Calidad de vida y toxicidad financiera de los receptores de trasplantes de células madre hematopoyéticas en COVID-19 / Quality of life and financial toxicity of hematopoietic stem cell transplant recipients in COVID-19 / Qualidade de vida e toxicidade financeira dos transplantados de células-tronco hematopoéticas na COVID-19

Objetivo: evaluar y correlacionar la calidad de vida y la toxicidad financiera de pacientes adultos sometidos a trasplante de células madre hematopoyéticas durante el período de la pandemia de COVID-19. Método: estudio observacional, analítico, realizado con 35 pacientes en un hospital de referencia para trasplante en Latinoamérica. Para la recolección de datos, se utilizaron los cuestionarios Functional Assessment Cancer Therapy Bone Marrow Transplantation y el COmprehensive Score for financial Toxicity. Para el análisis de los datos se utilizaron las pruebas de correlación de Spearman y Mann-Whitney. Resultados: la calidad de vida general durante la COVID-19 mostró un puntaje bajo (67,09/108) con mayor deterioro en el bienestar funcional (14,47/28), bienestar social (16,76/28) y preocupaciones adicionales (23,41/40). Los promedios del grupo alogénico fueron inferiores a los del grupo autólogo en todos los dominios, presentando diferencia significativa en relación a preocupaciones adicionales (p=0,01) y en el índice de evaluación del tratamiento (p=0,04). Se consideró que la toxicidad financiera tenía un impacto leve (22.11/44). Se observó una relación, aunque no significativa, entre la calidad de vida y la toxicidad financiera (p=0,051). Conclusión: la calidad de vida de la muestra fue baja; existe una correlación entre la calidad de vida y la toxicidad financiera, aunque no significativa. Cuanto mayor es la toxicidad financiera, menor es la calidad de vida.

Objective: to evaluate and correlate the quality of life and financial toxicity of adult patients undergoing hematopoietic stem cell transplantation during the COVID-19 pandemic. Method: observational, analytical study, carried out with 35 patients in a reference hospital for transplantation in Latin America. For data collection, the Functional Assessment Cancer Therapy Bone Marrow Transplantation and COmprehensive Score for Financial Toxicity questionnaires were used. Spearman and Mann-Whitney correlation tests were used for data analysis. Results: general quality of life during COVID-19 had a low score (67.09/108) with greater impairment in functional well-being (14.47/28), social well-being (16.76/28) and additional concerns (23.41/40). The means of the allogeneic group were lower than those of the autologous group in all domains, showing a significant difference in relation to additional concerns (p=0.01) and in the treatment evaluation index (p=0.04). Financial toxicity was considered to have a slight impact (22.11/44). There was a relationship, albeit not significant, between quality of life and financial toxicity (p=0.051). Conclusion: the quality of life of the sample was low; there is a correlation between quality of life and financial toxicity, although not significant. The higher the financial toxicity, the lower the quality of life.

Objetivo: avaliar e correlacionar a qualidade de vida e a toxicidade financeira dos pacientes adultos submetidos ao transplante de células-tronco hematopoéticas no período da pandemia de COVID-19. Método: estudo observacional, analítico, realizado com 35 pacientes em um hospital de referência para o transplante na América Latina. Para coleta de dados, utilizaram-se os questionários Functional Assessment Cancer Therapy Bone Marrow Transplantation e COmprehensive Score for financial Toxicity. Na análise dos dados empregaram-se os testes de correlação de Spearman e Mann-Whitney. Resultados: a qualidade de vida geral, durante a COVID-19, apresentou baixo escore (67,09/108), com maior comprometimento nas funções bem-estar funcional (14,47/28), social (16,76/28) e preocupações adicionais (23,41/40). As médias do grupo alogênico foram inferiores às do autólogo em todos os domínios, apresentando diferença significativa em relação às preocupações adicionais (p=0,01) e ao índice de avaliação do tratamento (p=0,04). A toxicidade financeira foi considerada de impacto leve (22,11/44). Observou-se relação, ainda que não significativa, entre a qualidade de vida e a toxicidade financeira (p=0,051). Conclusão: a qualidade de vida da amostra foi baixa, logo há uma correlação entre qualidade de vida e a toxicidade financeira, embora não significativa. Quanto maior a toxicidade financeira, menor a qualidade de vida.

Percepción del impacto económico en pacientes con cáncer en un hospital de tercer nivel, La Paz - Bolivia: un estudio exploratorio cualitativo / Perception of the economic impact in patients diagnosed with cancer in a third level hospital, La Paz - Bolivia: a qualitative exploratory study

Los pacientes con cáncer experimentan además del impacto de la enfermedad, el impacto económico, y este es más evidente en los pacientes con escasos recursos económicos, los motivos son multifactoriales. OBJETIVO: describir la percepción sobre el impacto económico en los pacientes bolivianos con cáncer en el Hospital de Clínicas Universitario- La Paz. MÉTODOS: el diseño es cualitativo exploratorio, muestreo por bola de nieve, se realizaron entrevistas a profundidad dirigidas a pacientes con cáncer del hospital de Clínicas Universitario de La Paz- Bolivia entre diciembre de 2018 a febrero de 2019. RESULTADOS: se entrevistaron a 11 pacientes y 9 familiares. Se han identificado el impacto de los gastos en los pacientes con cáncer en las siguientes categorías: Ahorros y deudas, vivienda, trabajo, familia, tratamiento, esfera psicológica, gastos a futuro, y en el cuidado de otros enfermos en la casa. Las percepciones son variables, algunos pacientes muestran mayor preocupación por su economía que por su enfermedad, relatan además el cambio que significó en su económica recibir el diagnóstico de cáncer en distintas áreas. CONCLUSIÓN: se ha encontrado, en el presente trabajo, que la percepción del impacto económico para los pacientes con cáncer es multidimensional. Se ha evidenciado además, que el impacto depende del estadio de la enfermedad y del contexto social que vive el paciente, siendo este variable y dando como resultado necesidades de acompañamiento variable por parte de los equipos oncológicos

Cancer patients experience, is about disease´s and economic impact, and this impact is more evident in patients with limited economic resources in low-income countries, the reasons are multifactorial. OBJECTIVE: describe the perception of the economic impact on Bolivian patients with cancer at the Hospital de Clínicas Universitario-La Paz. METHODS: the design is qualitative and exploratory, sampling was by snowball, in-depth interviews were conducted at cancer patients at the Clínicas Universitario de La Paz hospital - Bolivia between December 2018 and February 2019. RESULTS: 11 patients and 9 family members were interviewed. The impact of expenses on cancer patients has been identified in the following categories: Savings and debts, housing, work, family, treatment, psychological sphere, future expenses, and caring for other patients at home. Perceptions are variable, some patients show more significant concern about their finances than about their illness, and they also report the change that receiving the diagnosis of cancer meant in their finances in different areas. CONCLUSION: in this investigation, the perception of economic impact on cancer patients is multidimensional. It has also been shown that the impact depends on the stage of the disease, and the social context in which the patient lives, this being variable and resulting in variable support needs from the oncology teams

Identification and economic burden of main adverse events of nerve injuries caused by regional anesthesia: a systematic review

Abstract Background and objectives: Anesthesiologists and hospitals are increasingly confronted with costs associated with the complications of Peripheral Nerve Blocks (PNB) procedures. The objective of our study was to identify the incidence of the main adverse events associated with regional anesthesia, particularly during anesthetic PNB, and to evaluate the associated healthcare and social costs. Methods: According to the Preferred Reporting Items for Systematic Reviews and Meta-Analyses (PRISMA) guidelines, we conducted a systematic search on EMBASE and PubMed with the following search strategy: (‟regional anesthesia" OR ‟nerve block") AND (‟complications" OR ‟nerve lesion" OR ‟nerve damage" OR ‟nerve injury"). Studies on patients undergoing a regional anesthesia procedure other than spinal or epidural were included. Targeted data of the selected studies were extracted and further analyzed. Results: Literature search revealed 487 articles, 21 of which met the criteria to be included in our analysis. Ten of them were included in the qualitative and 11 articles in the quantitative synthesis. The analysis of costs included data from four studies and 2,034 claims over 51,242 cases. The median claim consisted in 39,524 dollars in the United States and 22,750 pounds in the United Kingdom. The analysis of incidence included data from seven studies involving 424,169 patients with an overall estimated incidence of 137/10,000. Conclusion: Despite limitations, we proposed a simple model of cost calculation. We found that, despite the relatively low incidence of adverse events following PNB, their associated costs were relevant and should be carefully considered by healthcare managers and decision makers.

Interferências da toxicidade financeira na qualidade de vida de adultos com insuficiência renal crônica em tratamento hemodialítico / Interferences of financial toxicity in the quality of life of adults with chronic renal failure undergoing hemodialysis treatment

Resumo: O diagnóstico da doença renal crônica acarreta, muitas vezes, modificações às quais obrigam a pessoa a reduzir a jornada de trabalho, diminuindo a renda familiar, situação que pode ocasionar um fenômeno chamado toxicidade financeira que contribui para redução da qualidade de vida relacionada a saúde. Trata-se de um estudo observacional, analítico e correlacional com corte transversal de abordagem quantitativa, com objetivo de investigar a relação da toxicidade financeira na qualidade de vida relacionada à saúde de pessoas com doença renal crônica em tratamento hemodialítico. A coleta de dados foi realizada de fevereiro de 2022 a maio de 2022 em um grupo de clínicas de diálise de Curitiba-PR e Região Metropolitana. O processo de amostragem foi probabilístico, mas o recrutamento foi por conveniência, obedecendo aos critérios de inclusão: pessoas com doença renal crônica, idade igual ou acima de 18 anos e que estavam em tratamento hemodialítico por período maior que seis meses (n=214). Para realização do estudo, foram utilizados os instrumentos sociodemográfico e clínico, Comprehensive Score For Financial Toxicity - COST e Kidney Disease Quality Of Life - Short Form -KDQOL-SFTM. A análise dos dados foi realizada descritivamente com frequências absolutas e relativas das variáveis da caracterização sociodemográfica e clínica da população do estudo, para os escores da toxicidade financeira e qualidade de vida relacionada à saúde foi usado o odds ratio, modelos de regressão logística bayesiano e o método de análise de variância (Anova). Participaram do estudo 214 pessoas com doença renal crônica, sendo 54,67% do sexo masculino, 52,80% tinham 60 anos ou mais, 53,52% eram casados ou estavam em união consensual, 56,07% tinham de 1 a 3 filhos, mais da metade 54,67% tinham menos de 9 anos de escolaridade, 54,97% eram aposentados, 81,75% apresentavam alguma comorbidade além da doença renal crônica, 59,34% tinham o diagnóstico de doença renal crônica de 1 a 5 anos, 88,26% faziam uso de medicação de uso contínuo, 69,69% não eram tabagistas e 72,89% não ingeriam bebida alcoólica. Em relação à toxicidade financeira, a média do escore total encontrado, considerando todas as unidades de coleta de dados, foi de 20,30/44. Pessoas do sexo feminino e renda familiar mensal de no máximo dois salários-mínimos têm maiores chances de apresentarem algum grau de toxicidade financeira (odds ratio: 0,85; 0,76). Verificou-se que na relação entre as medidas COST e qualidade de vida relacionado à saúde o maior impacto da toxicidade financeira foi associado a pior qualidade de vida relacionado à saúde. Sendo assim, foi identificado neste estudo a existência da toxicidade financeira em pessoas com doença renal crônica em hemodiálise e há, também, associação dos piores graus de toxicidade financeira com características sociodemográficas e clínicas. Portanto, a mensuração da toxicidade financeira pode auxiliar a enfermagem a orientar ações para minimizar esse evento.

Abstract: The diagnosis of chronic kidney disease often entails changes that force the person to reduce the workday, reducing family income, a situation that can cause a phenomenon called financial toxicity that contributes to a reduction in the quality of life related to health. This is an observational, analytical and correlational study with a cross-sectional quantitative approach, with the aim of investigating the relationship between financial toxicity and the health-related quality of life of people with chronic kidney disease undergoing hemodialysis treatment. Data collection was carried out from February 2022 to May 2022 in a group of dialysis clinics in Curitiba-PR and the Metropolitan Region. The sampling process was probabilistic, but the recruitment was for convenience, according to the inclusion criteria: people with chronic kidney disease, aged 18 years or older and who were on hemodialysis for a period longer than six months (n=214). To carry out the study, the sociodemographic and clinical instruments, Comprehensive Score For Financial Toxicity - COST and Kidney Disease Quality Of Life - Short Form -KDQOL-SFTM were used. Data analysis was performed descriptively with absolute and relative frequencies of the variables of the sociodemographic and clinical characterization of the study population, for the scores of financial toxicity and health-related quality of life, the odds ratio, Bayesian logistic regression models and the analysis of variance method (Anova). The study included 214 people with chronic kidney disease, 54.67% male, 52.80% aged 60 years or older, 53.52% married or in a consensual union, 56.07% had 1 to 3 children, more than half 54.67% had less than 9 years of schooling, 54.97% were retired, 81.75% had some comorbidity in addition to chronic kidney disease, 59.34% had a diagnosis of chronic kidney disease from 1 to 5 years, 88.26% used continuous medication, 69.69% were non-smokers and 72.89% did not drink alcohol. Regarding financial toxicity, the mean total score found, considering all data collection units, was 20.30/44. Females with a monthly family income of at most two minimum wages are more likely to have some degree of financial toxicity (odds ratio: 0,85; 0.76). It was found that in the relationship between COST measures and health-related quality of life, the greater impact of financial toxicity was associated with worse health-related quality of life. Therefore, this study identified the existence of financial toxicity in people with chronic kidney disease on hemodialysis and there is also an association of the worst degrees of financial toxicity with sociodemographic and clinical characteristics. Therefore, measuring financial toxicity can help nursing guide actions to minimize this event.

Vivências de trabalho precoce de adolescentes em medida socioeducativa / Experience of child labor of adolescents complying with a social-educational measure / Vivencias de trabajo infantil de adolescentes en medidas socioeducativas

Este artigo tem como objetivo analisar a vivência de trabalho precoce de adolescentes e jovens em cumprimento de medida socioeducativa, no estado da Paraíba. Os instrumentos utilizados foram um Questionário Mosquito Diagnóstico e uma Entrevista Semiestruturada. A análise foi realizada com o software Iramuteq, (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), através da Análise Hierárquica Descendente, que gerou seis classes: significado do trabalho; infância e escola; condições objetivas de vida; trabalho, drogas e ato infracional; consequências do trabalho infantil; e trabalho infantojuvenil. A perspectiva teórica utilizada foi a psicologia histórico-cultural e os dados discutidos a partir do conceito de vivência. Conclui-se que as vivências e situações sociais de desenvolvimento foram caracterizadas pelo trabalho precoce que oportunizou o envolvimento com atos infracionais e as instituições responsáveis pela garantia de direitos em vez de garantir a proteção social, criminalizaram por meio de medidas socioeducativas.(AU)

This article aims to analyze the experience of child labor of adolescents and youngsters that are complying a social-educational measure, in the State of Paraíba. The instruments utilized were a Questionnaire Mosquito Diagnóstico and a Semi-Structured Interview. The analysis was performed by using the Iramuteq software (Interface de R pour les Analyses Multidimensionnelles de Textes et de Questionnaires), by using Descending Hierarchical Analysis, which generated six classes: meaning of labor; childhood and school; objective conditions of life; labor, drugs, and act of infraction; consequences of child labor; and child labor. The theoretical perspective used was historical-cultural psychology and the data were discussed from the concept of experience. It was concluded that the experiences and social situations of development were characterized by child labor, which enabled the involvement with acts of infraction; and the institutions responsible for guaranteeing rights, instead of guaranteeing social protection, criminalized by using social-educational measures.(AU)

Este artículo tiene como objetivo analizar la vivencia precoz de adolescentes y jóvenes que cumplen medidas socioeducativas en el estado de Paraíba (Brasil). Los instrumentos utilizados fueron un Cuestionario Mosquito Diagnóstico y una entrevista semiestructurada. El análisis se realizó con el software Iramuteq (Interface de R pour les Multidimensionnelles Analyzes de Textes et de Questionnaires), mediante análisis jerárquico descendente, que generó seis clases: Significado del trabajo; Infancia y escuela; Condiciones objetivas de vida; Trabajo, drogas y acto de infracción; Consecuencias del trabajo infantil; y Trabajo infantojuvenil. La perspectiva teórica que se utilizó fue la psicología histórico-cultural, y los datos se discutieron desde el concepto de vivencia. Se concluye que las vivencias y situaciones sociales de desarrollo se caracterizaron por trabajo infantil que permitió la participación en infracciones y que las instituciones responsables de garantizar los derechos en lugar de la protección social los criminalizaron mediante medidas socioeducativas.(AU)

Adaptação acadêmica em universitários / Academic adaptation in university students / Adaptación académica en estudiantes universitários

O objetivo do estudo foi investigar o impacto das variáveis habilidades sociais, resolução de problemas sociais, automonitoria, autoeficácia e coping na adaptação acadêmica em estudantes de instituições de ensino superior públicas e privadas. Participaram 637 estudantes de ambos os sexos, sendo 36,5% (115) homens de instituições públicas e 22,3% (72) de instituições privadas, com idade variando entre 18 e 38 anos (M=24,7; DP=6,3), de diferentes graduações. Foram utilizados o Inventário de Resolução de Problemas Sociais, o Inventário de Habilidades Sociais, a Escala de Automonitoria, a Escala de Autoeficácia Acadêmica de Estudantes do Ensino Superior, o Inventário de Estratégias de Coping e o Questionário de Vivências Acadêmicas-reduzido. A autoeficácia na gestão acadêmica (40,9%) e a autoafirmação na expressão de afeto positivo (13,7%) apresentaram maior impacto para os estudantes de instituições públicas e privadas, podendo contribuir com possíveis intervenções no processo de adaptação ao ensino superior. Pesquisas prospectivas podem investigar questões relacionadas a dados sociodemográficos.(AU)

The aim of the study was to investigate the impact of the variables Social Skills, Resolution of Social Problems, Self-monitoring, Self-efficacy and Coping on Academic Adaptation in students from public and private higher education institutions. 637 students of both sexes participated, being 36.5% (115) men from public institutions and 22.3% (72) from private institutions, aged between 18 to 38 years (M = 24.7; SD = 6.3), of different grades. The Social Problem Solving Inventory, the Social Skills Inventory, the Self-Monitring Scale, the Higher Education Students' Academic Self-Efficacy Scale, the Coping Strategies Inventory and the Academic Experiences-Reduced Questionnaire were used. Self-efficacy in Academic Management (40.9%) and Self-affirmation in the Expression of Positive Affection (13.7%) had a greater impact on students from public and private institutions, which may contribute to possible interventions in the process of adapting to Higher Education. Prospective research can investigate issues related to sociodemographic data.(AU)

El objetivo del estudio fue investigar el impacto de las variables Habilidades sociales, Resolución de problemas sociales, Autocontrol, Autoeficacia y Afrontamiento en la adaptación académica en estudiantes de instituciones de educación superior públicas y privadas. Participaron 637 estudiantes de ambos sexos, siendo 36,5% (115) hombres de instituciones públicas y 22,3% (72) de instituciones privadas, con edades entre 18 y 38 años (M = 24,7; SD = 6,3), de diferentes grados. Se utilizaron el Inventario de Resolución de Problemas Sociales, el Inventario de Habilidades Sociales, la Escala de Autocontrol, la Escala de Autoeficacia Académica de los Estudiantes de Educación Superior, el Inventario de Estrategias de Afrontamiento y el Cuestionario de Experiencias Académicas Reducidas. La Autoeficacia en la Gestión Académica (40,9%) y la Autoafirmación en la Expresión de Afecto Positivo (13,7%) tuvieron un mayor impacto en los estudiantes de instituciones públicas y privadas, lo que puede contribuir a posibles intervenciones en el proceso de adaptación a la Educación Superior. La investigación prospectiva puede investigar cuestiones relacionadas con los datos sociodemográficos.(AU)

Orientação a pais por chamadas de áudio durante a pandemia de covid-19 / Support for parents via audio calls during the covid-19 pandemic / Orientación de los padres mediante llamadas de audio durante la pandemia de covid-19

O distanciamento social ocasionado pela pandemia de Covid-19 levou a profundas mudanças na rotina das famílias com crianças pequenas, aumentando o estresse no ambiente doméstico. Este estudo analisou a experiência de planejamento e implementação de um projeto de extensão universitária que ofereceu orientação a pais com filhos de 0 a 11 anos por meio de chamadas de áudio durante a pandemia. O protocolo de atendimento foi desenvolvido para atender às necessidades de famílias de baixa renda e listava problemas específicos relacionados ao confinamento em casa e ao fechamento das escolas seguidos por uma variedade de estratégias de enfrentamento. A análise de 223 queixas relatadas pelos usuários em 130 ligações revelou que 94% dos problemas referidos pelos pais foram contemplados pelo protocolo de atendimento e estavam relacionados aos problemas externalizantes (39%) ou internalizantes (26%) das crianças ou ao declínio do bem-estar subjetivo dos pais (29%). Serviços de apoio devem orientar os pais quanto ao uso de práticas responsivas e assertivas que promovam o bem-estar emocional da criança e estabeleçam expectativas comportamentais em contextos estressantes. A diminuição dos conflitos entre pais e filhos resultante do uso dessas estratégias tende a reduzir o sofrimento dos pais, aumentando sua sensação de bem-estar subjetivo. Recomenda-se ampla divulgação dessas iniciativas e seguimento dos casos.(AU)

The social distancing the COVID-19 pandemic entailed has led to profound changes in the routine of families with young children, increasing stress in the home environment. This study analyzed the experience of planning and implementing a university extension program that offered support to parents with children from 0 to 11 years old via audio calls during the COVID-19 pandemic. The service protocol was developed to meet the needs of low-income families and listed specific problems related to home confinement and school closure followed by a variety of coping strategies. The analysis of 223 complaints reported by users in 130 calls revealed that 94% of the problems reported by parents were addressed by the protocol and were related to children's externalizing (39%) or internalizing (26%) problems or to the decline in parents' subjective well-being (29%). Support services should guide parents on the use of responsive and assertive practices that promote the child's emotional well-being and set behavioral expectations in stressful contexts. The reduction in conflicts between parents and children resulting from the use of these strategies tends to reduce parents' suffering, increasing their sense of subjective well-being. Wide dissemination of these initiatives and case follow-up are recommended.(AU)

La distancia social causada por la pandemia de COVID-19 condujo a cambios profundos en la rutina de las familias con niños pequeños, aumentando el estrés en el entorno del hogar. Este estudio analizó la experiencia de planificar e implementar un proyecto de extensión universitaria que ofreció orientación a los padres con niños de cero a 11 años a través de llamadas de audio durante la pandemia COVID-19. El protocolo de atención se desarrolló para satisfacer las necesidades de las familias de bajos ingresos y enumeró problemas específicos relacionados con el confinamiento en el hogar y el cierre de la escuela, seguido de una variedad de estrategias de afrontamiento. El análisis de 223 quejas informadas por los usuarios en 130 llamadas reveló que el 94% de los problemas informados por los padres fueron abordados por el protocolo de atención y estaban relacionados con los problemas de externalización (39%) o internalización (26%) de los niños o la disminución del bienestar subjetivo de los padres (29%). Los servicios de apoyo deberían aconsejar a los padres sobre el uso de prácticas receptivas y asertivas que promuevan el bienestar emocional del niño y establezcan expectativas de comportamiento en contextos estresantes. La reducción de los conflictos entre padres e hijos como resultado del uso de estas estrategias tiende a reducir el sufrimiento de los padres, aumentando su sensación de bienestar subjetivo. Se recomienda una amplia difusión de estas iniciativas y seguimiento de casos.(AU)

Dificuldades financeiras, aspectos alimentares e de saúde em estudantes universitários, durante a pandemia de Covid-19 / Financial difficulties, dietary and health aspects in university students during the Covid-19 pandemic

Introdução: As dificuldades financeiras advindas da pandemia, em virtude de mudanças econômicas do país, além de refletirem no estado de segurança alimentar e nutricional e no estado de saúde dos indivíduos, acarretaram o aumento da evasão dos cursos superiores. Objetivo: Verificar a associação entre as dificuldades financeiras, durante a pandemia de Covid-19, com os aspectos alimentares e de saúde dos graduandos da Universidade Federal de Juiz de Fora (UFJF). Método: Estudo transversal com graduandos da UFJF. Os dados foram coletados entre setembro de 2020 e março de 2021, através de questionário on-line. Utilizou-se Teste Qui-quadrado (p<0,05) para avaliar os fatores associados às dificuldades financeiras durante a pandemia. Verificou-se a razão de chances (Odds Ratio - OR) das associações encontradas. Resultados: Avaliaram-se 584 graduandos, dentre os quais se constatou que 31,7% passaram por dificuldades financeiras durante a pandemia. Notou-se que a presença de dificuldades financeiras no período pandêmico se associou positivamente à presença de Insegurança Alimentar e Nutricional (INSAN), à autopercepção negativa de saúde, à má qualidade do sono e às alterações de depressão, ansiedade e estresse. Além disso, os indivíduos caracterizados com dificuldades financeiras tinham maiores chances de apresentarem INSAN, percepção negativa de saúde, má qualidade do sono, bem como alterações nos níveis de depressão, ansiedade e estresse, quando comparados à sua contraparte. Conclusão: Conclui-se que as dificuldades financeiras durante o período pandêmico são associadas à presença de INSAN e aspectos de saúde alterados. Assim, ressalta-se a necessidade de criação de estratégias que visem à assistência financeira e psicológica dos graduandos.

Introduction: The financial difficulties caused by the pandemic due to economic changes in the country, in addition to affecting food and nutrition security and the state of health of individuals, resulted in greater evasion from higher education courses. Objective: To check the association between financial difficulties during the COVID-19 pandemic with the dietary and health aspects of undergraduate students from Universidade Federal de Juiz de Fora (Federal University of Juiz de Fora ­ UFJF). Methods: Transversal study with UFJF undergraduate students. The data were collected between September 2020 and March 2021, via an online survey. The chi-square test (p<0.05) was used to evaluate the factors associated with financial difficulties during the pandemic. We also checked the odds ratio (OR) for the associations found. Results: We assessed 584 undergraduate students, 31.7% of which were found to have gone through financial difficulties during the pandemic. We observed that the presence of financial difficulties in that period was positively associated with Food and Nutrition Insecurity (INSAN, Portuguese acronym), negative self-perception of health, bad sleep quality, and changes in depression, anxiety, and stress levels. Moreover, individuals characterized as having financial difficulties had a higher chance of having INSAN, negative perception of health, bad sleep quality, as well as changes in the levels of depression, anxiety, and stress, when compared to their counterparts. Conclusion: We concluded that financial difficulties during the pandemic period are associated with INSAN and affected health aspects. Therefore, we highlight that there is a need for the development of strategies which aim to provide financial and psychological assistance to undergraduate students.

Psicologia escolar na educação superior: demandas apresentadas por coordenadores de cursos / School psychology in higher education: demands presented by course coordinators / Psicología escolar en educación superior: demandas presentadas por coordinadores de cursos

A Psicologia Escolar e Educacional vem conquistando novos espaços para a atuação e campo de pesquisa, dentre eles, destacamos a educação superior. Assim, este estudo teve por objetivo conhecer as demandas apresentadas por coordenadores de cursos de graduação, analisá-las à luz da Psicologia Escolar na vertente crítica e apontar possibilidades de atuação do psicólogo escolar junto a estes. A pesquisa, de caráter qualitativo, foi realizada a partir da análise de conteúdo das respostas obtidas dos questionários enviados por e-mail aos coordenadores dos 77 cursos de graduação oferecidos por uma instituição pública de ensino superior de Minas Gerais. Contamos com 28 questionários respondidos. As demandas apresentadas referem-se a questões acadêmicas e emocionais dos estudantes; sobrecarga de trabalho docente; relações interpessoais e formação continuada; burocracias enfrentadas pelos coordenadores; além da falta de preparação prévia e apoio para o exercício da função e concepções sobre o trabalho do psicólogo escolar. Concluímos que o coordenador, ao ouvir e compreender demandas advindas de discentes, docentes e técnicos, responde a elas por meio de uma parceria auspiciosa com o psicólogo escolar, juntamente com outros segmentos e instâncias da instituição.(AU)

The School and Educational Psychology has been conquering new spaces for professional performance and research field, among them, we highlight Higher Education. Therefore, this study aimed to get the demands presented by coordinators of undergraduate courses and analyze them in the light of School Psychology in the critical perspective and to point out possibilities for the performance of the school psychologist with them. The qualitative research was carried out based on the content analysis of the answers obtained from the questionnaires sent by e-mail to the coordinators of the 77 undergraduate courses offered by a public Higher Education institution in Minas Gerais. We have 28 answered questionnaires. The demands presented refer to students' academic and emotional issues; the overload of teaching work; interpersonal relationships and continuing education; the bureaucracies faced by coordinators; and the lack of prior preparation and support for the practice of the function and conceptions about the work of the school psychologist. We conclude that the coordinator, when listening to and understanding demands from students, teachers, and technicians, seeks to respond to them with an auspicious partnership with the school psychologist, together with other segments and instances of the institution.(AU)

La Psicología Escolar y Educacional sigue conquistando nuevos espacios para la actuación y campo de investigación, entre ellos destaca la educación superior. Por lo tanto, este estudio tuvo como objetivo conocer las demandas presentadas por los coordinadores de cursos de graduación, analizarlas desde la perspectiva crítica de la Psicología Escolar y señalar posibilidades de actuación del psicólogo escolar. La investigación cualitativa realizó el análisis de contenido de las respuestas obtenidas de los cuestionarios enviados por correo electrónico a los coordinadores de los 77 cursos ofrecidos por una institución pública de educación superior en Minas Gerais (Brasil). Se respondieron 28 cuestionarios. Las demandas presentadas se refieren a cuestiones académicas y emocionales de los estudiantes; a la sobrecarga del trabajo docente; a las relaciones interpersonales y educación continua; a las burocracias que enfrentan los coordinadores; además de la falta de preparación previa y apoyo para el ejercicio de la función y concepciones sobre el trabajo del psicólogo escolar. Se concluye que el coordinador escucha y considera las demandas de los estudiantes, profesores y técnicos, y trata de responderlas por medio de una asociación favorable con el psicólogo escolar, junto con otros segmentos e instancias de la institución.(AU)

Analysis of the direct economic burden of measles cases and its influencing factors in Shanghai from 2017 to 2019 / 中华预防医学杂志

Objective: To analyze the direct economic burden caused by measles cases in Shanghai from 2017 to 2019 and its influencing factors. Methods: A total of 161 laboratory-confirmed measles cases reported from January 1, 2017, to December 31, 2019, in Shanghai were included in the study through the "Measles Surveillance Information Reporting and Management System" of the "China Disease Surveillance Information Reporting and Management System". Through telephone follow-up and consulting hospital data, the basic information of population, medical treatment situation, medical treatment costs and other information were collected, and the direct economic burden of cases was calculated, including registration fees, examination fees, hospitalization fees, medical fees and other disease treatment expenses, as well as transportation and other expenses of cases. The multiple linear regression model was used to analyze the main influencing factors of the direct economic burden. Results: The age of 161 measles cases M (Q1, Q3) was 28.21 (13.33, 37.00) years. Male cases (56.52%) were more than female cases (43.48%). The largest number of cases was≥18 years old (70.81%). The total direct economic burden of 161 measles cases was 540 851.14 yuan, and the per capita direct economic burden was 3 359.32 yuan. The direct economic burden M (Q1, Q3) was 873.00 (245.01, 4 014.79) yuan per person. The results of multiple linear regression model analysis showed that compared with other and unknown occupations, central areas and non-hospitalized cases, the direct economic burden of measles cases was higher in scattered children, childcare children, students, and cadre staff in the occupational distribution, suburban areas and hospitalized, with the coefficient of β (95%CI) values of 0.388 (0.150-0.627), 0.297 (0.025-0.569), 0.327 (0.148-0.506) and 1.031 (0.853-1.209), respectively (all P values<0.05). Conclusion: The direct economic burden of some measles cases in Shanghai is relatively high. Occupation, area of residence and hospitalization are the main factors influencing the direct economic burden of measles cases.

Health care financial support for patients needing medical assistance in Southern Philippines Medical Center: Policy notes

@#Accessing health care services can lead to a significant financial burden on patients, especially when an episode of illness necessitates out-of-pocket (OOP) expenditures.1 Apart from health improvement, an essential function of health care systems is to provide financial protection for individuals against the costs associated with illness.2 The establishment of the Philippine Health Insurance Corporation (PhilHealth) has emerged as a crucial step towards achieving the goal of universal health care for individuals in need of medical services.3 Since the passage of the Universal Health Care Act in 2019, all Filipinos have been automatically enrolled in PhilHealth for social health risk protection. In 2021, PhilHealth covered health care utilization claims amounting to over Php 88 billion.4 PhilHealth coverage is usually not sufficient to fund the entire hospital expense in a single episode of illness. Meanwhile, the creation of other government health care financing schemes helps alleviate the financial burden of patients. Through the enactment of the Republic Act (RA) 11463, also known as the Malasakit Centers Act, patients may now seek financial aid from a unified assistance hub to settle outstanding health care expenses not covered by PhilHealth. The Malasakit Centers Act mandates the establishment of one-stop shops for medical and financial assistance. This one-stop shop consists of representatives from the Department of Health (DOH), PhilHealth, the Philippine Charity Sweepstakes Office (PCSO), and Department of Social Welfare and Development (DSWD).5 This article aims to recommend health care policies to improve the existing health financing mechanisms currently sought by patients to cover their medical expenses during an episode of illness.

Estressores financeiros e o comprometimento da saúde mental e sexual / Financial stressors and compromised mental and sexual health

Em geral, maior nível de estresse durante a pandemia agravou a saúde mental e sexual. Estresse financeiro refere-se à ausência de renda satisfatória e insatisfação com essa condição. Piores condições econômicas geraram o estresse financeiro e o comprometimento da qualidade de vida dos casais. O objetivo desse texto é discutir a influência de estressores financeiros no relacionamento conjugal e na saúde mental e sexual. Embora os casais iniciem a vida conjugal com expectativas positivas, dificuldades financeiras preveem aumento de depressão, diminuição da satisfação conjugal e aumento dos conflitos, com maior probabilidade de divórcio. A administração conjunta da renda tem sido associada a uma melhor qualidade e coesão nos relacionamentos, especialmente para as mulheres, enquanto contas individuais podem minar a satisfação feminina, reduzindo sentimentos de intimidade, compatibilidade sexual e satisfação com a resolução de conflitos. Na abordagem de relacionamento conjugal e saúde sexual, as percepções podem desempenhar um papel mais importante do que os fatos objetivos. A percepção da satisfação financeira e sexual prevê melhor a estabilidade conjugal do que os recursos financeiros objetivos ou a frequência de relações sexuais. O estresse financeiro está associado não só a maior insatisfação financeira como também sexual, levando a maior instabilidade conjugal. Habilidades comunicacionais saudáveis, para comunicação financeira e relacional, facilitam a abordagem de questões relativas a dinheiro e sexo, adequando a percepção dessas questões. Gestão financeira, percepção de satisfação sexual e habilidades comunicacionais juntas desempenham um papel preponderante na qualidade da vida conjugal.

Covid-19 e as dimensões do trabalho: análise sócio-histórica dos impactos vivenciados por homens na pandemia / Covid-19 and work dimensions: a socio-historical analysis of impacts affecting men during the pandemic / COVID-19 y las dimensiones del trabajo: análisis sociohistórico de los impactos experimentados por los hombres en la pandemia

OBJETIVO: Apreender os impactos vivenciados por homens residentes no Brasil na pandemia da Covid-19 em relação às dimensões do trabalho. MÉTODO: Estudo sócio-histórico, qualitativo, realizado durante a pandemia da Covid-19 com 400 adultos e idosos residentes no Brasil. Aplicou-se um formulário on-line. Os dados foram analisados com base no Discurso do Sujeito Coletivo, interpretados à luz do Materialismo Histórico Dialético. RESULTADOS: A pandemia da Covid-19 provocou e intensificou impactos: sobrecarga provocada pelo trabalho home office; inadequações no trabalho e exposição à contaminação pelo Coronavírus; estresse e medo de ser contaminado no trabalho e de perder o emprego; dificuldade na manutenção econômica/financeira e adaptações repentinas no desempenho do trabalho. CONCLUSÃO: As dimensões do mundo do trabalho intensificaram as vulnerabilidades sociais e em saúde de homens no contexto da pandemia da Covid-19. Repercutiram em maior exposição ao SARS-CoV-2 e vivência de estressores na vida cotidiana.

OBJECTIVE: To apprehend the impacts affecting men residing in Brazil during the Covid-19 pandemic concerning work dimensions. METHOD: A socio-historical, qualitative study carried out during the Covid-19 pandemic with 400 adult and old males residing in Brazil. An on-line form was applied. Data were analyzed based on the Discourse of the Collective Subject, interpreted according to the Dialectic Historical Materialism. RESULTS: The Covid-19 pandemic did cause and intensify impacts: overload resulting from home-office jobs; inadequacies as to the work and exposition to contamination by the Coronavirus; stress and fear to be contaminated at work and losing employment; difficulties to maintain economic/financial conditions and unexpected adaptations in work performance. CONCLUSION: The dimensions of the work environment did intensify both social and health vulnerabilities for men in the context of the Covid-19 pandemic, rebounding on even higher exposure to SARS-CoV 2 and daily life stressors.

OBJETIVO: Comprender los impactos experimentados por los hombres residentes en Brasil en la pandemia de COVID-19 respecto a las dimensiones del trabajo. MÉTODO: Estudio sociohistórico, cualitativo, realizado durante la pandemia de COVID-19, con 400 adultos y personas mayores residentes en Brasil. Se aplicó un formulario online. Los datos se analizaron con base en el Discurso del Sujeto Colectivo y fueron interpretados a la luz del Materialismo Histórico Dialéctico. RESULTADOS: La pandemia de COVID-19 ha ocasionado e intensificado los impactos: sobrecarga causada por el teletrabajo; inadecuaciones en el trabajo y exposición a la contaminación por el coronavirus; estrés y miedo a contaminarse en el trabajo y a perder el empleo; dificultad en el mantenimiento económico/financiero y adaptaciones repentinas en el rendimiento del trabajo. CONCLUSIÓN: Las dimensiones del mundo del trabajo han intensificado las vulnerabilidades sociales y de salud de los hombres en el contexto de la pandemia de COVID-19. Han repercutido en una mayor exposición al SARS-CoV-2 y vivencia de estresores en la vida cotidiana.

Quality of life among cancer patients at Queen Elizabeth and Kamuzu Central Hospitals in Malawi: a cross-sectional double-center study

Introduction: Many cancer patients experience psychosocial challenges that affect quality of life during the trajectory of their disease process. We aimed at estimating quality of life among cancer patients at two major tertiary hospitals in Malawi. Methods: The study was conducted among 398 cancer patients using semi-structured questionnaire. Quality of life was measured using EQ-5D-3L instrument. Results: Mean age was 45 years ± 12.77. Pain (44%) was the most prevalent problem experienced by cancer patients. About 23% had worst imaginable health status on the subjective visual analogues scale. Attending cancer services at QECH (AOR= 0.29, 95% CI: 0.17-0.54, p<0.001) and having normal weight (AOR=0.25, 95% CI: 0.08-0.74, p = 0.012), were associated with improved quality of life. A history of ever taken alcohol (AOR= 2.36, 95% CI: 1.02-5.44, p = 0.045) and multiple disease comorbidities (AOR= 3.78, 95% CI: 1.08-13.12, p = 0.037) were associated with poor quality of life. Conclusion: Loss of earning, pain, marital strife, sexual dysfunction, were among the common psychosocial challenges experienced. History of ever taken alcohol and multiple comorbidities were associated with poor quality of life. There is need to integrate psychosocial solutions for cancer patients to improve their quality of life and outcomes

Challenges of Case Management of COVID-19 in University of Uyo Teaching Hospital: A One-Year Experience

BACKGROUND AND OBJECTIVES: Coronavirus disease 2019 (COVID-19) is a global pandemic. Older people and those with poorly controlled co-morbidities have higher risk of mortality. This study was conducted to highlight the clinical features, challenges of management and outcome for the patients we have seen in our centre over the past one year. METHODS: This was a retrospective cross-sectional study involving all patients admitted in the COVID-19 Isolation unit of University of Uyo Teaching Hospital (UUTH) from June, 2020­May, 2021. Clinical and laboratory information were obtained from the patient case notes. Ethical clearance for the conduct of the study was obtained from the Ethics committee, UUTH, Uyo. Data was analysed with STATA version 13. RESULTS: Thirty-three (37.9%) patients were COVID-19 PCR positive. The mean ± SD age of COVID-19 PCR positive patients was 57.3 ± 13.4 years with majority (69.7%) being above 50 years. There was a male preponderance (75%). Eleven (34.4%) patients died while 21(65.6%) were discharged. The highest co-morbidity associated with COVID-19 mortality was diabetes mellitus (7 out of 11; 63.6%). There was a poor uptake of supportive investigations for the management of COVID-19 patients. A raised body temperature (P=0.0006), a low SPO2(0.00004), high respiratory rate (0.0009) on admission and shorter duration of admission (0.0002), were associated with mortality. CONCLUSION: The presence of co-morbidities, fever, low SPO2 and high respiratory rates on admission are associated with increased mortality from COVID-19 disease. A paucity of supportive investigations was a major challenge to COVID-19 management. We therefore recommend the strengthening of our laboratory capacity.

The effects of COVID-19 on food insecurity, financial vulnerability and housing insecurity among women and girls living with or at risk of HIV in Nigeria

Aim: Women and girls living with or at high risk of acquiring HIV (WGL&RHIV) in Africa are economically vulnerable. This study aims to advance understanding of the economic impact of COVID-19 on WGL&RHIV and to identify the factors associated with this insecurity.Methods: Data were collected from a cross-sectional survey conducted among a convenience sample of WGL&RHIV in Nigeria between May and September 2021. Logistic regressions enabled the study of the role of HIV status, mental health and macrosocial characteristics (people with disability, transgender women, sex workers, persons engaged in transactional sex, substance users, and people on the move) on economic vulnerability, measured by food, financial and housing insecurity, since the COVID-19 pandemic began. The model accounted for the possible interactions between the macrosocial characteristics and controlled for confounders.Results: There were 3 313 (76.1%) of 4 355 respondents facing food insecurity, 3 664 (83.6%) of 4 385 with financial vulnerability and 1 282 (36.2%) of 3 544 with housing insecurity. Being a member of the key and vulnerable groups was strongly associated with food insecurity, financial vulnerability and housing insecurity, regardless of HIV serostatus. For example, WGL&RHIV engaging in transactional sex were more than four times more likely (aOR 4.42; 95% CI 2.57­7.59) to face housing insecurity and more than twice more likely to face food insecurity (aOR 2.47, 95% CI 1.35­4.52) and financial vulnerability (aOR 2.87, 95% CI 1.39­5.93). This economic vulnerability may reduce their negotiating power for safer sex or the use of HIV prevention methods, exposing them to increased risks of HIV infection. Poor mental health was also associated with the three forms of economic vulnerability.Conclusions: As the long-term impact of the COVID-19 crisis on African economies unfolds, HIV programmes at the country level must include economic vulnerability and mental unwellness mitigation activities for WGL&RHIV

Challenges encountered by human immunodeficiency virus positive pregnant women on taking antiretrovirals in a public health unit of the Manzini region, Swaziland

In Swaziland, the Ministry of Health adopted the prevention of mother-to-transmission (PMTCT) Option A as a feasible and less costly way to expand the PMTCT services nationwide. Despite major success since the programme started, some barriers, such as the challenge of follow-up care for human immunodeficiency virus (HIV)-positive pregnant mothers still exist. The present study aimed to describe the challenges that HIV-positive pregnant mothers encountered on taking antiretrovirals (ARVs) in a health unit of the Manzini region, Swaziland. A qualitative, exploratory and descriptive research design was used, and data were collected through semi-structured individual interviews and field notes. Purposive sampling was used to select the study site and the population. Permission was requested from the participants to record the interviews. The study population were HIV-positive pregnant mothers, aged between 18 and 40 years, which were enrolled in the PMTCT B+ programme. The PMTCT B+ programme was perceived as preventing the transfer of HIV transmission from mother to child. It boosts the mother's immune system, prevents opportunistic infections and prolongs life. Challenges of taking ARVs emerged as a theme. The participants displayed knowledge and understanding of the programme, yet discrimination and no support from families and partners were mentioned. (Afr J Reprod Health 2022; 26[5]: 41-49).

Utilisation of HIV services by female sex workers in Zimbabwe during the COVID-19 pandemic: a descriptive phenomenological study

This study focuses on female sex workers as a key population group that suffers a degree of vulnerability according to the World Health Organisation (WHO). Key populations refer to people at heightened risk of contracting the human immunodeficiency virus (HIV) due to specific behaviours and social and legal environments which increase their vulnerability to the virus. Key populations are disproportionately affected by HIV, yet they have less access to HIV services compared to the general population. The coronavirus (COVID-19) lockdown and its restrictive measures have further widened the inequalities and gaps in accessing HIV services for this group. A descriptive phenomenological study was undertaken to explore female sex workers' experiences of utilisation of HIV services during COVID-19. The study setting was the Bulawayo Metropolitan Province, Zimbabwe. Data were collected through in-depth individual interviews with 10 female sex workers. Purposive sampling coupled with snowballing was utilised for recruiting participants. Data were analysed guided by the seven-step Colaizzi technique. Rigour was ensured through adhering to Lincoln and Guba's trustworthiness criteria. The study found that the COVID-19 pandemic adversely affected the livelihoods of sex workers and their utilisation of HIV services. There was limited access to HIV services due to an initial lack of travel authorisation letters and financial challenges experienced by study participants. In addition, the quality of care in health care facilities was further compromised by poor screening processes and reduced provider-client interactions. Maintaining access to HIV services for female sex workers during pandemics is critical for the country to attain HIV epidemic control.

Challenges of caregivers providing care to children with disabilities at non-governmental organisations in Tshwane townships, South Africa

Caregivers of children with disabilities are vital stakeholders when it comes to safeguarding the health, well-being and overall survival of the children that they care for. Caregivers, however, face many challenging conditions that make it difficult for them to optimally fulfil their caregiving role. Understanding these challenges is crucial for developing empowerment programmes for caregivers, which will ensure that children with disabilities receive comprehensive, optimal care and that caregivers experience a good quality of life. Objectives: The aim of this study was to explore and describe the experiences of caregivers providing care to children with disabilities at non-governmental organisations (NGOs) in townships of Tshwane, South Africa. Method: This study followed an exploratory, descriptive and contextual research design within a qualitative methodology. The population in this study included caregivers who care for children with disabilities at NGOs (n = 10). Participants for the study were selected using the purposive sampling technique. Data were collected by conducting semi structured interviews with caregivers. Data were analysed according to the six phases of thematic analysis proposed by. Results: The study revealed six themes that represent the challenges experienced by caregivers, namely (1) initial impressions, (2) rendering care, (3) stress, (4) lack of outside support, (5) coping and (6) poor community recognition. Conclusion: Support from the Departments of Health and Social Development and other institutions providing community rehabilitation services to townships should be provided to caregivers in order to empower them with skills and knowledge to effectively address the challenges they face so that they can render optimal care to the children they care for. Contribution: Results of this study could assist in ensuring improved recognition, resilience and supportive resources for caregivers in collaboration with community-based rehabilitation stakeholders in the community that would ultimately lead to improved care for children with disabilities in townships within South Africa.