15 research outputs found
sj-docx-1-smo-10.1177_20503121221095942 – Supplemental material for ‘I got to understand what it means to be a cancer patient’: Qualitative evidence from health professional cancer patients and survivors
No full textSupplemental material, sj-docx-1-smo-10.1177_20503121221095942 for ‘I got to understand what it means to be a cancer patient’: Qualitative evidence from health professional cancer patients and survivors by Germans Natuhwera, Peter Ellis, Stanley Wilson Acuda and Elizabeth Namukwaya in SAGE Open Medicine</p
Women's lived experiences of advanced cervical cancer: a descriptive qualitative study.
No full textTo explore the lived experiences of women with advanced incurable cervical cancer attending a palliative care service in Uganda. This qualitative and exploratory study was conducted at Mobile Hospice Mbarara in South Western Uganda. The target population was a convenience sample of all patients with a confirmed histological diagnosis of advanced cervical cancer; stage 2B to 4B, and clinically advanced disease. Demographic data were collected prior to conducting semi-structured audio-taped interviews. Transcripts were read and re-read, coded and codes were then abstracted into emergent broad-based meaningful themes by consensus. A total of 10 participants, average age of 53.4, age range 40-71, cancer staging 2B to 4 and average duration of illness 3.5 years were interviewed. Six themes emerged from the data: socio-demographic profiles of the women; road to cancer diagnosis; effects of disease on women's quality of life; experiences with main stream medicine; adapting to having cancer and needs of the women. Living with advanced incurable cervical cancer is associated with significant disruptions in all domains of life. Good palliative care enables patients to achieve an optimal quality life. Poverty and a lack of knowledge about cervical cancer among women and health workers are the strongest predictors of a patient receiving a late advanced diagnosis
The Epidemiology of Addiction in Sub-Saharan Africa: A Synthesis of Reports, Reviews, and Original Articles
No full textPsychosocial and emotional morbidities after a diagnosis of cancer: Qualitative evidence from healthcare professional cancer patients
No full textThis inquiry aimed to; (1) examine the psychosocial and emotional sequelae associated with cancer patient-hood experience in healthcare professionals (HCPs) in Uganda, (2) generate evidence to inform clinical and nursing practice about the needs of HCP patients with cancer. This was a qualitative phenomenological study. The study was conducted among HCP cancer patients and survivors recruited from oncology and palliative care settings in Uganda. Data were collected via audio-taped, face-to-face or telephone open-ended interviews. Interviews were transcribed verbatim. Thematic analysis was used. Eight HCP cancer patients and survivors participated in the study. Their mean age was 56 years, range 29-85 years. Three major themes emerged: (1) From a healthcare provider to a patient, (2) Socioeconomic challenges, and (3) Coping and support strategies. [Abstract copyright: © 2022 The Authors. Nursing Open published by John Wiley & Sons Ltd.
‘I got to understand what it means to be a cancer patient’: Qualitative evidence from health professional cancer patients and survivors
No full textObjective: The study sought to (1) examine healthcare professionals’ (HCPs) lived experiences of cancer and (2) generate evidence to inform policy and clinical practice for cancer care. Methods: This was a qualitative study conducted between January and December 2020 on HCPs who were ill with, or who had survived cancer in Uganda. Purposive sampling was used. A demographic form and an open-ended topic guide were used to collect data. Face-to-face and telephone interviews were conducted in English; audio-recorded data was collected until saturation was reached. Colaizzi’s framework of thematic analysis was used. Results: Eight HCP cancer patients and survivors from medical, allied health, and nursing backgrounds participated in the study. Their mean age was 56 years (29–85). Five were female. Four broad themes emerged from the interviews: (1) experience of pre-diagnosis and receiving bad news, (2) impact on self and role identity, (3) healthcare system and treatment experiences, and (4) the gaps and what should be done. Conclusion: Cancer patient-hood introduces vulnerability and remarkable disruptions and suffering in nearly all domains of quality-of-life, that is, in professional identity and work, social, emotional, physical, and economic facets of life. Participants identified how they experienced a healthcare system which was costly and staffed by unmotivated staff with limited access to resources, which resulted in many unmet needs and an overall poor experience. Participants identified how, in their view, the healthcare system in Uganda needed to be better resourced, protected by policy and legislation and how cancer awareness among the population needed to be improved
Serious Adverse Drug Reactions to Long-Term Oral Liquid Morphine in Patients with Chronic Pain: A Cross-Sectional Survey in Palliative Care
No full textBarbara Duncan,1 Germanus Natuhwera,1,2 Doris Nassuuna,3 Roselight Katusabe,1 Hanif Kasozi,1 Wilson Acuda2 1Clinical Department, Hospice Africa Uganda, Kampala, Uganda; 2Education Department, Institute of Hospice and Palliative Care in Africa, Kampala, Uganda; 3Research Department, International Rescue Committee, Kampala, UgandaCorrespondence: Germanus Natuhwera, Email [email protected]; [email protected]: Behaviour suggestive of addiction in some patients on long-term oral liquid morphine (OLM) caused concern amongst the Hospice Africa Uganda clinical team and prompted the survey. This survey aimed to identify serious adverse drug reactions to long-term OLM in patients with chronic pain receiving palliative care.Methods: In Phase 1, the database of patients receiving palliative care at Hospice Africa Uganda was analyzed to find patients taking OLM from 12.7.2017 to 19.10.2017. A purposive review of their medical records was undertaken to identify those on long-term OLM. Phase 2 was conducted between 12.6.2018 and 23.10.2018. All patients on long-term OLM were offered biopsychosocial and spiritual assessment by a pain specialist (BD) to determine whether they were experiencing any serious adverse drug reactions. Phase 3 immediately followed phase 2 assessment. The pain specialist discussed with the participant any medication changes (including OLM) or other therapies to facilitate holistic management of pain for the individual.Results: In phase 1, 653 patients on OLM were identified. Phase 2 identified 49 patients who were on long-term OLM. Thirty-four patients agreed to participate in the assessment with the pain specialist. Of the 34 participants, 24 had chronic non-cancer pain and two had chronic cancer pain. Eight cancer survivors had incidental chronic non-cancer pain. Serious adverse drug reactions were identified in four participants with chronic non-cancer pain. Two cases of addiction, one case of opioid hyperalgesia, and one probable diversion of morphine.Conclusion: To our knowledge, the study identified the first documented cases of addiction to OLM in sub-Saharan Africa. Future research involving a larger multicenter sample, longitudinal, and qualitative designs is needed. Education of healthcare practitioners prescribing opioids should put equal emphasis on management of chronic non-cancer pain as do chronic cancer pain to minimize the risk of serious adverse reactions.Keywords: chronic pain, opioids, oral liquid morphine, palliative care, serious adverse drug reaction
Medically Unexplained Somatic Symptoms in Different Cultures. A Preliminary Report From Phase I of the World Health Organization International Study of Somatoform Disorders
No full textThe World Health Organization has recently launched an international study of somatoform disorders in different cultures. Five centres representing distinct cultures participated in phase I of the project, the main objective of which was to test the cross-cultural applicability and reliability of instruments for the assessment of somatoform disorders. The analysis of the assessed somatic symptoms showed that various aches and pains in different parts of the body represented cross-culturally the most frequent symptoms for which there was no medical explanation. Such symptoms may indicate the presence of an underlying mental disorder but can also represent a means for culture-specific expression of psychosocial distress. This bears particular significance for health professionals in primary and general medical care, who are most likely to encounter patients presenting with multiple, persistent and medically unexplained somatic symptoms.TEXAS A&M UNIV,HLTH SCI CTR,DEPT PSYCHIAT,TEMPLE,TX 76508UNIV ZIMBABWE,DEPT PSYCHIAT,HARARE,ZIMBABWEUNIV CAGLIARI,INST PSYCHIAT,CAGLIARI,ITALYNATL INST MENTAL HLTH & NEUROSCI,DEPT PSYCHIAT,BANGALORE 560029,KARNATAKA,INDIAESCOLA PAULISTA MED,DEPT PSYCHIAT,SAO PAULO,BRAZILUNIV MILAN,PSYCHIAT CLIN,MILAN,ITALYESCOLA PAULISTA MED,DEPT PSYCHIAT,SAO PAULO,BRAZILWeb of Scienc
Human Resource and Funding Constraints for Essential Surgery in District Hospitals in Africa: A Retrospective Cross-Sectional Survey.
No full textThere is a growing recognition that the provision of surgical services in low-income countries is inadequate to the need. While constrained health budgets and health worker shortages have been blamed for the low rates of surgery, there has been little empirical data on the providers of surgery and cost of surgical services in Africa. This study described the range of providers of surgical care and anesthesia and estimated the resources dedicated to surgery at district hospitals in three African countries. We conducted a retrospective cross-sectional survey of data from eight district hospitals in Mozambique, Tanzania, and Uganda. There were no specialist surgeons or anesthetists in any of the hospitals. Most of the health workers were nurses (77.5%), followed by mid-level providers (MLPs) not trained to provide surgical care (7.8%), and MLPs trained to perform surgical procedures (3.8%). There were one to six medical doctors per hospital (4.2% of clinical staff). Most major surgical procedures were performed by doctors (54.6%), however over one-third (35.9%) were done by MLPs. Anesthesia was mainly provided by nurses (39.4%). Most of the hospital expenditure was related to staffing. Of the total operating costs, only 7% to 14% was allocated to surgical care, the majority of which was for obstetric surgery. These costs represent a per capita expenditure on surgery ranging from US0.14 between the eight hospitals. African countries have adopted different policies to ensure the provision of surgical care in their respective district hospitals. Overall, the surgical output per capita was very low, reflecting low staffing ratios and limited expenditures for surgery. We found that most surgical and anesthesia services in the three countries in the study were provided by generalist doctors, MLPs, and nurses. Although more information is needed to estimate unmet need for surgery, increasing the funds allocated to surgery, and, in the absence of trained doctors and surgeons, formalizing the training of MLPs appears to be a pragmatic and cost-effective way to make basic surgical services available in underserved areas. Please see later in the article for the Editors' Summary
Depressive symptoms and palliative care concerns among patients with non-communicable diseases in two Southern African countries
No full textCONTEXT: Non-communicable diseases (NCDs), associated with health-related suffering, can benefit from palliative care in resource-limited settings, where over four-fifths of these deaths occur.OBJECTIVE: To measure the prevalence of depressive symptoms, palliative care-related concerns, physical and other psychological symptoms among adult patients with NCDs in Malawi and Namibia.METHODS: This multi-center, cross-sectional study consecutively recruited outpatients from four tertiary referral hospitals. Stepwise regression analysis was used to assess factors associated with physical and psychological symptom burden.RESULTS: Among 457 participants, primary diagnosis was cancer (n=147, 32%); cardiovascular disease (CVD) (n=130, 28%), chronic respiratory disease (CRESD) (n=73, 16%) or diabetes (n=107, 23%). Over half were female (58.9%; n=269), mean age was 48 (SD=15.7). Clinically significant psychological distress was identified among cancer (57.2%), diabetes (57.0%), CRESD (45.2%) and CVD patients (43.1%), with criterion for major depression symptoms met for cancer (42.9%), diabetes (39.2%), CVD (30.0%) and CRESD (28.8%). Most severe palliative care concerns were: first sharing feelings (i.e., not at all/not very often), reported by CVD (28%), CRESD (23%), cancer (22%) and diabetes (21%) patients; second help and advice (i.e., none/very little), among cancer (28%), CVD (26%), diabetes (22%), and CRESD (16%) patients. High prevalence of moderate-to-severe pain was reported (cancer 54%, CVD 41%, CRESD 38%, diabetes 38%). Functional status, age and presence of comorbidities were associated with physical and psychological symptom distress.CONCLUSION: Given the high burden of physical and psychosocial symptoms and symptom distress, the findings highlight the need for integrated person-centered palliative care for NCDs to optimize care outcomes.</p
Estilo de vida dos portadores do vírus HIV atendidos no município de Florianópolis
No full textEste estudo objetivou avaliar o estilo de vida de indivíduos portadores do vírus HIV ou soropositivos. A amostra final foi constituída de 111 soropositivos (erro amostral de 8%). Foram 68 homens e 43 mulheres, com média de idade de 37,04 anos (DP = 7,47), e que voluntariamente aceitaram fazer parte do estudo. Os dados foram coletados através de um roteiro de entrevista, no período de outubro a dezembro de 2002, contendo as seguintes informações: a)sociodemográficas; c) clínicas de saúde e antropométricas; d) estilo de vida (Perfil do Estilo de Vida Individual) e e) nível de atividade física habitual (IPAQ-8). Na análise dos dados foi utilizado o pacote estatístico SPSSvers ão 10.0 e adotou-se um nível de significância de 5%. Destacaram-se as características sociodemográficas: 71,1% possuíam fonte de renda, sendo que 47,8% eram economicamente ativos; prevaleceram as profissões que caracterizavam um tipo de trabalho ativo, 55,9% pertenciam a famílias pequenas (com até 3 pessoas), mais da metade não era chefe da família (54,1%), estado civil solteiro/a, viúvo/a, separado/a ou divorciada/a (53,2%) com mais de oito anos de estudo formal (56,8%), e com renda familiar inferior ou até R$ 300,00 (50,4%). O tempo médio de soropositividade informado pelos pacientes foi de 5,6 anos (DP = 4,4). Dentre as categorias de exposição ao vírus HIV, destacaram-se: a heterossexual (48,7%) e a UDI (26,1%). A contagem do número de linfócitos T CD4+ apresentou uma média de 345,3 cél/mm3. O valor médio para carga viral foi de 38876,49 cópias/ml. Em torno de 80% dos pacientes faziam tratamento com anti-retrovirais e 64% usavam medicamentos profiláticos. Aproximadamente 56,8% dos entrevistados já estiveram hospitalizados devido a uma ou mais infecções oportunistas. Apesar disto, a autopercepção de saúde foi predominantemente boa, muito boa ou excelente (70,3%). Com relação ao índice de massa corporal, 66,7% apresentaram valores dentro da faixa recomendável. Quanto ao estilo de vida, maior proporção de indivíduos (61,3%), tiveram o perfil considerado satisfatório, sendo maior proporção de mulheres (69,8%), do que de homens (55,9%). O comportamento preventivo foi o aspecto mais destacado pelos soropositivos, provavelmente devido à gravidade da doença. Quanto ao nível de atividade física habitual, maior parte dos indivíduos, foi classificada como ativa ou muito ativa (79,3%). Houve associações estatisticamente significativas (p p<0,05) entre a contagem do número de linfócitos T CD4+ igual ou superior a 296 células/mm3 , possuir nível de atividade física habitual classificado como ativoou muito ativo, estar casado/a ou vivendo com parceiro/a e possuir de 21 a 37 anos de idade. Não foram verificadas associações estatisticamente significativas entre a contagem do número de linfócitos T CD4+ e as variáveis sociodemográficas (sexo, raça, nível de escolaridade e renda familiar)
