Tuberculosis in migrant populations. A systematic review of the qualitative literature.

BACKGROUND The re-emergence of tuberculosis (TB) in low-incidence countries and its disproportionate burden on immigrants is a public health concern posing specific social and ethical challenges. This review explores perceptions, knowledge, attitudes and treatment adherence behaviour relating to TB and their social implications as reported in the qualitative literature. METHODS Systematic review in four electronic databases. Findings from thirty selected studies extracted, tabulated, compared and synthesized. FINDINGS TB was attributed to many non-exclusive causes including air-born transmission of bacteria, genetics, malnutrition, excessive work, irresponsible lifestyles, casual contact with infected persons or objects; and exposure to low temperatures, dirt, stress and witchcraft. Perceived as curable but potentially lethal and highly contagious, there was confusion around a condition surrounded by fears. A range of economic, legislative, cultural, social and health system barriers could delay treatment seeking. Fears of deportation and having contacts traced could prevent individuals from seeking medical assistance. Once on treatment, family support and "the personal touch" of health providers emerged as key factors facilitating adherence. The concept of latent infection was difficult to comprehend and while TB screening was often seen as a socially responsible act, it could be perceived as discriminatory. Immigration and the infectiousness of TB mutually reinforced each another exacerbating stigma. This was further aggravated by indirect costs such as losing a job, being evicted by a landlord or not being able to attend school. CONCLUSIONS Understanding immigrants' views of TB and the obstacles that they face when accessing the health system and adhering to a treatment programme-taking into consideration their previous experiences at countries of origin as well as the social, economic and legislative context in which they live at host countries- has an important role and should be considered in the design, evaluation and adaptation of programmes.

Effectiveness of a pediatric palliative home care team as experienced by parents and health care professionals.

OBJECTIVES: Little data are available on palliative home care for children. The objective of this study was to evaluate the effectiveness of a specialized pediatric palliative home care team (PPHCT) as experienced by parents and health care professionals (HCPs). METHODS: Parents and HCPs involved in the care of terminally ill children who died and whom the PPHCT was in charge of were surveyed with questionnaires focusing on satisfaction with the PPHCT, satisfaction with the course of the dying phase, and the development of anxiety, depression, and prolonged grief disorder. RESULTS: Forty-three parent dyads participated (return rate, 88%). Satisfaction with the PPHCT scored a median of 10 (numeric rating scale, 0-10). The child's death was predominantly experienced as very peaceful (median, 9); 71% died at home. According to parents, involvement of the PPHCT led to highly significant (p<0.001) improvements in the children's symptoms and quality of life, as well as in aspects of communication and administrative barrier reduction. Anxiety was detected in 25% of parents, depression in 19%, and prolonged grief disorder in 13%. HCPs (return rate, 83%) evaluated all investigated care domains (particularly cooperation/communication/family support) as being significantly improved (p<0.001). Thirty-five percent of HCPs felt uncertain concerning pediatric palliative care; 79% would welcome specific training opportunities. CONCLUSIONS: Involvement of a PPHCT is experienced as a substantial improvement of care by parents and HCPs. Coordination of palliative care during the last phase of life appears to be an important quality factor for the home care of dying children and their families.

An Examination of Iowa's School Liaison Program, 2001

In the early 1990’s the Chief Juvenile Court Officers (JCOs) and other key players desired to provide services, such as school support, family support, and community support to both juvenile court and at-risk youths within the school setting. With strong support from both Iowa’s Attorney General and Governor the Iowa State Legislature first appropriated funds for school liaisons in 1994. The liaison program is currently funded with 75 percent state dollars appropriated to the Department of Human Services and a minimum of 25 percent match from the local school districts. In some cases the schools do not actually match funds with “school money,” rather they may utilize community money from other sources, such as the local decategorization process. In 1994, the state legislature funded this effort at $400,000. Since that time the amount has grown to more than $3,000,000. In the early years there were just a handful of liaisons working in a few school districts, but by the beginning of the 2000-2001 school year there were 304 schools served by 147 liaisons. The cost per liaison, including salary and benefits, was estimated at approximately $34,324 including both the DHS and school contributions. It was a desire of the Chief JCOs to place the liaisons under the school districts and thus allow them to be independent of the juvenile court. Agreements were developed between the schools and juvenile court regarding employee status, funding, information sharing, and other such issues.

Patients' knowledge of Diabetes five years after the end of an educational program

We present a cross-sectional study that aims to describe the sociodemographic and clinical conditions of individuals with diabetes mellitus and to analyze their knowledge of treatment five years after the end of an educational program in which they took part. In 2010, 40 individuals who had participated in a diabetes educational program for 12 months in 2005 at a primary care service were interviewed. A form was used for data collection that included their knowledge of the notion, physiopathology, and treatment of the disease; exercise; nutrition; foot care; self-monitoring of capillary blood glucose at home; hypoglycemia; chronic complications; special situations; and family support. The results showed that the volunteers incorporated the information about the notion, physiopathology, and treatment of the disease; exercise; foot care; self-monitoring; care associated with hypoglycemia; chronic complications; and special situations. In contrast, nutrition and family support require further reinforcement. It is concluded that five years after the end of the educational program, the participants kept most of the information provided.

Needs of psychopedagogical training for the care of children with chronic disease: perceptions of hospital nursing

OBJECTIVE To identify the psychopedagogical training needs of the pediatric nurses in the largest public hospital of the Balearic Islands, Spain. METHOD This study was developed with a quantitative and qualitative design, where 78 nurses (97.5% of the service) answered a questionnaire, and 15 participated in interviews that were analyzed via content analysis. RESULTS The quantitative results show gaps in the knowledge and psychopedagogical skills of the staff. These aspects could facilitate the development of tasks tailored to the personality and the psychoevolutional time of children with chronic diseases, as well as to the emotional state of families. The qualitative data was organized into four categories: family support; hospital and education; psychopedagogical training and difficulties in practice. The little communication between nurses and teachers is evident. CONCLUSION The data reinforces the need to implement training strategies and interdisciplinary work among health professionals, educators and families.

Do Jardim-de-Infância ao Centro de Actividades de Tempos Livres: Representações das Crianças sobre o Brincar

A investigação “Do Jardim-de-infância ao Centro de Actividades de Tempos Livres: Representações das Crianças sobre o Brincar” reconhece as crianças como actores sociais, sujeitos de direitos, entre eles, o direito à participação em assuntos que lhes digam directamente respeito, a assuntos de seu interesse, nomeadamente o direito ao brincar. O brincar é uma actividade lúdica, assim como o jogar, importante no processo de crescimento e desenvolvimento da criança e, nos tempos que correm, a sociedade, de uma forma geral, e particularmente as famílias, preocupam-se muito com o trabalho e colocam as necessidades básicas das crianças em segundo plano ao valorizarem acima de tudo o sucesso e o desempenho das mesmas. Assim, se participar significa “tomar parte em”, reconhece-se a necessidade de ouvir as crianças e o que elas têm a dizer sobre essa actividade lúdica, sobre a forma como organizam o seu dia e o tempo que despendem para brincar e sobre a forma como gostariam de ver os seus dias ocupados. É neste pressuposto, de que é através da acção e da voz das crianças, que é possível a construção de um conhecimento teórico e válido que contribua para uma melhor intervenção educativa com as crianças. Esta investigação, que decorreu numa instituição com várias vertentes, entre elas a vertente da Animação Infantil, enquadra-se no paradigma qualitativo de natureza participativa, e procura interpretar os significados atribuídos pelas crianças, que frequentam o Jardim-deinfância da rede pública e a mesma instituição, na condição de Componente de Apoio à Família, ao brincar, às suas vivências no que concerne à gestão do seu quotidiano, quer no que refere ao tempo que passam no Jardim-de-infância, quer no que passam no Prolongamento de Horário/Actividades de Tempos Livres. Neste trabalho de investigação que decorreu numa instituição situada numa freguesia pertencente ao Distrito de Viana do Castelo e que disponibiliza os serviços de ATL, participaram como protagonistas as crianças da faixa etária entre os três e os seis anos de idade e que frequentam dois contextos: educacional e lúdico. Este trabalho é sustentado por um referencial teórico que engloba o brincar na sociedade actual e a sua importância, a educação pré-escolar e as suas funções, a natureza da componente de apoio à família, a animação sócio-educativa e os contextos de vida das crianças, que permitiram questionar a participação infantil em assuntos de seu interesse. Ainda que este estudo não permita generalizações, reflecte-se sobre a realidade existente, dá voz às crianças e indica aspectos que, de uma forma geral, precisam de mais atenção. Afinal o brincar na infância é um assunto sério…

Libertad condicional : propuestas para aumentar su concesión

La libertad condicional es una institución cuya aplicación no se da con la frecuencia que debería para lograr una resocialización y reinserción adecuada. Para reducir las tasas de encarcelamiento y los costes que se derivan, así como para igualar las tasas de liberados condicionales en Cataluña con las del resto del Estado, se proponen posibles mejoras para la concesión del último grado penitenciario. Las propuestas se desarrollan a partir de una investigación empírica basada en una revisión exhaustiva de los informes de pronóstico de reinserción de la Junta de Tratamiento y las resoluciones del Fiscal de Vigilancia Penitenciaria.Se formularán propuestas generales y específicas. Las primeras estarán encabezadas a modificar el punitivismo de la sociedad y la implementación de la libertad condicional. Las segundas estarán orientadas a focalizar el último grado penitenciario también a internos con alto riesgo de reincidencia, siempre y cuando se les proporcione una intervención intensiva; a mejorar y tratar tanto los factores estáticos como los dinámicos –hábitos laborales, toxicomanías, apoyo familiar– para facilitar el acceso a la libertad condicional según los actuales requisitos; a concienciar sobre la importancia de satisfacer la responsabilidad civil y a seguir la línea del modelo de riesgo, necesidad y responsividad.ABSTRACTParole is an institution whose application does not occur as often as it should to achieve resocialization and reintegration adequately. To reduce incarceration rates and its costs, as well as to equalize Catalonia’s parole rates with the rest of the state, it is suggested possible improvements for the last grade prison’s granting. The proposals were developed from an empirical research based on the analysis of the Treatment Assembly’s forecast reports reintegration and the Fiscal’s resolutions.It will be formulated general and specific proposals. The first one will be led to modify society’s punitivity and parole’s implementation. The second one will be directed on focusing parole in high risk prison inmates, as long as they have an intensive intervention; on improving and treat both static and dynamic factors –work habits, addictions, family support– to facilitate the access on parole under the current requirements; on raising the importance of paying the civil liability and follow the principles of the model of risk, needs and responsivity.

El suport familiar en la malaltia mental: influència del suport familiar en el control de la malaltia en una persona que pateix un transtorn mental server

Aquest treball té com a objectiu principal conèixer si hi ha millora en el control de la malaltia d’una persona que pateix un trastorn mental sever quan disposa d’un suport adequat de la família. Els objectius específics marcats són, avaluar la càrrega familiar que suposa tenir la responsabilitat de cuidar un familiar amb malaltia mental, conèixer les actituds dels familiars de persones que pateixen una malaltia mental, involucrar a la família dins de la teràpia del familiar amb malaltia mental severa, i aconseguir un grau de cooperació i comunicació favorable de la família al pacient. Es tracta d’un estudi d’investigació quantitatiu, transversal i de tipus analític, el qual la mostra de la població estudiada estarà composta de 100 pacients entre 20 i 30 anys amb diagnòstic de trastorn mental sever segons el DSM-IV, atesos durant l’últim any en el Centre de Salut Mental d’Adults de Vic i els seus cuidadors principals o persones més properes. Es realitzarà recollida de dades a través de la revisió de les històries clíniques, informació facilitada pel terapeuta que tracta al pacient i entrevistes als familiars cuidadors o persona més propera i als mateixos pacients. Aquesta entrevista la faran professionals entrenats i competents. Amb tot això s’establirà una correlació entre les variables d’estrès, suport als familiars i el desenvolupament dels rols, i s’agruparan les variables de manera que quedin estructurades en subgrups.

Uusperheen voimavarat ja lasten hyvinvointi

The resources of the step family and the children’s well-being The present study investigates children's well-being in stepfamilies and fac¬tors, both external and internal, that are related to the children's well-being. Of the external factors, the study focuses on factors related to the structure of the stepfamily, parents' education, socio-economic status and factors related to work, livelihood and living conditions. The internal resources include the general functioning of the family, parenthood and parenting, family support networks and issues that the stepfamilies themselves consider important. Another important resource in a stepfamily is a functioning network of human relationships, which in the present study is approached from the maternal viewpoint. Changing family relations are considered a potential threat to the children's well-being. Therefore, in addition to looking into the stepfamily's resources, the other important goal of the study is to explore other factors potentially related to the well-being of children living in stepfamilies. In view of the stepfamily's resources, it is important to explore how the functioning of the relationships network is linked with the child's well-being. The study employs survey and interview data. The survey data (n=2236) are part of national survey data on the well-being of families and children and factors impacting them which were gathered as part of ”Origins of Exclusion in Early Childhood”, a research project carried out in 2002. The data consists of 667 stepfamilies. The interview data consists of interviews with 24 parents in stepfamilies. In the study, the analyses of survey and interview data are combined. Both descriptive statistical analyses and multivariate methods are employed. Content analysis is employed in the analysis of the interview data. The results indicate that the stepfamilies’ resources in general but their external resources in particular differed from those of the nuclear and single-parent families. The level of education and the socio-economic status of the stepfamily parents were somewhat lower than those of the nuclear family parents. The differences in relation to single-parent families were primarily related to the better economic status of the stepfamilies. The analysis of internal resources showed relatively minor differences: the stepfamilies assessed themselves a somewhat better general functioning of the family than did the nuclear families. Parenting issues caused more disagreement in stepfamilies than in nuclear families. The analysis of the functioning of the human relations in stepfamilies showed that the stepfamily mothers experienced the external relationships of the family (e.g., between the child and the absent father) as significantly more problematic than the relationships within the stepfamily. Living in a stepfamily thus challenges the functioning of the relationship between the child and the absent father. As a result of the analysis of the relationships networks in the stepfamilies, three groups were formed. One group had the nuclear family as an ideal goal, another valued an extended family composed of a variety of relationships, and the third one appreciated a strong intimate relationship between the parents. In the present study, the most common group was the multi-relationship, extended type of stepfamily. In conclusion, living in a stepfamily does not seem to pose a risk to the child’s well-being, but it may influence the family’s resources and thus have an indirect effect on the child’s well-being. In view of the resources of the stepfamily, the child’s well-being was best supported by a functioning network of human relationships in the stepfamily: there was a distinct connection with the children’s problems and the non-functioning of the relationships network. According to the mothers, the internal relationships in the stepfamily seemed to be more important than the external relationships of the family. A child’s functioning relationship with the absent father can be viewed as a positive resource, supporting the child’s well-being in the stepfamily.

Självkänsla och familjestöd hos ungdomar med olika aggressionsroll : en representativ studie bland högstadieelever i Österbotten

Objektive: To examine differences in the degree of self-esteem and family support among adolescents involved in different aggression roles from Ostrobothnia in Finland and to examine the relation between aggression role, family support and self-esteem. Method: A sample of 3512 adolescents in school at grades 7 and 9 from Ostrobothnia was considered for this study. The sample consisted of 1741 boys and 1771 girls with the mean age of 14.3 years and SD of 1.10 years. Aggression was measured with the Mini Direct Indirect Aggression inventory (Mini-DIA) by Österman and Björkqvist (2008), self-esteem was measured with the Rosenberg Self-Esteem Scale (RSES) by Rosenberg (1965) and family support was measured with the family support part from the Multidimensional Scale of Perceived Social Support (PSSS) by Zimet, Dahlem, Zimet and Farley (1988). Chi-square test, multivariate analysis and regression analyses were carried out. Results: The boys reported higher self-esteem and received higher family support than girls. The adolescents who were involved in aggression as victims or perpetrators reported lower self-esteem and family support than adolescents who were not involved in aggression. The regression analyses showed that family support and aggression role had significant effects on the adolescents’ self-esteem in both boys and girls. There was also an interaction effect between family support and aggression role for girls, so that the difference in self-esteem between perpetrator-victims and control group for example was higher for girls with low family support than for girls with high family support.

Le processus d'adaptation de conjoints dont la femme est atteinte d'un cancer de l'ovaire

Le but de cette étude est de cerner, à partir de leur propre point de vue, la trajectoire d’adaptation de conjoints dont l’épouse est atteinte d’un cancer de l’ovaire. Une approche qualitative, la théorisation ancrée, a été utilisée dans le cadre de cette recherche. Les données ont été recueillies à l’aide d'entretiens semi-structurés effectués auprès de neuf conjoints qui accompagnaient leur épouse lors de leurs traitements dans une unité montréalaise ultra-spécialisée de soins pour les cancers gynécologiques. Nos résultats font ressortir qu’une fois passé le choc de l’annonce du diagnostic, nos répondants se ressaisissent et élaborent toute une série de stratégies de protection pour leur épouse et eux-mêmes, puis d’attaque de la maladie. Au bilan, pour eux, le cancer se révèle une expérience « transformante» aux plans personnel, conjugal et social. Les contrastes observés entre nos résultats et ceux des études antérieures, qui insistent sur le désarroi de conjoints, peuvent être expliqués par la prise en charge efficace de la femme par le réseau de la santé, qui valorise le rôle du conjoint et qui l’outille pour accompagner son épouse. S’ajoutent à cela la force du lien conjugal, trempé par les épreuves passées, certains traits de personnalité des conjoints et l'action du réseau de soutien personnel. En regard de la pratique infirmière, notre recherche met en évidence le bien-fondé des politiques soutenant l’intégration des familles dans les plans de soins et les retombées positives d’une approche concertée entre tous les intervenants de la santé. Répéter une telle étude dans d'autres institutions du réseau de la santé permettrait de cerner encore plus finement son impact sur l’adaptation de conjoints à la maladie.

L'apprentissage de l'approche systémique familiale dans la formation universitaire de premier cycle en sciences infirmières

Rapport de stage présenté à la Faculté des sciences infirmières en vue de l'obtention du grade de Maître ès sciences (M.Sc.) en sciences infirmières option expertise-conseil en soins infirmiers

Prevalencia y factores asociados a la no adherencia en el tratamiento farmacológico de mantenimiento en adultos con trastorno afectivo bipolar

La prevalencia de no adherencia en el tratamiento de mantenimiento en el Trastorno Afectivo Bipolar esta en los rangos de 20% y un 60%, interviniendo diversos factores relacionados con el paciente, la enfermedad, el tratamiento, y la relación con el terapeuta, asociándose a una mayor morbilidad, mortalidad y riesgo de reingresos hospitalarios. Objetivos: Determinar la prevalencia y factores asociados a la no adherencia en tratamiento de mantenimiento de pacientes adultos con diagnóstico de trastorno afectivo bipolar. Métodos: Estudio de corte transversal incluyo 124 paciente que asistieron a consulta los meses de noviembre y diciembre , se aplicó cuestionario estructurado, que contenía las variables de factores asociados, demográficos, relacionadas con el paciente, con la enfermedad, el tratamiento, relación terapéutica y el sistema de salud, relacionados con la familia; la Escala de Impresión Global Para el Trastorno Bipolar Modificado (CGI – BPM -M) y apgar familiar Resultados: La prevalencia de no adherencia al tratamiento farmacológico de mantenimiento fue del 29.8%. Siendo esta mayor para las mujeres (64.9%) que para los hombres (35.1%), aunque esta diferencia no fue estadísticamente significativa (p= 0.17). Los factores asociados que estadísticamente significativos fueron mayor gravedad de la enfermedad OR 1.9 , antecedente de no adherencia (38% P=0.001), percepción negativa del terapeuta, menor insight( 87% RP4.65), mayor estigma(50% RP 6.2), no tener familiar que le recuerde toma del medicamento(73%). Conclusiones: La prevalencia estuvo en el rango de otros estudios realizados por Scott, Vieta et al, los factores asociados como estigma, antecedente de no adherencia, no tener apoyo familiar, un insight pobre y el habito de fumar ,pueden ser identificados desde el abordaje del paciente y modificados para mejorar la adherencia terapéutica

Satisfacción familiar, apoyo familiar y conflicto trabajo-familia en una muestra de trabajadores chilenos

Se analiza la relación existente entre satisfacción familiar, apoyo familiar y conflicto trabajo-familia en una muestra de trabajadores del comercio mayorista chileno, controlando variables sociodemográficas. A 128 trabajadores técnicos y profesionales entre 20 y 49 años, pertenecientes a dos ciudades ubicadas en la región del Maule (Chile) le fueron aplicados tres instrumentos de medición de las variables referidas. Se observa que tanto el apoyo familiar como la satisfacción familiar son variables que se encuentran relacionadas (r= 0,470; p=0,001), por tanto se pueden utilizar en conjunto y ambas se ven a su vez relacionadas con el conflicto trabajo-familia. Al realizar el estudio de regresión se obtuvo que apoyo familiar y satisfacción familiar son predictores del conflicto trabajo-familia (β= -0,386; t[91]= -4,698; p<0,001), relacionándose significativa y negativamente con el conflicto trabajo-familia (r= -0,684; p=0,001), es decir, que a mayores niveles de apoyo y satisfacción familiar, menores son los niveles de conflicto trabajo-familia.

Modelo integrador para las rutas de señalización diferencial del receptor ionotrópico de glutamato activado por el N-metil-D-aspartato

El receptor ionotrópico de glutamato activado por N-metil-D-aspartato (iGluR-NMDA) es un complejo macromolecular heteromultimérico constituido por entre 3 y 5 subunidades de tres diferentes tipos, a saber: NR1, NR2A-D y NR3A y B. Se ha demostrado su participación activa en prácticamente todos los procesos fisiológicos, patológicos e intermediarios de efectos farmacológicos que ocurren en las células de tejidos excitables, inclusive se ha reportado su presencia en otros tejidos no excitables. En el sistema nervioso central (SNC) participa en los procesos de aprendizaje, memoria, plasticidad, diferenciación, migración de la célula neural y apoptosis. Además, en los eventos de índole farmacológica se ha demostrado su intervención en excitotoxicidad, drogadicción y alcoholismo. Surge entonces la pregunta de cómo un mismo complejo macromolecular puede participar en tantos y tan diversos procesos. La revisión de literatura en la que se demuestra la interacción del iGluR-NMDA con proteínas de señalización, soporte, adaptadoras, moduladoras, de adhesión celular, de citoesqueleto y enzimas reporta un conjunto de más de 160 moléculas que participan en las cascadas que generan las señales a diferentes niveles de interacción y con diferentes sustratos. En este artículo se presenta un modelo predictivo estructural y funcional que permite distinguir, por lo menos, tres rutas diferenciadas de señalización.