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991.
Zhila Fereidouni Naeemeh Seyed Fatemi Jila Mirlashari Mohammad Hassan Meshkibaf Jim Orford 《Addiction Research & Theory》2015,23(2):99-107
Drug misuse is increasing and diversifying in Iran. This study is the first to explore in detail the impact on, and ways of coping used by, spouses of addicted men in Iran. Semi-structured interviews were conducted with 24 spouses. Four main themes were identified in the data: heart-breaking news of the husband’s addiction; coping alone; progressive deterioration and suffering; and disruption of family relationships and finances. Reactions upon learning of the husband’s addiction involved shock and collapse, and/or fear, disbelief and confusion. Spouses tried to hide the problem and to solve the problem alone, feeling for a long time as if they were “walking in the dark” without any social support and exposed to stigma. As time had gone on they had experienced distress and turmoil, and mixed feelings towards, and loss of trust and confidence in, their husbands, whose behaviour was increasingly unreliable. This had led to impairment in the relationship, and financial stress, and a general degradation and disruption of normal family life, leading to strain for spouses, akin to a state of burnout. Present findings confirm the conclusions of similar research conducted in other countries, that substance misuse in the family can have devastating effects for spouses, on children and all aspects of family life. The situation for Iranian wives may be compounded by the relatively closed nature of family life, and the existence of culturally based attitudes, including shame, towards “family defects” such as addiction. More information and support is needed for Iranian families of addicted individuals. 相似文献
992.
《American journal of infection control》2022,50(10):1171-1177
ObjectivesWe sought to investigate the nature and incidence of bloodstream infection complications and to identify the risk factors of central catheter-related bloodstream infections (CRBSI).MethodsDuring the study period, 291 consecutive patients with hematological malignancies who underwent PICC placement were retrospectively enrolled. We analyzed the covariates that were specified a priori for their association with CRBSI through multivariate Cox proportional hazards regression models. The association between each predictor and the related outcome was expressed using hazard ratios (HRs) with corresponding 95% confidence intervals (CIs).ResultsOf 391 peripherally inserted central catheter (PICCs) were inserted in 291 patients for a total of 63,714 catheter days during 7 years, with an infection rate of 0.71/1,000 catheter days. Among the patients with hematological malignancies, those with acute leukemia were prone to CRBSI. Having previous bloodstream infection (BSI) (HR 18.139; 95% CI, 8.19-40.174; P < .0001), the number of PICCs insertions (HR 4.695; 95% CI, 1.842-11.967; P = .001) (twice), (HR 6.794; 95% CI, 1.909-24.181; P = .003) (≥3 times) were significantly associated with CRBSI. Not accompanied by chronic comorbidities (HR 0.34; 95% CI, 0.131-0.887; P = .028) and longer duration of PICC use (days) (HR 0.997; 95% CI, 0.994-0.999; P = .008) might be protective factors preventing CRBSI.ConclusionsOur finding suggests that previous BSI and a higher number of PICC insertions are associated with an increased risk of CRBSI. A lack of chronic comorbidities may help prevent CRBSI. 相似文献
993.
ObjectiveTo examine whether co-existing social isolation and homebound status influence medical care utilization and expenditure in older adults.MethodsPostal surveys on social isolation and homebound status were performed on older adults aged ≥65 years residing in a Japanese suburban city. Information on medical care utilization and expenditure was obtained from insurance claims data. These outcomes were examined over a three-year period (December 2008 to November 2011) for all participants (Analysis I, n = 1386) and during the last year of life for mortality cases (Analysis II, n = 107). A two-part model was used to analyze the influence of social isolation and homebound status on medical care utilization (first model: logistic regression model) and its related expenditure (second model: generalized linear model).ResultsAlmost 12 % of participants were both socially isolated and homebound. Analysis I showed that these participants were significantly less likely to use outpatient and home medical care than participants with neither characteristic (odds ratio: 0.536, 95 % confidence interval: 0.303−0.948). However, Analysis II showed that participants with both characteristics had significantly higher daily outpatient and home medical expenditure in the year before death than participants with neither characteristic (risk ratio: 2.155, 95 % confidence interval: 1.338−3.470).DiscussionOlder adults who are both socially isolated and homebound are less likely to regularly utilize medical care, which may eventually lead to serious health problems that require more intensive treatment. Measures are needed to encourage the appropriate use of medical care in these individuals to effectively manage any existing conditions. 相似文献
994.
Anna Willis Jennifer Swann Joanne Thompson 《The British journal of general practice》2015,65(638):e593-e600
Background
Improving child health and wellbeing in England was the key focus of the Chief Medical Officer’s Annual Report 2012, which recommended that all children with long-term conditions (LTCs) have a named GP responsible for their care. Little is known, however, about practitioners’ views and experiences of supporting children with LTCs in primary care.Aim
To explore practitioners’ views of supporting children with LTCs and their families in primary care.Design and setting
Qualitative interview study in primary care settings in South Yorkshire, England.Method
Interviews explored practitioners’ views and experiences of supporting children with asthma, cystic fibrosis, type 1 diabetes, and epilepsy. Interviews were audiotaped, transcribed verbatim, and analysed using the framework approach.Results
Nineteen practitioners were interviewed: 10 GPs, five practice nurses, and four nurse practitioners. The GPs’ clinical roles included prescribing and concurrent illness management; nurse practitioners held minor illness clinics; and practice nurses conduct asthma clinics and administer immunisations. GPs were coordinators of care and provided a holistic service to the family. GPs were often unsure of their role with children with LTCs, and did not feel they had overall responsibility for these patients. Confidence was dependent on experience; however, knowledge of GPs’ own limits and accessing help were felt to be more important than knowledge of the condition.Conclusion
Primary care has a valuable role in the care of children with LTCs and their families. This study suggests that improving communication between services would clarify roles and help improve the confidence of primary care practitioners. 相似文献995.
Anne McAteer Deokhee Yi Verity Watson Patricia Norwood Mandy Ryan Philip C Hannaford Alison M Elliott 《The British journal of general practice》2015,65(636):e478-e488
BackgroundSymptoms are important drivers for the use of primary care services. Strategies aimed at shifting the focus away from the GP have broadened the range of primary healthcare available.AimTo explore preferences for managing symptoms and investigate trade-offs that the public are willing to make when deciding between different primary care services.MethodA discrete choice experiment examined management preferences for three symptoms of differing seriousness (diarrhoea, dizziness, and chest pain). Willingness-to-pay estimates compared preferences between symptoms, and by sex, age, and income.ResultsPreferences differed significantly between symptoms. ‘Self-care’ was the preferred action for diarrhoea and ‘consulting a GP’ for dizziness and chest pain. ‘Waiting time’ and ‘chance of a satisfactory outcome’ were important factors for all three symptoms, although their relative importance differed. Broadly, people were more prepared to wait longer and less prepared to trade a good chance of a satisfactory outcome for symptoms rated as more serious. Generally, preferences within subgroups followed similar patterns as for the whole sample, although there were differences in the relative strength of preferences.ConclusionDespite increased choices in primary care, ‘traditional’ actions of ‘self-care’ for minor symptoms and ‘GP consultation’ for more serious symptoms were preferred. The present findings suggest, however, that people may be willing to trade between different health services, particularly for less serious symptoms. Understanding the relative importance of different factors may help inform interventions aimed at changing management behaviour or improving services. 相似文献
996.
安贞小区脑卒中病人经济负担调查分析 总被引:6,自引:0,他引:6
于1992.10.1-1992.10.31对安贞小区1988.1-1991.12首发脑卒中(按照MONICA诊断标准)存活病人161例,进行了疾病经济负担调查。培训10名调查员,采用统一问卷均入户调查。用历史性回顾询问法。直接经济负担部分作为本次调查分析重点。对结果用SAS软件进行单因素及多因素分析。调查结果表明:161例脑卒中平均年龄62.8岁,男性100例,女性61例。平均患病年限2.26年。直接经济负担费用为6308.8元/2.26年,2791元/年。其中医院保健花费中住院及门诊费用比例为81.35%,急诊、去单位医务室就诊及家庭病床的费用比例占6.74%。非医院保健花费部分比例为11.9%。6308.8元中由国家报销比例平均为87.1%。分析表明:影响直接经济负担的主要因素有年龄、职业、医疗负担方式等。年龄低、在职、享受公费医疗的病人费用相对较高。此次调查的结果为脑卒中的预防效果的评价、健康保险的开展、卫生政策的制定等提供了可靠的数值依据。 相似文献
997.
《Journal of the American College of Cardiology》2019,73(22):2806-2815
BackgroundIn patients with end-stage renal disease (ESRD), surgical aortic valve replacement is associated with higher early and late mortality, and adverse outcomes compared with patients without renal disease. Transcatheter aortic valve replacement (TAVR) offers another alternative, but there are limited reported outcomes.ObjectivesThe purpose of this study was to determine the outcomes of TAVR in patients with ESRD.MethodsAmong the first 72,631 patients with severe aortic stenosis (AS) treated with TAVR enrolled in the Society of Thoracic Surgeons (STS)/American College of Cardiology (ACC) TVT (Transcatheter Valve Therapies) registry, 3,053 (4.2%) patients had ESRD and were compared with patients who were not on dialysis for demographics, risk factors, and outcomes.ResultsCompared with the nondialysis patients, ESRD patients were younger (76 years vs. 83 years; p < 0.01) and had higher rates of comorbidities leading to a higher STS predicted risk of mortality (median 13.5% vs. 6.2%; p < 0.01). ESRD patients had a higher in-hospital mortality (5.1% vs. 3.4%; p < 0.01), although the observed to expected ratio was lower (0.32 vs. 0.44; p < 0.01). ESRD patients also had a similar rate of major vascular complications (4.5% vs. 4.6%; p = 0.86), but a higher rate of major bleeding (1.4% vs. 1.0%; p = 0.03). The 1-year mortality was significantly higher in dialysis patients (36.8% vs. 18.7%; p < 0.01).ConclusionsPatients undergoing TAVR with ESRD are at higher risk and had higher in-hospital mortality and bleeding, but similar vascular complications, when compared with those who are not dialysis dependent. The 1-year survival raises concerns regarding diminished benefit in this population. TAVR should be used judiciously after full discussion of the risk-benefit ratio in patients on dialysis. 相似文献
998.
Balancing research interests and patient interests: A qualitative study into the intertwinement of care and research in paediatric oncology
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999.
Participation in pediatric oncology research protocols: Racial/ethnic,language and age‐based disparities
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1000.
A strategy to improve treatment‐related mortality and abandonment of therapy for childhood ALL in a developing country reveals the impact of treatment delays
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Amaranto Suarez MD Martha Piña MD Diana X. Nichols‐Vinueza MD John Lopera MD Lyda Rengifo MD Mauricio Mesa MD Marcela Cardenas RN Lisa Morrissey RN Galo Veintemilla MD Martha Vizcaino MD Ligia Del Toro MD Victor Vicuna PhD Jorge Fernandez LICSW Donna Neuberg ScD Kristen Stevenson MS Alejandro Gutierrez MD 《Pediatric blood & cancer》2015,62(8):1395-1402