scholarly journals INTREPID II: protocol for a multistudy programme of research on untreated psychosis in India, Nigeria and Trinidad

BMJ Open ◽  
2020 ◽  
Vol 10 (6) ◽  
pp. e039004
Author(s):  
Tessa Roberts ◽  
Oye Gureje ◽  
Rangaswamy Thara ◽  
Gerard Hutchinson ◽  
Alex Cohen ◽  
...  
Keyword(s):  
Rural Areas ◽  
Help Seeking ◽  
Psychotic Disorders ◽  
Global South ◽  
Ethical Review ◽  
Target Populations ◽  
Key Stakeholders ◽  
Pilot Work ◽  
Urban And Rural Areas

IntroductionThere are few robust and directly comparable studies of the epidemiology of psychotic disorders in the Global South. INTREPID II is designed to investigate variations in untreated psychotic disorders in the Global South in (1) incidence and presentation (2) 2-year course and outcome, (3) help-seeking and impact, and (4) physical health.MethodsINTREPID II is a programme of research incorporating incidence, case–control and cohort studies of psychoses in contiguous urban and rural areas in India, Nigeria and Trinidad. In each country, the target samples are 240 untreated cases with a psychotic disorder, 240 age-matched, sex-matched and neighbourhood-matched controls, and 240 relatives or caregivers. Participants will be followed, in the first instance, for 2 years. In each setting, we have developed and are employing comprehensive case-finding methods to ensure cohorts are representative of the target populations. Using methods developed during pilot work, extensive data are being collected at baseline and 2-year follow-up across several domains: clinical, social, help-seeking and impact, and biological.Ethics and disseminationInformed consent is sought, and participants are free to withdraw from the study at any time. Participants are referred to mental health services if not already in contact with these and emergency treatment arranged where necessary. All data collected are confidential, except when a participant presents a serious risk to either themselves or others. This programme has been approved by ethical review boards at all participating centres. Findings will be disseminated through international conferences, publications in international journals, and through local events for key stakeholders.

scholarly journals The effect of COVID-19 pandemic and lockdown on consultation numbers, consultation reasons and performed services in primary care: results of a longitudinal observational study

2021 ◽  
Vol 22 (1) ◽  
Author(s):  
Ingmar Schäfer ◽  
Heike Hansen ◽  
Agata Menzel ◽  
Marion Eisele ◽  
Daniel Tajdar ◽  
...  
Keyword(s):  
Primary Care ◽  
Observational Study ◽  
Rural Areas ◽  
Longitudinal Observational Study ◽  
Multivariable Analyses ◽  
Gastrointestinal Complaints ◽  
Urban And Rural Areas ◽  
Quota Sampling ◽  
Primary Care Practices

Abstract Objectives The aims of our study were to describe the effect of the COVID-19 pandemic and lockdown on primary care in Germany regarding the number of consultations, the prevalence of specific reasons for consultation presented by the patients, and the frequency of specific services performed by the GP. Methods We conducted a longitudinal observational study based on standardised GP interviews in a quota sampling design comparing the time before the COVID-19 pandemic (12 June 2015 to 27 April 2017) with the time during lockdown (21 April to 14 July 2020). The sample included GPs in urban and rural areas 120 km around Hamburg, Germany, and was stratified by region type and administrative districts. Differences in the consultation numbers were analysed by multivariate linear regressions in mixed models adjusted for random effects on the levels of the administrative districts and GP practices. Results One hundred ten GPs participated in the follow-up, corresponding to 52.1% of the baseline. Primary care practices in 32 of the 37 selected administrative districts (86.5%) could be represented in both assessments. At baseline, GPs reported 199.6 ± 96.9 consultations per week, which was significantly reduced during COVID-19 lockdown by 49.0% to 101.8 ± 67.6 consultations per week (p < 0.001). During lockdown, the frequency of five reasons for consultation (-43.0% to -31.5%) and eleven services (-56.6% to -33.5%) had significantly decreased. The multilevel, multivariable analyses showed an average reduction of 94.6 consultations per week (p < 0.001). Conclusions We observed a dramatic reduction of the number of consultations in primary care. This effect was independent of age, sex and specialty of the GP and independent of the practice location in urban or rural areas. Consultations for complaints like low back pain, gastrointestinal complaints, vertigo or fatigue and services like house calls/calls at nursing homes, wound treatments, pain therapy or screening examinations for the early detection of chronic diseases were particularly affected.

Risk factors and features of stroke among young persons in urban and rural areas of the Tambov Region

2021 ◽  
pp. 45-52
Author(s):  
Ekaterina B. Zvonareva ◽  
Lubov I. Grigorova
Keyword(s):  
Risk Factors ◽  
Rural Areas ◽  
Cerebral Circulation ◽  
Young Patients ◽  
Clinical Hospital ◽  
Regional Features ◽  
Urban And Rural Areas ◽  
Concomitant Factors ◽  
Causes And Risk Factors

Since 2011 according to the national project “Health” the Regional Vascular Center has been operating on the basis of the Tambov Regional Clinical Hospital. This is a ward for patients with acute cerebral circulation disorder. Since 2017 there has been an increase in patients due to an increase in the number of attached population to Tambov Regional Clinical Hospital and, accordingly, unfortunately, the mortality rate from acute cerebral circulation disorder has been increasing. Between 2016 and 2020, a study was conducted based on the follow-up of young patients with hemorrhagic and ischemic stroke. In the study we emphasized the research of regional features of the structure, causes, and risk factors of stroke in persons in the city of Tambov and the districts of the Tambov Region. We verified pathogenetic subtypes of stroke among young patients. We identified and considered main and concomitant factors determining stroke outcome, degree of neurological deficiency, and disabled patients. We identified the leading causes of stroke in persons, the main of which were: arterial hypertension, cardiac pathology, atherosclerosis.

scholarly journals 1299. Iowa TelePrEP: Preliminary Experience with a Public Health-Partnered, Telemedical PrEP Delivery Model in a Rural State

2018 ◽  
Vol 5 (suppl_1) ◽  
pp. S397-S397 ◽  
Author(s):  
Angela Hoth ◽  
Cody Shafer ◽  
Dena Dillon ◽  
Constanza Scheetz ◽  
Seth Owens ◽  
...  
Keyword(s):  
Public Health ◽  
Rural Areas ◽  
Local Treatment ◽  
Linkage To Care ◽  
University Of Iowa ◽  
Transmitted Infection ◽  
Delivery Model ◽  
Sexually Transmitted ◽  
Urban And Rural Areas

Abstract Background Access to HIV pre-exposure prophylaxis (PrEP) is often poor in small urban and rural areas due to long distances to PrEP providers and stigma. In 2017, the Iowa Department of Public Health (IDPH), University of Iowa (UI), and community representatives collaborated to develop a public health-partnered telemedical PrEP delivery model to overcome these barriers (TelePrEP). IDPH personnel working in five sexually transmitted infection (STI) clinics and partner services (PS) programs in Eastern Iowa screened clients for PrEP indications and referred those with need to TelePrEP pharmacist providers at UI. Via collaborative practice, pharmacists completed initial and follow-up PrEP home video visits with clients on smart phones and laptops. Clients obtained laboratory monitoring and STI screening in public health-affiliated and local laboratories in accordance with USPHS/CDC guidelines, and received PrEP medication by mail. PS personnel linked TelePrEP clients with newly-identified STIs to local treatment. Methods Using the PrEP continuum as framework, we used IDPH databases and UI medical records to conduct a retrospective process evaluation of the TelePrEP model (February 2017–April 2018). Results TelePrEP received 44 referrals from public health and 59 self-referrals via advertising. Pharmacists completed 84 initial visits (81% of referrals), including 37 visits (84%) with clients referred by public health. Most (94%) started emtricitabine/tenofovir after initial visits. Retention in TelePrEP at 6 months was 87%. 96% of guideline-indicated laboratory tests (HIV, creatinine, STI, hepatitis) were completed at baseline and follow-up. Rates of extragenital chlamydia and gonorrhea screening were lower (74 of 104 completed screens) due to variable availability of swabs at local laboratories. 15 clients were diagnosed with 20 STIs on screening (6 syphilis, four gonorrhea, 10 chlamydia) and one unrecognized pregnancy was identified. PS linked all clients with STIs on screens to treatment within 14 days (80% in 3 days). Conclusion Using telemedicine, healthcare systems can partner with public health administered STI clinics and PS programs to create virtual PrEP delivery models in rural settings. Public health partnerships enhance client identification and ensure linkage to care for new STI diagnoses in telemedicine programs. Disclosures A. Hoth, Gilead Sciences, Inc.: Research team member, Research support. M. Ohl, Gilead Sciences, Inc.: Grant Investigator, Research grant.

scholarly journals Understanding parents’ experiences of disease course and influencing factors: a 3-year follow-up qualitative study among parents of children with functional abdominal pain

BMJ Open ◽  
2020 ◽  
Vol 10 (8) ◽  
pp. e037288
Author(s):  
Mette Brekke ◽  
Anne Brodwall
Keyword(s):  
Abdominal Pain ◽  
Rural Areas ◽  
Specific Treatment ◽  
Common Symptom ◽  
Functional Abdominal Pain ◽  
Open Questions ◽  
Urban And Rural Areas ◽  
Southern Norway ◽  
Parents Experiences

ObjectiveFunctional abdominal pain is a common symptom in children and adolescents. Three years ago, we investigated the experiences among parents whose children had chronic abdominal pain but no somatic diagnosis. The aim of the present follow-up study was to explore those families’ current situations.DesignInterviews with open questions about the families’ current pain situations were carried out by the first author. Interviews were audio-recorded and transcribed, and subsequently analysed using descriptive content analysis.SettingUrban and rural areas in two municipalities in Southern Norway.ParticipantsParents of children with abdominal pain who had been referred to a local hospital by their general practitioner and had been discharged without a somatic diagnosis. Fifteen parents of 14 children aged 8–17 years who had also been interviewed in 2016.ResultsNine of the children had recovered from their abdominal pain. During the pain period, the parents reported frustration with not having a diagnosis nor a specific treatment for their child’s abdominal pain. The siblings in some families received less attention and were afraid that something serious might happen to their sister or brother. The parents wished that their child’s school cared more about the child when they had weeks of absence. All parents maintained that their child’s pain was physical, although they thought that psychological aspects might have influenced the symptoms. The parents stated that they, as well as their children, needed guidance from professionals to understand the complex pain situation.

scholarly journals The Community Pharmacist’s Role in Reducing Cardiovascular Risk Factors in Lebanon: A Longitudinal Study

2018 ◽  
Vol 27 (6) ◽  
pp. 508-514 ◽  
Author(s):  
Iqbal M. Fahs ◽  
Souheil Hallit ◽  
Mohamad K. Rahal ◽  
Diana N. Malaeb
Keyword(s):  
Risk Factors ◽  
Blood Pressure ◽  
Lipid Profile ◽  
Rural Areas ◽  
Prospective Survey ◽  
Average Body Mass ◽  
Ascvd Risk ◽  
Urban And Rural Areas

Objective: To assess the role of the pharmacist in modifying risk factors for cardiovascular disease (CVD) among Lebanese adults in urban and rural areas. Methods: In a prospective survey, 865 out of 1,000 participants aged ≥45 years, previously interviewed, agreed to be followed at 1 and 2 years time points. Parameters including blood pressure, lipid profile, blood glucose, average number of risk factors, and atherosclerotic CVD (ASCVD) risk were assessed and evaluated at the beginning of the study, then after 1 and 2 years. Results: During both follow-ups, the mean average body mass index and systolic blood pressure decreased significantly and the lipid profile improved significantly. Further significant improvements in ASCVD risk occurred during the second follow-up. Monitoring parameters revealed significant improvements as well. Conclusion: This study showed that a plan that includes pharmacists, who regularly monitor and follow-up patients, could improve CVD prevention through the reduction of risk factors.

scholarly journals LIMPACT DES THERAPIES TRADITIONNELLES SUR LA PRISE EN CHARGE DES MALADES MENTAUX

2021 ◽  
Vol 9 (02) ◽  
pp. 911-916
Author(s):  
S. Belbachir ◽  
◽  
A. Benzineb ◽  
A. Ouanass ◽  
◽  
...  
Keyword(s):  
Mental Disorder ◽  
Rural Areas ◽  
Psychotic Disorders ◽  
Psychiatric Symptoms ◽  
Prise En Charge ◽  
Strongly Correlated ◽  
Traditional Therapy ◽  
Almost All

In spite of the development of the psychiatry in Morocco, the traditional therapy is another current phenomenon always using to treat mental disorder. The surnatural was dominating in the representation of the mental disorder, and it as well at the level of its origin as of its treatment.The objective of this work is to describe the cultural perception of the first psychiatric symptoms by the families of the mental sick, to determine the first approach of care.It is about a descriptive forward-looking study using a heteroquestionnary including a sample of 184 families of hospitalized or consultant patient to the Ar-razipsychiatric hospital in Sale (Morocco) over a period of three months of the current year.We counted 184 families who have a member consulted or hospitalized at the Arrazi hospital. 38% represent mother of patient. All the socioeconomic and educational levels were represented. Almost all the diseases were founded with a big ascendancy of the psychotic disorders. The appeal to Fkihs in front of first symptoms was almost important the conversifs disorders and anxious seem to be the preference illness of this kind of practice but you should not forget that the psychoses also represent a not insignificant rate with 66%. The cultural interpretations of the mental illness are represented by the charm in 35 % of the cases, the Toukal (deliberate poisoning) in 29% and the ownership by devils in 21 %. The bad eye is reported in 20%. More than 63% of families turned to the traditional therapy in front of the first psychiatric symptoms, while only 36 % returned the patients at a general doctor or a psychiatrist. 62 % of families continue to turn to the traditional therapies in spite of the psychiatric follow-up, in this case they tend to stop the medical treatment in 30 % of the cases. There is a significant link between the first orientation and the interpretation of the disease. Traditherapeutes was more requested at the patients of whom families think that their disease is of surnatural origin (p = 0,001). The appeal to the traditional therapy and the residence in rural areas and not schooling are also strongly correlated. (P = 0,011 and p = 0,001). The Moroccan psychiatry was able to realize a lot of progress during the last two decades, in spite of the insufficiency of the human resources and the infrastructures. Additional efforts are necessary, especially with the high request of care, for it all the community should participate in the promotion of the mental health to reduce the stigmatization of this discipline and offer a better management of patients. The family is at the heart of the care of the mental disorders. Simple interventions with family can largely improve the quality of life of the sick person and that of the whole family.

scholarly journals Differences in Cancer Death Risk Long After ACS Among Selected Urban and Rural Areas in North Italy: The ABC-7a† Study on Heart Disease

2021 ◽  
Vol 11 ◽  
Author(s):  
Heba T. Mahmoud ◽  
Giuseppe Berton ◽  
Rocco Cordiano ◽  
Rosa Palmieri ◽  
Tobia Nardi ◽  
...  
Keyword(s):  
Rural Areas ◽  
Cox Regression ◽  
Veneto Region ◽  
Cancer Death ◽  
Positive Interaction ◽  
Death Risk ◽  
Coronary Syndrome ◽  
Urban And Rural Areas ◽  
Risk Of Cancer

BackgroundAn increased risk of cancer death has been demonstrated for patients diagnosed with acute coronary syndrome (ACS). We are investigating possible geographic risk disparities.MethodsThis prospective study included 541 ACS patients who were admitted to hospitals and discharged alive in three provinces of Italy’s Veneto region. The patients were classified as residing in urban or rural areas in each province.ResultsWith 3 exceptions, all patients completed the 22-year follow-up or were followed until death. Urban (46%) and rural (54%) residents shared most of their baseline demographic and clinical characteristics. Pre-existing malignancy was noted in 15 patients, whereas 106 patients developed cancer during the follow-up period, which represented 6232 person-years. No difference in the cancer death risk was found between the urban and rural areas or between southern and northern provinces (hazard ratio [HR] 1.1; 95% confidence interval [CI] 0.7–1.7; p = 0.59 and HR 1.1; 95% CI 0.9–1.4; p = 0.29, respectively) according to the unadjusted Cox regression analysis. Geographic areas, however, showed a strong positive interaction, with risk increasing from the urban to rural areas from southern to northern provinces (HR 1.9; 95% CI 1.1–3.0; p = 0.01). The fully adjusted Cox regression and Fine-Gray competing risk regression models provided similar results. Interestingly, these results persisted, and even strengthened, after exclusion of the 22 patients who developed malignancy and survived to the end of follow-up. We did not observe an urban/rural difference in non-neoplastic death risk or a significant interaction between the geographic areas.ConclusionOur analysis reveals that the cancer death risk among unselected ACS patients in Italy’s Veneto region significantly differs by geography. The northern rural area has the highest risk. These results highlight the importance of implementing a preventive policy based on area-specific knowledge.

scholarly journals Risk of malignancy long after acute coronary syndrome in selected urban and rural areas and comparison with smoking risk: the ABC-7* study on Heart Disease

2021 ◽  
Vol 7 (1) ◽  
Author(s):  
Giuseppe Berton ◽  
Heba T. Mahmoud ◽  
Rosa Palmieri ◽  
Fiorella Cavuto ◽  
Rocco Cordiano ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Cancer Risk ◽  
Rural Areas ◽  
Positive Interaction ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Urban And Rural Areas ◽  
Adjusted Model

Abstract Background Increased cancer risk has been reported in patients with acute coronary syndrome (ACS). Objectives To investigate geographic differences in risk malignancy long after ACS. Methods We enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy in this prospective study. Patient’s residency was classified into three urban and three nearby rural areas. Results All (except for 3) patients completed the follow-up (22 years or death) and 54 % were living in rural areas. Sixteen patients had pre-existing malignancy, and 106 developed the disease during follow-up. Cancer prevalence was 17 % and 24 % (p = 0.05) and incidence of malignancy was 16 and 21/1000 person-years for urban and rural areas, respectively. In unadjusted logistic regression analysis, cancer risk increased from urban to rural areas (odds ratio [OR] 3.4;95 % confidence interval [CI] 1.7–7.1; p = 0.001), with little change from north to south provinces (OR 1.5;95 % CI 1.0-2.2; p = 0.06). Yet, we found a strong positive interaction between urban-rural areas and provinces (OR 2.1;95 % CI 1.2–3.5; p = 0.003). These results kept true in the fully adjusted model. Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR 3.0;95 % CI 1.5–6.2; p = 0.02), but not among provinces (HR 1.3;95 % CI 1.0–2.0; p = 0.14). Also, we found a strong positive interaction between geographic areas (HR 2.1;95 % CI 1.3–3.5; p = 0.002), even with a fully adjusted model. Conclusions The results in unselected real-world patients demonstrate a significant geographic difference in malignancy risk in ACS patients, with the highest risk in the north-rural area.

scholarly journals Risk of Malignancy Long After Acute Coronary Syndrome in Selected Urban and Rural Areas and Comparison With Smoking Risk: The ABC-7* Study on Heart Disease. (*ABC is An Acronym for Adria, Bassano, Conegliano, and Padova Hospitals)

2020 ◽  
Author(s):  
Giuseppe Berton ◽  
Heba Talat Mahmoud ◽  
Rosa Palmieri ◽  
Fiorella Cavuto ◽  
Rocco Cordiano ◽  
...  
Keyword(s):  
Acute Coronary Syndrome ◽  
Regression Analysis ◽  
Cancer Risk ◽  
Rural Areas ◽  
Positive Interaction ◽  
Cox Regression Analysis ◽  
Coronary Syndrome ◽  
Urban And Rural Areas ◽  
Adjusted Model

Abstract Background Increased cancer risk has been reported in patients with acute coronary syndrome (ACS). Objectives To investigate geographic differences in risk malignancy long after ACS. Methods We enrolled 586 ACS patients admitted to hospitals in three provinces in the Veneto region of Italy in this prospective study. Patient's residency was classified into three urban and three nearby rural areas. Results All (except for 3) patients completed the follow-up (22 years or death) and 54% were living in rural areas. Sixteen patients had pre-existing malignancy, and 106 developed the disease during follow-up. Cancer prevalence was 17% and 24% (p=0.05) and incidence of malignancy was 16 and 21/1000 person-years for urban and rural areas, respectively. In unadjusted logistic regression analysis, cancer risk increased from urban to rural areas (odds ratio [OR] 3.4;95% confidence interval [CI] 1.7-7.1; p=0.001), with little change from north to south provinces (OR 1.5;95% CI 1.0-2.2; p=0.06). Yet, we found a strong positive interaction between urban-rural areas and provinces (OR 2.1;95% CI 1.2-3.5; p=0.003). These results kept true in the fully adjusted model. Unadjusted Cox regression analysis revealed increasing hazards ratios (HRs) for malignancy onset from urban to rural areas (HR 3.0;95% CI 1.5-6.2; p=0.02), but not among provinces (HR 1.3;95% CI 1.0-2.0; p=0.14). Also, we found a strong positive interaction between geographic areas (HR 2.1;95% CI 1.3-3.5; p=0.002), even with a fully adjusted model. Conclusion The results in unselected real-world patients demonstrate a significant geographic difference in malignancy risk in ACS patients, with the highest risk in the north-rural area.

scholarly journals Epidemiology of Psychotic Disorders Based on Demographic Variables in Iranian Children and Adolescents

2021 ◽  
Author(s):  
Seyyed Salman Alavi ◽  
Mohammad Reza Mohammadi ◽  
Zahra Hooshyar ◽  
Soroush Mohammadi Kalhori ◽  
Mona Salehi ◽  
...  
Keyword(s):  
Children And Adolescents ◽  
Rural Areas ◽  
Psychotic Disorders ◽  
Total Sample ◽  
Demographic Variables ◽  
Psychotic Symptoms ◽  
Cluster Sampling ◽  
Logistic Regression Method ◽  
Urban And Rural Areas ◽  
Iranian Children

Objective: Psychosis is still among the most debilitating and severe mental disorders. The main objective of the present study was to investigate the estimated prevalence of psychotic disorders and finding the main predictors of psychotic disorders among Iranian children and adolescents. Method: Our total sample consisted of 30 553 individuals (49% males and 51%females) from 30 provinces of Iran, aged between 6 and 18 years, who were selected via cluster sampling method from urban and rural areas of all provinces. The data were analyzed using descriptive statistical analysis and multiple logistic regression method. Results: The results of multiple regression analysis showed that prevalence estimate of psychotic disorders was 0.25%. It was 0.3% and 0.2% in males and females, respectively. The age of 10-14 (OR = 2.24; 95% CI, 1.11-4.55) and the age of 15-18 (OR = 3.42; 95% CI, 1.74-6.75) were significant positive predictors, whereas none of the demographic variables were predictors for psychotic symptoms. Conclusion: This research highlights the main predictors of psychosis in children and adolescents. The study design also allowed a better understanding of predictors of psychotic disorders. The assessment of the prevalence

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