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Effectiveness of a Nurse-Led Workplace Intervention in Reducing Cardiovascular Risks Among Thai Workers: A Randomized Controlled Trial. 护士主导的工作场所干预对降低泰国工人心血管风险的效果:随机对照试验
IF 3 Q1 PRIMARY HEALTH CARE Pub Date : 2024-01-01 DOI: 10.1177/21501319241281211
Arisara Ritngam, Surintorn Kalampakorn, Sunee Lagampan, Ann Jirapongsuwan

Background: The prevalence of cardiovascular diseases (CVD) is continuously increasing. A nurse-led workplace health promotion program (NWHPP) has demonstrated potential in reducing cardiovascular risks among employees. This study aimed to evaluate the effectiveness of the NWHPP in reducing CVD risks among at-risk workers.

Methods: Sixty workers from 2 factories in Thailand, each with an estimated 10-year cardiovascular risk of 5% or higher (determined by the WHO/ISH cardiovascular risk prediction chart), were enrolled. Participants were randomly assigned to either the intervention or control group based on their factory. The intervention group received an 8-week program comprising 3 core components: redesigning healthcare services, strengthening self-management, and obtaining organizational support. Evaluations of the estimated 10-year CVD risk, systolic blood pressure (SBP), smoking status, and body mass index (BMI) were conducted at baseline and at 1- and 3-month follow-ups.

Results: The intervention group showed significant improvements compared to the control group in CVD risk score (F = 4.827, P = .017) and SBP (F = 12.136, P < .001). Moreover, non-smokers were significantly higher in the intervention group (75.0%) compared with the control group (46.2%) after the 3-month follow-up (OR = 3.50; 95%CI 1.11-11.07; P = .030). However, BMI differences between the groups were not statistically significant.

Conclusion: The nurse-led workplace health promotion program effectively improved cardiovascular risk scores among at-risk workers. Developing workplace policies and environments that promote healthy behaviors is essential for reducing CVD risks among at-risk workers.

背景:心血管疾病(CVD)的发病率持续上升。由护士主导的工作场所健康促进计划(NWHPP)在降低员工心血管疾病风险方面具有潜力。本研究旨在评估 NWHPP 在降低高危工人心血管疾病风险方面的效果:研究人员招募了来自泰国两家工厂的 60 名工人,每名工人的 10 年心血管风险估计为 5%或更高(根据世界卫生组织/国际卫生组织心血管风险预测表确定)。参与者根据所在工厂的情况被随机分配到干预组或对照组。干预组接受为期 8 周的计划,包括 3 个核心部分:重新设计医疗保健服务、加强自我管理和获得组织支持。在基线以及 1 个月和 3 个月的随访中,对估计的 10 年心血管疾病风险、收缩压 (SBP)、吸烟状况和体重指数 (BMI) 进行了评估:结果:与对照组相比,干预组在心血管疾病风险评分(F = 4.827,P = .017)和收缩压(F = 12.136,P = .030)方面有明显改善。结论:以护士为主导的职场健康促进计划在促进职场健康方面发挥了重要作用:护士主导的工作场所健康促进计划有效改善了高危工人的心血管风险评分。制定促进健康行为的工作场所政策和环境对降低高危工人的心血管疾病风险至关重要。
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引用次数: 0
Adolescent Healthcare Access: A Qualitative Study of Provider Perspectives. 青少年获得医疗保健的机会:对提供者观点的定性研究。
IF 3.6 Q1 Nursing Pub Date : 2024-01-01 DOI: 10.1177/21501319241234586
Whitney R Garney, Sara A Flores, Kristen M Garcia, Sonya Panjwani, Kelly L Wilson

Introduction: Adolescent access to quality healthcare is key to prevention and early intervention for health risk behaviors. This paper provides a healthcare provider perspective on barriers and facilitators to youth accessing care.

Methods: Five focus groups were conducted from November to December 2020 with providers from a variety of healthcare settings. Participants were asked to describe their respective adolescent patient populations, adolescent-specific health concerns, and organizational accommodations specific for youth services. Transcripts were analyzed using Inductive Thematic Analysis and themes were grouped using a social-ecological framework.

Results: At an individual level, providers noted that an adolescent's knowledge and ability to navigate services varied greatly across settings. Providers identified provider trust and parent/guardian support as key interpersonal factors that support adolescents' access to services. Organizational factors included bureaucratic barriers and the clinic's reputation among youth. Community factors centered on mistrust within healthcare systems and stigmatization of seeking certain types of services. Participants also described how state-level policies influence parent/guardian consent requirements, which can limit adolescents' access to care.

Conclusion: Adolescent access to and utilization of healthcare in the United States is a complex problem requiring systems-level change. Healthcare organizations and providers have the opportunity and capacity to positively influence adolescents' healthcare access and experiences, however a lack of standardized, clinic-level priorities and guidelines can limit adolescent-centered care.

介绍:青少年获得优质医疗服务是预防和早期干预健康风险行为的关键。本文从医疗服务提供者的角度,阐述了青少年获得医疗服务的障碍和促进因素:2020 年 11 月至 12 月期间,我们与来自不同医疗机构的医疗服务提供者进行了五次焦点小组讨论。参与者被要求描述各自的青少年患者群体、青少年特有的健康问题以及针对青少年服务的组织调整。采用归纳式主题分析法对记录誊本进行分析,并采用社会生态框架对主题进行分组:在个人层面上,服务提供者注意到,青少年在不同环境中对服务的了解和驾驭能力有很大差异。服务提供者认为,服务提供者的信任和家长/监护人的支持是支持青少年获得服务的关键人际因素。组织因素包括官僚主义障碍和诊所在青少年中的声誉。社区因素主要是医疗系统内部的不信任以及寻求某些类型服务的耻辱感。参与者还描述了州一级的政策如何影响家长/监护人的同意要求,这可能会限制青少年获得医疗服务:在美国,青少年获得和利用医疗服务是一个复杂的问题,需要系统层面的变革。医疗机构和医疗服务提供者有机会、也有能力对青少年获得医疗服务的机会和经历产生积极影响,然而,缺乏标准化的、诊所层面的优先事项和指导方针会限制以青少年为中心的医疗服务。
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引用次数: 0
Access to MAT: Participants' Experiences With Transportation, Non-Emergency Transportation, and Telehealth. 获得 MAT 的途径:参与者在交通、非紧急交通和远程保健方面的经验。
IF 3.6 Q1 Nursing Pub Date : 2024-01-01 DOI: 10.1177/21501319241233198
Jennifer Boyd, Martha Carter, Adam Baus

Introduction: Access to medication assisted treatment (MAT) for opioid use disorder (OUD) in the United States is a significant challenge for many individuals attempting to recover and improve their lives. Access to treatment is especially challenging in rural areas characterized by lack of programs, few prescribers, and transportation barriers. This study aims to better understand the roles that transportation, Medicaid-funded non-emergency medical transportation (NEMT), and telehealth play in facilitating access to MAT in West Virginia (WV).

Methods: We developed this survey using an exploratory sequential mixed methods approach following a review of current peer-reviewed literature plus information gained from 3 semi-structured interviews and follow-up discussions with 5 individuals with lived experience in MAT. Survey results from 225 individuals provided rich context on the influence of transportation in enrolling and remaining in treatment, use of NEMT, and experiences using telehealth. Data were collected from February through August 2021.

Results: We found that transportation is a significant factor in entering into and remaining in treatment, with 170 (75.9%) respondents agreeing or strongly agreeing that having transportation was a factor in deciding to go into a MAT program, and 176 (71.1%) agreeing or strongly agreeing that having transportation helps them stay in treatment. NEMT was used by one-quarter (n = 52, 25.7%) of respondents. Only 13 (27.1%) noted that they were picked up on time and only 14 (29.2%) noted that it got them to their appointment on time. Two thirds of respondents (n = 134, 66.3%) had participated in MAT services via telehealth video or telephone visits. More preferred in-person visits to telehealth visits but a substantial number either preferred telehealth or reported no preference. However, 18 (13.6%) reported various challenges in using telehealth.

Conclusions: This study confirms that transportation plays a significant role in many people's decisions to enter and remain in treatment for OUD in WV. Additionally, for those who rely on NEMT, services can be unreliable. Finally, findings demonstrate the need for individualized care and options for accessing treatment for OUD in both in-person and telehealth-based modalities. Programs and payers should examine all possible options to ensure access to care and recovery.

导言:在美国,获得阿片类药物使用障碍(OUD)的药物辅助治疗(MAT)是许多试图康复和改善生活的人面临的重大挑战。在缺乏项目、处方医生少、交通不便的农村地区,获得治疗尤其具有挑战性。本研究旨在更好地了解交通、医疗补助资助的非紧急医疗运送(NEMT)和远程医疗在促进西弗吉尼亚州(WV)获得 MAT 方面所发挥的作用:我们采用探索性顺序混合方法制定了本调查,在此之前,我们查阅了当前的同行评议文献,并与 5 名具有 MAT 生活经验的个人进行了 3 次半结构式访谈和后续讨论,从中获得了相关信息。来自 225 人的调查结果提供了丰富的背景信息,包括交通对加入和坚持治疗的影响、NEMT 的使用以及使用远程医疗的经验。数据收集时间为 2021 年 2 月至 8 月:我们发现,交通是加入和坚持治疗的一个重要因素,170 名受访者(75.9%)同意或非常同意交通是决定加入 MAT 项目的一个因素,176 名受访者(71.1%)同意或非常同意交通有助于他们坚持治疗。四分之一(n = 52,25.7%)的受访者使用过非紧急医疗运送服务。只有 13 位受访者(27.1%)表示他们被准时接走,只有 14 位受访者(29.2%)表示他们能准时赴约。三分之二的受访者(n = 134,66.3%)曾通过远程医疗视频或电话访问参与过 MAT 服务。与远程医疗相比,更多的受访者更喜欢面谈,但也有相当多的受访者更喜欢远程医疗或表示没有偏好。然而,有 18 人(13.6%)报告了在使用远程保健时遇到的各种挑战:这项研究证实,在西弗吉尼亚州,交通在许多人决定是否接受和继续接受 OUD 治疗中起着重要作用。此外,对于那些依赖 NEMT 的人来说,服务可能并不可靠。最后,研究结果表明,有必要提供个性化的护理和选择,以便通过面对面和基于远程医疗的方式获得对 OUD 的治疗。计划和付款人应研究所有可能的选择,以确保获得护理和康复。
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引用次数: 0
Patient Time Spent With Professional Medical Interpreters and the Care Experiences of Patients With Limited English Proficiency. 患者与专业医疗口译人员的接触时间以及英语水平有限的患者的护理体验。
IF 3 Q1 PRIMARY HEALTH CARE Pub Date : 2024-01-01 DOI: 10.1177/21501319241264168
Pamela Torresdey, Jacob Chen, Hector P Rodriguez

Introduction/objectives: More time spent with interpreters may support clinician-patient communication for patients with limited English proficiency (LEP), especially when interpreter support before and after clinical encounters is considered. We assessed whether more time spent with interpreters is associated with better patient-reported experiences of clinician-patient communication and interpreter support among patients with LEP.

Methods: Patients with LEP (n = 338) were surveyed about their experiences with both the clinician and interpreter. Duration of interpreter support during the encounter (in min) and auxiliary time spent before and after encounters supporting patients (in min) were documented by interpreters. Multivariable linear regression models were estimated to assess the association of the time duration of interpreter support and patient experiences of (1) clinician-patient communication, and (2) interpreter support, controlling for patient and encounter characteristics.

Results: The average encounter duration was 47.7 min (standard deviation, SD = 25.1), the average auxiliary time was 43.8 min (SD = 16.4), and the average total interpreter time was 91.1 min (SD = 28.6). LEP patients reported better experiences of interpreter support with a mean score of 97.4 out of 100 (SD = 6.99) compared to clinician-patient communication, with a mean score of 93.7 out of 100 (SD = 14.1). In adjusted analyses, total patient time spent with an interpreter was associated with better patient experiences of clinician-patient communication (β = 7.23, P < .01) when auxiliary time spent by interpreters supporting patients before and after the encounter was considered, but not when only the encounter time was considered.

Conclusions: Longer duration of time spent with an interpreter was associated with better clinician-patient communication for patients with LEP when time spent with an interpreter before and after the clinician encounter is considered. Policymakers should consider reimbursing health care organizations for time interpreters spend providing patient navigation and other support beyond clinical encounters.

导言/目标:对于英语水平有限(LEP)的患者而言,与口译员共事的时间越多,临床医生与患者之间的沟通就越顺畅,尤其是在考虑到临床会面前后的口译支持时。我们评估了在 LEP 患者中,与口译员共事的时间越多,患者报告的临床医生与患者沟通和口译员支持的体验是否越好:我们对 LEP 患者(n = 338)进行了调查,了解他们与临床医生和口译人员的沟通体验。口译员记录了口译员在会诊期间为患者提供支持的时间(分钟)以及会诊前后为患者提供支持的辅助时间(分钟)。我们估算了多变量线性回归模型,以评估口译支持时长与患者在以下方面的体验之间的关联:(1)临床医生与患者之间的沟通;(2)口译支持,同时控制患者和会诊特征:会诊平均持续时间为 47.7 分钟(标准差,SD = 25.1),平均辅助时间为 43.8 分钟(SD = 16.4),平均总口译时间为 91.1 分钟(SD = 28.6)。与临床医生与患者之间的交流(平均分为 93.7 分,满分 100 分,标差 = 14.1)相比,LEP 患者对口译支持的体验更好,平均分为 97.4 分,满分 100 分(标差 = 6.99)。在调整分析中,患者与口译员共处的总时间与患者对临床医生与患者沟通的更好体验相关(β = 7.23,P 结论:患者与口译员共处的总时间越长,患者对临床医生与患者沟通的体验越好:如果考虑到患者在就诊前后与口译员共处的时间,那么患者与口译员共处的时间越长,LEP 患者与临床医生之间的沟通效果越好。政策制定者应考虑向医疗机构补偿口译员在临床会诊之外为患者提供导航和其他支持的时间。
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引用次数: 0
A Randomized Trial to Address Food Insecurity and Promote Smoking Cessation Among Low-Income Adults. 解决粮食不安全问题并促进低收入成年人戒烟的随机试验。
IF 3.6 Q1 Nursing Pub Date : 2024-01-01 DOI: 10.1177/21501319241245275
Jin E Kim-Mozeleski, Madeline C Castele, Pooja Nambiar, Kevin M Chagin, Stephanie Pike Moore, Patricia Hardy, Karen Cook, Ashwini R Sehgal

Many low-income adults who smoke also have unmet social needs, such as food insecurity, which can serve as a barrier to smoking cessation. We developed a novel intervention to jointly address smoking cessation and food insecurity and assessed its feasibility, acceptability, and preliminary outcomes. We enrolled participants who screened for food insecurity, reported smoking daily, and were ready to quit. All participants received 3 months of resources navigation from a community health worker through monthly telephone calls for referrals and check-ins for smoking cessation and food access resources. Participants randomized to the intervention group received an economic intervention equivalent to the cost of 1 week of groceries/month for 3 months. We randomized 55 participants who were smoking on average 13 cigarettes/day. The trial was feasible and acceptable based on 3-month retention rates (80%) and end-of-study qualitative feedback (91% would recommend the study to others). At 3 months, participants in the intervention versus control group reported a longer length of abstinence from smoking and had a higher proportion of serious quit attempts. Results from this pilot study suggest the importance of attending to social needs, particularly food insecurity, as a strategy to promote smoking cessation among low-income adults who smoke.

许多吸烟的低收入成年人也有未得到满足的社会需求,如粮食不安全,这可能成为戒烟的障碍。我们开发了一种新型干预措施,以共同解决戒烟和粮食不安全问题,并对其可行性、可接受性和初步结果进行了评估。我们招募了经筛查发现存在食物不安全问题、每天吸烟并准备戒烟的参与者。所有参与者都接受了社区卫生工作者为期 3 个月的资源导航,每月通过电话转介和签到获得戒烟和食物资源。被随机分配到干预组的参与者将在 3 个月内接受相当于每月 1 周食品杂货费用的经济干预。我们随机抽取了 55 名参与者,他们平均每天吸烟 13 支。根据 3 个月的保留率(80%)和研究结束时的定性反馈(91% 的人愿意向其他人推荐这项研究),这项试验是可行的,也是可以接受的。3个月后,干预组与对照组相比,戒烟时间更长,尝试戒烟的比例更高。这项试点研究的结果表明,关注社会需求(尤其是粮食不安全问题)是促进低收入成年吸烟者戒烟的重要策略。
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引用次数: 0
Assessing the Disruption Impact on Healthcare Delivery. 评估变革对医疗服务的影响。
IF 3 Q1 Nursing Pub Date : 2024-01-01 DOI: 10.1177/21501319241260351
Maymunah Fatani, Abdulrahim Shamayleh, Hussam Alshraideh

Health emergency outbreaks such as the COVID-19 pandemic make it challenging for healthcare systems to ration medical resources and patient care. Such disastrous events have been increasing over the past years and are becoming inevitable, necessitating the need for healthcare to be well-prepared and resilient to unpredictable rises in demand. Quantitative and qualitative based decision support systems increase the effectiveness of planning, alleviating uncertainties associated with the crisis. This study aims to understand how the COVID-19 pandemic has affected the performance of healthcare systems in different areas and to address the associated disruption. A cross-sectional online survey was conducted in the Kingdom of Saudi Arabia and the United Arab Emirates among healthcare workers who worked during the pandemic. The pandemic-related disruption and its psychometric properties were assessed using Structural Equations Modeling (SEM) with 5 latent factors: Staff Mental Health, Communication Level, Planning and Readiness, Healthcare Supply Chain, and Telehealth. Responses from highly qualified participants with many years of experience in hospital settings were collected and analyzed. Results show that the model satisfactorily fits the data with a CLI of 0.91 and TLI of 0.88. The model indicates that enhancing supply chain management, planning, telehealth usage, and communication level across the healthcare system can mitigate the disruption. However, the lack of mental health management for healthcare workers can significantly disrupt the quality of delivered care. Staff mental health and healthcare supply chain, respectively, are the highest contributors to varying degrees of disruption in healthcare delivery. This study provides a direction for more research focusing on determinants of healthcare efficiency. It also provides decision-makers insights into the main factors leading to disruptions in healthcare systems, allowing them to shape their outbreak response and better prepare for future health emergencies.

COVID-19 大流行病等紧急卫生事件的爆发使医疗系统在合理分配医疗资源和病人护理方面面临挑战。在过去几年中,此类灾难性事件不断增加,已变得不可避免,因此医疗保健系统必须做好充分准备,以应对不可预测的需求增长。基于定量和定性的决策支持系统提高了规划的有效性,缓解了与危机相关的不确定性。本研究旨在了解 COVID-19 大流行如何影响了不同地区医疗系统的表现,并解决相关的干扰问题。我们在沙特阿拉伯王国和阿拉伯联合酋长国对在大流行期间工作的医护人员进行了横断面在线调查。采用结构方程模型(SEM)对大流行相关干扰及其心理测量特性进行了评估,其中包含 5 个潜在因素:员工心理健康、沟通水平、计划与准备、医疗供应链和远程医疗。收集并分析了具有多年医院工作经验的高素质参与者的回答。结果显示,模型与数据的拟合效果令人满意,CLI 为 0.91,TLI 为 0.88。该模型表明,加强整个医疗系统的供应链管理、规划、远程医疗的使用和沟通水平可以缓解中断。然而,缺乏对医护人员的心理健康管理会严重影响医疗服务的质量。员工心理健康和医疗供应链分别是造成不同程度医疗服务中断的最大因素。本研究为更多关注医疗效率决定因素的研究提供了方向。它还为决策者提供了洞察力,使他们了解导致医疗保健系统中断的主要因素,从而制定疫情应对措施,更好地为未来的突发卫生事件做好准备。
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引用次数: 0
Practical Considerations and Implementation of Sodium-Glucose Co-Transporter-2 Inhibitors in Chronic Kidney Disease: Who, When, and How? A Position Statement by Nephrologists. 慢性肾脏病钠-葡萄糖共转运体-2 抑制剂的实际考虑因素和应用:谁、何时、如何使用?肾病学家的立场声明。
IF 3 Q1 PRIMARY HEALTH CARE Pub Date : 2024-01-01 DOI: 10.1177/21501319241259905
Anjay Rastogi, Ashté Collins, Ellie Kelepouris, Wayne Kotzker, John P Middleton, Minesh Rajpal, Prabir Roy-Chaudhury, Glenn M Chertow

Introduction: There remains an unmet need to reduce kidney and cardiovascular risk in patients with chronic kidney disease (CKD). This report is therefore intended to provide real-world clinical guidance to primary care providers on sodium-glucose co-transporter-2 (SGLT2) inhibitor use in patients with CKD, focusing on practical considerations. Initially developed as glucose-lowering drugs, SGLT2 inhibitors preserve kidney function and reduce risks of cardiovascular events and mortality. Clinical benefits of SGLT2 inhibitors in CKD have been demonstrated in multiple clinical trials, yet utilization in practice remains relatively low, likely due to the complexity of labeled indications (past and present) and misconceptions about SGLT2 inhibitors as a class.

Methods: A panel of 8 US-based nephrologists convened in August 2022 to develop consensus guidance for the primary care community surrounding risk assessment as well as initiation and implementation of SGLT2 inhibitors in patients with CKD. Here, we provide an adapted version of the Kidney Disease: Improving Global Outcomes (KDIGO) heatmap and a treatment-decision algorithm.

Conclusions: We advocate SGLT2 inhibitors as co-first-line therapy with renin-angiotensin-aldosterone system (RAAS) inhibitors, where RAAS inhibitor dose titration need not be completed before initiation of an SGLT2 inhibitor. In fact, SGLT2 inhibitor therapy may facilitate up-titration or maintenance of optimal RAAS inhibitor dosing. We describe potential strategies to aid implementation of an SGLT2 inhibitor in clinical practice, including improving education and awareness among care providers and patients and dispelling misconceptions about the safety of SGLT2 inhibitors. In summary, we support the use of SGLT2 inhibitors with RAAS inhibitors as co-first-line therapy in most patients with CKD.

导言:降低慢性肾脏病(CKD)患者肾脏和心血管风险的需求仍未得到满足。因此,本报告旨在为初级保健提供者提供关于钠-葡萄糖协同转运体-2(SGLT2)抑制剂在慢性肾脏病患者中应用的实际临床指导,重点关注实际注意事项。SGLT2 抑制剂最初是作为降糖药物开发的,它可以保护肾功能,降低心血管事件和死亡率的风险。SGLT2抑制剂对慢性肾脏病的临床益处已在多项临床试验中得到证实,但在实际应用中的使用率仍然相对较低,这可能是由于标注适应症(过去和现在)的复杂性以及对SGLT2抑制剂作为一类药物的误解:由 8 位美国肾病专家组成的小组于 2022 年 8 月召开会议,围绕 CKD 患者的风险评估以及 SGLT2 抑制剂的启动和实施,为初级保健社区制定共识指南。在此,我们提供了《肾脏病:改善全球结局》(KDIGO)热图的改编版和治疗决策算法:我们主张将 SGLT2 抑制剂作为肾素-血管紧张素-醛固酮系统(RAAS)抑制剂的联合一线疗法,在开始使用 SGLT2 抑制剂之前无需完成 RAAS 抑制剂的剂量滴定。事实上,SGLT2 抑制剂治疗可促进 RAAS 抑制剂剂量的提升或维持。我们介绍了在临床实践中帮助实施 SGLT2 抑制剂的潜在策略,包括加强对医疗服务提供者和患者的教育和宣传,消除对 SGLT2 抑制剂安全性的误解。总之,我们支持将 SGLT2 抑制剂与 RAAS 抑制剂作为大多数慢性肾脏病患者的联合一线疗法。
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引用次数: 0
Association Between Alcohol Consumption and Blood Pressure Levels Among HIV Sero-Positive and Sero-Negative Cohorts: A Secondary Analysis of the Vukuzazzi Study. HIV 血清阳性和阴性人群饮酒与血压水平之间的关系:武库扎齐研究的二次分析。
IF 3.6 Q1 Nursing Pub Date : 2024-01-01 DOI: 10.1177/21501319241235594
Manasseh B Wireko, Jacobus Hendricks, Kweku Bedu-Addo, Marlise Van Staden, Emmanuel A Ntim, John A Larbi, Isaac K Owusu

Background: The effect of hypertension is aggravated by lifestyle factors such as alcohol consumption. This study sought to determine the association between alcohol consumption and the level of blood pressures among HIV seronegative and seropositive cohorts.

Methods: This secondary analysis was performed on a cross-sectional survey data of 17 922 participants during the period between 2018 and 2020. A questionnaire was used to obtain participants' alcohol consumption history, which was categorized into non-alcohol consumers, non-heavy alcohol consumers, and heavy alcohol consumers. A linear regression model was used to establish relationships among participants with raised blood pressure (BP ≥ 140/90 mmHg).

Results: Out of the total participants, 3553 (19.82%) were hypertensives. Almost 13% of the hypertensives (n = 458; 12.89%) were undiagnosed, and 12.44 % (442) had uncontrolled hypertension. About 14.52% of the hypertensives (3553) were not on any antihypertensive medication. Male non-consumers of alcohol had the highest systolic and diastolic BP; uncontrolled systolic BP (165.53 ± 20.87 mmHg), uncontrolled diastolic BP (102.28 ± 19.21mmHg). Adjusted for covariates, moderate alcohol consumption was associated with HTN among participants who were HIV seropositive [unadjusted (RR = 1.772, P = .006, 95% CI (1.178-2.665)], [RR = 1.772, P = .005, 95% CI (1.187-2.64)]. [unadjusted RR = 1.876, P = .036, 95% CI (1.043-3.378)], adjusted RR = 1.876, P = .041, 95% CI (1.024-3.437). Both moderate and heavy alcohol consumption were significantly related to hypertension among HIV sero-negative [unadjusted model, moderate consumption RR = 1.534 P = .003, 95% CI (1.152-2.044)], [adjusted model, moderate alcohol consumption RR = 1.535, P = .006, 95% CI (1.132-2.080)], [unadjusted model, heavy alcohol consumption, RR = 2.480, P = .030, 95% CI (1.091-5.638)], [adjusted model RR = 2.480, P = .034, 95% CI (1.072-5.738)].

Conclusion: Alcohol consumption is significantly related to increase BP regardless of HIV infection.

背景:饮酒等生活方式因素会加重高血压的影响。本研究旨在确定 HIV 血清阴性和血清阳性人群中饮酒与血压水平之间的关联:这项二次分析是对 2018 年至 2020 年期间 17 922 名参与者的横断面调查数据进行的。调查问卷用于获取参与者的饮酒史,并将其分为非饮酒者、非重度饮酒者和重度饮酒者。采用线性回归模型确定参与者与血压升高(血压≥ 140/90 mmHg)之间的关系:在所有参与者中,有 3553 人(19.82%)是高血压患者。近 13% 的高血压患者(n = 458;12.89%)未经诊断,12.44%(442 人)的高血压未得到控制。约 14.52% 的高血压患者(3553 人)没有服用任何降压药物。不饮酒的男性收缩压和舒张压最高;未控制的收缩压为(165.53 ± 20.87 mmHg),未控制的舒张压为(102.28 ± 19.21 mmHg)。经协变量调整后,在艾滋病毒血清反应呈阳性的参与者中,中度饮酒与高血压相关[未经调整(RR = 1.772,P = .006,95% CI (1.178-2.665)],[RR = 1.772,P = .005,95% CI (1.187-2.64)]。[未调整 RR = 1.876,P = .036,95% CI (1.043-3.378)],调整 RR = 1.876,P = .041,95% CI (1.024-3.437)。在艾滋病毒血清阴性者中,中度和重度饮酒均与高血压明显相关[未调整模型,中度饮酒 RR = 1.534,P = .003,95% CI (1.152-2.044)],[调整模型,中度饮酒 RR = 1.535,P = .006,95% CI (1.132-2.080)],[未调整模型,大量饮酒,RR = 2.480,P = .030,95% CI (1.091-5.638)],[调整模型 RR = 2.480,P = .034,95% CI (1.072-5.738)]:结论:无论是否感染艾滋病毒,饮酒都与血压升高密切相关。
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引用次数: 0
Post-Stroke Depression and Suicidal Ideations: Relationship with Gender and Marital Status: A Cross Sectional Study. 中风后抑郁和自杀意念:与性别和婚姻状况的关系:一项横断面研究。
IF 3.6 Q1 Nursing Pub Date : 2024-01-01 DOI: 10.1177/21501319241233172
Mgbeojedo Ukamaka Gloria, Osiri Emmanuel Jonah, Akosile Christopher Olusanjo, Okoye Emmanuel Chiebuka, John Jeneviv Nene, Akobundu Uzoamaka Nwakego, Anyaene Chiamaka Chinyere

Objectives: To determine the prevalence and contributing factors of depression and suicidal ideations among stroke survivors in Nigeria.

Methods: This was a cross-sectional study comprising 75 consenting stroke survivors who were purposively recruited from 2 tertiary hospitals. Suicidal ideations and depression were measured using standard questionnaires. Obtained data was analyzed with appropriate statistical tools.

Results: 9.3% of the participants had depression while 4% reported suicidal ideations. Significant correlation existed between suicidal ideations and depression (ρ = .31, P = .01), and levels of depression and suicidal ideations (χ2 = 85.76; P < .01). Depression had a significant relationship with gender and marital status, while suicidal ideations had a significant relationship with marital status. Females were significantly more depressed than their male counterparts (U = 512.50, P = .04) and also had a higher score on suicidal ideations. The widowed/divorced recorded the highest scores on depression (χ2 = 8.77, P = .01) and suicidal ideations (χ2 = 6.62; P = .04).

Conclusion: A worrisome prevalence of depression was reported among the study participants. The level of suicidal ideations was quite low. Depression and suicidal ideations were higher among females and those who lost their life partners (either by divorce or death).

目的确定尼日利亚中风幸存者抑郁和自杀意念的发生率和诱因:这是一项横断面研究,从两家三级医院有目的地招募了 75 名同意的中风幸存者。采用标准问卷对自杀意念和抑郁进行测量。获得的数据使用适当的统计工具进行分析:结果:9.3%的参与者患有抑郁症,4%的参与者有自杀倾向。自杀意念与抑郁之间存在显著相关性(ρ = .31,P = .01),抑郁程度与自杀意念之间也存在显著相关性(χ2 = 85.76; P U = 512.50,P = .04),而且自杀意念的得分也较高。丧偶/离婚者的抑郁(χ2 = 8.77,P = .01)和自杀意念(χ2 = 6.62;P = .04)得分最高:结论:在研究参与者中,抑郁症的发病率令人担忧。结论:在研究参与者中,抑郁症的发病率令人担忧,自杀意念的发病率较低。在女性和失去生活伴侣(离婚或死亡)的人群中,抑郁症和自杀倾向的发生率较高。
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引用次数: 0
Primary Care Providers' Experiences Treating Opioid Use Disorder Using Telehealth in the Height of the COVID-19 Pandemic. 初级保健提供者在 COVID-19 大流行期间利用远程保健治疗阿片类药物使用障碍的经验。
IF 3.6 Q1 Nursing Pub Date : 2024-01-01 DOI: 10.1177/21501319241246359
Sarah Alexandra Marshall, Lachan E Siebenmorgen, Katherine Youngen, Tyrone Borders, Nickolas Zaller

Background: The COVID-19 pandemic catalyzed a rapid shift in healthcare delivery towards telehealth services, impacting patient care, including opioid use disorder (OUD) treatment. Regulatory changes eliminated the in-person evaluation requirement for buprenorphine treatment, encouraging adoption of telehealth. This study focused on understanding experiences of primary care providers in predominantly rural areas who used telehealth for OUD treatment during the pandemic.

Methods: Semi-structured interviews were conducted with 22 primary care providers. Participants practiced in 13 rural and 9 urban counties in Kentucky and Arkansas. Data were analyzed using conventional content analysis.

Results: The pandemic significantly impacted healthcare delivery. While telehealth was integrated for behavioral health counseling, in-person visits remained crucial, especially for urine drug screenings. Telehealth experiences varied, with some facing technology issues, while others found it efficient. Telehealth proved valuable for behavioral health counseling and sustaining relationships with established patients. Patients with OUD faced unique challenges, including housing, internet, transportation, and counseling needs. Stigma surrounding OUD affected clinical relationships. Building strong patient-provider relationships emerged as a central theme, emphasizing the value of face-to-face interactions. Regarding buprenorphine training, most found waiver training helpful but lacked formal education.

Conclusion: This research offers vital guidance for improving OUD treatment services, especially in rural areas during crises like the COVID-19 pandemic. It highlights telehealth's value as a tool while acknowledging its limitations. The study underscores the significance of strong patient-provider relationships, the importance of reducing stigma, and the potential for training programs to elevate quality of care in OUD treatment.

背景:COVID-19 大流行促使医疗服务迅速转向远程医疗服务,影响了患者护理,包括阿片类药物使用障碍 (OUD) 治疗。监管方面的变化取消了丁丙诺啡治疗的亲自评估要求,鼓励采用远程医疗。本研究的重点是了解主要是农村地区的初级医疗服务提供者在大流行期间使用远程医疗进行 OUD 治疗的经验:对 22 名初级医疗服务提供者进行了半结构化访谈。参与者在肯塔基州和阿肯色州的 13 个农村县和 9 个城市县执业。采用传统的内容分析法对数据进行了分析:结果:大流行严重影响了医疗服务的提供。虽然远程医疗被整合到了行为健康咨询中,但面对面就诊仍然至关重要,尤其是尿液药物筛查。远程医疗的经验各不相同,有些人面临技术问题,而另一些人则认为远程医疗很高效。事实证明,远程保健对于行为健康咨询和维持与既有患者的关系很有价值。OUD 患者面临着独特的挑战,包括住房、网络、交通和咨询需求。围绕 OUD 的污名化影响了临床关系。建立稳固的患者-医护人员关系是一个核心主题,强调了面对面交流的价值。关于丁丙诺啡培训,大多数人认为豁免培训很有帮助,但缺乏正规教育:这项研究为改善 OUD 治疗服务提供了重要指导,尤其是在 COVID-19 大流行等危机期间的农村地区。它强调了远程保健作为一种工具的价值,同时也承认了其局限性。该研究强调了患者与医疗服务提供者之间牢固关系的重要性、减少污名化的重要性以及培训计划在提高 OUD 治疗质量方面的潜力。
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引用次数: 0
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Journal of Primary Care and Community Health
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