Care Institutions Research Articles

Structural violence and necropolitics among Indigenous Peoples living with HIV who use substances in the Prairie provinces during COVID-19

BackgroundWithin Manitoba and Saskatchewan, pre-existing health inequities amongst Indigenous groups were intensified during the COVID-19 pandemic. Service disruptions in the health and social service sector—combined with the effects of intersectional stigma—disproportionately impacted Indigenous peoples living with HIV (IPLH). IPLH experience structural violence and necropolitical exclusion through systemic forms of stigma situated within Canada's expansive colonial history. Utilizing the theoretical foundations of structural violence and necropolitics, this qualitative study examines how the COVID-19 pandemic amplified preceding states of inequity for IPLH. MethodsSemi-structured interviews were conducted with 60 participants. The sample comprised of those with lived experience (n = 45) as well as those who provided services for IPLH (n = 15). Indigenous Storywork guided the data collection and analysis process. Topics explored within each interview included access to health and social services, harm reduction, substance use, and experiences in providing services during COVID-19 pandemic. Thematic analysis was used to identify common themes throughout each story. ResultsOur results indicate that the COVID-19 pandemic exposed and amplified pre-existing forms of structural violence and necropolitical logics for IPLH within Manitoba and Saskatchewan. Specifically, we describe how structural violence and necropolitics are manifested via three main avenues— (i) restrictions and removal of care, (ii) bureaucracy and institutional care politics, and (iii) discrimination and systemic racism within the Canadian healthcare system. ConclusionThe COVID-19 pandemic within Manitoba and Saskatchewan sparked massive changes in service provision within settler-colonial and neoliberal institutions of care. For those services that remained open to IPLH, masking requirements, questionnaire requirements, scheduling requirements, and a lack of in-person services acted as only some of the barriers described by community members as detrimental to care access. Increased experiences of discrimination in health care on the basis of substance use or HIV status further limited access to needed services.

Oral health knowledge, attitudes, and practices of paediatric nurses caring for hospitalized children

ObjectivesNurses are well positioned to provide oral care to hospitalized children. This study explores pediatric hospital nurses’ knowledge, attitudes, practices and perceived barriers to providing oral care.MethodsUsing a descriptive cross-sectional design, previously validated surveys were adapted based on input from key stakeholders and administered to all nurses and staff providing patient care on inpatient units (N = 239) of a pediatric hospital.ResultsThe survey response rate was 40% (N = 96), providing a margin of error of 7.59% (95% C.I.). Most participants were unaware that caries is infectious (51%, n = 49) and caries-producing bacteria is transmissible (35%, n = 34). The majority (57%, n = 52) of participants did not recall oral care content within their formal education or oral care continuing education (88%, n = 81), despite high interest (87%, n = 80). Oral care was rated by most as a priority (85%, n = 81), yet the majority (74%, n = 69) believed it is under performed. More nurses with 6 or more years of experience placed a high or very high value on prioritizing oral health (p = 0.005). Furthermore, most nurses do not assess oral health on admission (63%, n = 60), routinely incorporate oral health into the care plan (45%, n = 43), or document oral care (60%, n = 56). Commonly reported barriers include lack of patient cooperation, medical status, and competing needs.Conclusions and outcomeDespite nurses valuing the importance of oral care and their willingness to learn, oral care practices are lacking, and barriers exist. Future investigation is required to further explore the findings related to barriers to care and lack of practice. These results and future findings will be used to guide institutional oral care policy and education.

Family Members’ Perspectives on the Unmet Care Needs of People Living With Dementia in Nursing Homes

While the number of older people living with dementia grows, savings in public resources leads to situations where services and supports for older people are cut, even in the traditionally generous Nordic welfare states, such as Finland. This development is expected to lead to care poverty, meaning older people are not receiving the services they need. Our aim was to uncover whether care poverty already exists within institutional care for older adults in Finland. Thematic analysis was utilized to study 19 interviews with family members of people with dementia living in a nursing home. Signs of care poverty were found in relation to timeliness and safety of access to long-term care and quality of professional care. In addition, the threshold of questioning the care system was high, and managing disagreements about care with professionals was challenging for the family members. The results raise concerns that reducing long-term care risks the whole concept of welfare states. Family members should be more systematically involved in needs assessment and decision-making concerning the care of older people with dementia.

Oncology nurses' practices on diagnosis, prevention, and management of delirium

Objective: To determine oncology nurses’ practices about the diagnosis, prevention, and management of delirium. Background: Delirium can occur at any stage of the disease process of patients with cancer, or it can develop when the first diagnosis is learned. Study Design and Methods: A cross-sectional design was used. The study was conducted between May 10 and July 16, 2021 in Turkey with 181 nurses who worked in the oncology units of public and private hospitals and were reached by using the snowball sampling method. Data were statically analysed. Results: Of the nurses, 48.6% have a bachelor's degree and the average working years in oncology is 6.61+ 5.47, 38.1% had been making routine delirium assessments, and only 5.5% of these nurses had prior experience using a screening tool. Also, 38.1% of the nurses had difficulty diagnosing delirium, with the patient group they had difficulty diagnosing most often being patients with dementia, hypoactive delirium, and those who were sedated, respectively. The rate of nurses who worked with a patient with delirium in the last month was 31.5%, and 40.3% could not determine the type of delirium. While the nurses' definition of hyperactive delirium findings was high, their definition of hypoactive delirium findings such as lethargy (48.8%), decreased psychomotor activity (47.7%) and withdrawal (56.1%) was low. In the study, it was found that being male, having an undergraduate degree in nursing, having professional work experience, having a lower patient-to-nurse ratio, using a screening tool, having experience working with patients diagnosed with delirium, and having positive views on delirium treatment had a significant impact on nurses' routine follow-up of delirium (p<0.05). In addition, it was determined that those who had experience working with patients diagnosed with delirium had less difficulty diagnosing delirium (p<0.05). Also, 82.4% of the nurses stated that they first applied pharmacological treatment after the diagnosis of delirium and that they most frequently used haloperidol (35%), benzodiazepine (29.8%) and dexmedetomidine (22.8%). Although nurses were self-confident about the management of delirium, they thought that it was difficult to prevent and treat delirium in patients with cancer. Conclusions: Although approximately one-third of the nurses had cared for patients diagnosed with delirium in the last month, the rate of using a measurement tool for routine delirium screening and diagnosis was low. Implications for research, policy, and practice: It was concluded that it was important to support the education of nurses with case examples in in-service or certificate programs, workforce planning should be made according to patient/nurse ratios, and evidence-based care procedures should be prepared and implemented so that oncology nurses could do routine follow-up of delirium in patients diagnosed with cancer, use a valid and reliable screening tool, and manage effectively and appropriately delirium. What is already known about this topic? Although the incidence of delirium is high in cancer patients, it is not always diagnosed appropriately or managed effectively. Despite the factors limiting diagnosis and treatment in cancer patients, 40% of delirium cases can be prevented. Delirium is a syndrome that can be managed with pharmacological and non-pharmacological applications. What this paper adds: In the diagnosis and management of delirium, whether nurses use screening tools and do routine follow-up, the level of their education, their experience working with patients diagnosed with delirium, the number of patients they provide care for, their self-confidence, and their positive attitudes towards delirium are factors that impact on the diagnosis and outcomes. Nurses should be supported with case-based education that will increase their knowledge and skills regarding the diagnosis and management of delirium in patients diagnosed with cancer. This approach will increase nurses' experience before they encounter a patient with delirium. For effective diagnosis and management of delirium, workforce planning should consider patient/nurse ratios in oncology units as a workload management and patient safety measure. It is recommended to prepare and implement institutional care procedures for the diagnosis, management and follow-up of delirium in oncology units.

Development and evaluation of a narrative therapy program combined with a solution-focused approach for nursing home residents: A quasi-experimental study

The transition from the family home to a nursing home can be an emotionally stressful experience for older adults. This study aimed to examine the feasibility and effects of a narrative therapy combined with a solution focus (NTCSF) program on the psychological adjustment, depression, and self-efficacy of nursing home residents. A non-random concurrent controlled trial was conducted in Fujian, China that involved 81 participants (intervention = 41, comparison = 40) from four separate nursing homes. The control group received routine institutional care, while the intervention group underwent a three-week NTCSF program in addition to receiving routine care. In the variance analyses, significant differences were found in “psychological adjustment” (T = 4.007, P < 0.001) and “self-efficacy” (T = 3.204, P = 0.002), compared to the control group. There was no significant difference in “depression” (t = -1.550, P = 0.125) between the groups at the baseline, but the experimental group showed a significant decrease in depression (t = -2.204, P = 0.033) after the intervention. The NTCSF program was found to be effective in improving the psychological adjustment of nursing home residents.Trial registration This study was registered on the Chinese Clinical Trial Registry (Registration No: ChiCTR-2100042767).

Medical-statistical indicators of dental disease prevalence among students of general educational institutions of the Ministry of Defense of Russian Federation

BACKGROUND: Currently, the Ministry of Defense of Russian Federation has 33 general educational institutions, with around 18,000 students who are part of the personnel reserve aimed at enhancing the country’s defense capability. AIM: To evaluate the medical-statistical indicators of dental disease prevalence among students, which can be used to optimize dental care in the general educational institutions of the Ministry of Defense of Russian Federation. MATERIALS AND METHODS: We analyzed the dental disease prevalence (ICD-10 codes K00–K14) among students from the academic years 2009/2010 to 2021/2022 using the reporting form 13K/MED approved by the Main Military Medical Directorate of the Ministry of Defense of Russian Federation, as well as during annual medical examinations. The level of dental disease prevalence was calculated per mil (‰).The number of those in need of and sanitized children were calculated in percentages (%). The results were tested for the normal distribution of characteristics. The text includes the mean values and their errors. RESULTS: The average annual level of total dental disease prevalence or incidence among students was 1687.9±16.0‰ and 563.4±12.2‰ for primary dental disease. This was significantly higher by an order of magnitude compared to previously examined conscripted military personnel, achieved through personalized approaches and strict medical-statistical accounting. No significant differences were observed in dental disease prevalence indicators among different age groups of students. A decrease in both total and primary dental disease prevalence rates has been observed in recent years. The average annual percentage of students requiring oral cavity sanitation was 40.9±1.2% and 75.4±1.8% of those who underwent sanitation. The proportion of sanitized students in the 16–18 age group was significantly higher than in younger age groups (p 0.001). CONCLUSION: Medical-statistical indicators should be used to optimize dental care in the general educational institutions of the Ministry of Defense of Russian Federation.

Impacts of early deprivation on behavioral and neural measures of executive function in early adolescence

Children reared in institutional settings experience early deprivation that has lasting implications for multiple aspects of neurocognitive functioning, including executive function (EF). Changes in brain development are thought to contribute to these persistent EF challenges, but little research has used fMRI to investigate EF-related brain activity in children with a history of early deprivation. This study examined behavioral and neural data from a response conflict task in 12–14-year-olds who spent varying lengths of time in institutional care prior to adoption (N = 84; age at adoption – mean: 15.85 months, median: 12 months, range: 4–60 months). In initial analyses, earlier- and later-adopted (EA, LA) youth were compared to a group of children raised in their biological families (non-adopted, NA). NA youth performed significantly more accurately than LA youth, with EA youth falling in between. Imaging data suggested that previously institutionalized (PI) youth activated additional frontoparietal regions, including dorsolateral prefrontal cortex, as compared to NA youth. In addition, EA youth uniquely activated medial prefrontal regions, and LA uniquely activated parietal regions during this task. A separate analysis in a larger group of PI youth examined whether behavioral or brain measures of EF varied with the duration of deprivation experienced. Duration of deprivation was negatively associated with activation of default mode network (DMN) regions. Overall, results suggest that there are lasting effects of deprivation on EF, but that those who are removed from institutional care earlier may be able to recruit additional neural resources as a compensatory mechanism.

The Depression Anxiety Stress Scale 8: investigating its cutoff scores in relevance to loneliness and burnout among dementia family caregivers

The global trend of advanced aging comes at the cost of amplified onset of age-related diseases. Dementia is a common multifactorial age-related neurodegenerative disorder, which manifests with progressive declines in cognitive functioning and ability to perform activities of daily living. As polices discourage institutionalized care, family members act as primary caregivers and endure increased vulnerability to physical and mental health problems secondary to care-related changes in life routine and relationships. Targeting clinically significant distress at earlier stages through valid brief measures may promote caregivers’ wellbeing and dementia care continuity/quality. This study aimed to determine the optimal cutoff score of the Depression Anxiety Stress Scale 8-items (DASS-8) in a convenience sample of 571 European caregivers (Mean age = 53 ± 12 years, Italian = 74.4%, Swiss = 25.6%) through three methods. K-means clustering classified the sample into high- and low-distress clusters based on DASS-8 score of 19. Receiver operator curve (ROC) analysis using 48 and 7 cutoffs of the Zarit Burden Interview (ZBI) and the Three-Item University of California, Los Angeles, Loneliness Scale-version 3 (UCLALS3), revealed two DASS-8 cutoffs (12.5 and 14.5, area under the curve (AUC) = 0.85 and 0.92, p values < .001, 95% CI 0.82–0.88 and 0.89 to 0.94, sensitivity = 0.81 and 0.78, specificity = 0.76 and 0.89, Youden index = 0.57 and 0.67, respectively). Decision modeling produced two DASS-8 cutoffs (9.5 and 14.5) for predicting low and high caregiving burden and loneliness, respectively. According to the median of all DASS-8 cutoffs (14.5) the prevalence of mental distress was 50.8%. Distress correlated with key mental problems such as burnout and loneliness—in path analysis, DASS-8 scores were predicted by the ZBI, UCLALS3, care dependency, and receiving help with care, especially among older, female, and spouse caregivers. Further diagnostic workup should follow to confirm psycho-pathogenicity among caregivers with DASS-8 scores above 14.5. Investigations of the DASS-8 in other countries/populations may confirm the validity of this cutoff score.

Access to urban green spaces and use of social services and institutional long-term care among older people in Malmö, Sweden: a longitudinal register study

BackgroundFinding ways to prolong independence in daily life among older people would be beneficial for both individuals and society. Urban green spaces have been found to improve health, but only a few studies have evaluated the association between urban green spaces and independence in daily life. The aim of this study was to assess the long-term effect of urban green spaces on independence in daily life, using social services and support, mobility aids, and relocation to institutional long-term care as proxies, among community dwelling people 65 + years.MethodsWe identified 40 357 people 65 + years living in the city of Malmö, Sweden in 2010. Using geographical information systems (GIS), we determined the amount of urban green spaces (total, public, and quiet) within 300 m of each person’s residence. All three measures were categorized based on their respective percentiles, so that the first quartile represented the 25% with the least access and the fourth quartile the 25% with the most access. In 2015 and 2019, we assessed the outcomes minor assistance (non-personal support), major assistance (personal support), and relocation into institutional long-term care. These three outcome measures were used as proxies for independence in daily life. The effect of amount of urban green spaces in 2010 on the three outcomes in 2015 and 2019, respectively, was assessed by pairwise comparing the three highest quartiles to the lowest.ResultsCompared to the lowest quartile, those in the highest quartile of quiet green spaces in 2010 were less likely to receive minor assistance in both 2015 and 2019. Besides this, there were no indications that any of the measures of urban green space affected independence in daily life at the five- and nine-year follow-up, respectively.ConclusionAlthough urban green spaces are known to have positive impact on health, physical activity, and social cohesion among older people, we found no effect of total, public, or quiet green spaces on independence in daily life. This could possibly be a result of the choice of measures of urban green spaces, including spatial and temporal aspects, an inability to capture important qualitative aspects of the green spaces, or the proxy measures used to assess independence in daily life.

SOCIALIZATION OF THE CHILD IN THE CONDITIONS FAMILY-TYPE CHILDREN’S HOME

The article, based on the analysis of theory and practice, characterizes the features of a child’s socialization in the conditions of a family-type orphanage.The peculiarity of the modern stage of society’s development, the contradictions of social relations, the negative effects on the social development of the individual require a deep rethinking of the mission of institutions for the socialization of children in order to create favorable conditions for their social development in modern realities.Today, questions regarding the practical implementation of provisions declared in state documents that define family policy in Ukraine remain partially unresolved. In particular, alternative forms of social protection and family arrangement for orphans – forms of care for children who for certain reasons cannot live with their biological parents (establishment of custody and care, placement in foster families, family-type children’s homes, foster families, children’s institutions with living conditions close to family ones (National strategy for reforming the system of institutional care and upbringing of children for 2017–2026).In modern realities, in conditions of priority attention to each child, one of the important tasks of the state family policy is to solve the problem of orphanhood. First of all, the social phenomenon of orphanhood violates one of the basic rights of the child – the right to family upbringing and parental care, proclaimed by the UN Convention on the Rights of the Child.The system of state guardianship of orphans and children deprived of parental care, created for decades, was oriented towards collective forms of child rearing. As a result, the format of social education (in particular, in traditional orphanages) has acquired a number of negative features, first of all, regarding the process of child socialization: children who grow up outside the family adapt much worse in society, as a rule, find it difficult to navigate the role hierarchy social ties, etc.Ukrainian and foreign experience of caring for orphans and children deprived of parental care show that it is family forms of care that are the most effective in various aspects – educational, social, economic.The development of family forms of upbringing, solving the problem of child socialization in the conditions of a family-type orphanage are topical interdisciplinary tasks of the state’s modern social policy, the need for a civilized society and human morality. The identified vital arguments determine the need to find and implement alternative measures and innovative approaches in family policy and the social sphere, which is the subject of further research.

Disability level and use of long-term care services in Norway: a nation-wide registry study.

In Norway, disability level is an important criterion when deciding the type and level of long-term care services. Each care recipient can be scored on 20 different disability level measures. Our aims were to investigate completeness in disability level information in the Norwegian Registry of Primary Health Care (NRPHC), to group disability level measures into meaningful groups, and to study the relationship between grouped disability scores and the type of services received. We retrieved information on type of care and disability level from the NRPHC on individuals who received long-term care services in 2022. Type of care was divided into hierarchical and mutually exclusive groups, with long-term institutional care as the most complex service group. We used principal components analysis to summarise and visualise the information in the 20 different disability level measures, and to create grouped scores. A total of 386,697 persons aged 0-104 years were registered as recipients of long-term care services in Norway on 31 December 2022. Information on disability measures were of high completeness (72.4 % of the population were registered with all 20 measures) but was lower for younger age groups in which the number of recipients was lower. Principal components analyses identified two groups of measures, which we termed physical and cognitive functioning. Physical and cognitive functioning were poorest for individuals receiving the most complex and extensive services. NRPHC disability data are reasonably complete, the 20 measures readily fall into two distinct categories, and seem to reflect real life differences in disability.

Functional Performance and Tendon Morphology After Operative or Nonoperative Treatment of Achilles Tendon Ruptures.

While controversy remains as to the relative benefit of operative (OM) versus non-operative management (NOM) of Achilles tendon (AT) ruptures (ATR), few studies have examined the effect on high impact maneuvers such as jumping and hopping. The purpose of this study was to determine if functional performance including strength, jumping, and hopping outcomes differed between OM and NOM of acute ATR. The secondary objective was to assess the degree of association between AT morphology and performance outcomes. Retrospective cohort with a single prospective evaluation. All patients were treated at an institutional secondary care center. Eligible participants (n=12 OM; 12 NOM) who were treated with OM or NOM of ATR within three weeks of injury were evaluated a minimum 20 months following ATR. AT length, thickness and gastrocnemius muscle thickness were assessed with B-mode ultrasound. Isokinetic plantar flexor strength, hop tests and countermovement and drop jumps were completed. Two-way ANOVAS were completed on all tests with unilateral values, independent t-tests were used for bilateral outcomes, and linear regressions were completed to assess the relationship between normalized AT length and performance. Affected limb AT was elongated and thickened (p\<0.01), gastrocnemius was atrophied (p\< 0.01) and angle-specific plantar flexor torque was reduced at 120°/s when measured at 20° plantar flexion (p = 0.028). Single leg drop vertical jump was higher in OM (p = 0.015) with no difference for hop and jump tests. AT length was related to plantar flexor torque but had no relationship with hopping performance. Hop test performance was maintained despite plantarflexion weakness, gastrocnemius atrophy, and AT elongation. This may be the result of compensatory movement patterns. AT length holds limited explanatory power in plantar flexor strength, although this relationship should be evaluated further. Level III.

A Good Investment: Expanding Capacity to Care for Older Adults in the Home and Community Care Sector Through Increased Personal Support Worker Wages.

Most older adults prefer to age in place, which for many will require home and community care (HCC) support. Unfortunately, HCC capacity is insufficient to meet demand due in part to low wages, particularly for personal support workers (PSWs) who provide the majority of paid care. Using Ontario as a case study, this paper estimates the cost and capacity impacts of implementing wage parity between PSWs employed in HCC and institutional long-term care (ILTC). Specifically, we consider the cost of increased HCC PSW wages versus expected savings from avoiding unnecessary ILTC placement for those accommodated by HCC capacity growth. The expected increase in HCC PSW retention would create HCC capacity for approximately 160,000 people, reduce annual health system costs by approximately $7 billion, and provide an 88 per cent return on investment. Updating wage structures to reduce turnover and enable HCC capacity growth is a cost-efficient option for expanding health system capacity.

Serum 25(OH)D and vitamin K1 levels in patients with severe motor and intellectual disability: A Japanese single-center experience

PurposeTo investigate whether patients with severe motor and intellectual disability (SMID) have nutritional vitamin D and K insufficiencies and clarify the required vitamin supplementation. MethodsThis prospective observational study enrolled Japanese adults with SMID receiving institutionalized care who underwent blood sampling between February 2020 and February 2022 during annual medical checkups. Serum vitamin K1 and 25-hydroxy vitamin D (25(OH)D) levels were measured to determine their relationship with serum uncarboxylated osteocalcin (ucOC) levels. Vitamin D and K intake was compared among tube-fed and oral-intake patients with SMID and control participants using corresponding serum levels. ResultsThe study included 124 patients with SMID (56 men and 68 women; mean age: 53.0 years) and 20 control participants. Serum 25(OH)D levels were significantly higher in the SMID group than in the control group and the oral intake SMID group than in the tube-fed SMID group. In the tube-fed SMID group, vitamin D intake was lower than the daily recommended intake and correlated with serum 25(OH)D levels. Daily vitamin K intake in the tube-fed group was lower than recommended but not correlated with serum vitamin K levels. Serum ucOC levels were significantly higher in the SMID group than in the control group. Tube feeding was significantly and positively correlated with serum 25(OH)D levels. Serum 25(OH)D levels were not correlated with serum vitamin K1 levels. ConclusionsThe SMID group had higher ucOC levels than the control group, possibly owing to daily vitamin K and D deficiencies. Vitamin D supplementation is recommended to decrease ucOC levels.

Practical Implementation of Gerontechnology Smart Products: Product Suitability Assessment

Because of the critical importance to national healthcare of developing and applying smart technologies to address the needs of Taiwan's rapidly aging society, "gerontechnology" is an industry sector that must be promoted to achieve related policy goals. The scope of technologies involved in gerontechnology is broad, with the application of smart technology often the focus of industrial development. The most crucial feature of gerontechnology-related "smart" products is the collection, analysis, and feedback of target data in the application process necessary to facilitate the provision of "precision" aged care. The application of smart technology to meet the rapidly increasing life and care needs of older adults in aging societies is increasingly valued worldwide. However, the practical implementation of smart technology in aged care is still not widespread, and thus represents an urgent problem to be solved. There are many aspects to consider in the practical application of gerontechnology, among which caregivers are the key to practical application, with product suitability being the first concern of caregivers. In this article, a process is proposed to allow caregivers to assess the suitability of gerontechnology smart products in terms of "data sensing and transmission," "indicator identification and analysis," "event prediction and feedback," and "intervention measures." Based on the World Health Organization's concept of implementing research in healthcare, decision-making evaluation indicators for product selection and a product suitability questionnaire for institutional care are proposed with the goal of providing a practical tool for care institutions to assess the suitability of gerontechnology smart products.

Mediating Mundane Life

Abstract The recent and ongoing exodus of Venezuelans to the surrounding Latin American region has sparked international humanitarian intervention. Drawing on research conducted in Brazil in late 2019, this article focuses on the state-led humanitarian response to Venezuelan migration and its collaborative efforts with the military and leading organizations. Looking at two sites of institutional care, I argue that temporal structures created by military-humanitarian agencies work to govern the everyday mobilities of urban migrants living without shelter, who are often framed as criminals or threats within neoliberal securitization narratives. This article further reveals conflicting temporalities with regard to the practice of waiting, whereby the act is viewed as risky when visible in urban public spaces but favored in institutional settings where it can be closely monitored.

COVID-19 Pandemic and Food Insecurity among Pregnant Women in an Important City of the Amazon Region: A Study of the Years 2021 and 2022.

Food insecurity (FI) experienced during pregnancy represents a relevant public health problem, as it negatively affects maternal and child health. To investigate the prevalence of FI among pregnant women during the COVID-19 pandemic and determine associated factors. A cross-sectional study was carried out in the period from 2021 to 2022, with a representative sample of 423 women resulting from a sample calculation based on the average (2912 births) that occurred in the years 2016 to 2020 in the only maternity hospital in the municipality. After analyzing the medical records, interviews were carried out with the postpartum women using a standardized questionnaire and the Brazilian Food Insecurity Scale. Poisson regression with robust variance was used to calculate prevalence ratios and 95% confidence intervals to measure associations. FI was observed in 57.0% of cases and was associated with age under 20 years (PR = 1.52; 95% CI 1.29; 1.79), receipt of government assistance (PR = 1.31; 95% CI 1.10; 1.55), loss of family employment (PR = 1.40; 95% CI 1.20; 1.64), greater number of residents (PR = 1.17; 95% CI 1.00; 1.37), and prenatal care in a public institution (PR = 1.53; 95% CI 1.04; 2.26). There was a high prevalence of FI cases, associated with socioeconomic, demographic, and prenatal care characteristics during the COVID-19 pandemic.

COVID-19 related barriers to institutional childbirth during the early phase of the pandemic in rural Arsi zone, Ethiopia, 2022: A qualitative study

IntroductionGlobal, national, and local studies revealed that the COVID-19 pandemic has significantly reduced institutional childbirth. However, it is not well understood how the COVID-19 epidemic affected institutional childbirth service utilization. Therefore, this study aimed to evaluate COVID-19 related impediments to institutional childbirth service uptake during the early phase of the COVID-19 pandemic (March 20/2020–June 20/2020) in the rural Arsi zone of Ethiopia. MethodsA community-based Phenomenological study was conducted from January 10–25/2022, among mothers who gave birth in the Arsi zone during the early phase of the COVID-19 epidemic (March 20/2020–June 20/2020) in Ethiopia. Data was collected by the primary author and a university graduated Midwives with experience in qualitative data collection. Eight focus group discussions and six in-depth interviews were conducted among mothers who gave birth in selected rural areas of the Arsi zone during the early phase of the COVID-19 pandemic. Nine key informant interviews were also conducted among Midwives, Maternity Ward Heads, and Community Health Extension Workers. Data was transcribed, translated, and analyzed thematically using Atlas Ti.7 version. ResultsFour major themes and eleven sub-themes emerged regarding the barriers to institutional childbirth during the early phase of COVID-19 pandemic. The COVID-19 related fear was a reason for avoiding institutional childbirth for almost all participants. COVID-19 restrictions such as transportation bans, market bans and public transport price doubling were also critical concerns to seeking institutional childbirth. Perceived Poor quality of institutional childbirth care during the curfew was also an impeding factor. Poor communication, incomplete care components and absenteeism were mentioned under this theme. Unbalanced mass media tragedies and rumors of unknown sources were COVID -19 related infodemics found affecting the practice of institutional childbirth. ConclusionsCOVID-19 related fears, COVID-19 restrictions, Perceived Poor quality of care during the COVID-19 pandemic and the COVID-19 Infodemic were the main reasons for reduced institutional childbirth service utilization during the early phase of the COVID-19 pandemic in Ethiopia. Therefore, strategies must be designed proactively to maintain essential maternal health services, particularly institutional childbirth, during pandemics like COVID-19 and similar future epidemics.

Trends and clinical outcomes of abdominal compartment syndrome among intensive care hospitalizations

BackgroundAbdominal compartment syndrome has been shown to be a highly morbid condition among patients admitted to the intensive care unit. The present study sought to characterize trends as well as clinical and financial outcomes of patients with abdominal compartment syndrome. MethodsThe 2010 to 2020 National Inpatient Sample was used to identify adults (≥18 years) admitted to the intensive care unit. Standard mean differences were obtained to demonstrate effect size with >0.1 denoting significance. Hospitals were divided into tertiles based on annual institutional intensive care unit admissions. Multivariable regression models were used to evaluate the association of abdominal compartment syndrome on outcomes. The primary endpoint was in-hospital mortality, while complications, costs, and length of stay were secondarily considered. ResultsOf 11,804,585 patients, 19,644 (0.17%) developed abdominal compartment syndrome. Over the study period, the incidence of abdominal compartment syndrome (2010–0.19%, 2020–0.20%, P < .001) remained similar. Those with abdominal compartment syndrome were more commonly admitted for gastrointestinal (22.8% vs 8.4%) and cardiovascular (22.6% vs 14.9%) etiologies and were more frequently managed at urban teaching hospitals (77.7% vs 65.1%) as well as high-volume intensive care units (85.2% vs 79.1%) (all standard mean differences >0.1). After adjustment, abdominal compartment syndrome was associated with higher odds of mortality (adjusted odds ratio: 3.84, 95% confidence interval: 3.57–4.13, reference: non-abdominal compartment syndrome). Incremental length of stay (β: +5.0 days, 95% confidence interval: 4.2–5.8) and costs (β: $49.3K, 95% confidence interval: 45.3–53.4) were significantly higher in abdominal compartment syndrome compared to non-abdominal compartment syndrome. ConclusionAbdominal compartment syndrome, while an uncommon occurrence among intensive care unit patients, remains highly morbid with significant resource burden. Further work exploring factors to mitigate its clinical and financial burden is needed.

The relationship between the spirituality levels and the happiness and life satisfaction of elderly individuals living in their homes and nursing homes

ABSTRACT Spirituality and religion have an important place in the lives of Turkish elderly people. With modernization and changes in social life, the position of Turkish elderly people at home has changed and the need for institutional care has increased. Elderly individuals who have partially lost their place in traditional Turkish culture often resort to spirituality in coping with the problems they experience. This situation requires conducting studies on determining and comparing the relationship between the spirituality levels, happiness and life satisfaction of elderly individuals living at home or in nursing homes in our country. The sample of the study consisted of 139 elderly individuals over the age of 65 who were followed in nursing homes and Family Health Centers. The data of the research were collected by face-to-face interview technique using the “Personal Information Form, Spirituality Scale, Life Satisfaction Scale and Subjective Happiness Scale”. The research revealed that there is a significant difference between the spirituality levels of elderly individuals living in homes and nursing homes. It also showed that, although there was no significant difference, the life satisfaction and happiness levels of elderly individuals living at home were higher than those of elderly individuals living in a nursing home.