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[PMID]:29373574
[Au] Autor:Tweya H; Oboho IK; Gugsa ST; Phiri S; Rambiki E; Banda R; Mwafilaso J; Munthali C; Gupta S; Bateganya M; Maida A
[Ad] Endereço:The International Union Against Tuberculosis and Lung Disease, Paris, France.
[Ti] Título:Loss to follow-up before and after initiation of antiretroviral therapy in HIV facilities in Lilongwe, Malawi.
[So] Source:PLoS One;13(1):e0188488, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:INTRODUCTION: Although several studies have explored factors associated with loss to follow-up (LTFU) from HIV care, there remains a gap in understanding how these factors vary by setting, volume of patient and patients' demographic and clinical characteristics. We determined rates and factors associated with LTFU in HIV care Lilongwe, Malawi. METHODS: We conducted a retrospective cohort study of HIV-infected individuals aged 15 years or older at the time of registration for HIV care in 12 ART facilities, between April 2012 and March 2013. HIV-positive individuals who had not started ART (pre-ART patients) were clinically assessed to determine ART eligibility at registration and during clinic follow-up visits. ART-eligible patients were initiated on triple antiretroviral combination. Study data were abstracted from patients' cards, facility ART registers or electronic medical record system from the date of registration for HIV care to a maximum follow-up period of 24 months. Descriptive statistics were undertaken to summarize characteristics of the study patients. Separate univariable and multivariable poisson regression models were used to explore factors associated with LTFU in pre-ART and ART care. RESULTS: A total of 10,812 HIV-infected individuals registered for HIV care. Of these patients, 1,907 (18%) and 8,905 (82%) enrolled in pre-ART and ART care, respectively. Of the 1,907 pre-ART patients, 490 (26%) subsequently initiated ART and were included in both the pre-ART and ART analyses. The LTFU rates among patients in pre-ART and ART care were 48 and 26 per 100 person-years, respectively. Of the 9,105 ART patients with reasons for starting ART, 2,451 (27%) were initiated on ART because of pregnancy or breastfeeding (Option B+) status. Multivariable analysis showed that being ≥35 years and female were associated with decreased risk of LTFU in the pre-ART and ART phases of HIV care. However, being in WHO clinical stage 3 (adjusted risk ratio (aRR) 1.35, 95% confidence interval (CI): 1.20-1.51) and stage 4 (aRR 1.87, 95% CI: 1.62-2.18), body mass index ≤ 18.4 (aRR 1.24, 95% CI: 1.11-1.39) at ART initiation, poor adherence to clinic appointments (aRR 4.55, 95% CI: 4.16-4.97) and receiving HIV care in rural facilities (aRR 2.32, 95% CI: 1.94-2.87) were associated with increased risk of LTFU among ART patients. Being re-initiated on ART once (aRR 0.20, 95% CI: 0.17-0.22), more than once (aRR 0.06, 95% CI: 0.05-0.07), and being enrolled at a low-volume facility (aRR 0.25, 95% CI: 0.20-0.30) were associated with decreased risk of LTFU from ART care. CONCLUSION: A sizeable proportion of ART LTFU occurred among women enrolled during pregnancy or breast-feeding. Non- compliance to clinic and receiving ART in a rural facility or high-volume facility were associated with increased risk of LTFU from ART care. Developing effective interventions that target high-risk subgroups and contexts may help reduce LTFU from HIV care.
[Mh] Termos MeSH primário: Infecções por HIV/tratamento farmacológico
Perda de Seguimento
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Fármacos Anti-HIV/uso terapêutico
Estudos de Coortes
Feminino
Seguimentos
Infecções por HIV/complicações
Seres Humanos
Malaui
Masculino
Meia-Idade
Cooperação do Paciente
Gravidez
Complicações Infecciosas na Gravidez/tratamento farmacológico
Estudos Retrospectivos
Fatores de Risco
Serviços de Saúde Rural
Serviços Urbanos de Saúde
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Nm] Nome de substância:
0 (Anti-HIV Agents)
[Em] Mês de entrada:1802
[Cu] Atualização por classe:180213
[Lr] Data última revisão:
180213
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180127
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0188488


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[PMID]:28982194
[Au] Autor:Alhassan RK; Beyere CB; Nketiah-Amponsah E; Mwini-Nyaledzigbor PP
[Ad] Endereço:School of Nursing and Midwifery, University of Health and Allied Sciences, Ho, Ghana.
[Ti] Título:Perceived needs of health tutors in rural and urban health training institutions in Ghana: Implications for health sector staff internal migration control.
[So] Source:PLoS One;12(10):e0185748, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The population of Ghana is increasingly becoming urbanized with about 70% of the estimated 27 million people living in urban and peri-urban areas. Nonetheless, eight out of the ten regions in Ghana remain predominantly rural where only 32% of the national health sector workforce works. Moreover, the rural-urban disparities in the density of health tutors (staff responsible for pre-service training of health professionals) are enormous. This paper explores perceived needs of health tutors in rural and urban health training institutions in Ghana. METHODS: This is a descriptive qualitative study conducted in the Greater Accra and Northern regions of Ghana. The Study used the deductive thematic and sub-thematic analysis approaches. Five health training institutions were randomly sampled, and 72 tutors engaged in separate focus group discussions with an average size of 14 participants per group in each training institution. RESULTS: Perceived rural-urban disparities among health tutors were found in the payment of extra duty allowances; school infrastructure including libraries and internet connectivity; staff accommodation; and opportunities for scholarships and higher education. Health tutors in rural areas generally expressed more frustration with these work conditions than those in urban areas. CONCLUSIONS: There is the need to initiate and sustain work incentives that promote motivation of rural health tutors to control ongoing rural-urban migration of qualified staff. It is recommended the following incentives be prioritized to promote retention of qualified health tutors in rural health training schools: payment of research, book and rural allowances; early promotion of rural staff; prioritizing rural tutors for scholarships, and introduction of national best health tutor awards.
[Mh] Termos MeSH primário: Pessoal de Saúde
Necessidades e Demandas de Serviços de Saúde
Serviços de Saúde Rural/organização & administração
Serviços Urbanos de Saúde/organização & administração
[Mh] Termos MeSH secundário: Grupos Focais
Gana
Disparidades em Assistência à Saúde
Seres Humanos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171006
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185748


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[PMID]:28975305
[Au] Autor:He J; Irazola V; Mills KT; Poggio R; Beratarrechea A; Dolan J; Chen CS; Gibbons L; Krousel-Wood M; Bazzano LA; Nejamis A; Gulayin P; Santero M; Augustovski F; Chen J; Rubinstein A; HCPIA Investigators
[Ad] Endereço:Department of Epidemiology, Tulane University School of Public Health and Tropical Medicine, New Orleans, Louisiana.
[Ti] Título:Effect of a Community Health Worker-Led Multicomponent Intervention on Blood Pressure Control in Low-Income Patients in Argentina: A Randomized Clinical Trial.
[So] Source:JAMA;318(11):1016-1025, 2017 09 19.
[Is] ISSN:1538-3598
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Importance: Despite extensive knowledge of hypertension treatment, the prevalence of uncontrolled hypertension is high and increasing in low- and middle-income countries. Objective: To test whether a community health worker-led multicomponent intervention would improve blood pressure (BP) control among low-income patients with hypertension. Design, Setting, and Participants: A cluster randomized trial was conducted in 18 centers for primary health care within a national public system providing free medications and health care to uninsured patients in Argentina. A total of 1432 low-income adult patients with uncontrolled hypertension were recruited between June 2013 and April 2015 and followed up to October 2016. Interventions: Nine centers (743 patients) were randomized to the multicomponent intervention, which included a community health worker-led home intervention (health coaching, home BP monitoring, and BP audit and feedback), a physician intervention, and a text-messaging intervention over 18 months. Nine centers (689 patients) were randomized to usual care. Main Outcomes and Measures: The coprimary outcomes were the differences in systolic and diastolic BP changes from baseline to the end of follow-up of patients with hypertension. Secondary outcomes included the proportion of patients with controlled hypertension (BP <140/90 mm Hg). Three BP measurements were obtained at each of 2 baseline and 2 termination visits using a standard protocol, the means of which were used for analyses. Results: Of 1432 participants (mean age, 55.8 years [SD, 13.3]; 772 women [53.0%]), 1357 (94.8%) completed the trial. Baseline mean systolic BP was 151.7 mm Hg for the intervention group and 149.8 mm Hg for the usual care group; the mean diastolic BP was 92.2 mm Hg for the intervention group and 90.1 mm Hg for the usual care group. Systolic BP reduction from baseline to month 18 was 19.3 mm Hg (95% CI, 17.9-20.8 mm Hg) for the intervention group and 12.7 mm Hg (95% CI, 11.3-14.2 mm Hg) for the usual care group; the difference in the reduction was 6.6 mm Hg (95% CI, 4.6-8.6; P < .001). Diastolic BP decreased by 12.2 mm Hg (95% CI, 11.2-13.2 mm Hg) in the intervention group and 6.9 mm Hg (95% CI, 5.9-7.8 mm Hg) in the control group; the difference in the reduction was 5.4 mm Hg (95% CI, 4.0-6.8 mm Hg; P < .001). The proportion of patients with controlled hypertension increased from 17.0% at baseline to 72.9% at 18 months in the intervention group and from 17.6% to 52.2% in the usual care group; the difference in the increase was 20.6% (95% CI, 15.4%-25.9%; P < .001). No adverse events were reported. Conclusions and Relevance: Low-income patients in Argentina with uncontrolled hypertension who participated in a community health worker-led multicomponent intervention experienced a greater decrease in systolic and diastolic BP than did patients who received usual care over 18 months. Further research is needed to assess generalizability and cost-effectiveness of this intervention and to understand which components may have contributed most to the outcome. Trial Registration: clinicaltrials.gov Identifier: NCT01834131.
[Mh] Termos MeSH primário: Agentes Comunitários de Saúde
Serviços de Assistência Domiciliar
Hipertensão/terapia
[Mh] Termos MeSH secundário: Adulto
Argentina
Pressão Sanguínea
Feminino
Seres Humanos
Masculino
Meia-Idade
Pobreza
Atenção Primária à Saúde/métodos
Serviços Urbanos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE; MULTICENTER STUDY; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171016
[Lr] Data última revisão:
171016
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171005
[Cl] Clinical Trial:ClinicalTrial
[St] Status:MEDLINE
[do] DOI:10.1001/jama.2017.11358


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[PMID]:28968447
[Au] Autor:Omulo S; Thumbi SM; Lockwood S; Verani JR; Bigogo G; Masyongo G; Call DR
[Ad] Endereço:Paul G. Allen School for Global Animal Health, Washington State University, Pullman, WA, United States of America.
[Ti] Título:Evidence of superficial knowledge regarding antibiotics and their use: Results of two cross-sectional surveys in an urban informal settlement in Kenya.
[So] Source:PLoS One;12(10):e0185827, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:We assessed knowledge and practices related to antibiotic use in Kibera, an urban informal settlement in Kenya. Surveys was employed at the beginning (entry) and again at the end (exit) of a 5-month longitudinal study of AMR. Two-hundred households were interviewed at entry, of which 149 were also interviewed at exit. The majority (>65%) of respondents in both surveys could name at least one antibiotic, with amoxicillin and cotrimoxazole jointly accounting for 85% and 77% of antibiotics mentioned during entry and exit, respectively. More than 80% of respondents felt antibiotics should not be shared or discontinued following the alleviation of symptoms. Nevertheless, 66% and 74% of respondents considered antibiotics effective for treating colds and flu in the entry and exit surveys, respectively. There was a high (87%, entry; 70% exit) level of reported antibiotic use (past 12 months) mainly for colds/flu, coughs and fever, with >80% of respondents obtaining antibiotics from health facilities and pharmacies. Less than half of respondents remembered getting information on the correct use of antibiotics, although 100% of those who did reported improved attitudes towards antibiotic use. Clinicians and community pharmacists were highly trusted information sources. Paired household responses (n = 149) generally showed improved knowledge and attitudes by the exit survey although practices were largely unchanged. Weak agreement (κ = -0.003 to 0.22) between survey responses suggest both that unintended learning had not occurred, and that participant responses were not based on established knowledge or behaviors. Targeted public education regarding antibiotics is needed to address this gap.
[Mh] Termos MeSH primário: Antibacterianos/uso terapêutico
Serviços Urbanos de Saúde
[Mh] Termos MeSH secundário: Estudos Transversais
Conhecimentos, Atitudes e Prática em Saúde
Seres Humanos
Quênia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Anti-Bacterial Agents)
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171031
[Lr] Data última revisão:
171031
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:171003
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185827


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[PMID]:28949978
[Au] Autor:Bazie GW; Adimassie MT
[Ad] Endereço:Department of Public Health, College of Medicine and Health Sciences, Wollo University, Dessie, Ethiopia.
[Ti] Título:Modern health services utilization and associated factors in North East Ethiopia.
[So] Source:PLoS One;12(9):e0185381, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Ethiopia is one of the developing countries with the poorest health status and the health services utilization is generally low with different patterns in different regions of the country. Therefore, the aim of this study was to assess utilization of modern health services and associated factors in Dessie, Ethiopia. METHODS: A cross sectional study design was employed from January to March, 2015 in Dessie City. The total sample was 420 adults. Adults were selected by stratified random sampling. The strata were made using residence as urban and rural residents. The data was collected using pre-tested, interviewer administered questionnaire. The data was entered into Epi infoTM7 software and exported to Statistical Package for Social Sciences (SPSS) version 20 Software for analysis. Binary logistic regression was used to evaluate independent effect of each variable on modern health service utilization by controlling the effect of others. The strength of association between dependent variable and independent variables was expressed by odds ratio with 95% confidence interval. RESULTS: The overall modern health services utilization rate was 41.8%. Being Female sex, annual income greater than poverty line, poor perception of health status, high perceived severity of illness, two or more than two number of illnesses in the last 12 months prior to the survey and presence of chronic health problem were found to have a significant association with utilization of modern health services. CONCLUSION: Modern health services utilization was found to be low. Being female sex, annual income above poverty line, having poor perceived health status, having two or more than two illnesses, severe perceived severity of illness and having chronic health problem were found to have a statistically significant association with utilization. Therefore, efforts have to be made to increase utilization of modern health services through establishing systems like health extension workers and health development army.
[Mh] Termos MeSH primário: Serviços de Saúde Rural/utilização
Serviços Urbanos de Saúde/utilização
[Mh] Termos MeSH secundário: Adulto
Idoso
Estudos Transversais
Etiópia
Feminino
Seres Humanos
Masculino
Meia-Idade
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170927
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0185381


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[PMID]:28841665
[Au] Autor:Pati S; Schellevis FG
[Ad] Endereço:Department of Health & Family Welfare, Government of Odisha, Bhubaneswar, Odisha, India.
[Ti] Título:Prevalence and pattern of co morbidity among type2 diabetics attending urban primary healthcare centers at Bhubaneswar (India).
[So] Source:PLoS One;12(8):e0181661, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: India has the second largest diabetic population in the world. The chronic nature of the disease and high prevalence of co-existing chronic medical conditions or "co morbidities" makes diabetes management complex for the patient and for health care providers. Hence a strong need was felt to explore the problem of co morbidity among diabetics and its dimensions in primary health care practices. METHOD: This cross sectional survey was carried out on 912 type 2 diabetes patients attending different urban primary health care facilities at Bhubaneswar. Data regarding existence of co morbidity and demographical details were elicited by a predesigned, pretested questionnaire"Diabetes Co morbidity Evaluation Tool in Primary Care (DCET- PC)". Statistical analyses were done using STATA. RESULTS: Overall 84% had one ormore than one comorbid condition. The most frequent co morbid conditions were hypertension [62%], acid peptic disease [28%], chronic back ache [22%] and osteoarthritis [21%]. The median number of co morbid conditions among both males and females is 2[IQR = 2]. The range of the number of co morbid conditions was wider among males [0-14] than females [0-6]. The number of co morbidities was highest in the age group > = 60 across both sexes. Most of the male patients below 40 years of age had either single [53%] or three co morbidities [11%] whereas among female patients of the same age group single [40%] or two co morbidities [22%] were more predominantly present. Age was found to be a strong independent predictor for diabetes co morbidity. The odds of having co morbidity among people above poverty line and schedule caste were found to be[OR = 3.50; 95%CI 1.85-6.62]and [OR = 2.46; CI 95%1.16-5.25] respectively. Odds were increased for retired status [OR = 1.21; 95% CI 1.01-3.91] and obesity [OR = 3.96; 95%CI 1.01-15.76]. CONCLUSION: The results show a high prevalence of co morbidities in patients with type 2 diabetes attending urban primary health care facilities. Hypertension, acid peptic disease, chronic back ache and arthritis being the most common, strategies need to be designed taking into account the multiple demands of co morbidities.
[Mh] Termos MeSH primário: Diabetes Mellitus Tipo 2/epidemiologia
Atenção Primária à Saúde/organização & administração
Serviços Urbanos de Saúde/organização & administração
[Mh] Termos MeSH secundário: Estudos Transversais
Diabetes Mellitus Tipo 2/complicações
Seres Humanos
Índia/epidemiologia
Prevalência
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171023
[Lr] Data última revisão:
171023
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170826
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0181661


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[PMID]:28832588
[Au] Autor:Nangendo J; Obuku EA; Kawooya I; Mukisa J; Nalutaaya A; Musewa A; Semitala FC; Karamagi CA; Kalyango JN
[Ad] Endereço:Clinical Epidemiology Unit, School of Medicine, College of Health Sciences, Makerere University, Kampala, Uganda.
[Ti] Título:Diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending an urban public health facility in Kampala, Uganda.
[So] Source:PLoS One;12(8):e0182050, 2017.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The prevalence of HIV in Uganda is 7.3%, and yet nearly 40% of people living with HIV are unaware of their status. The current HIV testing policy which is strictly blood-based poses several challenges including: a need for high level laboratory skills, stringent waste disposal needs, and painful sample collection. It is envisaged that introduction of a rapid, painless HIV oral fluid test as a potential alternative is likely to increase the number of people testing. The aim of this study was to determine the diagnostic accuracy and acceptability of rapid HIV oral testing among adults attending Kisenyi Health Centre IV in Kampala. METHODS AND FINDINGS: We conducted a cross-sectional study among 440 adults recruited consecutively at Kisenyi Health Centre IV from January to March 2016. The diagnostic accuracy of the HIV oral test was assessed by comparing to the national HIV serial testing algorithm. We also assessed for acceptability among patients and health care workers (HCWs) by triangulating responses from a structured questionnaire, three focus group discussions and seven key informant interviews. Acceptability was defined as willingness to take the test at the time of the study and intention for future use of the test if it was availed. The prevalence of HIV infection among study participants was 14.8%. The HIV oral fluid test was highly accurate with sensitivity of 100% (95% CI; 94.5-100.0), specificity of 100% (95% CI; 99.0-100.0), positive predictive value (PPV) of 100% (95% CI; 94.5-100.0) and negative predictive value (NPV) of 100% (95% CI; 99.0-100.0). Acceptability of HIV oral testing was also high at 87.0% (95% CI; 83.6-89.9). Participants preferred HIV oral testing because it was: pain free (91%, n = 399) and did not require blood draw (82%, n = 360). CONCLUSION: The HIV oral fluid test has high diagnostic accuracy and acceptability. HIV oral testing is a suitable addition to the national HIV testing strategies with the potential of increasing access to HIV testing services in Uganda.
[Mh] Termos MeSH primário: Infecções por HIV/diagnóstico
Instalações de Saúde
Aceitação pelo Paciente de Cuidados de Saúde
Setor Público
Saliva/virologia
Serviços Urbanos de Saúde
[Mh] Termos MeSH secundário: Adolescente
Adulto
Estudos Transversais
Feminino
Seres Humanos
Masculino
Meia-Idade
Uganda
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171019
[Lr] Data última revisão:
171019
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0182050


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[PMID]:28802783
[Au] Autor:Greenwood-Ericksen MB; Tipirneni R; Abir M
[Ad] Endereço:Department of Emergency Medicine, University of Michigan, Ann Arbor, MI; National Clinician Scholars Program, University of Michigan, Ann Arbor, MI; Institute for Healthcare Policy and Innovation, University of Michigan, Ann Arbor, MI; Ann Arbor Veterans Affairs, Ann Arbor, MI. Electronic address: greenwom@med.umich.edu.
[Ti] Título:An Emergency Medicine-Primary Care Partnership to Improve Rural Population Health: Expanding the Role of Emergency Medicine.
[So] Source:Ann Emerg Med;70(5):640-647, 2017 Nov.
[Is] ISSN:1097-6760
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The health of rural America is failing and our traditional approaches have proved ineffective at improving health in rural communities. Rural populations are now a health disparity population, facing higher mortality rates for the 5 leading causes of death compared with their urban counterparts. We must generate novel, rural-specific approaches to solve this challenge-and there is a clear role for the field of emergency medicine. Building on emergency departments' (EDs') expanding role in health care delivery and emergency medicine's increasing involvement in population health, we propose a new health care delivery model for rural population health based on partnership between emergency medicine and primary care that embraces the important role that EDs play in rural areas.
[Mh] Termos MeSH primário: Medicina de Emergência/métodos
Serviço Hospitalar de Emergência/utilização
Prática Associada/organização & administração
Atenção Primária à Saúde/utilização
Serviços de Saúde Rural/estatística & dados numéricos
[Mh] Termos MeSH secundário: Assistência à Saúde
Medicina de Emergência/economia
Serviço Hospitalar de Emergência/normas
Serviço Hospitalar de Emergência/estatística & dados numéricos
Acesso aos Serviços de Saúde
Necessidades e Demandas de Serviços de Saúde/organização & administração
Disparidades em Assistência à Saúde
Seres Humanos
Mortalidade/tendências
Atenção Primária à Saúde/estatística & dados numéricos
Serviços de Saúde Rural/economia
Serviços de Saúde Rural/normas
População Rural
Estados Unidos
Serviços Urbanos de Saúde
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1711
[Cu] Atualização por classe:171102
[Lr] Data última revisão:
171102
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170814
[St] Status:MEDLINE


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[PMID]:28784330
[Au] Autor:Ehrlich A; Kostecki J; Olkaba H
[Ad] Endereço:Department of Dermatology, George Washington University, Washington, DC.
[Ti] Título:Trends in dermatology practices and the implications for the workforce.
[So] Source:J Am Acad Dermatol;77(4):746-752, 2017 Oct.
[Is] ISSN:1097-6787
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: The American Academy of Dermatology (AAD) practice profile surveys have been conducted for more than a decade to gauge trends in our workforce supply and demand. OBJECTIVE: To update the trends and current workforce issues for the field of dermatology. METHODS: The AAD Practice Profile Survey is sent by both e-mail and postal mail to a random sample of practicing dermatologists who are AAD members. RESULTS: Shifts are noted in the primary practice setting; fewer dermatologists are in solo practice and more are in group practices than in previous years. Teledermatology use trended upward from 7% to 11% between 2012 and 2014. The implementation of electronic health records increased from 51% in 2011 to 70% in 2014. LIMITATIONS: There is potential for response bias and inaccurate self-reporting. Survey responses collected may not be representative of all geographic areas. CONCLUSION: The demand for dermatology services remains strong. Shifts in the practice setting may be related to increases in overhead costs that are partially associated with the implementation of technology-based medical records. Integration of electronic health records and utilization of telemedicine are increasing.
[Mh] Termos MeSH primário: Dermatologistas/provisão & distribuição
Dermatologia/organização & administração
Registros Eletrônicos de Saúde/utilização
Serviços de Saúde Rural/recursos humanos
Telemedicina/utilização
Serviços Urbanos de Saúde/recursos humanos
[Mh] Termos MeSH secundário: Dermatologia/recursos humanos
Dermatologia/tendências
Feminino
Prática de Grupo/estatística & dados numéricos
Prática de Grupo/tendências
Seres Humanos
Cobertura do Seguro/tendências
Seguro Saúde/tendências
Masculino
Meia-Idade
Profissionais de Enfermagem/estatística & dados numéricos
Assistentes Médicos/estatística & dados numéricos
Prática Privada/estatística & dados numéricos
Prática Privada/tendências
Área de Atuação Profissional
Inquéritos e Questionários
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170927
[Lr] Data última revisão:
170927
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170809
[St] Status:MEDLINE


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[PMID]:28679857
[Au] Autor:Sangha RS; Naidech AM; Corado C; Ansari SA; Prabhakaran S
[Ad] Endereço:From the Departments of Neurology (R.S.S., A.M.N., C.C., S.P.) and Radiology (S.A.A.), Northwestern Memorial Hospital, Chicago, IL.
[Ti] Título:Challenges in the Medical Management of Symptomatic Intracranial Stenosis in an Urban Setting.
[So] Source:Stroke;48(8):2158-2163, 2017 Aug.
[Is] ISSN:1524-4628
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND AND PURPOSE: Since the SAMMPRIS trial (Stenting and Aggressive Medical Management for Preventing Recurrent Stroke in Intracranial Stenosis), aggressive medical management (AMM), which includes dual antiplatelet therapy (DAPT) and high-dose statin (HDS) therapy, is recommended for patients with symptomatic intracranial atherosclerotic disease. However, limited data on the real-world application of this regimen exist. We hypothesized that recurrent stroke risk among patients treated with AMM is similar to the medical arm of the SAMMPRIS cohort. METHODS: Using a prospective registry, we identified all patients admitted between August 2012 and March 2015 with (1) confirmed ischemic stroke or transient ischemic attack; (2) independently adjudicated symptomatic intracranial atherosclerotic disease; and (3) follow-up at 30 days. We analyzed 30-day risk of recurrent ischemic stroke stratified by treatment: (1) AMM: DAPT plus HDS therapy, (2) HDS alone, and (3) DAPT alone. We also assessed 30-day risk among patients who met prespecified SAMMPRIS eligibility criteria. RESULTS: Among 99 patients who met study criteria (51.5% male, 54.5% black, mean age 68.2±11.2 years), 49 (48.5%) patients were treated with AMM, 69 (69.7%) with DAPT, and 73 (73.7%) with HDS therapy. At 30 days, 20 (20.2%) patients had recurrent strokes in the territory of stenosis. Compared with the risk in the medical arm of SAMMPRIS (4.4%), the 30-day risk of recurrent stroke was 20.4% in AMM patients, 21.5% in HDS patients, 22.4% in DAPT patients, and 23.2% in SAMMPRIS-eligible patients (all <0.001). CONCLUSIONS: Recurrent stroke risk within 30 days in patients with symptomatic intracranial atherosclerotic disease was higher than that observed in the medical arm of SAMMPRIS even in the subgroup receiving AMM. Replication of the SAMMPRIS findings requires further prospective study.
[Mh] Termos MeSH primário: Gerenciamento Clínico
Hospitais Urbanos/tendências
Inibidores de Hidroximetilglutaril-CoA Redutases/administração & dosagem
Arteriosclerose Intracraniana/tratamento farmacológico
Inibidores da Agregação de Plaquetas/administração & dosagem
Acidente Vascular Cerebral/prevenção & controle
[Mh] Termos MeSH secundário: Idoso
Estudos de Coortes
Feminino
Seguimentos
Hospitais Urbanos/normas
Seres Humanos
Arteriosclerose Intracraniana/epidemiologia
Estudos Longitudinais
Masculino
Meia-Idade
Estudos Prospectivos
Acidente Vascular Cerebral/epidemiologia
Resultado do Tratamento
Serviços Urbanos de Saúde/normas
Serviços Urbanos de Saúde/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Nm] Nome de substância:
0 (Hydroxymethylglutaryl-CoA Reductase Inhibitors); 0 (Platelet Aggregation Inhibitors)
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170904
[Lr] Data última revisão:
170904
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170707
[St] Status:MEDLINE
[do] DOI:10.1161/STROKEAHA.116.016254



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