RESUMO
Exposure to polycyclic aromatic hydrocarbons (PAHs) of high molecular weight from chimney soot can cause cancer among chimney sweepers. These sweepers may also be exposed to high concentrations of nanosized particles, which can cause significant inflammatory responses due to their relatively greater surface area per mass. In this study, the authors aimed to assess the exposure profiles of airborne personal exposure to gaseous and particulate PAHs, and real-time samples of the particle number concentrations (PNCs), particle sizes, and lung-deposited surface areas (LDSAs), for chimney sweepers in Norway. Additionally, the authors aimed to assess the task-based exposure concentrations of PNCs, sizes, and LDSAs while working on different tasks. The results are based on personal samples of particulate PAHs (n = 68), gaseous PAHs (n = 28), and real-time nanoparticles (n = 8) collected from 17 chimney sweepers. Samples were collected during a "typical work week" of chimney sweeping and fire safety inspections, then during a "massive soot" week, where larger sweeping missions took place. Significantly higher PAH concentrations were measured during the "massive soot" week compared to the "typical work week," however, the time-weighted average (TWA) (8-hr) of all gaseous and particulate PAHs ranged from 0.52 to 4.47 µg/m3 and 0.49 to 2.50 µg/m3, respectively, well below the Norwegian occupational exposure limit (OEL) of 40 µg/m3. The PNCs were high during certain activities, such as emptying the vacuum cleaner. Additionally, during 2 days of sweeping in a waste sorting facility, the TWAs of the PNCs were 3.6 × 104 and 7.1 × 104 particles/cm3 on the first and second days, respectively, which were near and above the proposed nano reference limit TWA value of 4.0 × 104 particles/cm3 proposed by the International Workshop on Nano Reference Values. The corresponding TWAs of the LDSAs were 49.5 and 54.5 µm2/cm3, respectively. The chimney sweepers seemed aware of the potential health risks associated with exposure, and suitable personal protective equipment was used. However, the PNCs reported for the activities show that when the activities change or increase, the PNCs' TWAs can become unacceptably high.
Assuntos
Poluentes Atmosféricos , Exposição Ocupacional , Hidrocarbonetos Policíclicos Aromáticos , Hidrocarbonetos Policíclicos Aromáticos/análise , Fuligem , Gases , Exposição Ocupacional/análise , Poeira/análise , Pulmão/química , Poluentes Atmosféricos/análise , Material Particulado/análise , Monitoramento Ambiental/métodosRESUMO
In forensic mental health care (FMHC), family caregivers perceive themselves as burdened in their relationships with the service user (the family member with mental illness) and by difficult collaboration with healthcare professionals (HCPs). There is a political objective to involve this group in the care and treatment of the service user in mental health care. To improve family caregiver involvement in care and treatment in FMHC, research about their perceptions is needed. This study aims to explore family caregivers' perceptions of their interactions with the service user and HCPs. The method used was qualitative. Semi-structured, in-depth interviews with 12 family caregiver participants were carried out and analyzed thematically. The analysis resulted in three interrelated main themes: Strategies to normalize everyday living; Distrust of the quality of care; and Loss and grief. Family caregiver feelings of loss and grief may be suppressed, which additionally could prevent them from supporting the service user.
Assuntos
Cuidadores , Transtornos Mentais , Humanos , Cuidadores/psicologia , Saúde Mental , Pesquisa Qualitativa , Pessoal de Saúde/psicologia , Transtornos Mentais/terapia , Transtornos Mentais/psicologia , Família/psicologiaRESUMO
Clinical algorithms used in the assessment of febrile children in the Paediatric Emergency Departments are commonly based on threshold values for vital signs, which in children with fever are often outside the normal range. Our aim was to assess the diagnostic value of heart and respiratory rate for serious bacterial infection (SBI) in children after temperature lowering following administration of antipyretics. A prospective cohort of children presenting with fever between June 2014 and March 2015 at the Paediatric Emergency Department of a large teaching hospital in London, UK, was performed. Seven hundred forty children aged 1 month-16 years presenting with a fever and ≥ 1 warning signs of SBI given antipyretics were included. Tachycardia or tachypnoea were defined by different threshold values: (a) APLS threshold values, (b) age-specific and temperature-adjusted centiles charts and (c) relative difference in z-score. SBI was defined by a composite reference standard (cultures from a sterile site, microbiology and virology results, radiological abnormalities, expert panel). Persistent tachypnoea after body temperature lowering was an important predictor of SBI (OR 1.92, 95% CI 1.15, 3.30). This effect was only observed for pneumonia but not other SBIs. Threshold values for tachypnoea > 97th centile at repeat measurement achieved high specificity (0.95 (0.93, 0.96)) and positive likelihood ratios (LR + 3.25 (1.73, 6.11)) and may be useful for ruling in SBI, specifically pneumonia. Persistent tachycardia was not an independent predictor of SBI and had limited value as a diagnostic test. Conclusion: Among children given antipyretics, tachypnoea at repeat measurement had some value in predicting SBI and was useful to rule in pneumonia. The diagnostic value of tachycardia was poor. Overreliance on heart rate as a diagnostic feature following body temperature lowering may not be justified to facilitate safe discharge. What is Known: ⢠Abnormal vital signs at triage have limited value as a diagnostic test to identify children with SBI, and fever alters the specificity of commonly used threshold values for vital signs. ⢠The observed temperature response after antipyretics is not a clinically useful indicator to differentiate the cause of febrile illness. What is New: ⢠Persistent tachycardia following reduction in body temperature was not associated with an increased risk of SBI and of poor value as a diagnostic test, whilst persistent tachypnoea may indicate the presence of pneumonia.
Assuntos
Antipiréticos , Infecções Bacterianas , Pneumonia , Criança , Humanos , Lactente , Frequência Cardíaca/fisiologia , Taxa Respiratória/fisiologia , Estudos Prospectivos , Infecções Bacterianas/diagnóstico , Infecções Bacterianas/tratamento farmacológico , Infecções Bacterianas/complicações , Taquipneia/complicações , Febre/complicações , Serviço Hospitalar de EmergênciaRESUMO
BACKGROUND: Traffic-derived particles are important contributors to the adverse health effects of ambient particulate matter (PM). In Nordic countries, mineral particles from road pavement and diesel exhaust particles (DEP) are important constituents of traffic-derived PM. In the present study we compared the pro-inflammatory responses of mineral particles and DEP to PM from two road tunnels, and examined the mechanisms involved. METHODS: The pro-inflammatory potential of 100 µg/mL coarse (PM10-2.5), fine (PM2.5-0.18) and ultrafine PM (PM0.18) sampled in two road tunnels paved with different stone materials was assessed in human bronchial epithelial cells (HBEC3-KT), and compared to DEP and particles derived from the respective stone materials. Release of pro-inflammatory cytokines (CXCL8, IL-1α, IL-1ß) was measured by ELISA, while the expression of genes related to inflammation (COX2, CXCL8, IL-1α, IL-1ß, TNF-α), redox responses (HO-1) and metabolism (CYP1A1, CYP1B1, PAI-2) was determined by qPCR. The roles of the aryl hydrocarbon receptor (AhR) and reactive oxygen species (ROS) were examined by treatment with the AhR-inhibitor CH223191 and the anti-oxidant N-acetyl cysteine (NAC). RESULTS: Road tunnel PM caused time-dependent increases in expression of CXCL8, COX2, IL-1α, IL-1ß, TNF-α, COX2, PAI-2, CYP1A1, CYP1B1 and HO-1, with fine PM as more potent than coarse PM at early time-points. The stone particle samples and DEP induced lower cytokine release than all size-fractionated PM samples for one tunnel, and versus fine PM for the other tunnel. CH223191 partially reduced release and expression of IL-1α and CXCL8, and expression of COX2, for fine and coarse PM, depending on tunnel, response and time-point. Whereas expression of CYP1A1 was markedly reduced by CH223191, HO-1 expression was not affected. NAC reduced the release and expression of IL-1α and CXCL8, and COX2 expression, but augmented expression of CYP1A1 and HO-1. CONCLUSIONS: The results indicate that the pro-inflammatory responses of road tunnel PM in HBEC3-KT cells are not attributed to the mineral particles or DEP alone. The pro-inflammatory responses seem to involve AhR-dependent mechanisms, suggesting a role for organic constituents. ROS-mediated mechanisms were also involved, probably through AhR-independent pathways. DEP may be a contributor to the AhR-dependent responses, although other sources may be of importance.
Assuntos
Poluentes Atmosféricos , Material Particulado , Humanos , Material Particulado/toxicidade , Espécies Reativas de Oxigênio/metabolismo , Fator de Necrose Tumoral alfa/metabolismo , Ciclo-Oxigenase 2 , Citocromo P-450 CYP1A1/genética , Inibidor 2 de Ativador de Plasminogênio/metabolismo , Inibidor 2 de Ativador de Plasminogênio/farmacologia , Citocinas/metabolismo , Células Epiteliais , Emissões de Veículos/toxicidade , Poluentes Atmosféricos/toxicidade , Poluentes Atmosféricos/metabolismoRESUMO
PURPOSE: To explore and describe the enactment of user involvement and combined care in a Danish clinic that aimed at providing integrated diabetes and mental health care. DESIGN: An ethnographic study. DATA SOURCES AND METHODS: Data consisted of field notes from 96 hours of participant observations and field notes from 32 informal conversations with healthcare providers, users and relatives as well as 12 semistructured interviews with users. Data were analysed using a thematic analysis. This study reports to the SRQR guidelines. RESULTS: Treatment was not combined as intended if only one healthcare provider handled the consultations. Here, the healthcare providers' focus was often on their own area of expertise-either mental health or diabetes. If more than one healthcare provider handled consultations, the consultations were often divided between them, focussing on one condition at the time. Healthcare providers noted, that learning from peer colleagues was a way to increase the possibility for combined care. Furthermore, combined care was highly dependent on the healthcare providers' ability to involve users' illness experiences in their own care planning. Here, a high level of user involvement increased the levels of combined care during consultations. CONCLUSION: This study set out to explore and describe user involvement and combined care in a specialised diabetes and mental health outpatient clinic. Combined care is complexed and requires that healthcare providers are well-equipped to manage the complexity of delivering care for people with both conditions. The degree of combined care was linked with the healthcare providers' ability to involve users and their knowledge on the condition outside there are of expertise. RELEVANCE TO CLINICAL PRACTICE: A peer-learning environment in combination with clinical guidelines and joint display could support healthcare providers in involving users in own care and when delivering care outside their area of expertise. PUBLIC CONTRIBUTION: No patient or public contribution. Due to the COVID-19 pandemic, the original user council withdraw their consent to participate due to health-related worries and anxiety concerning the pandemic. The user council consisted of three members diagnosed with diabetes and severe mental illness. They were invited to participate in physical meetings, phone or online meetings. Presenting findings from the study to the study participants were also hindered by the second lockdown. This influenced the possibility for data triangulation.
Assuntos
COVID-19 , Diabetes Mellitus , Humanos , Saúde Mental , Pandemias , Controle de Doenças Transmissíveis , Diabetes Mellitus/terapiaRESUMO
AIM: To review the evidence of the existing literature on the impact of guided self-determination across methodologies in different healthcare settings. METHODS: An integrated five-stage review. RESULTS: Forty-five eligible papers were included. Guided self-determination was applied in full- or small-scale, or combined with another intervention or approach in different healthcare settings handling, for example diabetes, stroke survivorship, schizophrenia, attention-deficit hyperactivity disorder and medical disorder, gynaecological and breast cancer, endometriosis, persons with chronic pain, persons in haemodialysis and intensive care survivors. The included studies covered 12 randomised trials, 26 qualitative and seven papers of different methodology. A statistically significant effect was found in three trials. Six main themes describe the qualitative findings across papers on patients: (1) Guided self-determination reduces disease-related loneliness, (2) Insight enables integration of life and disease, (3) Reflection sheets-appreciated but challenging tool to prompt insights and person-specific knowledge, (4) New person-specific knowledge enables person-centred support, (5) Feeling seen and believed in a new and trusted relationship and (6) Exchange of knowledge enables the development of life skills. Four themes describe the healthcare professionals' experience: (1) Change of usual practice-a decision from above, (2) A new role-unlearning previous behaviour and need for support, (3) Reflection sheets as facilitators and barriers and (4) Discovering the benefits of changing to a person-centred approach. CONCLUSION: Overall, guided self-determination proved to have a great impact on patient important outcomes and was useful and well-accepted by the majority of patients and healthcare professionals. Albeit guided self-determination is not a 'one size fits all' method. Continuous training and supervision of professionals are a necessary mean when implementing guided self-determination to enhance adoption and sustainability in clinical practice.
Assuntos
Atenção à Saúde , Pessoal de Saúde , Feminino , Humanos , Pessoal de Saúde/educação , Diálise RenalRESUMO
Person-specific evidence was developed as a grounded theory by analyzing 20 selected case descriptions from interventions using the guided self-determination method with people with various long-term health conditions. It explains the mechanisms of mobilizing relational capacity by including person-specific evidence in shared decision-making. Person-specific self-insight was the first step, achieved as individuals completed reflection sheets enabling them to clarify their personal values and identify actions or omissions related to self-management challenges. This step paved the way for sharing these insights and challenges in a relationship with a supportive health professional, who could then rely on person-specific evidence instead of assumptions or a narrow disease perspective for shared decision-making. Trust in the evidence encouraged the supportive health professional to transfer it to the interdisciplinary team. Person-specific evidence then enhanced the ability of team members to apply general evidence in a meaningful way. The increased openness achieved by individuals through these steps enabled them to eventually share their new self-insights in daily life with other people, decreasing loneliness they experienced in self-management. Relational capacity, the core of the theory, is mobilized in both people with long-term health conditions and healthcare professionals. Further research on person-specific evidence and relational capacity in healthcare is recommended.
Assuntos
Pessoal de Saúde , Autonomia Pessoal , Humanos , Teoria FundamentadaRESUMO
BACKGROUND: Traffic particulate matter (PM) comprises a mixture of particles from fuel combustion and wear of road pavement, tires and brakes. In countries with low winter temperatures the relative contribution of mineral-rich PM from road abrasion may be especially high due to use of studded tires during winter season. The aim of the present study was to sample and characterize size-fractioned PM from two road tunnels paved with different stone materials in the asphalt, and to compare the pro-inflammatory potential of these fractions in human bronchial epithelial cells (HBEC3-KT) in relation to physicochemical characteristics. METHODS: The road tunnel PM was collected with a vacuum pump and a high-volume cascade impactor sampler. PM was sampled during winter, both during humid and dry road surface conditions, and before and after cleaning the tunnels. Samples were analysed for hydrodynamic size distribution, content of elemental carbon (EC), organic carbon (OC) and endotoxin, and the capacity for acellular generation of reactive oxygen species. Cytotoxicity and pro-inflammatory responses were assessed in HBEC3-KT cells after exposure to coarse (2.5-10 µm), fine (0.18-2.5 µm) and ultrafine PM (≤ 0.18 µm), as well as particles from the respective stone materials used in the pavement. RESULTS: The pro-inflammatory potency of the PM samples varied between road tunnels and size fractions, but showed more marked responses than for the stone materials used in asphalt of the respective tunnels. In particular, fine samples showed significant increases as low as 25 µg/mL (2.6 µg/cm2) and were more potent than coarse samples, while ultrafine samples showed more variable responses between tunnels, sampling conditions and endpoints. The most marked responses were observed for fine PM sampled during humid road surface conditions. Linear correlation analysis showed that particle-induced cytokine responses were correlated to OC levels, while no correlations were observed for other PM characteristics. CONCLUSIONS: The pro-inflammatory potential of fine road tunnel PM sampled during winter season was high compared to coarse PM. The differences between the PM-induced cytokine responses were not related to stone materials in the asphalt. However, the ratio of OC to total PM mass was associated with the pro-inflammatory potential.
Assuntos
Células Epiteliais , Material Particulado , Carbono , Citocinas , Humanos , Material Particulado/toxicidade , Estações do AnoRESUMO
AIM: The objective of this scoping review was to summarize, understand and provide an overview of the empirical literature on interventions involving own treatment choice for people with coexisting diabetes (type 1 and 2) and severe mental illness (SMI). METHODS: This scoping review undertook a systematic literature assessment. Searches were performed in MEDLINE, Embase, PsycINFO, Web of Science, CINAHL, the Cochrane Library and grey literature (OpenGrey, Google Scholar and Danish Health and Medicine Authority databases). Publications from 2000 to July 2020 were of interest. Studies were included if they involved the users' own choice of treatment. INCLUDED STUDIES: RCT, intervention, cohort and case-based studies. RESULTS: A total of 4320 articles were screened, of which nine were included. The review identified eight studies from the United States and one from Canada testing different interventions for people with SMI and diabetes (one diabetes education program, five randomized controlled trials, one retrospective cohort study, one naturalistic intervention program and one case vignette). The interventions described in the nine articles involved service users, the majority incorporated individualized healthcare plans, and all interventions were based on multidisciplinary teamwork. CONCLUSIONS: Research in the area is limited. Care management interventions tend to focus on a single condition, paradoxically excluding SMI during enrolment. Interventions aimed at people with both conditions often prioritize one condition treatment leading to an unbalanced care.
Assuntos
Atenção à Saúde/métodos , Diabetes Mellitus Tipo 1/epidemiologia , Diabetes Mellitus Tipo 2/epidemiologia , Educação em Saúde , Transtornos Mentais/epidemiologia , Comorbidade , Saúde Global , Humanos , IncidênciaRESUMO
Mental health care professionals are at risk of experiencing burnout. This cross-sectional study aims to investigate burnout in two settings: open and closed psychiatric wards, and two professions: registered nurses and social healthcare assistants in eight psychiatric wards in Denmark. A total of 114 professionals completed the Copenhagen Burnout Inventory and a demographic questionnaire. No statistically differences in burnout in professionals working in closed and open wards were found. However, we found professionals to score highest on personal and work-related burnout and lowest on client-related burnout. This indicates that patients may only play a minor role in burnout in health professionals.
Assuntos
Esgotamento Profissional , Hospitais Psiquiátricos , Estudos Transversais , Pessoal de Saúde , Humanos , Pacientes InternadosRESUMO
Provision of physical health care to people diagnosed with severe mental illness is widely reported as inadequate. This interview study explored perspectives of a group of key informants on current practices of providing physical health care within two mental health care settings in Denmark. Thematic analysis of their accounts provided insights into 1) barriers to the provision of physical health care in mental health settings, and 2) possible solutions to overcome existing barriers. Negative attitudes and limited specialist health care knowledge among mental health care professionals constituted serious barriers. To effectively address these barriers, mental health services need to be reoriented towards the prioritisation of physical health alongside mental health. This will require equipping mental health professionals with relevant knowledge and skills and organisational resources, to effectively work with people experiencing or at risk of physical comorbidities.
Assuntos
Transtornos Mentais , Serviços de Saúde Mental , Atenção à Saúde , Dinamarca , Humanos , Transtornos Mentais/terapia , Saúde Mental , Pesquisa QualitativaRESUMO
Adolescents with ADHD are at increased risk of having a co-existing medical disorder. Research shows that having co-existing ADHD and a medical disorder interferes with the adolescents' daily life, creating a dual task that cannot be managed as two independent disorders. Interventions to support adolescents in managing the dual task of living with co-existing ADHD and medical disorder are needed. The Guided-Self-Determination intervention might be suitable for this population, as it is an empowerment-based intervention facilitating patient involvement and self-management of a disease. The purpose of this study was to evaluate how the Guided Self-Determination intervention impacted 10 adolescents with ADHD and a co-existing medical disorder. The study used a convergent mixed methods design. Quantitative data measuring support from nurses, support from parents, and self-management were collected though self-reported questionnaires at baseline, 3 months, and 6 months and were analyzed with descriptive statistics. Qualitative data capturing the adolescents' experiences of the intervention and the intervention's impact on support from nurses, parents, and self-management were collected through semi-structured interviews and analyzed thematically. Results of the quantitative and qualitative analyses were integrated in a mixed methods analysis. The integrated results suggest that this intervention may improve adolescents' management of the difficulties of living with co-existing ADHD and a medical disorder, and that self-insight and nurse support are prerequisites for developing self-management strategies. However, the results showed that the intervention did not impact parental support. Further research is needed to evaluate the impact of the intervention on a larger scale.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Autogestão , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/complicações , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Humanos , Pais , Autonomia Pessoal , Inquéritos e QuestionáriosRESUMO
AIM: The study aim was to explore adolescents' with co-existing ADHD and medical disorder (MD) perceptions of everyday life and support from parents and healthcare professionals. DESIGN AND METHODS: In this qualitative study, 10 adolescents aged 13-17 years diagnosed with ADHD and a MD were included from a general pediatric hospital clinic and a child and adolescent psychiatric hospital clinic. Data obtained through semi-structured interviews were analyzed using thematic analysis. RESULTS: The adolescents' perceptions were categorized into four themes: 1) ADHD perceived as part of the adolescent's self-understanding - yet with daily frustrations, 2) MD perceived as an interruption in everyday life, 3) ADHD and MD - an overlooked dual task, and 4) the need for supportive relationships in navigating ADHD and MD. CONCLUSION: Living with co-existing ADHD and MD is a complex dual task, as ADHD and MD interfere with each other in everyday life. However, the adolescents overlook the dual task as they believe their difficulties would be resolved if the MD was eliminated. Moreover, supportive relationships are essential in navigating the complexities in living with co-existing ADHD and MD. Nevertheless, the adolescents take a passive role in the encounters with the healthcare professionals, whereas they are more active in encounters with peers, parents and teachers. PRACTICE IMPLICATIONS: Healthcare professionals treating and caring for adolescents with co-existing ADHD and MD need interventions facilitating patient involvement in a patient-centered approach to support both adolescents and healthcare professionals in recognizing the dual task of having co-existing ADHD and MD.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Adolescente , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Dinamarca , Humanos , Pais , Percepção , Pesquisa QualitativaRESUMO
PURPOSE: To explore and describe everyday life and hospital-based healthcare experiences and utilization in families of children with ADHD in Denmark. DESIGN AND METHODS: The present work is a multistage, mixed methods study. The design consists of three individual studies: a meta-synthesis, a focused ethnographic study, and a historical cohort study. RESULTS: The integrated findings show that: 1) parental stressors affect everyday life and hospital-based service use; 2) parents have concerns for their child from early childhood and fight to have their concerns recognized; and 3) healthcare professionals are important for parents to navigate the persistent challenges of everyday life. CONCLUSIONS: Having a child with ADHD pervades everyday life and children with ADHD use more medical and psychiatric services in hospitals during the first 12 years of life than children without ADHD. The findings demonstrate a vulnerable everyday life experience and highlight the importance of the families being recognized, accepted, and respected in hospital-based healthcare services from early childhood. PRACTICE IMPLICATIONS: Healthcare professionals need to recognize the challenges the family of a child with ADHD faces and to acknowledge that ADHD pervades all aspects of everyday life and all other healthcare issues. It is important for healthcare professionals, regardless of specialty, to engage with individual families and to positively contribute to the medical and psychiatric healthcare experience.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade , Transtorno do Deficit de Atenção com Hiperatividade/diagnóstico , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca , Família , Humanos , PaisRESUMO
BACKGROUND: Life expectancy of people with severe mental illness (SMI) is greatly shortened compared to the general population, and despite extensive research, this issue is unsolved. Although it is widely recognised that people with SMI need support from health care services to manage health related issues, profound health inequalities exist within provision of health care. The aim of this study was to examine how mental health care professionals accounted for their actions and responsibilities related to managing physical health issues among people with SMI. METHODS: Three focus groups were conducted with 22 mental health care professionals, employed at three mental health care locations. Participants' situated accounts were subjected to discourse analysis. RESULTS: Participants accounted for actions and responsibilities in three typical ways; 1) by positioning people with SMI as difficult to motivate and actively resisting intervention, 2) by positioning people with SMI as so impaired that intervention was futile, and 3) by arguing they are undertreated for physical conditions and might have physical illnesses that staff are not aware of because of prominent mental illness. These discursive strategies seemed to legitimise situations where participants described not responding to physical health issues, and to downplay potential trouble in situations where participants described not succeeding in facilitating lifestyle changes or promoting compliance to treatment of physical conditions. DISCUSSION AND CONCLUSION: Mental health care professionals need to increase their awareness of latent discriminating attitudes towards people with SMI. Such attitudes are suggested to reinforce barriers for people with SMI receiving physical health care.
Assuntos
Gerenciamento Clínico , Pessoal de Saúde/psicologia , Nível de Saúde , Transtornos Mentais/psicologia , Transtornos Mentais/terapia , Índice de Gravidade de Doença , Adulto , Feminino , Grupos Focais , Humanos , Estilo de Vida , Masculino , Pessoa de Meia-IdadeRESUMO
OBJECTIVES: To compare the mean number of medical and psychiatric hospital-based services in children with and without attention deficit hyperactivity disorder (ADHD) and to assess the effect of ADHD on hospital-based service use, including child-, parental-, and socioeconomic-related risk factors. STUDY DESIGN: A Danish birth cohort was followed through 12 years, and children with ADHD were identified using Danish nationwide registries. Poisson regression analyses were used to assess the association of ADHD with service use and to adjust for a comprehensive set of explanatory variables. RESULTS: Children diagnosed with ADHD used more medical and psychiatric hospital-based healthcare than those without ADHD. In children with ADHD, intellectual disability and parental psychiatric disorder were associated with increased medical and psychiatric service use. Low birth weight and low gestational age were associated with increased medical service use. Psychiatric comorbidity and having a divorced or single parent were associated with increased psychiatric service use. CONCLUSIONS: ADHD independently affected medical and psychiatric hospital-based service use even when adjusting for a comprehensive set of explanatory variables. However, the pattern of medical and psychiatric hospital-based service use is complex and cannot exclusively be explained by the child-, parental-, and socioeconomic-related variables examined in this study.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/epidemiologia , Hospitais/estatística & dados numéricos , Serviços de Saúde Mental/estatística & dados numéricos , Aceitação pelo Paciente de Cuidados de Saúde/estatística & dados numéricos , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Pré-Escolar , Estudos de Coortes , Dinamarca/epidemiologia , Feminino , Seguimentos , Humanos , Lactente , Recém-Nascido , Masculino , Pais , Sistema de Registros , Fatores de Risco , Fatores SocioeconômicosRESUMO
AIM: The aim of this qualitative study was to explore parental experiences of how healthcare practices and healthcare professionals in hospital clinics in Denmark influence everyday life of parents with a child with ADHD. DESIGN AND METHODS: The methodology was focused ethnography. Participant observation and interviews were used as the primary data collection methods. Fifteen families of children with ADHD were included from somatic and psychiatric hospital clinics. RESULTS: Three main themes emerged from the experiences of the families: When the house of cards collapses in everyday life, Treading water before and after receiving the ADHD diagnosis, and Healthcare as a significant lifeline. CONCLUSIONS: Accessibility to healthcare, trusting relationships and healthcare professionals recognizing how ADHD pervades all aspects of everyday life appear to be important factors in providing a lifeline for parents to help them regain confidence and control in disruptive phases. The parents depend on help from healthcare professionals and family-centred care to manage the complex challenges in everyday life.
Assuntos
Transtorno do Deficit de Atenção com Hiperatividade/psicologia , Cuidadores/psicologia , Pais/psicologia , Estresse Psicológico/psicologia , Adaptação Psicológica , Transtorno do Deficit de Atenção com Hiperatividade/terapia , Criança , Dinamarca , Família , Saúde da Família , Feminino , Humanos , Masculino , Pesquisa Qualitativa , Apoio SocialRESUMO
Plant oil is an essential dietary and bio-energy resource. Despite this, the effects of climate change on plant oil quality remain to be elucidated. The present study is the first to show changes in oil quality and quantity of four rapeseed cultivars in climate scenarios with elevated [CO2], [O3] and temperature (T) combined and as single factors. The combination of environmental factors resembled IPCC's 'business as usual' emission scenario predicted for late this century. Generally, the climate scenarios reduced the average amounts of the six fatty acids (FAs) analysed, though in some treatments single FAs remained unchanged or even increased. Most reduced was the FA essential for human nutrition, C18:3-ω3, which decreased by 39% and 45% in the combined scenarios with elevated [CO2]+T+[O3] and [CO2]+T, respectively. Average oil content decreased 3-17%. When [CO2] and T were elevated concurrently, the seed biomass was reduced by half, doubling the losses in FAs and oil content. This corresponded to a 58% reduction in the oil yield per hectare, and C18:3-ω3 decreased by 77%. Furthermore, the polyunsaturated FAs were significantly decreased. The results indicate undesirable consequences for production and health benefits of rapeseed oil with future climate change. The results also showed strong interactive effects of CO2, T and O3 on oil quality, demonstrating why prediction of climate effects requires experiments with combined factors and should not be based on extrapolation from single factor experiments.
Assuntos
Brassica rapa/efeitos dos fármacos , Óleos de Plantas/metabolismo , Brassica rapa/metabolismo , Brassica rapa/fisiologia , Dióxido de Carbono/farmacologia , Mudança Climática , Ácidos Graxos/metabolismo , Temperatura Alta , Ozônio/farmacologia , Óleo de Brassica napusRESUMO
In the present study a set of 108 spring barley (H. vulgare L.) accessions were cultivated under predicted future levels of temperature and [CO2] as single factors and in combination (IPCC, AR5, RCP8.5). Across all genotypes, elevated [CO2] (700 ppm day/night) slightly decreased protein concentration by 5%, while elevated temperature (+5 °C day/night) substantially increased protein concentration by 29%. The combined treatment increased protein concentration across accessions by 8%. This was an increase less than predicted from strictly additive effects of the individual treatments. Despite the increase in grain protein concentration, the decrease in grain yield at combined elevated temperature and elevated [CO2] resulted in 23% less harvestable protein. There was variation in the response of the 108 accessions, which might be exploited to at least maintain if not increase harvestable grain protein under future climate change conditions.
Assuntos
Mudança Climática , Ecótipo , Hordeum/metabolismo , Proteínas de Plantas/metabolismo , Sementes/metabolismo , Cruzamento , Dióxido de Carbono/farmacologia , Hordeum/efeitos dos fármacos , Modelos Biológicos , Estações do Ano , Espectroscopia de Luz Próxima ao InfravermelhoRESUMO
OBJECTIVES: To investigate the exposure to number concentration of ultrafine particles and the size distribution in the breathing zone of workers during rehabilitation of a subsea tunnel. METHODS: Personal exposure was measured using a TSI 3091 Fast Mobility Particle Sizer (FMPS), measuring the number concentration of submicrometre particles (including ultrafine particles) and the particle size distribution in the size range 5.6-560â nm. The measurements were performed in the breathing zone of the operators by the use of a conductive silicone tubing. Working tasks studied were operation of the slipforming machine, operations related to finishing the verge, and welding the PVC membrane. In addition, background levels were measured. RESULTS: Arithmetic mean values of ultrafine particles were in the range 6.26×10(5)-3.34×10(6). Vertical PVC welding gave the highest exposure. Horizontal welding was the work task with the highest maximum peak exposure, 8.1×10(7) particles/cm(3). Background concentrations of 4.0×10(4)-3.1×10(5) were found in the tunnel. The mobility diameter at peak particle concentration varied between 10.8â nm during horizontal PVC welding and during breaks and 60.4â nm while finishing the verge. CONCLUSIONS: PVC welding in a vertical position resulted in very high exposure of the worker to ultrafine particles compared to other types of work tasks. In evaluations of worker exposure to ultrafine particles, it seems important to distinguish between personal samples taken in the breathing zone of the worker and more stationary work area measurements. There is a need for a portable particle-sizing instrument for measurements of ultrafine particles in working environments.