence of neurological features might increase again. Identifying some neurological manifestations like smell and taste disturbances can be used to screen patients with COVID-19 so that early identification and isolation is possible.
Collapse
|
2020
|
Fonseca-Teixeira SA, Parreira P, Mónico L, Salgueiro-Oliveira A, Amado JC. Referral to the national network of integrated care: the nurses' perception. Rev Lat Am Enfermagem 2020; 28:e3372. [PMID: 33084775 PMCID: PMC7575240 DOI: 10.1590/1518-8345.3800.3372] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/01/2019] [Accepted: 06/06/2020] [Indexed: 11/22/2022] Open
Abstract
OBJECTIVE to understand the referral to the National Network of Integrated Continuous Care, from the perspective of nurses who work in this care context. METHOD an exploratory and descriptive study with a qualitative approach, with data collection between July and September 2019 through interviews with 12 nurses who work in Integrated Continuous Care Teams, in Northern Portugal. The content analysis technique was used to analyze the statements. RESULTS the professionals revealed that there are difficulties and constraints in the process of referring users to the National Network of Integrated Continuous Care. The process is bureaucratic, complex, and time-consuming, conditioning user accessibility to timely care. CONCLUSION the referral process is a very bureaucratic and time-consuming procedure, which not only conditions and delays users' access to the National Network of Integrated Continuous Care network, contributing to the worsening of the clinical status of some patients. The number of professionals is insufficient, inducing the demand for services through urgency. The focus on primary care should seek to improve inequalities in access, compete for more equitable and accessible care, generating more quality in health care.
Collapse
Affiliation(s)
| | - Pedro Parreira
- Escola Superior de Enfermagem de Coimbra, Unidade de Pesquisa em
Ciências da Saúde: Enfermagem, Coimbra, Portugal
| | - Lisete Mónico
- Universidade de Coimbra, Faculdade de Psicologia e Ciências da
Educação, Coimbra, Portugal
| | - Anabela Salgueiro-Oliveira
- Escola Superior de Enfermagem de Coimbra, Unidade de Pesquisa em
Ciências da Saúde: Enfermagem, Coimbra, Portugal
| | - João Costa Amado
- Universidade Católica Portuguesa, Centro de Investigação
Interdisciplinar em Saúde, Instituto de Ciências da Saúde, Porto, Portugal
| |
Collapse
|
2021
|
Feng Z, Hayat K, Huang Z, Shi L, Li P, Xiang C, Gong Y, Chang J, Jiang M, Yang C, Zhao M, Ji W, Fang Y. Knowledge, attitude, and practices of community pharmacy staff toward antimicrobial stewardship programs: a cross-sectional study from Northeastern China. Expert Rev Anti Infect Ther 2020; 19:529-536. [PMID: 32945697 DOI: 10.1080/14787210.2021.1826307] [Citation(s) in RCA: 10] [Impact Index Per Article: 2.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/23/2022]
Abstract
BACKGROUND Antimicrobial resistance is one of the most significant challenges of the twenty-first century, and the illegal sale of antimicrobial drugs at community pharmacies is a driver of antimicrobial resistance. This study explores the knowledge, attitudes, and practices (KAP) of pharmacy staff toward antimicrobial stewardship programs (ASPs). METHODS We conducted a descriptive cross-sectional study among community pharmacy staff in Northeastern China, from April 1 to 31 May 2019, using a self-administered KAP questionnaire comprising 20 items. The data analysis was carried out by employing Mann-Whitney and Kruskal-Wallis tests. RESULTS A response rate of 98.5% (394/400) was obtained. The majority of participants (94.9%) demonstrated a good understanding of antimicrobial use, but they lacked an adequate understanding of ASPs. Nearly half of the participants (40.6%) reported that they sold antimicrobials to patients without a prescription. Education level, age, occupation, and experience were all significantly associated (P < 0.05) with participants' median ASPs scores. Besides, the presence of a licensed pharmacist (OR 46.327, 95% CI 2.443-878.451, P = 0.011) was the main factor associated with the pharmacy staff's understanding of antimicrobial use policies. CONCLUSIONS The participants' knowledge of antimicrobials was good, and their attitudes regarding ASPs were positive, but their practices regarding ASPs were poor.
Collapse
Affiliation(s)
- Zhitong Feng
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Khezar Hayat
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Institute of Pharmaceutical Sciences, University of Veterinary and Animal Sciences, Lahore, Pakistan
| | - Zhe Huang
- School of Business Administration, Shenyang Pharmaceutical University, Shenyang, China
| | - Li Shi
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Pengchao Li
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Cheng Xiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Yilin Gong
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Jie Chang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Minghuan Jiang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Caijun Yang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Mingyue Zhao
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Wenjing Ji
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| | - Yu Fang
- Department of Pharmacy Administration and Clinical Pharmacy, School of Pharmacy, Xi'an Jiaotong University, Xi'an, China.,Center for Drug Safety and Policy Research, Xi'an Jiaotong University, Xi'an, China.,Shaanxi Centre for Health Reform and Development Research, Xi'an, China.,Research Institute for Drug Safety and Monitoring, Institute of Pharmaceutical Science and Technology, China's Western Technological Innovation Harbor, Xi'an, China
| |
Collapse
|
2022
|
Yoshioka T, Funada S, Luo Y. The inherent problems with the generalizability of the CALL score: towards reliable clinical prediction models for COVID-19. Clin Infect Dis 2020; 73:e2818. [PMID: 33064127 PMCID: PMC7665360 DOI: 10.1093/cid/ciaa1564] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/09/2023] Open
Affiliation(s)
- Takashi Yoshioka
- Center for Innovative Research for Communities and Clinical Excellence (CiRC2LE), Fukushima Medical University, Fukushima city, Fukushima, Japan.,Department of Healthcare Epidemiology, Kyoto University School of Public Health in the Graduate School of Medicine, Kyoto city, Kyoto, Japan
| | - Satoshi Funada
- Department of Urology, Kyoto University Graduate School of Medicine, Kyoto city, Kyoto, Japan.,Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto city, Kyoto, Japan
| | - Yan Luo
- Department of Health Promotion and Human Behavior, Kyoto University Graduate School of Medicine/ School of Public Health, Kyoto city, Kyoto, Japan
| |
Collapse
|
2023
|
The Meaning of Physical Activity: A Qualitative Study on the Perspective of South American Immigrant Parents. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17207500. [PMID: 33076326 PMCID: PMC7602638 DOI: 10.3390/ijerph17207500] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 09/18/2020] [Revised: 10/11/2020] [Accepted: 10/12/2020] [Indexed: 12/13/2022]
Abstract
Physical activity facilitates the acquisition of healthy habits from childhood to adulthood. There are differences in the practice of physical activity between immigrant children and native Spanish children. The aim was to describe physical activity in children, from the perspective of South American immigrant parents. A qualitative case study was conducted. Parents were recruited using purposeful sampling. Data were collected from 12 participants by means of unstructured interviews together with researcher notes. A thematic analysis was applied. The following topics were identified: (a) physical activity and health, (b) socialization, (c) the need for movement, (d) gender, (e) barriers, (f) educational burden, (g) community living, and (h) reason for immigrating. Parents described how physical activity is fundamental and has benefits for health, and for the relationship between children. They perceived that physical activity should not be limited by gender. The time dedicated to other school activities, the norms related to community living, and financial limitations were especially relevant as barriers for the performance of physical activity. These results can be used to revise the curriculum in schools, promote equal opportunities for physical activity and support family participation.
Collapse
|
2024
|
Sepehrian E, Pooralmasi M, Abdi A, Rajati M, Mohebi S, Tavakol K, Rajati F. Life After Myocardial Infarction: A Qualitative Study on Experiences of Kurdish Patients Affected by Iran-Iraq War. PATIENT-RELATED OUTCOME MEASURES 2020; 11:209-219. [PMID: 33132705 PMCID: PMC7592835 DOI: 10.2147/prom.s265124] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 05/29/2020] [Accepted: 09/15/2020] [Indexed: 12/11/2022]
Abstract
Background Coronary artery disease (CAD) is a major cause of death globally. Myocardial infarction (MI) secondary to CAD affects patients’ quality of life and their lifestyle. The experience of war can affect people’s perception of phenomena. Given the scarcity of information in Kurdish patients with MI, the current study was designed to explore the lived experiences of individuals after MI in Kurdish patients affected by Iran–Iraq war. Methods This interpretive-phenomenological study was conducted on eleven patients with MI (9 men, 2 women) at Imam Ali Hospital, Center for Heart Diseases, in Kermanshah, Iran, considering MI as a phenomenon. Data was collected by a semi-structured interview and analyzed using the Van Mannen method. We employed the Lincoln and Guba criteria to examine the credibility, confirmability, dependability, and transferability of data. MAXQDA software was used for data management. We followed the COREQ checklist to ensure the rigor of our study Results Four themes and ten sub-themes were emerged as (1) “changes in the quality of life” including (a) negative physical outcomes, (b) mental effects, (c) social support, (d) adopting healthy behaviors, (e) increase or decrease in self-efficiency, (f) previous experience, and (g) developing future behaviors; (2) “bodily perceptions and medical care” including (a) medical care: saving or terminating life?, (b) a new message from the heart; (3) “returning to spirituality against death” including (a) spirituality as a guiding principle, (b) accepting death as an eventual destiny; and (4) denial. Conclusion The results suggest that MI could change the quality of physical and mental health of the person, anywhere from deterioration to full recovery. Furthermore, the influence of spirituality and previous experience of war to overcome the complications of MI has been discussed, leading to either acceptance or denial of MI, and the consequences.
Collapse
Affiliation(s)
- Elahe Sepehrian
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Maryam Pooralmasi
- Student Research Committee, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Alireza Abdi
- Critical Care and Emergency Department, Nursing and Midwifery School, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Mojgan Rajati
- Department of Obstetrics and Gynecology, School of Medicine, Kermanshah University of Medical Sciences, Kermanshah, Iran
| | - Siamak Mohebi
- Department of Health Education and Health Promotion, Faculty of Public Health, Qom University of Medical Sciences, Qom, Iran
| | - Kamran Tavakol
- School of Medicine, Howard University, Washington, DC, USA
| | - Fatemeh Rajati
- Research Center for Environmental Determinants of Health, Health Institute, Kermanshah University of Medical Sciences, Kermanshah, Iran
| |
Collapse
|
2025
|
Cohen-Kfir N, Bentwich ME, Kent A, Dickman N, Tanus M, Higazi B, Kalfon L, Rudolf M, Falik-Zaccai TC. Challenges to effective and autonomous genetic testing and counseling for ethno-cultural minorities: a qualitative study. BMC Med Ethics 2020; 21:98. [PMID: 33059675 PMCID: PMC7565773 DOI: 10.1186/s12910-020-00537-8] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/24/2020] [Accepted: 09/21/2020] [Indexed: 02/07/2023] Open
Abstract
Background The Arab population in Israel is a minority ethnic group with its own distinct cultural subgroups. Minority populations are known to underutilize genetic tests and counseling services, thereby undermining the effectiveness of these services among such populations. However, the general and culture-specific reasons for this underutilization are not well defined. Moreover, Arab populations and their key cultural-religious subsets (Muslims, Christians, and Druze) do not reside exclusively in Israel, but are rather found as a minority group in many European and North American countries. Therefore, focusing on the Arab population in Israel allows for the examination of attitudes regarding genetic testing and counseling among this globally important ethnic minority population. Methods We used a qualitative research method, employing individual interviews with 18 women of childbearing age from three religious subgroups (i.e., Druze, Muslim, and Christian) who reside in the Acre district, along with focus group discussions with healthcare providers (HCPs; 9 nurses and 7 genetic counselors) working in the same geographical district. Results A general lack of knowledge regarding the goals and practice of genetic counseling resulting in negative preconceptions of genetic testing was identified amongst all counselees. Counselors’ objective of respecting patient autonomy in decision-making, together with counselees’ misunderstanding of genetic risk data, caused uncertainty, frustration, and distrust. In addition, certain interesting variations were found between the different religious subgroups regarding their attitudes to genetic counseling. Conclusions The study highlights the miscommunications between HCPs, particularly counselors from the majority ethno-cultural group, and counselees from a minority ethno-cultural group. The need for nuanced understanding of the complex perspectives of minority ethno-cultural groups is also emphasized. Such an understanding may enhance the effectiveness of genetic testing and counseling among the Arab minority group while also genuinely empowering the personal autonomy of counselees from this minority group in Israel and other countries.
Collapse
Affiliation(s)
- Nehama Cohen-Kfir
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel.,The Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel
| | - Miriam Ethel Bentwich
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel.
| | - Andrew Kent
- Division of Hematology and Oncology, University of Colorado Hospital, Aurora, Colorado, USA
| | - Nomy Dickman
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel
| | - Mary Tanus
- Israeli Ministry of Health, Akko District, Acre, New York, USA
| | - Basem Higazi
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel
| | - Limor Kalfon
- The Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel
| | - Mary Rudolf
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel
| | - Tzipora C Falik-Zaccai
- The Azrieli Faculty of Medicine, Bar Ilan University, 8 Henrietta Szold St, P.O. Box 1589, Safed, Israel.,The Institute of Human Genetics, Galilee Medical Center, Nahariya, Israel
| |
Collapse
|
2026
|
Chang JCJ, Hwang SJ, Chen TJ, Chiu TY, Yang HY, Chen YC, Huang CK, Jan CF. Team-based care improves quality of diabetes care -Family Practice Integrated Care Project in Taiwan. BMC FAMILY PRACTICE 2020; 21:209. [PMID: 33059587 PMCID: PMC7561235 DOI: 10.1186/s12875-020-01284-w] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 03/23/2019] [Accepted: 10/08/2020] [Indexed: 11/10/2022]
Abstract
BACKGROUND The Family Practice Integrated Care Project (FPICP) is a team-based program in Taiwan initiated in 2003. This study investigates the influence of FPICP on the quality of diabetes care. METHODS This population-based cohort study used Taiwan's National Health Insurance Administration data on FPICP (fiscal year 2015-2016, with follow-up duration of one year). Participants included diabetic patients aged ≥30 in primary care clinics. We used conditional logistic regression modeling of patient characteristics and annual diabetes examinations and compared FPICP participants with non-participating candidates. Main outcome measures included completion of annual diabetes examinations, including glycated hemoglobin (A1c), low-density lipoprotein (LDL), urine microalbumin (MAU), routine urinalysis (UR), and fundus examination (FE). RESULTS The sample included 298,208 FPICP participants and 478,778 non-participating candidates. After 1:1 propensity score matching, the examination completion rates for FPICP participants and non-participants, respectively, were 94.4% versus 93.6% in A1c, 84.2% versus 83.8% in LDL, 61.9% versus 60.1% in MAU, 59.2% versus 58.0% in UR, and 30.1% versus 32.4% in FE. CONCLUSION Our findings indicate that a program like FPICP helps improve the quality of diabetes care through regular examinations of Alc, LDL, MAU, and UR.
Collapse
Affiliation(s)
- Jerry Che-Jui Chang
- Department of Family Medicine, National Taiwan University Hospital, No. 17 Xuzhou Road, Taipei, 100, Taiwan
- Taiwan Medical Association, Taipei, Taiwan
| | - Shinn-Jang Hwang
- Taiwan Association of Family Medicine, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Tzeng-Ji Chen
- Taiwan Association of Family Medicine, Taipei, Taiwan
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Tai-Yuan Chiu
- Department of Family Medicine, National Taiwan University Hospital, No. 17 Xuzhou Road, Taipei, 100, Taiwan
- Taiwan Medical Association, Taipei, Taiwan
| | - Hsiao-Yu Yang
- Institute of Environmental and Occupational Health Sciences, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Public Health, National Taiwan University College of Public Health, Taipei, Taiwan
- Department of Environmental and Occupational Medicine, National Taiwan University Hospital and National Taiwan University College of Medicine, Taipei, Taiwan
| | - Yu-Chun Chen
- Department of Family Medicine, Taipei Veterans General Hospital, Taipei, Taiwan
- School of Medicine, National Yang Ming University, Taipei, Taiwan
| | - Cheng-Kuo Huang
- Taiwan Association of Family Medicine, Taipei, Taiwan
- Dr. Cheng-Kuo Huang Clinic, Keelung, Taiwan
| | - Chyi-Feng Jan
- Department of Family Medicine, National Taiwan University Hospital, No. 17 Xuzhou Road, Taipei, 100, Taiwan.
- Taiwan Association of Family Medicine, Taipei, Taiwan.
| |
Collapse
|
2027
|
Quan XQ, Xu C, Wang RC, Zhang CT, Zhang Q, Zhou HL. The relationship between Chlamydia pneumoniae infection and CD4/CD8 ratio, lymphocyte subsets in middle-aged and elderly individuals. Microb Pathog 2020; 149:104541. [PMID: 33068732 DOI: 10.1016/j.micpath.2020.104541] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/08/2019] [Revised: 04/19/2020] [Accepted: 09/28/2020] [Indexed: 12/21/2022]
Abstract
Chlamydia pneumoniae (C. pneumoniae) is a common respiratory pathogen associated with many inflammatory diseases. There are few data concerning the lymphocyte subsets in middle-aged and elderly individuals with C. pneumoniae infection. A total of 191 patients were included in this study. The study population was categorized into the middle-aged group (40-64 years old) and the elderly group (65-89 years old). Lymphocyte subsets in peripheral blood were examined with multi-colored flow cytometry. Immunological monitoring included lymphocyte subsets, C. pneumoniae IgG and IgM serology. In the middle-aged group, 69.83% individuals presented IgG positivity, which was associated with the inverted CD4/CD8 ratio. Individuals with C. pneumoniae IgG positivity also presented an increased percentage of CD8+CD28- cells and a decreased CD4/CD8 ratio when compared to weakly-positive individuals. In the elderly group, C. pneumoniae IgG positivity was associated with a significant increase in the percentage of CD3+CD56+CD45+ (NKT) cells. In conclusion, altered lymphocyte homeostasis was shown in middle-aged individuals with C. pneumoniae IgG positivity. The senescent phenotypes of T cells might be associated with C. pneumoniae infection in middle-aged individuals.
Collapse
Affiliation(s)
- Xiao-Qing Quan
- Department of General Pratice, Shenzhen Longhua District Central Hospital, The Affiliated Central Hospital of Shenzhen Longhua District, Guangdong Medical University, Shenzhen, China
| | - Chang Xu
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Run-Chang Wang
- Department of Urology, Lanzhou University Second Hospital, Lanzhou, Gansu, China
| | - Cun-Tai Zhang
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China
| | - Qing Zhang
- Department of Neurology, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China. Qing--
| | - Hong-Lian Zhou
- Department of Geriatrics, Tongji Hospital, Tongji Medical College, Huazhong University of Science and Technology, Wuhan, China.
| |
Collapse
|
2028
|
Batchelor M, Maguire S, Shearn J. "They just get it" an exploration of father's experiences and perceptions of a support group for men caring for children with disabilities and/or developmental delay. JOURNAL OF APPLIED RESEARCH IN INTELLECTUAL DISABILITIES 2020; 34:263-273. [PMID: 33047415 DOI: 10.1111/jar.12804] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/09/2019] [Revised: 07/29/2020] [Accepted: 08/26/2020] [Indexed: 11/30/2022]
Abstract
BACKGROUND Support groups available to parents/carers of children with a disability or developmental delay (DDD) are predominately attended by women. Limited data exists reporting experiences of the few male-only support groups. This paper examines experiences of fathers of children with DDD attending a male-only support group from South Wales. METHOD All fifteen members from a support group for fathers/male carers of children with DDD were invited to take part in qualitative interviews and seven participated. The data were analysed following Braun and Clarke's (Qualitative research in psychology, 2006, 3:77) thematic framework. RESULTS Within the group, fathers felt understood by similarly situated men, and a sense of connectivity and belonging. Fathers perceived exclusion elsewhere, including mixed-gender groups. Fathers felt permission to talk in a way consistent with their male identities, and valued receiving, and giving, support. CONCLUSIONS Mixed-gender support groups may not meet the needs of fathers, and there are potential benefits in providing male-only groups.
Collapse
Affiliation(s)
- Molly Batchelor
- Child and Family Psychological Health Service, Family and Therapy Services Division, Caerleon, UK.,Sparkle (South Wales) Ltd, Serennu Children's Centre, Newport, UK
| | | | - Julia Shearn
- Sparkle (South Wales) Ltd, Serennu Children's Centre, Newport, UK
| |
Collapse
|
2029
|
Alsufyani AM, Alforihidi MA, Almalki KE, Aljuaid SM, Alamri AA, Alghamdi MS. Linking the Saudi Arabian 2030 vision with nursing transformation in Saudi Arabia: Roadmap for nursing policies and strategies. INTERNATIONAL JOURNAL OF AFRICA NURSING SCIENCES 2020; 13:100256. [PMID: 33072514 PMCID: PMC7553899 DOI: 10.1016/j.ijans.2020.100256] [Citation(s) in RCA: 16] [Impact Index Per Article: 4.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/09/2020] [Revised: 09/29/2020] [Accepted: 10/08/2020] [Indexed: 11/04/2022] Open
Abstract
The Saudi government is currently facing multiple challenges in achieving “The Gold Standard” in nursing practice. This is not limited to educational challenges, staffing shortage, paucity of international and national benchmark evidence, absence of clear and defined scope of nursing practice, and lack of appropriate policies and regulations. This study presented a comprehensive plan for developing a policy based on current challenges, recognition of policy goals, assessment of potential options and alternatives, identification of stakeholders, proposition of recommended solutions, and implementation of the framework to transform nursing standards and link these changes with the Saudi Vision 2030. However, amendments are required in the present strategic plan for the better management of the nursing profession. It is doubtful that the current nursing profession status quo is capable of meeting the golden standards for health care. Thus, the transformation of the nursing profession in Saudi Arabia is necessary.
Collapse
Affiliation(s)
- Abdulaziz M Alsufyani
- College of Nursing, King Saud University, Riyadh, Saudi Arabia.,Ministry of Human Resources and Social Development, Saudi Arabia
| | | | | | - Sayer M Aljuaid
- Ministry of Human Resources and Social Development, Saudi Arabia
| | | | | |
Collapse
|
2030
|
Mohamed Ahmed E, Chen EP. Perspectives of Surgeons from Atlanta, USA. J Card Surg 2020; 36:1693-1695. [PMID: 33058270 DOI: 10.1111/jocs.15098] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/07/2020] [Accepted: 09/24/2020] [Indexed: 11/29/2022]
Abstract
BACKGROUND The COVID-19 pandemic in late 2019 quickly stretched health care system across the globe. Mortalities, shortages in health care system capacity, and lack of experience in similar circumstances required innovation in the way health care is delivered. Health care systems changed operating schedules, staff work pattern, and how patients are cared for. The effects of these changes reached patients, staff and training in different ways. METHODS We searched the Pubmed and EMBASE for articles related to COVID-19. We also searched local emails and information provided to staff during the pandemic RESULTS: The COVID-19 pandemic affected organizations, patients, and staff. The organizations and staff had to adapt to the times to provide a safe and appropriate service to our patients. CONCLUSION The pandemic challenged and changed the way we work as health care providers, and how we train the future surgeons. Changes in the system were effective.
Collapse
Affiliation(s)
- Eltayeb Mohamed Ahmed
- Division of Cardiothoracic Surgery, Department of Surgery, Emory School of Medicine, Atlanta, Georgia, USA
| | - Edward P Chen
- Division of Cardiothoracic Surgery, Department of Surgery, Emory School of Medicine, Atlanta, Georgia, USA
| |
Collapse
|
2031
|
Positive association between systemic immune-inflammatory index and mortality of cardiogenic shock. Clin Chim Acta 2020; 511:97-103. [PMID: 33045194 DOI: 10.1016/j.cca.2020.09.022] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/04/2020] [Revised: 09/14/2020] [Accepted: 09/16/2020] [Indexed: 01/04/2023]
Abstract
BACKGROUND Cardiogenic shock (CGS) is not only a state of hypoperfusion, but also related to inflammation. The prognostic value of systemic immune-inflammatory index (SII), an innovate biomarker of inflammation, in CGS patients has not been assessed. This study aims to explore the associations between SII and mortality in patients with CGS. METHODS Data on patients diagnosed with CGS were extracted from MIMIC-III database version 1.4. The follow-up started on the patients' first admission to ICU. The primary outcome was 30-day mortality. 90-day and 365-day mortality were the secondary outcomes. Cox proportional hazards models were used to investigate the associations between SII and mortality of CGS patients. RESULTS 707 patients with CGS were included in our study (59.8% male, 67.5% the white, 70.27 ± 14.56 years). For 30-day mortality, the HR (95% CI) value of high-SII group was 2.17 (1.60, 2.93) compared with the reference of low-SII group (P < 0.0001). The HR value of mid-SII group, however, showed none statistical significance (HR: 1.03, 95% CI: 0.74-1.43, P = 0.8516). When adjusted for age, gender and ethnicity in Model I, the adjusted HR (95% CI) value of high-SII group was 2.28 (1.69, 3.09). When further adjusted for heart rate, SBP, serum potassium, PTT, INR and ECI in Model II, the adjusted HR value of high-SII group was still statistically significant (HR: 2.08, 95% CI: 1.52-2.86, P < 0.0001). Similar results were also shown in the secondary outcomes of 90-day and 365-day mortality. CONCLUSIONS High level of SII is associated with increased short- and long-term mortality of patients with CGS. SII, a readily available biomarker, can independently predict the prognosis of CGS patients.
Collapse
|
2032
|
Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 PMCID: PMC7544065 DOI: 10.1371/journal.pone.0240205] [Citation(s) in RCA: 132] [Impact Index Per Article: 33.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 12/11/2022] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
Collapse
Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| |
Collapse
|
2033
|
Koh WC, Naing L, Chaw L, Rosledzana MA, Alikhan MF, Jamaludin SA, Amin F, Omar A, Shazli A, Griffith M, Pastore R, Wong J. What do we know about SARS-CoV-2 transmission? A systematic review and meta-analysis of the secondary attack rate and associated risk factors. PLoS One 2020; 15:e0240205. [PMID: 33031427 DOI: 10.1101/2020.05.21.20108746] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/25/2020] [Accepted: 09/23/2020] [Indexed: 05/28/2023] Open
Abstract
INTRODUCTION Current SARS-CoV-2 containment measures rely on controlling viral transmission. Effective prioritization can be determined by understanding SARS-CoV-2 transmission dynamics. We conducted a systematic review and meta-analyses of the secondary attack rate (SAR) in household and healthcare settings. We also examined whether household transmission differed by symptom status of index case, adult and children, and relationship to index case. METHODS We searched PubMed, medRxiv, and bioRxiv databases between January 1 and July 25, 2020. High-quality studies presenting original data for calculating point estimates and 95% confidence intervals (CI) were included. Random effects models were constructed to pool SAR in household and healthcare settings. Publication bias was assessed by funnel plots and Egger's meta-regression test. RESULTS 43 studies met the inclusion criteria for household SAR, 18 for healthcare SAR, and 17 for other settings. The pooled household SAR was 18.1% (95% CI: 15.7%, 20.6%), with significant heterogeneity across studies ranging from 3.9% to 54.9%. SAR of symptomatic index cases was higher than asymptomatic cases (RR: 3.23; 95% CI: 1.46, 7.14). Adults showed higher susceptibility to infection than children (RR: 1.71; 95% CI: 1.35, 2.17). Spouses of index cases were more likely to be infected compared to other household contacts (RR: 2.39; 95% CI: 1.79, 3.19). In healthcare settings, SAR was estimated at 0.7% (95% CI: 0.4%, 1.0%). DISCUSSION While aggressive contact tracing strategies may be appropriate early in an outbreak, as it progresses, measures should transition to account for setting-specific transmission risk. Quarantine may need to cover entire communities while tracing shifts to identifying transmission hotspots and vulnerable populations. Where possible, confirmed cases should be isolated away from the household.
Collapse
Affiliation(s)
- Wee Chian Koh
- Centre for Strategic and Policy Studies, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Lin Naing
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Liling Chaw
- PAPRSB Institute of Health Sciences, Universiti Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Muhammad Ali Rosledzana
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Mohammad Fathi Alikhan
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Sirajul Adli Jamaludin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Faezah Amin
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Asiah Omar
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Alia Shazli
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| | - Matthew Griffith
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Roberta Pastore
- Western Pacific Regional Office (Manila), World Health Organization, Manila, Philippines
| | - Justin Wong
- Disease Control Division, Ministry of Health, Brunei Darussalam, Bandar Seri Begawan, Brunei
| |
Collapse
|
2034
|
Trankle SA, Usherwood T, Abbott P, Roberts M, Crampton M, Girgis CM, Riskallah J, Chang Y, Saini J, Reath J. Key stakeholder experiences of an integrated healthcare pilot in Australia: a thematic analysis. BMC Health Serv Res 2020; 20:925. [PMID: 33028299 PMCID: PMC7542969 DOI: 10.1186/s12913-020-05794-2] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 02/02/2020] [Accepted: 10/01/2020] [Indexed: 11/10/2022] Open
Abstract
BACKGROUND In Australia and other developed countries, chronic illness prevalence is increasing, as are costs of healthcare, particularly hospital-based care. Integrating healthcare and supporting illness management in the community can be a means of preventing illness, improving outcomes and reducing unnecessary hospitalisation. Western Sydney has high rates of diabetes, heart and respiratory diseases and the NSW State Ministry of Health funded a range of key strategies through the Western Sydney Integrated Care Program (WSICP) to integrate care across hospital and community settings for patients with these illnesses. Complementing our previously reported analysis related to specific WSICP strategies, this research provided information concerning overall experiences and perspectives of WSICP implementation and integrated care generally. METHODS We administered 125 in-depth interviews in two rounds over 12 months with 83 participants including patients and their carers, care facilitators, hospital specialists and nurses, allied health professionals, general practitioners and primary care nurses, and program managers. Half of the participants (n = 42) were interviewed twice. We conducted an inductive, thematic analysis on the interview transcripts. RESULTS Key themes related to the set-up and operationalising of WSICP; challenges encountered; and the added value of the program. Implementing WSICP was a large and time consuming undertaking but challenges including those with staffing and information technology were being addressed. The WSICP was considered valuable in reducing hospital admissions due to improved patient self-management and a focus on prevention, greater communication and collaboration between healthcare providers across health sectors and an increased capacity to manage chronic illness in the primary care setting. CONCLUSIONS Patients, carers and health providers experienced the WSICP as an innovative integrated care model and valued its patient-centred approach which was perceived to improve access to care, increase patient self-management and illness prevention, and reduce hospital admissions. Long-term sustainability of the WSICP will depend on retaining key staff, more effectively sharing information including across health sectors to support enhanced collaboration, and expanding the suite of activities into other illness areas and locations. Enhanced support for general practices to manage chronic illness in the community, in collaboration with hospital specialists is critical. Timely evaluation informs ongoing program implementation.
Collapse
Affiliation(s)
- Steven A Trankle
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia.
| | - Tim Usherwood
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
- George Institute for Global Health, Sydney, Australia
| | - Penelope Abbott
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| | - Mary Roberts
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
| | | | - Christian M Girgis
- Westmead Clinical School, Sydney Medical School, The University of Sydney, Sydney, Australia
- Western Sydney Local Health District (Westmead Hospital), Sydney, Australia
- Royal North Shore Hospital, Sydney, Australia
| | - John Riskallah
- Western Sydney Local Health District (Blacktown Hospital), Sydney, Australia
| | - Yashu Chang
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
- Western Sydney Local Health District (Blacktown Hospital), Sydney, Australia
| | - Jaspreet Saini
- Western Sydney Primary Health Network, Sydney, Australia
| | - Jennifer Reath
- Department General Practice, School of Medicine, Western Sydney University, Building 30.3.18 Campbelltown Campus, Locked Bag 1797, Penrith, NSW, 2751, Australia
| |
Collapse
|
2035
|
Latkin C, Dayton L, Strickland JC, Colon B, Rimal R, Boodram B. An Assessment of the Rapid Decline of Trust in US Sources of Public Information about COVID-19. JOURNAL OF HEALTH COMMUNICATION 2020; 25:764-773. [PMID: 33719879 PMCID: PMC7968001 DOI: 10.1080/10810730.2020.1865487] [Citation(s) in RCA: 41] [Impact Index Per Article: 10.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Subscribe] [Scholar Register] [Indexed: 05/04/2023]
Abstract
We conducted a longitidinal assessment of 806 respondents in March, 2020 in the US to examine the trustworthiness of sources of information about COVID-19. Respondents were recontacted after four months. Information sources included mainstream media, state health departments, the CDC, the White House, and a well-known university. We also examined how demographics, political partisanship, and skepticism about COVID-19 were associated with the perceived trustworthiness of information sources and decreased trustworthiness over time. At baseline, the majority of respondants reported high trust in COVID-19 information from state health departments (75.6%), the CDC (80.9%), and a university (Johns Hopkins, 81.1%). Mainstream media was trusted by less than half the respondents (41.2%), and the White House was the least trusted source (30.9%). At the 4-month follow-up, a significant decrease in trustworthiness in all five sources of COVID-19 information was observed. The most pronounced reductions were from the CDC and the White House. In multivariate analyses, factors associated with rating the CDC, state health department, and a university as trustworthy sources of COVID-19 information were political party affiliation, level of education, and skepticism about COVID-19. The most consistent predictor of decreased trust was political party affiliation, with Democrats as compared to Republicans less likely to report decreased trust across all sources.
Collapse
Affiliation(s)
- Carl Latkin
- Department of Health, Behavior and Society, Bloomberg
School of Public Health, Johns Hopkins University
| | - Lauren Dayton
- Department of Health, Behavior and Society, Bloomberg
School of Public Health, Johns Hopkins University
| | - Justin C. Strickland
- Behavioral Pharmacology Research Unit, Department of
Psychiatry and Behavioral Sciences, Johns Hopkins University School of
Medicine
| | - Brian Colon
- Krieger School of Arts & Sciences, Johns Hopkins
University
| | - Rajiv Rimal
- Department of Health, Behavior and Society, Bloomberg
School of Public Health, Johns Hopkins University
| | - Basmattee Boodram
- Division of Community Health Sciences, University of
Illinois at Chicago School of Public Health, Chicago, IL
| |
Collapse
|
2036
|
Abstract
OBJECTIVES To understand how individuals with tinnitus perceive their sound generating devices help them in managing their tinnitus. DESIGN A qualitative interview based study employing grounded theory methodology to establish a theory as to the mechanisms that sound therapies contribute to coping with tinnitus. Ten National Health Service patient participants (who had been issued with sound generating devices from an Audiology department in England) participated in in depth interviews. RESULTS This study identified that sound therapies helped create a sense of escapism and control. In addition, the process of obtaining devices created a sense of validation of the patient and their tinnitus. These mechanisms restore the previously disrupted harmony between the self and body. CONCLUSION Sound generating devices can assist coping through a number of mechanisms. There is no evidence that they ablate or remove perception of tinnitus. This study contributes novel theory based on patient accounts as to the potential benefits of sound generating device use.
Collapse
Affiliation(s)
- Shameela Munir
- Audiology department, School of Life and Health Sciences, Aston University, Birmingham, UK.,Centre of Hearing and Balance Disorders, University Hospital, Coventry, UK
| | - Helen Pryce
- Audiology department, School of Life and Health Sciences, Aston University, Birmingham, UK
| |
Collapse
|
2037
|
'You're not just a medical professional': Exploring paramedic experiences of overdose response within Vancouver's downtown eastside. PLoS One 2020; 15:e0239559. [PMID: 32986736 PMCID: PMC7521748 DOI: 10.1371/journal.pone.0239559] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/08/2020] [Indexed: 12/17/2022] Open
Abstract
BACKGROUND Overdose response has become an increasingly relevant component of paramedic practice, particularly in light of increased opioid overdose globally. Previous studies have noted gaps in our understanding regarding the unique challenges which paramedics face during this form of pre-hospital emergency care. The aim of this study is to explore and describe the ways in which paramedics experience overdose response, specifically within a community markedly affected by the overdose crisis. METHODS Ten participants were recruited from a single ambulance station located in an urban center in Western Canada. Two rounds of semi-structured individual interviews were conducted, and data saturation was found to have been reached. Verbatim transcripts were produced and subject to two rounds of descriptive and pattern coding. A second researcher reviewed all of the codes, with disagreements being handled by discussion until agreement was obtained. Themes were identified, along with a Core Category which seeks to describe the underlying dynamics of overdose response represented in our data. The concept of a Core Category was borrowed from Grounded Theory methodology. FINDINGS Five major themes were identified: Connecting with patients' lived experiences; Occupying roles as clinicians and patient advocates; Navigating on-scene hazards; Difficulties with transitions of care; and Emotional burden of the overdose crisis. A core category was identified as One's capacity to help. CONCLUSIONS This research contributes to existing literature on overdose response by specifically examining paramedic experiences during this form of emergency care. While paramedics felt highly confident in providing clinical care, their capacity to address underlying causes of drug use was understood as much more limited. Participants found ways to address this lack of control, along with feelings of frustration, by trying to understand patient perspectives and adopting empathetic attitudes.
Collapse
|
2038
|
Dios-Quiroga F, Soliño-Lourido S, Pallas-Queijo C, González-Formoso C, Constenla-Castro A, Conde-Freire S, Clavería A. Multidimensional Geriatric Assessment with MAGIC Questionnaire and Quality of Life in Elderly Primary Care Patients. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17197089. [PMID: 32998200 PMCID: PMC7579506 DOI: 10.3390/ijerph17197089] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 07/13/2020] [Revised: 09/17/2020] [Accepted: 09/23/2020] [Indexed: 11/24/2022]
Abstract
The Manageable Geriatric Assessment (MAGIC) questionnaire, recently developed by a group of European family doctors for multidimensional geriatric assessment in primary care, has not yet been evaluated in clinical practice. The objectives of this study were to translate and adapt it to Spanish and to check the association between the limitations of older adults identified by this questionnaire and their perceived health status assessed by the five-level version of the EuroQol-5D (EQ-5D-5L). First, questionnaire translation, back translation and cognitive test were applied. Then, a cross-sectional observational study was performed in two Spanish health centers Galicia, Spain. Participants were 170 people aged over 75, recruited opportunistically by consecutive case sampling. Anonymous surveys were used to collect data. The MAGIC questionnaire, the EQ-5D-5L scale, age and sex were employed. The visual analog scale of EQ-5D-5L (EQ VAS) was used as the outcome variable. Descriptive and bivariate analyses by sex and outcome variable are presented. The linear regression analysis showed an association with quality of life for daily activities, recognizing people and stress incontinence. As this is associated with quality of life, the MAGIC questionnaire may be useful in primary care and a study to investigate the impact on health with a clinical trial would be worth considering.
Collapse
Affiliation(s)
- Fátima Dios-Quiroga
- Quality and Research Unit, Health Area of Vigo, Galician Health Service, RedIAPP, Group I-Saúde (Institute of Health Research Galicia Sur), CP 36201 Vigo, Spain;
- Correspondence: ; Tel.: +67-885-7799
| | - Susana Soliño-Lourido
- Lérez Health Center, Lugar Porta do Sol s/n, Health Area of Pontevedra, CP 36156 Pontevedra, Spain; (S.S.-L.); (A.C.-C.)
| | - Carmen Pallas-Queijo
- Vigo Family and Community Medicine and Nursing Teaching Unit, Health Area of Vigo, Galician Health Service, RedIAPP, Group I-Saúde (Institute of Health Research Galicia Sur), CP 36201 Vigo, Spain; (C.P.-Q.); (C.G.-F.)
| | - Clara González-Formoso
- Vigo Family and Community Medicine and Nursing Teaching Unit, Health Area of Vigo, Galician Health Service, RedIAPP, Group I-Saúde (Institute of Health Research Galicia Sur), CP 36201 Vigo, Spain; (C.P.-Q.); (C.G.-F.)
| | - Aurelia Constenla-Castro
- Lérez Health Center, Lugar Porta do Sol s/n, Health Area of Pontevedra, CP 36156 Pontevedra, Spain; (S.S.-L.); (A.C.-C.)
| | - Soledad Conde-Freire
- Val Miñor Health Center, Avenida Portugal, 91 (A Xunqueira)—A Ramallosa, Health Area of Vigo, CP 36379 Pontevedra, Spain;
| | - Ana Clavería
- Quality and Research Unit, Health Area of Vigo, Galician Health Service, RedIAPP, Group I-Saúde (Institute of Health Research Galicia Sur), CP 36201 Vigo, Spain;
| |
Collapse
|
2039
|
Social networks, health and identity: exploring culturally embedded masculinity with the Pakistani community, West Midlands, UK. BMC Public Health 2020; 20:1432. [PMID: 32957934 PMCID: PMC7507824 DOI: 10.1186/s12889-020-09504-9] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 03/05/2020] [Accepted: 09/06/2020] [Indexed: 11/10/2022] Open
Abstract
Background Migrants from South Asia living in developed countries have an increased risk for developing cardiovascular disease (CVD), with limited research into underlying social causes. Methods We used social capital as an interpretive lens to undertake analysis of exploratory qualitative interviews with three generations of at-risk migrant Pakistani men from the West Midlands, UK. Perceptions of social networks, trust, and cultural norms associated with access to healthcare (support and information) were the primary area of exploration. Results Findings highlighted the role of social networks within religious or community spaces embedded as part of ethnic enclaves. Local Mosques and gyms remained key social spaces, where culturally specific gender differences played out within the context of a diaspora community, defined ways in which individuals navigated their social spheres and influenced members of their family and community on health and social behaviours. Conclusions There are generational and age-based differences in how members use locations to access and develop social support for particular lifestyle choices. The pursuit of a healthier lifestyle varies across the diverse migrant community, determined by social hierarchies and socio-cultural factors. Living close to similar others can limit exposure to novel lifestyle choices and efforts need to be made to promote wider integration between communities and variety of locations catering to health and lifestyle.
Collapse
|
2040
|
Bagonza A, Peterson S, Mårtensson A, Wamani H, Awor P, Mutto M, Musoke D, Gibson L, Kitutu FE. Regulatory inspection of registered private drug shops in East-Central Uganda-what it is versus what it should be: a qualitative study. J Pharm Policy Pract 2020; 13:55. [PMID: 32944257 PMCID: PMC7488315 DOI: 10.1186/s40545-020-00265-9] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/19/2020] [Indexed: 11/21/2022] Open
Abstract
Background Regulatory inspection of private drug shops in Uganda is a mandate of the Ministry of Health carried out by the National Drug Authority. This study evaluated how this mandate is being carried out at national, district, and drug shop levels. Specifically, perspectives on how the inspection is done, who does it, and challenges faced were sought from inspectors and drug sellers. Methods Six key informant interviews (KIIs) were held with inspectors at the national and district level, while eight focus group discussions (FGDs) were conducted among nursing assistants, and two FGDs were held with nurses. The study appraised current methods of inspecting drug sellers against national professional guidelines for licensing and renewal of class C drug shops in Uganda. Transcripts were managed using Atlas ti version 7 (ATLAS.ti GmbH, Berlin) data management software where the thematic content analysis was done. Results Five themes emerged from the study: authoritarian inspection, delegated inspection, licensing, training, and bribes. Under authoritarian inspection, drug sellers decried the high handedness used by inspectors when found with expired or no license at all. For delegated inspection, drug sellers said that sometimes, inspectors send health assistants and sub-county chiefs for inspection visits. This cadre of people is not recognized by law as inspectors. Inspectors trained drug sellers on how to organize their drug shops better and how to use new technologies such as rapid diagnostic tests (RDTs) in diagnosing malaria. Bribes were talked about mostly by nursing assistants who purported that inspectors were not interested in inspection per se but collecting illicit payments from them. Inspectors said that the facilitation they received from the central government were inadequate for a routine inspection. Conclusion The current method of inspecting drug sellers is harsh and instills fear among drug sellers. There is a need to establish a well-recognized structure of inspection as well as establish channels of dialogue between inspectors and drug sellers if meaningful compliance is to be achieved. The government also needs to enhance both human and financial resources if meaningful inspection of drug sellers is to take place.
Collapse
Affiliation(s)
- Arthur Bagonza
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Stefan Peterson
- Department of Health Policy Planning and Management, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda.,International Maternal and Child Health Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Andreas Mårtensson
- International Maternal and Child Health Unit, Department of Women's and Children's Health, Uppsala University, Uppsala, Sweden
| | - Henry Wamani
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Phyllis Awor
- Department of Community Health and Behavioural Sciences, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Milton Mutto
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - David Musoke
- Department of Disease Control and Environmental Health, School of Public Health, Makerere University College of Health Sciences, Kampala, Uganda
| | - Linda Gibson
- School of Social Sciences, Nottingham Trent University, Nottingham, UK
| | - Freddy Eric Kitutu
- Department of Pharmacy, School of Health Sciences, Makerere University College of Health Sciences, Kampala, Uganda
| |
Collapse
|
2041
|
Paliwal VK, Garg RK, Gupta A, Tejan N. Neuromuscular presentations in patients with COVID-19. Neurol Sci 2020; 41:3039-3056. [PMID: 32935156 PMCID: PMC7491599 DOI: 10.1007/s10072-020-04708-8] [Citation(s) in RCA: 146] [Impact Index Per Article: 36.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/07/2020] [Accepted: 09/01/2020] [Indexed: 12/20/2022]
Abstract
COVID-19 is caused by the coronavirus SARS-CoV-2 that has an affinity for neural tissue. There are reports of encephalitis, encephalopathy, cranial neuropathy, Guillain-Barrè syndrome, and myositis/rhabdomyolysis in patients with COVID-19. In this review, we focused on the neuromuscular manifestations of SARS-CoV-2 infection. We analyzed all published reports on SARS-CoV-2-related peripheral nerve, neuromuscular junction, muscle, and cranial nerve disorders. Olfactory and gustatory dysfunction is now accepted as an early manifestation of COVID-19 infection. Inflammation, edema, and axonal damage of olfactory bulb have been shown in autopsy of patients who died of COVID-19. Olfactory pathway is suggested as a portal of entry of SARS-CoV-2 in the brain. Similar to involvement of olfactory bulb, isolated oculomotor, trochlear and facial nerve has been described. Increasing reports Guillain-Barrè syndrome secondary to COVID-19 are being published. Unlike typical GBS, most of COVID-19-related GBS were elderly, had concomitant pneumonia or ARDS, more prevalent demyelinating neuropathy, and relatively poor outcome. Myalgia is described among the common symptoms of COVID-19 after fever, cough, and sore throat. Duration of myalgia may be related to the severity of COVID-19 disease. Few patients had muscle weakness and elevated creatine kinase along with elevated levels of acute-phase reactants. All these patients with myositis/rhabdomyolysis had severe respiratory complications related to COVID-19. A handful of patients with myasthenia gravis showed exacerbation of their disease after acquiring COVID-19 disease. Most of these patients recovered with either intravenous immunoglobulins or steroids.
Collapse
Affiliation(s)
- Vimal Kumar Paliwal
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | | | - Ankit Gupta
- Department of Neurology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| | - Nidhi Tejan
- Department of Microbiology, Sanjay Gandhi Postgraduate Institute of Medical Sciences, Lucknow, UP 226014 India
| |
Collapse
|
2042
|
Fridman S, Bres Bullrich M, Jimenez-Ruiz A, Costantini P, Shah P, Just C, Vela-Duarte D, Linfante I, Sharifi-Razavi A, Karimi N, Bagur R, Debicki DB, Gofton TE, Steven DA, Sposato LA. Stroke risk, phenotypes, and death in COVID-19: Systematic review and newly reported cases. Neurology 2020; 95:e3373-e3385. [PMID: 32934172 DOI: 10.1212/wnl.0000000000010851] [Citation(s) in RCA: 84] [Impact Index Per Article: 21.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/09/2020] [Accepted: 08/25/2020] [Indexed: 12/13/2022] Open
Abstract
OBJECTIVES To investigate the hypothesis that strokes occurring in patients with coronavirus disease 2019 (COVID-19) have distinctive features, we investigated stroke risk, clinical phenotypes, and outcomes in this population. METHODS We performed a systematic search resulting in 10 studies reporting stroke frequency among patients with COVID-19, which were pooled with 1 unpublished series from Canada. We applied random-effects meta-analyses to estimate the proportion of stroke among COVID-19. We performed an additional systematic search for cases series of stroke in patients with COVID-19 (n = 125), and we pooled these data with 35 unpublished cases from Canada, the United States, and Iran. We analyzed clinical characteristics and in-hospital mortality stratified into age groups (<50, 50-70, >70 years). We applied cluster analyses to identify specific clinical phenotypes and their relationship with death. RESULTS The proportions of patients with COVID-19 with stroke (1.8%, 95% confidence interval [CI] 0.9%-3.7%) and in-hospital mortality (34.4%, 95% CI 27.2%-42.4%) were exceedingly high. Mortality was 67% lower in patients <50 years of age relative to those >70 years of age (odds ratio [OR] 0.33, 95% CI 0.12-0.94, p = 0.039). Large vessel occlusion was twice as frequent (46.9%) as previously reported and was high across all age groups, even in the absence of risk factors or comorbid conditions. A clinical phenotype characterized by older age, a higher burden of comorbid conditions, and severe COVID-19 respiratory symptoms was associated with the highest in-hospital mortality (58.6%) and a 3 times higher risk of death than the rest of the cohort (OR 3.52, 95% CI 1.53-8.09, p = 0.003). CONCLUSIONS Stroke is relatively frequent among patients with COVID-19 and has devastating consequences across all ages. The interplay of older age, comorbid conditions, and severity of COVID-19 respiratory symptoms is associated with an extremely elevated mortality.
Collapse
Affiliation(s)
- Sebastian Fridman
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Maria Bres Bullrich
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Amado Jimenez-Ruiz
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Pablo Costantini
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Palak Shah
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Caroline Just
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Daniel Vela-Duarte
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Italo Linfante
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Athena Sharifi-Razavi
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Narges Karimi
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Rodrigo Bagur
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Derek B Debicki
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Teneille E Gofton
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - David A Steven
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada
| | - Luciano A Sposato
- From the Department of Clinical Neurological Sciences (S.F., M.B.B., P.S., C.J., D.B.D., T.E.G., D.A.S., L.A.S.), Department of Medicine (R.B.), Division of Cardiology, Department of Anatomy and Cell Biology (L.A.S.), and Department of Epidemiology and Biostatistics (R.B., D.A.S., L.A.S.), Schulich School of Medicine and Dentistry, Heart & Brain Laboratory (A.J.-R., L.A.S.), and Robarts Research Institute (L.A.S.), Western University, London, Ontario, Canada; Instituto de Neurología y Neurocirugía de Neuquén (P.C.), Argentina; Miami Cardiac & Vascular Institute (D.V.-D., I.L.), Baptist Hospital Neuroscience Center, FL; Clinical Research Development Unit of Bou Ali Sina Hospital (A.S.-R.) and Immunogenetics Research Center (N.K.), Toxoplasmosis Research Center, Mazandaran University of Medical Sciences, Sari, Iran; and Lawson Health Research Institute (L.A.S.), London, Ontario, Canada.
| |
Collapse
|
2043
|
Fernández-Martínez E, Abreu-Sánchez A, Pérez-Corrales J, Ruiz-Castillo J, Velarde-García JF, Palacios-Ceña D. Living with Pain and Looking for a Safe Environment: A Qualitative Study among Nursing Students with Dysmenorrhea. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:E6670. [PMID: 32933209 PMCID: PMC7558082 DOI: 10.3390/ijerph17186670] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Subscribe] [Scholar Register] [Received: 08/20/2020] [Revised: 09/09/2020] [Accepted: 09/10/2020] [Indexed: 12/11/2022]
Abstract
Dysmenorrhea refers to chronic pain associated with menstruation that is often accompanied by other symptoms. Primary dysmenorrhea (PD) occurs without any associated pelvic disease. Nonetheless, it may negatively affect women's quality of life. Among university students, dysmenorrhea decreases academic performance and is a cause of absenteeism. The purposes of our study were to describe how nursing students experienced PD and the changes affecting their body and mood. A qualitative case study was performed among 33 nursing students with PD. Data were collected through five focus groups (with two sessions each) and 10 researchers' field notes. We used a video meeting platform to conduct the focus groups. A thematic analysis was performed, and the Standards for Reporting Qualitative Research and the Consolidated Criteria for Reporting Qualitative Research guidelines were followed. Three main themes emerged from the data: (a) living with dysmenorrhea, with two subthemes: menstruation and pain; (b) body changes and mood swings; and (c) seeking a safe environment, with three subthemes: safe environment, unsafe environment, and key safety aspects. Students considered menstruation to be negative and limiting, causing physical and mood changes, making them feel less attractive, and conditioning their way of dressing and relating.
Collapse
Affiliation(s)
- Elia Fernández-Martínez
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Ana Abreu-Sánchez
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Jorge Pérez-Corrales
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Avenida Atenas s/n, 28922 Alcorcón, Spain;
| | - Javier Ruiz-Castillo
- Department of Nursing, University of Huelva, Avenida Tres de Marzo s/n, 21071 Huelva, Spain; (E.F.-M.); (A.A.-S.); (J.R.-C.)
| | - Juan Francisco Velarde-García
- Department of Nursing, Red Cross College, Instituto de Investigación Sanitaria Gregorio Marañón (IiSGM), Universidad Autónoma de Madrid, Calle Reina Victoria 28, 28003 Madrid, Spain;
| | - Domingo Palacios-Ceña
- Department of Physical Therapy, Occupational Therapy, Physical Medicine and Rehabilitation, Research Group of Humanities and Qualitative Research in Health Science of Universidad Rey Juan Carlos (Hum&QRinHS), Avenida Atenas s/n, 28922 Alcorcón, Spain;
| |
Collapse
|
2044
|
Hao HS, Gao H, Li T, Zhang D. Assessment and Comparison of Patient Safety Culture Among Health-Care Providers in Shenzhen Hospitals. Risk Manag Healthc Policy 2020; 13:1543-1552. [PMID: 32982512 PMCID: PMC7494381 DOI: 10.2147/rmhp.s266813] [Citation(s) in RCA: 7] [Impact Index Per Article: 1.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/11/2020] [Accepted: 07/31/2020] [Indexed: 11/23/2022] Open
Abstract
Purpose To investigate the health-care providers’ perceptions of patient safety culture in Shenzhen hospitals and to compare 2019 with 2015 data. Methods This cross-sectional study adopted a questionnaire survey and targeted hospital staff fitting the sampling criteria (physicians, nurses, technicians, and managers). A total of 5490 staff from 13 Shenzhen hospitals were surveyed using the Hospital Survey on Patient Safety Culture (HSOPSC). Results The average positive response rates of this study were generally higher than the data from the 2018 Agency for Healthcare Research and Quality (AHRQ) survey and the 2015 HSOPSC Shenzhen survey. Bivariate and multivariate regression showed that respondents who had direct contact with patients were less likely to report high overall patient safety grade. The probability of high overall patient safety grade was rated higher by men than by women. Compared with nurses, the probability of high overall patient safety grade was higher for both physicians and technicians. Conclusion The overall results of the patient safety culture in Shenzhen hospitals were relatively good and have improved significantly in recent years, but some areas of weakness still need improvement. Our recommendations are to develop training programs for various positions, recruit more employees, provide management support, and establish a just culture to promote a strong patient safety culture. Regular assessment is also needed to provide valuable information to hospital leaders on areas requiring improvement and to evaluate the quality improvement plan that has been implemented.
Collapse
Affiliation(s)
- Horng-Shuh Hao
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, People's Republic of China
| | - Han Gao
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, People's Republic of China
| | - Ting Li
- Administrative Office, The Third People's Hospital of Shenzhen, Shenzhen, People's Republic of China
| | - Dan Zhang
- Institute for Hospital Management, Tsinghua Shenzhen International Graduate School, Tsinghua University, Shenzhen, People's Republic of China
| |
Collapse
|
2045
|
Woolley A, Li L, Solomon J, Li J, Huang K, Chahal P, Chahal P, Tu G, Chahal P, Chattopadhyay K. What are the development priorities for management of type 2 diabetes by general practitioners in Ningbo, China: a qualitative study of patients' and practitioners' perspectives. BMJ Open 2020; 10:e037215. [PMID: 32912986 PMCID: PMC7485253 DOI: 10.1136/bmjopen-2020-037215] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/30/2022] Open
Abstract
OBJECTIVES To explore patients' and general practitioners' (GPs') perspectives on primary care management of patients with type 2 diabetes mellitus (T2DM) in Ningbo, China. We aimed to understand the current benefits and challenges and to identify development priorities. DESIGN Exploratory qualitative descriptive study using face-to-face interviews and analysed by thematic, inductive analysis. SETTING 11 primary care facilities spread across the city of Ningbo, China. PARTICIPANTS 23 patients with T2DM and 20 GPs involved in caring for patients with T2DM. RESULTS GPs were considered the first point of contact and providers of information. However, the care varied, and many GPs lacked confidence and felt overworked. The medication was a particularly weak area. The diagnostic screening commenced late, leading to crisis presentations. Patients were variably informed about their condition, contributing to poor adherence. CONCLUSIONS Future developments of primary care for T2DM in Ningbo should centre around improving GP confidence and workload and patient education and adherence.
Collapse
Affiliation(s)
- Angharad Woolley
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Li Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Josie Solomon
- School of Pharmacy, University of Lincoln, Brayford Campus, Lincoln, United Kingdom
| | - Jialin Li
- Department of Endocrinology and Metabolism, Ningbo First Hospital, Ningbo, China
| | - Kai Huang
- Department of General Practice, Ningbo First Hospital, Ningbo, China
| | - Punam Chahal
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Priya Chahal
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Gloria Tu
- Department of Research and Knowledge Exchange, University of Nottingham, Ningbo, China
- Department of Research and Innovation, University of Nottingham, Nottingham, United Kingdom
| | - Pritpal Chahal
- Health Education England, Leeds, United Kingdom
- Division of Medicine, University of Nottingham, Nottingham, United Kingdom
| | - Kaushik Chattopadhyay
- Division of Epidemiology and Public Health, University of Nottingham, Nottingham, United Kingdom
- The Nottingham Centre for Evidence-Based Healthcare: a Joanna Briggs Institute Centre of Excellence, University of Nottingham, Nottingham, United Kingdom
| |
Collapse
|
2046
|
Means AR, Wagner AD, Kern E, Newman LP, Weiner BJ. Implementation Science to Respond to the COVID-19 Pandemic. Front Public Health 2020; 8:462. [PMID: 32984248 PMCID: PMC7493639 DOI: 10.3389/fpubh.2020.00462] [Citation(s) in RCA: 12] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/14/2020] [Accepted: 07/23/2020] [Indexed: 12/16/2022] Open
Abstract
The COVID-19 pandemic continues to expand globally, requiring massive public health responses from national and local governments. These bodies have taken heterogeneous approaches to their responses, including when and how to introduce and enforce evidence-based interventions—such as social distancing, hand-washing, personal protective equipment (PPE), and testing. In this commentary, we reflect on opportunities for implementation science to contribute meaningfully to the COVID-19 pandemic response. We reflect backwards on missed opportunities in emergency preparedness planning, using the example of PPE stockpiling and supply management; this planning could have been strengthened through process mapping with consensus-building, microplanning with simulation, and stakeholder engagement. We propose current opportunities for action, focusing on enhancing the adoption, fidelity, and sustainment of hand washing and social distancing; we can combine qualitative data, policy analysis, and dissemination science to inform agile and rapid adjustment to social marketing strategies to enhance their penetration. We look to future opportunities to enhance the integration of new evidence in decision-making, focusing on serologic and virologic testing systems; we can leverage simulation and other systems engineering modeling to identify ideal system structures. Finally, we discuss the ways in which the COVID-19 pandemic challenges implementation science to become more rapid, rigorous, and nimble in its approach, and integrate with public health practice. In summary, we articulate the ways in which implementation science can inform, and be informed by, the COVID-19 pandemic, looking backwards, proposing actions for the moment, and approaches for the future.
Collapse
Affiliation(s)
- Arianna Rubin Means
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Anjuli D Wagner
- Department of Global Health, University of Washington, Seattle, WA, United States
| | - Eli Kern
- Public Health-Seattle and King County, Seattle, WA, United States
| | - Laura P Newman
- Department of Global Health, University of Washington, Seattle, WA, United States.,Office of Communicable Disease Epidemiology, Washington State Department of Health, Seattle, WA, United States
| | - Bryan J Weiner
- Department of Global Health, University of Washington, Seattle, WA, United States.,Department of Health Services, University of Washington, Seattle, WA, United States
| |
Collapse
|
2047
|
Molan A, Nosaka K, Hunter M, Wang W. Seroprevalence and associated risk factors of Toxoplasma gondii infection in a representative Australian human population: The Busselton health study. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.005] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/30/2022] Open
|
2048
|
Lee CW, Chen GL, Lee YK. User Experience Evaluation of the EPAs-Based e-Portfolio System and an Analysis of Its Impact. J Acute Med 2020; 10:115-125. [PMID: 33209570 DOI: 10.6705/j.jacme.202009_10(3).0003] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/14/2022]
Abstract
Background To carry out competency-based medical education, this study has established five Entrustable Professional Activities (EPAs) for the emergency medicine residents. The EPAs involve substantial data collection, which requires integration and analysis for the fi nal interpretation. Therefore, the "EPAs-Based e-Portfolio System" has been developed for assisting users to perform ad-hoc assessment, recording of a discussion, teaching, and feedback. The purpose of this study is to examine, from the perspective of the Technology Acceptance Model, residents and clinicians' experience of the EPAs-Based e-Portfolio System, including the use of functions such as recording, feedback, and assessment, as well as the impact thereof. Methods This study uses in-depth interviews as a means of data collection. The interviewees are from emergency medicine training hospitals in north, central, and south Taiwan-11 resident doctors and nine medical teachers. Results The interviewees agree that (1) the EPAs-based e-Portfolio System provides users with a complete learning trajectory record through cloudization and ease of use; (2) it can assist users to gain feedback, case review, and reflection; (3) information on user status can reflect their learning progress, competencies, and performance; (4) other potential functions that can be added include shortcut keys, initiation of assessment sheets by a learner, feedback to teacher's comment, and voice/picture input. Conclusions The results of this study indicate that the easier a system is for users to use, the more helpful they will consider it and the more positive they will be, which will then translate into greater willingness to use the system and higher frequency of actual use. The system can authentically reflect trainees' professional capabilities if the ad-hoc teaching and feedback in the clinical setting connect strongly with the online assessment and recording.
Collapse
Affiliation(s)
- Chen-Wei Lee
- Buddhist Tzu Chi Medical Foundation Department of Emergency Medicine, Dalin Tzu Chi Hospital Chiayi Taiwan
| | - Guan-Liang Chen
- National Chung Cheng University Center for Innovative Research on Aging Society Chiayi Taiwan
| | - Yi-Kung Lee
- Buddhist Tzu Chi Medical Foundation Department of Emergency Medicine, Dalin Tzu Chi Hospital Chiayi Taiwan.,Tzu Chi University School of Medicine Hualien Taiwan
| |
Collapse
|
2049
|
Ozcelik S, Alim M, Ozpinar N. Detection of Toxoplasma gondii infection among diabetic patients in Turkey. CLINICAL EPIDEMIOLOGY AND GLOBAL HEALTH 2020. [DOI: 10.1016/j.cegh.2020.02.020] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/29/2022] Open
|
2050
|
Chaudhri I, Koraishy FM, Bolotova O, Yoo J, Marcos LA, Taub E, Sahib H, Bloom M, Ahmad S, Skopicki H, Mallipattu SK. Outcomes Associated with the Use of Renin-Angiotensin-Aldosterone System Blockade in Hospitalized Patients with SARS-CoV-2 Infection. ACTA ACUST UNITED AC 2020; 1:801-809. [PMID: 33345195 DOI: 10.34067/kid.0003792020] [Citation(s) in RCA: 20] [Impact Index Per Article: 5.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 02/06/2023]
Abstract
Background Data regarding the benefits or harm associated with the continuation of Angiotensin Converting Enzyme Inhibitors (ACEIs) and Angiotensin II Receptor Blockers (ARBs), especially the impact on inflammation, in hypertensive, hospitalized patients with COVID-19 in the United States is unclear. Methods This is a single-center cohort study of sequentially hospitalized patients with COVID-19 at Stony Brook University Medical Center from March 7, 2020 to April 1, 2020, inclusive of these dates. Data collection included history of known comorbidities, medications, vital signs and laboratory values (admission and during the hospitalization). Outcomes include inflammatory burden (composite scores for multiple markers of inflammation), acute kidney injury (AKI), admission to the intensive care unit (ICU), need for invasive mechanical ventilation, and mortality. Results Of the 300 patients in the study cohort, 80 patients (26.7%) had history of ACEI or ARB use prior to admission, with 61.3% (49/80) of these patients continuing the medications during hospitalization. Multivariable analysis revealed that the history of ACEI or ARB use prior to hospitalization was not associated with worse outcomes. In addition, the continuation of these agents during hospitalization was not associated with an increase in adverse outcomes and predicted fewer ICU admissions (OR=0.25, 0.08-0.81) with a decrease in the severity of inflammatory burden (peak CRP (6.9±3.1mg/dl, p=0.03) and peak inflammation score (2.3±1.1unit reduction, p=0.04)). Conclusion Use of ACEI or ARBs prior to hospitalization was not associated with adverse outcomes in COVID-19 and the therapeutic benefits of continuing ACEI or ARB in hospitalized patients with COVID-19 was not offset by adverse outcomes.
Collapse
Affiliation(s)
- Imran Chaudhri
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | | | - Olena Bolotova
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Jeanwoo Yoo
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Luis A Marcos
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Erin Taub
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Haseena Sahib
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Michelle Bloom
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Sahar Ahmad
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Hal Skopicki
- Department of Medicine, Stony Brook University, Stony Brook, NY
| | - Sandeep K Mallipattu
- Department of Medicine, Stony Brook University, Stony Brook, NY.,Renal Section, Northport VA Medical Center, Northport, NY
| |
Collapse
|