Adaptation needs and concerns of senior citizens living in old age homes

Context: Adaptation needs of senior citizens are not well explored in research, especially among people living in old age homes situated in developing countries like India. Aim: The aim of the study was to understand the needs and concerns of senior citizens living in old age homes and its effect on their adaptation. Subjects and Methods: Using the purposive sampling method, fifteen residents of an old age home and their three caregivers were interviewed to describe their views and experiences. The tools used were the Montreal Cognitive Assessment and an in-depth interview schedule. Statistical Analysis: Qualitative data were analyzed using Atlas ti. 7 for identifying major themes and subthemes. Results: The results showed that the major needs and concerns of senior citizens were unmet medical needs, difficulty to handle negative attitudes of staff, difficulty to adapt with new environment and culture, and emotional issues. Conclusion: Findings indicate the importance of addressing the adaptation needs of the elderly living in old age homes.

Unmet needs in multiple myeloma in Brazil from physicians' perspective ­ barriers in quality of life and disease management / Necessidades não atendidas em mieloma múltiplo no Brasil sob a perspectiva de médicos ­ barreiras na qualidade de vida e manejo da doença

Objective: There is an increasing trend of the overall survival rates of multiple myeloma (MM) patients over the years, increasing the necessity to improve their quality of life and attenuate unmet medical needs. Therefore, this study aims to explore and describe unmet medical needs and barriers in Brazilian MM patients, based on physicians' perspective. Methods: A questionnaire with 41 questions was developed to collect information regarding clinical characteristics, unmet medical needs and barriers for the diagnosis and treatment of MM in Brazil. After physicians' responses, a panel discussion with all the participants was had in order to collect additional data and validate physicians' responses. Results: Participants had a mean of 18 years of professional experience and attended to mean of thirty MM patients per month. MM patients treated by these physicians had a median time of disease of 7.5 months when initiating treatment in the public sector, and 2.5 months in the private sector. In both systems, the majority of patients referred were from general practitioners. Peripheral neuropathy was the most common adverse event reported with higher impact on patients' adherence and QoL. Conclusion: There are several challenges as to unmet medical needs, especially when comparing the private and public healthcare systems in Brazil. According to physicians, providing access to basic diagnostic procedures and adopting educational measures for both physicians and patients would help to minimize barriers in the current scenario of MM management in Brazil.

Objetivo: Existe uma tendência no aumento das taxas de sobrevida global de pacientes de mieloma múltiplo (MM) ao longo dos anos, aumentando a necessidade de melhorar sua qualidade de vida e atenuar as necessidades médicas não atendidas na área. Desta forma, o objetivo deste estudo explorar e descrever as necessidades médicas não atendidas e as barreiras em pacientes brasileiros de MM, a partir da perspectiva de médicos. Métodos: Um questionário com 41 questões foi desenvolvido para coletar dados sobre as características clínicas, necessidades médicas não atendidas e barreiras no diagnóstico e tratamento de MM no Brasil. Depois de coletar a resposta dos médicos, uma discussão em forma de painel com todos os participantes foi realizada para coletar dados adicionais validar as respostas do questionário. Resultados: Os participantes tinham, em média, 18 anos de experiência profissional, atendendo-se no total uma média de 30 pacientes de MM por mês. Os pacientes de MM atendidos por esses médicos no sistema público apresentam em média 7,5 meses de doença ao iniciar o tratamento, enquanto no sistema privado apresentavam 2,5 meses. Em ambos os sistemas, a maioria dos pacientes foi referenciada por clínicos gerais. Neuropatia periférica foi o evento adverso mais frequentemente reportado pelos médicos, com maior impacto na adesão ao tratamento e na qualidade de vida. Conclusão: Existem diversos desafios relativos às necessidades médicas não atendidas, especialmente ao comparar os sistemas público e privado no Brasil. De acordo com os participantes, o acesso aos procedimentos diagnósticos básicos e a adoção de medidas de educação médica e de pacientes minimizariam as barreiras importantes no cenário brasileiro atual.

New treatment approaches for relapsing/refractory Hodgkin's lymphoma: An overview of the Brazilian scenario / Novas abordagens de tratamento para o linfoma de Hodgkin recidivante/refratário: uma revisão

Hodgkin's lymphoma (HL) is a B-cell malignancy with a classical bimodal distribution with incidence peaking in the third and sixth decades of life. The purpose of this review is to describe the current unmet medical need for relapsing/refractory HL and the main data of emerging treatments, including brentuximab vedotin, the immune checkpoint inhibitors nivolumab and pembrolizumab, as well as other compounds in development. Available guidelines for relapsing/refractory HL are discussed.

O linfoma de Hodgkin (LH) é uma neoplasia de células B com distribuição bimodal clássica com pico de incidência na terceira e sexta décadas de vida. O objetivo desta revisão é descrever as atuais necessidades médicas não atendidas dos pacientes com LH recidivante/refratário e os dados principais dos tratamentos emergentes, incluindo brentuximabe vedotina, os inibidores do ponto de verificação imunológico, nivolumabe e pembrolizumabe, bem como outros compostos em desenvolvimento. Além disso, discutem-se as diretrizes disponíveis para LH recidivante/refratário.

The Effect of Stress and Depression on Unmet Medical Needs

BACKGROUND: Mental health issues such as stress and depression have been regarded as major social problems in Korea. We investigated the relationship between stress and depression with unmet medical needs (UMN). METHODS: Using the nationwide database of 2010 Korea National Health and Nutritional Examination Survey (K-NHANES), subjects aged 19 years or above were selected (n=6,055). In the K-NHANES questionnaire, subjects were asked about their UMN experience, severity of stress, and perceived depression lasting at least 2 weeks over the past year. The effects of stress and depression on UMN were analyzed in 4 models established by adding predisposing, enabling and need factors in a step-wise fashion. The risks for UMN were also assessed according to the causes of UMN. RESULTS: Individuals who felt stress ‘very often’ (odds ratio (OR) 3.28, 95% CI=2.23-4.86) and ‘often’ (OR 2.53, 95% CI=1.93-3.31) and who experienced depression (OR 1.68, 95% CI=1.35-2.10) reported significantly elevated UMN rates, and these effects were substantial especially for the individuals who had UMN due to economic constraint. Females, lower education level, lower income, unemployed status, and negative perceptions about health status were found to be additional risk factors for UMN. CONCLUSION: Our results confirmed the risks of stress and depression on UMN. It is strongly advisable to create initiatives to improve mental health, particularly stress and depression, and to fulfill individuals' medical utilization needs.

The Impact of Health Care Coverage on Changes in Self-Rated Health: Comparison between the Near Poor and the Upper Middle Class / 보건행정학회지

BACKGROUND: This study aims to analyze the impact of levels of health care coverage on the trajectory of self-rated health, comparing the near-poor which tends to be excluded in traditional health care systems with the upper middle class. METHODS: The study participants were 3,687 people who sincerely responded questions regarding health care expenditures, unmet medical needs, and self-rated health in the Korea Health Panel data in 2009-2012. RESULTS: The higher health care expenditures and the presence of unmet medical needs were significantly associated with the lower level of self-rated health. However, both factors did not significantly predict the steeper decline in the self-rated health. The results from multiple group analyses showed that health care expenditures and unmet medical needs had greater impact on the near-poor compared to their higher income counterparts. CONCLUSION: Public health care coverages need to be enhanced as well as reducing health care expenditures and unmet medical needs.

Mode of antiretroviral treatment based on the medical needs of people living with HIV/AIDS / 中华流行病学杂志

Objective To explore and evaluate the model of antiretroviral treatment that oriented to the medical needs of people living with HIV/AIDS (HIV/AIDS),based on the local prevalence of HIV/AIDS.Methods A total of 268 HIV/AIDS were selected the CDC of 13 administrative district in Wuhan from 2012 to 2013 and 275 HIV/AIDS were selected in the hospitals of 13 administrative district in Wuhan from 2013 to 2014.The antiretroviral effect of the two groups was compared and the related factors were analyzed.Results An antiretroviral treatment network that oriented to the medical needs of HIV/AIDS was developed.Data showed that the adherence of patients was better than that when the treatment was carried out at the CDC offices and the status of immuno-recovery on HIV/AIDS was more effective than the hospital-based treatment (P＜0.05).Data from multivariable logistic regression analysis showed that different patterns did play different roles on the effects of treatment.Conclusions The mode of antiretroviral treatment that oriented to the medical needs of HIV/AIDS could effectively improve the adherence and outcomes of treatment.We believe this model could also be adopted elsewhere.

Perfil da publicação científica brasileira sobre a temática da classe hospitalar / Profile of Brazilian scientific publications on the subject of hospital shooling

O objetivo do trabalho foi descrever o perfi l da publicação científi ca brasileira sobre a temática da escolarização em hospitais, iniciativa justifi cada a partir do reconhecimento da importância da produção científi ca na legitimação e consolidação de uma nova área do saber. Foram analisados 47 artigos publicadosem periódicos científi cos entre os anos de 1997 e 2008. Tratou-se, basicamente, de um estudo de avaliação do Estado do Conhecimento (ou Estado da Arte) de uma área de interesse crescente dentro da Educação Especial: a escolarização de crianças hospitalizadas e/ou doentes crônicas, designada pelo MEC segundo o termo Classe Hospitalar. Do ponto de vista do corpus empírico, tratou-se de uma pesquisa documental, alicerçada metodologicamente na Análise de Conteúdo. Os artigos da amostra foram quantifi cados e qualifi cados segundo o tipo de investimento empírico predominante, quais fossem: ensaio, relato de experiência, relatos de pesquisa original (pesquisa com desenho de investigação) ou revisão de literatura. Buscou-se, também, identifi car se o periódico ao qual o artigo pertencia encontrava-se indexado em bases de dados: SciELO, Edubase, Bireme e catálogo do INEP. Descreveu-se, ainda, a distribuição dos artigos por área de conhecimento e por instituições de onde provinham. Os principais resultados obtidos revelaram que dos 47 artigos analisados 22 foram classifi cados como sendo oriundos de pesquisa original, apenas dois periódicos encontravam-se indexados em todas as bases de dados consideradas em relevância e as publicações foram originadas, em sua grande parte, da atividade de pesquisadores estabelecidos em instituições federais de ensino superior.

The aim of this paper was to describe the profi le of Brazilian scientifi c publications on the topic of education in hospitals, an initiative justifi ed since the recognition of the importance of scientifi c output in legitimizing and consolidating this new area of knowledge. We analyzed 47 articles published in scientifi c journals between the years 1997 to 2008. Basically, the study assessed the state of knowledge (or state of the art) of an area of growing interest and importance within the fi eld of Special Education: the education of hospitalizedchildren and/or chronic patients, designated by the Brazilian Ministry of Education under the term Hospital Schooling. From the standpoint of the empirical corpus, this was a documentary study, methodologically based on a technique called Content Analysis. The articles of the sample were classifi ed and quantifi ed according to the predominant type of empirical investment, i.e.: essay, case study, reports of original research (survey with design of research) and literature review. We also sought to identify the indexation databases to which the journals in question pertained, such as: SciELO, Edubase, Bireme and INEP catalog. We also described the distribution of thearticles by area of expertise and institutions they came from. The main results showed that 22 of the 47 articles analyzed were classifi ed as having been derived from original research; only two journals were indexed in all the relevant databases, and most the publications were produced by researchers working in federal institutions of higher education.