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1.
Isr J Health Policy Res ; 9(1): 61, 2020 11 02.
Artigo em Inglês | MEDLINE | ID: mdl-33138855

RESUMO

BACKGROUND: Israel hosts nearly 70,000 migrant careworkers. Migrant careworkers work and live with populations extremely vulnerable to the novel Coronavirus, including the elderly and people with pre-existing physical conditions. This rapid assessment aimed to explore psychosocial status and mental wellbeing of migrant careworkers in Israel during the ongoing Covid-19 pandemic and determine risk and protective factors associated with mental distress, anxiety, and depression. METHODS: This quantitative study was conducted via an online survey. The online survey collected social and demographic data, including country of origin, residence, age, sex, and time in Israel. In addition, questions were asked about knowledge of COVID-19 guidelines, access to supplies, and COVID-related racism. Respondents also completed a psychosocial screening tools, the Hopkins Symptom Checklist-10 (HSCL-10), which was used to screen for depression and anxiety. RESULTS: As of May 3rd, 2020, 307 careworkers responded to the online survey, of whom 120 (39.1%) were found symptomatic using the HSCL-10. Separating the HSCL-10 into subscales, 28.0% were symptomatically anxious, and 38.1% were symptomatic for depression. In multivariate regression, emotional distress was associated with household food insecurity (OR: 5.85; p < 0.001), lack of confidence to care for oneself and employer during the pandemic (OR: 3.85; p < 0.001), poorer general health (OR: 2.98; p < 0.003), non-Philippine country of origin (OR: 2.83; p < 0.01), female sex (OR: 2.34; p < 0.04),, and inversely associated with age (p < 0.03). While 87.6% of careworkers reported having access to hand sanitization materials regularly, only 58.0% had regular access to a medical grade mask, and 21.5% reported household food insecurity. Moreover, 40.0% of careworkers claimed to lack confidence to care for themselves and their employer during the COVID-19 pandemic. CONCLUSIONS: Migrant careworkers exhibited high levels of mental distress during the COVID-19 lockdown, associated with lack of confidence or resources to properly care for themselves and their employer. Guidelines and support programs specific to the carework sector, that respect their rights and guard their health, must be developed as part of a coordinated COVID-19 response.


Assuntos
Cuidadores/psicologia , Infecções por Coronavirus/prevenção & controle , Transtornos Mentais/epidemiologia , Pandemias/prevenção & controle , Pneumonia Viral/prevenção & controle , Quarentena/psicologia , Migrantes/psicologia , Adulto , Idoso , Ansiedade/epidemiologia , Cuidadores/estatística & dados numéricos , Infecções por Coronavirus/epidemiologia , Depressão/epidemiologia , Feminino , Inquéritos Epidemiológicos , Humanos , Israel/epidemiologia , Masculino , Pessoa de Meia-Idade , Pneumonia Viral/epidemiologia , Fatores de Proteção , Angústia Psicológica , Fatores de Risco , Migrantes/estatística & dados numéricos
2.
Psychiatr Pol ; 54(3): 421-436, 2020 Jun 30.
Artigo em Inglês, Polonês | MEDLINE | ID: mdl-33038878

RESUMO

SARS-CoV-2 poses a particular risk to the elderly and people with many comorbidities. In the case of people with dementia, the compliance with sanitary recommendations and the necessary physical isolation can have far-reaching negative consequences in terms of limiting the continuation of tailored care, support and treatment. The recommendations related to the SARS-CoV-2 pandemic must take into account not only the medical consequences of lack of access to medical care, but also their long-term effects and the disease progression in accordance with the concept of social health. A plan of action for the psychoeducation of informal carers, adapted to the elderly group (including people with dementia), is also necessary. Prepared under the auspices of the Polish Psychiatric Association, the recommendations for people living alone, with their family and in long-term care facilities are intended to draw attention to key epidemiological issues that can be planned by medical staff within the organization of patient care. However, mental and social needs of patients, whose fulfilment is particularly significant in times of restrictions related to everyday activities, are of equal importance. Further monitoring of the epidemiological situation and scientific reports related to the SARS-CoV-2 pandemic are necessary to verify and update the guidelines.


Assuntos
Betacoronavirus , Cuidadores/estatística & dados numéricos , Infecções por Coronavirus/terapia , Demência/terapia , Pneumonia Viral/terapia , Atividades Cotidianas , Idoso , Cuidadores/educação , Infecções por Coronavirus/epidemiologia , Humanos , Pandemias , Pneumonia Viral/epidemiologia , Polônia , Guias de Prática Clínica como Assunto , Medição de Risco , Isolamento Social , Sociedades Médicas
3.
Niger J Clin Pract ; 23(10): 1333-1338, 2020 Oct.
Artigo em Inglês | MEDLINE | ID: mdl-33047688

RESUMO

Backround: The fiduciary duty of a managing physician makes paediatric discharges against medical advice (DAMA) particularly challenging as children lack the legal power or authority to make their health decisions. Aim: It is aimed in the present study to determine the prevalence of paediatric DAMA in a mission tertiary hospital. Methods: This was a prospective descriptive study carried out from June 2018 to May 2019 among paediatric inpatients at the Bowen University Teaching Hospital, Ogbomoso, Nigeria whose parent/ care giver signed DAMA, despite adequate counselling. Data was analysed using SPSS version 23. Results: The prevalence of DAMA in the study was of 4.1%, and the neonatal group accounted for the largest bulk of DAMA. Birth asphyxia was the commonest diagnosis among this group. There was a slight female predominance among the patients whose parents signed DAMA. Financial constraint was the commonest reason [13(30.2%)] given for DAMA and none of the children whose parents signed DAMA was enrolled on the National Health Insurance Scheme (NHIS). Conclusion: Rate of DAMA in a private mission tertiary hospital was lower than previously reported from government tertiary hospitals in the present-day Nigeria.


Assuntos
Cuidadores/estatística & dados numéricos , Hospitais Religiosos/estatística & dados numéricos , Pais/psicologia , Alta do Paciente/estatística & dados numéricos , Pediatria , Recusa do Paciente ao Tratamento/estatística & dados numéricos , Cuidadores/psicologia , Criança , Pré-Escolar , Aconselhamento , Feminino , Hospitais Privados , Humanos , Pacientes Internados , Masculino , Nigéria/epidemiologia , Prevalência , Estudos Prospectivos , Fatores Socioeconômicos
4.
PLoS One ; 15(10): e0239767, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33044968

RESUMO

INTRODUCTION: HIV status disclosure in children is one of acontroversial issue in current health. Over 44,000 children in Ethiopia were living with HIV in the year 2019 with a variable level of disclosure, which ranges from 16.3% to 49%. Therefore, this study aimed to assess HIV-positive status disclosure and associated factors among HIV-infected children. METHODS: A cross-sectional study was conducted in ten public health facilities providing pediatric antiretroviral therapy services. Systematic random sampling was used to select 221 caregivers of children aged 6-15 years. Face-to-face interviews were employed to generate the data. Binary logistic regression was used to analyze the association between HIV-positive status disclosure to children and independent variables with statistical significance set at p-value <0.05. RESULTS: Out of the total, 134 (60.6%) of HIV-infected children knew about their HIV status. The mean age at disclosure was 10.71 years. Children aged older than 10 years [AOR = 22, 95% CI: 5.3-79.2], female children [AOR = 3; 95% CI = 1.2-8.7], children lost their family member by HIV [AOR = 3.5, 95% CI: 1.2-10], caregiver's perception of child did not get stigmatized [AOR = 4, 95% CI: 1.6-11], and children's responsible for anti-retroviral therapy [AOR = 16, 95% CI: 5-50] were significantly associated with HIV positive status disclosure compared to their counterpart respectively. Children who stayed on anti-retroviral for 10-15 years were [AOR = 7; 95% CI: 2-27] more likely to know their HIV positive status compared to those staying on anti-retroviral therapy for <6 years. CONCLUSION: The proportion of disclosure of HIV-positive status among HIV-infected children was low. Factors associated were the age of the child, sex, existence of parent, stigma, ART duration, and responsibility of the child for his/her drugs. HIV care providers should consider these factors while supporting disclosure.


Assuntos
Fármacos Anti-HIV/uso terapêutico , Revelação/estatística & dados numéricos , Infecções por HIV/tratamento farmacológico , Adolescente , Adulto , Cuidadores/estatística & dados numéricos , Criança , Estudos Transversais , Etiópia , Feminino , Instalações de Saúde/estatística & dados numéricos , Humanos , Modelos Logísticos , Masculino , Pessoa de Meia-Idade , Pais , Estigma Social , Adulto Jovem
5.
PLoS One ; 15(10): e0238693, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-33007005

RESUMO

INTRODUCTION: Most research depicts older adults as needing personal care, with limited research on older adults' contributions in the lives of others in developing countries like Ghana. The purpose of the study was to examine the personal care provision and socio-demographic correlates of personal care provision by older adult inpatients in Ghana. MATERIALS AND METHODS: A hospital-based survey was conducted among 400 consecutively surveyed older adult inpatients at Komfo Anokye Teaching Hospital in southern Ghana. Stata 15 was used to analyse the data. The relationship between personal care and older adult inpatients' socio-demographic characteristics were analysed using the chi-square test. Multivariate logistic regression analysis was employed. RESULTS: Overall, 28% of older adult inpatients provided personal care. Participants were mostly females, married or cohabiting, completed at most junior high school, Christians, urban residents, not working and living with their immediate family. Primarily, most participants provided personal care to one person, once a week, and one-hour duration. Nearly three-quarters of participants provided personal care to someone who lives with them. After adjustment, male older adults were 50% less likely to and urban residents were 83% more likely to provide personal care. Being single, separated or divorced was statistically significantly associated with personal care provision, however, were not statistically significant after adjusting for sex and residence. A post hoc analysis testing for interaction revealed no relationship existing between sex and marital status concerning personal care provision (p = 0.106). CONCLUSION: Female and urban resident older adult inpatients in Ghana are not just passive receivers of care but also provide personal care to others with functional difficulties, independent on age. It further draws attention to the need for policies and programs that can support older adults, particularly females and urban residents, to be productive in the later life.


Assuntos
Cuidadores , Pacientes Internados , Autocuidado , Idoso , Idoso de 80 Anos ou mais , Cuidadores/estatística & dados numéricos , Características da Família , Feminino , Gana , Humanos , Pacientes Internados/estatística & dados numéricos , Masculino , Pessoa de Meia-Idade , Análise Multivariada , População Rural , Autocuidado/estatística & dados numéricos , Fatores Socioeconômicos , Inquéritos e Questionários , População Urbana
6.
Cien Saude Colet ; 25(9): 3555-3556, 2020 Sep.
Artigo em Inglês, Português | MEDLINE | ID: mdl-32876280

RESUMO

We live in a global pandemic unprecedented in our generation. These are challenging times for healthcare workers. We are all in the same storm and join the same collective effort against COVID-19. However, we are not in the same boat. Inequality determines how each category of the health workforce is affected by the new coronavirus in Brazil. Exposed to the disease on the frontlines, nursing technicians and assistants suffer disproportionately the dire effects of the pandemic. More than 1.3 million technicians and almost 420 thousand nursing assistants provide essential care in health units and do not have the assistance and financial backing to mitigate the effects of COVID-19 on themselves and their families. Eight in every ten of these professionals are women, who are providers and also assume, in most cases, the role of primary caregivers for children, older adults, and the sick in their families. Low wages make hinder access to safer transportation and care alternatives for dependents, which is the reality of most professionals who keep the health system running throughout the pandemic.


Assuntos
Infecções por Coronavirus/epidemiologia , Pessoal de Saúde/estatística & dados numéricos , Disparidades nos Níveis de Saúde , Pneumonia Viral/epidemiologia , Brasil/epidemiologia , Cuidadores/estatística & dados numéricos , Infecções por Coronavirus/terapia , Assistência à Saúde/organização & administração , Feminino , Pessoal de Saúde/organização & administração , Humanos , Masculino , Pandemias , Pneumonia Viral/terapia
7.
Pediatrics ; 146(4)2020 10.
Artigo em Inglês | MEDLINE | ID: mdl-32938778

RESUMO

BACKGROUND: Involvement with Child Protective Services (CPS) provides an opportunity to recognize those children at risk for ongoing adverse childhood experiences (ACEs). The relationship between ACEs and child health among CPS-involved children and the role of primary care providers (PCPs) in moderating this relationship is unknown. METHODS: We conducted a convergent mixed-methods study of caregivers of children age 2 to 12 years with a CPS finding of physical abuse, modeling the association between cumulative ACEs and child health-related quality of life (HRQoL) using the PedsQL4.0, a validated 23-item survey of multidimensional health, with and without the moderator of a patient-centered medical home. Interviews elicited descriptions of a child's experience with ACEs, the impact of ACEs on child health, and the role of a PCP in this context. RESULTS: One hundred seventy-eight surveyed caregivers reported a mean of 5.5 (±3.3) ACE exposures per child. In a fully adjusted model, each ACE resulted in a 1.3-point (95% confidence interval: 0.7-2.0) reduction in HRQoL, a clinically important difference in HRQoL associated with ACE exposures. This association was explained by reduced psychosocial HRQoL and was not moderated by a patient-centered medical home. Twenty-seven interviewed caregivers described the influence of ACEs on a child's health. Many felt that a trusted PCP could support a child's well-being after such experiences. CONCLUSIONS: Children with CPS involvement have ACE exposures that are associated with reduced HRQoL. Although PCPs are often unaware of CPS involvement or other ACEs, many caregivers welcome the support of a child's PCP in improving child well-being after adversity.


Assuntos
Experiências Adversas da Infância/estatística & dados numéricos , Cuidadores/psicologia , Maus-Tratos Infantis/psicologia , Saúde da Criança , Serviços de Proteção Infantil , Qualidade de Vida/psicologia , Adulto , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Intervalos de Confiança , Feminino , Humanos , Masculino , Assistência Centrada no Paciente , Pesquisa Qualitativa , Tamanho da Amostra
8.
Cochrane Database Syst Rev ; 9: CD012780, 2020 09 30.
Artigo em Inglês | MEDLINE | ID: mdl-32996586

RESUMO

BACKGROUND: Serious illness is often characterised by physical/psychological problems, family support needs, and high healthcare resource use. Hospital-based specialist palliative care (HSPC) has developed to assist in better meeting the needs of patients and their families and potentially reducing hospital care expenditure. There is a need for clarity on the effectiveness and optimal models of HSPC, given that most people still die in hospital and also to allocate scarce resources judiciously. OBJECTIVES: To assess the effectiveness and cost-effectiveness of HSPC compared to usual care for adults with advanced illness (hereafter patients) and their unpaid caregivers/families. SEARCH METHODS: We searched CENTRAL, CDSR, DARE and HTA database via the Cochrane Library; MEDLINE; Embase; CINAHL; PsycINFO; CareSearch; National Health Service Economic Evaluation Database (NHS EED) and two trial registers to August 2019, together with checking of reference lists and relevant systematic reviews, citation searching and contact with experts to identify additional studies. SELECTION CRITERIA: We included randomised controlled trials (RCTs) evaluating the impact of HSPC on outcomes for patients or their unpaid caregivers/families, or both. HSPC was defined as specialist palliative care delivered by a palliative care team that is based in a hospital providing holistic care, co-ordination by a multidisciplinary team, and collaboration between HSPC providers and generalists. HSPC was provided to patients while they were admitted as inpatients to acute care hospitals, outpatients or patients receiving care from hospital outreach teams at home. The comparator was usual care, defined as inpatient or outpatient hospital care without specialist palliative care input at the point of entry into the study, community care or hospice care provided outside of the hospital setting. DATA COLLECTION AND ANALYSIS: We used standard methodological procedures expected by Cochrane. We assessed risk of bias and extracted data. To account for use of different scales across studies, we calculated standardised mean differences (SMDs) with 95% confidence intervals (CIs) for continuous data. We used an inverse variance random-effects model. For binary data, we calculated odds ratio (ORs) with 95% CIs. We assessed the evidence using GRADE and created a 'Summary of findings' table. Our primary outcomes were patient health-related quality of life (HRQoL) and symptom burden (a collection of two or more symptoms). Key secondary outcomes were pain, depression, satisfaction with care, achieving preferred place of death, mortality/survival, unpaid caregiver burden, and cost-effectiveness. Qualitative data was analysed where available. MAIN RESULTS: We identified 42 RCTs involving 7779 participants (6678 patients and 1101 caregivers/family members). Twenty-one studies were with cancer populations, 14 were with non-cancer populations (of which six were with heart failure patients), and seven with mixed cancer and non-cancer populations (mixed diagnoses). HSPC was offered in different ways and included the following models: ward-based, inpatient consult, outpatient, hospital-at-home or hospital outreach, and service provision across multiple settings which included hospital. For our main analyses, we pooled data from studies reporting adjusted endpoint values. Forty studies had a high risk of bias in at least one domain. Compared with usual care, HSPC improved patient HRQoL with a small effect size of 0.26 SMD over usual care (95% CI 0.15 to 0.37; I2 = 3%, 10 studies, 1344 participants, low-quality evidence, higher scores indicate better patient HRQoL). HSPC also improved other person-centred outcomes. It reduced patient symptom burden with a small effect size of -0.26 SMD over usual care (95% CI -0.41 to -0.12; I2 = 0%, 6 studies, 761 participants, very low-quality evidence, lower scores indicate lower symptom burden). HSPC improved patient satisfaction with care with a small effect size of 0.36 SMD over usual care (95% CI 0.41 to 0.57; I2 = 0%, 2 studies, 337 participants, low-quality evidence, higher scores indicate better patient satisfaction with care). Using home death as a proxy measure for achieving patient's preferred place of death, patients were more likely to die at home with HSPC compared to usual care (OR 1.63, 95% CI 1.23 to 2.16; I2 = 0%, 7 studies, 861 participants, low-quality evidence). Data on pain (4 studies, 525 participants) showed no evidence of a difference between HSPC and usual care (SMD -0.16, 95% CI -0.33 to 0.01; I2 = 0%, very low-quality evidence). Eight studies (N = 1252 participants) reported on adverse events and very low-quality evidence did not demonstrate an effect of HSPC on serious harms. Two studies (170 participants) presented data on caregiver burden and both found no evidence of effect of HSPC (very low-quality evidence). We included 13 economic studies (2103 participants). Overall, the evidence on cost-effectiveness of HSPC compared to usual care was inconsistent among the four full economic studies. Other studies that used only partial economic analysis and those that presented more limited resource use and cost information also had inconsistent results (very low-quality evidence). Quality of the evidence The quality of the evidence assessed using GRADE was very low to low, downgraded due to a high risk of bias, inconsistency and imprecision. AUTHORS' CONCLUSIONS: Very low- to low-quality evidence suggests that when compared to usual care, HSPC may offer small benefits for several person-centred outcomes including patient HRQoL, symptom burden and patient satisfaction with care, while also increasing the chances of patients dying in their preferred place (measured by home death). While we found no evidence that HSPC causes serious harms, the evidence was insufficient to draw strong conclusions. Although these are only small effect sizes, they may be clinically relevant at an advanced stage of disease with limited prognosis, and are person-centred outcomes important to many patients and families. More well conducted studies are needed to study populations with non-malignant diseases and mixed diagnoses, ward-based models of HSPC, 24 hours access (out-of-hours care) as part of HSPC, pain, achieving patient preferred place of care, patient satisfaction with care, caregiver outcomes (satisfaction with care, burden, depression, anxiety, grief, quality of life), and cost-effectiveness of HSPC. In addition, research is needed to provide validated person-centred outcomes to be used across studies and populations.


Assuntos
Cuidadores/estatística & dados numéricos , Serviços Hospitalares de Assistência Domiciliar/economia , Cuidados Paliativos/economia , Cuidados Paliativos/métodos , Assistência Terminal/economia , Assistência Terminal/métodos , Assistência Ambulatorial/economia , Viés , Cuidadores/psicologia , Análise Custo-Benefício , Família , Insuficiência Cardíaca/mortalidade , Insuficiência Cardíaca/terapia , Hospitalização/economia , Humanos , Neoplasias/mortalidade , Neoplasias/terapia , Manejo da Dor/estatística & dados numéricos , Satisfação do Paciente , Qualidade de Vida , Ensaios Clínicos Controlados Aleatórios como Assunto , Avaliação de Sintomas/estatística & dados numéricos
9.
PLoS One ; 15(9): e0238286, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32898141

RESUMO

BACKGROUND: Young people in state care, often due to abuse or neglect, have a four-fold increased risk of drug and alcohol use compared to their peers. AIM: The SOLID study aimed to investigate the feasibility of a definitive randomised controlled trial, comparing two behaviour change interventions to reduce risky substance use (illicit drugs and alcohol), and improve mental health, in young people in care. METHODS: We recruited young people in care aged 12-20 years, self-reporting substance use within the previous 12 months and residing in 1 of 6 participating local authority sites in the North East of England. Participants were randomised to either i. Motivational Enhancement Therapy (MET), ii. Social Behaviour and Network Therapy (SBNT) or iii. Control (usual care). All interventions were delivered by trained drug and alcohol workers. Follow-up data were collected 12 months post recruitment. Feasibility for trial progression was compared to pre-specified stop: go criteria (recruitment of 60% of eligible participants, 80% of participants attending 60% of offered sessions and retention of 70% of participants at 12 month follow up). RESULTS: Of 1450 eligible participants, 860 (59%) were screened for drug and alcohol use by social workers, 211 (24.5%) met inclusion criteria for the trial and 112 young people (7.7%) consented and were randomised. Sixty of these 112 participants (54%) completed 12-month follow-up questionnaires. Only 15 out of the 76 (20%) participants allocated to an intervention arm attended any of the offered MET or SBNT sessions. CONCLUSION: By reference to pre-specified stop: go criteria it is not feasible to conduct a definitive trial for SOLID in its current format. Despite co-designing procedures with staff and young people in care, the screening, referral and treatment pathway did not work here. Future work may require dedicated clinically embedded research resource to evaluate effectiveness of new interventions in services.


Assuntos
Terapia Comportamental/métodos , Cuidadores/estatística & dados numéricos , Educação de Pacientes como Assunto , Qualidade de Vida , Transtornos Relacionados ao Uso de Substâncias/terapia , Inquéritos e Questionários/normas , Adolescente , Adulto , Criança , Análise Custo-Benefício , Estudos de Viabilidade , Feminino , Humanos , Masculino , Saúde Mental , Projetos Piloto , Autocuidado , Transtornos Relacionados ao Uso de Substâncias/psicologia , Adulto Jovem
10.
BMC Public Health ; 20(1): 1241, 2020 Aug 15.
Artigo em Inglês | MEDLINE | ID: mdl-32799826

RESUMO

BACKGROUND: Providing universal access to safe water, sanitation and hygiene (WASH) in remote Nepal remains challenging. We investigated WASH conditions and their association with children's nutritional status, intestinal parasitic infections and diarrhoea. METHODS: Data was collected through a cross-sectional survey of 1427 households, including questionnaires, observations, stool analysis, anthropometry, water quality measurements, and assessment of clinical signs of nutritional deficiencies. RESULTS: We found 55.5% of children were undernourished, 63.9% had clinical signs of nutritional deficiencies, 51.1% had intestinal parasitic infections and 52.2% had diarrhoea. Multivariate mixed logistic regression analysis revealed a statistically significant negative association between undernutrition and socio-economic level, with adjusted odds ratios (AOR) of 0.70 (95%-CI = 0.43-1.11) and 0.43 (95%-CI = 0.25-0.75) for high and intermediate levels compared to the lowest level. Undernutrition was negatively associated with regular deworming of children (AOR = 0.44, 95% CI = 0.20-0.94), food supplements (AOR = 0.57, 95% CI = 0.38-0.84), household's own food production (AOR = 0.67, 95% CI = 0.46-0.97) and personal hygiene (AOR = 0.83, 95% CI = 0.51-1.35). Nutritional deficiency was negatively associated with handwashing after cleaning a baby's bottom (AOR = 0.60, 95% CI = 0.40-0.92) and cleanliness of caregiver's hands (AOR = 0.61, 95% CI = 0.41-0.89) and positively associated with keeping animals inside the house overnight (AOR = 1.71, 95% CI = 1.17-2.51) and the presence of total coliforms in the drinking water source (AOR = 10.44, 95% CI = 1.61-67.4). Diarrhoea was positively associated with intermittent water supply (AOR = 2.72, 95% CI = 1.18-6.31) and the presence of a mud floor (AOR = 2.29, 95% CI = 1.20-4.37) and negatively associated with cleanliness of the toilet (AOR = 0.68, 95% CI = 0.47-0.98), and the cleanliness of children's hands (AOR = 0.62, 95% CI = 0.40-0.96). CONCLUSIONS: Our study found, more than half of the survey children were in a critical health condition. Results suggest that child health improvements are dependent on multiple public health improvements, including providing better nutrition, promoting adequate hygiene behaviour, such as handwashing, keeping the latrines clean, keeping the household environment free from animal faeces and assuring a reliable supply of safe water.


Assuntos
Diarreia/epidemiologia , Higiene , Enteropatias Parasitárias/epidemiologia , Estado Nutricional , Saúde da População Rural/estatística & dados numéricos , Saneamento/estatística & dados numéricos , Abastecimento de Água/estatística & dados numéricos , Adulto , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Nepal/epidemiologia
11.
Niger J Clin Pract ; 23(8): 1127-1134, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32788491

RESUMO

Background: The Child Welfare Card (CWC) contains the records of a child's immunization and information on the other aspects of the child's health, including growth curves and home treatment of diarrheal disease to mention a few. How easily retrievable these records are and what influence the cards have on parents/caregivers regarding the child's nurture are uncertain in our environment. Aim: The present study was aimed at assessing the parents/caregivers' knowledge and utilization of CWCs as well as the health-providers' accessibility of the card in the hospital. Method: This study was a cross-sectional descriptive one that involved the parents/caregivers of children aged 60 months and below, attending the children's clinics and wards in a tertiary center. We collected the relevant information, including the sociodemographic data of the parents/caregivers, their knowledge, and assessed the utilization of CWC. The analysis of the categorical data was performed with the IBM Statistical Package for Social Sciences (S.P.S.S) version 23.0 for windows. P values < 0.05 were considered significant. Results: Of the 377 parents/caregivers enrolled in the study, good knowledge of the contents of the CWC was demonstrated by 82 (21.8%) while 78 (20.7%) made the cards available to the health care providers. Eighty (21.2%) made adequate use of the cards at home. A greater number of parents/caregivers from the higher social class had good knowledge of the intervention contents of the CWC (P = 0.005). The accessibility of the cards to the health care-providers was significantly higher among the older parents/caregivers (P = 0.010), those with a good knowledge of CWC (P = 0.020) and parents/caregivers from higher social class (P = 0.001). Subjects with good knowledge were 2.4 times (OR = 2.4, 95% CI = 1.4-4.2) more likely to utilize the intervention contents in the CWC. Conclusion: The overall knowledge, utilization, and accessibility of the CWC were poor. Parents/caregivers with good knowledge were more likely to utilize the information on the CWC compared with participants with poor knowledge.


Assuntos
Cuidadores/estatística & dados numéricos , Serviços de Saúde da Criança/estatística & dados numéricos , Bem-Estar da Criança/estatística & dados numéricos , Conhecimentos, Atitudes e Prática em Saúde , Pessoal de Saúde/psicologia , Registros Médicos/estatística & dados numéricos , Adulto , Cuidadores/psicologia , Criança , Saúde da Criança , Serviços de Saúde da Criança/organização & administração , Pré-Escolar , Estudos Transversais , Família , Feminino , Pesquisas sobre Serviços de Saúde , Humanos , Esquemas de Imunização , Masculino , Pessoa de Meia-Idade , Nigéria , Classe Social , Fatores Socioeconômicos
12.
Pediatrics ; 146(3)2020 09.
Artigo em Inglês | MEDLINE | ID: mdl-32753371

RESUMO

BACKGROUND AND OBJECTIVES: Although clinical settings are increasingly screening for social determinants of health, essential questions about optimal screening remain. We aimed to assess primary care contexts of individuals choosing not to answer questions about health-related social needs and to compare screening question response with subsequent use of resource information. METHODS: We compared caregiver responses to an electronic survey administered during a child's emergency department visit and through telephone follow-up 2 weeks later by responses to questions about health-related social needs (no social needs endorsed, ≥1 endorsed, none endorsed but ≥1 question not answered). RESULTS: Of 146 respondents, 42 (29%) endorsed ≥1 health-related social need. Additionally, 19 (13%) endorsed no social needs but did not answer ≥1 question. Compared with those denying all social needs and those endorsing ≥1 social need, respondents who did not answer social needs screening questions reported longer duration since their child's last primary care visit, lower perceptions of primary care, and less social support. For the 61 respondents participating in the 2-week follow-up survey, reported use of a community resource packet was 37% among those who had reported a social need, 26% among those who had denied all social needs, and 0% among those who had not answered ≥1 social needs questions. CONCLUSIONS: Clinicians and systems implementing screening for health-related social risks should plan for individuals who choose not to respond to specific items and may also wish to consider strategies that do not rely on screening and disclosure, particularly in communities known to have high prevalence of social needs.


Assuntos
Acesso à Informação , Cuidadores/estatística & dados numéricos , Inquéritos Epidemiológicos/estatística & dados numéricos , Determinação de Necessidades de Cuidados de Saúde/estatística & dados numéricos , Determinantes Sociais da Saúde/estatística & dados numéricos , Adulto , Cuidadores/psicologia , Distribuição de Qui-Quadrado , Pré-Escolar , Feminino , Seguimentos , Abastecimento de Alimentos/estatística & dados numéricos , Recursos em Saúde/organização & administração , Humanos , Comportamento de Busca de Informação , Masculino , Pessoa de Meia-Idade , Atenção Primária à Saúde , Apoio Social , Transportes/estatística & dados numéricos , Adulto Jovem
13.
N C Med J ; 81(4): 270-274, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32641467

RESUMO

Medical advances paired with expanding home care technology and shorter hospital stays have placed increased responsibilities on family and friends. Yet, most caregivers report they are ill-prepared for their role. There are services and supports specifically designed to assist family caregivers.


Assuntos
Cuidadores/psicologia , Apoio Social , Estresse Psicológico/prevenção & controle , Adulto , Cuidadores/economia , Cuidadores/estatística & dados numéricos , Humanos , North Carolina
14.
Saudi Med J ; 41(7): 733-739, 2020 Jul.
Artigo em Inglês | MEDLINE | ID: mdl-32601642

RESUMO

OBJECTIVES: To investigate the level of asthma control among children and to investigate the association between asthma control and the knowledge of caregivers. METHODS: A cross-sectional study was conducted from January 2018 to July 2018 among 278 children with asthma aged 1-12 with their caregivers attending the primary health care centers in Al Madinah Al Munawarah, Saudi Arabia. An asthma knowledge questionnaire was used to measure the parents' knowledge. The Test for Respiratory and Asthma Control in Kids (TRACK) and the Childhood Asthma Control Test (C-ACT) were used to evaluate asthma control among the children. Univariate and multivariate analyses were used to compare the knowledge level between the controlled and uncontrolled asthma groups. RESULTS: Approximately 62.6% of children had uncontrolled asthma and 37.4% were controlled. The knowledge scores of the caregivers ranged from 43 to 64, with a mean score of 52.55. The mean knowledge score was higher in the controlled group (55.57) than in the uncontrolled group (50.76). There was a statistically significant difference in the knowledge scores between the participant groups (t=9.892, p less than 0.001). CONCLUSION: There is a high percentage of children with uncontrolled asthma and 3 is a high knowledge deficit among the caregivers of children with asthma. An educational program targeting the general population and the caregivers should be implemented to correct any false beliefs regarding asthma and asthma medications.


Assuntos
Asma/terapia , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Educação em Saúde , Conhecimento , Adulto , Asma/epidemiologia , Asma/etiologia , Asma/prevenção & controle , Criança , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Lactente , Masculino , Pessoa de Meia-Idade , Arábia Saudita/epidemiologia , Inquéritos e Questionários
15.
Public Health ; 185: 139-143, 2020 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-32622221

RESUMO

OBJECTIVES: There is a lack of evidence on the health-related impacts of being a young carer. This article takes a population approach to young carer research specifically to investigate the prevalence of young carers and explore differences in their health, well-being and future expectations. STUDY DESIGN: This is a cross-sectional regression analysis. METHODS: Secondary analysis of a representative Scottish secondary school survey was undertaken. Pupils with caring responsibilities were identified, and their outcomes in terms of physical and mental health and postschool expectations were analysed. RESULTS: Almost one in eight (12%) surveyed reported caring for someone in the household. Young carers' physical and mental health and psychosocial outcomes were significantly poorer, and they were significantly less likely to see themselves entering further or higher education. CONCLUSION: This research suggests that Glasgow could have many more young carers than previously thought and provides clear evidence that young people's outcomes are influenced by carer status.


Assuntos
Cuidadores/estatística & dados numéricos , Nível de Saúde , Adolescente , Cuidadores/psicologia , Criança , Estudos Transversais , Feminino , Humanos , Masculino , Saúde Mental , Escócia/epidemiologia , Inquéritos e Questionários
16.
Epidemiol Health ; 42: e2020031, 2020.
Artigo em Inglês | MEDLINE | ID: mdl-32493005

RESUMO

OBJECTIVES: The characteristics of depressive symptoms in the family members of home-dwelling patients with dementia have not been clearly reported. This study aimed to investigate the characteristics of depressive symptoms in middle-aged family members living with a patient with dementia. METHODS: This study used the data from the nationwide 2017 Korea Community Health Survey. Among the 228,381 survey participants, 77,276 participants in their 40s and 50s were finally selected for this study. The participants consisted of 760 family members of home-dwelling dementia patients and 76,516 general family members comprising a control group. RESULTS: The positive rate of Patient Health Questionnaire-9 (PHQ-9)-measured depressive symptoms was significantly higher in the family members of home-dwelling dementia patients (4.4%; control group: 1.9%). After adjusting for potential confounders, the prevalence of PHQ-measured depressive symptoms was 1.72 times (95% confidence interval [CI], 1.03 to 2.85) higher in the family members of home-dwelling dementia patients compared to the control group. The positive rate of depressive symptoms was 2.26 times higher (95% CI, 1.26 to 4.05) in the female middle-aged family members of home-dwelling dementia patients compared to the control group. In addition, those who reported having symptoms almost every day in the PHQ-9 questions had significantly higher positive rates on questions about loss of interest, depression, sleep disturbance, fatigue, poor appetite, and suicidal ideation, and not on questions regarding feelings of worthlessness and psychomotor agitation, compared to the control group. CONCLUSIONS: Active interventions are needed to relieve depression in the family members of home-dwelling dementia patients.


Assuntos
Cuidadores/psicologia , Demência/terapia , Depressão/epidemiologia , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Estudos de Casos e Controles , Estudos Transversais , Feminino , Inquéritos Epidemiológicos , Humanos , Masculino , Pessoa de Meia-Idade , República da Coreia/epidemiologia , Características de Residência
17.
Environ Health Prev Med ; 25(1): 24, 2020 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-32590934

RESUMO

BACKGROUND: The Japanese health and welfare industry has a shortage of professional caregivers, and work-related accidents and injuries among this group are therefore especially critical issues. This study aimed to examine the factors associated with turnover intentions and work-related injuries and accidents among professional caregivers in Japan. METHODS: Self-report questionnaires were distributed to care workers (N = 1396) at 26 geriatric-care facilities. The questionnaire addressed basic attributes, work and organizational characteristics, wage adequacy, and intrinsic motivations for work (e.g., "being suited to caring work"). Social-relational aspects of the work environment were assessed via three subscales of the Social Capital and Ethical Climate in the Workplace instrument (i.e., "Social Capital in the Workplace," "Exclusive Workplace Climate," and "Ethical Leadership"). Dependent variables were the experience of work-related accidents or injuries in the prior year and organizational and occupational turnover intentions. We used datasets of professional caregivers for analyses. RESULTS: The response rate was 68% (N = 949). Among the 667 professional caregivers, 63% were female. On multivariable logistic regression analysis for work-related accidents and injuries for each sex, those with higher scores for "being suited to caring work" were found to experience significantly fewer work-related accidents and injuries (odds ratio [OR] = 0.78, p < 0.01) among female caregivers. Male caregivers who perceived an exclusive workplace climate experienced more work-related accidents and injuries (OR = 1.61, p < 0.01). However, experience of work-related accidents and injuries did not show significant relationships with organizational and occupational turnover intentions. Additionally, "being suited to caring work" (OR = 0.73, p < 0.01) and ethical leadership (OR = 0.76, p < 0.05) were found to be negatively associated with organizational turnover intentions. "Being suited to caring work" (OR = 0.61, p < 0.01), inadequacy of wage (OR = 2.22, p < 0.05), and marital status (OR = 2.69, p < 0.01) were also associated with occupational turnover intentions of professional caregivers. CONCLUSIONS: These findings highlight the need to foster intrinsic motivations for work as well as providing a supportive and ethical work environment to reduce high turnover rates and work-related injuries and accidents among professional caregivers.


Assuntos
Acidentes de Trabalho/estatística & dados numéricos , Atitude do Pessoal de Saúde , Cuidadores/psicologia , Satisfação no Emprego , Traumatismos Ocupacionais/estatística & dados numéricos , Reorganização de Recursos Humanos/estatística & dados numéricos , Adulto , Cuidadores/estatística & dados numéricos , Feminino , Humanos , Intenção , Japão , Masculino , Pessoa de Meia-Idade , Autorrelato
19.
Artigo em Inglês | MEDLINE | ID: mdl-32560553

RESUMO

BACKGROUND: Patients of malignant mesothelioma (MM) and their caregivers face significant physical and psychological challenges. The purpose of the present study is to examine the emotional impact after the diagnosis of MM in a group of patients and familial caregivers in a National Priority Contaminated Site (NPCS). METHODS: A sample of 108 patients and 94 caregivers received a sociodemographic/clinical questionnaire, the Beck Depression Inventory II, the Davidson Trauma Scale, the Coping Orientation to the Problems Experienced-New Italian Version, and the Defense style questionnaire. The risk of depressive and post-traumatic stress disorder (PTSD) symptoms in relation to the strategies of coping and defense mechanisms was estimated in patients and caregivers separately by logistic regression models. RESULTS: For patients, a high risk of depression was associated with high usage of Defense Style Questionnaire (DSQ) Isolation (OR: 53.33; 95% CI: 3.22-882.30; p = 0.01) and DSQ Somatization (OR: 16.97; 95% CI: 1.04-275.90; p = 0.05). Other significant risks emerged for some coping strategies and some defenses regarding both depression and trauma in patients and caregivers. CONCLUSIONS: This research suggests that for both patients and caregivers unconscious adaptive processes have a central role in dealing with overwhelming feelings related to the disease.


Assuntos
Cuidadores/psicologia , Mesotelioma/epidemiologia , Mesotelioma/psicologia , Doenças Profissionais/epidemiologia , Doenças Profissionais/psicologia , Angústia Psicológica , Adaptação Psicológica , Adulto , Idoso , Asbestos/efeitos adversos , Asbestose/diagnóstico , Asbestose/epidemiologia , Asbestose/etiologia , Asbestose/psicologia , Carcinógenos , Cuidadores/estatística & dados numéricos , Estudos Transversais , Depressão/epidemiologia , Depressão/etiologia , Depressão/psicologia , Exposição Ambiental/estatística & dados numéricos , Feminino , Humanos , Itália/epidemiologia , Masculino , Mesotelioma/diagnóstico , Mesotelioma/etiologia , Pessoa de Meia-Idade , Doenças Profissionais/diagnóstico , Doenças Profissionais/etiologia , Sistema de Registros/estatística & dados numéricos , Fatores de Risco , Transtornos de Estresse Pós-Traumáticos/epidemiologia , Transtornos de Estresse Pós-Traumáticos/etiologia , Transtornos de Estresse Pós-Traumáticos/psicologia , Inquéritos e Questionários
20.
Neurology ; 95(9): e1257-e1266, 2020 09 01.
Artigo em Inglês | MEDLINE | ID: mdl-32518152

RESUMO

OBJECTIVE: To assess the rapid implementation of child neurology telehealth outpatient care with the onset of the coronavirus disease 2019 (COVID-19) pandemic in March 2020. METHODS: This was a cohort study with retrospective comparison of 14,780 in-person encounters and 2,589 telehealth encounters, including 2,093 audio-video telemedicine and 496 scheduled telephone encounters, between October 1, 2019 and April 24, 2020. We compared in-person and telehealth encounters for patient demographics and diagnoses. For audio-video telemedicine encounters, we analyzed questionnaire responses addressing provider experience, follow-up plans, technical quality, need for in-person assessment, and parent/caregiver satisfaction. We performed manual reviews of encounters flagged as concerning by providers. RESULTS: There were no differences in patient age and major ICD-10 codes before and after transition. Clinicians considered telemedicine satisfactory in 93% (1,200 of 1,286) of encounters and suggested telemedicine as a component for follow-up care in 89% (1,144 of 1,286) of encounters. Technical challenges were reported in 40% (519 of 1,314) of encounters. In-person assessment was considered warranted after 5% (65 of 1,285) of encounters. Patients/caregivers indicated interest in telemedicine for future care in 86% (187 of 217) of encounters. Participation in telemedicine encounters compared to telephone encounters was less frequent among patients in racial or ethnic minority groups. CONCLUSIONS: We effectively converted most of our outpatient care to telehealth encounters, including mostly audio-video telemedicine encounters. Providers rated the vast majority of telemedicine encounters to be satisfactory, and only a small proportion of encounters required short-term in-person follow-up. These findings suggest that telemedicine is feasible and effective for a large proportion of child neurology care. Additional strategies are needed to ensure equitable telemedicine use.


Assuntos
Infecções por Coronavirus/terapia , Neurologia/estatística & dados numéricos , Pediatria/estatística & dados numéricos , Pneumonia Viral/terapia , Telemedicina/estatística & dados numéricos , Adolescente , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Estudos de Coortes , Feminino , Humanos , Satisfação no Emprego , Masculino , Grupos Minoritários/estatística & dados numéricos , Pandemias/estatística & dados numéricos , Satisfação do Paciente , Estudos Retrospectivos , Inquéritos e Questionários
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