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The purpose of this study was to examine the mental health of community-dwelling older adults as they adapted their everyday health behaviors during the COVID-19 pandemic. In response to a telephone survey, 126 older adults described perceived changes in physical and mental health, and adaptations in their everyday health behaviors. Descriptive statistics, bivariate correlations, and multiple regressions revealed that participants experienced changes in mental and physical health, reduced health service access, lower social engagement, and increased coping behaviors. Greater negative social impact of the pandemic was associated with higher levels of COVID-19 distress. Reduced mental health was significantly related to reductions in health service access, health changes, and fewer adaptive coping behaviors. Adaptive coping behaviors were helpful, just as reduced health access and social contact added risk for mental health problems. Suggestions were provided for alleviating mental health needs by increasing social contact and engaging in adaptive coping behaviors.

Cerebral palsy (CP) comprises a heterogeneous group of conditions recognized by disturbances of movement and posture and is caused by a non-progressive injury to the developing brain. Birth prevalence of CP is about 2–2.5 per 1,000 live births. Although the motor impairment is the hallmark of the diagnosis, individuals with CP often have other impairments, including cognitive ones. Cognitive impairments may affect communication, education, vocational opportunities, participation, and mental health. For many years, CP has been considered a “childhood disability,” but the challenges continue through the life course, and health issues may worsen and new challenges may arise with age. This is particularly true for cognitive impairments, which may become more pronounced as the demands of life increase. For individuals with CP, there is no one-to-one correlation between cognition and functioning in other areas, and therefore, cognition must be individually assessed to determine what targeted interventions might be beneficial. To facilitate this for children with CP, a systematic follow-up protocol of cognition, the CPCog, has been implemented in Norway and Sweden. However, no such protocol currently exists for adults with CP. Such discontinuity in healthcare services that results from lack of follow-up of cognitive functioning and subsequent needs for adjustments and interventions makes transition from pediatric to adult healthcare services challenging. As a result, a protocol for the surveillance of cognition in adults with CP, the CPCog-Adult, has been developed. It includes assessment of verbal skills, non-verbal reasoning, visual–spatial perception, and executive functioning. It is recommended to perform these assessments at least once in young adulthood and once in the mid-fifties. This report describes the process of developing the CPCog-Adult, which has a three-fold purpose: (1) to provide equal access to healthcare services to enable the detection of cognitive impairments; (2) to provide interventions that increase educational and vocational participation, enhance quality of life, and prevent secondary impairments; and (3) to collect systematic data for research purposes. The consent-based registration of data in the well-established Swedish and Norwegian national CP registries will secure longitudinal data from childhood into adulthood.

The number of migrant workers in Taiwan increases annually. The majority is from Indonesia and most of them are female caregivers. This study aims to determine the access to health services and the associated factors among Indonesian female domestic workers in Taiwan. In this cross-sectional study, data were collected from February to May 2019, using a structured questionnaire. Subsequently, multiple logistic regression was used to examine the association between socio-demographic factors and health service access. Two hundred and eighty-four domestic migrant workers were interviewed. Eighty-five percent of the respondents declared sickness at work, but only 48.8% seek health care services. Factors associated with health service access were marital status, income, and the availability of an attendant to accompany the migrant workers to the healthcare facilities. Language barrier and time flexibility were the main obstacles. Further research and an effective health service policy are needed for the domestic migrant workers to better access health care services.

O acesso universal aos serviços de saúde é um desafio para a gestão municipal numa sociedade em que apresenta a saúde como mercadoria e privilegia o indivíduo consumidor em detrimento do cidadão. O estudo teve como objetivo reconhecer as representações sociais presentes na narrativa das práticas dos gestores municipais de saúde de uma microrregião do sudeste do Brasil sobre o acesso aos serviços de saúde. Trata-se de pesquisa qualitativa mediante entrevista com 16 gestores. Na análise, utilizou-se a técnica do Discurso do Sujeito Coletivo, com o auxílio do programa Qualiquantisoft. Identificaram-se quatro Ideias Centrais: articulação interfederativa; reorganização da porta de entrada; atendimento ao usuário; e, fragilidade para a garantia de acesso. Constatou-se que a qualidade, resolutividade, aproximação com as necessidades do usuário e organização das redes de atenção são pouco expressas, o que reflete um entendimento que não leva em consideração o 'acesso de qualidade e resolutivo'. Compreende-se que a impotência apresentada pelos gestores para gerar mudanças e a falta de participação da sociedade e dos trabalhadores na gestão fortalecem a supremacia dos interesses do mercado e contribuem para a garantia de um 'acesso limitado' e a manutenção do modelo de atenção hegemônico. Universal access to health services is a challenge for municipal administration in a society that treats health as a commodity and gives preference to the individual consumer to the detriment of the citizen. This study sought to identify the social representations in the narrative of local health managers in a micro-region of southeast Brazil about access to health services. It consists of qualitative research with interviews conducted with 16 managers. The Collective Subject Discourse technique was employed with the use of Qualiquantisoft software in the data analysis. Four core ideas were identified: coordination between federal states; reorganization of admission procedures; user service and the precariousness of guaranteed access. It was revealed that the quality, resolvability, approach to the user's needs and the care network organization are poorly addressed, which reflects an understanding that does not consider 'access quality and resolution.' It is understood that the managers' impotence to make changes and the lack of society and worker engagement in management bolster the supremacy of market interests and contribute to 'limited access' and the continuity of the hegemonic model of care.

OBJETIVO: Caracterizar o perfil de indivíduos que não obtiveram o procedimento de contracepção cirúrgica e fatores associados. MÉTODOS: Estudo transversal realizado em Ribeirão Preto (SP), em 2004, com 230 indivíduos que não obtiveram cirurgia de esterilização no período de 1999 a 2004 pelo Sistema Único de Saúde. Foi aplicado um questionário com informações sociodemográficas, uso de métodos anticoncepcionais e aspectos da esterilização e desejo de esterilizar-se no futuro. Foram comparadas as variáveis sexo, idade, religião, renda per capita, estado marital e escolaridade do total dos que não obtiveram o procedimento com 297 indivíduos esterilizados. RESULTADOS: Dos 230 entrevistados 21,3% eram homens e 78,7% mulheres. A maioria era casada, branca, católica e tinha pelo menos quatro anos de estudo. A renda per capita mediana mensal foi R$ 140,00. Dos entrevistados, 23 (10%) tinham expectativa de fazer a cirurgia. Os restantes 207 foram classificados em dois grupos: 71% decidiram adiar cirurgia e 29% encontraram obstáculos no acesso à esterilização. O segundo grupo foi associado a ser mulher, jovem e negra. Após regressão logística, ser negro foi o único fator que se manteve associado à não-obtenção da esterilização. Ao comparar com o grupo dos que obtiveram o procedimento, pertencer ao sexo feminino, ser de maior idade, ter como religião a evangélica e ser solteiro estiveram associados à não obtenção da esterilização, enquanto maior renda e maior escolaridade favoreceram o acesso. CONCLUSÕES: Poucos indivíduos estudados não tiveram acesso à esterilização, sobretudo por terem adiado esse procedimento e uma menor parcela teve obstáculos institucionais. Os negros encontraram mais barreiras que os brancos. OBJECTIVE: To characterize the profile of individuals who were unable to obtain the surgical contraception procedure, and associated factors. METHODS: This was a cross-sectional study conducted in Ribeirão Preto (Southeastern Brazil) in 2004, on 230 individuals who were unable to obtain sterilization surgery through the National Health System between 1999 and 2004. A questionnaire on sociodemographic information, use of contraceptive methods, aspects of sterilization and desire to undergo sterilization in the future was applied. The variables of sex, age, religion, per capita income, marital status and schooling level were compared between the total number of individuals who were unable to obtain this procedure and 297 individuals who were sterilized. RESULTS: Among the 230 interviewees, 21.3% were men and 78.7% were women. Most of them were married, white and Catholic and had had at least four years of schooling. The median monthly per capita income was R$ 140.00. Twenty-three of them (10%) had hopes of undergoing the operation. The remaining 207 were classified in two groups: 71% had decided to postpone the operation and 29% had faced obstacles in relation to gaining access to sterilization. The latter group was associated with being female, young and black. After logistic regression, being black was the only factor that remained associated with inability to obtain sterilization. Comparison with individuals who were able to obtain the procedure showed that being female, older, evangelical and single were associated with inability to obtain sterilization, while higher income and schooling levels favored access. CONCLUSIONS: Few of the individuals studied had not had access to sterilization. Most had postponed the procedure and a smaller proportion had encountered institutional obstacles. Blacks encountered more barriers than whites did. OBJETIVO: Caracterizar el perfil de individuos que no obtuvieron el procedimiento de contracepción quirúrgica y factores asociados. MÉTODOS: Estudio transversal realizado en Ribeirão Preto (Sureste de Brasil), en 2004, con 230 individuos que no obtuvieron cirugía de esterilización en el período de 1999 a 2004 por el Sistema Único de Salud. Fue aplicado un cuestionario con informaciones sociodemográficas, uso de métodos anticonceptivos y aspectos de la esterilización y deseo de esterilizarse en el futuro. Fueron comparadas las variables sexo, edad, religión, renta per capita, estado marital y escolaridad del total de los que no obtuvieron el procedimiento con 297 individuos esterilizados. RESULTADOS: De los 230 entrevistados 21,3% eran hombres y 78,7% mujeres. La mayoría era casada, blanca, católica y tenía por lo menos cuatros años de estudio. La renta per capita mediana mensual fue R$ 140,00. De los entrevistados, 23 (10%) tenían expectativa de hacer la cirugía. Los restantes 207 fueron clasificados en dos grupos: 71% decidieron posponer la cirugía y 29% encontraron obstáculos en el acceso a la esterilización. El segundo grupo fue asociado a ser mujer, joven y negra. Posterior a la regresión logística, ser negro fue el único factor que se mantuvo asociado a la no obtención de la esterilización. Al comparar con el grupo de los que obtuvieron el procedimiento, pertenecer al sexo femenino, ser mayor de edad, tener como religión la evangélica y ser soltero estuvo asociado a la no obtención de la esterilización, mientras que mayor renta y mayor escolaridad favorecieron el acceso. CONCLUSIONES: Pocos individuos estudiados no tuvieron acceso a la esterilización, sobretodo por haber pospuesto ese procedimiento y una menor parcela tuvo obstáculos institucionales. Los negros encontraron más barreras que los blancos.

Background Access to health services such as palliative care is determined not only by health policy but a number of legacies linked to geography and settlement patterns. We use GIS to calculate potential spatio-temporal access to palliative care services. In addition, we combine qualitative data with spatial analysis to develop a unique mixed-methods approach. Methods Inpatient health care facilities with dedicated palliative care beds were sampled in two Canadian provinces: Newfoundland and Saskatchewan. We then calculated one-hour travel time catchments to palliative health services and extended the spatial model to integrate available beds as well as documented wait times. Results 26 facilities with dedicated palliative care beds in Newfoundland and 69 in Saskatchewan were identified. Spatial analysis of one-hour travel times and palliative beds per 100,000 population in each province showed distinctly different geographical patterns. In Saskatchewan, 96.7% of the population living within a-1h of drive to a designated palliative care bed. In Newfoundland, 93.2% of the population aged 65+ were living within a-1h of drive to a designated palliative care bed. However, when the relationship between wait time and bed availability was examined for each facility within these two provinces, the relationship was found to be weak in Newfoundland (R2 = 0.26) and virtually nonexistent in Saskatchewan (R2 = 0.01). Conclusions Our spatial analysis shows that when wait times are incorporated as a way to understand potential spatio-temporal access to dedicated palliative care beds, as opposed to spatial access alone, the picture of access changes.

Background Although the burden of cardiopulmonary diseases in the Aboriginal community is high, utilisation of rehabilitation services has been poor. We evaluated the uptake and effectiveness of a cardiovascular and pulmonary rehabilitation program specifically designed and provided for the Aboriginal community, by the Tasmanian Aboriginal Centre, for people with diagnosed chronic heart or respiratory disease and those at high risk of developing such conditions. Methods Participants had established chronic obstructive pulmonary disease, ischaemic heart disease or chronic heart failure or were at high risk of developing such diseases because of multiple risk factors. Rehabilitation programs (n = 13) comprised two exercise and one education session per week over eight weeks. Data, collected at baseline and on completion, included health status, risk factors, attendance, anthropometric measurements, physical capacity and quality of life. Data from participants who attended at least one program session were analysed. Qualitative written feedback from participants and staff was analysed thematically. Results Of 92 participants (39% with an established disease diagnosis), 72 provided follow-up data. Participants lost weight, and waist circumference decreased (mean -3.6 cm, 95% confidence interval (CI)-2.5 to -4.7). There were clinically significant improvements in six-minute walk distance (mean 55.7 m, 95% CI 37.8 to 73.7) and incremental shuttle walk (mean 106.2 m, 95% CI 79.1 to 133.2). There were clinically significant improvements in generic quality of life domains, dyspnoea and fatigue. Generally, the improvements in participants with established cardiac or respiratory diseases did not differ from that in people with risk factors. Analysis of qualitative data identified three factors that facilitated participation: support from peers and health workers, provision of transport and the program structure. Participants’ awareness of improvements in their health contributed to ongoing participation and positive health outcomes, and participants would recommend the program to family and friends. Conclusion A cardiopulmonary program, which included exercise and education and met national guidelines, was designed and delivered specifically for the Aboriginal community. It increased participation in rehabilitation by Aborigines with, or at high risk of, established disease and led to positive changes in health behaviours, functional exercise capacity and health related quality of life.