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1.
BMC Health Serv Res ; 23(1): 68, 2023 Jan 23.
Artigo em Inglês | MEDLINE | ID: mdl-36690992

RESUMO

BACKGROUND: In Canada, Ontario Health Teams (OHTs) are a new model for integrated healthcare. Core to OHTs are family physicians (FPs) and their ability to collaborate with other FPs and healthcare providers. Whereas the factors for intra-organizational collaboration have been well-studied, inter-organizational collaboration between FPs and other healthcare organizations as an integrated care network, are less understood. This paper aims to explore the structural factors, processes, and theoretical frameworks that support FPs' collaboration for integrated healthcare. METHODS: A scoping review was undertaken based on Joanna Briggs Institute (JBI) methodology for scoping review and using the Preferred Reporting Items for Systematic Review and Meta-Analysis for Scoping Review (PRISMA_ScR) checklist. A search for academic and relevant grey literature published between 2000-2021 was conducted across databases (MEDLINE, EMBASE, EBSCOhost).Thematic analysis was used to identify the key findings of the selected studies. RESULTS: Thirty-two studies were included as eligible for this review. Three structural components were identified as critical to FPs' successful participation in inter-organizational partnerships: (1) shared vision/values, (2) leadership by FPs, and (3) defined decision-making procedures. Also, three processes were identified: (1) effective communication, (2) a collective sense of motivation for change, and (3) relationships built on trust. Three theoretical frameworks provided insight into collaborative initiatives: (1) Social Identity Approach, (2) framework of interprofessional collaboration, and (3) competing values framework. CONCLUSION: FPs hold unique positions in healthcare and this review is the first to synthesize the best evidence for building collaborations between FPs and other healthcare sectors. These findings will inform collaboration strategies for healthcare integration, including with OHTs.


Assuntos
Atenção à Saúde , Médicos de Família , Humanos , Instalações de Saúde , Ontário , Grupos Populacionais
2.
PLoS One ; 18(1): e0279563, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36662793

RESUMO

BACKGROUND: This scoping review analyses the literature on community-based participatory research (CBPR)-based cardiovascular disease (CVD) management programmes, examining the key elements of their development and implementation and exploring their effectiveness. METHODS: This scoping review's methodology had six stages: 1) identifying the research question; 2) identifying relevant studies-search strategy; 3) study selection; 4) charting the data; 5) collating, summarising, and reporting the results; and 6) consultation exercise. The databases used were PubMed, Cochrane, and CINAHL, for the period from 4 March to 3 April 2022. We selected studies 1) published after 2000; 2) targeting community residents over 18 years old; and 3) proposed a CBPR-based CVD management programme, described its development, and evaluated its effects based on its application. Data were extracted independently by each of the two researchers, using a standardised form. RESULTS: Among the key aspects of such programmes were the many cases where community organisations led establishment of partnerships and cases where a decision-making committee was formed. Regarding application of the CBPR principles, community partners participated only in executing the research, not in analysing and interpreting research results. In addition, among the 21 studies selected were 6 randomised controlled trials, all of which showed a significant positive effect in experimental groups compared to control groups. CONCLUSION: Improvement strategies are needed to allow implementation of CBPR principles in a CBPR-based CVD management programme. Moreover, further verification of programme evaluation research methods is needed. SCOPING REVIEW REGISTRATION: This protocol has been registered to the OSF registries. 0000000204460911. Key Elements and Effects of Cardiovascular Disease Management Programs Based on Community-based Participatory Research: Protocol for a Scoping Review'. OSF, 4 Sept. 2020. Web.


Assuntos
Doenças Cardiovasculares , Pesquisa Participativa Baseada na Comunidade , Humanos , Adolescente , Doenças Cardiovasculares/terapia , Grupos Populacionais , Grupos Controle
3.
BMC Health Serv Res ; 23(1): 75, 2023 Jan 24.
Artigo em Inglês | MEDLINE | ID: mdl-36694193

RESUMO

BACKGROUND: Having a research-engaged health and medical workforce is associated with improvements in clinical outcomes for patients. As such, there has been significant government investment internationally to support health care organisations and services to increase staff engagement with research. OBJECTIVES: This scoping review sought to provide an overview of the literature describing strategies employed to increase research engagement by health care providers and organisations, and to undertake a qualitative analysis to generate a list of research engagement strategies. METHODS: A scoping review using systematic search strategies was undertaken to locate peer-review publications and grey literature related to research engagement by health care providers and organisations. Research engagement was defined as a 'deliberate set of intellectual and practical activities undertaken by health care staff and organisations to conduct research'. A database search of electronic records was performed with no limit on publication date. Publications were included regardless of study type (excluding systematic reviews) and categorised as either databased (presenting data or new analysis of existing data) and non-databased (no new data or analyses). Databased publications were further classified according to study type, study design and setting. A qualitative synthesis using a Framework Approach was undertaken with all studies that described a strategy to improve research engagement. RESULTS: A total of 152 publications were included in this study with 54% categorised as non-databased. Of the databased articles, the majority (72%) were descriptive studies describing prevalence of correlates of research engagement, 17 (25%) described intervention studies where only two were controlled studies. The following research engagement strategies were identified: i) dual skilled team/staff, ii) resources or physical infrastructure, iii) incentives, iv) leadership support of research, v) education/training, vi) networks, vii) forming partnerships or collaborations and viii) overall leadership structure of entity. CONCLUSIONS: The literature on research engagement is primarily opinion-based and descriptive in nature. To provide the evidence needed to inform strategies, this needs to progress beyond descriptive to more rigorous well-designed intervention research.


Assuntos
Atenção à Saúde , Pessoal de Saúde , Humanos , Grupos Populacionais
4.
PLoS One ; 18(1): e0279847, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36602984

RESUMO

INTRODUCTION: In the quest to improve the understanding of climate change impacts on elements of the atmospheric, physical, and life systems, scientists are challenged by the scarcity and uneven distribution of grounded data. Through their long history of interaction with the environment, Indigenous Peoples and local communities have developed complex knowledge systems that allow them to detect impacts of climate change in the local environment. The study protocol presented here is designed 1) to inventory climate change impacts on the atmospheric, physical, and life systems based on local knowledge and 2) to test hypotheses on the global spatial, socioeconomic, and demographic distribution of reported impacts. The protocol has been developed within the framework of a project aiming to bring insights from Indigenous and local knowledge systems to climate research (https://licci.eu). METHODS: Data collection uses a mixed-method approach and relies on the collaboration of a team of 50 trained partners working in sites where people's livelihood directly depend on nature. The data collection protocol consists of two steps. Step 1 includes the collection of secondary data (e.g., spatial and meteorological data) and site contextual information (e.g., village infrastructure, services). Step 1 also includes the use of 1) semi-structured interviews (n = 20-30/site) to document observations of environmental change and their drivers and 2) focus group discussions to identify consensus in the information gathered. Step 2 consist in the application of a household (n from 75 to 125) and individual survey (n from 125 to 175) using a standardized but locally adapted instrument. The survey includes information on 1) individual and household socio-demographic characteristics, 2) direct dependence on nature, 3) household's vulnerability, and 4) individual perceptions of climate change impacts. Survey data are entered in a specifically designed database. EXPECTED RESULTS: This protocol allows the systematic documentation and analysis of the patterned distribution of local indicators of climate change impacts across climate types and livelihood activities. Data collected with this protocol helps fill important gaps on local climate change impacts research and can provide tangible outcomes for local people who will be able to better reflect on how climate change impacts them.


Assuntos
Mudança Climática , Povos Indígenas , Humanos , Inquéritos e Questionários , Grupos Populacionais , Bases de Dados Factuais
5.
PLoS One ; 18(1): e0280648, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36656893

RESUMO

Early identification of vulnerable children to protect them from harm and support them in achieving their long-term potential is a community priority. This is particularly important in the Northern Territory (NT) of Australia, where Aboriginal children are about 40% of all children, and for whom the trauma and disadvantage experienced by Aboriginal Australians has ongoing intergenerational impacts. Given that shared social determinants influence child outcomes across the domains of health, education and welfare, there is growing interest in collaborative interventions that simultaneously respond to outcomes in all domains. There is increasing recognition that many children receive services from multiple NT government agencies, however there is limited understanding of the pattern and scale of overlap of these services. In this paper, NT health, education, child protection and perinatal datasets have been linked for the first time. The records of 8,267 children born in the NT in 2006-2009 were analysed using a person-centred analytic approach. Unsupervised machine learning techniques were used to discover clusters of NT children who experience different patterns of risk. Modelling revealed four or five distinct clusters including a cluster of children who are predominantly ill and experience some neglect, a cluster who predominantly experience abuse and a cluster who predominantly experience neglect. These three, high risk clusters all have low school attendance and together comprise 10-15% of the population. There is a large group of thriving children, with low health needs, high school attendance and low CPS contact. Finally, an unexpected cluster is a modestly sized group of non-attendees, mostly Aboriginal children, who have low school attendance but are otherwise thriving. The high risk groups experience vulnerability in all three domains of health, education and child protection, supporting the need for a flexible, rather than strictly differentiated response. Interagency cooperation would be valuable to provide a suitably collective and coordinated response for the most vulnerable children.


Assuntos
Maus-Tratos Infantis , Gravidez , Feminino , Humanos , Criança , Pré-Escolar , Northern Territory/epidemiologia , Maus-Tratos Infantis/prevenção & controle , Escolaridade , Instituições Acadêmicas , Grupos Populacionais
6.
Addict Sci Clin Pract ; 18(1): 1, 2023 Jan 02.
Artigo em Inglês | MEDLINE | ID: mdl-36593469

RESUMO

BACKGROUND: Substance use among youth is a longstanding global health concern that has dramatically risen in the era of highly toxic and unregulated drugs, including opioids. It is crucial to ensure that youth using unregulated opioids have access to evidence-based interventions, and yet, youth encounter critical gaps in the quality of such interventions. This study aims to address these gaps by identifying opportunities to improve the quality of opioid use services from the perspective of service providers, a perspective that has received scant attention. METHODS: This community-based participatory study was conducted in four communities in British Columbia (Canada), a province that declared a public health overdose emergency in 2016. Human-centered co-design workshops were held to understand service providers' (n = 41) experiences, needs, and ideas for improving the quality of youth opioid use services/treatments in their community. Multi-site qualitative analysis was used to develop overarching experiences and needs themes that were further contextualized in each local community. A blended deductive and inductive thematic analysis was used to analyze the ideas data. RESULTS: Three overarching themes were identified, reflecting service providers' goals to respond to youth in a timely and developmentally appropriate manner. However, this was significantly limited by organizational and systems-level barriers, revealing service providers' priorities for intra- and inter-organizational support and collaboration and systems-level innovation. Across communities, service providers identified 209 individual ideas to address these prioritized needs and improve the quality of youth opioid use services/treatments. CONCLUSION: These themes demonstrate a multi-level tension between macro-level systems and the meso-level organization of youth opioid use services, which undermine the quality of individual-level care service providers can deliver. These findings underscore the need for a coordinated multi-level response, such as developing youth-specific standards (macro-level), increasing inter-organizational activities and collaboration (meso-level), and creating programs that are specific to youths' needs (micro-level).


Assuntos
Overdose de Drogas , Transtornos Relacionados ao Uso de Opioides , Humanos , Adolescente , Colúmbia Britânica , Analgésicos Opioides/uso terapêutico , Transtornos Relacionados ao Uso de Opioides/terapia , Grupos Populacionais
7.
PLoS One ; 18(1): e0277629, 2023.
Artigo em Inglês | MEDLINE | ID: mdl-36634074

RESUMO

Sustainable wildlife management is necessary to guarantee the viability of source populations; but it is rarely practiced in the tropics. The yellow anaconda (Eunectes notaeus) has long been harvested for its leather. Since 2002 its harvest has operated under a management program in northeastern Argentina, which relies on adaptive management practices, that limit the minimum body length permitted for harvesting, the number of active hunters and the length of hunting seasons. Here we investigated the effects of yellow anaconda harvest on its demography based on 2002-2019 data and show that exploitation levels are sustainable. The gradual reduction in annual hunting effort, due to a decrease in the number of hunters and hunting season duration, reduced the total number of anacondas harvested. Conversely, captures per unit effort increased across the study period. The body size of anacondas was not influenced by the harvesting, and more females than males were caught. We also found that a decrease in mean temperature positively influenced anaconda harvest and the capture of giant individuals. Because sustainable use is a powerful tool for conservation, and anacondas are widespread in South America, these discoveries are highly applicable to other species and regions.


Assuntos
Boidae , Conservação dos Recursos Naturais , Humanos , Animais , Masculino , Feminino , Animais Selvagens , Grupos Populacionais , América do Sul
8.
Eur Respir Rev ; 32(167)2023 Mar 31.
Artigo em Inglês | MEDLINE | ID: mdl-36631131

RESUMO

Since 2015, the World Health Organization (WHO) has recommended prioritising testing and treatment of tuberculosis (TB) infection (TBI) in 11 high-risk groups. With new options emerging for TB preventive treatment, we conducted a scoping review, in consultation with the WHO's Global Tuberculosis Programme, to explore the evidence for other population groups at potentially high risk of progression to active TB. We searched six databases for preprints and articles published between 2000 and August 2022. 18 out of 33 668 screened records were included (six meta-analyses and 12 original research studies). Most were observational studies reporting the incidence of active TB in a risk group versus control. Glomerular diseases had the strongest association with active TB (standardised incidence ratio 23.36, 95% CI 16.76-31.68) based on an unpublished study. Other conditions associated with increased risk of active TB included hepatitis C, malignancies, diabetes mellitus, rheumatoid arthritis and vitamin D deficiency. Corticosteroid use was also associated with increased risk in several studies, although heterogeneous definitions of exposure and indications for use challenge interpretation. Despite methodological limitations of the identified studies, expanding the recommendations for TBI screening and treatment to new risk groups such as those reported here should be considered. Further group-specific systematic reviews may provide additional data for decision-making.


Assuntos
Tuberculose Latente , Tuberculose , Humanos , Tuberculose Latente/diagnóstico , Tuberculose Latente/epidemiologia , Grupos Populacionais , Fatores de Risco , Tuberculose/diagnóstico , Tuberculose/epidemiologia , Tuberculose/prevenção & controle , Organização Mundial da Saúde , Metanálise como Assunto , Estudos Observacionais como Assunto
9.
Int J Circumpolar Health ; 82(1): 2166447, 2023 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36642913

RESUMO

Advances in rheumatoid arthritis (RA) management have significantly improved clinical outcomes of this disease; however, some Indigenous North Americans (INA) with RA have not achieved the high rates of treatment success observed in other populations. We review factors contributing to poor long-term outcomes for INA with RA. We conducted a narrative review of studies evaluating RA in INA supplemented with regional administrative health and clinical cohort data on clinical outcomes and health care utilisation. We discuss factors related to conducting research in INA populations including studies of RA prevention. NA with RA have a high burden of genetic and environmental predisposing risk factors that may impact disease phenotype, delayed or limited access to rheumatology care and advanced therapy. These factors may contribute to the observed increased rates of persistent synovitis, premature end-stage joint damage and mortality. Novel models of care delivery that are culturally sensitive and address challenges associated with providing speciality care to patients residing in remote communities with limited accessibility are needed. Progress in establishing respectful research partnerships with INA communities has created a foundation for ongoing initiatives to address care gaps including those aimed at RA prevention. This review highlights some of the challenges of diagnosing, treating, and ultimately perhaps preventing, RA in INA populations.


Assuntos
Artrite Reumatoide , Humanos , Artrite Reumatoide/diagnóstico , Artrite Reumatoide/tratamento farmacológico , Estudos Longitudinais , Grupos Populacionais , Povos Indígenas , América do Norte
10.
Nicotine Tob Res ; 25(1): 3-11, 2023 01 01.
Artigo em Inglês | MEDLINE | ID: mdl-35869642

RESUMO

INTRODUCTION: Indigenous North Americans have the highest cigarette smoking prevalence among all racial and ethnic groups in the United States. We seek to identify effective components of smoking cessation interventions in Indigenous people in the United States associated with favorable cessation outcomes. METHODS: A review of literature studying smoking cessation interventions in Indigenous North Americans (American Indians and Alaska Natives) from January 2010 through August 2021 was completed. The primary objective of this study was to identify components of interventions associated with positive smoking cessation outcomes in Indigenous people. The studies identified were synthesized in a meta-narrative approach. RESULTS: Ten studies out of 608 titles were included (6 randomized trials, 2 single-arm studies, 1 cohort study, and 1 prospective observational study). Five categories of smoking cessation interventions were identified; phone or web-based tools, culturally-tailored interventions, the inclusion of Indigenous study personnel, pharmaceutical cessation aids, and behavioral health interventions. Phone and web tools, cultural tailoring, and inclusion of Indigenous personnel conditions inconsistently influenced smoking cessation. Pharmaceutical aids were viewed favorably among participants. Individualized behavioral counseling sessions were effective at promoting smoking cessation, as was input from local communities in the planning and implementation phases of study. CONCLUSION: A successful smoking cessation intervention in Indigenous North Americans includes Tribal or community input in intervention design and implementation; should provide individualized counseling sessions for participants, and offer access to validated smoking cessation tools including pharmacotherapy. IMPLICATIONS: This study identifies a paucity of smoking interventions utilizing standard of care interventions in Indigenous North Americans. Standard of care interventions including individualized cessation counseling and pharmacotherapy were effective at promoting cessation. The use of novel culturally tailored cessation interventions was not more effective than existing evidence-based care with the exception of including Tribal and local community input in intervention implementation. Future smoking cessation interventions in Indigenous North Americans should prioritize the use of standard of care cessation interventions.


Assuntos
Abandono do Hábito de Fumar , Humanos , Estados Unidos , Estudos de Coortes , Terapia Comportamental , Aconselhamento , Grupos Populacionais , Estudos Observacionais como Assunto
11.
PLoS One ; 17(12): e0277899, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36454968

RESUMO

BACKGROUND: This study attempts to provide a picture of the hesitancy to vaccination against COVID-19 in Spain during the 2021 spring-autumn vaccination campaign, both in the general population and in healthcare professionals. METHODS: The participants were recruited using social media such as Facebook and Twitter, in addition to the cooperation of health personnel contacted with the collaboration of medical scientific societies. A cross-sectional study was carried out that included the response of an online questionnaire. The data were collected from April 30 to September 26, 2021. To assess the different associations between variables to be measured, we fit Poisson regression models with robust variance. RESULTS: Responses were obtained from 3,850 adults from the general population group and 502 health professionals. Of the overall sample, 48.6% of participants from the general population were vaccinated against COVID-19, whereas in the healthcare professionals, 94.8% were vaccinated. The prevalence of general population vaccination increased with age, and was higher in women than men. Most participants did not show a preference for any vaccine itself. However, the prevalence of people vaccinated with their preferred vaccine was higher for the ones vaccinated with Pfizer's vaccine. 6.5% of the general population reported being reticent to be vaccinated. People from younger age groups, people with lower educational levels and those who were not from a risk group showed greater reluctance to be vaccinated. No gender differences in reluctancy were found. CONCLUSIONS: Health professionals were significantly less likely to refuse vaccination even though they had more doubts about the safety and efficacy of vaccines. On the other hand, younger people, those with a lower level of education and those who were not from a risk group were the most hesitant.


Assuntos
COVID-19 , Coronavirus , Adulto , Masculino , Humanos , Feminino , Espanha/epidemiologia , Grupos Populacionais , Vacinas contra COVID-19 , COVID-19/epidemiologia , COVID-19/prevenção & controle , Estudos Transversais , Vacinação , Pessoal de Saúde , Atenção à Saúde
12.
J Health Care Poor Underserved ; 33(4S): 234-242, 2022.
Artigo em Inglês | MEDLINE | ID: mdl-36533472

RESUMO

The COVID-19 pandemic required collaboration to address vaccine hesitancy in populations of color. A large not-for-profit health system collaborated with a philanthropic organization and a technology company, using principles of community-based participatory research, to develop an outreach program aimed at increasing access to COVID-19 vaccines in two geographically distinct locations.


Assuntos
COVID-19 , Pesquisa Participativa Baseada na Comunidade , Humanos , Vacinas contra COVID-19 , Pandemias , COVID-19/epidemiologia , COVID-19/prevenção & controle , Grupos Populacionais
13.
Popul Health Manag ; 25(6): 807-813, 2022 Dec.
Artigo em Inglês | MEDLINE | ID: mdl-36576382

RESUMO

The United States has one of the highest cumulative mortalities of coronavirus disease 2019 (COVID-19) and has reached 1 million deaths as of May 19th, 2022. Understanding which community and hospital factors contributed to disparities in COVID-19 mortality is important to inform public health strategies. This study aimed to explore the potential relationship between hospital service area (1) community (ie, health professional shortage areas, market competition, and uninsured percentage) and (2) hospital (ie, teaching, system, and ownership status) characteristics (2013-2018) on publicly available COVD-19 (February to October 2020) mortality data. The study included 2514 health service areas and used multilevel mixed-effects linear model to account for the multilevel data structure. The outcome measure was the number of COVID-19 deaths. This study found that public health, as opposed to acute care provision, was associated with community health and, ultimately, COVID-19 mortality. The study found that population characteristics including more uninsured greater proportion of those over 65 years, more diverse populations, and larger populations were all associated with a higher rate of death. In addition, communities with fewer hospitals were associated with a lower rate of death. When considering region in the United States, the west region showed a higher rate of death than all other regions. The association between some community characteristics and higher COVID-19 deaths demonstrated that access to health care, either for COVID-19 infection or worse health from higher disease burden, is strongly associated with COVID-19 deaths. Thus, to be better prepared for potential future pandemics, a greater emphasis on public health infrastructure is needed.


Assuntos
COVID-19 , Humanos , Estados Unidos/epidemiologia , COVID-19/epidemiologia , Distanciamento Físico , Atenção à Saúde , Grupos Populacionais , Hospitais
14.
BMC Public Health ; 22(1): 2338, 2022 12 13.
Artigo em Inglês | MEDLINE | ID: mdl-36514032

RESUMO

BACKGROUND: Prior studies indicate that older members of LGBTQ+ communities have specific health provision and health information needs related to coping with COVID-19, its long-term effects, and the social and economic impact of the pandemic. This study addresses the issue of a lack of timely, complete, and high-quality data about this population's healthcare and healthcare information needs and behaviors. Recognizing also that this is a diverse population made up of multiple communities and identities with different concerns and experiences, this research seeks to develop and refine a method that can provide additional nuanced data and insights that can support improved and more closely targeted health interventions and online information provision. METHODS: We use computational discourse analysis, which is based on NLP algorithms, to build and analyze a digital corpus of online search results containing rich, wide-ranging content such as quotes and anecdotes from older members of LGBTQ+ communities as well as practitioners, advice, and recommendations from policymakers and healthcare experts, and research outcomes. In our analysis, we develop and apply an innovative disparities and resilience (D&R) framework to identify external and internal perspectives and understand better disparities and resilience as they pertain to this population. RESULTS: Results of this initial study support previous research that LGBTQ+ elders experience aggravated health and related social-economic disparities in comparison to the general population of older people. We also find that LGBTQ+ elders leverage individual toughness and community closeness, and quickly adapt mentally and technologically, despite inadequate social infrastructure for sharing health information and elders' often low social economic status. The methods used therefore are able to surface distinctive resilience in the face of distinctive disparities. CONCLUSIONS: Our study provides evidence that methodological innovation in gathering and analyzing digital data relating to overlooked, disparately affected, and socially and economically marginalized intersectional communities such as LGBTQ+ elders can result in increased external and self-knowledge of these populations. Specifically, it demonstrates the potential of computational discourse analysis to surface hidden and emerging issues and trends relating to a multi-faceted population that has important concerns about public exposure in highly timely and automated ways. It also points to the potential benefits of triangulating data gathered through this approach with data gathered through more traditional mechanisms such as surveys and interviews. TRIAL REGISTRATION: Not Applicable.


Assuntos
COVID-19 , Humanos , Idoso , Pandemias , Inquéritos e Questionários , Grupos Populacionais , Fatores Socioeconômicos
15.
BMC Public Health ; 22(1): 2343, 2022 12 14.
Artigo em Inglês | MEDLINE | ID: mdl-36517778

RESUMO

BACKGROUND: Colonially imposed jurisdictional boundaries that have little meaning to Indigenous peoples in Canada may confound tuberculosis (TB) prevention and care activities. This study explores how inter-jurisdictional mobility and the current accommodation of mobility through policies and programming sustain a regional TB epidemic in northwestern Saskatchewan, and northeastern Alberta. METHODS: A qualitative instrumental case study was performed using a community based participatory approach. Semi-structured interviews were conducted with First Nations peoples from a high-incidence community in Canada including community-based healthcare workers. These interview data are presented in the context of a multi-level document analysis of TB program guidelines. RESULTS: The location of the community, and related lack of access to employment, services and care, necessitates mobility across jurisdictional boundaries. There are currently no formal federal or provincial guidelines in place to accommodate highly mobile patients and clients within and across provincial TB prevention and care programs. As a result, locally developed community-based protocols, and related ad-hoc strategies ensure continuity of care. CONCLUSION: Indigenous peoples living in remote communities face unique push/pull factors that motivate mobility. When these motivations exist in communities with increased risk of contagion by communicable infectious diseases such as TB, public health risks extend into increasingly large areas with competing jurisdictional authority. Such mobility poses several threats to TB elimination. We have identified a gap in TB services to systematically accommodate mobility, with specific implications for Indigenous peoples and reconciliation. We recommend clearly defined communication paths and inter-jurisdictional coordination to ensure maintenance of care for mobile populations.


Assuntos
Serviços de Saúde Comunitária , Grupos Populacionais , Humanos , Canadá , Alberta/epidemiologia , Participação da Comunidade , Saúde Pública
16.
BMC Public Health ; 22(1): 2377, 2022 12 19.
Artigo em Inglês | MEDLINE | ID: mdl-36536345

RESUMO

BACKGROUND: Indigenous peoples of Canada, United States, Australia, and New Zealand experience disproportionately high rates of suicide as a result of the collective and shared trauma experienced with colonization and ongoing marginalization. Dominant, Western approaches to suicide prevention-typically involving individual-level efforts for behavioural change via mental health professional intervention-by themselves have largely failed at addressing suicide in Indigenous populations, possibly due to cultural misalignment with Indigenous paradigms. Consequently, many Indigenous communities, organizations and governments have been undertaking more cultural and community-based approaches to suicide prevention. To provide a foundation for future research and inform prevention efforts in this context, this critical scoping review summarizes how Indigenous approaches have been integrated in suicide prevention initiatives targeting Indigenous populations. METHODS: A systematic search guided by a community-based participatory research (CBPR) approach was conducted in twelve electronic bibliographic databases for academic literature and six databases for grey literature to identify relevant articles. the reference lists of articles that were selected via the search strategy were hand-searched in order to include any further articles that may have been missed. Articles were screened and assessed for eligibility. From eligible articles, data including authors, year of publication, type of publication, objectives of the study, country, target population, type of suicide prevention strategy, description of suicide prevention strategy, and main outcomes of the study were extracted. A thematic analysis approach guided by Métis knowledge and practices was also applied to synthesize and summarize the findings. RESULTS: Fifty-six academic articles and 16 articles from the grey literature were examined. Four overarching and intersecting thematic areas emerged out of analysis of the academic and grey literature: (1) engaging culture and strengthening connectedness; (2) integrating Indigenous knowledge; (3) Indigenous self-determination; and (4) employing decolonial approaches. CONCLUSIONS: Findings demonstrate how centering Indigenous knowledge and approaches within suicide prevention positively contribute to suicide-related outcomes. Initiatives built upon comprehensive community engagement processes and which incorporate Indigenous culture, knowledge, and decolonizing methods have been shown to have substantial impact on suicide-related outcomes at the individual- and community-level. Indigenous approaches to suicide prevention are diverse, drawing on local culture, knowledge, need and priorities.


Assuntos
Grupos Populacionais , Suicídio , Humanos , Estados Unidos , Grupos Populacionais/psicologia , Povos Indígenas , Governo , Canadá
17.
Nutrients ; 14(23)2022 Dec 05.
Artigo em Inglês | MEDLINE | ID: mdl-36501206

RESUMO

High adherence to a Mediterranean diet (MD) is favourable for its sustainability and beneficial effects on health. The available questionnaires, according to the MD dietary pattern, include the assessment of moderate alcohol consumption; but some groups, such as young adults and pre-conceptional and pregnant women, are not allowed to consume it. The aim of this study was to validate a new short questionnaire (MedQ-Sus) excluding alcohol consumption, to measure the adherence to the MD and to evaluate the nutritional adherence to a sustainable diet. The Harvard validated questionnaire was used for the validation study. A total of 316 subjects (20 to 70 YOA) completed both questionnaires. A high Spearman correlation coefficient (rho = 0.69; p < 0.01) was found between the MedQ-Sus and Harvard scores; a statistically significant positive correlation was found for all eight food groups. The MedQ-Sus had a significant discriminative capacity between adherence and non-adherence to the MD (optimal cut-off point = 9.5, sensitivity 0.86, specificity = 0.65). A very high nutritional adherence to a sustainable diet was found in the subjects for olive oil (97%), dairy food (90%), fresh vegetables (89%), fish and fish products (73), fresh fruit (56%), and cereals and cereals products (42%). A very low adherence was found for legumes (22%) and meat and meat products (9%). The results showed MedQ-Sus is a valid and quick assessment instrument for the evaluation of the adherence to the MD in all population groups, and could also be useful to evaluate the nutritional sustainability of the diet.


Assuntos
Dieta Mediterrânea , Animais , Feminino , Humanos , Gravidez , Grupos Populacionais , Verduras , Frutas , Inquéritos e Questionários , Comportamento Alimentar
18.
Sante Ment Que ; 47(1): 181-217, 2022.
Artigo em Francês | MEDLINE | ID: mdl-36548798

RESUMO

Objective The objective of this paper is to provide an overview of the provision and organization of forensic mental health services around the world. In particular, we attempt to address the following question: What system-level characteristics are important to consider in relation to the organization and structure of forensic mental health services? Methods To do so, we synthesize publicly accessible information, identified through Academic Search Complete (EBSCO), ProQuest Central, Scopus, PsycInfo, Google Scholar and Google, to describe how forensic systems are organized throughout the world. We examine the fundamental principles in the organization of services and examine potential quality indicators. Results This review is a steppingstone for the identification of best practices. Based on these fundamental principles, an efficient forensic mental health system would include the following elements: providing a comprehensive and balanced continuum of services; integrating services within and between systems; matching services to individual need; adhering to human rights; responding to population diversity; and using the best available evidence to make system-wide improvements. Conclusion Though all of these system-level principles are important, we focus on how the first three (service continuum, system integration, and service matching) may be applied to the organization of forensic mental health services.


Assuntos
Serviços de Saúde Mental , Humanos , Grupos Populacionais , Medicina Legal
19.
Artigo em Inglês | MEDLINE | ID: mdl-36498237

RESUMO

BACKGROUND: Australia's social, structural, and political context, together with the continuing impact of colonisation, perpetuates health care and outcome disparities for First Nations Australians. A new approach led by First Nations Australians is required to address these disparities. Co-design is emerging as a valued method for First Nations Australian communities to drive change in health policy and practice to better meet their needs and priorities. However, it is critical that co-design processes and outcomes are culturally safe and effective. Aims: This project aimed to identify the current evidence around optimal approaches to co-design in health with First Nations Australians. METHODS: First Nations Australian co-led team conducted a comprehensive review to identify peer-reviewed and grey literature reporting the application of co-design in health-related areas by and with First Nations Australians. A First Nations Co-Design Working Group (FNCDWG) was established to guide this work and team.A Collaborative Yarning Methodology (CYM) was used to conduct a thematic analysis of the included literature. RESULTS: After full-text screening, 99 studies were included. Thematic analysis elicited the following six key themes, which included 28 practical sub-themes, relevant to co-design in health with First Nations Australians: First Nations Australians leadership; Culturally grounded approach; Respect; Benefit to First Nations communities; Inclusive partnerships; and Evidence-based decision making. CONCLUSION: The findings of this review provide a valuable snapshot of the existing evidence to be used as a starting point to guide appropriate and effective applications of co-design in health with First Nations Australians.


Assuntos
Serviços de Saúde do Indígena , Havaiano Nativo ou Outro Ilhéu do Pacífico , Humanos , Austrália , Grupos Populacionais , Atenção à Saúde
20.
Artigo em Inglês | MEDLINE | ID: mdl-36554743

RESUMO

INTRODUCTION: Participation is an important dimension of healthy child development and is associated with higher self-rated health, educational attainment and civic engagement. Many children with special healthcare needs (SHCN) experience limited participation and are thus at risk for adverse health and developmental outcomes. Despite this, interventions that promote participation in healthcare are scarce. We therefore evaluate the effectiveness of a complex age- and condition-generic intervention that strengthens participation-centred care involving parents and their children with SHCN by, inter alia, assessing preferences, specifying participation goals and facilitating shared decision-making in care. METHODS AND ANALYSIS: In this study protocol we describe the design and procedures for an unblinded, stepped wedge, cluster randomised trial conducted in 15 German interdisciplinary healthcare facilities providing services for children aged 0-18 years with SHCN. Sites are randomised to five periods in which they switch from control to intervention condition in blocks of three. The intervention includes: (1) team training focused on participation-centred care, (2) introduction of a new software facilitating participation-focused documentation and (3) implementation support promoting the transfer of training content into routine care. Study sites deliver routine care while in the control condition. As primary outcome, the degree of perceived shared decision-making with parents (CollaboRATEpediatric parent scale), a potential antecedent of achieving participation goals in everyday life, is assessed on one randomly selected day per week during the entire study period, directly following care appointments. We aim to sample 70 parents per study site and period. Additionally, participation of children is assessed within a closed embedded cohort with three parent and patient surveys. Intervention effectiveness will be modelled with a marginal model for correlated binary outcomes using generalised estimation equations and complete cases. A comprehensive mixed-methods process evaluation complements the effectiveness analyses.


Assuntos
Tomada de Decisões , Participação do Paciente , Humanos , Criança , Família , Grupos Populacionais , Tomada de Decisão Compartilhada , Ensaios Clínicos Controlados Aleatórios como Assunto
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