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1.
Estima (Online) ; 19(1): e0921, jan.-dez. 2021.
Artigo em Português | BDENF - Enfermagem | ID: biblio-1280948

RESUMO

Objetivo:descrever o processo de implementação da Rede de Atenção à Saúde em Lesões Cutâneas no município de Divinópolis − MG. Método: trata-se de um relato de experiência sobre a implementação de uma Rede de Atenção à Saúde em Lesões Cutâneas a partir do Programa de Educação Pelo Trabalho para Saúde (PET-Saúde/GraduaSUS), no período de maio de 2016 a abril de 2018. Participaram das ações professores e alunos de uma universidade pública e profissionais enfermeiros vinculados à Secretaria Municipal de Saúde do município. Resultados: foi possível implementar a Rede de Atenção à Saúde para prevenção e tratamento de lesões cutâneas de maneira estruturada e sistematizada. Foi estabelecido um fluxo de atendimento, supervisão de casos e acompanhamento clínico por meio da construção de um protocolo assistencial. Conclusão: a habilidade prática e o conhecimento científico de alunos e profissionais de saúde para o tratamento e manejo de lesões cutâneas foram desenvolvidos fortalecendo, assim, a tríade ensino-serviço-comunidade.


Objective: describe the process of implementing the Rede de Atenção à Saúde em Lesões Cutâneas (Health Care Network for Skin Injuries) in the municipality of Divinópolis - MG. Method: it is an experience report on the implementation of a Health Care Network for Skin Injuries from the Programa de Educação Pelo Trabalho para Saúde (PET-Saúde/GraduaSUS) (Education Through Work for Health Program), from May 2016 to April 2018. Teachers and students from a public university and professional nurses linked to the Municipal Health Secretariat of the municipality participated in the actions. Results: it was possible to implement the Health Care Network for the prevention and treatment of skin lesions in a structured and systematic way. A flow of care, case supervision and clinical follow-up was established through the construction of an assistance protocol. Conclusion: the practical skill and scientific knowledge of students and health professionals for the treatment and management of skin lesions were developed, thus strengthening the teaching-service-community triad.


Assuntos
Ferimentos e Lesões , Relações Comunidade-Instituição , Atenção à Saúde , Acesso aos Serviços de Saúde
3.
Adv Rheumatol ; 61(1): 55, 2021 09 03.
Artigo em Inglês | MEDLINE | ID: mdl-34479631

RESUMO

BACKGROUND: Anti-rheumatic drugs can increase the predisposition to infection, and patients may be unaware of continuing their treatment during the COVID-19 pandemic. OBJECTIVE: This study aimed to assess whether patients maintain their treatment for rheumatic conditions during the pandemic period and determine the factors responsible for discontinuation. METHODS: Patients were randomly selected from the prospectively collected database of our tertiary referral center. The patients were interviewed by telephone through a standardized closed-ended questionnaire, which is targeting the continuity of the treatment plan and the considerations related to the individual choice. The patients were asked whether they hesitated to visit the hospital for follow-up or intravenous drug administration. RESULTS: A total of 278 patients completed the questionnaire. While 62 of the patients (22.3%) had reduced or interrupted the treatment, only 11 patients (3.9%) stopped the treatment completely. A significant difference was observed between the duration of illness and the discontinuation of treatment. (p = 0.023) There was a significant difference in disease activity between the group that stopped treatment and continued treatment. (p = 0.001) There was no statistically significant difference in other demographic characteristics. One hundred thirty-five patients (48.6%) made the treatment decision by themselves, and 80% continued the treatment. Reasons for stopping the treatment were anxiety (48.4%), not being able to go to the hospital for intravenous treatment (45.1%), and not being able to find the drug (6.5%). CONCLUSION: Since patients with long-term illnesses were found to be significantly more likely to stop their treatment, this group of patients should be monitored.


Assuntos
Antirreumáticos/uso terapêutico , Atitude Frente a Saúde , COVID-19/epidemiologia , Pandemias , Doenças Reumáticas/tratamento farmacológico , Suspensão de Tratamento/estatística & dados numéricos , Adulto , Idoso , Antirreumáticos/provisão & distribuição , Ansiedade , Continuidade da Assistência ao Paciente , Bases de Dados Factuais , Tomada de Decisões , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Pessoa de Meia-Idade , Doenças Reumáticas/psicologia , Inquéritos e Questionários/estatística & dados numéricos , Centros de Atenção Terciária , Adulto Jovem
5.
East Mediterr Health J ; 27(8): 772-781, 2021 Aug 26.
Artigo em Inglês | MEDLINE | ID: mdl-34486713

RESUMO

Background: The health and social care needs of people aged ≥ 80 years are a neglected topic. Aims: To determine the prevalence of unmet health and social care needs and associated factors in community-dwelling individuals aged ≥ 80 years in Izmir District of Balçova, Turkey. Methods: There were 1075 participants aged ≥ 80 years. The dependent variables were unmet health and social care needs. Independent variables were sociodemographic, socioeconomic and lifestyle characteristics. The data were collected in face-to-face interviews conducted at the homes and analysed by multiple logistic regression model. Ethical approval was obtained from the Non-Invasive Research Ethics Board of Dokuz Eylul University Medical Faculty (2017/26-24). Results: The mean age was 84.1 (3.7) years and 61.0% were female. Healthcare needs were expressed by 88.2% of the participants and 78.9% claimed that they had social care needs. Prevalence of unmet health and social care needs was 32.5% and 46.6%, respectively. Approximately 90.0% of their needs were covered by families. Perceived low-income status was a risk factor for unmet healthcare needs, and lack of social support was a risk factor for unmet social care needs. Additionally, not receiving formal education was a protective factor in unmet social care needs. Conclusion: Public health policy should be developed to enable better access to care, especially for the oldest people, considering that nearly one third of the participants in this study had unmet healthcare needs and almost half had unmet social care needs.


Assuntos
Acesso aos Serviços de Saúde , Apoio Social , Idoso , Idoso de 80 Anos ou mais , Estudos Transversais , Feminino , Necessidades e Demandas de Serviços de Saúde , Humanos , Fatores Socioeconômicos , Turquia/epidemiologia
7.
Pan Afr Med J ; 39: 99, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34466201

RESUMO

Introduction: the provision of basic diagnostic imaging services is pivotal to achieving universal health coverage. An estimated two-thirds of the world's population have no access to basic diagnostic imaging. Accurate data on current imaging equipment resources are required to inform health delivery strategy and policy at national level. This is an audit of Zimbabwean public sector diagnostic ultrasound resources and services. Methods: utilising the Ministry of Health and Child Care (MHCC) database, sequential interviews were conducted with provincial health authorities and local facility managers. Ultrasound equipment, personnel and services in all hospitals and clinics, nationally were recorded, collated, and analysed for the whole country, and by province. Results: of the 1798 Zimbabwean public sector healthcare facilities, sixty-six (n=66, 3.67%) have ultrasound equipment. Ninety-nine (n=99) ultrasound units are distributed across the sonar facilities, representing a national average of 8 units per million people. More than half the equipment units (n=53, 54%) are in secondary-level healthcare facilities (district and mission hospitals), and approximately one-fifth (n=22, 22%) in the central hospitals (quaternary level). The best-resourced province has twice the resources of the least resourced. One-hundred and forty-two (n=142) healthcare workers, from six different professional groups, provide the public sector ultrasound service. Most facilities with sonar equipment (n=64/66, 97%) provide obstetrics and gynaecology services, while general abdominal scanning is available at one third (n=22, 33%). Two facilities with ultrasound equipment have no capacity to offer a sonography service. Conclusion: in order to reach the WHO recommendation of 20 sonar units per million people, an estimated 140 additional sonar units are required nationally. The need is greatest in Masvingo, Midlands and Mashonaland East Provinces. Task-shifting plays a key role in the provision of Zimbabwean sonar services. Consideration should be given to formal training and accreditation of all healthcare workers involved in sonar service delivery.


Assuntos
Atenção à Saúde/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Acesso aos Serviços de Saúde , Ultrassonografia/estatística & dados numéricos , Bases de Dados Factuais , Instalações de Saúde/estatística & dados numéricos , Política de Saúde , Humanos , Setor Público , Cobertura Universal do Seguro de Saúde , Zimbábue
8.
Acta Dermatovenerol Croat ; 291(1): 58, 2021 Apr.
Artigo em Inglês | MEDLINE | ID: mdl-34477068

RESUMO

The year 2020 has been marked by the coronavirus disease 2019 (COVID-19) pandemic, caused by an RNA virus called SARS-COV2 (severe acute respiratory syndrome coronavirus). The fight against this epidemic has become the center of our daily clinical practice as well as of our private lives, in which avoiding infection has become one of our most important goals. Even though COVID-19 is a potentially lethal disease, especially for the elderly and people with chronic diseases, it did not cause all the other life-threatening diseases to vanish. On the contrary, many scheduled medical activities and procedures, especially preventive and non-urgent internal and surgical activities, had to be postponed due to COVID-19 crisis. This interruption in the health care system can negatively affect the diagnosis and management of our patients with other health issues, namely malignant skin tumors, of which melanoma is the most aggressive. In this letter, we as dermatovenereologists from the Croatian Referral Centre of The Ministry of Health for Melanoma needed to express our concern regarding the increasing number of patients with delayed diagnosis of skin cancer, with special emphasis on melanoma detection and treatment. In the last few months, a large number of our newly-diagnosed patients with melanoma, as well as those with non-melanoma skin cancers, reported that they had noticed a suspicious skin lesion a few months ago but decided not to seek help from dermatologist due to the worrisome epidemiologic situation. In the current environment, clinical skin examination may be viewed as less important and thus postponed, but neglecting melanoma throughout the virus outbreak may lead to increased rates of morbidity, mortality, and consequently a greater financial burden for the health system (1). There are several reasons for such a relaxed attitude towards skin health in our patients. Unlike cardiac, pulmonary, or digestive difficulties, which patients consider life-threatening and for which they seek emergency care despite the coronavirus pandemic, skin tumors do not cause great subjective or significantly noticeable objective symptoms. Moreover, all of the skin tumors and especially melanoma , mostly present as small changes of just a few millimeters in diameter in the early stage at which they are prognostically most favorable. For the average person with no medical education, such small lesions usually do not cause any concern as they have no awareness of the fact that small and inconspicuous skin lesions may be dangerous and potentially even lethal. According to the recommendations concerning patient management during COVID-19 pandemic, oncological examinations should still be performed regularly (2). In spite of that, the cancelation of appointments, especially by patients who are being monitored for high-risk lesions, is inevitable when COVID-19 is disrupting everyone's lives. With the pandemic evolving and no clear solutions in sight, now is the time to emphasize the importance of self-examination and teledermatology in early melanoma diagnosis. Even though diagnosing and managing pigmented skin lesions usually requires face-to-face examinations and dermoscopy as a crucial tool in early melanoma detection, in these times, and especially for people with a higher risk of SARS-COV2 infection, remote communication could prevent delays resulting in worse prognosis and could also eliminate the risk of infecting healthcare workers. Moreover, teledermatology can also be initiated by doctors asking patients to monitor lesions between clinical visits (3). However, we should not rely solely on this technology but should instead assess every patient individually and insist on a face-to-face examination for those at greater risk, with the aim that, if necessary, surgery be performed in timely manner. The collaboration between general practitioners and dermatologists represents an important aspect of achieving the most rational and effective health care in terms of performing triage of patients who can be assessed by teledermatology as well as referring to hospital centers those who need face-to-face examination and further treatment. During the first breakout of the epidemic in March 2020, the multidisciplinary team for melanoma from the Croatian National Referral Melanoma Centre provided recommendations for the management of patients with melanoma during COVID epidemic, designed according to the guidelines of the National Comprehensive Cancer Network (NCCN) (4) and considering the specifics of health care and clinical practice in the Republic of Croatia. Due to epidemic circumstances, preventive actions such as Euromelanoma and many other campaigns that included massive preventive skin examinations of the population and which were conducted for years by Croatian dermatologists throughout the country, could not be organized this year. This is particularly worrisome because on average about 800 patients are diagnosed with melanoma annually in Croatia, of which 60 during public health preventive actions. Despite these circumstances, we were able to maintain public awareness of the importance of early skin cancer recognition by sending the message through different media such as newspapers, television, and social media (Facebook and Instagram). We find that now more than ever it is essential to remind and teach the population about the importance of regular monthly skin self-examinations and recognition of atypical lesions. Clearly, a thorough dermatological examination includes full skin examination from head to toe. Herein we would also like to remind our readers that most skin cancers develop in the head and neck area, which is the most UV-exposed part of the body. Therefore, despite the epidemic conditions, the removal of patients' masks and thorough inspection of the face is mandatory. We find it most practical and efficient to perform the body and scalp examination first, followed by the face examination after the patient gets dressed. Prior to removal of the mask, we ask the patient not to talk during close examination. Even though this could make dermoscopic examination harder to perform, we strongly suggest wearing a protective shield and mask during close examination whenever possible. Between patients, the examining room should be disinfected and ventilated. As doctors, we live in uncertain times when we are heavily burdened by the currently unstoppable COVID epidemic, always awaiting new instructions from the state administration every day and wondering whether perhaps tomorrow we dermatologists will be assigned solely to the service of patients with COVID-19. In the end, we would like to once again remind you that despite the ravaging COVID pandemic and all the epidemiological measures that come with it, other diseases still exist. It is expected of us to draw attention to the still growing incidence of skin cancers and the serious consequences that can occur as a result of a delayed diagnosis.


Assuntos
COVID-19/epidemiologia , Diagnóstico Tardio , Melanoma/diagnóstico , Melanoma/terapia , Neoplasias Cutâneas/diagnóstico , Neoplasias Cutâneas/terapia , Tempo para o Tratamento , Croácia/epidemiologia , Acesso aos Serviços de Saúde , Humanos , Pandemias , Aceitação pelo Paciente de Cuidados de Saúde , SARS-CoV-2
9.
BMC Health Serv Res ; 21(1): 920, 2021 Sep 06.
Artigo em Inglês | MEDLINE | ID: mdl-34488758

RESUMO

BACKGROUND: The Affordable Care Act (ACA) enabled millions of people to gain coverage that was expected to improve access to healthcare services. However, it is unclear the extent of the policy's impact on Federally Qualified Health Centers (FQHC) and the patients they served. This study sought to understand FQHC administrators' views on the ACA's impact on their patient population and organization. It specifically explores FQHC administrators' perspective on 1) patients' experience with gaining coverage 2) their ability to meet patients' healthcare needs. METHODS: Twenty-two semi-structured interviews were conducted with administrators from FQHCs in urban counties in 2 Medicaid-expanded states (Arizona and California) and 1 non-expanded state (Texas). An inductive thematic analysis approach was used to analyze the interview data. RESULTS: All FQHC administrators reported uninsured patients were more likely to gain coverage from Medicaid than from private health insurance. Insured patients generally experienced an improvement in accessing healthcare services but depended on their plan's covered services, FQHCs' capacity to meet demand, and specialist providers' willingness to accept their coverage type. CONCLUSION: Gaining coverage helped improved newly insured patients' access to care, but limitations remained. Additional policies are required to better address the gaps in the depth of covered services in Medicaid and the most affordable PHI plans and capacity of providers to meet demand to ensure beneficiaries can fully access the health care services they need.


Assuntos
Cobertura do Seguro , Patient Protection and Affordable Care Act , Arizona , California , Acesso aos Serviços de Saúde , Humanos , Medicaid , Pessoas sem Cobertura de Seguro de Saúde , Texas , Estados Unidos
11.
Allergy Asthma Proc ; 42(5): 378-385, 2021 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-34474707

RESUMO

Background: Infectious diseases are a leading cause of morbidity and mortality worldwide. As of 2018, the total world population of children < 5 years of age was roughly estimated at 679 million. Of these children, an estimated 5.3 million died of all causes in 2018, with an estimated 700,000 who died of vaccine-preventable infectious diseases; 99% of the children who died had lived in low- and middle-income countries. The infectious diseases that remain major causes of mortality for which vaccines have been shown to provide proven preventive success include, in order of prevalence, are those caused by Streptococcus pneumoniae, Rotavirus, Bordetella pertussis, measles virus, Haemophilus influenzae type b and influenza virus. Objective: The purpose of the present report was to address the global burden of these six vaccine-preventable infectious diseases in children < 5 years of age, together with implications for the prevention of coronavirus disease 2019 (COVID-19) infection in children. Methods: The current immunization strategies for the prevention of the six vaccine-preventable infectious diseases in children are reviewed as a framework for new strategies of vaccine prevention of COVID-19 in children. Results: The burden of addressing vaccine prevention of future infectious disease in children can be effectively pursued through knowledge gained from past experiences with vaccine usage in these six vaccine-preventable childhood infectious diseases. Conclusion: Issues with regard to the burden of disease mortality, disease transmission, and available vaccines as well as vaccine successes and shortcomings for specific pathogens can serve as important landmarks for effective use of future vaccines. Although much success has been made globally in preventing these childhood deaths, much remains to be done.


Assuntos
Vacinas contra COVID-19 , COVID-19/prevenção & controle , Saúde Global/estatística & dados numéricos , Vacinação em Massa , Doenças Preveníveis por Vacina/epidemiologia , COVID-19/epidemiologia , Mortalidade da Criança , Pré-Escolar , Efeitos Psicossociais da Doença , Países em Desenvolvimento , Feminino , Acesso aos Serviços de Saúde , Humanos , Lactente , Mortalidade Infantil , Recém-Nascido , Masculino , Prevalência , Recusa de Vacinação , Doenças Preveníveis por Vacina/prevenção & controle
12.
Einstein (Sao Paulo) ; 19: eGS5914, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34468592

RESUMO

OBJECTIVE: To evaluate a p-median model for health care services accessibility based on decentralization and optimal allocation of Primary Health Care Units in the State of São Paulo, Brazil. METHODS: Using geographical data of Primary Health Care Units located in the State of São Paulo, potential support and supply facility allocations were simulated by means of a random approach. Several constraints were then imposed on the system to simulate different scenarios. Results were assessed according to geographic disposition. RESULTS: Using a fixed number of supply facilities, ten as a constraint, the p-median approach allocated three facilities near the state capital (the area with the highest concentration of Primary Health Care Units), while remaining facilities were spread throughout the west of the state. A second round of tests assessed the impact of fixed costs alone on optimization, ranging from 71 optimal locations with a fixed unit cost to six optimal locations at a cost 300-fold higher. This finding was relevant to decision-making, since it encompassed scenarios in which only the final number of facilities or only the budget was known. A third set of simulations contemplates an intermediate scenario. CONCLUSION: The p-median approach was capable of optimizing a wide range of scenarios with an average running time of less than 2 hours and 30 minutes while considering a large dataset of more than 4,000 locations. In spite of some shortcomings, such as estimation of Euclidean distances, the method is simple yet powerful enough to be considered a useful tool to assist decision makers in the distribution of resources, and facilities across large areas with high number of locations to be supplied.


Assuntos
Acesso aos Serviços de Saúde , Atenção Primária à Saúde , Brasil , Humanos , Política
13.
Cien Saude Colet ; 26(suppl 2): 3791-3804, 2021.
Artigo em Português | MEDLINE | ID: mdl-34468673

RESUMO

The scope of this article is to present a theoretical-methodological model as the basis for the analysis of the potential provision of Brazilian public health services (SUS) using an approach based on complex network theory. The model sought to analyze the potential provision of health services through the relationship of Euclidean distance between census sectors and services offered by health facilities, as defined in the National Register of Health Establishments (CNES). Two types of metrics are proposed for the analysis of the relationship network: the average distance of health services to the census sectors and the importance of the health unit in the potential provision of each type of service based on the centrality and availability of this service. To demonstrate the application of the model, a network was built based in the Metropolitan Area of Brasilia, including the Federal District and 12 surrounding municipalities. The model was able to map and analyze CNES data with census sectors defined in the CENSUS, opening up the possibility of constructing new perspectives of analysis in the understanding of the potential distribution of health resources and services according to socioeconomic variables, as well as an important evidence-based management tool.


Assuntos
Acesso aos Serviços de Saúde , Serviços de Saúde , Brasil , Instalações de Saúde , Humanos , Modelos Teóricos
14.
Bull World Health Organ ; 99(9): 653-660, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475602

RESUMO

Poor control of cardiovascular disease accounts for a substantial proportion of the disease burden in developing countries, but often essential anticoagulant medicines for preventing strokes and embolisms are not widely available. In 2019, direct oral anticoagulants were added to the World Health Organization's WHO Model list of essential medicines. The aims of this paper are to summarize the benefits of direct oral anticoagulants for patients with cardiovascular disease and to discuss ways of increasing their usage internationally. Although the cost of direct oral anticoagulants has provoked debate, the affordability of introducing these drugs into clinical practice could be increased by: price negotiation; pooled procurement; competitive tendering; the use of patent pools; and expanded use of generics. In 2017, only 14 of 137 countries that had adopted national essential medicines lists included a direct oral anticoagulant on their lists. This number could increase rapidly if problems with availability and affordability can be tackled. Once the types of patient likely to benefit from direct oral anticoagulants have been clearly defined in clinical practice guidelines, coverage can be more accurately determined and associated costs can be better managed. Government action is required to ensure that direct oral anticoagulants are covered by national budgets because the absence of reimbursement remains an impediment to achieving universal coverage. Tackling cardiovascular disease with the aid of direct oral anticoagulants is an essential component of efforts to achieve the World Health Organization's target of reducing premature deaths due to noncommunicable disease by 25% by 2025.


Assuntos
Anticoagulantes/economia , Custos de Medicamentos , Medicamentos Essenciais/provisão & distribuição , Medicamentos Genéricos/provisão & distribuição , Acesso aos Serviços de Saúde/estatística & dados numéricos , Anticoagulantes/administração & dosagem , Anticoagulantes/uso terapêutico , Custos e Análise de Custo , Medicamentos Essenciais/economia , Medicamentos Genéricos/economia , Custos de Cuidados de Saúde , Humanos
15.
Bull World Health Organ ; 99(9): 674-679, 2021 Sep 01.
Artigo em Inglês | MEDLINE | ID: mdl-34475604

RESUMO

Problem: Mental ill health in the United Kingdom of Great Britain and Northern Ireland has been a major driver of labour market exclusion through sickness absence, reduced productivity and job loss. Approach: A government-supported programme for improving access to psychological therapies was launched in 2008 and expanded across England in 2010. The aim was to provide evidence-based treatments for people with common mental disorders through three principal strategies: (i) routine session-by-session outcome monitoring; (ii) integration with the wider care system; and (iii) delivery of psychological therapies as part of a stepped-care approach. Local setting: Access to effective psychological therapies was previously low in the United Kingdom. In 2010, only about 35% of people with moderately severe mental disorders were in specialist or non-specialist treatment. Relevant changes: The accessibility of quality mental health services has increased, as has the efficiency of the country's mental health system. The numbers of people entering treatment have increased steadily from 0.43 million in 2012-2013 to 1.09 million in 2018-2019. The recovery rate of patients in treatment increased from 42.8% to 52.1% during 2012-2018. The number of people moved off sick pay and benefits rose from 3683 to 18 039 over the same period. Lessons learnt: A clinical guideline on psychological therapies is a prerequisite for increasing the accessibility and efficiency of mental health services. An integrated approach allows mental health services to have better reach. Routine collection of patient-level outcome data plays an important role in the value and function of the mental health care system.


Assuntos
Acesso aos Serviços de Saúde , Transtornos Mentais/terapia , Serviços de Saúde Mental/organização & administração , Qualidade da Assistência à Saúde , Eficiência Organizacional , Humanos , Transtornos Mentais/epidemiologia , Saúde Mental , Irlanda do Norte , Avaliação de Processos e Resultados em Cuidados de Saúde , Reino Unido
16.
BMC Public Health ; 21(1): 1618, 2021 09 06.
Artigo em Inglês | MEDLINE | ID: mdl-34482819

RESUMO

BACKGROUND: In national public health surveys including those assessing sexual and reproductive health, migrants generally tend to be underrepresented due to cultural, linguistic, structural and legal barriers, minimising the possibility to measure sexual rights' fulfilment in this group. This study aims to describe to what extent sexual rights of young migrants in Sweden are being fulfilled. METHODS: A self-administered questionnaire was used to collect data from 1773 young (16-29 years) migrants by post, online, and at language schools and other venues. Sexual rights were operationalised and categorised into five domains adapted from the Guttmacher-Lancet Commission's definition. These domains included the right to: 1) access sexual and reproductive healthcare, 2) access information and education about sexuality and sexual and reproductive health and rights, 3) have bodily integrity, 4) make free informed decisions about sexuality and sexual relations and 5) have a satisfying and safe sexual life. Descriptive analysis was used to assess the extent of fulfilment for each right. RESULTS: There were wide variations in the fulfilment of sexual rights between subgroups and among the five domains. Most respondents rated their sexual health as good/fair, however, 6.3% rated their sexual health as bad/very bad. While most of those who visited related services were satisfied, 17.4% of respondents refrained from visiting the services despite their needs. Around four in ten respondents did not know where to get information about sexuality and sexual health. One-fourth of respondents reported sexual violence. Another 12.7% were limited by family members or fellow countrymen regarding with whom they can have an intimate relationship. Most respondents were satisfied with their sexual life, except for 11.9%. Men, non-binary respondents, lesbians, gays, bisexuals, asexuals, those who were awaiting a decision regarding residence permit and those born in South Asia reported poor sexual health to a greater extent and fulfilment of their sexual rights to a lesser extent than other groups. CONCLUSIONS: Timely and culturally adapted information about sexual rights, gender equalities, laws and available services in Sweden should be provided in appropriate languages and formats in order to raise awareness about sexual rights and improve access to available services. Tailored attention should be paid to specific vulnerable subgroups.


Assuntos
Saúde Sexual , Migrantes , Estudos Transversais , Feminino , Acesso aos Serviços de Saúde , Humanos , Masculino , Saúde Reprodutiva , Suécia
17.
Biomed Res Int ; 2021: 6658070, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34485525

RESUMO

In light of the devastation caused by COVID-19, the Agreement on Trade-Related Aspects of Intellectual Property Rights (TRIPS) and vaccine research and development (R&D) have been occupying a prominent position in the field of global health diplomacy (GHD). Most countries, international organizations, and charitable organizations have been engaged in the R&D of COVID-19 vaccines to ensure timely affordability and accessibility to all countries. Concomitantly, the World Trade Organization (WTO) provides some provisions and enforcements regarding copyrights, patents, trademarks, geographical indications, and industrial designs. Given these safeguards, it is considered that intellectual property rights (IPRs) have become major barriers to the affordability and accessibility of vaccines/medicines/technology, particularly to the developing/least developed countries. Realizing the gravity of the pandemic impact, as well as its huge population and size, India has elevated this issue in its global health diplomacy by submitting a joint proposal with South Africa to the World Trade Organization (WTO) for a temporary waiver of IPRs to ensure timely affordability and accessibility of COVID-19 medical products to all countries. However, the issue of the temporary waive off had become a geopolitical issue. Countries that used to claim per se as strong advocates of human rights, egalitarianism, and healthy democracy have opposed this proposal. In this contrasting milieu, this paper is aimed at examining how the TRIPS has become a barrier for developing countries' development and distribution of vaccines/technology; secondly, how India strategizes its role in the WTO in pursuant of its global health diplomacy? We conclude that the IPRs regime should not become a barrier to the accessibility/affordability of essential drugs and vaccines. To ensure access, India needs to get more engaged in GHD with all the involved global stakeholders to get strong support for their joint proposal. The developed countries that rejected/resisted the proposal can rethink their full support.


Assuntos
Vacinas contra COVID-19/imunologia , COVID-19/imunologia , Diplomacia/métodos , Indústria Farmacêutica/métodos , Saúde Global , Acesso aos Serviços de Saúde , Direitos Humanos/métodos , Humanos , Índia , Saúde Pública/métodos , SARS-CoV-2/imunologia
18.
Artigo em Inglês | MEDLINE | ID: mdl-34501496

RESUMO

International mobility has increased steadily in recent times, bringing along a myriad of health, social and health system challenges to migrants themselves and the host nations. Mental health issues have been identified as a significant problem among migrants, with poor accessibility and underutilisation of the available mental health services (MHSs) repeatedly reported, including in Australia. Using a qualitative inquiry and one-on-one in-depth interviews, this study explored perspectives of African migrants and service providers on barriers to accessing MHSs among African migrants in South Australia. The data collection took place during the COVID-19 pandemic with lockdown and other measures to combat the pandemic restricting face to face meetings with potential participants. Online platforms including Zoom and/or WhatsApp video calls were used to interview 20 African migrants and 10 service providers. Participants were recruited from community groups and/or associations, and organisations providing services for migrants and/or refugees in South Australia using the snowball sampling technique. Thematic framework analysis was used to guide the data analysis. Key themes centred on personal factors (health literacy including knowledge and the understanding of the health system, and poor financial condition), structural factors related to difficulties in navigating the complexity of the health system and a lack of culturally aware service provision, sociocultural and religious factors, mental health stigma and discrimination. The findings provide an insight into the experiences of African migrants of service provision to them and offer suggestions on how to improve these migrants' mental health outcomes in Australia. Overcoming barriers to accessing mental health services would need a wide range of strategies including education on mental health, recognising variations in cultures for effective service provision, and addressing mental health stigma and discrimination which strongly deter service access by these migrants. These strategies will facilitate help-seeking behaviours as well as effective provision of culturally safe MHSs and improvement in access to MHSs among African migrants.


Assuntos
COVID-19 , Serviços de Saúde Mental , Refugiados , Migrantes , Controle de Doenças Transmissíveis , Acesso aos Serviços de Saúde , Humanos , Pandemias , Pesquisa Qualitativa , SARS-CoV-2 , Austrália do Sul
19.
Artigo em Inglês | MEDLINE | ID: mdl-34501767

RESUMO

BACKGROUND: The disruption in healthcare provision due to the COVID-19 pandemic forced many non-urgent medical treatments and appointments to be postponed or denied, which is expected to have huge impact on non-acute health conditions, especially in vulnerable populations such as older people. Attention should be paid to equity issues related to unmet needs during the pandemic. METHODS: We calculated concentration indices to identify income-related inequalities and horizontal inequity in unmet needs due to postponed and denied healthcare in people over 50 during COVID-19, using data from the Survey on Health, Ageing and Retirement in Europe (SHARE). RESULTS: Very few countries show significant income-related inequalities in postponed, rescheduled or denied treatments and medical appointments, usually favouring the rich. Only Estonia, Italy and Romania show a significant horizontal inequity (HI) in postponed healthcare, which apparently favours the poor. Significant pro-rich inequity in denied healthcare is found in Italy, Poland and Greece. CONCLUSIONS: Although important income-related horizontal inequity in unmet needs of European older adults during the early waves of the COVID-19 pandemic is not evident for most countries, some of them have to carefully monitor barriers to healthcare access. Delays in diagnosis and treatments may ultimately translate into adverse health outcomes, reduced quality of life and, even, widen socio-economic health inequalities among older people.


Assuntos
COVID-19 , Idoso , Europa (Continente)/epidemiologia , Acesso aos Serviços de Saúde , Disparidades em Assistência à Saúde , Humanos , Pandemias , Qualidade de Vida , SARS-CoV-2 , Fatores Socioeconômicos
20.
Lakartidningen ; 1182021 Sep 07.
Artigo em Sueco | MEDLINE | ID: mdl-34498239

RESUMO

Adults with developmental disabilities, e.g. intellectual disability, autism, cerebral palsy or neuromuscular diseases ,have an increased risk of somatic and psychiatric disorders and of premature death. Many are dependent on others to communicate symptoms and access health care, and standard treatments often need to be individually adapted. The services offered these adults vary between regions. Physicians are scarce and of varying medical background. Adults with developmental disabilities should be entitled to equivalent specialized services, regardless of region of residence. Preventable morbidity and mortality should be minimized. To achieve this: Nurses and physicians should be included in the specialized services in all regions A curriculum for physicians in specialized services is needed The knowledge of developmental disabilities and accompanying health conditions needs to be enhanced throughout the health care system.


Assuntos
Transtorno Autístico , Paralisia Cerebral , Deficiência Intelectual , Adulto , Paralisia Cerebral/terapia , Criança , Deficiências do Desenvolvimento/terapia , Acesso aos Serviços de Saúde , Humanos , Deficiência Intelectual/terapia
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