Examining resilience and burnout in parents of children with chronic disease.

AIM: The study determines the relationship between resilience and burnout in parents of children with chronic diseases and the influencing factors. METHOD: The study was conducted with a descriptive design. The study population consisted of the parents of children with any chronic illness who applied to the pediatric outpatient clinics of a state hospital located in a province in the northeast of Turkey. The study sample consisted of 207 parents who came to the hospital between October 2020 and June 2022, who met the criteria, and agreed to participate. "Descriptive Information Form," "Family Resilience Scale (FRS)," and "Burnout Inventory (BI)" were employed to collect data. The data were analyzed using the SPSS for Windows 22 package program. RESULTS: 37.2% of the parents participating in the study were in the age group of 30-39 years, 52.2% were female, 93.2% had no other children with chronic diseases, 20.3% were diagnosed with asthma, and the duration of the diagnosis was between 1 and 4 years in 44.4%. The participants scored 130.64 ± 25.73 points in the Family Resilience Scale and 36.16 ± 7.78 points in the overall Burnout Inventory. CONCLUSION: It was determined that parents' resilience was high and their burnout was moderate. Burnout decreases as resilience increases in parents of children with chronic diseases. PRACTICE IMPLICATIONS: To strengthen family resilience and reduce parental burnout, nurses should support and provide holistic care to parents with chronically ill children.

Framing the work: A coparenting model for guiding infant mental health engagement with families.

When working with families of infants and toddlers, intentionally looking beyond dyadic child-parent relationship functioning to conceptualize the child's socioemotional adaptation within their broader family collective can enhance the likelihood that clinical gains will be supported and sustained. However, there has been little expert guidance regarding how best to frame infant-family mental health therapeutic encounters for the adults responsible for the child's care and upbringing in a manner that elevates their mindfulness about and their resolve to strengthen the impact of their coparenting collective. This article describes a new collaborative initiative organized by family-oriented infant mental health professionals across several different countries, all of whom bring expansive expertise assessing and working with coparenting and triangular family dynamics. The Collaborative's aims are to identify a means for framing initial infant mental health encounters and intakes with families with the goal of assessing and raising family consciousness about the relevance of coparenting. Initial points of convergence and growing points identified by the Collaborative for subsequent field study are addressed.

Cuando se trabaja con familias de infantes y niños pequeñitos, el mirar intencionalmente más allá del funcionamiento de la relación diádica niño-progenitor para conceptualizar la adaptación socioemocional del niño dentro de la amplitud del colectivo familiar puede mejorar la posibilidad de que los logros clínicos sean apoyados y mantenidos. Sin embargo, ha habido poca guía de expertos acerca de cómo enmarcar mejor los encuentros terapéuticos infante-familia de salud mental para los adultos que son responsables del cuidado y crianza del niño de una manera que se eleve su estado consciente acerca de y su determinación de reforzar el impacto del colectivo en el proceso de la crianza compartida. Este artículo describe una nueva iniciativa colaborativa organizada por profesionales de la salud mental infantil orientados hacia la familia en varios diferentes países, todos los cuales aportan su conocimiento amplio evaluando y trabajando con las dinámicas familiares de crianza compartida y triangular. Las metas de este esfuerzo Colaborativo son identificar un medio para enmarcar los encuentros y la proporción de salud mental infantil con familias que se proponen evaluar y crear consciencia familiar acerca de la relevancia de la crianza compartida. Se abordan los puntos iniciales de convergencia y puntos de crecimiento identificados por el esfuerzo Colaborativo para subsecuentes estudios en el campo.

En travaillant avec des familles de nourrissons et de petits enfants, le fait de regarder délibérément au- delà du fonctionnement de la relation dyadique enfant-parent afin de conceptualisation l'adaptation socio émotionnelle de l'enfant, au sein de leur collectif familial plus large, peut accroître la probabilité que les gains cliniques seront bien soutenus et prolongés. Cependant il y a eu peu de directive experte concernant la meilleure manière d'encadrer les rencontres thérapeutiques nourrisson-famille de santé mentale pour les adultes responsables du soin de l'enfant et de son éducation d'une manière qui élève la pleine conscience et la détermination qu'il y a à renforcer l'impact de leur coparentage collectif. Cet article décrit une nouvelle initiative collaborative organisée par des professionnels de la santé mentale du nourrisson centrés sur la famille au travers de plus pays différents, tous étant de grands experts évaluant et travaillant avec des dynamiques de coparentage et de famille triangulaire. Les buts de cette collaboration sont d'identifier un moyen d'encadrer des rencontres de santé mentale initiales et les apports des familles avec le but d'évaluer et d'améliorer la conscience de la famille quant à la pertinence du coparentage. Les premiers points de convergence et de développement identifiés par la collaboration pour des études sur le terrain à venir sont discutés.

Family health partners in regional network structures (NEST): A non-randomized controlled trial among parents of chronically ill and disabled children.

BACKGROUND: The overarching project goal is to evaluate the effectiveness of a cross-sectoral and cross-service provider offering professional support for families with chronically ill and disabled children: so-called Family Health Partners (in German: 'Familien-Gesundheits-Partner' or FGP). This needs-oriented service, which is anchored in regional networks, aims to provide 'holistic' support for families with children in need of care. METHODS: We are carrying out a non-randomized controlled trial with four points of measurement (t0-t3 in 18 months), beginning in January 2022. Both intervention and control group include 102 families. Primary outcome measure is the quality of life, secondary outcomes are resilience factors and associated measures as well as the access to care. Multilevel regression models will be used to analyze the longitudinal data. DISCUSSION: The strength of this study is that it looks at the health and resilience of all family members involved by examining how a FGP can influence the entire family system with regard to increasing quality of life, resilience and self-efficacy. The network structures of FGP also open up better to previously unknown regional supply offers. There are, however, a number of limitations (e.g. type of outcomes, sample size). TRIAL REGISTRATION: This study was first registered on the German Clinical Trials Register before enrolment of participants started (ID: DRKS00027465, 4 January 2022). In order to promote its dissemination, it was also retrospectively registered on ClinicalTrials.gov (ID: NCT05418205, 14 June 2022).

Signatures of Neuropsychological Test Results in the Long Life Family Study: A Cluster Analysis.

BACKGROUND: Discovering patterns of cognitive domains and characterizing how these patterns associate with other risk factors and biomarkers can improve our understanding of the determinants of cognitive aging. OBJECTIVE: To discover patterns of cognitive domains using neuropsychological test results in Long Life Family Study (LLFS) and characterize how these patterns associate with aging markers. METHODS: 5,086 LLFS participants were administered neuropsychological tests at enrollment. We performed a cluster analysis of six baseline neuropsychological test scores and tested the association between the identified clusters and various clinical variables, biomarkers, and polygenic risk scores using generalized estimating equations and the Chi-square test. We used Cox regression to correlate the clusters with the hazard of various medical events. We investigated whether the cluster information could enhance the prediction of cognitive decline using Bayesian beta regression. RESULTS: We identified 12 clusters with different cognitive signatures that represent profiles of performance across multiple neuropsychological tests. These signatures significantly correlated with 26 variables including polygenic risk scores, physical and pulmonary functions, and blood biomarkers and were associated with the hazard of mortality (p < 0.01), cardiovascular disease (p = 0.03), dementia (p = 0.01), and skin cancer (p = 0.03). CONCLUSION: The identified cognitive signatures capture multiple domains simultaneously and provide a holistic vision of cognitive function, showing that different patterns of cognitive function can coexist in aging individuals. Such patterns can be used for clinical intervention and primary care.

The relationship between trait mindfulness and resilience: A meta-analysis.

Resilience is a positive psychological resource that promotes health. Trait mindfulness was found to be related to resilience. However, previous studies on this relationship have shown contradictory results. The current meta-analysis explored the relationship between trait mindfulness and resilience based on a three-level random-effects meta-analysis model. A significant and positive relationship between trait mindfulness and resilience (r = 0.385; p < 0.0001) was revealed by analyzing 197 effect sizes from 103 studies. Furthermore, the subsequent moderator analysis found that the facet of mindfulness (e.g., awareness, nonjudging) (F(6, 190) = 6.181; p < 0.001), measurement of mindfulness (e.g., the Mindful Attention Awareness Scale) (F(7, 191) = 4.758; p < 0.001), aspect of resilience (e.g., family resilience) (F(5, 191) = 3.455; p < 0.05), measurement of resilience (e.g., the Connor-Davidson Resilience Scale) (F(11, 185) = 2.256; p < 0.05), and age (F(1, 150) = 4.588; p < 0.05) acted as significant moderators. Overall, this study confirmed the positive relationship between trait mindfulness and resilience, suggesting that people with higher levels of trait mindfulness were more likely to have higher levels of resilience. The current findings provided insightful information for interventions targeted at improving resilience.

Finding family resilience in adversity: A grounded theory of families with children diagnosed with leukaemia.

AIMS AND OBJECTIVES: To develop a conceptual framework that explores the process of building family resilience among Chinese families with children diagnosed with leukaemia. BACKGROUND: The diagnosis of childhood leukaemia has a devastating effect on the family. Nonetheless, some families were able to positively respond to the crisis. The process through which Chinese families bounce back has received little attention. DESIGN: Grounded theory. METHODS: This study used purposive and theoretical sampling to select 16 parents who agreed to participate in semistructured interviews after children were diagnosed with leukaemia. Data collection and analysis occurred simultaneously. Data were analysed through a process of open, axial and selective coding. The COREQ checklist was followed for reporting. RESULTS: A core category of 'finding family resilience in adversity' was generated. The core category was underpinned by a transition process between two fluid stages: (a) Disrupting the family system, informed by subcategories of negative emotional disturbances and challenges of the diagnosis and treatment journey; (b) Cultivating resilience in families, informed by subcategories of increasing positive attitudes; establishing new family routines; activating good support systems; and practising open family communication. CONCLUSIONS: The transition process from the disruption of the family system to the cultivation of family resilience is perceived as a complex family dynamic in response to childhood leukaemia. Our findings can form the basis for further research about resilience-based family interventions that promote family well-being during the early stages of a childhood leukaemia diagnosis. RELEVANCE TO CLINICAL PRACTICE: It is necessary for healthcare professionals to provide essential support for families to face the challenges of diagnosis and treatment to facilitate the successful transition to family resilience. By understanding the dynamic process of developing family resilience, healthcare professionals are able to focus on these families to provide holistic care that satisfies the specific demands of family members.

Relatos da pandemia: ser mulher e mãe em tempos de covid-19 / Pandemic reports: being a woman and mother in covid-19 times / Relatos de la pandemia: ser mujer y madre en tiempos del covid-19

Partindo da pergunta "Como tem sido ser mulher e mãe em tempos de pandemia?", o presente estudo convidou mulheres que são mães, em redes sociais virtuais, a partilhar um relato de suas experiências com a readaptação parental em função do distanciamento social causado pela pandemia de covid-19. O objetivo foi refletir sobre a experiência de ser mulher e mãe em tempos de covid-19 e distanciamento social, apontando algumas ressonâncias do cenário pandêmico na subjetividade dessas mulheres. O estudo teve como base o referencial psicanalítico, tanto na construção da pesquisa e análise dos relatos quanto na sua discussão. A análise dos cerca de 340 relatos coletados, os quais variaram de uma breve frase a longos parágrafos, apontou para uma série de questionamentos, pontos de análise e reflexões. A pandemia, e o decorrente distanciamento social, parece ter colocado uma lente de aumento sobre as angústias das mulheres que são mães, evidenciando sentimentos e sofrimentos sempre presentes. Destacaram-se, nos relatos, a sobrecarga das mulheres com as tarefas de cuidado dos filhos e da casa, a culpa, a solidão, a exaustão, e o sentimento de que não havia espaço nesse contexto para "ser mulher", sendo isso entendido especialmente a questões estéticas e de vaidade.(AU)

Starting from the question "How does it feel to be a woman and a mother in pandemic times?", this study invited women who are mothers, in virtual social networks, to share their experiences regarding parental adaptations due to social distancing caused by the COVID-19 pandemic. The objective was to reflect on the experience of being a woman and a mother in the context of COVID-19 and of social distancing, pointing out some resonances of the pandemic scenario in the subjectivity of these women. The study was based on the psychoanalytical framework, both in the construction of the research and analysis of the reports and in their discussion. The analysis of about 340 collected reports, which ranged from a brief sentence to long paragraphs, pointed to a series of questions, analysis topics, and reflections. The pandemic, and the resulting social distancing, seems to have placed a magnifying glass over the anguish of women who are mothers, showing ever-present feelings and suffering. The reports highlighted women's overload with child and house care tasks, the guilt, loneliness, exhaustion, and the feeling that there was no space in this context to "be a woman," and it extends to aesthetic and vanity related questions especially.(AU)

A partir de la pregunta "¿cómo te sientes siendo mujer y madre en tiempos de pandemia?", este estudio invitó por las redes sociales a mujeres que son madres a compartir un relato de sus experiencias sobre la readaptación parental en función del distanciamiento social causado por la pandemia del covid-19. Su objetivo fue reflexionar sobre la experiencia de ser mujer y madre en tiempos del covid-19 y el distanciamiento social, señalando algunas resonancias del escenario pandémico en la subjetividad de estas mujeres. Este estudio se basó en el marco psicoanalítico, tanto en la construcción de la investigación y análisis de los informes como en su discusión. El análisis de los casi 340 relatos, que variaron de una pequeña frase a largos párrafos, generó en las investigadoras una serie de cuestionamientos y reflexiones. La pandemia y el consecuente distanciamiento social parece haber agrandado las angustias de las mujeres que son madres, evidenciando sentimientos y sufrimientos siempre presentes. En los relatos destacan la sobrecarga de las mujeres con las tareas de cuidado de los hijos y del hogar, la culpa, la soledad, el cansancio, así como el sentimiento de que no hay espacio em este contexto para "ser mujer", relacionado principalmente a cuestiones estéticas y de vanidad.(AU)

Intervenções psicológicas necessárias: a prática como residente no serviço de medicina fetal / Necessary psychological interventions: the practice as a resident in the fetal medicine service / Intervenciones psicológicas necesarias: la práctica como residente en el servicio de medicina fetal

Com os avanços tecnológicos e o aprimoramento da prática médica via ultrassonografia, já é possível detectar possíveis problemas no feto desde a gestação. O objetivo deste estudo foi analisar a prática do psicólogo no contexto de gestações que envolvem riscos fetais. Trata-se de um estudo qualitativo sob formato de relato de experiência como psicólogo residente no Serviço de Medicina Fetal da Maternidade Escola da Universidade Federal do Rio de Janeiro (UFRJ). Os registros, feitos por observação participante e diário de campo, foram analisados em dois eixos temáticos: 1) intervenções psicológicas no trabalho em equipe em consulta de pré-natal, exame de ultrassonografia e procedimento de amniocentese; e 2) intervenções psicológicas em casos de bebês incompatíveis com a vida. Os resultados indicaram que o psicólogo nesse serviço é essencial para atuar de forma multiprofissional na assistência pré-natal para gravidezes de alto risco fetal. Ademais, a preceptoria do residente é relevante para sua formação e treinamento para atuação profissional no campo da psicologia perinatal.(AU)

Face to the technological advances and the improvement of medical practice via ultrasound, it is already possible to detect possible problems in the fetus since pregnancy. The objective of this study was to analyze the psychologist's practice in the context of pregnancies which involve fetal risks. It is a qualitative study based on an experience report as a psychologist trainee at the Fetal Medicine Service of the Maternity School of UFRJ. The records, based on the participant observation and field diary, were analyzed in two thematic axes: 1) psychological interventions in the teamwork in the prenatal attendance, ultrasound examination and amniocentesis procedure; and 2) psychological interventions in cases of babies incompatible to the life. The results indicated that the psychologist in this service is essential to work in a multidisciplinary way at the prenatal care for high fetal risk pregnancies. Furthermore, the resident's preceptorship is relevant to their education and training for professional performance in the field of Perinatal Psychology.(AU)

Con los avances tecnológicos y la mejora de la práctica médica a través de la ecografía, ya se puede detectar posibles problemas en el feto desde el embarazo. El objetivo de este estudio fue analizar la práctica del psicólogo en el contexto de embarazos de riesgos fetal. Es un estudio cualitativo basado en un relato de experiencia como residente de psicología en el Servicio de Medicina Fetal de la Escuela de Maternidad de la Universidade Federal do Rio de Janeiro (UFRJ). Los registros, realizados en la observación participante y el diario de campo, se analizaron en dos ejes temáticos: 1) intervenciones psicológicas en el trabajo en equipo, en la consulta prenatal, ecografía y los procedimientos de amniocentesis; y 2) intervenciones psicológicas en casos de bebés incompatibles con la vida. Los resultados señalaron como fundamental la presencia del psicólogo en este servicio trabajando de forma multidisciplinar en la atención prenatal en el contexto de embarazos de alto riesgo fetal. Además, la tutela del residente es relevante para su educación y formación para el desempeño profesional en el campo de la Psicología Perinatal.(AU)

Study protocol for a real-world evaluation of an integrated child and family health hub for migrant and refugee women.

INTRODUCTION: Continuity of child and family healthcare is vital for optimal child health and development for developmentally vulnerable children. Migrant and refugee communities are often at-risk of poor health outcomes, facing barriers to health service attendance including cultural, language, limited health literacy, discrimination and unmet psychosocial needs. 'Integrated health-social care hubs' are physical hubs where health and social services are co-located, with shared referral pathways and care navigation. AIM: Our study will evaluate the impact, implementation and cost-benefit of the First 2000 Days Care Connect (FDCC) integrated hub model for pregnant migrant and refugee women and their infants. MATERIALS AND METHODS: This study has three components. Component 1 is a non-randomised controlled trial to compare the FDCC model of care with usual care. This trial will allocate eligible women to intervention and control groups based on their proximity to the Hub sites. Outcome measures include: the proportion of children attending child and family health (CFH) nurse services and completing their CFH checks to 12 months of age; improved surveillance of growth and development in children up to 12 months, post partum; improved breastfeeding rates; reduced emergency department presentations; and improved maternal well-being. These will be measured using linked medical record data and surveys. Component 2 will involve a mixed-method implementation evaluation to clarify how and why FDCC was implemented within the sites to inform future roll-out. Component 3 is a within-trial economic evaluation from a healthcare perspective to assess the cost-effectiveness of the Hubs relative to usual care and the implementation costs if Hubs were scaled and replicated. ETHICS AND DISSEMINATION: Ethical approval was granted by the South Eastern Sydney Local Health District Human Research Ethics Committee in July 2021 (Project ID: 020/ETH03295). Results will be submitted for publication in peer-reviewed journals and presented at relevant conferences. TRIAL REGISTRATION NUMBER: ACTRN12621001088831.

Child health promotion from the perspective of family health strategy nurses.

OBJECTIVE: To apprehend nurses' conceptions and experiences about actions of child health promotion in family health units. METHODS: Exploratory study, with thematic content analysis of statements, obtained through semi-structured interviews with 11 nurses from a municipality in São Paulo. RESULTS: Three thematic categories emerged on child health promotion actions: they must be contextualized, provide for comprehensive care, and aim at self-care; they are carried out through health guidelines shared by professionals with children and their families, inside and outside the health units; present challenges to be overcome by health services, such as lack of involvement and appreciation of the family regarding child follow-up. CONCLUSIONS: The concepts apprehended approached the premises of official documents on health promotion; however, practical experiences included difficulties related to the life contexts of children, their families and health services, compromising the achievement of comprehensive care.

Cuidados de enfermagem na atenção primária à pessoa com úlcera varicosa: relato de caso / Nursing care in primary care for people with varicose ulcer: case report / Atención de enfermería en atención primaria a personas con úlcera variciosa: reporte de caso

Objetivo: Descrever os cuidados de enfermagem aplicados a um paciente com lesão venosa em membros inferiores na Atenção Primária à Saúde. Métodos:Pesquisa exploratória-descritiva, do tipo estudo de caso, que apresenta o acompanhamentode um paciente, sexo masculino, atendido em uma Unidade Básica de Saúde organizada no modelo de Estratégia Saúde da Família, pertencente a um município de Minas Gerais, no período de junho a dezembro de 2020. Resultados:Considerando as condições de saúdeapresentadas pelo paciente na primeira consulta de enfermagem, foi traçado um plano de cuidado assistencial sistematizado, visando atender as necessidades de saúde reportadas, com foco nas mudanças de estilo de vida, protagonismo e autonomia do paciente, que positivamente ao longo de toda assistência, permitiu reduzir as complicações vasculares e consequentemente evoluir para a cicatrização das lesões ao longo do acompanhamento. Considerações finais:A abordagem do paciente com úlcera varicosa na Atenção Primária à Saúde, deve ser para além da realização do curativo. A cicatrização das lesões e a prevenção de recidivas está relacionada a oferta de uma assistência de enfermagem integral e holística, com coordenação do cuidado e participação de toda a equipe multidisciplinar.

Objective: To describe the nursing care applied to a patient with venous injury in the lower limbs in PrimaryHealth Care. Methods:Exploratory-descriptive research, of the case study type, which presents the follow-up of a male patient, assisted in a Basic Health Unit organized in the Family Health Strategy model, belonging to a municipality of Minas Gerais, from June to December 2020. Results:Considering the health conditions presented by the patient in the first nursing consultation, a plan was drawn up of systematized care, aiming to meet the reported health needs, with a focus on changes in lifestyle, protagonism and patient autonomy, which positively throughout the entire care, allowed to reduce vascular complications and consequently evolve to the healing of lesions over time.throughout the follow-up. Final considerations: The approach of the patient with varicose ulcer in Primary Health Care must go beyond the dressing. Wound healing and relapse prevention are related to the provision of comprehensive and holistic nursing care, with care coordination and participation of the entire multidisciplinary team.

Objetivo: Describir los cuidados de enfermería aplicados a un paciente con lesión venosa en miembros inferiores en la Atención Primaria de Salud. Métodos:Investigación exploratoria-descriptiva, del tipo estudio de caso, que presenta el seguimiento de un paciente del sexo masculino, atendido en una Unidad Básica de Salud organizada en el modelo Estrategia de Salud de la Familia, perteneciente a un municipio de Minas Gerais, en el período de Junio a diciembre de 2020. Resultados:Considerando las condiciones de salud presentadas por el paciente en la primera consulta de enfermería, se elaboró un plan de cuidados sistematizado, con el objetivo de atender las necesidades de salud relatadas, con foco en cambios de estilo de vida, protagonismo y autonomía del paciente, que positivamente a lo largo toda la asistencia, permitió la reducción de las complicaciones vasculares y consecuentemente avanzar a la cicatrización de las lesiones durante el seguimiento. Consideraciones finales:El abordaje del paciente con úlcera varicosa en Atención Primaria de Salud debe ir más allá del apósito. La cicatrización de heridas y la prevención de recaídas están relacionadas con la prestación de cuidados de enfermería integrales y holísticos, con coordinación asistencial y participación de todo el equipo multidisciplinario.

Evaluation of dietary folate in children assisted in Family Health Strategy units: A cross-sectional study.

BACKGROUND AND AIMS: Folate is an indispensable nutrient in human food and its deficiency may affect growth and development, and influence the risk of infant morbidity and mortality. The objective was to analyze the consumption of folic acid and its association with socioeconomic, environmental, maternal and anthropometric data of children aged 12-14 months assisted in Family Health Strategy units in a Brazilian capital. METHODS: This is a cross-sectional study included in a pragmatic clinical trial conducted with 101 children. Food intake was analyzed by means of a 24-h recall, a simple and multiple linear regression analysis was performed in a hierarchical model, and the outcome variable Dietary Folate Equivalents (DFE) was calculated. A hierarchical model was used at three levels (distal: sociodemographic; medial processes: maternal characteristics; proximal: individual processes of the child) in the adjustment of the model, in which the variables presenting p < 0.20 in the crude analysis were inserted in the adjusted analysis, from distal to proximal block, in the increasing order of magnitude of association with the outcome. RESULTS: Regarding folic acid consumption, 10.9% (n = 11) of children presented deficiency according to the calculated DFE considering the evaluation by Estimated Average Requirement (EAR), and 42.6% (n = 43) had excessive intake according to the calculated DFE considering the evaluation by the Tolerable Upper Intake Levels (UL). After multiple linear regression analysis flour intake was associated with an increase in DFE intake by 2.05 µg (95% CI: 1.72-2.45) and the presence of at least one more child under 5 years of age with an increase in DFE intake by 0.77 µg (95% CI: 0.67-0.89), while receiving the Bolsa Família Program is associated with an increase in DFE intake by 1.39 µg (95% CI: 1.07-1.65) in the model adjusted for birthweight and maternal age, regardless of the child's age. CONCLUSION: Data from this study showed low prevalence of deficient consumption and high percentage of excessive consumption of folic acid in the children. In addition, receiving the Bolsa Família Program, consuming flour and the number of children under 5 years of age were positively associated with the calculated DFE.

Challenges in Implementing Community-Based Healthcare Teams in a Low-Income Country Context: Lessons From Ethiopia's Family Health Teams.

BACKGROUND: Addressing chronic diseases and intra-urban health disparities in low- and middle-income countries (LMICs) requires new health service models. Team-based healthcare models can improve management of chronic diseases/complex conditions. There is interest in integrating community health workers (CHWs) into these teams, given their effectiveness in reaching underserved populations. However healthcare team models are difficult to effectively implement, and there is little experience with team-based models in LMICs and with CHW-integrated models more generally. Our study aims to understand the determinants related to the poor adoption of Ethiopia's family health teams (FHTs); and, raise considerations for initiating CHW-integrated healthcare team models in LMIC cities. METHODS: Using the Consolidated Framework for Implementation Research (CFIR), we examine organizational-level factors related to implementation climate and readiness (work processes/incentives/resources/leadership) and system-level factors (policy guidelines/governance/financing) that affected adoption of FHTs in two Ethiopian cities. Using semi-structured interviews/focus groups, we sought implementation perspectives from 33 FHT members and 18 administrators. We used framework analysis to deductively code data to CFIR domains. RESULTS: Factors associated with implementation climate and readiness negatively impacted FHT adoption. Failure to tap into financial, political, and performance motivations of key stakeholders/FHT members contributed to low willingness to participate, while resource constraints restricted capacity to implement. Workload issues combined with no financial incentives/perceived benefit contributed to poor adoption among clinical professionals. Meanwhile, staffing constraints and unavailability of medicines/supplies/transport contributed to poor implementation readiness, further decreasing willingness among clinical professionals/managers to prioritize non-clinic based activities. The federally-driven program failed to provide budgetary incentives or tap into political motivations of municipal/health centre administrators. CONCLUSION: Lessons from Ethiopia's challenges in implementing its FHT program suggest that LMICs interested in adopting CHW-integrated healthcare team models should closely consider health system readiness (budgets, staffing, equipment/medicines) as well as incentivization strategies (financial, professional, political) to drive organizational change.

Saúde bucal na gestação: percepções e práticas da gestante na Estratégia Saúde da Família / Oral health in pregnancy: perceptions and practices of pregnant women in the Family Health Strategy / Salud bucal en el embarazo: percepciones y prácticas de la gestante en la Estrategia Salud de la Familia

A gestação é um período que pode predispor ou agravar algumas alterações bucais, uma vez que é caracterizado por mudanças hormonais, fisiológicas e psicológicas complexas. Apesar disso, o atendimento odontológico pré-natal ainda é negligenciado. Este estudo descritivo, transversal e de natureza quantitativa teve por objetivo analisar percepções e práticas das gestantes que utilizam os serviços de pré-natal de uma Unidade de Saúde da Família (USF) de Itabuna (BA) acerca da saúde bucal durante a gestação, bem como sobre o atendimento odontológico no decorrer do período gestacional. Em 2019, entrevistadores previamente treinados aplicaram questionário único a todas as gestantes residentes na área de abrangência da USF. Utilizou-se o programa estatístico IBM SPSS® Statistics versão 21.0 na análise descritiva. Para verificar a normalidade dos dados foi realizado o teste Kolmogorov-Smirnov, e para o teste de correlação dos dados não-paramétricos foi utilizado o coeficiente de correlação de postos de Spearman, adotando valor de p < 0,05. Dentre as 51 gestantes incluídas neste estudo, 92,2% nunca participaram de atividades educativas sobre saúde bucal na gestação, 76,5% não fizeram nenhum tipo de acompanhamento odontológico pré-natal, 70,6% consideraram que a gestação provoca problemas periodontais e 64,7% afirmaram que a gestação é responsável pelo aparecimento de cáries. Além disso, 94,1% das participantes afirmaram que gostariam de receber mais informações sobre como cuidar melhor da saúde bucal e 64,7% responderam que não existem restrições para a realização dos atendimentos odontológicos durante a gestação. Houve correlação estatisticamente significante entre as condições de saúde e a renda (r_s = 0,291 e p = 0,038), e entre escolaridade e renda (r_s = 0,434 e p = 0,01). Ficou evidente a necessidade de uma melhor inclusão da odontologia no cuidado pré-natal da Estratégia de Saúde da Família (ESF), uma vez que o reconhecimento da importância da saúde bucal na gestação, tanto pelos profissionais da equipe quanto pelas mulheres grávidas, é fundamental para um cuidado integral nesse período singular da vida da mulher.

Characterized by complex hormonal, physiological, and psychological changes, pregnancy can predispose or worsen some oral alterations; however, prenatal dental care is still neglected. This descriptive, cross-sectional, quantitative study analyzed the perceptions and practices regarding oral health and dental care during pregnancy of pregnant women who procured prenatal services at a Family Health Unit (FHU) in Itabuna, Bahia, Brazil. In 2019, previously trained interviewers applied a single questionnaire to all pregnant women living in the area covered by the FHU. Descriptive analysis was performed via IBM SPSS® Statistics version 21.0 to verify data normality (Kolmogorov-Smirnov test) and for the correlation test of non-parametric data (Spearman's rank correlation coefficient), adopting p < 0.05. Of the 51 pregnant women interviewed, 92.2% had never participated in educational activities for pregnancy oral health, 76.5% did not attend prenatal dental care, 70.6% thought that pregnancy causes periodontal diseases, and 64.7% stated that pregnancy is responsible for the appearance of dental caries. Moreover, 94.1% of the participants showed interest in receiving more information on how to take better care of their oral health, and 64.7% stated no restrictions for dental care during pregnancy. Correlation between health conditions and income (r_s = 0.291 and p = 0.038) and between education and income (r_s = 0.434 and p = 0.01) were statistically significant. Dentistry must be better included in prenatal care within the Health Family Strategy (HFS), since recognition by both professionals and pregnant women of the importance of oral health during pregnancy is fundamental for comprehensive care in this unique period.

El embarazo es un período que puede predisponer o empeorar algunas alteraciones bucodentales, además de caracterizarse por complejos cambios hormonales, fisiológicos y psicológicos. A pesar de ello, la atención odontológica prenatal se sigue descuidada. Este estudio descriptivo, transversal y de tipo cuantitativo tiene como objetivo analizar las percepciones y las prácticas de las embarazadas que utilizan los servicios prenatales de una Unidad de Salud Familiar (USF) de Itabuna, en Bahía (Brasil), acerca de la salud bucal durante el embarazo, así como sobre la atención odontológica en ese período. En 2019, entrevistadores previamente capacitados aplicaron un único cuestionario a todas las mujeres embarazadas que residen en el área cubierta por la USF. Se utilizó el programa estadístico IBM SPSS® Statistics, versión 21.0, para realizar el análisis descriptivo. Para verificar la normalidad de los datos se utilizó la prueba de Kolmogorov-Smirnov, y para la prueba de correlación de los datos no paramétricos se aplicó el coeficiente de correlación de rangos de Spearman, adoptando un valor de p < 0,05. De las 51 embarazadas incluidas en este estudio, el 92,2% nunca participó en actividades educativas sobre salud bucal para embarazadas, el 76,5% no se sometió a ningún tipo de atención odontológica prenatal, el 70,6% consideró que el embarazo provoca problemas periodontales y el 64,7% afirmó que el embarazo es responsable de la aparición de caries. Además, el 94,1% de las participantes afirmó que le gustaría recibir más información sobre cómo cuidar mejor su salud bucodental, y el 64,7% respondió que no hay restricciones para la atención dental durante el embarazo. Hubo una correlación estadísticamente significativa entre las condiciones de salud y los ingresos (r_s = 0,291 y p = 0,038) y entre la educación y los ingresos (r_s = 0,434 y p = 0,01). Se hizo evidente la necesidad de una mejor inclusión de la odontología en la atención prenatal de la Estrategia de Salud Familiar (ESF), ya que el reconocimiento de la importancia de la salud oral durante el embarazo, tanto por los profesionales del equipo como por las mujeres embarazadas, es esencial para la atención integral en este período único de la vida de la mujer.

Relato da implantação do matriciamento em um município cearense: dos desafios às conquistas / Report of the matrix implementation in a municipality of Ceara: from challenges to achievements / Informe del desarrollo del apoyo matricial en una ciudad de Ceará: de los desafíos a los logros

O apoio matricial constitui uma das prerrogativas básicas para o acompanhamento longitudinal, holístico e eficaz de casos complexos das comunidades, sendo essa a base de sustentação do Núcleo Ampliado de Saúde da Família e Atenção Básica (Nasf-AB), hoje chamado de equipe multiprofissional em saúde. O objetivo deste artigo foi descrever como ocorreu o processo de implantação das reuniões de matriciamento em um Nasf municipal do interior cearense, por meio de um relato de experiência qualitativo, transversal, narrativo-descritivo e com base na vivência de instituição da reunião de matriciamento. Foram utilizados registros escritos das atas de reunião e os eventos memoráveis. O processo de instituição das reuniões de matriciamento se deu em três etapas: análise territorial, na qual foram levantados os problemas da comunidade, bem como identificadas as redes disponíveis no município; reunião de esclarecimento sobre a ideia do apoio matricial, benefícios e maneiras de sua implantação na rotina profissional (nessa etapa, além da conscientização dos profissionais, buscou-se o apoio da gestão); e pactuação acerca das frequências em que os encontros se realizariam, tomando por base reuniões de maneira sequencial e seleção dos casos que seriam discutidos. Foi concluído que, para que se realizem de maneira eficaz, é necessário que as reuniões de matriciamento tenham objetivos esclarecidos diante dos profissionais que participarão delas, uma vez que muitos processos de trabalho não têm a ótica do apoio matricial. Porém, deve-se compreender que surgirão dificuldades na manutenção de tais encontros e que o sucesso ou fracasso das reuniões será responsabilidade de todos os participantes.

Matrix support is one of the basic prerogatives for the longitudinal, holistic, and effective follow-up of complex cases in the communities, which is the basis of support of the Expanded Nucleus of Family Health and Primary Care (NASF-AB), now called multiprofessional health team. This article aimed to describe how the process of implementing matrix support meetings took place in a municipal NASF from the interior of the state of Ceará, by a qualitative, cross-sectional, narrative-descriptive experience report and based on the experience from the institution of the matrix support meeting. Written records of meeting minutes and memorable events were used. The process of establishing the matrix meetings took place in three stages: territorial analysis, in which the problems of the community were raised and the networks available in the municipality were identified; clarification meeting on the idea of matrix support, benefits and ways of implementing it in the professional routine (at this stage, in addition to raising awareness among professionals, management support was sought); and agreement on the frequencies at which the meetings would take place, based on sequential meetings and selection of the cases that would be discussed. In conclusion, for them to be carried out effectively, the matrix support meetings need to have clear objectives in front of the professionals who will participate in them, since many work processes do not have the perspective of matrix support. However, it must be understood that difficulties will arise in maintaining such meetings and that the success or failure of the meetings will be the responsibility of all participants.

El apoyo matricial es una de las atribuciones básicas para el seguimiento longitudinal, holístico y efectivo de casos complejos en las comunidades, que es la base de apoyo del Núcleo Ampliado de Salud de la Familia y Atención Primaria (Nasf-AB), hoy denominado equipo multiprofesional en salud. El objetivo de este artículo fue describir cómo ocurrió el proceso de desarrollo de las reuniones de apoyo matricial en un municipio de Ceará (Brasil) mediante relato de experiencia cualitativo, transversal, narrativo-descriptivo y basado en la experiencia de institución del apoyo matricial y reunión. Se utilizaron registros escritos de las actas de reuniones y eventos memorables. El proceso de establecimiento de las reuniones matrices se llevó a cabo en tres etapas: análisis territorial, en el que se plantearon los problemas de la comunidad, así como se identificaron las redes disponibles en el municipio; la reunión de aclaración sobre la idea de apoyo matricial, beneficios y formas de implementarlo en el cotidiano profesional (en esta etapa, además de sensibilizar a los profesionales, se buscó tener el apoyo de la gestión); y acuerdo sobre las frecuencias en que se llevarían a cabo las reuniones, tomando como referencia las reuniones secuenciales y la selección de los casos que se discutirían. Se concluyó que la realización efectiva de las reuniones de apoyo matricial deberán comprender objetivos claros frente a los profesionales que participarán en ellas, ya que muchos procesos de trabajo no tienen la perspectiva del apoyo matricial. Sin embargo, debe entenderse que surgirán dificultades para mantener tales reuniones y que el éxito o el fracaso de las reuniones será responsabilidad de todos los participantes.

Building a community-based participatory approach to child, youth, and family health: Learnings from organizational engagement in the Peel Region of Ontario.

BACKGROUND AND OBJECTIVES: As hospital-based pediatric clinicians and researchers, we conducted engagement with representatives from public, private, and nonprofit organizations in the Peel Region of Ontario. Objectives were to build relationships and inform research, education, innovation, and programming to improve the health of local children, youth, and families (CYF). METHOD: Relevant public, private, and nonprofit organizations were identified through an extensive environmental scan. Semistructured interviews and focus groups were conducted with front-line, managerial, and executive representatives. Analysis consisted of thematic analysis and quantitative content analysis. All participants were invited to a 1-day community networking event to discuss the engagement findings and brainstorm next steps. RESULTS: Final sample was n = 155 individuals from n = 61 organizations. The community networking event included n = 45 participants from n = 41 organizations. Participants identified the top three health issues facing families as: (a) mental health and wellbeing (63%); (b) socioeconomic insecurity (52%); (c) lack of physical activity (43%). Major themes included: holistic health and wellness; equity and sociocultural dimensions of health; cross-sector/organizational collaboration and integration; need for inclusive, action-oriented, and participatory approaches. CONCLUSIONS: Insights from these engagement activities led to the development of a community-based participatory research (CBPR) approach to CYF health in Peel. In this article we posit CBPR and a population health approach can come together in research and care to prioritize equity, collaboration, and active participation in a community-wide approach to CYF health. (PsycInfo Database Record (c) 2021 APA, all rights reserved).

Apoio Matricial e Saúde Mental: relato das potencialidades e desafios no fazer do NASF por uma psicóloga em uma Residência Multiprofissional em Saúde da Família / Apoyo Matriarcal y Salud Mental: relato de las potencialidades y desafíos en hacer el NASF por una psicóloga en una Residencia Multiprofesional en Salud de la Familia / Matrix Support and Mental Health: report of the potentials and challenges in the making of the NASF by a psychologist in a Multiprofessional Residence in Family Health

| INTRODUÇÃO: Uma das principais ferramentas do NASFAB é o Apoio Matricial (AM), sendo uma estratégia de organização do trabalho, buscando a integração de equipes de referência e equipe especializada. Por ser uma estratégia essencial para o desenvolvimento de um cuidado integral é que temáticas como a Saúde Mental têm sido incluídas nas ações desenvolvidas na AB. Nesse sentido, o apoio matricial em saúde mental deve propiciar que os profissionais de referência possam qualificar a produção de cuidado em SM. OBJETIVO: Refletir sobre as potencialidades e desafios vivenciados na prática de apoio matricial em saúde mental na AB a partir da experiência de uma psicóloga do NASF em uma Residência Multiprofissional em Saúde. METODOLOGIA: A prática descrita neste artigo refere-se a um estudo qualitativo, do tipo relato de experiência, onde buscou-se refletir sobre as atividades desenvolvidas ao longo do período de dois anos em uma Residência Multiprofissional em Saúde. Foram utilizados como fonte de dados escritos em portfólios e diários de campo da autora. RESULTADOS: Foram desenvolvidas ações que propiciaram a aproximação entre a equipe com as discussões relacionadas a Luta Antimanicomial, consultas compartilhadas e construção de PTS. Ao longo do processo de trabalho foi interessante perceber a apropriação dos profissionais na equipe de referência na condução das ações em saúde mental, demonstrando o papel essencial do AM para efetivar a clínica ampliada. CONCLUSÃO: O percurso traçado neste relato permite refletir sobre a importância de se estender e consolidar o cuidado em saúde mental na AB, promovendo mudanças importantes na lógica de atenção.

INTRODUCCIÓN: Una de las principales herramientas del NASF-AB es el Apoyo Matriarcal (AM), siendo una estrategia de organización del trabajo, buscando la integración de equipos de referencia y equipo especializado. Por ser una estrategia esencial para el desarrollo de un cuidado integral es que temáticas como la Salud Mental han sigo añadidas en las acciones desarrolladas en la AB. En ese sentido, el apoyo matriarcal en salud mental debe propiciar que los profesionales de referencia puedan calificar la producción de cuidado en SM. OBJETIVO: Reflejar sobre las potencialidades y desafíos vividos en la práctica de apoyo matriarcal en salud mental en la AB a partir de la experiencia de una psicóloga del NASF en una Residencia Multiprofesional en salud. METODOLOGÍA: La práctica descripta en este artículo se refiere a un estudio cualitativo, del tipo relato de experiencia, donde se buscó reflejar acerca de las actividades desarrolladas a lo largo del periodo de dos años en una Residencia Multiprofesional en Salud. Fueron utilizados como fuente de datos, escritos en portafolios y diarios de campo de la autora. RESULTADOS: Fueron desarrolladas acciones que proporcionaron el acercamiento entre el equipo con las discusiones relacionadas a Lucha Antimanicomial, consultas compartidas y construcción de PTS. A lo largo del proceso de trabajo fue interesante percibir la apropiación de los profesionales en el equipo de referencia en el manejo de las acciones en salud mental demostrado el rol esencial del AM para efectivar la clínica ampliada. CONCLUSIÓN: El camino delimitado en este relato permite reflejar sobre la importancia de extenderse y consolidar el cuidado en salud mental en la AB, promoviendo cambios importantes en la lógica de atención.

Situational diagnosis of professionals of family health units on phytotherapy / Diagnóstico situacional dos profissionais de unidades de saúde da família sobre a fitoterapia

Abstract The incorporation of the use of phytotherapy in the primary health care is an important gain for the Unified Health System, besides reducing the cost in the treatment of the patient, rescues the popular knowledge and promotes the rational use of the medicinal plants. To determine the situational diagnostic profile of professionals of family health units on phytotherapy. A quantitative observational study was carried out, in which forms were applied to the team of the family health units of the municipality of Marechal Deodoro da Fonseca/Alagoas. Only 23% of the interviewed professionals reported having had contact with scientific information on phytotherapy during professional training. All of them approve the implantation of the official practice of phytotherapy and routinely prescribe phytotherapics and medicinal plants, but they do not know the possible risks of drug interaction with the use of medicinal plants. Health professionals Health professionals support the official practice of phytotherapy in public health and show interest in participating in courses / training on the subject to better serve the population.

Resumo A incorporação do uso da fitoterapia na atenção primária à saúde é um ganho importante para o Sistema Único de Saúde, além da redução do custo no tratamento do paciente, resgata o conhecimento popular e promove o uso racional das plantas medicinas. Determinar o perfil diagnóstico situacional dos profissionais de unidades de saúde da família sobre fitoterapia. Foi realizado um estudo observacional quantitativo, no qual foram aplicados formulários para a equipe das unidades de saúde da família do município de Marechal Deodoro da Fonseca/Alagoas. Apenas 23% dos profissionais entrevistados afirmaram ter tido contato com informações científicas sobre fitoterapia durante a formação profissional. Todos aprovam a implantação da prática oficial da fitoterapia e prescrevem rotineiramente fitoterápicos e plantas medicinais, entretanto desconhecem os possíveis riscos de interação medicamentosa com o uso das plantas medicinas. Os profissionais de saúde apoiam a prática oficial da fitoterapia na saúde pública e demonstram interesse em participar de cursos/treinamentos sobre a temática para melhor atender a população.

Impact of the Brazilian Family Health Strategy on child oral health-related quality of life: a cohort study.

Most of the Brazilian population is covered by the Family Health Strategy (FHS), however no longitudinal study has assessed the impact of the FHS on child oral health-related quality of life (OHRQoL). The objective of the study was to evaluate the longitudinal impact of the FHS on the OHRQoL. This study followed up 459 children aged 2 to 5 years for 2 years. OHRQoL was assessed by the Brazilian version of the Early Childhood Oral Health Impact Scale (ECOHIS) at baseline (April to November 2016) and follow-up (April to December 2018). Children's parents answered a questionnaire regarding sociodemographic information, FHS service, and dental service. Participants were clinically examined for dental caries. Multilevel Poisson regression was used to assess the associations between FHS variables at baseline and overall/domain-specific of the ECOHIS scores over time. A total of 365 children were reassessed for OHRQoL (follow-up rate: 79.5%). The absence of FHS coverage from the child's first year of age was associated with higher scores in the family function domain [rate ratio (RR) = 2.42; 95% confidence interval (CI) 1.28-4.58)]. Home visits by the FHS team members were associated with higher psychological domain scores (RR = 1.60; 95%CI 1.01-2.57). Children not covered by the FHS since the first year of age reported worse OHRQoL over time. This fact highlights the importance of an integrated health approach to promote children's health.