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Syftet med föreliggande studie var att redogöra för hälso- och sjukvårdspersonalens följsamhet till hygienföreskrifter avseende handhygien och de faktorer som påverkar detta. Metod: Artiklar söktes via CINAHL, Pubmed och Scopus. Sökord som användes i olika kombinationer var: hand hygiene, adherence, hygiene guidelines, health care workers, compliance, hand disinfection, infection control, nursing, nurse och hand cleansing. Tretton vetenskapliga artiklar erhölls. Vidare gjordes en manuell sökning ifrån inkluderade artiklars referenslistor och genererade två artiklar som ingick i resultatet. Resultat: Resultatet visade att hälso- och sjukvårdspersonalens följsamhet till hygienföreskrifter avseende handhygien var låg. Vidare framkom av resultatet att det fanns sju kategorier av faktorer som påverkade följsamheten till hygienföreskrifterna. Dessa var: utbildning och kunskap, arbetsbelastning och tidsbrist, tillgänglighet, hudproblem och handskar. Slutsats: Följsamheten till hygienföreskrifter avseende handhygien är låg. Kontinuerlig utbildning i kombination med ökad tillgänglighet och minskad arbetsbelastning är de viktigaste förutsättningarna för att öka följsamheten till hygienföreskrifter gällande handhygien.

Introduction: The aim of this study was to assess the patient, practice and practice management related factors contributing to non-adherence of type 2 diabetes mellitus clinical practice guideline in Estonia.Methods: Descriptive postal survey using a self-administered questionnaire. Results: Of the 354 doctors who received the questionnaire 46% (n=163) responded. 76% of them have type 2 diabetes guidelines. Low awareness of diabetes and its complications among patients as well as their low motivation to change their lifestyle were considered to be the biggest difficulties in managing individual patients. In addition to the most often listed problems, non-compliance with medical regimen, patients’ financial problems and their non-attendance were mentioned. The greatest health care systems related barriers to practices providing desirable care wereinadequate number of patients` educational materials, the lack of special diabetes education for nurses and underfunding. The patient related issues were regarded as problems in 96% of the cases and health care system related factors were mentioned in 79% of the cases. / <p>ISBN 91-7997-114-8</p>

The current study employed quantitative and qualitative methods to examine predictors of adherence and diabetes health outcomes in Latino youth, and to gain understanding of mechanisms that underlie health behaviors and outcomes. Forty-nine Latino youth and their caregivers were recruited at a hospital-based outpatient diabetes clinic, 76% of the youth were either first or second-generation Latino youth (i.e., immigrant youth or youth whose parents are immigrants). A primary aim of this study was to quantitatively examine the impact of parent immigrant-related stress on child health behaviors and outcomes. This study complements these quantitative analyses by qualitatively exploring how (e.g., under what conditions) pathways to health are created. Specifically, qualitative analyses examined the unique experiences of Latino immigrant families in managing adherence to treatment and metabolic control, and gain insight into specific health promoters and barriers. Further, the author intended to qualitatively explain the effects of recently enacted immigration laws on Latino youths’ health behaviors and outcomes. Results revealed that higher levels of fear of deportation predict lower child-reported adherence, β = -41, p < .05. Higher levels of caregiver immigrant stress predict higher BMI rates in children, β = .30, p < .05. Immigrant related stressors, including fear of deportation, did not predict A1c or diabetes ketoacidosis (DKA) hospitalizations in the last year. Qualitative results highlight themes related to direct and indirect barriers to health behaviors and outcomes for youth, as well as ethnocultural promoters of coping and resilience.

Colorectal cancer (CRC) is the second leading cause of death in the United States and has the highest death rate among Blacks. Whereas studies have targeted patients to increase CRC adherence in the general population few studies have focused on improving providers’ adherence to screening guidelines. Also, CRC screening studies among HIV-positive patients consistently show lower screening rates compared to screening rates among HIV negative persons. Results of screening colonoscopy studies among HIV positive patients show higher prevalence of neoplastic lesions and colon cancer is diagnosed at advanced cancer stages; these patients have shorter disease-free survival compared to HIV-negative patients. The aim of this transdisciplinary retrospective–prospective and randomized control study is to examine providers’ adherence to screening colonoscopy guidelines before and after screening reminders, evaluate the impact of an educational screening video and review of colonoscopy decisions tree plus usual care on patient adherence compared to usual care only. Results showed that providers’ adherence to screening colonoscopy guidelines significantly increased after reminders to refer patients were placed in medical records. The randomized trial showed that patients in the intervention group were more adherent to screening colonoscopy appointments compared to patients in the usual care arm. Also, patients with little or no social support in the intervention arm were more likely to keep appointments. This is the first reported study of a Transdisciplinary prevention model integrating evidence-based medicine, behavioral medicine and human factors decision support through a multi-faceted intervention to increase screening colonoscopy adherence in the HIV population. We integrated a provider reminder system, patient informed decision support of colonoscopy educational video and decision tree review in addition to patient provider communication to promote increased provider and patient screening behavior. Further studies are needed to elucidate the impact of patient centered intervention strategies and social support on screening colonoscopy behavior.

This thesis examines the economic and time barriers to dietary adherence for T2D patients living in Edmonton by using utility theory, household production theory and the concept of health capital. Socio-demographic, food consumption, food purchase and time use information was obtained by administering a questionnaire and a food record; collecting grocery receipts and a blood sample; conducting a telephone interview, and taking measurements. Multivariate regression analysis and correlations showed a negative association between fruit and vegetable expenditure and A1c. Diet quality was negatively associated with A1c and total food expenditure but had an inverted U-shaped association with income. While working time was negatively correlated with diet quality and positively correlated with A1c, regression analysis showed a negative association between working time and diet quality only among higher income participants. Budget constraints and time constraints appear to be the barriers to dietary adherence among low-income and high-income patients, respectively. / Agricultural and Resource Economics

国立情報学研究所で電子化したコンテンツを使用している。

The quality of care for Swedish patients with acute myocardial infarction (AMI) is continuously increasing. Nevertheless, a great potential for improvement still exists. The aim of the present study was to design and implement a systematic quality improvement (QI) collaborative in the area of AMI care, and to validate its usefulness primarily by analyzing its effect on hospital adherence to national guidelines. Also, the impact on patient morbidity and mortality was to be evaluated. The intervention was based on proven QI methodologies, as well as interactive use of a web-based quality registry with enhanced, powerful feedback functions. 19 hospitals in the intervention group were matched to 19 similar control hospitals. In comparison with the control group, the intervention group showed significantly higher post-interventional improvements in 4 out of 5 analyzed quality indicators (significance shown for ACE-inhibitors, Clopidogrel, Heparin/LMWH, Coronary angiography, no significance for Lipid-lowering therapy). From baseline to the post-intervention measurement, the intervention hospitals showed significantly lower all-cause mortality and cardiovascular re-admission rates (events per 100 patient-years; -2,82, 95% CI -5,26 to -0,39; -9,31, 95% CI -15,48 to -3,14, respectively). No significant improvements were seen in the control group. The improved guideline adherence rates in the intervention hospitals were sustained for all indicators but one (ACE-inhibitors), this during a follow-up measurement three months after study support withdrawal. No effects were seen on any indicators other than those primarily targeted. In conclusion, by combining a systematic QI collaborative with the utilization of a national quality registry, significant improvements in quality of care for patients with AMI can be achieved.