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[PMID]:29447291
[Au] Autor:Tanuseputro P; Beach S; Chalifoux M; Wodchis WP; Hsu AT; Seow H; Manuel DG
[Ad] Endereço:Bruyère Research Institute, Ottawa, Ontario, Canada.
[Ti] Título:Associations between physician home visits for the dying and place of death: A population-based retrospective cohort study.
[So] Source:PLoS One;13(2):e0191322, 2018.
[Is] ISSN:1932-6203
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: While most individuals wish to die at home, the reality is that most will die in hospital. AIM: To determine whether receiving a physician home visit near the end-of-life is associated with lower odds of death in a hospital. DESIGN: Observational retrospective cohort study, examining location of death and health care in the last year of life. SETTING/PARTICIPANTS: Population-level study of Ontarians, a Canadian province with over 13 million residents. All decedents from April 1, 2010 to March 31, 2013 (n = 264,754). RESULTS: More than half of 264,754 decedents died in hospital: 45.7% died in an acute care hospital and 7.7% in complex continuing care. After adjustment for multiple factors-including patient illness, home care services, and days of being at home-receiving at least one physician home visit from a non-palliative care physician was associated with a 47% decreased odds (odds-ratio, 0.53; 95%CI: 0.51-0.55) of dying in a hospital. When a palliative care physician specialist was involved, the overall odds declined by 59% (odds ratio, 0.41; 95%CI: 0.39-0.43). The same model, adjusting for physician home visits, showed that receiving palliative home care was associated with a similar reduction (odds ratio, 0.49; 95%CI: 0.47-0.51). CONCLUSION: Location of death is strongly associated with end-of-life health care in the home. Less than one-third of the population, however, received end-of-life home care or a physician visit in their last year of life, revealing large room for improvement.
[Mh] Termos MeSH primário: Hospitais/utilização
Visita Domiciliar/utilização
Assistência Terminal/métodos
[Mh] Termos MeSH secundário: Canadá
Estudos de Coortes
Morte
Feminino
Serviços de Assistência Domiciliar/tendências
Serviços de Assistência Domiciliar/utilização
Cuidados Paliativos na Terminalidade da Vida/tendências
Hospitalização/tendências
Hospitais/tendências
Seres Humanos
Masculino
Razão de Chances
Cuidados Paliativos
Médicos
Qualidade de Vida
Estudos Retrospectivos
Assistência Terminal/tendências
[Pt] Tipo de publicação:JOURNAL ARTICLE; RESEARCH SUPPORT, NON-U.S. GOV'T
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180309
[Lr] Data última revisão:
180309
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180216
[St] Status:MEDLINE
[do] DOI:10.1371/journal.pone.0191322


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[PMID]:29365346
[Au] Autor:Hodder RK; Stacey FG; O'Brien KM; Wyse RJ; Clinton-McHarg T; Tzelepis F; James EL; Bartlem KM; Nathan NK; Sutherland R; Robson E; Yoong SL; Wolfenden L
[Ad] Endereço:Hunter New England Population Health, Hunter New England Local Health District, Locked Bag 10, Wallsend, Australia, 2287.
[Ti] Título:Interventions for increasing fruit and vegetable consumption in children aged five years and under.
[So] Source:Cochrane Database Syst Rev;1:CD008552, 2018 01 25.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Insufficient consumption of fruits and vegetables in childhood increases the risk of future chronic diseases, including cardiovascular disease. OBJECTIVES: To assess the effectiveness, cost effectiveness and associated adverse events of interventions designed to increase the consumption of fruit, vegetables or both amongst children aged five years and under. SEARCH METHODS: We searched the Cochrane Central Register of Controlled Trials (CENTRAL) in the Cochrane Library, MEDLINE and Embase to identify eligible trials on 25 September 2017. We searched Proquest Dissertations and Theses and two clinical trial registers in November 2017. We reviewed reference lists of included trials and handsearched three international nutrition journals. We contacted authors of included studies to identify further potentially relevant trials. SELECTION CRITERIA: We included randomised controlled trials, including cluster-randomised controlled trials and cross-over trials, of any intervention primarily targeting consumption of fruit, vegetables or both among children aged five years and under, and incorporating a dietary or biochemical assessment of fruit or vegetable consumption. Two review authors independently screened titles and abstracts of identified papers; a third review author resolved disagreements. DATA COLLECTION AND ANALYSIS: Two review authors independently extracted data and assessed the risks of bias of included studies; a third review author resolved disagreements. Due to unexplained heterogeneity, we used random-effects models in meta-analyses for the primary review outcomes where we identified sufficient trials. We calculated standardised mean differences (SMDs) to account for the heterogeneity of fruit and vegetable consumption measures. We conducted assessments of risks of bias and evaluated the quality of evidence (GRADE approach) using Cochrane procedures. MAIN RESULTS: We included 55 trials with 154 trial arms and 11,108 participants. Thirty-three trials examined the impact of child-feeding practices (e.g. repeated food exposure) in increasing child vegetable intake. Thirteen trials examined the impact of parent nutrition education in increasing child fruit and vegetable intake. Eight studies examined the impact of multicomponent interventions (e.g. parent nutrition education and preschool policy changes) in increasing child fruit and vegetable intake. One study examined the effect of a nutrition intervention delivered to children in increasing child fruit and vegetable intake.We judged 14 of the 55 included trials as free from high risks of bias across all domains; performance, detection and attrition bias were the most common domains judged at high risk of bias for the remaining studies.Meta-analysis of trials examining child-feeding practices versus no intervention revealed a positive effect on child vegetable consumption (SMD 0.38, 95% confidence interval (CI) 0.15 to 0.61; n = 1509; 11 studies; very low-quality evidence), equivalent to a mean difference of 4.03 g of vegetables. There were no short-term differences in child consumption of fruit and vegetables in meta-analyses of trials examining parent nutrition education versus no intervention (SMD 0.11, 95% CI -0.05 to 0.28; n = 3023; 10 studies; very low-quality evidence) or multicomponent interventions versus no intervention (SMD 0.28, 95% CI -0.06 to 0.63; n = 1861; 4 studies; very low-quality evidence).Insufficient data were available to assess long-term effectiveness, cost effectiveness and unintended adverse consequences of interventions. Studies reported receiving governmental or charitable funds, except for three studies reporting industry funding. AUTHORS' CONCLUSIONS: Despite identifying 55 eligible trials of various intervention approaches, the evidence for how to increase children's fruit and vegetable consumption remains sparse. There was very low-quality evidence that child-feeding practice interventions are effective in increasing vegetable consumption in children aged five years and younger, however the effect size was very small and long-term follow-up is required. There was very low-quality evidence that parent nutrition education and multicomponent interventions are not effective in increasing fruit and vegetable consumption in children aged five years and younger. All findings should be considered with caution, given most included trials could not be combined in meta-analyses. Given the very low-quality evidence, future research will very likely change estimates and conclusions. Such research should adopt more rigorous methods to advance the field.This is a living systematic review. Living systematic reviews offer a new approach to review updating, in which the review is continually updated, incorporating relevant new evidence as it becomes available. Please refer to the Cochrane Database of Systematic Reviews for the current status of this review.
[Mh] Termos MeSH primário: Ingestão de Alimentos
Comportamento Alimentar
Frutas
Verduras
[Mh] Termos MeSH secundário: Pré-Escolar
Condicionamento (Psicologia)
Visita Domiciliar
Seres Humanos
Lactente
Ensaios Clínicos Controlados Aleatórios como Assunto
Recompensa
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; REVIEW
[Em] Mês de entrada:1803
[Cu] Atualização por classe:180301
[Lr] Data última revisão:
180301
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:180125
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD008552.pub4


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[PMID]:27777181
[Au] Autor:Bryant-Stephens T; Reed-Wells S; Canales M; Perez L; Rogers M; Localio AR; Apter AJ
[Ad] Endereço:Children's Hospital of Philadelphia, Philadelphia, Pa; Perelman School of Medicine, University of Pennsylvania, Philadelphia, Pa. Electronic address: stephenst@email.chop.edu.
[Ti] Título:Home visits are needed to address asthma health disparities in adults.
[So] Source:J Allergy Clin Immunol;138(6):1526-1530, 2016 Dec.
[Is] ISSN:1097-6825
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Research on asthma frequently recruits patients from clinics because the ready pool of patients leads to easy access to patients in office waiting areas, emergency departments, or hospital wards. Patients with other chronic conditions, and with mobility problems, face exposures at home that are not easily identified at the clinic. In this article, we describe the perspective of the community health workers and the challenges they encountered when making home visits while implementing a research intervention in a cohort of low-income, minority patients. From their observations, poor housing, often the result of poverty and lack of social resources, is the real elephant in the chronic asthma room. To achieve a goal of reduced asthma morbidity and mortality will require a first-hand understanding of the real-world social and economic barriers to optimal asthma management and the solutions to those barriers.
[Mh] Termos MeSH primário: Asma/epidemiologia
Agentes Comunitários de Saúde
Visita Domiciliar
[Mh] Termos MeSH secundário: Adulto
Redes Comunitárias
Disparidades em Assistência à Saúde
Seres Humanos
Avaliação de Resultados da Assistência ao Paciente
Pobreza
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE; REVIEW
[Em] Mês de entrada:1707
[Cu] Atualização por classe:171223
[Lr] Data última revisão:
171223
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:161026
[St] Status:MEDLINE


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[PMID]:29019887
[Au] Autor:Ko MC; Huang SJ; Chen CC; Chang YP; Lien HY; Lin JY; Woung LC; Chan SY
[Ad] Endereço:aDepartment of Urology, Taipei City Hospital, Taipei City bDepartment of Health Care Management, National Taipei University of Nursing and Health Sciences, Taipei City cSchool of Medicine, Fu-Jen Catholic University, New Taipei City dSuperintendent Office, Taipei City Hospital, Taipei City eDepartment of Surgery, National Taiwan University, Taipei City fCenter of Quality Management, Taipei City Hospital, Taipei City gCross-Strait Medical and Management Communication Center, Taipei City Hospital, Taipei City hAdministrative Center, Ministry of Health and Welfare Taipei Hospital, New Taipei City iDepartment of Cardiology, Taipei City Hospital, Taipei City, Taiwan.
[Ti] Título:Factors predicting a home death among home palliative care recipients.
[So] Source:Medicine (Baltimore);96(41):e8210, 2017 Oct.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Awareness of factors affecting the place of death could improve communication between healthcare providers and patients and their families regarding patient preferences and the feasibility of dying in the preferred place.This study aimed to evaluate factors predicting home death among home palliative care recipients.This is a population-based study using a national representative sample retrieved from the National Health Insurance Research Database. Subjects receiving home palliative care, from 2010 to 2012, were analyzed to evaluate the association between a home death and various characteristics related to illness, individual, and health care utilization. A multiple-logistic regression model was used to assess the independent effect of various characteristics on the likelihood of a home death.The overall rate of a home death for home palliative care recipients was 43.6%. Age; gender; urbanization of the area where the patients lived; illness; the total number of home visits by all health care professionals; the number of home visits by nurses; utilization of nasogastric tube, endotracheal tube, or indwelling urinary catheter; the number of emergency department visits; and admission to intensive care unit in previous 1 year were not significantly associated with the risk of a home death. Physician home visits increased the likelihood of a home death. Compared with subjects without physician home visits (31.4%) those with 1 physician home visit (53.0%, adjusted odds ratio [AOR]: 3.23, 95% confidence interval [CI]: 1.93-5.42) and those with ≥2 physician home visits (43.9%, AOR: 2.23, 95% CI: 1.06-4.70) had higher likelihood of a home death. Compared with subjects with hospitalization 0 to 6 times in previous 1 year, those with hospitalization ≥7 times in previous 1 year (AOR: 0.57, 95% CI: 0.34-0.95) had lower likelihood of a home death.Among home palliative care recipients, physician home visits increased the likelihood of a home death. Hospitalizations ≥7 times in previous 1 year decreased the likelihood of a home death.
[Mh] Termos MeSH primário: Esclerose Amiotrófica Lateral
Serviços de Assistência Domiciliar/organização & administração
Neoplasias
Cuidados Paliativos
Assistência Terminal
Doente Terminal/psicologia
[Mh] Termos MeSH secundário: Idoso
Idoso de 80 Anos ou mais
Esclerose Amiotrófica Lateral/mortalidade
Esclerose Amiotrófica Lateral/psicologia
Esclerose Amiotrófica Lateral/terapia
Feminino
Visita Domiciliar/estatística & dados numéricos
Seres Humanos
Masculino
Mortalidade
Neoplasias/mortalidade
Neoplasias/psicologia
Neoplasias/terapia
Cuidados Paliativos/métodos
Cuidados Paliativos/psicologia
Cuidados Paliativos/estatística & dados numéricos
Preferência do Paciente
Relações Médico-Paciente
Distribuição Espacial da População
Medição de Risco/métodos
Serviços de Saúde Rural/organização & administração
Assistência Terminal/métodos
Assistência Terminal/psicologia
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1710
[Cu] Atualização por classe:171122
[Lr] Data última revisão:
171122
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:171012
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000008210


  5 / 2922 MEDLINE  
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[PMID]:28847981
[Au] Autor:Duffee JH; Mendelsohn AL; Kuo AA; Legano LA; Earls MF; COUNCIL ON COMMUNITY PEDIATRICS; COUNCIL ON EARLY CHILDHOOD; COMMITTEE ON CHILD ABUSE AND NEGLECT
[Ti] Título:Early Childhood Home Visiting.
[So] Source:Pediatrics;140(3), 2017 Sep.
[Is] ISSN:1098-4275
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:High-quality home-visiting services for infants and young children can improve family relationships, advance school readiness, reduce child maltreatment, improve maternal-infant health outcomes, and increase family economic self-sufficiency. The American Academy of Pediatrics supports unwavering federal funding of state home-visiting initiatives, the expansion of evidence-based programs, and a robust, coordinated national evaluation designed to confirm best practices and cost-efficiency. Community home visiting is most effective as a component of a comprehensive early childhood system that actively includes and enhances a family-centered medical home.
[Mh] Termos MeSH primário: Serviços de Saúde da Criança/organização & administração
Visita Domiciliar
[Mh] Termos MeSH secundário: Criança
Maus-Tratos Infantis/prevenção & controle
Serviços de Saúde da Criança/economia
Serviços de Saúde da Criança/história
Financiamento Governamental
História do Século XX
Visita Domiciliar/economia
Seres Humanos
Assistência Centrada no Paciente/economia
Assistência Centrada no Paciente/organização & administração
Pobreza/prevenção & controle
Estados Unidos
[Pt] Tipo de publicação:HISTORICAL ARTICLE; JOURNAL ARTICLE
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170830
[St] Status:MEDLINE


  6 / 2922 MEDLINE  
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[PMID]:28834470
[Au] Autor:Krem MM
[Ad] Endereço:From the Division of Blood and Bone Marrow Transplantation, University of Louisville School of Medicine, Louisville, KY.
[Ti] Título:Man versus Nature - Also Sprach Zarathustra and an End-of-Life House Call.
[So] Source:N Engl J Med;377(8):709-711, 2017 Aug 24.
[Is] ISSN:1533-4406
[Cp] País de publicação:United States
[La] Idioma:eng
[Mh] Termos MeSH primário: Música
Relações Médico-Paciente
Assistência Terminal/psicologia
[Mh] Termos MeSH secundário: Visita Domiciliar
Seres Humanos
Masculino
Neoplasias
Filosofia
Suicídio Assistido
[Pt] Tipo de publicação:JOURNAL ARTICLE; PERSONAL NARRATIVES
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170919
[Lr] Data última revisão:
170919
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170824
[St] Status:MEDLINE
[do] DOI:10.1056/NEJMp1705492


  7 / 2922 MEDLINE  
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[PMID]:28814455
[Au] Autor:Beck CA; Beran DB; Biglan KM; Boyd CM; Dorsey ER; Schmidt PN; Simone R; Willis AW; Galifianakis NB; Katz M; Tanner CM; Dodenhoff K; Aldred J; Carter J; Fraser A; Jimenez-Shahed J; Hunter C; Spindler M; Reichwein S; Mari Z; Dunlop B; Morgan JC; McLane D; Hickey P; Gauger L; Richard IH; Mejia NI; Bwala G; Nance M; Shih LC; Singer C; Vargas-Parra S; Zadikoff C; Okon N; Feigin A; Ayan J; Vaughan C; Pahwa R; Dhall R; Hassan A; DeMello S; Riggare SS; Wicks P; Achey MA; Elson MJ; Goldenthal S; Keenan HT; Korn R; Schwarz H; Sharma S; Connect.Parkinson Investigators
[Ad] Endereço:From the Department of Biostatistics and Computational Biology (C.A.B.), University of Rochester, NY; National Parkinson Foundation (D.B.B., P.N.S.), Miami, FL; Department of Neurology (K.M.B., E.R.D., I.H.R., H.S.) and The Center for Human Experimental Therapeutics (E.R.D., M.A.A., M.J.E., S.G., H.
[Ti] Título:National randomized controlled trial of virtual house calls for Parkinson disease.
[So] Source:Neurology;89(11):1152-1161, 2017 Sep 12.
[Is] ISSN:1526-632X
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:OBJECTIVE: To determine whether providing remote neurologic care into the homes of people with Parkinson disease (PD) is feasible, beneficial, and valuable. METHODS: In a 1-year randomized controlled trial, we compared usual care to usual care supplemented by 4 virtual visits via video conferencing from a remote specialist into patients' homes. Primary outcome measures were feasibility, as measured by the proportion who completed at least one virtual visit and the proportion of virtual visits completed on time; and efficacy, as measured by the change in the Parkinson's Disease Questionnaire-39, a quality of life scale. Secondary outcomes included quality of care, caregiver burden, and time and travel savings. RESULTS: A total of 927 individuals indicated interest, 210 were enrolled, and 195 were randomized. Participants had recently seen a specialist (73%) and were largely college-educated (73%) and white (96%). Ninety-five (98% of the intervention group) completed at least one virtual visit, and 91% of 388 virtual visits were completed. Quality of life did not improve in those receiving virtual house calls (0.3 points worse on a 100-point scale; 95% confidence interval [CI] -2.0 to 2.7 points; = 0.78) nor did quality of care or caregiver burden. Each virtual house call saved patients a median of 88 minutes (95% CI 70-120; < 0.0001) and 38 miles per visit (95% CI 36-56; < 0.0001). CONCLUSIONS: Providing remote neurologic care directly into the homes of people with PD was feasible and was neither more nor less efficacious than usual in-person care. Virtual house calls generated great interest and provided substantial convenience. CLINICALTRIALSGOV IDENTIFIER: NCT02038959. CLASSIFICATION OF EVIDENCE: This study provides Class III evidence that for patients with PD, virtual house calls from a neurologist are feasible and do not significantly change quality of life compared to in-person visits. The study is rated Class III because it was not possible to mask patients to visit type.
[Mh] Termos MeSH primário: Visita Domiciliar
Doença de Parkinson/terapia
Telemedicina
[Mh] Termos MeSH secundário: Idoso
Cuidadores/psicologia
Estudos de Viabilidade
Feminino
Seguimentos
Visita Domiciliar/economia
Seres Humanos
Masculino
Doença de Parkinson/economia
Doença de Parkinson/psicologia
Satisfação do Paciente
Médicos/psicologia
Qualidade da Assistência à Saúde/economia
Qualidade de Vida
Inquéritos e Questionários
Telemedicina/economia
Fatores de Tempo
Resultado do Tratamento
[Pt] Tipo de publicação:JOURNAL ARTICLE; RANDOMIZED CONTROLLED TRIAL
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170917
[Lr] Data última revisão:
170917
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170818
[St] Status:MEDLINE
[do] DOI:10.1212/WNL.0000000000004357


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[PMID]:28770973
[Au] Autor:Yonemoto N; Dowswell T; Nagai S; Mori R
[Ad] Endereço:Department of Epidemiology and Biostatistics, Translational Medical Center, National Center of Neurology and Psychiatry, 4-1-1 Ogawahigashimachi, Kodaira, Tokyo, Japan, 187-8553.
[Ti] Título:Schedules for home visits in the early postpartum period.
[So] Source:Cochrane Database Syst Rev;8:CD009326, 2017 08 02.
[Is] ISSN:1469-493X
[Cp] País de publicação:England
[La] Idioma:eng
[Ab] Resumo:BACKGROUND: Maternal complications including psychological and mental health problems and neonatal morbidity have been commonly observed in the postpartum period. Home visits by health professionals or lay supporters in the weeks following the birth may prevent health problems from becoming chronic with long-term effects on women, their babies, and their families. OBJECTIVES: To assess outcomes for women and babies of different home-visiting schedules during the early postpartum period. The review focuses on the frequency of home visits, the duration (when visits ended) and intensity, and on different types of home-visiting interventions. SEARCH METHODS: We searched the Cochrane Pregnancy and Childbirth Group's Trials Register (28 January 2013) and reference lists of retrieved articles. SELECTION CRITERIA: Randomised controlled trials (RCTs) (including cluster-RCTs) comparing different types of home-visiting interventions enrolling participants in the early postpartum period (up to 42 days after birth). We excluded studies in which women were enrolled and received an intervention during the antenatal period (even if the intervention continued into the postnatal period) and studies recruiting only women from specific high-risk groups. (e.g. women with alcohol or drug problems). DATA COLLECTION AND ANALYSIS: Study eligibility was assessed by at least two review authors. Data extraction and assessment of risk of bias were carried out independently by at least two review authors. Data were entered into Review Manager software. MAIN RESULTS: We included data from 12 randomised trials with data for more than 11,000 women. The trials were carried out in countries across the world, and in both high- and low-resource settings. In low-resource settings women receiving usual care may have received no additional postnatal care after early hospital discharge.The interventions and control conditions varied considerably across studies with trials focusing on three broad types of comparisons: schedules involving more versus fewer postnatal home visits (five studies), schedules involving different models of care (three studies), and home versus hospital clinic postnatal check-ups (four studies). In all but two of the included studies, postnatal care at home was delivered by healthcare professionals. The aim of all interventions was broadly to assess the wellbeing of mothers and babies, and to provide education and support, although some interventions had more specific aims such as to encourage breastfeeding, or to provide practical support.For most of our outcomes only one or two studies provided data, and overall results were inconsistent.There was no evidence that home visits were associated with improvements in maternal and neonatal mortality, and no consistent evidence that more postnatal visits at home were associated with improvements in maternal health. More intensive schedules of home visits did not appear to improve maternal psychological health and results from two studies suggested that women receiving more visits had higher mean depression scores. The reason for this finding was not clear. In a cluster randomised trial comparing usual care with individualised care by midwives extended up to three months after the birth, the proportions of women with Edinburgh postnatal depression scale (EPDS) scores ≥ 13 at four months was reduced in the individualised care group (RR 0.68, 95% CI 0.53 to 0.86). There was some evidence that postnatal care at home may reduce infant health service utilisation in the weeks following the birth, and that more home visits may encourage more women to exclusively breastfeed their babies. There was some evidence that home visits are associated with increased maternal satisfaction with postnatal care. AUTHORS' CONCLUSIONS: Increasing the number of postnatal home visits may promote infant health and maternal satisfaction and more individualised care may improve outcomes for women, although overall findings in different studies were not consistent. The frequency, timing, duration and intensity of such postnatal care visits should be based upon local and individual needs. Further well designed RCTs evaluating this complex intervention will be required to formulate the optimal package.
[Mh] Termos MeSH primário: Visita Domiciliar
Cuidado Pós-Natal/organização & administração
[Mh] Termos MeSH secundário: Feminino
Visita Domiciliar/estatística & dados numéricos
Seres Humanos
Lactente
Mortalidade Infantil
Recém-Nascido
Mortalidade Materna
Mortalidade Perinatal
Cuidado Pós-Natal/estatística & dados numéricos
Período Pós-Parto
Ensaios Clínicos Controlados Aleatórios como Assunto
[Pt] Tipo de publicação:JOURNAL ARTICLE; META-ANALYSIS; RESEARCH SUPPORT, NON-U.S. GOV'T; REVIEW
[Em] Mês de entrada:1709
[Cu] Atualização por classe:170920
[Lr] Data última revisão:
170920
[Sb] Subgrupo de revista:IM
[Da] Data de entrada para processamento:170804
[St] Status:MEDLINE
[do] DOI:10.1002/14651858.CD009326.pub3


  9 / 2922 MEDLINE  
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[PMID]:28720035
[Au] Autor:Casey PH; Irby C; Withers S; Dorsey S; Li J; Rettiganti M
[Ad] Endereço:1 University of Arkansas for Medical Sciences, Little Rock, AR, USA.
[Ti] Título:Home Visiting and the Health of Preterm Infants.
[So] Source:Clin Pediatr (Phila);56(9):828-837, 2017 Aug.
[Is] ISSN:1938-2707
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:The results of home visiting programs which target medically fragile low-birth-weight preterm infants (LBWPT) have been inconsistent. We provided nurse/social worker home visits to families of LBWPT infants on a regular schedule. Teams were trained in approaches to improve the health and development of the infants. The completion of immunization series was sigmificantly higher and the infant mortality rates of the home visits childen were significanly lower compared to national and state rates. We used state Medicaid data and examined frequency of hospitalization, emergency department visits, routine and nonscheduled visits to primary care physician, and pharmacy use of the home-visited subjects compared with a propensity-matched group. The home-visited group had more routine and nonscheduled visits but no more hospitalizations or E.D. visits. Home visiting teams improved important markers of child health, including completed immunizations and mortality rate, perhaps by the careful monitoring of health status and assuring health care when needed.
[Mh] Termos MeSH primário: Serviços de Assistência Domiciliar/estatística & dados numéricos
Visita Domiciliar/estatística & dados numéricos
Cuidado Pós-Natal/métodos
[Mh] Termos MeSH secundário: Arkansas
Pré-Escolar
Feminino
Hospitalização/estatística & dados numéricos
Seres Humanos
Imunização/estatística & dados numéricos
Lactente
Mortalidade Infantil
Recém-Nascido de Baixo Peso
Recém-Nascido
Recém-Nascido Prematuro
Masculino
Medicaid
Atenção Primária à Saúde/estatística & dados numéricos
Estados Unidos
[Pt] Tipo de publicação:JOURNAL ARTICLE
[Em] Mês de entrada:1708
[Cu] Atualização por classe:170809
[Lr] Data última revisão:
170809
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170720
[St] Status:MEDLINE
[do] DOI:10.1177/0009922817715949


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[PMID]:28562551
[Au] Autor:Fukushi M; Ishibashi Y; Nago N
[Ad] Endereço:aMusashi Kokubunji Park Clinic (Jikkoukai Medical Corporation) bIshibashi Clinic (Jikkoukai Medical Corporation), Tokyo, Japan.
[Ti] Título:Final diagnoses and probability of new reason-for-encounter at an urban clinic in Japan: A 4-year observational study.
[So] Source:Medicine (Baltimore);96(22):e6999, 2017 Jun.
[Is] ISSN:1536-5964
[Cp] País de publicação:United States
[La] Idioma:eng
[Ab] Resumo:Past clinical data are not currently used to calculate pretest probabilities, as they have not been put into a database in clinical settings. This observational study was designed to determine the initial reasons for utilizing home visits or visits to an outpatient urban clinic in Japan.All family medical clinic outpatients and patients visited by the clinic (total = 11,688) over 1460 days were enrolled.We used a Bayes theorem-based clinical decision support system to analyze codes for initial reason-for-encounter (examination and final diagnosis: pretest probability) and final diagnosis of patients with fever (conditional pretest probability).Total number of reasons-for-encounter: 96,653 (an average of 1.2 reasons per visit). Final diagnosis: 62,273 cases (an average of 0.75 cases per visit). The most common reasons for initial examination were immunizations, physical examinations, and upper respiratory conditions. Regarding the final diagnosis, the combination of physical examinations and acute upper respiratory infections comprised 73.4% of cases. In cases where fever developed, the bulk of the final diagnoses were infectious diseases such as influenza, strep throat, and gastroenteritis of presumed infectious origin. For the elderly, fever often occurred with other health issues such as pneumonia, dementia, constipation, and sleep disturbances, though the cause of the fever remained undetermined in 40% of the cases.The pretest probability changed significantly based on the reason or the combination of reasons for which patients requested a medical examination. Using accumulated data from past diagnoses to modify subsequent subjective diagnoses, individual diagnoses can be improved.
[Mh] Termos MeSH primário: Instituições de Assistência Ambulatorial/estatística & dados numéricos
Assistência Ambulatorial/estatística & dados numéricos
Sistemas de Apoio a Decisões Clínicas
Visita Domiciliar/estatística & dados numéricos
Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos
[Mh] Termos MeSH secundário: Adolescente
Adulto
Idoso
Teorema de Bayes
Estudos Transversais
Diagnóstico Diferencial
Seres Humanos
Meia-Idade
Tóquio
População Urbana
Adulto Jovem
[Pt] Tipo de publicação:JOURNAL ARTICLE; OBSERVATIONAL STUDY
[Em] Mês de entrada:1706
[Cu] Atualização por classe:170630
[Lr] Data última revisão:
170630
[Sb] Subgrupo de revista:AIM; IM
[Da] Data de entrada para processamento:170601
[St] Status:MEDLINE
[do] DOI:10.1097/MD.0000000000006999



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