RESUMO
Achieving effective community reintegration is important to maximize recovery in patients with traumatic brain injury, simultaneously limiting caregiver burden and improving satisfaction with quality of life. Certain medical complications that are common after brain injury may impact community reintegration, and should be addressed by the physician in a systematic approach. Additionally certain social and environmental factors such as mobility or return to work or school may arise, and should be addressed proactively by the physician. Inpatient/residential or outpatient programs with case management and a multi-disciplinary team can facilitate community reentry for patients, and should be considered when available.
Assuntos
Lesões Encefálicas Traumáticas , Humanos , Lesões Encefálicas Traumáticas/reabilitação , Lesões Encefálicas Traumáticas/psicologia , Integração Comunitária , Qualidade de VidaRESUMO
Introduction: This article explores how systemic injustices and social inequalities affect refugee and asylum seeker integration, thriving, and mental health in London. This is pertinent as the United Kingdom currently operates a 'broken' asylum system with unfair policies and a 'tough' immigration rhetoric which makes it extraordinarily difficult for asylum seekers and refugees to achieve community integration, have a good quality of life, be able to thrive, and have good health including mental health. Paradoxically, the United Kingdom Home Office also features an Indicators for Integration Framework to provide practical ways to design more effective strategies, monitor services and evaluated integration interventions. Methods: This study employed a qualitative research design including semi-structured interviews with 19 mental health and psychosocial support service providers working in third-sector organizations in London. Results: The study results show that the current asylum system severely undermines efforts to support asylum seekers and refugees with their integration. All participants highlighted that asylum seekers and refugees lacked experienced poor quality of life and faced structural challenges to build meaningful social connections; to have access education, fair employment and good work; to achieve good mental health and wellbeing; and to be able to thrive. Discussion: To improve community integration, quality of life, thriving, and mental health for asylum seekers and refugees in London and, beyond, the United Kingdom, four recommendations are made on structural and service-levels: (1) reform of the current asylum system by centering human rights; (2) implement and carry out needs assessments among asylum seekers and refugees focussing on key social determinants; (3) ensure asylum seekers and refugees benefit from the NHS Inclusion Health framework; and (4) extend the NHS Patient and Carer Race Equality framework beyond England. To be effective, all four initiatives need to be grounded in a participatory approach that meaningfully involves diverse groups of stakeholders including asylum seekers and refugees.
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Integração Comunitária , Saúde Mental , Pesquisa Qualitativa , Qualidade de Vida , Refugiados , Humanos , Refugiados/psicologia , Londres , Feminino , Masculino , Entrevistas como Assunto , Adulto , Serviços de Saúde MentalRESUMO
BACKGROUND: This comparative qualitative study explores the experiences of individuals transitioning back to the community after institutionalization following an episode of acute suicidality. METHODS: Semi-structured interviews were conducted with eight individuals who had either been hospitalized (n=4) or incarcerated (n=4) during a mental health crisis that involved acute suicidality. Thematic analysis was conducted first within groups and then between groups. RESULTS: The findings reveal possible disparities in social determinants of mental health, family dynamics, treatment seeking, and coping mechanisms between groups. Social isolation, barriers to socioeconomic stability, and lack of treatment access were all found to be risk factors for poor outcomes during the vulnerable transition period and were experienced by participants in this limited sample. CONCLUSIONS: Individuals transitioning from the hospital after a suicide crisis may benefit from increased family involvement, follow-up, and social support at discharge. After a suicide crisis and incarceration, there is a significant need for housing and employment support to allow for mental health treatment seeking. Future research should build on the proof of concept for comparing the experiences of individuals across institutional settings.
Assuntos
Hospitalização , Pesquisa Qualitativa , Humanos , Masculino , Adulto , Feminino , Hospitalização/estatística & dados numéricos , Pessoa de Meia-Idade , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Prisões Locais , Apoio Social , Integração Comunitária/psicologia , Entrevistas como Assunto , Prisioneiros/psicologia , Prisioneiros/estatística & dados numéricos , Adaptação Psicológica , Rhode Island , Isolamento Social/psicologia , Saúde MentalRESUMO
This study aimed to translate and validate the traditional Chinese version of the Community Integration Questionnaire-Revised (TC-CIQ-R) in patients with traumatic brain injury (TBI). We included participants aged ≥20 years and diagnosed as having TBI for ≥6 months from neurosurgical clinics. The 18-item TC-CIQ-R, Participation Measure - 3 Domains, 4 Dimensions (PM-3D4D), Extended Glasgow Outcome Scale (GOSE), and Taiwanese Quality of Life After Brain Injury (TQOLIBRI) were completed. The sample included 180 TBI survivors (54% male, mean age 47â years) of whom 87% sustained a mild TBI. Exploratory factor analysis extracted four factors - home integration, social integration, productivity, and electronic social networking - which explained 63.03% of the variation, after discarding the tenth item with a factor loading of 0.25. For criterion-related validity, the TC-CIQ-R was significantly correlated with the PM-3D4D; convergent validity was exhibited by demonstrating the associations between the TC-CIQ-R and TQOLIBRI. Known-group validity testing revealed significant differences in the subdomain and total scores of the TC-CIQ-R between participants with a mean GOSE score of ≤6 and >7 (all P â <â 0.001). The TC-CIQ-R exhibited acceptable Cronbach's α values (0.68-0.88). We suggest the 17-item TC-CIQ-R as a valid tool for rehabilitation professionals, useful for both clinical practice and research in assessing community integration levels following TBI.
Assuntos
Lesões Encefálicas Traumáticas , Integração Comunitária , Psicometria , Qualidade de Vida , Humanos , Masculino , Feminino , Lesões Encefálicas Traumáticas/reabilitação , Lesões Encefálicas Traumáticas/psicologia , Pessoa de Meia-Idade , Adulto , Inquéritos e Questionários , Análise Fatorial , Taiwan , Reprodutibilidade dos Testes , Escala de Resultado de Glasgow , Sobreviventes/psicologia , Traduções , Integração Social , IdosoRESUMO
OBJECTIVE: To investigate the community integration of patients following stroke and determine the predictors of their level of community integration at 1-year follow-up. DESIGN: A multicenter, longitudinal, and observational study. SUBJECTS: Sixty-five inpatients (41 men) with a mean age of 56.9 (standard deviation = 17.0) years, who had their first stroke at least 1 month prior to this study were recruited from 4 rehabilitation inpatient wards in China. METHODS: In the initial assessment, the participants were evaluated using the Community Integration Questionnaire, the Fugl-Meyer Assessment, the Berg Balance Scale, the Modified Barthel Index, the Mini Mental State Examination, and the Modified Ashworth Scale. In the follow-up assessments, which were conducted via telephone no less than 1 year after discharge, the participants were evaluated using the Community Integration Questionnaire and also assessed for other disease-related conditions. RESULTS: The participants' scores on the Community Integration Questionnaire in the follow-up assessment were significantly greater than those at the initial assessment (p < 0.05). In addition, the participants' Community Integration Questionnaire scores in the follow-up assessment were significantly correlated with their ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination scores in the initial assessment (p < 0.05), and marginally significantly correlated with their scores on Fugl-Meyer Assessment in the initial assessment (p = 0.058). The participants' ages, numbers of years of education, and Modified Barthel Index, Berg Balance Scale, Mini Mental State Examination, Fugl-Meyer Assessment of the lower extremity, and Fugl-Meyer Assessment scores in the initial assessment were predictive of their Community Integration Questionnaire scores at follow-up, with coefficients of determination ranging from 0.254 to 0.056 (p < 0.05). CONCLUSIONS: The level of community integration of the participants was generally low, but it was greater at 1-year follow-up than it was initially. Balance function and daily living ability may be key predictors of community integration of patients following stroke.
Assuntos
Integração Comunitária , Reabilitação do Acidente Vascular Cerebral , Acidente Vascular Cerebral , Humanos , Masculino , Pessoa de Meia-Idade , Feminino , Reabilitação do Acidente Vascular Cerebral/métodos , Estudos Longitudinais , Idoso , Acidente Vascular Cerebral/fisiopatologia , Inquéritos e Questionários , Adulto , China , Avaliação da Deficiência , Equilíbrio Postural/fisiologiaRESUMO
Las escuelas de salud son proyectos comunitarios con un bagaje y una evidencia científica ya conocidos y demostrados. Su influencia en la mejora de la calidad de vida de las persones mayores con soledad no deseada es uno de sus grandes beneficios. Por este motivo, como equipo de Atención Primaria apostamos por ella. El objetivo principal de la escuela es promover el envejecimiento activo y mejorar el estado de salud percibido por las persones mayores de 60 años participantes. Las escuelas de salud son espacios sanadores. Su repercusión es bidireccional, ya que influye en todas las personas que participan, mejorando su calidad de vida y dotándolas de herramientas útiles y sencillas para su día a día a través de los conocimientos adquiridos y las experiencias compartidas. Generar puntos de encuentro en el barrio enriquece y aporta salud más allá de los centros sanitarios. Salir a la calle, hablar de igual a igual, fomentar las redes de apoyo y vincularse a una red, son elementos que fortalecen y mejoran la vertiente social de las personas, ayudándolas a curar heridas de vida. Apostar por la salud comunitaria, es apostar por la salud en todas sus dimensiones. (AU)
Health schools are community projects with a well-known and proven scientific past and background. Their influence in improving the quality of life for elderly individuals experiencing unwanted loneliness is one of their significant benefits. That's why we, as a primary health care team, decided to support it. The main aim of the school is to promote active aging and enhance the perceived health status of participants aged over 60. Health schools are healing spaces. Their impact is bidirectional, which has an impact on all participants. Our quality of life improves as we share knowledge and experiences, providing us with healing, useful and straightforward tools for our daily lives. Creating meeting points in the neighbourhood enriches us and contributes to our well-being beyond healthcare centres. Going out into the community, having peer to peer conversations, fostering support networks, and connecting with others sustain us and make us socially stronger, healing life's wounds. To take a chance on the community is in essence to bet on health in all its dimensions. (AU)
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Humanos , Masculino , Feminino , Pessoa de Meia-Idade , Idoso , Instituições Acadêmicas , Participação da Comunidade/métodos , Integração Comunitária , Envelhecimento Saudável , Saúde Pública , Saúde do IdosoRESUMO
INTRODUCTION: Community integration (CI) is recognised as an overarching goal for the rehabilitation of individuals with acquired brain injury (ABI). However, adults with less severe ABI often experience a lack of support when they return home after discharge from hospital or inpatient rehabilitation, despite having persistent impairments and ongoing needs. Individuals living in rural areas are even less likely to receive adequate support during this period, which is often marked by challenges and uncertainty. This review aims to map and explore the research literature to identify existing models for rehabilitation service provision aimed at promoting the CI of home-dwelling adults with ABI living in rural areas. METHODS: A scoping review of the research literature was conducted. The study followed the Joanna Briggs Institute guidelines for scoping reviews and the PRISMA extension for scoping reviews. The databases searched were MEDLINE, Embase, AMED, CINAHL, Web of Science, Cochrane Library, PsycInfo, and Google Scholar. No limitations were set for the study design, time of publication, or country of origin, but only literature in English, Danish, Norwegian, or Swedish was considered for inclusion. RESULTS: Twenty-seven articles were included. All of them originated from four Western and predominantly English-speaking countries: Australia, Canada, the UK, and the US. A thematic analysis identified six model categories that reflect different strategies for providing rehabilitation that promote CI in adults with ABI in rural areas. Sorting the model categories into micro (individual, interpersonal), meso (organisational, community), and macro (policy, society) levels highlighted that most of the included literature concentrates on microlevel issues at the individual or interpersonal level. Microlevel model categories encompass self-management and education, the use of navigators, and the incorporation of everyday life activities into rehabilitation. Far fewer articles addressed mesolevel issues such as service development in rural areas or the development of inclusive rural communities, and only a single article addressed policy development at the macro level. CONCLUSION: The relatively low number of included articles and limited geographical distribution of studies indicate that more research is needed on rehabilitation models aimed at promoting CI in adults with ABI in rural areas. Although we identified several existing approaches to rehabilitation service provision in rural areas, there is still a need to develop models that fully consider the complexity and long-term nature of CI after ABI. The results also demonstrate that CI in rural areas not only is dependent on professional service delivery aimed at the individual with ABI but also can be promoted by supporting significant others, developing inclusive communities, and improving policies. More knowledge on such issues may facilitate a wider reorganisation of care systems to enhance the CI of adults with ABI in rural areas. However, this will require more research with a wider scope than microlevel service delivery.
Assuntos
Lesões Encefálicas , Integração Comunitária , População Rural , Adulto , Humanos , Austrália , Lesões Encefálicas/reabilitação , População Rural/estatística & dados numéricosRESUMO
PURPOSE: The manual, user-operated Arise Standing Wheelchair (SWC) is the end result of multiple design iterations based on findings and feedback from user trials. The Arise SWC provides standing functionality, outdoor mobility, affordability, and customisability. This paper describes a long-term community integration study of the Arise SWC. METHODS: All participants (N = 8; 7 Male, 1 Female) were persons with spinal cord injuries. During the study period (six months), the participants integrated the Arise SWC into their daily routines. To assess the impact of the Arise SWC on various outcome measures, participants' responses were captured using a Likert-scale questionnaire at the beginning of the study, after 30 days, and after 180 days of Arise SWC usage. RESULTS: The long-term usage of the Arise SWC positively impacted the users' standing performance (ability to stand regularly, stand at different locations, and stand in community settings), productive ability (accessibility to environmental controls and ability to perform overhead reaches), and pathophysiology (spasticity and ability to get proper sleep). Furthermore, all the users were able to independently move using the Arise SWC over even and uneven terrain (some needed minimal assistance over uneven terrain). CONCLUSIONS: Overall, we believe that Arise SWC will benefit eligible users and improve their ability and performance in daily activities.
Arise Standing Wheelchair (SWC) positively impacted users' standing performance, mobility over uneven terrain, ability to transfer between surfaces, and overhead reaches.Arise SWC positively impacted users' overall physical well-being.The study shows that Arise SWC improved the users' overall daily living activities.Arise SWC, an affordable solution, is anticipated to have a global impact, especially on low-income nations.
Assuntos
Desenho de Equipamento , Traumatismos da Medula Espinal , Cadeiras de Rodas , Humanos , Masculino , Feminino , Traumatismos da Medula Espinal/reabilitação , Adulto , Pessoa de Meia-Idade , Pessoas com Deficiência/reabilitação , Posição Ortostática , Atividades Cotidianas , Integração Comunitária , Inquéritos e QuestionáriosRESUMO
BACKGROUND: The independent predictive power of fatigue for community integration has not been investigated, although there is an increasing amount of literature that recognizes the importance of fatigue in people with stroke. OBJECTIVES: To examine the correlation between community integration and fatigue, walking endurance, and fear of falling; and to quantify the relative contribution of fatigue to community integration in people with stroke. METHODS: This was a cross-sectional study with 75 community-dwelling people with stroke. Data were collected using the Community Integration Measure (CIM), Fatigue Assessment Scale (FAS), 6-minute walk test (6MWT), and Survey of Activities and Fear of Falling in the Elderly (SAFE). Multiple linear regressions (forced entry method) were used to quantify the relative power of the FAS score to predict community integration in a model covering distance in the 6MWT and the SAFE score. RESULTS: After controlling for age, the CIM score significantly correlated with the scores for FAS (r=-0.48, p < 0.001), 6MWT distance (r = 0.24, p = 0.039), and SAFE (r=-0.39, p = 0.001). The entire model, including age, FAS score, 6MWT distance, and SAFE score, explained 26.1% of the variance in the CIM scores (F [4, 70] = 7.52, p < 0.001). The FAS scores independently explained 10.6% of the variance in the CIM scores. CONCLUSIONS: This study suggests that fatigue is an independent predictor of community integration among people with stroke, taking into account walking endurance and fear of falling.
Assuntos
Fadiga , Acidente Vascular Cerebral , Humanos , Masculino , Feminino , Idoso , Estudos Transversais , Pessoa de Meia-Idade , Acidente Vascular Cerebral/fisiopatologia , Acidente Vascular Cerebral/complicações , Fadiga/etiologia , Fadiga/fisiopatologia , Idoso de 80 Anos ou mais , Integração Comunitária , Medo , Reabilitação do Acidente Vascular Cerebral , Acidentes por QuedasRESUMO
BACKGROUND: Individuals returning to the wider community from incarceration face many re-entry barriers, including stigmatising beliefs regarding past criminal record, that have impact on health and re-entry. Understanding the development and impact of self-stigma on health can inform re-entry and rehabilitation services. AIMS: The two aims of this study were first, to evaluate a previously established model of self-stigma applied to individuals who have experienced incarceration and, secondly, to study the impact of self-stigma on physical and mental health as well as community integration on re-entry. METHODS: This is a cross-sectional study of 129 formerly incarcerated adults recruited using an online platform and asked to complete online rating scales about self-stigmatisation, health and sense of community integration. Repeated-measures analysis of variance, correlation analysis, and path analyses were used to evaluate the model. RESULTS: There was support for the four distinct stages of self-stigmatisation apparent in mental health research. There was a relationship between self-stigma harm and sense of community integration, mediated by mental but not physical health status scores. CONCLUSION: Our findings add to work on self-stigmatisation in the field of mental health by showing that the concept appears relevant and appears in similar staging among formerly incarcerated individuals and that self-stigmatisation is likely to be important for their community reintegration. Our sample was not typical of the wider prison population for race and gender distribution, in particular having fewer than expected those minority groups likely to be especially vulnerable to stigmatisation by others. Our findings nevertheless suggest that further, preferably, longitudinal research on self-stigma to enable better understanding of pathways could substantially help treatment and rehabilitation of individuals after release from a correctional facility.
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Integração Comunitária , Encarceramento , Adulto , Humanos , Estudos Transversais , Estigma Social , Saúde MentalRESUMO
Adults who have substantial histories of homelessness and complex support needs may feel ambivalent about integrating into their communities and find it difficult to do so. Being familiar to and recognized by others as a resident in a neighborhood or community are sources of "distal support" that provide individuals with feelings of belonging to their community and are important to recovery from homelessness. We hypothesized that individuals engaged with Housing First (HF) programs would report more distal support than individuals engaged with traditional homeless services (treatment as usual, TAU), and that distal support would predict more community integration, growth-related recovery, and achieved capabilities. We analyzed data collected from homeless services users (n = 445) engaged with either HF or TAU in eight European countries. Measures included achieved capabilities, growth-focused recovery, distal supports, and community integration. Serial mediation analyses confirmed our hypothesis that the effects of HF on growth-related recovery and achieved capabilities are indirect, mediated by distal supports and community integration. Findings are discussed in relation to the importance of modeling the effects of HF on social and psychological outcomes as indirect and identifying important mediators that translate the effects of HF components on social and psychological outcomes. We also note the importance of case management activities that encourage clients to develop and sustain distal supports with others who live and work in their neighborhoods.
Assuntos
Pessoas Mal Alojadas , Apoio Social , Humanos , Pessoas Mal Alojadas/psicologia , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Integração Comunitária , Habitação , Europa (Continente) , Continuidade da Assistência ao PacienteRESUMO
Current models of care delivery are failing patients with complexity, like those living with HIV, mental illness and other psychosocial challenges. These patients often require resource-intensive personalized care across hospital and community settings, but available supports can be fragmented and challenging to access and navigate. To improve this, the authors created a program to enhance integrated, trauma-informed care through an innovative educational role for a HIV community caseworker embedded in an academic HIV Psychiatry clinic, called the Mental Health Clinical Fellowship. Through qualitative interviews with 21 participants (patients, physicians, clinicians and Mental Health Clinical Fellows) from October 2020-March 2023, the authors explore how implementation of this program affects patient experiences and satisfaction with care. Patients described their care experiences as less stigmatizing, more accessible, holistic and coordinated. They often attributed this to the integration between fellow and psychiatrist, and specifically the accessible stance of community organizations embedded within a hospital, which helped build trust. Interchangeable and integrated support by caseworker and psychiatrist improved patient engagement in psychiatric management and patient satisfaction with their care. Cross-context and cross-disciplinary care provision that includes providers from community and hospital working directly together to deliver care can improve care for patients with significant complexity.
Assuntos
Infecções por HIV , Transtornos Mentais , Humanos , Integração Comunitária , Infecções por HIV/terapia , Transtornos Mentais/terapia , Assistência Centrada no Paciente , Hospitais , Satisfação do PacienteRESUMO
BACKGROUND: While health care payers are increasingly considering approaches that help support stable and affordable housing for their beneficiaries, experience with these initiatives is limited. Through its §1115 HealthChoice waiver, Maryland Medicaid has begun experimenting with programs designed to pay for housing and tenancy support/case management services. This study investigates barriers and facilitators to the success of Maryland's pilot program initiative - Assistance in Community Integration Services (ACIS). METHODS: The study focused on key stakeholders employed by the four Lead Entities that currently participate in the ACIS program. The stakeholders included members of each Lead Entity's administration, direct service providers, state and local government officials, and case managers from local hospitals. The convenience sample was selected through an initial list of stakeholders and was supplemented using snowball sampling methods. Interviews were audio recorded and turned into transcripts via Otter.ai and then analyzed using NVivo by two independent reviewers. RESULTS: A total of 23 interviews were conducted between February 2022 and May 2022, representing a broad range of stakeholders across different Maryland geographies. A total of 4 themes were identified through the course of the interviews. Stakeholders identified difficulty finding housing for the target population in a tight housing market, challenges with communication within the program and with its clients, and problems with non-healthcare providers documenting services for reimbursement. At the same time, ACIS was seen as creating opportunities for organizations to work together across siloes in meeting client needs. CONCLUSIONS: The findings of this study helps to highlight Medicaid §1115 waivers as a novel approach to using Medicaid funds to support tenancy-based services, such as ACIS and to improve the lives of individuals while reducing healthcare costs. Implementation of the ACIS program in Maryland has been a resounding success in helping individuals obtain and sustain stable housing. However, continued efforts to align capacity with demand, streamline billing and reimbursement and improve communication with clients and across partners will need to be prioritized. The program also highlights the growing need to address root causes of housing insecurity including the limited supply of affordable housing.
Assuntos
Habitação , Medicaid , Estados Unidos , Humanos , Maryland , Administração de Caso , Integração ComunitáriaRESUMO
William (Bill) A. Anthony was a pioneer in the field of psychosocial/psychiatric rehabilitation and recovery. He established the Center for Psychiatric Rehabilitation at Boston University and served as the editor/coeditor of the Psychosocial Rehabilitation Journal (later Psychiatric Rehabilitation Journal). He helped to clarify ideas, principles, policies, and practices that promoted the right and ability of people living with psychiatric disabilities and mental health challenges to aspire to and achieve their own vision of a meaningful life. This introductory article briefly overviews Bill's contributions to psychiatric rehabilitation and recovery of people with mental health challenges and his influence on recent work in this field, a sample of which is presented in the current special section dedicated to him. To conclude, the article overviews this special section, which reports on studies in the United States and elsewhere, addressing supported education, recovery colleges, photovoice to promote community integration, and policy developments in Israel. (PsycInfo Database Record (c) 2023 APA, all rights reserved).
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Integração Comunitária , Reabilitação Psiquiátrica , Masculino , Humanos , Escolaridade , Saúde Mental , UniversidadesRESUMO
Introduction: The aim of this study was to identify the associated factors with lower self-esteem and restriction in community reintegration in SpA patients. Methods: This study was a cross-sectional study including SpA patients (ASAS criteria) aged 1850 years. The level of self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). The Reintegration to Normal Living Index (RNLI) evaluated the degree of reintegration to normal social activities. Anxiety, depression, and fibromyalgia were screened by the Hospital Anxiety and Depression Scale (HADS)-A, HADS-D, and FiRST, respectively. Statistical analysis was performed. Results: A total of 72 patients were enrolled (sex-ratio=1.88), with median (IQR) age of 39 years (28.2546). Median (IQR) disease duration was 10 (614) years. Median (IQR) BASDAI and ASDAS were 3 (2.14.7) and 2.7 (1.93.48), respectively. Anxiety symptoms were screened in 10% of SpA patients, depression in 11%; and fibromyalgia in 10%. Median (IQR) RSES and RNLI scores were 30 (23.2534), and 83 (53.2593.25), respectively. Multivariate regression analysis identified the domain (work) of pain interference, VAS pain, HAD anxiety, PGA, marital status, and morning stiffness as factors associated with lower self-esteem. Restriction in the reintegration community was predicted by the presence of IBD, VAS pain, FIRST, deformity, enjoyment of life, and HAD depression. Conclusion: Pain intensity and interference, deformities, extra-articular manifestations, and deterioration of mental health were associated with low self-esteem and severe restriction in community reintegration among patients with SpA rather than inflammatory parameters.(AU)
Introducción: El objetivo de este estudio fue identificar el factor asociado a la baja autoestima y la restricción en la reintegración comunitaria en pacientes con espondiloartritis (EspA). Métodos: Este estudio fue un estudio transversal llevado a cabo incluyendo a pacientes con EspA (criterios ASAS) de entre 18 y 50 años de edad. El nivel de autoestima se evaluó mediante la Rosenberg Self-Esteem Scale (RSES). El Reintegration to Normal Living Index (RNLI) evaluó el grado de reintegración a las actividades sociales normales. La ansiedad, la depresión y la fibromialgia se evaluaron mediante la Hospital Anxiety and Depression Scale (HADS)-A, HADS-D y FIRST, respectivamente. Se realizó un análisis estadístico. Resultados: Se inscribieron 72 pacientes (razón por sexo: 1,88), con una mediana (IQR) de edad de 39 años (28,25-46). La IQR de la duración de la enfermedad fue de 10 (6-14) años. La IQR de BASDAI y ASDAS fue de 3 (2,1-4,7) y 2,7 (1,9-3,48), respectivamente. Se detectaron síntomas de ansiedad en el 10% de los pacientes con EspA, depresión en el 11% y fibromialgia en el 10%. La IQR de las puntuaciones RSES y RNLI fue de 30 (23,25-34) y 83 (53,25-93,25), respectivamente. El análisis de regresión multivariante identificó el dominio (trabajo) de la interferencia del dolor, el dolor VAS, la ansiedad HAD, la PGA, el estado civil y la rigidez matinal como factores asociados a una menor autoestima. La restricción en la comunidad de reintegración se predijo por la presencia de EII, el dolor VAS, la herramienta FIRST, la deformidad, el disfrute de la vida y la depresión HAD. Conclusiones: La intensidad y la interferencia del dolor, las deformidades, las manifestaciones extra-articulares y el deterioro de la salud mental se asociaron a una baja autoestima y de una severa restricción en la reintegración a la comunidad entre los pacientes con EspA más que los parámetros inflamatorios.(AU)
Assuntos
Humanos , Masculino , Feminino , Adulto Jovem , Adulto , Pessoa de Meia-Idade , Integração Comunitária , Espondilartrite , Autoimagem , Ansiedade , Depressão , Fibromialgia , Reumatologia , Doenças Reumáticas , Estudos Transversais , Saúde Mental , Dor , Deformidades Articulares AdquiridasRESUMO
INTRODUCTION: The aim of this study was to identify the associated factors with lower self-esteem and restriction in community reintegration in SpA patients. METHODS: This study was a cross-sectional study including SpA patients (ASAS criteria) aged 18-50 years. The level of self-esteem was assessed using the Rosenberg Self-Esteem Scale (RSES). The Reintegration to Normal Living Index (RNLI) evaluated the degree of reintegration to normal social activities. Anxiety, depression, and fibromyalgia were screened by the Hospital Anxiety and Depression Scale (HADS)-A, HADS-D, and FiRST, respectively. Statistical analysis was performed. RESULTS: A total of 72 patients were enrolled (sex-ratio=1.88), with median (IQR) age of 39 years (28.25-46). Median (IQR) disease duration was 10 (6-14) years. Median (IQR) BASDAI and ASDAS were 3 (2.1-4.7) and 2.7 (1.9-3.48), respectively. Anxiety symptoms were screened in 10% of SpA patients, depression in 11%; and fibromyalgia in 10%. Median (IQR) RSES and RNLI scores were 30 (23.25-34), and 83 (53.25-93.25), respectively. Multivariate regression analysis identified the domain (work) of pain interference, VAS pain, HAD anxiety, PGA, marital status, and morning stiffness as factors associated with lower self-esteem. Restriction in the reintegration community was predicted by the presence of IBD, VAS pain, FIRST, deformity, enjoyment of life, and HAD depression. CONCLUSION: Pain intensity and interference, deformities, extra-articular manifestations, and deterioration of mental health were associated with low self-esteem and severe restriction in community reintegration among patients with SpA rather than inflammatory parameters.
Assuntos
Fibromialgia , Espondilartrite , Humanos , Fibromialgia/diagnóstico , Integração Comunitária , Estudos Transversais , Qualidade de Vida/psicologia , Espondilartrite/complicações , DorRESUMO
BACKGROUND: No tool is currently available to evaluate the ability of patients with stroke to return to being productive members of their community. PURPOSE: This study was designed to translate the Community Integration Scale-Revised into traditional Chinese (TC-CIQR) and to verify the reliability and validity of this scale in patients with stroke. METHODS: A cross-sectional study design using convenient sampling was adopted in this study. All of the participants were patients undergoing treatment at neurological outpatient clinics and a rehabilitation department of a regional teaching hospital in northern Taiwan. The eligibility criterion was having been diagnosed with stroke for more than three months. The measurement tools used to collect data included an information sheet, the Chinese versions of the Franche Activity Index, EuroQol-5 dimensions, and TC-CIQR. RESULTS: One hundred twenty-four stroke survivors with a mean age of 67.48 years were enrolled as participants. Approximately 60% of the participants were male and over 80% had experienced a stroke of mild severity. The 18-item TC-CIQR yielded strong correlations with the total score of the Franche Activity Index (r = .49 to .83) and CEQ-visual analogue scale (r = .52). The internal consistency of the TC-CIQR (Cronbach's α coefficients = .91) was excellent, and test-retest reliability was .99, indicating the tool has acceptable reliability. CONCLUSIONS: The TC-CIQR was shown to have acceptable reliability and validity. Healthcare providers may integrate the TC-CIQR into clinical practice as an effective tool for evaluating the ability of patients with stroke who are undergoing rehabilitation to return to the community.
Assuntos
Integração Comunitária , Acidente Vascular Cerebral , Humanos , Masculino , Idoso , Feminino , Psicometria , Reprodutibilidade dos Testes , Estudos Transversais , Inquéritos e Questionários , Acidente Vascular Cerebral/diagnóstico , ChinaRESUMO
La crisis sanitaria derivada de la pandemia por COVID-19 ha aumentado la vulnerabilidad de determinados colectivos de Chile, como la población en edad escolar. Los Proyectos de Vinculación con el Medio pueden disminuir esta brecha mediante el acercamiento de los estudiantes universitarios a dichos ámbitos comunitarios. En Chile se llevaron a cabo dos proyectos de control de salud escolar en las comunas de Lota y Hualpén, de la ciudad de Concepción: Salud y Bienestar para Lota y Proyecto Escuelas Saludables. En ellos los estudiantes de 4º de Enfermería evaluaban el desarrollo psicomotor de preescolares y realizaban Educación para la Salud sobre diversos temas como: alimentación saludable, actividad física, convivencia escolar y hábitos de higiene entre otros. La evaluación de la satisfacción de los estudiantes reveló que aproximadamente tres de cada cuatro habían mejorado sus habilidades de atención al usuario y habían podido integrar conocimientos teóricos en la práctica. Además, la mayoría (un 92,8%) estaba de acuerdo en que realizar esta actividad en el 4º año favorecía el desarrollo de competencias esperadas para futuros desempeños en este campo de acción de la disciplina enfermera. Estas actividades generan un beneficio bidireccional cubriendo las necesidades en salud de la comunidad y generando una oportunidad de aprendizaje en contextos de Atención Primaria comunitaria, fuera de los centros de salud.(AU)
The healthcare crisis derived of the COVID-19 pandemic has increased the vulnerability of certain population groups in Chile, such as school-age children. Projects for Connection with the Environment can reduce this breach by approaching University students to said community settings. Two projects for school health monitoring were conducted in Chile, in the municipalities of Lota and Hualpén from the city of Concepción: Health and Wellbeing for Lota, and Project for Healthy Schools. In these projects, 4th year Nursing students assessed the psychomotor development of pre-schoolers and conducted Health Education on different subjects such as: healthy diet, physical activity, school coexistence and hygiene habits, among others. The satisfaction assessment in students revealed that approximately three out of four had improved their user support skills and had been able to integrate theoretical knowledge into practice. Besides, the majority (92.8%) agreed that conducting this activity on their 4th year encouraged the development of the skills expected for future performance in this field of action for Nurses. These activities generate a bidirectional benefit, covering the healthcare needs in the community, and creating a learning opportunity in the Primary Care community settings, outside health centres.(AU)
Assuntos
Humanos , Estudantes de Enfermagem , Enfermagem em Saúde Comunitária , Integração Comunitária , Pandemias , Infecções por Coronavirus/epidemiologia , Chile , Atenção Primária à SaúdeRESUMO
OBJECTIVES: The objective of this study was to understand the relative contribution of acute motor versus cognitive functioning on community integration 1 year after moderate-severe traumatic brain injury (TBI). METHODS: Secondary data analysis of 779 participants in the TBI Model Systems National Database who experienced a moderate-severe TBI requiring inpatient rehabilitation. Participants were categorized into four groups: low motor/low cognition, low motor/high cognition, high motor/low cognition, or high motor/high cognition. Community integration outcomes measured 1 year post-TBI included the Participation Assessment with Recombined Tools-Objective (PART-O), driving status, Supervision Rating Scale, residence, re-injury, and employment status. RESULTS: Participants with both high motor/high cognition had higher scores on the PART-O total score (p < 0.001), living independently (p = 0.023), living in a private residence (p = 0.002), and being employed (p = 0.026) at 1 year. Participants with high motor/high cognition and high motor/low cognition had higher odds of driving (p = 0.001 and p = 0.034, respectively) when compared to low motor/low cognition. All groups relative to the low motor/low cognition group had higher odds of being re-injured. DISCUSSION AND CONCLUSIONS: High motor and high cognitive function at rehabilitation are associated with favorable community integration outcomes 1 year post-injury, though greater participation afforded by high function may confer elevated risk of re-injury.
Assuntos
Lesões Encefálicas Traumáticas , Lesões Encefálicas , Relesões , Humanos , Integração Comunitária , Relesões/complicações , Lesões Encefálicas Traumáticas/complicações , Lesões Encefálicas Traumáticas/reabilitação , Lesões Encefálicas/complicações , CogniçãoRESUMO
BACKGROUND: Deinstitutionalization research shows better services and outcomes relative to institutional life but has not compared formerly institutionalised and never-institutionalised service users. METHODS: We used propensity score matching (PSM) to match formerly institutionalised and never-institutionalised participants on six personal characteristics. Data came from the 2018 to 2019 National Core Indicators In-Person Survey. We excluded current institution residents, and states with 25% + of missing data on former institutionalisation. RESULTS: Overall, 15.5% of participants in the 29-state full sample had lived in an institution for 1 year or more. Findings from the PSM sample showed that former-institution residents were more likely to use congregate living arrangements and less likely to live with family. They experienced more loneliness, less support-related choice, and had a consistent pattern of disability service-focused social connections. CONCLUSIONS: Many former institution residents remain disadvantaged relative to matched peers. There is a need to identify factors to enhance services and outcomes following deinstitutionalization.