Development and Feasibility Assessment of a Nutrition Screening Guideline in Older Patients for Use by Healthcare Staff in Health Clinic Setting: An Action Research Study

@#Introduction: Older persons are more susceptible to malnutrition. However, malnutrition identification through nutrition screening is not routinely performed in Malaysia’s health clinics due to no specific nutrition screening guideline and validated tool in this setting. This study aimed to develop a nutrition screening guideline for older patients and assess its feasibility for use by healthcare staff in health clinic setting. Methods: This study was conducted in three phases. In Phase I, needs assessment was conducted amongst healthcare staff. Development of nutrition screening guideline in Phase II involved scoping review and validation amongst six experts and twelve healthcare staff. In Phase III, twenty-two healthcare staff participated in feasibility assessment using in-depth interviews after completing nutrition screening in older patients. Interview data was analysed thematically using NVivo Software 12.0. Results: A Malay language version of nutrition screening guideline in A4-sized with 31 pages was developed and validated. Items with a content validity index ≥0.83 from experts review were retained, while <0.83 were revised accordingly. Validation amongst healthcare staff showed positive responses. The guideline was then assessed for feasibility, where 110 older patients (mean age= 68.7±6.1 years) were screened by healthcare staff using the newly developed nutrition screening guideline. Four themes emerged from in-depth interviews: 1) Ease of use; 2) Identification and management of malnutrition; 3) Acceptability; and 4) Implementation of nutrition screening. Conclusion: The newly developed and validated nutrition screening guideline is well-accepted and feasible for healthcare staff to screen older patients in health clinic setting for timely malnutrition identification and management.

Perceived knowledge, attitude and readiness to accept towards COVID-19 vaccine among health care staffs in a tertiary government hospital

Introduction@#Fear and concern over vaccine safety are the most common reasons for vaccine hesitancy. During the COVID-19 pandemic, healthcare staff are among those at high risk of contracting the virus. They are also the public’s vital source of information and in providing trust regarding COVID-19 vaccines. This study was conducted to assess perception, attitude, and vaccination acceptance towards COVID-19 vaccines among healthcare staff at Eastern Visayas Regional Medical (EVMC).@*Objective@#To assess the perceived knowledge, attitude, and readiness to accept COVID-19 Vaccines among Eastern Visayas Regional Medical Center (EVMC) healthcare staff.@*Methods@#This analytic cross-sectional study included all medical and allied personnel employed at EVMC. Data were collected with signed consent through self-administration of a researcher-developed validated questionnaire, subsequently analyzed using descriptive and inferential statistics.@*Results@#About 634 participated, many belonged to the age group 30-39 years old (47.8%), mostly female (66.3%), single (50 %), and Roman Catholic (89.4%). Data showed no significant relationship between age, sex, marital status, religion, and the presence of chronic illness of the healthcare staff towards perceived knowledge, attitude, and readiness towards the COVID-19 vaccine. However, their clinical role was noted as significant towards their perceived knowledge and attitude (p-value = <.001). Overall, the healthcare staff response showed a moderate to high perceived knowledge and attitude about COVID-19 vaccine acceptance (p-value= <.001).@*Conclusions@#Notably, the clinical role of healthcare staff is significantly related to their perceived knowledge and attitude towards the COVID-19 vaccine. Moreover, they manifested moderate to high levels of perceived knowledge, attitude, and COVID-19 vaccine acceptance. These results may help address COVID-19 vaccine hesitancy, thus strengthen vaccine confidence among the general population. Furthermore, it provides inputs to create strategies that will enhance vaccine literacy and acceptance, directly addressing the community’s concerns and misconceptions, particularly those vulnerable groups that may easily contract severe infection.

Health Professionals' Mental Health: A Look at their Suffering / A Saúde Mental dos Profissionais da Saúde: Um Olhar ao Sofrimento de quem Cuida / La Salud Mental de los Profesionales de la Salud: Una Mirada al sufrimiento de quien Cuida

Abstract This study aimed to recognize the characteristics of work within the hospital context and their potential effects on mental health of professionals who provide health care for end-of-life patients. The descriptive and qualitative study relied on interviews and observations. Thirty-four physicians and nurses who work in clinical medicine or emergency medical services in a teaching hospital in Rio Grande do Sul were interviewed. The results, obtained through content analysis, showed that in clinical medicine health professionals suffer more when patients die or their condition gets worse, such suffering being a threat to mental health. In emergency medical services, death causes suffering only when it is traumatic. Intercurrences which are characteristic of emergency medical services and work organization are the major source of stress for such professionals, thus affecting their mental health. Therefore, the mental health of these professionals is weakened due to the demands in health care work. It is thus necessary to rethink the institution's organization, redefine attitudes and implement procedures that are coherent with the professionals' needs, in search of better working conditions and improved mental health.

Resumo Este estudo teve como objetivo conhecer as características do trabalho no contexto hospitalar e os possíveis efeitos na saúde mental dos profissionais que realizam o cuidado de pacientes no fim de vida. Realizou-se um estudo descritivo e qualitativo com base em entrevistas e observações. Foram entrevistados 34 médicos e enfermeiros que atuam nas unidades de clínica médica e pronto-socorro em um hospital de ensino do Rio Grande do Sul. Os resultados, obtidos a partir da análise de conteúdo, mostraram que na clínica médica há maior sofrimento quando acontece a morte ou a piora do paciente, fontes de prejuízo à saúde mental. No pronto-socorro, a morte gera sofrimento apenas quando traumática. As intercorrências próprias da emergência e da organização do trabalho são as maiores fontes de estresse para os profissionais, afetando sua saúde mental. Logo, a saúde mental dos profissionais encontra-se fragilizada frente às exigências do trabalho em saúde. É necessário repensar a organização institucional, redefinir ações e agir coerentemente com as necessidades dos profissionais, buscando melhorias no trabalho e na saúde mental.

Resumen El objetivo de este estudio fue conocer las características del trabajo en el contexto hospitalario y los posibles efectos en la salud mental de los profesionales que realizan el cuidado de pacientes al final de la vida. Se realizó un estudio descriptivo y cualitativo basado en entrevistas y observaciones. Se entrevistó a 34 médicos y enfermeros que actúan en las unidades de clínica médica y de servicios médicos de urgencia en un hospital de enseñanza de Rio Grande do Sul. Los resultados, obtenidos a partir del análisis de contenido, mostraron que en la medicina clínica hay mayor sufrimiento cuando ocurre la muerte o el empeoramiento del paciente, factores de daño a la salud mental. En los servicios médicos de urgencia, la muerte genera sufrimiento solamente cuando es traumática. Las intercurrencias propias de la emergencia y de la organización del trabajo son las mayores fuentes de estrés para los profesionales, afectando su salud mental. Por lo tanto, la salud mental de los profesionales se encuentra debilitada ante las exigencias del trabajo en salud. Es necesario repensar la organización institucional, redefinir acciones y actuar coherentemente con las necesidades de los profesionales, buscando mejoras en el trabajo y en la salud mental.

O preconceito contra a mulher entre trabalhadores da Atenção Primária em Saúde / Sexism against women among primary healthcare workers

Resumo O objetivo deste trabalho foi pesquisar a existência de preconceitos contra a mulher entre trabalhadores da Atenção Primária em Saúde e identificar fatores associados. Estudo transversal que teve a participação de 163 profissionais de APS. Foram utilizados os questionários Estereótipos de Gênero (EG) e o Inventário do Sexismo Ambivalente. Pesquisou-se indivíduos dos dois sexos, com mais de 18 anos e escolaridade básica ou média. Os escores médios tinham valores acima de 50,0% do valor máximo: EG - 53,8%, Sexismo Hostil - 58,2%; Sexismo Benévolo - 64,1%. As médias estratificadas por variáveis sociodemográficas eram elevadas. Foram encontradas diferenças significantes por sexo (masculino maior que feminino), religiões (maior nos evangélicos) e nos que usavam bebidas alcoólicas, no Sexismo Hostil. No Sexismo Benévolo houve diferenças por escolaridade (maior no nível básico), religião (maior nos evangélicos e católicos) e atividade exercida (maior em serviços gerais). Estratificando EG não se encontrou diferenças significantes. Preconceitos sexistas hostis, benevolentes e estereótipos de gênero foram detectados. Esse achado pode influir negativamente na relação serviço-usuárias agravando as iniquidades em saúde geradas pelas desigualdades entre gêneros.

Abstract The objective of this study was to research the existence of sexism against women among primary healthcare (PHC) workers and to identify associated factors. This was a cross-sectional study in which 163 PHC professionals of both sexes participated, all of whom were aged over 18 and had completed their primary or secondary education. The Gender Stereotyping and Ambivalent Sexism Inventory questionnaires were used. The average scores were more than 50% of the maximum score: Gender Stereotyping - 53.8%, hostile sexism - 58.2%, benevolent sexism - 64.1%. The average scores stratified by sociodemographic variables were higher. Significant differences in the hostile sexism score were found for sex (men scored higher than women), religion (higher scores for evangelical Christians) and among those who drank alcohol. For benevolent sexism, differences were found for schooling (greater scores for those who had only completed their primary education), religion (higher scores for evangelical Christians and Catholics) and area of work (greater for those working in general services). The stratification of the Gender Stereotyping scores did not point to significant differences. Sexist prejudice was found to exist for hostile sexism, benevolent sexism and gender stereotyping. This finding could have a negative influence on the service-user relationship, leading to greater inequities in health as a result of gender inequality.

Recidiva oncológica: olhares dos profissionais hospitalares sobre as dificuldades do paciente pediátrico / Cancer recurrence: perspectives of hospital staff on the difficulties of pediatric patients / Recaída oncológica: observación de los profesionales de hospitales sobre las dificultades del paciente pediátrico

Em pediatria oncológica, a taxa de sobrevivência tem sofrido um aumento acentuado, sendo considerável a probabilidade de cura. Não obstante, o processo de confronto com a doença pode sofrer alguns contratempos, nomeadamente uma recidiva. Esta última é responsável por elevado sofrimento, o qual poderá ser ainda maior que o confronto com o diagnóstico. Procurando conhecer as percepções dos profissionais de oncologia, relativamente às principais dificuldades experienciadas pelas crianças e adolescentes cuja doença recidivou, as autoras desenvolveram um estudo investigando o olhar desses profissionais. Entrevistaram-se 17 profissionais, de dois hospitais portugueses, exercendo funções hospitalares na área da saúde, serviço social, psicologia e educação. Suas reflexões apontaram como principais dificuldades a aceitação de ter que passar novamente por um processo física e psicologicamente penoso sendo que, entre os adolescentes ­ mais conscientes da gravidade da doença e suas implicações ­ acrescem as dificuldades em ter esperança na cura. Para os mais pequenos, os profissionais apontaram como mais comum a dificuldade em compreender os motivos de nova submissão a tratamentos dolorosos e do afastamento dos seus contextos de vida. Dando a conhecer uma etapa particularmente desafiante da doença oncológica, o presente estudo traz um olhar multifocal de um grupo de profissionais que acompanham de perto essas crianças/adolescentes (e respectivas famílias). A sua longa e diversa experiência ­ em termos de tipologias de câncer, evolução do quadro clínico, idade ou temperamento dos pacientes (e dos próprios pais) ­ fazem desses profissionais informantes-chave no mapeamento das dificuldades associadas ao processo de recidiva oncológica em pediatria, bem como no desenho e implementação de respostas mais ajustadas à fenomenologia destes processos. (AU)

In pediatric oncology, the survival rate has risen considerably, and nowadays the probability of cure is very high. However, the process of fighting the disease can suffer some setbacks, namely a relapse. This event is responsible for high suffering, which may be even greater than dealing with the diagnosis of cancer. Aiming to understand the perceptions of oncology professionals regarding the main difficulties experienced by children/adolescents whose cancer relapsed, the authors developed a study in which the professionals' perspective was explored. A group of 17 professionals (from the areas of health, social work, psychology and education), working in two Portuguese hospitals, was interviewed. Their reflections indicated that the main difficulties during relapse were the acceptance of having to undergo such a - physically and psychologically - painful process all over again, and among adolescents, who are more aware of the severity of the disease and its implications, also difficulties in keeping up hope. Among the youngest, professional pointed out as more common the difficulty in understanding why they have to be resubmitted to such painful treatments and be parted from their life contexts. Emphasizing recurrence as a particularly challenging stage of the oncologic disease, this study brings a multifocal view of a group of professionals who closely follow these children/adolescents (and their families) all the way trough. Their long and diverse experience - in terms of type of cancer, evolution of the disease, age and/or temperament of the patients (and the parents' themselves) - make these professionals key informants in the mapping of the difficulties related to the pediatric oncological relapse, as well as in the design and implementation of more adjusted responses to the phenomenology of these processes. (AU)

En pediatría oncológica, el índice de sobrevivencia ha experimentado un aumento acentuado, siendo considerable la probabilidad de cura. Sin embargo, el proceso de enfrentar la enfermedad puede sufrir algunos contratiempos, en particular una recaída; ésta es responsable por mucho sufrimiento, el cual puede ser incluso mayor que enfrentar el propio diagnóstico. Tratando de conocer las percepciones de los profesionales de oncología y las principales dificultades experimentadas por los niños/adolescentes que tuvieron recaída, los autores desarrollaron un estudio con participación de 17 profesionales de la salud, trabajo social, psicología y educación de dos hospitales portugueses. Las reflexiones recogidas a través de entrevistas indicaron que las principales dificultades de los niños es aceptar y entender porqué razón tienen que pasar nuevamente por un proceso físico y psicológico tan doloroso y estar lejos de sus contextos naturales. Entre los adolescentes - más conscientes de la gravedad e implicaciones de la enfermedad ­ son mayores las dificultades para creer y tener esperanza en la cura. Describindo la recaída como una etapa particularmente difícil de la enfermedad oncológica, este estudio proporciona una mirada multifocal de un grupo de profesionales que siguen de cerca estos niños/adolescentes (y respectivas familias). Su larga y variada experiencia - en términos de tipos de cáncer, evolución de cuadro clínico, edad y temperamento de los pacientes (y de los propios padres) ­ hace que estos profesionales pasen a ser informantes clave para identificar las dificultades asociadas con la recaída del cáncer pediátrico, así como en el diseño e implementación de respuestas más ajustadas a la fenomenología de estos procesos. (AU)

Knowledge And Practice Regarding Dengue Fever And Acceptance Towards Wolbachia Among Universiti Kebangsaan Malaysia Medical Centre Healthcare Staff

@#Field trials of Wolbachia-transinfected mosquitoes, as a biological approach to curb dengue transmission, have been initiated. This study aimed to determine the knowledge regarding dengue fever (DF), practice of vector control, and acceptance of Wolbachia as a dengue control method among Universiti Kebangsaan Malaysia Medical Centre (UKMMC) healthcare staff. A questionnaire assessing knowledge regarding DF, vector control practices, and acceptance of Wolbachia was conducted among 330 UKMMC healthcare staff via convenience sampling. More than 70% of the respondents had good knowledge regarding DF, good vector control practice, and good acceptance of Wolbachia. Being female and having household income >MYR3000 had higher odds of having good knowledge regarding DF [(aOR 2.40; 95%CI 1.13, 5.12) and (aOR 3.86; 95%CI 1.91, 7.80)]. Having household income >MYR3000 had higher odds of having good vector control practice (aOR 2.33; 95%CI 1.20, 4.54) while academicians were three times (1-0.24) less likely to have good vector control practice than non-academicians (aOR 0.24; 95%CI 0.13, 0.48). Good acceptance of Wolbachia was associated with being academicians (aOR 8.83; 95%CI 2.60, 29.96) and having good knowledge regarding DF (aOR 6.07; 95% CI 2.89, 12.74). Gender, different income level and type of occupation have significant association with either good knowledge regarding DF or practice on vector control. Different type of occupation and level of knowledge also were notably significantly associated with good acceptance on Wolbachia as dengue biological control. These factors may be the focus for future plan to enhance the knowledge, acceptance and practice regarding DF and its control.

La atención prenatal: una mirada desde los profesionales de la salud. Estudio cualitativo. Bucaramanga, 2012 / Pre-natal care seen from the perspective of healthcare practitioners. Qualitative study. Bucaramanga 2012

Comprender los significados que tiene la atención prenatal (AP) para los profesionales de la salud (PS) que atienden a las embarazadas en control prenatal.Materiales y métodos: investigación cualitativa, con sustento teórico en interaccionismo simbólico y métodos de la teoría fundamentada (TF). Previo consentimiento informado se realizaron entrevistas en profundidad a 17 PS: médicos, ginecólogos, perinatólogos, enfermeras y psicólogas, quienes realizaban AP en instituciones públicas (centros de salud de atención primaria) y privadas (centros médicos y consultorios) de Bucaramanga (Colombia), en 2012. En estos escenarios también se observaron las interacciones de los profesionales y las gestantes. La información fue analizada simultáneamente con su recolección, usando razonamiento lógico inductivo y métodos propios de la TF para generar categorías, y muestreo teórico hasta lograr saturación de las categorías emergentes. El estudio fue aprobado por los comités de ética de las instituciones participantes.Resultados: emergieron tres categorías denominadas: 1) atención centrada en el manejo del riesgo, 2) dualidad entre las fallas del sistema y la calidad de la atención y 3) atención prenatal como un espacio de interacción y satisfacción.Conclusiones: los participantes perciben la AP en tres sentidos: como escenario técnico, como oportunidad de interacción y satisfacción, y como una preocupación por lograr franquear las barreras que impone el sistema y brindar atención de buena calidad a las gestantes...

To understand the meaning of prenatal care (PC) for the different healthcare professionals (HCP) who see pregnant women in antenatal consultation.Materials and methods: Qualitative research supported theoretically on Symbolic Interactionism and Grounded Theory (GT). After informed consents were obtained, in-depth interviews were conducted among 15 HCPs including physicians, gynaecologists, perinatologists, nurses and psychologists providing PC in public (primary care clinics) and private (medical centres and offices) institutions in Bucaramanga, Colombia, in 2012. Interactions between professionals and pregnant women were also observed in those settings. The information was analysed concurrently as it was gathered using inductive logic reasoning and GT methods in order to generate categories; logic sampling was then applied until saturation of the emerging categories was achieved. The study was approved by the Ethics Committees of the participating institutions.Results: Three categories emerged: 1) Risk management-focused care; 2) Dichotomy between the failings of the system and care quality; and 3) Prenatal care as a setting for interaction and satisfaction.Conclusions: The participants award meaning to PC from three perspectives: as a technical setting, as an opportunity for interaction and satisfaction, and as a motivation to overcome the barriers imposed by the system and provide good-quality care during pregnancy...