Care Advisors Research Articles

The prioritisation of curable sexually transmitted infections among pregnant women in Zambia and Papua New Guinea: Qualitative insights.

Curable sexually transmitted infections (STIs) are neglected in public health policy, services and society at large. Effective interventions are available for some STI but seem not to be prioritised at global, regional or local levels. Zambia and Papua New Guinea (PNG) have a high burden of STIs among pregnant women but little is known about the prioritisation of STI treatment and care among this group. We undertook a qualitative study to explore how STIs are prioritised among pregnant women in local health systems in Zambia and PNG. Semi-structured interviews were conducted with 19 key informants-health care workers providing antenatal care, and policy and programme advisers across the two countries. Audio recordings were transcribed and translated into English and stored, managed, and coded in NVivo v12. Analysis used deductive and inductive thematic analysis. Findings were coded against the World Health Organization health system building blocks. Participants spoke about the stigma of STIs at the community level. They described a broad understanding of morbidity associated with undiagnosed and untreated STIs in pregnant women. The importance of testing and treating STIs in pregnancy was well recognised but many spoke of constraints in providing these services due to stock outs of test kits for HIV and syphilis and antibiotics. In both settings, syndromic management remains the mainstay for treating curable STIs. Clinical practice and treatment were not in alignment with current STI guidelines in either country, with participants recognising the need for mentorship and in-service training, as well as the availability of commodities to support their clinical practice. Local disruptions to screening and management of syphilis, HIV and other curable STIs were widely reported in both countries. There is a need to galvanise priority at national and regional levels to ensure ongoing access to supplies needed to undertake STI testing and treatment.

Providing support for family carers: social workers describing their professional role

ABSTRACT Family carers have a growing significance, and they are increasingly regarded as clients in need of support. In Sweden, the municipal support for family carers is often provided by family care advisors. However, there is a lack of knowledge regarding this relatively new area of social work practice. This article aims to explore how family care advisors describe their work and construct their professional role in relation to family carers. The empiric material derives from a research circle, a form of focus group interview, with family care advisors. The theoretical framework is based on the concept categorical pair, where the description of the family care advisors’ work includes constructing themselves as professionals and the family carers as clients. Four themes have emerged in their stories: being neutral, being allies, being a container, and being an educator. The findings show how the family care advisors’ relationship with the family carers is described as being simultaneously personal and professional: a form of professional friendship with a delicate balancing act. The family care advisors also view their neutral role, with no power to exercise authority, as important and required. Family carers that are perceived as difficult are described from a paternalistic perspective, thus needing to be educated by the family care advisors. Accordingly, when the family care advisors construct their professional role, they also construct family carers, which includes implicit moral notions of a ‘good carer’.

Role of the European Pharmacist in the Implementation of the Latest WHO Guidelines for Malaria.

Following the publication a few months ago of the new WHO guidelines for malaria, the European pharmacist, even out of endemic areas, as a health care professional and advisor, has a major role to play in their effective implementation and in the interest of public health. The pharmacist is central in the health care system to ensure the correct application of these recommendations and to perform a decisive role in the prevention of malaria infections, both in the adapted pharmaceutical advice on personal protection against biting vector insects on the one hand, and in the pharmaceutical analysis and recommendations concerning antimalarial chemoprophylaxis prescriptions on the other hand. Physicians and pharmacist biologists, as well as hospital pharmacists, are also important for the analysis and treatment of effective malaria cases, particularly in the management of the diagnostic and therapeutic emergency that a P. falciparum infection represents.

Progress on the recommendations for an equal experience of CQC regulation for ethnic minority-led GP practices

The Care Quality Commission is the UK's regulator for health and social care providers. It faced criticisms regarding the fairness of its processes from minority-ethnic-led primary care providers in 2020. There were concerns that the regulatory outcomes for minority ethnic-led primary care services were more frequently subject to inspection, were more likely to receive an adverse outcome, suffer a negative impact on their own health/ wellbeing, and inspectors did not give due consideration to the multiple deprivation indices in the population and areas they operated in, as well as the availability of manpower or resources. 
 A survey conducted by the BAPIO GP forum[1] reported that the inspections were not considered practical or constructive and took the general practice team away from patient care. [2] Of particular concern was the perception that the system was unfair and discriminatory for Black and Asian GPs' small practices and those in the inner city or rural locations with multiple deprivations. The authors urge the CQC to ensure that the profession is supported and that any inspection process is fair and non-discriminatory and improves patient care. 
 CQC commissioned research to explore the nature of its relationship, or the existence of any causal link, between ethnic minority-led GP practices and regulatory outcomes such as ratings and frequency of inspection.
 However, in this survey, ethnic minority-led practices were more likely to report that the quality of care improved following a CQC inspection. In this article, the National Primary Care Advisor to CQC explores the findings of this research and outlines the actions in progress to address these concerns.

Support needs of care dependent individuals : Survey of general and specific needs for information, assistance and support of care dependent individuals and their relatives

HintergrundPflegeempfangende und deren Angehörige haben in Deutschland seit 2009 einen gesetzlichen Anspruch auf eine Pflegeberatung. Um Pflegeberatende angemessen auf aktuelle Beratungsbedarfe vorzubereiten, sind dafür zunächst die bestehenden Anliegen zu erfassen. Ziel der Studie war es, die unterschiedlichen Bedarfe von Pflegeempfangenden und deren Angehörigen zu ermitteln.MethodikEs erfolgte eine Online-Befragung von Pflegeberatenden mittels standardisiertem Fragebogen. Die Ausprägung des allgemeinen Beratungsbedarfs von Pflegeempfangenden und Angehörigen wurde mittels 10-stufiger Skala (1 [gering] bis 10 [hoch]) erhoben. Über eine 5‑stufige Likert-Skala wurde die Höhe vorliegender Beratungsbedarfe zu 16 Themenschwerpunkten bewertet. Mittels „classification and regression trees“ (CRT) und „random forest“ wurde der Zusammenhang zwischen den einzelnen Themenschwerpunkten und dem allgemeinen Beratungsbedarf analysiert.ErgebnisseDer allgemeine Informationsbedarf von Pflegeempfangenden bzw. Angehörigen wurde von den teilnehmenden Pflegeberatern (n = 276) mit MW 7,8 bzw. MW 9,2 eingeschätzt. Bei den Pflegeempfangenden bestand laut CRT der stärkste Zusammenhang zwischen allgemeinem Informationsbedarf und „Wohnraumberatung“, bei den Angehörigen zwischen allgemeinem Informationsbedarf und „Sozialrechtliche[n] Aspekte[n], Ansprüche[n], Leistungen“.DiskussionDer allgemeine Informationsbedarf von Pflegeempfangenden und Angehörigen wird als sehr hoch eingeschätzt. Dennoch lassen sich Unterschiede feststellen. Daher erscheint es notwendig, Pflegeberatungen nach den gruppenspezifischen Beratungsbedarfen auszurichten.Zusatzmaterial onlineZusätzliche Informationen sind in der Online-Version dieses Artikels (10.1007/s00391-022-02068-w) enthalten.

Swedish family care advisors’ views on existential loneliness and existential support to informal caregivers of older people: A cross-sectional national survey

The number of older people needing care is increasing, and care is often provided by informal caregivers. The mission of family care advisors (FCAs) is to provide them with support; however, whether and how support in existential matters such as existential loneliness is provided is unclear. Therefore, the aim of this study was to describe FCAs’ views on existential loneliness, and existential support provided to relatives who act as informal caregivers to older people. A national survey was distributed to 349 FCAs in Sweden, response rate n = 120 (36%). The STROBE checklist was followed when presenting the study. Existential loneliness was viewed as thoughts about life and meaning (78%). Existential support was provided by dialogues (87%), visits (75%) and support groups (73%); 45% of FCAs stated that they had time to provide existential support and 27% reported having knowledge of how to encounter existential loneliness. FCAs provide existential support, but often lack experience, knowledge and time. Time and knowledge are important prerequisites for acknowledging existential needs.

Over-the-counter protein supplement resulting in impaired thyroxine absorption in a hypothyroid patient

SummaryWhey protein is a popular dietary supplement that is claimed to provide multiple health benefits. It has been shown to delay gastric emptying and impair ileal nutrient absorption. Additionally, some of the other additives like papain enzyme, soy lecithin in these protein supplements could interfere with L-thyroxine absorption. There is no evidence in the literature for the effects of protein supplements on L-thyroxine absorption. Herein, we describe a case of a 34-year-old lady who was on endocrinology follow up for primary hypothyroidism with stable thyroid-stimulating hormone (TSH) levels within the normal range while on L-thyroxine with a dose of 125 µg daily for the last 3 years, presenting with mild hypothyroid symptoms and elevated TSH level following a recent introduction of a protein supplement by her physical care adviser. Her treatment adherence and ingestion technique were good throughout, she was not on other medications or herbal remedies, there were no other changes in her food pattern or features suggestive of malabsorption, she was not pregnant, was taking the same L-thyroxine brand and TSH test was done from the routine lab. Since the only factor which could have contributed to the deranged TSH levels was the recent introduction of the whey protein supplement, we advised her to stop the protein supplement while continuing the same dose of L-thyroxine. Her TSH level was repeated in 6 weeks and was found to be normal (1.7 mIU/L). Our case report demonstrates that over-the-counter protein supplements could interfere with L-thyroxine absorption. Therefore, patients on L-thyroxine should be cautious when taking them.Learning pointsOver-the-counter protein supplements could interfere with oral L-thyroxine absorption.The underlying mechanism could be the effect of whey protein by delaying gastric emptying and reduced responsiveness of organic anion transporters in the ileum, and there may be a contribution from other additives like papain and soy lecithin present in these supplements.When there is an elevation of previously stable thyroid-stimulating hormone (TSH) value in a hypothyroid patient on oral L-thyroxine, the patient's assessment should include inquiring for a recent introduction of protein supplement, in the absence of other well-known risk factors.Discontinuation of protein supplement results in normalization of thyroid function tests.Patients on oral L-thyroxine should be cautious when taking over-the-counter protein supplementation.

The Awareness of Risks Associated with OTC Drugs Available in Non-Pharmacy Outlets among Polish Patients-A Cross-Sectional Study.

Background: Many OTC drugs are available in non-pharmacy outlets, and as such the risk of overuse and/or improper use of this class of drugs is more likely. In light of this observation, our study was conducted with the aim of exploring opinions on non-pharmaceutical distribution among Polish patients. This study was a part of an informative project to educate patients about the possible risks associated with the use of OTC medicines. Methods: We conducted a cross-sectional study among Polish patients in which we used an authorial questionnaire, previously tested via content, face validity, and a pilot study. The questionnaire was distributed both electronically and in a traditional form. Results: ‘Time saving’ had a statistically significant role in the patient’s decision about purchasing drugs in a non-pharmacy outlet (p = 0.0052; R = 0.276994). The lack of a pharmacist’s consultation/advice (p = 0.0072; R = −0.3290490), improper storage (p = 0.0044; R = −0.238246), risk of overdose (p = 0.0125; R = −0.189564), and the risk of purchasing out-of-date drugs (p = 0.0125; R = −0.145411), as well as the risk of purchasing falsified drugs (p = 0.0265; R = −0.159428), were all associated with the patient’s non-willingness to purchase drugs in non-pharmacy outlets. Patients supported the idea of the elimination of non-pharmacy outlet distribution (p = 0.0074; R = −0.195932); they also emphasized that they are advocates of purchasing drugs only in community pharmacies (p = 0.0006; R = −0.238625). Conclusion: Patients are aware of the risks associated with buying drugs outside of community pharmacies. They perceived pharmacists as professional health care advisors and supported the fact that OTC drugs should be available only via pharmaceutical distribution.

‘Being pushed outside your comfort zone is a good way to learn’

Simon Johnson was a client care adviser before qualifying as a vet nurse. He recently volunteered at a neutering clinic in Ecuador, where he faced unexpected challenges.

Why the NHS Diabetes Prevention Programme isn't resting on its laurels

Why the <scp>NHS</scp> Diabetes Prevention Programme isn't resting on its laurels

Responding to Palliative Care Training Needs in the Coronavirus Disease 2019 Era: The Context and Process of Developing and Disseminating Training Resources and Guidance for Low- and Middle-Income Countries from Kerala, South India.

Background:Palliative care has an important role to play in the global coronavirus disease 2019 (COVID-19) pandemic. It is integrated and is a key component in the governmental and community structures and services in Kerala, in India. Palliative care in the state has grown to be a viable model recognized in global palliative care and public health scene. The community network of palliative care, especially the volunteers linking with clinical teams, is a strong force for advocacy, relief support including provision of emergency medications, and clinical care.Objective:To develop a palliative care resource tool kit for holistic care of patients affected with COVID-19 and to support the health-care workers looking after them to enable palliative care integration with COVID-I9 management.Methods:The Kerala State government included senior palliative care advisors in the COVID-19 task force and 22 palliative care professionals formed a virtual task force named Palli COVID Kerala as an immediate response to develop recommendations. Results: Developed a palliative care in COVID-19 resource toolkit which includes an e-book with palliative care recommendations, online training opportunities, short webinars and voice over power point presentations.Conclusion:Integrated Palliative care should be an essential part of any response to a humanitarian crisis. The e resource tool kit can be adapted for use in other low- and middle-income countries.

Factors Related to the Satisfaction with Pregnancy and Childbirth in Japanese Mothers Residing in the UK

This study aimed to investigate whether medical care and health services provided during pregnancy and childbirth influence the satisfaction with pregnancy and childbirth in Japanese mothers residing in the UK. The participants (N=41) were members of the Japanese child-rearing group in London, UK, who had experienced antenatal to postpartum care in the UK. The questionnaire contained the background of the Japanese mothers residing in the UK, pregnancy and childbirth, difficulties in the UK's hospital visiting, satisfaction with health care service, adviser and evaluation scales for pregnancy and childbirth. Almost all participants consulted their Japanese friends residing in the UK, or husbands/partners, and they obtained the information on pregnancy and childbirth from the Internet written in Japanese and Japanese friends who were living and had experienced childbirth in the UK. Approximately 80% of Japanese mothers were satisfied with pre-natal clinic and childbirth in the UK. They were satisfied with the health care provided by midwife and home visiting service after discharge from the hospital. The satisfaction with pre-natal clinics in Japanese mother residing was related to intercultural understanding, while the satisfaction with childbirth was related to understanding of medical system, cross-cultural understanding and trust of medical stuff.

Consumer Directed Services (CDS) Program in North Carolina : Reporting New Benefits of the Alternative Care Program

NC는 지난 10년간 CDS(Consumer Directed Services)를 시범 사업으로 구현해 왔다. 다른 주에서 이전 연구에서 확인 프로그램의 뛰어난 장점에도 불구하고 노스캐롤라이나 주의 CDS는 여전히 시범 단계에 있다. 본 연구를 위하여 11명의 참가자(클라이언트)와 5명의 케어 관리자를 대상으로 심층면담 실시하였다. 본 연구의 목적으로 CDS 프로그램의 강점이 실제 존재하는지 여부를 평가하였다. 본 연구 결과에서 케어 프로그램의 새로운 많은 혜택이 있는 것으로 확인되었다. 참가자들에게 강한 우정을 제공하고 참가자들의 사회적 요구를 충족시키는 것으로 확인되었다. 전통적인 사회복지기관 중심의 케어 프로그램 보다 CDS는 클라이언트의 개인의 사생활 보호와 안정감을 제공하고 있는 것으로 나타났다. 또한 가족들과 케어복지사들에게도 CDS는 많은 이익을 주는 것으로 확인되었다.The State of NC has been implementing Consumer Directed Services (CDS) as a pilot project for a decade. In spite of outstanding advantages of the program identified by previous studies in other states, CDS in NC is still at its pilot stage. For the research project, the semi-structured in-depth interviews were conducted with 11 participants and 5 care advisors to evaluate whether the previously identified strengths of the program indeed existed. This research study shows that the 16 interviews indicate the program’s congruent benefits with the previous studies. In addition, the study identifies new benefits of the alternative care program. It offers a strong companionship to its participants and sometimes satisfies participants’ social needs. Compared to traditional agency-based home care programs, participants appreciate the sense of privacy and security that CDS has given to them. CDS also benefits family members and care advisors.

足の大切さは子どもから高齢者まで ～いちサロンオーナーのフットケア指導士が「足の大切さ」を伝えるには～

足の大切さは子どもから高齢者まで ～いちサロンオーナーのフットケア指導士が「足の大切さ」を伝えるには～

【足病変や足トラブルの予防】の大切さを【地域】へ発信 ～フットケア指導士としての関わり～

【足病変や足トラブルの予防】の大切さを【地域】へ発信 ～フットケア指導士としての関わり～

She's football crazy

Stacy Wright is a 31-year-old Manchester City fan and dental nurse who is treatment coordinator and patient care advisor at two cosmetic dental practices in Manchester

Implementation of maternal influenza immunization in El Salvador: Experiences and lessons learned from a mixed-methods study

IntroductionThe World Health Organization (WHO) recommends that countries prioritize pregnant women for influenza vaccination, yet few low- or middle-income countries (LMICs) have implemented maternal influenza immunization programs. To inform vaccine decision-making and operational planning in LMICs, there is a need to document and share experiences from countries that provide seasonal influenza vaccine to pregnant women, particularly those with high coverage, like El Salvador. MethodsIn 2015 and 2016, PATH and country researchers conducted a mixed-methods study to document the experience and lessons learned from maternal influenza immunization delivery and acceptance in El Salvador as part of a collaborative effort between WHO and PATH. Researchers conducted focus group discussions, semi-structured interviews, antenatal clinic exit interviews, and key informant interviews with 326 participants from two municipalities in each of the country’s three regions. Respondents included pregnant and recently pregnant women, family members, community leaders, health personnel, public health managers and partners, and policymakers. ResultsFactors perceived as positively influencing maternal influenza immunization delivery and acceptance in El Salvador include the use of multiple vaccine delivery strategies, targeted education and community engagement efforts, and a high degree of trust between the community and health care providers. Influenza vaccine acceptance by pregnant women is high and has improved over time, largely attributed to education targeting health care advisors. Perceived challenges to pregnant women receiving health care and vaccination include the need for permission to attend services and limited access to health services in insecure areas related to the presence of criminal gang activity. ConclusionsWe identified approaches and barriers perceived to affect maternal influenza vaccine delivery in El Salvador. This information will be useful to public health decision-makers and implementers in El Salvador and other countries considering introduction of new maternal vaccines or striving to increase coverage of vaccines currently provided.

A person-centred approach to family carer needs assessment and support in dementia community care in Western Australia.

This feasibility study aimed to identify and address the support needs of family carers (FCs) of people living with dementia and to assess whether the use of the Carer Support Needs Assessment Tool (CSNAT) intervention in home-based care was acceptable and relevant to FCs. The CSNAT intervention comprised two FC support needs assessment visits, 7weeks apart, plus associated actions addressing prioritised needs by the Client Care Advisors of a community care service in Western Australia in 2015. Telephone interviews were conducted with FCs on their experience using the CSNAT at the end of the intervention. Twenty-one FCs were involved in the intervention and 15 of them completed the feedback interviews. Care recipients had moderate to severe dementia. The top five support needs reported by FCs were: having time to yourself in the day; knowing what to expect in the future; practical help in the home; looking after your own health and dealing with your feelings and worries. Three themes summarised their experience: a straightforward structured approach; awareness, acknowledgement and acceptance of their situation; and provision of support. FCs appreciated the opportunity to be heard and acknowledged, to have their practical and psychosocial support needs facilitated, to identify what is important to them and to receive a response in a timely manner. The CSNAT approach offered a structured carer-led, person-centred, supportive intervention that facilitated discussion between the family carer and the service provider about support needs and strategies to address them.

「市民の足を守ろう!!」から始まる地域活動 ～フットケア指導士として地域へ～

「市民の足を守ろう!!」から始まる地域活動 ～フットケア指導士として地域へ～

Annual report of the Women's Health Care Committee, Japan Society of Obstetrics and Gynecology, 2017.

To improve women's quality of life, the activity of the Women's Health Care Committee over a year up to July 2017 focused upon: (i) breast management; (ii) the influence of gynecological disease therapy on physical condition; (iii) non-surgical management of pelvic organ prolapse; (iv) survey of infectious diseases in obstetrics and gynecology in Japan; (v) health care for female athletes; (vi) a training program for women's health care advisors; (vii) revising the Japanese guidelines on hormone replacement therapy; and (viii) revising the 2016 Japanese guidelines for the proper use of emergency contraceptives. The detailed activity of the eight subcommittees is described herein. This report is based on the Japanese version of our annual report (Acta Obst Gynaec Jpn 2017;69(6):1480-1491), to publicize the activities of our committee.