RESUMEN
Objective: Native Hawaiian children have the highest prevalence of asthma among all ethnicities in Hawai'i. Malama Part 2 describes continuing research, exploring contemporary native Hawaiian parents' perspective, and experience of caring for their children with asthma in the context of uncertainty while living on the islands of Hawai'i, Kaua'i, Maui, Moloka'i and Lana'i. Design: Descriptive qualitative approach by means of directed content analysis using focus groups was applied to this study. Eight open-ended questions elicited asthma history, asthma management, and how the Hawaiian culture affects parents' health practices. Directed content analysis applied Mishel's Uncertainty in Illness Theory (UIT) to guide data collection, organization, and analysis. Sample: Thirty-three native Hawaiian parents with a child with asthma met in 9 separate focus groups during 2012-2015 on the islands of Hawai'i, Kaua'i, Maui, Moloka'i, and Lana'i. Results: The study's findings were congruent with the first Malama study results of focus groups on O'ahu. Contextual influences including indigenous worldview, cultural values, history, and assimilation and acculturation factors affected native Hawaiian parents' perceptions and experiences with conventional asthma care. Moreover, Hawaiian parents living on islands outside of metropolitan O'ahu reported geographic barriers that contributed to their uncertainty. Conclusion: Political action is required for comprehensive medical care, health education, and nursing services to be delivered to families living on all islands. Integrating Hawaiian cultural values, involving 'ohana, and applying complementary alternative therapies as well as standard asthma management will strongly support native Hawaiian parents caring for their children with asthma.
RESUMEN
Acute rheumatic fever is common among Samoans in Hawaii. During 2 visits to evaluate the magnitude of rheumatic fever problem among Samoans in American Samoa, we identified 148 patients with rheumatic fever on penicillin prophylaxis. Retrospective chart reviews were done showing possible delays in diagnosis of acute rheumatic fever.
Asunto(s)
Fiebre Reumática/tratamiento farmacológico , Fiebre Reumática/epidemiología , Infecciones Estreptocócicas/epidemiología , Streptococcus pyogenes , Enfermedad Aguda , Adolescente , Samoa Americana/epidemiología , Antibacterianos/administración & dosificación , Antibacterianos/uso terapéutico , Niño , Preescolar , Femenino , Humanos , Masculino , Penicilinas/administración & dosificación , Penicilinas/uso terapéutico , Fiebre Reumática/diagnóstico , Fiebre Reumática/microbiología , Fiebre Reumática/fisiopatología , Infecciones Estreptocócicas/diagnóstico , Infecciones Estreptocócicas/tratamiento farmacológico , Infecciones Estreptocócicas/microbiología , Streptococcus pyogenes/efectos de los fármacos , Streptococcus pyogenes/aislamiento & purificaciónRESUMEN
INTRODUCTION: A systematic review was conducted to review the effectiveness of workplace-based return-to-work (RTW) interventions. METHOD: Seven databases were searched, in English and French, between January 1990 and December 2003 for peer-reviewed studies of RTW interventions provided at the workplace to workers with work disability associated with musculoskeletal or other pain-related conditions. Methodological quality appraisal and data extraction were conducted by pairs of reviewers. RESULTS: Of a total of 4124 papers identified by the search, 10 studies were of sufficient quality to be included in the review. There was strong evidence that work disability duration is significantly reduced by work accommodation offers and contact between healthcare provider and workplace; and moderate evidence that it is reduced by interventions which include early contact with worker by workplace, ergonomic work site visits, and presence of a RTW coordinator. For these five intervention components, there was moderate evidence that they reduce costs associated with work disability duration. Evidence for sustainability of these effects was insufficient or limited. Evidence regarding the impact of supernumerary replacements was insufficient. Evidence levels regarding the impact of the intervention components on quality-of-life was insufficient or mixed. CONCLUSIONS: Our systematic review provides the evidence base supporting that workplace-based RTW interventions can reduce work disability duration and associated costs, however the evidence regarding their impact on quality-of-life outcomes was much weaker.
Asunto(s)
Enfermedades Profesionales/rehabilitación , Servicios de Salud del Trabajador/organización & administración , Evaluación de Resultado en la Atención de Salud , Análisis Costo-Beneficio , Humanos , Servicios de Salud del Trabajador/economía , Calidad de Vida , Rehabilitación Vocacional , Factores de TiempoRESUMEN
BACKGROUND: Considerable controversy and limited information surrounds the use of performance-based functional assessments for determining an injured worker's ability to function at work. PURPOSE: Amidst a variety of protocols, philosophies and tools, the key aspects of different assessment approaches are described and compared across a range of assessment provider organizations. METHOD: Qualitative and quantitative strategies were used to generate an in-depth understanding of the different assessment practices among 23 Southern Ontario assessment providers. RESULTS: Assessment approaches share common elements and variations that can be described along the continua of five dimensions: nature of assessor-evaluee interactions, fixed or flexible protocol delivery, efforts to contextualize, perceptions and use of evidence, and provider organizational environment. These approach dimensions are offered as a focus for appraising practices. PRACTICE IMPLICATIONS: Assessors need to reflect upon to what extent they are using a whole person, client-centred approach directed by clinical reasoning amidst a market driven industry.