RESUMO
Alongside peace, education, food, income, a stable ecosystem, sustainable resources and social justice, shelter is a prerequisite for health. According to international human rights law, everyone is entitled to an adequate standard of living, which includes adequate housing. Adequate housing, including access to water and sanitation, plays a critical role in the prevention and management of neglected tropical diseases, which affect over 1 billion people worldwide. Inadequate housing conditions represent a risk factor for many of them, e.g., Chagas disease that affects 6-8 million people worldwide, visceral leishmaniasis that kills 20,000-30,000 people/year, lymphatic filariasis which threatens 859 million people worldwide or dengue that has increased 8-10 fold over the last two decades. Vector control strategies for the above-mentioned diseases have shown their effectiveness and should include systematic and repetitive in-house spraying and individual protection (e.g., impregnated nets), as well as better-quality construction material and techniques and better sanitation infrastructures and practices. Access to adequate housing is a basic human right. The violation of the right to adequate housing may affect the enjoyment of other human rights. Access to adequate housing can strengthen (and facilitate access to) other basic human rights, such as the rights to work, health, security, and education.
RESUMO
BACKGROUND: Frequent users of emergency departments (FUEDs) (≥5 ED visits/year) represent a vulnerable population with complex needs accounting for a significant number of emergency department (ED) consultations, thus contributing to EDs overcrowding. Research exploring ED staff perceptions of FUEDs is scarce. OBJECTIVES: The current study aimed to evaluate in ED staff a) the extent to which FUEDs are perceived as an issue; b) their perceived levels of knowledge and understanding of FUEDs; c) levels of perceived usefulness of case management (CM) and interest in implementing this intervention in their ED service. METHODS: Head physicians of the EDs at all public hospitals in Switzerland (of various level of specialization) were sent a 19-item web-based survey, pilot tested prior to its dissemination. The head physicians were asked to forward the survey to ED staff members from different health professional backgrounds. RESULTS: The hospital response rate was 81% (85/106). The exploitable hospital response rate was 71% (75/106 hospitals) including 208 responding health professionals. Issues and difficulties around FUEDs were perceived as important by 64% of respondents. The perceived frequency of being confronted with FUEDs was higher among nurses in more specialized EDs. In total, 64% of respondents felt poorly informed about FUEDs, nurses feeling less informed than physicians. The understanding of FUEDs was lower in the French-Italian-speaking parts (FISP) of Switzerland than in the German-speaking part. Eighty-one percent of respondents had no precise knowledge of FUED-related interventions. The perceived usefulness of CM interventions after receiving explanations about it was high (92%). However, the overall level of interest for CM implementation was 59%. The interest in CM by physicians was low across all regions and ED categories. Nurses, on the other hand, showed more interest, especially those in EDs of high specialization. CONCLUSIONS: The majority of ED staff reported being confronted with FUEDs on a regular basis. Staff perceived FUEDs as a vulnerable population, yet, they felt poorly informed about how to manage the issue. The majority of ED staff thought a CM intervention would be useful for FUEDs, however there appears to be a gap in their desire or willingness to implement such interventions.
