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Roberti JE, Alonso JP, May CR. Negotiating treatment and managing expectations in chronic kidney disease: A qualitative study in Argentina. Chronic Illn 2023; 19:730-742. [PMID: 36062573 DOI: 10.1177/17423953221124312] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 11/17/2022]
Abstract
OBJECTIVES To describe how patients with CKD negotiated assigned responsibilities in the management of their disease, resulting in potential relational nonadherence. METHODS Qualitative study performed in two healthcare facilities in Buenos Aires, Argentina, including 50 patients and 14 healthcare providers. We conducted semistructured interviews which were analysed using a frame of reference with concepts of Burden of Treatment and Cognitive Authority theories. FINDINGS Adherence to treatment defined "good patients". Patients needed to negotiate starting treatment, its modality and dialysis schedule, although most patients felt they did not participate in the decision process and that providers did not acknowledge implications of these decisions on their routine. Some patients skipped dialysis if concerns were not attended. Regularly, patients negotiated frequency of visits, doses, dietary restrictions and redefined relationships with their support networks, sometimes with devasting effects. As a result of overwhelming uncertainty some patients refused enrolling into a transplant program. When the frequency of complications increased, patients considered abandoning dialysis. CONCLUSION When patients perceived demands were excessive or conflicting, they entered into negotiations. Relationally induced nonadherence may arise when professionals do not or cannot enter into negotiations over patients' beliefs or knowledge about what is possible for them to do.
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Affiliation(s)
- Javier E Roberti
- CIESP/CONICET, Buenos Aires, Argentina
- IECS, Buenos Aires, Argentina
| | - Juan P Alonso
- CIESP/CONICET, Buenos Aires, Argentina
- IECS, Buenos Aires, Argentina
| | - Carl R May
- London School of Hygiene and Tropical Medicine, London, UK
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Belizan M, Alonso JP, Nejamis A, Caporale J, Copo MG, Sánchez M, Rubinstein A, Irazola V. Barriers to hypertension and diabetes management in primary health care in Argentina: qualitative research based on a behavioral economics approach. Transl Behav Med 2020; 10:741-750. [PMID: 30947329 PMCID: PMC7529038 DOI: 10.1093/tbm/ibz040] [Citation(s) in RCA: 14] [Impact Index Per Article: 3.5] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/13/2022] Open
Abstract
Despite efforts to improve detection and treatment of adults with hypertension and diabetes in Argentina, many public healthcare system users remain undiagnosed or face barriers in managing these diseases. The purpose of this study is to identify health system, provider, and user-related factors that may hinder detection and treatment of hypertension and diabetes using a traditional and behavioral economics approach. We did qualitative research using in-depth semistructured interviews and focus groups with healthcare providers and adult users of Public Primary Care Clinics. Health system barriers included inadequate care accessibility; poor integration between primary care clinics and local hospitals; lack of resources; and gender bias and neglect of adult chronic disease. Healthcare provider-related barriers were inadequate training; lack of availability or reluctance to adopt Clinical Practice Guidelines; and lack of counseling prioritization. From a behavioral economics perspective, bottlenecks were related to inertia and a status quo, overconfidence, and optimism biases. User-related barriers for treatment adherence included lack of accurate information; resistance to adopt lifelong treatment; affordability; and medical advice mistrust. From a behavioral economics perspective, the most significant bottlenecks were overconfidence and optimism, limited attention, and present biases. Based on these findings, new interventions that aim to improve prevention and control of chronic conditions can be proposed. The study provides empirical evidence regarding the barriers and bottlenecks in managing chronic conditions in primary healthcare settings. Results may contribute to the design of behavioral interventions targeted towards healthcare provision for the affected population.
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Affiliation(s)
- Maria Belizan
- Institute for Clinical Effectiveness and Health Policy – IECS, Buenos Aires, Argentina
| | - Juan P Alonso
- Instituto de Investigaciones Gino Germani, Universidad de Buenos Aires, Buenos Aires, Argentina
- CONICET, Buenos Aires, Argentina
| | - Analía Nejamis
- Institute for Clinical Effectiveness and Health Policy – IECS, Buenos Aires, Argentina
| | - Joaquín Caporale
- Institute for Clinical Effectiveness and Health Policy – IECS, Buenos Aires, Argentina
| | - Mariano G Copo
- Physical and Mental Health Promotion Office, Ministry of National Security, Argentina
| | - Mario Sánchez
- Inter-American Development Bank, Buenos Aires, Argentina
| | - Adolfo Rubinstein
- Institute for Clinical Effectiveness and Health Policy – IECS, Buenos Aires, Argentina
| | - Vilma Irazola
- Institute for Clinical Effectiveness and Health Policy – IECS, Buenos Aires, Argentina
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Aguilar-Palacio I, Carrera-Lasfuentes P, Sánchez-Recio R, Alonso JP, Rabanaque MJ. Recession, employment and self-rated health: a study on the gender gap. Public Health 2017; 154:44-50. [PMID: 29197685 DOI: 10.1016/j.puhe.2017.10.013] [Citation(s) in RCA: 15] [Impact Index Per Article: 2.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/04/2017] [Revised: 10/05/2017] [Accepted: 10/19/2017] [Indexed: 11/17/2022]
Abstract
OBJECTIVES Employment status and economic recession have been associated with negative effects on self-rated health, and this effect differs by gender. We analysed the effects of the Spanish economic recession in terms of self-rated health, its differential effect among genders and its influence on gender gap. STUDY DESIGN Repeated cross-sectional study using Spanish health surveys (2001-2014). METHODS Logistic regression models were conducted to explore the association between self-rated health and employment status and its evolution over time and gender. To test the impact of the economic recession, pooled data regression models were conducted. RESULTS In this study, we considered 104,577 subjects. During the last 15 years, women have entered the labour market, leading to wide changes in the Spanish traditional family roles. Instead of an increasing proportion of women workers, gender employment differences persist. Therefore, in 2014, the prevalence of workers was 55.77% in men, whereas in women, it was 44.01%. Self-rated health trends during the economic recession differ by gender, with women improving slightly their self-rated health from a low self-rated health prevalence of 38.76% in 2001 to 33.78% in 2014. On the contrary, men seem more vulnerable to employment circumstances, which have led to substantial reduction in the gender gap. CONCLUSIONS Although a gender gap persists, the change in socio-economic roles seems to increase women's self-rated health, reducing this gap. It is important to promote women's labour market inclusion, even in economic recession periods.
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Affiliation(s)
- I Aguilar-Palacio
- Microbiology, Preventive Medicine and Public Health Department, Zaragoza University, Domingo Miral S/n, 50009, Zaragoza, Spain; Group of Health Services Research of Aragon, (GRISSA), Spain; IIS Aragon, Spain.
| | | | - R Sánchez-Recio
- Group of Health Services Research of Aragon, (GRISSA), Spain; Gender Violence Department, Government Representation Department, San Juan 4, 44001, Teruel, Spain
| | - J P Alonso
- Microbiology, Preventive Medicine and Public Health Department, Zaragoza University, Domingo Miral S/n, 50009, Zaragoza, Spain; Group of Health Services Research of Aragon, (GRISSA), Spain
| | - M J Rabanaque
- Microbiology, Preventive Medicine and Public Health Department, Zaragoza University, Domingo Miral S/n, 50009, Zaragoza, Spain; Group of Health Services Research of Aragon, (GRISSA), Spain; IIS Aragon, Spain
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Ly-Pen DL, Alonso JP, Perez MS, Moll FR, Serrano MZ, Vidal LD, Justo SJ. Diagnostic concordance of emergency doctor-performed bedside ultrasonography versus specialist-performed echo-Doppler ultrasonography in the diagnosis of deep venous thrombosis of lower limbs. Crit Care 2015. [PMCID: PMC4470915 DOI: 10.1186/cc14214] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.1] [Reference Citation Analysis] [What about the content of this article? (0)] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/10/2022] Open
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Daveson BA, Alonso JP, Calanzani N, Ramsenthaler C, Gysels M, Antunes B, Moens K, Groeneveld EI, Albers G, Finetti S, Pettenati F, Bausewein C, Higginson IJ, Harding R, Deliens L, Toscani F, Ferreira PL, Ceulemans L, Gomes B. Learning from the public: citizens describe the need to improve end-of-life care access, provision and recognition across Europe. Eur J Public Health 2014; 24:521-7. [PMID: 23487548 PMCID: PMC4032478 DOI: 10.1093/eurpub/ckt029] [Citation(s) in RCA: 13] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [What about the content of this article? (0)] [Affiliation(s)] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/17/2022] Open
Abstract
BACKGROUND Despite ageing populations and increasing cancer deaths, many European countries lack national policies regarding palliative and end-of-life care. The aim of our research was to determine public views regarding end-of-life care in the face of serious illness. METHODS Implementation of a pan-European population-based survey with adults in England, Belgium (Flanders), Germany, Italy, The Netherlands, Portugal and Spain. Three stages of analysis were completed on open-ended question data: (i) inductive analysis to determine a category-code framework; (ii) country-level manifest deductive content analysis; and (iii) thematic analysis to identify cross-country prominent themes. RESULTS Of the 9344 respondents, 1543 (17%) answered the open-ended question. Two prominent themes were revealed: (i) a need for improved quality of end-of-life and palliative care, and access to this care for patients and families and (ii) the recognition of the importance of death and dying, the cessation of treatments to extend life unnecessarily and the need for holistic care to include comfort and support. CONCLUSIONS Within Europe, the public recognizes the importance of death and dying; they are concerned about the prioritization of quantity of life over quality of life; and they call for improved quality of end-of-life and palliative care for patients, especially for elderly patients, and families. To fulfil the urgent need for a policy response and to advance research and care, we suggest four solutions for European palliative and end-of-life care: institute government-led national strategies; protect regional research funding; consider within- and between-country variance; establish standards for training, education and service delivery.
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Affiliation(s)
- Barbara A. Daveson
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
| | - Juan P. Alonso
- 2 CONICET and University of Buenos Aires, Buenos Aires, Argentina
| | - Natalia Calanzani
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
| | - Christina Ramsenthaler
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
| | - Marjolein Gysels
- 3 Barcelona Centre for International Health Research (CRISIS – Hospital Clínic), Universitat de Barcelona, Barcelona, Spain
| | - Barbara Antunes
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
| | - Katrien Moens
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
| | - Esther I. Groeneveld
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
| | - Gwenda Albers
- 4 Department of Public and Occupational Health, EMGO Institute for Health and Care Research, VU University Medical Center, Amsterdam, The Netherlands
| | - Silvia Finetti
- 5 Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni Fondazione ONLUS, Cremona, Italy
| | - Francesca Pettenati
- 5 Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni Fondazione ONLUS, Cremona, Italy
| | - Claudia Bausewein
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
- 6 Interdisciplinary Centre for Palliative Medicine, Munich University Hospital, Munich, Germany
| | - Irene J. Higginson
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
| | - Richard Harding
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
| | - Luc Deliens
- 7 End-of-Life Care Research Group, Ghent University and Vrije Universiteit Brussel, Brussels, Belgium
| | - Franco Toscani
- 5 Istituto di Ricerca in Medicina Palliativa, Fondazione Lino Maestroni Fondazione ONLUS, Cremona, Italy
| | - Pedro L. Ferreira
- 8 Faculty of Economics, Centre for Health Studies and Research (CEISUC), University of Coimbra
| | | | - Barbara Gomes
- 1 King's College London, Cicely Saunders Institute, Department of Palliative Care, Policy and Rehabilitation, UK
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Abstract
The purpose of this study was to determine the effect of muscle mass and the level of force on the contraction-induced rise in heart rate. We conducted an experimental study in a sample of 28 healthy men between 20 and 30 yr of age (power: 95%, alpha: 5%). Smokers, obese subjects, and those who performed regular physical activity over a certain amount of energetic expenditure were excluded from the study. The participants exerted two types of isometric contractions: handgrip and turning a 40-cm-diameter wheel. Both were sustained to exhaustion at 20 and 50% of maximal force. Twenty-five subjects finished the experiment. Heart rate increased a mean of 15.1 beats/min [95% confidence interval (CI): 5.5-24.6] from 20 to 50% handgrip contractions, and 20.7 beats/min (95% CI: 11.9-29.5) from 20 to 50% wheel-turn contractions. Heart rate also increased a mean of 13.3 beats/min (95% CI: 10.4-16.1) from handgrip to wheel-turn contractions at 20% maximal force, and 18.9 beats/min (95% CI: 9. 8-28.0) from handgrip to wheel-turn contractions at 50% maximal force. We conclude that the magnitude of the heart rate increase during isometric exercise is related to the intensity of the contraction and the mass of the contracted muscle.
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Affiliation(s)
- J M Gálvez
- Instituto de Ergonomía MAPFRE SA, 50639 Zaragoza, Spain
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Affiliation(s)
- M A Rivas
- Department of Paediatrics, Miguel Servet Children's Hospital, Zaragoza, Spain
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Foray J, Binder F, Alonso JP. [Mountain frostbite. Apropos of 105 cases observed in the Hôpital de Chamonix-Mont-Blanc]. Chirurgie 1977; 103:98-109. [PMID: 872698] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [What about the content of this article? (0)] [MESH Headings] [Subscribe] [Scholar Register] [Indexed: 12/24/2022]
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