Hjúkrunarfræðingar og skimun í ljósi reynslunnar af EFI-málþroskaskimun

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/OpenÁ haustráðstefnu Miðstöðvar heilsuverndar barna árið 2000 var m.a. fjallað um EFI-málþroskaskimun og gerð grein fyrir hvernig reynslan hefði verið af þeirri skimun. Niðurstöðurnar hafa leitt hugann að öðrum skimunum í ung- og smábarnavernd sem m.a. eru sjónpróf og hljóðholsmæling (tympanometri). Hér verður fjallað um þessar þrjár gerðir skimunar og þátt hjúkrunarfræðinga í þeim því í flestum tilvikum framkvæma hjúkrunarfræðingar þær

Prevalence and diversity of emotional abuse and neglect in childhood in Iceland.

Efst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinnInngangur: Uppeldisaðferðir foreldra sem fela í sér ofbeldi geta haft skaðleg áhrif á heilaþroska barna og heilsu þeirra og hegðun til lengri eða skemmri tíma. Umfang og margbreytileiki ofbeldisins er mikilvægur áhrifaþáttur og vanræksla er ein alvarlegasta birtingarmynd þess. Markmið rannsóknarinnar er að skoða algengi og umfang andlegs ofbeldis og vanrækslu sem fullorðnir Íslendingar segja að þeir hafi reynslu af í æsku og hvernig hún hefði áhrif á mat þeirra á uppeldi sínu. Efniviður og aðferðir: Slembiúrtak einstaklinga 18 ára og eldri úr Þjóðskrá Íslands. Viðmælendur voru beðnir um að meta uppeldi sitt og svara spurningum um reynslu af 8 mismunandi formum andlegs ofbeldis og reynslu af vanrækslu í æsku. Niðurstöður: Af 966 viðmælendum svöruðu 663 (69%) að þeir hefðu reynslu af einu eða fleiri af 8 formum andlegs ofbeldis. Þeir sem voru yngri en 30 ára voru 2,9 sinnum líklegri til að segja frá slíkri reynslu borið saman við þá sem voru eldri (95% CI 1,9-4,3). Meiri líkur voru á því að viðkomandi teldi uppeldi sitt slæmt eða ásættanlegt borið saman við gott eftir því sem svör um reynslu af andlegu ofbeldi voru fjölbreyttari (p<0,0001) og umfangsmeiri (p<0,0001). Samtals 105 (11%) töldu sig hafa verið van-ræktir í æsku. Marktækt fleiri karlar en konur höfðu reynslu af andlegu ofbeldi (p=0,0020) en konur af vanrækslu (p=0,0440). Ályktun: Rúmlega 2/3 af fullorðnum Íslendingum segja frá reynslu af einu eða fleiri af 8 formum andlegs ofbeldis í æsku og rúmlega 1/10 af vanrækslu. Uppeldisaðferðum má breyta, meðal annars með fræðslu, félagslegum stuðningi og lagasetningu.Introduction: Parenting styles that include abuse can harm the development of the child's brain with a long or short-term impact on his/her health and behaviour. The scope and diversity of abuse are important determinants, and neglect is one of its most serious manifestations. The aim of the study is to examine the prevalence and diversity of emotional abuse and neglect reported by adult Icelanders in their childhood, and how such experience had influenced their evaluation of their upbringing. Materials and methods: Icelanders 18 years and older were randomly selected from the national population register. They were invited to express their perception of their upbringing, and answer questions regarding their experience of 8 specific forms of emotional abuse in childhood, and neglect. Results: Of 966 interviewees, 663 (69%) had experienced one or more of the 8 forms of emotional abuse. Those younger than 30 years were 2.9 times more likely to have such an experience compared to those who were older (95% CI 1.9 to 4.3). The perception of upbringing as bad or acceptable compared to good was significantly related to the number of forms of emotional abuse applied (p <0.0001) and the scope of its application (p<0.0001). In total 105 (11%) considered that they had experienced neglect in childhood. Significantly more men than women had experienced emotional abuse (p= 0.0020), whereas women reported neglect (p=0.0440). Conclusion: More than 2/3 of adult Icelanders report experience of one or more out of 8 different forms of emotional abuse and 1/10 report neglect. Parenting styles can be changed, e.g. with education, social support, and legislation

Directorate of Health following a merger

Neðst á síðunni er hægt að nálgast greinina í heild sinni með því að smella á hlekkinn View/Open Allur texti - Full tex

Health education and cholera in rural Guinea-Bissau

AbstractObjective: The study was undertaken to explore local ideas about cholera and the diffusion of official health educational messages for cholera prevention and to assess whether such messages contributed to changed behavior in the population.Methods: During the ongoing cholera epidemic in 1994 in Guinea-Bissau, West Africa, a roster of all adult residents in a rural community was established. From this roster of 458 adults, 53 of 60 randomly chosen residents were interviewed for qualitative data on cholera and its prevention.Results: Local preventive rituals performed contributed to high awareness of the epidemic. Radio and word-of-mouth communication were the most important sources of information on cholera, whereas posters and television did not effectively reach the population. All persons with cholera rapidly sought care. Thirty-four (64%) of 53 participants recalled at least one preventive measure; specifically, treatment of water with lemon was mentioned by 21 (40%) of respondents. None of the respondents could explain how cholera is transmitted to humans.Conclusions: To improve compliance with recommended preventive measures, these should take local conceptions of diseases into account and be few in number, practical, and effective. The impact of the radio could be increased if those who hear the message are urged to spread the recommendation, especially to women who take care of food, water, and general hygiene in the household

Health services for children and the implementation of IMCI in Monkey Bay, Malawi

Hægt er að lesa greinina í heild sinni með því að smella á hlekkinn View/OpenOBJECTIVES: Examine primary health care services for ill children in a sub-Saharan African country, assess the appropriateness of the Integrated Management of Childhood Illness (IMCI) in such a setting and evaluate its implementation. MATERIAL AND METHODS: The study was carried out in March, 2005 in the Monkey Bay area, Malawi, in two state-run health facilities that provide services free of charge and in three privately run facilities that charge user fees. Data was collected from each facility regarding all out-patient visits but in particular of children under five years of age (U5s). Interviews were conducted with health workers and drug inventories were carried out in the facilities. RESULTS: Eight out of 10 health workers were trained in IMCI. It was 1.22 times more likely (RR, 95% CI 1.18-1.26) that U5s were brought to a state-run facility than a private one. Around 4/5 of all disease classifications during the research period are dealt with in the IMCI. About half of U5s were classified with malaria, 28% with other respiratory infections, 6% with pneumonia, and 5% with diarrhoea. Most IMCI-recommended drugs were in stock at the time of inspection but all facilities lacked at least one recommended drug. CONCLUSION: Results show that IMCI reaches the periphery of the health care system in a low-income country such as Malawi. They confirm that IMCI deals with the majority of diseases affecting U5s in such a setting. User fees seem to influence health care seeking behaviour. It is important to support and strengthen health services for ill children in the area, support continuous education of staff and ensure availability of drugs and equipment

Review shows that Icelandic society is taking firmer steps to tackle the diverse forms of child abuse and neglect that its children are exposed to

Publisher's version (útgefin grein).Aim: This review examined and summarised the research published on child abuse in Iceland, which was mainly in the country's native language, to make the findings more accessible to English speakers. It specifically focused on child rearing and the physical, emotional and sexual abuse, neglect and intrafamilial conflicts suffered by children at the hands of their parents and other carers. Method: The review drew on published research, books and reports and compared the findings with Nordic research and global estimates of child abuse. Results: Qualitative and quantitative research revealed that the prevalence of different forms of child abuse, child neglect and intra-familial conflicts in Iceland was similar to, or higher than, global and Nordic estimates. Younger respondents reported less physical abuse than older respondents, but higher levels of emotional abuse. Legislation, greater awareness, public debates and research on child abuse in Iceland have contributed to the growing recognition of the negative consequences of child abuse and strengthened support for prevention strategies. Conclusion: Icelandic children have reportedly experienced diverse forms of child abuse and neglect from their parents and other carers. Diverse initiatives have been put in place that underline the urgent need to tackle such behaviour.Peer Reviewe

Iceland and development aid in the era of the MDGs: a case study of an Alma Ata inspired primary healthcare project in southern Malawi

Publisher's version (útgefin grein)The monitoring of relevant health indicators is important in the examination of work that aims to improve health, not only globally, as for example, through the Millennium Development Goals 2000–2015, but also at the national, regional and/or sectoral, level. During the period 2000–2011, the Icelandic International Development Agency (ICEIDA) supported the strengthening of the primary healthcare system in the Monkey Bay area of Mangochi District, Malawi. Based on data collected through several evaluative approaches and the use of commonly used health indicators, we explore the overall performance and constraints of the services provided by ICEIDA during project implementation. Structural and diverse process indicators provided evidence that access to governmental services improved during the project period. The population expressed satisfaction with the ongoing improvement of the healthcare services they felt were of good value and quality. During the MDG era, Malawi succeeded in decreasing the under-5 mortality rate by 2/3 (MDG4 target), and maternal mortality by 66% by implementing evidence based interventions similar to those ICEIDA supported in the Monkey Bay area. Albeit small, ICEIDA's support was a relevant, effective, and efficient approach to strengthen primary healthcare services in the Monkey Bay area, resulting in tangible and sustainable benefits for the Monkey Bay communities, that may also be applicable in other settings.Peer Reviewe

Donor dilemmas in a fragile state: NGO-ization of community healthcare in Guinea-Bissau

Publisher's version (útgefin grein)There is increased emphasis on donor engagement in the world’s poorest and most fragile states, but aid modalities tend to differ depending on the recipient countries’ governance. In fragile states, donors often bypass governments and collaborate with non-state development actors (NGOs) to prevent aid capture, improve effective delivery and increase effectiveness. Based on ethnographic fieldwork over 20 months in 2009–2012, the aim of this paper is to explore the role of NGOs in community-based primary healthcare vis-à-vis the Ministry of Health in Guinea-Bissau. Revitalization of Guinea-Bissau’s formerly extensive community healthcare services was initiated in 2010. The Ministry of Health, in charge of its implementation, emphasized ownership, harmonization and alignment that created tension with NGOs. However, as a result of a military coup in 2012, donors bypassed the Ministry and gave NGOs a central role. Through the voices of stakeholders, this paper outlines donors’ dilemmas in a situation of state fragility. They found NGO-ization reasonable to protect funds and secure implementation while some worried that it might counteract alignment, harmonization, ownership and sustainability. The paper argues that aid to the health sector in fragile states needs to be long-term and predictable.This paper is based on findings from the PhD thesis of the first author. We would like to thank the various actors that financed the PhD research: The Doctoral Grants of The University of Iceland Research Fund that funded the research for three years; the Faculty of Sociology, Anthropology and Folkloristics at the University of Iceland for a one-year teacher’s stipend; and the Nordic Africa Institute for a travel scholarship to visit Guinea-Bissau, as well as two months PhD scholarships at the Institute and for use of its excellent library. We would also like to thank all donor representatives, international and national NGO workers, Ministry of Health officials and local health professionals that accepted to participate in this study.Peer Reviewe

‘Tiny Iceland’ preparing for Ebola in a globalized world

Publisher's version (útgefin grein)Background: The Ebola epidemic in West Africa caused global fear and stirred up worldwide preparedness activities in countries sharing borders with those affected, and in geographically far-away countries such as Iceland. Objective: To describe and analyse Ebola preparedness activities within the Icelandic healthcare system, and to explore the perspectives and experiences of managers and frontline health workers. Methods: A qualitative case study, based on semi-structured interviews with 21 staff members in the national Ebola Treatment Team, Emergency Room at Landspitali University Hospital, and managers of the response team. Results: Contextual factors such as culture and demography influenced preparedness, and contributed to the positive state of mind of participants, and ingenuity in using available resources for preparedness. While participants believed they were ready to take on the task of Ebola, they also had doubts about the chances of Ebola ever reaching Iceland. Yet, factors such as fear of Ebola and the perceived stigma associated with caring for a potentially infected Ebola patient, influenced the preparation process and resulted in plans for specific precautions by staff to secure the safety of their families. There were also concerns about the teamwork and lack of commitment by some during training. Being a ‘tiny’ nation was seen as both an asset and a weakness in the preparation process. Honest information sharing and scenario-based training contributed to increased confidence amongst participants in the response plans. Conclusions: Communication and training were important for preparedness of health staff in Iceland, in order to receive, admit, and treat a patient suspected of having Ebola, while doubts prevailed on staff capacity to properly do so. For optimal preparedness, likely scenarios for future global security health threats need to be repeatedly enacted, and areas plagued by poverty and fragile healthcare systems require global support.We are grateful to participating institutions for giving permission to conduct the study, but not the least, to the participants who contributed with their time and experience.Peer Reviewe