The day-to-day work of primary care (PC) was substantially changed by the COVID-19 pandemic. Teaching practices needed to adapt both clinical work and teaching in a way that enabled the teaching ...process to continue, while maintaining safe and high-quality care. Our study aims to investigate the effect of being a training practice on a number of different outcomes related to the safety culture of PC practices. PRICOV-19 is a multi-country cross-sectional study that researches how PC practices were organized in 38 countries during the pandemic. Data was collected from November 2020 to December 2021. We categorized practices into training and non-training and selected outcomes relating to safety culture: safe practice management, community outreach, professional well-being and adherence to protocols. Mixed-effects regression models were built to analyze the effect of being a training practice for each of the outcomes, while controlling for relevant confounders. Of the participating practices, 2886 (56%) were non-training practices and 2272 (44%) were training practices. Being a training practice was significantly associated with a lower risk for adverse mental health events (OR: 0.83; CI: 0.70-0.99), a higher number of safety measures related to patient flow (Beta: 0.17; CI: 0.07-0.28), a higher number of safety incidents reported (RR: 1.12; CI: 1.06-1.19) and more protected time for meetings (Beta: 0.08; CI: 0.01-0.15). No significant associations were found for outreach initiatives, availability of triage information, use of a phone protocol or infection prevention measures and equipment availability. Training practices were found to have a stronger safety culture than non-training practices. These results have important policy implications, since involving more PC practices in education may be an effective way to improve quality and safety in general practice.
LANGUAGE= "English" INTRODUCTION: This study aims to measure the perceived stress level of family caregivers of patients in palliative care units, and to reveal the socio-cultural and health-related ...characteristics that might affect their perceived stress.METHODS: The population of this cross-sectional study consisted of family members who had taken care of their patients who were hospitalized in palliative care units between March 1, 2018, and June 1, 2018. A sociodemographic questionnaire and Perceived Stress Scale-14 (PSS-14) was applied face-to-face to all participants. Moreover, the Patient Health Questionnaire (PHQ-2) was applied to all participants.RESULTS: Seventy-five family caregivers attended to the study. Twenty-two (34.7%) of family caregivers were patients’ children. Fifty-seven (75.0%) of family caregivers struggled with problems during care processes. Fifteen (19.5%) participants gave positive responses to both questions of the PHQ-2. The number of family caregivers who had chronic diseases was 49 (64.5%). The mean score of PSS-14 was 46.9±5.7.DISCUSSION AND CONCLUSION: Difficulties in the management of care processes may have increased perceived stress levels and may adversely affect the caregivers' health and social life. Providing early psychological support to family caregivers by health professionals may help to reduce perceived stress.
The definition of "nonurgent emergency service visits" is visits to conditions for medical conditions that require attention but are not life-threatening immediately or severe enough to require ...urgent intervention. This study aims to investigate the reasons why patients choose to self-refer to the emergency service (ES) instead of their primary care health center for nonurgent complaints. The study was carried out in a tertiary hospital. The survey consisted of 2 parts with sociodemographic questions, knowledge of their family physician, and the reason why it has been applied to the ES with multiple choice answers. Of the 325 patients, the mean age was 34.5 years and 54.2% were women. Also, 26 of the patients were reported as "urgent" by the doctor. The main reasons underlying self-referred patients were classified into 4 themes: "urgency" (13.8%), advantages of ES (12.9%); disadvantages of primary care (25.1%), and other (45.9%). The most common reason patients self-refer to the ES was their belief in "being urgent" (61%). In this study, 26.8%, (n = 84) of the patients are not happy with their family physicians, while only 13.2% (N = 43) prioritize the ES advantages.
Background/Aims: Caregivers are family members who provide unpaid assistance to their ill spouses. In Turkey, family caregiving, engagement, and support are needed when patients are hospitalized. ...This study aims to better understand the feelings of caregivers behind their behaviors in a terrier palliative care setting.
Methods: This research is a cross-sectional qualitative study designed with phenomenology. Five family caregivers who volunteered to participate were interviewed face-to-face. Inclusion criteria were adult informal caregivers who currently provided care to the patient at home and in the hospital.
Results: The family caregivers consist of five spouses with a mean age of 44.8 ± 4.80 years. Each caregiver is a female and the spouse of the patient. Of the patients diagnosis was Alzheimer’s disease, dementia, gastric cancer, and stroke, respectively. The caregiving time was approximately 2.79 ± 1.62 years. Four themes and eleven subthemes were indicated: Concerns about themselves: Overestimating their health care problems, Anxiety about staying strong; Consequences of the patient: Remembering the patient like a “hero”; Acceptance of the situation Fear of “finding him death” Challenges about caregiving Sacrificing from life Excessive responsibility Embarrassment from diaper care Lack of orientation for caregiving at first Coping strategies Devine providence Religious beliefs.
Conclusions: The findings of the study indicate that family caregivers have concerns about themselves and the consequences of their roles. Even if they try to cope with spirituality, healthcare providers can support them by recognizing their essential roles.
Giriş: Bakımverenler, hastalarına ücretsiz yardım sağlayan aile üyeleridir. Türkiye'de hastalar hastaneye yatırıldığında aile bakımı, katılım ve desteğe ihtiyaç duyulmaktadır. Bu çalışma, palyatif bakım ortamında bakımverenlerin davranışlarının ardındaki duygularını daha iyi anlamayı amaçlamaktadır.
Yöntemler: Bu araştırma fenomenoloji ile tasarlanmış kesitsel nitel bir çalışmadır. Katılmak için gönüllü olan beş yüz yüze görüşme yapıldı. Dahil etme kriterleri, hastaya evde ve hastanede bakım sağlayan yetişkin refakatçiler olarak belirlendi.
Bulgular: Bakımverenlerin yaş ortalaması 44,8 ± 4,80 yıl olan beş kadından oluşmaktadır. Hastaların tanısı sırasıyla Alzheimer hastalığı, demans, mide kanseri ve inme idi. Bakım süresi yaklaşık 2,79 ± 1,62 yıldı. Dört tema ve on bir alt tema belirtildi: Kendileriyle ilgili endişeler: Sağlık sorunlarını abartmak, Güçlü kalma kaygısı; Hastaya bağlı sonuçlar: Hastayı kahraman gibi hatırlamak; Durumun kabulü “Onu ölü bulma” korkusu ; Bakıcılıkla ilgili zorluklar Hayattan fedakarlık, Aşırı sorumluluk ,Bebek bezi bakımından utanç ,bakım vermeye başladığında oryantasyon eksikliği Başa çıkma stratejileri Dini inançlar.
Sonuç: Çalışmanın sonucunda, bakımverenlerin kendileri ve rollerindeki sonuçlar hakkında endişeleri olduğunu göstermektedir. Maneviyatla başa çıkmaya çalışsalar bile, sağlık hizmeti sağlayıcıları temel rollerini kabul ederek onlara destek olabilirler.
This study aimed to identify the prevalence of sexual violence between intimate partners among college women at Ankara University. The depression symptoms were compared with the history of their ...sexual abuse in the past and in six months. The study, a cross-sectional observational study was conducted on 400 college women. Intimate partner sexual violence was evaluated using the Intimate Partner Violence Victim version and depression was evaluated with the Personal Health Questionnaire-9. Study data were evaluated using statistics such as number, percentage, and mean Mann-Whintey U test, and sample t-test. Sexual violence between intimate partners is present during romantic relationships in college women. Using tobacco, alcohol compulsion, or substance abuse are risk factors for sexual violence with an intimate partner. Furthermore, depression is double diagnosed in college women with sexual violence from intimate partners.
Background
Statins are widely used to prevent cardiovascular disease (CVD). With advancing age, the risks of statins might outweigh the potential benefits. It is unclear which factors influence ...general practitioners’ (GPs) advice to stop statins in oldest-old patients.
Objective
To investigate the influence of a
history of CVD
,
statin-related side effects, frailty
and
short life expectancy
, on GPs’ advice to stop statins in oldest-old patients.
Design
We invited GPs to participate in this case-based survey. GPs were presented with 8 case vignettes describing patients > 80 years using a statin, and asked whether they would advise stopping statin treatment.
Main Measures
Cases varied in history of CVD, statin-related side effects and frailty, with and without shortened life expectancy (< 1 year) in the context of metastatic, non-curable cancer. Odds ratios adjusted for GP characteristics (OR
adj
) were calculated for GPs’ advice to stop.
Key Results
Two thousand two hundred fifty GPs from 30 countries participated (median response rate 36%). Overall, GPs advised stopping statin treatment in 46% (95%CI 45–47) of the case vignettes; with shortened life expectancy, this proportion increased to 90% (95CI% 89–90). Advice to stop was more frequent in case vignettes without CVD compared to those with CVD (OR
adj
13.8, 95%CI 12.6–15.1), with side effects compared to without OR
adj
1.62 (95%CI 1.5–1.7) and with frailty (OR
adj
4.1, 95%CI 3.8–4.4) compared to without. Shortened life expectancy increased advice to stop (OR
adj
50.7, 95%CI 45.5–56.4) and was the strongest predictor for GP advice to stop, ranging across countries from 30% (95%CI 19–42) to 98% (95% CI 96–99).
Conclusions
The absence of CVD, the presence of statin-related side effects, and frailty were all independently associated with GPs’ advice to stop statins in patients aged > 80 years. Overall, and within all countries, cancer-related short life expectancy was the strongest independent predictor of GPs’ advice to stop statins.
Most COVID-19 patients were treated in primary health care (PHC) in Europe.
To demonstrate the scope of PHC workflow during the COVID-19 pandemic emphasising similarities and differences of patient's ...clinical pathways in Europe.
Descriptive, cross-sectional study with data acquired through a semi-structured questionnaire in PHC in 30 European countries, created ad hoc and agreed upon among all researchers who participated in the study. GPs from each country answered the approved questionnaire. Main variable: PHC COVID-19 acute clinical pathway. All variables were collected from each country as of September 2020.
COVID-19 clinics in PHC facilities were organised in 8/30. Case detection and testing were performed in PHC in 27/30 countries. RT-PCR and lateral flow tests were performed in PHC in 23/30, free of charge with a medical prescription. Contact tracing was performed mainly by public health authorities. Mandatory isolation ranged from 5 to 14 days. Sick leave certification was given exclusively by GPs in 21/30 countries. Patient hotels or other resources to isolate patients were available in 12/30. Follow-up to monitor the symptoms and/or new complementary tests was made mainly by phone call (27/30). Chest X-ray and phlebotomy were performed in PHC in 18/30 and 23/30 countries, respectively. Oxygen and low-molecular-weight heparin were available in PHC (21/30).
In Europe PHC participated in many steps to diagnose, treat and monitor COVID-19 patients. Differences among countries might be addressed at European level for the management of future pandemics.
Abstract
Background and aim:
Primary health care (PHC) supported long-term care facilities (LTCFs) in attending COVID-19 patients. The aim of this study is to describe the role of PHC in LTCFs in ...Europe during the early phase of the pandemic.
Methods:
Retrospective descriptive study from 30 European countries using data from September 2020 collected with an ad hoc semi-structured questionnaire. Related variables are SARS-CoV-2 testing, contact tracing, follow-up, additional testing, and patient care.
Results:
Twenty-six out of the 30 European countries had PHC involvement in LTCFs during the COVID-19 pandemic. PHC participated in initial medical care in 22 countries, while, in 15, PHC was responsible for SARS-CoV-2 test along with other institutions. Supervision of individuals in isolation was carried out mostly by LTCF staff, but physical examination or symptom’s follow-up was performed mainly by PHC.
Conclusion:
PHC has participated in COVID-19 pandemic assistance in LTCFs in coordination with LTCF staff, public health officers, and hospitals.
Amaç:Ankara Üniversitesi'nde öğrenim görmekte olan kadın üniversite öğrencilerinde flört ilişkilerinde cinsel şiddete uğrama prevalansları ile bu kadınlarda cinsel şiddetin bağımsız risk faktörlerini ...araştırmak, üniversiteye devam etmekte olan kadın öğrencilerin depresyon prevalanslarını ve olası depresyonları ile cinsel şiddete uğrama durumlarını karşılaştırmak amaçlanmıştır.Gereç-yöntem:Çalışmada tarama modeli kullanılmıştır.Araştırma örneklemini oluşturan Ankara Üniversitesinde öğrenim görmekte kadın öğrencilereyerleşke içindeki sosyal alanlarda gönüllülük esası ile anket uygulanmıştır. Anket sosyodemografik bilgilerden, Mağdurların Cinsel Deneyimleri Ölçeği' nden, Hasta Sağlık Anketi-9 formundan oluşmaktaydı. Konunun mahremiyeti sebebiyle anketler kapalı zarf içinde isimsiz olarak büyük bir kutu içinde toplandı.Kullanılan ölçeklerin tümünün Türkçe geçerlilik ve güvenilirliği yapılmıştı.Bulgular:Çalışmaya,katılmayı kabul eden sağlıklı400 kadın üniversite öğrencisi alınmıştır. Katılımcılarınortalama yaşı 20.70 ± 2.12 dur. Üniversiteli olma yıllarına bakıldığında %30,8'inin üçüncü sınıfta olduğu belirlenmiştir (n=134). Katılımcıların %97,3'ü bekar (n=389 ); %2,8'i ise evlidir (n=11). Katılımcıların %18,3'ü şehirde büyümüş olup (n=73) % 81,8'i kırsal bölgeden gelmektedir (n=327). Öğrencilerin en son mezun oldukları lise sorulduğunda % 55,8 ile en sık Anadolu lisesi(n=223), ikinci sıklıkla %21 ile lise (n=84); en az olarak da %0,3 ile imam hatip lisesi (n=1) olduğu belirlenmiştir.Bu verilere göre cinsel şiddet prevalansı %17 olarak bulunmuştur. Öğrencilerin %17'sinin hayatlarında en az bir kez cinsel şiddete maruz kaldıkları tespit edilmiştir.Evli olanların hiçbiri cinsel şiddete maruz kalmamıştır. Son altı ay içinde cinsel şiddete maruz kalan kız öğrenci oranı %9 (n=36)' dir.Kişilerin annelerinin çalışıp çalışmama durumuna göre önceki ve şimdiki cinsel şiddet öyküleri istatiksel olarak anlamlı farklılık göstermekteydi ( p=0.005 ). Cinsel şiddet mağduriyet öyküsü olan kadın öğrencilerden %24'ünün annesi herhangi bir işte çalışıyorken, %13'ü çalışmıyor veya emekli olarak hesaplanmıştır. Flört süresi ile cinsel şiddete uğrama durumu arasında istatiksel olarak anlamlı bir fark bulunmadı ( p=0,122 ). İstatiksel olarak anlamlı olmasa da cinsel şiddete uğrayan kadın öğrencilerin flört ilişkilerini sonlandırma eğiliminde olduğu tespit edildi. Cinsel şiddet öyküsü bulunmayan ancak flörtü olan kadın öğrencilerin flört sürelerinin medianı 11 iken, cinsel şiddet öyküsü bulunan öğrencilerin flört sürelerinin medianı 6 olarak hesaplanmıştır. Lojistik regresyon yapıldığında fen fakültesi ve iletişim fakültesinin cinsel şiddete uğramak açısından riskli olduğu, aile içi şiddete tanık olmanın cinsel şiddete uğramayı 2,5 kat arttırdığını, alkol kullanımın cinsel şiddete uğrama oranını 3,4 kat artırdığını ve madde kullanımının ise 7,5 kat artırdığı hesaplandı. Depresyonun da cinsel şiddete uğrama oranını 2,03 kat artırdığı bulundu.Sonuç:Bu çalışmada, bir üniversite örneklemindeki kadın öğrencilerin cinsel şiddet prevalansının literatürle uyumlu olduğu, genç erişkinlerde depresyon sıklığının literatürle benzer olduğu bulundu. Sigara, alkol ve bağımlılık yapıcı madde kullanımının, ailede şiddete tanık olma öyküsünün, flört edinme ve flörtün zararlı alışkanlıkları olmasının yakın ilişkilerde cinsel şiddete uğrama riskini artırdığı bulunmuştur. Ayrıca, yakın ilişkilerinde cinsel şiddete uğramış kadın öğrencilerin depresyon tanısı alma ihtimalinin normal populasyona göre daha yüksek olduğu saptanmıştır.
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