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1.
Support Care Cancer ; 30(1): 145-155, 2022 Jan.
Artículo en Inglés | MEDLINE | ID: mdl-34241699

RESUMEN

PURPOSE: Given the large number of adolescents and young adults (AYAs) impacted by parental cancer and the potential for negative psychosocial outcomes in this vulnerable population, this study examined the mediating role of offspring unmet needs with regard to parental cancer and the relation between AYAs psychosocial adjustment and perceived illness unpredictability. METHODS: A total of 113 AYAs (aged 11-24 years) living with a parent diagnosed with cancer completed a questionnaire assessing illness unpredictability, offspring unmet needs, and psychosocial adjustment (i.e., health-related quality of life and internalizing problems). RESULTS: Higher offspring unmet needs were associated with lower health-related quality of life (r = -0.24**) and higher internalizing problems (r = 0.21*). Offspring unmet needs mediated the relation between illness unpredictability and health-related quality of life (standardized indirect effect = -0.100* [-0.183, -0.018]) but not internalizing problems (standardized indirect effect = 0.067 [-0.015, 0.148]). In particular, higher illness unpredictability was related to higher unmet needs (ß = 0.351**) which, in turn, predicted lower health-related quality of life (ß = -0.286**). CONCLUSION: These findings identify offspring unmet needs and illness unpredictability as implicated in AYAs positive psychosocial adjustment to parental cancer. Given that AYAs are at greater risk of elevated psychosocial difficulties, interventions should target offspring unmet needs and perception of illness unpredictability to mitigate the adverse effects of parental cancer.


Asunto(s)
Neoplasias , Calidad de Vida , Adolescente , Necesidades y Demandas de Servicios de Salud , Humanos , Neoplasias/terapia , Padres , Encuestas y Cuestionarios , Adulto Joven
2.
J Cyst Fibros ; 20 Suppl 3: 16-20, 2021 12.
Artículo en Inglés | MEDLINE | ID: mdl-34930535

RESUMEN

BACKGROUND: Chronic care delivery models faced unprecedented financial pressures, with a reduction of in-person visits and adoption of telehealth during the COVID-19 pandemic. We sought to understand the reported financial impact of pandemic-related changes to the cystic fibrosis (CF) care model. METHODS: The U.S. CF Foundation State of Care surveys fielded in Summer 2020 (SoC1) and Spring 2021 (SoC2) included questions for CF programs on the impact of pandemic-related restrictions on overall finances, staffing, licensure, and reimbursement of telehealth services. Descriptive analyses were conducted based on program type. RESULTS: Among the 286 respondents (128 pediatric, 118 adult, 40 affiliate), the majority (62%) reported a detrimental financial impact to their CF care program in SoC1, though fewer (42%) reported detrimental impacts in SoC2. The most common reported impacts in SoC1 were redeployment of clinical staff (68%), furloughs (52%), hiring freezes (51%), decreases in salaries (34%), or layoffs (10%). Reports of lower reimbursement for telehealth increased from 30% to 40% from SoC1 to SoC2. Projecting towards the future, only a minority (17%) of program directors in SoC2 felt that financial support would remain below pre-pandemic levels. CONCLUSIONS: The COVID-19 pandemic resulted in financial strain on the CF care model, including challenges with reimbursement for telehealth services and reductions in staffing due to institutional changes. Planning for the future of CF care model needs to address these short-term impacts, particularly to ensure a lack of interruption in high-quality multi-disciplinary care.


Asunto(s)
COVID-19 , Continuidad de la Atención al Paciente , Fibrosis Quística , Accesibilidad a los Servicios de Salud , Modelos Organizacionales , Telemedicina , Adulto , COVID-19/epidemiología , COVID-19/prevención & control , Niño , Continuidad de la Atención al Paciente/organización & administración , Continuidad de la Atención al Paciente/normas , Costos y Análisis de Costo , Fibrosis Quística/economía , Fibrosis Quística/epidemiología , Fibrosis Quística/terapia , Accesibilidad a los Servicios de Salud/organización & administración , Accesibilidad a los Servicios de Salud/tendencias , Necesidades y Demandas de Servicios de Salud , Humanos , Innovación Organizacional , Admisión y Programación de Personal/organización & administración , Mecanismo de Reembolso/tendencias , SARS-CoV-2 , Telemedicina/economía , Telemedicina/métodos , Estados Unidos/epidemiología
3.
Ann Agric Environ Med ; 28(4): 692-704, 2021 Dec 29.
Artículo en Inglés | MEDLINE | ID: mdl-34969231

RESUMEN

INTRODUCTION AND OBJECTIVE: The disabled are a group with a heterogeneous structure of causes and needs. The occurring physical, health, and social barriers constitute areas of public health. Assessment of these barriers requires systematic studies in order to use results supporting the tasks of public health, indispensable for pursuing the challenges of sustainable development. The aim of the study was to discuss the selected demographic, social, living and housing, as well as economic characteristics of the disabled rural and urban inhabitants, which are important for shaping the tasks of public health. MATERIAL AND METHODS: The study group consisted of 676 disabled aged 19 - 98 years, including 56.4% of females and 43.6% of males, 38.0% of whom lived in rural areas. The disabled were qualified into a study group by the method of targeted sampling. The research instruments were an author-constructed Disability Questionnaire, and the Research Protocol. Statistical analysis was performed using the software IBM SPSS Statistics v. 27. The p values p < 0.05 were considered statistically significant. RESULTS: The level of risk of the phenomenon of disability was similar among both males and females. Higher risk was observed among widows and widowers, females with a low level of education, the disabled in older age groups, as well as those living in rural areas, maintaining themselves on non-earned sources of income, and running a single person household. The main causes of disability were diseases. CONCLUSIONS: 1. The majority of the population in the study were disabled with a legal grade of disability. 2. The analyzed characteristics fell within two groups: demographic and social, and health characteristics with difficult to separate health and social problems. 3. The most important problems in the area of public health were specified. 4. It is necessary to conduct studies considering demographic and social variables in order to level-up health inequalities between the disabled and those able-bodied. Effective solving of barriers and risks embedded in the social, family, and occupational situation prevents secondary disability, and also provides an opportunity for sustainable development in this population group.


Asunto(s)
Personas con Discapacidad , Necesidades y Demandas de Servicios de Salud , Salud Pública , Adulto , Anciano , Anciano de 80 o más Años , Femenino , Vivienda , Humanos , Masculino , Persona de Mediana Edad , Población Rural , Factores Sociológicos , Adulto Joven
4.
Cien Saude Colet ; 26(suppl 3): 5351-5360, 2021.
Artículo en Portugués, Inglés | MEDLINE | ID: mdl-34787224

RESUMEN

This study explores access to health services for lesbians in the light of current literature. A literature search was conducted using various databases and an interpretive synthesis of the findings of the selected articles was produced anchored in the concepts of habitus and symbolic violence developed by Pierre Bourdieu. Two main themes and their respective units of meaning were identified: (a) barriers and difficulties experienced by lesbians in accessing healthcare (issues related to coming out as a lesbian and difficulties experienced by health services and professionals in dealing with lesbian women); and (b) lesbian women's experiences in health services (unequal care, invisibility, and feeling uncomfortable). We conclude that, despite advances in policy and care protocols, sexual and gender diversity needs to be widely discussed in social, educational, and health settings.


Asunto(s)
Homosexualidad Femenina , Minorías Sexuales y de Género , Femenino , Servicios de Salud , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos
6.
J Contemp Dent Pract ; 22(8): 894-899, 2021 Aug 01.
Artículo en Inglés | MEDLINE | ID: mdl-34753841

RESUMEN

AIM AND OBJECTIVE: The aim of the study was to evaluate the satisfaction of an oral health promotion program among parents and caregivers of children with special healthcare needs (CSHCN) in Riyadh, Saudi Arabia. MATERIALS AND METHODS: A digital survey using Google forms was used during an event to commemorate the World Disability Day. Stalls for oral health education and training were set up at Disabled Children Society, Riyadh, Saudi Arabia. Oral health education was carried out using written pamphlets, brochures, and videos. Live demonstration on dental models was used for tooth-brushing training using a powered toothbrush. Parents and caregivers were asked to complete a survey about oral health education during the event. An overall 189 parents and caregivers of CSHCN including 62 males and 127 females completed the survey. The responses were entered digitally prior to being evaluated. RESULTS: The respondents were parents and/or caregivers of children mostly having cerebral palsy followed by autism. Females consisted of 67% of the respondents. Eight-one percent of respondents rated it as highly satisfied. Ninety-one percent of the respondents perceived that the information provided was new for them regarding oral healthcare for CSHCN. Ninety-eight percent of respondents were likely to attend a similar event in the future. CONCLUSION: Majority of parents and caregivers of CSHCN were highly satisfied by the oral health education during the event. They felt that they can take better care of the oral health of their CSHCN after the oral health education and training. CLINICAL SIGNIFICANCE: Oral health among CSHCN is neglected when compared to children among the general population. CSHCN exhibit many barriers to oral health care. Oral health promotion among CSHCN is important as they have a high unmet oral health need.


Asunto(s)
Cuidadores , Niños con Discapacidad , Niño , Femenino , Educación en Salud Dental , Accesibilidad a los Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Humanos , Masculino , Padres , Satisfacción Personal , Arabia Saudita , Estados Unidos
8.
Int J Qual Health Care ; 33(4)2021 Oct 20.
Artículo en Inglés | MEDLINE | ID: mdl-34613344

RESUMEN

BACKGROUND: Extensive research has explored disparities in access to health care between people with and without disabilities, but much less is understood about disparities and associated factors within the disabled population. OBJECTIVE: The aim of this study was to examine differences in the prevalence of unmet health-care needs by residential status (hukou status) and disability type among people with disabilities. METHODS: Our data were from the National Survey on Basic Public Service Delivery of Persons with Disabilities. The analysis sample included a nationally representative sample of 9 642 112 adults (aged 16+ years) with disabilities. Associated factors were obtained at both individual level and community level. Cross-sectional multivariable logistic regression analyses were conducted to compare unmet medical, care, rehabilitation and accessibility needs among people with different residential statuses and different types of disabilities. RESULTS: The estimated prevalence of unmet medical, care, rehabilitation and accessibility needs is 15.4%, 10.2%, 45.6% and 13.7%, respectively. Rural hukou was associated with an important 13-40% increase in unmet health-care needs for people with disabilities in China. These rural-urban disparities in unmet health service needs can be partly explained by community-level factors, including access to facilities, social participation and health professionals. Disparities across the type of disability were smaller, but on average, people with multiple disabilities appeared to have the highest rates of unmet care, medical and accessibility needs, whereas those with physical disability had the highest unmet rehabilitation need. CONCLUSIONS: Differences by residential status and impairment type were evident in all types of unmet health service needs. Targeted policy designs that meet the needs for justice and equality of people with disabilities are advisable. Public health and policy efforts are required to improve access to health service and meet the needs of people with disabilities, especially in rural practices and for particular disability groups.


Asunto(s)
Personas con Discapacidad , Accesibilidad a los Servicios de Salud , Adulto , China , Estudios Transversales , Servicios de Salud , Necesidades y Demandas de Servicios de Salud , Disparidades en Atención de Salud , Humanos
10.
BMJ Open ; 11(9): e045936, 2021 09 30.
Artículo en Inglés | MEDLINE | ID: mdl-34593485

RESUMEN

OBJECTIVE: This paper presents the results of a realist evaluation of a knowledge translation (KT) intervention implemented in the field of health promotion and disease prevention at the local level in France. DESIGN: Realist evaluation study. SETTING: The target population comprised decision-makers and field professionals working in prevention and public health services operating in regions of France (ie, ARS (Agence Régionale de Santé: regional health agency), IREPS (Instance Régionale d'Education et de Promotion de la Santé pour tous: regional organisation for health promotion and education) and their partners). PARTICIPANTS: This evaluation was based on data collected from 2 seminars, 82 interviews, 18 observations and 4 focus groups over 18 months. INTERVENTION: The TC-REG intervention aimed to increase the use of evidence in cancer prevention, health promotion and disease prevention across four geographical regions in France. The intervention combined various activities: Supporting access to and adaptation of usable evidence, strengthening professionals' skills in analysing, adopting and using policy briefs, and facilitating the use of evidence in organisations and processes. RESULTS: The collected data was used to define favourable/unfavourable contexts for the use of scientific data and mechanisms to be activated to encourage the use of scientific knowledge. From these raw results eight final refined middle-range theories were defined. Organised around the mechanisms to be activated, these middle-range theories illustrate how to activate knowledge and under what conditions. These analyses provided a basis for the production of seven operational and contextualised recommendations to develop KT to inform regional policymaking regarding health promotion and disease prevention. CONCLUSION: The results obtained from the analyses led us to formulate two perspectives of an operational nature for the benefit of those involved in prevention and health promotion.


Asunto(s)
Formulación de Políticas , Atención a la Salud , Promoción de la Salud , Necesidades y Demandas de Servicios de Salud , Humanos
13.
Acta Myol ; 40(3): 113-115, 2021 Sep.
Artículo en Inglés | MEDLINE | ID: mdl-34632292

RESUMEN

COVID-19 outbreak has quickly reached alarming morbidity and mortality with vaccines being the only weapon to fight. Although the critical situation, no international guidelines on the vaccination management of patients with neuromuscular disorders (NMDs) has still been issued. We aimed to address some unmet needs about the management of COVID-19 vaccination in patients with NMDs.


Asunto(s)
Vacunas contra la COVID-19/administración & dosificación , Necesidades y Demandas de Servicios de Salud , Enfermedades Neuromusculares , Femenino , Humanos , Masculino , Pandemias , Seguridad del Paciente , SARS-CoV-2
16.
CMAJ Open ; 9(4): E948-E956, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34667075

RESUMEN

BACKGROUND: Respiratory syncytial virus (RSV) infection poses a substantial clinical burden among infants and young children. We sought to determine the health care costs of hospitalizations attributable to RSV in Ontario, Canada, from the health care payer perspective. METHODS: For this population-based matched cohort study, we identified children younger than 24 months who were or were not hospitalized with RSV infections in 2006-2016. We performed a cost-of-illness analysis using linked administrative health data, with subjects stratified by gestational age and congenital heart disease, and propensity score-matched on established risk factors. The primary outcome was attributable health care costs per patient, reflecting the difference in direct medical costs between the groups, calculated to 12 months postdischarge in 2020 Canadian dollars. RESULTS: We identified 14 608 RSV-infected children, matched to 72 040 controls. The adjusted attributable cost of hospitalized RSV was $134 931 900 over 10 years, or $9240 per patient (95% confidence interval [CI] $8790-$9690). Health care costs escalated 3 days before hospitalization, and persisted up to 12 months after discharge. Increased costs were associated with major comorbidities, but not extreme premature birth. The highest mean attributable cost per patient was in the presence of hemodynamically significant heart disease ($60 110, 95% CI $26 700-$93 060). Infants born at 36-43 weeks' gestation constituted the greatest overall cost burden at $117 886 720. INTERPRETATION: Although the greatest direct medical costs per patient hospitalized with RSV infection are among children with cardiac disease, the greatest overall cost burden is from children born at or near term, who are not targeted by current prophylaxis strategies. The substantial attributable health care costs of RSV can inform cost-effectiveness analyses of novel RSV vaccines and prioritization of health care resources.


Asunto(s)
Costo de Enfermedad , Cardiopatías Congénitas/epidemiología , Hospitalización , Nacimiento Prematuro/epidemiología , Infecciones por Virus Sincitial Respiratorio , Vacunas contra Virus Sincitial Respiratorio , Comorbilidad , Análisis Costo-Beneficio , Femenino , Edad Gestacional , Costos de la Atención en Salud/estadística & datos numéricos , Necesidades y Demandas de Servicios de Salud , Hospitalización/economía , Hospitalización/estadística & datos numéricos , Humanos , Lactante , Masculino , Ontario/epidemiología , Infecciones por Virus Sincitial Respiratorio/economía , Infecciones por Virus Sincitial Respiratorio/epidemiología , Infecciones por Virus Sincitial Respiratorio/prevención & control , Infecciones por Virus Sincitial Respiratorio/terapia , Vacunas contra Virus Sincitial Respiratorio/economía , Vacunas contra Virus Sincitial Respiratorio/uso terapéutico , Virus Sincitial Respiratorio Humano/aislamiento & purificación , Factores de Riesgo
17.
Artículo en Inglés | MEDLINE | ID: mdl-34639464

RESUMEN

The World Health Organization recommends carrying out periodic epidemiological studies in order to provide a basis for the evaluation of the state of health of the population at any given time; in doing so, action strategies can be established for the treatment of different pathologies. The objective of this study is to evaluate the need for orthodontic treatment in adolescents at school aged between 12 and 15 in the Spanish autonomous region known as Comunidad Valenciana (hereafter: Valencian Region). A cross-sectional study was carried out on a sample of 539 12-year-old schoolchildren and 460 15-year-olds, respectively, selected by cluster sampling and representative of the school-aged population of the Valencian Region, using the IOTN-DHC, IOTN-AC, and DAI indices. The need for specific orthodontic treatment according to the IOTN-DHC was 12.6% at 12 years and 7% at 15. For the IOTN-AC and DAI indices, the treatment needs were 4.3% and 0.9% at 12 years and 30.1% and 20.9% at the age of 15. These results were similar to those obtained in the previous study carried out on the same target population. There was no significant association between the need for treatment and gender or social class. We conclude that the need for orthodontic treatment presents values similar to those obtained in 2010.


Asunto(s)
Maloclusión , Adolescente , Niño , Estudios Transversales , Estética Dental , Necesidades y Demandas de Servicios de Salud , Humanos , Maloclusión/epidemiología , Maloclusión/terapia , España/epidemiología
18.
N Z Med J ; 134(1543): 19-29, 2021 10 08.
Artículo en Inglés | MEDLINE | ID: mdl-34695073

RESUMEN

AIM: To explore kaiawhina (Maori community health workers) perspectives on supporting whanau Maori with chronic pain, and to understand their views on the use of online resources for pain management. METHOD: A Maori-centred, qualitative design using focus groups as the primary data collection method. Analysis using the general inductive approach. RESULTS: Thirteen kaiawhina working in the Greater Wellington region took part in the focus groups. Four key themes were identified: (1) treatment of chronic pain in primary health relies exclusively on medication, (2) health literacy approaches to pain management are urgently required, (3) Maori have significant unmet need for culturally responsive pain management, and (4) the availability of, and referral practices to, specialist pain services are inadequate for Maori communities. CONCLUSION: Current chronic pain management was predominantly biomedical, and educational strategies lack health literacy approaches. Primary health services exclude traditional Maori methods of treating chronic pain and do not focus on whanau wellbeing. The lack of referral for Maori to specialist services highlights the existing health inequities for Maori. Developing new initiatives (both in-person and online) to address chronic pain management for Maori must be Maori-led and co-designed with whanau to result in holistic solutions for Maori.


Asunto(s)
Dolor Crónico/tratamiento farmacológico , Alfabetización en Salud , Necesidades y Demandas de Servicios de Salud/organización & administración , Servicios de Salud del Indígena/organización & administración , Manejo del Dolor , Grupos Focales , Personal de Salud/psicología , Humanos , Nueva Zelanda
19.
PLoS One ; 16(10): e0258664, 2021.
Artículo en Inglés | MEDLINE | ID: mdl-34695121

RESUMEN

This study aims to understand the experiences of families of children with special healthcare needs in rural areas in Thailand. Grounded theory (GT) was employed to understand families' experiences when caring for children with special healthcare needs (CSHCN) in rural areas. Forty-three family members from thirty-four families with CSHCN participated in in-depth interviews. Interviews were recorded and transcribed. The constant comparative method was used for data analysis and coding analysis. Adjusting family's life was the emergent theory which included experiencing negative effects, managing in home environment, integrating care into a community health system, and maintaining family normalization. This study describes the process that families undergo in trying to care for CSHCN while managing their lives to maintain a sense of normalcy. This theory provides some intervention opportunities for health care professionals when dealing with the complexities in their homes, communities and other ambulatory settings throughout the disease trajectory, and also indicates the importance of taking into consideration the family's cultural background.


Asunto(s)
Atención a la Salud/normas , Niños con Discapacidad/psicología , Familia/psicología , Teoría Fundamentada , Instituciones de Salud/normas , Necesidades y Demandas de Servicios de Salud/estadística & datos numéricos , Estrés Psicológico/etiología , Adolescente , Adulto , Niño , Femenino , Humanos , Masculino , Estrés Psicológico/psicología
20.
BMC Med Res Methodol ; 21(1): 234, 2021 10 27.
Artículo en Inglés | MEDLINE | ID: mdl-34706667

RESUMEN

Electronic health records (EHRs) are widely used in epidemiological research, but the validity of the results is dependent upon the assumptions made about the healthcare system, the patient, and the provider. In this review, we identify four overarching challenges in using EHR-based data for epidemiological analysis, with a particular emphasis on threats to validity. These challenges include representativeness of the EHR to a target population, the availability and interpretability of clinical and non-clinical data, and missing data at both the variable and observation levels. Each challenge reveals layers of assumptions that the epidemiologist is required to make, from the point of patient entry into the healthcare system, to the provider documenting the results of the clinical exam and follow-up of the patient longitudinally; all with the potential to bias the results of analysis of these data. Understanding the extent of as well as remediating potential biases requires a variety of methodological approaches, from traditional sensitivity analyses and validation studies, to newer techniques such as natural language processing. Beyond methods to address these challenges, it will remain crucial for epidemiologists to engage with clinicians and informaticians at their institutions to ensure data quality and accessibility by forming multidisciplinary teams around specific research projects.


Asunto(s)
Atención a la Salud , Registros Electrónicos de Salud , Sesgo , Necesidades y Demandas de Servicios de Salud , Humanos
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