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1.
Afr J Prim Health Care Fam Med ; 13(1): e1-e8, 2021 Jun 15.
Artigo em Inglês | MEDLINE | ID: mdl-34212738

RESUMO

BACKGROUND: The responsibility of caring for patients with advanced cancer in sub-Saharan Africa is mostly shouldered by family members because of paucity of institutional facilities. There is a growing concern that the number of women needing treatment for advanced breast cancer is rising at an unprecedented rate in Nigeria. AIM: To assess the caregiver burden and its associated factors amongst family caregivers of women with advanced breast cancer. SETTING: The study was conducted at the radiation oncology clinic of the University College Hospital, Ibadan, Nigeria. METHODS: A cross-sectional descriptive study was conducted amongst 157 eligible family caregivers of women with advanced breast cancer. The family caregivers completed an interviewer-administered questionnaire, which included the socio-demographic data, the caregiving process and the Zarit Burden Interview (ZBI). Logistic regression was used to identify factors, and ethical approval was obtained. RESULTS: Over half (53%) of the respondents were males with spousal caregivers dominantly constituting 27.4% of all respondents, closely followed by daughters (25.5%) of the care recipients. The mean ZBI score was 29.84 ± 13.9. Most (72%) of the caregivers experienced burden. Factors associated with caregiver burden were previous hospitalisation of the care recipient (odds ratio [OR] = 3.74, confidence interval [CI]: 1.67 to 8.38) and perceived dysfunction in patients activities of daily living (OR = 2.57, CI: 1.14 to 5.78). CONCLUSION: Family caregivers of women with advanced breast cancer experience burden of care. Recognition of this vulnerable population and the care recipient as a dyad is a sine qua non in mitigating the burden associated with their caregiving role.


Assuntos
Neoplasias da Mama/radioterapia , Fardo do Cuidador , Cuidadores/psicologia , Radioterapia (Especialidade) , Atividades Cotidianas , Adulto , Idoso , Neoplasias da Mama/patologia , Efeitos Psicossociais da Doença , Estudos Transversais , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Nigéria , Escalas de Graduação Psiquiátrica , Índice de Gravidade de Doença
2.
PLoS One ; 16(7): e0254077, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34214122

RESUMO

BACKGROUND: Nurse identification of patient deterioration is critical, particularly during the COVID-19 pandemic, as patients can deteriorate quickly. While the literature has shown that nurses rely on intuition to make decisions, there is limited information on what sources of data experienced nurses utilize to inform their intuition. The objectives of this study were to identify sources of data that inform nurse decision-making related to recognition of deteriorating patients, and explore how COVID-19 has impacted nurse decision-making. METHODS: In this qualitative study, experienced nurses voluntarily participated in focused interviews. During focused interviews, expert nurses were asked to share descriptions of memorable patient encounters, and questions were posed to facilitate reflections on thoughts and actions that hindered or helped their decision-making. They were also asked to consider the impact of COVID-19 on nursing and decision-making. Interviews were transcribed verbatim, study team members reviewed transcripts and coded responses, and organized key findings into themes. RESULTS: Several themes related to decision-making were identified by the research team, including: identifying patient care needs, workload management, and reflecting on missed care opportunities to inform learning. Participants (n = 10) also indicated that COVID-19 presented a number of unique barriers to nurse decision-making. CONCLUSIONS: Findings from this study indicate that experienced nurses utilize several sources of information to inform their intuition. It is apparent that the demands on nurses in response to pandemics are heightened. Decision-making themes drawn from participants' experiences can to assist nurse educators for training nursing students on decision-making for deteriorating patients and how to manage the potential barriers (e.g., resource constraints, lack of family) associated with caring for patients during these challenging times prior to encountering these issues in the clinical environment. Nurse practice can utilize these findings to increase awareness among experienced nurses on recognizing how pandemic situations can impact to their decision-making capability.


Assuntos
COVID-19/enfermagem , Tomada de Decisão Clínica , Enfermeiras e Enfermeiros/psicologia , Cuidados de Enfermagem/psicologia , Pandemias , SARS-CoV-2 , Adulto , Idoso , Feminino , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Relações Enfermeiro-Paciente , Avaliação em Enfermagem , Relações Profissional-Família , Pesquisa Qualitativa , Avaliação de Sintomas , Carga de Trabalho
3.
Health Qual Life Outcomes ; 19(1): 175, 2021 Jul 05.
Artigo em Inglês | MEDLINE | ID: mdl-34225737

RESUMO

BACKGROUND: Although telemedical applications are increasingly used in the area of both mental and physical illness, there is no quality of life (QoL) instrument that takes into account the specific context of the healthcare setting. Therefore, the aim of this study was to determine a concept of quality of life in telemedical care to inform the development of a setting-sensitive patient-reported outcome measure. METHODS: Overall, 63 semi-structured single interviews and 15 focus groups with 68 participants have been conducted to determine the impact of telemedical care on QoL. Participants were patients with chronic physical or mental illnesses, with or without telemedicine supported healthcare as well as telemedical professionals. Mayring's content analysis approach was used to encode the qualitative data using MAXQDA software. RESULTS: The majority of aspects that influence the QoL of patients dealing with chronic conditions or mental illnesses could be assigned to an established working model of QoL. However, some aspects that were considered important (e. g. perceived safety) were not covered by the pre-existing domains. For that reason, we re-conceptualized the working model of QoL and added a sixth domain, referred to as healthcare-related domain. CONCLUSION: Interviewing patients and healthcare professionals brought forth specific aspects of QoL evolving in telemedical contexts. These results reinforce the assumption that existing QoL measurements lack sensitivity to assess the intended outcomes of telemedical applications. We will address this deficiency by a telemedicine-related re-conceptualization of the assessment of QoL and the development of a suitable add-on instrument based on the resulting category system of this study.


Assuntos
Doença Crônica , Qualidade de Vida , Telemedicina , Adulto , Idoso , Idoso de 80 Anos ou mais , Feminino , Grupos Focais , Humanos , Entrevistas como Assunto , Masculino , Transtornos Mentais , Pessoa de Meia-Idade , Medidas de Resultados Relatados pelo Paciente , Pesquisa Qualitativa , Adulto Jovem
4.
N Z Med J ; 134(1538): 52-67, 2021 07 09.
Artigo em Inglês | MEDLINE | ID: mdl-34239145

RESUMO

AIM: This research explores the experience of low-income New Zealanders during the COVID-19 pandemic lockdown and their advice to the Government about addressing future pandemics. New Zealand had a rapid and effective lockdown that meant the virtual elimination of community transmission. METHOD: Twenty-seven semi-structured interviews were undertaken with low-income people in June-July 2020 immediately after lockdown was lifted. RESULTS: Life during lockdown was challenging for study participants. They were fearful of the virus and experienced mental distress and isolation. Most participants felt safe at home and reported coping financially while still experiencing financial stress. Participants were resourceful and resilient. They coped with lockdown by using technology, self-help techniques and support from others. New Zealand's welfare state ensured participants had access to health services and welfare payments, but there were challenges. Welfare payments did not fully meet participants' needs, and support from charitable organisations was critical. Participants were overwhelmingly positive about the Government's response and advised the Government to take the same approach in the future. This is a particularly reassuring finding from some of the most vulnerable New Zealanders. CONCLUSIONS: An early and hard lockdown, the welfare state, compassion and clearly communicated leadership were keys to a successful lockdown for the low-income people in this study. Research of the experience of low-income people during pandemics is critical to ensuring inequities in pandemic impact are mitigated.


Assuntos
COVID-19/prevenção & controle , COVID-19/psicologia , Pandemias/prevenção & controle , Pobreza , Assistência Pública , Adaptação Psicológica , Adulto , COVID-19/economia , Feminino , Abastecimento de Alimentos , Política de Saúde , Acesso aos Serviços de Saúde , Humanos , Entrevistas como Assunto , Masculino , Pessoa de Meia-Idade , Nova Zelândia , Angústia Psicológica , Pesquisa Qualitativa , SARS-CoV-2 , Segurança , Apoio Social , Seguridade Social , Tecnologia
5.
Nutrients ; 13(6)2021 Jun 03.
Artigo em Inglês | MEDLINE | ID: mdl-34205107

RESUMO

BACKGROUND: Low energy availability results in physiological adaptations which contribute to unfavourable health outcomes. Little information exists on perceptions of nutritional advice to eat more food to maintain health and enhance performance. The aim of this study was to explore athletes' and coaches' perceptions towards advice to athletes to eat larger than their current quantities of food and to explore how nutritionists could deliver this advice. METHODS: Semi-structured interviews (~20 min in length) were conducted using online communication technology, audio-recorded, and transcribed verbatim. The interview explored perceptions of the nutritional advice provided, its role in health and performance, and the challenges to eating larger amounts of food. Data were analysed using NVIVO 1.2 using an inductive thematic approach. RESULTS: Nine elite athletes (female = 6; males = 3) and nine high-performance coaches (female = 3; male = 6) completed the semi-structured interviews. Athletes reported improved training consistency, fewer injuries and illnesses, and improved resilience when consuming adequate energy and nutrients to meet their needs. Lack of time and meal preparation difficulties were the main challenges faced to fuelling. CONCLUSIONS: Although education about under-fuelling is important, motivating, enabling, and supporting athletes to change behaviour is pivotal to increasing athlete self-awareness and to make long-term nutritional changes.


Assuntos
Atletas/psicologia , Desempenho Atlético , Ingestão de Energia , Esportes/psicologia , Adulto , Feminino , Humanos , Entrevistas como Assunto , Masculino , Adulto Jovem
6.
Nutrients ; 13(6)2021 Jun 16.
Artigo em Inglês | MEDLINE | ID: mdl-34208726

RESUMO

Objective. In this study, we focus on elderly people (≥70 years old) benefiting from a home delivery meal service as part of a social welfare program. We aimed to: (i) assess the gap between the recommended and actual nutritional intake in this population and (ii) study the relationship between the intake of nutrients and the variables characterizing the participants' health and nutritional status. Design. A dietary survey (24-hour record) was conducted during a home interview, with 64 people receiving a home delivery meal service (75% women; 70-97 years old). At the same time, the participants answered questionnaires assessing their nutritional and health status. Results. Our data showed that the consumption of 70 to 80% participants was not sufficient for reaching the nutritional recommendations for energy and macronutrients. Additionally, the data showed that the lower the energy and protein intakes, the higher the risk of malnutrition. In addition, one third of the participants were both overweight or obese and at risk of undernutrition or undernourished. Our study demonstrated that the heavier the person, the more difficult it was for them to meet the nutritional recommendations based on kilograms of body weight. Finally, individuals receiving two to three delivered meals per day had higher energy and protein intakes than those receiving a single meal. Conclusion. These results suggest that it is important that home meal delivery companies improve the quality of their meals and service so that their recipients can better meet nutritional recommendations.


Assuntos
Ingestão de Alimentos , Serviços de Alimentação , Idoso , Idoso de 80 Anos ou mais , Inquéritos sobre Dietas , Feminino , Avaliação Geriátrica , Humanos , Entrevistas como Assunto , Masculino , Avaliação de Programas e Projetos de Saúde
7.
Surg Clin North Am ; 101(4): 635-652, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242606
8.
Surg Clin North Am ; 101(4): 667-677, 2021 Aug.
Artigo em Inglês | MEDLINE | ID: mdl-34242608

RESUMO

Residency programs should use a systematic method of recruitment that begins with defining unique desired candidate attributes. Commonly sought-after characteristics may be delineated via the residency application. Scores from standardized examinations taken in medical school predict academic success, and may correlate to overall performance. Strong letters of recommendation and a personal history of prior success outside the medical field both forecast success in residency. Interviews are crucial to determining fit within a program, and remain a valid measure of an applicant's ability to prosper in a particular program, even with many interviews being completed in the virtual realm.


Assuntos
Cirurgia Geral/educação , Internato e Residência/organização & administração , Critérios de Admissão Escolar , Prática Clínica Baseada em Evidências , Humanos , Entrevistas como Assunto , Personalidade , Habilidades Sociais , Estudantes de Medicina/psicologia , Estados Unidos
9.
Nutrients ; 13(7)2021 Jun 23.
Artigo em Inglês | MEDLINE | ID: mdl-34201793

RESUMO

Diabetes mellitus (DM) is a high-risk non-communicable disease with an emerging burden for the European Union (EU) member states in the past decades. The unfavorable trend of the burden is striking compared to the declining disease burden due to cardiovascular diseases or stagnation of neoplasms. The goal of this study is to describe the temporal changes of diabetes in the adult population of Slovakia through the three European Health Interview Survey (EHIS) waves and to assess the association between DM and socioeconomic and/or lifestyle characteristics. These cross-sectional studies were carried out using microdata derived from Slovakia's EHISs conducted in the years 2009 (n = 4972), 2014 (n = 5490), and 2019 (n = 5527). The DM variable was compared to the independent variables such as sociodemographic and lifestyle characteristics including dietary patterns and physical activity. DM prevalence for the EHIS in 2009, 2014, and 2019 were 6.1%, 8.2%, and 9.8%, respectively. In bivariate analysis, the relationship between DM and age, education level, job status, BMI, walking for at least 10 min, and physical activity was significant in the three EHISs. In 2014 and 2019, there was an inverse association between the risk of DM and walking regularly. There was no association between the frequency of eating fruits or vegetables and DM, with the exception of 2009, where a negative association between eating vegetables one to six times a week and DM was observed. Present health policies and activities in Slovakia were unable to reverse the increasing DM burden, indicating that a more systematic approach is needed. Complex policy strategies and legislative measures must be developed and implemented at both the national and EU levels.


Assuntos
Diabetes Mellitus/epidemiologia , Inquéritos Epidemiológicos , Entrevistas como Assunto , Adolescente , Adulto , Idoso , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Fatores de Risco , Eslováquia/epidemiologia , Adulto Jovem
10.
BMC Fam Pract ; 22(1): 108, 2021 06 02.
Artigo em Inglês | MEDLINE | ID: mdl-34078281

RESUMO

BACKGROUND: Attempts to manage the COVID-19 pandemic have led to radical reorganisations of health care systems worldwide. General practitioners (GPs) provide the vast majority of patient care, and knowledge of their experiences with providing care for regular health issues during a pandemic is scarce. Hence, in a Danish context we explored how GPs experienced reorganising their work in an attempt to uphold sufficient patient care while contributing to minimizing the spread of COVID-19. Further, in relation to this, we examined what guided GPs' choices between telephone, video and face-to-face consultations. METHODS: This study consisted of qualitative interviews with 13 GPs. They were interviewed twice, approximately three months apart in the initial phase of the pandemic, and they took daily notes for 20 days. All interviews were audio recorded, transcribed, and inductively analysed. RESULTS: The GPs re-organised their clinical work profoundly. Most consultations were converted to video or telephone, postponed or cancelled. The use of video first rose, but soon declined, once again replaced by an increased use of face-to-face consultations. When choosing between consultation forms, the GPs took into account the need to minimise the risk of COVID-19, the central guidelines, and their own preference for face-to-face consultations. There were variations over time and between the GPs regarding which health issues were dealt with by using video and/or the telephone. For some health issues, the GPs generally deemed it acceptable to use video or telephone, postpone or cancel appointments for a short term, and in a crisis situation. They experienced relational and technical limitations with video consultation, while diagnostic uncertainty was not regarded as a prominent issue CONCLUSION: This study demonstrates how the GPs experienced telephone and video consultations as being useful in a pandemic situation when face-to-face consultations had to be severely restricted. The GPs did, however, identify several limitations similar to those known in non-pandemic times. The weighing of pros and cons and their willingness to use these alternatives shifted and generally diminished when face-to-face consultations were once again deemed viable. In case of future pandemics, such alternatives seem valuable, at least for a short term.


Assuntos
Atitude do Pessoal de Saúde , COVID-19/prevenção & controle , Medicina Geral/tendências , Padrões de Prática Médica/tendências , Consulta Remota/tendências , COVID-19/epidemiologia , Tomada de Decisão Clínica/métodos , Dinamarca/epidemiologia , Medicina Geral/métodos , Medicina Geral/organização & administração , Humanos , Entrevistas como Assunto , Pandemias , Relações Médico-Paciente , Padrões de Prática Médica/organização & administração , Pesquisa Qualitativa , Consulta Remota/métodos , Consulta Remota/organização & administração , Telefone , Comunicação por Videoconferência
11.
Salud Colect ; 17: e3358, 2021 06 03.
Artigo em Espanhol | MEDLINE | ID: mdl-34105331

RESUMO

Among the social effects of the COVID-19 pandemic, increased poverty, unemployment, and social inequality in Brazil have led to worsening health problems, especially in the poorest citizens. The purpose of this research was to discuss the potentialities and limitations of the work process in primary health care based on the Family Health Strategy. In order to do so, we conducted semi-structured interviews with four women living in an informal settlement in the interior of the state of São Paulo, Brazil, between January and February 2020. We found that the women experienced suffering in relation to issues such as housing precariousness, transience, social isolation, and silencing. The way in which primary health care is organized and professionals' work processes make it difficult for this population to access health services and for professionals to perceive their suffering. The findings of this research point to the need to reevaluate and improve the Family Health Strategy.


Assuntos
COVID-19 , Acesso aos Serviços de Saúde , Disparidades nos Níveis de Saúde , Disparidades em Assistência à Saúde , Pobreza , Atenção Primária à Saúde , Populações Vulneráveis , Adulto , Atitude Frente a Saúde , Brasil/epidemiologia , COVID-19/epidemiologia , COVID-19/prevenção & controle , COVID-19/psicologia , Feminino , Habitação , Humanos , Entrevistas como Assunto , Pandemias , Saúde da População Urbana , Saúde da Mulher
12.
Rev Bras Enferm ; 74(5): e20200524, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105598

RESUMO

OBJECTIVE: to analyze the Health Care Network (dis)articulation of late and moderate premature infants in the first year of life. METHOD: a qualitative study with semi-structured interview, which addressed the care network constitution in a municipality in southern Brazil. Fifteen mothers of infants participated. Thematic content analysis and flowchart were used to describe networks and services. RESULTS: first contact in Primary Health Care is a decisive factor for the recognition and articulation of neonates/infants in the network and enables resolution, especially in childcare demands. Secondary and hospital care services support isolated acute events or chronic conditions, without articulation between levels of care and in a uniprofessional way. FINAL CONSIDERATIONS: attention to health conditions is organized and structured in a uniprofessional, fragmented and disjointed way, which makes it impossible to form a Health Care Network premature infants' perspective.


Assuntos
Serviços de Saúde , Recém-Nascido Prematuro , Enfermagem Pediátrica , Brasil , Atenção à Saúde , Feminino , Humanos , Lactente , Recém-Nascido , Entrevistas como Assunto , Mães , Pesquisa Qualitativa
13.
Rev Bras Enferm ; 74(5): e20200642, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105600

RESUMO

OBJECTIVE: to identify the information demands of families of children with Autism Spectrum Disorder. METHOD: this is a qualitative study conducted through semi-structured and audio-recorded interviews with 55 family members, in the states of Paraná, Ceará, and Macapá, between September 2018 and September 2019. Thematic category analysis and Qualitative Data Analysis Software resources were used for data organization. RESULTS: it was identified that families need information regarding the characteristics of Autism Spectrum Disorder (definition, cause, possibility of cure, prognosis and the probability of having another child with Autism Spectrum Disorder); child's routine and behavior; future rights and expectations. FINAL CONSIDERATIONS: information demands are relevant to support professionals, health managers and other services in health care organization to support families of children with autism.


Assuntos
Transtorno do Espectro Autista , Família/psicologia , Comportamento de Busca de Informação , Pais/psicologia , Adulto , Criança , Pré-Escolar , Conhecimentos, Atitudes e Prática em Saúde , Humanos , Entrevistas como Assunto , Pesquisa Qualitativa , Apoio Social
14.
Rev Bras Enferm ; 74(4): e20200404, 2021.
Artigo em Inglês, Português | MEDLINE | ID: mdl-34105640

RESUMO

OBJECTIVE: To understand how information about Planned Home Birth motivates or discourages women's decisions on this location of birth. METHOD: Descriptive exploratory study, qualitative approach. Data collection carried out from February to April 2019, through semi-structured interviews with 14 women and documentary sources. The data were analyzed using Bardin's content analysis process, with the help of ATLAS.ti 8.0. RESULTS: The motivations for choosing Planned Home Birth are: respect for the autonomy and natural process of childbirth and delivery, support from a partner and trust in professionals. Aspects that discourage this choice are fear of complications, the need for a hospital medical structure, opinions that value risk. CONCLUSION: Women's choices are based not only on information, but also on how that information is processed. This study demonstrated that the perception pertaining to the safety of Planned Home Birth is essential for making this decision.


Assuntos
Comportamento de Escolha , Tomada de Decisões , Parto Domiciliar , Motivação , Adulto , Feminino , Humanos , Entrevistas como Assunto , Parto , Gravidez , Pesquisa Qualitativa
15.
Rev Bras Enferm ; 74Suppl 4(Suppl 4): e20200118, 2021.
Artigo em Inglês | MEDLINE | ID: mdl-34105643

RESUMO

OBJECTIVE: to describe the health promotion competency domains, performed by nurses, for adolescents, according to the Galway Consensus. METHOD: a qualitative study based on the Galway Consensus theoretical methodological framework. Fifteen nurses from northeastern Brazil participated. Data were collected between April and May 2017 through pre-structured interviews, submitted to the content analysis technique and analyzed according to the Galway Consensus dimensions. RESULTS: the following competency areas were found: catalyzing changes, leadership, needs assessment, planning, implementation, and partnerships. These competencies were contemplated from embracement of adolescents at health unit, guidance, teamwork, educational activities and lectures, as well as active search. CONCLUSION: most health promotion domains were observed; however, it is still suggested that there are challenges to an effective performance of health promotion among adolescents because some competency domains in health promotion have not been evidenced.


Assuntos
Serviços de Saúde do Adolescente/organização & administração , Promoção da Saúde/métodos , Enfermeiras e Enfermeiros , Enfermagem/normas , Competência Profissional/normas , Adolescente , Brasil , Humanos , Entrevistas como Assunto , Liderança , Pesquisa Qualitativa
16.
Reprod Health ; 18(1): 131, 2021 Jun 24.
Artigo em Inglês | MEDLINE | ID: mdl-34167555

RESUMO

BACKGROUND: Children under 18 years old constituted more than half (52%) of the refugee population in 2017. Adolescent Sexual and reproductive health is an essential component of primary health care. Yet, not every refugee adolescent is able to access sexual and reproductive health services. METHODS: Using quantitative data from 356 refugee adolescents and qualitative data (17 in-depth interviews and nine key informant interviews), we examine refugee adolescent sexual behaviour in Bidibidi settlement-the largest refugee settlement in Uganda using a binary logistic regression model. RESULTS: The results show that 25% of refugee adolescents in Bidibidi refugee settlement had ever had sex. After controlling for all factors, results show that refugee adolescents aged 16-18 years (OR = 3.47; 95% CI = 1.09-10.94), males (OR = 17.59; 95% CI = 4.48-69.07), not in school (OR = 14.57; 95% CI = 2.20-96.35) were more likely to engage in sexual behaviour than their counterparts. Refugee adolescents who do not agree that a girl cannot get pregnant if she has sex while standing up (knowledge about getting pregnant) were significantly less associated with sexual behaviour (OR = 0.30; 95% CI = 0.10-0.85). CONCLUSIONS: Results from this study show that keeping refugee adolescents in school and providing sexual and reproductive health information are likely to delay refugee adolescents' engagement in sexual behaviour. Therefore, there is need to promote keeping refugee adolescents in school in order to improve sexual and reproductive health of adolescent refugees living in low-income countries such as Uganda.


Assuntos
Refugiados , Saúde Reprodutiva , Direitos Sexuais e Reprodutivos , Comportamento Sexual , Saúde Sexual , Adolescente , Comportamento do Adolescente , Feminino , Humanos , Entrevistas como Assunto , Masculino , Gravidez , Pesquisa Qualitativa , Refugiados/psicologia , Migrantes , Uganda
17.
Reprod Health ; 18(1): 133, 2021 Jun 26.
Artigo em Inglês | MEDLINE | ID: mdl-34174913

RESUMO

BACKGROUND: Gestational diabetes (GDM) is a global problem affecting millions of pregnant women, including in mainland China. These women are at high risk of Type II diabetes (T2DM). Cost-effective and clinically effective interventions are needed. We aimed to explore Chinese women's perspectives, concerns and motivations towards participation in early postpartum interventions and/or research to prevent the development of T2DM after a GDM-affected pregnancy. METHODS: We conducted a qualitative study in two hospitals in Chengdu, Southwest China. Face-to-face semi-structured interviews were conducted with 20 women with recent experience of GDM: 16 postpartum women and 4 pregnant women. Women were asked about their attitudes towards postpartum screening for type 2 diabetes, lifestyle interventions, mHealth delivered interventions and pharmacologic interventions (specifically metformin). An inductive approach to analysis was used. Interviews were recorded, transcribed, and coded using NVivo 12 Pro. RESULTS: Most women held positive attitudes towards participating in T2DM screening, and were willing to participate in postpartum interventions to prevent T2DM through lifestyle change or mHealth interventions. Women were less likely to agree to pharmacological intervention, unless they had family members with diabetes or needed medication themselves during pregnancy. We identified seven domains influencing women's attitudes towards future interventions: (1) experiences with the health system during pregnancy; (2) living in an enabling environment; (3) the experience of T2DM in family members; (4) knowledge of diabetes and perception of risk; (5) concerns about personal and baby health; (6) feelings and emotions, and (7) lifestyle constraints. Those with more severe GDM, an enabling environment and health knowledge, and with experience of T2DM in family members expressed more favourable views of postpartum interventions and research participation to prevent T2DM after GDM. Those who perceived themselves as having mild GDM and those with time/lifestyle constraints were less likely to participate. CONCLUSIONS: Women with experiences of GDM in Chengdu are generally willing to participate in early postpartum interventions and/or research to reduce their risk of T2DM, with a preference for non-drug, mHealth based interventions, integrating lifestyle change strategies, blood glucose monitoring, postpartum recovery and mental health.


Assuntos
Grupo com Ancestrais do Continente Asiático/psicologia , Diabetes Mellitus Tipo 2/prevenção & controle , Diabetes Gestacional/diagnóstico , Adolescente , Adulto , Glicemia , Automonitorização da Glicemia , China/epidemiologia , Diabetes Mellitus Tipo 2/etnologia , Diabetes Gestacional/etnologia , Feminino , Conhecimentos, Atitudes e Prática em Saúde/etnologia , Humanos , Entrevistas como Assunto , Saúde Materna , Período Pós-Parto , Gravidez , Serviços Preventivos de Saúde , Pesquisa Qualitativa
18.
Harm Reduct J ; 18(1): 64, 2021 06 12.
Artigo em Inglês | MEDLINE | ID: mdl-34118942

RESUMO

BACKGROUND: The COVID-19 pandemic has necessitated unprecedented changes in the way that health, social, and housing services are delivered to individuals experiencing homelessness and problem substance use. Protecting those at high risk of infection/transmission, whilst addressing the multiple health and social needs of this group, is of utmost importance. This study aimed to document the impact of the COVID-19 pandemic on individuals who were experiencing homelessness in one city centre in Scotland, and how services adapted in response. METHODS: Semi-structured interviews were conducted with individuals with lived/living experience of homelessness (n = 10), staff within onethird sector service (n = 5), and external professionals (n = 5), during April-August 2020, using a rapid case study design. These were audio-recorded, fully transcribed, and analysed using Framework. Analysis was informed by inclusion health and equity-orientated approaches to meeting the needs of people with multiple and complex needs, and emerging literature on providing harm reduction in the context of COVID-19. RESULTS: Those with lived/living experience of homelessness and problem substance use faced a range of additional challenges during the pandemic. Mental health and use of substances were affected, influenced by social isolation and access to services. A range of supports were provided which flexed over the lockdown period, including housing, health and social care, substance use treatment, and harm reduction. As well as documenting the additional risks encountered, findings describe COVID-19 as a 'path-breaking' event that created opportunities to get evidence into action, increase partnership working and communication, to proactively address risks. CONCLUSIONS: This rapid case study has described the significant impact of the COVID-19 pandemic on a group of people experiencing homelessness and problem substance use within one city centre in Scotland and provides a unique lens on service/professional responses. It concludes with lessons that can inform the international and ongoing response to this pandemic. It is vital to recognise the vision and leadership that has adapted organisational responses in order to reduce harms. We must learn from such successes that were motivated both by compassion and care for those vulnerable to harms and the desire to provide high-quality, evidence-based, harm reduction services.


Assuntos
COVID-19/prevenção & controle , Redução do Dano , Serviços de Saúde , Pessoas em Situação de Rua , Apoio Social , Transtornos Relacionados ao Uso de Substâncias/terapia , COVID-19/terapia , Humanos , Entrevistas como Assunto , Pandemias , SARS-CoV-2 , Escócia
19.
Med Educ Online ; 26(1): 1946237, 2021 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-34187346

RESUMO

Due to the COVID-19 pandemic, most graduate medical education (GME) training programs conducted virtual interviews for prospective trainees during the 2020-2021 application cycle. Many internal medicine (IM) subspecialty fellowship programs hosted virtual interviews for the first time with little published data to guide best practices.To evaluate how IM subspecialty fellowship applicants perceived the virtual interview day experience.We designed a 38-item questionnaire that was sent via email to applicants in eight IM subspecialty programs at a single tertiary academic medical center (University of California, San Francisco) from September-November, 2020.Seventy-five applicants completed the survey (75/244, 30.7%), including applicants from all eight fellowship programs. Most survey respondents agreed that the length of the virtual interview day (mean = 6.4 hours) was long enough to gather the information they needed (n = 65, 86.7%) and short enough to prevent fatigue (n = 55, 73.3%). Almost all survey respondents agreed that they could adequately assess the clinical experience (n = 71, 97.3%), research opportunities (n = 72, 98.6%), and program culture (n = 68, 93.2%). Of the respondents who attended a virtual educational conference, most agreed it helped to provide a sense of the program's educational culture (n = 20, 66.7%). Areas for improvement were identified, with some survey respondents reporting that the virtual interview day was too long (n = 11) or that they would have preferred to meet more fellows (n = 10).Survey respondents indicated that the virtual interview was an adequate format to learn about fellowship programs. These findings can inform future virtual interviews for GME training programs.


Assuntos
COVID-19/epidemiologia , Bolsas de Estudo , Medicina Interna/educação , Entrevistas como Assunto/métodos , Estudantes de Medicina/psicologia , Feminino , Humanos , Internato e Residência/organização & administração , Masculino , Pandemias , Estudos Prospectivos , SARS-CoV-2 , São Francisco , Critérios de Admissão Escolar
20.
J Med Internet Res ; 23(6): e29395, 2021 06 09.
Artigo em Inglês | MEDLINE | ID: mdl-34106074

RESUMO

BACKGROUND: In 2020, the number of internet users surpassed 4.6 billion. Individuals who create and share digital data can leave a trail of information about their habits and preferences that collectively generate a digital footprint. Studies have shown that digital footprints can reveal important information regarding an individual's health status, ranging from diet and exercise to depression. Uses of digital applications have accelerated during the COVID-19 pandemic where public health organizations have utilized technology to reduce the burden of transmission, ultimately leading to policy discussions about digital health privacy. Though US consumers report feeling concerned about the way their personal data is used, they continue to use digital technologies. OBJECTIVE: This study aimed to understand the extent to which consumers recognize possible health applications of their digital data and identify their most salient concerns around digital health privacy. METHODS: We conducted semistructured interviews with a diverse national sample of US adults from November 2018 to January 2019. Participants were recruited from the Ipsos KnowledgePanel, a nationally representative panel. Participants were asked to reflect on their own use of digital technology, rate various sources of digital information, and consider several hypothetical scenarios with varying sources and health-related applications of personal digital information. RESULTS: The final cohort included a diverse national sample of 45 US consumers. Participants were generally unaware what consumer digital data might reveal about their health. They also revealed limited knowledge of current data collection and aggregation practices. When responding to specific scenarios with health-related applications of data, they had difficulty weighing the benefits and harms but expressed a desire for privacy protection. They saw benefits in using digital data to improve health, but wanted limits to health programs' use of consumer digital data. CONCLUSIONS: Current privacy restrictions on health-related data are premised on the notion that these data are derived only from medical encounters. Given that an increasing amount of health-related data is derived from digital footprints in consumer settings, our findings suggest the need for greater transparency of data collection and uses, and broader health privacy protections.


Assuntos
Comportamento do Consumidor/estatística & dados numéricos , Informação de Saúde ao Consumidor/estatística & dados numéricos , Coleta de Dados/ética , Conjuntos de Dados como Assunto/provisão & distribuição , Entrevistas como Assunto , Privacidade/psicologia , Pesquisa Qualitativa , Adolescente , Adulto , Estudos de Coortes , Feminino , Humanos , Masculino , Pessoa de Meia-Idade , Estados Unidos , Adulto Jovem
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