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This ethnographic exploration of death in the Peruvian context draws on fieldwork among abandoned-both by their families and the state-older adults in a shelter for the homeless in Lima, Peru. I examine the conditions and local forces that shape the ways people at this institution socially and physically die. My argument is that people in this long-term care facility who have lived entire lives on the margins, usually, end up having irrelevant deaths to their families, other residents of the institution, and the Peruvian state. At this shelter, dying in an irrelevant way means dying without companionship from family members and receiving poor and flawed care from the institution that shelters them.
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Antropologia Médica , Humanos , Peru/etnologia , Feminino , Idoso , Masculino , Pessoas Mal Alojadas , Populações Vulneráveis , Idoso de 80 Anos ou mais , Pessoa de Meia-Idade , Assistência de Longa Duração , Instituição de Longa Permanência para IdososRESUMO
The early detection of sickle cell disease (SCD) is vital to reduce mortality among affected children. Suriname currently lacks a newborn screening programme (NSP) for SCD. We performed a pilot programme to evaluate the scalability of such an initiative. Dried blood spots were collected from five birth centres and subjected to electrophoresis analysis. The programme scalability was evaluated using the non-adoption, abandonment, scale-up, spread, and sustainability framework. Challenges across six domains (illness, technology, value proposition, adopter system, organisation, and societal system), were categorised hierarchically as simple ð, complicated ð, or complex ð¢. It has been proven that implementing programmes with mainly complicated challenges is difficult and those in mainly complex areas may be unachievable. SCD was detected in 33 of 5185 (0.64%) successfully screened newborns. Most of the domains were classified as simple or complicated. Disease detection and technology suitability for screening in Suriname were confirmed, with favourable parental acceptance. Only minor routine adjustment was required from the medical staff for programme implementation. Complex challenges included a reliance on external suppliers for technical maintenance, ensuring timely access to specialised paediatric care for affected newborns, and securing sustainable financial funding. Scaling up is challenging but feasible, particularly with a targeted focus on identified complex challenges.
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Background: Access to audiology services for older adults residing in sparsely populated regions is often limited compared to those in central urban areas. The geographic accessibility to follow-up care, particularly the influence of distance, may contribute to an increased risk of hearing aid abandonment. Objective: To assess the association between the home-to-healthcare-calibration-center distance and hearing aid abandonment among older adults fitted in the Chilean public health system. Methods: 455 patients who received hearing aids from two public hospitals in two regions were considered. Univariate and multivariate Poisson regression models with robust variance estimation were used to analyze the association between the geographical distance and hearing aid abandonment, accounting for confounding effects. Results: Approximately 18% of the sample abandoned the hearing aid, and around 50% reported using the hearing aid every day. A twofold increase in distance between home and the hearing center yielded a 35% (RR = 1.35; 95% CI: 1.04-1.74; p = 0.022) increased risk of hearing aid abandonment. Also, those in the second quintile had a 2.17 times the risk of abandoning the hearing aid compared to the first quintile (up to 2.3 km). Under the assumption that patients reside within the first quintile of distance, a potential reduction of 45% in the incidence of hearing aid abandonment would be observed. The observed risk remained consistent across different statistical models to assess sensitivity. Conclusion: A higher distance between the residence and the healthcare center increases hearing aid abandonment risk. The association may be explained by barriers in purchasing supplies required to maintain the device (batteries, cleaning elements, potential repairs, or maintenance).
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Acessibilidade aos Serviços de Saúde , Auxiliares de Audição , Humanos , Auxiliares de Audição/estatística & dados numéricos , Feminino , Idoso , Masculino , Acessibilidade aos Serviços de Saúde/estatística & dados numéricos , Idoso de 80 Anos ou mais , Chile , Perda Auditiva/reabilitaçãoRESUMO
BACKGROUND: Irresponsible dog ownership in urban areas is a public health concern with significant implications for human, animal, and environmental welfare. Factors such as abandonment, variations in adoption, insufficient supervision, emerging identification initiatives, and collective feeding impact the growth of stray dog populations and the transmission of diseases. Developing a modeling tool to understand the dynamics of canine population growth and the effect of human behavior on this phenomenon is essential. METHODS: An ordinary differential equation model was developed to depict the growth dynamics and movements of urban dog populations, distinguishing between those with owners (restricted and semi-restricted) and those without (stray and community dogs). Two equilibrium states of the system were analyzed: with and without the presence of individually owned dogs. An increase rate for the population of individually owned dogs was calculated, and a local sensitivity analysis was conducted to assess the impact of parameters on the reduction of this population. Additionally, two global sensitivity analysis methods were used to evaluate the simultaneous influence of the parameters. RESULTS: Findings indicate that system equilibrium depends on various dog categories. Although total eradication of stray and community dogs is unlikely, equilibrium levels are directly related to subpopulation growth rates, responsible ownership practices, and adoption and abandonment rates. The growth rates of the population of dogs without individual owners have a direct and proportional influence on their regulation, while adoption rates have an inverse and proportional effect. The study, through global sensitivity analysis, identifies key parameters for each dog subpopulation. For restricted dogs, environmental carrying capacity is the most variable factor; for semi-restricted dogs, awareness of responsible ownership is crucial. The abandonment of restricted dogs significantly impacts stray dog dynamics, while the transition from stray to community status is an important variable factor for community dogs. CONCLUSION: Addressing the situation of unowned dogs requires a collective effort to reduce risks associated with the spread of zoonotic diseases, environmental pollution, and biodiversity loss, thus contributing to public health and environmental conservation.
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Doenças do Cão , Modelos Teóricos , Animais , Cães , Humanos , Chile , Dinâmica Populacional , População Urbana , Propriedade , Doenças do Cão/epidemiologiaRESUMO
BACKGROUND: Different types of stress inflicted in early stages of life elevate the risk, among adult animals and humans, to develop disturbed emotional-associated behaviors, such as hyperphagia or depression. Early-life stressed (ELS) adults present hyperactivity of the hypothalamus-pituitary-adrenal (HPA) axis, which is a risk factor associated with mood disorders. However, the prevalence of hyperphagia (17%) and depression (50%) is variable among adults that experienced ELS, suggesting that the nature, intensity, and chronicity of the stress determines the specific behavioral alteration that those individuals develop. METHODS: We analyzed corticosterone serum levels, Crh, GR, Crhr1 genes expression in the hypothalamic paraventricular nucleus, amygdala, and hippocampus due to their regulatory role on HPA axis in adult rats that experienced maternal separation (MS) or limited nesting material (LNM) stress; as well as the serotonergic system activity in the same regions given its association with the corticotropin-releasing hormone (CRH) pathway functioning and with the hyperphagia and depression development. RESULTS: Alterations in dams' maternal care provoked an unresponsive or hyper-responsive HPA axis function to an acute stress in MS and LNM adults, respectively. The differential changes in amygdala and hippocampal CRH system seemed compensating alterations to the hypothalamic desensitized glucocorticoids receptor (GR) in MS or hypersensitive in LNM. However, both adult animals developed hyperphagia and depression-like behavior when subjected to the forced-swimming test, which helps to understand that both hypo and hypercortisolemic patients present those disorders. CONCLUSION: Different ELS types induce neuroendocrine, brain CRH and 5-hydroxytriptamine (5-HT) systems' alterations that may interact converging to develop similar maladaptive behaviors.
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Hormônio Liberador da Corticotropina , Serotonina , Humanos , Ratos , Animais , Hormônio Liberador da Corticotropina/genética , Hormônio Liberador da Corticotropina/metabolismo , Serotonina/metabolismo , Sistema Hipotálamo-Hipofisário/metabolismo , Depressão/etiologia , Privação Materna , Sistema Hipófise-Suprarrenal/metabolismo , Encéfalo/metabolismo , Hiperfagia/metabolismo , Receptores de Glucocorticoides/genética , Receptores de Glucocorticoides/metabolismo , Estresse PsicológicoRESUMO
Objetivo: Compreender a percepção dos idosos institucionalizados quanto ao abandono afetivo por parte de seus familiares.Método: Trata-se de um estudo exploratório, comabordagemqualitativa. Conduzido por meio de entrevistas semiestruturadas. A organização e análise dos dados foram baseadas na técnica de Minayo. O estudo foi realizado em uma Instituição de Longa Permanência para Idosos, localizada em uma cidade do nordeste de Santa Catarina.Resultados: Participaram do estudo nove idosos, com idades entre 60 e 89 anos, com diferentes estados civis (viúvos, casados e divorciados), variando sua escolaridade do nível básico ao superior, além de serem aposentados ou pensionistas. Foram identificadas quatro categorias analíticas: (1) vivência na instituição, (2) motivos para a institucionalização, (3) relacionamento familiar e (4) percepção do abandono familiar.Conclusão: alguns idosos enfatizaram sentir-se esquecidos na instituição, o que os deixa tristes e deprimidos. É crucial para a prática de a enfermagem compreender a realidade dos idosos nas Instituições de Longa Permanência, pois essa compreensão está diretamente ligada à prestação de cuidados em todos os níveis de assistência à saúde
Objective: To understand the perception of institutionalized elderly individuals regarding the emotional abandonment by their family members.Methodology: This is an exploratory study, using qualitative methods. Conducted through semi-structured interviews. Data organization and analysis were based on Minayo's technique. The study was conducted at a Long-Term Care Institution for the Elderly located in a city in northeastern Santa Catarina.Results: Nine elderly individuals participated in the study, ranging in age from 60 to 89 years old, with different marital statuses (widowed, married, and divorced), ranging in education from basic to higher levels, and being retirees or pensioners. Four analytical categories were identified: (1) experience in the institution, (2) reasons for institutionalization, (3) family relationships, and (4) perception of family abandonment.Conclusion: Some elderly individuals emphasized feeling forgotten in the institution, which makes them feel sad and depressed. Understanding the reality of the elderly in Long-Term Care Institutions is crucial for nursing practice, as this understanding is directly linked to providing care at all levels of healthcare assistance in the Health Care Network
Objetivo: Comprender la percepción de las personas mayores institucionalizadas con respecto al abandono afectivo por parte de sus familiares. Metodología:Se trata de un estudio exploratorio, utilizando métodos cualitativos. Realizado a través de entrevistas semiestructuradas. La organización y análisis de los datos se basaron en la técnica de Minayo. El estudio se llevó a cabo en una Institución de Larga Estadía para Personas Mayores lubicada en una ciudad del noreste de Santa Catarina. Resultados:Nueve personas mayores participaron en el estudio, con edades comprendidas entre 60 y 89 años, con diferentes estados civiles (viudos, casados y divorciados), variando en educación desde niveles básicos hasta superiores, y siendo jubilados o pensionistas. Se identificaron cuatro categorías analíticas: (1) experiencia en la institución, (2) motivos para la institucionalización, (3) relaciones familiares y (4) percepción del abandono familiar. Conclusión:Algunas personas mayores enfatizaron sentirse olvidadas en la institución, lo que los hace sentir tristes y deprimidas. Es crucial para la práctica de enfermería comprender la realidad de los adultos mayores en las Instituciones de Larga Estancia, ya que esta comprensión está directamente vinculada con la prestación de cuidados en todos los niveles de asistencia sanitaria en la Red de Atención a la Salud.
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Saúde do Idoso Institucionalizado , Família , Saúde do Idoso , Abuso de Idosos , Enfermagem GeriátricaRESUMO
Fundamento: el abandono en la vejez es un condicionante de muchos trastornos de salud y constituye en mayor medida una condición de gran incidencia a nivel mundial. Objetivo: comparar los síndromes geriátricos y el abandono en pacientes adultos mayores. Métodos: se realizó un estudio transversal, descriptivo, analítico y correlacional, en la Unidad de Medicina Familiar No. 33 del Instituto Mexicano del Seguro Social de Tabasco. La muestra se conformó con 203 pacientes de 60 años y más, que acudieron a consulta de Medicina Familiar y Atención Médica Continua. Se aplicaron 3 instrumentos: la escala de Pfeiffer, el International Consultation on Incontinence Questionnaire Short-Form, la Escala de Percepción de Abandono del Adulto Mayor y se interrogó sobre el consumo de medicamentos prescritos y automedicados. Resultados: existió relación entre los síndromes geriátricos y el abandono, como se comprobó en la correlación entre las variables analizadas. El deterioro cognitivo leve, moderado y severo, se encontró en bajas proporciones. El 40,7 % de los pacientes aceptó tener incontinencia urinaria. La presencia de polifarmacia se encontró en altas proporciones. Conclusiones: los síndromes geriátricos presentes en el estudio fueron: deterioro cognitivo, polifarmacia e incontinencia urinaria, más la presencia de ser soltero, viudo o divorciado muestran una relación significativa para sufrir abandono.
Foundation: abandonment in old age is a condition of many health disorders and is, to a greater extent, a condition of high incidence worldwide. Objective: to compare geriatric syndromes and abandonment in older adult patients. Methods: a cross-sectional, descriptive, analytical and correlational study was carried out in the Family Medicine Unit No. 33 of the Mexican Social Security Institute of Tabasco. The sample was made up of 203 patients aged 60 and over, who attended Family Medicine and Continuing Medical Care consultations. Three instruments were applied: the Pfeiffer scale, the International Consultation on Incontinence Questionnaire Short-Form, the Perception of Abandonment Scale for the Elderly, and questions were asked about the consumption of prescribed and self-medicated medications. Results: there is a relationship between geriatric syndromes and abandonment, as verified in the correlation between the variables analyzed. Mild, moderate and severe cognitive impairment was found in low proportions. 40.7 % of the patients accepted having urinary incontinence. The presence of polypharmacy was found in high proportions. Conclusions: the geriatric syndromes present in the study such as: cognitive impairment, polypharmacy and urinary incontinence, plus the presence of being single, widowed or divorced show a significant relationship to suffering abandonment.
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Resumo. Objetivo. Identificar os preditores sociodemográficos, laborais, estressores psicossociais, foco regulatório para a obtenção das metas no trabalho, trabalho emocional e a síndrome de burnout para a intenção de abandono profissional em professores brasileiros de acordo com os cinco níveis de ensino: Infantil, Fundamental, Médio, Graduação e Pós-graduação. Método. Utilizou-se uma amostra não probabilística de 1284 professores brasileiros distribuídos em cinco níveis de ensino que responderam a um instrumento on-line que continha cinco seções: questionário de dados sociodemográficos e laborais, Cuestionario para la Evaluación del Síndrome de Quemarse por el Trabajo, Escala Geral de Focus Regulatório, Escala de Emoções no Trabalho e a Escala de Avaliação de Estressores Psicossociais no Contexto Laboral. Resultados. Os resultados obtidos por meio da análise de regressão linear múltipla revelaram preditores diferenciados de acordo com os níveis de ensino. As variáveis que explicaram os modelos foram maiores índices de síndrome de burnout, pressão pela responsabilidade, conflito e ambiguidade de papel, sobrecarga de papéis, insegurança na carreira, variabilidade emocional, maior formação acadêmica e remuneração e menores índices de satisfação com a vida, menor tempo de trabalho e idade, não ter outra atividade profissional e trabalhar em instituição privada. A síndrome de burnout foi preditora em todos os níveis.
Abstract. Objective. To identify the sociodemographic, work predictors, psychosocial stressors, regulatory focus to achieve goals at work, and emotional labor for professional abandonment intention in Brazilian teachers according to the five levels of education: kindergarten, elementary, secondary, undergraduate, and postgraduate. Method. A non-probabilistic sample of 1,284 Brazilian teachers distributed across five levels of education was used, who responded to an online instrument that contained five sections: sociodemographic and labor data questionnaire, Burnout questionnaire, General Regulatory Focus Scale, Emotions Labor Scale and the Psychosocial Stressors Assessment Scale in the Work Context. Results. The results obtained through multiple linear regression analyses revealed different predictors according to educational levels. The variables that explained the models were higher rates of burnout syndrome, pressure for responsibility, role conflict and ambiguity, role overload, career insecurity, emotional variability, higher academic training and remuneration and lower rates of satisfaction with life, lower length of work and age, not having another professional activity, and working in a private institution. Burnout syndrome was a predictor at all levels.
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Humanos , Masculino , Feminino , Adulto , Pessoa de Meia-Idade , Estresse Psicológico , Esgotamento Profissional/psicologia , Intenção , Professores Escolares , EscolaridadeRESUMO
Ignoring the presence of dependent censoring in data analysis can lead to biased estimates, for example, not considering the effect of abandonment of the tuberculosis treatment may influence inferences about the cure probability. In order to assess the relationship between cure and abandonment outcomes, we propose a copula Bayesian approach. Therefore, the main objective of this work is to introduce a Bayesian survival regression model, capable of taking into account the dependent censoring in the adjustment. So, this proposed approach is based on Clayton's copula, to provide the relation between survival and dependent censoring times. In addition, the Weibull and the piecewise exponential marginal distributions are considered in order to fit the times. A simulation study is carried out to perform comparisons between different scenarios of dependence, different specifications of prior distributions, and comparisons with the maximum likelihood inference. Finally, we apply the proposed approach to a tuberculosis treatment adherence dataset of an HIV cohort from Alvorada-RS, Brazil. Results show that cure and abandonment outcomes are negatively correlated, that is, as long as the chance of abandoning the treatment increases, the chance of tuberculosis cure decreases.
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Cooperação e Adesão ao Tratamento , Tuberculose , Humanos , Teorema de Bayes , Brasil , Simulação por Computador , Tuberculose/tratamento farmacológicoRESUMO
OBJECTIVE: The objectives of this study were to determine the overall survival (OS) and event-free survival (EFS) rates of patients with medulloblastoma treated in a national pediatric hospital in Peru, as well as to identify demographic, clinical, imaging, postoperative, and histopathological characteristics and prognostic factors associated with OS and EFS. METHODS: The authors conducted a retrospective study analyzing information from the medical records of children with a diagnosis of medulloblastoma who underwent surgical treatment at the Instituto Nacional de Salud del Niño-San Borja, a public hospital in Lima, Peru, from 2015 to 2020. Clinical-epidemiological variables, degree of disease extension, risk stratification, extent of resection, postoperative complications, status of oncological treatment received, histological subtype, and neurological sequelae were taken into account. The Kaplan-Meier method and Cox regression analysis were used to estimate OS, EFS, and prognostic factors. RESULTS: Of the 57 children evaluated with complete medical records, only 22 children (38.6%) underwent complete oncological treatment. OS was 37% (95% CI 0.25-0.55) at 48 months. EFS was 44% (95% CI 0.31-0.61) at 23 months. High-risk stratification-meaning patients with ≥ 1.5 cm2 of residual postoperative tumor, those younger than 3 years, those with disseminated disease (HR 9.69, 95% CI 1.40-67.0, p = 0.02), and those who underwent subtotal resection (HR 3.78, 95% CI 1.09-13.2, p = 0.04)-was negatively associated with OS. Failure to receive complete oncological treatment was negatively associated with OS (HR 20.0, 95% CI 4.84-82.6, p < 0.001) and EFS (HR 7.82, 95% CI 2.47-24.7, p < 0.001). CONCLUSIONS: OS and EFS of patients with medulloblastoma in the author's milieu are below those reported in developed countries. Incomplete treatment and treatment abandonment in the authors' cohort were also high compared with high-income country statistics. Failure to complete oncological treatment was the most important factor associated with poor prognosis, both in terms of OS and EFS. High-risk patients and subtotal resection were negatively associated with OS. Interventions are needed to promote the completion of adjuvant oncological therapy for medulloblastoma in the disadvantaged Peruvian population.