911 resultados para telephone counseling
Resumo:
PURPOSE:
To assess the knowledge of patients with open angle glaucoma (OAG) and their family members about OAG risk factors and to study the referral of family members for eye examinations.
DESIGN:
Cross-sectional survey and prospective cohort study.
METHODS:
We interviewed OAG patients (probands) at the Wilmer Eye Institute and their biologically related parents, siblings, and children about their knowledge of OAG risk factors. Qualified family members were offered an eye examination through the EyeCare America program. Three months after initial contact, a follow-up telephone questionnaire determined the outcome of the referral.
RESULTS:
Among 102 probands and 100 (of 230 eligible) family members who were interviewed, there was high awareness that OAG is related to older age (85% both groups). More probands knew of the association with higher intraocular pressure (95%) compared with family (78%). Yet, 21% of both groups were not aware that OAG is hereditary, and only 53% of probands and 30% of family members knew that OAG is more common in certain ethnic groups. Only two-thirds of probands had suggested that family members have an eye examination. Eighty percent of family members had had an eye examination within the last year; of 21 with no recent examination, 66% (13/21) accepted referral.
CONCLUSIONS:
The Help the Family Glaucoma project developed a novel approach to identify those at high-risk for OAG. Screening of relatives of OAG patients deserves further study in a more representative selection of the general population.
Resumo:
PURPOSE: To determine the prevalence and impact on vision and visual function of ocular comorbidities in a rural Chinese cataract surgical program, and to devise strategies to reduce their associated burden. DESIGN: Cross-sectional cohort study. PARTICIPANTS: Persons undergoing cataract surgery by one of two recently trained local surgeons at a government-run village-level hospital in rural Guangdong between August 8 and December 31, 2005. INTERVENTIONS: Eligible subjects were invited to return for a comprehensive ocular examination and visual function interview 10 to 14 months after surgery. Prevalent ocular comorbid conditions were identified. MAIN OUTCOME MEASURES: Presenting and best-corrected vision, visual function, and treatability of the comorbidity. RESULTS: Of 313 persons operated within the study window, 242 (77%) could be contacted by telephone; study examinations and interviews were performed on 176 (74%). Examined subjects had a mean age of 69.4+/-10.5 years, 116 (66%) were female, and 149 (85%) had been blind (presenting vision < or = 6/60) in the operative eye before surgery. Among unoperated eyes, 89 of 109 (81.7%) had > or =1 ocular comorbidities, whereas for operated eyes the corresponding proportion was 72 of 211 (34.1%). The leading comorbidity among operated eyes was refractive error (43/72 [59.7%]), followed by glaucoma/glaucoma suspect (14/72 [19.4%]), whereas for unoperated eyes, it was cataract (80/92 [87.0%]), followed by refractive error (12/92 [13.0%]). Among operated eyes with comorbidities, 90.3% (65/72) had > or =1 comorbidities that were treatable. In separate models adjusting for age and gender, persons with > or =1 comorbidities in the operated eye had significantly worse presenting vision (P<0.001) than those without such findings, but visual function (P = 0.197) and satisfaction with surgery (P = 0.796) were unassociated with comorbidities. CONCLUSIONS: Ocular comorbidities are highly prevalent among persons undergoing cataract surgery in this rural Asian setting, and their presence is significantly associated with poorer visual outcomes. The fact that the great majority of comorbidities encountered in this program are treatable suggests that strategies to reduce their impact can be successful.
Resumo:
AIM: To study the effect of posterior capsular opacification (PCO) on vision and visual function in patients undergoing cataract surgery in rural China, and to compare this with the effect of refractive error. METHODS: Patients undergoing cataract surgery in at least one eye by local surgeons in a rural setting between 8 August and 31 December 2005 were examined with slit lamp grading of PCO 10-14 months after surgery. Subjects with any PCO associated with best-corrected visual acuity of 6/7.5 or worse, or with grade 2+ or worse PCO without visual decrement, were offered YAG laser capsulotomy. Vision and self-reported visual function were assessed, and various demographic and clinical factors potentially associated with PCO were recorded. RESULTS: Of 313 patients operated on within the study window, 239 (76%) could be contacted by telephone; study examinations were performed on 176 (74%). Examined subjects had a mean (SD) age of 69.4 (10.5) years, 116 (67%) were female, and 149 (86%) had been blind (presenting visual acuity < or = 6/60) in the operated eye before surgery. PCO of grade 1 or above was present in 34 of 204 operated eyes (16.7%). Those with PCO had significantly worse presenting vision (p = 0.007) but not visual function (p>0.3) than those without PCO. Women had a significantly higher prevalence of PCO (20.9%) than did men (8.6%, p<0.05). Of 19 eyes undergoing capsulotomy with best-corrected visual acuity measured the next day, 13 (68%) improved by one or more lines, and seven (37%) improved by two or more lines. Despite a higher uptake of capsulotomy (95%) as opposed to refraction (35%) in this cohort, the yield in terms of eyes with poor presenting visual acuity (< 6/18) that could be improved was higher for refraction (26% = 9/35) than for capsulotomy (9% = 3/35). CONCLUSION: The prevalence of PCO and impact on vision and visual function in this cohort was modest 1 year after surgery. However, PCO prevalence increases with time. Follow-up of this cohort is underway to determine the effectiveness of this early intervention in identifying and treating subjects who will eventually experience clinically significant PCO.
Resumo:
PURPOSE:
To characterize willingness to pay for private operations and preferred waiting time among patients awaiting cataract surgery in Hong Kong.
METHODS:
This was a cross-sectional survey. Subjects randomly selected from cataract surgical waiting lists in Hong Kong (n = 467) underwent a telephone interview based on a structured, validated questionnaire. Data were collected on private insurance coverage, preferred waiting time, amount willing to pay for surgery, and self-reported visual function and health status.
RESULTS:
Among 300 subjects completing the interview, 144 (48.2%) were 76 years of age or older, 177 (59%) were women, and mean time waiting for surgery was 17 +/- 15 months. Among 220 subjects (73.3%) willing to pay anything for surgery, the mean amount was US$552 +/- 443. With adjustment for age, education, and monthly household income, subjects willing to pay anything were less willing to wait 12 months for surgery (OR = 4.34; P = 0.002), more likely to know someone having had cataract surgery (OR = 2.20; P = 0.03), and more likely to use their own savings to pay for the surgery (OR = 2.21; P = 0.04). Subjects considering private cataract surgery, knowing people who have had cataract surgery, using nongovernment sources to pay for surgery, and having lower visual function were willing to pay more.
CONCLUSIONS:
Many patients wait significant periods for cataract surgery in Hong Kong, and are willing to pay substantial amounts for private operations. These results may have implications for other countries with cataract waiting lists.
Resumo:
PURPOSE:
To evaluate reasons for non-compliance with post-cataract surgical follow-up in rural China, and assess the impact of incentives on improving compliance.
METHODS:
Patients having undergone cataract surgery more than 3 months previously at cataract surgery training hospitals in Guangdong were invited by telephone and advertisements to a hospital-based study examination, with compensation for travel costs (US$7). Information on prior post-surgical follow up was collected by questionnaire at the hospital or by telephone. Logistic regression was used to assess predictors of post-operative attendance with or without compensation.
RESULTS:
Among 518 eligible patients, 426 (82.2%) underwent interviews and 342 (66.0%) attended the compensated study examination. Ninety nine participants (23.2%) reported previously returning for uncompensated follow-up ≥ 3 months post-operatively, and 225 (52.8%) had returned for any prior post-operative examination. Uncompensated follow-up at ≥ 3 months was associated with higher income (P = 0.037), and recalling instruction by a doctor to follow-up (P = 0.001), while age, gender, travel cost, and post-operative satisfaction and vision were not associated. Younger (P = 0.002) patients and those reporting being instructed to follow up (P = 0.008) were more likely to return for the compensated research examination. Among all interviewed subjects, only 170 (39.9%) reported knowing they were to return to hospital.
CONCLUSIONS:
Modest compensation, advertisements and telephone contact can increase medium-term follow-up rates after cataract surgery by three-fold. Better communication of specific targets for follow-up may improve follow-up compliance.
Resumo:
BACKGROUND:
A cancer diagnosis may lead to significant psychological distress in up to 75% of cases. There is a lack of clarity about the most effective ways to address this psychological distress.
OBJECTIVES:
To assess the effects of psychosocial interventions to improve quality of life (QoL) and general psychological distress in the 12-month phase following an initial cancer diagnosis.
SEARCH METHODS:
We searched the Cochrane Central Register of Controlled Trials (CENTRAL) (The Cochrane Library 2010, Issue 4), MEDLINE, EMBASE, and PsycINFO up to January 2011. We also searched registers of clinical trials, abstracts of scientific meetings and reference lists of included studies. Electronic searches were carried out across all primary sources of peer-reviewed publications using detailed criteria. No language restrictions were imposed.
SELECTION CRITERIA:
Randomised controlled trials of psychosocial interventions involving interpersonal dialogue between a 'trained helper' and individual newly diagnosed cancer patients were selected. Only trials measuring QoL and general psychological distress were included. Trials involving a combination of pharmacological therapy and interpersonal dialogue were excluded, as were trials involving couples, family members or group formats.
DATA COLLECTION AND ANALYSIS:
Trial data were examined and selected by two authors in pairs with mediation from a third author where required. Where possible, outcome data were extracted for combining in a meta-analyses. Continuous outcomes were compared using standardised mean differences and 95% confidence intervals, using a random-effects model. The primary outcome, QoL, was examined in subgroups by outcome measurement, cancer site, theoretical basis for intervention, mode of delivery and discipline of trained helper. The secondary outcome, general psychological distress (including anxiety and depression), was examined according to specified outcome measures.
MAIN RESULTS:
A total of 3309 records were identified, examined and the trials subjected to selection criteria; 30 trials were included in the review. No significant effects were observed for QoL at 6-month follow up (in 9 studies, SMD 0.11; 95% CI -0.00 to 0.22); however, a small improvement in QoL was observed when QoL was measured using cancer-specific measures (in 6 studies, SMD 0.16; 95% CI 0.02 to 0.30). General psychological distress as assessed by 'mood measures' improved also (in 8 studies, SMD - 0.81; 95% CI -1.44 to - 0.18), but no significant effect was observed when measures of depression or anxiety were used to assess distress (in 6 studies, depression SMD 0.12; 95% CI -0.07 to 0.31; in 4 studies, anxiety SMD 0.05; 95% CI -0.13 to 0.22). Psychoeducational and nurse-delivered interventions that were administered face to face and by telephone with breast cancer patients produced small positive significant effects on QoL (in 2 studies, SMD 0.23; 95% CI 0.04 to 0.43).
AUTHORS' CONCLUSIONS:
The significant variation that was observed across participants, mode of delivery, discipline of 'trained helper' and intervention content makes it difficult to arrive at a firm conclusion regarding the effectiveness of psychosocial interventions for cancer patients. It can be tentatively concluded that nurse-delivered interventions comprising information combined with supportive attention may have a beneficial impact on mood in an undifferentiated population of newly diagnosed cancer patients.
Resumo:
BACKGROUND: Physical inactivity has been associated with obesity and related chronic diseases. Understanding built environment (BE) influences on specific domains of physical activity (PA) around homes and workplaces is important for public health interventions to increase population PA.
PURPOSE: To examine the association of home and workplace BE features with PA occurring across specific life domains (work, leisure, and travel).
METHODS: Between 2012 and 2013, telephone interviews were conducted with participants in four Missouri metropolitan areas. Questions included sociodemographic characteristics, home and workplace supports for PA, and dietary behaviors. Data analysis was conducted in 2013; logistic regression was used to examine associations between BE features and domain-specific PA.
RESULTS: In home neighborhoods, seven of 12 BE features (availability of fruits and vegetables, presence of shops and stores, bike facilities, recreation facilities, crime rate, seeing others active, and interesting things) were associated with leisure PA. The global average score of home neighborhood BE features was associated with greater odds of travel PA (AOR=1.99, 95% CI=1.46, 2.72); leisure PA (AOR=1.84, 95% CI=1.44, 2.34); and total PA (AOR=1.41, 95% CI=1.04, 1.92). Associations between workplace neighborhoods' BE features and workplace PA were small but in the expected direction.
CONCLUSIONS: This study offers empirical evidence on BE supports for domain-specific PA. Findings suggest that diverse, attractive, and walkable neighborhoods around workplaces support walking, bicycling, and use of public transit. Public health practitioners, researchers, and worksite leaders could benefit by utilizing worksite domains and measures from this study for future BE assessments.
Resumo:
BACKGROUND: Promoting the use of public transit and active transport (walking and cycling) instead of car driving is an appealing strategy to increase overall physical activity.
PURPOSE: To quantify the combined associations between self-reported home and worksite neighborhood environments, worksite support and policies, and employees' commuting modes.
METHOD: Between 2012 and 2013, participants residing in four Missouri metropolitan areas were interviewed via telephone (n = 1,338) and provided information on socio-demographic characteristics, home and worksite neighborhoods, and worksite support and policies. Commuting mode was self-reported and categorized into car driving, public transit, and active commuting. Commuting distance was calculated using geographic information systems. Commuters providing completed data were included in the analysis. Multivariate logistic regression models were used to examine the correlates of using public transit and active commuting.
RESULT: The majority of participants reported commuting by driving (88.9%); only 4.9% used public transit and 6.2% used active modes. After multivariate adjustment, having transit stops within 10-15 minutes walking distance from home (p=0.05) and using worksite incentive for public transit (p<0.001) were associated with commuting by public transit. Commuting distance (p<0.001) was negatively associated with active commuting. Having free or low cost recreation facilities around the worksite (p=0.04) and using bike facilities to lock bikes at the worksite (p<0.001) were associated with active commuting.
CONCLUSION: Both environment features and worksite supports and policies are associated with the choice of commuting mode. Future studies should use longitudinal designs to investigate the potential of promoting alternative commuting modes through worksite efforts that support sustainable commuting behaviors as well as the potential of built environment improvements.
Resumo:
Potential human immunodeficiency virus transmission makes prompt disclosure of child sexual abuse in Africa critical. The pattern of disclosure of 133 children presenting to the largest hospital in Malawi were analyzed. Eighty percent presented early enough for effective use of HIV postexposure prophylaxis. Seventy-five percent of children made a disclosure of child sexual abuse; 29% spontaneously and 47% after prompting. Disclosures were most commonly made to a parent, and age did not affect the pattern of disclosure. The number of children reporting child sexual abuse is increasing, possibly because of increasing awareness, availability of services, and fear of HIV. Although prompt disclosure rates were relatively high, facilitating easier disclosure of child sexual abuse by a free telephone help-line and better training of teachers may be helpful.
Resumo:
Background: The EU Early Warning System currently monitors more than 450 new psychoactive substances (EMCDDA, 2015), far outweighing the total number of illicit drugs under international control (UNODC, 2013). Due to the recent emergence of NPS and rapidly changing nature of the market, evidence about the way in which the emerging drugs are managed in health and social care settings is limited. Methods: The study adopted a mixed methods design, utilising a cross sectional survey and follow up telephone interviews to capture data from staff working in drug and alcohol related services in statutory and voluntary sectors, across the five Health and Social Care (HSC) Trust areas in Northern Ireland. 196 staff participated in the survey and 13 took part in follow up telephone interviews. Results: Study respondents reported that addressing NPS related issues with service users was a key aspect of their daily role and function. Levels of injecting behaviours were also viewed as relatively high by the study participants. Almost all workers used harm reduction as their primary approach when working with service users and the majority of respondents called for additional practical training in relation to addressing drug interactions and intervening with NPS related issues.
Resumo:
O advento da Internet e da Web, na década de 1990, a par da introdução e desenvolvimento das novas TIC e, por consequência, a emergência da Sociedade da Informação e do Conhecimento, implicaram uma profunda alteração na forma de análise dos processos de ensino-aprendizagem, já não apenas segundo um prisma cognitivista, mas, agora, também social, isto é, segundo a(s) perspetiva(s) construtivista(s). Simultaneamente, torna-se imperativo que, para que possam transformar-se em futuros trabalhadores de sucesso, isto é, trabalhadores de conhecimento (Gates, 1999), os sujeitos aprendentes passem a ser efetivamente educados/preparados para a Sociedade da Informação e do Conhecimento e, tanto quanto possível, através da educação/formação ao longo da vida (Moore e Thompson, 1997; Chute, Thompson e Hancock, 1999). Todavia, de acordo com Jorge Reis Lima e Zélia Capitão, não se deve considerar esta mudança de paradigma como uma revolução mas, antes, uma evolução, ou, mais concretamente ainda, uma “conciliação de perspectivas cognitivas e sociais” (Reis Lima e Capitão, 2003:53). Assim, às instituições de ensino/formação cumprirá a tarefa de preparar os alunos para as novas competências da era digital, promovendo “a aprendizagem dos pilares do conhecimento que sustentarão a sua aprendizagem ao longo da vida” (Reis Lima e Capitão, Ibidem:54), isto é, “aprender a conhecer”, “aprender a fazer”, “aprender a viver em comum”, e “aprender a ser” (Equipa de Missão para a Sociedade da Informação, 1997:39; negritos e sublinhados no original). Para outros, a Internet, ao afirmar-se como uma tecnologia ubíqua, cada vez mais acessível, e de elevado potencial, “vem revolucionando a gestão da informação, o funcionamento do mercado de capitais, as cadeias e redes de valor, o comércio mundial, a relação entre governos e cidadãos, os modos de trabalhar e de comunicar, o entretenimento, o contacto intercultural, os estilos de vida, as noções de tempo e de distância. A grande interrogação actual reside em saber se a Internet poderá também provocar alterações fundamentais nos modos de aprender e de ensinar” (Carneiro, 2002:17-18; destaques no original). Trata-se, portanto, como argumenta Armando Rocha Trindade (2004:10), de reconhecer que “Os requisitos obrigatórios para a eficácia da aprendizagem a ser assim assegurada são: a prévia disponibilidade de materiais educativos ou de formação de alta qualidade pedagógica e didáctica, tanto quanto possível auto-suficientes em termos de conteúdos teóricos e aplicados, bem como a previsão de mecanismos capazes de assegurar, permanentemente, um mínimo de interactividade entre docentes e aprendentes, sempre que quaisquer dificuldades destes possam manifestarse”. Esta questão é também equacionada pelo Eng.º Arnaldo Santos, da PT Inovação, quando considera que, à semelhança da “maioria dos países, a formação a distância em ambientes Internet e Intranet, vulgo e-Learning, apresenta-se como uma alternativa pedagógica em franca expansão. Portugal está a despertar para esta nova realidade. São várias as instituições nacionais do sector público e privado que utilizam o e-Learning como ferramenta ou meio para formar as suas pessoas” (Santos, 2002:26). Fernando Ramos acrescenta também que os sistemas de educação/formação que contemplam componentes não presenciais, “isto é que potenciam a flexibilidade espacial, têm vindo a recorrer às mais variadas tecnologias de comunicação para permitir a interacção entre os intervenientes, nomeadamente entre os professores e os estudantes. Um pouco por todo o mundo, e também em Portugal, se têm implantado sistemas (habitualmente designados como sistemas de ensino a distância), recorrendo às mais diversas tecnologias de telecomunicações, de que os sistemas de educação através de televisão ou os sistemas de tutoria por rádio ou telefone são exemplos bem conhecidos” (Ramos, 2002b:138-139). Ora, o nosso estudo entronca precisamente na análise de um sistema ou plataforma tecnológica de gestão de aprendizagens (Learning Management System - LMS), o MOODLE, procurando-se, deste modo, dar resposta ao reconhecimento de que “urge investigar sobre a utilização real e pedagógica da plataforma” (Carvalho, 2007:27). Por outro lado, não descurando o rol de interrogações de outros investigadores em torno da utilização do MOODLE, nem enveredando pelas visões mais céticas que inclusive pressagiam a sua “morte” (Fernandes, 2008b:134), também nós nos questionamos se esta ferramenta nem sequer vai conseguir transpor “a fase de final de entusiasmo, e tornar-se uma ferramenta de minorias e de usos ocasionais?” (Fernandes, Op. cit.:133).
Resumo:
Portugal has strong musical traditions, which have been perpetrated by decades through folkloristic activities. In folk groups from Alto Minho (north of Portugal), folk singing is mostly performed by cantadeiras, amateur female solo singers who learn this style orally. Their vocal characteristics are distinctive when compared with other regions of the country; however, deep understanding of these vocal practices is still missing. The present work aims at studying Alto Minho cantadeira’s vocal performance in a multidimensional perspective, envisioning social, cultural and physiological understanding of this musical style. Thus, qualitative and quantitative data analyses were carried out, to: (i) describe current performance practices, (ii) explore existent perceptions about most relevant voice features in this region, (iii) investigate physiological and acoustic properties of this style, and (iv) compare this style of singing with other non-classical singing styles of other countries. Dataset gathered involved: 78 groups whose members were telephone interviewed, 13 directors who were asked to fill in a questionnaire on performance practices, 1 cantadeira in a pilot study, 16 cantadeiras in preliminary voice recordings, 77 folk group members in listening tests, and 10 cantadeiras in multichannel recordings, including audio, ELG, air flow and intra-oral pressure signals. Data were analysed through thematic content analysis, descriptive and inferential statistics, hierarchical principal components, and multivariate linear regression models. Most representative voices have a high pitched and loud voice, with a bright timbre, predominance of chest register without excessive effort, and good text intelligibility with regional accent. High representativeness levels were obtained by few cantadeiras; these sing with high levels of subglottal pressure and vocal fold contact quotient, predominance of high spectrum energy and vocal loudness, corroborating indications of prevalence of pressed phonation. These vocal characteristics resemble belting in musical theatre and share similarities with country (USA) and ojikanje (Croatia) singing. Strategies that may contribute to the preservation of this type of singing and the vocal health of current cantadeiras are discussed, pointing at the direction of continuous education among folk groups, following practices that are already adopted elsewhere in Europe.
Resumo:
Purpose: To identify facilitators and barriers to service reorganization, how they evolved and interacted to influence change during the implementation of a new service delivery model of paediatric rehabilitation. Methods: Over 3 years, different stakeholders responded to SWOT questionnaires (n = 139) and participated in focus groups (n = 19) and telephone interviews (n = 13). A framework based on socio constructivist theories made sense of the data. Results: Facilitators related to the programme's structure (e.g. funding), the actors (e.g. willingness to test the new service model) and the change management process (e.g. participative approach). Some initial facilitators became barriers (e.g. leadership lacked at the end), while other barriers emerged (e.g. lack of tools). Understanding factor interactions requires examining the multiple actors’ intentions, actions and consequences and their relations with structural elements. Conclusions: Analysing facilitators and barriers helped better understand the change processes, but this must be followed by concrete actions to successfully implement new paediatric rehabilitation models.
Resumo:
In Zeitmultiplex-Vielfachzugriff-(TDMA-)Durchschalte-Vermittlungsnetzen mit verteilter Steuerung können Kollisionen von Zugriffsvorgängen auftreten. Es wird unterstellt, daß die den kollidierenden Zugriffsvorgängen zugehörigen Verbindungswünsche nicht weiterbehandelt werden und deshalb wegen Kollision zu Verlust gehen. Die zugehörige Verlustwahrscheinlichkeit -genannt Kollisionsverlust BK - wird allgemein berechnet. Die numerische Auswertung zeigt, daß für Fernsprechverkehr diese - gegenüber Systemen mit konzentrierter Steuerung - zusätzlichen Kollisionsverluste vernachlässigt werden können gegenüber den üblichen Planungsverlusten wegen Abnehmermangels.
Resumo:
Für ein baumförmiges Zeitmultiplex-Durchschalte-Vermittlungsnetz mit Vielfachzugriff wird ein neues Funktionsprinzip vorgestellt. Dessen wesentliches Merkmal ist der geringe Bandbreitenbedarf. Die in solchen Vermittlungsnetzen bei verteilter Steuerung durch Zugriffskonflikte auftretenden Verluste an Verbindungswünschen werden berechnet. Außerdem werden die Einsatzmöglichkeiten solcher Vermittlungsnetze sowie deren verkehrstheoretische Bemessung bei Internverkehr untersucht.
