RESUMEN
BACKGROUND: Hepatitis C infection could be eliminated. Underdiagnosis and lack of treatment are the barriers to cure, especially for vulnerable populations (i.e. unable to pay for health care). METHODS: A multilevel intervention from September 2014 to September 2019 focused on the providers and organizations in 'the safety net' (providing health care to populations unable to pay), including: (i) public education, (ii) training for primary care providers (PCPs) and case managers, (iii) case management for high-risk populations, (iv) policy advice and (v) a registry (Registry) for 13 health centers contributing data. The project tracked the number of PCPs trained and, among Registry sites, the number of people screened, engaged in care (i.e. clinical follow-up after diagnosis), treated and/or cured. RESULTS: In Chicago, 215 prescribing PCPs and 56 other health professionals, 86% of whom work in the safety net, were trained to manage hepatitis C. Among Registry sites, there was a 137% increase in antibody screening and a 32% increase in current hepatitis C diagnoses. Engagement in care rose by 18%. CONCLUSIONS: Hepatitis C Community Alliance to Test and Treat (HepCCATT) successfully targeted safety net providers and organizations with a comprehensive care approach. While there were challenges, HepCCATT observed increased hepatitis C screening, diagnosis and engagement in care in the Chicago community.
Asunto(s)
Hepatitis C , Poblaciones Vulnerables , Humanos , Chicago/epidemiología , Hepatitis C/diagnóstico , Hepatitis C/tratamiento farmacológico , Hepatitis C/epidemiología , Hepacivirus , Tamizaje MasivoRESUMEN
November 11, 2016/65(44);1234-1237. What is already known about this topic? Candida auris is an emerging pathogenic fungus that has been reported from at least a dozen countries on four continents during 2009-2015. The organism is difficult to identify using traditional biochemical methods, some isolates have been found to be resistant to all three major classes of antifungal medications, and C. auris has caused health care-associated outbreaks. What is added by this report? This is the first description of C. auris cases in the United States. C. auris appears to have emerged in the United States only in the last few years, and U.S. isolates are related to isolates from South America and South Asia. Evidence from U.S. case investigations suggests likely transmission of the organism occurred in health care settings. What are the implications for public health practice? It is important that U.S. laboratories accurately identify C. auris and for health care facilities to implement recommended infection control practices to prevent the spread of C. auris. Local and state health departments and CDC should be notified of possible cases of C. auris and of isolates of C. haemulonii and Candida spp. that cannot be identified after routine testing.
Asunto(s)
Candida/aislamiento & purificación , Candidiasis/diagnóstico , Candidiasis/microbiología , Farmacorresistencia Fúngica Múltiple , Antifúngicos/uso terapéutico , Candida/efectos de los fármacos , Candidiasis/tratamiento farmacológico , Enfermedades Transmisibles Emergentes , Salud Global , Humanos , Pronóstico , Factores de Riesgo , Factores de Tiempo , Estados UnidosAsunto(s)
Atención Ambulatoria/organización & administración , Organizaciones de Beneficencia/organización & administración , Área sin Atención Médica , Pacientes no Asegurados , Atención no Remunerada , Adolescente , Adulto , Anciano , Atención Ambulatoria/normas , Atención Ambulatoria/estadística & datos numéricos , Organizaciones de Beneficencia/economía , Niño , Preescolar , Femenino , Accesibilidad a los Servicios de Salud/economía , Accesibilidad a los Servicios de Salud/organización & administración , Humanos , Lactante , Recién Nacido , Masculino , Massachusetts , Pacientes no Asegurados/psicología , Persona de Mediana Edad , Modelos Organizacionales , Estudios de Casos Organizacionales , Pobreza , Evaluación de Programas y Proyectos de Salud , Calidad de la Atención de Salud , Atención no Remunerada/economía , Estados UnidosAsunto(s)
Enfermería Geriátrica/métodos , Personal de Enfermería en Hospital/educación , Calidad de Vida , Restricción Física , Anciano , Enfermería Geriátrica/educación , Humanos , Personal de Enfermería en Hospital/psicología , Refuerzo en Psicología , Restricción Física/efectos adversos , Restricción Física/psicologíaRESUMEN
A group of practising physicians, family practice academicians and medical students visited Cuba in 1991. The purpose of this visit was to assess the current status of the discipline of family medicine in the country. Numerous interviews were conducted with practising family physicians, Cuban medical physicians in other medical specialties, the medical school faculty, patients and officials from the Ministry of Public Health. A summary of the content of these interviews constitutes the following paper. The authors conclude that the Cubans have developed a medical care system that has its basis in family practice, and provides a model which could be emulated not only in less developed, but also in more developed countries.
Asunto(s)
Países en Desarrollo , Medicina Familiar y Comunitaria/tendencias , Causas de Muerte , Servicios de Salud Comunitaria/tendencias , Comparación Transcultural , Cuba , Educación Médica/tendencias , Medicina Familiar y Comunitaria/educación , Predicción , Gastos en Salud/tendencias , Accesibilidad a los Servicios de Salud/tendencias , Humanos , MortalidadRESUMEN
Five Veterans' Administration Medical Centers formed a consortium to promote nursing research. Consortium arrangements focusing on research are reviewed based on the literature, the consortium's experience, and a survey of 171 VA facilities. Consortiums are suggested for multisite facilities, such as city, state, proprietary, and religious hospital systems, to increase the quality and quantity of nursing research where institutional mechanisms for overcoming the difficulties of meeting and sharing information are already in place.