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1.
BMC Neurol ; 19(1): 267, 2019 Nov 04.
Artigo em Inglês | MEDLINE | ID: mdl-31684922

RESUMO

AIM: To study the association of caregiver factors and stroke patient factors with rehospitalizations over the first 3 months and subsequent 3-12 months post-stroke in Singapore. METHODS: Patients with stroke and their caregivers were recruited in the Singapore Stroke Study, a prospective yearlong cohort. While caregiver and patient variables were taken from this study, hospitalization data were extracted from the national claims database. We used Poisson modelling to perform bivariate and multivariable analysis with counts of hospitalization as the outcome. RESULTS: Two hundred and fifty-six patient with stroke and caregiver dyads (N = 512) were analysed, with patients having spouse (60%), child (29%), sibling (4%) and other (7%) as their caregivers. Among all participants, 89% of index strokes were ischemic, 57% were mild in severity and more than half (59%) of the patients had moderate or severe disability post-stroke as measured on the Modified Rankin Scale. Having social support in the form of a foreign domestic worker for general help of caregiver reduced the hospitalization rate over 3 months post-stroke by 66% (IRR: 0.342; 95% CI: 0.180, 0.651). Compared to having a spousal caregiver, those with a child caregiver had an almost three times greater rate of hospitalizations over 3-12 months post-stroke (IRR: 2.896; 95% CI: 1.399, 5.992). Higher reported caregiving burden at the 3-month point was associated with the higher subsequent rate of hospitalization. CONCLUSION: Recommendations include the adoption of a dyadic or holistic approach to post-stroke care provision by healthcare practitioners, giving due importance to both patients with stroke and their caregivers, integrating caregivers in the healthcare system to extend the care continuum to include informal care in the community and provision of timely support for caregivers.


Assuntos
Cuidadores/estatística & dados numéricos , Hospitalização/estatística & dados numéricos , Acidente Vascular Cerebral , Família , Humanos , Estudos Prospectivos , Singapura , Cônjuges , Acidente Vascular Cerebral/epidemiologia , Acidente Vascular Cerebral/terapia
2.
BMC Public Health ; 19(1): 1436, 2019 Nov 01.
Artigo em Inglês | MEDLINE | ID: mdl-31675934

RESUMO

BACKGROUND: The study investigated the self-assessed mental and general health status of informal carers in Australia. It evaluated the influence of carer's health behaviours, namely physical activity, smoking and drinking status, along with their social connectedness and workforce engagement on their health status. METHODS: The study used a retrospective longitudinal design using data from the Household Income and Labour Dynamics of Australia survey, waves 5-15 (2005-2015). It included individuals aged 15 years and older from Australian households surveyed over a period of 11 years. The sample consisted of 23,251 individuals. The outcome measures included: mental health, general health and physical functioning domains of the Short Form 36 Questionnaire, a widely used multi-dimensional measure of health-related quality of life. Using fixed effects regression and following individuals over time, the analysis took care of the issue of individuals self-selecting themselves as carers due to some predisposing factors such as age, poor health, socioeconomic status and sedentary behaviour. RESULTS: There were statistically significant carer-noncarer status differences in mental (Beta = - 0.587, p = 0.003) and general health (Beta = - 0.670, p = 0.001) outcomes. Aging had a modifying impact on carers' mental and general health outcomes. Older carers coped better with their caregiving responsibilities than younger ones. Moreover, while physical activities had a positive influence on both mental and general health for non-carers, with more activities generating better health outcomes, it only had a modifying impact on carers' mental health. Furthermore, the study found that moderate levels of social drinking had beneficial modifying impact on carers' mental and general health. CONCLUSION: This study added value to the literature on informal carers' mental and general health in Australia by identifying some of the protective and risk factors. The study found the modifying effects of carers' age, health behaviours such as physical activity, smoking and drinking status on their health. Finally, the study identified an apparent beneficial link between moderate levels of social drinking and carer health that needs to be further explored with more targeted future research.


Assuntos
Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Nível de Saúde , Saúde Mental/estatística & dados numéricos , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Austrália , Feminino , Humanos , Estudos Longitudinais , Masculino , Pessoa de Meia-Idade , Estudos Retrospectivos , Inquéritos e Questionários , Adulto Jovem
3.
J Frailty Aging ; 8(4): 210-214, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31637408

RESUMO

BACKGROUND: Home-based primary care (HBPC) provides team-based clinical care for homebound patients who have difficulty accessing typical outpatient care. Interdisciplinary team members also provide social and emotional support and serve as a resource for family caregivers, who often experience significant emotional stress. OBJECTIVES: This qualitative study explores the impact of HBPC on family caregivers to identify aspects of the program that caregivers find most helpful and meaningful as well as areas for improvement. DESIGN: Semi structured recorded interviews were conducted with family caregivers of frail, elderly homebound patients. Interviews included the following topics: overall program satisfaction and suggestions for improvement. SETTING: A HBPC program serving patients in Queens, Nassau and Suffolk counties in New York. PARTICIPANTS: Nineteen family caregivers: 13 women, 6 men; 10 were adult children; 6 were spouses, and 3 were other family members of patients in a HBPC program. MEASUREMENTS: Thematic coding of all recorded transcribed interviews was prepared by 3 qualitative coders. Interrater reliability was conducted to ensure reliability across coders before themes were disseminated and discussed until consensus was achieved with the larger group of investigators. RESULTS: Three main themes were identified: the importance of staff emotional support; the burden of caring for homebound patients; and the need for a broader range of home-based services. Multiple family members noted that the program not only had saved their loved one's life, but had also metaphorically saved their own. CONCLUSIONS: Family caregivers value the communication and accessibility of HBPC and report that the program has a positive impact on their stress and mental health. Results can inform key aspects that need to be retained or enhanced with the expansion in HBPC programs.


Assuntos
Cuidadores/psicologia , Serviços de Assistência Domiciliar , Atenção Primária à Saúde , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Feminino , Idoso Fragilizado , Pacientes Domiciliares , Humanos , Masculino , Avaliação de Programas e Projetos de Saúde , Pesquisa Qualitativa
4.
BMC Health Serv Res ; 19(1): 763, 2019 Oct 28.
Artigo em Inglês | MEDLINE | ID: mdl-31660961

RESUMO

BACKGROUND: The aim of this study was to estimate the mean cost per caregiver of informal care during the first year after myocardial infarction event in France. METHODS: We used the Handicap-Santé French survey carried out in 2008 to obtain data about MI survivors and their caregivers. After obtaining the total number of informal care hours provided by caregiver during the first year after MI event, we estimated the value of informal care using the proxy good method and the contingent valuation method. RESULTS: For MI people receiving informal care, an annual mean cost was estimated at €12,404 (SD = 13,012) with the proxy good method and €12,798 (SD = 13,425) with the contingent valuation method per caregiver during the first year after myocardial infarction event. CONCLUSIONS: The present study suggests that informal care should be included more widely in economic evaluations in order not to underestimate the cost of diseases which induce disability.


Assuntos
Cuidadores/economia , Análise Custo-Benefício , Infarto do Miocárdio/terapia , Assistência ao Paciente/economia , Idoso , Cuidadores/estatística & dados numéricos , Pessoas com Deficiência/estatística & dados numéricos , Feminino , França , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários , Sobreviventes/estatística & dados numéricos
5.
Rev Lat Am Enfermagem ; 27: e3200, 2019 Oct 14.
Artigo em Português, Inglês, Espanhol | MEDLINE | ID: mdl-31618393

RESUMO

OBJECTIVE: to describe the level of uncertainty in illness in family caregivers of palliative care patients and detect associations between the profile of the caregiver and the levels of uncertainty. METHOD: descriptive correlational study conducted with 300 family caregivers of hospitalized patients. The sociodemographic characterization of caregiver and patient was used to assess the caregiver profile, as well as the Uncertainty in Illness scale for family caregivers. Spearman's Rho correlation test was applied to detect associations. RESULTS: the average score of illness uncertainty was 91.7 points. The analysis showed significant correlations between the level of uncertainty and patient dependence (r=0.18, p=0.001), symptom assessment (r=0.312, p<0.001), length of service as a caregiver (r=0.131, p=0.023), perception of support from health professionals (r=-0.16, p=0.048), family (r=-0.145, p=0.012) and religious support (r=-0.131, p=0.050). CONCLUSIONS: there were high levels of uncertainty in caregivers about their patient's illness. These levels are associated with the health condition and symptoms of the patient who is cared for, the length of service as a caregiver and the perceived support from health professionals, family and religion.


Assuntos
Cuidadores/psicologia , Cuidados Paliativos/psicologia , Incerteza , Adaptação Psicológica , Adolescente , Adulto , Idoso , Idoso de 80 Anos ou mais , Cuidadores/estatística & dados numéricos , Estudos Transversais , Feminino , Hospitalização/estatística & dados numéricos , Humanos , Masculino , Pessoa de Meia-Idade , Cuidados Paliativos/estatística & dados numéricos , Percepção , Fatores Socioeconômicos , Espiritualidade , Inquéritos e Questionários , Adulto Jovem
6.
Pan Afr Med J ; 33: 152, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31558949

RESUMO

Introduction: Access to free diagnoses and treatments has been shown to be a major determinant in malaria control. The Cameroon government launched in 2011 and 2014 the exemption of the under-fives' simple and severe malaria treatment policy to increase access to health care and reduce inequality, so as to reduce the mortality related to malaria among the under-fives. This study assessed the effect of providing free malaria treatment in the Buea health district. Methods: This retrospective and cross sectional study was carried out in the Buea health district. Aggregated monthly data from (2008-2010) before and (2012-2014) after the implementation of free malaria treatment was compared, to assess the attributable outcomes of free treatment. A semi-structure questionnaire was also used to assess barriers faced in providing free malaria treatment services by health care workers. Data was collected using a semi-structure questionnaire and a data review summary sheet. The data was analysed using Epi-Info 7, Excel and SPSS (Statistical Package for the Social Sciences) version 20.0 for Windows. All statistical tests were performed at 95% confidence interval (significance level of 0.05). Results: Increase utilisation of health care; as general and malaria related consultations (by 5.7% (p=0.001) witnessed an increase after the implementation of free malaria treatment services. Severe malaria hospitalisation also increased, indicating that most caregivers used the health facility when complications had already set in, which could have led to no significant reduction in mortality due to malaria among under-five children (4.4%, p=0.533). Conclusion: Utilisation of health care increased; as consultation and morbidity rate increased after the implementation of free malaria treatment services. Communication strategy should therefore be strengthened so as to better disseminate information, so as to enhance the effectiveness of the program. There is the need to make a large-scale study to assess the impact of subsidized malaria treatment.


Assuntos
Antimaláricos/administração & dosagem , Política de Saúde , Acesso aos Serviços de Saúde/economia , Malária/tratamento farmacológico , Antimaláricos/economia , Camarões , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Financiamento Governamental/economia , Hospitalização/estatística & dados numéricos , Humanos , Malária/economia , Estudos Retrospectivos , Índice de Gravidade de Doença , Fatores Socioeconômicos , Inquéritos e Questionários
7.
BMC Public Health ; 19(1): 1240, 2019 Sep 09.
Artigo em Inglês | MEDLINE | ID: mdl-31500598

RESUMO

BACKGROUND: Family carers provide significant support to people with a mental illness; yet may experience poor mental and physical health themselves. Among limited research addressing the physical health of carers, studies of carers of people with dementia and young people with psychosis suggest increased risk of chronic diseases in conjunction with higher levels of potentially modifiable lifestyle risk behaviours. This exploratory study, conducted with carers of people with various mental illnesses, aimed to determine: carer prevalence of health risk behaviours (inadequate fruit and vegetable consumption, inadequate physical activity, harmful alcohol consumption, and tobacco smoking); interest in changing 'at risk' behaviours; and potential associations of socio-demographic characteristics with risk status and interest in change. METHODS: A cross-sectional survey was conducted among family carers of people with a mental illness (N = 144) residing in New South Wales, Australia. Analyses explored risk behaviour prevalence and interest in change, and associations with socio-demographic variables. RESULTS: Inadequate fruit and vegetable consumption was most prevalent (74.8%), followed by engaging in inadequate amounts of physical activity (57.6%); harmful alcohol consumption (36.3%) and smoking (11.8%). The majority of carers were interested in improving 'at risk' behaviours (56.3-89.2%), with the exception of alcohol consumption (41.5%). Previously or never married participants were more likely to consume inadequate amounts of fruits and/or vegetables compared to those married or cohabiting (Odds Ratio [OR]: 4.1, 95% Confidence Interval [CI]: 1.3-12.9, p = .02). Carers in the workforce were more likely to be engaging in inadequate physical activity (OR: 2.6, 95% CI: 1.2-5.7, p = .02); and male participants were more likely to engage in harmful alcohol consumption (OR: 2.9, 95% CI: 1.1-7.9, p = .03). Working carers were approximately five times more likely to report interest in improving their alcohol consumption (OR: 5.1, 95% CI: 1.3-20.5, p = .02) compared to those not currently in the workforce. CONCLUSIONS: Results suggest high engagement in health risk behaviours among carers of people with a mental illness, particularly with regards to harmful alcohol consumption. Findings suggest a need to develop and implement chronic disease prevention strategies. Further research with larger representative samples is needed to confirm findings.


Assuntos
Cuidadores/psicologia , Comportamentos de Risco à Saúde , Transtornos Mentais/terapia , Adolescente , Adulto , Idoso , Cuidadores/estatística & dados numéricos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , New South Wales , Prevalência , Inquéritos e Questionários , Adulto Jovem
8.
Pediatrics ; 144(4)2019 10.
Artigo em Inglês | MEDLINE | ID: mdl-31501233

RESUMO

BACKGROUND AND OBJECTIVES: Food insecurity and pediatric obesity affect young children. We examine how food insecurity relates to obesity, underweight, stunting, health, and development among children <4 years of age. METHODS: Caregivers of young children participated in a cross-sectional survey at medical centers in 5 US cities. Inclusion criteria were age of <48 months. Exclusion criteria were severely ill or injured and private health insurance. The Household Food Security Survey Module defined 3 exposure groups: food secure, household food insecure and child food secure, and household food insecure and child food insecure. Dependent measures were obesity (weight-age >90th percentile), underweight (weight-age <5th percentile), stunting (height/length-age <5th percentile), and caregiver-reported child health and developmental risk. Multivariable logistic regression analyses, adjusted for demographic confounders, maternal BMI, and food assistance program participation examined relations between exposure groups and dependent variables, with age-stratification: 0 to 12, 13 to 24, 25 to 36, and 37 to 48 months of age. RESULTS: Within this multiethnic sample (N = 28 184 children, 50% non-Hispanic African American, 34% Hispanic, 14% non-Hispanic white), 27% were household food insecure. With 1 exception at 25 to 36 months, neither household nor child food insecurity were associated with obesity, underweight, or stunting, but both were associated with increased odds of fair or poor health and developmental risk at multiple ages. CONCLUSIONS: Among children <4 years of age, food insecurity is associated with fair or poor health and developmental risk, not with anthropometry. Findings support American Academy of Pediatrics recommendations for food insecurity screening and referrals to help families cope with economic hardships and associated stressors.


Assuntos
Desenvolvimento Infantil , Abastecimento de Alimentos/estatística & dados numéricos , Transtornos do Crescimento/epidemiologia , Nível de Saúde , Obesidade Pediátrica/epidemiologia , Magreza/epidemiologia , Afro-Americanos/estatística & dados numéricos , Fatores Etários , Arkansas/epidemiologia , Baltimore/epidemiologia , Boston/epidemiologia , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Grupo com Ancestrais do Continente Europeu/estatística & dados numéricos , Feminino , Hispano-Americanos/estatística & dados numéricos , Humanos , Lactente , Recém-Nascido , Masculino , Minnesota/epidemiologia , Inquéritos Nutricionais , Philadelphia/epidemiologia , Pobreza , Análise de Regressão
9.
Artigo em Inglês | MEDLINE | ID: mdl-31480218

RESUMO

Since the start of the HIV and AIDS epidemic, very little research has been conducted on the older persons' provision of HIV-related care to adult children. This is despite the fact that a large proportion of adults who die of AIDS-related illnesses stay with their elderly parents during the terminal stage of their illnesses. This paper explores how older persons in rural settings experience caring for their adult children with AIDS-related illnesses. In-depth interviews took place with older persons aged 60 years and above. The qualitative data analysis was informed by thematic approach to identify and report themes using inductive approach. The paper found that the older persons undertake the caring role without resources and support. As a result, they are burdened with having to care for adult children with AIDS-related illness. Fatigue arising from the hard work of physically caring for their sick adult children day and night adds to the physical burden on the older persons. Older persons will continue to carry the burden of caring for people with AIDS-related illnesses due to the increase in the number of new infections in South Africa. There is a need to involve them in HIV/AIDS programmes; their experience and wisdom would surely contribute positively and assist in addressing HIV prevention.


Assuntos
Síndrome de Imunodeficiência Adquirida/terapia , Crianças Adultas , Cuidadores/estatística & dados numéricos , População Rural/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Cuidadores/psicologia , Humanos , Pessoa de Meia-Idade , África do Sul
10.
J Rehabil Med ; 51(9): 665-674, 2019 Oct 04.
Artigo em Inglês | MEDLINE | ID: mdl-31414140

RESUMO

OBJECTIVE: Despite the increasing availability of eRehabilitation, its use remains limited. The aim of this study was to assess factors associated with willingness to use eRehabilitation. DESIGN: Cross-sectional survey. SUBJECTS: Stroke patients, informal caregivers, health-care professionals. METHODS: The survey included personal characteristics, willingness to use eRehabilitation (yes/no) and barri-ers/facilitators influencing this willingness (4-point scale). Barriers/facilitators were merged into factors. The association between these factors and willingness to use eRehabilitation was assessed using logistic regression analyses. RESULTS: Overall, 125 patients, 43 informal caregivers and 105 healthcare professionals participated in the study. Willingness to use eRehabilitation was positively influenced by perceived patient benefits (e.g. reduced travel time, increased motivation, better outcomes), among patients (odds ratio (OR) 2.68; 95% confidence interval (95% CI) 1.34-5.33), informal caregivers (OR 8.98; 95% CI 1.70-47.33) and healthcare professionals (OR 6.25; 95% CI 1.17-10.48). Insufficient knowledge decreased willingness to use eRehabilitation among pa-tients (OR 0.36, 95% CI 0.17-0.74). Limitations of the study include low response rates and possible response bias. CONCLUSION: Differences were found between patients/informal caregivers and healthcare professionals. Ho-wever, for both groups, perceived benefits of the use of eRehabilitation facilitated willingness to use eRehabili-tation. Further research is needed to determine the benefits of such programs, and inform all users about the potential benefits, and how to use eRehabilitation.


Assuntos
Cuidadores/estatística & dados numéricos , Pessoal de Saúde/estatística & dados numéricos , Pacientes/estatística & dados numéricos , Acidente Vascular Cerebral/terapia , Telemedicina/métodos , Estudos Transversais , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Inquéritos e Questionários
11.
Artigo em Inglês | MEDLINE | ID: mdl-31394752

RESUMO

Public involvement (PI) is of great interest. However, little is known about this topic in the design, development, and/or implementation of health interventions in geriatric facilities. This study aimed to provide a critical overview of the involvement of caregivers and end-users in interventions in these facilities, based on Rifkin's analytical framework. This systematic review, supplemented by a questionnaire to the corresponding authors, covered non-drug intervention reports targeting nurses, doctors, residents, and their relatives. Articles were published in Pubmed, Medline, Scopus, and Cinahl, from January 2016 to April 2018. Ninety-seven articles were included. The review shows a low level or partial PI in geriatric facilities where it exists. These results are further supported by the authors' responses to the questionnaire. PI remains uncommon in geriatric institutions and consists of a consumerist model, suggesting the need for improved practices. More efforts are needed to experiment with recommendations to meet the challenges of PI and enhance the public ownership of interventions. The protocol was registered on Prospero under the number CRD42018098504.


Assuntos
Cuidadores/estatística & dados numéricos , Assistência à Saúde/métodos , Serviços de Saúde para Idosos/estatística & dados numéricos , Instituição de Longa Permanência para Idosos/estatística & dados numéricos , Protocolos Clínicos
12.
BMC Public Health ; 19(1): 1164, 2019 Aug 27.
Artigo em Inglês | MEDLINE | ID: mdl-31455340

RESUMO

BACKGROUND: Resilience to disease is a process of positive adaptation despite the loss of health, it involves the development of vitality and skills to overcome the negative effects of adversity, risks, and vulnerability caused by disease. In Mexico, cancer is the leading cause of death in children. Both the diagnosis and the treatment of childhood cancer affect the health of family caregivers. However, resilience is a personality trait that can be protective in these situations. Therefore, resilience is an important psychological construct to measure, evaluate and develop in specific populations and contexts. In Mexico, a scale to assess this trait has been developed. This study aimed to test the reliability and factor structure of the Mexican Measurement Scale of Resilience (RESI-M), describe its distribution, evaluate its relationship with sociodemographic variables, and verify its concurrent validity with psychological well-being, depression, anxiety and parental stress and its independence from social desirability. METHODS: A cross-sectional study was conducted involving an intentional nonprobability sample of 330 family caregivers of children with cancer hospitalized at the National Institute of Health in Mexico City. The participants responded to a sociodemographic variables questionnaire, the Mexican Measurement Scale of Resilience RESI-M, and five other assessment scales. RESULTS: Overall internal consistency was very high (ordinal alpha = .976). The confirmatory factor analysis demonstrated that the five-factor model had a close fit to the data: NFI = .970, CFI = .997, SRMR = .055, and RMSEA = .019. The distributions of the RESI-M total score followed a normal distribution. The RESI-M total score correlated positively with psychological well-being and negatively with depression, parental stress and anxiety. The overall RESI-M total score also correlated positively with age, but there was no difference in means between women and men. Resilience was independent of social desirability. CONCLUSIONS: The RESI-M shows reliability and construct validity in family caregivers of children with cancer and does not show a bias in relation to social desirability.


Assuntos
Cuidadores/psicologia , Neoplasias/psicologia , Pais/psicologia , Resiliência Psicológica , Inquéritos e Questionários , Adolescente , Adulto , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Análise Fatorial , Feminino , Humanos , Lactente , Masculino , México , Pessoa de Meia-Idade , Neoplasias/terapia , Psicometria , Reprodutibilidade dos Testes , Adulto Jovem
13.
Pan Afr Med J ; 33: 67, 2019.
Artigo em Inglês | MEDLINE | ID: mdl-31448029

RESUMO

Introduction: in 2014, Tanzania introduced the combined measles-rubella vaccine in the routine immunization schedule. Two doses of measles-rubella vaccine (MR1 and MR2) are recommended at 9 and 18 months, respectively. In 2015, MR2 coverage among eligible 18-month-old children in Tanzania was only 57%, lower than the WHO-recommended coverage (95%). During the same period Mtwara District Council (MDC) reported a coverage of 52% which is lower than the nation average. We determined factors associated with non-uptake of MR2 among children in MDC Tanzania. Methods: we conducted a community-based cross-sectional survey using cluster sampling during January - April 2017 in MDC. Caretakers of children born during January 2014 - January 2015 and residing in MDC for the past three years were recruited. We interviewed participants and reviewed vaccination cards. Logistic regression modeling was employed to identify independent factors associated with uptake of MR2. Results: of 1,000 children assessed, 558 (55.8%) were unvaccinated with MR2. Factors independently associated with non-uptake of MR2 included the caretaker being unaware of the ages for MR1 and MR2 administration [aOR=3.50; 95%CI 1.98-6.21; p<0.001], having MR2 vaccination services offered at the local vaccination station fewer than three days per week [aOR=1.50; 95%CI 1.42-5.59; p<0.001], not having the vaccine available during vaccination days [aOR=3.38; 95%CI 1.08-10.61; p<0.01], unwillingness of health workers to open multi-dose vaccine vials for a single child [aOR=3.80; 95% CI 2.12-6.79; p<0.001], and long waiting times for vaccination services [aOR=1.80; 95% CI 1.08-3.00; p<0.01]. Conclusion: more than half the children under five years in MDC were not vaccinated with MR2. Lack of caretaker knowledge about appropriate vaccination age, unavailability of vaccine, having insufficient numbers of children waiting to warrant multidose vial use, and long clinic waiting times were associated with MR2 non-uptake. The community should receive education about MR vaccine; we recommend thorough screening of children?s vaccination status at each clinic visit and provision of vaccine whenever possible. Vaccine distribution should be improved in MDC.


Assuntos
Vacina contra Sarampo/administração & dosagem , Vacina contra Rubéola/administração & dosagem , Cobertura Vacinal/estatística & dados numéricos , Vacinação/estatística & dados numéricos , Adulto , Cuidadores/estatística & dados numéricos , Pré-Escolar , Estudos Transversais , Feminino , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Esquemas de Imunização , Modelos Logísticos , Masculino , Inquéritos e Questionários , Tanzânia , Listas de Espera , Adulto Jovem
14.
BMC Infect Dis ; 19(1): 734, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438865

RESUMO

BACKGROUND: Schistosomiasis and soil-transmitted helminth infections are among the most chronic infections worldwide. Based on their demonstrable impact on human health, the WHO recently recommended the implementation of robust strategies aimed at controlling or eliminating schistosomiasis and soil-transmitted helminths by 2020. The implementation of this strategy, however, warrants a clear understanding of the community's knowledge, attitudes and practices in relation to these infections. This study sought to identify sociocultural gaps that should be addressed to ensure the success of cost-effective community-based schistosomiasis-soil-transmitted helminths control and elimination programs. METHODS: This was a cross-sectional mixed methodology study. Quantitative data were collected using a structured questionnaire from 442 caregivers of preschool aged children. In-depth interviews and focus group discussions were conducted among caregivers, preschool teachers, traditional authorities and community caregivers. All interviews were captured using an audio recorder to maximize accuracy. Quantitative data were analysed using bivariate and multivariate techniques while qualitative data were analysed thematically. RESULTS: Findings reflected inadequate knowledge, attitudes and practices in relation to schistosomiasis and soil-transmitted helminths while awareness of schistosomiasis and soil-transmitted helminths was high (87.1 and 79.2% respectively). Correct knowledge on transmission, prevention, signs and symptoms and life cycle was low (below 50%) for both infections among those who had heard of the disease. From multivariate analysis, being aged at least 35 years increased the odds of reporting good practices on schistosomiasis by 65% (COR 1.652, 95% CI: 1.073-2.543) while receiving health information through community meetings (COR 0.072, 95% CI: 0.010-0.548) significantly reduced the odds of having good knowledge on schistosomiasis. CONCLUSIONS: These findings are valuable in designing behavioural change approaches towards enhancing health outcomes through community-based interventions to ensure effective control and elimination of schistosomiasis and soil-transmitted helminths. There is a critical need for channelling efforts towards making health education the core of schistosomiasis and soil-transmitted helminths programs aimed at achieving intensified control or elimination of these infections by 2020.


Assuntos
Cuidadores , Conhecimentos, Atitudes e Prática em Saúde , Esquistossomose , Adulto , Idoso , Animais , Cuidadores/psicologia , Cuidadores/normas , Cuidadores/estatística & dados numéricos , Criança , Pré-Escolar , Estudos Transversais , Feminino , Grupos Focais , Educação em Saúde , Helmintíase/parasitologia , Helmintos , Humanos , Masculino , Pessoa de Meia-Idade , Esquistossomose/parasitologia , Esquistossomose/terapia , Esquistossomose/transmissão , Professores Escolares/normas , Professores Escolares/estatística & dados numéricos , Solo/parasitologia , África do Sul/epidemiologia , Inquéritos e Questionários
15.
BMC Public Health ; 19(1): 1156, 2019 Aug 22.
Artigo em Inglês | MEDLINE | ID: mdl-31438901

RESUMO

BACKGROUND: Choking is one of the leading causes of death among unintentional injuries in young children. Food choking represents a considerable public health burden, which might be reduced through increased effective preventative education programs. We present a protocol for a community intervention trial termed CHOP (CHOking Prevention project) that aimed to teach Italian families how to prevent food choking injuries and increase knowledge relating to nutrition. METHODS: Italian educational facilities were enrolled. Stratified randomization blocked by geographical area was performed. Each stratum was randomized to one of three different intervention strategies or to a control group. Educational intervention was delivered in the schools by experts and certified trainers as per the following three intervention strategies: directly to families (Strategy A); to teaching staff only, who subsequently delivered the same educational intervention to families (Strategy B); to health service staff only, who then delivered the educational intervention to teaching staff, who subsequently delivered the intervention to families (Strategy C). Participants completed a questionnaire about their knowledge on the topics presented during the educational interventions (pre-, post-, and follow-up of intervention). Information from the questionnaires was synthetized into 6 indicators in order to measure how effective each intervention strategy was. DISCUSSION: The issue of food choking injuries in children is relevant to public health. The protocol we present provides an opportunity to progress towards overcoming such challenges through a working model that can be implemented also in other countries. TRIAL REGISTRATION: ClinicalTrials.gov NCT03218618. The study was registered on 14 July 2017.


Assuntos
Obstrução das Vias Respiratórias/prevenção & controle , Cuidadores/educação , Fenômenos Fisiológicos da Nutrição Infantil , Alimentos/efeitos adversos , Corpos Estranhos/prevenção & controle , Conhecimentos, Atitudes e Prática em Saúde , Adolescente , Adulto , Cuidadores/estatística & dados numéricos , Pré-Escolar , Serviços de Saúde Comunitária , Humanos , Lactente , Itália , Pessoa de Meia-Idade , Avaliação de Programas e Projetos de Saúde , Saúde Pública , Projetos de Pesquisa , Serviços de Saúde Escolar , Inquéritos e Questionários , Adulto Jovem
16.
BMC Public Health ; 19(1): 1193, 2019 Aug 29.
Artigo em Inglês | MEDLINE | ID: mdl-31464623

RESUMO

BACKGROUND: Despite the extensive implementation of control measures and achievements in morbidity reductions, malaria continues to contribute to substantial morbidity and mortality in children under-five. Innovative approaches involving the use of mobile phones have been suggested to improve health outcomes. However, evidence of its effect on reducing the prevalence of malaria is limited. This study, therefore, aimed to assess the effect of a theory-driven mHealth intervention on the prevalence of malaria among children under-five living in rural districts of Ghana. METHODS: We conducted a quasi-experimental study of a 12-month intervention using a random sample of 332 caregivers with children under-five from two rural districts, assigned to either an intervention or a control group. Caregivers in the intervention group received voice short message service (SMS) on malaria prevention based on a behavior change theory to improve their health behaviors and practice, once a week for twelve months, while caregivers in the control group received none. Pre- and post-intervention assessment of the treatment effect (ATT) on malaria in children under-five was conducted using propensity score and difference-in-difference (DiD) analyses. RESULTS: Among children whose caregivers received the intervention, the prevalence of malaria decreased from 58.4% at baseline to 37.8% at endline (difference: -20.6%; 95% CI: - 31.1, - 10.1) compared with children in the control group, where a reduction of 65.0 to 59.9% (difference - 5.1%; 95% CI: - 15.5, 5.4) was observed. The treatment effect at endline revealed a statistically significant reduction in malaria prevalence (ATT: -0.214; 95% CI: - 0.36, - 0.07) compared with the baseline (ATT: -0.035; 95% CI: - 0.16, 0.09). Overall, the intervention effect showed a significant reduction in the prevalence of malaria among children under-five was positive (DiD: - 0.154; p = 0.043). CONCLUSION: The results of the study indicate the effectiveness of mobile phone SMS as a control tool for reducing the burden of malaria in children under-five.


Assuntos
Malária/prevenção & controle , Telemedicina/métodos , Mensagem de Texto , Adulto , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Pré-Escolar , Feminino , Gana/epidemiologia , Comportamentos Relacionados com a Saúde , Humanos , Lactente , Malária/epidemiologia , Masculino , Avaliação de Programas e Projetos de Saúde , População Rural/estatística & dados numéricos , Adulto Jovem
17.
Rev Esc Enferm USP ; 53: e03481, 2019 Jul 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31365727

RESUMO

OBJECTIVE: To analyze the social and conceptual skills of people with Intellectual Disability. METHOD: A descriptive study conducted with 100 caregivers, 9 teachers and 100 people with Intellectual Disability from a Philanthropic Institution in Campina Grande, Paraíba, Brazil. The participants ages in the study ranged from 9 to 83 years. Three-hundred (300) questionnaires were administered. The data were processed by Factorial Matching Analysis in the Tri-Deux-Mots program . RESULTS: Considering the factorial correspondence plan, it should be noted that the social skills of students in the age group between 21 and 40 years were related to playing educational games, playing ball with friends and dating. Regarding conceptual skills, students revealed autonomy in relation to school activities, however the caregivers emphasized that they lack autonomy in relation to these skills. In perceiving the realities of students from different classes, teachers presented opposing opinions on dependency and independence issues. CONCLUSION: Education and health professionals and caregivers can collaborate more effectively in developing the autonomy of people with Intellectual Disability by promoting a more interactive environment which provides skills development and interpersonal relationships without discrimination, disrespect or prejudice.


Assuntos
Deficiência Intelectual/psicologia , Autonomia Pessoal , Comportamento Social , Habilidades Sociais , Adolescente , Adulto , Fatores Etários , Idoso , Idoso de 80 Anos ou mais , Brasil , Cuidadores/estatística & dados numéricos , Criança , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Professores Escolares/estatística & dados numéricos , Inquéritos e Questionários , Adulto Jovem
18.
Rev Gaucha Enferm ; 40: e20180225, 2019 Jul 29.
Artigo em Português, Inglês | MEDLINE | ID: mdl-31365735

RESUMO

OBJECTIVE: To compare the physical, cognitive and psychological health profile and care context of elder caregivers of the elderly in different home arrangements. METHOD: Quantitative and transversal study with elderly caregivers. The sample consisted of 349 caregivers divided into mono-gerational, bi-gerational and multi-generational housing arrangements. Sociodemographic and care questionnaires and physical, cognitive and psychological health assessment instruments were used for evaluation. The Chi-square distribution and Mann Whitney's U were used for data analysis. RESULTS: Elderly caregivers in mono-generational homes were significantly older and independent for instrumental activities of daily living. In multigenerational households there was a significantly greater proportion of caregivers who considered family income insufficient, received emotional help, and felt overwhelmed and stressed. CONCLUSION: The differences identified between the groups can contribute to the elaboration of care policies and for the health promotion of elderly caregivers.


Assuntos
Cuidadores , Características da Família , Nível de Saúde , Habitação , Fatores Etários , Idoso , Cuidadores/psicologia , Cuidadores/estatística & dados numéricos , Distribuição de Qui-Quadrado , Estudos Transversais , Depressão/diagnóstico , Escolaridade , Feminino , Humanos , Renda , Masculino , Pessoa de Meia-Idade , Satisfação Pessoal , Estatísticas não Paramétricas , Estresse Psicológico/diagnóstico , Carga de Trabalho
19.
Cien Saude Colet ; 24(7): 2737-2744, 2019 Jul 22.
Artigo em Inglês | MEDLINE | ID: mdl-31340290

RESUMO

The aim of this study was to evaluate the relationship between oral health literacy (OHL) among caregivers and untreated dental caries among preschoolers. A cross-sectional study was conducted involving 415 preschool children and their caregivers from Curitiba, Brazil. The children were examined for dental caries and dental plaque. The caregivers' OHL was evaluated using an instrument translated and validated for Brazilian Portuguese: the Brazilian Rapid Estimate of Adult Literacy in Dentistry-30. The prevalence of children with untreated caries was 42.9% (95%CI: 38.1-47.7%). A low degree of OHL was found among 15.7% (95%CI: 12.2-19.2) of caregivers. The multivariable Poisson regression analysis indicated a higher prevalence of untreated caries among children whose caregivers had a low OHL (PR = 1.35; 95% CI: 1.01-1.79), those with visible plaque (PR = 1.28; 95% CI: 1.01-1.62) and those who never or only occasionally had their teeth brushed by their caregivers (PR = 1.48; 95% CI: 1.16-1.91) in comparison to those without these conditions. In conclusion, a higher prevalence of untreated dental caries was found among preschool children whose caregivers had a low degree of OHL.


Assuntos
Cuidadores/estatística & dados numéricos , Cárie Dentária/epidemiologia , Alfabetização em Saúde , Saúde Bucal , Adulto , Brasil/epidemiologia , Pré-Escolar , Estudos Transversais , Feminino , Humanos , Masculino , Projetos Piloto , Prevalência
20.
Artigo em Alemão | MEDLINE | ID: mdl-31297549

RESUMO

BACKGROUND: Currently, there are 1.7 million people living with dementia (PwD) in Germany. This number is expected to double within the next decades. Estimates of the total societal economic burden of dementia are currently missing. OBJECTIVES: The aim was to estimate the current and future total cost and excess cost of dementia from a public payer and societal perspective. METHODS: Studies demonstrating the healthcare resource utilization of PwD in Germany were identified. Utilization data were aggregated using the sample size of different studies as a weight. Annual per capita costs of PwD and excess cost of dementia were calculated using standardized unit costs. Current and future costs were calculated based on published prevalence and population forecasts. RESULTS: PwD living at home had lower costs from a payer perspective compared to those who are institutionalized, but higher total societal cost due to the higher informal care time. The total cost for PwD from a payer perspective was 34 billion € in 2016. These costs could reach 90 billion € by 2060. The excess cost of dementia was 18 billion € in 2016 and is estimated to become 49 billion € by 2060 from a payer perspective, representing 54% of the total cost of PwD and up to 15% of the total costs associated with the elderly population. The total societal cost was 73 billion € in 2016 and is estimated to become 194 billion € by 2060. The excess cost of dementia was 54 billion € in 2016 and is estimated to become 145 billion € by 2060, representing 74% of the total societal cost of PwD and 36% of the total societal cost of the elderly. CONCLUSION: Dementia diseases represent a tremendous social and economic burden. Without a cure, supporting caregivers and implementing interventions that delay the functional and cognitive decline will be crucial to relieving the increasing costs.


Assuntos
Cuidadores/economia , Efeitos Psicossociais da Doença , Demência/economia , Demência/psicologia , Custos de Cuidados de Saúde/estatística & dados numéricos , Idoso , Idoso de 80 Anos ou mais , Envelhecimento , Cuidadores/estatística & dados numéricos , Alemanha , Humanos , Aceitação pelo Paciente de Cuidados de Saúde , Alocação de Recursos
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