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Felix JB, de Campos AC, Logan SW, Machado J, Souza Monteiro K, Longo E. Go Zika Go: feasibility study with modified motorized ride-on cars for the mobility of children with Congenital Zika Syndrome (CZS). Disabil Rehabil Assist Technol 2024:1-14. [PMID: 38166551 DOI: 10.1080/17483107.2023.2300052] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/23/2023] [Accepted: 12/21/2023] [Indexed: 01/04/2024]
Abstract
PURPOSE To explore the feasibility of an intervention using modified ride-on cars in terms of acceptability and potential changes in goal attainment, mobility, social function, and participation of children with Congenital Zika Syndrome (CZS). MATERIALS AND METHODS A pre- and post-intervention feasibility study was conducted with children with CZS, levels IV and V of the Gross Motor Function Classification System (GMFCS). The intervention consisted of 12 weeks of training (3 times a week for 40 min per session) and 4 weeks of follow-up. The primary outcomes included adherence, satisfaction, and learning in mobility. Secondary outcomes encompassed goal attainment, mobility, social/cognitive function, and participation. Descriptive statistics were performed. To explore potential individual changes with the intervention, Wilcoxon test was used to analyze Pediatric Evaluation of Disability Inventory - Computer Adaptive Test (PEDI-CAT) data and Young Children's Participation and Environment Measure (YC-PEM)/Participation and Environment Measure for Children and Youth (PEM-CY), along with standard error measurements of the PEDI-CAT domains. RESULTS Four children participated (median age 4.75 years; two females: three at level V on the GMFCS). Adherence was 75% of the total intervention time, and family members reported being satisfied or very satisfied. Children showed gains in learning the use of the modified ride-on cars and an increase in goal attainment after the intervention. Individual changes were observed in the PEDI-CAT domains (mobility and social/cognitive), but there were no significant changes in participation outcomes. CONCLUSIONS Children with CZS at GMFCS levels IV and V can learn to use motorized ride-on cars, attainment goals, and experience satisfaction.
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Affiliation(s)
- Jean Bendito Felix
- Postgraduate Program in Rehabilitation Sciences, University of Rio Grande do Norte/Faculty of Health Sciences of Trairi, Santa Cruz, Brazil
| | | | - Samuel W Logan
- College of Public Health and Human Sciences, Oregon State University, Corvallis, Oregon, USA
| | - Julianne Machado
- Postgraduate Program in Rehabilitation Sciences, University of Rio Grande do Norte/Faculty of Health Sciences of Trairi, Santa Cruz, Brazil
| | - Karoline Souza Monteiro
- Postgraduate Program in Rehabilitation Sciences, University of Rio Grande do Norte/Faculty of Health Sciences of Trairi, Santa Cruz, Brazil
| | - Egmar Longo
- Postgraduate Program in Rehabilitation Sciences, University of Rio Grande do Norte/Faculty of Health Sciences of Trairi, Santa Cruz, Brazil
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2
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Moreira MCN, Steffen RE, Zin AA, Santos MDS, Costa ACCD, Campos DDS, Barros LBDP, Moreira MEL, Mendes CHF, Kuper H, Pinto M. [Depression, anxiety, stress, and social support: a cross-sectional study with caregivers of visually impaired children in Rio de Janeiro, Brazil - Views-QoL Study]. CAD SAUDE PUBLICA 2023; 39:e00247622. [PMID: 38126419 PMCID: PMC10727032 DOI: 10.1590/0102-311xpt247622] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 12/29/2022] [Revised: 06/19/2023] [Accepted: 07/27/2023] [Indexed: 12/23/2023] Open
Abstract
We aimed to identify the reports of symptoms of depression, anxiety, and stress among caregivers of children without visual impairment, with low vision, and with blindness and their relationship with the degree of social, emotional, material, and affective support. This cross-sectional and multicenter study was conducted in the municipality of Rio de Janeiro, Brazil, from 2019 to 2020. A questionnaire was applied to obtain caregivers' sociodemographic and economic data. The Medical Outcomes Study Social Support Scale (MOS-SSS) and The Depression, Anxiety, and Stress Scale (DASS-21) were used. Tests were used for multiple comparisons of these scales. The prevalence ratio of symptoms of depression, anxiety, and stress was estimated. Of all caregivers (N = 355), more than 90% were women-mothers. Caregivers of children with visual impairment show the highest proportion of no schooling, incomplete elementary education, or lower average monthly income. Most caregivers of children with blindness reported symptoms of depression, anxiety, and stress (66.7%, 73.3%, and 80%, respectively) as did those of children with low vision. The evaluation of the relationship between MOS-SSS and DASS-21 results shows greater support and lower scores of reports of depression, anxiety, and stress for caregivers of children without disabilities or with less visual impairment. For caregivers of blind children, the highest prevalence of such reports was independent of the received support. Results indicate the need for a care policy with mechanisms to protect the mental health of caregivers of visually impaired children.
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Affiliation(s)
- Martha Cristina Nunes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ricardo Ewbanck Steffen
- Instituto de Medicina Social, Universidade do Estado do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Andrea Araujo Zin
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | | | - Ana Carolina Carioca da Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Daniel de Souza Campos
- Escola de Serviço Social, Universidade Federal do Rio de Janeiro, Rio de Janeiro, Brasil
| | - Letícia Baptista de Paula Barros
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Corina Helena Figueira Mendes
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Hannah Kuper
- London School of Hygiene & Tropical Medicine, London, U.K
| | - Márcia Pinto
- London School of Hygiene & Tropical Medicine, London, U.K
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3
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Rothschild J, Haase E. The mental health of women and climate change: Direct neuropsychiatric impacts and associated psychological concerns. Int J Gynaecol Obstet 2023; 160:405-413. [PMID: 36165632 DOI: 10.1002/ijgo.14479] [Citation(s) in RCA: 3] [Impact Index Per Article: 3.0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 04/13/2022] [Revised: 08/11/2022] [Accepted: 09/26/2022] [Indexed: 01/20/2023]
Abstract
Climate change brings exposures to heat, air pollution, poorer quality food, and infectious disease that have significant direct effects on women and their mental health. These environmental impacts are multifaceted in their consequences and raise risks of depression, suicide, violent victimization, post-traumatic stress disorder, and various other neuropsychiatric symptoms. Women also suffer increased climate psychological risks from higher rates of stillbirth, preterm birth, and developmental problems in their children. Here we review what is known about the overlap of women's individual mental health and climate change, and highlight areas where more research is needed.
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Affiliation(s)
- Julia Rothschild
- Department of Psychiatry and Behavioral Sciences, Duke University School of Medicine, Durham, North Carolina, USA
| | - Elizabeth Haase
- Department of Psychiatry, Carson Tahoe Regional Medical Center, Carson City, Nevada, USA.,University of Nevada School of Medicine at Reno, Reno, Nevada, USA
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4
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Laza-Vásquez C, Briones-Vozmediano E, Gea-Sánchez M. Caring for children with Congenital Zika Syndrome: The unmet needs of mothers in Southern Colombia. Glob Public Health 2022; 17:2752-2763. [PMID: 34632950 DOI: 10.1080/17441692.2021.1987500] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/15/2022]
Abstract
ABSTRACTIn Latin America, the Zika virus (ZIKV) epidemic of 2015-2016 resulted in children being born with a spectrum of neurological disorders called Congenital Zika Syndrome (CZS). Women are the primary caregivers of those children. The objective of the study was to identify the perceived needs of women to care for their children with CZS in Southern Colombia. In 2019, a qualitative ethnographic study was conducted in southern Colombia, including 21 women belonging to a self-managed support group and who had prenatal ZIKV between 2015 and 2016 and, as a consequence, their children were born with CZS. Three discussion groups and six semi-structured interviews were conducted and analyzed through qualitative content analysis. Three main perceived needs to care for their children were identified: knowledge and skills to provide the complex care their children require and for which they did not feel prepared, economic and social support. This study showed that women face unmet needs when caring for their children with CZS, especially regarding social support. Therefore, it is urgent to generate public policies and intervention strategies for professionals to support these women in order to meet not only the needs of their children but also their own.
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Affiliation(s)
- Celmira Laza-Vásquez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Health Institut of Lleida (IRBLleida), Lleida, Spain.,Nursing Program, Surcolombiana University, Neiva, Colombia
| | - Erica Briones-Vozmediano
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Health Institut of Lleida (IRBLleida), Lleida, Spain.,Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
| | - Montserrat Gea-Sánchez
- Department of Nursing and Physiotherapy, Faculty of Nursing and Physiotherapy, University of Lleida, Lleida, Spain.,Health Care Research Group (GRECS), Biomedical Health Institut of Lleida (IRBLleida), Lleida, Spain.,Society, Health, Education and Culture Research Group (GESEC), University of Lleida, Lleida, Spain
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5
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Souza MPA, da Natividade MS, Werneck GL, Dos Santos DN. Congenital Zika syndrome and living conditions in the largest city of northeastern Brazil. BMC Public Health 2022; 22:1231. [PMID: 35725427 PMCID: PMC9208747 DOI: 10.1186/s12889-022-13614-x] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/25/2021] [Accepted: 06/09/2022] [Indexed: 12/01/2022] Open
Abstract
Background The Zika virus (ZIKV) epidemic hit Brazil in 2015 and resulted in a generation of children at risk of congenital Zika syndrome (CZS). The social vulnerability of certain segments of the population contributed to the disproportional occurrence of CZS in the Brazilian Northeast, the poorest region in the country. Living conditions are essential factors in understanding the social determination of CZS, which is embedded in a complex interaction between biological, environmental, and social factors. Salvador, the biggest city in the region, played a central role in the context of the epidemic and was a pioneer in reporting the ZIKV infection and registering a high number of cases of CZS. The aim of the study was identifying the incidence and spatial distribution pattern of children with CZS in the municipality of Salvador, according to living conditions. Methods This is an ecological study that uses the reported cases of ZIKV and CZS registered in the epidemiological surveillance database of the Municipal Secretariat of Health of the city of Salvador between August of 2015 and July of 2016. The neighborhoods formed the analysis units and the thematic maps were built based on the reported cases. Associations between CZS and living conditions were assessed using the Kernel ratio and a spatial autoregressive linear regression model. Results Seven hundred twenty-six live births were reported, of which 236 (32.5%) were confirmed for CZS. Despite the reports of ZIKV infection being widely distributed, the cases of CZS were concentrated in poor areas of the city. A positive spatial association was observed between living in places with poorer living conditions and births of children with CZS. Conclusions This study shows the role of living conditions in the occurrence of births of children with CZS and indicates the need for approaches that recognize the part played by social inequalities in determining CZS and in caring for the children affected.
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Affiliation(s)
- Marcos Paulo Almeida Souza
- Instituto de Saúde Coletiva, Federal University of Bahia, Salvador, Bahia, Brazil. .,Department of Surgery, University Hospital of Lagarto, Federal University of Sergipe, Lagarto, Sergipe, Brazil.
| | | | - Guilherme Loureiro Werneck
- Instituto de Estudos em Saúde Coletiva, Federal University of Rio de Janeiro, Rio de Janeiro, Brazil.,Instituto de Medicina Social, State University of Rio de Janeiro, Rio de Janeiro, Brazil
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6
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Gullo G, Scaglione M, Cucinella G, Riva A, Coldebella D, Cavaliere AF, Signore F, Buzzaccarini G, Spagnol G, Laganà AS, Noventa M, Zaami S. Congenital Zika Syndrome: Genetic Avenues for Diagnosis and Therapy, Possible Management and Long-Term Outcomes. J Clin Med 2022; 11:jcm11051351. [PMID: 35268441 PMCID: PMC8911172 DOI: 10.3390/jcm11051351] [Citation(s) in RCA: 17] [Impact Index Per Article: 8.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/27/2022] [Revised: 02/21/2022] [Accepted: 02/25/2022] [Indexed: 02/01/2023] Open
Abstract
Zika virus (ZIKV) was discovered in Uganda in 1947 and was originally isolated only in Africa and Asia. After a spike of microcephaly cases in Brazil, research has closely focused on different aspects of congenital ZIKV infection. In this review, we evaluated many aspects of the disease in order to build its natural history, with a focus on the long-term clinical and neuro-radiological outcomes in children. The authors have conducted a wide-ranging search spanning the 2012–2021 period from databases PubMed, PubMed Central, Web of Science, Medline, Scopus. Different sections reflect different points of congenital ZIKV infection syndrome: pathogenesis, prenatal diagnosis, clinical signs, neuroimaging and long-term developmental outcomes. It emerged that pathogenesis has not been fully clarified and that the clinical signs are not only limited to microcephaly. Given the current absence of treatments, we proposed schemes to optimize diagnostic protocols in endemic countries. It is essential to know the key aspects of this disease to guarantee early diagnosis, even in less severe cases, and an adequate management of the main chronic problems. Considering the relatively recent discovery of this congenital infectious syndrome, further studies and updated long-term follow-up are needed to further improve management strategies for this disease.
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Affiliation(s)
- Giuseppe Gullo
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.)
| | - Marco Scaglione
- School of Medicine and Surgery, University of Palermo, 90127 Palermo, Italy;
- Department of Biomedicine, Neurosciences and Advanced Diagnostics, University of Palermo, 90133 Palermo, Italy
| | - Gaspare Cucinella
- Department of Obstetrics and Gynecology, Villa Sofia Cervello Hospital IVF UNIT, University of Palermo, 90146 Palermo, Italy; (G.G.); (G.C.)
| | - Arianna Riva
- Department of Women’s and Children’s Health, Padova Hospital, 35128 Padova, Italy;
| | - Davide Coldebella
- Department of Women’s and Children’s Health, Gynaecological Clinic, University of Padova, 35128 Padova, Italy; (D.C.); (G.B.); (G.S.); (M.N.)
| | - Anna Franca Cavaliere
- Department of Gynecology and Obstetrics, Santo Stefano Hospital, ULS Toscana Centro, 59100 Rome, Italy;
| | - Fabrizio Signore
- Department of Gynecology and Obstetrics, Sant’Eugenio Hospital, 00144 Rome, Italy;
| | - Giovanni Buzzaccarini
- Department of Women’s and Children’s Health, Gynaecological Clinic, University of Padova, 35128 Padova, Italy; (D.C.); (G.B.); (G.S.); (M.N.)
| | - Giulia Spagnol
- Department of Women’s and Children’s Health, Gynaecological Clinic, University of Padova, 35128 Padova, Italy; (D.C.); (G.B.); (G.S.); (M.N.)
| | - Antonio Simone Laganà
- Department of Obstetrics and Gynecology, “Filippo Del Ponte” Hospital, University of Insubria, 21100 Varese, Italy;
| | - Marco Noventa
- Department of Women’s and Children’s Health, Gynaecological Clinic, University of Padova, 35128 Padova, Italy; (D.C.); (G.B.); (G.S.); (M.N.)
| | - Simona Zaami
- Department of Anatomical, Histological, Forensic and Orthopedic Sciences, “Sapienza” University of Rome, 00161 Rome, Italy
- Correspondence:
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7
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Pinto M, Moreira MEL, Barros LBDP, Costa ACCD, Fernandes S, Kuper H. [Catastrophic expenditure on congenital Zika syndrome: results of a cross-sectional study of caregivers of children in Rio de Janeiro, Brazil]. CAD SAUDE PUBLICA 2021; 37:e00007021. [PMID: 34816948 DOI: 10.1590/0102-311x00007021] [Citation(s) in RCA: 3] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/12/2021] [Accepted: 04/01/2021] [Indexed: 01/07/2023] Open
Abstract
In 2015, there was an increase in cases of congenital malformations in newborns in Brazil, associated with maternal Zika virus infection, having serious social and economic repercussions for the families. The study aimed to estimate the prevalence of catastrophic expenditure by families of children with severe or mild/moderate congenital Zika syndrome (CZS) in comparison to families of children without a diagnosis of CZS in the state of Rio de Janeiro. Catastrophic expenditure occurs when spending exceeds a given proportion of the family income due to a disease. Family caregivers of children with severe CZS were younger and had less schooling and lower income. Prevalence of catastrophic expenditure was higher in families of children with CZS. Among caregivers of children with severe CZS, the prevalence of catastrophic expenditure was higher in those with severe or very severe depression, anxiety, and stress. Low social support among caregivers was also a determinant factor for increased prevalence of catastrophic expenditure. The burden on caregivers of children with severe CZS exacerbates a situation of vulnerability that requires the expansion of mechanisms for financial and social protection, through linkage of various policies capable of effectively reaching this group.
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Affiliation(s)
- Márcia Pinto
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Maria Elisabeth Lopes Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Letícia Baptista de Paula Barros
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Ana Carolina Carioca da Costa
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fundação Oswaldo Cruz, Rio de Janeiro, Brasil
| | - Silke Fernandes
- Department of Global Health and Development, London School of Hygiene and Tropical Medicine, London, U.K
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, U.K
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8
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Wilder-Smith A, Brickley EB, Ximenes RADA, Miranda-Filho DDB, Turchi Martelli CM, Solomon T, Jacobs BC, Pardo CA, Osorio L, Parra B, Lant S, Willison HJ, Leonhard S, Turtle L, Ferreira MLB, de Oliveira Franca RF, Lambrechts L, Neyts J, Kaptein S, Peeling R, Boeras D, Logan J, Dolk H, Orioli IM, Neumayr A, Lang T, Baker B, Massad E, Preet R. The legacy of ZikaPLAN: a transnational research consortium addressing Zika. Glob Health Action 2021; 14:2008139. [PMID: 35377284 PMCID: PMC8986226 DOI: 10.1080/16549716.2021.2008139] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.3] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/27/2022] Open
Abstract
Global health research partnerships with institutions from high-income countries and low- and middle-income countries are one of the European Commission's flagship programmes. Here, we report on the ZikaPLAN research consortium funded by the European Commission with the primary goal of addressing the urgent knowledge gaps related to the Zika epidemic and the secondary goal of building up research capacity and establishing a Latin American-European research network for emerging vector-borne diseases. Five years of collaborative research effort have led to a better understanding of the full clinical spectrum of congenital Zika syndrome in children and the neurological complications of Zika virus infections in adults and helped explore the origins and trajectory of Zika virus transmission. Individual-level data from ZikaPLAN`s cohort studies were shared for joint analyses as part of the Zika Brazilian Cohorts Consortium, the European Commission-funded Zika Cohorts Vertical Transmission Study Group, and the World Health Organization-led Zika Virus Individual Participant Data Consortium. Furthermore, the legacy of ZikaPLAN includes new tools for birth defect surveillance and a Latin American birth defect surveillance network, an enhanced Guillain-Barre Syndrome research collaboration, a de-centralized evaluation platform for diagnostic assays, a global vector control hub, and the REDe network with freely available training resources to enhance global research capacity in vector-borne diseases.
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Affiliation(s)
- Annelies Wilder-Smith
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden.,Heidelberg Institute of Global Health, University of Heidelberg, Heidelberg, Germany
| | | | | | | | | | - Tom Solomon
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Bart C Jacobs
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Carlos A Pardo
- Department of Neurology, Johns Hopkins School of Medicine, Baltimore, Maryland, USA
| | | | | | - Suzannah Lant
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | - Hugh J Willison
- Institute of Infection, Immunity & Inflammation, University of Glasgow, Glasgow, UK
| | - Sonja Leonhard
- Departments of Neurology and Immunology, Erasmus Universitair Medisch Centrum Rotterdam, The Netherlands
| | - Lance Turtle
- NIHR Health Protection Research Unit for Emerging and Zoonotic Infections, Institute of Infection, Veterinary and Ecological Sciences University of Liverpool, Liverpool, UK
| | | | | | - Louis Lambrechts
- Insect-Virus Interactions Unit, Institut Pasteur, UMR2000, CNRS, 75015 Paris, France
| | - Johan Neyts
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Suzanne Kaptein
- KU Leuven Department of Microbiology, Immunology and Transplantation, Rega Institute for Medical Research, Laboratory of Virology and Chemotherapy, Leuven, Belgium
| | - Rosanna Peeling
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - James Logan
- London School of Hygiene & Tropical Medicine, London, United Kingdom
| | - Helen Dolk
- Centre for Maternal, Fetal and Infant Research, Institute for Nursing and Health Research, Ulster University, Ulster, United Kingdom
| | - Ieda M Orioli
- RELAMC and ECLAMC at Genetics Department, Federal University of Rio de Janeiro, Brazil
| | - Andreas Neumayr
- Department of Medicine, Swiss Tropical and Public Health Institute, Basel, Switzerland
| | - Trudie Lang
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Bonny Baker
- The Global Health Network, Centre for Tropical Medicine and Global Health, University of Oxford, Oxford, UK
| | - Eduardo Massad
- School of Medicine, University of Sao Paulo and Fundacao Getulio Vargas, Sao Paulo, Brazil
| | - Raman Preet
- Department of Epidemiology and Global Health, Umeå University, Umeå, Sweden
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9
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Pinto M, Fernandes S, Barros L, Valongueiro S, Moreira MEL, Barreto de Araújo TV, Jofre-Bonet M, Entringer A, Lyra TM, Kuper H. Estimating the cost of congenital Zika syndrome to families and healthcare providers in Rio de Janeiro and Pernambuco, Brazil: results of a case-control study. Wellcome Open Res 2021. [DOI: 10.12688/wellcomeopenres.16623.1] [Citation(s) in RCA: 1] [Impact Index Per Article: 0.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background: Children with congenital Zika syndrome (CZS) have a wide range of additional healthcare needs. This study aimed to estimate the direct costs of CZS from the health provider and family perspectives, and the indirect costs for families, in two Brazilian states: Rio de Janeiro and Pernambuco. Methods: A case-control study was undertaken between May 2017-January 2018 recruiting 174 cases with severe CZS, 41 with mild/moderate CZS and 269 children with no CZS, across the two sites, from existing studies. The primary caregiver was interviewed using a structured questionnaire to collect information on healthcare use and costs incurred during the previous 12 months. In Rio de Janeiro, health care utilization data was also extracted from electronic medical records. We estimated direct and indirect costs incurred as a result of CZS from the perspective of the health system and families. Results: Children with CZS accessed more healthcare facilities and reported longer travel and waiting times than children unaffected by CZS. Total costs from the health provider perspective of outpatient visits, were highest for children with severe CZS (U$1,411) followed by children with mild/moderate CZS (U$264) and children without CZS (U$107). This pattern was apparent for direct costs incurred by families, while median indirect costs were low. Families of children with CZS reported high levels of catastrophic expenditures; Expenses incurred by families to meet their child’s needs as a proportion of household income was 30% (IQR=14%-67%, p<0.01) for children with severe CZS, 11% (IQR=4%-33%, p<0.01) for mild/moderate CZS, and 1% (IQR=0%-8%) for controls. Costs incurred by families were generally higher in Rio de Janeiro than Pernambuco. Conclusions: Families of children affected by CZS in Brazil may need additional public health resources and social benefits to protect them from incurring catastrophic expenses while meeting the needs of their children.
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10
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Three-Year Clinical Follow-Up of Children Intrauterine Exposed to Zika Virus. Viruses 2021; 13:v13030523. [PMID: 33810110 PMCID: PMC8005078 DOI: 10.3390/v13030523] [Citation(s) in RCA: 5] [Impact Index Per Article: 1.7] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/31/2021] [Revised: 03/08/2021] [Accepted: 03/12/2021] [Indexed: 02/01/2023] Open
Abstract
Congenital Zika virus (ZIKV) infection may present with a broad spectrum of clinical manifestations. Some sequelae, particularly neurodevelopmental problems, may have a later onset. We conducted a prospective cohort study of 799 high-risk pregnant women who were followed up until delivery. Eighty-three women and/or newborns were considered ZIKV exposed and/or infected. Laboratory diagnosis was made by polymerase chain reaction in the pregnant mothers and their respective newborns, as well as Dengue virus, Chikungunya virus, and ZIKV serology. Serology for toxoplasmosis, rubella, cytomegalovirus, herpes simplex virus, and syphilis infections were also performed in microcephalic newborns. The newborns included in the study were followed up until their third birthday. Developmental delay was observed in nine patients (13.2%): mild cognitive delay in three patients, speech delay in three patients, autism spectrum disorder in two patients, and severe neurological abnormalities in one microcephalic patient; sensorineural hearing loss, three patients and dysphagia, six patients. Microcephaly due to ZIKV occurred in three patients (3.6%). Clinical manifestations can appear after the first year of life in children infected/exposed to ZIKV, emphasizing the need for long-term follow-up.
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11
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Duttine A, Smythe T, Calheiros de Sa MR, Ferrite S, Moreira ME, Kuper H. Juntos: A Support Program for Families Impacted by Congenital Zika Syndrome in Brazil. GLOBAL HEALTH: SCIENCE AND PRACTICE 2020; 8:846-857. [PMID: 33361247 PMCID: PMC7784063 DOI: 10.9745/ghsp-d-20-00018] [Citation(s) in RCA: 9] [Impact Index Per Article: 2.3] [Reference Citation Analysis] [Abstract] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 12/23/2019] [Accepted: 11/04/2020] [Indexed: 11/29/2022]
Abstract
Development of Juntos, a community-based family support program for caregivers of children with congenital Zika syndrome, contained innovative approaches such as using mothers as facilitators, fast-track learning, and de-isolation of families affected by Zika. Background: The 2015–2016 Zika virus outbreak in Brazil was unprecedented and resulted in the birth of more than 3,000 children with congenital Zika syndrome (CZS). These children experience multiple complex health conditions and have limited services to support them and their family’s needs. Program Development and Piloting: An existing family support program for children with cerebral palsy (Getting to Know Cerebral Palsy) was adapted to the Zika context in Brazil through expert consultation. The program was pilot tested at 2 sites among 6 groups of caregivers (total of 48 families) from August 2017 to June 2018. Group observation and focus group discussions with facilitators and participants at the end of each session informed fast-track learning, which was used to tailor the program for future groups. Fast-track learning—adjusting the intervention in real time based on gathered feedback—was found to be a helpful process to inform and hone the program from its initial concept. Program Description: The intervention, Juntos, is a facilitated participatory group program for caregivers of children who have CZS. The group sessions are cofacilitated by a parent of a child who has CZS and an allied health professional. The group meets for 10 sessions that last 4 hours. Each session includes an icebreaker, activities, and group discussions. Content covers practical information on caring for a child with a developmental disability including that caused by Zika. Psychosocial support forms an important component, and families are guided from the first week to define and develop their own communities of support. Six pilot groups were successfully run in Rio de Janeiro and Greater Salvador, Bahia. The groups gave positive feedback on acceptability and demand. Conclusions: The program has the potential to be an important tool for community health and social support services in South America in response to Zika. The program can also be applied to children with neurodevelopmental disabilities other than those caused by the Zika virus, which could be important in ensuring families of children with CZS are less isolated.
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Affiliation(s)
- Antony Duttine
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom.
| | - Tracey Smythe
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
| | | | - Silvia Ferrite
- Department of Speech and Hearing Sciences, Federal University of Bahia, Salvador, Brazil
| | - Maria Elisabeth Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Fiocruz, Rio de Janeiro, Brazil
| | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene & Tropical Medicine, London, United Kingdom
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"Life Is Taking Me Where I Need to Go": Biographical Disruption and New Arrangements in the Lives of Female Family Carers of Children with Congenital Zika Syndrome in Pernambuco, Brazil. Viruses 2020; 12:v12121410. [PMID: 33302536 PMCID: PMC7763975 DOI: 10.3390/v12121410] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 09/30/2020] [Revised: 11/19/2020] [Accepted: 11/23/2020] [Indexed: 01/23/2023] Open
Abstract
The congenital Zika syndrome (CZS) epidemic in Brazil turned the spotlight on many other factors beyond illness, such as poverty, gender, and inequalities in health care. Women were the emblematic subjects in this study, not only because Zika virus is a vertical transmission disease, but also because women—in Brazil and elsewhere—typically represent the primary carers of children. This is a qualitative analytic study using semi-structured interviews with 23 female family carers of children with CZS in Brazil. Through the concept of biographical disruption, we analysed some of the social impacts experienced by women involved in caring for affected children. We identified that the arrival of a child with disabilities resulted in biographical disruption similar to that experienced by people with chronic illnesses. Social support networks were configured through an alliance between women from different generations, revealing solidarity networks, but also highlighting the absence of the state in tackling these social vulnerabilities. Tracing the pathways of these biographical narratives enables us to understand how women have acted to defend the value of their disabled children in a society structured on the model of body normativity and inequality. These results may provide clues to a more inclusive society, which confronts systems of gender oppression and the sexual division of labour focused on women.
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13
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AlHeresh R, Cahn PS. Expanding Global Rehabilitation Services through International Academic-Community Partnerships. Ann Glob Health 2020; 86:71. [PMID: 32676300 PMCID: PMC7333551 DOI: 10.5334/aogh.2876] [Citation(s) in RCA: 4] [Impact Index Per Article: 1.0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 11/20/2022] Open
Abstract
Background More than one billion people worldwide live with a disability, yet rehabilitation professionals are scarce in low- and middle-income countries. Attempts to expand access to rehabilitation services have encountered barriers on multiple levels: limited resources on the systemic level, hierarchies on the professional level, and cultural stigma on the community level. Objectives We sought to determine if an academic-community partnership could overcome multiple levels of barriers to expand services for people with disabilities. Methods Toward an All-Inclusive Jordan incorporates community-based rehabilitation with prelicensure health professions education to address the three primary levels of barriers to rehabilitation services in low- and middle-income countries. The yearlong curriculum includes formal training, research, and advocacy with graduate students from the United States and health professions students and community members in Palestinian refugee camps near Amman, Jordan. Findings After two cycles of the program, 14 Jordanian volunteers have partnered with 20 graduate students from the United States. They have delivered over 300 direct rehabilitation sessions, conducted ten workshops with mothers of children with disabilities, and trained 12 community-based rehabilitation workers in the refugee camps. Conclusions The academic-community partnership model builds on the evidence base for the success of community-based rehabilitation services in low- and middle-income countries. Its components address barriers on multiple levels to create a sustainable expansion of services to people with disabilities.
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Affiliation(s)
- Rawan AlHeresh
- “Toward an All-Inclusive Jordan”, Department of Occupational Therapy, School of Health and Rehabilitation Sciences, MGH Institute of Health Professions, Boston, MA, US
| | - Peter S. Cahn
- Center for Interprofessional Studies and Innovation, MGH Institute of Health Professions, Boston, MA, US
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14
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Duttine A, Smythe T, Ribiero Calheiro de Sá M, Ferrite S, Zuurmond M, Moreira ME, Collins A, Milner K, Kuper H. Congenital Zika Syndrome-Assessing the Need for a Family Support Programme in Brazil. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2020; 17:ijerph17103559. [PMID: 32438700 PMCID: PMC7277658 DOI: 10.3390/ijerph17103559] [Citation(s) in RCA: 18] [Impact Index Per Article: 4.5] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 04/15/2020] [Revised: 05/12/2020] [Accepted: 05/14/2020] [Indexed: 11/26/2022]
Abstract
The Zika outbreak in Brazil caused congenital impairments and developmental delays, or Congenital Zika Syndrome (CZS). We sought to ascertain whether a family support programme was needed and, if so, could be adapted from the Getting to Know Cerebral Palsy programme (GTKCP) designed for children with cerebral palsy (CP). We conducted a systematic review of the needs of families of children with CZS or CP in low- and middle-income countries and reviewed the findings of the Social and Economic Impact of Zika study. We undertook a scoping visit to three facilities offering services to children with CZS in Brazil to understand potential utility and adaptability of GTKCP. The literature review showed that caregivers of children with CZS experience challenges in mental health, healthcare access, and quality of life, consistent with the CP literature. The scoping visits demonstrated that most support provided to families was medically orientated and while informal support networks were established, these lacked structure. Caregivers and practitioners expressed an eagerness for more structure community-based family support programmes. A support programme for families of children with CZS in Brazil appeared relevant and needed, and may fill an important gap in the Zika response.
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Affiliation(s)
- Antony Duttine
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
- Correspondence:
| | - Tracey Smythe
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Míriam Ribiero Calheiro de Sá
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro 22250-020, Brazil; (M.R.C.d.S.); (M.E.M.)
| | - Silvia Ferrite
- Department of Speech and Hearing Sciences, Institute of Health Sciences, Federal University of Bahia, Salvador 40110-902, Brazil;
| | - Maria Zuurmond
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Maria Elisabeth Moreira
- Instituto Nacional de Saúde da Mulher, da Criança e do Adolescente Fernandes Figueira, Rio de Janeiro 22250-020, Brazil; (M.R.C.d.S.); (M.E.M.)
| | - Anna Collins
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
| | - Kate Milner
- Murdoch Children’s Research Institute and Department of Paediatrics, University of Melbourne, Parkville, Victoria 3052, Australia;
| | - Hannah Kuper
- International Centre for Evidence on Disability, Department of Clinical Research, Faculty of Infectious and Tropical Diseases, London School of Hygiene & Tropical Medicine, London WC1E 7HT, UK; (T.S.); (M.Z.); (A.C.); (H.K.)
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15
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Passos MJ, Matta G, Lyra TM, Moreira MEL, Kuper H, Penn-Kekana L, Mendonça M. The promise and pitfalls of social science research in an emergency: lessons from studying the Zika epidemic in Brazil, 2015-2016. BMJ Glob Health 2020; 5:e002307. [PMID: 32345582 PMCID: PMC7213811 DOI: 10.1136/bmjgh-2020-002307] [Citation(s) in RCA: 8] [Impact Index Per Article: 2.0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Grants] [Track Full Text] [Download PDF] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/09/2020] [Revised: 03/25/2020] [Accepted: 03/25/2020] [Indexed: 11/08/2022] Open
Abstract
Social science generates evidence necessary to control epidemics. It can help to craft appropriate public health responses, develop solutions to the epidemic impacts and improve understanding of why the epidemic occurred. Yet, there are practical constraints in undertaking this international research in a way that produces quality, ethical and appropriate data, and that values all voices and experiences, especially those of local researchers and research participants. In this paper, we reflected on the experience of undertaking social science research during the 2015/2016 Zika epidemic in Brazil. This experience was considered from the perspective of this paper's authors: three Brazilian academics, two UK academics and two mothers of children affected by congenital Zika syndrome. This group came together through the conduct of the Social and Economic Impact of Zika study, a mixed-methods social science study. The key findings highlight practical issues in the achievement of three goals: the conduct of high-quality social science in emergencies and efforts towards the decolonisation of global health in terms of levelling the power between Brazilian and UK researchers and optimising the role of patients within research. From our perspective, the information collected through social science was valuable, providing detailed insight into the programmatic needs of mothers and their affected children (eg, economic and social support and mental health services). Social science was considered a low priority within the Zika epidemic despite its potential importance. There were logistical challenges in conducting social science research, foremost of which are the difficulties in developing a trusting and balanced power relationship between the UK and Brazilian researchers in a short time frame. When these issues were overcome, each partner brought unique qualities, making the research stronger. The mothers of affected children expressed dissatisfaction with research, as they were involved in many studies which were not coordinated, and from which they did not see a benefit. In conclusion, the importance of social science in epidemics must continue to be promoted by funders. Funders can also set in place mechanisms to help equalise the power dynamics between foreign and local researchers, researchers and participants, both to promote justice and to create best quality data.
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Affiliation(s)
| | - Gustavo Matta
- Escola Nacional de Saúde Pública, Fundação Oswaldo Cruz, Rio de Janeiro, Brazil
| | - Tereza Maciel Lyra
- Aggeu Magalhães Institute, FIOCRUZ/PE, Recife, Brazil
- Faculty of Medicine, University of Pernambuco, Recife, Brazil
| | | | - Hannah Kuper
- International Centre for Evidence in Disability, London School of Hygiene and Tropical Medicine, London, UK
| | - Loveday Penn-Kekana
- Infectious Disease Epidemiology, London School of Hygiene and Tropical Medicine, London, UK
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