Background Demographic changes are taking place in most industrialized countries. Geriatric patients are defined by the European Union of Medical Specialists as aged over 65 years and suffering from frailty and multi-morbidity, whose complexity puts a major burden on these patients, their family caregivers and the public health care system. To counteract negative outcomes and to maintain consistency in care between hospital and community dwelling, the transitional of care has emerged over the last several decades. Our objectives were to identify and summarize the components of the Transitional Care Model implemented with geriatric patients (aged over 65 years, with multi-morbidity) for the reduction of all-cause readmission. Another objective was to recognize the Transitional Care Model components’ role and impact on readmission rate reduction on the transition of care from hospital to community dwelling (not nursing homes). Methods Randomized controlled trials (sample size ≥50 participants per group; intervention period ≥30 days), with geriatric patients were included. Electronic databases (MEDLINE, CINAHL, PsycINFO and The Cochrane Central Register of Controlled Trials) were searched from January 1994 to December 2019 published in English or German. A qualitative synthesis of the findings as well as a systematic assessment of the interventions intensities was performed. Results Three articles met the inclusion criteria. One of the included trials applied all of the nine Transitional Care Model components described by Hirschman and colleagues and obtained a high-intensity level of intervention in the intensities assessment. This and another trial reported reductions in the readmission rate (p < 0.05), but the third trial did not report significant differences between the groups in the longer follow-up period (up to 12 months). Conclusions Our findings suggest that high intensity multicomponent and multidisciplinary interventions are likely to be effective reducing readmission rates in geriatric patients, without increasing cost. Components such as type of staffing, assessing and managing symptoms, educating and promoting self-management, maintaining relationships and fostering coordination seem to have an important role in reducing the readmission rate. Research is needed to perform further investigations addressing geriatric patients well above 65 years old, to further understand the importance of individual components of the TCM in this population.

Background: As the COVID-19 pandemic progresses, the fear of infection increases and, with it, the stigma-discrimination, which makes it an additional problem of the epidemic. However, studies about stigma associated with coronavirus are scarce worldwide. Aims: To determine the association between stigmatisation and fear of COVID-19 in the general population of Colombia. Method: A cross-sectional study was carried out. A total of 1,687 adults between 18 and 76 years old ( M = 36.3; SD = 12.5), 41.1% health workers, filled out an online questionnaire on Stigma-Discrimination and the COVID-5 Fear Scale, adapted by the research team. Results: The proportion of high fear of COVID-19 was 34.1%; When comparing the affirmative answers to the questionnaire on stigma-discrimination towards COVID-19, it was found that the difference was significantly higher in the general population compared to health workers in most of the questions evaluated, which indicates a high level of stigmatisation in that group. An association between high fear of COVID-19 and stigma was evidenced in 63.6% of the questions in the questionnaire. Conclusion: Stigma-discrimination towards COVID-19 is frequent in the Colombian population and is associated with high levels of fear towards said disease, mainly people who are not health workers.

The Interpersonal Needs Questionnaire (INQ) assesses Thwarted Belongingness (TB) and Perceived Burdensomeness (PB), two predictors of suicidal thoughts. Up to now, the use of item response theory (IRT) for the evaluation of the INQ has been restricted to a single study with clinically depressed and suicidal youth. Therefore, the psychometric properties of the two INQ-15-subscales TB and PB were now evaluated in a general population sample (N = 2508) and a clinical adult population sample (N = 185) using IRT, specifically the Rasch model (RM) and the graphical log-linear Rasch model (GLLRM). Of special interest was whether the INQ-subscales displayed differential item functioning (DIF) across the two different samples and how well the subscales were targeted to the two sample populations. For the clinical sample, fit to a GLLRM could be established for the PB-subscale and fit to a RM was established for a five-item version of the TB-subscale. In contrast, for the general population sample fit to a GLLRM could only be achieved for the PB-subscale. Overall, there was strong evidence of local dependence (LD) across items and of some age-and gender-related DIF. Both subscales exhibited massive DIF related to the sample, indicating that they don't work the same across the general population and clinical sample. As expected, targeting of both INQ-subscales was much better for the clinical population. Further investigations of the INQ-15 under the Rasch approach in a large clinical population are recommended to determine and optimize the scale performance.

Introducción. El estigma hacia la tuberculosis afecta la búsqueda de atención médica oportuna y la adherencia al tratamiento por temor al rechazo familiar, social o institucional. Objetivo. Validar un instrumento para medir el estigma hacia la tuberculosis aplicando la metodología Rasch. Métodos: Estudio de corte transversal. El análisis se basó en los aspectos sugeridos por Messick y operacionalizados por Wolfe y Smith con la metodología Rasch; se empleó el modelo dicotómico, donde se evaluaron los estimados de ajuste de los ítems, coherencia en la medida, índices de separación y confiabilidad, invarianza, unidimensionalidad y la relación persona-ítem. Resultados. Se entrevistaron 250 personas, 195 sin tuberculosis y 55 con tuberculosis. Se evaluaron 35 ítems, de los que 10 fueron excluidos por presentar desajustes y funcionamiento diferencial del ítem. Se obtuvieron 25 ítems validos con ajustes apropiados entre 0,5 y 1,5, correlación >0,3, porcentaje de coherencia >40% e invarianza en la medición de importantes variables exógenas. El índice de separación en ítems fue de 6,5 y confiabilidad de 0,98. En las personas fue de 1,51 y 0,69 respectivamente. Conclusiones. Se obtuvo un instrumento válido con medida unidimensional del estigma hacia la tuberculosis para uso en población general y en pacientes con tuberculosis, soportado en la rigurosidad estadística del modelo Rasch.

Background Delay in tuberculosis (TB) diagnosis is one of the first obstacles for controlling the disease. Delays generate greater deterioration of the health of the patients and increase the possibilities of transmission and infection at home and in the community. The aim of the study was to identify profiles and individual variables associated with patient delays and health care system delays in patients with pulmonary tuberculosis (PTB) in Medellín, Colombia, a city that notifies 1400 new cases per year. Methods A retrospective cohort study in adults with PTB was conducted from May to September of 2017. Sociodemographic, health care-seeking behaviour, and clinical variables were measured. The outcomes were patient delay and health care system delay. The data were obtained from records of the local TB program, and a questionnaire was applied by the health care team that performs routine field visits. Simple correspondence analysis was used to identify groups (profiles), and their characteristics. Cox’s proportional hazards model was carried out to identify the variables associated with the delays. Results The study included 183 patients. The total delay median was 101 days (IQR: 64–163). Patient delay was of 35 days (IQR: 14–84), the profile with greater delay belonged to consumers of psychoactive substances. The health care system delay was of 27 days (IQR: 7–89), the attributes of the profile with greater delay were being a female, having more than two consultations before the diagnosis, and having prescribed antibiotics. Basic-medium educational level [HRa = 0.69; 95% CI (0.49–0.97)] and having a TB home contact [HRa = 0.68; 95% CI (0.48–0.96)] were associated with greater patient delay. Having negative acid-fast bacilli (AFB) smear [HRa = 0.64; 95% CI (0.45–0.92)] and more than two consultations before the diagnosis [HRa = 0.33; 95% CI (0.22–0.49)] was associated with greater health care system delay. Conclusions Data from epidemiological surveillance allowed locating risk groups with delays in TB diagnosis which requires the prioritisation of the local TB control program to promote early detection and prevention of adverse outcomes.