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BMC Public Health ; 21(1): 1631, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488695


BACKGROUND: Hot weather leads to increased illness and deaths. The Heatwave Plan for England (HWP) aims to protect the population by raising awareness of the dangers of hot weather, especially for those most vulnerable. Individuals at increased risk to the effects of heat include older adults, particularly 75+, and those with specific chronic conditions, such as diabetes, respiratory and heart conditions. The HWP recommends specific protective actions which relate to five heat-health alert levels (levels 0-4). This study examines the attitudes to hot weather of adults in England, and the protective measures taken during a heatwave. METHODS: As part of a wider evaluation of the implementation and effects of the HWP, a survey (n = 3153) and focus groups, a form of group interview facilitated by a researcher, were carried out after the June 2017 level 3 heat-health alert. Survey respondents were categorised into three groups based on their age and health status: 'vulnerable' (aged 75+), 'potentially vulnerable' (aged 18-74 in poor health) and 'not vulnerable' (rest of the adult population) to hot weather. Multivariable logistic regression models identified factors associated with these groups taking protective measures. In-person group discussion, focused on heat-health, were carried out with 25 people, mostly aged 75 + . RESULTS: Most vulnerable and potentially vulnerable adults do not consider themselves at risk of hot weather and are unaware of the effectiveness of important protective behaviours. Only one-quarter of (potentially) vulnerable adults reported changing their behaviour as a result of hearing hot weather-related health advice during the level 3 alert period. Focus group findings showed many vulnerable adults were more concerned about the effects of the sun's ultra-violet radiation on the skin than on the effects of hot temperatures on health. CONCLUSIONS: Current public health messages appear to be insufficient, given the low level of (potentially) vulnerable adults changing their behaviour during hot weather. In the context of increasingly warmer summers in England due to climate change, public health messaging needs to convince (potentially) vulnerable adults of all the risks of hot weather (not just effects of sunlight on the skin) and of the importance of heat protective measures.

Mudança Climática , Temperatura Alta , Idoso , Atitude , Inglaterra/epidemiologia , Humanos , Estações do Ano , Tempo (Meteorologia)
J Health Serv Res Policy ; 26(3): 189-197, 2021 07.
Artigo em Inglês | MEDLINE | ID: mdl-33337256


OBJECTIVE: To describe the disruptions in care experienced by persons with Multiple Sclerosis in Italy due to the COVID-19 pandemic and the self-reported impact on their health and wellbeing. METHODS: A cross-sectional online survey was completed by 2722 persons with Multiple Sclerosis, after Italy instituted a national lockdown in response to the pandemic. RESULTS: Persons with Multiple Sclerosis reported that the pandemic caused broad disruptions to usual health and social care services, which impacted on their health and wellbeing. Disruptions in care were consistently associated with negative self-reported impacts on the expected progression of the disease, on out-of-pocket expenditure and on carer's stress. Psychological consequences were associated with interruption to usual psychological support, and concerns about the safety of care delivered in person. CONCLUSIONS: The quality of life of persons with Multiple Sclerosis depends greatly on prompt access to a broad range of health and care services. Negative psychological impacts reported by persons with Multiple Sclerosis with less severe disabilities show that accessible integrated services are crucial for maintenance of their wellbeing. Most persons with Multiple Sclerosis with more severe disability experienced negative impacts on perceived health. Their carers compensating for lack of social input resulted in care overburden. As continuity of care is crucial for persons with Multiple Sclerosis, as well as for persons with chronic conditions in general, strategies must be in place to ensure it is included in future pandemic response plans.

COVID-19/epidemiologia , Continuidade da Assistência ao Paciente/organização & administração , Esclerose Múltipla/epidemiologia , Esclerose Múltipla/psicologia , Adulto , Fardo do Cuidador/epidemiologia , Estudos Transversais , Atenção à Saúde/organização & administração , Pessoas com Deficiência/psicologia , Feminino , Financiamento Pessoal , Nível de Saúde , Humanos , Itália , Masculino , Saúde Mental , Pessoa de Meia-Idade , Pandemias , Qualidade de Vida , SARS-CoV-2 , Autorrelato , Índice de Gravidade de Doença , Serviço Social/organização & administração , Estresse Psicológico/epidemiologia
Br J Gen Pract ; 67(658): e370-e376, 2017 May.
Artigo em Inglês | MEDLINE | ID: mdl-28450345


BACKGROUND: The Friends and Family Test (FFT) was introduced into general practices in England in 2015 to provide staff with information on patients' views of their experience of care. AIM: To examine the views of practice staff and patients of the FFT, how the results are used, and to recommend improvements. DESIGN AND SETTING: A qualitative study of a national representative sample of 42 general practices. METHOD: Semi-structured interviews with 43 clinicians, 48 practice managers, and 27 patient representatives. Interviews were audiotaped, transcribed, and analysed thematically. RESULTS: Although the FFT imposed little extra work on practices, it was judged to provide little additional insight over existing methods and to have had minimal impact on improving quality. Staff lacked confidence in the accuracy of the results given the lack of a representative sample and the risk of bias. The FFT question was judged to be inappropriate as in many areas there was no alternative practice for patients to choose, patients' individual needs would not be the same as those of their friends and relatives, and an overall assessment failed to identify any specific aspects of good- or poor-quality care. Despite being intended to support local quality improvement, there was widespread unease about the FFT, with many responders perceiving it as a tool for national bodies to monitor general practices. CONCLUSION: If the use of a single-item questionnaire is to continue, changes should be made to the wording. It should be focused on stimulating local quality improvement, and practice staff should be supported to use the results effectively.

Atitude do Pessoal de Saúde , Atitude Frente a Saúde , Saúde da Família/normas , Medicina Geral/normas , Inglaterra , Retroalimentação , Controle de Acesso , Humanos , Satisfação do Paciente , Pesquisa Qualitativa , Melhoria de Qualidade , Saúde da População Rural , Inquéritos e Questionários/normas , Saúde da População Urbana