Accurate assessment is the foundation on which effective nursing interventions rest. However, it is not known how accurately nurses identify and prioritize the needs of parents whose children have chronic conditions. When nurses proceed with interventions based on inaccurate assessments, the results can be unsuccessful interventions that neither meet parental needs nor provide optimal health care for this population of children. This descriptive comparative study was conducted to 1) examine parental needs identified and prioritized by parents of children with chronic conditions and their respective nurse care-givers, and 2) identify similarities and differences between the two groups. Patterns that evolved from these similarities and differences provide us with information related to where nurses have expertise or difficulty identifying and prioritizing the needs of parents. Kleinman's (1978) health care systems theory, which supports the premise that health care professionals and clients perceive health care episodes differently, provided the conceptual framework for this study. Study participants included 38 parents and 13 nurses who were affiliated with ten ambulatory programs in a Western Canadian pediatric hospital. Both groups completed the modified Family Needs Survey (Bailey & Simeonsson, 1988b) and socio-demographic tool developed by this investigator. Responses to the 35-item scale of the Family Needs Survey were described and ranked, in addition to being analyzed using inferential parametric statistics to determine differences between parents' and nurses' identification of parental needs. Responses to the open-ended question on the Survey were described and ranked. Research findings revealed some similarities and a number of striking differences between the responses of parents and nurses. On the 35-item scale, parents and nurses agreed that five parental needs were 1) information about current research, future services and treatments, 2) help locating competent regular or respite care providers, 3) reading material about other parents with a similar child, 4) opportunity to meet and talk with other parents, with a similar child, and 5) more time for self, spouse and other children. Both groups were consistent in their ranking of the first two needs as the most important needs in the information and community services subscales, respectively. However, nurses had generally higher responses on all subscales and identified eight more parental needs than did parents which were related to information, support, and family functioning. Parents and nurses repeated most of the above needs on the open-ended question, although nurses indicated that parents also had a number of needs related to psychosocial issues and family functioning. Nurses ranked counselling (child's condition, treatment, stress management) as the primary support need. Further, both groups differed in their prioritization of parental needs on the open-ended question. Where parents ranked information, community services, and support needs as the most important, nurses ranked support, information, and community services. The implications of these research findings for nursing practice and education are discussed and recommendations for future research are presented. / Applied Science, Faculty of / Nursing, School of / Graduate

A l'adolescence, les patients porteurs de maladie chronique depuis l'enfance passent une étape de transition des soins, qui implique la sortie des services pédiatriques et l'entrée dans les services pour adultes. Cette étape pose de nombreux défis et elle est reconnue comme une période à risque de rupture de soins. Pour éviter ces situations, des recommandations internationales et des programmes variés ont été proposées. En France, il n'existe pas de recommandation générique pour la transition. Notre objectif était de proposer un programme générique, pertinent et faisable pour la transition des jeunes porteurs de maladies chroniques variées dans un grand nombre de services en France. Pour cela nous avons employé une méthode mixte : 1) Revue systématique des études interventionnelles au niveau international ; 2) Enquête qualitative des pratiques de transition existantes dans un ensemble de services hospitaliers d'Ile de France ; 3) Enquête de consensus national pour l'élaboration d'un programme de transition pertinent et faisable par la méthode Delphi. Nous avons observé que l'existence de programmes de transition était très dépendante des services : certains ne proposant pratiquement aucune adaptation de la prise en charge, d'autres proposant des programmes très structurés. Globalement, les programmes sont peu spécifiques des pathologies. A l'issue de ce travail de thèse, nous avons proposé un programme générique qui peut être considéré comme un tronc commun. Il pourra notamment permettre aux professionnels impliqués dans le suivi de pathologies peu étudiées dans le contexte de la transition de proposer des pratiques essentielles et minimales aux patients concernés. / At the end of their adolescence, patients with chronic disease since childhood go through a phase of healthcare transition, which involves the discharge of pediatric services and the entry into adult care services. This step poses many challenges and is recognised as a high risk period of discontinuity in care pathway. To avoid these situations, international recommendations and various programs have been proposed. In France, there is no generic recommendation for transition to adult care.The final goal of this thesis work was to propose a generic, relevant and feasible program for the transition of young people with varied chronic diseases into a large number of services in France.For this purpose, we used a mixed method research including: 1) Systematic review of intervention studies at the international level; 2) Qualitative study of existing transition practices in a set of hospital services in the Ile de France region (including Paris and its surroundings); 3) National consensus survey for the development of a relevant and feasible transition program using the Delphi method.We observed that the existence of transition programs was highly dependent on services: some offering almost no adaptation of care during this process, others offering highly structured programs. Overall, the programs were not really specific to pathologies.At the end of this thesis work, we proposed a generic program which can be considered as a common core of transition practices. Among other thing, it will allow professionals involved in the follow-up of pathologies that are under-studied in the context of the transition to propose essential and minimal practices to their patients.

Hintergrund: Ein signifikanter Anteil der Patienten mit einer chronischen körperlichen Erkrankung weist eine komorbide psychische Störung auf. Ob und in welchem Ausmaß sich die Prävalenzraten psychischer Störungen bei Patienten mit einer chronischen Erkrankung von denen der Allgemeinbevölkerung unterscheiden, ist bislang noch kaum untersucht. Fragestellung: Die vorliegende epidemiologische Studie untersucht geschlechts- und altersadjustierte 4-Wochen, 12-Monats- und Lebenszeitprävalenzen psychischer Störungen bei Rehabilitationspatienten mit muskuloskelettalen und kardiovaskulären Erkrankungen im Vergleich zu Prävalenzraten der Allgemeinbevölkerung. Methode: Die Daten der drei Stichproben (N = 4192) basieren jeweils auf einem zweistufigen, epidemiologischen Untersuchungsansatz mit einer schriftlichen Befragung der Patienten bzw. Probanden zu ihrem psychischen Befinden (GHQ-12; M-CIDI-S) und einem anschließenden Interview (M-CIDI) bei einem randomisiert ausgewählten Teil der Gesamtstichprobe. Ergebnisse: Mit adjustierten Lebenszeitprävalenzen von 59.3 % (OR: 1.6) und 56.2 % (OR: 1.4) weisen die Patienten mit einer muskuloskelettalen und kardiovaskulären Erkrankung im Vergleich zur Allgemeinbevölkerung (47.9 %) eine deutlich erhöhte Prävalenz psychischer Störungen auf. Am häufigsten sind affektive Störungen (22.5 % bis 34.9%) und Angststörungen (18.4 % bis 33.8 %). Schlussfolgerung: Der im Vergleich zur Allgemeinbevölkerung deutliche Zusammenhang zwischen chronischen körperlichen Erkrankungen und psychischen Störungen verdeutlicht die Bedeutsamkeit einer verstärkten Diagnostik und Behandlung komorbider psychischer Störungen bei chronisch erkrankten Patienten. / Background: A significant part of patients with chronic diseases have comorbid mental disorders. However, by now it is nearly unexplored if and to what extend the prevalence rates of mental disorders in patients with chronic diseases differ from the rates of the general population. Objective: The present epidemiologic study investigates sex- and age-adjusted 4-week, 12-months, and lifetime prevalence rates of mental disorders in inpatients with musculoskeletal and cardiovascular diseases compared to prevalence rates of the general population. Methods: In each sample (N = 4192), the data based on a two-stage epidemiologic design. The first stage entailed the use of a screening questionnaire for mental disorders (GHQ-12; M-CIDI-S). The second stage consisted of an interview (M-CIDI) of a randomised part of the sample. Results: The adjusted lifetime prevalence in both clinical samples (musculoskeletal: 59.3 %, OR 1.6; cardiovaskular: 56.2 %, OR 1.4) is high compared to the rate of the general population (47.9 %). Affective disorders (22.5 % to 34.9 %) and anxiety disorders (18.4% to 33.8 %) are the most common disorders. Conclusions: Compared to the general population there is a clear correlation between chronic diseases and mental disorders, that shows the importance of an improved diagnostic and treatment of patients suffering from comorbid mental disorders.

La tendencia en los últimos años por el cuidado de la salud ha ido en aumento. Hoy más que nunca se ve reflejado debido a la pandemia por el Covid-19. Muchas personas requieren de un buen sistema inmunológico para contrarrestar los efectos del virus y, es por ello, que optan por una buena alimentación, sobre todo aquellos que requieren de una especial. YouDiet nace con la idea de poder cubrir esta necesidad, brindando una dieta balanceada a celiacos, diabéticos e hipertensos, quienes requieren de una alimentación especial y balanceada. Nuestro objetivo es brindar un servicio de delivery de comida especial a distintos distritos de Lima para facilitarles el acceso a estos productos. Con ello les mostraremos una manera rápida de conseguir nuestros planes alimenticios de acuerdo con las necesidades específicas de cada posible consumidor, así como la entrega a domicilio de este. Para ello, se realizaron diversos experimentos. Inicialmente, comprobamos la existencia de la necesidad presentada. A continuación, se presentaron las posibles soluciones y concierges del proyecto, para validar los canales de atención y comunicación. Finalmente, validamos la intención de compra de nuestros clientes y el grado de satisfacción de estos. Asimismo, para poner en marcha el proyecto, se desarrollaron los siguientes planes de acuerdo con un previo análisis de mercado: Plan de Marketing, Plan de Operaciones, Plan de Recursos Humanos, Plan de Responsabilidad Social Empresarial y, por último, el Plan Financiero. Se desarrollaron estrategias para cada uno de ellos y como resultado de una inversión inicial de 16,650 soles, se obtuvo una utilidad neta de -8,214.90 soles para el primer año de operaciones, 15,981.97 soles para el segundo año y 96,770.34 soles para el tercer año. Considerando lo anteriormente mencionado, ponemos a disposición de los lectores, nuestro proyecto para ser tomado como ejemplo para la realización de futuras ideas de negocio sostenibles e innovadoras. / The trend in recent years for health care has been increasing. Today more than ever, it is reflected due to the Covid-19 pandemic. Many people require an effective immune system to counteract the effects of the virus, and that is why they choose a good diet, especially those that require a special one. YouDiet was born with the idea of being able to cover this need, offering a balanced diet to celiac, diabetic and hypertensive patients, who require a special balanced diet. Our main goal is to provide a special food delivery service to multiple and different districts of Lima to facilitate access to these products. With this project, will show you a quick way to get tour food plans according to the specific needs of each potential consumer, as well as the delivery to their homes. For this, multiple experiments were carried out. Initially, we check the existence of the presented. Next, the possible solutions and project concierges were presented. Finally, we validate the purchase intention of our customers and their level of satisfaction. Likewise, to start the project, the following plans were developed according to a previous market analysis: Marketing Plan, Operations Plan, Human Resources Plan, Corporate Social Responsibility Plan and, finally, the Financial Plan. Strategies were developed for each of them and as a result of an initial investment of 16,650 soles, a net profit of -8,214.90 was obtained for the first year of operations, 15,981.97 soles for the second year and 96,770.34 soles for the third year. Considering the abovementioned, we make our project available to readers to be taken as an example for future sustainable and innovative business ideas. / Trabajo de investigación

Frequent absences resulting from a chronic illness can disrupt adolescent school involvement, impacting academic achievement and psychosocial development as a result. This study explores whether certified child life specialists (CCLSs) could be a resource for parents as they address their adolescents' academic disruptions. Specifically, this study assesses an online training program designed to increase CCLSs' knowledge and self-efficacy as related to adolescents' academic adjustment following frequent absences. This knowledge and skill based training was designed as a three part module with sections including: academic considerations, psychosocial considerations, and availability of school resources in promoting successful adolescent academic adjustment. 62 CCLSs were recruited to participate and complete measures evaluating knowledge, in relation to content included in each module, and self-efficacy, involving communication with parents in regards to adolescent academic adjustment. T-tests were conducted to determine whether there were differences in reports of self-efficacy and knowledge following participation in the intervention between and within the treatment and control groups. Results indicate statistical significance for enhanced knowledge and self-efficacy for the treatment group at post-test. Therefore, the outcomes from this study support the effectiveness of brief online training in fostering knowledge and feelings of efficacy for CCLSs in a context not typically included in child life education or certification. As a result, findings from this study may be used to expand intervention programs in the clinical setting to provide more comprehensive psychosocial care to adolescents diagnosed with a chronic illness.

Thesis (MPH.) -- University of Limpopo, 2021 / Background: Chronic illnesses, including non-communicable diseases (NCDs), continue to be a public health concern, globally, and contribute to the high burden of diseases. These health challenges have led to the introduction of community health workers (CHWs) in both developed and developing countries as a way of dealing with these challenges. It is more than five years since ward-based outreach teams (WBOTs) were introduced into the Julesburg area in order to respond to the needs of the community, based on the government’s focus on quadruple burden of diseases. The researcher is aware of the increasing workload, unclear roles and responsibilities, different approaches to CHWs’ work taken, and the ever-changing focus of their work, based on the community needs and diseases that the community faces at a particular time. It is for this reason that the researcher is interested in understanding the CHWs’ experiences and the manner in which they cope with challenges when working in their ever-changing environment, workload, work focus and roles and responsibilities. Methods: A qualitative exploratory, descriptive and contextual study approach was used; data was collected using focus group discussions with CHWs and one-on-one interviews with key informants, using their supervisors to gather more information that could not have been shared by CHWs. Result: The findings from the focus group discussions revealed that the CHWs have a high workload, while receiving stipend and are not permanently employed. CHWs have had experiences that make them feel unimportant and not needed, as well as enduring poor working conditions without sufficient personal protective equipment (PPE). Even though they experience dissatisfaction, they are passionate about continuing with their community-based work for many years, evidenced by those who have up to 22 years of service.

No description available.

Objetivo: Evaluar la viabilidad de bacterias ácido lácticas y levaduras y composición nutricional del kéfir de leche durante su almacenamiento en refrigeración. Metodología: Fue un estudio experimental de laboratorio, desarrollado en cuatro etapas. En la primera, se realizó la elaboración de la bebida. La segunda etapa abarcó los análisis físico-organoléptico y fisicoquímico. La tercera etapa implicó el recuento de BAL y levaduras en la bebida refrigerada durante los días 1, 7 y 20. En la última etapa, se llevó a cabo el análisis químico-proximal del kéfir refrigerado al día 20. Resultados: Los resultados del recuento de BAL mostraron viabilidad de las mismas en los tres periodos de almacenamiento en frío, sin embargo, su variación no fue significativa. Con respecto a las levaduras, estas se mantuvieron viables hasta el día 7, pues tras ocurrir una disminución de hasta 3 Log (UFC/ml), su recuento al día 20 fue inferior al mínimo establecido como adecuado según las normativas. Conclusiones: Las muestras de kéfir de leche almacenadas en frío (5 a 7°C) presentaron valores de BAL y levaduras dentro de lo establecido por las normas internacionales vigentes, a excepción del recuento de levaduras en el día 20. El análisis químico proximal del kéfir demostró un bajo contenido de energía, grasa, carbohidratos y lactosa, por lo que se recomienda que la población intolerante a la lactosa pueda consumir esta bebida. / Objective: To evaluate the viability of lactic acid bacteria, yeasts and the nutritional composition of milk kefir during its refrigerated storage. Methodology: This laboratory experimental investigation was developed in four parts. In the first phase, the kefir drink was elaborated. The second phase involved its physico-chemical and organoleptic analysis. The third phase entailed the count of LAB and yeasts in the refrigerated kefir drink during days 1, 7, and 20. In the last part, the 20 days refrigerated kefir was proximal- chemical analyzed. Results: The results of the BAL count shown viability of itselve in the trhee periods of cold storage, their variation was non-significant. Regarding the yeasts, these remained viable until day 7, because after a decrease of up to 3 Log (CFU / ml) occurred, their count on day 20 was lower than the minimum established as adequate according to the regulations. Conclusions: The milk kefir samples stored cold (5 to 7°C) showed BAL and yeast values that were mostly within the established by the current regulations, with the exception of the yeast count on day 20. Likewise, the proximal-chemical analysis of kefir showed a low content of energy, fat, carbohydrates, and lactose so it is recommended that the lactose intolerant population could consume this drink. / Tesis

The increased number of international immigrants and associated global problems of health deterioration and vitamin D (vitD) deficiency/insufficiency may lead to significant burdens for host countries. This thesis investigated immigrants’ health deterioration and vitD status through a comprehensive analysis of Canadian national vitD data, systematic evaluation of the quality/content of clinical practice guidelines, and global systematic review of vitD status and determinants among first-generation immigrants. Immigrants had lower serum 25-hydroxyvitamin D (S-25(OH)D) and higher melanin levels than non-immigrants. S-25(OH)D levels improved over time, with ethnicity the main factor explaining variations. The longer immigrants lived in Canada, the higher the prevalence of chronic diseases (CDs), potentially reflecting health deterioration. Low levels of accumulated S-25(OH)D may impact CD-related biomarkers, partially explaining immigrants’ health deterioration over time. Local and international guidance regarding immigrants’ vitD deficiency/insufficiency was lacking. Improving immigrants’ vitD status requires prevention and intervention programs (e.g., vitD supplementation/screening), relevant national/international guidelines, and longitudinal research clarifying the complex bidirectional association between S-25(OH)D and CDs.

In order for a medication treatment to be considered successful, several roles and functions along the pharmacological treatment chain must function and cooperate effectively. The chain can most easily be described as five transitions; diagnosis, prescription treatment, dispensing, drug use and finally results and follow-up. Unfortunately, there are many problems and inefficiencies in the pharmacological drug chain. Unfortunately, those who study medication errors and their solutions have focused on individual parts of the pharmacological treatment system. However, for this reason, this study aims to develop a general framework for system analysis of inefficiencies along the pharmacological treatment chain. Due to the size of the problem, this project focused on medication adherence. Adherence can be defined as to what extent the patient follows the medication treatment plan. Adherence has many known problems and difficulties, among other things, it has major financial consequences. It can also be difficult to measure compliance, and there is no recognized perfect method. A system dynamic model is a theoretical image of a real system or object, which is a model used to understand the nonlinear behavior of complex systems. These models are useful when considering interventions and their effects when there are complex relationships. The project started with a literature study, and then went into data collection. Here, a search design and refinements were designed to find relevant articles. Once the articles were selected, the data was compiled from the articles and the analysis began. Here, factors and effects on adherence were identified as well as other interesting information from the articles. When the information was compiled and analyzed, the system dynamic model was created. The model was then sent via email to experts in the field to validation and revise the model. During the data collection, 23 relevant articles were found, compiled into 38 factors associated with compliance. In addition to these factors, 8 were excluded because they were too disease-specific or too ambiguous in their effect of adherence. The various articles studied many different chronic diseases, but hypertension was the most common. How adherence was measured in the articles also varied greatly, however, some form of self-report or questionnaire was most common method used. Three out of seven experts responded to the sent-out model and provided valuable comments. Although these are not sufficient to validate the model, their views showed that a validation can be designed in this way. The model would have to be sent to a larger set of experts and stakeholders, but because these experts are recognized in their fields, it gave weight to the results even though they were few reviewers. With the support of the literature and the experts’ statement, it was concluded that this model provides a good foundation and structure to continue to build upon. In addition, the model has proven to have many key relationships and cornerstones with important and relevant factors. It is also concluded that it is possible to translate the model into quantitative patterns, which is based on the fact that the factor itself can be translated quantitatively. Overall, it is also finally concluded that the model created in this project could be of great use in future projects when working towards a framework for system analysis of inefficiencies along the pharmacological treatment chain.