Dissertations / Theses on the topic 'Health screening clinics'

Introduction: Prediabetes is major risk factor for the development of Type 2 Diabetes Mellitus (T2DM). One-third of the population in the United States has prediabetes, but 90% remain undiagnosed because healthcare providers are not performing screenings, making this a public health challenge. The purpose of this process improvement project was to implement prediabetes screening, prediabetes identification, and a referral process to a nutritionist to prevent or delay the onset of T2DM in patients in two Federally Qualified Health Centers. Methods: This was a quality improvement project conducted over a six-week period after receiving exemption from the University’s Internal Review Board. The Knowledge to Action framework was used to guide implementation of screening, prediabetes identification, management, and referral process. The outcomes were to measure the number and percent of screenings performed after provider education on prediabetes screening, those at risk for prediabetes, and the evidence-based interventions providers chose for management. The prediabetes risk assessment tool (PRAT) was the “Are you at risk for Type 2 Diabetes?” It was administered in both English and Spanish to adults who were not pregnant and had no previous diagnosis of Type 1 Diabetes Mellitus or T2DM. The preferred interventions included referral to a nutritionist, encourage 5%-7% total body weight loss, and/or 150 minutes of exercise per week. The PRAT and interventions data were coded, extracted into SPSS Version 25, and analyzed. Descriptive statistics were used to report patient characteristics, quantity of screenings performed, evidence-based recommendations offered, and patient risk factors for prediabetes. Results: In both clinics, 41% (n=269) of patients screened were found to be at risk for prediabetes. The most self-reported risk factor for prediabetes was family history of T2DM. Healthcare providers mostly provided education on weight loss and exercise, and recommended/referred less than 20% (n=49) of patients for nutritional education. The screening rates in the clinics were 52% (n=92) at site A and 72% (n=177) in site B, falling below the goal of 100%. Conclusions: There remains a gap in provider knowledge and use of evidence-based recommendations to decrease patients’ risk for prediabetes. The authors project that implementation of the PRAT and evidence-based interventions in the electronic health record would positively impact future screening results. This project set the benchmark for future efforts to educate, encourage, and measure providers successes.

Objectives: Violence victimization is common in youth, and the association between victimization and ill-health is well established. Youth is also the period when alcohol risk drinking is most prevalent. At youth clinics in Västernorrland, Sweden, a randomized controlled intervention was conducted examining health outcomes and risk drinking after implementing routine inquiry about violence victimization and alcohol consumption. Methods: Participants in the intervention group underwent routine inquiry about violence victimization and alcohol consumption. Victimized participants received empowering strategies and were offered further counseling. Risk drinkers received motivational interviewing (MI). All participants answered questionnaires about sociodemography and health at baseline, at 3 months and at 12 months. Of 1,445 eligible young women, 1,051 (73%) participated, with 54% of them completing the 12-month follow-up. Males were excluded from the quantitative analysis owing to the low number of male participants. Fifteen research interviews examining the experience of routine inquiry were conducted. Results: Violence-victimized young women reported more ill health than non-victimized women did. This was especially evident for those who had been multiply victimized. There were no differences in health outcomes between the baseline and the 12-month follow-up for the intervention group and for the control group. Of the victimized women in the intervention group, 14% wanted and received further counseling. There was a significant decrease in risk drinking from baseline to follow-up, but no differences between the MI group and the controls. There was a large intra-individual mobility in the young women’s drinking behavior. In interviews, the participants described how questions about violence had helped them to process prior victimization. For some, this initiated changes such as leaving a destructive relationship or starting therapy. The participants considered risk drinking in terms of consequences and did not find unit-based guidelines useful. Conclusion: Violence victimization, especially multiple victimization, was strongly associated with ill health in young women. Routine inquiry about violence and subsequent follow-up led to a high degree of disclosure but did not improve self-reported health. However, victimized participants described talking about prior victimization as very helpful. Participants viewed risk drinking in terms of consequences rather than in quantity or frequency of alcohol, which may render unit-based drinking guidelines less useful when addressing risk drinking in youth.

HIV infection is a leading cause of morbidity and mortality in our country today with nearly 1.2 million Americans living with HIV infection. Early recognition of infection is imperative for appropriate initiation of treatment to prevent comorbidities. Additionally, identification of infection can serve as a primary preventative measure to reduce spread of the disease. National organizations have supported the initiation of routine screening policies for HIV in health care settings. Primary care providers are uniquely positioned to be able to offer HIV screenings and identify infected persons very early in the course of the disease. Despite support for routine testing in the literature and by national evidence-based guidelines, testing is still not offered routinely in the primary care setting. The purpose of this project was to explore if a clinical reminder improves the frequency of HIV screening offered in a rural primary care clinic (PCC) located in Central Louisiana. Results of the project did show a statistically significant increase in the frequency of HIV screening offered following implementation of the clinical reminder system.

During the past three decades, there has been an abundance of research regarding cardiovascular disease and the pathology responsible for it. The incidence of childhood obesity and dyslipidemia are at the highest in history. Evidence exists demonstrating that arterial changes leading to cardiovascular disease begin in childhood. The National Heart, Lung, and Blood Institute (NHLBI), along with the American Academy of Pediatrics (AAP), issued guidelines in 2011 advocating for the screening of all children for dyslipidemia in order to identify children at-risk for development of cardiovascular disease and to implement interventions. The purpose of this synthesis project was to implement an evidence-based quality improvement project to screen lipids in children at the Start Community Clinic (SCC), a rural health clinic in Northeast Louisiana. Statistical Process Control (SPC) was used to evaluate both processes and outcomes. Outcomes measured include the number of children eligible to be screened compared to the number of children screened. Control charts were used to determine the stability and success of the improvement effort in implementing the evidence-based guideline. The guideline implementation using quality management techniques was successful and resulted in lipid screening of 60% of eligible children within the project time frame.

Ten to fifteen per cent of women from affluent countries, utilising private health care services are diagnosed with Postnatal Depression (PND) annually. Despite the high prevalence and the negative consequences for mother, child and partner, PND remains largely undiagnosed. Thus, this study explored health practitioners' experience of and attitude towards screening for postnatal depression to explore the barriers to screening as well as potential mechanisms to improve the rate of detection.

Purpose: Implement and evaluate a formal evidence-based risk screening protocol in a rural clinic setting to optimize early identification of prediabetes and T2DM in asymptomatic, non-pregnant adults age 18–44.

Significance: Absence of an evidence-based risk screening protocol contributed to under/overutilization in laboratory test referral and inconsistency in prescribed treatments among clinic providers. Early identification of prediabetes and initiation of appropriate treatment plans may assist in preventing T2DM and its associated complications.

Methodology: Quality improvement project utilizing a retrospective, randomized representative sample of charts, n = 30 and a convenience sample of participants, n = 40. The American Diabetes Association Diabetes Risk Test (ADA DRT) served as a prediabetes risk screening tool. Provider adherence to ADA DRT risk screening and laboratory test referral, type of laboratory test ordered, the relationship between demographic characteristics and the ADA DRT score, participant follow-up, and treatment ordered based on risk screening and laboratory results were analyzed using group data.

Results: Thirteen (35.7%) participants had laboratory values in the prediabetes or T2DM range and 100% of treatment ordered are substantiated by ADA guidelines. Using the ADA DRT tool, risk screening was completed in 100% of eligible participants; accordingly, appropriate utilization of laboratory test referral improved by 33.33%.

Recommendation: Incorporation of best-practices for risk screening and laboratory test referral for early identification of prediabetes is needed. APRNs are instrumental in promoting efficacious screening strategies and preventative treatment aimed at improving health outcomes. The benefits of using the ADA DRT as a prediabetes risk screening protocol in primary care should be elucidated in a prospective study.

The National Institute of Health has estimated that over 1 million new cancer cases will occur yearly. Posttraumatic stress disorder (PTSD) is commonly associated with near death experiences or traumatic events, such as cancer diagnosis and treatment. There is a lack of knowledge and awareness by healthcare professionals in identifying PTSD in cancer patients. In this population, PTSD symptoms often contribute to anxiety, and there is no standardized protocol being used to screen these individuals for the trauma they are facing or have faced. The purpose of this project was to develop a clinical practice guideline for screening cancer patients for PTSD in a clinic population serving cancer patients. The stress theory developed by Lazarus and Folkman guided this project. The project questions were to identify the most appropriate screening tool for PTSD in cancer patients and recommend a clinical practice guideline to the clinic healthcare providers. Five widely used PTSD screening tools were reviewed. Based on the project question the Clinician Administered PTSD Scale was identified as the most appropriate for this clinic setting and patient population. An expert panel consisting of 3 experienced psychiatric nurse practitioners reviewed the proposed guideline using the AGREE II tool. Using a scale of 1 (strongly disagree) to 7 (strongly agree), the team members agreed with a score of 5 or higher in each domain with the proposed guideline. Utilization of this guideline will promote a positive social change towards mental health awareness and improve the quality of life for these patients and their families.

In the United States, 30.3 million people live with diabetes. The cost of the disease is immense and the need for successful management strategies is pertinent. Food insecurity is associated with both the development and the poor management of diabetes. Several behavioral risk factors associated with food insecurity that influence the poor management of the disease include financial concerns, smoking, and disrupted eating patterns. Food insecurity screening in the clinical setting is endorsed by several professional organizations. To address the intersection between clinical care and this social determinant of health, an educational and training program was developed and implemented. The Theory of Planned Behavior is utilized for provider-level interventions and was applied to the program design for What About Food? Food insecurity screening in the clinical setting, which focuses on the topics of food insecurity and screening patients for food insecurity. Program content was evidence-based and employed a variety of learning strategies. The program was evaluated with a non-experimental pre- and post-test design. The program was successful in increasing knowledge about food insecurity, self-efficacy in screening for food insecurity, and in improving attitude toward food insecurity screening. The potential to tailor the program for specific groups is promising.

Abstract Background: Foot screening is an important part of diabetic care as it prevents significant morbidity, loss of function and mortality from diabetic foot complications. However, foot screening is often neglected. This project was aimed at educating health care workers (HCWs) in a primary health care clinic to increase diabetic foot screening practices. Methods: A quality improvement project using a plan, do, study, act (PDSA) cycle was used. HCW needs were assessed using a questionnaire; this was followed by a focus group discussion with HCWs, which was recorded, transcribed and assessed using a general inductive approach for common themes. Staff training was done using the Diabetic Foot Assessment Questionnaire. Patient information pamphlets and screening tools were made available to all clinical staff. Thirty-two consecutive diabetic patient folders were audited to compare screening in 2013 to that in the first half of 2014 after initiation of the PDSA cycle. Results: HCW confidence in conducting foot screening using the Diabetic Foot Assessment Questionnaire improved markedly after initial training. Diabetic foot screening practices increased from 9% in 2013 to 69% in 2014 after the first PDSA cycle. A strengths, opportunities, aspirations and results (SOAR) analysis showed promise for continuing quality improvement cycles. Conclusions: The findings showed a significant improvement in the number of diabetic patients who received foot screening. A feedback session was held with the team of HCWs involved in the project to discuss their experience and for future improvement planning. Using strategic planning with appreciative intent based on SOAR, proved to be inspirational and will be used in the planning of the next cycle.

The aim of this research was to examine an individual's stage of change (SOC) for positive sexual health behaviours, (i.e. using condoms and seeking screening for sexually transmitted infections-STIs) and level of state anxiety at different times during attendance at a sexual health clinic (before examination, after treatment and at 6 week follow up). The study investigated whether there is a relationship between level of anxiety and SOC for positive sexual health behaviours depending on whether a patient is asymptomatic or not. Furthermore the research aimed to find out if level of anxiety and SOC for positive sexual health behaviours predict whether patients return back to the clinic. The study involved a repeated measures longitudinal design. Participants were asked to complete a sexual health questionnaire, which examined components of the Transtheoretical Model of behaviour change and level of state anxiety at three different phases of the study. There was no relationship between SOC for condom use and patients who were asymptomatic and those who were not. There was a relationship found with STI screening; asymptomatic patients were more likely to be in the earlier SOC and symptomatic patients were more likely to be in the later SOC. There was no difference in levels of anxiety between patients who were asymptomatic and those who were not. Level of anxiety was not a predictor for SOC for positive sexual health behaviours at initial attendance. Finally, SOC for positive sexual health behaviour and anxiety did not predict whether a patient would return to the clinic.

INTRODUCTION: Almost 38 million people were living with HIV at the end of 2020, 73% of whom were estimated to be receiving antiretroviral therapy (ART). The face of HIV has changed greatly since the first highly effective ART regimens were introduced in 1996, and PLHIV who initiate ART at a sufficiently early disease stage have a near-normal life expectancy. Yet their lives are markedly different in some ways from the lives of people without HIV. The prevalence of multimorbidity is higher in PLHIV than in the general population, with a wide range of infectious and noninfectious conditions contributing to the multimorbidity burden. PLHIV report being troubled by uncertainty about the future, and have high levels of depression and anxiety. Furthermore, even among PLHIV who have responded well to ART, some studies have documented poorer health-related quality of life (HRQoL) in comparison to that of the general population. PLHIV also report experiencing a high symptom burden, social isolation and multiple forms of HIV-related stigma. Improving the health and HRQoL of PLHIV in the context of high uptake of ART is the ultimate goal of the group of studies presented in the following thesis, which describes the development and piloting of a novel patient-reported outcome measure (PROM) for use in HIV clinical care in Spain. This work is timely because of the pressing need to rethink conventional approaches to HIV care in Spain and many other countries. From the mid-1990s onward, healthcare providers and public health experts have emphasised the importance of using ART to reduce viremia in PLHIV, while giving less attention to other health-related issues in this population. However, with growing awareness of the high burden and health effects of these other issues, it has become clear that conventional criteria for assessing the effectiveness of HIV care in terms of viral load outcomes and HIV-related mortality are insufficient. There are growing calls by researchers, PLHIV and other stakeholders for the HIV community to recognise the quality of life of PLHIV as a major healthcare concern. This changing paradigm is reflected in the UNAIDS Global AIDS Strategy for 2021–2026, which addresses “optimizing quality of life and well-being across the life-course”. Integrating people-centred healthcare principles and standards into clinical practice is an essential strategy for improving the HRQoL of PLHIV who are engaged in care. Taking a people-centred approach entails giving attention to the health-related issues that matter to individual PLHIV rather than merely focusing on how to halt HIV disease progression. There must be effective communication between patients and healthcare providers in order for patients’ needs and preferences to meaningfully inform their interactions with health systems. Various research findings call into question whether HIV care providers sufficiently understand their patients’ concerns. Studies have documented providers’ lack of awareness of clinically important symptoms in PLHIV patient populations, and PLHIV have reported communication barriers with their providers. There is also evidence that HIV care providers and PLHIV may not be in agreement about healthcare priorities. At the time of this writing, various stakeholders had published recommendations and guidance regarding the health-related needs of PLHIV beyond viral suppression, and the World Health Organization’s draft 2022–2030 strategy on HIV calls on countries to “address chronic care needs of adults and children living with HIV”. Clinical tools are needed to support healthcare providers in implementing this vision. PROMs can make an important contribution to the next chapter of HIV care by providing a structured mechanism for PLHIV to directly express health-related concerns to healthcare providers. PROMs may address a wide range of health-related issues and may be administered via interview, paper-based forms, or digital devices such as touch-screen tablets. Historically, they have had a more prominent role in research than in clinical practice. In recent years, there has been increasing interest in the potential for PROMs to contribute to clinical management across different healthcare fields, in part because of greater awareness of the principles of people-centred healthcare. When PROMS are used effectively in clinical practice, benefits may include greater provider awareness of health issues, improved patient-provider communication, more effective symptom management, and better health and HRQoL outcomes. There is currently an unmet need for short broadly focused PROMs that can give healthcare providers a convenient means of identifying disparate health-related challenges commonly experienced by PLHIV. The general objective of the body of research presented in this thesis is to design and pilot a PROM instrument that can be used in routine clinical practice to identify issues undermining the health-related quality of life of PLHIV in Spain, thus aiding health systems in responding more effectively to the long-term needs of this population beyond antiretroviral therapy. METHODS: The research presented in this thesis is based on three studies, which are presented in four articles. The first study was a policy survey that collected data from one expert in each of six European countries to investigate health system capacity to monitor aspects of healthcare such as mental health and psychosocial services. Findings are reported in Article 1. The second study used an observational cross-sectional ex-post-facto study design to validate the Spanish version of WHOQOL-HIV-BREF, a widely used HIV-specific HRQoL PROM, and to explore the HRQoL of Spanish PLHIV. Findings are reported in Article 2. The third study focused on the development of the CST-HIV in accordance with standard instrument development procedures. Findings from the first two phases of the study process, a literature review and a qualitative investigation of PLHIV and healthcare provider perceptions of issues that undermine the well-being of PLHIV in Spain, are reported in Article 3. Findings from the latter phases, including a Spanish pilot study assessing the psychometric properties of the new instrument, are reported in Article 4. RESULTS: The first article reports on a policy survey that investigated the national monitoring of HIV care issues in six European countries: Estonia, Italy, the Netherlands, Slovenia, Sweden and Turkey. The survey was administered in April–June 2018, with one purposively selected expert in each country providing information about health system monitoring capacity in relation to issues such as comorbidities, HRQoL, psychosocial services, and HIV-related discrimination in healthcare settings. According to respondents, only two countries (Slovenia and Sweden) had the capacity to monitor indicators addressing the screening, diagnosis and treatment of anxiety and depression. None of the respondents reported the use of national- level indicators to monitor the provision of psychosocial services. Respondents from three countries (the Netherlands, Slovenia and Sweden) indicated that their national monitoring systems had the capacity to report on the HRQoL of PLHIV. The second article reports on the validation of WHOQOL-HIV-BREF in a nationally representative sample of PLHIV in Spain (N=1,462) and on the HRQoL of this population. Data were collected between October 2016 and April 2017. Psychometric testing demonstrated that the Spanish version of the instrument has adequate construct, convergent and concurrent validity. Female study participants and heterosexual study participants had poorer HRQoL in comparison to their counterparts, as did people with low socioeconomic status, people who had been living with HIV for a longer period of time, and people older than 50. The third article reports on the literature review findings and focus group discussion findings that informed the early development of the CST-HIV. The literature review documented high prevalence of symptoms such as sleep-related problems, fatigue, and pain in PLHIV populations, and also identified studies that showed symptom burden and other issues such as social support, emotional health and material security to be associated with HRQoL in PLHIV. An analysis of data from the focus group discussions, two with HIV service providers (N=8 per group) and two with PLHIV (N=8 and N=7), identified a number of broad categories of issues impacting the HRQoL of PLHIV. The issues emphasised the most by both categories of focus group participants were social problems including HIV-related stigma and discrimination, sleep-related problems, fatigue, pain, and emotional distress. The fourth article reports on the entire CST-HIV instrument development process, including the definition of domains, development of potential items, expert assessment of items, cognitive debriefing interviews with eight PLHIV, and validation of the instrument in a cohort of 226 PLHIV in Spain. The eight domains chosen for the initial pilot instrument were anticipated stigma, emotional distress, sexuality, social support, material deprivation, sleep/fatigue, cognitive problems, and physical symptoms. Pilot findings confirmed the suitability of these domains, and led to the selection of three items per domain from among the 40 items used in the pilot instrument. The resulting 24-item instrument met standards for content, face, construct, convergent and concurrent validity. DISCUSSION AND CONCLUSIONS: The results of this thesis contribute to ongoing efforts to reorient HIV care to address the wide-ranging physical, emotional and social issues that challenge people who are living with HIV on a long-term basis. The PROM developed through this research, the CST-HIV, shows adequate preliminary validity and is currently undergoing additional validation to strengthen the evidence supporting its use in routine clinical care. To our knowledge, it is one of only three short validated instruments developed specifically to support HIV care providers in identifying a wide range of health-related issues that affect the well-being of PLHIV, and the only such instrument developed in Spain. The CST-HIV was developed through a methodologically rigorous process that closely followed best practices for instrument development. It displayed good psychometric properties in pilot testing, as well as evidence of convergent and concurrent validity. Its brevity and simplicity allow for rapid completion by clinic patients and easy assessment of data by healthcare workers. In light of these considerations, the research team anticipates that the CST-HIV has the potential to meaningfully inform HIV care in Spain, and perhaps also in other countries with similar social, cultural, epidemiological and health system contexts. Methodologically rigorous studies are needed to assess how the use of the CST-HIV affects specific dimensions of the clinical experience such as patient-provider communication, clinical decision-making, and health and HRQoL outcomes. Commonalities and differences can be observed when the CST-HIV is compared to two other short, broadly focused PROMS developed to support the clinical care of PLHIV: the Positive Outcomes PROM, developed in England and Ireland, and the Short-Form HIV Disability Questionnaire, developed in Canada. It is not known how differences among PLHIV and healthcare providers in Spain and these other settings might be reflected in differences across the CST-HIV and these other two instruments. Thus, an open question that should inform future research and practice in this area is whether one instrument or another might be a better “fit” with the self-defined needs of PLHIV and healthcare providers in other countries. In sum, the CST-HIV is a promising new tool for improving healthcare for PLHIV in Spain. Its relevance for HIV care in other countries should be explored. Researchers must engage with policy-makers and affected communities to maximise the potential for PROMs of this nature to contribute to advancing the multidimensional health and HRQoL of PLHIV, consistent with the World Health Organization’s vision of health as “a state of complete physical, mental and social well-being and not merely the absence of disease or infirmity”.
INTRODUCCIÓN: Casi 38 millones de personas vivían con VIH a finales del 2020, de los cuales se estima que el 73% estaban recibiendo terapia antirretroviral (TAR). El panorama del VIH ha cambiado enormemente desde que se introdujeron los primeros, altamente efectivos regímenes de TAR en 1996 y las personas con VIH que inician TAR en una etapa suficientemente temprana de la enfermedad tienen una esperanza de vida casi normal. Sin embargo, sus vidas son notablemente diferentes de alguna manera en comparación con las personas sin VIH. La prevalencia de multimorbilidad es mayor en personas con VIH que en la población general, con una amplia gama de enfermedades infecciosas y no infecciosas que contribuyen a la carga de multimorbilidad. Las personas con VIH reportan que se preocupan por la incertidumbre sobre el futuro y tienen altos niveles de depresión y ansiedad. Además, incluso entre las personas con VIH que han respondido bien al TAR, algunos estudios han documentado una peor calidad de vida relacionada con la salud (CVRS) en comparación con la población general. Las personas con VIH también reportan sentir una alta carga de síntomas, aislamiento social y múltiples formas de estigma relacionado con vivir con VIH. Mejorar la salud y CVRS de personas con VIH en un contexto de alta captación de TAR es el objetivo final del grupo de estudios presentados en la siguiente tesis, la cual describe el desarrollo y pilotaje de una nueva medida de resultado reportado por el paciente (por sus siglas en inglés, PROM - patient-reported outcome measure) para su uso en la atención clínica del VIH en España. Este trabajo es oportuno debido a la necesidad apremiante de repensar el abordaje convencional de la atención del VIH en España y muchos otros países. A partir de mediados de la década de los 90, los proveedores de atención médica y expertos en salud pública han enfatizado la importancia de usar el TAR para reducir la viremia en personas con VIH, prestando menos atención a otros temas relacionados con la salud en esta población. Sin embargo, debido a la conciencia creciente sobre las altas cargas y los efectos de salud de estas otras cuestiones, ha quedado claro que los criterios convencionales para evaluar la efectividad de la atención del VIH en términos únicamente en resultados de carga viral y mortalidad relacionada con el VIH son insuficientes. Hay llamadas crecientes a reconocer la calidad de vida de las personas con VIH como una preocupación importante de atención médica por parte de investigadores, personas viviendo con VIH y otras partes interesadas en la comunidad del VIH. Este paradigma cambiante se refleja en la Estrategia Mundial sobre el Sida 2021-2026 del Programa Conjunto de las Naciones Unidas sobre el VIH/Sida (ONUSIDA), que aborda "optimizar la calidad de vida y el bienestar a lo largo del curso de la vida". La integración de estos principios y estándares de atención médica centrados en las personas en la práctica clínica es una estrategia esencial para mejorar la CVRS de personas con VIH que están recibiendo cuidado. Un abordaje centrado en la persona conlleva prestar atención a las cuestiones relacionadas con la salud que son importantes para una persona viviendo con VIH en lugar de simplemente centrarse en cómo detener la progresión de la enfermedad del VIH. Debe haber comunicación efectiva entre pacientes y proveedores de atención médica para que las necesidades y preferencias de los pacientes informen de manera significativa sus interacciones con los sistemas de salud. Varios hallazgos de investigación cuestionan si los proveedores de atención del VIH comprenden suficientemente las preocupaciones de sus pacientes. Varios estudios han documentado la falta de conocimiento de los proveedores de los síntomas clínicamente importantes en las poblaciones de pacientes con VIH y personas con VIH han reportado barreras de comunicación con sus proveedores. También hay evidencia de que los proveedores de atención del VIH y las personas con VIH pueden no estar de acuerdo sobre las prioridades de atención médica. En el momento de esta escritura, varias partes interesadas habían publicado recomendaciones y guías con respecto a las necesidades relacionadas con la salud de las personas con VIH, más allá de la supresión viral, y el borrador de la estrategia del 2022-2030 de la Organización Mundial de la Salud (OMS) sobre el VIH llama a que los países "aborden las necesidades de atención crónica de los adultos y niños que viven con VIH". Se necesitan herramientas clínicas para apoyar a los proveedores de atención médica en la implementación de esta visión. Los PROMs pueden contribuir importantemente en el siguiente capítulo de atención del VIH al proporcionar un mecanismo estructurado para que las personas con VIH puedan expresar directamente sus preocupaciones relacionadas con la salud a los proveedores de atención médica. Los PROMs pueden abordar una amplia gama de problemas relacionados con la salud y pueden administrarse a través de entrevistas, formularios de papel o dispositivos digitales, como tabletas de pantalla táctil. Históricamente, los PROMs han tenido un papel más prominente en la investigación que en la práctica clínica. En los últimos años, ha habido un interés creciente en el potencial de la contribución de los PROMs en la gestión clínica en diferentes campos de atención médica, en parte debido a una mayor conciencia de los principios de la atención médica centrada en las personas. Cuando los PROMs se utilizan de manera efectiva en la práctica clínica, los beneficios pueden incluir un mayor conocimiento delos problemas de salud por parte del proveedor, una mejor comunicación entre el proveedor y el paciente, una gestión más efectiva de los síntomas y mejora en los resultados de salud y CVRS. En la actualidad existe una necesidad insatisfecha de PROMs cortas y ampliamente enfocadas que puedan dar a los proveedores de servicios de salud un medio conveniente para identificar los diferentes desafíos relacionados con la salud que comúnmente experimentan las personas que viven con VIH. El objetivo general del cuerpo de investigación presentado en esta tesis es diseñar y pilotar un instrumento de PROM que se pueda usar en la práctica clínica rutinaria para identificar problemas que socavan la CVRS de personas con VIH en España, lo que ayudará a los sistemas de salud al responder más efectivamente a las necesidades a largo plazo de esta población, más allá del TAR. MÉTODOS: La investigación presentada en esta tesis se basa en tres estudios que se presentan en cuatro artículos. El primer estudio fue una encuesta de políticas que recopiló datos de un experto en cada uno de los seis países europeos para investigar la capacidad del sistema de salud para monitorear los aspectos de la atención médica, como la salud mental y los servicios psicosociales. Los hallazgos están reportados en el Artículo 1. El segundo estudio utilizó un diseño de estudio ex post facto transversal observacional para validar la versión española del “WHOQoL-HIV-BREF”, un PROM de CVRS específico para el VIH ampliamente utilizado, y para explorar la CVRS de personas con VIH de España. Los hallazgos están reportados en el Artículo 2. El tercer estudio se centró en el desarrollo del PROM “CST-VIH” de acuerdo con los procedimientos de desarrollo de instrumentos estándar. Los hallazgos de las dos primeras fases del proceso de estudio, una revisión de la literatura y una investigación cualitativa de las percepciones de personas con VIH y proveedores de atención médica sobre problemas que socavan el bienestar de personas con VIH en España, están reportados en el Artículo 3. Los hallazgos de las últimas fases, incluyendo un estudio piloto español que evalúa las propiedades psicométricas del nuevo instrumento, están reportados en el Artículo 4. RESULTADOS: El primer artículo se trata de una encuesta de políticas que investigó el monitoreo nacional de los problemas de atención del VIH en seis países europeos: Estonia, Italia, Holanda, Eslovenia, Suecia y Turquía. La encuesta se administró de abril a junio del 2018, con un experto seleccionado a propósito en cada país que proporciono información sobre la capacidad de monitoreo del sistema de salud en relación con temas como las comorbilidades, la CVRS, los servicios psicosociales y la discriminación relacionada con el VIH en entornos de atención médica. Según los encuestados, solo dos países (Eslovenia y Suecia) tenían la capacidad de monitorear los indicadores que abordan el cribado, diagnóstico y tratamiento de la ansiedad y depresión. Ninguno de los encuestados report el uso de indicadores a nivel nacional para monitorear la provisión de servicios psicosociales. Los encuestados de tres países (Holanda, Eslovenia y Suecia) indicaron que sus sistemas de monitoreo nacional tenían la capacidad para reportar sobre la CVRS de personas con VIH. El segundo artículo informa sobre la validación del WHOQoL-HIV-BREF en una muestra representativa a nivel nacional de personas con VIH en España (n = 1,462) y la CVRS de esta población. Los datos se recopilaron entre octubre del 2016 y abril del 2017. Pruebas psicométricas demostraron que la versión española del instrumento tiene una construcción adecuada y una validez convergente y concurrente. Las mujeres que participaron en el estudio y los participantes heterosexuales tuvieron una peor CVRS en comparación con sus contrapartes, al igual que las personas de estrato socioeconómico bajo, las personas que habían estado viviendo con VIH durante un período de tiempo más largo y las personas mayores de 50 años. El tercer artículo trata sobre todo el proceso de desarrollo de instrumentos CST-VIH, incluida la definición de dominios, el desarrollo de ítems potenciales, la evaluación experta de los ítems, los interrogatorios cognitivos con ocho personas con VIH y la validación del instrumento en una cohorte de 226 personas con VIH en España. Los ocho dominios elegidos para el instrumento piloto inicial fueron el estigma anticipado, la angustia emocional, la sexualidad, el apoyo social, la privación material, el sueño/fatiga, los problemas cognitivos y los síntomas físicos. Los hallazgos del piloto confirmaron la idoneidad de estos dominios, y llevaron a la selección de tres ítems por dominio entre los 40 elementos utilizados en el instrumento piloto. El instrumento resultante de 24 elementos cumplió con los estándares para el contenido, la cara, la construcción y la validez convergente y concurrente. El cuarto artículo informa sobre los hallazgos de la revisión de la literatura y los hallazgos de las discusiones de los grupos de enfoque que informaron el desarrollo temprano del CST- VIH. La revisión de la literatura documentó la alta prevalencia de síntomas, como los problemas relacionados con el sueño, la fatiga y el dolor en las poblaciones de personas con VIH, y también identifico estudios que demostraron que la carga de síntomas y otros asuntos, como el apoyo social, la salud emocional y la seguridad material se asocian con la CVRS en personas con VIH. Un análisis de los datos de las discusiones de los grupos de enfoque, dos con proveedores de servicios de VIH (n = 8 por grupo) y dos con personas con VIH (n = 8 y n = 7), identificó una serie de categorías amplias de problemas que afectan la CVRS de personas con VIH. Las cuestiones más destacadas por ambas categorías de participantes de los grupos de enfoque fueron problemas sociales, incluido el estigma y la discriminación relacionados con el VIH, los problemas relacionados con el sueño, la fatiga, el dolor y la angustia emocional. DISCUSIÓN Y CONCLUSIONES: Los resultados de esta tesis contribuyen a los esfuerzos en curso para reorientar la atención del VIH con el fin abordar la amplia gama de problemas físicos, emocionales y sociales que desafían a las personas que viven con VIH a largo plazo. El PROM desarrollado a través de esta investigación, el CST-VIH, demuestra una validez preliminar adecuada y actualmente está siendo validada más allá para fortalecer la evidencia que respalde su uso en la atención clínica rutinaria. Hasta donde sabemos, este es uno de los tres instrumentos concisos y validados, desarrollados específicamente para ayudar a los proveedores de atención del VIH en la identificación de una amplia gama de problemas relacionados con la salud que afectan al bienestar de las personas con VIH y el único instrumento de este tipo desarrollado en España. El CST-VIH se desarrolló a través de un proceso metodológicamente riguroso que siguió de cerca las mejores prácticas para el desarrollo del instrumento. Este demostró buenas propiedades psicométricas en las pruebas piloto, así como validez convergente y concurrente. Su brevedad y simplicidad permiten la finalización rápida por pacientes en las clínicas y una fácil evaluación de los datos por parte de los trabajadores de la salud. A la luz de estas consideraciones, el equipo de investigación anticipa que el CST-VIH tiene el potencial de informar significativamente la atención del VIH en España y quizás también en otros países con contextos similares, epidemiológicos y de salud. Se necesitan estudios metodológicamente rigurosos para evaluar cómo el uso del CST-VIH afecta las dimensiones específicas de la experiencia clínica, como la comunicación entre el proveedor y el paciente, la toma de decisiones clínicas y los resultados de salud y CVRS. Se pueden observar similitudes y diferencias cuando el CST-VIH se compara con otros dos PROMs concisos y ampliamente enfocados desarrollados para respaldar la atención clínica de personas con VIH: el PROM “Positive Outcomes” (“Resultados Positivos”), desarrollado en Inglaterra e Irlanda, y el “Short-Form HIV Disability Questionnaire” (“Cuestionario Corto de Discapacidad del VIH”), desarrollado en Canadá. Aún no se sabe cómo las diferencias entre las personas con VIH y los proveedores de atención médica en España y estos otros entornos pueden reflejarse en las diferencias en el CST-VIH y estos otros dos instrumentos. Por lo tanto, una pregunta abierta que debe informar a futuras investigaciones y prácticas en esta área es si un instrumento u otro podría encajar mejor con las necesidades autodefinidas de las personas con VIH y los proveedores de atención médica en otros países. En resumen, el CST-VIH es una nueva herramienta prometedora para mejorar la atención médica para las personas con VIH en España. Se debe explorar su relevancia dentro de la atención del VIH en otros países. Los investigadores deben interactuar con los responsables de la formulación de políticas y las comunidades afectadas para maximizar el potencial de los PROMs de este tipo, para contribuir a promover la salud multidimensional y CVRS de las personas con VIH, lo cual es consistente con la visión de la salud de la OMS como “un estado de completo bienestar físico, mental y social, y no solamente la ausencia de afecciones o enfermedades”.

Safety net clinics across the country struggle with a lack of resources to tackle the needs presented. Screening programs set up for children and elderly have proven to be effective in triaging need, prioritizing care, and maximizing resources. These programs do not currently exist for working uninsured adults. Research was initiated to answer the question: Does the screening process improve patient care for the community clinic? During a 6-week pilot study a licensed dental hygienist performed 30 screenings in the community clinic setting. Findings were recorded and coded according to patient’s level of need identified. Pre- and posttest data for patient care factors were attained. Statistical tests showed a significant effect on patient care factors. While the evidence existed to support the implementation of screening, more research would quantify the specific impact on this population.

Well-Child Examinations are an integral part of monitoring growth and development for children. These visits allow for establishment of a therapeutic relationship between patient and caregiver, and provide opportunities to screen for underlying conditions while simultaneously following growth and development milestones. Well-child examinations provide opportunities for parents to voice concerns and help to identify those children at risk for delays or underlying medical conditions. When these conditions are identified early, they tend to have an improvement of outcomes. Since the core items to be included in wellness examinations vary by age, insurance provider, and risk factors, our aim is to measure and improve the knowledge and comprehension of examination components among a group of Family Medicine resident physicians that provide primary care to a pediatric population. Provider knowledge and understanding was measured by means of a set of multiple-choice questions prior to an educational session. A post-educational examination was then administered to assess recruitment and retention of information. There appeared to be an overall positive trend toward increased knowledge base following the education session, indicating and improvement of understanding and medical knowledge.

Thesis (M.S.C.E.) PLEASE NOTE: Boston University Libraries did not receive an Authorization To Manage form for this thesis or dissertation. It is therefore not openly accessible, though it may be available by request. If you are the author or principal advisor of this work and would like to request open access for it, please contact us at open-help@bu.edu. Thank you.
BACKGROUND: Patient navigation programs were designed to address barriers to healthcare among underserved populations in order to reduce delays in cancer care delivery. While emerging data suggest modest effects of navigation on reducing delays, there is limited understanding of the association between barriers to care and clinical outcomes within patient navigation programs. OBJECTIVE: To investigate the impact of barriers on timely diagnostic care in the multicenter Patient Navigation Research Program (PNRP). STUDY DESIGN: Secondary analysis of data from the intervention arms of PNRP centers that navigated women for abnormal breast or cervical cancer screening tests from 2007 to 2010. METHODS: Analyses were performed separately for breast and cervical subjects. The main independent variables were (a) number of unique barriers to care (0, 1, 2, or 3+) documented during patient navigation encounters and (b) presence of socio-legal barriers (yes/no), those social problems related to meeting life’s most basic needs that are supported by public policy, regulation, and programming and thus potentially remedied through legal advice or advocacy. The outcome of interest was median time to diagnostic resolution, or the interval from index screening abnormality to diagnostic resolution, estimated using Kaplan-Meier cumulative incidence curves. Multivariable Cox proportional hazards regression with time to diagnostic resolution as the outcome examined the impact of barriers, controlling for socio-demographics and stratifying by study center. RESULTS: Among 2600 breast screening subjects, three-quarters had barriers to care (25% 1 barrier, 16% 2 barriers and 34% 3+ barriers). Among 1387 cervical screening subjects, slightly more than half had barriers (31% 1 barrier, 11% 2 barriers, and 13% 3+ barriers). Among breast subjects, we found the presence of barriers was associated with less timely resolution for any number of barriers compared to no barriers. Among cervical subjects, only the presence of 2 or more barriers was associated with less timely resolution. Both socio-legal and non socio-legal barriers were associated with delay among breast and cervical subjects. CONCLUSIONS: Navigated women with barriers resolve cancer screening abnormalities at a slower rate compared to those with no barriers. Further research is necessary to maximize the impact of patient navigation programs nationwide.
2031-01-01

People living with heart failure (PLHF) should be screened for symptoms at every healthcare visit since they are 3 times more likely to experience ventricular arrhythmias. This quality improvement project (QIP) compared 3 self-administered HF symptoms questionnaires to determine the best screening tool for a tertiary hospital arrhythmia devices clinic. The instruments included the Minnesota Living with Heart Failure Questionnaire (MLHFQ), the Kansas City Cardiomyopathy Questionnaire (KCCQ), and the Self-Reported Heart Failure Symptoms (SHEFS) questionnaire. For a 30-day period, 76 people were eligible to participate in the QIP, with 55 participants included in the final analysis (72.5% participation). The questionnaires were compared and assessed with the gold standard laboratory test for HF (NT-proBNP) for sensitivity and specificity. For HF, the SHEFS was the most sensitive (83%) compared to the NT-proBNP, but the MLHFQ was most specific (89%). When compared to the MLHFQ as the standard, SHEFS was 71% sensitive, and 73% specific for HF. Similarly, when compared to the KCCQ, the SHEFS was both, 75% specific and sensitive in identifying HF. However, the rate of correlation to a positive or negative NT-proBNP test results was the highest for the SHEFS (87%). All 3 questionnaires were statistically significant in predicting admission to hospital for HF in the past 6 months (p = 0.02 to 0.03). Finally, given the shortest length and simplicity of use, the SHEFS was selected by the stakeholders to be the standard screening tool for the clinic. This project contributes to positive social change by providing the first reported comparison in the literature to implement questionnaires in a clinic to assess symptoms for PLHF attending an arrhythmia devices clinic.

Purpose The Johnson City Downtown Day Center (JCDDC) provides integrated inter-professional primary care, mental health, and social work case management services to homeless and under-served persons who have difficulty accessing traditional systems. Because of the exponential rise in substance abuse in the Appalachian region, the JCDDC providers and staff initiated SBIRT as recommended standard of care, as endorsed by SAMHSA, United States Public Health Services Task Force, and the National Institute on Alcohol Abuse and Alcoholism. The JCDDC has two mechanisms by which patients can choose to participate in substance abuse treatment: SMART Recovery, and psychiatric nurse practitioner (NP) referrals. The purpose of the project evaluates use of SBIRT at the JCDDC by determining process of (1) referral and (2) follow-up rates of those who received SBIRT; analyzing outcomes by measuring numbers of: (1) screens administered; (2) brief interventions; (3) positive screens; (4) referrals to either SMART Recovery or to the psychiatric NP; (5) participation in one follow-up. Review of Literature: Approximately 6.4 million people, or 2.4% of the U.S. population 12 years and older, currently misuse prescription medications. There is an undeniable and tangible correlation between the chronic disease of substance use disorder and unstable housing or homelessness (de Chesnay & Anderson, 2016). Similarly, substance use disorder was found to be much more common in people facing homelessness than in people who had stable housing (National Coalition for the Homeless, 2009). Substance Abuse and Mental Health Services Administration (SAMHSA) has been the most significant funding source for SBIRT proliferation in the United States. Despite a demonstrated need for substance abuse services among this vulnerable population, people who are homeless have substantially greater barriers to obtaining treatment and often go without. Summary of Innovation or Practice The current SBIRT process includes use of DAST-10 and AUDIT tools. Evaluating clinic processes and outcomes in vulnerable populations who have inconsistent erratic follow-up is challenging. However, new ways of understanding patterns and incremental outcomes is essential to addressing clinic practice that can impact outcomes in vulnerable groups. Implications for NPs The heterogeneity of the homeless population is often precipitated by a host of complicating factors including co-occurring mental illness, multiple chronic conditions, unstable income, and lack of transportation. Therefore, the importance of finding effective, cost-conscious processes that are population specific and patient-centered is essential for future research and policy. The inter-professional model of care also informs future practice by evaluating the feasibility of administering all of the elements of SBIRT in a single facility.

WISEWOMAN (WW) is a comprehensive program for medically underserved women in South Dakota (SD), aged 30 to 64, which aims to reduce morbidity and mortality from chronic diseases. Screening services include blood total cholesterol, blood pressure and blood glucose, and body mass index (BMI). Lifestyle intervention (LSI) sessions are also offered to address physical activity and nutrition. The purpose of this retrospective longitudinal study was to quantitatively examine whether the combination of LSI's and clinical screenings or clinical screenings alone lead to improvements in blood pressure, blood glucose, total cholesterol, and/or BMI at rescreening 10 to14 months from initial screening. Guided by the social ecological model, it was hypothesized that SD-WW participants attending the screening sessions as well as the intervention sessions would have greater reductions in blood pressure, total cholesterol, and blood glucose than participants who only received screenings. Participants included 653 low-income women aged 30 to 64 enrolled in the screening alone (N=423) and SD-WW program (N=230) from 2000-2005, who completed both the screening and rescreening 10 to14 months later. Secondary data analysis using forced-entry multiple regression of the traditional measures employed in the screening alone control condition yielded significant predictive models for change scores in blood pressure, BMI, blood glucose, and cholesterol among all participants. Neither dummy variable regression nor ANOVA results indicated any significant impact of the SD-WW intervention on these same health outcome changes. Findings contribute to positive social change by demonstrating that screening alone is effective in predicting health outcomes, thus allowing more disadvantaged women to be served by public agencies that may face reduced funding for their array of programs.

Despite there being pragmatic national guidelines for assigning risk to women with a family history of breast cancer, the evidence base is still sparse. There are three major questions: First, how can an assignment of "low" risk be made most efficiently? Second, what are the actual outcomes for higher-risk women enrolled in special surveillance programmes? Third, what are the costs and benefits of current management of members of breast cancer families? My thesis reviews the evolution of clinical services for familial breast cancer and the existing literature in the field. I describe the gathering of information from the service records of the Tayside Breast Cancer Family History Clinic and from specific research exercises that involved collaboration with other centres in the UK and abroad. My findings are as follows: 1. Histories provided by the families are not sufficient to assign risk accurately. They must be extended and verified from other records by clinical geneticists. Women assigned a low risk can be informed by post, but some may require further support. The 2004 NICE guidelines for assigning risk are fairly accurate, but may under-estimate it for some women aged 45--55 years. 2. Annual screening of young women at increased risk results in detection of most cancers at a curable stage. Women who carry BRCA1 mutations fare less well, even when tumours are detected at an apparently early stage. 3. Costs of accurate risk assessment are outweighed by savings from the better targeting of surveillance programmes. Early cancer detection in young women enrolled in these programmes achieves a substantial gain in life expectancy at a cost of £3,700 per quality adjusted life year (QALY). Prophylactic surgery for carriers of BRCA1 mutations is highly cost-effective. The thesis concludes with a discussion as to how these findings might be extended and clinical practice improved in the future.

Cervical cancer can be detected and successfully treated through recommended Pap screenings, but it remains the second most diagnosed type of cancer among women, due in large part, to lack of participation in recommended screening. Researchers utilize different theories when attempting to predict health behaviors, such as theory of planned behavior (TPB). TPB remains a primary lens through which health studies are conducted. However, TPB does not take into account the affective components that have been shown to influence decision making and behavior, such as fear. Fear of cancer has been shown to influence decision making with respect to preventative healthcare. The purpose of this quantitative, correlational study was to attempt to determine to what extent fear of cancer served as a predictor of Pap screening behaviors, over and above the predictive value of TPB. A convenience sample of women between the ages of 21 - 65 years, with a mean age of 46.6 years, was recruited via social media to participate in an online survey which is the demographic for whom Pap screening is recommended. Independent variables included TPB components (attitudes, subjective norms, and perceived behavior control) and fear of cancer. Demographic variables (age, race, and socioeconomic status) were controlled during hierarchical regression analysis in order to predict the dependent variable - intention to get Pap screenings. Multiple regression analysis showed that TPB components were all significant predictors of pap screen intention. Perceived behavior control (PBC) (t (85) = 4.357, p < .001), attitudes (t (85) = 2.046, p < .05), and subjective norms (SN) (t (85) = 2.550, p < .05) were all significant predictors of PSI. Demographics and fear of cancer (FOC) were not significant within this coefficient model. However, in terms of generalizing results to the larger population of women between 21 – 65 years, the model summary showed that demographics only accounted for .02% predictability, but when TPB components were added to the model, they accounted for 43% of the variance. Finally, when FOC was subsequently introduced to the model, predictability of pap screen intention increased from 43% to 44.5%. Albeit a small increase, these results suggest that while FOC may not be a better predictor over and above the predictive value of TPB components, a combination of affective components and TPB components may be beneficial for future health care studies.

Cervical cancer, a completely curable disease with early detection and management, is an international concern. Early identification allows for treatment of the disease, which prevents or slows progression, ultimately reducing morbidity and mortality. Due to the regressive nature of most cervical lesions, the duration between cervical cytology has been lengthened to prevent over diagnosis and treatment. This was reflected in the 2012 United States Preventative Services Task Force (USPSTF) clinical practice guideline for cervical cancer screening. The purpose of this project was to determine the effectiveness of a quality improvement initiative to increase adherence to the 2012 USPSTF guideline at a volunteer medical clinic for the working uninsured. In this retrospective, time series observational evaluation, data were collected via chart review regarding adherence to the guideline. The intervention consisted of the placement of a visual algorithm educational tool for clinical decision-making for cervical cytology screening in each exam room. Data were collected during three time periods: (1) the 3 months prior to initial education of clinic staff regarding the guideline; (2) the 3months between initial education and introduction of the algorithm; and (3) the 3 months post introduction of the algorithm. A total of 335 charts were reviewed. There was a significant difference in the proportion of appropriate screening among the three groups (Χ2= 6.83 p=.03). There was also a significant difference in appropriate screening rates between the new and established patients’ group, controlling for group (p<.0001). The use of the interventional algorithm is recommended to improve adherence to evidence-based practice guideline related to cervical screening as it decreases harm(s) to the patient by reduction of fear, cost to the patient, and overtreatment of benign regressive lesions.

Lung cancer affects many individuals each year and accounts for many deaths around the globe. Lung cancer screening is a preventative health measure that has the ability to detect lung cancer earlier. The purpose of this project was to focus on the education of nursing staff within a community health system, with subsequent implementation of an electronic health record clinical decision support system, to create a direct referral pathway to lung cancer screening, delivered through patient education. The concept of prevention was the framework for this project design, which was further organized around the plan-do-study -act model, while taking into consideration the health belief model and theory of interpersonal relations. Using systemized dashboard reports within the electronic health record software, specific variables were targeted for data collection and analyzed for the purpose of this project. Final data demonstrated an increase of triple the programmatic volume of the previous year, directly following the implementation of the above initiative. Further comparative statistics bespeak to the significant needs of the community regarding tobacco dependence and lung cancer screening. High-risk individuals who are current or former smokers will benefit from this initiative by receiving education about lung cancer screening and tobacco dependence treatment while within the care of the community based health system. A nursing-driven pathway to preventative care could also serve other cancer screening programs effectively, as well as be applied to a variety of chronic disease comorbidities to make a significant positive social change.

Although less than half of all patients with mental disorders seek mental health treatment per se, approximately 80% of all people will visit their primary care physician (PCPs) within a year (Strosahl, 1998). However, it is not well understood how to best handle patients presenting with mental health issues in primary care practices. The purpose of this project was to implement an intervention involving a screening measure for anxiety and mood disorders in a primary care setting to increase the volume of anxiety and mood disorder screening, to increase the accuracy of disorder detection, and to also enhance PCPs patterns of referral to mental health professionals (MHPs). Though starting with a quantitative design, difficulties encountered throughout the project eventually led to a largely qualitative analysis, which did yield useful information. A pilot project demonstrated anxiety and mood disorders were commonly noted in patients’ medical charts (46%), but also found referrals were rarely made for mental health services (7%), despite colocation of a licensed psychologist and licensed clinical social worker within the practice. This indicated that services available to provide comprehensive integrated total health care may not be have been used to their full potential. In the main project, 59 participants from a family medicine clinic and 20 PCPs from that clinic participated. The My Mood Monitor (M3) was administered to the patients and became part of their Electronic Medical Records (EMR). The M3 screens for anxiety, depression, and bipolar disorders within primary care settings. In 2 separate noon conferences, PCPs were trained on diagnostic criteria for anxiety disorders and mood disorders, interpretation of M3 results, and the internal Mental Health Professional referral process. The project was hampered by a full-scale switch from paper-based medical records to an EMR and accompanying lack of user experience with EMR functions, lack of efficient transfer of M3 results into the EMR, and an unforeseen switch of psychologists mid-way through the study. However, results were obtained that showed relatively low levels of PCP review of M3 results, potentially high rates of anxiety disorders and mood disorders within the setting, relatively high levels of PCP knowledge of diagnostic criteria for anxiety and mood disorders, and that patients may not prefer a ‘warm handoff’ model of mental health referral. These findings are couched within a number of important caveats, but future directions for research were clearly implied.

Between one quarter and one third of all primary care patients meet criteria for at least one mental disorder. However, many women are not screened for mental disorders as recommended by the literature. Some studies suggest even lower rates of screening and treatment in rural areas. This researcher sought to identify barriers and facilitators to mental and behavioral health screening and treatment for women in primary care and solicit feedback on how to ameliorate perceived barriers. Given the limited extant data describing rural Appalachian women’s perceptions of barriers and facilitators to receiving mental health services an exploratory qualitative analysis was conducted. Eighteen individual interviews with female primary care patients were conducted. Results identified stigma, lack of support, and lack of patient education around mental health as major barriers; facilitators included integrated care and positive experiences with providers. Directions for future research and implications for behavioral health practice in rural primary care are discussed.

Over one million women in the United States are physically, sexually, or emotionally abused by a partner or former partner every year. Women between the ages of 18 and 34 are the most likely to experience intimate partner violence (IPV), with prevalence rates for that group double the overall national average. Although the U.S. Preventive Services Task Force has recommended universal screening for all women of child-bearing age, compliance with this recommendation remains low. The present study examined the effectiveness of an asynchronous educational intervention to increase perceived knowledge, actual knowledge, and screening behaviors among 44 college-based health care providers. Data were collected using the Physician Readiness to Manage Intimate Partner Violence Survey (PREMIS). Results indicated that participation in the educational intervention did not have a significant effect on provider knowledge or screening behaviors. A positive trend was observed for perceived knowledge and knowledge regardless of treatment condition, but not for screening behaviors. The lack of significant findings may have been related to insufficient sample size and low power. Recruitment was challenging, despite multiple strategies and the offer of one free continuing education credit for all participants. Future research should explore how college health care providers prefer to engage in clinically informed research and whether IPV screening is viewed as an important clinical practice.

This study examined associations among the nutritional risks, the risk levels, and the ages of independently living elderly. The Checklist of the Nutrition Screening Initiative (NSI) was administered to a purposive sample of 1004 Northeast Florida elderly to estimate an age-profile at risk for malnutrition. Checklist nutritional scores (cumulative of ten risks) were grouped into risk levels of low (scores 0-2, 64.3%), moderate (3-5, 29.5%), and high (6 and greater, 24.2%). Within each level, Checklists were grouped by respondents' age into young-old (60-74), old-old (75-79), and fragile-old (80-102). Eight nutritional risks' distribution across risk levels was significantly greater in respondents of the high-risk level as compared to those in the moderate and low-risk levels. A significant difference was found in the distribution of age groups across levels (x2=9.742, df=4, P=.045), with a larger proportion of the fragile-old in the low risk level (53.6%) than either the old-old (42.5%) or the young-old (43.6%). Elderly at greatest risk for malnutrition are aged 74-75 years and report illness, multiple medicines, economic hardship, and reduced social contact. The distribution of the risk "multiple medicines" (x2=12.17, df=4, P=.016) was consistently significant across all risk levels and age groups.

In medical settings, a teachable moment (TM) has been described as an event which may lead to psychological changes prompting individuals to engage in health promoting behaviors. A cancer screening (CS) has been suggested as a potential TM because several types of positive health behavior change (HBC), ranging from dietary changes to smoking cessation, have been linked to CS. However, most research has examined the TM in CS settings using cross-sectional and prospective methodologies and has lacked a theory-driven model. Moreover, few intervention studies have attempted to capitalize on the potential TM in CS settings. In light of this, the primary purpose of this study was to examine the potential for routine ovarian CS to serve as a TM to enhance the potential for HBC using a theory-driven conceptual model of a TM. A prospective, longitudinal design was used to track changes in positive affect, self-efficacy (SE), HBC intentions and HBC following participation in routine ovarian CS. The impact of a brief, written intervention intended to enhance SE to engage in HBC was also examined. There were three total study assessments: the baseline (T1), 24-hour follow-up (T2), and one month follow-up (T3) assessment. Results indicated positive affect and positive consequences of screening increased over time (p’s<.01) and increases in positive affect were positively associated with greater healthy diet HBC. Additionally, greater positive consequences of screening at T2 predicted greater exercise HBC. No significant changes were observed in exercise or healthy diet intentions over time; there were no differential effects based upon the intervention for positive affect, SE, HBC, or HBC intentions (p’s>.05). Healthy diet SE and exercise SE remained stable (p>.05) but were found to be a robust predictor for both exercise and healthy diet HBC intentions. While several of our hypotheses were supported, the brief health information intervention did not appear to impact SE, HBC intentions, or actual HBC. To better equip health providers in CS settings, studies should continue examining both the potential for CS settings to serve as a TM to enhance HBC and how receipt of a normal test result impacts this potential.

This study utilised secondary data from a larger study that looked at individuals that are already infected by HIV which is entitled Implicative personal dilemmas and cognitive conflicts in health decision making in HIV positive adults and adults with AIDS. The primary aim of the larger study was to examine the cognitive construction of the individual and how they utilised their individual resources to construct who they are and how they perceived the difficulties and challenges that they face and the decisions they make regarding their health. HIV and AIDS is a debilitating disease and it affects millions worldwide. South Africa, presently, has the largest burden of this disease with those between the ages of 15 &ndash
49 years of age being most affected. As previously 
mentioned the decisions that individuals make can impact on their health. Decisions to take necessary precautions such as protected sex during sexual intercourse can decrease the 
progression of the disease. Decisions made regarding abstinence of risky behaviour as well as being committed to taking medication could also positively impact health. People living with HIV and AIDS find it 
difficult to adjust to the challenges that this disease presents. Depression is often experienced due to the changes in self image and perception. Studies show that 
females are twice more likely to experience depression than men. There has however been no conclusive evidence showing the reason for this, however, the perception of stress based on 
gender could shed some light on this matter and how these perceptions can increase the likelihood of women being more vulnerable to depression. Due to the limitation of this study, it will 
only look at depression as it relates to HIV and AIDS. Psychological problems such as depression can hamper the adjustment process and the effect of depression is evident in that it can lower the CD 4 + cells. Not only are those 
living with HIV and AIDS affected by depression, but they also have a lifetime prevalence to depression. It is important to have an effective screening tool for depression so that the detection of this 
disease can be made and effective treatment can be implemented to enhance health. The sample consisted of 113 adult participants that have already been diagnosed with HIV and AIDS. The 
primary aim of this study was to compare the Beck&rsquo
s Depression Inventory II (BDI II) and the Hospital Anxiety and Depression Scale &ndash
(the Depression component) (HADS-D) as a screening tool 
 
for depression. Exploratory Factor Analysis revealed a 5 factor structure which accounted for 60.14 % of the total variance. The HADS yielded one factor accounting for 14.33% of total variance. The BDI II has proven to be more a reliable measure of depression with 0.89 according to the Cronbach&rsquo
s Alpha co efficient opposed to 0.375 as per the HADS-D. The secondary aim was to establish 
the sociodemographic and disease profiles of the participants under study.

A lack of consistent, evidence-based practices for blood lead testing of children existed in a local public health department (LHD). No known blood lead level is safe, and toxicity can result in behavioral and cognitive impairments. The purpose of this project was to develop and analyze a clinical practice guideline to establish blood lead testing procedures in the LHD to improve testing procedures and enhance future testing within the jurisdiction. The RE-AIM framework was used to address the reach, effectiveness, adoption, implementation, and maintenance of the clinical practice guideline. Five experts evaluated the guideline using the Appraisal of Guidelines for Research and Evaluation instrument. The assessment results indicated 96.4% agreement across all domains. The experts agreed unanimously to recommend adoption of the clinical practice guideline. Implementation of the guideline might advance nursing practice and patient care in the LHD through incorporation of evidence-based practices. Implementation might also lead to early identification of lead-burdened children and may provide the opportunity for treatment to mitigate cognitive and behavioral deficits related to lead toxicity, thereby improving child health and decreasing related health care costs. Engagement of the clinical practice guideline will support positive social change through the empowerment of public health nurses to provide optimal care to a population of children at risk of deleterious and long-term side effects of lead exposure.

Background: Worksite screening programs are increasingly being provided by employers as a means to reduce cardiovascular risk in employees. A screening program that consists of fasting serum analysis of glucose plus a lipid panel is offered yearly to employees at the VA medical center in Tampa. A retrospective study was conducted to determine if a wellness clinic exposure resulted in significant changes in employees' markers of cardiovascular risk. Methods: Computerized records were used to follow serial outcomes for glucose, triglycerides, HDL cholesterol, and LDL cholesterol in employees whose screening results showed abnormal levels of one or more of these markers. An intervention group with 66 subjects received a wellness clinic visit including a health risk assessment and education for lifestyle change, and a reference group with 109 subjects received only serum analysis. Outcomes at repeat screening were compared for the two groups. Results: Both groups showed improvement in cardiovascular risk. In the intervention group there was significant intra-subject improvement from baseline for all markers except glucose. For triglycerides and LDL cholesterol there was a significantly greater proportion of subjects who improved in the intervention group. In addition, the improvement for triglycerides was significantly better in the intervention group. Conclusions: This investigation confirms the value of a worksite wellness program in reducing cardiovascular risk in the population studied. A differential impact of age and gender was seen for glucose and triglycerides and indicates that such modifiers should be considered through covariate analysis in assessing wellness program effectiveness. Increasing levels of employee wellness participation to targets identified in this study and adding a health risk assessment for everyone screened will help to identify the specific benefits of the face to face wellness counseling intervention.

The primary purpose of this clinical scholarly research project is to determine whether there are undiagnosed symptoms of depression among the residents in a small population Long Term Care facility (LTC). Caregivers at the LTC receive specific knowledge regarding older adult late-life depression and then apply said knowledge by surveying the LTC residents (LTCR’s) using the Geriatric Depression Scale instrument (GDS-15). The secondary purpose is to determine whether the LTC caregivers perceive this training as beneficial. Using two-sample t-test statistical analysis, the results of this study indicate a positive correlation with the alternative hypothesis; the number of LTCRs with previously undetected depressive symptoms increased. H_a: μ LTCR with depression or delirium ≠ μ LTCR with depression or delirium. In this study, the number of LTCRs with symptoms of depression or delirium increased by 60.4 percent. The P (T<=t) two-tail value is less than 0.001. In the literature, this difference is extremely statistically significant. The mean of the medical records examined minus the mean of the number of medical records with an indication of depression or delirium is 0.60. For a 95% confidence interval, this difference must fall between the ranges of 0.45 to 0.76. These data confirm the alternative hypothesis.

Additionally, the caregiver participant’s satisfaction outcome survey results reported the training was substantially beneficial.

Sarcopenia is a disease of muscle wasting primarily seen in older adults. Although this term was first coined over three decades ago, there is a lack of consensus on a definition, screening criteria, and treatment protocol for sarcopenia. The primary purpose of this study is to determine whether registered dietitian nutritionists (RDNs) in the United States (U.S.) screen for sarcopenia. Study participants were recruited through a randomized email list and included RDNs throughout the U.S. Respondents completed a survey questioning knowledge of sarcopenia, screening tools and company protocols in place, and the need and desire for sarcopenia education. Data revealed a lack of pre-existing protocols in place, a dissonance of validated and unvalidated screening tools used in practice, and substantial need for sarcopenia education.

The stigma of mental illness endorsed by healthcare professionals has been linked to adverse outcomes. This issue underscores the need for early anti-stigma interventions in the context of professional training. The present study measured stigma change and suicide screening behaviors among medical, nursing, and pharmacy students enrolled in an interprofessional Communication Skills for Healthcare Professionals course. The Mental Health Knowledge Schedule (MAKS; Evans-Lacko et al., 2010), Opening Minds Scale for Health Care Providers (OMS-HC; Modgill, Patten, Knaak, Kassam, & Szeto, 2014), and the Marlowe-Crowne Social Desirability Scale Form C (M-C SDS Form C; Reynolds, 1982) was administered at baseline (T1), a mid-semester assessment (T2), and post-intervention (T3) to 176 students. Post-intervention changes in stigma components (knowledge, attitudes, and behavioral intent) were mixed for all groups. Knowledge, attitudes, and behavioral intent did not predict whether students screened for suicidal ideation (p > .05). Findings from the present study support past research indicating that the stigma can be improved with appropriate intervention. Findings also support interprofessional training as an appropriate context for anti-stigma interventions. Currently, there is no general consensus regarding the best method and combination of tools to measure stigma among healthcare students. Additionally, the relationship between stigma and screening for suicidal ideation is an important area for further scientific inquiry.

INTRODUCCIÓ: La prova de detecció de sang oculta en femta és la prova de cribratge de càncer colorectal (CCR) més implementada a Europa. Tot i que aquesta ha demostrat reduir la mortalitat per CCR, encara dista de ser una prova perfecta donat el seu risc de resultats falsos positius i falsos negatius. Els efectes adversos del cribratge podrien reduir-se si coneguéssim els determinants associats a resultats falsos positius i negatius. A més, la identificació de polimorfismes genètics, en combinació amb altres biomarcadors moleculars i factors ambientals podria permetre personalitzar el cribratge poblacional. OBJECTIUS: 1) ldentificar els factors associats a un resultat fals positiu de la prova de detecció de sang oculta en femta immunològica (PDSOFi). 2) Determinar la proporció de resultats falsos negatius de la PDSOFi i explorar els seus determinants. 3) Elaborar un model de predicció de risc de CCR basat en població espanyola que combini la predisposició genètica juntament amb factors ambientals i antecedents familiars per estratificar la població en grups de risc de CCR. METODOLOGIA: Per respondre als primers dos objectius es van utilitzar dades del programa poblacional de cribratge de CCR que coordina l'lnstitut Català d'Oncologia. Es realitzaren dos estudis transversals amb participants en el cribratge que van obtenir un resultat positiu (n = 427) o negatiu (n = 218) en la PDSOFi i als que posteriorment se'ls va realitzar una colonoscopia i un qüestionari. Finalment, per respondre al tercer objectiu s'aprofitaren les dades de l'estudi MCC-Spain, que es un estudi de casos i controls multicèntric que va recollir 1.336 casos de CCR i 2.744 controls. De tots ells disposàvem d'un qüestionari epidemiologic i un array d'exoma que contenia 21 polimorfismes de nucleotid simple associats a risc de CCR. Amb aquestes dades varem desenvolupar un model de predicció de risc per estratificar la població en grups de risc de CCR. RESULTATS: Estudi 1: Mitjançant l'estudi que avalua el risc de resultats falsos positius en la PDSOFi, s'observa que les variables que van resultar ser determinants de fals positiu foren: ser dona, haver participat préviament en el cribratge, la presència d'hemorroides i/o fissura anal, així com prendre fàrmacs inhibidors de la bomba de protons. Estudi 2: A l'avaluar el risc de resultats falsos negatius en la PDSOFi, la proporció de falsos negatius observada va ser del 15,6%. L'hemoglobina fecal va ser indetectable en un 45,5% dels resultats i va ser inferior a 4 microgr. Hb/g en un 94,0% d'individus amb un resultat fals negatiu. Estudi 3: Vam observar que les variables (ajustades pel model basal) que es van associar de forma independent a CCR van ser: el nombre d'al·lels de risc, antecedents familiars de CCR, l'obesitat, l'activitat física, la ingesta de carn vermella i vegetals, i el no consum d'antiinflamatoris no esteroïdals. Els individus amb més de 25 al·lels de risc tenien un 82% més de risc que els individus amb menys de 19 al·lels de risc. CONCLUSIONS: 1. L'ús d'inhibidors de la bomba de protons durant la realització de la PDSOFi podria incrementar la probabilitat d'un resultat fals positiu. 2. Disminuïr el llindar de positivitat de la PDSOFi no detectaria més neoplàsia avançada i augmentaria els costos i els riscos innecessaris per als pacients. 3. El model de predicció del risc de CCR basat en població espanyola que combina la predisposició genètica amb factors ambientals i antecedents familiars podria ser útil per estratificar individus de risc.
INTRODUCCIÓN: La prueba de detección de sangre oculta en heces es la prueba de cribado de cáncer colorrectal (CCR) más implementada en Europa. Aunque ésta ha demostrado reducir la mortalidad por CCR, dista de ser una prueba perfecta dado su riesgo de resultados falsos positivos y falsos negativos. Los efectos adversos del cribado podrían reducirse si conociéramos los determinantes asociados a resultados falsos positivos y negativos. Además, la identificación de polimorfismos genéticos, en combinación con otros biomarcadores moleculares y factores ambientales podría permitir personalizar el cribado poblacional. OBJETIVOS: 1) ldentificar los factores asociados a un resultado falso positivo de la prueba de detección de sangre oculta en heces inmunológica (PDSOHi). 2) Determinar la proporción de resultados falsos negativos de la PDSOHi y explorar sus determinantes. 3) Elaborar un modelo de predicción de riesgo de CCR basado en población española que combine la predisposición genética junto con factores ambientales y antecedentes familiares para estratificar la población en grupos de riesgo de CCR. METODOLOGIA: Para responder a los primeros dos objetivos se utilizaron datos del programa poblacional de cribado de CCR que coordina el lnstituto Catalán de Oncología. Se realizaron dos estudios transversales con participantes en el cribado que obtuvieron un resultado positivo (n = 427) o negativo (n = 218) en la PDSOHi y a quienes posteriormente se les realizó una colonoscopia y un cuestionario. Finalmente, para responder al tercer objetivo se aprovecharon los datos del estudio MCC-Spain, que es un estudio de casos y controles multicentrico que recogió 1.336 casos de CCR y 2.744 controles. De todos ellos disponíamos de un cuestionario epidemiológico y un array de exoma que contenía 21 polimorfismos de nucleótido simple asociados a riesgo de CCR. Con estos datos pudimos desarrollar un modelo de predicción de riesgo para estratificar la población en grupos de riesgo de CCR. RESULTADOS: Estudio 1: Mediante el estudio que evaluó el riesgo de resultados falsos positivos en la PDSOHi, se observó que las variables que resultaron ser determinantes de falso positivo fueron: ser mujer, haber participado previamente en el cribado, la presencia de hemorroides y/o fisura anal, así como tomar fármacos inhibidores de la bomba de protones. Estudio 2: Al evaluar el riesgo de resultados falsos negativos en la PDSOHi, la proporción de falsos negativos observada fue del 15,6%. La hemoglobina fecal fue indetectable en un 45,5% de los resultados y fue inferior a 4 microgr. Hb/g en un 94,0% de individuos con un resultado falso negativo. Estudio 3: Se observó que las variables (ajustadas por el modelo basal) que se asociaron de forma independiente a CCR fueron: el numero de alelos de riesgo, antecedentes familiares de CCR, la obesidad, la actividad física, la ingesta de carne roja y vegetales, y el no consumo de antiinflamatorios no esteroideos. Los individuos con más de 25 alelos de riesgo tenían un 82% más de riesgo que los individuos con menos de 19 alelos de riesgo. CONCLUSIONES: 1. El uso de inhibidores de la bomba de protones durante la realización de la PDSOHi podría incrementar la probabilidad de un resultado falso positivo. 2. Disminuir el umbral de positividad de la PDSOHi no detectaría mas neoplasia avanzada y aumentaría los costes y los riesgos innecesarios para los pacientes. 3. El modelo de predicción del riesgo de CCR basado en población española que combina la predisposición genetica con factores ambientales y antecedentes familiares podría ser útil para estratificar individuos de riesgo.
INTRODUCTION: ln Europe, the most commonly implemented test to screen colorectal cancer (CCR) is the faecal occult blood test. Although it has shown to reduce CRC mortality, it is far from perfect because of its false positive and false negative results. The adverse effects of screening could be reduced if we knew the determinants associated with false positive and negative results. ln addition, the identification of genetic polymorphisms in combination with other molecular biomarkers and environmental factors could allow personalizing population screening. OBJECTIVES: 1) To identify the factors associated with a false positive result of the faecal immunochemical test (FlT). 2) To determine the false negative proportion in and to explore its determinants. 3) To develop a risk stratification model that combined environmental factors with family history and genetic susceptibility to stratify the population in risk groups of CRC. METHODOLOGY: ln order to respond to the first two objectives, the population of the CRC screening program coordinated by the Catalan lnstitute of Oncology was used. Two cross-sectional studies were performed with screening participants who had a positive (n = 427) or negative (n = 218) FlT result and who subsequently underwent a colonoscopy and a questionnaire. Finally, in order to respond to the third objective, data from the MCC-Spain study was used. This multicentre case-control study recollected an epidemiological questionnaire and an exoma array containing 21 simple nucleotide polymorphisms associated with CRC risk of 1,336 cases of CRC and 2,744 controls. With these data we developed a risk stratification model to stratify the population in groups at risk of CRC. RESULTS: Study 1: While evaluating factors associated with false-positive results in a CRC screening, the variables associated with a false-positive result were: women, successive screening, haemorrhoids and/or anal fissure and the use of proton pump inhibitors. Study 2: When analysing the risk of false negative results in the FlT, the false negative rate observed was 15.6%. Faecal haemoglobin was undetected in 45.5% and it was below 4 micrograms Hb/g in 94.0% of the individuals with a FN result. Study 3: The variables (adjusted by the baseline model) that were independently associated with CRC were: the number of risk alleles, family history of CRC, alcohol consumption, obesity, physical activity, red meat and vegetable intake, and nonsteroidal anti- inflammatory drug use. The risk of subjects with more than 25 risk alleles was 82% higher than subjects with less than 19 alleles. CONCLUSIONS: 1. Concurrent use of proton pump inhibitors at the time of FlT might increase the likelihood of a false-positive result. 2. Decreasing the positivity threshold of FlT does not increase the detection rate of advanced neoplasia, but may increase the costs and potential adverse effects. 3. A Spanish population-based CRC risk prediction model that combines genetic predisposition with environmental factors and family history may be useful for stratifying at-risk individuals.

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This is a qualitative study aimed to evaluate the limits and possibilities for implementation of user embracement and risk assessment. In particular, from the perspective of local health managers of San Carlos, a town in the state of São Paulo. To collect the data, some semi-structured interviews were conducted with managers of the municipal health system: 61.53% graduated in nursing, 15.38% in medicine, 7.69% in dentistry; 7.69% in management and production engineering. The data were analyzed through thematic analysis. For this research, after collecting and analyzing data, six categories emerged from the analysis: (1) user embracement by organizing the service, (2) undesirable reality or constructed intentionally, (3) something intended but not accomplished, (4) A dream under construction, (5) learning to learn in daily service, (6) speaking the same language. From this definition, the study pointed out that there are different conceptions of user embracement , due to the approach assumed by each manager as suitable. There are also disparities in taking user embracement and under risk assessment as a procedure, possibly as a result of intricate political actions on health. To implement user embracement and risk assessment, it was possible to perceive the existence of limits and possibilities, with regards to organization of the service, local reality, care approaches, quality of assistance, permanent and continuing education as well as networking.
Trata-se de um estudo qualitativo cujo objetivo foi avaliar por onde perpassam os limites e possibilidades para implantação do acolhimento com avaliação de risco. Em específico, na perspectiva dos gestores municipais de saúde de São Carlos, uma cidade do interior do estado de São Paulo. Para coleta de dados, foram realizadas entrevistas semi-estruturadas com gestores do sistema municipal de saúde: 61,53% graduados em enfermagem; 15,38% medicina; 7,69% odontologia; 7,69% administração e 7,69% engenharia de produção. Os dados foram tratados através da análise temática. Para esta pesquisa, após coleta e análise dos dados, emergiram seis categorias de análise; (1) O acolhimento organizando o serviço; (2) Realidade não desejada ou construída intencionalmente; (3) Desejo algo e pratico outro; (4) Um sonho em construção; (5) Aprendendo a aprender no cotidiano do serviço; (6) Falar a mesma língua. A partir dessa delimitação, o estudo apontou que existem diferentes concepções sobre o acolhimento, em decorrência do modelo de atenção que cada gestor assume como sendo resolutivo. Também há disparidades em assumir o acolhimento com avaliação de risco como prática, possivelmente por questões políticas intrincadas nas ações em saúde. Para implementação do acolhimento com avaliação de risco, foi possível perceber a existência de limites e possibilidades, no que diz respeito à organização do serviço, realidade local, modelos de atenção, qualidade da assistência, educação permanente e continuada, trabalho em rede.

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The neonatal screening is methodology populational specific screening if year old age from 0 to 30 days the of life that allow the early diagnostic of diseases like Congenital Hypothyroidism, Phenylketonuria, Sickle Cell Anaemia and others haemoglobinopathies as a preventive action and specific treatment to reduce or elimination of disorders associated to these diseases. Objective: To evaluate the profile of the Neonatal Screening Program in Sao José do Rio Preto - SP. Methods: Retrospective study based on Association of the Parents and Friends of the Handicapped from Sao Paulo (APAE-SP) database, based on the principle of all the collected exams in live births from January 2005 to December 2007. Data for the profile related to sample characteristics, program coverage, exams numbers and estimated number of live births were obtained from the APAE-SP Laboratory, the data from the comparative analysis were obtained from hospitals collecting and Health Department of that city in the period. Results: Of a total of 17,494 children 51.5% were female and 48.4% were male. Samples were collected after 7 days of life in 62.5% of the sample. The average time to recievement of results was 28.2 days. In the sample studied, 435 showed altered results, and 5 cases (0.03%) of Congenital Hypothyroidism (incidence of 1:3,499), 2 cases (0.01%) of Phenylketonuria (incidence of 1:8747) and 428 cases of Hemoglobinopathies (incidence of 1:40,874) with a single case (0.006%) of sickle cell disease (incidence 1:17,494). Conclusion: Although the study demonstrate that within the period recommended as suitable for the collection process, shipment of samples and delivery of results, it s necessary to develop strategies to improving the structure, the dissemination of the neonatal program, orientation the parents of the importance of "foot test" and greater involvement of health managers.
Triagem neonatal é um método de rastreamento especifica para uma população com idade entre 0-30 dias de vida, que permite o diagnóstico precoce de doenças como o Hipotireoidismo Congênito, a Fenilcetonúria, a Anemia Falciforme e outras hemoglobinopatias, tem como objetivo a ação preventiva com tratamento específico para diminuição ou eliminação das seqüelas associadas a estas doenças. Objetivo: Avaliar o perfil do Programa de Triagem Neonatal em São José do Rio Preto SP. Casuística e Métodos: Estudo retrospectivo baseado no banco de dados da Associação de Pais e Amigos dos Excepcionais de São Paulo (APAE-SP); tendo como princípio todos os exames coletados nos nascidos vivos no período de janeiro de 2005 à dezembro 2007. Os dados relativos ao perfil referente à caracterização da amostra, cobertura do programa, fluxo dos exames e número estimado de nascidos vivos foram obtidos junto ao Laboratório da APAE-SP. Os dados da análise comparativa foram obtidos junto aos hospitais de coleta e a Secretaria de Saúde da referida cidade. Resultados: De um total de 17494 crianças 51,5% eram do sexo feminino e 48,4% do sexo masculino. As coletas foram realizadas após 7 dias de vida em 62,5% da amostra. O tempo médio para recebimento dos resultados foi de 28,2 dias. Da amostra estudada, 435 resultados se mostraram alterados sendo, 5 casos (0,03%) de Hipotireoidismo Congênito (incidência de 1:3499), 2 casos (0,01%) de Fenilcetonúria (incidência de 1:8747) e 428 casos (2,45%) de Hemoglobinopatias (incidência de 1:40.874) com um único caso (0,006%) de Anemia Falciforme (incidência de Conclusão: Apesar de o estudo demonstrar-se dentro do período preconizado como adequado para o processo de coleta, envio de amostras e entrega de resultados, mostra-se necessário o desenvolvimento de estratégias de melhoria na estrutura, na divulgação do Programa Nacional de Triagem Neonatal, orientação aos pais da importância do teste do pezinho e maior envolvimento dos gestores de saúde.