A Double-Sided View to Adult Vaccination:The Opinions and Attitudes of Patients and Health Workers

Objective: Although there are adult vaccination schemes in our country, there are serious deficiencies in the way that doctors direct the patients to this vaccination, but also patients have to make and demand these vaccinations. The aim of our study is to identify the shortcomings in this area and draw a roadmap for what arrangements should be made in terms of physicians and patients in order to increase adult immunization rates in primary care. Method: We conducted a two-phase, multicentered, descriptive clinical trial between October and December 2017. The first phase of the trial was carried out with patients from 3 Family Health Centers in Antalya, Istanbul and Osmaniye. Patients to be interviewed were selected voluntarily among Family Health Center’s applicants. The second phase of the trial was carried out with health workers, who were participated to trial from 26 different provinces of Turkey. In the process, a questionnaire of 19 questions was applied to primary health care workers by the internet. Results: 490 patients were included in the study. There was a significant difference between gender, age, education level and guideline follow-up and vaccination status of patients [p Conclusion: As a result of the studies including our study about adult vaccination, only 10% - 20% of the targeted groups in adults can be vaccinated. However, just like in childhood during adulthood, vaccinations protect individuals from diseases and provide economic benefits. Firstly, the knowledge level of physicians on adult immunization should be updated with in-service trainings, they should first be convinced to vaccinate because they are in risk group and then they should be recommended vaccination to patient to increase the vaccination rates.

The Influence of Socio-Demographic, Health and Work-Related Factors on Health-Related Quality of Life among Iranian Industrial Workers

Health-related quality of life (HRQOL) has not been investigated among Iranian industrial workers. The present paper aimed to study the influence of the socio-demographic, health and work-related factors on HRQOL among Iranian industrial workers. In this cross-sectional study, participants were 280 workers of two factories. The Persian version of World Health Organization Quality of Life-Brief (WHOQOL-BREF) was used to assess the HRQOL. A questionnaire was developed to assess the socio-demographic, health and work-related factors. Results showed that the means (SD) of physical health, psychological health, social relationships, and environment domains of HRQOL were 13.2 (2.7), 13.3 (2.6), 14.2 (3.5) and 12.6 (2.5), respectively. A multiple linear regression showed that types of job, exercise activity, working schedule, sleep quality, smoking, and conflict between work and social life were significantly associated with physical health domain;whereas, working schedule, marital status, working demand, sleep quality, BMI, and conflict between work and individual life were significantly associated with psychological health domain. Working schedule, working demand, sleep quality, conflict between work and individual life, and having children over two years were significantly associated with social relationship domain;however, working demand, working schedule, smoking, sleep quality, working hour, job satisfaction, marital status and exercise activity were significantly associated with environment domain. Collectively, work-related factors including unhealthy working conditions, unsafe working environments, long working hours, irregular working schedules, and the lack of occupational training may negatively influence the HRQOL of workers. To improve workers’ HRQOL, intervention programs should focus on improving work environment, working schedule, occupational training and restricting working hours.

Patient satisfaction and occupational health of workers in hospital care setting: Associations and reciprocity

Research studies conducted in the healthcare sector usually examine patients’ and workers’ wellbeing as separate entities;however, recent studies have revealed significant correlations between, for example, patient satisfaction, workers stress and burnout. The present study examines the relationships between patient perceived quality of care (in terms of satisfaction with regard to accessibility, organizational efficiency and humaneness of care), and workers’ perceived quality of organizational life (in term of organizational support and availability of resource and reward), quality of relationship in the work-unit (superior and coworkers), quality of relationship with patients (disproportionate client expectations and customer verbal aggression) and individual health (emotional exhaustion and depersonalization, job satisfaction). 147 workers and 132 patients from seven hospital wards in northern Italy constitute the data base for the study. Analyses showed that accessibility and humaneness of care were negatively associated with disproportionate patient expectations, patient verbal aggression, emotional exhaustion and positively associated with availability of material recourses. Moreover, accessibility was also positively associated with the organizational support while organizational efficiency with support from colleagues. Globally, the results of the present study confirm that staff wellbeing is an essential aspect in relation to the patient perception of the quality of care and supporting the assumption that healthy organizations improve the wellbeing of their workers, their organizational performance and the quality of their service at the same time.

A Study on Oral Health-Related Quality of Life and Its Influencing Factors in Elderly Diabetic Patients

Objective:To investigate the oral health related quality of life in elderly diabetic patients and analyze its influencing factors.Methods:Convenience sampling was used to select 190 elderly patients with diabetes under the Department of Endocrinology and Department of Integrated Traditional Chinese and Western Medicine in the Affiliated Hospital of Hebei University as the research subjects.The Chinese version of the Oral Health Influence Scale(OHIP-14)was used to conduct a questionnaire survey,and univariate analysis and multiple stepwise regression analysis were used to analyze the influencing factors of oral health related quality of life in elderly diabetic patients.Results:The elderly diabetic patients'oral health related quality of life score was 34.48±3.23,which is in the middle-lower range.The findings of multivariate stepwise regression analysis revealed that the course of disease,regular visits to the dentist,sleep quality,oral health knowledge,and oral health attitude together explained 58.9%of the total variance in elderly diabetic patients in terms of their oral health related quality of life(p<0.05).Conclusion:The oral health related quality of life of elderly diabetic patients is generally low,and is affected by the duration of diabetes,sleep quality,and oral health knowledge,attitude,and behavior(regular visits to the dentist).Improving patientsJ attention to oral health problems by improving sleep as well as their own oral health knowledge,attitude,and behavior is an effective way to enhance oral health related quality of life.

Literature review and analysis of the development of health outcomes assessment instruments in Chinese medicine

OBJECTIVE： To evaluate the development of health outcomes assessment instruments in Chinese medicine. METHODS： A comprehensive literature search for all published articles in China National Knowledge Infrastructure Database, Chongqing VIP Database and WANFANG Data was conducted. The studies that met the inclusion and exclusion criteria were used to extract information according to a predesigned assessment instrument. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine were identified. Of these questionnaires, 7 were generic, 12 were condition-specific and 78 were disease-specific. All instruments were suitable for adults, children, and both men and women. These instruments aimed to evaluate the health-related quality of life, signs and symptoms as well as patient satisfaction and doctor-reported outcome. However, the descriptions were poorly constructed for some of the most basic parameters, such as the domains and items, administrative mode, response options, memory recall periods, burden evaluation, format, copyright, content validity, and other properties. CONCLUSION： The instrument development for health outcomes assessment in Chinese medicine is increasing rapidly; however, there are many limitations in current methodologies and standards, and further studies are needed.

Health-related quality of life in high-grade glioma patients

Gliomas are malignant primary brain tumors and yet incurable. Palliation and the maintenance or improvement of the patient's quality of life is therefore of main importance. For that reason, health-related quality of life(HRQoL) has become an important outcome measure in clinical trials, next to traditional outcome measures such as overall and progression-free survivals, and radiological response to treatment. HRQoL is a multidimensional concept covering physical, psychological, and social domains, as well as symptoms induced by the disease and its treatment. HRQoL is assessed by using self-reported, validated questionnaires. Various generic HRQoL questionnaires, which can be supplemented with a brain tumor- specific module, are available. Both the tumor and its treatment can have a negative effect on HRQoL. However, treatment with surgery, radiotherapy, chemotherapy, and supportive treatment may also improve patients' HRQoL, in addition to extending survival. It is expected that the impact of HRQoL measurements in both clinical trials and clinical practice will increase. Hence, it is important that HRQoL data are collected, analyzed, and interpreted correctly. Methodological issues such as selection bias and missing data may hamper the interpretation of HRQoL data and should therefore be accounted. In clinical trials, HRQoL can be used to assess the benefits of a new treatment strategy, which should be weighed carefully against the adverse effects of that treatment. In daily clinical practice, HRQoL assessments of an individual patient can be used to inform physicians about the impact of a specific treatment strategy, and it may facilitate the communication between the physicians and the patients.

Literature review and analysis of the application of health outcome assessment instruments in Chinese medicine

OBJECTIVE： To evaluate the application of health assessment instruments in Chinese medicine. METHODS： According to a pre-defined search strategy, a comprehensive literature search for all articles published in China National Knowledge Infrastructure databases was conducted. The resulting articles that met the defined inclusion and exclusion criteria were used for analysis. RESULTS： A total of 97 instruments for health outcome assessment in Chinese medicine have been used in fundamental and theoretical research, and 14 of these were also used in 29 clinical trials that were randomized controlled trials, or descriptive or cross-sectional studies. In 2 152 Chinese medicine-based studies that used instruments in their methodology, more than 150 questionnaires were identified. Among the identified questionnaires, 51 were used in more than 10 articles （0.5%）. Most of these instruments were developed in Western countries and few studies （4%） used the instrument as the primary evidence for their conclusions. CONCLUSION： Usage of instruments for health outcome assessment in Chinese medicine is increasing rapidly; however, current limitations include selection rationale, result interpretation and standardization, which must be addressed accordingly.

Reliability and Validity of the Audit on Diabetes-Dependent Quality of Life (ADDQoL) and EQ-5D in Elderly Slovenian Diabetes Mellitus Type 2 Patients

Purpose: This study reports the reliability and validity analyses of the Audit on diabetes-dependent quality of life (ADDQoL) and EQ-5D in elderly Slovenian diabetic patients. Methods: A cross-sectional study of elderly (age ≥ 65 years) non-insulin dependent diabetes mellitus type 2 (DMT2) patients was carried out. The ADDQoL and EQ-5D surveys were conducted between January and May, 2012. Statistical analysis was performed using IBM SPSS Statistics software, version 20.0. Results: After exclusion of non-eligible respondents, the final sample for the analysis was 261 cases (51% male), resulting in 52.2%of response rate. The mean age of the patients was 70.3 years (SD ± 4.1). The Cronbach’s alpha was 0.93 for ADDQoL and 0.73 for EQ-5D.There was no improvement in the alpha value if any item was deleted in all instruments. Missing value items ranged from 0.8% to 1.5% for EQ-5D, and from 0.8% to 59.1% (working life) in ADDQoL. Spearman’s correlation between the EQ-5D VAS score and ADDQoL weighted overall score resulted in weak correlations coefficient (r = 0.294;p < 0.001). Conclusions: The ADDQoL proved reliable and valid for assessing Health Related Quality of Life (HRQoL) among elderly Slovenian DMT2 patients. EQ-5D seemed to be too generic to describe limitations of DMT2 patients in detail. Using disease specific QoL instruments to learn about patient limitations was recommended. Comparison of ADDQoL results between various studies provided significant differences in the impact of diabetes.

Perceived health-related stigma among patients with breast cancer

Breast cancer survivors face many challenges(particularly changes in body image) on their road to restoring physical and psychosocial health following diagnosis. Perceived health-related stigma(PHS)refers to the attachment of negative connotations to some types of disease diagnoses. PHS is common among patients with breast cancer and is associated with adverse emotions, attitudes and behaviors. This article summarizes the latest advances and new perspectives on PHS of breast cancer patients and approaches to block this deleterious process. Effects of PHS on patients with breast cancer, in this paper,and measures, predictors and interventions of PHS have been discussed in depth. Future studies should continue to develop more effective instruments that are specialized for measuring PHS of breast cancer patients, explore the predictors of PHS, and discuss effective interventions on the basis of the predictors.

Identifying pain-related concerns in routine follow-up clinics following oral and oropharyngeal cancer

AIM:To describe clinical characteristics of head and neck cancer(HNC)patients with pain and those wishing to discuss pain concerns during consultation.METHODS:Cross-sectional,questionnaire study using University of Washington Quality of Life,version 4(UWQOL)and the Patients Concerns Inventory(PCI)in disease-free,post-treatment HNC cohort.Significant pain on UW-QOL and indicating"Pain in head and neck"and"Pain elsewhere"on PCI.RESULTS:One hundred and seventy-seven patientscompleted UW-QOL and PCI.The prevalence of selfreported pain issues was 38%(67/177)comprising25%(44/177)with significant problems despite medications and 13%(23/177)with lesser or no problems but wishing to discuss pain.Patients aged under 65years and patients having treatment involving radiotherapy were more likely to have pain issues.Just over half,55%(24/44)of patients with significant pain did not express a need to discuss this.Those with significant pain or others wanting to discuss pain in clinic had greater problems in physical and social-emotional functioning,reported suboptimal QOL,and also had more additional PCI items to discuss in clinic compared to those without significant pain and not wishing to discuss pain.CONCLUSION:Significant HNC-related pain is prevalent in the disease-free,posttreatment cohort.Onward referral to a specialist pain team may be beneficial.The UW-QOL and PCI package is a valuable tool that may routinely screen for significant pain in outpatient clinics.

Intensive care environment: Perspective of relatives of critically ill patient sustained by health technology

The intensive care unit(ICU)is a complex setting by nature,and some have described it as bizarre due to its numerous sirens that sound when anything is dangerous,constant activity,equipment,bright lights,and high fatality rate.The demands placed on nurses to care for critically ill patients in this environment frequently prevent nurses and other health‑care professionals from acknowledging the feelings of patient’s relatives or family caregivers,resulting in a hostile environment from the patient’s relative’s perspective.When a patient’s family enters the ICU,they feel that hospital administrators do little to nothing to alleviate their discomfort and fear.Despite research demonstrating the importance of providing a homely environment for patients’families,In Nigeria ICU is still far behind how a conventional ICU environment should be structured to accommodate patient’s relations in the unit.The goal of this study was to look at the patient’s relative’s perspective on providing care for a critically ill patient in an ICU,with a focus on the unit’s complexity and overall experience.Based on the findings of this study,we recommend that hospital administrators ensure that the environment of the upcoming ICU is designed to meet the needs of patient’s relatives by addressing identified environmental concerns,like caring neglect,by providing a friendly and stress‑free environment.

Service Delivery Factors That Influence Utilization of HIV Integrated Primary Health Care Programme in Embu Referral Hospital, Kenya

Globally, there are approximately 36.7 million people living with HIV. Integration of HIV treatment with primary care services improves effectiveness, efficiency and equity in service delivery. The study sought to establish service delivery factors that influenced utilization of integrated HIV and primary health care services in Embu Teaching and Referral hospital. A descriptive cross-sectional survey design was used to collect data at a specific period and point of time from a sample of 302 seropositive clients who were selected using simple random method. Data collection tool was structured and semi-structured questionnaire. The tool was reliable at Cronbach’s alpha of 0.817. SPSS version 23 was used to analyze the data. A binary logistic regression model was used to predict the relationship between service delivery and utilization of integrated services. Results: Majority of the respondents (59.6%) were aged over 35 years with majority being female (58.9%) and the married were 57.6% of the total sample. On service delivery factors, majority (94.7%) felt that their health status had improved. Action taken when clients developed side effects, 78.8% reported that the drugs were changed. Action taken following drug side effects significantly affected utilization, χ2 = 1.305, p = 0.001, df = 1. The findings showed that waiting time significantly influenced utilization, χ2 = 9.284, df = 1, p = 0.002. Source of information on self care also significantly influenced utilization, χ2 = 10.689, df = 1, p = 0.001. Kind of treatment at the facility also significantly influenced utilization, χ2 = 5.713, p = 0.048. Conclusion: significant factors that influenced utilization of integrated services were source of health care information, secondly waiting time was another factor which influenced utilization. Majority of the respondents were satisfied with duration of time they take before they were served;they reported to take utmost 1 hour to be attended to and action taken by health care provider following side effects was another factor that influenced the utilization.

Why the Partnership of OAT Italian Patients Association in Cosenza＇s Hospital Matters？

The activism of patients associations, in decision making, about health and social services, is an expanding phenomenon in Italy and elsewhere. But the civic roles of these patients associations, in health care settings, remain largely unexplored, especially in the case of patients assuming oral anticoagulant therapy （OAT Patients） for various chronic and severe diseases （stroke, chronic arthritis, maintenance or substitution of cardiac valves）. This is a qualitative study, on a Civic Health Organization, the Italian Association of Anti Coagulant Patients （Associazione ltaliana Pazienti Anticolagulati, hereinafter A.I.P.A.） which promotes the rights of OAT patients. The study was carried out in the south of Italy at Cosenza＇s Hospital. Cosenza is a city in the north of Calabria, a poor Southern Italian region. The research, done between March 2010 and December 2012, involved focus groups, key-informant interviews with volunteers from the local A.I.P.A. unit and the hospital professionals （physicians, nurses, managers） of Cosenza＇s Annunziata Hospital. This essay mainly analyzes a micro-form of co-deliberative health care democracy： a stable partnership between AIPA members and the cited hospital professionals, based on a mix of advocacy, planning, and co-delivery service roles. In doing this, the paper sketches the development, aims, activities, internal structure and resources, and the role played by this specific citizen-user/patient/career organization in promoting and/or representing the interests of anti-coagulated patients within the legal arena of the Italian health policy. Finally, the paper comes to the point in which OAT patients refer their perceptions of relational rights.

Health 3.0—The patient-clinician “arabic spring” in healthcare

A growing number of citizen-patients and clinicians use Communication and Self-Managed Health Technologies (CSMHT) in their relationship. Doing so, they shift from the current paradigm of dependency to a co-responsibility paradigm in healthcare. Facing the runaway utilization of health services, we need to think “outside the box” to unblock the system. A Health 3.0 development model of governance that position patients as primary members of the clinicians’ team is presented to map this institutional transformation. At the practical level, an MD 3.0 relational model and a Citizen-Patient 3.0 behavioral profile are presented.

家庭医生签约服务的健康效应及作用机制研究——来自6省12县1191位农村慢性病患者的证据

目的:探究家庭医生签约服务对农村慢性病患者健康的影响及作用机制。方法:2023年6—8月,通过面对面问卷调查收集了6省12县有效样本1191份,利用Tobit模型和KHB方法分析家庭医生签约服务对EQ-5D-5L效用值的影响和作用路径。结果:我国农村地区慢性病患者家庭医生签约率为59.19%,健康效用值为0.831;家庭医生签约服务显著提高了慢性病患者的效用值(β=0.047,P<0.05);且通过公共卫生服务利用完全中介路径影响效用值(β=0.028,P<0.01,95%CI=0.009~0.047),间接效应占总效应的66.77%。结论:我国农村地区慢性病患者家庭医生签约率较低,健康相关生命质量较差,我国家庭医生签约服务主要通过提高公共卫生服务利用改善慢性病患者健康状况,尚需加强家庭医生签约服务在医疗服务利用和个人自我保健行为方面的影响,以充分发挥家庭医生签约服务的综合健康效应。

患者报告结局测量工具在幼儿健康相关生活质量评估领域的研究进展

随着医疗界对患者体验的的日益重视,开发和应用标准化的患者报告结局(patient-reported outcomes, PROs)测量工具以辅助健康相关生活质量(health-related quality of life, HRQOL)的测量成为研究热点。其中,儿童尤其是婴幼儿患者报告健康结局的测量一直是此领域研究的难点。本文对患者(家长代言人)报告结局在5岁以下幼儿健康相关生活质量评估领域的应用研究进展进行综述,旨在为临床使用标准化患者报告结局工具对幼儿进行早期的生活质量问题识别和精准测量,并进行及时的干预提供指导。

基于患者报告结局的风湿病儿童健康相关生活质量现状及照顾者负担的影响研究

目的 了解基于患者报告结局的风湿病儿童健康相关生活质量及其照顾者负担现状,并探讨其影响因素。方法 采取便利抽样法,应用一般资料调查表、照顾者负担量表(caregiver burden inventory, CBI)及儿童患者报告结局测量信息系统特征集(PROMIS pediatric-25 profile V2.0)横断面调查2022年6月-2023年6月在上海某儿童医院收治的100例8~12岁风湿病儿童的患者报告结局及其照顾者负担现状。结果 PROMIS Pediatric-25 Profile的抑郁、疲劳、疼痛、焦虑、同伴关系及身体功能-移动性6个维度的得分分别为(46.32±9.23)分、(45.94±8.99)分、(42.90±7.44)分、(46.07±8.49)分、(40.95±12.29)分、(25.21±4.57)分,其中抑郁、焦虑和疲劳得分最高。风湿病儿童照顾者中等负担发生率为45.3%,照顾者负担的时间依赖性负担、发展受限性负担、身体性负担、社会性负担和情感性负担5个维度的得分平均分分别为(1.33±0.76)分、(0.71±0.59)分、(0.67±0.60)分、(2.20±1.20)分、(1.47±0.88)分,其中社会性负担得分最高。单因素分析结果显示:家庭年收入在抑郁维度(F=3.44,P<0.05)和疼痛维度(F=3.58,P<0.05)差异有统计学意义,是否首次使用激素在身体功能-移动性维度差异有统计学意义(t=2.00,P<0.05)。结论 风湿病儿童抑郁、焦虑和疲劳现状有待改善,且家庭年收入在5万~10万元的儿童抑郁和疼痛水平最高、在10万~15万元的儿童抑郁和疼痛水平最低,初次使用激素可能对风湿病儿童的身体功能-移动性存在影响。未来可参照影响因素制定风湿病儿童精准症状管理模式,关注风湿病儿童的真实感受。这些发现也提供了风湿病儿童照顾者所面临的压力和挑战,未来的研究应该进一步探索不同类型的照顾者支持和干预措施,以帮助减轻他们的负担,并提高其生活质量。

海军某部队基层官兵健康相关生活质量潜在剖面及人群特征研究

目的探索海军某部队基层官兵健康相关生活质量(health-related quality of life,HRQoL)的潜在类别及人群特征。方法2023年5-7月,采用便利抽样法选取海军某部队基层官兵1056名,使用患者报告结局测量信息系统(patient-reported outcomes measurement information system,PROMIS)对基层官兵的HRQoL进行调查,并进行潜在剖面分析,使用Logistic回归识别不同HRQoL类别官兵人群特征。结果官兵分为无症状困扰与功能受损组[894(84.66%)]和轻度症状困扰与功能受损组[162(15.34%)]两个类别,两个类别官兵在入伍前生活地、文化程度、饮食规律情况、核心力量训练频率、球类运动频率、慢性病、服药情况、慢性疼痛、自觉健康状况上均有显著差异(均P<0.05)。结论根据HRQoL可官兵分为两个类别,应针对性制订护理方案,以改善其HRQoL。

患者报告结局测量信息系统在孕产妇健康相关生活质量研究中的应用进展

孕产妇健康相关的生活质量(HRQoL)是一种相对复杂且难以及时捕捉的主观感受,属于孕产妇自我报告的范畴,如何准确测量孕产妇HRQoL尤为重要。患者报告结局测量信息系统(PROMIS)已被证实是一个标准化且具有可比性的HRQoL测量工具,适用于患者及健康人群,目前已广泛应用于癌症和慢病管理领域,但在孕产妇人群中应用尚处于起步阶段。本文就PROMIS在孕产妇HRQoL中的研究进行综述,为PROMIS助力孕产妇HRQoL评估与干预提供参考。

蚌埠市社区医院慢性病患者使用新媒体获取健康相关知识现状及影响因素分析

目的了解蚌埠市社区医院慢性病患者使用新媒体获取健康相关知识的现状及其影响因素,为制订健康传播策略提供参考依据。方法2022年4—12月便利抽取蚌埠市两家社区医院的150例慢性病患者进行问卷调查,获得其人口学特征、慢性病情况和使用新媒体获取健康相关知识情况,采用单因素分析、多因素Logistic回归分析其影响因素。结果150例慢性病患者中,42例(28.0%)使用新媒体获取健康相关知识。Logistic回归分析结果显示,年龄、文化程度、职业是蚌埠市社区医院慢性病患者使用新媒体获取健康相关知识的影响因素。结论蚌埠市社区医院慢性病患者获取健康相关知识时新媒体使用率有待进一步提升。面向慢性病患者的健康相关知识传播应以可及性强的媒体为主,加强重点人群的新媒体普及,提高慢性病患者新媒体使用率。