Examining preconditions for integrated care: a comparative social network analysis of the structure and dynamics of strong relations in child service networks.

BACKGROUND: To help ensure that children and families get the right support and services at the right time, strong and stable relationships between various child service organizations are vital. Moreover, strong and stable relationships and a key network position for gatekeepers are important preconditions for interprofessional collaboration, the timely and appropriate referral of clients, and improved health outcomes. Gatekeepers are organizations that have specific legal authorizations regarding client referral. However, it is largely unclear how strong relations in child service networks are structured, whether the gatekeepers have strong and stable relationships, and what the critical relations in the overall structure are. The aim of this study is to explore these preconditions for integrated care by examining the internal structure and dynamics of strong relations. METHODS: A comparative case study approach and social network analysis of three inter-organizational networks consisting of 65 to 135 organizations within the Dutch child service system. Multiple network measures (number of active organizations, isolates, relations, average degree centrality, Lambda sets) were used to examine the strong relation structure and dynamics of the networks. Ucinet was used to analyze the data, with use of the statistical test: Quadratic Assignment Procedure. Visone was used to visualize the graphs of the networks. RESULTS: This study shows that more than 80% of the organizations in the networks have strong relations. A striking finding is the extremely high number of strong relations that gatekeepers need to maintain. Moreover, the results show that the most important gatekeepers have key positions, and their strong relations are relatively stable. By contrast, considering the whole network, we also found a considerable measure of instability in strong relationships, which means that child service networks must cope with major internal dynamics. CONCLUSIONS: Our study addressed crucial preconditions for integrated care. The extremely high number of strong relations that particularly gatekeepers need to build and maintain, in combination with the considerable instability of strong relations considering the whole network, is a serious point of concern that need to be managed, in order to enable child service networks to improve internal coordination and integration of service delivery.

HIGHLIGHTS: More than 80% of the organizations in the network has strong relations.Gatekeepers need to maintain an extremely high number of strong relations.Child service networks need to cope with major internal dynamics.These insights offer leads for optimizing how a network functions.

Virtual social networks and health technologies in the daily life of clients and households: care and health promotion. / Redes sociais virtuais e tecnologias em saúde no quotidiano de usuários e famílias: cuidado e promoção da saúde.

This study aimed to understand the use of technosociality in the daily lives of the Family Health Strategy clients during the COVID-19 pandemic for care and health promotion. This holistic, qualitative, multiple case study based on the Comprehensive Everyday Life Sociology was conducted with 61 clients from three Brazilian municipalities, two in Minas Gerais and one in Santa Catarina. The sources of evidence were the open-ended individual interview and field notes. We adopted thematic content analysis to analyze data. The use of virtual social networks and health technologies for care, monitoring, prevention of risks and conditions, health promotion, and access to information is found in clients' daily lives. We highlight the importance of support and solidarity networks. The infodemic and misinformation about COVID-19 denote uncertainty about the veracity of information and concern about mental health. We should pay close attention to using technologies and social networks for health promotion, enabling strategies to enhance their use and minimize the indicated harms.

Este estudo teve por objetivo compreender o uso da tecnossocialidade no quotidiano de usuários da Estratégia Saúde da Família em tempos da pandemia de COVID-19 para o cuidado e promoção da saúde. Trata-se de estudo de casos múltiplos holístico-qualitativo, fundamentado na Sociologia Compreensiva do Quotidiano, no qual participaram 61 usuários provenientes de três municípios brasileiros, sendo dois de Minas Gerais e um de Santa Catarina. As fontes de evidência foram a entrevista individual aberta e notas de campo. Para a análise dos dados utilizou-se a Análise de Conteúdo Temática. O uso das redes sociais virtuais e tecnologias em saúde para o cuidado, acompanhamento, prevenção de riscos e agravos, promoção da saúde e acesso às informações se faz presente no quotidiano de usuários. A importância das redes de apoio e solidariedade é ressaltada. A infodemia e a desinformação sobre a COVID-19 denotam um contexto de incerteza da veracidade das informações e a preocupação com a saúde mental. É imperativo um olhar atento sobre o uso das tecnologias e redes sociais para a promoção da saúde, viabilizando estratégias para potencializar seu uso e minimizar os prejuízos apontados.

Evaluation of approaches to recruitment of racially and ethnically diverse breast cancer patients from an integrated health care setting for collection of observational social network data.

PURPOSE: We compared approaches to recruitment of diverse women with breast cancer in a study designed to collect complex social network data. METHODS: We recruited 440 women from the Kaiser Permanente Northern California population newly diagnosed with breast cancer, either in person at a clinic, by email, or by mailed letter. In clinic and mail recruitment, women completed a brief 3-page paper survey (epidemiologic data only), and women had the option to complete a separate, longer (30-40 min) personal social network survey online. In email recruitment, we administered epidemiologic and personal social network measures together in a single online survey. In email and mail recruitment, we limited the sample of non-Hispanic white (NHW) women to 30% of their total. We used descriptive analysis and multinomial logistic regression to examine odds of recruitment vs. mailed letter. RESULTS: Women responded to the social network surveys on average 3.7 months post-diagnosis. Mean age was 59.3 (median = 61.0). In-person clinic recruitment was superior with a 52.1% success rate of recruitment compared with 35.6% by mail or 17.3% by email (χ2 = 65.9, p < 0.001). Email recruitment produced the highest completion rate (82.1%) of personal network data compared with clinic (36.5%) or mail (28.7%), (χ2 = 114.6, p < 0.001). Despite intentional undersampling of NHW patients, response rates for Asian, Hispanic, and Black women by email were lower. However, we found no significant differences in recruitment rates by race and ethnicity for face-to-face clinic recruitment vs. by letter. Letter recruitment produced the highest overall response. CONCLUSION: Mailed letter was the best approach to representative recruitment of diverse women with breast cancer and collection of social network data, and further yielded the highest absolute response.

Effectiveness of web-based mindfulness program on college students with social network addiction.

AIMS: In this study a web-based mindfulness cultivation program was implemented to investigate its effectiveness on the addiction symptoms and negative emotions of college students with social network addiction. METHODS: A total of 66 students were recruited and randomly divided into the intervention group or the control group. Participants in the intervention group received a web-based mindfulness cultivation program including the group training and self-cultivating. The primary outcome was addiction level, and the secondary outcome was anxiety, depression and perceived stress. Repeated measures analysis of variance were utilized to analyze the differences between the control and intervention group over the course of the intervention and the follow-up. RESULTS: There were significant interaction effects on addiction level (F = 39.39, P < .00), anxiety (F = 31.17, P < .00), depression (F = 37.93, P < .00) and perceived stress (F = 22.04, P < .00). CONCLUSION: A web-based mindfulness cultivation program could improve the addiction level and negative emotions of college students with social network addiction.

'Nesting networks': Women's experiences of social network support in high-risk pregnancy.

OBJECTIVE: Social support, an individual's social relationships (both online and offline), may provide protection against adverse mental health outcomes, such as anxiety and depression, which are high in women who have been hospitalised with high-risk pregnancy. This study explored the social support available to women at higher risk of preeclampsia during pregnancy by examining personal social networks. DESIGN: Semi-structured interviews were accompanied by social network mapping using the web-based social networking tool GENIE. SETTING: England. PARTICIPANTS: Twenty-one women were recruited, of whom 18 were interviewed both during pregnancy and postnatally between April 2019 and April 2020. Nineteen women completed maps pre-natally, 17 women completed maps pre-natally and post-natally. Women were taking part in the BUMP study, a randomised clinical trial that included 2441 pregnant individuals at higher risk of preeclampsia and recruited at a mean of 20 weeks' gestation from 15 hospital maternity units in England between November 2018 and October 2019. RESULTS: Women's social networks tightened during pregnancy. The inner network changed most dramatically postnatally with women reporting fewer network members. Interviews revealed networks were primarily 'real-life' rather than online social networks, with members providing emotional, informational, and practical support. Women with a high-risk pregnancy valued the relationships they developed with health professionals during pregnancy, and would like their midwife to have a more central role in their networks by providing informational and, where needed, emotional support. The social network mapping data supported the qualitative accounts of changing networks across high-risk pregnancy. CONCLUSION: Women with a high-risk pregnancy seek to build "nesting networks" to support them through pregnancy into motherhood. Different types of support are sought from trusted sources. Midwives can play a key role. PRACTICE IMPLICATIONS: As well as highlighting other potential needs during pregnancy and the ways in which they can be met, support from midwives has a key role. Through talking to women early in their pregnancy, signposting information and explaining ways to contact health professionals regarding informational or emotional support would fill a gap that currently is met by other aspects of their network.

Efeito da resina de âmbar e terapêuticas não farmacológicas para sintomatologia da erupção de dentes decíduos / Effect of amber resin and nonpharmacological therapeutic for syntptomatology of eruption of deciduous theeth

Esta tese é composta por 5 artigos científicos e 1 produto técnico. O primeiro artigo científico, é uma revisão sistemática sobre a eficácia de tratamentos para alívio dos sinais e sintomas da erupção de dentes decíduos. Foram incluídos estudos clínicos que avaliaram o efeito de qualquer intervenção para aliviar os sinais e sintomas associados à dentição em bebês e crianças. O risco de viés foi avaliado usando as ferramentas ROB-2 e ROBINS-I. Foram selecionados 5 artigos, classificados como alto ou grave risco de viés respectivamente. Três estudos usando homeopatia relataram melhora nos distúrbios do apetite, desconforto nas gengivas e excesso de salivação. Um estudo mostrou que um novo gel com ácido hialurônico foi mais eficaz do que um gel anestésico na melhora de sinais e sintomas como dor, vermelhidão gengival e má qualidade do sono. Outro estudo selecionado aplicou tratamentos não farmacológicos, que se mostraram mais eficazes, principalmente contra o excesso de salivação. O segundo artigo avaliou as práticas clínicas adotadas por odontopediatras (OPs) frente aos sinais e sintomas da erupção dos dentes decíduos e a influência do tempo de formado e de especialista no autorrelato (AR) de segurança na adoção de tais medidas. Aplicou-se um questionário online aos OPs. Coletaram-se dados sobre tipo de prática, relato de eficácia, fonte de conhecimento sobre o tema, segurança na prática adotada, tempo de formado e tempo de especialista. Realizaram-se análises descritivas e inferenciais (teste X2, α=0,05). Foram 451 respondentes. Mordedores gelados (96,8%); alimentos congelados (69,1%) e massagem digital (58,3%) foram os mais prescritos e considerados eficazes (78,2%, 30,3% e 28,8%, respectivamente). Livros de odontopediatria (58,9%), curso/congresso (56,3%) e experiência profissional (40,7%) foram as fontes de conhecimento mais citadas. O tempo médio de formado dos OPs foi 18,4±11,3 anos, sendo 13,1±11,0 anos de especialista. A maioria sente-se seguro (79,6%) no tratamento dos sinais e sintomas da erupção dentária, mas 93,1% sentem falta de estudos científicos sobre o tema. O tempo de formado (p=0,12) e o de especialista (p=0,90) não influenciaram no AR de segurança na prática adotada. O terceiro artigo analisou a composição molecular de uma amostra de âmbar báltico, verificou-se a presença ou ausência de compostos benéficos à saúde humana e discutiu o potencial terapêutico dessa resina fóssil. Para isso, foi realizada uma análise qualitativa por cromatografia gasosa acoplada à espectrometria de massas (sistema GC-MS), que é capaz de realizar uma separação automatizada em componentes individuais do âmbar. As amostras eram compostas por terpenos e terpenóides: monoterpenóides; sesquiterpenóides; diterpenóides; hidronaftaleno; ácido succínico e ácido isopimárico. Estes componentes têm potencial terapêutico para várias doenças; inibem várias fases do processo inflamatório e tem efeitos analgésicos. No quarto artigo analisouse e avaliou-se a qualidade, confiabilidade e visualizações dos vídeos disponibilizados no Youtube® como fonte de informação, relacionados ao uso terapêutico do colar de âmbar para bebês durante o período de erupção dentária. Uma busca no YouTube®, foi realizada no dia 23 de agosto de 2022. O termo escolhido para a busca foi "colar de âmbar para bebê" no site Google Trends®. Como critério de inclusão, os vídeos deveriam conter informações sobre o uso do colar de âmbar como terapia para diminuir os sintomas da erupção dentária em bebês. Os vídeos foram analisados quanto à confiabilidade das informações, com base em uma escala de 5 pontos, adaptada da ferramenta DISCERN, e quanto à qualidade com a ferramenta Global Quality Score (GQS), que varia de 1- má qualidade a 5- excelente qualidade. Foram encontrados 22 vídeos com o termo de busca, dos quais 15 foram selecionados. A frequência de qualidade GQS "1" foi a mais alta e observou-se que houve diferença de qualidade entre as origens dos vídeos (p<0,05). As fontes provenientes de jornais e profissionais de saúde foram iguais e melhores (p=0,002) na escala de confiabilidade, quando comparadas aos outros grupos como Opiniões e Fontes de marketing. No quinto artigo objetivou-se identificar os possíveis benefícios da resina de âmbar na sintomatologia da fase de erupção dentária dos bebês, através de um estudo clínico preliminar observacional. Foram incluídos bebês de ambos os gêneros, com idade entre 8 e 36 meses que já tivessem pelo menos um dente da dentição primária em erupção. A amostra foi composta por 3 grupos: 1. Grupo que não usou nenhum tratamento (controle); 2. Grupo que usou a pulseira placebo e 3. Grupo que usou a pulseira de âmbar. Os sintomas da dentição mais frequentes na linha de base (t1) foram coceira, inchaço e irritação; após o tratamento foram os mesmos, acrescido de vermelhidão. Houve diferenças de frequência, com diminuição dos sintomas, entre os grupos, para as manifestações clínicas irritação e coceira. A segunda etapa consistiu na criação de um vídeo, na plataforma de criação de vídeos PowToon®, informativo para os responsáveis, sobre a fase de erupção dentária. No vídeo procurou-se abordar sobre a sequência comum de erupção dentária, os principais sinais e sintomas e possíveis tratamentos não farmacológicos para alívio dessa fase que gera muitas dúvidas nos responsáveis. Pode-se concluir com os estudos que algumas terapias não farmacológicas podem ter um efeito favorável sobre os sinais e sintomas relacionados à dentição. No entanto, conclusões definitivas sobre sua eficácia não podem ser tiradas, devido à certeza muito baixa das evidências. Pesquisas primárias, intervencionais sobre o assunto são escassas, heterogêneas e tem falhas metodológicas; a prescrição de tratamentos não farmacológicos para a dentição decídua é uma prática comum entre os odontopediatras, e seu auto relato de segurança no uso de tais medidas não está associada ao tempo decorrido após a graduação e especialização; o âmbar da amostra testada no terceiro estudo, é formado por terpenos e terpenóides, substâncias com propriedades anti-inflamatórias e analgésicas. Entretanto, é necessário um estudo aprofundado sobre a liberação e absorção de substâncias na pele humana, ou seja, atentar a sua real eficácia; Vídeos assistidos através da plataforma do YouTube®, ainda que postados por profissionais e veículos de comunicação, não possuem embasamento científico suficiente sobre o assunto quando se fala sobre o âmbar e seu uso para saúde, o que implica baixa confiabilidade e segurança da informação. Nesse sentido, estudos clínicos controlados, com maior número de participantes, sobre os reais benefícios do uso da resina de âmbar para bebês no período de erupção dentária, são fundamentais e devem ser realizados, a fim de consolidar as evidências sobre o assunto e reais benefícios para a saúde. Da mesma forma que o vídeo criado serve como informação aos pais sobre a fase de erupção dentária, e que foi baseado no que foi encontrado em evidências científicas. Após a realização da presente tese, observou-se que não existem muitos estudos que abordem sobre os tratamentos mais eficazes para essa fase na vida do bebê. (AU)

This thesis is composed of 5 scientific articles and 1 technical product. The first scientific article is a systematic review on the effectiveness of treatments to relieve the signs and symptoms of eruption of deciduous teeth. Clinical trials evaluating the effect of any intervention to alleviate signs and symptoms associated with teething in infants and children were included. The risk of bias was assessed using the ROB-2 and ROBINS-I tools. Five articles were selected, classified as high or severe risk of bias. Three studies using homeopathy reported improvement in appetite disorders, gum discomfort and excess salivation. One study showed that a new gel with hyaluronic acid was more effective than an anesthetic gel in improving signs and symptoms such as pain, gum redness and poor sleep quality. Another selected study applied nonpharmacological treatments, which proved to be more effective, especially against excess salivation. The second article evaluated the clinical practices adopted by pediatric dentists (POs) in view of the signs and symptoms of eruption of deciduous teeth and the influence of time since graduation and specialist in the self-report (AR) of safety in the adoption of such measures. An online questionnaire was applied to the OPs. Data were collected on the type of practice, effectiveness report, source of knowledge on the subject, safety in the adopted practice, time since graduation and time as a specialist. Descriptive and inferential analyzes were performed (X2 test, α=0.05). There were 451 respondents. iced teethers (96.8%); frozen foods (69.1%) and digital massage (58.3%) were the most prescribed and considered effective (78.2%, 30.3% and 28.8%, respectively). Pediatric dentistry books (58.9%), course/conference (56.3%) and professional experience (40.7%) were the most cited sources of knowledge. The average time since graduation of OPs was 18.4±11.3 years, with 13.1±11.0 years as a specialist. Most feel confident (79.6%) in treating the signs and symptoms of tooth eruption, but 93.1% feel that there is a lack of scientific studies on the subject. Time since graduation (p=0.12) and specialist time (p=0.90) did not influence the AR of safety in the adopted practice. The third article analyzed the molecular composition of a sample of Baltic amber, verified the presence or absence of compounds beneficial to human health and discussed the therapeutic potential of this fossil resin. For this, a qualitative analysis was carried out by gas chromatography coupled to mass spectrometry (GC-MS system), which can perform an automated separation into individual amber components. The samples were composed of terpenes and terpenoids: monoterpenoids; sesquiterpenoids; diterpenoids; hydronaphthalene; succinic acid and isopimaric acid. These components have therapeutic potential for various diseases; inhibit various phases of the inflammatory process and have analgesic effects. The fourth article analyzed and evaluated the quality, reliability and views of the videos available on YouTube® as a source of information, related to the therapeutic use of the amber necklace for babies during the period of tooth eruption. A search on YouTube® was performed on August 23, 2022. The term chosen for the search was "baby amber necklace" on the Google Trends® website. As an inclusion criterion, the videos should contain information about the use of the amber necklace as a therapy to reduce the symptoms of tooth eruption in babies. The videos were analyzed for the reliability of the information, based on a 5-point scale, adapted from the DISCERN tool, and for quality with the Global Quality Score (GQS) tool, which ranges from 1-poor quality to 5-excellent quality. 22 videos were found with the search term, of which 15 were selected. The GQS quality frequency "1" was the highest and it was observed that there was a difference in quality between the origins of the videos (p<0.05). Sources from newspapers and health professionals were equal and better (p=0.002) on the reliability scale, when compared to other groups such as Opinions and Marketing sources. The fifth article aimed to identify the possible benefits of amber resin in the symptomatology of the tooth eruption phase of babies, through a preliminary observational study. Infants of both genders, aged between 8 and 36 months, who already had at least one erupting primary dentition tooth, were included. The sample consisted of 3 groups: 1. Group that did not use any treatment (control); 2. Group that used the placebo bracelet and 3. Group that used the amber bracelet. The most frequent dentition symptoms at baseline (t1) were itching, swelling and irritation; after treatment they were the same, plus redness. There were differences in frequency, with a decrease in symptoms, between the groups, for the clinical manifestations of irritation and itching. The second stage consisted of creating a video, on the PowToon® video creation platform, informative for those responsible, about the tooth eruption phase. In the video, an attempt was made to address the common sequence of tooth eruption, the main signs and symptoms and possible nonpharmacological treatments to alleviate this phase, which raises many doubts in those responsible. It can be concluded from the studies that some non-pharmacological therapies can have a favorable effect on signs and symptoms related to dentition. However, definitive conclusions about its effectiveness cannot be drawn, due to the very low certainty of the evidence. Primary, interventional research on the subject is scarce, heterogeneous and has methodological flaws; the prescription of nonpharmacological treatments for the primary dentition is a common practice among pediatric dentists, and their self-reported safety in the use of such measures is not associated with the time elapsed after graduation and specialization; the amber of the sample tested in the third study is formed by terpenes and terpenoids, substances with anti-inflammatory and analgesic properties. However, an in-depth study on the release and absorption of substances in human skin is necessary, that is, paying attention to their real effectiveness; Videos watched through the Youtube® platform, even if posted by professionals and communication vehicles, do not have sufficient scientific basis on the subject when talking about amber and its use for health, which implies low reliability and information security. In this sense, controlled clinical studies, with a larger number of participants, on the real benefits of using amber resin for babies in the period of tooth eruption, are fundamental and must be carried out, in order to consolidate the evidence on the subject and real benefits for health. In the same way that the video created serves as information to parents about the stage of tooth eruption, and which was based on what was found in scientific evidence. After carrying out this thesis, it was observed that there are not many studies that address the most effective treatments for this phase in the baby's life. (AU)

Expectativas de mães e cuidadoras sobre participação em um programa de prevenção à violência / Expectations of mothers/caregivers regarding the participation in a violence prevention program / Expectativas de madres/cuidadoras sobre la participación en un programa de prevención de la violencia

O presente estudo qualitativo objetivou compreender as expectativas de mães e cuidadoras sobre a sua participação no Programa ACT para Educar Crianças em Ambientes Seguros na versão remota, no período da pandemia de covid-19. Também visou identificar a percepção das participantes sobre educar uma criança em um ambiente seguro. Foram realizadas entrevistas semiestruturadas on-line com doze mães e cuidadoras, antes da participação no Programa ACT. Os resultados indicaram diferentes expectativas sobre a participação no Programa ACT, entre elas: adquirir novos conhecimentos, aprimorar as habilidades parentais, trocar experiências, receber auxílio no momento da pandemia de covid-19 e possibilitar para a criança um desenvolvimento saudável. Na percepção das mães e cuidadoras, a versão remota do Programa ACT apresenta aspectos positivos; entre eles, a participação de pais e cuidadores que não residem na cidade em que é oferecida a intervenção. No entanto, apontaram como fatores negativos a ausência do contato físico e as interrupções que podem acontecer a partir das falhas de internet. Para as mães e cuidadoras, educar a criança em um ambiente seguro estava relacionado a promover os direitos estabelecidos no Estatuto da Criança e do Adolescente (ECA), como educação, saúde, lazer, cuidado, afeto, assim como protegê-la de situações de violência. Considera-se que as expectativas das participantes estavam alinhadas aos objetivos do Programa ACT. Torna-se prioritário oferecer programas de prevenção à violência aos pais e cuidadores, em especial em momentos adversos como o da pandemia de covid-19, a fim de promover o desenvolvimento e a saúde das crianças, assim como prevenir situações de violação de direitos.(AU)

This qualitative study aims to understand the expectations of mothers and caregivers about participating in the ACT Raising Safe Kids Program in its remote version, during the COVID-19 pandemic period. It also aims to identify the participants' perception of raising a child in a safe environment. Semi-structured on-line interviews were conducted with 12 mothers/caregivers, prior to participation in the ACT Program. The results indicated different expectations regarding the participation in the ACT Program, for example: acquiring new knowledge, improving parenting skills, exchanging experiences, receiving support during the COVID-19 pandemic, and enabling the child to have a healthy development. In the perception of mothers and caregivers, the remote version of the ACT Program has positive aspects, such as the participation of parents and caregivers who do not live in the city where the intervention is offered. However, they pointed out as negative factors absence of physical contact and interruptions due to internet failures. For the mothers/caregivers, educating children in a safe environment was related to promoting the rights established by the Brazilian Child and Adolescent Statute, namely education, health, leisure, care, affection, as well as protecting them from situations of violence. The expectations of the participants were aligned with the objectives of the ACT Program. Offering violence prevention programs to parents and caregivers is a priority, especially in adverse moments such as the COVID-19 pandemic, in order to promote the development and health of children, as well as prevent situations of violation of rights.(AU)

Este estudio cualitativo pretendió comprender las expectativas de madres y cuidadoras sobre la participación en el Programa de ACT para Educar a Niños en Ambientes Seguros en la versión remota, en el periodo de la pandemia de la COVID-19. También se propuso identificar la percepción de las participantes sobre educar a un niño en un ambiente seguro. Se llevaron a cabo entrevistas semiestructuradas en línea con 12 madres/cuidadoras, antes de la participación en el Programa ACT. Los resultados señalaron diferentes expectativas con la participación del Programa de ACT, entre ellas: adquirir nuevos conocimientos, perfeccionar las habilidades parentales, intercambiar experiencias, recibir auxilio en el momento de la pandemia de la COVID-19 y posibilitar al niño un desarrollo saludable. En la percepción de las madres y cuidadoras, la versión remota del Programa de ACT presenta aspectos positivos, como la participación de padres y cuidadores que no residen en la ciudad donde es ofrecida la intervención. Sin embargo, señalaron como factores negativos la ausencia del contacto físico y las interrupciones, que pueden ocurrir por fallas en Internet. Para las madres/cuidadoras, educar al niño en un ambiente seguro estaba relacionado a promover los derechos establecidos en el Estatuto del Niño y del Adolescente de Brasil, como educación, salud, ocio, cuidado, afecto, así como protegerlo de situaciones de violencia. Se considera que las expectativas de las participantes estaban alineadas con los objetivos del Programa de ACT. Es prioritario ofrecer programas de prevención a la violencia a los padres y cuidadores, en especial en momentos adversos como el de la pandemia de la COVID-19, con el fin de promover el desarrollo y la salud de los niños, así como prevenir situaciones de vulneración de derechos.(AU)

Social Networking Service, Patient-Generated Health Data, and Population Health Informatics: National Cross-sectional Study of Patterns and Implications of Leveraging Digital Technologies to Support Mental Health and Well-being.

BACKGROUND: The emerging health technologies and digital services provide effective ways of collecting health information and gathering patient-generated health data (PGHD), which provide a more holistic view of a patient's health and quality of life over time, increase visibility into a patient's adherence to a treatment plan or study protocol, and enable timely intervention before a costly care episode. OBJECTIVE: Through a national cross-sectional survey in the United States, we aimed to describe and compare the characteristics of populations with and without mental health issues (depression or anxiety disorders), including physical health, sleep, and alcohol use. We also examined the patterns of social networking service use, PGHD, and attitudes toward health information sharing and activities among the participants, which provided nationally representative estimates. METHODS: We drew data from the 2019 Health Information National Trends Survey of the National Cancer Institute. The participants were divided into 2 groups according to mental health status. Then, we described and compared the characteristics of the social determinants of health, health status, sleeping and drinking behaviors, and patterns of social networking service use and health information data sharing between the 2 groups. Multivariable logistic regression models were applied to assess the predictors of mental health. All the analyses were weighted to provide nationally representative estimates. RESULTS: Participants with mental health issues were significantly more likely to be younger, White, female, and lower-income; have a history of chronic diseases; and be less capable of taking care of their own health. Regarding behavioral health, they slept <6 hours on average, had worse sleep quality, and consumed more alcohol. In addition, they were more likely to visit and share health information on social networking sites, write online diary blogs, participate in online forums or support groups, and watch health-related videos. CONCLUSIONS: This study illustrates that individuals with mental health issues have inequitable social determinants of health, poor physical health, and poor behavioral health. However, they are more likely to use social networking platforms and services, share their health information, and actively engage with PGHD. Leveraging these digital technologies and services could be beneficial for developing tailored and effective strategies for self-monitoring and self-management.

The effect of a social network-based cognitive behavioral therapy intervention on the severity of premenstrual syndrome symptoms: a protocol of a randomized clinical trial study.

BACKGROUND: Premenstrual syndrome (PMS) is one of the most widespread menstrual disorders in women of reproductive age. This recurrent syndrome is a combination of physically, mentally, or behaviorally disturbing changes occurring during the secretory phase of the menstrual cycle. The aim of this study is to determine the effect of a cognitive-behavioral therapy-based educational intervention using social networks on PMS in female health center employees in Rudbar, Iran. METHODS/DESIGN: A randomized superiority controlled trial will be conducted involving 140 female employees of health centers affiliated with the Guilan University of Medical Sciences, Rudbar. The study involves a block size of 4 and 6 in a randomly varied order, 140 women who meet all the inclusion criteria will be randomly and equally divided into 2 groups: the intervention and the control groups. Those in the former group will receive a cognitive-behavioral therapy-based treatment for eight consecutive weeks on the social network platform WhatsApp; however, those in the control group will not be offered any treatment except usual care practices (unprotocolized usual care). The study's primary outcome is the severity of PMS symptoms, and the secondary outcomes include general self-efficacy, work-related quality of life, the impact of PMS on daily life, coping with the symptoms, and experiencing anxiety and depression at the beginning of the study to identify people with PMS. A daily record of the symptoms will be completed for two consecutive months by all female employees aged 20-45 years who wish to participate in the study. According to the initial screening, those with moderate to severe PMS will be included. We will use the MLwin software for the analyses. All questionnaires will be completed by both groups immediately and 8 weeks after the termination of the treatment. The data will be analyzed using linear mixed-effects modeling with random intercepts and slopes. DISCUSSION: It is anticipated that the findings of the present study may demonstrate the effectiveness of the cognitive behavioral therapy intervention on the severity of PMS symptoms that could guide healthcare providers in opting for suitable treatment alternatives for the syndrome. ETHICS AND DISSEMINATION: The research proposal is approved by the Human Ethics Committee of Qazvin University of Medical Sciences (IR.QUMS.REC.1399.252). The results of this intervention trial will be submitted for publication in a peer-reviewed research journal. TRIAL REGISTRATION: Iranian Registry of Clinical Trials IRCT20180218038789N4 . Registered prospectively on October 28, 2020.

Building a country-wide Fistula Treatment Network in Kenya: results from the first six years (2014-2020).

It is estimated that one million women worldwide live with untreated fistula, a devastating injury primarily caused by prolonged obstructed labor when women do not have access to timely emergency obstetric care. Women with fistula are incontinent of urine and/or feces and often suffer severe social and psychological consequences, such as profound stigma and depression. Obstetric fistula affects economically vulnerable women and garners little attention on the global health stage. Exact figures on fistula incidence and prevalence are not known. In Kenya, results from a 2014 population-based survey suggest that 1% of reproductive-aged women have experienced fistula-like symptoms. In collaboration with key stakeholders, Fistula Foundation launched the Fistula Treatment Network (initially known as Action on Fistula) in 2014 to increase access to timely, quality fistula treatment and comprehensive post-operative care for women with fistula in Kenya. The integrated model built linkages between the community and the health system to support women through all parts of their treatment journey and to build capacity of healthcare providers and community leaders who care for these women. Fistula Foundation and its donors provided the program's funding. Seed funding, representing about 30% of the program budget, was provided by Astellas Pharma EMEA.Over the six-year period from 2014 to 2020, the network supported 6,223 surgeries at seven hospitals, established a fistula training center, trained eleven surgeons and 424 Community Health Volunteers, conducted extensive community outreach, and contributed to the National Strategic Framework to End Female Genital Fistula. At 12 months post fistula repair, 96% of women in a community setting reported that they were not experiencing any incontinence and the proportion of women reporting normal functioning increased from 18% at baseline to 85% at twelve-months.The Fistula Treatment Network facilitated collaboration across hospital and community actors to enhance long-term outcomes for women living with fistula. This model improved awareness and reduced stigma, increased access to surgery, strengthened the fistula workforce, and facilitated post-operative follow-up and reintegration support for women. This integrated approach is an effective and replicable model for building capacity to deliver comprehensive fistula care services in other countries where the burden of fistula is high.

Preliminary insights into associations between C-reactive protein and social network dynamics.

Recent social psychoneuroimmunology models suggest bidirectional associations between social experiences and the immune system. This work posits that social relationships and networks may influence the functioning of the immune system, but we know little about the role that the immune system plays in how social networks are created and maintained. We examine how salivary C-reactive protein (CRP), as an inflammatory protein, is associated with making new and keeping existing friendship and conflicted relationships among young adult members of a social group. Participants (n = 37; 67.6% female; M age = 18.18 years, 56.81% white/non-Hispanic) provided nominations of friends and individuals with whom they have conflict at wave 1 and two months later at wave 2. At wave 1, in a group setting, participants donated saliva, later assayed for CRP. Stochastic actor-based models revealed that CRP levels were negatively associated with keeping existing friends and positively associated with developing new friendships. We also found that CRP levels were negatively associated with creating new conflicted relationships and predicted an increased likelihood that group members continue conflicted relationships with the focal individual. These preliminary results support the premises of recent social psychoneuroimmunology models by suggesting that inflammation can also serve as a signal to seek new supportive relationships such as friendships and avoid creating new relationships characterized by threat and/or conflict. Findings provide new insights into the theorized function of the immune system for social approach and withdrawal patterns through which our social connections are constructed.

Integrating network theory into the study of integrated healthcare.

Healthcare policy in the United States (U.S.) has focused on promoting integrated healthcare to combat fragmentation (e.g., 1993 Health Security Act, 2010 Affordable Care Act). Researchers have responded by studying coordination and developing typologies of integration. Yet, after three decades, research evidence for the benefits of coordination and integration are lacking. We argue that research efforts need to refocus in three ways: (1) use social networks to study relational coordination and integrated healthcare, (2) analyze integrated healthcare at three levels of analysis (micro, meso, macro), and (3) focus on clinical integration as the most proximate impact on patient outcomes. We use examples to illustrate the utility of such refocusing and present avenues for future research.

Visual Sentiment Analysis With Social Relations-Guided Multiattention Networks.

These days, social media users tend to express their feelings through sharing images online. Capturing the emotions embedded in these social images involves great research challenges and practical values. Most existing works concentrate on extracting the visual feature from a global view, while ignoring the fact that visual objects are also rich in emotion. How to leverage the multilevel visual features to improve the sentiment analysis performance is important yet challenging. Besides, existing works view each social image as an independent sample while ignoring the rich correlations among social images, which may be helpful in detecting visual emotion. In this article, we propose a novel model called social relations-guided multiattention networks (SRGMANs) to incorporate both the multilevel (region-level and object-level) visual features of a single image and the correlations among multiple social images to conduct visual sentiment analysis. Specifically, we first construct a heterogeneous network consisting of various types of social relations and introduce a heterogeneous network embedding method to learn the network representation for each image. Then, two visual attention branches (region attention network and object attention network) are devised to extract emotional and discriminative visual features. For each branch, we design a self-attention module to capture the emotional dependencies among visual parts. Besides, a network-guided attention module is also designed in each branch to focus on more network-related emotional visual parts with the guidance of the topology information. Finally, the attended visual features from the two attention models, together with network representation features, are combined within a holistic framework to predict the sentiment of social images. Extensive experiments demonstrate the superiority of our model on three benchmark datasets.

Razões da escolha de fitoterapia por usuários da atenção primária no município do Rio de Janeiro / Purpose of choose of phytoterapy among users of basic health care in the city of Rio de Janeiro

O presente estudo,com abordagem descritiva de caráter exploratório, quantitativo e qualitativo,objetivou identificar razões da escolha de fitoterapia na cidade do Rio de Janeiro. A população de estudo foi composta por 50 usuários de uma unidade básica de saúde (UBS), que oferta fitoterapia, na área programática (AP 2.1). Participaram da pesquisa,com abordagem na Teoria de Análise de Redes Sociais,pessoas que declararam fazer uso de plantas medicinais e/ou fitoterápicos. Buscou-se,por meio de um breve roteiro, identificar o perfil sociodemográfico dos usuários, quem foram as pessoas que haviam indicado a fitoterapia e quais eram as razões para seu uso. Como resultado sobre as razões de uso para a fitoterapia evidenciamos neste estudo que 1-Ela está fortemente ligada à rede pessoal do usuário. A indicação na rede pessoal é maior do que na rede formal de saúde, aqui representada pela UBS; 2-Parece haver correlação entre sistema de crenças pessoais, como cientificidade e religiosidade/espiritualidade em certos casos; 3-Identificamos uma percepção da fitoterapia pelo usuário como sendo uma terapêutica menos agressiva em termos de efeitos colaterais e adversos.Para institucionalização da fitoterapia na atenção primária, os resultados sugerem que o acesso à informação e a indicação sobre a prática da fitoterapia é fortemente ligada aos contextos sociais. Portanto, estas evidências sugerem a importância de que sejam inseridos nos serviços de fitoterapia espaços de discussão concernentes ao paradigma das Práticas Integrativas e Complementares.

This descriptive, exploratory, quantitative and qualitative study aimed to identify reasons for the use of phytotherapy, in the city of Rio de Janeiro. The study population consisted of 50 users of a basic health unit (UBS), that offer phytotherapy in the program area (AP 2.1). Participants in this research based on the Theory of Social Network Analysis were people who declared that they made use of medicinal plants and/or herbal medicines. Through questions, we sought to identify the sociodemographic profile of users, who recommended and what were the reasons for using phytotherapy. As a result, on the reasons for using herbal medicine, 1 ­It seems to be strongly related to the personal network, more than the health service advice, here represented by the UBS; 2-There seems to be a correlation between the personal beliefs such as religion, science and spirituality in certain cases; 3-We identified a perception of herbal medicine as less aggressive in terms of collateral effects and adverse effects. In order to the institutionalization of phytotherapy in primary care, our results suggest that access to information and indication about the practice of phytotherapy is strongly linked to social contexts. Therefore, this evidence suggest the importance of being inserted into the phytotherapy services spaces of discussion concerning the paradigm of Integrative and Complementary Practices.

A Mixed Methods Population Health Approach to Explore Radon-Induced Lung Cancer Risk Perception in Canada.

BACKGROUND: Radon is a predominant indoor air pollutant and second leading cause of lung cancer in radon-prone areas. Despite the gravity of the health risk, residents in Canada have inadequate perception and taken minimal protective actions. Better perception of a risk motivates people to take preventive measures. Scholarship about radon health risk perception is lacking in Canada. We applied a mixed methods population health approach to explore the determinants shaping perception and actions of a resident population in Canada. METHODS: We conducted mixed surveys (n = 557) and qualitative bilingual interviews (n = 35) with both homeowners and tenants of Ottawa-Gatineau areas. The study explored residents' risk perception and adaptations factors. Descriptive, correlational and regression analyses described and established associations between quantitative variables. Thematic, inductive analyses identified themes in the qualitative data. A mixed methods analysis triangulated both results to draw a holistic perception of the health risk. RESULTS: Residents' quantitative perceptions of radon health risk, smoking at home, synergistic risk perception, social influence and care for family were associated significantly with their intention to test for radon levels in their home, actual testing and mitigation. These results were explained further with the qualitative findings. Residents who had dual cognitive and emotional awareness of the risk were motivated enough to take preventive actions. Caring for family, knowing others who contracted lung cancer and financial capability were enablers, whereas lack of awareness and homeownership, cost of mitigation and stigma were obstacles to preventive actions. We also explored the dual subjective and objective aspects of risk perception that are influenced by micro- and macro-level determinants. CONCLUSIONS: Inducing protective action to reduce risk requires comprehensive population-level interventions considering dual perceptions of the risk that can modify the risk determinants. Future research can explore the dual aspects of risk perception and unequal distribution of the risk factors.

A Cost-Efficient 5G Non-Public Network Architectural Approach: Key Concepts and Enablers, Building Blocks and Potential Use Cases.

The provision of high data rate services to mobile users combined with improved quality of experience (i.e., zero latency multimedia content) drives technological evolution towards the design and implementation of fifth generation (5G) broadband wireless networks. To this end, a dynamic network design approach is adopted whereby network topology is configured according to service demands. In parallel, many private companies are interested in developing their own 5G networks, also referred to as non-public networks (NPNs), since this deployment is expected to leverage holistic production monitoring and support critical applications. In this context, this paper introduces a 5G NPN architectural approach, supporting among others various key enabling technologies, such as cell densification, disaggregated RAN with open interfaces, edge computing, and AI/ML-based network optimization. In the same framework, potential applications of our proposed approach in real world scenarios (e.g., support of mission critical services and computer vision analytics for emergencies) are described. Finally, scalability issues are also highlighted since a deployment framework of our architectural design in an additional real-world scenario related to Industry 4.0 (smart manufacturing) is also analyzed.

Reinforcement Effects of Social Network Intervention during Nutritional Supplementation in Frail Older Adults.

INTRODUCTION: Chronic undernutrition and a homebound state are corelated and are both important components of frailty. However, whether social network intervention combined with protein supplementation is an effective strategy to prevent functional decline among frail older adults is unclear. METHODS: 150 frail older adults participated in a 3-month, 3-armed, community-based clinical trial and were randomly assigned to one of 3 groups: high-protein supplementation (additional 27 g of protein/day), the Social Nutrition Program (additional 27 g of protein/day and social network intervention), or a control group. Those assigned to the Social Nutrition Program group received individual counseling from 1 dietitian and 1 social worker during 6 home visits and were encouraged to participate in 4 sessions of community-based cooking activities, the social kitchen program. Primary outcomes were changes in Physical Functioning (PF) and the Timed Up and Go (TUG) test and were assessed at 0 months (baseline), 1.5 months (interim), and 3, 6, and 9 months (postintervention). RESULTS: Compared with the control group, participants in the Social Nutrition Program showed an average improvement of 2.2-3.0 s in the TUG test and this improvement persisted for 3 months after the end of the program (post hoc p ≤ 0.030). The Social Nutrition Program also increased PF by 1.3 points while the control group showed a 1.4 point reduction at the end of the program (post hoc p = 0.045). Improvement in PF and TUG results was primarily observed for the socially frail subgroup of older adults in the Social Nutrition Program group rather than the physically frail subgroup. Frequency of leaving home functioned as a mediator (p = 0.042) and explained 31.2% of the total effect of the Social Nutrition Program on PF change. CONCLUSION: Our results indicate that social network intervention combined with protein supplementation can improve both the magnitude and duration of functional status among frail older community-dwelling adults.

Macro and meso level influences on distributed integrated COPD care delivery: a social network perspective.

BACKGROUND: Care guidelines for people with chronic obstructive pulmonary disease (COPD) recommend an integrated approach for holistic, flexible, and tailored interventions. Continuity of care is also emphasised. However, many patients with COPD experience fragmented care. Discontinuities in healthcare and related social services are likely to result in disjointed rather than integrated care which can negatively affect patient health outcomes. The purpose of this qualitative study was to improve our understanding of, and how, contextual features pertaining to structures and processes of COPD integrated care influence delivery of care within patients' healthcare networks. METHODS: We conducted individual interviews with 28 participants (9 patients, 16 healthcare professionals, and 3 spousal caregivers). Participants were recruited through the lung clinic at a city hospital in western Canada. We employed a social network paradigm to analyse and interpret the data. RESULTS: The analysis revealed an overarching theme of fragmented COPD care with two sub-themes: (1) Funding shortfalls and availability of resources, and (2) Dis(mis)connected communication pathways. The overarching theme depicts variations, delays, and discontinuities in patient care. The sub-themes describe how macro level influences and meso level shortfalls were perceived to influence the availability of respiratory care resources that contributed to fragmented COPD care. CONCLUSIONS: Employing a social network lens drew particular attention to family physicians' pivotal role in delivering community-based COPD care. While an integrated approach to care is recommended by care guidelines, institutional and organizational structures and processes, such as financial and communication structures, may inhibit delivery of integrated care. Thus, macro and meso level structures and processes have the potential to shape patient care by constraining family physicians' purposive and communication actions necessary for facilitating an integrated distributed approach to care. We propose a context of care which fosters a context for family physicians' delivery of patient-centered care. Integrated care delivery may improve patients' wellbeing and alleviate financial constraints on the healthcare system.

Comparación de las estructuras de difusión de información errónea y verídica en las redes sociales durante una emergencia de salud pública

[RESUMEN]. Objetivos. Elaborar un esquema operativo integral para detectar la información errónea principal sobre el zika distribuida en Twitter® en el 2016; reconstruir las redes por las que se difunde información mediante retuiteo; contrastar la información verídica frente a la errónea con diversos parámetros; e investigar cómo se difundió en las redes sociales la información errónea sobre el zika durante la epidemia. Métodos. Revisamos sistemáticamente los 5 000 tuits más retuiteados con información sobre el zika en inglés, definimos “información errónea” a partir de la evidencia, buscamos tuits que tuvieran información errónea y conformamos un grupo equiparable de tuits con información verídica. Elaboramos un algoritmo para reconstruir las redes de retuiteo de 266 tuits con información errónea y 458 tuits equiparables con información verídica. Calculamos y comparamos nueve parámetros para caracterizar la estructura de las redes a varios niveles, entre los dos grupos. Resultados. En los nueve parámetros se aprecian diferencias estadísticamente significativas entre el grupo de información verídica y el de información errónea. La información errónea en general se difunde mediante estructuras más sofisticadas que la información verídica. También hay una considerable variabilidad intragrupal. Conclusiones. Las redes de difusión de la información errónea sobre el zika en Twitter fueron sustancialmente diferentes que las de información verídica, lo cual indica que la información errónea se sirve de mecanismos de difusión distintos. Nuestro estudio permitirá formar una comprensión más holística de los desafíos que plantea la información errónea sobre salud en las redes sociales.

[ABSTRACT]. Objectives. To provide a comprehensive workflow to identify top influential health misinformation about Zika on Twitter in 2016, reconstruct information dissemination networks of retweeting, contrast mis- from real information on various metrics, and investigate how Zika misinformation proliferated on social media during the Zika epidemic. Methods. We systematically reviewed the top 5000 English-language Zika tweets, established an evidence-based definition of “misinformation,” identified misinformation tweets, and matched a comparable group of real-information tweets. We developed an algorithm to reconstruct retweeting networks for 266 misinformation and 458 comparable real-information tweets. We computed and compared 9 network metrics characterizing network structure across various levels between the 2 groups. Results. There were statistically significant differences in all 9 network metrics between real and misinformation groups. Misinformation network structures were generally more sophisticated than those in the real-information group. There was substantial within-group variability, too. Conclusions. Dissemination networks of Zika misinformation differed substantially from real information on Twitter, indicating that misinformation utilized distinct dissemination mechanisms from real information. Our study will lead to a more holistic understanding of health misinformation challenges on social media.

Developing a model of long-term social rehabilitation after traumatic brain injury: the case of the head forward centre.

BACKGROUND: Social isolation and inactivity are highly problematic long-term consequences of Traumatic Brain Injury. They are rarely addressed by rehabilitation programmes, which focus on early phases of recovery. Day centres, or "drop-in" peer support groups, have emerged as an informal solution to social rehabilitation needs. However, there is a lack of knowledge regarding the therapeutic ingredients of these services. METHODS: Twelve survivors of Traumatic Brain Injury that attended a social rehabilitation service (Head Forward Centre, UK; HFC), were interviewed to explore the meanings attached to the service and its activities. Thematic analysis was used to describe emerging themes and build a model of social rehabilitation. RESULTS: Four therapeutic functions were attached to HFC: (a) HFC as a safe and predictable milieu; (b) HFC as a space where identity can be reconstructed; (c) HFC as a place where survivors can remain cognitive and socially active; (d) HFC as a network of continuous support. CONCLUSION: A model of long-term social rehabilitation should consider both psychological and practical/functional ingredients. Such a model can help informal rehabilitation services reflect upon their goals and activities, as well as articulate therapeutic actions along the rehabilitation path. The conceptualization of these four therapeutic ingredients in holistic rehabilitation models is described, and contrasted with its use in long-term social rehabilitation.IMPLICATIONS FOR REHABILITATIONSocial isolation and inactivity are important problems in the long-term rehabilitation of people with TBI. Both problems can be addressed by social rehabilitation services (day centres and peer support groups).Participation in social rehabilitation can promote a sense of normality and belongingness, which contribute to the long-term process of identity reconstruction.Social rehabilitation can help maintaining people with TBI cognitive and socially active, as well as developing a network of continuous support.