The role of pharmacists in caring for young people with chronic illness

Purpose - To explore the perceived and potential roles of pharmacists in the care of young people aged 10-24 years with chronic illness, through the exemplar of juvenile arthritis, from the perspectives of UK community and hospital pharmacists, health service commissioners, rheumatology health professionals and lay advocates. Methods - A sequential mixed methods study design comprising: focus groups with community and hospital pharmacists; telephone interviews with pharmacy and rheumatology stakeholders and commissioners, and multidisciplinary group discussions to prioritize roles generated by the first two qualitative phases. Results - The high priority roles for pharmacists, identified by pharmacists and rheumatology staff, were: developing generic healthcare skills among young people; transferring information effectively across care interfaces; building trusting relationships with young people; helping young people to find credible online health information, and the need to develop specialist expertise. Participants identified associated challenges for pharmacists in supporting young people with chronic illness. These challenges included parents collecting prescription refills alone, thus reducing opportunities to engage, and pharmacist isolation from the wider healthcare team. Conclusions - This study has led to the identification of specific enhancements to pharmacy services for young people which have received the endorsement of a wide range of stakeholders. These suggestions could inform the next steps in developing the contribution of community and hospital pharmacy to support young people with chronic illness in the optimal use of their medication.

Ensuring Quality Services for Infants and Toddlers with Disabilities and their Families within the BabyNet Early Intervention System: An Analysis of Current and Needed Resources

This report prioritizes the targeted, additional resources First Steps and system stakeholders believe will be necessary to ensure the BabyNet system earns a federal designation of “meets requirements” for the first time in its 25 year history. It lists key recommendations to help meet those requirements.

An exploration of treatment burden and patient capacity in people with stroke

Background and aims: Advances in modern medicine have led to improved outcomes after stroke, yet an increased treatment burden has been placed on patients. Treatment burden is the workload of health care for people with chronic illness and the impact that this has on functioning and well-being. Those with comorbidities are likely to be particularly burdened. Excessive treatment burden can negatively affect outcomes. Individuals are likely to differ in their ability to manage health problems and follow treatments, defined as patient capacity. The aim of this thesis was to explore the experience of treatment burden for people who have had a stroke and the factors that influence patient capacity. Methods: There were four phases of research. 1) A systematic review of the qualitative literature that explored the experience of treatment burden for those with stroke. Data were analysed using framework synthesis, underpinned by Normalisation Process Theory (NPT). 2) A cross-sectional study of 1,424,378 participants >18 years, demographically representative of the Scottish population. Binary logistic regression was used to analyse the relationship between stroke and the presence of comorbidities and prescribed medications. 3) Interviews with twenty-nine individuals with stroke, fifteen analysed by framework analysis underpinned by NPT and fourteen by thematic analysis. The experience of treatment burden was explored in depth along with factors that influence patient capacity. 4) Integration of findings in order to create a conceptual model of treatment burden and patient capacity in stroke. Results: Phase 1) A taxonomy of treatment burden in stroke was created. The following broad areas of treatment burden were identified: making sense of stroke management and planning care; interacting with others including health professionals, family and other stroke patients; enacting management strategies; and reflecting on management. Phase 2) 35,690 people (2.5%) had a diagnosis of stroke and of the 39 co-morbidities examined, 35 were significantly more common in those with stroke. The proportion of those with stroke that had >1 additional morbidities present (94.2%) was almost twice that of controls (48%) (odds ratio (OR) adjusted for age, gender and socioeconomic deprivation; 95% confidence interval: 5.18; 4.95-5.43) and 34.5% had 4-6 comorbidities compared to 7.2% of controls (8.59; 8.17-9.04). In the stroke group, 12.6% of people had a record of >11 repeat prescriptions compared to only 1.5% of the control group (OR adjusted for age, gender, deprivation and morbidity count: 15.84; 14.86-16.88). Phase 3) The taxonomy of treatment burden from Phase 1 was verified and expanded. Additionally, treatment burdens were identified as arising from either: the workload of healthcare; or the endurance of care deficiencies. A taxonomy of patient capacity was created. Six factors were identified that influence patient capacity: personal attributes and skills; physical and cognitive abilities; support network; financial status; life workload, and environment. A conceptual model of treatment burden was created. Healthcare workload and the presence of care deficiencies can influence and be influenced by patient capacity. The quality and configuration of health and social care services influences healthcare workload, care deficiencies and patient capacity. Conclusions: This thesis provides important insights into the considerable treatment burden experienced by people who have had a stroke and the factors that affect their capacity to manage health. Multimorbidity and polypharmacy are common in those with stroke and levels of these are high. Findings have important implications for the design of clinical guidelines and healthcare delivery, for example co-ordination of care should be improved, shared decision-making enhanced, and patients better supported following discharge from hospital.

Subjective Aspects of People with Chronic Ulcers: a Qualitative Study in Brazil and Portugal

Introduction: The experience built in the process of living with chronic ulcer is marked by changes such as the inability to work, to relate socially and causes the need to adapt to a routine care. Understanding this network of meanings is important to develop techniques of individual or collective care. Objective: To understand impregnated subjectivities in the everyday experiences of Brazilian and Portuguese patients with chronic ulcers, in the light of the Oral History of life. Method: Comparative study with a qualitative approach, using Oral History as method and technique. The network of collaborators, formed by males and females, aged 39-82 years, was structured into two groups, one consisting of 06 people in Natal/RN, Brazil and another composed of 10 people in Évora/Portugal. In both groups, the narratives were collected through open questions, which were recorded, transcribed and analyzed by the technique of thematic content analysis. Results: Through the analysis, three themes were revealed: Social repercussion in Brazil and in Portugal; Trajectory of theinjured person; and Coping mechanisms. Conclusion: Changes were observed in social life, leading contributors to isolation, in addition to confronting the stigma experienced. There were also identified points as the reinterpretation of chronic wound carrier about their disease and coping strategies of their chroniccondition.

Quality of life in people with leg ulcer, integrative review

Objective: To identify the main changes in the daily life of people with leg ulcer and how that affects the person’s life’s quality. Methodology: We used the methodology PI [C] OD and were selected four research articles, taken from EBSCO, PubMed, and EWMA. Results: The main changes identified in the people’s daily live with leg’s ulcers are physical (pain, decreased mobility, presence of exudate, bad smell from the wound and change in the style of clothing), psychological (sleep disorders, depression, anxiety, feelings of rejection and low self-esteem), social (isolation, restriction in leisure activities, inability to perform household chores). Conclusions: The literature about person’s life’s quality with leg ulcer reported a significant impact in the daily life of that person. The care provided by nurses should be centred on the person itself, integrating all the kind of needs and the leg ulcer mustn’t be the sole focus of care.

Self-care in older people with functional deficit: needs of long-term care.

The group of 65-year-olds is becoming more numerous and with greater needs for health care. So, is necessary the reflection about new models of provision, organization, and allocation of health resources. According to the United Nations Organization, 2015, in 2050 elderly people will reach two million people (20% of the world’s population), what mean that the number of people over 60 years old will exceed a population of young people under 15 years. Parallel to aging, less healthy lifestyles have contributed to the prevalence of chronic diseases, especially cerebrovascular diseases. Hypertension and diabetes mellitus are risk factors and increase predisposition to other diseases. With aging, there is an increased risk for developing chronic, oncological and degenerative diseases, which account for more than 50% of the burden of diseases, with profound implications on independency, use of health care and services.

The blue side of diabetes: assessing the impact of depression in people with type 2 diabetes using real-world data

The aim of the thesis is to assess the impact of depression in people with type 2 diabetes. Using Healthcare Utilization Databases, I estimated in a large population-based cohort with type 2 diabetes the incidence of depression over 10 year-period, identified the demographic and clinical predictors of depression, and determined the extent to which depression is a risk factor for acute and long-term complications and mortality. In the context of COVID-19 pandemic, I evaluated whether the presence of a history of depression in type 2 diabetes increased the Emergency Department (ED) access rate for diabetes-related complications, and I investigated changes in the incidence of depression during the first year of the pandemic. Findings from the first study indicated that developing depression was associated with being a woman, being over 65 years, living in rural areas, having insulin as initial diabetes medication and having comorbid conditions; the study also confirmed that depression was associated with an increased risk for acute and long-term diabetes complications and all-cause mortality. The second observational study showed a higher rate of ED access for diabetes-related complications during the pandemic in people with type 2 diabetes and a history of depression than in those without a history of depression, similar to what was observed in a pre-pandemic period. As shown in the third population-based study, the incidence of depression decreased in 2020 compared to 2019, mainly during the first and the second waves of the COVID-19 pandemic, when people probably had difficulty reaching healthcare services. This new real-world evidence will help healthcare professionals identify timely patients at high risk of developing depression. Lastly, policymakers and physicians will benefit from new evidence of the effects of the COVID-19 pandemic on depression in people with type 2 diabetes to ensure a high level of care during crisis periods.

O esporte paraolímpico no Brasil : abordagem da sociologia do esporte de Pierre Bourdieu

Universidade Estadual de Campinas . Faculdade de Educação Física

Atividade motora adaptada : o conhecimento produzido nos programas Stricto Sensu em Educação Física no Brasil

Universidade Estadual de Campinas . Faculdade de Educação Física

Procedimentos pedagogicos para o ensino das lutas : contextos e possibilidades

Universidade Estadual de Campinas . Faculdade de Educação Física

A ação do professor de ensino superior na educação fisica adaptada : construção mediada pelos aspectos dos contextos historicos, politicos e sociais

Universidade Estadual de Campinas. Faculdade de Educação Física

O Taekwondo como modalidade paradesportiva

Universidade Estadual de Campinas . Faculdade de Educação Física

O ensino do esporte paralímpico na escola a partir da visão dos professores : o caso do Goolball e do voleibol sentado = The teaching paralympic sport at school from teacher's perspective : the case of Goalball and sitting volleyball

Universidade Estadual de Campinas . Faculdade de Educação Física

Acessibilidade em ambiente universitário: identificação de barreiras arquitetônicas no campus da USP de Bauru

A acessibilidade é um direito do cidadão assegurado por lei para que portadores de deficiência tenham a possibilidade de usufruir de recursos e ações no âmbito social. Barreiras arquitetônicas interferem na vida destes podendo deixá-los a parte da convivência e vida social. Os objetivos deste estudo foram: identificar, descrever e mapear barreiras físicas no Campus da Universidade de São Paulo de Bauru e apresentar as intervenções realizadas, durante o período de outubro de 2001 a dezembro de 2005. O estudo foi descritivo-quantitativo, no qual a coleta de dados centrou-se na análise das condições arquitetônicas das três unidades que compõe este campus, observada as normativas da Associação Brasileira de Normas técnicas e realizada intervenções. Foram identificados: 72 pontos de guias não rebaixadas, 21 pontos de acessos com diferenças de níveis sem rampas; 220m² de escadas/rampas sem corrimãos; 658m² de escadas/rampas com corrimãos em discordância com as normas vigentes; 03 rampas com inclinações superiores às determinadas nas normas técnicas; 10 banheiros parcialmente adaptados para deficientes; 02 vagas de estacionamento parcialmente adaptadas e 02 elevadores existentes. Foram executados, em 19 pontos, rebaixamentos de guias, somando 115 m², com linhas de piso tátil, pintados; 8 rampas; 14 pontos de escadas e rampas externas instaladas com corrimãos e guarda-corpos, 5 vagas exclusivas no estacionamento; instalado 2 centrais de atendimento telefônico para surdo e adquiridas 3 cadeira de rodas. As intervenções realizadas contribuíram para melhorar a acessibilidade de portadores de deficiência no campus favorecendo a utilização dos recursos existentes neste espaço público.